Biopsy of the posterior interosseous nerve: a low morbidity method for assessment of peripheral nerve disorders.

AIMS: The sural nerve is the commonest peripheral nerve biopsied to help in the diagnosis of peripheral neuropathy of unknown cause. However, associated complications limit its use. The aim was, as an alternative, to asses biopsy of the terminal branch of the posterior interosseous nerve (PIN) in the forearm. METHODS: PIN pathology was morphometrically quantified in 10 male patients with Type 2 diabetes and compared with six PIN biopsy specimens taken post mortem from male cadavers with no history of neuropathy or trauma. RESULTS: The PIN biopsy procedure provides a long (approximately 3 cm) mono- or bifascicular nerve biopsy with generous epineurial tissue and adjacent vessels. Our results show a significantly lower myelinated fibre density in subjects with diabetes [5782 (3332-9060)/mm(2)] compared with autopsy control material [9256 (6593-12,935)/mm(2), P < 0.007]. No postoperative discomfort or complications were encountered. CONCLUSIONS: A reduction in myelinated fibre density has previously been shown to be a clinically meaningful measure of neuropathy in diabetic patients. We demonstrate similar findings using the PIN biopsy. The PIN biopsy procedure fulfils the criteria for nerve biopsy and was well tolerated by the patients. It may be a possible alternative to sural nerve biopsy to allow for diagnosis of neuropathy

Diabetic retinopathy is associated with oxidative stress and mitigation of gene expression of antioxidant enzymes

Mohamed Fath El-Bab,1,4 Nashaat S Zaki,2,5 Moaz A Mojaddidi,1 Maan AL-Barry,2 Hesham A El-Beshbishy3,6 1Department of Physiology, Taibah University, Almadinah, Kingdom of Saudi Arabia; 2Department of Ophthalmology, College of Medicine, Taibah University, Almadinah, Kingdom of Saudi Arabia; 3Department of Medical Laboratories Technology, Faculty of Applied Medical Sciences, Taibah University, Almadinah, Kingdom of Saudi Arabia; 4Department of Physiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; 5Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 6Biochemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo, Egypt Abstract: Type 2 diabetes is a metabolic disease associated with serious complications, including diabetic retinopathy (DR). The authors&#39; main aim was to investigate biochemical parameters and the oxidative stress associated with the type 2 DR patients and to study gene expression of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) among patients with DR [DR(+)] compared with a control nondiabetic group. In all, 67 patients with DR included in this study were diabetic for more than 10 years. Among them, 22 patients were DR(+), and 45 patients did not have DR [DR(-)]. The subjects&#39; age range was 14 years to 80 years old with diabetes duration range between 2 and 45 years. Body mass index (BMI) was 31.43 &plusmn; 5.94 and 32.33 &plusmn; 6.54, systolic blood pressure was 117.15 &plusmn; 18.16 mmHg and 126.15 &plusmn; 20.26 mmHg, diastolic blood pressure was 81.11 &plusmn; 10.55 mmHg and 82.77 &plusmn; 10.85 mmHg, HbA1c was 7.2 &plusmn; 1.1 and 8.19 &plusmn; 1.95, serum total cholesterol was 6.61 &plusmn; 1.11 and 4.11 &plusmn; 0.31, serum triglycerides were 3.52 &plusmn; 0.89 and 3.42 &plusmn; 0.79, serum low-density lipoprotein (LDL) was 2.12 &plusmn; 0.10 and 2.42 &plusmn; 0.15, high-density lipoprotein (HDL) was 2.66 &plusmn; 0.30 and 2.55 &plusmn; 0.21, SOD was 3.12 &plusmn; 0.87 and 1.53 &plusmn; 0.14, GPx was 11.14 &plusmn; 2.21 and 8.2 &plusmn; 1.84, CAT was 26.43 &plusmn; 3.34 and 9.60 &plusmn; 2.14, for DR(-) and DR(+) patients, respectively. SOD, GPx and CAT polymerase chain reaction (PCR) products of the DR(+) patients revealed the diminished expression of CAT gene followed by GPx and SOD genes. All were significant compared with the normal controls, P < 0.05. Linear regression analysis revealed a strong significant positive correlation between the retinopathy grade and the diastolic blood pressure, diabetes duration, hemoglobin A1c (HA1c)%, and fasting blood glucose (P < 0.001). A marginally significant positive correlation between the retinopathy grade and LDL-cholesterol was observed (P < 0.05), and a significant negative correlation between the retinopathy grade and total cholesterol was observed (P < 0.05). Poor glycemic control and alteration in mRNA gene expression of antioxidant enzymes are strongly associated with development of DR and the regular screening is mandatory for early detection and treatment. Keywords: diabetic retinopathy, antioxidant enzymes, gene expressio

Early Diagnosis of Diabetic Neuropathy in Almadinah Almunawwarah

AbstractObjectivesDiabetes mellitus (DM) is a major public health problem worldwide. The aim is to assess the early detection of impaired nerve function and the risk factors associated with the development of diabetic neuropathy.MethodsIt is a prospective descriptive study of age-matched 263 diabetic Saudi patients from the outpatient clinic of the Diabetic Centre in King Fahd Hospital in Almadinah Almunawwarah in Kingdom of Saudi Arabia during 2008-2009. Written informed consent was obtained from each subject after the protocol was approved by the local ethics committee. All subjects were diagnosed as diabetics using WHO criteria. We obtained detailed demographic data as age, sex, special habits, height, weight and body mass index, arterial blood pressure, type and duration of diabetes, glycosated haemoglobin (HbA1C), lipid profile, management, family history of hypertension, diabetes. Assessment of neuropathy by using the Diabetic neuropathy index and diabetic neuropathy score. Asymptomatic patients who scored less than two in clinical examination were referred to be assessed by complete neurological examination, and nerve conduction studies. Data were calculated and compared by using SPSS version 13.0.ResultsThe type I were 39 (14.8%) and type II were 244 (85.2%) diabetic patients and the mean duration of diabetes mellitus in all diabetic patients was 13.89 ± 8.7 years. The symptomatic diabetic neuropathy patients were 165 (62.7%)s out of 263 diabetic patients and the asymptomatic were 98 (37.3%). The risk factors for neuropathy were old age, poor blood sugar control, long duration of diabetes, hyperlepidemia, Body Mass Index (BMI). There were no statistical significant differences in relation to types of diabetes mellitus. There was positive correlation which shown by the linear regression charts between the grades of nerve conduction defects in asymptomatic diabetic neuropathy patients and duration of diabetes, age, BMI and HbA1C.ConclusionThe early detection of by sub-clinical nerve conduction of diabetic patients is of a major clinical interest that could lead to more intensive supervision of diabetic patients. Further studies should be performed in order to confirm these findings