Silent myocardial ischaemia is now well-recognised in patients with symptomatic coronary artery disease. Its pathogenesis remains speculative, though diminished sensitivity to pain is thought to be one of the mechanisms involved. Because cardiovascular autonomic dysfunction occurs frequently in diabetic patients, we postulate that it contributes towards painless myocardial ischaemia among them. Forty consecutive diabetic (type II) male patients and ten normal volunteers were studied. Using 5 previously-validated noninvasive tests for autonomic dysfunction, 14 of these diabetic men had definite autonomic neuropathy (at least 2 abnormal tests). All 50 subjects were then exercised on a motor-driven treadmill to either exhaustion or chest pains. Thirty-three diabetic subjects were tested positive, with significant (greater than 1 mm) ST segment depression over at least 2 contiguous leads. Of these, 18 were associated with typical angina but the other 15 stopped because of fatigue or exhaustion (ie painless). Thirteen subjects who had definite autonomic neuropathy (AN+) had positive exercise ECG tests-10 had painless ischaemia, and only 3 had angina. This contrasted with 15 patients who had painful ischaemia and 5 who had painless ischaemia among the group without (AN-)autonomic dysfunction (p = 0.0047, Fisher's exact test). There were no significant differences among the various groups for peak rate-pressure-product, all subjects attaining similar maximal oxygen consumption states during which ischaemic ST segment changes were noted (painful AN+: 21917 +/- 4753; painless AN+: 20117 +/- 6752; painful AN-: 16544 +/- 4063; painless AN-: 22220 +/- 4341, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
A 68-year-old diabetic and hypertensive woman presented with chronic autonomic diarrhoea, syncope and palpitations which were associated with QT prolongation and recurrent episodes of torsade de pointes. She was on glibenclamide, indapamide and probucol (for type V hyperlipidaemia). Despite intravenous infusions of potassium, lignocaine and amiodarone, the unstable rhythm persisted. However, intravenous magnesium sulphate with small doses of intravenous propranolol terminated the torsade de pointes. She was stabilised but following discharge she relapsed, and upon re-admission, succumbed to intractable ventricular fibrillation. Early recognition and aggressive treatment of this condition is emphasised. Multiple aggravating factors ie autonomic diarrhoea resulting in severe potassium and magnesium depletion, kaliuretic effect of indapamide, probable QT prolongation associated with diabetic autonomic neuropathy and probucol; probable underlying coronary artery disease and heightened emotional and sympathetic discharge could have contributed to this very unstable ventricular arrhythmia and sudden death.
Two important parameters for utilizing Ko-standardization method namely, absolute peak efficiency at reference position and peak-to-total ratio at different geometrical positions using standard point sources and HPGe were experimentally determined. Coincidence correction factor, C, for reference position and certain nuclides were also calculated and all almost equal to one. The importance and implication of this work to the K0-standardization method are presented. Other essential nuclear parameters which have to be experimentally determined or obtained from literature are also presented.
Dua parameter untuk kegunaan kaedah pemiawaian K0 iaitu kecekapan puncak absolut pada kedudukan rujukan dan nisbah jumlah-ke-puncak pada berbagai kedudukan geometri telah ditentukan secara eksperimen. Punca titik piawai dan HPGe digunakan. Faktor pembetulan koinsiden, C, yang digunakan untuk kedudukan piawai dan beberapa nuklid telah dihitung dan semuanya mempunyai nilai hampir sama dengan satu. Kepentingan dan implikasi kerja ini kepada kaedah pemiawaian K0 dikemukakan. Parameter nuklear lain yang ditentukan secara eksperimen atau yang diperolehi daripada pustaka juga dibentangkan.
Thirty patients with diabetic polyneuropathy were recruited from the diabetic clinic in Hospital Universiti Sains Malaysia from 1996 to 1998. They were randomly assigned either sulbutiamine (Arcalion(®)) (15 patients) or no treatment (control group; 15 patients). Glycaemic control was assessed by blood glucose and HbA1. Severity of neuropathy was assessed by symptom and sign score, and electrophysiological parameters (nerve conduction velocity and compound muscle action potential) at entry to the study and after 6 weeks. There were improvements in the electrophysiological parameters in the treatment group when compared to the controls with significant improvement in the median nerve conduction velocity (p<0.001), median compound muscle action potential (p<0.001), peroneal nerve conduction velocity (p<0.001), and peroneal compound muscle action potential (p<0.001). No significant improvement in symptom and sign scores were noted between the groups but a significant improvement compared to base line was noted for the sulbutiamine treated group. (p< 0.05). The glycaemic control in both groups was not significantly different at base line and was stable throughout the study. Sulbutiamine objectively improved peripheral nerve function in diabetic polyneuropathy although the symptom score did not improve, possibly due to the short duration of the study.
This study was undertaken to clinically estimate the prevalence of diabetic peripheral neuropathy amongst patients attending an outpatient clinic and to evaluate their risk factors for developing peripheral neuropathy. It was a cross-sectional study of 134 diabetes mellitus patients who attended the Primary Care Clinic, University Hospital, Kuala Lumpur. The patients were interviewed for their demographic data, past and present medical/surgical history, social history, personal habits and symptoms of peripheral neuropathy. Foot examination and clinical neurological tests were conducted and the presence of peripheral neuropathy was assessed. The main outcome measures were the Neuropathy Symptom Score and the Neuropathy Disability Score. The prevalence of diabetic peripheral neuropathy was found to be 50.7%. Peripheral neuropathy was related to the age of the patient and the duration of diabetes but did not seem to be significantly related to diabetic control. To conclude, there was a high prevalence of peripheral neuropathy amongst the diabetics in this study. These patients developed peripheral neuropathy at a younger age and shorter duration of diabetes compared to a similar study that was done in the UK.
Study site: Primary care clinc, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Poor glycaemic control and the duration of diabetes mellitus are known to accelerate development and progression of neuropathy. Diabetic co-morbidities: hypertension and hyperlipidaemia, have been postulated to associate with development of neuropathy. A diabetic foot with low temperature and frequent exposure to low temperature environment has recently been hypothesized to be at higher risk to develop early neuropathy. This cross-sectional study is undertaken to identify risk factors for diabetic neuropathy and the association between foot temperature and development of diabetic neuropathy by using simple clinical examination in the outpatient setting. From April 18, to April 30, 2005, universal sampling method was used to select 134 diabetic patients (type 1 or type 2 for >1 year) with peripheral neuropathy. Excluded are those with chronic alcoholism, drug-induced neuropathy, dietary history of vitamin B deficiency and family history of porphyria and hereditary sensorimotor neuropathy. The patient's duration of diabetes, glycaemic control status and the presence of co-morbids: hypertension and hyperlipidemia, were recorded. The temperature of the foot was measured by using thermo buddy. Of 134 patients representing Malaysian ethnic distribution with an equal number of males and females, 20.1% were in the age group of 61 to 65 years and, 85.1% and 67.9% belonged to lower socioeconomic and educational groups respectively. Associations between diabetic neuropathy and glycaemic control (p = 0.018) and duration of diabetes (p < 0.05) were significant. However, hypertension, hyperlipidaemia and low foot temperature were not significantly associated with development of diabetic neuropathy. Poor glycaemic control is significantly associated with diabetic neuropathy. Foot temperature alteration is merely an effect of autonomic neuropathy with a cold foot is attributed to co-existing peripheral arterial disease.
Study site: Pusat Perubatan Primer Bandar Tasik Selatan, Kuala Lumpur, Malaysia
OBJECTIVE: The prevalence of type 2 diabetes, often leading to diabetic nephropathy, has increased globally, especially in Asia. Irbesartan treatment delays the progression of kidney disease at the early (microalbuminuria) and late (proteinuria) stages of nephropathy in hypertensive type 2 diabetics. This treatment has proven to be cost-effective in Western countries. This study assessed the cost-effectiveness of early irbesartan treatment in Asian settings.
METHODS: An existing lifetime model was reprogrammed in Microsoft Excel to compare irbesartan started at an early stage to irbesartan or amlodipine started at a late stage, and standard treatments from a health-care perspective in China, Malaysia, Thailand, South Korea, and Taiwan. The main effectiveness parameters were incidences of end-stage renal disease, time in dialysis, and life expectancy. All costs were converted to 2004 US$ using official purchasing power parity. Local data were obtained for costs, transplantation,dialysis, and mortality rates. Probabilities regarding disease progression after treatment with the investigated drugs were extracted from two published clinical trials. A probabilistic sensitivity analysis was performed.
RESULTS: Early use of irbesartan yielded the largest clinical and economic benefits reducing need for dialysis by 61% to 63% versus the standard treatment, total costs by 9% (Thailand) to 42% (Taiwan), and increasing life expectancy by 0.31 to 0.48 years. Early irbesartan had a 66% (Thailand) to 95% (Taiwan) probability of being dominant over late irbesartan.
CONCLUSION: Although the absolute results varied in different settings, reflecting differences in epidemiology, management, and costs, early irbesartan treatment was a cost-effective alternative in the Asian settings.
BACKGROUND: The role of endothelial injury and circulating adhesion molecule in the development and progression of diabetic peripheral neuropathy in the long-term has been established previously.
AIMS: To study the effects of short-term glycemic control using insulin and oral hypoglycemic agent therapy (OHA) on the peroneal nerve function and vascular cell adhesion molecule-1 (VCAM-1) and advanced glycation endproducts (AGE) levels in type 2 diabetic patients.
SETTINGS AND DESIGN: A randomized controlled study involving poorly controlled (HbA1c, 7.5%-11%) type 2 diabetic patients attending the endocrinology outpatient center in a tertiary hospital in Kuala Lumpur.
MATERIALS AND METHODS: Twenty-nine patients were randomized to receive insulin (n=15) or OHA (n=14) for 8 weeks. The glycemic variables (HbA1c, fasting plasma glucose [FPG], fructosamine), VCAM-1, serum AGE and the peroneal motor conduction velocity (PMCV) were measured at baseline and at 4-week intervals.
STATISTICAL ANALYSIS USED: Paired 't' test or Kruskal Wallis test; and the unpaired 't' test or Mann-Whitney U test were used for within-group and between-group analyses, respectively. Correlation was analyzed using Spearman's correlation coefficient.
RESULTS: Within-group analysis showed significant progressive improvement in HbA1c at weeks 4 and 8 in the insulin group. The PMCV improved significantly in both groups by week 8, and by week 4 (P = 0.01) in the insulin group. PMCV correlated negatively with VCAM-1 (P = 0.031) and AGE (P = 0.009) at week 8.
CONCLUSION: Aggressive glycemic control with insulin improves the peroneal nerve function within 4 weeks. Improvement in the serum VCAM-1 and AGE levels correlated significantly with improvement in peroneal nerve conduction velocity only in the insulin group.
Study site: Tertiary endocrinology outpatient center in Kuala Lumpur, Malaysia
Satu kajian awal bagi menyaring kecelaruan psikogeriatrik di kalangan warga tua telah dijalankan. Tujuan kajian ini dijalankan adalah untuk menentukan peratusan kes kecelaan kognitif, strok dan kemurungan dalam sampel populasi yang berumur di antara 60-89 tahun. Seramai 40 orang subjek dan pemberi maklumat subjek di sekitar Lembah Kelang, Kuala Lumpur dan Selangor dipilih. Alat penyaringan yang digunakan dalam kajian ini ialah Psychogeriatric Assessment Scale (PAS). Psychogeriatric Assessment Scale (PAS) terdiri daripada dua bahagian iaitu laporan subjek dan laporan pemberi maklumat subjek. Laporan subjek digunakan untuk menyaring kecelaan kognitif, strok dan kemurungan. Manakala laporan pemberi maklumat subjek digunakan untuk menyaring kemerosotan kognitif, strok dan perubahan tingkah laku subjek. Dapatan kajian menunjukkan peratusan kes kecelaan kognitif (lelaki 67% kes, perempuan 64.3% kes) dan strok (lelaki 75% kes, perempuan 64.3% kes) yang tinggi di kalangan subjek lelaki dan wanita. Terdapat juga hubungan yang signifikan di antara laporan subjek dengan laporan pemberi maklumat subjek mengikut setiap skala PAS. Alat ujian psikologi PAS mampu menyaring masalah psikogeriatrik di kalangan warga tua dan ketepatan penyaringan dapat dinilai dengan data pemberi maklumat daripada alat ujian PAS. Penyaringan psikogeriatrik adalah penting untuk mengenal pasti kehadiran kecelaan fungsi kognitif dan kemurungan di kalangan warga tua pada peringkat awal.
Suatu kajian mengenai Indeks Kualiti Air (IKA) telah dijalankan di lembangan Sungai Paka, Terengganu. Ianya melibatkan pengukuran oksigen terlarut, pH, permintaan oksigen biokimia, permintaan oksigen kimia, jumlah pepejal terampai dan ammonia di lapan buah stesen pensampelan. Hasil kajian menunjukkan semua stesen pensampelan berada dalam status bersih kecuali dua stesen tercemar yang terletak di Sungai Rengat dan Sungai Rasau. Walau bagaimanapun, secara keseluruhannya purata nilai IKA bagi lembangan Sungai Paka adalah 72.4% dan boleh diklasifikasikan sebagai kelas II dengan status sedikit tercemar. Hasil kajian juga menunjukkan kumbahan daripada kilang kelapa sawit merupakan penyumbang utama kepada kemerosotan nilai IKA di kawasan kajian.
Penjadualan jururawat merupakan perkara penting dalam memastikan perkhidmatan yang berterusan dapat diberikan kepada para pesakit. Corak bertugas yang berterusan iaitu 24 jam sehari 7 hari seminggu, memerlukan waktu kerja mengikut syif yang boleh mengakibatkan perubahan kepada kehidupan sosial dan masalah kesihatan kepada jururawat. Oleh itu, pembangunan sebuah model penjadualan jururawat yang boleh diterima pakai oleh semua pihak dan bersifat adil amatlah penting untuk memastikan perkhidmatan berterusan yang berkualiti. Proses penjadualan melibatkan beberapa peraturan dan kekangan yang perlu dipertimbangkan, iaitu berdasarkan polisi yang telah ditentukan oleh pihak hospital dan permintaan daripada jururawat sendiri. Polisi atau objektif hospital antara lain adalah memastikan bilangan minimum jururawat setiap syif, mengelakkan pengasingan hari bertugas dan mempertimbangkan permintaan cuti daripada jururawat. Permintaan jururawat yang diambil kira pula adalah seperti mendapat bilangan hari bertugas yang sama per jadual, bilangan syif pagi yang melebihi syif petang dan memperolehi sekurang-kurangnya sekali cuti hujung minggu dalam tempoh jadual 2 minggu. Model dibangunkan menggunakan data daripada sebuah hospital tempatan. Kaedah pengaturcaraan gol 0-1 diaplikasikan di dalam pembangunan model penjadualan jururawat ini kerana keupayaannya menghasilkan sebuah model dengan pelbagai matlamat. Jadual kerja berkala ini akan dibina setiap 2 minggu. Daripada hasil penyelesaian yang diperoleh menggunakan perisian Lingo, didapati model penjadualan jururawat yang dibangunkan memenuhi polisi pihak hospital dan permintaan jururawat. Model penjadualan jururawat ini mampu memberikan penyelesaian yang lebih baik berbanding penjadualan semasa secara manual yang mana pengagihan syif adalah lebih sama rata di kalangan jururawat dari segi bilangan syif pagi, petang dan juga malam.
Tinjauan sepanjang lebuhraya Puchong-Kajang telah dijalankan khususnya di kawasan Puchong, Selangor. Terdapat 12 stesen telah dilawati dan 6 daripadanya telah dilakukan pensampelan tanah bagi analisis makmal. Cerun-cerun yang terbabit dengan pensampelan ini melibatkan cerun jenis tanih dengan julat darjah luluhawa di antara gred IV dan VI. Sampel-sampel tanih yang diambil mewakili cerun yang mengalami kegagalan dan cerun yang stabil. Ciri-ciri fiziko-kimia tanih yang dikaji melibatkan kandungan air segar dan dalam keadaan tepu, kandungan bahan organik, taburan saiz zarah, ketumpatan pukal dan sebenar, keporosan tanah, serakan liat, pH dan kandungan oksida ferum. Kandungan air tanah segar menunjukkan peratusan yang lebih tinggi pada cerun gagal berbanding cerun yang stabil. Semua sampel menunjukkan kandungan air tanah lapangan di bawah tahap kandungan air tepu. Kandungan bahan organik adalah sangat rendah (<2%) dan tanah boleh dikelaskan sebagai berpotensi tidak stabil. Terdapat hubungan positif yang jelas antara kandungan air dan bahan organik khususnya pada cerun gagal. Porositi tanah menunjukkan perkaitan positif terhadap lempung dan kandungan bahan organik. Kebanyakan tanah dikelaskan sebagai bertekstur lempung berpasir berbanding tekstur lain. Nilai-nilai koefisien serakan liat menunjukkan struktur tanah berada dalam kategori stabil hingga sangat stabil berbanding satu stesen yang dikelaskan sebagai tidak stabil. Secara umumnya, tanah terdiri daripada jenis asidik (pH4.87 - pH4.34) dengan kehadiran oksida ferum kurang daripada 6%.
Lemah konvergens (CI) adalah anomali penglihatan binokular yang melibatkan kesukaran dua mata menumpu semasa penglihatan dekat. Kajian ini mengkaji prestasi penglihatan binokular subjek CI. Prestasi binokular iaitu, akuiti penglihatan (VA) binokular jauh, VA binokular dekat dan stereoakuiti dibandingkan antara subjek CI dengan subjek normal. Seramai 30 subjek CI purata umur 17.33 ± 5.49 tahun dan 30 subjek normal purata umur 18.77 ± 6.08 tahun mempunyai VA 6/6 atau lebih baik, ralat refraksi sfera tidak melebihi ± 4.00 DS, astigmatisme tidak lebih daripada 2.00 DC, tiada juling dan tidak pernah menjalani terapi penglihatan, mempunyai kesihatan am dan kesihatan okular yang baik mengambil bahagian dalam kajian ini. VA monokular mata kanan, VA monokular mata kiri, VA binokular dan stereoakuiti dua kumpulan subjek diukur dan dibandingkan. Keputusan kajian mendapati perbezaan yang signifikan bagi VA binokular jauh (t = 2.31, p < 0.05), VA binokular dekat (t = 0.89, p < 0.05) dan stereoakuiti (Z = -2.81, p < 0.01) antara subjek CI dengan subjek normal. Kesimpulan kajian menunjukkan subjek kumpulan CI mengalami penurunan prestasi penglihatan binokular jauh, prestasi penglihatan binokular dekat dan stereoakuiti yang signifikan lebih rendah berbanding kumpulan normal.
Acanthamoeba is a free living protozoa that can cause keratitis and granulomatous amoebic encephalitis. Physiological characteristics of this amoeba are found to have a medical importance and related to the pathogenic potential of the organism. This study was carried out to investigate the physiological characteristic from the aspect of temperature tolerance. Six Acanthamoeba strains from three clinical isolates (HSB 1, HKL 48 and HKL 95) and three environmental isolates (PHS 2, PHS 11 and PHS 15) were used in this study. Test was done by culturing cysts at 30°C, 37°C and 42°C for two weeks and the ability of cysts to change to trophozoites were observed. The result showed all strain was able to change to trophozoites at 30°C and 37°C. However, no trophozoites were observed at 42°
C. This indicate that there is a similarity in the physiological trait of strains from both isolates are the same and strains from the environment are able to show the pathogenic potential thus capable of causing infection to human.
Keywords: Acanthamoeba; temperature tolerance; clinical; environmental isolates.
Peningkatan aktiviti perbandaran dan perindustrian telah mencetuskan masalah pengurusan sisa pepejal. Sebagai usaha penyelesaian, pendekatan bersepadu telah dipilih bagi menguruskan sisa pepejal. Membangunkan dan melaksanakan rancangan pengurusan sisa pepejal bersepadu perlu melibatkan gabungan teknologi dan pilihan yang sesuai dengan keadaan dan undang-undang tempatan. Kajian ini menunjukkan Proses Analisis Hierarki (PAH) berpotensi sebagai kaedah membuat keputusan yang boleh digunakan dalam proses pemilihan teknologi pengurusan sisa pepejal. Tiga aras hierarki dibangunkan dengan matlamat di aras tertinggi, diikuti oleh kriteria dan alternatif. Dengan menggunakan teknik ini, penentuan keutamaan untuk semua teknologi pengurusan sisa pepejal yang dipertimbangkan akan ditentukan dan teknologi dengan nilai keutamaan tertinggi lebih sesuai untuk dibangunkan. Analisis sensitiviti dilakukan bagi menguji sensitiviti keputusan akhir terhadap perubahan kecil penilaian. Aplikasi PAH dalam menentukan keutamaan proses pemilihan teknologi pengurusan sisa pepejal diperjelaskan dalam kajian ini berdasarkan kepada kajian kes di Majlis Perbandaran Port Dickson. Hasil analisis menunjukkan kombinasi teknologi kitar semula dan pengkomposan sesuai diaplikasikan di daerah Port Dickson.
Pembinaan model geometri berbantukan komputer (CAGD) dengan titik data yang mempunyai ketakpastian adalah sukar dan mencabar. Dalam kertas ini, pembinaan model splin-B kabur sebagai perwakilan matematik bagi lengkung dengan data ketakpastian menggunakan titik kawalan kabur dan titik kawalan penyahkaburan dibincangkan. Lengkung splin-B kabur atau splin-B penyahkaburan kubik untuk masalah data ketakpastian akan diperihalkan dengan menggunakan kaedah penghampiran splin-B kubik yang ditakrif menerusi titik kawalan kabur dan titik kawalan penyahkaburan. Bagi menyelesaikan masalah mengenai titik data ketakpastian pula, kaedah pengkaburan dan penyahkaburan titik data berkomponen kabur (penyahkaburan) beserta modelnya diperkenalkan. Bagi menguji tahap keberkesanan model, beberapa contoh lengkung simulasi data tersebut juga dibincangkan.
Kajian kepekatan logam dalam air di Tasik Bukit Merah telah dijalankan pada April 2009. Lima belas stesen persampelan telah dipilih dan sampel air permukaan bagi penentuan logam telah diambil. Beberapa parameter kualiti air seperti suhu, konduktiviti, oksigen terlarut, pH dan keliatan air telah ditentukan di setiap stesen. Sebanyak 11 jenis logam iaitu kadmium, zink, plumbum, kuprum, nikel, ferum, kobalt, aluminium, barium, kromium dan mangan (Mn) telah ditentukan dalam sampel air. Keputusan menunjukkan kepekatan semua logam kajian berada di bawah kepekatan maksimum yang dicadangkan oleh piawaian Malaysia dan antarabangsa bagi melindungi hidupan akuatik kecuali bagi logam Fe dan Al. Bagi parameter kualiti air, kajian menunjukkan semua parameter berada dalam julat kepekatan semula jadi (kelas I) berdasarkan Piawaian Kualiti Air Kebangsaan (NWQS Malaysia) kecuali oksigen terlarut dan pH di beberapa stesen persampelan terutama di bahagian timur tasik yang didapati dipengaruhi oleh faktor-faktor semula jadi dan antropogenik.
Peripheral neuropathy is highly associated with foot complications among diabetics. This
study aimed to identify risk factors associated with the development of peripheral neuropathy in diabetic patients and their association with degree of severity of peripheral neuropathy. A cross-sectional study was conducted in follow-up clinics at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia involving 72 diabetic patients and 19 controls. Exclusion criteria were those with amputated limbs, gross foot deformity and existing peripheral neuropathy. Controls were non diabetics who walked normally, had no history of foot problem and attended the clinic as subjects’ companion. Quantitative assessment of neuropathy was done using Semmes-Weinstein monofilament. Neuropathy Disability Score (NDS) were used to quantify severity of diabetic neuropathy. Spearman’s Rank test and Mann-Whitney test were used to determine correlation between variables and their differences. Logistic regression analysis was used to determine risk factors associated with peripheral neuropathy. The mean HbA1c among diabetics was 8.6% + 4.1, and mean NDS was 7.0 + 6.0. A total of 79.1% demonstrated various level of neuropathy with presence of callus was associated with higher NDS scores. Older age (P=0.02), body weight (P=0.03), HbA1c (P=0.005) and duration of diabetes (P <0.005) showed positive correlation with NDS. Proper foot care program for diabetics should include recognition of the callus, with special emphasis given to those with heavier weight and increasing age.
Key words: diabetes mellitus, peripheral neuropathy, Neuropathy Disability Score
(NDS), Semmes Weinstein monofilament (SWMF), callus
Study site: follow-up clinics at the Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Painful neuropathy, a common complication of diabetes mellitus is characterized by allodynia and hyperalgesia. Recent studies emphasized on the role of non-neuronal cells, particularly microglia in the development of neuronal hypersensitivity. The purpose of the present study is to evaluate the effect of minocyline, a selective inhibitor of microglial activation to define the role of neuroimmune activation in experimental diabetic neuropathy. Cold allodynia and thermal and chemical hyperalgesia were assessed and the markers of inflammation and oxidative and nitrosative stress were estimated in streptozotocin-induced diabetic rats. Chronic administration of minocycline (40 and 80 mg/kg, i.p.) for 2 weeks started 2 weeks after diabetes induction attenuated the development of diabetic neuropathy as compared to diabetic control animals. In addition, minocyline treatment reduced the levels of interleukin-1β and tumor necrosis factor-α, lipid peroxidation, nitrite and also improved antioxidant defense in spinal cords of diabetic rats as compared to diabetic control animals. In contrast, minocycline (80 mg/kg, per se) had no effect on any of these behavioral and biochemical parameters assessed in age-matched control animals. The results of the present study strongly suggest that activated microglia are involved in the development of experimental diabetic neuropathy and minocycline exerted its effect probably by inhibition of neuroimmune activation of microglia. In addition, the beneficial effects of minocycline are partly mediated by its anti-inflammatory effect by reducing the levels of proinflammatory cytokines and in part by modulating oxidative and nitrosative stress in the spinal cord that might be involved in attenuating the development of behavioral hypersensitivity in diabetic rats.
INTRODUCTION: Peripheral diabetic neuropathy, which is a cause of increasing morbidity and mortality following foot ulcers and amputations, is a burden to health and the economy. Various adjunct treatments to improve neuropathy have been introduced into the market; one such treatment is monochromatic infrared energy (MIRE) therapy, which claimed to produce promising results. This study aimed to evaluate the effects of MIRE on diabetic feet with peripheral neuropathy.
METHODS: A randomised controlled, single-blinded study was conducted at Hospital Universiti Sains Malaysia from February 2008 to October 2008. A total of 30 feet from 24 patients were studied. Neuropathy was screened using the Michigan neuropathy scoring instrument, followed by an assessment of the current perception threshold using a neurometer at frequencies of 2,000 Hz, 250 Hz and 5 Hz. The feet were randomised to receive either daily MIRE or sham treatment for a total of 12 treatments. Each foot was then reassessed using the neurometer at six weeks and three months following treatment.
RESULTS: The data obtained was analysed using a non-parametric test to compare the pre- and post-treatment groups. No significant difference was found between the neuropathic foot of diabetic patients in both the MIRE and sham groups.
CONCLUSION: No improvement of neuropathy was observed following MIRE treatment in the neuropathic feet of diabetic patients.