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Patients are encouraged to maintain open communication with their GP, bariatric nurse, and dietitian, and to attend follow-up appointments consistently

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When mitochondrial homeostasis is shifted, these pathways become altered or shut down, likely contributing to the death of hepatocytes with activation of inflammation and hepatic stellate cells, causing liver fibrosis and cirrhosis

Spinules can originate from postsynaptic spines, presynaptic terminals, or glial cell projections, and the range of small invaginating projections has been reviewed extensively (, )

However, the decision must always follow confirmation of true hypogonadism through laboratory testing

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