Objective(s) Roux-en-Y Gastric Bypass (RYGB) is well-known to ameliorate type 2 diabetes mellitus (T2DM), and recent work suggests that the pre-operative DiaREM model predicts successful remission up to 1-year post-RYGB. However, no data exist for long-term validity. Therefore, we sought to determine the utility of this score on long-term RYGB effectiveness for T2DM resolution at 2 and 10 years respectively. Methods T2DM patients (Age: 48, BMI: 49, HbA1C: 8.1) undergoing RYGB at the University of Virginia between 2004-2006 (n=42) and 2012-2014 (n=59) were evaluated prospectively to assess pre-operative DiaREM score, defined from insulin use, age, HbA1C and type of antidiabetic medication. T2DM partial remission status was based on the American Diabetes Association guidelines (HbA1C <6.5% and fasting glycemia <125 mg/dl, and no anti-diabetic medications). Chi-square test was used to compare patient's T2DM status to their DiaREM probability of remission. Results Among RYGB patients with 2-year postoperative data, 2 were lost (n=1 no follow-up and n=1 died) resulting in 57 patients for analysis. For the 10-year postoperative data, 11 were lost (n=6 no follow-up and n=5 died) thereby resulting in only 31 patients for analysis. Patients were distributed by DiaREM score to correlate with the predicted probability of remission as follows: 0-2 (Predicted 94%, 2-year 100% p=0.61, 10-year 100% p=0.72), 3-7 (Predicted 76%, 2-year 94% p=0.08, 10-year 83% p=0.57), 8-12 (Predicted 36%, 2-year 47% p=0.38, 10-year 43% p=0.72), 13-17 (Predicted 22%, 2-year 20% p=0.92, 10-year 33% p=0.64), and 18-22 (Predicted 9%, 2-year 15% p=0.40, 10-year 14% p=0.64). Conclusions Pre-operative DiaREM scores are a good tool for predicting both short- and long-term T2DM remission following RYGB. This study highlights the need to identify strategies that improve T2DM remission in those at highest risk.

Objective(s) Monitoring and prevention of long-term nutrient deficiency after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remains ill defined due to limited surgical follow-up after bariatric surgery. This study compared nutrient supplementation as well as surgeon and primary care physician (PCP) follow-up between patients with short-term versus long-term follow-up. Methods All patients undergoing LRYGB at a single institution in 2004 (long-term group, n=281) and 2012–2013 (short-term group, n=149) were evaluated. Prospectively collected database, Electronic Medical Record (EMR) review and telephone survey were used to obtained follow-up for both cohorts. Multivariate logistic regression was used to assess factors independently predicting multivitamin use. Results Complete follow-up was achieved in 172 (61%) long-term and 107 (72%) short-term patients. We demonstrate a significant difference (p < 0.0001) in time since last surgeon follow-up (13.3±7.8 vs 86.9±39.9 months) for the long-term group with no difference in PCP follow-up, (3.1±4.3 vs 3.7±3.4). Nutrient supplementation was higher in the short-term group, including multivitamin (70.3% vs 58.9%, p<0.05), iron (84.2% vs 67.1%, p=0.02) and calcium (49.5% vs 32.9%, p=0.01). After adjusting for interval since surgery, %EBMI, and current comorbidities logistic regression (c=0.797) demonstrated shorter time since last surgeon visit was independently predictive of multivitamin use (p=0.001). Conclusions While it appears patients prefer to follow-up with their PCP this study reveals a large disparity in malnutrition screening and nutrient supplementation following LRYGB. Therefore, implementation of multidisciplinary, best-practice guidelines to recognize and prevent malnutrition is paramount in the management of this growing population of high-risk patients.

Participants readily shared comments regarding their gastric bypass experience. Exploring themes provided insight into patients' satisfaction with bariatric surgery even when weight-loss goals were not met and conversely substantial dissatisfaction even when weight loss occurred. This study underscores the importance of understanding the patients' long-term experience following bariatric surgery.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in over 120 million cases and nearly 3 million deaths worldwide. 1 The Pfizer-BioNTech (BNT162b2) (Pfizer, Inc) mRNA vaccine was the first to be approved in the United States and received Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA) on December 11, 2020. 2 Health care workers were prioritized to receive the vaccine, and several women who were pregnant or considering becoming pregnant were faced with the difficult decision to receive the potentially lifesaving vaccine with little data about potential effects to their fetus. The American College of Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine issued a joint statement in December advocating pregnant individuals at high risk for contracting the virus should be able to decide whether they will receive the vaccination during pregnancy. 3 Although there remains limited data about adverse effects to the fetus, we report a case of vertical transmission of IgG SARS-CoV-2 antibodies from a vaccinated mother to her son with no evidence of prior infection.