This document discusses diabetic painful neuropathy, which requires attention due to its painful condition and wide spectrum of clinical syndromes. It describes various types of diabetic neuropathy including symmetrical distal polyneuropathies affecting small and large fibers, proximal motor neuropathies, and focal asymmetric neuropathies affecting specific areas. Symptoms, clinical features, and treatments for different types are outlined. Relief of pain is important, though current treatment options provide unsatisfactory relief and consist of analgesics, antidepressants, anticonvulsants, and capsaicin cream.
Peripheral Neuropathy Diabetic Connection? - A Critical AnalysisGraMedica
Peripheral nerve damage is blamed solely as a result of diabetes. This presentation takes a hard look at the evidence, asks and answers the hard questions to show that diabetes should be the last consideration after all other causes are eliminated.
Learn more at www.GraMedica.com.
Peripheral Neuropathy Diabetic Connection? - A Critical AnalysisGraMedica
Peripheral nerve damage is blamed solely as a result of diabetes. This presentation takes a hard look at the evidence, asks and answers the hard questions to show that diabetes should be the last consideration after all other causes are eliminated.
Learn more at www.GraMedica.com.
this presentation discusses pain pathways, definition and glossary of pain symptoms, classification of pain, pathogenesis, causes, diagnosis , types and treatment of neuropathic pain
illustrated with figures
Diabetic polyneuropathy
Diabetic polyneuropathy (DPN) is defined as peripheral nerve dysfunction. There are three main alterations involved in the pathologic changes of DPN: inflammation, oxidative stress, and mitochondrial dysfunction.
Neuropathic Pain
Causes, Mechanisms and Treatment of Neuropathic Pain
Presented to General Practitioners and Hospital Doctors in London
25th September 2007
Neuropathic Pain
Causes, Mechanisms and Treatment of Neuropathic Pain
Presented At Primed, QE2 Conference Centre, Westminster, London to National Audience of Primary Care Doctors
5th November 2009
this presentation discusses pain pathways, definition and glossary of pain symptoms, classification of pain, pathogenesis, causes, diagnosis , types and treatment of neuropathic pain
illustrated with figures
Diabetic polyneuropathy
Diabetic polyneuropathy (DPN) is defined as peripheral nerve dysfunction. There are three main alterations involved in the pathologic changes of DPN: inflammation, oxidative stress, and mitochondrial dysfunction.
Neuropathic Pain
Causes, Mechanisms and Treatment of Neuropathic Pain
Presented to General Practitioners and Hospital Doctors in London
25th September 2007
Neuropathic Pain
Causes, Mechanisms and Treatment of Neuropathic Pain
Presented At Primed, QE2 Conference Centre, Westminster, London to National Audience of Primary Care Doctors
5th November 2009
Guillain-Barré syndrome (GBS) can be described as a collection of clinical syndromes that manifests as an acute inflammatory polyradiculoneuropathy with resultant weakness and diminished reflexes.
Although the classic description of GBS is that of a demyelinating neuropathy with ascending weakness, many clinical variants have been well documented in the medical literature.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
2. Diabetic painful neuropathy
This is a definite subset of diabetic
neuropathy and requires more attention
owing to its painful condition, disability and
wide spectrum of clinical syndrome
3. Diabetic painful neuropathy
Comprises of clinical syndromes like acute
painful neuropathy, chronic sensorimotor
neuropathy, proximal painful symmetrical
motor neuropathy, proximal painful
asymmetrical motor neuropathy (diabetic
amyotrophy) painful diabetic external
ophthalmoplegia, treatment induced insulin
neuritis, hypoglycaemic neuritis and
painful painless leg .
4. Diabetic painful neuropathy
* Pain is a feature of small fiber neuropathy.
The small fibers also carry autonomic
impulses.
* It seems logical to expect increased
incidence of autonomic denervation in
painful diabetic neuropathies
5. Diabetic painful neuropathy
Relief of pain is of paramount importance and
obligatory on the part of physician.
But the state of the art of pain relief in this
syndrome is far from satisfactory.
Many modalities of treatment have been
advocated but the arena of therapy is full of
claims and counter claims.
6. Diabetic painful neuropathy
* These modalities range from simple
analgesic to most modern aldolase
reductase inhibitors
* In the national context, pain relief must be
obtained by simple measures
7. Clinical types of painful diabetic
neuropathy - 1
Although a rigid classification of painful
diabetic neuropathy is very difficult they may
be grouped under following three major
categories
1. Symmetrical distal painful poly-
neuropathies
2. Proximal motor neuropathies
3. Focal asymmetrical painful neuropathies
8. Clinical types of painful diabetic
neuropathy - 2
Symmetrical distal painful polineuropathies
may be grouped as
1. Small fibre type
2. Mixed large and small fibre type
3. Hypoglycaemic neuropathy/insulin neuritis
4. Mixed distal sensory-motor neuropathy
9. Clinical types of painful diabetic
neuropathy - 3
Proximal motor neuropathies can be divided
into two groups
1. Symmetrical proximal motor neuropathy
2. Asymmetrical proximal motor neuropathy
- diabetic amyotrophy
10. Focal asymmetric neuropathies-1
1. Predominantly sensory:
a) Intercostal Neuropathy
b) Truncal neuropathy
c) Thoraco-abdominal radiculopathy
d) Neuropathy due to involvement of lateral
cutaneous nerve of thigh
11. Focal asymmetric neuropathies-2
Predominantly motor:
Mononeuritis or mononeuritis
Multiplex which may include -
a) Ocular neuropathy
b) Femoral neuropathy
c) Sciatic neuropathy
d) Median neuropathy
13. Distal polyneuropathies
a) Acute sensory neuropathy
b) Chronic sensory motor neuropathies
c) Proximal motor neuropathies
d) Truncal polyneuropathy
14. Symmetrical distal
polyneuropathies - 1
Small fibre type:
* In small fibre type neuropathy
* Pain and paraesthesis, most commonly of
the lower extremities are the characteristic
symptoms
* Pain - dull, burning, aching, lancinating,
crushing and cramp-like
15. Symmetrical distal
polyneuropathies - 1
Paraesthesia may manifest as a sensation of
coldness, numbness, tingling or burning
On exam - dysesthesia and calf tenderness
16. Symmetrical distal
polyneuropathies - 3
* In addition - diminished pain and
temperature perception in the lower
extremity with less involvement of reflex
and position and vibratory sensation
* Autonomic dysfunction most prevalent
17. Diabetic neuropathic cachexia:
* Outstanding symptoms - weight loss and
severe pain
* Emotional disturbance
* Anorexia
* Impotence
* Mild diabetes
* Simultaneous onset of diabetes and
neuropathy
18. Painful-painless leg
* Patient experience pain or paraesthesia
* On neurological examination - pain
sensation absent
* Such patients are at greatest risk of painless
injury to the feet
19. Hypoglycemic neuropathy /
insulin neuritis
* Hypoglycaemia is rare - but treatable
* Usually presents symmetrical motor,
sensory or mixed neuropathies of uncertain
aetiology
* Distal symmetrical symptoms
* More common in nondiabetic patients
subjected to insulin shock therapy
20. Mixed distal sensory motor
neuropathies
* Usually occur in middle aged and elderly
with type 2 diabetes
There are two entities
1. Subacute proximal neuropathy of insidious
onset
2. Ischaemic mononeuropathy multiplex of
acute onset
21. Focal asymmetrical diabetic
neuropathy
* Intercostal neuropathy
* Middle aged or older patients
* Present with longstanding diabetes with
abrupt onset of unilateral pain
* Associated with peripheral sensory
neuropathy,weight loss and worsening of
pain at night
* Condition recovers in 3 months
22. Truncal neuropathy - 1
* Pain in the trunk
* Abdominal bulge causing muscle weakness
* Clinical features suggestive of malignant
disease
* Electromyography reveals correct diagnosis
* Spontaneous and complete recovery
23. Truncal neuropathy - 2
* Most diabetic with this syndrome are in 5th
or 6th decade of life
* Associated with weight loss, beginning with
the onset of pain
* Denervation of paraspinal muscles present
* Lesion is proximal, either in the nerve roots
or the spinal nerves
24. Truncal neuropathy - 3
* Spinal cord compression should be
excluded by appropriate investigations
* Caused by ischaemic infarction of nerve
* No pathological evaluation of involved
intercostal nerve has been reported
25. Truncal neuropathy - 4
* Involvement of lateral cutaneous nerve may
present with sensory disturbance in thigh
* Usually asymmetrical without motor deficit
* Recover spontaneously
26. Cranial neuropathy
* With the exception of pupillary
sparing,disruption of oculomotor nerve
function – most frequent
* Recovery usually occurs within 6-12 weeks
* Lower cranial nerves can get involved.
* Internuclear opthalmoplegia
27. Drugs used in painful diabetic
neuropathy - 1
* Non steroidal anti inflammatory agents
* Ibuprofen 600mg four times daily
* Sulindac 200 mg twice daily
28. Drugs used in painful diabetic
neuropathy - 2
* Carbamazepine upto 200 mg q 6h
* Amitryphyline-fluphenazine combination
* Gabapentin 900 mg q 8h
* Whereas lignocaine and phenytoin failed to
do so
* Mexiteline 150 mg – 450 mg / day
29. Drugs used in painful diabetic
neuropathy - 3
Tricyclic antidepressant drugs:
Amitriptyline 50-150 mg at night
* Nortriptyline 50-150 mg at night
* Imipramine 100 mg daily
* Paroxetine 40 mg daily
Other drugs: Capsaicin 0.075% q 6h
Fluphenazine 1 mg/day