Abstract Objective: Congenital hyperinsulinism (CHI) is a heterogeneous genetic disease characterized by increased insulin secretion and causes persistent hypoglycemia in neonates and infants due to dysregulation of insulin secretion by pancreatic β cells. Babies with severe hypoglycemia and for whom medical treatment has been ineffective usually require surgical treatment with near-total pancreatectomy. To evaluate the clinical and surgical aspects affecting survival outcomes in babies diagnosed with CHI in a single tertiary care center. Methods: Retrospective Cohort study involving a single university tertiary center for the treatment of CHI. The authors study the demographics, clinical, laboratory, and surgical outcomes of this casuistic. Results: 61 % were female, 39 % male, Birth weight: 3576 g (±313); Age of onset of symptoms: from the 2nd hour of life to 28 days; Time between diagnosis and surgery ranged between 10 and 60 days; Medical clinical treatment, all patients received glucose solution with a continuous glucose infusion and diazoxide. 81 % of the patients used corticosteroids, 77 %. thiazide, 72 % octreotide, 27 % nifedipine; Neurological sequelae during development and growth: 54 % had some degree of delay in neuropsychomotor development, 27 % obesity. Surgery was performed open in 6 and 12 minimally invasive surgery (MIS). Histopathology: 2 focal and 16 diffuse, Length of stay (days) was lower in MIS (p < 0.05). Survival was 100 %. Conclusions: CHI is a rare and difficult-to-manage tumor that must be performed in a multidisciplinary and tertiary center. Most surgical results are good and the laparoscopic approach to disease has been the best choice for patients. Objective (CHI cells neartotal near total pancreatectomy Methods demographics laboratory casuistic Results female 3 male weight 357 ±313 313 (±313) symptoms nd days 1 diazoxide 8 corticosteroids 7 thiazide octreotide nifedipine growth 5 obesity MIS. . (MIS) Histopathology diffuse (days p 0.05. 005 0.05 0 05 0.05) Conclusions difficulttomanage difficult manage 35 ±31 31 (±313 (MIS 00 0.0 ±3 (±31 0. ± (±3 (± (

Abstract Objectives: Clinical-laboratory comparison of a population of children and adolescents with DM1 followed at a Brazilian outpatient university clinic, at two different periods (2014 and 2020), regarding changes made both to the insulin therapy scheme and to the nutritional approach to carbohydrate counting. Methods: The data of patients with DM1 aged 0–19 years enrolled in the service in 2014 and 2020 were collected. Student’s t-test was performed to compare the means of HbA1c and the variables of interest. Results: NPH + regular insulin was predominantly used in 2014 (49.1%), while in 2020, the predominance shifted to insulin analogs (48.4%). Pump use tripled from 1.3% in 2014 to 4.4% in 2020, and the percentage of patients performing carbohydrate counting reduced from 28.3% to 17.8%. Regarding HbA1c, the 2014 group of patients had a mean of 9.8%, while the 2020 group had a mean of 9.6% (p = 0.49). Conclusion: The change in treatments between 2014 and 2020 did not result in a significant improvement in HbA1c levels. However, it was identified the importance of carbohydrate counting and the use of insulin analogs to improve metabolic control in this population at both times. Objectives Clinicallaboratory Clinical laboratory DM clinic (201 , 2020) Methods 019 0 19 0–1 201 202 collected Students Student s ttest t test HbAc HbA c interest Results 49.1%, 491 49.1% 49 1 (49.1%) 48.4%. 484 48.4% . 48 4 (48.4%) 13 3 1.3 44 4.4 283 28 28.3 178 17 8 17.8% 98 9 9.8% 96 6 9.6 p 0.49. 049 0.49 0.49) Conclusion levels However times (20 01 0– 20 49.1 (49.1% 48.4 (48.4% 1. 4. 2 28. 17.8 9.8 9. 04 0.4 (2 49. (49.1 48. (48.4 17. 0. ( (49. (48. (49 (48 (4

RESUMO Objetivo: Traçar o perfil clínico e sociodemográfico de adolescentes com diabetes mellitus tipo 1 em seguimento em um hospital público do interior paulista e associá-lo à qualidade de vida. Método: Estudo quantitativo, transversal e analítico, realizado com 80 díades: adolescentes e seus respectivos responsáveis. Os dados foram coletados através de formulário clínico/sociodemográfico e do Instrumento de Qualidade de Vida para Jovens com Diabetes. Para a análise de dados, utilizou-se estatística descritiva e, para verificar a associação entre a qualidade de vida e as variáveis clínicas e sociodemográficas, aplicaram-se os testes Qui-quadrado de Pearson e o Exato de Fisher. Resultados: Do total dos adolescentes, 52,5% eram do sexo feminino e 56,3% estavam na faixa etária de 15 a 17 anos, 51,3% autodeclararam-se brancos e 40,1% cursavam o ensino médio. Os adolescentes apresentaram alta qualidade de vida. No domínio preocupação, entretanto, constatou-se associação significativa com o tempo de diagnóstico (p=0,035), demonstrando que os jovens com mais tempo de doença apresentaram pior qualidade de vida. Conclusão: A maior parte dos adolescentes deste estudo (51,3%) tinha 10 ou mais anos convivendo com a diabetes. Identificou-se que o tempo de diagnóstico é potencialmente capaz de interferir na qualidade de vida desses jovens. Objetivo associálo associá lo Método quantitativo analítico 8 díades responsáveis clínicosociodemográfico Diabetes utilizouse utilizou se sociodemográficas aplicaramse aplicaram Quiquadrado Qui quadrado Fisher Resultados 525 52 5 52,5 563 56 3 56,3 513 51 51,3 autodeclararamse autodeclararam 401 40 40,1 médio preocupação entretanto constatouse constatou p=0,035, p0035 p p=0,035 , 0 035 (p=0,035) Conclusão (51,3% Identificouse Identificou 52, 56, 51, 4 40, p003 p=0,03 03 (p=0,035 (51,3 p00 p=0,0 (p=0,03 (51, p0 p=0, (p=0,0 (51 p=0 (p=0, (5 p= (p=0 ( (p= (p

ABSTRACT Objective: To describe the clinical and sociodemographic profile and associate them with the quality of life of adolescents with type 1 diabetes mellitus being followed up in a public hospital in an inner city of the state of São Paulo. Method: Quantitative, cross-sectional, and analytical study, performed with 80 dyads. Data were collected through a clinical/sociodemographic form and a Quality of Life Instrument. For analysis, descriptive statistics were used, and Pearson's Chi-square and Fisher's Exact tests were applied to assess the association between quality of life and clinical/sociodemographic variables. Results: Out of the total participants, the ones who scored high quality of life were mostly, female (52.5%), in the age group 15 to 17 years old (56.3%), 51.3% self-identified as white, and 40.1% were attending high school. In the preoccupation domain, a significant association was found to the time since diagnosis (p=0.035), demonstrating that young adolescents with a longer time of diagnosis had a worse quality of life. Conclusion: The majority of adolescents in this study (51.3%) had been living with diabetes for 10 or more years. It was identified that the duration of the diagnosis has the potential to interfere with the quality of life of these young individuals. Objective Paulo Method Quantitative crosssectional, crosssectional cross sectional, sectional cross-sectional 8 dyads clinicalsociodemographic Instrument analysis used Pearsons Pearson s Chisquare Chi square Fishers Fisher variables Results participants mostly 52.5%, 525 52.5% , 52 5 (52.5%) 56.3%, 563 56.3% 56 3 (56.3%) 513 51 51.3 selfidentified self white 401 40 40.1 school domain p=0.035, p0035 p p=0.035 0 035 (p=0.035) Conclusion (51.3% individuals 52.5 (52.5% 56.3 (56.3% 51. 4 40. p003 p=0.03 03 (p=0.035 (51.3 52. (52.5 56. (56.3 p00 p=0.0 (p=0.03 (51. (52. (56. p0 p=0. (p=0.0 (51 (52 (56 p=0 (p=0. (5 p= (p=0 ( (p= (p

RESUMEN Objetivo: Describir el perfil clínico y sociodemográfico y asociarlo con la calidad de vida de adolescentes con diabetes mellitus tipo 1 en seguimiento en un hospital público del estado de São Paulo. Método: Estudio cuantitativo, transversal y analítico, realizado con 80 diadas. Los datos fueron recogidos mediante un formulario clínico/sociodemográfico y un Instrumento de Calidad de Vida. Se utilizó estadística descriptiva y se aplicaron las pruebas de Chi-cuadrado de Pearson y Exacto de Fisher para verificar la asociación entre la calidad de vida y las variables clínicas/sociodemográficas. Resultados: Del total de adolescentes, 52,5% eran del sexo femenino y 56,3% se encontraban en el grupo de edad de 15 a 17 años, el 51,3% se autodeclararon como blancos y el 40,1% asistían a la escuela secundaria. Los adolescentes presentaron una alta calidad de vida. En el dominio preocupación, se encontró asociación significativa con el tiempo desde el diagnóstico (p=0,035), demostrando que los jóvenes con más tiempo del diagnóstico presentaron peor calidad de vida. Conclusión: La mayoría de los adolescentes en este estudio (51,3%) llevaban 10 años o más conviviendo con la diabetes. Se identificó que la duración del diagnóstico tiene el potencial de interferir en la calidad de vida de estos jóvenes. Objetivo Paulo Método cuantitativo analítico 8 diadas clínicosociodemográfico Vida Chicuadrado Chi cuadrado clínicassociodemográficas clínicas sociodemográficas clínicas/sociodemográficas Resultados 525 52 5 52,5 563 56 3 56,3 513 51 51,3 401 40 40,1 secundaria preocupación p=0,035, p0035 p p=0,035 , 0 035 (p=0,035) Conclusión (51,3% 52, 56, 51, 4 40, p003 p=0,03 03 (p=0,035 (51,3 p00 p=0,0 (p=0,03 (51, p0 p=0, (p=0,0 (51 p=0 (p=0, (5 p= (p=0 ( (p= (p

Abstract Objective: Evaluate the impact of teleconsultation on glycemic control and prevention of acute complications related to diabetes mellitus in children and adolescents treated in a reference hospital during the COVID-19 pandemic in 2020. Method: Descriptive study of data from pediatric diabetic patients who received teleconsultation between April and September 2020. Results: During this period, 143 diabetic patients were evaluated, with a median of 3.4 teleconsultations per patient in the studied period, requiring adjustment of insulin doses in 84.6% of cases. The hospital admission rate was 8,4% due to diabetic decompensation. The metabolic control (HbA1c) became worse in 46% of the sample and improved in 37%. Conclusion: The teleconsultation promoted health care for patients with diabetes mellitus during the COVID-19 pandemic but was not able to guarantee adequate glycemic control.

ABSTRACT We assess the severity and frequency of diabetic ketoacidosis (DKA) in new-onset type 1 diabetes mellitus (T1D) patients and in patients with previous diagnosis of T1D in a referral Brazilian university hospital in the first five months of the COVID-19 pandemic. We also compare the data with data from pre-pandemic periods. Forty-three new-onset T1D patients were diagnosed between April and August of the years 2017, 2018, 2019, and 2020. During the COVID-19 pandemic, the number of new-onset T1D was over twice the number of new-onset T1D in the same period in the three previous years. All the 43 patients survived and are now on outpatient follow-up. We also compared the characteristics of the T1D patients hospitalized between April and August of the years 2017, 2018, and 2019 (32 hospitalizations) to the characteristics of the T1D patients hospitalized between April and August/2020 (35 hospitalizations; 1 patient was hospitalized twice in this period). Fourteen of the 34 patients admitted during the pandemic presented with COVID-19-related symptoms (any respiratory symptom, fever, nausea, vomiting, and diarrhea), but only one had positive SARS-CoV-2 RT-PCR test. Samples from 32 out of these 34 patients were assayed for SARS-CoV-2 antibodies, and four patients were positive for total antibodies (IgM and IgG). In agreement with recent reports from European countries, we observed increased frequency of DKA and severe DKA in new-onset and previously diagnosed T1D children and adolescents in a large referral public hospital in Brazil in the first five months of the COVID-19 pandemic. The reasons for this outcome might have been fear of SARS-CoV-2 infection in emergency settings, the more limited availability of primary healthcare, and the lack of school personnel’s attention toward children’s general well-being.

Resumo Objetivo: Comparar terapia com múltiplas doses de insulina e o sistema de infusão continua de insulina no tratamento da diabetes melito tipo 1. Métodos: 40 pacientes com diabetes melito tipo 1 (21 mulheres) com idades entre 10 e 20 anos (média=14,2) e duração média do diabetes de sete anos utilizaram múltiplas doses de insulina durante pelo menos seis meses e, depois disso, sistema de infusão continua de insulina por pelo menos seis meses. Todos os pacientes usaram múltiplas doses de insulina e sistema de infusão continua de insulina. Para a análise de HbA1c, níveis médios de hemoglobina glicada (mHbA1c) foram obtidos em cada período de tratamento (múltiplas doses de insulina e sistema de infusão continua de insulina). Resultados: Embora os níveis de mHbA1c tenham sido menores com o uso de sistema de infusão continua de insulina a diferença não foi estatisticamente significante. Durante o uso de múltiplas doses de insulina, 14,2% tiveram valores de mHbA1c <7,5% vs. 35,71% quando usando sistema de infusão continua de insulina; demonstrando melhor controle glicêmico com o uso de sistema de infusão continua de insulina. Durante o uso de múltiplas doses de insulina, 15-40 pacientes tiveram eventos hipoglicêmicos graves contra 5–40 com sistema de infusão continua de insulina. Não foram registrados episódios de cetoacidose. Conclusões: Esse é o primeiro estudo cujo desenho comparou o uso de múltiplas doses de insulina e sistema de infusão continua de insulina no Brasil, não demonstrando nenhuma diferença significativa nos níveis de HbA1c. Eventos hipoglicêmicos foram menos frequentes com o uso de sistema de infusão continua de insulina do que com múltiplas doses de insulina e a porcentagem de pacientes que obteve um HbA1c <7,5% foi maior com sistema de infusão continua de insulina do que com múltiplas doses de insulina.

Abstract Objective: To compare multiple doses of insulin and continuous insulin infusion therapy as treatment for type 1 diabetes mellitus. Methods: 40 patients with type 1 diabetes mellitus (21 female) with ages between 10 and 20 years (mean=14.2) and mean duration of diabetes of 7 years used multiple doses of insulin for at least 6 months and after that, continuous insulin infusion therapy for at least 6 months. Each one of the patients has used multiple doses of insulin and continuous insulin infusion therapy. For analysis of HbA1c, mean glycated hemoglobin levels (mHbA1c) were obtained during each treatment period (multiple doses of insulin and continuous insulin infusion therapy period). Results: Although mHbA1c levels were lower during continuous insulin infusion therapy the difference was not statistically significant. During multiple doses of insulin, 14.2% had mHbA1c values below 7.5% vs. 35.71% while on continuous insulin infusion therapy; demonstrating better glycemic control with the use of continuous insulin infusion therapy. During multiple doses of insulin, 15–40 patients have severe hypoglycemic events versus 5–40 continuous insulin infusion therapy. No episodes of ketoacidosis events were recorded. Conclusions: This is the first study with this design comparing multiple doses of insulin and continuous insulin infusion therapy in Brazil showing no significant difference in HbA1c; hypoglycemic events were less frequent during continuous insulin infusion therapy than during multiple doses of insulin and the percentage of patients who achieved a HbA1c less than 7.5% was greater during continuous insulin infusion therapy than multiple doses of insulin therapy.

OBJETIVO: Rever a apresentação dos casos de hipoglicemia hiperinsulinêmica da infância (HHI), tratamento e histologia nos serviços de endocrinologia pediátrica no Brasil. MATERIAIS E MÉTODO: Os serviços receberam protocolo para resgatar dados de nascimento, resultados laboratoriais, tipo de tratamento instituído, necessidade de pancreatectomia e histologia. RESULTADOS: Vinte e cinco casos de HHI de seis centros foram resgatados, 15 do sexo masculino, 3/25 nascidos de parto normal. A mediana de idade do diagnóstico foi 10,3 dias. As dosagens de glicose e insulina na amostra sérica crítica apresentaram mediana de 24,7 mg/dL e 26,3 UI/dL. A velocidade de infusão de glicose endovenosa foi superior a 10 mg/kg/min em todos os casos (M:19,1). Diazóxido foi utilizado em 15/25, octreotide em 10, corticoide em 8, hormônio de crescimento em 3, nifedipina em 2 e glucagon em 1. Quarenta por cento (10/25) foram pancreatectomizados, nos quais a análise histológica revelou a forma difusa da patologia. CONCLUSÃO: Primeira análise crítica de uma amostra brasileira de portadores de HHI congênita. Arq Bras Endocrinol Metab. 2012;56(9):666-71

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

A hipoglicemia hiperinsulinêmica da infância (HHI) é uma emergência no período neonatal. Após curtos períodos de jejum, o cérebro ávido por glicose corre o risco de ficar sem seu principal substrato energético. Os critérios de diagnóstico de HH, tanto no período neonatal quanto na criança maior e na adolescência, foram revisados. Foram descritas as etiologias e a fisiopatologia da HHI. As alterações moleculares frequentemente encontradas, bem como a descrição das principais mutações, são abordadas.

The hypoglycemia hyperinsulinemic of the infancy (HHI) is an emergency in the neonatal period. After a short period of fast the avid brain runs out of its main energy substrate. The authors overhaul the diagnosis of HH, not only in the neonatal period, but also in the late infant and in the adolescence. The aspects of the molecular alterations found in these cases, as well like the description of the main mutations are also approached.

O objetivo deste estudo foi avaliar a ocorrência de depressão, problemas comportamentais e competência social em crianças obesas, comparativamente a crianças não obesas. Participaram do estudo 90 crianças, das quais 60 eram obesas e 30 não eram, com idade entre 7 e 13 anos. Na coleta de dados foram utilizados: Ficha de Identificação, Inventário de Depressão para Crianças e Inventário de Comportamentos da Infância e Adolescência. Os dados foram analisados quantitativamente, com testes estatísticos não paramétricos e paramétricos, com nível de significância de 0,05. Os resultados apontaram diferença significativa entre as crianças obesas e as crianças não obesas em relação às variáveis psicológicas estudadas. Na análise multivariada, a depressão e os distúrbios internalizantes foram as variáveis que mais discriminaram as crianças obesas das não obesas. Os dados indicam, portanto, a necessidade de uma intervenção precoce e a realização de programas de prevenção.

The objective of the study was to evaluate the occurrence of depression, behavioral problems and social skills in obese children, contrasting to children who are not obese. Ninety children, ages between 7 and 13, participated in this study; 60 were obese and 30 were not. Data was collected using the following methods: Identity Cards; Children's Depression Inventory and the Child Behavior Checklist. Data analysis was performed quantitatively, using parametric and non-parametric statistical tests, with a significance level of 0.05. Results demonstrated a significant difference between obese and non-obese children, as regards the psychological variables studied. Based on a multivante analysis, depression and internal disorders distinguished obese children from those who were not obese. The data indicates, however, that there is a need for early intervention and a need to establish programs of prevention.

CONTEXTO AND OBJETIVO: Obesidade e asma são sérios e crescentes problemas em nossa sociedade. Como o tecido adiposo produz substâncias inflamatórias, o objetivo foi estimar a prevalência de asma entre os estudantes (Fase 1), e verificar uma hipótese de associação entre obesidade e asma (Fase 2), em escolares de São José do Rio Preto, São Paulo. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado pela Faculdade de Medicina de São José do Rio Preto (Famerp), São Paulo. MÉTODOS: O estudo foi realizado em duas etapas sucessivas e dependentes. A Fase I, em estudo transversal de prevalência com 4.103 escolares (13-14 anos de idade), para determinar a prevalência e a gravidade da asma. A Fase II, transversal analítico, com 431 (190 asmáticos e 231 não asmáticos), provenientes do grupo da Fase I, avaliou a associação entre obesidade, classificada por índice de massa corporal (IMC) e asma. As amostras foram selecionadas aleatoriamente. Para os diagnósticos de asma e obesidade foram empregados os critérios do International Study of Asthma and Allergies in Childhood (ISAAC) e a tabela do Centers for Disease Control (CDC) 2000. Os dados obtidos foram analisados utilizando o teste t de Student. RESULTADOS: Notou-se que 5,6% do grupo analisado na Fase I são asmáticos; e observou-se um aumento do IMC de asmáticos (21,8 kg/m²) em relação ao dos não-asmáticos (21,73 kg/m²). No entanto, o valor de p obtido foi de 0,766. CONCLUSÃO: Neste estudo não foi encontrada uma associação entre IMC elevado e prevalência de asma, no grupo estudado.

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 Student's 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/m²) was higher than the BMI among the non-asthmatics (21.73 kg/m²), 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.

OBJETIVO: Conhecer a prevalência de obesidade e sua distribuição por sexo e idade em pacientes com diabetes melito tipo 1 (DM1), em acompanhamento em Serviço de Endocrinologia Pediátrica. MÉTODOS: Estudo transversal descritivo de pacientes em acompanhamento no Serviço de Endocrinologia Pediátrica do Hospital de Base de São José do Rio Preto, avaliando as seguintes variáveis: sexo, idade, dose e número de aplicações diárias de insulina, hemoglobina glicada (HbA1c), peso, estatura e índice de massa corpórea (IMC). A definição de sobrepeso e obesidade baseou-se nas curvas de IMC para a idade do Centers for Disease Control and Prevention (CDC, 2000). RESULTADOS: Foram incluídos 77 portadores de DM1 (44 meninas e 33 meninos) com idade entre três e 18 anos (média: 13,4). A determinação de HbA1c variou de 4,1 a 10,6% (média: 7,7%) e o IMC, de 15,1 a 28,6 kg/m² (média: 23,2). Conforme critérios do CDC, 8% dos pacientes (três meninas e três meninos) apresentavam obesidade e 8% (duas meninas e quatro meninos), sobrepeso. CONCLUSÕES: Nesta casuística de pacientes diabéticos, a prevalência de sobrepeso e obesidade não se mostrou diferente de populações não diabéticas.

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 São José do Rio Preto, São 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.

OBJETIVO: Identificar as dificuldades da criança com diabetes mellitus tipo 1 no convívio diário com familiares e com a sociedade, enfocando aspectos relativos à alimentação e ao tratamento. MÉTODOS: Estudo transversal, realizado por meio de questionário semi-estruturado aplicado a pais e crianças com diabetes mellitus tipo 1, acompanhados pelo Grupo de Diabetes mellitus do Ambulatório de Pediatria da Faculdade de Medicina de São José do Rio Preto (Famerp), São Paulo. Foram estudadas 13 crianças, coletando-se dados demográficos e aspectos relativos às dificuldades no controle da doença. RESULTADOS: As características do grupo de crianças estudadas foram: gênero feminino (77%), idade entre oito e 12 anos (77%), brancas (77%), católicas (61%) e com antecedentes familiares de diabetes (54%). Como dificuldades foram citadas: o custo de alimentos especiais; o medo do desconhecido; ter que aprender sobre a doença rapidamente; ter vergonha de ter diabetes. Do total de crianças, 23% estavam aprendendo a aplicar insulina e 46% dos pacientes seguiam a orientação alimentar. A mãe foi o parente mais próximo que auxiliava a criança no tratamento em 69% dos casos. A hiperglicemia foi relatada por 62% das crianças, sendo detectada apenas após a realização da glicemia capilar. CONCLUSÕES: O presente trabalho salienta a importância de campanhas para orientar os pais sobre o controle da doença, os fatores associados ao desenvolvimento da doença e a necessidade de identificar os sintomas de hiperglicemia e a terapêutica alimentar, a fim de minimizar riscos futuros.

OBJECTIVE: To identify the difficulties of children with diabetes mellitus type 1 in their family and social daily life, focusing on aspects related to feeding and treatment. METHODS: This cross-sectional study was performed with a semi-structured questionnaire applied to parents and children with diabetes mellitus type 1 at the Diabetes Clinic of the São José do Rio Preto Medical, São Paulo, Brazil. The interview of 13 children included questions regarding demographic data and difficulties related to the control of the disease. RESULTS: The following characteristics were found among the studied children: female gender in 77%, age between eight and 12 years in 77%, white race in 77%, catholics in 61% and presence of family history of diabetes in 54%. Regarding the disease control, the following difficulties were mentioned: special food cost, fear of the unknown, need for quick learning about the disease and shame of having diabetes. Out of 13 children, 23% were learning how to apply insulin and 46% followed the diet prescription at the time of the interview. In 69% of cases, the mother was the closest relative that has helped the child to manage the treatment. Hyperglycemia was present in 62% of the children, and it was detected only after capillary glycemia test. CONCLUSIONS: The present study points out the importance of campaigns to guide parents about the disease control, about factors associated with the development of the disease and the need for identifying the hyperglycemia symptoms in order to minimize future complications of the diabetes.

A obesidade infantil alcança índices preocupantes e sua ocorrência na população brasileira tem adquirido grande significância na área da saúde, principalmente devido ao impacto que causa na vida das crianças, trazendo conseqüências físicas, sociais, econômicas e psicológicas. Neste artigo enfatiza-se a depressão, a ansiedade, a competência social e os problemas comportamentais, dentre os múltiplos fatores relacionados à obesidade infantil. São discutidos estudos que mostram estes fatores como causa ou como conseqüência da obesidade infantil, apesar de não haver consenso na área. Porém, a ocorrência concomitante de depressão, ansiedade e déficits de competência social com obesidade infantil demonstra a relevância deste tema. Uma maior difusão desse conhecimento e a proliferação desses estudos são importantes para proporcionar um atendimento e intervenção adequados a essa população.

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's 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.

OBJETIVO: Analisar o perfil lipídico e sua correlação com fatores de risco para doenças cardiovasculares (DCV) em estudantes de medicina. MÉTODOS: Foram avaliados 153 estudantes, independente do sexo, com idade entre 18 e 31 anos, submetidos à análise do perfil lipídico, incluindo níveis séricos de colesterol total (CT), fração de colesterol das lipoproteínas de baixa (LDLc), alta (HDLc) e muito baixa densidade (VLDLc) e triglicérides (TG), além de hábitos de vida e dados antropométricos. Aplicou-se análise estatística, incluindo teste de Mann Whitney, qui-quadrado, correlação de Pearson e análise multivariada, admitindo-se nível de significância para valor p<0,05. RESULTADOS: Destacaram-se sedentarismo (43,1%) e antecedentes familiais para DCV, particularmente hipertensão arterial (74,5%). O perfil lipídico mostrou-se desejável, embora níveis alterados de CT, LDLc e TG foram detectados em 11,8%, 9,8% e 8,5% dos estudantes, respectivamente, e níveis reduzidos de HDLc em 12,4% deles. As mulheres apresentaram valores significativamente reduzidos para LDLc e elevados para HDLc comparado aos homens (p=0,031 e p<0,0001, respectivamente). Houve associação significante entre perfil lipídico e, preferencialmente, índice de massa corpórea (IMC), sedentarismo, ingesta de álcool, uso de anticoncepcional, antecedentes familiais de acidente vascular cerebral e dislipidemia. CONCLUSÃO: Antecedentes familiais para DCV, sedentarismo e uso de anticoncepcional entre os estudantes de medicina mostram-se freqüentes e associados ao perfil lipídico, assim como ingesta de álcool e IMC. Embora com perfil lipídico desejável, independente do sexo, níveis mais elevados de LDLc e reduzidos de HDLc no sexo masculino conferem aos homens desvantagem comparado às mulheres.

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, Pearson's 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 men's (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.