ABSTRACT
The majority of cystic pancreatic lesions are incidental findings, especially with the increasing use of advanced imaging modalities for non-related conditions. Most of these lesions were previously attributed to pseudocysts, although cystic neoplasms are now an important differential to be considered and excluded. This article aims to describe the types of cystic pancreatic lesions, demonstrate their imaging findings and discuss the management of these conditions.
Subject(s)
Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Pseudocyst/diagnostic imaging , Tomography, X-Ray Computed , Diagnosis, Differential , Endosonography , Humans , Magnetic Resonance ImagingABSTRACT
BACKGROUND: Several studies have cited the incidence of malnutrition in hospitals, which is correlated to negative clinical outcomes, to be up to 60%. Data in Singapore, however, are scarce. Its impact on casemix funding is not known. AIMS: The aims of the present study were to determine the prevalence of malnutrition, the predisposing risk factors and the impact of documentation and coding of malnutrition on casemix funding in a local population in Singapore. METHODS: Patients admitted to selected wards over a 1-month period were screened for malnutrition. Those at risk were further assessed using subjective global assessment. Logistic regression was used to ascertain the impact of identified factors on malnutrition. Financial impact analysis of coding of malnutrition as a comorbidity was carried out and tested with Wilcoxon signed rank tests. RESULTS: Six hundred and fifty-eight patients were eligible for screening. The overall prevalence of malnutrition in the selected wards was 14.7% (95% confidence interval (CI): 12.0-17.4%). Old age, the occurrence of cancer and the admitting unit were statistically significant in explaining the occurrence of malnutrition. Coding of malnutrition was found to significantly increase the complexity of 24 of 105 episodes (22.9%) of patient care as measured by expected cost weights (P < 0.001) and expected lengths of stay (P < 0.001). As a result, the expected financing for these 24 patients increased by 59.7%. CONCLUSIONS: Malnutrition is prevalent in hospitalised medical and surgical patients. Certain clinical factors should heighten awareness and prompt detection for malnutrition. Coding for malnutrition impacts favourably on casemix funding for a subset of malnourished patients.
Subject(s)
Insurance, Health, Reimbursement/statistics & numerical data , Malnutrition/diagnosis , Malnutrition/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Causality , Female , Forms and Records Control , Hospitalization/economics , Humans , Inpatients , Male , Mass Screening/methods , Middle Aged , Prevalence , Singapore/epidemiologyABSTRACT
A 78-year-old retired pig farmer developed brucellosis and died of liver failure >20 years after her last exposure to infected livestock. This is an exceptionally long incubation period for this infection, which usually presents within weeks of exposure.
Subject(s)
Abdominal Abscess/microbiology , Brucella/classification , Brucellosis/microbiology , Liver Abscess/microbiology , Occupational Exposure/adverse effects , Abdominal Abscess/physiopathology , Aged , Animals , Brucella/isolation & purification , Brucellosis/physiopathology , Fatal Outcome , Female , Humans , Liver Abscess/physiopathology , Retirement , SwineABSTRACT
Cold biopsy of the gastric mucosa is useful in many gastroduodenal disorders. Antral biopsies are done with increasing frequency to confirm Helicobacter pylori infection and to determine the type and content of gastritis. Gastrointestinal bleeding after gastric cold biopsy is rare. We report two patients who developed melena after cold biopsy of the gastric antrum. Repeat gastroscopies excluded lesions other than the biopsied sites as the source of bleeding. Colonoscopies in both cases did not reveal any evidence of lower GI bleed. Relevant medications include amlodipine, in case 1, and brufen, which was used in case 2 but discontinued before biopsy. Literature review has shown the rarity of clinically significant hemorrhage resulting from gastric cold biopsy. Nevertheless, all patients undergoing gastroscopy should be informed of this potential complication.
