Evaluation of quality of life in patients with type 2 diabetes Mellitus with symptomatic distal symmetric polyneuropathy / Avaliação da qualidade de vida em doentes com diabetes Mellitus tipo 2 com polineuropatia simétrica distal sintomática

INTRO/BACKGROUND The complications of Diabetes Mellitus (DM) are traditionally categorized as micro and macrovascular disorders. Among them, diabetic polyneuropathy (DPN) is one of the most common, presenting with or without associated neuropathic pain, and its morbidity exerts a significant impact on the quality of life (QOL) of these patients. About 50% of individuals with type 2 DM (T2DM) suffer from this condition and the distal symmetric polyneuropathy (DSPN) constitutes its most frequent clinical form.  OBJECTIVE: To demonstrate the effect of symptomatic DSPN on the QOL of T2DM patients in a sample of the Brazilian population, correlating clinical and electrophysiological findings, besides comparing the results obtained by the Medical Outcomes Study Questionaire 36-Item Short Form Health Survey (SF-36) among patients with painful and non-painful diabetic DSPN. METHODS: This study comprised 25 outpatients with DSPN and T2DM submitted to a detailed anamnesis to identify clinical and demographic characteristics, besides comorbidities and complications of DM. Clinical evaluation was performed through neurological physical examination, in addition to specific scales for neuropathy as the Neuropathy Disability Score (NDS). In order to assess the health-related quality of life (HRQoL) of these patients, the SF-36 translated and adapted for the Brazilian population was applied. Nerve conduction study (NCS) was performed for the examined nerves (motor part of peroneal nerve and sensory part of the sural nerve). The following parameters were assessed: motor conduction velocity (MCV), amplitude of the compound muscle action potentials (CMAP) and amplitude of the sensory nerve action potentials (SNAP). RESULTS: Role Physical (RP) domain of SF-36 was significantly related to some of the clinical and electrophysiological factors measured. RP had an inverse and significant relationship with the NDS values (Rho: -0.44), showing the impact of neuropathy severity on these patients’ QOL. The sural nerve SNAP and peroneal nerve MCV showed a significant and positive relationship with RP (Rho: 0,52 and 0,36, respectively). The Mental Health (MH) domain showed a statistically significant difference between those patients with pain and without pain (p = 0.002), and patients without pain had higher mean values, as well as a higher minimum and maximum value. The Role Emotional (RE) domain also showed a significant difference between patients with and without pain, and patients with pain had a lower mean value (p = 0.04). For all other domains, patients with pain showed lower mean values than those without pain, however without statistical difference in the test performed. Between DM complications, only nephropathy presented statistically different RP scores from those without nephropathy (p = 0.02). CONCLUSION: There was a significant inverse relationship between the severity of DSPN and the QOL of the evaluated patients, as evidenced by lower values in the SF-36 specific RP domain, as polyneuropathy becomes more severe. This domain also presented significantly lower values in patients with associated nephropathy. The presence of pain negatively affected the QOL of patients with painful DPN, who presented significantly lower mean values in the MH and RE domains when compared to patients without pain

Guillain-Barré syndrome: advances and future perspectives

The first case of Guillain-Barré syndrome was described in 1916. Since then, knowledge about the pathophysiology and immunogenesis of this acquired inflammatory polyradiculoneuropathy has been growing steadily, especially after the advent of nerve conduction studies and the discovery of pathogenic autoantibodies. In the present study, we conducted a review of the main information available in the literature to date about the syndrome, including its diagnosis and management

Familial Amyloid Polyneuropathy: A Proposal for an Epidemiological Study Through the Creation of a Virtual Platform

Amyloidosis are characterized by mutations in the gene coding for transthyretin (TTR), located on chromosome 18. TTR is a set of four 127-aminoacid polypeptides structured as homotetrameric protein of 56 kDa with a secondary ß sheet structure. It plays the role of thyroxin (T4) carrier, and has a bindingdomain for retinol (vitamin A). It is synthesized in the liver, although a small quantity is also produced by the choroid plexus, and retinal cells. Mutations of this gene result in loss of tetramer stability. Insoluble amyloid fibrils (AF) are formed and deposited in tissues and organs. The abnormal aggregation ofTTR protein trigger several syndromes, such as familial amyloid polyneuropathy (FAP-TTR), cardiomyopathies (CMP), and senile systemic amyloidosis (SSA). It is estimated there are 5,000 to 10,000 cases of FAP-TTR globally. Objective: The study intends to develop an online platform for the diagnosis of FAP-TTR. The aim is to facilitate the diagnosis process and promote a tool for epidemiological study.Methods: The project was based on a literature review featuring clinical and epidemiological evidence for the development of a practical platform (applied research). Results: It was elaborated a platform containing a questionnaireto allow a more dynamic, cheaper, and efficient operation, mediated by a better characterization of the disease to enable its early diagnosis. Conclusion: The platform might become a valuable resource for the characterization, diagnosis, and future epidemiological study of FAP-TTR

Evaluation of clinical, epidemiological and electrophysiological variables for early diagnosis of amyotrophic lateral sclerosis

Motor neuron disease (MND) is a systemic disease with a broad clinical spectrum. It is characterized by primary involvement of the lower or upper motor neuron (UMN), or both, simultaneously, represented by the most common form, amyotrophic lateral sclerosis (ALS). ALS is rapidly progressive and fatal disease that evolve to death due to respiratory failure, on average, in three to five years since the onset of symptoms. This fact attends to the early and correct diagnosis of the disease. Objective: To evaluate clinical, epidemiological and electrophysiological variables for the early diagnosis of ALS. Methods: This is an observational, descriptive and retrospective study, conducted from the collect of the database, in which the variables were submitted to statistical analysis: Mann-Whitney test and Fisher's exact test. Results: When correlating clinical, epidemiological and electrophysiological findings of patients with ALS and other forms of MND, the variables: age of onset of symptoms (P=0,02) hyperreflexia (P=0,001), presence of bulbar symptoms/signs (P0,001), pathological reflexes (P=0.001), and presence of fasciculation in electromyography (P=0,001) presented statistical significance for the diagnosis of ALS. Conclusion: Despite the small sample size, the findings reinforce the importance of well- done neurological examination, to search for signs of involvement of the UMN, in the first evaluation of patients with suspected MND. And that more research is needed to better understand the different phenotypes of the disease in order to obtain an increasingly early diagnosis to offer improvements in the quality of life of thesepatients

Is the “lactormone” a key-factor for exercise-related neuroplasticity? A hypothesis based on an alternative lactate neurobiological pathway

International audienc

Comparison of cognitive functions among frail and prefrail older adults: a clinical perspective

To compare cognitive function among frail and prefrail older adults. Design: Cross-sectional clinical study. Participants: Fifty-one non-institutionalized older individuals participated in this study. Measurements: Cognitive functions were evaluated through Mini-Mental State Examination (Global Cognition), Digit Span Forward (short-term memory), Digit Span Backward (working memory), Verbal Fluency Test (semantic memory/executive function). Data were compared using parametric and non-parametric bivariate tests. Binary logistic regression was used to test a frailty prediction model. Statistical significance was defined as p <= 0.01 to compare groups. In the regression model, the p value was set to be <= 0.05. Results: Statistically significant differences were observed in global cognition, and short-term memory between frail and prefrail individuals (p <= 0.01). Global cognition explained 14-19% of frailty's model. Conclusion: According to our findings, the evaluation of cognitive functions among older persons with frailty and prefrailty provides important complementary information to better manage frailty and its progression312297301COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE MINAS GERAIS - FAPEMIGsem informaçãosem informaçã

Brazilian consensus for diagnosis, management and treatment of hereditary transthyretin amyloidosis with peripheral neuropathy: second edition

Hereditary transthyretin amyloidosis with peripheral neuropathy (ATTRv-PN) is an autosomal dominant inherited sensorimotor and autonomic polyneuropathy with over 130 pathogenic variants identified in the TTR gene. Hereditary transthyretin amyloidosis with peripheral neuropathy is a disabling, progressive and life-threatening genetic condition that leads to death in ∼ 10 years if untreated. The prospects for ATTRv-PN have changed in the last decades, as it has become a treatable neuropathy. In addition to liver transplantation, initiated in 1990, there are now at least 3 drugs approved in many countries, including Brazil, and many more are being developed. The first Brazilian consensus on ATTRv-PN was held in the city of Fortaleza, Brazil, in June 2017. Given the new advances in the area over the last 5 years, the Peripheral Neuropathy Scientific Department of the Brazilian Academy of Neurology organized a second edition of the consensus. Each panelist was responsible for reviewing the literature and updating a section of the previous paper. Thereafter, the 18 panelists got together virtually after careful review of the draft, discussed each section of the text, and reached a consensus for the final version of the manuscript