Saqib Saeed

Background. Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have comparable weight loss outcomes in a general bariatric population. Objectives. This study aimed to investigate whether similar outcomes can be observed in Hispanic and African American population. Settings. Community Hospital in New York, New York, United States. Methods. The 5-year prospective data of patients who underwent LRYGB and LSG at a single center were retrospectively reviewed. The long-term weight loss outcomes between patients who had LRYGB and LSG were compared after adjusting for age, sex, race, diabetes mellitus, and hypertension with the linear mixed-effects or logistic regression model. Results. Most patients were Hispanic (59.2%) and African American (22.7%). The mean% total weight loss (%TWL) values of patients with BMI 50 kg/m² who had LRYGB and LSG were 53% and 42% after 1 year, 53% and 45% after 2 years, and 49% and 36% after 5 years, respectively. All results were statistically significant and remained valid after adjusting for cofactors. Conclusion. Thus, LRYGB had consistent and sustained long-term weight loss outcomes compared with LSG in a predominantly ethnically diverse patient population with different BMI. Our study had several limitations in that it is retrospective in nature and some patients were lost to follow-up during the study period.

Diaphragmatic injuries can be a direct result of penetrating thoracoabdominal trauma such as gunshot or stab wounds. Diaphragmatic rupture can lead to herniation of intra-abdominal organs into the thoracic cavity. Diagnosis can be difficult as the results of a physical exam can be unremarkable. A CT scan of the chest is diagnostic for diaphragmatic injuries. In most emergency cases, diaphragmatic injuries are managed with laparotomy where CT was diagnostic. We report a rare case of a 25-year-old man with right diaphragmatic injury sustained after a stab wound to the right liver managed successfully with laparoscopy.

Background Bariatric surgery is associated with improved renal dysfunction in general population studies. The study examined the effects of bariatric surgery on renal function in a predominantly Hispanic and African American population at a community hospital in New York, USA. Methods This retrospective study analyzed prospectively collected bariatric surgical data from 2247 patients (89% female) who underwent bariatric surgery at a single center. Changes in glomerular filtration rate (eGFR), urine albumin–creatinine ratio (UACR), micro- and macroalbuminuria, and hyperfiltration, which were measured preoperatively and then yearly for 3 years postoperatively, were evaluated with t tests and logistic regression analysis, after adjusting for confounding variables. The mean age of the patients at surgery was 37.1 years; the mean preoperative body mass index was 45 ± 7 kg/m². Results The results obtained 3 years postoperatively showed the following significant improvements compared with the preoperative values: mean UACR decreased from 40.3 to 11.1 mg/g, mean eGFR improved from 79.4 to 87.3 mL/min, the prevalence of microalbuminuria decreased from 13.7 to 6.2%, the prevalence of macroalbuminuria decreased from 2.5 to 0%, and the prevalence of hyperfiltration decreased from 4.4 to 2.7% (all P < .0001). In adjusted multivariate regression analysis, these results remained significant after adjusting for age, sex, race, type of surgery, and presence of diabetes mellitus or hypertension. Conclusion In this large study at an inner-city hospital, bariatric surgery was associated with significant improvements in renal dysfunction parameters. These results could assist with informed decisions regarding indications for bariatric surgery.

Phlegmonous gastritis is a rare and progressive fatal condition that affects the mucosa and submucosa of the gastric wall. It can be localized or diffuse, affecting the entire stomach. It usually presents with upper gastrointestinal symptoms, such as nausea, vomiting, and hematemesis, along with systemic symptoms, including fever, chills, and fatigue. Risk factors include mucosal injury, surgery, hypoacidity, and immunosuppression that can be seen in human immunodeficiency virus (HIV)-positive or alcoholic patients. We present a case of phlegmonous gastritis which developed after a laparoscopic sleeve gastrectomy. The patient presented with epigastric pain, nausea, and chills two months post-sleeve gastrectomy. The diagnosis was made with computed tomography (CT) scan of the abdomen. She was managed successfully with CT-guided drainage and antibiotics.

We report a case of giant mucinous carcinoma of the breast in a 55-year-old female who presented with left breast lump for two years. The patient did not seek any medical attention for two years. On exam, the lump measured 12 x 14 cm. Core needle biopsy showed invasive mucinous adenocarcinoma without ductal component. The patient underwent neo-adjuvant chemotherapy without any response. She underwent left modified radical mastectomy. All lymph nodes were negative. This was followed by adjuvant chemotherapy. Mucinous carcinoma is a rare type of breast cancer that carries a good prognosis compared to other types of breast cancers. In this report, we presented a giant mucinous carcinoma measuring 14 cm.

Laryngeal fracture is a rare but potentially lethal injury. A high degree of suspicion along with an expeditious investigation is warranted to prevent airway complications. The initial assessment of the airway is vital as the patient can suffer a severe anoxic brain injury. If the patient is stable, a computed tomography (CT) scan of the neck should be obtained; this was done urgently for our patient and was managed without any extraneous intervention. We report a case of a 38-year-old man that presented to the emergency room with anterior neck pain after falling onto the back of a paintball gun. The patient was managed conservatively and favorable outcomes were obtained.

Tracheostomy tube change is a relatively common and simple procedure once a tract is formed between the skin and the trachea. Regular tracheostomy tube changes decrease the risk of postoperative pulmonary infection and granulation tissue formation. However, serious complications, such as loss of airway, subcutaneous emphysema, and mediastinitis, can occur if the tube exchange is performed inappropriately. We present a rare association of subcutaneous emphysema, tension pneumothorax, pneumomediastinum, and pneumoperitoneum following a tracheostomy tube exchange in a 56-year-old patient who had his tracheotomy placed a month ago. The patient was successfully managed conservatively by chest tube and supportive care.

Small bowel obstruction in HIV patients is reportedly caused by inflammatory pseudotumor, Kaposi’s sarcoma, cryptococcal lymphadenopathy and intestinal tuberculosis. The incidence of Mycobacterium avium complex (MAC) infection in HIV patients is 3% for CD4 cell count of 100–199 /mm³. MAC causing small bowel obstruction is rarely reported in the literature. We report a rare case of MAC causing mesenteric abscess with small bowel obstruction in a HIV patient with a CD4 cell count of 144 /mm³. Patient was a 35-year-old HIV-positive male on highly active antiretroviral therapy who presented with partial small bowel obstruction secondary to mesenteric abscess. He underwent operative intervention for drainage with cultures growing MAC.