Peripheral Neuropathy Score Research Articles

A single-center retrospective review of the impact of cryotherapy on peripheral neuropathy scores in patients with breast cancer who received chemotherapy with a taxane-based treatment regimen.

e24106 Background: Taxanes are a class of chemotherapy frequently used for neoadjuvant and adjuvant treatment of breast cancer. While effective, taxane use is not without adverse effects, the most well-known being chemotherapy-induced peripheral neuropathy (CIPN). As CIPN is dose-related, it can lead to dose reductions and interruptions in therapy that may be detrimental to the patient. Cryotherapy has been used as a prevention strategy, but its efficacy remains unclear. Methods: We performed a retrospective review of the cryotherapy program in our center. Included patients had breast cancer of any stage treated with a taxane in the neoadjuvant or adjuvant setting. All patients were offered cryotherapy at the time of their treatment and were separated into cohorts whether they opted in or out (“cryotherapy” and “non cryotherapy,” respectively). Neuropathy scores were collected by nursing staff via survey and scaled from 0-4. Patient demographics and neuropathy scoring were compared between the “cryotherapy” and “non cryotherapy” cohorts. Results: In total, 41 patients were included. Nearly half of patients in each cohort experienced neuropathy, 10 patients (41.7%) treated with cryotherapy and 8 patients (47.1%) without cryotherapy use. Younger age (46.5 years vs 57 years, p = 0.060), and patients using Medicaid (35.3% vs 75.0%, when compared to all other insurance types, p = 0.023) predicted cryotherapy use. Use of paclitaxel also predicted cryotherapy used when compared to docetaxel (76.0% and 31.2%, respectively, p = 0.009). There was not a significant difference in predicted neuropathy score between the cohorts (Adjusted Multiplicative Effect = .81, 95% CI = .34-1.96, p = .645). Conclusions: Our data did not suggest that the use of cryotherapy could predict lower neuropathy scores, but our study suffered from small sample size and short-duration of follow-up. Additional large, randomized trials with standard neuropathy scoring scales are needed to better evaluate the efficacy of cryotherapy in prevention of CIPN for breast cancer patients receiving taxane-based therapy.

The Effect of Peripheral Neuropathy on Disability and Anxiety.

One of the most common problems in individuals receiving neurotoxic chemotherapy is neuropathy. The study aimed to evaluate the peripheral neuropathy and the relationship between neuropathy, disability, and anxiety in patients receiving neurotoxic chemotherapy. The sample of the study consisted of individuals with cancer in the chemotherapy unit of a city hospital between March and July 2021. The study was conducted in 180 patients who underwent at least three cycles of neurotoxic chemotherapy and agreed to participate. The Introductory Information Form, Brief Disability Questionnaire, Beck Anxiety Inventory, and Common Terminology Criteria for Adverse Events were used to collect data. The prevalence of peripheral neuropathy in patients undergoing neurotoxic chemotherapy was 73.3% in this study. According to the severity of peripheral neuropathy, disability and anxiety scores of the patients showed a significant difference (p < .001). A positive, moderate significant correlation was determined between the scores for anxiety and disability. The variables affecting the neuropathy levels of individuals receiving chemotherapy were determined as marital status (odds ratio=0.239), number of cycles (odds ratio=0.125), and anxiety levels (odds ratio=1.076). The results of the present study indicated that the frequency of neuropathy was high and the severity of neuropathy was associated with anxiety and disability levels. According to the holistic approach, the physical and psychosocial effects of neuropathy should be evaluated.

Impact of pain and adverse health outcomes on long-term US testicular cancer survivors.

No study has quantified the impact of pain and other adverse health outcomes on global physical and mental health in long-term US testicular cancer survivors or evaluated patient-reported functional impairment due to pain. Testicular cancer survivors given cisplatin-based chemotherapy completed validated surveys, including Patient-Reported Outcomes Measurement Information System v1.2 global physical and mental health, Patient-Reported Outcomes Measurement Information System pain questionnaires, and others. Multivariable linear regression examined relationships between 25 adverse health outcomes with global physical and mental health and pain-interference scores. Adverse health outcomes with a β^ of more than 2 are clinically important and reported below. Among 358 testicular cancer survivors (median age = 46 years, interquartile range [IQR] = 38-53 years; median time since chemotherapy = 10.7 years, IQR = 7.2-16.0 years), median adverse health outcomes number was 5 (IQR = 3-7). A total of 12% testicular cancer survivors had 10 or more adverse health outcomes, and 19% reported chemotherapy-induced neuropathic pain. Increasing adverse health outcome numbers were associated with decreases in physical and mental health (P < .0001 each). In multivariable analyses, chemotherapy-induced neuropathic pain (β^ = -3.72; P = .001), diabetes (β^ = -4.41; P = .037), obesity (β^ = -2.01; P = .036), and fatigue (β^ = -8.58; P < .0001) were associated with worse global mental health, while being married or living as married benefited global mental health (β^ = 3.63; P = .0006). Risk factors for pain-related functional impairment included lower extremity location (β^ = 2.15; P = .04) and concomitant peripheral artery disease (β^ = 4.68; P < .001). Global physical health score reductions were associated with diabetes (β^ = -3.81; P = .012), balance or equilibrium problems (β^ = -3.82; P = .003), cognitive dysfunction (β^ = -4.43; P < .0001), obesity (β^ = -3.09; P < .0001), peripheral neuropathy score (β^ = -2.12; P < .0001), and depression (β^ = -3.17; P < .0001). Testicular cancer survivors suffer adverse health outcomes that negatively impact long-term global mental health, global physical health, and pain-related functional status. Clinically important factors associated with worse physical and mental health identify testicular cancer survivors requiring closer monitoring, counseling, and interventions. Chemotherapy-induced neuropathic pain must be addressed, given its detrimental impact on patient-reported functional status and mental health 10 or more years after treatment.

IDF21-0105 Serum Vitamin B12 In Relation To Anemia And Neuropathy By MNSI Among Type 2 Diabetes Mellitus Adults On Metformin

Background: Type 2 diabetes mellitus (T2DM) patients on metformin (the first line therapy to treat T2DM) are prone to have low serum B12 as evident from western literature. There is limited evidence from India regarding the same. Symptoms of B12 deficiency can manifest as hematological and neurological manifestations. The study was planned to understand the association of B12 deficiency, anemia and neuropathy among T2DM patients on metformin. Aim: To assess the magnitude of B12 deficiency and study it in relation to anemia and peripheral neuropathy (PN) among T2DM patients on metformin. Method: A hospital based cross sectional survey of 245 T2DM adults on metformin from a tertiary health care hospital of Delhi was conducted for PN assessment by Michigan Neuropathy Screening Instrument (MNSI). After meeting the inclusion and exclusion criteria, 155 subjects gave fasting blood samples for estimation of Vitamin B12, HbA1c,Hemoglobin and cell morphology by chemiluminescent enzyme immunoassay (C.L.I.A), HPLC and C.B.C respectively. Results: The prevalence of B12 deficiency (B12≤200pg/ml) was 52% among T2DM adults on metformin. Odds Ratio of B12 deficiency and vegetarian diet was 2.33(C.I. 1.22-4.47) (p<0.05). Anemia was present in 40% but it was not associated with B12 deficiency as there were no cases of macrocytic anemia. The prevalence of PN was 38% by PN score ≥2.5 and the mean PN scores was 2.14 ± 1.98.There was 39.2% low grade PN (PN score > 0 ≤ 2.5) followed by high grade PN (34.3%) (PN score >2.5).By Receiver Operating Curve (ROC) analysis serum B12 has shown fair test performance in predicting PN scores of 2.25 (p<0.001). Discussion: The prevalence of vitamin B12 deficiency in T2DM adults on metformin in our study is higher than that reported in other countries. The higher prevalence of B12 deficiency in our study (52 %) is not stunning owing to the higher prevalence of vitamin B12 deficiency in general population in India. The prevalence of B12 deficiency in T2DM patients in our study is more than other Indian studies on metformin. This study showed that though metformin lowers serum B12 but this had no impact on hematological parameter (hemoglobin and cell morphology) assessed in our study. Similar results have been reported by an Indian study and study from the other country. In our study the vitamin B12 deficiency was associated with PN in T2DM adults on metformin which is similar to the finding of a multi centric study from an Asian country Pakistan and several studies from other countries It can be said from our study that vitamin B12 test has fair chance of predicting PN among T2DM patients on metformin and taking a decision regarding which patients should be referred to a neurologist for electrophysiological studies. Conclusions: Metformin use was associated with biochemical B12 deficiency but not with clinical B12 deficiency as none had macrocytic anemia. Those who were B12 deficient were probable to have PN scores of 2.5 by MNSI physical assessment score. Serum B12 screening and use of MNSI for PN is recommended in T2DM patients on metformin.

DF21-0668 Bariatric Surgery Induced Weight Loss Relation to Peripheral Neuropathy by Sudoscan: Clinical Study

Background: Obesity is a risk factor for peripheral neuropathy (PN). PN is found in subjects with diabetes, pre-diabetes and metabolic syndrome. Bariatric surgery (BS) – most successful obesity treatment results in stable weight loss. Though, BS impact on PN is unknown. Aim: To investigate impact of weight loss on PN in type 2 diabetes (T2DM) post-BS by Sudoscan. Method: A male (51yrs), T2DM diagnosed 8yrs ago; pre-operative examination results: weight-145 kg, BMI-42kg/m2, HbA1c-10.2%, T/A -150/90mmHg (on ACE/Amlodipine); vitamins D/B12 - within the normal range. Patient was on intensive insulin therapy (sol. Glulisine, short-acting insulin/SAI+ sol. Glargine, long-acting insulin/LAI): LAI - 24 IU/at bedtime; SAI-12x12x12 IU / before main meals. Neuropathy tests/BNT (monofilament, tip-term, vibration tests) were moderately positive; Sudoscan revealed moderate PN (scores 50 feet/48 hands). Diagnosis: T2DM, diabetic neuropathy, obesity class III, AH II. Treatment: BS (sleeve-gastrectomy) was performed; dietary therapy, multivitamins, calcium citrate, iron, vitamins D/ B12 were initiated post-operatively. Results: Post-operatively weight loss and glycemic profile improved, insulin doses gradually reduced, finally insulin and antihypertensive therapy were stopped. Post-operative examination results (month 3): HbA1c-6.7%, BMI-33.2kg/m2, T/A -130/80 mmHg; no symptoms of high ABP and/or hyperglycemia. Neuropathic complains and test scores improved: BNT - weak positive; by Sudoscan - moderate neuropathy (scores 55 feet/50 hands). Vitamins D/B12 and ionized calcium levels - within normal range. Patient was physically active. Dietary therapy/physical activity continued. Examination results (month 6): HbA1c-5.9%, BMI-28.9kg/m2, T/A - 120/70 mmHg. BNT results - weak positive; by Sudoscan - moderate neuropathy (scores 68 feet/56 hands). Treatment: dietary therapy, physical activity, calcium citrate, vitamins D/B12, multivitamins. Examination results (month 12): HbA1c-5.4%, BMI-26.5kg/m2, T/A -125/70 mmHg; general condition - satisfactory, mood/motivation – high; no PN symptoms; weight loss continued. BNT were near normal; no neuropathy by Sudoscan (scores 75 feet/68 hands). Discussion: The case study shows positive impact of weight loss on glycemia control, ABP and PN. Data of some research indicate positive effect weight loss on diabetic/non-diabetic PN. Further studies are necessary to approve these findings.

The impact of vitamin D supplementation on peripheral neuropathy in a sample of Egyptian prediabetic individuals.

Background: Vitamin D deficiency is seen more frequently in diabetic patients with distal symmetrical polyneuropathy. Unfortunately, there is a shortage of data concerning prediabetic individuals with peripheral neuropathy (PN). Therefore, we aimed to study the association of vitamin D deficiency with PN severity and to determine the effect of vitamin D supplementation on PN in prediabetics. Methods: A case-control study was conducted consisting of 89 prediabetic individuals with PN and a control group of prediabetics without PN, recruited from the outpatient department of the National Institute of Diabetes and Endocrinology, Cairo, Egypt. All patients were screened for PN using clinical examination and Douleur Neuropathique 4 diagnostic questionnaire (DN4). Group A (with PN) was assessed for neuropathic severity using the Short-Form McGill Pain Questionnaire (SF-MPQ). In addition, 25-hydroxyvitamin D, ionized calcium, phosphorus, parathyroid hormone (PTH), glycated hemoglobin (HbA1c), fasting blood glucose (FBG), 2-hour post 75g glucose (2h-PPBG) and lipid profile were measured for both groups. Prediabetic patients with PN were given vitamin D3 200.000 IU IM monthly for three months. After three months, clinical assessment, DN4, SF-MPQ and all laboratory measures were repeated. Results: Vitamin D was not associated with the severity of PN patients. However, supplementation of vitamin D resulted in a highly significant improvement in glycemic parameters , p≤0.001. Interestingly, neuropathy score and severity before vitamin D supplementation were (6.4±1.6 and 28.3±7.2) and after became (2.5±0.9 and 17±6.3, p≤0.001). Conclusion: Correction of vitamin D deficiency in prediabetics with PN as well as hypovitaminosis D, improves glycemic parameters, PN score and severity.

The impact of vitamin D supplementation on peripheral neuropathy in a sample of Egyptian prediabetic individuals.

Background: Vitamin D deficiency is seen more frequently in diabetic patients with distal symmetrical polyneuropathy . Unfortunately, there is a shortage of data concerning prediabetic individuals with peripheral neuropathy (PN). Therefore, we aimed to study the association of vitamin D deficiency with PN severity and to determine the effect of vitamin D supplementation on PN in prediabetics. Methods : A case-control study was conducted consisting of 178 prediabetic individuals recruited from the outpatient department of the National Institute of Diabetes and Endocrinology, Cairo, Egypt. All patients were screened for PN using clinical examination and Douleur Neuropathique 4 diagnostic questionnaire (DN4). They were divided into 89 patients with and 89 patients without PN (group A and B). Group A was assessed for neuropathic severity using the Short-Form McGill Pain Questionnaire (SF-MPQ). In addition, 25-hydroxyvitamin D, ionized calcium, phosphorus, parathyroid hormone (PTH), glycated hemoglobin (HbA1c), fasting blood glucose (FBG), 2-hour post 75g glucose (2h-75g glucose) and lipid profile were measured. Prediabetic patients with PN were given vitamin D3 200.000 IU IM monthly for three months. After three months, clinical assessment, DN4, SF-MPQ and all laboratory measures were repeated. Results: Vitamin D level was negatively correlated with neuropathy score and severity (r = -0.65, -0.47, p <0.001) among group A. Moreover, vitamin D level was an independent predictor of neuropathic severity (odds ratio -0.18, 95% CI -0.33 -0.03, P ≤ 0.05). Supplementation of vitamin D resulted in a highly significant improvement in glycemic parameters and lipid profile, p ≤ 0.001. Interestingly, neuropathy score and severity before vitamin D supplementation were (6.4 ± 1.6 and 28.3 ± 7.2) and after became (2.5 ± 0.9 and 17 ± 6.3, p ≤ 0.001). Conclusion: Vitamin D deficiency is an independent risk factor for PN. Correction of vitamin D deficiency improves glycemic parameters, PN score and severity.

Effect of reflexology on ankle brachial index, diabetic peripheral neuropathy, and glycemic control in older adults with diabetes: A randomized controlled trial

ObjectiveThe purpose of this study was to determine the effect of foot reflexology on ankle brachial index, diabetic peripheral neuropathy and glycemic control in older adults with diabetes. MethodsA randomized controlled, parallel-group trial study was conducted at the outpatient elderly health center in Bolu, Turkey. 48 adults aged 65 and over enrolled in the elderly health center were randomized into two groups in a ratio of 1:1 (experimental, n = 24; control, n = 24). Foot reflexology was performed for 12-week in the experimental group, whereas the control group continued their routine treatment and follow-up. The outcome measures included: (1) ankle brachial index, (2) diabetic peripheral neuropathy measured by a comprehensive foot exam, and (3) glycemic control by a glycated hemoglobin A blood test at baseline and after 12 weeks. ResultsPost-test diabetic peripheral neuropathy scores (p < 0.001) and glycated hemoglobin A levels (p = 0.002) decreased in the experimental group and increased in the control group. There was no significant between-group difference regarding post-test ankle brachial index scores (p = 0.726). Foot reflexology had a medium effect size on diabetic peripheral neuropathy (95% confidence interval 0.003–2.24; d = 0.51; p < 0.001) and glycated hemoglobin A (95% confidence interval 0.72–1.22; d = 0.52; p = 0.002). ConclusionsA foot reflexology practice can be a useful for improving the glycemic control and diabetic peripheral neuropathy in the older adults with diabetes. Trial registration numberNCT04416503.

Spontaneous Internal Anal Sphincter Relaxation During High-resolution Anorectal Manometry Is Associated With Peripheral Neuropathy and Higher Charlson Comorbidity Scores in Patients With Defecatory Disorders.

Background/AimsWe aimed to evaluate associations between comorbidities, peripheral neuropathy, and spontaneous internal anal sphincter relaxation (SAR) in patients with defecatory disorders.MethodsA patient was considered to exhibit SAR during high-resolution anorectal manometry (HR-ARM) when the nadir pressure is < 15 mmHg and the time from onset to relaxation was ≥ 15 seconds in the resting pressure frame. A case-control study was performed using HR-ARM data collected from 880 patients from January 2010 to May 2015. We identified 23 cases with SAR (median age 75 years; 15 females; 12 fecal incontinence and 11 constipation). We compared HR-ARM values, Charlson index comorbidity scores, neuropathy, and the prevalence of diseases that potentially cause neuropathy between controls and SAR patients. Each SAR case was compared to 3 controls. Controls were selected to match the age, gender, and examination year of each SAR case.ResultsCompared to controls (26.1%), SAR patients (52.2%) exhibited a significantly higher frequency of fecal incontinence. SAR patients also had higher Charlson index scores (5 vs 4, P = 0.028). Nine of 23 SAR patients (39.1%) exhibited peripheral neuropathy— this frequency was higher than that for the control group (11.6%; P = 0.003). Diseases that potentially cause neuropathy were observed in 17 of 23 SAR cases and 32 of 69 controls (P = 0.022).ConclusionsSAR develops in patients with constipation and fecal incontinence but is more common in patients with fecal incontinence. Our controlled observational study implies that SAR is associated with peripheral neuropathy and more severe comorbidities.

Nocturia in Women With Type 2 Diabetes Mellitus: A Cross-sectional, Correlation Study.

The first aim of this study was to compare nighttime voiding frequency (nocturia), serum hemoglobin A1c level, peripheral neuropathy score, and global sleep quality score in younger (>40 to <65 years) versus older (≥65 years) women with type 2 diabetes mellitus (DM). Additional aims were to identify factors associated with clinically relevant nocturia (≥2 episodes/night) and to analyze relationships between nocturia frequency, glycemic control, peripheral neuropathy, and sleep quality in these women. Cross-sectional study. Participants were 118 women older than 40 years and with type 2 DM. Their mean age was 65.25 (SD = 9.66) years; the mean duration since diagnosis of type 2 DM was 10.96 (SD = 7.66) years. The study setting was 2 metabolism and endocrinology outpatient departments located in Taipei City and Taoyuan, Taiwan. Data were collected using a questionnaire that queried sociodemographic information, lower urinary tract symptoms, and sleep quality. We also assessed peripheral neuropathy and lower extremity edema and obtained pertinent information from participants' medical records. Independent t tests, multivariate logistic regression analyses, Spearman's rank correlation coefficients, and one-way analysis of variance were used to address the 3 study aims. Analyses found that older women (aged ≥65 years) had a significantly higher nighttime voiding frequency, a higher peripheral neuropathy score, and a higher sleep quality score than younger (>40 to <65 years) women. Multivariate logistic regression analyses identified 4 factors associated with clinically relevant nocturia advanced age, elevated hemoglobin A1c level, suspected peripheral neuropathy, and lower extremity edema. Significant correlation coefficients were found between nighttime voiding frequency and serum hemoglobin A1c levels, peripheral neuropathy scores, and sleep quality scores. Analyses also found that women with a greater nocturia frequency had higher hemoglobin A1c levels, peripheral neuropathy scores, and sleep quality scores. Healthcare professionals should screen for nocturia in women with type 2 DM and provide appropriate management for those experiencing nocturia.

Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy

PurposeSevere peripheral neuropathy is a common dose-limiting toxicity of taxane chemotherapy, with no effective treatment. Frozen gloves have shown to reduce the severity of neuropathy in several studies but comes with the incidence of undesired side effects such as cold intolerance and frostbite in extreme cases. A device with thermoregulatory features which can safely deliver tolerable amounts of cooling while ensuring efficacy is required to overcome the deficiencies of frozen gloves. The role of continuous-flow cooling in prevention of neurotoxicity caused by paclitaxel has been previously described. This study hypothesized that cryocompression (addition of dynamic pressure to cooling) may allow for delivery of lower temperatures with similar tolerance and potentially improve efficacy.MethodA proof-of-concept study was conducted in cancer patients receiving taxane chemotherapy. Each subject underwent four-limb cryocompression with each chemotherapy infusion (three hours) for a maximum of 12 cycles. Cryocompression was administered at 16 °C and cyclic pressure (5–15 mmHg). Skin surface temperature and tolerance scores were recorded. Neuropathy was assessed using clinician-graded peripheral sensory neuropathy scores, total neuropathy score (TNS) and nerve conduction studies (NCS) conducted before (NCSpre), after completion (NCSpost) and 3 months post-chemotherapy (NCS3m). Results were retrospectively compared with patients who underwent paclitaxel chemotherapy along with continuous-flow cooling and controls with no hypothermia.ResultsIn total, 13 patients underwent 142 cycles of cryocompression concomitant with chemotherapy. Limb hypothermia was well tolerated, and only 1 out of 13 patients required an intra-cycle temperature increase, with no early termination of cryocompression in any subject. Mean skin temperature reduction of 3.8 ± 1.7 °C was achieved. Cryocompression demonstrated significantly greater skin temperature reductions compared to continuous-flow cooling and control (p < 0.0001). None of the patients experienced severe neuropathy (clinician-assessed neuropathy scores of grade 2 or higher). NCS analysis showed preservation of motor amplitudes at NCS3m in subjects who underwent cryocompression, compared to the controls who showed significant deterioration (NCS3m cryocompression vs. NCS3m control: ankle stimulation: 8.1 ± 21.4%, p = 0.004; below fibula head stimulation: 12.7 ± 25.6%, p = 0.0008; above fibula head stimulation: 9.4 ± 24.3%, p = 0.002). Cryocompression did not significantly affect taxane-induced changes in sensory nerve amplitudes.ConclusionWhen compared to continuous-flow cooling, cryocompression permitted delivery of lower temperatures with similar tolerability. The lower skin surface temperatures achieved potentially lead to improved efficacy in neurotoxicity amelioration. Larger studies investigating cryocompression are required to validate these findings.

The Correlation between Malondialdehyde and Nerve Growth Factor Serum Level with Diabetic Peripheral Neuropathy Score.

AIM:This study was conducted to identify malondialdehyde (MDA) serum level, nerve growth factor (NGF) serum level, diabetic peripheral neuropathy score and the correlation between MDA and NGF serum level with diabetic peripheral neuropathy score.METHODS:A cross-sectional study was conducted to observe diabetic patients in the internal medicine department in Dr M. Djamil Hospital, Padang, Indonesia. The MDA serum level was measured using Beuge method with thiobarbituric acid. The NGF serum level was analysed using ELISA method. Diabetic peripheral neuropathy score was defined when history score in Michigan Neuropathy Screening Instrument (MNSI) ≥ 7 and physical assessment score in MNSI > 2.RESULTS:Thirty subjects with diabetes has diabetic peripheral neuropathy score 3.53 (± 0.91), MDA serum level 2.16 (± 2.89) nmol/ml, and NGF serum level 10.56 (± 2.89) pg/dl. There were significant correlations between the MDA serum level and the diabetic peripheral neuropathy score (r = 0.364, p = 0.048), and between the NGF serum level with the diabetic peripheral neuropathy score (r = -0.59, p = 0.001).CONCLUSION:There are high MDA serum level and low NGF serum level in patients with diabetic peripheral neuropathy. Low NGF serum level plays a bigger role than high MDA serum level in diabetic peripheral neuropathy.

DIAGNOSTIC TEST OF POLYNEUROPATHY SCORE, 10-G SEMMES WENSTEIN MONOFILAMENT (SWM) AND VIBRATION PERCEPTION TRESHOLD (VPT)-QUANTITATIVE SENSORY TESTING (QST) IN DISTAL SENSORY POLYNEUROPATHY (DSP)-HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Background: HIV/AIDS is a worldwide pandemic. Peripheral neuropathy is the most common neurologic complication with distal sensory polyneuropathy (HIV-DSP) as the most frequent form of manifestation. HIV-DSP is one of the major causes of global pain morbidity and often undiagnosed earlier, resulting in treatment given when HIV-DSP grade is already severe. Early detection is imperative to prevent the progression of HIV-DSP and improve patient’s quality of life. Polyneuropathy score, 10-g Semmes-Weinstein Monofilament (SWM) and vibration perception threshold (VPT)-quantitative sensory testing (QST) are considered to be potential candidates for HIVDSP screening tool. Objective: To measure the reability of Polyneuropathy Score, SWM and VPT- QST in diagnosing HIV-DSP. Methods: This research is a descriptive study with cross-sectional design. Research was conducted on 77 patients of HIV/AIDS outpatient clinic in RS Saiful Anwar (RSSA) during November 2016 - April 2017 (n = 77). Patients were screened for HIV-DSP by using polyneuropathy score, such as: Michigan Neuropathy Screening Instrument (MNSI), Toronto Clinical Scoring Sysytem (TCSS), Brief Peripheral Neuropathy Score (BPNS), SWM, and VPT-QST. Sensitivity, specificity, positive predictive value and negative predictive value of BPNS, TCSS, MNSI, SWM and VPT-QST are analyzed using cross tabulation. Area under receiver operating characteristic (ROC) curve analysis was used to measure diagnostic accuracy of each tools. SPSS 19.0 was used for statistical analysis. Results: TCSS had a sensitivity, specificity, positive predictive value, negative predictive value positive likelihood ratio, negative likelihood ratio, and accuracy as much as: 70%, 97%, 97%, 74%, 23,33, 0,28 and 83%. The result of TCSS analysis using ROC showed that TCSS had excellent diagnostic value with AUC (Area Under Curve) of 0.89 (95%CI 82%-96,5%). The AUC of BPNS score, monofilamen and VPT-QST respectively: 0,469, 0,194, and 0,189. Conclusion: The result of the HIV-DSP diagnostic test using TCSS score has the best value compared to other tools.

Prevalence of Peripheral Neuropathy and its Related Factors in Diabetic Children, Neishabour City, Iran

Background One of themost common metabolic diseases is diabetes mellitus (DM), which its prevalence is growing trend. Early diagnose peripheral neuropathy (DPN) in early stages of patients with DM contributes to metabolic control and prevents severe complications. We aimed to determine the prevalence of peripheral neuropathy (PN) and its related factor in Diabetic children. Materials and Methods This cross-sectional study was performed among 60 children with diabetes (type 1) who referring the pediatric endocrinology clinic of Hakim Hospital, Neyshabur city, Iran, in 2016. The neurological symptom score was used for the assessment of neurological features. Neuropathy disability score (NDS) was obtained from the examination of vibration perception (by means of a 128-Hz tuning fork). Peripheral vascular examination was also carried out via evaluating dorsalis pedis and posterior tibial pulses by a neurologist. Results The mean age of the children was 10.8±3.38 years. About 56.2% of the patients were female. Diabetic peripheral neuropathy (DPN) score was moderate in 6.7% of the children and it was mild in 38.3% of them. In general, 23% of the children with hemoglobin A1C (HbA1c) higher than the normal range had PN. Assessment of the degree of DPN based on duration of diabetes showed a significant difference among the participants (P=0.05). The study of HbA1C rate based on different degrees of DPN showed a significant difference (P=0.001). In addition, we found a significant difference in FBS score between the children with DPN and children without it (P=0.01). Conclusion According the results, more than 23% of children with diabetes had DPN, and the duration of diabetes was a related factor in PN. Therefore, neurological assessment including nerve conduction studies and meticulous physical examination should be performed for evaluating the function of large sensory and motor fibers.

The prevalence and associations of erectile dysfunction in a South African male diabetic urban population

Background: Erectile dysfunction (ED) is a common condition in patients with type 1 or type 2 diabetes mellitus. The prevalence and predictors in our patient population are unknown since minimal data exist for this condition in South Africa.Method: An observational, cross-sectional study was performed on 150 consecutive male patients aged ≥ 50 years, with either type 1 or type 2 diabetes mellitus, attending the Steve Biko Academic Hospital Diabetes Clinic. These patients were evaluated for diabetes mellitus control and medical complications, and for the presence of ED. Morning serum testosterone levels were determined.Results: Some degree of ED was reported in 95% of the patients, with 51% reporting serious dysfunction. Using multivariate logistic regression, it was determined that the significant factors associated with ED were age, body mass index, the peripheral neuropathy score and diuretic therapy. Differences in quality-of-life scores were seen in some ED subgroups.Conclusion: This study confirms th...

Comparing and Validating Simple Measures of Patient-Reported Peripheral Neuropathy for Oncology Clinical Trials: NCCTG N0897 (Alliance) A Pooled Analysis of 2440 Patients.

Current standard evaluation of Peripheral Neuropathy (PN) is based on an investigator-reported classification system that is commonly unable to correctly reflect the subjective symptoms for patients. Thus more reliable methods to assess PN are needed. This study assessed alternative methods of assessing patient-reported PN in 5 North Central Cancer Treatment Group (NCCTG) clinical trials. Two single-item assessments relating to numbness and tingling were used to measure PN. Patients' Quality Of Life (QOL) was also assessed using the Uniscale, Symptom Distress Scale (SDS), Profile of Mood States (POMS), Brief Pain Inventory (BPI) and Subject Global Impression of Change (SGIC). Wilcoxon tests compared QOL scores between patients with PN (score > 50) vs. no PN (score ≤ 50). Changes from baseline in QOL were compared by Wilcoxon rank sum test with a 20-point change in PN defined as clinically meaningful. Both distribution-based and anchor-based approaches were used to derive estimates of Minimal Important Differences (MID). Standardized Response Means (SRM), Effect Sizes (ES) and Guyatt's responsiveness statistic were used to measure responsiveness. The proportion of patients reporting numbness (tingling) at baseline was 10.7% (10.0%) and 18.4% (17.8%) at last assessment. The correlation between numbness and tingling at baseline was 0.81, and at last assessment was 0.83. Patients with substantial PN reported an average of 10 points lower overall QOL, mood and worse symptom distress and 20 points lower in the BPI interference items. Patients having a ≤ 20 point worsening in PN score reported significantly worse in symptom distress and BPI worst pain, but not in POMS or overall QOL. The MID estimates were similar between numbness and tingling items but varied depending on the approach used. Responsiveness statistics indicated that the two PN assessments are sensitive and responsive instruments for cancer patients with PN. The two PN items for numbness and tingling were redundant. Evidence of criterion validity and responsiveness indicates that these simple measures of PN can be used successfully in cancer clinical trials.

Effect of Vitamin E on Oxaliplatin-induced Peripheral Neuropathy Prevention: A Randomized Controlled Trial.

Background:Peripheral neuropathy is one of the most important limitations of oxaliplatin base regimen, which is the standard for the treatment of colorectal cancer. Evidence has shown that Vitamin E may be protective in chemotherapy-induced peripheral neuropathy. The aim of this study is to evaluate the effect of Vitamin E administration on prevention of oxaliplatin-induced peripheral neuropathy in patients with colorectal cancer.Methods:This was a prospective randomized, controlled clinical trial. Patients with colorectal cancer and scheduled to receive oxaliplatin-based regimens were enrolled in this study. Enrolled patients were randomized into two groups. The first group received Vitamin E at a dose of 400 mg daily and the second group observed, until after the sixth course of the oxaliplatin regimen. For oxaliplatin-induced peripheral neuropathy assessment, we used the symptom experience diary questionnaire that completed at baseline and after the sixth course of chemotherapy. Only patients with a score of zero at baseline were eligible for this study.Results:Thirty-two patients were randomized to the Vitamin E group and 33 to the control group. There was no difference in the mean peripheral neuropathy score changes (after − before) between two groups, after sixth course of the oxaliplatin base regimen (mean difference [after − before] of Vitamin E group = 6.37 ± 2.85, control group = 6.57 ± 2.94; P = 0.78). Peripheral neuropathy scores were significantly increased after intervention compared with a base line in each group (P < 0.001).Conclusions:The results from this current trial demonstrate a lack of benefit for Vitamin E in preventing oxaliplatin-induced peripheral neuropathy.

Retinopathy, nephropathy, peripheral neuropathy and geriatric scale scores in elderly people with Type 2 diabetes

To analyse the relationships between retinopathy, nephropathy, peripheral neuropathy and geriatric scale scores in elderly people with Type2 diabetes. GERODIAB is the first French multi-centre, prospective, observational study designed to assess the influence of glycaemic control on mortality and morbidity through a 5-year follow-up study in people with Type2 diabetes aged 70years and older. In this report the relationships at baseline between retinopathy, nephropathy and peripheral neuropathy, and five geriatric scale scores in 987 people, using bivariate and multivariate analyses are analysed. Retinopathy (26%) was significantly associated with impaired scores on the Mini Geriatric Depression Scale, the Mini Nutritional Assessment and the Instrumental Activities of Daily Living scale. Logistic regression showed that the duration of diabetes, BMI, Mini Geriatric Depression Scale, hypoglycaemia and HbA1c were associated with retinopathy (concordance 69.1%; P<0.001). Nephropathy (47.4%, including 34.8% with Modification of Diet in Renal Disease <60ml/min) was significantly associated with impaired Activities of Daily Living and Instrumental Activities of Daily Living scale scores. Using the logistic model, the most significant factors were age, duration of diabetes, triglycerides, HDL cholesterol, hypoglycaemia, hypertension and BMI (concordance 66.3%; P<0.001). Peripheral neuropathy (28.2%) was associated with impaired scores on the Mini Mental State Examination, Activities of Daily Living, Instrumental Activities of Daily Living and Mini Geriatric Depression Scales. In the logistic model, diastolic blood pressure, duration of diabetes and the Instrumental Activities of Daily Living, Mini Geriatric Depression Scale and Mini Mental State Examination scales were included (concordance 69.8%; P<0.001). In this specific sample, classical microvascular complications of diabetes were found to be associated with impaired geriatric scale scores. This highlights the benefits of systematic assessment in elderly people with Type2 diabetes.

Medical and Psychological Risk Factors for Incident Hypertension in Type 1 Diabetic African-Americans

Objective. To determine risk factors for the development of hypertension among African-Americans living with type 1 diabetes. Methods. African-Americans with type 1 diabetes (n = 483) participated in a 6-year followup. At both baseline and followup blood pressure was measured twice in both sitting and standing positions using a standard protocol. Patients had a structured clinical interview, ocular examination, retinal photographs, and blood and urine assays and completed the Hostility and Direction of Hostility Questionnaire (HDHQ) and the Beck Depression Inventory (BDI). Results. Of the 280 diabetic patients with no hypertension at baseline, 82 (29.3%) subsequently developed hypertension over the 6-year followup. Baseline older age, longer duration of diabetes, family history of hypertension, greater mean arterial blood pressure, overt proteinuria, increasing retinopathy severity, peripheral neuropathy, smoking, and higher hostility scores were significantly associated with the development of hypertension. Multivariate analyses showed that higher hostility scores and overt proteinuria were significantly and independently associated with the development of hypertension in this population. Conclusions. The development of hypertension in African-Americans living with type 1 diabetes appears to be multifactorial and includes both medical (overt proteinuria) as well as psychological (high hostility) risk factors.

Prevalence of painful diabetic peripheral neuropathy among patients suffering from diabetes mellitus in Saudi Arabia

Objective:To determine the prevalence of painful diabetic peripheral neuropathy in adult patients with diabetes mellitus (type 1 and 2) attending outpatient clinics in Saudi Arabia and to determine the demographic profile and pharmaceutical management of these patients.Research design and methods:Eligible patients from 100 outpatient clinics treating patients with diabetes mellitus across Saudi Arabia completed an epidemiologic questionnaire to obtain demographic information and medication history. Following this, the validated DN4 pain questionnaire was used to identify the presence of painful diabetic peripheral neuropathy (score of ≥4).Results:A total of 1039 patients were enrolled. Following the DN4 pain questionnaire, an overall prevalence of painful diabetic peripheral neuropathy of 65.3% (n = 678) was found. The age of patients, their sex, and the duration of underlying diabetes were found to be statistically significant factors in the development of painful diabetic peripheral neuropathy. No statistically significant difference was found between smoking history, body mass index, or racial origin and presence of painful diabetic peripheral neuropathy. On initial evaluation, 42.3% (n = 440) stated they were receiving treatment for pain. Following evaluation using the DN4 pain questionnaire, the number prescribed therapeutic pain management increased to more than two thirds (68.7%, n = 714) of which 62.3% (n = 579) were prescribed pregabalin.Conclusions:In patients with reduced pain intensity DN4 has not been directly compared with other tools to measure neuropathic pain; however, using the DN4 in this study 65.3% of adult outpatients with type 1 and 2 diabetes in Saudi Arabia were found to have painful diabetic peripheral neuropathy; far higher than anticipated.