: The impact of the COVID-19 pandemic on the incidence rate of childhood type 1 diabetes (T1D) is controversial. Our aim was to analyze the incidence of new-onset T1D among children aged 0-17 before ...and during the COVID-19 pandemic in Israel.
: Data obtained from the national T1D registry for children aged 0-17 were analyzed for the pre-pandemic (1997-2019) and pandemic (2020-2022) periods. In the pre-pandemic period, 7246 children with newly diagnosed T1D were compared with 1490 children diagnosed during the pandemic period.
: T1D incidence significantly increased in the 0-17 age group from a mean of 12.9/10
(pre-pandemic) to 17.7/10
and 16.7/10
during the first two years of the pandemic (2020 and 2021, respectively) (
= 0.0001). Stratifying by age group (0-4, 5-9, 10-14, and 15-17) revealed a significant increase in the 5-9, 10-14, and 15-17 groups, both in 2020 (
= 0.0001) and in 2021 (
= 0.0001). The incidence rate in the 0-4 age group showed no change in the first year of the pandemic (2020) (
= 0.4). However, in the second year of the pandemic (2021), there was a significant increase from 6.3/10
in the pre-pandemic period to 9.1/10
(
= 0.001). Anti-COVID-19 vaccination in 2022 led to a significant decrease in the incidence rates in the 10-14 and 15-17 age groups (
= 0.03 and
= 0.02, respectively).
: The COVID-19 pandemic was associated with a significant increase in the incidence of new-onset T1D in prepubertal and pubertal children. Anti-COVID-19 vaccination decreased the incidence rate significantly only in pubertal children.
Background
Little evidence is available on the choice of linear staple reloads in laparoscopic sleeve gastrectomy (LSG). Previous literature recommends matching closed staple height (CSH) to ...tissue-thickness (TT) to avoid ischemia. Our objective was to examine feasibility and safety of “tight” hemostatic (CSH/TT <1) stapling and map the entire gastric wall TT in LSG patients.
Methods
Prospectively collected outcomes on 202 consecutive patients who underwent LSG with tight order of staples (Ethicon Endosurgery) in this order: pre-pylorus—black (CSH = 2.3 mm), antrum—green (CSH = 2.0 mm), antrum/body—blue (CSH = 1.5 mm), and white (CSH = 1.0 mm) on the body and fundus. Measurements of entire gastric wall TT were made on the first 100 patients’ gastric specimens with an electronic-dogmatic indicator.
Results
Study included 147 females and 55 males with a mean age of 41.5 ± 11.9 years and body mass index of 41.5 ± 3.8 kg/m
2
. Gastric wall measurements revealed mean CSH/TT ratio <1, decreasing from 0.7 ± 0.1 at pre-pylorus to 0.5 ± 0.1 at the fundus. There were 3.1% mechanical failures, mainly (68%) at pre-pylorus—black reloads. Post-operative bleeding occurred in 5 (2.5%) patients. There were no leaks or clinical evidence of sleeve ischemia. Stepwise regression analysis revealed that body mass index (
P
< 0.001), hypertension (
P
< 0.01), and male gender (
P
< 0.001) were associated with increased gastric TT
.
Conclusions
Our study suggests that reloads with CSH
/
TT <1 in LSG including staples with CSH of 1 mm on body and fundus are safe. The results challenge the concept that tight stapling cause’s ischemia. Since tight reloads are designed to improve hemostasis, their application could have clinical benefit.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objective
Most published work on bariatric surgery (BS) in adolescents describes outcomes after laparoscopic adjustable gastric banding (LAGB) or Roux-en-Y gastric bypass. We compared the efficacy of ...LAGB and laparoscopic sleeve gastrectomy (LSG) in adolescents.
Methods
A National Bariatric Registry was queried for adolescents who underwent BS between June 2013 and December 2015. We collected data on weight and height at baseline and 1-year following surgery, subsequent hospitalizations, interventions, and mortality, which were compared at 30 days post-surgery and until last follow-up (maximum 4.2 years post-surgery). Mortality and hospitalization data were extracted from national databases.
Results
Two hundred fifty-nine adolescents (60% females) aged 12–19 years were included. Mean age and body mass index (BMI) were 17.5 ± 1.2 years and 45.1 ± 5.0 kg/m
2
, respectively. LSG (
n
= 227, 87.6%) and LAGB (
n
= 32, 12.4%) were the most common procedures performed. LSG group achieved greater average at 1 year BMI loss compared to LAGB group (15.4 ± 4.7 kg/m
2
vs. 10.3 ± 5.1 kg/m
2
respectively;
p
= 0.0001) and higher rate with BMI < 30 kg/m
2
1 year post-surgery (57.7% (
n
= 131) vs. 25% (
n
= 8), respectively;
p
= 0.0005). Males who underwent LSG reduced BMI more than their female counterparts (p = 0.0001), LSG was the strongest independent predictor for BMI < 30 after 1 year (OR = 4.1; 95% CI 1.7–9.9) followed by age (OR = 1.3; 95% CI1.0–1.6). No mortality was observed. Postoperative hospitalizations between the two groups did not differ (hazard ratio 2.4; 95% CI 0.7–7.9;
p
= 0.1).
Conclusion
Compared to LAGB, LSG is superior regarding weight loss with a similar risk of short- and long-term hospitalizations, complications, and interventional procedures. Males lose more weight following LSG.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The scale and variables linked to bariatric surgery's effect on dyslipidemia have not been conclusive.
To compare the effect of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and ...adjustable gastric banding (LAGB) on dyslipidemia SETTING: National bariatric surgery registry.
Plasma lipids and associated variables were compared at baseline and 1 year (12±4 mo) after surgery for registry patients with dyslipidemia enrolled from June 2013 to August 2014.
The greatest mean total-cholesterol (TC) reduction was observed post-RYGB, 226.7±26.4 to 181.3±30.9 mg/dL (19.9%, n = 208), followed by post-SG, 227.9±24.4 to 206.7±34.2 mg/dL (8.9%, n = 1515; P<.001). Normal TC levels of below 200 mg/dL were achieved by 76% post-RYGB patients compared with 43.5% post-SG patients (odds ratio OR = 6.24, 95% confidence interval CI: 3.69-10.53) and 25.6% post-LABG patients (OR = 9.66, 95% CI: 4.11-22.67; P<.01). Although equivalent patterns were observed for low-density-lipoprotein cholesterol (LDL), the levels of high-density-lipoprotein cholesterol (HDL) were most improved post-SG, reaching normal levels in 58.1% of SG male patients versus 39.5% of RYGB male patients (OR = 1.56, 95% CI: 1.04-2.35), (P = .02). The lowering of triglyceride levels by approximately 75% was comparable after SG and RYGB procedures. The type of surgery was the strongest independent predictor for all lipid level improvements or remissions. Male sex was an independent predictor for LDL normalization only (OR = 1.88, 95% CI: 1.24-2.85). Excess weight loss offered no meaningful prediction for lipid improvement (OR = 1.01-1.03).
Particular types of bariatric surgeries had different effects on dyslipidemia, independent of weight loss. Overall, the RYGB achieved the biggest reduction in plasma lipids (TC and LDL), although SG did affect HDL. Our results could aid in the decision-making process regarding the most appropriate procedure for patients with dyslipidemia.
We compared the effect of perioperative COVID-19, before and after vaccination, on 30-day mortality after cardiac surgery.
Data was extracted from several national registries. The study period was ...March 1st, 2020–March 31st, 2022.
2594 adult patients underwent cardiac surgery before the availability of a universal COVID-19 vaccine. 33 patients were diagnosed with COVID-19 prior to surgery (mean age 58.3±10.0, mean length of time 73.6±60.1 days) and 7 patients were diagnosed with COVID-19 0–14 days after surgery (age 66.4±7.6). These were compared to 4426 patients who underwent cardiac surgery after the availability of a universal vaccine: 469 patients were diagnosed with COVID-19 prior to surgery (age 62.1±10.1, length of time 175.8±158.2) and 32 patients diagnosed with COVID-19 0–14 days after surgery (age 60.8±14.5). In patients diagnosed with COVID-19 prior to surgery, there was no excess 30-day mortality either before or after vaccination (1 (3.0%) vs. 57 (2.2%), respectively, P<0.8, and 8 (1.7%) vs. 87 (2.2%), respectively, P<0.5). Patients diagnosed with COVID-19 after surgery, but before vaccination, had significantly higher 30-day mortality compared to COVID-19 negative patients (2 (28.6%) vs. 56 (2.2%) respectively, P<0.0001). This excess mortality disappeared after universal vaccination (1 (3.1%) vs. 94 (2.1%) respectively, P<0.7).
COVID-19, when diagnosed in the early post-operative period, was a risk factor for mortality before available vaccinations, but not after vaccination was widely available. Pre-surgery screening and post-surgical isolation is essential until vaccines are available. This data may be useful for patient management in future respiratory pandemics.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Long-term survival is an important metric in assessing procedural value. We previously confirmed that the Society of Thoracic Surgeons predicted risk of mortality score (PROM) accurately predicts ...30-day mortality in Israeli patients. The present study investigated the ability of the PROM to reliably predict long-term survival.
Data on 1279 patients undergoing cardiac surgery were prospectively entered into our database and used to calculate PROM. Long-term mortality was obtained from the Israeli Social Security Database. Patients were stratified into five cohorts according to PROM (A: 0-0.99%, B: 1.0-1.99%, C: 2.0-2.99%, D: 3.0-4.99% and E: ≥ 5.0%). Kaplan-Meier estimates of survival were calculated for each cohort and compared by Wilcoxon signed-rank test. We used C-statistics to assess model discrimination. Cox regression analysis was performed to identify predictors of long-term survival.
Follow-up was achieved for 1256 (98%) patients over a mean period of 62 ± 28 months (median 64, range 0-107). Mean survival of the entire cohort was 95 ± 1 (95% CI 93-96) months. Higher PROM was associated with reduced survival: A-104 ± 1 (103-105) months, B-96 ± 2 (93-99) months, C-93 ± 3 (88-98) months, D-89 ± 3 (84-94) months, E-74 ± 3 (68-80) months (p < 0.0001). The Area Under the Curve was 0.76 ± 0.02 indicating excellent model discrimination. Independent predictors of long-term mortality included advanced age, lower ejection fraction, reoperation, diabetes mellitus, dialysis and PROM.
The PROM was a reliable predictor of long-term survival in Israeli patients undergoing cardiac surgery. The PROM might be a useful metric for assessing procedural value and surgical decision-making.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background
We investigated national trends in volume and outcomes of percutaneous coronary angioplasty (PCI), coronary artery bypass grafting (CABG), and ischemic heart disease–related mortality in ...Israel.
Methods and Results
Using International Classification of Diseases 9th and 10th revision codes, we linked 5 Israeli national databases, including the Israel Center for Disease Control National PCI and CABG Registries, the Ministry of Health Hospitalization Report, the Center of Bureau of Statistics, and the Ministry of Interior Mortality Report, to assess the annual PCI and CABG volume, procedural mortality, comorbidities, and ischemic heart disease‐related mortality between 2002 and 2014. Trends over time were analyzed using linear regression, assuming a Poisson distribution. A total of 298 390 revascularization procedures (PCI: 255 724, CABG: 42 666) were performed during the study period. PCI volume increased by 9% from 2002 to 2008 (387.4/100 000 to 423.2/100 000), steadily decreasing by 10.5% to 378.5/100 000 in 2014 (P=0.70 for the trend). CABG volume decreased by 59% (109.0/100 000 to 45.2/100 000) from 2002 to 2013, leveling at 46.4/100 000 (P<0.0001). PCI/CABG ratio increased from 3.6 in 2002 to 8.5 in 2013, slightly decreasing to 8.2 by 2014 (P<0.0001). In‐hospital procedural mortality remained stable (PCI: 1.2–1.6%, P=0.34, CABG: 3.7–4.4%, P=0.29) despite a significant change in patient clinical profile. During the course of the study, ischemic heart disease‐related mortality decreased by 46% (84.6–46/100 000, P<0.001).
Conclusions
We observed a dramatic change in coronary revascularization procedures type and volume, and a marked decrease in ischemic heart disease‐related mortality in Israel. The reasons for the observed changes remain unclear and need to be further investigated.
Objective
To assess the trends in the incidence of type 1 diabetes between 1997 and 2010 among 0–17‐yr‐old Israeli Jews and Arabs compared with global trends.
Methods
Data on children with newly ...diagnosed type 1 diabetes reported by pediatric endocrinologists from 19 medical centers to the Israel Center for Disease Control, as part of the National Diabetes Register.
Results
During 1997–2010, 2857 Jews and 757 Arabs were diagnosed with type 1 diabetes. The average age‐adjusted incidence among Jews was higher than Arabs 12.2 per 100 000, 95% confidence interval (CI) 10.5–14.2 and 8.9 per 100 000, 95% CI 7.5–10.7, p = 0.0001, respectively, however, the annual percent change was higher for Arabs compared with Jews (4.0 vs. 3.6%, p = 0.005, respectively). The mean age at diagnosis was similar for Jews and Arabs (9.6 ± 4.4 vs. 9.9 ± 4.4 yr, p = 0.08), and it remained stable during 1997–2010 in both ethnic groups (p = 0.6). In both Jews and Arabs the highest annual percent change was observed in younger children. It was 4.9% for children aged 5–9 yr and 10.7% for children aged 0–4 yr, respectively. There were no differences in the frequency of diabetic ketoacidosis (DKA) between Jews (39.9%) and Arabs (41.3%), (p = 0.5).
Conclusion
Type 1 diabetes incidence of Jews and Arabs in Israel is increasing. The incidence is higher in Jews than in Arabs; however, the annual percent change is higher in Arabs than in Jews. In both Ethnic groups the incidence of type 1 diabetes is increasing especially among young children.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Children and adolescents with early onset autoimmune diseases have a different seasonality of month of birth than the general population.
This pattern is consistent with an infection during pregnancy ...affecting the fetus or an infection immediately after birth that act as early triggers of the autoimmune diseases. We present data supporting the use of Rotavirus vaccinations in the reduction of incidence of childhood T1D and propose further investigations into whether other anti-virus vaccinations may reduce the burden of other autoimmune diseases such as multiple sclerosis, atopic dermatitis, psoriasis and subtypes of rheumatoid arthritis, Hashimoto thyroiditis.
•Viral infection in pregnant mothers may trigger an autoimmune disease in the fetus.•Children with autoimmune diseases have an abnormal seasonality of month of birth.•Specific vaccination of infants may reduce early childhood Type I diabetes.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
PDF
