Mahendra Narwaria

Max Super Speciality Hospital

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Shashank Shah

Max Super Speciality Hospital

Randeep Wadhawan

Max Super Speciality Hospital

Pradeep Chowbey

Max Super Speciality Hospital

Surendra Ugale

Kirloskar Hospital

Arya Singh

Narendra Dev University of Agriculture and Technology

Manish Khaitan

Max Super Speciality Hospital

Rahnuma Ahmad

Medical College For Women and Hospital

Ramen Goel

Wockhardt Hospitals

Aparna Govil Bhasker

Max Super Speciality Hospital

Nandakishore Dukkipati

Max Super Speciality Hospital

Cooperative Institutions

University of Birmingham

South Tyneside and Sunderland NHS Foundation Trust

University College London

Max Super Speciality Hospital

Royal London Hospital

Sir Ganga Ram Hospital

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Creative Commons

Cleveland Clinic

Ain Shams University

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Handling of the Covid-19 Pandemic and Its Effects on Bariatric Surgical Practice: Analysis of GENEVA Study Database

Obesity Surgery (2022)

Rishi Singhal Tom Wiggins Sjaak Pouwels Yashasvi Rajeev Brijesh Madhok

The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams.The current study is a subset analysis of the GENEVA study which was an international cohort study between 01/05/2020 and 31/10/2020. Data were specifically analysed regarding the timing of BMS suspension, patterns of service recovery, and precautionary measures deployed.A total of 527 surgeons from 439 hospitals in 64 countries submitted data regarding their practices and handling of the pandemic. Smaller hospitals (with less than 200 beds) were able to restart BMS programmes more rapidly (time to BMS restart 60.8 ± 38.9 days) than larger institutions (over 2000 beds) (81.3 ± 30.5 days) (p = 0.032). There was a significant difference in the time interval between cessation/reduction and restart of bariatric services between government-funded practices (97.1 ± 76.2 days), combination practices (84.4 ± 47.9 days), and private practices (58.5 ± 38.3 days) (p < 0.001). Precautionary measures adopted included patient segregation, utilisation of personal protective equipment, and preoperative testing. Following service recovery, 40% of the surgeons operated with a reduced capacity. Twenty-two percent gave priority to long waiters, 15.4% gave priority to uncontrolled diabetics, and 7.6% prioritised patients requiring organ transplantation.This study provides global, real-world data regarding the recovery of BMS services following the COVID-19 pandemic.

Pandemic

Personal Protective Equipment

10.1007/s11695-022-06267-7

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Citations (2)

CAN CHILDREN WITH GENETIC SYNDROME BE OFFERED BARIATRIC SURGERY?

Surgery for Obesity and Related Diseases (2018)

Mahendra Narwaria

Genetic syndromes

10.1016/j.soard.2018.09.186

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Global 30-day outcomes after bariatric surgery during the COVID-19 pandemic (GENEVA): an international cohort study

The Lancet Diabetes & Endocrinology (2020)

Rishi Singhal Abd A. Tahrani Christian Ludwig Kamal Mahawar A Abou-Mrad-Fricquegnon

Pandemic

10.1016/s2213-8587(20)30375-2

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Citations (66)

30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data

International Journal of Obesity (2021)

Rishi Singhal Victor Roth Cardoso Tom Wiggins Jonathan Super Christian Ludwig

Abstract Background There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% ( p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% ( n = 51) as compared to 7.5% ( n = 53) in the OAGB group ( p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% ( n = 127) as compared to 7.9% ( n = 166) in the RYGB group ( p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % ( n = 53; p = 0.07). Conclusions This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts.

Sleeve gastrectomy

Roux-en-Y anastomosis

10.1038/s41366-021-01048-1

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Citations (43)

Early Experience of High-dose Intravenous Mycobacterium w in Critically Ill Patients of COVID-19

Indian Journal of Critical Care Medicine (2021)

Parth Patel Sudhendu Patel Vidhi Shah Varsha Aswani Mahendra Narwaria

Immune dysregulation is one of the main reasons for mortality and morbidity in coronavirus disease 2019 (COVID-19). Mycobacterium w (Mw) is recently approved for gram-negative sepsis. Moreover, it is also found effective in COVID-19 patients in previous studies. The traditional route of administration for Mw is intradermal, which has a limitation of administering 0.1 mL per injection and local injection site reaction. Intravenous (IV) administration of Mw has not been explored in COVID-19. We report the retrospective analysis of six critically ill COVID-19 patients who received Mw (IV).At baseline, all patients in this case series required O2 supplementation, and their inflammatory biomarkers were elevated. All patients received 0.6 mL Mw (high-dose) in normal saline along with the standard-of-care treatment.After Mw administration, gradual improvement in O2 requirement was observed and patients were discharged from the hospital with no mortality. A reduction in mean C-reactive protein (CRP) (51.48-18.52 mg/dL), interleukin-6 (IL-6) (260.22-14.47 pg/mL), and FiO2 (81.67-43.33) was also observed. No side effects were observed with the use of Mw by IV route.Use of 0.6 mL Mw by IV route in this case series was associated with decreased O2 supplementation without any side effects in critically ill patients of COVID-19.Patel PS, Patel S, Shah V, Aswani V, Narwaria M. Early Experience of High-dose Intravenous Mycobacterium w in Critically Ill Patients of COVID-19. Indian J Crit Care Med 2021;25(9):1066-1068.

10.5005/jp-journals-10071-23963

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A Delphi Consensus on Surgical Technique of Roux-en-Y Gastric Bypass: An Obesity and Metabolic Surgery Society of India Initiative

Journal of Bariatric Surgery (2024)

Vivek Bindal Dhananjay Pandey Randeep Wadhawan Aparna Govil Bhasker Ramen Goel

Abstract Introduction: Roux-en-Y gastric bypass (RYGB) is considered the gold standard bariatric surgical procedure. However, its complexity has led to various technical adaptations being practiced globally, including in India. Recognizing the need for uniformity in such a crucial procedure, the Obesity Surgery Society of India (OSSI) took the initiative of doing a Delphi consensus on the technique of RYGB. Methods: A panel of 17 experts, chosen from OSSI members, was formed based on their extensive experience with RYGB, years of practice, the proportion of RYGB in their practice, and their academic contributions and recommendations from the executive committee. A questionnaire comprising 40 statements regarding the key steps of the procedure was shared with the selected experts through email. Consensus was deemed to be reached when the statements received scores exceeding 70%. Results: After three rounds of surveys, consensus was reached on 34 statements. Following the first round, statements without consensus underwent reformulation and were redistributed along with pertinent literature. Despite these efforts, six statements remained unresolved by the end of the third round, indicating areas where expert consensus could not be achieved. Conclusions: This Delphi consensus gives a snapshot in the practices of experts doing RYGB in India. It details the various intricacies and technical aspects of the procedure.

Roux-en-Y anastomosis

Obesity Surgery

Gastric bypass surgery

Delphi Method

10.4103/jbs.jbs_4_24

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Citations (1)

Severe Acute Bronchial Asthma with Sepsis: Determining the Status of Biomarkers in the Diagnosis of the Disease

Diagnostics (2023)

Susmita Sinha Santosh Kumar Mahendra Narwaria Arya Singh Mainul Haque

Bronchial asthma is a widely prevalent illness that substantially impacts an individual's health standard worldwide and has a significant financial impact on society. Global guidelines for managing asthma do not recommend the routine use of antimicrobial agents because most episodes of the condition are linked to viral respiratory tract infections (RTI), and bacterial infection appears to have an insignificant impact. However, antibiotics are recommended when there is a high-grade fever, a consolidation on the chest radiograph, and purulent sputum that contains polymorphs rather than eosinophils. Managing acute bronchial asthma with sepsis, specifically the choice of whether or not to initiate antimicrobial treatment, remains difficult since there are currently no practical clinical or radiological markers that allow for a simple distinction between viral and bacterial infections. Researchers found that serum procalcitonin (PCT) values can efficiently and safely minimize antibiotic usage in individuals with severe acute asthma. Again, the clinical manifestations of acute asthma and bacterial RTI are similar, as are frequently used test values, like C-reactive protein (CRP) and white blood cell (WBC) count, making it harder for doctors to differentiate between viral and bacterial infections in asthma patients. The role and scope of each biomarker have not been precisely defined yet, although they have all been established to aid healthcare professionals in their diagnostics and treatment strategies.

Procalcitonin

Chest radiograph

10.3390/diagnostics13162691

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Citations (1)

One Anastomosis Gastric Bypass Surgery: Consequences Over Diabetic Parameters

Bangladesh Journal of Medical Science (2024)

Arya Singh Rahnuma Ahmad Susmita Sinha Md. Ahsanul Haq Mahendra Narwaria

Introduction: Excessive weight gain in individuals leads to various metabolic disorders, such as diabetes mellitus, contributing to a further increase in body mass index (BMI). Thus, the patient enters a vicious cycle that leads to irreversible health damage. Bariatric surgery has displayed positive outcomes of weight loss with the return of BMI towards normal, which may reduce blood glucose levels to near normal. The remission of diabetes mellitus may be attributed to the reduction in inflammation, improvement of insulin resistance, lowering of peptide YY, and overall improved metabolic state of the body. Methods: One fifty patients, both female and male, in the age group of 20-60 years with grade II and grade III obesity having mean BMI of 45.63±6.54 (male) and 41.81± 5.93kg/m2 (female) were randomly selected for this study. Hemoglobin, Fasting Blood sugar (FBS), 2 hours postprandial blood sugar (PP2BS). Hemoglobin A1c (HbA1c) serum insulin was assessed at the visit, marked as a baseline, then again at the visit 3 months, and finally at the visit by the patient 6 months after bariatric surgery. Results: Hemoglobin level increased significantly from baseline at the 3rd-month post-surgery visit. FBS increased substantially from baseline at the 3rd-month postsurgery visit, which decreased considerably at the 6th-month visit following surgery. HbA1c showed a significant decrease in level from baseline following surgery. Conclusion: Improvement in BMI following bariatric surgery may have a positive impact on blood glucose levels in diabetic patients who may hope to see better management of their condition and may enjoy a better quality of life. Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 29-38

Blood sugar

Gastric bypass surgery

10.3329/bjms.v23i1.70666

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Sump syndrome following choledochoduodenostomy

Formosan Journal of Surgery (2020)

Dhaivat Vaishnav Mahendra Narwaria

Sump syndrome is a rare long-term complication of side-to-side choledochoduodenostomy (CDD), a common surgical procedure in patients with biliary tract disease in the era before endoscopic retrograde cholangiopancreatography (ERCP). In the setting of a side-to-side CDD, the bile does not drain through the distal common bile duct (CBD) anymore. Therefore, the part of the CBD distal from the CDD anastomosis consequently transforms into a poorly drained reservoir, making this so-called “sump” prone to accumulation of debris. These patients are prone to cholangitis. We present a case of a 56-year-old woman with a history of side-to-side CDD 8 years ago who presented with cholangitis and ruptured liver abscess. Sump syndrome was diagnosed by magnetic resonance cholangiopancreatography. Laparoscopic peritoneal lavage was done for the ruptured liver abscess. After endoscopic debris removal and antibiotic treatment, the patient recovered well. In the ERCP era, little is known about CDD and its long-term complications. Therefore, this report provides an opportunity to refresh the knowledge and raise awareness of this syndrome.

Magnetic resonance cholangiopancreatography

10.4103/fjs.fjs_79_19

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An Indian multicentre real‐world study on long‐term quality of life outcomes following bariatric surgery

Clinical Obesity (2024)

Vivek Bindal Priyanka Agarwal Manish Khaitan Arun Prasad Atul N. C. Peters

Summary Background The purpose of this study was to assess the impact of metabolic and bariatric surgery (MBS) on Quality of Life (QoL) in Indian patients with obesity over 10 years. Methods A retrospective chart review was conducted at 11 centres for individuals with MBS between February 2013 and May 2022. Patient medical records provided the source of de‐identified data. Results Data from 2132 individuals with a mean age of 43.28 ± 11.96 years was analysed. There were 37.43% men and 62.57% females in the study population. The study population had a mean preoperative body mass index (BMI) of 45.71 ± 10.38 kg/m 2 . The Bariatric Analysis and Reporting Outcome System (BAROS) scoring method showed a higher overall QoL score throughout all follow‐up periods, with ‘very good’ outcomes at one, three and 7 years and ‘good’ outcomes at 5 and 10 years. Improvements in QoL were associated with a substantial improvement ( p < .01) in BMI at every follow‐up time point. Conclusions Following MBS, individuals with obesity exhibited a substantial and long‐term improvement in their overall QoL for up to 10 years. This study presents Indian data on QoL, which is considered one of the most important decision‐making factors for or against an intervention.

10.1111/cob.12693

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