OAGB bowel function in patients with up to 5 years follow-up: updated outcomes

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Objective: One-anastomosis gastric bypass (OAGB) is considered an effective technique in weight reduction and remission of comorbidities. However, in common with many bariatric and metabolic/bariatric procedures, gastrointestinal side effects are frequently reported, but clinical experience varies. The objective of this study was to analyze the bowel function of patients who undergo OAGB looking at 5-year postoperative outcomes. Method: This study is cross-sectional, descriptive and analytical, developed with individuals undergoing OAGB (n = 208) in yhe period between 2015 and 2020. The time periods evaluated were 1 to 6 months (T1), 6 to 12 months (T2), and 1 to 5 years (T3). Data analysis was performed using SPSS v.28.0, considering a significance level p ≤ 0.05. Results: 114 participants (54.8%), 79.8% women, mean age 47.0 ± 12.6 years, and BMI 40.1 ± 5.6 kg/m2, 51.9% dyslipidemia, 43.6% arterial hypertension, and 19.1% diabetes mellitus. The T1 group had more severe symptoms/nausea than the T2 group. The T2 group had a significantly lower defecation frequency than the T1 and T3 groups. As for the occurrence of diarrhea, associations were not found in the considered groups. The T3 group had a greater severity of constipation associated with greater difficulty in consuming red meat, white meat, rice, vegetables, and salads. Conclusions: Gastrointestinal symptoms are prevalent in the first postoperative months. However, diarrhea was not common. The patient selection policy and surgical technique were decisive in this result. Constipation was prevalent in patients between 1 and 5 postoperative years. It was also prevalent in those who had food intolerance, which from a nutritional point of view is an adverse factor for optimal bowel function.Open access funding provided by FCT|FCCN (b-on). No funding received.info:eu-repo/semantics/publishedVersio

A fibrilhação auricular não valvular e o acidente vascular cerebral

Trabalho final de mestrado integrado em Medicina àrea científica de Neurologia, apresentado à Faculdade de Medicina da Universidade de CoimbraIntrodução A fibrilhação auricular é a arritmia cardíaca mais comum na população ocidental. Estima-se que 6 milhões de pessoas na Europa têm fibrilhação auricular. O acidente vascular cerebral tromboembólico constitui a complicação mais grave deste tipo de arritmia. Objectivos e Métodos Este trabalho de revisão teve por objectivo analisar a associação entre a fibrilhação auricular não-valvular e o acidente vascular cerebral isquémico. Abordou-se a epidemiologia, etiologia e fisiopatologia e deu-se particular ênfase ao diagnóstico e às actuais recomendações terapêuticas no âmbito da prevenção de eventos cardioembólicos. Foram consultados, através dos motores de busca Pubmed, Medline, Emedicine, um conjunto de artigos científicos que versavam os tópicos: «fibrilhação auricular» e «acidente vascular cerebral». Desenvolvimento Os doentes com fibrilhação auricular, cuja prevalência tem vindo a aumentar, apresentam um risco cinco vezes maior de desenvolver um acidente vascular cerebral isquémico em relação à população geral. Admite-se ainda que esta arritmia responda por cerca de 20% de todos os acidentes vasculares cerebrais isquémicos. Estes eventos cardioembólicos, no contexto de fibrilhação auricular, são habitualmente mais graves e causam maior compromisso funcional do que os atribuídos a outra etiologia. A primeira manifestação de fibrilhação auricular é frequentemente um acidente vascular cerebral isquémico. Assim, todo o enfoque deve ser colocado na detecção precoce deste tipo de arritmia, designadamente através de estratégias coordenadas de rastreio. Uma vez efectuado o diagnóstico de fibrilhação auricular, as medidas a instituir baseiam-se em dois pressupostos: o controlo/ abolição da arritmia (terapêutica «upstream») e a prevenção dos eventos tromboembólicos («downstream»). O score CHADS2 permite a estratificação deste risco e, desta forma, apresenta-se como o método adequado para a definição da melhor estratégia terapêutica. Em doentes com um score igual ou superior a 2 está indicada a terapêutica anticoagulante com antagonistas da vitamina K, que se traduz numa redução de risco relativo de 62%. Apesar da sua eficácia, estes fármacos exigem uma monitorização especial e apresentam um elevado número de interacções (alimentos, outros fármacos). Os resultados do estudo RE-LY recentemente publicados, demonstraram que o inibidor directo da trombina dabigatran, quando comparado com o varfarina, apresenta uma eficácia não inferior na dose de 110 mg duas vezes/dia e resulta numa redução significativa no número de hemorragias major. Na dose de 150 mg, administrada em duas tomas diárias, revelou uma eficácia superior. Apesar do seu elevado preço, tem a vantagem de não exigir uma monitorização laboratorial apertada. Apresenta-se, desta forma, como uma terapêutica altamente promissora, estando por definir, no entanto, os sub-grupos nos quais se constitui como terapêutica de primeira linha. Apesar dos recentes desenvolvimentos, não existe, no momento, evidência clínica robusta de benefício a longo prazo das diversas abordagens cirúrgicas ou percutâneas, no sentido de promover a ablação da FA ou prevenção dos eventos tromboembólicos. Conclusão A fibrilhação auricular constitui-se como um dos principais problemas de saúde pública no âmbito das doenças cardiovasculares. Apresentam-se, neste trabalho, as medidas que conduzam à sua detecção precoce e, na sua presença, à estratificação do risco de modo a definir a melhor abordagem terapêutica que previna os eventos tromboembólicos.Introduction Atrial fibrillation is the most common cardiac arrhythmia in western population. It is estimated that 6 million people in Europe have atrial fibrillation. The thromboembolic stroke is the most serious complication of this type of arrhythmia. Objectives and Methods This review aimed to analyse non-valvular atrial fibrillation and ischemic stroke association. The author approaches epidemiology, etiology and pathophysiology emphasizing this arrhythmia diagnosis and the current therapeutic recommendations for cardioembolic events prevention. A wide range of scientific articles approaching «atrial fibrillation» and «stroke» were consulted through the following search engines: Pubmed, Medline and Emedicine. Discussion Atrial fibrillation patients, whose prevalence has been increasing, have a fivefold risk boost of developing an ischemic stroke compared to general population. This arrhythmia accounts for about 20% of all ischemic strokes. The cardioembolic events associated to atrial fibrillation are frequently more severe, with worse functional impairment than attributed to other etiology. The first manifestation of atrial fibrillation is often an ischemic stroke. Thus, all focus should be placed on early detection of this type of arrhythmia, particularly through coordinated screening strategies. Following atrial fibrillation diagnosis, measures should be considered on two assumptions: arrhythmia control / elimination («upstream» therapy) and thromboembolic events prevention («downstream»). The CHADS2 score allows risk stratification, thus presenting itself as an appropriate method for defining the best therapeutic strategy. For CHADS2 scores ≥2 oral anticoagulation therapy with vitamin K antagonists is indicated, promoting a relative risk reduction of 62%. Despite their effectiveness, these drugs not only require special monitoring but also have a high number of interactions (food, other drugs). The RE-LY study results, recently published, showed that direct thrombin inhibitor dabigatran compared with warfarin has no inferiority at a dose of 110 mg twice a day, resulting in a significant major bleedings reduction .At a dose of 150 mg administered twice a day, showed superiority. Despite its high price, it has the advantage of not requiring tight laboratory control. Thus is presented as a highly promising therapeutic, despite of the need to identify the sub-groups in which can be applied as a first-line therapy. At the moment, in spite of recent developments, there is no clinical evidence concerning long-term benefit of surgical or catheter approaches in order to promote atrial fibrillation ablation or thromboembolic events prevention. Conclusion Atrial fibrillation is one of the major health public problems in cardiovascular diseases context. In this review, the author presents early detection measures and risk stratification to define the best therapeutic approach for thromboembolic events prevention, in atrial fibrillation patients

Bypass gástrico de anastomose única (OAGB): análise sos sintomas gastrintestinais até 5 anos pós-operatório

O bypass gástrico de anastomose única (OAGB) é a terceira técnica mais utilizada no mundo, considerada eficaz na redução de peso e na emissão de comorbilidades. Entretanto, dados sobre os sintomas gastrointestinais a médio prazo são limitados. Objetivos: Avaliar os sintomas gastrointestinais de indivíduos submetidos a OAGB em três momentos pós-operatório: T1 (um a seis meses), T2 (seis a doze meses) e T3 (um a cinco anos).info:eu-repo/semantics/publishedVersio

Gastrointestinal reported outcomes following one anastomosis gastric bypass based on a multicenter study

Objectives: To describe gastrointestinal-related side-effects reported following One Anastomosis Gastric Bypass (OAGB). Methods: A multicenter study among OAGB patients across Israel (n=277) and Portugal (n=111) who were recruited to the study based on time elapsed since surgery was performed. An online survey with information on demographics, anthropometrics, medical conditions, and gastrointestinal outcomes was administered in both countries simultaneously. Results: Respondents from Israel (pre-surgery age of 41.6±11.0 years, 75.8% females) and Portugal (pre-surgery age of 45.6±12.3 years, 79.3% females) presented mean excess weight loss of 51.0±19.9 and 62.4±26.5%, 89.0±22.0 and 86.2±21.4%, and 89.9±23.6 and 98.2±20.9% (P<0.001 for both countries), at 1-6 months, 6-12 months, and 1-5 years post-surgery, respectively. The Median Gastrointestinal Symptom Rating Scale score was similar between time elapsed since surgery groups among respondents from Israel and Portugal (≤1.97 and ≤2.12). A notable proportion of respondents from Israel and Portugal at all time points reported 1-3 bowel movements per day (≤62.8 and ≤87.6%), Bristol stool scale categories which represent diarrhea-like stools (≤51.9 and ≤56.3%), having discomfort due to flatulence (≤79.4 and ≤90.2%), and mild to severe dyspepsia symptoms (≤50.5 and ≤73.0%). Conclusions: A notable proportion of OAGB patients might experience certain gastrointestinal symptoms postoperatively, including flatulence, dyspepsia, and diarrhea-like stools.info:eu-repo/semantics/publishedVersio