Metabolic syndrome and liver disease in the era of bariatric surgery: What you need to know!

Metabolic syndrome(MS)is defined as the constellation of obesity,insulin resistance,high serum triglycerides,low high-density lipoprotein cholesterol,and high blood pressure.It increasingly affects more and more people and progressively evolves into a serious issue with widespread healthcare,cost,and quality of life associated consequences.MS is associated with increased morbidity and mortality due to cardiovascular or chronic liver disease.Conservative treatment,which includes diet,exercise,and antidiabetic agents,is the mainstay of treatment,but depends on patient compliance to medical treatment and adherence to lifestyle modification recommendations.Bariatric surgery has recently emerged as an appropriate alternative treatment with promising longterm results.Sleeve gastrectomy and Roux-en-Y gastric bypass constitute the most commonly performed procedures and have been proven both cost-effective and safe with low complication rates.Liver transplantation is the only definitive treatment for end-stage liver disease and its utilization in patients with nonalcoholic steatohepatitis has increased more than fivefold over the past 15 years.In this review,we summarize current state of evidence on the surgical treatment of MS.

Pediatric surgery during the COVID-19 pandemic

The coronavirus disease 2019(COVID-19)pandemic has had a major impact on pediatric surgery.The infection is often asymptomatic and atypical in children,while overlapping presentations with other infectious diseases generate additional diagnostic challenges.The high probability of missed pediatric cases and the invasive nature of surgery generate great concern for widespread transmission in this setting.Current guidelines suggest that triage of cases should be made on a case-by-case basis by a multidisciplinary team of experts.Decisionmaking can be assisted by classifying cases as elective,urgent,or an emergency according to the risks of delaying their surgical management.A workflow diagram should ideally guide the management of all cases from admission to discharge.When surgery is necessary,all staff should use appropriate personal protective equipment,and high-risk practices,such as aerosol-generating tools or procedures,should be avoided if possible.Furthermore,carefully designed organizational protocols should be established to minimize transmission while ensuring the uninterrupted operation of pediatric surgery units.For example,surgical teams can be divided into small weekly rotating groups,and healthcare workers should be continuously monitored for COVID-19 symptoms.Additionally,team protocols in the operating room can optimize communication and improve adherence to personal protective equipment use.Isolated operating rooms,pediatric intensive care units,and surgical wards should be specifically designed for suspected or confirmed COVID-19 cases.Finally,transportation of patients should be minimal and follow designated short routes.All these measures can help mitigate the effects of the COVID-19 pandemic on pediatric surgery units.

Platelet rich plasma effectiveness in bowel anastomoses:A systematic review

BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery.Technical insufficiency,topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage,with detrimental effects on patient postoperative outcomes.Despite the investigation of several factors and the invention of protective materials,the ideal agent to prevent anastomotic leaks is yet to be determined.AIM To study the effect of platelet rich plasma(PRP)on the healing of bowel anastomoses.METHODS A systematic literature search was performed in PubMed,EMBASE,and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis.RESULTS Eighteen studies were eligible with a total population of 712 animals including rats(14 studies),rabbits(2 studies)and pigs(2 studies).No postoperative complications were reported following PRP application.Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention,such as intraperitoneal chemotherapy or peritonitis.Similar results were reported by ten studies in terms of tissue hydroxyproline levels.One study reported significant increase in collagen deposition in PRP groups.PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy(6 studies).CONCLUSION The application of PRP is associated with improved bowel anastomosis outcomes,especially in animal models having an underlying condition affecting the normal healing process.PRP application seems to augment the normal healing process under these circumstances.However,further studies are needed to investigate the potential role of PRP on bowel anastomosis healing,especially in clinical settings.

Imaging in the COVID-19 era:Lessons learned during a pandemic

The first year of the coronavirus disease 2019(COVID-19)pandemic has been a year of unprecedented changes,scientific breakthroughs,and controversies.The radiology community has not been spared from the challenges imposed on global healthcare systems.Radiology has played a crucial part in tackling this pandemic,either by demonstrating the manifestations of the virus and guiding patient management,or by safely handling the patients and mitigating transmission within the hospital.Major modifications involving all aspects of daily radiology practice have occurred as a result of the pandemic,including workflow alterations,volume reductions,and strict infection control strategies.Despite the ongoing challenges,considerable knowledge has been gained that will guide future innovations.The aim of this review is to provide the latest evidence on the role of imaging in the diagnosis of the multifaceted manifestations of COVID-19,and to discuss the implications of the pandemic on radiology departments globally,including infection control strategies and delays in cancer screening.Lastly,the promising contribution of artificial intelligence in the COVID-19 pandemic is explored.

Complement-mediated microvascular injury and thrombosis in the pathogenesis of severe COVID-19: A review

Coronavirus disease 2019(COVID-19)causes acute microvascular thrombosis in both venous and arterial structures which is highly associated with increased mortality.The mechanisms leading to thromboembolism are still under investigation.Current evidence suggests that excessive complement activation with severe amplification of the inflammatory response(cytokine storm)hastens disease progression and initiates complement-dependent cytotoxic tissue damage with resultant prothrombotic complications.The concept of thromboinflammation,involving overt inflammation and activation of the coagulation cascade causing thrombotic microangiopathy and end-organ damage,has emerged as one of the core components of COVID-19 pathogenesis.The complement system is a major mediator of the innate immune response and inflammation and thus an appealing treatment target.In this review,we discuss the role of complement in the development of thrombotic microangiopathy and summarize the current data on complement inhibitors as COVID-19 therapeutics.