ABSTRACT BACKGROUND: Although bariatric surgery is highly effective for the treatment of obesity and its comorbidities, preoperative weight loss has an impact on its results. AIMS: The aim of this study was to correlate preoperative weight loss with the outcome of bariatric surgery using the Bariatric Analysis and Reporting Outcome System scores. METHODS: This is a cross-sectional, observational study with 43 patients undergoing bariatric surgery that compared a group of 25 patients with a percentage of preoperative excess weight loss ³8% with a group of 18 patients with a percentage of preoperative excess weight loss <8% or with weight gain. The research took place at the bariatric surgery outpatient clinic of the Oswaldo Cruz University Hospital with patients 1 year after the surgery. RESULTS: Patients had a mean age of 40.8 years (42.7 percentage of preoperative excess weight loss ≥8% vs. 38.2 percentage of preoperative excess weight loss <8%, p=0.095). No significant difference was found between the two groups regarding preoperative comorbidities and body mass index at entry into the program. Higher preoperative body mass index (48.69 vs. 44.0; p=0.029) was observed in the group with percentage of preoperative excess weight loss <8%. No significant difference was found regarding the percentage of excess weight loss (71.4±15.4%; percentage of preoperative excess weight loss ≥8% vs. 69.47%±14.5 percentage of preoperative excess weight loss <8%; p=0.671), the result of the surgery according to the Bariatric Analysis and Reporting Outcome System scores protocol, the resolution of comorbidities, the quality of life, and the surgical complications between the two groups. CONCLUSIONS: Based on the available data, it is reasonable that bariatric surgery should not be denied to people who have not achieved pre-established weight loss before surgery.

RESUMO RACIONAL: Apesar da cirurgia bariátrica ser altamente eficaz para o tratamento da obesidade e suas comorbidades, ainda não está bem estabelecido o impacto da perda de peso pré-operatória em seus resultados. OBJETIVOS: Correlacionar a perda de peso pré-operatória com o resultado da cirurgia bariátrica pelos escores do método Bariatric Analysis and Reportig Outcome System. MÉTODOS: Estudo observacional transversal com 43 pacientes submetidos a cirurgia bariátrica que comparou um grupo de 25 pacientes com percentual de perda do excesso de peso pré-operatória igual ou maior a 8% com um grupo de 18 pacientes com percentual de perda do excesso de peso pré-operatória menor a 8% ou com ganho de peso. A pesquisa ocorreu no ambulatório de Cirurgia Bariátrica do Hospital Universitário Oswaldo Cruz com pacientes após um ano da cirurgia. RESULTADOS: Os pacientes tinham uma média de idade de 40,8 anos (42,7 percentual de perda do excesso de peso pré-operatória ≥8% vs 38,2 percentual de perda do excesso de peso pré-operatória <8%, p=0.095). Não foram encontradas diferenças significativas entre os dois grupos em relação às comorbidades pré-operatórias e o IMC na entrada do programa. Foi observado maior IMC pré-operatório (48,69 vs 44,0; p=0,029) no grupo com percentual de perda do excesso de peso pré-operatória <8%. Não foram encontradas diferenças significativas em relação ao percentual de perda do excesso de peso (71,4±15,4%; percentual de perda do excesso de peso pré-operatória ≥8% vs 69,47±14,5% percentual de perda do excesso de peso pré-operatória <8%, p=0,671), ao resultado da cirurgia pelo protocolo Bariatric Analysis and Reportig Outcome System, a resolução das comorbidades, a qualidade de vida e as complicações cirúrgicas entre os dois grupos. CONCLUSÕES: Com base nos dados disponíveis é condizente que a cirurgia bariátrica não seja negada a pessoas que não atingiram uma perda de peso pré-estabelecida antes da cirurgia.

ABSTRACT Introduction: The monitoring of cardiorespiratory signals (acquisition, processing and analysis) in different scenarios facilitates the diagnosis but faces the loss of information due to disturbances and the lack of robust processing and analysis methods. In this research, we used 3 cardiorespiratory signals: electrocardiogram (ECG), phonocardiogram (PCG) and seismocardiogram (SCG), and their corresponding time series. Methods: We characterized the source of disturbances and the performance of ECG processing and analysis methods using international and in-house databases. Twenty-one novel approaches were proposed and evaluated with 1 or more of the aforementioned signals. Moreover, we presented 4 tools that showcase the practical contribution. Results: The 6 findings derived from the characterization suggest how to extract meaningful information from the electrocardiographic signal. The proposed methods performed similarly or better than the state-of-the-art and proved to be robust to disturbances in the signals and in their time series. This opens new alternatives to avoid errors during the processing. These innovative monitoring tools allow for ubiquitous, reliable, friendly, fast, and robust diagnosis in presence of disturbances in the signals and in their time series. As some conclusions was the obtained findings, methods and tools improve the diagnosis and life quality of the patients by using portable, non-invasive, safe, reusable, non-polluting, easily generalized and low-cost devices. This allows for extending and enhancing cardiology services in Cuba.

RESUMEN Introducción: La monitorización (adquisición, procesamiento y análisis) de señales cardiorrespiratorias en diferentes escenarios facilita el diagnóstico, pero enfrenta la pérdida de información debido a la presencia de perturbaciones y a la carencia de métodos de procesamiento y análisis robustos. En esta investigación se trabaja con 3 señales cardiorrespiratorias: electrocardiograma (ECG), fonocardiograma (PCG) y seismocardiograma (SCG) y con series temporales derivadas de estas. Métodos: Se caracterizan las fuentes de perturbaciones y el desempeño de los métodos de procesamiento y análisis del ECG usando bases de datos internacionales y propias. Se proponen y evalúan: 21 nuevos métodos de procesamiento y análisis, para 1 o más de estas 3 señales, y 4 herramientas que delimitan el aporte práctico. Resultados: Los 6 hallazgos derivados de la caracterización sugieren cómo extraer mayor información de la señal electrocardiográfica. Los inéditos métodos de procesamiento y análisis mostraron un desempeño igual o superior a lo más relevantes, son robustos a la presencia de perturbaciones en las señales y en las series temporales derivadas de estas, abriendo nuevas alternativas que evitan corregir muchos errores debidos al procesamiento. Las innovadoras herramientas de monitorización permitieron realizar un diagnóstico ubicuo, confiable, amistoso, rápido y robusto a la presencia de perturbaciones en las señales y series temporales. Y como conclusiones, los hallazgos, métodos y herramientas obtenidos contribuyen a mejorar el diagnóstico y calidad de vida de las pacientes usando dispositivos portables, no invasivos, seguros, reusables, no contaminantes, de fácil generalización y bajo costo. Esto permite extender y potenciar los servicios cardiológicos en Cuba.

ABSTRACT Cardiovascular diseases are the leading cause of death worldwide, accounting for 17.3 million deaths per year. The electrocardiogram (ECG) is a non-invasive technique widely used for the detection of cardiac diseases. To increase diagnostic sensitivity, ECG is acquired during exercise stress tests or in ambulatory way. Under these acquisition conditions, the ECG is strongly affected by some types of noises, mainly by baseline wander (BLW). In this work, nine methods, widely used, for the elimination of BLW were implemented, which are: interpolation using cubic splines, finite impulse response (FIR) filter, infinite impulse response (IIR) filter, least mean square adaptive filtering, moving-average filter, independent component analysis, interpolation and successive subtraction of median values in RR interval, empirical mode decomposition, and wavelet filtering. For the quantitative evaluation, the following similarity metrics were used: absolute maximum distance, the sum of squares of distances and percentage root-mean-square difference. Several experiments were performed using synthetic ECG signals generated by ECGSYM software, real ECG signals from QT Database, artificial BLW generated by software and real BLW from the Noise Stress Test Database. The best results were obtained by the method based on FIR high-pass filter with a cut-off frequency of 0.67 Hz.

RESUMEN Las enfermedades cardiovasculares son la principal causa de muerte en el mundo, y representan 17,3 millones de muertes por año. El electrocardiograma (ECG) es una técnica no invasiva ampliamente utilizada para la detección de enfermedades cardíacas. Para aumentar la sensibilidad diagnóstica, el ECG se adquiere durante las pruebas de esfuerzo o de forma ambulatoria. En estas condiciones, el ECG se ve fuertemente afectado por algunos tipos de ruidos, principalmente por las derivas de línea base (BLW). En este trabajo se implementaron nueve métodos ampliamente utilizados para la eliminación de BLW, que son: interpolación utilizando splines cúbicos, filtro de respuesta a impulso finita (FIR), filtro de respuesta a impulso infinita (IIR), filtrado adaptativo de mínimos cuadrados medios, filtro de media móvil, análisis de componentes independientes, interpolación y substracción sucesiva de los valores de la mediana en el intervalo RR, descomposición en modos empíricos y filtrado de wavelets. Para la evaluación cuantitativa, se utilizaron las siguientes métricas de similitud: distancia máxima absoluta, la suma de los cuadrados de las distancias y la diferencia porcentual de la raíz media cuadrática. Se realizaron varios experimentos utilizando: señales de ECG sintéticas generadas por el software ECGSYM, señales de ECG reales de la base de datos QT, BLW artificiales generadas por software y BLW reales de la base de datos “Noise Stress Test Database”. Los mejores resultados se obtuvieron mediante el método basado en el filtro FIR paso alto con una frecuencia de corte de 0,67 Hz.

The present work aims at the preliminary evaluation of the Paspalun repens macrophyte dry biomass adsorbent material of zinc (Zn) and copper (Cu) metals from water. The diversity of Species is due to the extensive aquatic environment where it is inserted. The Paspalun repens species comes from the Buiuçu lake located in the region of Parintins-Amazonas- Brazil. The macrophyte was dried in a mill and then a digestion through biomass microwaves was done before and after its exposure to the solutions containing different concentrations of zinc and copper (1.00, 1.50, 2.00, 3.00 mg mL-1 of metals) for a period of 48 hours. As a source of the metals, zinc sulfate (ZnSO4 7H2O) for zinc, and copper sulfate (CuSO4 5H2O) for copper were used as the source. As a result, the efficiency of Paspalun repens was observed in the metals removal, the highest removal percentage, of 29.67 and 37.07% in the leaves, whereas in the root it was 25.25 and 32.84% (at the concentration 1.0 and 2.0 mg/mL consequently), was of zinc, therefore the dry biomass of this species can be considered as a low cost alternative material in the removal of these heavy metals, contributing to the improvement of water quality.

RACIONAL: Na esquistossomose mansônica na forma hepatoesplênica ocorre fibrose hepática difusa que associada à congestão venosa do sistema porta resulta em hepatoesplenomegalia. Pode produzir hemorragia digestiva alta por rotura das varizes de esôfago e do estômago ou lesões pépticas da mucosa gastroduodenal. OBJETIVO: Estudar os efeitos da esplenectomia e ligadura da veia gástrica esquerda sobre a hemodinâmica portohepática. MÉTODO: Vinte e três portadores de esquistossomose mansônica na forma hepatoesplênica foram estudados prospectivamente, antes e cerca de duas semanas após a operação, através de estudos angiográficos dos diâmetros da artéria hepática comum e própria, artéria esplênica, artéria mesentérica superior, veia porta, veia mesentérica superior e veia gástrica esquerda. Foram aferidas as pressões da veia cava inferior, venosa central, da veia hepática livre, da veia hepática ocluída e sinusoidal. RESULTADOS: A ligadura da veia gástrica esquerda determinou acréscimo significante nas seguintes variáveis: diâmetros da artéria hepática comum e própria; diâmetro da veia mesentérica superior; o acréscimo não foi significante nas seguintes medidas: pressão venosa central e diâmetro da artéria mesentérica superior. Ela promoveu decréscimo não significante nas variáveis: pressão da veia cava inferior; pressão da veia hepática livre; pressão da veia hepática ocluída; pressão sinusoidal; diâmetro da veia porta. CONCLUSÃO: A ligadura da veia gástrica esquerda, na maioria dos casos, não determina alterações hemodinâmicas significantes do sistema porta capazes de quebrar o equilíbrio hemodinâmico funcional, que caracteriza a esquistossomose mansônica na forma hepatoesplênica.

BACKGROUND: In hepatosplenic schistosomiasis occurs diffuse hepatic fibrosis associated with venous congestion of the portal system resulting in hepatosplenomegaly. It can produce digestive hemorrhage caused by rupture of esophageal and stomach varices or peptic gastroduodenal mucosal lesions. AIM: To study the effects of splenectomy and ligature of the left gastric vein on portohepatic hemodynamics. METHOD: Twenty-three patients with hepatosplenic schistosomiasis mansoni were studied before and about two weeks after operation through angiographic diameter of the common and proper hepatic artery, splenic artery, superior mesenteric artery, portal vein, superior mesenteric vein and left gastric vein. The pressures of the inferior vena cava and central venous pressure, free hepatic vein, the hepatic sinusoidal and occluded vein were measured. RESULTS: The splenectomy and ligature of the left gastric vein determined low morbidity and null mortality. It determined significant addition to the following variables: diameters of the common and proper hepatic artery; diameter of the superior mesenteric vein. It determined non significant increase on the following measurements: right atrial pressure and diameter of the superior mesenteric artery. It determined non significant decrease to the following variables: inferior vena cava pressure; free hepatic vein pressure; occluded hepatic vein pressure; sinusoidal pressure, diameter of the portal vein. CONCLUSION: Splenectomy and ligature of the left gastric vein do not determine portal hemodynamic changes capable of breaking the functional hemodinamic balance that characterizes the hepatosplenic mansoni schistosomiasis.

RACIONAL: Expressivo contingente de pacientes esquistossomóticos com a forma hepatoesplênica e hipertensão portal apresentam hemorragia causada pela ruptura de varizes esofagogástricas, principal causa de alta morbidade e mortalidade da doença. OBJETIVO: Investigar os efeitos da esplenectomia e ligadura da veia gástrica esquerda sobre fatores de risco de sangramento por varizes esofagogástricas em portadores de esquistossomose mansônica, forma hepatoesplênica, com antecedente de hemorragia digestiva alta. MÉTODO: Estudaram-se, de forma prospectiva, 34 pacientes, com idade entre 1 e 74 anos (média 44,14), sendo 18 (53%) mulheres. Analisaram-se: 1) pressão das varizes do esôfago, aferida pela técnica endoscópica do balão pneumático; 2) tamanho, local, cor e sinais de cor vermelha nas varizes do esôfago; 3) varizes gástricas e gastropatia da hipertensão portal. Realizaram-se avaliações no pré-operatório, no pós-operatório imediato e no sexto mês após a ligadura da veia gástrica esquerda. RESULTADOS: A pressão das varizes do esôfago diminuiu de 22,3+/-2,6 mmHg, antes da operação, para 16,0+/-3,0 mmHg no pós-operatório imediato (p<0,001), caindo para 13,3+/-2,6 mmHg no pós-operatório do sexto mês (p<0,001). A proporção de varizes de grosso calibre, varizes no esôfago superior, varizes de cor azul, varizes com sinais de cor vermelha e de gastropatia da hipertensão portal decresceu de forma significante apenas no sexto mês de pós-operatório. CONCLUSÃO: A ligadura da veia gástrica esquerda, em esquistossomóticos hepatoesplênicos, com antecedente de hemorragia digestiva alta, revelou-se eficaz em diminuir alguns dos principais fatores de risco de hemorragia por varizes esofagogástricas, indicando boa perspectiva no controle definitivo do sangramento.

BACKGROUND: A significant number of patients with schistosomiasis develop the hepatosplenic form, with portal hypertension, in which bleeding caused by rupture of esophagogastric varices emerged as the leading cause of morbidity and mortality. AIM: To investigate the effects of splenectomy and ligature of the left gastric vein on risk factors for bleeding of esophagogastric varices in patients with schistosomiasis mansoni, hepatosplenic form, with a history of upper gastrointestinal bleeding. METHODS: The main risk factors of bleeding from esophagogastric varices were studied in 34 patients. The following parameters were investigated: 1) esophageal variceal pressure, measured by the endoscopic pneumatic balloon technique; 2) size, fundamental color, extension and red signs of esophageal varices, gastric varices and gastropathy of portal hypertension. The evaluations were performed in the preoperative period, immediate postoperative period (between the sixth and eighth postoperative days) and the sixth month of follow-up. RESULTS: The variceal pressure has fallen from 22.3+/-2.6 mmHg before surgery to 16.0+/-3.0 mmHg in the immediate postoperative period (p<0.001), reaching 13.3+/- 2.6 mmHg in the sixth month of follow-up. A significant reduction of the frequency of the parameters associated with a greater risk of hemorrhage was observed between the preoperative period and six-month follow-up, when the proportion of large esophageal varices (p<0.05), varices extending to the upper esophagus (p<0.05), bluish varices (p<0.01), varices with red signs (p<0.01) and gastropathy (p<0.05) decreased. CONCLUSION: In patients with hepatosplenic schistosomiasis with a previous history of variceal hemorrhage, splenectomy and gastric vein ligation was effective in reducing the main hemorrhagic risk factors until the sixth month of follow-up, indicating a good way to control the bleeding episodes.

OBJETIVO: Estudar, a curto e médio prazos, o resultado e complicações da coledocoduodenostomia (CDD) realizada por via laparoscópica. MÉTODO: Estudo prospectivo de 20 pacientes com indicação de coledocoduodenostomia vídeo-laparoscópica operados na DIGEST no período de 1991 a 2003. RESULTADOS: Dos 20 pacientes com indicação para CDD laparoscópica, quatro tinham coledocolitíase associada à litíase vesicular, oito litíase residual de colédoco, dois estenose benigna e seis tumor periampolar. Houve duas conversões para ressecção de colédoco. Dentre as 18 CDD, todos tinham via biliar acima de 1,5 cm de diâmetro. Foi observado vazamento biliar pelo dreno cavitário em quatro casos (duração máxima de quatro dias) resolvidos espontaneamente, uma infecção de ferida e uma morte súbita no 2º. dia de pós-operatório. Os seis portadores de tumor periampolar tiveram sobrevida média de 7,2 meses evoluindo sem prurido ou icterícia até o óbito. CONCLUSÕES: Além da demonstração da viabilidade do método laparoscópico na realização da CDD, evidenciou-se que o posicionamento de trocarte adicional facilita a confecção da anastomose. Acredita-se que, a ocorrência de vazamento da anastomose possa diminuir com a experiência e que a CDD seja alternativa interessante na paliação dos tumores periampolares.

BACKGROUND: This study reviews short and medium follow up results and complications of the choledochoduodenostomy (CDD) by laparoscopic procedure. METHODS: Prospective study of 20 patients with indication for laparoscopic CDD operated on at DIGEST (private clinic) , for 1991 at 2003. RESULTS: Of the twenty patients with indication to laparoscopic CDD four had choledocholitiasis with gallstones, eight residual choledocholithiasis, two benign stenosis and six periampullary cancer. Two conversions for common bile duct resection were required. From the 18 CDD, all of them had a bile duct diameter greater than 1.5 cm. Bile leakage through the drain (maximum duration of four days) in four cases that resolved spontaneously, one wound infection and one sudden death in the 2nd. postoperative day were observed . The six periampullary cancer had medium survival of 7.2 months without itch or jaundice recurrence until the death. CONCLUSION: Besides the demonstration of the laparoscopic procedure feasability in the CDD, it was evidenced that positioning with one more trocar was better. It is believed that, the leakage index will decrease with the experience and that CDD is an interesting alternative for the palliative treatment of periampullary cancer.