ABSTRACT
Diabetic neuropathy occurs in about 50% of individuals with long-standing type 1 and type 2 diabetes mellitus. The aim of the study was to detect sensory neuropathy in diabetic patients at risk for foot ulceration, using monofilament and neuropathic symptoms in Diabetes clinic of Kashan University of Medical Sciences from 2008 to 2010. Three-hundred and fifty-two diabetic patients were enrolled in this cross-sectional study. Firstly patients were surveyed with a questionnaire concerning their subjective symptoms. The neuropathic symptoms were assessed using a quantitative neuropathy symptom score. Then the patients were examined by 5.07/10g monofilament. Data description and analysis were performed by reporting mean +/- standard deviations, proportions, odds ratios [OR] and 95% confidence interval [95% CI] and conducting chi square and kappa tests. 15.6% of patients had sensory neuropathy using monofilament test. 19.4% of men and 14.3% of women had neuropathy [OR=1.4, P=0.24]. The mean duration of diabetes in patients with neuropathy was longer than patients without neuropathy [9.96 vs 9.68 year, P>0.05]. 72.7% of patients with history of foot ulcer had neuropathy [OR=16.6, P<0.001]. According to neuropathic symptoms 17.6% of patients had no neuropathy, 12.8% had mild neuropathy, 41.8% had moderate neuropathy and 27.8% had severe neuropathy. Screening with monofilament test is necessary for all diabetic patients to prevent diabetic foot ulcer development, without considering neuropathic symptoms
ABSTRACT
A 7 - year - old Caucasian girl presented with a 3-month history of nodules on her thighs and buttocks. During a one-month period, the lesions gradually increased in size and number. They became indurate and tender. Similar nodules appeared on forearms after 4 months. The lesions gradually healed with a depressed scar. On physical examination, we found many indurate areas 10-40 mm in diameter .The surface of some of them was erythematous and scaly. The lesions were not ulcerated and did not have a discharge [figure 1]. On examination, she was afebrile and healthy, organs such as heart, lungs, abdomen, joints and muscles were normal. Laboratory evaluation findings including complete blood cell count, liver and renal function test values, ESR, CRP,VDRL, BUN, Creatinin, complement were all normal .The titers for FANA, Anti ds DNA, Anti Sm, Anti Scl-70, Anti -RNP, Anti-Ro, Anti-La, Anti -Jo1, Anti Phospholipid Ab, Anti cardiolipin Ab, c- ANCA, p- ANCA were negative. A skin biopsy was taken [figures 2]