Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study

BACKGROUND: Bariatric surgery prevents and induces remission of type 2 diabetes in many patients. The effect of preoperative glucose status on long-term health-care costs is unknown. We aimed to assess health-care costs over 15 years for patients with obesity treated conventionally or with bariatric surgery and who had either euglycaemia, prediabetes, or type 2 diabetes before intervention. METHODS: The Swedish Obese Subjects (SOS) study is a prospective study of adults who had bariatric surgery and contemporaneously matched controls who were treated conventionally (age 37-60 years; BMI of ≥34 in men and ≥38 in women) recruited from 25 Swedish surgical departments and 480 primary health-care centres. Exclusion criteria were identical for both study groups, and were previous gastric or bariatric surgery, recent malignancy or myocardial infarction, selected psychiatric disorders, and other contraindicating disorders to bariatric surgery. Conventional treatment ranged from no treatment to lifestyle intervention and behaviour modification. In this study, we retrieved prescription drug costs for the patients in the SOS study via questionnaires and the nationwide Swedish Prescribed Drug Register. We retrieved data for inpatient and outpatient visits from the Swedish National Patient Register. We followed up the sample linked to register data for up to 15 years. We adjusted mean differences for baseline characteristics. Analyses were by intention to treat. The SOS study is registered with ClinicalTrials.gov, number NCT01479452. FINDINGS: Between Sept 1, 1987, and Jan 31, 2001, 2010 adults who had bariatric surgery and 2037 who were treated conventionally were enrolled into the SOS study. In this study, we followed up 4030 patients (2836 who were euglycaemic; 591 who had prediabetes; 603 who had diabetes). Drug costs did not differ between the surgery and conventional treatment groups in the euglycaemic subgroup (surgery US$10,511 vs conventional treatment $10,680; adjusted mean difference -$225 [95% CI -2080 to 1631]; p=0·812), but were lower in the surgery group in the prediabetes ($10,194 vs $13,186; -$3329 [-5722 to -937]; p=0·007) and diabetes ($14,346 vs $19,511; -$5487 [-7925 to -3049]; p<0·0001) subgroups than in the conventional treatment group. Compared with the conventional treatment group, we noted greater inpatient costs in the surgery group for the euglycaemic ($51,225 vs $25,313; $22,931 [19,001-26,861]; p<0·0001), prediabetes ($58,699 vs $32,861; $27,152 [18,736-35,568]; p<0·0001), and diabetes ($61,569 vs $47,569; 18,697 [9992-27,402]; p<0·0001) subgroups. We noted no differences in outpatient costs. Total health-care costs were higher in the surgery group in the euglycaemic ($71,059 vs $45,542; $22,390 [17,358-27,423]; p<0·0001) and prediabetes ($78,151 vs $54,864; $26,292 [16,738-35,845]; p<0·0001) subgroups than in the conventional treatment group, whereas we detected no difference between treatment groups in patients with diabetes ($88,572 vs $79,967; $9081 [-1419 to 19,581]; p=0·090). INTERPRETATION: Total health-care costs were higher for patients with euglycaemia or prediabetes in the surgery group than in the conventional treatment group, but we detected no difference between the surgery and conventional treatment groups for patients with diabetes. Long-term health-care cost results support prioritisation of patients with obesity and type 2 diabetes for bariatric surgery. FUNDING: AFA Försäkring and Swedish Scientific Research Council.

Study of lithium conducting single ion conductor based on polystyrene sulfonate for lithium battery application

The effect of processing history and morphology is of particular importance for lithium-ion electrolytes for achieving higher ionic conductivities. In this study, single ion conducting poly (4-lithium styrene sulfonic acid) was synthesized by neutralization reaction from polystyrene sulfonic acid, and the effect of morphology and processing method was studied by comparing pelletized, electrospun and gel samples. The PSSLi gels displayed best ionic conductivity, while the pelletized samples showed the worst ionic conductivity. Although electrospinning led to a free standing electrolyte, the lower amount of solvent phase led to lower ionic conductivity when compared to the PSSLi gel. The ionic conductivity at room temperature improved from 6.6 × 10−5 S/cm to 1.4 × 10−3 S/cm by optimizing the processing methodology and the lithium ion concentration. The results show that PSSLi based single ion conducting lithium (SICL) gels are a promising candidate for lithium ion battery application.

Comparison of antimicrobial activity, phytochemical profile and minerals composition of garlic Allium sativum and Allium tuberosum

Allium species are considered to be one of the world's oldest cultivated vegetables. Most commonly used species of garlic in Pakistan and India is Allium sativum, while Allium tuberosum is mainly consumed and cultivated in China, Southeast Asia, and North-east part of India. The present study was conducted to compare the antimicrobial activity, nutritional value and antioxidant profile of Allium sativum and Allium tuberosum. The outcome indicates that Allium tuberosum have slightly higher antimicrobial activity, higher mineral profile, and enriched in antioxidants in comparison with Allium sativum. The highest antimicrobial activity of Allium tuberosum was noticed against Staphylococcus aureus and Bacillus subtilis with 43.9 and 40.7 mm zone of inhibition using 100% extract. Allium tuberosum contains high contents of calcium (28.662±.00mg/100 g), potassium (10.62±0.50) and zinc (59.00±1.00). Allium tuberosum also showed higher antioxidant activity (0.24±0.03 mg vitamin C equivalent (VCE)/g fresh weight in ferric reducing antioxidant power assay, 0.18±0.02 mg VCE/g fresh weight in 2,2-diphenyl-1-picrylhydrazyl assay and 1.09±0.12 mg VCE/g fresh weight in 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) assay) in comparison with Allium sativum.

Overweight/obesity and HIV disease progression in HIV+ adults in Botswana

Studies indicate that overweight and obesity protect against HIV-disease progression in antiretroviral therapy (ART)-naïve patients. We examined retrospectively the relationship of overweight/obesity with HIV-disease progression in ART-naïve HIV+ adults in Botswana in a case-control study with 18-month follow-up, which included 217 participants, 139 with BMI 18.0-24.9 kg/m 2 and 78 with BMI ≥25 kg/m2. Archived plasma samples were used to determine inflammatory markers: leptin and bacterial endotoxin lipopolysaccharide (LPS), and genotype single nucleotide polymorphisms (SNPs) of the Fat Mass and Obesity Associated Gene (FTO). ^ At baseline, BMI was inversely associated with risk for AIDS-defining conditions (HR=0.218; 95%CI=0.068, 0.701, P=0.011), and higher fat mass was associated with reduced risk of the combined outcome of CD4+cell count ≤250/µL and AIDS-defining conditions, whichever occurred earlier (HR=0.918; 95%CI=0.847, 0.994, P=0.036) over 18 months, adjusting for age, gender, marriage, children, and baseline CD4+cell count and HIV-viral load. ^ FTO-SNP rs17817449 was associated with BMI (OR=1.082; 95%CI=1.001, 1.169; P=0.047). Fat mass was associated with the risk alleles of rs1121980 (OR=1.065; 95%CI=1.009, 1.125, P=0.021), rs8050136 (OR=1.078; 95%CI=1.021, 1.140; P=0.007), and rs17817449 (OR=1.086; 95%CI=1.031, 1.145; P=0.002), controlling for age, gender, tribe, total energy intake, and activity. There were no associations of SNPs with markers of disease progression. ^ Leptin levels were positively associated with BMI (β=1.764; 95%CI=0.788, 2.739; P=0.022) and fat mass (β=0.112; 95%CI=0.090, 0.135; P<0.001), but inversely with viral load (β=-0.305; 95%CI=-0.579, -.031; P=0.030). LPS levels were inversely associated with BMI (OR=0.790, 95%CI=0.630, 0.990; P=0.041), and fat mass (OR=0.852, 95%CI=0.757, 0.958; P=0.007) and directly with viral load (OR=2.608, 95%CI=1.111, 6.124; P=0.028), adjusting for age, gender, smoking and %fat mass. ^ In this cohort, overweight/obesity predicted slower HIV-disease progression. Obesity may confer an advantage in maintaining fat stores to support the overactive immune system. FTO-SNPs may contribute to the variation in fat mass; however, they were not associated with HIV-disease progression. Our findings suggest that the obesity paradox may be explained by the association of increased LPS with lower BMI and higher viral load; while viral load decreased with increasing leptin levels. Studies in African populations are needed to clarify whether genetic variation and inflammation mediate the obesity paradox in HIV-disease progression.^

Ketamina para el tratamiento de la hiperalgesia causada por remifentanil en cirugía: revisión sistemática de literatura

La hiperalgesia secundaria a la administración de remifentanil se ha documentado tanto en estudios animales como en estudios experimentales en humanos y ha aumentado su incidencia dado su uso cada vez más frecuente para el mantenimiento durante diferentes procedimientos anestésicos, anestesia general balanceada, anestesia total intravenosa y sedaciones. La hiperalgesia secundaria al uso de remifentanil es un proceso pro-nociceptivo relacionado pero que difiere de la tolerancia aguda, en el que los neurotransmisores excitatorios de N- metil D aspartato (NMDA) juegan un rol central. Por tanto la ketamina se ha utilizado en diferentes dosis para la prevención de dicha hiperalgesia sin que se haya establecido su efectividad para la prevención y tratamiento de esta condición. Se encontraron 8 estudios publicados en los últimos 10 años que proponen a la ketamina como una estrategia útil y efectiva el tratamiento de la hiperalgesia inducida por el uso de remifentanil. Los resultados demuestran que la ketamina es un tratamiento costo efectivo para el tratamiento de la hiperalgesia en diferentes poblaciones sometidas a diversos procedimientos quirúrgicos y anestésicos que incluyan la administración de remifentanil tanto en la inducción como en el mantenimiento anestésico sin generar efectos secundarios adicionales, así como que logra disminuir el consumo de opioides y la EVA en el posoperatorio.

Entrepreneurial Motivations Questionnaire: AFC and CFA in academy.

Background Entrepreneurship has been considered essential to create value, being a powerful driver of economic and social development. Academy must invest in the development of entrepreneurial skills in students ("Entrepreneurial Academy"). Objective: To analyse the psychometric proprieties of the EMQ-Entrepreneurial Motivations Questionnaire. Methods Sample: 6,532 students from 17 polytechnic Institutes of Portugal. Measure: EMQ, composed by measures of Entrepreneurial motives for the business, Entrepreneurial influences, and Support Services. Results Exploratory factor analysis (EFA) for Entrepreneurial-Motives-for-thebusiness (KMO = .921, X2 = 54387.94, p < .001) extracted 4 factors, explaining 53.81 % of variance (EV): F1-Family security (19.92 % EV; M= 4.07, SD = 0.67), F2-Prestige (14.60 % EV; M= 3.25, SD = 0.75), F3- Independence (13.13 % EV; M= 3.33, SD = 0.75), and F4-Realization of an opportunity (11.15 % EV; M= 4.08, SD = 0.56). This factorial structure was supported by Confirmatory factor analysis (CFA), with an acceptable fit: RMSEA = .084. EFA of Entrepreneurial-Influences (KMO = .916, X2 = 60584.93, p < .001), extracted 4 factors, EV 60.08 %: F1-Resources availability (21.25 % EV; M= 3.86, SD = 0.68), F2-Stable customers and incentives (19.70 % EV; M= 3.82, SD = 0.65), F3-Social and economic instability (11.11 % EV; M= 2.96, SD = 1.06), and F4-Opportunities in the sector and residence area (8.03 % EV; M= 3.29, SD = 0.95). This factorial structure was supported by CFA, with an acceptable fit: RMSEA = .073. EFA of Support-Services (KMO = .995, X2 = 57311.43, p < .001) extracted 2 factors, EV 58.43 %: F1-Financial support (32.59 % EV; M= 3.93, SD = 0.69) and F2-Prestige (25.84 % EV; M= 3.95, SD = 0.65). This factorial structure was supported by CFA, with an acceptable fit: RMSEA = .090. The health group showed scores mostly above global average in factors. Conclusions EMQ showed adequate psychometric properties. The instrument is useful for measuring entrepreneurships motivations in health.