Congenital toxoplasmosis: evaluation of serological methods for the detection of anti-Toxoplasma gondii IgM and IgA antibodies

A study was carried out to evaluate the presence of serological markers for the immunodiagnosis of the vertical transmission of toxoplasmosis. We tested the sensitivity, specificity and predictive values (positive and negative) of different serological methods for the early diagnosis of congenital toxoplasmosis. In a prospective longitudinal study, 50 infants with suspected congenital toxoplasmosis were followed up in the ambulatory care centre of Congenital Infections at University Hospital in Goiânia, Goiás, Brazil, from 1 January 2004-30 September 2005. Microparticle Enzyme Immunoassay (MEIA), Enzyme-Linked Fluorescent Assay (ELFA) and Immune-Fluorescent Antibody Technique (IFAT) were used to detect specific IgM anti-Toxoplasma gondii antibodies and a capture ELISA was used to detect specific IgA antibodies. The results showed that 28/50 infants were infected. During the neonatal period, IgM was detected in 39.3 percent (11/28) of those infected infants and IgA was detected in 21.4 percent (6/28). The sensitivity, specificity and predictive values (positive and negative) of each assay were, respectively: MEIA and ELFA: 60.9 percent, 100 percent, 100 percent, 55.0 percent; IFAT: 59.6 percent, 91.7 percent, 93.3 percent, 53.7 percent; IgA capture ELISA: 57.1 percent, 100 percent, 100 percent, 51.2 percent. The presence of specific IgM and IgA antibodies during the neonatal period was not frequent, although it was correlated with the most severe cases of congenital transmission. The results indicate that the absence of congenital disease markers (IgM and IgA) in newborns, even after confirming the absence with several techniques, does not constitute an exclusion criterion for toxoplasmosis.

Gliclazide and bedtime insulin are more efficient than insulin alone for type 2 diabetic patients with sulfonylurea secondary failure

To determine the effects of combined therapy of gliclazide and bedtime insulin on glycemic control and C-peptide secretion, we studied 25 patients with type 2 diabetes and sulfonylurea secondary failure, aged 56.8 + or - 8.3 years, with a duration of diabetes of 10.6 + or - 6.6 years, fasting plasma glucose of 277.3 + or - 64.6 mg/dl and a body mass index of 27.4 + or - 4.8 kg/m². Patients were submitted to three therapeutic regimens lasting 2 months each: 320 mg gliclazide (phase 1), 320 mg gliclazide and bedtime NPH insulin (phase 2), and insulin (phase 3). At the end of each period, glycemic and C-peptide curves in response to a mixed meal were determined. During combined therapy, there was a decrease in all glycemic curve values (P<0.01). Twelve patients (48 percent) reached fasting plasma glucose <140 mg/dl with a significant weight gain of 64.8 kg (43.1-98.8) vs 66.7 kg (42.8-101.4) (P<0.05), with no increase in C-peptide secretion or decrease in HbA1. C-Peptide glucose score (C-peptide/glucose x 100) increased from 0.9 (0.2-2.1) to 1.3 (0.2-4.7) during combined therapy (P<0.01). Despite a 50 percent increase in insulin doses in phase 3 (12 U (9-30) vs 18 U (11-60); P<0.01) only 3 patients who responded to combined therapy maintained fasting plasma glucose <140 mg/dl (P<0.02). A tendency to a higher absolute increase in C-peptide (0.99 (0.15-2.5) vs 0.6 (0-2.15); P = 0.08) and C-peptide incremental area (2.47 (0.22-6.2) vs 1.2 (0-3.35); P = 0.07) was observed among responders. We conclude that combined therapy resulted in a better glucose response to a mixed meal than insulin alone and should be tried in type 2 diabetic patients before starting insulin monotherapy, despite difficulties in predicting the response

Residual ß-cell function and microvascular complications in type 1 diabetic patients

To determine the influence of residual ß-cell function on retinopathy and microalbuminuria we measured basal C-peptide in 50 type 1 diabetic outpatients aged 24.96 + or - 7.14 years, with a duration of diabetes of 9.1 + or - 6.2 years. Forty-three patients (86 percent) with low C-peptide (<0.74 ng/ml) had longer duration of diabetes than 7 patients (14 percent) with high C-peptide (<0.74 ng/ml) (9 (2-34) vs 3 (1-10) years, P = 0.01) and a tendency to high glycated hemoglobin (HBA1) (8.8 (6-17.9) vs 7.7 (6.9-8.7)percent, P = 0.08). Nine patients (18 percent) had microalbuminuria (two out of three overnight urine samples with an albumin excretion rate (AER)> or - 20 and <200 µg/min) and 13 (26 percent) had background retinopathy. No association was found between low C-peptide, microalbuminuria and retinopathy and no difference in basal C-peptide was observed between microalbuminuric and normoalbuminuric patients (0.4 + or - 0.5 vs 0.19 + or - 0.22 ng/ml, P = 0.61) and between patients with or without retinopathy (0.4 + or - 0.6 vs 0.2 + or - 0.3 ng/ml, P = 0.43). Multiple regression analysis showed that duration of diabetes (r = 0.30, r2 = 0.09, P = 0.031) followed by HBA1 (r = 0.41, r2 = 0.17, P = 0.01) influenced basal C-peptide, and this duration of diabetes was the only variable affecting AER (r = 0.40, r2 = 0.16, P = 0.004). In our sample of type 1 diabetic patients residual ß-cell function was not associated with microalbuminuria or retinopathy

Infecçäo diagnosticada em diabéticos durante internaçäo hospitalar / Infection in diabetics during inpatient care

Objetivo. Analisar o perfil de processos infecciosos em diabéticos internados em um hospital geral. Material e Métodos. Foram selecionados, retrospectivamente, 233 prontuários de diabéticos no período de setembro a novembro de 1990. Num total de 38 (16,3 por cento) pacientes com infecçäo, 76,3 por cento (n=29) eram do sexo feminino, com média de idade de 58,9 + 15,3 anos, duraçäo do diabetes de 10,8 + 9,1 anos e predomínio do diabetes melito tipo II na amostra (86,3 por cento, n = 33). Resultados. O principal motivo de internaçäo foi a doença macrovascular de extremidades (42 por cento). Quarenta processos infecciosos foram estudados (dois pacientes apresentavam infecçäo em dois sítios). Foram realizadas culturas em 77,5 por cento dos casos, näo tendo sido observado predomínio de nenhum germe, mesmo nos diferentes sítios. A infecçäo urinária foi a mais freqüente (55 por cento, n = 22, p < 0,01) e, dessa amostra, 86,4 por cento (n = 19) eram do sexo feminino. A sepse ocorreu em 18,4 por cento (n = 7) dos pacientes; destes, a infecçäo pulmonar foi responsável por 71,4 por cento. Todos os casos de sepse foram a óbito. Conclusäo. CCnsiderando as infecçöes um fator agravante no processo mórbido de diabéticos, torna-se importante a realizaçäo de medidas profiláticas a fim de evitar o seu surgimento.

The C-peptide response to a standard mixed meal in a group of Brazilian type 1 diabetic patients

In order to analyze the different parameters used in the interpretation of C-peptide response in a functional test, we compared a group of 26 type 1 diabetics aged 21.1 + 8.2 years, with a diabetes duration of 7.9 + 6.7 months, with a group of 24 non-diabetic subjects aged 25.0 + 4.4 years. A standard mixed meal of 317 kcal was used as a stimulus. Blood sampling for C-peptide determinations was performed at regular intervals. Although all the studied C-peptide variables were significantly lower in the diabetic group (P<0.0001), some overlapping of parameters was observed between the two groups. The highest degree of overlapping was found for basal value (BV) (30.8 percent) and percent increase (42.31 percent), and the lowest for incremental area, absolute increase, peak value (PV) (3.8 percent), and total area (7.7 percent) (X2 = 31.6, P<0.0001). We did not observe a definite pattern in the time of maximum response among the 21 diabetics who showed an increase in C-peptide levels after the stimulus. In this group, however, there was a highly significant number of late responses (120 min) (X2 = 5.7, P<0.002). Although BV showed a significant correlation with PV (rs = 0.95, P<0.0001), the basal levels of C-peptide did not differentiate the groups with and without response to the stimulus. We conclude that the diabetic group studied showed delayed and reduced C-peptide responses, and that the functional test can be an important tool for the evaluation of residual beta cell function.

Influence of first morning urine volume, fasting blood glucose and glycosylated hemoglobin on first morning urinary albumin concentration

The aim of the present study was to evaluate the effect of first morning urinary volume (collected on three different non-consecutive days), fasting blood glucose (determined on the first and third days of urine collection), and glycosylated hemoglobin (determined on the first and third days of urine collection) on the albumin concentration in first morning urine samples collected on three different days. We found 3.6 per cent asymptomatic bacteriuria in the urine samples; therefore, every urine sample must be tested to exclude infection. One hundred and fifty urine samples were provided by 50 IDDM patients aged 21.9 ñ 7 (l2-38) years with a disease duration of 6.8 + 5.8 (0.4-31) years attending the Diabetes Clinic at the State University Hospital of Rio de Janeiro. There were no differences in albumin concentration (6.1 vs 5.8 vs 6.2 mug/ml; P = NS) or urinary volume (222.5 vs 210 vs 200 ml) between the three samples. In addition, there were no differences in fasting blood glucose (181.9 + 93.6 vs 194.6 + 104.7 mg per cent; P = NS) or glycosylated hemoglobin (HbA 1) (8.4 ñ 1.3 vs 8.8 ñ 1.5 per cent; P = NS) between the first and third blood samples. Six patients (group 1) had a mean urinary albumin concentration of more than 20 mug/ml for the three urine samples. This group was compared with the 44 patients (group 2) with a mean urinary albumin concentration for the three urine samples of less than 20 mug/ml. No difference was found between groups 1 and 2 in relation to fasting blood glucose (207.1 ñ 71.7 vs 187.6 ñ 84.6 mg/dl), HbA 1 (8.1 ñ 0.9 vs 8.6 ñ 1.1 per cent) or urinary volume [202 (48.3-435) vs 246 (77.3-683.3) ml]. Stepwise multiple regression analysis with albumin concentration of first morning urine samples as the dependent variable, and urinary volume, fasting blood glucose and glycosylated hemoglobin as independent variables, showed that only 12 per cent (P = 0.01) of the albumin concentration could be accounted for by the independent effect of morning urine volume on the first day of urine collection. No urine samples showed a change in the cutoff level of 20 mug/ml of albumin concentration as the result of volume. Fasting blood glucose and glycosylated hemoglobin did not influence the urinary albumin concentration. Considerable variability in urinary albumin concentration was found in the three morning urine samples with a mean intraindividual coefficient variation of 56 per cent. In conclusion, in the present study, urinary volume...

Prevalence of autoantibodies in simplex and multiplex families of Brazilian insulin-dependent diabetic patients

Forty-one simplex and 6 multiplex families of Brazilian IDDM patients were studied by the indirect immunofluorescence technique to determine the prevalence of the following autoantibodies: islet cells (ICA), islet cells which fix complement (ICA-CF), thyroid microsomes (TMA), thyroglobulin (TGA), and gastric-parietal cells (PCA). A total of 54 IDDM patients belonging to two family groups were analyzed. A significantly higher frequency of ICA-CF and TMA was detected among the siblings from multiplex families than among those from simplex families (18.7% vs 1.7%). A prospective study of ICA-positive siblings was undertaken, and 2 who later became diabetic were found to be positive to both ICA and ICA-CF. The prevalence of islet-cell antibodies in these 54 Brazilian IDDM patients and their unaffected first-degree relatives from generally mixed groups suggest that the humoral autoimmune mechanisms of the disease are probably identical to those observed in other population of different ethnic backgrounds

Lipoproteinas de alta densidade (HDL) em diabeticos insulino-dependentes. / High density lipoprotein (HDL) in insulin-dependent diabetes

As liproteinas de alta densidade ("High Density Lipoproteins", HDL) tem sido apontadas como provaveis fatores de protecao para a aterosclerose que costuma instalarse mais precoce e rapidamente em diabeticos. O presente estudo foi feito com o objetivo de avaliar o comportamento dos niveis de HDL - colesterol num grupo de diabeticos insulino-dependentes e numa populacao controle pareando-se idade e sexo.Nao se observou diferenca significativa entre os grupos, embora se tenham constatado niveis mais elevados dessas lipoproteinas nos diabeticos

Histocompatibility antigens and insulin-dependent diabetes: a study of 20 brazilian families

The relationship between histocompatibility antigens (HLA) and insulin-dependent diabetes was examined. The relative frequency of HLA and the relative risk were determined for 20 families containing 82 individuals, 23 of whom hda insulin-dependent diabetes. The control group contained 102 individuals. 2 The B8, B13, and B15 antigens had the highest relative frequency in the group of diabetic patients, whereas B5, B7 and B12 were lowest. A high relative frequency of histocompatibility antigens was found not only in the diabetic patients, but also in their parents and siblings. There was a predominance of A2B8, A2B15, and A9B15 haplotypes in the diabetic population. The diabetic siblings hda identical haplotypes. 3. These data support previous reports suggesting gwenetic linkage between susceptibility to diabetes and the histocompatibility antigen systen

Antigenos de histocompatibilidade e diabetes insulino-dependente: estudo em familias. / Histocompatibility antigens and insulin-dependent diabetes: a study in families

Foram estudadas 20 familias de individuos com diabetes insulino-dependente, em um total de 23 pacientes, visando a determinar a frequencia dos antigenos de historia compatibilidade e calculo do risco relativo. Foi observada maior frequencia dos antigenos B8, B13, e B15 e menor de B5, B7, e B12, na populacao diabetica. Para os antigenos nos quais se observou frequencia superior nos diabeticos, o fenomeno tambem ocorreu entre pais e irmaos. Tal situacao, entretanto, nao se repetiu quando a frequencia era mais baixa entre os diabeticos. Na populacao diabetica, houve predominancia dos haplotipos A2B8, A2B15, A9B13, e A9B15. Todos os irmaos diabeticos apresentavam haplotipos identicos, o que sugere a provavel segregacao de genes de suscetibilidade a doenca com o sistema HLA

Prevalencia de auto-anticorpos em uma populacao hospitalar. / Prevalence of autoantibodies in an hospital population

Foi realizada uma pesquisa, pela tecnica de imunofluorescencia indireta para fator antinuclear, anticorpo antimusculo liso, anticorpo antimitocondrio e anticorpo anticelula parietal, no soro de 1.090 pacientes. O fator antinuclear foi positivo em 95% dos pacientes com lupus sistemico. Nao se determinou um padrao especifico para nenhuma doenca, apesar de o padrao salpicado ter sido o mais frequente. O anticorpo antimusculo liso foi mais frequente nas doencas hepaticas, apesar de ter sido detectado em outras patologias. O anticorpo para celula parietal foi mais frequente na anemia megaloblastica (6 casos), mas tambem apresentou positividade no diabetes insulino-dependente e D.P.O.C. Anticorpo antimitocondria foi detectado em 5 casos de doenca hepatica, mas em nehum o diagnostico de cirrose biliar primaria foi confirmado

HLA e diabetes insulino-dependente: tres familias com mais de um membro da prole afetado. / HLA and insulin-dependent diabetes: three families with more than one member with the disease

Foram determinados os antigenos de histocompatibilidade em tres familias que apresentavam mais de um membro na prole com diabetes insulino-dependente. Observou-se que os irmaos apresentavam haplotipos identicos, o que pode ser considerado de relevante importancia em relacao a segregacao de genes de suscetibilidade a doenca com o sistema HLA