Asad Ullah

By Asad Ullah

The prevalence of obesity has increased globally. Management of obesity consists of medical and surgical interventions. The results of bariatric surgery are consistently more significant than medical therapy. Importantly, bariatric surgery achieves durable weight loss in more patients than medical therapy. Moreover, studies have reported improvement in most obesity-related complications after bariatric surgery. Improvement or remission of type 2 diabetes mellitus, hypertension and dyslipidemia is noteworthy. Due to better outcomes, the indications of bariatric surgery are expanding. In conclusion, bariatric surgery is a cost-effective and safer alternative for morbidly obese patients who fail to respond to non-surgical treatments. Some studies have raised concerns about the worsening of mental health problems after bariatric surgerys. It requires careful management of high-risk patients and further research.

Part of the book: Bariatric Surgery

By Asad Ullah, Muhammad Jamil and Johar Jamil

The epidemic of obesity is taking over many parts of the world. The etiology of obesity is multifactorial; however, disordered energy balance regulation is a central feature. Obesity is managed by lifestyle changes alone or in combination with pharmacotherapy or bariatric surgery. Diet is an essential part of the primary and secondary prevention of obesity. Various dietary patterns have successfully induced acute weight loss, but no diet stands apart from others. Most agree that an ideal weight loss diet should be nutritionally adequate, safe, effective, affordable, and culturally admissible. Creating a negative energy balance is the underpinning theme across weight loss diets. Despite early weight loss, most individuals struggle to maintain weight long-term. Weight gain occurs due to a complex interaction of physiological, environmental, and psychological factors. Long-term weight management is influenced by lifelong conformity to low energy diet, lifestyle changes and ongoing support from family, friends, and healthcare professionals. Strategies should be implemented at the population level to prevent obesity. Policymakers, schools, businesses, healthcare providers, community leaders and individuals must unite at local, national, and international levels to fight the epidemic of obesity.

Part of the book: Obesity

By Asad Ullah and Muhammad Jamil

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a heterogeneous, chronic, and debilitating condition. It affects 400,000 individuals in the United Kingdom. IC/BPS presents with suprapubic pain or discomfort perceived to be related to the urinary bladder with one or more urinary symptoms (e.g., urgency, frequency or nocturia) for more than 6 weeks. The exact etiology is not clearly understood. It can sometimes co-exist with other chronic pain disorders, complicating the diagnosis and management. IC/BPS can adversely impact the quality of life, impede work, and interfere with the sleep, sexual and social life of the affected individual. The contemporary treatments are palliative and aim for symptom control only. There is no cure available presently. Moreover, treatment effects are highly variable; therefore, personalization of treatment is vital for achieving the desired outcomes. Management includes lifestyle modifications, physical therapy, systemic pharmacotherapy, intravesical therapies and surgery. Conservative treatments are usually used first, followed by invasive and combination therapies if required. Treatment should aim beyond symptom improvement and encompass improvement in quality of life. Further research is needed to understand the etiology and pathophysiology of IC/BPS. It will assist in the development of new biomarkers and drug development.

Part of the book: Cystitis

By Asad Ullah and Khalid AlMeshari

Solid organ transplantation (SOT) has revolutionized the management of end-stage organ disease. Human Leukocyte antigen (HLA) sensitization and ABO incompatibility (ABOi) pose formidable barrier to SOT. The risk of acute rejection is high. They wait longer for compatible organs than their counterparts do. Furthermore, the graft and patient survival are suboptimal in incompatible transplants. Access to SOT could be promoted in this population by prioritizing them to well-matched organs in the allocation system via acceptable mismatch or paired donation programs. If these strategies fail to achieve transplantation, desensitization could provide an alternative. Desensitization is a process that allows transplantation in highly sensitized and ABO incompatible donor and recipient. Researchers initially developed principles of desensitization for kidney transplantation and have subsequently applied them to other types of solid organ transplantation. Desensitization protocols vary by the transplant center, but most use combinations of apheresis, intravenous immunoglobulin (IVIG), and anti-CD20 monoclonal antibodies. The desensitization aims to ease the immunological détente by removing preformed donor-specific alloantibodies (DSA) and creating a favorable immune environment for the allograft. Desensitization caries risk; therefore, careful patient selection and close monitoring are essential to mitigate the risk of complications. Further work is required to enhance the outcomes of desensitization.

Part of the book: Recent Scientific and Therapeutic Advances in Allograft