Cintilografia de perfusão miocárdica na detecção da isquemia silenciosa em pacientes diabéticos assintomáticos

OBJECTIVE: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. MATERIALS AND METHODS: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with 99mTc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. RESULTS: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). CONCLUSION: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia.OBJETIVO: Este estudo teve por finalidade avaliar a perfusão miocárdica de pacientes com diabetes mellitus tipo 1 (DM1) e tipo 2 (DM2) assintomáticos, sem diagnóstico prévio de doença arterial coronariana (DAC) ou acidente vascular cerebral. MATERIAIS E MÉTODOS: Cinquenta e nove pacientes consecutivos (16 DM1, 43 DM2) foram submetidos a cintilografia de perfusão miocárdica com sestamibi-99mTc (CPM). Foram avaliados quanto ao índice de massa corpórea, controle metabólico do diabetes, dislipidemia, terapia para o diabetes, hipertensão arterial sistêmica, nefropatia, retinopatia, neuropatia periférica, tabagismo e história familiar de DAC. RESULTADOS: CPM foi anormal em 25,4%: 12 (20,3%) com alterações de perfusão e 3 com disfunção ventricular esquerda isolada. Os mais fortes preditores de perfusão miocárdica anormal foram: idade igual ou maior a 60 anos (p = 0,017, odds ratio [OR] = 6,0), neuropatia periférica (p = 0,028, OR = 6,1), nefropatia (p = 0,031, OR = 5,6) e ECG de esforço positivo para isquemia (p = 0,049, OR = 4,08). CONCLUSÃO: A isquemia miocárdica silenciosa ocorre em mais de um em cada cinco diabéticos assintomáticos. Os mais fortes preditores de isquemia foram: idade avançada, neuropatia periférica, nefropatia, retinopatia e ECG de esforço positivo para isquemia.714Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Expressão de colageno IV e laminina urinarios no diabetes mellitus induzidos por drogas (aloxana e estreptozotocina) e avaliação morfo-funcional renal

Orientador: Ricardo de Lima ZollnerTese (doutorado) - Universidde Estadual de Campinas, Faculdade de Ciencias MedicasResumo: A excreção urinária de componentes da membrana basal, especificamente colágeno IV e laminina, foi determinada através de "immunoblotting", e estudada em ratos Wistar machos, diabéticos-induzido por drogas (aloxana e estreptozotocina) EV, e comparada a controles, em função do tempo de doença. Estudamos, também, as funções renais: glomerular e tubular, avaliando, respectivamente, clearance de creatinina e de lítio. Além disso, aspectos morfológicos renais foram analisados utilizando-se técnicas de PAS e de imuno-histoquímica, para colágeno IV e laminina, com o objetivo de verificar possíveis alterações da membrana basal. Assim, pudemos observar excreções de frações urinárias de colágeno IV (88 e 75 kDa) e laminina (108 e 88 kDa), em ambos os modelos de DM, em todos os tempos estudados. Entretanto, a fração de 57 kDa da laminina, nos animais diabéticos-induzido por estreptozotocina, somente foi expressa a partir da 5a semana de doença, enquanto nos diabéticos- induzido por aloxana sua excreção foi verificada precocemente (2º dia). As alterações da função renal foram semelhantes nos dois modelos, porém de maneira mais intensa no modelo aloxânico. Dentre elas destacaram-se: diminuição progressiva da taxa de filtração glomerular, aumento da fração de excreção de sódio; e, diminuição da reabsorção proximal deste ion, não compensada por aumento da reabsorção distai. Os achados morfológicos evidenciaram espessamento da membrana basal do capilar glomerular e aumento da matriz mesangial, iniciando-se precocemente no diabetes melliíus aloxânico. De acordo com os dados observados neste estudo, concluímos que no DM induzido por aloxana e estreptozotocina, frações urinárias de colágeno IV e laminina podem ser utilizadas como marcadores precoces de nefropatia diabética. Outrossim, o DM induzido por aloxana promove alterações funcionais renais mais intensas, principalmente tubulares, quando comparado ao modelo induzido por estreptozotocina; em adição, as alterações morfológicas observadas pela técnica de imuno-histoquímica puderam ser correlacionadas às alterações bioquímico-funcionais-renaisAbstract: The urine excretion of basement membrane components, specifically collagen IV and laminin, was determinated by immunoblotting and analyzed in male diabetic Wistar rats diabetic-induced (alloxan and streptozotocin) and compared to controls, considering the disease period. We also studied the renal functions: glomerular and tubular, evaluating creatinine and lithium clearance, respectively Moreover morphological renal aspects were analyzed by using PAS and immunohistochemical staining, for collagen IV and laminin, with the purpose of examining possible alterations at the basement membrane. In this way, we could observe urine fractions excretions of collagen IV (88, 75 kDa) and laminin (108, 88 kDa), in both DM models, in all periods of study. However the laminin fraction of 57 kDa, in the streptozotocin-induced diabetic animals, was expressed only from the 5th week of the disease, while in the alloxan-induced diabetic animals their excretion was verified earlier (on the 2nd. day). The renal function alterations were similar in the two models, but with more intensity in the alloxan model. Among them we can underline following; progressive decrease of the glomerular filtration rate, increase of the fractional sodium excretion and decrease of the proximal reabsorption of this ion, not compensated by distal reabsorption increase. The morphological findings showed a thickness of the capilar glomerular basement membrane and an increase of the mesangial matrix, beginning earlier at the alloxanic diabetes mellUus. In accordance with the data observed in this study, we conclude that at the alloxan and streptozotocin induced DM, urine fractions of collagen IV and laminin can be used as early markers of diabetic nephropathy. Besides this, the alloxan-induced DM produces functional renal alterations with more intensity, mainly tubular, when compared to the streptozotocin-induced model; in addition, the morphological alterations observed by the immunohistochemical technic could be related to the renal biochemical- functional alterationsDoutoradoMedicina InternaDoutor em Ciências Médica

Adaptation and psychometric assessment of the instrument “Partners of Adults with Type 1 Diabetes Distress Scale” in a Brazilian population

Objectives: To adapt the instrument “Partners of Adults with Type 1 Diabetes Distress Scale” (Partner-DDS) into Brazilian culture, and to evaluate the psychometric characteristics of the adapted version. Methods: All the cultural adaptation steps of the measure's instruments were followed. The psychometric properties such as reliability (stability by test-retest; internal consistency), and convergent construct validity were performed. Results: Of all 72 partners, 69.4% were male, mean age: 42.69 ± 14.09 years, mean of marriage duration: 14.74 ± 12.41 years, and mean schooling: 11.81 ± 3.91 years.The internal consistency of the instrument (Cronbach Alpha) was 0.90. The intra-class coefficient (stability) was 0.80 (0.72–0.84). The Spearman coefficient (convergent construct validity) between the Partner-DDS scale and the Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) was 0.4273 (p < 0.0002). Conclusions: The steps of the instruments' cultural adaptation were appropriately performed. The Brazilian version of the Partner- DDS scale demonstrates reliable psychometric properties for being used in POPWT1D distress evaluation in Brazil. Innovation: The cultural adaptation of Partner-DDS scale into Brazilian Portuguese is a helpful innovation to assess the emotional burden in POPWT1D. This tool could be used to provide education and psychological support for this population

Dyspeptic Symptoms In Patients With Type 1 Diabetes: Endoscopic Findings, Helicobacter Pylori Infection, And Associations With Metabolic Control, Mood Disorders And Nutritional Factors.

To evaluate, in a group of patients with long-standing type 1 diabetes (DM1), an association of dyspepsia symptoms with: changes in the gastroduodenal mucosa, infection by Helicobacter pylori, glycemic control, and psychological and nutritional factors. A total of 32 patient with DM1 were studied (age: 38 ± 9 years; females: 25; diabetes duration: 22 ± 5 years). All patients answered a standardized questionnaire for the evaluation of gastrointestinal symptoms and underwent upper gastrointestinal endoscopy, with gastric biopsies for the evaluation of Helicobacter pylori infection. The presence of anxiety and depression was evaluated by the HAD scale. Nutritional parameters were BMI, arm and waist circumference, skinfold measurement, and body fat percentage. Upper endoscopy detected lesions in the gastric mucosa in 34.4% of the patients, with similar frequency in those with (n = 21) and without dyspepsia (n = 11). The patients with dyspepsia complaints showed greater frequency of depression (60% vs. 0%; p = 0.001), higher values for HbA1c (9.6 ± 1.7 vs. 8.2 ± 1.3%; p = 0.01) and lower values for BMI (24.3 ± 4.1 vs. 27.2 ± 2.6 kg/m2; p = 0.02), body fat percentage (26.6 ± 6.2 vs. 30.8 ± 7.7%; p = 0.04), and waist circumference (78.7 ± 8 vs. 85.8 ± 8.1 cm; p = 0.02). No association was found between the symptoms and the presence of Helicobacter pylori. Dyspepsia symptoms in patients with long-standing DM1 were associated with glycemic control and depression, and they seem to negatively influence the nutritional status of these patients.59129-13

Dyspeptic symptoms in patients with type 1 diabetes: endoscopic findings, Helicobacter pylori infection, and associations with metabolic control, mood disorders and nutritional factors

Objectives To evaluate, in a group of patients with long-standing type 1 diabetes (DM1), an association of dyspepsia symptoms with: changes in the gastroduodenal mucosa, infection by Helicobacter pylori, glycemic control, and psychological and nutritional factors. Subjects and methods A total of 32 patient with DM1 were studied (age: 38 ± 9 years; females: 25; diabetes duration: 22 ± 5 years). All patients answered a standardized questionnaire for the evaluation of gastrointestinal symptoms and underwent upper gastrointestinal endoscopy, with gastric biopsies for the evaluation of Helicobacter pylori infection. The presence of anxiety and depression was evaluated by the HAD scale. Nutritional parameters were BMI, arm and waist circumference, skinfold measurement, and body fat percentage. Results Upper endoscopy detected lesions in the gastric mucosa in 34.4% of the patients, with similar frequency in those with (n = 21) and without dyspepsia (n = 11). The patients with dyspepsia complaints showed greater frequency of depression (60% vs. 0%; p = 0.001), higher values for HbA1c (9.6 ± 1.7 vs. 8.2 ± 1.3%; p = 0.01) and lower values for BMI (24.3 ± 4.1 vs. 27.2 ± 2.6 kg/m2; p = 0.02), body fat percentage (26.6 ± 6.2 vs. 30.8 ± 7.7%; p = 0.04), and waist circumference (78.7 ± 8 vs. 85.8 ± 8.1 cm; p = 0.02). No association was found between the symptoms and the presence of Helicobacter pylori. Conclusions Dyspepsia symptoms in patients with long-standing DM1 were associated with glycemic control and depression, and they seem to negatively influence the nutritional status of these patients