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BackgroundClozapine, an antipsychotic with unique efficacy in treatment-resistant psychosis, is associated with increased susceptibility to infection, including pneumonia.AimsTo investigate associations between clozapine treatment and increased risk of COVID-19 infection in patients with schizophrenia-spectrum disorders who are receiving antipsychotic medications in a geographically defined population in London, UK.MethodUsing information from South London and Maudsley NHS Foundation Trust (SLAM) clinical records, via the Clinical Record Interactive Search system, we identified 6309 individuals who had an ICD-10 diagnosis of schizophrenia-spectrum disorders and were taking antipsychotics at the time of the COVID-19 pandemic onset in the UK. People who were on clozapine treatment were compared with those on any other antipsychotic treatment for risk of contracting COVID-19 between 1 March and 18 May 2020. We tested associations between clozapine treatment and COVID-19 infection, adjusting for gender, age, ethnicity, body mass index (BMI), smoking status and SLAM service use.ResultsOf 6309 participants, 102 tested positive for COVID-19. Individuals who were on clozapine had increased risk of COVID-19 infection compared with those who were on other antipsychotic medication (unadjusted hazard ratio HR = 2.62, 95% CI 1.73–3.96), which was attenuated after adjusting for potential confounders, including clinical contact (adjusted HR = 1.76, 95% CI 1.14–2.72).ConclusionsThese findings provide support for the hypothesis that clozapine treatment is associated with an increased risk of COVID-19 infection. Further research will be needed in other samples to confirm this association. Potential clinical implications are discussed.

This paper evaluates effective dose (ED) of overweight and obese patients who undergo body computed tomography (CT) examinations. ED calculations were based on tissue weight factors in the International Commission on Radiological Protection Publication 103 (ICRP 103). ED per unit dose length product (DLP) are reported as a function of the tube voltage, body mass index (BMI) of patient. The VirtualDose software was used to calculate ED for male and female obese phantoms representing normal weight, overweight, obese 1, obese 2 and obese 3 patients. Five anatomic regions (chest, abdomen, pelvis, abdomen/pelvis and chest/abdomen/pelvis) were investigated for each phantom. The conversion factors were computed from the DLP, and then compared with data previously reported by other groups. It was observed that tube voltage and BMI are the major factors that influence conversion factors of obese patients, and that ED computed using ICRP 103 tissue weight factors were 24% higher for a CT chest examination and 21% lower for a CT pelvis examination than the ED using ICRP 60 factors. For body CT scans, increasing the tube voltage from 80 to 140 kVp would increase the conversion factors by as much as 19–54% depending on the patient's BMI. Conversion factor of female patients was ~7% higher than the factors of male patients. DLP and conversion factors were used to estimate ED, where conversion factors depended on tube voltage, sex, BMI and tissue weight factors. With increasing number of obese individuals, using size-dependence conversion factors will improve accuracy, in estimating patient radiation dose.

BackgroundMental capacity to consent to treatment in anorexia nervosa is a neglected area in clinical decision-making.AimsTo examine clinical and neuropsychological parameters associated with diminished mental capacity in anorexia nervosa.MethodAn explorative study was conducted in 70 adult female patients with severe anorexia nervosa. Mental capacity to consent to treatment was assessed by experienced psychiatrists. Further measurements included the MacCAT-T (to assess mental capacity status), a range of clinical measures (body mass index (BMI) and comorbidity) and neuropsychological tests assessing decision-making, central coherence and set-shifting capacity.ResultsDiminished mental capacity occurs in a third of patients with severe anorexia nervosa and is associated with a low BMI, less appreciation of illness and treatment, previous treatment for anorexia nervosa, low social functioning and poor set shifting.ConclusionsAssessment of diminished mental capacity in anorexia nervosa requires careful evaluation of not only BMI, but also the degree of appreciation of illness and treatment, history and the tendency to have a rigid thinking style.

This study presents an investigation of adult effective dose (E) per unit Kerma-Area Product (KAP) in Modified Barium Swallow Study (MBSS) examinations. PC program for X-ray Monte Carlo (version 2.0.1) was used to calculate patient organ doses during MBSS examinations, which used combined to generate effective dose. Normalized patient doses were obtained by dividing the effective dose (mSv) by the incident KAP (Gy·cm2). Five standard projections were studied and the importance of X-ray beam size and in patient size (body mass index) were investigated. Lateral projections had an average E/KAP conversion factor of 0.19 ± 0.04 mSv/Gy·cm2. The average E/KAP was highest for upper gastrointestinal (GI) anterior-posterior projections (0.27 ± 0.04 mSv/Gy·cm2) and lowest for upper GI posterior-anterior projections (0.09 ± 0.03 mSv/Gy·cm2). E/KAP always increased with increasing filtration and/or X-ray tube voltage. Reducing the X-ray beam cross-sectional area increased the E/KAP conversion factors. Small patients have the E/KAP conversion factors that are twice those of a standard adult. Conversion factors for effective dose of adult patients undergoing MBSS examinations must account for X-ray beam projection, beam quality (kV and filtration), image size and patient size.

Background Foundation Year One (FY1) doctors are often the first medical staff responders at in-hospital cardiac arrests. The study objectives were to assess the cardiopulmonary resuscitation (CPR) skills of FY1 doctors at a Belfast teaching hospital and to highlight factors that influence their performance. Methods A group of FY1 doctors working in a Belfast teaching hospital were asked to participate in this study. These junior doctors were regularly on-call for acute medical emergencies including cardiac arrest. Participants were instructed to perform two, 3 minute sessions of CPR on a skills reporter manikin. Each session was separated by a 5 minute rest period, one session using a compression-to-ventilation ratio of 15:2 and the other using a ratio of 30:2. Performance was gauged both objectively, by measuring the depth of chest compressions, and subjectively by a panel of 5 Advanced Life Support (ALS) instructors who reviewed the tracings of each CPR session. Results Overall, 85% of medical FY1's working in the hospital participated in the study. Objective results determined that males performed significantly better than their female counterparts using both the 15:2 and 30:2 ratios. The male FY1 doctors performed equally well using both 15:2 and 30:2 ratios, in comparison to female doctors who were noted to be better using the 15:2 ratio. Individuals with a Body mass index (BMI) greater than the mean for the group, performed significantly better than those with a lower BMI when using the 30:2 ratio. BMI was an important factor and correlated with chest compression depth. Females with a low BMI performed less well when using a ratio of 30:2. Overall, expert opinion significantly favoured the 15:2 ratio for the FY1 doctor group. Conclusion CPR performance can be influenced by factors such as gender and BMI, as such the individual rescuer should take these into account when determining which compression to ventilation ration to perform in order to maximise patient outcome. This study showed that males and those females with a BMI of >24 performed satisfactory CPR when using the recommended Resuscitation Council guidelines. Females with a BMI

Aims Achalasia is a rare incurable neuromuscular disorder of the oesophagus. A number of treatment options are available. We reviewed our results of laparoscopic cardiomyotomy over a 30 month period. Methods 18 patients with manometric features of achalasia underwent surgery between 2004 and 2006. Pre and postoperative weight and dysphagia scores were recorded (maximum score 45=normal, 0=complete dysphagia). Change in the Body Mass Index (BMI) was measured. Other symptoms (heartburn, epigastric pain, regurgitation, odynophagia and sleep disturbance) were scored on a 0–4 scale of increasing severity. Results At mean follow up of 16.2 months the mean dysphagia score was significantly improved from 7.5 to 33.9 (p

BACKGROUND: The Moorehead-Ardelt II (MA-II) questionnaire is the most frequently applied instrument to assess quality of life (QoL) in bariatric surgery patients. Our aim was to validate the Czech, German, Italian, and Spanish version of the MA-II. METHODS: A total of 893 patients were enroled in a prospective cross-sectional European study. Two thirds of the patients (n = 591) were postsurgical cases. In addition to demographic and clinical data, QoL data was collected using the MA-II questionnaire, the EuroQoL-5D (EQ-5D),and the Short Form 36 Health Survery (SF-36). Statistical parameters for contingency (Cronbach's alpha),construct and criterion validity (Pearson's r),and responsiveness (standardised effect sizes) were calculated for each language version. RESULTS: In the different languages, Cronbach's alpha ranged from 0.817 to 0.885 for the MA-II. These values were higher than those obtained for the SF-36 (0.418–0.607). The MA-II was well correlated to the EQ-5D (r = 0.662) and to 3 of the 8healthdomains of the SF-36 (0.615, 0.548, and 0.569 for physical functioning, physical role, and general health, respectively). As expected, there was a negative correlation between the MA-II and the BMI (r = −0.404 for all patients), but no significant correlation with age was found. When comparing both the heaviest and the lightest third of the patients, mean responsiveness was higher for the MA-II (−1.138) than for the domains of the SF-36 (range −0.111 to −1.070) and the EQ-5D (−0.874). CONCLUSION: The Czech, German, Italian, and Spanish version of the MA-II questionnaire are valid instruments and should be preferred to generic questionnaires as they provide better responsiveness.

BACKGROUND: Gastric balloon therapy (GBT)is a temporay, nonsurgical treatment for obesity. This retrospective study evaluates safety and efficacy of GBT in obese patients. METHODS: The BioEnterics® Intragastric Balloon (BIB) was endoscopically implanted into each patient's stomach and inflated with saline (450–750 ml). Extraction was planned after 6 months. Data from 190 patients receiving GBT were evaluated. Mean weight was 168.4 − 58.9 kg (range 76.5–310.0) and mean BMI was 55.6 − 17.5 kg/m(2) (range 27.0–95.7). RESULTS: Mean weight loss at the time of balloon removal was 21.2 − 14.0 kg (range 0–80.0). The mean BMI loss and EBL (Excess BMI Loss) were 7.2 − 4.9 kg/m(2) (range 0–28.9) and 30.1 − 26.4% (0–184.4), respectively. The most substantial weight and BMI loss was observed in the most massively obese patients. Minor complications at implantation were encountered in 2 cases (1.1%) due to leakage of the balloon, and in 3 cases at explantation (1.6%). No mortality or major complications such as gastric perforation or ulcers occurred. Of the 190 patients, 76 received subsequent surgery (40.0%). Of those, 7 patients had a BMI < 50 kg/m(2) while all other patients where super-obese(BMI > 50 kg/m(2)). 58 patients (30.5%) with a BMI > 60 kg/m(2) which had an extra ordinary high operation risk were able to receive subsequent surgical treatment because of a substantial weight loss and/or reduced comorbidity. CONCLUSION: GBT appears to be a safe, tolerable, and potentially effective procedure for the initial treatment of morbid obesity.

BACKGROUND: The success rate of laparoscopic adjustable gastric banding (LAGB)in the treatment of morbid obesity isvery variable. A reasonable preoperative selection of eligible patients seems to be important for a successful outcome of LAGB. In the present study, criteria were investigated to predict the outcome of LAGB. METHODS: 85 morbidly obese patients were operated with LAGB between 1999 and 2005. 71of these patients were analysed according to several possible predictive parameters of success or failure of LAGB. Success was defined as excess bodyweight loss (EBWL) > 50% without band removal, failure was defined as EBWL < 20% and/or band removal. Median follow-up was 27 months (range 8–90 months). RESULTS: After LAGB a median EBWL of 43%(−41 to171.5%) was observed in all patients with a decrease in BMI of 8.0 kg/m(2) (– 9 to 35 kg/m(2)). The success rate after LAGB was 37%, the failure rate 19.7%. Female sex (p = 0.023), baseline weight (p = 0.024), and eating behaviour after LAGB (p = 0.008) were significant predictors of success following LAGB, whereas complications such as port dislocation and reoperation after LAGB did not have a significant impact on a successful course following LAGB. Significant predictors of failure were male sex (p = 0.038) and missing physical activity after LAGB (p = 0.045), where as the eating behaviour did not have a significant effect concerning failure following LAGB. Baseline excess body weight (EBW) was identified as an independent predictor of failure in a multivariate analysis. CONCLUSION: According to the results of this study, female patients with a lower EBW who improve their postoperative eating behaviour have the best chanceof success following LAGB.

Objectives To describe lung function in correlation with information on exposure to dust and fibers in soft tissue paper-producing factories in Germany. Methods Ambient monitoring was performed for inhalable, respirable dust and fibers in nine soft tissue paper-producing factories. In a study group of 1,047 workers (189 control subjects, 240 workers with moderate exposure, and 618 workers with high exposure), spirometry (FVC, FEV 1 ) was performed. Information on occupational history, duration of exposure, workshop within the company, former occupational exposures, and smoking habits were collected. By employing multiple linear regression modeling, the potentially confounding effects of age, sex, body mass index, smoking habits, and factory were incorporated into the analysis of FVC, FEV 1 , and FEV 1 in percent of FVC (FEV 1 %FVC). By employing a logistic regression model, odds ratios were calculated for FVC Results The mean concentrations for inhalable, respirable, and fibrous dusts were 12.4 mg/m 3 , 0.28 mg/m 3 , and 420,000 fibers per cubic meter. With relation to cumulative dust and fiber exposure, a decrease of FVC from 105.4% predicted to 96.9% predicted (dust) and 97.1% predicted (fibers) in the subgroup with highest cumulative exposure was observed. For FEV 1 , a decrease from 107.3% predicted to 103.0% predicted (dust) and 102.8% predicted (fibers) was found. The parameter estimates show dose-response relationships that are more pronounced for FVC compared to FEV 1 . FEV 1 %FVC did not change significantly with increasing cumulative exposure, indicating a restrictive pattern of the findings. Conclusions Due to high ambient dust concentrations and the observed adverse effects on lung function, a reduction of dust exposure and secondary preventive measures is advised.

Objective: To study whether lower arterial oxygen saturation (SaO2) and chronic obstructive pulmonary disease (COPD) are associated with cerebral white matter lesions and lacunar infarcts. Methods: We measured SaO2 twice with a pulse oximeter, assessed the presence of COPD, and performed MRI in 1077 non-demented people from a general population (aged 60–90 years). We rated periventricular white matter lesions (on a scale of 0–9) and approximated a total subcortical white matter lesion volume (range 0–29.5 ml). All analyses were adjusted for age and sex and additionally for hypertension, diabetes, body mass index, pack years smoked, cholesterol, haemoglobin, myocardial infarction, and left ventricular hypertrophy. Results: Lower SaO2 was independent of potential confounders associated with more severe periventricular white matter lesions (score increased by 0.12 per 1% decrease in SaO2 (95% confidence interval 0.01 to 0.23)). Participants with COPD had more severe periventricular white matter lesions than those without (adjusted mean difference in score 0.70 (95% confidence interval 0.23 to 1.16)). Lower SaO2 and COPD were not associated with subcortical white matter lesions or lacunar infarcts. Conclusion: Lower SaO2 and COPD are associated with more severe periventricular white matter lesions.

Background and objective: Obstructive sleep apnoea (OSA) is suggested to be associated with peripheral nerve damage. A case–control study was conducted to provide further support to this observation. In a longitudinal intervention study, it was examined whether treatment for OSA has a possible beneficial effect on peripheral nerve function. Methods: Participants were 23 patients with OSA and 23 controls matched for age and body mass index (BMI), all without any known cause of peripheral nerve damage. The sensory nerve action potential (SNAP) amplitudes of both sural nerves were determined. After 6 months of treatment for OSA, treatment compliance was evaluated and nerve conduction studies were repeated. Results: Patients with OSA had significantly lower mean (standard deviation) sural SNAP amplitudes than controls (6.3 (3.5) v 11.2 (5.0), p Conclusion: OSA is an independent risk factor for axonal dysfunction of peripheral sensory nerves. Impaired neural function is at least partly reversible with treatment for sleep apnoea.

BACKGROUND: Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany) since January 1, 2005. METHODS: In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an internet online data registry. Perioperative characteristics such as the spectrum of diagnostic measurements, type of surgical procedures, and short-and long-term out comes were investigated. RESULTS: During the study period 3,123 surgical procedures were performed. In 2005 and 2006, gastric banding (GB) was the operation performed most frequently, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean BMI ranged from 48.5 kg/m(2) in 2005 to 48.0 kg/m(2) in 2007. Follow-up data after 12 months were available for 63.8% of the patients operated in 2005 and 2006. The mortality was 0.1% (30 days) and 0.16% (overall). CONCLUSION: As indicated by the worldwide trend, there is an ongoing change from GB to sleeve gastrectomy (SG) and malabsorptive procedures. The BMI of German bariatric surgical patients is substantially higher than that of patients from most other countries. There were no differences in overall outcomes during follow-up as compared to published studies.

HINTERGRUND: Der temporÄre Einsatz eines Magenballons zur Behandlung der Adipositas Grad1 und 2 nimmt weltweit zu; bei der Adipositas Grad 3 wird der Magenballon als adjuvantes Hilfsmittel zur prÄoperativen Gewichtsreduktion implantiert. Ziel dieser retrospektiven Kohorten analyse ist, die Wirksamkeit des Magenballons auf Gewichtsreduzierung und das Risikoprofil der Methode zu evaluieren. METHODEN: Retrospektive Kohortenanalysen aus 4 Adipositas-Zentren, in denen der Magenballon seit 2001 regelmÄßig implantiert wurde. ERGEBNISSE: Von Februar2001 bis April 2008 wurde bei 634 Patienten ein Magenballon implantiert (BIBTM Intragastric Balloon System; Allergan Medical, Irvine, CA, USA). Die Geschlechterverteilung war 31,5% MÄnnerzu 68,5% Frauen; das Durchschnittsalter betrug 41,5 Jahre. Das durchschnittliche Ausgangsgewicht lag bei 126 kg. Der initiale BMI bei Implantation des Magenballons war 42,5 kg/m(2). Die Implantation der Prothese war in allen FÄllen unkompliziert. Der durchschnittliche Gewichtsverlust lag bei 20,75 kg bzw. 7,05 BMI-Punkten. SUMMARY: The Gastric Balloon — a Retrospective Cohort Analysis with 634 Patients BACKGROUND: The temporary use of a gastric balloon for the treatment of obesity grade 1 and 2 is increasing worldwide, whereas in grade 3 obesity, it is implanted as a tool for preoperative adjuvant weight loss. The aim of this retrospective cohort analysis is to evaluate the effectiveness of weight reduction and to describe the risk profile of the method. METHODS: Retrospective cohort analysis of 4 obesity centers where gastric balloons had been regularly implanted since 2001. RESULTS: Between February 2001 and April 2008, the gastric balloon (BIBTM Intragastric Balloon System; Allergan Medical, Irvine, CA, USA) was implanted in 634 patients. The gender ratio was 31.5% males to 68.5% females; the average age was 41.5 years. The average initial weight was 126 kg. The initial BMI at implantation of the gastric balloon was 42.5 kg/m2. The implantation of the prosthesis was uncomplicated in all cases. Average weight loss was 20.75 kg or 7.05 BMI points, respectively.

BACKGROUND: The choice between different bariatric procedures for each patient is an important question in bariatric surgery. In this article, we explain criteria for patient selection for laparoscopic Roux-en-Y gastric bypass at the Obesity Center Wuerzburg and compare the corresponding outcomes for these selection criteria. METHODS: 60 consecutive patients underwent gastric bypass surgery (34 female, 26 male; mean age 45.1–10.2 years). Mean preoperative BMI was 53.7 − 8.7 kg/m(2). Selection criteria were age > 40, male sex, BMI > 50, metabolic syndrome, and/or reduced compliance. RESULTS: 42 patients (70%) were > 40 years old, 26 patients (43%) were male, 42 patients (70%) had a BMI > 50, and 28 patients had a metabolic syndrome (47%). 10 out of these 60 patients were reoperated after failed gastric banding. Overall weight loss was 43.7–18.7 kg, BMI loss was 15.0–6.4 kg/m(2), and excess body weight loss (EBWL) was 54.3–19.7%. There were 34 patients with an EBWL of ≥50%. Age, sex, and presence or absence of metabolic syndrome were irrelevant for postoperative weight loss. Although the EBWL wass lightly higher in patients with a BMI < 50, patients with a BMI > 50 lost significantly more weight. DISCUSSION: The indication for a gastric bypass may be substantiated by the higher weight reduction in patients with a BMI > 50. Other selection criteria had no influence on the postoperative outcome.

Die Kriterien zur Indikation fÜr ein Gastric Banding (GB) oder einen Bypass sind in den bekannten Leitlinien nur unscharf definiert und orientieren sich meist am BMI der Patienten. In der vorliegenden Arbeitwerden neben dem BMI auch die Rolle von hormonalen Mediatoren, die mit der morbiden Adipositasverbunden sind, die KomplikationstrÄchtigkeit und die Langzeitresultatedes GB dem laparoskopischen Gastric Bypass gegenÜbergestellt, um gegebenenfalls Grenzen des GB aufzuzeigen. Laparoscopic Gastric Banding - Where Are the Limits? The criteria for the indication of gastric banding (GB) or bypass in morbidly obese patients are poorly defined in the available guidelines and usually rely on the BMI of the patients. In this study, the role of the BMI and of hormonal mediators associated with morbid obesity are outlined. Furthermore, the complications and long-termresults of GB are analyzed and compared with laparoscopic gastric bypass in order to define the limits of GB.

Background: To assess whether the premorbid dietary intake of fatty acids, cholesterol, glutamate or antioxidants was associated with the risk of developing amyotrophic lateral sclerosis (ALS). Methods: Patients referred to our clinic during 2001–2002, who had definite, probable or possible ALS according to El Escorial criteria, without a familial history of ALS, were asked to participate in a case–control study (132 patients and 220 healthy controls). A food-frequency questionnaire was used to assess dietary intake for the nutrients of interest. Multivariate logistic regression analysis was performed with adjustment for confounding factors (sex, age, level of education, energy intake, body mass index and smoking). Results: A high intake of polyunsaturated fatty acid (PUFA) and vitamin E was significantly associated with a reduced risk of developing ALS (PUFA: odds ratio (OR) = 0.4, 95% confidence interval (CI) = 0.2 to 0.7, p = 0.001; vitamin E: OR = 0.4, 95% CI = 0.2 to 0.7, p = 0.001). PUFA and vitamin E appeared to act synergistically, because in a combined analysis the trend OR for vitamin E was further reduced from 0.67 to 0.37 (p = 0.02), and that for PUFA from 0.60 to 0.26 (p = 0.005), with a significant interaction term (p = 0.03). The intake of flavonols, lycopene, vitamin C, vitamin B 2 , glutamate, calcium or phytoestrogens was not associated with the risk of developing ALS. Conclusion: A high intake of PUFAs and vitamin E is associated with a 50–60% decreased risk of developing ALS, and these nutrients appear to act synergistically.