Singap Med J
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Length of stay (LOS) in hospitals is the largest contributor of direct stroke care cost. Rehabilitation accounts for 16 percent of healthcare cost in the six-month post-stroke period. It is important to determine factors extending LOS in rehabilitation hospitals to identify focus areas of cost-control strategies. The aim of the study was to ascertain the predictors of LOS of post-stroke patients admitted into two community hospitals offering rehabilitation. ⋯ Medical complication is a key reversible determinant of increased LOS of post-stroke patients receiving rehabilitation in community hospitals. Strategies for prevention, early detection and treatment of medical complications during stroke rehabilitation are discussed.
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Eventration of the diaphragm is a rare condition where the muscle is permanently elevated, but retains its continuity and attachments to the costal margins. It is seldom symptomatic and often requires no treatment, but may be confused with a traumatic rupture of the diaphragm. We present a 51-year-old man with previously-undiagnosed congenital eventration, mimicking traumatic rupture of the diaphragm. The role of clinical examination, imaging and diagnostic laparoscopy to differentiate between eventration and traumatic rupture of the diaphragm are discussed.
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Ascites is common and represents an important feature of liver disease and other diseases. The aim of this study is to determine the causes of ascites in Qatar, and to evaluate the value of ascitic fluid analysis in different types of ascites. ⋯ Liver cirrhosis is the main cause of ascites in Qatar. SAAG is a better distinguishing marker for separating ascites related to portal hypertension from other causes of ascites without portal hypertension. In patients with low gradient ascites, ascitic fluid glucose and LDH level are useful indicators for separating tuberculous from malignant ascites.
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A 28-year-old Malay woman presented with recurrent abdominal pain for five years. She had delivered her child seven months earlier. She was found to have bicytopenia, with a haemoglobin level of 7.9 g/dL and a platelet count of 85 x 10(9)/L. ⋯ A splenectomy was performed and at operation, splenomegaly with a long mesentery was found. Splenic histology was negative for malignancy. The bicytopenia resolved postoperatively, and she remains well.