Prevalence Of Neuropathy Research Articles

Changes over time in the cardiovascular risk profile of type 2 diabetes from 2007 to 2020: A community-based study.

To quantify changes over time in cardiovascular (CV) risk factor control and in the uptake of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors from 2007 to 2020 in a real-world community-based cohort of type 2 diabetes (T2D) patients. This study identified 95 461 T2D patients, who were followed for an average of 6.4 years through a single healthcare organization's electronic health record. The primary outcome was global risk factor control according to four factors ("ABCS"): glycated haemoglobin (HbA1c [<8%]); Blood pressure (systolic/diastolic <140/90 mmHg); Cholesterol (non-HDL cholesterol <130 mg/dL); and Smoking (not). Concomitant presence of microvascular complications and commonly used medication classes were tracked. According to the ABCS metric, global risk factor control did not appreciably change over time; in 2020, 40.9% (95% confidence interval 40.2, 41.5) of patients had all four factors controlled. Among individual components, HbA1c control (<8%) worsened over time from 84% in 2007 to 78% in 2020, while lipid control (non-HDL cholesterol <130 mg/dL) improved from 59% to 72%. Coexisting microvascular complications were more prevalent over time; for example, neuropathy prevalence increased from 21% (2007) to 35% (2020). Use of thiazolidinediones and sulphonylureas decreased over time while metformin, insulin, dipeptidyl peptidase-4 inhibitor, GLP-1RA and SGLT2 inhibitor use increased. In 2020, GLP-1RAs and SGLT2 inhibitors were each used by 13% of T2D patients. In this community-based study, global CV risk factor control in T2D did not improve, although glycaemic control worsened and lipid control improved. Given increased uptake of GLP-1RAs and SGLT2 inhibitors, the collective effect of these changes on CV outcomes warrants evaluation.

IDF21-0196 Study of peripheral arterial disease among type 2 diabetes mellitus patients

Background: Diabetes is a complex chronic metabolic disorder, characterized by persistent hyperglycemia because of lack of insulin secretion, insulin resistance, or both. Peripheral arterial disease (PAD) is one of the major recognised diabetic macro vascular complications. It is a marker of generalised systemic atherosclerosis and is closely associated with symptomatic coronary and cerebrovascular disease, hence significant morbidity and mortality. Aim: To study the various risk factors contributing to development of peripheral arterial disease in adult type2 diabetic patients and vasculopathy profile. Method: This was a retrospective analytical descriptive study conducted at internal medicine department on 13 months. Forty-seven type 2 diabetic patients were included. All patients underwent a detailed history which included age, gender, smoking intake, history of diabetes mellitus with duration and treatment. Biochemical characteristics were studied. Diagnosis of PAD was made by using color Doppler ultrasound. The statistical analysis was carried out using Epi-Info7. Results: The study was conducted on 47type2 diabetic patients with a mean age of 66±10 years with male predominance (77%) compared to females (23%). Mean duration of diabetes mellitus was15±9 years. Majority of patients were on insulin (n=22;46.81%). Eleven patients (23.40%) were on combined insulin and OHA. and ten were on oral hypoglycemic agents (OHA) (21.28%). Sixteen (34%) patients were cigarette smokers. Regarding hypertension status, 24 (51.06%) patients were hypertensive. Metabolic syndrome was prevalent in twenty patients, with mean of BMI 25±5 kg/m2. PAD was prevalent in 38(80.85%) patients. Of these, there were 27(57.45%) obliterating arteriopathy of the lower limbs,20(42.55 %) had mediacalcinosis, 10 (21.28 %) had acute arterial occlusion, 8 (17.02%) stenosis, and 2(4.26 %) arterial thrombosis. The prevalence of neuropathy was 46.81% (n=22) and diabetic foot was present in all patients (n=47) of patients. Regarding biochemical parameters: mean of fasting blood glucose was 1.73±0.76g/l, mean of post prandial blood glucose 2.45±0.77g/l, mean of HBA1C 9±3%, mean of HDLc 0.32±0.14 g/l, mean of triglycerides1.56±1.29g/l, mean of creatinine clearance according MDRD equation was 69±41 ml/min/1.73m2, mean of protein C reactive in this population was 88±80mg/l. Discussion: The increasing burden of diabetes is considered as one of the greatest global public health problem of our time. Diabetic patients with PAD are at high risk of increased morbidity and mortality from cardiovascular diseases and a high rate of lower extremity amputation. Various risk factors like age, gender persistant hyperglycemia, increased glycated hemoglobin, smoking and hypertension, and dyslipidaemia are associated with an increased risk of peripheral artery disease. This study documents a high prevalence of PAD among adult type2 diabetic patients. This strongly calls for aggressive screening for PAD be emphasised.

IDF21-0476 Macrovascular complications in type 1 diabetes mellitus patients with over 25 years of disease

Background: Macrovascular complications (MvC) are the most common cause of death in people with diabetes. Intensive glycemic control has proven to reduce its incidence in diabetes mellitus type 1 (T1DM). However, as for the general population, there are other factors influencing the development of cardiovascular disease. Aim: In a sample of T1DM patients with 25 years of disease: to evaluate the prevalence of MvC; to analyze the relationship between the development of MvC and several factors; to analyze the relationship between macrovascular and microvascular complications. Method: We performed a retrospective study based on the clinical files of T1DM patients with over 25 years of disease. Information was gathered regarding years of disease, average A1C per patient for each five year time period (A-A1C), types of treatment and complications. Statistical analysis was performed with SPSSv23, using: qui-square test for categorical variables, t-test (if normal distribution) or Mann-Whitney (if non-normal distribution) for continuous variables and Kaplan-Meier curves. The results were considered statistically significant if p<0,05. Results: The sample was constituted by 43 patients, 60,5% female, average age 52,6±1,5 years and average duration of T1DM 35,1±1,0 years. Arterial hypertension was present in 60,5% and dyslipidemia in 83,7%. The prevalence of MvC was 39,5% (average time for first MvC 29,4±2 years after diagnosis): 23,3% coronary heart disease; 20,9% heart failure; 20,9% peripheral artery disease and 9,3% cerebrovascular disease. All the patients were treated with intensive insulin therapy (median beginning time 1±7,5 years after diagnosis); 88,4% used functional insulin therapy (average start 19,5±2,0 years after diagnosis); 46,5% used subcutaneous continuous insulin perfusion (average start 21,7±1,5 years after diagnosis). A-A1C analysis was difficulted by several missing values, specially from the initial years of disease. However we observed that patients with MvC tended to have greater A-A1C values in most time periods, without statistical significance. The group with MvC had a longer course of disease (p=0,036) and predominance of the male gender (p=0,036). The patients with arterial hypertension had more (p=0,003) and more precocious (p=0,022) MvC. There were also more MvC in the patients with dyslipidemia (p=0,019). There was a tendency towards more prevalence of nephropathy, retinopathy and neuropathy in the group with MvC (p=0,068, 0,056 e 0,084, respectively). The group with MvC had more time of evolution of microvascular complications in average (p=0,019). Discussion: This work stands out the importance of dyslipidemia and arterial hypertension as contributors to MvC. There was a longer time of evolution of microvascular complications in the MvC group and a tendency towards a higher prevalence of each type of microvascular complications in this group. This data is likely explained by the importance of glycemic control in both types of complications. Although higher A-A1C values in the group with McV did not attain statistical significance, this is probably due to low sample size and several missing data.

The Role of Neuropathy Screening Tools in Patients Affected by Fibromyalgia.

Fibromyalgia syndrome (sFM) is one of the most common causes of chronic pain. This study aimed to assess the presence of small and large fiber impairment in fibromyalgic patients by applying validated scores used in the screening for diabetic neuropathy. The endpoints for the study were the assessment of neuropathy prevalence in sFM patients using the NerveCheck Master (NCM), the Michigan Neuropathy Screening Instrument (MNSI), the Diabetic Neuropathy Symptom (DNS) and the Douleur Neuropathique 4 Questions (DN4). The sample was composed of 46 subjects: subjects with sFM (n = 23) and healthy controls (HC) (n = 23). The positivity rates in each group for DN4 were significantly different (p < 0.001), with a prevalence in symptomatic subjects of 56.3% (n = 9) among sFM individuals. A similar difference was also observed with the DNS total score (p < 0.001). NCM and MNSI did not disclose significant differences between the two groups. This finding seems to confirm the data regarding the prevalence of a neuropathic pain in sFM patients.

Epidemiological Study on complications of Diabetes and its Treatment Options

Diabetes is a major health hazard with its attendant acute and long-term complications. Globally type-2 diabetes were 15.1 million in 2000. The number of people with diabetes worldwide is projected to increase to 36.6 million by 2030. Diabetes incidence is higher in developing countries than developed countries. A physician’s based study was carried out in 4 Rayalaseema districts, Kadapa, Anantapuramu, Kurnool and Chittor. About 100 physicians who include Diabetologists, Cardiologists and General Physicians were interviewed using a structured questionnaire to determine the prevalence of diabetic complications and their possible treatment options. Physicians responded that about 46% of the diabetic population was having associated complications like diabetic hypertension, diabetic neuropathy, diabetic nephropathy, diabetic retinopathy and diabetic foot. Among those females showing a significantly higher prevalence than males. Among the diabetics, the prevalence of diabetic hypertension, diabetic neuropathy, diabetic nephropathy, diabetic foot, diabetic gastroparesis and diabetic retinopathy were 30%, 25%, 15%, 10%, 8% and 7% of the patients respectively. The prevalence of the diabetes and its associated complications were increased with age and duration of the diabetes. All the diabetic populations need to be treated with suitable prevention and control strategies. As the prevention is better than cure community programmes need to be implemented to create the awareness among the diabetic population.

Prevalence of Diabetic Neuropathy in Diabetic Type II Patients from Khyber Pakhtunkhwa

Introduction: Diabetic neuropathy is the main cause of neuropathy and major complications of diabetes mellitus throughout the world. This may lead to incapacity and amputations due to severe diabetes. The morbidity and mortality rates increase in diabetes due to severe neuropathy. The present study was aimed to determine the prevalence of diabetic diabetic neuropathy in diabetic mellitys type II affected patients. Materials and Methods: This research took place in Peshawar from September 2019 to January 2020. A total of 205 blood samples were collected from diabetic patients with type II diabetes, both neuropathic (n=105) and non-neuropathic (n=100). Blood samples were taken in order to estimate random blood sugar levels (RBS). Results: The age group 50-55 years had the highest percentage of cases (66.8%), followed by 56-60 years (21.5%), and 61-65 years (5.5%). Female patients were more likely than male patients to have diabetes, both neuropathic (62.9 percent) and non-neuropathic (58 percent). The predominance of neuropathic and non-neuropathic diabetes patients involved in this study because it was undertaken in Peshawar.(50.2 percent). Conclusion: It is concluded that female were more prone to diabetes both with neuropathy and without neuropathy. Keywords: Prevalence, Diabetes, Neuropathy, Diabetic mellitus type II,

A systematic review of the prevalence, risk factors and screening tools for autonomic and diabetic peripheral neuropathy in children, adolescents and young adults with type 1 diabetes.

We aimed to estimate the prevalence of Diabetic peripheral neuropathy (DPN) and Cardiac autonomic neuropathy (CAN) in youth with type 1 diabetes; identify key risk factors; identify the most useful tests for the diagnostic evaluation of DPN and CAN; identify key treatment options for DPN and CAN. A systematic search was performed including studies published in the last 15years. PICO framework was used in the selection process and evidence was assessed using the GRADE system. A total of 758 studies were identified and a final number of 49 studies were included in this systematic review. According to moderate-high level quality studies, the prevalence of probable DPN, ranged between 13.5 and 62%; subclinical DPN between 22 and 88%; confirmed DPN between 2.6 and 11%. The Michigan Neuropathy Screening Instrument was the tool with higher sensitivity and specificity for detecting DPN, which needs to be confirmed by nerve conduction velocity. The prevalence of CAN was 4-39%. Specific treatment options for DPN or CAN in patients younger than 25years are not available. Key risk factors for DPN and CAN are hyperglycemia/HbA1c, age, diabetes duration, the presence of other microvascular complications, waist/height ratio, lipid profile and blood pressure. For CAN, additional risk factors were cigarette smoking, BMI and total daily insulin. Prevalence of neuropathy in youth with type 1 diabetes varies depending on different screening methods and characteristics of the study populations. However, the assessed studies confirmed a relatively high prevalence of subclinical neuropathy, reiterating the importance of early identification of risk factors to prevent this complication.

Efficacy of Habb-e-Asab in diabetic peripheral neuropathy: a randomized placebo control study.

Diabetic peripheral neuropathy (DPN) is a common diabetes complication. The prevalence of neuropathy is 55% for type 1 and 66% for type 2 diabetes. In Unani medicine neuropathy is known as Khidr (numbness). It is treated with drugs possessing hypoglycemic and analgesic properties, etc. Habb-e-Asab, a polyherbal Unani formulation used for the treatment of Waja-ul-Asab (neuralgia) is routinely used for its indications in neurological pain in Unani medicine. The aim of this study to investigate the efficacy of Habb-e-Asab in diabetic peripheral neuropathy. Thirty patients with DPN were randomly assigned to test (n=20) and control (n=10) groups in a randomized single-blind placebo control study. For 45days, the test group was given 250mg Habb-e-Asab twice a day and the control group 250mg placebo twice a day. The subjective parameters Pain in feet, burning in feet, and tingling in feet was assessed by the arbitrary scale and VAS fortnightly and objective parameters MNSI, and VPT was assessed in pre-post-treatment. The research drug revealed highly statistically significant with p<0.001 on VAS score and MNSI whereas VPT is significant with p<0.01 on few points. But control group exhibits no significant effect in any of the parameters. No adverse effects had been reported in either group. Our finding indicated that the Habb-e-Asab for 45days improved and reduced the severity of DPN in a patient with diabetes (CTRI/2018/02/011725).

Neuropathy in Parkinson's disease: Risk determinants and impact on quality of life

Neuropathy has been described in significantly higher proportion of PD patients than in control subjects. This study ascertains the prevelance of neuropathy and its determinants in PD patients, in particular relation with nutritional status, along with impact of neuropathy on Quality of life.Methods:This was a hospital based observational cross-sectional study of PD patients attending the Neurology OPD of a tertiary care hospital. The prevalence and type of neuropathy was determined using the validated MNSI scale. The nutritional status was assessed using MNA score and PDQ-39 was used for assessing quality of life. Patients with and without neuropathy were compared to ascertain risk factors for neuropathy.Results:Twenty-four out of 93 PD patients (26%) had neuropathy and 12 (50%) out of them had painful neuropathy. Older patents and those who had longer duration of disease had higher prevalence of neuropathy. In addition there was significant correlation with malnutrition and neuropathy. 79% of patients with neuropathy had abnormal nutritional status. On comparison of patients with painful neuropathy as compared to those without pain, Vitamin B 12 levels were found to be low only in the former group.Conclusions:Our study shows that there is significant prevalence of neuropathy in PD patents that affects the quality of life of PD patients. Neuropathy in PD is disease dependent and is precipitated by malnutrition. Hence, neuropathy must be timely diagnosed and effective nutritional management may help to improve the patient's quality of life.

Peripheral Neuropathy in Children With Chronic Kidney Disease: Are We Looking Enough?

Background:Peripheral neuropathy in chronic kidney disease (CKD) is the most common neurological complication. We aimed to look at the prevalence and patterns of neuropathy in children with CKD.Methods:This cross-sectional study was conducted over 1 year in children with CKD, stage III and above. Nerve conduction studies (NCS) were performed as per standard protocols using surface electrodes on the muscles and by supramaximal stimulation of the corresponding nerves. Presence of electrophysiological abnormalities in the absence of clinical symptoms or signs was considered as subclinical neuropathy.Results:Nearly 45 children were evaluated. The majority were males (n = 39, 86.7%). The mean age was 7.9 ± 3 years (range 2–14). The mean estimated glomerular filtration rate (GFR) at enrolment was 23.3 ± 14.6 mL/min/1.73 m2 (range 5–67). The majority of children were in stage III (n = 19, 42%), followed by stages V (n = 15, 33%) and IV (n = 11, 25%). There was no evidence of clinical neuropathy; 13 children (29%) showed subclinical neuropathy. All the nerves had an axonal pattern of involvement. Motor polyneuropathy was most common type of peripheral neuropathy. The commonest nerves involved were tibial and common peroneal nerves. There were no biochemical or clinical predictors of neuropathy in our cohort.Conclusion:The prevalence of subclinical neuropathy is high in children with CKD, stage III and above. Axonal motor polyneuropathy is the predominant pattern. Electrophysiological assessment of nerve function should be routinely done in children with advanced stages of CKD to prevent chronic complications.

Study of Diabetic Peripheral Neuropathy in Adults of Telangana

Background: Diabetic peripheral neuropathy (DPN) predisposes to foot ulceration and gangrene. It has been reported thatprevalence of DPN is lower in Indians relative to Caucasians. Studies among recent onset patients with type 2 diabetesmellitus (Type2-M) are very few. We studied the prevalence and risk factors of DPN in patients with newly diagnosedType2DM.Methods: We prospectively studied 80 consecutive patients over age 30 with a duration of diabetes ≤1 year. Every patientunderwent a clinical and biochemical evaluation and was screened for DPN using TCSS scale (Toronto clinical scoringsystem) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale.Results: The cases had a mean age of 60.28 years and duration of symptoms of DM is &lt;1year prior to presentation. Theoverall prevalence of DPN was 12.5%. The prevalence of DPN showed an increasing trend with FBS (trend chi-square=3.517, P = 0.0304). A logistic regression analysis showed that DPN was independently associated with Fasting Blood Sugar(P = 0.0304), Body mass index (P= 0.0389), HbA1c (P = 0.0451), family history (P= 0.0426) and physical activity (P= 0.0219)but not with age, sex and education.Conclusions: Our study showed high prevalence of PN in recently diagnosed patients with Type2DM, which wasindependently associated with age and duration of symptoms of diabetes prior to the diagnosis. FBS, HbA1c, BMI, werefound to be risk factors for prevalence of Diabetic Neuropathy.

Large fibre, small fibre and autonomic neuropathy in adolescents with type 1 diabetes: A systematic review.

To estimate the prevalence of neuropathy in adolescents with type 1 diabetes. Systematic collection of published studies exploring the prevalence of large fibre neuropathy (LFN), small fibre neuropathy (SFN), and autonomic neuropathy in adolescents with type 1 diabetes. Following prospective registration (Prospero CRD42020206093), PubMed, EMBASE, and Cochrane Library were searched for studies from 2000 to 2020. PICO framework was used in the selection process (Population: adolescents aged 10-19years with type 1 diabetes; Intervention: diagnostic methods for neuropathy; Comparison: reference data; Outcome: data on prevalence or comparison). Data were extracted concerning study quality based on available data and established methods for determining and diagnosing various neuropathy types. From 2,017 initial citations, 27 studies (7589 participants) fulfilled eligibility criteria. The study population (47% males) had a diabetes duration between 4.0 and 10.6years, and HbA1c level between 7.3 and 10.8%, 56-95mmol/mol. The prevalence of LFN, based on nerve conduction studies, was 10-57%. Based on other tests for neuropathy, the prevalence of LFN and SFN was 12-62%, and that of cardiac autonomic neuropathy was 12-75%. The described prevalence of neuropathy in adolescents with type 1 diabetes varied, which can be methodological due to different screening methods and classifications of neuropathy.

Small Fiber Neuropathy Incidence, Prevalence, Longitudinal Impairments, and Disability.

There are limited population-based data on small fiber neuropathy (SFN). We wished to determine SFN incidence, prevalence, comorbid conditions, longitudinal impairments, and disabilities. Test-confirmed patients with SFN in Olmsted, Minnesota, and adjacent counties were compared 3:1 to matched controls (January 1, 1998-December 31, 2017). Ninety-four patients with SFN were identified, with an incidence of 1.3/100,000/y that increased over the study period and a prevalence of 13.3 per 100,000. Average follow-up was 6.1 years (0.7-43 years), and mean onset age was 54 years (range 14-83 years). Female sex (67%), obesity (body mass index mean 30.4 vs 28.5 kg/m2), insomnia (86% vs 54%), analgesic-opioid prescriptions (72% vs 46%), hypertriglyceridemia (180 mg/dL mean vs 147 mg/dL), and diabetes (51% vs 22%, p < 0.001) were more common (odds ratio 3.8-9.0, all p < 0.03). Patients with SFN did not self-identify as disabled with a median modified Rankin Scale score of 1.0 (range 0-6) vs 0.0 (0-6) for controls (p = 0.04). Higher Charlson comorbid conditions (median 6, range 3-9) occurred vs controls (median 3, range 1-9, p < 0.001). Myocardial infarctions occurred in 46% vs 27% of controls (p < 0.0001). Classifications included idiopathic (70%); diabetes (15%); Sjögren disease (2%); AL-amyloid (1%); transthyretin-amyloid (1%); Fabry disease (1%); lupus (1%); postviral (1%); Lewy body (1%), and multifactorial (5%). Foot ulcers occurred in 17, with 71% having diabetes. Large fiber neuropathy developed in 36%, on average 5.3 years (range 0.2-14.3 years) from SFN onset. Median onset Composite Autonomic Severity Score (CASS) was 3 (change per year 0.08, range 0-2.0). Median Neuropathy Impairment Scale (NIS) score was 2 at onset (range 0-8, change per year 1.0, range -7.9 to +23.3). NIS score and CASS change >1 point per year occurred in only AL-amyloid, hereditary transthyretin-amyloid, Fabry, uncontrolled diabetes, and Lewy body. Death after symptom onset was higher in patients with SFN (19%) vs controls (12%, p < 0.001), 50% secondary to diabetes complications. Isolated SFN is uncommon but increasing in incidence. Most patients do not develop major neurologic impairments and disability but have multiple comorbid conditions, including cardiovascular ischemic events, and increased mortality from SFN onsets. Development of large fiber involvements and diabetes are common over time. Targeted testing facilitates interventional therapies for diabetes but also rheumatologic and rare genetic forms.

EPIDEMIOLOGICAL CHARACTERISTICS OF HEREDITARY MOTOR AND SENSORY NEUROPATHY IN THE KHARKOV REGION

Hereditary motor and sensory neuropathies are one of the most common diseases among monogenic hereditary diseases of the nervous system. Hereditary motor and sensory neuropathies are the group of clinically and genetically heterogeneous diseases characterized by peripheral nerve damage. Hereditary motor and sensory neuropathies have little effect on life expectancy, and this leads to their significant accumulation in individual families and in populations as a whole. The most common form of this disorder is hereditary motor and sensory neuropathy with an autosomal dominant type of inheritance - type 1A, caused by a mutation in the gene of peripheral myelin protein 22 (PMP22) on chromosome 17p11.2-12. According to various researches, the frequency of all hereditary motor and sensory neuropathies in the general population is 1:2500. The prevalence of hereditary motor and sensory neuropathies in different populations varies widely, therefore, the most appropriate at the initial stage of the genetic-epidemiological study of hereditary motor and sensory neuropathies is to determine the population frequency of this mutation in a specific region. The research of the territorial and ethnic distribution of hereditary motor and sensory neuropathies in the Kharkiv region was not carried out. That is why the aim of the research was to study and analyze the prevalence rates of hereditary motor and sensory neuropathies in the Kharkiv region in the context of administrative and territorial units and individual ethnic groups of the population. The epidemiological study of hereditary motor and sensory neuropathies in the Kharkiv region was carried out in the period from 2015 to 2020. The diagnosis of hereditary motor and sensory neuropathy was established in accordance with the recommendations of the WHO Research Group on neuromuscular diseases on the basis of diagnostic criteria.The prevalence rate of hereditary motor and sensory neuropathy was calculated both for various administrative and territorial units of the Kharkiv region and for individual ethnic groups of the population and expressed as the number of cases per 100,000 people. The results of the research showed that the prevalence rate of all forms of hereditary motor and sensory neuropathies in the Kharkiv region is 5.56 per 100,000 population and this indicator is unevenly distributed. The reason for the uneven distribution of hereditary motor and sensory neuropathies in the Kharkiv region may be the "effect of small samples" due to differences in population size both in individual administrative regions and in some ethnic groups of the population. In the Kharkiv region, the part of registered patients with hereditary motor and sensory neuropathies among the urban population (55.3%) is higher than among residents of country areas (44.7%). The heterogeneity of the prevalence rate of hereditary motor and sensory neuropathies in various ethnic groups of the Kharkiv region is due to the non-representativeness of these groups to the corresponding ethnic populations and such indicators cannot be transferred to the entire population as a whole. The high prevalence of hereditary motor and sensory neuropathies among certain ethnic groups is most likely due to the presence of ethnic isolates with a high degree of inbred members of the group.

What Is in the Field for Genetics and Epigenetics of Diabetic Neuropathy: The Role of MicroRNAs.

Despite the high prevalence of diabetic neuropathy, its early start, and its impact on quality of life and mortality, unresolved clinical issues persist in the field regarding its screening implementation, the understanding of its mechanisms, and the search for valid biomarkers, as well as disease-modifying treatment. Genetics may address these needs by providing genetic biomarkers of susceptibility, giving insights into pathogenesis, and shedding light on how to select possible responders to treatment. After a brief summary of recent studies on the genetics of diabetic neuropathy, the current review focused mainly on microRNAs (miRNAs), including the authors' results in this field. It summarized the findings of animal and human studies that associate miRNAs with diabetic neuropathy and explored the possible pathogenetic meanings of these associations, in particular regarding miR-128a, miR-155a, and miR-499a, as well as their application for diabetic neuropathy screening. Moreover, from a genetic perspective, it examined new findings of polymorphisms of miRNA genes in diabetic neuropathy. It considered in more depth the pathogenetic implications for diabetic neuropathy of the polymorphism of MIR499A and the related changes in the downstream action of miR-499a, showing how epigenetic and genetic studies may provide insight into pathogenetic mechanisms like mitochondrial dysfunction. Finally, the concept and the data of genotype-phenotype association for polymorphism of miRNA genes were described. In conclusion, although at a very preliminary stage, the findings linking the genetics and epigenetics of miRNAs might contribute to the identification of exploratory risk biomarkers, a comprehensive definition of susceptibility to specific pathogenetic mechanisms, and the development of mechanism-based treatment of diabetic neuropathy, thus addressing the goals of genetic studies.

Electrophysiological study of peripheral neuropathies in chronic kidney disease patients and relation of severity of peripheral neuropathy with degree of renal failure

Background: Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. Peripheral neuropathy occurs in 60-100% patients of CKD. Nerve conduction study is the gold standard method to diagnose uremic neuropathy. In this study we have examined the correlation of nerve conduction latency, amplitude and nerve conduction velocity with serum creatinine, blood urea, serum uric acid levels and compared these parameters among dialysis and non-dialysis dependent CKD patients.Methods: The present cross-sectional study was conducted on 100 adult patients diagnosed to have and treated for CKD. All cases were subjected to nerve conduction study (NCS) which was performed on median nerve, ulnar nerve, common peroneal nerve, tibial nerve and sural nerve.Results: The prevalence of neuropathy was 68% in both dialysis and non-dialysis dependent groups. The most involved nerve was sural nerve. On NCS, there was prolongation of nerve latency, decrease in nerve amplitude and nerve conduction velocity with rising blood urea and serum creatinine levels. All these abnormalities were more evident in dialysis dependent patients as compared to non-dialysis dependent patients. Depressed amplitude was the most common abnormality in all the tested nerves.Conclusions: The nerve latency, amplitude and nerve conduction velocity worsened with rise in blood urea, serum creatinine and decrease in eGFR suggesting that neuropathy progress with increased severity of renal failure. Nerve conduction abnormalities were more prominent in dialysis dependent patients and therefore was associated with more advanced stage of CKD.

Complications and its association with sleep quality in the elderly diabetic patients.

Background: Sleep disorders are commonly seen in type 2 diabetic patients. However, there is not much research about the association of diabetic complications and poor sleep quality. Objectives: To evaluate diabetic complications and to find out which diabetic complications are associated with poor sleep quality in older diabetic patients treated at National Geriatric Hospital. Methods: A cross-sectional study on 178 older diabetic patients treated at National Geriatric Hospital from March to October, 2020. Quality of sleep was assessed using the Pittsburgh Sleep Quality Index. Results: 93 patients (52.2%) had peripheral nerve complications. 50% patients had diabetic retinopathy. There were 86 patients (48.3%) had experienced hypoglycemia in the last 3 months. The prevalence of diabetic neuropathy, cerebral vascular disease, cardiovascular disease, peripheral artery disease and foot complication were 12.9%; 12.9%; 9%; 8.4% and 7.3%, respectively. 19.1% patients didn’t have any complications of diabetes. Patients with diabetic retinopathy and cerebral vascular disease had a significantly higher rate of poor sleep quality compared with the group without these complications. There were no significant association between diabetic nephropathy, cardiovascular disease, peripheral nerve complication, foot complication, hypoglycemia and sleep quality. Conclusion: This study showed that older diabetic patients had many complications. Diabetic retinopathy and cerebral vascular disease were higher in the poor sleep quality group.

Peripheral neuropathy after viral eradication with direct-acting antivirals in chronic HCV hepatitis: A prospective study.

BackgroundHCV‐related extra‐hepatic complications include peripheral neuropathies, with important prevalence and impact. A recent metanalysis of previous intervention trials concluded for insufficient data to support evidence‐based treatments for this complication. In this longitudinal study, we assessed for the first time prevalence and outcome of neuropathy in a cohort of patients with chronic HCV, before and after direct‐acting antiviral agent (DAA) treatment.MethodNinety‐four patients (mean age 58.5 ± 9.9, infection duration 22.2 ± 6.3 years) without systemic and metabolic diseases, underwent neurological examination and electroneurography studies before (T0) and 10.4 ± 1.7 months after the end of DAA therapy (T1), and cryoglobulins (CG) assessment. Muscle strength was evaluated by Medical Research Council (MRC) score; neuropathic pain, sensory function, disability, quality of life were assessed by validated questionnaires (DN4, NPSI, SSS, INCAT and Euro‐QoL).ResultsAt T0, sensory‐motor neuropathy was detected in 22 patients (23%), reflexes were depressed in 32 (34%) with no association with infection duration, viral load, age, CG. Neuropathic pain (DN4 ≥4) was present in 37 patients (39%). At T1, out of the 22 patients with altered electroneurography, 3 had died or developed HCC, 4 showed normal electroneurography, and nerve amplitude parameters tended to improve in the whole group. Only 11 patients (12%) had depressed reflexes and 10 (11%) DN4 ≥4 (P < .05 compared to T0). Scores for MRC, questionnaires and Euro‐QoL improved significantly (P < .05).ConclusionOur study confirms the high prevalence of clinical and subclinical peripheral sensory‐motor neuropathy in patients with HCV infection and indicates improvement after eradication by DAA. These results support the need for larger intervention studies.

SY7.6. HIV associated neuropathy in the non-stavudine era

HIV-associated sensory neuropathy (HIV-SN) remains common in HIV patients receiving anti- retroviral therapy (ART). Neuropathies resulting from HIV infection itself and toxic side effects of ART have similar presentations and include neuropathic pain, tingling and numbness. Some nucleoside analogue reverse transcriptase inhibitors used to treat HIV were strongly associated with HIV-SN. The prevalence of HIV-SN in patients receiving stavudine at Cipto Mangunkusumo Hospital was 34% and had strong association with age and height. As stavudine has been phased out recently, some patients still have HIV-SN. In 2016, the prevalence of HIV-SN had been significantly reduced became 14.2% and associated factors was viral load >500 copies HIV RNA/mL. It is an evidence that lack of stavudine exposure is central to the lower neuropathy prevalence. One of clinical manifestation of HIV-SN is neuropathic pain. Neuropathic pain can be found as solely symptom without other sensory neuropathy symptoms (numbness) and signs (decreased physiological reflex and vibration). Prevalence of neuropathic pain (NP) of HIV patients was 6.6% at Cipto Mangunkusumo Hospital, smaller than HIV-SN. Our study showed that HIV patients with NP had shorter duration of ART than patients with HIV-SN, and may be an early symptom of small fiber neuropathy in HIV patients. Some evidences indicate that HIV-SN is immune-mediated. Intra-epidermal fiber density of HIV-SN patients is lower than HIV-noSN and healthy control. Low fiber density in HIV-SN seems to be corelated with low nadir CD4+ counts. CD14+ macrophages were evident at surrounding intra-epidermal nerve of HIV-SN and HIV-noSN patients. Some chemokine receptors such as CX3CR1, CCR2 and CCR5 was more common in HIV-SN patients. These evidences showed that inflammatory macrophages expressing chemokine receptors may participate in peripheral nerve damage leading to HIV-SN in HIV patients treated without stavudine.

Epidemiology and Treatment of Peripheral Neuropathy in Systemic Sclerosis.

The epidemiology and treatment of peripheral neuropathy in systemic sclerosis (SSc) is poorly understood. The objectives of this study were to evaluate the incidence, prevalence, risk factors, and treatments of peripheral neuropathy in SSc. A systematic review of MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for literature reporting peripheral neuropathy in SSc was performed. Studies evaluating incidence, prevalence, risk factors, and treatments were synthesized. A metaanalysis using a random effects model was used to evaluate the prevalence of peripheral neuropathy. This systematic review identified 113 studies that reported 949 of 2143 subjects with at least 1 type of peripheral neuropathy. The mean age was 48.5 years. The mean time between SSc onset and detection of peripheral neuropathy was 8.85 years. The pooled prevalence of neuropathy was 27.37% (95% CI 22.35-32.70). Risk factors for peripheral neuropathy in SSc included advanced diffuse disease, anticentromere antibodies, calcinosis cutis, ischemia of the vasa nervorum, iron deficiency anemia, metoclopramide, pembrolizumab, silicosis, and uremia. There were 73 subjects with successful treatments (n = 36 restoring sensation, n = 37 restoring motor or sensorimotor function). Treatments included decompression surgery, prednisone, cyclophosphamide, carbamazepine, transcutaneous electrical nerve stimulation, tricyclic antidepressants, and intravenous Ig. All-cause peripheral neuropathy is not uncommon in SSc. Compression neuropathies can be treated with decompression surgery. Observational data reporting immunosuppressives and anticonvulsants to treat peripheral neuropathy in SSc are limited and conflicting. Randomized controlled trials are needed to evaluate the efficacy of these interventions.