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Fulltext Association of diabetic autonomic neuropathy with painless myocardial ischaemia induced by exercise

Quek DK, Khor PG, Ong SB

Singapore Med J, 1992 Apr;33(2):177-81.
PMID: 1621124

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)

Matched MeSH terms: Diabetic Neuropathies/complications*
Fulltext Torsade de pointes and sudden death associated with diabetic autonomic diarrhoea--a case report

Quek DK, H'ng PK

Singapore Med J, 1993 Jun;34(3):266-70.
PMID: 8266190

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.

Matched MeSH terms: Diabetic Neuropathies/complications*
Fulltext Effects of sulbutiamine on diabetic polyneuropathy: an open randomised controlled study in type 2 diabetics

Kiew KK, Wan Mohamad WB, Ridzuan A, Mafauzy M

Malays J Med Sci, 2002 Jan;9(1):21-7.
PMID: 22969314 MyJurnal

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.

Matched MeSH terms: Diabetic Neuropathies
Dual-Tasking Effects on Gait and Turning Performance of Stroke Survivors with Diabetic Peripheral Neuropathy

Tajuddin K, Justine M, Mohd Mustafah N, Latif L, Manaf H

Malays J Med Sci, 2021 Apr;28(2):63-71.
PMID: 33958961 DOI: 10.21315/mjms2021.28.2.6

Background: Stroke survivors depend on the unaffected leg during walking and standing. The presence of diabetic peripheral neuropathy (DPN) affecting both legs may further affect the postural balance and gait instability and increase the risk for falls in such patients. Thus, this study was conducted to investigate the effect of dual taskings on the gait and turning performance of stroke survivors with DPN.
Methods: Forty stroke survivors were recruited (20 with DPN and 20 without DPN) in this cross-sectional study design. Instrumented timed up and go (iTUG) tests were conducted in three different tasking conditions (single task, dual motor and dual cognitive). APDM® Mobility Lab system was used to capture the gait parameters during the iTUG tests. A two-way mixed analysis of variance was used to determine the main effects of gait performance on three taskings during the iTUG test.
Results: Spatiotemporal gait parameters and turning performance (turning time and turning step times) were more affected by the tasking conditions in stroke survivors with DPN compared to those without DPN (P < 0.05).
Conclusion: Stroke survivors with DPN had difficulty walking while turning and performing a secondary task simultaneously.

Matched MeSH terms: Diabetic Neuropathies
Fulltext The prevalence of diabetic peripheral neuropathy in an outpatient setting

Mimi O, Teng CL, Chia YC

Med J Malaysia, 2003 Oct;58(4):533-8.
PMID: 15190629

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

Matched MeSH terms: Diabetic Neuropathies/epidemiology*
Fulltext Severe diabetic papillopathy mimicking non-arteritic anterior ischemic optic neuropathy (NAION) in a young patient

Mallika PS, Salowi MA, Thanaraj A, Chong MS, Tan AK, Chua CN

Med J Malaysia, 2012 Apr;67(2):228-30.
PMID: 22822654 MyJurnal

With the pathophysiology not clearly understood and fewer than 130 cases having been reported in the literature, diabetic papillopathy presents a special challenge to the ophthalmologist. We report a case of a young patient with more than 12 years of type 1 diabetes mellitus (T1DM) on insulin with poor compliance to treatment who presented with sudden bilateral loss of vision. Ocular examination, fluorescence angiography (FA) and systemic signs were conclusive of diabetic papillopathy. His fasting blood sugar level was high and serum glycosylated haemoglobin (HbA1c) indicated a long term fluctuating blood glucose control. His vision initially improved with treatment, but later deteriorated with tight glycemic control.

Matched MeSH terms: Diabetic Neuropathies/diagnosis*; Diabetic Neuropathies/pathology
Fulltext Alteration of foot temperature in diabetic neuropathy: is it another piece of puzzle?

Naicker AS, Roohi SA, Lee CS, Chan WH, Tay LS, Din XJ, et al.

Med J Malaysia, 2006 Feb;61 Suppl A:10-3.
PMID: 17042221

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

Matched MeSH terms: Diabetic Neuropathies/physiopathology; Diabetic Neuropathies/prevention & control*
Fulltext CABARAN PEKERJA SOSIAL DALAM MENGENDALIKAN PENGURUSAN KES PENDERAAN KANAK-KANAK DI TASKA

NANTHINI RAMALINGAM, KHADIJAH ALAVI

UMT Journal of Undergraduate Research, 2021;3(1):99-100.
MyJurnal

Peningkatan kes penderaan kanak-kanak sehingga kematian kanak-kanak amat membimbangkan keluarga dan masyarakat. Artikel ini akan membahaskan tentang cabaran pekerja sosial dalam melindungi penderaan kanak-kanak di taska. Kajian lepas amat kurang mengkaji isu penderaan kanak-kanak di taska. Kajian ini dijalankan dengan menggunakan pendekatan kualitatif berpandukan kajian fenomenologi. Teknik pengumpulan data kajian melalui temubual berstruktur secara bertulis. 6 orang informan terdiri daripada pekerja sosial telah dipilih bagi kajian ini dengan menggunakan teknik persampelan bertujuan (purposive sampling). Lokasi kajian yang dipilih ialah taska sekitar Bandar Baru Bangi. Data temubual berstruktur dianalisis secara tematik dan hasil kajian mendapati terdapat tiga cabaran utama iaitu pertama praktis kerja sosial, konflik profesion dan kemahiran dalam mengendalikan pengurusan kes penderaan kanak-kanak. Implikasi kajian ini mencadangkan program kaunseling individu dan kelompok kepada pekerja sosial dan penting meningkatkan latihan dalam kemahiran mengendalikan pengurusan kes penderaan kanak-kanak yang semakin kompleks dan kritikal di masa depan.

Matched MeSH terms: Diabetic Neuropathies
Fulltext KAJIAN PENCEMARAN AIR TERHADAP KOMUNITI ORANG ASLI DI TASIK CHINI, PAHANG

IDA ROYANI AMRAN, RAHAYA MD. JAMIN

UMT Journal of Undergraduate Research, 2021;3(2):119-128.
MyJurnal

Pencemaran air di Tasik Chini, Pahang kian meruncing akibat pembangunan sekitar yang tidak terkawal menyebabkan kemusnahan rantaian makanan sekaligus mengancam kelangsungan hidup komuniti asli. Justeru, kajian telah dijalankan bagi mengenal pasti faktor, impak dan keberkesanan strategi dengan menggunapakai Teori Pengambilalihan. Selain itu, kajian ini dipilih untuk memenuhi kelompangan kajian terdahulu yang lebih menekankan kepentingan pengekalan biodiversiti flora dan fauna berbanding kajian terhadap kehidupan komuniti setempat. Maka, kajian deskritif tinjauan telah digunakan melalui kaedah pemerhatian, temu bual mendalam bersama empat orang informan, dianalisis secara transkripsi, triangulasi dan analisis kandungan. Dapatan kajian menunjukkan faktor pencemaran air berpunca daripada pembinaan empangan air, projek pembangunan, aktiviti pembalakan, aktiviti perlombongan dan hakisan tanih. Sementara, pertanian komersial juga menjejaskan kegunaan domestik, hidupan akuatik terganggu, perubahan sifat air, kehilangan sumber pendapatan, dan tahap kesihatan terjejas. Oleh itu, cadangan memperluaskan program advokasi seperti pengawalan pembuangan sampah sarap, pematuhan Penilaian Impak Alam Sekitar (EIA), penglibatan pihak awam dan swasta, pemantauan kesihatan, kesedaran awam, dan melakukan penyelidikan lanjutan. Kajian mendapati dua buah syarikat China mengeksport bijih besi yang diperoleh sekitar Tasik Chini menggunakan permit AP (Eksport dan Import) dari negeri lain, bukannya Pahang. Meskipun syarikat tersebut tidak mempunyai lesen melombong tetapi mereka mempunyai segala kelengkapan alatan memproses dan menjalankan operasinya hingga kini. Diharapkan isu pencemaran air di Tasik Chini dapat dipulihkan demi menjamin kelestarian sejagat.

Matched MeSH terms: Diabetic Neuropathies
Fulltext ANALISIS RANGKAIAN SOSIAL TERHADAP PEMAIN UTAMA DALAM MEMPERKASAKAN KEMPEN BEBAS BEG PLASTIK DI KUANTAN PAHANG

MUHAMMAD AFIQ ‘AIZUDDIN MD DIN

UMT Journal of Undergraduate Research, 2021;3(1):111-122.
MyJurnal

Penggunaan beg plastik sangat popular di seluruh dunia. Di Malaysia beg plastik menjadi keperluan masyarakat terutama dalam proses jual beli. Peningkatan itu sekaligus mewujudkan kebimbangan bagi pemain utama seperti kerajaan persekutuan yang berperanan menggerak dan memperjuangkan kelestarian alam sekitar. Kempen bebas beg plastik merupakan kempen yang kerap dilaungkan dalam menggubah budaya penggunaan plastik dalam kehidupan seharian. Menerusi pelaksanaan kempen bebas beg plastik yang dijalankan di seluruh negeri khususnya di Kuantan, Pahang, maka kajian ini dapat mengkaji rangkaian pemain utama dengan menggunakan kaedah kualitatif temubual melalui Analisis Rangkaian Sosial (ARS). Secara khususnya, rangkaian tadbir berjaya memaparkan pelbagai saliran berkaitan komunikasi dan kerjasama antara pemain utama. Struktur berpusat didapati menjadi asbab kepada kapasiti terhad dalam menyelaraskan tindakan bersama. Temubual yang mendalam menunjukkan kepentingan kedudukan pemain utama dalam rangkaian tindakan bersama memudahkan pihak terlibat. Hasil kajian menunjukkan peluang lebih berkesan dan realistik jika diselaras hukuman dan tindakan di peringkat persekutuan dengan kerjasama Majlis Perbandaran, Jabatan Alam Sekitar, institusi penyelidikan, organisasi perniagaan dan pemain lain yang berkaitan. Justeru, kajian akan datang harus memperkasakan pendidikan dalam kalangan masyarakat dari setiap lapisan umur, kaum dan agama serta budaya. Malah, penerokaan terhadap keberkesanan penyampaian dan penerangan maklumat perlu divisualkan secara jelas oleh pihak berkepentingan dalam usaha mensifarkan penggunaan beg plastik di Malaysia.

Matched MeSH terms: Diabetic Neuropathies
Fulltext An Asian regional analysis of cost-effectiveness of early irbesartan treatment versus conventional antihypertensive, late amlodipine, and late irbesartan treatments in patients with type 2 diabetes, hypertension, and nephropathy

Annemans L, Demarteau N, Hu S, Lee TJ, Morad Z, Supaporn T, et al.

Value Health, 2008 May-Jun;11(3):354-64.
PMID: 17888064 DOI: 10.1111/j.1524-4733.2007.00250.x

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.

Matched MeSH terms: Diabetic Neuropathies/drug therapy*; Diabetic Neuropathies/economics

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