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Articles by R. A. Malik
Total Records ( 7 ) for R. A. Malik
  N. O. B. Thomsen , M. Mojaddidi , R. A. Malik and L. B. Dahlin
  Aims  The sural nerve is the commonest peripheral nerve biopsied to help in the diagnosis of peripheral neuropathy of unknown cause. However, associated complications limit its use. The aim was, as an alternative, to asses biopsy of the terminal branch of the posterior interosseous nerve (PIN) in the forearm.

Methods  PIN pathology was morphometrically quantified in 10 male patients with Type 2 diabetes and compared with six PIN biopsy specimens taken post mortem from male cadavers with no history of neuropathy or trauma.

Results  The PIN biopsy procedure provides a long (approximately 3 cm) mono- or bifascicular nerve biopsy with generous epineurial tissue and adjacent vessels. Our results show a significantly lower myelinated fibre density in subjects with diabetes [5782 (3332-9060)/mm2] compared with autopsy control material [9256 (6593-12 935)/mm2, P < 0.007]. No postoperative discomfort or complications were encountered.

Conclusions  A reduction in myelinated fibre density has previously been shown to be a clinically meaningful measure of neuropathy in diabetic patients. We demonstrate similar findings using the PIN biopsy. The PIN biopsy procedure fulfils the criteria for nerve biopsy and was well tolerated by the patients. It may be a possible alternative to sural nerve biopsy to allow for diagnosis of neuropathy.

  U. Alam , O. Najam , S. Al-Himdani , S. Benolie , P. Jinadev , J. L. Berry , M. Kew , O. Asghar , I. N. Petropoulos and R. A. Malik
  Not available
  F. L. Bowling , C. A. Abbott , W. E. Harris , S. Atanasov , R. A. Malik and A. J. M. Boulton
  Aims  To compare the Ipswich Touch Test and the VibraTip with the Neuropathy Disability Score and the vibration perception threshold for detecting the ‘at-risk’ foot.

Methods  We directly compared the Ipswich Touch Test and the VibraTip with both the Neuropathy Disability Score ≥ 6 and the vibration perception threshold ≥ 25 V indicating ‘at-risk’ feet in 83 individuals.

Results  The vibration perception threshold and Neuropathy Disability Score tests exhibited almost perfect agreement with each other (P < 0.001). The VibraTip and Ipswich Touch Test results were identical (P < 0.001). The VibraTip and Ipswich Touch Test results also exhibited almost perfect agreement with the vibration perception threshold (P < 0.001) and the Neuropathy Disability Score (P < 0.001).

Conclusions  These two simple and efficient tests are easy to teach, reliable and can be used in any setting, and neither requires an external power source. We conclude that both the VibraTip and the Ipswich Touch Test are reliable and sensitive tests for identifying the ‘high-risk’ foot.

  N. Papanas , A. J. M. Boulton , R. A. Malik , C. Manes , O. Schnell , V. Spallone , N. Tentolouris , S. Tesfaye , P. Valensi , D. Ziegler and P. Kempler
  A simple non-invasive indicator test (Neuropad®) has been developed for the assessment of sweating and, hence, cholinergic innervation in the diabetic foot. The present review summarizes current knowledge on this diagnostic test. The diagnostic ability of this test is based on a colour change from blue to pink at 10 min, with excellent reproducibility, which lends itself to patient self-examination. It has a high sensitivity (65.1-100%) and negative predictive value (63-100%), with moderate specificity (32-78.5%) and positive predictive value (23.3-93.2%) for the diagnosis of diabetic peripheral neuropathy. It also has moderate to high sensitivity (59.1-89%) and negative predictive value (64.7-91%), but low to moderate specificity (27-78%) and positive predictive value (24-48.6%) for the diagnosis of diabetic cardiac autonomic neuropathy. There are some data to suggest that Neuropad can detect early diabetic neuropathy, but this needs further evaluation. It remains to be established whether this test can predict foot ulceration and amputation, thereby contributing to the identification of high-risk patients.
  E. A. C. Sellers , I. Clark , M. Tavakoli , H. J. Dean , J. McGavock and R. A. Malik
  Not available
  R. A. Malik , S. Tesfaye and D. Ziegler
  Lower extremity amputation is a common and disabling complication of Type 2 diabetes. Whilst the introduction of specialist multidisciplinary teams has led to a reduction in the incidence of lower extremity amputation in some centres, the overall prevalence of diabetes-related amputation has actually increased in recent decades. The aetiology of diabetes-related amputation is complex, with neuropathy, macrovascular and microvascular disease contributing significantly. Ulceration, previous amputation, increasing diabetes duration and poor long-term control of glycaemia and lipids are important risk factors for amputation in populations with diabetes. Major randomized intervention trials of blood glucose-lowering or anti-hypertensive therapies in populations with diabetes have shown limited reductions in neuropathy and/or macrovascular disease, and no benefit on amputation rates. In contrast, a recent analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study showed a significantly reduced rate of minor, but not major amputations in patients with Type 2 diabetes treated with fenofibrate. Mechanistic studies are clearly needed to understand the basis of this benefit.
  G. Bitirgen , A. Ozkagnici , R. A. Malik and H. Kerimoglu


To quantify the morphological alterations in corneal nerve fibres and cells in patients with Type 2 diabetes mellitus in relation to the severity of diabetic retinopathy.


One hundred and thirty-two eyes of 132 patients with Type 2 diabetes and 32 eyes of 32 healthy control subjects were evaluated with in vivo corneal confocal microscopy. Patients with diabetes were classified into three groups: patients without diabetic retinopathy, patients with non-proliferative diabetic retinopathy and patients with proliferative diabetic retinopathy. Anterior and posterior stromal keratocyte, endothelial cell and basal epithelial cell densities and sub-basal nerve fibre structure were evaluated.


Significant reductions in basal epithelial cell, anterior stromal keratocyte and endothelial cell densities were observed only in patients with diabetic retinopathy. However, nerve fibre density, nerve branch density and nerve fibre length were reduced in patients without diabetic retinopathy and worsened progressively with increasing severity of retinopathy.


Corneal cell pathology occurs in patients with diabetic retinopathy, but corneal nerve fibre damage seems to precede the development of diabetic retinopathy.

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