Obesity bias: How can this underestimated problem affect medical decisions in healthcare? A systematic review.

INTRODUCTION: Obesity is often labeled as a physical characteristic of a patient rather than a disease and it is subject to obesity bias by health providers, which harms the equality of healthcare in this population. OBJECTIVE: Identifying whether obesity bias interferes in clinical decision-making in the treatment of patients with obesity. METHODS: A systematic review of observational studies published between 1993 and 2023 in MEDLINE, Embase, and Cochrane Library on obesity bias and therapeutic decisions was carried out. The last search was conducted on June 30, 2023. The main outcome was the difference between clinical decisions in the treatment of individuals with and without obesity. The Newcastle-Ottawa scale for observational studies was used to assess for quality. After the selection process, articles were presented in narrative and thematic synthesis categories to better organize the descriptive analysis. RESULTS: Of the 2546 records identified, 13 were included. The findings showed fewer screening exams for cancer in patients with obesity, who were also susceptible to less frequent pharmacological treatment intensification in the management of diabetes. Women with obesity received fewer pelvic exams and evidence of diminished visual contact and physician confidence in treatment adherence was reported. Some studies found no disparities in treatment for abdominal pain and tension headaches between patients presented with and without obesity. CONCLUSION: The presence of obesity bias has negative effects on medical decision-making and on the quality of care provided to patients with obesity. These findings reveal the urgent necessity for reflection and development of strategies to mitigate its adverse impacts. (The protocol was registered with the international prospective register of systematic reviews, PROSPERO, under the number CRD42022307567).

Type 1 diabetes and the challenges of emotional support in crisis situations: results from a feasibility study of a multidisciplinary teleintervention.

The association between type 1 diabetes and mental health disorders could be exacerbated in a stressful environment. This study aimed to evaluate the feasibility of a teleguided intervention on emotional disorders in patients with type 1 diabetes during the COVID-19 outbreak. This study was performed during the social distancing period in the COVID-19 outbreak in Brazil. Individuals with type 1 diabetes aged ≥ 18 years were selected to receive a teleguided multidisciplinary intervention or the usual care plus an educational website access. The proposed intervention aimed addressing aspects of mental health, diabetes care and lifestyle habits during the pandemic. The feasibility outcome included the assessment of recruitment capability and adherence to the proposed intervention. Moreover, we evaluated the presence of positive screening for emotional disorders (Self Report Questionnaire 20) after a 16-week intervention, patients' perceptions of pandemic-related changes, diabetes-related emotional distress, eating disorders, and sleep disorders. Data were analyzed with the intent-to-treat principle. Fifty-eight individuals (mean age, 43.8 ± 13.6 years) were included (intervention group, n = 29; control group, n = 29). At the end of the study, a total of 5 participants withdrew from the study in the intervention group compared to only 1 in the control group. Participants who dropout from the study had similar mean age, sex and income to those who remained in the study. The analysis of mental health disorders was not different between the groups at the follow up: a positive screening result was found in 48.3% and 34.5% of participants in the intervention and control groups, respectively (P = 0.29). The intervention group felt more supported in their diabetes care during the social distancing period (82.8% vs. 48.3% in the control group, P < 0.01). Our study identified a disproportionate higher number of withdrawals in the intervention group when compared to the control group. This difference may have compromised the power of the study for the proposed assessments and should be reevaluated in future studies.Trial registration: ClinicalTrials.gov (NCT04344210). Date of registration: 14/04/2020.

Type 1 diabetes and the challenges of emotional support in crisis situations: results from a randomized clinical trial of a multidisciplinary teleintervention.

The association between type 1 diabetes and mental health disorders could be exacerbated in a stressful environment. This study aimed to evaluate the effectiveness of a teleguided intervention on emotional disorders in patients with type 1 diabetes during the COVID-19 outbreak. An open-label clinical trial was performed during the social distancing period in the COVID-19 outbreak in Brazil. Individuals with type 1 diabetes aged ≥ 18 years were randomized to receive a teleguided multidisciplinary intervention or the usual care plus an educational website access. The primary outcome was a positive screening for emotional disorders (Self Report Questionnaire 20) after a 16-week intervention. Secondary outcomes included evaluation of patients' perceptions of pandemic-related changes, diabetes-related emotional distress, eating disorders, and sleep disorders. Data were analyzed with the intent-to-treat principle. Fifty-eight individuals (mean age, 43.8 ± 13.6 years) were included (intervention group, n = 29; control group, n = 29). The primary outcome was not different between the groups. The intervention group felt more supported in their diabetes care during the social distancing period (82.8% vs. 48.3% in the control group, P < 0.01). Both groups reported a similar self-perceived worsening of physical activity habits and mental health during the outbreak. There was no benefit to using the telehealth strategy proposed for emotional disorders in patients with type 1 diabetes during the COVID-19 outbreak. Further studies are needed to determine the impact on metabolic parameters and to understand why it is so difficult to emotionally support these patients.Trail Registration: ClinicalTrials.gov (NCT04344210), 14/04/2020.

Mental health in the era of COVID-19: prevalence of psychiatric disorders in a cohort of patients with type 1 and type 2 diabetes during the social distancing.

BACKGROUND: In patients with diabetes, the prevalence of depression and anxiety symptoms is about two to four times greater than in the general population. The association between diabetes and mental health disorders could be exacerbated in a stressful environment, and psychological distress could increase depressive symptoms and cause adverse diabetes outcomes. OBJECTIVES: To assess the prevalence of mental health disorders in patients with diabetes during the social distancing period due to COVID-19 pandemic. METHODS: This is a cross-sectional study developed to assess the impact of social distancing on a cohort of adults with type 1 (n = 52) and type 2 diabetes (n = 68) in Brazil. Inclusion criteria involved having an HbA1c test collected in the past 3 months and having a valid telephone number in electronic medical records. The primary outcome was the prevalence of minor psychiatric disorders, assessed by survey (SRQ-20). Secondary outcomes included the prevalence of diabetes related emotional distress, eating and sleeping disorders, all assessed by validated surveys at the moment of the study. Statistical analyses included unpaired t-test for continuous variables and χ 2 test for categorical variables. RESULTS: Overall (n = 120), participants had a mean age of 54.8 ± 14.4 years-old, and HbA1c of 9.0 ± 1.6% (75 ± 17.5 mmol/mol); 93% of patients showed signs of current mental suffering based on the surveys measured. Almost 43% of patients showed evidence of significant psychological distress, with a significant greater tendency in patients with type 2 diabetes. The presence of diabetes related emotional distress was found in 29.2% of patients; eating disorders in 75.8%; and moderate/severe sleeping disorders in 77.5%. CONCLUSIONS: We found a high prevalence of evidence of psychological distress among patients with diabetes during the COVID-19 pandemic and this highlights the need for mental health access and support for patients with type 1 and type 2 diabetes.

Efetividade da Terapia Medicamentosa e dos Procedimentos de Revascularização como Estratégia Inicial na Doença Arterial Coronariana Estável: Estudo de Coorte / Effectiveness of Medical and Revascularization Procedures as the Initial Strategy in Stable Coronary Artery Disease: A Cohort Study

Fundamento: A cirurgia de revascularização miocárdica (CRM) e a intervenção coronária percutânea (ICP) são estratégias amplamente utilizadas no manejo da doença arterial coronariana (DAC) estável. Objetivo: Avaliar o prognóstico de pacientes com DAC estável inicialmente tratada com terapia médica (TM), em comparação com os pacientes submetidos a procedimentos de revascularização. Métodos: Estudo prospectivo de coorte com 560 pacientes ambulatoriais de um hospital terciário com seguimento médio de 5 anos. Os pacientes foram classificados nos grupos TM (n = 288), ICP (n = 159) e CRM (n = 113) de acordo com sua estratégia inicial de tratamento. Os desfechos primários foram mortalidade global e eventos combinados de morte, síndrome coronária aguda e AVC. Resultados: Durante o seguimento, as taxas de mortalidade foram de 11,1% em TM, 11,9% em ICP e 15,9% em pacientes submetidos à CRM, sem diferença estatística (Hazard Ratio [HR] para ICP, 1,05; Intervalo de Confiança de 95% [IC95%], 0,59 a 1,84; e HR para CRM, 1,20; IC95%, 0,68 a 2,15). Os desfechos combinados ocorreram com maior frequência entre os pacientes inicialmente submetidos à ICP em relação à TM (HR 1,50, IC 95% 1,05 a 2,14) e não diferiram entre TM e CRM (HR 1,24, IC95% 0,84 a 1,83). Entre os pacientes com diabetes (n = 198), a ICP foi a única estratégia terapêutica preditiva de desfechos combinados (HR 2,14; IC 95%: 1,25 a 3,63). Conclusão: Neste estudo observacional de doença arterial coronariana estável, não houve diferença na mortalidade global entre as estratégias iniciais de terapia médico ou de cirurgia de revascularização. Os pacientes inicialmente tratados com ICP tiveram maior chance de desenvolver eventos cardiovasculares maiores combinados

Background: Coronary artery bypass grafting surgery (CABG) and percutaneous coronary intervention (PCI) are widely-used strategies in the management of stable coronary artery disease (CAD). Objective: To evaluate the prognosis of patients with stable CAD initially treated by medical therapy (MT), compared to the patients who were submitted to revascularization procedures. Methods: We conducted a prospective cohort study of 560 patients from an outpatient clinic in a tertiary hospital, with a mean follow-up of 5 years. Patients were classified into MT (n = 288), PCI (n = 159) and CABG (n=113) groups according to their initial treatment strategy. Primary endpoints were overall mortality and combined events of death, acute coronary syndrome, and stroke. Results: During follow-up, death rates were 11.1% in MT, 11.9% in PCI and 15.9% in CABG patients, with no statistical difference (hazard ratio [HR] for PCI, 1.05; 95% confidence interval [95%CI], 0.59 to 1.84; and HR for CABG, 1.20; 95% CI: 0.68 to 2.15). Combined outcomes occurred more often among patients initially submitted to PCI compared to MT (HR 1.50, 95% CI 1.05 to 2.14), and did not differ between MT and CABG patients (HR 1.24, 95% CI 0.84 to 1.83). Among patients with diabetes (n=198), PCI was the only therapeutic strategy predictive of combined outcomes (HR 2.14; 95% CI 1.25 to 3.63). Conclusion: In this observational study of stable coronary artery disease, there was no difference in overall mortality between initial medical therapy or revascularization surgery strategies. Patients initially treated with PCI had greater chance to develop combined major cardiovascular events

O papel da proteína ligadora de ácidos graxos como marcador para a detecção do infarto agudo do miocárdio / The paper of fatty acid-binding protein as marker for acute myocardial infarction detection

A proteína ligadora de ácidos graxos (FABP) possui baixo peso molecular (15kDa) e localização citosólica, estando presente em grandes concentrações nas células miocárdicas. Em virtude dessa características, recentemente seu uso tem sido proposto para a detecção precoce do infarto agudo do miocárdio. Aumentos significativos em sua concentração plasmática podem ser observados dentro de três horas do início dos sintomas, com retorno aos valores normais em torno de 24 horas. Além disso, sua sensibilidade e especificidade têm-se mostrado bastante elevadas. Os autores realizam extensa revisão do tema, abordando os principais aspectos desse novo marcador.

The fatty acid-binding protein (FABP) is a low molecular weight cytosolic protein (15kDa), found in high concentrations in myocardial cells. Due to these characteristics, is has recently been proposed its use to detect acute myocardial infarction. Plasmatic concentration values of this protein signicantly increased can be observed within three hours of the beginning of the symptoms and the level returns to normal in about 24 hours. In addition, its sensivity and specificity as biochemical infarction marker are very high. The authors reviewed this theme emphasizing the main positive aspects of this marker.

[Intramuscular hydatid cyst: a case report]. / Cisto hidático intramuscular: relato de caso.

The muscular localization of the hydatid cyst is uncommon (0.5 to 5.4%) and it is usually secondary to hepatic or pulmonary disease. A case of gluteus intramuscular hydatid cyst is reported, calling attention to this atypical localization of the disease, which should be taken into account in the practice of surgery. The absence of residual cysts in the most common sites confers a higher interest to the case reported in this work.

Cisto hidático intramuscular: relato de caso / Intramuscular hydatid cyst: a case report

A localizaçäo muscular dos cistos hidáticos é incomum (0,5 a 5,4 por cento) e geralmente secundária à doença hepática ou pulmonar. Reporta-se um caso de hidatidose intramuscular glútea, chamando-se a atençäo para essa localizaçäo atípica da doença, que deve ser considerada na prática cirúrgica. A inexistência de cistos concomitantes nas sedes mais comuns confere interesse ainda maior ao caso apresentado

Doença de Madelung / Madelung's disease

A doença de Madelung é uma patologia (cerca de 200 casos descritos na literatura), que acomete predominantemente indivíduos adultos, alcoolistas, do sexo masculino. Caracteriza-se por múltiplos depósitos simétricos de tecido adiposo nas regiöes cervical, torácica e abdominal. Sua etiologia näo está bem estabelecida e o tratamento ainda näo é efetivo. Descreve-se um caso da doença associada ao abuso crônico de álcool diagnosticado em Pelotas/RS.