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Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients

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dc.contributor.author Halperin, Anthony
dc.contributor.author Pajuelo, Monica
dc.contributor.author Tornheim, Jeffrey A.
dc.contributor.author Vu, Nancy
dc.contributor.author Carnero, Andres M.
dc.contributor.author Galdos-Cardenas, Gerson
dc.contributor.author Ferrufino, Lisbeth
dc.contributor.author Camacho, Marilyn
dc.contributor.author Justiniano, Juan
dc.contributor.author Colanzi, Rony
dc.contributor.author Bowman, Natalie M.
dc.contributor.author Morris, Tiffany
dc.contributor.author MacDougall, Hamish
dc.contributor.author Bern, Caryn
dc.contributor.author Moore, Steven T.
dc.contributor.author Gilman, Robert H.
dc.date.accessioned 2019-02-06T14:45:34Z
dc.date.available 2019-02-06T14:45:34Z
dc.date.issued 2016
dc.identifier.uri https://hdl.handle.net/20.500.12866/5078
dc.description.abstract Autonomic dysfunction is common in Chagas disease and diabetes. Patients with either condition complicated by cardiac autonomic dysfunction face increased mortality, but no clinical predictors of autonomic dysfunction exist. Pupillary light reflexes (PLRs) may identify such patients early, allowing for intensified treatment. To evaluate the significance of PLRs, adults were recruited from the outpatient endocrine, cardiology, and surgical clinics at a Bolivian teaching hospital. After testing for Chagas disease and diabetes, participants completed conventional autonomic testing (CAT) evaluating their cardiovascular responses to Valsalva, deep breathing, and orthostatic changes. PLRs were measured using specially designed goggles, then CAT and PLRs were compared as measures of autonomic dysfunction. This study analyzed 163 adults, including 96 with Chagas disease, 35 patients with diabetes, and 32 controls. PLRs were not significantly different between Chagas disease patients and controls. Patients with diabetes had longer latency to onset of pupil constriction, slower maximum constriction velocities, and smaller orthostatic ratios than nonpatients with diabetes. PLRs correlated poorly with CAT results. A PLR-based clinical risk score demonstrated a 2.27-fold increased likelihood of diabetes complicated by autonomic dysfunction compared with the combination of blood tests, CAT, and PLRs (sensitivity 87.9%, specificity 61.3%). PLRs represent a promising tool for evaluating subclinical neuropathy in patients with diabetes without symptomatic autonomic dysfunction. Pupillometry does not have a role in the evaluation of Chagas disease patients. en_US
dc.language.iso eng
dc.publisher American Society of Tropical Medicine and Hygiene
dc.relation.ispartof urn:issn:1476-1645
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Reflex, Pupillary en_US
dc.subject Adult en_US
dc.subject Autonomic Nervous System Diseases/diagnosis/pathology/physiopathology en_US
dc.subject Bolivia/epidemiology en_US
dc.subject Chagas Disease/complications/epidemiology/physiopathology en_US
dc.subject Diabetes Mellitus/physiopathology en_US
dc.subject Diabetic Retinopathy/diagnosis/epidemiology/physiopathology en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Middle Aged en_US
dc.title Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.4269/ajtmh.14-0775
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.06 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.06


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