Weight Loss and Glycemic Control after Sleeve Gastrectomy: Results from a Middle Eastern Center of Excellence.

Obesity and its associated metabolic disorders are strongly linked to both morbidity and mortality. Sleeve gastrectomy (SG) has been established as an effective means of weight loss for obese patients as well as a treatment for type 2 diabetes mellitus (T2DM). This study was designed to examine the short- and midterm outcomes of patients who underwent SG in a Middle Eastern Center of Excellence, a military training teaching hospital. The clinical outcomes of 59 patients with impaired glucose tolerance and T2DM who underwent SG between 2011 and 2014 with at least one and up to four years of follow-up were studied. Data were collected and compared, including the pre- and post-surgery measures of weight, body mass index, glycosylated hemoglobin (HbA1c), and fasting blood glucose. Complete remission was defined as a fasting blood glucose level ≤100 mg/dL, an HbA1c ≤6 mg/dL, without use of antidiabetic medications. All patients showed significant reduction in body mass index following SG. Tight glycemic control was achieved among both diabetic and prediabetic patients. In this study, 88.14 per cent of all patients (diabetic and prediabetic) achieved complete resolution from their impaired glucose tolerance and T2DM and maintained normal blood glucose and HbA1C levels from one to four years postoperatively. SG is beneficial both in terms of short- and midterm weight loss and glucose control in both diabetic and prediabetic obese patients.

Analyzing the Psychometric Properties of the Short Form-36 Quality of Life Questionnaire in Patients with Obesity.

PURPOSE: The Short Form-36 (SF-36) questionnaire is a valuable and easy-to-use tool for the measurement of quality of life in patients with obesity. To become a widely used tool, the questionnaire must be validated in many different contexts. Thus, the present study aimed to evaluate the construct validity and reliability of the SF-36 questionnaire among patients with obesity in Bahrain. METHODOLOGY: The 36-item questionnaire was administered to a study cohort scheduled to undergo bariatric surgery at the Bahrain Defence Force Hospital in Bahrain. Demographic data were extracted. Principal component analysis was used to extract component factors. Factor analysis was used to determine construct validity and fit. The Cronbach's alpha value of the extracted factors was used to determine the internal consistency reliability. Statistical analyses were performed using SPSS version 19.0 and IBM AMOS version 22.0. RESULTS: Most of the participants were female with a mean body mass index (BMI) of 43.24 kg/m2. A six-factor solution explaining 52.31% of variance was generated. The global fit parameter estimates indicated that the suggested model exhibited an acceptable-to-good fit. Overall, the internal consistency reliability estimate of the SF-36 questionnaire was greater than 0.70. CONCLUSION: The identified six-factor model of the SF-36 questionnaire is a valuable tool for the measurement of quality of life among patients with obesity in Bahrain.

Quality of life, food tolerance, and eating disorder behavior after laparoscopic gastric banding and sleeve gastrectomy - results from a middle eastern center of excellence.

BACKGROUND: Obesity is a major health problem in Arab countries. Bariatric surgery can improve the quality of life of an obese individual. However, different types of bariatric surgery result in varying levels of food intolerance as a side effect. Many patients who undergo bariatric surgery are also at risk of subsequently developing eating disorder behaviors. The aim of the study was to compare the quality of life, food tolerance, and behaviors of eating disorders related to laparoscopic sleeve gastrectomy and gastric banding. METHODS: A retrospective review of medical records and a questionnaire-based survey was completed for all patients who had undergone either bariatric sleeve gastrectomy or gastric banding at the Bahrain Defense Force Hospital between 2011 and 2014. Each patient was administered 3 questionnaires to assess the quality of life, food tolerance, and eating disorder behaviors. RESULTS: Forty-eight patients who had undergone sleeve gastrectomy and 36 who had undergone gastric banding participated in the study. Sleeve gastrectomy patients showed better food tolerance (P < 0.001) and better eating behaviors (P = 0.001) post-surgery compared with gastric banding patients. Health-related quality of life (HRQOL) did not differ significantly between the 2 groups. Only sleeve patients had preoperative evaluation of these parameters (HRQOL). However, in the gastric sleeve group, after the surgery, significant improvement was found in all parameters of HRQOL except for mental health status. CONCLUSION: Laparoscopic gastric sleeve surgery patients had superior outcomes in both food tolerance and eating disorder behaviors. The quality of life did not significantly differ between the gastric sleeve and gastric banding surgery groups.

Sphingomonas jeddahensis sp. nov., isolated from Saudi Arabian desert soil.

A novel Sphingomonas strain was isolated from a sample of desert soil collected near Jeddah in Saudi Arabia. A polyphasic approach was performed to characterize this strain, initially designated as G39T. Cells of strain G39T are motile, Gram-negative, catalase- and oxidase-positive. The strain is able to grow aerobically at 20-35 °C, pH 6.5-8 and tolerates up to 4 % (w/v) NaCl. Based on 16S rRNA gene sequence similarity, the closest relative type strains of G39T are Sphingomonas mucosissima DSM 17494T (98.6 %), S. dokdonensis DSM 21029T (98.4 %) and S. hankookensis DSM 23329T (97.4 %). Furthermore, the average nucleotide identities between the draft genome sequence of strain G39T and the genome sequences of all other available and related Sphingomonas species are significantly below the threshold of 94 %. The G+C content of the draft genome (3.12 Mbp) is 65.84 %. The prevalent (>5 %) cellular fatty acids of G39T were C18 : 1ω7c, C16 : 1ω7c and/or C16 : 1ω6c, C14 : 0 2-OH and C16 : 0. The only detectable respiratory quinone was ubiquinone-10 and the polar lipids profile is composed of diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, sphingoglycolipid, as well as unidentified lipids, phospholipids and glycolipids. The results of the conducted polyphasic approach confirmed that this isolate represents a novel species of the genus Sphingomonas, for which the name Sphingomonas jeddahensis sp. nov. is proposed. The type strain of this species is G39T (=DSM 103790T=LMG 29955T).

Dietary exposure to acrylamide from cafeteria foods in Jeddah schools and associated risk assessment.

BACKGROUND: Acrylamide (AA) is a carcinogenic and genotoxic food contaminant produced at high temperatures in foods that are rich in carbohydrates. Foods sold in schools in Jeddah, Saudi Arabia, are among such carbohydrate-rich foods produced at high cooking temperatures. It is crucial to determine the importance of AA exposure with respect to cafeteria foods and assess the associated risks. RESULTS: The highest mean AA level was measured in chocolate pies (439 µg kg-1 ), followed by custard pies (435 µg kg-1 ) and cheese pies (432 µg kg-1 ). The average and 95th percentile values of AA exposure were 0.51 and 1.17 [µg kg-1 body weight (BW) school day-1 ]. The average exposure significantly decreased with an increase in age, from 0.65 (µg kg-1 BW school day-1 ) in primary school students to 0.37 in secondary school students. Cheese and chocolate pies are the main contributors in AA intake. The contributions of cheese and chocolate pies to the average exposure among primary, middle and secondary school students were 23.1%, 24.7% and 29.4% and 16.9%, 12.1% and 11.9%, respectively. Other products with significant contributions included cheese sandwiches (10.8%, 8.9% and 12.7%), plain cookies (7.7%, 5.6% and 6.7%) and custard pies (7.7%, 4.8% and 8.9%). Other cafeteria products contributed to AA exposure at much lower percentages. CONCLUSION: The calculated margins of exposure (MOEs) for the average [356 and 614 for both benchmark dose lower confidence limit (BMDL) 0.18 and 0.31 mg kg-1 BW day-1 ] and 95th percentile AA exposure values (154 and 265 for both BMDL 0.18 and 0.31 mg kg-1 BW day-1 ) suggest that there is a health concern with respect to school-aged students. © 2017 Society of Chemical Industry.

Phosphodiesterase type 5 inhibitors: Irrational use in Saudi Arabia.

OBJECTIVE: To identify the criteria of phosphodiesterase type 5 inhibitor (PDE5i) users and to analyse the knowledge, attitude, and practices of PDE5i use amongst Saudi men. SUBJECTS AND METHODS: A web-based, cross-sectional survey was conducted in Saudi Arabia between January and April 2015. Sexually active adult men were interviewed using a website questionnaire designed by the authors. Descriptive statistics were used to analyse the data. RESULTS: In all, 1008 men participated in the survey with 378 (37.5%) reporting use of PDE5i. Of those using PDE5i, 144 (38.1%) reported erectile dysfunction and 234 (61.9%) reported normal erection (recreational users). We found several demographic features, including high education level, health field occupation, high income, smoking, and increased frequency of sexual intercourse amongst the PDE5i users. Most of the PDE5i users (92.3%) had knowledge about PDE5i and 84.1% of them bought it without medical prescription. The most commonly used PDE5i was tadalafil (46.1%) and most of the users (79.9%) reported improvement in their sexual activity after PDE5i usage. Amongst the recreational users, the main reasons for PDE5i usage were curiosity (38.5%) and improving self-confidence (25.6%). Of them, 69.2% reported benefits from PDE5i usage, mainly in the form of enhancement of erection (36.7%) and increasing erection duration (31.2%). CONCLUSION: PDE5i use appears to be frequent in Saudi Arabia. Most of the users had knowledge about PDE5i and claimed to get benefits from it, even if used as a recreational drug.

Idiopathic omental infarction, diagnosed and managed laparoscopically: a case report.

Idiopathic omental infarction is a rare cause of acute abdomen in adults, and the clinical finding can mimic acute appendicitis. Although idiopathic omental infarction is uncommon, the incidence of its detection has become more frequent as a result of advances in radiological technologies. We reported on a 21-year-old man who presented with sudden onset of intermittent right lower quadrant abdominal pain for seven days. The pain became more localized at the right iliac fossa (RIF) at day 2 before admission. A physical examination revealed a fever (38.2°C), severe RIF tenderness, mass-like fullness, and positive rebound tenderness. A CT of the abdomen showed inflammatory changes and increased fat density mass in the right upper quadrant measuring 5 × 4 cm representing focal panniculitis. However, the appendix was visualized normally and the findings were not in favor of acute appendicitis. Diagnosis was carried on laparoscopically. Serosanguinous free fluid was found in all abdominal quadrants. A 6 × 4 cm gangrenous omental mass was noted. The omental mass was excised and an appendectomy was performed. In summary, omental infarction should be considered as a deferential diagnosis for acute right-sided abdominal pain, especially if the clinical finding does not correspond to appendicitis.

Multisource feedback to assess surgical practice: a systematic review.

BACKGROUND: The assessment, maintenance of competence, and recertification for surgeons have recently received increased attention from many health organizations. Assessment of physicians' competencies with multisource feedback (MSF) has become widespread in recent years. The aim of the present study was to investigate further the use of MSF for assessing surgical practice by conducting a systematic review of the published research. METHODS: A systematic literature review was conducted to identify the use of MSF in surgical settings. The search was conducted using the electronic databases EMBASE, PsycINFO, MEDLINE, PubMed, and CINAHL for articles in English up to August 2012. Studies were included if they reported information about at least 1 out of feasibility, reliability, generalizability, and validity of the MSF. RESULTS: A total of 780 articles were identified with the initial search and 772 articles were excluded based on the exclusion criteria. Eight studies met the inclusion criteria for this systematic review. Reliability (Cronbach α ≥ 0.90) was reported in 4 studies and generalizability (Ep2 ≥ 0.70) was reported in 4 studies. Evidence for content, criterion-related, and construct validity was reported in all 8 studies. CONCLUSION: MSF is a feasible, reliable, and valid method to assess surgical practice, particularly for nontechnical competencies such as communication skills, interpersonal skills, collegiality, humanism, and professionalism. Meanwhile, procedural competence needs to be assessed by different assessment methods. Further implementation for the use of MSF is desirable.

Adrenal cyst presenting as hepatic hydatid cyst.

Introduction. Although adrenal cysts are uncommon, the incidence rate is increasing with the advances in radiological technologies. The incidental detection of adrenal cysts nowadays has become more frequent as a result of the increase usage of high quality imaging modalities. Adrenal cysts originate from the adrenal gland and can be classified into either true or pseudocyst. Presentation of Case. In this report, we described an adrenal cyst of endothelial type, in a 30-year-old lady who was mistakenly diagnosed to have a hydatid cyst both clinically and by imaging. Discussion. Although adrenal cysts are uncommon, the incidence rate is increasing with the frequent use of various high quality radiological technologies. Adrenal cyst should be considered in the differential diagnosis when dealing with upper abdominal cysts. The size of the adrenal cyst can vary from a few millimeters up to 50 cm in diameter. Most of the adrenal cysts are unilateral, while 8%-15% of those cysts do present bilaterally. The majority of cases are diagnosed between the 3rd and 5th decades. Conclusion. Although most of the adrenal cysts are benign in nature, surgical excision is advisable especially when the cysts are greater than 5 cm in diameter and in the case of suspecting malignancy.

Estrogen-like effects in male goldfish co-exposed to fluoxetine and 17 alpha-ethinylestradiol.

The antidepressant fluoxetine (FLX) and the synthetic estrogen, 17 alpha-ethinylestradiol (EE2), are present in municipal sewage discharges. To better understand possible interactions between them, male goldfish were exposed to an ethanol control or to nominal concentrations of FLX (0.54 µg/L) and EE2 (5 ng/L) alone and in combination for 14 days. Real-time reverse-transcription polymerase chain reaction was used to assess effects on hepatic gene expression and liquid chromatography tandem mass spectrometry to analyze the plasma proteome. The results showed an increase in estrogen receptor alpha (esr1) and vitellogenin (vtg) gene expression by 1.9-2.4-fold in the FLX and EE2 groups, but this did not reach statistical significance. In contrast, co-exposure up regulated esr1 and vtg gene expression by 5.5- and 5.3-fold, respectively. Fluoxetine and EE2 alone did not affect estrogen receptor beta (esr2), but the co-exposure down regulated esr2 expression by 50%. There was a significant increase in the number of plasma proteins that were related to endocrine system disorders in the FLX and FLX plus EE2 groups. The level of VTG protein was increased in the plasma from goldfish exposed to EE2, FLX, and FLX plus EE2. Our study demonstrates that low concentrations of FLX and EE2 in a simple mixture produce strong estrogen-like effects in the male goldfish.

Reduction in weight and BMI and changes in Co-morbidities following laparoscopic adjustable gastric banding procedure for morbidly obese patients in Bahrain: a five year longitudinal study.

BACKGROUND: Obesity and its related illnesses are pan-endemic health problems which require intervention. Laparoscopic Adjustable Gastric Banding (LAGB) is seen as a safe surgical procedure with satisfactory results on weight reduction and improvement in obesity related illness. METHODS: Data were collected in a repeated-measures longitudinal five year study for 143 morbidly obese patients who underwent laparoscopic adjustable gastric banding (LAGB). Follow up was continued from 3 to 60 months post operatively. Patients were assessed for diabetes, hypertension and dyslipidemia. RESULTS: Repeated measures ANOVAs revealed that both men and women lose weight and reduce their BMIs at a consistent rate. At 3, 6 and 9 months post-operative there are no differences in percent weight loss between men and women with mean weight loss at 8.9%, 13.1% and 16.0% respectively of pre-operative weight. At 12, 24 and 60 months post-operatively, however, men significantly increase the percentage of weight loss as well as improve their BMI compared to women (p < .05). At 24 months post-operative, men and women have BMIs of 36.03 and 32.85, both still in the obese range. By 60 months men have achieved a BMI that is slightly under the obese range into the overweight range (30.76) while women (BMI = 36.61) were still in the obese range. At 60 months, men have lost a total of 33.75% of their pre-operative body weight while women have lost a total of 21.50. Diabetes, hypertension and dyslipidemia were significantly reduced in the sample post-operatively (p < .01). CONCLUSION: LAGB is a safe and effective surgical procedure for morbidly obese patients resulting in weight loss, BMI decrease and reduction in co-morbid illnesses.

The development of an optimized sample preparation for trace level detection of 17α-ethinylestradiol and estrone in whole fish tissue.

The purpose of this study was to develop an optimized method for the extraction and determination of 17α-ethinylestradiol (EE2) and estrone (E1) in whole fish tissues at ng/g levels. The optimized procedure for sample preparation includes extraction of tissue by accelerated solvent extraction (ASE-200), lipid removal by gel permeation chromatography (GPC), and a cleanup step by acetonitrile precipitation followed by a hexane wash. Analysis was performed by gas chromatography/mass spectrometry (GC/MS) in negative chemical ionization (NCI) mode after samples were derivatized with pentafluorobenzoyl chloride (PFBCl). The method was developed using high lipid content wild fish that were exposed to the tested analytes. The whole procedure recoveries ranged from 74.5 to 93.7% with relative standard deviation (RSD) of 2.3-6.2% for EE2 and 64.8 to 91.6% with RSD of 9.46-0.18% for E1. The method detection limits were 0.67 ng/g for EE2 and 0.68 ng/g for E1 dry weight. The method was applied to determine EE2 levels in male goldfish (Carrasius auratus) after a 72 h dietary exposure. All samples contained EE2 averaging 1.7ng/g (±0.29 standard deviation, n=5). This is the first optimized protocol for EE2 extraction from whole fish tissue at environmentally relevant concentrations. Due to high sensitivity and recovery, the developed method will improve our knowledge about the environmental fate and uptake of synthetic steroidal estrogens in fish populations.