The spectrum of non alcoholic fatty liver disease in morbidly obese patients: prevalence and associate risk factors

PURPOSE: To determine the prevalence of non alcoholic fatty liver disease (NAFLD) and non alcoholic steatohepatitis (NASH) in morbidly obese patients undergoing bariatric surgery and to identify risk factors associated with the disease spectrum. METHODS: Liver biopsy was performed in 60 patients who underwent bariatric surgery, after other causes of liver disease were excluded. Clinical, biochemical and histological features were evaluated. RESULTS: NAFLD was detected in fifty-seven patients (95%) of the sample and forty patients (66.7%) of the total sample met the criteria for NASH. Perisinusoidal fibrosis was only found in three (7.5%) patients with NASH. The γGT was an independent predictive factor associated with the degree of hepatic steatosis. The variables such as dyslipidemia and ALT were independently associated with the presence of Mallory's corpuscles with the following values, respectively, OR 0, 05, 95% CI 0.002 to 0.75, P = 0.031 and OR 10, 99, 95% CI 1.44 to 83.93, P = 0.021. CONCLUSIONS: Non alcoholic fatty liver disease seems to be an obese-related condition with approximately half of asymptomatic morbidly obese patients having histological NASH. The γGT was an independent predictor of the degree of steatosis.

Qualidade de vida e câncer de mama: uma comparação entre mulheres com e sem linfedema / Quality of life and breast cancer: a comparison between women with and without lymphedema

No Brasil, o câncer de mama é a segunda localização de câncer mais incidente na população feminina. Nos últimos anos, tem aumentado a sobrevida livre de doença, despertando o interesse em investigar a qualidade de vida de pacientes tratadas. O objetivo deste estudo é avaliar a qualidade de vida em uma coorte de mulheres submetidas a tratamento cirúrgico para câncer de mama, para verificar possíveis diferenças derivadas do desenvolvimento de linfedema de membro superior. A população de estudo foi constituída por 549 mulheres oriundas de uma coorte constituída em 2001, para estudar a incidência de linfedema. Todas as participantes realizaram exame físico com fisioterapeuta, para caracterização da presença de linfedema. A definição dos casos de linfedema teve como base a perimetria dos membros superiores. As participantes foram entrevistadas para coleta de dados sócio-demográficos, sendo aplicado o questionário de qualidade de vida EORTC QLQ C-30 e o módulo BR-23. Informações sobre as características do tratamento e demais variáveis clínicas foram obtidas nos prontuários médicos. Os escores de qualidade de vida das pacientes foram agregados e transformados em valores em uma escala de 0 a 100 pontos. Para cada item do questionário foram calculadas medidas de tendência central e dispersão. Foram verificadas possíveis diferenças de qualidade de vida entre mulheres com e sem linfedema...

In Brazil, breast cancer is the second most common cancer among women. In recent years, there has been an increase in progression-free survival of the disease, raising interest in the quality of life of patients treated for it. The objective of this study was to evaluate the quality of life in a cohort of women who received surgical treatment for breast cancer in order to verify any possible differences arising from the development of lymphedema of the upper extremities. The study population consisted of 549 women from a cohort formed in 2001 for the purpose of studying the incidence of lymphedema. All participants underwent a physical exam with a physiotherapist to check for the presence of lymphedema. The perimetry of the upper extremities was used as a base for defining cases of lymphedema. Participants were interviewed to collect socio-demographic data, using the EORTC QLQ C-30 questionnaire about quality of life and the BR-23 module. Information about the type of treatment and other clinical variables was obtained from medical records. The quality of life scores of the patients were aggregated and transformed into values on a 0–100 point scale. Measures of central tendency and dispersion were calculated for each item on the questionnaire. Possible differences between the quality of life for women with and without lymphedema were verified. Prevalence ratios were used to explore the magnitude of associations between the different variables, and differences in the average scores for the individual questions between women with and without this pathology were analyzed. The average global quality of life was 75.2 points, with a median of 75.0; for women with lymphedema, these values were 72.4 and 86.7, respectively. Additional studies are needed that use instruments oriented towards the social life of the patients, since this seems to be one of the principal areas in which they experience problems with quality of life.

Condição de saúde bucal de pacientes gastroplastizados / Oral health status of patients under bariatric surgery

A obesidade vem atingindo padrões de epidemia tornando-se um problema grave de saúde pública. Dentre os tratamentos propostos no combate à obesidade mórbida, a cirurgia bariátrica é um dos mais utilizados atualmente. O presente estudo teve como objetivo avaliara condição de saúde bucal de pacientes gastroplastizados. Foram avaliados 30 pacientes através de um questionário para coleta de dados de sua saúde geral. Posteriormente, cada indivíduo foi submetido a exame clínico da cavidade bucal para investigação do Índice de Sangramento Gengival(ISG), Registro Periodontal Simplificado (PSR), Índice de Dentes Cariados, Perdidos e Obturados (CPOD) e fluxo salivar. No grupo foram observados 17 (56,7%) pacientes que apresentavam hipossalivação. O CPOD médio9,9 e 9 pacientes apresentaram bolsas periodontais. A hipossalivação foi um achado frequente assim como a baixa ocorrência de sangramento gengival e dentes cariados

Obesity is reaching epidemic levels becoming a seriousPublic Health problem. Among the proposed treatmentsagainst obesity, bariatric surgery is one of the most widelyused. This study aimed to evaluate the oral health of patientswho were submitted to the surgical procedure. Were evaluated30 patients through an interview to collect data from yourgeneral health. Subsequently, each person underwent clinicalexamination of the oral cavity to investigate the GingivalBleeding Index (GBI), Periodontal Screening and Recording(PSR), Decayed, Missing and Filled Teeth Index (DMFT) andflow rate. In the group was observed 17 (56.7%) patients whohad hyposalivation. The mean DMFT was 9.9 and 9 patientsshowed periodontal pockets. Gingival bleeding was observedin alow percentage of teeth (8.3%). A reduced salivary flowwas a frequent finding as well as low occurrence of gingivalbleeding and decayed teeth.