Five‐year long‐term clinical outcome after bariatric metabolic surgery: A multi‐ethnic Asian population in Singapore

Bariatric surgery is an effective treatment for morbid obesity and its metabolic related comorbidities; type 2 diabetes, hypertension and hyperlipidaemia.¹ However, the literature is scarce regarding the long‐term outcome after bariatric surgery, especially among multi‐ethnic Asian populations. Considering the growing number of bariatric metabolic surgeries in Asia, we have attempted to provide a regional perspective on 5‐year long‐term clinical outcomes post bariatric surgery in Singapore. Between 2010 and 2016, all bariatric operative cases were included, and these comprised: laparoscopic sleeve gastrectomy (LSG), 393; laparoscopic Roux‐En‐Y gastric bypass (RYGB), 125; laparoscopic mini‐gastric bypass (MGB), 43. The primary outcome measure was the percentage of excess weight loss (% EWL) at 6 months, 1, 2, 3, 4 and 5 years, with % remission of type 2 diabetes mellitus (T2DM) at 1 year following LSG (49.7%, 61.2%, 56.1%, 47.8%, 40.8% and 47.3%; 82.2%), RYGB (60.2%, 62.1%, 57.6%, 50.1%, 48.7% and 47.7%; 86.9%) and MGB (58%, 68.1%, 62.7%, 66.2%, 64.0%, 65.2%; 71.9%). In conclusion, MGB and RYGB showed the greatest % EWL at 5 years and are recommended for moderate T2DM. LSG is an effective bariatric operation with a high % EWL up to 2 years, and a high remission rate of mild T2DM. The remission rate of T2DM was equally high in all 3 surgical groups, independent of ethnic differences.     

Immunogenicity and safety of recombinantHelicobacter pylori urease in a nonhuman primate

Groups of squirrel monkeys (Saimiri spp.), predetermined to be free ofHelicobacter infections in the gastric mucosa, were immunized orally with 0.5–4.5 mg ofHelicobacter pylori recombinant urease (rUrease) and 25–500 µg ofEscherichia coli heat-labile enterotoxin (LT) adjuvant. Oral immunization with rUrease resulted in a markedly elevated serum immunoglobulin G (IgG) antibody response with peak levels at 45 days after immunization. No significant gastric inflammation or cytotoxicity was evident in rUrease immunized monkeys as determined by light and electron microscopy. Twenty-five micrograms of LT was a sufficient and safe adjuvant dosage, whereas higher dosages resulted in diarrhea and lethargy. Animals developed a serum IgG antibody response to LT that did not impede the production of anti-rUrease antibody levels. The results of this investigation indicate that rUrease is immunogenic in a nonhuman primate.This work was funded by OraVax, Inc., Cambridge, Massachusetts.     

The Mechanism of Weight Loss after Ileo-gastrostomy for Morbid Obesity

Twelve patients (weight 107-178 kg and age range 19-43 years) were investigated following ileo-gastrostomy for morbid obesity. A number of variables were studied prospectively, pre- and postoperatively, to determine the cause of weight loss--previously attributed to malabsorption or decreased caloric intake. Weight loss of 10.9-36.5 kg, mean 22.9 kg, occurred. Three-day calorie counts demonstrated a postoperative decrease in daily caloric consumption of 320-3870, mean 1975 cal. Analysis of body compartment composition after derivation of lean body mass (from calculation of total body water with tritiated water) showed a mean decrease in adipose tissue of 17.7 kg. Postoperative weight loss, mainly fat, could not all be accounted for by decreased caloric consumption or steatorrhoea (72-h stool fat increased by a mean of 30 g). Pulmonary studies showed no significant change in respiratory quotient, but a large decrease in both postoperative utilization of oxygen and the production of carbon dioxide. This may indicate an alternate, anaerobic, energy cycle utilization. Other statistically significant variables included a large fall in cholesterol, LDH cholesterol and triglycerides, and smaller decrease in HDL cholesterol. Changes in gastro-intestinal (GI) hormones and cell counts in stomach and small intestine were also measured and will be reported later.     

Prevalence of Primary Headache Syndrome in Adults in the Qassim Region of Saudi Arabia

Background and Purpose: Headache occurs worldwide, but documentation on the burden of headache in Saudi communities is quite limited. The aim of this study was to determine the prevalence of primary headache in a rural community in the Qassim region of Saudi Arabia.
Methods: A door-to-door survey of subjects older than 15 years of age was used for completion of a structured questionnaire to determine headache types based on defined criteria. Physical examination was used to exclude secondary causes.
Results: Of 5891 inhabitants, 473 suffered from headaches. The crude lifetime prevalence rate was 8% (95% CI, 7.3% to 8.7%) and with age adjustment was 9.3% (8.6% to 10%). Headache sufferers were predominantly women. The age-specific rate increased progressively, peaking in the sixth decade. Tension-type headache diagnosed in 185 subjects predominated (3.1%), while the prevalence of migraine was 2.6%.
Conclusion: The findings agree with the reported prevalence of 10% to 12% in other communities in the Kingdom of Saudi Arabia, but lower than the rates in Western countries. The lower rates are probably related to sociocultural factors.