Search

Diabetic retinopathy is a complication of diabetes mellitus and a leading cause of blindness and visual impairment globally. Limited information existed on the epidemiology of diabetic retinopathy at the national level in Ethiopia. Thus, the objective of this review was to determine the pooled prevalence of diabetic retinopathy and its associated risk factors in Ethiopia. A systematic review and meta-analysis was conducted using previous primary studies that were found in electronic databases such as Web of Science, Scopus, PubMed, CINHAL, Google Scholar, and online African journals. We evaluated the quality of the included studies using the Newcastle-Ottawa Assessment Scale. The random-effects model was applied because heterogeneity was expected. I-Square and the Cochrane Q statistics were used to evaluate heterogeneity. Publication bias was examined using Egger's test and a funnel plot. A random-effect meta-analysis was applied to pool the odds ratios of risk factors to determine the association between the independent and dependent variables. After 598 articles were found, 22 studies that met the eligibility requirements were included. The pooled prevalence of retinopathy among patients with diabetes in Ethiopia was 24.35% (95% CI: 18.88–29.83), with considerable heterogeneity (I2 = 98.18%, p < 0.001). Ten years and longer with diabetes (AOR = 4.36, 95% CI: 1.71–7.01), hypertension (AOR = 2.54, 95% CI: 1.45–3.63), poor glycemic control (AOR = 3.83, 95% CI: 1.62–6.04), and positive proteinuria (AHR = 1.55, 95% CI: 1.02–2.07) were risk factors for diabetic retinopathy. Retinopathy affects one in four patients with diabetes. Diabetic patients with longer duration, hypertension, poor glycemic control, and positive proteinuria should receive special care. [ABSTRACT FROM AUTHOR]

Prolonged hyperglycemic conditions in type 2 diabetes mellitus (T2DM) cause pathological and functional damage to many organs and tissues, including the kidneys, retina, skin, and neuronal tissues, resulting in the development of microvascular diabetic complications. The altered renin angiotensin aldosterone system (RAAS) pathway has been reported to play an important role in the development of insulin resistance in T2DM and associated complications. The current study was carried out to evaluate the association of risk factors and altered expression of RAAS genes in T2DM patients without complications and T2DM patients with complications (retinopathy, nephropathy, and neuropathy). Four hundred and twenty subjects including 140 healthy controls, 140 T2DM patients with diabetic complications, and 140 T2DM patients without diabetic complications were included in the study. Risk factors associated with the development of T2DM and diabetic complications were evaluated. Further, expression analysis of RAAS genes (AGT, ACE, ACE2, and AGT1R) was carried out using qRTPCR in healthy controls, T2DM patients with complications, and T2DM patients without complications. Various risk factors like urban background, higher BMI, alcoholism, smoking, and family history of diabetes among others were found to be associated with the development of T2DM as well as diabetic complications. The expression level of AGT, ACE, and AGT1R was found to be upregulated whereas ACE2 was found to be downregulated in T2DM patients with complications and T2DM patients without complications as compared to controls. Altered expression of the studied genes of RAAS pathway is associated with the development of microvascular diabetic complications. [ABSTRACT FROM AUTHOR]

Background: Proteinuria is considered as a predictor for cardiovascular complications in diabetes mellitus (DM). However, no study has examined the association between changes in proteinuria and the risk of diabetic microvascular complications. Methods: Study participants were 71,825 DM patients who received urine dipstick test for proteinuria both in 2003–2004 and 2006–2007. They were categorized into four groups according to changes in proteinuria over 3 years (negative: negative → negative, resolved: proteinuria ≥ 1+ → negative, incident: negative → proteinuria ≥ 1+, persistent: proteinuria ≥ 1+ → proteinuria ≥ 1+). Cox-proportional hazard model was used in assessing the adjusted hazard ratios (HR) and 95% confidence interval (CI) for incidence of retinopathy, and neuropathy (adjusted HR [95% CI]). Result: In all of DM patients, risk for comprehensive incidence of retinopathy and neuropathy increased in all types of proteinuria changes. In type 1 DM, HR for retinopathy and neuropathy generally increased in order of negative (reference), resolved (2.175 [1.150–4.114] and 1.335 [0.909–1.961]), incident (2.088 [1.185–3.680] and 1.753 [1.275–2.409]), and persistent proteinuria (1.314 [0.418–4.134] and 2.098 [1.274–3.455]). This pattern of relationship was similarly observed in type 2 DM for retinopathy and neuropathy: negative (reference), resolved (1.490 [1.082–2.051] and 1.164 [0.988–1.371]), incident (1.570 [1.161–2.123] and 1.291 [1.112–1.500]), and persistent proteinuria (2.309 [1.407–3.788] and 1.272 [0.945–1.712]). Conclusion: Risk for diabetic retinopathy and neuropathy generally increased in order of negative, resolved, incident, and persistent proteinuria. Once manifested proteinuria was associated with the increased risk of diabetic retinopathy and neuropathy even after remission of proteinuria. [ABSTRACT FROM AUTHOR]

The development of fetal organs can be impacted by systemic changes in maternal circulation, with the placenta playing a pivotal role in maintaining pregnancy homeostasis and nutrient exchange. In clinical obstetrics, oxytocin (OXT) is commonly used to induce labor. To explore the potential role of OXT in the placental homeostasis of OXT, we compared OXT levels in neonatal cord blood among neonates (23–42 weeks gestation) whose mothers either received prenatal OXT or experienced spontaneous labor. Our previous research revealed that the oxytocin receptor (OXTR), essential in forming the blood–retina barrier, is expressed in the retinal pigment epithelium (RPE). We hypothesized that perinatal OXT administration might influence the development of the neural retina and its vasculature, offering therapeutic potential for retinal diseases such as retinopathy of prematurity (ROP). Plasma OXT levels were measured using a commercial OXT ELISA kit. Human fetal RPE (hfRPE) cells treated with OXT (10 µM) were assessed for gene expression via RNA sequencing, revealing 14 downregulated and 32 upregulated genes. To validate these differentially expressed genes (DEGs), hfRPE cells were exposed to OXT (0.01, 0.1, 1, or 10 µM) for 12 h, followed by RNA analysis via real-time PCR. Functional, enrichment, and network analyses (Gene Ontology term, FunRich, Cytoscape) were performed to predict the affected pathways. This translational study suggests that OXT likely crosses the placenta, altering fetal OXT concentrations. RNA sequencing identified 46 DEGs involved in vital metabolic and signaling pathways and critical cellular components. Our results indicate that the perinatal administration of OXT may affect neural retina and retinal vessel development, making OXT a potential therapeutic option for developmental eye diseases, including ROP. [ABSTRACT FROM AUTHOR]

PurposeMethodResultsConclusionTo report a case of asymmetric melanoma-associated retinopathy (MAR) associated with metastatic melanoma which was thought to be in remission for 6 years. Identification of MAR led to the discovery of recurrent malignancy.A man in his 60s presented with monocular visual disturbances with a large relative afferent pupillary defect, rapidly progressing visual field defect and otherwise normal eye examination. Initial work-up for retrobulbar optic neuropathy was inconclusive. After a few months, similar symptoms developed in his fellow eye and a full-field electroretinogram revealed a reduced b:a wave ratio suspicious for MAR.Visual field defects were present in both eyes at initial examination, but the visual field of one eye progressed rapidly while the fellow eye did not develop symptoms or progress until roughly 3 months later. Visual field defects and symptoms improved following resection of the lymph node with active metastatic disease and serum plasmapheresis.This report highlights a case of MAR with asymmetric objective findings and progression of visual field defects. It also demonstrates the success of plasmapheresis, in combination with treating recurrent metastatic disease, in improving visual function. [ABSTRACT FROM AUTHOR]

Background: Hypertensive emergency is a critical disease that causes multiple organ injuries. Although the renin-angiotensin-aldosterone system (RAS) is enormously activated in this disorder, whether the RAS contributes to the development of the organ damage has not been fully elucidated. This cross-sectional study was conducted to characterize the association between RAS and the organ damage in patients with hypertensive emergencies. Methods: We enrolled 63 patients who visited our medical center with acute severe hypertension and multiple organ damage between 2012 and 2020. Hypertensive target organ damage was evaluated on admission, including severe kidney impairment (eGFR less than 30 mL/min/1.73 m2, SKI), severe retinopathy, concentric left ventricular hypertrophy (c-LVH), thrombotic microangiopathy (TMA), heart failure with reduced ejection fraction (HFrEF) and cerebrovascular disease. Then, whether each organ injury was associated with blood pressure or a plasma aldosterone concentration was analyzed. Results: Among 63 patients, 31, 37, 43 and 8 cases manifested SKI, severe retinopathy, c-LVH and ischemic stroke, respectively. All populations with the organ injuries except cerebral infarction had higher plasma aldosterone concentrations than the remaining subset but exhibited a variable difference in systolic or diastolic blood pressure. Twenty-two patients had a triad of SKI, severe retinopathy and c-LVH, among whom 5 patients manifested TMA. Furthermore, the number of the damaged organs was correlated with plasma aldosterone levels (Spearman's coefficient = 0.50), with a strong association observed between plasma aldosterone (≥ 250 pg/mL) and 3 or more complications (odds ratio = 9.16 [95%CI: 2.76–30.35]). Conclusion: In patients with hypertensive emergencies, a higher aldosterone level not only contributed to the development of the organ damage but also was associated with the number of damaged organs in each patient. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is a common complication of diabetes characterized by vascular pathology and neuroinflammation. Pentraxin 3 (PTX3) is a soluble pattern recognition molecule that functions at the crossroads between innate immunity, inflammation, and tissue remodeling. DR is known to involve inflammatory pathways, although the potential relevance of PTX3 has not been explored. We found that PTX3 protein levels increased in the retina of diabetic mice. Similarly, evaluation of a publicly available transcriptomic human dataset revealed increased PTX3 expression in DR with diabetic macular edema and proliferative retinopathy, when compared to nondiabetic retinas or diabetic retinas without complications. To further understand the role of PTX3 within DR, we employed the streptozotocin-induced diabetes model in PTX3 knockout mice (PTX3KO), which were followed up for 9 mo to evaluate hallmarks of disease progression. In diabetic PTX3KO mice, we observed decreased reactive gliosis, diminished microglia activation, and reduced vasodegeneration, when compared to diabetic PTX3 wild-type littermates. The decrease in DR-associated pathological features in PTX3KO retinas translated into preserved visual function, as evidenced by improved optokinetic response, restored b-wave amplitude in electroretinograms, and attenuated neurodegeneration. We showed that PTX3 induced an inflammatory phenotype in human retinal macroglia, characterized by GFAP upregulation and increased secretion of IL6 and PAI-1. We confirmed that PTX3 was required for TNF-α-induced reactive gliosis, as PTX3KO retinal explants did not up-regulate GFAP in response to TNF-α. This study reveals a unique role for PTX3 as an enhancer of sterile inflammation in DR, which drives pathogenesis and ultimately visual impairment. [ABSTRACT FROM AUTHOR]

Background: Pathological retinal neovascularization is marked by microvascular lesions manifested initially as endothelial cell dysfunction and metabolic disturbances. However, the regulatory mechanism guiding retinal vascular endothelial cell function remian controversial. Main body: Previous studies have demonstarted that high glucose or oxidative stress can induce premature senescence in endothelial cells, triggering inflammatory responses within the vascular system and promoting the secretion of pro‐inflammatory factors, ultimately leading to pathological angiogenesis. Endothelial cell senescence has thus become a key target for anti‐angiogenic therapies. Conclusion: This review delves into current research on the mechanisms driving senescence‐induced retinal angiogenesis and highlights potential target protein pathways, aiming to provide insights for future investigations. [ABSTRACT FROM AUTHOR]

Background: The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. Present study was aimed to study associated comorbidities and microvascular/macrovascular complications in diabetic patients attending a tertiary care center. Material and Methods: Present study was Cross sectional study, conducted in Type 1 and Type 2 Diabetes mellitus or newly diagnosed diabetes mellitus patients. Results: In present study regarding the eGFR maximum patients 47 (46.54%) were in stage III-B (G3a) followed by 37 (36.63%) were in stage IV (G4), 9 (8.91%) were in stage 5 (G5) and 8 (7.92%) in stage III-A (G3b) of chronic kidney disease. Data revealed that majority of patient's eGFR was moderately decreased. Majority of patients 93 (92.08%) lies in very high risk as per KDIGO classification and remaining 8 (7.92%) were at high risk. In present study out of 101 patients 48 (47.52%) had retinopathy. Among the 48 cases of retinopathy maximum patients 43 (89.58%) were having non-proliferative diabetic retinopathy (NDRP) followed by 4 (8.33%) were having mixed NDRP/PDR and single case was having proliferative retinopathy. Majority 81 (80.20%) not having neuropathy and 20 (19.80%) had neuropathy. Regarding macrovascular complication majority of patients 30 (29.70%) had unstable angina followed by myocardial infarction in 25 (24.75%), Heart failure in 18 (17.82%) and 15 (14.85%) had stroke. In present study maximum patients 97 (96.04%) were discharged and 4 (3.96%) were died during the study period. Further data reveals significant correlation between stages of CKD with outcome as p<0.05. Maximum mortality was seen in progressive stage of CKD. Conclusion: Among diabetic population, advancing age, gender, concomitant hypertension, increasing duration of diabetes and the presence of macrovascular complication were found to be important risk factors. [ABSTRACT FROM AUTHOR]

Background Results and Conclusion Shared anatomical, histological and physiological pathways between the kidney and the eye are well documented, demonstrating that ocular manifestations serve as valuable prognostic indicators in chronic kidney disease (CKD), providing insights into disease severity and progression. Through non‐invasive imaging modalities such as retinal fundus photography, early retinal microvascular alterations indicative of CKD progression can be detected, enabling timely intervention and risk stratification. However, the conclusions drawn from the review primarily demonstrate a strong or independent association between glaucoma or retinopathy and CKD.Multiple shared pathophysiological events have been implicated in the pathogenesis in the alterations at eye and kidney including renin‐angiotensin‐aldosterone system. Patients with CKD are more likely to experience glaucoma, age‐related macular degeneration, cataracts, uremic optic neuropathy and retinopathy. To establish the role of ocular manifestations in predicting CKD progression, it is crucial to address the limitations of correlation and explore the underlying causality with further research on common disease pathogenesis. Additionally, specific methods for risk stratification based on retinal changes, the effectiveness of timely interventions, and the development of predictive tools combining ocular and renal data are of utmost importance research topics to enlighten the bidirectional causality. [ABSTRACT FROM AUTHOR]

Worldwide, the number of individuals suffering from visual impairment, as well as those affected by blindness, is about 600 million and it will further increase in the coming decades. These diseases also seriously affect the quality of life in working-age individuals. Beyond the characterization of metabolic, genetic, and environmental factors related to ocular pathologies, it is important to verify how lifestyle may participate in the induction of the molecular pathways underlying these diseases. On the other hand, scientific studies are also contributing to investigations as to whether lifestyle could intervene in modulating pathophysiological cellular responses, including the production of metabolites and neurohormonal factors, through the intake of natural compounds capable of interfering with molecular mechanisms that lead to ocular diseases. Nutraceuticals are promising in ameliorating pathophysiological complications of ocular disease such as inflammation and neurodegeneration. Moreover, it is important to characterize the nutritional patterns and/or natural compounds that may be beneficial against certain ocular diseases. The adherence to the Mediterranean diet (MeDi) is proposed as a promising intervention for the prevention and amelioration of several eye diseases. Several characteristic compounds and micronutrients of MeDi, including vitamins, carotenoids, flavonoids, and omega-3 fatty acids, are proposed as adjuvants against several ocular diseases. In this review, we focus on studies that analyze the effects of MeDi in ameliorating diabetic retinopathy, macular degeneration, and glaucoma. The analysis of knowledge in this field is requested in order to provide direction on recommendations for nutritional interventions aimed to prevent and ameliorate ocular diseases. [ABSTRACT FROM AUTHOR]

Objective: There are very few reports on the prevalence of diabetic retinopathy (DR) in children and youth with type-1 diabetes (T1D). Studies have also found very low rates of referral for DR screening in children and youth with T1D. We conducted this study to determine the prevalence of DR, to study the reliability of ISPAD screening recommendations and to identify predictors of DR, its progression and regression in Indian children and youth with T1D. Methods: This study included 882 children and youth with T1D. Demographic data, anthropometry, blood pressure, sexual maturity rating, ophthalmological examination (slit lamp for cataract) and biochemical measurements were performed using standard protocols. Fundus images were captured using the Forus Health 3netra classic digital non-mydriatic fundus camera by the same experienced operator. De-identified images were assessed by a senior grader and ophthalmologist (Belfast Ophthalmic Reading Center). Severity of DR was graded as per the UK National Health Service (NHS) DR classification scale. Result: We report 6.4% and 0.2% prevalence of DR and cataract in Indian children and youth with T1D, respectively. All the subjects with DR had early non-proliferative DR. We report that amongst subjects with DR, only 2 subjects were aged less than 11 years and had duration of illness less than 2 years. Presence of hypertension and older age were significant predictors of DR (P <.05). Subjects with DR had significantly higher triglyceride concentrations (P <.05), of these, 6.9% had progression and 2.9% had regression at 1 year follow up; the change in glycaemic control was a significant positive predictor of progression of DR (P <.05). None of the participants included in the study progressed to develop sight-threatening DR. Conclusion: DR is not uncommon in Indian children and youth with T1D, thus screening for DR needs to be initiated early, particularly in older individuals with higher disease duration. Controlling blood pressure and triglyceride concentrations may prevent occurrence of DR. Improving glycaemic control may prevent progression of DR in Indian children and youth with T1D. Plain Language Summary: Diabetic retinopathy in Indian children with Type 1 Diabetes We found that 6.4% and 0.2% Indian children and youth with type-1 diabetes had diabetic retinopathy and cataract respectively. We report that amongst subjects with DR, only 2 subjects were aged less than 11 years and had duration of illness less than 2 years. Thus, International Society for Paediatric and Adolescent Diabetes (ISPAD) screening criteria must be implemented by all centres to avoid missing cases. Presence of high blood pressure, high triglyceride levels and older age were significant predictors of DR. Of the subjects with DR, 6.9% had progression and 2.9% had regression at 1 year follow up; the change in glycaemic control was a significant positive predictor of progression of DR. None of the participants included in the study progressed to develop sight-threatening DR. DR is not uncommon in Indian children and youth with T1D, hence, screening for DR needs to be initiated early, particularly in older individuals with higher disease duration. Controlling blood pressure and triglyceride concentrations may prevent occurrence of DR. Improving glycaemic control may prevent progression of DR in Indian children and youth with T1D. [ABSTRACT FROM AUTHOR]

This study aimed to assess the prevalence and selected correlates of dry eye disease (DED) among patients with type 2 diabetes in Kosovo. A case-series study was conducted in Kosovo from July 2023 to July 2024, including a consecutive sample of 400 patients with type 2 diabetes aged =18 years seeking healthcare services at the Eye Clinic of the Clinical University Center of Kosovo in Prishtina (51% females; overall mean age: 62.4±9.7 years; response rate: 80%). Data collection consisted of a detailed clinical examination and a structured questionnaire. Almost 70% of the patients had DED (standalone or combined with retinopathy, which, in turn, had a separate prevalence of 3%). Significant positive correlates of autonomous and/or combined DED and retinopathy included older age, unhealthy dietary patterns, sedentary lifestyle, high blood pressure, and treatment of diabetes with insulin and pills. Our findings indicate a high prevalence of DED among type 2 diabetes patients in Kosovo. DED and retinopathy were strongly associated with a range of demographic factors, behavioral characteristics, and preexisting conditions pertinent to type 2 diabetes patients in this population. [ABSTRACT FROM AUTHOR]

Diabetes Mellitus (DM) is on the rise making it a major concern for global health. DM can be classified into type 1 or type 2, and both can lead to changes in brain metabolites. These can result in serious complications like cognitive decline, particularly if not managed properly by diabetic patients. Magnetic Resonance Spectroscopy (MRS) is a non-invasive technique that allows us to study the brain metabolite levels. The present review utilises available Magnetic Resonance Imaging (MRI) data to understand how brain metabolites are affected in both type 1 and type 2 diabetes (T2DM). Research shows that in individuals with diabetes, there are changes in important brain chemicals such as creatine (Cr), N-Acetyl Aspartate (NAA), Myo-Inositol (MI), choline (Cho), glutamate, and glutamine. A consistent finding across multiple studies showed a reduction in NAA levels, which is a key indicator of brain neuron health. This suggests that diabetes negatively impacts the function of neurons in the brain. Changes were seen in other metabolites indicating potential disruptions in energy regulation and membrane function. This review concludes that alterations in brain metabolites as measured using MRS, could serve as a non-invasive biomarker for tracking the progression of DM and its related complications. [ABSTRACT FROM AUTHOR]

Non‐proliferative diabetic retinopathy (NPDR) is the early stage of diabetic retinopathy (DR) and is a chronic oxidative stress‐related ocular disease. Few treatments are approved for early DR. This study aimed to investigate the pathogenic mechanisms underlying the retinal micro‐vasculopathy induced by diabetes and to explore an early potential for treating early DR in a mouse model. The mouse model of type 1 diabetes was established by intraperitoneal injection of streptozotocin (STZ, 180 mg/kg), which was used as the early DR model. The body weight and blood glucose mice were measured regularly; The retinal vascular leakage in the early DR mice was determined by whole‐mount staining; Label‐free quantitative proteomic analysis and bioinformatics were used to explore the target proteins and signaling pathways associated with the retinal tissues of early DR mice; To detect the effects of target protein on endothelial cell proliferation, migration, and tube formation, knockdown and overexpression of VEGF‐B were performed in human retinal vascular endothelial cells (HRECs); Western blotting was used to detect the expression of target proteins in vitro and in vivo; Meanwhile, the therapeutic effect of VEGF‐B on vascular leakage has also been evaluated in vitro and in vivo. The protein expressions of vascular endothelial growth factor (VEGF)‐B and the Rho GTPases family member CDC42 were reduced in the retinal tissues of early DR. VEGF‐B upregulated the expression of CDC42/ZO1/VE‐cadherin and prevented hyperglycemia‐induced vascular leakage in HRECs. Standard intravitreal VEGF‐B injections improved the retinal vascular leakage and neurovascular response in early DR mice. Our findings demonstrated, for the first time, that in diabetes, the retinal vessels are damaged due to decreased VEGF‐B expression through downregulation of CDC42/ZO1/VE‐cadherin expression. Therefore, VEGF‐B could be used as a novel therapy for early DR. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a rapidly growing health challenge and potential epidemic across low-and-middle-income countries like India. Diabetic retinopathy (DR) is a consequence of diabetic microangiopathy, which may cause visual deterioration due to macular edema in any stage and vitreous hemorrhage or tractional retinal detachment in the advanced proliferative retinopathy stages. Aims and Objectives: The aim was to study the retinopathy status in diabetic patients with a risk of diabetic foot syndrome (DFS) visiting a western regional hospital in India. Materials and Methods: In this cross-sectional study, all patients with diabetes mellitus (DM) with a risk of DFS, visiting a tertiary care hospital during the study period, underwent an ophthalmological evaluation for documentation of their retinopathy status. Results: One hundred and fourteen patients diagnosed to have a risk profile for DFS were included in the study. Their mean age was 61.22 years and 81.6% were males. The mean duration of DM was 12.24 years, respectively. Of the 114 patients, 72 had DR. An increased presence of retinopathy in patients with an increased risk grade of diabetic foot (DF) was found significant by the Chi-square test. (P<0.001). Conclusion: Our study found an increased presence of DR in Western Indian cohort with DFS. The severity of retinopathy was greater in patients with higher grades of risk for DF, therefore establishment of an association between DR and DFS will help in developing an integrated management strategy for these two grave consequences of diabetes. [ABSTRACT FROM AUTHOR]

Diabetes is a metabolic disorder whose prevalence has become a worrying condition in recent decades. Chronic diabetes can result in serious health conditions such as impaired kidney function, stroke, blindness, and myocardial infarction. Despite a variety of currently available treatments, cases of diabetes and its complications are on the rise. This review article provides a comprehensive account of the ameliorative effect of prebiotics and probiotics individually or in combination i.e. synbiotics on health complications induced by Type 2 Diabetes Mellitus (T2DM). Recent advances in the field underscore encouraging outcomes suggesting the consumption of synbiotics leads to favorable changes in the gut microbiota. These changes result in the production of bioactive metabolites such as short-chain fatty acids (crucial for lowering blood sugar levels), reducing inflammation, preventing insulin resistance, and encouraging the release of glucagon-like peptide-1 in the host. Notably, novel strategies supplementing synbiotics to support gut microbiota are gaining attraction as pivotal interventions in mitigating T2DM-induced health complications. Thus, by nurturing a symbiotic relationship between prebiotics and probiotics i.e. synbiotics, these interventions hold promise in reshaping the microbial landscape of the gut thereby offering a multifaceted approach to managing T2DM and its associated morbidities. Supporting the potential of synbiotics underscores a paradigm shift toward holistic and targeted interventions in diabetes management, offering prospects for improved outcomes and enhanced quality of life for affected individuals. Nevertheless, more research needs to be done to better understand the single and multispecies pre/pro and synbiotics in the prevention and management of T2DM-induced health complications. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of bilateral exudative retinal detachments and panuveitis in a patient with multiple myeloma (MM). Case Report: A 54-year-old patient with non-proliferative diabetic retinopathy was referred with blurred vision and scotomas in both eyes (OU). Three months prior to the onset of ocular symptoms, he was diagnosed with systemic MM and was receiving chemotherapy. Clinical examination revealed best-corrected visual acuities of 20/80 OU, rare anterior chamber cell, 2+ vitreous cell, diffuse intraretinal hemorrhages, and exudative retinal detachments (RD). Optical coherence tomography of the macula showed central subretinal fluid with cystic intraretinal fluid OU. The findings were consistent with panuveitis and exudative RD in the setting of MM. He reported symptomatic improvement after plasmapheresis and oral prednisone initiation. Conclusion: Extensive, bilateral exudative RD and panuveitis are rare but potentially sight-threatening findings in patients with MM. [ABSTRACT FROM AUTHOR]

The occurrence and development of ophthalmic diseases are related to the dysfunction of eye tissues. Ubiquitin is an important form of protein post-translational modification, which plays an essential role in the occurrence and development of diseases through specific modification of target proteins. Ubiquitination governs a variety of intracellular signal transduction processes, including proteasome degradation, DNA damage repair, and cell cycle progression. Studies have found that ubiquitin can play a role in eye diseases such as cataracts, glaucoma, keratopathy, retinopathy, and eye tumors. In this paper, the role of protein ubiquitination in eye diseases was reviewed. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is a leading cause of blindness, yet its molecular mechanisms are unclear. Extracellular vesicles (EVs) contribute to dysfunction in DR, but the characteristics and functions of vitreous EVs are unclear. This study investigated the inflammatory properties of type 2 diabetic (db) vitreous EVs. EVs isolated from the vitreous of db and non-db donors were used for nanoparticle tracking analysis (NTA), transmission electron microscopy (TEM), immunogold staining, Western blotting, and proteomic analysis by mass spectrometry. Intracellular uptake of vitreous EVs by differentiated macrophages was evaluated using ExoGlow membrane labeling, and the impact of EVs on macrophage (THP-1) activation was assessed by cytokine levels using RT-qPCR. NTA and TEM analysis of db and non-db vitreous EVs showed non-aggregated EVs with a heterogeneous size range below 200 nm. Western blot detected EV markers (Alix, Annexin V, HSP70, and Flotillin 1) and an upregulation of Cldn5 in db EVs. While the db EVs were incorporated into macrophages, treatment of THP-1 cells with db EVs significantly increased mRNA levels of TNFα and IL-1β compared to non-db EVs. Proteomic and gene enrichment analysis indicated pro-inflammatory characteristics of db EVs. Our results suggest a potential involvement of EC-derived Cldn5+ EVs in triggering inflammation, offering a novel mechanism involved and presenting a possible therapeutic avenue for DR. [ABSTRACT FROM AUTHOR]

Background/Aim: Although nutritional risk factors for developing complications in type 2 diabetes mellitus (T2DM) have been examined, the effect of protein intake on nephropathy is debated, and there is little research on retinopathy. This cross-sectional case-series study aimed to examine the risk factors, including nutritional status, for complications in patients newly diagnosed with T2DM. Patients and Methods: Fifty-four patients were recruited, based on the results of examinations of blood glucose and/or glycated hemoglobin level for T2DM. To evaluate nutritional status, blood and urine examinations were performed and the Food Frequency Questionnaire was administered. Two-way analysis of variance, Fisher’s exact test and logistic regression analyses were performed. Results: The patients were categorized into four groups: 24 without albuminuria and without retinopathy, four without albuminuria with retinopathy, 21 with albuminuria without retinopathy, and five with albuminuria with retinopathy. Logistic analysis of albuminuria revealed that estimated sodium intake was significantly independent as the explanatory factors of age, sex, and body mass index. Patients with retinopathy had significantly higher blood urea nitrogen, and significantly lower plasma total protein levels than patients without retinopathy, suggesting that retinopathy is related to a higher catabolic state. Through a questionnaire on food intake, patients with retinopathy had a significantly lower intake of fat and monounsaturated fatty acids and a significantly higher intake of iodine based on intake of seaweed, corrected for energy intake, than patients without retinopathy. Conclusion: The present study may lead to planning a large cohort study for examining nutritional risk factors related to complications in patients newly diagnosed with T2DM in Japan. [ABSTRACT FROM AUTHOR]

Abstract Diabetic retinopathy is a complication of diabetes mellitus and a leading cause of blindness and visual impairment globally. Limited information existed on the epidemiology of diabetic retinopathy at the national level in Ethiopia. Thus, the objective of this review was to determine the pooled prevalence of diabetic retinopathy and its associated risk factors in Ethiopia. A systematic review and meta-analysis was conducted using previous primary studies that were found in electronic databases such as Web of Science, Scopus, PubMed, CINHAL, Google Scholar, and online African journals. We evaluated the quality of the included studies using the Newcastle-Ottawa Assessment Scale. The random-effects model was applied because heterogeneity was expected. I-Square and the Cochrane Q statistics were used to evaluate heterogeneity. Publication bias was examined using Egger’s test and a funnel plot. A random-effect meta-analysis was applied to pool the odds ratios of risk factors to determine the association between the independent and dependent variables. After 598 articles were found, 22 studies that met the eligibility requirements were included. The pooled prevalence of retinopathy among patients with diabetes in Ethiopia was 24.35% (95% CI: 18.88–29.83), with considerable heterogeneity (I2 = 98.18%, p

Abstract Introduction This study aimed to evaluate intraretinal microvascular abnormalities (IRMA) in eyes with advanced nonproliferative diabetic retinopathy (NPDR) using multimodal approach in co-located areas focusing on central retina (up to 50°) and to look at possible correlations between IRMA and other structural changes, like ischemia and presence of microaneurysms. Methods The RICHARD study (NCT05112445) included 60 eyes from 60 patients with type 2 diabetes with moderate-severe NPDR, diabetic retinopathy severity levels 43, 47, and 53 (DRSS). IRMA were defined as capillary tortuosity covering a minimum circular area of 300 µm (calculated to correspond to the Early Treatment Diabetic Retinopathy Study standard photo 8A) and were identified using multimodal imaging with distinct fields of view (FoV): color fundus photography (CFP) using a Topcon TRC-50DX camera (Topcon Medical Systems, Japan), Optos California ultra wide field fundus fluorescein angiography (UWF-FFA) (Optos plc, UK), and swept-source optical coherence tomography angiography (SS-OCTA) (PLEX® Elite 9000, ZEISS, USA). Different areas of the retina were examined: central macula (up to 20°) and posterior pole (between 20° and 50°). Results Multimodal imaging was used to identify IRMA in co-located areas (FoV 20°). Our results show that when evaluating the presence of IRMA (FoV

Abstract Background Hypertensive emergency is a critical disease that causes multiple organ injuries. Although the renin-angiotensin-aldosterone system (RAS) is enormously activated in this disorder, whether the RAS contributes to the development of the organ damage has not been fully elucidated. This cross-sectional study was conducted to characterize the association between RAS and the organ damage in patients with hypertensive emergencies. Methods We enrolled 63 patients who visited our medical center with acute severe hypertension and multiple organ damage between 2012 and 2020. Hypertensive target organ damage was evaluated on admission, including severe kidney impairment (eGFR less than 30 mL/min/1.73 m2, SKI), severe retinopathy, concentric left ventricular hypertrophy (c-LVH), thrombotic microangiopathy (TMA), heart failure with reduced ejection fraction (HFrEF) and cerebrovascular disease. Then, whether each organ injury was associated with blood pressure or a plasma aldosterone concentration was analyzed. Results Among 63 patients, 31, 37, 43 and 8 cases manifested SKI, severe retinopathy, c-LVH and ischemic stroke, respectively. All populations with the organ injuries except cerebral infarction had higher plasma aldosterone concentrations than the remaining subset but exhibited a variable difference in systolic or diastolic blood pressure. Twenty-two patients had a triad of SKI, severe retinopathy and c-LVH, among whom 5 patients manifested TMA. Furthermore, the number of the damaged organs was correlated with plasma aldosterone levels (Spearman’s coefficient = 0.50), with a strong association observed between plasma aldosterone (≥ 250 pg/mL) and 3 or more complications (odds ratio = 9.16 [95%CI: 2.76–30.35]). Conclusion In patients with hypertensive emergencies, a higher aldosterone level not only contributed to the development of the organ damage but also was associated with the number of damaged organs in each patient.

Diabetes Mellitus (DM) is on the rise making it a major concern for global health. DM can be classified into type 1 or type 2, and both can lead to changes in brain metabolites. These can result in serious complications like cognitive decline, particularly if not managed properly by diabetic patients. Magnetic Resonance Spectroscopy (MRS) is a non-invasive technique that allows us to study the brain metabolite levels. The present review utilises available Magnetic Resonance Imaging (MRI) data to understand how brain metabolites are affected in both type 1 and type 2 diabetes (T2DM). Research shows that in individuals with diabetes, there are changes in important brain chemicals such as creatine (Cr), N-Acetyl Aspartate (NAA), Myo-Inositol (MI), choline (Cho), glutamate, and glutamine. A consistent finding across multiple studies showed a reduction in NAA levels, which is a key indicator of brain neuron health. This suggests that diabetes negatively impacts the function of neurons in the brain. Changes were seen in other metabolites indicating potential disruptions in energy regulation and membrane function. This review concludes that alterations in brain metabolites as measured using MRS, could serve as a non-invasive biomarker for tracking the progression of DM and its related complications.

Background: Diabetes is a rapidly growing health challenge and potential epidemic across low-and-middle-income countries like India. Diabetic retinopathy (DR) is a consequence of diabetic microangiopathy, which may cause visual deterioration due to macular edema in any stage and vitreous hemorrhage or tractional retinal detachment in the advanced proliferative retinopathy stages. Aims and Objectives: The aim was to study the retinopathy status in diabetic patients with a risk of diabetic foot syndrome (DFS) visiting a western regional hospital in India. Materials and Methods: In this cross-sectional study, all patients with diabetes mellitus (DM) with a risk of DFS, visiting a tertiary care hospital during the study period, underwent an ophthalmological evaluation for documentation of their retinopathy status. Results: One hundred and fourteen patients diagnosed to have a risk profile for DFS were included in the study. Their mean age was 61.22 years and 81.6% were males. The mean duration of DM was 12.24 years, respectively. Of the 114 patients, 72 had DR. An increased presence of retinopathy in patients with an increased risk grade of diabetic foot (DF) was found significant by the Chi‐square test. (P

INTRODUCTION: Vascular amyloid beta (Aβ) protein deposits were detected in retinas of mild cognitively impaired (MCI) and Alzheimers disease (AD) patients. We tested the hypothesis that the retinal vascular tight junctions (TJs) were compromised and linked to disease status. METHODS: TJ components and Aβ expression in capillaries and larger blood vessels were determined in post mortem retinas from 34 MCI or AD patients and 27 cognitively normal controls and correlated with neuropathology. RESULTS: Severe decreases in retinal vascular zonula occludens-1 (ZO-1) and claudin-5 correlating with abundant arteriolar Aβ40 deposition were identified in MCI and AD patients. Retinal claudin-5 deficiency was closely associated with cerebral amyloid angiopathy, whereas ZO-1 defects correlated with cerebral pathology and cognitive deficits. DISCUSSION: We uncovered deficiencies in blood-retinal barrier markers for potential retinal imaging targets of AD screening and monitoring. Intense retinal arteriolar Aβ40 deposition suggests a common pathogenic mechanism of failed Aβ clearance via intramural periarterial drainage.

In this study, we aimed to explore whether circulating microRNA-27b (miR-27b) is affected in diabetic patient with microvascular complicationsMethods This study was conducted on 90 participants, 30 had type 2 diabetes with chronic limb ischemia, 30 diabetics without chronic limb ischemia and 30 healthy controls. The relative expression of microRNA 27b was assessed in the patient groups and its relation between diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN).Results Concerning relation between miR-27b and other microvascular complications, DR & DN, miR-27b plasma expression showed no significant difference between T2DM patients with increased VPT compared to those with normal VPT. Comparably, there was no significant difference in the plasma miR-27b expression between patients with DR and those with normal fundus examination. Additionally, neither DR nor VPT correlated with plasma miR-27bexpression.Conclusion Plasma miR-27b expression showed no change between the patient groups and there was no correlation with microvascular complications and miR-27b expression.

Introduction: This study aimed to evaluate intraretinal microvascular abnormalities (IRMA) in eyes with advanced nonproliferative diabetic retinopathy (NPDR) using multimodal approach in co-located areas focusing on central retina (up to 50°) and to look at possible correlations between IRMA and other structural changes, like ischemia and presence of microaneurysms. Methods: The RICHARD study (NCT05112445) included 60 eyes from 60 patients with type 2 diabetes with moderate-severe NPDR, diabetic retinopathy severity levels 43, 47, and 53 (DRSS). IRMA were defined as capillary tortuosity covering a minimum circular area of 300 µm (calculated to correspond to the Early Treatment Diabetic Retinopathy Study standard photo 8A) and were identified using multimodal imaging with distinct fields of view (FoV): color fundus photography (CFP) using a Topcon TRC-50DX camera (Topcon Medical Systems, Japan), Optos California ultra wide field fundus fluorescein angiography (UWF-FFA) (Optos plc, UK), and swept-source optical coherence tomography angiography (SS-OCTA) (PLEX® Elite 9000, ZEISS, USA). Different areas of the retina were examined: central macula (up to 20°) and posterior pole (between 20° and 50°). Results: Multimodal imaging was used to identify IRMA in co-located areas (FoV < 50°) including UWF-FFA, CFP, and SS-OCTA. In eyes with DRSS levels 47 and 53, IRMA were identified in both areas of the retina, while in eyes with DRSS level 43, IRMA were detected only outside of the central macula (FoV > 20°). Our results show that when evaluating the presence of IRMA (FoV < 50°), UWF-FFA detected 203 IRMA, SS-OCTA detected 133 IRMA, and CFP detected 104 IRMA. Our results also show that the presence of IRMA was positively associated with presence of microaneurysms. Conclusions: Identification of IRMA in eyes with advanced NPDR is better achieved by UWF-FFA than CFP and SS-OCTA. A statistically significant correlation was found between the presence of IRMA and the increase in number of microaneurysms. Trial Registration: ClinicalTrials.gov, identifier NCT05112445. [ABSTRACT FROM AUTHOR]

Deep learning algorithms effectively work with, a significant amount of data. trained on small datasets tend to have poor generalization. Data augmentation techniques can be used to make better use of existing training data, improving the applicability of deep learning methods. However, traditional data augmentation methods often produce limited additional credible data. The deep learning approach's performance can be enhanced by generating new data by employing generative adversarial networks (GANs). Although GANs have been extensively used to improve the performance of convolutional neural networks (CNNs), there has been relatively less research on data augmentation methods specifically for GAN training. This study focuses on using a Wasserstein GAN (WGAN) architecture for generating synthetic optical coherence tomography angiography (OCTA) images of diabetic retinopathy to aid in the detection of different types of diabetic retinopathy diseases, including proliferative diabetic retinopathy (PDR), Severe non-PDR (NPDR), Moderate NPDR, and Mild NPDR. WGAN, provides the generator with a more informative learning signal, making training more stable, particularly in high-dimensional spaces. The trained WGAN model is saved in .h5 file format (HDF), converted to portable network graphics (PNG) image format, and then classified into different categories of diabetic retinopathy using a ResNet50 model with various fine-tuning methods. The proposed model has demonstrated better results than the previous study. 99.95% accuracy is exhibited. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is one of the significant disabling outcomes of diabetes mellitus characterized by retinal microvascular damage, inflammation, and neuronal dysfunction. Allicin (Alc), a natural compound found in garlic, has garnered attention for its antioxidant and anti-inflammatory properties, positioning it as a potential therapeutic agent for DR. The aim of the present study was to investigate the therapeutic efficacy of Alc in DR management and elucidate its underlying mechanisms of action. We established a DR model in male Sprague–Dawley rats (n = 50, 200–250 g, 12 weeks old) using a high-fat diet for 8 weeks plus a low dose of streptozotocin administered at the start of the 4th week. The diabetic (Diab) animals were administered Alc (16 mg/kg/day, orally), either alone or in combination with mitochondrial division inhibitor-1 (Mdivi-1) as a mitophagy inhibitor, starting 28 days before tissue sampling. We evaluated histopathological changes, metabolic abnormalities associated with type 2 diabetes mellitus (T2DM), the expression of proteins regulating pyroptosis (NOD-like receptor family pyrin domain containing 3, cleaved-caspase 1, and gasdermin D-N terminal) and mitophagy (phosphatase and tensin homolog-induced kinase 1 [PINK1] and Parkin), as well as the levels of oxidative stress mediators and proinflammatory cytokines. Alc treatment effectively ameliorated histopathological changes and metabolic abnormalities associated with T2DM. It downregulated pyroptosis-related proteins, upregulated mitophagy-related proteins, reduced proinflammatory cytokine levels, and attenuated oxidative stress. Treatment with Mdivi-1 suppressed the beneficial effects of Alc. Our findings highlight the therapeutic potential of Alc in managing DR by targeting multiple pathophysiological pathways, including pyroptosis, inflammation, and oxidative stress. The observed antipyroptotic effects of Alc were partially mediated by the activation of the PINK1/parkin-mediated mitophagy pathway. Additional studies are necessary to thoroughly understand the therapeutic mechanisms of Alc and its viability as a treatment choice for DR.

Introduction: Myelin oligodendrocyte glycoprotein (MOG)-associated disorders can cause inflammation of the central nervous system in various specific organs. Ocular involvement manifests as optic neuritis is one of the most common presentations; other ocular presentations are uncommon. Recently, rare ocular complications have been reported in conjunction with MOG-associated optic neuritis. We reported a rare case of acute venous stasis retinopathy co-occurring with bilateral optic neuritis. Case Presentation: A 27-year-old woman complained of a throbbing headache for 2 weeks before developing visual loss in her right eye. She was diagnosed with presumed central retinal vein occlusion and was scheduled for further investigations. Two days later, she suddenly lost vision in her left eye and was admitted to the hospital. An eye examination revealed tortuous and dilated veins and optic disk swelling, notably in the right eye, compatible with venous stasis retinopathy in both eyes. Her right eye also had a premacular hemorrhage and vitreous hemorrhage. Magnetic resonance imaging showed an enhancement of bilateral optic nerves, and MOG antibody was detected in her serum. She successfully achieved a rapid improvement of vision in the left eye with intravenous methylprednisolone. However, her vision in the right eye did not recover due to dense vitreous hemorrhage. Conclusion: Venous stasis retinopathy is a rare complication of MOG-associated optic neuritis. High-dose corticosteroids result in a rapid response and excellent symptom recovery. Ongoing reports may uncover new clinical presentations associated with this disorder.

Abstract Human embryonic stem cells and human induced pluripotent stem cells may be used to create 3D tissues called brain organoids. They duplicate the physiological and pathological characteristics of human brain tissue more faithfully in terms of both structure and function, and they more precisely resemble the morphology and cellular structure of the human embryonic brain. This makes them valuable models for both drug screening and in vitro studies on the development of the human brain and associated disorders. The technical breakthroughs enabled by brain organoids have a significant impact on the research of different brain regions, brain development and sickness, the connections between the brain and other tissues and organs, and brain evolution. This article discusses the development of brain organoids, their use in diabetes research, and their progress.

Background: Retinopathy of prematurity (ROP) screening in Nigeria is at a nascent stage and at the moment there are no National guidelines for ROP screening in Nigeria. Thus it is desirable for screening programs to report findings amongst screened preterm infants in order to facilitate the development of national ROP screening criteria and guidelines. The aim of this report is to describe the frequency, severity and risk factors for retinopathy of prematurity (ROP) among preterm and very low-birth-weight babies screened within the first year of initiating an ROP screening program at a Nigerian tertiary facility. Methods: A cross-sectional study of infants born at less than 34 weeks gestational age; or with birth weight less than 1500g between May 2016 and May 2017. ROP screening examinations were performed by ophthalmologists with the use of an indirect ophthalmoscope, after pupillary dilation, in collaboration with the neonatology team. Information on gestational age at birth, birth weight, oxygen therapy and presence of other risk factors were recorded and analyzed. Results: A total of 74 infants were screened during the period. There were 36 (48.6%) males. Mean gestational age at birth was 29.6 (±2.35) weeks. Mean birth weight was 1.26 (±0.27) kg with a range of 800 to 1950g. ROP was detected in 9 (12.2%) infants. Two (22.2%) of these had Threshold ROP. There was no significant difference between the mean birth weight and mean gestational age of the infants who had ROP compared to those without ROP. The two infants with Threshold ROP were treated with intravitreal Bevazicumab and had regression of ROP. Conclusion: Retinopathy of prematurity was diagnosed in at risk infants in this facility. There is, therefore, a need to establish ROP screening programs in all neonatal units across the country. In addition, established programs need to evaluate their screening criteria with a view towards developing country-specific screening guidelines.

Abstract Background Prior case reports and animal studies have reported on potential ophthalmologic complications of babesiosis, but this issue has not previously been addressed in a cohort of patients with babesiosis. This cross-sectional descriptive pilot study evaluated the retinas of patients with acute babesiosis to determine if retinal abnormalities are a feature of the disease. Methods We screened all patients admitted to Yale New Haven Hospital with laboratory confirmed babesiosis during the summer of 2023 and obtained informed consent. Patients were interviewed and underwent pupil dilation and a retinal examination using an indirect ophthalmoscope. Demographic and clinical information were obtained by questionnaire and through chart review. Results Ten patients underwent retinal eye exams with results that were generally unremarkable. No study patients showed any signs of retinal inflammation, infection, retinal bleeding, retinal tears, or abnormal vessel formation that could be attributed to infection. Conclusion This small study did not find evidence of retinopathy in patients with babesiosis. Further studies with larger populations, repeated exams, and long term follow up will further elucidate the potential small vessel complications of human babesiosis.

Background: Retinopathy of prematurity (ROP) is one of the common complications in premature neonates. ROP examination is one of the most important examinations for premature babies, which is associated with pain and can be very annoying. This study aimed to compare the effectiveness of pharmacological and non-pharmacological methods in reducing the pain of ROP examination. Materials and Methods: This study was conducted as a double-blind, randomized control trial on 300 ROP examinations of patients who were hospitalized in the NICU department of Mahdieh Hospital in Tehran. The neonates were randomly selected into three groups, and ketamine 2mg/kg nasally, fentanyl two µg/kg nasally10minutes before an examination, and acetaminophen 2drop/kg orally 30 minutes before each examination were given to each neonate as two pharmacological groups. In the non-pharmacological group, infants received saddling-pacifier oral sucrose 25% 0.5cc 2 minutes before examination. Pain was assessed based on PIPP (premature infant pain index). Results: The amount of pain after using oral sucrose was significantly lower than the ketamine-acetaminophen (P-value=0.011) and fentanyl-acetaminophen (P-value=0.027) groups, but there was not a statistically significant difference between the two groups of ketamine-acetaminophen and fentanyl-acetaminophen (P-value=0.953). The hypoxia was more prevalent in the ketamine-acetaminophen group (18.8%), and the least hypoxia occurred in the oral sucrose treatment group (7%) (P-value=0.028). Conclusion: It is concluded that the effect of non-pharmacological drugs is greater than pharmacological drugs in reducing the pain of neonates during ROP examination. The effect of oral sucrose in reducing pain was more significant than ketamine-acetaminophen and fentanyl-acetaminophen. However, there was no significant difference between the two groups of ketamine-acetaminophen and fentanyl-acetaminophen.

Abstract Background The purpose of this review was to examine if dipeptidyl peptidase-4 inhibitor (DPP4i) use affects the risk of diabetic retinopathy (DR). Methods Cohort studies published up to 20th July 2023 in the databases of PubMed, CENTRAL, Embase, Scopus, and Web of Science were searched. The adjusted effect size was pooled to calculate the odds ratio (OR). Results Seven studies were included. Meta-analysis showed that the use of DPP4i was not associated with any significant change in the risk of DR (OR: 0.86 95% CI: 0.70, 1.06 I2 = 78%). The pooled analysis also found that DPP4i use was not associated with any significant risk of progression of DR (OR: 0.87 95% CI: 0.47, 1.59 I2 = 86%). The results did not change during sensitivity analysis. Conclusion Present evidence from a limited number of real-world studies shows that DPP4i may not affect the incidence and progression of DR. There is a need for further studies from different countries using accurate definitions of DR and its progression to validate the current results.

Diabetic retinopathy (DR) is a major complication of diabetes mellitus and is a leading cause of vision loss globally. A prompt and accurate diagnosis is crucial for ensuring favorable visual outcomes, highlighting the need for increased access to medical care. The recent remarkable advancements in artificial intelligence (AI) have raised high expectations for its role in disease diagnosis and prognosis prediction across various medical fields. In addition to achieving high precision comparable to that of ophthalmologists, AI-based diagnosis of DR has the potential to improve medical accessibility, especially through telemedicine. In this review paper, we aim to examine the current role of AI in the diagnosis of DR and explore future directions.

Introduction: Epithelial-mesenchymal transition (EMT) of retinal pigment epithelial (RPE) cells is related to the pathogenesis of various retinopathies including age-related macular degeneration (AMD). Oxidative stress is the major factor that induces degeneration of RPE cells associated with the etiology of AMD. Objectives: Sodium iodate (NaIO3) generates intracellular reactive oxygen species (ROS) and is widely used to establish a model of AMD due to the selective induction of retinal degeneration. This study was performed to clarify the effects of multiple NaIO3-stimulated signaling pathways on EMT in RPE cells. Methods: The EMT characteristics in NaIO3-treated human ARPE-19 cells and RPE cells of the mouse eyes were analyzed. Multiple oxidative stress-induced modulators were investigated and the effects of pre-treatment with Ca2+ chelator, extracellular signal-related kinase (ERK) inhibitor, or epidermal growth factor receptor (EGFR) inhibitor on NaIO3-induced EMT were determined. The efficacy of post-treatment with ERK inhibitor on the regulation of NaIO3-induced signaling pathways was dissected and its role in retinal thickness and morphology was evaluated by using histological cross-sections and spectral domain optical coherence tomography. Results: We found that NaIO3 induced EMT in ARPE-19 cells and in RPE cells of the mouse eyes. The intracellular ROS, Ca2+, endoplasmic reticulum (ER) stress marker, phospho-ERK, and phospho-EGFR were increased in NaIO3-stimulated cells. Our results showed that pre-treatment with Ca2+ chelator, ERK inhibitor, or EGFR inhibitor decreased NaIO3-induced EMT, interestingly, the inhibition of ERK displayed the most prominent effect. Furthermore, post-treatment with FR180204, a specific ERK inhibitor, reduced intracellular ROS and Ca2+ levels, downregulated phospho-EGFR and ER stress marker, attenuated EMT of RPE cells, and prevented structural disorder of the retina induced by NaIO3. Conclusions: ERK is a crucial regulator of multiple NaIO3-induced signaling pathways that coordinate EMT program in RPE cells. Inhibition of ERK may be a potential therapeutic strategy for the treatment of AMD.

This review explored the role of mitochondria in retinal ganglion cells (RGCs), which are essential for visual processing. Mitochondrial dysfunction is a key factor in the pathogenesis of various vision-related disorders, including glaucoma, hereditary optic neuropathy, and age-related macular degeneration. This review highlighted the critical role of mitochondria in RGCs, which provide metabolic support, regulate cellular health, and respond to cellular stress while also producing reactive oxygen species (ROS) that can damage cellular components. Maintaining mitochondrial function is essential for meeting RGCs' high metabolic demands and ensuring redox homeostasis, which is crucial for their proper function and visual health. Oxidative stress, exacerbated by factors like elevated intraocular pressure and environmental factors, contributes to diseases such as glaucoma and age-related vision loss by triggering cellular damage pathways. Strategies targeting mitochondrial function or bolstering antioxidant defenses include mitochondrial-based therapies, gene therapies, and mitochondrial transplantation. These advances can offer potential strategies for addressing mitochondrial dysfunction in the retina, with implications that extend beyond ocular diseases. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of laser surgery assisted with Leizumab on retinal thickness and visual acuity recovery in patients with type II diabetes retinopathy (DR). Methods A total of 140 type II DR patients in Hopeshine-Minsheng Hospital of Xinzheng from February 2021 to February 2023 were selected retrospectively, and divided into the control group (70 cases) and the observation group (70 cases) according to different surgical methods. The control group received laser treatment, while the observation group received laser surgery assisted by Leizumab. The visual acuity levels, time to clinical symptom improvement. hemodynamic levels [end diastolic blood flow velocity (EDV), peak blood flow velocity (PSV), blood flow resistance index(RI)], low-vision quality of life (CLVQOL) scores, and incidence of complications between two groups were compared. Results The observation group had shorter absorption times for exudate, fundus hemorrhage, and retinal edema compared to the control group, with statistical significance (P<0.05). The observation group had higher visual acuity and the best corrected visual acuity at one month after surgery, and the grayscale value and retinal thickness of the field of view were smaller than those of the control group, with statistical significance (P<0.05). The EDV and PSV levels in the observation group were higher than those in the control group one month after surgery, while the RI levels were lower than those in the control group, with statistical significance (P<0.05). The CLVQOL score of the observation group was higher than that of the control group one month after surgery, and the difference was statistically significant (P<0.05). The incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). Conclusion Laser surgery assisted with Leizumab can promote blood circulation in the eyes of type II DR patients, reduce retinal thickness, improve vision, reduce the incidence of postoperative complications, and improve postoperative quality of life. [ABSTRACT FROM AUTHOR]

Human embryonic stem cells and human induced pluripotent stem cells may be used to create 3D tissues called brain organoids. They duplicate the physiological and pathological characteristics of human brain tissue more faithfully in terms of both structure and function, and they more precisely resemble the morphology and cellular structure of the human embryonic brain. This makes them valuable models for both drug screening and in vitro studies on the development of the human brain and associated disorders. The technical breakthroughs enabled by brain organoids have a significant impact on the research of different brain regions, brain development and sickness, the connections between the brain and other tissues and organs, and brain evolution. This article discusses the development of brain organoids, their use in diabetes research, and their progress. [ABSTRACT FROM AUTHOR]

Purpose: This study describes how the diagnosis of Usher syndrome was revised to PRPS1-associated retinopathy and Charcot—Marie—Tooth disease type 5. Case Report: A 38-year-old female with bilaterally subnormal vision and non-congenital hearing loss was initially diagnosed with Usher syndrome, based on finding variants in three genes (MYO7A, USH2A, and PCDH15), was re-evaluated at the inherited retinal disorders clinic. She had asymmetric retinopathy and right macular pseudocoloboma. She was also found to have myopathic facies, poor grip strength and atrophy of the calf muscles. Whole exome sequencing including variants in PRPS1 showed a variant (NM_002764.4:c.287 G > A; p.Arg96Gln), which was not detected by targeted Sanger sequencing of the DNA from her mother and sister. Conclusion: The constellation of asymmetric retinopathy and non-congenital hearing impairment should prompt the clinician to search for other diagnoses that may not be covered by an Usher syndrome next generation sequencing panel. Interpretation of genetic testing results should be correlated with a detailed clinical phenotype. [ABSTRACT FROM AUTHOR]

Background The initiation of type-2 diabetes mellitus (T2DM) is frequently asymptomatic and gradual. One reason newly diagnosed type-2 diabetes mellitus patients have a higher risk of microvascular problems is untreated long-standing hyperglycemia. The objective of our study was to evaluate the frequency of microvascular problems in recently diagnosed patients with type 2 diabetes mellitus at a tertiary care hospital in India. Material and Methods: A cross-sectional study was undertaken in the medicine department of a tertiary care hospital. The study included a cohort of 100 patients who were recently diagnosed with type 2 diabetes mellitus. Microvascular complications were diagnosed after a thorough study of the patient's medical history, clinical assessment, and pertinent diagnostic tests. Results: Subjects who had an IDRS score of 60 or higher showed a higher occurrence of peripheral neuropathy (86.5% vs 13.5%, p=0.371), retinopathy (91.7% vs 8.3%, p=0.157), and nephropathy (77.8% vs 22.2%, p=0.410) compared to subjects with an IDRS score below 60. However, there was no statistically significant difference in the occurrence of microvascular problems between the two IDRS subgroups. Those diagnosed with nephropathy exhibit a statistically significant higher average IDRS score compared to those without nephropathy (65.00±17.32 vs 62.66±12.50, p-value = 0.037). However, no statistically significant difference was detected in the mean values of the IDRS scores of the other two microvascular complications. Conclusion: IDRS is a valuable tool for predicting newly diagnosed type 2 diabetes mellitus. However, further large, multi-centric studies will be required to detect its usefulness in microvascular complications. [ABSTRACT FROM AUTHOR]

Evaluation of retinal macular oxygen saturation in healthy controls can aid in understanding the pathological changes seen in similar locations of those with vascular diseases like diabetes. The aim of this study was to determine the test-retest repeatability of localised retinal oximetry measurements in the macula on the Zilia Oximeter within healthy subjects of different races, 18–40 years old. Oxygen saturation was measured between three time points within the same locations of the right eye. Twenty seven subjects were included (aged 26.3 ± 3.6 years). All were confirmed to have healthy retinas and at least 6/9 vision. Oximetry measurements were taken using the Zilia to acquire local oxygen saturation measurements (300 µm diameter) at four points 3.1 degrees from the fovea in the superior/temporal, superior/nasal, inferior/temporal, and inferior/nasal locations. Oximetry measurements were taken twice on the same day 20 minutes apart and then again 1–2 weeks later. Oximetry data was analysed with intraclass correlation between visits. To assess intrasubject repeatability, the Bland-Altman repeatability coefficient and coefficient of variation were calculated. Average Intraclass correlation for the three acquisition times of the right eye was 0.78. The averaged intrasubject repeatability coefficient for the three acquisition times was 8.4. The averaged coefficient of variation was 5.4%. The Zilia oximeter has good macular test-retest repeatability; however, multiple measurements may be needed to ensure accuracy. [ABSTRACT FROM AUTHOR]

Aim: To assess clinical and biochemical measurements that can identify people with dysglycaemia (i.e. diabetes or pre‐diabetes) who remain free of serious outcomes during follow‐up. Materials and Methods: We conducted exploratory analyses using data from the Outcomes Reduction with an Initial Glargine Intervention (ORIGIN) study to identify independent determinants of outcome‐free status in 12 537 middle‐aged and older adults with prediabetes and early type 2 diabetes from 40 countries. Serious outcome‐free status was defined as the absence of major cardiovascular outcomes, kidney or retinal outcomes, peripheral artery disease, dementia, cancer, any hospitalization, or death during follow‐up. Results: In total, 3328 (26.6%) participants remained free of serious outcomes during a median follow‐up of 6.2 years (IQR 5.8, 6.7). Independent clinical determinants of outcome‐free status included younger age, female sex, non‐White ethnicity, shorter diabetes duration, absence of previous cardiovascular disease, current or former smokers, higher grip strength, Mini‐Mental State Examination score, and ankle‐brachial index, lower body mass index and kidney disease index, and non‐use of renin‐angiotensin system drugs and beta‐blockers. In a subset of 8401 people with baseline measurements of 238 biomarkers, growth differentiation factor 15, kidney injury molecule‐1, N‐terminal pro‐brain natriuretic peptide, uromodulin, C‐reactive protein, factor VII and ferritin were independent determinants. The combination of clinical determinants and biomarkers best identified participants who remained outcome‐free (C‐statistics 0.71, 95% confidence interval 0.70‐0.73; net reclassification improvement 0.55, 95% confidence interval 0.48‐0.58). Conclusions: A set of routinely measured clinical characteristics and seven protein biomarkers identify middle‐aged and older people with prediabetes or early type 2 diabetes as least likely to experience serious outcomes during follow‐up. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease is the most prevalent chronic liver disease globally and is linked to augmented susceptibility to type 2 diabetes mellitus (DM), cardiovascular disease, and microvascular complications inherent to DM, such as nephropathy, neuropathy, and retinopathy. The fibrosis-4 (FIB-4) scoring system, a noninvasive tool, is useful for predicting the extent of liver fibrosis across diverse pathologies. This study aimed to assess the potential predictive role of FIB-4 scores in microvascular complications associated with diabetes. The medical records of patients with type 2 DM admitted to our endocrinology clinic between February 2019 and December 2020 were retrospectively evaluated. Parameters including demographic attributes, fasting blood glucose, glycated hemoglobin, aspartate aminotransferase, alanine aminotransferase, thrombocyte levels, and microvascular complications were recorded. The FIB-4 score was computed, and patients were categorized based on these scores (<1.3 and ≥ 1.3). The analysis included 312 patients with a median age of 60 (50–68 years); 39.7 % were men. The median duration of diabetes was 10 years (5–20 years), and the median FIB-4 score was 0.93 (0.63–1.34). Neuropathy, nephropathy, and retinopathy were observed in 50.6 %, 31.4 %, and 34 % of the patients, respectively. Although the FIB-4 score did not differ significantly between patients with and without neuropathy or retinopathy, patients with nephropathy exhibited higher FIB-4 scores. Notably, patients with FIB-4 scores ≥ 1.3 demonstrated a significantly higher prevalence of nephropathy. Logistic regression analysis demonstrated that higher FIB-4 scores were significantly associated with an increased risk of nephropathy. The FIB-4 score is a cost-effective and straightforward tool with potential applicability in predicting nephropathy in individuals with type 2 DM. [ABSTRACT FROM AUTHOR]

Copyright of Balikesir Health Sciences Journal / Balıkesir Sağlık Bilimleri Dergisi is the property of Balikesir Health Sciences Journal (BAUN Health Sci J) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Prior case reports and animal studies have reported on potential ophthalmologic complications of babesiosis, but this issue has not previously been addressed in a cohort of patients with babesiosis. This cross-sectional descriptive pilot study evaluated the retinas of patients with acute babesiosis to determine if retinal abnormalities are a feature of the disease. Methods: We screened all patients admitted to Yale New Haven Hospital with laboratory confirmed babesiosis during the summer of 2023 and obtained informed consent. Patients were interviewed and underwent pupil dilation and a retinal examination using an indirect ophthalmoscope. Demographic and clinical information were obtained by questionnaire and through chart review. Results: Ten patients underwent retinal eye exams with results that were generally unremarkable. No study patients showed any signs of retinal inflammation, infection, retinal bleeding, retinal tears, or abnormal vessel formation that could be attributed to infection. Conclusion: This small study did not find evidence of retinopathy in patients with babesiosis. Further studies with larger populations, repeated exams, and long term follow up will further elucidate the potential small vessel complications of human babesiosis. [ABSTRACT FROM AUTHOR]

Many diseases produce pathological changes in the fundus; analyzing the retinopathy of the fundus could help diagnose diseases in time. A fundus camera is a medical imaging device that specializes in taking fundus images to diagnose hypertension, coronary heart disease, diabetes, and others. The fundus optical imaging system is the core part of it. Nevertheless, the conventional fundus optical imaging system is large and not suitable for mobile examination and follow-up use. So, it has not been widely used in medical institutions. In this paper, a miniaturized fundus optical imaging system based on aspheric technology and non-coaxial illumination is proposed. The length of the imaging system is only 34.6   mm , the field of view is 50°, and the MTF curve is greater than 0.2 at 100 lp / mm , which can resolve the structure of 5   um . The illumination system adopts a non-coaxial annular array illumination structure to avoid occlusion of the imaging system. Our study effectively tackles the pressing predicament of fundus optical system miniaturization. This innovative paradigm harbors the potential to revolutionize fundus image data acquisition, propelling the field of fundus diagnosis forward and efficiently catering to crucial applications, improving the versatility of fundus examination, and providing technical support for the intelligent diagnosis system. [ABSTRACT FROM AUTHOR]