Singap Med J
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The chance finding of the vermiform appendix lying within an inguinal hernia occurs in approximately one percent of cases of inguinal hernia, and is known as an Amyand's hernia. We report a rare presentation of Amyand's hernia, where the appendix was found within the left hernial sac during surgery for an obstructed inguinal hernia in a nine-month-old male baby.
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Comparative Study
Are all troponin assays equivalent in the emergency department?
Cardiac-specific troponins (cTn) are recently-introduced, sensitive and specific markers of myocardial injury, and their absence should allow to safely exclude a coronary event. Various assays are commercially available but the relative advantage of each is not clear. Our objective was to compare the reliability of the two most commonly used troponin assays (cTnI and cTnT), in the emergency department (ED) for clinical decision when myocardial infarction (MI) or acute coronary syndrome (ACS) is suspected. ⋯ In the ED, bedside assays of troponins are invaluable tools for the clinician, and their use is cost-effective. However, in the recommended cutoffs levels, only troponin I but not troponin T allowed the safe discharge of patients not requiring acute hospital care.
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Beta-thalassaemia major is one of the commonest genetic disorders in South East Asia. The strategy for the community control of beta-thalassaemia major requires the characterisation of the spectrum of beta-globin gene mutations in any multi-ethnic population. There is only a single report of mutation analyses of the beta-globin gene in an isolated Kadazandusun community in Kota Belud, Sabah, Malaysia, which showed the presence of a common 45 kb deletion. ⋯ This finding confirmed the deletion in the homozygous state was associated with a severe phenotype. The reason for the predominance of this mutation in Kota Kinabalu is most likely to be due to founder effects and possibly intermarriages between the various ethnic groups. Prenatal diagnosis using PCR for this common mutation is feasible in this community. Medical workers and scientists at molecular diagnostic centres serving large South East Asian populations should incorporate a diagnostic strategy for this deletion in the appropriate population. Future studies on these indigenous ethnic groups in other areas and other groups in Sabah are required.
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Systematic reviews form a potential method for overcoming the barriers faced by clinicians when trying to access and interpret evidence to inform their practice. This fourth article in the Evidence-Based Medicine and Healthcare series of the Singapore Medical Journal introduces readers to systematic reviews, outlining why they are important, describing their methods and providing readers with the skills to recognise and understand a reliable review.