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1.
Br J Psychiatry ; 222(1): 7-17, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-35657651

RESUMO

BACKGROUND: Research has shown that 20-30% of prisoners meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but effects in prisoners are uncertain because of comorbid mental health and substance use disorders. AIMS: To estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD. METHOD: We conducted an 8-week parallel-arm, double-blind, randomised placebo-controlled trial of OROS-methylphenidate versus placebo in male prisoners (aged 16-25 years) meeting the DSM-5 criteria for ADHD. Primary outcome was ADHD symptoms at 8 weeks, using the investigator-rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcomes were measured, including emotional dysregulation, mind wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression. RESULTS: In the OROS-methylphenidate arm, mean CAARS-O score at 8 weeks was estimated to be reduced by 0.57 points relative to the placebo arm (95% CI -2.41 to 3.56), and non-significant. The responder rate, defined as a 20% reduction in CAARS-O score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm differences were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm. CONCLUSIONS: ADHD symptoms did not respond to OROS-methylphenidate in young adult prisoners. The findings do not support routine treatment with OROS-methylphenidate in this population. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multi-modal treatments and preventative interventions in the community.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Estimulantes do Sistema Nervoso Central , Metilfenidato , Prisioneiros , Adulto Jovem , Masculino , Humanos , Metilfenidato/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Preparações de Ação Retardada/uso terapêutico , Resultado do Tratamento , Método Duplo-Cego
2.
J Environ Manage ; 344: 118529, 2023 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-37418912

RESUMO

Organic matter decomposition is a biochemical process with consequences affecting climate change and ecosystem productivity. Once decomposition begins, C is lost as CO2 or sequestered into more recalcitrant carbon difficult to further degradation. As microbial respiration releases carbon dioxide into the atmosphere, microbes act as gatekeepers in the whole process. Microbial activities were found to be the second largest CO2 emission source in the environment after human activities (industrialization), and research investigations suggest that this may have affected climate change over the past few decades. It is crucial to note that microbes are major contributors in the whole C cycle (decomposition, transformation, and stabilization). Therefore, imbalances in the C cycle might be causing changes in the entire carbon content of the ecosystem. The significance of microbes, especially soil bacteria in the terrestrial carbon cycle requires more attention. This review focuses on the factors that affect microorganism behavior during the breakdown of organic materials. The key factors affecting the microbial degradation processes are the quality of the input material, nitrogen, temperature, and moisture content. In this review, we suggest that to address global climate change and its effects on agricultural systems and vice versa, there is a need to double-up on efforts and conduct new research studies to further evaluate the potential of microbial communities to reduce their contribution to terrestrial carbon emission.


Assuntos
Ecossistema , Microbiota , Humanos , Dióxido de Carbono/análise , Agricultura , Solo/química , Mudança Climática , Microbiologia do Solo
3.
Plant Sci ; 348: 112235, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39186952

RESUMO

Myeloblastosis (MYB) is one of the largest family of transcription factors (TFs) in plants. It plays a key role in plant life activities, such as metabolic regulation, stress resistant, as well as helpful for plant growth and development. In China, cucurbit is an important and nutrients rich vegetable crop, which have high medicinal and socio-economic values. In this review, we discussed the structure and characterization of MYB TFs and how do regulate flower development, fruit maturity, fruit quality, and flavonoid biosynthesis. Furthermore, we highlight the effect and contribution of MYB TFs in the regulation of biotic and abiotic stress resistance. This comprehensive review will provide a new reference for the more effective application of MYB TF in quality control, stress resistance research and molecular breeding of cucurbit crops.


Assuntos
Produtos Agrícolas , Proteínas de Plantas , Fatores de Transcrição , Produtos Agrícolas/genética , Produtos Agrícolas/metabolismo , Fatores de Transcrição/metabolismo , Fatores de Transcrição/genética , Proteínas de Plantas/metabolismo , Proteínas de Plantas/genética , Cucurbitaceae/genética , Cucurbitaceae/metabolismo , Cucurbitaceae/crescimento & desenvolvimento , Regulação da Expressão Gênica de Plantas
4.
J Chromatogr A ; 1733: 465254, 2024 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-39173503

RESUMO

The main purpose of the current work was to develop a new method to evaluate and quantify sixteen polyphenol compounds from tomato fruit using high-performance liquid chromatography (HPLC). The separation of 16 polyphenols from tomato fruit was achieved in < 60 min by using a Waters Symmetry C18 column (250 × 4.6 mm i. d, 5 µm particle sizes) with a gradient system of ultrapure water (1 % acetic acid) and 100 % methanol, a temperature of 30 °C, an injection volume of 10 µL and a flow rate of 1.1 mL/min, respectively. The analytical characteristics of evaluation method provide sufficient sensitivity for all tomato polyphenols compounds within normal range 0.1-20 µg·mL-1 (R2≥0.999) with 0.069-0.365 µg·mL-1 LOD, and 0.171-1.106 µg·mL-1 LOQ, with good system suitability (<2 % RSD of retention time, peak area, and tailing factor, 6,000-1,336,000 N, and >1.5 peak resolution), <10 % RSD of precision, stability, repeatability, and robustness, and 99.2 - 105.0 % of recovery. The applicability of this method was demonstrated by the determination of polyphenols in nine cultivars of tomatoes. The results showed that '184' possessed the highest content of total polyphenols (1249.53 µg·g-1 DW) followed by 'Disease resistance 184' (1064.93 µg·g-1 DW). The main polyphenol components were rutin, quercetin, gallic acid, chlorogenic acid, 2,5-dihydroxy benzoic acid, caffeic acid and benzoic acid in tomato fruits. In conclusion, this novel HPLC method is useful and acceptable to analyze polyphenols in tomato fruit.


Assuntos
Frutas , Polifenóis , Solanum lycopersicum , Solanum lycopersicum/química , Cromatografia Líquida de Alta Pressão/métodos , Polifenóis/análise , Frutas/química , Limite de Detecção , Reprodutibilidade dos Testes
5.
PLoS One ; 19(10): e0311386, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39405285

RESUMO

The paper introduces a new class of convexity named strongly modified (p, h)-convex functions and establishes various properties of these functions, providing a comprehensive understanding of their behavior and characteristics. Additionally, the paper investigates Schur inequality and Hermite-Hadamard (H-H) inequalities for this new class of convexity. Also, H-H inequalities are proved within context of Riemann-Liouville integrals and Caputo Fractional derivatives. The efficiency and feasibility of Schur inequality and H-H inequalities are supported by incorporating multiple illustrations, that demonstrate the applicability of strongly modified (p, h)-convex functions. The results contribute to the field of mathematical analysis and provide valuable insights into the properties and applications of strongly modified (p, h)-convex functions.


Assuntos
Algoritmos , Modelos Teóricos
6.
Heliyon ; 10(17): e36508, 2024 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-39281557

RESUMO

To address the shortcomings of the cubic intuitionistic fuzzy sets (CIFSs) for the entitlement of multi-argument approximate function, the cubic intuitionistic fuzzy hypersoft set (Ω-set) is an emerging study area. This type of setting associates the sub-parametric tuples with the collection of CIFSs. Categorizing the evaluation of parameters into their corresponding sub-parametric values based on non-overlapping sets has significance in decision making and optimization related situations. Some operations of Ω-set are proposed in this study, along with certain practical features. We provide the complement, P-order, and R-order subsets, P-union ( ∪ P ), R-union ( ∪ R ), P-intersection ( ∩ P ) and R-intersection ( ∩ R ) of Ω-sets. The internal cubic intuitionistic fuzzy hypersoft set ( Ω I -set) and the external cubic intuitionistic fuzzy hypersoft set ( Ω E -set) are also proposed in this paper, which will aid researchers in applying this new theory to other areas of study. We show a few examples in this context and look into some more aspects of ∪ P , ∪ R , ∩ P and ∩ R of Ω I -sets and Ω E -sets. Arguments for a few significant theorems about Ω I -sets and Ω E -sets are also presented. Lastly, an algorithm is presented that assists decision-makers in evaluating appropriate solar panels to establish solar plants. The proposed algorithm uses the idea of ∪ P and ∪ R for two Ω-sets constructed based on expert opinions of decision makers.

7.
Chemosphere ; 353: 141565, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38423145

RESUMO

The growing global population has led to a heightened need for food production, and this rise in agricultural activity is closely tied to the application of phosphorus-based fertilizers, which contributes to the depletion of rock phosphate (RP) reserves. Considering the limited P reserves, different approaches were conducted previously for P removal from waste streams, while the adsorption of ions is a novel strategy with more applicability. In this study, a comprehensive method was employed to recover phosphorus from wastewater by utilizing biochar engineered with minerals such as calcium, magnesium, and iron. Elemental analysis of the wastewater following a batch experiment indicated the efficiency of the engineered biochar as an adsorbent. Subsequently, the phosphorus-enriched biochar, hereinafter (PL-BCsb), obtained from the wastewater, underwent further analysis through FTIR, XRD, and nutritional assessments. The results revealed that the PL-BCsb contained four times higher (1.82%) P contents which further reused as a fertilizer supplementation for Brassica napus L growth. PL-BCsb showed citric acid (34.03%), Olsen solution (10.99%), and water soluble (1.74%) P desorption. Additionally, phosphorous solubilizing bacteria (PSB) were incorporated with PL-BCsb along two P fertilizer levels P45 (45 kg ha-1) and P90 (90 kg ha-1) for evaluation of phosphorus reuse efficiency. Integrated application of PL-BCsb with half of the suggested amount of P45 (45 kg ha-1) and PSB increased growth, production, physiological, biochemical, and nutritional qualities of canola by almost two folds when compared to control. Similarly, it also improved soil microbial biomass carbon up to four times, alkaline and acid phosphatases activities both by one and half times respectively as compared to control P (0). Furthermore, this investigation demonstrated that waste-to-fertilizer technology enhanced the phosphorus fertilizer use efficiency by 55-60% while reducing phosphorus losses into water streams by 90%. These results have significant implications for reducing eutrophication, making it a promising approach for mitigating environmental pollution and addressing climate change.


Assuntos
Brassica napus , Fósforo , Fósforo/análise , Águas Residuárias , Fertilizantes/análise , Fosfatos/química , Bactérias , Carvão Vegetal/química , Solo/química , Nutrientes/análise , Água/análise
8.
PeerJ Comput Sci ; 9: e1540, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37705663

RESUMO

Supplier selection is a critical decision-making process for any organization, as it directly impacts the quality, cost, and reliability of its products and services. However, the supplier selection problem can become highly complex due to the uncertainties and vagueness associated with it. To overcome these complexities, multi-criteria decision analysis, and fuzzy logic have been used to incorporate uncertainties and vagueness into the supplier selection process. These techniques can help organizations make informed decisions and mitigate the risks associated with supplier selection. In this article, a complex picture fuzzy soft set (cpFSS), a generalized fuzzy set-like structure, is developed to deal with information-based uncertainties involved in the supplier selection process. It can maintain the expected information-based periodicity by introducing amplitude and phase terms. The amplitude term is meant for fuzzy membership, and the phase term is for managing its periodicity within the complex plane. The cpFSS also facilitates the decision-makers by allowing them the opportunity to provide their neutral grade-based opinions for objects under observation. Firstly, the essential notions and set-theoretic operations of cpFSS are investigated and illustrated with examples. Secondly, a MADM-based algorithm is proposed by describing new matrix-based aggregations of cpFSS like the core matrix, maximum and minimum decision value matrices, and score. Lastly, the proposed algorithm is implemented in real-world applications with the aim of selecting a suitable supplier for the provision of required materials for construction projects. With the sensitivity analysis of score values through Pythagorean means, it can be concluded that the results and rankings of the suppliers are consistent. Moreover, through structural comparison, the proposed structure is proven to be more flexible and reliable as compared to existing fuzzy set-like structures.

9.
Plants (Basel) ; 12(17)2023 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-37687319

RESUMO

The demand for a better agricultural productivity and the available phosphorus (P) limitation in plants are prevailing worldwide. Poor P availability due to the high pH and calcareous nature of soils leads to a lower P fertilizer use efficiency of 10-25% in Pakistan. Among different technologies, the use of biologically acidified amendments could be a potential strategy to promote soil P availability and fertilizer use efficiency (FUE) in alkaline calcareous soils. However, this study hypothesized that an acidified amendment could lower soil pH and solubilize the insoluble soil P that plants can potentially uptake and use to improve their growth and development. For this purpose, the test plant Zea mays was planted in greenhouse pots with a recommended dose rate of 168 kg ha-1 of P for selected phosphatic fertilizers, viz., DAP (diammonium phosphate), SSP (single superphosphate), and RP (rock phosphate) with or without 2% of the acidified product and a phosphorus solubilizing Bacillus sp. MN54. The results showed that the integration of acidified amendments and PSB strain MN54 with P fertilizers improved P fertilizer use efficiency (FUE), growth, yield, and P uptake of Zea mays as compared to sole application of P fertilizers. Overall, organic material along with DAP significantly improved plant physiological-, biochemical-, and nutrition-related attributes over the sole application of DAP. Interestingly, the co-application of RP with the acidified product and MN54 showed a higher response than the sole application of DAP and SSP. However, based on our study findings, we concluded that using RP with organic amendments was a more economically and environmentally friendly approach compared to the most expensive DAP fertilizer. Taken together, the current study suggests that the use of this innovative new strategy could have the potential to improve FUE and soil P availability via pH manipulation, resulting in an improved crop productivity and quality/food security.

10.
Obes Surg ; 33(12): 4026-4033, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37884692

RESUMO

BACKGROUND: Bariatric surgery has been postulated to impact liver function resulting in favorable effects on nonalcoholic fatty liver disease (NAFLD). We aimed to analyze the long-term impact of bariatric surgery on noninvasive scores predicting the progression of liver fibrosis in a bariatric population. METHODS: We retrospectively reviewed the records of patients without pre-existing liver disease who underwent sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) at our center between 2010 and 2018. Four predictive scores for liver fibrosis (AST/ALT, APRI, Fib-4, and BARD) were calculated preoperatively, 6 months post-operatively, and annually up to 5 years. Correlations were analyzed with Pearson R. Subgroup and sensitivity analyses were performed to identify populations at increased risk. RESULTS: A total of 2769 patients were included. The mean age was 40 years, and the majority was females (88.5%) and of Hispanic ethnicity (59.2%). There was a steady post-operative increase in the percentage of patients at increased risk of progression of liver fibrosis. The Fib-4 score showed the largest increase in the population at risk for liver fibrosis (11.3% preoperatively to 28.9% at 5 years). Patients with diabetes and those who underwent a sleeve gastrectomy continued to display a higher risk for liver fibrosis than did patients without diabetes and those who underwent RYGB, respectively. CONCLUSION: There was an overall trend to increased liver fibrosis scores over the 5-year post-operative follow-up, but this increase remained lower than that reported in previous literature. Bariatric surgery offers NAFLD risk reduction in a high-risk population.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus , Derivação Gástrica , Hepatopatia Gordurosa não Alcoólica , Obesidade Mórbida , Feminino , Humanos , Adulto , Hepatopatia Gordurosa não Alcoólica/cirurgia , Estudos Retrospectivos , Obesidade Mórbida/cirurgia , Redução de Peso , Cirurgia Bariátrica/métodos , Derivação Gástrica/métodos , Cirrose Hepática/cirurgia , Gastrectomia/métodos , Diabetes Mellitus/cirurgia
11.
Int J Surg Case Rep ; 86: 106296, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34450531

RESUMO

INTRODUCTION: Hundreds of thousands of cholecystectomies and appendectomies are performed in the United States annually. Due to the prevalence of cholecystitis and appendicitis, a subset of patients will require both operations. The limited literature describing these patients supports a laparoscopic approach over open surgery; consistent with the advantages of laparotomy over open surgery in the treatment of each condition individually. CASE PRESENTATION: We report two cases where a patient presented with cholecystitis and appendicitis simultaneously. An abdominal computer tomography (CT) scan revealed the presence of the two diagnoses, which was then confirmed by an abdominal ultrasound. A four-access port was utilized for simultaneous appendectomy and cholecystectomy. DISCUSSION: A review of the literature indicates that simultaneous infection with appendicitis and cholecystitis is rare, and thus clinical presentation, lab work, and imaging studies are all needed to support such a diagnosis. Potential findings on imaging in these patients may include distended gallbladder with thickened wall and fluid-filled dilated appendix with mural enhancement. In the event that both clinical presentation and further work-up indicate both pathologies, laparoscopic intervention is suitable. A four-access port is deemed the conservative approach to dealing with such cases. CONCLUSION: Finding a single diagnosis responsible for a patient's illness is a high priority in an acute care setting, a concept known as diagnostic parsimony. However, it is inevitable that very common illnesses will be comorbid in a subset of patients, and physicians should be prepared to consider contemporaneous illness in the isolated circumstances it is warranted.

12.
Front Plant Sci ; 12: 780454, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34956276

RESUMO

Maximizing the function of indigenous arbuscular mycorrhizal (AM) fungi by choosing specific crop genotypes offers one of the few untapped opportunities to improve the sustainability of agriculture. In this study, the differences in mycorrhizal responsiveness (MR) in plant growth and shoot phosphorus (P) content among cotton (Gossypium spp. L.) genotypes from different release dates were compared and then the relationships between MR and P uptake-related traits were determined. The experimental design in a greenhouse included 24 genotypes released from 1950 to present in Xinjiang Province, inoculation with or without AM fungi, and P levels (15 and 150 mg P kg-1 added as KH2PO4). Results showed that the modern cotton genotypes exhibited a higher degree of mycorrhizal colonization, the hyphal length density (HLD), and mycorrhizae-induced changes in shoot growth than the old genotypes when inoculated with indigenous AM fungi at both the P levels. Moreover, MR was highly correlated with the HLD at low P levels and the HLD may provide useful insights for future cotton breeding aimed at delivering crop genotypes that can benefit more from AM fungi.

13.
Obes Surg ; 31(1): 260-266, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32815104

RESUMO

BACKGROUND: Bariatric surgery is associated with improved renal dysfunction in general population studies. The study examined the effects of bariatric surgery on renal function in a predominantly Hispanic and African American population at a community hospital in New York, USA. METHODS: This retrospective study analyzed prospectively collected bariatric surgical data from 2247 patients (89% female) who underwent bariatric surgery at a single center. Changes in glomerular filtration rate (eGFR), urine albumin-creatinine ratio (UACR), micro- and macroalbuminuria, and hyperfiltration, which were measured preoperatively and then yearly for 3 years postoperatively, were evaluated with t tests and logistic regression analysis, after adjusting for confounding variables. The mean age of the patients at surgery was 37.1 years; the mean preoperative body mass index was 45 ± 7 kg/m2. RESULTS: The results obtained 3 years postoperatively showed the following significant improvements compared with the preoperative values: mean UACR decreased from 40.3 to 11.1 mg/g, mean eGFR improved from 79.4 to 87.3 mL/min, the prevalence of microalbuminuria decreased from 13.7 to 6.2%, the prevalence of macroalbuminuria decreased from 2.5 to 0%, and the prevalence of hyperfiltration decreased from 4.4 to 2.7% (all P < .0001). In adjusted multivariate regression analysis, these results remained significant after adjusting for age, sex, race, type of surgery, and presence of diabetes mellitus or hypertension. CONCLUSION: In this large study at an inner-city hospital, bariatric surgery was associated with significant improvements in renal dysfunction parameters. These results could assist with informed decisions regarding indications for bariatric surgery.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Insuficiência Renal Crônica , Adulto , Albuminúria , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , New York , Obesidade Mórbida/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos
14.
Minim Invasive Surg ; 2021: 9702976, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33953983

RESUMO

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have comparable weight loss outcomes in a general bariatric population. OBJECTIVES: This study aimed to investigate whether similar outcomes can be observed in Hispanic and African American population. Settings. Community Hospital in New York, New York, United States. METHODS: The 5-year prospective data of patients who underwent LRYGB and LSG at a single center were retrospectively reviewed. The long-term weight loss outcomes between patients who had LRYGB and LSG were compared after adjusting for age, sex, race, diabetes mellitus, and hypertension with the linear mixed-effects or logistic regression model. RESULTS: Most patients were Hispanic (59.2%) and African American (22.7%). The mean% total weight loss (%TWL) values of patients with BMI <45 kg/m2 who underwent LRYGB and LSG were 73% and 62% after 1 year, 69% and 56% after 2 years, and 71% and 54% after 5 years, respectively. In patients with a BMI of 45-50 kg/m2 who underwent LRYGB and LSG, the mean %TWL values were 69% and 56% after 1 year, 75% and 58% after 2 years, and 57% and 45% after 5 years, respectively. Meanwhile, the %TWL values of patients with BMI >50 kg/m2 who had LRYGB and LSG were 53% and 42% after 1 year, 53% and 45% after 2 years, and 49% and 36% after 5 years, respectively. All results were statistically significant (p < 0.0001) and remained valid after adjusting for cofactors. CONCLUSION: Thus, LRYGB had consistent and sustained long-term weight loss outcomes compared with LSG in a predominantly ethnically diverse patient population with different BMI. Our study had several limitations in that it is retrospective in nature and some patients were lost to follow-up during the study period.

15.
Cureus ; 12(8): e10071, 2020 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-32999789

RESUMO

Diaphragmatic injuries can be a direct result of penetrating thoracoabdominal trauma such as gunshot or stab wounds. Diaphragmatic rupture can lead to herniation of intra-abdominal organs into the thoracic cavity. Diagnosis can be difficult as the results of a physical exam can be unremarkable. A CT scan of the chest is diagnostic for diaphragmatic injuries. In most emergency cases, diaphragmatic injuries are managed with laparotomy where CT was diagnostic. We report a rare case of a 25-year-old man with right diaphragmatic injury sustained after a stab wound to the right liver managed successfully with laparoscopy.

16.
Surg Obes Relat Dis ; 16(10): 1414-1418, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32703734

RESUMO

BACKGROUND: Obesity is a well-known risk factor for the development of type 2 diabetes. The efficacy of bariatric surgery in reducing weight with resulting improvement in type 2 diabetes has been reliably demonstrated. OBJECTIVES: We investigated and compared the effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on glycated hemoglobin (HbA1C) levels in a predominantly Hispanic and black population. SETTINGS: Community Hospital in New York, New York, United States. METHODS: This is a retrospective review of a 5-year data from a single center where patients with diabetes who underwent LRYGB or LSG were included. HbA1C levels and body mass index were analyzed preoperatively and then annually postoperatively for up to 5 years. Improvements in HbA1C were compared between the 2 groups after adjusting for age, sex, race, and hypertension with linear mixed-effects or logistic regression models. RESULTS: Of the 676 included patients, 84.8% were females and the mean age was 47 years. HbA1C levels decreased significantly (P < .05) in the entire group at 1 (21%), 2 (20%), 3 (20%), 4 (18%), and 5 (14%) years. Compared with LSG, LRYGB patients displayed greater improvement in HbA1C levels at 1 year (25% versus 17%, P = .001). The differences in the reduction of HbA1C between LRYGB and LSG for the other time intervals were not significant (P > .05), 24% versus 17% (2 yr), 22% versus 16% (3 yr), 22% versus 13% (4 yr), and 17% versus 10% (5 yr). Changes in body mass index were not correlated to changes in HbA1C at various study points. CONCLUSION: Both LRYGB and LSG resulted in significant decreases in HbA1C levels and are correlated with changes in body mass index. LRYGB had the greatest effect at 1 year postoperatively. There was no significant difference in HbA1C reduction for LRYGB and LSG after 1 year postoperatively in this predominantly Hispanic and black cohort.


Assuntos
Diabetes Mellitus Tipo 2 , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Diabetes Mellitus Tipo 2/cirurgia , Feminino , Gastrectomia , Hemoglobinas Glicadas , Humanos , Masculino , Pessoa de Meia-Idade , New York , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Redução de Peso
17.
Case Rep Crit Care ; 2019: 1571423, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30918726

RESUMO

Methemoglobinemia is a rare complication in clinical practice. It is most commonly seen in patients undergoing endoscopic procedures, including EGDs, laryngoscopies, bronchoscopies, and nasogastric tube insertions. This is thought to be a disease seen almost exclusively in patients with genetic predispositions to develop it; the increasing use of topical anesthetics during procedures has made methemoglobinemia a disease entity that every clinical provider should be able to recognize and treat. Clinically, patients become cyanotic with mild oxygen derangements on pulse oximetry, in the range of 84 to 90%. Paradoxically, these patients demonstrate normal to supranormal oxygen levels in the blood on blood gas analysis. We report a case of 34-year-old female postoperative Roux-en-Y gastric bypass patient who developed hypoxia and cyanosis after a routine EGD procedure to relieve a food impaction. Differentials of aspiration and pulmonary embolism were plausible; stat blood gas analysis clinched the diagnosis and managed with intravenous methylene blue.

18.
Cureus ; 11(9): e5763, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31723522

RESUMO

The chondroid syringoma is an extremely rare skin tumor most commonly found in the area of the head and neck region. Its rarity, potential for malignancy, and frequent misdiagnosis for other more common tumors can impart unique challenges in diagnosis and management. Diagnosis is usually revealed by excision followed by histologic examination. We report a case of a 42-year-old male with no prior medical history diagnosed with chondroid syringoma of the forehead and review the relevant literature.

19.
J Emerg Trauma Shock ; 11(1): 57-59, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29628671

RESUMO

Scrotal loss from Fournier's gangrene can be a devastating injury with esthetic and functional consequences. Local reconstructive options can be limited by the presence of infection or the loss of neighboring tissue from debridement. IntegraTM bilayer matrix wound dressing is a well-established reconstructive modality, but only one report exists of its use in scrotal reconstruction and this was not in the setting of Fournier's gangrene. We report the successful use of Integra and a subsequent split-thickness skin graft for reconstruction of the anterior scrotum and coverage of the exposed testes in a 43-year-old man who developed Group A Streptococcus necrotizing fasciitis of his right lower extremity, groin, and scrotum requiring serial operative debridements. Stable testicular coverage was achieved with closely matched skin and minimal donor-site morbidity. Further study and a larger sample size will be necessary to better understand the advantages and disadvantages of scrotal reconstruction with Integra.

20.
Int J Surg Case Rep ; 43: 69-71, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29477026

RESUMO

INTRODUCTION: Traumatic brain injury (TBI) is one of the main causes of morbidity and mortality in young trauma patients with resultant multi-organ effects. Hypopituitarism following TBI can be debilitating and life threatening. TBI which causes hypopituitarism may be characterized by a single head injury, such as from a motor vehicle accident, or by chronic repetitive head trauma, as seen in combative supports including boxing, kick-boxing, and football. In the majority of cases, a diagnosis of hypopituitarism can be entirely missed resulting in severe neuro-endocrine dysfunction. We present a case series of two patients diagnosed with hypopituitarism after TBI and treated appropriately with favorable outcome. CASE PRESENTATIONS: The first case is a 34 year-old male, who presented to the emergency department with blunt head trauma after a motor vehicle accident while riding his bicycle. He suffered from severe cranio-facial injuries, resulting in multifocal hemorrhagic contusions, epidural hematoma, and extensive cranio-facial fractures involving the sinuses. The patient developed persistent hypotension with a blood pressure as low as 60/40 mmHg on hospital day three. The second case is a 56 year-old male with a history of schizophrenia, who suffered traumatic brain injury after he was hit by a train. The patient sustained multiple facial fractures, pneumocephalus and C2/7 transverse processes fractures. He also had persistent hypotension, unresponsive to standard treatment. Investigation revealed a deficiency of anterior pituitary hormones resulting from pituitary axis disruption. DISCUSSION: Hypopituitarism is becoming an increasingly recognized complication following TBI, ranging from total to isolated deficiencies. Traumatic Brain Injury is a major public health problem and is one of the leading causes of disability. Understanding and recognizing pituitary dysfunction after TBI can lead to better outcomes and improved quality of life. CONCLUSION: Patients with major head injury and, in particular, those with fractures of the base of the skull, must be closely monitored for signs and symptoms of endocrine dysfunction. Appropriate dynamic pituitary-function screening should be performed.

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