High Plasma Tnf-? Levels And Mononuclear Cells Inos And Tnf-? Expression AS Risk Factors For Painful Diabetic Neuropathy

Painful Diabetic Neuropathy (PDN) is one of the most common and annoyingcomplications of diabetes mellitus. The pathogenesis of PDN is complex and still unclear.Recently it has become clear that nitric oxide (NO) and proinflammatory cytokines playan important role in the pathogenesis and maintenance of pain in PDN. Based on thisphenomenon, this study was conducted to investigate whether the cytokine tumornecrosis factor-alpha (TNF-?) and NO, in this case inducible Nitric Oxide Synthase(iNOS), play a role in PDN pathogenesis.The study was carried in two steps. The first step was a cross sectional and thesecond step was a case-control study. The study was performed in 110 type-2 diabeticpatients. The plasma TNF-? levels were determined by ELISA while the expression ofTNF-? and iNOS in mononuclear cells were analyzed immunohistochemically.Of 110 subjects, 59 patients suffered from Painful DN (case) and the remaining51 patients were Painless DN (control). Cross sectionally, plasma TNF-? levels andimmunoreactivity for iNOS and TNF-? were higher in patients with more severe pain inthe Visual Analog Scale (VAS). There were statistically significant differences (p <0.05) between mild and severe pain in regard to TNF-? level (15.24 pg/ml ± 5.42 vs.20.44 pg/ml ± 10.34 ); to iNOS immunoreactivity (9.72 % ± 8.61 vs. 15.6% ± 11.84); andto TNF-? immunoreactivity (13.0 % ± 9. 48 vs. 20.44% ± 11.75).The case control study showed that TNF-? had an odd ratio of 5.053 [CI 95%(2.241-11.392); p < 0.001]. TNF-? immunoreactivity of 4.125 [CI 95% (1.805-9.425); p< 0.001]; and iNOS immunoreactivity of 3.546 [CI 95% (1.613-7.795); p = 0.002]. There were correlations between TNF-? level, TNF-? and iNOS immunoreactivity andVAS with coefficient correlation: 0.330; 0.285 and 0.275 (p < 0.05) respectively.It is concluded that Diabetic Neuropathy patients with high TNF-? levels, iNOSand TNF-? immunoreactivity of mononuclear cells have higher risk for painful DN thanpainless DN. The higher TNF-? level, iNOS and TNF-? immunoreactivity the moresevere was the pain. This supports the hypothesis that TNF-? and iNOS have role inPDN pathogenesis. The results of this research could be applied as a basic for furtherresearch in pursuit of better management of PDN

Diagnosis dan Manajemen Fibromialgia

Fibromyalgia (FM) syndrome is a common chronic pain syndrome characterized by widespread musculoskeletal pain and hyperalgesia. Despite increased awareness and understanding, FM remains underdiagnosed due to heterogeneity of its clinical presentation, pain site and comorbid conditions. The American College of Rheumatology (2010) proposed a simple, practical criteria more suitable for use in primary and specialty care for clinical diagnosis of fibromyalgia. Extensive researches suggested a neurogenic origin for the most prominent symptom of FM. The clinical presentation of FM is heterogeneous; treatment should be individualized, depends on pain severity, presence of other symptoms or comorbidities and degree of functional impairment.Fibromialgia (FM) merupakan sindrom nyeri kronik yang umum dijumpai, ditandai dengan nyeri muskuloskeletal yang tersebar luas disertai hiperalgesia. Meskipun pengetahuan dan pemahaman tentang fibromialgia meningkat, penyakit ini sering tidak terdiagnosis karena heterogenitas gambaran klinis, lokasi nyeri, dan kondisi komorbid. The American College of Rheumatogy (ACR) pada tahun 2010 merekomendasikan kriteria praktis yang lebih tepat digunakan dalam diagnosis klinis fibromialgia pada layanan kesehatan primer maupun spesialistik. Penelitian-penelitian skala besar membuktikan bahwa gejala paling mencolok pada FM bersifat neurogenik. Manifestasi klinis FM sangat bervariasi sehingga manajemennya bersifat individual, bergantung pada berat ringannya nyeri, ada tidaknya gejala lain atau komorbiditas, dan derajat gangguan fungsi yang terjadi

Trauma Medula Spinalis: Patobiologi dan Tata Laksana Medikamentosa

Trauma medula spinalis merupakan keadaan yang dapat menimbulkan kecacatan permanen dan mengancam nyawa. Saat ini penggunaan kortikosteroid masih menjadi perdebatan di samping obat-obat baru yang diharapkan mampu memberikan pilihan terapi bagi pasien trauma medula spinalis.Spinal cord injury can cause disability and life threatening condition. Corticosteroid use is still controversial despite newest research. New management guideline recommendation is urgently needed