Evaluation of the outcome of a proposed more physiological bypass surgery technique in morbid obesity: Long term 3 years follows up.

Background: Obesity is a chronic condition that affects millions globally; consequently, bariatric surgery is the key to this serious issue. Bariatric procedures are rapidly expanding in number and methods to address the recognized problems. So, it would make a sense for surgeons and patients if there is a more physiological bypass surgery technique in Morbid obesity. This study aims to evaluate the outcome proposed technique. Patients and methods: The present study is a retrospective analysis on 256 participants subjected to the proposed bypass procedure from December 1999 to January 2017, the participants were followed up for an interval of 3years. Results: The findings of the present study revealed a significant Excess Weight Loss (EWL). In addition, patients experienced decreased calcium, iron, vitamin B12, Hemoglobin, zinc, and Prothrombin Concentration. However, three to six months after surgery, they experienced a significant improvement until they reached normal levels without any supplement by the end of 12,18 months, with a three-year follow-up. Conclusion: This proposed Bypass Operation aims to adequate digestions as well as selective absorption without inducing any vital deficit. Most of study's population showed no elements inadequacies, although few percentages emerged during the interval of maximal weight reduction, and it were transient and minimal. No minerals or vitamins were needed.

Combined opioid free and loco-regional anaesthesia enhances the quality of recovery in sleeve gastrectomy done under ERAS protocol: a randomized controlled trial.

BACKGROUND: It is debatable whether opioid-free anaesthesia (OFA) is better suited than multimodal analgesia (MMA) to achieve the goals of enhanced recovery after surgery (ERAS) in patients undergoing laparoscopic sleeve gastrectomy. METHODS: In all patients, anaesthesia was conducted with an i.v. induction with propofol (2 mg. kg-1), myorelaxation with cisatracurium (0.15 mg.kg-1), in addition to an ultrasound-guided bilateral oblique subcostal transverse abdominis plane block. In addition, patients in the OFA group (n = 51) received i.v. dexmedetomidine 0.1 µg.kg-1 and ketamine (0.5 mg. kg-1) at induction, then dexmedetomidine 0.5 µg. kg-1.h-1, ketamine 0.5 mg.kg-1.h-1, and lidocaine 1 mg. kg-1.h-1 for maintenance, while patients in the MMA group (n = 52) had only i.v. fentanyl (1 µg. kg-1) at induction. The primary outcome was the quality of recovery assessed by QoR-40, at the 6th and the 24th postoperative hour. Secondary outcomes were postoperative opioid consumption, time to ambulate, time to tolerate oral fluid, and time to readiness for discharge. RESULTS: At the 6th hour, the QoR-40 was higher in the OFA than in the MMA group (respective median [IQR] values: 180 [173-195] vs. 185 [173-191], p < 0.0001), but no longer difference was found at the 24th hour (median values = 191 in both groups). OFA also significantly reduced postoperative pain and morphine consumption (20 mg [1-21] vs. 10 mg [1-11], p = 0.005), as well as time to oral fluid tolerance (238 [151-346] vs. 175 min [98-275], p = 0.022), and readiness for discharge (505 [439-626] vs. 444 min [356-529], p = 0.001), but did not influence time to ambulate. CONCLUSION: While regional anaesthesia achieved most of the intraoperative analgesia, avoiding intraoperative opioids with the help of this OFA protocol was able to improve several sensible parameters of postoperative functional recovery, thus improving our knowledge on the OFA effects. CLINICAL TRIAL NUMBER: Registration number NCT04285255.

Prevalence and factors associated with stunting among school children in Egypt.

BACKGROUND: Stunting adversely affects children's health and development. Few studies on the prevalence of stunting and factors associated with stunting have been done in Upper Egypt. AIMS: This study aimed to determine the prevalence of and factors associated with stunting in schoolchildren in Sohag, Egypt. METHODS: This was a cross-sectional study conducted in 2017 in Sohag governorate. Two public schools were randomly selected (one urban, one rural) and all children in these schools aged 4-12 years whose parents consented were included in the study. Parents were interviewed to collect data on child and family characteristics. The children were examined for vitamin deficiency, anaemia and parasitic infection, and body mass index was calculated. Multivariate logistic regression analysis was done to determine factors significantly associated with stunting; odds ratios (ORs) and 95% confidence intervals (CIs) are given. RESULTS: A total of 1786 children were included (response rate 69%), of whom 329 (18.4%) were stunted (-2 z-score and below). Factors significantly associated with stunting were: parasite infestation (OR = 1.8, 95% CI: 1.3-2.5), anaemia (OR = 1.7, 95% CI: 1.3-2.7), low body mass index (OR = 1.2, 95% CI: 1.1-1.3), frequent gastroenteritis (OR = 1.1, 95% CI: 1.06-1.2), first-cousin consanguinity of parents (OR = 1.3, 95% CI: 1.2-1.6) and familial short stature (OR = 1.5, 95% CI: 1.2-2.1). CONCLUSION: Screening and treatment of parasitic infestation, provision of iron/multivitamin supplementation and education on healthy nutrition should be part of school health programmes to prevent stunting in schoolchildren in Sohag.