Ankle Reflexes Research Articles

Risk factors associated with overactive bladder severity in patients with type 2 diabetes.

The prevalence of overactive bladder (OAB) is known to be higher in patients with type 2 diabetes (T2DM) however there are not many studies about specific risk factors contributing to its progression among diabetes mellitus (DM) patients, so this study aimed to investigate the risk factors specific to DM that influence the progression of OAB in Syrian population. This cross-sectional study was carried out at five endocrinology centers situated in four Syrian provinces: Damascus, Aleppo, Homs, Hama, and Latakia. The study comprised patients who were diagnosed with both T2DM and OAB and had visited these centers from March 2020 and February 2024. The Arabic version of the OAB Symptom Score (OABSS) scale was used to categorize the participants based on the severity score into two groups: the mild OAB group and the moderate-severe OAB group. A logistic analysis was conducted to assess the risk factors associated with the progression of OAB among patients with diabetes. Among the 186 patients diagnosed with both DM and OAB, significant distinctions were found between the two groups concerning the severity of OAB, age, duration of diabetes, symptomatic diabetic peripheral neuropathy (DPN), and ankle reflex (p < 0.05). Furthermore, a multivariate analysis revealed that age (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.68-1.58), duration of diabetes (OR 2.14, 95% CI 1.75-3.74), and symptomatic DPN (OR 2.47, 95% CI 1.17-3.54) independently acted as risk factors for the advancement of OAB. The progression of OAB in Syrian patients with diabetes is closely associated with the severity of DM. Factors such as age, duration of diabetes, and symptomatic DPN are independent predictors of the severity of OAB. Patients who experience symptomatic DPN are at an increased risk of developing OAB.

Can clinical presentation predict radiologically confirmed cauda equina syndrome: retrospective case review of 530 cases at a tertiary emergency department.

Cauda equina syndrome (CES) may have significant individual consequences if diagnostic delays occur. Our aim was to evaluate the presenting subjective and objective features of patients with suspected CES in comparison to those with radiologically confirmed cauda equina compression (CEC).. This was a retrospective analysis of all cases presenting with suspected CES to a tertiary emergency care unit over a two-year period. CEC was defined as radiological confirmation of CEC by Consultant Musculoskeletal (MSK) Radiologist report (MSK-CEC) and by measured canal occupancy due to an acute disc extrusion (> 75%)[measured by a Senior Spinal Surgeon (SP-CEC)]. Routine data collection was compared between categories. Chi square, multivariate regression analyses and ROC analysis of multiple predictors was performed. 530 patients were included in this analysis, 60 (11.3%) had MSK-CEC, and 470 had NO- CEC. Only 43/60 (71.7%) had emergent surgery. Those with MSK-CEC and SP-CEC were statistically more likely to present with bilateral leg pain [(MSK-CEC OR 2.6, 95%CI 1.2, 5.8; p = 0.02)(SP-CEC OR 4.7, 95%CI 1.7, 12.8; p = 0.003)]; and absent bilateral ankle reflexes [(MSK-CEC OR 4.3; 95% CI 2.0, 9.6; p < 0.001)(SP CEC OR 2.5; 95%CI 1.0, 6.19; p = 0.05)] on multivariate analysis. The ROC curve analysis acceptable diagnostic utility of having SP-CEC when both are present [Area under the curve 0.72 (95%CI 0.61, 0.83); p < 0.0001]. This study suggests that in those presenting with CES symptoms, the presence of both bilateral leg pain and absent ankle reflexes pose an acceptable diagnostic tool to predict a large acute disc herniation on MRI scan..

Screening tools for diabetic foot ulcers: a narrative review.

The prevalence of diabetic foot ulcers (DFUs) is 4 to 10% among people with diabetes mellitus. DFUs are associated with increased morbidity and mortality as well as reduced quality of life and have a significant impact on overall healthcare expenditure. The main predisposing factors for DFU are diabetic neuropathy, peripheral arterial disease, and trauma. The fact that a range of tests can be used to identify patients at risk for DFU often causes confusion among practitioners regarding which screening tests should be implemented in clinical practice. Herein we sought to determine whether tests of somatic nerve function, such as pinprick sensation, thermal (cold/hot) test, ankle reflexes, vibration perception, 10-g monofilament, Ipswich touch test, neuropathy disability score, and nerve conduction studies, predict the development of DFUs. In addition, we examined whether sudomotor function screening tests, such as Neuropad, sympathetic skin response, and other tests, such as elevated plantar pressure or temperature measurements, can be used for DFU screening. If not treated properly, DFUs can have serious consequences, including amputation, early detection and treatment are vital for patient outcomes.

Risk factors associated with the severity of overactive bladder among Syrian patients with type 2 diabetes

The prevalence of overactive bladder (OAB) is known to be higher in patients with type 2 diabetes (T2DM). However, few studies have examined specific risk factors contributing to its progression among diabetes mellitus (DM) patients, so this study aimed to investigate the risk factors specific to diabetes mellitus that influence overactive bladder in the Syrian population. This cross-sectional study was conducted at four endocrinology centers in four Syrian provinces: Damascus, Aleppo, Homs, Hama, and Latakia. The study was comprised of patients who had been diagnosed with both T2DM and OAB and had visited these centers from February 2020 to January 2023. The Arabic version of the Overactive Bladder Symptom Score (OABSS) scale was used to categorize the participants based on the severity score into two groups: the mild OAB group and the moderate-severe OAB group. A logistic analysis was conducted to assess the risk factors associated with the OAB among patients with diabetes. Among the 153 patients diagnosed with both DM and OAB, significant distinctions were found between the two groups concerning the severity of overactive bladder, age, duration of diabetes, symptomatic diabetic peripheral neuropathy (DPN), and ankle reflex (P < 0.05). Furthermore, a multivariate analysis revealed that age (OR 1.48, 95% CI 0.89–2.19), duration of diabetes (OR 1.94, 95% CI 0.53–2.23), and symptomatic DPN (OR 2.74, 95% CI 1.39–4.13) independently acted as risk factors for the advancement of OAB. The severity of OAB in Syrian patients with diabetes is closely associated with the severity of DM. Factors such as age, duration of diabetes, and symptomatic DPN are independent predictors of the severity of OAB. Patients who experience symptomatic DPN are at an increased risk of developing OAB.

Elevated Biomarkers of Inflammation and Vascular Dysfunction Are Associated with Distal Sensory Polyneuropathy in People with HIV.

Distal sensory polyneuropathy (DSP) is a disabling, chronic condition in people with HIV (PWH), even those with viral suppression of antiretroviral therapy (ART), and with a wide range of complications, such as reduced quality of life. Previous studies demonstrated that DSP is associated with inflammatory cytokines in PWH. Adhesion molecules, essential for normal vascular function, are perturbed in HIV and other conditions linked to DSP, but the link between adhesion molecules and DSP in PWH is unknown. This study aimed to determine whether DSP signs and symptoms were associated with a panel of plasma biomarkers of inflammation (d-dimer, sTNFRII, MCP-1, IL-6, IL-8, IP-10, sCD14) and vascular I integrity (ICAM-1, VCAM-1, uPAR, MMP-2, VEGF, uPAR, TIMP-1, TIMP-2) and differed between PWH and people without HIV (PWoH). A cross-sectional study was conducted among 143 participants (69 PWH and 74 PWoH) assessed by studies at the UC San Diego HIV Neurobehavioral Research Program. DSP signs and symptoms were clinically assessed for all participants. DSP was defined as two or more DSP signs: bilateral symmetrically reduced distal vibration, sharp sensation, and ankle reflexes. Participant-reported symptoms were neuropathic pain, paresthesias, and loss of sensation. Factor analyses reduced the dimensionality of the 15 biomarkers among all participants, yielding six factors. Logistic regression was used to assess the associations between biomarkers and DSP signs and symptoms, controlling for relevant demographic and clinical covariates. The 143 participants were 48.3% PWH, 47 (32.9%) women, and 47 (33.6%) Hispanics, with a mean age of 44.3 ± 12.9 years. Among PWH, the median (IQR) nadir and current CD4+ T-cells were 300 (178-448) and 643 (502-839), respectively. Participants with DSP were older but had similar distributions of gender and ethnicity to those without DSP. Multiple logistic regression showed that Factor 2 (sTNFRII and VCAM-1) and Factor 4 (MMP-2) were independently associated with DSP signs in both PWH and PWoH (OR [95% CI]: 5.45 [1.42-21.00], and 15.16 [1.07-215.22]), respectively. These findings suggest that inflammation and vascular integrity alterations may contribute to DSP pathogenesis in PWH, but not PWoH, possibly through endothelial dysfunction and axonal degeneration.

Severity of Neuropathy-Related Disability and Associated Factors of Diabetic Peripheral Neuropathy in a Tertiary Healthcare Center: A Comparative Cross-Sectional Study.

The widespread presence of diabetic peripheral neuropathy (DN) and its related variables among diagnosed diabetes mellitus (DM) patients in Kerala lacks sufficient evidence. The objective of this study was to evaluate the frequency of DN and its related risk variables among those with DM who were receiving care at a tertiary health institution in Kerala. This study was conducted in a tertiary health center in Kerala using a cross-sectional design. The diagnosis of diabetes was established by assessing the glycated hemoglobin A1c (HbA1c) level and the fasting blood glucose (FBG) level. A validated survey questionnaire was employed to gather demographic data as well as the medical history of DM and associated ailments. A thorough physical examination, BMI, and blood pressure were recorded. Dermatological, musculoskeletal, neurological, and vascular assessments were conducted. The subjects were assessed for neuropathy using a neuropathy disability score (NDS). Consequently, those who met the criteria for DM were classified into two groups: those with neuropathy and those without neuropathy. All research participants underwent laboratory examinations such as blood lipid profiles, HbA1c, and vitamin B12 complex concentrations. The study included 200 DM patients; 120 men and 80 women. Study participants were 40-70 years old, with a median age of 53. The prevalence of DN significantly increased with age (p<0.001). The longer a patient had DM, the higher the prevalence of DN, and this variance in percentage was statistically significant (p<0.009) with an OR (odds ratio) of 9.246. A statistically significant 81 (40.5%) of participants graduated, compared to 119 (59.5%) with only higher secondary education or less (OR = 2.042; p = 0.014). Approximately 107 (53.5%) of individuals earned an income under two lakhs, and this disparity was deemed statistically significant (p = 0.003) with an OR of 2.357. In the group of individuals being studied, 53 (26.5%) of them experienced a decrease in pressure sensation, 47 (23.5%) had a decrease or absence of vibration perception, 48 (24%) had an absence or decreased pinprick response, and 46 (23%) had an absent ankle reflex. The study found that the most commonly reported symptoms were tingling (n = 44; 22%), numbness (n = 42; 21%), burning (n = 37; 18.5%), pricking (n = 29; 14.5%), and pain (n = 27; 13.5%). A strong association was found between DN and glycemic status, namely, FBG levels exceeding 140 mg/dL(OR = 4.511, p < 0.001) and HbA1c levels exceeding 6.5% (OR = 3.87, p < 0.001). The prevalence of abnormal vitamin B12 levels in individuals with DN was 63% (p = 0.19), indicating that the finding was not statistically significant. Within the group of individuals with DN being studied, 22% exhibited mild neuropathy, 34% displayed moderate neuropathy, and 44% had severe neuropathy. The DN individuals had significantly reduced ankle dorsiflexion in cases of severe NDS scores compared to those with mild to moderate NDS scores (p = 0.009). During the binary logistic regression analysis, it was shown that the duration of DM (OR = 1.73; p = 0.038) and FBG levels (OR = 2.87; p = 0.018) were determined as predictors for DN. The findings of this study reveal that the duration of diabetes, age, literacy level, income, HbA1c, and FBG were substantially related to a higher likelihood of DN among diabetic patients.

Ankle reflex and neurological symptom score: a primary level screening method for diabetic peripheral neuropathy.

Herein, we aimed to develop an easily available and efficient screening method for diabetic peripheral neuropathy (DPN) suitable for primary care settings, emphasizing simplicity, speed, and accuracy. Nerve conduction studies were conducted on 214 patients with diabetes, encompassing the outcomes of five distinct assessments: diabetic neuropathy symptom (DNS), vibration perception threshold (VPT), and nerve screening. The diagnostic accuracy of the VPT and nerve screening was evaluated by comparing them with that of the nerve conduction study. To assess diagnostic efficacy, various combinations were examined, including DNS combined with VPT, pain, temperature, touch, and ankle reflex. The diagnostic performance of DNS was superior to that of the five neurological screening items and VPT, with sensitivity, specificity, and accuracy of 0.68, 0.81, and 0.73, respectively. Among the two combined methods, "DNS + ankle reflex" was identified as having the highest diagnostic value, with an area under the curve, a sensitivity, a specificity, and an accuracy of 0.81, 0.89, 0.70, and 0.80, respectively. Furthermore, a combination of "DNS + ankle reflex + touch + pain + VPT" achieved the best performance among the five combinations, with an area under the curve, sensitivity, specificity, and accuracy of 0.85, 0.93, 0.68, and 0.81, respectively. The combination of DNS, ankle reflex, touch, pain, and VPT methods showed the highest diagnostic value for DPN. However, considering factors including accuracy, time, and economic cost, we recommend using a simpler combination of DNS and ankle reflex for large-scale screening of patients with DPN.

Rosuvastatin-induced myopathy in a case of undiagnosed Vitamin D deficiency

For patients who qualify, statins are among the most frequently prescribed drugs for the primary and secondary prevention of cardiovascular disease. A wide range of clinical manifestations, from generalized muscle aches to severe necrotizing myositis, are present in statin-induced myopathy. Here, we present a case of a 49-year-old woman with Vitamin D deficiency who developed statin-induced myopathy 45 days after starting rosuvastatin. A 49-year-old female was admitted to the hospital with a history of lower back pain and bilateral lower limb pain for 7 days. Her ongoing medications include ticagrelor 90 mg BD, metoprolol 25 mg OD, nicorandil 5 mg BD, telmisartan 20 mg OD, dapagliflozin 10 mg OD, metformin 1000 mg OD, vildagliptin 100 mg OD, pantoprazole 40 mg OD, and rosuvastatin 40 mg OD, which were started 45 days back when she was diagnosed with ischemic heart disease. On neurological evaluation, muscle weakness was present in the lower extremities with proximal muscle involvement more than the distal muscle, power at the hip was 2/5, knee and ankle joint were 4/5, knee and ankle reflex were 2/5, and the plantar reflex was normal, with no upper limb involvement. Laboratory investigation on the day of admission revealed elevated creatine phosphokinase (9873.00 U/L) and serum creatinine (2.45 mg/dl). Arterial blood gas analysis revealed a high anion gap with increased lactate levels. Vitamin D levels were found to be insufficient, and serum calcium was in the low normal range. Magnetic resonance imaging of the bilateral lower limb revealed bilaterally symmetrical abnormal edematous signal in muscles of the gluteal region, extensor, adductor, and flexor compartment indicative of myopathy. Volitional testing revealed the presence of spontaneous activity, and an electromyography study revealed that the interference pattern was complete with early recruitment, similar to what is seen in inflammatory myopathy. The motor unit action potential was polyphasic with short duration and amplitude. She was diagnosed with statin-induced myopathy with acute kidney injury. In this case, initiation of rosuvastatin and Vitamin D deficiency were the only positive associated factors that were responsible for myopathy and acute kidney injury and liver injury. Despite the reported incidence of myopathy and renal toxicity by rosuvastatin in the present era, rosuvastatin holds a major market across the globe. Although the case was successfully treated by withholding rosuvastatin, it added to significant morbidity and health-care costs. Therefore, this case report not only calls for increased pharmacovigilance when prescribing rosuvastatin but also adds to the already existing safety controversies surrounding this drug.

A rare case of Guillain-Barrè syndrome with unilateral facial palsy and asymmetrical ascending weakness: a case report.

A 39-year-old male presented with pain and weakness in the right lower limb with right sided facial weakness. The cranial nerve examination revealed lower motor neuron type right facial palsy (Bell 's palsy). On rest neurological examination, he had decreased power in the right lower limb with an absent knee and ankle reflex on presentation. Later, the weakness was symmetrical in both lower limbs. Cerebrospinal fluid analysis showed albuminocytologic dissociation with no cells and an elevated protein of 203.2mg/dl. The nerve conduction study was abnormal in bilateral lower limbs suggesting severe demyelinating motor neuropathy. Intravenous Immunoglobulin was started with the dose of 25gm (0.4mg/kg) once daily for 5 days, that is, five doses. The patient started showing signs of recovery with the initial dose of immunoglobulin. The course of the disease usually recovers spontaneously and completely; however, plasma exchange and immunomodulatory therapy have shown improvement in patient with rapidly deteriorating symptoms.

VRK1 mutation associated with adult-onset spinal muscular atrophy and persistently elevated creatine kinase (P3-8.011)

<h3>Objective:</h3> NA <h3>Background:</h3> NA <h3>Design/Methods:</h3> We present a patient with persistently elevated creatinine kinase and a clinical syndrome consistent with adult-onset spinal muscular atrophy (dSMA) without pontocerebellar atrophy secondary to a vaccinia-related kinase 1 (VRK1) mutation. <h3>Results:</h3> A 46-year-old male presented for evaluation of persistently elevated creatinine kinase, leg weakness, and decreased balance for more than 5 years. He reported mild weakness mainly in the lower extremities and reduced calf size. The patient has had persistently elevated creatine kinase (CK) for the past 5 years, ranging from 580–7,000 units/L. On examination, he had bilateral high arches, calf fasciculations, and atrophy. Motor showed decreased strength in feet dorsiflexion and minimal bilateral hand interosseous weakness. Reflexes were normal except for the absent left ankle reflex. The rest of the neurologic examination was unremarkable. EMG/NCS showed reduced motor responses with diffuse neurogenic changes in the right arm and leg concerning for motor neuropathy. CK level remained elevated along with aldolase; otherwise negative myopathy labs. The neuropathy panel showed two pathogenic mutations of the VRK1 gene, variant c1072C&gt;T (p.Arg358) and c.356 A&gt;G (p.His119Arg), consistent with compound heterozygosity. <h3>Conclusions:</h3> VRK1 mutation is a rare cause of distal predominant spinal muscular atrophy. This disease is characterized by slowly progressive distal symmetric limb muscle weakness and atrophy, frequently leading to foot deformities such as pes cavus, with minimal or no sensory involvement. Mild elevations in CK can be seen in up to 50% of motor neuron disease cases. Our patient’s presentation was consistent with adult-onset spinal muscular atrophy. There was no pontocerebellar hypoplasia, which has also been described with this mutation. Creatine kinase level remained very elevated in our patient, beyond what has previously been described in the literature. Future investigation should be done to determine the significance of this, including whether there may be a myopathic component to this illness. <b>Disclosure:</b> Dr. Rodriguez-Hernandez has nothing to disclose. Dr. Carranza-Renteria has nothing to disclose. Dr. Faktorovich has a non-compensated relationship as a Board of Directors with Brother’s Brother Foundation that is relevant to AAN interests or activities.

Michigan Neuropathy Screening Instrument: A tool for diabetic peripheral neuropathy diagnosis in a rural area in Ecuador. (P13-4.001)

<h3>Objective:</h3> This study aims to evaluate the usefulness of the Michigan Neuropathy Screening Instrument in diabetic patients in a primary care center in a rural area of Ecuador. <h3>Background:</h3> Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of type 2 diabetes mellitus (T2DM). Its devastating consequences such as chronic pain, foot ulcers, and limb amputation require early detection and management to reduce complications associated with the disease. The MNSI is a screening tool for DPN that includes two assessments: Part A, a questionnaire done by the patient and Part B, the inspection and assessment of vibratory sensation and ankle reflexes provided by the physician. <h3>Design/Methods:</h3> This is an observational and cross-sectional study. We included all diabetic patients that attended to our primary care center that is located in a rural area of Jipijapa, Ecuador from January to October 2022 and that had updated blood work. Data was analyzed using SPSS v. 25. <h3>Results:</h3> Out of the 30 patients that were included in the study, 53.3% were females and 46.7% were males. The mean age of the population was 65 years. 26.7% were illiterate patients, 63.3% were low-literacy and 10% were middle-educated patients. A total of 22 patients tested positive for DPN in part B MSNI, but only 6 were positive for part A. This might be attributed to the low-literacy in our study population. The Michigan part A median score was 6 SD± 2 and the part B median score was 4.1 SD± 1.9. Patients who had DPN according to MNSI part B had a median glucose of 217 mg/dl. MNSI part B showed a positive relationship with creatinine levels (p= 0.021). <h3>Conclusions:</h3> MNSI can be used as a screening tool for DNP in limited-resourced settings where only clinical assessment is possible. <b>Disclosure:</b> Dr. Bustamante has nothing to disclose. Kiara Velez has nothing to disclose. Jorge Torres Ortiz has nothing to disclose.

Assessment of intraepidermal nerve fiber density and neurophysiological studies in patients with idiopathic polyneuropathy

Abstract Background Idiopathic polyneuropathy is an asymmetrical, length-dependent neuropathy in which neurophysiology demonstrates axonal damage involving large fibers, along with insidious onset and slow progression over 6 months, with no identified etiology in spite of thorough investigations. This study aimed to evaluate the diagnostic role of clinical, electrophysiological, and histopathological studies in patients with idiopathic polyneuropathy. Methods Case–control study included 20 patients with clinical and neurophysiological evidence of sensory or sensory–motor neuropathy with no apparent etiology after laboratory investigation were recruited from 127 patients with sensory–motor neuropathy of unknown etiology (the patients group). Twenty apparently healthy individuals, age- and sex-matched, with no neuropathy symptoms (the control group), were recruited from the Neurology Clinic of Al-Azhar University, Assuit. Results Age of onset of patients with idiopathic polyneuropathy (44–70) years, duration of illness (1–6) years, 60% had painful neuropathy, diagnostic neuropathic pain questioner (DN4 score) (5–7), abnormal pin brick (80%), abnormal vibration (90%), abnormal fine touch (75%), distal weakness (70%), and lost ankle reflex (90%). In the control group, there were substantial differences with respect to prolonged latency, diminished sympathetic skin response amplitude, and significant intraepidermal nerve fiber density reduction in skin biopsy cases. In diagnosing idiopathic polyneuropathy, the specificity and sensitivity of sympathetic skin response were (80–86)% and (81–89.5)%, respectively, whereas those of diminished intraepidermal nerve fiber density were (92.5%) and (97.5%), respectively. Conclusion The assessment of intraepidermal nerve fiber density had an important good diagnostic role in cases presented with polyneuropathy.

Relationship between serum sodium, serum potassium levels and ankle reflex grades in malnourished children

Background: Malnutrition among children is a major health issue in South East Asia presenting with stunting and wasting. Many research studies have been conducted to establish the signs, symptoms, corresponding effects of malnutrition on child health, growth and development and the current study focusses more specifically on the effects of electrolyte levels on ankle reflex grades in malnourished children.Methods: This is an observational case-control type of study conducted in two teaching hospitals in India. Cases of protein-energy malnutrition (PEM) (n=30), children with mid upper arm circumference (MUAC) lesser than 12.5 along with control group of normal healthy children (n=30), all aged between 1 and 5 years were selected. Ankle reflexes were noted using a knee hammer on three consecutive days and graded based on the NINDS reflex grading scale for cases and controls and noted against the corresponding serum sodium and serum potassium values obtained from the children.Results: A Chi square test performed and p=0.379 obtained for serum sodium and 0.026 for serum potassium for cases.Conclusions: A conclusion could be drawn that serum sodium levels and ankle reflex grades have no statistically significant relationship in cases of controls, while serum potassium levels and ankle reflex grades have statistically significant relationship in cases but not in control group indicating a plausible cause for hyporeflexia in the patients.

Pediatric spinal cord injury with radiographic abnormality: the Beijing experience

BACKGROUND CONTEXTSpinal cord injury (SCI) without radiographic abnormality (SCIWORA) is a syndrome that usually occurs in children primarily because of the unique biomechanics of the pediatric spine. We recently found that the histopathological and behavioral effects of SCI with radiographic abnormality (SCIWRA) and SCIWORA are very different from each other in animal models. Although numerous studies were conducted to understand the epidemiological and clinical characteristics of the overall pediatric SCI population and the pediatric SCIWORA population, the characteristics of the pediatric SCIWRA population and their differences from those of the SCIWORA population are poorly understood. PURPOSETo describe the epidemiology and clinical outcomes of pediatric patients with SCIWRA and their differences from those with SCIWORA. STUDY DESIGN/SETTINGRetrospective study. PATIENT SAMPLEA total of 47 pediatric SCIWRA patients. OUTCOME MEASURESEpidemiological characteristics, injury severities, functional deficits, and management and recovery outcomes. METHODSReview of all cases with SCIWRA at Beijing Children's Hospital between July 2007 and December 2019 and comparison between the present data and our previous SCIWORA data. RESULTSOf the 187 pediatric SCI patients, 47 had SCIWRA (age: 7.06 ± 3.75 years, male-to-female ratio: 3:2). Main causes of SCIWRA were fall (38%) and traffic accidents (38%). Lesions were often located at multiple levels (62%). Incubation period was 3 ± 18 hours. According to the American Spinal Injury Association impairment scale (AIS), many SCIWRA patients had incomplete impairment (AIS B, 9%; AIS C, 9%; AIS D, 32%). Specifically, many of them had abnormal upper and lower limb muscle powers (55% and 60%), upper and lower limb muscle tones (34% and 49%), sensation (38%), and knee, ankle, and abdominal reflexes (47%, 34%, and 36%). 72% of SCIWRA patients were treated with methylprednisolone, dexamethasone, or both. 81% of them showed neurological improvement before discharge. There was no association between corticosteroid therapy and neurological improvement. Moreover, functional outcomes of their upper and lower limb muscle powers were significantly associated with functional outcomes of their upper and lower limb muscle tones (p < 0.01), respectively. In comparison to the SCIWRA population, the SCIWORA population had a higher ratio of younger and female patients of sports-related thoracic injuries with long incubation period leading to lower-body deficits and complete impairment (p<0.05 or p<0.01). Despite all the differences, their neurological improvement was similar (p>0.05). CONCLUSIONSDemographic differences exist in the SCIWRA population. Corticosteroids do not appear to be effective in the different types of pediatric SCI. Limb muscle tone may be used to evaluate the functional status of limb muscle power. The epidemiological and clinical characteristics of SCIWRA and SCIWORA are very different from each other. It is important to formulate tailor-made prevention, evaluation, and management strategies for the pediatric population to optimize the SCI outcomes.

Study of ankle reflex grades in protein energy malnourished children aged between 1 and 5 years

Background: Malnutrition among children is a major health issue throughout India and South East Asia presenting with stunting and wasting. Many research studies have been conducted to establish the signs, symptoms, corresponding effects of malnutrition on child health, growth, and development. Objective: The objective of the current study is to find a difference in grading of Ankle reflex between children with Protein Energy Malnourishment (PEM) and normal healthy subjects. This will help draw a conclusive relationship between hyporeflexia and PEM. Methods: The study design is an observational case-control type of study conducted in two teaching hospitals in India. Cases of PEM (n = 30), children with Mid Upper Arm Circumference (MUAC) &lt;12.5 and weight for height Z score (WHZ) score of lesser than -2 along with control group of normal healthy children (n = 30), all aged between 1 and 5 years were selected for the study. Ankle reflexes were noted using a simple knee hammer on 3 consecutive days of cases and control group, graded based on the NINDS Reflex Grading Scale to determine any differences between cases and controls. Results: A Chi-square test was performed and a P value result of 0.002 was obtained rejecting the null hypothesis which states that there is no relation between ankle reflex grades and presence of malnutrition. Conclusion: A conclusion could be drawn where a significant association was observed between lower ankle reflex grades and cases of PEM as compared to those noted in the control group. The Achilles Tendon reflexes obtained from cases was significantly reduced. Eliciting the Deep Tendon reflexes and drawing a relation with PEM children can be used as an initial diagnosis for neurological deficits associated with PEM.

Comparison of the Diagnostic Yields of Some Methods of Screening for Diabetic Peripheral Neuropathy in North Central Nigeria

Background: Peripheral neuropathy is one of the microvascular complications of diabetes mellitus, a risk factor for diabetic foot, and a major cause of disability world wide. Several authors have variedly reported on the efficacies of the different simple and sophisticated methods used in the diagnosis of peripheral neuropathy. The aim of this study is to compare the diagnostic yields of different simple methods of screening for diabetic peripheral neuropathy.&#x0D; Methodology: This is a multi-center cross-sectional study involving 1040 participants recruited consecutively, following consent. Relevant biodata and medical history were obtained, while physical examinations including anthropometry, and blood glucose levels were done for each participant. History of paresthesia, 10g monofilament test, vibration test using 128Hz tuning fork, and ankle reflex assessment were the methods used to screen for diabetic peripheral neuropathy. Student ‘t’ test and chi square were used to compare continuous and categorical variables respectively. Significant p-value was put at less than or equal to 0.05.&#x0D; Results: The percentage of participants with positive screen for diabetic peripheral neuropathy based on the different methods include: positive neuropathic symptoms (64%), negative neuropathic symptoms (50.7%), 10g monofilament testing (31.9%), vibration sensation by tuning fork (21.8%), and ankle reflex impairment (13.1%). A total of 80.1% of the participants were screened positive for diabetic peripheral neuropathy when all the methods were used.&#x0D; Conclusion: Positive and negative neuropathic symptoms have higher diagnostic yields for diabetic peripheral neuropathy screening than 10g monofilament testing, vibration sensation using tuning fork, and ankle reflex examination. However, it is encouraged to use all available methods to screen for diabetic peripheral neuropathy, as this increases the diagnostic yield, and ensure early adoption of preventive and therapeutic strategies.

467-P: The Relationship between Diabetic Peripheral Neuropathy and Metformin Treatment in Type 2 Diabetes Mellitus

Background: Metformin is the first-line therapy for the treatment of Type 2 diabetes mellitus (T2DM) . However, the use of metformin may lead to neuropathy by affecting the absorption of vitamin B12. Our objective was to explore the association between the application of metformin and diabetic peripheral neuropathy (DPN) . Methods: The multicenter randomized cross-sectional study was conducted in 13 hospitals in Beijing from October 2015 to April 2016. T2DM Patients were divided into confirmed DPN group, suspected DPN group and non-DPN group by the five physical examinations (Ankle reflex, acupuncture pain, temperature, vibration, and pressure) . Non-parametric Mann-Whitney test was used for the comparison between non-normally distributed variables between two groups. Chi-square test was used for the comparison of categorical variables. The risk factors of DPN in T2DM Patients were assessed using logistic regression. Results: Compared with patients without metformin, patients taking metformin were more likely to suffer from DPN and suspected DPN (P &amp;lt; 0.0for both) . Similar results were obtained after stratifying the data based on age, BMI, and HbA1c. It was shown that the application of metformin was a risk factor for DPN (OR = 5.06, 95%Cl: 3.90-6.56; P &amp;lt; 0.001) and suspected DPN (OR = 3.58, 95%Cl: 2.78-4.62; P &amp;lt; 0.001) in T2DM patients after the adjustment for age, BMI and HbA1c. In addition, prolonged application of metformin, increased cumulative and single doses would also be associated with the risk of DPN (P &amp;lt; 0.0for all) . Conclusion: The application of metformin was observed relate to DPN in T2DM patients. The vitamin B12 concentration and peripheral nerve function of T2DM patients with the application of metformin should be monitored. Disclosure Q.Pan: None. J.Luo: None. L.Guo: None. Funding National Key R&amp;D Program of China (2020YFC2009006)

Longitudinal effects of one-leg standing time on neuropathy outcomes in association with glycemic control in non-elderly patients with type 2 diabetes.

Aims/IntroductionDiabetic neuropathy leads to postural instability. This study compared longitudinal changes in neuropathy outcomes relative to long‐term glycemic control in patients aged <60 years with uncontrolled type 2 diabetes with and without a short one‐leg standing time (OLST <60 s).Materials and MethodsIn this retrospective study, 58 hospitalized patients with type 2 diabetes (glycated hemoglobin [HbA1c] >7.0%; aged 17–59 years), who underwent re‐evaluation of neuropathic sensory symptoms, ankle reflexes and nerve conduction attributes, and cardiac autonomic function (R‐R interval), >1 year after discharge were divided into OLST <60 and ≥60 s groups. Patients were followed up every 2–3 months for HbA1c levels for up to 8 years. Neuropathy outcomes relative to OLST and HbA1c levels at baseline and over follow up were compared.ResultsAdditional development of sensory symptoms (one patient) and abnormal ankle reflexes (five patients) were identified during follow up, and decreased peripheral and cardiac autonomic function at both baseline and follow up, only in patients with OLST <60 s. Mean HbA1c levels were significantly higher in patients with OLST <60 s versus ≥60 s (7.8 ± 0.9% vs 7.2 ± 1.2%; P = 0.022). Better glycemic control during follow up was associated with better neuropathy outcomes only in patients with OLST ≥60 s.ConclusionNon‐elderly type 2 diabetes patients with OLST <60 s and decreased peripheral nerve function at baseline are at increased risk for intractable diabetic neuropathy. Better glycemic control alone might not improve neuropathy outcomes in these patients.

Lower limb axonal mononeuropathies as sequelae of COVID-19: a case report and review of literature

BackgroundNeurological symptoms and complications of Coronavirus disease 2019 (COVID-19) were seldom discussed in the literature initially. Neurological symptoms such as headache, dizziness, anosmia, hypogeusia, and neuralgia are, however, now being reported commonly. Mononeuropathies are rare complications of COVID-19, with most cases associated with prolonged intensive care stay.Case presentationA 61-year-old gentleman with prior history of well-controlled diabetes and hypertension was recently treated for COVID-19 pneumonia with supplemental oxygen and positive pressure ventilation. He now presented with left-sided foot weakness two weeks after recovering from the viral illness. On examination he had normal bulk and tone and a power of 4/5 in proximal and distal muscles of bilateral lower limbs except for ankle dorsiflexion on the left which was 2/5. He also had absent ankle and knee reflexes bilaterally with bilateral flexor plantar reflexes. Since the patient had no back pain and the sensory system was normal, the lesion was localized to the peripheral nerves and a Nerve Conduction Studies and Electromyography (NCS/EMG) was done. NCS/EMG showed findings suggestive of axonal mononeuropathies. Relevant workup done to identify the cause of mononeuropathy was negative including infectious and autoimmune workup. Since diabetes was well-controlled and he had no intensive care stay his findings were presumed to be associated with resolving COVID-19 infection. The patient underwent aggressive daily physical therapy and has started to show improvement in symptoms.ConclusionsComplications such as mononeuropathies should be kept in mind in patients recovering from COVID-19 infection, since timely diagnosis can improve clinical outcomes in patients.

Atypical Presentation of Systemic Lupus Erythematous with Vasculitic Polyneuropathy

A 22-year-old female patient with Systemic Lupus Erythematous (SLE) without any significant history with no comorbidities presented with complaints of acute onset pain and burning sensation in bilateral lower limbs predominantly involving soles and feet with additional history of hair loss and Malar rash. On evaluation her vitals were stable, pedal edema was present, cardiovascular, respiratory, abdominal system revealed no significant abnormality. Neurological examination revealed absent ankle reflexes bilaterally. Plantars were flexor bilaterally, altered sensation and decreased proprioception and joint sensation bilateral lower limbs. She was evaluated for above mentioned complaints and examination findings. Nerve conduction study revealed severe sensory motor polyneuropathy predominantly involving bilateral lower limbs. MRI Brain and whole spine screening were within normal limits. Autoimmune workup was positive for antinuclear antibodies, anti-dsDNA, anti-SmD1, anti-histone, anti RibPO,c-ANCA. Bilateral lower limb arteriovenous color doppler was suggestive of subcutaneous edema over ankle and foot with no DVT. According to SLICC (systemic lupus international collaborating clinic criteria) was diagnosed with SLE. Hence, this is a case of SLE with primary presentation of vasculitic polyneuropathy.