Laparoscopic Sleeve Gastrectomy has A Positive Impact on Subclinical Hypothyroidism Among Obese Patients: A Prospective Study.

BACKGROUND: The effect of bariatric surgery on postoperative thyroid function remains incompletely understood. In this study, we aimed to evaluate the changes in thyroid functions after gastric sleeve operation for morbidly obese Egyptian patients. METHODS: This was a prospective study that recruited 128 patients who underwent sleeve gastrectomy through the period from December 2016 to April 2020. We measured thyroid-stimulating hormone (TSH), free thyroxin (FT4), and free triiodothyronine. Subclinical hypothyroidism was defined by a TSH level > 4.5 mIU/L but a normal FT4 level. All patients were followed for 12 months after the procedure. RESULTS: Preoperatively, 30 (23.4%) patients had subclinical hypothyroidism. The prevalence of subclinical hypothyroidism decreased significantly to reach 7.8% at the end of follow-up (p < 0.001). None of the patients developed de novo hypothyroidism at the end of follow-up. Patients with subclinical hypothyroidism were more likely to be females (p = 0.037) and had significantly higher waist circumference (p < 0.001), DBP (p = 0.02), serum cholesterol (p < 0.001), and serum triglyceride (p < 0.001). However, patients with subclinical hypothyroidism at the end of follow-up had significantly higher BMI at the end of the sixth month (p = 0.048). Similarly, patients with subclinical hypothyroidism at the end of follow-up had significantly higher serum cholesterol (p = 0.002), LDL, (p = 0.038), and serum triglyceride (p < 0.001) at the end of the sixth months of follow-up. A similar trend was noted at the end of the 12th month. The preoperative value of serum TSH correlated significantly with serum cholesterol and triglyceride levels. CONCLUSION: The positive effect of the LSG procedure on the hypothyroid bariatric population, including enhanced thyroid function, was demonstrated.

Effect of weight loss induced by laparoscopic sleeve gastrectomy on liver histology and serum adipokine levels.

BACKGROUND & AIM: Bariatric surgery is a valid treatment option for persons with non-alcoholic fatty liver disease. This study prospectively examined the impact of laparoscopic sleeve gastrectomy (LSG) on liver histopathology, and blood levels of adiponectin, leptin, resistin, and pre-B cell enhancing factor/Nampt/visfatin. PATIENTS & METHODS: In 81 patients with non-alcoholic fatty liver disease who underwent LSG, paired liver biopsies and blood specimens were obtained before and 18 months after LSG. Differences between preoperative and 18 months postoperative data were tested by paired Student's t-test or Wilcoxon rank test as appropriate. RESULTS: At follow up, there was a significant improvement in biochemical markers for glucose homeostasis, including fasting glucose, HbA1c, insulin levels, and homeostatic model assessment index. Postoperative liver function tests, namely serum alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transpeptidase level, showed a significant improvement compared to before weight loss. The number of patients who had definite, borderline, or no non-alcoholic steatohepatitis was 43 (53%), 27 (33%), and 11 (14%), respectively, at baseline, and 9 (11%), 32 (40%), and 40 (49%) at 18-month post-surgery follow up. A significant reduction in steatosis, liver fibrosis, lobular inflammation, and hepatocyte ballooning was observed in the postoperative biopsies (P < 0.001 each). In addition, at the follow-up assessment, there was a significant increase in serum adiponectin levels and significant decline in serum levels of leptin, resisitin, and pre-B cell enhancing factor/Nampt/visfatin. CONCLUSION: Weight loss after sleeve gastrectomy was associated with a significant improvement in several metabolic parameters, liver enzyme levels, liver histopathology, and changes in serum adipokine levels towards antidiabetic and anti-inflammatory profiles.

Role of Biomarkers Diagnostic Tools in Patients with COVID-19: Stratification Made Easy.

Background and Aims: In coronavirus disease 2019 (COVID-19) patients, several serum biomarkers have been identified. Upon intensive care unit (ICU) admission, these laboratory markers become more crucial to distinguish between patients with severe cases of COVID-19. It might assist doctors in predicting the course of illnesses and treating patients appropriately. This work was to investigate the role of biomarkers in patients with COVID-19 classification admitted to the hospital and identified by reverse transcription polymerase chain reaction (RT-PCR). Methods: Peripheral blood sample was taken from COVID-19 cases isolated on admission to determine C-reactive protein (CRP), D-dimer, Fibrinogen, neutrophil-lymphocyte ratio (NLR), leukocytes CRP ratio (LeCR), lymphocyte-CRP ratio (LCR), interleukin-6 (IL6), leukocytes interleukin 6 ratio (LeIL6), systemic inflammatory index (SII), platelet-to-lymphocyte ratio (PLR), and tissue plasminogen activator inhibitor one (tPAI-1). Follow-up for IL6, Ferritin, D-dimer, and tPAI-1 were determined on the 3rd and 7th days. Results: Comparisons of severity revealed that hypertension, chronic obstructive pulmonary disease (COPD), and Ischemia were major risk factors in COVID-19 patients. There was a statistically significant difference between the test groups for fibrinogen (p < 0.000), IL6 (p < 0.009), LeCR (p < 0.006), and LCR (p < 0.011). Conclusion: Based on laboratory test findings at the time of ICU admission, we can distinguish severe cases of COVID-19.

Antithyroid Peroxidase Antibodies and Histopathological Outcomes in Egyptian Patients Subjected to Total Thyroidectomy for Non-Malignant Nodular Goiter.

OBJECTIVE: The study aimed to assess antithyroid antibodies in patients with benign thyroid masses and the effect of total thyroidectomy on the antibodies titers. PATIENTS AND METHODS: This is a retrospective work of 112 cases managed with total thyroidectomy with positive antithyroid peroxidase antibodies (TPO-Ab), anti-thyroglobulin antibodies (Tg-Ab), or both. All patients were euthyroid before surgery. Thyroid function tests and thyroid antibodies levels were measured before and 6 and 12 months after surgery. RESULTS: Histopathological evaluation revealed Hashimoto thyroiditis (47.3%), colloid nodules (22.3%), and lymphocytic thyroiditis (30.4%). All patients were TPO-Ab positive, while 96 patients (85.7%) were Tg-Ab positive before surgery. There was no considerable change in TPO-Ab and Tg-Ab after surgery (p = 0.817, and p=0.560, respectively). Also, there was no significant difference between the three histopathological diagnoses in the levels of TPO-Ab (p = 0.086) or Tg-Ab (p = 0.673). CONCLUSION: Antithyroid antibodies are not valuable markers for diagnosis or prognosis of benign thyroid diseases subjected to total thyroidectomy. We do not recommend their use beyond supporting evidence of the possibility of the autoimmune nature of the illness if other criteria are confirmed.

Changes of Urinary Cytokines in Non-Diabetic Obese Patients After Laparoscopic Sleeve Gastrectomy.

INTRODUCTION: Adipose tissues synthesize and secrete various proinflammatory and anti-inflammatory mediators, termed cytokines. This work aims to assess different serum and urinary cytokine levels before and 12 months after laparoscopic sleeve gastrectomy (LSG). PATIENTS: This prospective study was performed on 61 obese non-diabetic patients who underwent LSG. All patients were followed up postoperatively at 12 months with the assessment of arterial blood pressure, microalbuminuria, urinary and serum levels of inflammatory cytokines (macrophage migration inhibitory factor "MIF," monocyte chemotactic protein "MCP"-1, chemokine (C-C motif) ligand 15 (CCL-15), and CCL-18), in addition to serum creatinine, total cholesterol, and C-reactive protein (CRP). RESULTS: Mean BMI showed decreased substantially from 44.78 ± 3.59 Kg/m2 to 34.56 ± 2.45. Systolic blood pressure decreased from 147.03 ± 16.89 mmHg to 128.82 ± 12.52 and diastolic blood pressure decreased from 90.51 ± 12.71 mmHg to 79.69 ± 10.39. At one-year of follow-up, there was statistically significant decrease of mean serum creatinine, total cholesterol, CRP, CCL-15, CCL-18, MIF/creatinine ratio, MCP-1/creatinine ratio, CCL-15/creatinine ratio, and CCL-18/creatinine ratio (P value <0.001). CONCLUSION: Improvement of systemic and renal inflammatory states after LSG may positively affect obesity-related renal disease by steering the adipokine levels towards anti-inflammatory profiles.

Changes in Plasma Growth Differentiation Factor-15 After Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients: A Prospective Study.

PURPOSE: This study aimed to assess the potential changes of Growth differentiation factor 15 (GDF15) after laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients. METHODS: We conducted a prospective study on 68 patients who underwent LSG and 58 cases, who were enrolled as a control group, to whom conservative measures of weight loss were adopted. Both groups were followed for 12 months. RESULTS: At the baseline, the serum GDF15 was comparable between LSG and conservative groups (409.93±119 versus 385.8±120.2 pg/mL, p =0.246). However, at 12 months after the operation, the serum GDF15 was significantly higher in the LSG than conservative groups (699.941 ±193.5 versus 559 ±159.7; p <0.001). The degree of serum GDF15 increase was higher in the LSG group (290.01 ±189.9 versus 173.14 ±116.7; p <0.001). The degree of serum GDF15 increase correlated negatively with the final BMI (r = -0.352, p =0.001) and weight loss (r = -0.793, p =0.001) at 12 months after the operation. The correlation analysis demonstrated that the initial GFD15 did not correlate with any baseline parameters. Multiple regression analysis of change in serum GDF15 showed a statistical significance of the weight loss after 12 months. CONCLUSION: The present work confirms the impact of successful weight loss on the circulating level of GDF15. Our study demonstrated that the circulating GDF15 increased significantly after LSG and it was correlated to the degree of weight loss.

Long-Term Changes in Leptin, Chemerin, and Ghrelin Levels Following Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy.

AIM: Published reports showed conflicting results regarding the sustained alterations in leptin, chemerin, and ghrelin concenratios after metabolic surgery. Therefore, we performed the present work to contrast the alterations in leptin, chemerin, and ghrelin levels one year after Roux-en-Y gastric bypass (RYGB) versus laparoscopic sleeve gastrectomy (LSG). METHODS: The present research is a prospective, comparative one that followed 100 cases for whom RYGB or LSG was done. We assessed the serum values of adiposity-associated mediators, including adipokcytokines (leptin and active chemerin) and gastrointestinal hormones (total ghrelin). The primary outcome in the present study was the alterations in leptin, chemerin, and ghrelin values at 12 months after RYGB and LSG. RESULTS: The serum leptin level decreased significantly in the LSG group with a mean change of - 170.8 ± 29.4 ng/mL (p < 0.001). Similarly, the serum leptin concentration decreased significantly in the RYGB group, with a mean change of - 165.42 ± 53.4 (p < 0.001). In addition, the mean reduction in baseline chemerin levels 12 months after the operation was considerable in the LSG cohort (- 23.24 ± 9.5 ng/mL) and RYGB group (- 22.12 ± 15.9 ng/mL). The ghrelin values demonstrated a notable reduction in the LSG cohort (- 0.083 ± 0.11 pg/mL) and RYGB group (- 0.068 ± 0.097 pg/mL). However, the changes in the three hormones were not substantially different between both groups (p > 0.05). CONCLUSION: Both RYGB and LSG result in a considerable, comparable decrease in the postoperative serum concentrations of leptin, chemerin, and ghrelin.

Long-term Impact of Mini-Gastric Bypass on Inflammatory Cytokines in Cohort of Morbidly Obese Patients: a Prospective Study.

PURPOSE: One anastomosis gastric bypass (OAGB) is a promising bariatric procedure. We performed this study to evaluate the changes in a group of inflammatory cytokines 12 months after OAGB. METHODS: A single-arm prospective study was conducted on obese patients who underwent OAGB. The serum levels of the following adipocytokines were monitored pre- and 12 months postoperatively: adiponectin, leptin, interleukin 6 (IL-6), interleukin 8 (IL-8) levels, tumor necrosis factor-alpha (TNF-α), serum amyloid A (SAA), high-sensitivity C-reactive protein (hs-CRP), and monocyte chemotactic protein 1 (MCP-1). RESULTS: A total of 62 patients were included with a mean age of 43.9 ± 6.8 years old. The serum adiponectin increased significantly from 7.64 ± 0.29 to 8.76 ± 0.42 µg/mL 12 months after the operation (p < 0.001). hs-CRP and IL-6 decreased significantly 12 months after the OAGB from 3323.35 ± 643.4 ng/mL and 3.72 ± 7.7 pg/mL to 1376.81 ± 609.4 ng/mL and 3.64 ± 6.9 pg/mL, respectively (p < 0.001). The MCP-1 showed significant increase in its level after OAGB as well (p = 0.014). In contrary, there were no significant changes in serum levels of IL-8 (p = 0.12) and TNF-α (p = 0.84) 12 months after the operation. The correlation analysis showed significant correlations between initial body mass index (BMI) with serum adiponectin, IL-8, and serum SAA. CONCLUSION: OAGB can significantly impact the inflammatory cytokine profile in obese patients with possible subsequent protection from obesity-related comorbidities such as insulin resistance, cardiovascular diseases, and certain cancers.

Validity and clinical impact of glucose transporter 1 expression in colorectal cancer.

BACKGROUND/AIM: There is no doubt that colorectal cancer (CRC) poses a major threat to public health worldwide, and despite improvement in managements, prognosis still remains an irritating question with no definite answer. Being a fundamental player in cancer metabolism, glucose transporter 1 (GLUT1) could be utilized as a prognostic biomarker that could fuel development of new treatment strategies. The aim of this study was to assess the validity of GLUT1 expression as a prognostic biomarker and to elucidate to what extent it is immersed in poor clinical outcome among CRC patients. PATIENTS AND METHODS: GLUT1 expression in peripheral blood specimens was analyzed by quantitative real-time polymerase chain reaction in 47 CRC patients and 20 healthy controls. RESULTS: There was significantly elevated GLUT1 expression in peripheral blood of CRC patients than in controls (P < 0.001). The cutoff value of 0.605 provided 98% sensitivity and 100% specificity. There were significantly higher values of GLUT1 expression in patients under 50 years (P = 0.003), performance status 2 (P = 0.009), stage IV (P < 0.001), and presence of metastasis (P < 0.001). GLUT1 expression showed nonsignificant association with overall survival (P = 0.068), while tumor stage (P = 0.01) and metastasis (P = 0.009) were significantly associated with lower overall survival. CONCLUSION: GLUT1 is sensitive and specific marker for CRC. It is overexpressed in young age patients, poor performance status, and stage IV patients. Although this was not statistically significant, GLUT 1 showed higher expression level in patients with lesser survival.

Assessment of risk factors of incidental parathyroidectomy during thyroid surgery: a prospective study.

OBJECTIVES: To determine the incidence, risk factors and clinical relevance of incidental parathyroidectomy during thyroidectomy. METHODS: A total of 207 consecutive patients with benign and malignant thyroid disorders undergoing unilateral or bilateral thyroidectomy were included prospectively in the present study. Patients were divided into two groups according to incidental parathyroidectomy. RESULTS: Two hundred and ten thyroidectomies were performed. Group A included 26 patients with incidental parathyroidectomy and group B included 181 patients without incidental parathyroidectomy. The parathyroid tissue in the resected specimens was found in intrathyroid (57.7%), extrathyroid (23.1%) and central node compartment (19.2%) sites. On multivariate analysis, two factors sustained their significance independently; reoperation for recurrent goitre (p=0.001) and concomitant central neck dissection (p=0.001). There was no statistically significant difference regarding the occurrence of postoperative hypocalcemia between the two groups (p=0.55). CONCLUSION: Reoperation for recurrent goitre and concomitant central neck dissection for cancer thyroid may increase the risk of incidental parathyroidectomy. Incidental parathyroidectomy is not associated with symptomatic postoperative hypocalcemia. Most of removed parathyroid glands were intrathyroid, so incidental parathyroidectomy may be unavoidable.

Varicocelectomy in men with nonobstructive azoospermia: is it beneficial?

OBJECTIVES: To investigate the effect of open lymph sparing high ligation varicocelectomy in nonobstructive azoospermic men with palpable varicocele and determine predictive parameters of outcome. METHODS: After a standard diagnostic evaluation, a total number of 83 men with nonobstructive azoospermia (54 men with complete azoospermia and 29 with virtual azoospermia) and palpable varicocele underwent open lymph sparing high ligation varicocelectomy. Testicular core biopsy was also performed perioperatively in all patients. Varicocelectomy was performed bilaterally in 60 patients and unilaterally in 23. The outcome success was assessed in terms of improvement in semen parameters and spontaneous pregnancy. Four patients with recurrent varicocele were excluded from final data analysis. RESULTS: After a mean follow up of 7.4 months, motile sperm in the ejaculate could be identified in 27 (34.2%) nonobstructive azoospermic patients with a mean postoperative sperm count of 3.56+/-4.8 x 106/mL (range 0.3-18.9) and a mean sperm motility of 42.24+/-17.64% (range 24-76). No predictive parameters of postoperative improvement other than testicular histopathology could be concluded. Of these 27 patients, 2 had Sertoli-only-cell pattern, 6 had maturation arrest at spermatid stage pattern, 13 had hypospermatogenesis and 8 had normal spermatogenesis. Spontaneous pregnancy was achieved in 6 (7.7%) patients. Of these 6 patients, 2 had maturation arrest at spermatid stage pattern, 2 had hypospermatogenesis and 2 had normal spermatogenesis. No predictive parameters of spontaneous pregnancy achievement could be concluded. CONCLUSION: High ligation varicocelectomy may offer nonobstructive azoospermic men an opportunity to have motile sperm via ejaculate and even the chance of natural conception, instead of the more bothersome assisted reproductive techniques.