Effect of high-risk factors on postoperative major adverse cardiovascular and cerebrovascular events trends following bariatric surgery in the United States from 2012 to 2019.

BACKGROUND: Recent examination of trends in postoperative major adverse cardiovascular and cerebrovascular events (MACE) following bariatric surgery, including accredited and nonaccredited centers, and the factors affecting those trends, is lacking. OBJECTIVES: The objective of this study was to evaluate current trends for postoperative MACE after bariatric surgery in both accredited and nonaccredited centers and the factors affecting these trends. SETTING: This retrospective study was conducted using National Inpatient Sample database from 2012 to 2019. METHODS: All patients who underwent inpatient laparoscopic sleeve gastrectomy (LSG), open sleeve gastrectomy (SG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and open Roux-en-Y gastric bypass (RYGB) were examined. Composite MACE (acute myocardial infarction, cardiac arrest, acute stroke, and in-hospital death during bariatric surgery hospitalization) was calculated and analyzed over time along with patient demographic and co-morbid diseases using survey-weighted logistic regression. RESULTS: MACE incidence was lowest for LSG (0.07%), followed by LRYGB (0.16%), SG (3.47%), and RYBG (3.51%). Open procedure, increasing age, male sex, body mass index ≥50, coronary artery disease, congestive heart failure, and chronic kidney disease were independent predictors for increased MACE risk. MACE incidence increased over time for SG (odds ratio [OR] 1.25 [1.16, 1.34]; P < .0001) and RYGB (OR 1.14 [1.06, 1.22]; P = .0004) but decreased for LRYGB (OR 0.93 [0.87, 1] P = .06). After adjustment for high-risk covariates, increased MACE trend seen over time was attenuated in SG (OR 1.13 [1.04-1.22]; P = .005) and RYGB (OR 1.04 [0.96-1.12]; P = .36), while there was minimal effect of these high-risk covariates on MACE trend over time in LSG and LRYGB. CONCLUSIONS: MACE following LSG and LRYGB is rare, occurring in 0.1% of patients. Persistently increasing high-risk conditions and demographics has had minimal effect on MACE over time for LSG and LRYGB but has had significant effect on MACE trend over time in SG and RYGB.

A Comprehensive Review of the Neurological Manifestations of Celiac Disease and Its Treatment.

Celiac disease (CD) is a common chronic inflammatory disorder occurring in genetically predisposed individuals secondary to gluten ingestion. CD usually presents with gastrointestinal symptoms such as pain, bloating, flatulence, and constipation or diarrhea. However, individuals can present in a nonclassical manner with only extraintestinal symptoms. The neurological manifestations of CD include ataxia, cognitive impairment, epilepsy, headache, and neuropathy. A lifelong gluten-free diet is the current recommended treatment for CD. This review discusses the relevant neurological manifestations associated with CD and the novel therapeutics. Further research is required to get a better understanding of the underlying pathophysiology of the neurological manifestations associated with CD. Clinicians should keep CD in the differential diagnosis in individuals presenting with neurological dysfunction of unknown cause.

Ambivalent participation: sex, power, and the anthropologist in Mozambique.

Participation in young peoples' sexual cultures in Maputo, Mozambique led to reflections about the field dynamics of power, participation, desire, and discomfort. Structural inequalities of race, gender, and educational status resulted in informants seeing me as a morally righteous person to whom they could not give open accounts about sexual practice. Attempting to overcome these barriers, I participated in excessive nightlife activities, and as a consequence they began viewing me as a more accepting and reliable person. Although breaking down these barriers provided invaluable insight into their sexual culture, it also caused anxiety and troubling desires vis-à-vis informants. I discuss how anthropologists, through fieldwork are transformed from powerful seducers of informants to objects of informants' seduction. This creates dilemmas for the anthropologist whose fieldwork depends on informants' continued participation. I show how negotiating the risks of participation may simultaneously satisfy the desire for knowledge and curb erotic desires.

Safe sex pioneers: class identity, peer education and emerging masculinities among youth in Mozambique.

Studies on sexual behaviour within the area of HIV prevention in sub-Saharan Africa have largely focussed on unsafe sex and obstacles to condom use rather than examined factors potentially favouring safe sex. The present study examines how class, gender and peer education affects safe sex in male youth and identifies the reasons behind condom use by combining a questionnaire survey with ethnographic fieldwork. Findings from the field study among male secondary school youth in Maputo, Mozambique point to middle class youth from urban schools as more likely to use condoms than working class youth from suburban schools. Examining the meanings behind use or non-use of condoms the study identified narratives in middle class youth favouring safe sex in response to better social conditions, career opportunities and 'modern' masculinities, whereas working class youth explained non-use of condoms as due to lack of hope and job opportunities and by reference to fatalist ideas that life is out of their hands and that it's better to 'live in the moment'.

Health discourse, sexual slang and ideological contradictions among Mozambican youth: implications for method.

Despite the urgency of improving an understanding of sexual cultures in the face of a globally devastating HIV epidemic, methodological reflection and innovation has been conspicuously absent from qualitative research in recent years. Findings from fieldwork on condom use among young people in Mozambique confirm the need to remain alert to the ideological and linguistic bias of applied methods. Interviewing young people about their sexuality using a conventional health discourse resulted in incorrect or socially acceptable answers rather than accurate information about their sexual behaviour. Young people's resistance to enquiry, the paper argues, is due to ideological contradictions between their sexual culture and slang, on the one hand, and Western health discourses associated with colonial and post-colonial opposition to traditional culture and languages, on the other. Mixing colloquial Portuguese and changana sexual slang is constructed around ideas of safedeza and pleasure, while dominant health discourses address sexuality as both 'risky' and 'dangerous'. In order to gain a deeper understanding of sexual cultures and to make HIV prevention efforts relevant to young people, it is suggested that researchers and policy makers approach respondents with a language that is sensitive to the local ideological and linguistic context.