Bilateral diabetic papillopathy developed after starting insulin treatment. Potential toxic effect of insulin? A case report

2020 ◽  
pp. 112067212098438
Author(s):  
Marco Mafrici ◽  
Laura Toscani ◽  
Umberto Lorenzi
Keyword(s):  
Diabetic Retinopathy ◽  
Optic Nerve ◽  
Insulin Therapy ◽  
Rare Case ◽  
Insulin Treatment ◽  
Brain Magnetic Resonance Imaging ◽  
Diabetic Patients ◽  
Ischemic Optic Neuropathy ◽  
History Of ◽  
Hypoglycemic Therapy

Background: Diabetic papillopathy is a complication of diabetes. It presents with edema, uni or bilateral and vascular alteration of the anterior optic nerve. Often this complication is observed in patients with severe diabetic retinopathy, but is rarely observed in isolated form. Some authors believe that diabetic papillitis is a particular form of non-arteritic anterior ischemic optic neuropathy (NAION). But there is important evidence that confers an inflammatory component to diabetic papillopathy. We report in this work a rare case of isolated acute bilateral diabetic papillopathy developed in a diabetic patient after adding the insulin to the oral hypoglycemic therapy. Case presentation: Male patient, 49-years-old, diabetic type 2, with altered glycemia at follow up, with clinical history of HbA1c 8% to 12% in the last 2 years, on oral hypoglycemic therapy for 10 years. He never had a history of diabetic retinopathy. At the last check-up, this patient presented bilateral papillopathy, without reduction of visual acuity bilaterally. The patient reports he added 10 days before the insulin therapy to the oral hypoglycemic therapy, under medical supervision. Hematochemical and serological tests were requested, which excluded the presence of inflammatory and infectious diseases. The brain magnetic resonance imaging (MRI) with gadolinium excluded the hypothesis of optic neuritis or intracranial hypertension. Cardio-circulatory tests were normal. Fluorescein angiographic examinations and optical coherence tomography (oct) confirmed the bilateral edema and the thickening of optic nerve without other retinal damage. Therefore he was diagnosed with bilateral diabetic papillopathy. Then, diabetologists added pump insulin treatment to the oral hypoglycemic therapy. After 2 months, his blood sugar levels and HbA1C improved and papillopathy regressed. Conclusion: We have reported a rare case of bilateral acute diabetic papillopathy associated with the addition of insulin to the oral hypoglycemic therapy. A randomized control study with diabetic patients, would be useful to verify the possible injuries of the optic nerves during the delicate transition to insulin therapy.

Association of systemic cardio-vasculature status with retinal vascular endothelium in diabetes

2020 ◽  
Vol 1 (1) ◽  
pp. 52-57
Author(s):  
Galina Dimitrova ◽  
Keyword(s):  
Blood Flow ◽  
Diabetic Retinopathy ◽  
Optic Nerve ◽  
Arterial Stiffness ◽  
Vascular Endothelium ◽  
Lamina Cribrosa ◽  
Central Retinal Artery ◽  
Diabetic Patients ◽  
Retinal Artery ◽  
Central Retinal Vein

The relationship between diabetic retinopathy and macro-vascular complications in diabetes suggests a pathogenic association between these conditions. Vascular endothelium has been identified as a main site of blood vessel injury in diabetes. Diabetic retinopathy is associated with systemic arterial stiffness and altered vascular endothelium function and structure. Retinal vasculature endothelium at the macula, arterio-venous crossings, and in the optic nerve at the lamina cribrosa region is reported to differ from the endothelium in the rest of the retinal blood vessels. The central retinal artery and vein are in close proximity in the optic nerve where they share a common adventitia; thus, increased arterial wall stiffness and thickness may affect blood flow in the neighboring central retinal vein in this region. Moreover, increased arterial stiffness in small arterial beds is associated with retinal venular widening; it suggests the possibility of central retinal artery compressing the central retinal vein at the lamina cribrosa, thereby compromising venular outflow in the retina of diabetic patients. Altered blood flow in the central retinal vein in the postlaminar region has been detected in patients who experience progression of diabetic retinopathy. Increased hydrostatic pressure in the central retinal vein may play a major role in the pathogenesis of diabetic retinopathy. The aim of this review article is to emphasize this pathogenetic mechanism that has often been overlooked.

scholarly journals Knowledge about Diabetic Retinopathy, Eye Check-up Practice and Associated Factors among Adult Patients with Diabetes Mellitus Attending at Debark Hospital, Northwest Ethiopia

2020 ◽  
Author(s):  
Abel Sinshaw Assem ◽  
Mebratu Muusew Tegegne ◽  
Destaye Shiferaw Alemu ◽  
Asamere Tsegaw Woredekal ◽  
Tsehay Kassa Tefera
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Northwest Ethiopia ◽  
Good Knowledge ◽  
Eye Disease ◽  
Diabetic Patients ◽  
Duration Of Diabetes ◽  
Patients With Diabetes ◽  
History Of ◽  
Eye Examination

Abstract Background: Routine eye examination plays a vital role in detecting diabetic retinopathy in its earliest stage before the onset of blindness. Patients’ knowledge about the nature and the consequences of diabetic retinopathy and routine eye checkup helps for timely identification and early treatment. However, there is limited evidence on knowledge of patients with diabetes mellitus on diabetic retinopathy and their eye check-up practices in Ethiopia. The aim of this study was to assess knowledge about diabetic retinopathy, eye check-up practice and associated factors of diabetic retinopathy among adult diabetic patients at Debark hospital, Northwest Ethiopia. Methods: Institution based cross-sectional study was conducted at Debark hospital, Northwest Ethiopia, from April 20/2018- May 20/2018. A pretested interviewer administered structured questionnaire was used to collect data among 230 diabetic patients aged 18 years and above. Data were entered in to Epi Info version 7 and exported to SPSS version 20 for analysis. Bivariable and multivariable binary logistic regression analyses were done. Odds ratio with 95% confidence level was determined and variables with p–value of < 0.05 were considered as statistically significant. Result: Out of 238 sample 230 were participated, among this, 119 (51.7%) were males. The mean age of the respondents was 49 (SD ±17.6) years. One hundred nine (47.4%) participants had good knowledge and 91 (39.6%) had good eye check-up practice. Urban residence [AOR= 2.65;95% CI: 1.16-6.07)]), monthly income of 3501-8000 birr [AOR=4.54;(1.31-15.7)], type II diabetes mellitus [AOR=3.9;(1.6-9.6)], duration of diabetes (6-12 years[AOR=4.4;(1.4-13.5)]), history of eye disease [AOR=5.5;(2.3-13.0)] were associated with good knowledge. Similarly, longer duration of diabetes (13-25 years [AOR=3.77; (1.05-13.5)]) and history of eye disease [AOR=2.47; (1.09-5.62)] were associated with good eye check-up practice. Conclusion: The proportion of good knowledge about diabetic retinopathy among diabetic patients at Debark hospital was fair (47.4%) and good eye check-up practice (eye examination at least once in the past year) was low (39.6%). Longer duration of diabetes and history of eye disease were identified as positive factors for good knowledge and eye check-up practice. Knowledge and regular eye check-up practice needs to be enhanced through provision of appropriate health education.

scholarly journals Knowledge about diabetic retinopathy, eye check-up practice and associated factors among patients with diabetes mellitus attending Debark hospital, northwest Ethiopia

2019 ◽  
Author(s):  
Mebratu Muusew Tegegne ◽  
Abel Sinshaw Assem ◽  
Destaye Shiferaw Alemu ◽  
Asamere Tsegaw Woredekal ◽  
Tsehay Kassa Alemu
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Associated Factors ◽  
Northwest Ethiopia ◽  
Good Knowledge ◽  
Eye Disease ◽  
Diabetic Patients ◽  
Duration Of Diabetes ◽  
Patients With Diabetes ◽  
History Of

Abstract Background: Routine eye examination plays a vital role in detecting diabetic retinopathy in its earliest stage before the onset of blindness. Patients’ knowledge about the nature and the consequences of diabetic retinopathy and routine eye checkup helps in timely identification and early treatment. However, there is limited evidence on knowledge of patients with diabetes mellitus on diabetic retinopathy and their eye check-up practices in Ethiopia in general and the study area in particular. Purpose: The aim of this study was to assess knowledge, eye check-up practice and associated factors of diabetic retinopathy among diabetic patients at Debark hospital, Northwest Ethiopia. Materials and Methods: Institution based cross – sectional study was conducted at Debark hospital, Northwest Ethiopia, from April 20/2018- May 20/2018. A pretested interviewer administered structured questionnaire was used to collect data among 230 diabetic patients aged 18 years and above. Data were entered in to Epi Info version 7 and exported to SPSS version 20 for analysis. Bivariable and multivariable binary logistic regression analyses were done. Odds ratio with 95% confidence level was determined and variables with p–value of < 0.05 were considered as statistically significant. Result: Out of 238 sample 230 were participated, among this, 119 (51.7%) were males. The mean age of the respondents was 49 (SD ±17.6) years. One hundred nine (47.4%) participants had good knowledge and 91 (39.6%) had good eye check-up practice. Urban residence [AOR= 2.65;95% CI: 1.16-6.07)]), monthly income of 3501-8000 birr [AOR=4.54;(1.31-15.7)], type II diabetes mellitus [AOR=3.9;(1.6-9.6)], duration of diabetes (6-12 years[AOR=4.4;(1.4-13.5)]), history of eye disease [AOR=5.5;(2.3-13.0)] were associated with good knowledge. Similarly, longer duration of diabetes (13-25 years [AOR=3.77; (1.05-13.5)]) and history of eye disease [AOR=2.47;(1.09-5.62)] were associated with good eye check-up practice. Conclusion: The proportion of good knowledge about diabetic retinopathy among diabetic patients was fair (47.4%) in the study setting and good eye check-up practice was low (39.6%) Longer duration of diabetes and history of eye disease were identified as positive factors for good knowledge and eye check-up practice. Knowledge and regular eye check-up practice needs to be enhanced through provision of appropriate health education.

scholarly journals Knowledge About Diabetic Retinopathy, Eye Check-Up Practice And Associated Factors Among Adult Patients With Diabetes Mellitus Attending At Debark Hospital, Northwest Ethiopia

2020 ◽  
Author(s):  
Mebratu Muusew Tegegne ◽  
Abel Sinshaw Assem ◽  
Destaye Shiferaw Alemu ◽  
Asamere Tsegaw Woredekal ◽  
Tsehay Kassa Tefera
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Northwest Ethiopia ◽  
Good Knowledge ◽  
Eye Disease ◽  
Diabetic Patients ◽  
Duration Of Diabetes ◽  
Patients With Diabetes ◽  
History Of ◽  
Eye Examination

Abstract Background:Routine eye examination plays a vital role in detecting diabetic retinopathy in its earliest stage before the onset of blindness. Patients’ knowledge about the nature and the consequences of diabetic retinopathy and routine eye checkup helps in timely identification and early treatment. However, there is limited evidence on knowledge of patients with diabetes mellitus on diabetic retinopathy and their eye check-up practices in Ethiopia.The aim of this study was to assess knowledge, eye check-up practice and associated factors of diabetic retinopathy among adult diabetic patients at Debark hospital, Northwest Ethiopia.Methods: Institution based cross – sectional study was conducted at Debark hospital, Northwest Ethiopia, from April 20/2018- May 20/2018. A pretested interviewer administered structured questionnaire was used to collect data among 230 diabetic patients aged 18 years and above. Data were entered in to Epi Info version 7 and exported to SPSS version 20 for analysis. Bivariable and multivariable binary logistic regression analyses were done. Odds ratio with 95% confidence level was determined and variables with p–value of < 0.05 were considered as statistically significant.Result: Out of 238 sample 230 were participated, among this, 119 (51.7%) were males. The mean age of the respondents was 49 (SD ±17.6) years. One hundred nine (47.4%) participants had good knowledge and 91 (39.6%) had good eye check-up practice. Urban residence [AOR= 2.65;95% CI: 1.16-6.07)]), monthly income of 3501-8000 birr [AOR=4.54;(1.31-15.7)], type II diabetes mellitus [AOR=3.9;(1.6-9.6)], duration of diabetes (6-12 years[AOR=4.4;(1.4-13.5)]), history of eye disease [AOR=5.5;(2.3-13.0)] were associated with good knowledge. Similarly, longer duration of diabetes (13-25 years [AOR=3.77; (1.05-13.5)]) and history of eye disease [AOR=2.47; (1.09-5.62)] were associated with good eye check-up practice. Conclusion: The proportion of good knowledge about diabetic retinopathy among diabetic patients at Debark hospital was fair (47.4%) and good eye check-up practice (eye examination at least once in the past year) was low (39.6%). Longer duration of diabetes and history of eye disease were identified as positive factors for good knowledge and eye check-up practice. Knowledge and regular eye check-up practice needs to be enhanced through provision of appropriate health education.

scholarly journals VHL-Associated Optic Nerve Hemangioblastoma Treated with Stereotactic Radiosurgery

2018 ◽  
Vol 5 (2) ◽  
pp. 1-6 ◽  
Author(s):  
Hiroshi Kanno ◽  
Seiki Osano ◽  
Masamichi Shinonaga
Keyword(s):  
Optic Nerve ◽  
Stereotactic Radiosurgery ◽  
Rare Case ◽  
Tumor Volume ◽  
Pancreatic Cysts ◽  
Von Hippel Lindau ◽  
First Case ◽  
History Of ◽  
Fractionated Stereotactic Radiosurgery ◽  
Vhl Disease

Central nervous system hemangioblastomas are generally restricted to the cerebellum, spinal cord, and brainstem. Supratentorial hemangioblastomas are uncommon, and optic nerve hemangioblastomas are extremely rare, with fewer than 25 reports including this case. In this report, we present the case of a 36-year-old woman with von Hippel-Lindau (VHL) disease who presented with progressive diminution of vison in the left eye due to a retrobulbar optic nerve hemangioblastoma. The patient had a history of cerebellar /spinal hemangioblastomas and pancreatic cysts, and her father and brother were patients with VHL disease. Gadolinium enhanced MRI showed intraorbital retrobulbar enhanced mass on the left optic nerve. The optic nerve hemangioblastoma was treated with fractionated stereotactic radiosurgery using Novalis. Eighteen months after the stereotactic radiosurgery, the tumor volume decreased although the patient lost vision. This report presents an extremely rare case of optic nerve hemangioblastoma, which is the first case treated with stereotactic radiosurgery.

scholarly journals Effect of physical activity on reducing the risk of diabetic retinopathy progression: 10-year prospective findings from the 45 and Up Study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0239214
Author(s):  
Xixi Yan ◽  
Xiaotong Han ◽  
Changfan Wu ◽  
Xianwen Shang ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Lower Risk ◽  
Cox Regression ◽  
Large Cohort ◽  
P Value ◽  
Diabetic Patients ◽  
Family History Of Diabetes ◽  
South Wales ◽  
History Of

Objective To examine the association of physical activities (PA) with diabetic retinopathy (DR) progression based on a 10-year follow-up of a large cohort of working-aged diabetic populations in Australia. Methods Nine thousand and eighteen working-aged diabetic patients were enrolled from the baseline of the 45 and Up Study from New South Wales, Australia. Self-reported PA collected by questionnaire at baseline in 2006 was graded into low (<5 sessions/week), medium (≥5–14), and high (≥14) levels. Retinal photocoagulation (RPC) treatment during the follow-up period was used as a surrogate for DR progression and was tracked through the Medicare Benefits Schedule, which was available from 2004 to 2016. Cox regression was used to estimate the association between PA and RPC incidence. Results In the fully adjusted model, higher PA level was significantly associated with a lower risk of RPC incident (Cox-regression, p-value for trend = 0.002; medium vs. low, hazard ratio (HR) = 0.78, 95% Confidence Interval (CI): 0.61–0.98; high vs. low, HR = 0.61, 95%CI: 0.36–0.84. In addition, gender, body mass index, insulin treatment, family history of diabetes, history of cardiovascular disease were significant effect modifiers for the association between PA and RPC. Conclusions Higher PA level was independently associated with a lower risk of DR progression among working-aged diabetic populations in this large cohort study.

scholarly journals Knowledge, Attitude, and Practice (KAP) of Diabetes and Diabetic Retinopathy among Patients with Diabetes in Riyadh City.

2020 ◽  
Author(s):  
Abdulrahman Abdullah Al-Yahya ◽  
Abdulrahman Almizel ◽  
Alwaleed Mohammad Alsulaiman ◽  
Abdulrahman Mohammed barri ◽  
fadwa aladel
Keyword(s):  
Diabetic Retinopathy ◽  
Knowledge Score ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
University Hospitals ◽  
Cross Sectional ◽  
Riyadh City ◽  
Patients With Diabetes ◽  
History Of ◽  
Education And Awareness

Abstract Objective To identify the knowledge, attitude, practice (KAP) of diabetes and diabetic retinopathy among Saudi patients with diabetes in Riyadh Saudi Arabia.Methods A cross sectional study that was conducted in 50 randomly selected primary care centers and two university hospitals, involving diabetic patients that are 18 years and older during May 2018 and December 2018 in Riyadh, Saudi Arabia, using a validated KAP-45 questionnaire to assess the KAP levels of diabetes and diabetic retinopathy.Results A total of 313 participants were enrolled in the study. Most of them 168(59.8%) were males and 38(12.3%) were illiterate and 141(45.4%) had at least a bachelor's degree. Most of them had a family history of DM and long standing history of DM The average knowledge score for diabetes was good and was suboptimal for diabetic retinopathy. While the attitude scores for both diabetes and diabetic retinopathy were suboptimal. Meanwhile the average practice score for diabetes was good and was low for diabetic retinopathy.Conclusions Findings observed in our study stress on the importance of improving education and awareness as it’s the key for controlling the disease and reducing its complications.

scholarly journals Natural History of Diabetic Retinopathy Through Retrospective Analysis in Type 2 Diabetic Patients—An Exploratory Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Mehak Gupta ◽  
Amarjeet Singh ◽  
Mona Duggal ◽  
Ramandeep Singh ◽  
Sanjay Bhadada ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Natural History ◽  
Medical Records ◽  
Vision Loss ◽  
Adult Population ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
History Of ◽  
Type 2 Diabetic

Background and Aims: Diabetic retinopathy is the most common diabetes-associated microvascular complication and is among the leading causes of vision loss or blindness in the adult population. The present study is a retrospective study that reported the natural history of diabetic retinopathy.Methods: Retrospective medical records of 170 patients aged &gt; 20 years with a confirmed complication of diabetic retinopathy were recruited into the present study. A questionnaire was also sent to each subject for gathering their experiences, and verification was done by the attending medical physicians. The questionnaire was answered by all recruited patients.Results: The results showed that 23 (13.5%) subjects have a family history of diabetic retinopathy with 10 (5.9%) having mild NPDR, 63 (37.1%) with moderate NPDR, 60 (25.3%) have severe NPDR while 37 (21.8%) have PDR complications. The presence of co-morbidities was found in 139 (81.8%) subjects. Patients with PDR reported a significantly longer duration of diabetes mellitus with worse glycemic control.Conclusions: The study revealed and concluded that adherence to the prescribed management regimen is important, for which patient education was the key which was lacking.

scholarly journals Knowledge about Diabetic Retinopathy, Eye Check-up Practice and Associated Factors among Adult Patients with Diabetes Mellitus Attending at Debark Hospital, Northwest Ethiopia

2020 ◽  
Author(s):  
Abel Sinshaw Assem ◽  
Mebratu Muusew Tegegne ◽  
Destaye Shiferaw Alemu ◽  
Asamere Tsegaw Woredekal ◽  
Tsehay Kassa Tefera
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Northwest Ethiopia ◽  
Good Knowledge ◽  
Eye Disease ◽  
Diabetic Patients ◽  
Duration Of Diabetes ◽  
Patients With Diabetes ◽  
History Of ◽  
Eye Examination

Abstract Background: Routine eye examination plays a vital role in detecting diabetic retinopathy in its earliest stage before the onset of blindness. Patients’ knowledge about the nature and the consequences of diabetic retinopathy and routine eye checkup helps for timely identification and early treatment. However, there is limited evidence on knowledge of patients with diabetes mellitus on diabetic retinopathy and their eye check-up practices in Ethiopia. The aim of this study was to assess knowledge about diabetic retinopathy, eye check-up practice and associated factors of diabetic retinopathy among adult diabetic patients at Debark hospital, Northwest Ethiopia. Methods: Institution based cross-sectional study was conducted at Debark hospital, Northwest Ethiopia, from April 20/2018- May 20/2018. A pretested interviewer administered structured questionnaire was used to collect data among 230 diabetic patients aged 18 years and above. Data were entered in to Epi Info version 7 and exported to SPSS version 20 for analysis. Bivariable and multivariable binary logistic regression analyses were done. Odds ratio with 95% confidence level was determined and variables with p–value of < 0.05 were considered as statistically significant. Result: Out of 238 sample 230 were participated, among this, 119 (51.7%) were males. The mean age of the respondents was 49 (SD ±17.6) years. One hundred nine (47.4%) participants had good knowledge and 91 (39.6%) had good eye check-up practice. Urban residence [AOR= 2.65;95% CI: 1.16-6.07)]), monthly income of 3501-8000 birr [AOR=4.54;(1.31-15.7)], type II diabetes mellitus [AOR=3.9;(1.6-9.6)], duration of diabetes (6-12 years[AOR=4.4;(1.4-13.5)]), history of eye disease [AOR=5.5;(2.3-13.0)] were associated with good knowledge. Similarly, longer duration of diabetes (13-25 years [AOR=3.77; (1.05-13.5)]) and history of eye disease [AOR=2.47; (1.09-5.62)] were associated with good eye check-up practice. Conclusion: The proportion of good knowledge about diabetic retinopathy among diabetic patients at Debark hospital was fair (47.4%) and good eye check-up practice (eye examination at least once in the past year) was low (39.6%). Longer duration of diabetes and history of eye disease were identified as positive factors for good knowledge and eye check-up practice. Knowledge and regular eye check-up practice needs to be enhanced through provision of appropriate health education.

scholarly journals Analysis of risk factors for falls in geriatric patients: a single institutional experience

2019 ◽  
Vol 6 (3) ◽  
pp. 605
Author(s):  
Osama Shukir Muhammed Amin ◽  
Asso Faraidoon Ali Amin ◽  
Saad Kazim Karim ◽  
Saad Suud Shwani ◽  
Raed Thandoon
Keyword(s):  
Risk Factors ◽  
Insulin Therapy ◽  
Diabetic Patients ◽  
Oral Hypoglycaemic Agents ◽  
Risk Of Falls ◽  
Institutional Experience ◽  
History Of ◽  
Risk Factors For Falls ◽  
Falls In Elderly

Background: In elderly people, falls have been recognized as one of the major causes of disability and potentially preventable mortality. Authors analyzed the incidence of falls in elderly diabetic people who have been receiving insulin therapy versus those on oral hypoglycaemic agents (OHGAs).Methods: This observational study was conducted at the department of neurology of Shorsh military general teaching hospital and its outpatients’ department, Iraq, from April 1st to September 30st, 2016. A total of 100 diabetic patients older than 65 years of age, who had a history of one or more falls, were included in the study. The duration of diabetes, mode of its treatment, and its complications all were analyzed in addition to the risk factors for falls.Results: Females (n=57) outnumbered males (n=43) and the mean age of the patients was (71.2±3.6) years. Increasing patient’s age, long-standing diabetes, poor glycaemic control, insulin therapy, and polypharmacy (of 3 and more antidiabetic agents) were significantly and statistically encountered and associated parameters for the risk of falls. The presence of additional risk factors for falls (e.g., previous stroke, alcoholism, cardiac dysrhythmia, and osteoarthrosis) augmented this risk.Conclusions: Diabetes and its treatment render older people more liable for falls. The longer duration of the disease and the higher patients’ age (which were the commonest risks) are irreversible and non-correctable parameters for falls. Further analytic studies are required to unveil the role of each risk factor authors have detected.

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