POS0808 CHARACTERISTICS AND PROGNOSIS OF BINOCULAR DIPLOPIA IN PATIENTS WITH GIANT CELL ARTERITIS

Background

Giant cell arteritis (GCA) is a large vessel vasculitis associated with a risk of permanent ophthalmologic complications. Diplopia is an uncommon feature at GCA diagnosis and data about diplopia in GCA are scarce, especially regarding its prognosis.

Objectives

This study was designed to better characterize diplopia in newly diagnosed GCA patients.

Methods

All consecutive patients diagnosed with GCA between January 2015 and April 2021 in a French tertiary ophthalmologic center were retrospectively reviewed. GCA diagnosis relied on 1990 ACR criteria and either a positive temporal artery biopsy or high-definition MRI.

Results

Among 111 patients diagnosed with GCA in our tertiary eye-care center, 80 patients (72%) had visual signs, including 30 patients (27%) with binocular diplopia. Characteristics of patients with diplopia were similar to other GCA patients. Twenty-eight patients (93%) had cephalic symptoms (Headaches n = 25, scalp tenderness n = 14, jaw claudication n = 17) and 7 patients (23%) had associated polymyalgia rheumatica. All patients with diplopia had an elevated C-reactive protein compared with 91% of patients without diplopia (p = 0.06). Large vessel involvement was found in 4 patients (16%) with diplopia. Diplopia was attributed to cranial nerve palsy in 21/24 (88%) patients, especially third (50%) and sixth cranial nerve (48%) palsies. Median duration of diplopia before GCA diagnosis was 10 days (Inter-quartile range [IQR]: 4-19). Eleven patients (37%) were diagnosed with ocular ischemic lesions, including 5 patients (17%) with bilateral visual impairment, resulting in a severe loss of vision in 9 patients and a resolution of binocular diplopia in all these patients due to unilateral or bilateral vision loss. Acute ischemic optic neuropathy (AION) was diagnosed in 11 eyes, central retinal artery occlusion (CRAO) in 4 eyes and paracentral acute middle maculopathy in 2 eyes. Diplopia resolved spontaneously in 6 patients (20%). In the remaining 13 patients, diplopia resolved after the initiation of corticosteroids in 12 patients (92%) with a median delay of 10 days (IQR: 5-24). IV corticosteroids seemed to be associated with a quicker improvement than oral corticosteroids (6 days [IQR 4-28] vs 11 days [IQR 6-13], p = 0.81) but with a similar resolution rate of diplopia at one month (66% vs 78 %, p = 1). Two patients had visual impairment after the initiation of corticosteroids and two patients had diplopia relapse during the course of GCA.

Conclusion

Diplopia is a rare but not exceptional feature at GCA diagnosis and should raise clinician suspicion for GCA when associated with cephalic symptoms and elevated inflammatory biomarkers. We confirmed in this study that patients with diplopia were also at risk of ischemic ocular lesions, particularly AION and CRAO, with a subsequent risk of severe loss of vision. In patients without visual impairment, the prognosis of diplopia is good after initiation of treatment with a complete resolution in most patients at one month but with a potential risk of diplopia recurrence in case of GCA relapse.

Disclosure of Interests

None declared

The wide spectrum of COVID-19 neuropsychiatric complications within a multidisciplinary centre

A variety of neuropsychiatric complications has been described in association with COVID-19 infection. Large scale studies presenting a wider picture of these complications and their relative frequency are lacking. The objective of our study was to describe the spectrum of neurological and psychiatric complications in patients with COVID-19 seen in a multidisciplinary hospital centre over 6 months. We conducted a retrospective, observational study of all patients showing neurological or psychiatric symptoms in the context of COVID-19 seen in the medical and university neuroscience department of Assistance Publique Hopitaux de Paris—Sorbonne University. We collected demographic data, comorbidities, symptoms and severity of COVID-19 infection, neurological and psychiatric symptoms, neurological and psychiatric examination data and, when available, results from CSF analysis, MRI, EEG and EMG. A total of 249 COVID-19 patients with a de novo neurological or psychiatric manifestation were included in the database and 245 were included in the final analyses. One-hundred fourteen patients (47%) were admitted to the intensive care unit and 10 (4%) died. The most frequent neuropsychiatric complications diagnosed were encephalopathy (43%), critical illness polyneuropathy and myopathy (26%), isolated psychiatric disturbance (18%) and cerebrovascular disorders (16%). No patients showed CSF evidence of SARS-CoV-2. Encephalopathy was associated with older age and higher risk of death. Critical illness neuromyopathy was associated with an extended stay in the intensive care unit. The majority of these neuropsychiatric complications could be imputed to critical illness, intensive care and systemic inflammation, which contrasts with the paucity of more direct SARS-CoV-2-related complications or post-infection disorders.

Influence of migration on characteristics of type 2 diabetes in sub-Saharan Africans

AIM

This study compared the clinical and biochemical characteristics and microvascular complications found in three groups of type 2 diabetes (T2D) patients: Africans living in Africa; African immigrants living in France; and Caucasians living in France.

METHODS

Diagnosed T2D Africans living in Cameroon (n=100) were compared with 98 African migrants diagnosed with T2D after having moved to France, and a group of 199 T2D Caucasian patients living in France. All underwent clinical and biochemical evaluations, and all were assessed for microvascular complications.

RESULTS

The median duration of stay of the migrants in France was 15years before being diagnosed with diabetes. Despite similar durations of diagnosis, they were 8.9years younger at the time of diagnosis than Africans living in Cameroon (P<0.001). Caucasians and African immigrants in France had lower HbA1c values than Africans in Cameroon (P<0.001); they were also more aggressively treated for hypertension and dyslipidaemia and, therefore, had significantly lower blood pressure levels and better lipid profiles. Diabetic nephropathy and retinopathy rates were higher in Cameroon than in the two other groups. After adjusting for age, diabetes duration, HbA1c, hypertension and other covariates, only the prevalence of diabetic nephropathy (OR: 5.61, 95% CI: 2.32-13.53; P<0.0001) was higher in Cameroon compared with those living in France.

CONCLUSION

Our results suggest that Africans who emigrate to France may develop diabetes earlier than those staying in their home country. However, the latter may be a reflection of late diagnosis of diabetes. Also, the less adequate diabetes and hypertension control in the latter would explain their higher rates of nephropathy. Large-scale cohorts are now warranted to substantiate these observations.

Prevention of type 2 diabetes: are we ready?

Type 2 diabetes is the most common metabolic disease. The cost of diabetes to the individual and to society, and the pandemic prevalence makes disease prevention of extreme importance. Persons with impaired glucose tolerance, modest elevations in blood glucose that remain below levels diagnostic for diabetes, are at increased risk of progression to overt diabetes. New studies evaluate the role of lifestyle interventions including diet and exercise, and the potential role of multiple classes of pharmaceutical agents including the insulin sensitizers, biguanides and thiazolidendiones, and carbohydrase and lipase inhibitors in disease prevention of such high-risk individuals. Many of these strategies appear to be effective to delay, and perhaps prevent, the development of type 2 diabetes and thus should be considered for broader clinical application. Awareness of the extent of the problem and the potential benefits of prevention needs to be raised in both physicians and in the at high risk population.

Comparison of anti-HBe-positive and HBe-antigen-positive chronic hepatitis B in France. French Multicentre Group

Two groups of patients with HBV DNA-positive chronic active hepatitis B, from 20 French hospitals, separated according to HBe status, were prospectively subjected to a comparative analysis of various epidemiological, clinical, biochemical, serologic and histologic features. There were 61 patients with anti-HBe and 215 patients with HBeAg. At diagnosis, 25 variables were compared between the two groups. Some of the patients were followed up for 1 year. Anti-HBe chronic hepatitis B occurred with a prevalence of 22.1%. In the anti-HBe-chronic hepatitis B group, the patients were older, and more often of Southern European origin; the source of infection was more frequently unknown, hepatitis B markers were more frequently observed within the family, and the estimated duration of liver disease was longer. Serum HBV DNA levels were lower in the anti-HBe-positive group. No difference was observed in ALT levels at diagnosis and during follow up in the patients studied. Cirrhosis was more frequent in the anti-HBe-positive group. There was no difference in histological activity score between the two groups. These results suggest that anti-HBe-positive, chronic active hepatitis B is not rare in France, and that the higher occurrence of cirrhosis in this group may be related to a longer duration of the disease.