OF ADVANCED RESEARCH RESEARCH ARTICLEKnowledge, attitude and practice of complementary and alternative medicine among medical students in Al-

Introduction Bariatric surgery provides an effective option for the management of morbid obesity. Several studies have investigated the association between bariatric surgery and secondary hyperparathyroidism (SHPT). This study aims to compare the levels of blood biomarkers, specifically, calcium (Ca), vitamin D, and phosphate (PO4), and their association with parathyroid hormone (PTH) levels pre- and post-bariatric surgery. In addition, it aims to assess the prevalence of hyperparathyroidism post-bariatric surgery in a tertiary care hospital in Saudi Arabia. Material and Methods A prospective cohort study was conducted at a large tertiary care hospital between May 2017 and April 2019. The study included adult obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Patients were excluded if they were known to have any comorbidities, receiving vitamin supplements, and those who had undergone bariatric procedures previously. Routine blood tests, including PTH, vitamin D, Ca, and PO4, were collected at baseline, and post-surgery. Results A total of 143 patients who underwent LSG were included in the study. Hyperparathyroidism was observed in 15.4% of patients at baseline and in 36.4% of patients’ post-surgery (p < 0.001). Low vitamin D levels, which were highly prevalent before surgery, decreased sustainably (66.4% pre-operative and 28% at follow-up after surgery, P=0.032). Baseline hypocalcemia was observed in 20.3% of patients compared to 8.4% post-surgery (P=0.546). Hypophosphatemia was present in 60.8% of subjects at baseline, while the percentage dropped to 21.7% post-surgery. There was a significant association between PO4 and PTH levels at baseline. Post-operatively, there was a significant correlation between PTH and both vitamin D and calcium levels. Conclusion Our study showed that the higher levels of PTH post LSG can be related to vitamin D deficiency and lower calcium levels, despite patients following the provided recommendations for supplementation. This study also emphasizes the importance of routine testing for hyperparathyroidism both before and after bariatric surgery.

Urinary tract infection (UTI) is the second most popular infection in the geriatric community, and the first popular is urine and fecal incontinence. Because of the effects of immunological aging, elderly are more susceptible to bacterial microorganisms and viral infections. The disease ranges from relatively harmless cystitis to potentially fatal pyelonephritis. This article aims to discuss the epidemiology, diagnosis, risk factors, progress of the disease, causative microorganisms, and guidelines for drug management of UTIs in geriatric patients. This study was performed following the PRISMA checklist. PubMed (2016-2022), Biological Sciences (ProQuest) (2012-2022), and ScienceDirect were used to locate English-language literature (2018-2022). We extracted data to assess the epidemiology, diagnosis, risk factors, causative microorganisms, and treatment management of UTIs in geriatric patients. This systematic review encompassed 11 observational studies including a total of 945,908 elderly patients and were published between 2012 and 2022. The prevalence varies across the studies. Urinary catheterization, gender, polypharmacy, comorbidities especially diabetes mellites older age, dementia, older age, vaginitis, previous history of UTI, bedridden state, and antimicrobial use were the independent risk factors. E. coli was the most found causative agent. Antibiotics were given specifically for UTIs. Despite the high rate of risk factors and prevalence of UTIs in the geriatric, treatment options are minimal. There is no evidence to support the use of antibiotics for long-term UTI prevention. However, alternative prophylaxis methods for patients with recurring infections must be developed. Although further studies are required to properly understand the clinical features and treatment modalities in elderly patients within the community or under institutional care.