Predictors of suicide attempt in patients with obsessive-compulsive disorder: an exploratory study with machine learning analysis.

BACKGROUND: Patients with obsessive-compulsive disorder (OCD) are at increased risk for suicide attempt (SA) compared to the general population. However, the significant risk factors for SA in this population remains unclear - whether these factors are associated with the disorder itself or related to extrinsic factors, such as comorbidities and sociodemographic variables. This study aimed to identify predictors of SA in OCD patients using a machine learning algorithm. METHODS: A total of 959 outpatients with OCD were included. An elastic net model was performed to recognize the predictors of SA among OCD patients, using clinical and sociodemographic variables. RESULTS: The prevalence of SA in our sample was 10.8%. Relevant predictors of SA founded by the elastic net algorithm were the following: previous suicide planning, previous suicide thoughts, lifetime depressive episode, and intermittent explosive disorder. Our elastic net model had a good performance and found an area under the curve of 0.95. CONCLUSIONS: This is the first study to evaluate risk factors for SA among OCD patients using machine learning algorithms. Our results demonstrate an accurate risk algorithm can be created using clinical and sociodemographic variables. All aspects of suicidal phenomena need to be carefully investigated by clinicians in every evaluation of OCD patients. Particular attention should be given to comorbidity with depressive symptoms.

Avaliação dos achados endoscópicos de DRGE no pré e pós-operatório de pacientes submetidos ao bypass gástrico em Y-de Roux e à gastrectomia vertical em hospital no sul de Santa Catarina, 2008 a 2013 / Pre- and postoperative endoscopic findings of GERD in patients submitted to Y-de Roux gastric bypass and vertical gastrectomy in a hospital in south Santa Catarina, 2008-2013

Introdução: A doença do refluxo gastroesofágico (DRGE) é muito frequente na população obesa. Atualmente, como tratamento cirúrgico para a obesidade e suas comorbidades, o bypass em Y-de Roux e a gastrectomia vertical tem sido as técnicas cirúrgicas mais utilizadas. Sabe-se que a endoscopia digestiva alta (EDA) é o método de escolha para o diagnóstico das lesões causadas pela DRGE e para a avaliação da evolução dessa patologia antes e após a cirurgia bariátrica. Objetivos: Analisar a resolução dos achados endoscópicos de DRGE em pacientes submetidos à cirurgia bariátrica, comparando a gastrectomia vertical e o bypass em Y-de Roux, além de associar com a perda de peso e a alteração no IMC dos pacientes. Métodos: Realizou-se um estudo transversal observacional por conveniência dos prontuários de 53 pacientes submetidos à cirurgia bariátrica com achados endoscópicos de DRGE no pré e/ou pós-operatório de 3 meses, no período de 2008 a 2013. Foram avaliadas a variação do peso, IMC e a presença ou não de esofagite no pré e pós-operatório através da classificação endoscópica de Los Angeles. Resultados/Conclusão: Não houve diferença na perda de peso em 3 meses pós-operatórios entre os pacientes submetidos ao bypass em Y-de Roux e à gastrectomia vertical. Entretanto, a piora dos achados endoscópicos de DRGE no pós-operatório de 3 meses foi 4 vezes maior na gastrectomia vertical quando em comparação com o bypass em Y-de Roux.

Introduction: Gastroesophageal reflux disease (GERD) is very common in the obese population. Currently, Y-of-Roux bypass and vertical gastrectomy have been the most common surgical techniques for treatment of obesity and its comorbidities,. It is known that upper digestive endoscopy (UDE) is the method of choice for diagnosing lesions caused by GERD and evaluating the evolution of this disorder before and after bariatric surgery. Aims: To analyze the resolution of endoscopic findings of GERD in patients undergoing bariatric surgery by comparing vertical gastrectomy and Y-of-Roux bypass, and to associate these with weight loss and change in patient BMI. Methods: We conducted an observational cross-sectional study by convenience of 53 records from patients undergoing bariatric surgery with endoscopic findings of GERD preoperatively and/or during the 3-month post operative period, from 2008 to 2013. We evaluated change in weight, BMI and presence or absence of esophagitis preoperatively and postoperatively using the Los Angeles endoscopic classification. Results/Conclusion: There was no difference in weight loss between patients undergoing Y-of-Roux bypass and vertical gastrectomy during the 3-month post operative period. However, the worsening of endoscopic findings of GERD in this period was four times higher in vertical gastrectomy than in Y-of-Roux bypass.

GLYCEMIC BEHAVIOR IN 48 HOURS POSTOPERATIVE PERIOD OF PATIENTS WITH TYPE 2 DIABETES MELLITUS AND NON DIABETIC SUBMITTED TO BARIATRIC SURGERY.

UNLABELLED: Although there is no indication for surgery taking only into account the glycemic condition, results have shown that benefits can be obtained in glycemic control with bariatric surgery. AIM: To compare the glycemic behavior among type 2 diabetic and non-diabetic patients within 48 h after bariatric surgery, and clarify whether there is a reduction in blood glucose level in obese patients with diabetes before the loss of weight excess. METHODS: Descriptive epidemiological study with prospective cohort design with 31 obese patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy. The patients were controlled with hemoglucotests in different periods of time: preoperative, postoperative and each 6 h after surgery for 48 h. RESULTS: Average ambulatory blood glucose in diabetics was 120.7±2.9 mg/dl vs 91.8±13.9 mg/dl in the nondiabetic. After 48 h there was decrease in diabetics to 100.0±17.0 mg/dl (p=0.003), while the non-diabetic group did not change significantly (102.7±25.4 mg/dl; p=0.097). There were no differences between the surgical techniques. There were no death. CONCLUSIONS: Diabetic patients significantly reduced blood glucose after surgery regardless of the use of exogenous insulin or oral hypoglycemic agents.

GLYCEMIC BEHAVIOR IN 48 HOURS POSTOPERATIVE PERIOD OF PATIENTS WITH TYPE 2 DIABETES MELLITUS AND NON DIABETIC SUBMITTED TO BARIATRIC SURGERY / COMPORTAMENTO GLICÊMICO NO PÓS-OPERATÓRIO DE 48 HORAS DE PACIENTES DIABÉTICOS TIPO 2 OU NÃO DIABÉTICOS SUBMETIDOS À CIRURGIA BARIÁTRICA

Although there is no indication for surgery taking only into account the glycemic condition, results have shown that benefits can be obtained in glycemic control with bariatric surgery.Aim: To compare the glycemic behavior among type 2 diabetic and non-diabetic patients within 48 h after bariatric surgery, and clarify whether there is a reduction in blood glucose level in obese patients with diabetes before the loss of weight excess.Methods: Descriptive epidemiological study with prospective cohort design with 31 obese patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy. The patients were controlled with hemoglucotests in different periods of time: preoperative, postoperative and each 6 h after surgery for 48 h.Results: Average ambulatory blood glucose in diabetics was 120.7±2.9 mg/dl vs 91.8±13.9 mg/dl in the nondiabetic. After 48 h there was decrease in diabetics to 100.0±17.0 mg/dl (p=0.003), while the non-diabetic group did not change significantly (102.7±25.4 mg/dl; p=0.097). There were no differences between the surgical techniques. There were no death.Conclusions: Diabetic patients significantly reduced blood glucose after surgery regardless of the use of exogenous insulin or oral hypoglycemic agents.

Racional: Apesar de não haver indicação cirúrgica levando-se exclusivamente em consideração apenas o estado glicêmico, resultados já revelaram que pode ser obtido benefício no controle da glicemia com operação bariátrica.Objetivos: Comparar o comportamento glicêmico dos pacientes diabéticos tipo 2 ou não nas 48 h após cirurgia bariátrica, e esclarecer se há redução nos níveis glicêmicos de obesos com diabete antes da perda de excesso de peso.Métodos: Realizou-se estudo epidemiológico descritivo com delineamento de coorte prospectiva de 31 pacientes obesos submetidos ao bypass gástrico em Y-de-Roux e gastrectomia vertical. Acompanhou-se o hemoglicoteste nos momentos pré, trans, pós-operatório e a cada 6 h após a operação durante 48 h.Resultados: A glicemia ambulatorial média nos diabéticos era 120,7±2,9 mg/dl vs 91,8±13,9 mg/dl nos não diabéticos. Após 48 h houve queda nos diabéticos para 100,0±17,0 mg/dl (p=0,003), enquanto o grupo não diabético não se modificou de forma significante (102,7±25,4 mg/dl; p=0,097). Não houve diferenças quanto às técnicas cirúrgicas empregadas. Não houve óbito.Conclusões: Os pacientes diabéticos reduziram significativamente a glicemia após a operação independentemente do uso de insulina exógena ou drogas hipoglicemiantes orais.