Diabetes Distal Peripheral Neuropathy: Subtypes and Diagnostic and Screening Technologies

2022 ◽  
pp. 193229682110353
Author(s):  
Kelley Newlin Lew ◽  
Tracey Arnold ◽  
Catherine Cantelmo ◽  
Francky Jacque ◽  
Hugo Posada-Quintero ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Point Of Care ◽  
Clinical Signs ◽  
Industrialized Countries ◽  
Comprehensive Literature Review ◽  
Small Fiber ◽  
Large Fiber ◽  
Research Advance ◽  
Increasing Risk ◽  
Prevalent Form

Diabetes distal symmetrical peripheral neuropathy (DSPN) is the most prevalent form of neuropathy in industrialized countries, substantially increasing risk for morbidity and pre-mature mortality. DSPN may manifest with small-fiber disease, large-fiber disease, or a combination of both. This review summarizes: (1) DSPN subtypes (small- and large-fiber disease) with attention to clinical signs and patient symptoms; and (2) technological diagnosis and screening for large- and small-fiber disease with inclusion of a comprehensive literature review of published studies from 2015-present ( N = 66). Review findings, informed by the most up-to-date research, advance critical understanding of DSPN large- and small-fiber screening technologies, including those designed for point-of-care use in primary care and endocrinology practices.

scholarly journals Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 165
Author(s):  
Jamie Burgess ◽  
Bernhard Frank ◽  
Andrew Marshall ◽  
Rashaad S. Khalil ◽  
Georgios Ponirakis ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Nerve Fibre ◽  
Diabetic Peripheral Neuropathy ◽  
Point Of Care ◽  
Unmet Need ◽  
Screening Tools ◽  
Nerve Fibres ◽  
Diagnostic Laboratory ◽  
Corneal Confocal Microscopy ◽  
Small Nerve

Diabetic peripheral neuropathy (DPN) is the most common complication of both type 1 and 2 diabetes. As a result, neuropathic pain, diabetic foot ulcers and lower-limb amputations impact drastically on quality of life, contributing to the individual, societal, financial and healthcare burden of diabetes. DPN is diagnosed at a late, often pre-ulcerative stage due to a lack of early systematic screening and the endorsement of monofilament testing which identifies advanced neuropathy only. Compared to the success of the diabetic eye and kidney screening programmes there is clearly an unmet need for an objective reliable biomarker for the detection of early DPN. This article critically appraises research and clinical methods for the diagnosis or screening of early DPN. In brief, functional measures are subjective and are difficult to implement due to technical complexity. Moreover, skin biopsy is invasive, expensive and lacks diagnostic laboratory capacity. Indeed, point-of-care nerve conduction tests are convenient and easy to implement however questions are raised regarding their suitability for use in screening due to the lack of small nerve fibre evaluation. Corneal confocal microscopy (CCM) is a rapid, non-invasive, and reproducible technique to quantify small nerve fibre damage and repair which can be conducted alongside retinopathy screening. CCM identifies early sub-clinical DPN, predicts the development and allows staging of DPN severity. Automated quantification of CCM with AI has enabled enhanced unbiased quantification of small nerve fibres and potentially early diagnosis of DPN. Improved screening tools will prevent and reduce the burden of foot ulceration and amputations with the primary aim of reducing the prevalence of this common microvascular complication.

scholarly journals Guidelines for Point-of-Care Fluorescence Imaging for Detection of Wound Bacterial Burden Based on Delphi Consensus

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1219
Author(s):  
Alisha R. Oropallo ◽  
Charles Andersen ◽  
Raymond Abdo ◽  
Jenny Hurlow ◽  
Martha Kelso ◽  
...  
Keyword(s):  
Wound Healing ◽  
Fluorescence Imaging ◽  
Nurse Practitioners ◽  
Point Of Care ◽  
Clinical Signs ◽  
Care Providers ◽  
Bacterial Burden ◽  
Term Care ◽  
Assessment Protocol ◽  
Treatment Plans

Excessive levels of bacteria impede wound healing and can lead to infectious complications. Unfortunately, clinical signs and symptoms of elevated bacterial burden are often unreliable. As a result, point--of--care fluorescence imaging, used to detect critical bacterial burden in wounds, is becoming widely recognized and adopted by clinicians across the globe as an accepted and added component of wound assessment protocol. A Delphi method was employed to establish consensus guidelines describing fluorescence imaging use. A multidisciplinary panel of 32 wound experts (56% MD, 22% podiatrist, 12.5% nurses/nurse practitioners) representing multiple sites of service (e.g., hospital outpatient, inpatient, private office, long-term care) completed two rounds of online questionnaires. The Delphi included key topics, including competencies required to perform imaging, clinical indications for imaging (e.g., signs/symptoms present, procedures warranting imaging), frequency of imaging, and a clinical workflow algorithm. Describing their clinical experiences of imaging impact, >80% reported changes in treatment plans, 96% reported that imaging-informed treatment plans led to improved wound healing, 78% reported reduced rates of amputations, and 83% reported reduced rates of microbiological sampling. The guidelines provided here will help to standardize use of fluorescence imaging among wound care providers and enhance the quality of patient care.

scholarly journals Case Studies in Neuroscience: The central and somatosensory contributions to finger interdependence and coordination: lessons from a study of a “deafferented person”

2019 ◽  
Vol 121 (6) ◽  
pp. 2083-2087 ◽  
Author(s):  
Cristian Cuadra ◽  
Ali Falaki ◽  
Robert Sainburg ◽  
Fabrice R. Sarlegna ◽  
Mark L. Latash
Keyword(s):  
Peripheral Neuropathy ◽  
Equilibrium Point ◽  
Force Production ◽  
Total Force ◽  
Equilibrium Point Hypothesis ◽  
Somatosensory Feedback ◽  
Central Origin ◽  
Neural Origin ◽  
Zero Values ◽  
Large Fiber

We tested finger force interdependence and multifinger force-stabilizing synergies in a patient with large-fiber peripheral neuropathy (“deafferented person”). The subject performed a range of tasks involving accurate force production with one finger and with four fingers. In one-finger tasks, nontask fingers showed unintentional force production (enslaving) with an atypical pattern: very large indices for the lateral (index and little) fingers and relatively small indices for the central (middle and ring) fingers. Indices of multifinger synergies stabilizing total force and of anticipatory synergy adjustments in preparation to quick force pulses were similar to those in age-matched control females. During constant force production, removing visual feedback led to a slow force drift to lower values (by ~25% over 15 s). The results support the idea of a neural origin of enslaving and suggest that the patterns observed in the deafferented person were reorganized based on everyday manipulation tasks. The lack of significant changes in the synergy index shows that synergic control can be organized in the absence of somatosensory feedback. We discuss the control of the hand in deafferented persons within the α-model of the equilibrium-point hypothesis and suggest that force drift results from an unintentional drift of the control variables to muscles toward zero values. NEW & NOTEWORTHY We demonstrate atypical patterns of finger enslaving and unchanged force-stabilizing synergies in a person with large-fiber peripheral neuropathy. The results speak strongly in favor of central origin of enslaving and its reorganization based on everyday manipulation tasks. The data show that synergic control can be implemented in the absence of somatosensory feedback. We discuss the control of the hand in deafferented persons within the α-model of the equilibrium-point hypothesis.

scholarly journals Clinical Characteristics, Electrophysiology, and Skin Biopsy of 38 Peripheral Neuropathy Cases with Small Fiber Involvement of Various Etiologies

2017 ◽  
Vol 130 (14) ◽  
pp. 1683-1688 ◽  
Author(s):  
Bo Sun ◽  
Li-Zhi Liu ◽  
Yi-Fan Li ◽  
Zhao-Hui Chen ◽  
Li Ling ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Skin Biopsy ◽  
Clinical Characteristics ◽  
Small Fiber

55. Assessing the risk of restless legs syndrome in small fiber peripheral neuropathy

2017 ◽  
Vol 128 (12) ◽  
pp. e428
Author(s):  
F. Rinaldi ◽  
S. Damioli ◽  
M. Pasolini ◽  
G. De Maria ◽  
A. Padovani ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Restless Legs Syndrome ◽  
Restless Legs ◽  
Small Fiber

scholarly journals Long-Time Course of Idiopathic Small Fiber Neuropathy

2018 ◽  
Vol 79 (3-4) ◽  
pp. 161-165 ◽  
Author(s):  
Pia Flossdorf ◽  
Walter F. Haupt ◽  
Anna Brunn ◽  
Martina Deckert ◽  
Gereon R. Fink ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Time Course ◽  
Benign Disease ◽  
Small Fiber Neuropathy ◽  
Disease Course ◽  
Peripheral Neuropathies ◽  
Small Fiber ◽  
Long Time ◽  
Large Fiber

Background: Small fiber neuropathy (SFN) is a challenging subtype of peripheral neuropathies. Once the diagnosis has been established, there is an uncertainty how SFN may progress, whether larger fibers will become involved over time, whether quality of life may be compromised, or whether repeated diagnostic workup in patients with unknown underlying cause may increase the yield of treatable causes of SFN. Methods: We evaluated 16 patients with documented long-time course of idiopathic SFN. Results: Clinical and electrophysiological course remained stable in 75% of the patients, while 25% SFN-patients developed large fiber neuropathies. Conclusions: Our data suggest that SFN represents a benign disease course in the majority of patients without severely limiting the quality of life.

scholarly journals Cancer Surveillance Guideline for individuals with PTEN hamartoma tumour syndrome

2020 ◽  
Vol 28 (10) ◽  
pp. 1387-1393 ◽  
Author(s):  
Marc Tischkowitz ◽  
◽  
Chrystelle Colas ◽  
Sjaak Pouwels ◽  
Nicoline Hoogerbrugge ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Cancer Colorectal ◽  
Evidence Base ◽  
Cancer Surveillance ◽  
Clinical Genetics ◽  
International Consensus ◽  
Comprehensive Literature Review ◽  
Increasing Risk ◽  
System Disorder ◽  
Current Guidelines

Abstract PTEN hamartoma tumour syndrome is a diverse multi-system disorder predisposing to the development of hamartomatous growths, increasing risk of breast, thyroid, renal cancer, and possibly increasing risk of endometrial cancer, colorectal cancer and melanoma. There is no international consensus on cancer surveillance in PHTS and all current guidelines are based on expert opinion. A comprehensive literature review was undertaken and guidelines were developed by clinicians with expertise from clinical genetics, gynaecology, endocrinology, dermatology, radiology, gastroenterology and general surgery, together with affected individuals and their representatives. Recommendations were put forward for surveillance for breast, thyroid and renal cancers. Limited recommendations were developed for other sites including endometrial, colon and skin. The proposed cancer surveillance recommendations for PHTS require a coordinated multidisciplinary approach and significant patient commitment. The evidence base for cancer surveillance in this guideline are limited, emphasising the need for prospective evaluation of the effectiveness of surveillance in the PHTS population.

scholarly journals OC 8173 RAPID DETECTION OF MYCOBACTERIUM ULCERANS BY RECOMBINASE POLYMERASE AMPLIFICATION

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A2.1-A2
Author(s):  
Michael Frimpong ◽  
Hubert Ahor ◽  
Francisca Sarpong ◽  
Ken Laing ◽  
Mark Wansbrough-Jones ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Point Of Care ◽  
Clinical Signs ◽  
Buruli Ulcer ◽  
Cross Reactivity ◽  
Current Control ◽  
Mycobacterium Ulcerans ◽  
Recombinase Polymerase Amplification ◽  
Clinical Samples ◽  
Clinical Sensitivity

BackgroundThere are no primary measures to prevent people from contracting Buruli ulcer, mainly due to poor understanding of its epidemiology. The current control strategy emphasises early diagnosis and prompt treatment, with the goal of avoiding the complications associated with advanced stages of the disease. There is no diagnostic test for the disease appropriate for use at the primary health care level where most cases are detected and treated. Diagnosis based on clinical signs is unreliable in inexperienced hands and complicated by infections that have similar presentations. This study was to develop and evaluate the use of recombinase polymerase amplification (RPA) assay for the detection of Mycobacterium ulcerans at the point of patient care.MethodsA specific fragment of IS2404 of M. ulcerans was amplified in 15 min at a constant temperature of 42°C, using the RPA assay and analysed on a portable fluorometre. The’method was tested for sensitivity and specificity with molecular standard of IS2404 DNA fragment, various M.’ulcerans strains, other mycobacteria and environmentally associated bacteria. Additionally, the assay performance as a diagnostic tool was tested with archived DNA from symptomatic patients. All results were compared with that of a highly sensitive IS2404 PCR.ResultsThe detection limit was 50 copies of IS2404 in 15 min using plasmid standard and 125 fg with genomic Mu DNA equivalent 25 genomic copies. The assay was highly specific in detecting all strains of M. ulcerans with no observed cross reactivity with other mycobacteria and common skin colonising bacteria. The clinical sensitivity and specificity of the BU-RPA assay using clinical samples was 86% and 100% respectively.ConclusionWe have developed a real-time isothermal RPA assay for the detection of M. ulcerans as a cheaper alternative to PCR. Combining this assay with a simple extraction protocol will maximise its use as point-of-care test for Buruli ulcer.

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