Comparison of peri-operative core temperature in obese and non-obese patients*

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comparison of Macintosh and AirtraqTM laryngoscopes in obese patients placed in the ramped position

This study compared intubation conditions produced by the Macintosh and AirtraqTM laryngoscopes when used in obese patients in the ramped position. One hundred and thirty-two patients having bariatric surgery were placed in the ramped position and randomly assigned to have their tracheas intubated using either the Macintosh (n = 64) or an Airtraq (n = 68) laryngoscope. Mean (SD) intubation times were 37 (23) s and 14 (3) s for Macintosh and Airtraq, respectively (p < 0.0001). Compared with the Macintosh laryngoscope, the Airtraq laryngoscope provided an improved vocal cord view as assessed by the Cormack and Lehane score (number of patients with Cormack-Lehane scores of 1/2/3/4/37/20/4/3 for the Macintosh, and 65/3/0/0 for the Airtraq laryngoscopes, p < 0.0001). One patient in the Macintosh group had a failed intubation and intubation was achieved with the Airtraq. For obese patients in ramped position, Airtraq affords faster tracheal intubation than the Macintosh laryngoscope.

Evaluation of obstructive sleep apnea in obese patients scheduled for bariactric surgery

PURPOSE: To evaluate the frequency of obstructive sleep apnea (OSA) in obese patients scheduled for bariatric surgery and their identification for risk of OSA by Berlin Questionnaire (BQ) and excessive daytime sleepiness by Epworth Sleepiness Scale (ESS). METHODS: Fifty nine patients were evaluated by BQ and ESS. Out of these individuals, 35 performed a full-night sleep study using a type 3 portable monitoring (PM). The questionnaire results were compared for gender and BMI. The presence and severity of OSA was correlated with gender and both questionnaires. RESULTS: 94.75% of the respondents presented high risk for OSA by BQ and 59.65% presented positivity by ESS. Taking into account the AHI> 5 per hour for OSA diagnosis, all of them presented OSA, average AHI of 45.31±26.3 per hour and 68.6% have severe OSA (AHI>30). The male patients had a higher AHI (p<0.05). There was a positive correlation between the positivity in both questionnaires as well as the severity of OSA measured by AHI (p<0.05). CONCLUSION: The frequency and severe obstructive sleep apnea in the studied group is high. The Berlin Questionnaire and Epworth Sleepiness Scale had a positive correlation with the diagnosis of OSA in the group studied.

Obesity and Physical Activity in the Daily Life of Patients with COPD

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Sleep duration in elderly obese patients correlated negatively with intake fatty

Study objectives: The purpose of the present study was to evaluate the relationship between sleep duration and dietary habits in elderly obese patients treated at an institute of cardiology.Methods: The fifty-eight volunteers were elderly patients with obesity (classified as obese according to BMI) of both genders, between 60 and 80 years of age. All participants were subjected to assessments of food intake, anthropometry, level of physical activity, and duration of sleep.Results: The men had significantly greater weight, height, and waist circumference than women. Sleep durations were correlated with dietary nutrient compositions only in men. We found a negative association between short sleep and protein intake (r = -0.43; p = 0.02), short sleep and monounsaturated fatty acids intake (r = -0.40; p = 0.03), and short sleep and cholesterol dietary intake (r = -0.50; p = 0.01).Conclusions: We conclude that mainly in men, volunteers that had short sleep duration showed a preference for high energy-density as fatty food, at least in part, may explain the relationship between short sleep duration and the development of metabolic abnormalities.

Response to Chemotherapy in Overweight/Obese Patients With Low-Risk Gestational Trophoblastic Neoplasia

Objective Despite rising global obesity rates, the impact of obesity on gestational trophoblastic neoplasia (GTN) remains uninvestigated. This study aimed at investigating whether overweight/obesity relates to response to chemotherapy in low-risk GTN patients.Methods This nonconcurrent cohort study included 300 patients with International Federation of Gynecology and Obstetrics-defined postmolar low-risk GTN treated with a single-agent chemotherapymethotrexate or actinomycin-D (actD)between 1973 and 2012 at the New England Trophoblastic Disease Center. Chemotherapy dosing was based on actual body weight regardless of obesity status, except for 5-day courses or pulse regimens of actD. Patients were classified as overweight/obese (body mass index [BMI] 25 kg/m(2)) or non-overweight/obese (BMI <25 kg/m(2)). Information on patient characteristics and response to chemotherapy (need for second-line chemotherapy, reason for changing to an alternative chemotherapy, number of cycles, need for combination chemotherapy, and time to human chorionic gonadotropin remission) was obtained.Results Of 300 low-risk GTN patients, 81 (27%) were overweight/obese. Overweight/obese patients were older than the non-overweight/obese patients (median age: 30 vs 28 years, P = 0.004). First-line therapy using actD was more frequent in overweight/obese patients (6.2% vs 1.4%, P = 0.036). Resistance and toxicity were similar between groups. No significant difference in the number of chemotherapy cycles needed for remission or time required to achieve remission was found between groups.Conclusions No association between overweight/obesity and low-risk GTN outcomes was found. Current chemotherapy dosing using BMI seems to be appropriate for overweight/obese patients with low-risk GTN.

Gene polymorphisms and increased DNA damage in morbidly obese women

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Preanesthetic assessment data do not influence the time for tracheal intubation with Airtraq (TM) video laryngoscope in obese patients

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Steatosis and hepatic markers before and shortly after bariatric surgery

Background We present new findings on liver steatosis detected in a group of 20 morbidly obese patients who were reassessed shortly after bariatric surgery (BS) by assaying hepatic markers in their serum.Methods We assayed aspartate aminotransferase (AST), alanine aminotransferase, lactate dehydrogenase, alkaline phosphatase, gamma-glutamyl transferase (gamma-GT), cholinesterase, cholesterol, total protein, and albumin, and measured the weight and the body mass index (BMI) of patients, before and one and three months after surgery.Results There were significant reductions in BMI following surgery and also falls in transaminases and gamma-GT activities three months after BS. No changes occurred in other parameters between periods, except that cholesterol was above reference values before BS and fell to normal levels three months after BS.Conclusions We suggest that before undergoing surgery, the patients suffered from slight steatosis, while after BS the reduction in AST and gamma-GT indicated that this condition was corrected within three months. Moreover, these enzymes may be useful markers for excess fat in the liver.

Menstrual irregularity: a possible clinical marker of metabolic dysfunction in women with class III obesity

Purpose. To evaluate whether menstrual irregularity in morbidly obese women is indicative of metabolic dysfunction.Patients and Methods. Fifty-seven women with morbid obesity were evaluated. They were divided into two groups: one comprising women without menstrual dysfunctions or hirsutism (Group 1), and another obese women showing menstrual dysfunction with or without hirsutism (Group 2). The following were evaluated: age, colour, childbirth, marital status, profession, socio-economic level, education, age at menarche, body weight, height, body mass index, presence of hirsutism (Ferriman Gallwey Index), abdominal circumference, hip circumference, waist-to-hip ratio, menstrual cycle, blood pressure, presence of acanthosis nigricans, insulin resistance (IR), fasting glycaemia, total cholesterol, HDL-C, LDL-C, triglycerides, thyroid-stimulating hormone, free T4, luteinising hormone (LH), follicle-stimulating hormone, prolactin, total testosterone, dehydroepiandrosterone sulfate, insulin and the Homeostasis Model Assessment (HOMA test).Results. Clinical and epidemiological aspects did not present statistical differences. Clinical and laboratory parameters did not show statistically significant alterations; however, HOMA test values for Group 2 were significantly higher than those for Group 1.Conclusions. The presence of IR in class III obese women can cause menstrual dysfunctions such as amenorrhoea or oligomenorrhoea even in the absence of hyperandrogenism, suggesting that IR plays an important role in the ovarian mechanisms involved in the menstrual cycle control.

Estudo da apneia do sono em pacientes obesos em programação de cirurgia bariátrica

Pós-graduação em Bases Gerais da Cirurgia - FMB

Análise de agrupamentos para a classificação de pacientes submetidos à cirurgia bariátrica Fobi-Capella

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Altered plasma response to zinc and iron tolerance test after Roux-en-Y gastric bypass

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Resistência à insulina em mulheres com síndrome dos ovários policísticos: relação com as variáveis antropométricas e bioquímicas

OBJETIVO: Analisar a prevalência de resistência à insulina de acordo com diferentes medidas antropométricas e bioquímicas em mulheres com síndrome dos ovários policísticos. MÉTODOS: Foram analisadas, retrospectivamente, 189 pacientes com síndrome dos ovários policísticos. O diagnóstico de resistência à insulina foi obtido utilizando-se insulinemia, HOMA-IR, QUICKI, índice de sensibilidade à insulina e relação glicemia/insulina. Foram utilizados o índice de massa corpórea e o lipid accumulation product. Para análise dos resultados, aplicou-se a estatística descritiva, a ANOVA, o pós-teste de Tukey e a correlação de Pearson. RESULTADOS: As pacientes apresentaram média de idade de 24,9±5,2 e de índice de massa corpórea de 31,8±7,6. O percentual de pacientes obesas foi de 57,14%. Dentre os métodos de investigação de resistência à insulina, o índice de sensibilidade à insulina foi a técnica que mais detectou (56,4%) a presença de resistência à insulina nas mulheres com síndrome dos ovários policísticos. em 87% das pacientes obesas, detectou-se a resistência à insulina. A relação glicemia/insulinemia de jejum e o índice de sensibilidade à insulina apresentaram correlação forte com o lipid accumulation product. CONCLUSÃO: A prevalência de resistência à insulina variou de acordo com o método utilizado e foi maior quanto maior o índice de massa corpórea. O lipid accumulation product também está relacionado à resistência à insulina.