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Ciprian Constantin, Aurelian Ranetti, Georgiana Constantin, Cristina Ioniţă, Irina Gal and Dan Mircea Cheţa
Background and Aims: A complete evaluation of complications should be done each time a new case of Type 2 Diabetes Mellitus (T2DM) is diagnosed. A good screening of complications will be the background of an oriented treatment. Our aim was to assess the vibratory and thermal sensitivity using a Computer Aided Sensory Analyzer (CASEIVSystem) in newly diagnosed T2DM patients and to compare it with the threshold determined by classical methods. Material and Methods: We sequentially enrolled 260 patients with newly diagnosed T2DM. The threshold of peripheral vibratory and thermal sensitivity was comparatively assessed using CASEIVSystem and classic tools. Other neurological scores were obtained from patients. Results: The vibratory threshold was abnormal in 56.92% (hand) and respectively 75.00% (foot) of subjects. Altered perception for the thermal threshold was registered in 76.15% and, respectively, 76.92% of subjects for the same sites. The 10g-monofilament exam was positive for 28.46% and the 128Hz-tuning-fork exam was positive for 20.38% of the examined patients. Mean time for a complete CASEIVSystem exam was around 27.23±9.34min vs. 3.21±0.24min (p<0.05) for a classic exam. Conclusions: In our study, CASEIVSystem allowed the assessment of the vibratory and thermal thresholds. The time needed for investigation renders this tool difficult to use in a time effective manner
Cristina Muntean, Bogdan Cătălin, Valerica Tudorică and Maria Moţa
Background and Aims: Little data regarding distal symmetric polyneuropathy (DSP) prevalence in Romania is available. The aim of the present study was to assess the prevalence of DSP in our cohort, to characterize it depending on glycemic control, and also to find an easy-to-apply method for DSP screening which could be used in Romania.
Material and Methods: We performed a cross-sectional study enrolling 51 patients followed in the Diabetes, Nutrition and Metabolic Diseases Clinic, Clinical County Hospital of Craiova, Romania. A complete evaluation protocol consisting in clinical examination and Michigan Neuropathy Screening Instrument (MNSI), together with nerve conduction studies were applied for evaluation.
Results: Among the type 2 diabetic patients investigated, 72.54% had DSP. Three-quarters of them had poor glycemic control (HbA1c ≥7%). Mean HbA1c level was 9.17%. Poor glycemic control led to a more severe DSP form as proven by nerve conduction studies and clinical examination. Allodynia and motor deficit were predominantly found with HbA1c ≥7%. Mean MNSI score for the group was 2.55, strongly correlated with nerve conduction studies.
Conclusion: MNSI is a simple and validated diagnostic tool for DSP with a strong correlation to electrophysiological parameters. Therefore, its daily implementation in clinical practice could help identify and follow patients at risk for DSP.
We looked for easy-to-use and predictable tools for identifying early risk ofprediabetes (PD) and preventing the natural course to diabetes in overweight andobese pre-teens and adolescents. In 89 children (9-18 years) family history, bodymass index (BMI), waist circumference (WC), acanthosis nigricans, blood pressure(BP), lipids, HbA1c, fasting glucose and oral glucose tolerance test were determined.We found 69 (77.5%) obese (BMI≥95th percentile) and 20 (22.5%) overweightchildren (BMI 85th-95th percentiles); thirty-six (41.4%) had PD; two had type 2diabetes mellitus; two had metabolic syndrome. PD was associated with obesity (RR5.1), HbA1c>5.5% (RR 2.5), acanthosis nigricans (RR=1.9), malegender (RR = 1.9), total cholesterol ≥170 mg/dL (RR=1.8), high BP (RR=1.7), urbanarea (RR = 1.6). BMI, WC, HbA1c and acanthosis nigricans are the majorpredictors for PD in this population. All blood values are both easy to measure andto accept by children, using finger prick method.
Georgeta Inceu, Horea Demea and Ioan Andrei Veresiu
Background and aims. This article aims to compare corneal confocal microscopy (CCM) with acknowledged tests of diabetic peripheral neuropathy (DPN), to assess corneal nerve morphology using CCM in diabetic patients, and to underline possible correlations between clinical and biological parameters, diabetes duration and DPN severity. Material and methods. A total of 90 patients with type 2 diabetes were included in the study for whom we measured anthropometric parameters and we performed laboratory measurements (tests). The patients were assessed for diabetic peripheral neuropathy using Semmes-Weinstein Monofilament Testing (SWMT), Rapid-Current Perception Threshold (R-CPT) measurements using the Neurometer®, and CCM. We stratified the patients according to DPN severity, based on four parameters extracted after image analysis. Results. A higher percentage of patients were diagnosed with DPN using CCM (88.8%), compared with SWMT and R-CPT measurement (17.8% and 40% respectively). The incidence of DPN detected with CCM was considerable in patients with normal protective sensation and with normal R-CPT values. Conclusions. Our study showed that corneal confocal microscopy is a useful noninvasive method for diabetic neuropathy assessement in early stages. It was proven to directly quantify small fiber pathology, and to stratify neuropathic severity, and therefore can be used as a new, reliable tool in the diagnosis, clinical evaluation, and follow-up of peripheral diabetic neuropathy.
Cornelia Zetu, Rubin Munteanu, Anca Frunză and Constantin Ionescu-Tîrgovişte
The prevalence of type 2 diabetes mellitus (T2DM) and obesity is steadily increasingworldwide. To fight the twin pandemics of obesity and T2DM, clinicians need everytool they can get. Major, durable weight loss is uncommon with medical andbehavioral approaches; many diabetes drugs promote weight gain, while using themto obtain better blood glucose profiles increases the risk of hypoglycemia. Bariatricsurgery seems to be the most effective method for promoting major and durableweight loss in obese subjects, leading also to ameliorations of obesity-associated comorbidities,especially T2DM. Currently, indications for bariatric surgery includemorbidly obese patients or patients with a body mass index (BMI) >35 withsignificant co-morbidities. Currently, bariatric surgery (also referred to as“metabolic surgery”) is advocated for the treatment of T2DM even in overweightsubjects who do not meet the current BMI criteria. This review examines the currentevidence regarding the mechanisms of T2DM resolution following bariatric surgery.
Olguţa Anca Orzan, George Simion, Irina Tudose, Mariana Costache and Călin Giurcăneanu
Aim: To document the spectrum of histological changes of cutaneous lesions found in patients with gout. Material and methods: Thirteen cutaneous biopsies were studied. The biopsies were fixed in formalin solution and stained with hematoxyline and eosin. Results: A common feature in all 13 cases was the presence of deposits of basophilic material with needle-like clefts. The main histological reaction pattern was palisading granuloma. In 7 cases the deposits were subcutaneously located and in 6 cases intradermal and subcutaneously. The inflammatory infiltrate contained mainly epithelioid histiocytes and multinucleate giant cells. In 5 cases it also contained neutrophils and in one case foam cells. Secondary changes were found in 6 cases. Conclusion: When the clinical findings are atypical, cutaneous biopsy remains an important tool to establish the diagnosis of tophi, even in those cases with no possibility to exam alcohol fixed specimens under polarized light. In our study the preliminary clinical diagnosis was consistent with the histological findings in only 3 cases. The key feature that allowed the correct diagnosis was the presence of basophilic material with needle-like clefts surrounded by a palisading histiocytic infiltrate.
Kamal Deep Joshi, Jeevan Ramachandra Galagali and Sanajeet Kumar Singh
Background and aims: Auditory dysfunctions in diabetes are known but are difficult to identify. Role of clinical tests and routine audiological tools are still to be established in early detection of diabetes-related auditory complication. The study aims to establish a link between diabetes and auditory dysfunction and assess the role of clinical examination and audiological investigations as a sensitive indicator of auditory dysfunctions in diabetics.
Material and Methods: The auditory functions of 100 diabetic patients and 100 non-diabetics were assessed by clinical otological examination including free-field hearing and pure tone audiometry (PTA) in this descriptive study. The data for diabetic and non-diabetic groups and effect of age on auditory functions were analyzed with suitable statistical tests using SPSS 2.0 software with an error margin of 10%.
Results: The demographical variables were comparable in both groups. The results showed a decline in free field hearing, which are furthur adversely affected by duration of diabetes and patient’s age. Overall pure tone thresholds were not significantly higher in diabetics, however the thresholds were higher in diabetics in older age groups. The hearing loss appears at an early age in diabetics but gradually becomes indistinguishable from age-related hearing loss.
Conclusions: The auditory dysfunction can be linked to diabetes. It is usually not detectable at earliest stages with routine clinical and audiological tests but the clinical tests and pure tone audiometry can have a utility in monitoring the auditory dysfunction.
Background and Aims: Ayurveda strongly emphasize on preventive and promotive aspects of health rather than curative. Centuries ago, Ayurveda laid the concepts of Dinacharya (daily regimen for healthy living), Ritucharya (seasonal regimen for healthy living), Sadvaritta (moral conducts) and Achara Rasayana (social conducts) as well established guidelines for healthy diet and lifestyle; but in current era, hardly anyone aptly follow it. As a result, there is tremendous rise in lifestyle disorders as pandemics, diabetes being the most menacing among them. The aim of this review is to bring into the limelight the Ayurvedic dietary and lifestyle guidelines for prevention of type 2 diabetes and available factual research evidence validating it. Materials and methods: Ayurvedic recommendations for prevention of diabetes were rationally reviewed in light of published information from several articles. Publications in Pubmed, Scopemed, Dhara online and other allied databases covering fields of therapeutics, pharmacology, biomedicine and health were also screened and taken into study for the report. Conclusion: Ayurvedic lifestyle guidelines of adopting a healthy dietary pattern together with physical activity are valuable tools in the prevention of type 2 diabetes.
Farzaneh Momeniarbat, Javad Karimi, Nosrolah Erfani and Javad Kiani
Background and Aims: The purpose of this study was to identify the role of neuroticism and psychological flexibility (PF) in quality of life (QOL) and chronic fatigue (CF) in patients with Type 2 Diabetes Mellitus (T2DM). Materials and Methods: We considered the all of the patients with T2DM over aged 30 years and living in the province of Hamadan, Iran in 2014 that were referred to the Hamadan Diabetes Center. A sample size of 170 patients was selected by the simple random sampling method. The measuring tools were completed by the patients. To test assumptions, the Pearson correlation and structural equation modeling were used. Results: The results showed that the correlation coefficient between neuroticism, with CF (r=0.579; p<0.001) and QOL (r=-0.242; p<0.001), and also correlation between PF and CF (r=0.287; p<0.001) are significant. There is no significant relationship between QOL and PF (r= -0.098; p=0.203). Structural equation modeling showed that neuroticism has a direct positive effect in CF (p<0.001) and a negative effect on QOL (p<0.001), and the PF has a significant direct effect on CF (p=0.014) and an indirect effect on QOL. The CF affects negatively on the QOL (p<0.001). Conclusion: It could be concluded that neuroticism and PF play important roles in QOL and CF and with effective intervention can help patients with diabetes to improve them QOL.