Diabetic neuropathy is a major cause of neuropathy worldwide and may lead to amputations and incapacity. This study aimed at a detailed and updated review on diabetic neuropathy, focusing on its epidemiology, classification, clinical features, risk factor, diagnostic investigation and treatment. Dr. Siva Rami Reddy E "A Basic Review on Diabetic Neuropathy" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21391.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/21391/a--basic-review-on-diabetic-neuropathy/dr-siva-rami-reddy-e
Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged.This damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems
Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged.This damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems
Myelitis is a spinal disorder. Myelitis is the infection of the white matter of spinal cord. White matter of spinal cord is a part of the central nervous system that functions as a bridge between the brain and the rest of the body.
Myelitis can result in muscle weakness or paralyzing legs and then arms.
A case of Neuromyelitis optica as a presenting manifestation of Systemic Lupu...Apollo Hospitals
Neuromyelitis optica (NMO) is a well characterised, autoimmune, clinicopathological syndrome, which is uncommon and occurs as an isolated entity. Unlike multiple sclerosis, in NMO, the autoimmunity is humorally mediated and the recent availability of Antiaquaporin antibody testing has increased the positive diagnosis of this condition. NMO can also occur in patients with established Systemic Lupus Erythematosis (SLE) who have multiple autoantibodies. The presence of Antiaquaporin antibody is specific for NMO and is seen in patients with SLE who develop inflammatory CNS disease. However, Neuromyelitis optica occurring as a presenting manifestation of SLE is extremely rare and we report one such case.
Myelitis is a spinal disorder. Myelitis is the infection of the white matter of spinal cord. White matter of spinal cord is a part of the central nervous system that functions as a bridge between the brain and the rest of the body.
Myelitis can result in muscle weakness or paralyzing legs and then arms.
A case of Neuromyelitis optica as a presenting manifestation of Systemic Lupu...Apollo Hospitals
Neuromyelitis optica (NMO) is a well characterised, autoimmune, clinicopathological syndrome, which is uncommon and occurs as an isolated entity. Unlike multiple sclerosis, in NMO, the autoimmunity is humorally mediated and the recent availability of Antiaquaporin antibody testing has increased the positive diagnosis of this condition. NMO can also occur in patients with established Systemic Lupus Erythematosis (SLE) who have multiple autoantibodies. The presence of Antiaquaporin antibody is specific for NMO and is seen in patients with SLE who develop inflammatory CNS disease. However, Neuromyelitis optica occurring as a presenting manifestation of SLE is extremely rare and we report one such case.
Diabetic neuropathy is one of the major complications in patients with type-1 and type-2 Diabetic Mellitus (DM). Th is disorder is the main contributing factor to the increased risk of foot ulceration an amputation in such patients [1], together with higher mortality rate as well as a huge economic burden. In older adults with type-2 DM, the risk of falling is higher than those without DM, resulting in deleterious consequences such as hospitalization and injury-related death: neuropathy is strongly linked to falling.
Segmentation and Classification for Hyperspectral Imaging of Foot Inspection ...ijtsrd
Diabetes Mellitus DM and Diabetic Neuropathy DN are the most common diseases in the worldwide, according to the World Health Organization WHO . A high index of death is also correlated with it. Diabetic neuropathy is a significant worldwide cause of neuropathy which can lead to amputations and disabilities. Diabetic neuropathy can have multiple clinical manifestations, the most common presentation being distal symmetric polyneuropathy and the key mechanism for diabetic foot development. One of the major problems is diabetic foot, which includes the creation of plantar foot hyper spectral which may result in amputation. Several studies report that hyperspectral is helpful in identifying differences in plantar temperature, which may lead to a higher risk of ulceration. However, in diabetic patients, the distribution of plantar temperature does not follow a standard sequence, thereby making it impossible to quantify the changes. There is also an importance in enhancing the performance of the methods of analysis and classification that help to diagnose abnormal variations in the temperature of the plantar. All this refers to the use of computer aided programmes that work with extremely structured data structures, such as those involved in artificial intelligence AI . This study combines approaches based on machine learning with Deep Learning DL structures. Furthermore, we developed a new DL structure, which is qualified and is able to achieve higher significance in terms of precision and other quality metrics. The key purpose of this study is to examine the use of AI and DL for the classification of hyperspectral images of the diabetic foot, demonstrating its advantages and disadvantages. To the best of our understanding, this is the first suggestion for the definition of diabetic foot hyperspectral implemented by DL networks. The studies are carried out in DM and control groups through hyperspectral images. Afterwards, based on a pre reported hyperspectral shift index, a multi level classification is done. The high precision attained illustrates the utility of AI and DL as auxiliary instruments to help in medical diagnosis. The aim of this study was to perform a systematic and updated analysis of diabetic neuropathy, concentrating on its classification, diagnostic research and treatment. Dr. C. Yesubai Rubhavathi | Diofrin. J | Eben Paul Richard. S | Arunachalam. R | Vishnu Durga. S "Segmentation and Classification for Hyperspectral Imaging of Foot Inspection in Vascular and Neuro Images" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-1 , February 2023, URL: https://www.ijtsrd.com/papers/ijtsrd52793.pdf Paper URL: https://www.ijtsrd.com/engineering/computer-engineering/52793/segmentation-and-classification-for-hyperspectral-imaging-of-foot-inspection-in-vascular-and-neuro-images/dr-c-yesubai-rubhavathi
Diabetes-related Clinical Complications: Novel Approaches for Diagnosis and M...asclepiuspdfs
Metabolic diseases such as hypertension, obesity, diabetes, and vascular diseases have reached epidemic proportions worldwide. In the past four decades, childhood and adolescent obesity has increased four-fold worldwide. During the same period, obesity in adults has doubled and diabetes has increased by four-fold. In China, India, and the USA, the number of prediabetes is more than diabetics. This population is at considerable risk for developing diabetes, its clinical complications, and acute vascular events. The management of modifiable risks for cardiometabolic risks has improved considerably. Several major studies have demonstrated, that robust management of modifiable risks for cardiovascular diseases (CVDs), significantly reduces premature mortality from CVDs. Considering the progress made in the risk assessment, risk management, we feel strongly, that not much progress is made in the areas of primary prevention and early risk assessment, for clinical complications associated with metabolic diseases, in particular, diabetes. The majority of the clinical complications associated with diabetes are due to dysfunction of the vascular system or nervous system. Complications include vasculopathy leading to subclinical atherosclerosis, heart attacks, and stroke.
Objective: Diabetic nephropathy is one of the most serious complications of diabetes mellitus. It develops in approximately one-third of diabetic patients, years after the onset of metabolic abnormalities.
Study Design: The biopsy specimens were evaluated with the focus on light microscopy. The aim of our study was to reveal differences in the details and the frequency of occurrence of individual histomorphological changes in diabetic nephropathy and other glomerulonephritides.
Results: Diabetic nephropathy accounted for 14 out of 82 analyzed biopsies. Isolated thickening of the glomerular basement membrane was not present in any case, but along with some degree of mesangial expansion, hypercellularity or glomerulosclerosis was seen in 12 out of 14 findings of diabetic nephropathy. In other glomerular diseases, mesangial changes, but without glomerular basement membrane thickening, were the most frequent findings. In addition to glomerular lesions, some of the tubular, interstitial, and vascular changes were seen in 13 out of 14 patients with diabetic nephropathy. In other glomerulonephritides the combination of all these changes was a rare finding.
Conclusion: There are cases where immunofluorescence and electron microscopy cannot be performed or their results are not helpful. In such cases we must rely on light microscopic histomorphological changes.
Rheumatic Manifestations in Diabetes Mellitus PatientsApollo Hospitals
Rheumatic manifestations of DM are the commonest of all
described endocrine rheumatic manifestations. These manifestations have generally been under-recognized and poorly treated, compared to the other complications, such as neuropathy, nephropathy and retinopathy. These manifestations, involve not only the joints, but also the soft tissues and the bones. In 2004, the National Health Interview Survey in US determined that 58%of diabetic patients will develop functional disability.The percentage of diabetic patients with functional disability will increase as the number of diabetic patients increases.Recent data reveals that the prevalence of rheumatic manifestations in the hands and shoulders in patientswith type 1 or type 2 diabetes is 30%.3These manifestations are closely
linked to age,4 prolonged disease duration,5,6 and vascular
complications like retinopathy.7
‘Six Sigma Technique’ A Journey Through its Implementationijtsrd
The manufacturing industries all over the world are facing tough challenges for growth, development and sustainability in today’s competitive environment. They have to achieve apex position by adapting with the global competitive environment by delivering goods and services at low cost, prime quality and better price to increase wealth and consumer satisfaction. Cost Management ensures profit, growth and sustainability of the business with implementation of Continuous Improvement Technique like Six Sigma. This leads to optimize Business performance. The method drives for customer satisfaction, low variation, reduction in waste and cycle time resulting into a competitive advantage over other industries which did not implement it. The main objective of this paper ‘Six Sigma Technique A Journey Through Its Implementation’ is to conceptualize the effectiveness of Six Sigma Technique through the journey of its implementation. Aditi Sunilkumar Ghosalkar "‘Six Sigma Technique’: A Journey Through its Implementation" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64546.pdf Paper Url: https://www.ijtsrd.com/other-scientific-research-area/other/64546/‘six-sigma-technique’-a-journey-through-its-implementation/aditi-sunilkumar-ghosalkar
Edge Computing in Space Enhancing Data Processing and Communication for Space...ijtsrd
Edge computing, a paradigm that involves processing data closer to its source, has gained significant attention for its potential to revolutionize data processing and communication in space missions. With the increasing complexity and data volume generated by modern space missions, traditional centralized computing approaches face challenges related to latency, bandwidth, and security. Edge computing in space, involving on board processing and analysis of data, offers promising solutions to these challenges. This paper explores the concept of edge computing in space, its benefits, applications, and future prospects in enhancing space missions. Manish Verma "Edge Computing in Space: Enhancing Data Processing and Communication for Space Missions" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64541.pdf Paper Url: https://www.ijtsrd.com/computer-science/artificial-intelligence/64541/edge-computing-in-space-enhancing-data-processing-and-communication-for-space-missions/manish-verma
Dynamics of Communal Politics in 21st Century India Challenges and Prospectsijtsrd
Communal politics in India has evolved through centuries, weaving a complex tapestry shaped by historical legacies, colonial influences, and contemporary socio political transformations. This research comprehensively examines the dynamics of communal politics in 21st century India, emphasizing its historical roots, socio political dynamics, economic implications, challenges, and prospects for mitigation. The historical perspective unravels the intricate interplay of religious identities and power dynamics from ancient civilizations to the impact of colonial rule, providing insights into the evolution of communalism. The socio political dynamics section delves into the contemporary manifestations, exploring the roles of identity politics, socio economic disparities, and globalization. The economic implications section highlights how communal politics intersects with economic issues, perpetuating disparities and influencing resource allocation. Challenges posed by communal politics are scrutinized, revealing multifaceted issues ranging from social fragmentation to threats against democratic values. The prospects for mitigation present a multifaceted approach, incorporating policy interventions, community engagement, and educational initiatives. The paper conducts a comparative analysis with international examples, identifying common patterns such as identity politics and economic disparities. It also examines unique challenges, emphasizing Indias diverse religious landscape, historical legacy, and secular framework. Lessons for effective strategies are drawn from international experiences, offering insights into inclusive policies, interfaith dialogue, media regulation, and global cooperation. By scrutinizing historical epochs, contemporary dynamics, economic implications, and international comparisons, this research provides a comprehensive understanding of communal politics in India. The proposed strategies for mitigation underscore the importance of a holistic approach to foster social harmony, inclusivity, and democratic values. Rose Hossain "Dynamics of Communal Politics in 21st Century India: Challenges and Prospects" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64528.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/history/64528/dynamics-of-communal-politics-in-21st-century-india-challenges-and-prospects/rose-hossain
Assess Perspective and Knowledge of Healthcare Providers Towards Elehealth in...ijtsrd
Background and Objective Telehealth has become a well known tool for the delivery of health care in Saudi Arabia, and the perspective and knowledge of healthcare providers are influential in the implementation, adoption and advancement of the method. This systematic review was conducted to examine the current literature base regarding telehealth and the related healthcare professional perspective and knowledge in the Kingdom of Saudi Arabia. Materials and Methods This systematic review was conducted by searching 7 databases including, MEDLINE, CINHAL, Web of Science, Scopus, PubMed, PsycINFO, and ProQuest Central. Studies on healthcare practitioners telehealth knowledge and perspectives published in English in Saudi Arabia from 2000 to 2023 were included. Boland directed this comprehensive review. The researchers examined each connected study using the AXIS tool, which evaluates cross sectional systematic reviews. Narrative synthesis was used to summarise and convey the data. Results Out of 1840 search results, 10 studies were included. Positive outlook and limited knowledge among providers were seen across trials. Healthcare professionals like telehealth for its ability to improve quality, access, and delivery, save time and money, and be successful. Age, gender, occupation, and work experience also affect health workers knowledge. In Saudi Arabia, healthcare professionals face inadequate expert assistance, patient privacy, internet connection concerns, lack of training courses, lack of telehealth understanding, and high costs while performing telemedicine. Conclusions Healthcare practitioners telehealth perceptions and knowledge were examined in this systematic study. Its collection of concerned experts different personal attitudes and expertise would help enhance telehealths implementation in Saudi Arabia, develop its healthcare delivery alternative, and eliminate frequent problems. Badriah Mousa I Mulayhi | Dr. Jomin George | Judy Jenkins "Assess Perspective and Knowledge of Healthcare Providers Towards Elehealth in Saudi Arabia: A Systematic Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64535.pdf Paper Url: https://www.ijtsrd.com/medicine/other/64535/assess-perspective-and-knowledge-of-healthcare-providers-towards-elehealth-in-saudi-arabia-a-systematic-review/badriah-mousa-i-mulayhi
The Impact of Digital Media on the Decentralization of Power and the Erosion ...ijtsrd
The impact of digital media on the distribution of power and the weakening of traditional gatekeepers has gained considerable attention in recent years. The adoption of digital technologies and the internet has resulted in declining influence and power for traditional gatekeepers such as publishing houses and news organizations. Simultaneously, digital media has facilitated the emergence of new voices and players in the media industry. Digital medias impact on power decentralization and gatekeeper erosion is visible in several ways. One significant aspect is the democratization of information, which enables anyone with an internet connection to publish and share content globally, leading to citizen journalism and bypassing traditional gatekeepers. Another aspect is the disruption of conventional media industry business models, as traditional organizations struggle to adjust to the decrease in advertising revenue and the rise of digital platforms. Alternative business models, such as subscription models and crowdfunding, have become more prevalent, leading to the emergence of new players. Overall, the impact of digital media on the distribution of power and the weakening of traditional gatekeepers has brought about significant changes in the media landscape and the way information is shared. Further research is required to fully comprehend the implications of these changes and their impact on society. Dr. Kusum Lata "The Impact of Digital Media on the Decentralization of Power and the Erosion of Traditional Gatekeepers" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64544.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/political-science/64544/the-impact-of-digital-media-on-the-decentralization-of-power-and-the-erosion-of-traditional-gatekeepers/dr-kusum-lata
Online Voices, Offline Impact Ambedkars Ideals and Socio Political Inclusion ...ijtsrd
This research investigates the nexus between online discussions on Dr. B.R. Ambedkars ideals and their impact on social inclusion among college students in Gurugram, Haryana. Surveying 240 students from 12 government colleges, findings indicate that 65 actively engage in online discussions, with 80 demonstrating moderate to high awareness of Ambedkars ideals. Statistically significant correlations reveal that higher online engagement correlates with increased awareness p 0.05 and perceived social inclusion. Variations across colleges and a notable effect of college type on perceived social inclusion highlight the influence of contextual factors. Furthermore, the intersectional analysis underscores nuanced differences based on gender, caste, and socio economic status. Dr. Kusum Lata "Online Voices, Offline Impact: Ambedkar's Ideals and Socio-Political Inclusion - A Study of Gurugram District" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64543.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/political-science/64543/online-voices-offline-impact-ambedkars-ideals-and-sociopolitical-inclusion--a-study-of-gurugram-district/dr-kusum-lata
Problems and Challenges of Agro Entreprenurship A Studyijtsrd
Noting calls for contextualizing Agro entrepreneurs problems and challenges of the agro entrepreneurs and for greater attention to the Role of entrepreneurs in agro entrepreneurship research, we conduct a systematic literature review of extent research in agriculture entrepreneurship to overcome the study objectives of complications of agro entrepreneurs through various factors, Development of agriculture products is a key factor for the overall economic growth of agro entrepreneurs Agro Entrepreneurs produces firsthand large scale employment, utilizes the labor and natural resources, This research outlines the problems of Weather and Soil Erosions, Market price fluctuation, stimulates labor cost problems, reduces concentration of Price volatility, Dependency on Intermediaries, induces Limited Bargaining Power, and Storage and Transportation Costs. This paper mainly devoted to highlight Problems and challenges faced for the sustainable of Agro Entrepreneurs in India. Vinay Prasad B "Problems and Challenges of Agro Entreprenurship - A Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64540.pdf Paper Url: https://www.ijtsrd.com/other-scientific-research-area/other/64540/problems-and-challenges-of-agro-entreprenurship--a-study/vinay-prasad-b
Comparative Analysis of Total Corporate Disclosure of Selected IT Companies o...ijtsrd
Disclosure is a process through which a business enterprise communicates with external parties. A corporate disclosure is communication of financial and non financial information of the activities of a business enterprise to the interested entities. Corporate disclosure is done through publishing annual reports. So corporate disclosure through annual reports plays a vital role in the life of all the companies and provides valuable information to investors. The basic objectives of corporate disclosure is to give a true and fair view of companies to the parties related either directly or indirectly like owner, government, creditors, shareholders etc. in the companies act, provisions have been made about mandatory and voluntary disclosure. The IT sector in India is rapidly growing, the trend to invest in the IT sector is rising and employment opportunities in IT sectors are also increasing. Therefore the IT sector is expected to have fair, full and adequate disclosure of all information. Unfair and incomplete disclosure may adversely affect the entire economy. A research study on disclosure practices of IT companies could play an important role in this regard. Hence, the present research study has been done to study and review comparative analysis of total corporate disclosure of selected IT companies of India and to put forward overall findings and suggestions with a view to increase disclosure score of these companies. The researcher hopes that the present research study will be helpful to all selected Companies for improving level of corporate disclosure through annual reports as well as the government, creditors, investors, all business organizations and upcoming researcher for comparative analyses of level of corporate disclosure with special reference to selected IT companies. Dr. Vaibhavi D. Thaker "Comparative Analysis of Total Corporate Disclosure of Selected IT Companies of India" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64539.pdf Paper Url: https://www.ijtsrd.com/other-scientific-research-area/other/64539/comparative-analysis-of-total-corporate-disclosure-of-selected-it-companies-of-india/dr-vaibhavi-d-thaker
The Impact of Educational Background and Professional Training on Human Right...ijtsrd
This study investigated the impact of educational background and professional training on human rights awareness among secondary school teachers in the Marathwada region of Maharashtra, India. The key findings reveal that higher levels of education, particularly a master’s degree, and fields of study related to education, humanities, or social sciences are associated with greater human rights awareness among teachers. Additionally, both pre service teacher training and in service professional development programs focused on human rights education significantly enhance teacher’s knowledge, skills, and competencies in promoting human rights principles in their classrooms. Baig Ameer Bee Mirza Abdul Aziz | Dr. Syed Azaz Ali Amjad Ali "The Impact of Educational Background and Professional Training on Human Rights Awareness among Secondary School Teachers" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64529.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/education/64529/the-impact-of-educational-background-and-professional-training-on-human-rights-awareness-among-secondary-school-teachers/baig-ameer-bee-mirza-abdul-aziz
A Study on the Effective Teaching Learning Process in English Curriculum at t...ijtsrd
“One Language sets you in a corridor for life. Two languages open every door along the way” Frank Smith English as a foreign language or as a second language has been ruling in India since the period of Lord Macaulay. But the question is how much we teach or learn English properly in our culture. Is there any scope to use English as a language rather than a subject How much we learn or teach English without any interference of mother language specially in the classroom teaching learning scenario in West Bengal By considering all these issues the researcher has attempted in this article to focus on the effective teaching learning process comparing to other traditional strategies in the field of English curriculum at the secondary level to investigate whether they fulfill the present teaching learning requirements or not by examining the validity of the present curriculum of English. The purpose of this study is to focus on the effectiveness of the systematic, scientific, sequential and logical transaction of the course between the teachers and the learners in the perspective of the 5Es programme that is engage, explore, explain, extend and evaluate. Sanchali Mondal | Santinath Sarkar "A Study on the Effective Teaching Learning Process in English Curriculum at the Secondary Level of West Bengal" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd62412.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/education/62412/a-study-on-the-effective-teaching-learning-process-in-english-curriculum-at-the-secondary-level-of-west-bengal/sanchali-mondal
The Role of Mentoring and Its Influence on the Effectiveness of the Teaching ...ijtsrd
This paper reports on a study which was conducted to investigate the role of mentoring and its influence on the effectiveness of the teaching of Physics in secondary schools in the South West Region of Cameroon. The study adopted the convergent parallel mixed methods design, focusing on respondents in secondary schools in the South West Region of Cameroon. Both quantitative and qualitative data were collected, analysed separately, and the results were compared to see if the findings confirm or disconfirm each other. The quantitative analysis found that majority of the respondents 72 of Physics teachers affirmed that they had more experienced colleagues as mentors to help build their confidence, improve their teaching, and help them improve their effectiveness and efficiency in guiding learners’ achievements. Only 28 of the respondents disagreed with these statements. With majority respondents 72 agreeing with the statements, it implies that in most secondary schools, experienced Physics teachers act as mentors to build teachers’ confidence in teaching and improving students’ learning. The interview qualitative data analysis summarized how secondary school Principals use meetings with mentors and mentees to promote mentorship in the school milieu. This has helped strengthen teachers’ classroom practices in secondary schools in the South West Region of Cameroon. With the results confirming each other, the study recommends that mentoring should focus on helping teachers employ social interactions and instructional practices feedback and clarity in teaching that have direct measurable impact on students’ learning achievements. Andrew Ngeim Sumba | Frederick Ebot Ashu | Peter Agborbechem Tambi "The Role of Mentoring and Its Influence on the Effectiveness of the Teaching of Physics in Secondary Schools in the South West Region of Cameroon" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64524.pdf Paper Url: https://www.ijtsrd.com/management/management-development/64524/the-role-of-mentoring-and-its-influence-on-the-effectiveness-of-the-teaching-of-physics-in-secondary-schools-in-the-south-west-region-of-cameroon/andrew-ngeim-sumba
Design Simulation and Hardware Construction of an Arduino Microcontroller Bas...ijtsrd
This study primarily focuses on the design of a high side buck converter using an Arduino microcontroller. The converter is specifically intended for use in DC DC applications, particularly in standalone solar PV systems where the PV output voltage exceeds the load or battery voltage. To evaluate the performance of the converter, simulation experiments are conducted using Proteus Software. These simulations provide insights into the input and output voltages, currents, powers, and efficiency under different state of charge SoC conditions of a 12V,70Ah rechargeable lead acid battery. Additionally, the hardware design of the converter is implemented, and practical data is collected through operation, monitoring, and recording. By comparing the simulation results with the practical results, the efficiency and performance of the designed converter are assessed. The findings indicate that while the buck converter is suitable for practical use in standalone PV systems, its efficiency is compromised due to a lower output current. Chan Myae Aung | Dr. Ei Mon "Design Simulation and Hardware Construction of an Arduino-Microcontroller Based DC-DC High-Side Buck Converter for Standalone PV System" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64518.pdf Paper Url: https://www.ijtsrd.com/engineering/mechanical-engineering/64518/design-simulation-and-hardware-construction-of-an-arduinomicrocontroller-based-dcdc-highside-buck-converter-for-standalone-pv-system/chan-myae-aung
Sustainable Energy by Paul A. Adekunte | Matthew N. O. Sadiku | Janet O. Sadikuijtsrd
Energy becomes sustainable if it meets the needs of the present without compromising the ability of future generations to meet their own needs. Some of the definitions of sustainable energy include the considerations of environmental aspects such as greenhouse gas emissions, social, and economic aspects such as energy poverty. Generally far more sustainable than fossil fuel are renewable energy sources such as wind, hydroelectric power, solar, and geothermal energy sources. Worthy of note is that some renewable energy projects, like the clearing of forests to produce biofuels, can cause severe environmental damage. The sustainability of nuclear power which is a low carbon source is highly debated because of concerns about radioactive waste, nuclear proliferation, and accidents. The switching from coal to natural gas has environmental benefits, including a lower climate impact, but could lead to delay in switching to more sustainable options. “Carbon capture and storage” can be built into power plants to remove the carbon dioxide CO2 emissions, but this technology is expensive and has rarely been implemented. Leading non renewable energy sources around the world is fossil fuels, coal, petroleum, and natural gas. Nuclear energy is usually considered another non renewable energy source, although nuclear energy itself is a renewable energy source, but the material used in nuclear power plants is not. The paper addresses the issue of sustainable energy, its attendant benefits to the future generation, and humanity in general. Paul A. Adekunte | Matthew N. O. Sadiku | Janet O. Sadiku "Sustainable Energy" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64534.pdf Paper Url: https://www.ijtsrd.com/engineering/electrical-engineering/64534/sustainable-energy/paul-a-adekunte
Concepts for Sudan Survey Act Implementations Executive Regulations and Stand...ijtsrd
This paper aims to outline the executive regulations, survey standards, and specifications required for the implementation of the Sudan Survey Act, and for regulating and organizing all surveying work activities in Sudan. The act has been discussed for more than 5 years. The Land Survey Act was initiated by the Sudan Survey Authority and all official legislations were headed by the Sudan Ministry of Justice till it was issued in 2022. The paper presents conceptual guidelines to be used for the Survey Act implementation and to regulate the survey work practice, standardizing the field surveys, processing, quality control, procedures, and the processes related to survey work carried out by the stakeholders and relevant authorities in Sudan. The conceptual guidelines are meant to improve the quality and harmonization of geospatial data and to aid decision making processes as well as geospatial information systems. The established comprehensive executive regulations will govern and regulate the implementation of the Sudan Survey Geomatics Act in all surveying and mapping practices undertaken by the Sudan Survey Authority SSA and state local survey departments for public or private sector organizations. The targeted standards and specifications include the reference frame, projection, coordinate systems, and the guidelines and specifications that must be followed in the field of survey work, processes, and mapping products. In the last few decades, there has been a growing awareness of the importance of geomatics activities and measurements on the Earths surface in space and time, together with observing and mapping the changes. In such cases, data must be captured promptly, standardized, and obtained with more accuracy and specified in much detail. The paper will also highlight the current situation in Sudan, the degree to which survey standards are used, the problems encountered, and the errors that arise from not using the standards and survey specifications. Kamal A. A. Sami "Concepts for Sudan Survey Act Implementations - Executive Regulations and Standards" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd63484.pdf Paper Url: https://www.ijtsrd.com/engineering/civil-engineering/63484/concepts-for-sudan-survey-act-implementations--executive-regulations-and-standards/kamal-a-a-sami
Towards the Implementation of the Sudan Interpolated Geoid Model Khartoum Sta...ijtsrd
The discussions between ellipsoid and geoid have invoked many researchers during the recent decades, especially during the GNSS technology era, which had witnessed a great deal of development but still geoid undulation requires more investigations. To figure out a solution for Sudans local geoid, this research has tried to intake the possibility of determining the geoid model by following two approaches, gravimetric and geometrical geoid model determination, by making use of GNSS leveling benchmarks at Khartoum state. The Benchmarks are well distributed in the study area, in which, the horizontal coordinates and the height above the ellipsoid have been observed by GNSS while orthometric heights were carried out using precise leveling. The Global Geopotential Model GGM represented in EGM2008 has been exploited to figure out the geoid undulation at the benchmarks in the study area. This is followed by a fitting process, that has been done to suit the geoid undulation data which has been computed using GNSS leveling data and geoid undulation inspired by the EGM2008. Two geoid surfaces were created after the fitting process to ensure that they are identical and both of them could be counted for getting the same geoid undulation with an acceptable accuracy. In this respect, statistical operation played an important role in ensuring the consistency and integrity of the model by applying cross validation techniques splitting the data into training and testing datasets for building the geoid model and testing its eligibility. The geometrical solution for geoid undulation computation has been utilized by applying straightforward equations that facilitate the calculation of the geoid undulation directly through applying statistical techniques for the GNSS leveling data of the study area to get the common equation parameters values that could be utilized to calculate geoid undulation of any position in the study area within the claimed accuracy. Both systems were checked and proved eligible to be used within the study area with acceptable accuracy which may contribute to solving the geoid undulation problem in the Khartoum area, and be further generalized to determine the geoid model over the entire country, and this could be considered in the future, for regional and continental geoid model. Ahmed M. A. Mohammed. | Kamal A. A. Sami "Towards the Implementation of the Sudan Interpolated Geoid Model (Khartoum State Case Study)" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd63483.pdf Paper Url: https://www.ijtsrd.com/engineering/civil-engineering/63483/towards-the-implementation-of-the-sudan-interpolated-geoid-model-khartoum-state-case-study/ahmed-m-a-mohammed
Activating Geospatial Information for Sudans Sustainable Investment Mapijtsrd
Sudan is witnessing an acceleration in the processes of development and transformation in the performance of government institutions to raise the productivity and investment efficiency of the government sector. The development plans and investment opportunities have focused on achieving national goals in various sectors. This paper aims to illuminate the path to the future and provide geospatial data and information to develop the investment climate and environment for all sized businesses, and to bridge the development gap between the Sudan states. The Sudan Survey Authority SSA is the main advisor to the Sudan Government in conducting surveying, mappings, designing, and developing systems related to geospatial data and information. In recent years, SSA made a strategic partnership with the Ministry of Investment to activate Geospatial Information for Sudans Sustainable Investment and in particular, for the preparation and implementation of the Sudan investment map, based on the directives and objectives of the Ministry of Investment MI in Sudan. This paper comes within the framework of activating the efforts of the Ministry of Investment to develop technical investment services by applying techniques adopted by the Ministry and its strategic partners for advancing investment processes in the country. Kamal A. A. Sami "Activating Geospatial Information for Sudan's Sustainable Investment Map" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd63482.pdf Paper Url: https://www.ijtsrd.com/engineering/information-technology/63482/activating-geospatial-information-for-sudans-sustainable-investment-map/kamal-a-a-sami
Educational Unity Embracing Diversity for a Stronger Societyijtsrd
In a rapidly changing global landscape, the importance of education as a unifying force cannot be overstated. This paper explores the crucial role of educational unity in fostering a stronger and more inclusive society through the embrace of diversity. By examining the benefits of diverse learning environments, the paper aims to highlight the positive impact on societal strength. The discussion encompasses various dimensions, from curriculum design to classroom dynamics, and emphasizes the need for educational institutions to become catalysts for unity in diversity. It highlights the need for a paradigm shift in educational policies, curricula, and pedagogical approaches to ensure that they are reflective of the diverse fabric of society. This paper also addresses the challenges associated with implementing inclusive educational practices and offers practical strategies for overcoming barriers. It advocates for collaborative efforts between educational institutions, policymakers, and communities to create a supportive ecosystem that promotes diversity and unity. Mr. Amit Adhikari | Madhumita Teli | Gopal Adhikari "Educational Unity: Embracing Diversity for a Stronger Society" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64525.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/education/64525/educational-unity-embracing-diversity-for-a-stronger-society/mr-amit-adhikari
Integration of Indian Indigenous Knowledge System in Management Prospects and...ijtsrd
The diversity of indigenous knowledge systems in India is vast and can vary significantly between different communities and regions. Preserving and respecting these knowledge systems is crucial for maintaining cultural heritage, promoting sustainable practices, and fostering cross cultural understanding. In this paper, an overview of the prospects and challenges associated with incorporating Indian indigenous knowledge into management is explored. It is found that IIKS helps in management in many areas like sustainable development, tourism, food security, natural resource management, cultural preservation and innovation, etc. However, IIKS integration with management faces some challenges in the form of a lack of documentation, cultural sensitivity, language barriers legal framework, etc. Savita Lathwal "Integration of Indian Indigenous Knowledge System in Management: Prospects and Challenges" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd63500.pdf Paper Url: https://www.ijtsrd.com/management/accounting-and-finance/63500/integration-of-indian-indigenous-knowledge-system-in-management-prospects-and-challenges/savita-lathwal
DeepMask Transforming Face Mask Identification for Better Pandemic Control in...ijtsrd
The COVID 19 pandemic has highlighted the crucial need of preventive measures, with widespread use of face masks being a key method for slowing the viruss spread. This research investigates face mask identification using deep learning as a technological solution to be reducing the risk of coronavirus transmission. The proposed method uses state of the art convolutional neural networks CNNs and transfer learning to automatically recognize persons who are not wearing masks in a variety of circumstances. We discuss how this strategy improves public health and safety by providing an efficient manner of enforcing mask wearing standards. The report also discusses the obstacles, ethical concerns, and prospective applications of face mask detection systems in the ongoing fight against the pandemic. Dilip Kumar Sharma | Aaditya Yadav "DeepMask: Transforming Face Mask Identification for Better Pandemic Control in the COVID-19 Era" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64522.pdf Paper Url: https://www.ijtsrd.com/engineering/electronics-and-communication-engineering/64522/deepmask-transforming-face-mask-identification-for-better-pandemic-control-in-the-covid19-era/dilip-kumar-sharma
Streamlining Data Collection eCRF Design and Machine Learningijtsrd
Efficient and accurate data collection is paramount in clinical trials, and the design of Electronic Case Report Forms eCRFs plays a pivotal role in streamlining this process. This paper explores the integration of machine learning techniques in the design and implementation of eCRFs to enhance data collection efficiency. We delve into the synergies between eCRF design principles and machine learning algorithms, aiming to optimize data quality, reduce errors, and expedite the overall data collection process. The application of machine learning in eCRF design brings forth innovative approaches to data validation, anomaly detection, and real time adaptability. This paper discusses the benefits, challenges, and future prospects of leveraging machine learning in eCRF design for streamlined and advanced data collection in clinical trials. Dhanalakshmi D | Vijaya Lakshmi Kannareddy "Streamlining Data Collection: eCRF Design and Machine Learning" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd63515.pdf Paper Url: https://www.ijtsrd.com/biological-science/biotechnology/63515/streamlining-data-collection-ecrf-design-and-machine-learning/dhanalakshmi-d
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
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Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
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A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
1. International Journal of Trend in Scientific Research and Development (IJTSRD)
Volume: 3 | Issue: 2 | Jan-Feb 2019 Available Online: www.ijtsrd.com e-ISSN: 2456 - 6470
@ IJTSRD | Unique Reference Paper ID – IJTSRD21391 | Volume – 3 | Issue – 2 | Jan-Feb 2019 Page: 508
A Basic Review on Diabetic Neuropathy
Dr. Siva Rami Reddy E
Faculty of Homoeopathy, Tantia University, Sri Ganganagar, Rajasthan, India
ABSTRACT
Diabetic neuropathy is a major cause of neuropathy worldwide and may lead to amputations and incapacity.Thisstudyaimed
at a detailed and updated review on diabetic neuropathy, focusing on its epidemiology, classification, clinical features, risk
factor, diagnostic investigation and treatment.
KEYWORDS: Diabetic, neuropathy.
INTRODUCTION
Neuropathy, a common complication of diabetes mellitus, is
generally considered to be related to duration and severity
of hyperglycaemia. However, it may also occur acutely even
with hypoglycaemia. Usually morethan50%of patientswith
duration of diabetes of 25 yearsor moreareaffected,making
it as one of the most common disease of the nervous system.
One of the largest published series reported a prevalence of
7.5% even at the time of diagnosis of diabetes. The
prevalence however, increases progressively without a
plateau1.
Diabetic neuropathy has been defined as presence of
symptoms and/or signs of peripheral nerve dysfunction in
diabetics after exclusion of other causes, which may range
from hereditary, traumatic, compressive, metabolic, toxic,
nutritional, infectious, immune mediated, neoplastic, and
secondary to other systemic illnesses. Since the
manifestations of diabetic neuropathyclosely mimicchronic
inflammatory demyelinating polyneuropathy, alcoholic
neuropathy, and other endocrine neuropathies, hence,
before labelling diabetic neuropathy it is mandatory to
exclude all other causes of peripheral nerve dysfunction2.
Epidemiology:
Diabetes mellitus is a pandemic with a prevalence of 8.3%
translating into 371 million diabeticsworldwide. Itrelatesto
type 2 diabetes mellitus, which may be asymptomatic in
many patients for a prolonged duration, and is diagnosed
only with the emergence of complications3. Involvement of
the nervous system by diabetes was described 150 years
ago. With increasing recognition of the variable nature, the
classifications of diabetic neuropathywerefirstsuggested in
1893. Almost six decades later, the relationship of
neuropathy and duration of diabetes was recognized.
Diabetic peripheral neuropathy(DPN)isawellknown micro
vascular complication of type 2 diabetes mellitus attributed
to chronic hyperglycemia, and is defined as the presence of
peripheral nerve dysfunction in diabetics after exclusion of
other causes4. This is associated with further infections,foot
ulcers and non traumatic amputations. Estimates of foot
infections in type 2 diabetes mellitus range from a lifetime
risk of 4 to 7% annually. Neuropathy and neuropathic pain
lead to reduced health related quality of life in patients with
type 2 diabetes mellitus and impose ahuge economicburden
on the patients and healthcare system. Apart from the direct
costs involved, DPN can also lead to work absence, changein
employment and disability5. Due to differences in defining
and testing diabetic neuropathy, and the type of patient
populations studied, the results of studies on diabetic
neuropathy have been variable. Using a combination of
clinical symptoms and signs, quantitative sensory testing,
nerve conduction studies and heart rate variability, the
prevalence was found to be 54% and 45% in type 1 and 2
diabetes respectively in a population based study6.
Approximately 11.9 million adults in the United States aged
> 40 years have diagnosed diabetes. Of those, 3.9 million
(32.7%) have diabetic neuropathy and 1.6 million (13.1%)
have co morbid neuro and retinopathy.
Figure 1: Anatomy of Neuron
Classification:
Diabetic neuropathy encompasses a series of different
neuropathic syndromes which can be schematized in the
following way.
Focal and multifocal neuropathies:
• Mononeuropathy
• Amyotrophy, radiculopathy
• Multiple lesions "mononeuritis multiplex"
• Entrapment (e.g. median, ulnar, peroneal)
Symmetrical neuropathies:
• Acute sensory
• Autonomic
• Distal symmetrical polyneuropathy(DSPN), thediabetic
type of which is also known as diabetic peripheral
neuropathy (DPN) (most common presentation)7.
Pathogenesis:
The following factors are thought to be involved in the
development of diabetic neuropathy:
The most distal axons of small fibers distribute in the
epidermis of the skin, sensing pain or pricking. Currently,
punched skin biopsy immunostained with protein gene
product (PGP) -9.5 is widely used for the evaluation of
2. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
@ IJTSRD | Unique Reference Paper ID – IJTSRD21391 | Volume – 3 | Issue – 2 | Jan-Feb 2019 Page: 509
peripheral neuropathy. The method is simple and minimally
invasive, but requires the equipment of confocal laser scan
microscopy and skills for the staining and measurement.
Usually, skin over the calf muscle is used, but other sites
might also be added. In diabetes, the nerve fibers in the
epidermis of the skin are significantly affected, resulting in
distortion, twisting, focal swelling or beading, and finally,
disappearance of nerve fibers.Thereduction was found even
in subjects of impaired glucose tolerance (IGT) and the
extent of fiber loss was marked in established diabetic
patients8. The nerve fiber loss in the skin was associated
with fiber loss in the nerve trunk of the sural nerve, thus in
keeping with the presence of clinically evident neuropathy.
In relation to the alteration of epidermal innervation, a
non-invasive method using corneal confocalmicroscopy has
now been developed for the evaluation of neuropathy. With
this method, small nerve fibers distributed in the corneacan
be observed without tissue sampling in live conditions.
Diabetic patients showed significant loss of nerve fibers,
twisting and increased branching on the cornea. Taking
advantage of non invasiveness, it is easy to follow by
repeated observations and to evaluate the treatment effects
on neuropathy by this method. In fact, the recovery of nerve
fibers by regeneration was detected in long standing type 1
diabetes mellitus patients 6 months after pancreas
transplantation. To understand the cause and the
development of neuropathy, spatialandtemporal changesof
nerve pathology and their clinical significance should be
explored in more detail9.
Micro vascular disease
Vascular and neural diseases are closely related and
intertwined. Blood vessels depend on normalnervefunction
and nerves depend on adequate blood flow.The first
pathological change in the small blood vessels is narrowing
of the blood vessels. As the disease progresses, neuronal
dysfunction correlatescloselywith thedevelopmentofblood
vessel abnormalities, such as capillary basement membrane
thickening and endothelial hyperplasia, which contribute to
diminished oxygen tension and hypoxia.. Neuronalischemia
is a well established characteristic of diabetic neuropathy10.
Blood vessel opening agents (e.g. ACE inhibitors, alfa 1
antagonists) can lead to substantial improvements in
neuronal blood flow, with corresponding improvements in
nerve condution velocities. Thus, small blood vessel
dysfunction occurs early in diabetes, parallels the
progression of neural dysfunction, and may be sufficient to
support the severity of structural, functional, and clinical
changes observed in diabetic neuropathy11.
Sensorimotor polyneuropathy:
Longer nerve fibers are affected to a greater degree than
shorter ones because nerve conduction velocity is slowed in
proportion to a nerve's length. In this syndrome, decreased
sensation and loss of reflexes occurs first in the toes on each
foot, then extends upward. It is usually described as a glove
stocking distribution of numbness, sensoryloss,dysesthesia
and night time pain. The pain can feel like burning, pricking
sensation, achy or dull. A pins and needles sensation is
common. Loss of proprioception,thesenseofwherealimbis
in space, is affected early. These patients cannot feel when
they are stepping on a foreign body, like a splinter, or when
they are developing a callous from an ill fitting shoe.
Consequently, they are at risk of developing ulcer and
infections on the feet and legs, which canlead to amputation.
Similarly, these patients can get multiple fractures of the
knee, ankle or foot, and develop a charcot joint. Loss of
motor function results in dorsiflexion, contractures of the
toes, loss of the interosseous muscle function that leads to
contraction of the digits, so called hammer toes. These
contractures occur not only in the foot but also in the hand
where the loss of the musculature makes the hand appear
gaunt and skeletal. The loss of muscular function is
progressive12.
Autonomic neuropathy
The autonomic nervous system is composed of nerves
serving the lungs, heart, blood vessels, bone, adipose tissue,
sweat gland, gastrointestinal system and genitourinary
system. Autonomic neuropathy can affect anyof theseorgan
systems. The most commonly recognized autonomic
dysfunction in diabetics is orthostatic hypotension or
becoming dizzy and possibly fainting when standing up due
to a sudden drop in blood pressure. In the case of diabetic
autonomic neuropathy, it is due to the failure of the heart
and arteries to appropriately adjust heart rate and vascular
tone to keep blood continually and fully flowing to thebrain.
This symptom is usually accompanied by a loss of
respiratory sinus arrhythmia –theusual changein heart rate
seen with normal breathing. These two findings suggest
autonomic neuropathy.GI tract manifestations include
gastroparesis, bloating,nausea anddiarrhoea.Becausemany
diabetics take oral medication for their diabetes, absorption
of these medicines is greatly affected by the delayed gastric
emptying. This can lead to hyperglycemia when an oral
diabetic agent is taken before a meal and does not get
absorbed until hours, or sometimes days later when there is
normal or low blood sugar already. Sluggish movement of
the small intestione can cause bacterial over growth, made
worse by the presence of hyperglycemia. This leads
to bloating, gas and diarrhoea. Urinary symptoms include
urinary frequency, urgency, incontinence and retention.
Again, because of the retention of urine, urinary tract
infection are frequent. Urinary retention can lead tobladder
diverticula, reflux nephropathy and stones 13.
Clinical Features:
Most symptomatic patients have positivesensorysymptoms
(excessive response to a stimulus or spontaneously),such as
paresthesia and pain, and in some cases may present
proprioceptive ataxia. These are referred as sensations of
numbness, tingling, imbalance and falls, shocks, pricks and
especially burning. They are distributed in LLll extremities
and may evolve to UULL and characteristicallypatientsrefer
worsening at night. In general these are mild symptoms,
however they may be severe and disabling. Negativesensory
symptoms (decreased response to a certain stimulus) are
those referred as loss of sensitivity in involved segment. At
neurologic evaluation there is distal
hypoesthesia/hyperesthesia in segments, initially in
thermoalgesic sensitivity modalities. In the presence of
severe painful neuropathy, there may be hyperesthesia
(exaggerated response to tactile stimuli), hyperalgesia
(exaggerated sensitivity to painful stimuli), hyperpathia
(persistence of pain even afer painful stimulus removal) or
even allodynia (painful sensation caused by painless
stimuli). It may evolve to deep sensitivity hypo/anesthesia
such as tactile, vibratory and proprioceptive. In addition,
when there is large fibers sensory impairment, there is deep
hypo/arreflexia, primarily in Achillean reflex, and there
might be global arreflexia in very severe cases14.
3. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
@ IJTSRD | Unique Reference Paper ID – IJTSRD21391 | Volume – 3 | Issue – 2 | Jan-Feb 2019 Page: 510
Hyperglycemia:
Hyperglycemia is the other major risk factor of diabetic
neuropathy .Its paramount importance has been
documented in both type 1 diabetes mellitus and type 2
diabetes. It has been calculated that every 1% increment in
HbA1c is connected with approximately 10-15% higher
frequency of diabetic neuropathy. Therefore, the
effectiveness of strict glycemic control in reducing the
incidence and progression of diabetic neuropathy has been
the object of several ambitious studies in both types of
diabetes. However, an important difference has emerged
between type 1 diabetes mellitus and type 2 diabetes
mellitus. As detected in a meta-analysis, optimized glycemic
control in type 1 diabetes mellitus exerts significantly
beneficial effects in preventing the development of clinical
diabetic neuropathy and reducing neurological deficits,
while in type 2 diabetes mellitus this effect was not (wholly)
significant (p = 0.06). Another meta-analysis concluded that
intensive glucose-lowering treatment was not successful in
reducing diabetic neuropathy in patients with type 2
diabetes mellitus. These findings point to a potential
difference in terms of the pathogenesis of diabetic
neuropathy between the two typesofdiabetes.However,the
data are far from being conclusive, because the trials in type
2 diabetes mellitus have only secondarily looked at diabetic
neuropathy, and included only clinical evaluation measures.
Therefore, the identification of a beneficial treatment effect
was more difficult.
Age:
Age has long been regarded as a risk factor of diabetic
neuropathy. Several groups have shown that age exerts an
independent effect on diabetic neuropathy, leading to a
progressive increase in its prevalence for approximately
every decade of life. The independent effect of age has also
been shown for prediabetes in epidemiological surveys.
However, there is an important caveatin theseobservations.
As age per se causes a progressive deterioration in
neurological functions, independent of diabetes, the
symptoms call for a differentiated interpretation.
Delcourt carried out an adjustment for age and found that
DSPN no longer correlated with age .On the other hand, it is
conceivable that the impact of age on nerve function
outweighs the influence of diabetes intheelderlypopulation
in which the prevalence of diabetic neuropathy in milder
degrees of hyperglycemia (prediabetes) may approach that
of known diabetes. Regrettably, no age-adjusted normal
values have been used in the vast majority of studies.
Hypertension:
Hypertension is another risk factor for diabetic neuropathy,
but there appears to be a difference between the two
diabetes types. In type 1 diabetes mellitus, the data is
affirmative. Forrest et al. have identifiedhypertension asthe
strongest predictor of diabetic neuropathy, as it increased
the relative risk approximately four times in a 6 year period.
Similarly, Tesfaye have reported that systolic hypertension
was an independent predictor after adjustment for age,
duration of diabetes, and metabolic control. In contrast,
studies in type 2 diabetes mellitus have been negative. Of
note, tight blood pressure control in the United Kingdom
Prospective Diabetes Study did not reduce deterioration of
diabetic neuropathy.
Smoking:
There is some evidence that smoking is an independent risk
factor of diabetic neuropathy in type 1 diabetes mellitus. In
type 2 diabetes mellitus, smoking may also be a risk factor,
but its contribution may be weak and not independent.
Surprisingly, a protective effect of smoking has been
reported in US veterans. More recently, a meta-analysis
including 10 prospective and 28 cross sectional studies has
found that smoking had an unadjusted OR of 1.26 for
prospectively developingdiabeticneuropathy(95%CI:0.86-
1.85). In the cross-sectional studies, the pooled OR for
diabetic neuropathy due to smoking was 1.42 (95%CI:1.21-
1.65). For both analyses, evidence was graded as low-
strength.
Obesity:
In the Southern German population, obesity has been
identified as a risk factor of diabetic neuropathy. In the
general US and Indian population ≥40 years, obesity and the
presence of at least 2 cardiovascular risk factors
(triglycerides or plasma glucose, reduced HDLc, increased
waist circumference, hypertension) increases the likelihood
of peripheral neuropathy (OR: 2.20, 95% CI: 1.43-3.39)].
Subjects with morbid obesity have been found to exhibit
features of small nerve fiber dysfunction (impaired pain
perception and diminished reflex vasodilatation).
Alcohol
Some studies have reported an association betweendiabetic
neuropathy and alcohol consumption,butothershavenot. In
general, it may be difficult to differentiate between diabetic
neuropathy with alcohol as a risk factor and alcoholic
neuropathy in a person with diabetes. It would be useful to
address this differentiation by careful patient selection in a
prospective cohort study.
Diagnosis
The diagnosis of diabetic neuropathy can only be made after
a careful clinical examination, and all patients with diabetes,
should be screened annually for diabetic neuropathy by
examining pinprick, temperature, and vibration perception
(using a 128-Hz tuning fork), 10 g monofilament pressure
sensation at the distal halluces, and ankle reflexes.
Combinations of more than one test have 87% sensitivity in
detecting diabetic neuropathy. Loss of 10 g monofilament
perception and reduced vibration perception predict foot
ulcers. Indeed, longitudinal studieshaveshown thatasimple
clinical examination is a good predictor of future foot ulcer
risk. The feet should be examined for ulcers, calluses, and
deformities, and footwear should be inspected. Different
scoring systems have been developed for monitoring
progression or response to intervention in clinical trials.
Other forms of neuropathy, including chronic inflammatory
demyelinating polyneuropathy (CIDP), B12 deficiency,
hypothyroidism, and uremia, occur more frequently in
diabetes and should be ruled out. The practitioner maywish
to refer the more complex patient, or those in whom
diagnosis needs confirmation, to a neurologist for
specialized examination and testing.Thediagnosisof chronic
diabetic neuropathy is therefore a clinical one and involves
the exclusion of nondiabetic causes:investigationsshouldbe
ordered as dictated by clinical findings and might typically
include serum B12, thyroid function, blood urea nitrogen,
and serum creatinine. A combination of typical
symptomatologyand distalsensoryloss withabsent reflexes,
4. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
@ IJTSRD | Unique Reference Paper ID – IJTSRD21391 | Volume – 3 | Issue – 2 | Jan-Feb 2019 Page: 511
or the signs in the absence of symptoms, is highly suggestive
of diabetic neuropathy15.
Management:
Many evidences indicate that oxidative stress is involved
with diabetes neuropathy genesis. So, antioxidant drugs
would be an excellenttherapeuticalternative.Intravenousα-
lipoic acid (thioctacideMR) (600mg/day for 3 weeks) is
currently the only treatment based on disease mechanism
with proven efficacy and amenable to be used in the clinical
practice68. The same drug orally (600mg/ day in fasting),
the only presentation currently available in Brazil, still need
further evidential studies, although evidences suggest its
efficacy. Other treatment modalities were proposed,butstill
lack data confirming that they are effective16. Among
available drugs for symptomatic pain treatment, there is
evidence level A supporting the use of tricyclic
antidepressants,anticonvulsants gabapentinand pregabalin,
and antidepressant duloxetine, selective dual inhibitor of
serotonin and norepinephrinereuptake.Thereisalsosecond
line evidence for the use of opioids such as tramadol and
oxicodone. The combination of first line drugs should be
considered before using opioids. Tricyclic antidepressants
have proven efficacy but their adverse effects are major
limiting factors because they might be associated to cardiac
conduction changes (A/V blocks, arrhythmias), xerostomy,
sweating, dizziness, sedation, urinary retention and
glaucoma. Above 100mg/day, their use seems to be
associated to sudden death risk, reason why they should be
carefully used in cardiopathic patients.Itisrecommended to
start with 10 to 25mg/day and gradually increase the dose
with careful follow up of patients. Although doses of up to
150mg/day are indicated, it is hard to go beyond 75mg/day.
The choice of the specific drug should take into
consideration patients’ manifestations and drugs adverse
effects.
CONCLUSION:
Besides the fact of many diabetic complications can be
reduced with improved blood glucose control and other
lifestyle interventions, such as quit smoking and reducing
alcohol consumption, the efficacy of these measures, as well
as the pharmacological treatments on diabetes neuropathy
are not predictable. The medications rated as level A based
on their efficacy are able to reduce pain and improve some
aspects of patients’ quality of life, but are not able to fully
eliminate pain or prevent/revert the neuropathy.Even their
combination does not result in satisfactory pain control,
being the best improvement in pain, restricted to 50% of
relief for the majority of the patients. Considering the
available pharmacological options, diabetes neuropathy
treatment has to be based mainly on patients’ symptoms,
pain level and tolerance of side effects.
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