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Better diagnostic accuracy of neuropathy in obesity: A new challenge for neurologists.

ABSTRACT: OBJECTIVE:To determine the comparative diagnostic characteristics of neuropathy measures in an obese population. METHODS:We recruited obese participants from the University of Michigan's Weight Management Program. Receiver operative characteristic analysis determined the area under the curve (AUC) of neuropathy measures for distal symmetric polyneuropathy (DSP), small fiber neuropathy (SFN), and cardiovascular autonomic neuropathy (CAN). The best test combinations were determined using stepwise and Score subset selection models. RESULTS:We enrolled 120 obese participants. For DSP, seven of 42 neuropathy measures (Utah Early Neuropathy Score (UENS, N?=?62), Michigan Neuropathy Screening Instrument (MNSI) reduced combined index, MNSI examination, nerve fiber density (NFD) leg, tibial F response, MNSI questionnaire, peroneal distal motor latency) had AUCs???0.75. Three of 19 small fiber nerve measures for SFN (UENS, NFD leg, Sudoscan feet (N?=?70)) and zero of 16 CAN measures had AUCs???0.75. Combinations of tests performed better than individual tests with AUCs of 0.82 for DSP (two parameters) and 0.84 for SFN (three parameters). CONCLUSIONS:Many neuropathy measures demonstrate good test performance for DSP in obese participants. Select few small fiber nerve measures performed well for SFN, and none for CAN. SIGNIFICANCE:Specific combinations of tests should be used for research studies to maximize diagnostic performance in obese cohorts.

SUBMITTER: Callaghan BC

PROVIDER: S-EPMC5808853 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Better diagnostic accuracy of neuropathy in obesity: A new challenge for neurologists.

Callaghan Brian C BC Xia Rong R Reynolds Evan E Banerjee Mousumi M Burant Charles C Rothberg Amy A Pop-Busui Rodica R Villegas-Umana Emily E Feldman Eva L EL

Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology 20180116 3

<h4>Objective</h4>To determine the comparative diagnostic characteristics of neuropathy measures in an obese population.<h4>Methods</h4>We recruited obese participants from the University of Michigan's Weight Management Program. Receiver operative characteristic analysis determined the area under the curve (AUC) of neuropathy measures for distal symmetric polyneuropathy (DSP), small fiber neuropathy (SFN), and cardiovascular autonomic neuropathy (CAN). The best test combinations were determined ...[more]

PMID: 29414409

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Project description:BackgroundA major challenge in dengue management in resource limited settings is the confirmation of diagnosis. Clinical features of dengue often overlap with other infections and molecular diagnostic tools are not readily accessible to clinicians at hospitals. In addition, the prediction of plasma leakage in dengue is also difficult. Hematocrit level and ultrasound scans (combined with clinical parameters) are helpful to detect plasma leakage once it has happened, not before.MethodsColombo Dengue Study (CDS) is a prospective cohort study of clinically suspected adult dengue patients recruited from the National hospital of Sri Lanka (within the first 3?days of fever) that aimed to a) identify clinical and basic laboratory test parameters to differentiate dengue from non-dengue fever, b) evaluate the comparative efficacy of loop-mediated isothermal amplification (LAMP) for dengue diagnosis (vs. NS1 antigen test and RT-qPCR) and c) identify early associations that are predictive of plasma leakage or severe dengue. The basic laboratory tests considered here included hematological parameters, serum biochemistry and inflammatory markers.ResultsOnly 70% of clinically suspected patients were confirmed as having dengue by either the NS1 antigen test or RT-qPCR. On a Bayesian latent class model which assumes no "gold standard", LAMP performed equally or better than RT-qPCR and NS1 antigen test respectively. When confirmed dengue patients were compared with others, the earlier group had significantly lower lymphocyte counts and higher aspartate aminotransferase levels (AST) within the first 3?days of fever. Confirmed dengue patients with plasma leakage had a lower mean age and a higher median baseline AST level compared to those without plasma leakage (p?<?0.05).ConclusionClinical suspicion overestimates the true number of dengue patients. RT-LAMP is a potentially useful low-cost diagnostic tool for dengue diagnosis. Confirmed dengue patients had significantly higher AST levels and lower lymphocyte counts in early disease compared to others. In confirmed dengue patients, younger age and a higher AST level in early infection were associated with subsequent plasma leakage.

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Better diagnostic accuracy of neuropathy in obesity: A new challenge for neurologists.

Publications

Better diagnostic accuracy of neuropathy in obesity: A new challenge for neurologists.

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