Effects of diabetes mellitus complications on sleep quality among Saudi Arabian patients-A national study.

Introduction: In diabetes mellitus (DM) patients, obtaining a good night's sleep is crucial for maintaining body caloric intake, controlling insulin levels, and reducing the likelihood of engaging in unhealthy behavior. Patients with poor sleep quality may experience impaired glycemia, playing a significant role in the development of chronic complications. This study aims to explore the effects of DM complications on sleep quality among Saudi Arabian patients. Patient and Methods: This is a cross-sectional study conducted among patients with diabetes. A self-administered, validated questionnaire translated into Arabic was distributed among diabetic patients using an online survey. The questionnaire includes sociodemographic characteristics (i.e. age, gender, marital status, etc.), the medical history of the patients, and a questionnaire about sleep quality. Results: Out of 4171 patients involved, 52.7% were females and 27.7% were aged between 40 and 60 years old. The prevalence of patients with perceived poor sleep quality was 24.1%. Significant predictors of poor sleep quality were the gender female, having social stressors, comorbid sleep disorders, associated comorbidities, increasing HbA1c levels, being overweight/obese, and diabetes complications. Furthermore, sleep disturbance, taking sleep medications, daytime sleepiness, and having bad dreams during sleep were also identified as prognostic factors for poor sleep quality. Conclusion: The subjective poor sleep quality of patients with diabetes was 24.1%. Poor sleep quality was significantly demonstrated by females who were having social stressors, comorbid sleep disorders, comorbidities, uncontrolled HbA1c levels, elevated BMI levels, and complications of diabetes. However, regular physical activity and adequate sleep were estimated to be the protective factors against poor sleep quality. Further research is needed to establish the effect of sleep quality among patients with DM.

Vision Loss as a Presenting Feature of Chronic Inflammatory Demyelinating Polyneuropathy: A Case Series.

BACKGROUND: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired, immune-mediated, and clinically heterogeneous demyelinating disease affecting the nerve roots and peripheral nerves. We report a series of 4 patients who presented with early and progressive vision loss in the context of new-onset CIDP: 3 due to papilledema and 1 due to optic neuropathy without papilledema. METHODS: This was a retrospective case series of 4 patients with vision loss as a presenting feature of CIDP evaluated at the Hospital of the University of Pennsylvania from January 2016 to August 2021. Demographic, clinical, diagnostic, and treatment data were collected via retrospective medical record review. RESULTS: Case 1 was a 51-year-old man with 2 months of progressive bilateral papilledema associated with reduced visual acuity (count fingers at 1 foot in each eye) and severely constricted visual fields. Case 2 was a 36-year-old man with 4 months of worsening headaches, reduced visual acuity (count fingers at 1 foot in each eye), severely constricted visual fields, and papilledema. Case 3 was a 39-year-old man with papilledema causing progressive vision loss (20/80 in both eyes), headaches, and relapsing limb sensorimotor deficits. Case 4 was a 19-year-old man with 3 months of progressive bilateral visual decline (20/400 in the right eye, 20/600 in the left eye), central scotoma, and optic disc pallor consistent with optic neuropathy without papilledema. All 4 patients met clinical and electrodiagnostic criteria of CIDP. Cases 3 and 4 each tested positive for serum neurofascin-155 IgG4 antibodies. All patients were managed with immunomodulatory therapy. Cases 1 and 2 also each required surgical intervention with bilateral optic nerve sheath fenestration and cerebrospinal fluid (CSF) shunting procedures. CONCLUSION: Vision loss from optic neuropathy with or without papilledema has rarely been reported in CIDP, and typically has been described in the context of longstanding disease. Our cases highlight how CIDP can present with early vision loss that may be profound and challenging to manage if diagnosis is delayed. CIDP should be considered in any patient with new progressive vision loss when associated with peripheral sensorimotor symptoms and elevated CSF protein. The small subgroup of CIDP patients with neurofascin-155 antibodies may be at particular risk of optic nerve involvement.

The Effect of Fluid Flow Shear Stress and Substrate Stiffness on Yes-Associated Protein (YAP) Activity and Osteogenesis in Murine Osteosarcoma Cells.

Osteosarcoma (OS) is an aggressive bone cancer originating in the mesenchymal lineage. Prognosis for metastatic disease is poor, with a mortality rate of approximately 40%; OS is an aggressive disease for which new treatments are needed. All bone cells are sensitive to their mechanical/physical surroundings and changes in these surroundings can affect their behavior. However, it is not well understood how OS cells specifically respond to fluid movement, or substrate stiffness-two stimuli of relevance in the tumor microenvironment. We used cells from spontaneous OS tumors in a mouse engineered to have a bone-specific knockout of pRb-1 and p53 in the osteoblast lineage. We silenced Sox2 (which regulates YAP) and tested the effect of fluid flow shear stress (FFSS) and substrate stiffness on YAP expression/activity-which was significantly reduced by loss of Sox2, but that effect was reversed by FFSS but not by substrate stiffness. Osteogenic gene expression was also reduced in the absence of Sox2 but again this was reversed by FFSS and remained largely unaffected by substrate stiffness. Thus we described the effect of two distinct stimuli on the mechanosensory and osteogenic profiles of OS cells. Taken together, these data suggest that modulation of fluid movement through, or stiffness levels within, OS tumors could represent a novel consideration in the development of new treatments to prevent their progression.

Hypotony Without Globe Rupture During Orbital Fracture Repair.

A 29-year-old male presented to the emergency department with an orbital fracture. He denied ocular symptoms and CT showed bilateral fracture of nasal bones, left medial orbital wall, and left orbital floor, with herniation of orbital fat and minimal retrobulbar hematoma. Pre-operative ophthalmic exam was unremarkable. Intra-operatively, intraocular pressure of the left eye was 5 mm Hg, a significant change from 17 mm Hg preoperatively. Globe exploration revealed no injury. Post-operatively, IOP normalized. With these findings it was felt that ocular manipulation related to the orbital fracture repair placed significant and intermittent pressure on the globe, thereby lowering IOP. Laryngoscope, 131:2238-2240, 2021.

Quantitative Assessment of Dry Eye Parameters After Müller's Muscle-Conjunctival Resection.

PURPOSE: Müller's muscle-conjunctival resection (MMCR) is a highly effective technique to correct upper eyelid ptosis. However, several authorities have raised concerns about the possibility of postoperative ocular surface dryness. This study was performed to assess the impact of MMCR on clinically meaningful parameters of the ocular surface. METHODS: In adult patients, tear break-up time, lipid layer thickness, and osmolarity were measured via direct observation, interferometry, and impedance measurements before surgery and 3 months after surgery in patients who underwent MMCR. Statistical analysis was performed via a dedicated software package. RESULTS: Fifteen eyes of 14 patients were included in the study. Mean pre- and postoperative tear break-up times were 12.71 ± 2.20 and 12.43 ± 2.41 seconds, respectively (p = 0.1648). Preoperatively, the mean lipid layer thickness measurement was 91.00 ± 7.02 nm, whereas the mean postoperative value was 88.86 ± 21.36 nm (p = 0.6613). The mean preoperative tear osmolarity measured 291.4 ± 8.86 mOsm/l, and the mean postoperative measurement was 289.86 ± 9.74 mOsm/l (p = 0.2652). CONCLUSIONS: MMCR does not appear to change clinically meaningful ocular surface disease parameters, and postoperative dryness did not result from this procedure. In appropriately selected patients, MMCR can be safely performed without increased concerns regarding postoperative dry eye disease.