2^nd Middle East Obesity, Bariatric Surgery and Endocrinology Congress May 30-31, 2019 Istanbul, Turkey

Dilip Kumar Kandar has his expertise in Evaluation and Management of Diabetes and the long term complications associated with diabetes. He has special interest in management of diabetic foot ulcers, diabetes in children, diabetes in pregnancy and insulin pump therapy.

Statement of the Problem: Diabetic foot ulcers are hard to manage because of persistent infection and concomitant defects in the local micro-vasculature. Despite the availability of best of the resources in management of diabetes and diabetes foot ulcers, amputations are still performed quite often.

 

Case report:

Case 1: In the first case, a 50 year old chronic uncontrolled type-2 diabetic presented with non-healing ulcer in the left foot (Grade 3-Wagner grading system). Patient had undergone debridement 4 times in the past. He was advised amputation. Glycated hemoglobin (A1c) at presentation was 11 and random blood sugar was 256 mg/dl. She was initiated on intensive insulin therapy and broad spectrum antibiotics. Patient was put on Continuous Glucose Monitoring (CGM). Her between day and within day variations in blood glucose were tightly controlled. She was managed in clinic on an outpatient basis. Services of trained nurse were sought. The ulcer healed in 30 days.

 

Case 2: 50 year old long standing diabetic presented to the clinic with non-healing diabetic foot ulcer on the left foot. He too was advised amputation similar to the previous case. On presentation, his fasting blood sugar was 364 mg/dl, postprandial blood sugar was 480 mg/dl and A1c was 14.8%. He was initiated on continuous subcutaneous insulin infusion. He was put on CGM. Within day and between days glucose was strictly controlled. Average glucose levels on CGM were 130 mg/dl and estimated A1c was 7%. Patient was managed on outpatient basis. Diabetic foot ulcer healed over a period of a month.

 

Conclusion: Tight glycemic control, intraday and interday using continuous glucose monitoring, trained dressing and intensive insulin therapy resulted in healing of two complicated diabetic foot ulcer. It was cost effective as the patients were managed on out-patient basis.

Alessandro Ferrario graduated in Medicine and Surgery in 1999, specialized in plastic surgery in 2004; he traveled abroad for work both to improve himself in renowned hospitals, and for humanitarian missions. After a fundamental experience in a department that is located for rhinoplasty, for the last 8 years now he has found his own professional dimension in postbariatric surgery; a surgery that combines functional indications and aesthetic potential has aroused such enthusiasm as to bring him with his group to national excellence.

Introduction: The navel plays a major role in the aesthetics of the abdomen. A navel that is abnormally shaped, malposition or has evident scarring may compromise the outcome of an otherwise well-executed full abdominoplasty. The aim of the technique in question is to recreate a navel that looks natural, with no visible scar, and that is properly positioned.

 

Method: The technique was performed in 147 abdominoplasties of patients of both sexes (123 females and 24 males), with an average age of 35 years and a mean BMI of 24 kg/m2. The procedure involves the creation of a navel of reduced size, 10×5 mm and its inset in the abdominal wall. Subsequently, the as-yet-not sutured abdominal flap is extended caudally to determine the point of projection of the navel. The abdominal skin is marked, the flap is reversed and an internal suture is carried out.

 

Result: The appearance of the navel is aesthetically pleasant and natural looking and with no visible scarring. In addition, the position of the umbilicus is always correct. At the two-year follow-up, the results remain stable. No major complication occurred.

 

Conclusion: The technique allows for the attainment of an extremely natural looking navel that satisfies the aesthetic criteria of attractiveness without visible scarring. The navel is always correctly positioned, without requiring measurements during surgery. The procedure is rapid and although it does require a short learning curve, the results are extremely aesthetically pleasing and reproducible. The patient satisfaction rate is extremely high.

Ali Youssef Fakhreddine is a practicing Physician in the Division of Gastroenterology and Hepatology at Scripps Clinic, California. He has completed his Bachelor of Science in Biology with Honors from the University of Texas in Austin and Master’s at UT Southwestern. He has completed his Internship and Residency at Harbor-UCLA. He was also a Chief Resident at Harbor-UCLA and Clinical Instructor at UCLA David Geffen School of Medicine. He is currently involved in four IRB-approved research projects and is the first author of a recently published review on cytomegalovirus in gastroenterology and hepatology.

Obesity is a wordwide pandemic accounting for approximately 2.8 million preventable deaths annually. It is a chronic disease associated with an increased risk of cardiovascular disease, insulin resistance and up to a 50% increased risk of mortality. Achieving sustainable weight-loss, even as little as 5% of Total Body Weight (TBW), can have clinically significant outcomes. Bariatric endoscopy is a rapidly evolving field that consists of non-surgical devices effective at achieving 10-20% TBW loss up to one year or longer depending on

the procedure. While less effective than bariatric surgery, randomized control data and cohort studies support an improved safety profile of bariatric endoscopy over surgery. Bariatric endoscopy devices can be broadly categorized into intragastric balloons, a gastric aspiration system and endoscopic gastroplasty procedures. Each device has multiple mechanisms of action, including reduction of gastric volume, delayed gastric emptying and an altered satiety hormone profile. Most importantly, all these devices promote behavioral modifications in patients, which is critical for the successful management of any chronic disease. For example, approximately 20% of weight-loss with the gastric aspiration system is attributed to behavior modification secondary to meal planning and careful chewing. In terms of efficacy and safety profile, bariatric endoscopy is therefore the bridge between lifestyle interventions and surgery. Successful implementation of bariatric endoscopy in the framework of obesity treatment involves careful selection of patients that would benefit from the short-term gains of the device and are motivated enough to maximize the long-term gains of learned behavior, all without the need of surgery.

Anshoo Agarwal is currently working as Professor & Chairperson at Department of Pathology, Northern Border University, Arar Kingdom of Saudi Arabia. She received her Bachelor of Medicine & Bachelor of Surgery from King George's Medical College Lucknow. She received her M.D in Pathology from LLRM Medical College / Ch. Charan Singh University. She is an Associate Professor and Discipline Coordinator in University Technology MARA, Malaysia. Dr. Anshoo Agarwal has served on many scientific memberships like life member of Indian Association of Pathology and Microbiology, Member of International Academy Pathology, Life Member of Indian Society of Hematology & Transfusion Medicine, Emirates Medical Association Pathology Society. She has more than 80 publications. She is an editorial member of 3 journals and has many reviewed publications. Her research interests include Advance Haematology & Immunohaematology, Breast cancer and Anticancer vaccines.

Background: A rapidly growing epidemic of obesity is associated with many health risks. Obesity is a complex condition, with serious social and psychological dimensions, affecting virtually all ages and socioeconomic groups. Sugar sweetened energy drinks are highly linked to obesity and other health problems such as type 2 diabetes and heart disease. Consequently, there are many campaigns being launched to reduce consumption of sweetened energy among children. To create better choices for people many associations and organizations have banned sugary drinks including fruit juices in addition to sugary soda drinks. One area that is not well known as a source of excess sugar and that can increase obesity risk are energy drinks. Since children who

consume these energy drinks may derive as much as 12% of their sugary drink intake from these drinks , as their parents also are misguided because mostly the labels on energy drinks mentions low calories and low sugar contents and they happily buy for their children or allow them to consume. Energy drinks are very popular in special need children also as their parents or guardian thinks that it will give strength to their children specially those who have physical disabilities also.

 

Material and Methods: A pre-validated self-designed detailing information on energy drinks and obesity was administered the staff and care takers and parents and guardian of special need children enrolled with different rehabilitation centers and schools for special need children in India, Pakistan, Nepal, Russia and Malaysia to study their attitude, perception and practices regarding sports or energy drinks and associated sugar contents and the myths and facts related to the reasons as why they allow their children to have such

drinks. The research on this topic is limited and diverse hence, the salient points in questionnaire were taken from the available literature and published articles. Staff and care takers and parents and guardian of special need children were also requested to give opinion about the calories and other details mentioned on the labels on energy drinks which their children are consuming . The special need children body mass index was also recorded to assess them whether they are overweight and in obese category and was corelated with the

amount of energy drink consumed by them.

 

Results and Discussion: Our study showed that there is link between excess usage of energy drinks and obesity, which may not be acknowledged as sources of sugar in special need children. This may be because, energy and sports drinks though may have fewer calories and less sugar than regular sugary drinks, so staff and care takers and parents and guardian of special need children take it for guaranteed as they are not given awareness regarding associated health risks and as a myth they also enjoy health ‘halos’ due to an advertising focus on their cognitive benefits. It was found out that staff and care takers and parents and guardian of special need children are misled energy or sports drinks labels. 26% of staff and care takers and parents mentioned that some labels do not convey how much sugar is actually in the product, or what is the effect of 20 grams of carbohydrate in one energy drink might imply for the individual consumer. 65% of them stated that they were not aware that the glucose found in energy drink is a simple carbohydrate, which is dispersed into the bloodstream immediately. 69% were not aware that too much glucose, as found in energy drinks, can adversely affect memory, concentration and other forms of mental activity. It was found in our study that on the analysis of 14 different energy drinks, it showed all drinks were contained in non-reusable

containers, thus providing excess sugar in a single serving. Our study showed that the added sugar intake from energy drinks had associated relationship to reduced sleep duration. 54% of parents and care takers of special need children stated that they were fascinated by information on energy drinks through media like facebook and were misguided as these drinks will help their disable children and will give them more physical and mental strength. Our study also showed that the sugar content across different brands of energy drink was inconsistent suggesting the amount is not guided by any legal limits.

 

Conclusion: This study conclude that energy drinks consumption is an increasingly dangerous, yet overlooked health issue for a variety of reasons, especially among special need children who are already physically and mentally challenged and where consumption is widespread. The added sugar content in the form of sucrose, glucose, or high fructose corn syrup ranges in quantity and is a potential contributor to the ongoing obesity problem in these children. Although many parents also today are often unaware of the sugar content of several popular brands, in the form of sucrose, glucose, or high fructose corn syrup and are unaware that 2-3 servings a day of these drinks are equal to 4-6 times the maximum recommended sugar intake. Yet, despite the magnitude of the obesity problem among special need children and the possibility that energy and sports drinks may be compounding this, there are very few active solutions discussed as what should be done to combat this threat.

Background: Iraq has a large population of Diabetic Foot Infection (DFI) patients with a vast geographical distribution and significant variations in the types of bacterial infections found in DFI wounds from different regions. Foot ulcers are accounting for up to twenty of diabetes-related hospital admission. If left untreated might result in amputation of feet and legs The purpose of the present study is to investigate the microbial distribution among foot ulcers in diabetic patients.

 

Patients and Methods: Forty diagnosed diabetic patients (18 male & 22 female), presented with wound infection attending Azadi Teaching Hospital from 10/9/2018 to 15/4/2019, were selected for the study. Their ages ranged between 44-73 years with a mean age of 56.47±9.77 years. Laboratory tests for evaluation of diabetes; fasting blood glucose (FBG; mmol/l) and hemoglobin A1c (HbA1c %) levels were collected from patients' laboratory data. A total of forty swab samples were obtained from wounds of both inpatients and outpatients, screened for the detection of pathogenic microorganisms by examination of swabs from wounds of diabetic patients.

 

Results: Polymicrobial infections were observed in 4(10%) of patients, and 12(30 %) isolates were negative. In the present study, the most frequent bacterial isolates were Pseudomonas aeruginosa (30%) and Staphylococcus aureus (25%). Regarding the gender of the subjected infected patients, there were two-thirds of the cases were female patients.

 

Conclusion: Age grouping showed that the older age and poor glycemic control are important risk factors related to diabetes foot development in the current T2DM population. Most of these factors can be corrected or at least controlled with a large opportunity for early prevention and treatment, with the subsequent decrease in patients with diabetic foot and its ending sequel of amputation.

Okhunov A O is a Professor, Head of the Department of General and Pediatric Surgery in Tashkent Medical Academy. His first researches were aimed at studying the features of endothelial dysfunction in patients with type-2 diabetes complicated by micro- and macro angiopathy. He received 8 copyright certificates for these studies.

Type-2 diabetes is a chronic disease, the pace and prevalence of which are increasing every year. In terms of growth rates, type-2 diabetes is equated by the international community with epidemics of such infectious diseases as AIDS, tuberculosis and malaria. Frightening is the upward trend in the frequency of type-2 diabetes in the young. According to some data, with disease duration of more than 20 years, the probability of lower extremity lesions exceeds 80% and 40-70% of all non-traumatic amputations are performed in patients with diabetes, while the immediate post-operative mortality exceeds 20%. The purpose of the study was to determine the influence frequency of various variants of metabolic surgical interventions on the course of the ulcerative-necrotic process of the lower extremities in patients with type-2 diabetes. The results of the examination and treatment of 85 patients with ulcerative-necrotic lesions of the lower extremities that underwent various metabolic surgical procedures were analyzed. Among the men surveyed there were 32 (37.6%), women-53 (62.4%). The average age ranged from 46±12.5 years. The average history of the diagnosis of diabetes was 12±2.5 years. Ulcer-necrotic lesion of the lower extremities was assessed by the method of Wagner. 12 (14%) patients were diagnosed with grade I, 34 (40%) patients had grade II and 39 (46%) patients had grade III, respectively. 58 (68.2%) patients underwent ileal interposition operations and 27 (31.8%) patients had transit bipartition. Such an approach for the choice of surgical intervention made it possible to avoid the development of mal absorption syndrome. Thee frees patients from lifelong intake of biological supplements in the form of vitamins and minerals, in the postoperative period, 78 (92%) patients achieved complete control of the blood glucose level, 4 patients (4.7%) used only 1 and 2.3% - 2 antihyperglycemic agents to ensure control of blood glucose levels. One patient required the use of a daily single dose of insulin. In the long-term postoperative periods, the regression of the necrotizing process was characterized by positive dynamics in the form of a decrease of manifestation process degree or completes scarring of the latter.