Increasing prevalence of obesity in children and adolescents might represent an emerging public health issue. Pathogenesis of obesity is multifactorial and involves a complex interplay of genetic and environmental factors. Adolescent obesity has been seen as a cosmetic problem only; nevertheless, a significant increase in cardiovascular risk, probably due to obesity-related metabolic disarrangement has been observed. Consequently, discussion on strategies for treating childhood and adolescent obesity has been promoted worldwide. The proposed treatment triad is life style modification, pharmacological, and surgical treatment. Although lacking definitive data, drug therapy has emerged as an efficacious tool, at least in adolescent obesity. Therefore, sibutramine and orlistat may be good therapeutic options when life style modifications alone do not work. Arq Bras Endocrinol Metab. 2009;53(2):252-261. KeywordsObesity; adolescent; anti-obesity agents; treatment; sibutramine; metformin; orlistat; bariatric surgery resumo O aumento da prevalência de obesidade em crianças e adolescentes pode representar um sério problema de saúde pública nos próximos anos. A patogênese da obesidade é multifatorial e envolve uma complexa interação de fatores genéticos com fatores ambientais. A obesidade na adolescência tem sido vista apenas como um problema estético, entretanto, tem sido observado significativo aumento de fatores de risco cardiovasculares, provavelmente em razão das alterações metabólicas relacionadas ao excesso de peso. Desde então, estratégias de tratamento da obesidade na infância e adolescência têm sido propostas. O tripé proposto para o tratamento é: mudança de estilo de vida, tratamento medicamentoso e cirúrgico. Apesar da falta de evidências definitivas, o tratamento medicamentoso em adolescentes emerge como uma ferramenta eficaz. Sibutramina e orlistat, desse modo, podem ser uma boa opção terapêutica quando as mudanças de estilo de vida, isoladamente, não forem eficazes. Arq Bras Endocrinol Metab. 2009;53(2):252-261. Descritores

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A young woman with achondroplasia and morbid obesity (two disabling conditions) is presented. She underwent open Roux-en-Y gastric bypass (RYGBP). We emphasize preoperative preparation by a multidisciplinary team and the use of the 6-minute walk test to follow and assess mobility and quality of life.

RESUMOO balanço energético é um dos mais importantes mecanismos de homeostase e de sobrevivência das espécies. O sistema endocanabinóide é um novo e importante componente entre estes mecanismos. Os seus receptores e agonistas endógenos se expressam no sistema nervoso central (SNC) e perifericamente, em vários sítios, estabelecendo uma rede de comunicação periferia-SNC. Um aspecto marcante é a sua expressão no tecido adiposo, onde regula a lipogênese e aumenta a expressão de genes influentes no metabolismo dos lipídeos e dos carboidratos. Estes aspectos são importantes para o controle do peso corporal e da Síndrome Metabólica (SM). O sistema é ativado sob demanda e desativado rapidamente, atuando autócrina e paracrinamente, e as evidências sugerem que mantém-se hiperativado em estados de obesidade. Um antagonista específico do seu principal receptor (CB1), o Rimonabant, tem se mostrado importante ferramenta no controle do peso em modelos animais de obesidade e de SM. Da mesma forma, grandes estudos em humanos confirmam sua eficácia no controle do peso e das variáveis metabólicas, sugerindo um papel importante deste medicamento para o controle do risco cardiovascular associado à SM. ABSTRACTThe Endocannabinoid System: a New Paradigm in the Metabolic Syndrome Treatment. Energetic balance is a fundamental homeostasis mechanism, which contributes to the species' survival. The endocannabinoid system is a new and important component among such mechanisms. Its receptors and endogenous agonists are expressed in central nervous system (CNS) and at various peripheral organs, establishing a CNS-periphery net communication. A relevant aspect is its expression in the adipose tissue, where it regulates lipogenesis and increases the expression of influent genes on lipids and carbohydrate metabolism. Interestingly, it seems to be upregulated in human and animal obesity, although it is activated on demand and rapidly deactivated. Its activation increases food intake and promotes weight gain, contributing to Metabolic Syndrome (MS). Rimonabant is a specific antagonist to the main endocannabinoid receptor (CB1). In animal models of obesity and MS, as well as in humans, Rimonabant has demonstrated to be a useful tool in controlling weight and metabolic aspects. Indeed, some new human trials suggest a possible role for this substance in controlling cardiovascular risk factors related to MS.

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SCH in overweight and obese adolescents appears to be associated with excess weight, especially visceral weight. In euthyroid adolescents, there appears to be a direct relationship between TSH and some CRF. In conclusion, in the present sample of overweight and obese adolescents, TSH levels appear to be associated with IR and CRF.

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BackgroundDrug-induced increase in QT dispersion has been associated with potentially fatal ventricular arrhythmias. Little is known about the use of psychotropic substances, alone or in combination with other drugs on QT dispersion. ObjectivesTo evaluate the impact of psychotropic drugs on QT interval dispersion in adults. MethodsAn observational cohort study was designed involving 161 patients hospitalized from an emergency department at a tertiary hospital, divided into psychotropic users or non-users. Demographic, clinical, laboratory data and drugs used on a regular basis were collected on admission, in addition to 12-lead electrocardiogram with QT dispersion measurement. ResultsQT dispersion was significantly higher in the psychotropic user group compared to non-users (69.25 ± 25.5 ms vs. 57.08 ± 23.4 ms; p = 0.002). The QT interval corrected by Bazzett formula was also higher in the psychotropic drugs user group, with statistical significance. (439.79 ± 31.14 ms vs. 427.71 ± 28.42 ms; p = 0.011). A regression analysis model showed a positive association between the number of psychotropic drugs used and QT interval dispersion, with r = 0.341 and p < 0.001. ConclusionsThe use of psychotropic drugs was associated with increased QT dispersion and this increase was accentuated, as the number of psychotropic drugs used was higher.