Glucose homeostasis and weight loss in morbidly obese patients undergoing banded sleeve gastrectomy: a prospective clinical study

OBJECTIVE: To assess glucose homeostasis and weight loss in morbidly obese patients undergoing Silastic® ring sleeve gastrectomy. METHODS: This was a prospective clinical study. Thirty-three female patients with a mean body mass index (BMI) of 42.33 ± 1.50 kg/m² (range: 40-45 kg/m²), a mean age of 36.7 ± 9.4 years and a mean waist circumference of 118.7 ± 5.98 cm were included in this study. Type 2 diabetes mellitus was observed in 11 patients (33.3 percent), and glucose intolerance was observed in 4 patients (12.1 percent). Mean plasma fasting glucose levels were 109.77 ± 44.19 mg/dl (75-320) in the preoperative period. All Silastic® ring sleeve gastrectomy procedures were performed by the same surgical team using the same anesthetic technique. The patients were monitored for at least 12 months after surgery. RESULTS: The mean weight of the patients decreased from 107.69 ± 6.57 kg to 70.52 ± 9.36 kg (p < 0.001), the mean BMI decreased to 27.4 ± 2.42 kg/m² (p < 0.001), and the mean waist circumference decreased to 89.87 cm ± 6.66 (p < 0.001) in the postoperative period. Excess BMI loss was 86.5 ± 14.2 percent. Fasting glucose levels were reduced to 80.94 ± 6.3 mg/dl (p < 0.001). Remission of diabetes and glucose intolerance was observed in all patients. CONCLUSION: Silastic® ring sleeve gastrectomy was effective in promoting weight loss, waist circumference reduction and control of glucose homeostasis in morbidly obese patients.

Hemorrhagic encephalopathy in dengue shock syndrome: a case report

Dengue fever is the most important arboviral infection in the world, with an estimated 100 million cases per year and 2.5 billion people at risk. Encephalopathy is a rare complication of dengue virus infection and may occur as a consequence of intracranial hemorrhage, cerebral edema, hyponatremia, cerebral anoxia, fulminant hepatic failure with portosystemic encephalopathy, microcapillary hemorrhage or release of toxic products. We report a rare case of hemorrhagic encephalopathy in dengue shock syndrome caused by type 3 dengue virus.

Doença de Castleman multicêntrica / Multicentric Castleman's disease

A doença de Castleman (DC) é uma rara desordem linfoproliferativa de origem desconhecida. É classificada histologicamente em três tipos: hialinovascular, o mais comum, células plasmocitárias e mista. O tipo hialinovascular é usualmente caracterizado por um curso benigno sem apresentar sintomas sistêmicos. Relataremos o raro caso de um paciente de 45 anos com doença de Castleman tipo hialinovascular com queixas de emagrecimento e fraqueza muscular de dois anos de evolução

Aminotransferase changes and acute hepatitis in patients with dengue fever: analysis of 1, 585 cases

INTRODUCTION: Type 3 dengue virus caused an extensive epidemic in the state of Rio de Janeiro in summer 2002. In some of the patients, it was found in an atypical form with increased aminotransferase levels and acute hepatitis. MATERIAL AND METHODS: An analysis was made of 1,585 serologically confirmed dengue cases at the Dengue Reference Center in Campos dos Goytacazes, Rio de Janeiro state. The grade of hepatic aggression was established according to the alterations in the aminotransferase levels: grade A - normal levels of aminotransferase; grade B - elevated aminotransferase, with increased levels of at least one of the enzymes; grade C - elevated aminotransferase, with the levels of at least one of the enzymes increased to more than three times the reference values; grade D - acute hepatitis, with aminotransferase levels increased to at least 10 times their normal values. RESULTS: Among the 1,585 serologically confirmed dengue cases, 44.5 percent presented alterations in the aminotransferase levels (grade B), 16.9 percent presented grade C liver involvement and 3.8 percent of the patients had progressed to acute hepatitis (grade D). The average values for the rise in aspartate aminotransferase and alanine aminotransferase were 93.3 U/L and 86.0 U/L. The greatest alterations were observed among females (p<0.001), cases of dengue hemorrhagic fever (p<0.001), and cases with sequential infections (p=0.001). CONCLUSIONS: Liver damage with elevation of aminotransferases and reactive hepatitis was a common complication of dengue virus infection in these patients.

Prevalência de obesidade e fatores de risco cardiovascular em Campos, Rio de Janeiro / Prevalence of obesity and cardiovascular risk factors in Campos, RJ

OBJETIVOS: Determinar a prevalência de obesidade e sua associaçäo com hipertensäo arterial sistêmica (HAS), dislipidemias (DL), diabetes mellitus (DM) e outros fatores de risco cardiovascular. CASUíSTICA E MÉTODOS: Estudo de delineamento transversal de 1039 adultos >18 anos da regiäo urbana, amostragem aleatória em estágios múltiplos e conglomerados. Os dados foram obtidos no domicílio, através de questionário, avaliaçäo clínica e coleta de sangue para análise laboratorial. RESULTADOS: A prevalência de obesidade (IMC >30kg/m2) foi de 17,8 por cento (IC95 por cento 15,5-20,1), enquanto que a obesidade abdominal (CA >102cm e >88cm para homens e mulheres, respectivamente) esteve presente em 35,1 por cento (IC95 por cento32,2-38) dos entrevistados. A obesidade foi mais freqüente entre as mulheres - 20,2 por cento do que entre os homens - 15,2 por cento (p= 0,01) e apresentou associaçäo positiva com a idade (p= 0,05), sedentarismo (p= 0,02), HAS (p< 0,001) e DL (p= 0,005). Nos pacientes com e sem excesso de gordura abdominal as freqüências de HAS, DM e DL foram respectivamente de: 57,7 por cento / 32,0 por cento (p< 0,001), 11,8 por cento / 6,4 por cento (p= 0,03) e 32,2 por cento / 24,1 por cento (p= 0,005). CONCLUSöES: A obesidade foi mais freqüente entre as mulheres e aumentou com o avançar da idade. Os indivíduos com obesidade e/ou excesso de gordura abdominal apresentaram maior prevalência de HAS, DM e DL em relaçäo aos pacientes eutróficos.

Granulomatose de Wegener e mononeurite múltipla / Wegener granulomatosis and mononeuritis multiplex

A granulomatose de Wegeber (GW) é uma vasculite sistêmica de pequenos vasos que se caracteriza pela tríade clássica de sinusite, vasculite sistêmica e acometimento renal. Neste relato apresentamos um caso de granulomatose de Wegener em uma paciente de 48 anos com história pregressa de sinusite de longa data e estenose subglótica, que apresentou quadro de mononeurite múltipla e púrpura palpável.

Prevalência de dislipidemia e fatores de risco em Campos dos Goytacazes - RJ / Prevalence of dyslipidemia and risk factors in Campos dos Goytacazes, in the Brazilian State of Rio de Janeiro

OBJECTIVE: To determine the prevalence of dyslipidemias in adults in the city of Campos dos Goytacazes, in the Brazilian state of Rio de Janeiro, and to identify its relation to risk factors. METHODS: Cross-sectional, population-based, observational study with sampling through conglomerates and stratified according to socioeconomic levels, sex, and age, with 1,039 individuals. Risk factors, familial history, blood pressure, anthropometric measurements, glucose, triglycerides and cholesterol were determined. RESULTS: The following prevalences were observed: of dyslipidemias 24.2 percent; of hypercholesterolemia, 4.2 percent; of elevated LDL-C, 3.5 percent; of low HDL-C, 18.3 percent; and of hypertriglyceridemia, 17.1 percent. The following mean levels were observed: cholesterol, 187.6± 33.7 mg/dL; LDL-C, 108.7±26.8 mg/dL; HDL-C, 48.5±7.7 mg/dL; and triglycerides, 150.1±109.8 mg/dL. The following variables showed a positive correlation with dyslipidemia: increased age (P<0.001), male sex (P<0.001), low familial income (P<0.001), familial history (P<0.01), overweight/obesity (P<0.001), waist measure (P<0.001), high blood pressure (P<0.001), and diabetes mellitus (P<0.001). The following variables had no influence on dyslipidemias: ethnicity, educational level, smoking habits, and sedentary lifestyle. CONCLUSION: The frequency of lipid changes in the population studied was high, suggesting that measures for the early diagnosis should be taken, in association with implementation of programs for primary and secondary prevention of atherosclerosis

Prevalência de diabetes mellitus e fatores de risco em Campos dod Goycatazes, RJ / Prevalence of diabetes mellitus and risk factors in Campos dos Goycatazes, RJ

Objetivo: Determinar a prevalência de diabetes mellitus (DM) e fatores de risco em adultos, em Campos dos Goytacazes. Métodos: Estudo transversal, de base populacional, com amostragem por conglomerados, estratificada pelo nível sócio-econômico. Foram realizadas duas visitas a 1039 indivíduos, com aplicação de questionário, avaliação da pressão arterial, medidas antropométricas e coleta de amostra de sangue em jejum para análise da glicose, triglicerídeos, colesterol, HDL-c e LDL-c. Resultados: A prevalência ajustada pela idade foi de 6,0 por cento. Homens (6,3 por cento) e mulheres (5,7 por cento) tiveram resultados semelhantes, assim como brancos (5,9 por cento) e não brancos (6,3 por cento). A prevalência de DM foi maior em pessoas com história familiar da doença (p<0,001). A prevalência de DM aumentou de 2,1 por cento na faixa de 18-29 anos para 18,3 por cento nos pacientes acima de 70 anos de idade (p<0,001). O DM foi mais prevalente entre os pacientes portadores de hipertensão arterial, dislipidemia e excesso de peso (p<0,001). Conclusões: Os resultados se encontram próximo dos números de prevalência em outras regiões do Brasil. Assim, percebemos a grande importãncia do DM no contexto de saúde pública como doença crônica não transmissível.

Hepatitis in Dengue Shock Syndrome

Dengue fever is the most frequent arbovirus disease in the world and the most important one in terms of morbidity and mortality. Atypical manifestations of dengue have become commonplace during the last few years, including hepatic damage, which manifests mainly by pain in the right hypochondrium and an increase in the levels of aminotransferases. We describe a case of acute hepatitis in a patient with Dengue Shock Syndrome Grade III. We analyzed the clinical and laboratory aspects of this atypical complication of dengue as well as the differential diagnoses.