Mas de obesidad

Junio 22, 2017. No. 2727

Morbilidad y mortalidad asociadas con la obesidad Morbidity and mortality associated with obesity. Abdelaal M1,2, le Roux CW1,3,4, Docherty NG1,3. Ann Transl Med. 2017 Apr;5(7):161. doi: 10.21037/atm.2017.03.107. Abstract Obesity and its repercussions constitute an important source of morbidity, impaired quality of life and its complications can have a major bearing on life expectancy. The present article summarizes the most important co-morbidities of obesity and their prevalence. Furthermore, it describes classification and grading systems that can be used to assess the individual and combined impact of co-morbid conditions on mortality risk. The literature was screened for assessment tools that can be deployed in the quantification of morbidity and mortality risk in individual patients. Thirteen specific domains have been identified that account for morbidity and mortality in obesity. Cardiovascular disease (CVD) and cancer account for the greatest mortality risk associated with obesity. The King's Criteria and Edmonton Obesity Staging System (EOSS) were identified as useful tools for the detection and monitoring of individual patient mortality risk in obesity care. The stark facts on the complications of obesity should be capitalized on to improve patient management and knowledge and referred to in the wider dissemination of public health messages aimed at improving primary prevention. KEYWORDS: Morbidity; mortality; obesity PDF ¿Debe realizarse cirugía bariátrica en adolescentes? Should bariatric surgery be performed in adolescents? Beamish AJ1,2, Reinehr T3. Eur J Endocrinol. 2017 Apr;176(4):D1-D15. doi: 10.1530/EJE-16-0906. Abstract Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications. PDF Cirugía bariátrica en cirróticos. Revisión narrativa Bariatric surgery in individuals with liver cirrhosis: A narrative review. Cazzo E1, Gestic MA2, Utrini MP3, Chaim FD2, Callejas-Neto F4, Pareja JC5, Chaim EA6. Author information Abstract INTRODUCTION:Bariatric surgery has become the gold standard treatment for morbid obesity, but there is no consensus regarding its safety and efficacy among individuals with chronic liver diseases. OBJECTIVE:: To critically evaluate the existing evidence on literature about bariatric surgery in individuals with liver cirrhosis. METHOD:: Narrative review performed by means of an online search in the MEDLINE and LILACS databases. RESULTS:: Bariatric surgery is safe and effective in individuals with chronic liver disease without clinical decompensation or significant portal hypertension. Individuals with severe liver function impairment present significantly higher surgical morbidity and mortality. Among candidates to liver transplantation, surgery may be performed before, after and even during transplantation, and there is a predominant trend to perform it after. Vertical sleeve gastrectomy seems to be the most adequate technique in this group of subjects. CONCLUSION:: Bariatric surgery is safe and effective in individuals with compensated cirrhosis without significant portal hypertension, but presents higher morbidity. Among candidates to liver transplantation and/or individuals with severe portal hypertension, morbidity and mortality are significantly higher. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Obesidad

Junio 23, 2017. No. 2728

¿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. Norris P1, Ralph N2,3, Moloney C1. Syst Rev. 2017 Jun 17;6(1):115. doi: 10.1186/s13643-017-0515-6. Abstract 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 PDF  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. Keleidari B1, Jamalouee SD2, Mahmoudieh M1, Zolfaghari B3, Gharzi M2. J Res Med Sci. 2017 Apr 26;22:56. doi: 10.4103/jrms.JRMS_931_16. eCollection 2017. Abstract 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 PDF Desafíos clínicos en las neoplasias malignas gastrointestinales superiores después de la cirugía bariátrica. Clinical Challenges in Upper Gastrointestinal Malignancies after Bariatric Surgery. Tse WHW1, Kroon HM, van Lanschot JJB. Dig Surg. 2017 May 30. doi: 10.1159/000477267. [Epub ahead of print]Abstract BACKGROUND/AIMS: 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 PDF 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. Kurnicka K1, Domienik-Karłowicz J, Lichodziejewska B, Bielecki M, Kozłowska M, Goliszek S, Dzikowska-Diduch O, Lisik W, Kosieradzki M, Pruszczyk P. Cardiol J. 2017 May 25. doi: 10.5603/CJ.a2017.0059. [Epub ahead of print] Abstract 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 PDF  XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org