Long-term Medical Complications Research Articles

Semaglutide Effects on Metabolic Outcomes in Diabetes Mellitus Patients - Real World Study.

Diabetes is a public health problem that requires strategies to impact glycemic control and reduce the risk of long-term medical complications. Pharmacological management is a necessary treatment for this disease. Therefore, semaglutide is an essential tool to achieve the treatment targets. The present study aimed to evaluate the semaglutide effects on a cohort with type 2 diabetes mellitus (T2DM) in Colombia. The cohort included 49 patients with T2DM that have been treated in a specialized care center. Their glycemic outcomes, weight, renal function, and adverse events were evaluated through a 3-, 6- and 12-month follow-up. Significant differences were observed in the outcome evaluation: reduction of glycated hemoglobin levels (MD -2.74 CI -1.95 to -3.52 in 6 months), fasting plasma glucose levels, body weight (MD -7.11 CI -5.97 to -8.24), and the albumin-to-creatinine ratio. The results were maintained throughout the treatment period. The adverse event rate was 16.3%, predominating gastrointestinal events. This real-world evidence shows the efficacy of semaglutide in achieving treatment goals in patients with T2DM.

Exploration of AI-powered DenseNet121 for effective diabetic retinopathy detection.

Diabetic Retinopathy (DR) is a severe complication of diabetes that damages the retina and affects approximately 80% of patients with diabetes for 10years or more. This condition primarily impacts young and productive individuals, resulting in significant long-term medical complications for patients and society. The early stages of diabetic retinopathy often advance without noticeable symptoms, resulting in delayed identification and intervention. Therefore, develop approaches employing transfer learning methodologies to enhance early detection capabilities, facilitating timely diagnosis and intervention to mitigate the progression of diabetic retinopathy. This study introduces a transfer learning approach for detecting four stages of DR: No DR, Mild, Moderate, and Severe. The methods AlexNet, VGG16, ResNet50, Inception v3, and DenseNet121 are utilized and trained using the Kaggle DR dataset. To assess the efficiency of the suggested improved network, the Kaggle dataset is employed to analyze four performance metrics: Sensitivity, Precision, Accuracy, and F1 score. DenseNet121 demonstrated superior accuracy among the two models, outperforming other models, making it a suitable option for automatic DR sign detection. The integration of the DenseNet121 model shows great promise in transforming the timely identification and treatment of DR, resulting in enhanced patient results in the long run and alleviating the burden on society.

Changing faces: A case-based review of acromegaly

Acromegaly is a rare and underdiagnosed acquired disorder. It is commonly caused by an underlying pituitary adenoma that often requires surgical excision. Diagnosis is normally preceded by ~5–10 years of excessive growth owing to hypersecretion of growth hormone. This can have long-term medical complications and result in a reduced life expectancy. Acromegalic patients present to a number of healthcare professionals prior to diagnosis, including general dental practitioners. As changes in occlusion are often a patient's primary concern prior to acromegaly diagnosis, it is important that all dentists are aware of the presentation and differential diagnoses of such disorders. CPD/Clinical Relevance: Dentists should be aware of the initial presentation of acromegaly to facilitate early diagnosis.

Looking Beyond the Growth Curve: A Retrospective Study on Nutrient Deficient Diets in Children with Severe Food Selectivity.

Severe food selectivity places children at risk for nutrient deficiencies and long-term medical complications, if unaddressed. However, poor nutrition in highly selective eaters is often overlooked when considering other behavioral or medical concerns. Additionally, studies regarding food selectivity are sparse and limited to children with developmental delays. This study further investigates the nutritional deficiencies and growth characteristics of children with severe food selectivity to assist pediatricians in the earlier identification of patients for nutrition screening. A retrospective chart review was completed for 13 patients admitted to a pediatric feeding program solely for table-textured food selectivity. Nutrition and anthropometric data from the medical record were analyzed. All patients were determined to be following an age-appropriate growth curve but had multiple micronutrient deficiencies. Additionally, 6 children were typically developing outside of the feeding context. Results suggest that children with food selectivity may require more intensive and earlier nutrition screening beyond their growth patterns.

Current innovative treatments of obesity

Obesity is a complex and pervasive chronic health concern with multifaceted origins in which abnormal or excessive fat accumulation worsens health, increases the risk of long-term medical complications and shortens life expectancy. It is associated with type 2 diabetes, non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease. More than 603.7 million adults are estimated to be obese. The cause of obesity is a long-term energy imbalance caused by a combination of increased energy intake and decreased energy expenditure.
 The purpose of this study is to analyze the effectiveness of modern obesity treatments such as intermittent fasting, semaglutide and surgical interventions. Intermittent fasting involves voluntary periods of restricted or zero caloric intake at specified intervals. However, research results on the effectiveness of this dietary strategy are conflicting. The findings indicate that incorporating physical exercise can further enhance the outcomes of applying this diet. Semaglutide, a GLP-1 (glucagon-like peptide-1) analog, has shown efficacy in promoting weight loss among adults and adolescents, along with metabolic and cardiovascular improvements. Laparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure, while Roux-en-Y gastric bypass (LRYGB) is another option. Long-term studies show that both methods effectively promote weight loss.
 In conclusion, obesity is a multifaceted condition that requires a comprehensive treatment approach. Individualized strategies including dietary changes, pharmaceutical interventions such as semaglutide, and surgical options can together contribute to effective weight management and improved health outcomes.

Engineering is pregnant with possibilities.

Recent engineering advances provide new tools and techniques to alleviate poor pregnancy outcomes that can lead to maternal and fetal death and long-term medical complications.

Does Samoa Have Adequate Policies to Reduce Obesity and Obesity-Related Disease?

In obesity, abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications, and results in decreased lifespan. There are many long-term medical complications to consider, such as heart disease, cancer, stroke, type 2 diabetes mellitus, and non-alcoholic fatty liver disease, among others. These are all difficult and expensive conditions to treat in a small developing country like Samoa. The prevalence of obesity in Samoa has steadily increased since the 1960s, and today, 53% of Samoa’s adult population are obese. People living in the small island country of Samoa, with a total population of fewer than 200 thousand people, are one of the most obese people in the world today. Factors that have contributed to obesity over the previous four decades include urbanization, the dependence on a dietary transition from one based on fresh local food to highly processed imported food, poverty, as well as probable genetic predisposition. Efforts by the Samoa Ministry of Health and partners to reverse the trend of obesity have mainly relied on behavior change strategies since the 1970s, with no clinical evidence of success. This study critically reviews current policies and strategic plans in Samoa to reduce the obesity problem and proposes that because of the contributing structural factors, the health sector alone cannot achieve its objective without matching multi-sectorial government initiatives.

A contemporary view on obesity treatment in adults

Today, the prevalence of overweight and obesity is pandemic. This disorder is defined as “a complex chronic disease in which abnormal or excess body fat impairs health, increases the risk of long-term medical complications, and decreases life expectancy”.This article presents evidence-based clinical guidelines for the management of obese patients, as well as excerpts comments on pharmacological treatment.Treatment approaches for overweight and obese patients include behavioral interventions, lifestyle adjustments, etc. One of the methods is pharmacological therapy, based on the following principles: therapy for weight loss can be used starting already at a body mass index ≥ 27 kg/m2 or ≥ 30 kg/m2 with complications associated with excess body fat. As drugs can be used liraglutide, combination of naltrexone + bupropion, orlistat. Pharmacotherapy must be accompanied by lifestyle modification, including if necessary therapeutic diet, increased physical activity on ongoing basis with its mandatory control, and behavioral or cognitive-behavioral therapy. Pharmacotherapy can be used to support the weight loss achieved through lifestyle modifications and to prevent weight gain. It is forbidden to use over-the-counter drugs unless they are approved for weight control. Patients with metabolic obesity should be consulted by specialists to assess the feasibility of bariatric surgery, followed by treatment with this specialist.Every clinician must have sufficient knowledge to diagnose obesity and offer their patients an individualized, long-term, evidence-based weight loss regimen. The success of obesity treatment depends on the patient's trust the doctor and on the doctor's knowledge in this area.

Physical and Psychological Recovery Following Toxic Epidermal Necrolysis: A Patient Survey.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute, life-threatening diseases that cause sloughing of the skin and mucous membranes. Despite improved survival rates, few studies focus on long-term outcomes. We conducted a single-center review of all patients with SJS/TEN admitted from January 2008 to 2014. SJS/TEN survivors were invited to participate in the validated Veterans RAND 12-Item Health Survey (VR-12) to assess health-related quality of life using a mental health composite score and physical health component score (PCS). The sample was compared to U.S. norms using one-sample two-tailed t tests. A second questionnaire addressed potential long-term medical complications related to SJS/TEN. Of 81 treated subjects, 24 (30%) long-term survivors responded. Participants identified cutaneous sequelae most frequently (79%), followed by nail problems (70%), oral (62%), and ocular (58%) sequalae. Thirty-eight percent rated their quality of life to be "unchanged" to "much better" since their episode of SJS/TEN. The average PCS was lower than U.S. population norms (mean: 36 vs 50, P = .006), indicating persistent physical sequelae from SJS/TEN. These results suggest that SJS/TEN survivors continue to suffer from long-term complications that impair their quality of life and warrant ongoing follow-up by a multidisciplinary care team.

Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies.

Type 1 diabetes (T1D) is one of the most common chronic childhood diseases, and its prevalence is rapidly increasing. The management of glucose in T1D is challenging, as youth must consider a myriad of factors when making diabetes care decisions. This task often leads to significant hyperglycemia, hypoglycemia, and glucose variability throughout the day, which have been associated with short- and long-term medical complications. At present, most of what is known about each of these complications and the health behaviors that may lead to them have been uncovered in the clinical setting or in laboratory-based research. However, the tools often used in these settings are limited in their ability to capture the dynamic behaviors, feelings, and physiological changes associated with T1D that fluctuate from moment to moment throughout the day. A better understanding of T1D in daily life could potentially aid in the development of interventions to improve diabetes care and mitigate the negative medical consequences associated with it. Therefore, there is a need to measure repeated, real-time, and real-world features of this disease in youth. This approach is known as ecological momentary assessment (EMA), and it has considerable advantages to in-lab research. Thus, this viewpoint aims to describe EMA tools that have been used to collect data in the daily lives of youth with T1D and discuss studies that explored the nuances of T1D in daily life using these methods. This viewpoint focuses on the following EMA methods: continuous glucose monitoring, actigraphy, ambulatory blood pressure monitoring, personal digital assistants, smartphones, and phone-based systems. The viewpoint also discusses the benefits of using EMA methods to collect important data that might not otherwise be collected in the laboratory and the limitations of each tool, future directions of the field, and possible clinical implications for their use.

Long-term and quality of survival in patients treated for acute lymphoblastic leukemia during the pediatric age.

Long-term survival for acute lymphoblastic leukemia (ALL) in children improved over the last three decades up to 80-90% of affected patients. Consequently, the quality of life of survivors has become increasingly important. This study analyses the clinical features and outcome of 119 children with ALL, focusing on the quality of long-term survival in a subset of 22 patients over 18 years of age. Among this group, the 10-year event-free survival and overall survival were 83.1% (C.I. 74.0-89.2) and 88.4% (C.I. 80.9-93.1), respectively. Treatment related long-term medical complications were reported only in 2 patients (9.1%). Secondary school was completed successfully in 20 of 22 patients (89.9%). The remaining 2 patients were still attending at the time of the analysis. In conclusion, current treatment for ALL is well tolerated and does not compromise significantly the quality of life of survivors.

Eating disorders in adolescents with type 1 diabetes mellitus.

Eating disorders represent one of the most common psychiatric disorders in adolescents with type 1 diabetes mellitus (T1DM), with a prevalence twice as high as in individuals without diabetes. The increased risk for acute and long-term medical complications and a three-fold mortality rate with this dual condition makes it extremely important to screen adolescents for eating disorders as soon as possible. A number of 13 surveys in the last two years focussed on prevalence rates of disordered eating and associations with sociodemographic, eating disorder-specific and diabetes-related factors in this population. Variations in study design, sample size, age range, sex, instruments to assess eating disorders and outcome make comparisons difficult. Healthcare professionals report challenges in detecting and treating adolescents with this dual condition because of a lack of validated screening tools, guidelines, and integration across specialist care. Studies on psychological treatments for the comorbidity of eating disorders and T1DM are scarce, especially for adolescents. The development and evaluation of psychological treatments for adolescents with eating disorders and T1DM are urgently needed.

Obesity in adults: a clinical practice guideline.

KEY POINTS Obesity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications and reduces lifespan.[1][1] Epidemiologic studies define obesity using the body mass index (BMI; weight/height2), which can stratify

Obesity in Living-Donor Kidney Transplant: What Risks for the Donor and the Recipient?

For a kidney transplant candidate, a living-donor kidney transplant is the best option: it offers the longest survival to the recipient. Currently, more than 27000 living-donor kidney transplants are done each year in the world. More than 25% of all living kidney donors are now considered obese at the time of donation compared with fewer than 8% in the 1970s, and the proportion of obese recipients is doubling every 15 years as a result of the global epidemic of obesity. Obesity exposes both the donor and recipient to multiple complications: first, of an immediate surgical nature in the intra- and postoperative periods, then of a medical nature in the short and long term. Although surgical complications are well known and better mastered thanks to great technical progress, long-term medical complications can be severe and compromise patient survival and that of the transplanted kidney. For the recipient, the benefits of kidney transplant compared with end-stage renal disease are significant despite all the risks and complications caused by obesity. For the donor, however, no risk of severe complications is acceptable, and the main objective of pretransplant explorations is to ensure that the donation of a kidney occurs in complete safety for the donor. In the presence of obesity, if the donor is highly motivated and barring other exclusion criteria, it is mandatory to clearly inform the donor of all potential obesity-related risks, to strongly encourage him/her to lose weight before the donation, and to maintain this weight afterward.

Medical Complications of Anorexia Nervosa

Anorexia nervosa (AN) is a mental illness which is associated with many different medical complications. A comprehensive medical literature review of the medical complications of AN was undertaken using relevant search terms on PubMed to prepare this manuscript. We demonstrate that every body system is adversely affected by the ravages of AN. As the body mass index becomes progressively lower, the number and acuity of these medical complications increase. No body system is ultimately immune to medical complications, which most commonly impact the cardiac, gastrointestinal, and endocrine systems. AN has the highest mortality of any psychiatric illness. About half of the excess mortality risk associated with AN is due to the medical complications which are inextricably tied to AN. Nutritional rehabilitation and weight restoration attenuate and reverse the long-term medical complications.

The paradox of marrow adipose tissue in anorexia nervosa.

Anorexia nervosa (AN) is a psychiatric disorder characterized by inappropriate nutrient intake resulting in low body weight. Multiple hormonal adaptations facilitate decreased energy expenditure in this state of caloric deprivation including non-thyroidal illness syndrome, growth hormone resistance, and hypogonadotropic hypogonadism. Although these hormonal adaptations confer a survival advantage during periods of negative energy balance, they contribute to the long-term medical complications associated with AN, the most common of which is significant bone loss and an increased risk of fracture. In recent years, marrow adipose tissue (MAT) has emerged as an important potential determinant of the low bone mass state characteristic of AN. Unlike subcutaneous and visceral adipose tissue depots which are low in AN, MAT levels are paradoxically elevated and are inversely associated with BMD. In this review, we discuss what is known about MAT in AN and the proposed hormonal determinants of this adipose tissue depot.

Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities

The association of bariatric surgery and specialized medical obesity treatment with beneficial and detrimental outcomes remains uncertain. To compare changes in obesity-related comorbidities in patients with severe obesity (body mass index ≥40 or ≥35 and at least 1 comorbidity) undergoing bariatric surgery or specialized medical treatment. Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n = 2109) with severe obesity assessed (221 patients excluded and 1888 patients included). Bariatric surgery (n = 932, 92% gastric bypass) or specialized medical treatment (n = 956) including individual or group-based lifestyle intervention programs. Primary outcomes included remission and new onset of hypertension based on drugs dispensed according to the Norwegian Prescription Database. Prespecified secondary outcomes included changes in comorbidities. Adverse events included complications retrieved from the Norwegian Patient Registry and a local laboratory database. Among 1888 patients included in the study, the mean (SD) age was 43.5 (12.3) years (1249 women [66%]; mean [SD] baseline BMI, 44.2 [6.1]; 100% completed follow-up at a median of 6.5 years [range, 0.2-10.1]). Surgically treated patients had a greater likelihood of remission and lesser likelihood for new onset of hypertension (remission: absolute risk [AR], 31.9% vs 12.4%); risk difference [RD], 19.5% [95% CI, 15.8%-23.2%], relative risk [RR], 2.1 [95% CI, 2.0-2.2]; new onset: AR, 3.5% vs 12.2%, RD, 8.7% [95% CI, 6.7%-10.7%], RR, 0.4 [95% CI, 0.3-0.5]; greater likelihood of diabetes remission: AR, 57.5% vs 14.8%; RD, 42.7% [95% CI, 35.8%-49.7%], RR, 3.9 [95% CI, 2.8-5.4]; greater risk of new-onset depression: AR, 8.9% vs 6.5%; RD, 2.4% [95% CI, 1.3%-3.5%], RR, 1.5 [95% CI, 1.4-1.7]; and treatment with opioids: AR, 19.4% vs 15.8%, RD, 3.6% [95% CI, 2.3%-4.9%], RR, 1.3 [95% CI, 1.2-1.4]). Surgical patients had a greater risk for undergoing at least 1 additional gastrointestinal surgical procedure (AR, 31.3% vs 15.5%; RD, 15.8% [95% CI, 13.1%-18.5%]; RR, 2.0 [95% CI, 1.7-2.4]). The proportion of patients with low ferritin levels was significantly greater in the surgical group (26% vs 12%, P < .001). Among patients with severe obesity followed up for a median of 6.5 years, bariatric surgery compared with medical treatment was associated with a clinically important increased risk for complications, as well as lower risks of obesity-related comorbidities. The risk for complications should be considered in the decision-making process.

Laboratory screening in overweight/obese adolescents: do the results change the management?

Due to the growth of the epidemic of obesity and the association of obesity with both short-term and long-term medical complications, many professional organizations have recommended performing laboratory testing as part of the initial evaluation of overweight and obese children and adolescents. We report on the results of laboratory testing performed on 110 patients (mean age 14.0 years, range 8-20 years) referred to our weight management program between 2011 and 2013. Our results showed mild abnormalities in levels of cholesterol, glucose, liver enzymes, and thyroid stimulating hormone (TSH) in fewer than 5% of patients for each test and no changes in management based on these results for any of the patients. We call for re-consideration of the recommendations for laboratory testing in children and adolescents being evaluated and treated for overweight and obesity.

Cutting slack and cutting corners: an ethical and pragmatic response to Arora and Jacobs’ ‘Female genital alteration: a compromise solution’

Arora and Jacobs recommend a tidy way of respecting the desire of certain communities to perpetuate the tradition of altering the genitals of girls and women while ensuring that those...

Surgical intervention for urolithiasis: does it result in long-term medical complications?

The association of shock wave lithotripsy (SWL) and hypertension is a controversial subject. This Commentary discusses the article by Denberg et al., which found an association between new-onset hypertension and SWL, but not ureteroscopy. Ureteroscopy has improved significantly since its introduction and now plays a role as a primary initial treatment for stone disease.