RESUMEN
OBJECTIVE: Type 2 diabetes mellitus (T2DM) is a chronic disease with numerous complications that increase mortality and reduce the quality of life (QoL). The current study compares QoL in T2DM patients treated with insulin to those treated with oral antihyperglycemics (OAHs), as well as the frequency and severity of depression in patients. SUBJECTS AND METHODS: This prospective cross-sectional study included 200 patients with insulin or OAHs. Triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein cholesterol levels were measured. The Beck Depression Inventory and the SF-36 Quality of Life Questionnaire were used to assess depression symptoms and QoL in response to different treatment modalities. RESULTS: Insulin-treated patients have a longer duration of illness, higher preprandial glycemic levels, lower scores in three of four dimensions of the SF-36 physical component, and a lower score in the SF-36 psychological component's emotional role dimension. Patients on insulin have milder depression symptoms than those with OAHs. Depression symptoms, according to the findings, worsen QoL and glycemic control in insulin-treated patients. CONCLUSIONS: According to these findings, any treatment modality's success in T2DM patients primarily depends on psychological support and preventive measures that promote and maintain mental health.
Asunto(s)
Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Depresión/complicaciones , Calidad de Vida , Estudios Transversales , Estudios Prospectivos , Insulina/uso terapéutico , ColesterolRESUMEN
OBJECTIVE: Uremia is known to be followed by changes in the serous membranes of pleura, pericardium, and peritoneum. During continuous ambulatory peritoneal dialysis (CAPD), the peritoneum is exposed to altered body conditions as well as to the influence of dialysate. The aim of the present study was to examine the ultrastructure of the mesothelial cells in CAPD patients, and to compare the findings with those from studies of the peritoneum in uremic controls. Paracrystalline intracytoplasmic inclusions in mesothelial cells were objects of special interest. METHODS: Biopsies of human parietal peritoneum were studied. These were taken from 12 uremic patients during catheter implantation before the start of CAPD, and from 7 CAPD patients during catheter removal for infection or malfunction. The samples were prepared in the standard way to be studied by transmission electron microscopy (TEM). RESULTS: Paracrystalline intracytoplasmic inclusions were seen in mesothelial cells only by TEM. They appear as filamentous structures at the outer part of the inclusions, and as pearl-like structures at the core of the inclusions. Sacculate dilatations of rough endoplasmic reticulum cisternae with partly destroyed membranes and only few ribosomes were also seen, with and without densely osmiophilic filaments within the cisternae. We have found paracrystalline intracytoplasmic inclusions in mesothelial cells from uremic and CAPD patients both. According to the literature, these changes are present in one third of biopsies from uremic patients. Until now, however, they have not been mentioned in CAPD patients.
Asunto(s)
Cuerpos de Inclusión/ultraestructura , Diálisis Peritoneal Ambulatoria Continua , Peritoneo/ultraestructura , Cristalización , Retículo Endoplásmico Rugoso/ultraestructura , Epitelio/ultraestructura , Femenino , Humanos , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Uremia/patología , Uremia/terapiaRESUMEN
The introduction of peritoneal dialysis (PD) as a respectable modality of renal replacement therapy some three decades ago, suddenly drew attention of many authors to peritoneal membrane as insufficiently investigated structure. In order to explain the pathological changes in peritoneum due to renal diseases, it became necessary to explore the normal peritoneal structure. The aim of this study was to examine the morphology of peritoneal lining cells in healthy persons. Biopsies of the peritoneum were performed on 20 volunteer kidney donors. Tissue samples were taken during renal transplantation. Special care was taken in getting appropriate samples without artificial damage because of the extreme fragility of the peritoneal tissue. The preparing procedure was standard for routine HE staining and for plastic embedded semifine and fine sections studies. Semifine sections were made on ultramicrotome, stained with Toluidin blue and studied by light microscope, while fine sections were made by ultramicrotome and studied by transmission electron microscope. One layer of cuboidal or flattened lining cells present over the lamina propria connective tissue presented mesothelium. The cells were overlapped like tiles on the roof. Lateral parts of their interdigitated membranes were interconnected with different types of cell junctions: unpermeable, adhesion and communication junctions; inhibiting intercellular transport. Cell surface was often covered with great number of microvilli and lamellar bodies. A single kinocilia was also often present on apical cell surface. Nuclei were euchromatic with well developed nucleoli. Cytoplasm was filled with a great number of ribosomes, mitochondria, cisterns of rough endoplasmatic reticulum and Golgi apparatus, lamellar bodies and lipid inclusions. Numerous pinocytic vesicles on all parts of the membrane as well as in the cytoplasm indicating active endocytosis, egsocytosis and transcytosys in the process of secretion and reabsorption of serous liquid in peritoneal cavity, were visible. Euchromatic nuclei with prominent nucleoli and numerous mitochondria indicate cells of great metabolic activity.
Asunto(s)
Células Epiteliales/ultraestructura , Peritoneo/ultraestructura , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Some thirty years ago, peritoneal dialysis (PD) became a respectable modality of renal replacement therapy. That is why peritoneal membrane attracted the interest of investigators. Uremia is followed by changes in the morphology of serous membranes (uremic serositis). Uremic effects on pleura and pericardia have been studied for a long time, but the peritoneum is affected as well. The aim of our study was to examine the morphology of the peritoneum in uremic patients before the start of PD and to compare the findings with those from examinations of peritoneum in healthy controls. We examined 12 uremic patients and 10 healthy controls (kidney donors). Biopsies were taken from parietal peritoneum. The samples were prepared in the standard way for study by transmission electron microscopy (TEM). Certain pathological changes--deformation of mesothelial cells, their detachment from the basement membrane, and unusual bulging of apical surface--were identified at the light microscopy level on semi-fine sections. Paracrystalline intracytoplasmic inclusions were seen in mesothelial cells only by TEM. We hypothesize that the inclusions were causing deformation of the mesothelial cells and detachment of those cells from the basement membrane. Sacculate dilatations of rough endoplasmic reticulum (RER) cisternae with partly destroyed membranes and few ribosomes were also seen, with and without densely osmiophilic filaments within cisternae. Although these changes are mentioned in the literature, the exact reason for their appearance remains unknown.