Loss Outcomes Research Articles

Comparative study of midterm outcomes between Roux-en-Y gastric bypass (RYGB), diverted one-anastomosis gastric bypass (D-OAGB), and one anastomosis gastric bypass (OAGB)

PurposeDiverted one anastomosis gastric bypass (D-OAGB) is a new procedure that entails performing Roux-en-Y diversion during OAGB to preclude post-OAGB bile reflux. This study aimed to compare the mid-term outcomes of Roux-en-Y gastric bypass (RYGB) and OAGB versus D-OAGB.MethodsThis is a retrospective study that encompassed the analysis of data from patients undergoing bypass surgeries from 2015 to May 2021. The patients’ data until 2 years of follow-up were compared.ResultsThis study included 140 patients who underwent OAGB (n = 64), RYGB (n = 24), and D-OAGB (n = 52). In the OAGB, RYGB, and D-OAGB groups, complication rates were 3.1%, 8.3%, and 5.8%, respectively. At the 3-month and 6-month follow-ups, the OAGB and D-OAGB groups showed a statistically significant higher percentage of excess weight loss (EWL%). Otherwise, the weight measures and weight loss outcome were comparable among the three groups in the other follow-up visits (p > 0.05). There was a significantly lower number of gastroesophageal reflux disease (GERD) remission cases and a higher number of de novo GERD cases in the OAGB group.ConclusionD-OAGB demonstrated favorable outcomes, including lower early adverse events and superior weight loss results in the first 6 months post-surgery when compared to RYGB. The D-OAGB group also showed higher rates of GERD remission and lower de novo GERD occurrence than OAGB. Further research is warranted to validate these findings and expand our understanding of this innovative surgical approach.

Lateral Graft Failure Resulted In Graft Volume Loss And Poor Clinical Outcomes Compared With Medial Failure After Superior Capsule Reconstruction

Lateral Graft Failure Resulted In Graft Volume Loss And Poor Clinical Outcomes Compared With Medial Failure After Superior Capsule Reconstruction

IFSO Bariatric Endoscopy Committee Evidence-Based Review and Position Statement on Endoscopic Sleeve Gastroplasty for Obesity Management.

Obesity is a significant global health issue. Metabolic and bariatric surgery (MBS) is the gold standard in the treatment of obesity due to its proven effectiveness and safety in the short and long term. However, MBS is not suitable for all patients. Some individuals are at high surgical risk or refuse surgical treatment, while others do not meet the criteria for MBS despite having obesity-related comorbidities. This gap has driven the development of endoscopic solutions like endoscopic sleeve gastroplasty (ESG), which offers a less invasive alternative that preserves organ function and reduces risks. A recent IFSO International Delphi consensus study highlighted that multidisciplinary experts agree on the utility of ESG for managing obesity in patients with class I and II obesity and for those with class III obesity who do not wish to pursue or qualify for MBS. This IFSO Bariatric Endoscopy Committee position statement aims to augment these consensus statements by providing a comprehensive systematic review of the evidence and delivering an evidence-based position on the value of ESG within the spectrum of obesity management. A comprehensive systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Cochrane guidelines. Systematic Review: The systematic review included 44 articles encompassing 15,714 patients receiving ESG. The studies varied from large case series to cohort studies and a randomized controlled trial (RCT). The mean baseline BMI was 37.56kg/m2. The review focused on weight loss outcomes and safety data. Time point Mean %EWL Mean %TBWL 6months 48.04 15.66 12months 53.09 17.56 18months 57.98 16.25 24months 46.57 15.2 36months 53.18 14.07 60months 45.3 15.9 These results demonstrate significant weight loss following ESG. The pooled serious adverse event (SAE) rate was 1.25%. This low rate of SAEs indicates that ESG is a relatively safe procedure. The quality of evidence from the included observational studies was assessed as very low, primarily due to the inherent limitations associated with observational study designs, such as potential biases and lack of randomization. In contrast, the quality of evidence from the single randomized controlled trial was rated as MODERATE, reflecting a more robust study design that provides a higher level of evidence despite some limitations. The IFSO Bariatric Endoscopy Committee, after conducting a comprehensive systematic review and meta-analysis, endorses endoscopic sleeve gastroplasty (ESG) as an effective and valuable treatment for obesity. ESG is particularly beneficial for patients with class I and II obesity, as well as for those with class III obesity who are not suitable candidates for metabolic bariatric surgery. ESG provides significant weight loss outcomes and demonstrates a favorable safety profile with a low rate of serious adverse events. Despite the limitations of the included observational studies, the randomized controlled trial included in the analysis reinforces the efficacy and safety of ESG and provides an evidence-based foundation for the position statement. Thus, the IFSO position statement supports and provides an evidence base for the role of ESG within the broader spectrum of obesity management.

Long-term outcomes of childhood otitis media and hearing loss: a systematic review

ABSTRACT Otitis media (OM) is a common childhood illness which can cause hearing loss and developmental delays. This is the first systematic review to investigate the long-term, longitudinal health and social outcomes of OM and hearing loss in childhood. The study was registered in PROSPERO (CRD42023396318). A structured search strategy identified literature in the following databases: CINAHL, Scopus, Medline, PsychInfo, and EmCare. Articles were independently dual-screened and extracted data were synthesised. From 2825 potential studies, 25 were selected for inclusion. These assessed broad outcomes: physical health, audiological health academic, behavioural, social function, service use, and housing. Overall, 28% of papers found no difference between those with a childhood history of OM and those without, 40% found poorer outcomes for those with a history of OM, and 32% found mixed results. This is the first study of its kind to explore the long-term effects of otitis media and resultant hearing loss in children. Trends of poor academic, behavioural, and audiological outcomes were identified in children with OM and hearing loss. Multiple gaps in the literature were identified including a paucity of recent research, studies extending into adulthood, and studies focusing on high-risk populations.

Mental health status and quality of life among Thai people after the COVID-19 outbreak: a cross-sectional study

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on individuals’ mental health and well-being worldwide. This study investigated the prevalences of and association between mental health and quality of life (QOL) in Thailand after the COVID-19 outbreak. A cross-sectional study was conducted among Thai individuals aged ≥ 20 years across all regions. Descriptive statistics, chi-square tests, and multiple logistic regression analyses were performed to examine the association between mental health and QOL. A total of 1,133 participants (mean age: 35.1 ± 17.2 years) completed the survey. The prevalence of depression with PHQ-9 instrument was 19.4%. Depression was significantly associated with those who have had family members die from COVID-19 infection (adjusted odds ratio [AOR] 2.27, 95% confidence interval [CI] [1.13–4.52]). The percentages of depression, anxiety, and stress with DASS-21 instrument were 32.4%, 45.4%, and 24.1%, respectively. Smokers and alcohol consumption had approximately 1.5-time higher risk of stress compared with non-smokers and no alcohol consumption (AOR = 1.50, 95% CI [1.01–2.24], AOR = 1.48, 95% CI [1.09–2.02], respectively). An association was observed between socioeconomic factors such as job and income loss and mental health outcomes. Depression, anxiety, and stress were significantly negatively associated with QOL. This study demonstrates a strong association between mental health and QOL among Thai people after the COVID-19 outbreak. The findings underscore the need for interventions targeting lifestyles, including those addressing alcohol consumption and smoking, especially among those who have had family members die from COVID-19 infection and mental health support services that can address depression, anxiety, and stress to improve the overall well-being of the population.

Robotic Single Anastomosis Duodenal-ileal Bypass With Sleeve Gastrectomy (SADI-S) for Morbid Obesity: A Systematic Review.

The global obesity epidemic has seen a dramatic increase in prevalence since 1975, posing significant health and economic challenges worldwide. Robotic-assisted single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) has emerged as a promising surgical intervention for morbid obesity, offering potential advantages over traditional laparoscopic approaches in terms of precision, safety, and recovery outcomes. This study aimed to evaluate the efficacy and safety of robotic-assisted SADI-S, focusing on perioperative and postoperative outcomes including intraoperative complications, operative time, conversion rates, mortality, length of hospital stay, weight loss, and postoperative complications. A comprehensive literature search was conducted on PubMed, Scopus, and Cochrane Library, adhering to inclusion and exclusion criteria focused on obese adult humans undergoing robotic SADI-S. Seven studies, published between 2015 and 2024, involving 204 patients, were ultimately included for analysis. The analysis revealed a low rate of intraoperative complications (0.49%), no mortality, and varied operative times (138 to 205.7 min). The median hospital stay ranged from 2 to 6.7 days, with minimal readmission rates. Postoperative complications occurred in 6.37% of patients, but no late complications (>30 days) were reported. Notably, significant weight loss outcomes were documented, with mean excess weight loss (EWL) up to 113.74% at 24 months follow-up. Robotic-assisted SADI-S demonstrates a favourable safety profile with promising weight loss outcomes, highlighting its potential as a primary or revisional treatment for morbid obesity. Further research, including randomized controlled trials, is needed to establish its long-term efficacy and cost-effectiveness compared to traditional laparoscopic methods.

Clinical outcomes in patients with unintended pregnancy after liver transplantation: A multicenter registry cohort study.

The consequences of unintended pregnancy in liver transplant (LT) recipients, a growing part of the high-risk obstetric population, remain unknown. To fill this gap, we conducted a retrospective registry cohort study to describe the risk factors, obstetric and neonatal morbidity, and graft outcomes associated with unintended pregnancy after LT. This study utilized the Transplant Pregnancy Registry International (TPRI) and included 565 pregnancies of LT recipients between 1967 and 2019 from 289 hospitals, primarily in North America. The primary outcome of acute cellular rejection (ACR) and secondary outcomes of graft loss, severe maternal morbidity, and neonatal composite morbidity were compared by pregnancy intention. The study population included 60.9% with intended pregnancies and 39.1% unintended pregnancies. Recipients with unintended pregnancy were more likely to self-report as Black race, to be younger, nulliparous, and have exposure to teratogenic immunosuppression. ACR was more common with unintended pregnancy (3.7% vs 1.2%, p=0.047). Unintended pregnancies had lower median birth weight (2806.6 vs 2948.4 grams, p=0.033). Unintended pregnancy was not associated with increased neonatal morbidity or severe maternal morbidity. These findings underscore the importance of family planning counseling, access to safe and effective contraceptive options, as well as multidisciplinary prenatal care in the growing population of reproductive-aged LT recipients.

Effect of participant baseline characteristics on adherence to self-monitoring of diet, physical activity and weight in a 12-month weight loss mHealth trial

Abstract Background Self-monitoring (SM) of lifestyle behaviors is the centerpiece of standard behavioral treatment (SBT) for weight loss as SM increases one’s awareness of their behaviors. Extensive evidence demonstrates a significant relationship between adherence to SM and successful weight loss outcomes. Purpose Examine baseline characteristics of participants that are associated with higher adherence to SM of diet, physical activity (PA), and weight in a 12-month mHealth weight loss trial. Methods SMARTER was a single-site, 2-arm randomized controlled trial. We randomized 502 adults with a body mass index (BMI) 27-43 kg/m2 to diet, weight, and PA SM plus tailored feedback messages (SM+FB, n=251) or SM alone (n=251). We provided the SM+FB group feedback messages via the SMARTER app on diet daily, PA every other day and weight weekly. The study provided a wearable PA tracker and smart scale for weight and utilized a smartphone app for dietary SM. Adherence of dietary SM was defined as the % of days with ≥50% of calorie goal recorded and PA SM was % of days with ≥500 steps. Weight SM was the % of days with weight based on the scale record. Linear mixed modeling was applied to assess the monthly percent adherence to SM of diet, PA, and weight over a 12-month period. Our analysis incorporated time effects in months and polynomials of time, treatment group assignment (SM+FB vs. SM), baseline variables of interest (e.g., BMI, age, sex, race, education years, income), and the interactions between treatment and time effects with other variables. For parsimony, non-significant effects were removed. Results The sample (N=502) was 82% white (n=414), 79% female (n=399), and had a mean age of 45.0±14.4 years and BMI of 33.7±4.0 kg/m2. Over 12 months, percent adherence to SM of diet, PA, and weight declined non-linearly. Treatment groups did not demonstrate significant differences. The impact of treatment on the monthly decline in adherence to diet SM was curvilinear and varied significantly over 12 months. Older age was associated with greater adherence to the SM of diet (b=0.72, 95% CI: 0.55-0.88, P < .0001), PA (b=0.50, 95% CI: 0.35-0.66, P < .0001), and weight (b=0.71, 95% CI: 0.57-0.85, P < .0001). Conversely, higher baseline BMI was associated with lower adherence to SM of diet (b=-1.14, 95% CI: -1.73 to -0.55, P < .0001) and PA (b=-0.79, 95% CI: -1.35 to -0.22, P= .006). Other baseline variables were not significantly related to adherence. Conclusion The findings suggest that individuals with a higher BMI at baseline may need additional enhancement strategies to improve their engagement with the digital tools for SM lifestyle which could lead to improved weight outcomes.

Impact of semaglutide on weight and functional outcomes among obese heart failure patients: a propensity scores matching analysis

Background & objectivesObesity is a common comorbidity in heart failure, yet effective pharmacological options for weight loss in these patients are limited. Semaglutide, a glucagon-like peptide 1 receptor agonist, has shown promise for weight reduction in obese adults. This study aims to evaluate semaglutide’s impact on weight loss, functional status, and clinical outcomes in obese patients with heart failure.MethodsA retrospective analysis was conducted on all consecutive obese (BMI > 30 kg/m²) patients with heart failure at the University Hospital Bonn outpatient clinic from July 2019 to July 2022. Propensity score matching paired patients receiving semaglutide as an add-on therapy (SEMA) with those on medical therapy alone (Control).ResultsAmong 1,942 patients with heart failure screened, 26 matched pairs were identified. At one year, the SEMA group exhibited significant weight loss, with a mean BMI reduction of -2.91 kg/m² (95% CI: -4.27 to -1.55; p < 0.001), while the control group showed a non-significant mean change of -0.41 kg/m² (95% CI: -1.08 to 0.26; p = 0.22). The difference in BMI between the two groups was statistically significant (mean difference: 3.42 kg/m², 95% CI: 1.43 to 5.42; p = 0.001). Improvements by at least one NYHA class were observed in 65% of the SEMA group (p < 0.001) compared to 15% of the control group (p = 0.18). The SEMA group also showed a significant increase in 6-minute walk distance (6MWD), with a mean difference of 75 m between the groups at one year (95% CI: 0.53 to 150.02; p = 0.049). NT-proBNP levels significantly decreased in the SEMA group (p < 0.001) compared to the control group (p = 0.78), with a statistically significant difference in NT-proBNP between the groups (p = 0.048). Both improvements in 6MWD and reductions in NT-proBNP were significantly correlated with BMI percentage reductions.ConclusionsSemaglutide was associated with significant weight reduction in obese patients with heart failure, accompanied by improved NYHA classification and 6-minute walk distance. Larger, multi-center trials and prospective, randomized controlled trials are warranted. These studies should focus on assessing long-term outcomes, optimizing dosage, and exploring the potential cardiovascular benefits beyond weight reduction.

A Meta-Analysis Comparing RYGB with Long Biliopancreatic Limb (BPL) Versus Long Alimentary Limb (AL) in Groups with Equal or Nearly Equal Combined Bypass Lengths (Combined BPL and AL Lengths): Does Switching Seats Enhance Weight Loss?

It is well-established that extending either the biliopancreatic limb (BPL), the alimentary limb (AL), or both, results in increased combined bypass (CB) length, which in turn leads to enhanced weight loss and potential nutritional deficiencies due to heightened malabsorptive effects. However, a key question remains: Assuming no change in CB length, does altering BPL length affect outcomes? To address this question, we examined studies comparing long BPL and long AL (short BPL) while maintaining equal or nearly equal CB lengths. We conducted this systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a meta-analysis on weight loss outcomes, adverse events and safety-related outcomes, gastrointestinal complaints, and nutritional outcomes at the 2-year mark.

Is Fasting Superior to Continuous Caloric Restriction for Weight Loss and Metabolic Outcomes in Obese Adults? A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

fasting-based strategies (FBS) and continuous caloric restriction (CCR) are popular methods for weight loss and improving metabolic health. FBS alternates between eating and fasting periods, while CCR reduces daily calorie intake consistently. Both aim to create a calorie deficit, but it is still uncertain as to which is more effective for short- and long-term weight and metabolic outcomes. this systematic review and meta-analysis aimed to compare the effectiveness of FBS and CCR on these parameters in obese adults. after screening 342 articles, 10 randomized controlled trials (RCTs) with 623 participants were included. both interventions led to weight loss, with a reduction of 5.5 to 6.5 kg observed at the six-month mark. However, the results showed that FBS led to slightly greater short-term reductions in body weight (-0.94 kg, p = 0.004) and fat mass (-1.08 kg, p = 0.0001) compared to CCR, although these differences are not clinically significant. Both interventions had similar effects on lean mass, waist and hip circumference, blood pressure, lipid profiles, and glucose metabolism. However, FBS improved insulin sensitivity, with significant reductions in fasting insulin (-7.46 pmol/L, p = 0.02) and HOMA-IR (-0.14, p = 0.02). despite these short-term benefits, FBS did not show superior long-term outcomes compared to CCR. Both strategies are effective for weight management, but more research is needed to explore the long-term clinical relevance of FBS in obese populations.

Impact of Leptin-Melanocortin Pathway Genetic Variants on Weight Loss Outcomes After Endoscopic Transoral Outlet Reduction.

Variants in the leptin-melanocortin pathway (LMP) are associated with severe obesity. We evaluated weight loss of patients with or without heterozygous LMP variants, with weight recurrence after Roux-en-Y gastric bypass, who underwent endoscopic transoral outlet reduction (TORe). We retrospectively reviewed patients genotyped for an LMP who had undergone TORe, classified as "carriers" or "non-carriers" of genetic variants. We included 54 patients (22 carriers, 32 non-carriers). We identified 34 genetic variants in 21 different genes in 22 patients. Total body weight loss (%TBWL) after TORe was significantly different at 9 and 12months (12months: 0.68 ± 7.5% vs. 9.6 ± 8.2%, p < 0.01). This difference in weight loss was present even when analyzed in subgroups of patients who had undergone tubular TORe technique, and TORe plus APC. At 3, 6, and 12months, the percentage of carriers achieving ≥ 5% and ≥ 10% TBWL was lower than non-carriers. Patients with LMP variant who underwent RYGB had decreased weight loss 1year after undergoing TORe.

Efficacy of in-person versus digital enhanced lifestyle interventions in adults with overweight and obesity

BackgroundLifestyle interventions (LIs) are the cornerstone for obesity management. The Mayo Clinic Diet (MCD) offers two approaches for LIs: the In-Person LI (IPLI) and the Digital Enhanced LI (DELI). The IPLI includes a 2-day in-person program with monthly follow-ups, whereas the DELI provides on-demand digital tools. The comparative efficacy of these approaches is currently unknown. MethodsThis retrospective study included two cohorts of adults with a body mass index (BMI) of ≥25 kg/m2 and weight metrics at least 3 months after starting either the IPLI or DELI program. The primary endpoint was the total body weight loss percentage (TBWL%) at 6 months. ResultsThe study included 133 participants in the IPLI cohort (mean age 46.3 years, 65.4 % female, BMI 36.4) and 9603 in the DELI cohort (mean age 60.1 years, 85.0 % female, BMI 33.1). The DELI group achieved superior TBWL% at 1, 3, and 6 months compared to the IPLI group (3.4 % vs. 1.5 %, 4.7 % vs. 2.4 %, 5.3 % vs. 2.9 %, respectively; p < 0.001). After adjusting for age, gender, and starting weight, the DELI group maintained a higher TBWL% (difference 2.0 %; 95 % CI [1.0, 3.0], p < 0.001) and a greater proportion of participants achieved >5 % TBWL at 6 months (OR 1.66; 95 % CI [1.08, 2.55], p < 0.023). ConclusionThe DELI approach resulted in superior weight loss outcomes compared to the IPLI. Further research is needed to explore how digital tools can improve weight loss effectiveness.

Comparison of clinical efficacy between reconstruction of the superior acromioclavicular ligament with acellular dermal allografts and clavicular hook plate in acromioclavicular dislocations

Purposes: We aimed to compare the clinical efficacy of superior acromioclavicular ligament reconstruction (SALR) using acellular dermal allograft with that of clavicular hook plate fixation (HP) in patients with acromioclavicular (AC) dislocations. We hypothesized that the SALR could provide more stability than hook plate. Methods: Twenty-two cases of acute AC joint dislocation between November 2021 to December 2023 were retrospectively reviewed. All patients were divided into 2 groups based on the treatment with SALR (12 cases) or HP (10 cases). Patients were evaluated radiologically and clinically using coracoclavicular distance and ratio, pain visual analogue scale (PVAS), Single Assessment Numerical Evaluation (SANE), and American Shoulder and Elbow Surgeons (ASES) at postoperative 3 months and 1 year. We evaluated whether patient achieve MCID of PVAS at the last visit, based on the minimal clinically important differences (MCIDs) of PVAS. Results: The SALR group showed a lower rate of reduction loss (8.3 % vs. 40.0 %) and similar clinical outcomes compared to the hook plate group. Initial SANE score was statistically significantly lower in SALR group (SANE: SALR, 45.8 ± 20.7; HP, 68.0 ± 15.5, p = 0.009), but there were no significant differences in final clinical outcomes, including PVAS, ASES, and SANE scores. Conclusion: SALR with acellular dermal allograft demonstrates comparable clinical outcomes to hook plate fixation and may offer a viable alternative, especially in complicated cases. Study Design: Case series; Level of evidence, 4.

Long-Term Weight Loss and Attendance Outcomes Following Metabolic and Bariatric Surgery: An Evaluation of The Cleveland Clinic Behavioral Rating System.

Interdisciplinary guidelines recommend preoperative psychological evaluation before metabolic and bariatric surgery (MBS). The Cleveland Clinic Behavioral Rating System (CCBRS) has been developed to evaluate the psychological state of individuals undergoing MBS. However, its predictive value concerning long-term weight loss and follow-up attendance has not been extensively studied. This study aims to assess the predictive value of the CCBRS regarding weight loss and follow-up attendance up to 5years after MBS. In this cohort study (n = 1236), psychologists administered the CCBRS to each patient prior to MBS in addition to the standard psychosocial-behavioral screening. The CCBRS consists of nine psychological domains and is scored on a five-point Likert scale, from "poor" to "excellent." Linear mixed models and ordinal regression analysis were used to analyze the percentage total weight loss over time and follow-up attendance up to 5years after surgery. A total of 1086 patients underwent subsequent MBS. Significant differences in weight loss and follow-up attendance were observed between some CCBRS groups compared to the reference group "excellent." However, these differences were not consistent across all groups within any given domain. In this cohort, the predictive value of the CCBRS for weight loss and follow-up attendance up to 5years after MBS was limited. It is important to consider certain limitations, such as considerable loss to follow-up. Nevertheless, the CCBRS remains valuable for structured psychological assessments by helping to identify patients' strengths and areas needing improvement.

General anesthesia is associated with lower perioperative bleeding and better functional outcomes than spinal anesthesia for endoscopic enucleation of the prostate: a single-center experience.

Holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) are safe and effective treatment options for benign prostatic hyperplasia (BPH). Spinal anesthesia (SA) is widely used for endoscopic enucleation of the prostate (EEP) in place of general anesthesia (GA). We aimed to assess the impact of GA vs. SA on blood loss, postoperative course and functional outcomes after HoLEP and B-TUEP. After propensity score matching, we analyzed data from 148 patients treated with EEP in our centre for symptomatic BPH. We recorded patient's characteristics, procedural data, type of anesthesia (SA vs. GA). Postoperatively we evaluated hemoglobin drop, catheterization time (CT), and length of hospital stay (LOS). Functional outcomes were evaluated with the International Prostate Symptoms Score (IPSS) at baseline and 3 months after surgery. Descriptive statistics and linear regression models tested the association between anesthesia type and EEP outcomes. After matching groups were comparable in terms of pre- and intra-operative variables. Of all, 111 (75%) patients were treated under SA. Haemoglobin drop was lower in GA compared to SA group (1 vs. 1.4g/dL, p < 0.01). CT was shorter in the GA group (1 vs. 2 days, p = 0.01). Postoperative IPSS score was lower in GA group (4 vs. 8, p = 0.04). Multivariable linear regression models revealed that prostate volume (p = 0.01) and SA vs. GA (p = 0.01) were associated with higher haemoglobin drop, after accounting for age and use of anticoagulants/antiplatelets. Similarly, SA vs. GA (p = 0.02) and postoperative complications occurrence (p < 0.001) were associated with a longer LOS, after accounting for age, prostate volume and use of anticoagulants/antiplatelets. EEP can be safely performed under both GA and SA. GA offers better outcomes in terms of perioperative bleeding and 3-month functional outcomes.

The First Triple Agonist for Antiobesity: Retatrutide

The prevalence of individuals with overweight and obesity has increased by 18% since 1990 and it is projected that by 2030, nearly 50% of US adults will have obesity. Lifestyle modifications, such as diet and exercise, typically lead to approximately 3–5% weight loss, whereas 5–15% weight loss is necessary to significantly impact obesity-associated comorbidities and improve overall health outcomes. In addition to lifestyle modifications, pharmacotherapy has been utilized as an adjunctive treatment to increase weight loss and improve health outcomes. The Food and Drug Administration has currently approved 6 drugs to treat overweight and obesity, with the recently approved drugs surging in popularity after demonstrating superior weight loss outcomes. Additionally, a number of agents are in the pipeline, offering promise of unprecedented degrees of weight loss. One such drug is retatrutide, which is a triple agonist targeting the glucagon-like peptide-1 receptor (GLP-1R), glucose-dependent insulinotropic polypeptide receptor, and glucagon receptor. Phase 1 and 2 clinical trials have demonstrated the safety, tolerability, and pharmacokinetics of retatrutide in patients with obesity and/or type 2 diabetes. The pharmacokinetics of retatrutide were dose proportional and its mean half-life of approximately 6 days supported a once-weekly dosing. The safety profile was similar to GLP-1R agonists and glucose-dependent insulinotropic polypeptide receptor/GLP-1R co-agonists, with gastrointestinal disorders being the most common adverse effects reported. Each trial demonstrated greater weight loss with retatrutide treatment in comparison to placebo, with greatest efficacy at higher doses. Overall, these clinical trials have demonstrated the superior efficacy of retatrutide as a weight loss medication in patients with overweight and obesity.

MATERNAL AND PERINATAL OUTCOMES OF EARLY TRIMESTER BLEEDING

Bleeding per vagina is one of the most everyday presentations in the first trimester, with an incidence of 15- 25%. These pregnancies end up in pregnancy loss and multiple poor feto-maternal outcomes requiring early registration and treatment. Objectives: To evaluate for maternal perinatal outcomes in normal intrauterine pregnancies complicated by first-trimester vaginal bleeding Methods: This cohort study was conducted at the Gynecology and Obstetrics department of Lady Reading Hospital Peshawar from January 2024 till the required sample size is obtained in May 2024. Data were collected from 195 pregnant females. Women were divided into two groups. All pregnant women with singleton pregnancy and with or without vaginal bleeding during the first trimester, defined as up to the first 12 weeks of pregnancy, both delivering at our institute, were selected. Results: Miscarriage rates were notably higher in the exposed group (20.4% vs. 10.3%, OR 3.5, p=0.02), as were preterm births (22.4% vs. 15.5%, OR 2.8, p=0.01) and placental complications (12.2% vs. 5.2%, OR 4.2, p=0.03). The exposed group also had higher rates of postpartum hemorrhage (14.3% vs. 10.3%, OR 2.2, p=0.01), though cesarean section rates were similar between groups (30.6% vs. 30.9%, OR 2.0, p=0.15). Conclusion: It is concluded that early trimester bleeding is associated with an increased risk of adverse maternal and perinatal outcomes, including miscarriage, preterm birth, placental complications, and low birth weight.

6851 Rapidly Increasing Use of Anti-Obesity Medications among Veterans in the Veterans Health Administration (VA)

Abstract Disclosure: V. Vimalananda: None. S. Qian: None. R. Bolton: None. A. Hung: None. V. Smith: None. M. Maciejewski: None. Introduction: Obesity is a prevalent and costly chronic disease that compromises quality of life; increases risks of cardiometabolic disease, osteoarthritis, and several cancers; and accounts for 28% of U.S. health care costs. Anti-obesity medications (AOMs) may fill the treatment gap given the low uptake of bariatric surgery and limited effectiveness of behavioral interventions, and are guideline-recommended as part of a comprehensive obesity treatment plan. The landscape for obesity treatment has changed with introduction of the highly effective and in-demand glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1 + GIP receptor agonists (GIP/GLP-1 RAs). Given limited knowledge of use patterns, we describe use of AOMs among patients receiving care in the Veterans Health Administration (VA), which is the largest integrated health system in the United States. Methods: In a retrospective cohort study of VA patients from 7/1/2021-6/30/2023, we examined data from the VHA Corporate Data Warehouse separately for patients on AOMs without and with diagnosed diabetes, since the newer AOMs can be used at lower doses for the diabetes indication. Results: There were 31,106 patients without diabetes and at least one AOM prescription in the two year study period, who were 60% male and 62% White. AOM prescriptions from Year 1 to Year 2 among this group increased 215%. Overall, prescriptions were: semaglutide 34%, liraglutide 18%, orlistat 18%, phentermine/topiramate 14%, bupropion/naltrexone 12%, phentermine 4% and tirzepatide 0.03%. Prescribers were physicians 60%, LIPs 25%, and pharmacists 13%. There were 188,017 patients with diagnosed diabetes and at least one AOM prescription, and they were 92% male and 67% white. AOM prescriptions from Year 1 to Year 2 among this group increased 14% and were primarily (87%) for semaglutide. Prescribers were physicians 63%, licensed independent practitioners (LIPs) 23%, and pharmacists 10%. Conclusions AOM use is increasing in VA across all AOM classes, particularly among patients without diabetes, indicating growing interest in medical treatment of obesity. As AOM use spreads, real-world evidence on weight loss and clinical outcomes is needed among patients like those in VA who tend to be older and less healthy than the highly selected patients included in randomized clinical trials. Data is especially needed to guide practice among patients with obesity and without diabetes, given the dramatic increase in use among that group over the past 2 years. Presentation: 6/1/2024

Marginal bone loss and soft tissue health around two-implant mandibular overdenture retained with milled versus selective laser melted cobalt chromium bar: a randomized clinical trial

BackgroundTo assess marginal bone loss and soft tissue health around two-implant mandibular overdenture retained with milled versus selective laser-melted cobalt chromium (Co-Cr) bars.MethodThis research was set to be a parallel, triple-blinded, randomised controlled trial. Twenty completely edentulous patients received new conventional complete dentures according to conventional techniques. Two implants were placed at mandibular canine areas bilaterally, and patients were randomly allocated into two equal groups: the milled Co-Cr bar group and the selective laser melted (SLM) Co-Cr bar group. Marginal bone loss (MBL), modified plaque index (mPI), modified gingival index (mGI), and probing depth (PD) were evaluated at 0-month (baseline), 6-month, and 12-month follow-up visits. Repeated measures ANOVA test and Bonferroni’s post-hoc test were used for parametric data as PD, while for non-parametric data as MBL, mGI, and mPI, Mann-Whitney U test and Friedman’s test were used. A P-value ≤ 0.05 was set as the statistical level of significance. The study protocol was approved by the Faculty Research Ethics Committee at Minia University (636 4/10/2022). Registration for the clinical trial was made retrospectively on clinicaltrials.gov with ID NCT06401200 at 04/30/2024.ResultsThe follow-up period (one year) was completed without a dropout. Regarding MBL, no statistically significant difference was found between the two groups throughout the study. However, the milled group showed significantly increased MBL from 0- to 6-month follow up period. In both groups, mPI increased significantly from 0- to 6-months post-loading. On the other hand, no statistically significant difference between the two groups was found regarding mPI and mGI throughout the study follow-up periods. The PD was significantly lower in the milled compared to the SLM group at the 6- and 12-month follow up period.ConclusionTwo-implant mandibular overdenture retained with milled or SLM Co-Cr bar can provide an acceptable treatment option for completely edentulous patients regarding marginal bone loss and soft tissue outcomes.