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7%), seroma (2.6%), fat necrosis (1.7%), and wound dehiscence (2.6%). No arterial/venous thrombosis nor flap losses were recorded. Patients reported high satisfaction in all BREAST-Q domains, with mean postoperative scores being higher than preoperative ones, suggesting a positive effect in quality of life and satisfaction. Scores were significant in the satisfaction with breast domain (p=0.0016).

Breast reconstruction with PAP flap yields a high success, low complications, and excellent cosmetic outcomes in the breast and donor sites. It improves patients' satisfaction and quality of life; hence, it can be considered an excellent option for autologous breast reconstruction.

Breast reconstruction with PAP flap yields a high success, low complications, and excellent cosmetic outcomes in the breast and donor sites. It improves patients' satisfaction and quality of life; hence, it can be considered an excellent option for autologous breast reconstruction.

Adherence to follow-up visits is often unsatisfactory after bariatric surgery.

To identify predictors, including surgery type and preoperative demographics, body mass index (BMI), medical conditions, and smoking status, of 30-day follow-up visit completion.

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers (2015-2018).

Patients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy were included in this analysis. Data were analyzed using weighted logistic regression. Subanalyses included stratification of the sample by sex and age (<45, 45-60, and >60 years).

Patients (n = 566,774) were predominantly female (79.6%), White (72.4%), non-Hispanic (77.9%), and middle-aged (44.5 ± 11.9 years), with a mean BMI of 45.3 ± 7.8 kg/m

. More than 95% of patients completed the 30-day visits. In the whole-sample analysis, older age (odds ratio [OR], 1.02) and the presence of non-insulin-dependent diabetes (OR, 1.04), hypertension (OR, 1.03), hyperlipidemia (OR, 1.10), obstructive sleep apnea (OR, 1.15), and gastroesophageal reflux disease (OR, 1.16) were positive predictors of the 30-day visit completion (P

< .01). Conversely, sleeve gastrectomy procedure (OR, .86), Black race (OR, .87), Hispanic ethnicity (OR, .94), and the presence of insulin-dependent diabetes (OR, .96) and smoking (OR, .83) were negative predictors (P

< .01). Several differences emerged in subanalyses. For example, in sex stratification, Hispanic ethnicity lost its significance in men. In age stratification, BMI and male sex emerged as positive predictors in the age groups of <45 and 45-60 years, respectively.

Although challenged by small effect sizes, this analysis identified subgroups at a higher risk of being lost to follow-up after bariatric surgery.

Although challenged by small effect sizes, this analysis identified subgroups at a higher risk of being lost to follow-up after bariatric surgery.

Although a large proportion of patients with type 2 diabetes (T2DM) who have undergone metabolic surgery experience initial remission some patients later suffer from relapse. While several factors associated with T2D remission are known, less is known about factors that may influence relapse.

To identify possible risk factors for T2D relapse in patients who initially experienced remission.

Nationwide, registry-based study.

We conducted a nationwide registry-based retrospective cohort study including all adult patients with T2D and body mass index ≥35 kg/m

who received primary metabolic surgery with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in Sweden between 2007 and 2015. Patients who achieved complete diabetes remission 2 years after surgery was identified and analyzed. Main outcome measure was postoperative relapse of T2D, defined as reintroduction of diabetes medication.

In total, 2090 patients in complete remission at 2 years after surgery were followed for a median of 5.9 years (interquartile range [IQR] 4.3-7.2 years) after surgery. The cumulative T2D relapse rate was 20.1%. Duration of diabetes (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.05-1.14; P < .001), preoperative glycosylated hemoglobin A1C (HbA1C) level (HR, 1.01; 95% CI, 1.00-1.02; P = .013), and preoperative insulin treatment (HR, 2.67; 95% CI, 1.84-3.90; P < .001) were associated with higher rates for relapse, while postoperative weight loss (HR, .93; 95% CI, .91-.96; P < .001), and male sex (HR, .65; 95% CI, .46-.91; P = .012) were associated with lower rates.

Longer duration of T2D, higher preoperative HbA1C level, less postoperative weight loss, female sex, and insulin treatment prior to surgery are risk factors for T2D relapse after initial remission.

Longer duration of T2D, higher preoperative HbA1C level, less postoperative weight loss, female sex, and insulin treatment prior to surgery are risk factors for T2D relapse after initial remission.

COVID-19 lockdown imposes many challenges to patients with diabetes. We aimed to assess the impact of COVID-19 lockdown on health-related behavior and disease control among patients with diabetes.

A cross-sectional study was conducted among adults with diabetes attending a diabetes clinic in Colombo, Sri Lanka in June-July 2020. Lifestyle and disease control changes before and during the lockdown, were determined using an interviewer-administered questionnaire and review of medical records.

Among 1727 participants mean HbA1c decreased by 0.30% (95% CI 0.24-0.36, p < 0.001). HbA1c improved in 37.6% but deteriorated in 18.8%. Male sex (OR 1.36, 95% CI 1.10-1.67), better education (OR 1.10, 95% CI 1.01-1.20) and being employed (OR 1.08, 95% CI 1.00-1.16) were sociodemographic predictors of improved control. Better dietary adherence (OR 1.55, 95% CI 1.13-2.12), night-time sleep (OR 1.46, 95% CI 1.13-1.88) and indoor exercise (OR 1.62, 95% CI 1.23-2.07) were behavioural determinants of improved glycaemia. Decreases in self-monitoring of blood glucose (OR 1.45, 95% CI 1.09-1.93), exercise (OR 1.7, 95% CI 1.32-2.20), medication use (OR 1.95, 95% CI 1.37-2.78), dietary adherence (OR 1.72, 95% CI 1.32-2.26) and family income (OR 1.45, 95% CI 1.12-1.88) predicted worsening glycaemia. Only 4.1% used telehealth services; 83.1% of them reported good satisfaction.

Mean HbA1c improved during the lockdown. Overall, 37.6% of participants improved their glycaemic control. Well-educated employed men were more likely to improve glycaemic status. Improving diabetes control through healthy lifestyle practices and self-monitoring are feasible even in resource limited settings.

Mean HbA1c improved during the lockdown. Overall, 37.6% of participants improved their glycaemic control. Well-educated employed men were more likely to improve glycaemic status. Improving diabetes control through healthy lifestyle practices and self-monitoring are feasible even in resource limited settings.

Pancreatic steatosis is an incidental radiologic finding in asymptomatic patients, and its clinical importance is unclear. Primary aim to study the prevalence of pancreatic steatosis (PS) in consecutive patients registered at our hospital, that underwent computed axial tomography (CAT) scanning of the abdomen and pelvis, excluding known pancreatic diseases. Secondary aim to review the association of PS with the demographic and clinical data of the patients, as well as with hepatic steatosis (HS).

An observational study was conducted on adult patients that had CAT scans of the abdomen and pelvis.

a) tissue density was measured in Hounsfield units (HU) in five 1 cm

areas of the pancreas, three areas of the spleen, and in segments VI and VII of the liver; b) fatty pancreas a difference < -10 HU between the mean pancreas and mean spleen densities; and c) fatty liver density < 40 HU. We registered the epidemiologic and laboratory data of the patients. The association of those factors with the presence of PS was analyzed using SPSS version 24.0 software, and statistical significance was set at a p < 0.05.

Of the 203 patients, PS was found in 61 (30%). The patients with PS were significantly older and had a higher body mass index. We found no significant association with the rest of the parameters studied, nor with HS (55 patients). Flavopiridol in vivo None of the patients had symptoms attributable to a disease of the exocrine pancreas.

Fatty infiltration of the pancreas is a frequent finding in CAT scans, and its clinical importance is unclear. Aging of the population and the increase in obesity underline the need for future studies on PS.

Fatty infiltration of the pancreas is a frequent finding in CAT scans, and its clinical importance is unclear. Aging of the population and the increase in obesity underline the need for future studies on PS.

Lower respiratory tract infection (LRTI) is one of the most fatal diseases for adults. Influenza is a well-recognized cause of severe pneumonia; however, the outcomes of LRTI caused by non-influenza respiratory viruses (NIRVs) have not been sufficiently investigated. This study aimed to describe the characteristics and outcomes of LRTI associated with respiratory viruses (RVs) in adults.

A retrospective review was performed using medical records of adult patients whose lower respiratory tract (LRT) specimens (endotracheal aspirate and bronchoalveolar lavage fluid) tested positive for RVs using multiplex PCR. Underlying comorbidities, laboratory data, and clinical outcomes were analyzed.

Among the 808 LRT specimens collected from 666 adult patients, RV was identified in 115 specimens (14%) from 106 patients (16%). The underlying comorbidities and laboratory data did not differ between patients with influenza- and NIRV-related LRTI. The 14-day and 30-day mortality rates were higher in the influenza group than in the NIRV group (24% versus 7%, p=0.03 and 33% versus 13%, p=0.02, respectively), whereas the 90-day mortality rate did not. In a multivariate Cox model to predict 90-day mortality, shock and acute kidney injury independently predicted a higher mortality rate (hazard ratio (HR) 4.28, 95% CI 1.46-12.58, p=0.01 and HR 2.80, 95% CI 1.28-6.15, p=0.01, respectively), whereas the detection of influenza did not.

Influenza and NIRVs were associated with increased mortality due to LRTI in adults. Therefore, NIRVs are among key pathogens causing LRTI and should not be neglected by clinicians.

Influenza and NIRVs were associated with increased mortality due to LRTI in adults. Therefore, NIRVs are among key pathogens causing LRTI and should not be neglected by clinicians.Health and health care disparities are widespread with major impacts on outcomes for children and families. Inequitable care is poor quality care. Though health IT has the potential to improve disparities, health IT implementation can have unintended consequences of widening, maintaining, or creating disparities by disproportionately benefiting advantaged children, adolescents, and their caregivers. Narrowing disparities can be achieved by embracing an approach that places marginalized patients at the center of health IT design and implementation. Health care systems can leverage the disparity-reducing potential of health information technologies by housing innovation within an equity framework. Initial steps include evaluating for disparities exacerbated by health IT, implementing universal precautions to prevent health IT intervention-generated inequalities, and co-designing future innovations with marginalized communities. By directly addressing community needs, health IT systems designed to effectively benefit underserved children, adolescents, and their caregivers have the potential to yield more equitable health care IT, and better outcomes for our young patients.