Neuropathy Complications Research Articles

Effectiveness of the Monofilament Test and Ipswich Touch Test (IpTT) in the Early Detection of Neuropathy Complications in Patients with Type 2 Diabetes Mellitus

Backgrounds: Diabetes Mellitus is a condition characterized by high levels of sugar in the blood caused by abnormal insulin production in the body, leading to metabolic disorders that can gradually damage parts or all of the body. Diabetes mellitus can cause serious complications if not properly treated or managed, including neuropathy, which is the most common complication resulting in nerve damage. Neuropathy can be detected early in several ways, including using the monofilament test and Ipswich touch test (IpTT). Purpose: To compare the effectiveness of the monofilament test and Ipswich touch test (IpTT) in the early detection of neuropathy complications in patients with type 2 diabetes mellitus. Method: This study is a quantitative quasi-experiment with a posttest-only control group design. The sample in this study consisted of 32 patients with type 2 diabetes mellitus, divided into 2 groups: 16 respondents who were treated with the monofilament test and 16 respondents who were treated with the Ipswich touch test. Due to the results of the statistical analysis indicating non-normally distributed but homogeneous data, the Mann-Whitney test was used for data analysis. Results: From the results of the tests carried out, a significance value of 0.003 < 0.05 was obtained; this suggests that the Monofilament Test and Ipswich Touch Test (IpTT) are effective in the early detection of neuropathy complications in patients with type 2 diabetes mellitus. However, between the two, the monofilament test was found to be more effective compared to the Ipswich Touch Test, with a mean result of 20.84 > 12.16. Conclusions: Both the monofilament test and Ipswich touch test (IpTT) are effective in the early detection of neuropathy complications in patients with type 2 diabetes mellitus.

The 'vulnerable nerve'; surgically acquired neuropathy in distal humeral surgery patients and the role of a tourniquet.

The complication of neuropathy is high in patients undergoing distal humerus surgery. Tourniquets (TQs) are typically used but can lead to nerve injury. We present a comparative study of a pre-intervention group (n = 38) and a post-intervention group (n = 38) undergoing distal humerus surgery between November 2020 and July 2023. The intervention included TQ discontinuation and the introduction of intravenous tranexamic acid at induction. Our analysis encompasses patient, anaesthetic, and surgical variables, as well as the rates and severity of neuropathy. Post-intervention, the rate of surgically acquired or deterioration in nerve injury improved from 15.8% (n = 6) to 2.6% (n = 1). Pre-intervention, the mean TQ duration was significantly longer for patients with post-operative neuropathy versus those without (120 min, SD = 29 vs. 88 min, SD = 38, p = 0.032). Surgery duration was not significantly longer without a TQ but was associated with a greater reduction in haemoglobin (12.7 g/L, SD = 10.9 vs. 25.2 g/L, SD = 15.5, p = 0.03). Trauma patients have a high risk of acquiring a nerve injury following elbow surgery or deterioration of a pre-surgical nerve injury, which emphasises the concept of vulnerable nerves. The cessation of using a TQ was associated with a lower nerve injury rate, with no cases of major nerve injury and no significant increase in surgical time.

Expert Perspectives on Prescription Practices and Management Strategies for Neuropathy and Vitamin B12 Deficiency in Indian Settings

Objective: To gather expert opinion regarding prescription practices and management strategies for neuropathy and vitamin B12 deficiency with a special focus on methylcobalamin among clinicians in Indian settings. Methodology: This cross-sectional study utilized a 24-item, multiple-response questionnaire to gather expert opinion from specialists in managing neuropathy and vitamin B12 deficiency. The survey encompassed questions about current prescription practices, clinical observations, preferences, and experiences related to managing neuropathy and vitamin B12 deficiency in patients in routine settings. Results: The survey included 81 experts, with more than half (62.96%) of clinicians identifying diabetes as a significant confounding factor for neuropathy in patients. As indicated by 46% and 44% of the clinicians, an appropriate diet for nutrition and maintaining glycemic levels helps to overcome the progression of neuropathy. A significant proportion of experts (60.49%) reported that 26% to 50% of patients with neuropathy have vitamin B12 deficiency. Additionally, 73% of clinicians noted that diabetes mellitus is a common co-morbid condition with vitamin B12 deficiency. In patients with neuropathy complications, 74% of clinicians preferred benfotiamine alongside vitamin B12. As stated by 44% of clinicians, besides those patients with neuropathy, elderly patients are also recommended with methylcobalamin 1500 mcg. About 43% of clinicians suggested a 12-week duration for prescribing a combination of benfotiamine and methylcobalamin for patients with neuropathy. Additionally, more than half (54.32%) of clinicians favored prescribing a combination of methylcobalamin 1500 mcg, pregabalin 75 mg, and nortriptyline 10 mg tablets to patients with chronic neuropathic pain. Conclusion: The survey highlights diabetes as a significant factor in neuropathy management, emphasizing the importance of nutrition and glycemic control. A high prevalence of vitamin B12 deficiency is noted among diabetic patients with neuropathy, leading to recommendations for benfotiamine and methylcobalamin supplementation. Additionally, the use of combination therapy for chronic neuropathic pain demonstrates a comprehensive approach to improving patient outcomes.

The Relationship Between the Duration of Diabetes Mellitus and Diabetic Neuropathy in the Internal Medicine Polyclinic of Linggajati General Hospital

Based on data by IDF (International Diabetic Federation), Indonesia has been the 5th country in the world as the biggest diabetes mellitus with the prevalence approximate 9.1 billion people and increasing every year, tha the burden of the country. Diabetic neuropathy is the common complication which presents in diabetic patients, researchers suggest fifty percent of patients with diabetes will get the diabetic neuropathy complication. This study aimed to know the relationship between duration of Diabetes Mellitus Disease and Diabetic Neuropathy also clinical manifestations in Internal Medicine Policlinic Linggajati General Hospital in January to May 2020 period. Sampling technique is consecutive sampling with Inclusion Criteria including identity, gender, age, symptoms and DM duration, statistical test using Chi Square in SPSS 16.0. There is a significant relationship between duration of Diabetes Mellitus and Diabetic Neuropathy (p value = 0.02 ) . There is a relationship between duration of Diabetes Mellitus and Diabetic neuropathy and the clinical features are woman most gender, most age range is 50-60 years old, most DM duration is 5-10 years, and most symptomps is Numbness.

Charcot Foot: An Update on Diagnosis, Treatment, and Areas of Uncertainty.

Charcot neuroosteoarthropathy (CN) is considered a rare complication of diabetic neuropathy. Due to its insidious mode of presentation, CN may be difficult to diagnose timely and a high index of suspicion is required from both, the diabetic patient (especially those with neuropathy) and their physicians for the early diagnosis and treatment to prevent major complications. We planned a narrative review and searched MEDLINE database to identify evidence regarding CN incidence, treatment options, and recent guidelines. As practitioners do not commonly treat CN, a characteristic clinical case is also presented. The available evidence for diagnosis and treatment remains of low quality. On the one hand, there is an urgent need for action to increase awareness of the disease in both practitioners and people with diabetes. On the other hand, prospective nationwide registries of patients with diabetic neuropathy will help clarify the prognostic factors that may predispose to this complication, and more randomized clinical trials are needed to identify whether medical treatment may improve CN outcomes. For the time being, offloading of the foot to stop the perpetuation of trauma, and inflammation, and importantly to arrest the progression to a deformed nonfunctional foot is the cornerstone of medical therapy of CN. Multidisciplinary assessment between diabetologists and radiologists is fundamental for prompt diagnosis. To avoid potentially deleterious delays in diagnosis and treatment, every physician should bear in mind that every patient with diabetic neuropathy presenting with a warm swollen foot should be treated as having CN until proven otherwise.

The Effect of Intra-abdominal Pressure on Heart Rate Variability and Hemodynamics During Laparoscopic Cholecystectomy: A Prospective Observational Study.

Introduction This study aimed to evaluate hemodynamic changes using heart rate variability (HRV) measurements in diabetic and nondiabetic patients who will undergo laparoscopic cholecystectomy and to provide our preoperative measurements to guide us for better perioperative anesthesia management. Materials and methods The study included 143 patients aged 40 years and older who would undergo elective laparoscopic surgery, did not have any comorbidities other than diabetes mellitus (DM) type II, and were in theAmerican Society of Anesthesiologists(ASA) class I-III risk group. Patients were divided into two groups: the control group (n = 77) and the DM group (n = 66). The preoperativeglycated hemoglobin (HbA1C) level was measured. Peripheral oxygen saturation (SpO2) and hemodynamic parameters such as systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and HRV parameters were measured preoperatively, perioperatively, and postoperatively. Intra-abdominal pressure (IAP) was administered at 10-12 mmHg. Results Even though SAP, DAP, MAP, and HR decreased with induction, they increased with insufflation, and an overall decrease was seen at the postoperative 24th hour for all parameters. When the groups were evaluated, no difference was observed except that the DAP was significantly lower in the DM group (p = 0.029) at insufflation and the HR was higher in the DM group at induction, and the difference was significant (p = 0.001). Preoperative HRV parameters were significantly lower in the DM group. According to the HRV parameters, although a decrease was observed after induction and insufflation, conversely, an increase was observed postoperatively. When the postoperative and preoperative values were compared, the standard deviation of the NN (R-R) intervals (SDNN), SDNN index, high frequency (HF), low frequency (LF), and LF/HF parameters were found to be significantly lower in the DM group than in the control group. Conclusion Diabetic patients are more sensitive to increased intra-abdominal pressure (IAP) in laparoscopic surgery, and the effects on cardiac autonomic functions can be determined by HRV measurements without clinically reflecting on hemodynamic data. Additionally, in diabetic patients with preoperative LF and/or HF values less than 100, we believe that careful follow-up in terms of autonomic neuropathy complications and anesthesia management should be done more meticulously in these patients.

Association between ABO-Rh Blood Groups and Type-2 Diabetes Mellitus in Aden, Yemen, 2022

Introduction: Ongoing research is examining the possible role of blood groups in the etiopathogenesis of various medical conditions including type-2 diabetes mellitus (T2DM). The purpose of this research is to identify association of ABO and Rh blood group in patients with T2DM in the Diabetic Center Aden, Yemen, 2022. Methods: A cross-sectional study was conducted in the National Blood Transfusion and Research Center (N.B.T.R.C), Aden between May- September 2022. A total of 226 blood samples were collected from type -2 diabetic patients aged ≥ 18 years in the Diabetic Center, Aden, Yemen. Results: There most common blood group was blood group O (+) followed by A (+) and the least common was blood group AB(-). No association was found between ABO and Rh blood group with either the sex or family history in type-2 diabetic Patients. The most frequent complication observed in the different groups is the neuropathy complications (46.8%) followed by retinopathy complications (40.7%) and finally nephropathy complications (12.5%). Conclusion: No significant association in T2DM patients between ABO – Rh with sex or family history and the most frequent microvascular complication is neuropathy.

Long Time Suffering Influences The Occurrence of Diabetic Neuropathy

Diabetic neuropathy is the most common complication in diabetes mellitus sufferers. One of the factors that influence the occurrence of neuropathy complications is long-suffering because neuropathy occurs due to microvascular damage caused by the development of chronic disease. The aim of this study was to determine the relationship between long suffering from diabetes mellitus and the incidence of diabetic neuropathy. This type of research is a descriptive correlation with a cross-sectional approach. The population in this study were all type 2 diabetes mellitus patients who visited the internal medicine polyclinic at Indramayu District Hospital. The number of samples used was 64 respondents taken using accidental sampling. Data was taken using an observation sheet. Meanwhile, data analysis used the Chi-square test. The result show that a total of 32 (50.0%) respondents had suffered from DM for ≥ 54 months (4.5 years), and 34 (53.1%) respondents had experienced neuropathy (Score 1-3). The results of the further analysis showed that P-value = 0.000 (α = 0.05; OR, namely 69.6), which means that there is a relationship between long suffering from type 2 diabetes mellitus and the incidence of diabetic neuropathy. In conclusion, long-suffering from the disease is related to the incidence of diabetic neuropathy. Suggestions are directed to nurses to prevent the occurrence of diabetic neuropathy, especially in patients who have suffered from the disease for a long time by carrying out activities that can increase blood flow to the periphery, such as diabetic foot exercises.

USE OF HONEY FOR THE WOUND-HEALING PROCESS OF DIABETES MELLITUS

Diabetes Mellitus is an increase in blood sugar levels in the blood or hyperglycemia. In this condition, there are abnormalities in carbohydrate, fat and protein metabolism caused by decreased insulin secretion or decreased insulin sensitivity or both. It causes chronic complications of microvascular, macrovascular, and neuropathy. This literature review aims to find out more about the use of honey for the wound-healing process in Diabetes Mellitus. The literature search method used the Google Scholar database, and Hurzing Publish or Perish (2017-2023) using the keywords "Honey for Wound-Healing" AND "Diabetes Mellitus." There were 3 journals that met the specified inclusion criteria. The results of the literature analysis were published in 2017, 2019, and 2022, and the research design used was quasi-experimental. The sampling techniques used were purposive sampling, accidental sampling, and consecutive sampling. The research instrument used was an observation sheet. The data analysis used by the majority (66%) was the Independent T Test analysis test. The results of a review of all journals state that there is a significant effect of using honey in wound care on the wound healing process, growth of granulation tissue, reduction of exudate, wound depth, necrotic tissue, wound size, and signs of infection in the wound. Health workers can apply/apply the use of honey in wound care in Diabetes Mellitus patients.

Effectiveness of physiotherapy interventions in alleviating symptoms and complications of diabetic peripheral neuropathy: A review of evidence

This review presents a comprehensive analysis of physiotherapy interventions for Diabetic Peripheral Neuropathy (DPN), summarizing key findings derived from an examination of approximately 654 studies, including randomized controlled trials, systematic reviews, meta-analyses, conducted up to September 2021. Ultimately, 19 studies met the inclusion and exclusion criteria. The findings affirm the effectiveness of physiotherapy interventions in enhancing the quality of life for individuals with DPN. Notable discoveries encompass the positive impact of various interventions, such as aerobic and resistance exercises, electrical stimulation modalities (e.g., transcutaneous electrical nerve stimulation, percutaneous electrical nerve stimulation, and functional electrical stimulation), as well as manual therapies (e.g., massage and joint mobilization). These interventions have demonstrated their ability to reduce pain, enhance balance, and improve sensory function. While acknowledging certain limitations, this review underscores the potential of evidence-based physiotherapy interventions to optimize DPN management and enhance patient outcomes.

Secondary complications of vestibular neuropathy.

Vestibular neuropathy represents the third most common cause of peripheral vestibular disorders. The clinical picture of the disease is characterized by acute vertigo with vegetative accompaniment. Atypical course is monophasic with the resolution of symptoms within afew days to complete adjustment. In some patients, secondary complications may occur, which we define into three groups: organic, cognitive, and functional. The occurrence of complications and their persistence is often an overlooked issue, which does not receive sufficient attention and can lead to asignificant deterioration in quality of life. Therefore, the management of these patients requires acomprehensive approach and interdisciplinary cooperation between neurologists, physiotherapists, psychologists, and psychiatrists. In the following text, the authors attempt to elucidate this issue further (Fig. 1, Ref. 49). Keywords: vestibular neuropathy, secondary complications, vertigo, acute vestibular syndrome.

The Effects of Resveratrol Supplementation on the Quality of Life of Diabetic Patients with Neuropathy: Small Randomized Clinical Trial

The diabetic neuropathy complication exerts a considerable decline in the level of patient’s well-being. The main approaches to hamper the progression of diabetic complications and improve patient’s life quality are controlling the glycemic levels and amelioration of the hyperglycemia-induced neuroinflammation, oxidative stress and pain. Supplementation of appropriate anti-inflammatory and anti-oxidants such as resveratrol may therefore be effective in the management of diabetic complications. The aim of this trial was to assess resveratrol’s impact on improving life quality of patients with the neuropathic complication of diabetes. Sixty-one patients with diabetic neuropathy were recruited in this double-blinded placebo-controlled trial. Patients were randomized into the resveratrol (n=31) group; who received a 500mg resveratrol capsule once daily concomitantly with the conventional hypoglycemic agents for three months, and the placebo (n=30) group. From each group 25 patients completed the study. The quality of life (QoL) of the patients was estimated utilizing RAND 36-item survey questionnaire. Fasting blood glucose levels were analyzed at the baseline and on the last day of the 3rd month. There was a significant decrement (p< 0.001) in the fasting serum glucose level of the patients supplemented with resveratrol at the end of the 3rd month, in comparison with the patient using the placebo. There was also a significant improvement in patient’s severity of pain (p<0.001) as shown in the bodily pain score of the RAND 36 scale and a remarkable (p < 0.05) improvement in physical functioning, physical health, social functioning, emotional well-being, energy/fatigue, and health change subscales of the questionnaire. The study concluded that resveratrol is the polyphenol that has a positive effect on reducing pain associated with diabetic neuropathy and improving the overall QoL of the patient.

Vitamin B12 Deficiency in Type 2 Diabetes Patients on Metformin

Type 2 Diabetes mellitus is a chronic metabolic disorder with complications of microangiopathies, macroangiopathies, neuropathy and nephropathy. Metformin is often the first line treatment in type 2 diabetes. There is evidence of a higher prevalence of vitamin B12 deficiency observed among patients on metformin. It is believed that Metformin may cause vitamin B12 malabsorption which aggravates neuropathy and anaemia. Methods A cross-sectional study was designed with randomly selected type 2 diabetes patients attending a tertiary diabetes clinic in Southern India, recruited over a period of 3 months, divided in 2 groups (control and study groups) based on their use of metformin. They were assessed for serum B12, Folic acid levels and mean corpuscular volume. Clinical manifestations of neuropathy, anaemia and vitamin B12 deficiency were documented on clinical examination. Results There were 100 patients recruited, showing those on metformin had a higher prevalence of vitamin B12 deficiency (58.3% vs 33.3%, p<0.05), however, folic acid deficiency was lower (16.7% vs 37.5%, p<0.05). Conclusion Patients with type 2 diabetes on metformin required protocols for monitoring and replacement of vitamin B12 as necessary, to prevent onset of neuropathy.

The Relationship between Muscle Ultrasound Parameters and Diabetic Peripheral Neuropathy among Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study.

Muscle dysfunction is an early complication of diabetic peripheral neuropathy (DPN). As a convenient and low-cost tool, muscle ultrasound has been used to assess muscle quality and muscle mass. However, the relationship between different muscle ultrasound parameters and DPN is unclear. This study was designed to investigate the relationship between ultrasound parameters of different muscles and DPN among patients with type 2 diabetes mellitus, including the rectus femoris (RF), tibialis anterior (TA), and medial head of gastrocnemius (MG). The research enrolled 90 patients with type 2 diabetes mellitus (T2DM). All images were attained from both sides. Muscle measurements contained muscle thickness (MT), cross-sectional area (CSA), echo intensity (EI), and corrected EI. The binary logistic regression and multiple linear regression were used to investigate the association between muscle ultrasound parameters and DPN or vibration perception threshold (VPT). EI, corrected EI, MT of MG, and EI of TA were associated with DPN separately after adjusting other clinical variates. Among these muscle parameters, the EI of MG had a better predictive value (OR: 1.114, 95% CI: 1.039, 1.196) of DPN. Combined with CSA of RF, peripheral artery disease (PAD), and sex, the corrected EI of MG was associated with the vibration perception threshold (VPT) (standard β = 0.242, p < 0.001), better than the EI of MG (standard β = 0.215, p = 0.002). MG (MT, EI, and corrected EI) and TA (EI) were associated with DPN, respectively. CSA of RF and corrected EI or EI of MG combined with PAD and sex were associated with VPT significantly, which supported that muscle ultrasound might be a substantial quantitative tool for detecting the exercise benefits for DPN.

The Efficacy of Intradermal Injection of Botulinum Toxin Type-A on Painful Diabetic Neuropathy: A Systematic Review.

Diabetes is one of the most common causes of neuropathy. Morbidity and mortality increase in patients suffering from diabetic polyneuropathy and are experienced by approximately 10 to 54% of diabetic patients. Severe pain, loss of sensation, increased risk of ulceration, and even amputation are the complications of diabetic neuropathy. Intradermal injection of botulinum toxin type-A (BTX-A) is a relatively novel method for the treatment of painful diabetic neuropathy. This method is becoming popular considering its acceptable and long-lasting pain control and minimal systemic side effects. This narrative systematic review aimed to evaluate the effectiveness of intradermal BTX-A injection on painful diabetic neuropathy. The queried databases included PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, Web of Science, Scopus, and Google Scholar. The final search was performed in February 2022, and no time limits were set for the search. All the relevant clinical trials were included. The inclusion criteria and search strategy were set as follows: Type of study: Randomized clinical trial (RCT) or other types of interventional studies; publication date: All published studies until February 22, 2022; sample size: No restrictions; outcomes: Effect on diabetic neuropathy pain; quality: Earning a minimum acceptable score based on critical appraisal; and language: English. The searches and article screening were performed by two independent reviewers to minimize the possibility of bias. In case of disagreement about a study, the comments of an expert (as a third person) were used to resolve the ambiguity. In a review of 4 RCTs and 1 case-control study on the effectiveness of BTX-A in reducing the pain of diabetic neuropathy, 273 patients were evaluated in total. The lowest and highest number of subjects was 18 and 141. The sex distribution included 43.22% men and 56.77% women, all of whom were 47.8 to 74.8 years old. Three studies were conducted in Iran, Taiwan, and Egypt. The results of this review showed significant improvement in pain reduction, e.g., based on the Visual Analog Scale (VAS) and Neuropathic Pain Scale (NPS). A few studies evaluated sleep and psychosocial complications, and their results indicated a statistically significant improvement in the Pittsburgh sleep quality index (PSQI) and the physical subscale of the 36-Item Short Form Survey (SF-36). The results of this systematic review demonstrated that intradermal injection of BTX-A causes significant and long-term (up to 12 weeks) improvement in diabetic neuropathy pain. The improvement in sleep and mental or physical functions was not consistent, and no conclusive result could be reached.

Identification of Potential Aldose Reductase Inhibitors Using Convolutional Neural Network-Based in Silico Screening.

Aldose reductase (ALR2) is a notable enzyme of the polyol pathway responsible for aggravating diabetic neuropathy complications. The first step begins when it catalyzes the reduction of glucose to sorbitol with NADPH as a coenzyme. Elevated concentrations of sorbitol damage the tissues, leading to complications like neuropathy. Though considerable effort has been pushed toward the successful discovery of potent inhibitors, its discovery still remains an elusive task. To this end, we present a 3D convolutional neural network (3D-CNN) based ALR2 inhibitor classification technique by dealing with snapshots of images captured from 3D chemical structures with multiple rotations as input data. The CNN-based architecture was trained on the 360 sets of image data along each axis and further prediction on the Maybridge library by each of the models. Subjecting the retrieved hits to molecular docking leads to the identification of the top 10 molecules with high binding affinity. The hits displayed a better blood-brain barrier penetration (BBB) score (90% with more than four scores) as compared to standard inhibitors (38%), reflecting the superior BBB penetrating efficiency of the hits. Followed by molecular docking, the biological evaluation spotlighted five compounds as promising ALR2 inhibitors and can be considered as a likely prospect for further structural optimization with medicinal chemistry efforts to improve their inhibition efficacy and consolidate them as new ALR2 antagonists in the future. In addition, the study also demonstrated the usefulness of scaffold analysis of the molecules as a method for investigating the significance of structurally diverse compounds in data-driven studies. For reproducibility and accessibility purposes, all of the source codes used in our study are publicly available.

Trends in Utilization of Charcot Reconstruction

Category: Ankle; Diabetes Introduction/Purpose: Charcot arthropathy of the foot and ankle is a challenging complication of peripheral neuropathy with a 0.1% and 5.0% incidence in the diabetic population. The purpose of this study is to assess rates of foot or ankle reconstructions (fusions) for Charcot arthropathy, describe the associated patient demographics and hospital settings, and project the volume of Charcot reconstructions anticipated to be performed in 2030. Methods: The National Inpatient Sample database was queried from 2016-2019 using International Classification of Diseases (ICD) codes for foot or ankle fusion (midfoot, hindfoot, or ankle) and a diagnosis of Charcot arthropathy, ultimately identifying 1,343 patients undergoing surgical procedures. Patient information collected included age, sex, race, primary payer status, year of surgery, length of hospital stays, and median household income quartile. Hospital information included bed size, census region, teaching status, and ownership. Results: Between 2016-2019, there were approximately 1,343 patients treated surgically with midfoot, hindfoot, or ankle arthrodesis for Charcot arthropathy, and the number of cases increased by 12.11% annually. Between 2019-2030, there is projected to be a 121.41% increase in the frequency of Charcot reconstruction procedures from 383 to 848 total annual cases. Patients undergoing these procedures are predominantly white, male, and in their 50s. The most common payers were Medicare and private insurance. The mean hospital length of stay was 5.80 days. The procedures performed were predominantly large, urban teaching hospitals in the south with a private, non-profit ownership structure. Conclusion: Surgical reconstruction of Charcot arthropathy of the foot and ankle is steadily increasing in prevalence. These patients are predominantly white, male, and in their 50s. It is important for orthopaedic foot and ankle surgeons to be trained in the surgical management and reconstruction of Charcot arthropathy to meet the expected growing surgical need, which is projected to be 848 procedures annually by 2030.

EDUKASI-PENDAMPINGAN BUERGER ALLEN EXERCISE DAN 5 PILAR TERHADAP PERUBAHAN PENGETAHUAN DAN PERFORMA KESEHATAN FISIK PASIEN DIABETIK NEUROPATI PERIFER

Introduction &amp; Aim: Diabetes Mellitus patients with uncontrolled blood glucose levels for a long time will experience peripheral neuropathy complications with symptoms of tingling, numbness, pain in the feet, and disability in carrying out daily activities. The purpose of this community service was to evaluate Buerger Allen Exercise and 5 Pillars’ education on the knowledge and physical health performance of peripheral neuropathy diabetic patients. Method of Activity: Buerger Allen Exercise and 5 Pillars’ education was conducted on 28 diabetic patients with peripheral neuropathy who had previously been examined at the Gundih regional health center. This community service was carried out for 6 weeks at Jalan Kedinding RT 10 RW 01 Bubutan Surabaya with several stages of activity, namely: initial survey, education, application, assistance, and evaluation. Evaluated community behavior includes knowledge and physical health performance of diabetic peripheral neuropathy patients through measurement of the Ankle-Brachial Index (ABI), peripheral oxygen saturation in the feet (StO2), and physical activity ability. Data were analyzed using the Wilcoxon signed rank test and Paired t-test to evaluate the results of the service. Results: There were changes in community behavior such as knowledge increased by 21.5% (p=0.000); normal ABI by 57.1% (p=0.004); totally independent physical activity ability 92.9% (p=0.003), and normal StO2 100% (p=0.000). Discussion: Buerger Allen Exercise Education Assistance and 5 Pillars of Diabetes Mellitus provide optimal results in the management of diabetic peripheral neuropathy patients to prevent other complications such as diabetic ulcers, and amputation due to foot tissue death.

Relationship between β-Cell Autoantibodies and Their Combination with Anthropometric and Metabolic Components and Microvascular Complications in Latent Autoimmune Diabetes in Adults.

Our study aimed to investigate the relationship between three autoantibodies and their combination with anthropometric and metabolic components and microvascular complications in patients with latent autoimmune diabetes in adults (LADA). Our study included 189 LADA patients divided into four subgroups according to the autoantibodies present: glutamic acid decarboxylase autoantibodies (GADA) only; zinc transporter-8 autoantibodies (ZnT8A)+GADA; insulinoma-associated-2 autoantibodies (IA-2)+GADA; and ZnT8+IA-2+GADA. Compared to GADA positivity only, patients with ZnT8+GADA positivity and ZnT8+IA-2+GADA positivity had a shorter diabetes duration and lower body mass index (BMI); patients with ZnT8+GADA positivity were younger and showed an increase in glomerular filtration rate, while those with ZnT8+IA-2+GADA positivity had lower C-peptide and lower insulin resistance measured with HOMA2-IR. In a multiple regression analysis, ZnT8 positivity was associated with lower BMI (p = 0.0024), female sex (p = 0.0005), and shorter duration of disease (p = 0.0034), while IA-2 positivity was associated with lower C-peptide levels (p = 0.0034) and shorter diabetes duration (p = 0.02). No association between antibody positivity and microvascular complications of diabetes, including retinopathy, neuropathy, and microalbuminuria, as well as with variables of glucose control and β-cell function were found. The results of our study suggest that ZnT8 and IA-2 autoantibodies are present in a significant number of LADA patients and associated with clinical and metabolic characteristics resembling classic type 1 diabetes. Due to increased LADA prevalence, earlier identification of patients requiring frequent monitoring with the earlier intensification of insulin therapy might be of special clinical interest.

LEPROSY NEUROPATHY : CLINICAL PRESENTATION

Leprosy is a chronic infection caused by the bacteria M. leprae and causes damage to the skin and peripheral nervous system outside the brain and spinal cord, including the skin, mucous membranes of the nose, testicles, and eyes. This disease develops slowly over a long period, ranging from 6 months to 40 years, and can cause skin lesions and secondary defects. Leprosy is a common and treatable cause of peripheral neuropathy in many tropical and subtropical countries. Neuropathy is a condition that causes damage to the function and structure of the sensory, autonomic, and motor nerves in the peripheral nervous system. Complications of neuropathy can include loss of sensory abilities and muscle weakness. Impaired sensory nerve function is often the first symptom that appears in leprosy neuropathy. Therefore, early detection and treatment of neuropathy in leprosy is very important to prevent disability.