Assessment of Neuropathy by Temperature Threshold Testing in Type 2 Diabetes Mellitus

Introduction

Diagnosing diabetic neuropathy is a challenge at times as it is asymptomatic. Diagnosing diabetic neuropathy involves the use of quantitative sensory testing, nerve conduction study, and autonomic testing. Tempearture threshold testing (TTT) can aid in diagnosing small fiber neuropathy at early stages. This study aimed to assess the small fiber neuropathy using TTT in diabetes mellitus (DM) and correlate with age, duration of diabetes, and lipid profile.

Materials and Methods

The study was commenced after obtaining ethics approval from the institute ethics committee. The study participants included 100 patients with type 2 DM of both genders between the ages of 40 and 65 years. The glycemic status and lipid profile were noted along with physical examination. Neuropathy assessment was done using Michigan Neuropathy Screening Instrument (MNSI) and TTT.

Results

The prevalence of small fiber neuropathy based on TTT was 63%. The lipid profile was similar in both the groups. The MNSI B scale had significantly higher scores in the neuropathy group. In the neuropathy group, the thresholds for hot were significantly greater in all four limbs and cold were significantly lower. Age and years of DM were positively correlated with the neuropathy. Hot threshold in the lower limb had shown a strong positive correlation.

Conclusion

The age and duration of diabetes are independent risk factors for diabetic peripheral neuropathy. Small fiber neuropathy is a prequel to the motor neuropathy. Hot threshold testing in the lower limb is more sensitive than cold threshold testing for diagnosing small fiber neuropathy.

Comprehensive, continuous, and compulsory monitoring of frailty in elderly

Background

The increasing elderly population makes frailty an increasing concern in society with vulnerability to stress and functional decline. Unrecognised comorbidities are common among the elderly due to lack of mention by the patients. Physicians should be equipped with effective interviewing skills along with the use of screening tools to assess any impairments in activities of daily living, cognition and signs of depression.

Objectives

To measure the degree of independence or dependence using scales and stratify patients based on Clinical Frailty Scale (CFS) so as to recommend it as a routinely usable tool.

Materials and Methods

In total, 191 elderly subjects above the age of 65 years were recruited for geriatric assessment. Tools that assess performance in daily living activities and cognition were used. The prevalidated CFS was used to score frailty to stratify patients into frail and non-frail groups, and the parameters were compared.

Results

Mean age of the study population was 69.54 years with 53.4% males and 46.6% females. Mean Katz index and mean Lawton score were >5. The mean Global Deterioration Scale (GDS) score was 1.5, and the mean clinical frailty score was 3.55. Significantly high number of male individuals were found in the frailty group. Hypertension was significantly higher in the frail group. The mean Katz scores were significantly lower, and mean GDS scores were significantly higher in the frailty group. Multivariable logistic regression has shown gender to be an important determinant of frailty with an odds ratio of 0.05 (CI-0.01-0.20). The higher Lawton score and GDS scores were significantly associated with frailty with an odds ratio of 0.33 (CI: 0.21-0.52) and 2.62 (CI: 1.14-6.02), respectively.

Conclusion

Men are more frail than women and co-morbidities like hypertension and coronary artery disease contribute to frailty with cognitive decline and decreased autonomy. A comprehensive assessment to identify frailty will provide a holistic view of well being among the elderly.

Channeling of Brain Towards Engaging Sensorimotor Tasks for Inducing Hedonic Pleasure to Alleviate Blood Pressure in Hypertension

Background

Hypertension is a modifiable risk factor for cardiovascular disease and is responsible for major deaths due to stroke and coronary heart disease. Several pharmacological and non-pharmacological interventions for reducing blood pressure have been tried earlier. Modulating brain regions such as prefrontal cortex (PFC) to channelize activities is an effective tool to target blood pressure.

Purpose

Prefrontal cortex (PFC) exerts inhibitory control over sympathoexcitatory circuits, which was explored using a novel reaction time paradigm.

Methods

Thirty participants of both genders in the age group 40-70 years with established hypertension were included. A structured reaction time paradigm was designed to include psychomotor and visuomotor elements with integrated sensory attention and motor performance tasks. Blood pressure, Lead II ECG, and EEG from F3 and F4 were recorded. A paired t-test was used to examine the variations in these parameters across tasks.

Results

A significant reduction in mean arterial pressure by 4.04 mmHg (p = .0232) during the visuomotor task and a reduction of 3.38 mmHg during the auditory cue task (p = .0446) were observed. Analysis of the difference in heart rate has shown a profound decrease after passive listening tasks by 3.7 beats (p < .0001*). Spectral analysis from F3 and F4 shows high power in low-frequency zone of EEG indicating a relaxed state during auditory cues and passive listening.

Conclusion

The reaction time paradigm, when applied to hypertensives, helped decrease blood pressure and heart rate and improved the high frequency (HF) component of heart rate variability, indicating parasympathetic dominance. Such reward-oriented paradigms may act as biofeedback modules that cause hyperactivity of the PFC to suppress the sympathoexcitatory circuit with increased parasympathetic activity beneficial to hypertensive individuals.

Serum Adiponectin and Nitric Oxide Levels in Type II Diabetes and Its Correlation With Lipid Profile

Introduction

Various markers for diabetes have been identified in this new era of medicine, the most recent being adiponectin, which is primarily secreted from adipose tissue and has anti-diabetic, anti-inflammatory, and anti-atherogenic properties. It is also known to increase insulin sensitivity. Adiponectin deficiency or decreased secretion causes a variety of complications, including insulin resistance and the onset of type 2 diabetes mellitus (T2DM). One such complication of T2DM is endothelial dysfunction, which leads to decreased synthesis of nitric oxide (NO), another potent marker that normally disrupts key events in the progression of atherosclerosis.

Aims and objectives

The aim of the study was to compare and correlate serum adiponectin and nitric oxide levels with glycemic status in patients with T2DM and healthy controls.

Materials and methods

This comparative cross-sectional study included known cases of type II diabetes under group I and healthy age-matched controls under group II. Serum levels of adiponectin and nitric oxide were assessed in both the groups along with glycemic status [fasting blood sugar (FBS) and glycated hemoglobin (HbA1c)] and these parameters were compared between both groups using a t-test. Adiponectin and NO levels were correlated using Pearson’s correlation with glycemic status in group I.

Results

The mean adiponectin levels in group I were 5.94 ± 1.490 μg/mL, which was significantly (p<0.00) less than in group II, 10.30 ±1.669 μg/mL. The mean NO levels in group I (42.98 ± 6.300 μmol/L) were also significantly (p<0.00) less than in group II (56.126 ± 7.579 μmol/L). FBS and HbA1C levels were significantly higher in group I than in group II.

Conclusion

Adiponectin and NO levels were significantly reduced in individuals with T2DM when compared to healthy controls. Therapeutic interventions that increase adiponectin and NO levels may be useful targets for improving diabetes control and reducing complications.