The effectiveness of an online video-based group schema therapy in improvement of the cognitive emotion regulation strategies in women who have undergone bariatric surgery.

BACKGROUND: Adaptive cognitive emotion regulation (CER) strategies toward eating play a very important role in obesity and according to schema therapy, patients with obesity learn that don't respond to their emotional stimuli by eating. Thus, this study aimed to evaluate the effectiveness of an online video-based group schema therapy in improvement of the CER strategies and body mass index (BMI) in women who had undergone bariatric surgery. METHODS: Forty women who had undergone sleeve gastrectomy were selected and randomly divided into two groups of control and experimental. The experimental group received 10 weekly 90-min sessions of group schema therapy, the control group did not receive any intervention at all. Both groups completed the CER strategies questionnaire during pre-test, post-test and follow-up stages, and the data were analyzed using a multivariate analysis of covariance (MANCOVA) through SPSS software (version 20). RESULTS: Our results indicated that the experimental group demonstrated significantly higher adaptive CER strategies (P = 0.0001, F = 31.15) and significantly lower maladaptive CER strategies (P = 0.001, F = 9.42), significantly lower BMI (P = 0.001, F = 23.48), as compared to the control condition, following the group schema therapy after the follow-up stage. CONCLUSION: The findings demonstrated that group schema therapy could lead to an increases in adaptive CER strategies and a decrease in maladaptive CER strategies and BMI in women who had undergone bariatric surgery. TRIAL REGISTRATION: IRCT, IRCT20180523039802N2. Registered 5 August 2020, http://www.irct.com/IRCT20180523039802N2 .

Bone Densitometry and Fat Index after Sleeve and Subsleeve Gastrectomy in Animal Model.

Background: Previous studies have reported that gastrectomy and fundectomy can induce osteopenia. Body fat index is a new index of obesity that shows central obesity and other risks of obesity. Sleeve gastrectomy (SG) is a bariatric surgery and a new technique introduced as subsleeve, which only resected fundus of the stomach. In this study, it has been shown the effect of subsleeve and SG on fat index and bone densitometry in an animal model. Materials and Methods: Rabbits were underlined SG, fundectomy (surgical removal of fundus), or sham-operated (controls without any resection), and after 12 weeks, fat index and bone densitometry were obtained. Results: Our study showed that there was no significant difference between SG and fundectomy groups in bone mass density and fat mass after surgery in comparison with presurgery condition. SG group were associated with lower fat index and bone density, and it showed significantly decrease in weight after 1.5 months. Conclusion: Sub-SG did not show any significant effect on fat index and bone densitometry in comparison with SG. However, we found lower fat index in sleeve group of rabbits, but it was not statistically significant.

Self-management Behaviors and Anthropometric Indices after Roux-en-Y Gastric Bypass.

BACKGROUND: The aim of this study was to correlate the connection between self-management behaviors and anthropometric indices after Roux-en-Y gastric bypass (RYGB). METHODS: A sample of 180 patients suffering from obesity were treated with RYGB in 2019; 6 and 18 months after surgery, anthropometric indices, including weight, waist circumference, waist- to-height ratio, body mass index (BMI), and waist-to-hip ratio, were gauged, and participants completed the post-bariatric surgery self-management behaviors questionnaire. RESULTS: Correlation matrix results showed that all anthropometric indices had a significant positive relationship with self-management behaviors after RYGB; the results of the 18-month post-surgical follow-up exhibited no significant difference between anthropometric indices and self-management behaviors, 6 and 18 months after surgery. CONCLUSION: Therefore, the more self-management behaviors increase, the greater decrease in anthropometric indices will happen after RYGB.

Empyema Caused by Gastropleural Fistula Post Complicated Laparoscopic Sleeve Gastrectomy.

Gastropleural fistula (GPF) can occur as a rare complication of laparoscopic sleeve gastrectomy (LSG). Here, we present the clinical presentation, radiological findings, and outcome of a 19-year-old female who underwent LGS in Mother and Child Hospital in Shiraz, Iran, but due to leakage in the proximal of the stapler line, the operation converted to a single anastomosis sleeve ileal (SASI) bypass to decrease intraluminal pressure and accelerate healing of leakage site. Three months later, the patient admitted with the impression of empyema and diagnosed finally with a GPF. Although the conversion of LSG to SASI bypass for post leakage may be efficient in controlling the intraabdominal leakage, it will not prevent GPF formation, so applying another surgery method such as classic bypass in this situation may be more effective in the management of stapler line leakage.

Self-Efficacy, Happiness and Psychological Well-Being After Sleeve Gastrectomy.

PURPOSE: Sleeve gastrectomy (SG) is an effective treatment for patients with severe obesity and it leads to significant weight loss and promotes the quality of life. The aim of this study was evaluating the relationship between self-efficacy, happiness and psychological well-being after sleeve gastrectomy. METHODS: One hundred patients that underwent SG were participated in this study. They were asked to fill questionnaires 12 months after surgery. To assess self-efficacy, Sherer and et al. scale, for happiness, oxford happiness scale and for psychological well-being, Ryff scale were used. Regression analysis was used on psychological well-being and happiness for evaluating the prediction of self-efficacy. RESULTS: The results showed that 44% of happiness and 4% of psychological well-being were determined by self-efficacy after surgery. CONCLUSION: Based on these findings, self-efficacy is a significant predictor of psychological well-being and happiness.

Late Gastropleural Fistula after the Management of Laparoscopic Sleeve Gastrectomy Leakage.

One of the rare but serious complications of laparoscopic sleeve gastrectomy (LSG) with significant morbidity and mortality is gastropleural fistula (GPF). Here, we present a 34-year-old woman who underwent LSG. Due to leakage in the proximal site of the stapler line and splenic artery erosion into the site of leakage after 1 month, splenectomy and drainage catheter insertion was done. Three months later, she presented with dyspnea, fever, and lung abscess, GPF was diagnosed, and Roux-en-Y fistulo-jejunostomy was done. After 10 days, her clinical condition improved, but the patient expired due to hemorrhagic cerebrovascular accident (CVA). Therefore, GPF along with other common complications should be seriously considered in patients developing post-LSG chronic respiratory symptoms.

A Pregnant Lady Undergoing Bariatric Surgery.

The patient was a 34-year-old morbidly obese woman, a proper candidate for bariatric surgery, with a BMI of 49.5 (135 kg weight, and 165 cm height). All the routine blood tests, done prior to the surgery, were within the normal range, and her blood ß-hCG was particularly negative before the surgery.Sleeve gastrectomy was performed successfully and she was discharged three days later under acceptable medical conditions. Due to the lack of menstruation three months after the operation, Blood ß-hCG level was checked and turned out to be positive. Ultrasound examination confirmed a pregnancy at 14 weeks of gestational age, implying that the patient had been pregnant during the bariatric surgery.

The healing effect of Wharton's jelly stem cells seeded on biological scaffold in chronic skin ulcers: A randomized clinical trial.

BACKGROUND: Chronic wound or nonhealing ulcer is essentially a wound that does not progress normally through the wound healing process. This study assessed the healing effect of umbilical cord Wharton's jelly stem cells seeded on biological scaffold in chronic skin ulcers. MATERIALS AND METHODS: In a randomized clinical trial, five patients between 30 and 60 years with chronic diabetic wounds were enrolled. To cover the wounds, acellular amniotic membrane seeded with Wharton's jelly mesenchymal stem cells (WJSCs) was used for 9 days, every 3 days with a follow-up of 1 month. The percentage and time of wound healing and the size of wound were recorded for each patient. RESULTS: In treated patients, the wound healing time and wound size significantly decreased, and after 6 and 9 days, the wound size significantly declined (P < 0.002). CONCLUSION: As WJSCs seeded on amniotic membrane could significantly accelerate the healing effect in chronic diabetic wounds, they can be an alternative source in tissue engineering and repair of chronic ulcers.

Self-Management Behaviors in Obese Patients Undergoing Surgery Based on General and Specific Adherence Scales.

BACKGROUND: Adherence has been defined as the degree to which a patient's voluntary behavior corresponds with the clinical recommendations of health care providers. The aim of this study was to predict self-management behaviors in obese patients undergoing surgery based on general and specific adherence scales. METHODS: All obese patients who underwent bariatric surgery in Ghadir Mother and Child Hospital, Shiraz, Iran from April 2017 to September 2017 were enrolled. By using available sampling method, 201 patients with BMI above 35 (36.43±35.11) and in the age range of18-65 years (13.38±80/5) were selected. A questionnaire containing general adherence scale (GAS), specific adherence scale (SAS) and post-surgery self-management behaviors questionnaire (BSSQ) was completed by all patients. RESULTS: The general and specific adherence scales were significant predictors for self-management behaviors after surgery, and positive relation was found for general and specific adherence scales with self-management behaviors. CONCLUSION: Self-management behaviors regarding eating behaviors, supplements, fruits, vegetables, grains, protein and fluid intake, physical activity, dumping syndrome management have significant relationship with general and specific adherence scales. So increasing knowledge, skills, motivation, self-confidence, self-efficacy and self-monitoring of obese patients after surgery seem necessary.

The First Report about the Laparoscopic Sleeve Gastrectomy-Induced Lactose Intolerance.

The impact of laparoscopic sleeve gastrectomy (LSG) on the lactose intolerance (LI) remains unclear. We checked 8 men and 34 women with mean body mass index (BMI) of 43.94 ± 5.89 kg/m2 for LI using hydrogen breath test and clinical examination before LSG and at 3 months postoperation. In addition to appropriate weight loss (34.30 ± 5.51 kg/m2), 1 man and 3 women, who had not LI at starting, were suffered from LI at 3 months postoperation. Among these four patients, the most and least LI was seen in women who had the lowest and highest percentage of excess BMI loss. It seems LSG can induce LI which must be monitored in postoperative follow-ups.

Laparoscopic One-Anastomosis Gastric Bypass in a Patient with Morbid Obesity and Situs Inversus Totalis: a Case Report.

BACKGROUND: Laparoscopic one-anastomosis gastric bypass is a new bariatric surgery technique for weight loss in morbid obesity. This technique has come to be associated with suitable weight loss results, low technical complications, short surgery time, low cost, short post-operational period, and low chances of injury comparisons with other bariatric surgical approaches to weight loss in morbid obesity such as sleeve and Roux-en-Y gastric bypass. To the best of our knowledge, there has been no report of such surgery in the case of situs inversus totalis concurrent with morbid obesity. CASE PRESENTATION: The patient was a 36-year-old male suffering from morbid obesity (BMI, 56.8) along with situs inversus totalis. In spite of operational complexities due to the reversed location of abdominal and thoracic organs, the operation was performed similarly to routine subjects considering the diverse site of organs. CONCLUSION: Given the considerable superiorities of one anastomosis gastric bypass over other bariatric surgical techniques, particularly concerning the simpler procedure, low surgical complication and short surgery time, this approach may guarantee positive outcomes in subjects with concurrent situs inversus totalis and morbid obesity.

Analgesic Effect of Valerian Root and Turnip Extracts.

BACKGROUND: Medicinal plants are considered as one of the important sources of chemical substances with therapeutic effects. This study aimed to compare the analgesic effects of alcoholic extract of valerian root and turnip in rats. METHODS: Fifty female Wistar rats weighing 190 g were divided into 5 equal groups of control (subcutaneous injection of 2.5% formalin in the right foot), sham (subcutaneous injection of 2.5% formalin+distilled water), experimental 1 (subcutaneous injection of 2.5% formalin+200 mg/kg turnip extract), experimental 2 (subcutaneous injection of 2.5% formalin 2+200 mg/kg valerian root extract) and experimental 3 (subcutaneous injection of 2.5% formalin+200 mg/kg turnip extract+200 mg/kg valerian root extract). The time duration of 0-5 and 16-60 minutes after injection of formalin were respectively considered as acute and chronic phases. Injection of distilled water and the extracts was conducted 30 minutes before assessing the analgesic effects. RESULTS: A significant decrease in pain score in the acute phase was observed in the group received valerian root extract compared to the control group. Also, a significant reduction in pain score was noted in the acute and chronic phases of the group receiving simultaneous administration of valerian root and turnip extracts when compared to the control group. CONCLUSION: Simultaneous use of valerian root and turnip extracts is recommended for analgesic effects in both acute and chronic phases of the pain.

Enhanced Wound Healing after Leiomyoma Enucleation.

Leiomyoma is a rare esophageal tumor that constitutes less than 1% of esophageal malignancies. It should be removed when diagnosed even if asymptomatic. This study presents two cases of esophageal leiomyoma in 38 and 62 years old men who presented with dysphagia and evaluated for diagnosis and location of related tumors. Patients were clinically examined and upper gastrointestinal endoscopy, chest computerized tomography scan, barium swallow and endoscopic ultrasonography were performed. The masses were diagnosed and both patients underwent 3-port right videothoracoscopic enucleation of esophageal leiomyoma with sleeve calibration tube (SCT) assistance. SCT was used to protrude out the mass from surrounding tissues. Also immunohistochemistry was done after mass enucleation. Two patients were operated routinely without any unpredictable events by help of SCT assistance. Mass size was 3.5×2.5×1 cm in one case and 1.5×1×0.5 cm in another patient. Positive smooth muscle antigen, desmin and ki67 and negative CD34, CD117 and S100 in both cases were obtained in immunohistochemistry. Patients were followed after surgery for 3 months and no complications were detected in none of them. Thoracoscopic enucleation of esophageal leiomyoma is a safe and feasible procedure which can decrease hospitalization and operation time. Based on our findings, the use of esophageal SCT help to detect smaller tumor without need of intra-operative endoscopy, facilitates separation of the tumor mass from both esophageal mucosal and muscular layers, and may prevent perforation. Finally, use of SCT makes the operation faster and safer.

Relationship between Body Image and Psychological Well-being in Patients with Morbid Obesity.

BACKGROUND: Morbid obesity is rising around the world. It can cause unpleasant appearance and body image. Most of the studies have aimed to evaluate the psychopathology of overweight and obesity and paying attention to mental well-being in morbid obese individuals is rare. Therefore, this study aimed to assess the relationship between body image and psychological well-being in morbid obese patients. METHODS: This cross-sectional study, using simple random sampling method, was done on 124 morbid obese patients who referred to obesity clinic in Shiraz from 2016 to 2017. The data were collected by body image index and psychological well-being questionnaire. Results were analyzed using descriptive statistics, Pearson correlation coefficient test, ANOVA, and Regression analysis. RESULTS: The results showed a significant relationship between body image and psychological well-being (r=0.43) (P<0.001), and between the total score of the body image and all the subscales of psychological well-being except autonomy and purpose in life (P<0.05). There was also a significant relationship between the total score of psychological well-being and all the subscales of body image (P<0.05). However, there was no significant difference between the mean scores of the body image and those of psychological well-being in different categories of body mass index (BMI) (P>0.05). CONCLUSION: Final results indicated that body image defects caused by obesity could lie in negative psychological well-being in all aspects. This study can promote health clinicians' knowledge in supporting of mental status of obese individuals. It is suggested that preventing and supporting intervention should be performed as effective methods for encountering and coping with psychological effects of obesity.

The Effect of Lithospermum officinale, Silver Sulfadiazine and Alpha Ointments in Healing of Burn Wound Injuries in Rat.

BACKGROUND: Burn is the most devastating condition in emergency medicine leading to chronic disabilities. This study aimed to compare the effect of Lithospermum officinale, silver sulfadiazine and alpha ointments on healing of burn wounds in rat. METHODS: Ninety-five rats were divided into 5 groups. Group 1 just underwent burn injury, and groups 2-5 received alpha ointment, silver sulfadiazine (SSD), gel base and L. officinale extract, respectively. A hot plate was used for induction of a standard 3rd degree burn wound. Burn wounds were macroscopically and microscopically evaluated on days 7th, 14th and 21st after burn induction. RESULTS: A decrease in the number of inflammatory cells was noted when L. officinale and SSD were applied while the most inflammatory response was seen after administration of alpha ointment. The number of macrophages alone decreased after burn injury, while the frequency was the most when L. officinale and alpha ointment were applied. Re-epithelialization, angiogenesis and formation of granulation tissue were the best in relation to L. officinale and alpha ointment while, the worst results belonged to burn injury group and SSD regarding granulation tissue formation. Considering histological assessment, the best results were observed for scoring of inflammation, re-epithelialization, angiogenesis, formation of granulation tissue and number of macrophage when L. officinale and alpha ointment were used after burn injury. CONCLUSION: It can be concluded that topical application of L. officinale as a non-toxic, inexpensive and easy to produce herbal can lead to a rapid epithelialization and wound healing and these findings can be added to the literature on burn wound healing.

Association of retinol-binding protein 4 with metabolic syndrome in first-degree relatives of type 2 diabetic patients.

BACKGROUND: Retinol-binding protein 4 (RBP4) is known to regulate lipid and glucose metabolism and insulin resistance. The influences of RBP4 on metabolic syndrome (MS) are still unclear. The purpose of this study is to evaluate the association between serum levels of RBP4 and MS components in first-degree relations of type 2 diabetic patients. MATERIALS AND METHODS: This cross-sectional study was performed within the framework of the diabetes prevention project in Isfahan. This study has been conducted during 2012-2013. Seventy-eight subjects participate, with an average age of 43.20 ± 5.29 years. Weight, height, waist and hip circumferences, blood pressure (BP) of participants, fasting plasma glucose, hemoglobin A1c, total cholesterol, high-density lipoprotein cholesterol, triglyceride (TG), and serum RBP4 were measured from fasting blood sample taken from each participant after an overnight fast (12-14 h). RESULTS: Systolic and diastolic BP were significantly higher in people in top median of RBP4 (11.8 ± 1.5 vs. 11.0 ± 1.2, P = 0.01 and 7.8 ± 1.0 vs. 7.3 ± 0.9, P = 0.03). Moreover, TG in people with high levels of RBP4 was higher compared with those with low levels of RBP4 (177.7 ± 97.6 vs. 138.7 ± 56.9, P = 0.02). People with low levels of RBP4 had significant greater hip circumferences (107.9 ± 7.5 vs. 104.3 ± 8.0, P = 0.04). There was no correlation between RBP4 and MS in crude model (odds ratio [OR]: 1.00, 0.95-1.05, P = 0.97). This null correlation remained after adjustment for body mass index, age, and physical activity (OR: 0.93, 0.91-1.07, P = 0.31). CONCLUSION: Although RBP4 levels were positively association with some risk factors of MS including hip circumference, TG, and systolic and diastolic BP, it does not seem to be a valuable marker for identification of the MS in the first relative degree of diabetic patients.

The healing effect of curcumin on burn wounds in rat.

BACKGROUND: Burns are still considered one of the most devastating conditions in emergency medicine affecting both genders and all age groups in developed and developing countries, resulting into physical and psychological scars and cause chronic disabilities. This study was performed to determine the healing effect of curcumin on burn wounds in rat. METHODS: Seventy female Sprague-Dawley 180-220 g rats were randomly divided into 5 equal groups. Groups of A-C received 0.1, 0.5 and 2% curcumin respectively and Group D, silver sulfadiazine ointment. Group E was considered as control group and received eucerin. After 7, 14 and 21 days of therapy, the animals were sacrificed and burn areas were macroscopically examined and histologically were scored. RESULTS: Administration of curcumin resulted into a decrease in size of the burn wounds and a reduction in inflammation after 14(th) days. Reepithelialization was prominent in groups A-C while more distinguishable in group C. In group C, epidermis exhibited well structured layers without any crusting. There were spindle shaped fibroblasts in fascicular pattern, oriented parallel to the epithelial surface with eosinophilic collagen matrix. CONCLUSION: Curcumin as an available and inexpensive herbal was shown be a suitable substitute in healing of burn wounds especially when 2% concentration was applied.

Predicting of trend of hemoglobin a1c in type 2 diabetes: a longitudinal linear mixed model.

BACKGROUND: There are some evidences that control the blood sugar decreasing the risk of diabetes complications, and even fatal. There are so many studies, but they are mostly cross-sectional and ignore the trend and hence it is necessary to implement a longitudinal study. The aim of this prospective study is to find the trend of glycosylated hemoglobin (HbA1c) over time and the associative factors on it. METHODS: Participants of this longitudinal study were 3440 eligible diabetes patients referred to Isfahan Endocrine and Metabolism Research Center during 2000-2012 who are measured 2-40 times. A linear mixed model was applied to determine the association between HbA1c and variables, including lipids, systolic, diastolic blood pressure and complications such as nephropathy, and retinopathy. Furthermore, the effect of mentioned variables on trend of HbA1c was determined. RESULTS: The fitted model showed total cholesterol, retinopathy, and the method of therapy including oral antidiabetic drugs (OADs) plus insulin and insulin therapy decreased the trend of HbA1c and high-density lipoprotein, weight, hyperlipidemia and the method of therapy including diet, and OADs increased the trend of HbA1c. CONCLUSIONS: The present study shows that regular visits of diabetic patients as well as controlling blood pressure, lipid profile, and weight loss can improve the trend of HbA1c levels during the time.