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Introduction: Polyneuropathy (PNP) is a chronic progressive disease that over time can lead to damage of sensory, motor and/or autonomic peripheral nerves. Symptoms vary from predominantly sensory to severe sensorimotor affection both proximally and distally. This can result in considerable functional impairments that affect activities of daily living. In other neurological patients, strength training has shown to improve strength and functional outcomes. Since medical treatment only exists for very few percentages of the underlying causes it is obvious to consider if strength training could be a potential treatment for functional impairments. To date little is known on the effect of strength training in patients with PNP. Aim: The aim of this scoping review was to summarize research on strength training and outcomes on physical function in patients with PNP. Methods: We systematically searched five data bases; Pubmed, Embase, Cinahl, Cochrane library and Web of science. Studies on strength training (load ≥70% of 1RM) in patients with PNP were included. The search was carried out in November 2022. Results: 362 articles were screened by title and abstract, 101 articles were full text screened. Eight studies were included. Patients with Charcot-Marie-Tooth (CMT), chronic inflammatory polyneuropathy (CIDP) and diabetic polyneuropathy (DPN) were represented in the studies (five RCTs, two case-series, and one cross-over trial). The methodological quality ranged from fair-poor in seven studies, one study reached good quality. Results from the studies indicated that strength training in CMT, CIDP and DPN may improve strength. However, various outcomes were used to evaluate strength training, so direct comparisons were difficult. Discussion: In this scoping review we summarized research on strength training and outcomes evaluated in interventions in patients with PNP. Eight studies were included, they indicated that strength training may be beneficial for patients with P

Vascular complications are the leading cause of increased morbidity and mortality of diabetic patients. It has been postulated that matrix metalloproteinases MMP-2 and MMP-9, zinc-dependent endopeptidases through remodeling of the extracellular matrix, can contribute to the onset and progression of diabetic vascular complications. The aim of our study was to assess whether there is a major difference in single nucleotide polymorphisms in the MMP-2 (at position -1306C˃T) and MMP-9 (at position -1562C˃T) gene in type 2 diabetic patients and healthy controls and to determine whether there is an association of these gene variants with the presence of microvascular complications in diabetic patients. Our study included 102 type 2 diabetes patients and a control group which was comprised of 56 healthy controls. All diabetic patients were screened for microvascular diabetes complications. Genotypes were detected by polymerase chain reactions followed by restriction analyses with specific endonucleases and their frequencies were determined. The MMP-2 variant -1306C>T showed a negative correlation with type 2 diabetes (p=0.028). It was also shown that the presence of the -1306C allele increases the probability of developing type 2 diabetes. This was a 2.2 fold increase and that the -1306 T allele has a protective role in regards to

Background and Objectives: Lifestyle interventions such as exercise prescription and education may play a role in the management of peripheral neuropathy in people with diabetes. The aim of this study was to determine the effect of undertaking an exercise program in comparison with an education program on the signs and symptoms of peripheral neuropathy in people with diabetes at risk of neuropathic foot ulceration. Materials and Methods: Twenty-four adult participants with diabetes and peripheral neuropathy were enrolled in this parallel-group, assessor blinded, randomised clinical trial. Participants were randomly allocated to one of two 8-week lifestyle interventions, exercise or education. The primary outcome measures were the two-part Michigan Neuropathy Screening Instrument (MNSI) and vibratory perception threshold (VPT). Secondary outcome measures included aerobic fitness, balance and lower limb muscular endurance. Results: Participants in both lifestyle interventions significantly improved over time for MNSI clinical signs (MD: −1.04, 95% CI: −1.68 to −0.40), MNSI symptoms (MD: −1.11, 95% CI: −1.89 to −0.33) and VPT (MD: −4.22, 95% CI: −8.04 to −0.40). Although the interaction effects did not reach significance, changes in values from pre to post intervention favoured exercise in comparison to control for MNSI clinical signs (MD −0.42, 95% CI −1.72 to 0.90), MNSI clinical symptoms (MD −0.38, 95% CI −1.96 to 1.2) and VPT (MD −4.22, 95% CI −12.09 to 3.65). Conclusions: Eight weeks of exercise training or lifestyle education can improve neuropathic signs and symptoms in people with diabetes and peripheral neuropathy. These findings support a role for lifestyle interventions in the management of peripheral neuropathy.

Background and Objectives: Lifestyle interventions such as exercise prescription and education may play a role in the management of peripheral neuropathy in people with diabetes. The aim of this study was to determine the effect of undertaking an exercise program in comparison with an education program on the signs and symptoms of peripheral neuropathy in people with diabetes at risk of neuropathic foot ulceration. Materials and Methods: Twenty-four adult participants with diabetes and peripheral neuropathy were enrolled in this parallel-group, assessor blinded, randomised clinical trial. Participants were randomly allocated to one of two 8-week lifestyle interventions, exercise or education. The primary outcome measures were the two-part Michigan Neuropathy Screening Instrument (MNSI) and vibratory perception threshold (VPT). Secondary outcome measures included aerobic fitness, balance and lower limb muscular endurance. Results: Participants in both lifestyle interventions significantly improved over time for MNSI clinical signs (MD: −1.04, 95% CI: −1.68 to −0.40), MNSI symptoms (MD: −1.11, 95% CI: −1.89 to −0.33) and VPT (MD: −4.22, 95% CI: −8.04 to −0.40). Although the interaction effects did not reach significance, changes in values from pre to post intervention favoured exercise in comparison to control for MNSI clinical signs (MD −0.42, 95% CI −1.72 to 0.90), MNSI clinical symptoms (MD −0.38, 95% CI −1.96 to 1.2) and VPT (MD −4.22, 95% CI −12.09 to 3.65). Conclusions: Eight weeks of exercise training or lifestyle education can improve neuropathic signs and symptoms in people with diabetes and peripheral neuropathy. These findings support a role for lifestyle interventions in the management of peripheral neuropathy.

Routine nerve conduction studies (NCS) are the current standard test for the evaluation of suspected peripheral neuropathy, but are often normal in patients with diabetic polyneuropathy (DPN). This is because: i. NCS are unable to detect dysfunction of small fibres, which may be affected earlier and are the cause of painful neuropathic symptoms; and ii. Significant large fibre axonal loss +/- demyelination may need to occur before NCS detect this is an abnormality. This research project critically evaluates various newer/novel methods to detect and potentially monitor diabetic neuropathy, and to provide a feasible way that this can be routinely assessed in the neurophysiology laboratory. I chose to specifically analyse the diabetic population as this is by far the most common cause of peripheral neuropathy in the global community, causing significant burden of disease. The various known novel techniques to assess and monitor DPN are evaluated, firstly through that which is available in current literature. These are compared in terms of diagnostic accuracy, as well as availability and cost-effectiveness. Based on the findings from this literature review, various prospective clinical studies are developed to further evaluate the more promising techniques identified. A focus was made towards techniques that can be performed in the neurophysiology laboratory, as routine NCS have, and will remain likely to have a significant role in the assessment of diabetes-related neuropathy. Thus, this clinical visit provides an opportune time to perform these additional tests as a way of providing supplementary information on patient’s peripheral nerve status. Small and large nerve fibres are both affected by diabetes. However, these fibres display very different physiological properties, not just in terms of structure and function, but they are also evaluated by completely different techniques. Small fibres can then be further subdivided into different populations of thinly myelina

Aims: We hypothesized that adults with type 1 diabetes and severe polyneuropathy have alterations in neuronal transmission at different anatomical levels. The aims were to investigate upstream sensory neuronal activation in terms of peripheral, spinal, precortical, and cortical transmission. Methods: 48 participants with type-1 diabetes and polyneuropathy, and 21 age-matched healthy participants were included. Electrophysiological median nerve recordings were used to analyze peripheral transmission at Erb's point (P9-N11); spinal evoked potentials at Cv7 (P11-N14); subcortical evoked potentials at Oz (N14-P18); early cortical evoked potentials at CP5 (N20-P22); late cortical evoked potentials at C1 (N60-P80) and estimated cortical inter-peak latencies as measures of central conduction time. Results: In comparison to healthy, the presence of diabetes prolonged peripheral transmission at P9 and N11 (+0.49 ms, p =.000; +0.47 ms, p =.04, respectively), early cortical evoked potentials at CP5: N20 (+2.41 ms, p =.003) and P22 (+5.88 ms, p =.001) and cortical potentials at C1: N60 (+39.08 ms, p =.001) and P80 (+54.55 ms, p =.000) and central conduction time. Decreased amplitudes were shown peripherally (−2.13 μV, p =.000), spinally (−0.57 μV, p =.005) and pre-cortically (−0.22 μV, p =.004). In both healthy and people with diabetes increased central conduction time were associated with decreased parasympathetic tone (ρ = −0.52, p =.027; ρ = −0.35, p =.047, respectively). Conclusion: Neuronal afferent transmission and brain responses were significantly impaired in diabetes and the presence of prolonged central conduction time is indicative of severe extensive neuronal damage. Trial registry number: EUDRA CT: 2013-004375-12; clinicaltrials.gov: NCT02138045.

Актуальність. Цукровий діабет (ЦД) є одним із соціально значущих захворювань. На момент маніфестації ЦД до 6 % хворих мають ознаки діабетичної полінейропатії (ДПН), через 5 років захворювання її спостерігають у 15 % пацієнтів, а через 15 років — у 25 % хворих на ЦД. Близько 80 % пацієнтів із ДПН мають безсимптомну форму, а больова форма ДПН діагностується в 10–20 % випадків. ДПН у деяких випадках передує появі клінічних ознак ЦД. Для адекватного лікування ДПН необхідно знати, що патогенез нейропатії при ЦД пов’язаний із комплексним ураженням нейрональних мембран метаболічного характеру. Метою нашого дослідження було вивчення ефективності препарату Нуклео Ц.М.Ф. форте в комплексному лікуванні ДПН. Матеріали та методи. Було обстежено 30 хворих на ЦД 1-го і 2-го типу (8 чоловіків і 22 жінки) з ДПН. Рівень глікованого гемоглобіну становив від 7,1 до 10,4 %. Перша група (15 пацієнтів) отримувала: альфа-ліпоєву кислоту в дозуванні 600 мг внутрішньовенно, вітаміни групи В ін’єкційно протягом 10 днів під час перебування в стаціонарі й у таблетованій формі — протягом місяця лікування в домашніх умовах. Друга група (15 пацієнтів) на додаток до терапії, яку отримувала перша група, одержувала Нуклео Ц.М.Ф. форте внутрішньом’язово протягом 10 днів під час перебування в стаціонарі, потім по 1 капсулі 2 рази на день протягом 2 місяців. Усім пацієнтам до прийому препарату, через 10 днів лікування в умовах стаціонару й через 2 місяці після лікування для оцінки неврологічного статусу проводилося клінічне неврологічне обстеження, а також динамічне обстеження пацієнтів за спеціальними клінічними опитувальниками (шкалами): нейропатичного симптоматичного рахунку і загального симптоматичного рахунку. Результати. У хворих як першої, так і другої групи спостерігався статистично позитивний вплив на симптоматику через 10 днів лікування в умовах стаціонару відповідно до шкали нейропатичного симптоматичного рахунку. Cимптоматика нейропатії в першій групі до лікування становила 10,23 ± 0,35 бала, Актуальность. Сахарный диабет (СД) является одним из социально значимых заболеваний. На момент манифестации СД до 6 % больных имеют признаки диабетической полинейропатии (ДПН), через 5 лет заболевания ее наблюдают у 15 % пациентов, а через 15 лет — у 25 % больных СД. Около 80 % пациентов с ДПН имеют бессимптомную форму, а болевая форма ДПН диагностируется в 10–20 % случаев. ДПН в некоторых случаях предшествует появлению клинических признаков СД. Для адекватного лечения ДПН необходимо знать, что патогенез нейропатии при СД связан с комплексным поражением нейрональных мембран метаболического характера. Целью нашего исследования было изучение эффективности препарата Нуклео Ц.М.Ф. форте в комплексном лечении ДПН. Материалы и методы. Было обследовано 30 больных СД 1-го и 2-го типа (8 мужчин и 22 женщины) с ДПН. Уровень гликированного гемоглобина составлял от 7,1 до 10,4 %. Первая группа (15 пациентов) получала: альфа-липоевую кислоту в дозировке 600 мг, витамины группы В инъекционно в течение 10 дней во время пребывания в стационаре и в таблетированной форме — в течение месяца лечения в домашних условиях. Вторая группа (15 пациентов) вдобавок к терапии, которую получала первая группа, получала Нуклео Ц.М.Ф. форте внутримышечно в течение 10 дней во время пребывания в стационаре, затем по 1 капсуле 2 раза в день в течение 2 месяцев. Всем пациентам до приема препарата, через 10 дней лечения в условиях стационара и через 2 месяца после лечения для оценки неврологического статуса проводилось клиническое неврологическое обследование, а также динамическое обследование пациентов по специальным клиническим опросникам (шкалам): нейропатического симптоматического счета и общего симптоматического счета. Результаты. У больных как первой, так и второй группы наблюдалось статистически положительное влияние на симптоматику через 10 дней лечения в условиях стационара в соответствии со шкалой нейропатического симптоматического счета. Cимптоматика нейропатии в первой группе до лечения сост, Background. Diabetes mellitus (DM) is one of the socially significant diseases. At the time of manifestation of DM, up to 6 % of patients have signs of diabetic polyneuro­pathy (DPN), after 5 years of the disease, they are observed in 15 %, and after 15 years — in 25 % of patients with DM. About 80 % of patients with DPN are asymptomatic, and the painful form of DPN is diagnosed in 10–20 % of cases. Sometimes, DPN precedes the onset of clinical signs of DM. For adequate treatment of DPN, it is necessary to know that pathogenesis of neuropathy in DM is associated with overall metabolic lesion of neuronal membranes. The objective was to study the effectiveness of Nucleo C.M.P. Forte in the comprehensive treatment of DPN. Materials and methods. Thirty patients with DM types 1 and 2 (8 men and 22 women) and DPN were examined. The level of glycated hemoglobin was from 7.1 to 10.4 %. The first group (15 patients) received: alpha-lipoic acid at a dose of 600 mg intravenously, B vitamins: injections — for 10 days while in hospital and tablets — for one month at home. The second group (15 patients) before treatment received by group 1 was treated with Nucleo C.M.P. Forte intramuscularly for 10 days while in hospital, then 1 capsule twice a day for 2 months. In all patients before administration of the drug, after 10 days of in-hospital treatment and 2 months after treatment, clinical neurological examination was performed to evaluate neurological status, as well as dynamic examination using special clinical questionnaires (scales): Neurological Symptom Score and Total Symptom Score. Results. Patients in both the first group and the second groups had a statistically positive effect on the symptoms after 10 days of in-patient treatment according to Neurological Symptom Score. The severity of neuropathy in first group before treatment was 10.23 ± 0.35 points, and after treatment — 7.62 ± 0.26 points, p < 0.001; in the second group, before treatment — 10.23 ± 0.35 points, and

Introduction: Venlafaxine was the first the first serotonin norepinephrine reuptake inhibitor antidepressant to authorized in Spain. Although there is no indication in the data sheet in the treatment of neuropathic pain, there are clinical practice guidelines in which venlafaxine appears in the first or second line of treatment. Development: Following a literature search, this article summarizes the most relevant pharmacological data of venlafaxine, as well as the specific literature of this drug in neuropathic pain. Conclusions: Venlafaxine is a safe and well tolerated drug for the symptomatic treatment of neuropathic pain. Although the current evidence is quite encouraging (at doses of at least 150 mg/day), further research is needed to extend these findings, particularly when is compared to other possible pharmacological agents., Introducción: La venlafaxina fue el primer antidepresivo inhibidor de la recaptación de serotonina y noradrenalina autorizado en España. Aunque no tiene indicación en ficha técnica en el tratamiento del dolor neuropático, hay guías de práctica clínica en las que la venlafaxina aparece en primera o segunda línea de tratamiento. Desarrollo: Tras una búsqueda bibliográfica, en este artículo se resumen los datos farmacológicos más relevantes de la venlafaxina, así como la bibliografía específica de este fármaco en dolor neuropático. Conclusiones: La venlafaxina es un fármaco seguro y bien tolerado para el tratamiento sintomático del dolor neuropático. Aunque la evidencia actual es bastante alentadora (en dosis de al menos 150 mg/día), son necesarias nuevas investigaciones para ampliar estos hallazgos, particularmente cuando se compara con otros posibles agentes farmacológicos.

Introduction: Venlafaxine was the first the first serotonin norepinephrine reuptake inhibitor antidepressant to authorized in Spain. Although there is no indication in the data sheet in the treatment of neuropathic pain, there are clinical practice guidelines in which venlafaxine appears in the first or second line of treatment. Development: Following a literature search, this article summarizes the most relevant pharmacological data of venlafaxine, as well as the specific literature of this drug in neuropathic pain. Conclusions: Venlafaxine is a safe and well tolerated drug for the symptomatic treatment of neuropathic pain. Although the current evidence is quite encouraging (at doses of at least 150 mg/day), further research is needed to extend these findings, particularly when is compared to other possible pharmacological agents., Introducción: La venlafaxina fue el primer antidepresivo inhibidor de la recaptación de serotonina y noradrenalina autorizado en España. Aunque no tiene indicación en ficha técnica en el tratamiento del dolor neuropático, hay guías de práctica clínica en las que la venlafaxina aparece en primera o segunda línea de tratamiento. Desarrollo: Tras una búsqueda bibliográfica, en este artículo se resumen los datos farmacológicos más relevantes de la venlafaxina, así como la bibliografía específica de este fármaco en dolor neuropático. Conclusiones: La venlafaxina es un fármaco seguro y bien tolerado para el tratamiento sintomático del dolor neuropático. Aunque la evidencia actual es bastante alentadora (en dosis de al menos 150 mg/día), son necesarias nuevas investigaciones para ampliar estos hallazgos, particularmente cuando se compara con otros posibles agentes farmacológicos.

Aim: To study the efficacy of benfothiamine in treating patients with diabetic polyneuropathy (DPN) in its various stages of manifestation. Methods. The first stage of the study involved 45 patients with positive Diabetic Neuropathy Symptom (DNS) score, 28 females, 17 males with type 2 diabetes and average duration of diabetes 7-10 years. All the participants were assessed before the commencement of therapy (benfothiamine 300 mg) and after 6 weeks of therapy. Participants were assessed using the DNS score, biothesiometer, monofilament test. CBC, kidney profile, LFT, glycosylated haemoglobin were measured in all the subjects. All patients were questioned regarding the presence or otherwise of symptoms, either positive or negative indicating the presence of neuropathy. The questionnaire used was the DNS score. The score is based upon the regular occurrence of four different symptoms of distal sensory polyneuropathy, including tingling, burning, numbness and unsteadiness of gait. The score has a range of 0–4, and a score of ≥1 is considered indicative of DSPN. Results. The DNS score in 19 females decreased from +4 to +2 whereas in the male group in 12 patients the DNS score decreased from +4 to +2.5. Out of the 28 females 14 had moderate sensory loss on the biothesiometer with voltage ranging between 18-24 volts, 2 patients had severe sensory loss with voltage 38-40, and 12 patients had mild sensory loss with voltage between 17-25. In the male group, 10 patients had moderate sensory loss with voltage ranging between 26-34 volts, 5 patients had mild sensory loss with voltage between 15-22 volts, and 2 patients had normal values. Upon completion of the 6 week period on benfothiamine therapy the threshold of sensory loss decreased by 5-8% in the patients with moderate loss. Conclusion. The significance of benfothiamine in clinical practice has also been demonstrated in many clinical trials with variable trial structures, patient groups and history of diabetes. In the firs

Onemocnění diabetická polyneuropatie je nejčastější a nejobtížnější komplikací diabetu mellitu. Jedná se o nezánětlivé poškození nervové tkáně a mikro- a makrovaskulární komplikace způsobené chronickou hyperglykémií. Patogeneze diabetické polyneuropatie je multifaktoriální. Na jejím vzniku se významně podílejí faktory, jako jsou oxidační stres, systémový zánět a mitochondriální dysfunkce., Diabetic polyneuropathy is the most common and the most difficult complication of diabetes mellitus. It is non-inflammatory damage of nervous tissue and micro- and macrovascular complications caused by chronic hyperglycemia. The pathogenesis of diabetic polyneuropathy is multifactorial. On its development are involved significant factors such as oxidative stress, systemic inflammation and mitochondrial dysfunction., Fakulta chemicko-technologická, Průběh obhajoby bakalářské práce: 1. Prezentace výsledků bakalářské práce. 2. Diskuze k posudku bakalářské práce. 3. Studentka zodpověděla všechny dotazy a připomínky k BP.

Стаття присвячена особливостям діагностики й різноманіттю клінічних проявів первинного та вторинного синдрому неспокійних ніг. Наведено основні рейтингові шкали для оцінки клінічного перебігу вказаної патології. Доведено ефективність застосування препарату Медітан у дозі 1200 мг у лікуванні вторинного синдрому неспокійних ніг на основі отриманих даних власного спостереження за 63 пацієнтами із діабетичною полінейропатією., Статья посвящена особенностям диагностики и многообразию клинических проявлений первичного и вторичного синдрома беспокойных ног. Приведены основные рейтинговые шкалы для оценки клинического течения указанной патологии. Доказана эффективность применения препарата Медитан в дозе 1200 мг в лечении вторичного синдрома беспокойных ног на основе полученных данных собственного наблюдения за 63 пациентами с диабетической полинейропатией., The article considers the features of diagnosis and variety of clinical manifestations of primary and secondary restless legs syndrome. Basic ratings scales to evaluate the clinical course of this pathology are presented. Efficiency of using Meditan at a dose of 1200 mg for the treatment of secondary restless legs syndrome, based on the findings of our own observation of 63 patients with diabetic polyneuropathy, has been proved.

Вивчено ефективність застосування седативно-снодійного препарату, що містить зопіклон та ряд рослинних середників (настій пустирника, шишки хмелю, олія м’ятна), у поєднанні з праміпексолом у хворих на діабетичну поліневропатію, коморбідну із синдромом неспокійних ніг. Обстежено 46 хворих із синдромом неспокійних ніг на фоні діабетичної поліневропатії. Залежно від призначеної схеми лікування хворі були рандомізовані на 2 групи: 24 хворі І групи отримували праміпексол у дозі 0,75 мг на добу, 22 хворим ІІ групи призначено праміпексол та зопіклон у комбінації із седативними рослинними середниками. Проводилося опитування за шкалою оцінки ступеня тяжкості синдрому неспокійних ніг, шкалою сонливості Epworth та анкетою бальної оцінки суб’єктивних характеристик сну. З’ясовано, що при поєднаному застосуванні праміпексолу з зопіклоном у комбінації з рослинними середниками, окрім зменшення кількості рухів ногами під час засинання та сну, виявлено скорочення часу засинання пацієнтів, зниження кількості нічних пробуджень, підвищення якості ранкового пробудження та денної працездатності., Изучена эффективность применения седативно-снотворного препарата, содержащего зопиклон и ряд растительных средств (настой пустырника, шишки хмеля, масло мяты), в сочетании с прамипексолом у больных диабетической полиневропатией, коморбидной с синдромом беспокойных ног. Обследовано 46 больных с синдромом беспокойных ног на фоне диабетической полиневропатии. В зависимости от назначенной схемы лечения больные были рандомизированы на 2 группы: 24 больных I группы получали прамипексол в дозе 0,75 мг в сутки в течение 2 недель, 22 больным II группы назначены прамипексол 0,75 мг и зопиклон в сочетании с седативными растительными средствами. Проводился опрос по шкале оценки степени тяжести синдрома беспокойных ног, шкале сонливости Epworth и анкете балльной оценки субъективных характеристик сна. Выяснено, что при совместном применении прамипексола с зопиклоном в сочетании с растительными средствами, кроме уменьшения количества движений ногами во время засыпания и сна, выявлены сокращение времени засыпания пациентов, снижение количества ночных пробуджений, повышение качества утреннего пробуждения и дневной работоспособности., The feasibility and efficacy of sedative and hypnotic drug containing zopiclone and a range of herbal drugs (motherwort, hops extract, mint oil) in combination with pramipexole in patients with diabetic polyneuropathy, comorbid with restless legs syndrome were examined. The study involved 46 patients with restless legs syndrome associated with diabetic polyneuropathy. Depending on the treatment, the patients have been divided into 2 groups: the first group included 24 patients, who used pramipexole 0.75 mg daily for 2 weeks; the second group consisted of 22 patients who were treated with pramipexole 0.75 mg and zopiclone in combination with sedative herbal means. A survey by the rating scale of the restless legs syndrome severity, Epworth sleepiness scale was carried out. Subjective sleep characteristics were assessed by valid questionnaires. It was found that combined administration of pramipexole and zopiclone reduces the number of movements during sleep, patient sleep time, the number of night-time awakenings; improves the quality of daily morning awakening and working efficiency.

Вивчено доцільність та ефективність застосування праміпексолу у хворих на діабетичну поліневропатію (ДПН), резистентних до стандартної терапії, включаючи засоби для полегшення нейропатичного болю. Обстежено 144 хворі на цукровий діабет 2-го типу, ускладнений ДПН. За допомогою основних діагностичних критеріїв Міжнародної групи з вивчення синдрому неспокійних ніг (СНН) (2003) у 41 хворого було встановлено СНН. Усі хворі були поділені на 2 групи за схемою лікування: до І групи увійшло 19 хворих, які на фоні стандартної терапії поліневропатії отримували габапентин; ІІ групу становили 22 пацієнти, яким у комплексному лікуванні застосовували праміпексол. Проводилося опитування згідно з Міжнародною шкалою оцінки ступеня тяжкості СНН, шкалою СНН-6, якості життя при СНН і виявлено, що лікування хворих ІІ групи було більш ефективним. Це проявлялося покращенням показників рейтингових шкал. Також встановлено, що в 28,5 % хворих виявлено СНН. Можливо, це хворі на ДПН із низькою ефективністю габапентину., Изучена целесообразность и эффективность применения прамипексола у больных диабетической полиневропатией (ДПН), резистентных к стандартной терапии, включая средства для облегчения нейропатической боли. Обследовано 144 больных сахарным диабетом 2-го типа, осложненным ДПН. С помощью основных диагностических критериев Международной группы по изучению синдрома беспокойных ног (СБН) (2003) у 41 больного был установлен СБН. Все больные были разделены согласно схеме лечения на 2 группы: в I группу вошло 19 больных, которые на фоне стандартной терапии полиневропатии получали габапентин; ІІ группу составили 22 пациента, которым в комплексном лечении применяли прамипексол. Проводился опрос по Международной шкале оценки степени тяжести СБН, шкале СБН-6, оценки качества жизни при СБН и выявлено, что лечение больных II группы было более эффективным. Это проявлялось улучшением показателей рейтинговых шкал. Также установлено, что у 28,5 % больных выявлен СБН. Возможно, это больные ДПН с низкой эффективностью габапентина., The feasibility and efficacy of pramipexole use in patients with diabetic polyneuropathy (DPN) resistant to standard therapy, including medications for relief of neuropathic pain, were studied. The study involved 144 patients with type 2 diabetes mellitus, complicated with DPN. With the use of the main diagnostic criteria of International restless legs syndrome (RLS) study group (2003), RLS was detected in 41 patients. All patients were divided into 2 groups according to treatment regimen: I group included 19 patients, who used standard therapy of polyneuropathy and gabapentin; II group consisted of 22 patients who were treated with pramipexole in combination therapy. The survey was conducted with the use of International restless legs scale, RLS-6 scale, quality of life in RLS. It was found that the treatment of II group patients was more effective. This was reflected in improvements in rating scales. Also 28.5 % of patients were diagnosed with RLS. Probably, they were patients with DPN, with low efficiency of gabapentin.

A bibliographical review deals with modern concepts of the pathogenesis of diabetic polyneuropathy, whose knowledge and generalization is an indispensable component for etiopathogenetic treatment of the pathology inquestion., Библиографический обзор посвящен современным представлениям о патогенезе диабетической полинейропатии, знания и обобщение которых является необходимым компонентом для этиопатогенетического лечения осложнений сахарного диабета., В огляді літератури наведені сучасні уявлення про патогенез діабетичної полінейропатії, знання і узагальнення якого є необхідною складовою етіопатогенетичного лікування даної патології.

205 children with diabetes mellitus type one from Almaty city were investigated at the age of 3 till 16 years. The duration of the diabetes mellitus was from 6 months to 10 years (2.73±2.58). The diabetic neuropathy was found in 72.68% of cases, and in 55.03% of them had subclinical disease manifestations., Обследованы 205 детей г. Алматы с сахарным диабетом 1-го типа в возрасте от 3 до 16 лет. Длительность сахарного диабета составляла от 6 месяцев до 10 лет ((2,73±2,58 года). Диабетическая полинейропатия обнаружена в 72,68% случаев, причем в 55,03% из них заболевание имело субклиническую форму.

Introduction: The purpose of this study was to determine whether single-fiber conduction velocity (SF-CV) of a small number of axons increases sensitivity for identification of motor nerve conduction alterations in patients with diabetes. Methods: Twenty-one consecutive diabetic patients in good metabolic control were studied. For each patient, conventional (C-CV) and SF-CV results were correlated with the presence of neuropathic symptoms. Results: Nine of 21 patients reported symptoms suggestive of mild nerve impairment. Three patients had abnormal sural nerve CV, 1 of whom also had abnormal motor nerve conduction. Eighteen patients had normal findings on conventional tests, 3 of whom had slowing of SF-CV. Conclusions: SF-CV is able to detect mild myelin damage with higher sensitivity than conventional tests. The use of SF-CV may be a helpful tool in the early identification of diabetic polyneuropathy, and it may be useful for tailoring an approach to diabetic polyneuropathy.

Tato diplomová práce se zabývá dvěma experimentálními technikami použitými pro analýzu sérových lipidů. Jako první byla využita technika tenkovrstvé chromatografie k rozdělení lipidů ve vzorku do pěti frakcí: fosfolipidy, diacylglyceroly, triacylglyceroly, volné mastné kyseliny a estery cholesterolu. Tyto frakce byly dále analyzovány pomocí druhé techniky - plynové chromatografie. Touto technikou bylo zjišťováno procentuální zastoupení jednotlivých mastných kyselin v těchto frakcích. Bylo zjišťováno, zda se liší procentuální zastoupení jednotlivých kyselin u pacientů s diabetickou polyneuropatií, diabetem a u zdravých osob. Po vyhodnocení výsledků můžeme říci, že jsme zjistili výraznější změny u kyseliny palmitové ve vrstvě fosfolipidů a triacylglycerolů a tato kyselina by později mohla sloužit jako diagnostický marker pro určení diabetické polyneuropatie., This thesis deals with two experimental techniques used for analysis of serum lipids. The first technique was used to divide the thin-layer chromatography of lipids in the sample into five fractions: phospholipids, diacylglycerols, triacylglycerols, free fatty acids and cholesterol esters. These fractions were further analyzed by the second technique - gas chromatography. This technique has been established percentage of individual fatty acids in these fractions. It was examined whether the percentage share of individual fatty acids is defferent in group of patients with diabetics polyneuropathy, diabetes and healthy individuals. After evaluating the results we can say that we found more pronounced changes in palmitic acid in a layer of phospholipids and triglycerides, and the acid could later serve as a diagnostic marker for determination of diabetic polyneuropathy., Katedra biologických a biochemických věd, Dokončená práce s úspěšnou obhajobou

Objective: To collect a reference material of the medial plantar nerve action potential, to test intra/interobserver reliability in healthy controls and to apply the test to a group of patients with diabetes mellitus. Methods: 98 healthy controls and 50 patients with diabetes mellitus were included. The medial plantar nerve was stimulated orthodromically and recorded with a surface electrode. In the patient group, NCS of motor and sensory nerves and quantitative sensory testing were also performed. Results: Responses of the medial plantar nerve were obtained from all controls except from one aged 72. Amplitude decreased with age (r = -0.68, p < 0.0001). Intra/interobserver reliability was acceptable. 52% of the patients had abnormal overall NCS classification. Forty-eight percent had delayed tibial F-response latency. The medial plantar NCS were abnormal in 59% of the cases (47% abnormal NAP amplitude and 39% reduced CV), 59% of those with abnormal NCS had symptoms of sensory polyneuropathy. Only 24% had abnormal sural amplitude. Cold perception threshold was abnormal in more patients (30%) than warmth perception threshold (14%). Conclusions: Responses were easily obtained in controls under 70 years. In diabetics the amplitudes of the medial plantar nerve were abnormal more often than in the sural nerve. Significance: The medial plantar nerve response is reliable in patients under 70 years, and intra/interobserver reliability is acceptable.

To assess the relationship between peripheral nerve involvement and the patient's perception of his own quality of life, we studied 36 consecutive out-patients affected by insulin-dependent diabetes mellitus without other diabetic complications other than neuropathy (20 men, 16 women; mean age 39.1 years). We used clinical (Semmes-Weinstein, vibration perception threshold, muscle strength, osteotendinous reflexes), neurophysiological (sural, peroneal and ulnar nerves), metabolic (glycosylated haemoglobin) and patient-oriented (SF-36 and NASS questionnaires) measurements. Patient-oriented physical scores were significantly related to: (1) neurophysiological findings of the inferior limbs; (2) conventional measurements of sensitivity; (3) metabolic assessment. Conversely, patient-oriented mental scores were significantly related only to metabolic assessment. The patient-oriented measure provided an important perspective of the severity of the disease often closely related with the biological parameters and suggested new ways of interpreting conventional biological measurements. In particular, the peripheral nerve picture appeared strictly related with the physical aspects of the patients' quality of life, while the metabolic picture appeared related with both the mental and physical aspects of the quality of life.

Thiolepta (alpha-lipoic acid preparation) was used in treatment of 205 patients, 134 women and 71 men, mean age 59.3±10.1 years; 196 patients with diabetes mellitus (DM) type II and 9 patients with DM type I. Treatment duration was 4 weeks. Dosage of the drug was 600 mg daily. Patients were assessed neurologically and with psychometric scales. Special attention was drawn to the severity of positive and negative symptoms of neuropathy and sleep disorders. The results demonstrated the efficacy of thiolepta in diabetic polyneuropathy assessed by all parameters. The effect remained during 3 months after the end of treatment. Good tolerability and safety of the drug are highlighted.