Obesity and stroke sessions during PSIM Conference
Sleeve Gastrectomy is overtaking all other
forms of Bariatric Surgery-Prof.Mehmood Ayyaz
While treating obesity, target metabolism not
weight reduction alone - Dr. Asif Humayun

Lahore: Prof. Irshad Hussain Qureshi along with Prof. Munir Azhar chaired the session devoted to Obesity during the PSIM annual conference. Dr.Asif Humayun from UK was the first speaker who talked about medical management of obesity. This, he said, is a multifactorial disease which results in excessive fat. There is some genetic basis of obesity as well. One can use diet, exercise, drugs and surgery to manage obesity. He was of the view that we the physicians should target metabolism instead of weight reduction alone.

The physicians should advise the patients not to eat when they are not hungry. Remove positive calorie. Balance either with surgery or diet plan. Total diet can be replaced with shakes or soups but ensure to consume balanced food. Advice the patients to have thirty minutes exercise daily. He also talked about metabolic surgery, different diet plans for weight loss. Many patients do not use medications. His advice was to start with calorie restricted diet. For the management of Type-2 diabetes, I use GLP1 and SGLT2 inhibitors, he added.

Prof. Mehmood Ayyaz spoke about surgical interventions in obesity management. Services Institute of Medical Sciences, he said, has officially funded bariatric surgery programme and people with more than 35 BMI are targeted. Speaking about the disease burden globally, he said that at present there are about 1.9 billion adults who suffer from obesity. Bariatric surgery started in 1954. It got re-birth after the start of laparoscopic surgery. Dr. Mason did the first gastric bypass procedure in 1966 which controlled diabetes as well as resulted in weight loss. Later Bands were used to reduce the size of the stomach. The use of intra gastric balloons is no more recommended.

Prof. Mehmood Ayyaz

Continuing Prof. Mahmod Ayyaz said that sleeve Gastrecomy is overtaking all other forms of bariatric surgery. He also discussed the main steps of gastric bypass. Sleeve Gastrectomy, he further stated, is not an easy procedure and one has to be a well trained laparoscopic surgeon to undertake this procedure. It offers good results with weight loss. It is a non-reversible procedure and has high complications rate as compared to gastric band. However, the use of bands is associated with problems like band migration; band can also erode and lead to drastic complications. Patients keep on coming again and again for band adjustment. Gastric Band is an OPD procedure. It has few complications but sustained weight loss should be desired. Avoid protein deficiency with all these procedures. Bariatric surgery offers long term weight loss and improved longevity.

Giving details of the Bariatric Surgery performed at SIMS, Prof. Mehmood Ayyaz said that it started in 2007 and so far they have done three hundred seventeen procedures. It included 304 patients who underwent LSG procedures. Some of these patients are off their medications as their diabetes is under control. He then also showed a Video of Lap Sleeve Gastrectomy. These patients cannot take more food and they take food hourly. We have trained many surgeons in our unit over these years and they are doing this bariatric surgery in different hospitals all over the province, he remarked.

In his concluding remarks Prof. Irshad Hussain Qureshi said that almost 50% of our population suffers from obesity and they are not concerned with their weight. Female want to lose weight but they are not prepared to do exercise but only wish to take drugs without diet control which is not possible. Prof. Munir Azhar remarked that BMI and the co-morbid factors will determin which patients are suitable for bariatric surgery.

Management of Stroke

This session was chaired by Prof. M. Akbar Chaudhry along with Prof. Zaman Sheikh. Prof. Qasim Bashir was the only speaker who discussed management of hyper acute Stroke. He pointed out that now developed countires are talking about stroke survival. Silent CNS infections require aggressive risk reduction. Therapy is to avoid stroke. Talking about the warning signs of stroke he mentioned sudden weakness, confusion, sudden problems in seeing, trouble in walking. Every stroke which lasts for ten hours, 5% of those patients will die. It is important to take history when the patient was well last time as the number of hours will determine the treatment plan. tPA should be administered within sixty minutes. This is known as the golden hour for intervention. CT Angio is required in case of large vessel occlusion. Now stents are also used to aspirate the clot. Some of these new drugs and techniques are not available in Pakistan because DRAP is not willing to take decision. Replying to a question it was pointed out that Heparin is no more used in acute stroke. It was also pointed out that it is better to prevent stroke and treat early as per patient’s requirements.

Prof. Akbar Chaudhry in his concluding remarks said that the risk factors are the same as in case of acute myocardial infarction. We are not doing enough to prevent stroke that is why we lack behind. We need to provide more facilities for intervention, ensure the availability of TPA. Disability due to stroke is serious and it is the responsibility of the family to look after these patients.

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