Background
Cases presentation
Methods of case collection
Case 1
Case 1 | Case 2 | Case 3 | |
---|---|---|---|
Past medical history | Hypertension, dyslipidemia, T2DM, obstructive sleep apnea, obesity, gout, Burkitt’s lymphoma, HIV, CKD stage 2, hydrocele repair, tonsillectomy | Obesity, T2DM, obstructive sleep apnea, depression, HIV, fatty liver disease, tonsillectomy | Obesity, T2DM, asthma, dyslipidemia, obstructive sleep apnea, urinary incontinence, peripheral neuropathy, knee osteoarthritis, depression, vitamin D deficiency. |
Drug history | Allergic to co-trimoxazole. Metformin 500 mg twice a day Losartan 100 mg once a day Allopurinol 200 mg once a day Atorvastatin 10 mg once a day Indapamide 1.5 mg once a day | No known drug allergy. Mirtazapine 30 mg once a day Metformin 500 mg once a day | No known drug allergy. Ranitidine 300 mg once a day Atorvastatin 10 mg once a day Metformin 1 g three times a day Dapagliflozin 10 mg once a day Exenatide 20 mcg once a day Detemir 70 units twice a day |
HIV medications | Atripla (efavirenz/emtricitabine/tenofovir) 1 tablet once a day | Atripla (efavirenz/emtricitabine/tenofovir) 1 tablet once a day | Truvada (emtricitabine/tenofovir) 245/200 mg once a day Darunavir 800 mg once a day Ritonavir 100 mg once a day |
Family history | Father – aortic aneurysm Mother – Alzheimer’s | Nil | Nil |
Social history | |||
Tobacco smoking | Nil | Occasional | Nil |
Alcohol | 40 units/month | Occasional | Nil |
Employment | Computer programmer | Unemployed | Unemployed |
Independence | Lives with family, independent of daily activities | Lives with friends, independent of daily activities | Lives with daughter, wheelchair bound most of the time |
Observations | HR – 70 | HR – 100 | HR – 83 |
RR – 16 | RR – 16 | RR – 18 | |
Sats – 99% | Sats – 95% | Sats – 95% | |
BP – 128/72 | BP – 136/90 | BP – 145/83 | |
T – 36.4 °C | T – 36.1 °C | T – 36.7 °C | |
Physical examinations | Mild right knee joint pain | Mild bilateral joint pain and low back pain. Fungal infection right axilla | Mild bilateral joint pain and low back pain. |
Neurology examinations | NAD | NAD | Numbness below the knee bilaterally. Urinary incontinence |
Case 1 | Case 2 | Case 3 | ||||
---|---|---|---|---|---|---|
preoperatively | Postoperatively4 | preoperatively | Postoperatively4 | preoperatively | Postoperatively4 | |
BMI (kg/m2) | 44 | 37.8 | 48.1 | 37.9 | 47.9 | 41.1 |
Weight (kg) | 152.1 | 132.1 | 142.2 | 112.0 | 118.0 | 101.2 |
% TWL1 | 6.6% | 18.9% | 5.1% | 25.2% | −0.2% | 14.1% |
% EWL2 | 14.3% | 40.8% | 10.0% | 49.8% | −0.4% | 29.5% |
HbA1c (mmol/mol)3 | 41 | 33 | 35 | 34 | 128 | 90 |
Diabetes medications | Metformin 500 mg twice a day | Metformin 500 mg twice a day | Metformin 500 mg once a day | Nil | Metformin 1 g three times a day Dapagliflozin 10 mg once a day Exenatide 20 mcg once a day Detemir 70 units twice a day | Metformin 1 g twice a day Dapagliflozin 10 mg once a day Humulin M3 (human insulin, mixture 3) (22 units OM, 16 units ON) |
CD4 count (cells/μL) | 750 | 845 | 929 | 718 | 440 | 372 |
Viral load (cp/ml) | < 40 | < 40 | < 40 | < 20 | < 40 | < 20 |
HIV medications | Atripla 1 Tab once a day | Atripla (efavirenz/emtricitabine/tenofovir) 1 Tab once a day | Atripla (efavirenz/emtricitabine/tenofovir) 1 Tab once a day | Truvada (emtricitabine/tenofovir) 245/200 mg once a day Raltegravir 400 mg twice a day | Truvada (emtricitabine/tenofovir) 245/200 mg once a day Darunavir 800 mg once a day Ritonavir 100 mg once a day | Truvada (emtricitabine/tenofovir) 245/200 mg once a day Rezolsta (darunavir/cobicistat) 800/150 mg once a day |
Complications | Vitamin D deficiency | Nil | Stricture |
Case 1 | Case 2 | Case 3 | ||||
---|---|---|---|---|---|---|
Preoperation* | Postoperation^ | Preoperation* | Postoperation^ | Preoperation* | Postoperation^ | |
FBC | ||||||
Hb (g/L) | 129 | 156 | 143 | 165 | 122 | 119 |
WCC (×109/L) | 4.9 | 5.9 | 8.1 | 7.3 | 4.3 | 3.2 |
PLT (×109/L) | 149 | 204 | 186 | 243 | 270 | 182 |
CRP (mg/L) | 28 | 5 | 1 | 12 | 22 | 1 |
U&Es | ||||||
Na (mmol/L) | 138 | 142 | 138 | 139 | 137 | 144 |
K (mmol/L) | 3.8 | 3.6 | 4.3 | 4.6 | 4.1 | 4.3 |
Urea (mmol/L) | 4.6 | 6.5 | 2.2 | 5.4 | 4.0 | 7.2 |
Cr (mmol/L) | 94 | 139 | 67 | 54 | 80 | 65 |
eGFR (ml/minute/1.73m2) | 73 | 47 | > 90 | > 90 | 67 | > 90 |
LFTs | ||||||
Bili (μmol/l) | 10 | 6 | 9 | 9 | 6 | 4 |
ALP (IU/L) | 30 | 34 | 45 | 30 | 10 | 19 |
ALT (IU/L) | 59 | 65 | 80 | 95 | 109 | 66 |
ALB (g/L) | 36 | 40 | 35 | 41 | 28 | 33 |
Urine analysis | ||||||
Specific gravity | 1.030 | 1.030 | 1.015 | 1.020 | 1.030 | 1.010 |
pH | 5.5 | 5.0 | 6.0 | 5.5 | 5.5 | 6.0 |
Protein (mg/L) | Negative | + | Negative | Negative | + | + |
Glucose (mmol/L) | Negative | Negative | Negative | Negative | + | + |
Urine culture | Negative | Negative | Negative | Negative | Negative | Negative |
Fecal culture | N/A | N/A | N/A | N/A | N/A | N/A |
Blood culture | N/A | N/A | N/A | N/A | N/A | N/A |
Case 2
Case 3
Discussion
Baseline BMI | %TWL postop after 2 years | %EWL postop after 2 years | HbA1c | Complete remission of T2DM1 | ||
---|---|---|---|---|---|---|
Preop | Postop after 1 year | |||||
HIV case 1 (AGB) | 46.6 | 24.4% | 52.6% | 41 | 33 | No |
HIV case 2 (SG) | 50.7 | 25.2% | 49.8% | 35 | 32 | Yes |
HIV case 3 (SG) | 47.8 | 14.1% | 29.5% | 128 | 90 | No |
AGB-non HIV (n = 61) | 43.4 ± 6.2 | 14% ± 8% | 34% ± 22% | 60.6 ± 18.1 | 58.2 ± 13.5 | 5% |
SG-non HIV (n = 56) | 49.6 ± 10.7 | 22% ± 9% | 42% ± 20% | 59.5 ± 18.5 | 54.4 ± 18.1 | 27% |