Prevalência da doença hepática gordurosa não alcoólica definida pela biópsia hepática: o verdadeiro espectro em diabéticos tipo II

A doença hepática gordurosa não alcoólica (DHGNA) tornou-se a hepatopatia crônica mais comum no mundo, afetando principalmente alguns grupos de pacientes, como os diabéticos tipo II. A biópsia hepática permanece como método padrão ouro para o seu diagnóstico. A prevalência da DHGNA e seus subtipos, em especial a esteatohepatite (EH), pode estar subestimada por métodos não invasivos de diagnóstico ou superestimada pela realização da biópsia em pacientes selecionados por alterações na ultrassonografia (US) ou nas aminotransferases. Os objetivos deste estudo foram: determinar a prevalência da DHGNA (esteatose, EH e cirrose) em uma amostra de pacientes diabéticos tipo II, com base na biópsia hepática; quantificar a esteatose, inflamação e fibrose quando presentes; identificar fatores preditivos de DHGNA, EH e fibrose significativa (≥ estágio 2) e avaliar o valor das aminotransferases e da US de abdome para o diagnóstico de EH e fibrose significativa. Todos os diabéticos tipo II, entre 18 e 70 anos, consecutivamente atendidos no ambulatório de Diabetes do Hospital Universitário Pedro Ernesto, eram candidatos a participar do estudo. Foram excluídos pacientes com sorologias positivas para hepatite B ou C, outras doenças hepáticas crônicas, uso de drogas hepatotóxicas ou esteatogênicas, etilismo (≥20g/dia), obesidade grau III, comorbidades graves, gravidez ou por recusa em participar do estudo. Dos 396 pacientes triados com critérios de inclusão, 85 foram incluídos. Todos os pacientes foram submetidos à avaliação clínica, exames laboratoriais, US de abdome e biópsia hepática. As lâminas foram analisadas por dois patologistas independentes e a DHGNA foi graduada pelo NASH Clinical Research Network Scoring System. A concordância entre os patologistas foi medida pelo coeficiente Kappa (k) e foi realizada análise multivariada por regressão logística para avaliação dos fatores associados de forma independente à DHGNA, EH e fibrose significativa. A prevalência de DHGNA na amostra foi de 92%, sendo 50% esteatose simples, 40% EH e 2% cirrose. A concordância (k) entre os patologistas foi 0,78. A esteatose foi leve na maior parte dos pacientes com esteatose simples e predominantemente acentuada nos pacientes com EH (p<0,001). A fibrose foi verificada em 76% dos pacientes com EH, sendo significativa em 41% deles. A presença de síndrome metabólica foi associada de forma independente à DHGNA, o índice de massa corporal e a circunferência abdominal aumentada à EH e a dosagem de alanina aminotransferase (ALT) à EH e à fibrose significativa. Apenas um de 21 pacientes (5%) com US e ALT normais apresentou EH. A prevalência da EH aumentou progressivamente com o aumento do grau de esteatose na US e com o aumento da ALT. Conclusão: A prevalência da DHGNA estimada pela biópsia hepática sem vieses de seleção foi muito elevada. Apesar de alto, o percentual de EH e fibrose significativa foi inferior ao dos estudos com biópsias em diabéticos selecionados por alterações na US e aminotransferases. EH foi associada a esteatose acentuada na histologia. A obesidade foi um cofator importante no diagnóstico de EH. O melhor desempenho da ALT e da US foi o de excluir as formas graves de DHGNA quando normais.

Characterization of prolidase activity using capillary electrophoresis with tris(2,2'-bipyridyl)ruthenium(II) electrochemiluminescence detection and application to evaluate collagen degradation in diabetes mellitus

A new method for prolidase (PLD, EC 3.4.13.9) activity assay was developed based on the determination of proline produced from enzymatic reaction through capillary electrophoresis (CE) with tris(2,2'-bipyridyl)ruthenium(11) [Ru(bpy)(3)(2+)] electrochemiluminescence detection (ECL). A detection limit of 12.2 fmol (S/N = 3) for proline, corresponding to 1.22 x 10(-8) units of prolidase catalyzing for 1 min was achieved. PLD activity determined by CE-ECL method was in agreement with that obtained from the classical Chinard's one. CE-ECL showed its powerful resolving ability and selectivity as no sample pretreatmentwas needed and no interference existed. The clinical utility of this method was successfully demonstrated by its application to assay PLD activity in the serum of diabetic patients in order to evaluate collagen degradation in diabetes mellitus (DM). The results indicated that enhanced collagen degradation occurred in DM.

A Fitoterapia como tratamento complementar na Diabetes mellitus

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas

Higher incidence of childhood-onset type 1 diabetes mellitus in remote areas: a UK regional small-area analysis

Aims/hypothesis: We investigated the association between the incidence of type 1 diabetes mellitus and remoteness (a proxy measure for exposure to infections) using recently developed techniques for statistical analysis of small-area data.

Subjects, materials and methods: New cases in children aged 0 to 14 years in Northern Ireland were prospectively registered from 1989 to 2003. Ecological analysis was conducted using small geographical units (582 electoral wards) and area characteristics including remoteness, deprivation and child population density. Analysis was conducted using Poisson regression models and Bayesian
hierarchical models to allow for spatially correlated risks that were potentially caused by unmeasured explanatory variables.

Results: In Northern Ireland between 1989 and 2003, there were 1,433 new cases of type 1 diabetes, giving a directly standardised incidence rate of 24.7 per 100,000 personyears. Areas in the most remote fifth of all areas had a significantly (p=0.0006) higher incidence of type 1 diabetes mellitus (incidence rate ratio=1.27 [95% CI 1.07, 1.50]) than those in the most accessible fifth of all areas. There was also a higher incidence rate in areas that were less deprived (p<0.0001) and less densely populated (p=0.002). After adjustment for deprivation and additional adjustment for child population density the association between diabetes and remoteness remained significant (p=0.01 and p=0.03, respectively).

Conclusions/interpretation: In Northern Ireland, there is evidence that remote areas experience higher rates of type 1 diabetes mellitus. This could reflect a reduced or delayed exposure to infections, particularly early in life, in these areas.

Insulin Dependant Diabetes Mellitus: Implications for Male Reproductive Function.

BACKGROUND Diabetes mellitus (DM) is increasing in men of reproductive age. Despite this, the prevalence of diabetes in men attending fertility clinics is largely unknown. Furthermore, studies examining the effects of DM on sperm fertility potential have been limited to conventional semen analysis. METHODS Conventional semen analysis (semen volume, sperm count, motility and morphology) was performed for 27 diabetic (mean age 34 +/- 2 years) and 29 non-diabetic subjects (control group, men undergoing routine infertility investigations, mean age 33 +/- 1 years). Nuclear DNA (nDNA) fragmentation was assessed using the alkaline Comet assay and mitochondrial DNA (mtDNA) deletions by Long-PCR. RESULTS Other than a small, but significant, reduction in semen volume in diabetic men (2.6 versus 3.3 ml; P <0.05), conventional semen parameters did not differ significantly from control subjects. Diabetic subjects had significantly higher mean nDNA fragmentation (53 versus 32%; P <0.0001) and median number of mtDNA deletions (4 versus 3; P <0.05) compared with control subjects. CONCLUSIONS Diabetes is associated with increased sperm nuclear and mtDNA damage that may impair the reproductive capability of these men.

Differences In Metabolic Profile In the Testes of Streptozotocin Induced Diabetes Mellitus Mice As Detected By 1H NMR

Contrary to the traditional view, recent studies suggest that diabetes mellitus has an adverse influence on male reproductive function. Our aim was to determine the affect of diabetes on the testicular environment by identifying and then assessing perturbations in small molecule metabolites. Testes were obtained from control and streptozotocin induced diabetic C57BL/6 mice, two, four and eight weeks post treatment. Diabetic status was confirmed by HbA1c, non fasting blood glucose, physiological condition and body weight. Protein free, low molecular weight, water soluble extracts were assessed using 1H NMR spectroscopy. Principal Component Analysis of the derived profiles was used to classify any variations and specific metabolites were identified based on their spectral pattern. Characteristic metabolite profiles were identified for control and diabetic animals with the most distinctive being from mice with the greatest physical deterioration and loss of bodyweight. Eight streptozotocin treated animals did not develop diabetes and displayed profiles similar to controls. Diabetic mice had decreases in creatine, choline and carnitine and increases in lactate, alanine and myo-inositol. Betaine levels were found to be increased in the majority of diabetic mice but decreased in two animals with severe loss of body weight and physical condition. The association between perturbations in a number of small molecule metabolites known to be influential in sperm function, with diabetic status and physiological condition, adds further impetus to the proposal that diabetes influences important spermatogenic pathways and mechanisms in a subtle and previously unrecognised manner.