1
|
Gupta R, Kalra P, Ramamurthy LB, Rath S. Thyroid Eye Disease and Its Association With Diabetes Mellitus: A Major Review. Ophthalmic Plast Reconstr Surg 2023; 39:S51-S64. [PMID: 38054986 DOI: 10.1097/iop.0000000000002449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE Thyroid eye disease (TED) associated with diabetes mellitus (DM) presents unique challenges. DM is a risk factor for TED. Standard management of TED with glucocorticoids (GC), orbital radiation, or teprotumumab can cause adverse events in poor glycemic control. The authors reviewed the literature on the relationship between TED and DM and the management of co-existing diseases. METHODS The authors searched PubMed with keywords "thyroid eye disease," "diabetes mellitus," and similar terms from 2013 to 2022. The authors included relevant studies after screening the abstracts. Additional references to the selected studies were included where applicable. Data were extracted from the final articles according to the preplanned outline of the review. RESULTS The initial search yielded 279 abstracts. The final review included 93 articles. TED and DM interact at multiple levels-genetic, immunologic, cellular, nutritional, and metabolic. Both DM and thyroid dysfunction exacerbate the morbidity caused by the other. Metabolic factors also affect the inflammatory pathway for TED. Patients with DM develop TED with greater frequency and severity, necessitating interventions for vision salvage. Agents (GC, teprotumumab, or radiation) used for TED are often unsuitable for treatment with DM, especially if there is poor glycemic control or diabetic retinopathy. There were no studies on using steroid-sparing agents in TED with DM. CONCLUSION TED and DM co-exist because of multiple intersections in the pathophysiology. Challenges in the treatment include increased TED severity and risk of hyperglycemia and retinopathy. Multidisciplinary teams best undertake treatment of TED with DM.
Collapse
Affiliation(s)
- Roshmi Gupta
- Orbit, Oculoplasty and Ocular Oncology, Trustwell Hospital, Bengaluru, Karnataka, India
| | - Pramila Kalra
- Department of Endocrinology, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - Lakshmi B Ramamurthy
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Suryasnata Rath
- Ophthalmic Plastics, Orbit, and Ocular Oncology Services, Mithu Tulsi Chanrai campus, L V Prasad Eye Institute, Bhubaneswar, India
| |
Collapse
|
2
|
Muthu V, Agarwal R, Rudramurthy SM, Thangaraju D, Shevkani MR, Patel AK, Shastri PS, Tayade A, Bhandari S, Gella V, Savio J, Madan S, Hallur VK, Maturu VN, Srinivasan A, Sethuraman N, Sibia RPS, Pujari S, Mehta R, Singhal T, Saxena P, Gupta V, Nagvekar V, Prayag P, Patel D, Xess I, Savaj P, Panda N, Rajagopal GD, Parwani RS, Patel K, Deshmukh A, Vyas A, Sistla SK, Padaki PA, Ramar D, Sarkar S, Rachagulla B, Vallandaramam P, Premachandran KP, Pawar S, Gugale P, Hosamani P, Dutt SN, Nair S, Kalpakkam H, Badhwar S, Kompella KK, Singla N, Navlakhe M, Prayag A, Singh G, Dhakecha P, Chakrabarti A. Multicenter Case-Control Study of COVID-19-Associated Mucormycosis Outbreak, India. Emerg Infect Dis 2023; 29:8-19. [PMID: 36573628 PMCID: PMC9796192 DOI: 10.3201/eid2901.220926] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We found inappropriate glucocorticoid therapy and zinc supplementation were significantly associated with these illnesses. We performed a case–control study across 25 hospitals in India for the period of January–June 2021 to evaluate the reasons for an COVID-19–associated mucormycosis (CAM) outbreak. We investigated whether COVID-19 treatment practices (glucocorticoids, zinc, tocilizumab, and others) were associated with CAM. We included 1,733 cases of CAM and 3,911 age-matched COVID-19 controls. We found cumulative glucocorticoid dose (odds ratio [OR] 1.006, 95% CI 1.004–1.007) and zinc supplementation (OR 2.76, 95% CI 2.24–3.40), along with elevated C-reactive protein (OR 1.004, 95% CI 1.002–1.006), host factors (renal transplantation [OR 7.58, 95% CI 3.31–17.40], diabetes mellitus [OR 6.72, 95% CI 5.45–8.28], diabetic ketoacidosis during COVID-19 [OR 4.41, 95% CI 2.03–9.60]), and rural residence (OR 2.88, 95% CI 2.12–3.79), significantly associated with CAM. Mortality rate at 12 weeks was 32.2% (473/1,471). We emphasize the judicious use of COVID-19 therapies and optimal glycemic control to prevent CAM.
Collapse
|
3
|
Kathirvel S, Muthu V, Rudramurthy SM, Kaur H, Chakrabarti A, Agarwal R. Could cattle dung burning have contributed to the epidemic of COVID-19-associated mucormycosis in India? Results of an experimental aero-mycological study. Mycoses 2022; 65:1024-1029. [PMID: 35726395 PMCID: PMC9350001 DOI: 10.1111/myc.13487] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/11/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
Background Several hypotheses have been proposed for explaining the outbreak of coronavirus disease 2019 (COVID‐19)‐associated mucormycosis in India, including the burning of cattle dung cakes, though no study has yet been conducted to support this claim. Methods We conducted an aero‐mycological study to evaluate whether Mucorales in the air increased during or after burning cattle dung cakes. We further compared the growth of Mucorales in the indoor air samples from houses with and without cattle. We also cultured fresh and dried cattle dung and soil samples for Mucorales. Results We noted no significant difference in the proportion of air samples growing Mucorales during (4/22 [18.2%]) and after (3/2 [13.6%]) cattle dung burning than that collected immediately before (4/22 [18.2%]). Mucorales were isolated in 15.4% of the indoor air samples obtained from different houses (both rural and urban); the proportion of samples growing Mucorales was not significantly different in households with and without cattle. We also observed growth of Mucorales in 6 of the 8 [75%] fresh and 3 of the 6 [50%] dried dung samples. The most common Mucorales isolated from soil and dung samples was Lichtheimia corymbifera, while Rhizopus arrhizus was the most common species isolated from indoor air samples. Conclusions We found no significant increase in the proportion of air samples growing Mucorales during or after burning cattle dung cake than that before. It seems unlikely that cattle dung burning contributes to the occurrence of mucormycosis.
Collapse
Affiliation(s)
- Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, Postgraduate institute of medical education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate institute of medical education and Research, Chandigarh, India
| | | | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate institute of medical education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate institute of medical education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate institute of medical education and Research, Chandigarh, India
| |
Collapse
|
4
|
Jayagayathri R, Mohanty P, Yadalla D, Bakthavatchalam J, Rangarajan V, Maneksha V, Tanwar M, Venkatesh R, Jayashree S. Knowledge, attitude, and practice toward mucormycosis among patients presenting to six tertiary eye care hospitals in South India - A multicentric online questionnaire-based survey. Indian J Ophthalmol 2022; 70:2158-2162. [PMID: 35648003 PMCID: PMC9359275 DOI: 10.4103/ijo.ijo_103_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To study the awareness on mucormycosis among outpatients who visited six tertiary eye care hospitals at Madurai, Pondicherry, Coimbatore, Tirunelveli, Chennai, and Tirupati. Methods: This was a telephone-based survey conducted using questionnaires consisting of 38 questions in five sections from July 5 to 25, 2021. Patients visiting the eye hospitals for an examination were contacted over their phones and responses were directly entered onto the Google forms platform. Results: A total of 4573 participants were included in the study. Among all participants, a cumulative 83% of participants had some knowledge of mucormycosis. More than 80% of them reported that their prime source of information was through mass communication like television or radio. Around 34.8% of the respondents were aware that it can occur after treatment for coronavirus disease 2019 (COVID-19) infection, only half of them (54.3%) knew that systemic steroids were the main risk factor. The knowledge scores were higher for participants who were diabetics (n = 1235) or had been affected by COVID-19 earlier (n = 456) or whose friends had mucormycosis earlier (n = 312). Knowledge, attitude, and practice (KAP) scores of nonprofessional health-care workers (n = 103) were much better compared to patients. Conclusion: Such KAP studies give us an idea of the impact of the measures taken for educating the public. In this study, a cumulative 83% of participants had some knowledge of mucormycosis and 86% knew that this was an emergency. More than 50% of the participants were not aware that diabetes is a risk factor for mucormycosis.
Collapse
Affiliation(s)
| | - Preeti Mohanty
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Tirupati, Andhra Pradesh, India
| | - Dayakar Yadalla
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Pondicherry, India
| | | | - Viji Rangarajan
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Velu Maneksha
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Meghana Tanwar
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Rengaraj Venkatesh
- Chief Medical Officer, Department of Glaucoma, Aravind Eye Hospital, Pondicherry, India
| | | |
Collapse
|