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Ward K, Krishnan A, R Iyengar K, Robertson T, White R, Urkude R. Haycocknema perplexum myositis: the first description of subclinical disease and a proposed distinctive triad to evoke clinical suspicion. BMJ Neurol Open 2022; 4:e000290. [PMID: 35663589 PMCID: PMC9119132 DOI: 10.1136/bmjno-2022-000290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Haycocknema perplexum is an exceedingly rare cause of parasitic myositis endemic to Australia, more specifically, Tasmania and North Queensland. There is a paucity of literature regarding this diagnosis, with only nine previously described cases. Diagnosis This report details two cases of biopsy-confirmed H. perplexum myositis from Townsville University Hospital and describes the first-ever case of subclinical infection. There is limited known information regarding the H. perplexum life cycle and a definitive host which has hindered the development of a non-invasive diagnostic test. A review of the previously described cases has identified the hallmark features of this enigmatic condition: a triad of serological markers including deranged hepatic function, persistent eosinophilia and an elevated creatine kinase. Conclusions This report aimed to raise awareness of H. perplexum myositis and the possibility of subclinical infection, which suggests a protracted disease course. Further research is required to identify a non-invasive diagnostic test, given that early diagnosis and timely initiation of albendazole treatment may drastically limit patient disability.
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Affiliation(s)
- Kayla Ward
- Neurology Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Neurology Department, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Anirudh Krishnan
- Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | | | - Thomas Robertson
- Pathology, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - Richard White
- Neurology Department, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Ravindra Urkude
- Neurology Department, Townsville Hospital and Health Service, Townsville, Queensland, Australia
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Rodrigues BT, Vangaveti VN, Urkude R, Biros E, Malabu UH. Prevalence and risk factors of lower limb amputations in patients with diabetic foot ulcers: A systematic review and meta-analysis. Diabetes Metab Syndr 2022; 16:102397. [PMID: 35085918 DOI: 10.1016/j.dsx.2022.102397] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/24/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS The study aimed at determining prevalence and risk factors (RFs) of diabetic lower limb amputations (LLAs). METHODS Electronic databases including PubMed, Medline, Web of Science, and Cochrane Library were searched from January 2003 to April 2021. RESULTS Sixteen full-text published studies were reviewed. The prevalence of LLAs stood as high as 66%, with a combined prevalence of 19% (95% CI 10-29) using the random-effects model. The most prominent RFs for LLA were duration of diabetes mellitus (DM), age, renal impairment, and ethnic minority. Amongst Australians, Indigenous background is strongly associated with increased risk of the diabetic foot (DF) LLA. CONCLUSIONS LLAs are considerably prevalent amongst patients with the DF and occur at even higher rates in patients with multimorbidity.
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Affiliation(s)
- Beverly T Rodrigues
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Australia
| | - Venkat N Vangaveti
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Australia
| | - Ravindra Urkude
- Department of Neurology, Townsville University Hospital, Australia
| | - Erik Biros
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Australia
| | - Usman H Malabu
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Australia; Department of Diabetes and Endocrinology, Townsville University Hospital, Australia.
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Ly DHM, Vangaveti VN, Urkude R, Biros E, Malabu UH. Metabolic and Anthropometric Influences on Nerve Conduction Parameters in Patients with Peripheral Neuropathy: A Retrospective Chart Analysis. Neurol Int 2021; 13:166-174. [PMID: 33920752 PMCID: PMC8167754 DOI: 10.3390/neurolint13020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/26/2022] Open
Abstract
Background and Aims: Nerve conduction study (NCS) measures how fast an electrical impulse moves through the nerve and is a standard technique for diagnosing and assessing neurological diseases. Despite diabetes and obesity being a common accompaniment of peripheral neuropathy, their effects on NCS patterns have not been elucidated conclusively. Our study aimed to assess several anthropometric and metabolic factors with NCS outcomes to address this gap. Research Design and Methods: This retrospective chart analysis study was conducted on subjects who underwent NCS between 1 January 2009 and 31 December 2019 at a regional hospital. Metabolic, anthropometric, demographical and NCS data were collected from patients’ health records. Results: In total, 120 subjects presenting with sensorimotor peripheral neuropathy symptoms were included in the study. Age, HbA1c, urea and ESR variables were significantly negatively associated with nerve conduction outcomes (Spearman’s correlation rho between −0.210 and −0.456, p < 0.038). HbA1c and age consistently had the most substantial contribution to velocity and amplitude in all regression models (beta coefficients between −0.157 and 0.516, p < 0.001). Urea also significantly account for a large amount of variance in amplitude and velocity in the lower limbs. Conclusion: This study suggests that the severity of sensorimotor neuropathy is influenced by glycaemic control, age and uraemia. The interpretation of NCS results must consider these factors suggesting that improved glycaemic and uraemic control may improve nerve conduction outcomes.
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Affiliation(s)
- Daniel H M Ly
- Translational Research on Endocrinology and Diabetes (TREAD), College of Medicine and Dentistry, James Cook University, Douglas, QLD 4811, Australia; (D.H.M.L.); (V.N.V.); (E.B.)
| | - Venkat N. Vangaveti
- Translational Research on Endocrinology and Diabetes (TREAD), College of Medicine and Dentistry, James Cook University, Douglas, QLD 4811, Australia; (D.H.M.L.); (V.N.V.); (E.B.)
| | - Ravindra Urkude
- Department of Neurology, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia;
| | - Erik Biros
- Translational Research on Endocrinology and Diabetes (TREAD), College of Medicine and Dentistry, James Cook University, Douglas, QLD 4811, Australia; (D.H.M.L.); (V.N.V.); (E.B.)
| | - Usman H Malabu
- Translational Research on Endocrinology and Diabetes (TREAD), College of Medicine and Dentistry, James Cook University, Douglas, QLD 4811, Australia; (D.H.M.L.); (V.N.V.); (E.B.)
- Department of Neurology, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia;
- Correspondence: ; Tel.: +61-7-4433-2235
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Devlin M, Costello C, Hodges G, Urkude R. 091 Poems syndrome treated with autologous stem cell transplant. J Neurol Neurosurg Psychiatry 2018. [DOI: 10.1136/jnnp-2018-anzan.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionAcquired demyelinating neuropathies comprise a diverse spectrum of individual diseases and pathophysiological processes. Differential diagnoses can be distinguished through assessment of region of involvement, time course, neurophysiology and ancillary testing. Where an atypical presentation of chronic inflammatory demyelinating polyradiculoneuropathy arises, further investigation and changes to management are required. We present a single case report from the Townsville Hospital.CaseA 45 year old man presented with two months of altered sensation in the distal lower extremities. Lower limb weakness developed, and three months after symptoms onset the patient had bilateral foot drop, and developed sensory disturbance in the upper limbs. Electrophysiological testing revealed severely reduced lower limb CMAPs with demyelinating range conduction velocity without conduction block; upper limb SNAPs were normal in amplitude with conduction velocity slowing. A lumbar puncture revealed elevated CSF protein 870 mg/L without raised white cells. A trace lambda IgG band of uncertain significance was detected. IVIG was commenced and symptoms initially stabilised. After four months of monthly IVIG, symptoms worsened and neurophysiology revealed further neurogenic changes. Skeletal survey and whole Spine MR STIR sequences did not reveal any bony lesions, and bone marrow biopsy revealed 5% plasmacytosis. The patient’s functional status deteriorated to full-time wheelchair use despite escalation of therapy. Sural nerve biopsy revealed axonal loss and demyelination without inflammation. A final diagnosis of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, skin changes) syndrome was confirmed with vascular endothelial growth factor elevation, and the patient underwent an autologous stem cell transplant with significant improvement in symptoms and functional status by day 100.ConclusionPOEMS syndrome is a rare disorder and should be suspected in atypical cases of CIDP particularly when treatment resistance is present. Extensive investigation is often required to meet diagnostic criteria for POEMS.
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Shukla A, Anand D, Urkude R. Organophosphate induced delayed pure motor neuropathy. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-316074.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Koehler AV, Spratt DM, Norton R, Warren S, McEwan B, Urkude R, Murthy S, Robertson T, McCallum N, Parsonson F, Bradbury RS, Gasser RB. More parasitic myositis cases in humans in Australia, and the definition of genetic markers for the causative agents as a basis for molecular diagnosis. Infect Genet Evol 2016; 44:69-75. [PMID: 27312103 DOI: 10.1016/j.meegid.2016.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 11/18/2022]
Abstract
Since 1998, there have been six reported human cases of myositis in Australia, attributable to infection with the nematode Haycocknema perplexum. However, an unequivocal diagnosis of H. perplexum infection and associated disease has been seriously compromised by a lack of molecular markers for this nematode. Here, we report new cases of disseminated myositis in two male patients from the states of Queensland and Tasmania in Australia, respectively; genetically characterize the causative agent from each case; and, also establish a PCR-based sequencing approach as a tool to support the diagnosis of future cases and to underpin epidemiological studies.
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Affiliation(s)
- Anson V Koehler
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Victoria, Australia
| | - David M Spratt
- Australian National Wildlife Collection, Commonwealth Scientific and Industrial Research Organisation, Canberra, Australia
| | - Robert Norton
- Pathology Queensland, Townsville Hospital, Queensland, Australia
| | - Sanchia Warren
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Tasmania, Australia
| | - Belinda McEwan
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Tasmania, Australia
| | - Ravindra Urkude
- Department of Neurology, The Townsville Hospital, Queensland, Australia
| | - Suresh Murthy
- Department of Neurology, The Townsville Hospital, Queensland, Australia
| | - Thomas Robertson
- Anatomical Pathology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia; Department of Molecular and Cellular Pathology, School of Medicine, University of Queensland, Queensland 4006, Australia
| | - Naomi McCallum
- Electron Microscope Unit, Pathology Queensland, Royal Brisbane & Women's Hospital, Queensland, Australia
| | - Fiona Parsonson
- Pathology Queensland, Townsville Hospital, Queensland, Australia
| | - Richard S Bradbury
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, North Rockhampton, Queensland, Australia.
| | - Robin B Gasser
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Victoria, Australia.
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Tay LB, Urkude R, Verma KK. Clinical profile, electrodiagnosis and outcome in patients with carpal tunnel syndrome: a Singapore perspective. Singapore Med J 2006; 47:1049-52. [PMID: 17139401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Carpal tunnel syndrome (CTS ) is the most common entrapment neuropathy seen in our neurodiagnostic laboratory referrals. We describe the clinical profile, and outcome in patients with electrophysiological diagnosis of CTS seen in our centre over a six month period. METHODS A retrospective study was carried out and included 134 consecutive patients with CTS referred to the Neurodiagnostic Laboratory, National Neuroscience Institute, from October 2003 to March 2004, for the confirmatory testing. Severity grade was assigned following American Association of Electrodiagnostic Medicine criteria of CTS. RESULTS The majority of patients were female (81.3 percent) with mean age of presentation being 53.6 years. Chinese women constitute the majority racial group. Paraesthesia (70.1 percent) and numbness (19.4 percent) were the presenting sensory symptoms. In the nerve conduction study, 108 patients had bilateral CTS with 35 having unilateral symptoms. Dominant hand involvement was present in 92.3 percent. Overall, 40.3 percent had mild, 46.3 percent had moderate and 13.4 percent had severe CTS, with median duration of symptoms of two, four and 12 months, respectively. Follow-up data were available for 115 patients. 27 patients with surgical treatment showed resolution or improvement in 53.3 percent with moderate CTS, and 83.3 percent with severe CTS, at three-month follow-up. 14 patients turned up for six-month follow-up and 92.9 percent showed improvement in symptoms. 88 patients were managed conservatively; symptoms were unchanged or worsened in 80.6 percent with mild CTS, 65.9 percent with moderate CTS, and 62.5 percent with severe CTS at three-month follow-up. Of the 54 patients who turned up for six-month follow-up, the clinical symptom remain unchanged or worsened in 68.5 percent. CONCLUSION The severity of CTS is associated with longer duration of symptoms. Sensory symptoms and dominant hand involvement is more common. There is a high default rate in the clinical follow-up. Early surgical intervention results in either resolution or improvement in symptoms, whereas conservative management does not affect the natural history with symptoms that persisted or worsened with time.
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Affiliation(s)
- L B Tay
- Neurodiagnostic Laboratory, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore
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