scholarly journals Performance of the Rowland Universal Dementia Assessment Scale in Screening Mild Cognitive Impairment at an Outpatient Setting

2021 ◽  
pp. 181-188
Author(s):  
Manchumad Manjavong ◽  
Panita Limpawattana ◽  
Kittisak Sawanyawisuth
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Educational Level ◽  
Early Recognition ◽  
Tertiary Care ◽  
Assessment Scale ◽  
Cutoff Point ◽  
Care Hospital ◽  
Optimal Cutoff ◽  
Optimal Cutoff Point

<b><i>Introduction:</i></b> Mild cognitive impairment (MCI) is defined as the symptomatic pre-dementia phase on the continuum of cognitive decline. Early recognition and application of potential interventions could prevent or delay the progression to dementia. The Rowland Universal Dementia Assessment Scale (RUDAS) shows good performance in the screening of dementia but has limited data regarding its diagnostic properties in the screening of MCI. The objectives of this study were to assess the psychometric properties of the Thai version of the RUDAS (RUDAS-Thai) in the screening of MCI, identify associated factors for the RUDAS performance, and determine the optimal cutoff point in detecting MCI. <b><i>Methods:</i></b> This was a cross-sectional study conducted from January 2020 to March 2021. Older patients at the outpatient clinic of an internal medicine department at a tertiary care hospital in Thailand were examined. Baseline data were collected, and the RUDAS-Thai was administered to each patient. Afterward, a geriatrician assessed each patient for MCI. <b><i>Results:</i></b> A total of 150 patients were included, of whom 42 cases (28%) had MCI. The overall performance of the test using an area under the receiver operating characteristic curve (AUC) was 0.82 (95% confidence interval 0.75–0.89). At the optimal cutoff point of 25/30, the AUC was 0.76 with sensitivity and specificity of 76.2 and 75%, respectively. The educational level affected the test performance according to regression analysis. For patients with years of education ≤6 and &#x3e;6, the optimal cutoff points were 25/30 and 26/30, respectively. <b><i>Conclusion:</i></b> The RUDAS-Thai performed well in differentiating patients with MCI from normal cognition; however, it was affected by educational level. A score of 25/30 or lower for persons with ≤6 years of education or 26/30 or lower for persons with higher than 6 years of education is the optimal cutoff point for indication of developing MCI.

scholarly journals Efficacy of Emergency Severity Index (ESI) in Early Identification of Patients with Sepsis and Septic Shock at Triage

2020 ◽  
Author(s):  
Emad Uddin Siddiqui ◽  
Noman Ali ◽  
Mirza Noor Ali Baig ◽  
Ahmed Raheem ◽  
Nazir Najeeb ◽  
...  
Keyword(s):  
Septic Shock ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Tertiary Care ◽  
Area Under The Curve ◽  
Severity Index ◽  
Care Hospital ◽  
Emergency Severity Index ◽  
Optimal Cutoff ◽  
Sepsis And Septic Shock

Abstract Objectives The objective of the study is to determine the efficacy of Emergency Severity Index (ESI) tool in early recognition of “sepsis” and “septic shock” at the triage of an emergency room at a tertiary care hospital in Pakistan.Results A total of 240 patients were included in this study. The area under the curve (AUC) for the ESI score I for septic shock was 0.943 [0.921–0.964] with the optimal cutoff value of 2.0 with sensitivity of 88.5% and specificity of 100%. Similarly, the sensitivity and specificity of ESI score II for the diagnosis of sepsis was found to be 100.00% (CI 97.63–100.00%) and 66.28% (CI 55.28% to76.12%) with accuracy of 87.92% (83.11–91.76%)

Relationship between the levels of vitamin D in elderly adults with mild cognitive impairment and dementia in a tertiary care hospital

2019 ◽  
Vol 405 ◽  
pp. 371
Author(s):  
A. Mimenza ◽  
S. Aguilar Navarro ◽  
L. Bracho Vela ◽  
A. Zamudio Cruz ◽  
F. Hernandez Contreras ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Elderly Adults

scholarly journals P4-204: RELATIONSHIP BETWEEN THE LEVELS OF VITAMIN D IN ELDERLY ADULTS WITH MILD COGNITIVE IMPAIRMENT AND DEMENTIA IN A TERTIARY CARE HOSPITAL

2019 ◽  
Vol 15 ◽  
pp. P1354-P1354
Author(s):  
Sara Gloria Aguilar ◽  
Alberto Jose Mimenza ◽  
Leonardo Bracho ◽  
Alejandra Samudio ◽  
Francisco Hernández ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Elderly Adults

Mild cognitive impairment in primary care: a clinical review

2018 ◽  
Vol 94 (1117) ◽  
pp. 647-652 ◽  
Author(s):  
Georges Assaf ◽  
Maria Tanielian
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Clinical Review ◽  
Primary Care Physicians ◽  
Early Recognition ◽  
Neuropsychiatric Symptoms ◽  
Evidenced Based

Dementia is projected to become a global health priority but often not diagnosed in its earlier preclinical stage which is mild cognitive impairment (MCI). MCI is generally referred as a transition state between normal cognition and Alzheimer’s disease. Primary care physicians play an important role in its early diagnosis and identification of patients most likely to progress to Alzheimer’s disease while offering evidenced-based interventions that may reverse or halt the progression to further cognitive impairment. The aim of this review is to introduce the concept of MCI in primary care through a case-based clinical review. We discuss the case of a patient with MCI and provide an evidence-based framework for assessment, early recognition and management of MCI while addressing associated risk factors, neuropsychiatric symptoms and prognosis.

scholarly journals Assessment of adverse drug reaction profile of the disease-modifying anti-rheumatic drugs at the department of orthopaedics in a tertiary care hospital, Silchar, Assam, India

2019 ◽  
Vol 8 (5) ◽  
pp. 1007
Author(s):  
Vijoy S. Kairi ◽  
Pinaki Chakravarty ◽  
Arun Kumar Sipani
Keyword(s):  
Prospective Observational Study ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Case Record ◽  
Medical College ◽  
Disease Modifying ◽  
Reaction Profile

Background: The mainstay of treatment of Rheumatoid Arthritis (RA) is the use of the disease-modifying anti-rheumatic drugs (DMARDs). Methotrexate, sulfasalazine and hydroxychloroquine are some of the DMARDs which are used in combination for the treatment of RA. The current study was undertaken to assess the adverse drug reactions (ADRs) of DMARDs that are commonly encountered with the treatment of RA.Methods: The present study was designed as a prospective, observational study on newly diagnosed patients with RA. Patients diagnosed with RA above 18 years (excluding pregnant women) of either sex who were prescribed DMARDs in combination were included. ADRs reported spontaneously by the patients and also responses obtained in a questionnaire related to likely ADRs from the patients was recorded in the case record form. Statistical analysis was done using graph pad and p value <0.05 was considered to be statistically significant.Results: A total of 47 patients attending the Outpatient Department of Orthopaedics, Silchar Medical College and Hospital, Silchar, Assam, India were screened for the study. ADRs were monitored up to the last visit on 41 patients excluding the patients who were lost and who were not able to adhere to the treatment. A total of 27 ADRs were reported from 19 ADR forms. Gastrointestinal manifestations were the most common adverse effects of combination DMARDs seen in 10 patients (24.39%). Severity assessment done using modified Hartwig and Siegel scale that showed majority of the ADRs were mild (74.07%).Conclusions: Present study showed that DMARDs are well-tolerated and have an acceptable toxicity profile as majority of ADRs seen were mild. It was however difficult to prevent the occurrence of ADRs. Proper monitoring of therapy is needed for early recognition of ADRs.

scholarly journals A STUDY ON ADVERSE DRUG REACTIONS IN PATIENTS ON ANTIRETROVIRAL THERAPY IN A TERTIARY CARE HOSPITAL AT JAIPUR, RAJASTHAN

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Vishnu Gupta ◽  
Abhishek Agarwal
Keyword(s):  
Nervous System ◽  
Peripheral Nervous System ◽  
Early Recognition ◽  
Tertiary Care ◽  
Hiv Treatment ◽  
Research Review ◽  
Care Hospital ◽  
Medical College ◽  
The Status ◽  
Definition Of

Background: The present study was conducted to know the status of ADRs caused due to the first line ART in the ART center of SMS Hospital Jaipur, Rajasthan. This study would be beneficial to the HIV infected patients, with the ultimate goal of improving the tolerability and effectiveness of HIV treatment by promoting the early recognition of potentially serious adverse effects. Methods: Hospital based Prospective, Observational study conducted after approval by research review board and ethics committee SMS Medical College Jaipur (Rajasthan). WHO definition of ADR was used (any response to a medicine which is noxious and unintended and which occurs at doses normally used in man). The detail of ADRs collected including suspected drug involved, treatment given for ADRs and outcome. Results: Majority of ADRs were related to central and peripheral nervous system related 55 (47%) followed by gastro intestinal 28 (23.9%), dermatological 15 (12.8%), musculoskeletal 9 (7.7%) and metabolic 5 (4.3%). Conclusion: Majority of ADRs were related to central and peripheral nervous system related followed by gastro intestinal. Keywords: ADRs, HIV, WHO.

scholarly journals Development of a Sex-Specific Risk Scoring System for Predicting Cognitive Normal to Mild Cognitive Impairment (SRSS-CNMCI)

2021 ◽  
Author(s):  
Wen Luo ◽  
Hao Wen ◽  
Shuqi Ge ◽  
Chunzhi Tang ◽  
Xiufeng Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
High Risk ◽  
Scoring System ◽  
External Validation ◽  
Scoring Systems ◽  
Cutoff Point ◽  
Risk Scoring ◽  
Risk Scoring System

Abstract Objective: We aim to develop a sex-specific risk scoring system for predicting cognitive normal (CN) to mild cognitive impairment (MCI), abbreviated SRSS-CNMCI, to provide a reliable tool for the prevention of MCI.Methods: Participants aged 61-90 years old with a baseline diagnosis of CN and an endpoint diagnosis of MCI were screened from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database with at least one follow-up. Multivariable Cox proportional hazards models were used to identify risk factors associated with conversion from CN to MCI and to build risk scoring systems for male and female groups. Receiver operating characteristic (ROC) curve analysis was applied to determine the risk probability cutoff point corresponding to the optimal prediction effect. We ran an external validation of the discrimination and calibration based on the Harvard Aging Brain Study (HABS) database.Results: A total of 471 participants, including 240 women (51%) and 231 men (49%), aged 61 to 90 years, were included in the study cohort for subsequent primary analysis. The final multivariable models and the risk scoring systems for females and males included age, APOE ε4, Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). The scoring systems for females and males revealed C statistics of 0.902 (95% CI 0.840-0.963) and 0.911 (95% CI 0.863-0.959), respectively, as measures of discrimination. The cutoff point of high and low risk was 33% in females, and more than 33% was considered high risk, while more than 9% was considered high risk for males. The external validation effect of the scoring systems was good: C statistic 0.950 for the females and C statistic 0.965 for the males. Conclusions: Our parsimonious model accurately predicts conversion from CN to MCI with four risk factors and can be used as a predictive tool for the prevention of MCI.

scholarly journals A study of Acute Liver Failure in adults in a tertiary care hospital

2019 ◽  
Vol 5 (6) ◽  
pp. 204-207
Author(s):  
Dr. Mohini Singh ◽  
◽  
Dr. Srilakshmi Sathiyaseelan ◽  
Devarasetty Shashank ◽  
Dr. S.R. Ramakrishnan ◽  
...  
Keyword(s):  
Liver Function ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Viral Hepatitis ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Tertiary Care ◽  
Care Hospital ◽  
Arterial Blood ◽  
Function Test

Acute liver failure (ALF) is a condition with rapid deterioration of liver function resulting in hepatic encephalopathy and/or coagulopathy in patients with previously normal liver. Acute liver failure (ALF) is an uncommon condition associated with high morbidity and mortality. The prognosis is poor for untreated cases of Acute liver failure, so early recognition and management of patients with acute liver failure is crucial. A cause for acute liver failure can be identified in 60 to 80 percent of patients. Identifying the underlying cause of the liver failure is important because it influences the approach to management and provides prognostic information. Aims and Objectives: The aim of our study is to identify the clinical features, etiology and outcome of acute liver failure in a tertiary care hospital. Materials and Methods: This study is an observational study where patients with Acute Liver Failure admitted in ICU in our institution after meeting the diagnostic criteria for Acute liver failure were included in the study. Details of history, relevant symptoms and baseline investigations included, complete blood count, blood glucose, renal function test, serum electrolytes, liver function test (LFT), prothrombin time, international normalized ratio (INR), lactate dehydrogenase (LDH), creatine kinase (CK)], arterial blood gas analysis, arterial lactate, arterial ammonia, amylase and lipase level and pregnancy test (if female) and ultrasonography (USG) abdomen were recorded, MRI brain and other investigations relevant to the admission diagnosis, co morbidities and aetiology if needed were recorded. All the patients received standard supportive treatment for ALF. Results: In this study of 57 patients, majority of the patients were from the age group 41 to 50 years (17 patients) and 31 to 40 years (13 patients). 36 patients were male and 21 patients were females. Jaundice and encephalopathy was observed in all 57 (100%) patients, 24 (42%) patients had INR >2.5, 27 (47%) patients had serum creatinine >1.2 mg/dl and 18 (31.5%) patients had serum ammonia levels >100 micromol/L. The lowest value for serum aminotranferase was observed in infections (other than viral hepatitis) and maximum value was observed in drugs leading to ALF.In 20 (35%) patients viral hepatitis was the cause for ALD, followed by drugs and toxins which was the cause of ALD in 18 (31.5%) patients. Infections other viral hepatitis as the aetiology for ALF was observed in 16 (28%) of patients. Ischemic hepatitis was observed in 1 and Wilson’s disease was noted in 2 patients. Total 6 (10.5%) patients out of 57 patients had died, 4 patients with hepatitis B infection, 1 patient with paracetamol over dosage and 1 patient with dengue fever had died. Conclusion: Viral hepatitis and drugs are the commonest cause for acute liver failure. The aetiology of ALF varies significantly worldwide. Determining the etiology of acute liver failure requires a combination of detailed history taking and investigations. A broad evaluation is required to identify a cause of the acute liver failure, as the prognosis is poor in untreated cases of acute liver failure, so early recognition and management of patients with acute liver failure is crucial.

Characteristics of Pediatric Stroke and Association of Delayed Diagnosis with Mortality in a Mexican Tertiary Care Hospital

2021 ◽  
Author(s):  
Gerardo Garza-Alatorre ◽  
Ana Luisa Carrion-Garcia ◽  
Alfredo Falcon-Delgado ◽  
Elda Carolina Garza-Davila ◽  
Angel R Martinez-Ponce de Leon ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Early Recognition ◽  
Tertiary Care ◽  
Delayed Diagnosis ◽  
University Hospital ◽  
Pediatric Stroke ◽  
Care Hospital ◽  
Continuous Increase ◽  
Common Risk Factors

Abstract Background and objectives Pediatric cerebrovascular disease carries significant morbidity and mortality. Early recognition of a pediatric stroke as well and its most common risk factors are important, but that diagnosis is often delayed. It is believed that the incidence in our center is higher than it appears. This study aims to assess the incidence and characteristics of the pediatric stroke in our university hospital. Likewise, this study seeks to evaluate if a longer symptoms-to-diagnosis time is associated with mortality in patients with ischemic stroke. Methods A retrospective study including children with stroke admitted to the UANL University Hospital from January 2013 to December 2016. Results A total of 41 patients and 46 stroke episodes were admitted. About 45.7% had an ischemic stroke and 54.3% had a hemorrhagic stroke. A mortality of 24.4% and a morbidity of 60.9% were recorded. Regarding ischemic and hemorrhagic stroke, an increased symptoms-to-diagnosis time and a higher mortality were obtained with a relative risk of 2.667 (95% confidence interval [CI]: 1.09–6.524, p = 0.013) and 8.0 (95% CI: 2.18–29.24, p = < 0.0001), respectively. A continuous increase in the incidence rate, ranging from 4.57 to 13.21 per 1,000 admissions comparing the first period (2013) versus the last period (2016), p = 0.02, was found in our center. Conclusions Pediatric stroke is a rare disease; however, its incidence shows a continuous increase. More awareness toward pediatric stroke is needed.

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