Diagnóstico de microalbuminúria em pacientes com diabete melito : desempenho do Micral-Test II

03

Perfil lipídico de pacientes com diabete melito tipo 2 com e sem nefropatia diabética

23

Estudo de associação entre a composição de Gorduras da dieta usual e a presença de disfunção Endotelial em pacientes com diabetes melito tipo 2

A disfunção endotelial parece ser o evento desencadeante da doença aterosclerótica, sendo considerado um marcador precoce de risco cardiovascular. Evidências crescentes destacam o papel de determinados fatores dietéticos, principalmente as gorduras, no desenvolvimento da DCV, especialmente através da modulação da função endotelial. Esse artigo tem por objetivo revisar o papel das gorduras da dieta sobre a modulação da função endotelial e as evidências da sua associação com a disfunção endotelial. Estudos epidemiológicos e de intervenção sugerem um efeito adverso dos ácidos graxos (AG) saturados e dos AG trans e um efeito benéfico dos AG poliinsaturados n-3 na modulação da função endotelial. O papel dos AG monoinsaturados sobre a função endotelial é ainda controverso. A quantidade da gordura total por si só não parece ser fator determinante na função vascular a longoprazo quanto a composição destas gorduras. No entanto, a modificação da composição de ácidos graxos da dieta implica obrigatoriamente na manipulação de mais de um componente para manter o valor energético, dificultando, portanto, a interpretação do papel de cada ácido graxo isoladamente sobre a função endotelial. ensaios clínicos randomizados, especialmente de longo-prazo, são ainda necessários para melhor evidenciar os diferentes efeitos da composição de AG da dieta e seus mecanismos, sobre a função vascular.Endothelial dysfunction plays a central role in the development of atherosclerotic disease, and is considered an early marker of cardiovascular risk. Emerging evidence suggests an important role of dietary factors, especially fatty acids intake, in modulating endothelial function. The aim of this manuscript was to review the role of dietary fatty acids in modulating endothelial function and their potential association with endothelial dysfunction. Epidemiologic and clinical trials suggest an adverse effect of dietary saturated and trans fat acids in the modulation of endothelial function, whereas dietary polyunsaturated fatty acid had a beneficial effect. The role of monounsaturated fat remains obscure. Overall, the evidence suggest that total fat per se does not have a strong effect on vascular function and that the composition of dietary fatty acid may play a more important role. However, the modification of the composition of fatty acids in the diet necessarily implies manipulating more than one component to maintain the energy value, thus making it difficult to interpret the role of each fatty acid by itself in endothelial function. Randomized clinical essays, especially long-term ones, are still needed to show clearer evidence of the different effects of FA composition in the diet and its mechanisms on vascular function

Critical analysis of the American Diabetes Association dietary recommendations for cardiovascular disease in diabetes mellitus

A doença cardiovascular (DCV) é a principal causa de mortalidade em pacientes com diabetes melito (DM), sendo essencial a intervenção dietética no manejo dessa complicação. O objetivo deste manuscrito foi revisar as evidências científicas que fundamentam as recomendações dietéticas da American Diabetes Association (ADA) para prevenção e tratamento da DCV nos pacientes com DM. As diretrizes da ADA baseiam-se, em sua maioria, em estudos com pacientes com DCV, porém sem DM. Nos pacientes com DM, um aumento na ingestão de peixe e de fibras solúveis são as recomendações dietéticas com benefício comprovado. Embora o DM possa ser considerado um equivalente de DCV estabelecida, a adoção das recomendações dietéticas de pacientes sem DM e com DCV para todos pacientes com DM é questionável – em especial quando são consideradas as peculiaridades da DCV no DM. Ensaios clínicos aleatorizados em pacientes com DM deverão fundamentar melhor os benefícios das intervenções dietéticas sobre a DCV.Cardiovascular disease (CVD) is the main cause of mortality among patients with diabetes mellitus (DM), and dietary intervention is an essential measure to prevent and treat this complication. The aim of this manuscript was to review scientific evidence that underlies the dietetic recommendations of the American Diabetes Association (ADA) for prevention and treatment of CVD in patients with DM. The ADA guidelines are mostly based on studies performed on patients with CVD and without DM. The evidence-based dietary recommendations for patients with DM are to increase the intake of fish and soluble fibers. Although DM has been considered as an equivalent of established CVD, the adoption of the same dietary recommendations for patients without DM and with CVD for all patients with DM is still questionable – especially considering the peculiarities of CVD in DM. Randomized clinical trials including patients with DM should provide further information regarding the benefits of these dietary interventions for CVD

Critical analysis of the American Diabetes Association dietary recommendations for cardiovascular disease in diabetes mellitus

A doença cardiovascular (DCV) é a principal causa de mortalidade em pacientes com diabetes melito (DM), sendo essencial a intervenção dietética no manejo dessa complicação. O objetivo deste manuscrito foi revisar as evidências científicas que fundamentam as recomendações dietéticas da American Diabetes Association (ADA) para prevenção e tratamento da DCV nos pacientes com DM. As diretrizes da ADA baseiam-se, em sua maioria, em estudos com pacientes com DCV, porém sem DM. Nos pacientes com DM, um aumento na ingestão de peixe e de fibras solúveis são as recomendações dietéticas com benefício comprovado. Embora o DM possa ser considerado um equivalente de DCV estabelecida, a adoção das recomendações dietéticas de pacientes sem DM e com DCV para todos pacientes com DM é questionável – em especial quando são consideradas as peculiaridades da DCV no DM. Ensaios clínicos aleatorizados em pacientes com DM deverão fundamentar melhor os benefícios das intervenções dietéticas sobre a DCV.Cardiovascular disease (CVD) is the main cause of mortality among patients with diabetes mellitus (DM), and dietary intervention is an essential measure to prevent and treat this complication. The aim of this manuscript was to review scientific evidence that underlies the dietetic recommendations of the American Diabetes Association (ADA) for prevention and treatment of CVD in patients with DM. The ADA guidelines are mostly based on studies performed on patients with CVD and without DM. The evidence-based dietary recommendations for patients with DM are to increase the intake of fish and soluble fibers. Although DM has been considered as an equivalent of established CVD, the adoption of the same dietary recommendations for patients without DM and with CVD for all patients with DM is still questionable – especially considering the peculiarities of CVD in DM. Randomized clinical trials including patients with DM should provide further information regarding the benefits of these dietary interventions for CVD

Microscopy and polymerase chain reaction detection of Leishmania chagasi in the pleural and ascitic fluid of a patient with AIDS: Case report and review of diagnosis and therapy of visceral leishmaniasis

Atypical visceral leishmaniasis is increasingly reported in immunocompromised patients, including patients with AIDS. A case of visceral leishmaniasis in an HIV-infected Brazilian patient with pulmonary and peritoneal involvement is reported. Histological evaluation of pleural fluid and ascites aspirate revealed macrophages with intracellular Leishmania. Polymerase chain reaction analysis was positive for Leishmania in the pleural and ascitic fluid with use of primers specific for Leishmania chagasi. In addition to classical methods for diagnosing leishmaniasis, such as microscopy and culture, polymerase chain reaction detection and identification of Leishmania species in pleural effusions and ascites are important diagnostic tools that should be considered by clinicians evaluating HIV-infected patients from endemic areas of visceral leishmaniasis. The authors review the clinical manifestations, diagnostic and therapeutic aspects of visceral leishmaniasis in immunocompetent and HIV-infected patients