Factors associated with non-adoption of healthy behavior among individuals with diabetes: a population-based study in Brazil.

BACKGROUND: The non-adoption of behavioral changes to control diabetes mellitus contributes to a low adherence to self-care. This study aimed to investigate the factors associated with non-adoption of healthy behaviors among diabetic individuals. METHODS: Cross-sectional study using data from the National Health Survey (Pesquisa Nacional de Saúde) carried out in 2013 in Brazil, with adults (≥18 years) (n = 3098). The outcome variable was the non-adoption-two or fewer-of healthy behaviors. Logistic regression model was used to identify the factors associated with non-adoption of healthy behaviors. RESULTS: Approximately, 50% of the participants adopted two or fewer healthy habits and the most frequently mentioned were not drinking excessively (94.1%) and not smoking (89.1%). Not using diabetic medication (odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.02-1.85), not making regular doctor visits (OR = 1.42, 95% CI = 1.08-1.87), no limitation of usual activities (OR = 1.39, 95% CI = 1.01-1.94) and good self-rated health (OR = 1.47, 95% CI = 1.09-1.98) increased the chance of individuals non-adoption of healthy behaviors independently of gender, age, schooling and economic status. CONCLUSIONS: Health professionals need to be aware of issues, such as diabetic medication use, frequency of doctor visits, limitation of usual activities and good self-rated health, which are factors that can interfere with the adoption of healthy behaviors of diabetic patients.

Excess mortality associated with COVID-19 in Brazil: 2020-2021.

OBJECTIVE: To evaluate excess mortality in Brazil from January 2020 to April 2021, according to the primary causes of death registered in the Brazilian Mortality Information System (MIS). METHODS: Cross-sectional study with data extracted from the MIS. Excess deaths were examined by the primary cause of death according to 11 grouped causes. Autoregressive models used mortality data from 2015 to 2019 to predict expected deaths from January 2020 to April 2021. Excess deaths were calculated as the difference between the observed and the expected number of deaths. RESULTS: Total excess deaths of 370 055 were observed in the studied period, corresponding to a ratio of observed to expected of 1.14 in 2020 and 1.40 in 2021. Excess deaths were seen in three groups: symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified; other diseases of the respiratory system and coronavirus infection, unspecified site. CONCLUSIONS: The excess mortality in Brazil in these 16 months was 1.20 times greater than the previous year. The increase in not elsewhere classified causes and causes of death associated to COVID-19 indicate caution about the negative balance for some causes. Furthermore, the inequalities of mortality reporting systems in low- and middle-income countries in relation to underestimation of mortality still need to be addressed.

9 Years after the first laparoscopic adjusted gastric banding (LAGB) in adolescents: the Portuguese experience.

INTRODUCTION: Children all over the world are increasingly becoming overweight and obese. The experience with adults has demonstrated that surgery is the only effective way of achieving sustained weight loss in obese patients. Simultaneously, it has been proposed that bariatric surgery in the adolescent period would be a more effective treatment for childhood-onset extreme obesity rather than delaying surgery for extremely obese youth until adulthood. Nevertheless, the optimal surgical option for both adults and adolescents has yet to be established. The aim of our study was to evaluate the results of 9 years of laparoscopic adjusted gastric banding (LAGB) performed in our hospital for obesity-associated comorbidities (OAC), weight loss and surgical morbidity. METHODS: A prospective study of all patients who underwent LAGB at our hospital between July 2001 and May 2010 was carried out. Patient selection was by a multidisciplinary team and based on the "IPEG Guideline for the Surgical Treatment of Extremely Obese Adolescents". Data were reviewed retrospectively. RESULTS: 14 patients underwent LAGB (10♀; 4♂; average age: 16 years). Preoperative BMI ranged between 41.4 and 54.6 kg/m (2). Prior to surgery, 8 different OACs were identified. 6 months later, 4 types of OAC had resolved completely and the other 4 had improved, and the improvement was maintained over time. The average excess weight (EW) loss increased from 25.7 to 48.2% at 6 and 36 months of follow-up, respectively (10 patients). At 60 and 106 months of follow-up it was 41.5% (5 patients) and 31.8% (1 patient), respectively. There were no complications arising from the surgery itself. Long-term complications were few and easily managed. CONCLUSIONS: LAGB seems to be a good option to treat obese adolescents, as it is a minimally invasive procedure that does not radically change the patient's anatomy and is associated with minimal morbidity. It leads to a sustained improvement/resolution of OAC, and although weight loss is not continuous, it is maintained over time.

[Infantile hepatic hemangioendothelioma. A multifocal, bilobular and asymptomatic case with spontaneous regression]. / Hemangioendotelioma hepático infantil. Un caso multifocal y bilobular, asintomático, con regresión espontánea.

Infantile hepatic hemangioendothelioma is a severe disease with a high mortality rate. Nevertheless these vascular lesions may experience spontaneous regression within 12 to 18 months. The decision of trying a specific treatment and the choice among the several therapeutic options remains controversial, particularly in those asymptomatic cases of multifocal, bilobular involvement. We describe a case of multifocal, bilobular and asymptomatic infantile hepatic hemangioendothelioma, untreated, and with spontaneous regression before 2 years of age.

Hemangioendotelioma hepático infantil. Un caso multifocal y bilobular, asintomático, con regresión espontánea / Infantile hepatic hemangioendothelioma. A multifocal, bilobular and asymptomatic case with spontaneous regression

El hemangioendotelioma hepático infantil (HHI) es una enfermedad grave y con elevada mortalidad. A pesar de ello, estas lesiones vasculares pueden evolucionar espontáneamente para su resolución completa entre 12 y 18 meses. La decisión de intentar un tratamiento específico y la elección entre las varias opciones terapéuticas continúa siendo polémica, especialmente en los casos asintomáticos de afectación multifocal o bilobular. Describimos un caso de HHI, multifocal y bilobular, asintomático, no sometido a ningún tipo de terapia y con regresión de las lesiones antes de los 2 años de edad (AU)

Infantile hepatic hemangioendothelioma is a severe disease with a high mortality rate. Nevertheless these vascular lesions may experience spontaneous regression within 12 to 18 months. The decision of trying a specific treatment and the choice among the several therapeutic options remains controversial, particularly in those asymptomatic cases of multifocal, bilobular involvement. We describe a case of multifocal, bilobular and asymptomatic infantile hepatic hemangioendothelioma, untreated, and with spontaneous regression before 2 years of age (AU)

[Minimal invasive surgical of intersex abnormalities: our experience]. / Cirugía mínimamente invasiva en el intersexo: nuestra experiencia.

The term intersex makes reference to either newborn infants who show ambiguous external genitals or those who, having a normal phenotype, show growth alterations in the puberty. The etiologic diagnostic is oriented by the physical examination, biochemical studies, radiologic, surgical techniques and histological discoveries; that enables us to decide one more accurate sex assignment; the laparoscopy plays an important role, for the direct visualisation of the intra-abdominal gonads, internal genital identification, gonadal biopsy, as well as therapeutic interventions as gonadectomy, orchidopexy and resection of Müllerian remants, replacing totally the laparotomy. The purpose of our job was evaluate the role of the minimal invasive surgical as diagnostic and treatment of the intersex, in nine intersex children treated in our hospital over the last three years.

Testículos no palpables: experiencia del Hospital Central Especializado de Crianças Maria Pia / Nonpalpable testes: experience from the Hospital Central Especializado de Crianças Maria Pia

La incidencia de criptorquidia es del 1% en niños de 1 año de edad, siendo en el 20% de los casos el testículo no palpable. El objetivo de este trabajo fue estudiar la contribución de la cirugía mínimamente invasiva en el diagnóstico y tratamiento de estos pacientes. Los autores realizaron un estudio prospectivo, analítico y longitudinal durante el período de enero de 2001 a diciembre de 2004, englobando 89 niños portadores de 98 testículos no palpables sometidos a laparoscopia. Los autores analizaron los siguientes parámetros: localización del testículo no palpable, examen objetivo bajo anestesia general, ecografía inguinoescrotal, edad de la intervención, hallazgos laparoscópicos, tratamiento efectuado, resultados anatomopatológicos de las piezas extirpadas y seguimiento después de la cirugía (AU)

The incidence of cryptorchidism in children at age of 1 year is 1%, and 20% of these cases represent nonpalpable testes. The aim was to evaluate the use of minimal invasive surgery for the diagnosis and therapy of these patients. The authors made a prospective, analytical and longitudinal study from January 2001 through December 2004 in 89 consecutive boys undergoing laparoscopy for 98 impalpable testes. The following details were analyzed: examination under general anesthesia, ultrasound examination, age at surgery, findings at laparoscopy, operative procedure, results of the histology and follow up (AU)

Cirugía mínimamente invasiva en el intersexo: nuestra experiencia / Minimal invasive surgical of intersex abnormalities: our experience

El término intersexo hace referencia bien a aquellos recién nacidos que al nacer presentan los genitales externos ambiguos o bien aquellos que, teniendo un fenotipo normal, presentan alteraciones del desarrollo en la pubertad o adolescencia. Es a través de la exploración clínica, bioquímica, radiología, técnicas quirúrgicas y hallazgos anatomopatológicos, que nos permiten orientar el diagnóstico etiológico y decidir así una asignación del sexo más precisa. La laparoscopia juega un importante papel, no sólo para la visualización directa de las gónadas intraabdominales, identificación de los genitales internos o biopsia gonadal, sino también como medida terapéutica para la realización de gonadectomía, orquidopexia o exéresis de restos müllerianos, desplazando totalmente a la laparotomía. Es en esta perspectiva, que el objetivo de nuestro trabajo fue evaluar el papel de la cirugía mínimamente invasiva como medio diagnóstico y terapéutico del intersexo, en 9 niños tratados en nuestro Centro durante los últimos 3 años (AU)

The term intersex makes reference to either newborn infants who show ambiguous external genitals or those who, having a normal phenotype, show growth alterations in the puberty. The etiologic diagnostic is oriented by the physical examination, biochemical studies, radiologic, surgical techniques and histological discoveries; that enables us to decide one more accurate sex assignment; the laparoscopy plays an important role, for the direct visualisation of the intra-abdominal gonads, internal genital identification, gonadal biopsy, as well as therapeutic interventions as gonadectomy, orchidopexy and resection of müllerian remants, replacing totally the laparotomy. The purpose of our job was evaluate the role of the minimal invasive surgical as diagnostic and treatment of the intersex, in nine intersex children treated in our hospital over the last three years (AU)

[Nonpalpable testes: experience from the Hospital Central Especializado de Crianças Maria Pia]. / Testiculos no palpables: experiencia del Hospital Central Especializado de Crianças Maria Pia.

The incidence of cryptorchidism in children at age of 1 year is 1%, and 20% of these cases represent nonpalpable testes. The aim was to evaluate the use of minimal invasive surgery for the diagnosis and therapy of these patients. The authors made a prospective, analytical and longitudinal study from January 2001 through December 2004 in 89 consecutive boys undergoing laparoscopy for 98 impalpable testes. The following details were analyzed: examination under general anesthesia, ultrasound examination, age at surgery, findings at laparoscopy, operative procedure, results of the histology and follow up.

Cystic duplication of the rectum--report of two clinical cases.

The authors present two case reports of cystic rectal duplication which presented as rectal prolapse. Two girls, caucasian race, 8 months and 12 years old, went to the emergency department because of a rectal prolapse. After the diagnosis surgical excision was performed by transanal approach. The post-operative period was short and uneventful. Histological examination confirmed a rectal cystic duplication.

Acute gastric volvulus and congenital posterolateral diaphragmatic hernia.

Acute gastric volvulus in infancy is a rare disorder and a surgical emergency. Prompt clinical suspicion and radiological assessment are essential for this life-threatening condition. We report a 3-month-old female case, admitted for an initial suspicion of an intestinal obstruction. She presented unproductive retching, respiratory distress, epigastric distension and lethargy. It was not possible to introduce a naso-gastric tube. A radiological contrast study showed an occluded cardio-esophageal junction without passage of barium, two gastric fluid levels and a horizontally positioned stomach occupying the inferior portion of the left hemithorax, suggesting a left diaphragmatic hernia. Laparotomy revealed an acute mesenterico-axial gastric volvulus with a left posterolateral diaphragmatic hernia. The stomach volvulus was untwisted, the diaphragmatic defect was repaired after reduction of the herniated contents and no gastropexy was done. At 3 and 6-months follow-up examination the infant was asymptomatic and thriving.