Prevalence and determinants of albuminuria in a cohort of diabetic patients in Lebanon

<b>Background and Objectives: </b> Few data are available on the extent of albuminuria in diabetic populations in the Middle East generally and in Lebanon specifically. We conducted this study to determine the prevalence of albuminuria and its major risk factors in a cohort of diabetic patients in Lebanon. <b> Patients and Methods: </b> Diabetic patients followed in the outpatient department at the American University of Beirut Medical Center (AUBMC) were included in a prospective observational study. AUBMC is a tertiary referral center and the outpatient department typically handles patients of low socioeconomic status with ad-vanced disease. Patients were classified according to their urinary albumin-to-creatinine ratio (ACR) as having normoalbuminuria (ACR&#60; 30 mg/g creatinine), microalbuminuria (ACR=30 to &#60; 300 mg/g creatinine), or macro--albuminuria (ACR 2300 mg/g creatinine). The three groups were compared to analyze the association between albuminuria and its risk factors. In addition, independent predictors of albuminuria were determined using multivariate logistic regression and presented as an odds ratio.<b> Results: </b> Microalbuminuria<b> </b> and macroalbuminuria were present in 33.3&#x0025; and 12.7&#x0025; of 222 patients (mean age 56.4 years, mean deviation of diabetes 8.6 years, 58.7&#x0025; women, 43.8&#x0025; obese), respectively. Factors significantly associated with microalbuminuria included glycemic control, insulin use, and total and LDL cholesterol.Those associated with macroalbuminuria included in addition to glycemic control and insulin use, duration of diabetes, hypertension, elevated mean arterial pressure (MAP), and presence of neuropathy, retinopathy and peripheral vascular disease by bivariate analysis. Only glycemic control was an independent risk factor for both in addition to MAP and retinopathy for macroalbuminuria by multivariate analysis. <b> Conclusion:</b> Albuminuria is highly prevalent<b> </b> among this cohort of diabetic patients in Lebanon. Both glyce--mic control and blood pressure need to be better targeted in its management

Optical Coherence Tomography Findings in Anterior Chamber Ointment Globule after Phacoemulsification

We present 2 cases of anterior chamber ointment with evidence of progressive endothelial cell loss. In both cases, an anterior segment optical coherence tomography (OCT) was similar to an OCT of a tobramycin-dexamethasone ointment placed on a pen tip. An anterior segment OCT also demonstrated the direct contact of the globule with the corneal endothelium. A gas chromatography/mass spectrometry analysis documented the similarity to tobramycin-dexamethasone ointment in 1 case. Anterior segment OCT can help in confirming the diagnosis. Corneal endothelial injury is a continuous process, and its clinical manifestation is related to the size of the globule, the initial endothelium count, and the duration of ointment contact, which is related to supine positioning. It is advisable to avoid ointments in the immediate postoperative period, especially in corneal wounds larger than 3 mm

Changing Trends in Eye-Related Complaints Presenting to the Emergency Department in Beirut, Lebanon, over 15 Years

Objective. To report the 15-year trend in ophthalmic presentations to the emergency department (ED) at the only medical center in Lebanon that provides 24-hour ophthalmologic care. Methods. Retrospective review of 1967 patients presenting to the ED with eye-related complaints between September 1997 and August 1998 and between September 2012 and August 2013. Diagnoses were classified into 4 categories according to the International Society of Ocular Trauma and include penetrating eye injuries, nonpenetrating eye trauma, nontraumatic ophthalmic emergencies, and nontraumatic, nonurgent ophthalmic conditions. Results. One thousand sixty eye-related presentations out of 39,158 total ED visits (2.71%) presented in 1997 compared to 907 out of 46,363 in 2012 (1.96%). Penetrating and nonpenetrating eye emergencies decreased between 1997 and 2012 (7.17% to 4.19%, p=0.003 and 52.64% to 29.00%, p<0.001, resp.) while nonurgent cases increased from 30.19% to 53.47% (p<0.001). 57% of patients were covered by third-party guarantors in 1997 versus 73% in 2012. Conclusion. Our results demonstrate a significant increase in nonurgent cases in parallel with the proportion of third-party payers, an issue to be addressed by public health policies and proper resource allocation. A detailed nationwide review is needed to make solid recommendations for the management of ophthalmologic presentations in the ED

Hepatocyte Growth Factor Induces Retinal Vascular Permeability via MAP-Kinase and PI-3 Kinase without Altering Retinal Hemodynamics

Purpose. Although vascular endothelial growth factor (VEGF) is a key mediator of retinal vascular permeability (RVP), there may be additional humoral contributors. Hepatocyte growth factor (HGF) induces endothelial cell separation, regulates expression of cell adhesion molecules and is increased in the vitreous fluid of patients with proliferative diabetic retinopathy. The purpose of this study was to evaluate the in vivo effects of HGF on RVP and retinal hemodynamics and delineate the signaling pathways. Methods. RVP was assessed by vitreous fluorescein fluorophotometry in rats. Time course and dose-response were determined after intravitreal HGF injection. MAP kinase (MAPK), phosphatidylinositol 3-kinase (PI-3 kinase), and protein kinase C (PKC) involvement were examined by using selective inhibitors. Retinal blood flow (RBF) and mean circulation time (MCT) were evaluated by video fluorescein angiography. Results. HGF increased RVP in a time- and dose-dependent manner. HGF-induced RVP was evident 5 minutes after injection, and reached maximal levels after 25 minutes (+107% versus vehicle, P = 0.002). This effect was comparable to that of maximum VEGF stimulation (134% ± 128% at 25 ng/mL). Selective inhibitors of MAPK (PD98059) and PI-3 kinase (LY294002) suppressed HGF-induced RVP by 86% ± 44% (P = 0.015) and 97% ± 59% (P = 0.021), respectively. Non-isoform-selective inhibition of PKC did not significantly decrease HGF-induced RVP. Although VEGF increases RBF and reduces MCT, HGF did not affect either. Conclusions. HGF increases RVP in a time- and dose-dependent manner at physiologically relevant concentrations with a magnitude and profile similar to that of VEGF, without affecting retinal hemodynamics. Thus, HGF may represent another clinically significant contributor to retinal edema distinct from the actions of VEGF

Five-Year Incidence and Progression of Diabetic Retinopathy in Patients with Type II Diabetes in a Tertiary Care Center in Lebanon

Objective. To estimate the 5-year incidence of progression rate and regression rate and risk factors for diabetic retinopathy (DR) in a cohort of Lebanese patients with type II diabetes. Methods. We followed a cohort of 462 Lebanese patients with type II diabetes for over 5 years at the American University of Beirut Medical Center. Patients underwent yearly complete ophthalmic evaluation and fundus photographs and were assessed for the incidence, stage, and evolution of DR using modified Airlie House classification. Results. Among the 462 patients, 281 had no DR at baseline. The 5-year cumulative incidence of any DR was 10% (95% CI: 6-13), and only baseline microalbuminuria correlated with the development of DR (OR = 10 53, 95% CI: 4.39-25.23, p &lt; 0 0001). Among the 181 patients with baseline DR, the worsening and regression rates of DR were 31.5% (95% CI: 25-38) and 9% (95% CI: 5-13), respectively. Microalbuminuria also approached statistical significance as a risk factor for DR worsening (OR = 1 89, 95% CI: 0.97-3.70, p = 0 06). Conclusion. The 5-year incidence of DR in this hospital-based cohort is relatively low. Microalbuminuria was independently associated with the incidence and progression of the disease. We recommend to screen patients with type II diabetes for microalbuminuria as prognostic for the development and worsening of DR