Real life data: follow-up assessment on Spanish Gaucher disease patients treated with eliglustat. TRAZELGA project.

BACKGROUND: The availability of multiple treatments for type 1 Gaucher disease increases the need for real-life studies to evaluate treatment efficacy and safety and provide clinicians with more information to choose the best personalized therapy for their patients. AIMS: To determine whether treatment with eliglustat produces, in adult GD1 patients, ans optimal response in daily clinical practice. METHODS: We designed a real-life study with 2 years of follow-up (TRAZELGA [GEE-ELI-2017-01]) to uniformly evaluate the response and adverse events to eliglustat treatment. This study, conducted in 30 patients across Spain and previously treated with other therapies, included the evaluation of safety and efficacy by assessing visceral enlargement, bone disease (DEXA and T and Z scores), concomitant treatments and adverse events, as well as a quality of life evaluation (SF-36). In addition, the quantification of classical biomarkers (chitotriosidase activity, CCL18/PARC and glucosylsphingosine (GluSph)) and new candidates for GD biomarkers (YKL-40, cathepsin S, hepcidin and lipocalin-2 determined by immunoassay) were also assessed. Non-parametric statistical analysis was performed and p < 0.05 was considered statistically significant. MAIN RESULTS: Thirty patients were enrolled in the study. The median age was 41.5 years and the male-female ratio was 1.1:1. 84% of the patients had received ERT and 16% SRT as previous treatment. The most common symptoms at baseline were fatigue (42%) and bone pain (38%), no patient had a bone crisis during the study, and two years after switching, 37% had reduced their use of analgesics. Patient-reported outcomes showed a significant increase in physical function scores (p = 0.027) and physical pain scores (p = 0.010). None of the enrolled patients discontinued treatment due to adverse events, which were mild and transient in nature, mainly gastrointestinal and skin dryness. None of the biomarkers show a significant increase or decompensation after switching. CCL18/PARC (p = 0.0012), YKL-40 (p = 0.00004) and lipocalin-2 (p = 0.0155) improved after two years and GluSph after one year (p = 0.0008) and two years (p = 0.0245) of oral therapy. CONCLUSION: In summary, this real-life study, showed that eliglustat maintains stability and can improve quality of life with few side effects. Significant reductions in classic and other novel biomarkers were observed after two years of therapy.

Dificultad diagnóstica en masa retroperitoneal. Reporte de un caso / Diagnostic difficulty in retroperitoneal mass: A case report

El Schwannoma se origina de la vaina perineural de Schwannoma, se detecta con frecuencia incidentalmente en estudios imagenológicos siendo el principal método diagnóstico la Tomografía Computada. El tratamiento es la resección quirúrgica con márgenes libres. Se presenta una paciente femenina de 49 años, en control por oncología por enfermedad de base, cáncer de mama izquierda, se identifica por TAC y PECT/TC imagen voluminosa en retroperitoneo situación lateroaórtica izquierda de configuración no quística e hipermetabólica, solicita biopsia percutánea, ante la falta de ventana, se decide exeresis completa de masa. Diagnóstico definitivo patológico Schwannoma. Sin indicación de tratamiento adyuvante, cursa buena evolución postoperatoria sin recidiva.

Schwannoma, a benign tumor that arises from Schwann cells of the perineural nerve sheath, is often incidentally detected in imaging tests and mainly diagnosed by CT scan. Treatment consists of surgical resection with clear margins. We present the case of a 49-year-old female patient subject to Oncology Department follow-up due to an underlying disease, left breast cancer. A large, hypermetabolic, noncystic mass in the retroperitoneal region is identified by CT and PECT/CT scan in the left lateral aortic area. A percutaneous biopsy is requested. Due to the limited acoustic window, complete resection of the mass is decided. Final histopathology diagnosis of Schwannoma. No adjuvant treatment indication; undergoing favorable postoperative progress, without recurrence

Wellens pattern as the debut of acute pulmonary embolism: A case report.

The Wellens pattern is an electrocardiographic finding seen in patients with chest pain and atherosclerotic coronary artery disease and is described as a symmetrical T-wave inversion or biphasic T-wave inversion in precordial leads. The deep inversion of the precordial T wave is a sign associated with various etiologies, including left ventricular hypertrophy, vasospasm, and pulmonary embolism. We present the case of a patient who debuts with chest pain and electrocardiographic findings consistent with the Wellens and McGinn-White patterns, who was subsequently diagnosed with intermediate-risk pulmonary embolism after ruling out obstructive coronary artery disease. We discussed the differential diagnostic approach to T-wave inversion as a sign associated with high-risk conditions.

Unconventional OFF-ON Response of a Mono(calix[4]arene)-Substituted BODIPY Sensor for Hg2+ through Dimerization Reversion.

A new selective fluorogenic chemosensor for Hg2+, which combines a calixarene derivative with a BODIPY core as a fluorescent reporter, is described. The remarkable change in its fluorogenic properties in DMSO and CHCl3 has been analyzed. A study of its spectral properties on dilution, along with molecular modeling studies, allowed us to explain that this behavior involves the formation of a J-dimer, as well as how the sensing mechanism of Hg2+ proceeds.

Comparison of stationary and nonstationary estimation of return period for sewer design in Antioquia (Colombia).

Estimating the probability of occurrence of extreme hydrologic events is a fundamental input in the design of hydraulic infrastructure. The classical approach to this problem has been to fit parametric probability functions to annual maxima streamflow data and use them to calculate the risk of failure. An underlying assumption of this approach is the stationarity of the time series. However, the stationarity of streamflows may not hold due to the effect of land cover change and climate change on rainfall runoff processes on watersheds. This study assesses the effect of considering non-stationarity in the estimation of design peak flows at 33 gauging stations in the state of Antioquia, Colombia. Particularly, the effect of non-stationarity in the mean of Gumbel-distributed peak flows is evaluated. This study focuses on the 5-yr and 10-yr return period annual flood flows, which are customary in the design of type sewerage systems. The results show similar behaviours for both return periods. All gauge stations show an asymptotically tendency in the risk of failure to 100% as the project lifetime tends to 30 years. In general, 71.4% of gauging stations show that the estimated risk of failure is larger when non-stationary conditions are assumed, relative to assuming stationary conditions, and that the magnitude of the difference increases for larger return periods. The rest of gauging stations shows the opposite behaviour. Our results support the use of a probability model that includes non-stationary in the mean, and they suggest that a model that also includes non-stationary in the variance could be important.

Throughput Analysis of an Amazon Go Retail under the COVID-19-related Capacity Constraints.

The throughput of a finite-capacity queueing system is the mean number of clients served during a time interval. The COVID-19 outbreak has posed a serious challenge for many commercial establishments, including the retails, which have struggled to adapt to new working dynamics. Retails have been forced to adjust their service guidelines to comply with biosecurity protocols, ensuring to observe governmental and public health policies. A significant change for the retail market has been the capacity restrictions to ensure social distancing, i.e., a limitation on the number of customers simultaneously shopping in the store. Such a constraint has an impact on the throughput that can be achieved by a retail. This article assesses the impact of the capacity restriction measures on an Amazon Go-like retail performance through a throughput analysis under COVID-19-related capacity restrictions. For the assessment, we first retrieved real data from a retail located in Cartagena, Colombia. Two scenarios were considered: i) low demand and ii) high demand. Further, we built an Amazon Go-like, two-queue, M/M/c/K retail model with a CONWIP (Constant Work-In-Process) approach, considering biosecurity-based capacity restrictions due to the COVID-19 pandemic. The R package 'queueing' was used to set up the model, and an algorithm was created to go over each sampling period and find the hourly optimum capacity and throughput under the dynamic conditions of both scenarios (low and high demand). Results from the performance analysis show that, for some operational conditions, the optimum maximum throughput is achieved with capacities below the biosecurity-based capacity, while for some other operational conditions the maximum throughput cannot be achieved with the restrictions, as the optimum capacity lies beyond the biosecurity-based capacity. These results suggest that the maximum capacity definition should not be static. Instead, it should be done considering the retail's dimensions, the biosecurity policies, and the dynamic retail's operational conditions such as the demand and service capacity.

Co-occurrence of cohesin complex and Ras signaling mutations during progression from myelodysplastic syndromes to secondary acute myeloid leukemia.

Myelodysplastic syndromes (MDS) are hematological disorders at high risk of progression to secondary acute myeloid leukemia (sAML). However, the mutational dynamics and clonal evolution underlying disease progression are poorly understood at present. To elucidate the mutational dynamics of pathways and genes occurring during the evolution to sAML, next generation sequencing was performed on 84 serially paired samples of MDS patients who developed sAML (discovery cohort) and 14 paired samples from MDS patients who did not progress to sAML during follow-up (control cohort). Results were validated in an independent series of 388 MDS patients (validation cohort). We used an integrative analysis to identify how mutations, alone or in combination, contribute to leukemic transformation. The study showed that MDS progression to sAML is characterized by greater genomic instability and the presence of several types of mutational dynamics, highlighting increasing (STAG2) and newly-acquired (NRAS and FLT3) mutations. Moreover, we observed cooperation between genes involved in the cohesin and Ras pathways in 15-20% of MDS patients who evolved to sAML, as well as a high proportion of newly acquired or increasing mutations in the chromatin-modifier genes in MDS patients receiving a disease-modifying therapy before their progression to sAML.

Educational intervention to improve pharmacist knowledge to provide care for transgender patients.

BACKGROUND: Most pharmacists have not received formal training or education in the provision of care for transgender patients. Nonetheless, pharmacists have the potential to be valuable partners in the care of transgender patients, and a continuing education course might be valuable in addressing this knowledge gap. OBJECTIVE: The aim of this study was to examine the impact of a three-hour continuing education course in improving the knowledge of pharmacists to provide pharmaceutical care for transgender patients. METHODS: A quasi-experimental, one-group pre-test/post-test study design was used to measure the impact of a three-hour continuing pharmacy education course on the knowledge of pharmacists on transgender care. The course was divided into three units: (1) Transgender Patient Care Introduction, (2) General Health Issues of Transgender Patients, and (3) Gender Affirming Hormone Therapy. A total of 68 pharmacists participated in the study, of which 54 completed both the pre- and post-test. An ANOVA was used to compare differences in knowledge in the group before and after the educational intervention. RESULTS: The majority of the participating pharmacists were cisgender, heterosexual women who had not received any formal training related to transgender care. Participants demonstrated the largest increase in execution score in the third unit, with a percent improvement of 25.22% (pre-test 45.06%, post-test 70.28%; p<0.001). The average total execution score was 52.15% in the pre-test and 72.89% (p< 0.001) in the post-test. CONCLUSIONS: Pharmacists benefited from a three-hour continuing education course with an increase in knowledge regarding transgender patient care and hormone therapy for gender affirmation. As this study only evaluated the effect in short term memory, further studies are needed to assess long term impact of the continuing education course on transgender care knowledge.

Educational intervention to improve pharmacist knowledge to provide care for transgender patients

BACKGROUND: Most pharmacists have not received formal training or education in the provision of care for transgender patients. Nonetheless, pharmacists have the potential to be valuable partners in the care of transgender patients, and a continuing education course might be valuable in addressing this knowledge gap. OBJECTIVE: The aim of this study was to examine the impact of a three-hour continuing education course in improving the knowledge of pharmacists to provide pharmaceutical care for transgender patients. METHODS: A quasi-experimental, one-group pre-test/post-test study design was used to measure the impact of a three-hour continuing pharmacy education course on the knowledge of pharmacists on transgender care. The course was divided into three units: (1) Transgender Patient Care Introduction, (2) General Health Issues of Transgender Patients, and (3) Gender Affirming Hormone Therapy. A total of 68 pharmacists participated in the study, of which 54 completed both the pre- and post-test. An ANOVA was used to compare differences in knowledge in the group before and after the educational intervention. RESULTS: The majority of the participating pharmacists were cisgender, heterosexual women who had not received any formal training related to transgender care. Participants demonstrated the largest increase in execution score in the third unit, with a percent improvement of 25.22% (pre-test 45.06%, post-test 70.28%; p < 0.001). The average total execution score was 52.15% in the pre-test and 72.89% (p< 0.001) in the post-test. CONCLUSIONS: Pharmacists benefited from a three-hour continuing education course with an increase in knowledge regarding transgender patient care and hormone therapy for gender affirmation. As this study only evaluated the effect in short term memory, further studies are needed to assess long term impact of the continuing education course on transgender care knowledge

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The Development of a Knowledge Test on Transgender Patients' Care.

The objective of this study was to develop an assessment instrument to measure the effects of a continuing education intervention on 3 domains in pharmacists' knowledge needed to provide pharmaceutical care for transgender patients: (1) foundations of gender-affirming care, (2) health disparities and the specific needs of transgender patients, and (3) hormone treatments for transgender patients. Multiple-choice questions were developed, and an initial item bank of 47 items was drafted. Item bank revision was conducted by content matter experts, while feedback from 8 practicing pharmacists was provided for face validity and further insights. A preliminary test, containing 42 items was administered to 64 pharmacists before and after a three-hour continuing education intervention. Cronbach's alpha coefficient yielded a value of 0.65 as a pre-test and 0.77 as a post-test. Items were less difficult to answer by participants after taking the three-hour continuing education, showing better discrimination among high and low performers in the instrument administration as post-test, as well as better correlation when comparing participants' performance in the overall score against item-level performance. Psychometric evidence supports further instrument examination, which can improve this tool to measure gains in pharmacists' knowledge related to the care of transgender patients.

Branchial Cysts in Quito, Ecuador

Abstract Introduction Branchial cleft anomalies are the second most common congenital anomaly in children. However, some lesions may not develop clinically and are not diagnosed until adulthood. The recent literature of branchial cysts (BCs) in the adult population is really scanty. For this reason, we analyzed the clinical and surgical management of the adult population treated for a BC at a tertiary care general hospital. Methods A retrospective review of the clinical records of all the patients with histological diagnosis of BC who were surgically treated at the Social Security Hospital in Quito, Ecuador, was performed. Fifty-one patients (27 women) with congenital anomalies of the 2nd (43 patients with cysts) and 3rd (6 patients with cysts and 2 with fistula) branchial arches were diagnosed and treated. Diagnosis was made on clinical grounds and by computed tomography scan. Results The 43 patients with a 2nd branchial cleft cyst underwent complete surgical excision through a wide mid-neck transverse cervicotomy. The 6 cases of 3rd branchial cleft cyst underwent surgical resection through a lower-neck transverse incision, and the 2 patients with clinical fistula in the lower aspect of the neck were operated on via an elliptical incision around this external fistula opening. Postoperative evolution was uneventful in all patients. Conclusions Branchial cysts can occasionally be diagnosed in adult patients in the setting of a general hospital population. A correct clinical and imaging assessment was diagnostic in most patients. Complete surgical resection was curative in all our patients, and postoperative complications were exceptional.

Branchial Cysts in Quito, Ecuador.

Introduction Branchial cleft anomalies are the second most common congenital anomaly in children. However, some lesions may not develop clinically and are not diagnosed until adulthood. The recent literature of branchial cysts (BCs) in the adult population is really scanty. For this reason, we analyzed the clinical and surgical management of the adult population treated for a BC at a tertiary care general hospital. Methods A retrospective review of the clinical records of all the patients with histological diagnosis of BC who were surgically treated at the Social Security Hospital in Quito, Ecuador, was performed. Fifty-one patients (27 women) with congenital anomalies of the 2 nd (43 patients with cysts) and 3 rd (6 patients with cysts and 2 with fistula) branchial arches were diagnosed and treated. Diagnosis was made on clinical grounds and by computed tomography scan. Results The 43 patients with a 2 nd branchial cleft cyst underwent complete surgical excision through a wide mid-neck transverse cervicotomy. The 6 cases of 3 rd branchial cleft cyst underwent surgical resection through a lower-neck transverse incision, and the 2 patients with clinical fistula in the lower aspect of the neck were operated on via an elliptical incision around this external fistula opening. Postoperative evolution was uneventful in all patients. Conclusions Branchial cysts can occasionally be diagnosed in adult patients in the setting of a general hospital population. A correct clinical and imaging assessment was diagnostic in most patients. Complete surgical resection was curative in all our patients, and postoperative complications were exceptional.

Variables associated with frailty in a hospital population in Colombia / Variables asociadas a fragilidad en una población hospitalaria en Colombia

INTRODUCTION: Frailty predicts functional decline and could be associated with adverse outcomes such as disability, multiple hospitalizations, falls, loss of mobility, and cardiovascular disease. In Colombia 12.5% of prevalence has been reported. In the present study, the different clinical variables associated with frailty were evaluated in a population of hospitalized patients older than 65 years in Bucaramanga, Colombia, in order to predict the behavior of these variables to generate measurement tools of greater applicability than that of currently existing tools. METHODS: An analytical observational cross-sectional study with non-probabilistic sampling was conducted from January 2016 to June 2017 in patients older than 65 years of follow-up >48 hours by the internal medicine service. Fried criteria were used to evaluate patients on their last day of hospitalization. RESULTS: A total of 155 patients were included, of whom 60.6% were frail. A combined analysis of the variables that showed association with frailty revealed that a calf circumference lower than or equal to 31 cm, a gait speed lower than or equal to 0.8 m/s, and age above 75 years were associated with frailty. It was also shown that being male and having a BMI >27 kg/m2 are protective factors for frailty. CONCLUSIONS: The prevalence of frailty in hospitalized older adults was higher than that reported in local studies for the community population. According to multivariate analysis, the variables, when analyzed together, have a predictive ability of 92% to estimate frailty in hospitalized patients.

INTRODUCCIÓN: El síndrome de fragilidad puede asociarse a mayor riesgo de deterioro funcional y desenlaces adversos como discapacidad, múltiples hospitalizaciones, caídas, pérdida de movilidad y enfermedad cardiovascular. En Colombia se ha reportado una prevalencia del 12,5%. En el presente estudio, se evalúan las diferentes variables clínicas asociadas a fragilidad en una población de pacientes mayores de 65 años en una población hospitalaria en Colombia con el fin de predecir el comportamiento de estas variables y poder general herramientas de detección de mayor aplicabilidad que las que existen actualmente. MÉTODOS: Se realizó un estudio observacional analítico de tipo corte transversal con muestreo no probabilístico desde enero de 2016 a junio de 2017 en pacientes mayores de 65 años en seguimiento > 48 horas por el servicio de medicina interna. Se evaluó la presencia de fragilidad a través de los criterios de Linda Fried, medidos previo al egreso. RESULTADOS: Se incluyeron 155 pacientes, el 60,6% cumplió criterios de Fragilidad. Al realizar el análisis combinado de las variables que mostraron asociación con fragilidad se encontró que una circunferencia de la pantorrilla menor o igual a 31 cm, una velocidad de marcha menor o igual de 0,8 m/seg y ser mayor de 75 años tenían asociación de riesgo para tener fragilidad. También se evidenciaron que ser hombre y tener IMC > 27 kg/m2 , son factores protectores para tener fragilidad. CONCLUSIONES: La prevalencia de fragilidad en adultos mayores hospitalizados fue mayor de la reportada en estudios locales para población comunitaria. De acuerdo con el análisis multivariado, los criterios modificados de Fried incluyendo perímetro de pantorrilla, sin tener en cuenta dinamometría, tienen una capacidad predictiva del 92% para estimar fragilidad en pacientes hospitalizados.

Data supporting Maastrichtian paleoclimate variables applying a multi proxy approach to a paleosol profile, Arctic Alaska.

We provide the dataset of climate variables related to the research article "Paleoclimate reconstruction of the Prince Creek Formation, Arctic Alaska, during Maastrichtian global warming" [1]. The dataset includes mean annual precipitation (MAP) values determined using two independent proxies, estimates of the oxygen isotope composition of meteoric water (δ18Ow) obtained from smectites and a comparison with previously published siderite data. We also provide the data used to calculate the total flux of CO2 required for the weathering of silicates. This dataset is an example of a multi proxy approach that could add further insight for researchers in the selection of suitable proxies for paleoclimatic interpretations.

Elucidating sensing mechanisms of a pyrene excimer-based calix[4]arene for ratiometric detection of Hg(ii) and Ag(i) and chemosensor behaviour as INHIBITION or IMPLICATION logic gates.

This article reports the synthesis and characterisation of two lower rim calix[4]arene derivatives with thiourea as spacer and pyrene or methylene-pyrene as fluorophore. Both derivatives exhibit a fluorimetric response towards Hg2+, Ag+ and Cu2+. Only methylene-pyrenyl derivative 2 allows for selective detection of Hg2+ and Ag+ by enhancement or decrease of excimer emission, respectively. The limits of detection of 2 are 8.11 nM (Hg2+) and 2.09 nM (Ag+). DFT and TD-DFT computational studies were carried out and used to identify possible binding modes that explain the observed response during fluorescence titrations. Calculations revealed the presence of different binding sites depending on the conformation of 2, which suggest a reasonable explanation for non-linear changes in fluorescence depending on the physical nature of the interaction between metal centre and conformer. INHIBITION and IMPLICATION logic gates have also been generated monitoring signal outputs at pyrene monomer (395 nm) and excimer (472 nm) emission, respectively. Thus 2 is a potential primary sensor towards Ag+ and Hg2+ able to configure two different logic gate operations.

Melanomas nasosinusales / Sinonasal melanomas

Los melanomas mucosos representan 2 a 8% de todos los melanomas de cabeza y cuello. La mayoría se localizan en la cavidad nasal y senos paranasales. El objetivo de este estudio fue revisar la evolución de pacientes portadores de melanomas malignos nasosinusales (MMNS) en un hospital de atención terciaria. Material y Métodos: Serie de casos de 19 pacientes operados por MMNS en el Hospital "Carlos Andrade Marín" y algunos institutos privados de Quito. Todos con diagnóstico histológico confirmado. Resultados: Once varones con una edad promedio de 64 años. Sus síntomas más frecuentes fueron obstrucción nasal y epistaxis y la mayor parte de los tumores se localizaron en la fosa nasal. En 11 pacientes se encontró extensión extranasal. Doce pacientes estuvieron en estadios III-IV. Todos los pacientes recibieron tratamiento quirúrgico y siete de ellos radioterapia complementaria. Recurrencia local (11 eventos) ocurrió en 9 casos. Estos eventos fueron tratados con cirugía en ocho pacientes, que eventualmente recibieron radioterapia (RT) y quimioterapia (QT). 0cho de estos nueve pacientes fallecieron. La sobrevida global a 5 años fue del 46%. La mortalidad estuvo relacionada con la extensión de la enfermedad local y la presencia de metástasis. Todos los pacientes con estadio I están vivos. Discusión: La mayor parte de MMNS tiene mal pronóstico debido ­ principalmente- a enfermedad local inicialmente avanzada, recurrencia local y metástasis a distancia. La cirugía es el tratamiento de base seguido de RT.

Introduction: Head and neck mucosal melanoma account for 2 to 8% of head and neck melanomas, most of them arising in the nasal cavity or paranasal sinuses. The aim of this report was to review the follow up of patients with sinonasal malignant melanomas (SNMM), treated over a long period of time at a tertiary referral hospital. Methods: Case series of 19 patients surgically treated for SNMM at Social Security Hospital Carlos Andrade Marin and other private clinics from Quito Ecuador. All patients had histologically proven diagnosis; eleven men. Results: The mean age was 64 year-old. The most common symptoms were nasal obstruction and epistaxis. Most tumors were located at the nasal fossa. Extranasal extension occurred in 11 patients. Twelve tumor were at stages III-IV. All patients were surgically treated. Postoperative radiotherapy was given to 7 patients. Local recurrence (11 events) occurred in 9 cases. These events were treated with surgery in 8 patients, eventually associated to radiation therapy (RT) and chemotherapy (CT). Eight out of 9 patients died. Overall survival was 46%. Death was related to extension of the disease and distant metastases. All stage I tumor patients are still alive. Discussion: Most sinonasal melanomas have a poor prognosis, mainly attributed to initial advanced local disease, local recurrence and distant metastasis.

Cirugía para la obesidad y sus efectos metabólicos. artículo de revisión / Surgery for obesity and its metabolic effects. review article

En el Ecuador según la Encuesta Nacional de Salud y Nutrición publicada en el 2013, la prevalencia de Obesidad en personas mayores de 19 y menores a 60 años es del 62.8%, mientras que la principal causa de muerte de los ecuatorianos en el 2011 según el INEC fue la Diabetes Mellitus Tipo II. La aso-ciación entre obesidad y sus comorbilidades genera un importante impacto en la salud pública y en los costos que se generan de su atención. La cirugía metabólica (bariátrica) representa una excelente opción terapéutica para el tratamiento a largo plazo de la obesidad y sus comorbilidades.

In Ecuador, according to the National Health and Nutrition Survey published in 2013, the prevalence of obesity in people over 19 and under 60 years is 62.8%, while the main cause of Ecuadorians ́ death in 2011 according to the INEC was the Diabetes Mellitus Type II. The association between obesity and its comorbidities generates a significant impact on public health and its costs. The metabolic surgery is an excellent treatment option for long-term treatment of obesity and its comorbidities.