Acupuncture at / 中国针灸

OBJECTIVE@#To observe the effect of acupuncture at @*METHODS@#Sixty patients with type-2 diabetic peripheral neuropathy were randomly divided into an observation group and a control group, 30 cases in each one. Both groups were treated with basic treatment, and the observation group was additionally treated with acupuncture at Neiting (ST 44), Xiangu (ST 43), Dadu (SP 2), Taibai (SP 3), Zusanli (ST 36), etc. once every other day, 3 times a week for 4 weeks. The changes of TCM symptom score, Toronto clinical assessment (TCSS) score, visual analogue scale (VAS) score of pain and serum tumor necrosis factor α(TNF-α) level were observed before and after treatment in the two groups, and the clinical effects of the two groups were evaluated.@*RESULTS@#Compared before treatment, the TCM syndrome score and the TCSS score in the two groups were reduced after treatment (@*CONCLUSION@#Acupuncture at

Influencia de la diabetes mellitus en la superficie ocular / Influence of diabetes mellitus in the ocular surface

RESUMEN La diabetes mellitus (DM) es una de las enfermedades sistémicas más comunes a nivel mundial con una prevalencia en incremento y una elevada tasa de mortalidad. La retinopatía diabética es una de las principales causas de ceguera en todas las latitudes del mundo. Aunque otras enfermedades oculares secundarias a diabetes también causan ceguera, su influencia en la superficie ocular es poco estudiada; sin embargo, el 73,6 por ciento de los pacientes diabéticos tipo 2 sufren de complicaciones corneales o de la superficie ocular. Se realizó una revisión de la bibliografía actualizada en idiomas español e inglés, a la que se pudo acceder, disponible en textos completos y resúmenes en bases de datos como PubMed, Ebsco, Google Académico y Scielo. Además, se consultaron novedosos artículos en prestigiosas revistas especializadas, con el objetivo de brindar información actualizada sobre la influencia de la diabetes en la superficie ocular. La diabetes mellitus tiene un impacto adverso en la superficie ocular. La gravedad de la neuropatía corneal diabética se correlaciona con la neuropatía periférica diabética. El estudio de la superficie ocular, así como de la retina, es importante para el tratamiento óptimo de la diabetes. Se han introducido novedosas opciones terapéuticas, pero todavía hay muchas en fase investigativa para los trastornos de la superficie ocular asociados con la diabetes(AU)

ABSTRACT Diabetes mellitus (DM) is one of the most common systemic diseases worldwide with an increasing prevalence and a high mortality rate. Diabetic retinopathy is one of the leading causes of blindness in all the latitudes of the world. Although other eye diseases secondary to diabetes also cause blindness, such influence on the ocular surface is poorly studied; however, 73.6 percent of type 2 diabetic patients suffer from corneal or ocular surface complications. A review of the available updated bibliography in Spanish and English languages; was carried out from full texts and abstracts in databases such as PubMed, Ebsco, Google Scholar, and Scielo. In addition, novel articles were consulted in prestigious specialized journals, with the aim of providing updated information on the influence of diabetes on the ocular surface. Diabetes mellitus has an adverse impact on the ocular surface. The severity of diabetic corneal neuropathy correlates with diabetic peripheral neuropathy. The study of the ocular surface, as well as the retina, is important for the optimal treatment of diabetes. Novel therapeutic options have been introduced, but there are still many in the investigative phase for ocular surface disorders associated with diabetes(AU)

Terapia de oxigenación hiperbárica en el tratamiento del dolor / Hyperbaric oxygenation therapy in pain treatment

El dolor crónico constituye un reto terapéutico especial. Se presenta una revisión narrativa sobre el papel del tratamiento de oxigenación hiperbárica (TOHB) en el tratamiento del dolor neuropático, y sus aplicaciones en dolor crónico, síndromes neurosensitivos disfuncionales y oncodolor. El conocimiento de las indicaciones de TOHB en algiología y su aplicación en la práctica médica puede contribuir a mejorar la calidad de vida del paciente. (AU)

Chronic pain represents a special therapeutic challenge. We present a narrative review on the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of neuropathic pain, and its applications in chronic pain, dysfunctional neurosensitive syndromes and oncological pain. The knowledge of the indications of HBOT in algiology and its application in medical practice can contribute to improve the quality of life of the patient. (AU)

Cardiovascular autonomic neuropathy in type 2 diabetic patients

SUMMARY Diabetes is one of the most common chronic pathologies around the world, involving treatment with general clinicians, endocrinologists, cardiologists, ophthalmologists, nephrologists and a multidisciplinary team. Patients with type 2 Diabetes Mellitus (T2DM) can be affected by cardiac autonomic neuropathy, leading to increased mortality and morbidity. In this review, we will present current concepts, clinical features, diagnosis, prognosis, and possible treatment. New drugs recently developed to reduce glycemic level presented a pleiotropic effect of reducing sudden death, suggesting a potential use in patients at risk.

RESUMO Diabetes é uma das mais frequentes patologias crônicas em todo o mundo, cujo tratamento envolve uma equipe multidisciplinar, médicos generalistas, endocrinologistas, cardiologistas, nefrologistas e oftalmologistas. Pacientes com diabetes mellitus tipo 2 (DMT2) podem apresentar neuropatia autonômica cardíaca (NAC), levando a aumento de mortalidade e morbidade. Nesta revisão, apresentaremos atuais conceitos, características clínicas, diagnóstico, prognóstico e possíveis tratamentos. Novas drogas recentemente desenvolvidas para redução de níveis glicêmicos apresentaram efeito pleiotrópico de redução de morte súbita, sugerindo um potencial uso neste perfil de pacientes.

Ficha de avaliação clínica de membros inferiores para prevenção do pé diabético / Lower limb clinical assessment form for diabetic foot prevention

Objetivo: Esta pesquisa científica objetivou elaborar uma ficha de avaliação clínica (FAC) dos membros inferiores (MIs) para prevenção do pé diabético (PD), que constituiu o Produto Acadêmico deste Mestrado Profissional. Durante a etapa de revisão da literatura para a confecção do referido Produto Acadêmico, foi elaborado o artigo 1 intitulado: " A Homeopatia no Tratamento da Polineuropatia Diabética Simétrica Distal: uma nova perspectiva", onde foi possível aprofundar os conceitos relacionados a esta patologia tão intimamente relacionada à etiopatogênese do Pé Diabético, além de avaliar a eficácia da homeopatia no tratamento de sua sintomatologia. O artigo 2, intitulado: "Ficha de Avaliação Clínica de Membros Inferiores para Prevenção do Pé Diabético", descreve o processo de construção desta FAC. Métodos: Para o artigo 1, foi realizada uma revisão sistemática, além de pesquisa em livros-texto, que buscou artigos que avaliassem a eficácia da terapêutica homeopática no tratamento da polineuropatia diabética. Para o artigo 2, a partir da revisão da literatura sobre o tema e após a seleção do material obtido, elaborou-se uma FAC dos MIs composta de 4 fases: as Fases 1 e 2 contemplam o exame clínico (anamnese e exame físico, respectivamente) com ênfase na avaliação dos pés e na pesquisa de fatores de risco para úlceras e finaliza com uma classificação de risco para o PD; a Fase 3 avalia o autocuidado do diabético com os pés e a Fase 4, descreve as principais orientações para o cuidado com os pés. Resultados: O artigo 1 encontrou somente 2 artigos relacionados ao tema proposto, ambos com resultados favoráveis ao uso da homeopatia no tratamento da polineuropatia diabética. No artigo 2, a fase 1 identifica os dados sociodemográficos, histórico pessoal e familiar de doenças, fatores de risco para úlceras e discrimina os sintomas mais comuns nas pernas e pés em risco. Na fase 2, por meio do exame físico geral e específico, obtém-se as medidas antropométricas e da pressão arterial, e realiza-se as avaliações dermatológica, osteoarticular, neurológica e vascular dos MIs , utilizando ao final uma classificação de risco de ulceração dos pés. A fase 3 avalia com dez questões os cuidados com os pés e a fase 4 apresenta dez orientações educacionais para prevenção do PD. Conclusão: No artigo 1, concluiu-se haver necessidade de novos estudos para que se chegue a conclusões definitivas quanto à eficácia do tratamento homeopático na polineuropatia diabética. No artigo 2, o Produto Acadêmico desenvolvido possibilita identificar e classificar precocemente o pé em risco de ulceração, avaliar o grau de autocuidado com os pés e orientar pacientes e familiares quanto ao cuidado com os pés, sendo o instrumental utilizado para avaliação do pé em risco de baixo custo e de simples aplicação por equipe multidisciplinar, mostrando-se um instrumento útil na prevenção de amputações não traumáticas associadas à ulceração dos pés diabéticos, por permitir uma melhor organização dos dados coletados e com isso melhorando a qualidade do atendimento desta clientela. Ainda, o instrumento desenvolvido possibilita sua utilização como fonte de dados para pesquisas científicas que venham a ser realizadas

Objective: This scientific research sought to elaborate a clinical evaluation sheet (CES) of the lower limbs (LLs) for diabetic foot (DF) prevention, that constituted the Academic Product of this professional Master's Degree. During the literature revision stage for the making of the referred Academic Product, an article 1 was elaborated, entitled: Homeopathy on the Treatment of Distal Symmetric Diabetic Polineuropathy: A New Perspective", where it was possible to deepen the concepts related to this pathology so intimately related to Diabetic Foot's etiopathogenesis, also evaluating homeopathy's efficiency on the treatment of its symptomatology. Article 2, entitled "Clinical Evaluation Sheet of the Lower Limbs for Diabetic Foot prevention. Methods: A systematic revision has been executed for article 1,besides research in textbooks, that sought articles that evaluated homeopathic therapeutics on the treatment of Diabetic Neuropathy. For article 2,with a revision on the theme's literature and after a selection of the obtained material, a four-phased CES of the lower limbs has been elaborated: Phases 1 and 2 contemplate clinical exam (anamnesis and physical evaluation, respectively) with emphasis on feet evaluation and on the search of soreness risk factors and finalizes with a risk classification for the DF; Phase 3 evaluates the diabetic's personal feet care and Phase 4 describes the main guidelines for feet care. Results: Article 1 found only 2 articles related to the proposed, both with favorable results to the use of homeopathy on the treatment of diabetic polyneuropathy. On article 2, phase 1 identifies sociodemographic data, personal history and personal-familiar disease history, soreness risk factors and detects the most common symptoms on risky legs and feet. On phase 2, through general and specific physical exam, anthropometrical and blood pressure measurements are obtained, and dermatological, osteoarticular, neurological and vascular evaluations of the lower limbs, utilizing at the end a rating for feet soreness risk. Phase 3 evaluates feet care with ten questions and phase 4 presents ten educational guidelines for DF prevention. Conclusion: On article 1, it's been concluded there is need of new studies in order to obtain definitive conclusions regarding the homeopathic treatment's efficiency on Diabetic Polyneuropathy. On article 2, the developed Academic Product possibilitates early detection and classification of feet in risk of soreness, personal feet care evaluation and orientation of patients and familiars regarding feet care, being the utilized instrumental in evaluation of risky feet inexpensive and of simple application by a multidisciplinary team, proving to be a useful tool in the prevention of non-traumatic amputations associated to diabetic feet soreness, for allowing a better assortment of the collected data and with that raising the quality of this clientele's attendance. Still, the developed instrument possibilitates its use as data source for upcoming scientific researches

Electrical stimulation and electromagnetic field use in patients with diabetic neuropathy: systematic review and meta-analysis

BACKGROUND: Painful diabetic neuropathy (PDN) is a common complication of diabetes mellitus, and pharmacological therapies are ineffective in many patients. Therefore, other treatment modalities should be considered, including electrical stimulation and electromagnetic fields. OBJECTIVES: The research objective was to evaluate the effect of treatment with electrical stimulation and electromagnetic fields on pain and sensitivity in patients with painful diabetic neuropathy compared with placebo or another intervention. METHOD: We searched the following electronic databases (from inception to April 2012): MEDLINE (accessed by PubMed), LILACS, Physiotherapy Evidence Database (PEDro), EMBASE and Cochrane CENTRAL. We included randomized trials that compared electrical stimulation or electromagnetic fields with control groups in which the objective was to assess pain and sensitivity in patients with PDN. Two reviewers independently extracted the data. A random-effects model was used for the main analysis. RESULTS: The search retrieved 1336 articles, of which 12 studies were included. Reductions in the mean pain score were significantly greater in the TENS (transcutaneous electrical nerve stimulation) group than in the placebo group [-0.44 (95% CI: -0.79 to -0.09; I2: 0%)]. There was no improvement in pain relief when electromagnetic fields were compared with the control group [-0.69 (95% CI: -1.86 to 0.48; I2: 63%)]. CONCLUSIONS: We found that TENS improved pain relief in patients with diabetic neuropathy, while no such improvement was observed with the use of electromagnetic field treatment. Due to the methodological differences between the studies, a meta-analysis for the outcome of sensitivity could not be performed. .

Efecto del ácido tióctico en los cambios clínicos, neuroconductivos e histopatológicos de la neuropatía diabética sensitivo motora distal / Effect of thioctic acid in the clinical, histopathological and neuroconductivos the distal motor sensory diabetic neuropathy

La polineuropatía diabética es la más común de las complicaciones microvasculares de la diabetes mellitus, siendo causa importante de morbilidad y mortalidad asociada a la enfermedad. Evaluar el efecto del ácido tióctico en los cambios clínicos, neuroconductivos e histopatológicos en la neuropatía diabética sensitivo motora distal. Estudio prospectivo, longitudinal, de intervención terapéutica, en pacientes que acudieron a la consulta externa y unidad cardiometabólica del Servicio de Medicina Interna del Hospital Militar “Dr. Carlos Arvelo”, a quien se les realizó historia clínica con evaluación del score sensitivo-motor, pruebas de neuroconducción y biopsia de piel, con evaluación a la semana n° 1, 4,12, 18 y 24. 30 pacientes diabéticos con criterio clínico de neuropatía diabética sensitivo motora distal. Se observó mejoría de las parestesias a partir de la semana 12 (p <0.05) de la administración del ácido tióctico a dosis de 600mg/día por vía oral. En la neuroconducción hubo aumento de la velocidad de conducción durante el post tratamiento (p<0,05). Se realizaron 12 biopsias de piel: 2 fueron positivas (16,7%) previo tratamiento y 10 negativas (83,3%) con anticuerpo PGP 9,5. En la semana 24 post tratamiento 7 positivas (58,3%) y 5 negativas (41,7%) (p<0,05). Se demostró que el tratamiento con ácido tióctico es efectivo en mejorar los síntomas y la neuroconducción en los pacientes diabéticos con neuropatía sensitivo motora distal.

Diabetic neuropathy is the most common microvascular complication of diabetes mellitus, and a major cause of morbidity and mortality. To evaluate the effect of thioctic acid in the clinical, histopathological neuroconductive and sensory motor diabetic distal neuropathy. Prospective, longitudinal, therapeutic intervention, in patients attending the outpatient and cardiometabolic consultation Internal Medicine; an assessment of sentitivo-motor score was performed and blood chemistry was measured as well as HbA1c. Neuroconduction and skin biopsy with assessment at weeks 1, 4.12, 18 and 24 were done. 30 diabetic patients with clinical criteria of distal motor sensory neuropathy were included. The clinical symptom was paresthesia, which was present from week 12 and showed improvement (p <0.05) at weeks 18 and 24 (p<0.05). Neuroconduction was measured by increased conduction velocity post treatment (p <0.05). Biopsieswere performed in 12 patients; two were positive (16.7%) after treatment and 10 negative (83.3%) for PGP 9.5 antibody. At week 24 of treatment, 7 were positive (58.3%) and 5 negative (41.7%) (p<0.05). We demonstrated effectiveness of thioctic acid after week 12 of treatment.

Recurrent diabetic myonecrosis: A rare complication of a common disease.

Spontaneous aseptic diabetic muscle infarction (DMI) is one of the rare complications of diabetes. We report a case of type 2 diabetes mellitus with advanced microvascular complications presenting with severe muscular pain. She was diagnosed as DMI on the basis of clinical presentation, radiological and histopathological investigations. She was managed conservatively. During 18 months of follow up, she had good improvement but subsequently other muscle groups were involved suggesting recurrent DMI.

Efectos de la glicina sobre los trastornos de conducción del nervio auditivo en pacientes diabéticos tipo 2 con otoneuropatía / Effects of glycine on auditory evoked potentials among diabetic patients with auditory pathway neuropathy

Background: Glycine inhibits the formation of advanced glycation end products that may cause central and peripheral neuronal damage, affecting also the auditory nerve. Aim: To evaluate the effect of glycine on auditory nerve conduction and hearing level among patients with type 2 diabetes mellitus and auditory neuropathy. Material and Methods: Twenty grams of oral glycine per day were administered during 6 months to 28 type 2 diabetic patients aged 58 ± 6 years, with auditory pathway neuropathy. Hearing tests and evoked otoacustic potentials were performed regularly. Fifteen diabetic patients aged 49 ± 8 years, without auditory nerve neuropathy did not receive glycine and were followed as a control group. Results: Among patients receiving glycine, a significant improvement in left ear audiometry at 125, 250 and 500 Hz and right ear audiometry at 500 Hz, was observed. Waves I, III and V (p= 0.02) of evoked otoacustic potentials improved significantly in the left ear and wave I in the right ear. Among controls, waves V and III of evoked otoacoustic potentials had a significant impairment in the left ear. Conclusions: There was an improvement in auditory evoked potentials in patients receiving glycine and an impairment in untreated control patients.

Amitriptyline and Sertraline in Diabetic Neuropathy: a Comparative View

Purpose: To investigate the effect of amitriptyline (Ami) and sertraline (Sert) in diabetes neuropathy. Methods: Diabetes was induced in 3 groups of rats (n=6) with streptozotocin (STZ; 55mg/kg; i.p.). Two of the groups of diabetic rats received amitriptyline (15 mg/kg; p.o) and sertraline (30 mg/kg; p.o.) while another 2 groups (n=6) received the same drug treatment without prior administration of STZ. A normal group (n=6) of rats and STZ-induced group (n=6) of diabetic rats served as controls.The blood glucose; glycosylated hemoglobin (GHb); pain sensitivity and neuromuscular strength in all the rats were determined. Results: Ami (15mg/kg; p.o.) produced severe hyperglycemia (p 0.01) whereas Sert (30mg/kg; p.o.) produced significant hypoglycaemia in the diabetic rats. Ami significantly increased the GHblevel while Sert had no significant effect. Both Ami and Sert raised the grip strength that was significantly reduced by STZ. When administered for 3 weeks; Ami and Sert increased the STZ induced reduction of the grip strength in the diabetic rats (p 0.01). STZ (55mg/kg; i.p) increased the pain sensitivity. Pain sensitivity was significantly reduced by Ami (15 mg/kg; p.o; administered for 3 weeks) in the diabetic rats but marginally reduced in the normal group. However 3-week administration of Sert (30 mg/kg; p.o.) significantly reduced the pain sensitivity in both the diabetic and normal rats (p 0.01) when compared with STZ treated group. Conclusion: Sertraline could offer a good choice in the treatment of diabetic neuropathy particularly in patients with depression being treated with amitriptyline

Focal and multifocal diabetic neuropathies

Diabetic neuropathy is the most common neuropathy in industrialized countries, with a remarkable range of clinical manifestations. The vast majority of the patients with clinical diabetic neuropathy have a distal symmetrical form that progress following a fiber-length dependent pattern, with predominant sensory and autonomic manifestations. This pattern of neuropathy is associated with a progressive distal axonopathy. Patients are exposed to trophic changes in the feet, pains and autonomic disturbances. Less often, diabetic patients may develop focal and multifocal neuropathy that includes cranial nerve involvement, limb and truncal neuropathies. This neuropathic pattern tends to occur after 50 years of age, mostly in patients with longstanding diabetes mellitus. The LDDP does not show any trend to improvement and either relentlessly progresses or remain relatively stable over years. Conversely the focal diabetic neuropathies, which are often associated with inflammatory vasculopathy on nerve biopsies, remain self limited, sometimes after a relapsing course.

A neuropatia diabética é a mais predominante das neuropatias nos países industrializados apresentando uma gama variável de manifestações clinicas. A maioria dos pacientes com neuropatia diabética apresenta uma forma simétrica distal que progride para um padrão fibra comprimento dependente com manifestações sensitivas e autonomicas. Este tipo de neuropatia é associado com uma axonopatia distal progressiva. Os pacientes apresentam modificações tróficas nos pés, dores e distúrbios autonômicos. Menos freqüentemente os pacientes diabéticos podem desenvolver neuropatia focal e multifocal que incluem envolvimento de nervos cranianos, tronco e membros inferiores. Este padrão de neuropatia é mais freqüente em pacientes com mais de 50 anos e com longa historia de diabetes. Este tipo de neuropatia fibra-comprimento dependente não apresenta melhora, progride lentamente ou permanece estável por vários anos. As neuropatias focais que são associadas freqüentemente com vasculopatias inflamatórias nas biópsias de nervo, permanecem auto limitadas por vezes com surtos de remissão.

clinical and electrodiagnostic study of diabetic neuropathy at Jordan university hospital

To study diabetic neuropathy [DN] at Jordan University Hospital [JUH] with the aim of assessing age/gender distribution, risk factors, and other diabetic microvascular complications, clinical manifestations, results of nerve conduction studies [NCS], and treatment modalities, and to compare these findings with those from Western and other Middle/Far Eastern literatures. Among 562 patients with diabetes mellitus [DM] seen over a 2-year-period from January 2003 to January 2005, at the Diabetes center at Jordan University Hospital [JUH], 110 patients [10 DM type 1; 100 DM type 2] were studied retrospectively. The prevalence of DN was 20%. The mean age was 55.4 years [range 23-75], with 62 females and 48 males. The most common risk factors for DN were old age, long duration of DM, mean hemoglobin A1c, and hypertension. Almost 50% of patients had additional retinopathy, renal involvement, or both. The most common clinical symptoms were distal numbness/paresthesiae in the limbs [60% of patients] and the neurological examination was normal in 2/3 of patients [only 20% had stocking hypoesthesia to pain and temperature and absent ankle jerks]. The NCS showed an axonal neuropathy mainly affecting the lower limbs, especially sensory fibers [abnormal sural sensory action potential in 98% of patients]. Anticonvulsants [carbamazepine and gabapentin] were used efficiently in 50% of patients as symptomatic treatment, while tricyclic antidepressants were used as add-on in only 23 patients, due to anticholinergic side effects. In comparison with other studies, ours shows a lower prevalence of DN, similar age distribution with however, a predominance of females, similar risk factor profiles, clinical/NCS findings, and treatment modalities

Efeitos da atividade física na modulação autonômica em pacientes diabéticos com disfunção autonômica / Effects of exercise training in autonomic modulation in diabetic patients with autonomic dysfunction

A neuropatia autonômica diabética (NAD) é uma grave e comum complicação do diabetes. A neuropatia autonômica cardiovascular é uma das mais sérias e mais estudadas formas da NAD e está associada a alta morbidade e mortalidade em pacientes sintomáticos e assintomáticos, afetando a modulação autonômica e reduzindo a variabilidade da freqüência cardíaca (VFC). Os benefícios cardiovasculares, metabólicos e autonômicos após o exercício físico agudo e crônico, têm levado muitos investigadores a indicá-lo como uma conduta não-farmacológica no tratamento de diferentes doenças, inclusive o diabetes. Nesta revisão, apresentamos os efeitos do exercício físico na disfunção autonômica de pacientes com neuropatia autonômica, bem como os benefícios do exercício físico nessa disfunção, encontrados na literatura

Diabetic autonomic neuropathy (DAN) is a serious and common complication of diabetes. Cardiovascular autonomic neuropathy (CAN) is one of the most studied and clinically important forms of DAN. It is associated with high morbidity and mortality rates in symptomatic and asymptomatic patients, affecting autonomic modulation and reducing heart rate variability (HRV). Cardiovascular, metabolic and autonomic improvement induced by acute and chronic exercise have led many investigators to indicate exercise training as an important non-pharmacological treatment for different pathologies, include diabetes mellitus. In this review were carried out in literature the effects of exercise training in autonomic dysfunction in patients with autonomic neuropathy as well as the benefit of exercise training on control this dysfunction

Diabetic neuropathy and zinc therapy.

This was a double blind study conducted on 60 subjects; 20 age and sex matched healthy controls (Group-I), 20 patients of diabetes mellitus with neuropathy who received placebo for 6 weeks (Group-IIA); and 20 patients of diabetes mellitus with neuropathy who were given oral 660 mg zinc sulphate for 6 weeks (Group-IIB). Serum zinc level, fasting blood sugar (FBS), blood sugar 2 hour after breakfast (2HABF) and motor nerve conduction velocity (MNCV) were estimated on day 0 and after 6 weeks in all subjects. Serum zinc levels were significantly low (p<0.001) in group II-A and II-B as compared to healthy controls (group-I) at base line. After 6 weeks the changes in pre and post therapy values of FBS, 2HABF and MNCV (median and common peroneal nerve) were highly significant (p<0.001) for group II-B alone with insignificant change (p>0.05) in group II-A. Therefore, zinc therapy helps in achieving better glycemic control and improvement in peripheral neuropathy as assessed by MNCV.

Neuropatia autônoma cardiovascular em pacientes com diabetes “mellitus” tipo 2 / Cardiovascular autonomic neuropathy in diabetic mellitus type 2 patients

A neuropatia autônoma acomete grande parte dos pacientes diabéticos. Este acometimento pode envolver diversos órgãos e sistemas e isso geralmente ocorre de forma desigual. O envolvimento do sistema nervoso autônomo no decurso do diabetes mellitus (DM) é bem estabelecido e está associado com aumento da mortalidade. A presença de neuropatia autônoma cardíaca (NAC), evidenciada por alterações nas variações de freqüência cardíaca, está associada a uma mortalidade de 29 por cento em 10 anos, enquanto que naqueles pacientes ilesos de NAC essa taxa representa apenas 6 por cento. Devido ao valor prognóstico na NAC, é importante avaliarmos a sua presença nos pacientes com DM, bem como orient´-alos quanto às suas associações. Descrevemos os dados encontrados em nosso ambulatório e discutimos as evidências na NAC encontradas na literatura

Avaliação clínica e eletroneurográfica da eficácia do tratamento da neuropatia diabética com ácido tiótico / The clinical and eletroneurographical trial of thiocitic acid in the treatment of diabetic neuropathy

A polineuropatia diabética (PD) é uma complicação do diabetes melito (DM), com participação do estresse oxidativo na sua patogenia. O objetivo do estudo foi avaliar a eficácia do ácido tiótico (AT), um antioxidante, no tratamento da PD em diabéticos tipo II. Foi realizado estudo duplo-cego, cruzado, controlado, com duração de 2 anos. Foram avaliados sintomas, exame neurológico e condução nervosa. 13 pacientes foram tratados por via oral, na dose de 600 mg/dia / Diabetic polyneuropathy (PN) is a complication of diabetes mellitus (DM), with an important role of oxidative stress in its pathogeny. The aim of this study was to evaluate thioctic acid (TA), an anti-oxidant, in the treatment of PN in type II DM. It was a double-blind, crossed, controlled study, lasting 24-months. Symptoms, neurological examination and nerve conduction studies were evaluated. The treatment was administered orally to 13 patients, 600 mg daily...

Uso da gabapentina no tratamento da dor neuropática diabética / Gabapentin in diabetic neuropatic pain managemant

A gabapentina é um anticonvulsivante que tem sido proposto na literatura para tratamento da dor neuropática. Este estudo teve por objetivo avaliar sua eficácia em portadores de dor neuropática diabética, visto que esta é uma morbidade que prejudica sensivelmente a qualidade de vida do indivíduo. A medicaçäo foi fornecida a 13 pacientes para uso de 1200 mg, divididos em três doses diárias. A dor foi avaliada no início e após quatro semanas, por escore de zero a dez, sendo a ausência de dor e dez a dor máxima sentida. A maioria dos pacientes tinha mais de 5 anos do diagnóstico de diabetes (77,6 por cento). O escore de 10 foi dado por sete (53,8 por cento) pacientes na primeira consulta e por dois (15 por cento) na segunda; escore entre 9 e 6 foi dado por quatro (30,7 por cento) e um (7,6 por cento) paciente, respectivamente, enquanto que escore menor que 5 foi obtido em dois (15,3 por cento) pacientes na primeira consulta e oito (61,5 por cento) na segunda. Dois pacientes desistiram por motivos alheios. Sem efeitos colaterais relevantes, a gabapentina é um opçäo eficaz no tratamento da dor neuropática diabética, mas ainda limitada pelo custo.

The biomechanical management of diabetic foot ulcers

The primary goal in the treatment of diabetic foot ulcers is to obtain wound closure as expeditiously as possible and prevent the recurrence of foot wounds due to neuropathy, foot deformity, and poor circulation. Interventions that bring about the quick resolution of afoot wound and reduce the rate of recurrence have been shown to lower the risk of developing a secondary infection and decrease the incidence of lower extremity amputation in the diabetic patient.