30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients

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

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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Evaluation of bacteriophages in the biocontrol of Pseudomonas syringae pv. syringae isolated from cankers on sweet cherry (Prunus avium L.) in Turkey

2-s2.0-85101256072Background: Bacterial canker and subsequent gummosis are caused by multiple pathogens and lead to significant yield and productivity losses in sweet cherry cultivation in Turkey. This study identified that Pseudomonas syringae pathovars were responsible for bacterial canker on sweet cherry orchards by using classical and molecular methods and evaluated the biocontrol effects of bacteriophages against P. syringae pv. syringae. Results: Pathogenic bacteria were isolated from samples taken from plants showing symptoms of bacterial canker in cherry orchards located in İzmir and Manisa provinces. Specific pathogens were identified using pathogenicity, phenotypic tests, and simplex PCR. Bacteriophages effective against P. syringae strains were isolated from soil contaminated with pathogens identified in the diseased orchards using an optimized isolation protocol. The biocontrol activity of bacteriophage isolates against P. syringae pv. syringae was tested in vitro and in vivo. The results of pathogenicity tests on immature sweet cherry fruits and micropropagated cherry plantlets revealed 10 pathogenic bacteria isolates from 44 plant samples taken from sweet cherry orchards showing symptoms of bacterial canker. Conclusions: Ten isolates were identified as Pseudomonas syringae pv. syringae. Nine different pure bacteriophage isolates were effective. The results indicated that bacteriophage isolates may demonstrate variable reactivity against P. syringae pathovars. © 2021, The Author(s).Ege ÜniversitesiI would like to thank Dr. Monika Kaluzna (Research Institute of Horticulture in Skierniewice, Skierniewice, POLAND) for providing reference strains that have been used in the study and AGROM?LLORA Ltd. ?ti. (Turkey) and the company?s general manager Serhat Bozer for supplying micropropagated cherry plantlets.This work was supported by the Ege University Teaching Staff Training Program (OYP) coordination unit within the scope of OYP

CHAPTER 9: Biosynthesis of Curcumin and Molecular Targets and the Biological Mechanism of Curcumin

The biosynthesis of curcumin can be viewed from different perspectives, a natural pathway in Curcuma Longa (turmeric) and artificial pathways in Oryza sativa (rice) and rice bran pitch respectively, using Esterichia coli (E. Coli). The natural pathway for the synthesis of curcumin can be divided into two, an upstream and a downstream section. The transcription factor nuclear factor B (NF-B) governs several cellular signaling pathways associated with cancer, and targets various cytokines, proinflammatory molecules, growth factors, cell adhesion molecules, oncogenes and pro/anti-apoptotic proteins during carcinogenesis. Curcumin targets the transcription factors, protein kinases (PKs), angiogenesis, cell cycle regulators, sirtuins, NF-B signaling pathway, E-cadherin, vascular endothelial growth factor (VEGF), signal transducers and activators of the transcription 3 (STAT-3) signaling pathway, B-cell lymphoma (Bcl-2), p53, DNA, microRNA (miRNA), apoptosis and autophagy. The biological mechanism comprises different activities that are antioxidant, anticancer, antiviral, antifungal, antiproliferative, anti-immunomodulatory and anti-inflammatory. The main focus of this chapter is to provide valuable information on the biological synthesis, biological mechanism and molecular targets of curcumin. © 2021 The Royal Society of Chemistry

Life quality and affecting factors in chronic renal failure patients undergoing hemodialysis [Hemodiyalize Giren Kronik Böbrek Yetmezli{eth}i Hastalarynda Ya{thorn}am Kalitesi ve Etkileyen Faktörler]

Today health services aim to provide a higher level of life quality to individuals as much as possible and not being limited only to providing a good treatment. In this context it was aimed to evaluate the life quality and the factors affecting this in chronic renal failure (CRF) patients undergoing hemodialysis. Materials and method A total of 144 adult patients with CRF from two dialysis centers in Adana, one private and one in a University, were included in the study. A questionnaire investigating demographic characteristics and short form health survey "SF-36" were filled by face-to-face interview technique. Findings Male to female ratio of the participants was 91(63.2%) to 53(36.8%). The mean dialysis history was calculated as 44.4±34.3 months. One to six other diseases were recorded with a mean number of 2.9±1.1 to be concurrent to CRF. SF-36 revealed a health status score mean (TS=total score) of 48.1±21.8, with physical status scale (PSS) score mean of 46.0±21.1 and mental status scale (MSS) score mean of 50.3±22.0. The same scores were calculated to be significantly lower in females (with 40.4, 39.8 and 38.0, respectively) in comparison to males (with 52.5, 50.3 and 50.6, respectively) (p<0.05). As SF-36 scores lower than 51 were reported to be 'low', and even to be predictive of risky situations, when the risk effects of factors like age, gender, marital status, educational status, length of dialysis history and presence of concurrent diseases were investigated, only lower educational status and the number of concurrent diseases were found to be significant for the risk increase. Conclusion In the context of preventive medicine, optimum functionality is a secondary prevention in chronic diseases. Life quality indexes are not only important evaluators of the functionality, but they play a major role in the prevention of mortality, too. Hence health surveys like SF-36, based on patient's reporting, are suggested to be introduced in evaluations, not being limited to the evaluations based on performance scoring only