Clinical Study Comparison of Efficiencies of Michigan Neuropathy Screening Instrument, Neurothesiometer, and Electromyography for Diagnosis of Diabetic Neuropathy

Aim. This study compares the effectiveness of Michigan Neuropathy Screening Instrument (MNSI), neurothesiometer, and electromyography (EMG) in detecting diabetic peripheral neuropathy in patients with diabetes type 2. Materials and Methods. 106 patients with diabetes type 2 treated at the outpatient clinic of Ankara Numune Education and Research Hospital Department of Endocrinology between September 2008 and May 2009 were included in this study. Patients were evaluated by glycemic regulation tests, MNSI (questionnaire and physical examination), EMG (for detecting sensorial and motor defects in right median, ulnar, posterior tibial, and bilateral sural nerves), and neurothesiometer (for detecting alterations in cold and warm sensations as well as vibratory sensations). Results. According to the MNSI score, there was diabetic peripheral neuropathy in 34 (32.1%) patients (score ≥2.5). However, when the patients were evaluated by EMG and neurothesiometer, neurological impairments were detected in 49 (46.2%) and 79 (74.5%) patients, respectively. Conclusion. According to our findings, questionnaires and physical examination often present lower diabetic peripheral neuropathy prevalence. Hence, we recommend that in the evaluation of diabetic patients neurological tests should be used for more accurate results and thus early treatment options to prevent neuropathic complications

MULTİPL SKLEROZLU HASTALARDA FRAKTALKİN RESEPTÖR (CXCR1) POLİMORFİZMİ

Çalışmamızda, MSS inflamasyonu ile giden multipl sklerozda daha önce araştırılmamış, nöronların ekstrasellüler yüzeyinden salgılanan, antiinflamatuar ve nöroprotektif etkileri bulunan bir kemokin olan fraktalkin molekülünün reseptöründe yer alan V249I ve T280M polimorfizmlerini araştırarak ilgili polimorfizmlerin hastalıkla olası ilişkisini ortaya çıkartmayı amaçladık. Ayrıca MS hastalarından elde edilecek olan klinik ve genetik bulgular birlikte değerlendirilerek, hastaların klinik izlemlerine katkısının da aynı zamanda incelenmesi planlandı. Gazi Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalına başvuran ve Multipl Skleroz Polikliniği’nde değerlendirilen 92 MS’li hasta ve 91 kontrol birey çalışmaya alındı.. Katılımcıların serumlarından elde edilen DNA saflaştırılarak CX3CR1 geninde T280M ve V294I polimorfizmlerini içeren gen bölgeleri PCR yöntemiyle çoğaltılarak elde edilen fragmanlar restriksiyon enzimleri ile kesilip agoroz jel elektroforeze tabi tutuldu. Hasta ve sağlıklı bireyler karşılaştırıldığında Fraktalkin reseptör geninde yer alan T280M ve V294I polimorfizmlerinin genotip ve aleleri arasında anlamlı bir farklılık bulunmamıştır. T280M ve V294I polimorfizmine ait genotip gruplarından TM ve MM birleştirildiğinde gruplar arasında istatistiksel olarak anlamlı farklılık saptanmamıştır. Multipl sklerozda birçok polimorfizm çalışması yapılmış olmakla birlikte bir kemokin olan nöroinflamasyon ve nörodejenerasyonda önemli rol oynayan fraktalkin reseptörü ile ilişkili bir polimorfizm çalışması literatürde bulunmamaktadır. Daha önce literatürde hiç incelenmemiş olan bu parametrenin araştırılarak değerlendirilmesinin, bu yönde yapılacak çalışmalara katkı sağlayacağı düşünülmektedir.The aim of the study is, researching V249I and T280M polimorfizms which are located in the receptor of fraktalkin molecule that is being secreted on the extracelluler surface of neurons and has antiinflamatory and noroprotektive effects as a kemocin, to disclose the relations of V249I and T280M polimorfizms with the sickness of MSS inflammation with multiple skleroz which has not been investigated before. Furthermore, simultaneously evaluating clinical and genetical findings gathered from MS patients, it is also planned to analyze the contribution of these findings to the clinical observance of patients. 92 patients with MS and 91 controlled individuals who applied to the Neurology Department of Faculty of Medicine of Gazi University and being examined at the Policlinic of Multiple Skleroz were included in to the study. The DNA which is obtained from the serum of patients is purified and the fragment acquired from the gene regions covering T280M and V294I polimorfizms in the CX3CR1 gene multiplied by the PCR method were slashed with restriction enzyme and subjected to the agoroz jel elektroforeze. When the healthy individuals compared with diseased ones, it is not reached to meaningful findings between the genotype and allees of V249I and T280M polimorfizms which are located in the receptor of fraktalkin gene. When TM and MM which are the genotype groups of T280M and V294I were merged, statistically meaningful outcomes were reached between these groups. Although, there are numerous studies available regarding polimorfizm in Multiple Skleroz, there is no study in literature on polimorfizm related with fraktalkin receptor which has crucial function on neuroinflamation and neurodegeneration as a kemocin. It is believed that study and analysis of this parameter which has never been researched in the literature will contribute future studies on this subject

Comparison of Efficiencies of Michigan Neuropathy Screening Instrument, Neurothesiometer, and Electromyography for Diagnosis of Diabetic Neuropathy

WOS: 000320257800001PubMed: 23818897Aim. This study compares the effectiveness of Michigan Neuropathy Screening Instrument (MNSI), neurothesiometer, and electromyography (EMG) in detecting diabetic peripheral neuropathy in patients with diabetes type 2. Materials and Methods. 106 patients with diabetes type 2 treated at the outpatient clinic of Ankara Numune Education and Research Hospital Department of Endocrinology between September 2008 and May 2009 were included in this study. Patients were evaluated by glycemic regulation tests, MNSI (questionnaire and physical examination), EMG (for detecting sensorial and motor defects in right median, ulnar, posterior tibial, and bilateral sural nerves), and neurothesiometer (for detecting alterations in cold and warm sensations as well as vibratory sensations). Results. According to the MNSI score, there was diabetic peripheral neuropathy in 34 (32.1%) patients (score >= 2.5). However, when the patients were evaluated by EMG and neurothesiometer, neurological impairments were detected in 49 (46.2%) and 79 (74.5%) patients, respectively. Conclusion. According to our findings, questionnaires and physical examination often present lower diabetic peripheral neuropathy prevalence. Hence, we recommend that in the evaluation of diabetic patients neurological tests should be used for more accurate results and thus early treatment options to prevent neuropathic complications

Craniovertebral junction aneurysms

Objective: The course of the vertebral artery and its relationship to the C0–1–2 structures render it particularly vulnerable to mechanical trauma. In the present study, we investigated the course of vertebral arteries along the craniovertebral junction (CJ) to cast light on the biomechanical aspects of aneurysm formation, focusing mainly on the relation of the vertebral artery injuries to the CJ bony landmarks. Herein, we report our experience with fourteen cases of craniovertebral junction vertebral artery (CJVA) aneurysms and their presentations, management, and outcomes. Materials and methods: We extracted from 83 vertebral artery aneurysms only those 14 cases whose aneurysms were located at the C0–1–2. We reviewed all medical records, including operative reports and radiologic images. We divided the CJVA into 5 segments and then carefully reviewed the cases, largely focusing on the CJVA segments involved in the aneurysm. Angiographic outcomes were determined by angiography, which was scheduled at 3–6 months, 1, 2.5, and 5 years postoperatively. Results: A total of 14 patients with CJVA aneurysms were included in the present study. 35.7 % had cerebrovascular risk factors, while 23.5 % had other predisposing factors such as an AVM, an AVF, or a foramen magnum tumor. Predisposing factors in the form of neck trauma, both direct and indirect, were identified in 50 % of cases. The segmental distribution of aneurysms was as follows: three (21.4 %) at CJV 1, one (7.1 %) at CJV 2, four (28.6 %) at CJV 3, two (14.3 %) at CJV 4, and four (28.6 %) isolated to the CJV 5 segment. Of the 6 indirect traumatic aneurysms, 1 (16.7 %) was located at CJV 1, 4 (66.7 %) were located at CJV 3 and 1 (16.7 %) was located at CJV 5. The 1/1 direct traumatic aneurysm (100 %) from the penetrating injury was located at CJV 1. 100 % of cases with cerebrovascular risk factors, the affected vessels were on the dominant side. 42.9 % of cases presented symptoms of a vertebrobasilar stroke. All 14 aneurysms were managed only endovascularly. 85.8 % of patients we implemented flow diverters only. 57.1 % of follow-up cases were completely occluded angiographically, and 42.9 % of cases were near-completely or incompletely occluded at 1, 2.5, and 5-year follow-ups. Conclusions: The current article is the first report of a series of vertebral artery aneurysms located in CJ. Herein, the association of vertebral artery aneurysm, hemodynamics, and trauma is well established. We clarified all segments of the CJVA and showed that the segmental distribution of CJVA aneurysms significantly differs between traumatic and spontaneous cases. We showed that treatment with flow diverters should be the mainstay of CJVA aneurysm treatment

Assessment of voiding dysfunction in Parkinson's disease: Reliability and validity of the Turkish version of the Danish Prostate Symptom Score

WOS: 000408229600032PubMed ID: 28139847AimsTo investigate the reliability and validity of the Turkish version of the Danish Prostate Symptom Score (Dan-PSS) questionnaire in patients with Parkinson's disease (PD) and to compare the burden of LUTS (Lower urinary tract symptoms) in men and women. MethodsFor analysis of test-retest reliability, the Turkish version of the Dan-PSS scale was developed using the back translation method, and it was administered on the day of admission and repeated 1 week after in 60 patients with PD. The OAB-q (Overactive Bladder Questionnaire) and PDQ-39 (Parkinson's Disease Questionnaire-39) were administered to 73 patients for validity analysis. ResultsBoth the internal consistency (Cronbach's alpha coefficient: 0.99-1.00) and the test-retest reliability (intraclass correlation coefficient: 0.99-1.00) of the Dan-PSS were found to be high in patients with PD. Although weak to moderate correlations were found between the subscales of the Dan-PSS and PDQ-39 (r: 0.20-0.42; P<0.05), a strong correlation was found with the OAB-q (r: 0.60-0.79; P<0.05). Nocturnal urination was the most frequent (93.2%), and bothersome (54.8%) symptom. The majority of the symptom and bother responses were similar in men and women. ConclusionsCurrent study shows that the Turkish version of the Dan-PSS questionnaire is an internally consistent, reliable, and valid scale for patients with PD. Therefore, it can be used to evaluate frequency and severity of LUTS in PD. LUTS are commonly seen in patients with PD in both sexes. It is suggested that all patients with PD should be referred for urological assessment