Browsing by Person "Santos, Derek"

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A model of ischemic pain in the calf and tens modification of lower limb pain: preliminary results.
(2007) Roche, Patricia; Santos, Derek
PURPOSE: To develop a model of laboratory induced ischemic calf pain; to test the analgesic efficacy of TENS for calf pain, and to describe induced calf pain, in healthy volunteers. RELEVANCE: We aimed to modify the sub maximum effort tourniquet technique (SMETT), a standardised method of inducing experimental ischemic pain into the upper limb of volunteers, to create a laboratory model of lower limb ischemia (LLI). With exercise, LLI could serve as a model of intermittent claudication (IC) - the exercise induced ischemic pain that is the main symptom of Peripheral Arterial Disease (PAD). Testing TENS for LLI pain could indicate its potential efficacy in IC related to PAD. PARTICIPANTS: 14 healthy males volunteered for Experiment 1 (E1) and 20 healthy females for Experiment 2 (E2). Subjects met inclusion and exclusion criteria for SMETT. METHODS: E1 was a within subject, crossover, single-blind study. A pilot study was undertaken with 4 independent subjects. The SMETT technique (with broad pressure cuff) was applied to the thigh. Subjects then performed 20 resisted plantar-flexion / dorsi-flexion exercises, using a pulley and weight apparatus developed for the study, in order to induce ischemia over a period of 5 minutes. Measurment of the Post Occlusive Reactive Hyperaemic response (PORHmax), demonstrated that ischemia had occurred in the calf of each subject, via the adapted SMETT technique. The main study in E1 applied (A) the standard SMETT in the upper limb and 20 minutes later (B) the modified SMETT (minus PORHmax) in the lower limb. Each application was for a maximum of 20 minutes. A linear pain scale rated subjective reports of pain intensity, at intervals between self-reported 'pain threshold' and 'pain tolerance'. The cuff was deflated at 'pain tolerance', or at 20 minutes, whichever came first. Subjects retrospectively described the ischemic pain in (i) the forearm and (ii) the calf, five minutes after cuff deflation. E2 utilised the E1 procedure for inducing lower limb ischemia and recording pain, to conduct an independent subject study of continuous TENS (100Hz, 200us) for induced LLI. Subjects were randomly allocated to a Control or TENS group. In the TENS group, electrodes were placed proximal and distal to the area of pain in the calf. ANALYSIS: Parametric or nonparametric tests examined differences between conditions; linear pain scales and weighted-rank MPQ - Pain Rating Index (PRI) scores For all statistical tests p-<-0.05. RESULTS: In E1, pain ratings at 300, 600, 900 12000 seconds showed similar incremental increases in pain intensity that are typical of SMETT induced ischemic pain, over time. In E2, TENS significantly raised the mean pain threshold and tolerance levels, and reduced MPQ-PRI scores, compared to controls (P-<-0.01 all comparisons). Qualitative MPQ descriptions reliably identified 4 sensory and 1 affective subclass of words to describe induced LLI pain. CONCLUSIONS: Lower limb ischemic pain induced with a modified SMETT can be modified by continuous TENS. IMPLICATIONS: A study into the efficacy of TENS during exercise in patients with PAD is indicated. Ref. 1. ROCHE PA et al.Physiotherapy Theory and Practice 2001, 18: 129-138 KEYWORDS: Pain; laboratory model, electrical stimulation. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: proche@qmuc.ac.uk
A modular device to measure the effects of plantar foot pressure on the microcirculation of the heel
(Elsevier Science Ltd, 2003-03) Santos, Derek; Carline, Tom; Richmond, R.; Abboud, R.
Background: Past research has concentrated on foot function and plantar foot pressure, with many devices developed for this purpose. However, little is known of how cutaneous blood flow compensates for ambulatory repetitive circulatory insults and how ulceration occurs. Objectives: To develop a system to measure the effects of plantar foot pressure on cutaneous blood flow in the supine and semi-weight bearing positions. Method: A system was developed that integrated a laser Doppler fluxmeter with a pressure probe, allowing plantar foot pressure and skin blood flow to be recorded simultaneously. The system was tested using four volunteers (288.6 years). Results: A significant difference existed between baseline laser Doppler flowmetry (LDF) in the supine and semi-weight bearing positions (P=0.023). Differences between both positions also existed in the reduction in LDF levels following application of pressure (P=0.015), the maximum hyperaemic response (P=0.034) and time taken to reach maximum hyperaemic response (P=0.019). Conclusion: The device has shown that with current technology it is now possible not only to investigate plantar foot pressure but also how it affects skin blood flow, which in some cases can lead to ulceration. The effect of plantar foot pressure on cutaneous blood flow differs depending on whether the subject is supine or semi-weight bearing. Thus, to understand the effects of plantar foot pressure on skin blood flow future researchers must ensure that subjects are in an upright position when recording.
A multidisciplinary project of secondary prevention of coronary heart disease.
(2000) Santos, Derek; Gillies, John
A Pseudomonas aeruginosa infection of the nail: a case report
(1997) Santos, Derek; Carline, Tom; Weir, Evelyn C.
A review of the effects of external pressure on skin blood flow
(Elsevier, 2003-12) Santos, Derek; Carline, Tom; Richmond, R.; Abboud, R.
The human foot is a complex mechanical structure consisting of bones, ligaments and joints. They act together to provide a robust system capable of absorbing and dissipating the intermitted pressure that is subjected to its plantar surface during walking to prevent soft tissue breakdown. Current studies suggest that plantar foot pressure may lead to soft tissue breakdown (e.g. neuropathic ulceration) and hence research has so far concentrated on investigating the mechanical effects of plantar foot pressure on the foot's integrity. This has been possible through the widely available pressure and force platforms as well as in-shoe pressure systems. However, to understand how plantar foot pressure causes soft tissue breakdown it is vital to investigate both the physiological-mechanical interactions between the skin and plantar foot pressure. This review suggests that with the current advances in technology, the physiological response of skin blood flow to mechanical plantar foot pressure should be investigated and correlated further, both during static and dynamic loading, by developing a new system capable of either measuring both variables simultaneously or by synchronising two systems in real time.
A systematic review of the sensitivity and specificity of the toe-brachial index for detecting peripheral artery disease
(SAGE, 2016-05-10) Tehan, P. E.; Santos, Derek; Chuter, V. H.
The toe-brachial index (TBI) is used as an adjunct to the ankle-brachial index (ABI) for non-invasive lower limb vascular screening. With increasing evidence suggesting limitations of the ABI for diagnosis of vascular complications, particularly in specific populations including diabetes cohorts, the TBI is being used more widely. The aim of this review was to determine the sensitivity and specificity of the TBI for detecting peripheral artery disease (PAD) in populations at risk of this disease. A database search was conducted to identify current work relating to the sensitivity and specificity of toe-brachial indices up to July 2015. Only studies using valid diagnostic imaging as a reference standard were included. The QUADAS-2 tool was used to critically appraise included articles. Seven studies met the inclusion criteria. Sensitivity of the TBI for PAD was reported in all seven studies and ranged from 45% to 100%; specificity was reported by five studies only and ranged from 16% to 100%. In conclusion, this review suggests that the TBI has variable diagnostic accuracy for the presence of PAD in specific populations at risk of developing the disease. There was a notable lack of large-scale diagnostic accuracy studies determining the diagnostic accuracy of the TBI in detecting PAD in different at-risk cohorts. However, standardised normal values need to be established for the TBI to conclusively determine the diagnostic accuracy of this test.
Alcohol injections for the treatment of intermetatarsal neuromas [Summary]
(2019-08-15) Santos, Derek; Coda, Andrea
Intermetatarsal neuromas, sometimes called Morton’s neuroma, cause nerve pain in the forefoot. It arises due to entrapment of the nerve(s) supplying the toes(s) due to compression of the forefoot. Although any foot can be affected it’s uncommon to affect both feet. Similarly, it’s unusual to find multiple neuromas affecting the same foot. The condition is 8-10 times more common in females than males with people aged 45-50 years more at risk. The part of the forefoot most commonly affected is the third inter-metatarsal space with the first and fourth space rarely affected.
An overview of AVF maturation and endothelial dysfunction in an advanced renal failure
(BioMed Central, 2017-10-02) Siddiqui, Muhammad A.; Ashraff, Suhel; Santos, Derek; Carline, Tom
Assessment of the At-risk Foot
(1999) Santos, Derek
Paper adds to the growing body of evidence that children can acquire phonological systems before they are able to master the phonetic skills needed to convey the contrasts in that system
Beyond grades: integrating communication skills into the undergraduate curriculum for podiatry students
(Springer International Publishing, 2025-03-12) Coda, A.; Hawke, F.; Santos, Derek; Stevenson, E.; Girones, X.; Ruiz, X.; Escalona, C.; Sanson-Fisher, R.; Fellas, A.
This commentary paper emphasises the pivotal role of effective communication in the field of podiatry and advocates for its comprehensive integration into the educational curriculum. It argues that the combination of strong academic performance and well-developed communication skills equips podiatry students to improve diagnoses and successful future treatment outcomes. These skills should be comprehensively taught and carefully assessed as part of the patient-centered care approach for podiatry students. The paper explores the multifaceted role of communication in podiatry, highlighting its importance in various aspects of the profession. These include building rapport with patients, interpreting complex medical information, and fostering a therapeutic alliance that is conducive to successful treatment outcomes. It also underscores the significance of communication in collaborating with interdisciplinary teams and advocating for patient wellbeing. Proficiency in communicating with patients can contribute to the development of a wide range of career competencies in podiatric medicine, including clinical skills, research and innovation, cultural competence, and effective teamwork, both nationally and internationally. The paper also delves into various topics such as gathering patient history, explaining diagnoses and treatment options, providing patient education, and enhancing patient outcomes through interprofessional practice. This commentary paper explores the role of communication in research participation and the teaching and assessment of communication skills through innovative methods such as role-playing, simulations, and standardized patients. In conclusion, by reiterating that the essence of podiatry extends beyond technical proficiency to include meaningful interactions between the podiatrist and the patient, which are facilitated by strong communication skills. This paper may serve as a call to action for universities nationally and internationally to place greater emphasis in integrating and thoroughly assessing communication skills in their podiatric medicine programs.
The clinical impact of flash glucose monitoring, a digital health application and smart watch technology in patients with type 2 diabetes: a scoping review
(JMIR Publications, 2023-01-19) Alvarez, Sergio Diez; Fellas, Antoni; Santos, Derek; Sculley, Dean; Wynne, Katie; Acharya, Shamasunder; Xavier Girones; Girones, Xavier; Coda, Andrea
Background: Type 2 diabetes has a growing prevalence and confers significant cost burden to the health care system. Raising the urgent need for cost effective and easily accessible solutions. The management of type 2 diabetes requires significant commitment from the patient, caregivers and the treating team to optimise clinical outcomes and prevent complications. Technology and its implications for the management of type 2 diabetes is a nascent area of research. The impact of some of the more recent technological innovations in this space such as continuous glucose monitoring, flash glucose monitoring, web-based applications and smart phone and smart watch based interactive applications have received limited attention in the research literature. Objective: This scoping review aims to explore the literature available in type 2 diabetes, flash glucose monitoring and digital health technology to improve diabetic clinical outcomes and thus inform future research in this area. Methods: A scoping review was undertaken by searching Ovid MEDLINE and CINAHL databases. A second search using all identified keywords and index terms was performed on Ovid MEDLINE (January 1966 to July 2021), EMBASE (January 1980 to July 2021), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, latest issue), CINAHL (from 1982), IEEE XPlore and ACM Digital Libraries, and Web of Science databases. Results: There were very few studies that have explored the use of mobile health and Flash glucose monitoring in type 2 diabetes. These studies have explored somewhat disparate and limited areas of research, and there is a distinct lack of methodological rigor in this area of research. The 3 studies that met the inclusion criteria have addressed aspects of the proposed research question. Conclusions: This scoping review has highlighted the lack of research in this area, raising the opportunity for further research in this area, focusing on the clinical impact and feasibility of the use of multiple technologies including flash glucose monitoring in the management of patients with type 2 diabetes.
Complications of Stump Healing Among Diabetic Population
(Society of Endocrinology and Metabolism of Turkey, 2018-06-19) Ashraff, Suhel; Siddiqui, Muhammad A.; Santos, Derek; Carline, Tom
Lower limb amputation is a major procedure performed in diabetic patients with multiple comorbidities. Almost 10% of the National Health Service budget is taken up by diabetes, with diabetes-related complications accounting for 80% of the costs. The process of wound healing is complex and involves regenerating the cellular organization and the tissue layers. Diabetics are five times more predisposed to wound infection than patients without diabetes mellitus. The amputated stump frequently becomes infected due to inadequate blood circulation, a weak immune system, and poorly controlled diabetes mellitus. Pain, stump edema, and osteomyelitis are significant complications associated with lower limb amputation wounds. A number of factors may substantiate the need for re-amputation, such as stump pain and/or phantom limb pain, delayed stump infection, the formation of symptomatic bone spurs, assessment of the skin flap designed to preserve stump length, and preparation of the stump for the prosthetic device. There are currently no reliable standards that can be referred to prior to leg amputation. The clinicians, therefore, have to rely on their judgment and investigatory parameters. The main purpose of this review is to discuss the difficulties of stump healing in the diabetic population.
Contribution of vision, touch, and hearing to the use of sham devices in acupuncture-related studies
(Elsevier, 2019-12-23) Tan, Chee-Wee; Santos, Derek
This study investigates whether visual deprivation influences participants' accuracy in differentiating between real and sham acupuncture needles. It also evaluates the relative contributions of tactile, visual, and auditory cues that participants use in their decision-making processes. In addition, a simple sensory decision-making model for research using acupuncture sham devices as comparative controls is proposed. Forty healthy individuals underwent two conditions (blindfolded and sighted) in random sequence. Four sham and four real needles were randomly applied to the participants' lower limb acupoints (ST32 to ST39). Participants responded which needle type was applied. Participants then verbally answered a questionnaire on which sensory cues influenced their decision-making. The proportion of correct judgments, P(C), was calculated to indicate the participants' accuracy in distinguishing between the needle types. Visual deprivation did not significantly influence the participants' discrimination accuracy. Tactile cues were the dominant sensory modality used in decision-making, followed by visual and auditory cues. Sharp and blunt sensations were associated with the real and sham needles, respectively, for both conditions. This study confirmed that tactile cues were the main sensory modalities used in participant decision-making during acupuncture administration. Also, short-term blindfolding of participants during procedures will unlikely influence blinding effectiveness.
Development and Delivery of an Integrated Digital Healthcare Approach for children with Juvenile Idiopathic Arthritis: Usability Study
(JMIR Publications, 2024-09-17) Butler, Sonia; Sculley, Dean; Santos, Derek; Girones, Xavier; Singh-Grewal, Davinder; Coda, Andrea
Background: Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory disorder, with no cure. Most children are prescribed: several medications aimed to control disease activity, manage symptom, and reduce pain. Physical activity is also encouraged to retain musculoskeletal function. The primary determinants of treatment success are maintaining long term adherence, ongoing monitoring from a paediatric rheumatologist, and involvement from an interdisciplinary team. To support these goals, a new digital intervention was developed, InteractiveClinics, aimed to prompt children to take their medications, report pain levels, and increase their physical activity. Objective: This study aims to evaluate the usability of InteractiveClinics, by children with JIA. Methods: As part of this pediatric cross-sectional usability study, twelve children were asked to wear a smart watch for two weeks, synchronized to the InteractiveClinics phone app and web-based platform. Personalized notifications were sent daily to the watch and phone, to prompt and record medication adherence and pain levels. Physical activity was automatically recorded by the watch. At the end of the study, all children and parents completed a post-intervention survey. Written comments were also encouraged to gain further feedback. Descriptive statistics were used to summarize the survey results, and all qualitative data employed thematic analysis. Results: Twelve children, aged 10 to 18 years (mean 14.2, SD 3.1, female 66.7%, 8/12) and one parent for each child (n=12, 66.7%, 8/12, female) were enrolled in the study. Reviewing the highest and lowest agreement areas of the survey, most children and parents liked the smart watch and web-based platform, they found it easy to learn and simple to use. They were also satisfied with the pain and physical activity module. However, usability and acceptability barriers were identified in the phone app and medication module that hindered uptake. Children required a more unique in-app experience, and their suggestive improvements included: more personalisation within the app, simplification by removing all non-relevant links, flexibility in response times, improved conferment through gamification, additional comment fields for the input of more data such as medication side effects or pain-related symptoms, more detailed graphical illustrations of the physical activity module, including a breakdown of metrics, and importantly, interconnections between modules, because medication adherence, pain levels and physical activity can each influence the other. Overall improving usefulness for children and parents. Conclusions: Usability of InteractiveClinics was positive. Children and parents liked the watch and web-based platform and were satisfied with the pain and physical activity module. However, children wanted a more unique in-app experience, through more personalisation, simplification, flexibility, conferment, comment fields, graphical illustrations, a breakdown of metrics, and interconnections. Certainly, inclusions needed to promote user adoption and advancement of new validated digital health interventions in pediatric rheumatology, to support the delivery of integrated care. Clinical Trial: Australian and New Zealand Clinical Trial Registry: ACTRN12616000665437.
Development of a prognostic model for fistula maturation in patients with advanced renal failure
(2012-05-24) Siddiqui, Muhammad A.; Raza, Zahid; Santos, Derek; Ashraff, Suhel; Carline, Tom
Introduction This study aimed to explore the role of haematological markers and predictive factors on the maturation of arteriovenous fistulae in patients who underwent vascular access surgery at the Royal Infirmary of Edinburgh. Methods Retrospective analysis of 300 patients was retrieved who had undergone fistula creation between 2006 and 2009. A predictive model was developed using backward stepwise logistic regression. The model discrimination was assessed by the receiver operating characteristics curve and its calibration by the Hosmer and Lemeshow goodness of fit test. Results Three variables were identified which influenced fistula maturation. Gender - Males were twice as likely to undergo fistula maturation, compared to that of females (odds ratio [OR] 0.514; 95% confidence interval [CI] 0.308 to 0.857). Peripheral Vascular Disease - Patients with no evidence of PVD were three times more likely to mature their fistula (OR 3.140; 95% CI 1.596 to 6.177). Vein Size - A pre operative vein diameter > 2.5mm resulted in a five fold increase in fistula maturation compared to a vein size less than 2.5mm (OR 4.532; 95% CI 2.063 to 9.958). There was a good calibration as indicated by Hosmer and Lemeshow goodness of fit test (P=0.79) and the c-index was 0.677. Conclusion Gender, PVD and vein size are useful predictors of arteriovenous fistulae maturation. The clinical utility of these risk categories in the maturation of arteriovenous fistulae requires further clinical evaluation in a prospective study.
Development of a prognostic model for stump healing in major lower limb amputation among the diabetic population
(MDPI, 2021-07-12) Ashraff, Suhel; Siddiqui, Muhammad; Carline, Tom; Rush, Robert; Santos, Derek; Raza, Zahid
Background: This study aimed to explore the effect of haematological markers as well as patient characteristics on stump healing in patients who underwent a lower limb amputation procedure. In addition, a practical model regarding factors that affected stump healing was developed. Methods: Patients who underwent a major lower limb amputation (above knee and below knee) at the Royal Infirmary of Edinburgh from the period of 2007 to 2010 were included in this study. A prognostic model utilizing backward stepwise logistical regression was developed to measure the probability of lower limb stump healing. The relationship between the dependent and independent variables was identified using univariate and multivariate logistic regression. Results: Three variables, namely serum sodium, serum creatinine and serum high density lipid cholesterol were identified which influenced stump healing. Patients with normal serum sodium were 75% more likely to have lower limb stump healing compared to that of patients with abnormal serum sodium (odds ratio [OR] 1.756; 95% confidence interval [CI] 1.048–2.942). Patients with normal serum creatinine were 66% more likely to have their stump healed (OR 1.664; 95% CI 0.94 to 2.946). The healing rate of patients with a normal level of serum high density lipid cholesterol was 75%, in contrast to patients with an aberrant level of serum high density lipids cholesterol (OR 1.753; 95% CI 1.061 to 2.895). The effectiveness of the retrospective stump-healing model was demonstrated by the area under the ROC curve (0.612), which was supported by the Hosmer and Lemeshow goodness-of-fit test (p = 0.879). Conclusions: Serum sodium, serum high density lipid cholesterol and serum creatinine have a strong correlation with lower limb stump healing. However, serum sodium and serum high density lipid cholesterol secondary to multiple co-morbidities in this cohort group could be altered secondary to disease pathology itself.
Development of a prognostic model for stump healing in patients with advanced atherosclerosis
(2012-05-24) Ashraff, Suhel; Raza, Zahid; Santos, Derek; Siddiqui, Muhammad A.; Carline, Tom
Introduction This study aimed to explore the role of haematological markers and predictive factors on the stump healing in patients who underwent lower extremity amputation surgery at the Royal Infirmary of Edinburgh. Methods Retrospective analysis of 300 patients was retrieved who had undergone lower extremity amputation surgery between 2006 and 2010. A predictive model was developed using backward stepwise logistic regression. The model discrimination was assessed by the receiver operating characteristics curve and its calibration by the Hosmer and Lemeshow goodness of fit test. Result Three variables were identified which influenced stump healing. Serum Sodium - The lower limb stump healing was 75% likely in patients with normal serum sodium compared to that of patients with abnormal serum sodium (odds ratio [OR] 1.756; 95% confidence interval [CI] 1.048-2.942) Serum Creatinine- Patients with normal serum creatinine were 66% more likely to have their stump healed (OR 1.664; 95% CI 0.94 to 2.946) Serum High Density Lipoproteins - A normal serum HDL resulted in a 75% more likely chance of healing compared to those with abnormal serum HDL (OR 1.753; 95% CI 1.061 to 2.895). There was a good calibration as indicated by Hosmer and Lemeshow goodness of fit test (P=0.879) and the c-index was 0.612. Conclusion Serum Sodium, Serum High Density Lipids and Serum creatinine are useful predictors of lower limb stump. The clinical utility of these risk categories in the healing of a lower limb stump requires further clinical evaluation in a prospective study.
Development of prognostic model for fistula maturation in patients with advanced renal failure
(BioMed Central, 2018-03-07) Siddiqui, Muhammad A.; Ashraff, Suhel; Santos, Derek; Rush, Robert; Carline, Tom; Raza, Zahid
Background: This study aimed to explore the role of patient's characteristic and haematological factors as predictive on the maturation of arteriovenous fistulae in patients who underwent vascular access surgery at the Royal Infirmary of Edinburgh. Methods: Retrospective data from 300 patients who had undergone fistula creation between February 2007 and October 2010 was examined. A predictive logistic regression model was developed using the backward stepwise procedure. Model performance, discrimination and calibration, was assessed using the receiver operating characteristics (ROC) curve and Hosmer and Lemeshow goodness of fit test. Results: Three variables were identified which independently influenced fistula maturation. Males were twice as likely to undergo fistula maturation, compared to that of females (odds ratio (OR) 0.514; 95% confidence interval (CI) 0.308-0.857), patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula (OR 3.140; 95% CI 1.596-6.177) and a pre-operative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation compared to a vein size less than 2.5 mm (OR 4.532; 95% CI 2.063-9.958). The model for fistula maturation had fair discrimination as indicated by the area under the ROC curve (0.68; 95% CI 0.615-0. 738) but good calibration indicated by Hosmer and Lemeshow test (p = 0.79). Conclusion: Gender, PVD and vein size are independent predictors of arteriovenous fistula maturation. The clinical utility of these risk equation in the maturation of arteriovenous fistulae requires further validation in the newly treated patients.
Diabetic peripheral neuropathy, is it an autoimmune disease?
(2015-09-16) Janahi, Noor M.; Santos, Derek; Blyth, Christine; Bakhiet, Moiz; Ellis, Mairghread JH
Background: Autoimmunity has been identified in a significant number of neuropathies, such as, proximal neuropathies, and autonomic neuropathies associated with diabetes mellitus. However, possible correlations between diabetic peripheral neuropathy and autoimmunity have not yet been fully investigated. Objectives: This study was conducted to investigate whether autoimmunity is associated with the pathogenesis of human diabetic peripheral neuropathy. Research design and methods: A case-control analysis included three groups: 30 patients with diabetic peripheral neuropathy, 30 diabetic control patients without neuropathy, and 30 healthy controls. Blood analysis was conducted to compare the percentages of positive antinuclear antibodies (ANA) between the three groups. Secondary analysis investigated the correlations between the presence of autoimmune antibodies and sample demographics and neurological manifestations. This research was considered as a pilot study encouraging further investigations to take place in the near future. Results: Antinuclear antibodies were significantly present in the blood serum of patients with diabetic peripheral neuropathy in comparison to the control groups (p<. 0.001). The odds of positive values of ANA in the neuropathy group were 50 times higher when compared to control groups. Secondary analysis showed a significant correlation between the presence of ANA and the neurological manifestation of neuropathy (Neuropathy symptom score, Neuropathy disability score and Vibration Perception Threshold). Conclusion: The study demonstrated for the first time that human peripheral diabetic neuropathy may have an autoimmune aetiology. The new pathogenic factors may lead to the consideration of new management plans involving new therapeutic approaches and disease markers. 2015 Elsevier B.V.
Discrimination accuracy between real and sham needles using the Park sham device in the upper and lower limbs.
(2011-09-07) Tan, Chee-Wee; Sheehan, P.; Santos, Derek
Objective To evaluate the blinding effectiveness of the Park sham acupuncture device using participants' ability to discriminate between the real and sham acupuncture needles in the (1) upper limb (TE points) compared with pure guessing and (2) lower limb (BL points) compared with pure guessing. Methods 20 healthy acupuncture-naïve university students and staff were recruited through convenience sampling. Participants made Yes-No judgements on whether the real or sham needle was administered to four TE acupoints on the dominant upper limb, and four acupoints along the BL meridian on the dominant lower limb. The proportion of correct judgements, P(C), for each participant was calculated to indicate the discrimination accuracy of participants in distinguishing between the real and sham needles. Separate P(C) were computed for the upper limb acupoints and lower limb acupoints. The data were also pooled to calculate a P(C) for a combination of both body regions. Results The participants' discrimination accuracy between the real and sham needles was not statistically signifi cant from P(C)=0.5 (chance level) for the lower limb alone and combined body regions' acupoint comparisons (lower limb: t 19=0.00, unadjusted p=1.00; combined: t19=1.75, unadjusted p=0.10). However, the participants' discrimination accuracy was statistically signifi cant from P(C)=0.5 for the upper limb acupoints alone comparison (t 19=2.36, unadjusted p=0.03). Conclusions This study showed that the Park sham device is more likely to blind participants in differentiating between the real and sham needles in the lower limb (BL meridian) acupoints than in the upper limb (TE meridian). However, the participants' ability to differentiate between the needle types for the upper limb acupoints was signifi cantly different from chance levels