Diabetic retinopathy among Omanis: Prevalence and clinical profile.

PURPOSE: The aim of this study is to describe the prevalence, severity and clinical profile of diabetic retinopathy (DR) among Omani diabetic patients attending a tertiary care hospital. MATERIALS AND METHODS: This is a retrospective study involving the record review of diabetic patients attending the diabetes retina clinic of the National Diabetes and Endocrine Centre in the period between June 2015 and May 2016. Retinal evaluation of 442 native patients was conducted using direct ophthalmological examination and digital photography. DR was graded using the Early Treatment DR Study criteria. The statistical analysis was conducted using SPSS, version 20. RESULTS: The estimated total prevalence of DR was 31% (95% confidence interval: 26.6-35.3). Mild nonproliferative diabetic retinopathy (NPDR) constitutes 21.3%, while moderate-to-severe NPDR and proliferative diabetic retinopathy constitute 4.5% and 5.2%, respectively. The prevalence of vision-threatening diabetic retinopathy (VTDR) and diabetic maculopathy was 15.4% and 13.3%, respectively. Retinopathy was significantly associated with age, diabetes duration, Type 2 diabetes mellitus, coexisting comorbidities or complications, systolic blood pressure, glycated hemoglobin (HbA1c), fasting blood sugar, triglycerides, and albumin/creatinine ratio. In the regression analysis, age (P = 0.02), duration (P < 0.001), and HbA1c (P < 0.001) were independently associated with DR. CONCLUSIONS: The prevalence of DR and VTDR among Omani diabetics is high. Age, duration of diabetes, and HbA1c are the risk factors for the development of DR among Omanis. This emphasizes the importance of planning resources for different modalities of treatment of DR to face the future challenge.

Pediatric Diabetic Retinopathy: Experience of a Tertiary Hospital in Oman.

PURPOSE: The aim of this study is to describe the prevalence and clinical profile of pediatric diabetic retinopathy (DR) among Omani diabetic children and adolescents attending a tertiary care hospital. METHODS: This retrospective cross-sectional study involved the record review of 216 diabetic children attending the diabetes retina clinic of the National Diabetes and Endocrine Centre in the period between June 2015 and November 2018. The retinal evaluation was conducted using direct ophthalmological examination and fundus photography. DR was graded using the Early Treatment DR Study criteria. The statistical analysis was performed using SPSS, version 20. RESULTS: The prevalence of DR among the study sample was 3.7% (95% confidence interval: 1.2-6.2). Mild and moderate nonproliferative diabetic retinopathy was seen in 2.8% (6) and 0.9% (2) of patients, respectively. Diabetic maculopathy was observed in 2 (0.9%) cases. Diabetic ketoacidosis was seen in 33.8% of children at presentation. DR was significantly associated with age (P = 0.01), duration (P < 0.001), Type 1 diabetes mellitus (P = 0.01), dyslipidemia (P = 0.005), microalbuminuria (P = 0.001), glycated hemoglobin (P = 0.003), total cholesterol (P = 0.001), high-density lipoproteins (P = 0.001), low-density lipoproteins (P < 0.001), and albumin/creatinine ratio (P < 0.001). CONCLUSIONS: This is the first study describing DR among the pediatric age group in Oman. This study reveals a relatively low prevalence of DR and maculopathy among the pediatric diabetic population. However, novel strategies are to be adopted at primary levels to achieve timely screening of diabetic children to enhance the early detection of DR.

Effect of hypothyroidism on female reproductive hormones.

OBJECTIVE: Objective was to evaluate reproductive hormones levels in hypothyroid women and impact of treatment on their levels. MATERIALS AND METHODS: A total of 59 women with untreated primary hypothyroidism were included in this prospective study. Venous blood was taken at baseline and after euthyroidism was achieved for measuring serum free thyroxine, free triiodothyronine (FT3), thyroid stimulating hormone (TSH), prolactin (PRL), follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T), and thyroid peroxidase antibody. Thirty-nine healthy women with regular menstrual cycles without any hormonal disturbances served as controls. The statistical analysis was performed using the Statistical Package for the Social Sciences Version 20 ([SPSS] IBM Corporation, Armonk, NY, USA). P < 0.05 was considered statistically significant. RESULTS: On an average at diagnosis cases have more serum TSH (mean [M] = 77.85; standard error [SE] = 11.72), PRL (M = 39.65; SE = 4.13) and less serum E2 (M = 50.00; SE = 2.25) and T (M = 35.40; SE = 2.31) than after achieving euthyroidism (M = 1.74; SE = 0.73), (M = 16.04; SE = 0.84), (M = 76.25; SE = 2.60), and (M = 40.29; SE = 2.27), respectively. This difference was statistically significant t (58) = 6.48, P <0.05; t (58) = 6.49, P < 0.05; t (58) = 12.47; P < 0.05; and t (58) = 2.04, P < 0.05; respectively. Although average serum FSH (M = 12.14; SE = 0.40) and LH (M = 5.89; SE = 0.27) were lower in cases at diagnosis than after achieving euthyroidism (M = 12.70; SE = 0.40), (M = 6.22; SE = 0.25), respectively, but these differences were statistically insignificant t (58) = 1.61, P = 0.11; t (58) = 1.11, P = 0.27, respectively. CONCLUSION: The study has demonstrated low E2 and T levels in hypothyroid women which were increased after achieving euthyroidism. Although average serum FSH and LH were increased in hypothyroid women after achieving euthyroidism but this difference was statistically insignificant.

Congenital hypothyroidism.

Congenital hypothyroidism (CH) is the one of the most common preventable cause of mental retardation. In the majority of patients, CH is caused by an abnormal development of the thyroid gland (thyroid dysgenesis) that is a sporadic disorder and accounts for 85% of cases and the remaining 15% of cases are caused by dyshormonogenesis. The clinical features of congenital hypothyroidism are so subtle that many newborn infants remain undiagnosed at birth and delayed diagnosis leads to the most severe outcome of CH, mental retardation, emphasizing the importance of neonatal screening. Dried capillary blood is used for screening and it is taken from heel prick optimally between 2 and 5 days of age. Blood spot TSH or thyroxine (T4) or both are being used for CH screening in different programs around the world. Neonates with abnormal thyroid screening tests should be recalled immediately for examination and a venipuncture blood sample should be drawn for confirmatory serum testing. Confirmatory serum should be tested for TSH and free T4, or total T4. Serum TSH and T4 undergo dynamic changes in the first weeks of life; it is important to compare serum results with age-normal reference ranges. Treatment should be started promptly and infant should be rendered euthyroid as early as possible, as there is an inverse relationship between intelligence quotient (IQ) and the age at diagnosis. Levothyroxine (l-thyroxine) is the treatment of choice and American academy of pediatrics and European society of pediatric endocrinology recommend 10-15µgm/kg/day as initial dose. The immediate goal of therapy is to normalize T4 within 2 weeks and TSH within one month. The overall goal of treatment is to ensure growth and neurodevelopmental outcomes as close as possible to their genetic potential.

Association of serum lipids with diabetic retinopathy in type 2 diabetes.

A total number of 140 type 2 diabetic patients with diabetic retinopathy (DR) were enrolled in the study from diabetic clinic during May 2011 till June 2012 to determine correlation between severity of DR with serum lipid and other modifiable risk factors in type 2 diabetic patients. Information including age, sex, height, body weight, body mass index (BMI), waist-hip ratio (WHR), and systolic and diastolic blood pressure was collected from each patient. Fasting plasma sugar, low density lipoprotein (LDL), triglyceride level (TG), high density lipoprotein (HDL), glycated hemoglobin (HbA1C), creatinine, and 24 h urinary albumin excretion was done for each patient. Estimated glomerular filtration rate (eGFR) was measured by modification of diet in renal disease (MDRD) equation. Patients were divided in five groups according to retinopathy status based on early treatment DR study (ETDRS) disease severity level. Statistical analysis was performed with Statistical Packages for Social Sciences (SPSS) statistical software (version 17.0 for Windows). The alpha level was set at P = 0.05 for all tests. Statistically significant positive correlation between severity of DR with systolic blood pressure P = 0.005 (r = 0.974), diastolic blood pressure P = 0.001(r = 0.994), LDL P = 0.005 (r = 0.976), TG P = 0.001 (r = 0.990), and 24 h urinary albumin P = 0.004 (r = 0.977) was documented. DR was also strongly positively correlated with smoking P = 0.017 (r = 0.941) and duration of diabetes P = 0.003 (r = 0.981). There was strong inverse correlation of DR with HDL P = 0.001 (r = -0.994) and eGFR P = 0.002 (r = -0.987). Serum lipids were significantly correlated with severity of DR.

Correlation between liver fat content with dyslipidemia and Insulin resistance.

Total 33 obese patients were studied to determine correlation in between liver fat content with dyslipidemia and insulin resistance. Liver and spleen attenuation measurements were taken with three regions of interests (ROIs) from the liver and two ROIs from the spleen. Hepatic attenuation indices were measured as follows: (1) Hepatic parenchymal attenuation (CTLP); (2) liver to spleen attenuation ratio (LSratio); and (3) difference between hepatic and splenic attenuation (LSdif). Bivariate correlation analysis showed moderate but statistically significant negative correlation between CTLP, LSratio, and LSdif with body mass index, triglyceride, fasting plasma sugar, fasting plasma insulin, homeostasis model assessment-insulin resistance (HOMA IR), 2 h oral glucose tolerance test (OGTT), and statistically significant positive correlation with high density lipoprotein. Nonalcoholic fatty liver disease (NAFLD) is closely associated with features of the metabolic syndrome. The amount of intrahepatic fat closely correlates with the number of metabolic syndrome features. The values of CTLP, LSratio, and LSdif demonstrate strong inverse correlations with degree of steatosis.