Long-term chronic joint pain after sleeve gastrectomy and its influence on clinical and psychological outcomes.

INTRODUCTION: Bariatric surgery (BS) is effective in improving chronic joint pain (CJP). However, the long-term effects on this comorbidity are poorly understood. OBJECTIVES: To determine the prevalence of CJP in a sample of patients who had undergone BS with a minimum follow-up of 18 months. To determine whether or not there was any relationship between CJP and clinical or psychological outcomes after BS. MATERIAL AND METHODS: Cross-sectional study. The Lattinen index (LI) was used to evaluate CJP, using the cut-off point of 10 to define significant CJP (SCJP). RESULTS: Of the 110 subjects assessed, 31.2% (35/110) had SCJP. The patients with SCJP were older (57.4±13 vs 47.8±11.6 years; p<0.0001) and more time had elapsed since their BS (105.6±54.3 vs 78.5±39 months; p=0.023). The last BMI was higher in subjects with SCJP (35±5 vs 33.3±6.9kg/m2; p=0.05) and the percentage of patients who took significant regular exercise was lower (2.9% vs 68%; p<0.0001). Trauma problems after BS were more common in subjects with SCJP (61.8% vs 22.7%; p<0.0001). More patients with SCJP met depression criteria (47.1% vs 5.3%; p<0.0001) and/or were treated with antidepressants (38.2% vs 17.3%; p=0.003). Patients with SCJP reported fewer hours of sleep (6±1.4 vs 6.8±1.2h; p=0.003). CONCLUSIONS: SCJP is highly prevalent in patients who have had BS once they reach the weight plateau phase. There is an association between having SCJP and worse psychological and functional status, with potential detrimental metabolic effects.

Long-Term Prevalence of Food Addiction Among Bariatric Surgery Patients: Influence on Metabolic and Psychological Outcomes.

Background: We wanted to assess the prevalence of individuals with food addiction (FA) among bariatric surgery (BS) patients at long term and to determine if there was any relationship between FA and both clinical and psychological outcomes at the time of the evaluation. Methods: Participants were evaluated for the presence of FA with the Yale Food Addiction Scale 2.0. Results: Of 134 subjects, 32 (23.9%) included met criteria for FA. The frequency of patients with depression at the time of the evaluation was greater among subjects with FA (34.4% vs. 11.8%; P = 0.006). The score obtained with the Beck Depression Inventory at the time of the evaluation was greater among subjects with FA (14.8 ± 11.5 vs. 6 ± 6.5; P < 0.0001). The frequency of subjects with FA who had criteria for binge eating disorder at the time of the evaluation was significantly greater (56.3% vs. 20.5%; P < 0.001). Patients with FA scored higher in the Lattinen index for chronic pain at the time of the evaluation (8.7 ± 5.9 vs. 5.8 ± 5.4; P = 0.014). However, clinical outcomes were similar between the two groups. Conclusions: Routine screening for FA at long term postoperatively should be recommended to improve psychological outcomes of BS.

Three years prospective clinical and radiologic follow-up of laparoscopic sacrocolpoperineopexy.

BACKGROUND: When Rectocele is part of a complex pelvic organ prolapse, a full repair is recommended. The aim of this study was to evaluate the clinical and radiological results after laparoscopic surgery in patients with symptomatic rectocele and III/IV stage vaginal vault prolapse METHODS: This is a prospective cohort study of women with symptomatic rectoceles and middle compartment prolapse operated on between 2013 and 2015, who underwent a laparoscopic sacrocolpoperineopexy with synthetic Y mesh attached to puborectalis muscles, the anterior and posterior vagina wall and the sacrum. The clinical outcomes measured were symptoms of prolapse, obstructive defecation syndrome and quality of life. Radiological outcomes were distance of the vaginal vault below pubococcigeal line and depth of rectovaginal wall protrusion in dynamic pelvic resonance. RESULTS: 33 patients were included. 32 of them remained asymptomatic after a three years follow-up. Significant differences were shown in the obstructed defecation score and quality of life after 6, 12 and 36 months compared to preoperatively. No differences were identified when the postoperative results were compared. Significant differences were shown in preoperative vaginal vault prolapse (3.2 cms ± 0.8 SD below the pubococcigeal Line) and rectocele size, compared with 1 and 3 years after surgery. There were no significant differences in vaginal vault prolapse when compared after 1 and 3 years. When rectocele size after 1 and 3 years was compared, significant differences were shown, but only one clinical recurrence (3%) was identified after a mean follow-up of 47 months. CONCLUSIONS: Laparoscopic sacrocolpoperineopexy in patients with symptomatic rectocele and III/IV vaginal vault prolapse solves the constipation and obstructed defecation with an excellent quality of life and low clinical recurrences. Radiological deterioration, especially in rectocele size, was identified in the mid-term follow-up without clinical significance.

Reliability of blood test results in samples obtained using a 2-mL discard volume from the proximal lumen of a triple-lumen central venous catheter in the critically ill patient.

BACKGROUND: Intensive care patients require a high frequency of blood testing, which results in a significant amount of blood loss. When blood is obtained from a central venous catheter (CVC), a large volume is usually discarded to obtain an unaltered sample for testing. AIM: To determine the reliability of complete blood test results in blood samples obtained from the proximal lumen of a triple-lumen CVC using a 2-mL discard volume DESIGN: Observational study with the prospective collection of data METHODS: The subjects enrolled were all patients with a subclavian triple-lumen CVC, older than 17 years and consecutively admitted to intensive care over a 2-year period. In each of the 54 participants, one blood sample was drawn from the proximal lumen of the catheter, discarding 1·61 mL of blood plus 0·39 mL of catheter deadspace (2 mL) and without interrupting infusion in the middle and distal lumens. A second sample was then obtained by direct venous puncture. The reliability of blood test results was determined by comparing sets of variables recorded for the two sampling methods through intraclass correlation coefficients in the Bland-Altman method. RESULTS: Inter-method reliability for the variables examined was excellent, >0·75; range (0·868-0·998). Mean differences between the two sample types for the variables most often determined in critically ill patients were leukocytes: 0·200 × 103 /µL, 95% confidence interval (CI) (0·025 to 0·375); erythrocytes: 0·045 × 106 /uL, 95% CI (-0·003 to 0·094); sodium: 0·074 mEq/L, 95% CI (-0·369 to 0·517); potassium: -0·002mEq/L, 95% CI (-0·065 to 0·061) and glucose: 2·426 mg/dL, 95% CI (0·498-4·354). CONCLUSIONS: The sampling method proposed minimizes blood loss while offering reliable blood test results. RELEVANCE TO CLINICAL PRACTICE: The main benefit of the method proposed is reduced blood loss, improving the care of a critically ill patient.

Are subjects with criteria for adult attention-deficit/ hyperactivity disorder doing worse after bariatric surgery? A case-control study / ¿Tienen peores resultados los individuos con criterios para trastorno por déficit de atención/ hiperactividad tras la cirugía bariátrica? Estudio de casos y controles

Introduction: There is an increasing awareness of the strong associations between obesity and adult attention-deficit/hyperactivity disorder (ADHD), with high rates of ADHD (26-61%) in patients seeking weight loss. Aims: To determine the frequency of ADHD in a bariatric surgery (BS) sample and investigate whether there were any differences among clinical, analytical and psychological parameters in individuals with criteria for ADHD. Methods: Sixty patients (78.3% female, age 46.3±9.8, months since BS 46.28±18.1) who underwent BS, with a minimum follow-up of 18 months, were evaluated cross-sectionally. Initial and current BMI, eating patterns, comorbidity, socio-demographic and biochemical parameters were recorded. For the screening of ADHD, ADHD self rating scale-v1.1 was administered. Results: Nineteen individuals (31.6%) had a positive screening for ADHD. This group had higher levels of HDL-cholesterol (62.8±17.3mg/dl vs 53.5±9.9mg/dl; p=0.011) and Apo-A (177.7±28.4mg/dl vs 154.9±34.7mg/ dl; p=0.015), and an increased consumption of lipids (42.2±7.1% vs 36.7±8.3%; p=0.019). Subjects with ADHD symptoms had more difficulties in following visits after BS (52.6% vs 24.3%; p= 0.011).We could not find any differences in achieved BMI, depressive symptoms or quality of life. Conclusions: Patients who met criteria for ADHD face significant difficulties with compliance in follow-up, but we could not find differences in major clinical outcomes. Surprisingly, these patients could have a protective lipid profile (AU)

Introducción: Hay una creciente concienciación de la fuerte asociación entre la obesidad y el trastorno por déficit de atención/hiperactividad del adulto (TDAH), con elevadas tasas de TDAH (26-61%) en los pacientes que consultan por pérdida ponderal. Objetivos: conocer la frecuencia del TDAH en una muestra de sujetos sometidos a cirugía bariátrica (CB) e investigar si existen diferencias clínicas, analíticas y psicológicas en estos sujetos. Métodos: Sesenta pacientes (78.3% mujeres, edad 46.3±9.8, meses desde la CB 46.28±18.1) sometidos a CB, con un seguimiento mínimo desde ésta de 18 meses, fueron evaluados transversalmente. Se recogieron y analizaron el IMC inicial y en el momento de la evaluación, patrones alimentarios, comorbilidades, y parámetros sociodemográficos y bioquímicos. Para el screening del TDAH se administró la versión española del 'ADHD self-rating scale v 1.1'. Resultados: Diecinueve individuos (31.6%) tenían un screening positivo para TDAH. Estos sujetos tenían niveles superiores de HDL colesterol (62.8±17.3mg/dl vs 53.5±9.9mg/dl; p=0.011) y Apo-A (177.7±28.4mg/dl vs 154.9±34.7mg/dl; p=0.015), y un consumo mayor de lípidos en la dieta (42.2±7.1% vs 36.7±8.3%; p=0.019). Estos sujetos tenían más dificultades en seguir las visitas protocolizadas tras la CB (52.6% vs 24.3%; p= 0.011). No se evidenciaron diferencias en el IMC alcanzado, síntomas depresivos o calidad de vida. Conclusiones: Los pacientes sometidos a CB con criterios para TDAH presentan más dificultades en la adherencia al seguimiento, pero no se evidenciaron diferencias en resultados clínicos relevantes. Curiosamente, estos sujetos podrían presentar un perfil lipídico protector (AU)

Cardiovascular risk profile in Mediterranean patients submitted to bariatric surgery and intensive lifestyle intervention: impact of both interventions after 1 year of follow-up.

BACKGROUND: The aim was to compare obesity-related cardiovascular (CV) risk factors (classic and emerging) and the estimated CV risk at 10 years (calculated by REGICOR) in obese Mediterranean patients submitted to bariatric surgery and intensive lifestyle intervention at baseline and after 1 year of follow-up. METHODS: Patients submitted to bariatric surgery (n = 108) and standardized program of therapeutic changes in lifestyle (n = 90) were retrospectively included. Clinical history, physical examination, and laboratory analysis were routinely determined before weight loss intervention and at 1 year follow-up. RESULTS: Seventy-five percent of the surgery patients had a CV risk lower than 5 % and not one patient had a 10-year CV risk higher than 15 %. The percentage of patients with comorbidities (diabetes and sleep apnea syndrome) was higher in the surgery group. Seventeen of the surgery patients had no comorbidities. The improvement in CV risk profile was significant higher in the surgery group. CV risk benefit of both intervention groups was related to baseline higher CV risk, with type 2 diabetes with poor metabolic control and high cholesterol levels being the most important predictors for surgery patients. Neither body mass index nor excess of weight loss was related to CV risk improvement. CONCLUSIONS: Mediterranean patients undergoing a weight loss intervention have a low CV risk. In comparison with lifestyle intervention, surgery induces a better improvement of CV risk. This benefit is related to estimated CV risk, presence of diabetes, and cholesterol levels at baseline. These observations should be taken into account in order to optimize health resources.

Are subjects with criteria for adult attention-deficit/ hyperactivity disorder doing worse after bariatric surgery? A case-control study.

INTRODUCTION: There is an increasing awareness of the strong associations between obesity and adult attention- deficit/hyperactivity disorder (ADHD), with high rates of ADHD (26-61%) in patients seeking weight loss. AIMS: To determine the frequency of ADHD in a bariatric surgery (BS) sample and investigate whether there were any differences among clinical, analytical and psychological parameters in individuals with criteria for ADHD. METHODS: Sixty patients (78.3% female, age 46.3±9.8, months since BS 46.28±18.1) who underwent BS, with a minimum follow-up of 18 months, were evaluated cross-sectionally. Initial and current BMI, eating patterns, comorbidity, socio-demographic and biochemical parameters were recorded. For the screening of ADHD, ADHD self rating scale-v1.1 was administered. RESULTS: Nineteen individuals (31.6%) had a positive screening for ADHD. This group had higher levels of HDL-cholesterol (62.8±17.3 mg/dl vs 53.5±9.9 mg/dl; p=0.011) and Apo-A (177.7±28.4 mg/dl vs 154.9±34.7 mg/ dl; p=0.015), and an increased consumption of lipids (42.2±7.1% vs 36.7±8.3%; p=0.019). Subjects with ADHD symptoms had more difficulties in following visits after BS (52.6% vs 24.3%; p= 0.011).We could not find any differences in achieved BMI, depressive symptoms or quality of life. CONCLUSIONS: Patients who met criteria for ADHD face significant difficulties with compliance in follow-up, but we could not find differences in major clinical outcomes. Surprisingly, these patients could have a protective lipid profile.

Introducción: Hay una creciente concienciación de la fuerte asociación entre la obesidad y el trastorno por déficit de atención/hiperactividad del adulto (TDAH), con elevadas tasas de TDAH (26-61%) en los pacientes que consultan por pérdida ponderal. Objetivos: conocer la frecuencia del TDAH en una muestra de sujetos sometidos a cirugía bariátrica (CB) e investigar si existen diferencias clínicas, analíticas y psicológicas en estos sujetos. Métodos: Sesenta pacientes (78.3% mujeres, edad 46.3±9.8, meses desde la CB 46.28±18.1) sometidos a CB, con un seguimiento mínimo desde ésta de 18 meses, fueron evaluados transversalmente. Se recogieron y analizaron el IMC inicial y en el momento de la evaluación, patrones alimentarios, comorbilidades, y parámetros sociodemográficos y bioquímicos. Para el screening del TDAH se administró la versión española del "ADHD self-rating scale v 1.1". Resultados: Diecinueve individuos (31.6%) tenían un screening positivo para TDAH. Estos sujetos tenían niveles superiores de HDL colesterol (62.8±17.3mg/dl vs 53.5±9.9mg/dl; p=0.011) y Apo-A (177.7±28.4mg/dl vs 154.9±34.7mg/dl; p=0.015), y un consumo mayor de lípidos en la dieta (42.2±7.1% vs 36.7±8.3%; p=0.019). Estos sujetos tenían más dificultades en seguir las visitas protocolizadas tras la CB (52.6% vs 24.3%; p= 0.011). No se evidenciaron diferencias en el IMC alcanzado, síntomas depresivos o calidad de vida. Conclusiones: Los pacientes sometidos a CB con criterios para TDAH presentan más dificultades en la adherencia al seguimiento, pero no se evidenciaron diferencias en resultados clínicos relevantes. Curiosamente, estos sujetos podrían presentar un perfil lipídico protector.

[Nutrition iodine status in pregnant women in the sanitary district Sierra de Huelva-Andévalo, South of Spain]. / Deficiencia nutricional de yodo en gestantes pertenecientes al distrito sanitario Sierra de Huelva-Andévalo, sur de España.

BACKGROUND: Iodine is an essential trace element implicated in synthesis of thyroid hormones. Iodine requirements vary throughout life. This iodine requirement is increased during pregnancy and breastfeeding. In a previous study carried out by our group in 2008, we detected an iodine-deficient area in the province of Huelva, specially in district Sierra de Huelva-Andévalo by means of neonatal TSH determinations. OBJECTIVE: To reinforce the iodine supplementation campaign and its impact on their newborns in order to assess nutrition iodine status in pregnant women using questionnaire and ioduria determination. MATERIAL AND METHODS: This study has been jointly carried out by Congenital Hypothyroidism Unit of the Clinical Biochemistry Department of the Virgen Macarena University Hospital (Seville) and the Gynecology and Clinical Analysis Unit of the Río Tinto Hospital (Huelva) during two years. We studied 313 pregnant women. All of them filled out a personal questionnaire to know the iodine nutritional status in their area. Ioduria was determinated by high-resolution liquid chromatography. Data from pregnant women and results of the studied variables were analyzed with SPSS v13.0. CONCLUSIONS: Pregnant women from the sanitary district Sierra de Huelva-Andévalo present a median for ioduria which corresponds to an insufficient iodine intake according to the WHO classification. The questionnaires suggest that this iodine deficiency is consequence of an insufficient iodine intake and a low adherence to the treatment.

Technical feasibility of totally natural orifice cholecystectomy in a swine model.

The goal of this study was to evaluate the feasibility of totally NOTES performing a cholecystectomy without laparoscopic assistance. A gastroscope was used through a transvaginal access in five acute female pigs. An incision of 2 cm was created in the vagina and pneumoperitoneum was obtained with a Veress needle. The gallbladder was located in the abdominal cavity using endoscopic transillumination for spatial orientation. After the abdominal suspension of the gallbladder the cholecystectomy was completed with the NOTES technique in four animals without complications. In one animal we had technical problems and the procedure was stopped. The mean operative time was 110 minutes. The transvaginal approach provides complete abdominal exploration and both the cystic duct and artery were identified, clipped, and transected. After dissection the gallbladder was removed through the vagina. Our results showed that completely transvaginal NOTES cholecystectomy is a feasible technique performed only with a flexible endoscope.

Continuous vagus nerve stimulation effects on the gut-brain axis in Swine.

Objectives. This study was designed to assess vagus nerve stimulation effects on the food intake pattern in swine and determine the electrical stimulus direction. Material and Methods. Fifteen Large White pigs were randomly divided into three groups, groups A-C. All animals underwent implantation of a vagus nerve stimulator at the gastro-esophogeal junction. In group A, the stimulation was switched off, whereas stimulation was switched on in groups B and C. Food intake and body weight were registered in groups A and B, but not in group C, which was used to measure direction of stimulation in the vagus and effect on heart rate and blood pressure. Variables measured in group C included the bispectral index, blood pressure, and heart rate. A Student's t-test and one-way analysis of variance were used to detect differences between groups. All animals were sacrificed to identify effects of implantation and stimulation on the vagus nerve. Results. With respect to food intake, there was no difference between groups A and B; however, body weight did register a continuous increase. During stimulation, in group C arterial pressures decreased significantly, whereas the heart rate and bispectral index increased. Conclusion. The stimulation protocol applied in this study was insufficient to cause changes in the feeding behavior of swine; however, it did increase central nervous system activity.

[Malnutrition at an internal medicine service: impact of patients coming from homes for the elderly]. / Malnutrición en un servicio de Medicina Interna: influencia de los pacientes procedentes de residencias de ancianos.

OBJECTIVES: To compare nutritional state of patients referred from nursing homes (NH) and patients coming from their own home. PATIENTS AND METHODS: Several variables were recorded from patients being admitted to an internal medicine ward for a month. Sixty-six patients were included (36 women and 30 men). The mean age of studied patients was 75.7 +/- 14.4 years. RESULTS: Patients referred from NH had a tricipital skin fold (11.7 +/- 7.5 mm) thinner than patients coming from their home (14.4 +/- 6.5 mm, p = 0.08). Plasma albumin levels were lower in patients with advanced cancer (3 +/- 0.6 g/dl) than in remainder patients (3.2 +/- 0.6 g/dl, p > 0.05). Patients being fed by nasogastric tube had lower plasma levels (2.6 +/- 0.5) than any other patients (3.3 +/- 0.6, p = 0.03). In patients coming from their own home, febrile diseases were associated with a thinner tricipital skin fold and lower plasmatic albumin. CONCLUSIONS: Patients referred from NH and patients being fed by nasogastric tube presented a deficient protein-energy nutritional state. Febrile diseases were associated with a deficient nutritional state in patients coming from their own home.

Malnutrición en un servicio de Medicina Interna: influencia de los pacientes procedentes de residencias de ancianos / Malnutrition in a internal medicine ward: influence of patients referred from nursing homes

Objetivo. El objetivo fue comparar el estado nutricional de enfermos remitidos desde una residencia de ancianos (RA) con el de pacientes procedentes de su domicilio particular. Pacientes, material y métodos. Durante un 1 mes se recogieron un conjunto de variables en sesenta y seis pacientes (36 mujeres y 30 varones) ingresados en una sala de medicina interna. La edad de los individuos estudiados fue de 75,7 ± 14,4 años. Resultados. Los pacientes remitidos desde un RA tuvieron un grosor del pliegue tricipital (11,7 ± 7,5 mm) de menor magnitud que los procedentes de su domicilio particular (14,4 ± 6,5 mm; p=0,08). La concentración de albúmina plasmática en pacientes con neoplasias diseminadas (3,0 ± 0,6 g/dl) fue más baja que en el resto de enfermos (3,2 ± 0,6 g/dl; p > 0,05). Los pacientes que estaban siendo alimentados por sonda nasogástrica (SNG) tuvieron una concentración plasmática de albúmina (2,6 ± 0,5 g/dl) muy inferior a la de los restantes pacientes (3,3 ± 0,6, p=0,03). Las enfermedades febriles se asociaron con un pliegue tricipital y una concentración plasmática de albúmina inferiores en enfermos procedentes de su domicilio particular. Conclusiones. Los pacientes que procedían de una RA y los enfermos alimentados mediante SNG presentaron un estado nutricional proteico-energético deficiente. Las enfermedades febriles se asociaron con un estado nutricional deficiente en pacientes procedentes de su domicilio particular (AU)