Effect of Extracorporeal Shock Waves on Induced Neocollagenesis of Integumentary Tissue.

Background: Obesity became a worldwide public health problem and its treatment presents a strict relationship with skin flaccidity, for which the development of non-invasive therapies is an emerging field. Objective: This study aims to evaluate the physiological response of the skin tissue of individuals with obesity with flaccidity to the physiological stimulus of shockwave therapy (ESWT). Methods: This is a comparative intervention study based on histological and immunohistochemical analyses of a set of samples of skin tissue of women with Grade II obesity who achieved a 10 percent preoperative weight loss before bariatric surgery and complaints of skin flaccidity, subjected to the ESWT treatment. A total of seven sessions were carried out in the abdominal region on the left side, and the collateral side was used as control; the biological material was collected at the moment of the bariatric surgery. Hematoxylin and Eosin, Masson's trichrome, Picrosirius Red and the markers for immunohistochemical were used for the morphological evaluation. Results: Fourteen women were included in the research. The results demonstrated that the tissue which underwent the ESWT intervention presented significant increases of fibroblast cells (p<0.0001) and collagen fibers Type I and II (p<0.0002). In the significant expressions of the markers FGF1, FGF2, FGFR1 were identified in the exposed side (p<0.0002, 0.0017, <0.0001, respectively) as well as a significantly higher expression of Ki67 marker of cell proliferation (p<0.0002). Conclusion: ESWT was associated with a significant increase of cell proliferation and collagen expression in flaccid skin of individuals who achieved weight loss before bariatric surgery.

Effect of extracorporeal shock waves on inflammation and angiogenesis of integumentary tissue in obese individuals: stimulating repair and regeneration.

The technology of extracorporeal shock wave therapy (ESWT) has been studied around the world for its possible benefits in the treatment and rehabilitation of aesthetic disorders. To better elucidate its real physiological effect on the integumentary tissue, this study was proposed aimed at evaluating whether ESWT can act to stimulate the inflammatory process and angiogenesis in the dermis and epidermis of obese individuals. This is an immunohistological study that evaluated a set of samples of the integumentary tissue of women with grade II obesity with weight loss of 10% of the initial weight undergoing ESWT treatment; the collection of biological material was performed at the time of surgery of bariatric surgery. For immunohistochemical evaluation, the markers to assess the presence and distribution of inflammatory cells, anti-COX-2, CD3, CD20, CD163, and NK were used. For physiological stimulus pathways for blood vessel angiogenesis, markers CD 34, CD 105 and VEGF were used. Fourteen obese women were included in the study. Positivity was evidenced in the epidermal expression of markers of the inflammatory process COX-2, CD3, CD20, NK cells, CD68, and CD163 (p < 0.0001) in the intervention sample when compared to controls. There was a positive expression for the angiogenesis markers CD105 and VEGF (p < 0.0001) when comparing the intervention group with the control group. It was concluded that ESWT can stimulate a local inflammatory process, mediating and modulating important growth factors to act in the repair process and skin tissue regeneration, being considered a promising treatment for skin diseases related to weight gain or loss.

Evolution of anthropometric data and quality of life in active bariatric individuals.

OBJECTIVE: Obesity is a disease characterized by the accumulation of abnormal or excessive fat that can damage health. Bariatric surgery, an effective and safe way to treat this disease, requires multidisciplinary monitoring with an educational nature to change lifestyle. Adherence to routine physical activity can be a part of adopting a healthier lifestyle and can assist in the treatment of this disease and its related comorbidities. Thus, the aim of this study was to analyze the correlation between the evolution of anthropometric variables and the domains of quality of life at different times, including at one year after bariatric surgery in very active and irregularly active individuals. METHODS: This was a longitudinal, observational, prospective, and analytical study. The collected data included anamnesis, level of physical activity (International Physical Activity Questionnaire Short Form), height, weight, body mass index (BMI), average waist circumference, percentage of fat, and the World Health Organization Quality of Life Assessment Bref. RESULTS: Seven female individuals were evaluated and divided into two groups: a very active group and an irregularly active group. In the very active individuals, significant results were found in the evolutionary variables: weight (p<0.001); body mass index (p<0.001); average waist circumference (p<0.001); percentage of fat (p<0.001); and quality of life general (p=0.001). In the irregularly active individuals, a significant result was found only in one evolutionary variable: body mass index (p<0.001). CONCLUSION: Thus, it is evident that the improvement and maintenance of good health is more effective in bariatric individuals who maintain a routine with regular physical activity.

Evolution of anthropometric data and quality of life in active bariatric individuals

SUMMARY Obesity is a disease characterized by the accumulation of abnormal or excessive fat that can damage health. Bariatric surgery, an effective and safe way to treat this disease, requires multidisciplinary monitoring with an educational nature to change lifestyle. Adherence to routine physical activity can be a part of adopting a healthier lifestyle and can assist in the treatment of this disease and its related comorbidities. OBJECTIVE: Thus, the aim of this study was to analyze the correlation between the evolution of anthropometric variables and the domains of quality of life at different times, including at one year after bariatric surgery in very active and irregularly active individuals. METHODS: This was a longitudinal, observational, prospective, and analytical study. The collected data included anamnesis, level of physical activity (International Physical Activity Questionnaire Short Form), height, weight, body mass index (BMI), average waist circumference, percentage of fat, and the World Health Organization Quality of Life Assessment Bref. RESULTS: Seven female individuals were evaluated and divided into two groups: a very active group and an irregularly active group. In the very active individuals, significant results were found in the evolutionary variables: weight (p<0.001); body mass index (p<0.001); average waist circumference (p<0.001); percentage of fat (p<0.001); and quality of life general (p=0.001). In the irregularly active individuals, a significant result was found only in one evolutionary variable: body mass index (p<0.001). CONCLUSION: Thus, it is evident that the improvement and maintenance of good health is more effective in bariatric individuals who maintain a routine with regular physical activity.

Revisional surgery in severe nutritional complications after bariatric surgical procedures: report of four cases from a single institution and review of the literature.

INTRODUCTION: bariatric surgery is currently the only treatment that leads to long-term and sustained weight loss and decreased morbidity and mortality in morbidly obese individuals. Roux-en-Y bypass causes weight loss by restricting food intake associated with reduced intestinal absorption, in addition to multiple endocrine and satiogenic effects. Biliopancreatic diversion promotes weight loss mainly due to poor absorption of the nutrients ingested. Both procedures exclude parts of the gastrointestinal tract. OBJECTIVE: to describe four cases of revisional surgery after primary bariatric surgery, due to serious nutritional complications, and to review the literature regarding this subject. METHODS: a retrospective analysis of patients of Unicamps bariatric center database and review of the literatures were performed. RESULTS: four patients were identified, 2 women and 2 men, with a mean age of 48 years. The mean body mass index before revisional surgery was 23.7 kg/m2. Three patients underwent Scopinaro biliopancreatic diversion, and onde patient underwent Roux-en-Y gastric bypass. The revisional surgeries were revision, conversion, and reversion. One patient died. For the review of the literature 12 articles remained (11 case reports and 1 case series). Another five important original articles were included. CONCLUSION: fortunately, revision surgery is rarely necessary, but when indicated it has increased morbidity, It can be revision, reverion or conversion according to the severity of the patient and the primary surgery performed.

Malignant Uterine Neoplasms Attended at a Brazilian Regional Hospital: 16-years Profile and Time Elapsed for Diagnosis and Treatment.

OBJECTIVE: The present study aims to evaluate the profile of endometrial carcinomas and uterine sarcomas attended in a Brazilian cancer center in the period from 2001 to 2016 and to analyze the impact of time elapsed from symptoms to diagnoses or treatment in cancer stage and survival. METHODS: This observational study with 1,190 cases evaluated the year of diagnosis, age-group, cancer stage and histological type. A subgroup of 185 women with endometrioid histology attended in the period from 2012 to 2017 was selected to assess information about initial symptoms, diagnostic methods, overall survival, and to evaluate the influence of the time elapsed from symptoms to diagnosis and treatment on staging and survival. The statistics used were descriptive, trend test, and the Kaplan-Meier method, with p-values < 0.05 for significance. RESULTS: A total of 1,068 (89.7%) carcinomas (77.2% endometrioid and 22.8% non-endometrioid) and 122 (10.3%) sarcomas were analyzed, with an increasing trend in the period (p < 0.05). Histologies of non-endometrioid carcinomas, G3 endometrioid, and carcinosarcomas constituted 30% of the cases. Non-endometrioid carcinomas and sarcomas were more frequently diagnosed in patients over 70 years of age and those on stage IV (p < 0.05). The endometrioid subgroup with 185 women reported 92% of abnormal uterine bleeding and 43% diagnosis after curettage. The average time elapsed between symptoms to diagnosis was 244 days, and between symptoms to treatment was 376 days, all without association with staging (p = 0.976) and survival (p = 0.160). Only 12% of the patients started treatment up to 60 days after diagnosis. CONCLUSION: The number of uterine carcinoma and sarcoma cases increased over the period of 2001 to 2016. Aggressive histology comprised 30% of the patients and, for endometrioid carcinomas, the time elapsed between symptoms and diagnosis or treatment was long, although without association with staging or survival.

OBJETIVO: O presente estudo avaliou o perfil dos carcinomas endometriais e sarcomas uterinos atendidos em um centro brasileiro de câncer no período de 2001 a 2016, e avaliou o impacto do tempo decorrido entre os sintomas até o diagnóstico ou tratamento no estadiamento e sobrevida pelo câncer. MéTODOS: Estudo observacional com 1.190 casos que analisou o ano do diagnóstico, faixa etária, estágio e tipo histológico do câncer. Um subgrupo de 185 mulheres com histologia endometrioide e atendidas no período de 2012 a 2017 foi selecionado para avaliar informações sobre sintomas iniciais, métodos de diagnóstico, sobrevida global e para analisar a relação entre o tempo decorrido a partir dos sintomas até o diagnóstico e tratamento no estadiamento e sobrevida. Foram realizadas análises estatísticas descritiva, de tendência linear e de sobrevida pelo método de Kaplan-Meier, com valores de p < 0,05 para significância. RESULTADOS: Os casos estudados de acordo com a histologia foram 1.068 (89,7%) carcinomas (77,2% endometrioides e 22,8% não endometrioides) e 122 (10,3%) sarcomas, com tendência crescente no período (p < 0,05). Histologias de carcinomas não endometrioides, G3 endometrioides e carcinossarcomas consistiram em 30% dos casos. Carcinomas não endometrioides e sarcomas foram mais frequentemente diagnosticados em pacientes acima de 70 anos de idade e em estágio IV (p < 0,05). O subgrupo com 185 mulheres com carcinoma endometrioide apresentou 92% de sangramento uterino anormal e 43% de diagnóstico após curetagem. O tempo médio decorrido entre os sintomas e o diagnóstico foi de 244 dias e entre os sintomas e o tratamento, 376 dias, todos sem associação com estadiamento (p = 0,976) e sobrevida (p = 0,160). Apenas 12% das pacientes iniciaram o tratamento em até 60 dias após o diagnóstico. CONCLUSãO: O número de casos de carcinomas e sarcomas uterinos aumentaram no período de 2001 a 2016. A histologia agressiva compreendeu 30% dos pacientes e, no caso dos carcinomas endometrioides, o tempo decorrido entre os sintomas e o diagnóstico ou tratamento foi longo, embora sem associação com estadiamento ou sobrevida.

Revisional surgery in severe nutritional complications after bariatric surgical procedures: report of four cases from a single institution and review of the literature / Cirurgia revisional em complicações nutricionais graves após cirurgia bariátrica: relato de 4 casos de uma única instituição e revisão da literatura

ABSTRACT Introduction: bariatric surgery is currently the only treatment that leads to long-term and sustained weight loss and decreased morbidity and mortality in morbidly obese individuals. Roux-en-Y bypass causes weight loss by restricting food intake associated with reduced intestinal absorption, in addition to multiple endocrine and satiogenic effects. Biliopancreatic diversion promotes weight loss mainly due to poor absorption of the nutrients ingested. Both procedures exclude parts of the gastrointestinal tract. Objective: to describe four cases of revisional surgery after primary bariatric surgery, due to serious nutritional complications, and to review the literature regarding this subject. Methods: a retrospective analysis of patients of Unicamps bariatric center database and review of the literatures were performed. Results: four patients were identified, 2 women and 2 men, with a mean age of 48 years. The mean body mass index before revisional surgery was 23.7 kg/m2. Three patients underwent Scopinaro biliopancreatic diversion, and onde patient underwent Roux-en-Y gastric bypass. The revisional surgeries were revision, conversion, and reversion. One patient died. For the review of the literature 12 articles remained (11 case reports and 1 case series). Another five important original articles were included. Conclusion: fortunately, revision surgery is rarely necessary, but when indicated it has increased morbidity, It can be revision, reverion or conversion according to the severity of the patient and the primary surgery performed.

RESUMO Introdução: atualmente, a cirurgia bariátrica é o único tratamento que leva à perda de peso prolongada e sustentada e diminuição da morbimortalidade em indivíduos obesos mórbidos. O bypass em Y-de-Roux causa perda de peso restringindo a ingestão de alimentos associada à redução da absorção intestinal, além de múltiplos efeitos endócrinos e sacietógenos. O desvio biliopancreático promove a perda de peso principalmente devido à diminuição da absorção dos nutrientes ingeridos. Ambos os procedimentos excluem partes do trato gastrointestinal. Objetivo: descrever 4 casos de cirurgia revisional após cirurgia bariátrica primária, devido a graves complicações nutricionais, bem como realizar uma revisão da literatura sobre esse assunto. Métodos: foi realizada uma análise retrospectiva dos pacientes do banco de dados do serviço de cirurgia bariátrica da Unicamp e revisão da literatura. Resultados: foram identificados 4 pacientes, 2 mulheres e 2 homens, com média de idade de 48 anos, o IMC antes da cirurgia revisional eram em média 23,7. Os pacientes haviam sido submetidos em 3 casos a cirurgia de Scopinaro e 1 caso ao bypass gástrico em Y-de-Roux. As cirurgias revisionais foram de revisão, conversão e reversão. Um paciente evoluiu a óbito. Em relação a revisão da literatura, foram selecionados 12 artigos (11 relatos de casos e 1 série de casos). Outros cinco artigos originais importantes foram incluídos. Conclusão: felizmente, a cirurgia revisional raramente é necessária, mas, quando indicada, apresenta alta morbidade. São cirurgias de revisão, reversão ou conversão, de acordo com a gravidade do paciente e a cirurgia primária realizada.

Diagnosis, treatment and survival of uterine sarcoma: A retrospective cohort study of 122 cases.

The present study aimed to assess the diagnosis, treatment and follow-up of uterine sarcoma cases. A retrospective cohort study with 122 women recruited between 2001 and 2016 was performed. The data regarding epidemiology, clinical presentation, treatment and follow-up were analyzed based on the following histological types: Carcinosarcoma, leiomyosarcoma, endometrial stromal sarcoma (ESS) and adenosarcoma. Statistical analysis included descriptive statistics, logistic regression and survival curves. The diagnosis of uterine sarcoma exhibited an increasing trend of +1.2 new cases every 2 years (P=0.044) and comprised 10% of all uterine cancer diagnoses. There were 47% carcinosarcomas, 22% leiomyosarcomas, 16% ESS and 14% adenosarcomas. The majority of the women was ≥60 years old (62%). Among the subjects, 77% were postmenopausal, 61% had a body mass index up to 29.9 kg/m2 and 71% presented with a comorbidity. Regression analysis exhibited an association between post menopause and the histological type associated with lower overall survival (OS), namely leiomyosarcoma or carcinosarcoma (odds ratio, 5.45, P<0.001). Stage I malignancy was present in 44% and Stage IV in 22%. The treatment included primary surgery in 78% of the cases, whereas 79% received adjuvant therapy. Only 55 cases achieved disease control and 20 relapsed (36%) with a 5-year OS rate of 33%. The OS was lower for carcinosarcoma and leiomyosarcoma (20%; P=0.003). In summary, the present study indicated that the number of uterine sarcoma cases had increased between 2001 and 2016. The majority of the women were >60 years old and diagnosed in advanced stages. The postmenopausal status was associated with histological types of poor prognosis. The OS was low and worse for patients with carcinosarcoma and leiomyosarcoma.

Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature / Cirurgia bariátrica como tratamento para pseudotumor cerebri: estudo de caso e revisão narrativa de literatura

ABSTRACT CONTEXT: Pseudotumor cerebri occurs when there is an increase in intracranial pressure without an underlying cause, usually leading to loss of vision. It is most commonly observed in obese women of child-bearing age. CASE REPORT: A 46-year-old woman presented at our service with idiopathic intracranial hypertension that had been diagnosed two years earlier, which had led to chronic refractory headache and an estimated 30% loss of visual acuity, associated with bilateral papilledema. She presented partial improvement of the headache with acetazolamide, but the visual loss persisted. Her intracranial pressure was 34 cmH2O. She presented a body mass index of 39.5 kg/m2, also associated with high blood pressure. Computed tomography of the cranium with endovenous contrast did not show any abnormalities. She underwent Roux-en-Y gastric bypass with uneventful postoperative evolution. One month following surgery, she presented a 24% excess weight loss. An ophthalmological examination revealed absence of visual loss and remission of the papilledema. There were no new episodes of headache following the surgery. There was also complete resolution of high blood pressure. The intracranial pressure decreased to 24 cmH2O, six months after the surgery. CONCLUSION: Although the condition is usually associated with obesity, there are few reports of bariatric surgery among individuals with pseudotumor cerebri. In cases studied previously, there was high prevalence of resolution or improvement of the disease following bariatric surgery. There is no consensus regarding which technique is preferable. Thus, further research is necessary in order to establish a specific algorithm.

RESUMO CONTEXTO: O pseudotumor cerebri ocorre quando há aumento na pressão intracraniana sem causa subjacente, comumente levando a perda visual. É mais comum em mulheres obesas em idade fértil. RELATO DE CASO: Mulher de 46 anos, foi admitida com hipertensão intracraniana idiopática diagnosticada há dois anos, que levou a cefaleia refratária crônica e perda estimada de 30% da acuidade visual, associada a papiledema bilateral. Apresentou melhora parcial da cefaleia com acetazolamida, mas a perda visual persistiu. A pressão intracraniana era de 34 cmH2O. Apresentava índice de massa corpórea de 39,5 kg/m2, associado a hipertensão arterial. Tomografia computadorizada com contraste endovenoso de crânio não apresentou anormalidades. Foi submetida ao bypass gástrico em Y de Roux, com evolução pósoperatória sem intercorrências. Um mês após a cirurgia, apresentou perda de peso em excesso de 24%. Um exame oftalmológico demonstrou ausência de perda visual e remissão do papiledema; não houve novos episódios de cefaleia após a cirurgia. Houve também resolução completa da hipertensão arterial. A pressão intracraniana caiu para 24 cmH2O após seis meses da cirurgia. CONCLUSÃO: Embora a condição seja usualmente associada à obesidade, há escassos relatos de cirurgia bariátrica em indivíduos com pseudotumor cerebri. Nos casos previamente estudados, há alta prevalência de resolução ou de melhora da doença após a cirurgia bariátrica. Não há consenso sobre qual é a técnica cirúrgica de escolha. Portanto, mais estudos são necessários para estabelecer um algoritmo específico.

Bariatric surgery in individuals with severe cognitive impairment: report of two cases / Cirurgia bariátrica em indivíduos com déficits cognitivos graves: relato de dois casos

ABSTRACT CONTEXT: Bariatric surgery has become the gold-standard treatment for refractory morbid obesity. Obesity is frequently associated with certain syndromes that include coexisting cognitive deficits. However, the outcomes from bariatric surgery in this group of individuals remain incompletely determined. CASE REPORT: A 25-year-old male with Prader-Willi syndrome, whose intelligence quotient (IQ) was 54, was admitted with a body mass index (BMI) of 55 kg/m2, associated with glucose intolerance. He underwent the Scopinaro procedure for biliopancreatic diversion, with uneventful postoperative evolution, and presented a 55% loss of excess weight one year after the surgery, with resolution of glucose intolerance, and without any manifestation of protein-calorie malnutrition. A 28-year-old male with Down syndrome, whose IQ was 68, was admitted with BMI of 41.5 kg/m2, associated with hypertension. He underwent Roux-en-Y gastric bypass, with uneventful postoperative evolution. He presented a 90% loss of excess weight one year after the surgery, with resolution of the hypertension. CONCLUSION: Bariatric surgery among individuals with intellectual impairment is a controversial topic. There is a tendency among these individuals to present significant weight loss and comorbidity control, but less than what is observed in the general obese population. The severity of the intellectual impairment may be taken into consideration in the decision-making process regarding the most appropriate surgical technique. Bariatric surgery is feasible and safe among these individuals, but further research is necessary to deepen these observations.

RESUMO CONTEXTO: A cirurgia bariátrica tornou-se o tratamento padrão ouro para a obesidade mórbida refratária. A obesidade está frequentemente associada a certas síndromes nas quais também coexistem déficits cognitivos, entretanto, os resultados da cirurgia bariátrica nesse grupo de indivíduos ainda não foram completamente determinados. RELATO DE CASO: Um homem de 25 anos com síndrome de Prader-Willi, cujo quociente de inteligência (QI) era estimado em 54, foi admitido com índice de massa corporal (IMC) de 55 kg/m2, associado com intolerância à glicose. Foi submetido a uma derivação biliopancreática à Scopinaro, com evolução pós-operatória sem complicações significativas. Apresentou perda de 55% do excesso de peso um ano após a cirurgia, com resolução da intolerância à glicose, sem manifestação de desnutrição proteico-calórica. Outro paciente, homem de 28 anos com syndrome de Down, cujo QI era de 68, foi admitido com IMC de 41,5 kg/m2, associado a hipertensão arterial. Foi submetido ao bypass gástrico em Y de Roux, com evolução pós-operatória sem complicações. Apresentou perda de 90% do excesso de peso após um ano e resolução da hipertensão. CONCLUSÃO: A cirurgia bariátrica em indivíduos com déficits intelectuais é um tópico controverso. Existe uma tendência entre esses indivíduos de apresentar perda de peso e controle de comorbidades significativos, porém menores que os observados na população obesa geral. A gravidade do déficit intelectual pode ser considerada no processo de decisão sobre a técnica cirúrgica mais adequada. A cirurgia bariátrica é factível e segura nesse grupo de indivíduos. Porém, mais estudos são necessários para aprofundar estas observações.

Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature.

CONTEXT: Pseudotumor cerebri occurs when there is an increase in intracranial pressure without an underlying cause, usually leading to loss of vision. It is most commonly observed in obese women of child-bearing age. CASE REPORT: A 46-year-old woman presented at our service with idiopathic intracranial hypertension that had been diagnosed two years earlier, which had led to chronic refractory headache and an estimated 30% loss of visual acuity, associated with bilateral papilledema. She presented partial improvement of the headache with acetazolamide, but the visual loss persisted. Her intracranial pressure was 34 cmH2O. She presented a body mass index of 39.5 kg/m2, also associated with high blood pressure. Computed tomography of the cranium with endovenous contrast did not show any abnormalities. She underwent Roux-en-Y gastric bypass with uneventful postoperative evolution. One month following surgery, she presented a 24% excess weight loss. An ophthalmological examination revealed absence of visual loss and remission of the papilledema. There were no new episodes of headache following the surgery. There was also complete resolution of high blood pressure. The intracranial pressure decreased to 24 cmH2O, six months after the surgery. CONCLUSION: Although the condition is usually associated with obesity, there are few reports of bariatric surgery among individuals with pseudotumor cerebri. In cases studied previously, there was high prevalence of resolution or improvement of the disease following bariatric surgery. There is no consensus regarding which technique is preferable. Thus, further research is necessary in order to establish a specific algorithm.

Bariatric surgery in individuals with severe cognitive impairment: report of two cases.

CONTEXT: Bariatric surgery has become the gold-standard treatment for refractory morbid obesity. Obesity is frequently associated with certain syndromes that include coexisting cognitive deficits. However, the outcomes from bariatric surgery in this group of individuals remain incompletely determined. CASE REPORT: A 25-year-old male with Prader-Willi syndrome, whose intelligence quotient (IQ) was 54, was admitted with a body mass index (BMI) of 55 kg/m2, associated with glucose intolerance. He underwent the Scopinaro procedure for biliopancreatic diversion, with uneventful postoperative evolution, and presented a 55% loss of excess weight one year after the surgery, with resolution of glucose intolerance, and without any manifestation of protein-calorie malnutrition. A 28-year-old male with Down syndrome, whose IQ was 68, was admitted with BMI of 41.5 kg/m2, associated with hypertension. He underwent Roux-en-Y gastric bypass, with uneventful postoperative evolution. He presented a 90% loss of excess weight one year after the surgery, with resolution of the hypertension. CONCLUSION: Bariatric surgery among individuals with intellectual impairment is a controversial topic. There is a tendency among these individuals to present significant weight loss and comorbidity control, but less than what is observed in the general obese population. The severity of the intellectual impairment may be taken into consideration in the decision-making process regarding the most appropriate surgical technique. Bariatric surgery is feasible and safe among these individuals, but further research is necessary to deepen these observations.

Obstructive sleep apnea syndrome among obese individuals: A cross-sectional study.

INTRODUCTION: The obstructive sleep apnea syndrome (OSAS) is a respiratory illness, characterized by recurrent episodes of apnea and hypopnea, leading to reduction or cessation of the airflow. Obesity is one of the major risk factors for the development of OSAS. To help in the diagnosis of this disease, easily applicable and low-cost questionnaries were developed, such as the Berlin Questionnaire (BQ). OBJECTIVE: To evaluate the efficacy of the BQ for the screening of OSAS among candidates to bariatric surgery in a multidisciplinary preoperative program. METHOD: This is an observational, descriptive and cross-sectional study which evaluated obese individuals that were being prepared for bariatric surgery by means of the BQ. RESULTS: BQ was able to detect that minimal variations in the body mass index, neck circumference and hip-to-waist ratio lead to changes in the risk to develop OSAS; the higher the values of these variables, the higher the risk for OSAS development. CONCLUSION: BQ was an efficient and reliable tool to demonstrate the high risk for OSAS development in individual with obesity.

Obstructive sleep apnea syndrome among obese individuals: A cross-sectional study / Síndrome da apneia obstrutiva do sono em indivíduos portadores de obesidade: um estudo transversal

Summary Introduction: The obstructive sleep apnea syndrome (OSAS) is a respiratory illness, characterized by recurrent episodes of apnea and hypopnea, leading to reduction or cessation of the airflow. Obesity is one of the major risk factors for the development of OSAS. To help in the diagnosis of this disease, easily applicable and low-cost questionnaries were developed, such as the Berlin Questionnaire (BQ). Objective: To evaluate the efficacy of the BQ for the screening of OSAS among candidates to bariatric surgery in a multidisciplinary preoperative program. Method: This is an observational, descriptive and cross-sectional study which evaluated obese individuals that were being prepared for bariatric surgery by means of the BQ. Results: BQ was able to detect that minimal variations in the body mass index, neck circumference and hip-to-waist ratio lead to changes in the risk to develop OSAS; the higher the values of these variables, the higher the risk for OSAS development. Conclusion: BQ was an efficient and reliable tool to demonstrate the high risk for OSAS development in individual with obesity.

Resumo Introdução: A síndrome da apneia obstrutiva do sono (SAOS) é uma patologia respiratória, caracterizada por episódios recorrentes de apneia e hipopneia, resultando na cessação ou redução do fluxo aéreo. A obesidade é um dos principais fatores de risco para o desenvolvimento da SAOS. Foram criadas formas de auxiliar o diagnóstico da doença por meio de questionários de fácil aplicação e baixo custo, como o questionário de Berlim (QB). Objetivo: Avaliar a eficácia do QB para rastreamento do risco de desenvolvimento da SAOS em indivíduos portadores de obesidade que participaram do grupo multidisciplinar de preparo pré-operatório para cirurgia bariátrica do Hospital de Clínicas da Universidade Estadual de Campinas (HC-Unicamp). Método: O estudo foi observacional, descritivo e transversal, e avaliou portadores de obesidade que participavam do Programa multidisciplinar de preparo pré-operatório para cirurgia bariátrica do HC-Unicamp foram avaliados por meio do QB. Resultados: O QB foi capaz de detectar que mínimas oscilações no índice de massa corpórea (IMC), na circunferência cervical (Ccv), na circunferência da cintura e na relação cintura/quadril (RCQ) podem alterar o risco de desenvolvimento de SAOS, sendo que quanto maior esses valores, maior o risco de desenvolvimento de SAOS. Conclusão: O QB é uma ferramenta eficaz e fidedigna em demonstrar a prevalência do risco alto para o desenvolvimento da SAOS em indivíduos portadores de obesidade, dado esse que, quando correlacionado com IMC, aumento de idade, medida de cintura, Ccv e RCQ, faz o risco tender a aumentar de forma exponencial.

Quality of life of nursing professionals of a university hospital / Qualidade de vida dos profissionais de enfermagem de um hospital universitário / Calidad de vida de los profesionales de enfermería de un hospital universitario

Objective: identifying the satisfaction and the importance attributed by nursing professionals from a university hospital to the dimensions of quality of life. Method: an observational, cross-sectional study, with a non-probabilistic sample constituted by health professionals who met the selection criteria. The following instruments were self-administered: socio-demographic questionnaire constructed by the authors and Quality of Life Index of Ferrans & Powers, validated in Brazil. Data were submitted to descriptive statistics and specific tests. The study had the project approved by the Research Ethics Committee, Protocol 051/2011. Results: predominated: female gender (88%), aged between 31 and 40 years old (34%) and professional category of nursing technicians (66%). Conclusion: it is understood that even with a good quality of life, it becomes necessary to develop prevention and maintaining quality of life programs.(AU)

Objetivo: identificar a satisfação e a importância atribuídas por profissionais de enfermagem de um hospital universitário às dimensões de qualidade de vida. Método: estudo observacional, de corte transversal, com amostra não probabilística constituída por profissionais de enfermagem que atenderam aos critérios de seleção. Os seguintes instrumentos foram autoaplicados: questionário sociodemográfico construído pelos autores e Índice de Qualidade de Vida de Ferrans & Powers, validado no Brasil. Os dados foram submetidos à estatística descritiva e a testes específicos. O estudo teve o projeto aprovado pelo Comitê de Ética em Pesquisa, Protocolo 051/2011. Resultados: predominaram: sexo feminino (88%), com idade entre 31 e 40 anos (34%) e categoria profissional de Técnicos em Enfermagem (66%). Conclusão: entende-se que mesmo com uma boa qualidade de vida, faz-se necessário o desenvolvimento de programas de prevenção e manutenção da qualidade de vida.(AU)

Objetivo: identificar la satisfacción y la importancia atribuidas por los profesionales de enfermería de un hospital universitario a las dimensiones de la calidad de vida. Método: este es un estudio observacional, transversal, con muestra no probabilística constituida por los profesionales de enfermería que cumplieron con los criterios de selección. Los siguientes instrumentos fueron autoadministrados: cuestionario sociodemográfico construido por los autores y el Índice de Calidad de Vida de Ferrans & Powers, validado en Brasil. Los datos fueron sometidos a la estadística descriptiva y pruebas específicas. El estudio tenía el proyecto aprobado por el Comité de Ética en Investigación, Protocolo 051/2011. Resultados: predominaron: las mujeres (88%), con edades comprendidas entre 31 y 40 años (34%) y la categoría profesional de los técnicos de enfermería (66%). Conclusión: se entiende que incluso con una buena calidad de vida, es necesario desarrollar programas para la prevención y el mantenimiento de la calidad de vida.(AU)

[Supervised curricular internship: analysis of the students' experience]. / Estagio curricular supervisionado: analise da experiencia discente.

Qualitative study aimed to analyze the experience of students in the development of Supervised Curricular Internship activities which are part of the curricula of the undergraduate nursing course from a public university in the state of Sao Paulo, Brazil. The material for analysis was composed of the students' final reports taken on the end of the activities. Documental analysis was used in order to understand the experiences of the students. We analyzed six documents for which we used thematic content analysis as theoretical framework in an attempt to identify meanings and to obtain inferences about the documents produced. The reports allowed to conclude that the students' experience with the Supervised Curricular Internship was positive and contributed to develop a link between theory offered by the academy and daily routine/practice of nursing profession. Personal and professional growth was mentioned by the students as essential for them to feel empowered to act as confident and competent professionals.

Estagio curricular supervisionado: analise da experiencia discente / Supervised curricular internship: analysis of the students' experience / Pasantia universitaria supervisada: analisis de la experiencia de los estudiantes

Estudo qualitativo cujo objetivo foi analisar a experiência de estudantes no desenvolvimento das atividades do Estágio Curricular Supervisionado do curso de graduação em enfermagem de uma universidade pública do estado de São Paulo. O material foi constituído pelo relatório final dos discentes sobre o estágio desenvolvido. A análise documental foi utilizada para compreender as experiências vivenciadas pelos estudantes. Foram analisados seis documentos, utilizando-se como referencial a análise de conteúdo temático, na tentativa de identificar significados e obter inferências sobre os documentos produzidos. Os relatos permitiram concluir que a experiência dos discentes foi positiva, contribuindo para a construção de um elo entre a teoria oferecida pela universidade e a prática do serviço. O crescimento pessoal e profissional obtido foi referido pelos estudantes como fundamental para se sentirem capacitados a atuar como profissionais seguros e competentes.

Qualitative study aimed to analyze the experience of students in the development of Supervised Curricular Internship activities which are part of the curricula of the undergraduate nursing course from a public university in the state of Sao Paulo, Brazil. The material for analysis was composed of the students' final reports taken on the end of the activities. Documental analysis was used in order to understand the experiences of the students. We analyzed six documents for which we used thematic content analysis as theoretical framework in an attempt to identify meanings and to obtain inferences about the documents produced. The reports allowed to conclude that the students' experience with the Supervised Curricular Internship was positive and contributed to develop a link between theory offered by the academy and daily routine/practice of nursing profession. Personal and professional growth was mentioned by the students as essential for them to feel empowered to act as confident and competent professionals.

Estudio cualitativo cuyo objetivo fue analizar la experiencia de los estudiantes en el desarrollo de actividades de Pasantía Universitaria Supervisada del curso de grado en enfermería de una universidad pública del estado de São Paulo, Brasil. El material usado fue constituido de archivos obtenidos de los relatos finales de las actividades desarrolladas durante la pasantía. El análisis documental fue utilizado para comprender las experiencias de los estudiantes. Se analizaron seis documentos utilizando-se como referencia el análisis de contenido temático, en un intento de identificar los significados y obtener inferencias sobre los documentos aportados. Los relatos permitieron concluir que la experiencia de los estudiantes fue positiva, contribuyendo para la construcción de una integración entre la teoría ofrecida por la academia y la práctica cotidiana del servicio. El crecimiento personal y profesional fue relacionado por los estudiantes como esencial para que se sientan capaces de actuar con seguridad y competencia profesional.