Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures. There is an increasing awareness about a comorbidity-based indication for bariatric surgery regardless of weight (metabolic surgery). The best operation to mitigate obesity-associated comorbidities is a matter of controversy. This review is aimed at comparing LRYGB and LSG for the treatment of diabetes, hypertension, dyslipidemias, obstructive sleep apnea (OSA), and gastroesophageal reflux (GERD). We searched PubMed, MEDLINE, SCOPUS, Web of Science, and Cochrane library for articles comparing these two commonly used bariatric approaches. We identified 2,457 studies, 1,468 of which stood after the removal of duplications; from them, 81 full texts were screened and only 16 studies were included in the final meta-analysis. LRYGB was equal weight to LSG for diabetes (P-value = 0.10, odd ratio, 1.24, 95% CI, 0.96–1.61, I2 for heterogeneity = 30%, P-value for heterogeneity, 0.14), and OSA (P-value = 0.38, odd ratio, 0.79, 95% CI, 0.47–1.33, I2 for heterogeneity = 0.0%, P-value for heterogeneity, 0.98). However, LRYGB was superior to LSG regarding hypertension (P-value = 0.009, odd ratio, 1.55, 95% CI, 1.20–2.0, I2 for heterogeneity = 0.0%, P-value for heterogeneity, 0.59), dyslipidemia (odd ratio, 2.18, 95% CI, 1.15–4.16, P-value for overall effect, 0.02), and GERD (P-value = 0.003, odd ratio, 3.16, 95% CI, 1.48–6.76). LRYGB was superior to LSG for gastroesophageal reflux, hypertension, and dyslipidemia remission. While the two procedures were equal regarding diabetes and obstructive sleep, further reviews comparing LSG, and one anastomosis gastric bypass are recommended.

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Background: Adequately informed family physicians have the greatest potential to correctly identify the diagnosis of fibromyalgia (FM) and develop an initial treatment plan. Therefore, it is substantial to determine the levels of weakness and inaccuracies of primary care physicians regarding FM diagnostic criteria and management strategies. Aim: This study aimed to assess the knowledge, attitude, and practices regarding FM among primary care physicians in Tabuk, Saudi Arabia. Methods:This cross-sectional study included family physicians who were board-certified or registered in the family medicine training program and working at the government family health care centers in Tabuk. A pre-designed, structured questionnaire was distributed either in a written form or as an online survey. Results: This study included 52 primary healthcare physicians. Twenty-two (42.3%) participants incorrectly recorded localized pain as a diagnostic symptom, and 45 (86.5%) incorrectly recorded nonsteroidal anti-inflammatory drugs, prednisolone, and/or opioids as drugs that are used for treating FM. Only 59.6% were confident recognizing symptoms of FM and 55.8% were confident differentiating FM from other similar diseases. Conclusions: The primary healthcare physicians working in the governments primary healthcare centers in Tabuk city, Saudi Arabia have low levels of knowledge about diagnostic criteria and treatment strategies of FM. These findings highlight the need for continuous professional development involving family physicians in the primary health care setting with suitable continuous medical education programs concerning FM.

Gestational diabetes (GD) is a common and deadly disorder with deleterious effects on both the mother and fetus. The current review assessed the role of the Mediterranean diet and metformin in the prevention of GD. The PubMed, Medline, and Google Scholar databases were searched for relevant articles, and the keywords metformin, Mediterranean diet, and gestational diabetes prevention were used with the proteans AND and OR. Out of the 252 articles retrieved, 48 full texts were assessed, and only nine articles fulfilled the inclusion and exclusion criteria. A data extraction sheet was used to collect the author's name, year of publication, country, methods of the study, risk reduction, odds ratio, relative risk, 95% CI, and P values. Three (33.3%) articles assessed the effectiveness of metformin on GD, and another six (66.7%) investigated the effects of the MedDiet on GD. The studies on metformin showed no reduction in GD (odds ratio, 1.07, 0.79–1.44, P value for overall effect=0.65, I2 for heterogeneity=3%, P value=0.36. Chi-square=2.07, and the mean difference=2), while studies on the MedDiet showed a reduction in gestational diabetes risk ((odds ratio, 0.49, -0.32–0.73, P value for heterogeneity =0.0004, heterogeneity, I =278%, P value for overall effect=0.0005, Chi-square=22.40 and mean difference=5. The Mediterranean diet was effective in the prevention of GD; however, metformin showed no significant risk reduction as an interventional measure.