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Article ; Online: Neuromuscular electrical stimulation for the treatment of diabetic sensorimotor polyneuropathy: A prospective, cohort, proof-of-concept study.

Smith, Sasha / Ravikumar, Raveena / Carvalho, Catarina / Normahani, Pasha / Lane, Tristan / Davies, Alun H

Neurophysiologie clinique = Clinical neurophysiology

2024 Volume 54, Issue 3, Page(s) 102943

Abstract: Objective: To assess a potential efficacy signal, safety and feasibility of neuromuscular electrical stimulation (NMES) therapy as an adjunct to standard care in patients with diabetic sensorimotor polyneuropathy (DSPN).: Methods: In this single- ... ...

Abstract	Objective: To assess a potential efficacy signal, safety and feasibility of neuromuscular electrical stimulation (NMES) therapy as an adjunct to standard care in patients with diabetic sensorimotor polyneuropathy (DSPN). Methods: In this single-centre, prospective, cohort, proof-of-concept study, 25 patients with DSPN consented to at least one daily 30-minute NMES therapy session (Revitive® IX) for 10 weeks, with 20 patients completing the study. The primary outcome measure was nerve conductivity assessed using a nerve conduction study of the sural, superficial peroneal, common peroneal and tibial nerves at 10 weeks compared to baseline. Secondary outcomes included superficial femoral artery (SFA) haemodynamics during NMES therapy compared to rest and quality-of-life at 10 weeks compared to baseline. Results: At 10 weeks, there were significant increases in sural sensory nerve action potential amplitude and conduction velocity (p < 0.001), superficial peroneal sensory nerve action potential amplitude (p = 0.001) and conduction velocity (p = 0.002), common peroneal nerve conduction velocity (p = 0.004) and tibial nerve compound muscle action potential amplitude (p = 0.002) compared to baseline. SFA volume flow and time-averaged mean velocity significantly increased (p ≤ 0.003) during NMES compared to rest. Patient-reported Michigan Neuropathy Screening Instrument scores significantly decreased (p = 0.028) at 10 weeks compared to baseline. Three unrelated adverse events occurred, and 15 participants adhered to treatment. Conclusions: NMES therapy as an adjunct to standard care for 10 weeks significantly increased lower limb nerve conductivity in patients with DSPN and may be beneficial in the treatment of DSPN.
Language	English
Publishing date	2024-02-28
Publishing country	France
Document type	Journal Article
ZDB-ID	639421-8
ISSN	1769-7131 ; 0987-7053
ISSN (online)	1769-7131
ISSN	0987-7053
DOI	10.1016/j.neucli.2024.102943
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Zs.A 1049: Show issues

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Article ; Online: Machine learning-based classification of arterial spectral waveforms for the diagnosis of peripheral artery disease in the context of diabetes: A proof-of-concept study.

Normahani, Pasha / Sounderajah, Viknesh / Mandic, Danilo / Jaffer, Usman

Vascular medicine (London, England)

2022 Volume 27, Issue 5, Page(s) 450–456

Abstract: Background: Point-of-care duplex ultrasound has emerged as a promising test for the diagnosis of peripheral artery disease (PAD). However, the interpretation of morphologically diverse Doppler arterial spectral waveforms is challenging and associated ... ...

Abstract	Background: Point-of-care duplex ultrasound has emerged as a promising test for the diagnosis of peripheral artery disease (PAD). However, the interpretation of morphologically diverse Doppler arterial spectral waveforms is challenging and associated with wide inter-observer variation. The aim of this study is to evaluate the utility of machine learning techniques for the diagnosis of PAD from Doppler arterial spectral waveforms sampled at the level of the ankle in patients with diabetes. Methods: In two centres, 590 Doppler arterial spectral waveform images (PAD 369, no-PAD 221) from 305 patients were prospectively collected. Doppler arterial spectral waveform signals were reconstructed. Blinded full lower-limb reference duplex ultrasound results were used to label waveform according to PAD status (i.e., PAD, no-PAD). Statistical metrics and multiscale wavelet variance were extracted as discriminatory features. A long short-term memory (LSTM) network was used for the classification of raw signals, and logistic regression (LR) and support vector machines (SVM) were used for classification of extracted features. Signals and feature vectors were randomly divided into training (80%) and testing (20%) sets. Results: The highest overall accuracy was achieved using a logistic regression model with a combination of statistical and multiscale wavelet variance features, with 88% accuracy, 92% sensitivity, and 82% specificity. The area under the receiver operating characteristics curve (AUC) was 0.93. Conclusion: We have constructed a machine learning algorithm with high discriminatory ability for the diagnosis of PAD using Doppler arterial spectral waveforms sampled at the ankle vessels.
MeSH term(s)	Ankle Brachial Index ; Arteries ; Diabetes Mellitus ; Humans ; Machine Learning ; Peripheral Arterial Disease/diagnostic imaging
Language	English
Publishing date	2022-06-22
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1311628-9
ISSN	1477-0377 ; 1358-863X
ISSN (online)	1477-0377
ISSN	1358-863X
DOI	10.1177/1358863X221105113
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Article ; Online: Exploring depression through literature and art.

Mustafa, Chira / Normahani, Pasha

Journal of the Royal Society of Medicine

2020 Volume 113, Issue 4, Page(s) 136–139

MeSH term(s)	Depression ; Humans ; Literature, Modern ; Paintings
Language	English
Publishing date	2020-03-30
Publishing country	England
Document type	Journal Article
ZDB-ID	6731-3
ISSN	1758-1095 ; 0141-0768 ; 0035-9157
ISSN (online)	1758-1095
ISSN	0141-0768 ; 0035-9157
DOI	10.1177/0141076819899315
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Article ; Online: Harnessing Machine Learning to Personalize Web-Based Health Care Content.

Guni, Ahmad / Normahani, Pasha / Davies, Alun / Jaffer, Usman

Journal of medical Internet research

2021 Volume 23, Issue 10, Page(s) e25497

Abstract: Web-based health care content has emerged as a primary source for patients to access health information without direct guidance from health care providers. The benefit of this approach is dependent on the ability of patients to access engaging high- ... ...

Abstract	Web-based health care content has emerged as a primary source for patients to access health information without direct guidance from health care providers. The benefit of this approach is dependent on the ability of patients to access engaging high-quality information, but significant variability in the quality of web-based information often forces patients to navigate large quantities of inaccurate, incomplete, irrelevant, or inaccessible content. Personalization positions the patient at the center of health care models by considering their needs, preferences, goals, and values. However, the traditional methods used thus far in health care to determine the factors of high-quality content for a particular user are insufficient. Machine learning (ML) uses algorithms to process and uncover patterns within large volumes of data to develop predictive models that automatically improve over time. The health care sector has lagged behind other industries in implementing ML to analyze user and content features, which can automate personalized content recommendations on a mass scale. With the advent of big data in health care, which builds comprehensive patient profiles drawn from several disparate sources, ML can be used to integrate structured and unstructured data from users and content to deliver content that is predicted to be effective and engaging for patients. This enables patients to engage in their health and support education, self-management, and positive behavior change as well as to enhance clinical outcomes.
MeSH term(s)	Delivery of Health Care ; Health Personnel ; Humans ; Internet ; Machine Learning
Language	English
Publishing date	2021-10-19
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1438-8871
ISSN (online)	1438-8871
ISSN	1438-8871
DOI	10.2196/25497
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Article ; Online: Tensor decomposition and machine learning for the detection of arteriovenous fistula stenosis: An initial evaluation.

Poushpas, Sepideh / Normahani, Pasha / Kisil, Ilya / Szubert, Ben / Mandic, Danilo P / Jaffer, Usman

PloS one

2023 Volume 18, Issue 7, Page(s) e0286952

Abstract: Duplex ultrasound (DUS) is the most widely used method for surveillance of arteriovenous fistulae (AVF) created for dialysis. However, DUS is poor at predicting AVF outcomes and there is a need for novel methods that can more accurately evaluate ... ...

Abstract	Duplex ultrasound (DUS) is the most widely used method for surveillance of arteriovenous fistulae (AVF) created for dialysis. However, DUS is poor at predicting AVF outcomes and there is a need for novel methods that can more accurately evaluate multidirectional AVF flow. In this study we aimed to evaluate the feasibility of detecting AVF stenosis using a novel method combining tensor-decomposition of B-mode ultrasound cine loops (videos) of blood flow and machine learning classification. Classification of stenosis was based on the DUS assessment of blood flow volume, vessel diameter size, flow velocity, and spectral waveform features. Real-time B-mode cine loops of the arterial inflow, anastomosis, and venous outflow of the AVFs were analysed. Tensor decompositions were computed from both the 'full-frame' (whole-image) videos and 'cropped' videos (to include areas of blood flow only). The resulting output were labelled for the presence of stenosis, as per the DUS findings, and used as a set of features for classification using a Long Short-Term Memory (LSTM) neural network. A total of 61 out of 66 available videos were used for analysis. The whole-image classifier failed to beat random guessing, achieving a mean area under the receiver operating characteristics (AUROC) value of 0.49 (CI 0.48 to 0.50). In contrast, the 'cropped' video classifier performed better with a mean AUROC of 0.82 (CI 0.66 to 0.96), showing promising predictive power despite the small size of the dataset. The combined application of tensor decomposition and machine learning are promising for the detection of AVF stenosis and warrant further investigation.
MeSH term(s)	Humans ; Renal Dialysis/methods ; Arteriovenous Shunt, Surgical ; Constriction, Pathologic/diagnostic imaging ; Blood Flow Velocity ; Arteriovenous Fistula ; Machine Learning
Language	English
Publishing date	2023-07-25
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0286952
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Article ; Online: A Guytonian explanation for hemodynamic responses to interventions in superficial venous disease.

Normahani, Pasha / Shalhoub, Joseph / Narayanan, Sriram

Phlebology

2020 Volume 36, Issue 3, Page(s) 245–250

MeSH term(s)	Hemodynamics ; Humans ; Vascular Diseases/therapy ; Venous Insufficiency
Language	English
Publishing date	2020-11-27
Publishing country	England
Document type	Letter
ZDB-ID	645172-x
ISSN	1758-1125 ; 0268-3555
ISSN (online)	1758-1125
ISSN	0268-3555
DOI	10.1177/0268355520974862
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Article ; Online: Repurposing the systemic venous return model for conceptualisation of chronic venous insufficiency and its management.

Normahani, Pasha / Shalhoub, Joseph / Narayanan, Sriram

Phlebology

2020 Volume 35, Issue 10, Page(s) 749–751

MeSH term(s)	Chronic Disease ; Concept Formation ; Humans ; Veins ; Venous Insufficiency/therapy
Language	English
Publishing date	2020-06-11
Publishing country	England
Document type	Editorial
ZDB-ID	645172-x
ISSN	1758-1125 ; 0268-3555
ISSN (online)	1758-1125
ISSN	0268-3555
DOI	10.1177/0268355520932371
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Article ; Online: Peripheral blood mononuclear cell gene expression and cytokine profiling in patients with intermittent claudication who exhibit exercise induced acute renal injury.

Normahani, Pasha / Boyle, Joseph J / Cave, Luke / Brookes, Paul / Woollard, Kevin J / Jaffer, Usman

PloS one

2022 Volume 17, Issue 3, Page(s) e0265393

Abstract: Background: Intermittent claudication (IC) is a common manifestation of peripheral arterial disease. Some patients with IC experience a rise in Urinary N-acetyl-β-D-Glucosaminidase (NAG)/ Creatinine (Cr) ratio, a marker of renal injury, following ... ...

Abstract	Background: Intermittent claudication (IC) is a common manifestation of peripheral arterial disease. Some patients with IC experience a rise in Urinary N-acetyl-β-D-Glucosaminidase (NAG)/ Creatinine (Cr) ratio, a marker of renal injury, following exercise. In this study, we aim to investigate whether peripheral blood mononuclear cells (PBMC) from patients with IC who exhibit a rise in urinary NAG/ Cr ratio following exercise exhibit differential IL-10/ IL-12 ratio and gene expression compared to those who do not have a rise in NAG/ Cr ratio. Methods: We conducted a single center observational cohort study of patients diagnosed with IC. Blood and urine samples were collected at rest and following a standardised treadmill exercise protocol. For comparative analysis patients were separated into those with any rise in NAG/Cr ratio (Group 1) and those with no rise in NAG/Cr ratio (Group 2) post exercise. Isolated PBMC from pre- and post-exercise blood samples were analysed using flow cytometry. PBMC were also cultured for 20 hours to perform further analysis of IL-10 and IL-12 cytokine levels. RNA-sequencing analysis was performed to identify differentially expressed genes between the groups. Results: 20 patients were recruited (Group 1, n = 8; Group 2, n = 12). We observed a significantly higher IL-10/IL-12 ratio in cell supernatant from participants in Group 1, as compared to Group 2, on exercise at 20 hours incubation; 47.24 (IQR 9.70-65.83) vs 6.13 (4.88-12.24), p = 0.04. 328 genes were significantly differentially expressed between Group 1 and 2. The modulated genes had signatures encompassing hypoxia, metabolic adaptation to starvation, inflammatory activation, renal protection, and oxidative stress. Discussion: Our results suggest that some patients with IC have an altered immune status making them 'vulnerable' to systemic inflammation and renal injury following exercise. We have identified a panel of genes which are differentially expressed in this group of patients.
MeSH term(s)	Acetylglucosaminidase/urine ; Acute Kidney Injury/metabolism ; Biomarkers/urine ; Creatinine/urine ; Cytokines/genetics ; Female ; Gene Expression ; Humans ; Interleukin-10/genetics ; Interleukin-12/genetics ; Intermittent Claudication/genetics ; Leukocytes, Mononuclear/metabolism ; Male
Chemical Substances	Biomarkers ; Cytokines ; Interleukin-10 (130068-27-8) ; Interleukin-12 (187348-17-0) ; Creatinine (AYI8EX34EU) ; Acetylglucosaminidase (EC 3.2.1.52)
Language	English
Publishing date	2022-03-17
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0265393
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Article: Pathogenesis of Distal Symmetrical Polyneuropathy in Diabetes.

Smith, Sasha / Normahani, Pasha / Lane, Tristan / Hohenschurz-Schmidt, David / Oliver, Nick / Davies, Alun Huw

Life (Basel, Switzerland)

2022 Volume 12, Issue 7

Abstract: Distal symmetrical polyneuropathy (DSPN) is a serious complication of diabetes associated with significant disability and mortality. Although more than 50% of people with diabetes develop DSPN, its pathogenesis is still relatively unknown. This lack of ... ...

Abstract	Distal symmetrical polyneuropathy (DSPN) is a serious complication of diabetes associated with significant disability and mortality. Although more than 50% of people with diabetes develop DSPN, its pathogenesis is still relatively unknown. This lack of understanding has limited the development of novel disease-modifying therapies and left the reasons for failed therapies uncertain, which is critical given that current management strategies often fail to achieve long-term efficacy. In this article, the pathogenesis of DSPN is reviewed, covering pathogenic changes in the peripheral nervous system, microvasculature and central nervous system (CNS). Furthermore, the successes and limitations of current therapies are discussed, and potential therapeutic targets are proposed. Recent findings on its pathogenesis have called the definition of DSPN into question and transformed the disease model, paving the way for new research prospects.
Language	English
Publishing date	2022-07-19
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life12071074
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Article: Prevention and Management Strategies for Diabetic Neuropathy.

Smith, Sasha / Normahani, Pasha / Lane, Tristan / Hohenschurz-Schmidt, David / Oliver, Nick / Davies, Alun Huw

Life (Basel, Switzerland)

2022 Volume 12, Issue 8

Abstract: Diabetic neuropathy (DN) is a common complication of diabetes that is becoming an increasing concern as the prevalence of diabetes rapidly rises. There are several types of DN, but the most prevalent and studied type is distal symmetrical polyneuropathy, ...

Abstract	Diabetic neuropathy (DN) is a common complication of diabetes that is becoming an increasing concern as the prevalence of diabetes rapidly rises. There are several types of DN, but the most prevalent and studied type is distal symmetrical polyneuropathy, which is the focus of this review and is simply referred to as DN. It can lead to a wide range of sensorimotor and psychosocial symptoms and is a major risk factor for diabetic foot ulceration and Charcot neuropathic osteoarthropathy, which are associated with high rates of lower limb amputation and mortality. The prevention and management of DN are thus critical, and clinical guidelines recommend several strategies for these based on the best available evidence. This article aims to provide a narrative review of DN prevention and management strategies by discussing these guidelines and the evidence that supports them. First, the epidemiology and diverse clinical manifestations of DN are summarized. Then, prevention strategies such as glycemic control, lifestyle modifications and footcare are discussed, as well as the importance of early diagnosis. Finally, neuropathic pain management strategies and promising novel therapies under investigation such as neuromodulation devices and nutraceuticals are reviewed.
Language	English
Publishing date	2022-08-03
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life12081185
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