Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24.805
Filtrar
1.
Middle East Afr J Ophthalmol ; 27(2): 91-99, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874041

RESUMO

PURPOSE: This study compares a web-based teleophthalmology assessment with a clinical slit lamp examination to screen for diabetic retinopathy (DR) and age-related macular degeneration (AMD) among diabetic patients in a rural East African district. METHODS: Six hundred and twelve eyes from 306 diabetic patients underwent both a clinical slit lamp examination and a teleretina (TR) assessment by an experienced ophthalmologist. Both assessments were compared for any DR and AMD using the early treatment diabetic retinopathy study and age-related eye disease study grading scales, respectively. RESULTS: Of the 612 TR assessment photos, 74 (12%) were deemed ungradable due to media opacities, poor patient cooperation, or unsatisfactory photographs. The ability to detect DR and AMD showed a fair agreement (kappa statistic 0.27 and 0.23, respectively) between the TR and clinical slit lamp examination. Relative to a clinical slit lamp evaluation, a positive TR diagnosis carried a 75.0% positive predictive value when diagnosing DR and a 27.3% positive predictive value when diagnosing AMD. A negative TR diagnosis carried a 97.2% negative predictive value for the diagnosis of DR and a 98.1% negative predictive value for the diagnosis of AMD. CONCLUSION: When comparing TR assessments to clinical slit lamp examinations to diagnose DR and AMD, there was a fair agreement. Although further validation is needed, the TR approach provides a promising method to diagnose DR and AMD, two major causes of ocular impairment worldwide.


Assuntos
Retinopatia Diabética/diagnóstico , Degeneração Macular/diagnóstico , Oftalmologia/métodos , Exame Físico , Consulta Remota/métodos , Telemedicina/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus , Feminino , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Microscopia com Lâmpada de Fenda
2.
Vestn Oftalmol ; 136(4. Vyp. 2): 201-206, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32880140

RESUMO

There are currently no reliable biomarkers for predicting the response to treatment of diabetic macula edema (DME). PURPOSE: To asses the predictive role of neurodegenerative biomarker of the response to anti-VEGF therapy of DME. MATERIAL AND METHODS: Examination and treatment was carried out on 14 patients (20 eyes) with DME. The eyes were divided into 2 groups by the type of diabetes: 6 eyes with type 1 diabetes and 14 eyes with type 2 diabetes. The duration of diabetes was 16.5±7.9 years, the level of glycated hemoglobin was 8.4±2%. A number of indicators were evaluated using optical coherence tomography (OCT) in order to determine the neurodegenerative biomarkers of the response to anti-VEGF treatment. All patients underwent standard loading course of Aflibercept (5 intravitreal injections). RESULTS: Significant improvement in Best Corrected Visual Acuity (BCVA) and decrease of central retinal thickness (CRT) was seen after the treatment course. Data analysis revealed a correlation between functional outcomes of the treatment, and the following pathological changes in the retina: thickness of retinal nerve fiber layer (RNFL), thickness of the complex of ganglion cell and inner plexiform layers in the macular region (GCL+), thickness of the RNFL and GCL+ complex (GCL++) in the macular region, ΔCRT, as well as BCVA, patient age, and type of diabetes. Anatomical outcomes correlate with the stage of diabetic retinopathy, RNFL, GCL+, GCL++, violation of the integrity of the ellipsoid zone before treatment. CONCLUSION: The course of intravitreal administration of the Aflibercept drug has been established to be an effective method of treating patients with clinically significant DME. Neurodegenerative biomarkers of the response to the anti-VEGF drug therapy have been determined: thickness of the peripapillary RNFL, GCL+ and GCL ++, as well as integrity of the ellipsoid zone.


Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Edema Macular , Biomarcadores , Humanos , Células Ganglionares da Retina , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual
3.
Vestn Oftalmol ; 136(4. Vyp. 2): 272-278, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32880150

RESUMO

Diabetic retinopathy (DR) is an important, socially significant complication of diabetes mellitus that leads to irreversible loss of vision. This article reviews the studies of peripheral changes in DR, different methods used in its diagnostics, monitoring and assessment of therapeutic effects. The article contains detailed examination of the modern widefield imaging methods that allow studying the middle and extreme periphery of the retina and help obtain a wide range of DR biomarkers. Of greatest interest in this matter is optical coherence tomography angiography due to possibility of detailed non-invasive assessment of the condition of retinal microvasculature, precise determination of the area and visualization of the sites of neovascularization and non-perfused regions of the retina. Quantitative characteristics of these changes serve as important diagnostic and prognostic visual biomarkers of DR.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Angiofluoresceinografia , Humanos , Retina , Vasos Retinianos , Tomografia de Coerência Óptica
4.
Vestn Oftalmol ; 136(4. Vyp. 2): 300-309, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32880155

RESUMO

The incidence of diabetes in the world is steadily increasing, and so is growing the number of cases of vision loss and blindness resulting from diabetic retinopathy (DR). This pathology is asymptomatic in the initial stages, but only the early treatment can be effective. In this regard, DR screening is an important and actual problem. This article reviews the principles, criteria, and problems of the currently run DR screening programs that are based on digital photography of the fundus. Special attention is paid to the displayed biomarkers and their role in DR screening. Various research methods are described, such as fluorescence angiography, optical coherence tomography, optical coherence tomography agniography, laser scanning ophthalmoscopy, which can be used to visualize pathological changes in the retina associated with DR. These changes were considered as potential screening biomarkers for DR. The review also describes new areas of screening based on telemedicine, artificial intelligence, and mobile photo-registering devices.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Inteligência Artificial , Humanos , Retina , Tomografia de Coerência Óptica
5.
Vestn Oftalmol ; 136(4. Vyp. 2): 344-353, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32880160

RESUMO

Pathogenesis of diabetic retinopathy (DR) is complex and multifactorial, giving rise to a wide range of potential biomarkers - quantitatively and objectively measurable indicators of the biological, pathological processes or pharmacological response to therapy. This non-systemic review is devoted to a vital problem - possibility of using biomarkers acquired with optical coherence tomography angiography (OCTA-biomarkers) in DR. The review examines the qualitative and quantitative indicators obtained using OCTA as potential biomarkers of DR. Of greatest interest is the assessment of diabetic microvascular abnormalities such as microaneurysms, intraretinal microvascular abnormalities, neovascularization and non-perfusion (ischemia) zones. A separate section is devoted to currently well-studied indices reflecting the area and regularity of the foveolar avascular zone, and microcirculation indices such as capillary perfusion density, blood flow indices, fractal dimension of retinal microcirculation vessels, etc. The relationship of OCTA-biomarkers and diabetic macular edema is also discussed. Biomarkers obtained with wide-field OCTA, such as indices quantitatively reflecting ischemia and neovascularization are paid special attention in the review. The problems and solutions associated with the use of OCTA-biomarkers in DR are also considered. In general OCTA-biomarkers in DR are becoming an important tool for screening, diagnosis, monitoring of DR, and for predicting and preventing patients' clinical response to treatment.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Biomarcadores , Angiofluoresceinografia , Humanos , Vasos Retinianos , Tomografia de Coerência Óptica
6.
Vestn Oftalmol ; 136(4. Vyp. 2): 359-366, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32880162

RESUMO

Analysis of the current understanding of the role of internal limiting membrane in the pathogenesis of diabetic macular edema and the feasibility of its surgical removal is based on data from domestic and international literature on pathogenesis, clinical manifestations, outcomes of multicenter studies of treatment and prognosis of this disease. The advantages and disadvantages of both peeling and preservation of the inner limiting membrane are described. The limitations and inconsistencies of data provided by the authors of each theory requires more complete functional studies in the pre- and postoperative periods, increasing the selection of patients, modifying the criteria for inclusion in groups, and microscopic examination of removed membranes. Thus, this issue requires further study due to the ambiguity of the conclusions and the lack of comparative data on the long-term prospects of each of the methods.


Assuntos
Diabetes Mellitus , Retinopatia Diabética/cirurgia , Membrana Epirretiniana/cirurgia , Edema Macular , Humanos , Resultado do Tratamento , Acuidade Visual , Vitrectomia
7.
Medicine (Baltimore) ; 99(35): e21992, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871950

RESUMO

BACKGROUND: Diabetic macular edema (DME) can cause severe vision impairments for patients with diabetes. Recently, Conbercept has shown efficacy on DME with 3-monthly loading dose injection and pro re nata (PRN, 3+PRN) thereafter in retrospectivetrials. Furthermore, there are some other approaches have been recommended such as 2mg bimonthly (2q8) after 5 initial doses, or Conbercept 0.5mg treat-and-extend, however, some patients still have recurrence of the disease after treatment. Therefore, in order to identify more efficacy and safety approach on Conbercept inpatients with DME, a randomized controlled trial will be performed with 6-monthly loading dose injection and PRN (6+PRN) compared with 3+PRN treatments. METHODS: This study is a multicenter, randomized control trial of Conbecept treating DME in China. Patients with type 2 diabetes suffered from DEM who already planned to receive Conbercept treatment will be recruited. All subjects will be randomized divided into either a study agent treatment group (6+PRN) or a control group (3+PRN), and observes the subjects for 48 weeks after initiation of treatment. RESULTS: This study will provide a new powerful evidence of the efficacy and safety of Conbecept treating DME. DISCUSSION: This RTC study will determine whether multiple treatments of Conbercept provide better effectiveness in patients with DME. TRIAL REGISTRATION NUMBER: ChiCTR2000032728.


Assuntos
Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Proteínas Recombinantes de Fusão/uso terapêutico , Angiografia , Estudos de Equivalência como Asunto , Humanos , Estudos Multicêntricos como Assunto , Tomografia de Coerência Óptica
8.
Ann Agric Environ Med ; 27(3): 326-334, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32955210

RESUMO

INTRODUCTION AND OBJECTIVE: αB-crystallin belongs to the ubiquitous family of small heat-shock proteins. It was discovered as a physiological protein of the eye lens, maintaining its liquid-like property. Furthermore, αB-crystallin was proved to playa bipolar role in both physiological and pathophysiological conditions. This review discusses current knowledge about the biology and genetics of αB-crystallin, and summarizes recent advances in understanding its role in ophthalmic and neurological disorders, as well as breast cancer, renal cancer and other malignancies. STATE OF KNOWLEDGE: α-crystallins are established as important elements of the protein quality control network, and consequently their defects are related to multiple human diseases. New studies highlight αB-crystallin's involvement in proliferative diabetic retinopathy angiogenesis and point out its therapeutic potential in age-related macular degeneration. αB-crystallin is thought to be associated with the disease-causing protein aggregates, leading to its connection with such neurological disturbances as anaplastic astrocytoma, Parkinson disease, aging deficits in the peripheral nervous system and multiple sclerosis. In breast cancer, it was proven to be a marker of aggressive behaviur and cerebral metastases. Strong expression of αB-crystallin promoted growth and migration of clear cell renal cell carcinoma cells and was correlated with lower overall survival rate. Considering other malignancies, its various roles were established in colorectal and gastric cancers, head and neck squamous cell carcinomas and osteosarcomas. CONCLUSIONS: Further studies concerning αB-crystallin seem to be enormously promising, as they might improve our understanding of common human pathologies as well as contemporary diagnostics and treatment.


Assuntos
Astrocitoma/patologia , Neoplasias da Mama/patologia , Cristalinas/metabolismo , Retinopatia Diabética/patologia , Esclerose Múltipla/patologia , Doenças do Sistema Nervoso/patologia , Doença de Parkinson/patologia , Feminino , Humanos , Sistema Nervoso Periférico/patologia
9.
PLoS One ; 15(8): e0237149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764774

RESUMO

PURPOSE: To investigate the association between daily sunlight exposure duration and diabetic retinopathy in Korean adults with diabetes. METHODS: This study used data from the 2008-2011 Korea National Health and Nutrition Examination Survey. Overall, 1,089 patients with diabetes aged >40 years were included. The duration of daily sunlight exposure was assessed via health interviews. Comprehensive ophthalmic evaluations, including standard retinal fundus photography after pupil dilation, were conducted. Diabetic retinopathy was graded using the modified Airlie House Classification. Multivariate logistic regression analysis was performed to analyze the association between daily sunlight exposure duration and the diagnosis of diabetic retinopathy and non-proliferative diabetic retinopathy. RESULTS: The risk of diabetic retinopathy was 2.66 times higher in the group with ≥5 h of daily sunlight exposure than in the group with less exposure after adjusting for risk factors such as duration of diabetes, serum hemoglobin A1c level, hypertension, and dyslipidemia (P = 0.023). Furthermore, the risk of non-proliferative diabetic retinopathy was 3.13 times higher in the group with ≥5 h of daily sunlight exposure than in the group with less exposure (P = 0.009). In patients with diabetes for <10 years, the risks of diabetic retinopathy and non-proliferative diabetic retinopathy were 4.26 and 4.82 times higher in the group with ≥5 h of daily sunlight exposure than the group with less exposure, respectively (P < 0.05). CONCLUSIONS: This study revealed that sunlight exposure for ≥5 h a day was significantly associated with an increased risk of diabetic retinopathy and non-proliferative diabetic retinopathy in Korean patients with diabetes. The risks were significantly higher in patients with diabetes for <10 years. Therefore, reducing daily sunlight exposure could be an early preventive strategy against diabetic retinopathy in people with diabetes.


Assuntos
Retinopatia Diabética/epidemiologia , Luz Solar/efeitos adversos , Idoso , Estudos Transversais , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/etiologia , Retinopatia Diabética/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais/estatística & dados numéricos , Estresse Oxidativo/efeitos da radiação , Fotografação , Fotoperíodo , Prevalência , República da Coreia/epidemiologia , Retina/diagnóstico por imagem , Retina/efeitos da radiação , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
10.
PLoS One ; 15(8): e0234733, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822350

RESUMO

PURPOSE: To investigate the knowledge and practices regarding diabetic retinopathy (DR) among diabetic patients included in a community-based primary health system (CBPHS) in China. METHODS: Diabetic patients aged 18 years and above registered in the CBPHS in Yueqing city, Zhejiang province were recruited. Information obtained by questionnaire included: demographic and socioeconomic status, knowledge about DR, and ocular and medical history. The primary outcome was whether the participant knew that DM can affect the eyes, defined according to the question: "Do you know diabetes mellitus (DM) can affect eyes? (yes or no)". A knowledge score was calculated based on the responses to seven questions, with 1 point awarded for a correct response and 0 points for an incorrect or uncertain answer. RESULTS: A total of 1972 diabetic patients were included in the study with an average age of 65.2±10.8 years, 45.7% were male. One thousand two hundred and nineteen patients (61.8%) knew that DM can affect the eyes. Significant differences in age, education, income status, insurance covering eye care, fasting blood glucose, duration of DM, history of hypertension existed between subjects who knew and those who did not know that DM can affect the eyes (P<0.05 for all). The proportion of correct answers to the DR knowledge questions ranged from 33.3% to 61.8%, with an average score of 3.65±2.47. In the multiple regression analysis, the knowledge score was significantly associated with age, education, income, history of hypertension, duration of DM, being told that regular examinations should be performed and concern about vision loss (P <0.01 for all). CONCLUSIONS: The knowledge toward DR among DM patients were still low within the chronic disease management system in eastern China. Routine ophthalmic screening, health care promotions, and educational programs should be emphasized and implemented for better DR prevention and management.


Assuntos
Retinopatia Diabética/epidemiologia , Idoso , China/epidemiologia , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Doença Crônica/terapia , Retinopatia Diabética/prevenção & controle , Retinopatia Diabética/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Política Pública , Sistema de Registros/estatística & dados numéricos , População Rural/estatística & dados numéricos , Inquéritos e Questionários
11.
Science ; 369(6506)2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32820093

RESUMO

In developed countries, the leading causes of blindness such as diabetic retinopathy are characterized by disorganized vasculature that can become fibrotic. Although many such pathological vessels often naturally regress and spare sight-threatening complications, the underlying mechanisms remain unknown. Here, we used orthogonal approaches in human patients with proliferative diabetic retinopathy and a mouse model of ischemic retinopathies to identify an unconventional role for neutrophils in vascular remodeling during late-stage sterile inflammation. Senescent vasculature released a secretome that attracted neutrophils and triggered the production of neutrophil extracellular traps (NETs). NETs ultimately cleared diseased endothelial cells and remodeled unhealthy vessels. Genetic or pharmacological inhibition of NETosis prevented the regression of senescent vessels and prolonged disease. Thus, clearance of senescent retinal blood vessels leads to reparative vascular remodeling.


Assuntos
Envelhecimento/patologia , Retinopatia Diabética/patologia , Armadilhas Extracelulares/imunologia , Vasos Retinianos/patologia , Animais , Senescência Celular , Retinopatia Diabética/imunologia , Modelos Animais de Doenças , Células Endoteliais/imunologia , Células Endoteliais/patologia , Humanos , Inflamação/imunologia , Inflamação/patologia , Camundongos , Camundongos Endogâmicos C57BL , Neutrófilos/imunologia , Vasos Retinianos/imunologia
12.
Diab Vasc Dis Res ; 17(7): 1479164120945910, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32746630

RESUMO

BACKGROUND: The effect of interarm blood pressure difference on the development of diabetic retinopathy, proteinuria and chronic kidney disease remains unknown. We investigated to determine the impact of interarm blood pressure difference on the prevalence of diabetic retinopathy, proteinuria and chronic kidney disease in patients with type 2 diabetes. METHODS: The study included 563 patients with diabetes, who were evaluated with a simultaneous bilateral blood pressure measurement. The cutoff values for interarm blood pressure difference were 5, 10 and 15 mmHg. Logistic regression analysis was used to explore the relation between interarm blood pressure difference and diabetic retinopathy, proteinuria and chronic kidney disease. RESULTS: Diabetic patients with systolic interarm blood pressure difference ⩾5, ⩾10 and ⩾15 mmHg showed an increased risk of diabetic retinopathy [adjusted odds ratio = 1.48 (95% confidence interval = 1.01-2.18), odds ratio = 1.80 (95% confidence interval = 0.99-3.22), odds ratio = 2.29 (95% confidence interval = 1.00-5.23)] after adjustment. There were significant associations between interarm blood pressure difference ⩾5 and ⩾10 mmHg and proteinuria [odds ratio = 1.68 (95% confidence interval = 1.15-2.44), 1.89 (95% confidence interval = 1.05-3.37)]. CONCLUSION: The association between interarm blood pressure difference and the presence of diabetic retinopathy emerged even for systolic interarm blood pressure difference ⩾5 mmHg without interaction of systolic blood pressure. Systolic interarm blood pressure difference should be considered a surrogate marker for vascular complication in patients with type 2 diabetes.


Assuntos
Pressão Sanguínea , Diabetes Mellitus Tipo 2/fisiopatologia , Retinopatia Diabética/fisiopatologia , Extremidade Superior/irrigação sanguínea , Idoso , Índice Tornozelo-Braço , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/fisiopatologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Proteinúria/diagnóstico , Proteinúria/epidemiologia , Proteinúria/fisiopatologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Seul/epidemiologia
13.
PLoS One ; 15(7): e0236867, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735583

RESUMO

PURPOSE: To compare the anatomical and functional outcomes of severe diabetic macular edema (DME) with massive hard exudates managed by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling or nonsurgical treatment. METHODS: We retrospectively reviewed 40 eyes with DME and massive hard exudates treated with either PPV with ILM peeling (vitrectomy group, 21 eyes) or nonsurgical treatment with anti-vascular endothelium growth factor (VEGF) and/or steroids (nonsurgical group, 19 eyes). Changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) and resolution of macular hard exudates were compared between the two groups. RESULTS: After treatment, CRT decreased steadily in the vitrectomy group but fluctuated in the nonsurgical group. Compared with eyes in the nonsurgical group, eyes in the vitrectomy group had better visual improvement (P < 0.05 at 6 and 12 months and the final visit) and greater decrease in CRT (P < 0.05 at 3 and 6 months and the final visit) after adjustment for baseline BCVA. Hard exudates resolved more rapidly in the vitrectomy group than in the nonsurgical group, with 94.1% versus 47.4% eyes showing significant absorption after 6 months of the treatment (P = 0.003). In the vitrectomy group, 62% eyes did not require any further injections for treating DME after the operation. CONCLUSIONS: PPV with ILM peeling resulted in rapid resolution of hard exudates with significant anatomical and functional improvement in DME with massive hard exudates.


Assuntos
Retinopatia Diabética , Membrana Epirretiniana/cirurgia , Edema Macular , Vitrectomia/métodos , Idoso , Retinopatia Diabética/fisiopatologia , Retinopatia Diabética/cirurgia , Retinopatia Diabética/terapia , Feminino , Humanos , Edema Macular/fisiopatologia , Edema Macular/cirurgia , Edema Macular/terapia , Masculino , Pessoa de Meia-Idade , Retina/fisiopatologia , Doenças Retinianas/cirurgia , Doenças Retinianas/terapia , Estudos Retrospectivos , Resultado do Tratamento
14.
Retina ; 40(9): e53-e54, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32842093
15.
Cochrane Database Syst Rev ; 8: CD012927, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32813281

RESUMO

BACKGROUND: The widespread use of mobile technologies can potentially expand the use of telemedicine approaches to facilitate communication between healthcare providers, this might increase access to specialist advice and improve patient health outcomes. OBJECTIVES: To assess the effects of mobile technologies versus usual care for supporting communication and consultations between healthcare providers on healthcare providers' performance, acceptability and satisfaction, healthcare use, patient health outcomes, acceptability and satisfaction, costs, and technical difficulties. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and three other databases from 1 January 2000 to 22 July 2019. We searched clinical trials registries, checked references of relevant systematic reviews and included studies, and contacted topic experts. SELECTION CRITERIA: Randomised trials comparing mobile technologies to support healthcare provider to healthcare provider communication and consultations compared with usual care. DATA COLLECTION AND ANALYSIS: We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: We included 19 trials (5766 participants when reported), most were conducted in high-income countries. The most frequently used mobile technology was a mobile phone, often accompanied by training if it was used to transfer digital images. Trials recruited participants with different conditions, and interventions varied in delivery, components, and frequency of contact. We judged most trials to have high risk of performance bias, and approximately half had a high risk of detection, attrition, and reporting biases. Two studies reported data on technical problems, reporting few difficulties. Mobile technologies used by primary care providers to consult with hospital specialists We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: - probably make little or no difference to primary care providers following guidelines for people with chronic kidney disease (CKD; 1 trial, 47 general practices, 3004 participants); - probably reduce the time between presentation and management of individuals with skin conditions, people with symptoms requiring an ultrasound, or being referred for an appointment with a specialist after attending primary care (4 trials, 656 participants); - may reduce referrals and clinic visits among people with some skin conditions, and increase the likelihood of receiving retinopathy screening among people with diabetes, or an ultrasound in those referred with symptoms (9 trials, 4810 participants when reported); - probably make little or no difference to patient-reported quality of life and health-related quality of life (2 trials, 622 participants) or to clinician-assessed clinical recovery (2 trials, 769 participants) among individuals with skin conditions; - may make little or no difference to healthcare provider (2 trials, 378 participants) or participant acceptability and satisfaction (4 trials, 972 participants) when primary care providers consult with dermatologists; - may make little or no difference for total or expected costs per participant for adults with some skin conditions or CKD (6 trials, 5423 participants). Mobile technologies used by emergency physicians to consult with hospital specialists about people attending the emergency department We assessed the certainty of evidence for this group of trials as moderate. Mobile technologies: - probably slightly reduce the consultation time between emergency physicians and hospital specialists (median difference -12 minutes, 95% CI -19 to -7; 1 trial, 345 participants); - probably reduce participants' length of stay in the emergency department by a few minutes (median difference -30 minutes, 95% CI -37 to -25; 1 trial, 345 participants). We did not identify trials that reported on providers' adherence, participants' health status and well-being, healthcare provider and participant acceptability and satisfaction, or costs. Mobile technologies used by community health workers or home-care workers to consult with clinic staff We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: - probably make little or no difference in the number of outpatient clinic and community nurse consultations for participants with diabetes or older individuals treated with home enteral nutrition (2 trials, 370 participants) or hospitalisation of older individuals treated with home enteral nutrition (1 trial, 188 participants); - may lead to little or no difference in mortality among people living with HIV (RR 0.82, 95% CI 0.55 to 1.22) or diabetes (RR 0.94, 95% CI 0.28 to 3.12) (2 trials, 1152 participants); - may make little or no difference to participants' disease activity or health-related quality of life in participants with rheumatoid arthritis (1 trial, 85 participants); - probably make little or no difference for participant acceptability and satisfaction for participants with diabetes and participants with rheumatoid arthritis (2 trials, 178 participants). We did not identify any trials that reported on providers' adherence, time between presentation and management, healthcare provider acceptability and satisfaction, or costs. AUTHORS' CONCLUSIONS: Our confidence in the effect estimates is limited. Interventions including a mobile technology component to support healthcare provider to healthcare provider communication and management of care may reduce the time between presentation and management of the health condition when primary care providers or emergency physicians use them to consult with specialists, and may increase the likelihood of receiving a clinical examination among participants with diabetes and those who required an ultrasound. They may decrease the number of people attending primary care who are referred to secondary or tertiary care in some conditions, such as some skin conditions and CKD. There was little evidence of effects on participants' health status and well-being, satisfaction, or costs.


Assuntos
Pessoal de Saúde , Telemedicina/estatística & dados numéricos , Tempo para o Tratamento , Adulto , Viés , Telefone Celular/estatística & dados numéricos , Agentes Comunitários de Saúde/estatística & dados numéricos , Segurança Computacional , Dermatologistas , Retinopatia Diabética/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Custos de Cuidados de Saúde , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Satisfação do Paciente , Satisfação Pessoal , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , Insuficiência Renal Crônica/terapia , Dermatopatias/terapia , Telemedicina/economia , Fatores de Tempo , Ultrassonografia
16.
Curr Opin Ophthalmol ; 31(5): 357-365, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32740069

RESUMO

PURPOSE OF REVIEW: Diabetic retinopathy is the most common specific complication of diabetes mellitus. Traditional care for patients with diabetes and diabetic retinopathy is fragmented, uncoordinated and delivered in a piecemeal nature, often in the most expensive and high-resource tertiary settings. Transformative new models incorporating digital technology are needed to address these gaps in clinical care. RECENT FINDINGS: Artificial intelligence and telehealth may improve access, financial sustainability and coverage of diabetic retinopathy screening programs. They enable risk stratifying patients based on individual risk of vision-threatening diabetic retinopathy including diabetic macular edema (DME), and predicting which patients with DME best respond to antivascular endothelial growth factor therapy. SUMMARY: Progress in artificial intelligence and tele-ophthalmology for diabetic retinopathy screening, including artificial intelligence applications in 'real-world settings' and cost-effectiveness studies are summarized. Furthermore, the initial research on the use of artificial intelligence models for diabetic retinopathy risk stratification and management of DME are outlined along with potential future directions. Finally, the need for artificial intelligence adoption within ophthalmology in response to coronavirus disease 2019 is discussed. Digital health solutions such as artificial intelligence and telehealth can facilitate the integration of community, primary and specialist eye care services, optimize the flow of patients within healthcare networks, and improve the efficiency of diabetic retinopathy management.


Assuntos
Inteligência Artificial , Retinopatia Diabética/diagnóstico , Análise Custo-Benefício , Acesso aos Serviços de Saúde , Humanos , Oftalmologia/economia , Oftalmologia/tendências , Telemedicina/economia , Telemedicina/métodos
18.
Orv Hetil ; 161(35): 1475-1482, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32822326

RESUMO

INTRODUCTION: Swept-source optical coherence tomography is a useful non-invasive device that is used to understand better the role of choroid in the pathogenesis of diabetic retinopathy. AIM: To measure choroidal thickness in diabetic eyes and to correlate it with established systemic risk factors, the severity and the therapy of diabetic retinopathy. METHOD: Prospective cross-sectional study using swept-source optical coherence tomography has been performed. Choroidal and macular thickness maps of 117 eyes of 60 diabetic patients were compared to data from 45 eyes of 24 healthy controls. In all diabetic patients, the systemic risk factors (duration and type of diabetes, blood hemoglobin A1C level, hypertension), the type (no, non-proliferative or proliferative) and the therapy of diabetic retinopathy were recorded, and their relation to choroidal thickness was evaluated using multiple regression models. RESULTS: A significantly thinner choroid was measured in diabetic patients compared to controls (p<0.05). Analysing the whole cohort, aging (p<0.001) and the presence of hypertension (p<0.05) showed significant correlation with choroidal thinning. In diabetic patients, the duration of diabetes significantly correlated with choroidal thinning (p<0.05). In multivariable analysis, the duration of diabetes remained a significant predictor of choroidal thickness (ß -0.18; p = 0.02). A significantly thinner choroid was measured in patients with proliferative retinopathy and in patients after panretinal photocoagulation treatment compared to nonproliferative retinopathy (p<0.05). CONCLUSION: Diabetes mellitus itself and diabetic retinopathy progression affects choroidal thickness significantly. Choroidal thickness is affected significantly by systemic risk factors (age, the presence of hypertension, disease duration). Choroidal thinning proved to be correlated with panretinal photocoagulation treatment of diabetic retinopathy. Orv Hetil. 2020; 161(35): 1475-1482.


Assuntos
Corioide/diagnóstico por imagem , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/complicações , Macula Lutea/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Adulto , Glicemia/metabolismo , Estudos de Casos e Controles , Corioide/patologia , Estudos Transversais , Retinopatia Diabética/patologia , Hemoglobina A Glicada/metabolismo , Humanos , Hipertensão/complicações , Pessoa de Meia-Idade , Estudos Prospectivos
19.
J Assoc Physicians India ; 68(8): 25-29, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32738836

RESUMO

Objective: To find the serum hsCRP (high sensitive C reactive protein) levels in type 2 Diabetes Mellitus (DM) patients and compare its level between type 2 DM patients and healthy control subjects. To find the relationship of hsCRP levels in type 2 DM with and without vascular complications. To find the correlation of hsCRP with HbA1c and duration of type 2 DM among cases and to find the optimum cut-off value for hsCRP among type 2 DM patients. Methods: The study was conducted on type 2 DM patients with or without microvascular or macrovascular complications and nondiabetic healthy controls from April 2017 to July 2018. Fasting plasma glucose, postprandial plasma glucose, HbA1C, and hsCRP were estimated. Duration of diabetes was noted. SPSS for Windows version22 software was used for statistical analysis. Chi2 or Fisher's exact test was applied to compare frequency distribution. The student t-test was applied to compare two independent means. Test of normality was performed before applying the statistical test for significance. The area under the curve (AUC) and sensitivity and specificity of HSCRP levels in DM2 at various cut-off values were calculated. Results: The mean age of the patients 53.46±12.01 years with 49% among the age group 45 - 64 years and 62% were females. The mean value of hsCRP among diabetic subjects comes out to be 4.06 ± 2.59 mg/l, while among healthy controls is 0.93 ± 0.81 mg/l (p<0.0001). The mean duration of diabetes in our study is 6.90 ± 5.89 years with maximum cases had duration of diabetes between 1-5 years and a positive linear correlation with hsCRP (r=0.20; p=0.044). A positive linear correlation between hsCRP and HBA1C is found (r = 0.0507; p<0.0001). Among 100 cases, 71 cases were with overt complications of diabetes as either microvascular or macrovascular complications. Of these 71 cases with overt complications, 61.97% cases were with high risk levels of hsCRP (>3.0 mg/l). The mean value of hsCRP among cases with complications is 4.45 ± 2.74 mg/l while among cases without complications is 3.11 ± 1.89 mg/l (p=0.0176). The most common complication associated among the cases are microvascular complication in the form of diabetic retinopathy with mean hsCRP 4.61± 2.88 while the mean hsCRP was highest among the cases associated with cardiovascular complication as 5.37±3.10. In this study on 100 participants with type 2 diabetes mellitus, the maximum value of sensitivity of 89.00 % and specificity of 87.00% is found in diabetes at the best cut-off of serum hsCRP levels greater than 1.21 mg/L. Conclusion: hsCRP levels were high in type 2 diabetes mellitus with higher risk levels associated with macrovascular complications compared to microvascular complications. The levels of hsCRP correlated with duration of diabetes and HbA1c. Routine screening for future cardiovascular events in diabetes patients can be done with best cut-off value of hsCRP at 1.21 mg/L.


Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Adulto , Idoso , Glicemia , Estudos de Casos e Controles , Jejum , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
20.
Orv Hetil ; 161(30): 1243-1251, 2020 07.
Artigo em Húngaro | MEDLINE | ID: mdl-32653867

RESUMO

INTRODUCTION: The prevalence of diabetes mellitus is significantly increasing worldwide. Distal sensorimotor neuropathy (DSPN) is the most common and the earliest detectable microvascular complication. Due to its diverse clinical appearance and atypical symptoms, DSPN is often recognized in an advanced stage. AIM AND METHOD: In our study, the data of 431 patients who were examined using the Neurometer® between 2011 and 2018 at the Diabetic Neuropathy Center of the University of Debrecen were processed and the correlations between cardiovascular and microvascular complications, laboratory parameters and the severity of DSPN were investigated. RESULTS: The average age of patients was 63.4 years, 62% of them were women, and 92% had type 2 diabetes mellitus. The average duration of diabetes was 13.7 years. Cardiovascular disease (CVD) was diagnosed in 42% of the patients. The incidence of retinopathy was 12%, persistent microalbuminuria was 16%. Despite DSNP complaints, neuronal damage could not be detected in 19%; in the examined patients 49% had mild, 19% moderate and 13% severe neuropathy. Diabetes-related neurological damage was more serious in the presence of both diabetic retinopathy (p<0.001) and microalbuminuria (p<0.001). The incidence of these microvascular complications and the severity of DSPN showed a significant positive correlation (p<0.001). There was no correlation between the severity of peripheral neuropathy and the development of CVD, and we did not find any correlations between the severity of DSPN and CVD. CONCLUSION: Based on our investigation, correlation between the progression of diabetic neuropathy and cardiovascular complications was not found, although the progression of diabetic neuropathy indicated the development of other microvascular diseases. Peripheral neurological examination using the Neurometer® is appropriate for controlling the DSPN status and the establishment of the severity of neuropathy determines the quality of life in diabetic patients. Among these patients, the risk of CVD can be assessed by Ewing's test for autonomic nervous system function. Orv Hetil. 2020; 161(30): 1243-1251.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Neuropatias Diabéticas/epidemiologia , Retinopatia Diabética/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/psicologia , Neuropatias Diabéticas/psicologia , Retinopatia Diabética/psicologia , Feminino , Humanos , Hungria/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Doenças do Sistema Nervoso Periférico/epidemiologia , Qualidade de Vida
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA