Abstract Background: reduced cognitive performance has been observed in patients with severe obesity. Bariatric surgery and subsequent adipose tissue loss seem to affect cognitive functioning positively; however, improvement predictors are not well established. Aim: to evaluate the cognitive performance and the nutritional status of patients with severe obesity 6-month after bariatric surgery. Methods: we assessed the neuropsychological performance of 22 patients with obesity (body mass index: ~ 42.9 kg/m²). The nutritional evaluation consisted of the routine tests performed in the baseline and postoperative periods. Lastly, we calculated the correlation between neuropsychological assessment results and blood biomarkers. Results: the patients did not present cognitive impairment in the preoperative assessment, but performed below the standard range. The patients underwent significant weight loss after 6 months from surgery (~ 22 kg), with a change in obesity class III to I. Also, the patients presented a significant improvement in attention, mental flexibility, inhibitory control, and processing speed. Additionally, we observed a significant improvement in serum folic acid (108 %), gamma-glutamyl transferase (-41 %), uric acid (-32 %), ferritin (-28 %), triglycerides (-19 %), and high-density lipoprotein (9 %). Lastly, we found a moderate positive correlation between processing speed and body weight (r = 0.46), gamma-glutamyl transferase (r = 0.54), and total protein and mental flexibility (r = 0.75). Conclusion: bariatric surgery promoted significant weight loss and improved attention, mental flexibility, processing speed, and several nutritional biomarkers. Nevertheless, the surgery had limited effects on other cognitive functions such as short- and long-term memory and language.

Resumen Introducción: se ha observado una disminución del rendimiento cognitivo en los pacientes con obesidad grave. La cirugía bariátrica y la pérdida de tejido adiposo parecen mejorar el funcionamiento cognitivo; sin embargo, los predictores de mejora no están bien establecidos. Objetivos: evaluar el rendimiento cognitivo y el estado Nutricional de pacientes con obesidad severa después de 6 meses de una cirugía bariátrica. Métodos: evaluamos el desempeño neuropsicológico de 22 pacientes con un índice de masa corporal ~ 42,9 kg/m². Se analizaron las pruebas de rutina realizadas al inicio y después de la cirugía. Calculamos la correlación con la evaluación neuropsicológica y los biomarcadores sanguíneos. Resultados: los pacientes no mostraron deterioro cognitivo en la evaluación preoperatoria, pero sí un rendimiento por debajo del estándar. Los pacientes mostraron una pérdida de peso significativa 6 meses después de la cirugía (~ 22 kg), con un cambio de la clasificación de obesidad de III a I. Además, los pacientes mostraron una mejora significativa de la atención, la flexibilidad mental, el control inhibitorio y la velocidad de procesamiento. Además, observamos una mejora significativa del ácido fólico sérico (108 %), la gamma-glutamil-transferasa (-41 %), el ácido úrico (-32 %), la ferritina (-28 %), los triglicéridos (-19 %) y las lipoproteínas de alta densidad (9 %). Finalmente, encontramos una correlación positiva moderada entre la velocidad de procesamiento y el peso corporal (r = 0,46) y la gamma-glutamil-transferasa (r = 0,54), y entre la proteína total y la flexibilidad mental (r = 0,75). Conclusiones: la cirugía bariátrica promovió una pérdida de peso significativa y mejoró la atención, la flexibilidad mental, la velocidad de procesamiento y varios biomarcadores Nutricionales. Sin embargo, tuvo efectos limitados sobre otras funciones cognitivas, como la memoria y el lenguaje a corto y largo plazo.

Abstract The overweight population is growing in the world, and the search for obesity-associated mechanisms is important for a better understanding of this disease. Few studies with the FTO gene and miRs show how they associate to obesity and how they can impact this disease. The aim of this study was to verify the relationship between the FTO gene and the hsa-miR-150-5p expression with overweight/obesity, lipid profile, and fast blood glucose. Men and women (18 years older or above), with body mass index ≥ 18.5 kg/m2, were enrolled in the present study and the FTO gene and hsa-miR-150-5p expression, biochemical parameters of blood and anthropometric measurements were analyzed. The results highlight that the FTO gene expression is associated to obesity (p 0.029), LDL-C (p 0.02) and fasting blood glucose (p 0.02), but not with triglycerides (p 0.69), total cholesterol (p 0.21), and HDL-C (p 0.24). The hsa-miR-150-5p is not associated to obesity (p 0.84), triglycerides (p 0.57), total cholesterol (p 0.51), HDL-C (p 0.75), LDL-C (p 0.32), and fasting blood glucose (p 0.42). The FTO gene expression is related to obesity, LDL-C and blood fasting glucose, representing a good molecular marker for obesity.

Abstract Purpose: To compare open Lichtenstein repair and laparoscopic transabdominal preperitoneal (TAPP) repair to treat primary unilateral hernia, regarding systemic inflammatory response, postoperative pain, and complications. Methods: A non-randomized prospective cohort study, with the preoperative and postoperative (24 hours) collection of blood samples for C reactive protein (CRP), interleukin 6 (IL-6), leukocyte and neutrophil analysis. Visual Analog Scale (VAS) was used to quantify the level of pain, and the operative time was correlated with the inflammatory response. VAS and CRP were also obtained on the 8th postoperative day. Results: Groups were homogeneous regarding preoperative characteristics. There were no differences between groups in 24h values of CRP, IL-6, leukocytes, neutrophils or VAS. Similarly, CRP and VAS did not differ between groups on the 8th postoperative day. However, the operative time for laparoscopic hernia repair was longer than the time for the open procedure. There was a weak correlation (r coefficient 0.31) between the duration of the surgical procedure and the VAS score at the eighth day. Conclusions: There were no statistically significant differences in the inflammatory response, pain scores, or complications between groups. We conclude that there is no advantage performing a primary unilateral hernia repair by laparoscopy.

RESUMO Racional: O psicólogo que atua na área da cirurgia bariátrica tem papel de acolher, avaliar, preparar e conscientizar o paciente que vai ser submetido ao procedimento cirúrgico. A avaliação psicológica reveste-se de importância na medida em que obtém dados sobre história pessoal e familiar, além do rastreio de possíveis alterações psicopatológicas. Objetivo: Analisar as avaliações psicológicas dos pacientes de um serviço de cirurgia bariátrica de um hospital público, buscando traçar o perfil psicológico dos pacientes deste serviço. Métodos: Foram coletados dados de 827 pacientes entre 2001 e 2015, utilizando-se dados de uma entrevista, Inventário Beck de Depressão (BDI), Inventário Beck de Ansiedade (BAI) e Escala de Compulsão Alimentar Periódica (ECAP). Resultados: A idade média dos pacientes antes da operação foi 39 anos+10 e o IMC médio foi 51 kg/m²+7, sendo a maioria (81%) do gênero feminino. A pontuação média no BDI foi 14,8+8 e as mulheres tiveram pontuação significativamente maior que os homens. No BAI a pontuação média foi 11+ 8 e no ECAP 14+ 8, ambos sem diferença entre os grupos. Conclusão: A caracterização psicossocial dos pacientes avaliados aponta para a presença significativa de indicadores de depressão, com baixos níveis de ansiedade e de compulsão alimentar.

Abstract Background: The psychologist who works in bariatric surgery has a role to receive, evaluate, prepare and educate the patient who will undergo the surgical procedure. Psychological evaluation becomes important in so far as allows us to obtain data on personal and familiar history and allow tracing of possible psychopathology. Aim: To collect data on psychological evaluations of patients in a bariatric surgery service of a public hospital in order to describe the psychological profile of patients in this service. Method: Data were collected from 827 patients between 2001 and 2015, using data from an interview, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Binge Eating Scale (BES). Results: The mean age of patients before surgery was 39 years+/- 10, the mean BMI was 51 kg/m²+7, and most patients (81%) were female. The average score on the BDI was 14.8+8 and women had significantly higher scores than men. On the BAI the average score was 11+8 and on the ECAP was 14+8, both with no difference between groups. Conclusions: Psychosocial characteristics of the patients points to the significant presence of indicators of depression, with low levels of anxiety and binge eating.

OBJETIVO: Avaliar os efeitos de algumas providências para reduzir os custos da cirurgia bariátrica, adotando como referência a remuneração do procedimento pelo Sistema Único de Saúde. MÉTODOS: Análise retrospectiva, junto a Seção de Custos do Hospital das Clínicas de Ribeirão Preto, dos gastos com os pacientes submetidos a cirurgia bariátrica nos anos de 2004 e em 2007, após a adoção de rotinas e protocolos, no intervalo destes anos, na perspectiva de obter redução das despesas. RESULTADOS: Nove pacientes no ano de 2004 e sete no ano de 2007, submetidos à derivação gástrica em "Y de Roux" com anel por via convencional, foram estudados. Todos pacientes apresentaram boa evolução pós- operatória. O custo médio com estes pacientes no ano de 2004 foi de R$ 6.845,17. Apesar do esforço na contenção de despesas, o custo no ano de 2007 foi de R$ 7.525,64, por conta do aumento do preço de materiais e medicamentos. A remuneração do procedimento pelo SUS nos dois anos foi de R$ 3.259,72. CONCLUSÃO: Apesar da adoção de diversas medidas para reduzir as despesas da cirurgia bariátrica, houve aumento dos custos, o que reforça a necessidade de avaliação permanente do financiamento da prestação de serviço para o SUS pelos três entes da federação.

PURPOSE: Analyze the effect of some measures on the costs of bariatric surgery, adopting as reference the remuneration of the procedure provided by the Unified Health System (SUS). METHODS: A retrospective evaluation conducted in the Costs Section of the University Hospital of Ribeirão Preto, of the costs involved in the perioperative period for patients submitted to bariatric surgery from 2004 to 2007. Changes in the routines and protocols of the service aiming at the reduction of these costs during the study period were also analyzed. RESULTS: Nine patients in 2004 and seven in 2007 submitted to conventional vertical banded "Roux-en-Y" gastric bypass were studied. All patients presented good postoperative evolution. The average cost with these patients was R$ 6,845.17 in 2004. Even though an effort was made to contain expenditures, the cost in 2007 was of R$ 7,525.64 because of the increase in the price of materials and medicines. The Government remuneration of the procedure in the two years was R$ 3,259.72. CONCLUSION: Despite the adoption of diverse measures to reduce the expenditures of bariatric surgery, in fact there was an increase in the costs, a fact supporting the necessity of permanent evaluation of the financing of public health.

OBJETIVO: As ações clínicas e de ordenação do acesso à rede de saúde podem ser aperfeiçoadas pelo Complexo Regulador (CR) e pelos Protocolos Clínicos e de Regulação (PCR). Nesse trabalho apresenta-se a metodologia de elaboração dos PCR mediante cooperação entre universidade e sistema de saúde. MÉTODOS: O processo utilizado para a elaboração dos PCR envolve oficinas com a participação de profissionais da atenção básica, do CR e das equipes matriciais (especialistas da universidade que dão suporte às equipes de atenção básica). RESULTADOS: Dentre os temas selecionados para elaboração dos PCR, incluiu-se a icterícia no adulto e no idoso. Trata-se de um sinal clínico que comporta quatro cenários de apresentação com distintos percursos diagnósticos e terapêuticos passíveis de serem executados em diferentes pontos da rede assistencial. As diretrizes de avaliação, bem como as decisões e ações clínicas e reguladoras cabíveis para os diferentes cenários foram estabelecidas desde a atenção básica até o hospital terciário. As ações clínicas e reguladoras mais relevantes foram colocadas em algoritmo para facilitar o emprego do protocolo pelos profissionais de saúde. CONCLUSÃO: Há a expectativa que a implementação desse protocolo possa minimizar o descompasso entre as necessidades dos pacientes ictéricos e a modalidade de serviço oferecida e, assim, contribuir para a configuração de uma rede assistencial mais cooperativa.

PURPOSE: Clinical interventions and controlled access to the health care system can be improved by a Regulatory System (RS) and Clinical and Regulatory Protocols (CRPs). The objective of the present paper is to present the methodology used for elaborating the CRPs. METHODS: The process used to elaborate the CPRs involved a scientific co-operation between university and health care system. Workshops were held and attended by primary care practitioners, RS team, and matrix team (university specialists supporting primary care practitioners). RESULTS: The treatment of jaundice in adults and elderly subjects is amongst the themes selected for elaborating the CRPs since jaundice is a medical sign frequently seen in four clinical scenarios involving distinctive diagnostic and therapeutic interventions which can be performed in different health care settings. Evaluation guidelines as well as the clinical and regulatory procedures were established for different health care settings. The most relevant clinical and regulatory interventions were expressed as algorithms in order to facilitate the use of CRPs by health care practitioners. CONCLUSION: It is expected that the implementation of this protocol will minimise the imbalance between the icteric patients' needs and the treatment modalities being offered, thus contributing to a more co-operative health care network.

OBJETIVO: Desenvolvimento de um modelo letal de peritonite para avaliar o tratamento desta peritonite por videolaparoscopia e laparotomia. MÉTODOS: Foi desenvolvido um modelo de peritonite em ratos utilizando ligadura do ceco (CLP) contra um molde rígido de 2mm de diâmetro, seguido de punção do órgão. Dois experimentos foram realizados: determinação da letalidade de 7 dias; e análise da leucometria, hemocultura e dos valores de citocinas (Interleucina-1 beta, TNF-alfa e IL-6). Os animais foram divididos em quatro grupos: I - Cirurgia simulada; II - CLP; III - CLP + Videolaparoscopia; e IV- CLP + Laparotomia . RESULTADOS: A letalidade de sete dias foi de 0% no grupo I, 80% no grupo II (p<0.05), 60% no grupo III , e 20 % no grupo IV. Houve uma redução significativa na contagem de leucócitos e maiores níveis de citocinas séricas no grupo II quando comparado com o grupo controle. A porcentagem de hemoculturas positivas foi maior após videolaparoscopia quando comparado com o tratamento por laparotomia. CONCLUSÃO: O modelo experimental provocou uma forma de peritonite letal e que o tratamento por videolaparoscopia apresenta maiores taxas de bacteremia que o tratamento por laparotomia.

PURPOSE: Development of a lethal model of peritonitis to assess the results of treating that peritonitis using videolaparoscopy and laparotomy. METHODS: We developed a model of peritonitis in rats using cecal ligation (CLP) against a 2-mm diameter rigid mold and puncture. Two experiments were performed: determination of seven-day lethality; and analysis of white cell counts, blood cultures and cytokines (Interleukin-1 beta, Tumor Necrosis Factor-alpha and IL-6). The animals were divided into four groups: I - Sham surgery; II - CLP; III - CLP + Videolaparoscopy; and IV- CLP + Laparotomy . RESULTS: Seven-day lethality was 0% in group I, 80% in the group II (p<0.05), 60% in group III , and 20 % in group IV. There was a significant reduction in leukocyte counts and higher levels of serum IL-1 beta, TNF-alpha and IL-6 in the group II compared to controls. The percentages of positive blood cultures were higher after videolaparoscopic compared to laparotomic treatment. CONCLUSION: The experimental model provoked a lethal form of peritonitis and that videolaparoscopic treatment had more bacteraemia than laparotomy.

OBJETIVO: O objetivo deste artigo foi atualizar conceitos com relação à doença gordurosa não alcoólica do fígado (DGNAF) e a sua intrínseca relação com a obesidade. MÉTODOS: Por meio de revisão bibliográfica, com atenção especial às publicações dos últimos 5 anos, o assunto foi abordado com relação à conceituação, ao diagnóstico, estadiamento e tratamento. RESULTADO: A DGNAF está emergindo como uma das maiores causas de doença crônica do fígado e representa o componente hepático da síndrome metabólica, caracterizada por obesidade, hiperinsulinemia, resistência periférica à insulina, diabete, hipertrigliceridemia e hipertensão. O tratamento cirúrgico da obesidade mórbida faz parte do arsenal terapêutico da DGNAF. CONCLUSÃO: O tema foi amplamente discutido, baseado em estudos recentes.

PURPOSE: The aim of this review is to update concepts of the nonalcoholic fatty liver disease (NAFLD) and to establish a relationship between this condition and obesity. METHODS: By means of a comprehensive literature review where special attention was devoted to articles published in the last 5 years, NAFLD is discussed in view of new concepts, diagnosis, staging, and treatment. RESULTS: NAFLD is emerging as one of the main causes of chronic liver disease and it is believed to be the hepatic component of the metabolic syndrome, whose central features include obesity, hyperinsulinemia, peripheral insulin resistance, diabetes, dyslipidemia, and hypertension. The surgical treatment of morbid obesity is one of the options available for the treatment of NAFLD. CONCLUSION: Nonalcoholic fatty liver disease is strongly related with obesity.