Acompanhamento de pacientes submetidos à cirurgia bariátrica : aspectos laboratoriais nos períodos pré e pós-operatório

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Farmácia, Florianópolis, 2017A obesidade é uma doença crônica e endócrino-metabólica caracterizada pelo acúmulo excessivo de triacilgliceróis no tecido adiposo, capaz de ser revertida ou amenizada através de intervenção cirúrgica. Epidemiologicamente têm sido descritas associações entre o excesso de peso, resistência à insulina e processo inflamatório crônico. Além disso, nas últimas décadas o sistema complemento foi associado a doenças metabólicas e cardiovasculares e intimamente relacionado com a obesidade e resistência à insulina. Sendo assim, a melhora do estado metabólico e a remissão da inflamação em pacientes obesos submetidos à cirurgia bariátrica foram avaliadas, bem como a associação dos fatores 3 e 4 (C3 e C4) do sistema complemento com a sensibilidade à insulina e a perda de peso após a cirurgia bariátrica. Para isso, a presença de comorbidades e as concentrações séricas de leptina, adiponectina, resistina e grelina foram avaliados em pacientes obesos mórbidos antes, 1, 3 e 6 meses após a cirurgia bariátrica. Também foram medidas as concentrações de IL-1ß, IL-6, TNF-a, proteína amiloide sérica A (SAA), proteína quimiotática de monócitos 1 (MCP-1), C3, C4, glicose, insulina, colesterol total, triacilglicerol, LDL- colesterol, HDL-colesterol e foi realizado o cálculo do modelo de avaliação da homeostase da resistência à insulina (HOMA-IR) durante o seguimento da cirurgia, bem como em comparação com um grupo de indivíduos não-obesos. Como resultado, observou-se uma redução significativa de peso acompanhada de melhora do perfil lipídico, da sensibilidade à insulina e das comorbidades. Ainda, houve diminuição de leptina e aumento de adiponectina no período pós-cirúrgico. IL-1ß, IL-6, TNF-a, MCP-1 e SAA não mostraram diferença no acompanhamento da cirurgia, porém SAA correlacionou-se com o IMC e apresentou-se muito mais alto no grupo de pacientes obesos. Além disso, C3 e C4 foram significativamente maiores em indivíduos obesos quando comparados aos indivíduos não-obesos e C3 e C4 foram positivamente correlacionados com HOMA-IR e as concentrações de C3 foram significativamente diminuídas após a cirurgia. Com base nesses resultados, a cirurgia bariátrica mostrou melhorar o estado metabólico melhorando as comorbidades associadas à obesidade e os biomarcadores de adiposidade leptina e adiponectina, mas não os demais hormônios e citocinas inflamatórias e C3 e C4 foram fortemente associados à sensibilidade à insulina.Abstract: Obesity is a chronic and endocrine-metabolic disease characterized by triacylglycerol accumulation in the adipose tissue, which can be reversed or improved through surgical intervention. Epidemiologically, associations between overweight, insulin resistance and chronic inflammatory process have been described. Furthermore, in the last decades the complement system was associated with metabolic and cardiovascular diseases and related to obesity and insulin resistance. Thus, metabolic status improvement and inflammation remission in obese patients undergoing bariatric surgery were evaluated, as well as the association of complement system factors 3 and 4 (C3 and C4) with insulin sensitivity and weight loss after bariatric surgery. For this, comorbidities and leptin, adiponectin, resistin and ghrelin serum concentrations were evaluated in morbidly obese patients before, 1, 3 and 6 months after bariatric surgery. IL-1ß, IL-6, TNF-a, serum amyloid A protein (SAA), monocyte chemotactic protein 1 (MCP-1), C3, C4, glucose, insulin, total cholesterol, triacylglycerol, LDL-cholesterol, HDL-cholesterol concentrations and the calculation of the homeostasis model of insulin resistance (HOMA-IR) were performed during the surgery follow-up, as well in a group of non-obese individuals. As a result, significant weight loss followed by improvement in lipid profile, insulin sensitivity and comorbidities were observed. Still, there was a decrease in leptin and an increase in adiponectin in the postoperative period. IL-1ß, IL-6, TNF-a, MCP-1 and SAA showed no difference after surgery, but SAA correlated with BMI and was much higher in obese patients. In addition, both C3 and C4 were significantly higher in obese individuals when compared to lean individuals and positively correlated with HOMA-IR. C3 concentrations were significantly decreased after surgery. Based on these results, bariatric surgery has been shown to improve metabolic status by improving obesity-associated comorbidities and adiposity biomarkers leptin and adiponectin but not the other hormones and inflammatory cytokines and C3 and C4 were strongly associated with insulin sensitivity

Social Life of Captive Asian Elephants (Elephas maximus) in Southern India: Implications for Elephant Welfare

Asian elephants in the wild live in complex social societies; in captivity, however, management often occurs in solitary conditions, especially at the temples and private places of India. To investigate the effect of social isolation, this study assessed the social group sizes and the presence of stereotypies among 140 captive Asian elephants managed in 3 captive systems (private, temple, and forest department) in Tamil Nadu, India, between 2003 and 2005. The majority of the facilities in the private (82%) and temple (95%) systems held a single elephant without opportunity for social interaction. The forest department managed the elephants in significantly larger groups than the private and temple systems. Among the 3 systems, the proportion of elephants with stereotypies was the highest in temple (49%) followed by private system (26%) and the forest department facility (6%); this correlates with the social isolation trend observed in the 3 systems and suggests a possible link between social isolation and abnormal elephant behavior separate from other environmental factors. The results of this study indicate it would be of greater benefit to elephant well being to keep the patchily distributed solitary temple and private elephants who are socially compatible and free from contagious diseases in small social groups at ocommon elephant houseso for socialization

Prevalence and determinants of stereotypic behaviours and physiological stress among tigers and leopards in Indian zoos

<div><p>India’s charismatic wildlife species are facing immense pressure from anthropogenic-induced environmental perturbations. Zoos play a major role in the conservation of threatened species, but their adaptation in captivity is posing a major challenge globally. Stress from inadequate adaptation could lead to suppression of cognitive functioning and increased display of stereotypic behaviour. It is thus necessary to measure biological traits like behaviour, stress physiology, and contextual factors driving the animals maintained at zoos. In this study, we assessed stereotypic behaviour and stress physiology employing standard behaviour scoring, non-invasive stress monitoring, and their contextual drivers in a sub-population of two large felid species managed in six Indian zoos. The prevalence and intensity of stereotypic behaviours and levels of faecal corticosterone metabolites (FCM) were ascertained among 41 Royal Bengal tigers <i>Panthera tigris tigris</i> and 21 Indian leopards <i>Panthera pardus fusca</i> between April 2014 and March 2015. Behavioural observations showed that tigers spent more time stereotyping (12%) than leopards (7%) during daylight hours. Stress levels assessed using FCM revealed that tigers (23.6 ± 1.62 ng/g) had marginally lower level of corticosterone metabolites than leopards (27.2 ±1.36 ng/g). Stereotypic behaviour increased significantly with FCM level when the effect of heath status was controlled in tigers, and the effects tree cover, stone, den and keeper attitude controlled in leopards. Comparison of stereotypes of tigers with various biological and environmental factors using binary logistic regression revealed that stereotypic prevalence decreased with increased enclosure size, and enclosure enrichments like presence of pools and stones, when managed socially with conspecifics, and with positive keeper attitude, these factors accounting for 43% of variations in stereotypic prevalence among tigers. Stereotype among leopards was significantly absent when associated with increased tree cover and presence of pool, and den in the enclosure, age and among zoo-born than wild-born ones. These factors explain 81% of variations in stereotypic prevalence in them. A comparison of FCM levels with context-dependent factors revealed that stress levels among tigers decreased significantly with enclosure size and with individuals from nil to low, and severity of health issues. These factors explain 64% of variations in FCM levels. In leopards, the presence of stones in the enclosure and keepers with positive attitude resulted in significant decrease in FCM levels, these factors together accounting for 94% of variations. Multiple regressions on selected variables based on Factor Analysis of Mixed Data showed that in tigers the intensity of stereotype decreased significantly with enclosure size, sociality and positive keeper attitude and FCM level with health problems. Similarly, analyses in leopards revealed that intensity of stereotype decreased significantly with tree cover, age and FCM level with positive keeper attitude. Overall, our study suggests that to reduce stereotypes and stress level, tigers in captivity should be managed in larger enclosures enriched with pool, and stones, and in appropriate social conditions with adequate veterinary care. Leopards should be managed in enclosures with dense tree cover, pool, stones and den. Positive keeper attitude plays a crucial role in the welfare of both the species in captivity. Our study is promising and is comparable with their natural behaviour in the wild; for example, tigers require larger natural habitats, while leopards can manage even with smaller isolated patches but with dense vegetation cover.</p></div

Influence of variables (COS²) on different components obtained from Factor Analysis of Mixed Data (FAMD) by FactoMineR to evaluate the effects of biological and environmental variables on stereotype and FCM of tigers and leopards in captivity.

<p>Influence of variables (COS²) on different components obtained from Factor Analysis of Mixed Data (FAMD) by FactoMineR to evaluate the effects of biological and environmental variables on stereotype and FCM of tigers and leopards in captivity.</p

Extent of stereotypic behaviour and FCM (with± S.E) in relation to environmental factors in tigers (<i>n</i> = 41) and leopards (<i>n</i> = 21).

<p>Note: <i>F</i> indicates Univariate Analysis of Variance; <i>t</i> indicates independent-samples T test, and <i>U</i> indicates Mann-Whitney U-test.</p

Details of various study sites and study species.

<p>Details of various study sites and study species.</p

Extent of stereotypic behaviour and FCM (±SE) in relation to biological factors in tigers (<i>n</i> = 41) and leopards (<i>n</i> = 21).

<p>Note: <i>F</i> indicates Univariate Analysis of Variance; <i>t</i> indicates independent-samples T test, <i>U</i> indicates Mann-Whitney U test and <i>χ</i>^<i>2</i> = Kruskal-Wallis test.</p

MANOVA using stereotypic behaviour and FCM level on various biological and environmental variables among tigers in the study.

<p>MANOVA using stereotypic behaviour and FCM level on various biological and environmental variables among tigers in the study.</p

Binary logistic regression equation employed to predict the outcome of stereotypic behaviour (0 = absence and 1 presence) and FCM levels (0 = low and 1 high) in tigers and leopards using the biological and environmental variables.

<p>Binary logistic regression equation employed to predict the outcome of stereotypic behaviour (0 = absence and 1 presence) and FCM levels (0 = low and 1 high) in tigers and leopards using the biological and environmental variables.</p

Regression equation model to explore the effect of biological and environmental factors on the intensity of stereotype and FCM level among tigers and leopards at six Indian zoos.

<p>Regression equation model to explore the effect of biological and environmental factors on the intensity of stereotype and FCM level among tigers and leopards at six Indian zoos.</p