Pathogenesis of Painful Diabetic Neuropathy

The prevalence of diabetes is rising globally and, as a result, its associated complications are also rising. Painful diabetic neuropathy (PDN) is a well-known complication of diabetes and the most common cause of all neuropathic pain. About one-third of all diabetes patients suffer from PDN. It has a huge effect on a person’s daily life, both physically and mentally. Despite huge advances in diabetes and neurology, the exact mechanism of pain causation in PDN is still not clear. The origin of pain could be in the peripheral nerves of the central nervous system. In this review, we discuss various possible mechanisms of the pathogenesis of pain in PDN. We discuss the role of hyperglycaemia in altering the physiology of peripheral nerves. We also describe central mechanisms of pain

Diagnosis and Treatment of a Typical Painful Neuropathy Due to "Insulin Neuritis" in Patients with Diabetes

Diabetes is very common and its global prevalence is rising day by day. As a result we are seeing more complications related to diabetes. In order to prevent micro vascular and macro vascular complications such as retinopathy, nephropathy, erectile dysfunction, neuropathy, myocardial infarction and stroke health care professionals are keen to have better glycaemic control. When dealing with newly diagnosed or poorly controlled diabetes patients are encouraged to bring down glycated haemoglobin (HbA1c). Diabetic painful neuropathy (DPN) is one of the well-known complications associated with long- term poor glycaemic control. However, on the other hand rapid control of high blood sugar can precipitate painful neuropathy known as “insulin neuritis”. The rapid tight glycaemic control with either insulin or oral hypoglycaemic agents on poorly controlled diabetic patients cause flux of blood glucose and metabolic shift resulting in structural changes at nerve endings (endoneural blood vessels) which resemble the retinopathy changes in retina. It causes steal effect and hypoxia in the nerves and hence precipitates neuropathic pain. It lasts for about 6 months and responds well to standard treatment of painful neuropathy. Health professionals need to be aware of this condition and consider gentle glycaemic control when aiming for Target HbA1c. This review outlines the disease, the symptoms, the types and treatment

Tube Waves in Ultra-deep Waters: Preliminary Results

The oil and gas industry defines ultra-deep-water regions as areas in which water depths are greater than 1500 m. It is now well established that there are hydrocarbons in these regions. The reservoirs in these areas are generally located below basalt rocks or below salts. The focus of this thesis is to understand reflections, refractions, diffractions and scattering for acoustic lenses located below basalt rocks. The results of this study can potentially be used to understand the effect of tube waves on borehole seismic data in ultra-deep waters. Finite-difference modeling technique was used for this study. Finite-difference modeling allowed us to model refractions, reflections, diffractions and scattering; actually all events in surface seismic data, as well as borehole seismic data can be modeled. However, because of limited computational resources, this study will be based on a 2D finite difference instead of a 3D finite difference. This limitation implies that laterally infinite lenses were used to describe cylindrical boreholes. The four main characteristics of the geological constructs used here in simulating the ultra-deep-water regions were the size of the water column, the topography of the sea floor, the interfaces of basalt layers with the surroundings rocks, and the structure of heterogeneities inside the basalt layers. The average wavelength of wave propagation below the basalt layer is 125 m, which is very large compared to the size of a typical borehole (0.1 m). A lens with a thickness of 2.5 m, which corresponds to a dimension 50 times smaller than the average wavelength, sub-basalt was constructed. Also included were some lateral extensions in the construction of the lens to simulate wash-out zones. This study investigates the wave propagation below the basalt rocks and the effect of tube waves on borehole seismic data below the basalt layer by using these lenses instead of a cylindrical borehole. As the borehole geometry is different from that of the lens, the results are considered preliminary. Results suggest that tube waves are negligible in ultra-deep waters below basalt rocks because the wavelength of the seismic waves is large in comparison to the wash-out zone (192 times larger)

An Observational Study on Lignocaine Infusion for Intractable Chronic Pain

Objective: This study assessed the efficacy of lignocaine infusion as a treatment for painful diabetic neuropathy (PDN) groups compared to chronic pain (non-PDN group) in challenging cases where conventional treatment is not helpful. Methods: A total 11 patients participated in the study with 7 patients referred from pain clinic (non-PDN group) and 4 for patients referred from diabetic foot clinic (PDN group) for lignocaine infusion as a treatment for chronic pain. Both groups of participants were on multiple combination of pain medication with minimal help. All the subjects gave consent for participation and filled out McGill short form (SF) questionnaire before and after the lignocaine infusion. Results: The results show 33% reduction of visual analogue pain score after lignocaine infusion in PDN group compared to 11% reduction of visual analogue pain score in non-PDN group. These data were statistically significant (p0.05). All 11 patients had no reported adverse effects and their observations were in normal limits throughout the lignocaine infusion. Conclusion: Overall, the study showed that lignocaine infusion is both effective and safe in reducing chronic intractable pain when conventional treatments are intolerable or not helpful. It is more effective in painful diabetic neuropathy patients compared to other causes of chronic pain

Diabetic Foot Infections and Problems in Guyana

Diabetes mellitus (DM) is a major global metabolic disorder currently affecting more than 465 million people. If diagnosed late or left untreated, DM can induce a number of long-term complications which are due to DM-induced hyperglycaemia leading to nephropathy, cardiomyopathy, neuropathy, retinopathy, impotence, foot ulcers and amputations. Diabetic foot problems (DFB) are major concerns for the patients as they affect their quality of life and exert great financial burden on them, especially for people from a low income developing country as Guyana. In 2019, it was estimated that the expenditure for diagnosis, treatment and care for diabetic foot patients was USAD$75 million in Guyana. Both obesity and diabetes are on the increase in Guyana with almost 11 - 12% of the adult population have DM, due to obesity (diabesity) and more women compared to men. Moreover, there is an unacceptable high rate of amputations due to lack of organised foot-care programme and the absence of national guidelines in its management. There are various aspects of good diabetic foot care and this article now reviews what has been achieved and what needs prioritisation to improve the management of diabetic foot problems in Guyana among patients with diabetes mellitus. ’The Guyana Diabetes and Foot Care Project” has made significant improvement in this area but the lack of specialist vascular surgical service is obvious