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Our Study Aimed: To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on obese T2DM patients, its effect in remission of diabetes and role of gastrointestinal Glucagon like peptide 1(GLP1) and Peptide tyrosine tyrosine (PYY) hormones.Metabolic surgery should be recommended as an option in type 2 diabetic patients (T2DM) with body mass index (BMI) ≥40 Kg/m2, in patients who have BMI ≥35 Kg/m2and in selected patients with BMI < 35 Kg/m2, if not achieving diabetes control with maximum tolerated anti-hyperglycemic treatment. Methods:30 T2DM patients with BMI ≥ 40 kg/m2underwent laparoscopic sleeve gastrectomy after full clinical evaluation, routine blood tests, glucagon like peptide 1, Peptide tyrosine tyrosine (fasting, 0.5-hour post-mixed meal test (MMT) serum levels) and upper GIT endoscopy. Follow-up visits were at 3, 6and 9 months postoperatively to evaluate body weight, BMI and glycated hemoglobin (HbA1C) and at 18thmonth for confirmation of diabetes remission. Gut hormones were measured at 15 days and 9 months postoperatively.Results: (53.3%) of patients had partial remission of T2DM according to HbA1C remission criteria. There was significant increase in fasting and post-MMT levels of peptide tyrosine tyrosine, glucagon like peptide 1 postoperatively. The only independent predictors for remission of T2DM were the baseline serum low density lipoprotein cholesterol (LDL-Ch), duration of diabetes, preoperative post MMT Peptide tyrosine tyrosine plasma level, serum thyroid stimulating hormone (TSH) and age. Conclusions: laparoscopic sleeve gastrectomycan induce partial remission of diabetes in younger patients who had shorter duration of diabetes, higher level of preoperative post-MMT peptide tyrosine tyrosine,lower levels of preoperative serum LDL-Ch and thyroid stimulating hormone
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Background: The aim of this study is to predict difficult airway on the basis of various airway assessment parameter in the paediatric population between 5-12 years age group. To assess the value of modified Mallampati test (MMT), upper-lip-bite test (ULBT), thyromental distance (TMD), ratio of height to thyromental distance (RHTMD) from which Cormack Lehane grade was derived to predict difficult airway i.e. difficult intubation in paediatric patients ranging from 5-12 years age. Material and Methods: 100 ASA grade I & II paediatric patients of either sex between the age group of 5-12 years posted for elective surgery under general anaesthesia requiring endotracheal intubation were included in the study. Modified Mallampati test, upper lip bite test, thyromental distance and ratio of height to thyromental distance of the patients were measured and recorded. All the distances were measured with the help of a flexible measuring tape so as to measure the distances accurately. Results: Modified Mallampati test has the highest sensitivity (75%) and specificity (92.05%) among all the other screening tests. It also has high positive predictive value (56.25%), negative predictive value (96.43%) and diagnostic accuracy (90%). Upper Lip Bite test has high specificity (79.55%) and negative predictive value (93.33%) with high diagnostic accuracy (77%). It has a sensitivity of 58.33% which is similar to the sensitivity of thyromental distance and ratio of height to thyromental distance. Thyromental distance has high specificity (65.90%) with high negative predictive value (92.06%). Conclusion: Modified Mallampati test is a useful bedside screening test for predicting difficult intubation in patients between 5-12 years age group. The Upper Lip bite test and thyromental distance has high specificity with high negative predictive value and diagnostic accuracy. The ratio of height to thyromental distance is least useful predictor of airway assessment.
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@#In Malaysia, drug addiction has been a big threat since 1983.As of by latest statistic by National Anti-Drug Agency in 2016, the number of drug abusers in Malaysia was 30846.Acknowledging the importance of drug abuse and relapse as a public health issue, Malaysian government had implemented Harm Reduction Programme .Under this programme, Methadone Maintenance Therapy (MMT) was launched in Oct 2005. This study was undertaken to evaluate the effectiveness of MMT programme among opiate dependent individuals in their daily life. In this study, 100 individuals from the Ministry of Health (MoH), Klinik Kesihatan Bayan Lepas (Bayan Lepas Health Clinic) and Agensi Anti-Dadah Kebangsaan (National Anti-Drug Agency) in Telok Bahang were involved. The subjects were interviewed with WHOQOL BREF questionnaires before joining the MMT programme and also after minimum 4 months of joining MMT. Results obtained were used for comparing life style implications among methadone patients before and after joining the MMT programme. Subjects were predominantly of Malay ethnicity (82%). Subjects were mostly aged between 51 to 60 years old (34%). Paired t-test was done on the WHOQOL scores at baseline (before MMT) and after minimum of 4 months enrolment for all four domains. Each domain showed significant improvement in QOL (P<0.05).The highest improvement was shown in the psychology domain with the mean value increment of 15.13±17.49. Physical domain showed the least improvement with the mean value of 9.39±16.21.This study has proven that MMT have highly contributed to improvement of quality of life among MMT clients in Klinik Kesihatan Bayan Lepas and AADK Telok Bahang.
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Objective: To investigate the prevalence of alcohol use and related influencing factors among the patients with methadone maintenance treatment (MMT) in Shanghai, and to provide information for the alcohol intervention in the future. Methods: A total of 837 MMT patients were investigated and evaluated by General Situation Questionnaire, Alcohol Use Disorders Identification Test, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, General Well-being Schedule. According to whether drinking or not in the past year, the two groups were divided into the non-drinking group and the drinking group. T-test, Chi-square test and multivariate Logistic regression analysis were used to detected between two groups. Results: 30.9% of the patients had drinking behavior in the past year, 13.8% of them had problem drinking behavior. The main factors affecting patients' drinking behavior were sex (P=0.029), age of first drug use (P=0.005), drinking before taking heroin (P=0.000) and drinking when taking heroin (P=0.000). Conclusion: In Shanghai, alcohol consumption is generally prevalent among MMT patients who lack awareness of the dangerous of drinking. In the future, targeted intervention measures should be taken to reduce the harm of drinking among MMT patients.
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Chitosan/montmorillonite (MMT) and Poly vinyl Alcohol (PVA) / Silver nanoparticles (AgNPs) nanocomposites were prepared and formed hydrogel membranes using freeze thawing technique. The properties of the prepared hydrogels were investigated and compared to hydrogel membranes in presence and absence of nanometals. The physical behavior, mechanical properties and antibacterial activity was examined. Also the surface morphology monitored using scanning electron microscope. Antimicrobial activity against bacteria and yeast was also examined. The obtained results showed positive effect of nanometals especially AgNPs on swelling percent on the other hand tensile strength were combined by presence of MMT nanoparticles. The surface morphology showed homogenous images for all samples except samples containing MMT. All prepared samples containing nanoparticles showed antibacterial activity especially hydrogel membranes containing AgNPs.
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Objective To explore the efficacy of zolpidem in improvement of sleep quality of patients received methadone maintenance treatment (MMT).Methods 80 cases of MMT with insomnia were randomly divided into the study group (administered with zolpidem)and the control group (administered with placebo), 40 cases in each group.Pittsburgh sleep quality index (PSQI)and treatment emergent symptoms scale (TESS)were assessed before treatment and at the weekend of 4th,8th after treatment.Results The scores of PSQI in the study group were much lower than those in the control group (t =-2.517,P =0.014;t =-3.611,P =0.000),while the effective rate in the study group was significantly higher than that in the control group (χ2 =4.949,P =0.026). Conclusion Zolpidem could improve the sleep quality of patients with MMT.
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Drug dependence has been a hot topic in neuroscience research due to its complicated pathogenesis. Recently, huge scientific efforts have been continuously put into understanding the association between drug dependence and polymorphism in ATP-binding cassette subfamily B member 1 transporter ( ABCB1 ) gene, especially a mutation in exon 26 at position 3435 (3435C>T). This article reviews the relationship between opioid dependence and analgesic tolerance and ABCB1 gene pol-ymorphism, which will shed light on the underlying mechanisms of drug dependence and optimal MMT programs for individuals.
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Objective To study the status of continued heroin/amphetamine abuse among MMT outpatients and related factors.Method Urine analysis was conducted for randomly sampled MMT outpatients,and the results were recorded and analyzed by considering the basic conditions of the tested subjects.Results Of the 179 sampled MMT outpatients,39.1%(70/179) admitted continuing to use drugs,of whom 16.2%(29/179) used heroin,18.4%(33/179) used ice,and 4.5%(8/179) used heroin and methamphetamine in combination;gender difference and regular methadone administration were two factors which were related to the continued drug abuse among them.There were no obvious differences between the outpatients who abused heroin and those who abused ice.Conclusion Serious attention should be given to multiple drug abuse among MMT outpatients and to the risk of new emerging drugs.
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Objective To study the effect of methadone maintenance treatment(MMT) on reducing HIV infection among injecting drug users(IDUs) in Yueyang city of Hunan province.Methods Local IDUs were provided with MMT along with peer education and behavior interventions,and they were tested for HIV antibody to evaluate the effect of MMT after one year treatment.Results Of the 113 IDUs who were negative at the entry,none turned to be positive after one year treatment and the negative partners of 22 IDUs with positive HIV antibody remained negative one year later,and the negative rate of urine test maintained at 76.10%.Conclusion MMT combined with peer education and behavior interventions will decrease the use of heroin,prevent HIV infection among IDUs and reduce their partners' susceptibility to HIV.