Home care is an integral part of primary community care. It is a multi-disciplinary holistic service providing personalised care to patients who are homebound. This encompasses both the medical and psychosocial aspects and allows patients to be treated in the comfort of their home, with reliable support from healthcare professionals, the community and caregiver. This article seeks to explore and discuss the provision of home care in Singapore.

Clinic ; Hospitals

Pancytopenia can rarely complicate Grave's disease. It can be due to uncontrolled thyrotoxicosis or as a result of rare side effect of antithyroid medication. Pernicious anemia leading to Vitamin B12 deficiency is another rare associated cause. We report a case of a patient with Grave's disease and undiagnosed pernicious anemia whom was assumed to have antithyroid drug induced pancytopenia. Failure to recognize this rare association of pernicious anemia as a cause of pancytopenia had resulted in delay in treatment and neurological complication in our patient.

Personal failure ; Sabah ; Therapeutic procedure ; Fansidar ; Malaria

Introduction: Colonoscopy is an investigation for the evaluation of lower gastrointestinal symptoms. Just like any other conditions, it is important to be aware of the spectrum of findings so that appropriate referral and decisions can be made. Materials and Methods: Patients (mean age 52.3 ± 15.3 years old with almost equal proportion of genders) referred for colonoscopy in RIPAS Hospital over a five year period (January 2003 to December 2007) were retrospectively identified and studied. Results: The most common indication for colonoscopy was bleeding per rectum (22.9%), followed by evaluation of abdominal pain (18.6%), anaemia (11.7%), colorectal cancer screening (11.7%), evaluation of constipation (5.9%) and altered bowel habits (3.8%). A large proportion (58.4%) colonoscopy was normal. The most common positive finding was haemorrhoids (30.3%), majority of which were categorised as grade I. This was followed by colonic polyps (17.6%), diverticular disease (12.1%), non-specific colitis (4.0%), colorectal cancers (4.0%) and ulcers (3.6%), melanosis coli (0.4%) and telangiectasia (0.1%). Colorectal cancer was most common among the Malays (4.4%), followed by the Chinese (4.0%), the indigenous (2.8%) and the others (1.2%). Conclusions: Our study showed that the most common indication was for the evaluation of bleeding per rectum. Majority had normal colonoscopy and the most common positive finding was haemorrhoids. Importantly colorectal neoplasms accounted for one fifth of procedures with colorectal cancers accounting for four percent.
Diabetic Complications ; Diabetic Foot ; Microbiology ; Bacteriology

Objective To study the effects of propofol on cognitive function and expression of BDNF in the cerebral cortex after the traumatic brain injury (TBI).Methods Forty-eight SD rats treated with the Morris water maze were randomly divided into 3 groups with 16 rats in each group.Rats in the sham group were subjected to the operative procedure but prevented from traumatic brain injury.Rats in the control group and the propofol group were subjected to the traumatic brain injury named Feeney.After the operation,rats in the propofol group were injected propofol for 6 hours.The neurological functional status and the cognitive function of rats were assessed with NSS scores and Morris water maze tests on 3d and 14d post operation.RT-PCR and Westeron Blot were used to detect the expressional changes of BDNF in the injured cerebral cortex.Results Compared with the sham group,NSS scores and the latencies of escape among rats in the control group were increased and times of crossing platform were decreased at 3d and 14 d post operation (P ＜0.01),and the mRNA and protein levels of BDNF were decreased at 3d post operation (P ＜0.01).Compared with the control group,the mRNA and protein levels of BDNF in the propofol treated rats were increased at 3d and 14d post operation (P ＜0.01),NSS scores were lower at 14d (P ＜0.01),the latencies were shorter and the times were increased (P ＜0.01).Conclusion Propofol improves the the expression of BDNF in the injured cerebral cortex and facilitates the recovery of the neurological and cognitive function in rats with traumatic brain.

MRI has become important for the detection of prostate cancer. MRI-guided biopsy is superior to conventional systematic biopsy in patients suspected with prostate cancer. MRI is also increasingly used for monitoring patients with low-risk prostate cancer during active surveillance. It improves patient selection for active surveillance at diagnosis, although its role during follow-up is unclear. We aim to review existing evidence and propose a practical approach for incorporating MRI into active surveillance protocols.

MRI has become important for the detection of prostate cancer. MRI-guided biopsy is superior to conventional systematic biopsy in patients suspected with prostate cancer. MRI is also increasingly used for monitoring patients with low-risk prostate cancer during active surveillance. It improves patient selection for active surveillance at diagnosis, although its role during follow-up is unclear. We aim to review existing evidence and propose a practical approach for incorporating MRI into active surveillance protocols.

Objective To investigate the effect of epidural morphine for analgesia on the number of interstitial cells of Cajal (ICC) in the rabbit colon.Methods Thirty healthy rabbits of either sex,weighing 2.0-2.5 kg,were randomly divided into 2 groups (n =15 each):control group (group C) and morphine group (group M).The animals were anesthetized with iv 20% urethane 4 ml/kg.The epidural analgesia was performed at L3,4 interspace.In group M morphine 9.2 ug· kg-1 · h-1 was infused into the epidural space for 7 consecutive days,while the equal volume of normal saline was infused instead in group C.The characteristics of excrement and constipation were recorded during morphine infusion.Normal saline or Chinese ink mixture 5 ml was administered via a gastric tube inserted through the mouth 1 day after the end of administration.The rabbits were sacrificed 30 min later and laparotomy was performed.The intestinal segment numbered from the pylorus to the ileocecal region of the bowel was removed and the length of the intestinal segment and propelled distance of the ink within the intestinal tract were measured in the tension-free state.The rate of propelled distance was calculated.The proximal and distal colon tissues were taken for measurement of the expression of c-kit (by immunohistochemisty) and ICC count,and stained with haematoxylin and eosin for examination of pathological changes.Results Compared with group C,the incidence of constipation was significantly increased,and the rate of propelled distance,and expression of c-kit and ICC count in proximal colon tissues were decreased at 3-7 days of morphine infusion (P ＜ 0.05),and no significant change was found in the expression of c-kit and ICC count in distal colon tissues in group M (P ＞ 0.05).Conclusion Epidural morphine for analgesia can inhibit the motor function of the intestinal tract in rabbits,and reduction in the number of ICC count in proximal colon is involved in the mechanism.

BACKGROUND: How to reconstruct tissue-engineered bone with structure similar to natural bone iS a problem in the development of tissue engineering. Cell sheet engineering technology enables novel approaches to construction of tissue-engineered bone. OBJECTIVE: To observe the biocompatibility of call sheets to decalcified bone matrix (DBM) and their growth on DBM. DESIGN, TIME AND SETTING: An in vitro observation was performed at the Central Laboratory, Affiliated Hospital, Qingdao University Medical College between June and September 2009.MATERIALS: Dog bone marrow stromal cell sheets were prepared using temperatura-responsive medium. Dog DBM was prepared by defatting, decalcification, and noncotlagen protein removal procedures. METHODS: DBM surface was covered by call sheets prepared by temperature-responsive technology and cultured with DMEM containing 10% fetal bovine serum and osteoinductive agent.MAIN OUTCOME MEASURES: Under scanning electron microscope, DBM structure, as well as the attachment and growth of cell sheets on DBM surface, was observed. Porosity and aperture size of DBM were calculated. RESULTS: DBM exhibited a three-dimensional latticed structure, with a porosity of approximately 75%. The mean aperture size was (250.11±98.89) μm, exhibiting a normal distribution. Cell sheets well attached to and grew on DBM surface, and rapidly proliferated.CONCLUSION: Cell sheets show good biocompatibility to DBM. DBM/cell sheets complex can be applied in tissue-engineered bones, which promotes the construction of tissue-engineered bone with structure similar to natural bone.