Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic
Rishi SinghalIslam OmarBrijesh MadhokYashasvi RajeevYitka GrahamAbd A. TahraniChristian LudwigTom WigginsKamal MahawarMichał PędziwiatrPiotr MajorPiotr ZarzyckiAthanasios PantelisDimitris P. LapatsanisGeorgios StravodimosChris MatthysMarc FocquetWouter VleeschouwersAntonio SpaventaCarlos ZerrweckAntonio VitielloGiovanna BerardiMario MusellaAlberto Sanchez-MezaFelipe J. CantuFernando de MoraMarco CantùAbhishek KatakwarD. Nageshwar ReddyH ElmalehMohammad HassanAbdelrahman ElghandourMohey ElbannaAhmed OsmanAthar KhanLaurent LayaniNalini KiranAndrey VelikorechinMaria SolovyevaHamid MelaliShahab ShahabiAshish AgrawalApoorv ShrivastavaAnkur SharmaBhavya NarwariaMahendra NarwariaAsnat RazielNasser SakranSergio SusmallianLevent KaragözMurat AkbabaSalih Zeki PişkinAhmet Ziya BaltaZafer ŞenolEmilio MannoMichele IovinoAhmed OsmanMohamed QassemSebastián Arana-GarzaHeitor P. PóvoasMarcos Leão Vilas-BôasAlan LiBasil J. AmmoriHany BalamounMohammed SalmanAmrit Manik NastaRamen GoelHugo Sánchez-AguilarMiguel F. HerreraAdel Abou‐MradLucie CloixGuilherme Silva MazziniLeonardo KristemAndré LázaroJosé Luis CamposJoaquín BernardoJesús Santos GonzálezCarlos TrindadeOctávio ViveirosRui RibeiroDavid GoiteinDavid HazzanLior SegevTamar BeckHernán ReyesJerónimo MonterrubioPaulina GarcíaMarine BenoisRadwan KassirAlessandro ContineMoustafa ElshafeiSueleyman AktasSylvia WeinerTill HeidsieckLuis LevelSilvia PiñangoPatricia Martínez OrtegaRafael MoncadaVíctor ValentíIvan VlahovićZdenko BorasArnaud LiagreF. De MartiniGildas JuglardManish MotwaniSukhvinder Singh SagguHazem Al MomaniLuis Adolfo Aceves LópezMaría Angelina Contreras CortezRodrigo Aceves ZavalaChristine D’HaeseI. KempeneersJacqués HimpensAndréa LazzatiLuca PaolinoSarah BathaeiAbdülkadir BedirliAydın YavuzÇağrı BüyükkasapSafa ÖzaydınAndrzej KwiatkowskiKatarzyna BartosiakMaciej WałędziakAntonella SantonicolaLuigi AngrisaniPaola IovinoRossella PalmaAngelo IossaCristian Eugeniu BoruFrancesco De AngelisGianfranço SilecchiaAbdulzahra HussainSrivinasan BalchandraIzaskun Balciscueta ColtellJavier Lorenzo PérezAshok BohraAltaf AwanBrijesh MadhokPaul LeederSherif AwadWaleed Al‐KhyattAshraf ShomaHosam ElghadbanSameh GhareebBryan MathewsMarina KurianAndreas LarentzakisGavriella Zoi VrakopoulouKonstantinos AlbanopoulosAhemt BozdagAzmi LaleCüneyt KırkılMursid DincerAhmad BashirAshraf HaddadLeen Abu HijlehBruno ZilbersteinDanilo Dallago de MarchiWilly Petrini SouzaCarl Magnus BrodénHjörtur GíslasonKamran ShahAntonio AmbrosiGiovanna PavoneNicola TartagliaS. Lakshmi Kumari KonaK. KalyanCesar Ernesto Guevara PerezMiguel Alberto Forero BoteroAdrian CovicDaniel TimofteMadalina MaximDashti FarajLarissa TsengRonald S. L. LiemGürdal ÖrenEvren Dilektaşlıİlker YalçınHudhaifa AlMukhtarMohammed Al HadadRasmi MohanNaresh Chander AroraDigvijaysingh BediClaire Rives‐LangeJean‐Marc ChevallierTigran PoghosyanHugues SebbagLamia ZinaïSaadi KhaldiCharles MauchienDavide MazzaGeorgiana DinescuBernardo ReaFernando Pérez-GalazLuis ZavalaAnaïs BesaAnna CurellJosé M. BalibreaCarlos VazLuís Fonte GalindoNelson SilvaJosé Luis Estrada CaballeroSergio Ortiz SebastiánJoão Caetano MarchesiniRicardo Arcanjo da Fonseca PereiraWagner Herbert SobottkaFelipe Eduardo FioloMatias TurchiAntonio Cláudio Jamel CoelhoAndre Luis ZacaronAndré Martins BarbosaReynaldo QuininoGabriel MenaldiNicolás PaleariPedro Martinez‐DuartezGabriel Martínez de Aragon Ramírez de EsparzaValentin Sierra EstebanAntonio TorresJosé Luis Garcia-GalochaMiguel JosaJosé Manuel Pacheco-GarcíaMaría Ángeles Mayo-OssorioPradeep ChowbeyVandana SoniHércio Azevedo de Vasconcelos CunhaMichel Victor CastilhoRafael Meneguzzi Alves FerreiraThiago Alvim BarreiroAlexandros CharalabopoulosElias SdralisSpyridon DavakisBenoit BomansGiovanni DapriKoenraad Van BelleMazenTakieddineP VaneukemEsma Seda Akalın KaracaFatih Can KaracaAziz SümerÇağhan PekşenOsman Anıl SavaşElías ChouslebFahad ElmokayedIslam FakhereldinHany Mohamed AboshanabTalal SweliumAhmad GudalLamees GamlooAyushka UgaleSurendra UgaleClara BoekerChristian ReetzIbrahim Ali HakamiJulian W. MallAndreas AlexandrouEfstratia BailiZsolt BodnárAlmantas MaleckasRita GudaitytėCem Emir GüldoğanEmre GündoğduMehmet Mahir ÖzmenDeepti ThakkarNandakishore DukkipatiPoonam ShahShashank ShahSimran Shashank ShahMd Tanveer AdilPeriyathambi JambulingamRavikrishna MamidannaDouglas WhitelawMd Tanveer AdilVigyan JainDeepa Kizhakke VeetilRandeep WadhawanAntonio TorresMax TorresTabata TinocoWouter K. G. LeclercqMarleen M. RomeijnKelly van de PasAli K. AlkhazrajiSafwan A. TahaMurat UstunTaner YiğitAatif InamMuhammad BurhanulhaqAbdolreza PazoukiFoolad EghbaliMohammad KermansaraviAmir Hosein Davarpanah JaziMohsen MahmoudiehNeda MogharehabedGregory G. TsiotosKonstantinos StamouFrancisco J. Barrera RodriguezMarco A. Rojas NavarroOmar MOhamed TorresSergio Lopez MartinezElda Rocio Maltos TamezGustavo A. Millan CornejoJose Eduardo Garcia FloresDiya Aldeen MohammedMohamad Hayssam ElfawalAsim ShabbirKim GuoweiJimmy Bok Yan SoElif Tuğçe KaplanMehmet KaplanTuğba KaplanDangTuan PhamGurteshwar RanaMojdeh S. KappusRiddish GadaniManish KahitanKoshish PokharelAlan G. OsborneDimitri J. PournarasJames HewesErrichetta NapolitanoSonja ChiappettaVincenzo BottinoEvelyn DoradoAxel SchoettlerDaniel GaertnerKatharina FedtkeFrancisco Aguilar‐EspinosaSaul Aceves-LozanoAlessandro BalaniCarlo NagliatiDamiano PennisiAndrea RizziFrancesco FrattiniDiego FoschiLaura BenuzziChirag ParikhHarshil ShahEnrico PinottiMauro MontuoriVincenzo BorrelliJ. DargentCătălin CopăescuIonuţ HutopilăBogdan SmeuBart WittemanEric J. HazebroekLaura N. DedenLaura HeusschenSietske OkkemaTheo AufenackerWillem den HengstWouter VeningYonta van der BurghAhmad GhazalHamza IbrahimMourad NiaziBilal AlkhaffafMohammad AltarawniG CesanaMarco AnselminoMatteo UccelliStefano OlmiChristine StierTahsin AkmanlarThomas SonnenbergUwe SchieferbeinAlejandro MarcoliniDiego AwruchMarco VicentinEduardo Lemos de Souza BastosSamuel Azenha GregorioAnmol AhujaTarun MittalRoel BolckmansTom WigginsClément BaratteJudith Aron WisnewskyLaurent GenserLynn ChongLillian TaylorSalena WardLynn ChongLillian TaylorMichael W. HiHelen HeneghanNaomi FearonAndreas PlamperKarl Peter RheinwaltHelen HeneghanJustin GeogheganKin Cheung NgNaomi FearonKrzysztof KasejaMaciej KotowskiTarig A. SamarkandyAdolfo Leyva‐AlvizoLourdes Corzo-CulebroCunchuan WangWah YangZhiyong DongManel RieraRajesh JainHosam HamedMohammed SaidKatia ZarzarManuel GarciaAhmet Gökhan TürkçaparOzan ŞenE BaldiniLuigi ContiCácio Ricardo WietzycoskiEduardo LopesTadeja PintarJure SalobirCengiz AydınSemra Demirli AtıcıAnıl ErginHüseyin ÇiyiltepeMehmet Abdussamet BozkurtMehmet KızılkayaNezihe Berrin Dodur OnalanMariana Nabila Binti Ahmad ZuberWei Jin WongAmador García Ruiz de GordejuelaLaura VidalMarc BeisaniJorge PasquierRamón VilallongaSharad SharmaChetan ParmarLyndcie LeePratik SufiHüseyin SinanMehmet Bahrı Saydam
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Abstract Background Age ≥ 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort. Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups — patients ≥ 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality. Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 ± 2.5 years, 119.5 ± 24.5 kg, and 43 ± 7 in Group I and 39.8 ± 11.3 years, 117.7±20.4 kg, and 43.7 ± 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 ( p = < 0.001). The 30-day morbidity was significantly higher in Group I (11.4%) compared to Group II (6.6%) ( p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups. Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those ≥ 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups. Graphical abstractKeywords:
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The correct classification of an adverse drug reaction (ADR) as allergy (immunological) or intolerance (non-immunological) has important clinical implications. The aim of this study was to examine the ability of health professionals to discriminate between allergy and intolerance, classify the severity of the ADR and degree of contraindication.Health professionals were presented ten 'real-life' ADR scenarios using an online questionnaire and asked to: categorise the reaction as allergy or intolerance, rate the severity of the reaction and judge the level of contraindication of the causative drug. The number and proportion of responses were calculated for each of the cases presented and associations between classification of reaction type, severity and level of contraindication were examined.A total of 394 responses were received. Overall 59.0% (SD 28.9) correctly categorised the cases, 60.8% (SD 16.8) classified the severity correct, and less than half (44.7%, SD 28.6) correctly identified the level of contraindication. The proportion of health professionals correctly answering the type, severity and level of contraindication for the allergy case was significantly higher (p < 0.0001) by comparison to the intolerance cases (type: 56.6% ± 33.1; severity: 57.3 ± 11.9; level of contraindication: 38.5 ± 19.9).Health professionals have suboptimal understanding of classification of ADRs. Strategies are required to strictly avoid re-exposure of patients to drugs which carry an increased risk of inducing a dangerous reaction, whilst minimising the avoidance of drugs which are of minimal risk or allowing the use of low-risk drugs where the benefits may be significant.
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The literature dealing with the diagnosis and treatment of cervical spine injuries is considerable. Absent, however, are comprehensive criteria guidelines for permitting or prohibiting return to collision activities. The purpose of this report is to describe congenital, developmental, as well a posttraumatic conditions of the cervical spine presenting as either (1) no contraindication, (2) relative contraindication, or (3) an absent contraindication to continue participation in collision activities. In addition to reviewing the relevant concepts of Watkins and White and Panjabi, a comprehensive set of guidelines is presented. Spear tackler's spine, an absolute contraindication to participation in football, is described. Also, recommendations for managing individuals after cervical spine fusion is suggested.
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The literature dealing with the diagnosis and treatment of cervical spine injuries is considerable. Absent, however, are comprehensive criteria or guidelines for permitting or prohibiting return to contact activities. The purpose of this report is to describe congenital, developmental, as well as posttraumatic conditions of the cervical spine as presenting either (a) no contraindication, (b) relative contraindication, or (c) an absolute contraindication to continued participation. In addition to reviewing the relevant concepts of Bailes, Watkins, and White, a comprehensive set of guidelines is presented. In addition, "spear tackler's spine," an absolute contraindication to participation, is described. Also, recommendations for managing individuals following cervical spine fusion are suggested.
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Now the attention of the whole world is focused on the developing pandemic of the coronavirus infection COVID-19. This article discusses mortality patterns of the deadliest epidemic in the last 120 years – the Spanish flu pandemic of 1918. Statistical sources from Italy and the USA, published shortly after the pandemic, were analyzed. The analysis was carried out for mortality from all causes, since in this case inaccuracies associated with establishing the causes of death are minimized. Despite the fact that the first cases of the Spanish flu appeared in the United States as early as March 1918, this first wave of epidemic practically did not affect the total mortality rate. The main peak of mortality in 1918 occurred in October 1918 both in the USA and Italy, with a gradual decrease in mortality over several months. Analysis of age-specific mortality demonstrates a significant increase in mortality at middle ages (20-50 years) in 1918 compared with 1917. Analysis of mortality trends using the method of latent variables shows a significant increase in the background mortality factor in 1918, which turned out to be higher for Italy than the mortality losses during the Second World War. The Spanish flu pandemic differs from the current coronavirus pandemic, because of significant increase in mortality of middle-aged people, while the COVID-19 pandemic causes a more marked increase in mortality among the elderly. With this, the COVID-19 pandemic is more like the recent flu epidemics than the earlier Spanish flu pandemic.
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Chapter 5 presents a case regarding contraindication to lumbar puncture, and discusses coagulation dysfunction, thrombocytopenia with platelet count above 40,000, and transfusion immediately before LP, as well as pharmacological anticoagulation needing to be corrected prior to LP.
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Determining eligibility for a kidney transplant is an important decision. Practice guidelines define contraindications to transplantation; however many are not evidence based. Canadian guidelines recommend that patients unlikely to survive the wait period not be evaluated. The purpose of this study was to evaluate what proportion of patients with a contraindication would survive the wait time.Consecutive incident dialysis patients (January 2006 to December 2012) with a contraindication, defined using Canadian guidelines, were studied. Mortality rates were determined for each individual contraindication. Theoretical survival to the median wait time to transplantation was calculated.Of 746 incident patients, 435 (58 %) were deemed to have a contraindication at dialysis start. Nearly 80 % had a contraindication with a high mortality rate (dementia, multisystem disease, etc.). Patients with high mortality rates were less likely to survive the wait list than be transplanted. Patients with non-adherence, obesity, and potentially reversible disease had relatively low mortality rates, were more likely to survive, and possibly be transplanted at a time with the prospect of a better outcome.This study gives some credence that many patients with a contraindication are not likely to benefit. A better framework of defining contraindications is needed to allow better decision-making.
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In massive pulmonary embolism (PE), fibrinolytic therapy is a potential lifesaving treatment; therefore, if other treatments are not available, the physicians encounter this question: can we accept the risk of complications from fibrinolytic therapy, especially intracranial hemorrhage, in the presence of absolute contraindication, in order to save the patient's life? Here, we describe three cases of massive PE with absolute contraindication for fibrinolytic therapy who presented to emergency department following dyspnea. Since, surgical or catheter embolectomy were not available and patients were very high risk for transferring to another hospital, systemic fibrinolytic was administered. The patients improved clinically and were discharged from hospital. It seems that, if no other acceptable treatments are available, physicians could consider fibrinolytic therapy, even at the presence of contraindication, to save the patient's life.
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