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Caturano A, Rocco M, Tagliaferri G, Piacevole A, Nilo D, Di Lorenzo G, Iadicicco I, Donnarumma M, Galiero R, Acierno C, Sardu C, Russo V, Vetrano E, Conte C, Marfella R, Rinaldi L, Sasso FC. Oxidative Stress and Cardiovascular Complications in Type 2 Diabetes: From Pathophysiology to Lifestyle Modifications. Antioxidants (Basel) 2025; 14:72. [PMID: 39857406 PMCID: PMC11759781 DOI: 10.3390/antiox14010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 12/30/2024] [Accepted: 01/08/2025] [Indexed: 01/27/2025] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that significantly increases the risk of cardiovascular disease, which is the leading cause of morbidity and mortality among diabetic patients. A central pathophysiological mechanism linking T2DM to cardiovascular complications is oxidative stress, defined as an imbalance between reactive oxygen species (ROS) production and the body's antioxidant defenses. Hyperglycemia in T2DM promotes oxidative stress through various pathways, including the formation of advanced glycation end products, the activation of protein kinase C, mitochondrial dysfunction, and the polyol pathway. These processes enhance ROS generation, leading to endothelial dysfunction, vascular inflammation, and the exacerbation of cardiovascular damage. Additionally, oxidative stress disrupts nitric oxide signaling, impairing vasodilation and promoting vasoconstriction, which contributes to vascular complications. This review explores the molecular mechanisms by which oxidative stress contributes to the pathogenesis of cardiovascular disease in T2DM. It also examines the potential of lifestyle modifications, such as dietary changes and physical activity, in reducing oxidative stress and mitigating cardiovascular risks in this high-risk population. Understanding these mechanisms is critical for developing targeted therapeutic strategies to improve cardiovascular outcomes in diabetic patients.
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Affiliation(s)
- Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166 Rome, Italy;
| | - Maria Rocco
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
| | - Giuseppina Tagliaferri
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
| | - Alessia Piacevole
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
| | - Davide Nilo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
| | - Giovanni Di Lorenzo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
| | - Ilaria Iadicicco
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
| | - Mariarosaria Donnarumma
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
| | - Carlo Acierno
- Azienda Ospedaliera Regionale San Carlo, 85100 Potenza, Italy;
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
| | - Vincenzo Russo
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA;
- Division of Cardiology, Department of Medical Translational Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
| | - Caterina Conte
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166 Rome, Italy;
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, 20099 Milan, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
| | - Luca Rinaldi
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, Università degli Studi del Molise, 86100 Campobasso, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (A.C.); (M.R.); (G.T.); (A.P.); (D.N.); (G.D.L.); (I.I.); (M.D.); (R.G.); (C.S.); (E.V.); (R.M.)
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Jang J, Lee DW, Suh J, Shin J. Association of the COVID-19 Pandemic with HbA1c Testing and Complication Screening in Patients with Diabetes Mellitus. Yonsei Med J 2024; 65:669-676. [PMID: 39439171 PMCID: PMC11519130 DOI: 10.3349/ymj.2023.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 10/25/2024] Open
Abstract
PURPOSE This study aimed to identify the association between coronavirus disease 2019 (COVID-19) transmission levels and undergoing glycated hemoglobin (HbA1c) test and complication screenings among patients with diabetes mellitus. MATERIALS AND METHODS We included a total of 3601 diabetes patients' data from the 2020 Korean Community Health Survey to analyze the extent of the HbA1c testing and fundus examination, and 3592 diabetes patients' data to analyze kidney disease screening. COVID-19 transmission levels were classified into low transmission (Busan, Gwangju, Daejeon, Ulsan, and Sejong) and high transmission (Daegu, where the first large outbreak of COVID-19 occurred in Korea). Multiple logistic regression was used to obtain adjusted odds ratio (ORs) and 95% confidence interval (CI) to determine the association of COVID-19 transmission levels with undergoing HbA1c testing and diabetes complication screening. RESULTS The proportion of subjects who underwent complication screening of diabetes was lower in the high transmission region (low transmission vs. high transmission: 42.3% vs. 38.0% for fundus examination; 48.9% vs. 45.7% for kidney disease screening). A high COVID-19 transmission level was associated with decreased odds of undergoing fundus examination (OR, 0.82; 95% CI, 0.69-0.98) and kidney disease screening (OR, 0.76; 95% CI, 0.63-0.91). However, COVID-19 transmission levels were not significantly associated with undergoing HbA1c testing. CONCLUSION A high level of COVID-19 transmission was associated with a decrease in undergoing fundus examination and kidney disease screening. To fully realize the potential benefit of diabetes complication screenings, further effort is required to identify and address challenges to obtaining these screenings, especially in outbreak regions.
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Affiliation(s)
- Jieun Jang
- Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Doo Woong Lee
- Institute of Health Services Research, Yonsei University, Seoul, Korea
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Junghwan Suh
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.
| | - Jaeyong Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA.
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Alhadlaq RK, Afrah AA, Mohiden MT, Alsaad SZ. Knowledge and Attitudes Toward Telemedicine Among Family Medicine Residents in Riyadh, Saudi Arabia: An Observational Cross-Sectional Study. Cureus 2024; 16:e65655. [PMID: 39205708 PMCID: PMC11351959 DOI: 10.7759/cureus.65655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Background Telemedicine is an emerging concept that involves the use of electronic information and communications technologies to provide and support healthcare. This study aimed to assess the knowledge and attitudes of family medicine residents toward telemedicine in Riyadh, Saudi Arabia. Methodology This was a cross-sectional observational study using a self-administered questionnaire distributed among family medicine residents in Saudi Arabia. The collected data included sociodemographic features, residents' knowledge, and attitudes toward telemedicine. Data were collected in Excel and analyzed using SPSS software version 29. A P-value of less than 0.05 was considered statistically significant. Results The study included 279 family medicine residents with a median age of 27 years. The majority of participants (n=191, 68.5%) had a good level of knowledge regarding telemedicine, which was significantly associated with younger age (p-value = 0.012). Additionally, there was an overall good attitude toward telemedicine attributes, significantly associated with older age and female gender (p-values <0.05). Conclusion This study highlights that family medicine residents in Riyadh, Saudi Arabia, generally possess good knowledge and positive attitudes towards telemedicine. Key findings indicate that younger residents are more knowledgeable about telemedicine, while older residents and female participants show more favorable attitudes toward its attributes. However, further training and education on the ease of use of telemedicine applications are required.
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Affiliation(s)
| | - Amal A Afrah
- Family Medicine, King Saud Medical City, Riyadh, SAU
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Chang HC, Wang LU, Chiou HY, Chen RC, Chen HF, Yao CW, Liu SL, Chen KC, Liao YT, Lin TC, Chuang WP, Wang JK. Impact of Telemedicine on Blood Glucose Control and Ophthalmic Screenings for Patients with Diabetes in Remote Areas During the COVID-19 Pandemic: A Real-World Study in Northern Taiwan. Telemed J E Health 2024. [PMID: 38739447 DOI: 10.1089/tmj.2024.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2024] Open
Abstract
Introduction: The purpose of this study was to assess the impact of telemedicine on ophthalmic screening and blood glucose control for patients with diabetes in remote areas of Northern Taiwan during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Telemedicine was implemented in Shiding and Wanli Districts using a 5G platform from April 2021 to December 2022. Patients with poorly controlled diabetes received real-time consultations from endocrinologists at Far Eastern Memorial Hospital, 50 km away, for medication adjustment, diet control, and lifestyle recommendations. The study also provided cloud-upload blood glucose meters for self-monitoring and regular medical advice from hospital nurses. Ophthalmic screenings included fundus imaging, external eye image, and intraocular pressure measurement, with instant communication and diagnosis by ophthalmologists through telemedicine. A satisfaction questionnaire survey was conducted. Results: The study enrolled 196 patients with diabetes. Blood glucose and glycosylated hemoglobin levels were significantly reduced after applying telemedicine (p = 0.01 and p = 0.005, respectively). Ophthalmic screenings led to hospital referrals for 16.0% with abnormal fundus images, 15.6% with severe cataract or anterior segment disorders, and 27.9% with ocular hypertension or glaucoma. Fundus screening rates remained high at 86.3% and 80.4% in 2022, mainly using telemedicine, comparable with the traditional screening rate in the past 5 years. The overall satisfaction rate was 98.5%. Conclusions: Telemedicine showed effectiveness and high satisfaction in managing diabetes and conducting ophthalmic screenings in remote areas during the COVID-19 pandemic. It facilitated early diagnosis and treatment of ocular conditions while maintaining good blood glucose control and fundus screening rates.
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Affiliation(s)
- Hao-Chun Chang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ling-Uei Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hung-Yi Chiou
- Institute of Population Health Sciences, National Health Research Institute, Zhunan, Taiwan
| | - Ran-Chou Chen
- Department of Health, New Taipei City Government, New Taipei City, Taiwan
| | - Hua-Fen Chen
- Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Wei Yao
- Shiding District Health Center, Department of Health, New Taipei City Government, New Taipei City, Taiwan
| | - Shang-Lin Liu
- Wanli District Health Center, Department of Health, New Taipei City Government, New Taipei City, Taiwan
| | - Kuo-Cheng Chen
- Far EasTone Telecommunications Co., Ltd., Taipei City, Taiwan
| | - Yu-Ting Liao
- Institute of Population Health Sciences, National Health Research Institute, Zhunan, Taiwan
- Center for Community Health Development, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tzu-Chun Lin
- Center for Community Health Development, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wen-Po Chuang
- Center for Community Health Development, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jia-Kang Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan
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Cunha AS, Pedro AR, V Cordeiro J. Challenges of Using Telemedicine in Hospital Specialty Consultations during the COVID-19 Pandemic in Portugal According to a Panel of Experts. ACTA MEDICA PORT 2024; 37:198-206. [PMID: 38430471 DOI: 10.20344/amp.19931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/12/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION The COVID-19 pandemic has accelerated the adoption of telemedicine as a means of reducing face-to-face contact and protecting professionals and patients. In Portugal, the number of hospital telemedicine consultations has significantly increased. However, the rapid implementation of telemedicine has also led to disparities in access to these services, resulting in inequalities in healthcare delivery. The aim of this study was to identify the main challenges to accessing hospital medical specialty consultations through telemedicine in Portugal during the COVID-19 pandemic. Additionally, this study aimed to establish a consensus on possible solutions for the challenges which were identified. METHODS This study used the nominal group technique, which involved a panel of 10 experts. The panel generated a total of 71 ideas, which were then categorized into three groups: A) challenges relating to patients, which impact access to hospital-based medical specialty consultations through telemedicine; B) challenges relating to professionals, institutions and health systems, which impact access to hospital medical specialty consultations through telemedicine; C) recommendations to overcome the challenges faced in adopting telemedicine solutions. Each of the ideas was assessed, scored and ranked based on its relevance considering the study objectives. RESULTS This study identified several significant challenges that impacted the adoption of telemedicine in Portugal during the COVID-19 pandemic. The challenges that related to patients (A) that were deemed the most relevant were low digital literacy, lack of information about telemedicine processes, low familiarity with technologies and distrust about the quality of services; the challenges that impacted healthcare professionals, institutions, and health systems (B) and were deemed the most relevant were the lack of integration of telemedicine in the patient's journey, low motivation to adopt telemedicine solutions, poor interoperability between systems, and the absence of the necessary technological equipment. The most relevant recommendations (C) included investing in healthcare institutions, developing clear guidelines for the safety and quality of telemedicine practices, and incorporating telemedicine into the curricula of health professions. CONCLUSION This study identified several challenges that impacted the adoption and implementation of telemedicine services for hospital care in Portugal during the pandemic period. These challenges were related to digital health literacy, technological and operational conditions, and reluctance in technological adoption. To overcome these challenges, training programs for healthcare professionals and patients may be necessary, along with investment in technological infrastructures, interoperability between systems, effective communication strategies and the strengthening of specific regulations.
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Affiliation(s)
- Ana Soraia Cunha
- Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - Ana Rita Pedro
- Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon; Public Health Research Centre. Comprehensive Health Research Center (CHRC). NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - João V Cordeiro
- Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon; Public Health Research Centre. Comprehensive Health Research Center (CHRC). NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon; Interdisciplinary Center of Social Sciences. Universidade NOVA de Lisboa. Lisbon. Portugal
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Alawadhi A, Palin V, van Staa T. The impact of the COVID-19 pandemic on rates and predictors of missed hospital appointments in multiple outpatient clinics of The Royal Hospital, Sultanate of Oman: a retrospective study. BMC Health Serv Res 2023; 23:1438. [PMID: 38115022 PMCID: PMC10729569 DOI: 10.1186/s12913-023-10395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND The global outbreak of the COVID-19 pandemic resulted in significant changes in the delivery of health care services such as attendance of scheduled outpatient hospital appointments. This study aimed to evaluate the impact of COVID-19 on the rate and predictors of missed hospital appointment in the Sultanate of Oman. METHODS A retrospective single-centre analysis was conducted to determine the effect of COVID-19 on missed hospital appointments at various clinics at The Royal Hospital (tertiary referral hospital) in Muscat, Sultanate of Oman. The study population included scheduled face-to-face and virtual appointments between January 2019 and March 2021. Logistic regression models were used with interaction terms (post COVID-19) to assess changes in the predictors of missed appointments. RESULTS A total of 34, 3149 scheduled appointments was analysed (320,049 face-to-face and 23,100 virtual). The rate of missed face-to-face hospital appointments increased from 16.9% pre to 23.8% post start of COVID-19, particularly in early pandemic (40.5%). Missed hospital appointments were more frequent (32.2%) in virtual clinics (post COVID-19). Increases in missed face-to-face appointments varied by clinic (Paediatrics from 19.3% pre to 28.2% post; Surgery from 12.5% to 25.5%; Obstetrics & Gynaecology from 8.4% to 8.5%). A surge in the frequency of missed appointments was seen during national lockdowns for face-to-face and virtual appointments. Most predictors of missed appointments did not demonstrate any appreciable changes in effect (i.e., interaction term not statistically significant). Distance of patient residence to the hospital revealed no discernible changes in the relative effect pre and post COVID-19 for both face-to-face and virtual clinic appointments. CONCLUSION The rate of missed visits in most clinics was directly impacted by COVID-19. The case mix of patients who missed their appointments did not change. Virtual appointments, introduced after start of the pandemic, also had substantial rates of missed appointments and cannot be viewed as the single approach that can overcome the problem of missing hospital appointments.
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Affiliation(s)
- Ahmed Alawadhi
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Victoria Palin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Maternal and Fetal Research Centre, Division of Developmental Biology and Medicine, The Univeristy of Manchester, St Marys Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Tjeerd van Staa
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Paez-Escamilla M, Alabek ML, Beale O, Prensky CJ, Lejoyeux R, Friberg TR, Sahel JA, Rosin B. An Optical Coherence Tomography-Based Measure as an Independent Estimate of Retinal Function in Retinitis Pigmentosa. Diagnostics (Basel) 2023; 13:3521. [PMID: 38066762 PMCID: PMC10706660 DOI: 10.3390/diagnostics13233521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND With the clinical advances in the field of gene therapy, the development of objective measures of visual function of patients with inherited retinal dystrophies (IRDs) is of utmost importance. Here, we propose one such measure. METHODS We retrospectively analyzed data from a cohort of 194 eyes of 97 genetically diagnosed patients with retinitis pigmentosa (RP), the most common IRD, followed at the UPMC Vision Institute. The analyzed data included the reflectivity ratio (RR) of the retinal nerve fiber layer (RNFL) to that of the entire retina, visual acuity (VA) and the thickness of the retinal outer nuclear layer (ONL) and the RNFL. RESULTS There was a strong positive correlation between the RR and VA. Both VA and the RR were negatively correlated with disease duration; VA, but not the RR, was negatively correlated with age. The RR correlated with the ONL but not with the RNFL thickness or the intraocular pressure. Age, RR, disease duration and ONL thickness were found to be independent predictors of VA by multivariate analysis. CONCLUSION The OCT RR could serve as an independent predictor of visual acuity, and by extension of retinal function, in genetically diagnosed RP patients. Such objective measures can be of great value in patient selection for therapeutic trials.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
- Department of Ophthalmology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Michelle L. Alabek
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Oliver Beale
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Colin J. Prensky
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Raphael Lejoyeux
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
- Rothschild Foundation Hospital, 75019 Paris, France
- Institut Oeil Paupiere, Viry-Chatillon, 91170 Paris, France
| | - Thomas R. Friberg
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Jose-Alain Sahel
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Boris Rosin
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
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Galiero R, Caturano A, Vetrano E, Monda M, Marfella R, Sardu C, Salvatore T, Rinaldi L, Sasso FC. Precision Medicine in Type 2 Diabetes Mellitus: Utility and Limitations. Diabetes Metab Syndr Obes 2023; 16:3669-3689. [PMID: 38028995 PMCID: PMC10658811 DOI: 10.2147/dmso.s390752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is one of the most widespread diseases in Western countries, and its incidence is constantly increasing. Epidemiological studies have shown that in the next 20 years. The number of subjects affected by T2DM will double. In recent years, owing to the development and improvement in methods for studying the genome, several authors have evaluated the association between monogenic or polygenic genetic alterations and the development of metabolic diseases and complications. In addition, sedentary lifestyle and socio-economic and pandemic factors have a great impact on the habits of the population and have significantly contributed to the increase in the incidence of metabolic disorders, obesity, T2DM, metabolic syndrome, and liver steatosis. Moreover, patients with type 2 diabetes appear to respond to antihyperglycemic drugs. Only a minority of patients could be considered true non-responders. Thus, it appears clear that the main aim of precision medicine in T2DM is to identify patients who can benefit most from a specific drug class more than from the others. Precision medicine is a discipline that evaluates the applicability of genetic, lifestyle, and environmental factors to disease development. In particular, it evaluated whether these factors could affect the development of diseases and their complications, response to diet, lifestyle, and use of drugs. Thus, the objective is to find prevention models aimed at reducing the incidence of pathology and mortality and therapeutic personalized approaches, to obtain a greater probability of response and efficacy. This review aims to evaluate the applicability of precision medicine for T2DM, a healthcare burden in many countries.
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Affiliation(s)
- Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marcellino Monda
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Teresa Salvatore
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Błaszkiewicz M, Walulik A, Florek K, Górecki I, Sławatyniec O, Gomułka K. Advances and Perspectives in Relation to the Molecular Basis of Diabetic Retinopathy-A Review. Biomedicines 2023; 11:2951. [PMID: 38001952 PMCID: PMC10669459 DOI: 10.3390/biomedicines11112951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Diabetes mellitus (DM) is a growing problem nowadays, and diabetic retinopathy (DR) is its predominant complication. Currently, DR diagnosis primarily relies on fundoscopic examination; however, novel biomarkers may facilitate that process and make it widely available. In this current review, we delve into the intricate roles of various factors and mechanisms in DR development, progression, prediction, and their association with therapeutic approaches linked to the underlying pathogenic pathways. Specifically, we focus on advanced glycation end products, vascular endothelial growth factor (VEGF), asymmetric dimethylarginine, endothelin-1, and the epigenetic regulation mediated by microRNAs (miRNAs) in the context of DR.
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Affiliation(s)
- Michał Błaszkiewicz
- Student Scientific Group of Adult Allergology, Wroclaw Medical University, 50-369 Wroclaw, Poland
| | - Agata Walulik
- Student Scientific Group of Adult Allergology, Wroclaw Medical University, 50-369 Wroclaw, Poland
| | - Kamila Florek
- Student Scientific Group of Adult Allergology, Wroclaw Medical University, 50-369 Wroclaw, Poland
| | - Ignacy Górecki
- Student Scientific Group of Adult Allergology, Wroclaw Medical University, 50-369 Wroclaw, Poland
| | - Olga Sławatyniec
- Student Scientific Group of Adult Allergology, Wroclaw Medical University, 50-369 Wroclaw, Poland
| | - Krzysztof Gomułka
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, 50-369 Wroclaw, Poland
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10
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Wu J, Duan C, Yang Y, Wang Z, Tan C, Han C, Hou X. Insights into the liver-eyes connections, from epidemiological, mechanical studies to clinical translation. J Transl Med 2023; 21:712. [PMID: 37817192 PMCID: PMC10566185 DOI: 10.1186/s12967-023-04543-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/19/2023] [Indexed: 10/12/2023] Open
Abstract
Maintenance of internal homeostasis is a sophisticated process, during which almost all organs get involved. Liver plays a central role in metabolism and involves in endocrine, immunity, detoxification and storage, and therefore it communicates with distant organs through such mechanisms to regulate pathophysiological processes. Dysfunctional liver is often accompanied by pathological phenotypes of distant organs, including the eyes. Many reviews have focused on crosstalk between the liver and gut, the liver and brain, the liver and heart, the liver and kidney, but with no attention paid to the liver and eyes. In this review, we summarized intimate connections between the liver and the eyes from three aspects. Epidemiologically, we suggest liver-related, potential, protective and risk factors for typical eye disease as well as eye indicators connected with liver status. For molecular mechanism aspect, we elaborate their inter-organ crosstalk from metabolism (glucose, lipid, proteins, vitamin, and mineral), detoxification (ammonia and bilirubin), and immunity (complement and inflammation regulation) aspect. In clinical application part, we emphasize the latest advances in utilizing the liver-eye axis in disease diagnosis and therapy, involving artificial intelligence-deep learning-based novel diagnostic tools for detecting liver disease and adeno-associated viral vector-based gene therapy method for curing blinding eye disease. We aim to focus on and provide novel insights into liver and eyes communications and help resolve existed clinically significant issues.
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Affiliation(s)
- Junhao Wu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022 Hubei China
| | - Caihan Duan
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022 Hubei China
| | - Yuanfan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Zhe Wang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022 Hubei China
| | - Chen Tan
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022 Hubei China
| | - Chaoqun Han
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022 Hubei China
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022 Hubei China
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11
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Guardiola Dávila G, López-Fontanet JJ, Ramos F, Acevedo Monsanto MA. Examining Global Crises: Extracting Insights From the COVID-19 Pandemic and Natural Disasters to Develop a Robust Emergency Diabetic Retinopathy Strategy for Puerto Rico. Cureus 2023; 15:e47070. [PMID: 37846348 PMCID: PMC10577004 DOI: 10.7759/cureus.47070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 10/18/2023] Open
Abstract
In this critical analysis, we investigate the profound impact of natural disasters and pandemics on the care and adherence to treating diabetic retinopathy, a severe complication of diabetes requiring continuous monitoring and treatment to prevent vision loss. Our study also sheds light on the social and economic context of Puerto Rico, emphasizing recent emergency events that have exacerbated existing public health challenges. Through a comprehensive review of relevant literature from PubMed, Google Scholar, and the George Washington University Himmelfarb Health Sciences Library database, we identified 31 pertinent articles out of 45 evaluated, focusing on the effects of these crises on healthcare delivery, diabetic retinopathy screening, and treatment. The evidence strongly indicates that during such emergencies, barriers to healthcare escalate, leading to significant treatment delays and a reduction in diabetic retinopathy screening and diagnosis, ultimately resulting in deteriorated visual outcomes. Thus, our review underscores the urgent need for the development of effective emergency plans tailored specifically to diabetic retinopathy, particularly in Puerto Rico, where diabetes prevalence and its complications are notably higher. Such plans should not only incorporate established emergency measures but also harness emerging technological advances in the field of ophthalmology to ensure optimal preparedness for future pandemics and natural disasters.
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Affiliation(s)
| | - José J López-Fontanet
- Department of Ophthalmology, Medical Sciences Campus, University of Puerto Rico, San Juan, PRI
| | - Fabiola Ramos
- Department of Ophthalmology, Medical Sciences Campus, University of Puerto Rico, San Juan, PRI
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Khasawneh RA, Al-Shatnawi SF, Alhamad H, Rahhal D. General Public Perceptions and Perceived Barriers Toward the Use of Telehealth: A Cross-Sectional Study from Jordan. Telemed J E Health 2023; 29:1540-1547. [PMID: 36800178 DOI: 10.1089/tmj.2022.0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Background: Telemedicine implies the provision of health care services, such as diagnosis, treatment, and consultation related to different disease states remotely through harnessing a variety of technologies. Aim: Despite the widespread global applications related to telehealth, there are limited research articles exploring the perceptions and barriers related to telehealth implementation in developing countries such as Jordan. Thus, this study was conducted to explore general public perceptions regarding the provision of health care services through different technological devices and to examine perceived barriers and facilitators. Methods: A cross-sectional study was conducted for 6 months. Participants were recruited through different social media portals. A convenient sample from the Jordanian population was approached. A total of 1,136 responses were collected and included in the final analysis, which was done by the Statistical Package for Social Sciences (SPSS version 25). Results: A total of 1,136 responses were valid for further analysis. The results of this study expressed that the public has positive perceptions toward the use of telemedicine with the majority being capable of using telehealth based on having an active internet connection, technological devices, and the ability to use social media accounts or instant messaging services. Logistic regression analysis revealed that those with comorbid diseases and higher summated capability scores (p = -0.017 and p < 0.001, respectively) had a statistically significant relationship with willingness to use telehealth as reflected by stating a clear intention to use telehealth services once available. Conclusion: In conclusion, the Jordanians had positive perceptions toward the use of telehealth services. However, their willingness to use telehealth services was affected by limited knowledge about the service. Telehealth offers the opportunity to provide quality care and improve patient outcomes, especially for the inhabitants of rural areas or in cases where access to health care facilities is compromised such as pandemics.
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Affiliation(s)
- Rawand A Khasawneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Samah F Al-Shatnawi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Hamza Alhamad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, Zarqa, Jordan
| | - Dania Rahhal
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Creber A, Leo DG, Buckley BJR, Chowdhury M, Harrison SL, Isanejad M, Lane DA. Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis. BMC Cardiovasc Disord 2023; 23:469. [PMID: 37726655 PMCID: PMC10510185 DOI: 10.1186/s12872-023-03486-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Telemonitoring for the remote patient self-management of chronic conditions can be a cost-effective method for delivering care in chronic disease; nonetheless, its implementation in clinical practice remains low. The aim of this meta-synthesis is to explore barriers and facilitators associated with the use of remote patient monitoring of chronic disease, drawing on qualitative research, and assessing participant interactions with this technology. METHOD A meta-synthesis of qualitative studies was performed. MEDLINE, SCOPUS and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database date of inception to 5 February 2021. The Critical Appraisal Skills Programme (CASP) was used to critically appraise each study. Thematic synthesis was performed to identify user (patients, carers and healthcare professionals) perspectives and experiences of patient remote monitoring of chronic disease (Type 2 diabetes mellitus, chronic obstructive pulmonary disease, and cardiovascular disease). RESULTS Searches returned 10,401 studies and following independent screening by two reviewers, nine studies were included in this meta-synthesis. Data were synthesised and categorised into four key themes: (1) Improved care; (2) Communication; (3) Technology feasibility & acceptability; and (4) Intervention concerns. Most patients using patient remote devices felt motivated in managing their own lifestyles and felt reassured by the close monitoring and increased communication. Barriers identified involved generational differences and difficulties with the technology used. CONCLUSION Most studies showed a positive attitude to telemonitoring, with patients preferring the convenience of telemonitoring in comparison to attending regular clinics. Further research is required to assess the most effective technology for chronic disease management, how to maintain long-term patient adherence, and identify effective approaches to address generational variation in telemonitoring up-take.
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Affiliation(s)
- Anna Creber
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Donato Giuseppe Leo
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
| | - Benjamin J R Buckley
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- School of Sport and Exercise Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - Mahin Chowdhury
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Stephanie L Harrison
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Masoud Isanejad
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Musculoskeletal Ageing, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Deirdre A Lane
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Singh M, Chauhan AS, Mukherjee R, Pawar P, Sharma D, Yoosuf AS, Vaishnav B, Nargotra S, Gudibanda KR, Mohapatra A. Stakeholders' Initial Experience With Telemedicine Services Introduced at 13 Government Medical Colleges in Uttar Pradesh, India During the COVID-19 Lockdown: A Qualitative Study. Cureus 2023; 15:e41269. [PMID: 37533613 PMCID: PMC10391304 DOI: 10.7759/cureus.41269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND India went into a stringent lockdown in response to the coronavirus disease 2019 (COVID-19) pandemic in March 2020, and routine outpatient and elective health services were suspended. Thus, access to healthcare services got significantly disrupted. To mitigate the impact, 21 state-owned medical colleges in Uttar Pradesh, the most populous and among the most resource-constrained states in India, had to hastily launch telemedicine (TM) services. This created an opportunity to understand how stakeholders would react to such services and what initial challenges could be faced during service delivery. Through this study, we explored the experiences of stakeholders from 13 such "new-adopter" TM centres with the main objective to identify the perceived benefits and gaps related to TM services, and what "people-centric" TM services could look like going forward. METHODS We used an exploratory-descriptive qualitative design with a constructivist paradigm. Using interview schedules with open-ended questions and unstructured probes, we interviewed 13 nodal officers, 20 doctors, and 20 patients (i.e., one nodal officer and one to two doctors and patients from each of the 13 new-adopter centres) and stopped thereafter since we reached saturation of information. We analysed the data on NVivo (QSR International, Burlington, MA) and reported the findings using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS The perceived benefits that were reported included non-dependency on physical contact, economic benefit, better management of patient load, and ease of access to healthcare services. The common gaps identified in the TM services were lack of physical clinical examination, impeded communication due to lack of face-to-face interaction, technological challenges (e.g., inconsistent internet connectivity and unavailability of smartphones), lack of human resources and resources to manage the TM centres, cumbersome compliance requirements coupled with unclarity on medico-legal implications, and limited awareness of services among clients. Need for adequate promotion of TM services through information-education-communication efforts and frontline workers, strengthening of logistics for long-term sustainability, setting up a dedicated TM department at the hospitals, capacity building of the existing staff, reducing gaps in communication between doctors and patients for better consultation, and improved access to the prescribed medicines were some of the suggestions from different stakeholders. CONCLUSION The stakeholders clearly appreciated the benefits of TM services offered through the new-adopter centres amidst the pandemic disruptions. However, there were certain gaps and unmet expectations, which, if addressed, could improve the TM centres' performance with further people-centricity and enhance healthcare access and the popularity of system-based services. Avenues for sustaining the TM services and their efficient scale-up should be explored.
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Affiliation(s)
- Manish Singh
- Department of Community Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Abhimanyu S Chauhan
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Ritika Mukherjee
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Priyanka Pawar
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Divita Sharma
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Ahmed Shammas Yoosuf
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Bharathi Vaishnav
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Shikha Nargotra
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Kavita Rajesh Gudibanda
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Archisman Mohapatra
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
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15
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AlJaloud AM, Al Suwyed A, Al Zoman KH, Tabbaa MY, Alwin Robert A, Al-Nowaiser AM, Alotaibi F, Alfaifi MA, Almubarak SA. Patient Perceptions and Satisfaction With Virtual Clinics During the COVID-19 Pandemic: A Cross-Sectional Study. Cureus 2023; 15:e42450. [PMID: 37637632 PMCID: PMC10449483 DOI: 10.7759/cureus.42450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Background Virtual clinics played an important role for many patients during the COVID-19 pandemic. We conducted this cross-sectional study to evaluate patient perceptions and their satisfaction with virtual clinics during and after COVID-19 in Saudi Arabia. Methods An online questionnaire-based survey with questions in both Arabic and English was conducted among patients who attended outpatient clinics at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia from May 2021 to September 2021. Demographic variables, the clinic type, and the level of satisfaction with the remote appointments were recorded. Descriptive statistics and logistic regression analysis were used to analyze the data. Results A total of 1274 participants filled out the survey. Of them, 831 (65.23%) were females, and 749 (58.79%) were aged 18 to 30 years old. Of the sample studied, 411 (32.26%) had appointments with their healthcare provider remotely since the beginning of the pandemic; 311 (75.67%) were satisfied or highly satisfied with the remote appointments; and 198 (48.18%) participants desired to continue using virtual services post-COVID-19 pandemic. Logistic regression analysis showed that females were more satisfied with virtual clinics than males (OR= 1.18, 95% CI (1.01, 1.40), p=0.04). The age group of 18 to 30 was more satisfied than other age groups (OR= 53.23, 95% CI (2.01, 1347.18), p=0.02). Conclusion The majority of the participants who used virtual clinics were satisfied with the service. Nearly half of the participants wanted to continue using virtual services even after the COVID-19 pandemic was over. More effort should be made to increase patient awareness and knowledge about virtual clinics.
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Affiliation(s)
| | - Abdulaziz Al Suwyed
- Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Khalid H Al Zoman
- Dentistry, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Mohammad Y Tabbaa
- Dentistry, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | | | - Faisal Alotaibi
- Neurological Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Mohammed A Alfaifi
- Emergency Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Sultan A Almubarak
- Innovation and Knowledge Translation, Saudi National Institute of Health, Riyadh, SAU
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Bellido V, Morales C, Garach AM, Almeida JMG, Morera JLF, Aguilera BG, de la Torre ML, Bellido D. Descriptive study of a clinical and educational telemedicine intervention in patients with diabetes receiving glargine 300 U/ml (Toujeo) in Spain: results of the T-Coach programme. Drugs Context 2023; 12:dic-2023-1-1. [PMID: 37261244 PMCID: PMC10228333 DOI: 10.7573/dic.2023-1-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/29/2023] [Indexed: 06/02/2023] Open
Abstract
Background Diabetes is one of the most prevalent chronic diseases worldwide, and innovative patient support programmes can help and inform patients about their disease and improve their quality of life. The purpose of this study was to evaluate the effect of the T-Coach programme in terms of improvement of disease knowledge, self-management and adherence to treatment in a real-world setting in Spain between July 2016 and October 2018. Methods We analyzed data from the T-Coach programme, a telephone platform that gives support to patients with type 2 diabetes mellitus treated with insulin glargine 300 U/ml (Gla-300). Support was provided by diabetes care nurses. Patients followed their treatment and aimed to achieve fasting blood glucose targets through diabetes education. Results A total of 479 patients were included in the programme. The mean (SD) dose of Gla-300 was 28.5 (16.3) U at baseline and 31.8 (16.1) U, 31.4 (16.4) U and 32.2 (16.3) U, respectively, at 3, 6 and 12 months. A satisfaction survey was completed by 240 (50.1%) patients, who, on average, were very highly satisfied with the programme, general assistance provided, recommendations received, and calls from nurses. Conclusions T-Coach could be an effective tool to help patients achieve their optimal dose of Gla-300 insulin and manage their blood glucose levels. It could also act as an effective support for diabetes education.
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Affiliation(s)
- Virginia Bellido
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Cristóbal Morales
- Endocrinology Department, Hospital Clínico Universitario Virgen Macarena, Sevilla, Spain
| | - Araceli Muñoz Garach
- Endocrinology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | | | | | - Diego Bellido
- Endocrinology Department, Complejo Hospitalario Universitario de Ferrol, La Coruña, Spain
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Widyarman AS, Roeslan MO, Dewanto I. Pre-dental treatment screening in Indonesia during the COVID-19 pandemic: a questionnaire survey of dental practitioners. BMC Oral Health 2023; 23:311. [PMID: 37217988 DOI: 10.1186/s12903-023-03004-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Dental practitioners have a high risk of contracting COVID-19 during the treatment of patients because of exposure to airborne droplets. However, the application of pre-procedure treatment screening in dental practices in Indonesia varied during the pandemic. The purpose of this study was to investigate the use of updated pre-procedure dental treatment protocols and procedures among dental practitioners in Indonesia. METHODS This study consisted of dentists registered as members of the Indonesian Dental Association who attended the Indonesian Dental Association webinar series in 2021. All the participants completed a questionnaire survey. The participants, who were from various regions in Indonesia, were granted password-protected access to a URL hosting the questionnaire. The questionnaire collected demographic information and contained questions on adherence to updated protocols and patient screening procedures, to which the respondents answered "Yes" or "No". For the analysis, the participants were divided into three groups based on the type of facility where they were employed: public (government) hospitals, private hospitals, or university hospitals (dental schools). A chi-square test was used to investigate the association between professional background and the implementation of updated protocols, including pre-procedure dental treatment screening. A value of P < 0.05 was considered statistically significant. RESULTS The age range of the participants was 20 - 60 years. The participants worked in facilities in 32 provinces in Indonesia. In total, there were 5,323 participants (males: n = 829; females: n = 4,494). In terms of professional backgrounds, 2,171, 2,867, and 285 participants were employed in government hospitals, private hospitals, and dental faculties, respectively. Among 5,232 participants who implemented updated COVID-19 prevention protocols, 5,053 (98%) participants performed pre-surgery procedures Among 151 participants who did not implement updated COVID-19 prevention protocols, 133 (88%) individuals carried out pre-rinse procedures. CONCLUSIONS Almost all the dental practitioners employed in government hospitals, private hospitals, and dental faculties in Indonesia performed pre-surgery patient screening procedures. There was an agreement between the dental professionals in all three settings on the need for COVID-19 pre-treatment screening procedures in dental practices during the COVID-19 pandemic.
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Affiliation(s)
- Armelia Sari Widyarman
- Department of Microbiology, Faculty of Dentistry, Universitas Trisakti, Kyai Tapa 260, Grogol, 11440, West Jakarta, Indonesia
| | - Moehamad Orliando Roeslan
- Department of Oral Biology, Faculty of Dentistry, Universitas Trisakti , Kyai Tapa 260, Grogol, 11440, West Jakarta, Indonesia.
| | - Iwan Dewanto
- Faculty of Medical and Health Science, School of Dentistry, University Muhammadiyah Yogyakarta, Bantul, 55183, Indonesia
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Cunha AS, Pedro AR, Cordeiro JV. Facilitators and barriers to access hospital medical specialty telemedicine consultations during the COVID-19 pandemic: Systematic Review. J Med Internet Res 2023. [PMID: 37262124 DOI: 10.2196/44188] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND COVID-19 pandemic accelerated the digital transition in healthcare, which required a rapid adaptation of stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in healthcare access, especially for the most vulnerable populations. OBJECTIVE To characterize the determinants factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic; to identify the main opportunities and challenges (technological, ethical, legal and/or social) generated by the use of telemedicine in the context of the COVID-19 pandemic. METHODS A systematic review was conducted according to PRISMA guidelines. Four databases (Scopus, Web of Science, PubMed and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3rd, 2020, and December 31st, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and results were integrated into a thematic synthesis. The identification of main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results. RESULTS Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States of America (USA). The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to Internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to Internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and need for complementary diagnostic tests or for the delivery of test results. CONCLUSIONS The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of technological nature (access to technological devices and internet services, level of digital literacy), sociocultural and demographic nature (ethnic and racial disparities, geographical disparities, language barriers, age), socioeconomic nature (income level and health insurance coverage), and ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most vulnerable communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses. CLINICALTRIAL
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Affiliation(s)
- Ana Soraia Cunha
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Avenida Padre Cruz, Lisbon, PT
| | - Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
| | - João Valente Cordeiro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
- Interdisciplinary Centre of Social Sciences (CICS.NOVA), Universidade NOVA de Lisboa, Lisbon, Portugal, Lisbon, PT
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19
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Patient Perspective on the Monitoring of Their Wet Age-Related Macular Degeneration during Coronavirus Disease 2019: A Retrospective Study. Medicina (B Aires) 2023; 59:medicina59030490. [PMID: 36984491 PMCID: PMC10053385 DOI: 10.3390/medicina59030490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Background and Objectives: The purpose was to provide the patients’ perspective on the monitoring of their wet age-related macular degeneration (wet AMD) during coronavirus disease 2019 (COVID-19) and the importance of telemedicine. Materials and Methods: Wet AMD patients that underwent intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in two Swiss ophthalmology clinics, completed two questionnaires after the first confinement due to COVID-19 in Switzerland. The first evaluated their views concerning their adherence to scheduled injections during the confinement, and the application of telemedicine in the future. The second, adapted from the National Eye Institute Visual Function Questionnaire-25, assessed their opinions on visual function change during confinement. Results: From a total of 130 patients, 8.5% responded they did not respect their assigned schedule (group 1) while 91.5% responded they did (group 2). A total of 78.7% of group 2 considered treatment reception as more relevant compared to the risk of COVID-19 contraction. During the pre-lockdown period, group 2 patients required more help from others than group 1 patients (p = 0.02). In the possibility of another lockdown, 36.3% of group 1 and 8.7% of group 2 would choose telemedicine to monitor their wet AMD (p = 0.02), 54.5% and 86.9% would rather visit the clinic (p = 0.02), while 9.0% and 4.3% would cancel their appointment, respectively. It was found that 70% of group 1 and 33.6% of group 2 would prefer to use the telemedicine services than visiting a telemedicine centre (p = 0.04). Conclusions: During circumstances similar to the COVID-19 confinement, most patients would prefer to visit the clinic. Group 1 would prefer wet AMD monitoring via telemedicine at a higher rate than group 2.
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20
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Vonken L, Hussein H, Crutzen R, Vluggen S. Perceptions of Dutch general practitioners towards eHealth for patients with type-2 diabetes: a qualitative study. Fam Pract 2023; 40:91-97. [PMID: 35751556 PMCID: PMC9384395 DOI: 10.1093/fampra/cmac066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth provides a viable option to facilitate type-2 diabetes mellitus self-management and adherence. To this end, a web-based computer-tailored eHealth programme, My Diabetes Profile (MDP), was developed and implemented in Dutch diabetes care. To fully utilize the potential of eHealth, the reach of effective programmes like MDP should be maximized. Therefore, it is vital to explore perceptions of general practitioners (GPs) regarding eHealth and factors that influence GPs' decision to adopt eHealth programmes. OBJECTIVE To shed light on Dutch GPs' perceptions towards eHealth in general and specifically, the adoption of MDP. METHODS Interviews were conducted among a heterogeneous sample of 16 Dutch GPs. The interview guide, based on the Diffusion of Innovations Theory, addressed perceptions about eHealth in general, characteristics of MDP, organizational characteristics, and external influences on adoption. Audio-recordings were transcribed and analysed using deductive coding in NVivo. RESULTS Nearly all GPs used some form of eHealth and listed many benefits and few drawbacks about eHealth. Sometimes, GPs were unaware of what eHealth encompassed; programmes resembling MDP were not mentioned. COVID-19 immensely increased eHealth uptake, especially for remote communication. Regarding MDP, the organizational and external influences on adoption were limited, while characteristics of the innovation were deemed more important. GPs expressed benefits of MDP (e.g. uncomplex, user-friendly, tailored) other than attributed to eHealth in general and fewer drawbacks. CONCLUSION While GPs' opinions about eHealth and MDP were positive, the concept of MDP was relatively unfamiliar. Future research should focus on targeting GPs' awareness of eHealth possibilities.
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Affiliation(s)
- Lieve Vonken
- Maastricht University, Care and Public Health Research Institute, Department of Health Promotion, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Hani Hussein
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, PO Box 616, 6200 Maastricht, The Netherlands
| | - Rik Crutzen
- Maastricht University, Care and Public Health Research Institute, Department of Health Promotion, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Stan Vluggen
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, PO Box 616, 6200 Maastricht, The Netherlands
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21
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Wang R, Lv H, Lu Z, Huang X, Wu H, Xiong J, Yang G. A medical assistive robot for tele-healthcare during the COVID-19 pandemic: development and usability study in an isolation ward. JMIR Hum Factors 2023; 10:e42870. [PMID: 36634269 PMCID: PMC10131661 DOI: 10.2196/42870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/10/2022] [Accepted: 01/12/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is affecting the mental and emotional well-being of patients, family members, and healthcare workers. Patients in the isolation ward may have psychological problems due to long-term hospitalization, the development of the epidemic, and the inability to meet their families. The medical assistive robot (MAR), acting as an intermediary of communication, can be deployed to address mental pressures. OBJECTIVE CareDo, a MAR with telepresence and teleoperation functions, is developed in this work for remote healthcare. This study aims to investigate its practical performance in the isolation ward during the pandemic. METHODS Two systems were integrated into the CareDo robot. For the telepresence system, web real-time communications solution is used for the multi-user chat system and the convolutional neural network is used for expression recognition. For the teleoperation system, an incremental motion mapping method is used for operating the robot remotely. This study was finally conducted at the First Affiliated Hospital, Zhejiang University for clinical trials. RESULTS During the clinical trials in First Affiliated Hospital, Zhejiang University, tasks such as video chatting, emotion detection, and medical supplies delivery are performed through this robot. Seven voice commands are set for performing system wakeup, video chatting, and system exiting. Statistical durations from 1 second to 3 seconds of common commands are set to improve voice command detection. The facial expression was recorded 152 times for a patient in one day for the psychological intervention. The recognition accuracy reaches 95% and 92.8% for happy and neutral expressions respectively. CONCLUSIONS Patients and healthcare workers can use this MAR in the isolation ward for tele-healthcare during the COVID-19 pandemic. It can be a useful approach to break the chains of virus transmission, and also an effective way for remote psychological intervention. CLINICALTRIAL
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Affiliation(s)
- Ruohan Wang
- State Key Laboratory of Fluid Power & Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou 310027, China, No.38 Zheda Road, Hangzhou, P.R.China, Hangzhou, CN
| | - Honghao Lv
- State Key Laboratory of Fluid Power & Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou 310027, China, No.38 Zheda Road, Hangzhou, P.R.China, Hangzhou, CN
| | - Zhangli Lu
- State Key Laboratory of Fluid Power & Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou 310027, China, Hangzhou, CN
| | - Xiaoyan Huang
- College of Electrical Engineering, Zhejiang University, Hangzhou 310027, China, Hangzhou, CN
| | - Haiteng Wu
- Hangzhou Shenhao Technology Co., LTD., Hangzhou, China, Hangzhou, CN
| | - Junjie Xiong
- Hangzhou Shenhao Technology Co., LTD., Hangzhou, China, Hangzhou, CN.,School of Mechanical Engineering, Zhejiang University, Hangzhou, CN
| | - Geng Yang
- State Key Laboratory of Fluid Power & Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou 310027, China, No.38 Zheda Road, Hangzhou, P.R.China, Hangzhou, CN
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22
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Swed S, Alibrahim H, Bohsas H, Aljabali A, Hamouda HM, Sawaf B, albuni MK, Battikh E, Ahmed SMA, Sharif Ahmed EM, Motawea KR, Abdelazeem B, Shoib S, Rakab A, Hafez W. Awareness, knowledge, attitude, and skills regarding telemedicine among Syrian healthcare providers: A cross-sectional study. Digit Health 2023; 9:20552076231211662. [PMID: 37936959 PMCID: PMC10627024 DOI: 10.1177/20552076231211662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/09/2023] Open
Abstract
Background After the widespread of coronavirus disease (COVID-19) around the globe, it was imperative to establish preventative measures to restrict the virus's transmission. The purpose of this research was to present an overview of the awareness, knowledge, attitude, and abilities of Syrian physicians about telemedicine technology. Methods An online cross-sectional study was conducted from April 1 to May 15, 2022. The questionnaire was taken from published study, and the inclusion criteria consist the Syrian doctors who worked in hospitals during the COVID-19 pandemic, mainly those who had direct contact with patients. Results Among 385 responses, 52.72% of them were females, 83.9% of them were aged less than 30 years old, and 66% were working in the governmental sector; 66% of participants have moderate knowledge about using computers and the internet, 80% have heard about telemedicine. Despite that, 95.1% of participants have not attended any training workshop on telemedicine, and most of them have reported no availability of a telemedicine unit in their department. Only 31.7% participants have shown high awareness of telemedicine. Furthermore, no significant correlation was identified between the academic level with the age and telemedicine awareness, knowledge, attitude, or computer skills. Despite that, there was an obvious correlation between age and computer skills (P-value < 0.05). There was a significant correlation between the medical specialty and awareness, and computer abilities, especially the anesthesiology (88.5 ± 5.2), (84 ± 8.7), respectively. Spearman's rho test showed mild positive significant association in various subscales (awareness and experience, experience and skills, knowledge and attitude, knowledge and skills, and attitude and skills). Conclusion The study results demonstrate that most of the participating clinical doctors have a neutral view of telemedicine, even though they do not know much about it and do not have considerable experience with it. It is practical to educate and train academic staff, practicing physicians, residents and medical students within the clinical stages about telemedicine.
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Affiliation(s)
- Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | | | | | - Ahmed Aljabali
- Faculty of Medicine, Jordan University of Science and Technology, Amman, Jordon
| | | | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Elias Battikh
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Karam R Motawea
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Basel Abdelazeem
- Internal Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Sheikh Shoib
- Psychiatry, JLNM Hospital, Rainawari, Srinagar Directorate of Health Services, J&K, India
| | - Amine Rakab
- Internal Medicine, Weill Cornell Medical College, Qatar
| | - Wael Hafez
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE
- Medical Research Division, Department of Internal Medicine, The National Research Centre, Cairo, Egypt
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23
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Chen M, Wang Y, Feng P, Liang Y, Liu Q, Yang M, Lu C, Shi P, Cheng J, Ji A, Zheng Q. Association between Age at Type 2 Diabetes Onset and Diabetic Retinopathy: A Double-Center Retrospective Study. J Diabetes Res 2023; 2023:5919468. [PMID: 36726740 PMCID: PMC9886461 DOI: 10.1155/2023/5919468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND With the decreasing age of type 2 diabetes mellitus (T2DM) onset, the incidence of diabetic complications is gradually increasing. We evaluated the independent effect of age at diabetes onset on diabetic retinopathy (DR) development. METHODS A total of 7472 patients with T2DM were enrolled in the National Metabolic Management Center from September 2017 to May 2022. Anthropometry data, laboratory reports, and medical history were collected. The independent association of DR with age at diabetes onset was analyzed using multivariable logistic regression models. In addition, a stratified analysis was performed to determine the effect of confounding variables. RESULTS Of the 7472 patients recruited, 1642 (21.98%) had DR. Patients with DR had considerably younger ages of diabetes onset than those without DR (45 (38-53) years vs. 50 (43-57) years, P < 0.001). The proportion of patients with T2DM onset at a younger age was higher in the DR group than that in the non-DR group. Participants were divided into four groups according to their age at diabetes onset, namely, ≥60, <40, 40-49, and 50-59 years. Compared with patients with diabetes onset at age ≥ 60 years, those with diabetes onset at <40 years (odds ratio (OR): 5.56, 95% confidence interval (CI): 3.731-8.285, P < 0.001), 40-49 years (OR: 2.751, 95% CI: 2.047-3.695, P < 0.001), and 50-59 years (OR: 1.606, 95% CI: 1.263-2.042, P < 0.001) were at an increased risk of DR after adjusting for potential confounding factors. Furthermore, stratification analyses demonstrated that young age at diabetes onset is an independent risk factor for DR. CONCLUSIONS Compared with diabetes onset at an older age, diabetes onset at a younger age is associated with a significantly increased DR risk.
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Affiliation(s)
- Mengdie Chen
- Department of Endocrinology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, China
| | - Yiyun Wang
- Department of Internal Medicine, The Second People's Hospital of Yuhuan, Yuhuan 317600, China
| | - Ping Feng
- Department of Endocrinology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, China
| | - Yao Liang
- Department of Internal Medicine, The Second People's Hospital of Yuhuan, Yuhuan 317600, China
| | - Qiao Liu
- Department of Endocrinology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, China
| | - Mengyao Yang
- Department of Internal Medicine, The Second People's Hospital of Yuhuan, Yuhuan 317600, China
| | - Chaoyin Lu
- Department of Endocrinology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, China
| | - Penghua Shi
- Department of Internal Medicine, The Second People's Hospital of Yuhuan, Yuhuan 317600, China
| | - Jian Cheng
- Department of Internal Medicine, The Second People's Hospital of Yuhuan, Yuhuan 317600, China
| | - Anjing Ji
- Department of Internal Medicine, The Second People's Hospital of Yuhuan, Yuhuan 317600, China
| | - Qidong Zheng
- Department of Internal Medicine, The Second People's Hospital of Yuhuan, Yuhuan 317600, China
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24
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Xu W, Liang Y, Zhuang Y, Yuan Z. Identification of miRNA-mRNA Regulatory Networks Associated with Diabetic Retinopathy using Bioinformatics Analysis. Endocr Metab Immune Disord Drug Targets 2023; 23:1628-1636. [PMID: 37114785 PMCID: PMC10661965 DOI: 10.2174/1871530323666230419081351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/18/2023] [Accepted: 02/17/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Diabetic retinopathy (DR) is a major complication of diabetes and a leading cause of visual loss. This study aimed to explore biomarkers for DR that may provide additional reference to DR pathogenesis and development. METHODS The differentially expressed genes (DEGs) between the DR and control samples in the GSE53257 dataset were identified. Logistics analyses were performed to identify DR-associated miRNAs and genes, and correlation analysis was performed to determine the correlation between them in GSE160306. RESULTS A total of 114 DEGs in DR were identified in GSE53257. Three genes, including ATP5A1 (down), DAUFV2 (down), and OXA1L (down), were differentially expressed between DR and control samples in GSE160306. Univariate logistics analysis identified that ATP5A1 (OR=0.007, p = 1.40E-02), NDUFV2 (OR = 0.003, p = 6.40E-03), and OXA1L (OR = 0.093, p = 3.08E-02) were DR-associated genes. ATP5A1 and OXA1L were regulated by multiple miRNAs, of which hsa-let- 7b-5p (OR = 26.071, p = 4.40E-03) and hsa-miR-31-5p (OR = 4.188, p = 5.09E-02) were related to DR. ATP5A1 and OXA1L were closely correlated with each other in DR. CONCLUSION The hsa-miR-31-5p-ATP5A1 and hsa-let-7b-5p-OXA1L axes might play novel and important roles in the pathogenesis and development of DR.
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Affiliation(s)
- Weihai Xu
- Department of Ophthalmology, The Binhai County People’s Hospital, Yancheng, 224500, China, 210029
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 224500, China
| | - Ya Liang
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 224500, China
| | - Ying Zhuang
- Department of Stomatology, the Binhai County People’s Hospital, Yancheng, China, 224500
| | - Zhilan Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 224500, China
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25
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Chuter BG, Lieu A, Dayao JKO, Bu JJ, Chen K, Nishihara T, Baxter SL. Impact of COVID-19 on the Delivery of Eye Care to Uninsured Diabetic Patients at a Student-Run Free Clinic: A Comprehensive Evaluation of Eye Clinic Performance. JOURNAL OF STUDENT-RUN CLINICS 2022; 8:358. [PMID: 36890867 PMCID: PMC9991481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Background Diabetic retinopathy is the leading cause of blindness among working-age adults in the United States and requires timely screening and management. This study evaluates the impact of the coronavirus disease 2019 (COVID-19) pandemic on diabetic retinopathy screening (DRS) for uninsured, predominantly Latino patients at the University of California San Diego Student-Run Free Clinic Project (SRFCP). Methods A retrospective chart review was conducted of all living diabetic patients at SRFCP who were seen in 2019 (n=196), 2020 (n=183), and 2021 (n=178). Ophthalmology clinic referrals, scheduled patient visits, and visit outcomes were analyzed longitudinally to determine the impact of the pandemic on screening patterns. Results The study population was 92.1% Latino, 69.5% female, with a mean age of 58.7 years. The distribution of patients seen (p<0.001), referred (p=0.012), and scheduled (p<0.001) in 2020 and 2021 significantly differed from 2019. In 2019, 50.5% of 196 patients eligible for DRS were referred, 49.5% were scheduled, and 45.4% were seen. In 2020, 41.5% of 183 eligible patients were referred, but only 20.2% were scheduled and 11.4% were seen. In 2021, there was a rebound: 63.5% of 178 patients were referred, 56.2% scheduled and 46.1% seen. No shows and cancellations represented 12.4% and 6.2% of the 97 encounters scheduled in 2019, but were markedly higher (10.8% and 40.5% respectively) for the 37 encounters scheduled in 2020. Conclusions The COVID-19 pandemic significantly impacted the delivery of eye care at SRFCP. The need for annual DRS exceeded the capacity of the ophthalmology clinic in all years studied, but the difference was especially pronounced with more stringent COVID-19 restrictions in 2020. SRFCP patients could benefit from telemedicine DRS programs to improve screening capacity.
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Affiliation(s)
- Benton G Chuter
- School of Medicine, University of California San Diego, La Jolla, California, USA.,Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Alexander Lieu
- School of Medicine, University of California San Diego, La Jolla, California, USA.,Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - John Kevin O Dayao
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jennifer J Bu
- School of Medicine, University of California San Diego, La Jolla, California, USA.,Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Kevin Chen
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Taiki Nishihara
- School of Medicine, University of California San Diego, La Jolla, California, USA.,Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Sally L Baxter
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.,Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
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26
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Romero-Aroca P, Baget-Bernaldiz M, Sagarra R, Hervás E, Blasco R, Molina J, Moreno EF, Garcia-Curto E. Impact of the COVID-19 Pandemic on the Metabolic Control of Diabetic Patients in Diabetic Retinopathy and Its Screening. J Clin Med 2022; 11:jcm11237121. [PMID: 36498696 PMCID: PMC9737650 DOI: 10.3390/jcm11237121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
(1) Background: Diabetic retinopathy (DR) is a complication of diabetes mellitus (DM), screening programs of which have been affected by the COVID-19 pandemic. The aim of the present study was to determine the impact of the COVID-19 pandemic on the screening of diabetes patients in our healthcare area (HCA). (2) Methods: We carried out a retrospective study of patients with DM who had attended the DR screening program between January 2015 and June 2022. We studied attendance, DM metabolic control and DR incidence. (3) Results: Screening for DR decreased in the first few months of the pandemic. The incidence of mild and moderate DR remained stable throughout the study, and we observed little increase in severe DR, proliferative DR and neovascular glaucoma during 2021 and 2022. (4) Conclusions: The current study shows that during the COVID-19 pandemic, screening program attendance decreased during the year 2020, which then recovered in 2021. Regarding the most severe forms of DR, a slight increase in cases was observed, beginning in the year 2021. Nevertheless, we aimed to improve the telemedicine systems, since the conditions of a significant proportion of the studied patients worsened during the pandemic; these patients are likely those who were already poorly monitored.
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Affiliation(s)
- Pedro Romero-Aroca
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
- Medicine and Surgery Departement, Medicine and Health Science Faculty, Universitat Rovira & Virgili, 43204 Reus, Spain
- Pere Virgili Institute for Health Research (IISPV), 43204 Reus, Spain
- Correspondence:
| | - Marc Baget-Bernaldiz
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
- Medicine and Surgery Departement, Medicine and Health Science Faculty, Universitat Rovira & Virgili, 43204 Reus, Spain
- Pere Virgili Institute for Health Research (IISPV), 43204 Reus, Spain
| | - Ramon Sagarra
- Pere Virgili Institute for Health Research (IISPV), 43204 Reus, Spain
- Health Care Area Reus-Priorat, Institut Catala de la Salut, 43202 Reus, Spain
| | - Esther Hervás
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
- Medicine and Surgery Departement, Medicine and Health Science Faculty, Universitat Rovira & Virgili, 43204 Reus, Spain
| | - Reyes Blasco
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
- Medicine and Surgery Departement, Medicine and Health Science Faculty, Universitat Rovira & Virgili, 43204 Reus, Spain
| | - Julia Molina
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
- Medicine and Surgery Departement, Medicine and Health Science Faculty, Universitat Rovira & Virgili, 43204 Reus, Spain
| | - Empar F. Moreno
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
- Medicine and Surgery Departement, Medicine and Health Science Faculty, Universitat Rovira & Virgili, 43204 Reus, Spain
| | - Eugeni Garcia-Curto
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
- Medicine and Surgery Departement, Medicine and Health Science Faculty, Universitat Rovira & Virgili, 43204 Reus, Spain
- Pere Virgili Institute for Health Research (IISPV), 43204 Reus, Spain
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27
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Impact of the COVID-19 Pandemic on Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema in Japan. J Clin Med 2022; 11:jcm11226794. [PMID: 36431271 PMCID: PMC9696996 DOI: 10.3390/jcm11226794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Anti-vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME) improves visual acuity. However, repeated injections during routine outpatient visits are required to maintain this effect. The recent sudden global outbreak of coronavirus disease 2019 (COVID-19) had a major impact on daily life, including medical care, such as the provision of VEGF therapy. We retrospectively investigated the relationship between the number of anti-VEGF injections for DME and the number of new COVID-19-positive patients at 23 centers in Japan. We also surveyed ophthalmologists regarding the impact of the COVID-19 pandemic on anti-VEGF therapy. In the third and fourth waves of the pandemic, when the number of infected patients increased, the number of injections significantly decreased. In the first, third, and fourth waves, the number of injections increased significantly during the last month of each wave. Approximately 60.9% of ophthalmologists reported that the number of injections decreased after the pandemic. Of the facilities, 52.2% extended the clinic visit intervals; however, there was no significant difference in the actual number of injections given between before and after the pandemic. Although the number of injections temporarily decreased, Japanese ophthalmologists maintained the total annual number of anti-VEGF injections for DME during the pandemic.
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How effective are digital technology-based interventions at promoting colorectal cancer screening uptake in average-risk populations? A systematic review and meta-analysis of randomized controlled trials. Prev Med 2022; 164:107343. [PMID: 36368343 DOI: 10.1016/j.ypmed.2022.107343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Abstract
Despite the global prevalence of colorectal cancer (CRC) and efforts in screening advocacy, screening uptake remains relatively low. Considering the greater accessibility and popularity of telemedicine in behaviour change interventions, this meta-analysis seeks to examine the usefulness of digital interventions in promoting CRC screening uptake as compared to existing non-digital strategies. A systematic search on five databases identified articles published before September 2022. Randomized controlled trials comparing the effectiveness of digital interventions to usual care were included and assessed using the Cochrane's Risk of Bias tool. Effectiveness of interventions was measured by CRC screening completion rates, and pooled effect sizes were computed for both digital intervention subtypes identified - decision-making aids and tailored educational interventions. 14 studies (17,075 participants) assessed to have low or some risk of bias were included in this meta-analysis. A random-effects model revealed that digital interventions were more likely to promote CRC screening uptake (OR = 1.31, 95% CI: 1.11-1.56), and using a decision-making aid was almost 1.5 times more likely to result in screening completion (i.e., completed a colorectal investigation using stool-based or direct visualization test) (OR = 1.42, 95% CI: 1.24-1.63). Meanwhile, the tailored educational intervention subtype failed to achieve statistical significance in promoting screening uptake, bearing in mind the significant heterogeneity across studies (I2 = 88.6%). Digital decision-making aids significantly improved CRC screening uptake compared to tailored digital educational interventions and usual care. However, as all included studies were conducted in Western settings, its role in augmenting existing CRC screening promotion strategies especially among Asians should be further evaluated.
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Zhang J, Ren Z, Zhang Q, Zhang R, Zhang C, Liu J. Lower hydration status increased diabetic retinopathy among middle-aged adults and older adults: Results from NHANES 2005-2008. Front Public Health 2022; 10:1023747. [PMID: 36388275 PMCID: PMC9643860 DOI: 10.3389/fpubh.2022.1023747] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/10/2022] [Indexed: 01/28/2023] Open
Abstract
Background Diabetic retinopathy (DR) is a common complication of diabetic patients. Retinal physiological function is affected by hydration status. We aimed to explore the association between hydration status and DR. Methods National Health and Nutrition Examination Survey (NHANES) 2005-2008 was used to perform this cross-sectional study. Serum osmolality was used to assess hydration status for all participants and calculated osmolality was evaluated for only older people. DR and its severity were evaluated and graded into mild non-proliferative retinopathy, moderate/severe non-proliferative retinopathy, and proliferative diabetic retinopathy by the Early Treatment for Diabetic Retinopathy Study protocol and NHANES Digital Grading Protocol. Fully adjusted multivariable logistic regression models were used by SAS OnDemand for Academics. Results Among the 5,220 United States adults aged 40 or older, compared with the lowest osmolality group, participants with the highest quartile of serum osmolarity had higher odds of DR (OR: 1.371, 95% CI: 1.001-1.876). For participants with DR, the adjusted OR (95 % CI) of moderate/severe non-proliferative retinopathy and proliferative diabetic retinopathy in the higher serum osmolarity group was 2.119 (1.200-3.741) and 7.001 (3.175-15.438), respectively. Furthermore, in older people, higher calculated osmolarity was significantly associated with increased occurrence of DR (OR: 2.039, 95% CI: 1.305-3.186). Conclusions Adults with lower hydration status had higher risk of DR, moderate/severe non-proliferative retinopathy, and proliferative diabetic retinopathy. Dehydration in older adults, classified by calculated osmolality, is associated with a higher rate of DR. There was consistent trend in the results between the two methods.
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Affiliation(s)
- Jiayu Zhang
- Department of Nutrition, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Ziyang Ren
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Qiang Zhang
- Department of Nutrition, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Rui Zhang
- Department of Nutrition, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Chunmei Zhang
- Department of Nutrition, Beijing Luhe Hospital, Capital Medical University, Beijing, China,*Correspondence: Chunmei Zhang
| | - Jufen Liu
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China,Jufen Liu
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Development and Validation of the First Smart TV-Based Visual Acuity Test: A Prospective Study. Healthcare (Basel) 2022; 10:healthcare10112117. [PMID: 36360458 PMCID: PMC9691125 DOI: 10.3390/healthcare10112117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/04/2022] Open
Abstract
(1) Background: While smartphones are among the primary devices used in telemedical applications, smart TV healthcare apps are not prevalent despite smart TVs’ penetrance in home settings. The present study’s objective was to develop and validate the first smart TV-based visual acuity (VA) test (Democritus Digital Visual Acuity Test (DDiVAT)) that allows a reliable VA self-assessment. (2) Methods: This is a prospective validation study. DDiVAT introduces several advanced features for reliable VA self-testing; among them: automatic calibration, voice recognition, voice guidance, automatic calculation of VA indexes, and a smart TV-based messaging system. Normal and low vision participants were included in the validation. DDiVAT VA results (VADDiVAT) were compared against the ones from: (a) the gold-standard conventional ETDRS (VAETDRS), and, (b) an independent ophthalmologist who monitored the self-examination testing (VARES). Comparisons were performed by noninferiority test (set at 2.5-letters) and intraclass correlation coefficients (ICCs). DDiVAT’s test-retest reliability was assessed within a 15-day time-window. (3) Results: A total of 300 participants (185 and 115 with normal and low vision, respectively) responded to ETDRS and DDiVAT. Mean difference in letters was −0.05 for VAETDRS–VARES, 0.62 for VARES–VADDiVAT, and 0.67 for VAETDRS–VADDiVAT, significantly lower than the 2.5 letter noninferiority margin. ICCs indicated an excellent level of agreement, collectively and for each group (0.922-0.996). All displayed letters in DDiVAT presented a similar difficulty. The overall accuracy of the voice recognition service was 96.01%. ICC for VADDiVAT test-retest was 0.957. (4) Conclusions: The proposed DDiVAT presented non-significant VA differences with the ETDRS, suggesting that it can be used for accurate VA self-assessment in telemedical settings, both for normal and low-vision patients.
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Alemayehu HB, Tegegn MT, Tilahun MM. Prevalence and associated factors of visual impairment among adult diabetic patients visiting Adare General Hospital, Hawassa, South Ethiopia, 2022. PLoS One 2022; 17:e0276194. [PMID: 36227943 PMCID: PMC9560493 DOI: 10.1371/journal.pone.0276194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The increased prevalence of visual impairment among diabetic patients has become a major public health problem. However, there was limited information on the extent of visual impairment among diabetic patients in our country, and there was no study in the study area. Providing updated data regarding this area is critical for the prevention of visual impairment among diabetic patients. PURPOSE The study aimed to assess the prevalence and associated factors of visual impairment among adult diabetic patients visiting Adare General Hospital, Hawassa, South Ethiopia, 2022. METHODS A hospital-based cross-sectional study was conducted on adult diabetic patients from May 30 to July 15, 2022, at Adare General Hospital, Hawassa, South Ethiopia. A systematic random sampling method was used to select 398 study participants. Data was collected through a face-to-face interview, a medical chart review, and an ocular examination. A binary logistic regression was performed to identify potential risk factors for visual impairment and their strength of association was expressed using an adjusted odds ratio with a 95% confidence interval. Variables with a P-value of < 0.05 were considered statistically significant. RESULT In this study, a total of 391 participants were involved, with a response rate of 98.2%. The prevalence of visual impairment was 28.6% (95% CI: 24.6-33.0). Age ≥ 60 years (AOR = 4.03, 95% CI: 1.72, 10.71), poor physical exercise (AOR = 3.26, 95% CI: 1.62, 6.53), poor glycemic control (AOR = 4.34, 95% CI: 2.26, 8.34), history of eye examination (AOR = 2.94, 95% CI: 1.50, 5.76), duration of diabetes ≥ 9 years (AOR = 4.78, 95% CI: 2.11, 10.83) and diabetic peripheral neuropathy (AOR = 3.01, 95% CI: 1.21, 7.50) were positively associated with visual impairment. CONCLUSION The study found a high prevalence of visual impairment among adult diabetic patients. Older age, longer duration of diabetes, poor physical exercise, poor glycemic control, history of eye examination, and diabetic peripheral neuropathy were significantly associated with visual impairment. Thus, regular physical activity, good control of glucose levels, and regular eye exams were recommended for all diabetic patients.
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Affiliation(s)
- Henok Biruk Alemayehu
- Department of Ophthalmology and Optometry, Collage of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Melkamu Temeselew Tegegn
- Department of Optometry, School of Medicine, University of Gondar, Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Mikias Mered Tilahun
- Department of Optometry, School of Medicine, University of Gondar, Comprehensive Specialized Hospital, Gondar, Ethiopia
- * E-mail:
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Busnatu ȘS, Niculescu AG, Bolocan A, Andronic O, Pantea Stoian AM, Scafa-Udriște A, Stănescu AMA, Păduraru DN, Nicolescu MI, Grumezescu AM, Jinga V. A Review of Digital Health and Biotelemetry: Modern Approaches towards Personalized Medicine and Remote Health Assessment. J Pers Med 2022; 12:1656. [PMID: 36294795 PMCID: PMC9604784 DOI: 10.3390/jpm12101656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
With the prevalence of digitalization in all aspects of modern society, health assessment is becoming digital too. Taking advantage of the most recent technological advances and approaching medicine from an interdisciplinary perspective has allowed for important progress in healthcare services. Digital health technologies and biotelemetry devices have been more extensively employed for preventing, detecting, diagnosing, monitoring, and predicting the evolution of various diseases, without requiring wires, invasive procedures, or face-to-face interaction with medical personnel. This paper aims to review the concepts correlated to digital health, classify and describe biotelemetry devices, and present the potential of digitalization for remote health assessment, the transition to personalized medicine, and the streamlining of clinical trials.
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Affiliation(s)
- Ștefan Sebastian Busnatu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
| | - Alexandra Bolocan
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Octavian Andronic
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | | | - Alexandru Scafa-Udriște
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | | | - Dan Nicolae Păduraru
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Mihnea Ioan Nicolescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
- Academy of Romanian Scientists, Ilfov No. 3, 050044 Bucharest, Romania
| | - Viorel Jinga
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
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Differences in Multifocal Electroretinogram Study in Two Populations of Type 1 and Type 2 Diabetes Mellitus Patients without Diabetic Retinopathy. J Clin Med 2022; 11:jcm11195824. [PMID: 36233694 PMCID: PMC9572303 DOI: 10.3390/jcm11195824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Diabetic retinopathy (DR) is a diabetes mellitus (DM) complication where neurodegeneration plays a significant role. The aim of our study was to determine the differences between type 1 DM (T1DM) and 2 DM (T2DM) in the multifocal electroretinogram (mERG).; (2) Methods: A mERG study was performed in two groups, a T1DM group with 72 eyes of 36 patients compared with 72 eyes of 36 patients with T2DM, randomly selected from our DM databases, without DR. We studied how HbA1c and DM duration affects amplitude and implicit time of mERG; (3) Results: the study of DM duration shows patients with T1DM have lower amplitude values compared to T2DM patients, although implicit time increases in patients with T2DM. HbA1c over 7% only affects T1DM patients with an increase of implicit time; (4) Conclusions: the retinas of patients with T1DM seem more sensitive to changes in HbA1c levels than in patients with DMT2, although the duration of diabetes affects both types of DM patients.
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Yin W, Liu Y, Hu H, Sun J, Liu Y, Wang Z. Telemedicine management of type 2 diabetes mellitus in obese and overweight young and middle-aged patients during COVID-19 outbreak: A single-center, prospective, randomized control study. PLoS One 2022; 17:e0275251. [PMID: 36174028 PMCID: PMC9522303 DOI: 10.1371/journal.pone.0275251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
The coronavirus disease-2019 (COVID-19) pandemic severely affected the disease management of patients with chronic illnesses such as type 2 diabetes mellitus (T2DM). This study aimed to assess the effect of telemedicine management of diabetes in obese and overweight young and middle-aged patients with T2DM during the COVID-19 pandemic.
Methods
A single-center randomized control study was conducted in 120 obese or overweight (body mass index [BMI] ≥ 24 kg/m2) young and middle-aged patients (aged 18–55 years) with T2DM. Patients were randomly assigned to the intervention (telemedicine) or control (conventional outpatient clinic appointment) group. After baseline assessment, they were home isolated for 21 days, received diet and exercise guidance, underwent glucose monitoring, and followed up for 6 months. Glucose monitoring and Self-Rating Depression Scale (SDS) scores were evaluated at 22 days and at the end of 3 and 6 months.
Results
Ninety-nine patients completed the 6-month follow-up (intervention group: n = 52; control group: n = 47). On day 22, the fasting blood glucose (FBG) level of the intervention group was lower than that of the control group (p < 0.05), and the control group’s SDS increased significantly compared with the baseline value (p < 0.05). At the end of 3 months, glycated hemoglobin (HbA1c) and FBG levels in the intervention group decreased significantly compared with those in the control group (p < 0.01). At the end of 6 months, the intervention group showed a significant decrease in postprandial blood glucose, triglyceride, and low-density lipoprotein cholesterol levels as well as waist-to-hip ratio compared with the control group (p < 0.05); moreover, the intervention group showed lower SDS scores than the baseline value (p < 0.05). Further, the intervention group showed a significant reduction in BMI compared with the control group at the end of 3 and 6 months (p < 0.01).
Conclusion
Telemedicine is a beneficial strategy for achieving remotely supervised blood glucose regulation, weight loss, and depression relief in patients with T2DM.
Trial registration
ClinicalTrials.gov Identifier: NCT04723550.
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Affiliation(s)
- Wenwen Yin
- China University of Mining and Technology, Xuzhou, Jiangsu Province, China
- Department of Endocrinology, The First People’s Hospital of Xuzhou, Xuzhou, Jiangsu Province, China
| | - Yawen Liu
- Department of Intensive Care Unit, The First People’s Hospital of Xuzhou, Xuzhou, Jiangsu Province, China
| | - Hao Hu
- Department of Endocrinology, The First People’s Hospital of Xuzhou, Xuzhou, Jiangsu Province, China
| | - Jin Sun
- Department of Endocrinology, The First People’s Hospital of Xuzhou, Xuzhou, Jiangsu Province, China
| | - Yuanyuan Liu
- Department of Endocrinology, The First People’s Hospital of Xuzhou, Xuzhou, Jiangsu Province, China
| | - Zhaoling Wang
- Department of Endocrinology, The First People’s Hospital of Xuzhou, Xuzhou, Jiangsu Province, China
- * E-mail:
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Maulana S, Trisyani Y, Mirwanti R, Amirah S, Kohar K, Priyatmoko Putri AI, Novianti E. The Potential of Cardiac Telerehabilitation as Delivery Rehabilitation Care Model in Heart Failure during COVID-19 and Transmissible Disease Outbreak: A Systematic Scoping Review of the Latest RCTs. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1321. [PMID: 36295482 PMCID: PMC9609719 DOI: 10.3390/medicina58101321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023]
Abstract
Background and objective: Patients with heart failure are a high-risk group who may have a higher mortality rate if infected during the COVID-19 pandemic. The problem of a patient's non-adherence to cardiac rehabilitation programs is still a challenge, resulting in disappointing long-term benefits of cardiac rehabilitation. Telehealth, including telerehabilitation, has grown in popularity to improve access to quality healthcare. It is more valuable and safer compared to usual rehabilitation care, especially during the current COVID-19 pandemic, to cut down unnecessary hospital visits and reduce the risk of cluster infections. This study aims to identify the efficacy of relevant randomized control trials (RCTs) using telerehabilitation in managing heart failure. The model, delivery care, safety, and efficacy were assessed. Material and Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR). The authors included relevant records published in the last ten years from three databases: PubMed/MEDLINE, ProQuest, and EBSCO. Each included study was further assessed using Cochrane's Risk of Bias (Rob 2) tool. Results: The telerehabilitation models consisted of cellphones, instant messaging, or online videoconferencing software. Some also included tool sets to monitor patients' vital signs regularly or during exercise. Most patients adhered to and completed all provided programs. Cardiac telerehabilitation successfully improved patients' physical fitness, quality of life, and mental health. No major adverse outcomes or significant complications were associated with the program. Conclusion: Cardiac telerehabilitation has the potential to deliver rehabilitation for heart failure patients, evidenced by its feasibility, efficacy, and safety. As a future perspective, this delivery care type can be applied throughout transmissible disease outbreaks or even globally.
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Affiliation(s)
- Sidik Maulana
- Professional Nursing Program, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Yanny Trisyani
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Ristina Mirwanti
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Shakira Amirah
- Undergraduate Medical Education, Undergraduate Faculty of Medicine, Universitas Indonesia, Depok 16424, Indonesia
| | - Kelvin Kohar
- Undergraduate Medical Education, Undergraduate Faculty of Medicine, Universitas Indonesia, Depok 16424, Indonesia
| | | | - Evi Novianti
- Professional Nursing Program, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
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Hsieh T, Gundlach BS, Ashrafzadeh S, Sarraf D, Tsui I. Effects of COVID-19 on Intravitreal Injection Clinic After Lockdown. Clin Ophthalmol 2022; 16:3089-3096. [PMID: 36160732 PMCID: PMC9507280 DOI: 10.2147/opth.s358239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine the return of patients to intravitreal injection clinic after the COVID-19 lockdown. Patients and Methods The electronic medical records of all patients who received intravitreal injections at a tertiary care Veterans Health Administration (VHA) clinic 14 weeks post-lockdown (5/9/20-8/13/20) in Los Angeles County were reviewed. Reference groups included injection patients during the 7-week COVID-19 lockdown (3/19/20-5/8/20) and a 7-week pre-pandemic period in 2019 (3/19/19-5/8/19). Clinic volume was compared using a one-way ANOVA. Demographic data, medical and psychiatric co-morbidities, injection diagnoses, visual acuities, and clinic volumes were compared between the 3 periods using a generalized estimating equation multivariate analysis. Results The post-lockdown period group averaged 25.1 visits per week, compared with 12.3/week during lockdown and 25.4/week pre-COVID in intravitreal injection clinic. In the post-lockdown period, the VHA injection clinic returned closer to the pre-lockdown volume compared to the VHA comprehensive clinic (98.9% vs 57.4%, p < 0.001). Post-lockdown, COPD patients and organ transplant patients were less likely to receive injections compared to 2019 (OR 0.76 p = 0.008, OR 1.37 p < 0.0001, respectively). Patients with a diagnosis of cancer increased in proportion between the pre-pandemic and the post-lockdown periods (OR 1.31, p = 0.007). No differences were found, according to psychiatric co-morbidities. After lockdown, the proportion of patients receiving injections for diabetic macular edema (DME) increased (OR 1.11, p = 0.01). Conclusion Injection volume returned to pre-pandemic levels immediately after lockdown ended. However, patients with high-risk comorbidities did not return to intravitreal injection clinic post-lockdown. These results can inform medical organizations, which groups may need increased safety measures and targeted outreach to address their ophthalmic needs.
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Affiliation(s)
- Terry Hsieh
- Stein Eye Institute, University of California, Los Angeles, CA, USA
| | - Bradley S Gundlach
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sahar Ashrafzadeh
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - David Sarraf
- Ophthalmology Department, West Los Angeles Veterans Health Administration, Los Angeles, CA, USA
- Retinal Disorders and Ophthalmic Genetics - Stein Eye Institute, University of California, Los Angeles, CA, USA
| | - Irena Tsui
- Ophthalmology Department, West Los Angeles Veterans Health Administration, Los Angeles, CA, USA
- Retina Division - Stein Eye Institute, University of California, Los Angeles, CA, USA
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
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Coronary Microvascular Dysfunction in Diabetes Mellitus: Pathogenetic Mechanisms and Potential Therapeutic Options. Biomedicines 2022; 10:biomedicines10092274. [PMID: 36140374 PMCID: PMC9496134 DOI: 10.3390/biomedicines10092274] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Diabetic patients are frequently affected by coronary microvascular dysfunction (CMD), a condition consisting of a combination of altered vasomotion and long-term structural change to coronary arterioles leading to impaired regulation of blood flow in response to changing cardiomyocyte oxygen requirements. The pathogenesis of this microvascular complication is complex and not completely known, involving several alterations among which hyperglycemia and insulin resistance play particularly central roles leading to oxidative stress, inflammatory activation and altered barrier function of endothelium. CMD significantly contributes to cardiac events such as angina or infarction without obstructive coronary artery disease, as well as heart failure, especially the phenotype associated with preserved ejection fraction, which greatly impact cardiovascular (CV) prognosis. To date, no treatments specifically target this vascular damage, but recent experimental studies and some clinical investigations have produced data in favor of potential beneficial effects on coronary micro vessels caused by two classes of glucose-lowering drugs: glucagon-like peptide 1 (GLP-1)-based therapy and inhibitors of sodium-glucose cotransporter-2 (SGLT2). The purpose of this review is to describe pathophysiological mechanisms, clinical manifestations of CMD with particular reference to diabetes, and to summarize the protective effects of antidiabetic drugs on the myocardial microvascular compartment.
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Rauer T, Scherer J, Stäubli P, Gerber J, Pape HC, Heining SM. Satisfaction With Telemedicine in Patients With Orthopedic Trauma During the COVID-19 Lockdown: Interview Study. JMIR Form Res 2022; 6:e35718. [PMID: 36040961 PMCID: PMC9472502 DOI: 10.2196/35718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/08/2022] [Accepted: 08/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Telemedicine can take many forms, from telephone-only consultations to video consultations via a smartphone or personal computer, depending on the goals of the treatment. One of the advantages of videoconferencing is the direct visual contact between patients and therapists even over long distances. Although some telemedicine models require specially designed add-on devices, others get by with off-the-shelf equipment and software and achieve similarly successful successful results. This depends, among other things, on the nature of the injury, the desired outcome of therapy, and the medical consultation. In the last decade, the science and practice of telemedicine have grown exponentially and even more so during the COVID-19 pandemic. Depending on the traumatic lesion, posttraumatic and postoperative treatment and care of patients who experience trauma may require medical or physical therapy consultations in a clinic or office. However, due to the COVID-19 lockdown, direct physical follow-up was more difficult, and therefore, telemedicine solutions were sought and implemented. Objective The aim of this study was to assess satisfaction with telemedical aftercare in patients with orthopedic trauma. Methods Between March and July 2020, a standardized interview using a standardized questionnaire—Freiburg Index of Patient Satisfaction (FIPS)—among patients with orthopedic trauma who received telemedical postsurgical or physiotherapeutic care was conducted. The FIPS is composed of 5 questions regarding treatment and 1 question on the overall treatment satisfaction. Furthermore, we assessed patients’ demographics and their telemedical use. Subgroup analysis was performed for age groups (<65 years vs ≥65 years), the used device, and gender. Results In total, we assessed 25 patients with a mean age of 43 (SD 24.31) years (14 female). The majority of patients (n=19, 76%) used their smartphone for consultations. The mean overall FIPS score assessed was 2.14 (SD 0.87). The mean FIPS score for younger patients was 2.23 (SD 0.90) vs 1.91 (SD 0.82) for older patients. The vast majority of the surveyed patients (n=20, 80%) were absolutely confident with their smartphone or tablet use. Conclusions Most patients surveyed stated a high satisfaction with the telemedical follow-up. Older patients showed a higher satisfaction rate than their younger counterparts. It seems that telemedical postsurgical or physiotherapeutic care is a viable option, especially in times of reduced contact, like the current COVID-19 pandemic. Thus, telemedicine offers the opportunity to ensure access to effective patient care, even over long distances, while maintaining patient satisfaction.
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Affiliation(s)
- Thomas Rauer
- Department of Trauma Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Julian Scherer
- Department of Trauma Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Pascal Stäubli
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Jonas Gerber
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital of Zurich, Zurich, Switzerland
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The First Italian Telemedicine Program for Non-Critical COVID-19 Patients: Experience from Lodi (Italy). J Clin Med 2022; 11:jcm11185322. [PMID: 36142969 PMCID: PMC9501660 DOI: 10.3390/jcm11185322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Italy was the first Western country to face a massive SARS-CoV-2 outbreak. The limited information initially available on the natural course of the disease required caution in the discharge of patients accessing health facilities. This resulted in overcrowded health facilities and emergency services. In this context, improvements of other forms of hospital care assistance were needed. This study shows the results of the first Italian remote monitoring program for COVID-19 patients. The program was implemented by the Azienda Socio Sanitaria (ASST) Lodi (Italy) by using the innovative Zcare software®. Data generated during patient recruitment, monitoring, and discharge were extracted from the Zcare software and statistically analysed. Data refer to a sample of 1196 patients enrolled in the remote monitoring program in 2020. Patients reported symptoms mainly during the first week. The most frequently reported symptoms were general fatigue, cough, and loss of taste and smell (dysosmia). More than 80% of patients reported a saturation level below 96% at least once, and more than 70% had a temperature above 37 °C. Active monitoring of reported symptoms provided valuable insights into the disease’s natural history during its less severe acute phase. Only 109 individuals visited the emergency department at least once in the first 100 days of monitoring. Of these, 101 had COVID-19 infection, 69 of whom were hospitalized following a first clinical assessment at the emergency department. The ASST Lodi’s telemedicine strategy for COVID patients appears to be a viable alternative to hospitalization. This strategy enables the provision of proper care while making resources available for more critically ill patients, and enhances the availability of resources available for more critically ill patients.
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Alkharashi MS, Alsharif HM, Altahan FA, Alrashed AW, Abdulghani M. The Impact of the COVID-19 Pandemic on Ophthalmic Outpatient Care in a Tertiary Care Center in Riyadh. Healthcare (Basel) 2022; 10:1654. [PMID: 36141265 PMCID: PMC9498299 DOI: 10.3390/healthcare10091654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/27/2022] [Accepted: 08/28/2022] [Indexed: 01/18/2023] Open
Abstract
In this paper, we measured the impact of a full COVID-19 lockdown on ophthalmic patients after a period of lockdown in Saudi Arabia, from March to September 2020. A cross-sectional analytical study was carried out on 180 patients who had their appointments delayed or canceled due to the lockdown. Data was collected from electronic medical records and patients via voice calls using a validated questionnaire that were analyzed using a multivariable binary regression analysis. The results show no statistically significant mean difference in visual acuity when comparing pre- and post-lockdown measurements. The median number of appointment cancellations/delays per patient was two, and the estimated delay for the first canceled appointments was equal to 178.8 days. Of the cohort studied, 15.4% of patients faced delays in necessary surgical and therapeutic interventions; 22.1% of patients sought eye care at other institutions due to the delay, and 15% of those were seen by doctors unspecialized in ophthalmology. The odds of dissatisfaction with care were higher in patients who experienced cancellations in a surgical procedure and patients who experienced difficulty in obtaining medications. In conclusion, the pandemic hampered ophthalmic patients' access to medications. Subjective visual outcomes of patients were also negatively affected; however, the change in objective visual parameters was not statistically significant.
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Affiliation(s)
- Majed S. Alkharashi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Heba M. Alsharif
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Faisal A. Altahan
- College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Ahmad W. Alrashed
- College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Moath Abdulghani
- College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
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Harahsheh E, English SW, Hrdlicka CM, Demaerschalk B. Telestroke’s Role Through the COVID-19 Pandemic and Beyond. Curr Treat Options Neurol 2022; 24:589-603. [PMID: 35999901 PMCID: PMC9388966 DOI: 10.1007/s11940-022-00737-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Abstract
Purpose of review The goal of this paper is to discuss the role and utilization of telestroke services through the COVID-19 pandemic and to suggest future directions to sustain and increase patients’ access to stroke expertise. Recent findings Telestroke is an innovative and effective tool that has been shown to improve access, quality of care, and outcomes of patients with acute stroke syndromes in resource-limited areas for the last two decades. The COVID-19 pandemic posed a significant challenge and strained healthcare systems worldwide, but it created novel and unique opportunities to expand and increase the utilization of telehealth and telestroke services to deliver personalized healthcare across the continuum of stroke care outside of traditional settings. This rapid and widespread increase in telestroke use was facilitated by the removal of many legislative and regulatory barriers which have limited patients’ access to stroke expertise for many years. Summary As the public health emergency ends, there exists a unique opportunity to optimize and expand upon the pandemic-related rapid growth of telestroke care. Optimal utilization of telehealth and telestroke services will depend on maintaining and improving required infrastructure, laws, and regulations, particularly those governing reimbursement and licensing.
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Affiliation(s)
- Ehab Harahsheh
- Department of Neurology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259 USA
| | | | - Courtney M. Hrdlicka
- Department of Neurology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259 USA
| | - Bart Demaerschalk
- Department of Neurology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259 USA
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Tătaru I, Dragostin OM, Fulga I, Boros F, Carp A, Maftei A, Zamfir CL, Nechita A. The modern pharmacological approach to diabetes: innovative methods of monitoring and insulin treatment. Expert Rev Med Devices 2022; 19:581-589. [PMID: 35962571 DOI: 10.1080/17434440.2022.2113387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorders characterised by a high blood sugar level over a prolonged period of time. In order to maintain this blood glucose value in normal parameters, a careful monitoring of it and insulin administration are necessary. AREAS COVERED Thus, to facilitate this procedure, new blood glucose monitoring systems have been studied. The smart lens, the nano tattoo, non-invasive sensors based on reverse ionthophoresis and glucose oxidase - based continuous blood glucose monitoring systems, are the methods described in this study. Of course, not only is blood glucose monitoring important, but also the lifestyle of a drug or the way a drug is administered, especially in the cae of insulin. How insulin is administered is also a topic that we address in this article. In an attempt to promote compliance with the administration, we have discussed about new forms of administering insulin such as: oral, intranasal, administration on the oral mucosa and last but not least, transdermal administration. EXPERT OPINION Further, the attention of specialists should be directed to devices based on sensors, with a role in the interruption of insulin administration, in case of detection of hypoglycemia or the additional dose of insulin, if hyperglycemia is detected.
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Affiliation(s)
- Iulian Tătaru
- Faculty of Medicine, Department of Histology, University of Medicine and Pharmacy Grigore T. Popa, , 16 Universitatii Str 700115, Iasi, Romania
| | - Oana M Dragostin
- Dunarea de Jos University of Galati, Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, 47 Domneasca Str, Galati, Romania
| | - Iuliu Fulga
- Dunarea de Jos University of Galati, Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, 47 Domneasca Str, Galati, Romania
| | - Florentina Boros
- Dunarea de Jos University of Galati, Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, 47 Domneasca Str, Galati, Romania
| | - Adelina Carp
- Dunarea de Jos University of Galati, Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, 47 Domneasca Str, Galati, Romania
| | - Ariadna Maftei
- Dunarea de Jos University of Galati, Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, 47 Domneasca Str, Galati, Romania
| | - Carmen L Zamfir
- Faculty of Medicine, Department of Histology, University of Medicine and Pharmacy Grigore T. Popa, , 16 Universitatii Str 700115, Iasi, Romania
| | - Aurel Nechita
- Dunarea de Jos University of Galati, Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, 47 Domneasca Str, Galati, Romania
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Oshima H, Takamura Y, Hirano T, Shimura M, Sugimoto M, Kida T, Matsumura T, Gozawa M, Yamada Y, Morioka M, Inatani M. Glycemic Control after Initiation of Anti-VEGF Treatment for Diabetic Macular Edema. J Clin Med 2022; 11:jcm11164659. [PMID: 36012896 PMCID: PMC9410407 DOI: 10.3390/jcm11164659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022] Open
Abstract
Diabetic macular edema (DME) induces visual disturbance, and intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs are the accepted first-line treatment. We investigate its impact on glycemic control after starting VEGF treatment for DME on the basis of a questionnaire and changes in hemoglobin A1c (HbA1c). We conducted a retrospective multicenter study analyzing 112 patients with DME who underwent anti-VEGF therapy and their changes in HbA1c over two years. Central retinal thickness and visual acuity significantly improved at three months and throughout the period after initiating therapy (p < 0.0001); a significant change in HbA1c was not found. A total of 59.8% of patients became more active in glycemic control through exercise and diet therapy after initiating therapy, resulting in a significantly lower HbA1c at 6 (p = 0.0047), 12 (p = 0.0003), and 18 (p = 0.0117) months compared to patients who did not. HbA1c was significantly lower after 18 months in patients who stated that anti-VEGF drugs were expensive (p = 0.0354). The initiation of anti-VEGF therapy for DME affects HbA1c levels in relation to more aggressive glycemic control.
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Affiliation(s)
- Hideyuki Oshima
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
- Correspondence: ; Tel.: +81-776-61-8403
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano 390-0802, Matsumoto, Japan
| | - Masahiko Shimura
- Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Tokyo 193-0998, Hachioji, Japan
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
| | - Teruyo Kida
- Department of Ophthalmology, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Takehiro Matsumura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
| | - Makoto Gozawa
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
| | - Yutaka Yamada
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
| | - Masakazu Morioka
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
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Ma Y, Wang H, Jiang J, Han C, Lu C, Zeng S, Wang Y, Zheng Z, Peng Y, Ding X. Prevalence of and risk factors for diabetic retinopathy in residents with different types of abnormal glucose metabolism with or without hypertension: A suburban community-based cross-sectional study. Front Endocrinol (Lausanne) 2022; 13:966619. [PMID: 36004355 PMCID: PMC9393865 DOI: 10.3389/fendo.2022.966619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
Aims The present study examined the prevalence and risk factors for diabetic retinopathy (DR) in residents with abnormal glucose metabolism in a community. Methods 6029 subjects were included and underwent standardized interviews and comprehensive examinations. Residents with diabetes were divided into nondiabetic retinopathy (NDR) and DR groups and non-hypertension and hypertension groups. Unconditional multivariate logistic regression models were used to analyze the risk factors for DR in different groups. Results The prevalence of DR in diabetes was 9.9%, and the prevalence of retinopathy, which also has the typical signs of DRs, such as retinal microaneurysms, in prediabetes and normal glucose tolerance was 5.2% and 5.3%, respectively. An elevated waist-to-hip ratio (WHR) (female≥0.85, male≥0.9)[OR 1.683, 95% CI (1.016, 2.790)], systolic blood pressure (SBP)≥140 mmHg [OR 1.875, 95% CI (1.158, 3.034)], elevated HbA1c [OR 1.410, 95% CI (1.220, 1.629)], HbA1c ≥6.5% [OR 2.149, 95% CI (1.320, 3.498)], antidiabetic drug use [OR 3.798, 95% CI (2.209, 6.529)], elevated fasting blood glucose [OR 1.176, 95% CI (1.072, 1.289)], elevated postprandial blood glucose [OR 1.090, 95% CI (1.033, 1.150)] and nonspecific ST-T segment changes on electrocardiography [OR 2.555, 95% CI (1.556, 4.196)] were risk factors for DR. Duration of diabetes [OR 1.206, 95% CI (1.028, 1.415)], elevated WHR [OR 3.796, 95% CI (1.144, 12.603)], elevated waist circumference [OR 6.874, 95% CI (1.403, 33.665)], elevated HbA1c [OR 1.435, 95% CI (1.046, 1.970)], HbA1c ≥6.5% [OR 6.850, 95% CI (1.771, 26.501)], and concurrent metabolic syndrome [OR 3.975, 95% CI (1.144, 13.815)] were risk factors for DR in diabetes without hypertension, and elevated HbA1c [OR 1.395, 95% CI (1.183, 1.645)], HbA1c ≥6.5% [OR 1.745, 95% CI (1.027, 2.966)], use of antidiabetic drugs [OR 4.781, 95% CI (2.624, 8.711)], elevated fasting blood glucose [OR 1.146, 95% CI (1.034, 1.270)], elevated postprandial blood glucose [OR 1.083, 95% CI (1.020, 1.151)], and nonspecific ST-T segment changes on electrocardiography [OR 2.616, 95% CI (1.531, 4.469)] were risk factors for DR in diabetes with hypertension. Conclusion Retinopathy was found in subjects with normal glucose tolerance and prediabetes. There were differences in risk factors for DR in diabetic patients with and without hypertension.
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Affiliation(s)
- Yuhang Ma
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Wang
- Key Laboratory of Ophthalmology, Department of Ophthalmology, Hebei Eye Hospital, Xingtai, China
| | - Junyi Jiang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
| | - Changjing Han
- Department of Ophthalmology, The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
| | - Chunhua Lu
- Preventive Medicine Division, Community Health Service Center of Sijing, Shanghai, China
| | - Siliang Zeng
- Department of Rehabilitation Therapy, School of Health, Shanghai Normal University Tianhua College, Shanghai, China
| | - Yufan Wang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi Zheng
- Shanghai Key Laboratory of Ocular Fundus Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine and Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Yongde Peng
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoying Ding
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Yang Y, Zhou Y, Cao Y, Dong Y, Liu C, Zhu W. Impact of diabetic retinopathy on prognosis of patients with heart failure with preserved ejection fraction. Nutr Metab Cardiovasc Dis 2022; 32:1711-1718. [PMID: 35606228 DOI: 10.1016/j.numecd.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/07/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes mellitus (DM), and could increase the risks of adverse cardiovascular events among DM patients. Since heart failure with preserved ejection fraction (HFpEF) and DM often coexist, our present study aimed to explore the associations of DR with adverse outcomes in HFpEF patients. METHODS AND RESULTS We conducted this study in a large, international population suffering from HFpEF (n = 3442) based on the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. The associations of baseline DR with clinical outcomes were expressed as adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using the Cox proportional hazard regression models. The crude incidence rates of all the outcomes studied were significantly increased when DM patients with or without DR compared to those without DM (all P < 0.05), whereas there were no differences between DM patients without DR versus those with DR (all P > 0.05). In the multivariate cox regression analysis, DR was not significantly associated with increased risks of the primary composite outcome (HR, 1.178 [95% CI, 0.870-1.596]) and secondary outcomes including all-cause death, cardiovascular death, all-cause hospitalization, hospitalization for HF, myocardial infarction, and stroke (all P > 0.05). CONCLUSIONS Our results of current study suggested that DM but not DR could be regarded as an independent risk factor for the prognosis of HFpEF. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT00094302.
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Affiliation(s)
- Y Yang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, PR China
| | - Y Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Y Cao
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, 550001, PR China
| | - Y Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, PR China
| | - C Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, PR China.
| | - W Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, PR China.
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Zikhali T, Kalinda C, Xulu-Kasaba ZN. Screening of Diabetic Retinopathy Using Teleophthalmology to Complement Human Resources for Eye Health: A Systematic Review and Meta-Analysis. Clin Pract 2022; 12:457-467. [PMID: 35892436 PMCID: PMC9326517 DOI: 10.3390/clinpract12040050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/12/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Diabetic retinopathy is a vascular disease of the retina that affects patients with uncontrolled diabetes. Untreated diabetic retinopathy (DR) can eventually lead to blindness. To date, diabetic retinopathy is the third leading cause of vision loss in the working class globally. Frequent retinal screening for all diabetic people is an effective method of preventing diabetic retinopathy blindness. This has relied on the use of ophthalmologists, but due to scarce resources, such as a shortage of human resources for eye health, this has denied many patients quality eye health care in a resource-limited setting. The recent advances on the use of teleophthalmology are promising to close this gap. This study aimed to map available evidence on the use of teleophthalmology in the screening of DR globally and to explore how this can be used to complement short-staffed eye clinics, especially in resource-constrained contexts. Studies were sourced from Google Scholar, PubMed, Science Direct, and EBSCO host. The final study selection was presented using a PRISMA chart. The mixed method appraisal tool was used to assess the quality of the nine studies included. The random effect model was used to estimate pooled prevalence estimates. Levels of heterogeneity were evaluated using Cochran's Q statistic and I2. Of nine included studies, eight were from high-income countries. The screening was performed at the primary healthcare level in eight of nine included studies. Only one study used a mydriatic agent, and the commonly used fundus camera was the non-mydriatic fundus camera. The overall estimated pooled prevalence of DR was 29 (95%CI: 10-34). Teleophthalmology at the primary health care level showed that early intervention in diabetic retinopathy reduced avoidable blindness and ensured remote access to eye health professionals, thus alleviating the burden on them.
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Affiliation(s)
- Thembile Zikhali
- Department of Optometry, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4000, South Africa
| | - Chester Kalinda
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity (UGHE), Kigali 20093, Rwanda
- Institute of Global Health Equity Research (IGHER), University of Global Health Equity (UGHE), Kigali 20093, Rwanda
- Discipline of Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Zamadonda Nokuthula Xulu-Kasaba
- Department of Optometry, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4000, South Africa
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Yao X, Pei X, Fan S, Yang X, Yang Y, Li Z. Relationship between renal and liver function with diabetic retinopathy in patients with type 2 diabetes mellitus: a study based on cross-sectional data. Sci Rep 2022; 12:9363. [PMID: 35672376 PMCID: PMC9174192 DOI: 10.1038/s41598-022-13164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/05/2022] [Indexed: 11/12/2022] Open
Abstract
This study aims to explore the relationship between abnormal renal- and liver-function and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). A total of 994 T2DM patients who received inpatient treatment in the Endocrinology Department of Henan Province People’s Hospital were included in the study. Logistic regression was performed to identify the relationship between abnormal renal and liver function with DR. Receiver operator characteristic analysis was performed to explore the efficacy of risk factors in predicting DR. Higher urine albumin [OR(95%CI) = 3.344(1.921–5.822), P < 0.001] and urine albumin/creatinine ratio [OR (95%CI) = 2.901(1.911–5.822), P < 0.001] were closely related to the occurrence of DR. People with low TP had a 1.624-times higher risk (95%CI: 1.008–2.617) of developing DR than those with normal total protein (P = 0.046). The more risk factors that are present, the greater the risk of DR. For every one-point incremental increase in the risk-factor score, the risk of DR increased by 31.0% (P < 0.001). The area under receiver operating curve of risk-factor score was 0.839 (0.812, 0.866), with a sensitivity of 81.9% and a specificity of 74.8%. The risk of developing DR increased with an increased risk-factor score. These findings are potentially valuable for DR screening and early diagnosis in patients with T2DM.
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Affiliation(s)
- Xi Yao
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Xiaoting Pei
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Zhengzhou, 450003, Henan, China.
| | - Shuoning Fan
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Xueke Yang
- School of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Yingrui Yang
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Zhijie Li
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Zhengzhou, 450003, Henan, China.
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Impact of the COVID-19 pandemic on visual outcomes of diabetic macular edema patients at a tertiary care veterans affairs center. J Diabetes Metab Disord 2022; 21:759-768. [PMID: 35582648 PMCID: PMC9098215 DOI: 10.1007/s40200-022-01049-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/25/2022] [Indexed: 10/27/2022]
Abstract
Purpose There are limited studies on factors that impacted retina clinic patient outcomes during the COVID-19 pandemic. We aimed to evaluate visual and anatomic outcomes in patients with diabetic macular edema (DME) requiring anti-VEGF injections at the veterans' affairs tertiary care eye clinic in Houston, TX. Methods Patient volume from April 2020 was compared to that of April 2019 to determine attendance changes. To evaluate outcomes, we reviewed patients with DME who had scheduled appointments during April 2020. We tracked changes in central foveal thickness (CFT) and Snellen visual acuity (VA) measurements. Patient outcomes were classified as poor (defined as worsening VA or CFT at follow-up) or good (no worsening of either at follow-up). Regression analysis identified characteristics associated with poor outcomes. Results To prevent the spread of COVID-19, patients were called to reschedule clinic appointments. Attendance frequency decreased from 523 patients in April 2019 to 246 patients in April 2020. 134 patients met inclusion criteria (mean age of 64.7 ± 8.8 years). 19/134 of patients were seen on schedule, 89/134 had delayed appointments (average follow-up interval of 115.2 ± 50.0 days), and 26/134 were lost to follow-up. Patients with delayed appointments had higher odds of poor outcome at follow-up compared to patients seen on schedule (OR = 4.03, 95% CI: 1.14-16.92, p = 0.04). Patient's baseline visual acuity, macular thickness, comorbidities, and diabetic retinopathy severity, and demographics did not affect visual outcome at follow-up. Conclusions On average, patients were rescheduled to a visit 2.4 months later than their usual visit. Over half these patients experienced worsening of vision or edema. This demonstrates that lapses in care result in worsening of DME. However, there is no clear association between baseline characteristics and risk of disease progression. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-01049-5.
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Sharma K, Patel Z, Patel S, Patel K, Dabhi S, Doshi J, Amdani M, Shah D, Patel D, Konat A. Repostioning of Telemedicine in Cardiovascular World Post-COVID-19 Pandemic. Front Cardiovasc Med 2022; 9:910802. [PMID: 35711362 PMCID: PMC9196028 DOI: 10.3389/fcvm.2022.910802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background During the COVID-19 pandemic, telemedicine is a quickest expanding service solution to provide improved access to sophisticated healthcare that is efficient, cost-effective, and time-consuming. Methods This analysis is evaluated on the basis of several studies that look at the history, benefits, various techniques, challenges, uses, and impact of telemedicine in the treatment of heart failure and cardiac rehabilitation as during COVID-19 outbreak. Results Patients avoided or refused medical treatment during COVID-19 pandemic despite the risk of illness and the threat of infections spreading. Telemedicine has become a non-traditional form of care delivery due to better access and high-end technologies such as virtual consultations, face-to-face video, smartphone visits, two-way text communication, distant patient history, and distal characteristic assessment. Remote monitoring can help manage cardiovascular disease risk factors and increase patient participation in blood pressure, heart failure data, and workout or other activity progress. Conclusion Based on the findings of past studies, we can infer that telemedicine is still an emerging subject in the treatment and management of cardiovascular disease. Telemedicine and similar technologies will also revolutionize healthcare services by expanding their reach and providing a big pool of database for better research and analysis.
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Affiliation(s)
| | - Zeel Patel
- Amdavad Municipal Corporation (AMC) Medical Education Trust Medical College, Ahmedabad, India
| | - Smeet Patel
- Smt. Nathiba Hargovandas Lakhmichand (N.H.L.) Municipal Medical College, Ahmedabad, India
| | - Kalpen Patel
- Pandit Deendayal Upadhyay (P.D.U) Medical College, Rajkot, India
| | - Shweta Dabhi
- Amdavad Municipal Corporation (AMC) Medical Education Trust Medical College, Ahmedabad, India
| | - Jinish Doshi
- Amdavad Municipal Corporation (AMC) Medical Education Trust Medical College, Ahmedabad, India
| | - MohmadSabir Amdani
- Amdavad Municipal Corporation (AMC) Medical Education Trust Medical College, Ahmedabad, India
| | - Darshini Shah
- Gujarat Cancer Society (GCS) Medical College, Ahmedabad, India
| | - Dhyanee Patel
- All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Ashwati Konat
- Department of Zoology, Biomedical Technology and Human Genetics, Gujarat University, Ahmedabad, India
- *Correspondence: Ashwati Konat,
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de Kreutzenberg SV. Telemedicine for the Clinical Management of Diabetes; Implications and Considerations After COVID-19 Experience. High Blood Press Cardiovasc Prev 2022; 29:319-326. [PMID: 35579849 PMCID: PMC9111950 DOI: 10.1007/s40292-022-00524-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/07/2022] [Indexed: 12/15/2022] Open
Abstract
Telemedicine is a clinical approach that was seldom used in the day-to-day practice, if not only in certain settings, before the COVID-19 pandemic. As stated by the WHO, telemedicine is: the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies (ICT) for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, …. Telemedicine has actually represented the most useful and employed tool to maintain contacts between patients and physicians during the period of physical distance imposed by the pandemic, especially during the lockdown. Diabetes in particular, a chronic disease that often needs frequent confronting between patient and health professionals has taken advantage of the telehealth approach. Nowadays, technological tools are more and more widely used for the management of diabetes. In this review results obtained by telemendicine application in type 1 and type 2 diabetic individuals during COVID-19 are revised, and future perspectives for telemedicine use to manage diabetes are discussed.
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