MVH wins laurels for paper presentation at RSSDI – 2011

The 39th Annual meeting of RSSDI (Research Society for the Study of Diabetes in India) was held from 4th to 6th November, 2011 at Mumbai.

The research team from MVH won awards for various presentations. The excerpts are elaborated below.


1. Topic: Association of HSPA1B gene polymorphism in T2DM and its Complications: A South Asian Study.

Dhamodharan U, Ezhilarasi K, Parthiban M, Indira Padmalayam, Rama Rajaram, Vijay Viswanathan

Department of Biochemistry & Molecular Genetics, Prof. M.Viswanathan Diabetes Research Centre & M.V. Hospital for Diabetes in collaboraton with Department of Biochemistry & Biomaterials, Central Leather Research Institute , Adyar, Chennai.

Heat Shock Protein-70 (HSP70) a protein which is very active in the immune system is suppressed in people with diabetes because of cellular stress. Western studies have reported the association of this gene (HSP70) in diabetic individuals through its effect on insulin sensitivity.

Our researchers studied this effect on T2DM and its complications among South Indian population and have found the mutation of this gene in T2DM and in those with both micro- and macro vascular complications.

Thus this novel gene could be used as a marker to identify people with increased risk of diabetes and its complications and take preventive action at an early stage.


2. Topic: Stress Response Element (STRE) single nucleotide polymorphism in Lipoic acid Synthase gene is associated with T2DM with complications.

Ezhilarasi K, Dhamodharan U, Parthiban M, Indira Padmalayam, Rama Rajaram, Vijay Viswanathan

Department of Biochemistry & Molecular Genetics, Prof. M.Viswanathan Diabetes Research Centre & M.V. Hospital for Diabetes in collaboraton with Department of Biochemistry & Biomaterials, Central Leather Research Institute , Adyar, Chennai.

STRE in the LASY promoter region is important for the synthesis of Lipoic Acid Synthase gene which produces Lipoic Acid that acts as an antioxidant. Under normal conditions, Stress Response Element binds to STRE site and helps in the production of antioxidant enzymes such as Catalase LASY which helps to control oxidative stress.

Our researchers have found that in the case of T2DM with complications- neuropathy, nephropathy or retinopathy, this enzyme production is reduced due to single nucleotide polymorphism.

This provides great scope for further investigation into the use of this information in treating complications of diabetes.


3. Topic: Chennai Slim & Fit poster presentation.

Dr. Vigneswari, Research Assistant, Department of Epidemiology.

Childhood obesity has emerged as a major public health issue in India. These children are at high risk of developing diabetes, CVD earlier in their life compared to their normal counterparts.

As a school based approach, M.V Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre conducted an awareness creation programme (Chennai Slim and Fit) on childhood obesity in 13 CBSE schools with audiovisual aids and provided them with a chance for direct interaction with health experts. More than 20,000 children were benefited through this programme. It was highly successful, as the pre- and post- knowledge assessment showed that there was a significant increase in the degree of awareness among the children who participated in the programme.


The team from MVH at RSSDI- 2011. (L to R Mr.Dhamodharan Umapathy, Dr.K.Satyavani, Dr.Hemanga Barman, Prof.Vijay Viswanathan, Dr.M.Parthiban, Ms.K.Ezhilarasi, Mrs.R.Seena, Ms.Vimala, Dr.Vigneswari)

Cervical Spondylosis in Diabetes

S.Bamila

M.V. Centre for Diabetic Foot Care, Podiatry, Research & Management

Cervical spondylosis is a common cause of chronic neck pain. It occurs when there is abnormal wear on the cartilage and bones of the neck (cervical vertebrae).


The most common cause is ageing. By 60 years, most women and men show signs of cervical spondylosis.

Other factors that can cause spondylosis are:

* Not exercising and being overweight
* Lifting heavy weights or a lot of bending and twisting
* Previous neck injury (often several years before)
* Earlier spine surgery
* Ruptured or slipped disc
* Severe arthritis
* Small fractures to the spine due to osteoporosis

* Diabetes

* Faulty posture:

-slouching or sitting incorrectly on soft chairs and couches

- bad back and neck posture from sleeping on a soft mattress

- lifting weights incorrectly

* Malnutrition
* Stress and strain from sitting for a long time
* Emotional problems leading to muscle cramping

Symptoms

* Severe nagging pain spreading to both the sides of the shoulders, back of the neck, the collar bone and head. Pain in arms and fingers. At times, chest and throat too could be affected.
* Acute or chronic stiffness, leading to partial or complete loss of movement.
* Numbness and tingling or complete loss of sensation on the affected side.
* Headache
* Giddiness
* Weakness of muscles in the arm or hand.
* Loss of balance (less common)
* Loss of control over the bladder or bowels (if there is pressure on the spinal cord)

Treatment

Most symptoms respond to basic treatment such as:

* Rest - This may range from reducing normal activities to complete bed rest for three to five days.
* Neck collar or brace - this restricts neck movement so that the shoulders take the weight of the head.
* Traction - in some cases intermittent neck traction may be recommended for one to two weeks. This may be done in the hospital or at home.
* Pain relieving drugs /Pain-relieving injections
* Physical therapy /yoga work on improving posture. In cases of severe or chronic pain or loss of movement, surgery may be recommended.
* Chronic neck pain is also sometimes associated with anxiety and depression which may also need to be treated.

Exercises for Neck Pain and Spondylosis

Here are basic stretches and exercises that can be used by almost everyone in pain. However, always consult your doctor before beginning an exercise plan.

Exercise for 10-15 minutes a day. Do the entire routine for maximum relief.

1.Extension and flexion is especially helpful for stiff back and neck.

Flexion

Lower your head and bring it forward so that the chin touches the chest and your face is staring straight down at the floor. Do this slowly five times.





You can also add gentle pressure by putting your hands behind your head to hold the end position.

Extension

Allow the head to go back until you look directly at the ceiling.

Caution: Don’t do this movement fast or forcefully as it forces all the small joints at the back of the neck into an extreme position.


2. Rotation

Turn your head slowly round to one side until it cannot easily go any further.

Caution: Do not go from one side to the other in the individual movements or roll your neck about.


Hold your neck at the end of the movement for a few seconds. Do this five times to one side and then repeat on the other side.
Don’t do this if you feel dizzy. Dizziness, especially in older people, might mean that the blood vessels in your neck are being squeezed by the position.

3.Side Bend

Side bends increase your side-to-side flexibility. Start by lacing your fingers together and pointing your elbows outward. Bend at the waist, tilting your body to one side as far as you can. Then bend your head and neck in the same direction. Repeat on your other side. Repeat this exercise 10 times.



4. Sit And Twist

This exercise increases the flexibility of your entire spine. To begin, lace your fingers together and point your elbows outward. Slowly and gently twist at your waist, rotating your head and neck to the same side. Repeat toward the other side. Repeat this exercise 10 times.



5. Side / Lateral flexions (Tilt)

Facing forward try and tip your ear down towards the same shoulder.



6. Strengthening exercise.

Reach your right arm over your head so that your palm is on top of your skull, your fingers resting just above the left ear. Allow the weight of your arm, along with light fingertip pressure, to gently bend the head toward your right shoulder (fig.1). Check to make sure your shoulders are still relaxed. You should be looking forward. Hold the pose for 30 seconds.

Move your fingers toward the back left corner of your skull, this time allowing your head to bend forward and to the right, about 45 degrees in front of your shoulder (fig.2). Hold for 30 seconds.

Now place your fingers at the back of your skull and gently pull your head straight forward, toward your chest (fig.3). Hold for 30 seconds. Switch hands and repeat the stretches in reverse order: Pull forward, then 45 degrees in front of your left shoulder, and finally directly over your left shoulder. Do not push your head backward.



Place your hand against the side of your head. Try to bring to your ear to your shoulder, resisting the motion. Repeat this exercise on the other side. Hold each position for 5 seconds and when finished relax slowly. Repeat this exercise on the other side. Hold each position for 5 seconds and when finished relax slowly. Repeat with your right hand on the right side of the head. Do the same exercise, using either hand, with the back of the head (fig.5) and the forehead (fig.6)





Preventing Cervical Spondylosis

* Exercise regularly and don’t engage in activities that place pressure on the head, neck, and shoulders.
* Low-impact activities, such as swimming, walking, or yoga are ideal for the health of the cervical spine.
* Maintain good posture while standing, sitting, working at the computer, driving and sleeping.
* Do not hold the head in the same position for long periods. Take regular breaks when driving, watching TV or working on a computer.
*Use a seat belt in a car and avoid activities that strain the neck to protect the neck from injury.
*Avoid bending forward suddenly.
*Avoid nodding head movements.
*Make lifestyle modifications.

REFERENCE:

1. http://cervicalspondylosis.com/exercises_for_cervical_spondylosis.htm
2. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001472
3. http://www.patient.co.uk/health/CervicalSpondylosis.htm

Carpal Tunnel Syndrome in Diabetes

S.Bamila

M.V. Centre for Diabetic Foot Care, Podiatry, Research & Management

Diabetes, alcoholism and obesity are medical problems that are associated with carpal tunnel syndrome

This is also common among people who perform repetitive motions of the hand and wrist. Typing on a computer keyboard is probably the most common cause of carpal tunnel syndrome. Other causes include sewing, driving, writing, playing some musical instruments, painting and so on.

The median nerve in the wrist supplies feeling and movement to parts of the hand. The area in your wrist where the nerve enters the hand is called the carpal tunnel. Carpal tunnel syndrome is pressure on the median nerve, and this can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers. The condition occurs most often in people between 30 and 60 years, and is more common in women than in men. It also has a higher prevalence in people with diabetes and other conditions which directly affect the nervous system.


What causes Carpal Tunnel Syndrome?

* Doing the same action over and over again
* Uncomfortable joint posture
* High force
* Vibration
* Direct pressure
* Uncomfortable posture for a long time

Symptoms

* Numbness or tingling sensation in the thumb and the next two or three fingers of one or both hands
* Numbness or tingling sensation in the palm
* Pain spreading right up to the elbow
* Pain in the wrist or hand/s
* Problems with fine muscle coordination in one or both hands
* Wasting away of the muscle under the thumb (in advanced or long-term cases)
* Weak grip or difficulty in carrying heavy things like bags (a common complaint)
* Weakness in one or both hands
* Interruption of sleep with numbness and in pain in hands
* Poor circulation of blood in hands resulting in a temporary lack of sensation
* Cold hands
* Dropping objects especially small things.
* Loss of Grip Strength by Fore arms

Signs and Tests


Untreated CTS

* Numbness in the palm, thumb, index finger, middle finger, and thumb side of the ring finger
* Weak hand grip
* Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand (this is called Tinel's sign)
* Bending the wrist forward all the way for 60 seconds will usually result in numbness, tingling, or weakness (this is called Phalen's test)


* Electromyography
* Nerve conduction velocity
* Wrist X-rays should be done to rule out other problems like wrist arthritis
* MRI scan, ultrasound imaging

Using wrist splint at night or during sport activities, high-frequency sound waves directed toward the inflamed area , alternating warm and cold soaks, restricted movement, Vitamin B6 and acupuncture are some forms of treating this. Some stretching exercises can be done to prevent re-occurrence.

* Stretching exercises for Carpal Tunnel Syndrome


Pull forward and stretch both wrists and fingers as if they are in a hand-stand position. Hold for a count of 5.


Straighten both wrists and relax fingers.


Make a tight fist with both hands.


Then bend both wrists down while keeping the fist. Hold for a count of 5.


Straighten both wrists and relax fingers, for a count of 5.


Repeat the exercise (a-f) 10 times

Then let your arms hang loosely at the side and shake them for a few seconds.

* Wrist Curls without Weights: Sit in a chair with your forearm resting on your thigh (or on a table) keeping your palm up or palm down. Turn your wrist up about 2 to 3 inches and then slowly lower it down. Repeat 20 times.

* Shrugs

Stand with your arms by your sides. Lift your shoulders up to your ears and hold for 1 second. Then pull your shoulders back pinching your shoulder blades together. Hold for 1 second. Relax your shoulders. Do this 20 times.



Reference:

* Carpal Tunnel Syndrome in Patients with Diabetic Polyneuropathy : Bruce A Perkins, FRCPC; David Olaleye, PHd; Vera Bril, MD FRCPC

* Dr. Housang Seradge at the University of Oklahoma Orthopaedic & Reconstructive Research Foundation:
(http://ortho-ok.com.orrf.ORRF_CARPAL_TUNNEL_PREVENTION.html)

* Carpal Tunnel Syndrome Exercises – En Espanol
(http://www.medicinenet.com/carpal_tunnel_syndrome/article.html)

* [Carpal tunnel syndrome in diabetes mellitus].[Article in German]Bahrmann A, Zieschang T, Neumann T, Hein G, Oster P.