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%), and glucose intolerance was observed in 4 patients (12.1%). 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%. 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.

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.

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% presented alterations in the aminotransferase levels (grade B), 16.9% presented grade C liver involvement and 3.8% 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.

OBJETIVOS: Determinar a prevalência de obesidade e sua associação com hipertensão arterial sistêmica (HAS), dislipidemias (DL), diabetes mellitus (DM) e outros fatores de risco cardiovascular. CASUÍSTICA E MÉTODOS: Estudo de delineamento transversal de 1039 adultos >18anos da região urbana, amostragem aleatória em estágios múltiplos e conglomerados. Os dados foram obtidos no domicílio, através de questionário, avaliação clínica e coleta de sangue para análise laboratorial. RESULTADOS: A prevalência de obesidade (IMC >30kg/m2) foi de 17,8% (IC95%15,5-20,1), enquanto que a obesidade abdominal (CA >102cm e >88cm para homens e mulheres, respectivamente) esteve presente em 35,1% (IC95%32,2-38) dos entrevistados. A obesidade foi mais freqüente entre as mulheres - 20,2% do que entre os homens - 15,2% (p= 0,01) e apresentou associação 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% / 32,0% (p< 0,001), 11,8% / 6,4% (p= 0,03) e 32,2% / 24,1% (p= 0,005). CONCLUSÕES: 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 relação aos pacientes eutróficos.

OBJECTIVES: To determine the prevalence of obesity and its association with systemic arterial hypertension (SAH), dyslipidemia (DL), diabetes mellitus (DM) and other cardiovascular risk factors. SAMPLE AND METHODS: Cross-sectional study of 1039 adults >18 years from an urban region, randomly selected in conglomerates and in a multiple stage process. Data were obtained in the household through a questionnaire, clinical evaluation and blood sampling for laboratory analysis. RESULTS: The overall prevalence of obesity (BMI >30kg/m2) was 17.8% (CI95%15.5-20.1), while abdominal obesity (AC >102cm and >88cm for men and women, respectively) was present in 35.1% (CI95%32.2-38) of the interviewees. Overall obesity was more common among women (20.2%) than men (15.2%) (p= 0.01), with a positive association with age (p= 0.05), sedentarism (p= 0.02), SAH (p< 0.001) and DL (p= 0.005). Among the patients with and without excess abdominal fat, the SAH, DM and DL rates were respectively of: 57.7% / 32.0% (p< 0.001), 11.8% / 6.4% (p= 0.03) and 32.2% / 24.1% (p= 0.005). CONCLUSIONS: Overall obesity was more common among women and it increased with age. Individuals with obesity and/or excess abdominal fat presented a greater prevalence of SAH, DM and DL, as compared to healthy individuals.

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%; of hypercholesterolemia, 4.2%; of elevated LDL-C, 3.5%; of low HDL-C, 18.3%; and of hypertriglyceridemia, 17.1%. 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.

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%. Homens (6,3%) e mulheres (5,7%) tiveram resultados semelhantes, assim como brancos (5,9%) e não brancos (6,3%). A prevalência de DM foi maior em pessoas com história familiar da doença (p<0,001). A prevalência de DM aumentou de 2,1% na faixa de 18-29 anos para 18,3% 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 importância do DM no contexto de saúde pública como doença crônica não transmissível.

OBJECTIVE: To determine the prevalence of diabetes mellitus (DM) and risk factors in adults of Campos dos Goytacazes, RJ. METHODS: A cross-sectional study of a populational basis was performed, with sample conglomerates stratified by social and economical levels. Two visits were performed to 1039 individuals, with application of a questionnaire, evaluation of the arterial blood pressure, anthropometric measurements and collection of fasting blood for glucose, triglycerides, cholesterol, HDL-c and LDL-c. RESULTS: The age-adjusted prevalence was 6.0%. Men (6.3%) and women (5.7%) had similar results, as well white (5.9%) and non-white (6.3%). The prevalence of DM was higher in people with family history of the disease (p<0.001). The prevalence of DM increased from 2.1% in people with 18-29 years to 18.3% in those with more than 70 years of age (p<0.001). DM was more prevalent among patients with arterial hypertension, dyslipidemia and weight excess (p<0.001). CONCLUSIONS: The results are similar to prevalence numbers in other regions of Brazil. Thus, we realize the great importance of DM on public health context as a chronic and non-transmissible disease.

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.