Background & Objective: Diabetic peripheral neuropathy (DPN) is a common chronic complication of diabetes characterized by the involvement of the peripheral nervous system. This study aimed to investigate the association between the red blood cell distribution width/albumin ratio (RAR) and the presence of diabetic peripheral neuropathy (DPN). Methods: The association between DPN, RAR, and other variables was examined using logistic regression analysis. To determine the predictive validity and optimal cutoff value of RAR for the presence of DPN, Receiver Operating Characteristic (ROC) curve analysis was performed to calculate the Area Under the Curve (AUC). Results: Compared to those without DPN, patients with DPN had a significantly higher prevalence of hypertension (p=0.006), a higher rate of smoking (p=0.002), and a longer duration of diabetes (p<0.001). Patients with DPN had significantly lower albumin levels (p<0.001), and significantly higher RDW (p<0.001) and RAR (p<0.001) values. As an independent variable, RAR was independently associated with higher odds of DPN (OR: 1.545, 95% CI: 1.235-1.914, p<0.001). The optimal cutoff value for RAR to predict the presence of DPN was determined to be 4.4 %/(g/dL) (Spec.: 99.2%, Sen.: 32.2%, AUC: 0.67). Conclusion: Our findings suggest that RAR is an independent predictor of DPN and may serve as a complementary biomarker compared with RDW or albumin levels alone. Further prospective, multicenter studies with larger sample sizes are needed to more robustly establish the association between RAR and DPN.
Objective: Wolf-Hirschhorn syndrome (WHS) (#194190) is a well-defined microdeletion syndrome characterized by typical facial findings, prenatal and postnatal growth retardation, hypotonia, microcephaly, intellectual disability, and seizures. Clinical findings vary depending on the size of the deletion. WHSC1, WHSC2, LETM1, CPLX1, CTBP1, PIGG, and FGFRL1 were responsible for the clinical findings. The objective of this study was to describe the clinical, cytogenetic, and molecular characteristics of patients diagnosed with WHS and to contribute to the existing literature by presenting our data. Methods: This study retrospectively presents the clinical, cytogenetic, and molecular findings of 18 patients. Results: All the patients had typical facial findings, growth retardation, microcephaly, hypotonia, and intellectual disability. Seizures were present in all patients, except for two. Moreover, 16 patients had thin corpus callosum on cranial magnetic resonance imaging. The diagnosis was confirmed by chromosomal analysis, fluorescence in situ hybridization, and microarray analysis. Conclusion: Confirmation of the diagnosis is important for increasing clinical awareness, appropriate follow-up, of patients and genetic counseling.
Objective: In this study, we evaluated the relationship of plasma and cerebrospinal fluid (CSF) testosterone and dehydroepiandrosterone sulfate (DHEA-S) levels with CSF opening pressure in women diagnosed with idiopathic intracranial hypertension (IIH). Method: We prospectively evaluated 52 female patients (aged 15-45 years) diagnosed with IIH according to modified Dandy criteria. In the plasma and CSF samples collected simultaneously, testosterone and DHEA-S levels were measured using chemiluminescence microparticle immunoassay (CMIA). The patients were assigned into two groups based on CSF opening pressure. The hormone levels were compared and correlation and ROC analyses were performed. Results: In the group with high CSF pressure (>= 40 cmH(2)O), the plasma testosterone, plasma DHEA-S and CSF testosterone levels were found to be significantly higher (p<0.05). In addition, strong positive correlations were observed with CSF opening pressure and plasma testosterone (r=0.856), CSF testosterone (r=0.870) and plasma DHEA-S (r=0.915) levels. In the ROC analysis, the cut-off value was determined as >= 3.45 nmol/L for plasma testosterone, >= 295 & micro;g/dL for plasma DHEA-S and >= 0.08 nmol/L for CSF testosterone. Conclusion: Plasma testosterone and DHEA-S levels showed a significant relationship with CSF opening pressure. These findings suggest that plasma androgen levels can be used as a potential biomarker to predict intracranial pressure in a non-invasive manner.
Background & Objective: Frailty results from an age-associated decline in physiological reserve and function and is prevalent in older adults. In this retrospective cohort study, we aimed to validate the older patients hospitalised with ischemic stroke and hypothesise that frailty is a comparable predictor of adverse outcomes in stroke. Methods: Older patients aged 65 years and above with ischemic stroke admitted to a tertiary hospital in Singapore from 1st January 2019 to 31st December 2019 were identified and categorised into high risk (>15), intermediate risk (5-15) and low risk (<5) of frailty using HFRS. Results: A total of 1,023 patients with ischemic stroke were included in this study. HFRS was categorised as high risk in 271 patients (26.5%), intermediate risk in 544 patients (53.2%) and low risk in 208 patients (20.3%). Patients with higher HFRS scores were older, more likely female, have lower BMI and more comorbidities. Higher HFRS scores was also associated with increased length of stay, 90 day and 1 year mortality, but not 30-day readmission and inpatient mortality. Predictive models which incorporated HFRS and other relevant variables showed good predictive value for long length of stay and 1 year mortality with AUC of 0.811 (0.744 - 0.878) and 0.749 (0.619 - 0.878) respectively. Conclusion: Our study has shown that patients with high risk of frailty have higher healthcare utilisation than low risk patients. Identification of frailty can help stratify care for older frail patients.
Background & Objective: Locally, there are no recommendations on the use of magnesium sulfate (MgSO4) among tetanus patients. Moreover, some neurologists are unaware of its benefits in this cohort. Most start MgSO4 only when the patients are in the severe stage, have signs of dysautonomia, or if the physician is confident in its administration. This paper will determine the effect of MgSO4 on the survival of adult and pediatric non-neonatal tetanus patients in a tertiary hospital in the Philippines. Methods: This study utilized a retrospective cohort study design. Data from a previous study by Lanuza et al. (2024) was utilized. Baseline comparisons of MgSO4 versus non-MgSO4 groups were done using Wilcoxon rank sum test or independent t-test for continuous data while a Fisher Exact test was used for comparison of proportions. Those with a p-value lower than 0.2 were used for Cox regression analysis. Results: Crudely, survival is better in the MgSO4 group, and although this became non-significant when confounders were accounted, the survival in the MgSO4 group was still markedly higher than non-MgSO4 group. In terms of age group, MgSO4 was beneficial in both pediatric and adult patients, but only significant on the latter. The survival of MgSO4 administered non-neonatal tetanus patients was significantly higher among severe tetanus patients and among those without dysautonomia. Conclusion: Administration of MgSO4 in non-neonatal tetanus patients, may be effective in improving survival. Moreover, its benefit is magnified among adult patients, with severe tetanus and those with no dysautonomia.
