Short-term outcomes after long inverted versus short standard biliopancreatic limb in Roux-en-Y gastric bypass

Background: Obesity is a public health issue that affects the entire world and it is rising. Roux-en-Y gastric bypass is one of the most common bariatric procedures and it can reach a significant and sustained excess weight loss and efficient comorbidity control. The main objective was to compare short-term outcomes between standard versus long biliopancreatic limb gastric bypass patients.Methods: it was a retrospective, comparative, descriptive, single-center study. We evaluated obese patients that underwent a laparoscopic Roux-en-Y gastric bypass with standard or long biliopancreatic limb in Centro Medico ABC, Mexico City, and compared general demographics, weight loss, excess weight loss, comorbidities and quality of life.Results: Of 50 patients analyzed, 24 were in the standard gastric bypass (S-GB) and 26 in the long biliopancreatic limb (LBPL-GB). Mean weight loss in the S-GB group was 33.1±12.1 kg and in the LBPL-GB was 40.2±12.6 kg with a difference of 7.1 kg. The percentage of excess weight loss (%EWL) was 72.5±14% in S-GB and 72.9±19% in LBPL-GB, with a difference of 0.4% in the 12 months of follow-up. There was a complete reduction of hypoglycemic drugs in 80% in the S-GB group and 100% in the LBPL-GB group.Conclusions: With this modification of the technique, we achieved important outcomes in regard of comorbidities, without affecting drastically weight loss or the EWL. This procedure is safe and feasible

International Coercion, Emulation and Policy Diffusion: Market-Oriented Infrastructure Reforms, 1977-1999

Why do some countries adopt market-oriented reforms such as deregulation, privatization and liberalization of competition in their infrastructure industries while others do not? Why did the pace of adoption accelerate in the 1990s? Building on neo-institutional theory in sociology, we argue that the domestic adoption of market-oriented reforms is strongly influenced by international pressures of coercion and emulation. We find robust support for these arguments with an event-history analysis of the determinants of reform in the telecommunications and electricity sectors of as many as 205 countries and territories between 1977 and 1999. Our results also suggest that the coercive effect of multilateral lending from the IMF, the World Bank or Regional Development Banks is increasing over time, a finding that is consistent with anecdotal evidence that multilateral organizations have broadened the scope of the “conditionality” terms specifying market-oriented reforms imposed on borrowing countries. We discuss the possibility that, by pressuring countries into policy reform, cross-national coercion and emulation may not produce ideal outcomes.http://deepblue.lib.umich.edu/bitstream/2027.42/40099/3/wp713.pd

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

DIPLOMACIA E POLÍTICA DOMÉSTICA: A LÓGICA DOS JOGOS DE DOIS NÍVEIS

A política doméstica e as relações internacionais com freqüência são inextricavelmente vinculadas; todavia,as teorias existentes (particularmente as estatocêntricas) não levam adequadamente em consideraçõestais vínculos. Quando os líderes nacionais devem obter as ratificações (formais ou informais) dos membrosde seus parlamentos para um acordo internacional, seus comportamentos em negociações refletem os imperativossimultâneos tanto de um jogo de política doméstica quanto de um jogo de política internacional.Usando exemplos de cúpulas econômicas ocidentais, das negociações do Canal do Panamá e do Tratado deVersalhes, dos programas de estabilização do Fundo Monetário Internacional, da Comunidade Européia ede muitos outros contextos diplomáticos, o artigo oferece uma teoria da ratificação. Ele enfatiza o papel daspreferências, coalizões, instituições e práticas domésticas, das estratégias e táticas dos negociadores, daincerteza, das reverberações domésticas das pressões externas e o papel dos interesses do negociador-chefe.Essa teoria de “jogos de dois níveis” também pode ser aplicável a muitos outros fenômenos políticos, taiscomo a dependência, os comitês legislativos e as coalizões multipartidárias