Sowsan Rasheid

Gastric Bypass is an Effective Treatment for Obstructive Sleep Apnea in Patients with Clinically Significant Obesity

Background: We have demonstrated that obstructive sleep apnea (OSA) is prevalent in 60% of patients undergoing bariatric surgery. A study was conducted to determine whether weight loss following bariatric surgery ameliorates OSA. Methods: All 100 consecutive patients with symptoms of OSA were prospectively evaluated by polysomnography before gastric bypass. Preoperative and postoperative scores of Epworth Sleepiness Scale (ESS), Respiratory Disturbance Index (RDI), and other parameters of sleep quality were compared using t-test. Results: Preoperative RDI was 40±4 (normal 5 events/hour, n=100). 13 patients had no OSA, 29 had mild OSA, while the remaining 58 patients were treated preoperatively for moderate-severe OSA. At a median of 6 months follow-up, BMI and ESS scores improved (38±1 vs 54±1 kg/m2, 6±1 vs 12±0.1, P<0.001, postoperatively vs preoperatively). To date, 11 patients have completed postoperative polysomnography (3-21 months) after losing weight (BMI 40±2 vs 62±3 kg/m2, P<0.001).There was significant improvement in ESS (3±1 vs 14±2), minimum O2 saturation (SpO2 86±2 vs 77±5), sleep efficiency (85±2% vs 65±5%), all P<0.001, postop vs preop; and RDI (56±13 vs 23±7, P=0.041). Regression analysis demonstrated no correlation between preoperative BMI, ESS score and the severity of OSA; and no correlation between % excess body weight loss and postoperative RDI. Conclusion: Weight loss following gastric bypass results in profound improvement in OSA. The severity of apnea cannot be reliably predicted by preoperative BMI and ESS; therefore, patients with symptoms of OSA should undergo polysomnography.

DNA vaccination with HIV-1 expressing constructs elicits immune responses in humans

Humoral and cellular immune responses have been produced by intramuscular vaccination with DNA plasmids expressing HIV-1 genes, suggesting possible immunotherapeutic and prophylactic value for these constructs. Vaccination with these constructs has decreased HIV-1 viral load in HIV-1-infected chimpanzees. In addition, naive (i.e. non-HIV-1-infected) chimpanzees were protected against a heterologous challenge with HIV-1. Ongoing phase I clinical trials show that therapeutic vaccinations indeed boost anti-HIV-1 immune responses in humans. A therapeutic phase I trial on humans with these constructs induced a good safety profile and also demonstrated an immunological potentiation. These findings indicate that further studies with these constructs in humans are warranted.

A reproducible ex vivo model for transanal minimally invasive surgery.

The authors conclude that transanal laparoendoscopic procedures to excise rectal tumors can be successfully reproduced in an ex vivo porcine anorectal model.

Pre-procedural Considerations

Prior to performing endoscopic procedures it is imperative that the physician be knowledgeable of the many aspects of patient care in all phases of the encounter. This chapter focuses on the pre-procedural phase. Care must be taken to address patient risk factors as well as procedure associated risks that could potentially affect outcome. Co-morbid conditions must be taken into consideration and risk modification employed such as administration of pre-procedural antibiotics when indicated and discontinuation of anticoagulants when necessary. By being prepared to meet the challenging complexities related to a patient’s overall health the physician should be able to minimize procedural complications and improve patient safety and outcomes.