Low bone mineral density in pre-menopausal women one year after gastric bypass / Baixa densidade mineral óssea em mulheres pré-menopausadas um ano após bypass gástrico

Introduction: Nutritional deficiencies, hormonal changes and severe weight loss after Roux-en-Y Gastric Bypass (RYGB) can promote changes in bone metabolism which may lead to a reduction in bone mineral density (BMD). Objective: to investigate the prevalence of osteopenia/osteoporosis and factors associated with BMD in pre-menopausal women who underwent RYGB. Methodology: a cross-sectional study conducted with secondary data of patients followed-up in a specialized center for obesity treatment. Variables studied: biochemical and anthropometric data, body composition by multifrequency bioimpedance and BMD of the lumbar spine (LS), total femur (TF) and femur neck (FN) by dual-energy X-ray absorptiometry. For statistical analysis, the SPSS® software and a 5% significance level were utilized. Results: seventy-two (72) pre-menopausal women were evaluated. Mean age, BMI and mean post-surgery time was 38.7±6.5 years, 25.8±2.5 kg/m² and 13.1±1.7 months, respectively. The prevalence of osteopenia in at least one of the densitometry sites was 13.9%, with LS being the most frequent site. A lower LS BMD was associated with greater weight loss, higher percentage of body fat before surgery and lower post-surgery serum vitamin D levels. There was a positive correlation between skeletal muscle mass index adjusted for height in the pre-surgery period and LS BMD (r=0.361; p=0.010) and TF (r=0.404; p=0.004). Conclusion: a relevant prevalence of osteopenia was detected in pre-menopausal women after RYGB, mainly in the LS.

Introdução: o Bypass Gástrico em Y de Roux (BPGYR) pode promover mudanças no metabolismo ósseo decorrentes de deficiências nutricionais, alterações hormonais e perda severa de peso, podendo acarretar redução da Densidade Mineral Óssea (DMO). Objetivo: investigar a prevalência de osteopenia/osteoporose e fatores associados à DMO em mulheres pré-menopausadas submetidas à BPGYR. Metodologia: estudo transversal com dados secundários de pacientes acompanhadas em um serviço especializado no tratamento da obesidade. Variáveis estudadas: dados bioquímicos e antropométricos, composição corporal por bioimpedância multifrequencial e DMO de coluna lombar (CL), fêmur total (FT) e colo do fêmur (CF) por Absorciometria por Dupla Emissão de Raios X. Para análise estatística foi utilizado o programa SPSS®, com o nível de significância de 5%. Resultados: foram avaliadas 72 mulheres pré-menopausadas, com média de idade e de IMC de 38,7±6,5 anos e 25,8±2,5 kg/m², respectivamente, e tempo médio de pós-operatório de 13,1±1,7 meses. A prevalência de osteopenia em pelo menos um dos sítios densitométricos foi de 13,9%, sendo a CL o sítio mais frequente. Uma menor DMO na CL se associou a maior perda de peso, maior percentual de massa gorda antes da cirurgia e níveis séricos menores de vitamina D pós-operatória. Observou-se correlação positiva entre o índice de massa muscular esquelética ajustada pela altura no pré-operatório e a DMO da CL (r=0,361; p=0,010) e do FT (r=0,404; p= 0,004). Conclusão: detectou-se prevalência relevante de osteopenia em mulheres pré-menopausadas após BPGYR, principalmente na CL.

Thyroid Hormone Levels During Hospital Admission Inform Disease Severity and Mortality in COVID-19 Patients.

Background: Illness severity in patients infected with COVID-19 is variable. Methods: Here, we conducted an observational, longitudinal, and prospective cohort study to investigate serum thyroid hormone (TH) levels in adult COVID-19 patients, admitted between June and August 2020, and to determine whether they reflect the severity or mortality associated with the disease. Results: Two hundred forty-five patients [median age: 62 (49-75) years] were stratified into non-critical (181) and critically ill (64) groups. Fifty-eight patients (23.6%) were admitted to the intensive care unit, and 41 (16.7%) died. Sixteen (6.5%) exhibited isolated low levels of free triiodothyronine (fT3). fT3 levels were lower in critically ill compared with non-critical patients [fT3: 2.82 (2.46-3.29) pg/mL vs. 3.09 (2.67-3.63) pg/mL, p = 0.007]. Serum reverse triiodothyronine (rT3) was mostly elevated but less so in critically ill compared with non-critical patients [rT3: 0.36 (0.28-0.56) ng/mL vs. 0.51 (0.31-0.67) ng/mL, p = 0.001]. The univariate logistic regression revealed correlation between in-hospital mortality and serum fT3 levels (odds ratio [OR]: 0.47; 95% confidence interval [CI 0.29-0.74]; p = 0.0019), rT3 levels (OR: 0.09; [CI 0.01-0.49]; p = 0.006) and the product fT3 × rT3 (OR: 0.47; [CI 0.28-0.74]; p = 0.0026). Serum thyrotropin, free thyroxine, and fT3/rT3 values were not significantly associated with mortality and severity of the disease. A serum cutoff level of fT3 (≤2.6 pg/mL) and rT3 (≤0.38 ng/mL) was associated with 3.46 and 5.94 OR of mortality, respectively. We found three COVID-19 mortality predictors using the area under the receiver operating characteristic (ROC) curve (AUC score): serum fT3 (AUC = 0.66), rT3 (AUC = 0.64), and the product of serum fT3 × rT3 (AUC = 0.70). Non-thyroidal illness syndrome (fT3 < 2.0 pg/mL) was associated with a 7.05 OR of mortality ([CI 1.78-28.3], p = 0.005) and the product rT3 × fT3 ≤ 1.29 with an 8.08 OR of mortality ([CI 3.14-24.2], p < 0.0001). Conclusions: This prospective study reports data on the largest number of hospitalized moderate-to-severe COVID-19 patients and correlates serum TH levels with illness severity, mortality, and other biomarkers to critical illness. The data revealed the importance of early assessment of thyroid function in hospitalized patients with COVID-19, given the good prognostic value of serum fT3, rT3, and fT3 × rT3 product. Further studies are necessary to confirm these observations.

Association between bariatric surgery and oral health: a literature review

Objective: to review the literature on the relationship between oral health and bariatric surgery in obese individuals. Methods: articles published until March 2021 were searched in the Medline/PubMed, LILACS, BBO, and Web of Science databases. The search used a combination of descriptors related to the words: obesity, bariatric surgery, and oral health. Results: one hundred thirty-five studies were identified in the database search. Of these, 47 were included in this review. The oral changes investigated in the literature for individuals who underwent bariatric surgery were dental caries, tooth wear/erosion, hypersensitivity, periodontal disease, hyposalivation, halitosis, and changes in mastication and oral soft tissue. The evaluated articles showed methodological controversy regarding the study design, follow-up period, sample size, and assessed clinical parameters, which complicated the comparison of studies. Final considerations: there is no consensus in the literature regarding the relationship between oral health and bariatric surgery in obese individuals. Further prospective cohort studies should be conducted to investigate this association better.(AU)

Objetivo: revisar a literatura sobre a relação entre saúde bucal e cirurgia bariátrica em indivíduos obesos. Métodos: foi realizada uma busca de estudos publicados até março de 2021 nas bases de dados Medline/PubMed, LILACS, BBO e Web of Science. Foi utilizada uma combinação de descritores relacionada às palavras: obesidade, cirurgia bariátrica e saúde bucal. Resultados: foram identificados 135 estudos nas bases de dados pesquisadas. Desses, 47 estudos foram incluídos nesta revisão. As alterações bucais investigadas em indivíduos que realizaram cirurgia bariátrica apresentadas na literatura foram: cárie dentária, desgaste dentário/erosão dentária, hipersensibilidade, doença periodontal, hipossalivação, halitose, alterações da função mastigatória e alterações no tecido mole bucal. Os estudos avaliados mostraram controvérsia metodológica em relação a: tipo de desenho de estudo, tempo de seguimento, tamanho da amostra e parâmetros clínicos avaliados, fato que dificultou comparar os estudos. Considerações finais: não há consenso na literatura sobre a relação entre saúde bucal e cirurgia bariátrica em indivíduos obesos. Mais estudos de coorte prospectivos devem ser realizados para estudar melhor essa associação.(AU)

Prevalence of hypovitaminosis D in severely obese subjects referred to bariatric surgery / Prevalência de hipovitaminose D em obesos graves encaminhados à cirurgia bariátrica

ABSTRACT: Study Design: Cross-sectional. Objective: Estimating the prevalence of hypovitaminosis D in a group of severely obese subjects referred to bariatric surgery. Methods: This study evaluated severely obese patients aged ≥18 years assisted by a specialized team in bariatric surgery. Clinical, anthropometric, and laboratory data were obtained from patient records. Plasma 25 (OH) D was determined by chemiluminescence and levels ≤ 20 ng/mL was considered as Hypovitaminosis D. The data were analyzed using the Statistical Package for Social Sciences® (SPSS) 20.0. Variables were described using descriptive statistics. For the comparison of the three groups, ANOVA, Kruskal-Wallis, and Pearson's chi-square tests were used. Spearman correlation test was performed to assess correlations between 25(OH)D and the other variables. P-values <0.05 were considered to be significant. Results: The study included 400 individuals, 71% were female with the mean age (SD) and BMI (SD) of 35.6 (9.1) years and 41.4 (5.1) kg/m², respectively. The vitamin D ranged from 4.5 to 62.4 ng/mL and the mean (SD) was 24.7 (7.9) ng/mL. In this sample, 117 (29.3%) individuals had hypovitaminosis D. There was a negative correlation between 25(OH)D and BMI (r= -0.110; p=0.028) and parathormone (r= -0.152; p=0.006) and positive correlation with serum calcium (r= 0.132; p=0.013) and phosphorus (r= 0.116; p=0.027). Conclusion: Severely obese subjects had a high prevalence of hypovitaminosis D even living in a sunny state. (AU)

RESUMO Modelo do estudo: Estudo transversal. Objetivo: estimar a prevalência da hipovitaminose D em um grupo de obesos graves encaminhados à cirurgia bariátrica. Métodos: Foram estudados obesos atendidos por uma equipe especializada em cirurgia bariátrica, com 18 anos ou mais de ambos os sexos. Dados clínicos, antropométricos e laboratoriais foram obtidos dos prontuários dos pacientes. A 25 (OH) D plasmática foi determinada por quimiolu-minescência e valores ≤20 ng/mL foram considerados como hipovitaminose D. Os dados foram analisados utilizan-do o Statistical Package for the Social Sciences® (SPSS) 20.0. Estatística descritiva foi utilizada para apresentação das variáveis e para comparação dos três grupos foram utilizados os testes: ANOVA, Kruskal-Wallis e qui-quadrado de Pearson. Foram considerados estatisticamente significantes valores de p<0,05. Resultados: Foram estudados 400 pacientes, 71% do sexo feminino, com média (DP) de idade e IMC 35,6 (9,1) anos e 41,4 (5,1) kg/m², respec-tivamente. A vitamina D variou de 4,5 a 62,4ng/mL com média (DP) de 24,7 (7,9) ng/mL. Na amostra, 117 (29.3%) dos pacientes apresentaram hipovitaminose D. Houve correlação negativa entre 25 (OH) D e IMC (r = -0,110; p = 0,028) e paratormônio (r = -0,152; p=0,006) e correlação positiva com cálcio sérico (r=0,132; p = 0,013) e fósforo (r=0,116; p=0,027). Conclusão: Os obesos graves apresentaram alta prevalência de hipovitaminose D, mesmo vivendo em um estado ensolarado.

Prevalence of risk factors for oral diseases in obese patients referred for bariatric surgery.

BACKGROUND: Obesity is a risk factor for several chronic diseases, and scientific evidence suggests an association between obesity and oral diseases. In this study, the authors estimated the prevalence of risk factors for caries, dental erosion, and periodontal disease in a group of obese patients referred for bariatric surgery. METHODS: The authors invited obese patients who were referred for bariatric surgery at a private center for treatment of obesity to participate in this study. The patients answered a questionnaire about their sociodemographic data, general and oral health histories, dietary habits, and oral health care behavior. RESULTS: The authors evaluated a total of 255 participants; 200 (78.4%) were women, the median (interquartile range) age was 36.0 (30.0-43.0) years, and the median (interquartile range) body mass index was 39.7 (37.6-43.5) kilograms per square meter. The authors observed a high prevalence of risk factors for dental erosion; 78.4% of the participants consumed acidic foods daily, and 92.2% consumed acidic beverages daily. With respect to risk factors for caries, 38.5% of the participants reported high sucrose intake, and 59.6% preferred sweet beverages and foods with sucrose. Almost 13% of the participants reported having or having had dental mobility, and 59.6% reported having or having had gingival bleeding, suggesting a history of periodontal disease. CONCLUSIONS: Obese patients referred for bariatric surgery are exposed to risks of experiencing oral diseases and should be evaluated by a dentist. PRACTICAL IMPLICATIONS: Knowing the risk factors for oral diseases in obese patients is important in raising awareness about these risk factors, as well as to prevent complications in the oral cavity.

Determinação do risco periodontal em usuários de antipsicóticos típicos / Determination of periodontal risk in patients under typical antipsychotic medications

Objetivo: avaliar o risco periodontal de portadores de transtorno mental e comportamental assistidos no Núcleo Docente Assistencial de Odontologia e Saúde Mental, vinculado ao Hospital Juliano Moreira, em Salvador. Material e métodos: 40 pacientes ( >= 18 anos) foram classificados em baixo, moderado e alto risco periodontal, por meio do polígono do risco preconizado por Lang & Tonetti (2003). Através do teste Qui-quadrado, foi calculada a associação entre o risco periodontal e idade, sexo, raça/etnia, escolaridade, renda mensal, índice de placa visível e modelo assistencial psiquiátrico. Resultados: 25% da amostra apresentou baixo risco periodontal, 35% médio risco e 40% alto risco. Após análise bivariada, o índice de placa foi a variável associada com alto risco periodontal. Conclusão: entre os portadores de transtornos mentais e comportamentais, usuários de antipsicóticos típicos, a maioria apresentou alta prevalência de médio e alto risco periodontal, e o alto risco periodontal teve associação com o elevado índice de placa ( >= 40%), não havendo correlação com as variáveis socioeconômicas e com o modelo assistencial psiquiátrico. Esses resultados podem subsidiar a implantação de ações de promoção, restauração e manutenção da saúde bucal dos pacientes psiquiátricos assistidos nas diferentes modalidades terapêuticas.

Objective: to evaluate the periodontal risk in patients with mental and behavioral disorders in Teaching Core Care Dentistry and Mental Health linked to Juliano Moreira Hospital, Bahia, Brazil and its association with age, gender, race/ethnicity, education level, monthly income, visible plaque index and model psychiatric care. Material and methods: 40 patients ( >= 18 years) were classified as low, moderate and high periodontal risk, through risk polygon by Lang & Tonetti (2003), and the association between periodontal risk and age, gender, race/ethnicity, education level, monthly income, visible plaque index and psychiatric assistencial model were calculated. Results: 25% of the sample presented a low periodontal risk, 35% medium risk and 40% high risk. After the bivariate analysis the plaque index was the variable associated with high periodontal risk. Conclusion: among patients with mental and behavioral disorders, users of typical antipsychotics, the majority showed high prevalence of medium and high risk periodontal and high periodontal risk was associated with the high plaque index ( >= 40%), there was no correlation between socioeconomic variables and the psychiatric assistencial model. These results may support the implementation of actions for the promotion, restoration and maintenance of oral health of psychiatric patients, assisted in different therapeutic modalities.

Mouthrinses: active ingredients, pharmacological properties and indications / Enxaguatórios bucais: princípios ativos, propriedades farmacológicas e indicações

Objective: To evaluate the formulations of 29 mouthrinses marketed in the city of Salvador, Bahia, Brazil, in 2011, with respect to active principles - antimicrobial-agents - and other components. Methods: Data collection was performed in commercial wide circulation. Product labels were evaluated, information recorded, and afterwards data were complemented by consulting the scientific literature. Results: Of the three chlorhexidine-containing mouthrinses, two contained 0.12% chlorhexidine gluconate or digluconate formulated in a free base concentration of chlorhexidine 0.067%, while the third did not report the concentration. Only two mouthwashes contained the antimicrobial agent triclosan at 0.03% concentration associated with PVA Gantrez copolymer at 0.2% concentration to stabilize it. Cetylpyridinium chloride is an antiseptic substance present in most mouthwashes available on the market, while products containing essential oils as active principles in their formulations, usually associate thymol, menthol, eucalyptol and methyl salicylate. Irrespective of the antibacterial agent, the mouthrinses typically have similar complementary substances, especially the addition of fluoride ions.Conclusion: There are a a wide variety of mouthrinses containing antimicrobial agents in a variety of different spectra on the Market, but no data are provided on other substances added to them. Among antimicrobial agents, the most frequently found in mouthwashes was cetylpyridinium chloride. It is important for the dentist to have adequate knowledge of the spectrum of action of each antimicrobial agent, in order to prescribe the most appropriate type in each case.

Objetivo: Avaliar a constituição de 29 enxaguatórios, comercializados na cidade do Salvador, Bahia, Brasil, em 2011, relacionado aos princípios ativos-agentes antimicrobianos - além dos demais componentes.Métodos: A coleta das informações foi realizada em estabelecimentos comerciais de ampla circulação. Para tanto foram avaliados os rótulos dos produtos, registradas as informações, seguindo-se de complementação dos dados mediante consultas à literatura científica. Resultados: Dos três enxaguatórios contendo clorexidina, dois contêm gluconato de clorexidina a 0,12% ou digluconato formulado para uma base livre de clorexidina na concentração de 0,067%, enquanto que o terceiro não informa a concentração. Apenas dois colutórios possuem o agente antimicrobiano triclosan na concentração de 0,03% associado ao copolímero PVA Gantrez na concentração de 0,2% para estabilizá-lo. O cloreto de cetilpiridínio é a substância anti-séptica que está presente na maioria dos enxaguatórios veiculados no mercado, enquanto que os produtos que contêm em suas formulações os óleos essenciais como princípios ativos, geralmente associam timol, mentol, eucaliptol e salicilato de metila. Independente do agente antibacteriano, os enxaguatórios em geral possuem substâncias complementares semelhantes, com destaque à adição o íon fluoreto. Conclusão: O mercado apresenta uma ampla variedade de enxaguatórios contendo relativa variedade de agentes antimicrobianos de diferentes espectros, contudo são limitadas as informações sobre as demais substâncias adicionadas aos mesmos; dentre os agentes antimicrobianos aquele encontrado com maior freqüência nos enxaguatórios é o cloreto de cetilpiridínio; é importante que o cirurgião-dentista tenha conhecimento adequado do espectro de ação de cada agente antimicrobiano a fim de prescrever o mais apropriado a cada caso.