New approach to beta cell function screening by nitric oxide assessment of obese individuals at the population level

Background: Approximately 27% of Americans today are obese, and this condition increases the prevalence of metabolic syndrome and diabetes. The UK Prospective Diabetes Study suggests that loss of beta cell function can begin at least 10 years before diagnosis, and mean beta cell function is already less than 50% at diagnosis. The aim of this research was to assess the possibility of detecting loss of beta cell function in obese patients by a novel approach involving nitric oxide assessment using a combination of technologies. Materials and methods: One hundred and fifteen obese patients (93 women, 22 men) of mean age 39 (range 17-62) years, who were candidates for bariatric surgery were included in the study, and underwent laboratory tests, including fasting blood glucose, fasting insulin plasma, and examination with the Electro Sensor complex. The Electro Sensor complex offers a new way to assess nitric oxide production using five technologies managed by software, ie, the galvanic skin response, photoelectrical plethysmography, heart rate variability analysis, bioimpedance analysis, and blood pressure oscillometric measurements. The homeostasis model assessment 2% beta cell function (HOMA2% β) algorithm was calculated from fasting blood glucose and fasting insulin plasma using free software provided by The University of Oxford Diabetes Trial Unit. The Electro Sensor complex percent beta (ESC% β) algorithm was calculated from the Electro Sensor complex data and statistical neural network. Statistical analysis was performed to correlate ESC% β and HOMA2% β using the coefficient of correlation and Spearman's coefficient of rank correlation. Receiver-operating characteristic curves were also constructed to determine the specificity and sensitivity of ESC% β in detecting a HOMA2% β value < 100. Results: The coefficient of correlation between ESC% β and HOMA2% β was 0.72 (using log values) and the Spearman's coefficient of rank correlation (rho) was 0.799 (P < 0.0001). ESC% β had a sensitivity of 77.14% and specificity of 78.21% (cutoff ≤ 157, corresponding to 40% after conversion into a 0%-100% scale) to detect a HOMA2% β value < 100 (P < 0.0001). Conclusion: The ESC% β algorithm has a high predictive correlation with HOMA2% β, and good specificity and sensitivity to detect a HOMA2% β value < 100. Therefore, the Electro Sensor complex enabling nitric oxide assessment represents a novel method of screening for beta cell function in the obese population on a large scale. Such a tool, which is easy to administer, noninvasive, and cost-effective, would be of great benefit for widespread screening of beta cell function in obese patients. © 2012 Chaim and Gobato, publisher and licensee Dove Medical Press Ltd

Splenic artery aneurysm associated with anatomic variations in origin

Splenic artery aneurysm was first described by Beaussier in 1770, and the first successful treatment was reported by McLeod in 1940. The splenic artery aneurysm is considered the most common splanchnic site for aneurysm formation, affecting 46 to 60% of patients with visceral aneurysms. Most patients are asymptomatic, and splenic artery aneurysm is often found during imaging investigation of other abdominal diseases. We describe an unusual case of a 31-year-old female patient with a large splenic artery aneurysm originating from the superior mesenteric artery.O aneurisma de artéria esplênica foi descrito pela primeira vez por Beaussier em 1770, e o primeiro tratamento bem-sucedido foi apresentado por McLeod em 1940. O aneurisma da artéria esplênica é considerado o mais comum do território esplâncnico, afetando 46 a 60% dos doentes com aneurismas viscerais. A maioria dos doentes é assintomática, e o achado do aneurisma de artéria esplênica costuma ser casual, durante a investigação de outra doença abdominal por imagem. Descrevemos o caso incomum de uma doente do sexo feminino, com 31 anos de idade, com um grande aneurisma de artéria esplênica que se originava da artéria mesentérica superior.17718

Psychological characteristics of patients submitted to bariatric surgery

INTRODUCTION: The great number of patients submitted bariatric surgery who have psychological and psychiatric complications during the postoperative period require a thorough preoperative investigation and a categorization with the purpose of predicting possible complications and personalizing psychological care that might favor patient compliance. Psychodynamic assessment may provide data for such categorization and, thus, suggest effective pre- and postoperative approach strategies. Therefore, the objective of this study was to identify personality structures that may be useful in the postoperative follow-up, as well as additional inclusion and exclusion criteria for the surgical procedure. METHOD: Report of empirical survey conducted during psychotherapy sessions with an open group of patients who underwent bariatric surgery. DISCUSSION: After surgery, patients may experience phases of emotional restructuring, such as an initial phase of feeling triumphant, followed by a phase when there is risk of melancholic behavior and new addictions. We identified three categories of psychological structures: melancholic structure (patients seem to be more likely to develop other postoperative addictive behaviors, mainly eating disorders, since they cannot tolerate the frustration of the loss); dementalized structure (due to the lack of elaborative capacity, patients are unable to reorganize themselves in face of the challenge of keeping their weight under control); and perverse structure (patients comply with the scheduled weight loss; however, their behavior makes the health team experience uncomfortable situations). Establishing psychological categories may be crucial in order to suggest postoperative management strategies, including referral to a psychotherapist with the purpose of providing personalized care, thus increasing specific therapeutic success.INTRODUÇÃO: O grande número de pacientes submetidos a cirurgia bariátrica e que, no pós-operatório, apresentam complicações psicológicas e psiquiátricas justifica uma investigação pré-operatória acurada, bem como categorização daqueles que se submeterão ao procedimento cirúrgico, visando predizer eventuais complicações e individualizar condutas psicológicas que possam favorecer a adesão do paciente. A avaliação psicodinâmica pode fornecer elementos para tal categorização e, assim, propor estratégias de abordagem pré e pós-operatória eficazes. Procuramos identificar estruturas de personalidade que possam orientar o acompanhamento pós-operatório, bem como critérios auxiliares de inclusão/exclusão do procedimento cirúrgico. MÉTODO: Relato de pesquisa empírica conduzida em atendimentos a pacientes submetidos a cirurgia bariátrica, em grupo terapêutico aberto. DISCUSSÃO: Pacientes, depois de operados, podem passar por determinadas fases de reestruturação emocional, como uma primeira fase de triunfo, seguida de fase de risco para surgimento de quadros melancólicos e de novas adições. Identificamos três categorias estruturais psicológicas: estrutura melancólica, cujos pacientes parecem ter maior possibilidade de desenvolver outras condutas aditivas no pós-operatório, sobretudo alimentares, por não suportarem a frustração pela perda; estrutura desmentalizada, na qual, por faltar uma capacidade elaborativa, o paciente não consegue reorganizar-se frente ao desafio de permanecer com peso controlado; e, finalmente, a estrutura perversa, cujos sujeitos mantêm a programada perda de peso, porém a custas de comportamentos que levam desconfortos à equipe de saúde. Estabelecer categorias psicológicas classificatórias pode ser crucial para que se proponham condutas no pós-operatório, inclusive indicação de psicoterapia com especialista, visando a individualizar o atendimento incrementando sucesso terapêutico específico.737

Early menarche and teenager pregnancy as risk factors for morbid obesity among reproductive-age women: A case-control study

OBJECTIVES: The aim of this study was to evaluate potential risk factors, including non-communicable diseases, for morbid obesity in women between 20 and 49 years of age. METHODS: We performed a case-control study with 110 morbidly obese women and 110 women with adequate weight who were matched by age and with a 1:1 case to control ratio. All women were between 20 to 49 years old and non-menopausal. Possible risk factors were evaluated through a self-report questionnaire assessing socio-demographic, obstetric and gynecological characteristics, presence of non-communicable diseases and habits. Multiple logistic regression was used to estimate the odds ratio with respective confidence intervals. RESULTS: Menarche under 12 years old, teenage pregnancy and lower educational level were shown to be risk factors for morbid obesity among women of reproductive age. Incidences of non-communicable diseases (diabetes, hypertension, dyslipidemia, liver disease, lung disease, thyroid dysfunction, and joint pain) were increased in women with morbid obesity. CONCLUSIONS: Early menarche, teenage pregnancy and low education level are risk factors for the occurrence of morbid obesity in women of reproductive age. Some non-communicable diseases were already more prevalent in women with morbid obesity even before 50 years of age

Analysis of quality of life among asthmatic individuals with obesity and its relationship with pulmonary function: cross-sectional study

FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOThe combined effect of obesity and asthma may lead to significant impairment of quality of life (QOL). The aim here was to evaluate the prevalence of asthma among obese individuals, characterize the severity of impairment of quality of life and measure it1354332338FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOsem informaçã

Prevalence of body contouring surgery in post-bariatric patients at a university hospital

Introduction: The growing number of patients with massive weight loss after bariatric surgery is correlated with the demand for body contouring surgery. Such procedures reduce physical and psychological complaints, positively influencing the quality of life of these people. However, there is little data on the response of services that offer surgical treatment for morbid obesity to this need. The study aims to measure the prevalence of body contouring surgery between 2015 and 2018, in patients previously underwent on a bariatric surgery, in 2014 and 2015, at a University Hospital. Methods: Research in the hospital information system and medical records in order to assess the institutional prevalence of post-bariatric body contouring surgery. Patients who did not undergo both surgeries in our Service, those who underwent these surgical procedures in other years, as well as those with incomplete medical records were excluded. Results: Bariatric surgeries were performed in 208 patients. Of these, 11% (n=23) underwent 27 body contouring surgeries, with abdominal dermolipectomy (n=16) being the most frequently performed. The performance of more than one procedure to correct body deformity occurred in 13% (n=3) of patients. The mean age of patients undergoing body contouring surgery was 37 years, the majority was female (96%, n=22). Conclusion: Body contouring surgery is an important step in the treatment of morbid obesity and has a restorative feature. There is a huge lack of this therapy, which irreparably compromises the results obtained by bariatric surgery