Chicken bone perforation of an irreducible inguinal hernia: a case report and review of the literature.

Foreign bodies causing perforation of hernias are extremely uncommon with only a few cases reported in the literature. Here, we present a case of a patient with ingestion of a foreign body, which was initially managed expectantly but developed a perforation due to the foreign body impacting and causing perforation of an irreducible inguinal hernia. Management of this condition usually involves resection of the involved loop of bowel with repair of the hernia defect at the time of surgery. Patients with ingested foreign bodies who have irreducible hernias have altered anatomy and should be considered for early surgical intervention to prevent complications.

Engagement in retirement: an evaluation of the effect of Active Mentoring on engagement of older adults with intellectual disability in mainstream community groups.

BACKGROUND: As adults with intellectual disability age, retirement options need to be explored. One option is to attend a mainstream community group for retirees. Support within these groups could come from group members who are trained to act as mentors for the older adults with intellectual disability. This research evaluated a support training programme, Active Mentoring, which combines elements of Active Support and Co-worker Training. METHOD: Three older women with intellectual disability participated in a non-concurrent multiple baseline design. Effect size analyses (Percentage of Non-overlapping Data) were used to evaluate observational data. RESULTS: Active Mentoring was effective in increasing most types of engagement in activities, but there was no observed effect for social engagement. Mentor help also increased. CONCLUSION: Active Mentoring was effective in eliciting support from mentors, and in increasing activity engagement of older adults with intellectual disability in mainstream community groups.

The development of hyperbaric and diving medicine in Singapore.

Hyperbaric oxygen therapy is a noninvasive therapy used in the treatment of diving-related medical illnesses. It is an important adjunct in the management of a variety of medical conditions. The Republic of Singapore Navy Medical Service (NMS) is the main driver of the development of hyperbaric and diving medicine in Singapore. The practice of hyperbaric medicine has inherent risks, and unregulated application of this therapy may do more harm than good. NMS and Singapore General Hospital (SGH) signed a Memorandum of Understanding to combine NMS' experience with the clinical expertise of SGH to provide holistic care for diving and clinical hyperbaric treatment patients. This collaboration would increase the profile of this clinical specialty in Singapore, and help to establish safe clinical practice guidelines, training and accreditation requirements for diving and hyperbaric medicine practitioners in Singapore, thus ensuring that the practice of bona fide hyperbaric medicine is safeguarded and patient care is not compromised.

A comparison of thermal stress in the submarine escape using immersion half- and full suit in tropical weather operations.

OBJECTIVE: Submariners of disabled submarines are subject to drastic weather changes as they are awaiting rescue on the sea surface. Hyperthermia and hypothermia are just two of the adverse conditions that they can experience. The purpose of this study was to investigate the effectiveness of two models of submarine escape and the protective capabilities of immersion suits from environmental changes. METHOD: A randomized study involving 24 male subjects was conducted to compare the thermal capabilities of the full- versus half-configuration suit in a climate-controlled chamber. RESULTS: The full-configuration suits tested for a higher mean maximal core temperature (37.76 degrees C / 99.97 degrees F) than the mean maximal core temperature of the half-suits (37.52 degrees C / 99.54 degrees F). The full suits also tested for a higher mean minimal core temperature (36.13 degrees C / 97.03 degrees F) than the mean minimal core temperature (35.95 degrees C / 96.71 degrees F) of the half-suits. CONCLUSION: Results showed that the full-suit configuration did not induce clinically significant high levels of heat stress as compared to the half-suits, but instead provided better thermal protection against hypothermia than the half-suits.

Long-term effects of the combined oral contraceptive pill on carbohydrate and lipid metabolism in Singapore women--a cross-sectional study.

PIP: This is a cross-sectional study of the effects on carbohydrate and lipid metabolism in 316 women of oral contraceptives (OCs) given continuously for at least 2 years as compared with 358 women not on the pill. The 2 groups were matched for age, weight, height, and parity. The aim of this study was to ascertain whether any differences could be detected between different ethnic groups living in the same environment, and secondly, to examine the differences between OCs containing different progestogens. The mean duration of OC use was 61.3 months with a range from 32.4-90.2 months. OCs used were combined pills containing 50 mcg ethinyl estradiol. A total of 125 women were on pills containing the progestogen estrane and 170 were on Gonane. The remaining 21 women were taking a 17-OH-progesterone derived progestogen. Metabolic differences between Chinese and Malay women were not significant. For those women not on the pill, differences were minimal. Chinese women on OCs showed lower fasting plasma glucose values and this is a similar pattern in Western women. Malay women showed little change in fasting blood sugar. Judged by incremental glucose values, both Chinese and Malay women responded in exactly the same way to OCs; for plasma triglycerides and cholesterol, the metabolic effects of OCs seem to be greater in Chinese than in Malay women. The 19-nortestosterone and levonorgestrel pills appeared to have similar minimal effects on fasting and glucose values although insulin values after glucose were higher for levonorgestrel than for 19-nortestosterone; this suggests insulin resistance. The major difference between the 2 pills is seen in fasting plasma lipids. The relatively antiestrogenic progestagen levonorgestrel seems to effectively counteract hyperlipidemia seen in women using OCs containing a 19-nortestosterone progestogen. In general, the findings in this study closely parallel those seen in Western women.^ieng