Asymptomatic Neuropathy Research Articles

A Computer-Aided Screening Solution for the Identification of Diabetic Neuropathy from Standing Balance by Leveraging Multi-Domain Features.

The early diagnosis of diabetic neuropathy (DN) is fundamental in order to enact timely therapeutic strategies for limiting disease progression. In this work, we explored the suitability of standing balance task for identifying the presence of DN. Further, we proposed two diagnosis pathways in order to succeed in distinguishing between different stages of the disease. We considered a cohort of non-neuropathic (NN), asymptomatic neuropathic (AN), and symptomatic neuropathic (SN) diabetic patients. From the center of pressure (COP), a series of features belonging to different description domains were extracted. In order to exploit the whole information retrievable from COP, a majority voting ensemble was applied to the output of classifiers trained separately on different COP components. The ensemble of kNN classifiers provided over 86% accuracy for the first diagnosis pathway, made by a 3-class classification task for distinguishing between NN, AN, and SN patients. The second pathway offered higher performances, with over 97% accuracy in identifying patients with symptomatic and asymptomatic neuropathy. Notably, in the last case, no asymptomatic patient went undetected. This work showed that properly leveraging all the information that can be mined from COP trajectory recorded during standing balance is effective for achieving reliable DN identification. This work is a step toward a clinical tool for neuropathy diagnosis, also in the early stages of the disease.

Identification of asymptomatic neuropathy in diabetic patients from static posture data

Identification of asymptomatic neuropathy in diabetic patients from static posture data

Cervical and ocular vestibular evoked myogenic potentials in patients with Diabetic Peripheral Neuropathy

BackgroundDiabetes causes impaired microarterial blood flow, demyelination and neuronal damage, which may lead to cochlear damage and vestibular malfunction. Vestibular evoked myogenic potentials (VEMP) is a simple, reproducible test. Cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) can be explored in the saccadic-spinal and utriculo-ocular pathways in regular clinical practice.ObjectiveTo evaluate possible vestibular evoked myogenic potential (VEMP) abnormalities in patients with diabetic peripheral neuropathy.Materials and methods89 patients with Type 2 Diabetes in the present study consisted of three groups: 29 patients with no peripheral neuropathy (NDPN group), 26 patients with asymptomatic neuropathy (SDPN group), 34 patients with symptomatic neuropathy (DPN group). Meanwhile, 42 healthy subjects were recruited as controls. The clinical characteristics (including gender, age, body mass index (BMI), and illness duration), as well as lipids (including triglyceride (TG), cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL)), uric acid, fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) were compared among the four groups. Four groups were assessed using two vestibular tests including oVEMP and cVEMP. Latency and amplitude parameters were analyzed from VEMP plots.ResultsThe latency of n10, p15 (oVEMP), p13, n23 (cVEMP) were significantly prolonged in the SDPN and DPN groups compared with the control and NDPN groups (p < 0.01), whereas latencies were similar in NDPN and the control groups. The amplitudes were not significantly different (p > 0.05). oVEMP latency p15 and cVEMP latency (p13, n23) were positively correlated with HbA1c, FBG, and illness duration, and oVEMP latency n10 was positively correlated with HbA1c and FBG. A nomogram, including FBG, HbA1C, HDL, TG, TC, LDL and group, was constructed to predict VEMP parameters and p13 was found to be independently associated with diabetic subgroups. Receiver operating characteristic curve (ROC) analysis showed good accuracy in predicting p13 in this nomogram. A user-friendly website has been created to facilitate the application of this prediction model ( https://fyey.shinyapps.io/VEMP_Model/ ).ConclusionPatients with diabetic peripheral neuropathy may have vestibular dysfunction. VEMP may be useful in assessing vestibular impairment in diabetic patients.

DIABETIC POLYNEUROPATHY: FOCUS ON CLINIC AND DIAGNOSTICS

The objective of our research was to describe various clinical manifestations of diabetic polyneuropathy, modern diagnostic methods to increase the level of awareness of neurologists, endocrinologists and general practitioners of family medicine. Materials and methods. Specialized medical literature, medical databases PubMed and Medscape were analyzed. Discussion. In the genesis of the acute sensory neuropathy take part sharply pronounced fluctuations of glycemia, in connection with which they can be united into a single pathogenetic whole. A rare lesion of the peripheral nervous system in diabetes is “Bruns-Garland syndrome”. In all patients at the stage of clinically asymptomatic neuropathy, on electroneuromyography are showed the signs of sensory axonal polyneuropathy, mainly of the lower extremities. Reduced heart rate variability is the earliest indicator of cardiac autonomic neuropathy.

Serum uric acid and diabetic peripheral neuropathy: a double-edged sword

Background and objectivesResearch suggests that diabetic peripheral neuropathy (DPN) is related to high serum uric acid (SUA) level, although its correlation with low SUA level has not been reported. Here, diabetic patients with hyperuricemia were excluded, and the correlation between low SUA level and DPN was explored.Subjects and methodsThis prospective observational clinical study enrolled 525 type 2 diabetes mellitus (T2DM) patients without hyperuricemia, who were divided into the diabetes with symptomatic neuropathy (150 cases), diabetes with asymptomatic neuropathy (125 cases) and diabetes with no neuropathy (250 cases) groups.ResultsThe SUA slightly decreased in subjects with asymptomatic DPN compared with those with no neuropathy and greatly decreased in subjects with symptomatic DPN compared with those without (P < 0.001). The association of the SUA with diabetic neuropathy was independent of the hyperglycemic state and other potential confounders (odds ratio 0.985 [0.981–0.988], P < 0.001). The SUA was closely correlated with the means of motor/sensory nerve amplitude and CV (all P < 0.001). The optimal cut-off point for SUA to distinguish patients with diabetic neuropathy from those without was 324 umol/L, with a sensitivity of 76.0% and a specificity of 79.2% (AUC = 0.806).ConclusionsThe low SUA level is closely associated with DPN. Future studies are warranted to clarify the relationship.

Fibrinogen function indexes are potential biomarkers of diabetic peripheral neuropathy

Background and objectivesResearch suggests that diabetic peripheral neuropathy (DPN) is related to plasma fibrinogen (Fib) concentrations, although its correlation with Fib function has not been reported. Here, the k value and angle α, reflecting the plasma Fib function, were used to analyse its correlation with DPN, and their potential as biological indicators for diagnosing DPN was explored.Subjects and methodsThis prospective observational clinical study enrolled 561 type 2 diabetes mellitus (T2DM) patients, who were divided into the diabetes with symptomatic neuropathy (161 cases), diabetes with asymptomatic neuropathy (132 cases) and diabetes with no neuropathy (268 cases) groups. Meanwhile, 160 healthy unrelated subjects were recruited as controls.ResultsFib levels increased slightly in diabetic subjects with neuropathy compared with those without. The angle α levels increased slightly in subjects with asymptomatic DPN compared with those with no neuropathy and increased greatly in subjects with symptomatic DPN compared with those without. The k value levels slightly decreased in subjects with asymptomatic DPN compared with those with no neuropathy and greatly decreased in subjects with symptomatic DPN compared with those without. The association of the k value and angle α with diabetic neuropathy was independent of the hyperglycaemic state and other potential confounders (odds ratio 0.080 [0.051–0.124], P < 0.001; odds ratio 1.131 [1.063–1.204], P < 0.001). The k value and angle α levels were closely correlated with neuropathy stage (r = − 0.686, P < 0.000; r = 0.314, P < 0.001). The optimal cut-off point for k value levels to distinguish patients with diabetic neuropathy from those without was 1.8 min, with a sensitivity of 73.7% and a specificity of 83.2% (AUC = 0.873). The optimal cut-off point for angle α levels was 60°, with a sensitivity of 41.0% and a specificity of 95.6% (AUC = 0.669).ConclusionsThe k value and angle α are closely associated with DPN. The levels of the k value and angle α may be helpful in the early diagnosis of DPN.

Electrophysiological Detection of Asymptomatic Neuropathy in Alcohol Dependence Syndrome Patients- A Cross Sectional Observational Study

Aim: To detect the prevalence of asymptomatic neuropathy using nerve conduction study among alcohol dependence syndrome patients and to investigate the existence or not of correlation between duration, quantity of alcohol consumption and neuropathy.&#x0D; Study Design: Observational cross-sectional study.&#x0D; Place and Duration of Study: Department of General Medicine and Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Pondicherry, affiliated to Sri Balaji Vidyapeeth (Deemed to be) University, India between February 2019 and August 2020.&#x0D; Methods: Alcohol dependence syndrome patients, asymptomatic for neuropathy were prospectively included and, patients who were symptomatic and had other comorbid conditions that can cause neuropathy were excluded. Patients were then submitted to nerve conduction studies. In patients who had neuropathy, duration and quantity of alcohol consumption were compared for correlation.&#x0D; Results: This study included 65 male patients who were mostly middle aged heavy drinkers of alcohol. 73.8% (n=48) had neuropathy. Our research showed longer the duration, larger the quantity of alcohol consumption, and higher the Cut-Annoyed-Guilty-Eye (CAGE score), more were the prevalence of neuropathy. This research also used Severity Of Alcohol Dependence Questionnaire (SAD-Q) scoring for screening alcohol dependence which showed patients with neuropathy were moderate drinkers. We did not find correlation with age of patients and neuropathy.&#x0D; Conclusion: This research results like correlation of prevalence of neuropathy and duration of alcohol consumption and quantity of alcohol consumption were in contrast with previous studies on alcoholic neuropathy. This research used SAD-Q scoring for dependence, future researches can throw light on usage of SAD-Q score in asymptomatic neuropathy and the correlation of neuropathy with alcohol consumption.

Clinical study on electrophysiological evaluation of asymptomatic neuropathy in alcohol dependence syndrome

Clinical study on electrophysiological evaluation of asymptomatic neuropathy in alcohol dependence syndrome

Absent monofilament sensation in a type 2 diabetic feet.

Neuropathy is a common complication which can affect up to 90% of patients with diabetes mellitus. Asymptomatic neuropathy is a common presentation. We present a case that emphasises the importance of foot screening in people with diabetes. It also highlights that patient education is key to prevent development of foot ulceration which can lead to amputations. In addition, pharmacological therapy (as per NICE guidance) can be offered for pain relief. Patients with diabetic neuropathy are at high risk of falling and sustaining fractures.

Vibration upshot of operating mechanical sewing machine: an insight into common peroneal nerve conduction study

BackgroundMost of the people associated with tailoring occupation in Nepal are still using mechanical sewing machine as an alternative of new technology for tailoring. Common peroneal nerves of both right and left legs are exposed to strenuous and chronic stress exerted by vibration and paddling of mechanical sewing machine.MethodsThe study included 30 healthy male tailors and 30 healthy male individuals. Anthropometric variables as well as cardio respiratory variables were determined for each subject. Standard Nerve Conduction Techniques using constant measured distances were applied to evaluate common peroneal nerve (motor) in both legs of each individual. Data were analyzed and compared between study and control groups using Man Whitney U test setting the significance level p ≤ 0.05.ResultsAnthropometric and cardio respiratory variables were not significantly altered between the study and control groups. The Compound muscle action potential (CMAP) latency of common peroneal nerves of both right [(11.29 ± 1.25 vs. 10.03 ± 1.37), P < 0.001] and left [(11.28 ± 1.38 vs. 10.05 ± 1.37), P < 0.01] legs was found to be significantly prolonged in study group as compared to control group. The Amp-CMAP of common peroneal nerves of both right [(4.57 ± 1.21 vs. 6.22 ± 1.72), P < 0.001] and left [(4.31 ± 1.55 vs. 6.25 ± 1.70), P < 0.001] legs was found significantly reduced in study group as compared to control group. Similarly, the motor nerve conduction velocity (MNCV) of common peroneal nerves of both right [(43.72 ± 3.25 vs. 47.49 ± 4.17), P < 0.001] and left [(42.51 ± 3.82 vs. 46.76 ± 4.51), P < 0.001] legs was also found to be significantly reduced in study group in comparison to control group.ConclusionOperating mechanical sewing machine by paddling chronically and arduously could have attributed to abnormal nerve conduction study parameters due to vibration effect of the machine on right and left common peroneal nerves. The results of present study follow the trend towards presymptomatic or asymptomatic neuropathy similar to subclinical neuropathy.

The Preferential Impairment of Pupil Constriction Stimulated by Blue Light in Patients with Type 2 Diabetes without Autonomic Neuropathy.

The main aim of the present paper is to examine whether the pupillary light reflex (PLR) mediated by intrinsically photosensitive retinal ganglion cells (ipRGCs) is impaired in type 2 diabetic patients. One hundred and three diabetic patients without diabetic autonomic neuropathy (DAN) and 42 age-matched controls underwent a series of detailed neurological examinations. The patients were stratified into three groups: stage I, no neuropathy; stage II, asymptomatic neuropathy; stage III, symptomatic but without DAN. The PLR to 470 and 635 nm light at 20 cd/m2 was recorded. Small fiber neuropathy was assessed by corneal confocal microscopy and quantifying corneal nerve fiber (CNF) morphology. The 470 nm light induced a stronger and faster PLR than did 635 nm light in all subjects. The PLR to both lights was impaired equally across all of the diabetic subgroups. The postillumination pupil response (PIPR) after 470 nm light offset at ≥1.7 sec was attenuated in diabetic patients without differences between subgroups. Receiver operating characteristic analysis revealed that the PIPR mediated by ipRGCs in patients with stage II and stage III neuropathy was different from that of the control subjects. Clinical factors, nerve conduction velocity, and CNF measures were significantly correlated with PLR parameters with 470 nm light. PLR kinetics were more impaired by stimulation with blue light than with red light in diabetic patients without DAN.

Nerve Conduction Study on Sural Nerve among Nepalese Tailors Using Mechanical Sewing Machine.

The use of new technologies and innovations are out of access for people living in a developing country like Nepal. The mechanical sewing machine is still in existence at a large scale and dominant all over the country. Tailoring is one of the major occupations adopted by skilled people with lower socioeconomic status and education level. Sural nerves of both right and left legs are exposed to strenuous and chronic stress exerted by chronic paddling of mechanical sewing machine with legs. To evaluate the influence of chronic and strenuous paddling on right and left sural nerves. The study recruited 30 healthy male tailors with median age {34(31-37.25)} years (study group), and, 30 healthy male volunteers with age {34(32-36.25)} years (control group). Anthropometric measurements (age, height, weight, BMI and length of both right and left legs) as well as cardio respiratory measurements [Systolic Blood Pressure (SBP), Dystolic Blood Pressure (DBP), Pules Rate (PR) and Respiratory Rate (RR)] were recorded for each subject. Standard nerve conduction techniques using constant measured distances were applied to evaluate sural nerve (sensory) in both legs of each individual. The differences in variables between the study and control groups were tested using Student's t-test for parametric variables and Mann-Whitney U test for nonparametric variables. A p-value of ≤ 0.05 was considered significant. Age, height, weight, body mass index and leg length were not significantly different between tailors and control groups. Cardio respiratory measurements (SBP, DBP, PR and RR) were also not significantly altered between both the groups. The sensory nerve conduction velocities (m/s) of the right {44.23(42.72-47.83) vs 50(46- 54)} and left sural nerves {45.97±5.86 vs 50.67±6.59} m/s were found significantly reduced in tailors in comparison to control group. Similarly amplitudes (μv) of right sural (20.75±5.42 vs 24.10±5.45) and left sural nerves {18.2(12.43-21.8) vs 32.0(26.5-35.25)} were significantly less in tailors in comparison to control group whereas, latencies (ms) of right sural {2.6(2.2-2.7) vs 2.0(2.0-2.250} and left sural nerve {2.4(2.07-2.72) vs 2.0(2.0-2.0)} were found significantly high in tailors as compared with control group. Operating mechanical sewing machine by paddling chronically and arduously could have attributed to abnormal nerve conduction study parameters due to vibration effect of the machine on right and left sural nerves. The results of present study follow the trend towards presymptomatic or asymptomatic neuropathy similar to subclinical neuropathy.

Sudoscan is an effective screening method for asymptomatic diabetic neuropathy in Chinese type 2 diabetes mellitus patients.

Aims/IntroductionThe aim of the present study was to use the sudomotor function test, Sudoscan, as a screening method for the evaluation of asymptomatic diabetic distal symmetric polyneuropathy in Chinese type 2 diabetes patients. As a result, more attention could be paid to those asymptomatic patients who could be easily neglected and underdiagnosed in everyday clinic.Materials and MethodsA total of 394 Chinese type 2 diabetes patients were enrolled and tested for symptoms and clinical signs of neuropathy using the Neurological Symptom Score, Neuropathy Disability Score, and vibration perception threshold. Sudoscan was carried out, and the results were collected as the measurement of the electrochemical skin conductance of both hands and feet.ResultsIn the present study, we found that the abnormal rate of Sudoscan results in patients with asymptomatic neuropathy was higher than those without neuropathy and those with symptomatic neuropathy. This study also showed that lower electrochemical skin conductance at the feet was significantly associated with increasing symptoms, Neurological Symptom Score (r = −0.124, P < 0.05), Neuropathy Disability Score (r = −0.3, P < 0.01) and vibration perception threshold value (r = −0.18, P < 0.05). Logistic analysis showed that age (odds ratio 1.042, 95% confidence interval 1.014−1.071, P < 0.05) and feet electrochemical skin conductance levels (odds ratio 0.98, 95% confidence interval 0.962–0.993, P < 0.01) were independently associated with diabetic distal symmetric polyneuropathy.ConclusionsSudoscan might be a promising tool to screen asymptomatic diabetic distal symmetric polyneuropathy in Chinese patients with type 2 diabetes mellitus.

Evaluation of peripheral nerve conduction and visual evoked potential in newly diagnosed hypothyroid females.

Background: Hypothyroidism is a common medical condition in the general population. Usually hypothyroidism has both central and peripheral nerve involvement. The neurologic manifestations occur in conjunction with the systemic features of the disease and may be noted only incidentally. The peripheral neuropathy can be assessed using the sensory motor nerve conduction studies, which is a non-invasive method. Visual Evoked Potentials (VEPs) are electrical potential differences recorded from the scalp in response to visual stimuli. Aim: To study the motor and sensory nerve conduction in the Median nerve and Visual Evoked Potential in the newly diagnosed hypothyroid females. Materials and methods: The sample size is 30. The study design is a cross sectional study. Sensorimotor nerve conduction of the Median nerve and the VEP was done using NEUROSTIM NS2 machine, in the department of Physiology, Meenakshi Medical College, Hospital and Research Institute. The statistical analysis was done by Student unpaired t' test using SPSS software 17 version. Result: There was a significant in the nerve conduction of both motor and sensory components of the cases when compared to the controls. There was statistically significant prolongation of latency P 100 wave of VEP in the study group compared to the control group. Conclusion: Both peripheral and central nervous system are affected in hypothyroidism. To conclude, electrophysiological studies can be useful in the diagnosis of asymptomatic poly neuropathy in hypothyroid patients.

Asymptomatic Neuropathy at the Elbow - A Marker for Diabetes (P3.186)

Asymptomatic Neuropathy at the Elbow - A Marker for Diabetes (P3.186)

Asymptomatic Neuropathy in Recently Diagnosed Diabetic Patients: Electrophysiological Evaluation

Aim &amp; background: As significant electrophysiological changes are found in asymptomatic neuropathy in diabetes mellitus and electrophysiological studies of nerve conduction velocity are our most sensitive tools to quantify early abnormalities, therefore, we tried to find out status of asymptomatic peripheral nerve dysfunction in recently diagnosed diabetic patients in Bangladesh perspective. Method :This study was carried out at BSMMU and BIRDEM during November 2005 and April 2006. The study included 60 subjects, 30 recently diagnosed diabetic subjects (14 male, 16 female). None had neuropathic symptoms or signs. All cases were selected randomly diagnosed by ADA criteria accepted by WHO. Thirty healthy controls with mean age comparable to that of diabetic subject were selected from the friends of the subjects and patients attending neurology outdoor of BSMMU. Result:Findings (mean±SD) were (case and control, respectively): Tibial nerve, DML 4.05±0.81 and 3.84±0.70 msec (P&gt;0.10), CMAP 16.90±5.14 and 19.49±4.73 mV (P&lt;0.05), MCV 45.43±4.55 and 48.24±4.72 m/ s (P&lt;0.05), and F latency 45.09±12.43 and 42.50±8.93 msec (P&gt;0.10); peroneal nerve, DML 4.12±1.10 and 4.03±0.67 msec (P&gt;0.50), CMAP 5.80±2.89 and 6.97±1.79 mV (P&gt;0.05), MCV 43.10±8.89 and 48.27±3.56 m/s (P&lt;0.01), and F latency 50.27±10.81 and 41.32±3.05 msec (P&lt;0.001); median nerve, DML 3.57±0.46 and 3.55±0.52 msec (P&gt;0.50), CMAP 16.33±4.24 and 17.84±3.73 mV (P&gt;0.10) and MCV 55.16±5.33 and 57.70±4.33 m/s (P&lt;0.05), and F latency 25.08±5.28 and 24.39±4.83 msec (P&gt;0.50); and ulnar nerve DML 2.57±0.33 an 3.17±0.61 msec (P&lt;0.001), CMAP 14.65±3.32 and 17.29±6.83 mV (P&gt;0.05), MCV 55.74±5.00 and 58.50±5.13 m/s (P&lt;0.05), F latency 25.09±5.35 and 25.82±3.33 msec (P&gt;0.50); sural nerve, DSL 2.46±0.68 and 3.12±0.45 msec (P&lt;0.001), SNAP 19.44±10.25 and 25.32±7.88 ìV (P&lt;0.05), SCV 49.95±10.22 and 52.46±3.96 m/s (P&gt;0.10); median nerve, DSL 2.52±0.39 and 2.77±0.49 msec (P&lt;0.05), SNAP 30.23±12.79 and 31.69±11.02 ìV (P&gt;0.50), and SCV 56.90±6.77 and 57.41±5.85 m/s (P&gt;0.50); and ulnar nerve, DSL 2.03±0.39 and 2.48±0.49 msec (P&lt;0.001), SNAP 29.30±14.36 and 30.72±10.76 ìV (P&gt;0.50), and SCV 60.96±8.38 and 57.93±7.15 m/s (P&gt;0.10). Mean (±SD) HbA1c was significantly high (P&lt;0.001) in case group (7.10±0.80%) compared to control (5.51±0.65%). Mean (±SD) SGPT showed no significant difference between case (36.10±13.02 u/L) and control (36.20±7.94 u/L). Similarly, mean (±SD) total cholesterol also showed no significant difference between case (201.57±37.56 mg/dl) and control (191.00±17.17 mg/dl).&#x0D; Conclusion: Motor nerve conduction parameters are affected more than sensory nerves and F-wave latencies are more frequently and early involved in these subjects. Abnormalities on nerve conduction was started in the feet rather than the hands.Clinical spectrum of diabetic neuropathy is variable and may be asymptomatic, but once established as polyneuropathy, it is irreversible and may finally be disabling. Early detection of diabetic neuropathy is one of the major goals in the management of diabetes since timely intervention may substantially reduce mortality and morbidity.&#x0D; Bangladesh Journal of Neuroscience 2014; Vol. 30 (1): 16-22

Evaluation of spectrum of peripheral neuropathy in predialysis patients with chronic kidney disease

Introduction: Neurological complications secondary to the uremic state, contribute largely to the morbidity and mortality in patients with renal failure. The prevalence of peripheral neuropathy remains high in advanced renal dysfunction. Materials and methods: The present cross-sectional study was conducted on 100 adult patients of chronic kidney disease between 18 and 75 years of age with serum creatinine greater than 2 mg/dL. Apart from routine examination and baseline investigations, detailed history was elicited pertaining to patients’ neurological symptoms, and scored according to the Neurological Symptom Score. Motor nerve conduction velocity was measured from right median, ulnar, peroneal, and tibial nerves. Results: It was observed that neurological symptoms increased steadily with raise in serum creatinine. The mean nerve conduction velocities (NCVs) of right median nerve, ulnar nerve, peroneal nerve, and tibial nerve were 51.34 ± 6.07, 53.04 ± 5.91, 44.72 ± 6.14, and 44.20 ± 5.17, respectively. The NCVs of all the tested nerves decreased significantly with increase in serum creatinine levels (p < 0.01): 70% of the patients had uremic polyneuropathy; 6% had asymptomatic neuropathy, 51% had symptomatic non-disabling neuropathy, while disabling neuropathy was seen in 13% of the patients. Conclusion: Our data suggests that NCV testing when complimented with meticulous neurological assessment can provide invaluable input. These tests apart from helping us detect neuropathy in advanced renal dysfunction; can also detect the disease in largely asymptomatic patients which avoids the necessity to order for detailed neurophysiological investigation

Early Diagnosis of Diabetic Neuropathy in Almadinah Almunawwarah

Abstract Objectives Diabetes mellitus (DM) is a major public health problem worldwide. The aim is to assess the early detection of impaired nerve function and the risk factors associated with the development of diabetic neuropathy. Methods It is a prospective descriptive study of age-matched 263 diabetic Saudi patients from the outpatient clinic of the Diabetic Centre in King Fahd Hospital in Almadinah Almunawwarah in Kingdom of Saudi Arabia during 2008-2009. Written informed consent was obtained from each subject after the protocol was approved by the local ethics committee. All subjects were diagnosed as diabetics using WHO criteria. We obtained detailed demographic data as age, sex, special habits, height, weight and body mass index, arterial blood pressure, type and duration of diabetes, glycosated haemoglobin (HbA1C), lipid profile, management, family history of hypertension, diabetes. Assessment of neuropathy by using the Diabetic neuropathy index and diabetic neuropathy score. Asymptomatic patients who scored less than two in clinical examination were referred to be assessed by complete neurological examination, and nerve conduction studies. Data were calculated and compared by using SPSS version 13.0. Results The type I were 39 (14.8%) and type II were 244 (85.2%) diabetic patients and the mean duration of diabetes mellitus in all diabetic patients was 13.89 ± 8.7 years. The symptomatic diabetic neuropathy patients were 165 (62.7%)s out of 263 diabetic patients and the asymptomatic were 98 (37.3%). The risk factors for neuropathy were old age, poor blood sugar control, long duration of diabetes, hyperlepidemia, Body Mass Index (BMI). There were no statistical significant differences in relation to types of diabetes mellitus. There was positive correlation which shown by the linear regression charts between the grades of nerve conduction defects in asymptomatic diabetic neuropathy patients and duration of diabetes, age, BMI and HbA1C. Conclusion The early detection of by sub-clinical nerve conduction of diabetic patients is of a major clinical interest that could lead to more intensive supervision of diabetic patients. Further studies should be performed in order to confirm these findings.

Serum VEGF increases in diabetic polyneuropathy, particularly in the neurologically active symptomatic stage

To identify the relationship between vascular endothelial growth factor (VEGF) and diabetic polyneuropathy (DPN). Two hundred and twenty diabetic patients participated, 113 with DPN and 107 without DPN. All patients were also classified according to the four stages of DPN (no neuropathy: stage 0; asymptomatic neuropathy: stage 1; symptomatic neuropathy: stage 2; disabling neuropathy: stage 3). Serum VEGF concentration was measured using an enzyme-linked immunosorbent assay (ELISA) and levels between the patients with and without DPN and also between the different stages of DPN, were compared. The mean serum VEGF level in all patients was 264.6 +/- 218.8 pg/ml. The mean serum VEGF level was higher in patients with DPN (310.1 +/- 224.3 pg/ml) than in the patients without DPN (216.5 +/- 204.0 pg/ml, P = 0.0014). Serum VEGF was higher in the 'symptomatic' stage (stage 2, 364.8 +/- 225.9 pg/ml) in comparison with the 'asymptomatic' (stage 1, 256.7 +/- 224.4 pg/ml, P = 0.015) and 'disabling' (stage 3, 180.3 +/- 109.4 pg/ml, P = 0.042) stages. The mean serum VEGF level in patients with diabetic retinopathy (261.1 +/- 210.6 pg/ml) and in patients with diabetic nephropathy (241.5 +/- 185.7 pg/ml) was not increased. The serum VEGF level is increased in patients with DPN, particularly in patients in the neurologically active 'symptomatic' stage.

Cardiac safety of adjuvant bevacizumab (B) plus dose-dense doxorubicin/cyclophosphamide (AC) followed by nanoparticle albumin-bound paclitaxel (nab-P) in patients with early stage breast cancer.

Abstract Abstract #4104 Background: Dose dense (dd) q2wk AC-paclitaxel (P) is superior to q3wk AC-P. Both regimens are associated with a &amp;lt;1% incidence of CHF. In MBC, q3wk nanoparticle albumin-bound paclitaxel (nab-P) is superior to q3wk P and bevacizumab (B) improves progression-free survival when added to P. Based on the MBC data, B may be more effective when targeting minimal residual disease in the adjuvant setting and nab-P may offer superior efficacy with reduced toxicity. However, it is uncertain whether AC plus B increases the risk of CHF. We evaluated the cardiac safety of ddAC-nab-P with concurrent B as adjuvant therapy for BC.&amp;#x2028; Methods: Based upon the accepted cardiac event (CE) rate of approximately 4% in trials with adjuvant trastuzumab, this study was designed with similar monitoring and tolerability thresholds. The primary endpoint is cardiac safety: symptomatic CHF or death from LV dysfunction. Secondary endpoints are toxicity, DFS, OS, and biomarkers for efficacy and toxicity. Eligible pts have resected HER2(-) BC and normal LVEF. B is administered concurrently (10 mg/kg IV q2wk x 8) with chemotherapy (AC at 60/600 mg/m2 q2wk x 4 then nab-P at 260 mg/m2 q2wk x 4) and continues at 15 mg/kg q3wk thereafter for a total one year of B therapy. Pegfilgrastim is administered Day 2 of each chemotherapy cycle. Radiation and endocrine therapy are administered per standard of care. MUGAs are obtained at baseline and mos 2, 6, 9 and 18. Although asymptomatic LVEF declines are not considered CEs, B may be held per protocol and long-term cardiac monitoring initiated. If 3 CEs or &amp;gt; 1 cardiac death from LV dysfunction occur, B + ddAC-nab-P will not be considered safe.&amp;#x2028; Results: The target accrual of 80 pts has been met. Median age is 47y (27-75). As of May 31, 2008, median follow-up is 14 mo (1-21) and 51 pts have completed 1y of planned therapy. No patients have developed symptomatic LV dysfunction at any point during study therapy. Sixteen pts have discontinued treatment due to toxicity: asymptomatic LVEF decline (N=3), hypertension (N=3), wound healing (N=3), headache (N=2), sensory neuropathy (N=2), pain (N=1), hypersensitivity reaction (N=1), and pneumonitis (N=1). Three pts had disease progression, and 8 pts withdrew consent.&amp;#x2028; &amp;#x2028; Conclusions: At the time of this analysis, no symptomatic LV dysfunction has been observed with B + ddAC-nab-P. Follow-up is ongoing. Correlative studies, including analysis of troponin, renin, and circulating endothelial and tumor cells, are underway. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4104.