Polimorfismos gênicos e danos no DNA em indivíduos com obesidade mórbida

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influência da prática de atividades físicas sobre os gastos com o tratamento ambulatorial de pacientes da rede pública de Bauru, São Paulo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Uso do Airtraq® em cirurgias bariátricas: influência do posicionamento

Pós-graduação em Anestesiologia - FMB

Influência da combinação de métodos de aquecimento no intraoperatório na temperatura central em pacientes obesas e não obesas durante anestesia venosa total

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Classificação de Mallampati em fonação para predição da dificuldade de intubação traqueal em obesos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação dos distúrbios metabólicos de pacientes obesas, grau III, antes e depois da cirurgia bariátrica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O hiperandrogenismo influencia no desenvolvimento de síndrome metabólica em pacientes com síndrome dos ovários policísticos?

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Influencia da obesidade na correlacao entre refluxo faringolaringeo e apneia obstrutiva do sono

Introdução:A apneia obstrutiva do sono (AOS) é causada por episódios recorrentes de obstrução total ou parcial da via aérea superior com duração superior a 10 segundos durante o sono. Refluxo faringolaríngeo (RFL) é uma variante da doença do refluxo gastroesofágico que afeta a laringe e a faringe.Objetivos:Avaliar a influência da obesidade na relação entre RFL e AOS em pacientes com SAOS.Materiais e métodos:Estudo observacional transversal retrospectivo. Foram revisados protocolos de atendimento de pacientes com AOS que incluem questionários validados para RFL como Reflux Sympton Index (RSI) e Reflux Finding Score (RSI), nasolaringofibroscopia e polissonografia.Resultados:Cento e cinco pacientes foram divididos em grupo de obesos (39 pacientes) e não obesos (66 pacientes). Na avaliação das médias do RSI o grupo de não obesos foi semelhante entre pacientes com AOS leve (11,96) e moderada (11,43). No grupo de obesos a média do RSI foi de 6,7 em pacientes com AOS leve e de 11,53 em pacientes com AOS moderada a grave (p < 0,05).Discussão:O subgrupo de pacientes com AOS e RFL apresenta vários fatores que promovem a inflamação da via aérea superior. Pacientes com AOS devem ser pesquisados e tratados quanto a RFL, aumentando a qualidade de vida.Conclusão:O RFL e a AOS se correlacionam positivamente em pacientes obesos.

Weight-Reducing Gastroplasty with Roux-en-Y Gastric Bypass: Impact on Vitamin D Status and Bone Remodeling Markers

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

Função Pulmonar de pacientes submetidos a Cirurgia Bariátrica

Introduction: Obesity is a risk factor for postoperative pulmonary complications. Overweight can alter respiratory mechanics and decrease lung volumes and capacities. Bariatric surgery (BS) has been used as treatment for morbid obesity, but this surgery can lead to respiratory complications. Objective: To evaluate pulmonary function in morbid obese patients undergoing bariatric surgery. Methods: The patients were submitted to pulmonary function testing, including slow and forced vital capacity (SVC and FVC), forced expiratory volume in the first second (FEV1), Tiffenau index (FEV1/FVC), forced expiratory flow 25-75% (FEF25-75%) and maximal inspiratory and expiratory pressure (MIP and MEP). Descriptive analysis was performed. Results: We evaluated 18 patients, mean age of 37.33 ± 11.23 years, height 1.65 ± 0.09 m, weight 125.92 ± 25.24 kg and BMI 46.34 ± 9 20 kg/m2 , SVC 100.64 ± 22.91%, FVC 102.04 ± 21.82%, FEV1 104.85 ± 22.16%, FEV1 /FVC 83.54 ± 6.63% and FEF25-75% 84.47 ± 25.74%, 99.75 ± 24.55 for MIP and MEP 102.12 ± 25.06 cmH2O. Conclusion: The bariatric surgery candidates had normal values for manovacuometry and spirometry.

Longer immediate recovery time after anesthesia increases risk of respiratory complications after laparotomy for bariatric surgery: a randomized clinical trial and a cohort study

We compared the effects of two anesthesia protocols in both immediate recovery time (IRT) and postoperative respiratory complications (PRCs) after laparotomy for bariatric surgery, and we determined the association between the longer IRT and the increase of PRC incidence. We conducted the study in two stages: (i) in a randomized controlled trial (RCT), patients received either intervention (sevoflurane-remifentanil-rocuronium-ropivacaine) or control protocol (isoflurane-sufentanil-atracurium-levobupivacaine). All patients received general anesthesia plus continuous epidural anesthesia and analgesia. Treatment was masked for all, except the provider anesthesiologist. We defined IRT as time since anesthetics discontinuation until tracheal extubation. Primary outcomes were IRT and PRCs incidence within 15 days after surgery. We also analyzed post-anesthesia care unit (PACU) and hospital length of stays; (ii) after the end of the RCT, we used the available data in an extension cohort study to investigate IRT > 20 min as exposure factor for PRCs. Control protocol (n = 152) resulted in longer IRT (30.4 ± 7.9 vs 18.2 ± 9.6 min; p < 0.0001), higher incidence of PRCs (6.58 vs 2.5 %; p = 0.048), and longer PACU and hospital stays than intervention protocol (n = 200); PRC relative risk (RR) = 2.6. Patients with IRT > 20 min (n = 190) presented higher incidence of PRCs (7.37 vs 0.62 %; p < 0.0001); RR = 12.06. Intervention protocol, with short-acting anesthetics, was more beneficial and safe compared to control protocol, with long-acting drugs, regarding the reduction of IRT, PRCs, and PACU and hospital stays for laparotomy in bariatric patients. We identified a 4.5-fold increase in the relative risk of PRCs when morbid obese patients are exposed to an IRT > 20 min.

Metformin versus lifestyle changes in treating women with polycystic ovary syndrome

Objective: To compare the efficacy of metformin with that of lifestyle changes in patients with polycystic ovary syndrome (PCOS). Design: Prospective, randomized clinical trial of 40 women with PCOS to analyze the effects of metformin and lifestyle intervention treatments on menstrual pattern and hormone and metabolic profile. The duration of treatment was 6 months. Statistical analysis was done using Student's t-test. Results: Fifteen women in the metformin group and 12 in the lifestyle changes group completed the study. The menstrual pattern improved by similar to 67% in both groups. There was a significant decrease in waist circumference in the lifestyle changes group (101.8 +/- 3.9 and 95.1 +/- 3.6, at baseline and at 6 months of treatment, respectively; p<0.001) and in body mass index (BMI) in both groups. The predictor of menstrual pattern improvement was BMI. Conclusions: Both metformin and lifestyle changes may increase the number of menstrual cycles in PCOS. This effect was related to a decrease in BMI.

Daily vitamin supplementation and hypovitaminosis after obesity surgery

Objective: The objective of this study was to determine whether constant daily vitamin supplementation would be sufficient to prevent possible vitamin deficiencies in obese patients undergoing bariatric surgery. Methods: The study was conducted on 58 men and women (mean age 41 +/- 10 y) who underwent Roux-en-Y gastric bypass RYGB and were assessed preoperatively and at 3, 6, and 12 mo after surgery. During the postoperative period, the patients received a multivitamin-mineral supplement on a daily basis. Results: Serum beta-carotene and vitamin C were lower starting from the third postoperative month and continued to be low after 12 mo, and vitamin A was decreased by the sixth month and increased by 12 mo. Vitamin B12 levels were stable up to 6 mo but were decreased by 12 mo. Folic acid levels increased from the third month and remained higher throughout follow-up. One year after surgery there were 19% and 21% increases in the number of patients with vitamin A and vitamin C deficiency, respectively, and a 4% decreased of patients with folic acid deficiency. Conclusion: Weight loss and improvement in patients' general condition followed surgery, but serum levels of some vitamins were decreased despite the use of a vitamin-mineral supplement. These patients need continuous follow-up and individualized prescription of supplementation after the surgical procedure to prevent and treat vitamin deficiencies. (C) 2012 Elsevier Inc. All rights reserved.

Reporting Results After Bariatric Surgery: Reproducibility of Predicted Body Mass Index

There is a controversy about the best way to report results after bariatric surgery. Several indices have been proposed over the years such as percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and percentage of excess body mass index loss (%EBMIL). More recently, it has been suggested to individualize the body mass index (BMI) goal to be achieved by the patients (predicted BMI-PBMI). The objective was to assess the reproducibility of this PBMI in our service. In this retrospective study, we assessed the %TWL, %EWL, %EBMIL (with expected BMI of 25 kg/m(2)), and %EBMIL (with PBMI) over 4 years of observation in two groups of patients: BMI < 50 kg/m(2) and BMI a parts per thousand yen50 kg/m(2). The medical records of 403 patients were studied. From 18 to 42 months after surgery, %TWL was higher in the superobese group, whereas %EWL was similar for the two groups. %EBMIL was higher in less obese patients up to 24 months and similar thereafter. In contrast, %EBMIL with PBMI was greater in the superobese group, although it never reached the 100% goal. We conclude that %EBMIL results according to PBMI were not reproducible in our institution. There is a need to elaborate a new easy-to-obtain and reproducible index.

Sleeve Gastrectomy With Transit Bipartition A Potent Intervention for Metabolic Syndrome and Obesity

Objective: To present 5-year results of sleeve gastrectomy (SG) with transit bipartition (TB) as a metabolic intervention for obesity. Background: Recent data suggest that high glycemic index foods may lead to a hormonally hyperactive proximal gut and a hypoactivate distal gut, which are linked to metabolic syndrome. TB was designed to counterbalance these effects. Methods: A total of 1020 obese patients with body mass index (BMI) ranging from 33 to 72 Kg/m(2) underwent SG and TB (SG + TB). TB creates a gastroileal anastomosis in the antrum after the SG; nutrient transit is maintained in the duodenum, avoiding blind loops and minimizing malabsorption. The stomach retains 2 outflow pathways. A lateral enteroanastomosis connects both segments at 80 cm proximal to the cecum. Results: Adequate follow-up data were collected in 59.1% of patients from 4 months to 5 years. The average percent of excess BMI loss was 91%, 94%, 85%, 78%, and 74% in the first, second, third, fourth, and fifth year, respectively. Patients experienced early satiety and major improvement in presurgical comorbidities, including diabetes (86% in remission), following surgery. Two deaths occurred (0.2%). Other surgical complications occurred in 6% of patients. Signs of malabsorption were rare. Conclusions: SG + TB is a simple procedure that results in rapid weight loss and remission or major improvement of comorbidities. Strictly aiming at physiological correction, TB avoids prostheses, narrow anastomoses, excluded segments, and malabsorption. Weight and comorbidities are much improved. Diabetes is improved without duodenal exclusion. TB is an excellent complement to an SG.