Barrett’s esophagus: Review of natural history and comparative efficacy of endoscopic and surgical therapies

Barrett's esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC). Progression to cancer typically occurs in a stepwise fashion through worsening dysplasia and ultimately, invasive neoplasia. Established EAC with deep involvement of the esophageal wall and/or metastatic disease is invariably associated with poor long-term survival rates. This guides the rationale of surveillance of Barrett’s in an attempt to treat lesions at an earlier, and potentially curative stage. The last two decades have seen a paradigm shift in management of Barrett’s with rapid expansion in the role of endoscopic eradication therapy (EET) for management of dysplastic and early neoplastic BE, and there have been substantial changes to international consensus guidelines for management of early BE based on evolving evidence. This review aims to assist the physician in the therapeutic decision-making process with patients by comprehensive review and summary of literature surrounding natural history of Barrett’s by histological stage, and the effectiveness of interventions in attenuating the risk posed by its natural history. Key findings were as follows. Non-dysplastic Barrett’s is associated with extremely low risk of progression, and interventions cannot be justified. The annual risk of cancer progression in low grade dysplasia is between 1%-3%; EET can be offered though evidence for its benefit remains confined to highly select settings. High-grade dysplasia progresses to cancer in 5%-10% per year; EET is similarly effective to and less morbid than surgery and should be routinely performed for this indication. Risk of nodal metastases in intramucosal cancer is 2%-4%, which is comparable to operative mortality rate, so EET is usually preferred. Submucosal cancer is associated with nodal metastases in 14%-41% hence surgery remains standard of care, except for select situations.     

Movement control as an effective measure against Covid-19 spread in Malaysia: an overview

Journal of Public Health - The first Covid-19 cases were reported in Malaysia on 25 January 2019 followed by a quiescent period before an upward swing of the cases at the end of February 2020,...     

Standardisierte Kontrastmittelsonographie (CEUS) in der klinischen Akut- und Notfallmedizin sowie Intensivmedizin (CEUS-Akut)

Die Anaesthesiologie -     

Comparison of visual outcomes after two types of mix-and-match implanted trifocal extended-depth-of-focus and trifocal intraocular lenses

Graefe's Archive for Clinical and Experimental Ophthalmology - To compare visual outcomes between two types of mix-and-match implanted trifocal extended-depth-of-focus (EDoF) and trifocal...     

A Legal Approach to Cancer Epidemiology in Public Health

The Public Health Act encompasses scientific research and law enforcement as causes, distributions, and preventive factors for diseases and injuries of a particular population. Today, the Public Health Law is growing into a field that expects to cultivate and utilize lawful practitioners who can apply specialized legal skills in health policy development and public health performance. The multidisciplinary approach of the Public Health Act integrates the legal and scientific elements of the field and the workforce, characterized by a more dynamic understanding of the health impact of legislation and the rapid deployment of effective policies. Thus, legal health interventions that manage and treat diverse populations need to be evaluated more rigorously and quickly. In addition, funding for policy surveillance and other legislation and policy mapping needs to be more sophisticated to maximize utility and avoid duplication. This study investigated legal interventions to manage and treat various groups of populations for health and discussed the necessity of public health laws.