Bucket of nails: foreign body ingestion in a young adult

Foreign body (FB) ingestion is a potentially serious health problem. Majority of the cases are seen in pediatric populations; when encountered in adults, they are usually due to underlying mental health disturbances, edentulous state or alcohol intoxication. Most ingested FBs pass spontaneously. However, 10%–20% of cases require endoscopic intervention, while 1% or less require surgical procedures due to complications such as bowel perforation or obstruction. Medical history obtained from the patient is highly critical in the diagnosis of FB ingestion. Patients can present with a wide array of symptoms and signs such as dysphagia, non-specific abdominal pain, atypical chest pain, choking, gastrointestinal (GI) obstruction, GI bleeding as well as GI perforation. Presentations, clinical findings and management are distinct and based on the anatomical region where the FB is located

Menopausal hormone therapy and risk of venous thromboembolism: the story so far

Menopausal hormone therapy (MHT) is known to increase the risk of venous thromboembolism (VTE), which includes deep vein thrombosis, pulmonary embolism, and less frequently cerebral vein thrombosis, but the absolute risk for a given patient is very low. After starting MHT, the risk of VTE seems to be at its highest, declining to the non-HRT user baseline level of risk after stopping. Whether estrogen-only or estrogen-progestin HRT combination is linked to a similar risk of VTE is unclear from the available evidence. The aim of this study is to evaluate the risks of developing VTE in relation to different types as well as different modes of administration of MHT through a database search including PubMed, MEDLINE, Google Scholar, Cochrane Library, and others in order to provide the women carers with the up-to-date and evidence-based guidelines and recommendations while counseling the post-menopausal women enquiring on use of hormonal therapies either to alleviate the menopausal symptoms or to prevent the longterm sequelae of estrogen deficiency

A randomized controlled trial of the effectiveness of “chest pain evaluation at emergency room” (cheer) protocol in the ed of HUSM: a model for Malaysian emergency departments

Background Management of low risk chest pain in adults is a problem in emergency department in Malaysia. Traditional use of CK/CKMB ratio among others has been used to manage patients presenting with low risk chest pain in Malaysia. Sometimes patients are admitted to the medical ward for observation due to the ambiguity of management of low risk chest pain thus creating overcrowding in ED or unnecessary referral and admission to the medical wards, which will occupy beds and worsen backlog of admission Methods This prospective randomised control trial included 53 patients with low risk chest pain admitted to Emergency department in Hospital USM. Patients were randomised to either a standard care arm for chest pain treatment according to current HUSM guideline or CHEER (Chest Pain Evaluation in Emergency Room) protocol arm which involves 8 hours observation with serial ECG and Troponin test. Patients information such as age, chest pain characteristics, demography, ECG findings, HEART and TIMI score were calculated during the stay. Patients were followed up after 6 weeks and 6 months to determine prevalence of Major Adverse Cardiac Event, Readmission to ED for chest pain, and their length of stay in hospital and rate of early discharge from ED. Results Study shows that CHEER protocol has overall shorter length of stay at ED or hospital and has higher early discharge rate compared to standard care. There is Background Management of low risk chest pain in adults is a problem in emergency department in Malaysia. Traditional use of CK/CKMB ratio among others has been used to manage patients presenting with low risk chest pain in Malaysia. Sometimes patients are admitted to the medical ward for observation due to the ambiguity of management of low risk chest pain thus creating overcrowding in ED or unnecessary referral and admission to the medical wards, which will occupy beds and worsen backlog of admission Methods This prospective randomised control trial included 53 patients with low risk chest pain admitted to Emergency department in Hospital USM. Patients were randomised to either a standard care arm for chest pain treatment according to current HUSM guideline or CHEER (Chest Pain Evaluation in Emergency Room) protocol arm which involves 8 hours observation with serial ECG and Troponin test. Patients information such as age, chest pain characteristics, demography, ECG findings, HEART and TIMI score were calculated during the stay. Patients were followed up after 6 weeks and 6 months to determine prevalence of Major Adverse Cardiac Event, Readmission to ED for chest pain, and their length of stay in hospital and rate of early discharge from ED. Results Study shows that CHEER protocol has overall shorter length of stay at ED or hospital and has higher early discharge rate compared to standard care. There i