Vibration Perception Threshold Research Articles

Biothesiometric Assessment of Persons Living with Diabetes Mellitus in a Tertiary Hospital in Uyo, Southern Nigeria

<i>Background</i>: The burden of foot ulceration and amputation among persons living with diabetes mellitus is quite huge and peripheral neuropathy is a well known risk factor for this. The prevalence of peripheral neuropathy and associated factors among persons living with diabetes, using an objective assessment (biothesiometer), is unknown in our study environment. <i>Method</i>: This was a cross-sectional study involving 108 age matched diabetes mellitus patients and controls. The study was conducted in the Diabetes Clinic of the University of Uyo Teaching Hospital, in Southern Nigeria. Basic demographics and other parameters such as duration of diabetes and glycated haemoglobin were recorded. All participants were recruited consecutively and screened for vibration perception threshold (VPT) using a biothesiometer. Participants with VPT ≥ 25 were considered to have significant neuropathy. <i>Results</i>: Significant neuropathy was recorded in 18 (33.3%) of the 54 diabetes patients. Only 3 (5.5%) of the 54 controls had significant neuropathy (p<0.01). The diabetes patients with significant neuropathy had a mean HbA1c of 8.9% compared to 7.3% for diabetes patients without significant neuropathy (p=0.02). The mean age of the diabetes patients with peripheral neuropathy was 54.0±2.3 years compared to 48.3±1.9 years for the diabetes patients without peripheral neuropathy (p<0.01). The mean duration of diabetes among diabetes patients with significant neuropathy was 10.3 years compared to 6.7 years for diabetes patients without significant neuropathy (p=0.01). Conclusion: There is a high prevalence of significant peripheral neuropathy among diabetes patients as determined using a biothesiometer. Early detection and achieving a good glycaemic control may help in reducing this burden which exposes the patients to the risk of possible amputation, depression and even death.

Diabetic Neuropathy Assessed with Multifrequency Vibrometry Develops Earlier than Nephropathy but Later than Retinopathy.

Diabetes is associated with systemic complications. Prevalence of diabetic nephropathy, and retinopathy, in type 1 diabetes mellitus (T1DM) is declining, but it is not known if this is true also for diabetic neuropathy. To investigate the relationship between large fibre diabetic neuropathy and other diabetic complications. Neuropathy, defined here as large fibre neuropathy, was assessed by measuring vibration perception thresholds at four different frequencies on the sole of the foot, using a standard VibroSense Meter and/or neuropathic symptoms, in 599 individuals with T1DM. Retinopathy status was graded using the International Clinical Disease Severity Scale. Grade of albuminuria and previous history of any macrovascular complications were registered. Diabetic individuals without retinopathy had similar vibration thresholds as age- and gender-matched control participants without diabetes, whereas those without microalbuminuria had higher thresholds than controls. Two individuals out of 599 (0.3%) had microalbuminuria, but not retinopathy or neuropathy, and 12/134 (9%) without retinopathy had signs of neuropathy. Totally 119/536 (22%) of the patients without microalbuminuria had neuropathy. Vibration thresholds increased with the rising severity of retinopathy and grade of albuminuria. In a multinomial logistic regression analysis, neuropathy was associated with retinopathy (OR 2.96 [1.35-6.49], p=0.007), nephropathy (OR 6.25 [3.21-12.15]; p=6.7×10-8) and macrovascular disease (OR 2.72 [1.50-4.93], p=0.001). Despite recent changes in the incidence of diabetic complications, the onset of large fibre neuropathy follows that of retinopathy but precedes the onset of nephropathy in T1DM.

Abnormal vibration perception threshold alters the gait features in type 2 diabetes mellitus patients.

It is generally believed that gait characteristics of diabetic neuropathic patients differ from those of non-diabetic ones. However, it is still unclear how the abnormal foot sensation influences the gait during walking in type 2 diabetes mellitus (T2DM). For the purpose of gaining a better insight into the alterations of detailed gait parameters and figuring out important aspects in the gait indexes by peripheral neuropathy in elder T2DM patients, we compared the gait features in participants with normal glucose tolerance (NGT) controls and diabetic individuals complicated by peripheral neuropathy or not. Gait parameters were observed during the 10-m walk on flat land among different conditions of diabetes in 1,741 participants from three clinical centers. Subjects were divided into four groups: persons with NGT were taken as the control group; patients with T2DM included three subgroups: DM control (no chronic complications), DM-DPN (DM complicated by only peripheral neuropathy), and DM-DPN+LEAD (DM complicated by both neuropathy and artery disease). The clinical characteristics and gait parameters were assessed and compared among these four groups. Analyses of variance were employed to verify possible differences of gait parameters between groups and conditions. Stepwise multivariate regression analysis was performed to reveal possible predictors of gait deficits. Receiver operating characteristic (ROC) curve analysis was employed to find any discriminatory power of diabetic peripheral neuropathy (DPN) for the step time. In participants burdened with DPN, whether complicated by lower extremity arterial disease (LEAD) or not, step time increased sharply (p < 0.05). Stepwise multivariate regression models showed that independent variables of gait abnormality were sex, age, leg length, vibration perception threshold (VPT), and ankle-brachial index (ABI) (p < 0.01). Meanwhile, VPT was a significant independent predictor of step time, spatiotemporal variability (SDA), and temporal variability (SDB) (p < 0.05). ROC curve analysis was explored to find the discriminatory power of DPN for the occurrence of increased step time. The area under the curve (AUC) value was 0.608 (95% CI: 0.562-0.654, p < 0.01), and the cutoff point was 538.41 ms accompanied by a higher VPT. A significant positive association was observed between increased step time and the highest VPT group [odds ratio (OR) = 1.83, 95% CI: 1.32-2.55, p< 0.01]. In female patients, this OR value elevated to 2.16 (95% CI: 1.25-3.73, p< 0.01). In addition to sex, age, and leg length, VPT was a distinct factor that associated with altered gait parameters. DPN is associated with increased step time, and the step time increases with worsening VPT in type 2 diabetes.

Clinical and biochemical profile of childhood-adolescent-onset type 1 diabetes and adult-onset type 1 diabetes among Asian Indians.

To compare the clinical and biochemical profile and prevalence of complications among childhood/adolescent-onset (CAO; onset of diabetes< 20years of age) and adult-onset (AO; onset of diabetes- ≥ 20years of age) type 1 diabetes (T1D), seen at a tertiary care diabetes center in south India. Data of 5578 individuals with T1D, diagnosedbased on a history of diabetic ketoacidosis or ketonuria, fasting C-peptide < 0.3pmol/mL and stimulated C-peptide values < 0.6pmol/mL, and requirement of insulin right from the time of diagnosis, presenting to our center between 1991 and 2021, were retrieved fromour electronic medical records. Retinopathy was assessed by retinal photography, chronic kidney disease (CKD) by urinary albumin excretion ≥ 30µg/mg of creatinine and/or eGFR < 60mL/min, and neuropathy by vibration perception threshold >= 20v on biothesiometry. Overall, 3559 (63.8%) of individualswith T1D, belonged to CAO group and 2019 (36.2%) to AO category. AO had higher prevalence of all microvascular complications compared to CAO at every diabetes duration interval, even after adjusting for A1c. Among the AO group, prevalence of retinopathy, CKD, and neuropathy was higher in the GAD negative group. Among CAO there were no differences between the GAD negative and GAD positive groups with respect to prevalence of complications of diabetes. AO with T1D had higher prevalence of microvascular complications compared to CAO. Among AO, GAD negative individuals had higher percentage of retinopathy and CKD compared to GAD positive group.

Assessment of the diagnostic accuracy of Vibrasense compared to a biothesiometer and nerve conduction study for screening diabetic peripheral neuropathy

AimsPeripheral neuropathy is a common microvascular complication in diabetes and a risk factor for the development of diabetic foot ulcers and amputations. Vibrasense (Ayati Devices) is a handheld, battery-operated, rapid screening device for diabetic peripheral neuropathy (DPN) that works by quantifying vibration perception threshold (VPT). In this study, we compared Vibrasense against a biothesiometer and nerve conduction study for screening DPN.MethodsA total of 562 subjects with type 2 diabetes mellitus underwent neuropathy assessments including clinical examination, 10-g monofilament test, VPT evaluation with Vibrasense and a standard biothesiometer. Those with an average VPT ≥ 15 V with Vibrasense were noted to have DPN. A subset of these patients (N = 61) underwent nerve conduction study (NCS). Diagnostic accuracy of Vibrasense was compared against a standard biothesiometer and abnormal NCS.ResultsAverage VPTs measured with Vibrasense had a strong positive correlation with standard biothesiometer values (Spearman’s correlation 0.891, P < 0.001). Vibrasense showed sensitivity and specificity of 87.89% and 86.81% compared to biothesiometer, and 82.14% and 78.79% compared to NCS, respectively.ConclusionsVibrasense demonstrated good diagnostic accuracy for detecting peripheral neuropathy in type 2 diabetes and can be an effective screening device in routine clinical settings.Trial registrationClinical trials registry of India (CTRI/2022/11/047002). Registered 3 November 2022. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=76167.

Day II: Friday, March 24, 2023; 5.30 PM Agenda: Physiotherapy in Neurological condition/ Diabetes: AB No: 32 Effect of Structured Exercise program on Glycosylated hemoglobin and Vibration perception threshold in Type 2 Diabetes individuals with Painful Diabetic Neuropathy: A Pilot Study

Day II: Friday, March 24, 2023; 5.30 PM Agenda: Physiotherapy in Neurological condition/ Diabetes: AB No: 32 Effect of Structured Exercise program on Glycosylated hemoglobin and Vibration perception threshold in Type 2 Diabetes individuals with Painful Diabetic Neuropathy: A Pilot Study

Day II: Friday, March 24, 2023; 5.30 PM Agenda: Physiotherapy in Neurological condition/ Diabetes: AB No: 32 Effect of Structured Exercise program on Glycosylated hemoglobin and Vibration perception threshold in Type 2 Diabetes individuals with Painful Diabetic Neuropathy: A Pilot Study

Day II: Friday, March 24, 2023; 5.30 PM Agenda: Physiotherapy in Neurological condition/ Diabetes: AB No: 32 Effect of Structured Exercise program on Glycosylated hemoglobin and Vibration perception threshold in Type 2 Diabetes individuals with Painful Diabetic Neuropathy: A Pilot Study

Effects of Vibration Direction and Pressing Force on Finger Vibrotactile Perception and Force Control.

This paper reports about the effects of vibration direction and finger-pressing force on vibrotactile perception, with the goal of improving the effectiveness of haptic feedback on interactive surfaces. An experiment was conducted to assess the sensitivity to normal or tangential vibration at 250 Hz of a finger exerting constant pressing forces of 0.5 or 4.9 N. Results show that perception thresholds for normal vibration depend on the applied pressing force, significantly decreasing for the stronger force level. Conversely, perception thresholds for tangential vibrations are independent of the applied force, and approximately equal the lowest thresholds measured for normal vibration.

Reduced Cerebellar Brain Inhibition and Vibrotactile Perception in Response to Mechanical Hand Stimulation at Flutter Frequency

The cerebellum is traditionally considered a movement control structure because of its established afferent and efferent anatomical and functional connections with the motor cortex. In the last decade, studies also proposed its involvement in perception, particularly somatosensory acquisition and prediction of the sensory consequences of movement. However, compared to its role in motor control, the cerebellum’s specific role or modulatory influence on other brain areas involved in sensory perception, specifically the primary sensorimotor cortex, is less clear. In the present study, we explored whether peripherally applied vibrotactile stimuli at flutter frequency affect functional cerebello-cortical connections. In 17 healthy volunteers, changes in cerebellar brain inhibition (CBI) and vibration perception threshold (VPT) were measured before and after a 20-min right hand mechanical stimulation at 25 Hz. 5 Hz mechanical stimulation of the right foot served as an active control condition. Performance in a Grooved Pegboard test (GPT) was also measured to assess stimulation’s impact on motor performance. Hand stimulation caused a reduction in CBI (13.16%) and increased VPT but had no specific effect on GPT performance, while foot stimulation had no significant effect on all measures. The result added evidence to the functional connections between the cerebellum and primary motor cortex, as shown by CBI reduction. Meanwhile, the parallel increase in VPT indirectly suggests that the cerebellum influences the processing of vibrotactile stimulus through motor-sensory interactions.

Impaired postural control in diabetes-a predictor of falls?

People with type 1 diabetes (T1D) and type 2 diabetes (T2D) are at risk of falling, but the association with impaired postural control is unclear. Therefore,the aim was to investigate postural control by measuring the center of pressure (CoP) during quiet standing and to estimate the prevalence ratio (PR) of falls and the fear of falling among people with diabetes compared to controls. In a cross-sectional study, participants with T1D (n = 111) and T2D (n = 106) and controls without diabetes (n = 328) were included. Study procedures consisted of handgrip strength (HGS), vibration perception threshold (VPT), orthostatism, visual acuity, and postural control during quiet stance measured by CoPArea (degree of body sway) and CoPVelocity (speed of the body sway) with "eyes open," "eyes closed" in combination with executive function tasks. A history of previous falls and fear of falling was collected by a questionnaire. CoPArea and CoPVelocity measurements were analyzed by using a multiple linear regression model. The PR of falls and the fear of falling were estimated by a Poisson regression model. Age, sex, BMI, previous falls, alcohol use, drug, HGS, VPT, orthostatism, episodes of hypoglycemia, and visual acuity were covariatesin multiple adjusted analyses. Significantly larger mean CoPArea measures were observed for participants with T1D (p = 0.022) and T2D (0.002), whereas mean CoPVelocity measures were only increased in participants with T2D (p = 0.027) vs. controls. Additionally, T1D and T2D participants had higher PRs for falls (p = 0.044, p = 0.014) and fear of falling (p = 0.006, p < 0.001) in the crude analyses, but the PRs reducedsignificantly when adjusted for mean CoPArea and mean CoPVelocity, respectively.Furthermore,multiple adjustedPRsweresignificantly higher than crude the analyses. CONCLUSION: Impaired postural control during quiet stance was seen in T1D and T2D compared with controlseven in the occurrence of well-known risk factors.and correlated well with a higher prevalence of falls.

Abstract 141

Background: Diabetic retinopathy is a microvascular complication that can eventually lead to potential blindness. Timely interventions result in favourable outcomes in preserving eye-sight among patients with diabetic retinopathy, thus improving quality of life. Detectioin of diabetic retinopathy is done by ophthalmologists based on advance symptoms, however, a landmark for early detection has been of variable debate. The aim of the study was to identify the assocation between abnormalvibration perception threshold and presence of retinopathy in patients with type 2 diabetes. Methods: A total of 1662 participants with type 2 diabetes mellitus (595 males, 1067 females) were recruited using a systematic sampling technique, from the endocrinology clinic at the National Hospsital of Sri Lanka. Each participant was assessed for vibration perception threshold using a biothesiometer, and a diabetes retinopathy evaluation was done by a trained medical officer, using retinal photography. A biothesiometer reading of &gt;25 Hz on either leg, was considered as loss of vibration perception. Data were analysed, where associations were assessed using Chi square test at a 5% significance level. Results: The mean (SD) age of the study participants was 58.7 (10.47) years. The sample had a mean (SD) fasting blood sugar level of 156 (66.4) mg/dl and HbA1c value of 8.9% (5.46). 1025 participants had a positive biothesiometer reading, of which, 331 (32.3%) had evidence of diabetic retinopathy. Loss of vibration perception was significantly associated with the presence of diabetic retinopathy (p &lt; 0.05). Subgroup analysis based on sex revealed a significant association between loss of vibration perception among males and females, and the presence of diabetic retinopathy (p &lt; 0.05). Multivariate regression analysis for controlling confounding factors showed a HbA1c &gt;7% (p &lt; 0.05) and a positive vibration perception test (p &lt; d0.05) were significant. Conclusions and recommendations: Vibration perception threshold is an easy assessment that can be carried out in limited resource settings, and can be used as an early sign of referral, to screen for diabetic retinopathy which requires more complex technical expertise. Further evaluation on the association between the two is required to generalize the findings to the local population.

The Impact of Vitamin B12 Supplementation on Clinical Outcomes in Patients With Diabetic Neuropathy: A Meta-Analysis of Randomized Controlled Trials.

Diabetic neuropathy (DN) is one of the most prevalent and expensive microvascular consequences of diabetes mellitus (DM), which is noteworthy given that it is frequently both underdiagnosed and undertreated in daily clinical practice. The aim of the current article was to review the efficiency of vitamin B12 supplementationin isolation or in combination therapy for the treatment of diabetic peripheral neuropathy. This meta-analysis was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic electronic search was performed in PubMed and Cochrane Library to identify randomized controlled trials (RCTs) assessing the impact of vitamin B12 outcomes in patients with diabetic neuropathy without putting restrictions on the year of publication. A combination of the following keywords was used: "diabetic neuropathy," "vitamin B12," and "outcomes." The primary outcomes assessed in the current meta-analysis included neuropathic symptoms and vibration perception threshold (VPT). Secondary outcomes included a change in pain score from baseline, total cholesterol (mg/dL), high-density lipoprotein (HDL), and low-density lipoprotein (LDL). A total of six articles were selected to be included in the current meta-analysis.Patients receiving vitamin B12 showed a greater reduction of mean neuropathic symptoms(standardized mean difference (SMD): -0.39, 95% confidence interval (CI): -0.73, -0.05, p-value: 0.03) and pain score(SMD: -3.60, 95% CI: -4.68, -1.43, p-value<0.001) compared to the control group. No significant effect of vitamin B12 was found on VPT (mean difference (MD): -4.80, 95% CI: -11.03, 1.42, p-value: 0.13),change in HDL (MD: 0.14, 95% CI: -2.37, 2.65, p-value: 0.91), LDL (MD: 2.59, 95% CI: -5.94, 11.12, p-value: 0.55), and total cholesterol (MD: -2.72, 95% CI: -11.52, 6.08, p-value: 0.54).The current meta-analysis found that vitamin B12 can improve neuropathic symptoms and reduce pain in patients with diabetic neuropathy. However, the current study did not report any significant difference between patients who received vitamin B12 and placebo in terms of HDL, LDL, and total cholesterol.

Association between P300 parameters and cognitive function in people with diabetic neuropathy.

The purpose of this study was to investigate the association between event-related potential (ERP) P300 with cognitive function in people with diabetic peripheral neuropathy (DPN). We performed a cross-sectional analysis of 19 type 2 diabetes mellitus (T2DM) patients, aged 18 and older with DPN. The participants were assessed for neuropathy, cognitive function, & dual-task performance. DPN was examined via the administration of diabetic neuropathy symptom score (DNSS) and vibration perception threshold (VPT). Cognitive dysfunction was evaluated using Mini-mental state examination (MMSE), trail making test-B (TMT-B), and ERP P300 wave latency & amplitude. For assessing dual-task performance, the dual-task cost (DTC) was calculated using the timed-up and go (TUG) test and TUG with dual task (TUG-DT). P300 latency was linearly related to TMT-B (R = 0.31, p = 0.01) and DTC (R = 0.22, p = 0.04). A similar trend was observed in TMT-B (R = 0.13, p = 0.04) & DTC (R =0 .67, p = 0.001) with respect to P300 amplitude. MMSE did not relate with P300 latency (R = 0.14, p = 0.58) & amplitude (R = 0.63, p = .44). P300 latency and amplitude are associated with cognitive function and DTC of individuals with DPN.

Prevalence and correlates of vibration perception threshold based diabetic peripheral neuropathy in Gujarati urban population: A cross sectional study.

Diabetic peripheral neuropathy (DPN) is common microvascular complication with lack of data from many regions. Vibration perception threshold (VPT) is an objective tool to screen vibration-based neuropathy both quantitatively and qualitatively. We studied prevalence that correlates VPT in diabetic sample population. A cross-sectional study was performed in 100 under treatment urban type 2 diabetics. Using bioesthesiometer, we tested VPT from sole of lower limbs of each participant. VPT >25 was considered as DPN. VPT was further correlated to determinants using t test, chi square, and multiple linear regressions. P < 0.05 was taken as statistically significant. Mean age was 57, mean duration was 9.42 years, 40% were good glycemic, 28% were symptomatic for neuropathy, half subjects had co-existing hypertension and positive family history. VPT >25 was prevalent in 38% participants and mild, moderate, severe grades of DPN were present in 10%, 20%, 38%, respectively. VPT was associated with all three measures of glycemic control both quantitatively and qualitatively imposing significant odds risk (3.45, 2.63, 3.63 for HbA1C, FPG, 2hPG, respectively). Presence of symptoms, duration, and family history were significant predictors of VPT, whereas age, gender, hypertension, hyperlipidemia, and glycemic control were not. In chronic type 2 diabetics from a city Gujarat, we report 38% prevalence of DPN, related to symptoms, duration, family history, and all measures of glycemic triad. Unrelated to age and gender, VPT is superior to symptoms to detect DPN and it should be used optimally to insinuate timely preventive measures.

Advanced glycation end-products are associated with diabetic neuropathy in young adults with type 1 diabetes.

Aims/hypothesisAdvanced glycation end-products (AGEs) may contribute to the development of diabetic neuropathy. In young adults with type 1 diabetes, we aimed to investigate the association between AGEs and cardiovascular autonomic neuropathy (CAN) and distal symmetric polyneuropathy (DSPN).MethodsThis cross-sectional study comprised 151 young adults. CAN was assessed by cardiovascular autonomic reflex tests; lying-to-standing test, deep breathing test (E/I), Valsalva manoeuvre, and heart rate variability indices; and the mean square of the sum of the squares of differences between consecutive R-R intervals and standard deviation of normal-to-normal intervals (SDNN), high- (HF) and low-frequency (LF) power, total frequency power, and the LF/HF ratio. DSPN was assessed by light touch, pain and vibration perception threshold (VPT), neuropathy questionnaires, and objective measures. AGEs were analysed in four groups using z-scores adjusted for relevant confounders and multiple testing: i) “glycolytic dysfunction”, ii) “lipid peroxidation”, iii) “oxidative stress”, and iv) “glucotoxicity”.ResultsA higher z-score of “glycolytic dysfunction” was associated with higher VPT (4.14% (95% CI 1.31; 7.04), p = 0.004) and E/I (0.03% (95% CI 0.01; 0.05), p = 0.005), “lipid peroxidation” was associated with higher LF/HF ratio (37.72% (95% CI 1.12; 87.57), p = 0.044), and “glucotoxicity” was associated with lower SDNN (−4.20% (95% CI −8.1416; −0.0896), p = 0.047). No significance remained after adjustment for multiple testing.Conclusions/interpretationsIn young adults with type 1 diabetes, increased levels of AGEs involving different metabolic pathways were associated with several measures of CAN and DSPN, suggesting that AGEs may play a diverse role in the pathogeneses of diabetic neuropathy.

Corneal nerve and nerve conduction abnormalities in children with type 1 diabetes.

In vivo corneal confocal microscopy (CCM) is a novel, rapid, and non-invasive technique that identifies early small fiber damage and can predict the progression and development of clinical neuropathy in adults with type 1 diabetes. However, its usefulness in children is not well established. This study compared corneal confocal microscopy with neuropathic symptoms, signs, and objective measures of neuropathy for the diagnosis of diabetic neuropathy in children with type 1 diabetes. A total of 83 children with type 1 diabetes and 83 healthy participants of similar age underwent assessment of neuropathy symptoms, signs, nerve conduction studies, quantitative sensory and autonomic function testing, and in vivo CCM. Only of 3/83 (4%) children with type 1 diabetes had subclinical neuropathy. However, corneal nerve fiber density (p=0.001), branch density (p=0.006), fiber length (p=0.002), tibial motor nerve amplitude and conduction velocity, and sural sensory nerve amplitude and conduction velocity (all p < 0.004) were lower in participants with type 1 diabetes than in the controls. Vibration, cooling, and warm perception thresholds and deep breathing heart rate variability were not found to be different (all p > 0.05) between children with type 1 diabetes and healthy controls. Multivariate regression analysis identified a possible association between body mass index and decreased corneal nerves. Decreased corneal nerves and abnormal nerve conduction were found in children with type 1 diabetes. CCM may allow rapid objective detection of subclinical diabetic neuropathy in children and adolescents with type 1 diabetes.

Does plantar skin abrasion affect cutaneous mechanosensation?

In humans, plantar cutaneous mechanoreceptors provide critical input signals for postural control during walking and running. Because these receptors are located within the dermis, the mechanical properties of the overlying epidermis likely affect the transmission of external stimuli. Epidermal layers are highly adaptable and can form hard and thick protective calluses, but their effects on plantar sensitivity are currently disputed. Some research has shown no effect of epidermal properties on sensitivity to vibrations, whereas other research suggests that vibration and touch sensitivity diminishes with a thicker and harder epidermis. To address this conflict, we conducted an intervention study where 26 participants underwent a callus abrasion while an age‐matched control group (n = 16) received no treatment. Skin hardness and thickness as well as vibration perception thresholds and touch sensitivity thresholds were collected before and after the intervention. The Callus abrasion significantly decreased skin properties. The intervention group exhibited no change in vibration sensitivity but had significantly better touch sensitivity. We argue that touch sensitivity was impeded by calluses because hard skin disperses the monofilament's standardized pressure used to stimulate the mechanoreceptors over a larger area, decreasing indentation depth and therefore stimulus intensity. However, vibration sensitivity was unaffected because the vibrating probe was adjusted to reach specific indentation depths, and thus stimulus intensity was not affected by skin properties. Since objects underfoot necessarily indent plantar skin during weight‐bearing, calluses should not affect mechanosensation during standing, walking, or running.

A Prospective Observational Study Comparing the Efficacy and Safety of Duloxetine and Pregabalin in Diabetic Peripheral Neuropathic Pain.

Background and aimsPeripheral neuropathy is a frequent complication of long-standing diabetes mellitus that adversely affects the quality of life. Pregabalin (anticonvulsant) and duloxetine (antidepressant) are often prescribed for diabetic peripheral neuropathic pain. This study aimed to determine and compare the efficacy and safety of pregabalin and duloxetine in patients with diabetic peripheral neuropathic pain.Materials and methodsThis prospective observational study was conducted at District Headquarter (DHQ) Hospital, Daggar, Buner district, Pakistan, from February 15 to July 15, 2022, after approval from the Institutional Research and Ethical Review Board. Confirmation of diabetic peripheral neuropathy was based on the history of diabetes mellitus and vibration perception threshold (VPT) using a biothesiometer. The cut-off was set at 15 volts. VPT of more than 15 volts was considered confirmatory for peripheral neuropathy. Patients were divided equally into two groups. Baseline visual analog scale (VAS) score was recorded for all patients. Tablet pregabalin 300 mg daily was administered for four weeks to one group, while tablet duloxetine in 60 mg strength daily was administered to the other group. VAS score after four-week treatment was recorded and compared. Adverse events experienced by the patient were also noted.ResultsA total of 86 patients were enrolled. The patient ages ranged from 30 to 80 years. Baseline characteristics, including mean age, mean BMI, and mean disease duration of duloxetine versus pregabalin group, were 50.30 ± 8.55 versus 48.20 ± 8.99 years, 23.47 ± 1.23 versus 23.10 ± 1.59 kg/m2 and 21.64 ±7.41 versus 20.04±6.37 months respectively. Duloxetine effectively controlled peripheral neuropathic pain in 81.4% of patients compared to pregabalin in 74.4% of patients. Severe drug-related adverse reactions were observed in 4.6% of patients with duloxetine compared to 0% with pregabalin.ConclusionDuloxetine and pregabalin effectively reduce diabetes-related peripheral neuropathic pain. However, duloxetine has slightly better outcomes than pregabalin. The safety profile of pregabalin is better than duloxetine.

Sudomotor dysfunction and corneal nerve loss: An unusual presentation of syringomyelia and COVID-19 infection

Aim: To highlight unusual neurological findings in a patient with syringomyelia and COVID-19. Methods: Neurological examination, Vibration Perception Threshold (VPT), Magnetic Resonance Imaging (MRI) of the full neuroaxis, electrophysiologic studies, Corneal Confocal Microscopy (CCM) and Sudoscan were performed. Results: A previously fit and well 28-year-old lady presented with worsening shoulder and neck pain after COVID-19. She was found to have reduced pinprick sensation in both arms and base of the neck and MRI revealed a cervical syrinx. Electrophysiologic studies showed no evidence of upper limb neuropathy or cervical radiculopathy, but CCM showed corneal nerve loss and Sudoscan demonstrated severe sudomotor dysfunction in both hands. Conclusion: We present an unusual case of worsening pain with sudomotor dysfunction and corneal nerve fibre loss in a patient with syringomyelia and COVID-19 infection.

Amelioration of Diabetes and Neuropathy After Pancreas Transplantation: Measurable Differences in Vibration Perception Thresholds Impact Outcomes.

Amelioration of Diabetes and Neuropathy After Pancreas Transplantation: Measurable Differences in Vibration Perception Thresholds Impact Outcomes.