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Assessment of diabetic teleretinal imaging program at the Portland Department of Veterans Affairs Medical Center
摘要： We conducted a retrospective chart review of 200 diabetic patients who had teleretinal imaging performed between January 1, 2010, and January 1, 2011, at Portland Department of Veterans Affairs (VA) Medical Center outpatient clinics to assess the effectiveness of the diabetic teleretinal imaging program. Twenty patients (10%) had diabetic retinopathy. Ninety percent of the available teleretinal imaging studies were of adequate quality for interpretation. In accordance with local VA policy at that time, all teleretinal imaging patients should have been referred for a dilated retinal examination the following year. Image readers referred 97.5% of the patients to eye clinics for subsequent eye examinations, but the imagers scheduled appointments for only 80% of these patients. The redundancy rate, i.e., patients who had an eye examination within the past 6 mo, was 11%; the duplicate recall rate, i.e., patients who had a second teleretinal imaging performed within 1 yr of the eye examination, was 37%. Rates of timely diabetic eye examinations at clinics with teleretinal imaging programs, particularly when teleretinal imaging and eye clinics were colocated at the same community-based outpatient clinic, were higher than at those without a teleretinal imaging program. We concluded that the Portland VA Medical Center's teleretinal imaging program was successful in increasing the screening rate for diabetic retinopathy.
关键词： teleretinal imaging program,diabetes mellitus,dilated eye examination,diabetic retinal examination,primary care,diabetic retinopathy,outpatient clinic,screening,teleretinal imaging,telehealth
更新于2025-09-23 15:22:29
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Evaluation of plaque characteristics in coronary artery patients with impaired glucose tolerance through optical coherence tomography
摘要： OBJECTIVE: With the adoption of optical coherence tomography (OCT), this study targets the impacts on plaque characteristics brought about by impaired glucose tolerance (IGT) in patients with coronary artery disease. METHODS: For this study, 150 patients with coronary artery disease were recruited. Regarding glycosylated hemoglobin (HbAlc), the patients were sectioned into normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus (DM) groups. Coronary angiography (CAG) and OCT were conducted for 150 patients. RESULTS: There were 186 plaques discovered in 150 patients (37, 40, 44, and 65 in the NGT, IFG, IGT, and DM groups, respectively). Compared to the NGT group, the lipid core size, which is presented as the average angle of the lipid arc, was markedly larger in the IFG,IGT and DM groups ( 135.7 ± 32.7 ê, 161.2 ± 55.7 ê, 162.5 ± 55.8 ê, and 170.2 ± 59.7 ê, respectively, all P values< 0.05). Meanwhile, the fibrous cap over the lipid core in the NGT group was remarkably thicker than that in the IFG, IGT, and DM groups (115.7 ± 47.7 μm vs. 77.7 ± 23.5 μm, 75.1 ± 23.2 μm, 71.2 ± 22.1 μm, all P values<0.05). CONCLUSION: Coronary plaques in coronary artery patients with NDT are more stable than in those with IGT and DM.
关键词： Diabetes Mellitus,Tomography, Optical Coherence,Coronary Artery Disease,Atherosclerosis,Coronary Disease
更新于2025-09-23 15:21:01
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Multifocal electroretinogram in diabetic macular edema; Correlation with visual acuity and optical coherence tomography
摘要： Purpose: To evaluate multifocal electroretinogram (mfERG) changes in eyes with diabetic macular edema (DME) and investigate any possible correlation with optical coherence tomography (OCT) features and visual acuity (VA). Methods: Twenty?nine right eyes of 29 subjects with DME due to non?proliferative diabetic retinopathy and 30 eyes of 30 normal subjects were evaluated. All patients underwent a complete ophthalmic examination. Sixty?one scaled hexagon mfERG responses were recorded. Components of the first order kernel of N1, N2, and P1 in five concentric rings centered on the fovea, were measured in both groups. Correlation and regression analyses were performed among VA, central macular thickness (CMT) based on OCT, mfERG amplitude, and latency of the N1, N2 and P1 waves. Results: Significant differences were observed in all mfERG parameters in five?ring regions of the retina between eyes with DME versus controls (P < 0.05). There were significant correlations among VA with N2 (P = 0,001, b = 0.73) and P1 amplitudes (P = 0.001, b = ?0.84) in the central macular area, and there was a borderline association between VA and CMT (P = 0.042, b = 0.392). Conclusion: Amplitudes of mfERG components (N1, P1, and N2) are significantly reduced and their latencies are delayed in eyes with DME indicating functional impairment in the outer retina. The mfERG total amplitude was significantly correlated with VA even more than CMT, therefore the combined use of OCT and mfERG for macular evaluation may better evaluate visual status in DME patients.
关键词： Diabetes Mellitus,Multi?focal Electroretinography,Diabetic Macular Edema,Optical Coherence Tomography,Visual Acuity
更新于2025-09-23 15:21:01
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Effect of diode laser application as an adjunct to nonsurgical periodontal therapy on the reduction of red complex microorganisms in type 2 diabetics with chronic periodontitis
摘要： Bactericidal and detoxification effects of diode laser (DL) have been reported in periodontal treatment. The objective of this study was investigating the additional effect of DL with nonsurgical periodontal treatment on the red complex bacteria in type 2 diabetes mellitus (DM) patients with chronic periodontitis (CP). Sixty type 2 DM patients with chronic periodontitis (CP) were randomly assigned in two parallel groups to receive scaling root planning (SRP, n = 30) or SRP followed by DL periodontal pocket irradiation (SRP + DL, n = 30). Recording of clinical parameters and subgingival plaque sampling were performed at baseline, and post therapy (1 and 3 months after treatment). Amounts of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia were evaluated with quantitative RT-PCR. Significant reductions for numbers of all three bacterial species were observed at 1 and 3 months compared with baseline for both treatments (p < 0.001), but no significant differences were found between two groups regarding bacterial reductions at these follow-up time points. No additional benefit of DL as an adjunct to nonsurgical periodontal therapy was recognized in the reduction of P. gingivalis, T. denticola, and T. forsythia for type 2 DM patients with CP. Further studies are required to clarify the effects of diode laser on the other periodontopathogens.
关键词： Nonsurgical periodontal treatment,Periodontopathogens,Diabetes mellitus,Diode lasers,Chronic periodontitis
更新于2025-09-23 15:19:57
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Effect of Modified Laser Transcutaneous Irradiation on Pain and Quality of Life in Patients with Diabetic Neuropathy
摘要： Background: Diabetic neuropathy (DN) is one of the major complications developed by individuals with diabetes mellitus. DN is responsible for a high morbidity and mortality rate and impacts the public health and medical assistance resources. Intradermic laser irradiation on blood (ILIB) consists of the application of light beams on the radial arterial, providing anti-inflammatory and vasodilator effects, antiarrhythmic action, reduction of glucose, and stabilization of the hormonal and immunological systems. These effects help to maintain the physiological dynamics of the body. Objective: The goal of this research was to evaluate the effects of ILIB to relieve pain and improve the quality of life in DN patients. The sample comprised 30 diabetic volunteers with DN, randomly distributed into 3 groups: Control—conventional treatment; ILIB—100 mW, 660 – 10 nm, 30 applications in total, divided into 3 stages of 10 applications, 30 min each, daily, with a 20-day interval between each stage; SILIB—same protocol described for ILIB, with the equipment switched off. Before and after the application of the therapeutic protocols, all volunteers were evaluated by the following instruments: Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), visual analog scale, Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and PAIN DETECT scale. Collected data were statistically analyzed with a 95% confidence interval, p < 0.05. Results: The ILIB group presented significantly lower pain levels and a better quality of life compared with the control and SILIB groups. Conclusions: This study demonstrated that ILIB therapy was effective in reducing pain and improving quality of life in patients with DN.
关键词： photobiomodulation,diabetes mellitus,diabetic neuropathies,pain
更新于2025-09-23 15:19:57
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Validation of low-cost smartphone-based thermal camera for diabetic foot assessment
摘要： Infrared thermal imaging (IR) is not yet routinely implemented for early detection of diabetic foot ulcers (DFU), despite proven clinical effectiveness. Low-cost, smartphone-based IR-cameras are now available and may lower the threshold for implementation, but the quality of these cameras is unknown. We aim to validate a smartphone-based IR-camera against a high-end IR-camera for diabetic foot assessment. Methods: We acquired plantar IR images of feet of 32 participants with a current or recently healed DFU with the smartphone-based FLIR-One and the high-end FLIR-SC305. Contralateral temperature differences of the entire plantar foot and nine pre-specified regions were compared for validation. Intra-class correlations coefficient (ICC(3,1)) and Bland-Altman plots were used to test agreement. Clinical validity was assessed by calculating statistical measures of diagnostic performance. Results: Almost perfect agreement was found for temperature measurements in both the entire plantar foot and the combined pre-specified regions, respectively, with ICC values of 0.987 and 0.981, Bland-Altman plots’ mean Δ=-0.14 and Δ=-0.06. Diagnostic accuracy showed 94% and 93% sensitivity, and 86% and 91% specificity. Conclusions: The smartphone-based IR-camera shows excellent validity for diabetic foot assessment.
关键词： Smartphone,Thermal Infrared,Diabetes Mellitus,Diabetic Foot,Foot Ulcer,Temperature
更新于2025-09-19 17:15:36
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A predictive screening tool to detect diabetic retinopathy or macular edema in primary health care: construction, validation and implementation on a mobile application
摘要： The most described techniques used to detect diabetic retinopathy and diabetic macular edema have to be interpreted correctly, such that a person not specialized in ophthalmology, as is usually the case of a primary care physician, may experience difficulties with their interpretation; therefore we constructed, validated and implemented as a mobile app a new tool to detect diabetic retinopathy or diabetic macular edema (DRDME) using simple objective variables. We undertook a cross-sectional, observational study of a sample of 142 eyes from Spanish diabetic patients suspected of having DRDME in 2012–2013. Our outcome was DRDME and the secondary variables were: type of diabetes, gender, age, glycated hemoglobin (HbA1c), foveal thickness and visual acuity (best corrected). The sample was divided into two parts: 80% to construct the tool and 20% to validate it. A binary logistic regression model was used to predict DRDME. The resulting model was transformed into a scoring system. The area under the ROC curve (AUC) was calculated and risk groups established. The tool was validated by calculating the AUC and comparing expected events with observed events. The construction sample (n = 106) had 35 DRDME (95% CI [24.1–42.0]), and the validation sample (n = 36) had 12 DRDME (95% CI [17.9–48.7]). Factors associated with DRDME were: HbA1c (per 1%) (OR = 1.36, 95% CI [0.93–1.98], p = 0.113), foveal thickness (per 1 μm) (OR = 1.03, 95% CI [1.01–1.04], p < 0.001) and visual acuity (per unit) (OR = 0.14, 95% CI [0.00–0.16], p < 0.001). AUC for the validation: 0.90 (95% CI [0.75–1.00], p < 0.001). No significant differences were found between the expected and the observed outcomes (p = 0.422). In conclusion, we constructed and validated a simple rapid tool to determine whether a diabetic patient suspected of having DRDME really has it. This tool has been implemented on a mobile app. Further validation studies are required in the general diabetic population.
关键词： Diabetes mellitus,Macular edema,Diagnostic tests,Statistical models,Diabetic retinopathy,Optical coherence tomography
更新于2025-09-19 17:15:36
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Multiple renal ruptures after flexible ureteroscopic lithotripsy with holmium laser
摘要： The authors present a case report of multiple renal ruptures after flexible ureteroscopic lithotripsy (FURL) with holmium laser. Multiple renal ruptures following flexible ureterorenoscopy have not been reported so far. The etiology remains unclear. We like to share this case to make urologists aware of this unusual complication and discuss possible causes and therapeutic approaches.
关键词： urolithiasis,flexible ureteroscopy,infection,Renal rupture,diabetes mellitus
更新于2025-09-19 17:13:59
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Quantitative Analysis of Heel Skin Microcirculation Using Laser Doppler Flowmetry and Tissue Spectrophotometry
摘要： OBJECTIVE: To examine perfusion changes in the heel skin of individuals with and without diabetes mellitus to understand how skin is pathologically affected by diabetes mellitus. METHODS: This case-control study was conducted at an academic hospital in Tuebingen, Germany. A total of 30 subjects were enrolled in the study: 15 with known type 2 diabetes mellitus and 15 without. Each subject was asked to lie in a supine position on a hard lateral transfer mat for 10 minutes. MAIN OUTCOME MEASURES: Heel perfusion was quantitatively assessed directly after relief of pressure and after 3 and 6 minutes after relief of pressure using laser Doppler flowmetry and tissue spectrophotometry. MAIN RESULTS: Directly after relief of pressure, blood flow increased in the superficial skin layers (2 mm below the surface of the skin) in both groups. However, in deep skin layers (8 mm below the surface of the skin), blood flow increased in patients with diabetes mellitus and decreased in healthy patients. Oxygen saturation (SO2) was higher in healthy subjects directly after pressure relief. CONCLUSIONS: The increase in blood flow in superficial skin layers indicates reactive hyperemia after exposure in both groups. The prolonged hyperemia in deep skin layers in patients with diabetes indicates increased tissue vulnerability. Despite the increase in blood flow in deep skin layers, the SO2 and thus supply of tissue in patients with diabetes were reduced.
关键词： diabetes mellitus,pressure injury,oxygen saturation,blood flow,perfusion,diabetic foot ulcers,laser Doppler flowmetry,pressure ulcer,microcirculation
更新于2025-09-12 10:27:22
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Diabetic Nephropathy (Pathophysiology and Clinical Aspects) || Microvascular Complications in the?Eye: Diabetic Retinopathy
摘要： Diabetic retinopathy (DR) is a major cause of vision loss and blindness among persons with diabetes mellitus. It is estimated that approximately 35% of diabetes patients develop some form of DR [1]. DR is a progressive disease that is predominantly characterized by alterations in the retinal microvasculature. It may develop from an asymptomatic nonproliferative form associated with capillary non-perfusion, microaneurysms, and retinal hemorrhages, into a vision-threating disorder such as diabetic macular edema (DME) and proliferative DR (PDR).
关键词： vision loss,Diabetic retinopathy,retinal microvasculature,blindness,microvascular complications,diabetic macular edema,diabetes mellitus,proliferative diabetic retinopathy
更新于2025-09-10 09:29:36