Morbidly Obese Patients Research Articles

Decreased Hepatic and Serum Levels of IL-10 Concur with Increased Lobular Inflammation in Morbidly Obese Patients.

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is associated with obesity and ranges from simple steatosis to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma. Accumulating evidence in animal models suggests that loss of interleukin-10 (IL-10) anti-inflammatory actions might contribute to lobular inflammation, considered one of the first steps toward NASH development. However, the role of IL-10 in lobular inflammation remains poorly explored in humans. We examined mRNA and protein levels of IL-10 in liver biopsies and serum samples from morbidly obese patients, investigating the relationship between IL-10 and lobular inflammation degree. Materials and Methods: We prospectively enrolled morbidly obese patients of both sexes, assessing the lobular inflammation grade by the Brunt scoring system to categorize participants into mild (n = 7), moderate (n = 19), or severe (n = 13) lobular inflammation groups. We quantified the hepatic mRNA expression of IL-10 by quantitative polymerase chain reaction and protein IL-10 levels in liver and serum samples by Luminex Assay. We estimated statistical differences by one-way analysis of variance (ANOVA) and Tukey's multiple comparison test. Results: The hepatic expression of IL-10 significantly diminished in patients with severe lobular inflammation compared with the moderate lobular inflammation group (p = 0.01). The hepatic IL-10 protein levels decreased in patients with moderate or severe lobular inflammation compared with the mild lobular inflammation group (p = 0.008 and p = 0.0008, respectively). In circulation, IL-10 also significantly decreased in subjects with moderate or severe lobular inflammation compared with the mild lobular inflammation group (p = 0.005 and p < 0.0001, respectively). Conclusions: In liver biopsies and serum samples of morbidly obese patients, the protein levels of IL-10 progressively decrease as lobular inflammation increases, supporting the hypothesis that lobular inflammation develops because of the loss of the IL-10-mediated anti-inflammatory counterbalance.

F-7 | Thirty Days Readmission Rates and Outcome in Morbidly Obese Patients Undergoing Peripheral Angioplasty and Stenting for Chronic Lower Extremity Peripheral Arterial Diseases

F-7 | Thirty Days Readmission Rates and Outcome in Morbidly Obese Patients Undergoing Peripheral Angioplasty and Stenting for Chronic Lower Extremity Peripheral Arterial Diseases

The effect of significant weight loss after bariatric surgery on echocardiographic indices: an observational study focusing on left ventricular deformation by 2D speckle echocardiography and right ventricular size

BackgroundObesity is a known risk factor for atherosclerosis and cardiac disease.HypothesisThis study evaluated the effect of significant weight loss following bariatric surgery on myocardial deformation indices and right ventricular size (RV). This was a prospective cohort study. Morbid obese patients scheduled for bariatric surgery from July 2017 to February 2018 at Firoozgar Hospital were included in our study and referred for transthoracic echocardiography at Rajaie Cardiovascular Medical and Research Center.ResultsThirty-four patients entered the study. The absolute value of global longitudinal strain (GLS) at baseline, 3, and 6 months after surgery was 17.42 ± 2.94%, 18.24 ± 3.09%, and 19.52 ± 2.78%, respectively, with a statistically significant difference from baseline to after six months (P value < 0.001). The absolute value of global circumferential strain (GCS) at baseline, 3, and 6 months after surgery was 20.14 ± 4.22%, 23.32 ± 4.66%, and 24.53 ± 4.52%, respectively, with statistically significant changes (P value < 0.001) from baseline to three months and from baseline to six months and no significant difference from three months to six months. A significant decrease was reported in mechanical dispersion of circumferential strain (38.05 ± 23.81–23.37 ± 20.86 ms, P value = 0.006) 6 months after surgery. Right ventricular size three- and six-month post-surgery showed a significant decrease relative to baseline echocardiography.ConclusionsBariatric surgery could enhance cardiac function, as proven by 2D speckle echocardiography. Changes in RV size may be related to weight loss and should be considered when assessing patients who have undergone bariatric surgery.

Sixteen weeks of concurrent training do not increase the magnitude of the post-exercise hypotensive effect in hypercholesterolemic morbid obesity patients

Sixteen weeks of concurrent training do not increase the magnitude of the post-exercise hypotensive effect in hypercholesterolemic morbid obesity patients

Hybrid Technique for Caudal Epidural Steroid Injection in Morbid Obese Patient

Incidence of back pain related to disc prolapse is higher in morbid obesepatients. Treatment options including epidural injections and surgery is difficult in such patients. Here we are discussing a case of successful Hybrid technique for caudal epidural steroid injection in a morbidly obese patient.

Comparison of Different Weight Scalars to Dose Sugammadex for the Reversal of Neuromuscular Blockade in Morbidly Obese Patients: A Systematic Review.

This systematic review was conducted to evaluate the optimal weight scalar to dose sugammadex in a morbidly obese (MO) patient population (BMI≥40 kg/m2). The primary outcome was recovery time from moderate neuromuscular blockade (NMB) or deep NMB. Secondary outcomes included time to extubation and incidence of postoperative residual curarization (PORC). Eight randomized controlled trials (RCTs) involving 645 participants were included. The different dose scalars included were total body weight (TBW), ideal body weight (IBW), 20% corrected body weight (CBW) and 40% CBW). A dose of 2 mg/kg of sugammadex based on 40% CBW and a 4 mg/kg dose of sugammadex based on 40% CBW provide a reliable and timely reversal of moderate and deep NMB respectively in the MO patients.

Sarcopenia prevalence between obese and morbid obese patients in an obesity center

Background/Aim: Sarcopenia and obesity are independent diseases that result in decreased muscle strength and function. Few studies have been conducted on the association of sarcopenia and obesity, especially in women. This study aims to measure the possibility of sarcopenic obesity in women with obesity. Methods: Our study was organized using a prospective cross-sectional study in Turkey. A total of 135 volunteer were included in the study. Inclusion criteria required the patients to have a BMI &gt;35 kg/m2 or BMI &gt;40 kg/m2 and no current comorbid disease. The exclusion criteria included: age (&lt;18 and &gt;70 years were excluded), history of muscle disease, malignancy, psychiatric disorders such as bipolar disease and psychosis, malnutrition, and recent corticosteroid (CS) use (within the last three months). Probable sarcopenia is determined by low skeletal muscle strength, and confirmed sarcopenia is defined if there is both low skeletal muscle mass and low skeletal muscle quality. Muscle strength was measured with isometric dynamometry using the handgrip method. A six-minute walk test (6MWT), in which we measured walking speed, was performed to determine the physical performance of the patients. We adjusted appendicular skeletal muscle (ASM) using height squared (ASM/height2) bioelectrical impedance analysis (BIA) to measure the muscle mass. Results: Patients’ mean age was 43 (11.4) (20-69) years. Of the total participants, 64.6% were in the age range of 40-59; 19.2% of patients were defined as possible sarcopenia; and 2.2% had confirmed sarcopenia. A total of 78.5% of patients did not meet any of the sarcopenia criteria. We determined that there was no difference in anthropometric measurements between sarcopenic and non-sarcopenic patients (P&gt;0.05), except for waist and hip circumferences. However, we did observe a noteworthy distinction in waist and hip circumference measurements between the two groups, with sarcopenic patients exhibiting larger circumferences (P=0.05 and P=0.032, respectively). Our study revealed a significant disparity in the results of the six-minute walk test and handgrip strength values between sarcopenic and non-sarcopenic patients (P&lt;0.001). Specifically, non-sarcopenic patients demonstrated higher values in both tests.. Conclusion: Obesity and sarcopenic obesity will continue to be a public health problem in the future among middle-aged women. It should be considered that the prevalence of decreased muscle strength was high in our study group, and physical performance decreased due to muscle strength. We concluded that as success in the six-minute walk test and handgrip values increased, the diagnosis of sarcopenia decreased, and each increase in platelet count increased the risk of sarcopenia in obese female patients.

Effects Of Single Anastomosis Sleeve Ileal (SASI) Bypass on Morbid Obese Patients with Metabolic Syndrome

Background Metabolic syndrome (MetS) is a silent epidemic that is a major global public health concern. Bariatric surgery is an approved treatment for obesity where weight reduction is crucial for the control of metabolic syndrome. This study aimed to report our institutional experience in the effect of single anastomosis sleeve ileal (SASI) on metabolic syndrome. Patients and methods The current prospective study included 50 Morbid Obese Patients with MetS who were eligible for SASI. Follow-up was planned for 1 year. Results The mean age of patients was 41.56±6.32 years. The mean % EWL was 56.94±4.65 and 83.16±8.09 at 6 and 12 months, respectively. HbA1c showed significant improvement which decreased from 8.34±1.23 to 5.04±0.38 after 1 year follow-up. Triglycerides (mg/dl) and LDL-C (mg/dl) show significant reduction at 6 months and 1 year postoperative from 177.48±30.95 preoperative to 131.98±17.65 and 104.10±14.03 for Triglycerides, and from 180.76±21.04 preoperative to 104.64±7.13 and 77.56±8.93 for low density lipoprotein-C (LDL-C) (&lt;0.001). HDL-C (mg/dl) showed a significant increase from 40.44±10.93 preoperative to 49.58±8.71 and 57.96±6.64 (&lt;0.001). As regards the blood pressure; mean arterial pressure showed a significant decrease from a baseline of 103.38±11.38 to 88.36±5.72 at 6 months and to 74.46±5.83 at 1 year of follow-up. Conclusion As demonstrated by this study, all MetS characteristics significantly improved following the SASI bypass treatment.

An Increase in Prominent Probiotics Represents the Major Change in the Gut Microbiota in Morbidly Obese Female Patients upon Bariatric Surgery

The global increase in obesity carries inherent health implications, with an increased BMI being a known risk factor for diseases such as type 2 diabetes, cardiovascular diseases, or different cancer types. The long-term effectiveness of diet therapy in addressing morbid obesity is extremely limited, with no adequate pharmaceutical agents available as treatment options, resulting in bariatric surgery being the only viable option to achieve and maintain significant long-term weight loss. Something that plays an important role in overall human health is the gut microbiome and its complex composition, which is usually altered and reduced in complexity/diversity in severely obese patients. In this study, the influence of bariatric surgery and the resulting weight loss on the gut microbiome composition of twelve morbidly obese (BMI ≥ 40) adult female central European patients was investigated by comparing the relative abundances of the major microbial phyla Actinobacteria, Bacteroidetes, Firmicutes, and Proteobacteria pre- and post-surgery. We also aimed to give insight into the major changes in individual prominent and promising future probiotic bacteria characterized by an overall increase in abundance accompanied by a switch of enterotypes. Identifying specific microbial alterations associated with successful weight-loss outcomes may contribute to the development of future therapeutic interventions by supplementation with next-generation probiotics.

A Study of Comparison of Non-Invasive Fibrosis Scores and Ultrasound with Liver Biopsy for Evaluating Liver Fibrosis in Morbidly Obese Patients Undergoing Bariatric Surgery

Obesity has emerged as a global epidemic. Non-alcoholic fatty liver disease can progress to liver fibrosis, cirrhosis and hepatocellular carcinoma. Efforts to detect liver fibrosis early is crucial for effective intervention and preventing advanced stages like cirrhosis or liver failure. Liver Biopsy is gold standard for diagnosing liver fibrosis. The study assesses the efficacy of ultrasonography and non-invasive methods, including AST to platelet ratio index (APRI), fibrosis-4 (FIB-4) and NAFLD Score, in patients with morbid obesity scheduled for bariatric surgery. A prospective observational study was conducted among 53 patients having morbid obesity and who were planned to undergo bariatric surgery. Pre-operative ultrasound (USG) and invasive scores, such as FIB-4 and APRI, were found to be inadequate screening tools for diagnosing advanced liver fibrosis in patients undergoing bariatric surgery. Conversely, the NAFLD score proved to be an excellent tool for this purpose.

Comparison of enoxaparin 40 mg versus 60 mg dosage for venous thromboprophylaxis in patients undergoing bariatric surgery: A randomized controlled trial

BackgroundVenous thromboembolism (VTE) is a common cause of morbidity and mortality after bariatric surgery. Morbid obesity is an independent risk factor for VTE, with goals of prophylactic anti-factor Xa levels within 0.2–0.5 IU/mL. The recommended dosing regimen of enoxaparin for VTE prophylaxis in patients with morbid obesity is lacking in available guidelines. ObjectivesTo evaluate the achieving prophylactic anti-factor Xa levels with different dosages of enoxaparin for morbid obesity patients. SettingWe conducted a study at Chulalongkorn Bariatric and Metabolic Institute, King Chulalongkorn Memorial Hospital. MethodsWe conducted a randomized controlled trial comparing anti-factor Xa levels 4 h after the administration of enoxaparin. All recruited patients randomly received 40 mg or 60 mg of enoxaparin 12 h before the operation. Blood specimens were collected 4 h after the administration of enoxaparin. ResultsIn total, 56 patients who presented between April 2019 and March 2020 at King Chulalongkorn Memorial Hospital were recruited. Of these patients, 28 received 40 mg and 28 received 60 mg of enoxaparin. In both groups, the rates of achieving target levels were 53.57% and 78.57%, respectively (p-value = 0.048). The mean anti-factor Xa levels were 0.19 IU/mL ± 0.06 IU/mL and 0.28 and 0.28 ± 0.10 IU/mL, respectively (p < 0.001). No significant difference was found in the estimated blood loss between the groups. No patient obtained anti-factor Xa levels exceeding 0.5 IU/mL. In both groups, no symptomatic VTE occurred. ConclusionsA 60 mg of enoxaparin regimen achieved more prophylactic anti-factor Xa levels than 40 mg in obese patients undergoing bariatric surgery without any adverse events.

Laparoscopic Toupet-Sleeve gastrectomy in morbid obese patients with preoperative gastro-esophageal reflux: a 4-year follow-up cohort study

Aim To assess the 4-year outcomes after Toupet-Sleeve (TS) gastrectomy in morbid obese patients with concomitant preoperative gastro-esophageal reflux disease (GERD). Material and methods The study group consisted of 19 consecutive patients operated on between August 2017 and February 2019. There were 5 men and 14 women with a mean body mass index (BMI) of 43 ± 5 kg/m2 and a mean age of 42 ± 15 years. A retrospective analysis of database and telephone interview of patients who defaulted clinic follow-up was conducted. The main study end-points were weight loss and success of surgery, defined as no need for conversion and %EWL > 50%. Resolution of GERD was a secondary end-point. Results No patient was lost for follow-up. Nadir weight loss was reached after a follow-up of one year: mean BMI was 32 ± 5 kg/m2, %EWL 61 ± 21% and %TWL 24 ± 7%. Thereafter, we observed a progressive weight regain over time. With a mean follow-up of 51 ± 6 months, mean BMI was 36 ± 8 kg/m2, %EWL 43 ± 35% and %TWL 16 ± 12%. Two patients were converted to another bariatric procedure because of dysphagia and fundus dilatation or because of insufficient weight loss. The overall surgical success rate was 32% (6/19). Resolution of GERD without any PPI treatment was noted in 88% (15/17) of the non-converted patients. Conclusion In our experience, with a 4-year follow-up, TS is associated with a significant risk of conversion, a moderate weight loss and a poor surgical success rate.

Selecting the Best Gastric Anatomical Place for Biopsy to Detect Helicobacter Pylori in Iranian Morbid Obese Patients.

Obesity and Helicobacter pylori (H. pylori) infection are public health problems in the world and Iran. This study aimed to indicate the anatomical place with the most accurate results for H. pylori. According to gastric mapping, this study will be able to evaluate the prevalence of H. pylori based on the pathology of gastric mapping and the accuracy of the antral rapid urease test (RUT) based on endoscopic findings. In this cross-sectional study, upper digestive endoscopy and gastric pathology were studied in 196 obese patients candidates for bariatric surgery. Statistical analyses were performed using a t-test and Chi-square/fisher's exact test to compare the groups. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and odds ratio (OR) were used to compare RUT and pathological H. pylori test of each of the six areas of the stomach. We set a positive test of the pathology of 6 regions of the stomach as our gold standard (in this study). The most common area of the stomach for pathological findings of H. pylori were incisura (116, 59.2%), greater curvature of the antrum (115, 58.3%), lesser curvature of the antrum (113, 57.7%), lesser curvature of the corpus (112, 57.1%), greater curvature of the corpus (111, 56.6%) and cardia (103, 52.6%). The prevalence of H. pylori was 58.2% (114 cases) and 61.2% (120 cases) with RUT and gastric pathology, respectively. Mild, moderate, and severe infection of H. pylori in cardia (58, 29.6%), greater and lesser curvature of the antrum (61, 31.1%), and greater curvature of the antrum (37, 18.9%) had the highest percentages of incidence comparing to other sites of the stomach, respectively. The most sensitive area for pathologic biopsy was incisura (96.6%, 95% confidence interval: 91.7, 98.7). According to the highest sensitivity, PLR, NPV, and pathological findings of H. pylori in accordance with the lowest NLR in the incisura compared with other parts of the stomach, it is highly recommended to take the biopsy from the incisura instead of other anatomical places of stomach for detecting H. pylori specifically if our strategy is taking only one biopsy.

Simplified biplanar (0–90°) versus monoplanar renal puncture technique in flank free modified supine percutaneous nephrolithotomy regarding outcomes and learning curve: Randomized clinical trial

ABSTRACT Objective To evaluate the learning curve and the success rate of the biplanar (0–90°) puncture technique in the flank-free modified supine position in comparison to the monoplanar puncture technique. Methods Randomized controlled study included 68 patients more than 18 years with renal stones more than 2 cm from August 2021 to August 2022 were randomly classified by closed envelope method into group A (34 patients) scheduled for monoplanar renal puncture technique in flank-free modified supine PCN. Meanwhile, group B (34 patients) was scheduled for the 0–90° simplified fluoroscopic puncture technique. Morbid obese patients and patients with contraindications for PNL were omitted from the study. Results There was no significant difference between both groups regarding stone distribution and patients’ demographic data. There was a significant difference between both groups regarding puncture attempts. In 88.2% of patients in group B (Biplanar group), the success of renal puncture occurred from the 1st puncture attempt while in 11.2% of patients in group A (monoplanar group). There was a statistically significant difference between both groups in fluoroscopy time and total operation time (p-value <0.001 & p-value: 0.001), respectively. The stone-free rate was 85.2% vs. 88.2% in both groups, respectively, without significant difference. In this study puncture, attempt trials and puncture time were used as indicators for the easiness and rapid educability of the biplanar (0–90°) fluoroscopic guided renal puncture technique. In the biplanar (0–90°) group after 24 cases, the learning curve had reached the plateau. Conclusion Biplanar (0–90°) puncture technique in flank-free modified supine position allows an easy puncture technique with an easy learning curve without affecting the success rate or complication rate.

A Comparison of Miller Straight Blade and Macintosh Blade Laryngoscopes for Intubation in Morbidly Obese Patients

The primary objective of this study was to demonstrate whether the Miller blade laryngoscope could provide better visualization of the vocal cords in morbidly obese patients than the Macintosh blade laryngoscope. The secondary objective was to identify the patient-measured factors associated with better visualization of the vocal cords when using the Miller vs. Macintosh blade, as well as whether the application of external pressure might improve the visibility of the glottis during intubation. A prospective, observational study encompassing 110 patients with a BMI &gt; 40 undergoing elective bariatric surgery and intubation procedure was performed. The evaluation of the vocal cords was performed according to the Cormack–Lehane scale and POGO scale in the same patient during intubation, performed with a Miller and a Macintosh blade laryngoscope, in a random matter. The following parameters were assessed: body weight, height, BMI, neck circumference, thyromental distance, sternomental distance, mouth opening, and Mallampati scale and their impact on visualization of the vocal cords using the Miller blade without the application of external pressure. The Miller blade provides an improved view of the glottis compared to the Macintosh blade measured with both the Cormac–Lehane scale (45 (40.91%) without external pressure application on the larynx, and 18 (16.36%) with external pressure application on the larynx) and the POGO scale (45 (40.91%) without external pressure application on the larynx, and 19 (17.27%) with external pressure application on the larynx). The application of laryngeal pressure improved the view of the glottis. Among the measured features, a significant improvement in the visibility of the glottis could be found in patients with a BMI over 44.244 kg/m2 and a neck circumference over 46 cm. To conclude, the usage of the Miller blade improves the visibility of the glottis compared to the Macintosh blade in morbidly obese patients. The recommendation to use the Miller blade in this group of patients requires further investigation, taking into account the effectiveness of the intubation. Trial Registration: NCT05494463.

Anterior cervical surgery for morbidly obese patients should be performed in-hospitals.

Morbid obesity (MO) is defined by the World Health Organization (WHO) as Class II (i.e. Body Mass Index (BMI) >/= 35 kg/M2 + 2 comorbidities) or Class III (i.e. BMI >/= 40 kg/M2). Here, we reviewed the rates for adverse event/s (AE)/morbidity/mortality for MO patients undergoing anterior cervical surgery as inpatients/in-hospitals, and asked whether this should be considered the standard of care? We reviewed multiple studies to document the AE/morbidity/mortality rates for performing anterior cervical surgery (i.e., largely ACDF) for MO patients as inpatients/in-hospitals. MO patients undergoing anterior cervical surgery may develop perioperative/postoperative AE, including postoperative epidural hematomas (PEH), that can lead to acute/delayed cardiorespiratory arrests. MO patients in-hospitals have 24/7 availability of anesthesiologists (i.e. to intubate/run codes) and surgeons (i.e. to evacuate anterior acute hematomas) who can best handle typically witnessed cardiorespiratory arrests. Alternatively, after average 4-7.5 hr. postoperative care unit (PACU) observation, Ambulatory Surgical Center (ASC) patients are sent to unmonitored floors for the remainder of their 23-hour stays, while those in Outpatient SurgiCenters (OSC) are discharged home. Either for ASC or OSC patients, cardiorespiratory arrests are usually unwitnessed, and, therefore, are more likely to lead to greater morbidity/mortality. Anterior cervical surgery for MO patients is best/most safely performed as inpatients/in-hospitals where significant postoperative AE, including cardiorespiratory arrests, are most likely to be witnessed events, and appropriately emergently treated with better outcomes. Alternatively, MO patients undergoing anterior cervical procedures in ASC/OSC will more probably have unwitnessed AE/cardiorespiratory arrests, resulting in poorer outcomes with higher mortality rates. Given these findings, isn't it safest for MO patients to undergo anterior cervical surgery as inpatients/in-hospitals, and shouldn't this be considered the standard of care?

The Dosage of Muscle Relaxants in Morbidly Obese Patients in Daily Practice - A Narrative Review.

The prevalence of morbid obesity in today's population around the world is alarming. Morbid obesity involves substantial changes in body composition and function, which can affect the pharmacodynamics and pharmacokinetics of many drugs. This paper aims to discuss the application of muscle relaxants and their reversing agents in patients with morbid obesity. This work is based both on the available literature and the author's personal experience. Dosage recommendations for muscle relaxants in morbidly obese patients are as follows: non-depolarizing relaxants like rocuronium, vecuronium, atracurium, and cisatracurium should be based on ideal body weight. Succinylcholine dosage should be adjusted to total body weight with a 200 mg maximum, while mivacurium should also be based on total body weight. Pancuronium is not used due to its long duration. Neostigmine dosing remains uncertain, but some suggest using total body weight. When it comes to Sugammadex opinions of the authors are divided, some indicate that it should be dosed based on ideal body weight, but more recent studies show that it should be based on 40% of corrected body weight.

Digestive Surgery for Morbid Obesity in Patients from Iraq: Retrospective Study

Digestive Surgery for Morbid Obesity in Patients from Iraq: Retrospective Study

Metabolic Dysfunction-Associated Steatohepatitis Detected by Neutrophilic Crown-Like Structures in Morbidly Obese Patients: A Multicenter and Clinicopathological Study.

Metabolic dysfunction-associated steatohepatitis (MASH) is the progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD), and closely associated with a high risk of liver-related morbidity and mortality. Although enhanced neutrophil infiltration of the liver is a histological hallmark of MASH, the morphological pattern of hepatic neutrophils and their relevance to the definition of MASH remain unknown. This clinicopathological study aimed to determine the association of neutrophilic crown-like structures (CLSs) in liver biopsies and evaluate their relevance to the histological diagnosis of MASH. A total of 483 morbidly obese adults who underwent bariatric surgery were recruited. Neutrophilic CLSs in liver biopsies were detected by immunohistochemistry for neutrophil elastase and proteinase 3. All participants were classified into 4 histological subgroups: no MASLD (118, 24.4%), MASLD (76, 15.7%), borderline MASH (185, 38.3%), and definite MASH (104, 21.5%). In the discovery cohort (n = 379), the frequency of neutrophilic CLSs increased in line with the severity of liver disease. The number of neutrophilic CLSs was positively correlated with established histological characteristics of MASH. At a cutoff value of <0.3 per 20× microscopic field, the number of neutrophilic CLSs yielded a robust diagnostic accuracy to discriminate no MASLD and MASLD from borderline MASH and definite MASH; a cutoff at >1.3 per 20× microscopic field exhibited a statistically significant accuracy to distinguish definite MASH from other groups (no MASLD, MASLD, and borderline MASH). The significance of neutrophilic CLSs in identifying borderline MASH and definite MASH was confirmed in an external validation cohort (n = 104). The frequency of neutrophilic CLSs was significantly higher than that of macrophagic CLSs. In conclusion, neutrophilic CLSs in the liver represent a typical histological characteristic of MASH and may serve as a promising indicator to improve the diagnostic accuracy of MASH during histological assessment of liver biopsies.

Evaluation of the nutritional status of morbid obesity patients in the first six months after sleeve gastrectomy.

in recent years, bariatric surgery has gained popularity as a treatment for obesity worldwide. While patients do experience weight loss after surgery, it is important to be aware that serious nutritional deficiencies may also occur. This study was conducted to evaluate the nutritional status of morbidly obese patients in the first six months after sleeve gastrectomy. the study was planned as a retrospective study. The data of 76 patients aged 19-64 years who had undergone bariatric surgery and were followed by a dietitian for at least 6 months were included in the study. Preoperative and postoperative biochemical parameters and anthropometric measurements of the patients were taken. the lowest body weight of the patients was found at postoperative month 6 (81.74 ± 14.83 kg), the body weight at the preoperative period (115.86 ± 21.28 kg) and postoperative month 1 (100.39 ± 18.28 kg), and the body weight at postoperative month 1 was statistically lower than at the preoperative period. The preoperative body weights and BMI values of the patients were higher than at postoperative months 1 and 6, and the postoperative month 1 values were higher than at postoperative month 6 (p < 0.05). The lowest fasting blood glucose (83.48 ± 8.44 mg/dL), HbA1c (4.96 ± 0.95 %), and Homa-IR (3.34 ± 0.92) were observed at the postoperative month 6. Compared with the preoperative period, the iron level of the patients increased from 69.54 ± 29.82 µg/dL to 96.52 ± 25.39 µg/dL in postoperative month 6, vitamin D levels from 14.48 ± 8.70 µg/dL to 23.96 ± 4.79 µg/dL. While preoperative blood triglyceride and LDL values were statistically higher than in postoperative months 1 and 6, the HDL value was lower (p < 0.05). as a result, after sleeve gastrectomy, patient body weight decreased, and blood lipid profile and diabetes symptoms improved.