Background: Combination anti-obesity medications (AOMs) to treat postoperative bariatric surgery weight regain have limited data on their use in the clinical setting.Understanding the optimal treatment protocol in this cohort will maximize weight loss outcomes. Methods: A retrospective review of bariatric surgery patients (N = 44) presenting with weight regain at a single academic multidisciplinary obesity center who were prescribed AOM(s) plus intensive lifestyle modification for 12 months. Results: Age: 28-76 years old, 93% female, mean weight 110.2 � 20.3 kg, BMI 39.7 � 7.4 kg/m 2 , presenting 5.2 � 1.6 years post-bariatric surgery [27 (61.4%), 14 (31.8%), and 3 (6.8%) laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic vertical sleeve gastrectomy (VSG), and open RYGB, respectively], with 15.1 � 11.1 kg mean weight gain from nadir. Mean weight loss after medical intervention at 3-, 6-, and 12-month time points was 4.4 � 4.6 kg, 7.3 � 7.0 kg, and 10.7 � 9.2 kg, respectively. At 12 months, individuals prescribed 3 or more AOMs lost more weight than those prescribed one (−14.5 � 9.0 kg vs. −4.9 � 5.7 kg, p < 0.05) irrespective of age, gender, number of comorbidities, initial weight or BMI, type of surgery, or GLP1 use. RYGB patients lost less weight overall (7.4% vs. 14.8% VSG respectively; p < 0.05).Conclusions: Combination AOMs may be needed to achieve optimal weight loss results to treat post-operative weight regain.
INTRODUCTION: Racial disparities in outcomes have been reported in various medical conditions and in patients with traumatic brain injury (TBI). Despite equal access to acute rehabilitation, blacks had significantly worse long-term functional outcomes after TBI than non-Hispanic whites (NHWs). Much effort has been placed on raising awareness, improving access to care, expanding research, and on closing racial disparity gaps in healthcare.METHODS: Patients followed and tracked in the Southeastern Michigan Traumatic Brain Injury System (SEMTBIS) database were inquired, including 95 non-Hispanic whites (NHWs) and 97 blacks. Severe TBI was defined as Abbreviated Injury Scale [AIS] score of 3-5. Patients from February 2010 to December 2019 were included. Longterm outcomes were measured by 1) the percentage of patients discharged to home, and 2) the Glasgow Outcome Scale-Extended (GOSE) score after 1 year. Student's T-test was used for numeric data analysis. Chisquare was used for categorical data comparison.RESULTS: There were no significant differences in initial TBI severity between non-Hispanic whites (NHWs) and blacks, measured by the admission Glasgow Coma Scale (GCS), the percentage of people who had midline shift >5 mm on brain CT, the number of days from injury to date out of posttraumatic amnesia, and of days from injury to following commands. More NHWs were discharged to low acuity facilities (80% versus 58.8%, P = 0.0014). A higher percentage of NHWs had an upper good recovery score, which is a GOSE score of 8 (23.1% versus 9.3%, P = 0.074) after 1-year follow-up.CONCLUSIONS: Despite efforts to mitigate racial disparities in medical outcomes after TBI, the blacks in Southeastern Michigan continue to score lower than NHWs on their long-term functional outcomes at one-year follow-up.
BackgroundAn association between poor dentition and the risk of ischemic stroke has previously been reported in the literature. In this study we assessed oral hygiene (OH), including tooth loss and the presence of dental disease, to determine if an association exists with functional outcomes following mechanical thrombectomy (MT) for large-vessel ischemic stroke.MethodsA retrospective review was conducted of consecutive adult patients at a single comprehensive stroke center who underwent MT from 2012 to 2018. Inclusion criteria included availability of CT imaging to radiographically assess OH. A multivariate analysis was performed, with the primary outcome being 90-day post-thrombectomy modified Rankin Scale (mRS) score >2.ResultsA total of 276 patients met the inclusion criteria. The average number of missing teeth was significantly higher in patients with a poor functional outcome (mean (SD) 10 (11) vs 4 (6), p<0.001). The presence of dental disease was associated with poor functional outcome, including cavities (21 (27%) vs 13 (8%), p<0.001), periapical infection (18 (23%) vs 11 (6.7%), p<0.001), and bone loss (27 (35%) vs 11 (6.7%), p<0.001). Unadjusted, missing teeth was a univariate predictor of poor outcome (OR 1.09 (95% CI 1.06 to 1.13), p<0.001). After adjustment for recanalization scores and use of tissue plasminogen activator (tPA), missing teeth remained a predictor of poor outcome (OR 1.07 (95% CI 1.03 to 1.11), p<0.001).ConclusionMissing teeth and the presence of dental disease are inversely correlated with functional independence following MT, independent of thrombectomy success or tPA status.
Type 1 diabetes mellitus (T1DM) with obesity is increasingly common, prompting effective clinical interventions to induce weight loss in this population. We present 3 patients with T1DM and obesity prescribed a glucagon-like peptide 1 receptor agonist (GLP-1RA) and pramlintide. Case 1: A 32-year-old male with obstructive sleep apnea (OSA) who lost −20.9 kg (−16.1% of total body weight [TBW]) over 10 months on semaglutide and pramlintide. Case 2: A 68-year-old female with diabetic retinopathy, coronary artery disease, hypertension, hypothyroidism, and depression/anxiety initially treated with topiramate, losing −8.4 kg, but experiencing weight plateau. After adding dulaglutide and pramlintide, she lost an additional −12.8 kg (−14.0% TBW) over 7 months, with total weight loss of −21.2 kg (−23.1% TBW). Case 3: A 49-year-old female with hypertension, hypothyroidism, and depression who lost −14.6 kg (−17.9% TBW) over 6 months on semaglutide and pramlintide. No significant side effects were experienced. All patients reported decreased insulin requirements on pramlintide, and hemoglobin A1c levels remained constant or decreased throughout the treatment period. Pramlintide and GLP-1RA resulted in excellent weight loss in our patients with obesity and T1DM. This combination may have a synergistic effect on the gut-brain axis. More research is required to substantiate these findings.
Introduction: The middle fossa craniotomy (MFCs) is commonly utilized for spontaneous cerebrospinal fluid (CSF) leaks, encephaloceles, and semi-circular canal dehiscence (SSCD). This study compares postoperative outcomes of MFCs with and without LD use. Methods: A retrospective cohort study of adults over age 18-years presenting for repair of non-neoplastic CSF leak, encephalocele, or SSCD via MFC from 2009-2021 was conducted. The main exposure of interest was placement of a LD. The primary outcome was presence of postoperative complications (acute/delayed neurologic deficit, meningitis, intracranial hemorrhage, stroke). Secondary outcomes included operating room (OR) time, length of stay, recurrence, and need for reoperation. Results: In total, 172 patients were included, 96 of whom received an LD and 76 who did not. Patients not receiving an LD were more likely to receive intraoperative mannitol (n=24, 31.6% vs. n=16, 16.7%, p=0.02). On univariate logistic regression, LD placement did not influence overall postoperative complications (OR 0.38, 95% CI 0.05-2.02, p=0.28), CSF leak recurrence (OR 0.75, 95% CI 0.25-2.29, p=0.61), or need for reoperation (OR 1.47, 95% CI 0.48-4.96, p=0.51). While OR time was shorter for patients not receiving LD (349±71 minutes vs. 372±85 minutes), this difference was not statistically significant (p=0.07). Conclusion: No difference in postoperative outcomes was observed in patients who had an intraoperative LD placed compared to those without LD. Operative times were increased in the LD cohort, but this difference was not statistically significant. Given the similar outcomes, we conclude that LD is not necessary to facilitate safe MCF for non-neoplastic skull base pathologies.
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