Citations

Metabolic and bariatric surgery has been well described in the existing literature to be an effective and safe modality for weight loss in patients with obesity. Recently, hypoabsorptive procedures such as one-anastomosis gastric bypass (OAGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis duodenoileostomy with sleeve (SADI-S) have gained traction, particularly among patients with severe obesity. These procedures combine restrictive and hypoabsorptive mechanisms, resulting in significant and sustainable weight loss, especially in those with severe obesity and associated comorbidities. However, the risk of malnutrition and nutritional deficiency following these procedures has been a deterrent for surgeons in their adoption. This review evaluates the existing literature on the safety, efficacy, and long-term outcomes of OAGB, BPD-DS, and SADI-S. While these hypoabsorptive procedures represent highly effective options for treating obesity, the associated nutritional complications necessitate the need for long-term follow-up and supplementation and highlight the need for careful patient selection.

Background Sexual health is influenced by a complex interplay of biological, psychological, and social factors, all of which can be impacted by Parkinson's disease (PD). Female sexual dysfunction includes reduced sexual desire and/or arousal, pain during sexual activity, or difficulty achieving orgasm. Despite its impact on quality of life, sexual health in women with PD remains poorly understood. Objective To investigate the impact of motor, non-motor, and social PD aspects on sexual health of women with PD. Methods We conducted a cross-sectional study with 100 women with PD (Hoehn and Yahr stages 1–3) who reported an active sex life in the last six months. Data were collected via remote interviews and included demographic and clinical features, cognitive capacity, motor and non-motor experiences, fatigue, self-esteem, sleep disorders, couple relationship quality, depressive symptoms, and sexual health assessments using the Female Sexual Function Index (FSFI) and Sexual Quotient-Female (SQ-F). Multiple regression models were used to identify predictors of FSFI and SQ-F scores. Results Results indicated that while several motor, non-motor, and social factors correlated with sexual health, only couple relationship quality and sleep quality significantly predicted both short-term (FSFI) and long-term (SQ-F) sexual health. No significant associations were observed with age, disease onset, postmenopausal status, or daily medication dosage. Conclusions The present study's evidence identifies multiple key areas, such as couple's relationship quality and sleep quality that could be targeted for intervention to improve sexual health in women with PD.

AbstractDevelopmental and epileptic encephalopathies (DEEs) are a group of rare, severe, early-onset epilepsies characterized by pharmacoresistance, marked electroencephalographic abnormalities, and delayed or regressive psychomotor development. DEEs are associated with poor long-term outcomes and increased mortality; however, early recognition and targeted treatment can impact neurodevelopmental outcomes and overall quality of life. Treatment with antiseizure medication is often challenging given drug resistance, chronic polypharmacy, and medication interactions. With advances in genetic testing and increased understanding of the neurobiological mechanisms of DEEs, the treatment approach is evolving and includes repurposed antiseizure medications and targeted therapies, as well as early surgical intervention in select patients. In addition to high seizure burden and neurodevelopmental delay, DEEs are associated with comorbidities affecting a range of body systems; these can include intellectual disability, psychiatric disorders, motor dysfunction, and respiratory and gastrointestinal problems. Over time, these comorbidities increase the complexity of management and have important implications on the disease burden and quality of life for both patients and their caregivers. Multidisciplinary care in DEEs is paramount. We summarize the current evidence on the management of specific DEEs, focusing on targeted therapies and optimizing outcomes.

PURPOSE To investigate the clinical behavior of breast cancer in young BRCA carriers according to the specific BRCA gene ( BRCA1 v BRCA2 ) and the association of the timing of genetic testing (before v at diagnosis) with prognosis. METHODS This was an international, multicenter, hospital-based, retrospective cohort study that included 4,752 patients harboring germline pathogenic/likely pathogenic variants (PVs) in BRCA1 or BRCA2 , who were diagnosed with stage I-III invasive breast cancer at 40 years or younger between January 2000 and December 2020 in 78 centers worldwide (ClinicalTrials.gov identifier: NCT03673306 ). RESULTS Compared with BRCA2 carriers (n = 1,683), BRCA1 carriers (n = 3,069) had more frequently hormone receptor–negative (74.4% v 15.5%) and high-grade (77.5% v 49.1%) tumors. Similar outcomes were observed in BRCA1 and BRCA2 carriers but with a different pattern and risk of disease-free survival events over time. Compared with patients tested for BRCA at diagnosis (ie, between 2 months before and up to 6 months after diagnosis; n = 1,671), those tested before diagnosis (ie, any time up to 2 months before diagnosis; n = 411) had smaller tumors (T1: 61.3% v 32.4%), less nodal involvement (N0: 65.9% v 50.8%), less frequently received chemotherapy (84.4% v 92.9%), and axillary dissection (37.5% v 47.4%). Patients tested before diagnosis had better overall survival (OS; unadjusted hazard ratio [HR], 0.61 [95% CI, 0.40 to 0.92]); however, this result lost statistical significance after adjustment for potential confounders including tumor stage (adjusted HR, 0.74 [95% CI, 0.47 to 1.15]). CONCLUSION This global study provides evidence on the different clinical behavior of breast cancer in young BRCA1 and BRCA2 carriers. Identifying a BRCA PV in healthy individuals was associated with earlier-stage breast cancer diagnosis and lower treatment burden, as well as better unadjusted OS.

Accurate assessment of GFR is key in patients with cancer to guide drug eligibility, adjust dosing of systemic therapy, and minimize the risks of undertreatment and systemic toxicity. Several aspects of GFR evaluation in patients with cancer have been unclear, such as the choice of the GFR estimating equation and the overall lack of data on the reliability of new filtration markers, such as cystatin C. This uncertainty has led to concerns that inaccurate GFR estimation may have a large effect on clinical practice and research. Recent data have brought important developments to the field. The new and timely Kidney Disease Improving Global Outcomes 2024 Clinical Practice Guideline for the Evaluation and Management of CKD raised important considerations and provided guidance on key aspects of GFR evaluation in patients with cancer. The guidelines cover valid estimating equations, incorporation of cystatin C in GFR estimation, drawbacks of using race in GFR estimation, and acknowledge that non-GFR determinants of filtration markers may be prominent in patients with cancer, reducing the accuracy of GFR estimating equations, prompting greater utilization of GFR measurement. The aim of this review is to summarize advances in GFR evaluation in patients with cancer considering the new Kidney Disease Improving Global Outcomes guidelines and other recent data.