Effect of photobiomodulation on serum neuron specific enolase (NSE) among patients with diabetic peripheral neuropathy – A pilot study

Background and aimPhotobiomodulation is an emerging therapy for Diabetic peripheral neuropathy (DPN) of which the management is still a dilemma for clinicians. Elevated Neuron Specific Enolase (NSE) is associated with neuropathy. We aimed this study to assess the effect of Low Level Laser Therapy (LLLT) on Serum Neuron Specific Enolase in Type II Diabetes Mellitus patients with DPN.MethodologyPre post interventional study was done on 50 patients with DPN. DPN was confirmed using 10g Monofilament test, Vibration perception threshold (VPT) and Michigan Neuropathy Screening Instrument. All patients were provided with LLLT for 9 min on dorsal and plantar of foot with a dosage of 3.1 J/cm ² for 10 days. A blood sample was collected at baseline and 4 weeks after LLLT for NSE estimation.ResultA significant reduction in serum NSE levels (0.006) after 4 weeks of laser therapy was observed in 42 patients when compared with baseline. A significant reduction in the vibration perception threshold (p = 0.003) and Numeric pain rating scale (p = 0.004) were observed.ConclusionIn this pilot study, we have assessed the effect of LLLT on serum NSE levels among patients with DPN and showed improved quality of life and decrease in serum NSE levels. These findings should be investigated in larger trials.     

Fit for purpose? Footwear for patients with and without diabetic peripheral neuropathy: A cross-sectional study

AimThis paper determines whether patients with and without Diabetic Peripheral Neuropathy use suitable footwear, taking into account that these persons are subject to a significant loss of sensitivity in the feet.MethodsCross-sectional observational study was conducted of 108 participants with diabetes mellitus. Inclusion criteria were at least five years’ progression of diabetes, the ability to walk unaided and no distal amputation of the foot. The presence of DPN was evaluated according to the criteria of the International Working Group on the Diabetic Foot. Foot length was measured using a Brannock® device and internal shoe length was determined using a CEGI® pedometer.ResultsIn relation to adjustment, 21.6% of the shoes examined had no type of closure. The most common form of closure was laces, which were used in 32.4% of the shoes. 92.5% of footwear had internal seams. No significant relationship was found between the presence or otherwise of DPN and the use of appropriate shoe closure (p = 0.304), recommended heel height (p = 0.18), leather material (p = 0.77) and absence of internal seams (p = 0.759).ConclusionsThe majority of our participants living with DPN do not wear fitting shoes. Therefore, it is advisable to evaluate their use of footwear, both in primary health care and in podiatry clinics, to forestall potential complications.     

Fall episodes in elderly patients with asthma and COPD – A pilot study

Objective: Evidence of an increased risk of falls in patients with chronic obstructive pulmonary disease (COPD) exists; however, this has not been studied in elderly asthmatic patients. The aim of the study was to determine the incidence of falls in elderly patients who were diagnosed with bronchial asthma compared to subjects with COPD. Methods: A 12-month prospective observational study in elderly outpatients with diagnosis of either asthma or COPD was conducted. All of the participants were monitored on the following parameters: falls, comorbidities, drug therapy, and The Berg Balance Scale. The rate of falls was shown as an incidence ratio. Cluster analysis for subgroups with similar features was performed on all patients included in the study. Two clusters of frequent fallers were determined. Results: The fall incidence rate in falls per person per year was 1.41 (95% CI: 0.86–1.96) in asthmatic patients and 1.49 (95% CI: 1.05–2.11) in the COPD group. Frequent fallers were more prevalent in the COPD group, with 32% in this group compared to 28% in the groups of patients with asthma. In cluster analysis, frequent fallers were grouped into two models characterized by polytherapy, depression symptoms, hospitalizations, coronary disease, dementia, and diagnosis of COPD or asthma. Conclusion: Elderly asthmatic patients presented a high rate of falls, which is comparable to that of patients with COPD.     

Association of serum regenerating islet-derived protein 3-beta and oncostatin-M levels with the risk of acute coronary syndrome in patients with type 2 diabetes mellitus – A pilot study

Background and aimsRegenerating islet-derived protein 3-beta (Reg3β) and oncostatin-M (OSM), an inducer of Reg3β, are important for the recruitment of macrophages, tissue repair and survival after myocardial infarction. The study was planned to elucidate the diagnostic utility of serum Reg3β and OSM levels for the acute coronary syndrome (ACS).MethodsForty-two type 2 diabetes mellitus (T2DM) patients with ACS as cases and forty-two T2DM patients as controls were recruited. Routine biochemical investigations, creatine kinase-total (CK-T), and creatine kinase-MB (CK-MB) levels were estimated. Serum Reg3β and OSM levels were analysed by enzyme-linked immunosorbent assay.ResultsSerum Reg3β and OSM levels were significantly higher in cases as compared to controls. Serum Reg3β and OSM levels were positively correlated with random blood glucose, serum CK-total, CK-MB levels, and negatively correlated with serum high-density lipoprotein cholesterol (HDL-C) levels. Receiver operating characteristics curve analysis showed that serum OSM and Reg3β levels can be used for the diagnosis of ACS in patients with T2DM as compared to CK-MB levels. On regression analysis, serum Reg3β level was positively associated with body mass index and negatively with serum HDL-C levels and serum OSM level was positively associated with waist circumference and random blood glucose and negatively with serum HDL-C levels.ConclusionSerum Reg3β and OSM levels may be used as complementary markers besides traditional cardiac markers for the diagnosis of ACS in patients with T2DM. However, further studies are still needed to verify our claim.     

Is serum ferritin high in patients with diabetic retinopathy? A controlled study

It is suggested that an excessive absorption and storage of dietary iron might contribute in the pathogenesis of type II diabetes mellitus and its complications. However, previous studies had methodological problems including design, lack of matched controls and unspecified inclusion criteria. The aim of the study was to evaluate the relationship between diabetic retinopathy and serum ferritin levels in well-defined diabetic patients and controls. The study population comprised of 3 groups: patients with type II diabetes mellitus and severe diabetic retinopathy, diabetic patients without retinopathy, and non-diabetic, non-retinopathy patients. The groups were well matched by age, gender and hemoglobin levels, whereas diabetes characteristics and treatment differed. Serum iron, transferrin and ferritin levels were compared between the patients' groups. Twenty-two patients had diabetes and retinopathy, 29 patients had diabetes without retinopathy and 40 were non-diabetic, non-retinopathy patients. Serum iron or ferritin levels did not differ significantly between the 3 groups. Also, there was no correlation between HbA1c level and serum iron or ferritin levels between the 2 diabetic patients' groups. Our findings suggest that iron does not have a major role in the development of diabetes mellitus or diabetic retinopathy.     

The cross-sectional association of cognition with diabetic peripheral and autonomic neuropathy—The GRADE study

BackgroundStudies examining whether measures of cognition are related to the presence of diabetic peripheral neuropathy (DPN) and/or cardiovascular autonomic neuropathy (CAN) are lacking, as are data regarding factors potentially explaining such associations.MethodsParticipants were from the Glycemia Reduction Approaches in Diabetes Study (GRADE) that examined 5047 middle-aged people with type 2 diabetes of <10 years of known duration. Verbal learning and immediate and delayed recall (memory) were assessed with the Spanish English Verbal Learning Test; frontal executive function and processing speed with the Digit Symbol Substitution Test; and ability to concentrate and organize data with word and animal fluency tests. DPN was assessed with the Michigan Neuropathy Screening Instrument and CAN by indices of heart rate variability (standard deviation of normal beat to beat variation [SDNN] and root mean square of successive differences [RMSSD]).ResultsDPN was significantly inversely related to measures of immediate recall and processing speed. The percent of cognitive variation explained by DPN was small. Tests of CAN had an inconsistent or absent association with measures of cognition. Higher waist circumference and urine albumin creatinine (UACR) levels were the strongest correlates in the relationship between DPN and cognitive impairment.ConclusionDPN, but not CAN, was cross-sectionally associated with lower performance in measures of cognition in people with type 2 diabetes of <10 years of known duration. Greater waist circumference and UACR were important variables in this association. The mechanisms underlying the cross-sectional association of DPN with cognitive impairment are unknown.Clinicaltrials.gov: NCT01794143     

Does treatment affect the levels of serum Interleukin-6, Interleukin-8 and procalcitonin in diabetic foot infection? A pilot study

AimsTo investigate about serum PCT, IL-6 and IL-8 levels and how they are affected by the treatment in diabetic foot patients.MethodsFifty patients’ blood samples were taken to study ESR and CRP, IL-6, IL-8 and PCT before and at the 14th day of the treatment.ResultsThe pretreatment results of the 50 patients showed positive correlations between PCT and either ESH (r = 0.49, p < 0.001), or CRP (r = 0.56, p < 0.001). Similarly, there was a positive correlation between IL-6 and ESH (r = 0.46, p = 0.001), just like as it was between IL-6 and CRP (r = 0.54, p < 0.001). At the 14th day, the levels of ESR (70 ± 30.2 and 58.4 ± 26.2, p = 0.02), CRP (63.8 ± 73.1 and 18.1 ± 19.7, p < 0.001) and PCT (0.6 ± 2.1 and 0.05 ± 0.02, p = 0.007) were significantly decreased while IL-6 was decreased at a close range to statistical significancy at healing patients (97.5 ± 147.2 and 47.1 ± 77.6; p = 0.05), but they did not at nonhealing patients. IL-8 levels were not changed anyhow.ConclusionsPCT was significantly decreased such as ESR and CRP were in the early phase of healing; IL-6 and IL-8 levels were also decreased by the treatment, but not statistically significantly. IL-6 and PCT were affected in correlation with the other inflammatory parameters in the beginning, but IL-8 was not. PCT and IL-6 may be useful like CRP and ESR in the diagnosis and follow up of diabetic foot infection, but IL-8 is not. Further investigation is needed.     

Effect of tanshinone ⅡA in preventing and treating oxaliplatin induced peripheral neuropathy

<正>Objective To observe preventive and therapeutic effects of TanshinoneⅡA(TⅡA)on oxaliplatin induced peripheral neuropathy(OIPN)and to explore its effects on the expression of calcitonin gene related peptide(CGRP)and nerve growth factor(NGF).Methods Totally 36 phaseⅡ-Ⅲpatients with malignant tumor of digestive tract undergoing chemotherapy program with oxaliplatin were equally assigned to the TⅡA group(using     

Effect of colchicine on mortality in patients with COVID-19 – A systematic review and meta-analysis

Background and aimThis systematic review and meta-analysis aimed to evaluate the latest evidence on the association between colchicine and mortality in patients with COVID-19.MethodsWe performed a comprehensive literature search from the PubMed, Scopus, Embase, EuropePMC, and Clinicaltrials.gov up until 02 January 2022. We include randomized controlled trials (RCTs) and observational studies reporting colchicine use in patients with COVID-19 and mortality within 30 days. The intervention group was patients given colchicine during the course of treatment. The control group was patients given placebo or standard of care at the respective institutions. The outcome was mortality. The effect estimate was reported as risk ratio (RR).ResultsThere were 12 studies comprising of 6953 patients included in this meta-analysis. Mortality rate was 0.18 [95%CI 0.10, 0.26] in the colchicine group and 0.26 [95%CI 0.15, 0.38] in the control group. Colchicine was associated with reduction in mortality (RR 0.66 [95%CI 0.53, 0.83], p < 0.001; I²: 42%). Sensitivity analysis using fixed-effect model (RR 0.73 [95%CI 0.63, 0.83], p < 0.001; I²: 42%. Subgroup analysis on the four RCTs showed non-significant result (RR 0.81 [95%CI 0.54, 1.20], p = 0.29; I²: 10%). Meta-regression showed that the association between colchicine and reduced mortality was not affected by age (p = 0.613) [Fig. 3], sex (p = 0.915), diabetes (p = 0.795), and hypertension (p = 0.403).ConclusionThough the meta-analysis showed decreased mortality with colchicine in patients with COVID-19, the meta-analysis of randomized trials did not show any significant effect of colchicine on mortality.     

Serum levels of TNF-α in peripheral neuropathy patients and its correlation with nerve conduction velocity in type 2 diabetes mellitus

ObjectiveTo compare serum levels of TNF-α in patients of peripheral neuropathy and patients without neuropathy in type 2 diabetes mellitus.Material and methodsThis cross sectional study was conducted in diagnosed type 2 diabetes mellitus patients. They were divided in groups, Group I (n = 37) with clinically detectable diabetic peripheral neuropathy of shorter duration and Group II (n = 27) with clinically detectable diabetic peripheral neuropathy of longer duration. They were compared with patients without clinical neuropathy (n = 22), clinical diagnosis was based on neuropathy symptom score (NSS) and neuropathy disability score (NDS) for signs. Blood samples were collected for baseline investigations and estimation of serum TNF-α. Nerve conduction velocity was measured in both upper and lower limbs. Median, Ulnar, Common Peroneal and Posterior Tibial nerves were selected for motor nerve conduction study and Median and Sural nerves were selected for sensory nerve conduction study.ResultsThe comparisons were done between various clinical and biochemical parameters in clinically detectable and undetectable peripheral neuropathy groups of type 2 diabetes mellitus. The study showed raised serum levels of TNF-α in peripheral neuropathy patients and significant correlation with nerve conduction velocity.ConclusionHigh level of TNF-α in serum of T2DM patients with neuropathy shows possible contribution in development of neuropathy. Due to its independent association this cytokine might be used as biomarker for diabetic peripheral neuropathy.     

Effect of itopride, a new prokinetic, in patients with mild GERD： A pilot study

AIM: Itopride is a newly developed prokinetic agent, which enhances gastric motility through both antidopaminergic and anti-acetylcholinesterasic actions. The importance of esophageal motor dysfunction in the pathogenesis of gastro-esophageal reflux disease (GERD) makes it interesting to examine the effect of itopride on esophageal acid exposure. METHODS: The effect of itopride on esophageal acid reflux variables for 24 h was studied in 26 patients with GERD symptoms, pre-entry total acid exposure time (pH<4) of more than 5% and mild esophagitis (Savary-Miller grades I, II) proven by endoscopy. Ambulatory 24-h pH-metry and symptom assessment were performed after treatments with 150 or 300 mg itopride thrice a day (t.i. d.) for 30 d in random order, using an open label method. For evaluating the safety of itopride, blood biochemical laboratory test was performed and the serum prolactin level was also examined before and after treatment. RESULTS: Total symptom score was significantly decreased after treatment in 150- or 300-mg group. Itopride 300 mg was significantly effective than 150 mg on decreasing the total per cent time with pH<4, total time with pH<4 and DeMeester score. No serious adverse effects were observed with administration of itopride in both groups. CONCLUSION: Itopride 100 mg t.i.d. is effective on decreasing pathologic reflux in patient with GERD and therefore it has the potential to be effective in the treatment of this disease.     

Effect of vitamin D supplementation on endothelial function – An updated systematic review with meta-analysis and meta-regression

Background and aimsAtherogenesis and endothelial dysfunction contribute to cardiovascular risk and vitamin D has been implemented in endothelial repair. This systematic review, meta-analysis and meta-regression aims to establish the effect of vitamin D supplementation on endothelial function.Methods and ResultsTo conduct the systematic review we searched the Cochrane Library of Controlled Trials, PubMed, ProQuest and EMBASE for randomized controlled trials that investigated the effects of vitamin D supplementation on flow-mediated dilation (FMD%), pulse wave velocity (PWV), and central augmentation index (AIx). Meta-analysis was based on a random effects model and inverse-variance methods to calculate either mean difference (MD) or standardized mean difference (SMD) as effects sizes. This was followed by meta-regression investigating the effect of baseline vitamin D concentrations, vitamin D dosing and study duration. Risk of bias was assessed using the JADAD scale and funnel plots.We identified 1056 studies of which 26 studies met inclusion criteria for quantitative analysis. Forty-two percent of the 2808 participants had either deficient or insufficient levels of vitamin D. FMD% (MD 1.17% (95% CI −0.20, 2.54), p = 0.095), PWV (SMD −0.09 m/s (95% CI −0.24, 0.07), p = 0.275) and AIx (SMD 0.05% (95% CI −0.1, 0.19), p = 0.52) showed no improvement with vitamin D supplementation. Sub-analysis and meta-regression revealed a tendency for AIx and FMD% to increase as weekly vitamin doses increased; no other significant relationships were identified.ConclusionsVitamin D supplementation showed no improvement in endothelial function. More evidence is required before recommendations for management of endothelial dysfunction can be made.     

Effect of cigarette smoking on serum methylarginine and α-klotho levels

Background and aimsSmoking causes many diseases such as cardiovascular, lung diseases, stroke and premature aging. However, the role of smoking in the pathogenesis of these diseases is unclear. Increasing evidence suggests that methylarginine pathway metabolites and α-klotho may be strong markers for pathologies such as premature aging, endothelial dysfunction, and oxidant damage. Therefore, the study aimed to measure the serum levels of arginine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), N-monomethyl-l-arginine (L-NMMA), and α-klotho levels in smokers.Methods and resultsThis case-control analytical study included 65 smokers and 71 non-smokers. Sociodemographic characteristics, routine biochemistry parameters, Framingham risk scores and Fagerström Nicotine Dependence Test (FTND) were recorded. Serum methylarginine and α-klotho levels were analyzed by tandem mass spectrometry and enzyme-linked immunosorbent assay (ELISA), respectively. Serum ADMA (p < 0.001), L-NMMA (p = 0.024), SDMA (p < 0.001) levels of smokers were higher than non-smokers, and serum α-klotho (p < 0.001) and arginine levels (p < 0.001) were lower. There was a positive correlation between serum ADMA levels with FNDT, age and pack/year in smokers, while there was a negative correlation between klotho levels and age. A positive correlation was found between serum ADMA levels, Framingham risk score and age in non-smokers.ConclusionSmoking is related to premature aging and is a strong risk factor for various diseases such as cardiovascular, inflammatory, and renal diseases. Elevated serum methylarginine and decreased serum klotho levels were found in smokers. Therefore, our findings suggest that smoking may be involved in the pathogenesis of these diseases by affecting α-klotho and methylarginine-related pathways.     

Decreased serum levels of β-carotene in patients with hepatocellular carcinoma

The serum levels of β-carotene were determined in patients with liver disease. β-Carotene levels in the patients with chronic hepatitis (CH) were comparable with the reported normal values. However, the levels decreased significantly in patients with liver cirrhosis (LC) and hepatocellular carcinoma (HCC). Furthermore, the β-carotene levels of the HCC patients were significantly lower than those of the LC patients. The male patients had significantly lower levels of β-carotene than the female patients with CH and LC, but not with HCC. Possible contribution of the lower serum levels of β-carotene to the pathogenesis of hepatocellular carcinoma is discussed.     

Effectiveness of immunotherapy in children depends on place of living – A pilot study

BackgroundIt is considered that farm areas protect young patients from allergy and asthma due to high exposure to endotoxins. Allergen immunotherapy (AIT) is the only treatment of allergy modifying the immune response with the potential to change the natural history of allergic diseases. It seems that studies evaluating the efficacy of immunotherapy in large cohorts of allergic patients living in farm areas are needed to understand the influence of environment on immune response during AIT.Aim. To compare the clinical effectiveness of immunotherapy between children living in farm versus urban areas.Materials and methodsThis was a retrospective analysis of 87 children living in farm area (n = 42) and city area (n = 45), aged 8–16, who completed three years of subcutaneous immunotherapy due to allergic rhinitis/asthma. An AIT efficacy questionnaire has been designed to be filled in by the allergy specialist during a regular immunotherapy visit before and after AIT.ResultsWe observed significantly higher improvement in total score among children from farm area compared to children from city area (p < 0.001). Between-group differences in symptoms and drug scores did not reached the level of significance. Multivariate logistic regression analysis (adjustment for the effect of gender and type of allergy) showed that living in farm areas was independently associated with significant improvement in total score after immunotherapy (OR: 10.9; 95%CI: 3.7–32.2).ConclusionThe current analysis of the better AIT effectiveness in the farm population has shown the protective influence of environmental exposures on asthma and allergic rhinitis in our children.     

Anti-TNF-α antibody Infliximab and glucocorticoids reduce serum vascular endothelial growth factor levels in patients with rheumatoid arthritis: a pilot study

To compare the effect of oral glucocorticoid (GC) therapy with the effect of intravenous anti-TNF--therapy on serum VEGF levels of patients with rheumatoid arthritis (RA). Five RA patients (5/8) who had no prior treatment with DMARDs (Disease modifying antirheumatic drugs) or GCs were administered 20 mg prednisolone daily. Three patients who failed more than one DMARD therapy received infusion with Infliximab (200 mg). VEGF-serum levels were measured by enzyme-linked immunosorbent assay before treatment,and at day 10 or 13 during prednisolone therapy, or 14 days after the first Infliximab infusion. Serum VEGF levels in therapy naive RA patients (GC group) were higher than those in pretreated patients who received Infliximab (median serum VEGF level: 1106 vs 320 pg/ml; P=0.1). Treatment with Infliximab as well as GCs significantly decreased serum VEGF levels after 10–14 days in RA patients (median serum VEGF level after treatment: GC group 559 pg/ml, Infliximab group 92 pg/ml; P=0.01 vs without treatment or preinfusion). Conclusions: Anti-TNF- antibody Infliximab as well as GC are able to decrease serum VEGF levels in patients with active RA. Whether therapeutic reduction of serum VEGF levels is associated with inhibition of angiogenesis should be evaluated in future by imaging of synovial vasculature.