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

Pertussis vaccine and infantile spasms

The boy (case 1) at the age of 12 weeks started having attacks and jercked after the first injection of triple vaccine (diphtheria, retanus and whole cell pertussis) The electro-encephalogram (EEG) confirmed the typical features of hypsarrhythmia. Intramuscular ACTH was commenced for 2 weeks. No problem was reported until the age of 9 years when he started having attacks of jercking. He was treated with sodium valproate. The boy of the second case was a first cousin of case 1. At the age of 11 years the boy had momentary black outs. The EEG showed findings of idiopathic epilepsy. Treatment with sodium valproate was commenced. The children of both cases belong to a family in which there is a trendency to seizures. It seems unlikely the triple vaccine produced the infantile spasms in case 1.Vaccin

Fever of unknown origin

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Leishmaniasis mimicking collagen disease

Lance

Red cell phosphate metabolism in preterm infants with idiopathic respiratory distress syndrome

Phosphate metabolism was studied in twenty-one preterm infants with idiopathic respiratory distress syndrome during and after oxygen (O2) therapy using a hood. Plasma, red cell inorganic phosphate (Pi) and the red cell concentrations of organic phosphate metabolites ATP and 2,3-diphosphoglycerate were significantly lower in the sick infants when compared to controls of similar age and birthweight, and remained low even 24 h after cessation of therapy. Plasma cortisol levels were elevated at the onset of the disease and decreased to almost control levels by the end of O2 therapy while the values of plasma calcitonin did not show any difference from controls. Plasma creatinine phosphokinase and blood lactic acid levels followed the pattern of the control group with a small increase at the beginning of the study and decreasing thereafter. Several factors may be implicated in the cause of hypophosphatemia in these infants such as inadequate feeding, acidosis and hypercortisolaemia due to stress leading to phosphaturia.Acta Paediatr Scan

Cellular phosphate in renal tubular acidosis

In two infants with distal renal tubular acidosis phosphate depletion was observed in the extracellular and intracellular compartments of the erythrocytes. Treatment corrected this disturbance over a period of several months. Cell phosphate deficiency may contribute to the adverse effects of renal tubular acidosis on bone.Archives of Disease in Childhoo

The management of siblings with familial hypophosphatemic rickets

Two siblings (boy and girl) born to a mother with familial hypophosphatemic rickets had abnormal values of serum phosphorus and serum alkaline phosphatase at the age of six weeks. At this age therapy with 1 alpha-hydroxycholecalciferol (1 alpha OHD3) and phosphate was started resulting in both siblings having normal growth of body length and radiological healing of the bone lesions but persistently low values of fasting serum phosphorus during the time of observation up to 60 and 26 months of age, respectively. Phosphate and 1 alpha OHD3 have a positive influence on serum phosphorus through their effect on the intestine. Neither of the patients developed hypercalcaemia during treatment. It seems, therefore, that the early administration of 1 alpha OHD3 with phosphate in infants with familial hypophosphatemic rickets prevents dwarfism and has a positive effect on intestinal absorption of phosphorus but not on fasting hypophosphatemia.Helvetica Paediatrica Act