Women with Anemia Refractory to Oral Iron Treatment Following Bariatric Surgery: a Short-Term Analysis.

INTRODUCTION: Iron deficiency and anemia are common after bariatric surgery. Women have a higher risk of developing such long-term complications. Though oral supplementation is indicated, intravenous iron therapy is required in some cases. METHODS: This retrospective study included patients who underwent bariatric surgery between 2012 and 2018. Postoperative anemia patients receiving parental iron therapy were assessed during the first 24 months. Their baseline characteristics, surgery type, and laboratory test results were analyzed. A follow-up analysis included a subgroup of women with and without gynecological disorders. Patients with vitamin B12 or folic acid deficiencies were excluded. RESULTS: Six hundred eleven (63.3%) met the inclusion criteria: 525 underwent gastric bypass, of which 79.6% were women. Overall, postoperative anemia was 28.9% (24.5% related to gastric bypass), especially among women (84%). Anemia refractory to oral iron therapy was observed in 12.9% of patients. All the patients requiring iron infusions (n = 54) were women, and half of them (51.8%) reported abnormal uterine bleeding. Postsurgical hemogram values were significantly lower in patients with abnormal uterine bleeding (despite the same number of infusions) than in those without gynecological disorders; 89.2% of these women had preoperative anemia. CONCLUSION: Anemia is frequent in bariatric surgery patients despite supplementation. Women undergoing gastric bypass with a history of gynecological disorders are prone to require more iron infusions. Consulting with the patient about a higher risk is important, and probably knowing the plan or including the opinion of an OBGYN to determine as a team the assessment, treatment, and prognosis.

Complications Rate Variability after Bariatric Surgery and the Importance of Standardization of a Reporting System.

BACKGROUND: The rate of early (< 30 days) complications after bariatric surgery has been reported to be 0.4-27.4%. Although the incidence of serious adverse events has decreased with time and experience, controversy regarding how they are reported persists, and the current literature is heterogeneous. METHODS: Data from patients, who underwent primary bariatric surgery (gastric bypass and sleeve gastrectomy) at a single institution between 2012 and 2018, were retrospectively reviewed. Any deviation from a "normal" postoperative course (< 30 days) was identified, and a comparative analysis of early complications according to five models was performed: modified Clavien-Dindo; Longitudinal Assessment of Bariatric Surgery (LABS); Bariatric Surgery Centers of Excellence (BSCOE); American Society for Metabolic and Bariatric Surgery (ASMBS); and Li (major/minor). RESULTS: A total of 788 patients (83.7% gastric bypass), of whom 8.8% deviated from a "normal" postoperative course, were included. After applying the five classifications, the results were as follows: Clavien-Dindo, 8.8%; LABS, 2.3%; BSCOE, 0.4%; ASMBS, 9.9%; and Li, 11.2%. The incidence of major/severe/adverse outcomes were as follows: Clavien-Dindo, 2.4%; LABS, 2.3%; BSCOE, 0.4%; ASMBS, 6.9%; and Li 9.2%. Minor complications were as follows: Clavien-Dindo, 6.5%; ASMBS, 3%; and Li, 2%. There was no mortality. CONCLUSION: Germane heterogeneity was found in reporting of early complications after bariatric surgery. Incidence varied according to classification system applied, and Clavien-Dindo demonstrated accuracy as a reporting model. To avoid bias, standardized reporting should be mandatory, and a more stringent and homogeneous reporting system should be established.

Desensibilización y reprocesamiento por movimientos oculares (EMDR) para trastornos ansiosos y depresivos en niños y adolescentes: revisión de la evidencia disponible / Eye movement desensitization and reprocessing (EMDR) for anxiety and depressive disorders in children and adolescents: a review of the available literature

Resumen Introducción: la desensibilización y reprocesamiento por movimientos oculares (EMDR) tiene abundante evidencia de eficacia en desórdenes del espectro traumático. Su eficacia en trastornos ansiosos (TA) y depresivos (TD) en niños, niñas y adolescentes ha sido escasamente estudiada. Método: se realizó una revisión narrativa para describir la evidencia disponible sobre eficacia de EMDR en TA y TD en población infantojuvenil. Se buscaron artículos disponibles en PubMed/Medline, SciELO, PsycINFO y Cochrane Library. Se incluyeron todos los artículos primarios y secundarios que evaluaron el efecto de EMDR en TA y TD en población infantojuvenil. Se revisaron sus referencias como segundo método de inclusión. Resultados: se identificaron nueve estudios (cinco en TA y cuatro en TD); tres fueron observacionales y seis experimentales. Todos tuvieron tamaños muestrales reducidos. En TA, los estudios corroboraron la eficacia de EMDR sobre el temor fóbico en fobia a las arañas, pero no sobre la conducta evitativa, donde sería superior la exposición in vivo. Dos series de casos expusieron la utilidad de EMDR en fagogobia y en TA asociados a epilepsia. En TD, EMDR fue eficaz en la reducción de sintomatología depresiva en el contexto del trastorno depresivo mayor, trastorno de estrés agudo y trastornos conductuales. EMDR fue comparable a terapia cognitivo-conductual. Conclusiones: la evidencia corrobora la eficacia de EMDR en TA y TD en niños, niñas y adolescentes. Sin embargo, es muy escasa y cuenta con limitaciones metodológicas. Es necesario realizar estudios experimentales con protocolos estandarizados y especializados de EMDR para TA y TD en población infantojuvenil.

Introduction: Eye movement desensitization and reprocessing (EMDR) has abundant evidence of efficacy in traumatic spectrum disorders. Its efficacy in anxiety disorders (AD) and depressive disorders (DD) in children and adolescents has been scarcely studied. Methods: We conducted a narrative review to describe the available evidence on the efficacy of EMDR in AD and DD in children and adolescents. We searched for articles available in PubMed/Medline, SciELO, PsycInfo and the Cochrane Library. All primary and secondary studies evaluating the effect of EMDR on AD and DD in children and adolescents were included. Their references were reviewed as a second method of inclusion. Results: nine studies were identified (five in AD and four in DD); three were observational and six experimental. All had small sample sizes. In AD, studies corroborated the efficacy of EMDR on phobic fear in spider phobia, but not on avoidance behavior, where in vivo exposure would be superior. Two case series reported the efficacy of EMDR in choking phobia and AD associated with epilepsy. In DD, EMDR was effective in reducing depressive symptomatology in the context of major depressive disorder, acute stress disorder, and conduct disorders. EMDR was comparable to cognitive behavioral therapy. Conclusions: The evidence corroborates the efficacy of EMDR in AD and DD in children and adolescents. However, it is very scarce and has methodological limitations. It is necessary to carry out experimental studies with standardized and specialized EMDR protocols for AD and DD in the child and adolescent population.

Phycological debriefing in acute traumatic events: Evidence synthesis. / Debriefing psicológico en eventos traumáticos agudos: síntesis de la evidencia secundaria.

Stressful life situations can generate chronic symptomatology, so it is of great concern to analyze preventive strategies. Psychological debriefing is an intervention for acute trauma, which verbalizes perceptions, thoughts, and emotions experienced during a recent traumatic event. The evidence surrounding its efficacy is controversial. This article discusses the efficacy of psychological debriefing based on systematic reviews and clinical practice guidelines. In all, nine systematic reviews were included. Only one of them found that psychological debriefing effectively decreased psychological stress, while the remaining eight found no significant effects for outcomes such stress, depressive and anxious symptoms, or development and severity of post-traumatic stress disorder. Moreover, two clinical trials found that the intervention had a significantly deleterious effect. Another study found a worsening in the symptomatology associated with the event. Of the eight clinical practice guidelines incorporated, none recommended psychological debriefing as an intervention for acute trauma. Some phenomena could explain the lack of success of the intervention in the scientific evidence. The bioethical conditions related to the traumatic scenario hinder its research, and its lack of standardization makes its evaluation in clinical trials problematic. Other variables such as ethnicity, personality, culture, gender, and history of traumatic experiences have been little considered in research. Nevertheless, the intervention may hinder the adequate processing of traumatic memory and emotions. Current evidence is consistent in not recommending psychological debriefing as an intervention for acute trauma, so its management should avoid it. It is suggested to promote research on preventive interventions to develop chronic traumatic symptomatology.

Las situaciones vitales estresantes tienen el potencial de generar sintomatología crónica, por lo que es de gran interés analizar estrategias preventivas. El debriefing psicológico es una intervención para el trauma agudo, que consiste en la verbalización de percepciones, pensamientos y emociones experimentados durante un evento traumático reciente. La evidencia en torno a su eficacia es controvertida. Este artículo describe y discute la eficacia del debriefing psicológico a partir de los resultados de las revisiones sistemáticas y guías de práctica clínica al respecto. Se incluyeron nueve revisiones sistemáticas. Solo una de ellas encontró que el debriefing psicológico fue eficaz en la disminución del estrés psicológico. Las ocho restantes no encontraron efectos significativos para desenlaces como severidad de los síntomas de estrés postraumático, depresivos, ansiosos o desarrollo de trastorno de estrés postraumático. Dos ensayos clínicos incorporados en las revisiones sistemáticas verificaron que la intervención tenía un efecto significativamente deletéreo, y otro estudio corroboró un empeoramiento numérico en la sintomatología asociada al evento. De las ocho guías de práctica clínica incorporadas, ninguna recomendó al debriefing psicológico como intervención para el trauma agudo. Existen algunos fenómenos que explicarían la falta de éxito de la intervención en la evidencia científica. Las condiciones bioéticas relativas al escenario traumático dificultan su investigación. Asimismo, su falta de estandarización problematiza la evaluación en ensayos clínicos. Otras variables como etnia, personalidad, cultura, género y antecedentes de experiencias traumáticas han sido poco consideradas en la investigación. No obstante, la intervención podría entorpecer el procesamiento adecuado de la memoria y las emociones traumáticas. La evidencia actual es consistente en no recomendar el debriefing psicológico como intervención para el trauma agudo, por lo que debe ser una práctica evitada en su manejo. Se sugiere promover la investigación en intervenciones preventivas para el desarrollo de sintomatología traumática crónica.

Weight loss before bariatric surgery and its impact on poor versus excellent outcomes at 2 years.

PURPOSE: To identify preoperative factors that influence the outcomes of gastric bypass surgery, in terms of excess weight loss at 24 months. METHODS: This retrospective study included two groups of patients who underwent laparoscopic gastric bypass surgery. Group A (poor outcomes) had ≤ 50%EWL or BMI ≥ 30 kg/m2; group B (excellent outcomes) had ≥ 80%EWL at 24 months. A comparative analysis of demography, anthropometry, comorbidities, and metabolic status was performed. A linear regression model was used to evaluate %EWL association; the number of preoperative and postoperative consultations were also compared. RESULTS: A total of 202 patients completed follow-up; 71 (35.1%) and 78 (38%) had poor and excellent outcomes (%EWL 44.1 ± 9.4% vs. 92 ± 10.9%), respectively. Mean age was 40.4 ± 8.9 years. Patients with poor outcomes had higher weight and BMI, lesser preoperative %EWL, higher dyslipidemia and diabetes rates with longer periods of evolution, and increased HbA1c% levels. In the linear regression analysis, preoperative %EWL and initial and preoperative BMI were statistically significant determinants of %EWL at 24 months Diabetes remission was 46.2% (group A) vs. 66.6% (group B). Group A had higher non-attendance rates after surgery. CONCLUSION: The factors independently associated with greater %EWL at 24 months between groups were higher preoperative %EWL, and lower initial and preoperative BMI.

Madres adolescentes de Valparaíso: Riesgo relacional, apego y síntomas depresivos en comparación a madres adultas / Teenage mothers of Valparaiso: relational risk, attachment and depressive symptoms compared to adult others

El embarazo adolescente es considerado un factor de riesgo tanto para la salud de la madre como para la de su futuro hijo por significar una doble crisis del ciclo vital, poniendo en riesgo el proceso de vinculación. Objetivos. El presente estudio busca analizar el riesgo relacional, tipo de apego y comparar la aparición de síntomas depresivos en madres adolescentes y adultas durante la gestación y en el período postparto. Métodos. Estudio prospectivo de dos cohortes de primigestas adolescentes y adultas, pertenecientes a centros de atención primaria de Valparaíso durante el año 2013. Resultados. Las madres adolescentes presentaron una mayor prevalencia de apego no seguro, mayores tasas de alto riesgo relacional materno-fetal y madre-bebé y mayor prevalencia de síntomas depresivos en comparación a madres adultas. Sin embargo, sólo la diferencia en la prevalencia de apego no seguro entre ambas cohortes fue estadísticamente significativa.

Teenage pregnancy is considered a risk factor for both the mother and her child's health and wellbeing. It can be hypothesized that going through a double psychological crisis might be harmful to the development of a secure relationship of attachment in the dyad. Objectives. This investigation seeks to analyze relational risks, attachment styles, and to compare the prevalence of depressive symptoms between teenage mothers and adult mothers during pregnancy and postpartum. Methods. An observational prospective cohort study was carried out, considering primiparous mothers, both teenage and adults, who attended primary public healthcare centers in Valparaíso during 2013. Results: In comparison to adult mothers, teenage mothers were more likely to exhibit insecure attachment styles, depressive symptoms in pregnancy and postpartum, and scored higher in the relational risk assessment scale. However, only the difference on the rate of insecure attachment styles between teenage and adult mothers was statistically significant.

Long versus short biliopancreatic limb in Roux-en-Y gastric bypass: short-term results of a randomized clinical trial.

BACKGROUND: The Roux-en-Y gastric bypass continues to be one of the most performed bariatric surgeries because of its adequate balance of outcomes, complications, and durability. Recently, the role of the biliopancreatic limb on weight loss and co-morbidity control has gained attention because it seems to have a positive impact based on limb length. OBJECTIVE: To compare results at 12 months of a "standard" (group 1) versus a long (group 2) biliopancreatic limb bypass. Biliopancreatic limbs were 50 cm and 200 cm, and alimentary limbs were 150 cm and 50 cm, respectively. SETTING: Academic Referal Center; Mexico City; Public Seeting. METHODS: Randomized study with patients undergoing both types of surgeries at a single academic center from 2016 to 2018. The analysis included weight loss, co-morbidity control (diabetes and hypertension), biochemical panel, operative outcomes, and complications. RESULTS: Two-hundred ten patients were included (105 in each group). Almost all data were homogenous at baseline. Female sex comprised 86.1% of cases, with a mean body mass index of 43.5 kg/m2. Excess weight loss (77.6 ± 15.7% versus 83.6 ± 16.7%; P = .011) and total weight loss (33.5 ± 6.4% versus 37.1 ± 7.1%; P < .001) was higher in group 2; better HbA1C levels were also observed. Co-morbidity outcomes, operative data, and complications were similar between groups. CONCLUSION: The Roux-en-Y gastric bypass with 200 cm of biliopancreatic limb length induces more weight loss at 12 months than a 50 cm limb length. Better HbA1C levels were also observed, but similar effects on co-morbidities and complications were noted.

Metabolic Surgery and Class 1 Obesity (< 35 kg/m2): a Prospective Study with Short-, Mid-, and Long-term Results Among Latinos.

INTRODUCTION: Metabolic surgery for managing class 1 obesity and type 2 diabetes mellitus has recently gained popularity. The Latino population presents high rates of these diseases. Reports on surgical outcomes in this population are scarce. METHODS: Prospective study with Mexican patients diagnosed with diabetes and class 1 obesity submitted to Roux-en-Y gastric bypass. The objective was to determine short-, mid-, and long-term outcomes (weight loss, metabolic, morbidity, and diabetes remission). Sub-analysis was included, based on preoperative usage of one (group A) or more (group B) oral hypoglycemic agents ± insulin. RESULTS: Fifty-one patients with a mean body mass index of 33.1 ± 1.9 kg/m2, and glycated hemoglobin 7.2 ± 1.7% were included. Significant improvements were observed in almost every parameter. At 24, 36, and 60 months, complete diabetes remission was achieved in 73.8%, 52.2%, and 50% of patients with glycated hemoglobin levels of 5.7% ± 0.8%, 5.8% ± 0.5%, and 6.1% ± 0.8%, respectively. At 24, 36, and 60 months, patients in group A (N=28) showed 90.9%, 69.2%, and 75% remission, respectively, versus patients in group B (N=23), who had remission rates of 50%, 30%, and 25% during the same period. Diabetes relapse was higher in patients using ≥ 2 oral hypoglycemic agents ± insulin before surgery. CONCLUSION: Gastric bypass is a safe and effective metabolic surgery that results in excellent mid- and long-term results among Mexicans. Patients using one drug preoperatively showed improved results and remission rates, which underscores the importance of intervening in the early stages of the disease. TRIAL REGISTRATION: Clinical Trials identifier: NCT04595396 ( www.ClinicalTrials.gov ).

Type 2 Diabetes Mellitus Remission Models Following Laparoscopic Gastric Bypass: a 4-Model Analysis in a Latino Population.

BACKGROUND: Bariatric surgery is indicated for major weight loss and for the control of associated comorbidities, particularly type 2 diabetes. Remission prediction scores have been proposed for this end, such as: DiaRem, Ad-DiaRem, ABCD, and DiaBetter. Nevertheless, they have not been evaluated all together in a specific population. METHODS: Retrospective study with Mexican patients submitted to gastric bypass with at least 12 months follow-up. All patients had BMI > 30 kg/m2 and type 2 diabetes. The primary objective was to evaluate the remission prediction performance of scores. A baseline analysis (anthropometric, biochemical, and metabolic) and remission rates were obtained. Remission scores and cut-off values were assigned based on original descriptions. A ROC analysis was performed for sensibility and specificity. RESULTS: A total of 95 patients were included. Mean age 44 years, 85.6% female with mean BMI of 44.1 kg/m2, and mean HbA1C of 7.2%. At 12 months, complete remission was obtained in 76.8%. ROC curves were plotted showing that DiaRem had 75.3% sensitivity and 68.2% specificity (AUC 0.723 p = 0.001), Ad-DiaRem had 84.9% and 50% (AUC 0.702 p = 0.002), ABCD had 57.5% and 77.3% (AUC 0.0.690 p = 0.002), and DiaBetter had 72.6% and 77.3% (AUC 0.748 p < 0.001). CONCLUSION: In Mexican patients with obesity and type 2 Diabetes, submitted to gastric bypass, remission prediction could be assessed with any current model showing satisfactory sensibility and specificity. Among such models, DiaBetter obtained the best statistical performance in our population. Type 2 diabetes remission rate at 1 year is similar to any other race or ethnicity.

Rasgos de personalidad del grupo C y trastorno por déficit de atención en estudiantes de medicina: estudio transversal analítico

Background: Attentional deficit hyperactivity disorder (ADHD) in adults is associated with borderline personality characteristics or cluster B (emotional instability), but in certain populations, such as medical students, it might be associated with cluster C traits (perfectionism, dependency, anxiety). This may be compensatory to ADHD. Aim: To analyze the association between ADHD and cluster C personality traits in medical students. Material and Methods: Biodemographic characteristics, the presence of ADHD and personality traits according to clusters A, B and C were evaluated in medical students. These characteristics were compared between students with unlikely diagnosis of ADHD (Group 1) and likely or very likely diagnosis of ADHD (Group 2). Results: We included 336 participants (44% women). A likely or very likely diagnosis of ADHD was present in 64% (Group 2). Concerning personality traits, 45% exhibited traits of cluster A, 57% of cluster B, and 67% of cluster C. Compared to their counterparts of Group 1, participants in Group 2 were more likely to have a history of psychiatric/psychological care, previous diagnosis of ADHD and traits of cluster B (37 and 68% respectively) and C (55 and 74% respectively). The odds ratio of having A, B or C traits when a likely or very likely ADHD was present, were 1.29 95% confidence interval (CI) [0.8-2.07], 3.79 95% CI [2.3-6.22] and 2.4 95% CI [1.46-3.96], respectively. Conclusions: Cluster C personality traits were frequent among medical students and were significantly associated with ADHD.

[Cluster C personality traits and attention deficit disorder in medical students. An analytical cross-sectional study]. / Rasgos de personalidad del grupo C y trastorno por déficit de atención en estudiantes de medicina: estudio transversal analítico.

BACKGROUND: Attentional deficit hyperactivity disorder (ADHD) in adults is associated with borderline personality characteristics or cluster B (emotional instability), but in certain populations, such as medical students, it might be associated with cluster C traits (perfectionism, dependency, anxiety). This may be compensatory to ADHD. AIM: To analyze the association between ADHD and cluster C personality traits in medical students. MATERIAL AND METHODS: Biodemographic characteristics, the presence of ADHD and personality traits according to clusters A, B and C were evaluated in medical students. These characteristics were compared between students with unlikely diagnosis of ADHD (Group 1) and likely or very likely diagnosis of ADHD (Group 2). RESULTS: We included 336 participants (44% women). A likely or very likely diagnosis of ADHD was present in 64% (Group 2). Concerning personality traits, 45% exhibited traits of cluster A, 57% of cluster B, and 67% of cluster C. Compared to their counterparts of Group 1, participants in Group 2 were more likely to have a history of psychiatric/psychological care, previous diagnosis of ADHD and traits of cluster B (37 and 68% respectively) and C (55 and 74% respectively). The odds ratio of having A, B or C traits when a likely or very likely ADHD was present, were 1.29 95% confidence interval (CI) [0.8-2.07], 3.79 95% CI [2.3-6.22] and 2.4 95% CI [1.46-3.96], respectively. CONCLUSIONS: Cluster C personality traits were frequent among medical students and were significantly associated with ADHD.

Autoestima y bienestar subjetivo en mujeres con cáncer de mama temprano en quimioterapia / Self-esteem and subjecve wellbeing in early stage breast cancer chemotherapy paents

Introducción: El número de mujeres viviendo con cáncer de mama ha aumentado en el mundo. El cáncer de mama y su tratamiento pueden causar cambios físicos, metabólicos y de salud mental. No contamos con datos a nivel regional respecto al bienestar y autoestima de estas pacientes. Objetivo: Evaluar la autoestima y bienestar en un grupo de mujeres con cáncer de mama temprano en quimioterapia de nuestra región y compararlos con un grupo de mujeres sin cáncer. Materiales y métodos: Usamos la escala de autoestima de Rosenberg y la escala de bienestar psicológico de Ryff (cuestionarios autoaplicados) en un grupo de mujeres con cáncer de mama en estadios tempranos (I y II) y en un grupo de mujeres sin cáncer. Comparamos los resultados de ambos grupos y graficamos todos los dominios de cada cuestionario para cada grupo. Resultados: Incluimos 32 mujeres en cada grupo. Sus características basales fueron similares, a excepción del número de hijos, que fue mayor en el grupo control. Tanto en la autoestima como en el bienestar y todos sus dominios el grupo de mujeres con cáncer de mama obtuvo menores puntajes que el grupo control. Conclusión: El grupo de mujeres con cáncer de mama en la región de Valparaíso tuvo una autoestima y un bienestar menor que el grupo de mujeres sin cáncer de la región. Sugerimos evaluar la inclusión de más medidas terapéuticas para mejorar la salud mental.

Introduction: The number of women in the world living with breast cancer has risen. Breast cancer and its treatment can cause physical, metabolic, and mental health changes. There is no regional data on the wellbeing and self-esteem of these patients. Objectives: To evaluate the self-esteem and wellbeing of a group of female, early stage breast cancer sufferers undergoing chemotherapy and compare them with a group of women without cancer. Material and Methods: We use the Rosenberg Self-Esteem Scale and Ryff Psychological Wellbeing Scale (self-administered questionnaires) in a group of women with early stage breast cancer (I and II) and in a group of women without cancer. We compare the results of both groups and graph every category of each questionnaire for both groups. Results: Each group comprised 32 women. Their baseline characteristics were similar, apart from the number of children they had, which was greater in the control group. The cancer sufferers' group scored lower than the control group in self-esteem and wellbeing as well as having lower scores in all the separate categories. Conclusion: In Valparaíso, the group of women with breast cancer had lower self-esteem and sense of wellbeing than the group of women without cancer. We suggest evaluating the inclusion of more therapeutic measures to improve mental health.

Psychological and cognitive evaluation of autism in a patient with MOMO syndrome: a case report and literature review. / Evaluación psicológica y cognitiva de autismo en un paciente con síndrome de MOMO: reporte de caso y revisión de la literatura.

MOMO is an acronym for macrosomia, obesity, macrocephaly and ocular abnormalities. The syndrome was first described in 1993, with a total of nine patients published thus far. All the cases presented intellectual disability and in one case autism was described. We present a new case of a patient with MOMO syndrome, who consulted for hallucinatory phenomena. He completed a neuropsychological, clinical and cognitive evaluation, showing a borderline intelligence quotient and fulfilled the criteria for autism spectrum disorder. This is the first neurocognitive evaluation of a patient with MOMO, supporting the use of standardized scales in order to assess the autism and other psychiatric comorbidities in patients with genetics syndromes.

MOMO es un acrónimo para los términos macrosomía, obesidad, macrocefalia y anomalías oculares. El síndrome fue descrito por primera vez en 1993, con un total de nueve pacientes publicados a la fecha. Todos los casos reportaron discapacidad intelectual y en un caso se describió a un paciente con autismo. Presentamos un nuevo caso de paciente con síndrome de MOMO que consultó por fenómenos alucinatorios. Se completó una evaluación neuropsicológica, clínica y cognitiva, en donde se demostró un cociente intelectual limítrofe y se corroboraron los criterios para trastorno del espectro autista. Ésta es la primera evaluación neurocognitiva de un paciente con MOMO, la que apoya el uso de escalas estandarizadas a fin de evaluar el autismo y otras comorbilidades psiquiátricas en pacientes con síndromes genéticos.

Unexpected Intraoperative Findings, Situations, and Complications in Bariatric Surgery.

BACKGROUND: Bariatric surgery is considered a safe therapy to treat obesity. Postoperative complications are well known; however, there is a lack of data describing intraoperative complications and/or unexpected findings, and if there is further impact on outcomes. METHODS: Retrospective study with patients operated between 2013 and 2016 at a single institution. All operative information was collected prospectively and aimed to analyze the incidence and causes of unexpected intraoperative findings, complications, change in surgical plan, extra surgeries, and procedure interruption in patients submitted to bariatric surgery. Secondarily, a morbidity analysis was performed, correlating intraoperative complications with postoperative complications and length of stay. RESULTS: Four-hundred and five patients were included. Female sex comprised 82% of cases, and a median age of 38 years old was observed; almost 90% were gastric bypass. In 29.3% of cases, there were intraoperative findings, mainly adhesions, abdominal wall hernias, positive methylene blue test, hiatal hernias, and gastrointestinal stromal tumors. Associated surgeries were performed in 8.6% cases, and intraoperative adverse events reported in 7.1%, where organ injury and anastomosis problems were the most frequent. A change in the operative plan was done in 0.9% and surgery interruption in 1.2% of the cases. Early complications were observed in 6.6%. There was no correlation between intraoperative complications and length of stay or early complications. CONCLUSION: Unexpected intraoperative findings/complications are common in bariatric surgery, but without increasing morbidity or length of stay. Surgery suspension, change in the planned technique, or adding extra (non-bariatric) procedures may occur.

Depression Before and After Bariatric Surgery in Low-Income Patients: the Utility of the Beck Depression Inventory.

BACKGROUND: The prevalence of psychological disorders in bariatric surgery candidates is well established, where anxiety and depression are commonly observed. Depression prevalence and evolution after gastric bypass, and its impact on weight loss, have been less explored, especially among low-income patients. METHODS: A retrospective study with low-income patients undergoing bariatric surgery from 2015 to 2016. A comparative analysis of preoperative depression (the Beck Depression Inventory II) was performed and compared at 6 and 12 months. A demographic and weight loss analysis was also performed. RESULTS: Seventy-three patients were included. Female sex comprised 76.7% of cases, and baseline depression was present in 45.2%, being severe in 2.7%. The analysis at 6 months showed Beck's score improvement (12.3 baseline vs. 4.2 points at 6 months, p = 0.006), as well as for individual items (excepting irritability). At 12 months, the mean score was 5 points, without difference vs. 6 months. At 6 and 12 months, depression (any degree) was present in 9.6 and 8.6%, corresponding to percentage change rates of - 65.8 and - 59.3%. Only one patient (2.7%) presented severe depression. Depression status before surgery had no influence in weight loss amount at 12 months. CONCLUSION: Almost half of bariatric surgery candidates have some degree of depression that improves dramatically soon after bariatric surgery. Such change continues stable during the first year. Improvement was independent of gender, and depression has no influence on weight loss. In low-income bariatric patients, depression is lower than reports from developed countries, but similar improvement has been observed.

The Impact of Preoperative BMI (Obesity Class I, II, and III) on the 12-Month Evolution of Patients Undergoing Laparoscopic Gastric Bypass.

BACKGROUND: Whether or not the initial body mass index (BMI) influences weight loss and comorbidities improvement after bariatric surgery continues to be a matter of debate. The main reason for this is a lack of studies including obesity class I. METHODS: Retrospective study with patients submitted to gastric bypass at a single institution. They were classified based on initial BMI (obesity class I, II, and III), and a comparative analysis of their metabolic profile (glucose, HbA1c%, C-peptide, insulin and diabetes medication), lipid profile (triglycerides, total cholesterol, HDL, LDL), and clinical data (systolic/diastolic blood pressure and cardiovascular risk) was performed at 0 and 12 months. Diabetes remission and weight loss were also analyzed. RESULTS: Two-hundred and twenty patients were included (23 in group 1, 113 in group 2, and 84 in group 3). Initial weight, BMI, and number of patients with T2DM were statistically different in group 1; other parameters were homogenous. At 12 months, every group had similar improvement of the metabolic profile, excepting serum insulin. Diabetes remission was 57.9, 61.1, and 60% for group 1, 2, and 3. For weight loss, there were differences between groups when using BMI and percentage of excess weight loss, but not with percentage of total weight loss. The non-metabolic and clinical data improved without differences, except for total cholesterol and LDL. CONCLUSIONS: The metabolic, lipid, and clinical profiles associated with obesity present similar improvement 1 year after laparoscopic gastric bypass, despite different baseline BMI. Diabetes remission and percentage of total weight loss were also similar.

Metabolic syndrome 2 years after laparoscopic gastric bypass.

BACKGROUND: The latest diabetes consensus identified obesity as key component of the metabolic syndrome. The role of bariatric surgery over such syndrome has been less explored with a lack of long term studies, and especially among Mexicans. METHODS: Retrospective study including patients with metabolic syndrome submitted to laparoscopic gastric bypass at a single institution with complete data after 24 months. The objective was to analyze the improvement of the syndrome and each component. Demographic, anthropometric, biochemical and clinical parameters were analyzed at 12 and 24 months. Secondarily weight loss and other parameters were also analyzed. Finally, an analysis of syndrome improvement related to weight loss was performed. RESULTS: Sixty-three patients were included. The 2 most common components associated with obesity were reduced HDL and raised glucose or Type 2 diabetes. There was a significant improvement of metabolic syndrome and its components, as well as for the rest of the analyzed data, from the first check point and throughout follow-up. Prevalence of such syndrome was 6.3% at 12 and 24 months. Hypertension and raised glucose or Type 2 diabetes were the components with the greatest and fastest improvement; HDL levels and obesity were the least improved. There was a direct relationship between percentage of excess weight loss or percentage of excess BMI loss, and syndrome's improvement. CONCLUSION: Patients with metabolic syndrome improved after gastric bypass, with results lasting after 2 years; other metabolic parameters important for cardiovascular risk were also positively affected. There was a relationship between the amount of weight loss and improvement of metabolic syndrome.

Trypophobia: What Do We Know So Far? A Case Report and Comprehensive Review of the Literature.

In this article, we describe the case of a girl who suffers from a phobia to repetitive patterns, known as trypophobia. This condition has not yet been recognised by diagnostic taxonomies such as the Diagnostic and Statistical Manual of Mental Disorders. Trypophobia usually involves an intense and disproportionate fear towards holes, repetitive patterns, protrusions, etc., and, in general, images that present high-contrast energy at low and midrange spatial frequencies. It is commonly accompanied by neurovegetative symptoms. In the case we present here, the patient also suffered from generalised anxiety disorder and was treated with sertraline. After she was diagnosed, she showed symptoms of both fear and disgust towards trypophobic images. After some time following treatment, she only showed disgust towards said images. We finish this case report presenting a comprehensive literature review of the peer reviewed articles we retrieved after an exhaustive search about trypophobia, we discuss how this case report contributes to the understanding of this anxiety disorder, and what questions future studies should address in order to achieve a better understanding of trypophobia.

Type 2 diabetes mellitus outcomes after laparoscopic gastric bypass in patients with BMI <35 kg/m2 using strict remission criteria: early outcomes of a prospective study among Mexicans.

BACKGROUND: Mild obesity (BMI 30-34.9 kg/m2) is highly prevalent worldwide and is associated with type 2 diabetes mellitus. The efficacy of bariatric surgery remains unclear, including among Mexicans. The criteria for diabetes remission are inconsistent, as they are based on different thresholds for glycated hemoglobin, with remission rates ranging from 43 to 73%. METHODS: Mildly obese patients with type 2 diabetes mellitus who underwent laparoscopic gastric bypass were prospectively analyzed. The primary objective was to determine the impact of surgery on their metabolic profiles. Demographic, clinical, and biochemical parameters were measured at baseline and at 3, 6, 9, 12, and 18 months. Diabetes remission rate was defined as an HbA1c <5.7%. Complications within 30 days and weight loss (% total weight loss) were also analyzed. RESULTS: Twenty-three Mexican patients underwent surgery. Of the 19 patients, evaluable at 18 months, nine (47.4%) achieved complete diabetes remission, seven (36.8%) showed partial remission, and three (15.8%) showed improvement. Significant improvements in lipid profile, cardiovascular risk, blood pressure, and every metabolic parameter were observed, beginning at the first month and throughout the study. The final total percentage weight loss was 24.9%. Three patients (13%) experienced complications, but none required reoperation or died. CONCLUSION: Laparoscopic gastric bypass is a safe and effective method to improve the metabolic profile of mildly obese Mexican patients with type 2 diabetes mellitus, inducing high remission rates even when the strictest model is used.

Caracterización fenomenológica de las conductas repetitivas impulsivas orientadas hacia el cuerpo y el trastorno por excoriación en estudiantes universitarios / Phenomenological characterization of body-focused repetitive impulsive behaviours and excoriation disorder in college students

Resumen Introducción: Las conductas repetitivas impulsivas orientadas hacia el cuerpo (CRIOC) se caracterizan por el rascado, mordido y/o remoción de uñas, pelos y piel, pudiendo llegar a constituir un desorden mental. El trastorno por excoriación (TE) o dermatilomanía ha sido recientemente incorporado como desorden específico al DSM-5 como parte del espectro obsesivo-compulsivo. Su fenomenología describe una conducta reactiva a la ansiedad, seguida de tensión psíquica progresiva y luego placentera al realizarla, finalizando muchas veces en culpa. Se ha reportado una mayor incidencia de TE en estudiantes universitarios, sin embargo, los estudios en Latinoamérica son escasos. Objetivos: Establecer la frecuencia y las características fenomenológicas de las CRIOC y del TE en población universitaria. Métodos: Se realizó un estudio transversal mediante la aplicación de un cuestionario de autorreporte sobre aspectos relacionados con el TE en estudiantes universitarios. Resultados: 440 estudiantes fueron incluidos. Un 22,2% sintió siempre o casi siempre el impulso de rascar su piel hasta lesionarse; 13,2% ejecutó estas acciones varias veces al día y 4,3% desplegó mucho esfuerzo en resistirlas. Los afectos más frecuentemente asociados fueron culpa, vergüenza, arrepentimiento y autorreproche. Un 24,1% creyó que estos comportamientos fueron anormales y 6,1% que constituyeron una patología. Según criterios DSM-5 y establecidos por los autores, se hallaron cuatro casos compatibles con TE (0,91%), al descartar patologías psiquiátricas y médicas comórbidas. Conclusión: Aunque las CRIOC fueron frecuentes en población universitaria, la frecuencia de TE fue similar a la de la población general, describiendo una fenomenología característica congruente con la reportada por la literatura.

Introduction: Body-focused repetitive impulsive behaviors (BFRIB) are characterized by skin, nail and hair removing, scratching and/or biting, that configurate a mental disorder in some cases. Excoriation disorder (ED) or dermatillomania has been recently added as a specific disorder in DSM-5 obsessive-compulsive spectrum. Its phenomenology describes a behavior that emerges from anxiety, followed by a progressive psychic tension and then a pleasurable sensation, concluding in many times in guilt. Evidence has reported a greater incidence of ED in college students; however, studies in Latin America are scarce. Objective: To establish frequence and phenomenological features of BFRIB and ED in college students. Methods: We performed a cross-sectional study through the application of a self-administered questionnaire about ED aspects in college students. Results: 440 students were included; 22.2% felt always or almost always the impulse to scratch their skin until they were injured; 13.2% made these actions many times a day and 4.3% deployed considerable efforts in resisting them. Most frequent reported affects were guilt, shame, repentance, and self-reproach; 24.1% thought these behaviors were abnormal and 6.1% considered they constitute a pathology. According to DSM-5 and authors' criteria, four cases of ED were found (0.91%), when psychiatric and medical comorbidities were discarded. Conclusion: Although BFRIB were frequent in college students, dermatillomania frequency was similar to general population. A characteristic phenomenology was described, similar to the evidence reported one.