The prevalence, patterns and predictors of diabetic peripheral neuropathy in a developing country

ABSTRACT: Prevalence of diabetes mellitus (DM) has reached epidemic proportions in Sri Lanka. Presently there are studies on the community prevalence of distal peripheral neuropathy (DPN) in Sri Lanka. We describe prevalence, patterns and predictors of DPN in patients with DM in Sri Lanka. Data were collected as part of a national study on DM. In new cases DPN was assessed using the Diabetic-Neuropathy-Symptom (DNS) score, while in those with established diabetes both DNS and Toronto-Clinical-Scoring-System (TCSS) were used. A binary logistic-regression analysis was performed with 'presence of DPN' as the dichomatous dependent variable and other independent co-variants. The study included 528 diabetic patients (191-new cases), with a mean age of 55.0?±?12.4?years and 37.3% were males, while 18% were from urban areas. Prevalence of DPN according to DNS score among all patients, patients with already established diabetes and newly diagnosed patients were 48.1%, 59.1% and 28.8% respectively. Prevalence of DPN in those with established DM as assessed by TCSS was 24% and the majority had mild DPN (16.6%). The remainder of the abstract is based on subjects with established DM. The prevalence of DPN in males and female was 20.0% and 26.4% respectively. The mean age of those with and without DPN was 62.1?±?10.8 and 55.1?±?10.8?years respectively (p?相似文献   

Fistula First Is Not Always the Best Strategy for the Elderly

Whether placing a fistula first is the superior predialysis approach among octogenarians is unknown. We analyzed data from a cohort of 115,425 incident hemodialysis patients ≥67 years old derived from the US Renal Data System with linked Medicare claims, which allowed us to identify the first predialysis vascular access placed rather than the first access used. We used proportional hazard models to evaluate all-cause mortality outcomes based on first vascular access placed, considering the fistula group as the reference. In the study population, 21,436 patients had fistulas as the first predialysis access placed, 3472 had grafts, and 90,517 had catheters. Those patients with a catheter as the first predialysis access placed had significantly inferior survival compared with those patients with a fistula (HR=1.77; 95% CI=1.73 to 1.81; P<0.001). However, we did not detect a significant mortality difference between those patients with a graft as the first access placed and those patients with a fistula (HR=1.05; 95% CI=1.00 to 1.11; P=0.06). Analyzing mortality stratified by age groups, grafts as the first predialysis access placed had inferior mortality outcomes compared with fistulas for the 67 to ≤79-years age group (HR=1.10; 95% CI=1.02 to 1.17; P=0.007), but differences between these groups were not statistically significant for the 80 to ≤89- and the >90-years age groups. In conclusion, fistula first does not seem to be clearly superior to graft placement first in the elderly, because each strategy associates with similar mortality outcomes in octogenarians and nonagenarians.Currently, fistula first is the general recommendation for all hemodialysis (HD) patients,^1–3 with more recent discussions placing equal importance on a catheters last strategy.⁴ For the elderly, past and recent large cohort studies have shown that patients with arteriovenous fistulas (AVFs) have better survival compared with patients with catheters, with the next best vascular access being arteriovenous grafts (AVGs).^5,6 These outcomes were based on the vascular access first used for dialysis and not the access first placed, but the latter may better reflect the actual effect of the fistula first initiative on nephrology practice.Strong implications exist for different predialysis vascular access placement strategies in the elderly. For one, there is a greater competing risk of death before dialysis initiation in this age group,^2,7 and therefore, many fistulas may never be used. In addition, although one third of fistulas fail to mature,⁸ those patients >65 years old have two times the failure rate compared with the younger population.⁹ This increased failure rate is associated with increased access-related complications and procedures. The higher rate of fistulas that fail to mature may contribute to a greater use of catheters at the time of dialysis initiation. Therefore, although the incident use of AVGs in the elderly decreased from 28.2% in the mid-1990s to 4.2% recently, the incident catheter use has increased from 56.8% to 82.3%.^5,6,10The incident HD population is aging, with an annual increase of 8%–16% in those patients >75 years old. With this increase, it is important to define factors associated with outcomes in the elderly population and particularly, octogenarians. The aim of this study is to investigate the mortality rate associated with the initial type of vascular access placed rather than the access used at initiation of HD in the elderly population. Specifically, we questioned whether fistula first as an intention to treat strategy may not be the clearly superior predialysis vascular access placement strategy in octogenarians.     

Detection of myocardial capillary orientation with intravascular iron-oxide nanoparticles in spin-echo MRI.

In mammalian hearts the capillaries are closely aligned with the muscle fibers. We report our observation of a main-field direction-dependent contrast in MR spin-echo (SE) images of the heart in the presence of Ferumoxtran-10, an intravascular iron-oxide nanoparticle contrast agent (CA). We describe a novel MRI method for mapping the preferential orientation of capillaries in the myocardial wall. The eigenvector corresponding to the minimum eigen value of the R2 relaxation rate tensor is consistent with the expected orientation of the capillary network. Preliminary results also demonstrate the feasibility of this method for in vivo application to rodent imaging.     

Changes in auditory cortex and the development of mismatch negativity between 2 and 6 months of age.

Evoked responses to stimulus deviance were compared in infants between 2 and 6 months of age. A deviant stimulus containing a short silent gap occasionally replaced a repeating standard stimulus matched in duration, intensity and approximate spectral content. At two months, the standard stimuli evoked only a positive slow wave, and its amplitude was increased in response to the deviant stimuli. By 6 months, the deviant stimuli evoked an increased negativity at approximately 200 ms, similar to the mismatch negativity (MMN) response in adults. The results are considered with respect to layer-specific cortical maturation during this period.     

Impact of the vitamin D deficiency on COVID-19 infection and mortality in Asian countries

Background and aimsCOVID-19 is a pandemic that has affected beyond 100 million and caused nearly 3 million deaths globally. Vitamin D is a known risk factor for COVID-19. Therefore, we aimed to investigate the association of prevalence of vitamin D deficiency and mean vitamin D level with COVID-19 infection and mortality in Asia, predicting with other confounding factors such as median age, obesity, and diabetes.MethodsCOVID-19 infections and mortalities among the Asian countries were retrieved from the Worldometer website. Information on prevalence of vitamin D deficiency and mean vitamin D values in each Asian country was retrieved through literature searching on PubMed® and Google scholar. The associations between COVID-19 infections and mortalities with prevalence of vitamin D deficiency and mean vitamin D level were explored with correlation coefficients. As a predictive analysis, multiple linear regression was carried out with all confounders.ResultsPositive correlations were observed for prevalence of vitamin D deficiency with COVID-19 infections (r = 0.55; p = 0.01; R² = 0.31) and mortalities (r = 0.50; p = 0.01; R² = 0.25). Moreover, the associations for the COVID-19 infections and mortalities improved to r = 0.76 (p = 0.002; R² = 0.58) and r = 0.65 (p = 0.03; R² = 0.42), respectively, after predicting with confounding factors. Similarly, mean vitamin D level had a significant negative correlation with COVID-19 infections (r = ?0.77; p = 0.04; R² = 0.59) and mortalities (r = ?0.80; p = 0.03; R² = 0.63) when combining with confounders.ConclusionPrevalence of vitamin D deficiency is significantly positively associated whereas the mean vitamin D level is significantly negatively associated with both infection and mortality rate of COVID-19 among Asian countries upon predicting with all confounders.     

Comparison of the configuration of the posterior bifurcation of the posterior communicating artery between fetal and adult brains: A study of a Sri Lankan population

Objective:

The purpose of this study was to examine the degree of contribution from the vertebrobasilar and carotid systems to the origin of the PCA in fetal autopsy brains of last trimester of pregnancy and to compare with published data on the configuration of adult and fetal brains in a population of Sri Lankan origin.

Materials and Methods:

The external diameter of the PcomA, pre-communicating part (P1), and the post-communicating part (P2) of posterior cerebral artery (PCA) of 34 fetal brain in the last trimester of pregnancy (30 to 40 weeks of gestation) was measured using a stereomicroscope equipped with a micrometer calibrator.

Results:

The blood supply to the occipital lobe mainly via the PCA was seen in 25 (59%) of fetal brains as compared to that in the literature 220 (93%) in adults brains and the blood supply to the occipital lobe mainly via the internal carotid artery (ICA) was seen in 16 (34%) of fetal brains as compared to 25 (7%) of adults brains (P < 0.0001), transitional configuration where the PcomA is equal in diameter to P1 segment of the PCA was seen in 5 (7.4%) of fetal brains and 8 (2%) of adults brains.

Conclusions:

The present study reveals that from the newborn to the adult there is shift from carotid system to the vertebrobasilar system, this justifies further studies on different racial and geographic regions which may give a clearer picture about the cerebral hemodynamics from childhood to adult.     

Occasional changes in sound location enhance middle latency evoked responses

Rapid processing of sound location is critical for orienting attention. The present study investigated whether contextually sensitive early neural responses elicited by occasional changes in sound location could be measured. Using an oddball paradigm with stimuli consisting of brief noise bursts whose location was occasionally varied using head-related transfer functions, we found significant enhanced negativities in the event-related potentials elicited by deviant stimuli as early as 25 ms after stimulus onset, in addition to the differences around 125 ms which have previously been reported. Recent research suggests that occasional changes in auditory location information are processed in areas beyond primary auditory cortex. Our data suggest that any such processing is in fact preceded by activation in primary auditory cortex.     

Methods to develop figure rating scales (FRS): A systematic review

Background and aimsFigure Rating Scales (FRS) are psychometric instruments developed to measure individual’s perception of physical appearance and subsequently, to determine the level of body dissatisfaction. The following systematic review summarizes existing FRSs and the techniques used to development them.MethodsA systematic search was conducted in the following databases; PubMed®, Web of Science®, Scopus® using key words “figure rating scale” AND “Stunkard".ResultsFrom 466 potentially relevant articles, 24 publications were included, 22 publications reporting original FRSs with the other two scales being modifications of the original for children and babies. Fifteen were figural drawings or silhouettes and nine were developed by photographic techniques, video methods or using computer software. Most of the figural scales were applicable for adults and consisted of nine images. Ten of the 15 figural scales were without facial features and four scales had minimal facial features. Technological advancements including 3D modeling have played a pivotal role in the development of FRSs.ConclusionsFRSs have been developed by a mix of traditional and modern techniques. The development and validation of ethnic specific FRSs using modern technology should be the priority for future studies.