Intravascular large B-cell lymphoma (IVLBCL) is a rare non-Hodgkin lymphoma with variable clinical manifestations. Although neurological symptoms are common in patients with IVLBCL, isolated cauda equina-conus medullaris syndrome is rarely reported. We herein report a case of IVLBCL whose initial presentation was cauda equina-conus medullaris syndrome with neither dermatological nor hematological manifestations. A 54-year-old man without known immune-compromised state presented with progressive ascending numbness and weakness of bilateral legs and urine incontinence for 2 months. Lumbar-sacral magnetic resonance images showed gadolinium-enhanced conus medullaris and cauda equina nerve roots. Cerebrospinal fluid analysis revealed lymphocyte predominant pleocytosis and elevated protein level without malignant cells. Focal seizure and mental status changes followed several weeks later. Brain biopsy led to the diagnosis of IVLBCL. Conclusions: IVLBCL should be included in the differential diagnosis of patients with isolated cauda equina-conus medullaris syndrome. A survey of previously published cases in the literature also showed that early initiation of chemotherapy has better outcome.

Human immunodeficiency virus (HIV) infection can cause variable movement disorders, including parkinsonism. HIV-related parkinsonism usually responds well to highly-active antiretroviral therapy (HAART), suggesting a possible reversible dysfunction of the dopaminergic system. We report the case of a 42-year-old man who presented with rapidly progressive symmetric parkinsonism, cognitive decline, and loss of postural reflex as the initial manifestation of HIV infection. A significant improvement of his parkinsonism after HAART demonstrates a potentially reversible dopaminergic system dysfunction secondary to HIV infection. A normal 99mTc-TRODAT-1 SPECT image after HAART treatment paralleled the clinical improvement in extrapyramidal symptoms. Early identification of HIV-related parkinsonism, especially in patients with symmetrical akinetic-rigidity and early loss of posture reflex, is important for its potential reversibility with HAART therapy.

Parkinson's disease (PD) is a common neurodegenerative disorder arising from an interplay between genetic and environmental risk factors. Studies have suggested that the pathological hallmarks of intraneuronal α-synuclein aggregations may start from the olfactory bulb and the enteric nervous system of the gut and later propagate to the brain via the olfactory tract and the vagus nerve. This hypothesis correlates well with clinical symptoms, such as constipation, that may develop up to 20 years before the onset of PD motor symptoms. Recent interest in the gut–brain axis has led to vigorous research into the gastrointestinal pathology and gut microbiota changes in patients with PD. In this review, we provide current clinical and pathological evidence of gut involvement in PD by summarizing the changes in gut microbiota composition and gut inflammation associated with its pathogenesis.
Brain ; Constipation ; Enteric Nervous System ; Gastrointestinal Microbiome ; Humans ; Inflammation ; Microbiota ; Neurodegenerative Diseases ; Olfactory Bulb ; Parkinson Disease ; Pathology ; Risk Factors ; Vagus Nerve

We report a case of a 54-year-old man with severe HTG which did not respond to conventional anti lipid therapies. He was treated with intravenous insulin and concurrent dextrose infusions which led to a dramatic reduction in serum triglyceride levels.
Hypertriglyceridemia

Objectives: The Primary Care Network (PCN), comprising small private General Practitioner (GP) clinics supported by a mobile team of dedicated nursing and allied health professionals, as well as a chronic disease register (CDR), can be an alternative model for good chronic disease management. GPs in the network manage the mobile team, set common goals for each clinic and self-evaluate. In this paper we share the data and experience of the first year of the pilot PCN in Singapore. Methodology: Process indicators for diabetic patients seen from April 2011 to March 2012 (pre-PCN) and April 2012 to March 2013 were compared. McNemar test was performed. Results: There was statistically significant improvement in process indicators of yearly DRP, DFS and Urine ACR screening for diabetes in the first year post-PCN compared to baseline data. Rates of regular HbA1c and LDL-C testing, as well as smoking blood pressure and weight assessment also showed statistically significant improvement. Conclusion: The PCN has shown promise in improving quality of care for diabetes among small private GP clinics. Key challenges to the success of PCN include good clinician leadership, suitable IT support, and creating a viable business model for GPs.

Objective: To examine the cytotoxic properties of both the kenaf (Hibiscus cannabinus L.) seed extract and kenaf seed oil on human cervical cancer, human breast cancer, human colon cancer and human lung cancer cell lines.Methods:kenaf seed oil on human cancer cell lines was evaluated by using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and sulforhodamine B assays. Cell morphological changes were observed by using an inverted light microscope.Results:The in vitro cytotoxic activity of the kenaf (Hibiscus cannabinus L.) seed extract and cancer cell lines. Morphological alterations in the cell lines after KSE and KSO treatment were observed. KSE and KSO possessed effective cytotoxic activities against all the cell lines been selected.Conclusions:KSE and KSO could be potential sources of natural anti-cancer agents. Further The kenaf seed extract (KSE) exhibited a lower IC50 than kenaf seed oil (KSO) in all of the investigations on using kenaf seeds for anti-proliferative properties are warranted.

Education, Medical ; history ; Family Practice ; history ; History, 20th Century ; History, 21st Century ; Humans ; Medicine in the Arts ; Singapore ; Tuberculosis ; history

PURPOSE: This study aims to gain in-depth understanding of nurses' perspectives of working in an overcrowded emergency. METHODS: Symbolic interactionism and Charmaz's construction of grounded theory were used. Purposive sampling at the start of the study and a further theoretical sampling by snowball technique were used to recruit 40 registered nurses (RN) to participate in in-depth, semi-structured interviews betweenMay and November, 2014. Data analysis included analytic techniques of initial, focused and theoretical coding. RESULTS: Study findings showed searching for work role is derived by the themes of Finding the role of positioning in Emergency Department (ED), Recognizing causes of ED overcrowding, and Confined working environment. Nurses' work experience which represents the RNs not gained control over their work, as care actions influenced by the problematic overcrowded circumstance of the ED environment. CONCLUSION: The findings fill a gap in knowledge about how RNs experience their work role in the context of an overcrowded Emergency Department in Taiwan. Arising from the study result include taking account of nurses' perspectives when planning staff/patient ratios, strategies to reduce waiting time and ensure that clients receive appropriate care.
Clinical Coding ; Crowding ; Emergencies* ; Emergency Service, Hospital* ; Grounded Theory ; Humans ; Nurses ; Statistics as Topic ; Taiwan*

PURPOSE: The aim of this study is to explore non-steroid anti-inflammation drugs (NSAIDs) potency for pelvic floor muscle pain by measuring local concentration in a rat model. MATERIALS AND METHODS: We used nine NSAIDs, including nabumetone, naproxen, ibuprofen, meloxicam, piroxicam, diclofenac potassium, etodolac, indomethacin, and sulindac, and 9 groups of female Wister rats. Each group of rats was fed with one kind of NSAID (2 mg/mL) for three consecutive days. Thereafter, one mL of blood and one gram of pelvic floor muscle were taken to measure drug pharmacokinetics, including partition coefficient, lipophilicity, elimination of half-life (T1/2) and muscle/plasma converting ratio (Css, muscle/Css, plasma). RESULTS: Diclofenac potassium had the lowest T1/2 and the highest mean Css, muscle/Css, plasma (1.9 hours and 0.85+/-0.53, respectively). The mean Css, muscle/Css, plasma of sulindac, naproxen and ibuprofen were lower than other experimental NSAIDs. CONCLUSION: Diclofenac potassium had the highest disposition in pelvic floor muscle in a rat model. The finding implies that diclofenac potassium might be the choice for pain relief in pelvic muscle.
Animals ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Butanones/therapeutic use ; Chronic Pain/*drug therapy ; Diclofenac/therapeutic use ; Female ; Muscles/drug effects ; Naproxen/therapeutic use ; Pelvic Floor/*pathology ; Pelvic Pain/*drug therapy ; Piroxicam/therapeutic use ; Rats ; Rats, Wistar ; Thiazines/therapeutic use ; Thiazoles/therapeutic use