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1.
Surg Obes Relat Dis ; 2022.
Article in English | PubMed | ID: covidwho-2211458

ABSTRACT

BACKGROUND: During the past 2.5 years, select bariatric surgeons in the Commonwealth of Massachusetts have been implementing same-day sleeve gastrectomy (SDSG). Key reasons for this change have been to reduce risks associated with hospitalization in the context of the COVID-19 pandemic and to comply with third-party payer preference to reduce costs. OBJECTIVE: We aimed to evaluate bariatric surgeons' attitudes about outcomes and morbidity between patients who are hospitalized after sleeve gastrectomy and patients who undergo SDSG. SETTING: Beth Israel Deaconess Medical Center in Boston, Massachusetts (teaching hospital of Harvard Medical School). METHODS: This prospective cohort study was conducted among bariatric surgeons practicing in the Commonwealth of Massachusetts. An anonymous web-based questionnaire was distributed using the Research Electronic Data Capture software. A total of 58 bariatric surgeons in Massachusetts were identified and successfully contacted based on registration with the Massachusetts Board of Registration in Medicine, membership in the American Society for Metabolic and Bariatric Surgery, and internet search. RESULTS: A total of 33 bariatric surgeons in Massachusetts completed the survey, yielding a response rate of 56.9%. Among the respondents, 75.76% have not performed SDSG, reporting patient safety as the major concern, and 24.24% had performed SDSG in the past. CONCLUSION: Survey responses showed no significant differences in surgeon perception between SDSG and hospitalization after surgery. Optimal patient selection was an important factor influencing surgeons' decisions with regard to performing SDSG. However, bariatric surgeons in Massachusetts are reluctant to perform SDSG.

2.
Obesity Surgery. ; 2023.
Article in English | EMBASE | ID: covidwho-2174910

ABSTRACT

: Purpose: Applying eHealth interventions via social media is common in modern medicine. LINE is a popular communication app in Taiwan that can deliver messages 24 h a day. In addition to being free of charge, it also allows bariatric nurses (BNs) and patients to enjoy bidirectional communication via telecommunication services instead of direct, face-to-face contact for patients undergoing bariatric-metabolic surgery (BMS). We conducted this retrospective study to determine the frequency and reasons for early post-discharge of LINE messages/calls and investigate the relationship between this frequency and contents of these messages and postoperative outcomes after BMS. Material(s) and Method(s): A retrospective review of prospectively collected data was conducted in an Asian weight management center. The study period ran from August 2016 to December 2021, and a total of 143 native patients with severe obesity were enrolled. All patients were informed of the necessity of a postoperative dietitian consultation before bariatric surgery. The patterns of LINE communication with the BN and associated actions to resolve patients' needs within 180 days after index BMS were analyzed. Result(s): Among the 143 enrolled patients, 100 underwent laparoscopic sleeve gastrectomy and 43 underwent laparoscopic Roux-en-Y gastric bypass. A total of 1205 messages/calls were analyzed concomitantly;most LINE communications focused on diet problems (47.97%;n = 578), weight problems (11.54%;n = 139), and medications (9.21%;n = 111). Most problems could be resolved by LINE communications directly, and only a small portion (5.6%) was directed to local clinics or emergency departments. During the COVID-19 pandemic, the usage of LINE communications significantly increased (12.2 +/- 10.4 vs. 6.4 +/- 4.9;p < 0.01);nonetheless, a higher frequency of LINE communications would not hinder the regular clinic visits (r = 0.359;p = 0.01). Conclusion(s): Based on our limited experience, the LINE consultation service operated by the BN could effectively address patients' problems. Moreover, it might reduce the need for emergency department visits or unexpected clinic appointments for patients after BMS. Graphical : [Figure not available: see fulltext.]. Copyright © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

3.
Obes Surg ; : 1-10, 2022.
Article in English | Web of Science | ID: covidwho-2174909

ABSTRACT

BACKGROUND: Effects of the COVID-19 pandemic on rates of early postoperative follow-up after bariatric surgery are poorly understood. Our study characterizes 30-day follow-up after bariatric surgery prior to COVID-19 (years 2015-2019) and during the pandemic of COVID-19 (year 2020) and evaluates general predictive factors of short-term follow-up. METHODS: Data was extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015 to 2020. Cohorts were divided into pre-pandemic and pandemic years and patients with and without 30-day follow-up. Multivariable logistic regression analysis was used to identify general factors independently predictive of 30-day follow-up. The primary aim was to evaluate the impact of the COVID-19 pandemic on short-term 30-day follow-up adherence. A secondary outcome was to characterize general short-term postoperative 30-day follow-up associated with elective bariatric surgery and identify independent predictors of 30-day follow-up among bariatric surgery patients using multivariable logistic regression analysis. RESULTS: A total of 834,646 patients were identified. Follow-up rates significantly increased in the COVID era in 2020 (p < 0.0001). Patients who achieved 30-day follow-up were older and had an increased burden of medical comorbidities, including non-insulin and insulin-dependent diabetes mellitus, hypertension, dyslipidemia, as well as increased BMI compared to patients lacking follow-up. The cohort with successful 30-day follow-up was more likely to receive gastric bypass and had increased rates of metabolic comorbidities. After adjusting for comorbidities, the greatest independent predictors of follow-up were the 2020 COVID-19 era year, Asian race, black race, and gastroesophageal reflux disease. CONCLUSIONS: After adjusting for comorbidities, the 2020 COVID-19 era year was one of the greatest predictors of follow-up after bariatric surgery. Postoperative follow-up rates after elective bariatric surgery are excellent at > 95% and increased during the 2020 COVID-19 era year. Several independent predictors of follow-up were identified which may help in development of strategies aimed to mitigate lack of postoperative follow-up.

4.
Obesity Science and Practice. ; 2022.
Article in English | EMBASE | ID: covidwho-2173330

ABSTRACT

Background: The first year of the Covid-19 pandemic saw drastic changes to bariatric surgical practice, including postponement of procedures, altered patient care and impacting on the role of bariatric surgeons. The consequences of this both personally and professionally amongst bariatric surgeons has not as yet been explored. Aim(s): The aim of this research was to understand bariatric surgeons' perspectives of working during the first year of the pandemic to explore the self-reported personal and professional impact. Method(s): Using a retrospective, two phased, study design with global participants recruited from closed, bariatric surgical units. The first phase used a qualitative thematic analytic framework to identify salient areas of importance to surgeons. Themes informed the construction of an on-line, confidential survey to test the potential generalizability of the interview findings with a larger representative population from the global bariatric surgical community. Finding(s): Findings of the study revealed that the first year of the pandemic had a detrimental effect on bariatric surgeons both personally and professionally globally. Conclusion(s): This study has identified the need to build resilience of bariatric surgeons so that the practice of self-care and the encouragement of help-seeking behaviors can potentially be normalized, which will in turn increase levels of mental health and wellbeing. Copyright © 2022 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.

5.
Diabetes Care ; 46:S49-S67, 2023.
Article in English | EMBASE | ID: covidwho-2198236

ABSTRACT

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. Copyright © 2022 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www. diabetesjournals.org/journals/pages/license.

6.
British Journal of Surgery ; 109(Supplement 9):ix3, 2022.
Article in English | EMBASE | ID: covidwho-2188318

ABSTRACT

Background: The availability and popularity of bariatric and metabolic surgery (BMS) continues to increase worldwide and in turn so do the resources allocated to it. The last NBSR report (2020) demonstrated that 70% of patients were discharged on the second postoperative day and 80% left after the third day. An amended protocol was implemented within our Trust switching from a 2-3 night stay and reducing this to a planned one-night stay for a more efficient service. This review evaluates the safety and efficacy of a one-night stay protocol. Method(s): All patients undergoing BMS between two sets of dates were retrospectively identified from our local database, pre and post protocol change. Group A (old protocol, July-December '19) and Group B (one-night stay protocol, July '20-July '21). Group B capture time was extended due to smaller numbers due to COVID. Data gathered included: Patient demographics (Age, Gender, ASA, Weight, BMI);operation;length of stay (LOS);30-day complications, 30-day mortality, and 30-day readmission rates. Descriptive statistics and Chi-squared test were used to analyse results. Result(s): Group A had 94 patient and Group B 149 patients. Patient demographics, weight and ASA were similar in both groups. There were significantly more RYGB in Group A whilst more OAGBs and sleeves in Group B: RYGB;(48[51%] vs. 30[20%]), OAGB;(32[34%] vs. 80[53%]), Sleeve;(13[14%] vs. 36[24%]). Median LOS reduced from 3 days to 1 day and mean LOS 3.2 days to 1.3 days. In Group B, 115 patients (77%) were discharged on post-operative day 1 vs. 18 (19%) in Group A. In the 34 (23%) of patients that required stay beyond day 1 in Group B the most common reason was post-operative nausea and vomiting (n=8). Other frequent reasons were pain (n=5), low urine output/AKI (n=5) and not tolerating oral diet (n=4). There were no statistically significant differences between groups for 30-day complication (6[6%] vs. 5[3%] p=0.4) or re-admission (4[4%] vs. 8[5%] p=0.9) rates. In sub-group analysis, there was no difference between operation type and LOS/complication rates. In a review of the readmissions, it was not felt any were avoidable and only 1/8 readmissions were within 48h of discharge - this patient already had an extended admission. Conclusion(s): This study demonstrated that a planned one-night stay following BMS is both safe and effective;facilitating early patient discharges whilst having the necessary safety netting steps for those who require a require an extended period in hospital. The next step would be to explore the safety of day case surgery for selected patients undergoing sleeve gastrectomy.

7.
Obesity Surgery ; 32(SUPPL 4):1161-1162, 2022.
Article in English | Web of Science | ID: covidwho-2168558
8.
Journal of Psychosomatic Research ; 165:111144, 2023.
Article in English | ScienceDirect | ID: covidwho-2165632

ABSTRACT

Objective The COVID-19 pandemic has caused a global health crisis disrupting healthcare delivery for people with severe obesity who have undergone bariatric surgery. This study examined the role of psychological distress during the first Italian COVID-19 lockdown in predicting post-operative outcomes in post-bariatric patients reaching the end of the 12–18 months follow-up during the lockdown. By using a person-centered approach, groups of patients with different psychological distress profiles were identified. We hypothesized that compared to post-bariatric patients with low psychological distress, post-bariatric patients with high psychological distress will be more at risk of weight regain. Methods A total of 67 patients (71.6% female, Mage = 45.9) participated in this observational retrospective cohort study. Patients' anthropometric data were gathered from medical records while the weight at the end of the lockdown through phone interviews. Psychological distress, operationalized with anxiety symptoms, depressive symptoms, and sleep disturbances, was assessed by an online self-report questionnaire. Results Significant differences were highlighted in the high and low psychological distressed group in weight changes, F(1,58) = 5.2, p < 0.001, η2 = 0.3. Specifically, compared to post-bariatric patients in the low psychological distress group, those in the high psychological distressed group reported weight regained (95% CI = 1.0, 2.6). Conclusion Results highlight the need to target post-bariatric patients with high psychological distress who are at risk for weight regain during the COVID-19 pandemic. Interventions mitigating psychological distress and obesogenic behaviors during future pandemics or in post-COVID times are needed in vulnerable post-bariatric patients reporting high psychological distress.

9.
J Pers Med ; 12(10)2022 Sep 20.
Article in English | MEDLINE | ID: covidwho-2163484

ABSTRACT

BACKGROUND: Obesity is a multifactorial chronic disease involving multiple organs, devices, and systems involving important changes in the stomatognathic system, such as in the orofacial muscles, temporomandibular joint, cheeks, nose, jaw, maxilla, oral cavity, lips, teeth, tongue, hard/soft palate, larynx, and pharynx. Patients with obesity indicated for bariatric surgery reportedly presented with abnormalities in the structures and function of the stomatognathic apparatus. This occurs through the accumulation of adipose tissue in the oral cavity and pharyngeal and laryngeal regions. Therefore, this systematic review aimed to elucidate the changes occurring in the stomatognathic system of patients with obesity after undergoing bariatric surgery. METHOD: Information was searched based on the equations developed with the descriptors obtained in DECS and MESH using the PRISMA methodology. Studies published between 2010 and October 2021 in databases including PubMed, ProQuest, Scielo, Dialnet, EBSCO, and Springer Link were considered. RESULTS: Eighty articles met the inclusion criteria after evaluating the articles, thereby allowing for the determination of the morphophysiological correlation of the stomatognathic system with the population studied. At the morphological or structural level, changes were observed in the face, nose, cheeks, maxilla, jaw, lips, oral cavity, teeth, tongue, palate, temporomandibular joint, neck, muscles, head, shoulders, larynx, and pharynx. At the morphological level, the main changes occurred in, and the most information was obtained from, the labial structures, teeth, muscles, pharynx, and larynx. Physiological changes were in breathing, phonation, chewing, and swallowing, thereby revealing the imbalance in basic and vital functions. CONCLUSIONS: Analyzing the changes and structures of obese patients and candidates for bariatric surgery revealed that, in the preoperative period, the evidence is clear owing to the presence of a wide range of information. However, the information is more limited regarding the postoperative period; thus, further research focusing on characterization of the system postoperatively is warranted.

10.
Front Endocrinol (Lausanne) ; 13: 962090, 2022.
Article in English | MEDLINE | ID: covidwho-2141735

ABSTRACT

Introduction: Obesity affects a rising proportion of the population and is an important risk factor for unfavorable outcomes in viral disease including severe acute respiratory syndrome coronavirus 2- associated diseases. Torque Teno virus (TTV) is a ubiquitous and apathogenic virus which reflects the immune function of its host. The aim of this study was to investigate the association between obesity and TTV load - an indirect marker of compromised viral immune response. Methods: TTV was quantified by TTV R-GENE® PCR in a total of 89 participants of which 30 were lean (BMI <25 kg/m2) and 59 were obese (BMI >30 kg/m2). For 38 subjects, follow-up was available after bariatric surgery. Results: TTV load was higher in individuals with obesity (median 2.39, IQR: 1.69-3.33 vs. 1.88, IQR 1.08-2.43 log10 copies/mL; p = 0.027). Multivariable linear modeling revealed an independent association between TTV load and obesity. TTV was positively correlated with waist-to-hip ratio and inversely with 25OH vitamin D levels. Interleukin 6 and fasting insulin resistance were confounders of the association between TTV and obesity, while age was an effect modifier. TTV load increased by 87% (95% CI 2-243%) in the year following bariatric surgery. Discussion: A higher TTV load in obese individuals may reflect compromised immune function and thus might serve for risk stratification of unfavorable outcomes during infectious disease, including coronavirus disease 2019, in this population. Our data warrant further analysis of TTV-based risk assessment in obese individuals in the context of infectious disease-associated outcomes.


Subject(s)
COVID-19 , DNA Virus Infections , Torque teno virus , DNA Virus Infections/complications , DNA Virus Infections/epidemiology , Humans , Interleukin-6 , Obesity , Thinness , Vitamin D
11.
British Journal of Surgery ; 109(Supplement 5):v9, 2022.
Article in English | EMBASE | ID: covidwho-2134956

ABSTRACT

Background: The progressive growth of The older patients with obesity represents a challenge to The weight management teams. Although initially, old age was a relative contraindication to The surgical option, current advances in laparoscopic techniques and perioperative optimization protocols have changed The old notion. However, The performance of bariatric procedures in The older patients during The ongoing CoVID-19 pandemic carries a potential risk. This study aimed to assess The safety of bariatric surgery (BS) in older patients during The pandemic. Method(s): 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-older patients >65-year-old (group I) and young < 65-year-old (group II). Two groups were compared for 30-day morbidity and mortality. Result(s): We included 7084 patients, The mean age was 40.35+/-11.9 years, and 5197 (73.4%) were females. The mean preoperative weight and BMI were 119.49+/-24.4 Kgs and 43.03+/-6.9 Kg/m2, respectively. The overall comorbidities were significantly higher in group I, p= <0.001. In group II, 14.8% were current smokers, compared to 7.4% of group I. The complications in group I were significantly higher (11.4%) compared to group II (6.6%), p= 0.022. However, The mortality rate and CoVID-19 infection within 30 days were not significantly different between The two groups. Conclusion(s): Bariatric surgery during The CoVID-19 pandemic in The older patients (>65 years old) is associated with a higher complication rate than The younger age group. However, The mortality and postoperative CoVID-19 infection rates are comparable to The younger age group.

12.
PM and R ; 14(Supplement 1):S85-S86, 2022.
Article in English | EMBASE | ID: covidwho-2128005

ABSTRACT

Case Diagnosis: A 21-year-old female with a past medical history of gastric sleeve surgery admitted to acute inpatient rehab with bilateral lower extremity weakness and neuropathic pain who recovered after intramuscular vitamin supplementation. Case Description: A 21-year-old female with a past medical history of gastric sleeve surgery presented with bilateral lower extremity weakness with pins and needles sensation to her feet and a mild sore throat. During her initial hospital visit, patient was diagnosed with mild COVID-19 and as there was concern for Guillain-Barre syndrome (GBS), lumbar puncture was performed and GBS was ruled out. However, patient underwent IVIG treatment for empiric symptom management without improvement. Patient was subsequently admitted to acute inpatient rehabilitation. Setting(s): Acute Inpatient Rehab. Assessment/Results: Upon examination, patient presented impaired bilateral lower extremity weakness, absent lower extremity reflexes and paresthesias. Patient was unable to stand or ambulate due to lower extremity weakness and pain. Lumbar puncture performed and GBS ruled out due to lack of albuminocytological dissociation. Patient underwent course of two courses of IVIG, with no improvement of symptoms. Vitamin deficiency workup revealed insufficient vitamin B1 levels. Over the course of two weeks, she was started on daily vitamin B1 which led to a rapid improvement of her polyneuropathy and weakness. Upon discharge, patient was ambulating 150 feet with the use of a rolling walker and had complete resolution of her bilateral lower extremity neuropathy. Discussion(s): Bariatric surgeries are used to treat the ever-growing problem of obesity in America. Although bariatric surgery improves the overall quality of life in patients, acute and chronic neurologic complications such as polyneuropathies do occur and can be debilitating. It is important to complete vitamin workup in patients with history of bariatric surgery. Conclusion(s): Early diagnosis and treatment of vitamin deficiency after bariatric surgery can help prevent worsening polyneuropathies and bring back quality of life.

13.
Current Medical Issues ; 20(2):89-94, 2022.
Article in English | EMBASE | ID: covidwho-2144111

ABSTRACT

Excess ovarian activity, chronic anovulation, and androgen excess are the common traits of polycystic ovary syndrome (PCOS). Several advances have been made in understanding the pathophysiology in the process of finding quicker and more effective management measures. Androgen excess in PCOS was found to correlate with markedly elevated luteinizing hormone pulsatility. Impaired insulin response is also attributed to PCOS. Regimen with 3 mg drospirenone + 20 mug ethinyl estradiol combination is beneficial for hormonal imbalance and lipid profile while having a substantial safety profile. Clinical evidence has demonstrated that a 40:1 combination of Myo-inositol and D-chiro-inositol restores ovulation in PCOS women. For women with clomiphene citrate-resistant PCOS, laparoscopic ovarian drilling has proved to be a safe and effective surgical alternative. PCOS is also an indication of bariatric surgery. To conclude, constitutional management by a multidisciplinary team may be helpful for women with PCOS. Lifestyle interventions are best advised and, in so doing, decrease body adiposity and recuperate their metabolic and reproductive health. Copyright © 2022 Current Medical Issues Published by Wolters Kluwer-Medknow.

14.
Obes Surg ; 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2094761

ABSTRACT

BACKGROUND: Lingering severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in gut tissue might be a source of infection during bariatric surgery. This study aimed to confirm the presence of SARS-CoV-2 nucleocapsid in gastric and gallbladder tissues removed during bariatric surgery in individuals previously infected with coronavirus disease 2019 (COVID-19) who had negative polymerase chain reaction results prior to the surgery. METHODS: Gastric and gallbladder specimens from 80 patients who underwent bariatric surgery between November 2021 and May 2022 and had a history of COVID-19 infection with gastrointestinal symptoms were examined for the presence of lingering SARS-CoV-2 nucleocapsid proteins using immunohistochemistry. RESULTS: Gastric specimens from 26 (32.5%) patients and 4 (100%) cholecystectomy specimens showed positive cytoplasmic staining for the anti-SARS-CoV-2 nucleocapsid protein in surface mucosal epithelial cells. The mean age was 37.8 ± 10.3 years. The average body mass index was 44.2 ± 7.0 kg/m2; most of the patients were females (71.3%). The positive staining group was significantly younger than the negative staining group (p = 0.007). The full-dose vaccination rate was 58.8%, with a median of 91 days after the last vaccine dose. A positive serological anti-spike IgG response was observed in 99% of the patients. The median time between initial COVID-19 infection and surgery was 274 and 380 days in the positive and negative staining groups, respectively (p = 0.371). CONCLUSION: Gastric and gallbladder tissues can retain SARS-CoV-2 particles for a long time after COVID-19 infection, handling stomach specimens from patients during an operation must be done with care, as we usually do, but now with the knowledge that in 1/3 of patients they can be present. Performing LSG on post-COVID patients did not seem to increase perioperative morbidity.

15.
Surg Pract Sci ; 11: 100140, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2086725

ABSTRACT

Introduction: Obesity is linked with poor outcomes in patients with SARS-CoV-2 infection. In patients with BMI > 35 kg/m2, increased rates of hospital and subsequently ICU admissions have been noted. Bariatric surgery resulting in sustained weight loss is hypothesized to decrease the morbid outcomes associated with COVID. In this review, we update the evidence on the topic. Methods: An extensive literature search was conducted of electronic databases. Screening of the articles based on the eligibility criteria was followed by relevant data extraction. In addition to articles used in a previous meta-analysis, relevant databases were searched to filter for any new articles. Initially, two independent reviewers screened Pubmed and the Cochrane database followed by a thorough search of additional databases such as Google scholar and Medrxiv. Articles were first screened using title and abstract, followed by a full text read. Duplicates, meta-analysis, letter to the editors, and commentaries were excluded. No language restrictions were applied. Results: A total of nine articles with a population of 1,130,341 were entered into RevMan. Patients with bariatric surgery displayed significantly decreased hospitalization (OR: 0.52, 95% CI [0.45, 0.61]), were less likely to be admitted to the ICU (OR: 0.44, 95% CI [0.29, 0.67]), and had reduced overall mortality (OR: 0.42, 95% CI [0.25, 0.70]). Conclusion: Surgically induced weight loss is beneficial in reducing morbidity and mortality of COVID-19.

16.
Obes Surg ; 32(12): 3908-3921, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2085553

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams. MATERIALS AND METHODS: The current study is a subset analysis of the GENEVA study which was an international cohort study between 01/05/2020 and 31/10/2020. Data were specifically analysed regarding the timing of BMS suspension, patterns of service recovery, and precautionary measures deployed. RESULTS: A total of 527 surgeons from 439 hospitals in 64 countries submitted data regarding their practices and handling of the pandemic. Smaller hospitals (with less than 200 beds) were able to restart BMS programmes more rapidly (time to BMS restart 60.8 ± 38.9 days) than larger institutions (over 2000 beds) (81.3 ± 30.5 days) (p = 0.032). There was a significant difference in the time interval between cessation/reduction and restart of bariatric services between government-funded practices (97.1 ± 76.2 days), combination practices (84.4 ± 47.9 days), and private practices (58.5 ± 38.3 days) (p < 0.001). Precautionary measures adopted included patient segregation, utilisation of personal protective equipment, and preoperative testing. Following service recovery, 40% of the surgeons operated with a reduced capacity. Twenty-two percent gave priority to long waiters, 15.4% gave priority to uncontrolled diabetics, and 7.6% prioritised patients requiring organ transplantation. CONCLUSION: This study provides global, real-world data regarding the recovery of BMS services following the COVID-19 pandemic.


Subject(s)
Bariatrics , COVID-19 , Obesity, Morbid , Humans , COVID-19/epidemiology , Pandemics , SARS-CoV-2 , Cohort Studies , Obesity, Morbid/surgery , Surveys and Questionnaires
17.
Obesity Research & Clinical Practice ; 2022.
Article in English | ScienceDirect | ID: covidwho-2069535

ABSTRACT

Background The association of prior bariatric surgery (BS) with infection rate and prognosis of coronavirus disease 2019 (COVID-19) remains unclear. We conducted a meta-analysis of observational studies to address this issue. Methods We searched databases including MEDLINE, Embase, and CENTRAL from inception to May, 2022. The primary outcome was risk of mortality, while secondary outcomes included risk of hospital/intensive care unit (ICU) admission, mechanical ventilation, acute kidney injury (AKI), and infection rate. Results Eleven studies involving 151,475 patients were analyzed. Meta-analysis showed lower risks of mortality [odd ratio (OR)=0.42, 95% CI: 0.27 to 0.65, p<0.001, I2=67%;nine studies;151,113 patients, certainty of evidence (COE):moderate], hospital admission (OR=0.56, 95% CI: 0.36 to 0.85, p=0.007, I2=74.6%;seven studies;17,810 patients;COE:low), ICU admission (OR=0.5, 95% CI: 0.37 to 0.67, p<0.001, I2=0%;six studies;17,496 patients, COE:moderate), mechanical ventilation (OR=0.52, 95% CI: 0.37 to 0.72, p<0.001, I2=57.1%;seven studies;137,992 patients, COE:moderate) in patients with prior BS (BS group) than those with obesity without surgical treatment (non-BS group). There was no difference in risk of AKI (OR=0.74, 95% CI: 0.41 to 1.32, p=0.304, I2=83.6%;four studies;129,562 patients, COE: very low) and infection rate (OR=1.05, 95% CI: 0.89 to 1.22, p=0.572, I2=0%;four studies;12,633 patients, COE:low) between the two groups. Subgroup analysis from matched cohort studies demonstrated associations of prior BS with lower risks of mortality, ICU admission, mechanical ventilation, and AKI. Conclusion Our results showed a correlation between prior BS and less severe COVID-19, which warrants further investigations to verify.

18.
Obesity Surgery ; 32(SUPPL 2):478-478, 2022.
Article in English | Web of Science | ID: covidwho-2067805
19.
Chest ; 162(4):A428-A429, 2022.
Article in English | EMBASE | ID: covidwho-2060594

ABSTRACT

SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Chest CT features in COVID-19 pneumonia include scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, cavitary lesions are uncommon in these patients. We present a case of lung cavity in a patient who had recent COVID-19 pneumonia. CASE PRESENTATION: A 33-year-old male diagnosed with COVID-19 four weeks ago presented with hemoptysis and exertional dyspnea. He had pleuritic chest pain without fever, night sweats, weight loss, skin rashes, hematemesis, or epistaxis. He had COVID-19 in Brazil, where he had received dexamethasone, hydroxychloroquine, ivermectin, colchicine, azithromycin, and rivaroxaban. The last dose of rivaroxaban was three days prior to the presentation. He had no history of travel to caves or exposure to birds or animals. His past medical history included hypertension, diabetes, and bariatric surgery. He had no history of smoking or IV drug use. He had moved from Brazil to the United States six years ago and worked as an interpreter. Physical examination was notable for stable vitals with O2 sat of 99%. Systemic examinations were unremarkable. Blood work including CBC, platelet count, PT/INR was within normal limits. COVID-19 testing (PCR) was negative. A chest CT revealed bilateral scattered ground-glass opacities with central cavitation in the left lower lobe concerning for septic pulmonary emboli. HIV 1/2, ANA, rheumatoid factor, and Quantiferon TB gold were negative. Blood cultures showed no growth. An echocardiogram was negative for any vegetations. Bronchoalveolar lavage from the left lower lobe was negative for AFB and gram staining. Sputum cultures, fungal cultures, and NAAT for Mycobacterium tuberculosis were negative, as was the cytology. He was started on amoxicillin-clavulanic acid during his hospital stay. He did not experience any recurrence of hemoptysis and was discharged home. The subsequent follow-up chest CT scans showed resolving cavitation at one month and a complete resolution of the cavity at 3 months. DISCUSSION: Cavitary lung lesions are usually related to fungal, mycobacterial, autoimmune, parasitic, thrombotic, or neoplastic etiologies. While not often seen in patients with viral pneumonia, lung cavitation can rarely occur in COVID-19. Mycobacterium tuberculosis and Nocardia were suspected given the history of being an immigrant and a recent trip to Brazil. As these tests were negative and the lung cavity resolved over a few months with conservative treatment, the etiology of the cavity was attributed to a late presentation of COVID-19 pneumonia. CONCLUSIONS: COVID-19 has variable complications which are still to be explored. The lung cavity in a COVID patient is an under-recognized entity. This case report highlights the need for further studies to determine the cause of cavitation, which could be related to COVID infection or its treatment. Reference #1: Selvaraj V, Dapaah-Afriyie K Lung cavitation due to COVID-19 pneumonia. BMJ Case Reports CP 2020;13:e237245. Reference #2: Chen Y, Chen W, Zhou J, Sun C, Lei Y. Large pulmonary cavity in COVID-19 cured patient case report. Ann Palliat Med 2021;10(5):5786-5791. doi: 10.21037/apm-20-452 Reference #3: Zoumot, Z., Bonilla, MF., Wahla, A.S. et al. Pulmonary cavitation: an under-recognized late complication of severe COVID-19 lung disease. BMC Pulm Med 21, 24 (2021). https://doi.org/10.1186/s12890-020-01379-1 DISCLOSURES: no disclosure on file for Raul Davaro;No relevant relationships by Susant Gurung No relevant relationships by Bijay Khanal No relevant relationships by Anil Phuyal No relevant relationships by Kamal Pokhrel No relevant relationships by REGINA SHRESTHA No relevant relationships by Mithil Gowda Suresh

20.
Chest ; 162(4):A292, 2022.
Article in English | EMBASE | ID: covidwho-2060553

ABSTRACT

SESSION TITLE: Severe and Unusual Blastomycosis Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Severe pulmonary blastomycosis (PB) usually affects immunocompromised patients, with very high mortality rate of up to 40%. PB can mimic pneumonia caused by other organisms (1), which can delay diagnosis and treatment initiation. We present a case of severe PB that was initially thought to be COVID-19 pneumonia, to our knowledge this is 2nd case of concomitant PB and COVID-19 infection in literature. (2) CASE PRESENTATION: Patient is 52 year old female with past medical history of atrial fibrillation, asthma, bariatric surgery, that presents with shortness of breath for 2 weeks. Despite receiving only 1 dose of COVID-19 vaccine (Moderna) 5 months ago, patient tested positive for COVID-19 on PCR test at the urgent care 4 days prior. Her symptoms progressed despite initial outpatient treatment with steroids and antibiotics. Initial emergency department chest computed tomography (CT) revealed dense bilateral consolidations, with hypoxic respiratory failure, patient was admitted for treatment of presumed COVID-19 pneumonia, and guideline directed treatment was initiated. Despite maximal medical management, that included steroids, broad spectrum antibiotics, remedisivir, patient failed to improve, with repeat CT chest revealing worsening consolidations. Bronchoscopy was performed 12 days into the admission revealed thick white secretions, with cultures growing blastomyces dermatitidis. At this point patient development of septic shock with multiorgan failure. Patient was subsequently intubated, and due to significant renal failure, initiated on hemodialysis (HD). Anti-fungal treatment was initiated with amphotericin B, and transitioned to itraconazole afterwards. Patient required several HD sessions, after which her renal function fully recovered. Patient was successfully extubated 7 days later, but required additional 22 days of medical care and physical therapy before being ready for discharge to rehabilitation facility. On the outpatient follow up 6 weeks after discharge, patient continues to slowly recover. Repeat CT chest still with significant bilateral consolidations. Patient will require at least 12 months of itraconazole therapy. DISCUSSION: PB can mimic bacterial and viral pneumonia symptoms. (1) In the widespread COVID-19 pandemic, clinicians can be misled by COVID-19 positive test in patient with bilateral pneumonia, and initiate guideline directed therapy. Immunosuppression agents can lead to adverse outcomes in patients with underlying PB. Questionable is the significance of COVID positive PCR test in semi-vaccinated individual. Potentially even mild COVID-19 infection could predispose patient for PB. Early diagnosis of PB is important, as delay in treatment and medical immunosuppression can lead to worse outcomes. CONCLUSIONS: PB should be suspected even in patients presenting with positive COVID-19 PCR test. Guideline directed therapy for COVID-19 can worsen underlying PB. Reference #1: https://www.cdc.gov/fungal/covid-fungal.html Reference #2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8503152/ DISCLOSURES: No relevant relationships by Dovile Baniulis No relevant relationships by Dovile Cerkauskaite No relevant relationships by Igor Dumic No relevant relationships by Momcilo Durdevic No relevant relationships by Dragana Durdevic No relevant relationships by Ashutossh Naaraayan No relevant relationships by Ankita Subedi

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