First-World Care at Third-World Rates: Pakistan, an Attractive Destination for Bariatric Tourism.

Introduction Obesity, a complex and multifactorial disease, is defined by a body mass index (BMI) greater than 30 kg/m². When the BMI exceeds 40 kg/m², it is classified as morbid obesity. This condition leads to excessive fat accumulation, which impairs normal body function and metabolism. For individuals grappling with morbid obesity and those who have faced significant hurdles in their quest for substantial weight loss, bariatric surgery emerges as a vital option. Purpose The study aims to explore the dynamics of bariatric surgical tourism in Pakistan, shedding light on factors influencing the choice of Pakistan as a destination for bariatric tourism. Materials and methods A retrospective cross-sectional study design was adopted. Data were gathered from the medical records database, including all patients who had undergone bariatric surgery from 2018 until 2022. The data collection process involved comprehensive patient outreach, where investigators conducted phone interviews and collected patient satisfaction assessments. During these phone interviews, valuable information was gathered by posing questions. These inquiries encompassed various aspects, including the patient's overall satisfaction with the surgical experience, their countries of origin, the specific bariatric procedures they underwent, the motivating factors behind their decision to travel abroad for surgery, their postoperative follow-up routines, and any complications they may have encountered. Results One hundred and nine patients traveled to Pakistan for bariatric surgery from 2018 to 2022. Out of 109 patients, 78 responded to the questionnaire by phone or email. The proforma was filled by 41 (52.5%) males and 37 (47.5%) females. Forty-seven (60.2%) of these patients underwent Roux-en-Y gastric bypass and 31 (39.8%) patients underwent sleeve gastrectomy. Out of 78 bariatric patients, 72 (92.3%) were satisfied with their surgery, five patients (6.4%) were neutral in their response and one patient (1.3%) was dissatisfied with the surgery. Most of the patients (26, 33.3%) declared money as the main driving force for traveling, with long waiting times being the close second reason (19, 24.36%) patients. Conclusion At least 2% of worldwide bariatric procedures are provided for medical tourists. Countries such as Mexico, India, Lebanon, and Romania dominate as providers for patients mainly from the USA, UK, and Germany. The lack of affordable bariatric healthcare and long waiting lists are some of the reasons for patients choosing bariatric tourism. The 92.3% satisfaction rate of patients with the surgery and its outcomes is a significant finding, as it suggests that bariatric surgery services provided in Pakistan are meeting or exceeding the expectations of international patients. The exceptionally high level of patient satisfaction speaks to the quality of care provided by the medical institutions in Pakistan. The data and analysis presented in this study shed light on the motivations and experiences of international patients traveling to Pakistan for bariatric surgery. These insights are invaluable for healthcare providers, policymakers, and the medical tourism industry as they seek to enhance the accessibility, affordability, and quality of healthcare services for domestic and international patients.

Production and characterization of starch nanoparticles by mild alkali hydrolysis and ultra-sonication process.

In this report, synthesis of the starch nanoparticles from underutilized and cheap sources viz: Horse chestnut (HS), Water chestnut (WS) and Lotus stem (LS) by using mild alkali hydrolysis and ultra-sonication process has been presented. The particles were characterized by Differential scanning colorimeter (DSC), X-Ray Diffraction (XRD), Rheology, Scanning electron microscopy (SEM) and Fourier transform infra-spectroscopy (ATR-FTIR). The particle size measurements, functional properties and antioxidant potential of starch nanoparticles were also analyzed. The experimental results revealed that the average particle size diameter of Horse chestnut starch nanoparticles (HSP), Water chestnut starch nanoparticles (WSP) and Lotus stem starch nanoparticles (LSP) was found to be 420, 606 and 535 nm, respectively. We observed a notable increase in the water absorption capacity but decreased capacity for oil absorption in the starch nano-particles. SEM images revealed damaged starch granules after size reduction. Additionally, loss of crystallinity and molecular order was observed from XRD and ATR-FTIR spectra. It was concluded that the starch nanoparticles have better thermal stability, increased viscosity and antioxidant properties.

Pro-Atherogenic Inflammatory Mediators in Inflammatory Bowel Disease Patients Increase the Risk of Thrombosis, Coronary Artery Disease, and Myocardial Infarction: A Scientific Dilemma.

Inflammatory bowel disease (IBD), comprising ulcerative colitis and Crohn's disease, is characterized by widespread inflammation of the gastrointestinal tract with systemic manifestations. Inflammation is one of the driving forces for the pathogenesis of atherosclerosis and its dreaded complications like myocardial infarction (MI). Yet, the association between IBD and myocardial infarction has not been thoroughly established. Myocardial infarction in IBD patients was predominantly seen in young women during the active disease process. At the same time, elevated levels of C-reactive protein and other pro-inflammatory markers were observed in both IBD and atherosclerosis. Increasing evidence suggests inflammation inhibits fibrinolysis, expresses procoagulants, and suppresses anticoagulants promoting thrombosis formation. Moreover, the alteration of gut microbiota impacts the pathogenesis of inflammation and predisposes one to ischemic heart disease. Accordingly, all IBD patients should be screened and counseled on lifestyle modifications for the traditional risk factors of atherosclerosis. Future researchers should consider conducting more clinical trials on anti-inflammatory medication targeting atherosclerosis and therapeutics, while targeting the gut microbiota to reverse the inflammatory atherosclerotic process.

Intralobar Pulmonary Sequestration With A Patent Bronchus; A Rare Presentation.

A 25 years male working as labourer in Middle East presented with episodic chest pain and productive cough for last 10 years. There was polycystic lesion in left lower chest cavity having separate arterial supply from descending aorta on radiology. It was diagnosed as intralobar sequestration. Operative findings confirmed the presence of separate blood supply from descending aorta and patent bronchial connection of intrapulmonary sequestration to the rest of the lung parenchyma. There are only few case reports in the literature describing this entity. Posterobasal segmentectomy was done with stapling of communicating bronchus.

In Vivo Screening and Antidiabetic Potential of Polyphenol Extracts from Guava Pulp, Seeds and Leaves.

The present study investigates the antidiabetic potential of polyphenol extracts purified from guava pulp, seeds and leaves using an in vivo experiment on albino rats. The polyphenols from guava pulp, seeds and leaves were extracted using methanol solvent and the sonication method while being evaluated by total phenolic contents and radical scavenging activity assay. The proximate composition of powders revealed that ash, protein and total sugars were significantly (p < 0.05) higher in leaves and seeds, while vitamin C was highest in pulp. Total phenolic and antioxidant activities were highest in pulp followed by leaves and seeds. The findings of feed intake and body gain revealed that the supplementation of polyphenols, especially from pulp, significantly (p < 0.05) increased the feed intake, which resulted in increased body weight. Moreover, total cholesterol (TC) and low-density lipoprotein (LDL) levels were significantly (p < 0.05) decreased, while the level of high-density lipoprotein (HDL) was increased in groups fed with polyphenols from guava pulp compared to both (+ive and -ive) control groups. Furthermore, blood glucose and triglycerides were significantly (p < 0.05) decreased in supplemented groups compared to the control group of diabetes mice, which resulted in the inhibition of α-amylase and glucose transport. Besides this, packed cell volume (PCV), mean corpuscular volume (MCV), hemoglobin, red blood cells (RBCs), white blood cells (WBCs) and platelet levels were increased significantly (p < 0.05) in pulp's extract followed by leaves and seeds compared to both control groups. Overall, the antidiabetic potential of different extracts was in the following order: pulp > leaves > seeds. The findings suggest the feasibility of adding 200-250 mg/kg.bw of polyphenol extracts of pulp as an alternative to diabetic drugs.