Association Between Physical Activity Intensity and Physical Capacity Among Individuals Awaiting Bariatric Surgery

BACKGROUND

Physical activity is a routine component of the lifestyle modification program implemented prior to bariatric surgery, and one of the goals is to improve patients' physical capacity. However, the physical activity intensity recommended to meet that goal is unknown.

OBJECTIVE

This study aimed to assess the association between time spent at different physical activity intensities and physical capacity in patients awaiting bariatric surgery.

MATERIALS AND METHODS

A total of 39 women and 13 men were recruited. The primary outcome was physical capacity measured using six objective tests: 6-min walk, chair stand, sit and reach, unipodal balance (eyes open and eyes closed), and hand grip strength tests. The primary exposure variable was physical activity intensity (i.e., sedentary, light, moderate, and vigorous) measured by accelerometers.

RESULTS

The average body mass index was 46.3 ± 5.4 kg/m². Only 6% of total time was spent at moderate to vigorous intensity, while 71% of the time was spent sedentary. When adjusted for body mass index, age, and sex, four of the six physical capacity tests were significantly associated with moderate intensity physical activity β(SE): 6-min walk 9.7 (2.7), chair stand 0.3 (0.1), balance (eyes open) 1.8 (0.7), and hand grip strength 1.2 (0.4), and only the 6-min walk was associated with sedentary activity 1.7 (0.7).

CONCLUSION

These results suggest that physical capacity is associated with time spent at moderate intensity in individuals awaiting bariatric surgery. The next step is to study if an increase in time spent at moderate intensity will translate to improvements in physical capacity.

Comparison of ultrasound-guided supraclavicular, infraclavicular and below-C6 interscalene brachial plexus block for upper limb surgery: a randomised, observer-blinded study

This prospective, randomised, observer-blinded study was conducted to compare the ease of performance and surgical effectiveness of interscalene block below the C6 nerve root with supraclavicular and infraclavicular techniques of brachial plexus block for upper arm and forearm surgery. Sixty adult patients of American Society of Anesthesiologists grade 1 to 3, undergoing upper limb surgery, were randomly allocated into three groups. Group SC received supraclavicular blockade, group IC received infraclavicular blockade and Group IS received interscalene blockade. All blocks were guided by ultrasound with nerve stimulator confirmation. The anaesthetic mixture consisted of 0.5 ml/kg of equal volumes of 0.75% ropivacaine and 2% lignocaine-adrenaline. The imaging and block performance time, onset time, success rate, duration of block, and duration of postoperative analgesia were recorded by a blinded observer. The onset time was significantly longer in the interscalene group as compared with supraclavicular and infraclavicular approaches. The imaging time and block performance time were comparable between groups. No significant differences were observed between the three groups in terms of block-related pain scores, success rates, duration of block or of postoperative analgesia. Two patients in the interscalene group developed clinically detectable phrenic nerve palsy. Our findings indicate that, although interscalene block below the C6 nerve root can provide surgical anaesthesia for forearm and hand surgery, it appears to have a longer onset time than supra- and infraclavicular approaches and an unacceptable incidence of phrenic nerve palsy.

Comparison of palonosetron with palonosetron-dexamethasone combination for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

BACKGROUND

This randomized double-blind study was designed to compare palonosetron with palonosetron-dexamethasone combination for prevention of post operative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy.

METHODS

Eighty-four adult ASA 1-2 patients were randomly allocated into two groups. Group P patients received 0.075 mg palonosetron and group PD patients received 0.075 mg palonosetron and 8 mg dexamethasone intravenously before induction of anesthesia. Anesthesia was induced with propofol and fentanyl and maintained with N2O-isoflurane in oxygen. All patients received port-site infiltration with bupivacaine and intravenous diclofenac for postoperative analgesia. Metoclopramide was used as rescue antiemetic. Patients were observed for the incidence of PONV and requirement of rescue antiemetic for 48 h after surgery.

RESULTS

The complete response rate (no vomiting) was significantly higher in group DP as compared to group P between 0-24 h (P=0.004). 18 (42.9%) patients reported nausea and 14 (33.3%) patients had vomiting in group P while 6 (14.4%) patients had nausea and 5 (11.9%) patients complained of vomiting in group DP during 0-24 h. Two patients in group P reported nausea while none in group PD during 24-48 h. No patient had vomiting in either of the groups between 24-48 h. The requirement of rescue antiemetic was also less in group DP as compared to group P. Patients in group DP required less postoperative analgesia and were more satisfied with PONV treatment than group P patients.

CONCLUSION

The palonosetron-dexamethasone combination was more effective as compared to only palonosetron for reducing PONV after laparoscopic cholecystectomy.

Independent and combined effect of diet and exercise in adults with prediabetes

Prediabetes is defined as impaired fasting glucose and/or impaired glucose tolerance. Impaired fasting glucose is usually defined as fasting blood glucose between 5.6 mmol/L and 6.9 mmol/L (100.8-124.2 mg/dL), and impaired glucose tolerance is the 2-hour oral glucose tolerance test of 7.8-11.0 mmol/L (140.4-198.0 mg/dL). Most individuals with prediabetes are overweight or obese and are at greater risk of type 2 diabetes (T2D). The first line of treatment for individuals with prediabetes is lifestyle modification, including diet and exercise. The aim of this review, through the revision of primarily randomized control trials, is to discuss the independent and combined effect of diet and exercise on the incidence of T2D, glycemic control, and weight loss in adults with prediabetes. Based on the available literature, lifestyle modification combining both diet and exercise is effective at reducing the incidence of T2D and improving glycemic control, even without a significant reduction in body weight. Thus, it is unclear whether weight loss, through lifestyle modification, is a cornerstone for improving glycemic control in individuals with prediabetes. The independent effect of diet or exercise alone on the improvement in glycemic control and/or reduction in body weight in individuals with prediabetes still requires more studies to draw a clear conclusion, considering the quality and quantity of available studies. As of now, the best diet and/or exercise program to improve glycemic control and body weight in adults with prediabetes is unknown.

Postoperative analgesic effect of intravenous (i.v.) clonidine compared with clonidine administration in wound infiltration for open cholecystectomy

OBJECTIVES

This randomized double-blind study was designed to compare the postoperative analgesic effect of clonidine administered intravenously or in wound infiltration with bupivacaine.

METHODS

Sixty adults of ASA grade I-II undergoing open cholecystectomy were randomly allocated into three groups. Group 1 (control group) patients received wound infiltration with 30 ml of 0.25% bupivacaine at the end of surgery. Group 2 patients received 3 μg kg(-1) clonidine intravenously after resection of gall bladder plus wound infiltration with 30 ml of 0.25% bupivacaine. Group 3 patients received wound infiltration with 3 μg kg(-1) clonidine with 30 ml of 0.25% bupivacaine. A standard general anaesthesia technique was used. Postoperative analgesia was provided with i.v. diclofenac and morphine on demand. Postoperative pain, number of patients requiring rescue analgesia and total morphine consumption during 24 h after operation was recorded.

RESULTS

Postoperative morphine consumption was significantly less in patients receiving clonidine by either route when compared with the control group (P<0.0001). All patients in the control group required supplemental morphine, with nine patients in the i.v. clonidine group and 11 patients in the wound infiltration group (P<0.002). Pain scores were lower at rest for 12 h and on cough for 6 h in both clonidine groups when compared with the control group (P<0.01). Patients receiving i.v. clonidine had more hypotension (P<0.01) and sedation (P<0.001) compared with other groups.

CONCLUSIONS

Clonidine 3 μg kg(-1) provided effective postoperative analgesia and reduced morphine requirement when administered intravenously or in wound infiltration with bupivacaine. However, the incidence of complications was less with wound infiltration. CLINICAL TRIAL REGISTRY OF INDIA: (www.ctri.nic.in/), registration number CTRI/2012/12/003258.

The analgesic effect of intrathecal dexmedetomidine or clonidine, with bupivacaine, in trauma patients undergoing lower limb surgery: a randomised, double-blind study

This randomised, double-blind study was designed to compare the duration of analgesia and adverse effects following intrathecal administration of dexmedetomidine or clonidine, both with bupivacaine, in trauma patients. Ninety adult trauma patients of American Society of Anesthesiologists physical status I-II, scheduled for lower limb surgery under subarachnoid block, were randomly allocated to one of three groups. All groups received hyperbaric bupivacaine 0.5% 3 ml, to which was added saline 0.5 ml (Group B): clonidine 50 µg (Group C) or dexmedetomidine 5 µg (Group D). The onset and duration of sensory and motor blockade, severity of postoperative pain, time to first rescue analgesia and total analgesic requirement for 24 hours were noted. There was no significant difference in the onset time of the block but the duration of sensory and motor blockade was prolonged in Groups C and D, compared with Group B. The time to analgesia was significantly prolonged in Group D (824±244 minutes) compared with Group C (678±178 minutes; P=0.01), the latter being longer than Group B (406±119 minutes; P=0.0001). Postoperative pain scores were lower in Groups C and D compared with group b. The requirement for rescue analgesia during the first 24 postoperative hours was significantly less in Groups C and D as compared to Group B (P=0.0001), but comparable between Groups C and D (P=0.203). In conclusion, dexmedetomidine 5 µg added to intrathecal bupivacaine 15 mg produces longer postoperative analgesia than clonidine 50 µg among trauma patients undergoing lower limb surgery.

Spatial dynamics of meningococcal meningitis in Niger: observed patterns in comparison with measles

Throughout the African meningitis belt, meningococcal meningitis outbreaks occur only during the dry season. Measles in Niger exhibits similar seasonality, where increased population density during the dry season probably escalates measles transmission. Because meningococcal meningitis and measles are both directly transmitted, we propose that host aggregation also impacts the transmission of meningococcal meningitis. Although climate affects broad meningococcal meningitis seasonality, we focus on the less examined role of human density at a finer spatial scale. By analysing spatial patterns of suspected cases of meningococcal meningitis, we show fewer absences of suspected cases in districts along primary roads, similar to measles fadeouts in the same Nigerien metapopulation. We further show that, following periods during no suspected cases, districts with high reappearance rates of meningococcal meningitis also have high measles reintroduction rates. Despite many biological and epidemiological differences, similar seasonal and spatial patterns emerge from the dynamics of both diseases. This analysis enhances our understanding of spatial patterns and disease transmission and suggests hotspots for infection and potential target areas for meningococcal meningitis surveillance and intervention.

Analysis of resident-performed manual small incision cataract surgery (MSICS): an efficacious approach to mature cataracts

To examine and improve outcomes of resident-performed manual small incision cataract surgery (MSICS) cases via analysis of visual recovery, intraoperative adverse events, and early postoperative course. Particular focus was directed toward mature cataracts extracted by MSICS. A retrospective review was performed to identify MSICS cases performed by resident surgeons unfamiliar with the technique (initial ten cases) in an academic setting. Preoperative history, intraoperative adverse events, and postoperative course were reviewed. Of 30 cases identified, mean preoperative acuity was 1.8 ± 0.9 logMAR units (Snellen equivalent = 20/1262) improving to 0.20 ± 0.35 logMAR units (20/31) at final follow-up (p < 0.0001). Mean follow-up was 22.1 ± 19.0 days. The most frequent intraoperative adverse events were wound leak requiring intraoperative suturing (33 %), vitreous loss (6.7 %), and capsulorhexis radialization (6.7 %). Transient cornea edema was the most frequent (56.7 %) early postoperative minor complication. Two major complications occurred that required wound revision in one eye and iridoplasty in one eye. Of the 30 eyes undergoing surgery, 19 were noted to have mature cataracts. In this subset, mean acuity was 2.25 ± 0.64 logMAR units (20/3557) improving to 0.28 ± 0.42 logMAR (20/38) at final follow-up (p < 0.0001). Complications were similar in nature and frequency to the entire population in this subgroup. Supervised resident MSICS cataract surgery can result in excellent anatomic and visual outcomes. Appropriate wound construction is a frequently encountered difficulty, so particular attention should be directed to this step by both trainers and trainees.

Effect of spectrum bias on the diagnostic accuracy of spectral-domain optical coherence tomography in glaucoma

PURPOSE

To evaluate the influence of a control group on the diagnostic accuracy of spectral-domain optical coherence tomography (SD-OCT) in early glaucoma.

METHODS

In a diagnostic, case-control study, 119 eyes of 60 normal subjects with no findings suspicious for glaucoma (control cohort 1); 76 eyes of 41 subjects referred by general ophthalmologists as glaucoma suspects based on optic disc morphology, but found by glaucoma experts to be normal but with physiological variations in their optic nerves (control cohort 2); and 65 eyes of 46 early-glaucoma patients (cases) underwent imaging of the optic nerve head (ONH), retinal nerve fiber layer (RNFL), and ganglion cell complex (GCC) by SD-OCT.

RESULTS

Areas under the receiver operating characteristic curves (AUC) of ONH parameters discriminating glaucomatous eyes from normal eyes of control cohort 2 were significantly lesser (P < 0.001) than those discriminating glaucomatous eyes from normal eyes of control cohort 1. AUCs of RNFL parameters discriminating glaucomatous eyes from normal eyes of control cohorts 2 and 1 were comparable. Although the AUCs of GCC thickness parameters were comparable, AUCs of GCC focal and global loss volume in control cohort 2 (0.684 and 0.671. respectively) were significantly less (P < 0.05) than in control cohort 1 (0.881 and 0.841, respectively).

CONCLUSIONS

The effectiveness of most SD-OCT parameters in detecting glaucoma significantly decreased when evaluated against a clinically relevant control group with suspicious-looking optic nerves compared with that against a control group consisting of normal subjects with no findings suspicious for glaucoma.

Explaining seasonal fluctuations of measles in Niger using nighttime lights imagery

Measles epidemics in West Africa cause a significant proportion of vaccine-preventable childhood mortality. Epidemics are strongly seasonal, but the drivers of these fluctuations are poorly understood, which limits the predictability of outbreaks and the dynamic response to immunization. We show that measles seasonality can be explained by spatiotemporal changes in population density, which we measure by quantifying anthropogenic light from satellite imagery. We find that measles transmission and population density are highly correlated for three cities in Niger. With dynamic epidemic models, we demonstrate that measures of population density are essential for predicting epidemic progression at the city level and improving intervention strategies. In addition to epidemiological applications, the ability to measure fine-scale changes in population density has implications for public health, crisis management, and economic development.

Measles hotspots and epidemiological connectivity

Though largely controlled in developed countries, measles remains a major global public health issue. Regional and local transmission patterns are rooted in human mixing behaviour across spatial scales. Identifying spatial interactions that contribute to recurring epidemics helps define and predict outbreak patterns. Using spatially explicit reported cases from measles outbreaks in Niger, we explored how regional variations in movement and contact patterns relate to patterns of measles incidence. Because we expected to see lower rates of re-introductions in small, compared to large, populations, we measured the population-size corrected proportion of weeks with zero cases across districts to understand relative rates of measles re-introductions. We found that critical elements of spatial disease dynamics in Niger are agricultural seasonality, transnational contact clusters, and roads networks that facilitate host movement and connectivity. These results highlight the need to understand local patterns of seasonality, demographic characteristics, and spatial heterogeneities to inform vaccination policy.

Intraocular Pressure Changes Associated with Intubation with the Intubating Laryngeal Mask Airway Compared with Conventional Laryngoscopy

This open, prospective, randomised study was designed to evaluate the changes in intraocular pressure and haemodynamics after tracheal intubation using either the intubating laryngeal mask airway (ILMA) or direct laryngoscopy. Sixty adult patients, ASA physical status 1 or 2 with normal intraocular pressure were randomly allocated to one of the two techniques. Anaesthesia was induced with propofol followed by rocuronium. Tracheal intubation was performed using either the ILMA or Macintosh laryngoscope. Intraocular pressure, heart rate and blood pressure were measured immediately before and after tracheal intubation and then minutely for five minutes. In the laryngoscopy group there was a significant increase in intraocular pressure (from 7.2 ± 1.4 to 16.8 ± 5.3 mmHg, P <0.01), which did not return to pre-intubation levels within five minutes, and also in mean arterial pressure after tracheal intubation, which returned to baseline levels after five minutes. In the ILMA group there were no significant changes in intraocular pressure (from 7.6±1.8 to 10.4±2.8 mmHg, P >0.05) or mean arterial pressure after tracheal intubation. Time to successful intubation was longer with the ILMA, 56.8 ± 7.8 seconds, compared with the laryngoscopy group, 33±3.6 seconds (P <0.01). Mucosal trauma was more frequent with the ILMA (eight of 30) compared with the laryngoscopy group (three of 30) (P <0.01). The postoperative complications were comparable. In terms of minimising increases in intraocular pressure and blood pressure, we conclude that the ILMA has an advantage over direct laryngoscopy for tracheal intubation.