Painless nondiabetic lumbosacral radiculoplexus neuropathy with complete recovery: a case report

BACKGROUND

Lumbosacral radiculoplexus neuropathy, also known as amyotrophy, is an uncommon monophasic disorder characterized by inflammation of the lumbosacral nerve roots and plexuses. Lumbosacral radiculoplexus neuropathy is usually associated with diabetes mellitus, is typically painful at presentation, and often associated with long-term residual neurologic deficits. We report a case of painless, nondiabetic lumbosacral radiculoplexus neuropathy in a young Chinese woman, who made a full recovery after treatment with intravenous immunoglobulin, adding an atypical case to the scarce literature on lumbosacral radiculoplexus neuropathy.

CASE PRESENTATION

A 35-year-old Chinese woman presented to our emergency department with 1-week history of painless left lower limb weakness and numbness. Examination revealed weakness confined to the left lower limb but spanning various nerves and myotomes, with abnormal sensation. Clinical localization to the lumbosacral plexus was supported by neurodiagnostic tests, and magnetic resonance imaging of the lumbosacral plexus showed that the nerve roots were also involved. After treatment with intravenous immunoglobulin for nondiabetic lumbosacral radiculoplexus neuropathy, the patient had a full recovery.

CONCLUSION

Our patient's case highlights that lumbosacral radiculoplexus neuropathy, an already rare disorder, can occur in the absence of diabetes mellitus and pain, making it even harder to recognize. A systematic and meticulous clinical approach, supported by intelligent selection of adjunctive tests, is required for localization and diagnosis. With an accurate diagnosis, our case also demonstrates that appropriate and prompt treatment can lead to complete recovery, despite previous reports suggesting a high prevalence of long-term residual deficits after lumbosacral radiculoplexus neuropathy.

Association of triglyceride-glucose index with ischemic stroke recurrence in nondiabetic patients with small vessel occlusion: a multicenter hospital-based prospective cohort study

BACKGROUND

Triglyceride-glucose (TyG) index is a simple and reliable surrogate marker of insulin resistance. Elevated TyG index was related to stroke recurrence. This study aimed to explore the associations between TyG index with ischemic stroke recurrence in nondiabetic patients with small vessel occlusion.

METHODS

From November 1, 2016 to February 28, 2021, consecutive acute ischemic stroke patients admitted within 1 week after onset were screened. The stroke mechanism was determined based on medical history, laboratory examinations, cardiac examinations, vascular examinations and neuroimaging. Nondiabetic patients with small vessel occlusion were enrolled and followed up for 1 year. The primary outcome was ischemic stroke recurrence. Logistic regression and Kaplan-Meier survival curve were used to analyze the association of the TyG index and stroke recurrence.

RESULTS

A total of 6100 acute ischemic stroke patients were screened, with 1970 nondiabetic patients with small vessel occlusion included and divided into 4 groups according to the TyG index quartiles (Q1: < 8.20; Q2: 8.20-8.53; Q3: 8.54-8.92; Q4: > 8.92). There were significant differences in age, body mass index, systolic blood pression, diastolic blood pressure, lipid-lowering agents, infarct location, fasting blood glucose, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, uric acid, and stroke recurrence among the 4 groups. In the multi-adjusted models, compared to Q1 of the TyG index, the odds ratio for Q4 of the TyG index for stroke recurrence was 3.100 (1.366-8.019). The Kaplan-Meier survival (ischemic stroke-free) curves by quartiles of the TyG index also showed statistically significant differences (log-rank test, P = 0.004).

CONCLUSIONS

Our findings suggested that the TyG index was associated with ischemic stroke recurrence in nondiabetic patients with small vessel occlusion, and it could be a valuable biomarker for assessing the risk of ischemic stroke recurrence in these patients.

Effects of metformin on blood lipid profiles in nondiabetic adults: a meta-analysis of randomized controlled trials

PURPOSE

To evaluate the effects of metformin on serum lipid profiles in nondiabetic adults through a comprehensive meta-analysis.

METHODS

In the present meta-analysis, randomized and controlled trials were collected by searching PubMed, Embase, and Cochrane Libraries from inception to April 2019. Compared with placebos, the effects of metformin treatment on lipid profiles in nondiabetic adults were evaluated.

RESULTS

Forty-seven studies from 45 articles including 5731 participants were enrolled. Pooled results showed that metformin had significant effects on total cholesterol (mean change -6.57 mg/dl; 95% CI -9.66, -3.47; P = 0.000) and LDL-c (mean change -4.69 mg/dl; 95% CI -7.38, -2.00; P = 0.001), but insignificant effects on HDL-c (mean change -4.33 mg/dl; 95% CI -9.62, 0.96; P = 0.109) and triglyceride (mean change -0.85 mg/dl; 95% CI -0.36, 2.06; P = 0.169). Significant heterogeneities were found for all lipid profiles (HDL-c = 85.5%; LDL-c = 59.9%; total cholesterol = 75.3% and triglyceride = 67.1%). Different from the pooled data, in a subgroup analysis, the effect of metformin on triglyceride in patients with polycystic ovarian syndrome (PCOS) was significant with a mean reduction of 8.15 mg/dl. In addition, sensitivity analysis showed that the pooled effects of metformin on serum lipid profiles were stable. Publication bias derived from funnel plots or Begg's tests (P = 0.933, 0.860, 0.904, and 0.567 for HDL-c, LDL-c, total cholesterol, and triglyceride, respectively) was not significant.

CONCLUSION

This meta-analysis revealed that metformin could reduce total cholesterol and LDL-c in nondiabetic adults. In addition, metformin might exert a triglyceride-lowering effect in nondiabetics with PCOS status.

Impact of serum omentin-1 levels on functional prognosis in nondiabetic patients with ischemic stroke

OBJECTIVE

Omentin-1, an adipokine released from visceral fat tissue, is associated with diabetes and stroke. The purpose of this study was to assess the impact of serum omentin-1 levels on functional prognosis in nondiabetic patients with ischemic stroke.

METHODS

From March 2016 to December 2017, consecutive patients with first-ever ischemic stroke admitted to our hospital, China, were recorded. Functional impairment was evaluated at 3-month after admission using the modified Rankin scale (mRS). Uni-and multivariate analyses with Cox proportional hazard regression was used for assessing the relationship between serum level of omentin-1 and functional outcome.

RESULTS

We recorded 209 stroke patients, 52 of them (24.9%) experienced as poor functional outcome. The obtained omentin-1 level in patients with poor outcome was lower than in those patients with good outcome [100.8 (80.9-131.6) ng/ml vs. 137.6 (IQR, 106.1-171.5) ng/ml; Z=4.692; P<0.001). Multivariate analysis models were used to assess stroke outcome according to omentin-1 quartiles (the highest quartile [Q4] as the reference), the 1^st and 2^nd quartile of omentin-1 were compared against the Q4, and the risks were increased by 505% (HR=6.05; 95% CI: 2.13-12.15; P=0.007) and 215% (31.5; 1.21-7.98; P=0.03), respectively. The inclusion of omentin-1 in the routine prediction model for the prediction of poor functional outcome, enhanced the NRI (P=0.006) and IDI (P=0.001) values, confirming the effective reclassification and discrimination. Kaplan-Meier analysis suggested that the patients with low serum omentin-1 levels had a higher risk of death than those patients with high levels of omentin-1 (log-rank test P=0.033).

CONCLUSION

In this cohort of nondiabetic patients with ischemic stroke, a reduced baseline level of serum omentin-1 was related with an increased risk for poor functional outcome or death, independent of baseline variables.

Antihypertensive therapy in nondiabetic chronic kidney disease: a review and update

Hypertension is an important contributor to progression of nondiabetic chronic kidney disease (CKD). Compelling observational evidence indicates that the divergence of blood pressure (BP) away from an ideal range in either direction is associated with a progressive rise in the risk of mortality and cardiovascular and renal disease progression. To date, various clinical trials and meta-analyses examining strict versus less intensive BP control in nondiabetic CKD have not conclusively demonstrated a renal advantage of one BP-lowering approach over another, except in certain subgroups such as proteinuric patients where evidence is circumstantial. As recent data have come to light suggesting that intensive BP control yields superior survival and cardiovascular outcomes in patients at high risk for cardiovascular disease, interest in the prospect of whether such benefit extends to individuals with CKD has surged. This review is a comprehensive analysis of antihypertensive literature in nondiabetic renal disease, with a particular emphasis on BP target.

Mucormycosis of the middle ear: a case report with review of literature

Mucor is a saprophytic organism and commonly invades the nose and paranasal sinuses of immunocompromised and diabetic patients involvement of the middle ear and mastoid in a nondiabetic patients is very rare and this may be the first case report clinical presentation of ear pain with reference to the mastoid and upper neck may be the early symptoms unlike the foul smelling ear discharge as seen in atticoantral disease. Radical debridement in the form of M.R.M with or without the use of amphotericin B may suffice in non-diabetic patients this case is reported to highlight the point that mucormycosis can also involve middle ear and mastoid in nondiabetic patients.