Introduction

Diabetes mellitus is a group of metabolic disorders characterized by decreased

insulin secretion, insulin resistance or both causing a hyperglycemic state. Diabetes mellitus
(DM) is a major public health problem that prevails globally due to various factors such as a
change in lifestyle, age and lack of physical exercise or obesity.1 The elevated inflammatory
state in diabetes contributes to both microvascular and macrovascular complications and it is
clear that hyperglycemia can result in the activation of pathways that increase inflammation,
oxidative stress and apoptosis.2

Diabetes mellitus is classified according to its etiology as type 1, type 2, gestational diabetes
and other specific types. Type 1 diabetes mellitus results from the destruction of beta - cells
within the islets of Langerhans of the pancreas, which results in a complete insulin
deficiency. It can be immune -mediated or have an idiopathic etiology. Type 2 diabetes
mellitus ranges from an insulin resistance which progresses into an insulin deficiency due to a
secondary failure in the pancreatic beta cells. Gestational diabetes mellitus is defined as any
extent of glucose intolerance with onset or first recognition during pregnancy. Lastly, the
category "other specific types" comprehends a group of several types of diabetes mellitus
with different etiologies.3

More than 90% of diabetics have type2 diabetes, which is characterized by a triad of
resistance to insulin-induced glucose uptake in peripheral tissues, excessive production of
glucose in the liver due to deficient signalling by insulin and insufficient insulin secretion to
compensate for the insulin resistance.

The primary complications of DM are heart disease, stroke, hypertension, kidney disease,
diseases of nerves and oral disease. Secondary complications of un controlled glucose level
include nephropathy, retinopathy with possible blindness, neuropathy and delayed tissue
healing.

Histological staining is a series of processes undertaken in the preparation of sample tissues

by staining using histological stains to aid in the microscope study.4
Staining is a commonly used process in the diagnosis in which a dye colour is applied on the
borders of the sample tissues to locate the diseased or tumour cells or other pathological cells.
In biological studies, staining is used to mark cells and to flag nucleic acids, proteins or the
gel electrophoresis to aid in the microscopic examination.

Early histologists used the readily available chemicals to prepare tissues for microscopic
studies, these include potassium dichromate, alcohol and the mercuric chloride to harden
cellular tissues. Staining techniques used were carmine, silver nitrate, Giemsa, Trichrome
Stains, Gram Stain and Haematoxylin among others.4

In modern histology a combination of different staining techniques is used to enhance the

effectiveness of the staining process. Currently, improved histological stains, have been
modified and combined with other stains to improve their effectiveness.

The “special stain” terminology is most commonly used in the clinical environment, and
simply means any technique other than the Haematoxylin and Eosin (H & E) method that is
used to impart colours to a specimen.5

Although H & E is very popular among histotechnologists and pathologists for looking at
biopsies and surgical specimens, the method has some limitations. For example, H & E does
not identify microorganisms (e.g., H. pylori), or for that matter, specific tissue molecules in
cancers (e.g., glycoproteins or glycosaminoglycans) or abnormal increase of interstitial fibers
in some neoplastic clonal proliferations of the hematopoietic stem cell diseases (e.g.,
myelodysplastic syndromes). This is where the special stains are used for identifying
microorganisms or specific structures or molecules in cells or in tissue sections.6
These stains belong to a diverse family of slide-based stains that rely on basic chemical
reactions for microscopic visualization and general identification of various tissues,
structures, cells, organelles, carbohydrates, minerals and microorganisms. They enhance
detection and localization of individual tissue component. They also play an important role in
providing a powerful complement to immunohistochemistry, flow cytometry, in situ
hybridization and other diagnostic technologies that ultimately define a patient’s medical
profile.