Obesity is a major public health concern and should be considered in autoimmune inflammatory disorders, such as multiple sclerosis (MS). In these patients, obesity leads to increasing comorbidities as well as reduced quality of life. Obesity causes an inflammatory state in the body, especially in adolescents; obesity has a role in the pathogenesis of MS. Hence, it is identified as a lifestyle modifiable risk factor for MS disease. Among various treatments for obesity, bariatric surgery has been widely used. Although few studies have been performed on bariatric surgery in MS patients, in this review, we present the existing data regarding the effects of obesity on the MS course and evaluate the outcomes of bariatric surgery among this population.
Introduction Post-operative nausea and vomiting (PONV) is a common problem after sleeve gastrectomy. In recent years, following the increase in the number of such operations, special attention has been paid to preventing PONV. Additionally, several prophylaxis methods have been developed, including enhanced recovery after surgery (ERAS) and preventive antiemetics. Nevertheless, PONV has not been completely eliminated, and the clinicians are trying to reduce the incidence of PONV yet. Methods After successful ERAS implementation, patients were divided into five groups, including control and experimental groups. Metoclopramide (MA), ondansetron (OA), granisetron (GA), and a combination of metoclopramide and ondansetron (MO) were used as antiemetics for each group. The frequency of PONV during the first and second days of admission was recorded using a subjective PONV scale. Results A total of 130 patients were enrolled in this study. The MO group showed a lower incidence of PONV (46.1%) compared to the control group (53.8%) and other groups. Furthermore, the MO group did not require rescue antiemetics, however, one-third of control cases used rescue antiemetics (0 vs. 34%). Conclusion Using the combination of metoclopramide and ondansetron is recommended as the antiemetic regimen for the reduction of PONV after sleeve gastrectomy. This combination is more helpful when implemented alongside ERAS protocols.
Iodinated contrast agents are routinely used to diagnose a variety of diseases especially malignant tumors. They are crucial for accurate depiction of tumors, monitoring the response to treatment, and assessing possible recurrence of malignant lesions. Unfortunately, there are potential adverse effects associated with their administration. Metformin as an antidiabetic drug is prescribed widely. The drug is usually administered to control type II diabetes mellitus. One of the most important side effects of metformin is the possibility of lactate accumulation and occurrence of metforminassociated lactic acidosis (MALA), which develops under various circumstances including decreased renal function or concurrent use of toxic agents. Since, intravascular injection of iodinated contrast agents for radiologic purposes may result in kidney injury, it is suggested that metformin should be held in diabetic patients with renal failure before administration of contrast media and not to be taken by the patient again till 48 hours after the procedure and assessment of kidney function which should be normal.
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