Fracture Risk After Bariatric Surgery: A Systematic Literature Review and Meta-Analysis.

OBJECTIVE: Bariatric surgery has undeniable benefits for cardiovascular and metabolic health, but it can result in negative effects on mineral and bone metabolism. This study aimed to review the current data on fractures after the main types of bariatric surgery. METHODS: Therefore, a systematic review was performed using the electronic literature available in the databases LILACS, CENTRAL, Web of Science, Embase, and PubMed/MEDLINE, with results until January 2021. Keywords were descriptors for bariatric surgery or bariatric medicine or bariatrics or gastroplasty and bone or bones or bone fractures, referenced in all words of the text in the study. RESULTS: The meta-analysis of observational studies and interventional trials showed that the risk of any type of fracture was higher in the surgical group than in the nonsurgical group (relative risk [RR], 1.20 [95% confidence interval {CI}, 1.15-1.26; P < .00001; Phetero < 0.000001; I2 = 94%], and RR, 1.16 [95% CI, 1.00-1.33; P = .04; Phetero = 0.27; I2 = 23%], respectively). It is worth noting that the included interventional studies have a low rating on the risk of bias assessment scales. Compared with those who underwent restrictive procedures, subjects had an increased fracture risk after malabsorptive procedures (RR, 0.49 [95% CI, 0.40-0.61; P < .00001); Phetero = 0.96; I2 = 0%). CONCLUSION: We found that bariatric procedures are associated with an increased risk of fractures, especially the malabsorptive techniques.

Secondary Hyperparathyroidism, Bone Density, and Bone Turnover After Bariatric Surgery: Differences Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

PURPOSE: Bariatric surgery may lead to metabolic bone disease. MATERIALS AND METHODS: In this cross-sectional study, we compared the prevalence of secondary hyperparathyroidism (SHPT), impact on bone mass and turnover markers, and serum leptin after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in 117 patients (91% female, 51% RYGB, age 41.8 ± 6.7 years, time of surgery 4.3 ± 3.4 years) at different times (1-2 years, > 2 and < 5 years and ≥ 5 years). Body composition, bone mineral density (BMD), by dual-energy X-ray absorptiometry, and bone parameters (PTH, serum calcium, 25OHD, alkaline phosphatase (AP), C-telopeptide (CTX)) were analyzed. RESULTS: Prevalence of SHPT (PTH ≥ 65 pg/ml) was 26%, RYGB > SG (18.4% vs. 7.8%, p = 0.039), despite similar 25OHD and calcium levels. Mean PTH, CTX, and AP were higher in RYGB vs. SG (61.3 ± 29.5 vs 49.5 ± 32.3 pg/ml, p = 0.001; 0.596 ± 0.24 vs. 0.463 ± 0.23 ng/ml; 123.9 ± 60.8 vs. 100.7 ± 62.0 U/l). There were 13.5% decreases in femoral neck BMD in all patients, over the study period. In the last group, the RYGB group showed greater bone loss in total body BMD (1.016 vs. 1.151 g/cm2, - 8.1%, p = 0.003) and total femur BMD (1.164 vs. 1.267 g/cm2, - 11.7%, p = 0.007). Mean leptin was lower in the RYGB vs. SG group, with no correlation with BMD in any site. CONCLUSION: Our data suggest a more deleterious role of RYGB on bone remodeling up to 5 years postoperatively in comparison with SG.

Body Composition, Serum Sclerostin and Physical Function After Bariatric Surgery: Performance of Dual-Energy X-ray Absorptiometry and Multifrequency Bioelectrical Impedance Analysis.

INTRODUCTION: The aim of this study was to determine the effects of bariatric surgery and weight loss on body composition, serum sclerostin and physical performance. METHODS: Seventy-three consecutive patients (36 non-surgical controls and 37 who underwent bariatric surgery) were evaluated by means of laboratory tests, multifrequency bioelectrical impedance analysis (BIA), total-body dual-energy X-ray absorptiometry (DXA), gait speed and handgrip strength. RESULTS: The differences between non-surgical and surgical patients were as follows: body mass index (BMI) 42.9 ± 5.7 vs 34.8 ± 6.0 kg/m2 (p < 0.001); handgrip strength 31.3 ± 7.0 vs 27.1 ± 9.3 kg (p < 0.033); skeletal muscle mass index (SMI)-BIA 12.3 ± 1.2 vs 10.6 ± 1.2 kg/m2; fat-free mass index (FFMI)-BIA 21.9 ± 1.9 vs 18.9 ± 2.1 k/m2 (p < 0.001 for all comparisons); Baumgartner-DXA 10.8 ± 1.5 vs 9.0 ± 1.4 kg/m2 (p < 0.001); fat mass BIA 55.4 ± 12.5 vs 36.8 ± 9.6; fat mass DXA 54.3 ± 12.38 vs 35.1 ± 7.5 kg (p < 0.001 for both comparisons) and serum sclerostin 30.9 ± 31.9 vs 26.9 ± 21.1 pmol/L (p = 0.516). Positive correlation was found between BIA and DXA: SMI × Baumgartner (r = 0.842; p < 0.001) and fat mass (r = 0.970; p < 0.001). Gait speed was relatively preserved in sleeve gastrectomy (SG) compared with Roux-en-Y gastric bypass (RYGB) (1.2 ± 0.3 and 0.9 ± 0.1 m/s; p = 0.038). CONCLUSION: Bariatric surgery leads to lower values of lean and fat mass and of handgrip strength with no differences in serum sclerostin concentrations. There was a positive correlation between BIA and DXA for fat and lean mass parameters. Physical performance was better after SG than in RYGB.

Symptomatic primary iris cysts treated with frequency-doubled Nd: YAG laser photocoagulation / Cistos irianos primários sintomáticos tratados com fotocoagulação a laser de Nd: YAG de dupla frequência

Abstract We report the case of a 31-year-old woman who presented with a nine-month history of blurred vision in her left eye. Slit-lamp examination and optical coherence tomography showed four cystic masses hanging at the pupillary margin of the left eye. Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser photocoagulation was used to rupture the wall (cystotomy), drain the cyst content and shrink the remnants of the pigment epithelium, using laser parameters at the lowest effective levels. The patient's best corrected visual acuity improved significantly after treatment. Despite the increase of pigment at anterior chamber angle, no complication was observed during 6 months of follow up. This is the first report to describe frequency-doubled Nd:YAG laser (532 nm) photocoagulation as a therapeutic option for patients with symptomatic primary IPE cysts at pupillary margin.

Resumo Relatamos o caso de uma mulher de 31 anos com queixa de visão turva no olho esquerdo. Exame em lâmpada de fenda e tomografia de coerência óptica mostraram quatro lesões císticas nas margens da pupila esquerda. O laser do tipo Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) de dupla-frequência foi o tratamento de escolha para romper a parede (cistotomia), drenar o conteúdo do cisto e encolher os remanescentes do epitélio de pigmentar utilizando os menores parâmetros efetivos. Após o tratamento do olho comprometido, sua acuidade visual melhorou consideravelmente. Apesar do aumento da pigmentação no ângulo da câmara anterior, nenhuma complicação foi observada durante 6 meses de acompanhamento. Este é o primeiro relato que descreve o laser de Nd:YAG de dupla frequência (532 nm) como uma opção terapêutica para pacientes com cistos irianos primários do epitélio pigmentar sintomáticos na margem pupilar.

First description of pseudohypoparathyroidism with frontal lobe calcification and normal serum calcium at the initial manifestation in an otherwise healthy seven-year-old girl.

Pseudohypoparathyroidism (PHP) is characterized by resistance to the peripheral action of parathyroid hormone. We present a case of a seven-year-old girl who was admitted at the service of Instituto Materno Infantil de Pernambuco, IMIP, with motor episodes affecting the arms. Her calcium level was normal. Computed tomography showed calcifications in frontal lobes and basal ganglia. After six years: calcium was 5.5 mg/dL; phosphorus, 8.3 mg/dL and serum parathyroid hormone was 1,318 pg/mL. Pseudohypoparathyroidism diagnosis was considered. This is the first description of a case of pseudohypoparathyroidism without Albright's stigma, with cerebral calcification, and no calcium abnormalities at the initial clinical manifestation.

Evaluation of levels of cortisol in saliva using electro-chemical luminescence in low-risk and high-risk pregnancies / Avaliação do cortisol salivar por electroquimioluminecência em gestantes de baixo e de alto risco

OBJECTIVES: to compare the levels of cortisol (cortisolemia refers to the level of cortisol in blood) in women with a high-risk pregnancy compared with those with a low-risk pregnancy, by way of evaluation of levels of cortisol in saliva, using the electrochemical luminescence technique (ECL). METHODS: 38 women aged between 17 and 40 years in the third trimester of pregnancy were divided in two groups: 20 low-risk pregnancies and 18 high-risk ones. Cortisol in saliva was collected at midnight and measured using ECL. The mean levels of cortisol in saliva in the two groups were compared using the Kruskal-Wallis test. RESULTS: the mean systolic and diastolic pressure was normal in both groups. The levels of cortisol in the saliva of women with high-risk pregnancies was significantly higher than those for the low-risk pregnancy group (20.2 (±21,1) nmol/L vs 11.4(±16.2) nmol/L; p=0.007). CONCLUSIONS: a high risk pregnancy involves higher levels of cortisol than a low-risk one. The levels of cortisol in saliva, as measured using ECL, can be used to identify hypercortisolism in pregnancy.

OBJETIVOS: comparar os níveis de cortisol em mulheres com gravidez de alto risco em relação às gestantes de baixo risco, por meio da avaliação do cortisol salivar utilizando a técnica da electroquimioluminescência (EQL). MÉTODOS: foram estudadas 38 mulheres de 17a 40 anos de idade, no terceiro trimestre de gestação, divididas em dois grupos: 20 gestantes de baixo risco e 18 gestantes de alto risco. O cortisol salivar foi coletado à meia-noite e medido através da EQL. As médias do cortisol salivar foram comparadas entre os dois grupos de gestantes através do teste de Kruskal-Wallis. RESULTADOS: a média das pressões sistólica e diastólica foi normal nos dois grupos. O cortisol salivar das gestantes de alto risco foi significativamente mais elevado do que das gestantes baixo risco: (20,2 (±21,1) nmol/L vs 11,4(±16,2) nmol/L; p=0,007). CONCLUSÕES: a gestação de alto risco cursa com níveis mais elevados de cortisol quando comparada à gestação de baixo risco. O cortisol salivar, medido pelo EQL mostrou-se promissor para identificar o hipercortisolismo na gestação.

Postpartum depression in Recife - Brazil: prevalence and association with bio-socio-demographic factors / Depressão pós-parto em Recife - Brasil: prevalência e associação com fatores biossociodemográficos

OBJECTIVE:To use a semi-structured interview to detect depression in postpartum women according to the criteria proposed by the DSM in child health care clinics in the city of Recife, together with the proper association of this disorder to bio-socio-demographic data. METHODS: The study used a cross-section method and contained a convenience sample of 400 women that were between 2 and 26 weeks of postpartum in child health care clinics. A bio-socio-demographic questionnaire and the Portuguese version of the Structured Clinical Interview for DSM-IV Axis I Disorders were used. RESULTS: Twenty nine of the mothers (7.2 percent) were diagnosed as suffering from postpartum depression. Women with a past history of psychiatric disorders, a family history of psychiatric disorder and some sort of clinical complication presented a higher prevalence of depression. The same happened to those with a past history of spontaneous abortion, those who had a transpelvic birth and those over 8 weeks of puerperium. CONCLUSION: The rate of postpartum depression in this sample, 7.2 percent, was lower than that reported by other Brazilian studies. It probably occurred because the other researchers used screening scales to assess this estimate instead of a clinical interview.

OBJETIVO: Utilizar uma entrevista clínica semiestruturada para a detecção de depressão em mulheres puérperas, de acordo com os critérios do DSM em serviços de puericultura da cidade do Recife, juntamente com uma apropriada associação entre esse transtorno e dados biossociodemográficos. MÉTODOS: O estudo utilizou um corte transversal e teve uma amostra de conveniência de 400 mulheres que levavam seus bebês para ambulatórios de puericultura e que estavam entre 2 e 26 semanas de pós-parto. Um questionário biossociodemográfico e a versão em português do Structured Clinical Interview for DSM-IV Axis I Disorders foram utilizados. RESULTADOS: Vinte e nove das mães (7,2 por cento) foram diagnosticadas como tendo depressão pós-parto. Mulheres com história pregressa de transtornos mentais, história familiar de transtornos mentais e com alguma complicação médica geral apresentaram prevalência maior de depressão. O mesmo ocorreu com aquelas com história anterior de abortamento espontâneo, aquelas que haviam tido parto transpelviano e aquelas que estavam com mais de 8 semanas de puerpério. CONCLUSÃO: A taxa de depressão pós-parto na nossa amostra, 7,2 por cento, foi menor do que aquelas relatadas em outros estudos brasileiros. Isso provavelmente ocorreu porque os outros pesquisadores utilizaram instrumentos de triagem para depressão em vez de entrevistas clínicas.

Postpartum obsessive-compulsive disorder: prevalence and clinical characteristics.

OBJECTIVE: The principal aims of this study were to examine the prevalence rate, clinical characteristics, and related factors of postpartum obsessive-compulsive disorder (OCD). METHOD: The subjects were a nonclinical sample of 400 postpartum women. They were interviewed from the 2nd up to the 26th week after birth. The Mini International Neuropsychiatric Interview was used for diagnosis of OCD, the Yale-Brown Obsessive-Compulsive Symptom Checklist was used to determine the types of obsessions and compulsions, and the Structured Clinical Interview for DSM-IV Axis I Disorders was used to diagnose comorbid depressive episode. RESULTS: Thirty-six (9%) of the sample met the diagnostic criteria for OCD according to the Mini International Neuropsychiatric Interview, and 9 (2.3%) reported postpartum onset OCD. Obsessive-compulsive disorder was more frequent in mothers with personal history of previous psychiatric disorder, somatic disease, or obstetric complication in pregnancy/birth, and who were multiparous. The most common obsessions were aggressive, contamination and miscellaneous, and compulsion for washing/cleaning and checking, and 38.9% have a comorbid depressive episode. CONCLUSION: Women have increased risk of OCD or obsessive-compulsive symptoms in the postpartum period. For this reason, all women, particularly women with previous psychiatric history, somatic disease, or with complications in pregnancy or at the birth should be carefully screened for OCD in the postpartum period.

Hepatite B: perfil de proteção em estudantes dos Cursos de Medicina, Odontologia e Enfermagem da UFPE / Hepatitis B: protection profile in students of the medicine courses, dentistry and nursing of UFPE

Foi feito um estudo transversal em 863 estudantes dos cursos de Medicina, Odontologia e Enfermagem da UFPE, para verificar a prevalência presumível da Hepatite B e seu perfil de proteção. Parte significativa da amostra, 84,5 por cento, afirmou não ter tido hepatite, 13,7 por cento afirmaram ter tido a doença e 1,9 por cento não souberam informar. Dos estudantes que afirmaram ter tido hepatite, 66,1 por cento foram do tipo A, 13,6 por cento do tipo B e 0,8 por cento do tipo C. Em relação à cobertura vacinal, 49 por cento dos entrevistados disseram ter tomado vacina anti-hepatite B, 32,4 por cento afirmaram não ter tomado e 18,5 por cento não sabiam informar. A frequência de hepatite B entre os estudantes é preocupante, tanto em relação ao seu futuro profissional quanto ao seu papel como indivíduo/cidadão. Devido ao baixo nível de proteção e ao risco aumentado de infecção entre os profissionais de saúde, segure-se a obrigatoriedade e a comprovação da vacinação contra o vírus da hepatite B no ato da matrícula em Escolas de Saúde do país