Symptoms Of Neuropathy Research Articles

Inactive Graves’ orbitopathy: to treat or not to treat?

Purpose: to evaluate the expediency and efficacy of conservative therapy of patients with inactive stages of Graves’ orbitopathy complicated by optical neuropathy. Materials and methods. 62 patients with an inactive stage of Graves’ orbitopathy complicated by optical neuropathy were divided into two groups: group 1 (21 patients, 33.9%) received only symptomatic and local therapy, while group 2 (41 patients, 66.1%) additionally received periorbital injections of glucocorticoid drugs. The patients were examined clinically and instrumentally before and after treatment as well as after a long period of more than 12 months. Results. A positive clinical effect of treatment confirmed by positive dynamics of functional indices of computer perimetry (MS, MD) was achieved in 44 cases (71%), of which 33 patients (75.0% ) belonged to group 2. Positive changes in group 1 were achieved in 52.4% of cases and in group 2 in 80.5% of patients. Long-term results showed stable positive changes in 92.1% of cases. Conclusion. The need for complex therapy, involving local injections of glucocorticoid drugs, of patients in an inactive stage of Grave’s orbitopathy who develop symptoms of optical neuropathy was substantiated.

Peripheral Nerve Denervation in Streptozotocin-Induced Diabetic Rats Is Reduced by Cilostazol

Background and Objective: Our previous study demonstrated that consistent treatment of oral cilostazol was effective in reducing levels of painful peripheral neuropathy in streptozotocin-induced type I diabetic rats. As diabetic neuropathy is characterized by hyperglycemia-induced nerve damage in the periphery, this study aims to examine the neuropathology as well as the effects of cilostazol treatments on the integrity of peripheral small nerve fibers in type I diabetic rats. Materials and Methods: A total of ninety adult male Sprague-Dawley rats were divided into the following groups: (1) naïve (control) group; (2) diabetic rats (DM) group for 8 weeks; DM rats receiving either (3) 10 mg/kg oral cilostazol (Cilo10), (4) 30 mg/kg oral cilostazol (Cilo30), or (5) 100 mg/kg oral cilostazol (Cilo100) for 6 weeks. Pain tolerance thresholds of hind paws toward thermal and mechanical stimuli were assessed. Expressions of PGP9.5, P2X3, CGRP, and TRPV-1 targeting afferent nerve fibers in hind paw skin and glial cells in the spinal dorsal horn were examined via immunohistochemistry and immunofluorescence. Results: Oral cilostazol ameliorated the symptoms of mechanical allodynia but not thermal analgesia in DM rats. Significant reductions in PGP9.5-, P2X3-, CGRP, and TRPV-1-labeled penetrating nerve fibers in the epidermal layer indicated denervation of sensory nerves in the hind paw epidermis of DM rats. Denervation significantly improved in groups that received Cilo30 and Cilo100 in a dose-dependent manner. Cilostazol administration also suppressed microglial hyperactivation and increased astrocyte expressions in spinal dorsal horns. Conclusions: Oral cilostazol ameliorated hyperglycemia-induced peripheral small nerve fiber damage in the periphery of diabetic rats and effectively mitigated diabetic neuropathic pain via a central sensitization mechanism. Our findings present cilostazol not only as an effective option for managing symptoms of neuropathy but also for deterring the development of diabetic neuropathy in the early phase of type I diabetes.

The Role of Type 2 Diabetes in Patient Symptom Attribution, Help-Seeking, and Attitudes to Investigations for Colorectal Cancer Symptoms: An Online Vignette Study.

Type 2 diabetes is associated with a higher risk of colorectal cancer (CRC) and advanced-stage cancer diagnosis. To help diagnose cancer earlier, this study aimed at examining whether diabetes might influence patient symptom attribution, help-seeking, and willingness to undergo investigations for possible CRC symptoms. A total of 1307 adults (340 with and 967 without diabetes) completed an online vignette survey. Participants were presented with vignettes describing new-onset red-flag CRC symptoms (rectal bleeding or a change in bowel habits), with or without additional symptoms of diabetic neuropathy. Following the vignettes, participants were asked questions on symptom attribution, intended help-seeking, and attitudes to investigations. Diabetes was associated with greater than two-fold higher odds of attributing changes in bowel habits to medications (OR = 2.48; 95% Cl 1.32-4.66) and of prioritising diabetes-related symptoms over the change in bowel habits during medical encounters. Cancer was rarely mentioned as a possible explanation for the change in bowel habits, especially among diabetic participants (10% among diabetics versus 16% in nondiabetics; OR = 0.55; 95% CI 0.36-0.85). Among patients with diabetes, those not attending annual check-ups were less likely to seek help for red-flag cancer symptoms (OR = 0.23; 95% Cl 0.10-0.50). Awareness of possible cancer symptoms was low overall. Patients with diabetes could benefit from targeted awareness campaigns emphasising the importance of discussing new symptoms such as changes in bowel habits with their doctor. Specific attention is warranted for individuals not regularly attending healthcare despite their chronic morbidity.

Evaluating Diagnostic Ultrasound of the Vagus Nerve as a Surrogate Marker for Autonomic Neuropathy in Diabetic Patients.

Background and Objectives: Diagnostic ultrasound of the vagus nerve has been used to examine different polyneuropathies, and it has been suggested to be useful as a marker of autonomic dysfunction in diabetic patients. Materials and Methods: We analyzed the cross-sectional area (CSA) of the right vagus nerve of 111 patients with type 2 diabetes in comparison to 104 healthy adults and 41 patients with CIDP (chronic inflammatory demyelinating polyneuropathy). In the diabetes group, sympathetic skin response (SSR) was measured as an indicator for autonomic neuropathy. Carotid intima-media thickness (CIMT) was measured as a surrogate for atherosclerosis. Clinical symptoms of polyneuropathy were assessed using the Neuropathy Symptom Score and the Neuropathy Disability Score. Results: In total, 61.3% of the diabetes patients had clinical signs of polyneuropathy; 23.4% had no SSR at the feet as an indicator of autonomic neuropathy. Mean vagus nerve CSA did not differ in patients with and without diabetic polyneuropathy or in diabetic patients with and without SSR at the feet. No significant correlation was found between vagus nerve CSA and CIMT or SSR parameters in diabetic patients. Mean CSA of the right vagus nerve was slightly larger in diabetic patients (p = 0.028) and in patients with CIDP (p = 0.015) than in healthy controls. Conclusions: Effect sizes and mean differences were rather small so that a reliable diagnosis cannot be performed based on the vagus nerve measurement of a single person alone. Vagus nerve CSA seems not suitable as an indicator of autonomic dysfunction or cardiovascular risk in diabetic patients.

Acupuncture in Patients with Diabetic Peripheral Neuropathy-Related Complaints: A Randomized Controlled Clinical Trial

Background: Diabetic polyneuropathy (DPN) is a common complication of diabetes, which presents with a loss of sensorimotor function or pain. This study assessed the effectiveness and safety of acupuncture as a treatment for DPN-related complaints. Methods: In this randomized controlled trial, patients with type II diabetes and symptoms of neuropathy in the lower limbs were included. A total of 12 acupuncture treatments were administered over 8 weeks. The waitlist control group received the same acupuncture treatment starting at week 16 (after baseline). Results: A total of 62 patients were randomized (acupuncture group n = 31; control group n = 31). The primary outcome was overall complaints, and it was reduced with a significant difference of 24.7 on a VAS (CI 95% 14.8;34.7, p < 0.001) between both groups in favor of acupuncture. Reductions were recorded for the secondary outcomes VAS pain, neuropathic pain symptom inventory (NPSI), emotional dimensions of pain, SF-12, and diabetic peripheral neuropathic pain impact (DPNPI) after the intervention and at the follow-ups in the acupuncture group. Adverse reactions were minor and transient. Conclusions: Acupuncture leads to a significant and lasting reduction in DPN-related complaints when compared to routine care and is well tolerated, with minor side effects.

Cross-Sectional Study of Assessment of Predominance of Prakrutiamong Patients with Diabetic Neuropathy in Wardha City

India is a developing country, so much of the Indian subcontinent are converting into urban areas, which lead to changes in lifestyle involving major tourist in battery plateau physical activities and increasing mental stress, which leads to insulin inertia. Approximately 246 million people worldwide have diabetes mellitus. It is estimated that 20 to 30 million people globally suffer from symptomatic diabetic neuropathy. The prevalence of diabetic neuropathy also rises over time. If type 1 diabetes is not well controlled, severe diabetic polyneuropathy and poor glycemic control can appear in young adults just a few months after the disease manifests. Ayurveda can be correlated with MajjaDhatuDushti (Structural and functional defects of neurons). Identification of the predominance of a specific type of Prakrutiin patients with diabetic neuropathy in Wardha City. The prime objectives of the present study are to find out the predominance of specific Prakriti in patients with diabetic neuropathy in Wardhacity&amp;create awareness in them regarding complications of Diabetes mellitus, especially diabetic neuropathy and its relation with Prakruti. The current study was a cross-sectional study based on a personal interview of patients and Prakrutiquestionnaires. It occurred at Salod(H), Wardha, Maharashtra's Mahatma Gandhi Ayurved College, Hospital &amp; Research Center. It was found that the prevalence of diabetic neuropathy is high in PittajPradhanVataPrakruti. In this present study, most of the affected patients were male. The present study concludes that diabetic neuropathy was found more prevalently in patients with Pitta PradhanVataPrakruti. Specific lifestyle modifications can be recommended for patients with Prakriti, as mentioned earlier, to prevent diabetic neuropathy in the future. Keywords: , , , ,

Abstract PD8-06: Incidence of Acute and Persistent Clinically Meaningful Chemotherapy Induced Peripheral Neuropathy in Patients with Early-Stage Breast Cancer Receiving Taxane Therapy: SWOG S1714 (NCT# 03939481)

Abstract Background: Taxanes play an important role in the treatment of early-stage breast cancer. Chemotherapy induced peripheral neuropathy (CIPN) is a complication of taxane therapy and can lead to treatment dose reduction or discontinuation, which may ultimately affect overall survival, and can substantially impact quality of life and functional status in survivors. The trajectory of CIPN symptoms is not well described. Methods: SWOG S1714 enrolled participants 18 years or older with Stage I-III primary non-small cell lung, primary breast, or primary ovarian/fallopian tube/peritoneal cancer starting treatment with a taxane-based regimen. Participants with baseline neuropathy were eligible to enroll. Neuropathy was assessed with the patient-reported European Organization for Research and Treatment of Cancer QLQ-CIPN20 (CIPN-20). The occurrence of clinically meaningful sensory neuropathy was defined as an increase of 8 or more points (on a 0-100 scale, with a higher score indicating more severe symptoms) between baseline and follow-up in the sensory neuropathy subscale of the CIPN-20. Assessments occurred at baseline and at 4, 8, and 12 weeks +/- 14 days and 24, 52, 104, and 156 weeks +/- 28 days after registration. Results: Among N=1336 enrolled participants, 1321 were eligible (99%). Of the eligible participants, we will report on the 1198 (90.7%) with breast cancer. The median age was 55 years (range 23-84) and 99.3% were female. The breast cancer cohort included 72.2% White, 11.7% Black, 4.9% Asian, and 11.0% Hispanic/Latino participants. Paclitaxel (every week for 12 weeks or every 2 weeks for 8 weeks) was administered to 56.2% and docetaxel (every 3 weeks for 12-18 weeks) to 43.8%. The mean baseline patient-reported CIPN-20 sensory neuropathy subscale score was 6.2 (standard deviation 12.0). Through one full year of follow up, 1084 participants (90.5%) were evaluable for sensory neuropathy at any time point. At individual assessment times, clinically meaningful sensory neuropathy was reported by 18.7% of participants at week 4, 33.0% at week 8, 46.3% at week 12, 44.8% at week 24, and 47.4% at week 52. Clinically meaningful sensory neuropathy at one or more assessments was reported by 67.8% of participants. Conclusions: In this large prospective cohort of racially/ethnically diverse participants with breast cancer receiving taxane-based therapy, 2 out of every 3 experienced clinically meaningful sensory neuropathy symptoms during the first year of treatment and nearly 50% continue to experience clinically meaningful sensory neuropathy symptoms at the end of the first year. Given the high incidence of symptoms during taxane treatment and persistence of symptoms after treatment completion, it is critical to develop effective methods to predict, prevent, and treat this toxicity. Follow up of data at 104 and 156 weeks will further characterize the trajectory of long term CIPN symptoms. Funding: NIH/NCI/NCORP grant UG1CA189974 Citation Format: Meghna S. Trivedi, Joseph M. Unger, Dawn Hershman, Amy K. Darke, Daniel L. Hertz, Thomas H. Brannagan, Stephanie J. Smith, Bryan P. Schneider, William J. Irvin Jr, Amanda R. Hathaway, Amy C. Vander Woude, Vinay K. Gudena, N. Lynn Henry, Michael J. Fisch. Incidence of Acute and Persistent Clinically Meaningful Chemotherapy Induced Peripheral Neuropathy in Patients with Early-Stage Breast Cancer Receiving Taxane Therapy: SWOG S1714 (NCT# 03939481) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-06.

Abstract OT1-18-01: COMPARATIVE ANALYSIS BETWEEN ACUPUNCTURE AND EXERCISE IN IMPROVING DERMAL SENSITIVITY DURING PACLITAXEL-CONTAINING CHEMOTHERAPY: A RANDOMIZED CLINICAL TRIAL

Abstract OBJECTIVE: To compare skin sensitivity in patients diagnosed with breast cancer undergoing cycles of chemotherapy with taxanes, applied three different techniques, acupuncture needles, acupuncture with silicon tablets (Stiper) and kinesiotherapy. DESIGN: Randomized, controlled, open, parallel clinical trial. Inclusion criteria: women undergoing chemotherapy with taxanes from the 1st cycle onwards both neoadjuvant and adjuvant with stages I to III. Excluded were women with pre-existing diseases such as cancer in locoregional or distant activity, previous joint pain, rheumatologic diseases, and not undergoing chemotherapy containing Anthracyclines and/or Cisplatin, and those who had acupuncture in another service in the last three. METHODS: This study was carried out at the Oncomastology, Outpatient Clinic of the Mastology Discipline of the Gynecology Department of the Federal University of São Paulo (UNIFESP). 102 patients diagnosed with breast cancer. Excluded 39 patients,63 volunteers were selected and randomized, allocated to three groups (Group S:Stiper n=26, Group A Acupuncture n=18: and Group C: Kinesiotherapy n=19) to undergo treatment once a week for ten consecutive weeks. Signed the Informed Consent Form and agreed to participate in the project (ICF). INTERVENTION: Division of the groups, GS - non-invasive acupuncture technique (silicon pads covered with acrylic blanket) are used for stimulation of acupuncture points on the meridians. GA: acupuncture applied the technique with sterile, disposable systemic needles, (measuring 0.25mm x 30mm) for stimulation of the acupuncture points on the meridians. GC Kinesiotherapy, a physiotherapy technique consisting of upper and lower limb exercises and lower limb proprioception training and sensitivity improvement with vibration. GS, GA, performed acupuncture on the acupoints (B11Dazhu, SI14 Jianwaishu, CV12 Zhongwan, GB34 Yanglingquan, SP6 Sanyinjiao, LR3 Taichong), frequency of 1 time per week, for 10 consecutive weeks, duration of 30 minutes per session. To evaluate Sensitivity, the stesiometer was used, consisting of microfilaments thickness and the force (in grams) needed to bend the filaments, the colors and values are: green (0.05 g), blue (0.2 g), violet (2.0 g), dark red (4.0 g), orange (10.0 g) and magenta red (300 g).The evaluation of quality of life FACT/GOG-Ntx before and after treatment. RESULTS: The qualitative demographic characteristics of patients at the chemotherapy. Neoadjuvant Chemotherapy was predominantly in the three groups: GS(88.5%), GA(83.3%)and GC(89.5%), p=0.83. Cancer type CINE (Non-special Invasive Carcinoma), GS(92.6%), GA (93.8%) and GC (94.4%), p= 0.58. Diabetes Melittus GS(84.6%), GA(77.8%) and GC(79.8%), p=0.82 and Systemic Hypertension GS(72%), GA(72.2%) and GC(52.6%), p=0, 32. The C6D upper limb skin sensitivity assessment (p &amp;lt; 0.04 intergroup GS, GA and GC). T1D (p &amp;lt; 0.03 intergroup GS, GA and GC), corresponds to the forearm region. FACT/GOG-Ntx quality of life questionnaire in the domains (PWB, FWB and TaxS), Taxane Trial Outcome Index (TOI) comparing 1st session with 10th session p&amp;lt; 0.02, TaxS (Evaluates Symptoms of Chemotherapy Induced Peripheral Neuropathy) comparing 1st session with 10th session p&amp;lt; 0.03. Taxane total score) comparing 1st session with 10th session, p&amp;lt; 0.03. CONCLUSION: The C6 right hand and T1 right forearm sensitivity changes showed improvement in skin sensitivity after the intragroup intervention. FACT/GOG-Ntx questionnaire showed worsening of symptoms, physical, functional and peripheral neuropathy symptoms induced by chemotherapy compared to before and after. The cutaneous sensitivity of hands and feet remained stable and improved in the upper limbs, but chemotherapy had a negative impact on the quality of life, requiring further studies to evaluate the neuropathy of these patients. Keywords: Acupuncture, Chemotherapy, Quality of Life, Integrative and Complementary Practices.Table 1. Characteristics of skin sensitivity between groupsTable 1. Characteristics of skin sensitivity between groups Citation Format: ROBERTA P. COSTA LUZ, Carmen S. Alliz, Samantha K. Lopes de Almeida Rizzi, Cinira Haddad, Christiano Bittencourt Machado, Afonso Nazário, Gil Facina. COMPARATIVE ANALYSIS BETWEEN ACUPUNCTURE AND EXERCISE IN IMPROVING DERMAL SENSITIVITY DURING PACLITAXEL-CONTAINING CHEMOTHERAPY: A RANDOMIZED CLINICAL TRIAL [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-18-01.

Clinical Features of Peripheral Neurophaty among Onset Type 2 Diabestes Mellitus: A Michigan Neuropathy Screening Instrument (MNSI) Approach

Aims: Neuropathy is one of the complications that can occur in patients with Type 2 Diabetes Mellitus, around 21.3% to 34.5%. Untreated neuropathy can lead to diabetic foot ulcers that can lead to amputation. This can be prevented by conducting early detection using a neuropathy screening instrument. The study aimed to identify neuropathy symptoms through early examination of patients with type 2 diabetes using the Michigan Neuropathy Screening Instrument (MNSI). Method: The descriptive study with a survey was approached in this study. One hundred respondents with type 2 diabetes mellitus were selected using the purposive sampling technique. Results: The results showed that out of 100 patients had clinical symptoms of sensory neuropathy, such as pain and sensitivity disorders in the soles of the feet. In addition, autonomic neuropathy is in the form of cramps in the leg muscles. The level of neuropathy showed that from 100 patients, there were 59 respondents with low risk of neuropathy, 40 respondents with moderate risk, and 1 respondent with severe risk. Conclusion: Patients with Diabetes, primarily Type 2, have various neuropathy symptoms such as impaired nerve function: numbness, burning, and hypersensitivity, which can lead to diabetic foot ulcers. Therefore, early detection of neuropathy prevention is essential.

JAK 2 NEGATIVE POLYCYTHEMIA VERA IN A TERTIARY CARE CENTER IN WEST UP POPULATION IN INDIA :A RARE PRESENTATION OF 5 CASES

Introduction: Polycythaemia vera (PV) belongs to the group of myeloproliferative neoplasms with an excessive increase in hemoglobin levels.(1). It has been seen that JAK2 V617F mutation present in 80-90% of MPNs and JAK2 exon12 mutations are seen in 4%-5% cases of MPNs like PV.As per an Indian data the JAK2V617F mutational frequency in Indian population was 81.8% for PV, which was different from that reported in western literature as more than 95% for PV.Activation of JAK2 by either point mutation or fusion protein causes activation of the JAK-STAT pathway. While mutations in JAK2 are reported in numerous MPN phenotypes, exon 12 mutations specifically result in erythrocytosis due to increased EPO signalling. In India, the incidence of JAK2-negative polycythemia is relatively high, reaching up to 18%. (2,3) Case series: Case 1-A 21-year male presented to the hematology OPD with complains of paresthesias and off and on headache for the past 6 months. He was on multiple symptomatic medications but to no relief. On routine investigations it was seen that he had a persistent hemoglobin level fluctuating between 17.5gm/dl and 18.5 gm/dl. He has iron deficiency for which he is on single oral iron tablet. No definite organomegaly was seen. In hematology OPD he was investigated for polycythemia vera keeping in mind the WHO criterias.His Serum EPO levels are within normal range,JAK2 V617F/exon 12mutation analysis is negative.A bone marrow aspiration and biopsy study done shows Hypoplastic marrow for age with erythroid predominance. In view of clinical suspicion of JAK 2 negative PV he is being treated with ecosprin, phlebotomy every 3 months and supplemental iron orally. The patient is clinically relieved of his symptoms of peripheral neuropathy. His last hemoglobin value is stable at 16.5gm/dl.Case 2-A 32 -year male presented to hematology OPD with mild headache and weakness for 6 months. A routine CBC investigation showed a high hemoglobin level of 18.4 gm/dl. Mildly raised RBC count was also seen. A subnormal serum EPO levels of 3.7 mIU/Ml (4.3-29.0 mIU/ML) was seen. JAK 2V617F/exon 12 mutation analysis was negative. The patient has been started on ecosprin and phlebotomy every 3 months and is symptomatically relieved.Case 3- A 29-year male presented to hematology OPD with paresthesias and weakness for 3 months. A routine CBC investigation showed a high hemoglobin level of 19.7 gm/dl. Mildly raised RBC count was also seen. Rest all parameters were within normal limits. On examination no hepatosplenomegaly or lymphadenopathy was seen. A low serum EPO levels of &lt;1 mIU/Ml (4.3-29.0 mIU/ML) was seen. JAK 2V617F/exon12 mutation analysis was negative. The patient has been started on ecosprin and phlebotomy every 3 months and is symptomatically relieved. Case4-33 year male presented to OPD with fatigue and paresthesias.CBC showed increased hemoglobin of 18gm/dl.Patient was a non-smoker.Vitamin B12 was&gt;1000gm/dl.Bone marrow showed mildly predominant myeloid series.JAK2 mutation profile was negative but the patient responded to phlebotomy.Case5:A 28 year female had recurrent headaches however MRI and other investigations were normal. A serum EPO level done on suspicion of PV showed subnormal ranges.Bone marrow was reported as reactive.JAK2 mutation analysis was negative however patient responds to ecosprin and hyroxyurea. Conclusion-All five cases that presented to the department had been undiagnosed before they reached our setup. The unique feature of all these cases was negativity for both JAK2V617F as well as JAK2 exon 12 mutation despite its clinical behaviour being that of PV .These cases are being actively managed as low risk polycythemia vera and since the start of the treatment comprising of phlebotomy once every 3 months their hemoglobin and hematocrit concentrations are maintained.No cytoreductive therapy is being given .Such unique presentations need to be reported and discussed extensively.

JAK 2 NEGATIVE POLYCYTHEMIA VERA IN A TERTIARY CARE CENTER IN WEST UP POPULATION IN INDIA :A RARE PRESENTATION OF 5 CASES

Introduction: Polycythaemia vera (PV) belongs to the group of myeloproliferative neoplasms with an excessive increase in hemoglobin levels.(1). It has been seen that JAK2 V617F mutation present in 80-90% of MPNs and JAK2 exon12 mutations are seen in 4%-5% cases of MPNs like PV.As per an Indian data the JAK2V617F mutational frequency in Indian population was 81.8% for PV, which was different from that reported in western literature as more than 95% for PV.Activation of JAK2 by either point mutation or fusion protein causes activation of the JAK-STAT pathway. While mutations in JAK2 are reported in numerous MPN phenotypes, exon 12 mutations specifically result in erythrocytosis due to increased EPO signalling. In India, the incidence of JAK2-negative polycythemia is relatively high, reaching up to 18%. (2,3) Case series: Case 1-A 21-year male presented to the hematology OPD with complains of paresthesias and off and on headache for the past 6 months. He was on multiple symptomatic medications but to no relief. On routine investigations it was seen that he had a persistent hemoglobin level fluctuating between 17.5gm/dl and 18.5 gm/dl. He has iron deficiency for which he is on single oral iron tablet. No definite organomegaly was seen. In hematology OPD he was investigated for polycythemia vera keeping in mind the WHO criterias.His Serum EPO levels are within normal range,JAK2 V617F/exon 12mutation analysis is negative.A bone marrow aspiration and biopsy study done shows Hypoplastic marrow for age with erythroid predominance. In view of clinical suspicion of JAK 2 negative PV he is being treated with ecosprin, phlebotomy every 3 months and supplemental iron orally. The patient is clinically relieved of his symptoms of peripheral neuropathy. His last hemoglobin value is stable at 16.5gm/dl.Case 2-A 32 -year male presented to hematology OPD with mild headache and weakness for 6 months. A routine CBC investigation showed a high hemoglobin level of 18.4 gm/dl. Mildly raised RBC count was also seen. A subnormal serum EPO levels of 3.7 mIU/Ml (4.3-29.0 mIU/ML) was seen. JAK 2V617F/exon 12 mutation analysis was negative. The patient has been started on ecosprin and phlebotomy every 3 months and is symptomatically relieved.Case 3- A 29-year male presented to hematology OPD with paresthesias and weakness for 3 months. A routine CBC investigation showed a high hemoglobin level of 19.7 gm/dl. Mildly raised RBC count was also seen. Rest all parameters were within normal limits. On examination no hepatosplenomegaly or lymphadenopathy was seen. A low serum EPO levels of &lt;1 mIU/Ml (4.3-29.0 mIU/ML) was seen. JAK 2V617F/exon12 mutation analysis was negative. The patient has been started on ecosprin and phlebotomy every 3 months and is symptomatically relieved. Case4-33 year male presented to OPD with fatigue and paresthesias.CBC showed increased hemoglobin of 18gm/dl.Patient was a non-smoker.Vitamin B12 was&gt;1000gm/dl.Bone marrow showed mildly predominant myeloid series.JAK2 mutation profile was negative but the patient responded to phlebotomy.Case5:A 28 year female had recurrent headaches however MRI and other investigations were normal. A serum EPO level done on suspicion of PV showed subnormal ranges.Bone marrow was reported as reactive.JAK2 mutation analysis was negative however patient responds to ecosprin and hyroxyurea. Conclusion-All five cases that presented to the department had been undiagnosed before they reached our setup. The unique feature of all these cases was negativity for both JAK2V617F as well as JAK2 exon 12 mutation despite its clinical behaviour being that of PV .These cases are being actively managed as low risk polycythemia vera and since the start of the treatment comprising of phlebotomy once every 3 months their hemoglobin and hematocrit concentrations are maintained.No cytoreductive therapy is being given .Such unique presentations need to be reported and discussed extensively.

Demographic and Clinical Factors Associated with Depression in 140 Hospitalized Diabetic Patients with Distal Symmetric Polyneuropathy Evaluated Using Beck Depression Inventory and 6-Item Neuropathy Total Symptom Score Questionnaire.

BACKGROUND Diabetic distal symmetric polyneuropathy (DSPN) is one of the most common and costliest long-term complications. The pain and function limitations may lead to depression. This study aimed to assess the influence of demographic and clinical factors on the prevalence of depression among diabetic patients with distal symmetric polyneuropathy (DSPN). MATERIAL AND METHODS A total of 140 patients with diabetic DSPN completed the 21-item Beck Depression Inventory (BDI) measuring characteristic attitudes and symptoms of depression. The intensity of neuropathic complaints was assessed using the Neuropathy Total Symptom Score- 6 items (NTSS-6). Testing for peripheral neuropathy was performed. All patients completed questionnaires, which included anthropometric measures, social parameters, and medical aspects. Statistical analyses were done using STATISTICA 8 PL software. RESULTS Statistically significant relationships were found between the depression symptoms in diabetic patients and the intensity of subjective neuropathy symptoms evaluated by NTSS-6, body mass index (BMI), and education level. On average, each 1-point increase in NTSS-6 predicted a 16% increase in the risk of depression. Each 1 kg/m² increase in the BMI was associated with a 10% increase of depression risk. CONCLUSIONS The study showed the positive quantitative relationship between diabetic DSPN and depression symptoms. The BMI, severity of neuropathy symptoms, and lower level of education had a statistically significant association with the level of depression and may be useful in evaluating the risk of depression among DSPN patients.

A clinical observation of recurrent painful ophthalmoplegic neuropathy in a 49-year old female patient

Recurrent painful ophthalmoplegic neuropathy is a rare clinical syndrome, included into the International Classification of Headache Disorders, 3rd edition, and characterized by recurrent headache episodes associated with dysfunction of one or more ocular motor nerves. The diagnosis implies mandatory exclusion of other potential causes of the symptoms. The paper presents a clinical case of a 49-year old female patient with a unilateral headache paroxysms and subsequent paresis of the oculomotor nerve. A thorough clinical assessment, with neuroimaging (brain magnetic resonance imaging and magnetic resonance angiography of arteries and veins of the head) showed no morphological abnormalities that could cause clinical symptoms of oculomotor neuropathy. Her past history was remarkable for a similar episode of prolonged unilateral headache and oculomotor paresis about 10 years before, which were at that time considered as an acute cerebrovascular accident. Thus, two episodes of similar clinical signs of painful neuropathy, the absence of other possible causes of the disease, and the complete regression of symptoms after treatment (ibuprofen and gabapentin) confirmed the diagnosis of recurrent painful ophthalmoplegic neuropathy.

A Case of Subtype Giant Cell Arteritis Without Symptoms of Arteritic Anterior Ischemic Optic Neuropathy

Purpose: We report a case of papilledema without the typical symptoms of arteritic anterior ischemic optic neuropathy, ultimately diagnosed as a subtype of giant cell arteritis, which has not been reported previously in Korea.Case summary: A 72-year-old man visited the hospital with decreased visual acuity in his left eye of 0.02 that had occurred 1 week prior. Optic disc swelling and relative afferent pupillary disorder were also evident in the left eye. Magnetic resonance imaging revealed no specific findings, leading to a diagnosis of anterior ischemic optic neuropathy. Afterwards, there was no improvement in visual acuity, and optic nerve atrophy occurred. Six months later, the patient complained of decreased visual acuity in the contralateral eye; the same clinical findings as in the left eye were confirmed. Temporal artery biopsy was performed, ultimately revealing a subtype of giant cell arteritis.Conclusions: This case was finally diagnosed as a subtype of giant cell arteritis through temporal artery biopsy, despite the absence of typical clinical symptoms of this condition. Although giant cell arteritis is rare in Korea, it can cause permanent blindness. Therefore, the possibility of giant cell arteritis should always be considered with optic disc swelling in both eyes.

Self-Care Behavior of Type 2 Diabetes Patients with Symptoms of Peripheral Neuropathy during the Covid-19 Pandemic: A Qualitative Study

Purpose: This study aims to explore the experiences and perceptions of type 2 diabetes patients with symptoms of Diabetic Peripheral Neuropathy (DPN) in managing their self-care behavior during the COVID-19 pandemic. Methods: Qualitative research with a descriptive phenomenological approach reveals diabetes self-care behavior during the COVID-19 pandemic. Individual interviews were conducted at the participants’ homes with a semi-structured interview guide on twelve type 2 diabetes patients. All interviews were transcribed verbatim and analyzed using thematic content analysis. Results: A total of five themes were identified from the interview analysis, namely: 1) Perception of diabetes self-management; 2) Efforts to control blood sugar; 3) Barriers to blood sugar control; 4) Perceived disturbance; 5) Social support. Since its emergence, the Covid-19 pandemic has become a new obstacle in controlling blood glucose in diabetic patients. In addition to the covid-19 pandemic, negative spiritual coping, low self-motivation, and perceived physical effects are inhibiting factors for blood glucose control in type 2 diabetes patients with symptoms of DPN. Conclusions: Obstacles in efforts to control blood glucose in type 2 diabetes patients with symptoms of DPN include physical, psychological, social, and spiritual aspects. The suggestion in this study is that during the COVID-19 pandemic, it is necessary to adjust and modify diabetes self-management for patients with DPN symptoms. The interventions provided should not only focus on the physical aspect but also need holistic attention to the psychosocial and spiritual aspects simultaneously by involving family participation in the management of the patient’s diabetes.

Self-Care Behavior of Type 2 Diabetes Patients with Symptoms of Peripheral Neuropathy during the Covid-19 Pandemic: A Qualitative Study

Self-Care Behavior of Type 2 Diabetes Patients with Symptoms of Peripheral Neuropathy during the Covid-19 Pandemic: A Qualitative Study

Self-reported quality of life in symptomatic and asymptomatic women with X-linked adrenoleukodystrophy.

Up to 80% of women with X-linked adrenoleukodystrophy (X-ALD) develop symptoms of myelopathy and peripheral neuropathy during their lifetime. The study's objective was to compare symptomatic versus asymptomatic women with X-ALD regarding their physical and mental well-being and quality of life. Data were obtained from a prospective, international, cross-sectional cohort study of women with X-ALD recruited both clinically and population based. Symptoms, quality of life, and physical and mental co-morbidities were assessed by questionnaires. Women were considered symptomatic if they reported any sign of myelopathy or peripheral neuropathy. Group differences between symptomatic versus asymptomatic women and between age groups were examined using χ2 tests for categorical and independent sample t tests or analysis of variance for continuous variables. Complete data were available from N=180 women (mean age:51.2±13.6 years, range:18-85), of whom 71.7% were classified as symptomatic, with prevalence increasing with age. Symptomatic versus asymptomatic women reported poorer physical and mental health, with 26.4% meeting the criteria for a clinical depression, 73.6% reporting chronic pain, 80.6% sleeping disturbances, 38.2% sexual dysfunction, and 47.3% restless legs syndrome. Large group differences were found on the physical health, but not on the mental health component of quality of life, where symptomatic women only differed when controlling for having a boy affected by X-ALD (small effect) and treatment frequency (medium effect). Symptomatic women with X-ALD present with physical and psychological co-morbidities significantly reducing individuals' quality of life. The findings emphasize the need to develop new multi-disciplinary treatment options tailored to women's specific needs.

Emerging Nonpharmacologic Interventions to Treat Diabetic Peripheral Neuropathy.

Significance: Diabetic peripheral neuropathy (DPN), a complication of metabolic syndrome, type I and type II diabetes, leads to sensory changes that include slow nerve conduction, nerve degeneration, loss of sensation, pain, and gate disturbances. These complications remain largely untreatable, although tight glycemic control can prevent neuropathy progression. Nonpharmacologic approaches remain the most impactful to date, but additional advances in treatment approaches are needed. Recent Advances: This review highlights several emerging interventions, including a focus on dietary interventions and physical activity, that continue to show promise for treating DPN. We provide an overview of our current understanding of how exercise can improve aspects of DPN. We also highlight new studies in which a ketogenic diet has been used as an intervention to prevent and reverse DPN. Critical Issues: Both exercise and consuming a ketogenic diet induce systemic and cellular changes that collectively improve complications associated with DPN. Both interventions may involve similar signaling pathways and benefits but also impact DPN through unique mechanisms. Future Directions: These lifestyle interventions are critically important as personalized medicine approaches will likely be needed to identify specific subsets of neuropathy symptoms and deficits in patients, and determine the most impactful treatment. Overall, these two interventions have the potential to provide meaningful relief for patients with DPN and provide new avenues to identify new therapeutic targets.

STUDY OF NERVE CONDUCTION ABNORMALITIES IN ASYMPTOMATIC TYPE II DIABETIC INDIVIDUALS

Diabetic neuropathy occurs in 50% of individuals with long standing diabetes mellitus. It is the most dreadful microvascular complication of poorly controlled long standing diabetes mellitus, ending up in amputation in worst cases. It is signicantly associated with age, duration of diabetes, smoking and HbA1c. Neuropathy can cause sensory decit, neurological disorder, limb ulcers, osteomyelitis and lead to amputation. Nearly 50% of diabetic peripheral neuropathy is asymptomatic. Methods: 80 cases who were diabetic and without any symptoms of neuropathy were taken into the study and both motor and sensory nerve conduction studies were performed. Results:In this study, patterns of nerve conduction velocities show abnormal conduction patterns in 65% of individuals. Of these demyelinating axonal sensorimotor neuropathy is predominant (20%), followed by demyelinating sensorimotor (15%), axonal sensory (10%), demyelinating sensory (10%), demyelinating motor (5%), axonal sensorimotor (2.5%) and axonal motor (2.5%). Conclusions: Nerve conduction studies even in asymptomatic cases may prove to be valuable indices of progression to full blown diabetic neuropathy in due course and help initiate prophylactic measures to retard its progress

Association of C-peptide level with peripheral neuropathy in type 2 diabetes: An observational cross-sectional preliminary study

Backround and aimsPeripheral neuropathy is the most common microvascular complication of diabetes mellitus. In subjects with type 1 diabetes (T1D) relationship of C-peptide levels and neuropathy has been observed in several studies, however, there are very few studies in type 2 diabetes (T2D) subjects. In this study we aim to assess the association of C-peptide levels with peripheral neuropathy in Indian subjects with T2D. MethodOne hundred patients of T2D were included in this study. Clinical and laboratory parameter was assessed for all participants. The C-peptide level was measured by fluorometric enzyme immunoassay method. Assessment of diabetic peripheral neuropathy was based on diabetic neuropathy symptom score and the diabetic neuropathy examination scores. ResultsTotal 100 patients completed the study. Mean age of subjects was 60.03 years and male: female ratio was 1.17. Peripheral neuropathy was detected in 47% of subjects evaluated. Subjects were further divided in to neuropathy group and no-neuropathy group for analysis. Age in neuropathy group was significantly higher than no-neuropathy group [65.62 ± 10.5 vs 55.08 ± 9.41 yrs (p-value <0.0001)] and similarly duration of T2D was significantly higher in neuropathy group [10.11 ± 6.13 vs 4.16 ± 3.7 yrs (p-value <0.0001)]. Importantly mean fasting C-peptide (2.27 ± 0.98 vs 3.12 ± 0.84 ng/ml) and mean post meal C-peptide (4.27 ± 1.34 vs 5.33 ± 0.89 ng/ml) were significantly lower in neuropathy group compared to no-neuropathy group. An association of HbA1c level and neuropathy was statistically not significant (p = 0.793). ConclusionSerum C-peptide concentrations are associated with peripheral neuropathy in T2DM patients, independent of the degree of glycemic control.