Assessment of Diabetic Polyneuropathy in Inpatient Care: Fasting Blood Glucose, HbA1c, Electroneuromyography and Diabetes Risk Factors

Clinical Utility of Boston-CTS and Six-Item CTS Questionnaires in Carpal Tunnel Syndrome Associated with Diabetic Polyneuropathy

Diabetic polyneuropathy (DPN) is the most frequent complication of diabetes. Carpal tunnel syndrome (CTS), one of the most common neuropathies, is a chronic compression of the median nerve at the wrist. In our prospective cross-sectional study, we enrolled patients with type 2 diabetes presenting with signs and symptoms suggestive of DPN (n = 53). We aimed to compare two clinical scales: the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and the six-item CTS symptoms scale (CTS-6), with nerve conduction studies (NCS) for detecting CTS in patients with DPN. Carpal tunnel syndrome and DPN were clinically evaluated, and the diagnosis was confirmed by NCS. Depending on the NCS parameters, the study group was divided into patients with and without DPN. For each group, we selected patients with CTS confirmed through NCS, and the results were compared with the BCTQ and CTS-6 scales. The clinical evaluation of CTS performed through BCTQ and CTS-6 was statistically significantly different between patients with and without CTS. When comparing the BCTQ questionnaire with the NCS tests, we found area under the curve (AUC) = 0.76 (95% CI 0.65-0.86) in patients with neuropathy and AUC = 0.72 (95% CI 0.55-0.88) in patients without neuropathy. At the same time, the AUC values of the CTS-6 scale were 0.76 (95% CI 0.61-0.88) in patients with neuropathy and 0.70 (95% CI 0.51-0.86) in patients without neuropathy. Using multiple logistic regression, we demonstrated that DPN increased the chances of detecting CTS using the two questionnaires. The Boston Carpal Tunnel Syndrome and CTS-6 questionnaires can be used in the diagnosis of CTS in diabetic patients with and without DPN but with moderate AUC. The presence of DPN increased the chances of detecting CTS using the BCTQ questionnaire and the CTS-6 scale.

Vascular factors and neuropathy in lower limb of diabetic patients

Asymmetric clinical presentation in some patients with diabetic polyneuropathy may result from the different vascular environments in both lower limbs. The aim of the study is to determine the association of neuropathy with vascular factors in each lower limb of diabetic patients. A total of 102 patients (204 lower limbs) given a diagnosis of diabetic polyneuropathy were enrolled. The primary end points are sensory nerve action potential (SNAP) amplitude and conduction velocity (CV) of the sural nerve and independent variables are vascular and nonvascular factors. Vascular factors include mean arterial pressure and pulse pressure at the ankle, ankle-brachial index, and arterial stiffness assessed by pulse wave velocity. Nonvascular factors include age, gender, height, body weight, body mass index, total cholesterol, and hemoglobin A₁C. Age, hemoglobin A₁C, and ankle pulse pressure were inversely correlated with SNAP amplitude of the sural nerve, while no factors were correlated with CV of the sural nerve. Increased arterial stiffness was significant in the limbs group with abnormal SNAP amplitude of the sural nerve, while increased height was significant in the limbs group with abnormal CV of the sural nerve. Vascular factors were more significantly associated with decreased SNAP amplitude rather than decreased CV of the sural nerve in the nerve conduction study of diabetic patients.

Stroke emergency medical care: initial assessment, risk factors, triage and hospitalization outcome

CONFLICT OF INTEREST

none declared.

GOALS

THE GOALS OF THIS RESEARCH ARE: a) to determine the number, gender and age representation of patients with a working diagnosis of acute stroke referred by the Institute for Emergency Medical Care (IEMC) in the Clinical Center of Sarajevo University (CCSU); b) determine the incidence of patients that have been or have not been hospitalized and why; c) determine the time and procedure for emergency medical care; d) to determine the characteristics and outcomes of patients hospitalized with ischemic stroke at the Neurology Clinic CCUS.

MATERIAL AND METHODS

The study was retrospective and included time period from 1st June 2010 to 30th November 2010. The study included patients of both sexes, older than 18 years of age.

RESULTS

The study included a total of 233 patients. Of these, 65% are female, while 35% of patients were male. Of 82 patients who were admitted to hospital treatment at the Neurology Clinic, 55% of the patients were male and 45% female. The largest number of patients is older than 70 years (71%). Minimum time for emergency medical team arrival was 6 minutes and maximum 70 minutes (mean 35, SD 11.989). Motor weakness was noted in 31% of patients - left sided motor weakness was significantly more represented. In 73% of patients the diagnosis was confirmed. In 5% of patients thrombolytic therapy was administered, while 95% of patients were treated conservatively. Lethal outcome occurred in 30% of hospitalized patients, 37% were discharged as recovered, 30% were discharged as unaltered state, while 3% were discharged with worsening symptoms. Among risk factors, hypertension is the leading one, followed by an earlier stroke, diabetes mellitus, and cardiac arrhythmias.

CONCLUSIONS

In 91% of patients consciousness was preserved. In 73% of transported patients has been confirmed the diagnosis of ischemic stroke. Of the patients with confirmed diagnosis 59% were hospitalized. A significant number of strokes occur for the first time in relation to relapse. 5% of patients were treated with thrombolysis, while others were treated with conservative therapy. Recurrent stroke and patient confusion have significant impact on the outcome.