Outcomes of bariatric surgery in patients with inflammatory bowel disease from a French nationwide database

International audienceBackground: The outcomes of bariatric surgery (BS) in patients with chronic inflammatory bowel disease (IBD) remain rarely described. We aimed to evaluate the 90-day morbidity and mortality rates, and the risk of IBD complications 2 years after BS. Method: Patients from the French Programme de Médicalisation des Systèmes d’Information (PMSI) database who underwent a primary BS between 2016 and 2018 were included. We identified patients with a previous diagnosis of IBD. Postoperative 90-day (POD90) morbidity and mortality rates were compared between the two groups. The evolution of IBD was followed 2 years after BS. Results: Between 2016 and 2018, 138 980 patients underwent primary BS, including 587 patients with IBD: 326 (55.5 per cent) with Crohn’s disease (CD) and 261 (44.5 per cent) with ulcerative colitis (UC). The preferred surgical technique was sleeve gastrectomy, especially in the IBD group (81.1 per cent), followed by gastric bypass (14.6 per cent). Patients with IBD had more comorbidities (Charlson Comorbidity Index of 1 or more, hypertension, and diabetes; P < 0.001) than those without IBD. The POD90 mortality rate did not differ between the two groups (0.049 per cent in the IBD group versus 0 per cent in the non-IBD group), but more unscheduled rehospitalizations at POD90 were observed in patients with IBD (6.0 per cent versus 3.7 per cent; P = 0.004). Two years after BS, 86 patients (14.6 per cent) in the IBD group had at least one unplanned readmission for the management of their IBD; 15 patients stayed for 3 or more days. After multivariable analysis, patients with CD had an independent elevated risk of IBD-related unplanned readmissions 2 years after BS versus UC (adjusted odds ratio 1.90, 95 per cent c.i. 1.22 to 2.97; P = 0.005). Conclusion: In a highly selected cohort of patients with well-controlled IBD, BS did not result in added mortality or morbidity. A point of vigilance must be underlined regarding BS in patients with CD

Transmission network of an HIV type 1 strain with K103N in young Belgian patients from different risk groups

Transmitted drug resistance (TDR) influencing nonnucleoside reverse transcriptase inhibitor (NNRTI) activity is increasing among new HIV-1 patients in several countries. As we recently observed an increase of K103N prevalence among new diagnoses in Belgium, we mined the Belgian national sequence database for homologous sequences. The earliest reverse transcriptase (RT) sequences available for drug-naive patients as well as sequences related to treatment failure were included. Fifty-five sequences were aligned and subjected to phylogenetic analysis, revealing the presence of a cluster of 29 virus sequences. All except one of those sequences were from antiretroviral (ARV)-naive patients at the time of sampling, and 22 had the K103N mutation. Epidemiological data of clustered patients were collected through the Institute of Public Health. Seventy-two percent of the clustered patients were infected through homosexual or bisexual contacts while the others reported heterosexual contacts only. All patients reside and were infected in Belgium. Sixteen were diagnosed between January 2011 and June 2012; 14 were aged between 18 and 29 years at the time of diagnosis. Nearly 60% of the clustered patients live close to the city of Namur, where HIV incidence substantially increased in the past 2 years. The identification of this transmission network advocates for local prevention reinforcement and underscores the need for continuous TDR monitoring. The spread of NNRTI TDR could affect ARV initiation schemes and prophylaxis strategies

Characteristics and prognosis of pneumococcal endocarditis: a case-control study

International audienceCase series have suggested that pneumococcal endocarditis is a rare disease, mostly reported in patients with comorbidities but no underlying valve disease, with a rapid progression to heart failure, and high mortality. We performed a case-control study of 28 patients with pneumococal endocarditis (cases), and 56 patients with non-pneumococcal endocarditis (controls), not matched on sex and age, during years 1991-2013, in one referral center. Alcoholism (39.3% vs. 10.7%; P<.01), smoking (60.7% vs. 21.4%%; P<.01), the absence of previously known valve disease (82.1% vs. 60.7%; P=0.047), heart failure (64.3% vs. 23.2%; P<.01), and shock (53.6% vs. 23.2%; P<.01) were more common in pneumococcal than in non-pneumococcal endocarditis. Cardiac surgery was required in 64.3% of patients with pneumococcal endocarditis, much earlier than in patients with non-pneumococcal endocarditis (mean time from symptoms onset, 14.1 ± 18.2 vs. 69.0 ± 61.1 days). In-hospital mortality rates were similar (7.1% vs. 12.5%). Streptococcus pneumoniae causes rapidly progressive endocarditis requiring life-saving early cardiac surgery in most case

0418: Comparison of pre- and post-operative characteristics in octogenarians having isolated surgical aortic valve replacement before versus after introduction of transcatheter aortic valve implantation

International audience0418 – Figure Surgical aortic valve replacement (SAVR) is the reference treatment for severe aortic stenosis (AS). Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment. The aim of the study was to assess if the clinical profile of octogenarian patients treated surgically before and after the TAVI program initiation has changed. We retrospectively included consecutive octogenarian patients, who underwent isolated SAVR, between January 2006 and December 2014 in a single high-volume center. We compared preoperative, peri-operative and postoperative characteristics before and after the initiation of TAVI (February 2009). 845 patients were included: 229 in the pre-TAVI group (2006-2008; 3 years), 616 in the post-TAVI group (2009-2014; 6 years). Over time, there was an increased rate of SAVR performed. The mean age was the same, 83.2±2.0 years in the pre-TAVI group, 83.5±2.1 years in the post-TAVI group (p=0.06). The preoperative characteristics were statistically comparable, except for history of heart failure (25% in the pre-TAVI group vs 18% in the post-TAVI group, p=0.04), coronary artery disease (22% in the pre-TAVI group vs 14% in the post-TAVI group, p=0.01), hypertension (59% in the pre-TAVI group vs 68% in the post-TAVI group, p=0.02) and obesity (18% in the pre-TAVI group vs 24% in the post-TAVI group, p=0.03). Peri-operative data and post-operative adverse events were comparable between both groups. The operative mortality (30-day) was similar, 5.2% in the pre-TAVI group, 5.5% in the post-TAVI group (p=0.87). In conclusion, with the emergence of TAVI, the number of octogenarian patients operated on continued to increase, their preoperative characteristics were clinically similar and the operative mortality was stabl

Comparison of Pre- and Post-Operative Characteristics in Octogenarians Having Isolated Surgical Aortic Valve Replacement Before versus After Introduction of Transcatheter Aortic Valve Implantation

International audienceAortic stenosis (AS) is the most frequent heart valve disease. Surgical aortic valve replacement (SAVR) is the reference treatment. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment. New strategies for treating the AS are upcoming. The aim of the study was to assess if the clinical profile of octogenarian patients treated surgically before and after the TAVI program initiation has changed. We retrospectively included consecutive octogenarian patients, who underwent isolated SAVR, between January 2006 and December 2011 in a single high-volume center. We compared preoperative and postoperative characteristics before and after the initiation of TAVI (February 2009). 517 patients were included: 229 in the "before TAVI" group (2006-2008), 288 in the "after TAVI" group (2009-2011). The mean age was 83.2±2.0 in the "before TAVI" group, 83.5 ± 2.1 in the "after TAVI" group (p=0.106). There were no significant differences in preoperative characteristics: NYHA class (p=0.374), history of heart failure (p=0.680), left ventricular ejection fraction (59.8±12.2% in the "before TAVI" group, 59.9±11.3% in the "after TAVI" group, p=0.922), coronary artery disease (p=0.431), chronic pulmonary disease (p=0.363), previous cardiac surgery (p=0.085). The logistic EuroSCORE was 7.78±4.60% in the "before TAVI" group and 7.33±3.96% in the "after TAVI" group (p=0.236). The operative mortality (30-day) was comparable: 5.2% in the "before TAVI" group, 6.9% in the "after TAVI" group (p=0.424). Thus, with the emergence of TAVI, the number of octogenarian patients operated on, their preoperative characteristics and the operative mortality remained comparable

Correction: Diamant et al. Effectiveness of Early Radical Cystectomy for High-Risk Non-Muscle Invasive Bladder Cancer. Cancers 2022, 14, 3797

In the original article [...

Likely effect of the 2014 Ebola epidemic on HIV care in Liberia

WOS:000368457600001International audienceObjective: Liberia's health system has been severely struck by the 2014 Ebola epidemic. We aimed to assess the potential effect of this epidemic on the care of HIV patient in two clinics [John F. Kennedy (JFK) and Redemption Hospitals] in Monrovia, which stayed open throughout the epidemic.Design and methods: A preexisting electronic database of HIV patient's follow-up visits was used to estimate three weekly parameters from January 2012 to October 2014: number of visits, number of new patient, and proportion of patients with follow-up delay. We used segmented negative binomial regressions to assess trends before and after the week of the Ebola outbreak defined in June 2014 by WHO.Results: The cumulative number of patients in care comprised 5948 patients with a total of 56287 visits between January 2012 and October 2014. From June 2014, the number of visit per week, stable since 2012, abruptly decreased (59%) in Redemption (P\textless0.001) and progressively decreased by 3% per week in JFK (P\textless0.001). In both the clinics, the weekly proportion of patient with follow-up delay sharply increased after the point break from June 2014 (P value \textless 0.001). From June 2014, a significant decrease in new patients per week occurred in both the clinics: by 57% (P value \textless 0.001) in Redemption and by 4.6% per week (P value \textless 0.001) in JFK.Conclusion: The Ebola epidemic had a significant effect on HIV care in Monrovia. Given the particular impact on the rate of patients with follow-up delay, a long-term impact is feare