Pancreatic exocrine insufficiency after bariatric surgery

Morbid obesity is a lifelong disease, and all patients require complementary follow-up including nutritional surveillance by a multidisciplinary team after bariatric procedures. Pancreatic exocrine insufficiency (PEI) refers to an insufficient secretion of pancreatic enzymes and/or sodium bicarbonate. PEI is a known multifactorial complication after upper gastrointestinal surgery, and might constitute an important clinical problem due to the large number of bariatric surgical procedures in the world. Symptoms of PEI often overlap with sequelae of gastric bypass, making the diagnosis difficult. Steatorrhea, weight loss, maldigestion and malabsorption are pathognomonic for both clinical conditions. Altered anatomy after bypass surgery can make the diagnostic process even more difficult. Fecal elastase-1 (FE1) is a useful diagnostic test. PEI should be considered in all patients after bariatric surgery with prolonged gastrointestinal complaints that are suggestive of maldigestion and/or malabsorption. Appropriate pancreatic enzyme replacement therapy should be part of the treatment algorithm in patients with confirmed PEI or symptoms suggestive of this complication

Tebentafusp (IMCgp100) in the treatment of uveal melanoma — from preclinical evidence to clinical practice

Tebentafusp (IMCgp100) is a novel bispecific immunotherapy that contains a specifically engineered soluble T-cellreceptor (TCR) capable of recognising the gp100 epitope on the surface of tumour cells presented by human leukocyteantigen-A*02:01 (HLA- A*02:01 (HLA-A2) is a specific allele within the HLA-A2 group). The HLA-A2 is then fused tothe single-chain variable fragment of anti-CD3, which binds to T-cells and destroys them. Tebentafusp has been shownto cause a significant increase in pro-inflammatory cytokine levels that are detrimental to the tumour. The preliminaryresults of tebentafusp in solid tumours are encouraging, particularly in advanced/metastatic uveal melanoma (UM).In a randomised phase III study (IMCgp100-202; n = 378), patients with untreated HLA*02:01 positive metastatic UM(mUM), tebentafusp significantly improved overall survival (OS) with a hazard ratio (HR) of 0.51 compared to the investigator’schoice, mainly pembrolizumab (82%). The one-year OS rate for tebentafusp was 73% compared to 59%for pembrolizumab. For comparison, the single-arm GEM1402 study (n = 52) reported a one-year OS rate of 52% forthe combination of nivolumab and Ipilimumab in metastatic UM. The most common adverse reactions related totebentafusp include cytokine release syndrome (CRS) and dermatological reactions such as rash. It is the first drugwith OS benefit in advanced/metastatic UM patients. However, further research is needed to optimise its use, improvepatient selection, develop combination therapies and identify predictive and prognostic biomarkers

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Screening of Cardiovascular Risk Factors Among Political and Opinion Leaders as Constructive Lobbing for Efficient Cardiovascular Prevention in Poland

Wstęp Choroby układu krążenia są głównym zagrożeniem zdrowia Polaków. Co drugi dorosły Polak umiera z powodu chorób serca i naczyń. Posługując się nowoczesnymi metodami socjotechnicznymi, podjęto próbę przedstawienia elitom politycznym i opiniotwórczym w Polsce aktualnej sytuacji epidemiologicznej w dziedzinie chorób układu krążenia, przez indywidualną i grupową ocenę ryzyka sercowo-naczyniowego. Materiał i metody Badaniami objęto: członków Komisji Krajowej NSZZ &#8222;Solidarność&#8221;, członków Rady OPZZ, uczestników Zjazdu Polskiego Towarzystwa Higieny, przedstawicieli Zarządu Kasy Chorych Samorządów Pomorza, środowisko dziennikarskie oraz Posłów i Senatorów Parlamentu RP. Badania obejmowały: wypełnienie kwestionariusza pomiary ciśnienia tętniczego oraz antropometryczne, a także stężenia cholesterolu i glukozy. W dniu akcji szczegółowe wyniki odniesione do sytuacji ogólnopolskiej prezentowano badanym podczas konferencji edukacyjnej. Wyniki W poszczególnych grupach znajomość własnego ciśnienia tętniczego deklarowało 41&#8211;81% badanych. Podwyższone ciśnienie tętnicze (&#8805; 140/90 mm Hg lub aktualne leczenie) stwierdzono u 32&#8211;66%. Nadwagę otyłość (BMI &#8805; 25 kg/m2) wykazano u 31&#8211;85% badanych osób. Palenie tytoniu podawało 17&#8211;32%. Podwyższone stężenie cholesterolu (> 190 mg%) stwierdzono u 53&#8211;72% badanych. Wnioski 1. Rozpowszechnienie podwyższonych wartości ciśnienia tętniczego, nadwagi i otyłości było większe w badanych grupach opiniotwórczych w porównaniu z odpowiednimi pod względem wieku podgrupami dorosłych Polaków. 2. Znajomość własnego ciśnienia tętniczego oraz świadomość nadwagi była lepsza w badanych grupach opiniotwórczych niż w odpowiednich pod względem wieku podgrupach dorosłych Polaków. 3. Przedstawienie aktualnej sytuacji epidemiologicznej w dziedzinie chorób układu krążenia w Polsce, przez indywidualną i grupową ocenę ryzyka sercowo-naczyniowego, było skuteczną metodą edukacji i konstruktywnego lobbingu na rzecz walki z epidemią zawałów serca i udarów mózgu w Polsce.Background Cardiovascular diseases (CVD) are the main health problem in Poland. Every second death in Poland is caused by CVD. We decided to use modern social marketing methods to present current epidemiological situation to political leaders and key opinion leaders in Poland. We also assessed their individual and collective CVD risk. Material and methods The research was carried out on the following groups: members of executive bodies of two largest trade unions in Poland (members of the National Commission of NSZZ &#8220;Solidarność&#8221;, members of the OPZZ Council), participants of the Polish Hygiene Society Congress, representatives of Health Insurance Board and Local Government in the administrative district (voivodeship) of Pomerania, journalists (press and radio), Members of the Polish Parliament. The study consisted of: a questionnaire, anthropometric measurements, blood pressure measurements, cholesterol and glucose level tests. The results were presented to examined subjects in the form of an educational conference held on the same day. Results In the examined groups: awareness of one&#8217;s own blood pressure was declared 41&#8211;81% of the subjects. Increased blood pressure (BP &#8805; 140/90 mm Hg, or antihypertensive medication) was found in 32&#8211;66% of cases. Overweight and obesity (BMI &#8805; 25 kg/m2) was found in 31&#8211;85% of the examined persons. Cigarette smoking was declared by 17&#8211;32%. Elevated cholesterol level was found in 53&#8211;72%. Conclusions 1. Prevalence of increased blood pressure, overweight and obesity among the examined groups of opinion leaders was higher than among corresponding age subgroups representative for the general Polish population. 2. Awareness of one&#8217;s own BP and awareness of overweight among the examined groups of opinion leaders was better than among corresponding age subgroups representative of the general Polish population. 3. The idea to present of current epidemiological situation by assessment of individual and collective CVD risk appeared to be an effective method of education and constructive lobbing for fight against an epidemic of myocardial infarctions and strokes in Poland

Species trait shifts in vegetation and soil seed bank during fen degradation

Fens in Central Europe are characterised by waterlogged organic substrate and low productivity. Human-induced changes due to drainage and mowing lead to changes in plant species composition from natural fen communities to fen meadows and later to over-drained, degraded meadows. Moderate drainage leads to increased vegetation productivity, and severe drainage results in frequent soil disturbances and less plant growth. In the present article, we analyse changes in plant trait combinations in the vegetation and the soil seed bank as well as changes in the seed bank types along gradient of drainage intensity. We hypothesize that an increase in productivity enhances traits related to persistence and that frequent disturbance selects for regeneration traits. We use multivariate statistics to analyse data from three disturbance levels: undisturbed fen, slightly drained fen meadow and severely drained degraded meadow. We found that the abundance of plants regenerating from seeds and accumulating persistent seed banks was increasing with degradation level, while plants reproducing vegetatively were gradually eliminated along the same trajectory. Plants with strong resprouting abilities increased during degradation. We also found that shifts in trait combinations were similar in the aboveground vegetation and in soil seed banks. We found that the density of short-term persistent seeds in the soil is highest in fen meadows and the density of long-term persistent seeds is highest in degraded meadows. The increase in abundance of species with strong regeneration traits at the cost of species with persistence-related traits has negative consequences for the restoration prospects of severely degraded sites

Strategy of development of social services in the European socialist countries

Major changes can be observed in the strategy of development of social services in the socialist countries. These changes are prompted by such major factors in development of social services as changes in the structure of professionally active population, investment policy, and expenditure on social services from the state budget. Improvement in accessibility and quality of social services will depend in the future primarily on modernity of the structure and effectiveness of the national economy. A further conclusion drawn on the basis of the analysis of statistical data from 8 countries for the period 1950-1985 (Bulgaria, Czecho-slovakia, GDR, Hungary, Poland, Rumania, Yugoslavia and USSR) is a statement about the necessity of: 1) such increase in investment outlays on the social services sphere, which will outpace the rate of these outlays in the entire national economy, and 2) much more effective use of resources in this sphere