6 research outputs found
Su1976 - Utility of Upper GI Endoscopy in the Preoperative Assessment of Patients Going for Bariatric Surgery
No full text
Safety and efficacy of IL-23 inhibitors in patients with moderate to severe ulcerative colitis: a systematic review and meta-analysis of randomized controlled trials
No full textBackground and objective Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy and safety of IL-23 inhibitors for induction and maintenance therapy in UC. Methods A systematic search of PubMed, Cochrane, and Google Scholar was conducted up to May 2025 to identify randomized controlled trials (RCTs) of IL-23 inhibitors (mirikizumab, risankizumab, guselkumab) in UC. Data were analyzed using Review Manager (RevMan 5.4) with a random-effects model. Results Seven RCTs (four induction, three maintenance) including 4203 patients were analyzed. IL-23 inhibitors significantly increased clinical remission during both induction (RR 1.52) and maintenance (RR 1.62). Rates of histo-endoscopic healing were also higher with IL-23 blockade in both induction (RR 2.53) and maintenance (RR 1.81). Importantly, IL-23 inhibitors were associated with a reduced risk of serious adverse events during induction (RR 0.39), with no significant difference observed during maintenance (RR 0.68). Other outcomes, including clinical response and corticosteroid-free remission, also consistently favored IL-23 blockade. Conclusion IL-23 inhibitors provide significant improvements in clinical remission and mucosal healing, with a favorable safety profile, particularly during induction therapy in moderate to severe UC.https://link.springer.com/article/10.1007/s00384-025-05014-
Changing Trends in Myocardial Infarction Mortality Among Young Adults in the United States: A 25-Year Analysis of Disparities and the COVID-19 Impact
No full textIntroduction
Myocardial infarction (MI) generally occurs among old individuals. However, changing dietary patterns, stress, and smoking have led to an increased risk of MI among young adults. This study aimed to analyze 25-year MI-mortality-related trends among young adults (15–44 years) in the US.
Material and methods
The death certificates from the CDC WONDER database (1999–2023) were analyzed to identify MI-related mortality, reporting age-adjusted mortality rates (AAMRs) per 100,000 people, and annual percentage changes (APCs).
Results
A total of 91,482 deaths were attributed to MI among young adults in the US from 1999 to 2023. The AAMRs declined from 3.8 in 1999 to 2.5 in 2018, followed by an increase to 3.2 by 2021 (APC = 8.1), coinciding with the COVID-19 pandemic. This was followed by a decline to an AAMR of 2.3 in 2023. Men had consistently higher AAMR compared to women throughout the study period (average AAMR: 4.5 vs. 1.8). Among racial/ethnic groups, the highest AAMR was observed in the non-Hispanic (NH) Black or African American individuals (5), followed by the NH White (3.2), Hispanic or Latino (1.5), and NH Other populations (1.3) in 2023. The southern region had the highest AAMR when stratified by census regions, and rural areas had higher mortality rates than urban areas (6.4 vs. 2.6).
Conclusions
From 1999 to 2023, MI-related mortality among young adults in the US showed an overall decline, with a temporary increase during the COVID-19 pandemic. Men, NH Black individuals, and those in rural or southern regions had consistently higher mortality rates. These findings highlight persistent disparities in MI-related mortality across demographic and geographic groups
SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
No full textBackground: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.
Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.
Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.
Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population
30-day postoperative mortality and the effects of hospital preparedness during the COVID-19 pandemic: a pooled analysis of prospective international cohort studiesResearch in context
No full textSummary: Background: Surgical services were poorly prepared for the COVID-19 pandemic, leading to widescale disruption to elective activity. This study aimed to identify actionable priorities to strengthen pandemic preparedness of surgical and hospital systems. Methods: This study pooled data from three international, prospective cohort studies including patients who had a positive SARS-CoV-2 test result in the seven days before or within 30 days after surgery. Patients were included across four pandemic time periods: Period 1 (January–May 2020), Period 2 (June–July 2020), Period 3 (October 2020), and Period 4 (December–March 2022). The primary outcome measure was 30-day postoperative mortality. Hierarchical logistic regression models were developed to explore association between pandemic periods (primary analysis) and hospital-level preparedness (secondary analysis) on 30-day postoperative mortality. Hospital preparedness was classified in to poorly-, moderately-, and highly-prepared tertiles based on Surgical Preparedness Index (SPI) score. Findings: A total of 31,751 patients were included from 1589 hospitals and 102 countries. From Period 1 through to Period 4 there was a decrease in the proportion of patients aged ≥70 years and with ASA grades 3–5.30-day postoperative mortality fell from Period 1 (18.4% [1378/7502]), Period 2 (9.9% [219/2234], adjusted odds ratio (aOR) 0.65, 95% confidence interval (CI) 0.53–0.78), Period 3 (10.5% [246/2427], aOR 0.60, 95% CI 0.50–0.71), through to Period 4 (5.8% [1132/19,588], aOR 0.33, 95% CI 0.30–0.37). During Period 4, SARS-CoV-2 vaccinated patients had lower mortality compared to unvaccinated patients (4.9% [603/12,361] versus 7.4% [529/7178], aOR 0.49, 95% CI 0.42–0.57). Compared to poorly-prepared hospitals (11.2% [1019/9071]), moderately-prepared (9.4% [857/9071], aOR 0.84, 95% CI 0.75–0.94) and highly-prepared hospitals (5.8% [530/9071], aOR 0.70, 95% CI 0.62–0.80) had lower mortality. Interpretation: Postoperative mortality decreased over the course of the COVID-19 pandemic and was lower in better prepared hospitals. Hospitals are critical national infrastructure and strengthening their preparedness by developing formal pandemic plans, establishing patient and procedure prioritisation protocols, and ring-fencing surgical beds would ensure safer surgical care during future pandemics. Funding: National Institute for Health and Care Research, United Kingdom
