APOE genotype and neuropsychological outcome in mild-to-moderate traumatic brain injury: a pilot study.

PRIMARY OBJECTIVE: The influence of apolipoprotein (APOE) on neuropsychological outcome was investigated in 19 patients (25.79 ± 7.22 years) with mild-to-moderate traumatic brain injury and 14 matched healthy control subjects (27.43 ± 6.65 years). RESEARCH DESIGN: Within- and between-group comparisons were employed. METHODS AND PROCEDURE: APOE genotype was determined using the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism method. Verbal learning and memory, speed of processing and executive function were assessed at 6 weeks and 6 months post-injury. A three-way [Group*Type*Time] ANOVA with repeated measures on the third factor was employed to determine the differences between groups and APOE genotype. MAIN OUTCOMES AND RESULTS: No Group*APOE Genotype*Time interaction was found for all neuropsychological measures, Auditory Verbal Learning Test (p = 0.484, η(2 )= 0.017), Trail Making Test-B (p = 0.454, η(2 )= 0.019), Controlled Oral Word Association (p = 0.107, η(2 )= 0.087) and Wisconsin Card Sorting Test-64 (p = 0.291, η(2 )= 0.038). The results of this pilot study support earlier findings that showed no relationship between APOE ε4 and poor recovery in the same population. CONCLUSION: The preliminary findings suggest no clear APOE genotype influence on neuropsychological outcome in mild and moderate TBI patients. Large-scale studies with longer follow-up duration are warranted.

Insulin sensitivity and secretory status of a healthy malay population.

Insulin insensitivity is a common finding in several metabolic disorders including glucose intolerance, dyslipidemia, hyperuricemia and hypertension. Most of the previous studies on insulin sensitivity were performed on diabetic or obese population. So our knowledge about insulin sensitivity of healthy population remains limited. Rising prevalence of obesity, diabetes and metabolic syndrome is a serious issue in Malaysia and some other rapidly developing countries. So it is important to look at the insulin sensitivity status of healthy Malaysian subjects and to compare it in future with those of diabetic, obese or metabolic syndrome patients. In this study we sampled subjects who were independent of confounding factors such as obesity (including abdominal obesity), hypertension and glucose intolerance (diabetes, IGT or IFG) which may influence insulin sensitivity. Fasting plasma glucose, fasting insulin and lipid profile were determined. Insulin sensitivity and secretory status were calculated using the homeostasis model assessment (HOMA) software (HOMA%S, HOMA%B and HOMA-IR). The insulin sensitivity (HOMA%S) of healthy Malay subjects aged between 30-60 years was 155.17%, HOMA-IR was 1.05 and HOMA%B was 116.65% (values adjusted for age, sex, BMI and waist circumference). It was seen that non-obese Malaysians can prevent age related lowering of insulin sensitivity if they can retain their BMI within limit.

Dyslipidaemic pattern of patients with type 2 diabetes mellitus.

The aim of the study was to define dyslipidaemic pattern among type 2 diabetic patients using American Diabetes Association guidelines for the classification of lipoprotein concentrations into CVD risk categories. The total number screened was 211 type 2 diabetic patients who were on treatment between 2001 - 2002 for diabetes at the Outpatient Diabetes Clinic in HUSM Kubang Kerian. Fasting venous blood samples were analysed for plasma glucose, glycated hemoglobin and serum lipids. Type 2 diabetic patients with high, borderline, and low risk LDL cholesterol level were 62 %, 25 %, and 10 %, respectively. There were 26 % patients in the high risk HDL cholesterol group, 31 % were in the borderline risk group, and 43 % were in the low risk group. Only 3 % and 25 % of patients had triglycerides concentration in the high and borderline risk categories, respectively, but 72 % had low risk triglycerides levels. More female and younger subjects than men and older subjects had HDL cholesterol in high and borderline risk categories. The percentages of patients with triglycerides values at high and borderline high risk category were higher in poor and acceptable glycaemic control groups than good glycaemic control group. The most prevalent dyslipidaemia pattern was an isolated LDL cholesterol increase, which was observed in 35 % of the patients. The second most common pattern of dyslipidaemia was a combination of LDL cholesterol above goal with HDL cholesterol below target, which was observed in 30 % patients. Patients with established dyslipidaemia will require advice regarding diet, exercise and improvement in glycaemic control. An active strategy of early detection and drug treatment for dyslipidaemia is needed for type 2 diabetic patients.

An approach to enrich online medical Problem-Based Learning with tacit healthcare knowledge.

Existing Problem-Based Learning (PBL) problems, though suitable in their own right for teaching purposes, are limited in their potential to evolve by themselves and to create new knowledge. Presently, they are based on textbook examples of past cases and/or cases that have been transcribed by a clinician. In this paper, we present (a) a tacit healthcare knowledge representation formalism called Healthcare Scenarios, (b) the relevance of healthcare scenarios in PBL in healthcare and medicine, (c) a novel PBL-Scenario-based tacit knowledge explication strategy and (d) an online PBL Problem Composer and Presenter (PBL-Online) to facilitate the acquisition and utilisation of expert-quality tacit healthcare knowledge to enrich online PBL. We employ a confluence of healthcare knowledge management tools and Internet technologies to bring tacit healthcare knowledge-enriched PBL to a global and yet more accessible level.