Novel optical coherence tomography angiography biomarkers in the diagnosis and assessment of diabetic macular edema and diabetic macular ischemia in patients with non-proliferative diabetic retinopathy

Purpose: The present study aims to determine the macular and choroidal optical coherence tomography angiography (OCTA) biomarkers in the assessment and monitoring of diabetic macular edema (DME) and diabetic macular ischemia (DMI) in patients with non?proliferative diabetic retinopathy (NPDR). Methods: In this cohort study, a total of 176 eyes of 110 patients with NPDR were investigated at our institute over a period of 10 months. Eyes were divided into four groups based on the severity of NPDR. Each eye was subjected to OCTA (Topcon 3D OCT?1 Maestro2) macula 6 × 6 mm2 en face. It features IMAGEnet 6 software for dynamic viewing of OCTA and imaging data. Four OCTA biomarkers for the macula were identified: foveal avascular zone area (FAZ area), foveal avascular zone contour irregularity (FAZ?CI), capillary dropout areas (CDA), and perifoveal intercapillary areas (PICA). The choroidal OCTA biomarker was the number of choroidal circulation flow voids (CCFV). For all analyses, P < 0.05 was considered statistically significant. Results: Increase in FAZ area and number of CDA were statistically significant (p < 0.0001) with an increase in central foveal thickness, suggesting a correlation of ischemic changes with an increase in DME. FAZ?CI, enlarged PICA, and CCFV were significantly associated with more severe NPDR patients. Conclusion: A correlation between DME and DMI in a patient of NPDR and its progression can be evaluated in a single visit. A unique feature of our study is it revealed novel diagnostic biomarkers of OCTA for DMI and DME.

Recurrent diabetic myonecrosis: A rare complication of a common disease.

Spontaneous aseptic diabetic muscle infarction (DMI) is one of the rare complications of diabetes. We report a case of type 2 diabetes mellitus with advanced microvascular complications presenting with severe muscular pain. She was diagnosed as DMI on the basis of clinical presentation, radiological and histopathological investigations. She was managed conservatively. During 18 months of follow up, she had good improvement but subsequently other muscle groups were involved suggesting recurrent DMI.

Prevalência do polimorfismo -1031 T>C do gene TNFA em um grupo de diabéticos tipo I e sua relação com a periodontite severa / Prevalence of the TNFA -1031 T>C gene polymorphism in a group of type I diabetic patients and its relation to severe periodontitis

Diabetes mellitus e doenças periodontais são altamente prevalentes na população mundial. Doenças periodontais (DPs) compreendem um grupo de condições crônicas inflamatórias induzidas por microorganismos que levam à inflamação gengival, à destruição tecidual periodontal e à perda óssea alveolar. Diabetes mellitus (DM) é o termo utilizado para descrever um grupo de desordens metabólicas associadas à intolerância à glicose e ao metabolismo inadequado de carboidratos. Uma vez que DPs poderiam agir de forma similar a outros estados infecciosos sistêmicos, aumentando a severidade do diabetes, uma possível relação entre ambas tem sido considerada em todo o mundo. Polimorfismos genéticos de um único nucleotídeo (SNPs) têm sido estudados em diversas doenças. Nas periodontites, acredita-se que possam estar envolvidos na exacerbação da resposta inflamatória frente ao desafio bacteriano, modificando a susceptibilidade do hospedeiro. Neste estudo, a prevalência de periodontite foi avaliada em portadores de diabetes mellitus tipo I. Posteriormente, o SNP localizado na região promotora do gene TNFA (-1031T>C) foi analisado e sua importância para a doença periodontal destrutiva foi avaliada. O grupo teste foi constituído por diabéticos tipo I (DGT, n=113) enquanto o grupo controle por indivíduos não diabéticos (ND, n=73). Para as análises dos polimorfismos genéticos, um subgrupo foi retirado do grupo teste (DG, n=58) e comparado ao grupo ND. Os seguintes parâmetros clínicos e demográficos foram avaliados: percentual de sítios com profundidade de bolsa  6,0 mm (%PBS6,0 mm); índice gengival (IG); perda óssea radiográfica (POR); fumo; duração do diabetes ; idade; índice de massa corpórea (IMC), n de internações e n de dentes presentes. Amostras de sangue e/ou esfregaço bucal foram colhidas de 58 pacientes do grupo teste e de 73 controles. Após a extração do DNA genômico e amplificação da região genômica de interesse ...

Diabetes mellitus and periodontal diseases are highly prevalent worldwide. Periodontal disease (PD) combines a group of chronic inflammatory conditions induced by microorganisms that leads to gingival inflammation, periodontal tissue destruction and alveolar bone loss. Diabetes mellitus (DM) is a term used to describe a group of metabolic disorders associated to glucose intolerance and inappropriate carbohydrate metabolism. Once PDs could act in a similar way to other systemic infectious states increasing diabetes severity, a possible correlation between both has been considerate around the world. Single nucleotide polymorphisms (SNPs) have been studied in relation to several diseases. In periodontitis, it is believed to be involved in an exacerbated inflammatory response due to bacterial challenge, modifying the host susceptibility. In this study, the prevalence of periodontal disease was evaluated in type I diabetes patients (TIDM). Further on, the SNP in the promoter region of the TNFA gene (-1031T>C) was analyzed and its importance to destructive periodontal disease was considered. The test group was formed by type I diabetic patients (TDG, n=113) and the control group was composed by non-diabetic patients (ND, n=73). For the genetic polymorphism analysis a subgroup was taken from the test group (DG, n=58) and compared to the ND group. The following clinical and demographic parameters were assessed: percentage of sites with periodontal pocket depth (PPD)  6.0mm; gingival index (GI); radiographic bone loss (RBL); smoking habits; diabetes duration; age; bone mass index (BMI); number of admissions and number of teeth. Blood samples and oral epithelial cells were collected from 58 patients of the test group and 73 controls. After genomic DNA extraction and amplification of the genomic region of interest by PCR (Polymerase Chain Reaction), the TNFA –1031T>C polymorphism was analyzed ...

Prevalência do polimorfismo -1031 T>C do gene TNFA em um grupo de diabéticos tipo I e sua relação com a periodontite severa / Prevalence of the TNFA -1031 T>C gene polymorphism in a group of type I diabetic patients and its relation to severe periodontitis

Diabetes mellitus e doenças periodontais são altamente prevalentes na população mundial. Doenças periodontais (DPs) compreendem um grupo de condições crônicas inflamatórias induzidas por microorganismos que levam à inflamação gengival, à destruição tecidual periodontal e à perda óssea alveolar. Diabetes mellitus (DM) é o termo utilizado para descrever um grupo de desordens metabólicas associadas à intolerância à glicose e ao metabolismo inadequado de carboidratos. Uma vez que DPs poderiam agir de forma similar a outros estados infecciosos sistêmicos, aumentando a severidade do diabetes, uma possível relação entre ambas tem sido considerada em todo o mundo. Polimorfismos genéticos de um único nucleotídeo (SNPs) têm sido estudados em diversas doenças. Nas periodontites, acredita-se que possam estar envolvidos na exacerbação da resposta inflamatória frente ao desafio bacteriano, modificando a susceptibilidade do hospedeiro. Neste estudo, a prevalência de periodontite foi avaliada em portadores de diabetes mellitus tipo I. Posteriormente, o SNP localizado na região promotora do gene TNFA (-1031T>C) foi analisado e sua importância para a doença periodontal destrutiva foi avaliada. O grupo teste foi constituído por diabéticos tipo I (DGT, n=113) enquanto o grupo controle por indivíduos não diabéticos (ND, n=73). Para as análises dos polimorfismos genéticos, um subgrupo foi retirado do grupo teste (DG, n=58) e comparado ao grupo ND. Os seguintes parâmetros clínicos e demográficos foram avaliados: percentual de sítios com profundidade de bolsa  6,0 mm (%PBS6,0 mm); índice gengival (IG); perda óssea radiográfica (POR); fumo; duração do diabetes ; idade; índice de massa corpórea (IMC), nós de internações e nós de dentes presentes. Amostras de sangue e/ou esfregaço bucal foram colhidas de 58 pacientes do grupo teste e de 73 controles. Após a extração do DNA genômico e amplificação da região genômica de interesse...

Diabetes mellitus and periodontal diseases are highly prevalent worldwide. Periodontal disease (PD) combines a group of chronic inflammatory conditions induced by microorganisms that leads to gingival inflammation, periodontal tissue destruction and alveolar bone loss. Diabetes mellitus (DM) is a term used to describe a group of metabolic disorders associated to glucose intolerance and inappropriate carbohydrate metabolism. Once PDs could act in a similar way to other systemic infectious states increasing diabetes severity, a possible correlation between both has been considerate around the world. Single nucleotide polymorphisms (SNPs) have been studied in relation to several diseases. In periodontitis, it is believed to be involved in an exacerbated inflammatory response due to bacterial challenge, modifying the host susceptibility. In this study, the prevalence of periodontal disease was evaluated in type I diabetes patients (TIDM). Further on, the SNP in the promoter region of the TNFA gene (-1031T>C) was analyzed and its importance to destructive periodontal disease was considered. The test group was formed by type I diabetic patients (TDG, n=113) and the control group was composed by non-diabetic patients (ND, n=73). For the genetic polymorphism analysis a subgroup was taken from the test group (DG, n=58) and compared to the ND group. The following clinical and demographic parameters were assessed: percentage of sites with periodontal pocket depth (PPD)  6.0mm; gingival index (GI); radiographic bone loss (RBL); smoking habits; diabetes duration; age; bone mass index (BMI); number of admissions and number of teeth. Blood samples and oral epithelial cells were collected from 58 patients of the test group and 73 controls. After genomic DNA extraction and amplification of the genomic region of interest by PCR (Polymerase Chain Reaction), the TNFA –1031T>C polymorphism was analyzed ...