Relation between early stages of diabetic retinopathy and early stages of diabetic kidney disease in patients with type 2 diabetes in Egypt

Background. Diabetes mellitus is a pandemic disease. Type 2 diabetes (T2DM) is the most common type. Diabetic retinopathy (DR) and diabetic kidney disease (DKD) are disabling chronic complications. The relation between both is not yet well-established in T2DM. Egypt is considered one of the top ten countries re- garding the prevalence of diabetes that makes diabetes and its complications a major health problem. This encouraged us to conduct this research.  Materials and methods. The study included 79 patients with T2DM divided into two groups according to the presence of retinopathy. Both groups were subdivided according to urinary albumin to creatinine ratio (UACR) into normoalbuminuric and albuminuric subgroups. Retinopathy group was further subdivided according to severity of retinopathy into mild, moderate and severe non-proliferative DR (NPDR). Statistical analysis was done and relation between the severity of retinopathy and UACR was studied.  Results. Patients with retinopathy had significantly higher diabetes duration and UACR than non retinopathy group. Also in subgroups of normoalbuminuria and albuminuria, retinopathy group was significantly higher regarding the same parameters. On subdividing the retinopathy group according to severity, severe NPDR group had significantly higher UACR. The severity of DR was significantly positively correlated with UACR.  Conclusions. The present study identified a significantly positive correlation between early stages of DR and UACR in patients with T2DM in Egypt. Not all cases of DR had DKD especially in early stages and also not all cases of DKD are associated with the presence of DR in T2DM.   Background. Diabetes mellitus is a pandemic disease. Type 2 diabetes (T2DM) is the most common type. Diabetic retinopathy (DR) and diabetic kidney disease (DKD) are disabling chronic complications. The relation between both is not yet well-established in T2DM. Egypt is considered one of the top ten countries re- garding the prevalence of diabetes that makes diabetes and its complications a major health problem. This encouraged us to conduct this research.  Materials and methods. The study included 79 patients with T2DM divided into two groups according to the presence of retinopathy. Both groups were subdivided according to urinary albumin to creatinine ratio (UACR) into normoalbuminuric and albuminuric subgroups. Retinopathy group was further subdivided according to severity of retinopathy into mild, moderate and severe non-proliferative DR (NPDR). Statistical analysis was done and relation between the severity of retinopathy and UACR was studied.  Results. Patients with retinopathy had significantly higher diabetes duration and UACR than non retinopathy group. Also in subgroups of normoalbuminuria and albuminuria, retinopathy group was significantly higher regarding the same parameters. On subdividing the retinopathy group according to severity, severe NPDR group had significantly higher UACR. The severity of DR was significantly positively correlated with UACR.  Conclusions. The present study identified a significantly positive correlation between early stages of DR and UACR in patients with T2DM in Egypt. Not all cases of DR had DKD especially in early stages and also not all cases of DKD are associated with the presence of DR in T2DM. 

Light microscopic examination of the anterior chamber cells in uveitis

Background Uveitis is a serious ocular condition with potentially blinding complications. It can be a sign of a large number of disorders with diverse etiologies, both infectious and noninfectious. Methods A prospective study was done on patients who presented with uveitis and grade 4 anterior chamber cells. A 0.1 ml aqueous sample was withdrawn under aseptic conditions in the operation theatre. All samples were prepared and examined by the same pathologist. Results Light microscopic examination of the aqueous sample from the 16 eyes with a hypopyon revealed predominant neutrophils. On the other hand, light microscopic examination of the aqueous sample from the 22 eyes without a hypopyon revealed predominant lymphocytes. Discussion The convection currents of the aqueous can be regarded as a vertically oriented centrifuge. Some centrifugal force is exerted on the particles suspended in the aqueous humor, and examples of these particles are inflammatory cells in anterior uveitis. Conclusion The predominant type of inflammatory cells is not the same in all cases of anterior uveitis

Study of the different ocular manifestations in children with juvenile idiopathic arthritis

Purpose The aim of this study was to describe the features of uveitis in children with juvenile idiopathic arthritis (JIA). Patients and methods The present study was an observational study of 132 eyes of 75 children with JIA and uveitis, who were examined with a slit-lamp biomicroscope and a noncontact fundus lens. The features of uveitis are described. Results Among the 75 patients with JIA-associated uveitis, 132 eyes were affected by uveitis. At least one ocular complication was present in 64% of patients and in 67% of eyes affected with uveitis at presentation. In the 132 affected eyes, band keratopathy was the most frequent complication observed (32%), followed by posterior synechiae (28%), cataract (22%), and ocular hypertension (15%). Conclusion In summary, poor vision and ocular complications still occur commonly among children with JIA-related uveitis, particularly if there is a long delay in referral to a tertiary-care center

Assessment of prevalence of active pulmonary tuberculosis among patients with ocular tuberculosis

Background Tuberculosis (TB) is considered a multisystemic disease showing many extrapulmonary presentations. TB uveitis is one of the common forms of extrapulmonary TB. The lung is still the first organ to be attacked by TB, and pulmonary TB is the only infectious form of the disease. Aim The aim of the study was to detect the prevalence of active pulmonary TB among patients with TB uveitis. Patients and methods The present study included 37 patients with diagnosis of ocular TB on the basis of previous history, ocular examination, and exclusion of other suspected causes of uveitis. In addition, positive tuberculin skin test, or positive interferon-gamma release assays were carried out. All included patients were subjected to sputum examination for acid-fast bacilli and plain radiography of chest P-A view, and certain cases had a bronchoalveolar lavage. Patients with active pulmonary TB were detected. Both groups (patients with active pulmonary TB and patients with free chest) were compared with regard to all the previously mentioned studied parameters. Results The mean age of the studied patients was 34.8±12.5 years. All the studied patients showed positive tuberculin test with a mean of 18.5±3.4 mm. With regard to the Quantiferon Gold test, 34 patients (91.9%) had positive results. Concerning radiography, only 10 (27%) patients had normal radiograph, the rest of the patients showed various radiological lesions. Thirty (81.1%) patients were diagnosed to have active pulmonary TB. Sputum examination for acid-fast bacilli revealed that 22 (59.5%) patients had positive results; an additional eight patients (who had negative results on sputum examination) showed positive results when they underwent a bronchoalveolar lavage. There was no statistically significant difference with regard to all the previously mentioned parameters between patients with active pulmonary TB and patients with a free chest. Conclusion The present study revealed that a considerable percentage of the patients with TB uveitis had active pulmonary TB

Relation of anti-annexin V antibodies to disease manifestations and activity in Behҫet’s disease patients

Aim of the work: To assess the role of serum anti-annexin V antibodies in Behҫet’s disease (BD) patients in relation to disease manifestations and activity. Patients and methods 65 BD patients and 30 matching controls were included. Disease activity was estimated by the Behçet Disease Current Activity Form (BDCAF). Serum IgG anti-annexin V antibodies titre was measured using the enzyme-linked immunosorbent assay. Results The patients’ age was 36.1 ± 8.5 years and disease duration 7.2 ± 5.2 years; 56 males and 9 females. The serum anti-annexin V antibodies level was significantly increased in the BD patients (50.9 ± 12.9 AU/ml) compared to the control (7.3 ± 3.1 AU/ml) (p < 0.0001). Serum anti-annexin V antibodies were significantly increased in BD patients with ocular involvement, skin lesions and neuro-Behcet’s compared to those without (p = 0.02, p = 0.004 and p = 0.002 respectively). Levels were comparable between those with uveitis, vitrous cells, retinal vasculitis, conjunctivitis and hypopyon and those without (p = 0.12, p = 0.22, p = 0.9, p = 0.67, p = 0.79 and p = 0.46 respectively). While those with xerophthalmia had a significantly higher level of anti-annexin V antibodies (60.6 ± 5.7 AU/ml) compared to those without (50.2 ± 13.1 AU/ml) (p = 0.02). The anti-annexin V antibodies significantly correlated with the BDCAF (r = 0.41, p = 0.001) and age (r = 0.43, p < 0.0001) but not with the disease duration (r = 0.22, p = 0.08), steroid dose (r = −0.21, p = 0.09) or laboratory investigations. On regression analysis, only the age would predict the anti-annexin V antibodies level (p = 0.02) while the BDCAF would not (p = 0.33). Conclusion There is a role of apoptosis in the pathogenesis of BD with special relation to the ocular, cutaneous and neurological manifestations and a possible link to the disease activity

Zależność między wczesnymi stadiami retinopatii cukrzycowej a wczesnymi stadiami cukrzycowej choroby nerek u chorych na cukrzycę typu 2 w Egipcie

Wstęp. Cukrzyca jest chorobą uważaną za pandemię. Najczęstszą postać stanowi cukrzyca typu 2 (T2DM). Retinopatia cukrzycowa (DR) i cukrzycowa choroba nerek (DKD) to przewlekłe powikłania cukrzycy, prowadzące do niepełnosprawności. Dotychczas nie ustalono dokładnie, jakie relacje występują między tymi powikłaniami w T2DM. Egipt jest jednym z dziesięciu państw o największej częstości występowania cukrzycy, co sprawia, że choroba ta i jej powikłania stanowią poważny problem zdrowotny. To skłoniło autorów do przeprowadzenia niniejszego badania.  Metody. Do badania włączono 79 chorych na T2DM, których podzielono na dwie grupy w zależności od obecności retinopatii. Obie grupy podzielono dodatkowo w zależności od wartości współczynnika albumina/ /kreatynina (UACR) na podgrupę z normoalbuminurią i podgrupę z albuminurią. W grupie z retinopatią wydzielono dodatkowo w odniesieniu do ciężkości retinopatii trzy podgrupy: z łagodną, umiarkowaną i ciężką nieproliferacyjną DR (NPDR). Wykonano analizy statystyczne i oceniono zależności między ciężkością retinopatii a UACR.  Wyniki. U chorych z retinopatią czas trwania cukrzycy był istotnie dłuższy, a wskaźnik UACR istotnie wyższy niż w grupie bez retinopatii. Także w podgrupach z normoalbuminurią i albuminurią u osób z retinopatią stwierdzono wyższe wartości tych parametrów. Po podzieleniu grupy chorych z retinopatią ze względu na jej ciężkość stwierdzono, że w podgrupie z ciężką NPDR wskaźnik UACR był istotnie wyższy. Stwierdzono istotną dodatnią korelację między ciężkością DR a UACR.  Wnioski. W przedstawionym badaniu wykazano istotną dodatnią korelację między wczesnymi stadiami DR i UACR u chorych na T2DM w Egipcie. Nie u wszystkich chorych z DR występowała DKD, zwłaszcza we wczesnych stadiach. Z kolei nie wszystkie przypadki DKD były związane z obecnością DR w przebiegu T2DM.