Corneal Sensitivity as a Potential Marker of Diabetic Neuropathy

Diabetes mellitus (DM) is a complex and chronic metabolic disorder leading to many complications. One of the most common complications of DM is diabetic neuropathy. There are many studies exploring corneal sensitivity as a potential marker of diabetic neuropathy. This review aims to explore association between corneal sensitivity and diabetic neuropathy. In diabetic neuropathy, corneal sensitivity is impaired due to low level of corneal nerve trophic factors, impaired sensory nerve fibers, and lost communication of dendtritic cell. In diabetic patients, this condition can be assessed by several techniques, such as Cochet Bonnet aesthesiometry, non-contact corneal aesthesiometry, and confocal microscopy. Few promising therapeutic targets for impaired corneal sensitivity include stem cell and growth factor therapy that can be used to prevent complication in patient with diabetic neurotrophic keratopathy. Impaired corneal sensitivity serve as a potential marker of diabetic neuropathy. Doctors, opthalmologists and internists, should anticipate the possibility of observing the following changes in diabetic patients with neuropathy by using corneal sensitivity assessment test

The Role of Imaging in Uveitis Diagnosis

Uveitis is an inflammatory disease affecting iris, ciliary body, pars plana, vitreous, choroid and retina.Inflammation process can be either limited in uveal tract or as part of systemic inflammation caused byautoimune, infection or cancer. Uveitis can cause phophobia, pain, reduced visual accuity and blindness if notproperly treated. Therefore, right diagnosis and prompt treatment should be given immediately to reduce themorbidity. Diagnosis of uveitis is made based on anamnesis, ophtalmic and physical examination, followedby imaging to confirm the patologic changes in the eyes. Slit lamp and simple photography can be usedto evaluate sign of inflammation in anterior chamber and outer part of the eye. Inflammation marker canbe counted using laser flare photometry (LFP) and fundus fotography can visualize pathologic changes inposterior part of the eyes. Fundus fluorescein angiography (FFA), indocyanine green angiography (ICG), andfundus autofluorescence (FAF) can be used to evaluate the integrity of vascular part in retina and choroid.Ultrasound (USG), optical coherence tomography (OCT), and multimodal imaging visualize retina, choroid,optic nerve and nerve fiber layer of retina using non-contact and non-invasif technique. MRI also used toevaluate inflammatory process in the eye. These imaging modalities are usefull to confirm the diagnosis ofuveitis, monitor the disease progression and evalute the treatment

Perawatan Lensa Kontak untuk Mencegah Komplikasi Ratna Sitompul

Lensa kontak adalah alat bantu penglihatan yang diletakkan di permukaan kornea untuk memperbaiki gangguan refraksi. Pemakaian lensa kontak memberi Kenyamanan beraktivitas,tidak membatasi lapang pandang, dan lebih baik secara estetik. Meskipun demikian, penggunaanlensa kontak dapat menimbulkan komplikasi ringan sampai kebutaan. Komplikasi tersebut dapatdicegah dengan menjalankan prinsip penggunaan lensa kontak yang tepat. Pengguna lensakontak perlu melakukan pemeriksaan awal untuk mengetahui kelainan mata seperti mata kering,infeksi mata, katarak, glaukoma, serta penggunaan obat yang dapat menurunkan produksi airmata. Kondisi lain yang perlu diperhatikan adalah alergi, diabetes melitus, kehamilan, menopause,infeksi saluran napas kronik dan kondisi immunocompromised. Kebersihan dan kepatuhan yangburuk juga merupakan kontraindikasi penggunaan lensa kontak. Pengenalan cara penggunaandan perawatan lensa kontak dengan baik dan benar  sangat penting untuk mencegah komplikasi

Diagnosis and Treatment of Uveitis to Prevent Blindness

Uveitis is an inflammation of the uvea which may result in blindness. Uveitis may be caused by limited inflamation of the uveal tract, manifestation of systemic diseases (autoimmune, infection, cancer), expansion of inflammation in the cornea and sclera, trauma or idiopathic. Anterior uveitis is an inflammation of the iris and cilliary body with symptoms of pain, red eye, photophobia, and decrease in visual acuity. Intermediate uveitis is the inflammation of the pars plana and frequently involves anterior vitreous and posterior uveitis. Clinical manifestation of intermediate uveitis is usually mild without red eye and pain, however vision may decrease due to macular edema and cell aggregation in vitreous. Posterior uveitis is an inflammation involving choroid layer, which is common in developing countries due to high prevalence of infectious diseases (toxoplasmosis, tuberculosis, HIV, syphilis). Patient may complain of blurry vision but not accompanied by pain, red eye, and photophobia. Complications of posterior uveitis are cataract, glaucoma, macular edema, keratopathy, turbidity of vitreous, retinal detachment, and optic nerve atrophy. The prognosis of posterior uveitis is worse than anterior uveitis. Panuveitis is an inflammation of the uvea and surrounding structures (retina, vitreous). Diagnosis is made based on anamnesis, ophthalmic examination, laboratory examination, and imaging. Treatment of uveitis is intended to reduce inflammation, minimize structural destruction, prevent blindness, reduce pain and photophobia. Corticosteroid and immunosuppresant are the drugs of choice to manage the inflammation, where NSAID is used to reduce pain and cyclopegic administration to prevent posterior synechiae. Antimicrobial is given if uveitis is caused by infection. Underlying diseases of uveitis must be treated comprehensively to prevent further progression, complications and blindness.&nbsp

Viral Conjunctivitis: Diagnosis and Therapy in Primary Health Care

Conjunctivae is a transparent thin mucosal membrane covering the outer anterior eye and inner palpebrae. This structure is vital for eye defense from inflammation and infection. Inflammation occurring on the conjunctivae is called conjunctivitis and virus is one of the most common etiologic agent. Such viruses are adenovirus, herpes simplex virus, herpes zoster virus, poxvirus, myxovirus, paramyxovirus and arbovirus. It mostly occurs along or after respiratory tract infection as well as after contact with patients suffering from viral conjunctivitis. Clinical manifestations include redness, watery discharge, and pre auricular lymph enlargement. The manifestations are usually mild, self-limiting, and do not impair visual acuity thus viral conjunctivitis can be managed in primary health centers. However, there are cases which threaten visual acuity thus require referral to ophthalmologists or higher eye care services. Due to its high infectivity, patients should be educated to avoid of direct and indirect contact thus they would not spread the infection to environment. Although it is self-limiting, administration of artificial tears, topical antihistamine or cold compress, could reduce the manifestation. Antiviral agents are not required for conjunctivitis viral, unless for herpetic conjunctivitis.&nbsp

Proliferative Diabetic Retinopathy: An Overview of Vitreous Immune and Biomarkers

This chapter discusses about the effect of vitreous immune system and biomarkers on the progression of proliferative diabetic retinopathy. Immune system and biomarkers have been believed to have an important role in the progression of diabetic retinopathy (DR) severity. Hyperglycemic will influence immune cells resulting in chronic inflammation on the retina. This condition progressively disrupts the blood-retinal barrier in retina causing those inflammatory molecules and immune cells to transfer from circulation. The transfer of these molecules plays an important part in the progression of proliferative diabetic retinopathy. In addition, biomarkers are indicators for some complex processes happened in our body, and are measured to determine diagnosis and prognosis of some treatment. There are several biomarkers that have been identified in DR patients including biomarkers of oxidative stress, hypoxia-inducible factors, angiogenic factors, pro-inflammatory cytokines, chemokines, cell adhesion molecules, and soluble CD200. The value of these biomarkers will tell us their possible role in the progression of DR. By improving the knowledge of molecular pathway in DR pathophysiology, the advancement of selective therapy approaches could be discovered and the management of DR could be more efficient

Animal model of diabetic keratopathy

Diabetic keratopathy is one of the most common ocular complications in diabetes mellitus. Protocol for diabetes induction in rat model also has been established in many centers. Nonetheless, method in developing diabetic keratopathy rat model has not been well covered. Streptozotocin (STZ) -induced diabetes is widely being used as animal diabetic model. The purpose of this study is to obtain an animal model of diabetic keratopathy that can be used to study the morphology, metabolism, and function of cornea in cases where human samples can be difficult to obtain. A single dose STZ (50 mg/kg) was injected intraperitoneally to control and intervention group. Plasma glucose level concentrations were tested in day 3 postinjections. Obtained animal model of diabetic keratopathy, with significant difference of blood glucose level between intervention and control group (P<0.00). Sensibility of cornea was decreased by week 14th in intervention group. Epithelial defect were more prominent in diabetic group. Despite the differences between human and animal characteristic of diabetic keratopathy, the use of animal models has contributed to better understanding of this disease and to examine more effective treatment

Atopobiosis and Dysbiosis in Ocular Diseases: Is Fecal Microbiota Transplant and Probiotics a Promising Solution?

Purpose: To highlight the role of atopobiosis and dysbiosis in the pathomechanism of autoimmune uveitis, therefore supporting fecal microbiota transplant (FMT) and probiotics as potential targeted-treatment for uveitis. Methods: This review synthesized literatures upon the relation between gut microbiota, autoimmune uveitis, FMT, and probiotics, published from January 2001 to March 2021 and indexed in PubMed, Google Scholar, CrossRef. Results: The basis of the gut–eye axis revolves around occurrences of molecular mimicry, increase in pro-inflammatory cytokines, gut epithelial barrier disruption, and translocation of microbes to distant sites. In patients with autoimmune uveitis, an increase of gut Fusobacterium and Enterobacterium were found. With current knowledge of aforementioned mechanisms, studies modifying the gut microbiome and restoring the physiologic gut barrier has been the main focus for pathomechanism-based therapy. In mice models, FMT and probiotics targeting repopulation of gut microbiota has shown significant improvement in clinical manifestations of uveitis. Consequently, a better understanding in the homeostasis of gut microbiome along with their role in the gut–eye axis is needed to develop practical targeted treatment. Conclusion: Current preliminary studies are promising in establishing a causative gut–eye axis relationship and the possibility of conducting FMT and probiotics as targeted treatment to mitigate autoimmune uveitis, to shorten disease duration, and to prevent further complications

DESKRIPSI MOTIVASI BELAJAR FISIKA SISWA KELAS X MIA DI SMAN 9 KOTA JAMBI

The purpose of this research is to describe the learning motivation of physics students of class X MIA in SMAN 9 Kota Jambi. The type of this research is descriptive research with quantitative approach. The population of this study is the students of class X MIA in SMAN 9 Kota Jambi. The sampling technique in this research is total sampling. The research instrument used is questionnaire motivation learn physics student. The data type of this research is quantitative data. Data analysis technique used is quantitative analysis using descriptive statistics. The results of this study indicate that the learning motivation of physics students of class X MIA in SMAN 9 Kota Jambi on intrinsic motivation dimension derived from the diligent indicators in doing the task that tends to be in the high category with the percentage of 59.80% where student attitudes are in the category often and on dimensions extrinsic motivation stems from indicators of feedback that tend to be in the high category with a percentage of 61.76% where student attitudes are in the category often. Keywords: description, learning motivation, physicsTujuan penelitian ini adalah untuk mendeskripsikan motivasi belajar fisika siswa kelas X MIA di SMAN 9 Kota Jambi. Jenis penelitian ini adalah penelitian deskriptif dengan pendekatan kuantitatif. Populasi penelitian ini adalah siswa kelas X MIA di SMAN 9 Kota Jambi. Teknik pengambilan sampel dalam penelitian ini adalah total sampling. Instrumen penelitian yang digunakan adalah angket motivasi belajar fisika siswa. Jenis data penelitian ini adalah data kuantitatif. Teknik analisis data yang digunakan adalah analisis kuantitatif menggunakan statistik deskriptif. Hasil penelitian ini menunjukkan bahwa motivasi belajar fisika siswa kelas X MIA di SMAN 9 Kota Jambi pada dimensi motivasi intrinsik bersumber dari indikator tekun dalam mengerjakan tugas yang cenderung berada pada kategori tinggi dengan persentase 59,80% dimana sikap siswa berada pada kategori sering dan pada  dimensi motivasi ekstrinsik bersumber dari indikator adanya umpan balik yang cenderung berada pada kategori tinggi dengan persentase 61,76% dimana sikap siswa berada pada kategori sering. &nbsp

Accuracy of artificial intelligence model for infectious keratitis classification: a systematic review and meta-analysis

BackgroundInfectious keratitis (IK) is a sight-threatening condition requiring immediate definite treatment. The need for prompt treatment heavily depends on timely diagnosis. The diagnosis of IK, however, is challenged by the drawbacks of the current “gold standard.” The poorly differentiated clinical features, the possibility of low microbial culture yield, and the duration for culture are the culprits of delayed IK treatment. Deep learning (DL) is a recent artificial intelligence (AI) advancement that has been demonstrated to be highly promising in making automated diagnosis in IK with high accuracy. However, its exact accuracy is not yet elucidated. This article is the first systematic review and meta-analysis that aims to assess the accuracy of available DL models to correctly classify IK based on etiology compared to the current gold standards.MethodsA systematic search was carried out in PubMed, Google Scholars, Proquest, ScienceDirect, Cochrane and Scopus. The used keywords are: “Keratitis,” “Corneal ulcer,” “Corneal diseases,” “Corneal lesions,” “Artificial intelligence,” “Deep learning,” and “Machine learning.” Studies including slit lamp photography of the cornea and validity study on DL performance were considered. The primary outcomes reviewed were the accuracy and classification capability of the AI machine learning/DL algorithm. We analyzed the extracted data with the MetaXL 5.2 Software.ResultsA total of eleven articles from 2002 to 2022 were included with a total dataset of 34,070 images. All studies used convolutional neural networks (CNNs), with ResNet and DenseNet models being the most used models across studies. Most AI models outperform the human counterparts with a pooled area under the curve (AUC) of 0.851 and accuracy of 96.6% in differentiating IK vs. non-IK and pooled AUC 0.895 and accuracy of 64.38% for classifying bacterial keratitis (BK) vs. fungal keratitis (FK).ConclusionThis study demonstrated that DL algorithms have high potential in diagnosing and classifying IK with accuracy that, if not better, is comparable to trained corneal experts. However, various factors, such as the unique architecture of DL model, the problem with overfitting, image quality of the datasets, and the complex nature of IK itself, still hamper the universal applicability of DL in daily clinical practice