Diagnostic Accuracy of Different Bedside Clinical Methods in Evaluation of Peripheral Neuropathy in Patients of Diabetes: Experience at a Tertiary Care Center

Background and Objectives: At present, the gold standard for diagnosis of diabetic peripheral neuropathy is biothesiometry. Sincethe data are sparse comparing the biothesiometry with commonly used bedside tests, we conducted this study to evaluate theclinical accuracy of simple bedside clinical screening tools for evaluation of peripheral neuropathy in patients of diabetes mellitus.Materials and Methods: Atotal of 120 patients with diabetes mellitus referred from the endocrinology department, from August2014 to July 2017 were included in this study. A detailed clinical assessment including diabetic neuropathy symptom (DNS)score, diabetic neuropathy examination (DNE) score, ankle reflex, vibration sensation with a 128 Hz tuning fork, and 10 gSemmes-Weinstein monofilament, and biothesiometry was done in all the subjects.Results: The prevalence of peripheral neuropathy was 36% with biothesiometry. Only 33.33% of patients followed foot carepractices in the study population. Monofilament was the most sensitive and accurate of all the diagnostic tests for the evaluationof peripheral neuropathy in diabetes patients. On statistical analysis correlations observed between the biothesiometry andthe DNE score (r = 0.572, P < 0.00018) and DNS score (r = 0.436, P < 0.0004) and absent tuning fork sensation (r = 0.510;P < 0.0007), monofilament sensation (r = 0.713; P < 0.0002) and ankle reflex (r = 0.456, P = 0.0002) were significant.Interpretation and Conclusions: we concluded that simple bedside tests are useful for diagnosing peripheral neuropathy indiabetes patients including those in whom foot care practices are not followed.

Successful surgical resection of advanced gastrointestinal stromal tumor post neoadjuvent therapy

We report a case of a 48-year-old Indian male who presented with swelling and firmness in his left upper part of the abdomen of one month duration with anorexia and weight loss. Initial examination revealed an intra abdominal mass of around 16.8x11.0x24.5cm with minimal left sided pleural effusion. A biopsy from the mass confirmed the diagnosis of gastrointestinal stromal tumour [GISTs] as supported by immmunohistochemistry results which showed strong positivity for c-kit while stains for smooth muscle actin, desmin, myoglobin, S100 Protein and cytokerstin remained negative. The patient was not suitable for surgical intervention in view of advanced tumor, and Imatinib Mesylate 400mg daily was started with the aim of making the tumor operable. Such therapy lasted for twenty months and was tolerated well by the patient. It then resulted in gradual tumor regression, following which the patient underwent successful tumor resection. Post surgical resection patient had no radiological evidence of intra abdominal tumor but mild left sided pleural effusion with left lower lobe atelectasis. The patient had uneventful post operative recovery and he is currently on Imatinib mesylate and tolerating treatment well with mild skin rash. The experience with preoperative imatinib on surgical resection rates and post operative outcomes is limited especially with primary locally advanced GISTs. In our case successful surgical resection was possible for a huge locally advanced GIST with unusually prolonged treatment of twenty months with imatinib preoperatively

Study of unmet need for family planning in Dar Assalam, Sudan 2001

In this descriptive study, the main objective was to determine the magnitude of unmet need for family planning among women of child-bearing age [15-49 years] in Dar Assalam. Using a detailed questionnaire, we studied 530 ever-married women selected randomly through a multistage sampling technique. Current use of contraception was 21.3%. Using the Westoff model, unmet need was 30.7%. Contraceptive pills were the most commonly used method, 92%. Knowledge on contraception was 61.3% for a single method and 23.4% > or = 2 methods. Knowledge was obtained mainly from relatives, 48.6%

Accident prevention program in a glass factory in Shobra El - Khema district

An accident can be defined as an unplanned event that results in or suggests the possibility of personal injury, property damage, production interruption, diminished health or environmental damage. The accidents have a cost impact on the employees and the company itself. This Intervention study was carried out to decrease the accident rate in a glass factory in Shoubra EI-Khema district. A glass factory in Shoubra EI-Khema was selected to implement an intervention program. The program was done through three phases.1 A preliminary interview questionnaire. 2. Seminars of health education were done to all workers and managers with availability of health education posters, establishment of accident committee and a new reporting system, contract with a housekeeping company was done and also training of some leaders. 3. Concurrent and final evaluation of the program was done. The incidence rate, frequency and severity rate of accidents were decreased at the end of the year after the intervention program. The differences were statistically significant. The opinions of the workers and managers about the different causes of accidents were changed. The belief of the workers and managers about efficiency of health education program was changed. Some leaders were trained on skills of health education. Modification of reporting and notification system was done. This intervention study succeeded in decreasing accidents rates and increasing the awareness of the managers to decrease accident rates. The beliefs and thoughts of both workers and managers became near to each other. The production loss due to days lost by accidents was reduced. Upgrading process in the factory are recommended to eliminate the hazards at source. Sustaining and continuation of the established preventive program should be done. Trying to apply the program in similar factories is also recommended