Nutritional Deficiencies Before and After Bariatric Surgery in Low- and High-Income Countries: Prevention and Treatment.

Nutritional deficiencies represent a prevalent concern among individuals with obesity, stemming from suboptimal dietary habits, chronic inflammation, and preoperative weight reduction efforts. Bariatric surgical interventions, employing either restrictive, malabsorptive or a combination of the two methods, further compound these deficiencies. Commonly observed nutritional deficits following bariatric surgeries include vitamin B12, vitamin D, thiamine, folate, iron, and protein deficiencies. These deficiencies are further complicated by disparities in healthcare resources and income that distinguish low, medium, and high-income countries. The escalating rates of obesity in low- and medium-income countries are primarily attributed to the increasing availability of cheap, nutritionally depleted, and processed foods, coupled with limited access to healthcare. The provision of bariatric surgical interventions in such regions is hindered by the lack of appropriately trained medical personnel and adequate infrastructure. Additionally, the crucial facets of postoperative care, including diligent follow-up, precise weight loss monitoring, and the administration of appropriate nutritional supplements, often remain lacking. This narrative review provides a comprehensive examination of the prevention and treatment of nutritional deficiencies before and after bariatric surgery in the context of varying healthcare resources and income levels. Bariatric procedures and their global prevalence are discussed, and the prevalence, symptoms, and management strategies of specific nutritional deficiencies are explained. This review also outlines practical strategies for providing more equitable care in low- and medium-income countries.

Comparing Perioperative Outcomes of Total Intravenous Anesthesia (TIVA) With Volatile Anesthesia in Patients With Obesity: A Systematic Review.

In this systematic review, the perioperative outcomes of total intravenous anesthesia (TIVA) and volatile anesthesia were compared in obese adults (BMI ≥ 30 kg/m²) undergoing elective surgery. The review analyzed data from 12 randomized-controlled trials involving 935 patients, sourced from PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), Cochrane, Scopus, and Web of Science databases. The focus was on intraoperative vital signs, emergence time, postoperative nausea and vomiting (PONV), duration of post-anesthesia care unit (PACU) stay, and ICU admission rates. Findings showed that TIVA (using propofol) might reduce PONV, but there were no significant differences in other outcomes compared to volatile anesthesia (with desflurane as the most common agent). The review highlights the need for more research, especially comparing sevoflurane with TIVA, to establish clear clinical guidelines for anesthesia in obese patients.

Amelioration of Rheumatoid Arthritis by Anacardium occidentale via Inhibition of Collagenase and Lysosomal Enzymes.

Anacardium occidentale (cashew) has been used in the traditional system of medicine for curing many inflammatory disorders. The present study investigates the antiarthritic effects of cashew leaves extract using the rat model of FCA-induced rheumatoid arthritis. Arthritic rats were treated with 100 and 200 mg/kg b.w. ethanolic extract of cashew leaves. Animals were sacrificed at day 23, and before sacrificing the animals, gross pathological changes were observed. Histopathology of ankle joint was evaluated with hematoxylin and eosin staining, whereas the serum levels of C-reactive protein (CRP) were evaluated by the agglutination method. Inflammatory cells and other hematological parameters were assessed by employing an automated hemocytometer and chemistry analyzer. Rheumatoid factor (Rf) and lysosomal enzymes levels were determined in blood. Results indicated that A. occidentale significantly decreased the CPR levels, macroscopic arthritic score, and rheumatoid factor as compared to the diseased group. Histopathological evaluation showed significant attenuation in bone erosion, joint inflammation, and pannus formation by plant extract. Treatment with A. occidentale significantly suppressed the levels of acid phosphatase, ß-galactosidase, ß-glucuronidase, N-acetylglucosaminidase, and collagenase. Moreover, A. occidentale significantly raised the HB levels and RBCs counts which were found depleted in the diseased group. The raised counts of total leukocytes, platelets, neutrophils, lymphocytes, and monocytes were also significantly decreased by treatment with plant extract. Comparative analysis showed that higher dose of A. occidentale demonstrated superior amelioration of rheumatoid arthritis as compared to low dose. In conclusion, A. occidentale possesses significant antiarthritic potential, which may be attributed to the suppression of lysosomal enzymes and collagenase levels.

Antihyperlipidemic effect of Pistacia khinjuk.

BACKGROUND: Hyperlipidemia is a metabolic disorder that is caused by high levels of triglycerides and cholesterol in blood. Using of plants for the treatment of various ailments is a traditional practice in developing countries. The main objective of the study is to analyse the nutritional composition of Pistacia khinjuk and to assess its anti-hyperlipidemic activity. MATERIALS AND METHODS: In the present study, the ethanolic extract of Pistacia khinjuk leaves was evaluated for antihyperlipidemic activity. 40 adult albino rats were divided into five groups. Hyperlipidemia was induced using high fat diet for 60days. Pistacia khinjuk extract of 150mg/kg body weight and 300mg/kg of body weight was administered to the rats for 28days. Proximate analysis of Pistacia khinjuk was also performed. RESULTS: Proximate analysis of Pistacia khinjuk leaves showed 6.8% ash content, 12.8% crude fiber and only 6.85% fat content. Findings of present study revealed that both doses of Pistacia khinjuk extract improved the serum lipid profile in albino rats by reducing total lipids, total cholesterol, triglycerides and low density lipoprotein, and increasing high density lipoprotein levels in Pistacia khinjuk treated groups. Body weight findings showed significant increase in body weight of all groups from zero day to 60th day. But before sacrifice, there was a decrease in hyperlipidemic and high dose Pistacia khinjuk while increase in control and low dose Pistacia khinjuk group respectively. CONCLUSION: From the results of the present study, it is concluded that Pistacia khinjuk extract has curative effect against hyperlipidemia.

Nutritional Status of Patients Admitted in a General Surgical Ward at a Tertiary Hospital of Punjab.

Nutritional assessment, as a method to identify malnourishment, has long been documented as an essential component of patient management which predicts adverse outcomes. The objective of the study was to find out the frequency of malnutrition and its association with the frequency of complications and deaths postoperatively. This study included all patients who were operated upon in a general surgical unit of Mayo Hospital, Lahore from June to August, 2013. Evaluation of 280 patients showed that 112 (40%) of the patients were malnourished, 90 (32%) were at risk of being malnourished and remaining 78 (28%) of the patients had normal nutritional status, according to the Subjective Global Assessment. Thirteen percent (13%) malnourished and 2 (3%) of the normally nourished patients died within 30 days of operation (p=0.001). Incidence of complications in malnourished patients was 23 (20.53%) as compared to normally nourished patients (5.12%, p=0.006). Malnutrition is very common in patients admitted to surgery wards of our hospitals. It adversely effects the outcome of surgical operations by increasing complications and mortality.