P-EGS13 Risk Factors of Bleeding Gastroduodenal Ulcer Among Patient Undergo Emergency Upper Endoscopy in Hospital Melaka

Background Bleeding gastroduodenal ulcer has been one of the leading causes of admission in surgical or gastroenterology departments all over the world, requiring immediate intervention with high associated mortality exceeding 10%. We analyzed few important risk factors that lead to this potentially ill condition. Methods Data from a number of 548 patients who underwent emergency upper endoscopy were collected retrospectively from June 2020 till June 2021 in Hospital Melaka. Results From our data collection of emergency upper endoscopy performed, 111 patients had findings of high-risk ulcer (Forrest Ia, Ib, 2a and 2b). From these 111 patients, the most common presentation was low hemoglobin value (<10g/dL), with 43.6%. Presentation of melena encountered the second most common symptom (26.3%), while fresh per rectal bleeding counts the less common symptom (1%). Forrest Ib ulcer showed the commonest diagnosis found during endoscopy (45.5%), followed by Forrest IIa ulcer (34.5%), Forrest IIb ulcer (16.4%), and Forrest Ia ulcer (3.6%). There were 27 participants who undergo repetitive endoscopy. For Helicobacter Pylori infection, there were 367 patients (66.7%) underwent the test during endoscopy, which showed 187 patients detected (51%) with H.Pylori positive. We identify other risk factors which lead to this fatal condition such as, patient’s comorbidities including liver disease, renal disease and their medications, blood investigations including hemoglobin level, platelet count, total white cell count, total bilirubin, Alanine Transaminase (ALT), serum urea and creatinine. Conclusions It is a must to identify important risk factors for bleeding gastroduodenal ulcers to prevent morbidity and mortality, and to initiate emergency intervention medically and surgically. From this study, it was a great move for us to make further research on how these risk factors affecting our management of patients.

Choledochal cyst perforation: experience from a centre with limited emergency resources

Spontaneous perforation in Choledochal cyst (CDC) is a very rare initial manifestation and more commonly seen beyond infantile age. The management is challenging due to acute presentation, poor general condition of the patient and inflamed tissue that may jeopardize the appropriateness of any surgical intervention. The aim of the study was to analyse this rarity depending on clinical findings, diagnostic difficulty and optimum management plan in a limited resource set-up. It was a retrospective observational study where five patients presenting to the casualty department with biliary peritonitis between January 2015 and December 2020 were included. They were analysed with respect to symptomatology, laboratory parameters, radiology, emergency intervention with findings and definitive management plan. A female preponderance (60%) was found. Mean age was 5.4 years. One was a known case of CDC. Abdominal pain was the most common symptom. Inflammatory markers like Total leucocyte count (TLC) and Erythrocyte sedimentation rate (ESR) were raised in all (100%). Lipase was raised in 40% (2/5). Anaemia and low serum albumin were non-specific findings. A dilated Common bile duct (CBD) on Ultrasound (US) was seen in 80% (4/5). Magnetic resonance cholangio pancreaticography (MRCP) demonstrated type I CDC in all. All underwent laparotomy with lavage and external drainage followed by interval definitive surgery. Pre-operative diagnosis of a perforated CDC may not be possible. Strong clinical suspicion and bilious peritoneal fluid may point to this rare complication. Minimum exploratory manoeuvre with good lavage and external drainage should be the optimum emergency intervention. Definitive bilio-pancreatic reconstruction should be performed when tissue oedema subsides and general condition is improved. This approach usually achieves a rewarding outcome.

Ovarian cyst mimicking acute appendicitis in pregnancy: A case report

Ovarian cysts, also known as ovarian masses or adnexal masses are fluid filled sacs or pockets in an ovary or on its surface. These are found incidentally in asymptomatic women. Ovarian cysts are considered large in size when they are over 5 cm and giant when they are over 15 cm. Acute appendicitis is the most common surgical problem encountered during pregnancy. Pregnancy is associated with various anatomic and physiologic changes that may disguise and delay the diagnosis of acute appendicitis. Antibiotic treatment does not always improve the outcome and emergency intervention is required. Early diagnosis and surgical intervention is mandatory for the eventful outcome of pregnancy. Here we present a case of a primigravida patient with a large ovarian cyst mimicking acute appendicitis.

Validity and risk factor analysis for helicopter emergency medical services in Japan: a pilot study

Background Some emergency departments use triage scales, such as the Canadian Triage and Acuity Scale and Japan Urgent Stroke Triage Score, to detect life-threatening situations. However, these protocols have not been used for aeromedical services. Therefore, we investigated the factors predicting these life-threatening situations in aeromedical services as a pilot study for establishing the protocol. Method We retrospectively evaluated helicopter emergency medical service cases from 1 April 2015 to 31 March 2020 at Gifu University Hospital using the mission records. We only evaluated cases dealing with suggested internal medicine issues. We excluded cases influenced by external factors such as trauma or cases that included hospital-to-hospital transportation, focusing only on prehospital care. We evaluated the validity of the medical emergencies based on the needs for emergency interventions and hospital admission and of the suggested diagnoses and associated risk factors. Result A total of 451 cases were suitable for inclusion in the study. In the analysis for all emergency calls, 235 (52.11%) cases needed emergency intervention and 300 (64.4%) required hospital admission. The suggested diagnosis was valid for 261 (57.87%) cases. After the first assessment by emergency medical technicians, 75 cases were removed. Analysis after this first assessment found that 52.31% cases required emergency intervention, 70.26% needed admission, and the suggested diagnosis was valid for 69.41% of cases. In the analysis of emergency calls, the multivariate analysis of some key variables identified age, playing sports, and gasping as risk factors for emergency intervention. Hospital admission risk factors included being age only. The suggested diagnosis was valid only for sports situations. In the analysis after the first assessment by an emergency medical technician, risk factors for emergency intervention included being age being male, playing sports, and gasping, and those for hospital admission was being age, being male, and experiencing stroke symptoms and/or disturbance of consciousness. The suggested diagnosis was valid only for sports situations. Conclusion Some ‘second’ keywords/phrases predict medical emergencies. Therefore, the dispatch commander should gather these keyword/phrases to assess.

First experience of using favipiravir in the first healthcare worker patient with moderate case of Coronavirus Disease 2019 (COVID-19) at Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia: a case report

Background: During the early period of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, there was no approved and definitive drug available for the treatment of COVID-19. Favipiravir, chloroquine, hydroxychloroquine was used for re-purposing drugs while their efficacy and safety remained a major concern for healthcare workers. Clinical trial to assess efficacy and safety were ongoing. Case presentation: We present here the case of a 38-year-old woman, the first case of a healthcare worker diagnosed with COVID-19 who had moderate type, including first experience treatment with favipiravir in Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia. We present the clinical characteristics, chest X-ray, clinical laboratory profiles, the treatment process with favipiravir and hydroxychloroquine as well as the clinical outcome of moderate type COVID-19 patient. Conclusion: This case highlights that considering the use of emergency intervention outside of clinical trial in the COVID-19 population, the informed patient consent has been given and the use of emergency intervention was monitored. Keywords: COVID-19, favipiravir, medical worker, case report, Jakarta Abstrak Latar belakang: Periode awal pandemi Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), belum terdapat obat yang disetujui dan pasti tersedia untuk pengobatan COVID-19. Favipiravir, chloroquine, hydroxychloroquine digunakan sebagai obat dengan indikasi baru yang sementara efektifitas dan keamanannya menjadi perhatian para petugas medis. Penyajian kasus: Disini kami melaporkan kasus wanita umur 38 tahun, merupakan kasus pertama seorang tenaga kesehatan Rumah Sakit terdiagnosis Coronavirus Disease 2019 (COVID-19) dengan penggunaan terapi favipiravir untuk pertama kalinya di Rumah Sakit Pusat Infeksi Sulianti Saroso, Jakarta, Indonesia. Berikut ini kami gambarkan karakteristik klinis, hasil foto thorak, profil laboratorium dan proses terapi menggunakan favipiravir and hidroxychloroquine serta hasil akhir pada kasus COVID-19 derajat sedang. Kesimpulan: Kasus ini menggaribawahi bahwa pertimbangan penggunaan kegawatdaruratan obat antivirus diluar uji klinis pada populasi pasien COVID-19, pasien telah memberikan persetujuan dan penggunaan obat-obat tersebut dimonitor. Kata kunci: Covid-19, favipiravir, tenaga kesehatan, laporan kasus, Jakarta

Application of TEOS Modular System on the Preservation of Andesite Type Rock

Andesite rock is commonly used as a heritage building in Southeast Asia, especially in Indonesia. However, the study on consolidation of andesite rock is still limited. This study aimed to evaluate the application effectiveness of TEOS-based material on the andesite type rock in heritage materials. TEOS was used as a modular system with andesite powder to form mortar. This andesite-TEOS mortar system was applied to conservation techniques, especially for gap and joint filling. TEOS modular system was successfully applied to the andesite type rock, resulting in chemical and physical properties. The color of the mortar and the compatibility with the original rock color were designed from the rock powder preparation. The excellent repair was obtained by a combination of dot technique gluing using epoxy resin and the TEOS mortar application in the gaps. Furthermore, this technique was successfully applied to the big Buddha Statue Head andesite rock for the emergency intervention of the falling fragment. Keyword: Andesite, Consolidation, TEOS, Mortar

Validity and risk factor analysis for helicopter emergency medical services (HEMS): The emergency call dispatch of Japanese air ambulances (Doctor-HeliTM️)

Background:Some emergency departments use triage scales, such as the Canadian Triage and Acuity Scale and the JUST, to detect the status of life-threatening situations. However, these triage systems have not been used for aeromedical services in Japan. Therefore, we investigated these profiles and conducted a pilot study.Method:We retrospectively evaluated the helicopter emergency medical service cases from 1 April 2015 to 31 March 2020 at Gifu University Hospital using our mission record. In this study, we only evaluated cases that dealt with internal medicine. We excluded cases that were influenced by external factors such as trauma or cases that included hospital-to-hospital transportation, focusing only on prehospital care. We evaluated the validity of medical emergencies such as emergency interventions and the necessity of hospital admission. In addition, we evaluated the validity of the suggested diagnoses and the associated risk factors.Result:A total of 451 cases were suitable for inclusion in the study. In the analysis for all emergency calls, 235 (52.11%) needed emergency intervention and 300 (64.4%) required hospital admission. The suggested diagnosis was valid for 261 (57.87%) cases. After the first assessment by emergency medical technicians (EMTs), 75 cases were removed from the analysis.Therefore, the results of the analysis for all emergency calls requiring emergency intervention were: 52.31%, need admission: 70.26%, and the suggested diagnosis was valid for 69.41% of cases. Results of a multivariate analysis of some key variables identified risk factors for emergency intervention, namely, age, under sports, and gasping. Hospital admission risk factors are being years old only. The suggested diagnosis was only valid in under sports situations.In the first analysis, the risk factors for emergency intervention are years old, being male, under sports, and gasping, and for hospital admission they are years old, being male, detecting stroke symptoms, and disturbance of consciousness. The suggested diagnosis was only valid in under sports situations.Conclusion:There are some “second” keywords/phrases that predict medical emergencies. Therefore, the dispatch commander should gather these keyword/phrases to assess.