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Esophageal surgery has traditionally been associated with high morbidity rates. Despite the recent advances in the field of minimally invasive surgery and the introduction of enhanced recovery after surgery (ERAS) protocols, post-esophagectomy morbidity, especially that attributed to the respiratory system, remains a concern. In that respect, preoperative intensification of oral care or introduction of structured oral/dental hygiene regimens may lead to tangible postoperative benefits associated with reduced morbidity (respiratory or otherwise) and length of hospital stay. A systematic literature search of the Medline, Embase, Web of Knowledge and clinicaltrials.gov databases was undertaken for studies reporting use of preoperative oral/dental hygiene improvement regimens in patients scheduled to undergo esophagectomy for esophageal cancer. Meta-analysis was performed using a random-effects model. After screening 796 unique studies, seven were deemed eligible for inclusion in the meta-analysis. Pooled results indicated equivalent postoperative pneumonia rates in the oral pretreatment group and control groups (8.7 vs. 8.5%, respectively); however, the odds for developing pneumonia were reduced by 50% in the pretreatment group (odds ratio 0.5, 95% C.I. 0.37 to 0.69, P  < 0.001). No statistically significant difference was detected in the anastomotic leak (odds ratio 0.93, 95% C.I. 0.38 to 2.24, P  = 0.87) and length of stay outcomes (mean difference 0.63, 95% C.I. −3.22 to 4.47, P  = 0.75). Oral/dental pretreatment reduces the odds for developing post-esophagectomy pneumonia. This finding should be cautiously interpreted given the significant limitations inherent in this meta-analysis. Further investigation via well-designed clinical trials is thus warranted before implementation in routine practice can be recommended. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic has undoubtedly disrupted the well-established, traditional structure of medical education. Τhe new limitations of physical presence have accelerated the development of an online learning environment, comprising both of asynchronous and synchronous distance education, and the introduction of novel ways of student assessment. At the same time, this prolonged crisis had serious implications on the lives of medical students including their psychological well-being and the impact on their academic trajectories. The new reality has, on many occasions, triggered the 'acting up' of medical students as frontline healthcare staff, which has been perceived by many of them as a positive learning and contributing experience, and has led to a variety of responses from the educational institutions. All things considered, the urgency for rapid and novel adaptations to the new circumstances has functioned as a springboard for remarkable innovations in medical education,including the promotion of a more "evidence-based" approach. [ABSTRACT FROM AUTHOR]

Background Esophageal cancer patients often suffer from malnutrition. Older people constitute a group of patients more susceptible to nutritional status deterioration. The aim of this study is to investigate the differences in nutritional status between elderly patients and patients younger than 65 years of age with esophageal and gastroesophageal junction cancer. Methods The study sample consisted of 73 patients with esophageal (n = 11) and gastroesophageal junction cancer (n = 62) who were admitted for surgery in the First Department of Surgery, Laikon General Hospital, Athens, Greece, between September 2015 and December 2017. Patients were divided into 2 groups according to their age, those younger than 65 years (n = 39) and those older than 65 years (n = 34). The preoperative assessment of nutritional status was based on Patient Generated Subjective Global Assessment (PG-SGA), laboratory tests, anthropometric measurements, handgrip strength, unintentional weight loss during the last six months and Skeletal Muscle Index (SMI) derived from analysis of CT scans. Results Malnutrition and sarcopenia were more prevalent in the group of older patients compared to the group of younger ones (73.5% vs 41%, P  < 0.05 and 60% vs 35.3%, P  < 0.05). PG-SGA was significantly higher in elderly patients (12.35 vs 8.23, P  < 0.05), while SMI and handgrip strength were significantly lower in elderly patients (48.47 cm2/m2 vs 55.5 cm2/m2, P  < 0.05 and 31 kg vs 39.1 kg, P  < 0.05 respectively). Among the laboratory tests, albumin, hemoglobin and hematocrit were lower in the group of older patients (3.86 g/dL vs 4.15 g/dL, P  < 0.05, 12.25 g/dL vs 13.17 g/dL, P  < 0.05 and 36.5 vs 39.5, P  < 0.05, respectively), whereas platelet-to-lymphocyte ratio was higher (205.4 vs 156.2, P  < 0.05). Concerning anthropometric measurements, corrected mid arm muscle area and calf circumference were lower in older patients (42.15 cm2 vs 49.26 cm2, P  < 0.05 and 34.86 cm vs 36.89 cm, P  < 0.05, respectively), whereas no significant differences were observed in Body Mass Index values and unintentional weight loss between the two groups. Conclusion Geriatric patients with esophageal and gastroesophageal junction cancer have more compromised nutritional status compared to their younger counterparts. Preoperative nutritional assessment should be performed in all such patients in order to detect those who will benefit from perioperative nutritional support. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]