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1.
Rev. bras. cir. plást ; 34(4): 524-530, oct.-dec. 2019. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-1047920

ABSTRACT

A obesidade mórbida se caracteriza por acúmulo de tecido adiposo que se distribui de maneira heterogênea em todo o organismo, tendo a gastroplastia como o mais recente método de tratamento cirúrgico. Após perda considerável de peso, o doente apresenta sobras cutâneas, sob essas sobras acumulam-se secreções que favorecem a instalação de infecções cutâneas que podem ser minimizadas com a execução de dermolipectomias. Os autores descrevem a técnica de lipoabdominoplastia em âncora, adaptando os princípios de descolamento reduzido do retalho, lipoaspiração de abdome e flancos, e preservação da fáscia de Scarpa infraumbilical associado à marcação pré-cirúrgica em "Fleur-de-Lis". A técnica foi realizada em 17 pacientes em pós-operatório tardio de gastroplastia, entre janeiro de 2018 e junho de 2019, com idade entre 35 a 66 anos, sendo 16 pacientes do sexo feminino e 1 do sexo masculino. Todos os pacientes foram operados com exames pré-operatórios dentro da normalidade, condições clínicas satisfatórias e IMC<30. Na presente série de casos, um paciente apresentou epidermólise de coto umbilical; todos os pacientes apresentaram edema e equimoses, e um paciente apresentou seroma no 13º dia de pós-operatório. Hematoma, necrose, infecção, deiscência de ferida operatória ou eventos tromboembólicos não foram observados em nenhum paciente. A técnica demostrou ser segura e eficaz no tratamento de pacientes com excedente cutâneo abdominal, com melhora do contorno corporal, porém há necessidade de maior tempo de acompanhamento pós-operatório e maior número de casos operados para melhor mensurar os resultados, bem como a incidência de complicações.


Morbid obesity is characterized by the accumulation of adipose tissues distributed heterogeneously throughout the body, and gastroplasty is the latest method of surgical treatment. After considerable weight loss, patients present with excess skin under which secretions accumulate, increasing susceptibility for skin infections, which can be minimized with dermolipectomy. Herein, we describe the anchor lipoabdominoplasty technique, adapting the principles of reduced flap detachment, abdominal and flank liposuctions, and preservation of the infraumbilical Scarpa's fascia associated with the preoperative fleurde- lis marking. The technique was used for seventeen patients, including sixteen women and one man, with late postoperative gastroplasty, aged 35­66 years in the period from January 2018 to June 2019. The patients presented with normal preoperative testing, satisfactory clinical conditions, and body mass index scores less than 30 kg/m2. In the present case series, one patient had umbilical cord remnant epidermolysis; all patients had edema and ecchymosis; and one patient had seroma on postoperative day 13. Hematoma, necrosis, infection, wound dehiscence, or thromboembolic events were not observed in any patient. The technique is safe and effective in the treatment of patients with abdominal excess skin, improving their body contour. However, longer postoperative follow-up periods and more cases are necessary to better measure the results and incidence of complications.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , History, 21st Century , Obesity, Morbid , Gastroplasty , Abdomen , Creativity , Abdominoplasty , Obesity, Morbid/surgery , Obesity, Morbid/physiopathology , Gastroplasty/methods , Gastroplasty/statistics & numerical data , Abdominoplasty/methods , /methods , /statistics & numerical data , Abdomen/surgery
2.
Säo Paulo med. j ; 137(2): 177-183, Mar.-Apr. 2019. tab
Article in English | LILACS | ID: biblio-1014638

ABSTRACT

ABSTRACT BACKGROUND: Excess trunk body fat in obese individuals influences respiratory physiological function. The aims of this study were to compare volumetric capnography findings (VCap) between severely obese patients and normal-weight subjects and to assess whether there is any association between neck circumference (NC), waist-hip ratio (WHR) and VCap among grade III obese individuals. DESIGN AND SETTING: Analytical observational case-matched cross-sectional study, University of Campinas. METHODS: This cross-sectional study compared VCap variables between 60 stage III obese patients and 60 normal-weight individuals. RESULTS: In comparison with the normal-weight group, obese patients presented higher alveolar minute volume (8.92 ± 4.94 versus 6.09 ± 2.2; P = < 0.0001), CO2 production (278 ± 91.0 versus 209 ± 60.23; P < 0.0001), expiratory tidal volume (807 ± 365 versus 624 ± 202; P = 0.005), CO2 production per breath (21.1 ± 9.7 versus 16.7 ± 6.16; P = 0.010) and peak expiratory flow (30.9 ± 11.9 versus 25.5 ± 9.13; P = 0.004). The end-expiratory CO2 (PetCO2) concentration (33.5 ± 4.88 versus 35.9 ± 3.79; P = 0.013) and the phase 3 slope were normalized according to expired tidal volume (0.02 ± 0.05 versus 0.03 ± 0.01; P = 0.049) were lower in the obese group. CONCLUSIONS: The greater the NC was, the larger were the alveolar minute volume, anatomical dead space, CO2 production per minute and per breath and expiratory volume; whereas the smaller were the phase 2 slope (P2Slp), phase 3 slope (P3Slp) and pressure drop in the mouth during inspiration.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Obesity, Morbid/physiopathology , Tidal Volume/physiology , Pulmonary Ventilation/physiology , Spirometry , Case-Control Studies , Cross-Sectional Studies , Capnography , Waist-Hip Ratio
3.
Arq. bras. oftalmol ; 82(1): 6-11, Jan.-Feb. 2019. tab
Article in English | LILACS | ID: biblio-973873

ABSTRACT

ABSTRACT Purpose: Obesity is associated with eye diseases, but the underlying structural changes and pathogenic mechanisms have not been examined in detail. Here, we assessed the effects of morbid obesity on the morphometric indices of eye disease. Methods: Morbidly obese volunteers (n=101, body mass index [BMI] ³40) and healthy individuals (n=95, BMI: 18.50-24.99) were examined by Goldman applanation tonometry, pachymetry, and spectral domain optical coherence tomography. Intraocular pressure, anterior chamber depth, axial length, central corneal thickness, retinal nerve fiber layer thickness, central foveal thickness, and choroidal thickness were compared between groups. Results: Uncorrected intraocular pressure was significantly greater in the morbidly obese group than in the healthy control group (15.5 ± 2.5 vs. 14.5 ± 2.6 mmHg, p=0.009), whereas axial length, anterior chamber depth, and central corneal thickness did not differ between the groups. The mean retinal nerve fiber layer thickness at the temporal quadrant was reduced in the morbidly obese group (72.7 ± 13.6 vs. 85.05 ± 52.6 mm, p=0.024). Similarly, the mean retinal thicknesses at nasal and temporal 1500-mm locations were lower in the morbidly obese group (346.6 ± 18.2 vs. 353.7 ± 18.8 mm, p=0.008; 323.1 ± 20.3 vs. 330.0 ± 18.9 mm, p=0.001). The mean choroidal thickness was also reduced in almost all measurement locations (fovea, temporal 500 and 1000 mm, and nasal 500, 1000, and 1500 mm) of the obese group (p<0.05). Weight and BMI were negatively correlated with subfoveal choroidal thickness (r=-0.186, p=0.009; r=-0.173, p=0.015). Conclusion: Morbid obesity is associated with elevated uncorrected intraocular pressure and signs of neuropathy and retinopathy. Obesity may thus increase the risks of glaucoma and glaucomatous optic neuropathy.


RESUMO Objetivo: A obesidade está associada a doenças oulares, mas as mudanças estruturais subjacentes e os mecanismos patogênicos não foram examinados detalhadamente. Aqui avaliamos os efeitos da obesidade mórbida nos índices morfométricos da doença ocular. Métodos: Voluntários obesos mórbidos (n=101, índice de massa corporal ³40) e indivíduos saudáveis (n=95, índice de massa corporal 18,50 a 24,99) foram examinados por tonometria de aplanação de Goldman, paquimetria e tomografia de coerência óptica de domício espectral. A pressão intraocular, profundidade da câmara anterior, comprimento axial, espessura central da córnea, espessura da camada de fibras nervosas da retina, espessura foveal central e espessura da coroide foram comparadas entre os grupos. Resultados: A pressão intraocular não corrigida foi significativamente maior no grupo com obesidade mórbida do que no grupo controle saudável (15,5 ± 2,5 vs. 14,5 ± 2,6 mmHg, p=0,009), enquanto que o comprimento axial, profundidade da câmara anterior e espessura central da córnea não diferiram entre os grupos. A espessura média da camada de fibras nervosas da retina no quadrante temporal foi reduzida no grupo com obesidade mórbida (72,7 ± 13,6 vs. 85,05 ± 52,6 mm, p=0,024). Da mesma forma, a média das espesuras da retinianas nas localizações nasal e temporal de 1500 m foi menor no grupo com obesidade mórbida (346,6 ± 18,2 mm vs. 353,7 ± 18,8 mm, p=0,008; 323,1 ± 20,3 mm vs. 330,0 ± 18,9 mm, p=0,001). A espessura média da coroide também foi reduzida em quase todos os locais de mensuração (fóvea, temporal 500 e 1000 mm, nasal 500, 1000 e 1500 mm) do grupo obeso (p<0,05). Peso e índice de massa corporal foram negativamente correlacionados com a espessura da coroide subfoveal (r=-0,186, p=0,009; r=-0,173, p=0,015). Conclusão: A obesidade mórbida está associada à elevada pressão intraocular não corrigida e a sinais de neuropatia e retinopatia. A obesidade pode, assim, aumentar os riscos de glaucoma e neuropatia óptica glaucomatosa.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Retinal Diseases/etiology , Obesity, Morbid/complications , Choroid Diseases/etiology , Retina/pathology , Retinal Diseases/physiopathology , Tonometry, Ocular/methods , Obesity, Morbid/physiopathology , Body Mass Index , Case-Control Studies , Choroid Diseases/physiopathology , Glaucoma/etiology , Glaucoma/physiopathology , Choroid/pathology , Statistics, Nonparametric , Tomography, Optical Coherence/methods , Corneal Pachymetry/methods , Intraocular Pressure
4.
Braz. j. med. biol. res ; 52(9): e8402, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019567

ABSTRACT

Cardiopulmonary fitness assessment is a valuable resource to obtain quantitative indicators of an individual's physical performance. The cardiopulmonary exercise test (CPX), considered the gold standard test for this evaluation, is costly and difficult to be accessed by the general population. In order to make this evaluation more accessible, and to better reflect the performance of daily life activities, alternative tests were proposed. Morbidly obese patients present limitations that impair physical performance assessment and could benefit from a test of shorter duration, provided it is validated. This observational study aimed to validate the two-minute step test (2MST) as a tool to evaluate functional capacity (FC) in obese with comorbidities and morbidly obese patients, compared the 2MST with CPX as a measure of physical performance, and developed a predictive equation to estimate peak oxygen uptake (VO2) in the 2MST. The CPX and the 2MST were performed and metabolic and ventilatory parameters were recorded in 31 obese individuals (BMI>35 kg/m2). Pearson correlation and multiple linear regression analyses were performed to evaluate the peak VO2 best predictors. Bland-Altman analysis was performed to assess the agreement between the two methods. Peak VO2 measured by CPX and 2MST showed a strong correlation (r=0.70, P<0.001) and there was a moderate correlation between peak VO2 of the 2MST and the number of up-and-down step cycles (UDS) (r=0.55; P=0.01). The reference equation obtained was: VO2 (mL·kg-1·min-1) = 13.341 + 0.138 × total UDS - (0.183 × BMI), with an estimated standard error of 1.3 mL·kg-1·min-1. The 2MST is a viable, practical, and easily accessible test for FC. UDS and BMI can predict peak VO2 satisfactorily.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Oxygen Consumption/physiology , Exercise Tolerance/physiology , Walk Test/methods , Heart Rate/physiology , Obesity/physiopathology , Time Factors , Obesity, Morbid/physiopathology , Comorbidity , Cardiorespiratory Fitness/physiology
5.
J. bras. pneumol ; 45(5): e20180311, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1040280

ABSTRACT

RESUMO Objetivo avaliar os diferentes componentes da resistência do sistema respiratório e a força muscular respiratória, bem como investigar a ocorrência de limitação de fluxo expiratório (LFE) de pacientes obesos mórbidos (OM) na posição sentada. Métodos a amostra foi composta de OM (IMC ≥ 40 kg/m2) e de indivíduos não obesos (NO) com IMC entre 18 e 30 kg/m2. O protocolo foi composto de: avaliação antropométrica e da função respiratória (espirometria, pressões inspiratória (PIM) e expiratória máximas (PEM) e oscilometria de impulso). Na comparação entre os grupos, foi utilizado o teste T para amostras não pareadas. As correlações foram avaliadas pelo teste de Pearson, e o nível de significância foi de 5%. Resultados Foram avaliados 50 OM (idade 40,0 ± 10,4 anos, 1,64 ± 0,09 m, 138,8 ± 33,6 kg e 50,7 ± 8,9 kg/m2), além de 30 NO (idade 37,6 ± 11,5 anos, 1,67 ± 0,09 m, 65,2 ± 10,3 kg e 23,2 ± 22 kg/m2). Os OM apresentaram maiores valores de resistência total, central, de vias aéreas, tecidual e periférica quando comparados aos NO. Nenhum paciente apresentou LFE. A circunferência abdominal se associou com variáveis espirométricas PIM e PEM. A relação cintura-quadril se correlacionou com variáveis de mecânica respiratória, além das espirométricas PIM e PEM. Conclusões pacientes com obesidade mórbida e sem padrão espirométrico obstrutivo apresentam aumento nas resistências total, de vias aéreas, periférica e tecidual do sistema respiratório quando comparados a não obesos. Esses indivíduos, entretanto, não apresentam limitação de fluxo expiratório e redução da força muscular respiratória.


ABSTRACT Objective To evaluate the different components of the resistance of the respiratory system, respiratory muscle strength and to investigate the occurrence of expiratory flow limitation (EFL) in patients with morbid obesity (MO) when seated. Methods The sample was composed of MO (BMI≥40 kg/m2) and non-obese individuals (NO) with a BMI between 18 and 30 kg/m2. The protocol consisted of the anthropometric assessment and the following measures of respiratory function: spirometry, maximal inspiratory and expiratory pressures (MIP and MEP, respectively) and impulse oscillometry. The group comparison was performed using T-test for unpaired samples. The correlations were evaluated by the Pearson test with a significance level of 5%. Results Fifty MO (age 40±10.4 years, 1.64±0.09 m, 138.8±33.6 kg and 50.7±8.9 kg/m2), and 30 NO (age 37.6±11.5 years, 1.67±0.09 m, 65.2±10.3 kg and 23.2±22 kg/m2) were evaluated. The MO showed higher values of total, peripheral, airways, tissue and central resistance when compared to the NO. No patient showed EFL. The waist circumference was associated with spirometric variables, MIP, and MEP. The waist-to-hip ratio was correlated to respiratory mechanics and spirometric variables, MIP, and MEP. Conclusion Morbidly obese patients with no obstructive spirometric pattern show increased total, airway, peripheral, and tissue respiratory system resistance when compared to nonobese. These individuals, however, do not present with expiratory flow limitation and reduced respiratory muscles strength.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Obesity, Morbid/physiopathology , Respiratory Muscles/physiopathology , Respiratory Mechanics/physiology , Muscle Strength/physiology , Reference Values , Respiratory Function Tests , Case-Control Studies , Anthropometry , Cross-Sectional Studies , Statistics, Nonparametric , Exhalation/physiology
6.
Rev. Col. Bras. Cir ; 45(3): e1864, 2018. tab
Article in Portuguese | LILACS | ID: biblio-956554

ABSTRACT

RESUMO Objetivo: mensurar a eficácia da perda de peso, analisar a evolução de comorbidades, investigar a qualidade de vida e avaliar o protocolo BAROS (Bariatric Analysis and Reporting Outcome System) no pós-operatório de pacientes submetidos à cirurgia bariátrica. Métodos: estudo transversal e quantitativo, com força de verdade de 95% (P=0,05), de 103 pacientes submetidos à Gastrectomia Vertical SLEEVE (40) e à Derivação Gástrica em Y de Roux (63), a partir de quatro meses de pós-operatório. A pesquisa foi realizada no Ambulatório de Cirurgia Geral do Hospital das Clínicas da Universidade Federal de Pernambuco, tendo sido utilizado o protocolo BAROS. Resultados: a maioria dos pacientes era do sexo feminino (89,3%). A média de idade foi de 44,23 anos. A média de perda percentual do excesso de peso foi de 69,35%. A média de tempo de seguimento pós-cirúrgico foi de 41,87 meses (±37,35). As comorbidades com maior percentagem de resolução foram: apneia do sono (90,2%), diabetes (80,7%) e hipertensão (70,8%). As complicações mais frequentes foram queda de cabelo (79,6%), deficiência nutricional (37,9%) e anemia (35%). O protocolo BAROS demonstrou que a qualidade de vida foi avaliada de forma positiva em 93,2% dos casos. O questionário Moorehead-Ardelt demonstrou que a qualidade de vida "melhorou" ou "melhorou muito" para 94,1% dos pacientes. Conclusão: a cirurgia bariátrica demonstrou ser um procedimento eficaz no tratamento da obesidade mórbida e no controle das comorbidades. A análise da qualidade de vida foi avaliada de forma positiva através do protocolo BAROS.


ABSTRACT Objective: to assess the efficacy of weight loss, the evolution of comorbidities, the quality of life and the BAROS protocol (Bariatric Analysis and Reporting Outcome System) in the postoperative period of patients undergoing bariatric surgery. Methods: we conducted a cross-sectional, quantitative study with 95% true strength (P=0.05), with 103 patients submitted to SLEEVE Vertical Gastrectomy (40) and Roux-en-Y Gastric Bypass (63), from four months after surgery. We carried out the research at the Ambulatory of General Surgery of the Clinics Hospital of the Federal University of Pernambuco, using the BAROS protocol. Results: the majority of the patients were female (89.3%). The mean age was 44.23 years. The mean percentage loss of excess weight was 69.35%. The mean postoperative follow-up time was 41.87 months (±37.35). The comorbidities with the highest percentage of resolution were sleep apnea (90.2%), diabetes (80.7%) and hypertension (70.8%). The most frequent complications were hair loss (79.6%), nutritional deficiency (37.9%) and anemia (35%). The BAROS protocol demonstrated that patients positively evaluated quality of life in 93.2% of the cases. The Moorehead-Ardelt questionnaire showed that quality of life "improved" or "improved greatly" for 94.1% of patients. Conclusion: bariatric surgery has been shown to be an effective procedure in the treatment of morbid obesity and in the control of comorbidities. Quality of life analysis was evaluated positively through the BAROS protocol.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Quality of Life/psychology , Gastric Bypass/methods , Weight Loss/physiology , Bariatric Surgery/methods , Gastrectomy/methods , Postoperative Complications , Self Concept , Time Factors , Obesity, Morbid/surgery , Obesity, Morbid/physiopathology , Obesity, Morbid/epidemiology , Brazil/epidemiology , Gastric Bypass/psychology , Body Mass Index , Comorbidity , Cross-Sectional Studies , Surveys and Questionnaires , Treatment Outcome , Bariatric Surgery/psychology , Gastrectomy/psychology , Middle Aged
7.
Clinics ; 73: e20, 2018. tab, graf
Article in English | LILACS | ID: biblio-890767

ABSTRACT

OBJECTIVE: To determine whether weight loss in women with morbid obesity subjected to bariatric surgery alters lung function, respiratory muscle strength, functional capacity and the level of habitual physical activity and to investigate the relationship between these variables and changes in both body composition and anthropometrics. METHODS: Twenty-four women with morbid obesity were evaluated with regard to lung function, respiratory muscle strength, functional capacity, body composition, anthropometrics and the level of habitual physical activity two weeks prior to and six months after bariatric surgery. RESULTS: Regarding lung function, mean increases of 160 mL in slow vital capacity, 550 mL in expiratory reserve volume, 290 mL in forced vital capacity and 250 mL in forced expiratory volume in the first second as well as a mean reduction of 490 mL in inspiratory capacity were found. Respiratory muscle strength increased by a mean of 10 cmH2O of maximum inspiratory pressure, and a 72-meter longer distance on the Incremental Shuttle Walk Test demonstrated that functional capacity also improved. Significant changes also occurred in anthropometric variables and body composition but not in the level of physical activity detected using the Baecke questionnaire, indicating that the participants remained sedentary. Moreover, correlations were found between the percentages of lean and fat mass and both inspiratory and expiratory reserve volumes. CONCLUSION: The present data suggest that changes in body composition and anthropometric variables exerted a direct influence on functional capacity and lung function in the women analyzed but exerted no influence on sedentarism, even after accentuated weight loss following bariatric surgery.


Subject(s)
Humans , Female , Adult , Middle Aged , Obesity, Morbid/surgery , Obesity, Morbid/physiopathology , Respiratory Muscles/physiopathology , Exercise/physiology , Weight Loss/physiology , Bariatric Surgery/methods , Lung/physiopathology , Postoperative Period , Respiratory Function Tests/methods , Time Factors , Body Composition/physiology , Anthropometry , Prospective Studies , Surveys and Questionnaires , Treatment Outcome , Statistics, Nonparametric , Muscle Strength/physiology , Walk Test
8.
Clinics ; 72(9): 547-553, Sept. 2017. tab
Article in English | LILACS | ID: biblio-890733

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate potential risk factors, including non-communicable diseases, for morbid obesity in women between 20 and 49 years of age. METHODS: We performed a case-control study with 110 morbidly obese women and 110 women with adequate weight who were matched by age and with a 1:1 case to control ratio. All women were between 20 to 49 years old and non-menopausal. Possible risk factors were evaluated through a self-report questionnaire assessing socio-demographic, obstetric and gynecological characteristics, presence of non-communicable diseases and habits. Multiple logistic regression was used to estimate the odds ratio with respective confidence intervals. RESULTS: Menarche under 12 years old, teenage pregnancy and lower educational level were shown to be risk factors for morbid obesity among women of reproductive age. Incidences of non-communicable diseases (diabetes, hypertension, dyslipidemia, liver disease, lung disease, thyroid dysfunction, and joint pain) were increased in women with morbid obesity. CONCLUSIONS: Early menarche, teenage pregnancy and low education level are risk factors for the occurrence of morbid obesity in women of reproductive age. Some non-communicable diseases were already more prevalent in women with morbid obesity even before 50 years of age.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Middle Aged , Young Adult , Menarche/physiology , Obesity, Morbid/etiology , Pregnancy in Adolescence , Age Factors , Body Mass Index , Case-Control Studies , Exercise/physiology , Logistic Models , Obesity, Morbid/physiopathology , Risk Factors , Self Report , Socioeconomic Factors
9.
Clinics ; 72(5): 272-275, May 2017. tab
Article in English | LILACS | ID: biblio-840072

ABSTRACT

OBJECTIVE: The aim of our study was to evaluate associations between maximum voluntary contraction torques of the lower limbs and body composition for subjects with severe obesity. METHODS: Body composition was evaluated by bioelectrical impedance analysis, and maximum voluntary contraction torques of the lower limbs were measured using an isokinetic dynamometer. One hundred thirty-two patients were enrolled (100 females and 32 males). Eighty-seven patients had a body mass index between 40 and 49.9 kg/m2 (the A group), and 45 patients had a body mass index between 50 and 59.9 kg/m2 (the B group). RESULTS: Absolute extension and flexion torques had weak associations with fat-free mass but a moderate association with absolute extension torque and fat-free mass of the lower limbs. There were no significant differences between the A and B groups with respect to absolute extension and flexion torques. For the A group, absolute extension and flexion torques were moderately associated with fat-free mass and with fat-free mass of the lower limbs. For the B group, there were only moderate associations between absolute extension and flexion torques with fat-free mass of the lower limbs. CONCLUSIONS: Our findings demonstrate that both groups exhibited similar absolute torque values. There were weak to moderate associations between absolute extension and flexion torques and fat-free mass but a moderate association with fat-free mass of the lower limbs. Individuals with severe obesity should strive for greater absolute torques, fat-free mass and especially fat-free mass of the lower limbs to prevent functional limitations and physical incapacity.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Body Composition/physiology , Muscle Contraction/physiology , Muscle Strength/physiology , Obesity, Morbid/physiopathology , Anthropometry , Electric Impedance , Lower Extremity/physiopathology , Muscle Strength Dynamometer , Muscle, Skeletal/physiopathology , Reference Values , Severity of Illness Index , Statistics, Nonparametric , Torque
10.
Rev. Assoc. Med. Bras. (1992) ; 63(4): 324-331, Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-842558

ABSTRACT

Summary Introduction: The purpose of this study was to evaluate the prevalence of peripheral polyneuropathy (PPN) in subjects with grade II and III obesity (Ob-II,III) and metabolic syndrome (MetS) but without diabetes and to investigate possible associated factors. Method: A cross-sectional study was performed in non-diabetic Ob-II,III,MetS patients using the Michigan Neuropathy Screening Instrument (MNSI) to assess the presence of PPN. Results: A total of 24 of 218 non-diabetic Ob-II,III,MetS patients had PPN. Based on univariate analysis, serum levels of LDL-cholesterol (p=0.046) were significantly associated with PPN, while serum triglycerides (p=0.118) and low HDL-cholesterol (p=0.057) showed a tendency toward this association. On a Poisson regression analysis, when the three possible associations were included, low HDL-cholesterol (p=0.047) remained independently associated. Conclusion: In non-diabetic Ob-II,III,MetS patients, PPN defined by the MNSI showed a high prevalence and was associated with low levels of HDL-cholesterol. In order to diagnose that complication, neurological evaluation should be performed in these patients.


Resumo Objetivo: Avaliar a prevalência da polineuropatia periférica (PNP) em indivíduos obesos graus II e III com síndrome metabólica (Ob-II,III,SM) sem diabetes e buscar possíveis fatores associados. Método: Em um estudo transversal, realizado em indivíduos Ob-II,III,SM e sem diagnóstico de diabetes, o Instrumento de Screening de Michigan (MNSI) foi utilizado para avaliar a presença de PNP. Resultados: Um total de 24 de 218 pacientes Ob-II,III,SM e sem diabetes tinham PNP. Quando observamos as associações com PNP em uma análise univariada, níveis séricos de LDL-colesterol (p=0.046) estiveram significativamente associados e houve também uma tendência à associação com níveis séricos de triglicerídeos (p=0.118) e baixo HDL-colesterol (p=0.057). Em uma análise de regressão de Poisson, quando as três possíveis associações foram incluídas, baixo HDL-colesterol (p=0.047) manteve-se independentemente associado. Conclusão: Em pacientes Ob-II,III,SM, mas sem diabetes, a PNP definida pelo MNSI tem uma prevalência elevada e está associada a baixos níveis de HDL-colesterol. Para diagnóstico dessa complicação, recomenda-se realizar o exame neurológico desses pacientes.


Subject(s)
Humans , Male , Female , Adult , Polyneuropathies/etiology , Polyneuropathies/epidemiology , Obesity, Morbid/complications , Metabolic Syndrome/complications , Hypoalphalipoproteinemias/complications , Polyneuropathies/physiopathology , Polyneuropathies/metabolism , Triglycerides/blood , Blood Glucose/analysis , Obesity, Morbid/physiopathology , Obesity, Morbid/metabolism , Brazil/epidemiology , Poisson Distribution , Anthropometry , Prevalence , Cross-Sectional Studies , Prospective Studies , Surveys and Questionnaires , Risk Factors , Statistics, Nonparametric , Metabolic Syndrome/physiopathology , Hypoalphalipoproteinemias/physiopathology , Hypoalphalipoproteinemias/metabolism
11.
Rev. Assoc. Med. Bras. (1992) ; 62(2): 157-161, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-780966

ABSTRACT

Summary Objective: To determine the lung age (LA) in obese people before and after bariatric surgery, compare the LA with the chronological age (CA) before and after the peration, and verify whether there was a functional pulmonary rejuvenation after it. Methods: A prospective longitudinal study including 43 morbidly obese patients who underwent bariatric surgery. The patients underwent clinical and spirometric evaluation in two stages, before and after the surgery. In both stages, LA, CA and spirometric variables were measured. Results: A significant improvement in the spirometric variables (FVC; FEV1; and FEV1/FVC ratio) was found after the operation (p≤ 0.0001). Comparing the LA before (50.93±13.36 years) and after the surgery (39.02±12.95 years), there was an important reduction of 11.90±9.12 years (95CI:9.10-14.71; p≤0.0001) in LA after surgery. The difference between LA and CA before surgery was 12.20± 11.71 years (95CI:8.60-15.81) with significant difference (p≤0.0001), and the difference between LA and CA after surgery was -1.95±11.83 years (95CI: -5.59-1.69) with no significant difference (p≤0.28). Regarding LA, we observed a pulmonary aging of 12.20±11.71 years before the surgery and a pulmonary rejuvenation of 11.90±9.12 years after it. Conclusion: Morbid obesity is responsible for early damage and functional accelerated pulmonary aging. After the correction of the body weight by surgery, there is a functional pulmonary rejuvenation demonstrated by the normalization of LA in relation to CA.


Resumo Objetivo: determinar a idade pulmonar (IP) em obesos no pré e pós-operatório de cirurgia bariátrica, comparar a IP com a idade cronológica (IC) antes e após a cirurgia, e verificar se houve rejuvenescimento pulmonar funcional após a cirurgia. Métodos: estudo longitudinal, prospectivo, envolvendo 43 pacientes obesos mórbidos submetidos à cirurgia bariátrica. Os pacientes foram submetidos à avaliação clínica e espirométrica antes e após a cirurgia, sendo determinadas IP, IC e variáveis espirométricas. Resultados: observou-se melhora significativa nas variáveis espirométricas (VEF1, CVF e razão VEF1/CVF) após a cirurgia (p≤0,0001). Comparando a IP antes (50,93±13,36 anos) e após a cirurgia (39,02±12,95 anos), observou-se redução significativa da IP no pós-operatório de 11,90±9,12 anos (IC 95% 9,10-14,71; p≤0,0001). A diferença entre IP e IC no pré-operatório foi de 12,20±11,71 anos (IC 95% 8,60-15,81) com diferença significativa (p≤0,0001). A diferença entre IP e IC no pós-operatório foi de -1,95±11,83 anos (IC 95% -5,59-1,69), sem apresentar diferença significativa (p≤0,28). Quando comparamos a IP antes e após a cirurgia, observamos um envelhecimento pulmonar de 12,20±11,71 anos antes e um rejuvenescimento pulmonar de 11,90±9,12 anos após a cirurgia. Conclusão: a obesidade mórbida causa dano precoce e envelhecimento pulmonar funcional acelerado. Após a correção do peso corpóreo pela cirurgia, há um rejuvenescimento pulmonar funcional, mostrado pela normalização da IP em relação à IC.


Subject(s)
Humans , Male , Female , Adult , Rejuvenation/physiology , Obesity, Morbid/surgery , Obesity, Morbid/physiopathology , Bariatric Surgery , Lung/physiopathology , Postoperative Period , Spirometry , Aging/physiology , Weight Loss/physiology , Vital Capacity/physiology , Forced Expiratory Volume/physiology , Prospective Studies , Longitudinal Studies , Age Factors , Treatment Outcome , Middle Aged
12.
Clinics ; 71(2): 78-81, Feb. 2016. tab
Article in English | LILACS | ID: lil-774534

ABSTRACT

OBJECTIVE: To assess the postural control and flexibility of obese subjects before and both six and 12 months after bariatric surgery. To verify whether postural control is related to flexibility following weight reductions resulting from bariatric surgery. METHODS: The sample consisted of 16 subjects who had undergone bariatric surgery. All assessments were performed before and six and 12 months after bariatric surgery. Postural balance was assessed using an Accusuway¯ portable force platform, and flexibility was assessed using a standard chair sit and reach test (Wells’ chair). RESULTS: With the force platform, no differences were observed in the displacement area or velocity from the center of pressure in the mediolateral and anteroposterior directions. The displacement speed from the center of pressure was decreased at the six month after the surgery; however, unchanged from baseline at 12 months post-surgery. Flexibility increased over time according to the three measurements tested. CONCLUSIONS: Static postural balance did not change. The velocity of postural adjustment responses were increased at six months after surgery. Therefore, weight loss promotes increased flexibility. Yet, improvements in flexibility are not related to improvements in balance.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Bariatric Surgery/rehabilitation , Obesity, Morbid/physiopathology , Postural Balance/physiology , Range of Motion, Articular/physiology , Obesity, Morbid/surgery , Obesity/physiopathology , Obesity/surgery , Postoperative Period , Time Factors , Treatment Outcome , Weight Loss/physiology
13.
Rev. salud pública ; 18(1): 10-12, ene.-feb. 2016. ilus
Article in Portuguese | LILACS | ID: lil-777019

ABSTRACT

Objetivo O objetivo deste estudo foi estudar o efeito agudo do exercício físico em cicloergômetro adaptado para membros superiores sobre marcadores fisiológicos em obesos mórbidos. Métodos Participaram da pesquisa dez pacientes que realizaram 30 minutos de atividade contínua em um cicloergômetro adaptado para membros superiores. Foram avaliados a pressão arterial sistêmica, a frequência cardíaca, o duplo produto e a saturação de oxigênio. Para análise estatística utilizou-se de análise descritiva. Resultados Os pacientes apresentaram o valor de 52,1 ± 8,3 no Índice de Massa Corporal. A maioria dos avaliados apresentaram uma discreta redução na pressão arterial sistólica (PAS) e diastólica (PAD) após a atividade física, com valores médios pré e pós na PAS de 135,5±11,4 e 133,5±15,3 mmHg, e 83±7,5 e 77±7,1 na PAD. A frequência cardíaca média foi de 68±10,4 bpm antes, 100,6±16,5 bpm durante e 80,7±14,5 bpm após 1 minuto. O Duplo Produto (DP) apresentou aumento médio de 29,6±17,1 % entre os homens e de 10,4±8,9 % entre as mulheres quando comparado com a fase inicial. A saturação de oxigênio não apresentou diferença média antes, durante e após a atividade. Conclusão Conclui-se que o exercício físico em cicloergômetro para membros superiores, realizado de forma aguda em obesos mórbidos não apresenta risco elevado, sendo uma boa intervenção para promoção da saúde.(AU)


Objective The purpose of this study is to research effects of acute exercise with cycle ergometers adapted for the upper limbs on physiological markers in the morbidly obese. Methods Ten morbidly obese patients participated in the study. They were submitted to thirty minutes of continuous activity on a cycle ergometer adapted to the upper limbs. The following physiological markers were evaluated: systemic arterial pressure, heart rate, the double product, and oxygen saturation. For the statistical analysis, descriptive analysis was used. Results Patients showed a Body Mass Index (BMI) value of 52.1 ± 8.3. Most of the subjects showed a slight reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after physical activity, with SBP before and after physical activity of 135.5±11.4 and 133.5±15.3 mmHg, respectively, and, for DBP, 83±7.5 and 77±7.1 respectively. The average heart rate was 68±10.4 bpm before, 100.6±16.5 bpm during and 80.7±14.5 bpm 1 minute after. The double product (DP) had a mean increase of 29.6±17.1 % in men and 10.4±8.9 % in women when compared with the initial phase. The oxygen saturation showed no mean difference before, during or after activity. Conclusion It can be concluded that acute physical exercise with an upper limbs cycle ergometer in morbidly obese patients does not represent an elevated risk to these patients, being in fact a good intervention to promote health.(AU)


Objetivo El objetivo de este estudio fue investigar el efecto del ejercicio físico agudo en un ciclo ergómetro adaptado para miembros superiores sobre marcadores fisiológicos en obesos mórbidos. Métodos Participaron en la investigación diez pacientes que realizaron 30 minutos de actividad continua en un ciclo ergómetro adaptado para miembros superiores. Fueron evaluadas la presión arterial sistémica, la frecuencia cardíaca, el doble producto y la saturación de oxígeno. Para el análisis estadístico se utilizó el análisis descriptivo. Resultados Los pacientes presentaron un valor de Índice de Masa Corporal de 52,1±8,3. La mayoría de los evaluados presentaron una discreta reducción en la presión arterial sistólica (PAS) y diastólica (PAD) después de la actividad física, con valores medios pre y pos en la PAS de 135,5±11,4 y 133,5±15,3 mmHg respectivamente y, para la PAD, 83±7,5 y 77±7,1, respectivamente. El valor medio de la frecuencia cardíaca fue de 68±10,4 lpm antes, 100,6±16,5 lpm durante y 80,7±14,5 lpm 1 minuto después de la actividad física. El producto doble (DP) presentó un aumento medio de 29,6±17,1 % en los hombres y de 10,4±8,9 % en las mujeres comparado con la fase inicial. La saturación de oxigeno no presentó ninguna diferencia media antes, durante ni después de la actividad. Conclusión Se concluye que el ejercicio físico agudo en el ciclo ergómetro para miembros superiores realizado por obesos mórbidos no representa ningún riesgo elevado, siendo una buena intervención para la promoción de la salud.(AU)


Subject(s)
Humans , Obesity, Morbid/physiopathology , Exercise , Upper Extremity , Arterial Pressure , Heart Rate , Oximetry/instrumentation , Data Interpretation, Statistical
14.
Bauru; s.n; 2016. 86 p. tab, ilus, graf.
Thesis in Portuguese | LILACS, BBO | ID: biblio-881840

ABSTRACT

O objetivo deste estudo foi avaliar o limiar de dor a pressão (LDP) e a percepção de dor orofacial através do teste de fadiga mastigatória após um período de inatividade da mastigação. Estudo caracterizado como de coorte, prospectivo e observacional. Composto por 30 indivíduos obesos mórbidos, divididos em dois grupos. Experimental (GE) (n=15) que foram submetidos a cirurgia bariátrica e Controle (GC) (n=15) que se apresentavam na fase pré cirúrgica. O Limiar de Dor a Pressão e a Escala de Análise Visual (EAV) foram adotados como testes para compor a avaliação de fadiga mastigatória. Os dados foram registrados em dois tempos distintos para ambos os grupos, com um intervalo de 37 dias entre as coletas. No entanto, apenas o GE foi submetido a inatividade mastigatória. Empregou-se o teste de Shapiro-Wilk para avaliar a normalidade dos dados e adotou-se ANOVA mista de medidas repetidas (dados paramétricos) e o teste de Friedman (dados não paramétricos) para identificar diferenças intragrupos e para comparar os valores de LDP observados antes e depois da cirurgia bariátrica foram empregados o teste t de Student para amostras pareadas (dados paramétricos) e o teste de Wilcoxon pareado (dados não paramétricos) considerando-se uma probabilidade de erro do tipo I () de 0,05. Para o GE, os níveis do LDP apresentaram uma redução significativa e a percepção de dor aumentou durante o teste de fadiga mastigatória quando avaliado após o período de inatividade da mastigação. Outro dado observado foi a não recuperação dos níveis do LDP e EAV após a o teste de fadiga, no qual os níveis não retornaram aos registros iniciais como no período pré cirúrgico. Diante dos dados avaliados no teste de fadiga mastigatória, o Limiar de Dor a Pressão apresentou reduções significativas, caracterizando o aumento da sensibilidade à palpação nos músculos avaliados, após o período de inatividade mastigatória de 37 dias. Ao passo que houve aumento na percepção de dor orofacial dos pacientes obesos mórbidos no mesmo período de avaliação.(AU)


The aim of this study was to evaluate the pressure pain threshold (PPT) and the perception of orofacial pain through masticatory fatigue test after a period of inactivity of mastication. Study characterized as a cohort, prospective, observational. Composed of 30 morbid obese subjects, separated into two groups: Experimental (EG) (n = 15) were submitted to bariatric surgery and Control (CG) (n = 15) pre surgical procedure. The Pressure Pain Threshold and Visual Analysis Scale (VAS) have been adopted as testing to compose the evaluation of masticatory fatigue. Data were recorded at two different times for both groups, with an interval of 37 days between the analyses. However only the EG was subjected to masticatory inactivity. The Shapiro-Wilk test was employed to assess the normality of the data and adopted mixed repeated measures ANOVA (parametric data) and the Friedman test (nonparametric data) to identify intergroup differences and to compare the PPT values observed before and after bariatric surgery were used the Student t test for paired samples (parametric data) and Wilcoxon test (nonparametric data) considering a probability of error type I () of 0.05. For EG, the PPT levels showed a significant reduction and the perception of pain increased during the masticatory fatigue test when evaluated after a period of inactivity of mastication. Another fact observed was the non-recovery of the PPT and VAS levels after the fatigue test, in which the levels did not return to the original records as the surgical pre surgical procedure. According the data evaluated in the masticatory fatigue test, the pain threshold to pressure showed significant reductions, featuring increased tenderness to palpation in the muscles evaluated after masticatory inactivity period of 37 days. Whereas there was an increase in the perception of orofacial pain of morbidly obese patients in the same period of evaluation.(AU)


Subject(s)
Humans , Male , Female , Bariatric Surgery , Facial Pain/physiopathology , Mastication/physiology , Masticatory Muscles/physiopathology , Muscle Fatigue/physiology , Obesity, Morbid/surgery , Pain Threshold/physiology , Analysis of Variance , Obesity, Morbid/physiopathology , Observational Study , Pain Measurement , Postoperative Period , Preoperative Period , Prospective Studies , Statistics, Nonparametric , Time Factors
15.
Arq. bras. cardiol ; 105(6): 580-587, Dec. 2015. tab, graf
Article in Portuguese | LILACS | ID: lil-769535

ABSTRACT

Abstract Background: Morbid obesity is directly related to deterioration in cardiorespiratory capacity, including changes in cardiovascular autonomic modulation. Objective: This study aimed to assess the cardiovascular autonomic function in morbidly obese individuals. Methods: Cross-sectional study, including two groups of participants: Group I, composed by 50 morbidly obese subjects, and Group II, composed by 30 nonobese subjects. The autonomic function was assessed by heart rate variability in the time domain (standard deviation of all normal RR intervals [SDNN]; standard deviation of the normal R-R intervals [SDNN]; square root of the mean squared differences of successive R-R intervals [RMSSD]; and the percentage of interval differences of successive R-R intervals greater than 50 milliseconds [pNN50] than the adjacent interval), and in the frequency domain (high frequency [HF]; low frequency [LF]: integration of power spectral density function in high frequency and low frequency ranges respectively). Between-group comparisons were performed by the Student’s t-test, with a level of significance of 5%. Results: Obese subjects had lower values of SDNN (40.0 ± 18.0 ms vs. 70.0 ± 27.8 ms; p = 0.0004), RMSSD (23.7 ± 13.0 ms vs. 40.3 ± 22.4 ms; p = 0.0030), pNN50 (14.8 ± 10.4 % vs. 25.9 ± 7.2%; p = 0.0061) and HF (30.0 ± 17.5 Hz vs. 51.7 ± 25.5 Hz; p = 0.0023) than controls. Mean LF/HF ratio was higher in Group I (5.0 ± 2.8 vs. 1.0 ± 0.9; p = 0.0189), indicating changes in the sympathovagal balance. No statistical difference in LF was observed between Group I and Group II (50.1 ± 30.2 Hz vs. 40.9 ± 23.9 Hz; p = 0.9013). Conclusion: morbidly obese individuals have increased sympathetic activity and reduced parasympathetic activity, featuring cardiovascular autonomic dysfunction.


Resumo Fundamentos: A obesidade mórbida está diretamente relacionada à deterioração da capacidade cardiorrespiratória, incluindo alterações na modulação autonômica cardiovascular. Objetivo: Este estudo teve por objetivo avaliar a função autonômica cardiovascular de obesos mórbidos. Métodos: Estudo transversal, incluindo dois grupos, Grupo I, composto por 50 obesos mórbidos, e Grupo II, por 30 indivíduos não obesos. A função autonômica foi avaliada pela variabilidade da frequência cardíaca no domínio do tempo [desvio padrão de todos os intervalos R-R normais (SDNN); desvio-padrão de todos os intervalos R-R normais (SDNN); raiz quadrada das médias quadráticas das diferenças dos intervalos R-R sucessivos (RMSSD); e o percentual de diferenças de intervalo intervalos R-R sucessivos maior que 50 milissegundos (pNN50)] em comparação ao adjacente, e no domínio da frequência (HF, do inglês, “high frequency”, e LF, do inglês, “low frequency”: integração da função da densidade espectral de potência para as bandas de alta e baixa frequência, respectivamente). Os grupos foram comparados pelo teste t de Student, considerando-se um nível de significância de 5%. Resultados: Quando comparados aos controles, os indivíduos obesos apresentaram valores menores de SDNN (40,0 ± 18,0 ms vs. 70,0 ± 27,8 ms; p = 0,0004), RMSSD (23,7 ± 13,0 ms vs. 40,3 ± 22,4 ms; p = 0,0030), pNN50 (14,8 ± 10,4 % vs. 25,9 ± 7,2%; p = 0,0061) e HF (30,0 ± 17,5 Hz vs. 51,7 ± 25,5 Hz; p = 0,0023). A relação LF/HF média foi maior no Grupo I (5,0 ± 2,8 vs. 1,0 ± 0,9; p = 0,0189), refletindo alteração no equilíbrio simpato-vagal. Não houve diferença estatística entre os grupos I e II com relação ao índice LF (50,1 ± 30,2 Hz vs. 40,9 ± 23,9 Hz; p = 0,9013). Conclusão: obesos mórbidos apresentam aumento de atividade simpática e redução da atividade parassimpática, caracterizando uma disfunção autonômica cardiovascular.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Autonomic Nervous System Diseases/physiopathology , Cardiovascular Diseases/physiopathology , Obesity, Morbid/physiopathology , Anthropometry , Autonomic Nervous System Diseases/etiology , Case-Control Studies , Cross-Sectional Studies , Cardiovascular Diseases/etiology , Heart Rate/physiology , Muscle Strength/physiology , Obesity, Morbid/complications , Predictive Value of Tests , Reference Values , Respiratory Function Tests , Risk Factors , Respiratory Muscles/physiopathology , Statistics, Nonparametric
16.
J. bras. pneumol ; 41(5): 427-432, tab, graf
Article in English | LILACS | ID: lil-764565

ABSTRACT

Objective: To look for correlations between lung function and cardiac dimension variables in morbidly obese patients, in order to test the hypothesis that the relative size of the small airways is independently correlated with left ventricular hypertrophy.Methods: This was a retrospective study involving 192 medical records containing a clinical protocol employed in candidates for bariatric surgery between January of 2006 and December of 2010.Results: Of the 192 patients evaluated, 39 (10 males and 29 females) met the inclusion criteria. The mean BMI of the patients was 49.2 ± 7.6 kg/m2, and the mean age was 35.5 ± 7.7 years. The FEF25-75/FVC, % correlated significantly with left ventricular posterior wall thickness and relative left ventricular posterior wall thickness, those correlations remaining statistically significant (r = −0.355 and r = −0.349, respectively) after adjustment for weight, gender, and history of systemic arterial hypertension. Stepwise multivariate linear regression analysis showed that FVC and FEV1 were the major determinants of left ventricular mass (in grams or indexed to body surface area).Conclusions: A reduction in the relative size of the small airways appears to be independently correlated with obesity-related cardiac hypertrophy, regardless of factors affecting respiratory mechanics (BMI and weight), gender, or history of systemic arterial hypertension. However, FEV1 and FVC might be important predictors of left ventricular mass in morbidly obese individuals.


Objetivo: Verificar a existência de correlações entre variáveis de função pulmonar e de dimensões cardíacas em obesos mórbidos, buscando testar a hipótese de que o tamanho relativo das pequenas vias aéreas correlaciona-se com hipertrofia cardíaca esquerda de forma independente.Métodos: Estudo retrospectivo de 192 prontuários médicos que continham um protocolo clínico de candidatos à cirurgia bariátrica entre janeiro de 2006 a dezembro de 2010.Resultados: Dos 192 pacientes avaliados, 39 (29 mulheres) preencheram os critérios de inclusão. A média do IMC foi de 49,2 ± 7,6 kg/m2, e a média de idade foi de 35,5 ± 7,7 anos. As correlações da FEF25-75/CVF, % com a espessura da parede posterior do ventrículo esquerdo e a espessura relativa da parede posterior do ventrículo esquerdo se mantiveram estatisticamente significativas após ajuste para peso, sexo e história de hipertensão arterial sistêmica (r = −0,355 e r = −0,349, respectivamente). Após análise de regressão linear multivariada stepwise, a CVF e o VEF1foram os principais determinantes da massa ventricular esquerda (em gramas ou indexada para área de superfície corporal).Conclusões: Uma redução no tamanho relativo das pequenas vias aéreas parece apresentar uma correlação independente com hipertrofia cardíaca relacionada à obesidade, independente de fatores que afetam a mecânica respiratória (IMC e peso), sexo ou história de hipertensão arterial sistêmica. O VEF1 e a CVF, por outro lado, podem ser importantes determinantes preditivos da massa ventricular esquerda em obesos mórbidos.


Subject(s)
Adult , Female , Humans , Male , Bariatric Surgery , Hypertrophy, Left Ventricular/physiopathology , Lung/physiopathology , Obesity, Morbid/physiopathology , Anthropometry , Hypertension/physiopathology , Hypertrophy, Left Ventricular , Linear Models , Reference Values , Respiratory Function Tests , Retrospective Studies , Sex Factors , Smoking/adverse effects
17.
Ciênc. saúde coletiva ; 19(5): 1359-1365, 05/2014. tab, graf
Article in Portuguese | LILACS | ID: lil-710549

ABSTRACT

Foi realizado um estudo transversal comparativo sobre a evolução nutricional de pacientes obesos graves candidatos à cirurgia bariátrica assistidos pelo Sistema Único de Saúde (SUS) e a Rede Suplementar de Saúde (RS). O tempo médio de acompanhamento pré-operatório foi 14,3 ± 7,7meses no SUS e 2,4 ± 1,7meses na RS. Houve predominância feminina entre os pacientes assistidos pelo SUS (80,6%) e pela RS (75,7%). Foi observada uma redução significativa do peso, do IMC e na Circunferência da Cintura (CC) e nos valores de Colesterol Total dos pacientes de ambas as redes de saúde. Os pacientes assistidos pelo SUS não apresentaram diminuição significativa nos valores de LDL, Triglicérides e Glicemia de Jejum, enquanto que os pacientes assistidos pela RS apresentaram uma redução significativa desses valores. A maior perda ponderal entre os pacientes do SUS explica-se pelos mesmos terem sido acompanhados por um tempo mais longo. A redução insignificante da maioria dos indicadores bioquímicos dos pacientes do SUS pode ser justificada pelos mesmos apresentarem um grau mais avançado da obesidade.


A cross-sectional comparative study was conducted on the nutritional evolution of severely obese patients who are candidates for bariatric surgery attended by the Unified Health System (SUS) and the Supplemental Health Network (RS). The average preoperative follow-up period was 14.3 ± 7.7 months in the SUS and 2.4 ± 1.7 months in the RS. There was a predominance of females among patients attended by the SUS (80.6%) and by the RS (75.7%). A significant reduction in weight, BMI and waist circumference (WC) and total cholesterol values of patients of both health networks was observed. Patients attended by the SUS showed no significant decrease in LDL, Triglycerides and Fasting Glycemia, while patients assisted by the RS showed a significant reduction of these values. The greater weight loss among SUS patients is explained by the fact that they had been monitored for a longer period. The insignificant reduction of most biochemical indicators of SUS patients can be justified by the fact that they had a more advanced degree of obesity.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Bariatric Surgery , Nutritional Status , Obesity, Morbid/physiopathology , Brazil , Cross-Sectional Studies , Delivery of Health Care , Obesity, Morbid/surgery , Preoperative Period
18.
ABCD arq. bras. cir. dig ; 27(1): 43-46, Jan-Mar/2014. tab
Article in English | LILACS | ID: lil-703974

ABSTRACT

Background : Obese people have abnormal deposition of fat in the vocal tract that can interfere with the acoustic voice. Aim : To relate the fundamental frequency, the maximum phonation time and voice complaints from a group of morbidly obese women. Methods : Observational, cross-sectional and descriptive study that included 44 morbidly obese women, mean age of 42.45 (±10.31) years old, observational group and 30 women without obesity, control group, with 33.79 (±4.51)years old. The voice recording was done in a quiet environment, on a laptop using the program ANAGRAF acoustic analysis of speech sounds. To extract the values ​​of fundamental frequency the subjects were asked to produce vowel [a] at usual intensity for a period in average of three seconds. After the voice recording, participants were prompted to produce sustained vowel [ a] , [ i] and [ u] at usual intensity and height, using a stopwatch to measure the time that each participant could hold each vowel. Results : The majority, 31(70.5%), had vocal complaints, with a higher percentage for complaints of vocal fatigue 20(64.51%) and voice failures 19(61.29%) followed by dryness of the throat in 15 (48.38%) and effort to speak 13(41.93%). There was no statistically significant difference regarding the mean fundamental frequency of the voice in both groups, but there was significance between the two groups regarding maximum phonation. Conclusion : Increased adipose tissue in the vocal tract interfered in the vocal parameters. .


Racional: Sujeitos obesos apresentam deposição anormal de gordura no trato vocal que podem interferir nos parâmetros acústicos da voz e consequente queixa vocal. Objetivo: Verificar a frequência fundamental, o tempo máximo de fonação e as queixas vocais de mulheres com obesidade mórbida. Métodos: Estudo observacional, transversal e descritivo. Participaram 44 mulheres com obesidade mórbida, idade média de 42,45 (±10,31) anos de idade como grupo estudo e 30 mulheres sem obesidade, grupo controle, com média de 33,79 (±4,51) anos de idade. A gravação da voz foi realizada em ambiente silencioso, em laptop utilizando o programa ANAGRAF de análise acústica dos sons da fala. Para extrair os valores de frequência fundamental foi solicitado a emissão da vogal /a/ em intensidade e altura habituais, por um período em média de três segundos. Após a gravação da voz, foi solicitado a produção sustentada das vogais [a], [i] e [u] em intensidade e altura habituais, utilizando-se de cronômetro para mensurar o tempo que cada participante podia sustentar cada vogal. Resultados: As mulheres com obesidade mórbida, na sua maioria 31(70,5%) apresentaram queixa vocal, com percentual maior para as queixas de cansaço ao falar 20(64,51%) e falhas na voz 19(61,29%) seguidos de ressecamento na garganta 15(48,38%) e esforço ao falar 13(41,93%). Não houve diferença estatísticamente significante da média da frequência fundamental da voz em ambos os grupos; no entanto houve diferença significante na média do tempo máximo de fonação entre os dois grupos. Conclusão: O aumento de tecido adiposo no trato vocal interferiu nos parâmetros vocais do grupo analisado. .


Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Obesity, Morbid/complications , Obesity, Morbid/physiopathology , Phonation/physiology , Voice Disorders/etiology , Voice/physiology , Cross-Sectional Studies
19.
ABCD arq. bras. cir. dig ; 26(4): 315-318, nov.-dez. 2013. tab
Article in Portuguese | LILACS | ID: lil-701255

ABSTRACT

RACIONAL: A mastigação é composta de estruturas que devem ser equilibradas para obtenção de função ideal e a força de mordida é um dos componentes dessa função. OBJETIVO: Analisar a força de mordida de pacientes candidatos à gastroplastia em Y-de-Roux. MÉTODOS: Foi utilizado o eletromiógrafo de superfície Miotool 200/400 (Miotec®, Porto Alegre/RS, Brasil) acoplado à célula de carga de mordida, sensor SDS1000, com o registro da leitura da força máxima durante a execução da mordida. O aparelho era integrado ao software Miograph 2.0. Os critérios de inclusão foram: pacientes obesos mórbidos independentemente do sexo, faixa etária 20-40 anos, sem ausências e/ou alterações dentárias importantes e candidatos à gastroplastia em Y-de-Roux. Foram estudadas as mordidas em posição anterior e laterais direita e esquerda e a intensidade delas medida em quilograma força (Kgf). O critério de exclusão foi o de pacientes que apresentassem deformidades faciais e/ou oclusais impossibilitando quaisquer das posições de coleta. RESULTADOS: Foram analisados 39 pacientes (59% mulheres), média de idade 27,1 (±5,7). Eles apresentaram força de mordida anterior com média geral 9,1 Kgf (min 1,3 e max 22,9 Kgf - ±5,2); lateral esquerda com média geral 16,3Kgf (min 1,5 e max 55,6 Kgf -±11,9); lateral direita com média geral 14,0 Kgf (min 2,3 e max 45,3 Kgf - ±9,4). CONCLUSÃO: A força de mordida foi inferior àquelas descritas para a população em geral e o gênero não constituiu variável para ela.


BACKGROUND: Chewing is composed of structures that must be balanced to achieve optimal function and bite force is one of the components of this function. AIM: To analyze the bite force of candidates for bariatric surgeries. METHOD: Was used surface electromyography Miotool 200/400 (Miotec® , Porto Alegre/RS, Brazil) coupled to bite load cell, SDS1000 sensor, to record the maximum force reading during the execution of the bite. The device was integrated with software Miograph 2.0. Inclusion criteria were: morbidly obese patients regardless of gender, age 20-40 years, no absences and/or important dental changes and candidates for gastroplasty. Were studied the bites in left and right lateral position and their intensity measured in kilogram force (kgf). The exclusion criterion was that of patients who had facial deformities and/or occlusal position preventing any collection. RESULTS: Were analyzed 39 patients (59 % women), mean age 27.1 (+/-5.7). They had anterior bite force in average 9.1 kgf (min 1.3 and max 22.9 kgf - +/-5.2 ); left side with average 16.3 kgf (min 1.5 and max 55.6 kgf - +/-11.9); right side with average of 14.0 kgf (min 2.3 and max 45.3 kgf - +/-9.4 ). CONCLUSION: The bite force was inferior to those described for the general population and the gender did not have any influence on it.


Subject(s)
Adult , Female , Humans , Male , Bite Force , Gastroplasty , Obesity, Morbid/physiopathology , Obesity, Morbid/surgery , Cross-Sectional Studies
20.
Rev. bras. ter. intensiva ; 25(4): 312-318, Oct-Dec/2013. tab
Article in Portuguese | LILACS | ID: lil-701405

ABSTRACT

O desenvolvimento da cirurgia abdominal proporcionou uma alternativa terapêutica para obesos mórbidos; entretanto, os pacientes submetidos a esse procedimento frequentemente apresentam complicações pulmonares pós-operatórias. Uma possível alternativa para a redução dessas complicações é a utilização da manobra de recrutamento alveolar e/ou estratégias ventilatórias perioperatórias, com foco na redução das complicações pulmonares pós-operatórias. Nesta revisão, são descritos os benefícios de estratégias ventilatórias perioperatórias, assim como a realização de manobra de recrutamento alveolar em pacientes obesos submetidos a cirurgia abdominal.


The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the implementation of alveolar recruitment maneuvers in obese patients undergoing abdominal surgery are described.


Subject(s)
Humans , Abdomen/surgery , Obesity, Morbid/physiopathology , Pulmonary Alveoli/metabolism , Perioperative Care/methods , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Respiration, Artificial/methods
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