Spomenka Ljubić

Inflammation and Pharmacological Treatment in Diabetic Retinopathy

Diabetic retinopathy (DR), the most common microvascular complication of diabetes mellitus, is estimated to be the leading cause of new blindness in the working population of developed countries. Primary interventions such as intensive glycemic control, strict blood pressure regulation, and lipid-modifying therapy as well as local ocular treatment (laser photocoagulation and pars plana vitrectomy) can significantly reduce the risk of retinopathy occurrence and progression. Considering the limitations of current DR treatments development of new therapeutic strategies, it becomes necessary to focus on pharmacological treatment. Currently, there is increasing evidence that inflammatory processes have a considerable role in the pathogenesis of DR with multiple studies showing an association of various systemic as well as local (vitreous and aqueous fluid) inflammatory factors and the progression of DR. Since inflammation is identified as a relevant mechanism, significant effort has been directed to the development of new concepts for the prevention and treatment of DR acting on the inflammatory processes and the use of pharmacological agents with anti-inflammatory effect. Inhibiting the inflammatory pathway could be an appealing treatment option for DR in future practices, and as further prospective randomized clinical trials accumulate data, the role and guidelines of anti-inflammatory pharmacologic treatments will become clearer.

Body mass index: a risk factor for retinopathy in type 2 diabetic patients.

The aim of the study was to investigate whether body mass index (BMI) independently or in correlation with other risk factors is associated with diabetic retinopathy (DR) progression. The study included 545 patients with type 2 diabetes. According to DR status, they were divided into three groups: group 1 (no retinopathy; n = 296), group 2 (mild/moderate nonproliferative DR; n = 118), and group 3 (severe/very severe NPDR or proliferative DR; n = 131). Patients without DR were younger than those with signs of retinopathy at time of diabetes onset whilst diabetes duration was longer in groups with severe NPDR and PDR. DR progression was correlated with diabetes duration, BMI, HbA1c, hypertension, and cholesterol. Statistical analyses showed that the progression of retinopathy increased significantly with higher BMI (gr. 1: 26.50 ± 2.70, gr. 2: 28.11 ± 3.00, gr. 3: 28.69 ± 2.50; P < 0.01). We observed a significant deterioration of HbA1c and a significant increase in cholesterol and hypertension with an increase in BMI. Correlation between BMI and triglycerides was not significant. Thus, BMI in correlation with HbA1c cholesterol and hypertension appears to be associated with the progression of DR in type 2 diabetes and may serve as a predictive factor for the development of this important cause of visual loss in developed countries.

Inflammation, Haemostatic Disturbance, and Obesity: Possible Link to Pathogenesis of Diabetic Retinopathy in Type 2 Diabetes

Purpose. The pathogenesis of diabetic retinopathy (DR) is insufficiently understood but may possibly involve chronic, low-grade inflammation. The aim of this cross-sectional study was to investigate the relationship between inflammatory and haemostatic markers, other markers of endothelial dysfunction and anthropometric parameters, and their association with DR in patients with type 2 diabetes. Methods. According to the DR status patients were divided into three groups: no retinopathy, mild/moderate nonproliferative (NPDR), and severe NPDR/proliferative retinopathy (PDR). Results. The groups did not differ in the levels of inflammatory and haemostatic markers, other markers of endothelial dysfunction, and anthropometric parameters. After dividing the patients according to the level of obesity (defined by BMI, WC, and WHR) into three groups ANOVA showed the differences in C-reactive protein according to the WC (P = 0.0265) and in fibrinogen according to the WHR (P = 0.0102) as well as in total cholesterol (P = 0.0109) and triglycerides (P = 0.0133) according to the BMI. Logistic regression analyses showed that diabetes duration and prolonged poor glycemic control are the main predictors of retinopathy in patients with type 2 diabetes. Conclusion. Interrelations between obesity, inflammation, haemostatic disturbance, and other risk factors may possibly play an important additional role in endothelial dysfunction involved in the pathogenesis of diabetic retinopathy.

Inverse Levels of Adiponectin in Type 1 and Type 2 Diabetes Are in Accordance with the State of Albuminuria

Aims. To investigate the behaviour of adiponectin (ApN) in patients with type 1 and type 2 diabetic nephropathy. Methods. ApN and inflammatory and other markers of the metabolic syndrome were compared across diabetes types, albumin excretion rate (AER), and creatinine clearance (CrCl) categories in 219 type 1 and type 2 diabetic patients. Results. Significant differences among ApN levels according to AER were found in both types of diabetes (F = 8.45, df = 2, P < 0.001). With the progression of albuminuria, ApN increased in type 1 and decreased in type 2 diabetes. Patients with decreased CrCl had higher ApN levels than those with normal CrCl in either type of diabetes (F = 12.7, df = 1, P < 0.001). The best model for ApN (R 2 = 0.9002) obtained from stepwise regression in type 1 diabetes included CrCl, BMI, WBC, CRP, and age, while in type 2 diabetes (R 2 = 0.2882) it included ppPG, LDL, and UA. Conclusion. ApN behaved differently in relation to albuminuria, increasing with its progression in type 1 diabetes and decreasing in type 2 diabetes. It was however increased in the subgroups with decreased CrCl in both types of diabetes. Albuminuria seems to be more important than renal insufficiency in the definition of ApN levels in type 1 and type 2 diabetes.

The Prevalence of Depression and Anxiety in Seafarers Type 2 Diabetic Patients

A experimental pre-test and post-test design, in an Iranian oil and gas company. 248 employees were randomly selected and randomly assigned to three interventions and a waiting list control group. The program encompassed face-to-face, e-mail, combined face-to-face and e-mail. The face-to-face program was full day training about strengthening relationship, effective communication, emotional intelligence, and stress management. 206 participants completed both the baseline assessment and the three months follow-up were included in the mixed design repeated measure ANOVA analysis. Result showed significant factor between groups was communication subscale in the SCAT instrument group effect (p =0.030). However, there was a significant result for interaction of some scales with socio-demographic factors, such as relationships with gender, role with years of experience, role with age group, and change with age group. Current study developed a workplace psychosocial risk management module. Study discovered a positive variation and efficiency for combined face-to-face and email group. This research recommends combining organizational intervention with individual intervention to manage all workplace psychosocial risks..A needle stick injury which is the accidental puncture of the skin by a needle during a medical intervention is the most common cause of sharp injury events in the healthcare environment. Certain groups of individuals are at greater risk than others because of the nature of their work. A cross sectional study was conducted at the medical department of Social Security Organization, Khalij Fars hospital a 120 beds general hospital located in Bandar abbas the south harbor of Iran. This survey was based on a self administered questionnaire which was filled anonymously. The questionnaire covered the age, gender, educational level, occupation group, the details of need lestick injuries within the last 12 months, under each professional group, circumstances resulting in the sharps incident, the kind of activity and procedure under which the needle stick injury occurred, and the HBV vaccination status. Overall, 71 (31.7%) of respondents had experienced needle stick injury within the last 12 months. Only 32 (45.1%) of them reported the injury. Operation room was the most prevalent site of needle stick injuries occurrence (16.9%). The most needle stick injuries occurred during surgery (26.8%). There was a significant difference in case prevalence of needle stick injury among various job categories (p<0.05). Surgeons appeared to have the highest prevalence (66.7%). Needle stick injuries among health care workers are common and often not reported. These findings underscore the need for ongoing attention to reduce such injuries and to improve reporting systems.T hospitality and tourism industry is a major contributor to the economy of Uttarakhand. The sector also employs a high proportion of young workers and migrant workers. There are five main departments of hospitality and tourism industry i.e. front office, housekeeping, food production, food service and tours and travel. Tourism is not just about the facilities and attractions provided for visitors. It is about people and especially about the relationship between the customer and the individual providing service. Everybody employed in tourism needs to have the knowledge, skills and attitudes to provide the standard of product and service that customers expect. Knowing about the tourism industry, its component parts and especially where you fit in is an important starting point to a successful career in tourism. Basically for all those who are away from their home, hospitality industry provides services. In order to achieve the objectives of the study descriptive cum experimental design was planned. The present study was carried out in Kamaun regions of Uttarakhand. Both purposive/convenient and snowball sampling techniques were used to select the study area and samples. A total of 200 workers were selected from kumaun regions of the Uttarakhand. There are various hospitality and tourism industry in uttarakhand but we selected almora, mukteshwar, binsar and lohaghat towns because of the need of the research. While comparing the physical fitness index among workers of different departments, it was found that maximum of the total front office workers i.e. 68 per cent were having good physical fitness index and minimum i.e. 2 per cent housekeepers were having low average physical fitness index.T study has never been conducted in Pakistan before. Related researches have been carried out in neighboring countries, and my aim is not only to find current prevalence of malnutrition in target areas, but also to determine how a mother’s education and professional working status affect the nourishment status of the child. This is a cross sectional study in which children under 5 years of age were assessed by weight for age and height for age. A comparison was made between children of different socioeconomic strata, a structured questionnaire was developed, and a door-to-door survey was conducted. Data was analyzed by SPSS version 17. Regarding weight for age, the cut off values included were according to the WHO growth chart published in J.E Park. The height for age was calculated according to the Z score guidelines for cutoff values by WHO. For variation in the socioeconomic status, the study was conducted in two target populations with stark difference in socioeconomic status. The prevalence of malnutrition in children under 5 years of age of Lahore was determined to be 22.7%. The malnourished children were higher in percentage in housewife group, i.e., 62.2%, compared to only 37.8% in working women group. This is a surprise as the normal perception in our culture leads to the belief that the order should be reverse. There was a difference of 9% between housewives and working women as far as preference for home-made weaning food for children was considered. However, working women are slightly more prone to opt for commercially prepared foods like Cerelac etc. This study provides a base line for further research on factors associated with malnutrition in children among population of Pakistan.Depression and anxiety are co-morbid condition in diabetes as disease-related psychological reactions on this chronic metabolic illness. This study was aimed to determine the occurrence of depression and anxiety in seafarers type 2 diabetic patients. A random sample of 52 diabetic seafarers treated with diet and oral glucose lowering agents, and 56 healthy seafarers were screened for depression with The Beck Depression Inventory (BDI) and for anxiety with State-Trait Anxiety Inventory (STAI 1, STAI 2). Depression (BDI > 18.5) and anxiety (STAI < 28.5) was significantly higher in the group of diabetic seafarers than in control group (more than 30%). Significant correlation was noted between depression and duration of diabetes mellitus, degree of obesity and poor glycaemic control (HbA1C > 8%) and longer duration of shipping routes (over 6 months). The proportion of depression and anxiety was found higher in seafarers type 2 diabetic patients than in the healthy seafarers.

Body Mass Index and Retinopathy in Type 1 Diabetic Patients

Aim. To investigate whether body mass index (BMI) independently or in correlation with other risk factors is associated with diabetic retinopathy (DR) progression. Methods. The study included 176 patients with type 1 diabetes divided into three groups according to DR status: group 1 (no retinopathy; n = 86), group 2 (mild/moderate nonproliferative DR; n = 33), and group 3 (severe/very severe NPDR or proliferative DR; n = 57). Results. A significant deterioration of HbA1c, an increase in total cholesterol, systolic, diastolic blood pressure, and diabetic nephropathy with the progression of retinopathy were found. DR progression was correlated with diabetes duration, HbA1c, hypertension, total cholesterol, and the presence of nephropathy. In patients without nephropathy, statistical analyses showed that progression of retinopathy increased significantly with higher BMI (gr. 1: 24.03 ± 3.52, gr. 2: 25.36 ± 3.44, gr. 3: 26.93 ± 3.24; P < 0.01). A positive correlation between BMI and a significant deterioration of HbA1c, an increase in cholesterol, triglycerides, and hypertension was observed. Conclusion. BMI in correlation with HbA1c, cholesterol, and hypertension appears to be associated with the progression of DR in type 1 diabetic patients without nephropathy. However, additional studies are required to investigate the pathogenic role of obesity and weight loss in retinal diabetic complications particularly relating to nephropathy.

Age-dependent systemic DNA damage in early Type 2 Diabetes mellitus

Oxidative stress, capable of eliciting damage to various biomolecules including DNA, is a recognized component of diabetes mellitus and its complications. Metabolic syndrome (MetS) is associated with the development of type 2 diabetes mellitus (T2DM), as well as other unfavorable outcomes. The aim of this study was to elucidate the role of oxidative stress in the development of T2DM, by investigating association of oxidative DNA damage with metabolic parameters in subjects with MetS and early T2DM. Selected anthropometric and biochemical parameters of MetS, inflammation and oxidative DNA damage: body mass index (BMI), fatty liver index (FLI), waist circumference (WC), total cholesterol, HDL and LDL-cholesterol, gamma-glutamyl transpeptidase (GGT), uric acid, C-reactive protein (CRP), total leukocyte/neutrophil count, and urinary 8-hidroxy-deoxyguanosine (u-8-OHdG) were assessed in male subjects with MetS and both younger (≤55 years) and older (>55 years) subjects with T2DM of short duration without complications. BMI, FLI, WC, total and LDL-cholesterol and uric acid were higher, while the u-8-OHdG was lower in MetS group, when compared to older T2DM subjects. None of these parameters were different neither between MetS and younger T2DM, nor between two sub-groups of subjects with T2DM. Values of CRP, HDL-cholesterol, triglycerides, GGT, leukocytes and neutrophils were not different between all examined groups of subjects. Higher 8-OHdG in older subjects with T2DM suggests that both aging process and diabetes could contribute to the development of DNA damage. Oxidative DNA damage cannot serve as an universal early marker of T2DM.

Diabetic Macular Edema: Traditional and Novel Treatment

Diabetes is one of the leading public health problems worldwide. Diabetic macular edema (DME) is the main cause of vision loss in patients with diabetes. Ideal metabolic control of diabetes is the primary goal of treatment and the basic way of preventing and stopping the progression of DME. Although laser photocoagulation has been the standard treatment of DME for nearly three decades, superior outcomes can be achieved with novel, intravitreal anti-VEGF and steroid therapy. Novel treatment option for DME depends on visual acuity and location/extent of macular thickening based on optical coherence tomography scans. According to the International Clinical Classification Scale, DME is divided into no center-involving DME and center-involving DME (CI-DME). New guidelines recommend intravitreal treatment as the treatment of choice for patients with CI-DME and moderate visual impairment. Patients with no CI-DME and mild visual impairment should be treated with modified ETDRS laser photocoagulation and closely observed. Vitrectomy is the treatment of choice for patients with a tractional component of DME. Nowadays, traditional treatment goal of preventing blindness in patients with DME has been changed by the new goal aiming to restore impaired vision, prevent further vision loss and improve visual function. Therefore, many trials addressing this new concept have been underway worldwide.