Presence Of Neuropathy Research Articles

Sex Differences in Neuropathy and Neuropathic Pain in Long-Standing Diabetes—Results from the Canadian Study of Longevity in Type 1 Diabetes

Neuropathy and neuropathic pain are common complications in T1D. We aimed to determine if sex-specific differences in the prevalence of neuropathic pain and neuropathy exist in patients with longstanding T1D. In Phase 1 of the study, 361 Canadians with ≥50 years of T1D completed questionnaires which included subjective assessment for neuropathy defined by Michigan Neuropathy Screening Instrument Questionnaire score ≥3, termed NEUROPATHYMNSI-Q. In Phase 2 of the study, we studied a sub-cohort of 75 diabetes participants and 75 age- and sex-matched nondiabetic controls who completed objective neurological examinations which included assessment of abnormal nerve conduction studies (NCS) for neuropathy, termed NEUROPATHYNCS. In the Phase 1 cohort, more females than males reported neuropathic pain [87(42%) vs. 41(27%); p=0.003)], but the presence of neuropathy (NEUROPATHYMNSI-Q) did not differ by sex [87(42%) females vs. 66(43%) males, p=0.82], and thus neuropathic pain was independent of the presence of neuropathy [adjusted OR for neuropathic pain in females compared to males, 2.7 (1.4-5.0; p=0.002)]. In the Phase 2 participants, neuropathic pain was similar between the sexes (29% females vs. 21% males, p=0.43) while NEUROPATHYNCS was less prevalent among females (83% females vs. 97% males, p=0.05). Though not statistically significant, in a combined analysis of Phase 2 participants adjusted for NEUROPATHYNCS, females had a tendency to a higher adjusted OR for neuropathic pain compared to males [OR 2.0 (95% CI 0.8-4.7), p=0.11]. In conclusion, in patients with longstanding TID, neuropathic pain appears to be greater among females compared to males independent of the presence of neuropathy. Further research using larger datasets with objective neuropathy measures are required to further confirm and address these sex-specific differences. Disclosure N. Cardinez: None. L. Lovblom: None. J. Bai: None. A. Abraham: None. E.J. Lewis: Employee; Self; Nutarniq Corp. D. Scarr: None. J.A. Lovshin: Other Relationship; Self; AstraZeneca. Consultant; Self; Novo Nordisk Inc.. Research Support; Self; Sanofi, Merck Sharp & Dohme Corp.. Other Relationship; Self; Novo Nordisk Inc.. Y. Lytvyn: None. G. Boulet: Advisory Panel; Self; Medtronic, Sanofi, Novo Nordisk Inc.. Other Relationship; Self; Janssen Global Services, LLC., Abbott. M. Farooqi: None. A. Orszag: None. A. Weisman: None. H.A. Keenan: Research Support; Self; Sanofi. Employee; Self; Sanofi Genzyme. M.H. Brent: Research Support; Self; Novartis Canada. Advisory Panel; Self; Novartis Canada. Research Support; Self; Bayer Canada. Advisory Panel; Self; Bayer Canada, Allergan Canada. Research Support; Self; Roche Canada. N. Paul: None. V. Bril: Consultant; Self; Alexion Pharmaceuticals, Inc.. Research Support; Self; CSL Behring, Grifols. Advisory Panel; Self; CSL Behring. Consultant; Self; Grifols. Research Support; Self; Shire. Advisory Panel; Self; Pfizer Inc. D. Cherney: Consultant; Self; AbbVie Inc.. Other Relationship; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company. Consultant; Self; Sanofi. Other Relationship; Self; Merck & Co., Inc.. Consultant; Self; Mitsubishi Tanabe Pharma Corporation. Other Relationship; Self; Janssen Pharmaceuticals, Inc. B.A. Perkins: Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Boehringer Ingelheim GmbH, Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc., Abbott. Speaker's Bureau; Self; Abbott, Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Insulet Corporation. Speaker's Bureau; Self; Insulet Corporation, Dexcom, Inc..

Urinary symptoms in diabetes

Urinary symptoms in diabetes

MP27-06 RISK FACTORS ASSOCIATED WITH FECAL INCONTINENCE IN PATIENTS WITH OVERACTIVE BLADDER

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2018MP27-06 RISK FACTORS ASSOCIATED WITH FECAL INCONTINENCE IN PATIENTS WITH OVERACTIVE BLADDER Caitlin Lim, Joshua Cohn, Casey Kowalik, Melissa Kaufman, Roger Dmochowski, and W. Stuart Reynolds Caitlin LimCaitlin Lim More articles by this author , Joshua CohnJoshua Cohn More articles by this author , Casey KowalikCasey Kowalik More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , Roger DmochowskiRoger Dmochowski More articles by this author , and W. Stuart ReynoldsW. Stuart Reynolds More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.885AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Overactive bladder (OAB) and bowel conditions often occur together, and both can have profound effects on a woman′s quality of life. Treatment of OAB can impact bowel function as well, either negatively (e.g. constipation and antimuscarinics), or positively (e.g. reduced fecal incontinence, FI, with sacral neuromodulation). We sought to identify factors associated with FI in a community-based sample of women with OAB. METHODS Adult women with symptoms of OAB were identified via clinical practice and email-based advertisements. In all subjects, OAB was confirmed by a score of 4 on the OABv3 screening questionnaire. Standardized questionnaires assessed clinical characteristics, OAB severity (OAB-q8), quality of life (OAB-q SF HRQoL), and FI (Fecal Incontinence Severity Index, FISI). These data were compared between subjects with and without FI, defined as any leakage of mucus, liquid or solid stool at least monthly, and the association between OAB and FI severity assessed. RESULTS 101 (53%) participants reported having FI and 91 (47%) did not. Mean FISI scores were 27.9 ± 8.6 in those reporting FI and 5.5 ± 5.2 in those reporting no FI (p<0.001). Women reporting FI had more severe OAB (mean OABq8 SS: 47.5 ± 25.6 vs. 39.3 ± 21.2, p=0.017) and worse OAB-HRQL (59.6 ± 29.5 vs 69.3 ± 23.0, p=0.012). OAB severity (OABq8) (β 0.29, 95% 0.04-0.55) and OAB-related quality of life (OABq-SF HRQL) (β -0.33, 95% CI -0.61, -0.05) were significantly correlated with FISI scores. In addition to suffering from more severe OAB, women reporting any FI were older (mean age 46.8 ± 15.2 vs. 41.6 ± 14.0 years, p=0.015) and more likely to report suffering from neuropathy (p=0.013), spine or degenerative disc disease (p=0.003), irritable bowel syndrome (p=0.013), fibromyalgia (p=0.035), and chronic fatigue syndrome (p=0.044). CONCLUSIONS Over half of women with OAB reported at least monthly FI, which was associated with increased age and the presence of neuropathy, degenerative spinal disease, irritable bowel syndrome, and chronic pain syndromes. Furthermore, FI was associated with increased OAB symptom severity and decreased OAB condition-specific quality of life. In many patients, FI and OAB may be unique symptoms resulting from common pathophysiology, either due to pelvic organ or more global dysfunction. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e348 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Caitlin Lim More articles by this author Joshua Cohn More articles by this author Casey Kowalik More articles by this author Melissa Kaufman More articles by this author Roger Dmochowski More articles by this author W. Stuart Reynolds More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A survey of foot orthoses prescription habits amongst podiatrists in the UK, Australia and New Zealand

BackgroundFoot orthoses are frequently used but little is known about which types are used in contemporary practice. This study aimed to explore the types of foot orthoses currently used by podiatrists and the prescription variations in a range of conditions.MethodsA web-based, cross-sectional survey was distributed through professional bodies in the United Kingdom (UK), Australia, and New Zealand. Questions focussed on foot orthosis prescription habits in relation to 26 conditions affecting the back and lower limb.ResultsTwo hundred and sixty-four podiatrists practising in 19 different countries completed the survey; the majority practised in the UK (47%, n = 124), Australia (30%, n = 79) and New Zealand (12%, n = 32). Respondents qualified between 1968 and 2016, and 147 (56%) were female. Respondents worked in different healthcare sectors and this varied between countries: 42 (34%) respondents in the UK worked solely in the public sector, compared to 3 (4%) in Australia and 2 (6%) in New Zealand. Forty-four (35%) respondents in the UK worked solely in private practice, compared to 64 (81%) in Australia and 14 (44%) in New Zealand.UK respondents prescribed more prefabricated orthoses per week (mean 5.5 pairs) than simple insole-type devices (±2.7) and customised devices (±2.9). Similarly, respondents in New Zealand prescribed more prefabricated orthoses per week (±7.7) than simple (±1.4) and customised (±2.8) devices. In contrast, those in Australia prescribed more customised orthoses per week (±4.4) than simple (±0.8) and prefabricated (±1.9) orthoses. Differences in the types of orthoses prescribed were observed between country of practice, working sector, and the condition targeted. Generally, prefabricated orthoses were commonly prescribed for the 26 highlighted conditions in the UK and New Zealand. Australian podiatrists prescribed far fewer devices overall, but when they did prescribe, they were more likely to prescribe custom devices. Respondents in all three countries were more likely to prescribe customised orthoses for people with diabetes complicated by peripheral neuropathy than for diabetes without this complication.ConclusionsFoot orthosis prescription habits vary between countries. Prefabricated orthoses were frequently prescribed in the UK and New Zealand, and customised orthoses in Australia. Prescriptions for people with diabetes differed depending on the presence of neuropathy, despite a lack of robust evidence supporting these decisions. This study provides new insight into contemporary practice.

Assessment of the Podiatric Risk on Diabetics in Dakar Hospital Area: Cross-Sectional Study in Regard to 142 Patients

The prevention of diabetic foot goes through a systematic podiatric assessment of diabetic patients permitting to identify the foot at risk. Then, we realized a study in the Internal Medicine Department at Pikine Teaching Hospital in Dakar with the assessment of foot risk on admitted diabetic patients as our main objective. Methods: It was about a prospective cross-sectional, descriptive and analytic study done on 18 months period. Results: Overall, 142 patients were gathered. The average age was 56.22 years and the sex-ratio was 0.67. 87.2% of the patients were running type 2 diabetes. The capillary blood glucose and glycated hemoglobin were respectively around 3.24 g/L and 9%. High Blood Pressure was found in 62% of cases. The type of footwear most used by our patients was sandals (96.3%). Also, 30.6% of patients walked barefoot. Prior ulceration and/or amputation were noted in 30% of cases. During the foot examination, a lesion was found in 15.5% of patients. Loss of monofilament sensitivity was about 66.7%. The Ankle-Brachial Index (ABI) less than 0.9 was recorded in 34% of patients and at least a quarter of patients were posteriorly tibial pulselessness. The gradation of the foot risk according to the International Working Group of the Diabetic Foot (IWGDF) was established as follow: grade 0 (58%), grade 1 (9.8%), grade 2 (14.3%), grade 3 (17.3%). The presence of neuropathy (OR 12. 162 [3.368 - 43.923]; p = 0.000), plantar keratosis (OR 2.87 [1.119 - 7.399]; p = 0.024) and the absence of pulse perception (OR 9.00 [3.205 - 25.414]; p = 0.000) were significant associated factors of foot injury occurrence on our patients. Conclusion: The prevention of diabetic foot in emerging countries is accessible by a systematic clinical examination of all diabetic feet and the awareness of adapted footwear.

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion.

OBJECTIVE Given the increasing prevalence of obesity, more patients with a high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Thus, the purpose of this study was to compare surgical outcomes, postoperative narcotics consumption, complications, and hospital costs among BMI stratifications for patients who have undergone primary 1- to 2-level ACDF procedures. METHODS The authors retrospectively reviewed a prospectively maintained surgical database of patients who had undergone primary 1- to 2-level ACDF for degenerative spinal pathology between 2008 and 2015. Patients were stratified by BMI as follows: normal weight (< 25.0 kg/m2), overweight (25.0-29.9 kg/m2), obese I (30.0-34.9 kg/m2), or obese II-III (≥ 35.0 kg/m2). Differences in patient demographics and preoperative characteristics were compared across the BMI cohorts using 1-way ANOVA or chi-square analysis. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in visual analog scale (VAS) scores, incidence of complications, arthrodesis rates, reoperation rates, and hospital costs. Regression analyses were controlled for preoperative demographic and procedural characteristics. RESULTS Two hundred seventy-seven patients were included in the analysis, of whom 20.9% (n = 58) were normal weight, 37.5% (n = 104) were overweight, 24.9% (n = 69) were obese I, and 16.6% (n = 46) were obese II-III. A higher BMI was associated with an older age (p = 0.049) and increased comorbidity burden (p = 0.001). No differences in sex, smoking status, insurance type, diagnosis, presence of neuropathy, or preoperative VAS pain scores were found among the BMI cohorts (p > 0.05). No significant differences were found among these cohorts as regards operative time, intraoperative blood loss, length of hospital stay, and number of operative levels (p > 0.05). Additionally, no significant differences in postoperative narcotics consumption, VAS score improvement, complication rates, arthrodesis rates, reoperation rates, or total direct costs existed across BMI stratifications (p > 0.05). CONCLUSIONS Patients with a higher BMI demonstrated surgical outcomes, narcotics consumption, and hospital costs comparable to those of patients with a lower BMI. Thus, ACDF procedures are both safe and effective for all patients across the entire BMI spectrum. Patients should be counseled to expect similar rates of postoperative complications and eventual clinical improvement regardless of their BMI.

Patterns of finger sepsis and predictors of its outcome in patients with diabetic septic hand

The objectives of this study were to determine the different patterns of finger sepsis among diabetic patients, to know its different outcomes, and to detect the predictors of poor functional outcome (using the Sollerman hand function test). One hundred diabetic patients with finger sepsis were assessed using a prospective analytical hospital-based study, conducted in Khartoum Teaching Hospital and Jabir Abu Eliz Diabetic Centre (JADC) from October 2015 to October 2016. The most common pattern of finger sepsis was a superficial abscess (27.9%) followed by necrosis (27.1%), gangrene (14%), ulcers (11.5%), and cellulitis (6.3%). Finger sepsis spread to involve the hand in 39 patients (39%). Eighteen patients (18%) had an amputation of one or more fingers, and four patients (4%) had an amputation of the whole hand. Complete healing was the outcome in 82 (82%) patients. Twelve patients (12%) required reconstructive surgery and grafting. Forty-two patients (42%) presented with late complications such as stiffness, contractures, and deformities. Thirty-three patients (33%) had a Sollerman functional score below 80%. Poor control of diabetes, presence of neuropathy, low educational level, delayed presentation to hospital, and severe necrosis requiring surgical reconstruction were significant predictors of poor functional results of the hand (p value 0.05). The loss of more than one finger or the loss of the thumb resulted markedly in reduced hand function, compared to the loss of the middle or ring finger. Stiffness was an influencing factor in reducing hand function. It developed from severe tissue damage and prolonged periods of immobilization in a dressing which covered the whole hand. Finger sepsis among diabetics has different patterns and different outcomes. Better control of diabetes, early presentation to diabetic centers, and proper management of hand wounds will be in favor of good functional outcomes.

Relationship of planter pressure and glycemic control in type 2 diabetic patients with and without neuropathy

IntroductionFoot disease is a common complication of type 2 diabetes that can have tragic consequences. Abnormal plantar pressures are considered to play a major role in the pathologies of neuropathic ulcers in the diabetic foot. AimTo examine Relationship of Planter Pressure and Glycemic Control in Type 2 Diabetic Patients with and without Neuropathy. Materials and methodsThe study was conducted on 50 type 2 diabetic patients and 30 healthy volunteers. BMI calculation, disease duration, Hemoglobin A1c and presence of neuropathy (by history, foot examination and DN4 questionnaire) were recorded. Plantar pressure was recorded for all patients using the Mat-scan (Tekscan, Inc.vers. 6.34 Boston USA) in static conditions (standing) and dynamic conditions (taking a step on the Mat-scan). Plantar pressures (kPa) were determined at the five metatarsal areas, mid foot area, medial and lateral heel areas and medial three toes. ResultsStatic and dynamic plantar pressures in both right and left feet were significantly higher in diabetic with neuropathy group than in control group in measured areas (P<0.05). Static and dynamic pressures in right and left feet were significantly higher in diabetic with neuropathy group than in diabetic without neuropathy group in measured areas (P<0.05). On comparison between controls and diabetic without neuropathy group there was a significant difference in plantar pressures especially in metatarsal areas (P<0.05). No significant correlations were present between the studied variables age, disease duration, BMI and HbA1c and plantar pressures in all studied areas. ConclusionPersons with diabetic neuropathy have elevated peak plantar pressure (PPP) compared to patients without neuropathy and control group. HbA1c% as a surrogate for glycemic control had no direct impact on peak planter pressure, yet it indirectly impacts neuropathy evolution through out disease duration eventually leading to the drastic planter pressure and gait biomechanics changes.

Shoulder Adhesive Capsulitis in Type 1 Diabetes Mellitus: A Cross-Sectional Study on 943 Cases in Sardinian People.

Purpose To evaluate the prevalence of adhesive capsulitis (AC) of the shoulder in patients with type 1 diabetes mellitus (T1DM) in Sardinia. Methods In this cross-sectional study, we evaluated 943 patients with T1DM attending the division of Endocrinology and Metabolism at the University Hospital in Sassari, Italy. The criteria for diagnosing AC were: pain for at least 1 month, inability to lie on the affected shoulder, and restricted active and passive shoulder joint movements in at least three planes. Age, gender, duration of DM, blood pressure, and presence of neuropathy and retinopathy were noted. Metabolic control of DM was evaluated with glycosylated hemoglobin A1c (GHbA1c) blood concentrations. Results AC was diagnosed in 331 patients (prevalence: 35.1%). Age, duration of DM, high blood pressure levels, and the presence of neuropathy and retinopathy were significantly associated with AC. No significant association was observed between gender and AC. There was no significant difference in mean levels of GHbA1c in T1DM patients with or without AC. Conclusion This study shows that AC of the shoulder is a common disorder in patients with T1DM in Sardinia. It is significantly associated with age, duration of DM, and related complications. Level of Evidence Level IV, observational cross-sectional study.

Achilles Tendon in Diabetes.

Diabetes mellitus is one of the most common metabolic problems and is characterized by persistent hyperglycaemia. Exposure to chronic hyperglycaemia can affect many tissues including the Achilles Tendon, which is one of the largest tendons in the body. The current literature on the effects of hyperglycaemia on tendons is sparse, though evidence on rat models does suggest a process of chronic degeneration, which is increased in the presence of neuropathy and deformity. There is no epidemiological data on rupture of Achilles tendon in diabetes. Similarly, the knowledge of the best treatments for this condition in people with diabetes is also lacking. In this review we have systematically analysed current literature in this area and suggested future studies.

Psychological Factors Associated With Painful Versus Non-Painful HIV-Associated Sensory Neuropathy.

HIV-associated sensory neuropathy (HIV-SN) is a common, and frequently painful complication of HIV, but factors that determine the presence of pain are unresolved. We investigated: (i) if psychological factors associated with painful (n=125) versus non-painful HIV-SN (n=72), and (ii) if pain and psychological factors affected quality of life (QoL). We assessed anxiety and depression using the Hopkins Symptoms Checklist-25. Pain catastrophizing and QoL were assessed using the Pain Catastrophizing Scale and Euroqol-5D, respectively. Presence of neuropathy was detected using the Brief Neuropathy Screening Tool, and pain was characterised using the Wisconsin Brief Pain Questionnaire. Overall, there was a high burden of pain, depression and anxiety in the cohort. None of the psychological variables associated with having painful HIV-SN. Greater depressive symptoms and presence of pain were independently associated with lower QoL. In those participants with painful HIV-SN, greater depressive symptom scores were associated with increased pain intensity. In conclusion, in a cohort with high background levels of psychological dysfunction, psychological factors do not predict the presence of pain, but both depression and presence of pain are associated with poor quality of life.

An assessment of the patterns and severity of diabetic neuropathy using the modified - Toronto Clinical Neuropathy Score in recently detected diabetics

Introduction: Diabetic neuropathy is among the commonest vascular complication of diabetes mellitus. Even individuals with pre-diabetes are at risk of developing diabetic neuropathy (DN). Over 50% of individuals with DN are asymptomatic, keeping them at a higher risk of developing diabetic foot. The study aimed to ascertain the patterns and severity of diabetic neuropathy among patients with recently detected diabetes mellitus, using the ‘modified -Toronto Clinical Neuropathy Score’ (m-TCNS). Materials & methods: This prospective observational study was done on 50 patients with diabetes of less than 1 year duration. Patients who fulfilled the selection criteria were recruited to the study after obtaining a written informed consent. After obtaining details of their medical history, clinical examination and investigations, patients underwent m-TCNS. Laboratory tests included sugar levels, HbA1c and urine albumin. The incidence, severity and patterns of diabetic neuropathy (DN) and its correlation to the duration, diabetes control, presence of retinopathy and albuminuria were analyzed by descriptive statistics, Chi-square test and ‘t’ test. Results: Among the 50 patients, there were 18 males and 32 females with a mean (±SD) age of 56.44 (+10. 82) years. Among them, 29 patients were new to treatment for diabetes. The average random blood sugar (RBS) and glycated hemoglobin (HbA1c) were 249.92 (±126.63) mg/dl and 10.532 (±10.64) gm% respectively. Only 46% patients had symptoms and 34% had signs of diabetic neuropathy. Pain being the commonest symptom (24%) and loss of vibration sense the most frequent sign (26%) in these patients. Features of diabetic retinopathy and albuminuria were present in 6/50 (12%) and 20/50 (40%) patients respectively. The presence or severity of neuropathic signs or symptoms had no statistically significant correlation to their glycemic control. There was a significant correlation of presence of neuropathy with albuminuria and retinopathy. Conclusion: The study establishes the use of m-TCNS as a simple and good screening tool to detect diabetic neuropathy. Pain and loss of vibration sense were the most common symptom and sign in DN. The severity of neuropathy was mild in this study, but had a significant correlation with other microvascular complications. We recommend all newly detected patients with diabetes to undergo screening tests for its microvascular complications.

Association of risk factors with a major re-amputation in Malaysian diabetic patients: a retrospective cohort analysis of patient registry

This study aimed to determine the association of risk factors with a major re-amputation in Malaysian diabetes patients. This is a retrospective review and analysis of a patient cohort obtained from National Orthopedic Registry Malaysia (NORM) between June 2008 and December 2009. Re-amputation is defined as the removal of bones to advance to a higher level of amputation. An amputation can be regarded as a re-amputation if it is performed on the same limb within the same admission period and is also considered to be the final level of amputation. The plausible risk factors that are reported as importantly associated with the risk of re-amputation include patients’ baseline socio-demographic factors, clinical characteristics, and treatment outcomes, and these are analyzed both separately and together. A total of 137 patients were eligible for inclusion into the study. Only 23.4% of the total 137 patients were actually re-amputated. Baseline clinical characteristics such as the presence of neuropathy (p = 0.004), nephropathy (p = 0.005), and the topical application of emollient (p = 0.003) are found to be associated with requirement for a major re-amputation. Almost a quarter of patients who had an initial amputation will require a re-amputation. The patients who were at a particularly high risk of the need for re-amputation were those experiencing complications of diabetes such as nephropathy. Topical application of emollient is necessary to delay the need for re-amputation and if possible, avoid it altogether.

Identifying characteristics of women cancer survivors with a recent history of falls.

113 Background: Epidemiologic data suggest that fall rates are increased among women with a history of cancer compared to women never diagnosed with cancer. However, the unique characteristics of women cancer survivors who fall are not completely understood. Our study aimed to identify the demographic, clinical and physical attributes of women treated for cancer and who experienced falling in the past year. Methods: Secondary data analysis of baseline data from aging women cancer survivors (greater than 50 years of age) about to participate in clinical exercise trials (n = 611). Based on self-report of having fallen in the last year (yes/no), women were compared on the following: age, cancer type (breast vs. other), cancer stage, time since diagnosis, presence of neuropathy or pain, comorbidities, BMI, physical activity, maximal leg press strength, chair stand time, walk speed, gait patterns, and the short physical performance battery (sPPB). Stepwise regression was run to determine attributes significantly associated with fall history. Results: 28% of women reported falling in the last year (n = 173) and 79% of fallers experienced a related injury. Women cancer survivors who fell were significantly more likely than women who did not fall to have: not received chemotherapy (25% vs. 13%), higher morbidity scores (2.2 vs. 1.8), higher BMI (30.6 vs. 29.2 kg/m2), more neuropathy (49 vs. 39%), wider base of support (10.0 vs. 8.8 cm), more of the gait cycle spent in the stance phase (64 vs. 63%), longer chair stand times (12.8 vs. 11.9 sec.), and lower PPB scores (10.3 vs. 10.8). In stepwise regression models, receipt of chemotherapy, comorbidities, maximal leg strength, neuropathy, base of support, and % time in the stance phase of gait were significantly associated with the odds of having fallen in the last year. Conclusions: Women cancer survivors over 50 years old have a prevalence of falls approaching the 33% reported by the general population of women over 65; however, the rate of injurious falls is much higher in our sample of women cancer survivors. Fall prevention should be considered in women cancer survivors at an earlier age than usual for older women, particularly for survivors at higher risk for falls, and focus on exercise to improve gait and leg strength.

Addition of Cyclophosphamide and Higher Doses of Dexamethasone Do Not Improve Outcomes of Patients With AL amyloidosis Treated With Bortezomib

Addition of Cyclophosphamide and Higher Doses of Dexamethasone Do Not Improve Outcomes of Patients With AL amyloidosis Treated With Bortezomib

Association between the risk of falls and osteoporotic fractures in patients with type 2 diabetes mellitus.

Diabetes mellitus is associated with an increased risk of falls, which increases the incidence of osteoporotic fractures and accordingly decreases quality of life. However, the association between fall risk and diabetic complications is not completely understood. Therefore, the aim of this study was to examine the association between fall risk and osteoporotic fractures in patients with type 2 diabetes mellitus (T2DM). We enrolled 194 Japanese patients with T2DM and assessed their fall risk using a brief interview form that included five items covering physical and social aspects of functioning and environmental factors. We examined the associations between fall risk and the presence of diabetic complications, such as neuropathy, retinopathy, nephropathy, cardiovascular disease, cerebrovascular disease, peripheral artery disease (PAD), and osteoporotic fractures (including any fracture and vertebral fractures only). In the multivariate logistic regression analysis, a longer history of T2DM, the presence of neuropathy and PAD, and a history of any fractures were significantly and positively associated with the risk of falls. On the other hand, a lower body mass index, the presence of neuropathy, and the risk of falls were independently and positively associated with the risk of any fracture. When fractures were limited to vertebral fractures only, the association with the risk of falls remained significant. We found that the risk of falls and osteoporotic fractures were associated in patients with T2DM and that a brief screening test of the risk of falls was useful for assessing the risk of osteoporotic fractures.

Addition of Cyclophosphamide and Higher Doses of Dexamethasone Do Not Improve Outcomes of Patients with AL Amyloidosis Treated with Bortezomib

Treatment of AL amyloidosis is based on the elimination of the plasma cell clone that produces the amyloidogenic light chains. Typically, these are indolent clones and plasma cell burden is low, thus, even low dose, low toxicity, regimens may be very effective. Bortezomib is effective in targeting plasma cells. Several series have also shown that bortezomib either as single agent or in combinations, such as bortezomib with dexamethasone (VD) or with the addition of cyclophosphamide (VCD) induce high rates of hematologic CRs and organ responses. Patients with AL are frail due to multisystemic involvement and data from the treatment of frail patients with myeloma, usually elderly ones, have shown that addition of a third agent to VD does not improve outcomes and may increase toxicity. However, VCD is considered as a "standard" regimen for primary therapy of patients with AL, in most centers, but, it is not clear whether the addition of a third drug (cyclophosphamide) to bortezomib/dexamethasone (VD) further and significantly improves efficacy, given the substantial activity of bortezomib itself. Thus, we compared the outcomes of patients with AL amyloidosis who received (VD) or with VD plus a third agent (VCD). The analysis included 101 consecutive patients with biopsy confirmed AL amyloidosis, all diagnosed and treated in the Department of Clinical Therapeutics, Athens, Greece. All patients received similar supportive care and were treated in two consecutive periods (up to 2010 received VD and after 2011 received VCD). Median age was 65 years, 70% had cardiac and 71% renal involvement; Mayo stage was -1, -2 & -3 in 20%, 47% & 33% while renal stage was -1, -2 and -3 in 22%, 56% & 22% of the patients respectively. Treatment was VD in 59 (58%) and VCD in 42 (42%) patients. Compared to patients who received VCD, patients who received VD were older (median age 67 vs 60.5 years, p=0.024), were more often Mayo stage 3 (42% vs 29%, p=0.03), had lower eGFR (median 54 vs 86 ml/min/1.73 m2) but had similar distribution in renal stages. Heart, renal and nerve involvement were similar between those who received VD vs VCD (p>0.5 for all). According to our institutional guidelines for patients with AL amyloidosis schedule of bortezomib (twice per week vs weekly) and dexamethasone are adjusted to cardiac risk and presence of neuropathy. Weekly bortezomib was given in 41% of patients who received VD and vs 40% with VCD and the starting dose was 1.3 mg/m2 in 90% and 92.5% respectively. The median dose of dexamethasone for all patients was 160 mg/month, but for patients treated with VD was 240 mg/month and was 144 mg/month for those treated with VCD (p=0.01). Early mortality ( On intent to treat a hematologic response was achieved by 72% (CR:25%, VGPR:17% , PR: 30%) and was 68% for patients treated with VD and 78% for VCD (p=0.26); after adjustment for Mayo stage there was still no difference in response rates. Regarding CR+VGPR, it was 47.5% with VD and 35% with VCD. Notably higher doses of dexamethasone or twice-weekly bortezomib schedule were not associated with significantly higher hematologic response rates or CR+VGPR rates. Organ responses occurred in 35% of patients (cardiac in 26%, renal in 42%). For VD, cardiac response rate was 29% and renal response rate was 43%, while for VCD cardiac response was 21% and renal response was 41% (p>0.5 for all comparisons). Median follow up is 3 years and median overall survival (OS) is 34 months. Median OS of patients treated with VD vs VCD was similar (33 vs 36 months, p=0.45). After adjustment for the dose and schedule of bortezomib and dexamethasone, and Mayo stage, still there was no difference in the OS between patients treated with VD vs VCD and no prognostic effect of higher doses of dexamethasone and twice weekly bortezomib was found. In conclusion, our data indicate that bortezomib even with low doses of dexamethasone is effective for the treatment of AL amyloidosis; higher doses of dexamethasone and addition of a third agent (cyclophosphamide) does not seem to have a profound effect on efficacy and survival. Our data also indicate the limits of bortezomib-based therapies, and new agents either targeting the plasma cell clone (like monoclonal antiCD38) or targeting the amyloid deposits are needed. Disclosures Kastritis:Genesis: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Takeda: Consultancy, Honoraria. Terpos:Amgen: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy, Honoraria; Genesis: Consultancy, Honoraria, Research Funding; Novartis: Honoraria; Celgene: Honoraria. Dimopoulos:Novartis: Consultancy, Honoraria, Membership on an entity9s Board of Directors or advisory committees; Amgen: Consultancy, Honoraria, Membership on an entity9s Board of Directors or advisory committees; Celgene: Consultancy, Honoraria, Membership on an entity9s Board of Directors or advisory committees; Genesis: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Membership on an entity9s Board of Directors or advisory committees.

Newer anti-epileptic drugs, vitamin status and neuropathy: A cross-sectional analysis

ObjectiveWhether new antiepileptic drugs (AEDs) may result in neuropathy is unknown but possible given their effects on vitamin metabolism. This analysis aimed to determine frequency and correlates of neuropathy in subjects treated with new AEDs in relation to drug used, length of exposure and serum vitamin B12 and folate levels. MethodsWe performed a cross-sectional study of 52 consecutive epileptic subjects. Presence of neuropathy was determined using the Utah Early Neuropathy Score (UENS). Exposure to anti-epileptic drugs was quantified. Serum vitamin B12 and folate levels were measured. ResultsCommonly used AEDs were levetiracetam (28/52), carbamazepine (20/52), lamotrigine (20/52), sodium valproate (10/52) and zonisamide (10/52). Eight of 52 (15.4%) patients had neuropathy. There was no association with any particular AED. Neuropathy correlated with age (P=0.038) and total exposure to AEDs (P=0.032). UENS correlated with age (P=0.001), total AED exposure (P=0.001) and serum vitamin B12<240ng/L (P=0.018). Independent association of neuropathy was found with total AED exposure (P=0.032), but not age. UENS was independently associated with total exposure to AEDs (P<0.001), vitamin B12<240ng/L (P=0.002), but not age. Serum vitamin B12 and folate levels were highly inter-correlated (P<0.001). ConclusionsNeuropathy appears to be associated with the length of exposure to new AEDs. This may relate to the effects of new AEDs on vitamin B12 and folate metabolism. Although further research from controlled studies is needed and despite the presence of other possible confounding factors, monitoring for neuropathy and vitamin B12 and folate levels merits consideration in patients on long-term treatment with new AEDs.

Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy.

BackgroundThe association between long-term metformin use and low vitamin B12 levels has been proven. However, the prevalence estimates of metformin-induced vitamin B12 deficiency showed considerable variation among the studies. The potential of the deficiency to cause or worsen peripheral neuropathy in type-2 diabetes mellitus (T2DM) patients has been investigated with conflicting results. The aim of the study was to investigate: 1) the prevalence of vitamin B12 deficiency in T2DM patients on metformin; 2) the association between vitamin B12 and peripheral neuropathy; 3) and the risk factors for vitamin B12 deficiency in these patients.MethodsIn this cross-sectional study, consecutive metformin-treated T2DM patients attending diabetes clinics of two public hospitals in South Africa were approached for participation. Participation included measuring vitamin B12 levels and assessing peripheral neuropathy using Neuropathy Total Symptom Score-6 (NTSS-6) questionnaire. The prevalence of vitamin B12 deficiency (defined by concentrations <150 pmol/L) was determined. Those with NTSS-6 scores >6 were considered to have peripheral neuropathy. The relationship between vitamin B12 and peripheral neuropathy was investigated when the two variables were in the binary and continuous forms. Multiple logistic regression was used to determine risk factors for vitamin B12 deficiency.ResultsAmong 121 participants, the prevalence of vitamin B12 deficiency was 28.1 %. There was no difference in presence of neuropathy between those with normal and deficient vitamin levels (36.8 % vs. 32.3 %, P = 0.209). Vitamin B12 levels and NTSS-6 scores were not correlated (Spearman’s rho =0.056, P = 0.54). HbA1c (mmol/mol) (OR = 0.97, 95 % CI: 0.95 to 0.99, P = 0.003) and black race (OR = 0.34, 95 % CI: 0.13 to 0.92, P = 0.033) were risk factors significantly associated with vitamin B12 deficiency. Metformin daily dose (gram) showed borderline significance (OR = 1.96, 95 % CI: 0.99 to 3.88, P = 0.053).ConclusionsClose to third of metformin-treated T2DM patients had vitamin B12 deficiency. The deficiency was not associated with peripheral neuropathy. Black race was a protective factor for vitamin B12 deficiency.

High osteoprotegerin is associated with development of foot ulcer in type 1 diabetes

Background and aimThe bone-related peptide osteoprotegerin has been linked to vascular calcification and peripheral vascular disease. We investigated the association between osteoprotegerin and development of foot complications in persons with type 1 diabetes. Materials and methodsProspective observational study of 573 persons with type 1 diabetes, 225 women; age [mean±SD] 42.3±10.3years. Plasma osteoprotegerin was measured by ELISA. ResultsMedian (IQR) osteoprotegerin was 2.80(2.35–3.63)μg/L and follow-up time (median (range)) was 12.7(0.1–15.6)years. Endpoints included: new foot ulceration (n=153), Charcot foot (n=14), vascular surgery/amputation (n=53), loss of foot pulse (n=57), and peripheral neuropathy (n=99). In unadjusted analyses, higher osteoprotegerin was associated with development of all endpoints (p≤0.026). Higher osteoprotegerin remained associated with development of foot ulcer, and the combination of vascular surgery/amputation, loss of foot pulse and neuropathy (p≤0.001) in a sex and age adjusted model. After further adjustment (nephropathy status, smoking, HbA1c, systolic blood pressure, serum cholesterol, high sensitivity C-reactive protein, eGFR, and presence of neuropathy and/or claudication and/or foot ulcer at baseline), higher osteoprotegerin remained associated with development of foot ulcer (HR (95% CI) per doubling: 1.75 (1.04–2.97); p=0.037). ConclusionHigher osteoprotegerin levels were associated with development of foot ulcer, even after comprehensive adjustment.