Sheffield One‐Stop Service: A potential model to improve the screening uptake of diabetic peripheral neuropathy and other microvascular complications of diabetes

The world is experiencing an enormous rise in the prevalence of diabetes, which is associated with massive healthcare costs that threaten to overwhelm many healthcare systems. Most of the diabetes expenditure is attributed to the management of chronic diabetes complications, including diabetic peripheral neuropathy (DPN)/diabetic foot complications, chronic kidney disease, sight-threatening retinopathy and cardiovascular diseases. Of these complications, the most overlooked is DPN. Most consultations around the world do not even involve taking off shoes and socks to carry out a foot examination, and even when carried out, the peripheral neurological examination using the 10-g monofilament diagnoses DPN when it is already at an advanced stage. Thus, all too often diabetes complications are diagnosed late, resulting in devastating outcomes, particularly in low- to middle-income countries. There is, therefore, an urgent need to instigate new strategies to improve microvascular screening uptake using a holistic protocol for annual diabetes health checks outside the busy diabetes clinic. One such approach, the Sheffield One-Stop Microvascular Screening Service, which involves modern point of care devices to diagnose DPN, has been shown to be feasible and effective, resulting in high uptake and early management of diabetes complications. This article outlines the advantages of this One-Stop Microvascular Screening Service and a plan to trial an adapted version of this service to a resource-limited country, the Philippines. If successful, this model has the potential for implementation in other countries around the world

Cardiac morphology and function of hyperthyroid patients admitted at De La Salle University Medical Center

BACKGROUND: Most characteristics and common signs and symptoms of hyperthyroidism are the effects of thyroid hormones on the heart and cardiovascular system. With the advent of echocardiography, characterizing the effects of hyperthyroidism on the heart has been described mainly for overt hyperthyroidism. Data on subclinical hyperthyroidism are still conflicting.OBJECTIVE: To describe and compare the cardiac morphology and function of Filipino patients with uncontrolled overt and subclinical hyperthyroidism through echocardiogram, admitted at De La Salle University Medical Center (DLSUMC) for a period of five years and six months. METHODOLOGY: This is a retrospective descriptive study that utilized review of medical records. Seventy-five hyperthyroid patients were included; 56% with overt hyperthyroidism and 44% with subclinical hyperthyroidism. Cardiac morphology and systolic and diastolic functions were determined in the population and compared between overt and subclinical hyperthyroidism using 2-dimensional echocardiogram. RESULTS: Cardiac morphology was slightly compromised due to slight thickening of interventricular septum (IVSTd) and left ventricular posterior wall thickness at diastole (LVPWTd). There was also an increase in left ventricular mass (LVM), more pronounced in overt hyperthyroidism. Systolic function parameters such as fractional shortening (FS) and ejection fraction (EF) were normal. Impaired left ventricular myocardial relaxation manifested as low early mitral peak flow velocity, low E/A ratio and prolonged isovolumetricrelaxation time (IVRT) was observed in most patients, particularly in overt hyperthyroidism.CONCLUSION: Abnormalities noted were comparable between the two groups of hyperthyroidism. With cardiac parameters affected even in subclinical hyperthyroidism, treatment might be indicated regardless if hyperthyroidism is overt or subclinical

Clinical profile and etiology of hypopituitarism at the University Of Santo Tomas Hospital

Objective: To establish data determining the etiology of hypopituitarism in the University of Santo Tomas Hospital (USTH) and to describe the clinical and biochemical profile of these patients. Methodology: A retrospective descriptive study in a tertiary hospital (USTH) involving patients diagnosed by clinical evaluation and biochemical tests to have hypopituitarism, admitted or seen at the outpatient department from January 2001 to December 2009 and whose charts were available for review. The clinical profile, manifestations and biochemical profile were defined and causes of hypopituitarism identified. Descriptive statistics were applied using percentages and frequency distribution. Results: In the nine-year period (2001-2009), a total of 191 patients were recorded to have hypopituitarism but only 143 (75%) have adequate data available for review. Sixtyone (43%) were males and 82 (51%) were females with mean age was 45±6 years. Hypopituitarism was found to be most prevalent in the fourth to fifth decade of life and clinical manifestations were noted with mean duration of 20±4 months. The most predominant documented pituitary hormone deficiency was gonadotrophic hormone (60%) manifesting prominently as decreased libido (82%). The most common target end organ hormone deficiency was secondary adrenal insufficiency (90%) and most prevalent etiology of hypopituitarism was pituitary tumors (40%). Sheehan\u27s syndrome (8%) and tuberculosis (3%) were also noted as a cause of hypopituitarism. Conclusion: This study shows that the leading clinical manifestation and documented hormone deficiency of hypopituitarism is hypogonadism. Pituitary adenoma is the most common cause of hypopituitarism along with its treatment. Other causes not commonly seen in other countries but proved to be more prevalent here include Sheehan\u27s syndrome and tuberculosis infection

Validation of the UST thyroid scoring index against ultrasensitive assays for thyroid-stimulating hormone and free thyroxine

Background: Clinical manifestations of thyroid dysfunction are variable. The UST Scoring Index for thyroid disorders, formulated in the 1990s to evaluate thyroid functional status, was based on total thyroid hormone levels and thyroidal iodine uptake. However, with the advent of newer and more sensitive tests, the recommendations and practice now dictate the use of thyrotropin (TSH) and free thyroxine (FT4) levels in the confirmation of thyroid dysfunction. Objective: To validate the UST Scoring Index for thyroid disorders using TSH and FT4. Methods/Results: The UST Clinical Scoring Index was administered to 170 patients presenting for thyroid-related complaints. Thyroid function tests were then requested (TSH and Free T4) and they were classified according to biochemical status. We obtained the following: 43 hyperthyroid, 102 euthyroid and 25 hypothyroid subjects. The mean TSH for the 3 groups were 0.08, 1.28, and 41.50 uIU/mL respectively (NV 0.27-3.75.) Mean FT4 levels were 36.18, 18.33, and 8.43 pM/L respectively (NV 10.3-25.0.) The most frequent findings in the biochemically hyperthyroid group were thyroid enlargement (88%), easy tiredness (74%), palpitations (70%), and nervousness (65%); in the euthyroid group, easy tiredness (62%), thyroid enlargement (54%), palpitations (53%), and irritability (49%); in the hypothyroid group, easy tiredness (64%), exertional dyspnea (52%), weight gain (44%), and constipation (44%.) The UST scoring index for thyroid disorders has a sensitivity of 67%, specificity of 84%, and accuracy rate of 80%, with AUC of 0.850 on ROC analysis for the detection of hyperthyroidism. For detecting hypothyroidism, it has a sensitivity of 40%, specificity of 92%, and asccuracy rate of 85%, with AUC 0.7553 on ROC analysis. Conclusion: The UST scoring index for thyroid disorders has good sensitivity, specificity and accuracy rate based on ROC when validated using TSH and FT4 for the detection of hyperthyroidism and hypothyroidism

Diagnosing peripheral neuropathy in South-East Asia: A focus on diabetic neuropathy

© 2020 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd Burning and stabbing pain in the feet and lower limbs can have a significant impact on the activities of daily living, including walking, climbing stairs and sleeping. Peripheral neuropathy in particular is often misdiagnosed or underdiagnosed because of a lack of awareness amongst both patients and physicians. Furthermore, crude screening tools, such as the 10-g monofilament, only detect advanced neuropathy and a normal test will lead to false reassurance of those with small fiber mediated painful neuropathy. The underestimation of peripheral neuropathy is highly prevalent in the South-East Asia region due to a lack of consensus guidance on routine screening and diagnostic pathways. Although neuropathy as a result of diabetes is the most common cause in the region, other causes due to infections (human immunodeficiency virus, hepatitis B or C virus), chronic inflammatory demyelinating polyneuropathy, drug-induced neuropathy (cancer chemotherapy, antiretrovirals and antituberculous drugs) and vitamin deficiencies (vitamin B1, B6, B12, D) should be actively excluded