Bilateral exudative retinal detachment, unusual pattern of uveitis with multiple sclerosis.

MS (Multiple sclerosis) associated uveitis used to have limited phenotypes. Bilateral exudative retinal detachment has never been recognized as a pattern of MS-associated uveitis. We are reporting a patient with multiple sclerosis who presented initially with the usual pattern of intermediate uveitis and later developed bilateral exudative retinal detachment.

Metabolic and Metabo-Clinical Signatures of Type 2 Diabetes, Obesity, Retinopathy, and Dyslipidemia.

Macro- and microvascular complications of type 2 diabetes (T2D), obesity, and dyslipidemia share common metabolic pathways. In this study, using a total of 1,300 metabolites from 996 Qatari adults (57% with T2D) and 1,159 metabolites from an independent cohort of 2,618 individuals from the Qatar BioBank (11% with T2D), we identified 373 metabolites associated with T2D, obesity, retinopathy, dyslipidemia, and lipoprotein levels, 161 of which were novel. Novel metabolites included phospholipids, sphingolipids, lysolipids, fatty acids, dipeptides, and metabolites of the urea cycle and xanthine, steroid, and glutathione metabolism. The identified metabolites enrich pathways of oxidative stress, lipotoxicity, glucotoxicity, and proteolysis. Second, we identified 15 patterns we defined as "metabo-clinical signatures." These are clusters of patients with T2D who group together based on metabolite levels and reveal the same clustering in two or more clinical variables (obesity, LDL, HDL, triglycerides, and retinopathy). These signatures revealed metabolic pathways associated with different clinical patterns and identified patients with extreme (very high/low) clinical variables associated with extreme metabolite levels in specific pathways. Among our novel findings are the role of N-acetylmethionine in retinopathy in conjunction with dyslipidemia and the possible roles of N-acetylvaline and pyroglutamine in association with high cholesterol levels and kidney function.

Different Cabergoline Effect on Metabolic and Anthropometric Parameters in Female Prolactinoma Patients Versus Idiopathic Hyperprolactinemia Patients.

BACKGROUND: Hyperprolactinemia can lead to weight gain, insulin resistance, abnormal glucose homeostasis and dyslipidemia. Reversibility of these changes after normalization of prolactin with dopamine agonists is still controversial and needs more clarification. OBJECTIVE: We aimed to: 1) evaluate and compare metabolic and anthropometric profile in female with newly diagnosed prolactin-secreting adenoma versus female idiopathic hyperprolactinemic patients; 2) compare the effects of one year cabergoline therapy on the metabolic profile and anthropometric parameters (by using visceral adiposity index as index for evaluation of adipose tissue dysfunction) in females with prolactinoma to female idiopathic hyperprolactinemic patients. PATIENTS AND METHODS: We enrolled 40 female patients with newly diagnosed prolactinoma and 40 female patients with idiopathic hyperprolactinemia, who were matched according to: age; weight; BMI; waist; and prolactin levels. We enrolled the participants in this study at the time of diagnosis before therapy and they were followed up for 12 months. RESULTS: Cabergoline therapy had significant favorable effects on metabolic and anthropometric parameters, visceral adiposity index and in all patients (apart from HDLc in prolactinoma patients). Cabergoline therapy was significantly more effective in patient with idiopathic hyperprolactinemia than prolactinoma patients with regard to BMI, waist circumference, HDLc and visceral adiposity index despite normalization of prolactin levels in both groups. CONCLUSION: 12 months of Cabergoline treatment improved most of the anthropometric and metabolic parameters, and visceral adiposity index as a marker for adipose tissue dysfunction in both idiopathic hyperprolactinemia and prolactinoma patients. However, Cabergoline treatment was more effective in idiopathic hyperprolactinemic than prolactinoma patients.

Vitamin D status in Egyptian euthyroid multinodular non-toxic goiter patients and its correlation with TSH levels.

BACKGROUND AND AIM: Although the prevalence of MNG is widespread throughout the world, its pathogenesis is poorly understood, and the complex interactions of both genetic predisposition and the individuals' environment are likely. However, to the best of our knowledge, it remains unknown whether there is a relationship between vitamin D status and prevalence or pathogenesis of euthyroid MNG. Therefore, the goal of the present study was determination of vitamin D status in euthyroid MNG as well as exploration of the correlation between vitamin D status & TSH levels. METHODS: A total of 77 patients diagnosed with euthyroid MNG and 50 subjects without goiter were matched according to age, weight and BMI as control group in this case control study. RESULTS: We found that patients with euthyroid MNG had statistically significant lower mean of [25(OH)D] (24.21±8.68ng/mL) in comparison with its mean in control subjects (28.37±10.91ng/mL, P value=0.019). The 28 sufficient vitamin D MNG patients had statistically significant lower level of TSH than 49 insufficient vitamin D MNG patients. Vitamin D and TSH levels correlate with vitamin D levels in MNG patients in Pearson correlation. Also 25 OH vitamin D was a significant independent predictor for TSH levels among euthyroid MNG patients in regression analysis. CONCLUSIONS: Patients with euthyroid MNG have lower levels of vitamin D and TSH levels correlate with vitamin D levels in euthyroid MNG patients. In addition, 25 OH vitamin D was a significant independent predictor for TSH levels among euthyroid MNG patients. We recommend hypovitaminosis D evaluation and correction in patients with MNG.

Prevalence and determinants of diabetic retinopathy among persons ≥ 40 years of age with diabetes in Qatar: a community-based survey.

PURPOSE: We present the prevalence and determinants of diabetic retinopathy (DR) in persons 40 years and older with diabetes in Qatar. METHODS: This community-based survey was held in 2009 at 49 randomly selected clusters. Demographic details and history of diabetes mellitus (DM) and its management were collected by nurses. Ophthalmologists examined the retina by slit-lamp biomicroscopy using +90 D lens and/or indirect ophthalmoscopy. Digital photographs of retina were obtained. The best-corrected visual acuity of each eye was noted. Diabetic retinopathy was graded as mild, moderate, or severe nonproliferative DR, proliferative DR, or diabetic macular edema. RESULTS: We examined 540 (97.3%) participants with DM. Diabetes mellitus status of 487 persons could be confirmed from medical records. The age- and sex-adjusted prevalence of DR among the diabetic population 40 years and older was 23.5% (95% confidence interval [CI] 19.7-27.3), with 8192 cases of DR among patients with DM. Longer duration of diabetes (odds ratio 1.14 [95% CI 1.10-1.19]) and poor glycemic control (odds ratio 1.12 [95% CI 1.02-1.23]) were risk factors for DR. Awareness of regular eye checkup was found in 62% of participants. Only 20% of persons with sight-threatening DR had undergone laser treatment in at least 1 eye. Visual acuity in the better eye was 6/6 to 6/18 in 90% of persons with DR. CONCLUSIONS: Universal and periodic eye screening of patients with diabetes is recommended in Qatar. Health promotion for primary prevention and resource review are needed for early detection and management of sight-threatening DR.

Prevalence and causes of blindness, low vision and status of cataract in 50 years and older citizen of Qatar-a community based survey.

BACKGROUND: Rapid Assessment for the Avoidable Blindness (RAAB) was conducted in Qatar during 2009. We present the prevalence and determinants of visual disabilities and status of cataract among citizens aged 50 years and older. METHODS: Residents of randomly selected houses and clusters participated in the survey. Opticians noted the presenting and the best corrected vision of participants from 49 clusters. Ophthalmologists examined participants with additional instruments like bio-microscope, digital camera, auto-perimeter and auto-refractor in a mobile van. World Health Organization recommended principal cause of blindness (Visual acuity [VA] < 3/60 in better eye), Severe visual impairment (SVI) (<6/60), low vision (VA < 6/18) and unilateral blindness (VA < 3/60) were designated. Persons with VA < 6/18 and cataract were interviewed to calculate coverage and barriers for cataract surgeries. Age sex adjusted prevalence of visual disabilities and their 95% Confidence Intervals (CI) were estimated. RESULTS: We examined 2,433 (97.3%) participants. The age sex adjusted prevalence of bilateral blindness was 1.28% [95% CI 1.22-1.35], SVI (1.67%), low vision (3.66%) and unilateral blindness (3.61%) in 50 years and older population. Female and older age groups were significant risk factors of visual disabilities. Cataract and glaucoma were the main causes of visual disabilities. The coverage of cataract services was 68.2%. Believing that cataract as an aging process (25) and adequate vision in the fellow eye (15) were the reasons for delay in surgery. CONCLUSIONS: To reduce avoidable blindness, un-operated cataract should be addressed. Primary and secondary eye care systems should be strengthened to improve the care of blinding eye diseases in Qatar.