Bariatric surgery and the coronary artery calcium score

Assessment of the clinical and laboratorial profile of patients with obesity and asymptomatic COVID-19 undergoing bariatric surgery in Brazil

Purpose

to outline the clinical and laboratorial profile of patients with obesity undergoing bariatric surgery who presented positive reverse transcription-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (Sars-CoV-2) in the preoperative period without symptoms presentation.

Methods

Case series of 17 patients undergoing bariatric surgery who presented positive RT-PCR for Sars-CoV-2 in the preoperative period, with no reported symptoms. Data collected included demographic characteristics, length of hospital stay, waiting time for surgery, inflammatory markers, serum levels of micronutrients and dengue virus (DENV) serology.

Results

In total, 219 patients underwent bariatric surgery in our institution during the study period. The incidence of asymptomatic cases was 7.7%. The sample comprised 88.2% of women, with mean age of 39.3 years and mean preoperative body mass index (BMI) of 37.7 kg/m2. Thirty five percent of the sample had previous diagnosis of diabetes and 29.4% had hypertension. The mean time elapsed between positive RT-PCR and the operation was 17 ± 7.5 days and the mean length of postoperative hospital stay was 1.9 ± 0.43 day. Mean lymphocytes count was 2,409.7/mm3 and the mean platelet-to-lymphocyte ratio was 126.3. Mean C-reactive protein value was 5.8 mg/dL, while ferritin marked 107.4 µg/L. DENV IgG was identified in all patients who tested for it. Mean levels of vitamin D and zinc were 25.6 ng/mL and 79.9 µg/dL, respectively. There were no postoperative complications reported.

Conclusion

None of the included patients presented any of the laboratory markers related to disease severity. Moreover, it is important to notice that all patients who tested for DENV, had the specific IgG detected in their serum.

Graphical abstract

Vitamin D in the Preoperative and Postoperative Periods of Bariatric Surgery

OBJECTIVE

To evaluate the evolution of vitamin D levels (25OHD) in patients submitted to bariatric surgery.

METHODS

Retrospective study, conducted with patients submitted to bariatric surgery between 2013 and 2018, in a city in the Northeast of Brazil. The variations of 25OHD, weight, body mass index (BMI), and total lymphocyte count were analyzed and compared for preoperative and postoperative periods of 6 and 12 months. Vitamin D levels below 30ng/mL were considered insufficient. Analysis of variance (ANOVA) was used for repeated measures, followed by Bonferroni post hoc test. To identify variables related to vitamin D, Pearson's correlation test and linear regression analysis were used. A significance level of 5% (p <0.05) was adopted.

RESULTS

A total of 646 patients were evaluated, with a mean age of 41.3 ± 10.8 years. Most of the patients were female (75%) and had 25OHD insufficiency in the preoperative period (79.1%). It was found that in the postoperative period there was an increase in vitamin D levels. Linear regression showed that the variation in vitamin D is negatively influenced by BMI in the preoperative period (β = -0.20; p = 0.02) and by BMI (β = -0.38; p <0.001) and by age (β = -0.08; p = 0.02) in the 6-month postoperative period.

CONCLUSION

There was an increase in vitamin D levels in the postoperative period. BMI proved to be a negative factor for obtaining adequate levels of vitamin D in the preoperative period and in the 6-month postoperative period.

Oxidative Stress and Vascular Damage in the Context of Obesity: The Hidden Guest

The vascular system plays a central role in the transport of cells, oxygen and nutrients between different regions of the body, depending on the needs, as well as of metabolic waste products for their elimination. While the structure of different components of the vascular system varies, these structures, especially those of main arteries and arterioles, can be affected by the presence of different cardiovascular risk factors, including obesity. This vascular remodeling is mainly characterized by a thickening of the media layer as a consequence of changes in smooth muscle cells or excessive fibrosis accumulation. These vascular changes associated with obesity can trigger functional alterations, with endothelial dysfunction and vascular stiffness being especially common features of obese vessels. These changes can also lead to impaired tissue perfusion that may affect multiple tissues and organs. In this review, we focus on the role played by perivascular adipose tissue, the activation of the renin-angiotensin-aldosterone system and endoplasmic reticulum stress in the vascular dysfunction associated with obesity. In addition, the participation of oxidative stress in this vascular damage, which can be produced in the perivascular adipose tissue as well as in other components of the vascular wall, is updated.