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Background: Diabetic retinopathy (DR) is an important microvascular consequence of long-term type 2 diabetes mellitus (T2DM), and it can lead to blindness if not properly diagnosed and managed. Nailfold video capillaroscopy (NVC) is a non-invasive technique for observing capillary microvasculature. Aim: We aimed to evaluate the nail folds capillaroscopic alterations in patients with T2DM by NVC and correlated the results to DR, and their relation to disease duration and hemoglobin A1c (HbA1c). Methods: This cross-sectional study enrolled 62 cases with T2DM (as per the American Diabetes Association criteria). All patients were subjected to NVC and ophthalmological assessment. Results: NVC revealed that Patients with DR showed significantly higher frequencies of tortuous capillaries, branched capillaries and precapillary edema versus non-DR patients with P < .05. The DR patients with longer disease duration (15-20) years had significantly higher frequencies of branched capillaries, tortuous capillaries, microhemorrhages, and dilated apical capillaries. The frequency of tortuosity and precapillary edema were significantly higher in patients with poor glycemic control. The increased capillary width and branched capillaries were detected as predictors of DR in multivariate analysis. Conclusion: NVC is a cost-effective, quick, safe, simple, non-invasive, and newly emerging tool to assess the capillaroscopic alterations in diabetic patients as an indicator of severity of DR.
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BACKGROUND: The concept of detection and management of diabetes mellitus at primary health-care centers is justified and widely practised in Saudi Arabia. The objective of this study was to assess the efficacy of diabetic educational programs for noninsulin-dependent (type 2) diabetes mellitus patients, and to determine the predictors of compliance. MATERIALS AND METHODS: A longitudinal experimental research design was adopted for this study and conducted at the diabetic outpatient clinic of King Fahd Hospital of the University, Al Khobar, Kingdom of Saudi Arabia. A convenient sample of 150 adult patients diagnosed as type 2 diabetes was included in this study. RESULTS: There was a significant reduction in the body mass index (BMI) of patients, an improvement in regular self-checks of blood sugar, dietary regimen, foot care, and exercise and lifestyle behavior following the educational program. It was observed that patients' knowledge of diabetes had improved after exposure to the educational program in the three-time intervals. CONCLUSIONS: Type 2 diabetes mellitus exhibited significant change in both BMI, sugar accumulation, and adherence to medication after attending the educational program, and there was evidence of improved knowledge of regular self-checks of blood sugar, dietary regimen, foot care, exercise, and lifestyle behavior.
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Angiogenesis and microvascular endothelial injury play a role in the pathogenesis of systemic lupus erythematosus (SLE). Vascular endothelial growth factor (VEGF), a key regulator of angiogenesis, and nail fold capillaroscopy (NFC) have been investigated in few studies in SLE with no reports targeting SLE with cutaneous manifestations. To evaluate NFC changes and VEGF serum level in relation to disease activity in SLE patients with versus without cutaneous manifestations. Thirty SLE patients (15 with cutaneous manifestations [group I], 15 without [group II]) and 15 healthy controls were evaluated for VEGF serum levels, NFC changes and were related to disease activity. VEGF serum levels were significantly higher in patients than controls (median and interquartile range [IQR]: 2110.77, 471.09-4714.30 vs. 60.00, 14-366, respectively, P < 0.0001). VEGF cut-off value to predict SLE patients was more than 293 and to detect moderate and severe SLE activity was more than 422 pg/mL and more than 3800 pg/mL, respectively. Serum VEGF levels increased with increased disease activity (P < 0.05). It was significantly higher in group I than group II (median and IQR: 2624.74, 1801.39-4141.70 vs. 862.50, 180-2426.95, respectively, P < 0.05). Mean serum VEGF was significantly higher with NFC score 3 than 1 (P = 0.008). NFC score and SLE activity were significantly associated in patients (P < 0.05). Serum VEGF is significantly elevated in SLE patients with cutaneous manifestations and its cut-off values to detect different activity grades of SLE are identified. Abnormalities in NFC reflect the extent of microvascular involvement in SLE.
Asunto(s)
Lupus Eritematoso Sistémico/patología , Uñas/irrigación sanguínea , Neovascularización Patológica , Factor A de Crecimiento Endotelial Vascular/sangre , Adolescente , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Niño , Femenino , Humanos , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/fisiopatología , Masculino , Angioscopía Microscópica , Persona de Mediana Edad , Proyectos Piloto , Adulto JovenRESUMEN
BACKGROUND: Anti-cyclic citrullinated peptides (anti-CCP) are highly specific diagnostic and prognostic markers for rheumatoid arthritis (RA). They have been also found in psoriatic arthritis (PsA), with controversies as regards clinical and radiological associations. The current study assessed anti-CCP in PsA and determined its clinical and radiological associations. METHODS: Four groups contributed to this study. 40 PsA, 40 psoriasis without arthritis, 40 RA and 40 healthy controls. They were tested for anti-CCP. Clinical and radiological data were collected and statistically compared between anti-CCP-positive and -negative PsA patients. RESULTS: Seven PsA (17.5%) and 34 RA (85%) were seropositive for anti-CCP. Patients of other groups were anti-CCP-negative. Regarding anti-CCP concentrations, highly significant difference existed between different groups and between anti-CCP-positive and -negative PsA. Significantly higher numbers of involved, swollen and tender joints, deformities and functional impairment of peripheral joints and radiological changes were found in anti-CCP-positive PsA. CONCLUSION: Anti-CCP may be found in PsA and are associated with higher number of involved, swollen and tender joints, with deformities and functional impairment of peripheral joints and with erosive arthritis.