Infective endocarditis (IE) is a potentially life-threatening disease which carries high risk of morbidity and mortality. The variability of clinical presentation of infective IE remains a diagnostic challenge for the Emergency Physicians. The clinical manifestation may present as an acute, rapidly progressive infection with the absence of classical immunological vascular phenomenon or as subacute or chronic disease with vague constitutional symptoms that may mislead initial assessment and mimic other conditions. Symptoms may also manifest as a result of systemic embolization which can be catastrophic and life-threatening especially if it ends up in the cerebral circulation. IE complicated by cerebral mycotic aneurysm (CMA) is the worst neurological sequalae and can be misdiagnosed as a primary intracranial infection such as meningoencephalitis. Here, we report a case of neurological emergency secondary to systemic embolization of IE with a devastating diagnosis of CMA. History of prolonged fever associated with headache and focal neurological deficit led to the initial diagnosis of meningoencephalitis due to a low clinical suspicion of the disease in the Emergency Department. In emergency setting, a combination of high degree of clinical suspicion together with thorough history, physical examination and diagnostic imaging are crucial in order to guide and establish the diagnosis of this potentially devastating disease. Early recognition and initiation of aggressive treatment is crucial to provide better prognosis and higher survival rate for patients with CMA.
Kenaikan segmen ST di elektrod aVR elektrokardiografi di dalam kes diseksi aorta mempunyai risiko kematian yang tinggi. Ia melibatkan diseksi yang berlaku di akar aorta. Kami melaporkan kes pesakit lelaki muda yang menghidap penyakit darah tinggi, yang datang ke Jabatan Kecemasan dengan sakit dada dan sakit di bahagian kaki. Pemeriksaan fizikal pada bahagian bawah kiri anggota adalah konsisten dengan iskemia akut. Elektrokardiogram menunjukkan serangan jantung akut di bahagian elektrod anterolateral, dan kenaikan ST segmen di elektrod aVR. Ekokardiografi menunjukkan akar aorta yang berukuran 4.51 cm dan kehadiran flap intimal, meningkatkan kebarangkalian diseksi pada akar aorta dan arteri koronari. Tomography Computed Angiogram menunjukkan terdapat diseksi aorta dari akar aorta termasuk flap intimal berhampiran permulaan arteri koronari kiri, hingga ke arteri iliac utama ke arteri iliac kiri. Malangnya, pesakit memilih untuk tidak menjalani pembedahan dan akhirnya meninggal dunia selepas 48 jam di masukkan ke wad. Kes ini menjelaskan bahawa, dalam kes diseksi aorta yang hadir dengan sindrom 'malperfusion', kenaikan segmen ST pada elektrod aVR akan meningkatkan kebarangkalian terjadinya diseksi aorta yang teruk melibatkan akar aorta dan juga arteri koronari, yang menjadikan prognosis pesakit lebih teruk.
Future healthcare providers are facing the threat of needle stick injuries (NSIs) with the consequent risk of acquiring blood borne diseases. A cross sectional study was conducted from May 2017 to September 2017 among 327 students including medical, nursing and paramedic students from Faculty of Medicine UKM. This study aimed to determine the level of knowledge and awareness among students during their clinical years. A validated questionnaire was delivered via convenience sampling. Data was analyzed using SPSS 23 software and one sample t-test was used to compare with the standard setting value. The mean age of respondents was 23.32±2.37. The knowledge and awareness were significantly higher in both paramedic (knowledge (10.71 ± 1.64, p<0.001), awareness (5.50 ± 0.86, p<0.001), and nursing (knowledge (9.94 ± 1.38, p<0.001), awareness (5.35 ± 1.07, p<0.001) students as compared to standard setting, respectively. Meanwhile for medical students there was no significant difference in knowledge (9.95 ± 1.39, p=0.589) but significant difference in awareness (5.87 ± 1.03, p<0.001) compared to standard setting. The prevalence of NSIs was 8.3% with majority having at least one incident (85.2%) and main exposure is during medical posting (77.8%) during procedure needle recapping (70.4%) using hollow needle (63%). Incident of NSIs were mostly not reported (74.1%). Despite a significant good result on knowledge and awareness, the incidence of NSIs is alarming. Therefore, preventive steps need to be taken by the university to avoid the occurrence.
Keyword: Knowledge, Awareness, Students, Needle Stick Injury (NSI), Cross-sectional study
Study site: Universiti Kebangsaan Malaysia (UKM)