Prevalence of painful diabetic peripheral neuropathy among patients with diabetes mellitus in the Middle East region.

The prevalence of painful diabetic peripheral neuropathy (DPN) was evaluated in type 1 or type 2 diabetes mellitus patients (n = 4097) attending outpatient clinics across the Middle East. Overall, 53.7% of 3989 patients with DN4 data met the criteria for painful DPN (Douleur Neuropathique-4 [DN4] scores ≥ 4). Significant predictors of painful DPN included long history (≥ 10 years) of diabetes (odds ratio [OR] 2.43), age ≥ 65 years (OR 2.13), age 50 - 64 years (OR 1.75), presence of type 1 versus type 2 diabetes (OR 1.59), body mass index > 30 kg/m(2) (OR 1.35) and female gender (OR 1.27). Living in one of the Gulf States was associated with the lowest odds of having painful DPN (OR 0.44). The odds of painful DPN were highest among patients with peripheral vascular disease (OR 4.98), diabetic retinopathy (OR 3.90) and diabetic nephropathy (OR 3.23). Because of the high prevalence and associated suffering, disability and economic burden of painful DPN, it is important that diabetic patients are periodically screened, using a simple instrument such as the DN4, and receive appropriate treatment if symptoms develop.

Ataxia and hereditary disorders.

The last decade has seen great changes in the diagnosis of inherited ataxias. Previously mysterious diseases are now recognized to be caused by specific mutations for which genetic screening is readily available. In many cases, the discovery of the molecular basis has broadened the definition of possible clinical manifestations of particular inherited ataxias. The type of mutation underlying the more common forms of inherited ataxia-unstable trinucleotide repeat expansions-helps to explain some of the unusual features of these diseases. This article reviews recent genetic advances in ataxia. The aim is not to present an exhaustive summary but rather to provide guidance in evaluating ataxia, particularly with respect to recent molecular genetic findings.

Childhood Guillain-Barré syndrome: clinical and electrophysiologic features predictive of outcome.

The hospital records of 27 children with the diagnosis of Guillain-Barré syndrome were retrospectively reviewed. Based on the time to recovery, patients were divided into two groups: group 1 consisted of children whose times to complete or partial recovery extended beyond 2 months from onset of the disease; group 2 consisted of children who attained a full recovery within 2 months from onset of the disease. The clinical and electrophysiologic features of the two groups were statistically compared for their predictive value of outcome. Three clinical features (maximum disability score at presentation, intubation, and cranial nerve involvement) were predictive of poor outcome, whereas one electrophysiologic feature (conduction block) was predictive of favorable outcome. There was also a significant correlation between maximum disability score at presentation and the probability of intubation.

Idiopathic stabbing headache associated with monocular visual loss.

BACKGROUND: Idiopathic stabbing headache, which is a brief, sharp, severe jabbing pain that is confined to the head, responds well to treatment with indomethacin sodium. It may occur as a primary entity but more likely is associated with other types of headache, including migraine. SETTING: Emergency department of a teaching hospital. PATIENT: A 27-year-old man presented to the emergency department with stabbing, sharp pain in the right temporal area associated with complete of loss vision in his right eye. The patient had a history of migraine with aura since 1995. RESULT: The patient was treated with oxygen inhalation and indomethacin, with complete resolution of his symptoms. CONCLUSION: A case of idiopathic stabbing headache associated with monocular visual loss was relieved by oxygen and indomethacin therapy.