Doppler ultrasound features of ophthalmic artery in diabetic retinopathy in a Nigerian Teaching Hospital

Background: Diabetes mellitus is a metabolic disease characterized by elevated blood glucose level due to impaired insulin secretion, insulin action or both with diabetic retinopathy being the most common microangiopathic complication. A comparative, cross- sectional study aimed at evaluating Doppler blood flow indices in the ophthalmic artery in diabetic retinopathy and non-retinopathy patients when compared to normal controls in a Nigerian tertiary hospital.Methods: Data were collected over 7 months (April 2017-October 2017) in Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria. Sixty-five diabetic retinopathy patients, 65 diabetic patients without retinopathy and 65 non-diabetic controls had their ophthalmic artery Doppler indices assessed for comparison.Results: The end diastolic velocity (EDV) of the ophthalmic arteries in the diabetic patients were significantly lower than those of control group (EDV=5.84±2.59 cm/s, p<0.001 bilaterally). In diabetic patients with retinopathy, the end diastolic velocity of the ophthalmic arteries was significantly lower than those of diabetic patients without retinopathy (EDV=5.84±2.59 cm/s right eye, EDV=5.75±2.39 left eye, p<0.001 bilaterally). The resistivity index (RI) of the ophthalmic arteries was significantly higher in both diabetic patients with retinopathy and those without retinopathy compared to control group (RI=0.92±0.07 right eye, p=0.044 right eye, p<0.001 left eye) with resistivity index of diabetic retinopathy respondents significantly higher than the diabetic patients with no retinopathy.Conclusions: The study showed that Doppler is a useful screening parameter in identifying eyes at risk of developing sight threatening proliferative disease in diabetic patients. Significant differences exist in ophthalmic artery Doppler flow indices of diabetics with retinopathy compared to the healthy controls.

Exploratory study of plasma total homocysteine and its relationship to short-term outcome in acute ischaemic stroke in Nigerians

<p>Abstract</p> <p>Background</p> <p>Hyperhomocysteinemia is a potentially modifiable risk factor for stroke, and may have a negative impact on the course of ischaemic stroke. The role of hyperhomocysteinemia as it relates to stroke in Africans is still uncertain. The objective of this study was to determine the prevalence and short-term impact of hyperhomocysteinemia in Nigerians with acute ischaemic stroke. We hypothesized that Hcy levels are significantly higher than in normal controls, worsen stroke severity, and increase short-term case fatality rates following acute ischaemic stroke.</p> <p>Methods</p> <p>The study employed both a case-control and prospective follow-up design to study hospitalized adults with first – ever acute ischaemic stroke presenting within 48 hours of onset. Clinical histories, neurological evaluation (including National Institutes of Health Stroke Scale (NIHSS) scores on admission) were documented. Total plasma Hcy was determined on fasting samples drawn from controls and stroke cases (within 24 hours of hospitalization). Outcome at 4 weeks was assessed in stroke patients using the Glasgow Outcome Scale (GOS).</p> <p>Results</p> <p>We evaluated 155 persons (69 acute ischaemic stroke and 86 healthy controls). The mean age ± SD of the cases was 58.8 ± 9.8 years, comparable to that of controls which was 58.3 ± 9.9 years (T = 0.32; P = 0.75). The mean duration of stroke (SD) prior to hospitalization was 43.5 ± 38.8 hours, and mean admission NIHSS score was 10.1 ± 7.7. Total fasting Hcy in stroke patients was 10.2 ± 4.6 umol/L and did not differ significantly from controls (10.1 ± 3.6 umol/L; P = 0.88). Hyperhomocysteinemia, defined by plasma Hcy levels > 90^thpercentile of controls (>14.2 umol/L in women and >14.6 umol/L in men), was present in 7 (10.1%) stroke cases and 11 (12.8%) controls (odds ratio 0.86, 95% confidence interval 0.31 – 2.39; P > 0.05). In multiple regression analysis admission NIHSS score (but not plasma Hcy) was a significant determinant of 4 week outcome measured by GOS score (P < 0.0001).</p> <p>Conclusion</p> <p>This exploratory study found that homocysteine levels are not significantly elevated in Nigerians with acute ischaemic stroke, and admission Hcy level is not a determinant of short-term (4 week) stroke outcome.</p