Introduction
Obesity is a significant risk factor for cancer incidence and mortality. The number of patients with obesity who undergo bariatric surgery is increasing; however, the impact of such a ...procedure in affecting the risk of cancer is not completely understood yet.
Methods
We conducted a retrospective unicentric cohort study to characterize the occurrence of cancer in patients who underwent bariatric surgery from January 2010 to December 2018. For cases of cancer identified after bariatric surgery, we performed a cancer-free survival analysis over time. We also performed a cross-sectional analysis of demographic and clinical characteristics at the time of surgery and compared patients with or without a cancer diagnosis.
Results
Of the 2578 patients who underwent bariatric surgery, 117 patients (4.5%) were diagnosed with a cancer. Fifty-nine cases were diagnosed before surgery, and the remaining 58 cases occurred after the bariatric procedure. The prevalence of cancer was more accentuated in women (4.9%) than among men (2.7%). Thyroid and breast cancer were the most frequent before and after bariatric surgery, respectively. On average, patients with cancer diagnosis were older (49.0 vs 43.3 years,
p
<0.001) and with a lower level of education (7.4 vs 8.6 school years,
p
=0.002).
Conclusion
Almost all the cases of cancer identified in this study were obesity-related cancers. Further prospective studies are needed to extend the current knowledge regarding the cancer risk profile of patients who undergo bariatric surgery.
•Habitat use of jaguars and pumas was affected by anthropogenic landscape changes.•Some prey species were affected by pine plantations and related landscape changes.•Other species were not affected ...by plantations and could serve as alternative preys.•Pine plantations intermixed with forest patches could be corridors for these felids.•To improve habitat quality for these cats poaching activities must be restricted.
Large carnivores are key elements of natural ecosystems and most of them are declining due to the impacts of human activities. Jaguars and pumas are the largest felids of the American continent, and particularly jaguars are critically endangered in the Atlantic Forest of South America. As with other tropical forests, the Atlantic Forest has been converted to human land uses including forest tree plantations with exotic species. We assessed jaguars and pumas habitat use in a productive landscape of exotic pine plantations and forest areas in the Atlantic Forest of Argentina. We estimated the availability of their main preys in this landscape and evaluated the variables that affect their occupancy pattern. We developed large scale camera traps surveys between 2013 and 2014 in an area that includes pine plantations, protected areas, and unprotected areas covered by native forest and small rural properties. In total, we sampled 274 sampling stations with an effort of 13,347 camera-trap days. We used single-species single-season occupancy models to evaluate the effect of the proportion of pine plantation around the sampling station, the cost of human access, and the distance to the edge of the continuous forest block on the occupancy of the felids and its main prey species. For felids, we also evaluated the effect of the availability of their prey species. With a few exceptions, the occupancy probabilities of most prey were affected by one or two of the landscape variables tested. Habitat use by jaguars and pumas was affected by this anthropogenic landscape change. Even though the relative proportion of plantation to forest around camera stations did not affect the habitat use of either of the two feline species, other factors associated with this anthropic land-use, as human accessibility and distance to the continuous forest, did show an effect on these big cat species. According to our results, relatively small and well-managed areas of exotic tree plantations interspersed with forest areas do not constitute barriers for jaguars and pumas in the Atlantic Forest and can function as potential corridors. Forest plantations as such, do not appear to constitute optimal habitats for these felids. The role of tree plantations as potential corridors or supplementary habitat for pumas, jaguars and their prey relies, to different degrees, on the maintenance of a high proportion of native forest among the plantations, on a good connectivity with the large patches of protected forest, and on the control of poaching.
Thyroid function has an important role on body weight regulation. However, the impact of thyroid function on weight loss after bariatric surgery is still largely unknown. We evaluated the association ...between preoperative thyroid function and the excess weight loss 1 year after surgery, in 641 patients with morbid obesity who underwent bariatric surgery. Patients with a history of thyroid disease, treatment with thyroid hormone or antithyroid drugs and those with preoperative evaluation consistent with overt hypothyroidism or hyperthyroidism were excluded. The preoperative levels of TSH and FT4 were not associated with weight loss after bariatric surgery. The variation of FT3 within the reference range was also not associated with weight loss. In contrast, the subgroup with FT3 above the reference range (12.3% of patients) had a significantly higher excess weight loss than patients with normal FT3. This difference remained significant after adjustment for age, sex, BMI, type of surgery, TSH and FT4. In conclusion, we observed an association between high FT3 and a greater weight loss after bariatric surgery, highlighting a group of patients with an increased benefit from this intervention. Our results also suggest a novel hypothesis: the pharmacological modulation of thyroid function may be a potential therapeutic target in patients undergoing bariatric surgery.
•The overall prevalence of MLSB resistance in this set of S. aureus was 38%.•The phenotype distribution was: cMLSB, 22%; iMLSB, 10%; MSB, 5% and L, 1%.•ermA gene was prevalent in HA-MRSA isolates, ...mainly in those with a cMLSB phenotype.•The combination ermA and ermC genes was prevalent in isolates with inducible resistance.•SmaI-PFGE results suggest a great genetic diversity in this MLSB resistant isolates.
This study was undertaken to investigate the resistance phenotypes to macrolide-lincosamide-streptogramin B (MLSB) antibiotics and their associated genotypes in isolates of Staphylococcus aureus. We analyzed one hundred, consecutive, non-duplicate isolates (methicillin-susceptible MSSA, n=53 and methicillin-resistant MRSA, n=47) obtained from various clinical samples between July 2012 to December 2013. The resistance profile to MLSB antibiotics was determined by phenotypic methods and the resistance genes were detected by PCR assays. All of the isolates were subjected to pulsed-field gel electrophoresis (SmaI-PFGE). The overall prevalence of resistance to MLSB antibiotics was 38% and the resistance phenotype distribution was as follows: cMLSB, 22%; iMLSB, 10%; MSB, 5% and L, 1%. We detected ermA, ermC, ermB and mrsA/B genes in these resistant isolates. The single ermA gene was commonly observed mainly in those with a cMLSB R phenotype, whereas the combination ermA and ermC was more commonly observed in isolates with inducible expression. The patterns of SmaI-PFGE suggest a great genetic diversity in both MRSA and MSSA resistant to MLSB antibiotics. The results demonstrate the local presence of S. aureus resistant to MLSB antibiotics and its most frequently described responsible genes. Some of these isolates, especially those with the iMLSB phenotype, may be associated with therapeutic failure. Therefore, efforts should be directed to the correct detection of all MLSB resistant isolates using appropriate laboratory tests. PFGE results reveal a wide spread of resistance genes rather than the circulation of S. aureus clones resistant to MLSB antibiotics.
Los objetivos de este estudio fueron investigar en Staphylococcus aureus la presencia de fenotipos resistentes a los antibióticos macrólidos, lincosamidas y estreptograminas tipoB (MLSB) y conocer sus genotipos responsables. Analizamos 100 aislamientos consecutivos, no duplicados (53 sensibles a meticilina MSSA y 47 resistentes a meticilina MRSA), obtenidos entre 2012 y 2013 a partir de diferentes muestras clínicas. El perfil de resistencia a los antibióticos MLSB fue determinado por métodos fenotípicos y los genes de resistencia se detectaron por PCR. Todos los aislamientos fueron comparados por SmaI-PFGE. La prevalencia global de resistencia a los antibióticos MLSB fue del 38% y la distribución de los fenotipos de resistencia fue la siguiente: cMLSB, 22%; iMLSB, 10%; MSB, 5%; L, 1%. Se detectaron los genes ermA, ermC y mrsA/B en los aislamientos resistentes. El gen ermA se observó, sobre todo, en aislamientos con fenotipo resistente constitutivoR (cMLSB), mientras que la combinación ermA y ermC se detectó principalmente en aislamientos con resistencia inducible (iMLSB). Los patrones de SmaI-PFGE sugieren una gran diversidad genética en los aislamientos resistentes a los antibióticos MLSB, tanto MRSA como MSSA. Los resultados demuestran la presencia local de S. aureus resistentes a los antibióticos MLSB y de sus genes responsables más frecuentemente descritos. Estos cultivos, especialmente aquellos con fenotipo resistente iMLSB, pueden asociarse con fallas terapéuticas. Por lo tanto, los esfuerzos deben dirigirse a la correcta detección de todos los cultivos resistentes a MLSB utilizando pruebas de laboratorio adecuadas. Los resultados de SmaI-PFGE sugieren una amplia diseminación de genes de resistencia, más que la circulación de clones resistentes a los antibióticos MLSB.
For young adults, the first year of higher education represents a transition period into adulthood associated with an increased risk of developing depression, anxiety, and stress, contributing to ...deteriorating physical and mental health. The present study aimed to analyze the relationship between depressive symptoms and social capital and lifestyles among Colombian university students.
In 2020, a longitudinal repeated measures study was conducted on first year students at Universidad de los Andes in Bogota, Colombia. The study was conceptualized and approved by the university before the COVID-19 pandemic appeared. Each student completed a self-administered questionnaire including questions on sociodemographic characteristics, depressive symptoms, perceived stress, social capital, and lifestyles. The study's pilot was conducted in November 2019, and the two measurement points were in January 2020 (wave 1, before the COVID-19 pandemic was declared) and in August 2020 (wave 2, during the COVID-19 pandemic). A binary logistic regression analysis was performed to assess the relationship between depressive symptoms, perceived stress, social capital, and lifestyles.
A total of 609 first year students (response rate = 58.11%) participated in wave 1, and 42% of the participants showed signs of clinically relevant depressive symptoms. In wave 2, despite the difficulties encountered in collecting data due to the COVID-19 pandemic, 216 students from wave 1 participated (35.47%). An increase in a sedentary lifestyle was observed (31.49%). We found that cognitive and behavioral social capital levels decreased by 12.03 and 24.54%, respectively. In addition, we observed a 6.5% increase in students with clinically relevant depressive symptoms compared to wave 1. A low level of behavioral
: 1.88; 95% CI (1.16, 3.04) social capital was associated with clinically relevant depressive symptoms.
The health of university students continues to be a public health concern. The study suggests that social capital may play an important role in preventing depressive symptoms. Therefore, universities should put effort into programs that bring students together and promote the creation of social capital.
The development of the immune checkpoint inhibitors (ICI) is one of the most remarkable achievements in cancer therapy in recent years. However, their exponential use has led to an increase in ...immune-related adverse events (irAEs). Gastrointestinal and liver events encompass hepatitis, colitis and upper digestive tract symptoms accounting for the most common irAEs, with incidence rates varying from 2% to 40%, the latter in patients undergoing combined ICIs therapy. Based on the current scientific evidence derived from both randomized clinical trials and real-world studies, this statement document provides recommendations on the diagnosis, treatment and prognosis of the gastrointestinal and hepatic ICI-induced adverse events. Keywords: Immunotherapy. Immune checkpoint inhibitors. Toxicity. Hepatitis. Colitis. Drug-induced liver injury. Immune-related adverse events. Diarrhea. El descubrimiento de los inhibidores de checkpoint inmunologicos (ICI) es uno de los logros mas importantes en los ultimos ahos en Oncologfa. Sin embargo, su uso en aumen-to ha conlllevado a un incremento de los efectos adversos inmunomediados (irAEs). Los eventos hepaticos y gastroin-testinales incluyen la hepatitis, colitis y sintomas de tracto digestivo superior, que son de los irAEs mas frecuentes, con incidencias entre el 2% y 40%, esta ultima en paciente tratados con combo de ICI. Basados en la evidencia cientffica tanto de ensayo clfnicos randomizados como de estudio de vida real, este documento de consenso aporta recomenda-ciones sobre el diagnostico, tratamiento y pronostico de los efectos adversos hepaticos y gastrointestinales asociados con la inmunoterapia. Palabras clave: Inmunoterapia. Inhibidores de checkpoint in-munologicos. Toxicidad. Hepatitis. Colitis. Hepatotoxicidad. Efectos adversos inmunomediados. Diarrea.
Background
Bariatric surgery can improve glucose metabolism in obese patients with diabetes, but the factors that can predict diabetes remission are still under discussion. The present study aims to ...examine the impact of preoperative beta cell function on diabetes remission following surgery.
Materials and Methods
We investigated a cohort of 363 obese diabetic patients who underwent bariatric surgery. The impact of several preoperative beta cell function indexes on diabetes remission was explored through bivariate logistic regression models.
Results
Postoperative diabetes remission was achieved in 39.9 % of patients. Younger patients (
p
< 0.001) and those with lower HbA1c (
p
= 0.001) at the baseline evaluation had higher odds of diabetes remission. Use of oral anti-diabetics and insulin therapy did not reach statistical significance when they were adjusted for age and HbA1c. Among the evaluated indexes of beta cell function, higher values of insulinogenix index, Stumvoll first- and second-phase indexes, fasting C-peptide, C-peptide area under the curve (AUC), C-peptide/glucose AUC, ISR (insulin secretion rate) AUC, and ISR/glucose AUC predicted diabetes remission even after adjustment for age and HbA1c. Among them, C-peptide AUC had the higher discriminative power (AUC 0.76;
p
< 0.001).
Conclusions
Patients’ age and preoperative HbA1c can forecast diabetes remission following surgery. Unlike other studies, our group found that the use of oral anti-diabetics and insulin therapy were not independent predictors of postoperative diabetes status. Preoperative beta cell function, mainly C-peptide AUC, is useful in predicting diabetes remission, and it should be assessed in all obese diabetic patients before bariatric or metabolic surgery.
Hyperammonemia is a metabolic condition characterized by elevated levels of ammonia and a common event in acute liver injury/failure and chronic liver disease. Even though hepatic ammonia levels are ...potential predictive factors of patient outcome, easy and inexpensive methods aiming at the detection of liver ammonia accumulation in the clinical setting remain unavailable. Thus, herein we have developed a morphological method, based on the utilization of Nessler´s reagent, to accurately and precisely detect the accumulation of ammonia in biological tissue. We have validated our method against a commercially available kit in mouse tissue samples and, by using this modified method, we have confirmed the hepatic accumulation of ammonia in clinical and animal models of acute and chronic advanced liver injury as well as in the progression of fatty liver disease. Overall, we propose a morphological method for ammonia detection in liver that correlates well with the degree of liver disease severity and therefore can be potentially used to predict patient outcome.
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