Clinical Medicine Research

ISSN Online: 2326-9057 ISSN Print: 2326-9049

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Volume 3, Issue 3, May 2014

  • Authors: Wee Kooi Cheah, Hoon Lang Teh, Diana Xiao Han Huang, Alan Swee Hock Ch’ng, Mun Pung Choy, Ewe Eow Teh, Irene Looi

    Abstract: Background: Montreal Cognitive Assessment (MoCA) has been shown to be a sensitive tool for cognitive assessment. There are high proportion of Malaysian elderly with limited proficiency in English language. Malay language is a more familiar language across the multiracial population of Malaysia. Objective: The aim of this study is to validate the Malay version of Montreal Cognitive Assessment (MMoCA) in cognitive impairment patients. Methods: Elderly aged 60 years and above were recruited by using convenient sampling method from 4 government hospitals. Subjects were categorized into normal control group versus patients group with cognitive impairment (Alzheimer’s Disease (AD) and Mild Cognitive Impairment (MCI)). All subjects completed MMoCA & MMSE – Malay version, followed by a second assessment, which involved Clinical Dementia Rating (CDR), clinical neurological and psychiatry assessment. Results: Total of 66 subjects was enrolled in the study, 44 were normal control, 14 with AD, 8 with MCI. MMoCA is better than MMSE-Malay in differentiating CDR 0 from CDR > 0. With the cut off point of less than 22, MMoCA has the sensitivity of 0.824 and specificity of 0.818 to detect cognitive impairment. Whereas MMSE-Malay only has sensitivity of 0.765 and specificity of 0.636 with the cut off point of less than 27. Conclusion: The MMoCA is a validated and useful cognitive screening instrument in patients with cognitive impairment.

    Received: Mar. 23, 2014 Accepted: Apr. 15, 2014 Published: Apr. 30, 2014

    DOI: 10.11648/j.cmr.20140303.11 View: Downloads:

  • Authors: Omar Riyach, Mustapha Ahsaini, Mohammed Fadl Tazi, Jalal Eddine El Ammari, Mohammed Jamal El Fassi, Abdelhak Khallouk, Moulay Hassan Farih

    Abstract: Background: Neurogenic or neuropathic bladder is defined as any defective functioning of the bladder caused by impaired innervations. Pernicious anemia is a rare cause of neurogenic bladder and it is often accompanied by other neurological manifestations. The standard treatment is based on parenteral vitamin administration. We report a unique case of pernicious anemia revealed by a neurogenic bladder succefully managed by vitamin B12 administration. Case presentation: A 45-year-old man presented with lower urinary tract symptoms (LUTS) with urine retentions. The patient was an important postvoid residual volume. The uroflowmetry result of the patient was low. Cystoscopy reveals a normal urethra, prostatic fossa, and bladder. Urodynamic testing demonstrated a failure voiding bladder. The diagnostic of pernicious anemia was suspected in laboratory exams which have showed megaloblastic anemia and Serum antibodies to gastric parietal cells, the diagnostic was confirmed by gastric biopsy. The patient was traited by oral administration of vitamin B12. At his 6 months follow-up, clinical symptoms had improved, and there was no significant postvoid residual (PVR). Conclusion: The vesicosphincteriens disorders in pernicious anemia are very little detail in the literature .our case is to our knowledge the first to have urinary voiding dysfunction as the only symptom of pernicious anemia with spectacular improvement after vitamin B12 administration.

    Received: Mar. 26, 2014 Accepted: Apr. 14, 2014 Published: Apr. 30, 2014

    DOI: 10.11648/j.cmr.20140303.12 View: Downloads:

  • Author: Michael D. Innis

    Abstract: Background: Mr Darryl Elliot was convicted for the murder of Amelia Bowmar on the evidence of doctors who alleged Amelia was a victim of the Shaken Baby Syndrome because ofthe presence of a subdural haematoma, swelling of the brain with ischaemic changes and haemorrhagic contusions in the cortex of the right and left superior frontal gyri of the brain. The brain and spinal cord showed evidence of old and recent injury which the doctors attributed to “Non-accidental Injury”. Method: To prove that the allegation of murder was false the results of the blood tests were analyzed. Result:It is shown that the child had evidence of abnormal coagulation of blood, liver dysfunction and hypoinsulinaemia following mandated MMR vaccine administered a few days prior to the onset of symptoms. Conclusion:The Laboratory results prove the presence of vaccine induced Tissue Scurvy which would account for all the lesions found on the child.

    Received: Apr. 16, 2014 Accepted: May 4, 2014 Published: May 20, 2014

    DOI: 10.11648/j.cmr.20140303.13 View: Downloads:

  • Authors: Stephanie Lynn Garrett, Peter T. Baltrus, Patrick A. Griffith, George Staben Rust

    Abstract: Background: Little is known regarding in-hospital mortality for older African Americans hospitalized with delirium diagnoses. Objectives: To estimate the in-hospital mortality for older African Americans hospitalized with delirium diagnoses based on a national representative sample; differences in this outcome and other determinants of morbidity (i.e. length of stay) between well studied populations (non-Hispanic Whites) and African Americans was also the focus. Design: Retrospective cohort study. Setting: Database of hospital discharges from the 2006 Nationwide Inpatient Sample (NIS), a subset of the Healthcare Cost and Utilization Project (HCUP) from the Agency for Healthcare Research and Quality (AHRQ). Participants: Represented 54,003 hospital discharges for those 65 years old and above, both African Americans and non-Hispanic Whites discharged from US hospitals. Key Outcomes: In-hospital mortality and length of stay. Results: Among delirious patients, African Americans had a longer mean length of stay (LOS) than non-Hispanic Whites (7.8 vs. 7.3 days, p=0.005). A larger percentage of non-Hispanic White patients (7.4%) compared to African American patients (6.6%) died during their stay in the hospital, however this was not statistically significant (p=0.076). Limitations: Suspected under-detection of delirium by providers and the subsequent diminished diagnostic capture by evidence of paid billing claims. Conclusion: The in-hospital mortality rate for non-Hispanic White patients hospitalized with diagnoses of delirium was also significantly less than that found in other studies (7.3 vs. 9%) indicating that detection of delirium and its subsequent diagnostic capture in these claims data may have been very low. The most likely explanation is that determining mortality estimates for an already under-diagnosed syndrome based on claims diagnostic data may be suboptimal. Alternatively, these results may indicate that delirium is profoundly under-diagnosed in elderly hospitalized African Americans as compared to their non-Hispanic White counterparts.

    Received: Apr. 22, 2014 Accepted: May 22, 2014 Published: Jun. 10, 2014

    DOI: 10.11648/j.cmr.20140303.14 View: Downloads:

  • Authors: Onigbinde Ayodele Teslim, Fadare Oluseye Emmanuel, Akindoyin Olubukola, Tarimo Nesto

    Abstract: Body temperature is being speculated to be accurate for diagnosis and also monitor chronicity of diseases. Most studies on skin temperature are obsolete and were mostly done in Europe, and racial differences have been noted to have profound effect on human health. The primary objective of this study was to compare the temperatures on the affected and unaffected sides of selected patients with neuromuscular and musculoskeletal dysfunctions. Sixty-nine patients with neuromuscular and musculoskeletal disorders participated in the study. Temperatures were taken at both the pathologic and non-pathologic joints. Data obtained were analysed using descriptive and inferential statistics of paired t-test at 0.05 alpha levels. The results showed no significant difference between axillary, elbow, wrist, knee and ankle joints temperature of the pathologic and non-pathologic upper extremities of subjects with neurological conditions A mean skin temperature difference of 0.29 °C was observed between neuromuscular and musculoskeletal dysfunctions. However, within subjects with musculoskeletal dysfunctions; the skin temperature at the pathologic knee joint was significantly higher than that of the non-pathologic knee joint (t = 2.43, p = 0.02). We concluded that, for patients with neuromuscular dysfunctions; there was a minor but an insignificant decrease in skin temperature of pathologic joints compared to that of non-pathologic joints. The mean skin temperature at the pathologic knee joint of patients with musculoskeletal dysfunctions was significantly higher than that of the non-pathologic knee joint.

    Received: May 21, 2014 Accepted: Jun. 9, 2014 Published: Jun. 20, 2014

    DOI: 10.11648/j.cmr.20140303.15 View: Downloads:

  • Authors: Meng Xun, Haifeng Wang, Burong Li, Hongyan He, Qian He, Yonglie Chu

    Abstract: Objectives: Previous proteome analysis conducted by our group has demonstrated that cytokeratin 8 was overexpressed in HuH-7 cells harboring in vitro transcribed HCV 1b full length RNA (HuH-7-HCV). Present study was aim to verify the results of proteomics, and obtain the clinical data of CK8 expresson levels in HCV patients. Methods: The expression level of CK 8 in HuH-7-HCV cells was examined by Real time PCR and Western blotting. The concentration of CK8 in HCV patients’ serum was measured by enzyme-linked immunosorbent assay (ELISA). Results: The results showed expression level of CK8 transcript in HuH-7-HCV cells was 2.3 fold higher than that in HuH-7 mock cells (P<0.01). The protein expression of CK8 in HuH-7-HCV cells was approximately 3 fold higher than that in HuH-7 mock cells (P<0.01). However, results of ELISA demonstrated the serum CK8 concentration was significantly reduced in chronic HCV patients compared to normal healthy controls (P<0.01). And there was a negative linear correlation between serum CK8 concentration and HCV RNA titer (r=-0.380, P<0.01). Conclusion: Our present study supports the hypothesis that in response to HCV infection, expression of CK8 was increased, which may contribute to the essential cytoprotection provided by CK8 in the liver. Altered CK8 expression pattern could be an important event in the pathogenesis of HCV infection. CK8 have potential use as surrogate markers of liver injury.

    Received: May 21, 2014 Accepted: Jun. 16, 2014 Published: Jun. 30, 2014

    DOI: 10.11648/j.cmr.20140303.16 View: Downloads:

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