WEIGHT REGAIN AND THE METABOLIC PROFILE OF WOMEN IN THE POSTOPERATIVE PERIOD OF BARIATRIC SURGERY: A MULTIVARIATE ANALYSIS

ABSTRACT BACKGROUND: Weight regain in the postoperative period after bariatric surgery is directly related to the relapse of preoperative comorbidities and a negative impact on the patients’ biochemical profile. AIMS: To assess the metabolic impact of weight regain on preoperative comorbidities and on patients’ biochemical profiles, in order to show the impact of the complications on the metabolic outcomes of bariatric surgery. METHODS: A retrospective study was carried out with 75 women in the late postoperative period of bariatric surgery who presented pathological weight regain (≥20% of the maximum weight loss). Data of interest consisted of glycemic, lipid, and inflammatory profile measurements at three different moments of evaluation: preoperative period, at the weight nadir (minimum weight), and after weight regain. A multivariate analysis was performed. RESULTS: The mean age was 46.39±12.09 years. Preoperative body mass index was 40.10±4.11 kg/m2. There was an overall increase of 3.36 points in the mean body mass index between the nadir and after regain: from 26.30±3.9 kg/m2 to 29.66±4.66 kg/m2. The mean time to reach the nadir was 18±7.6 months, with an average percentage of excess weight loss of 91.08±11.8%. The median time for pathological weight regain was 48 months, and the mean regain amongst the sample was 8.85±5.65 kg. There was a significant correlation between pathological weight regain and levels of insulin (r=0.351; p<0.011), C-peptide (r=0.303; p<0.011), C-reactive protein (r=0.402; p<0.001), and vitamin D (r=-0.435; p<0.001), the last two being the most influenced by the percentage of weight regained. CONCLUSIONS: The pathological weight regain in the postoperative period of bariatric surgery results in losses in the patients’ metabolic and inflammatory profiles. However, the biochemical benefits are sustained up to the preoperative levels of the parameters analyzed

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Evaluation of nicotine patch in pain control of patients undergoing laparoscopic cholecystectomy

ABSTRACT Objective: to analyze the effects of nicotine patch on pain control, occurrence of nausea and its hemodynamic repercussions in laparoscopic cholecystectomy procedures. Methods: we conducted an analytical, prospective, randomized, triple-blinded, clinical study between January and July 2017. The sample consisted of 17 patients who underwent laparoscopic cholecystectomy for the treatment of cholelithiasis. Nine patients used nicotine patch, and eight, placebo patch. The studied variables were pain, nausea, patient satisfaction, blood pressure, heart rate, oximetry and morphine rescue. Results: taking into account the pain and nausea parameters, there was no statistically significant difference between the groups (p>0.05). Also, the evaluation of rescue medication, both opioids and prokinetics, did not show any significant statistical difference between the groups. Among the hemodynamic parameters, there was only one statistically significant difference in the analysis of oxygen saturation and systolic blood pressure (SBP) six hours after surgery: the mean oxygen saturation was higher in the Test group (97.89 x 95.88) and the mean SBP was higher in the Control group (123.89 x 110.0). Conclusion: although pain levels were lower for nicotine within 24 hours, the action of nicotine and the need for rescue opioids in pain control were not statistically significant between the groups and at the time intervals studied. There was no clinical repercussion in the hemodynamic parameters

Long-term evaluation of patients with BMI = 50kg/m2 who underwent Bariatric Surgery

ABSTRACT Purpose: to determine the risks and benefits of bariatric surgery in patients with super obesity (SO) in comparison with obesity grades II and III. Methods: retrospective cohort that included a study group of 178 patients with SO and a control group of 181 patients with BMI 35-49.9Kg/m2. The groups were formed in a 1:1 nearest neighbor matching. The main variables were pre- and postoperative BMI and comorbidities, occurrence of severe postoperative complications, bowel obstruction, marginal ulcer, fistulae and 30-day death, besides the necessity of emergency room (ER) admission and abdominal computed tomography (CT) scans in the postoperative period due to acute abdomen. Results: the study group comprised 74.0% of women while the control group had 56.7%. The mean follow-up time was similar between both groups (5.48 x 6.09 years, p=0.216). There was no statistically significant difference on the prevalence of hypertension and T2D between the groups according to the surgical technique. All deaths occurred in the Study group (BMI = 50kg/m2) who underwent RYGB. There was no difference between the groups regarding the occurrence of severe complications. Data on ER admissions and the need for abdominal CT to investigate postoperative abdominal pain did not show statistically significant difference between the groups. Conclusion: despite the high risk related to bariatric surgery in patients with SO, the benefits related to the remission of comorbidities are significant; although being lower than those found in patients with milder grades of obesity

Evaluation of nicotine patch in pain control of patients undergoing laparoscopic cholecystectomy

<div><p>ABSTRACT Objective: to analyze the effects of nicotine patch on pain control, occurrence of nausea and its hemodynamic repercussions in laparoscopic cholecystectomy procedures. Methods: we conducted an analytical, prospective, randomized, triple-blinded, clinical study between January and July 2017. The sample consisted of 17 patients who underwent laparoscopic cholecystectomy for the treatment of cholelithiasis. Nine patients used nicotine patch, and eight, placebo patch. The studied variables were pain, nausea, patient satisfaction, blood pressure, heart rate, oximetry and morphine rescue. Results: taking into account the pain and nausea parameters, there was no statistically significant difference between the groups (p>0.05). Also, the evaluation of rescue medication, both opioids and prokinetics, did not show any significant statistical difference between the groups. Among the hemodynamic parameters, there was only one statistically significant difference in the analysis of oxygen saturation and systolic blood pressure (SBP) six hours after surgery: the mean oxygen saturation was higher in the Test group (97.89 x 95.88) and the mean SBP was higher in the Control group (123.89 x 110.0). Conclusion: although pain levels were lower for nicotine within 24 hours, the action of nicotine and the need for rescue opioids in pain control were not statistically significant between the groups and at the time intervals studied. There was no clinical repercussion in the hemodynamic parameters.</p></div

PROSPECTIVE STUDY OF ASPIRIN FOR THROMBOEMBOLISM PROPHYLAXIS IN TOTAL HIP ARTHROPLASTY

<div><p>ABSTRACT Objectives: To evaluate the effectiveness of aspirin as prophylaxis for deep venous thrombosis (DVT) in patients undergoing total hip arthroplasty (THA), and to analyze the incidence of bleeding during the post-operative period. Methods: This prospective study carried out in 2017 consisted of 37 patients indicated for THA with high risk for DVT. Immediately after the procedure, aspirin, elastic compression socks and early deambulation were initiated. Doppler ultrasound was performed in the legs 6 days and 6 weeks post-procedure to rule out venous thromboembolism. Hematometric variables and clinical criteria were used to detect bleeding. Results: The incidence of VTE (venous thromboembolism) 6 days post-procedure was 21.6%. By 6 weeks post-procedure, it dropped to 8.1%, (p = 0.102). Only 2.7% were diagnosed with VTE, 6 days and also 6 weeks post-procedure. Within the immediate postoperative period, hemoglobin was lower (p < 0.001), in contrast to 6 weeks after surgery, when it returned to baseline levels. Conclusion: Aspirin was an effective chemical prophylaxis for venous thromboembolism in high-risk patients who underwent THA. There was no clinical record of postoperative bleeding and hematometric levels suggested that there was no chronic bleeding. Level of Evidence II; Prospective study.</p></div

Low prevalence of influenza A strains with resistance markers in Brazil during 2017–2019 seasons

This project was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES); Programa Estratégico de Apoio à Pesquisa em Saúde (PAPES), Fundação Oswaldo Cruz, CNPq, and Coordenação Geral de Laboratórios de Saúde Pública (CGLAB) from the Brazilian Ministry of Health.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Laboratório Central de Saúde Pública de Sergipe. Aracaju, SE, Brazil.Laboratório Central de Saúde Pública de Sergipe. Aracaju, SE, Brazil.Laboratório Central do Estado do Paraná. Curitiba, PR, Brazil.Laboratório Central do Estado do Paraná. Curitiba, PR, Brazil.Secretaria de Saúde do Estado do Espírito Santo. Laboratório de Saúde Pública do Estado do Espírito Santo. Vitória, ES, Brazil / Universidade Federal do Espírito Santo. Núcleo de Doenças Infecciosas. Vitória, ES, Brazil.Secretaria de Saúde do Estado do Espírito Santo. Laboratório de Saúde Pública do Estado do Espírito Santo. Vitória, ES, Brazil / Universidade Federal do Espírito Santo. Núcleo de Doenças Infecciosas. Vitória, ES, Brazil.Laboratório Central de Saúde Pública do Rio de Janeiro. Rio de Janeiro, RJ, Brazil.Laboratório Central de Saúde Pública do Rio de Janeiro. Rio de Janeiro, RJ, Brazil.Secretaria de Saúde do estado do Rio Grande do Sul. Laboratório Central de Saúde Pública. Porto Alegre, RS, Brazil.Secretaria de Saúde do estado do Rio Grande do Sul. Laboratório Central de Saúde Pública. Porto Alegre, RS, Brazil.Fundação Ezequiel Dias. Laboratório Central de Saúde Pública de Minas Gerais. Belo Horizonte, MG, Brazil.Fundação Ezequiel Dias. Laboratório Central de Saúde Pública de Minas Gerais. Belo Horizonte, MG, Brazil.Laboratório Central da Saúde Pública do estado da Bahia. Salvador, BA, Brazil.Laboratório Central da Saúde Pública do estado da Bahia. Salvador, BA, Brazil.Laboratório Central de Santa Catarina. Florianópolis, SC, Brazil.Laboratório Central de Santa Catarina. Florianópolis, SC, Brazil.Ministério da Saúde. Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos. Instituto Evandro Chagas. Ananindeua, PA. Brasil.Ministério da Saúde. Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos. Instituto Evandro Chagas. Ananindeua, PA. Brasil.Instituto Adolfo Lutz. Laboratório Central de Saúde Pública do Estado de São Paulo. São Paulo, SP, Brazil.Instituto Adolfo Lutz. Laboratório Central de Saúde Pública do Estado de São Paulo. São Paulo, SP, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Imunização e Doenças Transmissíveis. Brasília, DF, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Imunização e Doenças Transmissíveis. Brasília, DF, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.Fiocruz Fundation. Oswaldo Cruz Institute. Laboratory of Respiratory Viruses and Measles. Rio de Janeiro, RJ, Brazil.The influenza A virus (IAV) is of a major public health concern as it causes annual epidemics and has the potential to cause pandemics. At present, the neuraminidase inhibitors (NAIs) are the most widely used anti-influenza drugs, but, more recently, the drug baloxavir marboxil (BXM), a polymerase inhibitor, has also been licensed in some countries. Mutations in the viral genes that encode the antiviral targets can lead to treatment resistance. Worldwide, a low prevalence of antiviral resistant strains has been reported. Despite that, this situation can change rapidly, and resistant strain surveillance is a priority. Thus, the aim of this was to evaluate Brazilian IAVs antiviral resistance from 2017 to 2019 through the identification of viral mutations associated with reduced inhibition of the drugs and by testing the susceptibility of IAV isolates to oseltamivir (OST), the most widely used NAI drug in the country. Initially, we analyzed 282 influenza A(H1N1)pdm09 and 455 A(H3N2) genetic sequences available on GISAID. The amino acid substitution (AAS) NA:S247N was detected in one A(H1N1)pdm09 strain. We also identified NA:I222V (n = 6) and NA:N329K (n = 1) in A(H3N2) strains. In addition, we performed a molecular screening for NA:H275Y in 437 A(H1N1)pdm09 samples, by pyrosequencing, which revealed a single virus harboring this mutation. Furthermore, the determination of OST IC50 values for 222 A(H1N1)pdm09 and 83 A(H3N2) isolates revealed that all isolates presented a normal susceptibility profile to the drug. Interestingly, we detected one A(H3N2) virus presenting with PA:E119D AAS. Moreover, the majority of the IAV sequences had the M2:S31N adamantanes resistant marker. In conclusion, we show a low prevalence of Brazilian IAV strains with NAI resistance markers, in accordance with what is reported worldwide, indicating that NAIs still remain an option for the treatment of influenza infections in Brazil. However, surveillance of influenza resistance should be strengthened in the country for improving the representativeness of investigated viruses and the robustness of the analysis