Impact of Laparoscopic Sleeve Gastrectomy on Obese Type 2 Diabetic Patients and Role of Gut Hormones Peptide Tyrosine Tyrosine and Glucagon Like Peptide 1on Remission of Diabetes

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

Fraser syndrome: Phenotypic variability and unusual findings in four Egyptian families

Background and aim: Fraser syndrome [FS] is a rare autosomal recessive disorder characterized by cryptophthalmos, cutaneous syndactyly, laryngeal malformations and urogenital defects. It may be also associated with ear, nose and skeletal abnormalities. There is a marked interfamilial clinical variability. However, there is strong phenotypic similarity and concordance of the degree of severity of the disease within a family. Our aim was to report new cases of FS from the Egyptian population

Patients and methods: The study was carried out on 6 new cases of FS from four Egyptian families. All patients satisfied the diagnostic criteria for FS

Results: Cryptophthalmos and ambiguous genitalia were each present in 5/6 of the studied cases, while syndactyly and urinary tract abnormalities were found in 4/6 of them. Nasal anomalies, sclerocornea and abnormal hair growth pattern were constant features observed in 100% of the cases. The frequency of additional anomalies in our series was also higher than those previously reported as umbilical abnormalities and contractures of large joints

Conclusion: In conclusion, our findings add further evidence for the clinical variability associated with FS. The studied cases showed inconsistent compatibility with life and variable expressions in prenatal sonographic findings and postnatal clinical manifestations

Respiratory manifestations of heart stroke in the pilgrims

This study was carried out on 136 cases of heat stroke during Mecca pilgrimage of 1981. Clinical, radiological, ECG and laboratory studies including blood gases, acid base, electrolytes, enzymes, hepatic and renal functions and some hematological studies were done. Respiratory involvement was evidenced by the presence of disturbed rate or rhythm of breathing in all cases and the common finding of cyanosis [62%] X-ray chest for 82 cases revealed the presence of lobar or broncho-pneumonia in 31.4% and atelectasis of right upper lobe in two cases. Pulmonary edema was found in six cases. Hypoxemia was present in all measurements. Hypocapnia was present in the majority of cases [87.7%], while hypercapnia was found in three emphysematous and an obese patients. Serum electrolytes showed that sodium level was normal in 68.3%, low in 21.5% and high in 10.2%, while potassium level was low in 58%, none in 41.3% and high in only a case of acute renal failure [0.7%]. The multisystem involvement was evident. A relatively low mortality of 20% reflects the value of prompt diagnosis and immediate treatment

respiratory effects of ketamine in asthmatic patients

Clinical and pulmonary function studies including blood gas measurements were done on 20 volunteers: 10 controls and 10 asthmatics for evaluation of the respiratory effects of ketamine. During anaesthesia two asthmatic patients got apnea, 2 got cough while in controls one got apnea and another got cough. No dysrrhythmia developed in both groups. Pulmonary function and blood gas studies showed that ketamine does not significantly alter lung function in asthmatic patients. It can be concluded that ketamine can be safely given to asthmatic patients

Thiopentone, althesin, ketamine and diazepam effect on the intraocular pressure

The effect of thiopentone, althesin, ketamine and diazepam on the IOP were studied in 60 patients with cataract and/or glucoma. Thiopentone, althesin and diazepam reduce the IOP significantly to the same extent whereas ketamine increases the IOP significantly

Some liver function studies in post traumatic cases receiving total parenteral nutrition

Twenty patients with post traumatic coma admitted to I.C.U. were studied for liver functions. Fat free TPN therapy was given and some of the liver function tests were performed on five occasions. SAP, SGPT, SGOT and LDH showed a significant increase after 7, 14, and 21 days. Total serum proteins showed a significant decrease after 7, 14, and 21 days, while albumin also decreased significantly after 14 and 21 days. Balanced parenteral nutrition regimen consisting of dextrose vamin and intralipid supplemented by minerals, electrolytes, vitamins, co-factors and micronutrients is recommended for critically ill patients. Liver functions evaluation is essential in cases undergoing TPN therapy