Singap Med J
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Case Reports
Electrocardiography Series. What is the cause of the regular wide QRS complex tachycardia?
Regular broad QRS complex tachycardias may be ventricular in origin or due to supraventricular tachycardia with aberrancy. Antidromic atrioventricular re-entrant tachycardia occurring in Wolff-Parkinson-White syndrome is a third possibility. ⋯ Ventricular tachycardia may be monomorphic or polymorphic. The management of ventricular tachycardia depends on clinical symptoms and is influenced by the presence of structural heart disease.
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The accuracy of the Alvarado score in diagnosing acute appendicitis in an Asian population has been disappointingly low. We prospectively compared the RIPASA score with the Alvarado score for the diagnosis of acute appendicitis. ⋯ The RIPASA score at a cut-off threshold total score of 7.5 is a better diagnostic scoring system than the Alvarado score for the diagnosis of acute appendicitis in our local setting.
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Multicenter Study
Isolation of the first three cases of Clostridium difficile polymerase chain reaction ribotype 027 in Singapore.
The incidence of Clostridium (C.) difficile infection (CDI) was on the rise from 2001 to 2006 in Singapore. Recent unpublished data suggests that its incidence had remained stable or decreased in most local public hospitals between 2006 and 2010. It is, however, not known if the polymerase chain reaction (PCR) ribotype 027 strains have been circulating, although reports suggest that this strain is emerging in Asia, with the first cases reported from Japan in 2007, as well as in Hong Kong and Australia in 2009. We initiated a culture-based surveillance to detect this epidemic strain in Singapore. ⋯ We report the first three isolates of C. difficile 027 from Singapore. However, their susceptibility patterns are more consistent with the historical 027 strains. Rising CDI incidence may not be associated with the emergence of the epidemic 027 strain at this time.
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In a multiethnic nation, it is not uncommon for doctors to encounter patients of different cultural backgrounds. Often, patients' cultural beliefs influence their perception of health and illnesses, and their treatment option. Many Chinese cultural beliefs are influenced by the Taoist concept of yin-yang balance. ⋯ There is a discrepancy in the extent to which these beliefs influence the perception of health and illnesses among the general public and among medical students. Healthcare providers need to be aware of such beliefs and practices regarding traditional Chinese medicine among their Chinese patients.
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Colonic perforation is an uncommon cause of acute abdomen in paediatric patients, and can present a diagnostic enigma as well as management challenge to the paediatric surgeon. An adolescent developed multiple colonic perforations following a short course of oral indomethacin, requiring emergency hemicolectomy. This is the youngest known case of enteral non-steroidal anti-inflammatory drug (NSAID)-mediated large bowel injury. We review current evidence on NSAID-related enteropathy, and postulate potentiating mechanisms that may have accounted for the unusually rapid clinical course of our patient.