Junainah Nor

Acute poisoning is a frequent reason for emergency department (ED) visits, with varying patterns of presentation across different regions. This study examines the clinical characteristics, sociodemographic factors, and outcomes associated with acute chemical poisoning in a Malaysian population. This is a retrospective case note review of acute chemical poisoning presenting to the ED of a tertiary government hospital in Malaysia from 2016 to 2018. Data were collected on sociodemographic details, clinical presentations, and outcomes, with multiple logistic regression used to identify factors associated with its complications. A total of 260 cases were included, with 168 (64.6%) being intentional poisonings and 92 (35.4%) accidentals. The majority of patients were single (60.8%), male (58.5%), and of Indian ethnicity (57.3%). The most common agents were pesticides (42.2%). The overall complication rate was 14.2%, and the mortality rate was 4.6%. The most frequent complications were respiratory insufficiency (11.5%) and renal failure (6.5%). Factors significantly associated with complications included intentional poisoning (AOR 3.18, 95% CI 1.05-9.66, p=0.042), ethnicity (Chinese: AOR 12.85, 95% CI 1.40-118.35, p=0.024; other races: AOR 25.99, 95% CI 2.34-238.00, p=0.004), exposure during daytime hours (AOR 12.79, 95% CI 1.52-107.42, p=0.019), and a delay of 2-12 hours before ED visit (AOR 2.30, 95% CI 1.02-5.20, p=0.045). Acute chemical poisoning is more common in single males with intentional exposures. Important factors associated with its complications include age, ethnicity, the time of exposure, and delayed presentation to the ED.

Paediatric intussusception is the most common cause of intestinal obstruction in paediatric population. Since 2019, the global pandemic caused by SARS-CoV-2 infection has significantly impacted worldwide healthcare. It has variable manifestations such as respiratory and extra-respiratory manifestations, and paediatric intussusception has been reported as one of the rare gastrointestinal manifestations of COVID-19. Though COVID-19 is mainly associated with respiratory manifestations, paediatric population may present with gastrointestinal symptoms such as vomiting, diarrhoea, abdominal pain and poor oral intake, before or with the onset of respiratory symptoms. Paediatric intussusception in COVID-19 is uncommon, and the initial presentation may be mistaken not as gastrointestinal manifestation of COVID-19. It is important for physicians to have a high clinical suspicion, especially in paediatric population, to differentiate between these entities. Early recognition and prompt intervention can improve patient care and prevent complications. This case also raises the possibility of role of SARS-COV-2 virus in etiopathological cause of paediatric intussusception. Here, we report a case of paediatric ileocolic intussusception in a patient with SARS-CoV-2 infection.

Sexual assault is a serious social problem. Due to its stigma, it is severely underreported with the survivors delay in seeking treatment. We aim to study the patterns, clinical characteristics, and time taken to manage sexual assault cases in our One Stop Crisis Centre (OSCC), and determine the factors associated with delayed presentation. This was an observational case review study of all sexual assault cases from 2012-2017 at the OSCC of a suburban, tertiary hospital in Malaysia. A total of 304 cases were analysed. The median age of the survivors was 15 years old. Majority were females (n=291, 95.7%), single (n=290, 95.4%), students (n=235, 77.3%), and from low socio-economic class (n=230, 75.7%). Rape constitutes the majority (n=246, 80.6%) with 153 cases (62.1%) were statutory rape. The most common perpetrator was the victim's boyfriend (n=107, 35.2%) while only 60 cases (19.7%) involved strangers. Delayed presentations were more likely among victims who previously knew their perpetrators (AOR 2.53, 95% CI: 1.37 to 4.68, p<0.01). The median duration for management at OSCC was 6.48 hours. Majority of sexual assault survivors were females, teenagers, and from low socio-economic class. Rape, mainly statutory rape, made the majority of cases. Therefore, sexual and safety education targeting primary intervention should be started early. Multidisciplinary teams must work together to optimise the management of sexual assault.

Due to overcrowding, personnel shortages, or problematic intravenous (IV) cannulation, acute pain management is often sub-optimal in emergency departments (EDs). The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of intranasal (IN) ketamine for adult acute pain in the emergency setting. We searched and identified studies up to 21 May 2021 via PubMed, Scopus, Web of Science, Cochrane Database, and Google Scholar. The random-effects model with 95% confidence intervals (CIs) was used to estimate mean differences (MDs) and odds ratios (ORs). The I² statistic and Cochran’s Q test were used to determine heterogeneity. The protocol was registered in PROSPERO (CRD42020213391). Seven randomised controlled trials were included with a total of 1760 patients. There was no significant difference in pain scores comparing IN ketamine with IV analgesics or placebo at 5 (MD 0.94, p = 0.26), 15 (MD 0.15, p = 0.74), 25 (MD 0.24, p = 0.62), 30 (MD −0.05, p = 0.87), and 60 (MD −0.42, p = 0.53) minutes. There was also no significant difference in the need for rescue analgesics between IN ketamine and IV analgesics (OR 1.66, 95% CI: 0.57−4.86, p = 0.35, I² = 70%). Only mild adverse effects were observed in patients who received IN ketamine. Our results suggest that IN ketamine is non-inferior to IV analgesics and may have a role in acute pain management among adults in the ED.

Background: Emergency departments (EDs) are frequently misused for non-emergency cases such as upper respiratory tract infections (URTIs). Flooding of these cases may contribute to inappropriate antibiotic prescribing. The aim of this study was to determine the patient factors associated with inappropriate antibiotic prescribing for URTIs in the EDs. Methods: This cross-sectional study involved patients over age 3 years old who presented with URTI to the green zone of the ED of a tertiary hospital on the east coast of Malaysia in 2018– 2019. Convenient sampling was done. The patients were categorised into two groups according to their McIsaac scores: positive (≥ 2) or negative (< 2). Antibiotics given to the negative McIsaac group were considered inappropriate. Results: A total of 261 cases were included — 127 with positive and 134 with negative McIsaac scores. The most common symptoms were fever and cough. About 29% had inappropriate antibiotic prescribing with a high rate for amoxycillin. Duration of symptoms of one day or less (OR 18.5; 95% CI: 1.65, 207.10; P = 0.018), presence of chills (OR 4.36; 95% CI: 1.13, 16.88; P = 0.033) and diagnosis of acute tonsillitis (OR 5.26; 95% CI: 1.76, 15.72; P = 0.003) were significantly associated with inappropriate antibiotic prescription. Conclusion: Factors influencing inappropriate antibiotic prescribing should be pointed out to emergency doctors to reduce its incidence.

Background: Advanced cardiac life support provides healthcare professionals with knowledge and skills needed in dealing with cardiac emergencies. By incorporating e‐learning in advanced cardiac life support courses, it allows for easier accessibility of learning materials and a more personalized learning schedule at a lower overall cost.Objectives: This study aims to compare the outcome of e‐learning advanced cardiac life support versus conventional advanced cardiac life support among healthcare professionals and determine their attitude on e‐learning.Methods: A total of 96 candidates attending advanced cardiac life support courses in Hospital Universiti Sains Malaysia between January 2016 and May 2017 were included in the study. In total, 48 candidates were enrolled on each arm. Candidates in conventional advanced cardiac life support undertook a 2‐day face‐to‐face course. Participants in e‐learning advanced cardiac life support completed 6 h of online lecture videos prior to 1‐day modified face‐to‐face course. All candidates were assessed by pre‐ and post‐course multiple‐choice questions and practical cardiac arrest simulation test. Only post‐course and cardiac arrest simulation test marks contribute to the passing or failure of the candidates.Results: Candidates in e‐learning advanced cardiac life support courses had higher mean scores on the pre‐course multiple‐choice questions (69.1, SD: 19.1) compared to those in conventional advanced cardiac life support courses (58.6, SD: 16.6, p < 0.001). The cardiac arrest simulation test pass rate on e‐learning advanced cardiac life support was higher than conventional advanced cardiac life support courses although statistically not significant (95.8% vs 87.5%; p = 0.134). The overall pass rate was 93.8% for e‐learning advanced cardiac life support versus 83.3% in conventional advanced cardiac life support (p = 0.099). A majority of the candidates had positive attitude towards e‐learning.Conclusion: E‐learning advanced cardiac life support courses demonstrated better results in terms of knowledge compared to conventional advanced cardiac life support, with equivalent skill scores. Shorter course duration, lesser cost and participants’ satisfaction were the added benefits. Further study can be done to explore the utilization of e‐learning materials among healthcare professionals and its other advantages.