Raphael Del Roio Liberatore Junior

Perfil lipídico e fatores de risco para doenças cardiovasculares em estudantes de medicina

OBJECTIVE To analyze the lipid profile and its correlation with risk factors for cardiovascular diseases (CVD) among medicine students. METHODS We assessed 153 students, regardless of sex, with age between 18 and 31 years old, submitted to lipid profile analysis, including serum levels of total cholesterol (TC), fraction of cholesterol of low (LDLc), high (HDLc) and very low density (VLDLc) lipoproteins and triglycerides (TG), besides of life habits and anthropometric data. Statistic analysis was employed, including the test of Mann Whitney, chi-square test, Pearsons correlation and multivariate analysis, by adopting a significance level for a value of p<0.05. RESULTS Sedentary lifestyle (43.1%) and familial history for CVD, particularly hypertension (74.5%), were distinguished. The lipid profile showed desirable, although altered levels of TC, LDLc and TG were detected in 11.8%, 9.8% and 8.5% from the students, respectively, and reduced levels of HDLc in 12.4% of them. Women showed significantly reduced values for LDLc and high values for HDLc compared to mens (p=0.031 and p<0.0001, respectively). There was a significant association between lipid profile and, preferably, body mass index (BMI), sedentary lifestyle, ingestion of alcohol, contraceptive use, familial antecedents of cerebrovascular accident and dyslipidemia. CONCLUSION Familial history for CVD, sedentary lifestyle and contraceptive use among medicine students showed frequent and associated to the lipid profile, as well as ingestion of alcohol and BMI. Although with desirable lipid profile, regardless of sex, higher levels of LDLc and reduced levels of HDLc in male sex provide a disadvantage to men compared to women.

Avaliação de depressão, problemas de comportamento e competência social em crianças obesas

O objetivo deste estudo foi avaliar a ocorrencia de depressao, problemas comportamentais e competencia social em criancas obesas, comparativamente a criancas nao obesas. Participaram do estudo 90 criancas, das quais 60 eram obesas e 30 nao eram, com idade entre 7 e 13 anos. Na coleta de dados foram utilizados: Ficha de Identificacao, Inventario de Depressao para Criancas e Inventario de Comportamentos da Infância e Adolescencia. Os dados foram analisados quantitativamente, com testes estatisticos nao parametricos e parametricos, com nivel de significância de 0,05. Os resultados apontaram diferenca significativa entre as criancas obesas e as criancas nao obesas em relacao as variaveis psicologicas estudadas. Na analise multivariada, a depressao e os disturbios internalizantes foram as variaveis que mais discriminaram as criancas obesas das nao obesas. Os dados indicam, portanto, a necessidade de uma intervencao precoce e a realizacao de programas de prevencao.

Association between obesity and asthma among teenagers

CONTEXT AND OBJECTIVE Obesity and asthma are serious and growing problems. Since adipose tissue produces inflammatory substances, the aim of this study was to estimate the prevalence of asthma among students at schools in São José do Rio Preto (Phase 1), and to corroborate the hypothesis for an association between obesity and asthma among these students (Phase 2). DESIGN AND SETTING Cross-sectional study at Faculdade de Medicina de São José do Rio Preto (Famerp). METHODS The study consisted of two successive and dependent stages. Phase I was a cross-sectional study on 4103 randomly selected students (13-14 years old), to determine the prevalence and severity of asthma. Phase II was an analytical cross-sectional study on 431 students (190 asthmatics and 231 non-asthmatics) from Phase I, to evaluate the hypothesis of an association between obesity measured by the body mass index (BMI) and asthma. To diagnose asthma and obesity, the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC) and the chart from the Centers for Disease Control (CDC; 2000) were used. The data were analyzed using Students t test. RESULTS We found that 5.6% of the students analyzed in Phase I were asthmatic. The BMI among the asthmatic students (21.84 kg/m(2)) was higher than the BMI among the non-asthmatics (21.73 kg/m(2)), although the p value was 0.766. CONCLUSION In our study group, we did not find any association between increased BMI and the prevalence of asthma.

Depressão, ansiedade e competência social em crianças obesas

Childhood obesity has high rates of occurrence and in Brazil has acquired great importance in the area of health, mainly due to the consequences to children lives, bringing physical, social, economical and psychological consequences. In this article we emphasize depression, anxiety and social competence among the multiple factors related to childhood obesity. We discuss studies that present these factors as cause or consequence of childhood obesity, despite the fact that there is no consensus in the area. However the simultaneous occurrence of depression, anxiety and deficits in social competence and childhood obesity shows the importance of this matter. The spread of this knowledge and new research in the area will improve the care of these patients.Obesidade infantil alcanca indices preocupantes, e sua ocorrencia na populacao brasileira tem adquirido grande significância na area da saude, principalmente devido ao impacto que causa na vida das criancas, trazendo consequencias fisicas, sociais, economicas e psicologicas. Neste artigo da-se enfase a depressao, ansiedade e competencia social, dentre os multiplos fatores relacionados a obesidade infantil. Discutem-se aqui estudos que mostram estes fatores como causa ou como consequencia da obesidade infantil, apesar de nao haver consenso na area. Porem, a ocorrencia concomitante de depressao, ansiedade e deficits de competencia social com obesidade infantil demonstra a relevância deste tema. Uma maior difusao deste conhecimento bem como a proliferacao destes estudos sao importantes para proporcionar um atendimento e intervencao adequada a essa populacao.

Clinical and laboratory profile of pediatric and adolescent patients with type 1 diabetes

OBJECTIVE To evaluate clinical and laboratory profiles of patients with type 1 diabetes mellitus in three public hospitals in São Paulo, Brazil, since type 1 diabetes mellitus is a chronic illness that occurs mainly in the pediatric age group in the Brazilian population. METHODS Cross-sectional study with patients followed up in reference centers in São José do Rio Preto (FAMERP), Campinas (UNICAMP) and São Paulo (Conjunto Hospitalar do Mandaqui). Data about gender, age, diabetes duration, daily insulin dose, number of daily insulin injections, and glycosylated hemoglobin (HbA1c) were analyzed. RESULTS Two hundred and thirty-nine patients (131 females) were evaluated; mean age was 13.1+/-4.7 years and mean diabetes duration was 6.6+/-4.2 years. Daily insulin doses ranged from 0.1 to 1.78 units/kg/day (0.88+/-0.28), and 180 (74.7%) patients had two daily injections. HbA1c ranged from 4.6 to 17.9% (10.0+/-2.3%). CONCLUSIONS Although the hospitals included in this study are excellence centers for the follow-up of patients with diabetes in three municipalities in the state of São Paulo, one of the most developed states in Brazil, blood glucose control evaluated according to HbA1c was not adequate. Findings confirm that, despite the efforts of all the professionals involved, great challenges still lie ahead.

Prevalência de obesidade em crianças e adolescentes com diabetes melito tipo 1

OBJECTIVE: To describe the prevalence of obesity according to gender and age in patients with type 1 diabetes mellitus of a pediatric endocrinology follow-up clinic. METHODS: This cross-sectional descriptive study enrolled patients of the follow-up clinic of the Pediatric Endocrinology Unit of Hospital de Base of Sao Jose do Rio Preto, Sao Paulo, Brazil. The following data were collected: gender, age, insulin dosage, glycated hemoglobin (HbA1c), weight, height and body mass index (BMI). The cutoff criteria for overweight and obesity were based on BMI-for-age growth charts of the Centers for Disease Control and Prevention (CDC, 2000). RESULTS: 77 patients with type 1 diabetes mellitus were included (44 females and 33 males), with three to 18 years old (mean: 13.4). The value of HbA1c varied from 4.1 to 10.6% (mean: 7.7%) and the BMI ranged from 15.1 to 28.6 kg/m2 (average: 23.2). Based on BMI charts, 8% (three girls and three boys) were obese and 8% (two girls and four boys) had overweight. CONCLUSION: Compared to the prevalence of obesity and overweight in non-diabetic pediatric population, the presence of these nutritional disturbances in the studied children was not significantly different.

Depressão, ansiedade, competência social e problemas comportamentais em crianças obesas

Childhood obesity has high rates of occurrence and in Brazil has acquired great importance in the area of health, mainly due to the consequences to childrens lives, bringing physical, social, economical and psychological consequences. In this article we emphasize depression, anxiety, social competence and behavior problems among the multiple factors related to childhood obesity. We discuss studies that present these factors as cause or consequence of childhood obesity, despite the fact that there is no consensus in the area. However, the simultaneous occurrence of depression, anxiety and deficits in social competence and childhood obesity shows the importance of this matter. The awareness of this and more research in the area will improve the quality of life of these patients.

Perfil clínico e laboratorial de pacientes pediátricos e adolescentes com diabetes tipo 1

OBJECTIVE: To evaluate clinical and laboratory profiles of patients with type 1 diabetes mellitus in three public hospitals in Sao Paulo, Brazil, since type 1 diabetes mellitus is a chronic illness that occurs mainly in the pediatric age group in the Brazilian population. METHODS: Cross-sectional study with patients followed up in reference centers in Sao Jose do Rio Preto (FAMERP), Campinas (UNICAMP) and Sao Paulo (Conjunto Hospitalar do Mandaqui). Data about gender, age, diabetes duration, daily insulin dose, number of daily insulin injections, and glycosylated hemoglobin (HbA1c) were analyzed. RESULTS: Two hundred and thirty-nine patients (131 females) were evaluated; mean age was 13.1±4.7 years and mean diabetes duration was 6.6±4.2 years. Daily insulin doses ranged from 0.1 to 1.78 units/kg/day (0.88±0.28), and 180 (74.7%) patients had two daily injections. HbA1c ranged from 4.6 to 17.9% (10.0±2.3%). CONCLUSIONS: Although the hospitals included in this study are excellence centers for the follow-up of patients with diabetes in three municipalities in the state of Sao Paulo, one of the most developed states in Brazil, blood glucose control evaluated according to HbA1c was not adequate. Findings confirm that, despite the efforts of all the professionals involved, great challenges still lie ahead.

Novel compound aquaporin 2 mutations in nephrogenic diabetes insipidus

Nephrogenic diabetes insipidus (NDI) is a rare disease that is characterized by the excretion of abnormally large volumes of urine, due to the inability of the kidneys to concentrate urine in response to arginine vasopressin (AVP). Classical NDI symptoms include polydipsia and polyuria in infants during the first year of life. Acquired NDI is the most common form of this disease in adults. The majority of inherited cases are caused by mutations in the arginine vasopressin V2 receptor (AVPR2) gene (MIM# 300538) on chromosome Xq28, which leads to functional defects in the AVPR2. The aquaporin (AQP2) gene (MIM# 107777) on chromosome 12q13 (1) is associated with the disease (2,3) in the minority of cases (∼10%). The present study identified two novel compound heterozygous mutations in the AQP2 gene, H201Y and G211R, in one female patient with congenital NDI.

Hipoglicemia hiperinsulinêmica da infância: Análise de dados clínicos de uma amostra brasileira

OBJECTIVE: To review the presentation of hyperinsulinemic hypoglycemia of the infancy (HHI), its treatment and histology in Brazilian pediatric endocrinology sections. MATERIALS AND METHOD: The protocol analyzed data of birth, laboratory results, treatment, surgery, and pancreas histology. RESULTS: Twenty-five cases of HHI from six centers were analyzed: 15 male, 3/25 born by vaginal delivery. The average age at diagnosis was 10.3 days. Glucose and insulin levels in the critical sample showed an average of 24.7 mg/dL and 26.3 UI/dL. Intravenous infusion of the glucose was greater than 10 mg/kg/min in all cases (M:19,1). Diazoxide was used in 15/25 of the cases, octreotide in 10, glucocorticoid in 8, growth hormone in 3, nifedipine in 2 and glucagon in 1. Ten of the cases underwent pancreatectomy and histology results showed the diffuse form of disease. CONCLUSION: This is the first critic review of a Brazilian sample with congenital HHI. Arq Bras Endocrinol Metab. 2012;56(9):666-71