Haycocknema perplexum myositis: The first description of subclinical disease and a proposed distinctive triad to evoke clinical suspicion

Introduction: Haycocknema perplexum is an exceedingly rare cause of parasitic myositis endemic to Australia, more specifically, Tasmania and North Queensland. There is a paucity of literature regarding this diagnosis, with only nine previously described cases. Diagnosis: This report details two cases of biopsy-confirmed H. perplexum myositis from Townsville University Hospital and describes the first-ever case of subclinical infection. There is limited known information regarding the H. perplexum life cycle and a definitive host which has hindered the development of a non-invasive diagnostic test. A review of the previously described cases has identified the hallmark features of this enigmatic condition: a triad of serological markers including deranged hepatic function, persistent eosinophilia and an elevated creatine kinase. Conclusions: This report aimed to raise awareness of H. perplexum myositis and the possibility of subclinical infection, which suggests a protracted disease course. Further research is required to identify a non-invasive diagnostic test, given that early diagnosis and timely initiation of albendazole treatment may drastically limit patient disability

Metabolic and anthropometric influences on nerve conduction parameters in patients with peripheral neuropathy: a retrospective chart analysis

Background and Aims: Nerve conduction study (NCS) measures how fast an electrical impulse moves through the nerve and is a standard technique for diagnosing and assessing neurological diseases. Despite diabetes and obesity being a common accompaniment of peripheral neuropathy, their effects on NCS patterns have not been elucidated conclusively. Our study aimed to assess several anthropometric and metabolic factors with NCS outcomes to address this gap. Research Design and Methods: This retrospective chart analysis study was conducted on subjects who underwent NCS between 1 January 2009 and 31 December 2019 at a regional hospital. Metabolic, anthropometric, demographical and NCS data were collected from patients’ health records. Results: In total, 120 subjects presenting with sensorimotor peripheral neuropathy symptoms were included in the study. Age, HbA1c, urea and ESR variables were significantly negatively associated with nerve conduction outcomes (Spearman’s correlation rho between −0.210 and −0.456, p < 0.038). HbA1c and age consistently had the most substantial contribution to velocity and amplitude in all regression models (beta coefficients between −0.157 and 0.516, p < 0.001). Urea also significantly account for a large amount of variance in amplitude and velocity in the lower limbs. Conclusion: This study suggests that the severity of sensorimotor neuropathy is influenced by glycaemic control, age and uraemia. The interpretation of NCS results must consider these factors suggesting that improved glycaemic and uraemic control may improve nerve conduction outcomes

More parasitic myositis cases in humans in Australia, and the definition of genetic markers for the causative agents as a basis for molecular diagnosis

Since 1998, there have been six reported human cases of myositis in Australia, attributable to infection with the nematode Haycocknema perplexum. However, an unequivocal diagnosis of H. perplexum infection and associated disease has been seriously compromised by a lack of molecular markers for this nematode. Here, we report new cases of disseminated myositis in two male patients from the states of Queensland and Tasmania in Australia, respectively; genetically characterize the causative agent from each case; and, also establish a PCR-based sequencing approach as a tool to support the diagnosis of future cases and to underpin epidemiological studies

Prevalence and risk factors of lower limb amputations in patients with diabetic foot ulcers: A systematic review and meta-analysis

Background and aims: The study aimed at determining prevalence and risk factors (RFs) of diabetic lower limb amputations (LLAs). Methods: Electronic databases including PubMed, Medline, Web of Science, and Cochrane Library were searched from January 2003 to April 2021. Results: Sixteen full-text published studies were reviewed. The prevalence of LLAs stood as high as 66%, with a combined prevalence of 19% (95% CI 10-29) using the random-effects model. The most prominent RFs for LLA were duration of diabetes mellitus (DM), age, renal impairment, and ethnic minority. Amongst Australians, Indigenous background is strongly associated with increased risk of the diabetic foot (DF) LLA. Conclusions: LLAs are considerably prevalent amongst patients with the DF and occur at even higher rates in patients with multimorbidity

Influence of body mass index, height and hemoglobin A1c on nerve conduction study outcomes: a systematic review

Background/Aim: Nerve conduction study (NCS) is a gold standard technique in assessment and diagnosis of nerve dysfunction. Despite diabetes and obesity are common accompaniment of peripheral neuropathy, their effects on NCS patterns have not been conclusively elucidated. Few studies have investigated contribution of biochemical and anthropometric factors as they affect interpretation of NCS. The aim of this study was to review the existing reports on the degree of correlation and impact of anthropometric and metabolic risk factors on NCS. Methods: Systematic review. Results: A total of 333 studies were searched of which 9 studies were included in this literature review, with three studies, each investigating the effects of BMI, height and glycaemic control on NCS outcomes. Glycaemic control was found to inversely correlate with nerve conduction velocity across both upper and lower limb nerve sites. This was also true when investigated as a categorical variable (p=&lt;0.0001-0.03). Height also demonstrated a moderately inverse correlation to nerve conduction velocity in two studies (p= 0.01–0.05). However, BMI was found not to correlate with NCS outcomes. Conclusions: Our results have shown that both glycaemic control and height influence NCS velocity and amplitude. The interpretation of NCS should therefore take these factors into consideration, possibly through the development of linear models accounting for height and HbA1c. These findings posit that improved glycaemic control would therefore also improve nerve conduction outcomes