ABSTRACT
This systematic review aims to compare the accuracy of pre-existent scores predicting diabetes remission after bariatric and metabolic surgery. Among the scores, DiaBetter presented the largest area under the curve (AUC) (0.87; 95% CI, 0.84-0.9). Ad-DiaRem had the lowest AUC (0.79; 95% CI, 0.76-0.83). Ad-DiaRem showed the highest sensitivity (91%; 95% CI, 86-96%), with a specificity of 71.23% (95% CI 50.43 to 92.06%). IMS showed a sensitivity of 59% (95% CI, 20-90%), with the highest specificity (86%; 95% CI, 69-94%). Clinicians should associate the findings of the present review with patients' individual characteristics to help predict diabetes remission and evaluate the probability of the patient benefit from surgery.
Subject(s)
Bariatric Surgery , Diabetes Mellitus, Type 2 , Gastric Bypass , Obesity, Morbid , Humans , Treatment Outcome , Obesity, Morbid/surgery , Diabetes Mellitus, Type 2/surgery , Retrospective Studies , Remission InductionABSTRACT
BACKGROUND: Achalasia and other esophageal dysmotility disorders mimicking achalasia can be associated with cancer. This study aimed to review the main mechanisms for which cancer may develop in esophageal dysmotility disorder patients. METHODS: A narrative review was performed. RESULTS: The mechanism for developing squamous cell carcinoma and adenocarcinoma are discussed. Besides, achalasia-like syndromes related to familial KIT-gene mutation and pseudoachalasia are discussed. CONCLUSIONS: Knowing the main mechanism for which achalasia can be related to cancer is essential for clinicians to conduct the proper investigation, surveillance, and treatment.
Subject(s)
Adenocarcinoma , Carcinoma, Squamous Cell , Esophageal Achalasia , Esophageal Motility Disorders , Esophageal Neoplasms , Adenocarcinoma/complications , Esophageal Achalasia/diagnosis , Esophageal Motility Disorders/complications , Esophageal Neoplasms/diagnosis , HumansABSTRACT
BACKGROUND: Corrosive ingestion is a significant challenge for healthcare systems. Limited data are available regarding the best treatments, and there remains a lack of consensus about the optimal surgical approach and its outcomes. This study aims to review the current literature and show a single institution's experience regarding the surgical treatment of esophageal stenosis due to corrosive substance ingestion. METHODS: A retrospective review that accounted for demographics, psychiatric profiles, surgical procedures, and outcomes was performed. A systematic review of the literature was performed using PubMed. RESULTS: In total, 27 surgical procedures for esophageal stenosis due to corrosive substance ingestion were performed from 2010 to 2019. Depression and drug abuse were diagnosed in 30% and 22% of the included patients, respectively. Esophagectomies and esophageal bypasses were performed in 13 and 14 patients, respectively. No 30-day mortality was recorded. CONCLUSION: Surgical intervention either by esophagectomy or esophageal bypass results in durable relief from dysphagia. However, successful clinical outcomes depend on a high-quality multidisciplinary network of esophageal and thoracic surgeons, intensivists, psychologists, psychiatrists, and nutritional teams.
Subject(s)
Burns, Chemical/therapy , Caustics/poisoning , Esophageal Stenosis/therapy , Esophagectomy/statistics & numerical data , Self-Injurious Behavior/therapy , Behavior Therapy , Burns, Chemical/etiology , Burns, Chemical/mortality , Burns, Chemical/psychology , Depression/complications , Depression/epidemiology , Depression/psychology , Depression/therapy , Esophageal Stenosis/chemically induced , Esophageal Stenosis/mortality , Esophageal Stenosis/psychology , Esophagus/pathology , Esophagus/surgery , Humans , Nutritional Support , Patient Care Team , Risk Factors , Self-Injurious Behavior/etiology , Self-Injurious Behavior/mortality , Self-Injurious Behavior/psychology , Substance-Related Disorders/complications , Substance-Related Disorders/etiology , Substance-Related Disorders/psychology , Substance-Related Disorders/therapy , Treatment OutcomeABSTRACT
BACKGROUND: Governments have implemented social distancing interventions to curb the speed of SARS-CoV-2 spread and avoid hospital overload. SARS-CoV-2 social distancing interventions have modified several aspects of society, leading to a change in the emergency medical visit profile. OBJECTIVE: To analyze the impact of COVID-19 and the resulting changes on the non-SARS-CoV-2 emergency medical care system profile. METHODS: This is a retrospective multicenter cross-sectional study evaluating medical consultations, urgent hospitalizations, and deaths in São Paulo, the largest city of the Americas. Changes in the medical visit profile according to demographic data and diagnoses were assessed. The change in mortality was also assessed. RESULTS: A total of 462,412 emergency medical visits were registered from January 2019 to July 2020. Of these emergency medical visits, only 4.7% (21,653) required hospitalization. Of all visits, 592 resulted in deaths, equivalent to 0.1% of the sample. There was a clear decreasing trend in the number of weekly emergency medical visits as social distancing was mandated by decree (Coef. -3733.13; 95% CI -4579.85 to -2886.42; p < 0.001). The number of medical visits for conditions such as trauma, abdominal pain, chest pain, and the common cold decreased (p<0.05). However, the number of medical visits for the following conditions did not change after the onset of the pandemic (p≥0.05): ureterolithiasis, acute appendicitis, acute cholecystitis, acute myocardial infarction, and stroke. CONCLUSION: The COVID-19 pandemic has changed the non-SARS-CoV-2 emergency profile. The overall number of emergency medical visits has reduced. The mortality of non-SARS-CoV-2 emergencies has not increased in São Paulo.
