Prevalence Of Peripheral Neuropathy Research Articles

Prevalence of pesticide related occupational diseases among Indonesian vegetable farmers - A collaborative work.

This study was done to understand the prevalence of various occupational diseases including dry eyes, nail dystrophy, and neuropathy related to pesticide exposure in Indonesian local vegetable farmers. The data were collected through questionnaires and physical examination involving dermatology, neurology, and ophthalmology domains at Ngablak District, Magelang, Central Java directed to local vegetable farmers. Ocular Surface Disease Index (OSDI) questionnaire and the Schirmer test were used. Analysis was done using descriptive statistics using the Statistical Package for the Social Sciences (SPSS 21.0) and presented in tables. Inadequate spraying equipment and improper storage of pesticides were found. Out of 105 farmers, 41.9% experienced occupational skin diseases (OSD). Definite cognitive impairments were found in 3.4% of subjects but probable in 28.3% of subjects. Neuropathies were found in 61.7% of subjects, and dry-eyes syndrome were found in 28.78% of subjects. There was a high prevalence of peripheral neuropathy and tremor, dry eyes syndrome in one-third of the population, and the most common skin problem was nail discoloration, with a low incidence of contact dermatitis.

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

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

Prevalence of peripheral neuropathy and myopathy in patients post-COVID-19 infection.

BackgroundSevere acute respiratory syndrome (SARS‐CoV‐2), caused by the Coronavirus 2019 (COVID‐19), has become a life‐threatening epidemic, affecting multiple organs, including the nervous system. Recent studies have documented that COVID‐19‐associated peripheral neuropathy is a common and frequent problem, with central and peripheral nervous system complications.ObjectiveThis work aims to evaluate the peripheral nerves and muscle involvement after COVID‐19 infection, in addition to studying the prevalence rate and risk factors of their affection.MethodsThe study involved 400 patients, divided into 2 groups, with a history of COVID‐19 infection with or without symptoms of neuromuscular affection, and 30 gender‐ and age‐matched healthy volunteers were involved as controls. They were referred to the Department of Rheumatology and Rehabilitation for electro‐diagnosis. All participants performed complete clinical examination and laboratory measures with an electrophysiological study.ResultsThe prevalence of peripheral neuropathy and myopathy in post‐COVID‐19 patients was 56.3% among all patients. A significant difference was detected among patients of both groups regarding serum creatine phosphokinase level, clinical signs, and electrophysiologic findings of neuropathy and myopathy compared to the control group, with more prominent features among the symptomatic group. Histories of hospitalization, severe and long‐lasting respiratory symptoms were risk factors for developing neuromuscular complications.ConclusionsThe present study could indicate that muscle involvement and peripheral nerve affection are common problems even among asymptomatic patients after COVID‐19 infection, especially in the presence of any risk factors.

The Peripheral Neuropathy Prevalence and Characteristics Are Comparable in People with Obesity and Long-Duration Type 1 Diabetes

IntroductionPeripheral neuropathy is reported in obesity even in the absence of hyperglycaemia.ObjectiveTo compare the prevalence and characterise the phenotype of peripheral neuropathy in people living with obesity (OB) and long-duration type 1 diabetes (T1D).Patients and MethodsWe performed a prospective cross-sectional study of 130 participants including healthy volunteers (HV) (n = 28), people with T1D (n = 51), and OB (BMI 30–50 kg/m2) (n = 51). Participants underwent assessment of neuropathic symptoms (Neuropathy Symptom Profile, NSP), neurological deficits (Neuropathy Disability Score, NDS), vibration perception threshold (VPT) and evaluation of sural nerve conduction velocity and amplitude.ResultsPeripheral neuropathy was present in 43.1% of people with T1D (age 49.9 ± 12.9 years; duration of diabetes 23.4 ± 13.5 years) and 33.3% of OB (age 48.2 ± 10.8 years). VPT for high risk of neuropathic foot ulceration (VPT ≥ 25 V) was present in 31.4% of T1D and 19.6% of OB. Participants living with OB were heavier (BMI 42.9 ± 3.5 kg/m2) and had greater centripetal adiposity with an increased body fat percentage (FM%) (P < 0.001) and waist circumference (WC) (P < 0.001) compared to T1D. The OB group had a higher NDS (P < 0.001), VAS for pain (P < 0.001), NSP (P < 0.001), VPT (P < 0.001) and reduced sural nerve conduction velocity (P < 0.001) and amplitude (P < 0.001) compared to HV, but these parameters were comparable in T1D. VPT was positively associated with increased WC (P = 0.011), FM% (P = 0.001) and HbA1c (P < 0.001) after adjusting for age (R2 = 0.547). Subgroup analysis of respiratory quotient (RQ) measured in the OB group did not correlate with VPT (P = 0.788), nerve conduction velocity (P = 0.743) or amplitude (P = 0.677).ConclusionThe characteristics of peripheral neuropathy were comparable between normoglycaemic people living with obesity and people with long-duration T1D, suggesting that metabolic factors linked to obesity play a pivotal role in the development of peripheral neuropathy. Further studies are needed to investigate the mechanistic link between visceral adiposity and neuropathy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02208-z.

LXR agonist modifies neuronal lipid homeostasis and decreases PGD2 in the dorsal root ganglia in western diet-fed mice

The prevalence of peripheral neuropathy is high in diabetic and overweight populations. Chronic neuropathic pain, a symptom of peripheral neuropathy, is a major disabling symptom that leads to a poor quality of life. Glucose management for diabetic and prediabetic individuals often fail to reduce or improve pain symptoms, therefore, exploring other mechanisms is necessary to identify effective treatments. A large body of evidence suggest that lipid signaling may be a viable target for management of peripheral neuropathy in obese individuals. The nuclear transcription factors, Liver X Receptors (LXR), are known regulators of lipid homeostasis, phospholipid remodeling, and inflammation. Notably, the activation of LXR using the synthetic agonist GW3965, delayed western diet (WD)-induced allodynia in rodents. To further understand the neurobiology underlying the effect of LXR, we used translating ribosome affinity purification and evaluated translatomic changes in the sensory neurons of WD-fed mice treated with the LXR agonist GW3965. We also observed that GW3965 decreased prostaglandin levels and decreased free fatty acid content, while increasing lysophosphatidylcholine, phosphatidylcholine, and cholesterol ester species in the sensory neurons of the dorsal root ganglia (DRG). These data suggest novel downstream interplaying mechanisms that modifies DRG neuronal lipid following GW3965 treatment.

P978: IXAZOMIB VERSUS LENALIDOMIDE OR IXAZOMIB AND LENALIDOMIDE COMBINATION AS MAINTENANCE REGIMEN FOR PATIENTS WITH MULTIPLE MYELOMA: INTERIM ANALYSIS OF A MULTI-CENTER PROSPECTIVE STUDY IN CHINA

Background: Maintenance therapy (MT) deepens response and prolongs progression free survival (PFS) in patients with newly diagnosed multiple myeloma (NDMM) after frontline regimens. Ixazomib, a 2nd generation oral proteasome inhibitor (PI), has been approved for MT because of its convenience and tolerability. Aims: We conducted this prospective multi-center study to compare the efficacy and safety of Ixazomib (I-MT) or Ixazomib plus Lenalidomide (IL-MT) to Lenalidomide (L-MT) as maintenance regimen in NDMM patients. Methods: This study was approved by the Institutional Review Board of Peking Union Medical College Hospital and registered (NCT04217967). NDMM patients were enrolled from 10 centers of North China MM Registry since September 2019. After 4 cycles of front-line induction therapy, patients reached partial response (PR) would receive autologous stem cell transplantation (ASCT) if eligible, or keep up to 5 cycles of front regimens if ineligible, then start maintenance therapy. Patients did not reach PR would switch to 2nd-line induction for 2-5 cycles and start MT once PR was achieved. For MT, 4mg of Ixazomib was given on day 1,8,15, and 25mg of Lenalidomide every other day on days 1–21 of 28day cycles. Patients in dual drug group were administrated with both Ixazomib and Lenalidomide, dose as listed above. The primary endpoint was PFS from MT. Results: A total of 176 patients were enrolled, including 58 in I-MT, 72 in L-MT and 46 in IL-MT. The demographic and clinical characteristics, including gender ratio, age, paraprotein isotype, ISS, R-ISS, were comparable among different MT regimen groups either receiving ASCT or not at baseline (Table 1). The proportions of patients with high-risk cytogenetic abnormalities (HRCAs), defined as amplification 1q21, deletion 17p, t(4,14) and t(14,16), were lower in L-MT without ASCT and I-MT with ASCT. The median follow-up duration since MT was 10.6, 12.6 and 11.1 months in I-MT, L-MT and IL-MT groups in non-ASCT patients, while 9.3, 14.0 and 12.2 months in ASCT patients, respectively. In non-ASCT groups, the disease progression rates were 13.5%, 10.2% and 10.8%, whereas 0, 21.7% and 0 in ASCT groups. The median PFS and OS were not reached (NR) in all groups. There were 73.1%, 73.4% and 78.3% of the patients reached VGPR or better before MT in non-ASCT patients, while the rates improved to 80.8%, 81.6% and 86.5% during follow-up. The depth of response did not change in ASCT patients. In the whole cohort, the prevalence of peripheral neuropathy (PN) was 18.9% on I-MT, 8.3% on L-MT and 21.7% on IL-MT. Grade 2 PN occurred in 3, 0 and 2 patients, respectively. The incidence of gastrointestinal (GI) events was 12.1%, 1.4% and 15.2%, respectively. Grade 3 GI events occurred in 3, 0 and 1 patients. The incidence of grade 3-4 hematologic toxicities was 1.7%, 4.2%, and 2.2%. Infections developed in 10.3%, 2.8% and 4.3% patients. No drug withdrawal was related to adverse events. Image:Summary/Conclusion: Due to inadequate access to melphalan and low rate of ASCT, the PFS of NDMM in Chinese patients was relatively inferior. We design this multi-centered prospective study to evaluate if dual drug MT will further strengthen response and make up the gap. Though the primary endpoint--PFS has not been reached in all treatment groups, dual MT improves response most and is quite tolerable.

Frequency Of Peripheral Neuropathy in Chronic Hepatitis C Patients Presenting at Liaquat University Hospital, Hyderabad

Hepatitis C virus (HCV) and its infective pathogenic role leads to the psychiatric and neurological signs and symptoms. Therefore, close monitoring and regular follow-up is warranted. Objective: To find out the frequency of peripheral neuropathy among patients presenting at Liaquat University Hospital, Hyderabad, having Chronic Hepatitis C. Methods: The cross-sectional study included 359 patients with chronic HCV, aged 20 to 70 years, who presented to the Liaquat University Hospital's Hepatitis Clinic and Outpatient Department of General Medicine and Neurology. Non-probability - sequential sampling was used to choose patients. Patients were asked about demographic information and the duration of chronic HCV after giving informed written consent. The clinical examination was performed to see if there were any reduced tendon reflexes in all of the patient's extremities. To diagnose peripheral neuropathy based on nerve conduction velocity, all patients had an electrophysiological test using a simplified nerve conduction study (NCS) methodology (NCV). The research lasted six months, from June 2021 to December 2021. The information was examined via SPSS version 25.0. Results: There were 219 Men (61%) And 140 Females (39%) among the 359 Patients. The average age (SD) of the participants was 42.3 (8.7) years (range 22–70). HCV infection lasted 36 months on average (range 1–156). Out of 359 patients, 61 had clinical peripheral neuropathy (PN) (17%). Electrophysiological evidence of PN was present in all of these patients, electrophysiological investigation revealed subclinical PN in 19 more patients (5.3%). Conclusion: On the basis of the findings from this study, it can be concluded that a high prevalence of peripheral neuropathy is present among the patients with HCV in our locality. However, an electrophysiological examination should always be done to avoid underestimating PN, particularly in older HCV patients.

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.

IDF21-0568 Peripheral Neuropathy and potential risk factors in patients with Diabetes Mellitus in Kano, Northwestern Nigeria

Background: Peripheral Neuropathy is a common complication of DM and a cardinal event in the pathway to foot ulceration in many patients. It may be preventable if detected early and promptly managed. Aim: To determine the prevalence of peripheral neuropathy and its potential risk factors in patients with DM attending two hospitals in Kano, Nigeria. Method: In a cross – sectional descriptive study consenting patients with DM who fulfilled the inclusion criteria were recruited from the diabetes outpatient clinic and wards of two hospitals in Kano. Questionnaires were used to obtain Socio- demographic data and clinical characteristics of the study subjects. Vibration perception threshold using biothesiometer was used to assess for presence of peripheral neuropathy. Results: We recruited 394 patients with DM (163 males and 231 females) with mean age and duration of DM of 50.8±12.5years and 7.72±6.65years respectively. Ninety five percent of the study subjects had type 2DM. 149(37.2%) of the study subjects had VPT > 25 volts which is significant for PN. Older age, level of education, longer duration of DM, HTN, PVD, proteinuria, diabetic retinopathy, presence of DFU and foot deformities were significant predictors of PN. The independent risk factors for PN after multivariate regression were older age, longer duration of DM, proteinuria, presence of foot deformities and DFU. Discussion: Peripheral neuropathy still remains one of the most complications of DM which leads to development of DFU and subsequently amputation. Screening with early identification, education and treatment of associated risk factors may go a long way in reducing one of the cardinal event to foot ulceration.

Clinical Characteristics of Peripheral Neuropathy in Kenyan Patients with HIV Infection Compared with Patients with Concurrent HIV Infection and Diabetes Mellitus.

IntroductionPersons living with human immunodeficiency virus (HIV) are living longer and at risk of non-communicable diseases, including diabetes mellitus (DM). Both HIV and DM place patients at risk of peripheral neuropathy (PN). Our aim was to demonstrate the prevalence and characteristics of PN in our population of patients with HIV infection compared with concomitant HIV and DM.MethodsA prospective cross-sectional study was performed at the Aga Khan Hospital in Nairobi, Kenya. Data were collected on demographics and characteristics of DM and HIV. Symptoms and signs of PN were evaluated by Neuropathy Symptom Score, Neuropathy Disability Score, and 10 g monofilament testing.ResultsTwo groups were recruited, each consisting of 68 patients: (1) HIV only, (2) HIV and DM. The median age of patients was 51 years (IQR 42.8–58.6) and 55% were male. Median duration for HIV was 10 years (IQR 5–12) with a median CD4 count of 524 cells/mm3 (IQR 369–731). Median duration for DM was 1 year with a median glycosylated hemoglobin of 6.7% (IQR 6.6–7.6). Sixty-nine percent of patients with HIV had suppressed viral loads, and 9 patients (6.6%) had a history neurotoxic antiretroviral therapy use. PN was detected in 11 (16%) HIV-only patients, and in 17 (25%) participants who had both HIV and DM (Fisher exact test chi-square = 0.4). Univariate analysis demonstrated older age, high body mass index, and long duration of HIV were associated with an OR of 1.07 (95% CI 1.02–1.11), 1.21 (95% CI 0.46–3.11), and 1.07 (95% CI 0.99–1.15) in the overall group, respectively.ConclusionOur study demonstrates a higher but non-significant prevalence of PN in patients with both HIV and DM when compared to HIV alone. HIV disease control had no association with PN presence.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-022-01205-3.

Prevalence of peripheral neuropathy and associated risk factors in children with type 1 diabetes

AimTo detect the prevalence of diabetic polyneuropathy (DPN) in children with type 1 diabetes (T1D) and to identify associated the risk factors. MethodsThis cross-sectional study evaluated children aged between 2 and 16y with T1D for ≥2 y. Detailed neurological examination, neuropathy symptom score, and nerve conduction studies were done in all children to assess nerve dysfunction. Disease-related factors were evaluated for the prediction of neuropathy. ResultsSixty-six children (67% boys) were enrolled. The mean age at the time of diagnosis of T1D was 7.1 ± 2.6 years. The mean duration of diabetes was 4 ± 1.8 years. None of the patients had neuropathy on clinical examination or on the neuropathy symptom score. The prevalence of subclinical DPN was 18.2% (n = 12/66). The type of neuropathy was pure motor (n = 11, 91.6%) and mixed sensorimotor (n = 1, 8.3%). The common peroneal nerve was most commonly affected (n = 6, 50%), followed by the tibial (n = 4, 33.3%) nerve. The most common patterns of nerve involvement were mixed axonal and demyelination (n = 7, 58.3%), followed by axonal (n = 3, 25%) and demyelinating type (n = 2, 16.6%). Children with subclinical DPN had a significant reduction in velocity of tibial, common peroneal, median motor, and ulnar motor nerves; delayed latency in common peroneal, median motor, ulnar motor, and median sensory nerves compared to those without DPN (p value <0.05). A higher body mass index predicted the development of subclinical DPN (p value <0.05). ConclusionNearly one-fifth of children with T1D have subclinical neuropathy as early as two years of the disease. A higher body mass index is significantly associated with DPN. Electrophysiological studies should be performed regularly to screen for nerve dysfunction and its progression.

Prevalence and Risk Factors of Peripheral Neuropathy in Parkinson's Disease.

A lesser studied aspect of Parkinson's disease (PD) is its associated peripheral sensory-motor neuropathy. Peripheral neuropathy is an intriguing aspect of PD, a problem not given sufficient attention and which if tackled properly could make a difference to the multifaceted sufferings of the PD patient. Studies regarding the prevalence of peripheral neuropathy and its risk factors in patients with PD are scarce from the Indian subcontinent. This prospective observational study was conducted in a tertiary care teaching hospital in South India. Patients diagnosed with idiopathic Parkinson's disease (IPD) were screened and enrolled. All the patients underwent detailed evaluation of symptoms, signs, and electrophysiology (Nerve conduction study, Sympathetic skin response), stimulated skin wrinkling with Eutectic Mixture of Local Anesthetics. Patients found to have large/small fiber neuropathy underwent additional tests to exclude other causes of neuropathy. A total of 154 patients with IPD were enrolled in the study (mean age: 61.96 ± 9.15 years, mean duration of disease was 4.08 ± 3.16 years). The mean Hoehn and Yahr (H and Y) score was 2.3 ± 0.825 and the mean Unified Parkinsons Disease Rating Scale (UPDRS)-3 score in the ON state was 23.07 ± 11.14. The mean cumulative levodopa dose was 482.68 ± 651.76 (median: 292; range: 4728.57) grams. Peripheral neuropathy was found in 49 patients (31.8%), large fiber in 28 (18.2%) and small fiber in 47 (30.5%); an overlap of large and small fiber neuropathy was seen in 26 patients (16.9%). Around 34% of patients had serum homocysteine levels >20 mg/dl. In univariate analysis, duration of disease, levodopa cumulative dose, serum homocysteine level, H and Y score, UPDRS-3 ON score, Toronto Clinical Neuropathy Score (P < 0.001 for all), age at presentation, and rigidity predominant presentation (P = 0.02 for both) were associated with large fiber neuropathy. All of these variables were also associated with the presence of small fiber neuropathy (P = 0.004 for age at presentation and P < 0.001 for rest), except the type of PD presentation. However, in multivariate logistic regression analysis, only duration of disease, levodopa cumulative dose, and H and Y score were associated with the presence of large and small fiber neuropathy. In our cohort, majority of the patients were in early-stage PD and around one-fifth and one-third of patients suffer from large and small fiber polyneuropathy, respectively. Large and small fiber neuropathy in PD is mainly associated with duration of disease, levodopa cumulative dose, and H and Y score.

The Burden of Peripheral Neuropathy in Nondiabetic Chronic Kidney Disease and the Role of Ghrelin Isoforms in its Development.

Peripheral neuropathy is one of the most common complications in chronic kidney disease (CKD). The neuroprotective role of ghrelin is being explored recently. Here we aim to determine the burden of neuropathy in nondiabetic CKD and to find the association of peripheral nerve function with plasma ghrelin levels in these patients. This was a cross-sectional study conducted in nondiabetic CKD patients on conservative management to determine the magnitude of neuropathy. The association of ghrelin isoforms with nerve functions was assessed between three groups, namely CKD with neuropathy, CKD without neuropathy, and healthy volunteers, with 20 participants in each group. The proportion of neuropathy in nondiabetic CKD was 78% (n = 78), of which 51% (n = 40) were asymptomatic. Des acyl ghrelin (DAG) and total ghrelin (TG) levels were 1545.5 ± 487.4 and 1567.4 ± 485.3 pg/mL, respectively, in CKD patients with neuropathy and were found to be elevated compared to those without neuropathy, who had 1000.4 ± 264.2 and 1019.7 ± 264.3 pg/mL of DAG and TG, respectively (P < 0.001). Assessment of correlation between nerve conduction parameters and DAG levels showed positive correlation between DAG levels and common peroneal latency (r = 0.69; P < 0.01), median sensory latency (r = 0.45; P < 0.05), and sural latency (r = 0.51; P < 0.05). We found negative correlation between median velocity (r =-0.56; P < 0.05), common peroneal velocity (r = -0.64; P < 0.01), median sensory velocity (r =-0.49; P < 0.05), and sural velocity (r = -0.54; P < 0.05). There was no statistically significant difference in acyl ghrelin levels among the groups. The prevalence of peripheral neuropathy in CKD is significantly higher with almost half of them being asymptomatic. Impaired renal clearance in CKD leads to the accumulation of DAG, which subsequently inhibits the neuroprotective functions of AG leading to neuropathy in CKD.

Prevalence of peripheral neuropathy in children with type 1 diabetes mellitus

Prevalence of peripheral neuropathy in children with type 1 diabetes mellitus

AACE2021-A-1078: The Changeable Dynamics Between Glycaemic Control and Neuropathy Risk Across the Lifespan of Saudi Diabetic Patients; a Survey in Diabetes Healthcare Facility

This study aims to evaluate the prevalence of such a common and morbid neuropathy complication in a sample of Saudi diabetic patients. A descriptive questionnaire-based cross-sectional survey was conducted of sample of all diabetic patients who attend the specialist diabetes and endocrine centre in Prince Mansour Military Hospital in Taif, Saudi Arabia. A monofilament test was used to identify peripheral neuropathy cases, whereas its associated factors were identified through generalized linear logistic regression analysis. The study included (n = 343) diabetic patients. The prevalence of peripheral neuropathy was 84.8% affected patients (n = 291). Dyslipidaemia increased the risk for neuropathy by 98.4% (P = 0.04614). An interaction existed between the duration of diabetes and HbA1c levels in terms of their effect on peripheral neuropathy. When the interaction term is included, a positive association between neuropathy and both HbA1c (increased risk by 46.2%, P = 0.03222) and DM duration (increased risk by 19.6%, P = 0.04497). Cardiovascular disease reduced neuropathy risk by 62.1% (P = 0.03516), and retinopathy reduced neuropathy risk by 60.9% (P = 0.00782). over four out of every five patients have peripheral neuropathy. This is because our study was conducted among a high-risk group of attendees at the specialist diabetic centre. Dyslipidaemia, poor glycaemic control, and longer diabetes duration were associated with peripheral neuropathy in our participants, confirming a direct nerve-damaging effect for high levels of lipoproteins, glucose and lipids in the blood.

Diagnostic and Treatment Considerations in Restless Legs Syndrome Complicated by Diabetic Neuropathy.

Diabetic neuropathy from type I diabetes (DMI), type II diabetes (DMII), or gestational diabetes commonly occurs concurrently with restless legs syndrome (RLS) with an estimated prevalence in DMII specifically of 17.7 to 45%. The diagnosis of RLS can be obscured by symptoms of peripheral neuropathy, which may be similar to those of RLS, but also by other RLS mimics, including nocturnal leg cramps or akathisia. The purpose of this review is to outline a framework for considering comorbid diabetic neuropathy and RLS by discussing RLS and its association with peripheral nerve disease, diabetes, and sleep disruption. Treatment for patients with both diabetic neuropathy and RLS may differ from treatment of persons with solely RLS or diabetic neuropathy; key points in this difference are discussed. Finally, a treatment algorithm is provided to guide the approach to treating patients with comorbid RLS and diabetic neuropathy. There have been several revisions of the RLS diagnostic criteria which in addition to the main four essential criteria of having (1) an urge to move the legs which is (2) exacerbated by rest, (3) relieved temporarily by movement, and (4) occurs in the evening or night time, now includes a consideration for RLS mimics, requiring that (5) symptoms not be explained by any other symptoms. Additionally, the treatment of both diabetic neuropathy and RLS has evolved to focus first on controlling the blood glucose, avoiding exacerbating medications, supplementing with iron if serum ferritin is low, and starting pharmacotherapy with alpha-2-delta ligands such as gabapentin or pregabalin. Knowledge of the prevalence of peripheral neuropathy with RLS, revised RLS diagnostic criteria, and a general treatment algorithm for the combination of peripheral neuropathy and RLS is critical to providing appropriate care to patients suffering from these two diseases.

The prevalence, distribution and impact of peripheral neuropathy among Danish patients with cancer – a population-based cross-sectional study

Background Prevalence of peripheral neuropathy (PN) has been studied in patients undergoing treatment with taxanes, platinums and vinca alkaloids. The prevalence is unknown in the general oncological cancer population, characterized by advanced age, comorbidities and heterogeneous treatments. Material and Methods A cross-sectional survey was administered to all adult patients, attending outpatient services at three Danish departments of oncology. The survey contained the EORTC-CIPN20, the EORTC-QLQ-C30, the GAD7 and PHQ9 questionnaires. A high PN symptom score was defined as a summary score ≥30 points on the CIPN20. P-values were adjusted for multiple testing. Results With an overall response rate of 83% (2839 patients), prevalence of PN was 17% overall, varying from 6 to 33% between diagnosis groups. A high score was more common among females (19 vs. 14%, p = .008), smokers (21 vs. 15%, p = .04), patients living alone (21 vs. 15%, p = .002) and patients using cannabis (29 vs. 15%, p < .001), as well as patients suffering from diabetes (26 vs. 16%, p < .001), cardiac heart disease (27 vs. 16%, p < .001), arthritis (32 vs. 15%, p < .001) or chronic obstructive pulmonary disease (25 vs. 16%, p = .01). High score patients were also older (69ys vs 67ys, p = .048) and more likely experiencing polypharmacy (OR = 3.38 [95% CI, 2.64;4.35]). Patients with a high CIPN20 symptom score scored worse on all EORTC QLQ-C30 function and symptom scales. The mean adjusted C30 SumScore difference was −18.66 ([95% CI, −20.31; −17.02], p < .001). Conclusion Symptoms of PN are experienced widely across cancer groups in the oncology setting. PN symptoms were associated with clinically relevant worse health-related quality of life and with patient-related factors as living alone, various comorbidities, polypharmacy, and cannabis use.

Ixazomib Versus Lenalidomide or Ixazomib and Lenalidomide Combination As Maintenance Regimens for Patients with Multiple Myeloma: Interim Analysis of a Multi-Center Prospective Study in China

BackgroundMaintenance therapy (MT) deepens response and prolongs progression free survival (PFS) in patients with newly diagnosed multiple myeloma (NDMM) after frontline regimens. Ixazomib, a 2 nd generation oral proteasome inhibitor (PI), has been approved for MT because of the convenience and tolerability.AimsWe conducted this prospective multi-center study to compare the efficacy and safety of Ixazomib (I-MT) or Ixazomib plus Lenalidomide (IL-MT) to Lenalidomide (L-MT) as maintenance regimens in NDMM patients.MethodsThis study was approved by the Institutional Review Board of Peking Union Medical College Hospital and registered (NCT04217967). NDMM patients were enrolled from 10 centers of North China MM Registry since September 2019. After 4 cycles of front-line induction therapy, patients who reached partial response (PR) would receive autologous stem cell transplantation (ASCT) if eligible, or keep up to 5 cycles of front regimens if ineligible, then start maintenance therapy. Patients did not reach PR would switch to a 2nd-line induction for 2-5 cycles and start MT once PR was achieved. For MT, 4mg of Ixazomib was given on day 1,8,15, and 25mg of Lenalidomide every other day on days 1-21 of a 28-day cycle. Patients in dual drug group were administrated with both Ixazomib and Lenalidomide, dose as listed above. The primary endpoint was PFS from MT.ResultsA total of 149 patients were enrolled, including 54 in I-MT, 65 in L-MT and 30 in IL-MT. The demographic and clinical characteristics were comparable among three groups at baseline (Table 1), including gender ratio, age, paraprotein isotype, ISS, R-ISS, response status before MT, and ASCT rate. The proportions of patients with high-risk cytogenetic abnormalities (HRCAs), defined as amplification 1q21, deletion 17p, t(4,14) and t(14,16), were comparable.The median follow-up duration since MT was 6.1, 11.1, and 5.9 months in I-MT, L-MT and IL-MT group, respectively. Disease progression developed in 9.3%, 12.3% and 10% (N=5, 8, 3, respectively) patients. The median PFS was not reached (NR) in all groups. Only one death occurred in I-MT group. There were 84%, 72.3% and 83.3% of the patients reached very good partial response (VGPR) or better before MT, while the best response rates rose to 93%, 82.3% and 90% during maintenance.The prevalence of peripheral neuropathy was 18.5% on I-MT, 10.8% on L-MT and 30% on IL-MT. Grade 2 PN occurred in 3, 1, and 0 patients, respectively. The incidence of gastrointestinal events was 11.1%, 1.5% and 20%, respectively. Grade 3-4 hematologic toxicities was 3.7%, 4.6%, and 3.3%. Infection rates were 7.4%, 6.2% and 3.3%. Skin rashes were more common in lenalidomide containing regimens (3.7%, 7.3% and 6.7%). No drug withdrawal was related to adverse events.ConclusionsDue to inadequate access to melphalan and low rate of ASCT in China, there is still a gap of PFS in NDMM patients with those in western countries. We herein design this multi-centered prospective study to evaluate if dual drug MT will further strengthen response and make up the gap. Though the primary endpoint–PFS has not been reached in all treatment groups, dual MT improves response most and is quite tolerable.Figure 1. Baseline Characteristics in three groups. Abbreviations: ISS: international staging system; R-ISS: revised-ISS; HRCAs: high risk cytogenetic abnormalities. sCR: stringent complete remission. CR: complete remission. VGPR: very good partial remission. PR: partial remission. * p ＜ 0.05. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

P-142: Ixazomib versus Lenalidomide or Ixazomib and Lenalidomide combination as maintenance regimen for patients with multiple myeloma: interim analysis of a multi-center prospective study in China

<h3>Background</h3> Maintenance therapy (MT) deepens response and prolongs progression free survival (PFS) in patients with newly diagnosed multiple myeloma (NDMM) after frontline regimens. Ixazomib, a 2nd generation oral proteasome inhibitor, has been approved for MT because of the convenience and tolerability. We conducted this prospective multi-center study to compare the efficacy and safety of Ixazomib (I-MT) or Ixazomib plus Lenalidomide (IL-MT) to Lenalidomide (L-MT) as maintenance regimen in NDMM patients. <h3>Method</h3> This study was approved by the Institutional Review Board of Peking Union Medical College Hospital and registered (NCT04217967). NDMM patients were enrolled from 10 centers of North China MM Registry, since September 2019. After 4 cycles of front-line induction therapy, patients reached partial response (PR) would receive autologous stem cell transplantation (ASCT) if eligible, or keep up to 5 cycles of front regimens if ineligible, then start MT. Patients did not reach PR would switch to 2nd-line induction for 2-5 cycles and start MT once PR was achieved. For MT, 4mg of Ixazomib was given on day 1,8,15, and 25mg of Lenalidomide every other day on days 1–21 of 28day cycles. Patients in dual drug group were administrated with both Ixazomib and Lenalidomide. The primary endpoint was PFS from MT. <h3>Results</h3> A total of 111 patients were enrolled, including 45 in I-MT, 41 in L-MT and 25 in IL-MT. The demographic and clinical characteristics were comparable among three groups at baseline, including gender ratio, age, paraprotein isotype, ISS, R-ISS, response status before MT, and ASCT rate. Patients on IL-MT were slightly younger. The proportions of patients with high-risk cytogenetic abnormalities (HRCAs), defined as amplification 1q21, deletion 17p, t(4,14) and t(14,16), were comparable. The median follow-up duration since MT was 5.9, 13.5 and 5.3 months in I-MT, L-MT and IL-MT group, respectively. Disease progression rate was 4.4%, 12.2% and 8%. Mortality rate was 2.2%, 2.4% and 0. There were 84%, 88.8% and 80% of the patients reached VGPR or better before MT, while the rates improved to 95%, 84% and 92% during follow-up. The prevalence of peripheral neuropathy with grade 1 was 20% on I-MT, 36% on IL-MT and 4.9% on L-MT. No grade 2 PN or higher was recorded. The incidence of gastrointestinal events was 11.1%, 24% and 0, respectively. All hematologic toxicities were lower than 8%. Infection rates were 8.9%, 4% and 7.3%. Skin rashes were more common in lenalidomide containing regimens (2.2%, 8% and 7.3%). No drug withdrawal was related to adverse events. <h3>Conclusion</h3> Due to inadequate access to melphalan and low rate of ASCT in China, there is still a gap of PFS in NDMM patients with those in western countries. We herein design this multi-centered prospective study to evaluate if dual drug MT will further strengthen response and make up the gap. Though the primary endpoint–PFS has not been reached in all treatment groups, dual MT improves response most and is quite tolerable.

Comparison of prevalence and risk factors for peripheral neuropathy between patients with HIV infection and patients with concurrent HIV and diabetes mellitus

The ageing population living with HIV is predisposed to non-communicable comorbidities, including diabetes. Peripheral neuropathy (PN) can occur in both conditions, and it is thought co-existence of both illnesses has a synergistic impact on PN. We sought to identify the prevalence of PN in our population of patients with HIV infection compared with those with both HIV and diabetes.