ABSTRACT
Preoperative management of patients living with severe obesity can be challenging; in this context, the preoperative weight loss may help to obtain better outcomes and less morbidity for bariatric surgery. Therefore, we evaluated the effectiveness of GLP-1 analogue Liraglutide in preoperative weight loss. We performed a single-center, quasi-experimental prospective study. Eligible participants were adults in preoperative management for bariatric-metabolic surgery with body-mass index ≥ 48 kg/m2. All patients were assigned liraglutide treatment, with an initial dose of 0.6 mg subcutaneous per day, the dose was increased each week until reaching 3.0 mg for 12 weeks. Weight loss and body composition were evaluated monthly using bioelectric impedance (BIA) (InBody 770 Scale®). We analyzed data using descriptive statistics, central tendency measures and dispersion for quantitative variables and absolute and relative frequencies for qualitative variables. A total of 37 individuals were included in this study, 28 (76%) were female and 9 (24%) were males, with an average age of 44 years. About the BMI, 19 patients (51%) had a BMI > 50 kg/m2, 10 (27%) > 40 kg/m2 and 8 (22%) > 60 kg/m2; with a total average BMI of 56.04 kg/m2. The initial weight was 147.4 ± 14.9 kg which decreased to 139.3 ± 16.8 kg; after 3 months of liraglutide administration. A total of 35 patients had some degree of weight loss (94.6%), while 2 (5.40%) had no weight changes. The total weight loss was 5.50% at 3 months of liraglutide treatment. Liraglutide could be an effective adjuvant therapy for preoperative weight loss in patients living with severe obesity.
ABSTRACT
La extraordinaria expansión de la psiquiatría y la psicología está propiciando el tratamiento de personas sanas que acaban siendo etiquetadas como trastornos mentales. El reduccionismo biológico del modelo médico centrado en los síntomas favorece la transformación de problemas sociales en conflictos individuales y la exposición de los ciudadanos a los efectos adversos de tratamientos excesivos e improcedentes. La prevención cuaternaria en salud mental contempla el empleo de narrativas y formulación de casos (más allá de la etiqueta diagnóstica), la indicación de no-tratamiento y un empleo de los psicofármacos prudente, que considere su deprescripción.
A extraordinária expansão da psiquiatria e da psicologia está proporcionando o tratamento de pessoas saudáveis que acabam sendo rotuladas como transtornos mentais. O reducionismo biológico do modelo médico centrado em sintomas favorece a transformação de problemas sociais em conflitos individuais e a exposição dos cidadãos aos efeitos adversos de tratamentos excessivos e inadequados. A prevenção quaternária em saúde mental contempla o uso de narrativas e formulação de casos (para além do rótulo diagnóstico), a indicação de não-tratamento e um uso prudente de drogas psicoativas, que leve em consideração sua desprescrição.
The extraordinary expansion of psychiatry and psychology is leading the treatment of healthy people who end up being labelled as mental disorders. The biological reductionism of the medical model centred on the symptoms favours both the transformation of social problems in individual conflicts and the exposure of citizens to the adverse effects of excessive and inappropriate treatments. Quaternary prevention in mental health contemplates the use of narratives and case formulation (beyond the diagnostic label), the indication of non-treatment, and prudent use of psychoactive drugs, taking into account its deprescription.
Subject(s)
Mental Health , Drug-Related Side Effects and Adverse Reactions , Medicalization , Iatrogenic DiseaseABSTRACT
We present two patients with neuromyelitis optica (NMO; Devic's syndrome), one associated with systemic lupus erythematosus and the other with Hashimoto thyroiditis. Devic's syndrome, whose initial symptoms and signs mimic those of multiple sclerosis, can be associated with other autoimmune diseases. We emphasize the importance of ruling out other entities throughout the follow-up. NMO is seldom described in patients with lupus, which may be due to the rare occurrence of this association sometimes leading to its misdiagnosis.
Subject(s)
Autoimmune Diseases/complications , Neuromyelitis Optica/complications , Adolescent , Adult , Diagnosis, Differential , Female , Hashimoto Disease/complications , Humans , Lupus Erythematosus, Systemic/complications , Multiple Sclerosis/diagnosis , Spinal Cord/pathology , Treatment OutcomeABSTRACT
A revascularização do miocárdio co enxertos de artérias tem sido muito pesquisada como a melhor técnica para a revascularização do coração. Com o passar dos anos tem se procurado o uso de outros tipos de enxertos na revascularização para tentar melhorar e aumentar sua potência...
Subject(s)
Myocardial Revascularization , TransplantsABSTRACT
Antecedentes. La epidemiología de la resistencia antimicrobiana en el ambiente hospitalario ha sido motivo de innumerables publicaciones, sin embargo, con respecto a microorganismos de origen comunitario la información es menos abundante. Objetivo. Precisar la frecuencia con que Escherichia Coli resulta no susceptible a los 14 antimicrobianos habitualmente empleados, en urocultivos practicados a población comunitaria. Material y métodos. Con el método de Kirby Bauer estandarizado por NCCLS, se evaluó la susceptibilidad a 14 antibióticos en un total de 404 cepas de Eschirichia coli procedentes de urocultivos con cuentas mayores a 100,000 UFC/mL. De éstas, 71 por ciento se aislaron en el laboratorio del Hospital General de Zona número 11 del IMSS (HGZ II) y 20 por ciento en el departamento de microbiología de Laboratorios Rivas S. de R.L. de C. V. (LRI). Resultados. Se demostró que en promedio existe resistencia a 24.7 por ciento de los antimicrobianos; ser más evidente en el medio hospitalario que en la comunidad (Delta + 6.2); con influencia de la edad del paciente (R=0.99) y que afecta de manera diferente y específica en cada uno de los antimicrobianos. Conclusión. La resistencia antimicrobiana de Eschirichia Coli uropatógena es un problema clínico significativo. Es conveniente que en nuestro país se haga un esfuerzo por regular el uso de antibióticos dentro y fuera de los hospitales