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Aims@#Skin burns remain a noteworthy general medical issue throughout the world, as it boosts a condition of immuno-suppression. The present research aimed to evaluate the efficacy of Syzygium aromaticum extracts, silver sulphadiazine ointment, and different commercially available topical antibiotics against pathogenic bacteria, isolated from the skin of burn patients.@*Methodology and results@#A total of 124 clinical pus samples were collected from the skin of burn patients, admitted to two different tertiary care burn units at Peshawar, Pakistan. From these pus samples, 6 bacterial isolates from burned skin (Staphylococcus epidermidis, Streptococcus, Klebsiella, Enterobacter, Bacillus and Pseudomonas spp.) were isolated, while 4 different bacterial isolates (Staphylococcus epidermidis, Staphylococcus aureus, Bacillus and Streptococcus spp.) were isolated from unburned skin via conventional culturing techniques. Further, antibacterial assays were performed to compare the efficacy of S. aromaticum extracts (methanolic and aqueous extract), silver sulphadiazine ointment, and different commercially available antibiotics against tested bacteria. It was observed that both methanolic and aqueous extracts of S. aromaticum were effective at all concentrations against all the tested bacteria. In addition, all the tested antibiotics expressed substantial activity against most of the bacterial isolates. While silver sulphadiazine ointment was observed to be less potent against isolated bacteria as compared to S. aromaticum extracts. @*Conclusion, significance and impact of study@#It was concluded that both aqueous and methanolic extracts of S. aromaticum were effective antimicrobial agents and could be used as an alternative to control bacterial infections of burn patients. This study would help to distinguish the risk factors of bacterial pathogenicity in burn patients and would also provide a guideline to utilize medicinal plants and their extracts to minimize the chances of antibiotic resistance phenomenon in burn patients.
Subject(s)
Anti-Bacterial Agents , Cell Membrane , Oxidative Stress , Permeability , Plant Extracts , SyzygiumABSTRACT
Objective: To determine association of p53 overexpression with hormone receptor status in breast carcinoma
Study Design: Descriptive cross-sectional study
Place and Duration of Study: Department of Pathology in collaboration with Department of Oncology, King Edward Medical University, Lahore, from January 2017 to January 2018
Methodology: All adult female patients coming to Department of Oncology with reports of breast cancer biopsy and receptor status were included. Their age, type of surgery, grade of cancer, stage of cancer, and hormone receptor status were noted from records. P53 immunomarker was applied on tumor containing tissue blocks. Pearson Chi-square test was run for strength of association between the variables using SPSS V. 22
Results: Mean age of 91 patients at diagnosis was 48 years ±12.49. Fifty-five [60.4%] patients had ER positive tumors, 36 [39.6%] were ER negative, 53 [58.2%] had PR positive status, and 38 [41.8%] were negative. Same number was seen in HER2 neu staining. Out of 91 cases, 31 [34.1%] were p53 positive and 60 [65.9%] were negative. Out of 55 [60.4%] ER positive cases, 11 [12.1%] were positive for p53 and 44 [48.4%] were p53 negative [p<0.001]. PR positive cases [53/58.2%] showed p53 positivity in 7 [7.7%] and negativity in 46 [50.5%] cases [p< 0.001]. HER2 positive cases were positive for p53 stain in 8 [8.8%] and negative in 45 [49.5%] cases [p<0.001]. Fifteen [16.48%] biopsies were negative for all three hormone receptors. P53 was positive in all of these hormone receptor negative tumors [15/15, 100%], although 9 [60%] showed strong positivity and 6 [40%] exhibited weak staining intensity of p53
Conclusion: P53 overexpression is less frequent in hormone receptor positive breast cancers. However, hormone receptor negative [triple negative] tumors overwhelmingly overexpress p53 protein in tumor cells. P53, detected either immunohistochemically or serologically, can serve to predict poor prognosis and survival in breast cancer patients, unless newer anti-p53 treatments are introduced in Pakistan
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Background: Mandibular foramen (MF), present on the medial surface of ramus of the mandible, leads to themandibular canal through which inferior alveolar nerve (IAN) and vessels transmit. IAN block is a commonanaesthetic procedure before dental and reconstructive surgeries. Surgeons usually do IAN block in their clinicsand encounter failure of block because of variable position of MF.Objective: The present study was carried out to find the most common position of MF in north Indian population.Materials and Methods: Study was done on 50 dry adult human mandibles of unknown sex and age of northIndian origin. Height was measured from the angle of the mandible to the highest point on condyloid process.Mid point of the line joining these points was noted. The position of MF was observed in relation to pre noted midpoint.Results: MF was placed below the level of mid point in 40 mandibles (80%).Conclusion: The knowledge of most common position of MF will help the surgeons to reduce the chance ofunsuccessful IAN block.
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Background: Serum thyroid stimulating hormone [TSH] is advised to assess thyroid function and can be used to replace TFTs
Objective: To evaluate the role of TSH only for diagnosis of thyroid dysfunction in tertiary care hospital
Methodology: Study design: Cross sectional study. Study setting: Endocrinology, section of Pathology Department and Surgery Department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, Pakistan
Study Subjects: Patients referred for routine thyroid disease from surgical ward were selected for study. Their history was taken and detailed clinical examination was carried out
Data Collection: Data of all the patients in whom TSH, fT[4] and fT[3] tests or TSH and fT[4] were ordered by clinicians during the period of study was collected. ffT[3] , fT[4] and TSH were analyzed by fourth generation of ECLIA. Samples were assayed in batches, and sometimes 3 4 assays were performed in duplicate when necessary
Results: This study shows that TSH only strategy has 100% sensitivity in both hyperthyroid and hypothyroid cases when TSH plus fT was taken as golden standard, whereas in hypothyroid cases 4 specificity was 86% and in hyperthyroid cases was 90%
Conclusion:This study shows that TSH only strategy can be used as first line test for the diagnosis of thyroid disease and it has good sensitivity and specificity, as many patients with hypothyroidism or hyperthyroidism are diagnosed primarily on the basis of TSH measurement only
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Any academic course or program is incomplete without an assessment plan. Of late, MCQs have been widely used for assessment of medical and dental undergraduate students. Often enough, poorly constructed MCQs are used that do not fulfil the requirement of an assessment. Therefore, it is neces-sary that quality of MCQs be frequently evaluated. A quality assessment of MCQs is known as "item analysis". Item analysis allows identification of good-quality MCQs based on their Difficulty Index [DIF I/P], Discrimination Index [DI] and Distractor efficiency [DE]. The aim of this paper was to conduct an item analysis to evaluate the quality of MCQs being used to assess final year BDS students in the subject of Prosthodontics. An internal assessment for the subject of Prosthodontics was undertaken by fifty dental undergraduate students of final year in March 2018. The test consisted of 40 'one best type' MCQs, each with four options a - d. Post-validation of the test was done by item analysis. Data were analyzed using SPSS version 24. Majority [52.5%] MCQs were "too difficult" with a Diff Index less than 30%. About 67.5% MCQs had a poor discrimination index [DI < 0.2]. Of the 120 distractors, 62 [51.6%] were non-functional and only 5 MCQs had no non-functional distractors. It can be concluded that the items administered in this test need careful revision to improve their quality before using them in any future assessments
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Background: it is debatable whether a repeat renal biopsy during lupus nephritis [LN] flare is helpful in guiding the treatment and predicting prognosis
Objective: to determine the value of serial renal biopsies in detecting histological changes in patients with lupus nephritis with APL antibodies
Study design, settings and Duration: this cross sectional retrospective study was conducted at King Saud University Medical City Riyadh, Kingdom of Saudi Arabia [KSA] during May 2013 to August 2017
Patients and Methods: patients having diagnosis of systemic lupus erythematosus [SLE] with positive APL antibodies and who underwent two or more renal biopsies for various indications were included into the study. The histological features of serial renal biopsies were compared. Renal biopsies were reassessed with light microscopy, immunofluorescence and electron microscopic studies and were categorized according to ISN/RPS 2004 classification. Data was analyzed using chi-square test to assess the differences between categorical study variables
Results: a total of 15 patients with LN having positive APL antibodies were included. The mean age of the patients was 38 +/- 10.5 years, and the disease duration was 160 +/- 9 months. The Interval between the two biopsies was 73.5 +/- 48 months. Antiphospholipid syndrome nephropathy [APSN] was noted in 4 [26%] patients at time of the first renal biopsy and in 9 [60%] on repeat biopsies. Thrombotic microangiopathy [TMA] which is the hallmark of APSN was detected in the repeat biopsy in two patients Change in the histological class was frequent and was seen in 12 out of the 15 patients while patients with proliferative LN class switching to non-proliferative class was rare
Conclusion: histological changes are common in serial biopsies in patients with lupus nephritis with positive APL serology. Repeat renal biopsies led to change in immunosuppression treatment in more than half of patients on average
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Objective: To analyse the association of vital sign variations with complications during dialysis among end-stage renal disease patients
Study Design: Cross-sectional study
Place and Duration of Study: Dialysis Centre, Memon Medical Institute Hospital, Karachi, Pakistan, from December 2016 to February 2017
Methodology: Patients on regular hemodialysis with permanent vascular access were selected. Analysis was done during their regular hemodialysis session. Vital signs were measured before and after dialysis, and ultrafiltration [in litre] was recorded post-dialysis. Complications and the variations in vital sign during dialysis were documented as 'yes' or 'no' on the proforma. The association of vital sign on complications during dialysis was analysed by using Pearson Chi-square or Fisher Exact test. A p-value <0.05 was considered statistically significant
Results: Among the study participants, 250 [65.78%] were males and 130 [34.21] were females. Overall mean age and ultrafiltration rate were 51.89 +/-15.83 years and 2.11 +/-0.99, respectively. Most of the patients suffered with complications of cramps during dialysis, i.e. 151 [39.73%] followed by complication of hypotension 143 [37.63%]. Significant association was observed only in variation in systolic blood pressure with complication of hypotension [p<0.001], followed by variation in body weight with complication of cramps [p=0.016] and hypotension [p=0.037]
Conclusion: Vital signs variations, i.e. variation in systolic blood pressure and variation in body weight, are associated with intradialytic complications, i.e. hypotension and hypotension with cramps, respectively
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Medical ethics is a core issue for all specialties and is encompassed in professionalism. It is a presumption that not dealt appropriately in the undergraduate teaching curriculum. There is a paucity of awareness lectures and seminar workshops in teaching setups for medical ethics for undergraduates in developing countries. The current policy of PMDC does not provide a centralized curriculum for teaching of medical ethics in medical colleges, which results in lack of logical ethical reasoning among students. There is a need to develop a medical ethics curriculum taught by medical ethics department in every medical college in collaboration with the clinicians with real life case scenarios. Students should be evaluated through examinations at the end of every year with fixed hours dedicated to the teaching of the curriculum. Only, through these measures patient satisfaction will improve and medicine can achieve its lost glory and nobility in our part of the world
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Objective: To determine frequencies of various acute complications in patients undergoing hemodialysis
Study Design: Descriptive cross-sectional study
Place and Duration of Study: Department of Nephrology Military Hospital [MH] Rawalpindi, from Jan 2016 till Mar 2016
Material and Methods: A total of 150 patients who underwent haemodialysis at MH were enrolled in the study after informed consent on justification of inclusion and exclusion criteria. The patients were evaluated for the frequency of various intra-dialytic complications and data were analysed using SPSS version 19
Results: Out of the 150 enrolled patients, males were 125 [83.33%] and females were 25 [16.67%]. A total of 2520 haemodialysis session were performed. Hypotension was the most frequently observed complication during 318 [12.62%] dialysis sessions, followed by hypertension in 208 [8.25%] and fever in 193 [7.66%] sessions. Other complications were muscle cramps in 116 [4.60%], shivering in 94 [3.73%], headache in 70 [2.78%], nausea/vomiting 60 [2.38%], itching 41 [1.62%], chest pain 37 [1.47%], hypoglycaemia 31 [1.23%], seizures 23 [0.91%] and arrhythmias in 13 [0.52%] dialysis sessions
Conclusion: Haemodialysis, one of the renal replacement therapies, is a life-saving treatment modality but it is not without complications despite the advances in technology. However frequency with which they occur is low and majority are not life threatening
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Objectives: To study the prevalence of HBsAg, Anti-HCV, HIV, Syphilis and Malaria in blood donors
Methods: This is a cross sectional descriptive study, conducted at Blood bank and Transfusion center at Liaquat University of Medical and Health Sciences [LUMHS] Hyderabad, during the period from January, 2014 to June, 2015.A total of 4683 blood donors were screened for HBsAg, Anti-HCV and HIV on Architect 20001 [manufactured by Abbott], employing chemiluminescent microparticle immunoassay [CMIA]. For Syphilis, VDRL ICT kits were used and Malaria parasite was screen through MP slides. Blood grouping was performed by both forward and reverse methods
Results: This study showed a high frequency of HBsAg, VDRL and malaria positivity among the O-ve blood group donors, i.e. 3.70%, 9.25% and 0.61% respectively. Blood group B-ve individuals were commonly infected with HCV [12.5%] as compared with all other blood group donors. HIV is more commonly reported in A+ve blood group individuals. Blood group O+ve is more prevalent [37.41 %]
Conclusion: High frequency of HCV infection in blood donors advocates implementation of strict screening policy for donors and public awareness campaigns about preventive measures to reduce the spread of this infection as well as other transfusion transmissible infections
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Objective: To evaluate the impact and effectiveness of 24-hour helpline service in providing information and educating patients about self-management of diabetes
Method: The study was conducted at Baqai Institute of Diabetology and Endocrinology [BIDE], a tertiary diabetes care center, Karachi, Pakistan. People with diabetes attending the outpatient department from November 2012 to October 2014 were included in this study. After providing diabetes education, a helpline number was provided for emergency situations. Calls of registered patients were received by diabetes educators stationed at the BIDE around the clock. Data was collected through specially designed interface of HMS [health management system] in which the current complaint of caller and the advice of educator was recorded
Result: A total of 4842 calls were received. Out of those, 4268 [88%] were made by Type-2 diabetics and 526 calls [10%] were made by Type-1 diabetics. The average age of patients was 47.6 years. Three seventy four calls [7.7%] were received with complaint of Hypoglycemia [72-80mg/dl]. Six hundred and ninety eight calls [14.4%] were received with complaint of hyperglycemia [>200mg/dl]. Insulin dose was adjusted on 935 calls [19.3%]. Calls regarding other special situations such as [insulin handling, technique, medicine information] 2014 [41.6%] were received
Conclusion: Station based 24-hour telephonic helpline service is an effective tool for providing continuous support to people with diabetes and their families, for the self-management of diabetes. It can help in the management of various acute complication of diabetes, thereby preventing unnecessary hospital visits and admission
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Objectives: To assess the learning environment for anesthesia trainees and compare the results between two leading public and private hospitals of Islamabad region
Study Design: A prospective descriptive study involving postgraduate anesthesia trainees
Duration: January 2016 to February 2016
Setting: Anesthesia Department of a leading public and private hospital, Islamabad [Pakistan]
Methodology: Anesthesia Theater Education Environment Measure [ATEEM] questionnaire was administered to trainees of public and private teaching hospital after taking informed consent. ATEEM total score was calculated using descriptive statistics while comparisons were made using Student's t-test
Results: Thirty trainees responded each from one public and one private hospital. The mean total ATEEM score was 117.16/160. Mean score of trainees from private hospital was higher in all the domains of ATEEM. A total of 18 variables out of total 40 resulted in statistically significant results [p value < 0.05]
Conclusion: The learning environment of anesthesia trainees is positively perceived by all the participants. However, the ATEEM scores in four of the five domains showed that the trainees' perception of their educational environment varies profoundly between a public and the private hospital under study. There were no differences on the basis of gender and the scores are similar to international studies
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Background: Knowledge about the early diagnosis of breast cancer world help in early diagnosis and treatment
Objective: To evaluate the knowledge and practice of nurses about breast self examination BSE in BVH, Bahawalpur, Pakistan
Methodology: This cross sectional study was conducted at Bahawal Victoria Hospital, Bahawalpur from 20[th] April to 20[th] May 2017. Study comprised of total 100 female nurses selected randomly. The tool for data collection was pre designed, pretested, structured and self administered questionnaire to collect the information from constituted study population. The data analyzed by using SPSS version 20
Results: Out of 100 respondents 98% has knowledge about BSE. Breast self examination was performed by 47%
Conclusion: Knowledge and practice of BSE in the female nurses of BVH, Bahawalpur was satisfactory
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Background: Astrocytomas are common malignant brain tumours. Ki-67/MIB-1 index serves as an important supplementary tool in the diagnosis and prognosis of human astrocytoma
Methods: Forty [40] cases of various histopathological [WHO] grades of astrocytoma [Pilocytic, diffuse, Anaplastic and Glioblastoma multiforme] were included in this study. Ki-67/MIB-1 labelling index of these tumours was estimated by immunohistochemistry, performed on paraffin sections. Histopathological grading and Ki-67/MIB-1 labelling index were compared. The results were analyzed by one way ANOVA
Results: Out of 40 cases two were diagnosed as pilocytic astrocytoma [WHO grade-1] with a mean Ki-67/MIB-1 labelling index of 0.7+/-1.4 [range 0.6-0.8%]. Thirteen cases were of diffuse astrocytoma [WHO grade II], with a mean Ki-67/MIB-1 labelling index of 3.07+/-3.7 [range 1-15%]. Nine cases were diagnosed as Anaplastic astrocytoma [WHO grade III] with a mean Ki67/MIB-1 labelling Index of 11.55+/-7.8 [range 2-35%]. Sixteen cases were diagnosed as Glioblastoma multiforme with a mean Ki-67/MIB-1 labelling Index of 14.1+/-8.9 [range [5-36%]. ANOVA showed a significant differences between four compared groups [p=0.003]
Conclusion: Immunohistochemical analysis of Ki-67/MIB-1 labelling index increases significantly with increasing grade of malignancy. The Ki-67/MIB-1 labelling index can be used as an adjuvant to histopathological grading for proper diagnosis and grading of astrocytoma especially in borderline cases and in small biopsies
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Background: Breastfed and bottle-fed children's growth is not on the same pattern. This study was conducted to find out the effect of breast and bottle feeding on pre-pubertal children
Methods: This comparative study was conducted in the Department of Physiology, University of Health Sciences, Lahore. The study was conducted during the period from Oct 2013 to Apr 2015. A total number of 90 male pre-pubertal children were included in this study. Only male children were included to avoid bias of sex. Participants were selected from the school children of the locality around the University of Health Sciences [UHS] Lahore. They belonged to middle socioeconomic group. Their age range was 8-10 years, on the basis of history taken from parents of children. Participants were divided into two groups. Group-I, It included 45 male children having exclusive breastfeeding during the first year after birth. Group-II, It included 45 male children having exclusive bottle feeding during the first year after birth
Results: The median [Q1-Q3] weights were 27 Kg [25-29] and 25 Kg [22-29] in breastfed and bottle-fed groups respectively. The difference was considered significant with p=0.017. The median [Q1-Q3] heights were 133 Cm [130-137] and 130 Cm [122-136] in breastfed group and bottle-fed group respectively. The breastfed group children had significantly greater height [p=0.030] as compared with the bottle-fed group children
Conclusion: Breastfeeding has a positive effect on Height and weight of pre-pubertal children
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Objective: To evaluate the efficacy of concurrent Chemoradiation in patients with locally advanced inoperable squamous cell carcinoma of oral cavity in terms of local control and toxicity
Study Design: Case series
Place and Duration of Study: Institute of Nuclear Medicine and Oncology [INMOL], Lahore, from January 2008 to December 2013
Methodology: Sixty-nine patients with locally advanced inoperable oral cavity cancer, registered in INMOL hospital from January 2008 to December 2013 who fulfilled a pre-defined eligibility criteria, were enrolled in the study
Concurrent Chemoradiation protocol consisted of conventional fractionation delivering 70 Gy with weekly Cisplatin [50 mg/m[2]] during the course of radiation
Tumor response was calculated by RECIST criteria version 1.1 along with the median overall survival and disease-free survival. Acute treatment related toxicities were graded as [G]
Results: Thirty-six [52.17%] patients showed complete response; while 19 [27.54%], 8 [11.59%] and 6 [8.7%] were observed with partial response, stable and progressive disease, respectively. Treatment response was significant [p<0.001] in terms of responders vs. nonresponders to treatment. Median overall survival was 18.00 months; whereas, median disease-free survival remained 14.00 months. Main toxicities included mucositis [G3 and G4, 71%], xerostomia [G2 and G3, 82.5%], vomiting [G3 and G4, 51%], myelosuppression [G3 and G4, 26.2%], dermatitis [G3 and G4, 49.2%], and fatigue [G3 and G4, 57.9%]
Conclusion: Platinum based CCRT remained effective for inoperable oral cancer patients
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Aged , Radiotherapy, Adjuvant/methods , Drug Therapy, Combination/adverse effects , Carcinoma, Squamous Cell , Cisplatin/administration & dosage , Dose Fractionation, RadiationABSTRACT
Objectives: To determine the prevalence and risk factors of hepatitis C virus among injecting drugs users, furthermore different genotypes of HCV infection and their effect on viral load were also found and subsequently most prevalent subtype was predicted
Methods: All samples were processed for Anti-HCV antibody detection through ELISA by using third generation ELISA Kit. The Anti-HCV positive serum samples were stored for RT-PCR to estimate the viral load and genotypes of HCV for study. Injecting drug users selected from in and around Lahore Metropolitan from July 2012 to August 2013 was included. The data analysis was completed by using SPSS version 16. A p-value of < 0.05 was considered to be significant
Results: A total of 241 Injecting drug users were enrolled and screened for Anti HCV in the study. Prevalence of HCV infection in IDUs from Lahore was found to be 36.09%. Education [p=0.000], low socioeconomic status [p=0.011], Blood transfusion [0.003], any tattoo on the body [p=0.002], use of injectable drugs with reused syringes [p=0.000] and sharing of syringes [p=0.001] in groups was significantly associated with HCV infection. Some utensils were also significantly associated with HCV status. The most common subtype of HCV genotype was 3a [n=65] followed by 2a [n=15] and 1a [n=6]
Conclusion: The study reveals that IDUs with reused syringes status and sharing of syringes in group had more chances to get HCV infection. The viral load in IDUs infected with different subtypes of genotype was significantly associated
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Bergenia ciliata [locally known as Zakhm-e-hayat; wound healer] is commonly employed for wound healing, curing diarrhea and vomiting, fever, cough and pulmonary affections. Local community uses this plant as tea decoction with table salt. B. ciliata crude extract and its fractions were subjected to antibacterial, antioxidant effects as well as determination of total flavonoids and phenolics, DNA damage and anticancerous activities following standard protocols. Increased percentage inhibition of free radical in DPPH assay as well as elevated phenolic and flavonoid contents revealed antioxidant potential of this potent herb. Ethyl acetate and aqueous extracts showed IC50 of 0.7 and 0.3 mg/ml respectively, against H157 cell line. Antibacterial analysis showed MIC 0.4-10mg/ml for crude extract and fractions. The results obtained conclude that extracts of B. ciliata contain remedial latent and can be used as possible source for drug development by pharmaceutical industries
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Objective: To determine the accuracy of clinical methods for detection of sensory neuropathy as compared to biothesiometry
Study Design: Cross-sectional analytical study
Place and Duration of Study: 1 Mountain Medical Battalion, Azad Kashmir, from October 2013 to September 2014
Methodology: Patients with type 2 diabetes were enrolled by convenience sampling. Exclusion criteria included other identifiable causes of neuropathy, extensive ulceration of feet, amputated feet, those on treatment for neuropathy and unwilling patients. Average of 3 vibration perception threshold values measured with a biothesiometer on distal hallux was calculated. Ten gm monofilament was used to examine touch sensation over dorsal surfaces of great toes. Vibration sensation was checked over the tips of great toes using 128Hz tuning fork. Ankle jerks were checked bilaterally
Results: Neuropathy [vibration perception threshold > 25 volts] was present in 34 [21.12%] out of 161 patients and 93 [57.76%] were symptomatic. Measures of diagnostic accuracy for monofilament, tuning fork and ankle jerks were: sensitivity 41.18%, 55.88% and 64.71%; specificity 92.91%, 93.70% and 80.31%; positive predictive value [PPV] 60.87%, 70.37% and 46.81%; negative predictive value [NPV] 85.51%, 88.81% and 89.47%; and, diagnostic accuracy 81.99%, 85.71% and 77.02%, respectively. Values for any 1 positive sign, any 2 positive signs or all 3 positive signs were: sensitivity 35.29%, 14.71% and 32.35%; specificity 81.89%, 93.70% and 99.21%; PPV 34.29%, 38.46% and 91.67%; NPV 82.54%, 80.41% and 84.56%; and, diagnostic accuracy 72.05%, 77.02% and 85.09%, respectively
Conclusion: Clinical methods are high accurate and specific diagnosis in picking up symmetric sensory neuropathy in patients with type 2 diabetes, particularly when multiple signs are combined