Procedure

Hypoglycemia due to gastric bypass surgery

Hypoglycemia due to gastric bypass surgery

Obesity and its complications are common, yet on the rise. Subsequently, gastric bypass surgery is on the rise too. Severe hypoglycemia can be a long-term complication of bariatric surgery. The most common method to negate or reduce hypoglycemia is dietary modifications. Patients need to consume small meals of a low glycemic index frequently. Medical therapies with acarbose, diazoxide, and octreotide are often not useful.

Here authors describe the utility of calcium channel blockers (CCBs) in two patients. Difficult to treat hypoglycemia developed in 8 and 13 years after the bypass procedure. Standard approach did not work. Only the use of nifedipine and verapamil improved patient's resistant hypoglycemia. The proposed rationale is that CCBs reduce or delay insulin secretion by pancreatic beta cells.

Although more clinical studies are needed, it is essential to be aware of the potential benefits of CCBs. For some patients with refractory and devastating hypoglycemia, they could be the last resort. Additionally, physicians are already familiar with CCBs as they have been on the market for decades.

GT

Sexual function after bariatric surgery

Sexual function after bariatric surgery

This meta-analysis shows that bariatric surgery significantly improves sexual function in men but that a more limited degree of improvement is achieved in women.

In obese male patients who underwent bariatric surgery, the levels of the sex hormones TT, FT, LH, FSH, and SHBG significantly increased, and the level of E2 decreased. In obese female patients, the levels of the sex hormones TT, FT, and E2 decreased, but the levels of LH, FSH, and SHBG increased.

Future studies should be performed to elucidate the mechanism of the improved sexual function in obese patients after bariatric surgery. 

JES

New FDA approval: a more convenient test for adult growth hormone deficiency

New FDA approval: a more convenient test for adult growth hormone deficiency

FDA has approved the oral agent macrilen for evaluation of growth hormone deficiency in adults. Macrilen is a ghrelin agonist which leads to the provocative release of growth hormone by the anterior pituitary gland. The diagnostic procedure is safe, efficient and comparable with the gold standard isulin tolerance test (ITT). This is a meaningful advancement in the field of endocrinology.

GT

Bariatric surgery improves mortality outcomes

Bariatric surgery improves mortality outcomes

Bariatric surgery using laparoscopic banding, gastric bypass, or laparoscopic sleeve gastrectomy, compared with usual care nonsurgical obesity management, was associated with lower all-cause mortality over a 4.5 years follow-up.

JAMA

​​​​​​​Precision is everything, even in acute MI

​​​​​​​Precision is everything, even in acute MI

Among patients who had multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of a composite of death or severe renal failure leading to renal-replacement therapy was lower among those who initially underwent PCI of the culprit lesion only, than among those who underwent immediate multivessel PCI.

NEJM

New Treatment for blood pressure: Baroreflex activation therapy (BAT)

New Treatment for blood pressure: Baroreflex activation therapy (BAT)

Baroreflex activation therapy (BAT) is a new method to treat patients with advanced high blood pressure. It works by electrically stimulating the carotid sinus, leading to reduced sympathetic tone.

Impressively systolic BP dropped on average by 35 mmHg and diastolic BP by 17 mmHg. About 25% of patients reduced the number of anti-hypertensive medications by half. Full benefits were seen within the first 6 months of procedure, but more importantly results were maintained in 6 years.

I believe more research is needed to approve BAT for mainstream clinical use, given the procedural nature of treatment.

GT

Aspiration therapy for obesity - a possible Intervention?

Aspiration therapy for obesity - a possible Intervention?

Aspiration therapy was implemented in 25 adults with average body mass index 40. BMI decreased to 32 in one year and 31 in two years. No electrolyte anomalies or major side effects were noted. Stomach was drained 20 min after each meal, 3 times a day. Adherence to procedure was 80% in 12 months and 60% in 24 months.

Could this be a future viable therapy for obesity?

GT