The Hunger Games: A Systematic Review of Pediatric Bariatric Surgery
Arianne N. Theodorous, David M. Schwartzberg and Sathyaprasad C. Burjonrappa
Published: 25 May 2015
Abstract: Introduction: As childhood obesity in the US reaches alarming levels, bariatric surgery is becoming a more commonly implemented treatment option due to its high success rate compared with behavioral modification and medical therapy alone. The mechanisms by which it affects body weight and metabolic homeostasis are not well understood. The goal of the present study was to perform a systematic review of pediatric bariatric surgery to evaluate its effectiveness in the context of the physiologic changes that are produced.
Materials and Methods: The PubMed database, MEDLINE, Springer Link, Cochrane, and article bibliographies were used to identify original English-language articles published between 2009 and 2014 evaluating pediatric patients. Included studies evaluated patients undergoing Roux en Y gastric bypass, laparoscopic sleeve gastrectomy or laparoscopic adjustable gastric banding and analyzed weight loss, BMI reduction, postoperative complications and co-morbidity resolution post-procedure; all articles had at least a one year follow up.
Results: Five studies were included in our evaluation of the three most common bariatric procedures currently performed on the pediatric population for a total of 1,395 patients. The average patient age was 18.2 and 72% of patients were females. Most patients underwent roux en Y gastric bypass (RYGB) (n=659), followed by laparoscopic adjustable gastric banding (LAGB) (n=554) and finally laparoscopic sleeve gastrectomy (LSG) (n=149). The greatest decrease in BMI was seen in the RYGB group who lost an average BMI of 16.7kg/m2, followed by the LSG group with a loss of 14.0kg/m2. The LAGB patients lost 8.2kg/m2. Postoperative complications varied in severity, however the only death occurred in a patient following RYGB.
Conclusion:Bariatric surgery has proven to reduce BMI and weight in the adolescent population resulting in an enhanced quality of life and resolution of significant co-morbidities. The mechanism of weight loss is different among the three most common procedures, as is their affect on gut hormone profiles. Ghrelin may have an effect on weight loss, however it is not solely responsible for the procedures’ weight loss effect as levels vary postoperatively. RYGB has been shown to produce the greatest weight loss but postoperative ghrelin levels are not consistently decreased compared to LSG, which demonstrates low ghrelin levels routinely. Additional studies are needed to measure weight loss as it relates to postoperative gut hormone levels, as determining the physiologic changes after these procedures will guide future therapies.
Keywords: Adolescent Bariatric surgery, Outcomes, Ghrelin.
Formulation and Evaluation of Antimicrobial Activities of Herbal Cream Containing Ethanolic Extracts of Azadirachta indica Leaves and Aloe Vera Gel
Chukwuemeka Paul Azubuike, Sandra Ebele Ejimba, Abel Olusola Idowuand Issac Adeleke
Published: 12 May 2015
Abstract: The antimicrobial activity of ethanolic extract of dried leaves of Azadirachta indica (Neem), fresh gel of Aloe vera, combination of the two extracts and the creams formulated with these extracts were evaluated.
The preliminary in vitro antimicrobial activity of the extracts at various concentrations and those of their creams were determined against some microorganisms using the agar cup plate method. The growth inhibition zones of the extracts on the microorganisms were noted. The minimum inhibitory concentration (MIC) was also determined by agar dilution method. The physical properties of the creams formulated with these extracts were evaluated using standard procedures.
Gram positive bacteria were more susceptible to Neem extract of which Staphylococcus aureus was the most susceptible with the lowest MIC value (2.5mg/ml). The fungal strain Candida albicans had the lowest MIC value (2.0mg/ml) for the Aloe vera gel extract. The MIC values (mg/ml) of Neem leaves against Bacillus subtilis, Escherichia coli, Staphylococcus aureus, Pseudomonas aeroginosa, Candida albicans and Aspergillus niger were 5.00, 5.00, 2.50, 10.00, 2.50, 5.00 respectively, while MIC of Aloe extract were 8.00, 8.00, 4.00, 8.00, 2.00, 4.00 respectively. Among the formulated creams, the formulation containing equal concentrations of the extracts (1:1) showed the highest antimicrobial activity, however the commercial brand Funbact A® had better antimicrobial activity. Most of the creams showed comparable physical properties.
The study showed that the creams containing equal concentrations of the two ethanolic extracts have high potentials as topical antimicrobial agents especially against skin infections due to the tested Gram positive bacteria and Candida albicans.
Keywords: Azadirachta indica, Aloe vera, Antimicrobial activity, Herbal Creams.
Oxidative Stress Promotes Eating Behavior and Obesity in C. elegans via EGL-4 / DAF-16 Signaling
Wensheng Li, Eric Blough, Cuifen Wang, Larry Dial, Omolola Olajide, Randa Al-Jayoussi, Nesreen BenHamed and Miaozong Wu
Published: 12 May 2015
Abstract: Oxidative stress is associated with pathophysiological progress of many diseases. The objective of study was to investigate whether increased environmental oxidative stress stimulation can promote excessive eating behavior, a common cause of obesity, and to identify the molecular mechanism.The cGMP-dependent kinase (PKG) activator 8-pCPT-cGMP was applied in worm swimming assay to study behavior shifting between quiescence and foraging in C. elegans. Genetically modified C. elegans (egl-4 loss or gain of function, and daf-16 mutant) were treated with paraquat, an oxidative stress inducer. Worm’s foraging behavior, body fat accumulation and body length were determined. The foxo1::gfp-transfectedHEK293 cells and C. elegans (daf-16::gfpTJ356) were further used to examine the effect of paraquat on PKG expression and FOXO nuclear translocation.A novel swimming assay using PKGactivator stimulation was developed, which allows the rapid and effective study of foraging behavior in C. elegans. Paraquat treatment significantly inhibited quiescence, promoted foraging behavior, increased body fat accumulation and body growth. These responses were associated with diminished PKG expression/activation and increased FOXO (DAF-16) nuclear translocation in both transfected C. elegans and HEK293 cells.Our data suggest that PKG/FOXO signaling may plays an important role in mediating oxidative stress-induced excessive eating behavior and obesity development.
Keywords: Oxidative stress, Eating behavior, Obesity, EGL4/cGMP-dependent protein kinases, DAF-16/FOXO, C. elegans, HEK293 cells.
Standardization of Polyherbal Extract for Type-2 Diabetes
M. Mittal, V. Juyal and A. Singh
Published: 12 May 2015
Abstract: Aims: This study was aimed to standardize the polyherbal extract containing Annona squamosa, Phyllanthus emblica, Berberis aristata and Curcuma longa for the management of type-2 diabetes. The standardization of polyherbal formulation is indispensable in order to achieve the quality, purity, safety and efficacy of drugs.Study Design: Physico-chemical investigations, Physical characteristics, Qualitative phytochemical analyses, fluorescence analysis and HPLC analysis.Materials and Methods: The Standardization of polyherbal extract was based on systematic organoleptic evaluation, physico-chemical investigation, physical characteristics, heavy metal analysis, fluorescence analysis, phytochemical screening, total alkaloid content,determination of viscosity, surface tension, density and HPLC analysis were carried out by official method.
Results: Organoleptic evaluation resulted that it was yellowish green in colour with characteristic odour, bitter, pungent taste and fine texture. All the applied Physico-chemical parameters like total ash, acid insoluble, water soluble ash, extractive values, observed pH, moisture content, crude fibre, foaming index were found to be within limit. The limits obtained from physical and other parameters could be used as reference in quality control. The phytochemical analysis indicated the presence of alkaloids, carbohydrates, flavonoids, volatile oils, tannins, saponins, phytosterols and mucilage. Absence of detectable levels of heavy metal confirmed that extract was non-toxic in nature. HPLC studies confirm the presence of marker compounds in each extract.
Conclusion: On the basis of observations and experimental results, the study can be used as reference standard for the further quality control research as it significantly ensures the use of genuine and uniform material and well-designed methodologies for standardization and development of poly herbal extract.
Keywords: Standardization, HPLC, Annona squamosa, Berberis aristata, Curcuma longa, Phyllanthus emblica.
Impact of Production Practices on Organoleptic Intensity Scale of Different Rice Cultivars
Amit Kesarwani, Madhu Sharma, Sachin Kumar Vaid and Shih Shiung Chen
Published: 12 May 2015
Abstract: The purpose of this research was to relate mean organoleptic scores of organically and conventionally grown rice (n = 5) in japonica cultivars (Taikeng No. 16 and Kaohsiung No. 139). The 0-7 organoleptic scale is used in trials to measure the agronomic practices impact on sensory attributes of rice cultivars. However, the precise relationship between farming system and organoleptic analysis of rice remains independent variables. Judges (n = 10) used a common 0-7 scale to report the 6 sensory attributes viz. appearance, aroma, flavor, cohesion, hardness and overall acceptability while keeping cultivar Taikeng No. 9 as control. The scale ranges from – 3 to + 3 as very poor to excellent. The study demonstrates sensory attributes as inherited trait of rice; while no improvement found in cooking and eating quality under seasonal or agronomic variations. Interestingly, the aroma was reported as only better parameter when grown under organic farming compared to conventional farming (– 0.49 and – 0.62 over control, respectively). Also, the positive co-relationship exists between amylose content and organoleptic analysis while antagonistic link to crude protein content. The study cleared that management method, per se, did not influence any flavory attributes and detected no changes by the sensory panel. Further descriptive analysis needed with different conditions such as variety, degree of milling, growing location and moisture content which also played significant role in determining flavor and eating quality of rice cultivars.
Keywords: Organic farming, sensory evaluation, cooked rice, eating quality.
Analysis of Essential Elements in Commercially Important Lobster Species Collected From Coastal Areas of Karachi City, Pakistan
Tuba Kamal, Muhammad Asad Khan Tanoli, Majid Mumtaz and Sara Ayub
Published: 12 May 2015
Abstract: The study was undertaken to assess the sea food product having attractive environmental effects as they are important source of nutrients in human diets. A part from delicacy crustacean is of high value and appreciated food items, representing an important economic source in the last decade. The chemical composition and nutritional value of crustacean heavily investigated worldwide and composition benefit to human health have been much promoted. The lack of macronutrients in human leads to improper enzyme mediated metabolic functions and results in organo-malfunctions, chronic diseases and ultimately death. The aim of this study is to quantify the essential elements like Copper, Zinc, Sodium, Potassium, Calcium and Magnesium in different body parts of male and female lobster species. For this purpose lobster species were collected in year 2011 to 2013 from the different fish harbor of Karachi city. Atomic Absorption Spectroscopy (AAS) technique was used to analyze the Cu, Zn, Ca and Mg while Flame photometer was used to quantify the Na and K. The results were compared on the basis of WHO/ FAO values. The concentrations of selected essential metals were within the normal range in all the analyzed samples. Pearson correlation were applied to find out the inter metal relationship in different parts of lobster at significant level p < 0.01 or p < 0.05 and were found maximum relationship between the metals Cu:Zn, Zn:Na, Zn:K, Na:K, Na:Ca, Na:Mg, K:Mg and Ca:Mg in whole three years studied indicate that the strong correlation between the macronutrients and increasingly adverse impact of industrialization and urbanization on the commercially important lobsters community day by day.
Keywords: Lobster, Essential Elements, Karachi Coastal Areas, AAS and Flame Photometer.
A Comparative Study on Serum Level Concentration of Micronutrients Like Zinc, Copper and Chromium Status in Type 2 Diabetic Patients in Diabetes & Endocrinology Unit, Tikur Anbessa Specialized Hospital, Ethiopia
Mathewos Geneto, Melaku Umeta, Tedla Kebede, Aklilu Azazh, Ravi Nagphaul and Salahuddin Farooq Mohammed
Published: 12 May 2015
Abstract: Background: Diabetes mellitus (DM) is a chronic metabolic disorder, characterized by an absolute or relative deficiency of insulin and insulin resistance. Many studies have reported an association between diabetes and alterations in the metabolism of several micronutrients. In Ethiopia the study in the relationship between micronutrients (Zn, Cu and Cr) status and type 2 diabetes (T2DM) is scanty. The aim of this study was to assess and compare the concentration of the fasting serum zinc, copper and chromium status in T2DM and control subjects.
Method: A cross-sectional comparative study, conducted on 108 human subjects divided in to two groups: 54 subjects with the diagnosis of T2DM and the other 54 subjects were grouped as the control. After demographic and anthropometric information gathered, the blood sample was collected for the biochemical analysis. Fasting serum glucose was measured by glucose oxidase methods. The serum concentration of micronutrients namely zinc, copper and chromium were determined by using atomic absorption spectrophotometer. Data were analyzed using SPSS version 16 software.
Results: Compared with control groups, T2DM patients had greater BMI (p<0.001); higher WHR (p<0.001); elevated SBP (p<0.001); and higher diastolic DBP (p<0.001). Fasting serum glucose level of T2DM (196.4 ± 86.77mg/dl) was significantly higher than control (90 ± 14.39mg/dl). Mean serum levels of zinc in T2DM (0.744 ± 0.211mg/l) was significantly (p<0.003) lower than control (1.099 ± 0.502mg/l), chromium (0.679 ± 0.413 mg/l) was also significantly (p<0.0001) lower than control (1.064±0.483mg/l) and Cu (0.502±0.148mg/l) had significantly (p<0.0001) higher than control (0.340±0.137mg/l). In this study, the fasting serum glucose were found negatively correlated with serum levels of Zn (r= -0.290, p=0.033), and Cr (r=-0.012, p<0.0001) of diabetic subjects. Non-significant positive relationship was observed between concentrations of serum glucose and Cu(r = 0.438, p =0.113).
Conclusion: Findings of this study indicated a lower serum zinc and chromium concentrations and higher copper status were found in type 2 diabetics of Ethiopian subjects. The study suggests that another research should be conducted in the effect of the supplementation of micronutrients on controlling of type 2 diabetic mellitus.
Keywords: Type 2 diabetic, zinc, copper, chromium, atomic absorption spectrophotometer.