Dysphagia is a common problem among the elderly either as a result of age-related loss of musculature and function involved in the act of swallowing, and/or because of neurological, degenerative, respiratory and musculoskeletal diseases that cause decreased swallowing function. Assessment for dysphagia is important to prevent serious complications such as aspiration pneumonia. Referral to the speech-language therapist for comprehensive assessment paves the way for proper management. The management may include diet modification, compensatory swallowing techniques, swallowing exercises or use of feeding tubes and facilitative devices.

Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disorder resulting from uncontrolled hyperinflammatory response. There had been increase in cases of one of the secondary form of HLH, i.e., infectionassociated haemophagocytic syndrome (IAHS) in severe dengue in recent years. However, the condition remains under diagnosed due to lack of awareness compounded by the lack of validated diagnostic criteria. Severe hepatitis with prolonged cytopenias, severe hyperferritinemia, hypofibrinogenemia and persistent fever were evident in all four cases reported. All the subjects survived with supportive care and adjuvant steroid therapy. Prospective controlled studies are needed to develop diagnostic criteria and management protocol for IAHS in severe dengue.
Severe Dengue

Bullous pemphigoid (BP) has a recognized association with solid organ tumors, but is relatively rare in hematological malignancies. We report a 67-year-old male who developed BP after being diagnosed with myelodysplastic syndrome and refractory anemia with excess of blast (RAEB). Skin biopsy elucidated sub-epidermal bulla using direct immunofluorescence, revealing linear C3 and IgG deposits along the basement membrane. His BP was recalcitrant to the conventional treatment and only responded to a combination of high dose oral prednisolone and azathioprine. The relative refractory nature of his condition and concurrent RAEB supports a paraneoplastic nature.
Aged ; Anemia ; Anemia, Refractory ; Anemia, Refractory, with Excess of Blasts ; Azathioprine ; Basement Membrane ; Biopsy ; Blister ; Fluorescent Antibody Technique, Direct ; Hematologic Neoplasms ; Humans ; Immunoglobulin G ; Male ; Myelodysplastic Syndromes ; Paraneoplastic Syndromes ; Pemphigoid, Bullous ; Prednisolone ; Skin

Cat flea bite in humans results in extremely pruritic skin lesions. It has been reported to occur among those living in domiciliary accommodation. However, nosocomial infestation with cat flea has not been reported. We hereby report a case of nosocomial infestation of cat flea in a hospital facility. Identification of the parasite, its appropriate eradication, and adequate medical management of the patients resulted in a satisfactory outcome.
Adult ; Animals ; Bites and Stings/diagnosis/*parasitology ; Cross Infection/diagnosis/*parasitology ; Ctenocephalides/*physiology ; Female ; Flea Infestations/diagnosis/*parasitology ; Humans

Objective To investigate the relationship between source memory and item memory in children,adult and the elderly Chinese,to test the hypothesis that neuronal substrate of source memory includes frontal lobe,and that source memory and item memory were dissociated in child and the elderly.Methods A neuropsyehological battery was established to measure the performance of item memory and source memory.Child,adult and the health elderly Chinese(40 cases in each group, respectively)were enrolled.The performance of child and the elderly Chinese were compared with that of the adults,and were also analyzed among the groups to check the dissociation between the performance of item and source memory.Results Compared with the adults,the source memory in children(I value:0.87?0.08 vs.0.73?0.13,P＜0.01)were impaired,but not found in item memory(Pr value:0.73?0.14 vs.0.74?0.11,P＞0.05).The elderly Chinese was impaired in both item(Pr value:0.66?0.15,P＜0.05)in source memory(I value:0.68?0.13,P＜0.01).Double dissociation between item and source memory was found in the child and the elderly.Conclusions The evidence of double dissociation between item and source memory within child and the elderly supports the dual-process model of source and item memory.These findings also support that frontal lobe involves in source memory,the indicators of source memory damage is early behavior marker for mild cognitive impairment or early Alzheimer disease.

Entrapment of the burr within calcified lesion is an uncommon, but serious complication during rotational atherectomy and usually needs surgical retrieval. We report a case series of this complication and also review the possible mechanisms, such as kokesi phenomenon or insufficient pecking motion with decreased rotational speed. We also review the potential techniques ever proposed to rescue this complica-tion percutaneously, including simple manual traction, balloon dilation to release the trap, snaring the burr as distal as possible for forceful local traction and wedging the burr with a child catheter to facilitate retrieval. Gentle pecking motion of the burr for sufficient ablation and shortening the run less than 15 s may avoid such complications. Interventional cardiologists using the rotablator should be familiar with the tips and tricks to avoid and rescue this complication.

Objective To assess mutations in the ALDH3A2 gene in two patients with Sj(o)gren-Larsson syndrome manifesting primarily as congenital ichthyosis,mental retardation and spastic paraplegia.Methods Two patients,a 2-year-old girl and a 1.5-year-old boy,with Sj(o)gren-Larsson syndrome were included in this study.None of their family members suffered from this disease.Peripheral blood samples were collected from the two patients,their family members (an elder brother and both parents),and 100 unrelated healthy controls.DNA was extracted from the blood samples,and subjected to PCR for the amplification of 10 encoding exons and their flanking sequences of the ALDH3A2 gene followed by DNA sequencing.Results A homozygous missense mutation c.325G ＞ A,which leads to the substitution of glycine by arginine at position 109,was detected in the ALDH3A2 gene of patient 1,whose parents and elder brother were heterozygous carriers of this mutation.The patient 2 carried compound heterozygous mutations,including c.1157A ＞ G (p.Asn386Ser) inherited from his father and c.1294A ＞ T (p.Arg432X) inherited from his mother.None of these mutations was detected in the unrelated healthy controls.Conclusion The homozygous mutation p.Gly109Arg and compound heterozygous mutations p.Asn386Ser and p.Arg432X present in these patients may be associated with clinical phenotypes of Sj(o)grenLarsson syndrome.

PURPOSE: This study aimed to identify nurses' job satisfaction, patients' satisfaction, and direct nursing time according to the change in grade of nursing management fee.METHODS: Descriptive design was used in this study. Nurses (n = 200) and patients (n = 200) were recruited from one university hospital in Busan. Four aspects were measured: direct nursing time, overtime, nurses' job satisfaction, and patients' satisfaction. Data were analyzed using descriptive statistics, χ2-tests, and t-tests.RESULTS: There was a significant difference in patient satisfaction (t = -2.09, p = .038) and direct nursing time (t = -4.77, p < .001) when the nurse staffing grade was changed from the level two to the level one.CONCLUSION: The findings from this study showed that a higher nurse-to-patient ratio can provide a greater amount of direct nursing time for individual patients and increase patient satisfaction.
Busan ; Fees and Charges ; Humans ; Job Satisfaction ; Nursing Staff ; Nursing ; Patient Satisfaction

Malformation of the anus and rectum, frequently refered to as imperforate anus are the most common of congenital anomalies among the congenital anomalies of gastrointestinal tract, occuring about once in every 5,000births. They consist of variety of lesions ranging from mild congenital stenosis of the anus which requires simple dilation for cure to complex deformities which present some of the most vexing and discouraging problem in management. This is the report of clinical analysis and evaluation of 67 patients with congenital anorectal malformation, experienced at Severance Hospital, during past 15 years form Jan. 1963 to Dec. 1978. The results of observation were as follows: 1. Incidence of observation were as follows: 2. There were 47 males and 18 females and 2 cases of unknown sex, than male/female ratio was 2.6 : 1. 3. First and second born were more commonly observed than the others. 4. High anomalies were 37.3%, intermediate anomales were 11.9% and low anomalies were 46.3%. 5. Associated anomalies were noted in 12 out of 67 cases, which consist of congenital heart diseases, skeletal anomalies, single umbillical artery, congenital megacolon etc. 6. In general, perineal anoplasty with or without preliminary colostomy were performed in low anomalies and some cases of intermediate anomalies. And abdominoperineal pull-through operation with or without preliminary colostomy were done in high anomales. 7. Complication after surgery were main wound infection ad disruption, intestinal obstruction, fecal incontinence, urinary incontinence, vaginal perforation, and urethral injury etc. 8. Overall mortality was 19.4% and operative mortality was 9.4%. 9. Factors influencing on mortality were congenital heart diseases, sepsis, prematurity, multiple congenital anomalies, respiratory insufficiency, meningomyelocele and tracheoesophageal fistula.
Anal Canal ; Anus, Imperforate ; Arteries ; Colostomy ; Congenital Abnormalities ; Constriction, Pathologic ; Fecal Incontinence ; Female ; Gastrointestinal Tract ; Heart Diseases ; Hirschsprung Disease ; Humans ; Incidence ; Intestinal Obstruction ; Male ; Meningomyelocele ; Mortality ; Rectum ; Respiratory Insufficiency ; Sepsis ; Tracheoesophageal Fistula ; Urinary Incontinence ; Wound Infection

Adequate nutrition is important for mothers and their offspring during and after birth. This cross sectional study was conducted to determine nutritional status and nutritional knowledge of pregnant women from two selected private hospitals in Klang Valley, Malaysia. A total of 236 Malay pregnant women aged between 20 to 45 years old (mean age 31+5 years) were recruited through convenient sampling method. Socio-demographic data, nutritional knowledge and a 24-hours diet recall were obtained through a self-administered questionnaire. Anthropometric and haemoglobin data were obtained from the antenatal records in the respective hospitals. The percentages of participants who were underweight, normal, overweight and obese before pregnancy were 12.7%, 55.1%, 25.0% and 7.2% respectively. Among those who were obese before pregnancy, a total of 59.7% had inadequate weight gain, 24.6% gained adequate weight and 15.7% gained excessive gestational weight. About 33.5% of subjects were anaemic (Hb < 11.0g/dL). The mean daily energy intake of the participants was 1748 ± 526 kcal which was 76% of RNI. Calcium (73% of RNI), folic acid (36% of RNI), niacin (89% of RNI) and vitamin D (40% of RNI). The nutritional knowledge level of subjects was moderate (51.9 ± 13.8%). Lower monthly household income (p < 0.001), educational level (p < 0.001) and gestational stage (p < 0.05) of participants were associated with a lower nutritional knowledge level. Nutritional knowledge score was positively correlated with gestational weight gain (r = 0.166, p < 0.05) and haemoglobin level (r = 0.200, p < 0.05). Subjects who claimed practising food taboos had higher nutritional knowledge score (54.9 ± 12.5%) than those who did not (49.9 ± 14.4%)(p < 0.05). A comprehensive nutrition education should be integrated in the antenatal classes to improve nutritional status of pregnant women