Rahul Misra (name changed), who was always on the heavier side, became excessively overweight because of his lockdown-infused sedentary lifestyle. When his day-to-day life activity started getting affected because of his poor health condition, he decided to shed the weight through excessive exercise. But, as a result, he developed spine and joint injuries. When he visited a doctor, he was suggested to undergo bariatric surgery or weight loss surgery. The delay in surgery led to prolonged recovery and unnecessary ICU admission.

Health experts across the globe recommend that one shouldn’t delay bariatric surgery once indications and needs have been established. Weight gain and worsening of related diseases while awaiting surgery leads to poor quality of life and also slow recovery rates. Our sedentary lifestyle has contributed to many health problems and obesity is one of them. It has been quite dismal to see how the remote working and staying at home during the pandemic and has led to a rise in obesity in children of Delhi by 51% as per a recent report. The situation is not grim only in the national capital; the National family health survey of India has shown an increase in obesity in all of the Indian states.

COVID AND BARIATRIC SURGERY

The surge in obesity cases could be mainly due to the lifestyle and a change in diet pattern as people are mostly consuming processed food, which is causing a disturbance in metabolism and insulin resistance in their bodies. As the government has now lifted the restrictions on elective surgeries, it’s just the apt moment to go for it. This surgery is done when diet and exercise haven’t worked or when somebody has serious health problems because of the weight. Robotic surgery and endoscopic bariatrics are examples of how new technology has given us more options. Also, the industry has come up with improved stapling and suturing devices. Even the hospitals are adhering to all the Covid safety guidelines with their healthcare staff vaccinated; patients should get their bariatric surgery done without any hesitation. It is advisable that people who had decided to undergo bariatric surgery before the start of the pandemic should consider having it done sooner rather than later to avoid any further adverse health outcomes.

PROCEDURES OF BARIATRIC SURGERY: ROBOTIC SURGERY IS THE WAY AHEAD

One can opt for bariatric surgery if he/she has a BMI of 32.5, with specific significant health problems like Type 2 diabetes, sleep apnea or high blood pressure. A BMI of 37.5 or higher also is a qualifying criterion for the surgery. Depending on the BMI and patient requirements, endoscopic/laparoscopic/robotic surgery is offered. Endoscopic is preferred when a small amount of weight loss is needed and robotic is the choice in extreme cases. In robotic bariatric surgery, the latest in the field, the surgeon operates the procedures through a master console and the robotic patient cart operates through tiny holes on the patient similar to laparoscopy with much ease and precision. This procedure has many definite advantages over conventional laparoscopic surgery due to its 3D vision and precise intuitive multi-range instruments that add more safety to the patients. It also helps in better suturing skills and reduces post-operative pain and recovery time after surgery. Post-bariatric surgery, nutritional deficiencies can be a problem. However, it can be prevented by staying in close touch with the hospital team and following the dietary guidelines as suggested by the dietician. 

The writer is Senior Gastrointestinal & Bariatric Surgeon, Apollo Hospitals, New Delhi. 

Young but fragile Himalaya is blessed with rich Biodiversity.Its valuable resources have traditionally served as the foundation for economic and cultural life of vast & vibrant population.

A few attitudinal differences and climate change developments coupled with variation in soil conservation create striking changes in the terrain having fabulous flora and fauna.Such a unique bio diversity not only encompasses ecological, scientific or economic values,it is a capital of inheritance,passed down generations, stressing the need for Sustainable Development.

BIOTIC INTERFERENCE

2) Developments of past and present indicate ,however, extremes of biotic interference.Making wise use of bio diversity inheritance should not be tutored.It has to be felt ,imbibed and carried forward when one is confronted with the tentacles of Corona Auntie And whims & fancies of the Covid Uncle.Without entering into realm of discussion on the origin of the virus,one should believe that SARS II virus is an off shoot of the prevailing environment.An environment throttled by one and all..

Fauna Such As Elephants Need Fresh Look

3) Coming to judicious utilisation rather than exploitation of floral & faunal wealth, there may be a need for a fresh approach.Not only farming communities near forests have to be sensitized to extract forest and non forest timber products properly but they also have to be briefed to leave ENOUGH scope for growth and sustenance of grass,shrubs,water bodies etc, vital for life of animals,such as,Lions,Elephants,Tigers, Deer etc.While saying so,one is not aiming to touch upon the crucial Food Chain,
rather the purpose is to prick our mind specifically about the plight of gentle Elephants,who,being vegetarian,show full loyalty towards their masters.
Of 27,000 Asian Elephants in India,21% reside in Assam.Due to loss of forest habitat, they are increasingly coming face to face with humans.Every year,around 100 of them, unfortunately, get killed.They are also misused in the Tourism industry.The Wildlife Protection Act,1972 bans the sale of captive & unregistered elephants.
The mere fact that they live,eat and move in groups or clusters,goes on to show their strong family instincts,something reflected glaringly in:

A) Episode of 18 elephants in Nagaon,Assam in May,2021 crushed by lightening And
B) Freak,directionless walk of over 500 kms by 15 elephants in Kunming area of Yunan province of China in June,2021.

Sympathy Is Necessary

4) Despite the inherent friendly attitude of the elephants and many other animals often the reports of Entry into the human habitations, hit the head lines.There has to be some reason for such an entry.What they get in return is hectic,irrational and merciless action.The facial expression of the fauna in such a situation shows their State of helplessness. The onlookers, never the less ,get sarcastic pleasure in having an exciting glimpse.Whether it is a case of entry by the loveable Monkeys.,Leopards,Tigers or the Elephants into towns of different states, these should not be considered as an intrusion by the animals.

Assertion of Rights

5) It is felt that such a behavior has to be viewed as a valiant act of ASSERTION of rights by certain species to counter the actual intrusion into their bonafide habitat by the shrewd human beings.There should be no justification to suppress or subjugate the innocent animals either by mechanical or muscle power.
Will our Forest Service friends wake up and take requisite action especially during the current wave of Covid,when almost two dozen “positive” tigers and couple of similar infected lions have already left the world ?
.Lingering threat to pets & domestic animals who soothen our feelings when we are tired & exhausted, also fill the atmosphere,time and again.

5) Having stated so,I may humbly submit :
“When the animal instinct among the humans crosses conceivable limits,the actual and bonafide sons and daughters of mother earth are left with no alternative but to react vehemently or justifiably”.

Unhealthy Tussle

6) It is not only the competition or tussle factor for a habitat between the animals and human beings, But it is a question of displaying adequate love and care for the natural endowments,indiscriminately gifted by the Almighty.

Saviour Duty

7) It may not be out of context to remind ourselves about the basic Hindu philosophy of emphasizing reverence to the flora and fauna right from childhood.For generations, plants, such as,Peepal,Banyan,Tulsi,Banana,Mango, etc.and the animals,namely,Cow,Bull,Lion,Tiger,Elephant,Monkey,Rat,Cobra snakes etc were being worshipped. Also the morning ritual of offering water to Sun God, Tulsi plant and Peepal tree not only has given the requisite faith & confidence to the worshippers but it can also teach us again the forgotten lesson to do everything possible to Preserve Flora & Fauna.

8) To Sum Up:

If we are mandated to avoid Social Interaction due to Corona virus and more lethal Third Wave, how can we afford to undermine similar “social” instinct among the animals?
Their state of hunger and helpless facial expressios during last two rounds of Lock Downs, calls for improving our overall attitude towards them. Timely food intake and sound health of fauna not only can improve their internal social behavior but it may also ensure a refined attitude towards their human handlers, caretakers or masters.
Even if we get rid of COVIDITY clinically, the love and affection displayed by the pets may prove much more valuable if not decisive in reducing our anxiety and depression. It may Ultimately Facilitate Satisfactory Healing of the Community.

A new study from the University of Sheffield has revealed that Vitamin D supplements are not an effective treatment for easing painful symptoms of Irritable Bowel Syndrome (IBS).

The findings of the study appeared in the European Journal of Nutrition. Scientists from the University’s Department of Oncology and Metabolism – in conjunction with a health supplement company, BetterYou – carried out trials on participants who suffer from the chronic condition of the digestive system to assess whether vitamin D reduced the severity of their symptoms and whether it could improve their quality of life.

Results of the study found that despite an improvement in vitamin D status in the participants in response to a vitamin D3 oral spray supplementation over a 12-week trial, there was no difference to their IBS symptom severity over the same period, nor a reported change in the participants’ quality of life.IBS is a common functional bowel disorder, characterized by chronically relapsing perturbed bowel habits. It causes symptoms such as stomach cramps, bloating, diarrhea and constipation.

For some, symptoms will come and go, but for others, it can severely affect their quality of life, often causing embarrassment leading to many living with the condition undiagnosed, affecting both mental health and wellbeing.

A new study found that people who eat a diet that includes at least half a serving per day of foods high in flavonoids like strawberries, oranges, peppers and apples may have a 20 per cent lower risk of cognitive decline.The findings of the study were published in the online issue of ‘Neurology’, the medical journal of the American Academy of Neurology. The study looked at several types of flavonoids and found that flavones and anthocyanins may have the most protective effect.

Flavonoids are naturally occurring compounds found in plants and are considered powerful antioxidants. It is thought that having too few antioxidants may play a role in cognitive decline as you age. “There is mounting evidence suggesting flavonoids are powerhouses when it comes to preventing your thinking skills from declining as you get older,” said study author Walter Willett, MD, DrPH, of Harvard University in Boston, Mass.“Our results are exciting because they show that making simple changes to your diet could help prevent cognitive decline,” added Willett.The study looked at 49,493 women with an average age of 48 and 27,842 men with an average age of 51 at the start of the study. Over 20 years of follow up, people completed several questionnaires about how often they ate various foods. Their intake of different types of flavonoids was calculated by multiplying the flavonoid content of each food by its frequency.Study participants evaluated their own cognitive abilities twice during the study, using questions like, “Do you have more trouble than usual remembering recent events?” and “Do you have more trouble than usual remembering a short list of items?”

This assessment captured early memory problems when people’s memory has worsened enough for them to notice, but not necessarily enough to be detected on a screening test. The people in the group that represented the highest 20 per cent of flavonoid consumers, on average, had about 600 milligrams (mg) in their diets each day, compared to the people in the lowest 20 per cent of flavonoid consumers, who had about 150 mg in their diets each day. Strawberries, for example, have about 180 mg of flavonoids per 100 gram serving, while apples have about 113.

According to a new study, people with type 2 diabetes diagnosed during youth have a high risk of developing complications at early ages and have a greater chance of multiple complications within 15 years after diagnosis. The findings of the study were published in the New England Journal of Medicine. The results of the study are the culmination of a first-of-its-kind trial funded largely by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health.

Within 15 years of a type 2 diabetes diagnosis, 60 per cent of participants had at least one diabetes-related complication, and nearly a third of participants had two or more complications, according to results of the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) follow-up study, called TODAY2.

“The original TODAY study showed that youth-onset type 2 diabetes is distinct from adult-onset diabetes – it is both more aggressive and more difficult to control,” said Dr Barbara Linder, NIDDK project scientist for TODAY.“By following this unique disease course, TODAY2 shows the devastating complications that can develop in what should be the prime of these young people’s lives,” added Dr Linder.

TODAY2 involved 500 original participants from the TODAY study, which began in 2004. TODAY was the first major comparative effectiveness trial for the treatment of type 2 diabetes in youth. The study compared three treatments for managing blood glucose: metformin alone, metformin plus rosiglitazone, and metformin plus intensive lifestyle intervention. Metformin is the only oral medication approved by the US Food and Drug Administration to treat type 2 diabetes in youth.

At the time of enrollment, participants were between the ages of 10-17, had been diagnosed with type 2 diabetes for fewer than two years, and were overweight or had obesity. The average age of participants after the TODAY2 follow-up was 26 years.

Participants in TODAY2 were monitored annually for signs of diabetes complications, including heart disease, kidney disease, diabetic foot complications, and to report other health events. Diabetic eye disease was assessed once during the study, at the seven-year study visit.Overall, researchers saw a steady decline in blood glucose control over 15 years. In addition:

1. 67 per cent of participants had high blood pressure

2. Nearly 52 per cent had dyslipidemia or high-fat levels in the blood

3. Around 55 per cent had kidney disease

Rates did not differ based on the original TODAY study treatment group assignment. In addition, certain participants had a higher likelihood to develop multiple complications over time, with 28 per cent developing two or more over the follow-up period. Participants who belonged to a minority racial or ethnic group, or who had high blood glucose, high blood pressure, and dyslipidemia were at higher risk for developing a complication.“Compared to what we see in adults with type 2 diabetes, the participants in TODAY2 developed complications much earlier in their disease course and at a much faster pace over time,” said TODAY2 study chair Dr Philip Zeitler, professor of paediatrics-endocrinology at the University of Colorado School of Medicine.

“This study shows the importance of treating youth-onset type 2 diabetes intensively from beginning and using all available approaches to control blood glucose and aggressively treat developing complications,” added Dr Zeitler.

A recent study has discussed the psychological consequences of COVID-19 on healthcare and also highlighted the protective factors that can help people cope with the severe strain caused by the pandemic.

The study conducted by the University of Bonn is based on a large joint online survey at the University Hospitals Bonn, Erlangen, Ulm, Dresden, and Cologne, which also involves many other hospitals in Germany. The results have been published in the journal PLOS ONE. Perceived coherence was found to be particularly important – in simple terms: the feeling that life has meaning and challenges can be classified in an understandable way.

The researchers invited employees in health care to take part in an online survey from April to July last year, i.e. during the first wave of the pandemic. “Alongside physicians and nursing staff, this also included two groups who have so far been overlooked in the discussion,” explained Professor Dr Franziska Geiser, Director of the Clinic for Psychosomatic Medicine and Psychotherapy at University Hospital Bonn.

Geiser added, “Firstly, the comparatively small number of pastoral workers in the hospitals. Secondly, the many medical and technical employees – the medical technical assistants within the examination, radiology, and the laboratories.”

More than 4,300 completed questionnaires were evaluated during the current study. A good 80 per cent of the participants worked in hospitals at the time of the survey, 11 per cent at University Hospital Bonn. They were asked to state, among other things, how stressed they felt by their work at present and before the survey and how often they suffered from symptoms of depression and anxiety.

Information was also collected on three possible “resilience factors”, which are assumed to protect against mental consequences of stress: social support, religiosity, and sense of coherence.

More than 20 per cent of the respondents in each case stated that they had symptoms of depression or anxiety to an extent requiring treatment. “We do not know exactly what the situation was like for this sample before the pandemic,” explained Geiser.

He continued, “However, the values found are higher than in earlier studies among physicians and nursing staff, so we can assume there has been an increase during the pandemic. While, during normal times, physicians and nurses display higher mental strain than the rest of the population, they actually had lower anxiety values during the pandemic in our survey. This naturally makes us curious about possible protective factors.”All the more so as Geiser is part of an interdisciplinary DFG research group at the University of Bonn, which is dedicated to researching resilience.Sense of coherence particularly stands out among the potential resilience factors. The term comes from salutogenesis, a concept developed by medical expert Aaron Antonovsky in the 1980s, which focuses on searching for health-promoting factors and attitudes.

“Sense of coherence refers to the extent to which we perceive our life as understandable, meaningful, and manageable,” explained Jonas Schmuck from Geiser’s working group, who is the lead author of the study together with Dr Nina Hiebel.

The more pronounced the sense of coherence among employees, the less often they suffered from mental symptoms. “However, a causal relationship cannot necessarily be derived from this,” said Geiser as a warning against drawing premature conclusions. “It may also be the case that anxiety or depression themselves minimize perceived coherence.”

Nevertheless, she believes that this factor actually makes us more resilient to stress and particular challenges.

In her view, the study thus brings to light important conclusions on how people should handle crises like the COVID-19 pandemic in the future. “The more complex the situation, the better we need to communicate,” she stressed.

“Uncertainties and also contradictions, such as with regard to protective measures or treatment processes, are unavoidable in a new situation like the pandemic. The better it is explained to employees why this is the case and the more personal meaning they experience in their work, the better they can handle it. Timely information is therefore essential.” This information should not only flow in one direction, according to Geiser. “It is important to enter into a dialogue that also allows for questions and responses to concerns,” she said.