Religious/spiritual coping, symptoms of depression, stress, and anxiety in caregivers of children and adolescents with type 1 diabetes.

BACKGROUND: It was verified the level of religiosity and spirituality, and symptoms of depression, stress, and anxiety of caregivers of children and adolescents with type 1 diabetes, and its interference in glycaemic control. METHODS: Socio-economic and demographic data were collected from caregivers of 59 children and adolescents with type 1 diabetes and obtained dosages of fasting glucose (FG); postprandial glycaemia (PPG); fructosamine (FRUTO); and HbA1c, as well as the glycaemic variability-∆HbA1c. Levels of religiosity were obtained by the DUREL scale; the use of religious/spiritual coping was verified by the SRCOPE-Brief scale. Symptoms of depression, anxiety, and stress were analysed by the DASS-21 scale. The correlations between the variables were analysed by the Pearson coefficient, with significance at 5% level. RESULTS: Inverse correlations were observed between caregivers' schooling with PPG (r = -0.30; P = 0.002) and FRUTO (r = -0.34; P = 0.008) and between family income and FRUTO (r = -0.37; P = 0.004). Direct, moderate correlations were observed between negative religious/spiritual coping (NSRCOPE) with symptoms of depression (r = 0.588; P < 0.0001), stress (r = 0.500; P < 0.0001), and anxiety (r = 0.551; P < 0.0001). CONCLUSION: The direct association between NSRCOPE with symptoms of depression, stress, and anxiety was the highlighted item in the present study emphasizing the need for greater attention to the emotional health of informal caregivers of children and adolescents with DM1. It is necessary to reflect on the religious/spiritual support especially for the main caregiver of children and adolescents with DM1.

Assessment of Gonadotropin Concentrations Stimulated by Gonadotropin-Releasing Hormone Analog by Electrochemiluminescence in Girls with Precocious Puberty and Premature Thelarche.

OBJECTIVE: The aim of this study is to determine the cutoff values of gonadotropin response to gonadotropin-releasing hormone analogs (GnRHas) corresponding to the activation of the hypothalamic-pituitary-gonadal axis that could differentiate central precocious puberty (CPP) from premature thelarche (PT) and using the electrochemiluminescence assay method. METHODS: A total of 49 girls underwent the stimulation test with an intramuscular injection of 3.75 mg leuprolide acetate. Based on the clinical and laboratory characteristics, they were divided into two groups: CPP (n = 22) and PT (n = 27). Baseline estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were collected before GnRHa administration and LH and FSH at 60 and 120 min, respectively, after GnRHa administration. RESULTS: The girls with CPP presented an increased height Z-score, advanced bone age, and higher baseline LH, FSH, estradiol, and LH/FSH ratio in relation to PT (p < 0.001). Stimulated LH differed significantly between the two groups, and the LH cutoff values were ≥4.29 IU/L (p < 0.001) and ≥3.95 IU/L at 60 and 120 min, respectively (p < 0.001). The LH peak was found at 60 min after stimulation. CONCLUSIONS: The GnRHa test is effective in distinguishing CPP from PT, and a single sampling, at 60 min, with LH concentrations above 4.29 may be the parameter of choice with the advantage of greater convenience and practicality.

Ultrasound measurement of thyroid volume in euthyroid children under 3 years of age.

OBJECTIVE: To establish ultrasound reference values for thyroid volumes in children up to 3 years of age, given that ultrasound of the thyroid is an essential examination in the diagnosis of childhood thyroid disease. MATERIALS AND METHODS: This was a prospective study conducted in an iodine-sufficient city in southeastern Brazil. A total of 100 healthy children underwent clinical evaluation, anthropometric examination, and cervical ultrasound in accordance with conventional protocols. We evaluated characteristics such as echotexture, thyroid lobe volume, and total thyroid volume. The children were divided into five groups, by age: < 2 months; 2-12 months; 12-18 months; 18-24 months; and 24-36 months. RESULTS: The mean thyroid volume was lower in the < 2 month age group than in the other groups (0.4 mL vs. 0.18-0.70 mL; p < 0.001). For the subjects between 2 and 36 months of age, the mean volume was 1.0 mL (range, 0.30-2.0 mL). No other significant differences were observed between groups, thyroid lobes, or gender. However, body mass index correlated significantly with total thyroid volume (r = 0.347; p = 0.001). CONCLUSION: The mean thyroid dimensions were smallest in the < 2 month age group (0.35 ± 0.16 mL). For the subjects between 2 and 36 months of age, a reference value of 0.85 ± 0.42 mL can be used. Our data could guide the diagnostic investigation of thyroid disease, especially congenital hypothyroidism, in childhood.

OBJETIVO: Estabelecer valores de referência ultrassonográficos de volumes tireoidianos em crianças de até três anos de idade, por ser exame essencial no diagnóstico de doença tireoidiana infantil. MATERIAIS E MÉTODOS: Trata-se de estudo prospectivo conduzido em cidade do sudeste brasileiro suficiente em iodo. Participaram 100 crianças saudáveis, submetidas a exame clinicoantropométrico e ultrassonografia cervical seguindo protocolos convencionais. Características como ecotextura e volumes dos lobos e da tireoide total foram obtidos. Segundo a idade, as crianças foram distribuídas em cinco grupos: < 2 meses; 2-12 meses; 12-18 meses; 18-24 meses; e 24-36 meses. RESULTADOS: No grupo < 2 meses os volumes tireoidianos foram menores (p < 0,001) do que nos demais (0,4 mL; 0,18-0,70 mL). Além dessa idade, o volume total médio foi 1,0 mL (0,30-2,0 mL) e não diferiu entre os grupos. Não foram observadas diferenças entre lobos ou relacionadas a gênero. Houve correlação (r = 0,347; p = 0,001) entre índice de massa corporal e volume total. CONCLUSÃO: As dimensões tireoidianas foram menores até dois meses (0,35 ± 0,16 mL), e a partir dessa idade os mesmos valores de referência podem ser usados até 36 meses (0,85 ± 0,42 mL). Tais dados podem orientar a investigação diagnóstica, especialmente no hipotireoidismo congênito.

Ultrasound measurement of thyroid volume in euthyroid children under 3 years of age / Mensuração ultrassonográfica do volume tireoidiano em crianças eutireóideas menores de três anos

Abstract Objective: To establish ultrasound reference values for thyroid volumes in children up to 3 years of age, given that ultrasound of the thyroid is an essential examination in the diagnosis of childhood thyroid disease. Materials and Methods: This was a prospective study conducted in an iodine-sufficient city in southeastern Brazil. A total of 100 healthy children underwent clinical evaluation, anthropometric examination, and cervical ultrasound in accordance with conventional protocols. We evaluated characteristics such as echotexture, thyroid lobe volume, and total thyroid volume. The children were divided into five groups, by age: < 2 months; 2-12 months; 12-18 months; 18-24 months; and 24-36 months. Results: The mean thyroid volume was lower in the < 2 month age group than in the other groups (0.4 mL vs. 0.18-0.70 mL; p < 0.001). For the subjects between 2 and 36 months of age, the mean volume was 1.0 mL (range, 0.30-2.0 mL). No other significant differences were observed between groups, thyroid lobes, or gender. However, body mass index correlated significantly with total thyroid volume (r = 0.347; p = 0.001). Conclusion: The mean thyroid dimensions were smallest in the < 2 month age group (0.35 ± 0.16 mL). For the subjects between 2 and 36 months of age, a reference value of 0.85 ± 0.42 mL can be used. Our data could guide the diagnostic investigation of thyroid disease, especially congenital hypothyroidism, in childhood.

Resumo Objetivo: Estabelecer valores de referência ultrassonográficos de volumes tireoidianos em crianças de até três anos de idade, por ser exame essencial no diagnóstico de doença tireoidiana infantil. Materiais e Métodos: Trata-se de estudo prospectivo conduzido em cidade do sudeste brasileiro suficiente em iodo. Participaram 100 crianças saudáveis, submetidas a exame clinicoantropométrico e ultrassonografia cervical seguindo protocolos convencionais. Características como ecotextura e volumes dos lobos e da tireoide total foram obtidos. Segundo a idade, as crianças foram distribuídas em cinco grupos: < 2 meses; 2-12 meses; 12-18 meses; 18-24 meses; e 24-36 meses. Resultados: No grupo < 2 meses os volumes tireoidianos foram menores (p < 0,001) do que nos demais (0,4 mL; 0,18-0,70 mL). Além dessa idade, o volume total médio foi 1,0 mL (0,30-2,0 mL) e não diferiu entre os grupos. Não foram observadas diferenças entre lobos ou relacionadas a gênero. Houve correlação (r = 0,347; p = 0,001) entre índice de massa corporal e volume total. Conclusão: As dimensões tireoidianas foram menores até dois meses (0,35 ± 0,16 mL), e a partir dessa idade os mesmos valores de referência podem ser usados até 36 meses (0,85 ± 0,42 mL). Tais dados podem orientar a investigação diagnóstica, especialmente no hipotireoidismo congênito.

PUBERTY IN A SAMPLE OF BRAZILIAN SCHOOLBOYS: ONSET AND ANTHROPOMETRIC CHARACTERISTICS.

OBJECTIVE: To determine the age of puberty onset in boys and collect anthropometric data of participants at different puberty stages. METHODS: This is a cross-sectional study that assessed 430 boys in a random sample representing 48,390 students from public and private schools from the city of Uberaba, Southeast Brazil. The inclusion criteria were males, aged between 5 and 18 years, and absence of previous diseases. Participants and their guardians filled a semistructured questionnaire with questions relevant to their and their parents' puberty. We set the significance at p<0.05 and calculated the 95% confidence intervals. RESULTS: The mean age found in the puberty stage G2 was 11.2±1.8 (95% of participants in stage G2 were 9.2-13.4 years old). Pubarche data showed a mean of age of 11.0±1.6 years (95% of the participants experienced pubarche when they were 8.0-14.0 years old). When compared to the confidence intervals of two classical studies on the subject, our results showed a trend toward earlier pubarche. In addition, the mean age of this event in the children's parents was of 12.1±1.4 years, which was significantly higher than the age of the children's pubarche (p<0.001). CONCLUSIONS: These results indicate a secular decreasing trend in pubarche age and an earlier puberty onset. Considering these parameters, is important to design public policies aimed at preventing these early events.

Puberty in a sample of brazilian schoolboys: onset and anthropometric characteristics / Puberdade em uma amostra de meninos escolares brasileiros: início e características antropométricas

ABSTRACT Objective: To determine the age of puberty onset in boys and collect anthropometric data of participants at different puberty stages. Methods: This is a cross-sectional study that assessed 430 boys in a random sample representing 48,390 students from public and private schools from the city of Uberaba, Southeast Brazil. The inclusion criteria were males, aged between 5 and 18 years, and absence of previous diseases. Participants and their guardians filled a semistructured questionnaire with questions relevant to their and their parents' puberty. We set the significance at p<0.05 and calculated the 95% confidence intervals. Results: The mean age found in the puberty stage G2 was 11.2±1.8 (95% of participants in stage G2 were 9.2-13.4 years old). Pubarche data showed a mean of age of 11.0±1.6 years (95% of the participants experienced pubarche when they were 8.0-14.0 years old). When compared to the confidence intervals of two classical studies on the subject, our results showed a trend toward earlier pubarche. In addition, the mean age of this event in the children's parents was of 12.1±1.4 years, which was significantly higher than the age of the children's pubarche (p<0.001). Conclusions: These results indicate a secular decreasing trend in pubarche age and an earlier puberty onset. Considering these parameters, is important to design public policies aimed at preventing these early events.

RESUMO Objetivo: Determinar a idade em que a puberdade começa em meninos e coletar dados antropométricos de participantes em diferentes fases da puberdade. Métodos: Trata-se de um estudo transversal no qual foram avaliados 430 meninos, uma amostra aleatória representativa da população total de 48.390 estudantes de escolas públicas e particulares de Uberaba, Minas Gerais. Os critérios de inclusão foram: ser do sexo masculino, ter idade de 5 a 18 anos e ausência de doenças prévias. Os participantes e seus responsáveis preencheram um questionário semiestruturado com perguntas pertinentes à sua puberdade e à de seus pais. Os dados foram considerados significantes para p<0,05, e os intervalos de confiança calculados foram de 95%. Resultados: A média de idade encontrada no estágio G2 foi de 11,2±1,8 anos, sendo que 95% dos participantes em G2 tinham entre 9,2 a 13,4 anos. Quanto à pubarca, a média de idade foi de 11,0±1,6 anos, e 95% dos participantes apresentaram pubarca entre 8,0 e 14,0 anos. Quando tais resultados foram comparados aos intervalos de confiança de dois estudos clássicos sobre o tema, houve tendência à pubarca mais precoce. Além disso, a média de idade da pubarca nos pais das crianças foi de 12,1±1,4 anos, significantemente maior em relação à dos filhos (p<0,001). Conclusões: Os resultados indicam uma tendência secular em direção à diminuição da idade da pubarca e um possível início mais precoce da puberdade. É muito importante considerar esses parâmetros para estabelecer políticas públicas destinadas a prevenir esses eventos iniciais.

Effectiveness of screening for tuberculosis in HIV: a pragmatic clinical trial

ABSTRACT OBJECTIVE: To verify the effectiveness of screening for tuberculosis (TB) on all-cause mortality and tuberculosis cases in newly diagnosed HIV-infected patients through a clinical algorithm based on recommendations of the World Health Organization. METHODS: From March 2014 to April 2016, a pragmatic randomized clinical trial was conducted with newly diagnosed and TB-free HIV-infected adults undergoing antiretroviral therapy for up to one month at a major tertiary hospital for HIV in the state of Pernambuco, Brazil. Participants were randomized into intervention and control groups using an automatically-generated random list, and followed-up for at least 6 months. The intervention group was screened for TB at hospital admission and at every follow-up visit through a series of questions addressing TB-related symptoms (cough, fever, night sweating, and weight loss). Patients presenting with any of these symptoms were referred to a pulmonologist and underwent sputum smear microscopy, sputum culture, and rapid molecular testing (GeneXpert). When at least one test result came back positive, TB treatment was initiated. In turn, if patients tested negative but presented with severe clinal symptoms, TB preventive treatment was initiated. Screening for TB was not performed systematically in the control group. The primary outcome assessed in this study was death from all causes, and secondary outcomes included sensitivity and specificity of this screening test, as well as its detection time. RESULTS: This study evaluated 581 patients, 377 in the intervention group (64.9%) and 204 in the control group (35.1%). In total, 36 patients died during the follow-up period. Of these, 26 (6.9%) were from the intervention group, reaching a cumulative mortality coefficient of 69 per 1,000 inhabitants, and 10 (4.9%) from the control group (p = 0.341), with a cumulative mortality coefficient of 49 per 1,000 inhabitants (p = 0.341).

Effect of Spiritist "Passe" on Preoperative Anxiety of Surgical Patients: A Randomized Controlled Trial, Double-Blind.

The objective of this study was to evaluate the preoperative anxiety of hospitalized patients exposed to Spiritist "passe," laying on of hand with the intention of healing (Sham) and without laying on of hand. Other variables as depression, pain, physiological parameters, muscle tension, and well-being were assessed. Patients in the Spiritist "passe" intervention group showed greater reductions in anxiety (p < 0.05) and muscle tension (p < 0.01) and increases in well-being (p < 0.01). More marked reductions in preoperative anxiety and muscle tension and improvement in well-being were observed in patients exposed to Spiritist "passe" compared to Sham or standard medical care.Trial registration: ClinicalTrials.gov Identifier NCT03356691.

Clinical and Laboratory Parameters of Gonadotropin-Releasing Hormone Analog Treatment Effectiveness in Children with Precocious Puberty.

OBJECTIVE: There are no doubts about the clinical benefits of treatment with GnRH analogs for patients diagnosed with central precocious puberty (CPP). However, laboratory monitoring of CPP is still a matter of considerable controversy in the literature. Therefore, the main objective of this study was to evaluate the cut-off values of stimulated LH that determine gonadotrophic suppression. METHODS: Twenty-four girls, on treatment with leuprorelin acetate (LA) at 3.75 mg IM every 28 days, were studied. The clinical parameters used to indicate clinical effectiveness were regression or maintenance of sexual characteristics according to the Tanner stage, growth velocity reduction, reduction or maintenance of the difference between bone age and chronological age and maintenance or improvement of the final height prediction. For the laboratory effectiveness test, basal estradiol, LH, and FSH levels were collected before and 1 and 2 h after the administration of 3.75 mg LA. RESULTS: Eleven girls showed improvement in all clinical parameters, and their effectiveness tests were compared to those of the other patients to calculate the cut-off values, which were ≤3.64 IU/L (p=0.004*) for LH after 1 h and ≤6.10 IU/L (p<0.001*) for LH after 2 h. CONCLUSION: The LH response after the LA stimulation test, associated with clinical data and within a context of CPP, constitutes a reliable and feasible resource and can assist in monitoring the effectiveness of treatment.

Metabolic and hormonal assessment of adolescent and young adult women with prior premature adrenarche.

OBJECTIVE: Follow-up studies of girls with premature adrenarche have reported the development of polycystic ovary syndrome, insulin resistance, and dyslipidemia and a propensity to cardiovascular disease. The aim of this study was to analyze the presence of these conditions in patients previously treated at the Universidade Federal do Triângulo Mineiro. METHODS: A total of 130 medical records reported premature adrenarche. One hundred and twenty-two patients were invited to participate, of whom 54 accepted; 34 patients were selected, as they had reached their final height. Anthropometric, blood glucose, insulin, and lipid and hormonal profile (LH, FSH, estradiol, 17α-OH-progesterone, androstenedione, dehydroepiandrosterone sulfate, testosterone) data were obtained, the HOMA-IR index was calculated, and pelvic ultrasonography was performed. To characterize polycystic ovary syndrome and metabolic syndrome, the Rotterdam and International Diabetes Federation criteria, respectively, were used. Data were analyzed according to measures of dispersion, frequency and correlations of interest. RESULTS: The age of the participants ranged from 15.2 to 28.2 years/months; 23.5% of the patients were overweight, 11.8% were obese, 29.4% had a large waist circumference, and 8.8% were hypertensive. None of the patients had altered glucose levels, and insulin levels and HOMA-IR were elevated in 29.4% and 38.2% of the participants, respectively; 14.7% of the patients exhibited acanthosis nigricans. The lipid profiles of the participants were variable, and one patient (2.9%) had metabolic syndrome. Polycystic ovary syndrome was found in 41.2% of patients. CONCLUSION: The percentage of patients with polycystic ovary syndrome who also had overweight, obesity and insulin resistance corroborates the literature data about the need for follow-up aiming at interventions, especially for conditions associated with cardiometabolic risk.

Clinical and laboratory parameters of gonadotropin-releasing hormone analog treatment effectiveness in children with precocious puberty

OBJECTIVE: There are no doubts about the clinical benefits of treatment with GnRH analogs for patients diagnosed with central precocious puberty (CPP). However, laboratory monitoring of CPP is still a matter of considerable controversy in the literature. Therefore, the main objective of this study was to evaluate the cut-off values of stimulated LH that determine gonadotrophic suppression. METHODS: Twenty-four girls, on treatment with leuprorelin acetate (LA) at 3.75 mg IM every 28 days, were studied. The clinical parameters used to indicate clinical effectiveness were regression or maintenance of sexual characteristics according to the Tanner stage, growth velocity reduction, reduction or maintenance of the difference between bone age and chronological age and maintenance or improvement of the final height prediction. For the laboratory effectiveness test, basal estradiol, LH, and FSH levels were collected before and 1 and 2 h after the administration of 3.75 mg LA. RESULTS: Eleven girls showed improvement in all clinical parameters, and their effectiveness tests were compared to those of the other patients to calculate the cut-off values, which were ≤3.64 IU/L (p=0.004*) for LH after 1 h and ≤6.10 IU/L (p<0.001*) for LH after 2 h. CONCLUSION: The LH response after the LA stimulation test, associated with clinical data and within a context of CPP, constitutes a reliable and feasible resource and can assist in monitoring the effectiveness of treatment.

Metabolic and hormonal assessment of adolescent and young adult women with prior premature adrenarche

OBJECTIVE: Follow-up studies of girls with premature adrenarche have reported the development of polycystic ovary syndrome, insulin resistance, and dyslipidemia and a propensity to cardiovascular disease. The aim of this study was to analyze the presence of these conditions in patients previously treated at the Universidade Federal do Triângulo Mineiro. METHODS: A total of 130 medical records reported premature adrenarche. One hundred and twenty-two patients were invited to participate, of whom 54 accepted; 34 patients were selected, as they had reached their final height. Anthropometric, blood glucose, insulin, and lipid and hormonal profile (LH, FSH, estradiol, 17α-OH-progesterone, androstenedione, dehydroepiandrosterone sulfate, testosterone) data were obtained, the HOMA-IR index was calculated, and pelvic ultrasonography was performed. To characterize polycystic ovary syndrome and metabolic syndrome, the Rotterdam and International Diabetes Federation criteria, respectively, were used. Data were analyzed according to measures of dispersion, frequency and correlations of interest. RESULTS: The age of the participants ranged from 15.2 to 28.2 years/months; 23.5% of the patients were overweight, 11.8% were obese, 29.4% had a large waist circumference, and 8.8% were hypertensive. None of the patients had altered glucose levels, and insulin levels and HOMA-IR were elevated in 29.4% and 38.2% of the participants, respectively; 14.7% of the patients exhibited acanthosis nigricans. The lipid profiles of the participants were variable, and one patient (2.9%) had metabolic syndrome. Polycystic ovary syndrome was found in 41.2% of patients. CONCLUSION: The percentage of patients with polycystic ovary syndrome who also had overweight, obesity and insulin resistance corroborates the literature data about the need for follow-up aiming at interventions, especially for conditions associated with cardiometabolic risk.

Prevalence of overweight and obesity and associated factors in school children and adolescents in a medium-sized Brazilian city.

OBJECTIVES: The objective of this study was to describe the prevalence of overweight and obesity in school children and adolescents in a medium-sized Brazilian city. METHODS: In total, 1,125 children and adolescents between the ages of 5.6 and 18 years from public and private schools participated in the study. The sample included 681 girls and 444 boys. Each subject's weight and height were obtained according to Brazilian guidelines (SISVAN). The triceps (TSF), subscapular (SSF), biceps, suprailiac, femoral and calf skinfolds were measured in triplicate. Body mass index (BMI) was classified as the BMI percentile (BMIP) according to the World Health Organization (WHO) 2007 criteria. The percentage body fat (%BF) was obtained using the equations by Slaughter et al., 1998. Categorical variables were analyzed using the chi-squared test. RESULTS: Overall, 364 participants with excess weight were identified: 17.3% were overweight, and 15.0% were obese. Among the girls, 18.0% were overweight, and 12.5% were obese; among the boys, 15.3% were overweight, and 18.0% were obese. These prevalence rates were higher when the time spent watching TV or participating in media-related activities surpassed 5 hrs/day, when individuals belonged to a higher economic class and when the head of the family had a higher education level (≥12 years). CONCLUSION: It is important to emphasize the need to increase our understanding of factors associated with overweight and obesity, and it is essential to implement measures and policies aimed at reversing this trend, such as stimulating healthy eating habits and physical activity and reducing time spent watching TV and participating in other media activities, including video games and social networking.

Effect of Complementary Spiritist Therapy on emotional status, muscle tension, and wellbeing of inpatients with HIV/AIDS: A randomized controlled trial - single-blind.

Background Complementary Spiritist Therapy includes prayer, Spiritist "passe", fluid therapy (fluidic water or magnetized water), and spiritual education, among other therapeutic resources. The objective of this study was to evaluate the effects of Complementary Spiritist Therapy with conventional treatment on emotional status, muscle tension and wellbeing of hospitalized patients with HIV/AIDS. Methods Patients were randomly assigned into either the experimental (3 days [10 mins per day/session] of Complementary Spiritist Therapy alongside conventional treatment; n=20) or control (conventional treatment alone; n=21) group. The primary outcome were positive and negative affects evaluated by the Subjective Wellbeing Scale. The secondary outcome were muscle tension, and wellbeing were assessed by visual analogue scales. Results Significant reductions in negative effects (p=0.045), and muscle tension (p=0.022), along with significant increases in wellbeing (p=0.041) were recorded in the experimental group (Complementary Spiritist Therapy). Conclusions Reductions in negative effects and muscle tension, along with increased perceived wellbeing, were observed in hospitalized patients with HIV/AIDS exposed Complementary Spiritist Therapy combined conventional treatment compared to conventional treatment alone.

ASSOCIATION BETWEEN ACANTHOSIS NIGRICANS AND OTHER CARDIOMETABOLIC RISK FACTORS IN CHILDREN AND ADOLESCENTS WITH OVERWEIGHT AND OBESITY. / ASSOCIAÇÃO ENTRE ACANTOSE NIGRICANS E OUTROS FATORES DE RISCO CARDIOMETABÓLICO EM CRIANÇAS E ADOLESCENTES COM SOBREPESO E OBESIDADE.

OBJECTIVE: To evaluate the presence or absence of acanthosis nigricans and its association with metabolic alterations in a group of obese and overweight children and adolescents. METHODS: A cross sectional study of 161 overweight children and adolescents, who were divided into two groups, according to presence or absence of acanthosis nigricans. Anthropometric measurements (body mass index, skinfolds, abdominal circumference), blood pressure, laboratory tests (fasting glycemia, insulin, lipid profile, triglycerides, uric acid, transaminases) and homeostasis model assessment index. RESULTS: The acanthosis nigricans group represented 51.5% of the sample. The mean age was similar between groups. The group with acanthosis nigricans presented higher body mass index, Z score of body mass index, body fat percentage, abdominal circumference (p<0.0001), systolic (p=0.006) and diastolic blood pressure (p=0.002). There was no significant difference in the analysis of lipid profile, except for the high-density cholesterol, which was lower (p=0.003) in the group with acanthosis. On the other hand, uric acid (p<0.0001), fasting glycemia (p=0.006), insulin (p<0.0001), glutamic oxalacetic transaminase (p<0.0001), and homeostasis model assessment index (p<0.0001) were significantly higher in the group with acanthosis nigricans. CONCLUSIONS: Acanthosis nigricans in overweight and obese children and adolescents is associated with elevation of body fat, blood pressure, insulin and homeostasis model assessment index, indicating that it is a clinical marker associated with the metabolic syndrome.

OBJETIVO: Avaliar em um grupo de crianças e adolescentes com obesidade e sobrepeso a presença ou não de acantose nigricans e sua associação com alterações metabólicas. MÉTODOS: Estudo transversal envolvendo 161 indivíduos com excesso de peso, que foram divididos em dois grupos, segundo a presença ou não de acantose nigricans, e nos quais foram obtidas medidas antropométricas (índice de massa corporal, pregas cutâneas, circunferência abdominal), pressão arterial, análises laboratoriais (glicemia de jejum, insulina, perfil lipídico, triglicerídeos, ácido úrico, transaminases) e o índice homeostasis model assessment. RESULTADOS: O grupo com acantose nigricans representou 51,5% da amostra. A média de idade foi semelhante entre os grupos. O grupo com acantose nigricans apresentou maiores índice de massa corporal, escore Z do índice de massa corporal, percentual de gordura corporal, circunferência abdominal (p<0,0001) e pressão arterial sistólica (p=0,006) e diastólica (p=0,002). Não houve diferença significativa na análise do perfil lipídico, exceto o colesterol de alta densidade, que foi menor (p=0,003) no grupo com acantose. Já o ácido úrico (p<0,0001), a glicemia de jejum (p=0,006), a insulina (p<0,0001), a transaminase glutâmica oxalacética (p<0,0001) e o índice homeostasis model assessment (p<0,0001) foram significativamente maiores no grupo com acantose nigricans. CONCLUSÕES: Acantose nigricans em crianças e adolescentes com sobrepeso e obesidade esteve associada à elevação dos índices de adiposidade corporal, pressão arterial, insulina e homeostasis model assessment, indicando-a como marcador clínico associado à síndrome metabólica.

Associação entre acantose nigricans e outros fatores de risco cardiometabólico em crianças e adolescentes com sobrepeso e obesidade / Association between acanthosis nigricans and other cardiometabolic risk factors in children and adolescents with overweight and obesity

RESUMO Objetivo: Avaliar em um grupo de crianças e adolescentes com obesidade e sobrepeso a presença ou não de acantose nigricans e sua associação com alterações metabólicas. Métodos: Estudo transversal envolvendo 161 indivíduos com excesso de peso, que foram divididos em dois grupos, segundo a presença ou não de acantose nigricans, e nos quais foram obtidas medidas antropométricas (índice de massa corporal, pregas cutâneas, circunferência abdominal), pressão arterial, análises laboratoriais (glicemia de jejum, insulina, perfil lipídico, triglicerídeos, ácido úrico, transaminases) e o índice homeostasis model assessment. Resultados: O grupo com acantose nigricans representou 51,5% da amostra. A média de idade foi semelhante entre os grupos. O grupo com acantose nigricans apresentou maiores índice de massa corporal, escore Z do índice de massa corporal, percentual de gordura corporal, circunferência abdominal (p<0,0001) e pressão arterial sistólica (p=0,006) e diastólica (p=0,002). Não houve diferença significativa na análise do perfil lipídico, exceto o colesterol de alta densidade, que foi menor (p=0,003) no grupo com acantose. Já o ácido úrico (p<0,0001), a glicemia de jejum (p=0,006), a insulina (p<0,0001), a transaminase glutâmica oxalacética (p<0,0001) e o índice homeostasis model assessment (p<0,0001) foram significativamente maiores no grupo com acantose nigricans. Conclusões: Acantose nigricans em crianças e adolescentes com sobrepeso e obesidade esteve associada à elevação dos índices de adiposidade corporal, pressão arterial, insulina e homeostasis model assessment, indicando-a como marcador clínico associado à síndrome metabólica.

ABSTRACT Objective: To evaluate the presence or absence of acanthosis nigricans and its association with metabolic alterations in a group of obese and overweight children and adolescents. Methods: A cross sectional study of 161 overweight children and adolescents, who were divided into two groups, according to presence or absence of acanthosis nigricans. Anthropometric measurements (body mass index, skinfolds, abdominal circumference), blood pressure, laboratory tests (fasting glycemia, insulin, lipid profile, triglycerides, uric acid, transaminases) and homeostasis model assessment index. Results: The acanthosis nigricans group represented 51.5% of the sample. The mean age was similar between groups. The group with acanthosis nigricans presented higher body mass index, Z score of body mass index, body fat percentage, abdominal circumference (p<0.0001), systolic (p=0.006) and diastolic blood pressure (p=0.002). There was no significant difference in the analysis of lipid profile, except for the high-density cholesterol, which was lower (p=0.003) in the group with acanthosis. On the other hand, uric acid (p<0.0001), fasting glycemia (p=0.006), insulin (p<0.0001), glutamic oxalacetic transaminase (p<0.0001), and homeostasis model assessment index (p<0.0001) were significantly higher in the group with acanthosis nigricans. Conclusions: Acanthosis nigricans in overweight and obese children and adolescents is associated with elevation of body fat, blood pressure, insulin and homeostasis model assessment index, indicating that it is a clinical marker associated with the metabolic syndrome.

Interferência nutricional no tratamento de pacientes com diabetes mellitus tipo 1 / Interferencia nutricional en el tratamiento de pacientes con diabetes mellitus tipo 1 / Nutritional interference in the treatment of patients with diabetes mellitus type 1

RESUMO O tratamento do Diabetes Mellitus tipo 1 (DM1) constitui-se na adesão ao tratamento insulínico, na alimentação e na atividade física, visando ao controle glicêmico. O objetivo deste estudo foi observar os efeitos da interferência nutricional no tratamento de pacientes com DM1. Trata-se de estudo quantitativo, prospectivo e longitudinal desenvolvido no Ambulatório de Diabetes da UFTM. A coleta de dados foi realizada entre março de 2013 e setembro de 2014. Foram avaliados 41 crianças e adolescentes entre 6 e 17 anos, quanto à antropometria, controle glicêmico e lipídico em 4 momentos: M1 no início do seguimento; M2 após orientação nutricional convencional; M3 após aprendizagem da contagem de carboidratos (CCHO) e M4 em contagem plena. A análise estatística foi descritiva e inferencial. A antropometria comprovou que a CCHO não resultou em ganho de peso e foi efetiva no sexo masculino, demonstrada pela redução nas concentrações de frutosamina (p=0,050) e HbA1C (p=0,041) no M4 comparado ao M1. Considerando a frutosamina, o grupo com CCHO se diferenciou do grupo sem CCHO M4 (p=0,035). A terapêutica insulínica associada à CCHO demonstrou ser um recurso importante a ser integrado no tratamento do DM1, visando atingir alvos efetivos na redução das complicações.

RESUMEN El tratamiento de la Diabetes Mellitus tipo 1 (DM1) se constituye en la adhesión al tratamiento medicamentoso, en la alimentación y en la actividad física, centrando en el control glucémico. El objetivo de este estudio fue observar los efectos de la interferencia nutricional en el tratamiento de pacientes con DM1. Se trata de estudio cuantitativo, prospectivo y longitudinal desarrollado en el Ambulatorio de Diabetes de la UFTM (Universidade Federal do Triângulo Mineiro). La recolección de datos fue realizada entre marzo de 2013 y septiembre de 2014. Fueron evaluados 41 niños y adolescentes entre 6 y 17 años, en cuanto a la antropometría, control glucémico y lipídico en 4 momentos: M1 en el inicio del seguimiento; M2 tras orientación nutricional convencional; M3 tras aprendizaje del conteo de carbohidratos (CCHO) y M4 en conteo pleno. El análisis estadístico fue descriptivo e inferencial. La antropometría comprobó que el CCHO no resultó en ganancia de peso y fue efectivo en el sexo masculino, demostrado por la reducción en las concentraciones de fructosamina (p=0,050) y HbA1C (p=0,041) en el M4 comparado al M1. Considerando la fructosamina, el grupo con CCHO se diferenció del grupo sin CCHO M4 (p=0,035). La terapéutica insulínica asociada al CCHO demostró ser un recurso importante a ser integrado en el tratamiento del DM1, a fin de alcanzar blancos efectivos en la reducción de las complicaciones.

ABSTRACT The treatment of Diabetes Mellitus Type 1 (DM1) involves adherence to insulin treatment, diet and physical activity, aiming at glycemic control. The objective of this study was to observe the effects of nutritional interference in the treatment of patients with DM1. It is a quantitative, prospective and longitudinal study developed at the UFTM Diabetes Outpatient Clinic. Data collection was performed between March 2013 and September 2014. Thirty-one children and adolescents between 6 and 17 years old were evaluated for anthropometry, glycemic and lipid control in four stages: M1 at the beginning of follow-up; M2 after conventional nutritional counseling; M3 after learning the carbohydrate count (CCHO) and M4 in full count. Statistical analysis was descriptive and inferential. The anthropometry showed that CCHO did not result in weight gain and was effective in males, demonstrated by the reduction in the concentrations of fructosamine (p=0.050) and HbA1C (p=0.041) in M4 compared to M1. Considering the fructosamine, the CCHO group differed from the non-CCHO M4 group (p=0.035). CCHO-associated insulin therapy has been shown to be an important resource to be integrated into the treatment of DM1 to achieve effective targets in reducing complications.

Percepção de Acadêmicos de Medicina e de Outras Áreas da Saúde e Humanas (Ligadas à Saúde) sobre as Relações entre Espiritualidade, Religiosidade e Saúde / The Perception of Medical Students as well as Students from Other Health-Related Areas Regarding the Relations between Spirituality, Religiosity and Health

RESUMO Introdução: Alguns autores encontraram relação estreita e positiva da religiosidade e espiritualidade com comportamentos saudáveis, resultando em saúde adequada. Além disso, dados da literatura sugerem que, de modo geral, as pessoas se apoiam em suas crenças para enfrentar momentos de dificuldades pessoais e coletivas. Os profissionais cujas práticas estão ligadas ao cuidado em saúde necessitam se capacitar para atender e respeitar as manifestações e necessidades dos pacientes no que se refere a religiosidade e espiritualidade. Objetivos: Investigar o que pensam os acadêmicos ingressantes no curso de Medicina e de outras áreas da saúde e humanas acerca do tema; identificar o papel e a importância da religiosidade e espiritualidade em suas vidas e futuras práticas profissionais. Metodologia: Trata-se de estudo quantitativo-qualitativo, descritivo, transversal, de amostra intencional. Entre fevereiro e abril de 2014, foi aplicado aos acadêmicos do primeiro período de Medicina, Biomedicina, Enfermagem, Fisioterapia, Terapia Ocupacional, Educação Física, Nutrição, Psicologia e Serviço Social um questionário que avaliou variáveis sociodemográficas e conceitos que envolvem religiosidade e espiritualidade e saúde. A análise dos dados empregou Qui-Quadrado clássico, feita pelo SPSS versão 2.0, e P < 0,05 foi considerado significante. Resultados: Foram selecionados 270 alunos, de 18 a 43 anos; entretanto, 183 preencheram o questionário, sendo a maioria do sexo feminino, de família convencional, cristã/católica, que herdou a religião dos pais; 78,6% (144/183) referiram afiliação religiosa, 43,5% (87/183) a exercem de forma organizacional. A maioria dos indivíduos considerou que a religiosidade e espiritualidade confere sentido a suas vidas, fortalece em momentos difíceis, traz benefícios à saúde, e considera importante a abordagem de temas relacionados em sua formação acadêmica, enquanto 31,4% (57/183) referiram que houve influência da religiosidade e espiritualidade na escolha profissional. Conclusão: Os alunos das áreas estudadas que ingressaram na Universidade Federal do Triângulo Mineiro manifestaram características positivas relacionadas ao tema religiosidade e espiritualidade, e têm expectativa de uma abordagem mais integral e espiritual do homem na grade curricular.

ABSTRACT Introduction: Some authors have found close and positive relationship between religiosity and spirituality and healthy behaviors that result in good health. Furthermore, data drawn from the literature suggest that, in general, people rely on their beliefs to face moments of personal and collective difficulties. Professionals whose practices are linked to health care, need to be trained to meet and observe the needs of patients, in terms of religiosity and spirituality. Objective: To investigate what medical students as well as students in the health area think about this topic, in addition to identifying the role and importance they attribute to religiosity and spirituality in their lives and future professional practices. Methodology: This was a quantitative and qualitative, descriptive, cross intentional sample study. We applied a questionnaire to first-year students of medicine, biomedicine, nursing, physiotherapy, occupational therapy, physical education, nutrition, psychology and social service, which assessed socio-demographic variables and concepts involving religiosity and spirituality and health. For the data analysis, we used the Chi-Square test developed in SPSS version 2.0, and P<0.05 was considered significant. Results: We selected 270 students, aged between 18 and 43, however, only 183 completed the questionnaire. The majority of the respondents were female, who come from conventional Catholic and Christian families, and inherited their religion from their parents; 78.6% (144/183) report religious affiliation, 43.5% (87/183) practice it in a disciplined way. Most the individuals considered that R/S gives meaning to their lives, strengthens them in times of trouble and brings benefits to their health. They also consider religiosity and spirituality and issues related issues as very important to their academic background, whereas 31.4% (57/183) quoted that religiosity and spirituality have influenced their professional choice. Conclusion: Those who have become students at the Universidade Federal do Triângulo Mineiro have a positive attitude towards religiosity and spirituality and expect a more comprhensive and spiritual approach towards their curriculum.

Prevalence of overweight and obesity and associated factors in school children and adolescents in a medium-sized Brazilian city

OBJECTIVES: The objective of this study was to describe the prevalence of overweight and obesity in school children and adolescents in a medium-sized Brazilian city. METHODS: In total, 1,125 children and adolescents between the ages of 5.6 and 18 years from public and private schools participated in the study. The sample included 681 girls and 444 boys. Each subject's weight and height were obtained according to Brazilian guidelines (SISVAN). The triceps (TSF), subscapular (SSF), biceps, suprailiac, femoral and calf skinfolds were measured in triplicate. Body mass index (BMI) was classified as the BMI percentile (BMIP) according to the World Health Organization (WHO) 2007 criteria. The percentage body fat (%BF) was obtained using the equations by Slaughter et al., 1998. Categorical variables were analyzed using the chi-squared test. RESULTS: Overall, 364 participants with excess weight were identified: 17.3% were overweight, and 15.0% were obese. Among the girls, 18.0% were overweight, and 12.5% were obese; among the boys, 15.3% were overweight, and 18.0% were obese. These prevalence rates were higher when the time spent watching TV or participating in media-related activities surpassed 5 hrs/day, when individuals belonged to a higher economic class and when the head of the family had a higher education level (≥12 years). CONCLUSION: It is important to emphasize the need to increase our understanding of factors associated with overweight and obesity, and it is essential to implement measures and policies aimed at reversing this trend, such as stimulating healthy eating habits and physical activity and reducing time spent watching TV and participating in other media activities, including video games and social networking.

Evaluation of clinical and laboratory markers of cardiometabolic risk in overweight and obese children and adolescents.

OBJECTIVE:: This study analyzed the frequency of cardiometabolic risk markers and metabolic syndrome occurrence in overweight and obese children and adolescents. METHODS:: The participants included 161 overweight (n=65) and obese (n=96) individuals aged between 5 and 19 years. Clinical markers were assessed (body mass index, body fat percentage, waist circumference, acanthosis, systolic and diastolic blood pressures, laboratory parameters [glucose, insulin, cholesterol (total and fractions) and triglyceride levels and homeostasis model assessment of insulin resistance (HOMA-IR) index] and leptin and adiponectin levels). The frequency of changes, odds ratios and correlations among markers were determined. Metabolic syndrome was assessed according to International Diabetes Federation criteria. RESULTS:: A high frequency of acanthosis (51.6%); increased waist circumference (45.4%), systolic blood pressure / diastolic blood pressure (8.1% / 9.3%), glucose (10%), insulin (36.9%) and HOMA-IR (44.3%) values; and reduced high-density lipoprotein levels (47.2%) were observed. Leptin levels were increased in 95% of obese and in 66% of overweight subjects. Adiponectin was decreased in 29.5% of obese and in 34% of overweight subjects. An odd ratio analysis revealed a greater probability of increased waist circumference (9.0), systolic blood pressure (4.1), triglyceride (2.3) and insulin (2.9) levels and HOMA-IR (3.0) in the obese group than in the overweight group. The clinical and laboratory parameters and leptin levels exhibited significant correlations, whereas adiponectin was negatively correlated with systolic blood pressure. The occurrence rate of metabolic syndrome was 13.6%. CONCLUSIONS:: The high frequency of changes in clinical, laboratory and adipokine markers indicates the need for early interventions aimed at preventing cardiometabolic complications in adulthood.