Introduction: Pain is the most common chief complaint of patients presenting to Emergency Department (ED). Pain is not simply a signal for tissue injury, but also a signal to seek repair and recuperation. The aim of this study was to determine whether upper limb (UL) or lower limb (LL) fracture has more pain and to evaluate the association between types of fracture (UL vs LL) with adequacy of pain relief. Methodology: A study was conducted from July to October 2005 in ED, Hospital Universiti Sains Malaysia (HUSM). Patients who fulfill the inclusion criteria were selected. Paramedics in charged were the assistants; at the same time became the observer. The paramedics were not involved in the decision making for pain management. Pain severity score was assessed by using Numeric Rating Scale (NRS). Results: 42 patients were enrolled. 85.7% (n=36) were male and 14.3% were female. Mean age is 29.6 years old. Mean NRS on arrival for UL and LL fractures were 6.47 ± 1.70 and 7.80 ± 2.53 respectively. Mean NRS for mixed fractures (both UL and LL) was 7.60 ± 3.36. There was no statistically significant association between fracture sites and analgesic administration (p value=0.300). There were 70.6% and 70.0% of the patients with UL and LL fractures had adequate pain relief whereas 80% of patients with mixed fractures had adequate pain relief (p value= 0.902). Conclusion: LL and mixed fractures had more pain score on arrival but there was no statistically significant association between fracture sites and analgesics administration and no association between fracture sites with adequacy of pain relief.

Background Polycystic ovary syndrome (PCOS) is a disorder in reproductive age women and is characterized by hyperandrogenic anovulation and oligo-amenorrhea, which leads to infertility. Anovulation in PCOS is associated with low follicle-stimulating hormone levels and the arrest of antral follicle development in the final stages of maturation. L-carnitine (LC) plays a role in fatty acid metabolism, which is found to be lacking in PCOS patients. This systematic review and meta-analysis aimed to determine the effectiveness of LC supplementation for patients with PCOS. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information Database (PsycINFO), and the World Health Organization International Clinical Trials Registry Platform for all randomized control trials, comparing LC alone or in combination with other standard treatments for the treatment of PCOS from inception till June 2021. We independently screened titles and abstracts to identify available trials, and complete texts of the trials were checked for eligibility. Data on the methods, interventions, outcomes, and risk of bias from the included trials were independently extracted by the authors. The estimation of risk ratios and mean differences with a 95 percent confidence interval (CI) was performed using a random-effects model. Results Nine studies with 995 participants were included in this review. Five comparison groups were involved. In one comparison group, LC reduced the fasting plasma glucose (FPG) (mean differences (MD) −5.10, 95% CI [−6.25 to −3.95]; P = 0.00001), serum low-density lipoprotein (LDL) (MD −25.00, 95% CI [−27.93 to −22.07]; P = 0.00001), serum total cholesterol (MD −21.00, 95% CI [−24.14 to −17.86]; P = 0.00001), and serum triglyceride (TG) (MD −9.00, 95% CI [−11.46 to −6.54]; P = 0.00001) with moderate certainty of evidence. Another comparison group demonstrated that LC lowers the LDL (MD −12.00, 95% CI [−15.80 to −8.20]; P = 0.00001), serum total cholesterol (MD −24.00, 95% CI [−27.61 to −20.39]; P = 0.00001), and serum TG (MD −19.00, 95% CI [−22.79 to −15.21]; P = 0.00001) with moderate certainty of evidence. Conclusion There was low to moderate certainty of evidence that LC improves Body Mass Index (BMI) and serum LDL, TG, and total cholesterol levels in women with PCOS.

Background This systematic review and meta-analysis aimed to compare the effects of high-intensity interval exercise (HIIE) with different recovery modes versus moderate-intensity continuous exercise (MICE) on cardiac troponin (cTn) elevation. Methodology A literature search was conducted in four databases: Scopus, PubMed, EBSCO and Web of Science from January 2010 to June 2022. The articles were screened, evaluated for quality before data were extracted. The review protocol was registered at PROSPERO (CRD42021245649). Standardized mean differences (SMD) of peak cTn were analyzed with a 95% confidence interval (95% CI) using Revman 5.4 software. Results Six studies satisfied the inclusion criteria with a total of 92 and 79 participants for HIIE and MICE, respectively. Overall, there was no significant difference between HIIE and MICE in the elevation of cardiac troponin T (SMD: 0.41 [95% CI [−0.21, 1.03]], p = 0.20, I2 = 77%, p for heterogeneity <0.01). In subgroup analysis, HIIE with passive recovery elicits greater release of cardiac troponin T than MICE (SMD: 0.85 [95% CI [0.44, 1.27]], p < 0.01, I2 = 32%, p for heterogeneity = 0.22). Changes of cardiac troponin T (SMD: 0.41 [95% CI [−0.21, 1.03]], p = 0.20, I2 = 77%, p for heterogeneity < 0.01) after HIIE with active recovery were not significantly different from those of MICE. Conclusions There was no significant difference between HIIE and MICE in the elevation of cardiac troponin T. However, HIIE with passive recovery elicited more cardiac troponin T elevation than MICE, which should be considered when developing exercise programs.

Introduction: Haemoptysis is uncommon in toddler. Lower respiratory tract infections and foreign body are among the common causes. Case Presentation: We are reporting a case of a child presented to emergency department with complaint of mild haemoptysis, whom was later found to have a piece of broken satay skewer at the tonsillar region. The foreign body was removed during the procedure without any complication. Discussion: Foreign body ingestion, particularly a piece of broken satay skewer, is difficult to suspect without a proper history and eyewitness. Therefore, parent’s supervision is important. Emergency residents should have a high index of suspicion of foreign body ingestion in a child with vague symptoms. Conclusion: Foreign body is among the commonest cause of haemoptysis in an afebrile toddler. Acute haemoptysis in otherwise healthy toddler should alert the emergency residents about foreign body ingestion. History of food intake should be more thorough even if trivial.

Introduction:The number of elderly patients presenting to emergency departments (EDs) is rising in line with the growing geriatric population.There are valid concerns whether the existing emergency care system is prepared to deal with a larger geriatric population presenting with acute medical problems. The objective of this study is to assess baseline knowledge and attitudes of doctors toward elderly patients and to determine the factors that influence it. Methods: A cross-sectional study was conducted among emergency doctors in ED of Hospital Universiti Sains Malaysia (Hospital USM) from February 2020 to July 2020 using a validated questionnaire. The questionnaire consists of three sections: sociodemographic background of the respondents, their knowledge and core attitudes toward elderly. The responses were analyzed using descriptive analysis, simple and multiple logistic regression analysis. Results: A total of 198 ED doctors in Hospital USM participated in the study. Most respondents held positive attitudes toward elderly (53.5%).However, the majority of respondents had poor geriatric knowledge level (76.3%). The age of the doctor (AOR 0.08; 95%CI: 0.01, 0.89; p=0.042) was a factor that influenced attitudes toward geriatric patients. Nevertheless, no single factor was found to influence good geriatric knowledge. A significant weak positive correlation (r=0.154, p=0.031) was found between geriatric knowledge and attitudes toward elderly. Conclusion:A more innovative and structured geriatric continuing medical education should be implemented to enhance the knowledge and dispel negative attitudes, so emergency doctors are able to manage elderly patients more confidently.