Abstract in English:A possible etiologic role of enteroviruses for type 1 diabetes has been researched for 40 years, but evidence to date is inconclusive. This article summarizes new evidence from Cuban research supporting a role for enteroviruses, both in preclinical stages of autoimmune reactions against pancreatic β cells and at clinical onset, in a population with low type 1 diabetes incidence. Possible pathogenetic mechanisms are also discussed, such as acute cytolytic damage and molecular mimicry. Although direct causal effects of enteroviruses in type 1 diabetes are difficult to demonstrate, arguments supporting their role in type 1 diabetes pathogenesis should not be ignored; and confirmation could contribute to development of more effective preventive strategies.
Abstract in English:Cardiovascular disease is the main cause of death for diabetics, and in many cases its presence is silent due to cardiac autonomic neuropathy. Thus, early diagnosis of coronary disease is essential, permitting proper risk stratification and appropriate therapy. This paper examines the usefulness of several noninvasive imaging techniques to study cardiovascular diseases in individuals with diabetes mellitus, with emphasis on nuclear cardiology, and proposes a diagnostic algorithm for detection of silent ischemia.
Abstract in English:Hyperglycemia characteristic of diabetes mellitus triggers pathological processes in fetal development of various structures such as the retina, peripheral nerves, renal glomerulus, and arterial and venous beds. Women with diabetes prior to conception have children with birth defects three to five times more frequently than women without diabetes. There is no specific pattern of birth defects, but the central nervous and cardiovascular systems are the most affected. Hyperglycemia leads to mitochrondrial superoxide radical production, which activates five metabolic pathways that mediate damage leading to diabetic embryopathy. Once oxidative stress is established, there is modification of gene expression controlling embryonic development in critical periods. Vitamin E application in animal models has greatly lowered occurrence of birth defects in embryonic and fetal stages, consistent with an etiologic role for oxidative stress in dysmorphogenesis. Effective metabolic control before and during pregnancy, achieved in Cuba by implementing programs for control of birth defects in children of diabetic pregnant women, has been found effective.