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  • Esophageal and Gastric Malignancies After Bariatric Surgery: a Retrospective Global Study
    Publication . Parmar, C; Zakeri, R; Abouelazayem, M; Shin, T; Aminian, A; Mahmoud, T; Abu Dayyeh, B; Wee, M; Fischer, L; Daams, F; Mahawar, K; Gallardo, C; Agustin, C; Wright, F; Fuente, I; Carbajo, M; Cal, P; Chisholm, J; Kow, L; Tan, M; Gan, P; Gananadha, S; Felsenreich, D; Prager, G; Matthys, C; Himpens, J; Focquet, M; Ramos, A; Nato, M; Vidal, T; Andalib, A; Siblini, A; Ferri, L; Abdarabo, L; Nevo, Y; Pescarus, R; Yang, W; Hamed, H; Liagre, A; Bergeat, D; Marie, De M; Martini, F; Regis, F; Genser, L; Skalli, M; Nedelcu, M; Smejkal, M; Kassir, R; Nicolas, R; Stier, C; Nedelcut, DS; Christodoulidis, G; Vennapusa, A; Kermansaravi, M; Raziel, A; Sakran, N; Oldani, A; Boru, C; Mécheri, F; Ciccarese, F; Cesana, G; Musella, M; Uccelli, M; Foletto, M; Auricchio, P; Olmi, S; Seki, Y; Kasteleijn, A; Van 'T Hof, G; Apers, J; Hart, J; Van De Sande, J; Takkenberg, M; Feskens, P; Snoekx, R; Plat, V; Sandvik, J; Kalinowski, P; Nabais, C; Al-Bahrani, A; Al Zoubi, M; Bettonica, C; Osorio, J; Tejedor-Tejada, J; Sanz, L; Cuadrado, M; Moorjani, R; Yannick, F; Suter, M; Borbély, Y; Joerg, Z; Barajas-Gamboa, J; Kroh, M; Kisiel, A; Kamocka, A; Immanuel, A; Sgromo, B; Gopinath, B; Khoo, D; Mukherjee, S; Pournaras, D; Underwood, T; Griffiths, E; Miller, G; Jaretzke, H; Dmitrewski, J; Wadley, M; Al-Housni, R; Gillies, R; Singhal, R; Preston, S; Robinson, S; Hawkins, W; Adamo, M; El Kalaawy, M; Gossage, J; Crawford, C; Jaruvongvanich, V
    Background: Bariatric surgery can influence the presentation, diagnosis, and management of gastrointestinal cancers. Esophagogastric (EG) malignancies in patients who have had a prior bariatric procedure have not been fully characterized. Objective: To characterize EG malignancies after bariatric procedures. Setting: University Hospital, United Kingdom. Methods: We performed a retrospective, multicenter observational study of patients with EG malignancies after bariatric surgery to characterize this condition. Results: This study includes 170 patients from 75 centers in 25 countries who underwent bariatric procedures between 1985 and 2020. At the time of the bariatric procedure, the mean age was 50.2 ± 10 years, and the mean weight 128.8 ± 28.9 kg. Women composed 57.3% (n = 98) of the population. Most (n = 64) patients underwent a Roux-en-Y gastric bypass (RYGB) followed by adjustable gastric band (AGB; n = 46) and sleeve gastrectomy (SG; n = 43). Time to cancer diagnosis after bariatric surgery was 9.5 ± 7.4 years, and mean weight at diagnosis was 87.4 ± 21.9 kg. The time lag was 5.9 ± 4.1 years after SG compared to 9.4 ± 7.1 years after RYGB and 10.5 ± 5.7 years after AGB. One third of patients presented with metastatic disease. The majority of tumors were adenocarcinoma (82.9%). Approximately 1 in 5 patients underwent palliative treatment from the outset. Time from diagnosis to mortality was under 1 year for most patients who died over the intervening period. Conclusion: The Oesophago-Gastric Malignancies After Obesity/Bariatric Surgery study presents the largest series to date of patients developing EG malignancies after bariatric surgery and attempts to characterize this condition.
    2022-04Journal article Open access Show more
  • First Trimester Examination of Fetal Anatomy: Clinical Practice Guideline by the World Association of Perinatal Medicine (WAPM) and the Perinatal Medicine Foundation (PMF)
    Publication . Volpe, N; Sen, C; Turan, S; Sepulveda, W; Khalil, A; Rolnik, D; De Robertis, V; Volpe, P; Gil, M; Chaveeva, P; Dagklis, T; Pooh, R; Kosinski, P; Cruz, J; Huertas, E; D’ Antonio, F; Rodriguez Calvo, J; Daneva Markova, A
    This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for precise standardization to implement the ultrasound evaluation of the fetus in the first trimester of pregnancy and improve the early detection of anomalies and the clinical management of the pregnancy. The aim is to present a document that includes statements and recommendations on the standard evaluation of the fetal anatomy in the first trimester, based on quality evidence in the peer-reviewed literature as well as the experience of perinatal experts around the world.
    2022-04Journal article Open access Show more
  • Not All Pseudoaneurysms Are Femoral. A Transcaval Transcatheter Aortic Valve Replacement Rare Complication
    Publication . Mano, T; Ramos, R; Cacela, D; Patrício, L
    We report a case of a 73-year-old male with multiple comorbidities, including postpoliomyelitis severe scoliosis, referred to our tertiary center due to a severe symptomatic aortic stenosis, considered high risk for surgical aortic valve replacement (AVR). Due to unsuitable femoral and subclavian accesses, the patient underwent a transcaval transcatheter AVR (TAVR) procedure, complicated by the development of an iatrogenic infrarenal aortic pseudoaneurysm with aortocaval fistula. Scoliosis can cause varying anatomic relationships between retroperitoneal vessels and intervertebral disk spaces, which increase the difficulty of the procedure and consequently lead to this vascular complication. Although most aortocaval fistulas close spontaneously after 1 year, the risk of pseudoaneurysm rupture in this critical area was crucial in the decision of a new successful percutaneous aortic stent intervention.
    2022-04Journal article Open access Show more
  • HIV-1-Transmitted Drug Resistance and Transmission Clusters in Newly Diagnosed Patients in Portugal Between 2014 and 2019
    Publication . Pingarilho, M; Pimentel, V; Miranda, M; Silva, AR; Diniz, A; Ascenção, B; Piñeiro, C; Koch, C; Rodrigues, C; Caldas, C; Morais, C; Faria, D; Gomes da Silva, E; Teófilo, E; Monteiro, F; Roxo, F; Maltez, F; Rodrigues, F; Gaião, G; Ramos, H; Costa, I; Germano, I; Simões, J; Oliveira, J; Ferreira, J; Poças, J; Saraiva da Cunha, J; Soares, J; Henriques, J; Mansinho, K; Pedro, L; Aleixo, MJ; Gonçalves, MaJ; Manata, MJ; Mouro, M; Serrado, M; Caixeiro, M; Marques, N; Costa, O; Pacheco, P; Proença, P; Rodrigues, P; Pinho, R; Tavares, R; Correia de Abreu, R; Côrte-Real, R; Serrão, R; Sarmento e Castro, R; Nunes, S; Faria, T; Baptista, T; Martins, MR; Gomes, P; Mendão, L; Simões, D; Abecasis, A
    Objective: To describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks. Methods: Clinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses. Results: In Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (p for-trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G. Conclusion: Our molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.
    2022-04Journal article Open access Show more
  • Increased 30-Day Mortality in Very Old ICU Patients with COVID-19 Compared to Patients with Respiratory Failure without COVID-19
    Publication . Guidet, B; Jung, C; Flaatten, H; Fjølner, J; Artigas, A; Bollen Pinto, B; Schefold, J; Beil, M; Sigal, S; Vernon van Heerden, P; Szczeklik, W; Joannidis, M; Oeyen, S; Kondili, E; Marsh, B; Andersen, F; Moreno, R; Cecconi, M; Leaver, S; De Lange, D; Boumendil, A; Eller, P; Joannidis, M; Mesotten, D; Reper, P; Oeyen, S; Swinnen, W; Brix, H; Brushoej, J; Villefrance, M; Nedergaard, H; Bjerregaard, A; Balleby, I; Andersen, K; Hansen, M; Uhrenholt, S; Bundgaard, H; Fjølner, J; Hussein, A; Salah, R; Ali, Y; Wassim, K; Elgazzar, Y; Tharwat, S; Azzam, A; Habib, A; Abosheaishaa, H; Azab, M; Leaver, S; Galbois, A; Urbina, T; Charron, C; Guerot, E; Besch, G; Rigaud, JP; Maizel, J; Djibré, M; Burtin, P; Garcon, P; Nseir, S; Valette, X; Alexandru, N; Marin, N; Vaissiere, M; Plantefeve, G; Vanderlinden, T; Jurcisin, I; Megarbane, B; Caillard, A; Valent, A; Garnier, M; Besset, S; Oziel, J; Raphalen, J; Dauger, S; Dumas, G; Goncalves, B; Piton, G; Barth, E; Goebel, U; Barth, E; Kunstein, A; Schuster, M; Welte, M; Lutz, M; Meybohm, P; Steiner, S; Poerner, T; Haake, H; Schaller, S; Schaller, S; Schaller, S; Kindgen-Milles, D; Meyer, C; Kurt, M; Kuhn, K; Randerath, W; Wollborn, J; Dindane, Z; Kabitz, H; Voigt, I; Shala, G; Faltlhauser, A; Rovina, N; Aidoni, Z; Chrisanthopoulou, E; Papadogoulas, A; Gurjar, M; Mahmoodpoor, A; Ahmed, A; Marsh, B; Elsaka, A; Sviri, S; Comellini, V; Rabha, A; Ahmed, H; Namendys-Silva, S; Ghannam, A; Groenendijk, M; Zegers, M; de Lange, D; Cornet, A; Evers, M; Haas, L; Dormans, T; Dieperink, W; Romundstad, L; Sjøbø, B; Andersen, F; Strietzel, H; Olasveengen, T; Hahn, M; Czuczwar, M; Gawda, R; Klimkiewicz, J; Santos, ML; Gordinho, A; Santos, H; Assis, R; Oliveira, AI; Badawy, M; Perez-Torres, D; Gomà, G; Villamayor, M; Mira, A; Cubero, P; Rivera, S; Tomasa, T; Iglesias, D; Vázquez, E; Aldecoa, C; Ferreira, A; Zalba-Etayo, B; Canas-Perez, I; Tamayo-Lomas, L; Diaz-Rodriguez, C; Sancho, S; Priego, J; Abualqumboz, E; Hilles, M; Saleh, M; Ben-Hamouda, N; Roberti, A; Dullenkopf, A; Fleury, Y; Pinto, B; Schefold, J; Al-Sadaw, M
    Purpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods: Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results: 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion: Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear.
    2022-04Journal article Open access Show more
  • Presence of Multilobular Necrosis on Liver Biopsy Identifies Corticosteroid Responsiveness in Acute Indeterminate Hepatitis
    Publication . Lin, S; Araújo, C; Hall, A; Kumar, R; Phillips, A; Hassan, M; Engelmann, C; Quaglia, A; Jalan, R
    Background and aims: Treatment of patients with severe indeterminate hepatitis (IAH) is an unmet need. Corticosteroids are often used in the management of these patients but criteria for the selection of patients for this intervention are arbitrary. The aims of this study were to analyse the clinical and pathological features of patients with IAH to define predictors of corticosteroid responsiveness. Methods: This study included consecutive patients with acute indeterminate hepatitis admitted to a single hospital and underwent a liver biopsy. The clinical manifestation and histopathological features of steroid and non-steroid groups were compared and their relationship with corticosteroids response was evaluated. Results: Forty-eight patients were included, 24 (50%) recovered and the other half underwent liver transplantation or died within 3-months. Of the 48 cases, 24 received corticosteroids (initial dose of 45 ± 12 mg prednisolone). Corticosteroids were initiated 2.7 ± 3.8 days after admission. Liver biopsy was performed 2-days (median, IQR 1-3) after admission. Fifteen (62.5%) patients receiving corticosteroids survived without transplantation compared with 9 (37.5%) that did not receive steroids (P = .149). In those with multilobular necrosis, 50% reduction in the death/transplantation rate was observed after steroid treatment (P = .018). In patients without multilobular necrosis and with or without perivenulitis, corticosteroids did not impact the outcome. Response to corticosteroids was independent of the MELD score. Conclusions: The presence of multilobular necrosis on liver biopsy helps identify a subgroup of IAH cases who may benefit from the administration of corticosteroids.
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