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Goiânia, Brazil

Nery M.W.,Federal University of Goais | Nery M.W.,Catholic University of Goias | Martelli C.M.T.,Federal University of Goais | Martelli C.M.T.,National Institute for Health Technology Assessement | And 8 more authors.
The Scientific World Journal | Year: 2013

This study aims to estimate the risk of cardiovascular disease (CVD) and to assess the agreement between the Framingham, Framingham with aggravating factors, PROCAM, and DAD equations in HIV-infected patients. A cross-sectional study was conducted in an outpatient centre in Brazil. 294 patients older than 19 years were enrolled. Estimates of 10-year cardiovascular risk were calculated. The agreement between the CVD risk equations was assessed using Cohen's kappa coefficient. The participants' mean age was 36.8 years (SD = 10.3), 76.9% were men, and 66.3% were on antiretroviral therapy. 47.8% of the participants had abdominal obesity, 23.1% were current smokers, 20.0% had hypertension, and 2.0% had diabetes. At least one lipid abnormality was detected in 72.8%, and a low HDL-C level was the most common. The majority were classified as having low risk for CV events. The percentage of patients at high risk ranged from 0.4 to 5.7. The PROCAM score placed the lowest proportion of the patients into a high-risk group, and the Framingham equation with aggravating factors placed the highest proportion of patients into the high-risk group. Data concerning the comparability of different tools are informative for estimating the risk of CVD, but accuracy of the outcome predictions should also be considered. © 2013 Max Weyler Nery et al.


DePaula A.L.,Hospital de Especialidades | Stival A.R.,Hospital de Especialidades | DePaula C.C.L.,Catholic University of Goias | Halpern A.,University of Sao Paulo | Vencio S.,Hospital de Especialidades
Journal of Gastrointestinal Surgery | Year: 2010

Background: Dyslipidemia is known to increase significantly the odds of major cardiovascular events in the general population. Its control becomes even more important in the type 2 diabetic (T2DM) population. Bariatric surgeries, especially gastric bypass, are effective in achieving long-term control of dyslipidemia in morbidly obese patients. Objective: The objective of the study was to evaluate the control of dyslipidemia in patients with T2DM and BMI below 30 that were submitted to the laparoscopic ileal interposition associated to sleeve gastrectomy. Methods: An observational transversal study was performed in a tertiary care hospital, between June 2005 and August 2007. Mean follow-up was 24.5 months (range 12-38). The procedure was performed in 72 patients: 51 were men and 21 were women. Mean age was 53.1 years (38-66). Mean BMI was 27 kg/m2 (22.1-29.4). Mean duration of T2DM was 10.5 years (3-22). Mean HbA1c was 8.5%. Hypercholesterolemia was diagnosed in 68% of the patients and hypertriglyceridemia in 63.9%. Results: Mean postoperative BMI was 21.2.kg/m2 (17-26.7). Mean postoperative HbA1c was 6.1%, ranging 4.4% to 8.3%. Overall, 86.1% of the patients achieved an adequate glycemic control (HbA1c<7) without anti-diabetic medication. HbA1c below 6 was achieved by 50%, 36.1% had HbA1c between 6 and 7, and 13.9% had HbA1c above 7. Total hypercholesterolemia was normalized in 91.8% and hypertriglyceridemia in 89.1% of patients. Low-density lipoprotein below 100 mg/dl was seen in 85.7%. Conclusions: The laparoscopic ileal interposition associated to sleeve gastrectomy was an effective operation for the regression of dyslipidemia and T2DM in a non-obese population. © 2010 The Society for Surgery of the Alimentary Tract.


De Paula A.L.,Hospital de Especialidades | Stival A.R.,Hospital de Especialidades | Halpern A.,University of Sao Paulo | DePaula C.C.L.,Catholic University of Goias | And 4 more authors.
Journal of Gastrointestinal Surgery | Year: 2011

Introduction: Bariatric surgery in morbidly obese type 2 diabetic (T2DM) patients is associated with high rates of diabetes remission. We investigated the mechanisms of the anti-diabetic effect of the laparoscopic ileal interposition with sleeve gastrectomy (LII-SG) in normal weight (NW), overweight (OW) and obese (OB) T2DM patients. Methods: Ninety-four patients (aged 54 ± 8 years) with long-standing (median 10 years), treated diabetes (median HbA 1c = 8.6%), who were NW (15), OW (64) or OB (15) based on BMI, underwent LII-SG. Insulin sensitivity and parameters of ß-cell function were measured from an Oral Glycaemic Tolerance Test pre- and post-operatively. Results: At a median of 13.4 months post-operatively, weight loss averaged 9.4 ± 1.3, 16.8 ± 0.8 and 23.2 ± 1.7 kg in NW, OW and OB subjects, respectively (p<0.0001). Insulin sensitivity was fully restored (395 [108] vs 208 [99] ml min -1 m -2), fasting insulin secretion rate decreased (68 [52] vs 146 [120] pmol min -1 m -2) and total insulin output increased (52 [26] vs 39 [28] nmol m -2, all p≤0.001). ß-cell glucose sensitivity doubled (37 [33] vs 18 [24] mol min -1 m -2 mM -1, p<0.0001). The only parameter predicting remission of diabetes was a lower baseline insulin sensitivity (p=0.005). Conclusions: LII-SG induced changes on T2DM by mechanisms in part distinct from weight loss, principally involving restoration of insulin sensitivity and improvement of ß-cell function. © 2011 The Society for Surgery of the Alimentary Tract.


De Paula A.L.,Hospital de Especialidades | Stival A.R.,Hospital de Especialidades | De Paula C.C.L.,Catholic University of Goias | Halpern A.,University of Sao Paulo | Vencio S.,Catholic University of Goias
Journal of Gastrointestinal Surgery | Year: 2012

Background The objective of this study was to evaluate the mid-term outcomes of the laparoscopic ileal interposition into the jejunum (JII-SG) or into the duodenum (DII-SG) associated with sleeve gastrectomy for type 2 diabetes mellitus (T2DM) patients with BMI below 35. Methods The procedures were performed on 202 consecutive patients. Mean age was 52.2±7.5. Mean duration of T2DM was 9.8±5.2 years. Insulin therapy was used by 41.1%. Dyslipidemia was observed in 78.2%, hypertension in 67.3%, nephropathy in 49.5%, retinopathy in 31.2%, coronary heart disease in 11.9%, and other cardiovascular events in 12.9%. Results Mean follow-up was 39.1 months (range, 25-61). Early and late mortality was 0.99% and 1.0%, respectively. Early reoperation was performed in 2.5%. Early and late major complications were 8.4% and 3.5%. Early most frequent complications were pneumonia and ileus. Intestinal obstruction was diagnosed in 1.5%. Mean BMI decreased from 29.7 to 23.5 kg/m2, mean fasting glucose from 202.1 to 112.2 mg/dl, and mean postprandial glucose from 263.3 to 130 mg/dl. Triglycerides diminished from a mean of 273.4 to 110.3 mg/dl and cholesterol from a mean of 204.7 to 160.1 mg/dl. Hypertension was resolved in 87.5%. Mean hemoglobin A1c (HbA1c) decreased from 8.7 to 6.2% after the JII-SG and to 5.9% following the DII-SG. HbA1c below 7% was seen in 89.9% of the patients and below 6.5% in 78.3%. Overall, 86.4% of patients were off antidiabetic medications. Conclusion Both JII-SG and DII-SG demonstrated to be safe, effective, and long-lasting alternatives for the treatment of T2DM patients with BMI <35. Beyond glycemic control, other benefits were achieved. © 2012 The Society for Surgery of the Alimentary Tract.


Souza L.B.S.,Federal University of Goais | Schulz H.E.,University of Sao Paulo | Villela S.M.,Federal University of Goais | Villela S.M.,University of Sao Paulo | And 4 more authors.
Journal of Applied Fluid Mechanics | Year: 2010

The prediction of sedimentation is an important aspect of reservoir planning and design. Such prediction can be supported by detailed analyses of flow patterns and sediment transport inside reservoirs, usually conducted through numerical simulation. This research compares laboratorial sedimentation experiments in a shallow reservoir and predictions using a 2D numerical model with depth-average Navier-Stokes equations and a sediment transport code. A number of sediment transport equations were tested, among which the Engelund and Fredsøe formulation better represented the measured data. Flows without sediment transport or without bed dunes could be simulated using Smagorinski's turbulence model, while flows with sediment occurring over dunes needed the use of a constant turbulent viscosity. The similarity obtained between experimental data and numerical results, for both flow pattern and sediment deposition, confirms that the models and numerical codes used in this work are useful for the analysis and prediction of reservoir sedimentation.

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