ABSTRACT Purpose: To assess the impact of thinness on the outcome of the percutaneous nephrolithotomy (PCNL). Materials and Methods: A matched case–control study was performed using a prospectively collected database of all patients who underwent PCNL between June 2011 and October 2021. The patients were stratified into two groups according to their phenotypic characteristics, arbitrarily defined according to their body mass index (BMI): <20 kg/m2 (Group 1, very thin patients, G<20) and ≥25 kg/m2 (Group 2, non-thin patients, G≥25). Patients were randomly matched based on Guy's Stone Score (GSS) according to case complexity at a ratio of 1:3. Results: A total of 204 patients were enrolled in this study: 51 patients (G<20) and 153 controls (G≥25). Complications occurred in 15.2% of the patients, with 5.4% of these complications classified as major complications (Clavien grade ≥ 3). According to complications there were no significant differences between the groups. The overall complication rates were 17.6% in the G<20 and 14.4% in the G≥25 (p = 0.653). The major complication rates were 3.9% in the G<20 and 5.8% in the G≥25 (p=0.429). No differences in transfusion or urinary fistula rates were found. Conclusions: In this study, very thin patients were not at a higher risk of complications when submitted to PCNL than in those with a BMI of ≥25 kg/m2. Apparently, this technique can be used in these patients, just as it is used in any other type of patient, independently of their BMI. Purpose PCNL. . (PCNL) Methods casecontrol control 201 2021 characteristics (BMI) 20 <2 kgm2 kgm kg m2 m kg/m Group 1 G20 G 25 ≥2 2 nonthin non G≥25. G25 G≥25) Guys Guy s GSS (GSS 13. 13 3. 3 1:3 Results 5 (G<20 15 (G≥25) 152 15.2 54 4 5.4 Clavien 3) 176 17 6 17.6 G<2 144 14 14.4 G≥2 p 0.653. 0653 0.653 0 653 0.653) 39 9 3.9 58 8 5.8 p=0.429. p0429 p=0.429 429 (p=0.429) found Conclusions Apparently patient (PCNL 202 (BMI < G2 1: (G<2 (G≥25 15. 5. 17. G< 14. G≥ 065 0.65 65 p042 p=0.42 42 (p=0.429 (G< (G≥2 06 0.6 p04 p=0.4 (p=0.42 (G (G≥ 0. p0 p=0. (p=0.4 p=0 (p=0. p= (p=0 (p=

ABSTRACT Purpose: Minimally invasive radical nephrectomy is often preferred for larger renal tumours not suitable for partial nephrectomy (1). When performed with a multiport robot, the procedure is routinely performed with a transperitoneal approach, with recent studies highlighting important factors for surgical outcomes, including predictive factors (2), segmental artery unclamping techniques (3), and comparisons of robotic techniques (4). This video shows that SP Robot-Assisted Radical Nephrectomy (RARN) via a lower anterior approach is valuable in challenging cases. Materials and Methods: We performed SP-RARN on two complex patients using a retroperitoneal lower anterior approach. The first patient, a 54-year-old female with a BMI of 36.8 kg/m2, had a ventral hernia and bowel obstruction history, with a 9 cm right middle kidney mass. The second patient, a 58-year-old male with a BMI of 31.19 kg/m2, had ESRD and was on peritoneal dialysis for 8 years, with a 3.4x3.7 cm mass in the right superior pole, suspected to be RCC. The surgical technique is detailed in the video. Results: Both procedures were successful, with operative times of 173 and 203 minutes and blood loss of 150 mL. No complications occurred. Patients were discharged after 31 and 38 hours, respectively. Histopathology confirmed RCC. At the 3-month follow-up, no complications or readmissions were reported. Second patient continued peritoneal dialysis without issues. Conclusion: Retroperitoneal SP-RARN via the lower anterior approach avoids the peritoneal cavity, making it suitable for certain patients. In these patients, more so than in others, this procedure is feasible, safe, and less morbid than the standard multiport approach. Purpose 1. 1 . (1) robot outcomes 2, 2 , (2) 3, 3 (3) 4. 4 (4) RobotAssisted Robot Assisted RARN (RARN cases Methods SPRARN 54yearold yearold 54 year old 368 36 36. kgm2 kgm kg m2 m kg/m2 history 58yearold 58 3119 19 31.1 years 34x37 x 4x3 7 3.4x3. pole RCC Results successful 17 20 15 mL occurred hours respectively 3month month followup, followup follow up, up follow-up reported issues Conclusion cavity others feasible safe (1 (2 (3 (4 5 kg/m 311 31. 34x3 4x 3.4x3 ( 34x 3.4x

ABSTRACT Introduction: Robotic Radical Prostatectomy using the Da-Vinci Single-Port (SP) robot can provide comparable functional and oncological outcomes with potential advantages pertaining to peri-operative morbidity, especially in patients with an extensive history of prior abdominal surgeries (1, 2). Materials and Methods: Our case is a 74-year-old male with a history of diabetes, cardiac bypass, hypertension, and hyperlipidemia, presenting with a PSA of 7.2. His MRI showed a PIRADS-5 lesion in the left apex and mid-gland peripheral zone, and he was diagnosed with unfavorable intermediate-risk prostate cancer after MRI guided fusion biopsy. His BMI was 31, and past surgical history was pertinent for two exploratory laparotomies due to gunshot wounds and a colostomy creation followed by reversal. The standardized steps of robotic radical prostatectomy were carried out using SP robotic platform performed by author SH (3, 4). Results: Total operative time and estimated blood loss were 210 minutes and 150mL respectively. The patient was discharged on postoperative day one and final pathology showed adenocarcinoma of the prostate Gleason score 4+3=7, pT2NxR0 and negative surgical margins. The patient was continent four weeks after surgery and the PSA continues to be undetectable after three months. Conclusion: Transvesical Radical prostatectomy using the single port platform provides acceptable oncological and functional outcomes and quicker recovery given decreased risk of ileus and peritoneal irritation. Given that the abdominal cavity is not violated, the risk of bowel or vascular injury is mitigated, especially in patients with a hostile abdomen. Introduction DaVinci Da Vinci SinglePort Single Port (SP perioperative peri morbidity 1, 1 (1 2. 2 . 2) Methods 74yearold yearold 74 year old diabetes bypass hypertension hyperlipidemia 72 7 7.2 PIRADS5 PIRADS 5 PIRADS- midgland mid gland zone intermediaterisk intermediate biopsy 31 reversal 3, 3 (3 4. 4 4) Results 21 mL respectively 437 4+3=7 pTNxR pT NxR pT2NxR margins months Conclusion irritation violated mitigated abdomen ( 7. 43 4+3= 4+3 4+

Resumo: Introdução: A doença hepática gordurosa não alcoólica é uma das principais causas de doença hepática. A citoqueratina 18 surge como um marcador não invasivo para avaliação de fibrose hepática. O objetivo do trabalho foi validar o uso da citoqueratina 18 no sangue periférico no diagnóstico e evolução de pacientes com doença hepática gordurosa não alcoólica. Metodologia: Para validar a citoqueratina 18 no diagnóstico, foi realizado um estudo caso-controle. O grupo caso foi composto por pacientes maiores de 18 anos, de ambos os sexos, com diagnóstico de doença hepática gordurosa não alcoólica ligada à síndrome metabólica, recrutados entre 02/02/2019 a 02/02/2020. O grupo controle eram doadores de sangue. Eles foram comparados em 1 a 1 por idade e sexo. A citoqueratina 18 foi quantificada no sangue periférico de ambos os grupos. Para validar a citoqueratina 18 na evolução de pacientes com doença hepática gordurosa não alcoólica, foi realizado um estudo prospectivo e longitudinal. O grupo de pacientes recrutados foi acompanhado durante um ano sob tratamento padrão, ao final do qual a citoqueratina 18 foi quantificada no sangue periférico. As variáveis contínuas são expressas com média e desvio padrão. Foi analisado com teste t de Student, erro α < 5%. Resultados: Compõem o grupo caso 13 pacientes (12 mulheres), 53 ± 11 anos, com IMC 35,01 ± 8,9 kg/m2. O valor de citoqueratina 18 pré-tratamento foi de 1410 ± 120 UI e o valor pós-tratamento foi de 117 ± 56, p < 0,005. O grupo controle foi de 13 pessoas (12 mulheres), 43,4 ± 8,1 anos e IMC 28,10 ± 5,4 kg/m2 O valor da citoqueratina 18 foi de 193 ± 7,2 UI, p < 0,005 vs. grupo de casos pré-tratamento. Conclusões: A citoqueratina 18 é maior em pacientes com doença hepática gordurosa não alcoólica, sendo estatisticamente significativa, e diminui com o tratamento com significância estatística, podendo se tornar um marcador útil neste grupo de pacientes.

Abstract: Introduction: Nonalcoholic fatty liver disease is one of the main causes of liver disease. Cytokeratin 18 emerges as a non-invasive marker for the assessment of liver fibrosis. The objective of the work was to validate the use of cytokeratin 18 in peripheral blood in the diagnosis and evolution of patients with non-alcoholic fatty liver disease. Methodology: To validate cytokeratin 18 in the diagnosis, a case-control study was carried out. The case group was patients over 18 years of age, of both sexes, with a diagnosis of non-alcoholic fatty liver disease linked to metabolic syndrome, recruited between 2/2/2019 to 2/2/2020. The control group were blood donors. They were matched 1-1 for age and sex. Cytokeratin 18 was quantified in peripheral blood of both groups. To validate cytokeratin 18 in the evolution of patients with non-alcoholic fatty liver disease, a prospective, longitudinal study was carried out. The group of patients recruited were followed for one year under standard treatment, at the end of which cytokeratin 18 was quantified in peripheral blood. Continuous variables are expressed with the mean and standard deviation. It was analyzed with Student's t test, α error < 5%. Results: 13 patients make up the case group (12 women), 53 ± 11 years old, with BMI 35.01 ± 8.9 kg/m2. The pre-treatment cytokeratin 18 value was 1410 ± 120 IU, and the post-treatment value was 117 ± 56, p < 0.005. The control group was 13 people (12 women), 43.4 ± 8.1 years and BMI 28.10 ± 5.4 kg/m2 The cytokeratin 18 value was 193 ± 7.2 IU, p < 0.005 vs. pretreatment case group. Conclusions: Cytokeratin 18 is higher in patients with non-alcoholic fatty liver disease, being statistically significant, and decreases with treatment with statistical significance, and may become a useful marker in this group of patients.

Resumen: Introducción: La enfermedad por hígado graso no alcohólico es una de las principales causas de afección hepática. La citoqueratina 18 surge como marcador no invasivo para la valoración de fibrosis hepática. El objetivo del trabajo fue validar el uso de la citoqueratina 18 en sangre periférica en el diagnóstico y evolución de los pacientes con enfermedad por hígado graso no alcohólico. Metodología: Para validar la citoqueratina 18 en el diagnóstico se realizó un estudio de tipo caso-control. El grupo caso fueron los pacientes mayores de 18 años, de ambos sexos, con diagnóstico de enfermedad por hígado graso no alcohólico vinculado al síndrome metabólico, captados entre 2/2/2019 al 2/2/2020. El grupo control fueron personas donantes de sangre. Se parearon 1-1 por edad y sexo. Se cuantificó la citoqueratina 18 en sangre periférica de ambos grupos. Para validar la citoqueratina 18 en la evolución de los pacientes con enfermedad de hígado graso no alcohólico se realizó un trabajo prospectivo, longitudinal. El grupo de pacientes captados fueron seguidos durante un año bajo tratamiento estándar, finalizando el mismo se realizó la cuantificación de citoqueratina 18 en sangre periférica. Las variables continuas se expresan con la media y desvío estándar. Se analizó con test de t Student, error α < 5% Resultados: 13 pacientes integran el grupo caso (12 mujeres), de 53 ± 11 años, con IMC 35.01 ± 8.9 kg/m2. El valor de citoqueratina 18 pre-tratamiento fue de 1410 ± 120 UI, y el valor post-tratamiento fue de 117 ± 56, p < 0,005.El grupo control fueron 13 personas (12 mujeres), de 43,4 ± 8,1 años e IMC 28,10 ± 5,4 kg/m2 El valor de citoqueratina 18 fue de 193 ± 7.2 UI, p < 0.005 vs grupo caso pretratamiento. Conclusiones: La citoqueratina 18 es más elevada en los pacientes con enfermedad hígado graso no alcohólico, siendo estadísticamente significativa y disminuye con el tratamiento con significación estadística, pudiendo constituirse en un marcador útil en este grupo de pacientes.

RESUMEN La evaluación de la marcha en cinta caminadora puede resultar relevante para la toma de decisiones clínicas. No obstante, factores demográficos como la edad y el IMC pueden alterar la interpretación de los resultados. Nuestro objetivo fue obtener variables espacio- temporales, energéticas y costo de transporte durante la velocidad autoseleccionada en cinta caminadora para una muestra representativa de adultos uruguayos (n=28) y evaluar si diferentes rangos de edades e IMC pueden ser factores a tener en cuenta en pruebas clínicas donde se consideren dichas variables. Participaron 17 hombres y 11 mujeres (39,3 ± 14,8 años, 75,9 ± 12,5 kg, 1,74 ± 0,09 m, IMC 25,2 ± 4,06). Se realizó una reconstrucción 3D del movimiento en forma sincronizada con el consumo energético. Se obtuvieron valores de referencia y luego de agrupar los participantes según su IMC y rango de edad se compararon los datos mediante test de t (p≤0.05). Los resultados revelaron discrepancias significativas en las medidas espacio-temporales y energéticas de los adultos uruguayos al caminar en cinta con respecto a la literatura. La marcha difiere entre adultos jóvenes y de mediana edad en su velocidad autoseleccionada (p=0,03), longitud de zancada (p=0,01), trabajo mecánico externo (<0,001) y recuperación de energía mecánica (0,009), destacando la importancia de considerar la edad en evaluaciones clínicas. El IMC no influyó significativamente en estas variables. Estos hallazgos subrayan la necesidad de ajustar las interpretaciones de las pruebas clínicas de la marcha sobre cinta caminadora en adultos uruguayos de mediana edad (45 a 65 años).

RESUMO A avaliação da marcha na esteira pode ser relevante para a tomada de decisões clínicas. No entanto, fatores demográficos como idade e IMC podem alterar a interpretação dos resultados. Nosso objetivo foi obter variáveis espaço-temporais, energéticas e custo de transporte durante a velocidade de caminhada autoselecionada na esteira para uma amostra representativa de adultos uruguaios (n = 28) e avaliar se diferentes faixas etárias e IMC podem ser fatores a serem considerados em testes clínicos que envolvam essas variáveis. Dezessete homens e onze mulheres participaram (39,3 ± 14,8 anos, 75,9 ± 12,5 kg, 1,74 ± 0,09 m, IMC 25,2 ± 4,06). Foi realizada uma reconstrução tridimensional do movimento sincronizada com o consumo de energia. Foram obtidos valores de referência e os dados foram comparados usando testes t (p≤0,05), após agrupar os participantes por IMC e faixa etária. Os resultados revelaram discrepâncias significativas nas medidas espaço-temporais e energéticas dos adultos uruguaios ao caminhar na esteira, em comparação com a literatura. A marcha diferiu entre adultos jovens e de meia-idade em sua velocidade autoselecionada (p=0,03), comprimento da passada (p=0,01), trabalho mecânico externo (<0,001) e recuperação de energia mecânica (0,009), destacando a importância de considerar a idade em avaliações clínicas. O IMC não influenciou significativamente essas variáveis. Esses achados destacam a necessidade de ajustar as interpretações dos testes clínicos de marcha na esteira em adultos uruguaios de meia- idade (45 a 65 anos).

ABSTRACT Treadmill gait assessment can be relevant for clinical decision-making. However, demographic factors such as age and BMI may alter result interpretation. Our aim was to obtain spatiotemporal, energetic, and cost of transport variables during self-selected treadmill walking speed for a representative sample of Uruguayan adults (n=28) and to assess if different age ranges and BMI could be factors to consider in clinical tests involving these variables. Seventeen men and eleven women participated (39.3 ± 14.8 years, 75.9 ± 12.5 kg, 1.74 ± 0.09 m, BMI 25.2 ± 4.06). A synchronized 3D motion reconstruction was performed with energy consumption. Reference values were obtained and data were compared using t-tests (p≤0.05), after grouping participants by BMI and age range. Results revealed significant discrepancies in spatiotemporal and energetic measures of Uruguayan adults walking on the treadmill, compared to the literature. Gait differed between young and middle-aged adults in their self-selected speed (p=0.03), stride length (p=0.01), external mechanical work (p<0.001), and mechanical energy recovery (0.009), emphasizing the importance of considering age in clinical evaluations. BMI did not significantly influence these variables. These findings underscore the need to adjust interpretations of treadmill gait clinical tests in middle-aged Uruguayan adults (45 to 65 years).

Resumo Introdução: A deficiência de crescimento na doença renal crônica está relacionada à elevada morbidade e mortalidade. O retardo do crescimento nessa doença é multifatorial. É fundamental conhecer os fatores modificáveis e estabelecer estratégias para melhorar o atendimento às crianças afetadas. Objetivos: Descrever padrões de crescimento em crianças com DRC e fatores de risco associados à baixa estatura. Métodos: Analisamos retrospectivamente dados antropométricos e epidemiológicos, peso ao nascer, prematuridade e níveis de bicarbonato, hemoglobina, cálcio, fosfato, fosfatase alcalina e paratormônio de crianças com DRC estágios 3–5, não submetidas a diálise, acompanhadas por pelo menos um ano. Resultados: Incluímos 43 crianças, a maioria meninos (65%). O escore z médio de altura/comprimento/idade das crianças no início e no acompanhamento foi de –1,89 ± 1,84 e –2,4 ± 1,67, respectivamente (p = 0,011). Cinquenta e um por cento das crianças apresentaram baixa estatura, e essas crianças eram mais jovens que aquelas com estatura adequada (p = 0,027). Níveis de PTH no início do acompanhamento correlacionados com escore z de altura/comprimento/idade. Uma subanálise com crianças menores de cinco anos (n = 17) mostrou que 10 (58,8%) delas apresentaram déficit de desenvolvimento e escore z de peso/idade mais baixo (0,031) e escore z de IMC/idade mais baixo (p = 0,047). Conclusão: Crianças, especialmente mais jovens, com DRC, que não estavam em diálise, apresentaram elevada prevalência de baixa estatura. Níveis de PTH foram correlacionados com escore z de altura, e deficiência de crescimento foi associada a pior estado nutricional. Portanto, é essencial monitorar o crescimento dessas crianças, controlar o hiperparatireoidismo e fornecer suporte nutricional. Introdução mortalidade multifatorial afetadas Objetivos Métodos epidemiológicos nascer bicarbonato hemoglobina cálcio fosfato 35 3 5 3–5 diálise ano Resultados 4 65%. 65 65% . (65%) alturacomprimentoidade altura comprimento idade 189 1 89 –1,8 184 84 1,8 24 2 –2, 167 67 1,67 p 0,011. 0011 0,011 0 011 0,011) 0,027. 0027 0,027 027 0,027) n 17 58,8% 588 58 8 (58,8% pesoidade 0,031 0031 031 (0,031 IMCidade IMC 0,047. 0047 0,047 047 0,047) Conclusão Crianças nutricional Portanto 3– 6 (65% 18 –1, 1, –2 16 1,6 001 0,01 01 002 0,02 02 58,8 (58,8 0,03 003 03 (0,03 004 0,04 04 (65 –1 – 00 0,0 58, (58, (0,0 (6 0, (58 (0, ( (5 (0

Abstract Introduction: Growth failure in chronic kidney disease is related to high morbidity and mortality. Growth retardation in this disease is multifactorial. Knowing the modifiable factors and establishing strategies to improve care for affected children is paramount. Objectives: To describe growth patterns in children with chronic kidney disease and the risk factors associated with short stature. Methods: We retrospectively analyzed anthropometric and epidemiological data, birth weight, prematurity, and bicarbonate, hemoglobin, calcium, phosphate, alkaline phosphatase, and parathormone levels of children with stages 3–5 CKD not on dialysis, followed for at least one year. Results: We included 43 children, the majority of which were boys (65%). The mean height/length /age z-score of the children at the beginning and follow-up was –1.89 ± 1.84 and –2.4 ± 1.67, respectively (p = 0.011). Fifty-one percent of the children had short stature, and these children were younger than those with adequate stature (p = 0.027). PTH levels at the beginning of the follow-up correlated with height/length/age z-score. A sub-analysis with children under five (n = 17) showed that 10 (58.8%) of them failed to thrive and had a lower weight/age z-score (0.031) and lower BMI/age z-score (p = 0.047). Conclusion: Children, particularly younger ones, with chronic kidney disease who were not on dialysis had a high prevalence of short stature. PTH levels were correlated with height z-score, and growth failure was associated with worse nutritional status. Therefore, it is essential to monitor the growth of these children, control hyperparathyroidism, and provide nutritional support. Introduction mortality multifactorial paramount Objectives Methods data weight prematurity bicarbonate hemoglobin calcium phosphate phosphatase 35 3 5 3– year Results 4 65%. 65 65% . (65%) heightlength length age zscore z score followup follow up 189 1 89 –1.8 184 84 1.8 24 2 –2. 167 67 1.67 p 0.011. 0011 0.011 0 011 0.011) Fiftyone Fifty 0.027. 0027 0.027 027 0.027) heightlengthage zscore. score. subanalysis sub analysis n 17 58.8% 588 58 8 (58.8% weightage 0.031 0031 031 (0.031 BMIage BMI 0.047. 0047 0.047 047 0.047) Conclusion Children ones zscore, score, status Therefore hyperparathyroidism support 6 (65% 18 –1. 1. –2 16 1.6 001 0.01 01 002 0.02 02 58.8 (58.8 0.03 003 03 (0.03 004 0.04 04 (65 –1 – 00 0.0 58. (58. (0.0 (6 0. (58 (0. ( (5 (0

Resumo: Introdução : A obesidade está relacionada a um alto risco cardiovascular (RCV). Isso nos obriga a adotar comportamentos terapêuticos e preventivos. O objetivo deste trabalho é avaliar o risco cardiovascular em uma população com obesidade mórbida e avaliar a correta indicação de estatinas. Metodologia: Estudo transversal, descritivo, observacional, com a população com obesidade mórbida do Programa de Obesidade e Cirurgia Bariátrica (POCB) do Hospital Maciel, no período de novembro de 2014 a março de 2020. O RCV foi avaliado com a calculadora da organização pan-americana de saúde. A indicação de estatinas foi considerada de acordo com RCV ou diagnóstico de dislipidemia. Resultados: Foram analisados 478 pacientes, 84,3% eram mulheres, a mediana de idade foi de 44 anos e o IMC foi de 50 kg/m2. Um RCV baixo foi calculado para 57% dos pacientes; e alto ou muito alto para 37%. A prevalência de dislipidemia foi de 84,3%, com predomínio de hipercolesterolemia (33,7%) e dislipidemia aterogênica (19,5%). 60,6% (290) dos pacientes têm indicação de tratamento com estatinas, apenas 38,9%. (113) os recebe. 38,1% (43) alcançaram objetivos terapêuticos. Conclusões: A obesidade apresenta múltiplas comorbidades que aumentam o RCV, mas é subestimada pelas calculadoras de risco. É evidente o subtratamento farmacológico destes pacientes, não atingindo os objetivos terapêuticos propostos.

Abstract: Introduction: Obesity is related to a high cardiovascular risk (CVR). This forces us to take therapeutic and preventive behaviors. The objective of this work is to evaluate cardiovascular risk in a morbidly obese population and assess the correct indication of statins. Methodology: Cross-sectional, descriptive, observational study, with the morbidly obese population of the Obesity and Bariatric Surgery Program (POCB) of the Maciel Hospital, from November 2014 to March 2020. CVR was assessed with the calculator of the Pan-American health organization. The indication for statins was considered according to CVR or diagnosis of dyslipidemia. Results: 478 patients were analyzed, 84.3% were women, the median age was 44 years, and the BMI was 50 kg/m2. A low CVR was calculated for 57% of patients; and high or very high for 37%. The prevalence of dyslipidemia was 84.3%, with a predominance of hypercholesterolemia (33.7%) and atherogenic dyslipidemia (19.5%). 60.6% (290) of patients have an indication for treatment with statins, only 38.9%. (113) receives them. 38.1% (43) achieved therapeutic objectives. Conclusions: Obesity presents multiple comorbidities that increase CVR, yet it is underestimated by risk calculators. Pharmacological undertreatment of these patients is evident, not achieving the proposed therapeutic objectives.

Resumen: Introducción: La obesidad se relaciona con un riesgo cardiovascular (RCV) elevado. Esto nos obliga a tomar conductas terapéuticas y prevencionistas. El objetivo de este trabajo es evaluar el riesgo cardiovascular en una población de obesos mórbidos y valorar la correcta indicación de estatinas. Metodología: Estudio transversal, descriptivo, observacional, con la población obesos mórbidos del Programa de Obesidad y Cirugía Bariátrica (POCB) del Hospital Maciel, desde noviembre del 2014 a marzo del 2020. El RCV se valoró con la calculadora de la organización panamericana de la salud. La indicación de estatinas se consideró según RCV o diagnóstico de dislipemia. Resultados: Se analizaron 478 pacientes, el 84.3% fueron mujeres, la mediana para la edad fue de 44 años, y para el IMC 50 kg/m2. Se calculó un RCV bajo para el 57% de los pacientes; y alto o muy alto para un 37%. La prevalencia de las dislipemias fue 84,3%, a predominio de hipercolesterolemia (33,7%) y dislipemia aterogénica (19,5%). El 60.6% (290) de los pacientes presenta indicación de tratamiento con estatinas, solo el 38.9%. (113) las recibe. El 38.1% (43) alcanzan los objetivos terapéuticos. Conclusiones : La obesidad presenta múltiples comorbilidades que aumentan el RCV, aun así se encuentra subestimada por las calculadoras de riesgo. Queda en evidencia un infratratamiento farmacológico de estos pacientes, no logrando los objetivos terapéuticos propuestos.

Abstract The aim of this study was to describe some characteristics of pulmonary function in four para-swimmers with spinal cord injury from Cali-Colombia. Four paraswimmers with spinal cord injury of any neurological level who signed the informed consent form were included. Sociodemographic, clinical, athletic, anthropometric, functional independence and, pulmonary function by spirometry and thoracic mobility by cirtometry data were collected. The results show four patients between 26 and 42 years old, with neurological levels between T2-T4 and T10-T11. None of the cases had a history of respiratory diseases before or after the injury, two of the cases had a history of smoking. The cases had been practicing the sport for between three and twelve months, all with normal weight according to BMI; with mild dependence according to the Barthel Index. In addition, they presented FEV1/FVC values between 83 % and 93 % of predicted value. The best thoracic mobility was between 1.5 and 5.6 cm at the axillary level, and between 1.5 and 2.5 cm at the xiphoid level. It is concluded that the subjects had no changes in pulmonary function, that the athletes with a history of smoking and a higher level of injury presented a decrease in thoracic mobility, and that training in water can provide benefits at the pulmonary level.

Resumen El objetivo del presente trabajo fue describir algunas características de la función pulmonar de cuatro paranadores con lesión medular de Cali-Colombia. Se incluyeron cuatro deportistas de iniciación deportiva de para-natación con lesión medular de cualquier nivel neurológico, quienes firmaron el consentimiento informado. Se tomaron datos sociodemográficos, clínicos, deportivos, antropométricos, independencia funcional y función pulmonar mediante espirometría y movilidad torácica mediante la cirtometría. Los resultados evidencian cuatro paranadores entre 26 y 42 años, con niveles neurológicos entre T2-T4 y T10-T11. Ninguno de los casos presentó enfermedades respiratorias pre y post lesión, dos de los casos presentaron historial tabáquico. Los casos llevaban entre tres y doce meses practicando el deporte, todos con normopeso según IMC; con dependencia leve según Índice de Barthel. Además, presentaron valores entre 83 % y 93 % del valor predicho en la relación VEF1/CVF. La mejor toma de la movilidad torácica a nivel axilar estuvo entre 1,5 y 5,6 cm y a nivel xifoideo entre 1,5 y 2,5 cm. Se concluye que los sujetos no tuvieron alteraciones en la función pulmonar, que los deportistas con historial tabáquico y nivel de lesión más alto presentaron disminución en la movilidad torácica, el entrenamiento en agua puede otorgar beneficios a nivel pulmonar.

SUMMARY: The aim of this study was to determine the effects 12 weeks Step aerobics program on anthropometric characteristics and body composition in young females. A total of 94 female participants were randomly divided in two groups. The E group subsample consisted of 44 participants (20±0.4 years), who had three Step aerobics program trainings per week and the C group subsample consisted of 50 participants (20±0.6 years), who did not take part in any organized exercise program and only conducted their regular daily activities. The following measurements were used: Body height, body weight, waist size, abdomen skinfold, back skinfold, upper arm skinfold, upper leg skinfold, body fat percentage and muscle mass percentage. Upon the Step aerobics program implementation, there was a body fat reduction by 4.9 % and waist size by 7.7 %, while the muscle mass was increased by 9.4 %. Above mentioned skinfolds showed a reduction (p>0.05) at the final measurement compared to the initial one - abdomen by 25 %, upper leg by 23.7 %, back by 15.7 % and upper arm by 3.5 %. Likewise, there was a body fat percentage reduction by 2.1 % and BMI by 6.4 %. Based on the obtained results, we can conclude that the Step aerobics training is efficient in reducing subcutaneous fat tissue and viscelar fat, as well as in increasing muscle mass.

RESUMEN: El objetivo de este estudio fue determinar los efectos de un programa aeróbico Step de 12 semanas sobre las características antropométricas y la composición corporal en mujeres jóvenes. Un total de 94 mujeres participantes fueron divididas aleatoriamente en dos grupos. La submuestra del grupo E estuvo compuesta por 44 participantes (20 ± 0,4 años), que realizaron tres entrenamientos del programa aeróbico Step por semana y la submuestra del grupo C estuvo compuesta por 50 participantes (20 ± 0,6 años), que no participaron en ningún programa de ejercicio organizado y sólo realizaron sus actividades diarias habituales. Se utilizaron las siguientes mediciones: altura corporal, peso corporal, tamaño de cintura, pliegue cutáneo del abdomen, pliegue cutáneo de la espalda, pliegue cutáneo de la parte superior del brazo, pliegue cutáneo de la parte superior de la pierna, porcentaje de grasa corporal y porcentaje de masa muscular. Al implementar el programa aeróbico Step, hubo una reducción de la grasa corporal de un 4,9 % y del tamaño de la cintura de un 7,7 %, mientras que la masa muscular aumentó un 9,4 %. Los pliegues cutáneos mencionados anteriormente mostraron una reducción (p>0,05) en la medición final en comparación con la inicial: abdomen en un 25 %, parte superior de la pierna en un 23,7 %, espalda en un 15,7 % y parte superior del brazo en un 3,5 %. Asimismo, hubo una reducción del porcentaje de grasa corporal del 2,1 % y del IMC del 6,4 %. Con base en los resultados obtenidos, podemos concluir que el entrenamiento aeróbico Step es eficaz para reducir el tejido adiposo subcutáneo y la grasa visceral, así como para aumentar la masa muscular.

SUMMARY: Sarcopenia is a disease characterized by a decline in skeletal muscle mass, strength, and physical performance, leading to a loss of functional capacity. Appendicular skeletal muscle mass (ASMM) is one of the most used measurements to detect skeletal muscle mass loss; nevertheless, its assessment is expensive. Under this context, indirect anthropometric measurements include calf circumference (CC) and appendicular skeletal muscle mass index (SMI). However, these measurements may not be very sensitive in older people with different body mass index (BMI). The aim of this study was to determine the influence of BMI on indirect measurements of ASMM in overweight and obese older people. This study included 57 participants aged 60 years and over from the city of Los Angeles, Chile, divided into two groups according to nutritional status, overweight (OW; n=33; Men=8; Women=25; age, 72 ± 6 years; BMI, 27.54 ± 1.54 kg·m-2) and obesity (OB; n=24; Men=5; Women=19; age, 72. ± 6 years; BMI, 33.70 ± 6.22 kg·m-2). The results showed that 36 % of the variations observed in CC measurements are explained by BMI (p<0.05). Conversely, the variations in SMI are not explained by BMI. In conclusion, BMI in older people can affect CC results, but not SMI. These results contribute to the decision-making process regarding the use of SMI as a better method for the indirect measurement of ASMM in overweight and/or obese older individuals.

RESUMEN: La sarcopenia es una enfermedad caracterizada por una disminución de la masa del músculo esquelético, la fuerza y el rendimiento físico, lo que conduce a una pérdida de la capacidad funcional. La masa de músculo esquelético apendicular (ASMM) es una de las mediciones más utilizadas para detectar la pérdida de masa de músculo esquelético; sin embargo, su evaluación es costosa. En este contexto, las mediciones antropométricas indirectas incluyen la circunferencia de la pantorrilla (CC) y el índice de masa del músculo esquelético apendicular (SMI). Sin embargo, estas mediciones pueden no ser muy sensibles en personas mayores con diferentes índices de masa corporal (IMC). El objetivo de este estudio fue determinar la influencia del IMC en las mediciones indirectas de ASMM en personas mayores con sobrepeso y obesidad. Este estudio incluyó a 57 participantes de 60 años y más de la ciudad de Los Ángeles, Chile, divididos en dos grupos según estado nutricional, sobrepeso (SP; n=33; Hombres=8; Mujeres=25; edad, 72 ± 6 años; IMC, 27,54 ± 1,54 kg·m-2) y obesidad (OB; n=24; Hombres=5; Mujeres=19; edad, 72 ± 6 años; IMC, 33,70 ± 6,22 kg·m-2). Los resultados mostraron que el 36 % de las variaciones observadas en las mediciones de CC son explicadas por el IMC (p<0,05). Por el contrario, las variaciones del SMI no se explican por el IMC. En conclusión, el IMC en personas mayores puede afectar los resultados del CC, pero no el SMI. Estos resultados contribuyen al proceso de toma de decisiones sobre el uso del SMI como un mejor método para la medición indirecta de ASMM en personas mayores con sobrepeso y/u obesidad.

SUMMARY: This study aimed to determine differences in morphological characteristics and body composition between female handball players from the national teams of Montenegro and Kosovo (U16). Thirty-four participants were included in the study, divided into two subgroups. The first subgroup consisted of 18 players from the Montenegro national team, with an average age of 14.68±0.58 years. The second subgroup consisted of 16 players from the Kosovo national team, with an average age of 15.33±0.66 years. Testing was conducted during the qualification rounds for the European Championship took place in Podgorica in 2021. All players were assessed for anthropometric measurements and body composition, with a total of twelve variables: Body height, body weight, hand length, arm span, triceps skinfold, biceps skinfold, subscapular skinfold, abdominal skinfold, calf skinfold, thigh skinfold, body mass index (BMI), and body fat percentage (BF). The Tanita - model BC-418MA was utilized for the assessment of body composition. Differences in morphological characteristics and body composition of the female handball players from the two national teams were determined through discriminant parametric procedures using the T-test for independent samples with statistical significance set at p < .05. The results indicated that the players from the Montenegro team were significantly younger, had significantly greater average body height, body weight, and hand length compared to players from the Kosovo team. Statistical differences between the two treated teams were found in the variable thigh skinfold, while no significant differences were observed in BMI and BF.

RESUMEN: Este estudio tuvo como objetivo determinar las diferencias en las características morfológicas y la composición corporal entre jugadoras de balonmano de los equipos nacionales de Montenegro y Kosovo (U16). Se incluyeron en el estudio 34 participantes, divididas en dos subgrupos. El primer subgrupo consistió en 18 jugadoras del equipo nacional de Montenegro, con una edad media de 14,68 ± 0,58 años. El segundo subgrupo consistió en 16 jugadoras del equipo nacional de Kosovo, con una edad media de 15,33 ± 0,66 años. Las pruebas se llevaron a cabo durante las rondas de clasificación para el Campeonato Europeo que tuvo lugar en Podgorica en 2021. A todas las jugadoras se les evaluaron las medidas antropométricas y la composición corporal, con un total de doce variables: altura corporal, peso corporal, longitud de la mano, envergadura del brazo, pliegue cutáneo del tríceps, pliegue cutáneo del bíceps, pliegue cutáneo subescapular, pliegue cutáneo abdominal, pliegue cutáneo de la pantorrilla, pliegue cutáneo del muslo, índice de masa corporal (IMC) y porcentaje de grasa corporal (GC). Para la evaluación de la composición corporal se utilizó el modelo Tanita BC-418MA. Las diferencias en las características morfológicas y la composición corporal de las jugadoras de balonmano de los dos equipos nacionales se determinaron mediante procedimientos paramétricos discriminantes utilizando la prueba T para muestras independientes con significación estadística establecida en p <0,05. Los resultados indicaron que las jugadoras del equipo de Montenegro eran significativamente más jóvenes, tenían una altura corporal media, un peso corporal y una longitud de la mano significativamente mayores en comparación con las jugadoras del equipo de Kosovo. Se encontraron diferencias estadísticas entre los dos equipos tratados en la variable pliegue cutáneo del muslo, mientras que no se observaron diferencias significativas en el IMC y el GC.

Abstract Objective To compare the phase angle (PhA) through bioelectrical impedance (BIA) of children with intestinal failure (IF) using prolonged parenteral nutrition (PN) followed by an Intestinal Rehabilitation Program, with a control group. Methods Children under 10 years of age with IF using prolonged PN for >60 days (study group) were included. The control group consisted of healthy children without chronic pathologies, matched by sex and age. Anthropometric parameters evaluated were: weight, height, weight/age z-score (W/A), height/age z-score (H/A), BMI, BMI/A z-score, arm circumference, triceps skinfold, subscapular skinfold, mid-arm muscle circumference. BIA parameters were resistance (R), reactance (Xc), and phase angle (PhA). Results Twenty-eight children were included in the study group, median (IQR) age was 11 (8-27) months, 53.6 % were male. In the control group, 28 children were included, median (IQR) age was 12.5 (8-24.7) months, 50 % were male. Children from the study group had W/A z-scores and H/A z-scores significantly lower than controls. There was no significant difference between PhA in the study group and controls, [median (IQR) 4.3° (3.8;4.6) vs 4.0° (3.8;5.4) respectively, p = 0.980]. Prematurity was significantly higher in the study group than in the controls, but there was no significant correlation between gestational age at birth and PhA of the children from the study group. Conclusion Children with IF using prolonged PN showed lower W/A and H/A compared to the control group, but without significant difference between the PhA of children with IF compared to controls. (PhA (BIA (IF (PN Program 1 60 >6 pathologies weight height weightage zscore z score W/A, WA , W A (W/A) heightage H/A, HA H (H/A) BMI BMIA zscore, score, circumference skinfold midarm mid R, R (R) Xc, Xc (Xc) PhA. . Twentyeight Twenty eight IQR (IQR 827 8 27 (8-27 months 536 53 6 53. male 2 125 12 5 12. 824.7 8247 24.7 24 7 (8-24.7 zscores scores controls 43 4 3 4.3 3.84.6 3846 3.8 4.6 (3.8;4.6 40 0 4.0 3.85.4 3854 5.4 (3.8;5.4 respectively 0.980. 0980 0.980 980 0.980] > (W/A (H/A (R (Xc 82 (8-2 824 824. 247 24. (8-24. 4. 84 3.84. 384 38 3. 46 (3.8;4. 85 3.85. 385 54 5. (3.8;5. 098 0.98 98 (8- (8-24 3.84 (3.8;4 3.85 (3.8;5 09 0.9 9 (8 (3.8; 0. ( (3.8 (3. (3

Abstract Introduction Despite the evidence against drain placement after thyroidectomy, there is a lack of consensus on drain use in patients with substernal goiter. Objective To assess the factors that increase the likelihood of drain placement and its impact on postoperative hematoma and other 30-day complications among adult patients undergoing thyroidectomy for substernal goiter. Methods A retrospective cohort study that used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Adult patients (aged ≥ 18 years) who underwent elective thyroidectomy for substernal goiter from 2016 to 2020 were included. Cases with closed suction neck drains placed upon completion of surgery were included in the drain group, and the remaining cases formed the nondrain group. Results A total of 1,229 patients were included (46.5% with drain placement). The factors that increased the likelihood of drain placement included body mass index (BMI) ≥ 30 kg/m2, score between 3 and 5 on the American Society of Anesthesiologists (ASA) physical status classification, sternal split/transthoracic surgical approach, operative time ≥ 90 minutes, and surgery conducted by otolaryngologists. Patients with clean-contaminated or contaminated wound classifications were less likely to be submitted to drain placement. In addition, drain use had no impact on postoperative hematoma formation but was found to independently increase the risk of prolonged length of hospital stay. Conclusion Thyroidectomy without drain placement might be safe for substernal goiter. However, this decision should be individualized for each patient. Level Of Evidence: 3 30day day ACSNSQIP. ACSNSQIP ACS NSQIP . (ACS-NSQIP) aged 1 years 201 202 group 1229 229 1,22 46.5% 465 46 (46.5 placement) BMI (BMI kgm2 kgm kg m2 m kg/m2 ASA (ASA classification splittransthoracic split transthoracic approach 9 minutes otolaryngologists cleancontaminated clean addition stay However patient Evidence (ACS-NSQIP 20 122 22 1,2 46.5 4 (46. kg/m 2 12 1, 46. (46 (4 (

Abstract Introduction. Bariatric and metabolic surgery (BMS) has shown its efficacy in achieving short-term weight loss. However, there is limited evidence regarding long-term clinical and metabolic outcomes. Methods. Retrospective longitudinal study with patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) interventions in Bogotá, Colombia, between 2013 and 2021. Weight change, comorbidity control, and metabolic outcomes were collected at the onset, 3-, 6-, and 12-month post-surgery, and annually up to the fifth year. Comorbidity control rates were assessed using the Kaplan-Meier test. A Cox proportional hazards model was used to evaluate the effect of covariates on weight regain. Results. Of 1092 patients with BMS (71.4% SG and 28.6% RYGB), 67% were women, with a median age of 48 years, BMI 35.5 kg/m2. After five years of follow-up, the control rate in diabetes mellitus was 65.5%, in hypertension 56.6%, and dyslipidemia 43.6%. The weight regain rate was 28% with no differences between SG vs RYGB (p=0.482). The mean time to nadir weight was 14 months. Age at the time of BMS was the best independent predictor of weight regain (HR=1.02, 95%CI: 1.01-1.04), but with a modest clinical effect. Conclusion. BMS is safe and shows long-term benefits in weight loss and control of comorbidities in Colombian population.

Resumen Introducción. La cirugía bariátrica y metabólica (CBM) es efectiva en lograr pérdida de peso a corto plazo. Sin embargo, existe evidencia limitada en desenlaces clínicos y metabólicos a largo plazo. Métodos. Estudio longitudinal retrospectivo con pacientes llevados a baipás gástrico en Y de Roux (BGYR) o gastrectomía en manga (MG) por laparoscopia en Bogotá, D.C., Colombia, entre 2013 y 2021. El cambio de peso, control de comorbilidades y resultados metabólicos se recopilaron al inicio del estudio, 3, 6 y 12 meses después de cirugía, y anualmente hasta el quinto año. Las tasas de control de comorbilidades se evaluaron mediante la prueba Kaplan-Meier. Se utilizó un modelo de riesgos proporcionales de Cox para evaluar el efecto de covariables en la reganancia de peso. Resultados. De 1092 pacientes con CBM (71,4 % MG y 28,6 % BGYR), 67 % eran mujeres, con mediana de edad 48 años e índice de masa corporal de 35,5 Kg/m2. Después de cinco años de seguimiento, la tasa de control en diabetes mellitus fue 65,5 %, en hipertensión 56,6 % y en dislipidemia 43,6 %. La tasa de reganancia de peso fue 28 %, sin diferencias entre MG vs BGYR (p=0,482). El tiempo promedio hasta peso nadir fue 14 meses. La edad al momento de CBM fue el mejor predictor independiente de reganancia (HR=1,02, IC95% 1,01-1,04), pero con efecto clínico modesto. Conclusión. La CBM es segura y muestra beneficios a largo plazo en la pérdida de peso y control de comorbilidades en población colombiana.

Abstract Context: Female Sexual Dysfunctions (FSD) are prevalent conditions, can occur in any stage of life and can severely affect women’s quality of life. The etiology of FSD is often multifactorial, including biologic, psychological, interpersonal and sociocultural factors. Objectives: To evaluate FSD in a Portuguese population and what factors can influence the female sexual function. Methods: A cross-sectional study was conducted between August and September of 2023. Participants filled an anonymous online survey, including a demographic questionnaire and the Female Sexual Function Index (FSFI) for evaluation of sexual function. Inclusion criteria: age between 18 and 75 years old, residence in Portugal and being in a heterosexual relationship. The total score FSFI and domain scores (desire, arousal, lubrification, orgasm, satisfaction and discomfort) were analyzed using SPSS 22®. Results: A total of 401 women completed the questionnaire, 393 fulfilled the inclusion criteria. Women had a mean age of 41,6 years (range: 20-71 years). From these, 48% of women reported being moderately satisfied or very satisfied with their sex life and 9,6% reported no sexual intercourse in the past 4 weeks. Among sexually active women, the mean total FSFI score was 27.37 (range: 7.5-34.5±4.99) and 36% met the criteria for sexual dysfunction (FSFI score ≤ 26.55). Post-menopausal participants, when compared to women in reproductive age, had a lower mean total score and also had lower mean scores across all domains, except for discomfort (p<0.05). Women with children or a BMI ≥ 25 had lower mean total score and lower mean scores for desire, arousal and satisfaction domains (p<0.05). Conclusions: The prevalence of FSD was 36%. These findings highlight the importance of addressing FSD as a significant concern for women health and quality of life and the need for training and awareness among healthcare professionals.

Resumo Introdução: As disfunções sexuais femininas (DSF) são condições prevalentes. Estas podem ocorrer em qualquer fase da vida e podem afetar negativamente a qualidade de vida de muitas mulheres. A etiologia das DSF é frequentemente multifatorial, incluindo fatores biológicos, psicológicos, interpessoais e socioculturais. Objetivos: Avaliar as DSF em mulheres portuguesas e identificar possíveis fatores que possam influenciar a sexualidade feminina. Métodos: Estudo transversal observacional realizado entre agosto e setembro de 2023, através do preenchimento de questionário online anónimo, que incluía um questionário demográfico e o Female Sexual Function Index (FSFI) para avaliação da resposta sexual. A pontuação total e dos domínios (desejo, excitação, lubrificação, orgasmo, satisfação e desconforto) foram analisados utilizando o SPSS 22®. Resultados: De um total de 401 mulheres que completaram o questionário, 393 preenchiam os critérios de inclusão no estudo. A idade média das inquiridas foi de 41,6 anos (20-71 anos). Quando questionadas, 74% das mulheres referiram estar moderadamente satisfeitas ou muito satisfeitas com a sua vida sexual e 9,6% das mulheres referiu ausência de relações sexuais nas últimas quatro semanas. Entre as mulheres sexualmente ativas, a pontuação média total do FSFI foi de 27,37 (7,5-34,5±4,99) e 36% preenchiam os critérios para disfunção sexual (Pontuação FSFI ≤ 26,55). As participantes na pós-menopausa, em comparação com as mulheres em idade reprodutiva, apresentaram uma pontuação média total inferior, assim como pontuações médias inferiores em todos os domínios, exceto no desconforto (p<0,05). Mulheres com filhos ou com IMC ≥25 tiveram uma pontuação média total e pontuações médias inferiores nos domínios do desejo, excitação e satisfação (p<0,05). Conclusões: A prevalência de problemas sexuais na população em estudo foi de 36%. Estes achados destacam a importância de abordar as DSF como uma preocupação na saúde e qualidade de vida das mulheres e da necessidade de formação e sensibilização dos profissionais de saúde.