The Influence of Pregnancy on Weight Loss After Previous Bariatric Surgery.

Introduction: Bariatric surgery is routinely performed on obese women of reproductive age, most commonly with the laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass procedures (RYGB). This study analyzes the effects of postoperative pregnancy on excess BMI loss percentage (EBMIL%) after SG and RYGB. Methods: A retrospective study was conducted with 191 female patients of reproductive age between 20 and 40 years who underwent SG and RYGB performed at our institution between January 2017 and December 2018. A comparison of the results at 4-year follow-up was performed between patients who became pregnant after bariatric surgery with patients who did not. Results: Among 191 total cases, 32 (16.7%) patients became pregnant within a 4-year follow-up period, and 159 (83.2%) patients did not. The median postoperative body mass index (BMI) in the pregnant group was 33.3 kg/m2 (interquartile range [IQR] 30.1-38.5) and 33.5 kg/m2 (IQR 28.9-38.6) in the nonpregnant group. The mean EBMIL% within a 4-year follow-up in the pregnant group was 50.4% (standard deviation [SD] 23.5) and 55.5% (SD 30.4) in the nonpregnant group. The median weight before surgery in the pregnant group was 112 kg (IQR 107.9-132.2) and 117 kg (IQR 106-132.5) in the nonpregnant group. The median weight after surgery in the pregnant group was 89.5 kg (IQR 79.5-111) and 88.9 kg (IQR 78-103) in the nonpregnant group. There was no significant difference between outcomes. Conclusion: Weight loss maintenance after bariatric surgery is not impacted by postoperative pregnancy within a 4-year follow-up after SG and RYGB.

Effectiveness of Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) protocol on postoperative pain control.

BACKGROUND: Surgical pain management is a critical component in the success of bariatric procedures. With the opioid epidemic, there have been increased efforts to decrease opioid use. In 2019, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program developed the BSTOP protocol, a multimodal perioperative pain management regimen to minimize opioid use. The objective of this study is to evaluate the effectiveness of the BSTOP protocol on patients' need for opioid medications during their perioperative care. METHODS: This is a single-institution prospective cohort study on patients who underwent bariatric surgery from 10/2019 to 5/2021. Data was collected on morphine equivalent dose of opioids during different stages of inpatient and outpatient care. BSTOP was implemented on 7/2020. Primary outcomes were total inpatient and outpatient opioid use as well as hospital length of hospital stay (LOS). Gabapentin was removed from the protocol between 10/20/2020 and 12/31/2020 due to side effects; it was re-implemented on 1/1/2021 due to observed spikes in opioid use during its absence. RESULTS: 1264 patients who had bariatric surgery between 10/2019 and 5/2021 were included in the study, with 409 patients before (pre-BSTOP) and 855 patients after BSTOP implementation. There was a 36% reduction in total inpatient opiate use and a 57% reduction in total outpatient opiate use. LOS also significantly decreased, from 1.53 to 1.28 days. 179 patients received BSTOP without gabapentin. These patients used more opioids in the post-anesthesia care unit and on the inpatient floors compared to pre-BSTOP and BSTOP with gabapentin patients. With total inpatient and outpatient opioid use, patients on BSTOP without gabapentin used fewer opioids than those pre-BSTOP. However, those on BSTOP without gabapentin used more opioids than those with gabapentin. CONCLUSION: The BSTOP protocol significantly reduced inpatient and outpatient opioid use as well as LOS. Gabapentin is a crucial component of the BSTOP protocol.

Challenges and best practices for hepatitis C care among people who inject drugs in resource limited settings: focus group discussions with healthcare providers in Kenya.

People who inject drugs (PWID) living with Hepatitis C (HCV) in low- and middle-income countries face substantial barriers to HCV care. We sought to gain healthcare providers' perspectives on challenges and best practices for HCV care provision among PWID in Kenya. We conducted three focus group discussions (FGD) with 23 healthcare providers working with PWID living with HCV in Nairobi and Mombasa. Transcribed interviews were analysed thematically. Overarching themes regarding HCV prevention and treatment were: (1) lack of HCV-related knowledge at the provider and patient levels; (2) stigmatisation of people living with HCV and PWID; and (3) difficulties among PWID with navigating the healthcare system. Some providers suggested systematically integrating HCV care into existing PWID-specific harm reduction programs to improve HCV care provision as well as creating national HCV guidelines to guide clinicians. This study highlights the need for national HCV treatment guidelines and increased public HCV education, as well as culturally sensitive models integrating HCV care into programs PWID are already accessing. These strategies will be useful in improving access to HCV care among PWID and has the potential to decrease HCV transmission and prevalence among this vulnerable population.

Linking emergency department patients at risk for human immunodeficiency virus to pre-exposure prophylaxis.

OBJECTIVE: The objective of this study is to describe an Emergency Department (ED)-based, HIV prevention and navigation program and the individuals linked to an in-house clinic for HIV pre-exposure prophylaxis (PrEP) in the first eleven months of program implementation. METHODS: This is a retrospective, observational study of an ED-based HIV prevention and navigation program between January 1, 2019, and November 30, 2019. A status neutral navigation program is housed in the ED with 2-3 navigators staffing approximately 80 h per week. Navigators provide HIV screening with point-of-care testing, sexual health education and counseling, including PEP and PrEP information, and HIV risk assessments. They also make follow-up appointments, appointment reminder calls, and offer to accompany individuals to an in-house HIV clinic for clients who either test positive in the ED for HIV, are known to be living with HIV but are out-of-care, are HIV negative but require post-exposure prophylaxis (PEP) and/or meet criteria for and are interested in starting PrEP. Clients are approached if they request HIV or other sexually transmitted infection testing, present to the ED with genitourinary complaints, or are referred to the program by ED medical providers. Funding for the program is from a New York City Department of Health (NYCDOH) service grant. Data were manually abstracted from program records and from a NYCDOH database. The primary study outcomes are how many clients accepted clinic referral for PrEP, attended their appointments, and received a prescription for PrEP. RESULTS: In the time-period reviewed, complete demographic data and CDC risk factors for HIV were available for 1174 patients. Our program provided appointments for 22 patients who met CDC criteria for PrEP and expressed interest in initiating PrEP. Thirteen patients who attended their scheduled appointment had same day appointments at the on-site clinic, and 11 (85%) were prescribed PrEP. From 1024 paper records with complete data, 914 clients reported that they do not consider themselves at risk for HIV infection. CONCLUSIONS: Most clients that were both eligible and interested in PrEP were prescribed PrEP if given a same day follow-up appointment. Of the clients engaged in this navigation program, almost 80% did not perceive that they were at-risk for HIV infection.

Waist Circumference Measurement Methodology Study: National Health and Nutrition Examination Survey, 2016.

Objective This report compares five methods of waist circumference (WC) measurements: 1) the National Heart, Lung, and Blood Institute (NHLBI-WC); 2) the World Health Organization (WHO-WC); 3) the Multi-Ethnic Study of Atherosclerosis (MESA-WC) using Gulick II Plus tape; 4) the Multi-Ethnic Study of Atherosclerosis (MESA-WC) using Lufkin tape; and 5) assisted self-measurement over clothes (MESA-assisted). Method During 2016, measurements were obtained from 2,297 participants aged 20 and over, who participated in the National Health and Nutrition Examination Survey (NHANES). The mean differences and sensitivity and specificity for abdominal obesity (AO) were calculated between the NHLBI-WC (reference) and the other four WC measurements. Results The mean difference between NHLBI-WC and WHO-WC was 0.81 cm for men and 3.21 cm for women ( p ≤ 0.0125 for both); between NHLBI-WC and MESA-WC (Gulick) was -0.68 cm for men ( p ≤ 0.0125) and -0.89 cm for women; between NHLBI-WC and MESA-WC (Lufkin) was 0.02 cm for men and 0.08 cm for women; and between NHLBI-WC and MESA-assisted was -0.71 cm for men and 1.34 cm for women ( p ≤ 0.0125 for both). Sensitivity and specificity for AO, with NHLBI-WC as a reference, for men were greater than 90% for all methods; for women, sensitivity and specificity for AO for MESA-WC (Lufkin) were greater than 90%; for women, WHO-WC, MESAWC (Gulick), and MESA-assisted methods were greater than 85%.

A Community-Designed Play-Yard Intervention to Prevent Microbial Ingestion: A Baby Water, Sanitation, and Hygiene Pilot Study in Rural Zambia.

Malnourished children in low-income contexts usually suffer from environmental enteric dysfunction, which is damage to the intestines caused by chronic exposure to bacterial pathogens from feces hypothesized to contribute to stunting. Many intervention studies are piloting "Baby water, sanitation, and hygiene (WASH)" to help rural farming families reduce infant and young children's (IYC's) exposure to human and free-range livestock feces. One proposed Baby WASH intervention is a play-yard, which consists of a baby-proofed structure (i.e., playpen) that caregivers can place IYC into while doing chores around the household yard. This article describes the pilot development and assessment of a community-built Baby WASH play-yard and a plastic play-yard intervention with 21 caregivers of 6- to 24-month-old IYC in rural Zambia. A modified Trials of Improved Practices approach was used to conduct three visits in each household: an introductory visit during which play-yard use was explained, a second visit consisting of a semi-structured interview and a session of behavioral counseling, and a final visit which included a 2-hour observation of play-yard use. The second and final visits also included 24-hour recalls, and all three visits included spot observations of play-yard use. Reports from caregivers suggest that the community-built play-yard protected IYC from ingesting soil and livestock feces. Barriers to intervention use included caregivers' WASH beliefs and practices, community reactions, and play-yard maintenance. More work is needed to examine the role of women's time use in their home environment, community reactions to the intervention, and the biological efficacy to reduce microbial ingestion.