Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-05-16T12:16:46Z No. of bitstreams: 1 ANA_CRISTINA_DE_ASSUN??O_MACHADO.pdf: 2307269 bytes, checksum: f988b87a36ecbd0076d96a75830655c8 (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2018-05-16T12:59:41Z (GMT) No. of bitstreams: 1 ANA_CRISTINA_DE_ASSUN??O_MACHADO.pdf: 2307269 bytes, checksum: f988b87a36ecbd0076d96a75830655c8 (MD5) / Made available in DSpace on 2018-05-16T13:06:15Z (GMT). No. of bitstreams: 1 ANA_CRISTINA_DE_ASSUN??O_MACHADO.pdf: 2307269 bytes, checksum: f988b87a36ecbd0076d96a75830655c8 (MD5) Previous issue date: 2018-02-26 / Introduction: Obesity is one of the most important nutritional diseases in the modern world, especially in its abdominal form, where adipose tissue implies a higher cardiovascular risk and is responsible for inflammatory phenomena. Abdominal obesity predisposes to calcification of the coronary arteries and endothelial dysfunction, as well as the occurrence of other comorbidities such as hypertension diabetes and Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). OSAHS leads to decreased quality of life (QOL) and functional capacity, together with an increased risk of cardiovascular disease, predisposing to higher rates of morbidity and mortality. Objectives: To evaluate the impact of weight loss in the first six months after bariatric surgery on endothelial function in patients with and without obstructive sleep apnea syndrome (OSAHS). Methodology: the sample consisted of 56 patients homogeneously divided into groups without OSAHS (control group) and with OSAHS (OSAHS). All patients were evaluated in the Roux-en-Y Gastric Bypass (RYGB) preoperative period and six months after surgery. OSAHS diagnosis in the preoperative period was performed using instruments validated for apnea tracking and confirmed by polysomnography. The evaluations included anthropometric measurements, electrical bioimpedance, clinical symptoms of OSAHS and endothelial function, through the flow-mediated dilatation (FMD) of the brachial artery. Results: weight loss induced by surgery improved the anthropometric, bioimpedance and endothelial function results in both groups. Patients presented a significant clinical improvement in the symptoms of OSAHS throughout the study. However, patients with OSAHS had an improvement in the endothelial function 2.5% lower (p <0.001) than the control group. Conclusion: this study shows that the presence of OSAHS before bariatric surgery interferes in the clinical picture, interfering in the improvement of endothelial function. / Introdu??o: a obesidade ? uma das doen?as nutricionais mais importantes do mundo moderno, principalmente, em sua forma abdominal, onde o tecido adiposo implica em maior risco cardiovascular e ? respons?vel por fen?menos inflamat?rios. A obesidade abdominal predisp?e ? calcifica??o das art?rias coron?rias e ? disfun??o endotelial, bem como ao aparecimento de outras comorbidades como a hipertens?o, a diabetes e a S?ndrome da Apneia Hipopneia Obstrutiva do Sono (SAHOS). A SAHOS leva ? diminui??o da qualidade de vida (QV) e da capacidade funcional, juntamente com um risco aumentado de doen?a cardiovascular, predispondo a maiores ?ndices de morbidade e mortalidade. Objetivos: avaliar o impacto da perda de peso ocorrida nos primeiros seis meses ap?s a realiza??o da cirurgia bari?trica sobre a fun??o endotelial em pacientes, com e sem s?ndrome da apneia hipopneia obstrutiva do sono (SAHOS). Metodologia: a amostra foi composta por 56 pacientes homogeneamente divididos em grupos sem SAHOS (grupo controle) e com SAHOS (SAHOSG). Todos os pacientes foram avaliados no pr?-operat?rio do Bypass G?strico em Y de Roux (RYGB) e seis meses ap?s a cirurgia. O diagn?stico de SAHOS no pr?-operat?rio foi realizado atrav?s dos instrumentos validados para rastreamento de apneia e confirmados por polissonografia. As avalia??es compreenderam medidas antropom?tricas, bioimped?ncia el?trica, sintomas cl?nicos de SAHOS e fun??o endotelial, pela dilata??o mediada pelo fluxo (FMD) da art?ria braquial. Resultados: o emagrecimento induzido pela cirurgia melhorou os resultados antropom?tricos, da bioimped?ncia e da fun??o endotelial em ambos os grupos. Os pacientes apresentaram uma sens?vel melhora cl?nica nos sintomas da SAHOS ao longo do estudo. Entretanto, os pacientes com SAHOS, apresentaram uma melhora na fun??o endotelial 2,5% menor (p< 0.001) que o grupo controle. Conclus?o: Este estudo demostrou que a presen?a de SAHOS, previamente ? cirurgia bari?trica, interfere no quadro cl?nico e na melhora da fun??o endotelial.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2017-02-15T12:32:08Z No. of bitstreams: 1 DANIELA VICINANSA MONACO FERREIRA.pdf: 2575283 bytes, checksum: e154c9b7ae508a96205c1d597a55aee6 (MD5) / Made available in DSpace on 2017-02-15T12:32:08Z (GMT). No. of bitstreams: 1 DANIELA VICINANSA MONACO FERREIRA.pdf: 2575283 bytes, checksum: e154c9b7ae508a96205c1d597a55aee6 (MD5) Previous issue date: 2016-12-01 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Morbid obesity, a chronic and multifactorial disease, causes metabolic disorders and increases the risk of morbidity. Its prevalence has been increasing, with alarming data in Brazil and elsewhere. Globally, Brazil ranks second in number of bariatric surgeries, but surgical treatment is a challenge for the patients and the teams that provide care for these patients. Given the above, the present study aimed to assess changes in nutritional status and identify nutritional deficiencies before and 10 years after Roux-en-Y gastric bypass. This retrospective study lasted two years and included 166 patients submitted to Roux-en-Y gastric bypass at a private clinic. The statistical analyses included the chi-square, Fisher?s, Mann-Whitney, and Wilcoxon tests, analysis of variance (ANOVA), and generalized estimating equations. The significance level was set at 5%. At the ten-year follow-up, the percentage of excess weight loss (%EWL), body mass index (BMI), and weight regain were 51.64?18.03 (p<0.0001), 32.53?4.83 kg/m2 (p<0.0001), and 41% (p<0.0001), respectively, and the lipid and blood glucose profiles had improved (p<0.0001). Iron-deficiency anemia was found in 37.5% and 45.0% of the patients who attended the 10-year follow-up based on ferritin levels <15 ug/L and <30 ug/L, respectively. The effect of time was significant for hemoglobin, ferritin, iron overload (p<0.0001), and hematocrit (p=0.0007). Vitamin D deficiency was found in 29 patients (82.86%), and high parathormone (PTH), in 13 (41.94%). The effect of time was significant for PTH (p=0.0059). In conclusion, gastric bypass was a surgical success and improved the metabolic profile. Weight regain increased over time. The nutritional outcomes were iron-deficiency anemia and vitamin D deficiency associated with secondary hyperparathyroidism. These findings reaffirm the importance of multidisciplinary care and monitoring of nutritional deficiencies for the treatment of morbid obesity. / A obesidade m?rbida considerada uma doen?a cr?nica e multifatorial, que ocasiona desordens metab?licas e aumenta o risco de morbidade, vem crescendo, com dados alarmantes no Brasil e no Mundo. O Brasil ? o segundo Pa?s que mais realiza cirurgia bari?trica, sendo o tratamento cir?rgico, um desafio para os pacientes e para as equipes envolvidas no cuidado destes pacientes. Diante do exposto, o presente trabalho teve como objetivo avaliar a evolu??o do estado nutricional e identificar as defici?ncias nutricionais no pr? e no p?s-operat?rio de pacientes submetidos ao bypass g?strico em Y-de-Roux, com 10 anos de seguimento. O estudo realizado em dois anos, com delineamento retrospectivo longitudinal, envolveu 166 pacientes submetidos ao bypass g?strico em Y-de-Roux, em uma cl?nica privada. Na an?lise estat?stica, utilizou-se os testes Qui-Quadrado, Fisher, Mann-Whitney, Anova, Wilcoxon e Equa??es de Estimativas Generalizadas. O n?vel de signific?ncia adotado foi de 5%. Os resultados deste estudo, ap?s 10 anos de seguimento, demostraram percentual de perda do excesso de peso (%PEP) de 51,64?18,03 (p<0,0001); Indice de Massa Corporal (IMC) de 32,53?4,83 kg/m2 (p<0,0001); reganho de peso de 41% (p<0,0001). O perfil lip?dico e glic?mico diminuiu ao longo de 10 anos de seguimento (p<0,0001). Dos pacientes que permaneceram no estudo at? o final de 120 meses, 37,5% e 45,0%, apresentaram diagn?stico de anemia ferropriva, considerando-se os crit?rios utilizados de ferritina <15 ug/L e ferritina <30 ug/L, respectivamente. O efeito do tempo foi significativo para a hemoglobina, ferritina e sobrecarga de ferro, (p<0,0001) e hemat?crito (p=0,0007). Em rela??o ao metabolismo do c?lcio, 82,86% (29), apresentaram n?veis de defici?ncia de vitamina D e 41,94% (13) apresentaram PTH elevado. O efeito do tempo foi significativo para o PTH (p=0,0059). Em conclus?o, pacientes submetidos ao bypass g?strico, apresentaram sucesso cir?rgico e melhora do perfil metab?lico. O reganho de peso aumentou com o tempo de seguimento. A anemia ferropriva e a defici?ncia de vitamina D, associada ao hiperparatireoidismo secund?rio, foram desfechos nutricionais encontrados Tais achados reafirmam a import?ncia do cuidado multidisciplinar e ? aten??o ?s defici?ncias nutricionais para o tratamento da obesidade m?rbida.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-03-09T22:56:26Z No. of bitstreams: 1 ClarissaNesiVenzon_DISSERT.pdf: 2129281 bytes, checksum: 8bd476fcced3f9ebacf23659cc288b48 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-03-10T23:32:29Z (GMT) No. of bitstreams: 1 ClarissaNesiVenzon_DISSERT.pdf: 2129281 bytes, checksum: 8bd476fcced3f9ebacf23659cc288b48 (MD5) / Made available in DSpace on 2016-03-10T23:32:29Z (GMT). No. of bitstreams: 1 ClarissaNesiVenzon_DISSERT.pdf: 2129281 bytes, checksum: 8bd476fcced3f9ebacf23659cc288b48 (MD5) Previous issue date: 2013-09-19 / A Obesidade ? uma doen?a cr?nica de etiologia multifatorial que se caracteriza por excesso de gordura corp?rea, cujo grau varia de acordo com o ?ndice de Massa Corporal (IMC=m2 /kg). A obesidade grave ? caracterizada por IMC>40, frequentemente associada a altera??es cl?nicas end?crino-metab?licas ou mec?nicas e transtornos psicol?gicos; o quadro de Compuls?o Alimentar Peri?dica (CAP) tem alta incid?ncia nesta popula??o. A cirurgia Bari?trica vem sendo o tratamento de escolha para a obesidade grave, por apresentar r?pido emagrecimento e melhora nas condi??es cl?nicas. T?m-se verificado aumento de peso ap?s dois anos de cirurgia em 20% a 30% dos casos. O objetivo geral desta pesquisa ? avaliar caracter?sticas psicol?gicas e comportamentais entre obesos graves submetidos ? Cirurgia Bari?trica do tipo Bypass G?strico h? pelo menos 24 meses. Foram investigados aspectos espec?ficos como, (1) caracter?sticas do funcionamento personalidade e presen?a de transtornos cl?nicos e de personalidade; (2) a incid?ncia de CAP e sua rela??o com perda de peso; (3) a diferen?a entre os grupos em rela??o aos acompanhamentos p?s-cir?rgicos; atividade f?sica, acompanhamento psicol?gico e nutricional. M?todo: 40 adultos (homens e mulheres), com idades entre 23 a 60 anos, submetidos ? cirurgia bari?trica h? pelo menos 24 meses, na cidade de Natal-RN, foram divididos em dois grupos com n= 20, Grupo de Ganho, com perda < 50% do peso excedente inicial, e o Grupo de Perda, com perda >50%. O protocolo de pesquisa foi composto por question?rio biossociodemogr?fico, o m?todo de Rorschach ? Sistema Compreensivo (SC); Invent?rio de Personalidade de Millon (MCMI-III); e Escala de Compuls?o Alimentar Peri?dica (ECAP). Atrav?s do m?todo de Rorschach foram evidenciadas diferen?as significativas entre os dois grupos, relacionadas aos tipos vivenciais (EB), maior presen?a de EB Extratensivo no Grupo Ganho e Intratensivo no Grupo de Perda; e ao descontrole na express?o dos afetos, com eleva??o de respostas de Cor Pura no Grupo Ganho. Em rela??o ? popula??o normativa do SC, a amostra como um todo apresentou maior tend?ncia a experienciar sofrimento ps?quico, auto percep??o denegrida, autocr?tica excessiva, distor??es perceptivas, vulnerabilidade a desenvolver transtornos afetivos e eleva??o da pontua??o na Constela??o de Suic?dio. O MCMI-III indicou maior incid?ncia de transtornos cl?nicos e de personalidade no Grupo Ganho: Transtorno Depressivo e Esquizot?pico, Ansiedade, Distimia, Depress?o Maior; Transtorno do Pensamento, Bipolar- Man?aco e Transtornos de Estresse P?s-Traum?tico. Os resultados da ECAP indicaram diferen?a significativa, com eleva??o de CAP no Grupo de Ganho como tamb?m, entre a gravidade de CAP e presen?a de transtornos cl?nicos e de personalidade. Em rela??o aos acompanhamentos foi encontrada diferen?a significativa no quesito atividade f?sica com mediana elevada no Grupo de Perda. Os grupos ainda se diferenciaram em rela??o ao peso inicial e tempo p?scir?rgico, indicando que quanto maior o peso inicial e tempo percorrido maior o aumento de peso p?s-cir?rgico. Os resultados ainda revelam que os participantes com mais de 3 anos de tempo cirurgia, apresentam eleva??o na presen?a de Transtornos Cl?nicos de Transtorno Depressivo Maior; Transtorno Somatoforme; Distimia. Tais resultados corroboram conclus?es de estudos sobre a rela??o entre CAP p?s-cir?rgico e novo ganho de peso, como tamb?m acerca de maior incid?ncia de transtornos cl?nicos na popula??o obesa grave. Conclui-se que o processo cir?rgico ? apenas uma faceta do tratamento da obesidade grave, e que o acompanhamento p?s-cir?rgico deve receber maior aten??o e ocorrer em longo prazo para a manuten??o n?o s? dos resultados cir?rgicos, como da melhoria da qualidade de vida dos pacientes. / Obesity is a chronic disease that has multi-factorial aetiology, characterized by high degree of body fat; the degree of obesity will vary according to the Body Mass Index (BMI=m2 /kg). The severe degree of obesity is characterized by BMI>40 and it is regularly associated to endocrine-metabolic or mechanic clinical alterations, and to psychological disorders. Binge Eating (BE) results were overly high for this population. The Bariatric Surgery has been the treatment chosen by those diagnosed with severe obesity as this intervention provides prompt outcomes for loss of weight and clinical improvement conditions. However, recent research has acquiesced that after two years between 20% and 30% of people subject to this intervention gained weight. The main objective of this research is to assess the psychological and behavioral characteristics of those diagnosed with severe obesity that have been subject to Gastric Bypass Surgery in the past 24 months. Specific aspects were investigated: (1) characteristics of different personalities and diagnose of clinic and personality disorders; (2) BE and its relation with loss of weight; (2) the difference between the groups regarding post-surgery care, e.g. physical activity, psychological and dietician input. Method: 40 adults (women and men) aged 23 and 60 year-old who went through a bariatric surgery in the past 24 months, in the city of Natal-RN (Brazil); they were assembled in two groups n=20, Gain group displaying loss of < 50% of their initial surplus of weight, and the Loss group displaying loss of >50%. The research protocol is made of a socio-demographic questionnaire and 3 psychometric instruments: Rorschach ? Comprehensive System; Millon Personality Inventory (MCMI-III); and the Binge Eating Scale (Escala de Compuls?o Alimentar Peri?dica (ECAP). Through Rorschach significant differences between these groups were verified according to the kind of personality (EB) - more EB Extratensivo in Gain group and Intratensivo in Loss group ? and the lack of control to express affect, increasing the answer for Color Pure at Group I. Concerning the people standardization, the sample as a whole tends to show psychic pain, denigrated selfperception, high levels of self-criticism, distorted perceptions, vulnerability to develop mood disorders and high scores regarding Suicide. MCMI-III results showed more clinic and personality disorders in Group I: Depressive Disorder and Schizotypal, Anxiety, Dysthymia, Major Depressive Disorder; Thought Disorder, Bipolar- Manic and Posttraumatic Stress Disorder. In relation to ECAP, the results indicated significant differences, showing increased BE results in Gain group. There were found significant differences between BE severity and the presence of clinic and personality disorders. Concerning the post-surgery care, the observed differences are statistically significant regarding physical activities with median-increased differences in Loss group. There is a difference between the initial weight and the time post-surgery, indicating that the higher the initial weight and the time after the surgery the higher the re-gain of weight post-surgery. Finally, the results show that the participants with more than 3 years of surgery will have Clinic and Major Depressive Disorders; Somatoform Disorder; Dysthymia. These results confirm prior studies related to BE post-surgery and re-gain of weight as well as the proneness of clinic disorders in severe obesity people. That means the results reinforce that the surgery process is a facet of the severe obesity treatment. The post-surgery process needs to be the main focus of attention and have a long-term input to sustain the care of the surgery results and the quality of life of the patients.