viernes, 23 de junio de 2017


Junio 23, 2017. No. 2728

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¿El síndrome metabólico predice complicaciones quirúrgicas? Un protocolo para una revisión sistemática y meta-análisis.
Does metabolic syndrome predict surgical complications? A protocol for a systematic review and meta-analysis.
Syst Rev. 2017 Jun 17;6(1):115. doi: 10.1186/s13643-017-0515-6.
BACKGROUND: Metabolic syndrome (MetS) is defined by an accumulation of risk factors that include cardiovascular disease, diabetes, chronic high blood pressure, obesity, and hypercholesterolaemia which results in an increased risk of developing serious chronic diseases. MetS is widespread as it is estimated to affect up to 30% of the global population. For people with MetS who undergo surgery, an emerging body of literature points to significantly poorer postoperative outcomes compared with non-affected populations. Surgical patients with MetS are at significantly higher risk of a range of adverse outcomes including death, morbid cardiovascular events, coma, stroke, renal failure, myocardial infarction, and surgical site infections. Increased complication rates result in prolonged hospital stays, a greater need for post-hospitalisation care, and reduced effectiveness of surgical interventions. METHODS/DESIGN: We will search the following electronic bibliographic databases: MEDLINE, EMBASE, ScienceDirect, and CINAHL, and the reference lists of included articles. We will also search for unpublished literature. Two authors will screen titles and abstract information independently and select studies according to established inclusion and exclusion criteria. Data will be extracted by the study investigators using Review Manager 5 and will include information on demographics, incidence, prevalence, and outcome variables. Subgroup analysis and sensitivity analysis will be performed to assess the heterogeneity of included studies. Meta-analysis will also be carried out if appropriate study groups are identified. A descriptive narrative for statistical data will also be provided to highlight findings of the systematic review and meta-analysis. DISCUSSION: This study will report and summarise adverse outcomes among adult patients with MetS undergoing surgery across a range of surgical specialties. Developing insights into outcomes of this population of interest is necessary to develop guidelines towards better management of surgical patients with metabolic syndrome.
KEYWORDS: Adverse events; Complications; Metabolic syndrome; Prevalence; Risk; Safety; Surgery

Aspectos de la calidad de vida afectados en pacientes obesos mórbidos que decidieron someterse a cirugía bariátrica: Un estudio cualitativo para diseñar un cuestionario nativo.
Aspects of quality of life affected in morbidly obese patients who decided to undergo bariatric surgery: A qualitative study to design a native questionnaire.
J Res Med Sci. 2017 Apr 26;22:56. doi: 10.4103/jrms.JRMS_931_16. eCollection 2017.
BACKGROUND: Obesity is a known prevalent major health issue. The aim of this study is to assay Iranian patients' problems with obesity and their expectations of bariatric surgery. MATERIALS AND METHODS:
In this study, we included patients who have used different medical noninvasive treatments and were unsuccessful in losing weight from the obesity clinic in Al Zahra Hospital, Isfahan, from 2014 to 2015. Morbidly obese patients were interviewed using some open-ended questions, and then, directional content analysis of data was done. RESULTS: Analysis of data showed five main categories including (1) physical health, (2) psychological health, (3) social relationships, (4) environment, and (5) "about the causes of obesity" with some subcategories for each category. CONCLUSION: This study is the first step of designing a quality of life questionnaire while we focused on spiritual and cultural states of Iranian people.
KEYWORDS: Bariatric surgery; morbid obesity; qualitative studies; quality of life; questionnaire

Desafíos clínicos en las neoplasias malignas gastrointestinales superiores después de la cirugía bariátrica.
Clinical Challenges in Upper Gastrointestinal Malignancies after Bariatric Surgery.
Dig Surg. 2017 May 30. doi: 10.1159/000477267. [Epub ahead of print]Abstract
The incidence of morbid obesity has exponentially increased over the last decades. Bariatric surgery (BS) has been proven effective in inducing weight loss and resolving comorbidities associated with morbid obesity. However, BS can also lead to major diagnostic and treatment challenges in patients who develop upper gastrointestinal malignancies. It is important to create awareness of this rising problem. METHODS: Relevant literature was searched in PubMed. RESULTS: (Formerly) obese patients are more prone to develop upper gastrointestinal malignancies, mainly adenocarcinoma of the distal esophagus, since obesity induces a chronic pro-inflammatory state due to endocrinological changes. When an upper gastrointestinal malignancy develops after BS, diagnosis is often delayed and challenging due to a different presentation of complaints and the altered anatomy following the earlier surgery. Also, a potentially curative resection is often more complex and reconstruction of the gastrointestinal continuity can be seriously hampered. CONCLUSION: Due to the growing incidence of obesity and the increasing number of bariatric surgical procedures that are performed each year, it is expected that over the years to come, more post-BS patients will be diagnosed with upper gastrointestinal malignancies, providing great diagnostic and treatment challenges. Clinicians should be aware of this rising problem.
KEYWORDS: Bariatric surgery; Esophageal cancer; Gastric cancer; Upper gastrointestinal malignancies; Upper gastrointestinal surgery

Mejoría de la función diastólica del ventrículo izquierdo y la morfología del corazón izquierdo en mujeres jóvenes con obesidad mórbida seis meses después de la cirugía bariátrica.
Improvement of left ventricular diastolic function and left heart morphology in young women with morbid obesity six months after bariatric surgery.
Cardiol J. 2017 May 25. doi: 10.5603/CJ.a2017.0059. [Epub ahead of print]
BACKGROUND: Obesity contributes to left ventricular diastolic dysfunction (LVDD) and may lead to diastolic heart failure. Weight loss (WL) after bariatric surgery (BS) may influence LV morphology and function. Using echocardiography, this study assessed the effect of WL on LV diastolic function (LVDF) and LV and left atrium (LA) morphology 6 months after BS in young women with morbid obesity. METHODS: Echocardiography was performed in 60 women with BMI ≥ 40kg/m², aged 37.1 ± 9.6 years prior to and 6 months after BS. In 38 patients, well-controlled arterial hypertension was present. Heart failure, coronary artery disease, atrial fibrillation and mitral stenosis were exclusion criteria. Parameters of LV and LA morphology were obtained. To evaluate LVDF, mitral peak early (E) and atrial (A) velocities, E-deceleration time (DcT), pulmonary vein S, D and A reversal velocities were measured. Peak early diastolic mitral annular velocities (E') and E/E' were assessed. RESULTS: Mean WL post BS was 35.7 kg (27%). A postoperative decrease in LV wall thickness was observed, LV mass (mean 183.7 to 171.5 g, p = 0.001) and LA parameters (area, volume). LVDD was diagnosed in 3 patients prior to and in two of them subsequent to the procedure. An improvement in LVDF Doppler indices were noted: increased E/A, D and E' lateral, and decreased S/D and lateral E/E'. None of the patients showed increased LV filling pressure. No significant correlations between hypertension and echo-parameters were demonstrated. CONCLUSIONS: Six months after bariatric surgery weight loss resulted in the improvement of LVDF and left heart morphology in morbidly obese women.
KEYWORDS: bariatric surgery; echocardiography; left atrium; left ventricular diastolic function; morbid obesity

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