Search results for: gastric innervation
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 155

Search results for: gastric innervation

65 Metastatic Ovarian Tumor Discovered Accidentally during Cesarean Section in a 34 Year Old Woman: A Case Report

Authors: Ghada E. Esheba, Ghufran Kheshaifaty, Kholoud Al-Harbi, Wafa'a Al-Harbi, Ala'a Al-Orabi, Moayad Turkistani

Abstract:

Krukenberg tumor is a rare metastatic ovarian carcinoma that usually occurs in female between 30 - 40 year old and rarely seen after menopause. Stomach is the most common primary site. Histopathological features of krukenberg tumors appear as diffuse stromal proliferation, mucus-production, and numerous signet-cells and these tumors spread mostly by lymphatic route. Treatment and prognostic factors are not well established. This study describes a 34 year old female with a unilateral ovarian mass discovered accidentally during cesarean section delivery and it was misdiagnosed as luteoma of pregnancy, but histopathological examination showed a diffuse infiltration of the ovary and omentum by signet ring cells. These findings were not correlated with luteoma of pregnancy or any other types of primary ovarian tumors like surface epithelial tumor, sex cord stromal tumor or germ cell tumor. However, after the analysis of immunohistochemical results (negative CK7, positive CK20 and CDX-2), the finding was the diagnostic of metastatic krukenberg tumor. Two weeks later, the patient was evaluated and a large gastric tumor was found in her stomach and she underwent gastrectomy.

Keywords: CK7, CK20, CDX-2, Krukenburg tumor, metastatic ovarian tumor

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64 Gross Anatomical Study on the Tributaries of the Hepatic Portal Vein in Cattle Egret (Bubulcus Ibis)

Authors: Elsayed Fath Khalifa, Samer Mohamed Daghash

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The aim of the current work study to increase the anatomical knowledge about the cattle egret which considered economically important for farmers. The study was carried out on ten adult, apparently healthy cattle egrets of both sexes. Each bird was exsanguinated; the caudal vena cava was cannulated and flushed with warm normal saline solution (0.9%) then injected with blue colored neoprine (60%) latex in order to study the tributaries of the hepatic portal vein. The origin, course and tributaries of the right and left hepatic portal veins were studied. The hepatic portal venous system collected venous blood from the abdominal viscera including; glandular and muscular stomachs, liver, pancreas, spleen, small intestine and large intestine. The hepatic portal vein was formed by the left and the right hepatic portal veins. The smaller left one drained blood from the glandular and muscular stomachs through the ventral and the left proventriculus as well as the left gastric veins. The most tributaries of the right hepatic portal vein drained blood from the rest of the gastrointestinal tract and the spleen by the proventriculosplenic, the gastropancreaticoduodenal and the common mesenteric veins.

Keywords: cattle egret, common mesenteric vein, hepatic portal vein, anatomy

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63 A Gastro-Intestinal Model for a Rational Design of in vitro Systems to Study Drugs Bioavailability

Authors: Pompa Marcello, Mauro Capocelli, Vincenzo Piemonte

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This work focuses on a mathematical model able to describe the gastro-intestinal physiology and providing a rational tool for the design of an artificial gastro-intestinal system. This latter is mainly devoted to analyse the absorption and bioavailability of drugs and nutrients through in vitro tests in order to overcome (or, at least, to partially replace) in vivo trials. The provided model realizes a conjunction ring (with extended prediction capability) between in vivo tests and mechanical-laboratory models emulating the human body. On this basis, no empirical equations controlling the gastric emptying are implemented in this model as frequent in the cited literature and all the sub-unit and the related system of equations are physiologically based. More in detail, the model structure consists of six compartments (stomach, duodenum, jejunum, ileum, colon and blood) interconnected through pipes and valves. Paracetamol, Ketoprofen, Irbesartan and Ketoconazole are considered and analysed in this work as reference drugs. The mathematical model has been validated against in vivo literature data. Results obtained show a very good model reliability and highlight the possibility to realize tailored simulations for different couples patient-drug, including food adsorption dynamics.

Keywords: gastro-intestinal model, drugs bioavailability, paracetamol, ketoprofen

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62 Breakfast Skipping and Health Status Among University Professionals in Bangladesh

Authors: Shatabdi Goon

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OBJECTIVE: To determine the prevalence and associations between breakfast skipping and health status for university professionals in Bangladesh. DESIGN: A cross-sectional descriptive study design was performed using information on respondent’s sociodemographic status and eating behavior. Factors associated with breakfast skipping were identified using multivariate regression models. SETTINGS: Data obtained from a representative sample (n 120) of university professionals randomly selected from two distinct universities in Dhaka city, Bangladesh. SUBJECT: A total number of one hundred and twenty university professionals with a mean age of 29 years. RESULT: Results indicated that approximately 35.8% of the sample skipped breakfast. Gender was the only statistically significant sociodemographic variable, with females skipping at over two times the rate of males (OR 95% CI: 1.9; 0.90-4.13). The reasons given for skipping breakfast were almost exclusively habit (39.5%), work pressure (23.2%) and lack of time (16.2%). Skippers were significantly more likely to be obese (OR 2.4; 95% CI 1.02- 5.7), less energetic (OR 3.5; 95% CI 1.5-8.6), associated with health problems (OR 4.3; 95% CI 1.8- 10.17) and eating tendency of fast food (OR 2.5; 95% CI 1.13 - 5.5). Gastric and heart burn (X2=4.19, p<0.05) and high blood pressure (X2=5.027, p<0.05) were detected among 34.9% and 27.9 % of those employees respectively identified as breakfast skippers and they showed significantly high prevalence. CONCLUSION: Breakfast skipping is highly prevalent among university professionals with significant association of different health problems in Bangladesh. Health promotion strategies should be used to encourage all adults to eat breakfast regularly.

Keywords: breakfast, healthy lifestyle, breakfast skipping, health status, university professionals

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61 Characteristics of Acute Poisoning in Emergency Departments: Multicenter Study in Korea

Authors: Hyuk-Hoon Kim, Young Gi Min

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Background: Acute poisoning is the common cause of morbidity and mortality. Characteristics of acute poisoning differ between countries. While other countries operate the database system for poisoning, Korea has not collected the database for acute poisoning. Distribution of incidence of acute poisoning depending on the types of materials have also not studied in Korea. Our aims are to evaluate the etiologic and demographic characteristics of acute poisoning cases and to obtain up-to-date information on acute poisonings. Method: We retrospectively recorded cases of acute poisoning from eight emergency departments of second level or university hospitals from different cities in Gyeonggi province in Korea from April 2006 and March 2015. The distributions of incidence of acute poisoning depending on the types of materials are mapped by geographic information system. Result: A total of 3,449 poisoned cases were analyzed. Mean estimated age of patients was 39.56 ± 22.40 years. Mean male to female ratio of patients was 1:1.4. Mean proportion of intentional poisoning was 57.9%. Common materials are benzodiazepine (16.6%), carbon monoxide (10.5%), pesticide (8.1%) and zolpidem (7.1%) Common route of exposure is ingestion (79.5%) and followed by inhalation (16.5%). Common treatment methods are gastric lavage (20%) and activated charcoal (30%). Most cases had uneventful recovery; 61.4% were treated as outpatients and 0.1% of the poisoning resulted in death in ER. Conclusion: Even though the cases enrolled in our study is not the overall cases of acute poisoning in Korea, our study could be the basis of countermeasures for analysis and prevention of acute poisoning in Korea.

Keywords: acute poisoning, emergency department, epidemiology, Korea

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60 Antiplatelet Activity of Nitrated Fatty Acids from Tomato Pomace

Authors: Lyanne Rodriguez, Eduardo Fuente, Andrés Trostchansky, Ivan Palomo

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Cardiovascular diseases (CVD) are the leading cause of death in the world. The development of platelet-rich thrombi has been considered a trigger for acute cardiovascular events. A healthy diet, rich in fruit and vegetables, has been related to increased protection against cardiovascular events. Previous studies have observed that tomato pomace has a potent antiplatelet activity, due could be attributed to its high content of fatty acids (> 30%). It has been shown that unsaturated fatty acids can undergo endogenous intracellular nitration reactions during digestion after lipid consumption. Additionally, nitrated fatty acids (NO2-FA) can significantly reduce atherosclerotic lesion formation, inhibiting the expression of adhesion molecules on dysfunctional endothelium and platelet activation. In this work, we have proposed the nitration of fatty acids present in tomato pomace to improve its antiplatelet action. The gastric digestion of the tomato pomace allowed the nitration of the fatty acids, while by HPLC/MS/MS we were able to identify and quantify the nitrated fatty acids. The nitrated tomase extracts showed antiplatelet potential when platelets were stimulated with TRAP-6 and collagen. This activity was related to the presence of nitrated linoleic acid, which inhibited platelet activation by flow cytometry. The knowledge about the antiplatelet activity of nitrated fatty acids from tomato pomace will further develop new and more effective agents.

Keywords: cardiovascular, tomato extracts, nitrated fatty acids, antiplatelet activity

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59 The Regulation of the Pro-inflammatory Cytokine Interleukin 6 (IL6) by Epstein-Barr Virus (EBV)

Authors: Liu Xiaohan

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Epstein–Barr virus (EBV) is a human herpesvirus and is closely related to many malignancies of lymphocyte and epithelial origins, such as gastric cancer, Burkitt’s lymphoma, and nasopharyngeal carcinoma (NPC). NPC is a malignant epithelial tumor which is 100% associated with EBV latent infection. Most of the NPC cases are densely populated in southern China, especially in Guangdong and Hong Kong. To our knowledge, overexpression of pro-inflammatory cytokines may result in a loss of balance of the immune system and cause damage to human bodies. Interleukin-6 (IL6) is a pro-inflammatory cytokine which plays an important role in tumor progression. In addition, gene expression is regulated by both transcriptional and post-transcriptional pathways, while post-transcriptional regulation is an important mechanism to modulate the mature mRNA level in mammalian cells. AU-rich element binding factor 1 (AUF1)/heterogeneous nuclear RNP D (hnRNP D) is known for its function in destabilizing mRNAs, including cytokines and cell cycle regulators. Previous studies have found that overexpression of hnRNP D would lead to tumorigenesis. In this project, our aim is to determine the role played by hnRNP D in EBV-infected cells and how our anti-EBV agents can affect the function of hnRNP D. The results of this study will provide a new insight into how the pro-inflammatory cytokine expression can be regulated by EBV.

Keywords: interleukin 6 (IL6), epstein-barr virus (EBV), nasopharyngeal carcinoma (NPC, epstein-barr nuclear antigen-1 (EBNA1)

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58 In vitro Disaggregation and Dissolution of Four IR Lamotrigine Solid Dosage Forms

Authors: Ilaria Manca, Ilaria Manca, Francesca Pettinau, Ignazia Mocci, Elisabetta M. Usai, Barbara Pittau

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Lamotrigine is a phenyltriazine used in the treatment of epilepsy and bipolar disorder type I. The purpose of this study was to test and compare various solid forms of immediate release (IR) lamotrigine products, at different strenghts, in order to study their disaggregation and dissolution behavior. IR products are designed to release their active substance promptly after administration. Concentration of hydrochloric acid in gastric juice is about 0.1-0.001 M, so FDA (Food and Drug Administration) recommends, for lamotrigine regular tablets, dissolution tests in HCl 0.1 M.Toinvestigate the pH dependency of drug release in the entire gastrointestinal tract, we worked at two additional media with different pH values (4.5 and 6.8), that reflect conditions in it. To afford acceptable dissolution rates, tablets must disintegrate. Disaggregation of constituent particles increases the surface area and substantially increases the dissolution rate. For this reason availability of an active substance from tablets depends on its ability to disintegrate fast in dissolution media. pH of gastrointestinal fluid affects drug absorption by conditioning its solubility and dissolution, but also tablet disintegration may be influenced by it. To obtain information about the quantitative relationship between different mixture components, Nuclear Magnetic Resonance (NMR) spectroscopy was used. We also investigate tablet hardness. The investigation carried out confirms pH 1.2 as the ideal environment for the immediate availability of the active substance.

Keywords: dissolution, disaggregation, Lamotrigine, bioequivalence

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57 The Effect of Vitamin "E" on the Peripheral Neurotoxicity of Antimony in Adult Male Albino Rat

Authors: Pymaneh Bairami Rad

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The present work was planned with the aim to study the histological changes that might occur in the sciatic nerve of adult male albino rat following antimony trioxide exposure and to throw more light on the protective role of vitamin "E" on the peripheral neurotoxicity induced by this environmental toxin Sixty adult male albino rats, weighing 183 - 235 grams, were utilized in this work. The animals were divided into 3 groups; each of 20 rats: animals of group I served as control, animals of group II received antimony trioxide daily for 12 successive weeks , animals of group III received antimony trioxide and vitamin "E" daily for the same duration. Antimony trioxide was given in a daily dose of 500 mg/ kg body weight which represents 1/40 of the known LD50 and vitamin "E" was administered in a daily dose of 300 mg/kg body weight. Both antimony trioxide and vitamin "E" were given to the animals by gastric intubation. This research revealed many histological changes in the sciatic nerve, following exposure to antimony trioxide, including Wallerian degeneration in most myelinated nerve fibers with pleomorphic destruction, fragmentation, loss of normal lamination and rupture of myelin sheaths. The axoplasms of these nerve fibers were irregular, degenerated and contained myelin fragments with loss of neurofibrils. Obvious increase in endoneurium was also observed. Concomitant administration of vitamin "E" with antimony trioxide resulted in marked improvement in the histological changes observed in the sciatic nerve.

Keywords: neurotoxicity, antimony, vitamin e, anatomy, histology

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56 Development and Efficacy Assessment of an Enteric Coated Porous Tablet Loaded with F4 Fimbriae for Oral Vaccination against Enterotoxigenic Escherichia coli Infections

Authors: Atul Srivastava, D. V. Gowda

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Enterotoxigenic Escherichia coli (ETEC) infection is one of the major causes contributing to the development of diarrhoea in adults and children in developing countries. To date, no preventive/treatment strategy showed promising results, which could be due to the lack of potent vaccines, and/or due to the development of resistance of ETEC to antibiotics. Therefore, in the present investigation, a novel porous Sodium Alginate (SA) tablet formulation loaded with F4 fimbriae antigen was developed and tested for efficacy against ETEC infections in piglet models. Pre-compression parameters of the powder mixes and post compression parameters of tablets have been evaluated and results were found to be satisfactory. Loading of F4 fimbrial antigens in to the tablets was achieved by inducing pores in the tablets via the sublimation of camphor followed by incubation with purified F4 fimbriae. The loaded tablets have been coated with Eudragit L100 to protect the F4 fimbriae from (a) highly acidic gastric environment; (b) proteolytic cleavage by pepsin; and (c) to promote subsequent release in the intestine. Evaluation of developed F4 fimbrial tablets in a Pig model demonstrated induction of mucosal immunity, and a significant reduction of F4+ E. coli in faeces. Therefore, F4 fimbriae loaded porous tablets could be a novel oral vaccination candidate to induce mucosal and systemic immunity against ETEC infections.

Keywords: porous tablets, sublimation, f4 fimbriae, eudragit l100, vaccination

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55 Clarification of Taxonomic Confusions among Adulterated Drugs Coffee Seena and Seena Weed through Systematic and Pharmaceutical Markers

Authors: Shabnum Shaheen, Nida Haroon, Farah Khan, Sumera Javad, Mehreen Jalal, Samina Sarwar

Abstract:

Coffee Senna is pharmaceutically very important and used for multiple health disorders such as gastric pains, indigestion, snakebites, asthma and fever, tuberculosis and menstrual problems. However, its immense medicinal value and great demand lead to adulteration issue which could be injurious for users. Some times its adulterant Seena weed (Senna occidentalis L.) is used as its substitute which definitely not as effective as Coffee Senna. Hence, the present study was undertaken to provide some tools for systematic and pharmaceutical authentication of a shrubby plant Coffee Senna (Cassia occidentalis Linn.). These parameters included macro and micro morphological characters, anatomical and palynomorph characterization, solubility, fluorescence and phytochemical analysis. By the application of these parameters acquired results revealed that, these two plants are distinct from each other. The Coffee Seena was found to be an annual shrub with trilobed pollen, diacytic, paracytic and anisocytic stomata whereas the Seena weed stands out as an annual or perennial herb with spheroidal and circular pollen and paracytic type of stomata. The powdered drug of Coffee seena is dark grayish green whereas the powdered drug of Seena weed is light green in color. These findings are constructive in authentic identification of these plants.

Keywords: coffee senna, Senna weed, taxonomic evaluation, pharmaceutical markers

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54 Polysaccharide-Based Oral Delivery Systems for Site Specific Delivery in Gastro-Intestinal Tract

Authors: Kaarunya Sampathkumar, Say Chye Joachim Loo

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Oral delivery is regarded as the facile method for the administration of active pharmaceutical ingredients (API) and drug carriers. In an initiative towards sustainable nanotechnology, an oral nano-delivery system has been developed that is made entirely of food-based materials and can also act as a site-specific delivery device depending on the stimulus encountered in different parts of the gastrointestinal tract (GIT). The delivery system has been fabricated from food grade polysaccharide materials like chitosan and starch through electrospraying technique without the use of any organic solvents. A nutraceutical extracted from an Indian medicinal plant, has been loaded into the nano carrier to test its efficacy in encapsulation and stimuli based release of the active ingredient. The release kinetics of the nutraceutical from the carrier was evaluated in simulated gastric, intestinal and colonic fluid and was found to be triggered both by the enzymes and the pH in each part of the intestinal tract depending on the polysaccharide being used. The toxicity of the nanoparticles on the intestinal epithelial cells was tested and found to be relatively safe for up to 24 hours at a concentration of 0.2 mg/mL with cellular uptake also being observed. The developed nano carrier thus serves as a promising delivery vehicle for targeted delivery to different parts of the GIT with the inherent conditions of the GIT itself acting as the stimulus. In addition, being fabricated from food grade materials, the carrier could be potentially used for the targeted delivery of nutrients through functional foods.

Keywords: bioavailability, chitosan, delivery systems, encapsulation

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53 Design, Synthesis and Anti-Inflammatory Activity of Some Coumarin and Flavone Derivatives Containing 1,4 Dioxane Ring System

Authors: Asif Husain, Shah Alam Khan

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Coumarins and flavones are oxygen containing heterocyclic compounds which are present in various biologically active compounds. Both the heterocyclic rings are associated with diverse biological actions, therefore considered as an important scaffold for the design of molecules of pharmaceutical interest. Aim: To synthesize and evaluate the in vivo anti-inflammatory activity of few coumrain and flavone derivatives containing 1,4 dioxane ring system. Materials and methods: Coumarin derivatives (3a-d) were synthesized by reacting 7,8 dihydroxy coumarin (2a) and its 4-methyl derivative (2b) with epichlorohydrin/ethylene dibromide. The flavone derivatives (10a-d) were prepared by using quercetin and 3,4 dihydroxy flavones. Compounds of both the series were also evaluated for their anti-inflammatory, analgesic activity and ulcerogenicity in animal models by reported methods. Results and Discussion: The structures of all newly synthesized compounds were confirmed with the help of IR, 1H NMR, 13C NMR and Mass spectral studies. Elemental analyses data for each element analyzed (C, H, N) was found to be within acceptable range of ±0.4 %. Flavone derivatives, but in particular quercetin containing 1,4 dioxane ring system (10d) showed better anti-inflammatory and analgesic activity along with reduced gastrointestinal toxicity as compared to other synthesized compounds. The results of anti-inflammatory and analgesic activities of both the series are comparable with the positive control, diclofenac. Conclusion: Compound 10d, a quercetin derivative, emerged as a lead molecule which exhibited potent anti-inflammatory and analgesic activity with significant reduced gastric toxicity.

Keywords: analgesic, anti-inflammatory, 1, 4 dioxane, coumarin, flavone

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52 Revealing Potential Drug Targets against Proto-Oncogene Wnt10B by Comparative Molecular Docking

Authors: Shazia Mannan, Zunera Khalid, Hammad-Ul-Mubeen

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Wingless type Mouse mammary tumor virus (MMTV) Integration site-10B (Wnt10B) is an important member of the Wnt protein family that functions as cellular messenger in paracrine manner. Aberrant Wnt10B activity is the cause of several abnormalities including cancers of breast, cervix, liver, gastric tract, esophagus, pancreas as well as physiological problems like obesity, and osteoporosis. The objective of this study was to determine the possible inhibitors against aberrant expression of Wnt10B in order to prevent and treat the physiological disorders associated with it. Wnt10B3D structure was predicted by using comparative modeling and then analyzed by PROCHECK, Verify3D, and Errat. The model having 84.54% quality value was selected and acylated to satisfy the hydrophobic nature of Wnt10B. For search of inhibitors, virtual screening was performed on Natural Products (NP) database. The compounds were filtered and ligand-based screening was performed using the antagonist for mouse Wnt-3A. This resulted in a library of 272 unique compounds having most potent drug like activities for Wnt-4. Out of the 271 molecules analyzed three small molecules ZINC35442871, ZINC85876388, and ZINC00754234 having activity against Wnt4 abbarent expression were found common through docking experiment of Wnt10B. It is concluded that the three molecules ZINC35442871, ZINC85876388, and ZINC00754234 can be considered as lead compounds for performing further drug designing experiments against aberrant Wnt expressions.

Keywords: Wnt10B inhibitors, comparative computational studies, proto-oncogene, molecular docking

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51 Functional Yoghurt Enriched with Microencapsulated Olive Leaves Extract Powder Using Polycaprolactone via Double Emulsion/Solvent Evaporation Technique

Authors: Tamer El-Messery, Teresa Sanchez-Moya, Ruben Lopez-Nicolas, Gaspar Ros, Esmat Aly

Abstract:

Olive leaves (OLs), the main by-product of the olive oil industry, have a considerable amount of phenolic compounds. The exploitation of these compounds represents the current trend in food processing. In this study, OLs polyphenols were microencapsulated with polycaprolactone (PCL) and utilized in formulating novel functional yoghurt. PCL-microcapsules were characterized by scanning electron microscopy, and Fourier transform infrared spectrometry analysis. Their total phenolic (TPC), total flavonoid (TFC) contents, and antioxidant activities (DPPH, FRAP, ABTS), and polyphenols bioaccessibility were measured after oral, gastric, and intestinal steps of in vitro digestion. The four yoghurt formulations (containing 0, 25, 50, and 75 mg of PCL-microsphere/100g yoghurt) were evaluated for their pH, acidity, syneresis viscosity, and color during storage. In vitro digestion significantly affected the phenolic composition in non-encapsulated extract while had a lower impact on encapsulated phenolics. Higher protection was provided for encapsulated OLs extract, and their higher release was observed at the intestinal phase. Yoghurt with PCL-microsphere had lower viscosity, syneresis, and color parameters, as compared to control yoghurt. Thus, OLs represent a valuable and cheap source of polyphenols which can be successfully applied, in microencapsulated form, to formulate functional yoghurt.

Keywords: yoghurt quality attributes, olive leaves, phenolic and flavonoids compounds, antioxidant activity, polycaprolactone as microencapsulant

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50 A Cros Sectional Observational Study of Prescription Pattern of Gastro-Protective Drugs with Non-Steroidal Anti-Inflammatory Drugs in Nilgiris, India

Authors: B.S. Roopa

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Objectives: To investigate the prevalence of concomitant use of GPDs in patients treated with NSAIDs and GPDs in recommended dose and frequency as prophylaxis. And also to know the association between risk factors and prescription of GPDs in patients treated with NSAIDs. Methods: Study was a prospective, observational, cross-sectional survey. Data from patients with prescription of NSAIDs at the out-patient departments of secondary care Hospital, Nilgiris, India were collected in a specially designed proforma for a period of 45 days. Analysis using χ2 tests for discrete variables. Factors that might be associated with prescription of GPD with NSIADs were assessed in multiple logistic regression models. Results: Three hundred and three patients were included in this study, and the rate of GPD prescription was 89.1%. Most of the patients received H2-receptor antagonist, and, to a lesser degree, antacid and proton pump inhibitor. Patients with history of GI ulcer/bleeding were much more likely to be co-prescribed GPD than those who had no history of GI disorders .Compared with patients who were managed in general outpatient clinic, those managed in Secondary care hospital in Nilgrisis, India were more likely to receive GPD. Conclusions: The prescription rate of GPD with NSAIDs is high. Patients were prescribed with H2RA with dose of 150mg twice daily, which are not effective in reducing the risk of NSAIDs induced gastric ulcer. Only the frequency of NSAIDs prescription was considered significant determinant for the co-prescription with GPAs in patients who are < 65 years and ≥ 65 years old.

Keywords: gastro protective agents, non steridol anti inlfammatory agents

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49 Development and Characterization of a Film Based on Hydroxypropyl Methyl Cellulose Incorporated by a Phenolic Extract of Fennel and Reinforced by Magnesium Oxide: In Vivo - in Vitro

Authors: Mazouzi Nourdjihane, K. Boutemak, A. Haddad, Y. Chegreouche

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In the last decades, biodegradable polymers have been considered as one of the most popular options for the delivery of drugs and various conventional doses. The film forming system (FFS) can be used in topical, transdermal, ophthalmic, oral and gastric applications. Recently this system has focused on improving drug delivery, which can promote drug release. In this context, the aim of this study is to create polymeric film-forming systems for the stomach and to evaluate and test their gastroprotective effects, comparing the effects of changes in composition on film characteristics. It uses a plant-derived polyphenol extract extracted from fennel to demonstrate anti-inflammatory activity in the film. The films are made from hydroxypropyl methylcellulose polymer and different types of plastic, glycerol and polyethylene glycol. The ffs properties show that MgO-glycerol-reinforced hydroxypropylmethylcellulose (HPMC-MgO-Gly) is better than that based on MgO-PEG-reinforced hydroxypropylmethylcellulose (HPMC-MgO-PEG). It is durable, has a faster drying time and allows for maximum recovery. Water vapor strength and blowing speed and other additions show another advantage of HPMC-MgO-Gly compared to HPMC-MgO-PEG, indicating good adhesion between the support (top) and film production. In this study, the gastroprotective effect of fennel phenol extract was found, showing that this plant material has a gastroprotective effect on ulcers and that the film can absorb the active substance.

Keywords: film formin system, hydroxypropyl methylcellulose, magnesium oxide, in vivo

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48 Isolation, Purification and Characterisation of Non-Digestible Oligosaccharides Derived from Extracellular Polysaccharide of Antarctic Fungus Thelebolus Sp. IITKGP-BT12

Authors: Abinaya Balasubramanian, Satyabrata Ghosh, Satyahari Dey

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Non-Digestible Oligosaccharides(NDOs) are low molecular weight carbohydrates with degree of polymerization (DP) 3-20, that are delivered intact to the large intestine. NDOs are gaining attention as effective prebiotic molecules that facilitate prevention and treatment of several chronic diseases. Recently, NDOs are being obtained by cleaving complex polysaccharides as it results in high yield and also as the former tend to display greater bioactivity. Thelebolus sp. IITKGP BT-12, a recently identified psychrophilic, Ascomycetes fungus has been reported to produce a bioactive extracellular polysaccharide(EPS). The EPS has been proved to possess strong prebiotic activity and anti- proliferative effects. The current study is an attempt to identify and optimise the most suitable method for hydrolysis of the above mentioned novel EPS into NDOs, and further purify and characterise the same. Among physical, chemical and enzymatic methods, enzymatic hydrolysis was identified as the best method and the optimum hydrolysis conditions obtained using response surface methodology were: reaction time of 24h, β-(1,3) endo-glucanase concentration of 0.53U and substrate concentration of 10 mg/ml. The NDOs were purified using gel filtration chromatography and their molecular weights were determined using MALDI-TOF. The major fraction was found to have a DP of 7,8. The monomeric units of the NDOs were confirmed to be glucose using TLC and GCMS-MS analysis. The obtained oligosaccharides proved to be non-digestible when subjected to gastric acidity, salivary and pancreatic amylases and hence could serve as efficient prebiotics.

Keywords: characterisation, enzymatic hydrolysis, non-digestible oligosaccharides, response surface methodology

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47 Encapsulation of Probiotic Bacteria in Complex Coacervates

Authors: L. A. Bosnea, T. Moschakis, C. Biliaderis

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Two probiotic strains of Lactobacillus paracasei subsp. paracasei (E6) and Lactobacillus paraplantarum (B1), isolated from traditional Greek dairy products, were microencapsulated by complex coacervation using whey protein isolate (WPI, 3% w/v) and gum arabic (GA, 3% w/v) solutions mixed at different polymer ratio (1:1, 2:1 and 4:1). The effect of total biopolymer concentration on cell viability was assessed using WPI and GA solutions of 1, 3 and 6% w/v at a constant ratio of 2:1. Also, several parameters were examined for optimization of the microcapsule formation, such as inoculum concentration and the effect of ionic strength. The viability of the bacterial cells during heat treatment and under simulated gut conditions was also evaluated. Among the different WPI/GA weight ratios tested (1:1, 2:1, and 4:1), the highest survival rate was observed for the coacervate structures made with the ratio of 2:1. The protection efficiency at low pH values is influenced by both concentration and the ratio of the added biopolymers. Moreover, the inoculum concentration seems to affect the efficiency of microcapsules to entrap the bacterial cells since an optimum level was noted at less than 8 log cfu/ml. Generally, entrapment of lactobacilli in the complex coacervate structure enhanced the viability of the microorganisms when exposed to a low pH environment (pH 2.0). Both encapsulated strains retained high viability in simulated gastric juice (>73%), especially in comparison with non-encapsulated (free) cells (<19%). The encapsulated lactobacilli also exhibited enhanced viability after 10–30 min of heat treatment (65oC) as well as at different NaCl concentrations (pH 4.0). Overall, the results of this study suggest that complex coacervation with WPI/GA has a potential to deliver live probiotics in low pH food systems and fermented dairy products; the complexes can dissolve at pH 7.0 (gut environment), releasing the microbial cells.

Keywords: probiotic, complex coacervation, whey, encapsulation

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46 pH-Responsive Carrier Based on Polymer Particle

Authors: Florin G. Borcan, Ramona C. Albulescu, Adela Chirita-Emandi

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pH-responsive drug delivery systems are gaining more importance because these systems deliver the drug at a specific time in regards to pathophysiological necessity, resulting in improved patient therapeutic efficacy and compliance. Polyurethane materials are well-known for industrial applications (elastomers and foams used in different insulations and automotive), but they are versatile biocompatible materials with many applications in medicine, as artificial skin for the premature neonate, membrane in the hybrid artificial pancreas, prosthetic heart valves, etc. This study aimed to obtain the physico-chemical characterization of a drug delivery system based on polyurethane microparticles. The synthesis is based on a polyaddition reaction between an aqueous phase (mixture of polyethylene-glycol M=200, 1,4-butanediol and Tween® 20) and an organic phase (lysin-diisocyanate in acetone) combined with simultaneous emulsification. Different active agents (omeprazole, amoxicillin, metoclopramide) were used to verify the release profile of the macromolecular particles in different pH mediums. Zetasizer measurements were performed using an instrument based on two modules: a Vasco size analyzer and a Wallis Zeta potential analyzer (Cordouan Technol., France) in samples that were kept in various solutions with different pH and the maximum absorbance in UV-Vis spectra were collected on a UVi Line 9,400 Spectrophotometer (SI Analytics, Germany). The results of this investigation have revealed that these particles are proper for a prolonged release in gastric medium where they can assure an almost constant concentration of the active agents for 1-2 weeks, while they can be disassembled faster in a medium with neutral pHs, such as the intestinal fluid.

Keywords: lysin-diisocyanate, nanostructures, polyurethane, Zetasizer

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45 A Possible Connection Between Taste Change and Zinc Deficiency after Bariatric Surgery: A Literature Review

Authors: Boshra Mozaffar, Iskandar Idris

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Taste change is a common complication after Bariatric surgery (BS). However, the cause of this is still not clear. Since zinc is important fortaste perception, zinc deficiency, which is common after BS, may play an important role for taste change after BS. In this review, we aimto collate evidence relating to taste change and zinc deficiencyin relation to BS; effects of zinc replacement on taste perception in general and thereafter discuss the possible role of zinc deficiency to induce taste change after BS. A literature search was conducted, using four electronic bibliographical databases—EMBASE, PubMed, AMED and MEDLINE. We identified all available and relevant articles published before 30th February 2021.In total, 33 studies were included. The total number of participants analysed was N= 3264. We showed that taste change is a frequent complication after BS, especially after Roux-en-Y gastric bypass RYGBP comparing to other types of procedures. Patients' taste sensitivity differs among studies, but the most important decline in taste preference was observed for sweet food. Twelve studies investigating zinc deficiency following BS showed a significant decrease in zinc levels at six months after surgery. Supplementation with 45–50 mg of zinc sulphate was effective in improving taste, except in cancer patients, who showed no improvement in taste following zinc supplementation. Zinc deficiency appears to be associated with taste change after BS. Supplementation with much higher levels of zinc, at 45–50 mg, was effective in taste change treatment for many cases of taste disorder. The currently recommended levels of zinc replacements currently prescribed to patients following BS were not effective for avoiding zinc deficiency after BS—and thus not effective for averting taste change. It is therefore suggested that taste change following BS is closely related to zinc deficiency induced by the surgery.

Keywords: taste change, taste disorder, bariatric surgery, zinc, zinc sulphate or Zn, deficiency, supplementation, and micro-nutrient deficiencies

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44 Therapeutic Potential of mAb KP52 in Human and Feline Cancers

Authors: Abigail Tan, Heng Liang Tan, Vanessa Ding, James Hui, Eng Hin Lee, Andre Choo

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Introduction: Comparative oncology investigates the similarities in spontaneous carcinogenesis between humans and animals, in order to identify treatments that can benefit these patients. Companion animals (CA), like canines and felines, are of special interest when it comes to studying human cancers due to their exposure to the same environmental factors and develop tumours with similar features. The purpose of this study is to explore the cross-reactivity of monoclonal antibodies (mAbs) across cancers in humans and CA. Material and Methods: A panel of CA mAbs generated in the lab was screened on multiple human cancer cell lines through flow cytometry to identify for positive binders. Shortlisted candidates were then characterised by biochemical and functional assays e.g., antibody-drug conjugate (ADC) and western blot assays, including glycan studies. Results: Candidate mAb KP52 was generated from whole-cell immunisation using feline mammary carcinoma. KP52 showed strong positive binding to human cancer cells, such as breast cancer and ovarian cancer. Furthermore, KP52 demonstrated strong killing ( > 50%) as an ADC with Saporin as the payload. Western blot results revealed the molecular weight of the antigen targets to be approximately 45kD and 50kD under reduced conditions. Glycan studies suggest that the epitope is glycan in nature, specifically an O-linked glycan. Conclusion: Candidate mAb KP52 has a therapeutic potential as an ADC against feline mammary cancer, human ovarian cancer, human mammary cancer, human pancreatic cancer, and human gastric cancer.

Keywords: ADC, comparative oncology, mAb, therapeutic

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43 Emergency Management of Poisoning Tracery Care Hospital in India

Authors: Rajiv Ratan Singh, Sachin Kumar Tripathi, Pradeep Kumar Yadav

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The timely evaluation, diagnosis, and treatment of people who have been exposed to toxic chemicals is a crucial component of emergency poison management in the medical field. The various substances that can poison include chemicals, medications, and naturally occurring poisons. The toxicology of the particular drug involved, as well as the symptoms and indicators of poisoning, must be thoroughly understood to handle poisoning emergencies effectively. One of the most important aspects of emergency poison management in medicine is the prompt examination, diagnosis, and treatment of persons who have been exposed to dangerous substances. To properly manage poisoning crises, one must have a good understanding of the toxicology of the particular medication concerned, as well as the signs and indicators of poisoning. Emergency management of poisoning includes not only prompt medical attention but also patient education, follow-up care, and monitoring for any long-term consequences. To achieve the greatest results for patients, the management of poisoning is a complicated and dynamic process that calls for collaboration between medical professionals, first responders, and toxicologists. All poisoned patients who present to the emergency room are assessed and diagnosed based on a collection of symptoms and a biochemical diagnosis, and they are then provided targeted, specialized treatment for the toxin identified. This article focuses on the loxodromic strategy as the primary method of treatment for poisoned patients. The authors of this article conclude that mortality and morbidity can be reduced if patients visit the emergency room promptly and receive targeted treatment.

Keywords: antidotes, blood poisoning, emergency medicine, gastric lavage, medico-legal aspects, patient care

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42 Maternal and Neonatal Outcomes in Women Undergoing Bariatric Surgery: A Systematic Review and Meta-Analysis

Authors: Nicolas Galazis, Nikolina Docheva, Constantinos Simillis, Kypros Nicolaides

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Background: Obese women are at increased risk for many pregnancy complications, and bariatric surgery (BS) before pregnancy has shown to improve some of these. Objectives: To review the current literature and quantitatively assess the obstetric and neonatal outcomes in pregnant women who have undergone BS. Search Strategy: MEDLINE, EMBASE and Cochrane databases were searched using relevant keywords to identify studies that reported on pregnancy outcomes after BS. Selection Criteria: Pregnancy outcome in firstly, women after BS compared to obese or BMI-matched women with no BS and secondly, women after BS compared to the same or different women before BS. Only observational studies were included. Data Collection and Analysis: Two investigators independently collected data on study characteristics and outcome measures of interest. These were analysed using the random effects model. Heterogeneity was assessed and sensitivity analysis was performed to account for publication bias. Main Results: The entry criteria were fulfilled by 17 non-randomised cohort or case-control studies, including seven with high methodological quality scores. In the BS group, compared to controls, there was a lower incidence of preeclampsia (OR, 0.45, 95% CI, 0.25-0.80; p=0.007), GDM (OR, 0.47, 95% CI, 0.40-0.56; P<0.001) and large neonates (OR 0.46, 95% CI 0.34-0.62; p<0.001) and a higher incidence of small neonates (OR 1.93, 95% CI 1.52-2.44; p<0.001), preterm birth (OR 1.31, 95% CI 1.08-1.58; p=0.006), admission for neonatal intensive care (OR 1.33, 95% CI 1.02-1.72; p=0.03) and maternal anaemia (OR 3.41, 95% CI 1.56-7.44, p=0.002). Conclusions: BS as a whole improves some pregnancy outcomes. Laparoscopic adjustable gastric banding does not appear to increase the rate of small neonates that was seen with other BS procedures. Obese women of childbearing age undergoing BS need to be aware of these outcomes.

Keywords: bariatric surgery, pregnancy, preeclampsia, gestational diabetes, birth weight

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41 Phenolic Compounds and Antioxidant Capacity of Nine Genotypes of Thai Rice (Oryza sativa L.)

Authors: Pitchaon Maisuthisakul, Ladawan Changchub

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Rice (Oryza sativa L.) is a staple diet in Thailand. Rice cultivation is traditional occupation of Thailand which passed down through generations. The 1 Rai 1 san project is new agricultural theory according to sufficient economy using green technology without using chemical substances. This study was conducted to evaluate total phenolics using HPLC and colorimetric methods including total anthocyanin content of Thai rice extracting by simulated gastric and intestinal condition and to estimate antioxidant capacity using DPPH and thiocyanate methods. Color and visible spectrum of rice grains were also investigated. Rice grains were classified into three groups according to their color appearance. The light brown grain genotypes are Sin Lek, Jasmine 105, Lao Tek and Hawm Ubon. The red group is Sang Yod and Red Jasmine. Genotypes Kum, Hawm Kanya and Hawm Nil are black rice grains. Cyanidin-3-O-glucoside was found in only black rice genotypes, whereas chlorogenic acid was found in all rice grains. The black rice had higher phenolic content than red and light brown samples. Phenolic acids constitute a small portion of phenolic compounds after digestion in human and contribute to the antioxidant activity of Thai rice grains. Anthocyanin contents of all rice extracts ranged from 45.9 to 442.1 mg CGE/kg. All rice extracts showed the antioxidant efficiency lower than ferulic acid. Genotype Kum and Hawm nil exhibited the ability of antioxidant efficiency higher than α-tocopherol. Interestingly, the visible spectrum of only black rice genotypes showed the maximum peak at 530-540 nm. The results suggest that consumption of black rice gives more health benefits of grain to consumer.

Keywords: rice, phenolic, antioxidant, anthocyanin

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40 Nanowire Sensor Based on Novel Impedance Spectroscopy Approach

Authors: Valeriy M. Kondratev, Ekaterina A. Vyacheslavova, Talgat Shugabaev, Alexander S. Gudovskikh, Alexey D. Bolshakov

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Modern sensorics imposes strict requirements on the biosensors characteristics, especially technological feasibility, and selectivity. There is a growing interest in the analysis of human health biological markers, which indirectly testifying the pathological processes in the body. Such markers are acids and alkalis produced by the human, in particular - ammonia and hydrochloric acid, which are found in human sweat, blood, and urine, as well as in gastric juice. Biosensors based on modern nanomaterials, especially low dimensional, can be used for this markers detection. Most classical adsorption sensors based on metal and silicon oxides are considered non-selective, because they identically change their electrical resistance (or impedance) under the action of adsorption of different target analytes. This work demonstrates a feasible frequency-resistive method of electrical impedance spectroscopy data analysis. The approach allows to obtain of selectivity in adsorption sensors of a resistive type. The method potential is demonstrated with analyzis of impedance spectra of silicon nanowires in the presence of NH3 and HCl vapors with concentrations of about 125 mmol/L (2 ppm) and water vapor. We demonstrate the possibility of unambiguous distinction of the sensory signal from NH3 and HCl adsorption. Moreover, the method is found applicable for analysis of the composition of ammonia and hydrochloric acid vapors mixture without water cross-sensitivity. Presented silicon sensor can be used to find diseases of the gastrointestinal tract by the qualitative and quantitative detection of ammonia and hydrochloric acid content in biological samples. The method of data analysis can be directly translated to other nanomaterials to analyze their applicability in the field of biosensory.

Keywords: electrical impedance spectroscopy, spectroscopy data analysis, selective adsorption sensor, nanotechnology

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39 DOG1 Expression Is in Common Human Tumors: A Tissue Microarray Study on More than 15,000 Tissue Samples

Authors: Kristina Jansen, Maximilian Lennartz, Patrick Lebok, Guido Sauter, Ronald Simon, David Dum, Stefan Steurer

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DOG1 (Discovered on GIST1) is a voltage-gated calcium-activated chloride and bicarbonate channel that is highly expressed in interstitial cells of Cajal and in gastrointestinal stromal tumors (GIST) derived from Cajal cells. To systematically determine in what tumor entities and normal tissue types DOG1 may be further expressed, a tissue microarray (TMA) containing 15,965 samples from 121 different tumor types and subtypes as well as 608 samples of 76 different normal tissue types were analyzed by immunohistochemistry. DOG1 immunostaining was found in 67 tumor types, including GIST (95.7%), esophageal squamous cell carcinoma (31.9%), pancreatic ductal adenocarcinoma (33.6%), adenocarcinoma of the Papilla Vateri (20%), squamous cell carcinoma of the vulva (15.8%) and the oral cavity (15.3%), mucinous ovarian cancer (15.3%), esophageal adenocarcinoma (12.5%), endometrioid endometrial cancer (12.1%), neuroendocrine carcinoma of the colon (11.1%) and diffuse gastric adenocarcinoma (11%). Low level-DOG1 immunostaining was seen in 17 additional tumor entities. DOG1 expression was unrelated to histopathological parameters of tumor aggressiveness and/or patient prognosis in cancers of the breast (n=1,002), urinary bladder (975), ovary (469), endometrium (173), stomach (233), and thyroid gland (512). High DOG1 expression was linked to estrogen receptor expression in breast cancer (p<0.0001) and the absence of HPV infection in squamous cell carcinomas (p=0.0008). In conclusion, our data identify several tumor entities that can show DOG1 expression levels at similar levels as in GIST. Although DOG1 is tightly linked to a diagnosis of GIST in spindle cell tumors, the differential diagnosis is much broader in DOG1 positive epithelioid neoplasms.

Keywords: biomarker, DOG1, immunohistochemistry, tissue microarray

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38 Hypotonia - A Concerning Issue in Neonatal Care

Authors: Eda Jazexhiu-Postoli, Gladiola Hoxha, Ada Simeoni, Sonila Biba

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Background Neonatal hypotonia represents a commonly encountered issue in the Neonatal Intensive Care Unit and newborn nursery. The differential diagnosis is broad, encompassing chromosome abnormalities, primary muscular dystrophies, neuropathies and inborn errors of metabolism. Aim of study Our study describes some of the main clinical features of hypotonia in newborns and presents clinical cases of neonatal hypotonia we treated in our Neonatal unit in the last 3 years. Case reports Four neonates born in our hospital presented with hypotonia after birth, one preterm newborn 35-36 weeks of gestational age and three other term newborns (38-39 weeks of gestational age). Prenatal data revealed a decrease in fetal movements in both cases. Intrapartum meconium-stained amniotic fluid was found in 75% of our hypotonic newborns. Clinical features included inability to establish effective respiratory movements and need for resuscitation in the delivery room, respiratory distress syndrome, feeding difficulties and need for oro-gastric tube feeding, dysmorphic features, hoarse voice and moderate to severe muscular hypotonia. The genetic workup revealed the diagnosis of Autosomal Recessive Congenital Myasthenic Syndrome 1-B, Sotos Syndrome, Spinal Muscular Atrophy Type 1 and Transient Hypotonia of the Newborn. Two out of four hypotonic neonates were transferred to the Pediatric Intensive Care Unit and died at the age of three to five months old. Conclusion Hypotonia is a concerning finding in neonatal care and it is suggested by decreased intrauterine fetal movements, failure to establish first breaths, respiratory distress and feeding difficulties in the neonate. Prognosis is determined by its etiology and time of diagnosis and intervention.

Keywords: hypotonic neonate, respiratory distress, feeding difficulties, fetal movements

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37 Analysis of Expression of SP and NOS in the Porcine Nodose Ganglion (NG) Sensory Neurons Supplying Prepyloric Stomach Region after Intragastric Hydrochloric Acid Infusion

Authors: Liliana Rytel, Jarosław Całka

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One of the diseases that are very common health problem of modern man is the stomach hyperacidity. It is well known that this pathological state, during which gastric glands secrete too much of hydrochloric acid can be caused due to various factors such as stress, eating habits, alcohol, smoking and some, especially anti-inflammatory drugs. Moreover, hyperacidity is recognized as one of factors leading to development of peptic ulcer disease. Therefore, we analyzed expression of substance P (SP) and neuronal isoform of nitric oxide synthase (nNOS) in the porcine nodose ganglion sensory neurons innervating prepyloric stomach region in physiological state and following intragastric infusion of hydrochloric acid. The study was performed on 8 immature gilts of the Large White Polish breed. All animals were injected retrograde marker Fast Blue (FB) into the anterior prepyloric stomach wall. After injections of FB, pigs were divided into two groups: control (group C; n = 4) and experimental (HCL group, n = 4) and after convalescence period of 23 days, animals of HCL group were subjected to renewed anaesthesia. Then, 0.25 M aqueous solution of hydrochloric acid with a dose of 5 ml/kg body weight was administered intragastrically with use of a stomach tube. On 28th day, all control and HCL pigs were euthanized and bilateral reght (rNG) and left (lNG) were collected. Cryostat sections were processed for double immunofluorescence using anibodies against SP and NOS. Immunofluorescence staining in the even-numbered ganglia nodes showed the presence of FB-positive cells expressing SP (45,9 ± 3,38% in rNG and 60,4 ± 1,71% in lNG), and nNOS (34,9 ± 6,83% in rNG and 49,9 ± 9,32% in lNG). In HCL group increased expression of both SP (54,8 ± 5,34% in rNG and 56,9 ± 3,28 % in lNG) as well as nNOS (54,9 ± 4,45% in rNG and 52,5 ± 2,17 % in lNG) in FB+ perikaria was found. The acquired results suggest that SP and nNOS are neurotransmitters and/ or neuromodulators participating in the sensory regulation of the prepyloric region of porcine stomach function as well as their potential role in development of the stomach inflamatory state.

Keywords: nNOS, nodose ganglion, pig, SP

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36 Comparing the Efficacy of Minimally Supervised Home-Based and Closely Supervised Gym Based Exercise Programs on Weight Reduction and Insulin Resistance after Bariatric Surgery

Authors: Haleh Dadgostar, Sara Kaviani, Hanieh Adib, Ali Mazaherinezhad, Masoud Solaymani-Dodaran, Fahimeh Soheilipour, Abdolreza Pazouki

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Background and Objectives: Effectiveness of various exercise protocols in weight reduction after bariatric surgery has not been sufficiently explored in the literature. We compared the effect of minimally supervised home-based and closely supervised Gym based exercise programs on weight reduction and insulin resistance after bariatric surgery. Methods: Women undergoing gastric bypass surgery were invited to participate in an exercise program and were randomly allocated into two groups. They were either offered a minimally supervised home-based (MSHB) or closely supervised Gym-based (CSGB) exercise program. The CSGB protocol constitute two sessions per week of training under ACSM guidelines. In the MSHB protocol participants received a notebook containing a list of recommended aerobic and resistance exercises, a log to record their activity and a schedule of follow up phone calls and clinic visits. Both groups received a pedometer. We measured their weight, BMI, lipid profile, FBS, and insulin level at the baseline and after 20 weeks of exercise and were compared at the end of the study. Results: A total of 80 patients completed our study (MSHB=38 and CSGB=42). The baseline comparison showed that the two groups are similar. Using the ANCOVA method of analysis the mean change in BMI (covariate: BMI at the beginning of the study) was slightly better in CSGB compared with the MSHB (between-group mean difference: 3.33 (95%CI 4.718 to 1.943, F: 22.844 p < 0.001)). Conclusion: Our results showed that both MSHB and CSGB exercise methods are somewhat equally effective in improvement of studied factors in the two groups. With considerably lower costs of Minimally Supervised Home Based exercise programs, these methods should be considered when adequate funding are not available.

Keywords: postoperative exercise, insulin resistance, bariatric surgery, morbid obesity

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