ABSTRACT
Background: Bariatric surgery is seen as one of the most successful option for the control of morbid obesity and obesity related complications. Although, there are many surgical options available the Lincey Alexida, Xiaohua Qi, Patrick B. Asdell, José M. Martínez Landrón, Samarth B. Patel, Faustino Allongo. Frederick Tiesenga. Laparoscopic Adjustable Gastric Band as a Revision Surgery for Failed Vertical Gastric Sleeve or Roux-en-Y Gastric Bypass. IAIM, 2017; 4(12): 37-42. Page 38 laparoscopic vertical sleeve gastrectomy and the Roux-en-Y gastric bypass are among the most selected treatment methods. Even though the sleeve gastrectomy and the gastric bypass has proven to be efficacious in weight reduction in morbid obesity there are still some reported failures. Aim: This study main objective is to see if an adjustable gastric band can be offered as a sensible option for patients who have had a previously failed vertical sleeve gastrectomy or the Roux-en-Y gastric bypass surgery. The procedure will be classified as a revision surgery to increase the possibilities of additional weight loss not achieved with the sleeve gastrectomy or gastric bypass surgery alone. Method: A retrospective review of the charts for all the bariatric patients from April 2012 to April 2017 was conducted. The chart review yielded 12 patients who underwent either adjustable band over a previously failed vertical sleeve procedure or the adjustable band over a previously failed Roux-enY gastric bypass procedure. The patients were divided into two groups, group A and B. Group A is comprised of the 8 out 12 patients who had a previous failed gastric sleeve procedure. Group B has the remaining 4 patients who had a failed gastric bypass procedure. Observation: Both groups who underwent adjustable gastric band laparoscopically as a revision procedure after a two year follow up appointment showed Group A had a mean estimate weight loss of 30.75 lbs. (11%) with a mean Body Mass Index of 40.7 kg/m2 and Group B had a mean estimate weight loss of 42 lbs. (15%) with a mean Body Mass Index of 36.77 kg/m2 . Group A had an Excess Body Weight Loss of 27% at 1 month and 33% at the 2 year follow up and Group B had an Excess Body Weight Loss of 42.2%. Group B had an Excess Body Weight Loss of 15.1 % at 1 month and 42.2% at the 2 year follow up. Conclusion: Group A had an average of 27% Excess Body Weight Loss and Group B had an Excess Body Weight Loss of 15.1% after 1 month on follow up. Our study was limited by the small sample size. We suggest that further investigational studies, with greater and more diverse sample sizes, be conducted to assure the benefit of using the adjustable gastric band as a revision surgery. Based on our results we conclude that the adjustable gastric band as a revision surgery is a promising and sensible alternative treatment option for patients with a previously failed laparoscopic vertical sleeve gastrectomy or a failed Roux-en-Y gastric bypass.
ABSTRACT
Purpose: Escherichia coli isolated from asymptomatic bacteriuria (ABU) correlated genotypically and phenotypically with cystitis isolates may help in distinguishing urovirulence determinants from ‘fitness factors’, latter necessary only for survival of E. coli in urinary tract; for gaining insight into the pathogenesis of urinary tract infection. Materials and Methods: In this cross‑sectional study, we compared genotypic (phylogroups and 15 putative virulence genes), and phenotypic profiles of ABU E. coli strains with our previously genotyped collection of cystitis isolates. Virulence score was calculated for each isolate as a number of virulence genes detected. Results: Significant differences were observed in the proportion of four phylogenetic groups (P = 0.009) amongst cystitis and ABU isolates. Average virulence score was higher for ABU isolates (6.6) than cystitis strains (4.2); and hlyA (P = 0.001), cytotoxic necrotising factor 1 (P = 0.00), fyuA (P = 0.00), ibeA (P = 0.00), kpsMII (P = 0.01), and malX/pathogenicity‑associated island (P = 0.01) were more frequently present in ABU strains. Conclusions: The expression of adhesins, haemolysin, aerobactin, and capsule synthesis gene were similar in two groups suggesting their role as fitness factors. ABU isolates were better biofilm producers, reflecting its importance in silent persistence. Serum resistance gene which was more expressed in cystitis isolates may represent virulence determinant. Genetic makeup of E. coli does not change much rather genes helping in survival and colonisation are expressed equally in ABU and cystitis isolates as opposed to phenotypic attenuation of those that helps in invasion or inflammation in ABU isolates.
ABSTRACT
Background: Citrobacter is an important nosocomial pathogen and its multidrug resistant (MDR) isolates are increasingly being reported across the globe. They are known to produce extended spectrum beta lactamase (ESBL) and harbor CTX-M gene. Objective: The aim was to isolate Citrobacter sp. from clinical specimens, analyze their MDR status and look for the presence of CTX-M gene. Materials and Methods: In this prospective study, Citrobacter isolates positive for ESBL on screening, were confirmed by combined disc method along with minimum inhibitory concentration (MIC) for cefotaxime. In selected cefotaxime resistant isolates, multiplex polymerase chain reaction was done for blaCTX-M gene. Results: Of 146 Citrobacter sp. isolated, most (73%) were from admitted patients and hospital stay of >72 h and prior antibiotic intake were the most common associated factors. Maximum isolates were from pus (41.1%). Citrobacter freundii was the commonest species (49%) followed by Citrobacter koseri (28%); 79 were ESBL producers. Seventy were cefotaxime resistant as shown by MIC. blaCTX-M gene was detected in 15/40 of these isolates, all belonged to CTX-M group 1. Conclusion: Overall incidence of Citrobacter in our setup is low, but they were mostly MDR, and ESBL production was high, which is a cause of concern. blaCTX-M gene detection is important because of its rapid transmission to other bacterial species.
ABSTRACT
Environmental pollution adversely affects health of the people. Industrialization, urbanization, over exploitation of natural resources and increasing number of automobiles have aggravated the pollution manifold though there are various ways to mitigate the environmental pollution. Bio-remediation by using selected plant species is an effective method to control pollution which is universally accepted. Bougainvillea is a pollution tolerant plant and can help in the mitigation of air pollution besides its ornamental value in the landscaping. From the rich germplasm collection in NBRI Botanical Garden, tolerant plants have been experimented for road side plantation in view of mitigating the environmental pollution.