15 research outputs found
D-vitamin es neuropathia.
Diabetes is a widespread disease and, therefore, studies dealing with diabetes and its complications are very important for public health. Numerous reports link vitamin D deficiency to the increased risk of diabetes mellitus and complications such as neuropathy. However, there are limited and conflicting data available on vitamin D deficiency in patients with diabetic peripheral neuropathy. Studies in type 2 diabetics confirmed the relationship between vitamin D deficiency and incidence of neuropathy. Recent reports suggest a relationship between the incidence of plantar ulcers and vitamin D deficiency. Orv. Hetil., 2013, 154(51), 2012-2015
Vitamin D in the Prevention and Treatment of Diabetic Neuropathy
Purpose: Neuropathy is one of the most important complications of diabetes. According to recent advances, vitamin D deficiency might play a role in the development and progression of diabetic neuropathy. Moreover, therapeutic vitamin D supplementation has the potential to improve this condition. The aim of the present review was to summarize new data available in this area.Methods: The PubMed database was searched for articles written in English and published through September 2021, using combinations of the following key words: vitamin D, diabetes, diabetes mellitus, diabetic neuropathy, polyneuropathy, peripheral neuropathy, cardiac autonomic neuropathy, supplementation, and therapy.Findings: A number of studies have suggested that vitamin D deficiency can play a significant role in the development of peripheral neuropathy, diabetic foot ulcers, as well as cardiovascular autonomic neuropathy in patients with type 2 diabetes. Vitamin D supplementation might serve as an effective adjuvant therapy for neuropathic pain and may slow or stop the progression of neural damage. (C) 2022 The Author(s). Published by Elsevier Inc
Súlyos fokú distalis szenzoros polyneuropathia következményeként észrevétlenül elszenvedett lábsérülések és ennek talaján elvégzett többszörös alsó végtagi amputációk – esetbemutatás [Unobserved foot injuries and multiple amputations on both of the lower limbs due to extremly severe distal sensory polyneuropathy – case report]
A szerzĹ‘k diabeteses neuropathiában szenvedĹ‘ betegĂĽk lábsĂ©rĂĽlĂ©sĂ©nek következtĂ©ben kialakult, nem gyĂłgyulĂł neuropathiás fekĂ©ly kĂłrtörtĂ©netĂ©t foglalják össze esettanulmányukban. Az 59 Ă©ves fĂ©rfi beteg földmunka közben Ă©szrevĂ©tlenĂĽl megsebesĂtette lábait, aminek következtĂ©ben mindkĂ©t alsĂł vĂ©gtagon többszöri amputáciĂłt kellett vĂ©grehajtani. Klinikánkra törtĂ©nĹ‘ felvĂ©telekor a beteg jobb talpán egy nem váladĂ©kozĂł, tenyĂ©rnyi felszĂnes fekĂ©ly volt láthatĂł. A vizsgálatok sĂşlyos fokĂş, szenzoros neuropathiát igazoltak, ez alapján a korábban elvĂ©gzett minor Ă©s major amputáciĂłk dominálĂłan neuropathiás eredetűnek voltak tekinthetĹ‘k Ă©s a beteg alfa-liponsav infĂşziĂłs kezelĂ©sben rĂ©szesĂĽlt. A sebĂ©szeti konzĂlium szerint a fekĂ©ly aktuálisan sebĂ©szeti beavatkozást nem igĂ©nyelt, a vĂ©gtag polcolását Ă©s lokális kezelĂ©sĂ©t javasolták. EsetĂĽnk felhĂvja a figyelmet arra, hogy már a cukorbetegsĂ©g diagnĂłzisának felállĂtásakor kiemelten fontos a lehetsĂ©ges szövĹ‘dmĂ©nyekre – Ăgy a diabeteses lábra Ă©s annak megfelelĹ‘ ápolására – felhĂvni a betegek figyelmĂ©t. A már kialakult fekĂ©lyek kezelĂ©se multidiszciplináris összefogást igĂ©nyel, a kezelĂ©s alappillĂ©re a szĂ©nhidrát-anyagcsere egyensĂşlyban tartása, a neuropathia oki kezelĂ©se, a vĂ©gtag tehermentesĂtĂ©se, valamint a rendszeres sebellátás. | Foot injury in a patient with diabetic neuropathy is reported. A 59-year-old male patient’s legs had been injured by a split. The injuries have lead to multiple amputations on both of the lower extremities. The patient was admitted to our clinic with a non-healing, superficial palm size ulcer on his right sole. The minor and major amputations were the consequences of maximal degree of sensory neuropathy, the patient was treated by alpha-lipoic acid infusions. Currently there was not required any surgical intervention, the surgeon proposed only local treatment of the ulcer. Theses case demonstrates how important is to warn the patients about the potential complications (diabetic foot and its adequate care). The adequate care of the ulcers is multifactorial, the most important is the exact glycemic control, the casual therapy of the neuropathy, the off-loading of the lower limb and systematic wound care
Visszatérő talpi fekélyek, osteoneuroarthropathia és sebészi feltárást is igénylő osteomyelitis súlyos fokú distalis szenzoros polyneuropathia következményeként – esettanulmány [Recurrent plantar trophic ulcers, neuro-osteoarthropathy and osteomyelitis requiring surgical debridement as consequences of severe distal sensory polyneuropathy – case report]
A szerzĹ‘k közlemĂ©nyĂĽkben egy sĂşlyos szenzoros károsodásban szenvedĹ‘ cukorbeteg esetĂ©t ismertetik, akinek szenzoros neuropathiája korán trofikus fekĂ©ly kialakulásához vezetett. A neuropathia oki kezelĂ©sekĂ©nt alfa-liponsav-adást kezdtek, a megfelelĹ‘ glykaemiás kontroll mellett a kardiovaszkuláris rizikĂłfaktorok felmĂ©rĂ©sĂ©t követĹ‘en a beteg antihipertenzĂv kezelĂ©sĂ©t bĹ‘vĂtettĂ©k, statin- Ă©s allopurinolterápia is indult. Az Ă©vek folyamán jelentkezĹ‘ Ăşjabb Ă©s Ăşjabb trofikus talpi fekĂ©ly perifĂ©riás Ă©rbetegsĂ©g hiányában jĂł gyĂłgyhajlamot mutatott. A beteg neuropathiás eredetű fájdalmai idĹ‘vel jelentĹ‘sen fokozĂłdtak, Ăgy a neuropathia oki kezelĂ©sĂ©t tĂĽneti szerrel egĂ©szĂtettĂ©k ki, mellyel a beteg fájdalmai a továbbiakban jĂłl uralhatĂłak voltak. A szenzoros neuropathia további szövĹ‘dmĂ©nyekĂ©nt Charcot-fĂ©le osteoarthropathia, a lábfejek deformitása Ă©s kalapácsujj alakult ki, kezelĂ©sĂĽkre a beteg egyedileg kialakĂtott, tehermentesĂtĹ‘ szilikonbetĂ©tet Ă©s cipĹ‘t használt jĂł eredmĂ©nnyel. A beteg utolsĂł klinikai Ă©szlelĂ©sĂ©nek alkalmával a jobb II. lábujj váladĂ©kozĂł fekĂ©lye Ă©s a distalis lábfej erythemás duzzanata miatt jelentkezett, amelynek hátterĂ©ben Charcot-láb Ă©s ulceratio talaján kialakult krĂłnikus osteomyelitis igazolĂłdott. Többhetes cĂ©lzott antibiotikus kezelĂ©s, a lábujjak tehermentesĂtĂ©se Ă©s a distalis phalanx fertĹ‘zött csontfragmentumainak eltávolĂtása után a fekĂ©ly gyĂłgyult, a beteg lábujja megmenthetĹ‘ volt. A sĂşlyos fokĂş szenzoros neuropathia a visszatĂ©rĹ‘ talpi fekĂ©lyek Ă©s a Charcot-láb legfontosabb kĂłroki tĂ©nyezĹ‘je. A szerzĹ‘k esetĂĽk kapcsán áttekintik a Charcot-láb Ă©s diabetesesekben kialakulĂł osteomyelitis aktuális kĂ©rdĂ©seit, Ă©s felhĂvják a figyelmet arra, hogy a neuropathia megfelelĹ‘, a kardiovaszkuláris rizikĂłfaktorokra is kiterjedĹ‘ komplex kezelĂ©sĂ©vel Ă©s a diabeteses láb multidiszciplináris megközelĂtĂ©sĂ©vel az amputáciĂł megelĹ‘zhetĹ‘. | The authors review the case of a diabetic patient with severe sensory impairment leading shortly to foot ulceration. As pathogenetically oriented treatment, alpha-lipoic acid was initiated. Beneath good glycaemic control, his antihypertensive treatment was augmented, statin and allopurinol therapy was introduced as well. During the following years, the patient intermittently presented with new plantar ulcers that healed due to his preserved peripheral perfusion. His neuropathy showed rapid progression including severe hypaesthesia of all sensory nerve types of both lower extremities. The patient’s painful neuropathic symptoms substantially increased meantime and symptomatic medication was added on to the combined casual therapy leading to alleviated neuropathic pain. As further consequences of peripheral sensory neuropathy, Charcot-osteoarthropathy and hammer toe deformity developed. Foot deformity was treated with individually designed diabetic shoes and relieving silicon insole achieving good morphologic result. Last summer, the patient presented with a wet ulcer of the II. right toe and an erythematous forefoot. These symptoms were proven chronic osteomyelitis evolved on Charcot foot and ulceration. After targeted antibiotic treatment for weeks, off-loading of the toes and removing the infected bone fragments of the distal phalanx, the ulcer healed and the toe could be preserved. Severe sensory neuropathy is the major cause of recurrent plantar ulcers and Charcot foot. The authors assess the current issues on Charcot-foot and diabetic osteomyelitis and should draw attention to the fact that neuropathy combination treatment involving correction of cardiovascular risk factors and multidisciplinary approach could achieve limb survival
Heart rate variability is severely impaired among type 2 diabetic patients with hypertension.
INTRODUCTION: The aim of our study was to evaluate the relative effect of diabetes and hypertension on heart rate variability. RESEARCH DESIGN AND METHODS: Four age-matched groups including type 2 diabetic patients with and without hypertension, non-diabetic patients with essential hypertension and healthy control subjects were studied. Autonomic function was evaluated by the standard cardiovascular reflex tests and 24-hour heart rate variability measurement. Heart rate variability was characterized by the triangular index value and by the spectral components of the frequency domain analysis. RESULTS: According to the two-way analysis of variance on ranks, all parameters were influenced negatively by diabetes (heart rate variability triangular index: p < 0.001; low-frequency component: p < 0.0001; high-frequency component: p < 0.001; and total power: p < 0.0001), whereas hypertension had a negative effect only on the low-frequency component (p < 0.05). The interaction between hypertension and diabetes was not significant, indicating that their effects on the heart rate variability parameters are additive. Beat-to-beat variation upon deep breathing, the most sensitive cardiovascular reflex test was also negatively influenced by both diabetes (p < 0.001) and hypertension, (p < 0.05), and their effects were additive. CONCLUSIONS: Diabetes appears to have a greater effect on autonomic dysfunction compared with hypertension. Patients suffering from both diabetes and hypertension are at the highest risk of reduced heart rate variability. Early assessment of the autonomic nerve function is suggested in diabetic patients with hypertension
Diabeteses kéz? – Határterületi barangolások egy eset kapcsán [Diabetic hand? – A case report from the frontiers of diabetology and rheumatology]
A diabetes krĂłnikus szövĹ‘dmĂ©nyei kapcsán a mozgásszervi rendszert Ă©rintĹ‘ rendellenessĂ©gekre ritkán gondolunk. A mozgásszervi szövĹ‘dmĂ©nyek közĂ© tartozik az osteoneuroarthropathia mellett a cukorbetegekben gyakoribb befagyott váll szindrĂłma, a rotátorköpeny-tendinopathia Ă©s a diabeteses kĂ©z manifesztáciĂłi is, amelyek jelentĹ‘s mĂ©rtĂ©kben ronthatják a beteg Ă©letminĹ‘sĂ©gĂ©t Ă©s mozgáskorlátozottság forrásai lehetnek. A diabeteses kĂ©z szindrĂłma klasszikus Ă©rtelemben az ujj- Ă©s csuklĂłĂzĂĽletek elmerevedĂ©sĂ©vel járĂł cheiroarthropathiát, a Dupuytren-contracturát Ă©s a flexortenosynovitist foglalja magába. A szövĹ‘dmĂ©ny felismerĂ©se fontos, mert kezelĂ©s hiányában a kĂ©z funkciĂłját veszĂ©lyeztetheti. A szerzĹ‘k esetismertetĂ©sĂĽnkkel a diabeteses kĂ©z szindrĂłmára, differenciáldiagnosztikájára Ă©s egyĂ©b szövĹ‘dmĂ©nyekkel mutatott összefĂĽggĂ©seire szeretnĂ©k felhĂvni a figyelmet. | Chronic complications of diabetes mellitus rarely recall thoughts of musculosceletal disorders. Beyond osteoneuroarthropathy, musculosceletal complications of diabetes comprise the frozen shoulder syndroma, the rotator cuff tendinopathy and manifestations of the diabetic hand syndrome and may lead to impaired quality of life and disability. The diabetic hand syndrome traditionally encompasses diabetic cheiroarthropathy leading to hand and wrist stiffness, the Dupuytren-contracture and flexor tenosynovitis. Recognition of these complications is crucial as they threat with loss of hand function unless treatment is initiated. The authors would like to draw attention to the diabetic hand syndrome, its differential diagnosis and its associations with other diabetic complications
A diabeteses osteoneuroarthropathia, a rejtélyes és mostoha szövődmény [Diabetic osteoarthropathy, the mysterious and often neglected complication]
A diabeteses osteoneuroarthropathia a diabeteses neuropathiában szenvedĹ‘ betegek kis hányadában kialakulĂł, ritka szövĹ‘dmĂ©ny, amely elsĹ‘sorban a láb terĂĽletĂ©n jelenik meg, Ă©s akut szakaszban lokális gyulladásos jelekkel, majd a krĂłnikus szakaszban progresszĂv csont-ĂzĂĽleti destrukciĂłval jár. A szövĹ‘dmĂ©ny mozgáskorlátozottságot, az Ă©letminĹ‘sĂ©g romlását eredmĂ©nyezi, Ăşj, abnormális talpi nyomáspontok megjelenĂ©se által pedig jelentĹ‘sen emeli a talpi fekĂ©lyek, az amputáciĂł kockázatát – Ă©s vĂ©gĂĽl a cukorbetegek mortalitását. A szerzĹ‘k rĂ©szletesen összefoglalják a kĂłrkĂ©p törtĂ©neti gyökereit, feltĂ©telezett patomechanizmusát, hagyományos Ă©s Ăşjabb diagnosztikus lehetĹ‘sĂ©geit, differenciáldiagnosztikáját Ă©s terápiás lehetĹ‘sĂ©geit. A diagnosztikában a kĂ©palkotĂł eljárások fejlĹ‘dĂ©sĂ©vel elĹ‘tĂ©rbe kerĂĽltek a tomográfiai, illetve a nukleáris medicina eljárásai, de a diagnĂłzisnak a mai napig döntĹ‘en a klinikai kĂ©pen kell alapulnia. A farmakoterápiás lehetĹ‘sĂ©gek bĹ‘vĂĽlĂ©se ellenĂ©re a terápia sarokköve az Ă©rintett vĂ©gtag tehermentesĂtĂ©se, amivel a további szövĹ‘dmĂ©nyek, ulceráciĂłk Ă©s deformitások kialakulása megelĹ‘zhetĹ‘. Sajnos a diagnĂłzis Ă©s a terápia sok esetben kĂ©sik – a szerzĹ‘k összefoglalĂł közlemĂ©nyĂĽkkel szeretnĂ©k felhĂvni a figyelmet e szövĹ‘dmĂ©ny jelentĹ‘sĂ©gĂ©re. | Diabetic osteoneuroarthropathy is a rare complication of diabetic neuropathy occurring primarily on the foot. It is associated with local inflammatory symptoms in the acute phase and leads to progressive bone and joint destruction in the chronic phase. The Charcot-foot results in disability and poor quality of life. Beyond, it is accompanied with the occurrence of new abnormal pressure points on the foot being at high risk of foot ulceration, amputation and thereby leading to excessive mortality in diabetic patients. The authors give comprehensive insight in the historical background, assumed pathophysiology, traditional and modern diagnostic facilities, differential diagnosis and therapy of the complication. As a consequence of the development of imaging techniques, tomography and nuclear medicine procedures came into the front of diagnosis. However, clinical presentation should be the key to the diagnosis. Despite new pharmacological therapeutic options, off-loading is the paramount of Charcot-foot treatment. It can prevent further foot ulceration and deformity – unfortunately, the diagnosis and appropriate therapy are often delayed. The authors aim to attract more attention to the complication with the following review
Kialakulhat-e Charcot-láb 25 Ă©ves 1-es tĂpusĂş diabetes betegben? – esetismertetĂ©s [Charcot-foot in a 25 years old patient with type 1 diabetes – case report]
A szerzĹ‘k fiatal, 1-es tĂpusĂş cukorbetegsĂ©g szövĹ‘dmĂ©nyekĂ©nt diabeteses neuropathiában szenvedĹ‘ betegĂĽk lábsĂ©rĂĽlĂ©sĂ©nek következtĂ©ben kialakult Charcot-láb kĂłrtörtĂ©netĂ©t mutatják be esettanulmányukban. A 25 Ă©ves nĹ‘beteg felvĂ©telĂ©re a szĂ©nhidrát-anyagcsere egyensĂşlyának rendezĂ©se cĂ©ljábĂłl kerĂĽlt sor. Klinikai felvĂ©telekor jobb oldali nem gyĂłgyulĂł talpi fekĂ©lyre Ă©s következmĂ©nyesen kialakult Charcot-lábra derĂĽlt fĂ©ny. Inzulinadagjainak mĂłdosĂtását követĹ‘en vĂ©rcukorĂ©rtĂ©kei közel normális tartományba kerĂĽltek. A vizsgálatok közepes fokĂş, hypaesthesiás tĂpusĂş szenzoros neuropathiát igazoltak. A röntgen- Ă©s CT-vizsgálat a jobb boka csontjainak szerkezeti elváltozásait, a lábboltozat deformitását igazolták. A vĂ©gtag tehermentesĂtĂ©se mellett, 10 napos alfa-liponsav infĂşziĂłs Ă©s intravĂ©nás pamidronatkezelĂ©sben rĂ©szesĂĽlt a beteg, ortĂ©zisĂ©nek elkĂ©szĂtĂ©se folyamatban volt. EsetĂĽnk felhĂvja a figyelmet szĂ©nhidrátanyagcsere-helyzet egyensĂşlyban tartásának fontosságára, hiszen a diabeteses neuropathia már fiatalkorban is sĂşlyos szövĹ‘dmĂ©nyekhez, akár Charcot-láb kialakulásához vezethet. Cukorbetegeink figyelmĂ©t kiemelt fontosságĂş felhĂvnunk nem csak a szĂ©nhidrát-anyagcsere egyensĂşlyban tartására, hanem a neuropathiás fekĂ©lyek kialakulásának rizikĂłjára, valamint idĹ‘ben törtĂ©nĹ‘ szakszerű ellátására is. | Foot injury in a young, type 1 diabetic patient is reported. The 25 years old female patient has been referred to our department to optimalize her blood glucose levels. A chronic wound on her right sole and her ankle was observed and joints were deformated in a way known as Charcot-foot. Near normoglycaemia has been achieved after changes her insulin regimen. Moderate level of sensory hypoaesthesia was documented. X-ray and CT showed changes in the bone structure and a collapsed foot arch. A 10 days long parenteral alpha-lipoic acid for the treatment of diabetic neuropathy as well as intravenous pamidronate as the therapy of the Charcot-foot was applied. She tried to rest her right leg and her orthesis was in progress. We recommended following parenteral pamidronate therapy for the Charcot-foot. This case showed how important good metabolic status is, even in the young diabetic population. We have to teach our patients about the early and severe microvascular complications of diabetes as neuropathy, foot ulcers and Charcot-foot
A dohányzás szerepe a cukorbetegség és szövődményeinek kialakulásában
A dohányzás számos krĂłnikus betegsĂ©g, a szĂvĂ©rrendszeri esemĂ©nyek, a daganatos megbetegedĂ©sek, a krĂłnikus obstruktĂv tĂĽdĹ‘betegsĂ©gek Ă©s a halálozás fontos kockázati tĂ©nyezĹ‘je. KevĂ©sbĂ© ismert, hogy a dohányzás szerepet játszhat a 2-es tĂpusĂş cukorbetegsĂ©g kialakulásában is, amiben mind a bĂ©ta-sejteket károsĂtĂł, mind pedig az inzulinrezisztenciát fokozĂł hatása szerepet játszik. Számos adat szĂłl ma már amellett is, hogy a dohányzás elĹ‘segĂti a cukorbetegsĂ©g nemcsak makro-, de mikrovaszkuláris szövĹ‘dmĂ©nyeinek kialakulását Ă©s progressziĂłját. A szerzĹ‘k alábbi összefoglalĂł közlemĂ©nyĂĽkben ismertetik a dohányzás Ă©s a szĂ©nhidrátanyagcsere-zavar összefĂĽggĂ©seit, valamint a dohányzás szövĹ‘dmĂ©nyekre gyakorolt hatásait, rĂ©szletesen kitĂ©rve a dohányzás Ă©s a diabĂ©teszes neuropathia kapcsolatára
Differenciáldiagnosztikai problémák amyotrophia diabetica fennállása esetén – esetismertetés [Diabetic amyothrophy: problems of differential diagnosis – a case report]
A 74 Ă©ves, 2-es tĂpusĂş cukorbetegsĂ©gben szenvedĹ‘ fĂ©rfi beteg klinikai felvĂ©telĂ©re fĂ©l Ă©ven belĂĽl bekövetkezĹ‘ 25 kg-os fogyás, a test számos rĂ©szĂ©n megfigyelhetĹ‘, pörkkel fedett sebek, nagyfokĂş gyengesĂ©g miatt kerĂĽlt sor. A tumorirányĂş vizsgálatok negatĂv eredmĂ©nnyel zárultak. A bĹ‘rjelensĂ©gek ismĂ©telt bĹ‘rgyĂłgyászati konzĂlium vĂ©lemĂ©nye alapján bullosus pemphigoidnak bizonyultak. Biklonális gammopathia igazolĂłdott, a cristabiopszia eredmĂ©nye ugyanakkor nem igazolt malignus infiltráciĂłt. FĂ©l Ă©vvel kĂ©sĹ‘bbi, ismĂ©telt klinikai Ă©szlelĂ©se során motoros neuropathia tĂĽnetei kerĂĽltek elĹ‘tĂ©rbe. BetegĂĽnk esetĂ©ben összessĂ©gĂ©ben amyotrophia diabetica volt diagnosztizálhatĂł, a szerzĹ‘k a differenciáldiagnosztikai aspektusok mellett a több kĂłroki tĂ©nyezĹ‘ egyĂĽttes fennállása mellett kialakulĂł, sĂşlyos fokĂş neuropathia lehetĹ‘sĂ©gĂ©re hĂvják fel a figyelmet. | The 74 years old male patient with type 2 diabetes was admitted to our department due to 25 kg weight loss, widespread skin injuries and severe weakness. Investigations towards malignant tumours were negative. According to repeated dermatological consultations, skin alterations were diagnosed as bullous pemphigoid. Biclonal gammopathy was found while no malignancy was detected by bone biopsy. During his second clinical hospitalization, half a year later the clinical picture was dominated by symptoms of motor neuropathy. Altogether, diabetic amyotrophy was diagnosed. The authors provide a review on differential diagnostic aspects, as well as highlighting the probability of neuropathies due to more simultaneous pathogenetic factors