Intussusception is a common cause of gastrointestinal emergency in the paediatric population and it is usually diagnosed through Barium enema radiography or ultrasound. The skill of using an ultrasound by a minimally trained medical officer in diagnosing this cases in the Emergency Department are very helpful and expedite the management. We present the case of a 7-month-old girl who presented to Emergency Department (ED) with the chief complaint of passing blood in stool. Clinically she was dehydrated, irritable and in compensated shock. There was generalised tenderness per abdomen but it was soft and not distended. There was no palpable mass and bowel sound normal. Immmediate fluid resuscitated commenced. Bedside abdominal ultrasound performed by ED medical officer showed a 1.8 cm x 2.5 cm mass of alternating hypo-echoic and hyper-echoic rings at the right lower quadrant, consistent with the ‘target’ sign of intussusception. Supine plain abdominal X-ray did not reveal any abnormality. The ultrasound finding of intussusception was later confirmed by the radiologist. She underwent immediate hydrostatic reduction and was discharged well.
Keywords: diagnosis, Emergency Department, intussusception, paediatric, ultrasound
The use of fibers in cementitious composites yields numerous benefits due to their fiber-bridging capabilities in resisting cracks. Therefore, this study aimed to improve the shear-resisting capabilities of conventional concrete through the hybridization of multiple synthetic fibers, specifically on reinforced concrete structures in seismic-prone regions. For this study, 16 hybrid fiber-reinforced concretes (HyFRC) were developed from the different combinations of Ferro macro-synthetic fibers with the Ultra-Net, Super-Net, Econo-Net, and Nylo-Mono microfibers. These hybrids were tested under direct shear, resulting in improved shear strength of controlled specimens by Ferro-Ultra (32%), Ferro-Super (24%), Ferro-Econo (44%), and Ferro-Nylo (24%). Shear energy was further assessed to comprehend the effectiveness of the fiber interactions according to the mechanical properties, dosage, bonding power, manufactured material, and form of fibers. Conclusively, all fiber combinations used in this study produced positive synergistic effects under direct shear at large crack deformations.
Hereditary angioedema (HAE) is a rare and potentially life threatening autosomal dominant disease characterized by recurrent episodes of cutaneous and mucosal oedema. It results from reduced expression or loss of function of CI-esterase inhibitors (C1-INH). As opposed to the more common histamine-mediated angioedema, HAE does not respond well to conventional treatments with anti-histamines, steroids and adrenaline. Early recognition and timely intervention with the correct treatment are crucial particularly preventing airway obstruction. New disease specific treatment including plasma derived or recombinant C1-INH, ecallantide and icatibant have recently emerged and its appropriate use can reduce HAE-associated mortality and morbidity. However due to its costs, these disease specific treatments have yet to reach Malaysia. Despite that no randomized clinical trial on FFP has been performed, its efficacy in treating acute attacks of HAE is only demonstrated in case studies. This case report illustrates the successful treatment of acute HAE episode with FFP in a Malaysian government hospital setting.