José Egídio Paulo de Oliveira

NK cells and type 1 diabetes

Type 1 diabetes (T1D) is characterized by an immuno-mediated progressive destruction of the pancreatic β cells. Due to the ability of NK cells to kill target cells as well as to interact with antigen-presenting and T cells, it has been suggested that they could be involved in one or multiple steps of the immune-mediated attack that leads to T1D. Abnormalities in the frequency and activity of NK cells have been described both in animal models and patients with T1D. Some of these alterations are linked to its onset while others seem to be a consequence of the disease. Here, we discuss the main characteristics of NK cells and review the studies that investigated the role of NK cells in T1D, both in mouse models and humans.

Ethnicity and Type 2 Diabetes in Rio de Janeiro, Brazil, with a Review of the Prevalence of the Disease in Amerindians

To what extent can ethnic factors contribute to the prevalence of type 2 diabetes and impaired glucose tolerance (IGT) in an urban Brazilian population? Conversely, how can environmental factors such as diet change these prevalences in a given ethnic group, in this case Brazilian Indians? To answer these questions estimates of ethnic admixture in Afro- and Euro-Brazilians from Rio de Janeiro, Brazil, were established using eight genetic systems and compared with the prevalences of these conditions obtained previously. This information was integrated with results obtained inside and outside of Brazil. The similarity of prevalences for type 2 diabetes and IGT in Afro- and Euro-Brazilians may be related to the extensive gene flow that occurred between them and to similar socioeconomic levels in the samples investigated. On the other hand, changes in the traditional diet are probably conditioning the appearance of diabetes among Brazilian and other South American Indians.

Glicemia pós-prandial

Post-prandial hyperglycemia (PPH) is mainly attributed to a reduced first phase insulin secretion and lesser to insulin resistance. Although a marker of post-prandial glycemia (PPG), 2-hour post glucose load glycemic level (2hG) has low reproducibility. PPH is an important cardiovascular (CV) risk factor, particularly in DM in which CV diseases are the main cause of death. In non-diabetics, fasting and/or 2hG increase such risk, which occurs in a continuum within the normal range (dysglycemia). Atherosclerotic lesions are more pronounced in glucose metabolism disturbances; an association of arterial injury and 2hG was verified. In populations with normal fasting glycemia the risk of death increases along with 2hG. Non-enzymatic glycation of arterial wall components and lipoprotein oxidation accelerate atherosclerotic process. PPH is associated with conduction disturbances, which facilitate the occurrence of sudden death. Endothelial dysfunction could also predispose to vasoconstriction and post-prandial myocardial ischemia. ADA recommends that PPG should be monitored, especially when fasting glycemia and A1c are not proportional. While the efficacy of alpha-glucosidase inhibitors, glynides and ultra-short action insulin analogues are proved to reduce PPG it is still necessary to ascertain whether they are able to reduce long-term diabetic complications.

A fatal case of gastric mucormycosis and diabetic ketoacidosis.

OBJECTIVEnTo describe a case of gastric mucormycosis in conjunction with severe bleeding in a young woman, which occurred after an episode of ketoacidosis and had a fatal outcome.nnnMETHODSnWe present a case report, including detailed clinical and pathologic findings in a woman with gastric mucormycosis associated with severe bleeding.nnnRESULTSnA 17-year-old woman sought medical assistance for diabetic ketoacidosis and severe epigastric pain. Chest radiography showed normal findings, and blood and urine cultures were negative for bacterial growth. Endoscopy disclosed an extensive ulcerated lesion involving the greater curvature and posterior wall of the stomach. Biopsy specimens demonstrated the presence of invasive mucormycosis. Treatment with amphotericin B was initiated, but severe persistent gastrointestinal bleeding resulted in the patients demise.nnnCONCLUSIONnIn conjunction with diabetic ketoacidosis, severe infection by Mucor has been reported mainly in the rhino-orbital area. Although uncommon, the gastrointestinal tract can also be involved. In the case described, severe hemorrhage ensued and caused the patients death.

Mortalidade por diabetes mellitus e outras causas no município do Rio de Janeiro: diferenças por sexo e idade

Objective: Diabetes mellitus (DM) is considered a public health problem because of its great prevalence and the fact that the majority of the patients are not being treated or not following adequately the treatment for the disease. Therefore, there is an increased risk for morbidity and mortality. The underlying cause of death registered on the death certificates may stress the importance of this disease to society. Design, material and methods: Data were obtained from a database from the Department of Epidemiology of the Municipal Bureau of Health. Diabetic death rates were compared with the general population deaths in Rio de Janeiro during the years of 1994, 1995 and 1996, in relation to sex and age group criteria. Results: Among women of less than 50 years of age the mortality is equal, but after that the diabetics showed higher mortality rates. Among men, non-DM have higher mortality rates until 60 years of age, after that, diabetics showed higher death frequency. Conclusion: This study suggests that among DM patients, women showed higher percentile in the proportional mortality than men. However, among the non-DM the higher proportional mortality was found among men.

Implicações clínicas da persistência de anti-GAD positivo e peptídeo C detectável em pacientes com diabetes melito tipo 1 de longa duração

OBJETIVO: Avaliar se anti-GAD positivo e PC detectavel se correlacionam com a presenca de outras doencas autoimunes, com controle glicemico e com risco de retinopatia no diabetes melito tipo 1 (DMT1) > 3 anos de duracao. PACIENTES E METODOS: Cinquenta sujeitos com DMT1 foram entrevistados, realizaram fundoscopia e dosaram PC pre e pos-glucagon, HbA1C e anti-GAD. RESULTADOS: Pacientes anti-GAD+ (n = 17) apresentaram maior frequencia de doencas autoimunes em relacao aos demais (p = 0,02). PC detectavel (n = 11) tambem foi associado ao aumento dessa prevalencia (p = 0,03), porem nenhum dos dois parâmetros influenciou na presenca de retinopatia diabetica. PC detectavel nao influenciou no controle glicemico (HbA1C media) (p = 0,28), porem as doses diarias de insulina foram mais baixas (0,62 vs. 0,91 U/kg/dia; p = 0,004) neste grupo. CONCLUSAO: Apesar de nao ser um marcador para outras doencas autoimunes, o anti-GAD+ parece ser nao so um sinalizador de autoimunidade pancreatica. PC detectavel tambem parece ter papel promissor na deteccao dessas comorbidades. Ambos nao interferiram na presenca de retinopatia, entretanto, o PC detectavel se relacionou a menores necessidades de insulina.

Dosagem do peptídeo C sérico ao acaso em adultos com diagnóstico clínico de diabetes mellitus tipo 1

OBJETIVO: A dosagem de peptideo C (PC) pode ser util para a classificacao do Diabetes mellitus (DM). O objetivo deste estudo foi investigar a associacao entre o diagnostico clinico de DM tipo 1 e os niveis sericos de PC randomico. METODOS: Foi feita dosagem de PC ao acaso em pacientes de origem multietnica com diagnostico clinico de DM tipo 1 na idade adulta ( > 18 anos). RESULTADOS: Estudamos 51 pacientes, sendo 28 mulheres (54,9%) e 23 homens (45,1%), 36 brancos (70,6%) e 15 nao-brancos (29,4%) com idade media ao diagnostico de 27,9 (±7,5) anos e duracao media da doenca de 9,9 (±7,2) anos. Oito pacientes (15,7%) apresentaram PC > 1,5 ng/ml indicativo de funcao pancreatica preservada. Neste grupo, foi detectado indice de massa corporal mais elevado (26,05 vs 23,05 kg/m2; p=0,006) e maior proporcao de nao-brancos (62,5% vs 23,3%; p=0,039) do que naqueles com PC baixo. CONCLUSAO: A maioria dos pacientes com diagnostico clinico de DM tipo 1 apresenta PC baixo. Entretanto, a secrecao pancreatica de insulina parece preservada em uma quantidade significativa de pacientes com quadro clinico indicativo de DM tipo 1. E possivel que estes pacientes apresentem alguma forma atipica de DM, ainda nao completamente compreendida, com caracteristicas de DM tipo 1 e tipo 2 superpostas.