Diagnosis Of Peripheral Neuropathy Research Articles

The effect of the different waves of COVID-19 pandemic on the outcome of diabetic foot ulcers.

COVID-19 pandemic has massively impacted human health. We studied the effect of COVID-19 on outcome of Diabetic foot ulcers (DFUs). We recruited 483 people with DFUs from June 2020 to April 2022 (pandemic) together with a matched group of 226 people with DFU from March 2019 to March 2020 (pre-pandemic). Primary endpoint was outcome of ulcers-healed or amputation (major/minor). It was sub-analysed into 3 waves of COVID-19. Secondary endpoint was healing of individual types of DFUs. Basic anthropometric data included site and type of ulcer (ischemic or neuropathic), duration, presence or absence of infection and Wagner's grading of DFUs was collected for all patients. Diagnosis of peripheral neuropathy was done by monofilament testing and peripheral arterial disease by handheld Doppler and ankle brachial index (ABI). Standardized treatment protocol was provided. All patients were monitored for 6 months. In the pandemic group 323 (66.9%) patients in whom ulcers healed, 70 (14.5%) underwent minor amputation, 11 (2.2%) major amputation, 29 (6%) were lost to follow up, 22 (4.6%) were not healed. Rate of healing of DFU was higher (66.9% vs 53.5%) and rate of amputation was lower (16.7% vs 23.4%) in the pandemic group than in the pre-pandemic group (P = 0.001 and 0.037 respectively). Rate of healing in first, second and third wave was 65.4%, 75.2%, 58.3% respectively (P = 0.001). Neuropathic ulcers though less prevalent (49.8% vs 57.8%) in the first two waves than in the third wave, healing was better (79.3% vs 75.6%) in the first two waves than in the third wave (P = 0.085 and 0.488 respectively). Similarly, amputation rates in ischemic and neuro-ischemic ulcers were greater in the third wave than first two waves (46.7% vs 15.7%, P = 0.049). During the COVID-19 pandemic, healing of neuropathic ulcers was better, especially in the first and second waves and travel restriction may have accounted for this. However, worsening of ischemic and neuro-ischemic ulcers was observed with more amputation in these two groups. Conversely, in the third wave withdrawal of lockdown led to worsening of DFUs resulting in less healing and more amputation.

Earlier diagnosis of peripheral neuropathy in primary care: A call to action.

Peripheral neuropathy (PN) often remains undiagnosed (~80%). Earlier diagnosis of PN may reduce morbidity and enable earlier risk factor reduction to limit disease progression. Diabetic peripheral neuropathy (DPN) is the most common PN and the 10 g monofilament is endorsed as an inexpensive and easily performed test for DPN. However, it only detects patients with advanced neuropathy at high risk of foot ulceration. There are many validated questionnaires to diagnose PN, but they can be time-consuming and have complex scoring systems. Primary care physicians (PCPs) have busy clinics and lack access to a readily available screening method to diagnose PN. They would prefer a short, simple, and accurate tool to screen for PN. Involving the patient in the screening process would not only reduce the time a physician requires to make a diagnosis but would also empower the patient. Following an expert meeting of diabetologists and neurologists from the Middle East, South East Asia and Latin America, a consensus was formulated to help improve the diagnosis of PN in primary care using a simple tool for patients to screen themselves for PN followed by a consultation with the physician to confirm the diagnosis.

Progress in the nerve ultrasound of inflammatory peripheral neuropathies

Objective: In recent years, high-resolution nerve ultrasound has been increasingly used as a complementary tool to nerve conduction studies in the diagnosis of peripheral neuropathies. Inflammatory peripheral neuropathies include a heterogeneous group of neuropathies mainly including chronic inflammatory demyelinating polyneuropathies (CIDP), multifocal motor neuropathy (MMN), systemic vasculitic neuropathy (SVN), and Guillain-Barre syndrome (GBS). We describe the ultrasonic characteristics of different inflammatory neuropathies.
 Data sources and study selection: The MEDLINE database was searched to find studies on nerve sonography in inflammatory peripheral neuropathies. Reported studies up to December 2022 were included in this review.
 Results: In neuropathies, the changes in ultrasound include enlarged nerve size, nerve echo-intensity, fascicle diameter and vascularity. Most CIDP patients have moderately enlarged CSA, some have dramatically enlarged CSA, and few have CSA within the normal range. Since the enlargement patterns are different, ultrasound is useful to help differentiate CIDP from CMT1. In follow-ups after immune treatment, nerve CSAs in CIDP could decrease, increase, or remain unchanged. Regional enlargement next to normal segments predominated in MMN. Nerve enlargement and hyper vascularization were found in vasculitic neuropathy. In GBS patients, there were enlarged peripheral nerve and nerve roots, which became normal at follow-up.
 Conclusions: High-resolution nerve ultrasound is complementary to the diagnosis of inflammatory peripheral neuropathies. CSA enlargement and its distribution are the most useful and quantifiable parameters in the evaluation of peripheral nerves. For patients suspected to have inflammatory neuropathies, we advise measuring the CSA of several pre-determined sites in the median, ulnar nerve, C5-8 cervical roots, and brachial plexus.

Diabetic Peripheral Neuropathy in India and the United States: Clinical Insights from a Comparative Review

Abstract Diabetic peripheral neuropathy (DPN) is the most common microvascular complication of diabetes. This review aims to compare the published research on DPN from India and the United States, both having a significant diabetes population and having diverse means and approaches to health care. An online medical database search was conducted on PubMed using the key terms “global prevalence of diabetic neuropathy’, “epidemiology and risk factors of DPN”, “clinical presentation of diabetic neuropathy’, screening and diagnosis of peripheral neuropathy”, “DFU associated with diabetic neuropathy”, and “Charcot neuroarthropathy” from the onset to June 2022. Due to inadequate PubMed citations, a random Google Scholar search was performed. Out of a total of 209 citations (Title/Abstract) that were identified, following a thorough analysis by four different reviewers, 56 citations were chosen, and divided into various categories. Although data shows that DPN is more prevalent in India than in the United States, the former is largely based on clinic or institution-based data with small sample size and thus cannot be meaningfully compared to large population-based data from the United States.

Tunable Hydrogel Electronics for Diagnosis of Peripheral Neuropathy.

Peripheral neuropathy characterized by rapidly increasing numbers of patients is commonly diagnosed via analyzing electromyography signals obtained from stimulation-recording devices. However, existing commercial electrodes have difficulty in implementing conformal contact with skin and gentle detachment, dramatically impairing stimulation/recording performances. Here, we develop on-skin patches with polyaspartic acid-modified dopamine/ethyl-based ionic liquid hydrogel (PDEH) as stimulation/recording devices to capture electromyography signals for the diagnosis of peripheral neuropathy. Triggered by a one-step electric field treatment, the hydrogel achieves rapid and wide-range regulation of adhesion and substantially strengthened mechanical performances. Moreover, hydrogel patches assembled with a silver-liquid metal (SLM) layer exhibit superior charge injection and low contact impedance, capable of capturing high-fidelity electromyography. We further verify the feasibility of hydrogel devices for accurate diagnoses of peripheral neuropathy in sensory, motor, and mixed nerves. For various body parts, such as fingers, the elderly's loose skin, hairy skin, and children's fragile skin, we regulate the adhesion of PDEH-SLM devices to establish intimate device/skin interfaces or ensure benign removal. Noticeably, hydrogel patches achieve precise diagnoses of nerve injuries in these clinical cases while providing extra advantages of more effective stimulation/recording performances. These patches offer a promising alternative for the diagnosis and rehabilitation of neuropathy in future. This article is protected by copyright. All rights reserved.

Interest of electroneuromyography in the diagnosis of peripheral neuropathy in the Neurology Department of the Ignace Deen National Hospital

Interest of electroneuromyography in the diagnosis of peripheral neuropathy in the Neurology Department of the Ignace Deen National Hospital

Spastic Paraplegia Type 7-Associated Optic Neuropathy: A Case Series.

Hereditary optic neuropathies comprise a group of clinically and genetically heterogeneous disorders. Optic neuropathy has been previously reported in families with spastic paraplegia type 7 (SPG7) gene mutations. However, the typical time course and clinical presentation of SPG7-associated optic neuropathy is poorly understood. We report a series of 5 patients harboring pathogenic SPG7 mutations who originally presented to a neuro-ophthalmology clinic with symptoms of optic neuropathy. Retrospective case series of 5 patients with pathogenic SPG7 mutations and optic atrophy from 3 neuro-ophthalmology clinics. Demographic, clinical, diagnostic, and treatment data were collected and reported by the clinician authors. Five patients ranging in age from 8 to 48 years were evaluated in the neuro-ophthalmology clinic. Although there were variable clinical presentations for each subject, all noted progressive vision loss, typically bilateral, and several also had previous diagnoses of peripheral neuropathy (e.g., Guillain-Barré Syndrome). Patients underwent neuro-ophthalmic examinations and testing with visual fields and optic coherence tomography of the retinal nerve fiber layer. Genetic testing revealed pathogenic variants in the SPG7 gene. Five patients presented to the neuro-ophthalmology clinic with progressive vision loss and were diagnosed with optic atrophy. Although each patient harbored an SPG7 mutation, this cohort was phenotypically and genotypically heterogeneous. Three patients carried the Ala510Val variant. The patients demonstrated varying degrees of visual acuity and visual field loss, although evaluations were completed during different stages of disease progression. Four patients had a previous diagnosis of peripheral neuropathy. This raises the prospect that a single pathogenic variant of SPG7 may be associated with peripheral neuropathy in addition to optic neuropathy. These results support the consideration of SPG7 testing in patients with high suspicion for genetic optic neuropathy, as manifested by symmetric papillomacular bundle damage without clear etiology on initial workup. Applied judiciously, genetic testing, including for SPG7, may help clarify the cause of unexplained progressive optic neuropathies.

A Survey of the Diagnosis of Peripheral Neuropathy Using Intelligent and Wearable Systems

In recent years, the usage of wearable systems in healthcare has gained much attention, as they can be easily worn by the subject and provide a continuous source of data required for the tracking and diagnosis of multiple kinds of abnormalities or diseases in the human body. Wearable systems can be made useful in improving a patient’s quality of life and at the same time reducing the overall cost of caring for individuals including the elderly. In this survey paper, the recent research in the development of intelligent wearable systems for the diagnosis of peripheral neuropathy is discussed. The paper provides detailed information about recent techniques based on different wearable sensors for the diagnosis of peripheral neuropathy including experimental protocols, biomarkers, and other specifications and parameters such as the type of signals and data processing methods, locations of sensors, the scales and tests used in the study, and the scope of the study. It also highlights challenges that are still present in order to make wearable devices more effective in the diagnosis of peripheral neuropathy in clinical settings.

Trends in Gastroparesis Management: A United States Population-based Study From 2010 to 2020.

There is little consensus on the medical management of gastroparesis, a disorder characterized by delayed gastric emptying with symptoms of early satiety, nausea, vomiting, and upper abdominal pain. We utilized population-level data to: (1) describe the prevalence of different pharmacological and nonpharmacological therapies in patients with gastroparesis; and (2) trend the prevalence of these therapies from 2010 to 2020. More than 59 million unique medical records across 26 US-based major health care systems were surveyed using the Explorys platform to identify a cohort of adults with gastroparesis who completed both a gastric emptying study and upper endoscopy or upper gastrointestinal tract imaging. Prevalence of antiemetic, prokinetic, neuromodulator prescriptions, and surgical therapies for gastroparesis were searched within this cohort and trended annually from 2010 to 2020. Antiemetics (72% of patients), prokinetics (47%), and neuromodulators (75% of patients, 44% of patients without a concomitant psychiatric or diabetic peripheral neuropathy diagnosis) were all commonly used in the treatment of patients with gastroparesis. From 2010 to 2020, there was an increase in the prevalence of antiemetic and neuromodulator prescriptions (36.4% to 57.6%, P <0.001 and 47.0% to 66.9%, P <0.001, respectively), whereas the prevalence of prokinetics remained relatively constant (31.8% to 31.6%, P =0.52). Procedural and surgical treatments were used in 5% of gastroparesis patients. Treatments for gastroparesis have changed over the last decade: antiemetic and neuromodulator use has increased whereas prokinetic use has remained constant. This practice pattern may reflect the growing number and availability of antiemetics and neuromodulators and the small number and known side effects of prokinetics.

Clinical significance of small nerve fiber involvement in the early diagnosis and treatment of patients with Fabry disease

IntroductionPeripheral nervous system is early involved in Fabry disease (FD) and preferentially the small nerve fibers, causing the characteristic neuropathic pain crises usually beginning in childhood. Early detection of this likely underdiagnosed disease is an important approach because causal therapies are available. MethodsWe conducted a case-series study to investigate the small nerve fiber involvement in FD and its contribution to the diagnosis of the disease but also to the timely effective therapy administration. We used specific structured scales of symptoms and signs to detect peripheral neuropathy, as well as suitable functional and structural tests to diagnose the small fiber neuropathy (SFN). ResultsTwenty-seven consecutive patients (14 men, mean age 44.62 ± 10.70 years) with suspected FD were included in this study. Most of the patients presented symptoms of small nerve fiber involvement, which were accompanied by abnormal test results, fulfilling the criteria for SFN. The detection of SFN in our patients allowed the completion of the FD diagnostic criteria and thus the initiation of therapy. In five patients the SFN diagnosis determined the administration of therapy, whereas in two others it might be considered. ConclusionOur results further suggest the importance of early diagnosis of peripheral neuropathy, especially of small nerve fiber involvement, in patients with suspected FD as it contributes crucially not only to the diagnosis but also to the timely effective initiation of FD therapy.

Abstract #1401721: The Effect of the Different Waves of COVID-19 Pandemic on the Outcome of Diabetic Foot Ulcers

Diabetic foot ulcers (DFUs) are complications of diabetes mellitus. COVID-19 pandemic has massively impacted human health. We studied effect of COVID-19 on outcome of DFUs. We recruited 483 people with DFU from June 2020-April 2022 (pandemic group) together with a matched group of 227 people with DFU from March 2019-March 2020 (pre-pandemic group). Matching was done with respect to glycemic control (Average HbA1c in pandemic group 9.15%; pre-pandemic group 8.92%), and renal status. Primary endpoint was outcome of ulcers- healed or undergone amputation. Primary outcome was further sub analyzed in the 3 waves of COVID-19 Secondary endpoint was healing of individual types of DFUs. Basic anthropometric data with site, nature and Wegner’s grading of DFUs were collected. Diagnosis of peripheral neuropathy was done by monofilament testing and peripheral arterial disease by handheld Doppler and ABI. Standardized treatment protocol including glycemic control, infection control, debridement, dressing, offloading was provided. All patients were monitored for >6 months. In pandemic cohort of 483 patients 323(66.9%) patients had healed ulcers, 70(14.5%) had minor amputation, 11(2,2%) had major amputation, 29(6%) lost to follow up, 22(4.6%) had not healed and 28 are in follow up (5.8%). Rate of healing of DFU in pandemic group was higher (66.9%) than control group (53.5%). Similarly, rate of amputation in pandemic group was less (16.7%) than pre-pandemic group (23.4%). Among healed ulcers in pandemic group, non-infected neuropathic ulcers healed better (77.8%; 199/256) than other types (54.6%; 124/227) [p< 0.00001]. Similarly, rate of amputation (major/minor) in ischemic and neuroischemic ulcers in pandemic group was more (32.3%; 11/34) than other types (15.6%; 70/449) [p= 0.011]. Rate of healing of foot ulcers in 1st wave was 65.4% (53/81), 2nd wave 75.2% (158/210), 3rd wave 58.3% (112/192). Neuropathic ulcers though less prevalent in first two waves (49.8%; 145/291) than 3rd wave (57.8%; 111/192) healing rate was more in first two (79.3%; 115/145 vs 75.6%; 84/111). [p=0.488 (statistically not significant]. Ischemic and neuroischemic ulcers were more in 3rd wave (7.8%; 15/192) than first two waves (6.5%; 19/291) and undergone more amputation (46.7%; 7/15 vs 15.7%; 3/19). [p=0.58 (statistically not significant; due to small sample size]. COVID-19 pandemic (mainly first two waves) accounted for travel restrictions contributing to better healing of neuropathic ulcers whereas ischemic and neuroischemic ulcers worsened and underwent more amputation as patients could not seek intervention. Conversely, in third wave withdrawal of COVID restrictions lead to worsening of DFUs leading to less healing and more amputation.

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.

Artificial Intelligence Based Analysis of Corneal Confocal Microscopy Images for Diagnosing Peripheral Neuropathy: A Binary Classification Model.

Diabetic peripheral neuropathy (DPN) is the leading cause of neuropathy worldwide resulting in excess morbidity and mortality. We aimed to develop an artificial intelligence deep learning algorithm to classify the presence or absence of peripheral neuropathy (PN) in participants with diabetes or pre-diabetes using corneal confocal microscopy (CCM) images of the sub-basal nerve plexus. A modified ResNet-50 model was trained to perform the binary classification of PN (PN+) versus no PN (PN-) based on the Toronto consensus criteria. A dataset of 279 participants (149 PN-, 130 PN+) was used to train (n = 200), validate (n = 18), and test (n = 61) the algorithm, utilizing one image per participant. The dataset consisted of participants with type 1 diabetes (n = 88), type 2 diabetes (n = 141), and pre-diabetes (n = 50). The algorithm was evaluated using diagnostic performance metrics and attribution-based methods (gradient-weighted class activation mapping (Grad-CAM) and Guided Grad-CAM). In detecting PN+, the AI-based DLA achieved a sensitivity of 0.91 (95%CI: 0.79-1.0), a specificity of 0.93 (95%CI: 0.83-1.0), and an area under the curve (AUC) of 0.95 (95%CI: 0.83-0.99). Our deep learning algorithm demonstrates excellent results for the diagnosis of PN using CCM. A large-scale prospective real-world study is required to validate its diagnostic efficacy prior to implementation in screening and diagnostic programmes.

Selective stimulation of nociceptive small fibers during intraepidermal electrical stimulation: Experiment and computational analysis.

Electrical stimulation of skin nociceptors is gaining attention in pain research and peripheral neuropathy diagnosis. However, the optimal parameters for selective stimulation are still difficult to determine because they require simultaneous characterization of the electrical response of small fibers (Aδ- and C-fibers). In this study, we measured the in vivo electrical threshold responses of small fibers to train-pulse stimulation in humans for the first time. We also examined selective stimulation via a computational model, which combines electrical analysis, and terminal fiber and synaptic models, including the first cutaneous pain C-fiber model. Selective stimulation of small fibers is performed by injecting train-pulse stimulation via coaxial electrodes with an intraepidermal needle tip at varying pulse counts and frequencies. The activation Aδ- or C-fibers was discriminated from the differences in reaction time. Aδ-fiber elicited a pinpricking sensation with a mean reaction time of 0.522 s, and C-fiber elicited a tingling sensation or slight burning itch with a mean reaction time of 1.243 s. The implemented multiscale electrical model investigates synaptic effects while considering stimulation waveform characteristics. Experimental results showed that perception thresholds decreased with the number of consecutive pulses and frequency up to convergence (five pulses or 70 Hz) during the selective stimulation of Aδ- and C-fibers. Considering the synaptic properties, the optimal stimulus conditions for selective stimulation of Aδ- vs. C-fibers were train of at least four pulses and a frequency of 40-70 Hz at a pulse width of 1 ms. The experimental results were modeled with high fidelity by incorporating temporal synaptic effects into the computational model. Numerical analysis revealed terminal axon thickness to be the most important biophysical factor affecting threshold variability. The computational model can be used to estimate perception thresholds while understanding the mechanisms underlying the selective stimulation of small fibers. The parameters derived here are important in exploring selective stimulation between Aδ- and C-fibers for diagnosing neuropathies.

Neuropathies périphériques et facteurs associés chez les hémodialysés chroniques du Bénin

IntroductionPeripheral neuropathies, in hemodialysis patients, are frequent. ObjectiveTo study peripheral neuropathies in the population of chronic hemodialysis patients in Benin. MethodsThis was a descriptive and analytical cross-sectional study conducted from April 1st to July 31st, 2017 in the hemodialysis units of the two public dialysis centers in Benin. Recruitment was exhaustive with inclusion of all patients with hemodialysis for more than 3months, aged at least 18years and consenting. The diagnosis of peripheral neuropathy was based on the presence of sensory-motor and/or vegetative disorders associated with amyotrophy, abolition or reduction of osteotendinous reflexes and absence of central signs. ResultsA total of 189 hemodialysis patients were included in the two public hemodialysis centers of Benin, 180 at the CNHU-HKM and 9 at the CHUD/BA. The mean age was 50.23±13.31years with extremes from 20 to 85 years and a sex ratio of 1.59. The overall frequency of peripheral neuropathy was 59.26%, including polyneuropathies (72.32%), unifocal mononeuropathies (10.71%), polyradiculoneuropathies (9.82%), and multiple mononeuropathies (7.14%). The associated factor in multivariate analysis was socioeconomic level (P=0.001; OR 39.41; 95% CI 4.81–322.64). ConclusionPeripheral neuropathy is frequent in chronic hemodialysis patients in Benin, requiring early detection and management.

Primary Sjögren syndrome-related peripheral neuropathy: Asystematic review and meta-analysis.

Primary Sjögren syndrome (pSS) is a chronic, systemic, autoimmune disorder characterized by lymphocytic infiltrates of the exocrine organs, leading to sicca symptoms and parotid enlargement. pSS has been linked to various neurological manifestations, including peripheral neuropathy (PN). We aimed to provide a comprehensive analysis of the currently available evidence regarding pSS-related PN. A literature search in the PubMed database was performed, and 49 papers were eligible to be included in this systematic review and meta-analysis. The pooled prevalence of PN in pSS is estimated to be 15.0% (95% confidence interval=10.7%-20.7%). The mean age of pSS patients at PN diagnosis is 59 years. Among the patients with pSS and PN, 83% are females. Neuropathic symptoms usually precede or lead to the pSS diagnosis at a 2:1 ratio in patients with pSS-related PN. The commonest type of pSS-related PN is distal axonal polyneuropathy (80% of patients with pSS-related PN), followed by sensory ganglionopathy. Peripheral and cranial mononeuropathies-particularly trigeminal-are also frequent. Risk factors for developing PN include increasing age and presence of vasculitis. Immune-mediated pathogenetic mechanisms are discussed. Glucocorticoids are the most commonly used treatment option for managing pSS-related PN, when associated with vasculitis, followed by the use of intravenous immunoglobulin. PN is very common in pSS patients. Evidence on long-term prognosis of PN in pSS is limited, and further research is needed. Research into the use of immunosuppressive medication in nonvasculitic neuropathies in the context of pSS merits further consideration.

Diagnostic accuracy of nerve ultrasonography for the detection of peripheral neuropathy in type 2 diabetes.

Nerve conduction studies (NCS) are the current objective measure for diagnosis of peripheral neuropathy in type 2 diabetes but do not assess nerve structure. This study investigated the utility of peripheral nerve ultrasound as a marker of the presence and severity of peripheral neuropathy in type 2 diabetes. A total of 156 patients were recruited, and nerve ultrasound was undertaken on distal tibial and distal median nerves. Neuropathy severity was graded using the modified Toronto Clinical Neuropathy Scale (mTCNS) and Total Neuropathy Score (TNS). Studies were undertaken by a single ultrasonographer blinded to nerve conduction results. A stepwise increase in tibial nerve cross-sectional area (CSA) was noted with increasing TNS grade (p&lt; 0.001) and each mTCNS quartile (p&lt; 0.001). Regression analysis demonstrated a correlation between tibial nerve CSA and neuropathy severity (p&lt; 0.001). Using receiver operator curve analysis, tibial nerve CSA of &gt;12.88 mm yielded a sensitivity of 70.5% and specificity of 85.7% for neuropathy detection. Binary logistic regression revealed that tibial nerve CSA was a predictor of abnormal sural sensory nerve action potential amplitude (odds ratio=1.239, 95% confidence interval [CI]=1.142-1.345) and abnormal neuropathy score (odds ratio=1.537, 95% confidence interval [CI]=1.286-1.838). Tibial nerve ultrasound has good specificity and sensitivity for neuropathy diagnosis in type 2 diabetes. The study demonstrates that tibial nerve CSA correlates with neuropathy severity. Future serial studies using both ultrasound and NCS may be useful in determining whether changes in ultrasound occur prior to development of nerve conduction abnormalities and neuropathic symptoms.

Neuropathic first metatarsophalangeal arthrodesis: Deforming force of flexor hallucis longus tendon

Background Deformity of the Hallux interphalangeal joint (HIPJ) is a common complication following neuropathic 1st MPJ arthrodesis. Although largely asymptomatic, there have been no such studies evaluating the incidence of deformity and degeneration following 1st MPJ arthrodesis, in the neuropathic patient population. The aim of this paper was to highlight the incidence of deformity and degenerative changes at the HIPJ following 1st MPJ arthrodesis in neuropathic patients. Methodology/Procedures Retrospective radiographic review of 324 patients who underwent 1st MPJ arthrodesis, of these patients, 42 patients met inclusion criteria with a diagnosis of peripheral neuropathy due to all causes (diabetic, idiopathic, alcoholic). Preoperative, 12 weeks postoperative and long term (average of 48 weeks) weight bearing radiographs were evaluated for degenerative changes and angular deformity of the hallux interphalangeal joint. The evaluated angles include the hallux interphalangeal joint angle (HIA), the plantar distal hallux angle (PDHA), and the hallux to ground angle (H-G angle). Results Deformity and/or degenerative changes of the HIPJ were seen in 80.9% of patients at long term follow up as evaluated from the HIPJ angle and the PDHA angle. The mean percentage change of the HIPJ angle from preoperative to final postoperative follow up was 19.8% and from preoperative to long term follow up was 37.4%. The percentage change of the PDHA angle was 1.39% from preoperative to final follow up and 13.87% from preoperative to long term follow up. A paired t test was performed to showcase statistical significance and was found to be significant for the HIPJ angle preoperatively to final postoperative (p-value &lt; 0.0076) and the preoperative to long term follow up for the HIPJ angle (P-value &lt;0.001). The PDHA angle was statistically significant at long term follow up (p &lt;0.0001). These results demonstrate the degree of deformity and subsequent degeneration that is present in the HIPJ following first MPJ arthrodesis in neuropathic patients. Discussion The senior surgeons have identified a higher incidence of HIPJ deformity in neuropathic patients after 1st MPJ arthrodesis compared to historic literature incidence. These findings at the HIPJ that, if not addressed, could result in eventual breakdown of the joint with significant deformity. The results of this analysis suggest that a prophylactic flexor hallucis longus (FHL) tenotomy should be performed simultaneously with 1st MPJ arthrodesis to prevent progression of deformity and degeneration in this joint in the neuropathic population. This finding would be best explored in future studies as a prospective review.

Reference Values for the Cross Sectional Area of Normal Tibial Nerve on High-resolution Ultrasonography.

The aim of the study was to establish reference values for the cross-sectional area of the tibial nerve on high-resolution ultrasonography and to investigate the relationship between the cross-sectional area of the tibial nerve and subject's age, gender, height (in cm), weight (in kg) and body mass index. Two hundred subjects of either gender and over 18 years of age with no history of peripheral neuropathy or trauma to the lower limb were evaluated with high-resolution ultrasonography. Mean cross-sectional areas of tibial nerves were measured at two different levels in both lower limbs, first at 1 cm below the bifurcation of the sciatic nerve into tibial and common peroneal nerves (level I) and the second at 1 cm superior and posterior to the medial malleolus (level II). The mean cross-sectional area measured at level I (0.196 + 0.014 cm2) was larger than the one measured at level II (0.111 ± 0.011 cm2). A positive correlation was found between the mean cross-sectional area and height, weight, and body mass index (p <0.05). Women had smaller cross-sectional areas of the tibial nerves than men at both sites. In addition, no significant relationship was found with the age of the subjects (p >0.05). The established reference values of the cross-sectional area of the tibial nerve will aid in early diagnosis of peripheral neuropathy.

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.