Obese Females Research Articles

Prevalence and factors in diabetic retinopathy in obese females presenting at lady reading hospitals

background: The aim of this study is to examine the prevalence of diabetic retinopathy (DR) and its related variables in patients with diabetes treated at Lady Reading Hospital in Peshawar between July 1, 2023, and June 30, 2024. Method: Patients in this descriptive cross-sectional study, who were diabetes patients between the ages of 30 and 60, were treated at Lady Reading Hospital in Peshawar. Patients with a diagnosis of either Type 1 or Type 2 diabetes mellitus, complete medical records, and the ability to give informed permission were the requirements for inclusion. Patients with insufficient medical data, individuals who were pregnant, patients with additional retinal illnesses, and patients who refused to give consent were all excluded. With an emphasis on demographics, comorbidities, lifestyle factors, and clinical data, data was gathered through structured interviews, physical examinations, and inspections of medical records. Examinations of the eyes verified the existence of DR. Using chi-square tests, logistic regression analysis, and descriptive statistics, SPSS software version 24.0 was used to analyze the data with sample size 121 patients. Result: Patients with DR had a lower prevalence of cardiovascular illnesses (6%) compared to those without (51%), with a p-value of 0.000. Significant correlations were found between DR and high blood pressure (36.7% vs. 5.7%, p=0.000) and inflammation (42.4% vs. 7.9%, p=0.000). A strong correlation was seen between DR and higher parity (>2 children) (50% vs. 16.9%, p=0.000). Significant variables included being older (46–60 years, 52.9% vs. 30-45 years, 17.2%, p=0.000), married (55.5% vs. single, 0%, p=0.000), and a housewife (31.1% vs. employed, 5.6%, p=0.025). There was no significant correlation found between smoking status and p=0.283. Conclusion: Inflammation, higher parity, age, married status, and homemaker status were all found to be significant risk factors for diabetic retinopathy in the study. In order to reduce the risk of DR, these findings emphasize the necessity of focused screening and management programs for at-risk populations. Reducing the prevalence of diabetes-related disorders (DR) in patients may need careful blood pressure control as well as managing inflammation.

Persistent Complaints After Infection With COVID-19 in Patients Admitted to Jordan Hospital

Many COVID-19 patients recover within a few weeks, but some experience symptoms lasting over four weeks, known as post-COVID-19 condition (PCC) or long COVID syndrome. This cross-sectional observational study aimed to determine the prevalence of PCC in Jordan and identify its associated risk factors. Conducted at a tertiary teaching hospital, the study used an online questionnaire targeting patients who sought medical care for COVID-19 between 1 January 2019 and 20 December 2022. The survey included demographic data, medical conditions during infection, and symptoms persisting beyond four weeks (LC28). Among 1834 identified COVID-19 patients, 291 completed the survey. Over two-thirds (70.4%) reported persistent symptoms, with headache (47.4%), muscle pain (45.7%), fatigue (43%), and cough (40.5%) being most common. Female gender and obesity (BMI > 25) significantly increased PCC frequency. PCC is prevalent among Jordanian patients, highlighting the need for increased awareness and adherence to health preventive measures.

Abstract 4135712: Mortality and Cardiovascular Complications Associated with Weight Loss Drugs among Breast Cancer Females Under Cardiotoxic Therapies: A Real-World Populational Study in the United States

Background: Obesity is an adverse prognostic factor for breast cancer (BC). While liraglutide and semaglutide, derived from antidiabetic glucagon-like peptide-1 receptor agonists (GLP1RA), are established weight loss drugs known for their cardiovascular safety in the general obese population, their safety in BC patients undergoing cardiotoxic antineoplastic therapies remains less understood. Objective: To investigate the mortality and cardiovascular outcomes related to GLP1RA used for weight loss among the highly susceptible BC females. Methods: This retrospective cohort study was based on the TrinetX network, comprising real-time health records from over 60 US healthcare organizations. The study population included obese females (≥18 years old) who received at least three prescriptions of either exclusive GLP1RA (liraglutide or semaglutide) or non-GLP1RA weight loss drugs (phentermine, bupropion-naltrexone, orlistat) upon BC diagnosis between 01/01/2015 and 01/01/2022. The index date was the initiation of systemic anti-cancer treatment, including chemotherapy (anthracycline, taxane, or cyclophosphamide), and/or anti-HER2 agents (trastuzumab, pertuzumab, or lapatinib). We used 1:1 propensity score-matching (PSM) to balance demographics, BMI, comorbidities, concurrent medications for cardiovascular diseases and metabolic disorders, BC receptor status and prior treatment, and levels of serum cholesterol (LDL, HDL) and hemoglobin A1c. Cox regression models were applied to compute hazard ratios (HR) and 95% confidence intervals (CIs). Follow-up continued until 05/24/2024, or until adverse cardiovascular events or death occurred. Results: Among 380 PSM-balanced pairs, the GLP1RA group (mean age: 57.6±11) showed significantly lower risks of all-cause mortality (HR 0.593, 95% CI 0.457-0.77), acute heart failure (HR 0.496, 95% CI 0.286-0.859), angina pectoris (HR 0.566, 95% CI 0.343-0.936), and acute stroke (HR 0.661, 95% CI 0.46-0.951) than the non-GLP1RA group (mean age: 57.5±12). Otherwise, no significant difference was shown in acute myocardial infarction (HR 0.787, 95% CI 0.495-1.251), pulmonary hypertension (HR 0.777, 95% CI 0.55-1.099), or arrhythmias (HR 0.829, 95% CI 0.566-1.215). Conclusion: Compared to non-GLP1RA weight loss agents, GLP1RA offers better survival and cardiovascular protection for BC patients undergoing cardiotoxic therapies. Future studies are warranted to validate the safety of these weight loss drugs during the BC treatment continuum.

The impact of the COVID-19 pandemic on overweight and obesity: the case of NEET in Türkiye

The study aims to investigate how COVID-19 pandemic affects the probability of being overweight or obese in the case of NEET in Türkiye. This study delves into the comprehensive dataset provided by the Turkish Health Research Surveys from 2014 to 2022. The primary focus is on individuals aged 15–29, with a specific exploration of the repercussions of the COVID-19 pandemic on health conditions. The investigation centers on deciphering the intricate connections between NEET (Not in Education, Employment, or Training) status, pandemic ramifications, and the likelihood of being overweight or obese. Leveraging probit models and meticulous control for variables such as age, gender, regional fixed effects, and completed education levels, our findings indicate significant associations. Notably, the NEET subgroup demonstrates a 5.8% increase in the probability of being obese or overweight. We find suggestive evidence that the pandemic contributes to a marginal increase of 1.2%. A particularly intriguing revelation surfaces as being NEET significantly amplifies the likelihood of overweight or obesity in young females. Education plays a vital role in preventing overweight or obesity, as higher education levels correlate with a lower likelihood of obesity. Moreover, we analyze different age groups, our results show that being NEET is positively associated with the probability of overweight or obesity for females aged 19–24 and 25–29 in the post-pandemic period, indicating higher sensitivity to the pandemic among NEET females.

Liver adrenoceptor alpha-1b plays a key role in energy and glucose homeostasis in female mice.

The liver plays a major role in glucose and lipid homeostasis and acts as a key organ in the pathophysiology of metabolic diseases. Intriguingly, increased sympathetic nervous system (SNS) activity to the liver has been associated with the development and progression of type 2 diabetes and obesity. However, the precise mechanisms by which the SNS regulates hepatic metabolism remain to be defined. Although liver α1-adrenoceptors were suggested to play a role in glucose homeostasis, the specific subtypes involved are unknown mainly because of the limitations of pharmacological tools. Here, we generated and validated a novel mouse model allowing tissue-specific deletion of α-1b adrenoceptor (Adra1b) in hepatocytes to investigate the role of liver ADRA1B in energy and glucose metabolism. We found that selective deletion of Adra1b in mouse liver has limited metabolic impact in lean mice. However, loss of Adra1b in hepatocytes exacerbated diet-induced obesity, insulin resistance, and glucose intolerance in female, but not in male mice. In obese females, this was accompanied by reduced hepatic gluconeogenic capacity and reprogramming of gonadal adipose tissue with hyperleptinemia. Our data highlight sex-dependent mechanisms by which the SNS regulates energy and glucose homeostasis through liver ADRA1B.NEW & NOTEWORTHY The sympathetic nervous system plays an important role in regulating hepatic physiology and metabolism. However, the identity of the adrenoceptors involved in these effects is still elusive. Using CRISPR-Cas9, we developed a novel transgenic tool to study the role of liver α-1b adrenoceptor (ADRA1B). We show that ADRA1B plays a key role in mediating the effects of the sympathetic nervous system on hepatic metabolism, particularly in female mice.

Maternal adiponectin restores cholinergic vasodilation in resistance vessels from adult offspring exposed to maternal obesity in utero.

Maternal obesity increases the risk of cardiovascular and metabolic disease in the offspring both during childhood and adult life. Pregnant women and mice with obesity have lower circulating levels of adiponectin (ADN) compared to lean controls. ADN is an adipokine involved in regulating energy metabolism, vascular function, and placental function. We hypothesized that offspring of obese mice have impaired resistance artery function, which can be prevented by restoration of normal circulating ADN levels in obese dams during late pregnancy. Adult female mice were fed either control or obesogenic diet and mated with control diet-fed males. Control dams received a continuous infusion of phosphate saline buffer (PBS) during late pregnancy whereas obese females received either PBS or ADN. After weaning, offspring were fed a control diet. Mesenteric arteries (MsA) were dissected from adult offspring and mounted in a wire myograph or fixed for histology. MsA responses to vasoconstrictors (phenylephrine and endothelin-1) were not different between infusion groups. However, the vasodilatory responses to acetylcholine were reduced in offspring from obese dams as compared to control-fed dams. ADN supplementation during pregnancy restored the cholinergic vasodilatory responses of resistance vessels in offspring from obese dams. These observations suggest that normalizing circulating adiponectin levels in pregnancies complicated by obesity prevents in utero programming of vascular dysfunction in the offspring.

Dietary bisphenols exposure as an influencing factor of body mass index

BackgroundOver the past three decades, there has been a significant increase in the prevalence and incidence of overweight and obesity worldwide. The obesogen hypothesis suggests that certain external agents may affect pathways related to fat accumulation and energy balance by stimulating fat cell differentiation and proliferation. Previous research has indicated that exposure to bisphenol A (BPA) and some of its analogues may influence fat accumulation by promoting the transformation of preadipocytes into adipocytes. This study aimed to assess the possible contribution of dietary bisphenol exposure to the odds of developing overweight and obesity in a sample of Spanish children according to sex.MethodsDietary and anthropometric data were collected from 179 controls and 124 cases schoolchildren aged 3–12 years. Dietary exposure to BPA and bisphenol S (BPS) was assessed using a food consumption frequency questionnaire. Logistic regression models were used to assess the influence of dietary exposure to bisphenols on overweight and obesity stratified by sex.ResultsFor females, cases had significantly higher exposure to BPA from meat and eggs compared to controls (median = 319.55, interquartile range (IQR) = 176.39–381.01 vs 231.79 (IQR) = 162.11–350.19, p-value = 0.046). Diet quality was higher for controls (6.21 (2.14) vs 4.80 (2.24) p < 0.001) among males independently of a high or low exposure to bisphenols. However, higher diet quality was observed for female controls with an high exposure of total bisphenols (6.79 (2.04) vs 5.33 (2.02) p = 0.031). Females exposed to high levels of BPA from meat and eggs had higher likelihood of being overweight and obese (adjusted Odds Ratio = 2.70, 95% confidence interval = 1.00 – 7.32). However, no consistent associations were found in males.ConclusionsHigh BPA levels from meat and eggs were positively associated with overweight and obesity in females. The dietary intake of BPA in the schoolchildren in the present study was much higher than the acceptable daily intake established by EFSA for the last year.

The daily experience of hunger in UK females with and without food insecurity

Food insecurity (FI) is associated with increased mortality risk, depression, and obesity in females in high-income countries, but causal mechanisms remain unclear. FI is often assumed to lead to increased levels of hunger. However, quantitative evidence describing daily experiences of hunger in FI is lacking. Our pre-registered study used ecological momentary assessment to capture experiences of hunger in two groups of UK-based females: those experiencing FI (N = 143) and those experiencing food security (FS; N = 149). Participants self-reported hunger hourly (0900–2100) for one week (Monday-Sunday). There was no difference between groups in mean hunger (t(290) = 0.17, p = .866, d = 0.02) nor within-day standard deviation in hunger (t(290) = 1.31, p = .193, d = 0.15). However, both quantities fluctuated more from day to day in the FI group. Compared to the FS group, participants in the FI group had a larger day-to-day variation in mean hunger (t(284) = 2.43, p = .016, d = 0.29) and a larger day-to-day variation in the within-day standard deviation of hunger (t(284) = 2.90, p = .004, d = 0.34). In exploratory analyses, we found that the hunger of the two groups patterned differently across the day. Our findings suggest that experiences of hunger are less stable in those experiencing FI, which may reflect associations between FI and greater uncertainty in food access, higher variability in meal timings or the increased likelihood of chaotic home and work lives.

The female reproductive tract microbiome and obesity

High-throughput 16S rRNA sequencing has allowed us to identify novel microorganisms and their relationships in the female reproductive tract. However, in obese patients, the female reproductive tract microbiome, unlike the intestinal microbiome, has been understudied. Here, the literature review analyzes and describes microbiome features in the external genitalia, vagina, cervical canal, uterus, and ovaries in overweight and obese nonpregnant and pregnant females. The microbiome of the lower female reproductive tract in obese patients is characterized by increased bacterial diversity, pH, decreased Lactobacillus abundance, and increased abundance of obligate anaerobes and yeasts of the genus Candida. The endometrial microbiome in overweight and obese patients has been studied only in postmenopause and is characterized by higher Proteobacteria abundance. No data on the characteristics of the ovarian microbiome in obese patients are available. The mechanisms accounting for microbiome changes in obese patients are likely to due to the ability of adipose tissue-derived leptin and estrone to inhibit production of pituitary gonadotropic hormones resulting in blocked ovulation and lowered estradiol production in patients of reproductive age. Consequently, a decline in glycogen synthesis in the vaginal epithelium, decreased Lactobacillus abundance followed by elevated vaginal mucus pH value and number of obligate anaerobes, including those associated with bacterial vaginosis are observed. Weight loss can have a beneficial effect on the state of the vaginal microbiome, restoring normal Lactobacillus abundance.

Determinants of Caesarean Deliveries in Bangladesh: A Multilevel Analysis of a Nationwide Population-Based Survey

Caesarean section, a frequently conducted surgical procedure in obstetrics, is instrumental in safeguarding the well-being of both mothers and infants by addressing complications related to pregnancy and childbirth. While it significantly contributes to reducing maternal and infant mortality rates, its overuse can pose serious health risks. The prevalence of caesarean deliveries has surged globally, including in Bangladesh. This rise in caesarean deliveries has prompted this research to investigate the prevalence and various associated factors in the country. To achieve the study objectives, data were extracted from the Bangladesh Demographic and Health Survey (BDHS) conducted from 2017 to 2018. After preprocessing the data, a total of 4,884 women were included in the study. Frequency analysis was conducted to illustrate the distribution of sociodemographic characteristics among Bangladeshi women. Chi-square tests were performed to assess their association with caesarean delivery. Furthermore, multi-level logistic regression analysis was employed to identify the variables that have a significant impact on the likelihood of caesarean delivery. The study revealed that in Bangladesh, the prevalence of caesarean section deliveries was approximately 33.1%, with the majority of these occurring in the Dhaka division, accounting for approximately 25.3%. Women aged 20 or older were 1.62 times more likely to opt for a C-section during childbirth (OR 1.62, [1.38-1.89]) compared to those under 20. Overweight or obese women had twice the likelihood of delivering via C-section. Higher socioeconomic status also increased the probability of choosing a caesarean delivery. Women who had exposure to any form of media were 57% more likely to opt for a caesarean delivery (OR 1.57 [1.31-1.87]), while not working women had a 48% higher likelihood of having a C-section. Additionally, the study found that the use of caesarean delivery was positively associated with the husband's education level, the number of children previously born, and the number of antenatal care visits. The study revealed that the rate of C-sections in Bangladesh surpasses WHO recommendations significantly. It also identified various factors driving this trend, including women's education levels, socioeconomic status, media exposure, female obesity, age at first childbirth, and husband’s education. These insights may serve as a foundation for developing strategies to regulate the caesarean delivery rate. Urgent policy directives are essential within Bangladesh's healthcare system, coupled with vigilant monitoring of clinical indications for C-sections, to mitigate the adverse effects of unnecessary procedures. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 31−44

Regulation of Mitochondrial and Peroxisomal Metabolism in Female Obesity and Type 2 Diabetes.

Obesity and type 2 diabetes (T2D) are widespread metabolic disorders that significantly impact global health today, affecting approximately 17% of adults worldwide with obesity and 9.3% with T2D. Both conditions are closely linked to disruptions in lipid metabolism, where peroxisomes play a pivotal role. Mitochondria and peroxisomes are vital organelles responsible for lipid and energy regulation, including the β-oxidation and oxidation of very long-chain fatty acids (VLCFAs), cholesterol biosynthesis, and bile acid metabolism. These processes are significantly influenced by estrogens, highlighting the interplay between these organelles' function and hormonal regulation in the development and progression of metabolic diseases, such as obesity, metabolic dysfunction-associated fatty liver disease (MAFLD), and T2D. Estrogens modulate lipid metabolism through interactions with nuclear receptors, like peroxisome proliferator-activated receptors (PPARs), which are crucial for maintaining metabolic balance. Estrogen deficiency, such as in postmenopausal women, impairs PPAR regulation, leading to lipid accumulation and increased risk of metabolic disorders. The disruption of peroxisomal-mitochondrial function and estrogen regulation exacerbates lipid imbalances, contributing to insulin resistance and ROS accumulation. This review emphasizes the critical role of these organelles and estrogens in lipid metabolism and their implications for metabolic health, suggesting that therapeutic strategies, including hormone replacement therapy, may offer potential benefits in treating and preventing metabolic diseases.

8687 The Efficacy of GLP1 Receptor Agonists in Obese Women with PCOS in Promoting Weight Loss and Hormonal Regulation: A Systematic Review and Meta-Analysis

Abstract Disclosure: B. Austregesilo Athayde H Morais: None. V.M. Prizão: None. B. Ximenes Mendes: None. M.L. Defante: None. O.C. Martins: None. T.L. Correa: None. M.D. De Moura de Souza: None. Background: GLP1 receptor antagonists (GLP1a) are known for their efficacy in promoting weight loss among obese and diabetic patients. However, their impact on weight reduction and hormonal regulation in obese females with polycystic ovarian syndrome (PCOS) remains understudied. Therefore, we aimed to perform a meta-analysis exploring the efficacy of GLP1a against placebo for ameliorating symptoms of PCOS. Hypothesis: The use of GLP1 receptor agonists in obese women with PCOS reduces body mass index and waist circumference as well as normalizes hormone levels such as total testosterone, total cholesterol, and HOMA-IR. Methods: We conducted a comprehensive search of PubMed, Cochrane, and Scopus databases to identify trials comparing GLP1a against placebo among women diagnosed with PCOS based on the Rotterdam Criteria. Our primary outcomes of interest included body mass index (BMI), triglycerides, waist circumference, total testosterone, total cholesterol, and HOMA-IR. We performed data extraction and quality assessment for studies that met the inclusion criteria. Subsequently, we conducted a statistical analysis using Review Manager 5.1.7 (Cochrane Collaboration). We evaluated heterogeneity using I² statistics. Results: We included 176 participants from 4 studies, which all were RCTs. GLP1a was used to treat 111 (63.06%) patients. Analyzed outcomes included waist circumference (MD: −5.16 cm; 95% CI: −6.11 to −4.21; p &amp;lt; 0.00001), total testosterone (MD: −1.33; 95% CI: −2.55 to −0.12; p =0.03), BMI (MD: -2.42; 95% CI: -3.10 to -1.74; p &amp;lt; 0.00001), total cholesterol (MD: −0.04; 95% CI: −0.10 to 0.01; p =0.15), HOMA-IR (MD: −0.30; 95% CI: −0.92 to 0.32; p =0.35), Triglycerides (MD: −0.20; 95% CI: −0.30 to −0.11; p &amp;lt; 0.00001) were lower in patients treated with GLP1a compared with placebo. Most patients who discontinued the trials did so because of a nausea side effect. Conclusion: The utilization of GLP1a demonstrates efficacy in reducing body mass index (BMI), triglycerides, waist circumference, total testosterone, total cholesterol, and HOMA-IR. These results signify its viability as a favorable treatment option for managing PCOS in obese females. Presentation: 6/3/2024

8359 Increased hepatic SGK1 activity promotes metabolic dysfunction-associated fatty liver disease in a sex-dependent manner

Abstract Disclosure: A. Vastola-Mascolo: None. G. Hernández: None. D. Alvarez de la Rosa: None. The serum and glucocorticoid-induced kinase 1 (SGK1) is a Ser/Thr kinase with key roles in fluid and electrolyte homeostasis, blood pressure regulation and energy metabolism. Its expression is controlled by steroid hormones such as glucocorticoids, mineralocorticoids and estrogen, in addition to other stimuli such as glucose. SGK1 activation mainly depends on the PI3 kinase pathway, implicating it in insulin signaling. Previous work from our laboratory demonstrated that a systemic increase in SGK1 activity exacerbates diet-induced development of metabolic syndrome in mouse, characterized by obesity, glucose intolerance, insulin resistance, dyslipidemia and hypertension. In addition, a high-fat diet rapidly led to the development of hepatic steatosis. We now test the hypothesis that at least part of the effects of increased systemic SGK1 activity promoting the development of metabolic syndrome are due to alterations in liver glucose or lipid handling. To that end we developed a mouse strain with hepatocyte-specific transgenic SKG1 expression and challenged it with high-fat or high-fat/high-sucrose diets. Our results show sex differences in the development of obesity, with a marked increase in body weight in female, but not male transgenic animals. Glucose homeostasis was normal in both sexes. Increased obesity in females correlated with increased lipid accumulation in the liver. However, liver fibrosis, inflammation and dyslipidemia were more marked in male animals, further suggesting an interaction between SGK1 and sex steroid hormone signaling. Our results demonstrate a key role of SGK1 in liver lipid metabolism and suggest a crosstalk between this signaling pathway and sex hormones, which determine a more negative outcome in male animals. Presentation: 6/1/2024

8234 Composite Pheochromocytoma-Ganglioneuroma: Two Clinical Cases Presenting To St. Elizabeth’s Medical Center

Abstract Disclosure: M. El Najjar: None. E. Naous: None. C. Blake: None. A.T. Sweeney: None. Introduction: Pheochromocytomas (PCCS) are rare catecholamine producing tumors that originate from the chromaffin cells of the adrenal medulla. In 3-9% of cases, they may be accompanied by other tumors. Ganglioneuromas are the most encountered tumor type that occur with PCC and are termed composite PCC-GN. The entity is very rare with &amp;lt; 35 cases reported. Herein, we present 2 cases of composite PCC-GN. Case Presentation: Patient 1 (Pt1) &amp; Patient 2 (Pt2): were 35- &amp; 54-year-old obese females. Pt1 had controlled hypertension and symptoms of anxiety along with palpitations, diaphoresis and flushing. Pt2 had type 2 diabetes and complained of abdominal pain. Metabolic studies showed elevated total plasma fractionated metanephrines(MNs). MNs in Pt1 and Pt2 were: 76 and 61pg/ml respectively (normal &amp;lt;57 pg/ml) and normetaneprines levels were 161 and 116pg/ml respectively (normal &amp;lt;148 pg/ml). Abdominal computed tomography (CT) scans demonstrated right adrenal masses in both cases with Pt1 having a 2.3 x 2.3 x 2.6 cm mass (Figure1) with smooth margins measuring 36 Hounsfield units (HU) on non-contrast(NC) CT imaging with 0% washout on delayed imaging after IV contrast. Pt2 on NCCT had a 4.5 x 3.5 cm right adrenal mass measuring 73 HU and a subsequent abdominal MRI(Figure2) demonstrated the mass to have heterogenous signal intensity. Both patients were prepared with pre-operative a and b blockade and underwent laparoscopic robotic adrenalectomies without complications. Pathological analyses in both cases revealed composite PCC-GN. Pt2 underwent genetic testing which did not reveal any known mutations. Surveillance in both patients demonstrated no recurrence. Clinical lesson: The clinical presentation of PCC-GNs is indistinguishable from isolated PCCs. The definitive diagnosis is through histopathological analysis. Histologically the composite tumor is composed of two distinct patterns with PCC showing angular cells with granular, basophilic cytoplasm, arranged in nests, while GNs show ganglion cells in fibrous stroma. Immunohistochemistry show the PCCs staining for chromogranin A and synaptophysin while GNs stain for S-100 protein and neurofilament antibody. Most cases occur in patients between 40 - 60 years old. Most PCC-GNs are functional, with increased MNs. PCC-GN composite tumors may occur sporadically but have also been described as part of syndromes such as MEN2A and NF1. The definitive treatment for PCC-GN is complete surgical excision which is associated with an excellent prognosis. The probability of recurrence is low though distant metastases have rarely been reported. Therefore, lifetime surveillance is critical. Presentation: 6/3/2024

Predictors and Risk Factors of Wound Complications in Diabetic Patients Post Lower Limb Amputation: A Prospective Study

Abstract Background Despite advances in limb-salvage surgery, lower extremity amputation is still commonly required as an end result of the progression of arterial occlusive disease or failed arterial reconstruction. Furthermore, the increasing prevalence of diabetes has led to the appearance of more patients with foot complications leading to eventual lower extremity amputation. Objective To investigate the predictors and risk factors associated with wound complications after lower limb amputations in diabetic patients. Methods This is a prospective study, in which we follow up diabetic patients who went for lower limb amputation (AKA or BKA) and record the incidence of post operative wound complications. The study included 30 diabetic patients undergoing lower limb amputation in Ain Shams University hospitals, with postoperative follow up for 24 weeks, and the outcome measured is the incidence of post operative complication in relation to preoperative risk factors and predictors. Results Regarding the comparison between AKA and BKA it was found that patients who had BKA had higher rates of superficial SSI which were statistically significant (P &amp;lt; 0.05). While patients who had AKA had higher rates of pneumonia and mortality but not statistically significant (P &amp;gt; 0.05). Wound disruption, pulmonary embolism and MI were higher in patients who had BKA but was not statistically significant (P &amp;gt; 0.05). Regarding assessing predictors and risk factors for assessing post operative complications it was found that female gender, smoking and obesity (BMI &amp;gt;30) was statistically significant in assessing the risk factors (P value &amp;lt;0.05). Also regarding other predictors and risk factors of postoperative complication after the end of the study duration it was found that lower HGb levels (Anemia), Hct, ESR and CRP are considered predicators (P-value &amp;lt; 0.05). Other factors such as preoperative sepsis, emergency status and presence of infection were strongly related to post operative complication P-value 0.003 each (P-value &amp;lt; 0.05). Conclusion Surgical site infections (SSIs) following lower extremity amputations (LEAs) are a major cause of patient morbidity and mortality. The objectives of this study were to investigate the incidence of SSI and other wound complications after LEA in diabetic patients and to assess risk factors associated with SSI. This study found that below-the-knee amputation, smoking, obesity, emergency status, anemia, lower hematocrit and preoperative sepsis to be associated with SSIs.

A comparison of principal component analysis, reduced-rank regression, and partial least–squares in the identification of dietary patterns associated with cardiometabolic risk factors in Iranian overweight and obese women

BackgroundAccording to epidemiological studies, unhealthy dietary patterns and lifestyle lead to rising obesity and cardiometabolic diseases in Iran. Hybrid techniques were used to identify a dietary pattern characterized by fiber, folic acid, and carotenoid intake due to their association with cardiometabolic risk factors such as anthropometric measurements, blood pressure, lipid profile, C-Reactive Protein (CRP), Plasminogen Activator Inhibitor (PAI), Homeostatic Model Assessment Index (HOMA Index), cardiometabolic index (CMI), and monocyte chemoattractant protein (MCP-1). So, the objective of the recent study is to compare the reduced-rank regression (RRR) and partial least–squares (PLS) approaches to principal component analysis (PCA) for estimating diet-cardiometabolic risk factor correlations in Iranian obese women.MethodsData on dietary intake was gathered from 376 healthy overweight and obese females aged 18 to 65 years using a 147-item food frequency questionnaire (FFQ). In this cross-sectional study, participants were referred to health centers of Tehran. Dietary patterns were developed using PCA, PLS, and RRR, and their outputs were assessed to identify reasonable patterns connected to cardiometabolic risk factors. The response variables for PLS and RRR were fiber, folic acid, and carotenoid intake.ResultsIn this study, 3 dietary patterns were identified by the PCA method, 2 dietary patterns by the PLS method, and one dietary pattern by the RRR method. High adherence to the plant-based dietary pattern identified by all methods were associated with higher fat free mass index (FFMI) (P < 0.05). Women in the highest tertile of the plant-based dietary pattern identified by PLS had 0.06 mmol/L (95% CI: 0.007,0.66, P = 0.02), 0.36 mmHg (95% CI: 0.14,0.88, P = 0.02), and 0.46 mg/l (95% CI: 0.25,0.82, P < 0.001), lower FBS, DBP, and CRP respectively than women in the first tertile. Also, PLS and RRR-derived patterns explained greater variance in the outcome (PCA: 1.05%; PLS: 11.62%; RRR: 25.28%), while the PCA dietary patterns explained greater variance in the food groups (PCA: 22.81%; PLS: 14.54%; RRR: 1.59%).ConclusionPLS was found to be more appropriate in determining dietary patterns associated with cardiometabolic-related risk factors. Nevertheless, the advantage of PLS over PCA and RRR must be confirmed in future longitudinal studies with extended follow-up in different settings, population groups, and response variables.

Urinary metals are associated with obesity in U.S. children and adolescents: A cross-sectional study

Heavy metals are pervasive in the environment, and exposure to these metals may contribute to obesity in children and adolescents. We hypothesized that metal exposures are associated with obesity in children and adolescents. Data were drawn from children and adolescents aged 6 to 19 years from the 2007 to 2018 National Health and Nutrition Examination Survey. We employed weighted multivariate logistic regression and restricted cubic spline to explore the effects of individual metal exposures on obesity, and weighted quantile sum regression, quantile g-computed regression, and Bayesian kernel machine regression to explore the effects of mixed metal exposures on obesity. Subgroup analyses by gender were also performed. All models were adjusted for age, gender, race, poverty to income ratio, and serum cotinine. Among the 3,650 children and adolescents studied, 21.04% had obesity. Logistic regression revealed positive associations between barium (OR = 1.23, 95% CI: 1.07-1.40) and thallium (OR = 1.55, 95% CI: 1.23-2.15) with obesity, while cadmium (OR = 0.74, 95% CI: 0.61-0.89), cobalt (OR = 0.51, 95% CI: 0.41-0.62), and lead (OR = 0.70, 95% CI: 0.57-0.86) were negatively associated with obesity. Restricted cubic spline indicated a nonlinear relationship between lead and thallium and obesity. Quantile g-computed regression demonstrated that mixed metal exposure was negatively associated with obesity (OR = 0.50, 95% CI: 0.42-0.59). Subgroup analyses revealed a gender-specific effect for mercury (P for interaction = 0.03), which was negatively associated with obesity in females (OR = 0.83, 95% CI: 0.69-0.99). In conclusion, metal exposures are associated with obesity in children and adolescents, with gender differences.

The lifetime healthcare costs of female obesity: modeling of England data and the costs of current pharmacotherapy.

The lifetime healthcare costs of female obesity: modeling of England data and the costs of current pharmacotherapy.

Use of Autologous Leukocyte-Platelet Rich Fibrin (L-PRF) in Endoscopic Anterior Skull Base Defect Repair-A Newer Graft Material: Name of Authors.

CSF rhinorrhea secondary to anterior skull base defect may be spontaneous or traumatic (accidental or iatrogenic), spontaneous being common in middle aged, obese females. Nowadays endoscopic technique is gold standard for anterior skull base defect repair. The graft materials available may be autologous (fat, temporalis fascia, fascia lata, septal mucosa, cartilage, middle turbinate), homologous e.g., cadaveric pericardium or allograft e.g. dural substitute. Leukocyte-platelet rich fibrin (L-PRF) is a newer graft material that contain concentrated platelets and doesn't require any exogenous material or chemical in blood. A prospective study including 31 patients was carried out at tertiary care centre in eastern India, over the period of 2 years. All the surgeries targeted for closure of the anterior skull base defect were performed endoscopically under general anaesthesia. 30 out of 31 (96.77%) patients successfully improved after repair and one patient required revision surgery due to recurrence of disease and was cured after revision surgery. Autologous Leokocyte-plasma rich fibrin (L-PRF) is a newer and cost-effective graft material for the CSF leak repair with good healing property and with a success rate of more than 95%.

Obesity and oxidative stress: Implications for female fertility

AbstractObesity has reached epidemic proportions in most parts of the world, and it is estimated that 1 billion people globally are trapped in an obesity pandemic, which has seriously compromised human health. Recently, there has been a flood of research into obesity as well as redox and lipid metabolism; however, our understanding of the pathways and specific molecular mechanisms by which obesity‐induced oxidative stress affects female reproductive function remains limited. In this review, we discuss how the obesity pandemic has led to lower female fertility. We focus on multiple facets of obesity‐mediated reproductive dysfunction, including follicular atresia, oocyte maturation, embryo implantation, reproductive aging, and discuss therapeutic interventions that have the potential to normalize reproductive function in obese females, such as targeting mitochondrial lipid metabolism and antioxidant pathways.