Hospital Heliópolis

Metabolic and bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are both effective strategies for obesity management, but their comparative efficacy remains uncertain. This systematic review and meta-analysis aimed to compare weight loss outcomes between MBS and GLP-1 RA therapy in adults with obesity. A systematic search of PubMed, Scopus, and Cochrane Library was conducted from inception to September 22, 2025. Eligible studies included randomized and observational comparisons between MBS-specifically sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB)-and GLP-1 RA therapy in adults with obesity. Pooled mean differences (MDs) for total weight loss (TWL) and body mass index (BMI) change were calculated using a DerSimonian-Laird random-effects model. Risk of bias was assessed using ROBINS-I V2, and certainty of evidence was graded with GRADE. Five retrospective observational studies (n = 5,944; 3,489 MBS, 2,455 GLP-1 RA) met the inclusion criteria. Pooled analysis showed significantly greater TWL in the MBS group (MD - 18.15%; 95% CI 16.41 to 19.90; p < 0.0001; I² = 95%) and larger BMI reduction (MD 8.73kg/m²; 95% CI 5.87 to 11.58; p = 0.0001; I² = 94.6%). Sensitivity analyses confirmed the robustness of these results. Overall risk of bias was moderate, primarily due to non-randomized designs and treatment selection bias. Certainty of evidence was rated as moderate. MBS achieves significantly greater and more durable weight loss compared with GLP-1 RA therapy, reaffirming its role as the most effective intervention for severe obesity. While GLP-1 RAs represent valuable noninvasive or adjunctive options, surgery remains the benchmark for sustained metabolic and weight outcomes.

Introduction: Laparoscopic common bile duct exploration (LCBDE) is a well-established and effective minimally invasive surgical approach for managing choledocholithiasis. However, its safety in the elderly population is not well established. Therefore, this study compares surgery-related outcomes in elderly patients undergoing LCBDE. Methods: We systematically searched PubMed, Embase, and Cochrane Library for studies comparing elderly and young patients undergoing LCBDE. Binary outcomes were compared using odds ratios (ORs), with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.3.3. Results: Twelve studies comprising 3791 patients were included, of whom 1411 patients (37%) were from the elderly group. Elderly patients were associated with an increase in mortality (OR: 3.42; 95% CI: 1.08-10.85; P = .04; I2 = 0%), overall postoperative complications (OR: 1.60; 95% CI: 1.11-2.22; P = .01; I2 = 52%), and pneumonia (OR: 4.37; 95% CI: 2.00-9.55; P < .01; I2 = 0%) rates. However, there were no significant differences between groups in remnant stones (OR: 1.37; 95% CI: 0.70-2.68; P = .36; I2 = 0%) and recurrent stones (OR: 1.37; 95% CI: 0.64-2.95; P = .42; I2 = 0%) pancreatitis (OR: 0.98; 95% CI: 0.16-5.95; P = .98; I2 = 0%) and bile leakage (OR: 1.24; 95% CI: 0.75-2.07; P = .40; I2 = 0%). Conclusion: In this meta-analysis, elderly patients who underwent LCBDE experienced increased mortality, overall complications, and pneumonia rates compared with young patients. Furthermore, there were no significant differences between the groups in remnant and retained stones, pancreatitis, and bile leakage.

Introduction: The management of nutritional diseases in the nosocomial context, especially malnutrition, has raised considerable concern. Objective: In this context, the multi-professional nutritional therapy team (MNTT) emerged, aiming to provide a prompt diagnosis and effective treatment for these conditions. Methods: To assess the benefits of implementing MNTT in hospital services, a review was conducted, gathering articles and legislation related to the proposed topic. The search terms used included “nutritional therapy,” “nutritional therapy costs,” “MNTT,” “multidisciplinary nutritional therapy team,” “enteral nutrition,” and “parenteral nutrition.” Discussion: The presence of MNTT leads to reduced mortality, shorter hospital stays, fewer complications, lower hospital expenses, and improved nutritional support for patients compared to services without MNTT. Conclusion: The multitude of benefits from investing in MNTT implementation is evident, as they play a fundamental role in diagnosing, treating, and primarily preventing nutritional diseases, ultimately resulting in better patient care.

The complete mesocolic excision (CME) in right-sided hemicolectomy could result in higher lymph node yield and decreased local recurrence. However, this approach could increase intraoperative and postoperative complications. Therefore, our meta-analysis aims to demonstrate the outcomes of CME versus D2 conventional lymphadenectomy in right-side colon cancer. We searched MEDLINE, Cochrane Central Register of Clinical Trials, and Scopus for studies published until April 2024. Odds ratios (OR) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the Cochran Q test and I 2 statistics, with P values<0.10 and I 2>25% considered significant. Statistical analysis was performed using R Software, version 4.1.2. Three randomized controlled trials and four observational studies comprising 2296 patients were included, of whom 1138 (49.6%) were submitted to the CME and 1158 (50.4%) to the conventional D2 lymphadenectomy. CME was associated with decreased local recurrence rates (OR 0.07; 95% CI 0.001 to 0.36; P =0.002). There were no significant differences between groups in overall complications, severe complications, intraoperative complications, blood loss, and 30-day mortality. No difference between groups was observed in distance metastasis and 3-year disease-free survival. In this meta-analysis, CME significantly decreases local recurrence rates compared with D2 conventional lymphadenectomy in patients with right-side colon cancer. No significant difference was observed between groups in rates of overall complications, severe complications, intraoperative complications, blood loss, and 30-day mortality.

Objetivo: Investigar na literatura o impacto dos fármacos antirreabsortivos na prevenção de fraturas em pacientes diagnosticados com osteoporose. Método: Revisão Integrativa da Literatura. A pesquisa eletrônica ocorreu nas bases de dados LILACS e Pubmed Resultados: Foram selecionados 8 estudos, sendo o mais antigo publicado no ano de 2000 e o mais recente no ano de 2020. Quanto aos aspectos metodológicos, 100% dos estudos selecionados correspondem a ensaios clínicos randomizados controlados por placebo. Foram considerados como estratégias de busca, as seguintes palavras-chave registradas nos Descritores em Ciências da Saúde (DeCs): “Osteoporose”, “Tratamento”, “Bisfosfonatos”, “Saúde pública”, “Denosumabe”, “Estrogênio”, “Moduladores Seletivos de Recaptação de Estrogênio”, “Idosos”. Discussão: Os fármacos antirreabsortivos atuam impedindo a ação osteclástica e, consequentemente, reduzindo o processo de remodelamento ósseo. Os bisfosfonatos são o grupo de fármacos antirreabsortivos mais utilizados. Esses fármacos atuam prevenindo fraturas em pacientes com osteoporose. Considerações finais: Este estudo observou que, todos os fármacos antirrebsortivos analisados em ensaios clínicos randomizados e controlados por placebo reduziram o risco de fraturas em pacientes com osteoporose ao serem com parados com nenhum tratamento. Assim, o tratamento da osteoporose com a utilização de fármacos antirreabsortivos provavelmente representa melhor benefício aos pacientes, especialmente na melhora da DMO e no menor risco de fraturas.

This systematic review evaluates the comparative efficacy of low-carbohydrate diets (LCDs) versus low-fat diets (LFDs) in improving glycemic control, weight management, and lipid profiles in individuals with type 2 diabetes mellitus (T2DM) or prediabetes. Seven randomized controlled trials involving diverse populations were included, with dietary interventions ranging from very low-carbohydrate ketogenic (LCK) diets (typically <10% of total caloric intake from carbohydrates, with higher fat and moderate protein) to moderate carbohydrate regimens (30-45% of total calories). LFDs, in contrast, prioritized carbohydrate intake (50-60% of total calories), with reduced fat (<20-30%) and moderate protein (15-20%). Across studies, LCDs consistently demonstrated greater reductions in HbA1c, fasting glucose, and triglycerides, alongside superior weight loss and increased high-density lipoprotein cholesterol compared to LFDs. Additionally, LCDs were associated with significant reductions in diabetes medication use, highlighting their potential to decrease pharmacological dependency and improve metabolic outcomes, including enhanced insulin sensitivity and reduced inflammation. Despite variability in long-term outcomes and adherence, LCDs emerged as a promising alternative to traditional dietary approaches for managing T2DM. Further research is warranted to explore strategies to improve dietary adherence, such as behavioral interventions and technological support, and to evaluate long-term sustainability, including their effects on cardiovascular health and quality of life. These findings underscore the transformative potential of LCDs in diabetes management and highlight the need for personalized dietary approaches.

Case presentation A 33-year-old male presented with a three-year history of hematochezia, tenesmus, and anal prolapse.The condition progressed with worsening anal bleeding, requiring blood transfusion.He sought medical attention, and a colonoscopy revealed an arteriovenous malformation 2 cm above the pectinate line.Despite treatment, the symptoms persisted, and the bleeding worsened.He was referred to a specialized center with a provisional diagnosis of hemorrhoidal disease.A proctological examination under sedation was performed, revealing a bleeding, pedunculated lesion measuring 6 cm, located above the pectinate line.Local excision of the lesion was performed.Histopathological analysis showed intramucosal adenocarcinoma associated with a villous adenoma with high-grade dysplasia, with clear surgical margins.Discussion Primary adenocarcinoma of the anus is a rare disease accounting for only 5%-10% of anal canal malignancies.The presentation of this disease is generally late, with a mean age of diagnosis at 59 years, possibly due to the associated non-specific symptoms.Anal adenocarcinomas can be subdivided into two types: (1) colorectal from the mucosa above the dentate line and (2) extramucosal from anorectal fistulas or anal glands.Given the challenges with classification and the low number of cases overall, most of the literature is limited to case reports or outcome-driven observational studies.This case highlights the challenges of early diagnosis of anal malignancies and the importance of immediate evaluation of the anorectal region when recto-anal symptoms, such as bleeding or mucus in the stool, are reported through digital rectal examination, sometimes neglected in medicine.The lesion presented a clinical picture similar to symptoms of hemorrhoidal disease, such as bleeding and anal prolapse.Anal tumors can also be identified in routine or diagnostic colonoscopy, even in asymptomatic patients.Conclusion Due to delayed diagnosis, anal adenocarcinomas often have a poor prognosis.Understanding the patient's symptoms and performing a physical examination, such as a digital rectal exam, supports early diagnosis and targeted treatment.This approach contributes to better patient outcomes and helps reduce the morbidity and mortality associated with the disease.