Obese Female Patients Research Articles

SURGICAL OUTCOME OF MODIFIED LAPAROSCOPIC RETRORECTUS APPROACH FOR UPPER MIDLINE VENTRAL AND UMBILICAL HERNIAS

Background: The incidence of ventral hernias such as umbilical, epigastric and midline incisional hernias has increased over the years. Many surgical modalities of treatment have been evolved for better management and outcome of hernia repair. Igor Belyansky performed the rst successful endoscopic Rives Stoppa procedure (eTEP). The current Laparoscopic retrorectus repair needs more than three ports, and it also requires USG marking of the retrorectus space. Crossing over to the opposite retrorectus space will be difcult for beginners. This study standardises the easy and ergonomically better Laparoscopic Retrorectus approach for umbilical and upper midline hernias using three ports in the suprapubic area. Aim And Objectives: To study the feasibility and effectiveness of the Modied Laparoscopic Retrorectus approach. Material And Methods: This prospective study involved 18 patients admitted to tertiary health center, with umbilical hernia, epigastic hernia and upper midline ventral hernia. We performed the analysis after taking institutional ethical committee approval and informed consent from patients. A qualied surgeon performed laparoscopic retrorectus hernioplasty (e -TEP) with modication in port placement. An observational analysis was done on the feasibility and outcome of the modied approach. SPSS version 20. was used to perform the statistical analysis. Unpaired t-test, Pearson's correlation coefcient was applied. Results: A total of 18 patients were included in the study, with a mean age of 48.78 years. The hernia was predominantly seen in the female gender, overweight or obese patients. The mean duration of the procedure with the modied approach was 160minutes. The patients' numeric rating scale of pain on postoperative day 1 and day 2 was mild in 66.6% of patients. We noted seroma formation in two patients, which was signicantly associated with the duration of surgery (p =0.0069). Most of the patients were discharged on postoperative day 5. Follow up of patients up to 1 year had no history of recurrence or chronic pain. Conclusion: The standard of care for ventral hernia repair is the laparoscopic e – TEP approach. This study's modication of port placement showed better cosmetic results with reduced risk of chronic pain and low recurrence rate. The prolene mesh used during this procedure is very economical, making laparoscopic hernia surgery affordable for low socio–economic populations in developing countries.

A Systematic Review on Whether an Association Exists Between Adolescent Obesity and Idiopathic Intracranial Hypertension.

Pseudotumor cerebri syndrome (PTCS)/idiopathic intracranial hypertension (IIH) is a clinical presentation appertaining to signs/symptoms of raised intracranial pressure, like headache and papilledema. It is an uncommon but clinically significant cause of morbidity such as permanent vision loss. It is crucial to understand if idiopathic intracranial hypertension (IIH) is on the rise in adolescents, it is probably due to the rising prevalence of obesity worldwide. Our study aimed to find an association between obesity and IIH in adolescents. We utilized Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 (PRISMA) guidelines to run this systematic review. Many publications related to the topic in the discussion were scrutinized through a comprehensive database search. We filtered them down to a final count of 10 articles after utilizing our inclusion/exclusion criteria and assessing the quality of work. In these final papers, we identified several possibilities to explain the link between obesity and IIH in adolescents. Overweight and obese adolescents were found to have a significantly increased risk of IIH development, with a more severe clinical picture seen in morbidly obese female patients.

A BRIEF REPORT TO STUDY RISK ASSESMENT OF CKD IN TYPE-II DIABETIC AND HYPERTENSIVE PATIENTS

Chronic kidney disease (CKD) is a long-term pathological condition with loss of function over several months to years. In the present study the CKD risk assessment in diabetic, hypertension is assessed using CKD assessment questionnaire, GFR and other biochemical parameters. In the present study 1270 patients were identified with risk of CKD in which 250 patients were dropped due to various reasons, 1020 patients data was studied and analyzed as per our objectives. The findings suggest that the CKD risk is more in elder patients than younger patients with diabetics and hypertension. Females are at more risk to CKD when compared to males. When BMI was analyzed the Female Obese patients are 90% significant risk to CKD followed by obese male. 95% significant risk was observed for CKD in house wives, Govt employees followed by Private employees with sedentary life style. Family history of CKD in diabetic and hypertension was analyzed then there is no significant difference among them. When education status was analyzed in hypertension and diabetes patients then there is no significant difference among them. when GFR was analyzed then 95% significant risk was observed in stage-1 vs stage-3A, 95% significant risk was observed in stage-1 Vs stage-3B and 99% significant risk was observed between stage-1 Vs stage-5. It is concluded that increased age are at more risk, in Gender Females are more risk than males, in BMI higher BMI are more risk, Family history was Independent ,in Occupation house wives are more risk , in GFR – Stage 5 are more risk and in Social history was Independent. KEY WORDS: Age, Gender, BMI, GFR, Social history, family history, Occupation

Correlation of the Phase Angle with Muscle Ultrasound and Quality of Life in Obese Females.

Introduction Phase angle (PhA) has been suggested to be an indicator of body cell mass and nutritional status. Clinically, the phase angle supposedly reflects body cell mass and cell membrane function, and the higher the phase angle, the better is the cell function. Muscle ultrasound (US) is an emerging nutritional assessment technique. Objective The aim of this study was to investigate the usefulness and correlation of PhA with muscle US of quadriceps rectus femoris (QRF) in obese female subjects and the relationship with quality of life and physical performance. Material and Methods. In a total of healthy 50 obese female patients, anthropometric data by BIA, muscle mass by ultrasound at the QRF level, analytical determination, blood pressure, and quality of life were measured. Physical performance was assessed, too. Results In total, 50 female obese patients were included with a mean age of 45.9 ± 2.4 years. The mean body mass index was 32.1 ± 1.6 kg/m2 with a mean weight of 83.5 ± 14.6 kg. Correlation analysis showed a positive correlation of PhA with all US parameters corrected by squared height (anteroposterior muscle thickness, circumference, cross-sectional area, and Echo-intensity). The correlation analysis of biochemical parameters with PhA showed a positive correlation with serum albumin and total protein levels. Physical activity and vitality scores of SF36 were correlated with PhA. Finally, PhA was positive correlated with physical performance, doing push-ups in 30 seconds (r =0.42; p =0.03) and doing squats in 30 seconds (r =0.54; p =0.02), without correlation with the time of 1.5 km walk. Conclusion PhA was correlated with muscle area, muscle circumference, muscle echo intensity, serum protein, quality of life SF-36, and strength physical performance.

Comparison of complications in very obese women undergoing hysterectomy – Abdominal vs laparoscopic approach with short- and long-term follow-up

BackgroundSurgical treatment of obese female patients represents a real challenge. Over the last decade, minimally invasive techniques for hysterectomy have emerged. These approaches reduce the invasiveness of standard surgical procedures while maintaining efficacy and feasibility. ObjectiveTo evaluate the rates of perioperative, early, mid-term and late postoperative complications in very obese [body mass index (BMI) ≥ 35 and < 40 kg/m2] and severely obese (BMI ≥ 40 kg/m2) women who underwent total (non-radical) hysterectomy.Design: A prospective comparative multi-centre non-randomized study. MethodsIn total, 328 consecutive total (non-radical) hysterectomies were performed at seven teaching gynaecological centres. Of these, 153 (46.6%) were performed using an open laparotomy (LT) approach and 175 (53.4%) were performed laparoscopically (LS). All data were collected by medical specialists at the pre-operative examination prior to surgery, during surgery and three times postoperatively (during hospital stay, at 6-week follow-up and 6 months following surgery). Another analysis considered a total of 206 women who underwent laparoscopic hysterectomy. The subjects were divided according to BMI into 120 very obese women (BMI ≥ 35 and < 40 kg/m2) and 86 severely obese women (BMI ≥ 40 kg/m2). ResultsThe total number of composite perioperative complications was significantly lower in the LS group (p = 0.006). Composite complications occurred significantly more often in patients in the LT group compared with the LS group in the early (p < 0.001) and mid-term (p < 0.001) postoperative periods. In the late postoperative period, the total number of composite postoperative complications did not differ significantly between the groups (p < 0.396). Among 206 patients who underwent laparoscopic hysterectomy, the number of complications was generally low; the rates of composite perioperative (p = 0.393), early (p = 0.642), mid-term (p = 0.738) and late (p = 1) postoperative complications were generally low; and frequency did not differ significantly with BMI. ConclusionThe LS approach does not increase intra-operative morbidity associated with surgery, and has significantly better outcomes in terms of the postoperative complication rate.

ESR1 Regulates the Obesity- and Metabolism-Differential Gene MMAA to Inhibit the Occurrence and Development of Hepatocellular Carcinoma.

Obesity is often regarded as a factor that promotes tumorigenesis, but the role of obesity in promoting hepatocellular carcinoma (HCC) is still controversial. We compared the trend change of 14 obesity-related genes in the formation and development of HCC in normal, adjacent, and HCC tissues. Mendelian randomization (MR) analysis was used to verify the relationship between obesity and HCC occurrence. Metabolism of cobalamin-associated A (MMAA) was discovered as an obesity- and metabolism-differential gene, and its function in HCC was tested in vitro and in vivo. Finally, we explored how obese female patients with an originally high expression of female estrogen receptor (ESR1) directly upregulated MMAA to interfere with the progression of HCC. Fourteen obesity-related genes were downregulated in adjacent and tumoral tissues compared with normal liver tissues, which indicated that obesity may be inversely related to the occurrence of HCC and was consistent with the results of MR analysis. We also discovered that MMAA is a metabolic gene closely related to the occurrence and development of HCC by mining the TCGA database, and it functioned an anti-tumor-promoting role in HCC by damaging the mitochondrial function and preserving the redox balance. We further verified that obese females with a high expression of ESR1 can regulate MMAA to protect HCC from progression. This study elucidates that obesity might be a protective factor for female HCC patients, as they originally highly expressed ESR1, which could upregulate MMAA to suppress tumor growth and participate in metabolic reprogramming.

Spontaneous enteroatmospheric fistula in a patient with COVID-19 disease

Coronavirus 2019 (COVID-19) disease patients present with upper respiratory symptoms; however, these patients may show gastrointestinal symptoms on arrival at the hospital. This finding requires an abdominal physical examination and imaging for 33% of patients. Enteroatmospheric fistulas (EAF) may form a connection between the external environment and the gastrointestinal tract and usually presents various difficulties in controlling the disease without surgical intervention. Its management requires a high level of clinical expertise to control and treat the fistula. In this case report, spontaneous EAF and its management are presented in a 65-year-old morbidly obese female patient who spontaneously had EAF during her hospitalization for COVID-19.

DELINEATION OF DE QUERVAIN TENOSYNOVITIS IN SAUDI ARABIA AND LITERATURE REVIEW

Background: De Quervain Tenosynovitis was first reported in the literature in 1895 by Fritz De Quervain, describing entrapment tendinitis of the first dorsal compartment of the wrist. This study conducted to evaluate our institutions experience with De Quervain Tenosynovitis patients Methods :Retrospective cross-sectional hospital based study conducted at King Abdul-Aziz Medical City a tertiary care center in Riyadh.The study included all De Quervain Tenosynovitis cases treated in our institution between January 2008 and December 2014. Results: The study included 29 patients. Mean (Interquartile range) age was 42 (24-78) years and 19/29 (66%) were female. Mean (Interquartile range) BMI at the diagnosis was 30 (21-42). The most common radiological finding was distal radius cortical ridging17/29 (59%). Conservative treatment was initiated in 17/29 patients (59%), yet no clinical improvement noted and all the cases required surgical intervention 29/29 (100%). The intraoperative septum was observed in all cases 29/29 (100%). Conclusion: Routine wrist X-rays in DeQuervain Tenosynovitis is cost-effective and should be considered to guide the treatment course with low threshold for surgical intervention might be warranted particularly in obese female patient.

The Relationship between H. pylori and Dietary Habits in Obese Female Patients

The purpose of this study is to investigate the relationship between the dietary habits of obese women aged above 18 and the Helicobacter pylori (H. pylori). Five hundred and sixty-one women aged above 18 were included in the study. Patients filled in questionnaires consisting of questions regarding their sociodemographic variables, chronic diseases and dietary habits. Blood samples taken from the patients were tested according to the H. pylori kit procedures and the results were categorized as positive and negative. In the study, obese and nonobese patients were compared and then H. Pylori positive and negative groups were compared. No significant difference was found between groups in terms of H. pylori in the comparison of obese and nonobese patients (p = 0.272). When H. pylori positive and negative groups of obese patients were compared in terms of their dietary habits, consumption rates of butter, whole-fat or lowfat milk, cookies-cake etc., and chocolate-candies were detected to be higher in the H. pylori positive group (p &lt; 0.05). Red meat consumption (p = 0.044) and smoking rates were lower (p = 0.001). There was no significant difference between groups in terms of the consumption rates of bread, rice/pasta, corn, cheese, chicken, fish, sausages, fruit, vegetables, legumes and salt. No significant difference was found between obese and nonobese women in terms of H. pylori positivity. It was observed that H. pylori positive obese women had higher consumption rates of butter, whole-fat or low-fat milk, cake-cookies etc., and chocolate-candies.

Differential Association of Selected Adipocytokines, Adiponectin, Leptin, Resistin, Visfatin and Chemerin, with the Pathogenesis and Progression of Type 2 Diabetes Mellitus (T2DM) in the Asir Region of Saudi Arabia: A Case Control Study.

Background: Sedentary lifestyles, urbanization and improvements in socio-economic status have had serious effects on the burden of diabetes across the world. Diabetes is one of the 10 leading causes of death globally, and individuals with diabetes have a 2–3-fold increased risk of all-cause mortality. Adipose tissue is increasingly understood as a highly active endocrine gland that secretes many biologically active substances, including adipocytokines. However, the exact and discrete pathophysiological links between obesity and T2DM are not yet fully elucidated. Methods: In the current study, we present the association of five diverse adipocytokines, adiponectin, leptin, resistin, visfatin and chemerin, with T2DM in 87 patients (46 males and 41 females) with type 2 diabetes mellitus and 85 healthy controls (44 males and 41 females) from the Asir region of Saudi Arabia. The patients were divided into four groups: normal BMI, overweight, obese and severely obese. The baseline biochemical characteristics, including HbA1c and anthropometric lipid indices, such as BMI and waist–hip ratio, were determined by standard procedures, whereas the selected adipokine levels were assayed by ELISA. Results: The results showed significantly decreased levels of adiponectin in the T2DM patients compared to the control group, and the decrease was more pronounced in obese and severely obese T2DM patients. Serum leptin levels were significantly higher in the females compared to the males in the controls as well as all the four groups of T2DM patients. In the male T2DM patients, a progressive increase was observed in the leptin levels as the BMI increased, although these only reached significantly altered levels in the obese and severely obese patients. The serum leptin levels were significantly higher in the severely obese female patients compared to the controls, patients with normal BMI, and overweight patients. The leptin/adiponectin ratio was significantly higher in the obese and severely obese patients compared to the controls, patients with normal BMI, and overweight patients in both genders. The serum resistin levels did not show any significant differences between the males and females in thr controls or in the T2DM groups, irrespective of the BMI status of the T2DM patients. The visfatin levels did not reveal any significant gender-based differences, but significantly higher levels of visfatin were observed in the T2DM patients, irrespective of their level of obesity, although the higher values were observed in the obese and highly obese patients. Similarly, the serum chemerin levels in the controls, as well as in T2DM patients, did not show any significant gender-based differences. However, in the T2DM patients, the chemerin levels showed a progressive increase, with the increase in BMI reaching highly significant levels in the obese and severely obese patients, respectively. Conclusion: In summary, it is concluded that significantly altered concentrations of four adipokines, adiponectin, leptin, visfatin and chemerin, were found in the T2DM patient group compared to the controls, with more pronounced alterations observed in the obese and highly obese patients. Thus, it can be surmised that these four adipokines play a profound role in the onset, progression and associated complications of T2DM. In view of the relatively small sample size in our study, future prospective studies are needed on a large sample size to explore the in-depth relationship between adipokines and T2DM.

Efficacy of Estradiol Cream for Venipuncture Pain in Obese Female Patients: A Pilot Study.

Introduction: Venipuncture is often a painful procedure causing significant anxiety, distress, and psychological consequences. We evaluated the efficacy of estradiol cream and compared it with a eutectic mixture of local anesthetics (EMLA) cream for alleviation of venipuncture pain and to make cannulation easy in female obese patients.Materials and methods: The clearance from the Institutional Ethical Committee as well as prior written and informed consent were obtained from the participants. A total of 105 obese female adult patients aged between 25 and 64 years belonging to the American Society of Anesthesiologists (ASA) physical status I and II with body mass index (BMI) > 30 kg/m2 were included in our study. The study participants were randomly allocated into three groups: In group I, a placebo cream was applied; in group II, estradiol cream was applied, and in group III, EMLA cream was applied. Any abnormal sensation at the site of application of the cream was noted and followed up at 0, 2, and 6 hours for the same. The primary outcome was the measurement of the severity of the pain experienced during venipuncture using the visual analog scale (VAS). Ease of cannulation was our secondary outcome. VAS was compared with the Z test. Statistical Package for the Social Sciences (SPSS) v16.0 software (SPSS Inc., Chicago) was used for statistical analysis. A p-value of <0.05 was considered statistically significant.Result: The final analysis was carried out on 25 patients in group I, 27 patients in group II, and 33 patients in group III. There was no significant improvement in the ease of cannulation in group II when compared to group I. The mean VAS was similar in group I and group II, whereas it was significantly reduced in group III (p < 0.05).Conclusion: EMLA cream was found to significantly reduce the pain of venipuncture in comparison to placebo and estradiol cream. There is no beneficial effect of estradiol cream in reducing the pain from venipuncture or in ease of cannulation compared to placebo.

Anti-Mullerian Hormone Levels Increase After Bariatric Surgery in Obese Female Patients With and Without Polycystic Ovary Syndrome.

This study was aimed to investigate the effect of weight loss by bariatric surgery on the level of anti-Mullerian hormone (AMH) in morbidly obese female patients with or without polycystic ovary syndrome (PCOS). This prospective study includes 70 females, obese, and fertile patients of reproductive age. All patients were evaluated to determine the changes in weight, body mass index (BMI), serum AMH, and other biochemical parameters at the end of six months. The mean levels of the preop and postop AMH were 1.66±0.87 ng/ml and 5.99±1.39 ng/ml in the PCOS group; 1.35±0.76 ng/ml and 6.23±1.47 ng/ml in the non-PCOS group, respectively. The postop AMH levels were significantly higher than the preop levels for both groups (p<0.001). There were significant differences in the level of glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, total cholesterol, hemoglobin A1c, HOMA-IR, insulin between preop and postop 6th month. A negative correlation was found between postop AMH and body weight in all patients (r=-0.337, p=0.031). Postop AMH levels were negatively correlated with postop BMI levels in the non-PCOS patient group (r=-0.408, p=0.043). No significant difference was observed between the PCOS and non-PCOS groups in terms of all the parameters examined. In conclusion, our study suggests that the significantly increased AMH levels by losing weight with bariatric surgery in patients with morbid obesity with and without PCOS may indicate the improvement of fertilization potential. It could be considered when evaluating fertility in patients with morbid obesity.

Incidence of Adverse Perioperative Airway Complications in Obese Non-Pregnant and Pregnant Patients Undergoing General Anesthesia

Objective: Airway complications in obese patients are a major concern during surgical operation. This study aimed to determine the incidence of airway- and respiratory-related anesthetic complications for obese (including maternal) patients undergoing general anesthesia.Materials and Methods: This multicenter, retrospective, observational study evaluated obese female patients (BMI≥ 30 kg/m2), both non-pregnant and pregnant, undergoing general anesthesia in 5 hospitals across Thailand during May 2013 - August 2016. The primary observation was anesthesia-related airway complications (difficult and failed intubations, aspiration, desaturation, and airway injuries) detected during anesthesia. An analysis was performed to compare the incidents of the adverse events and to determine the risk factors for airway-related adverse events in both groups.Results: There were 1,347 obese patients enrolled (777 non-pregnant and 570 pregnant). The overall incidence of airway and respiratory complications was observed in 129 patients (9.6%), with a higher rate in pregnant patients (12.5% vs. 7.5%; p&lt;0.05). The most common complications were desaturation (5.6%) followed by airway injuries (3.6%) and difficult intubation (1.5%). The factors significantly associated with adverse airway-related events were obesity class II (OR=1.63 [1.05–2.54]), obesity class III (OR=2.25 [1.19–4.25]), pregnancy (OR=1.73 [1.18–2.54]), Mallampati classifications III–IV (OR=1.69 [1.16–2.48]), and neck circumference &lt;43 cm (OR=3.33 [1.02-10.81]), p&lt;0.05).Conclusion: The incidence of the anesthesia-related airway and respiratory complications was 9.6%, with a higher rate in pregnant patients. The most common adverse airway event was desaturation. However, the frequency of serious airway events was low.

Thinning of the Skull Base and Calvarial Thickness in Patients With Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) is a disorder characterized by elevated intracranial pressure without secondary causes on neuroimaging. IIH typically occurs in young, obese female patients and, when severe, can cause permanent and irreversible vision loss. The association between skull base thinning in patients with intracranial hypertension and obesity has been previously reported; however, no study has reported these findings in IIH. The goal of our study is to determine whether IIH is independently associated with skull base and calvarial thinning. A retrospective, matched case-control study was performed. Each patient diagnosed with IIH (case) was matched with a patient diagnosed with headache (control) by age, gender, and race. Patients were included if they underwent computed tomographic imaging of the head, maxillofacial, or orbits within 3 months of their diagnosis. Exclusion criteria were history of skull base or frontal bone pathology because of surgery or skull trauma, central nervous system infections, or incomplete radiologic data. Patient demographics, medical history, clinical examination, and skull base, calvarial, and zygoma thickness were recorded. Skull base thickness was measured by the height of the auditory canal in the coronal plane. Calvarial thickness was measured just anterior to the foramen rotundum in the coronal plane. Extracranial zygoma thickness was measured and used as an internal imaging control because the zygoma is not subject to intracranial forces. One hundred twenty-six patients were included in the study, 63 cases and 63 controls. Each group comprised 61 female patients (97%), 24 (38%) Caucasian, 23 (37%) black, 1 (2%) Asian, and 15 (24%) others. The average age was 31.5 ± 8.7 years. Patients with IIH were more likely to be obese (n = 60, 95%) compared with the control patients (n = 23, 37%, P < 0.001). All patients with IIH underwent lumbar puncture (LP) with an average opening pressure (OP) of 40.5 ± 15.6 cm H2O, whereas only 13 (20%) controls underwent an LP with a mean OP of 19.5 ± 8.5 cm H2O. There was no statistical difference in mean visual acuity between the IIH and control groups (logMar 0.22 [20/30] ± 0.45 vs logMar 0.09 [20/25] ± 0.30, P = 0.093, respectively). Compared with the controls, patients with IIH were more likely to have headache (97% vs 74%, P = 0.001), pulsatile tinnitus (48% vs 7%, P < 0.001), horizontal binocular diplopia (24% vs 4%, P = 0.006), confrontational visual field deficit (23% vs 2%, P = 0.003), and papilledema (74% vs 0%, P < 0.001). Patients with IIH had thinner skull base and calvarium width compared with the controls (mean skull base thickness 4.17 ± 0.94 mm vs 5.05 ± 1.12 mm, P < 0.001 and mean calvarial width 1.50 ± 0.50 mm vs 1.71 ± 0.61 mm, P = 0.024). Zygoma thickness was similar in both groups (mean zygoma thickness 1.18 ± 0.30 mm in the IIH group vs 1.26 ± 0.35 mm in the control group, P = 0.105). In a subgroup analysis controlling for obesity (body mass index >30 kg/m2), there was no statistically significant difference in skull base, calvarial, or zygoma thickness between obese and nonobese patients. Patients with IIH have thinner mean skull base and calvarial thickness compared with the controls. There was no difference in the mean extracranial zygoma thickness, which was the internal imaging control. Contrary to previous reports, we did not find an association between obesity and skull base or calvarial thinning. These findings suggest that IIH is associated with skull base and calvarial thinning.

Scleredema — Rare skin manifestation in diabetic

Scleredema is a connective tissue disorder of unknown etiology. A 44 years diabetic, obese female patient, admitted with edema feet, erythematous, indurated hyper pigmentation with ascending progression to trunk which rapidly transformed to painless dark pigmented blister and hard non-pitting edema of anterior abdominal wall. In a week time. She was managed with broad spectrum antibiotics, was aggressively diuresed along with albumin infusion. Her skin biopsy was done which revealed scleredema. She had poor LV function due to volume overload or cardiomyopathy. After initial improvement on 14 day, she suddenly developed fulminant septicemia. Within hours, she displayed multi organ dysfunction and the heart and kidney which were already delicately balanced, decompensated. There was intractable arrhythmias and severe LV dysfunction, renal failure and ischemic hepatitis following severe hypotension. Scleredema in diabetic subjects, can be an ominous sign for producing fulminant multiorgan dysfunction and can present as cardiomyopathy, myocarditis, liver dysfunction etc., and these patients are more prone to infections or may be vice versa. Scleredema can be considered as a marker of fulminant illness in immunocompromised individuals. There is a need for treatment protocols or research into this a rather enigmatic but rare illness.

Overweight and Obesity Determine the Risk for Gastrointestinal Cancer in a Sex-Dependent Manner: A Retrospective Cohort Study of 287,357 Outpatients in Germany.

Simple SummaryBy analyzing a large German primary care provider database, we demonstrated that obesity represents a decisive risk factor for the development of colon, rectal, and liver cancer, partly in a sex-dependent manner. Thus, along with previous data, our study including >280,000 patients suggests that the clinical management of overweight patients should include a careful and structured risk assessment for the development of cancer in order to improve long-term outcomes in these patients.Cancer represents the second leading cause of death worldwide, implementing a major health care and socioeconomic burden. Overweight and obesity, both of which are dramatically on the rise in both highly and less developed regions worldwide, have been established as modifiable risk factors for the development of various tumor entities including gastrointestinal (GI) cancers such as colorectal or gastric cancer. However, systematic data on an association between excessive body fat and GI cancer development from Germany are missing. Methods: A total of 287,357 adult outpatients with an available BMI value between 2010 and 2019 were identified from the Disease Analyzer database (IQVIA). The main outcome was the association between pre-obesity (BMI 25–30 kg/m2) and obesity (BMI ≥ 30 kg/m2) compared to normal weight (BMI 18.5–25 kg/m2) and the incident of a GI cancer diagnoses (including colon, rectum, stomach, pancreas, and liver cancer). Results: Within the observation period, the proportion of colon cancer patients increased stepwise from 0.5% and 0.64% in normal weight to 0.71% and 0.91% in obese female and male patients, respectively, which was confirmed in multivariable regression models (ORfemale obesity: 1.23; 95% CI: 1.03–1.48; ORmale obesity: 1.43, 95% CI: 1.17–1.74). In contrast, multivariable regression models revealed that obesity was significantly associated with rectal cancer (OR: 1.36, 95% CI: 1.01–1.84) as well as liver cancer (OR: 1.79, 95% CI: 1.17–2.73) in men only. Conclusions: Our data suggest that obesity represents a decisive risk factor for the development of colon, rectal, and liver cancer, partly in a sex-dependent manner. Since overweight and obesity are modifiable risk factors, the current results may help to establish appropriate prevention and lifestyle programs to reduce both the incidence as well as the high morbidity and mortality of GI tumors in the future.

Evaluation of morbid obese patients with attitudes toward obese persons scale prior to bariatric surgery: Obesity from the perspective of real patients

Background: The number of studies with the application of scales, such as Attitudes Toward Obese Persons Scale (ATOP), on morbid obese patients are limited. Therefore, we wanted to examine the attitudes toward obese people through the eyes of morbid obese patients. Methods: Between October 2019 - April 2020, 70 female and 20 male, morbid obese patients, who were admitted to the general surgery department to be evaluated for bariatric surgery were included in this study. These 90 morbid obese patients were asked to fill out ATOP, which included 20 statements. Results: The mean ATOP score of all morbid obese patients was 63.44±18.58 (range:19-116). The mean ATOP score of female patients was 63.47±20.34 (range:19-116), whereas the mean ATOP score of male patients was 63.35±10.69 (range:43-80) (p=0.98). The frequency of the responses given by the male and female patients to the third statement, which was “Most obese people are more self-conscious than other people” pointed out a statistically significant difference (p=0.02). Conclusions: Based on ATOP scores gained from morbid obese patients, 60% of morbid obese patients did not feel as happy as non-obese people, whereas 74.4% of the morbid obese patients thought that obese people were not as healthy as nonobese people. Moreover, ATOP scores which were slightly higher than 60 points in both female and male morbid obese patients indicated that morbid obese patients had neither negative nor highly positive attitudes toward obese people.

Simplified Technique of Conventional Cholecystectomy in a Patient with Situs Inversus Totalis: A Case Report from Nepal

Introduction: Situs inversus is a rare autosomal recessive disorder occurring in 1:5,000 to 1:20,000 indiviuals. Cholecystectomy is a standard treatment for symptomatic gallbladder stone. We report a case of cholelithiasis in patient with inversus totalis who underwent cholecystectomy.&#x0D; Case presentation: A 48 years old obese female patient with dextrocardia and hypertention presented with a recurrent left upper abdominal pain for two years. Ultrasound abdomen showed gallbladder stone. Conventional cholecystectomy was done with a small left subcostal incision. The postoperative period was uneventful and the patient was discharged on 3rd post operative day.&#x0D; Conclusion: Cholecystectomy is the treatment of choice in patients with a left sided gallbladder stone, like in normal gallbladder and it is safe.

Covid-19 Pneumonia with Acute Pulmonary Embolism in a Morbidly Obese Patient; At Home Dramatic Reversal Management

Rationale: A novel COVID-19 with the severe acute respiratory syndrome had arisen in Wuhan, China in December 2019 Thromboembolism is a critical clinical entity commonly recognized sequel in COVID-19 patients. Interestingly, the presentation of COVID-19 infection with thromboembolism has a risk impact on both morbidity and mortality in COVID-19 patients. Morbid obesity may add over significant risk value in the presence of COVID-19 pneumonia with thromboembolism. Patient concerns: Middle-aged housewife female COVID-19 morbid obese patient presented to physician outpatient clinic with unilateral pneumonia suspected acute pulmonary embolism. Diagnosis: COVID-19 pneumonia with acute pulmonary embolism in morbid obesity. Interventions: CT pulmonary angiography, non- contrasted chest CT scan, electrocardiography, and oxygenation. Outcomes: Dramatic of both clinical and radiological improvement had happened. Lessons: The combination of morbid obesity, QTc prolongation with COVID-19 infection is an indicator of the over-risk of thromboembolism. It signifies the role of anticoagulants, antiplatelet, anti-infective drugs, and steroids in COVID-19 patients with unilateral pneumonia and acute pulmonary embolism in morbid obesity are effective therapies. An increasing the dose of both low-molecular heparin and oral anticoagulant with a morbidly obese patient was reasonable.

Intraoperative ultrasound-guided serratus anterior plane catheter for postoperative analgesia after breast surgery in a morbidly obese patient

Inter-fascial plane blocks play a great role as part of the multimodal analgesic regimen for breast surgery. Fascial plane blocks are effective for immediate analgesia, but their use for prolonged postoperative analgesia is not yet explored. We present a hybrid technique of successful placement of intraoperative ultrasound-guided deep serratus anterior plane (SAP) catheter for continuous postoperative analgesia in a morbidly obese patient undergoing breast surgery. A sexagenarian morbidly obese female patient with left carcinoma breast was posted for modified radical mastectomy. The deep serratus anterior fascial plane was more than 9 cms deep and was poorly visualized. Hence, intraoperative catheter was placed under ultrasound guidance and used effectively for 5 days. The static and dynamic pain scores were <4 at all-time points with local anesthetics and nonopioid systemic analgesics. We observed that intraoperative ultrasound-guided SAP catheter can be effectively used for continuous postoperative analgesia in morbidly obese patients undergoing breast surgery.