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.

Benign Intermittent Gastric Outlet Obstruction in an Elderly: Endoscopic Management and Brief Review

We describe the clinical scenario in an 80 year old female who presented with history of epigastric discomfort and postprandial fullness of three weeks. duration without any alarming symptoms. On upper GI endoscopy she was found to have gastric polyp with a long stalk which was partially obstructing her pyloric ring giving rise to features of intermittent gastric outlet obstruction Polypectomy was done with complete relief of symptoms .She is following our clinic for last 6 months now. Although possibility of malignant etiology in gastric out let obstruction ranks high in the elderly some patients are lucky to have a benign cause as the index case. Report of the case and brief review is presented

Anterior seromyotomy with posterior truncal vagotomy in chronic duodenal ulcer.

Anterior seromyotomy with posterior truncal vagotomy was carried out on 25 patients with chronic duodenal ulcer to evaluate its effectiveness as an acid reducing procedure. There was a 76.7% and 76.8% reduction in basal and maximal acid output respectively (augmented histamine test). Twenty-three patients were asymptomatic at 4-6 years' follow-up, while two patients had delayed gastric emptying not necessitating reoperation. There was no mortality. This procedure is a reasonable alternative to highly selective vagotomy.