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Background: Obesity is an epidemic treatable disease. In Bahrain, the prevalence of obesity was 36.2%. Bariatric surgery should be considered for patients with BMI >= 40, or >= 30 with obesity-related comorbidities. Family physicians have a key role in identifying and counseling patients who may qualify for bariatric surgery. The most common reason for physicians' refusal of referral for bariatric surgeries is fear of complications followed by concern of ineffective weight loss following the surgery. Doctors are not comfortable providing post bariatric operation care. Aim(s): To study the PCPs' knowledge, attitude and practice towards bariatric surgeries in the kingdom of Bahrain. Method(s): this is a cross-sectional study of a convenient sample of physicians working in the Kingdom of Bahrain health centers, using an electronic and manual questionnaire to test the knowledge, attitude and practice towards bariatric surgery. Result(s): The sample included a total of 222 participants. 56.1% agreed that the BMI >= 40 without weight related comorbidities is an indication for bariatric surgery and 92.3% of them referred patients for bariatric surgery, with BMI (88.6%) as the most influential factor followed by presence of comorbidities (87.8%). On the other hand, lack of resources was the main cause for not referring patient for bariatric surgery (29.4%) followed by concerns with follow up (23.5%). 80.6% are comfortable to initiate conversations with their patients about bariatric surgery, while 36.1% feel comfortable explaining the procedural options to a patient. 83.8% agreed that additional medical education in bariatric surgical care would be useful. Conclusion(s): Primary care physicians showed well knowledge about the referral criteria to bariatric surgeries and that's reflected by the high referral rate (92.3%). But there is a gap in the knowledge mean score across different age groups and experience. Less than half of the physicians are not comfortable dealing with patients. Continuous medical education is essential to address the gap and to establish comprehensive obesity management guidelines for primary care physicians.Copyright © 2023, Bahrain Medical Bulletin. All rights reserved.
ABSTRACT
Background/Introduction: Applying eHealth interventions via social media is common in modern medicine. LINE is a popular communication app in Taiwan that can deliver messages 24 hours a day. In addition to being free-of-charge, it also allows bariatric nurses (BNs) and patients to enjoy bidirectional communication via telecommunication services instead of direct, face-to-face contact for patients undergoing bariatric-metabolic surgery (BMS). Objective(s): We conducted this retrospective study to determine the frequency and reasons for early post-discharge of LINE messages/calls and investigate the relationship between this frequency and contents of these messages and postoperative outcomes after BMS. Method(s): A retrospective review of prospectively collected data was conducted in an Asian weight management center. The study period ran from August 2016 to December 2021, and a total of 143 native patients with severe obesity were enrolled. All patients were informed of the necessity of a postoperative dietitian consultation before bariatric surgery. The patterns of LINE communication with the BN and associated actions to resolve patients' needs within 180 days after index BMS were analyzed. Result(s): Among the 143 enrolled patients, 100 underwent laparoscopic sleeve gastrectomy and 43 underwent laparoscopic Roux-en-Y gastric bypass. A total of 1,205 messages/calls were analyzed concomitantly;most LINE communications focused on diet problems (47.97%;n = 578), weight problems (11.54%;n = 139), and medications (9.21%;n = 111). Most problems could be resolved by LINE communications directly, and only a small portion (5.6%) was directed to local clinics or emergency departments. During the COVID-19 pandemic, the usage of LINE communications significantly increased (12.2 +/- 10.4 vs. 6.4 +/- 4.9;p < 0.01);nonetheless, a higher frequency of LINE communications would not hinder the regular clinic visits (r = 0.359;p = 0.01). Conclusion(s): Based on our limited experience, the LINE consultation service operated by the BN could effectively address patients' problems. Moreover, it might reduce the need for emergency department visits or unexpected clinic appointments for patients after BMS.
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Lee Ying New Haven CT1, Grace Chao New Haven CT1, Milot Thaqi New Haven CT1, Maija Cheung Branford CT1, Saber Ghiassi Fairfield CT1, Geoff Nadzam 1, Andrew Duffy New Haven CT1, John Morton MADISON CT2 Yale1 Yale University2 Background: When elective surgeries resumed during the COVID-19 pandemic of 2020, many in-person visits remained virtual. In this study we analyzed weight-loss outcomes for patients undergoing bariatric surgery during in 2020. Methods: This is a retrospective comparison of laparoscopic sleeve gastrectomies (LSG) from January to November at a large academic center in two separate calendar years (2020 and 2017). The average age, preoperative BMI, one-year postoperative percent total weight loss (%TWL), and postoperative follow-up was compared between patients who had surgery in 2020 and 2017. Results: There were 117 LSG cases in 2020, compared to 208 in 2017. There was no difference in the age of patients (years, 42.2 vs. 42), but patients in 2020 had a higher preoperative BMI (2020: 46.9, 2017: 43.5,;p<0.05). The one-year %TWL was lower for patients who underwent surgery in 2020 (2020: 17.9%, 2017: 22.1 %, p<0.05). Compared to outcomes in 2017, the average %TWL in 2020 was significantly lower for patients in 2020 who did not have one-year follow-up of any kind with bariatric surgery (22.1% versus 15.2%, p<0.01). There was no significant difference for those who did have one-year bariatric surgery follow-up (22.1% versus 22.4%, p=0.99). Patient satisfaction did not change. Conclusion: Compared to 2017, patients who underwent LSG during the COVID-19 pandemic tended to be similar in age but had a higher pre-operative BMI and lost less weight when they had no follow up. Ensuring follow-up within the bariatric surgery practice may improve weight loss in telemedicine patients.
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Purpose:determine the effect of sleeve gastrectomy on the quality of life of obese patients. Method: The initial search was based on relevant keywords in the electronic databases PubMed, Scopus, Web of Science, EBSCO and Embase between 2013 to September 2021. The mean difference was calculated with 95% confidence interval (CI) by fixed effect model and inverse variance method. Meta-analysis was performed Result: Three RCT studies, two Prospective studies and one Retrospective study have been included in present article. Mean of Weight and BMI were 126.16 +/- 22.9 kg and 45.45 +/-.21 kg/m(2). Mean differences of quality of life after laparoscopic sleeve gastrectomy in Morbid Obese patients was 21.75 (MD, 95% CI 20.54, 22.96). Conclusion:result indicate an improvement in patients' quality of life after one year of laparoscopic sleeve gastrectomy (p=0.00) and improvement in quality of life is observed in all questionnaires.
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Introduction: Obesity is highly prevalent among patients with renal transplants. It is associated with increased risk of overall mortality, obesity-related complications such as diabetes, increased renal graft loss rates and shortened graft survival. Roux en Y gastric bypass in contrast to other non malabsorptive procedures, may affect the pharmacokinetics of certain drugs, which is of particular importance for immunosuppressant drugs required by patients post-transplant to avoid graft rejection. Methods: 43-year-old female known case of IgA nephropathy biopsy proven in 2000, progressed to end stage renal disease (ESRD) and was initiated on hemodialysis. She underwent live unrelated renal transplantation. Creatinine was 79 micromole/L and eGFR 85ml/min/1.73 m2. Her maintenance immunosuppression included azathioprine 50 mg daily, cyclosporine 75 mg bid and prednisolone 5 mg daily. She had two successful pregnancies post renal transplantations. She developed post renal transplant diabetes in 2013 and uncontrolled hypertension. She had persistent microscopic hematuria. Her creatinine peaked up to 275 micromol/L, her allograft kidney biopsy showed histopathologic features for mild acute T-cell mediated rejection (probably modified slightly by anti-rejection treatment). Grade 1A by Banff working grading. C4d stain is negative with background of focal proliferative and sclerosing glomerulonephritis with associated IgA deposits, consistent with IgA nephropathy ("M1, E1, S1, T0" Oxford classification). Her rejection was treated with pulse IV steroids, azathioprine was changed to mycophenolate and dose of cyclosporine was increased to 100 mg bid. Her creatinine came down to 105 micromol/L. Her post transplantation course involved purpuric rash, joint pain, abdominal pain, h/o HSP biopsy proven with elevated ESR and CRP most likely this is HSP again associated with medication exposure, possible the fibrate. Results: She lost follow up in our clinic and showed up after 5 years with uremic symptoms and creatinine of 1,063micromol/L and was initiated on hemodialysis in 2019. She had second live unrelated renal transplantation, she received 3 sessions of plasma exchange and IVIG prior to transplantation and was maintained on tacrolimus, mycophenolate and prednisolone. Her creatinine was 88 micromol/L. She had Laparoscopic sleeve gastrectomy and Dermo lipectomy of abdominal wall 2 months following her transplantation and lost 22 kgs since then, her BMI was 32 kg/m2 dropped to 24 kg/m2 in 6 months duration. The patient suffered from recurrent multi drug resistant E.Coli urinary tract infection treated with IV ertapenem and continued on trimethoprim sulpha- methoxazole prophylaxis for 6 months. She is still using insulin in smaller doses and her blood sugar is within acceptable ranges. She recently suffered from covid 19 pneumonia requiring home quarantine during which her creatinine went up to 106 micromol/L but settled down to baseline of 88 micromol/L during further follow up. Conclusions: Limited evidence suggests that bariatric surgery is safe and feasible for selected obese patients post-renal transplant. It is associated with good, if variable, short-term excess weight loss and resolution of co-morbidities. More studies should address long term complications in renal trnasplant patient population. No conflict of interest