A Simple and Reliable Clinical Indicator for Rapid Evaluation of Neuropathy in Busy Diabetes Clinics: “Hair Loss Sign”
Notice bibliographique
Résumé
Sir, Diabetes mellitus (DM) currently affects more than 62 million Indians.[1] Studies show that approximately 20% of the patients with diabetes have peripheral neuropathy. Evaluation of diabetic neuropathy is important as it has a bearing on the comprehensive management. Conventional evaluation involves testing the sensory, motor and autonomic functions along with deep tendon reflexes. This is a time consuming process. The huge workload in Diabetes Outpatient clinics in India calls for a simple indicator towards the neuropathic process. One of us (S M Katrak) had observed that the loss of hair on the legs, signifying autonomic neuropathy gives a lead to the extent of somatosensory neuropathic deficits. To test this clinical observation, we designed this study. The study was approved by the Institutional Ethics Committee. Patients with DM reporting paresthesias were included in the study. After obtaining informed valid consent, history was recorded (age, sex, duration of DM, peripheral and autonomic symptoms viz. paresthesias, constipation, urinary complaints, abnormal sweating, and exercise intolerance) and clinical examination was performed (motor system, sensory system viz. fine and crude touch, pain and temperature, vibration and position sense were noted; reflexes and autonomic system viz. resting tachycardia, orthostatic hypotension and the level of hair loss was documented).[2] For the measurement of sensory deficit and hair changes, malleolus was taken as point zero. Toronto Clinical Scoring System (TCSS) was used for grading the severity of neuropathy.[3] In this cohort of 107 patients, mean age was 61.9 years and mean duration of DM was 8.7 years. Twenty four patients had no neuropathy (TCSS score ≤5), 41 had mild neuropathy (TCSS 6-8), 14 had moderate (TCSS 9-11) and 28 patients had severe neuropathy (TCSS ≥12). Of the 83 patients documented to have neuropathy (TCSS score ≥6), 36 (43%) had a distal stocking hair loss which correlated with the level of pain and temperature loss or the level of impaired fine or crude touch [Figure 1]. Of these 36 patients, 11 had moderate and 25 had severe neuropathy. Thus, 79% patients with moderate and 89% with severe neuropathy had hair loss over the distal part of the legs which corresponded with the level of sensory impairment. None of the patients with mild, pure sensory neuropathy exhibited any hair loss.Figure 1: Correlation of level of sensory loss (black line) to absence of hair (hair loss sign)Thus the level of hair loss, when present, can be used as a rapid and reliable clinical indicator of moderate to severe diabetic peripheral neuropathy. The somatic components of sensory neuropathy appear to correlate well with this component of autonomic neuropathy (hair loss). The finding of hair loss and its level on the leg (hair loss sign) can serve the clinician well in his busy diabetes clinic. Further, this could potentially be used in follow-up studies of these individuals with diabetes. The limitations of this study are that patients with mild neuropathy may not exhibit this sign and in female patients who wax their hair, the utility of the sign is lost. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».