#Bariatric surgery tied to risks for #suicide and #non-fatal self-harm

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  • The Lancet Diabetology


Bariatric surgery reduces mortality, but might have adverse effects on mental health. We assessed the risk of suicide and self-harm after bariatric surgery compared with non-surgical obesity treatment.


Suicide and non-fatal self-harm events retrieved from nationwide Swedish registers were examined in two cohorts. The non-randomised, prospective Swedish Obese Subjects (SOS) study compared bariatric surgery (n=2010; 1369 vertical-banded gastroplasty, 376 gastric banding, and 265 gastric bypass) with usual care (n=2037; recruitment 1987–2001). The second cohort consisted of individuals from the Scandinavian Obesity Surgery Registry (SOReg; n=20 256 patients who had gastric bypass) matched to individuals treated with intensive lifestyle modification (n=16 162; intervention 2006–13) on baseline BMI, age, sex, education level, diabetes, cardiovascular disease, history of self-harm, substance misuse, antidepressant use, anxiolytics use, and psychiatric health-care contacts.


During 68 528 person-years (median 18; IQR 14–21) in the SOS study, suicides or non-fatal self-harm events were higher in the surgery group (n=87) than in the control group (n=49; adjusted hazard ratio [aHR] 1.78, 95% CI 1.23–2.57; p=0.0021); of these events, nine and three were suicides, respectively (3.06, 0.79–11.88; p=0.11). In analyses by primary procedure type, increased risk of suicide or non-fatal self-harm was identified for gastric bypass (3.48, 1.65–7.31; p=0∙0010), gastric banding (2.43, 1.23–4.82; p=0.011), and vertical-banded gastroplasty (2.25, 1.37–3.71; p=0.0015) compared with controls. Out of nine deaths by suicide in the SOS surgery group, five occurred after gastric bypass (two primary and three converted procedures). During 149 582 person-years (median 3.9; IQR 2.8–5.2), more suicides or non-fatal self-harm events were reported in the SOReg gastric bypass group (n=341) than in the intensive lifestyle group (n=84; aHR 3.16, 2.46–4.06; p<0.0001); of these events, 33 and five were suicides, respectively (5.17, 1.86–14.37; p=0.0017). In SOS, substance misuse during follow-up was recorded in 48% (39/81) of patients treated with surgery and 28% (13/47) of controls with non-fatal self-harm events (p=0∙023). Correspondingly, substance misuse during follow-up was recorded in 51% (162/316) of participants in the SOReg gastric bypass group and 29% (23/80) of participants in the intensive lifestyle group with non-fatal self-harm events (p=0∙0003). The risk of suicide and self-harm was not associated with poor weight loss outcome.


Bariatric surgery was associated with suicide and non-fatal self-harm. However, the absolute risks were low and do not justify a general discouragement of bariatric surgery. The findings indicate a need for thorough preoperative psychiatric history assessment along with provision of information about increased risk of self-harm following surgery. Moreover, the findings call for postoperative surveillance with particular attention to mental health.


US National Institutes of Health and Swedish Research Council.


#PPIs could increase the risk of #major depressive disorder

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  • Noticias Médicas Univadis

Patients exposed to a higher cumulative defined daily dose (cDDD) of proton pump inhibitors (PPIs) could be at higher risk of developing major depressive disorder later in life, suggests new research published in Psychotherapy and Psychosomatics.

The study compared data from 2,366 patients who were exposed to PPIs and developed subsequent major depressive disorder and 9,464 subjects without major depressive disorder from the Taiwan National Health Insurance Research Database (NHIRD). The authors found patients with major depression had a greater prevalence of higher cDDD of PPIs than those without major depression. The increased risk of major depressive disorder was observed to be especially high for users of pantoprazole, lansoprazole, and rabeprazole, whereas only a trend significance was noted in subgroups using omeprazole and esomeprazole.

The authors noted a number of limitations to their study and said because it was a retrospective and observational study, it was very difficult to find a clear causality between PPI exposure and major depression. “Further studies will be necessary to clarify the pathophysiology between PPI exposure and risk of major depressive disorder. However, we still recommend that physicians should not refrain from using PPIs for appropriate indications,” they concluded.

La #microbiota intestinal puede ser clave en el #tratamiento de la psoriasis (Sci Report)

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  • Noticias Médicas

Scientific Reports publica una investigación liderada por Vicente Navarro, de la Universidad Católica San Antonio de Murcia (UCAM), con los últimos avances que utilizan la microbiota intestinal para mejorar el pronóstico y tratamiento de la psoriasis, según informan fuentes de la institución docente en un comunicado.

Estos resultados, junto con los aportados recientemente en el Congreso Nacional de Microbiota y Probióticos, demuestran que el tratamiento con un probiótico, junto a la terapia habitual de esta enfermedad, mejora, de manera importante, tanto pronóstico como la respuesta del paciente.

Hasta el momento, ningún grupo de investigación había demostrado que la microbiota intestinal de pacientes con psoriasis presenta datos diferenciales con la de la población sana y con la de pacientes de cualquier enfermedad conocida. Este hallazgo abre un nuevo campo de investigación para actuar sobre la microbiota como nueva diana terapéutica en estos pacientes, según las mismas fuentes.

Los resultados obtenidos por el grupo de investigación sobre el tratamiento de la psoriasis modificando la microbiota intestinal abren un campo de estudio importante para evaluar qué factores de la microbiota intestinal pueden estar influyendo en la aparición y posterior evolución de la psoriasis.

Esta investigación es uno más de los hallazgos del grupo de investigación, que recientemente ha demostrado la eficacia de una mezcla específica de probióticos funcionales para el tratamiento de la dermatitis atópica, producto que ha sido comercializado recientemente por una multinacional alemana en nuestro país.

Los datos publicados abren la puerta no solo a nuevos modelos de tratamiento, sino también de diagnóstico; ya que identificar los factores de la microbiota que participan en la aparición y evolución de la psoriasis pueden servir para prevenir su aparición y/o intervenir precozmente ante la eventual aparición de nuevos brotes de la enfermedad.

#Calcium supplements may increase risk of #colon polyps

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  • Noticias Médicas Univadis

Calcium supplements, taken with or without vitamin D, may increase the risk of colon polyps, according to the findings of a new study published in the journal Gut.

The secondary analysis of data from a randomised trial of vitamin D and calcium in patients with colorectal adenomas, found that calcium and the combination of calcium and vitamin D increased the risk of sessile serrated adenomas or polyps (SSA/Ps) 6-10 years after supplementation began. Although no increased risk was observed during the 3-5 years that participants consumed the supplements, over the following 6-10 years, calcium alone was associated with an adjusted risk ratio (aRR) of 2.65 (95% CI 1.43-4.91) and calcium with vitamin D had an aRR of 3.81 (95% CI 1.25-11.64). Women and current smokers had higher risks of serrated polyps (SPs) when exposed to supplemental calcium.

While further studies are needed to confirm the results, given that calcium supplements are taken by millions of people around the world, the findings may have important implications for bowel cancer screening and prevention.

Since SPs are important colorectal cancer precursors, the study authors suggest patients with a history of premalignant serrated polyps, especially women and smokers, may wish to avoid vitamin D and calcium supplementation.

#Oesophageal and #gastric cancer: ECCO essential care requirements

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  • Noticias Médicas Univadis

The European CanCer Organisation (ECCO) has published a list of essential requirements for quality cancer care (ERQCC) for patients with oesophageal and gastric (OG) cancer. The position paper covers a range of topics including recommended timelines for diagnosis and treatment, and target case volume for treatment centres.

ECCO reports that maximum time for an appointment for suspected cancer varies significantly between countries. The organisation strongly recommends that countries ensure that waiting times are minimal, as is the case in several European countries that make urgent referrals within 48  hours.

It also recommends that a specialist multidisciplinary team (MDT) at a centre or network should manage and consult on about 200 new OG cancer cases each year, which should include both curative and palliative treatments, and those referred but treated elsewhere.

Healthcare providers should publish on a website or make available to patients on request, data on centre/unit performance, including waiting times to first appointment, clinical outcomes, patient experience measurements (PREMs), and incidents/adverse events.

Outcome metrics which should be systematically measured and collected for audit include the proportion of patients discussed by the MDT, adherence to MDT recommendations, in-hospital mortality and overall survival rates.

#Estudo de médico português é ponto de viragem no tratamento da falência do fígado

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Estudo de médico português é ponto de viragem no tratamento da falência do fígado

  • Não havia consenso quanto à melhor forma de proteger o cérebro, e evitar a morte, quando o fígado deixa de funcionar. O gastroenterologista Filipe Sousa Cardoso mostrou que “lavandaria” é o método mais eficaz
Sara Sá



Filipe Sousa Cardoso, gastroenterologia

Filipe Sousa Cardoso, gastroenterologia

Quando o fígado entra em falência, deixando de funcionar, o corpo vai acumulando produtos tóxicos que podem levar à morte. Um destes produtos é a amónia, que num estado normal é convertida em ureia no fígado e eliminada na urina, depois de passar pelos rins. O problema da acumulação de amónia, que resulta do processo normal da digestão, é sobretudo o dano que causa no cérebro.

Se não for eliminada, a amónia chega à cabeça e acumula-se, causando um edema, ou inchaço. Para quem entra em falência hepática – o que pode acontecer por ingestão de cogumelos venenosos, excesso de paracetamol, ou hepatite – está é uma das principais causas de morte.

Até hoje, em todo o mundo, não havia grande consenso acerca da melhor forma de evitar este desfecho. Dependia da unidade de saúde em que o doente estava internado e até do médico responsável. Em alguns casos não se fazia nada, noutros aplicava-se uma técnica de limpeza do sangue, tipo hemodiálise, de forma intermitente, noutros ainda recorria-se à limpeza de forma contínua, ao longo de 48 horas. Ninguém sabia o que trazia melhores resultados.

Isto até Filipe Sousa Cardoso, 33 anos, gastrenterologista do Hospital Curry Cabral, em Lisboa, se ter proposto estudar o caso, para tentar tirar conclusões. Recorreu a uma base de dados com informação sobre doentes em falência hepática, atendidos em vários centros americanos e canadianos, e analisou-os à lupa. Ao comparar as três estratégias, o médico concluiu que a desintoxicação extracorpórea (através de uma máquina), contínua, era duas vezes mais eficaz a elininar a amónia, e que a mortalidade, ao fim de três semanas, era menor. Por este trabalho, publicado na revista Hepatology, a publicação mais relevante nesta área da Medicina, Filipe Sousa Cardoso recebeu um prémio de 20 mil euros, atribuído pelo Banco Carregosa e pela Secção Regional Norte da Ordem dos Médicos.

“Este é um prémio para a investigação clínica”, reforça o médico, que faz questão de dizer que o mesmo só foi possível graças à colaboração de colegas americanos e canadianos. “Qualquer hospital com unidade de cuidados intensivos tem possibilidade de fazer este tratamento.”

Por ano, há cerca de cem casos de falência hepática em Portugal. Em algumas situações, o fígado regenera-se sozinho, noutras só o transplante hepático cura o doente. Em qualquer dos casos, a remoção da amónia é fundamental para manter o doente vivo, até que uma ou outra solução ocorram.



#Study suggests link between #highly processed food and #cancer

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Findings from a major new study suggest an increase in the proportion of ultra-processed foods in the diet is associated with a significant increase in risks of overall and breast cancer. 

While previous research has linked ultra-processed foods to higher risks of obesity, hypertension and dyslipidaemia, no previous prospective epidemiological study has evaluated the association between food processing and risk of cancer.

For this study, researchers in France and Brazil examined data on 104,980 healthy adults from the NutriNet-Santé study who completed at least two online dietary questionnaires. 

They found a 10 per cent increase in the proportion of ultra-processed foods in the diet was associated with increases of 12 per cent in the risk of overall cancer and 11 per cent in the risk of breast cancer. No significant association was found for prostate and colorectal cancers.

Further testing found no significant association between less processed foods and risk of cancer, while consumption of fresh or minimally processed foods was associated with lower overall risk of cancer. 

Writing in The BMJ , the authors said the results suggest that the rapidly increasing consumption of ultra-processed foods may drive an increasing burden of cancer in the coming decades.

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