Syphilis is an ancient sex u a l ly transmitted infection, described since centuries ago, caused by the bacterium Treponema pallidum. Syphilis or luetic disease is known as the great imitator as it can have myriads of clinical presentations, often making it a diagnostic challenge to clinicians. We report a patient with secondary syphilis, wh o presented with scaly plaques on his trunk and face, sparing the palms and soles.

Introduction: Cumulative Sum (CUSUM) technique is an objective statistical method used in assessing and monitoring doctor’s performance. It has been incorporated into quality improvement strategies in clinical services by the Ministry of Health, Malaysia. A pilot study was aimed at evaluating its usefulness in monitoring the performance of specialists in conducting skin biopsy. Methods: All skin biopsies performed by specialists in the Department of Dermatology, Kuala Lumpur Hospital from September 2009 to April 2011 were included in the prospective observational study. Outcomes monitored were wound complications within 14 days post-biopsy, and tissue sample being adequate and representative for histopathological interpretation. CUSUM scores of each consecutive biopsy performed by individual specialist were calculated and charted with the eCUSUM web application (https://app.acrm.org.my/eCUSUM). Results: A total of 870 skin biopsies were performed by 15 clinical specialists and three consultant dermatologists during the study period. Wound infection or dehiscence were reported in 13 (4.1%) of the 318 biopsy wounds evaluated. Tissue samples were inadequate in 10 (1.2%) and non-representative in 11 (1.3%) of the 817 histopathological reports evaluated. No learning curve was observed in all CUSUM charts indicating that all specialists had been adequately trained for the procedure. However, out-of-control signals indicating unacceptable wound complication rates and either inadequate or non-representative tissue samples were detected in three clinical specialists. Feedback and counseling were given while monitoring was continued. Conclusions: The CUSUM method is a useful performance monitoring tool which is able to promptly detect unacceptable outcomes in skin biopsy. It is invaluable in the supervision of junior doctors and trainees as well as self-monitoring for the trained specialists.

BACKGROUND: Alcohol-based hand sanitizers (ABHSs) have been widely used in homes, workplaces and schools to prevent the spread of infectious diseases. We report a young child unintentionally ingested ABHS at a school, resulting in intoxication. METHODS: The child was a 6-year-old girl who had been brought to the emergency department (ED) for hypothermia, altered mental status (AMS), periods of hypoventilation, hypothermia and vomiting. Computed tomography of her head revealed nothing abnormal in intracranial pathology. Urine drug screening was negative. Alcohol level was 205 mg/dL on admission. Other abnormal values included potassium of 2.8 mEq/L, osmolality of 340 mOsm/kg and no hypoglycemia. Further investigation revealed that the patient had gone frequently to the class restroom for ingestion of unknown quantities of ABHSs during the day. The patient was admitted for one day for intravenous fluid hydration and close observation of her mental status. RESULTS: The patient was discharged from the hospital the next day without any complications. CONCLUSION: Despite the large safety margin of ABHSs, emergency physicians need to be aware of the potential risk of ingestion of a large amount of such products in children and consider it in the assessment and management of school-age children with acute AMS.

Traditional and Complimentary Medicines (TCMs) can potentially cause Adverse Cutaneous Drug Reactions (ACDRs). The aim of this study was to describe the characteristics of ACDRs due to TCMs and compare with those due to conventional medicine. This was a retrospective study with 134 cases being diagnosed with ACDR at the Dermatology Clinic of a tertiary hospital in Kuala Lumpur. Most (82.1%) ACDRs were caused by conventional drugs, while 17.9% were due to TCMs. Majority (70-75%) of the ACDRs were of mild to moderate severity. The most common ACDR to TCM was Exfoliative Dermatitis (ED) and Acute Generalized Exanthematous Pustulosis (AGEP) (both 16.7%) while maculopapular rash was the most common reaction for conventional medications (25.5%). The onset of adverse reaction to TCM was about 4 weeks (60.2%) while reactions due to conventional medication was earlier (1 to 6 days, 65.4%; p<0.05). The odds of developing delayed ACDR was 14 times more with TCM compared to conventional medicine (p<0.05). This study showed that ED and AGEP were the most common ACDR manifestations of TCM while macuplopapular rash was the most common manifestation of conventional medications. However, most of these reactions were of mild to moderate severity. ACDR due to TCM may manifest long after the initiation of these products and hence its use should be routinely inquired when patients present with skin problems. All suspected cases of ADRs to TCM should be reported to the Malaysian Adverse Drug Reactions Advisory Committee (MADRAC) for continuous pharmacovigilance of these products.

Most familial adenomatous polyposis (FAP) patients undergo total colectomy, but duodenal polyposis develops in up to 90% of patients with FAP and a 4% to 18% risk of duodenal and ampullary cancer remains. Laparoscopic pancreas-preserving near total duodenectomy is thought to be a potential option and can be an effective approach to preserve the pancreas. A 48-year-old male patient, who underwent laparoscopic total colectomy with end ileostomy because of FAP with colorectal cancer, was diagnosed with a 20 mm-sized duodenal adenoma in the second to the third portion. The operation was performed on December 27, 2021. Near total duodenectomy was done and type II Billroth gastrojejunostomy was done. Laparoscopic pancreas-sparing duodenectomy is shown to be safe, with favorable short-term oncologic outcome compared to laparoscopic pancreatoduodenectomy in terms of less blood loss, faster recovery time, and much less total cost.

Background: The circumstances surrounding the current COVID-19 pandemic has necessitated the employment of telemedicine for administering care to patients and families. There is difficulty of seeking medical help among those with chronic and recurrent illness like asthma. The authors conducted a metanalysis to determine whether telemedicine for asthma management is effective Objective: This study aimed to systematically review the effectiveness of telemedicine consultation among asthmatic adults and children in terms of: a) asthma control, b) quality of life, c) cost effectiveness, d) lung function and e) exacerbations. Methods: A comprehensive search of randomized controlled trials was performed using the MEDLINE (PubMed), EMBASE, The Cochrane Library, Google Scholar, clinical trial registries (e.g., clinicaltrials.gov, clinicaltrialregister.eu) and relevant websites. The authors were interested in studies that measured these outcomes: asthma control, quality of life, cost effectiveness, lung function and exacerbations. Three reviewers identified studies for inclusion in this meta-analysis. They extracted data then used fixed effect and random effect modelling. Results: The authors identified 15 RCTs with total of 3,015 enrolled patients. A variety of telemedicine interventions were incorporated: telephone and Internet-based models of care. Most control used was the conventional face-to-face. Meta-analysis did not show a clinically important improvement in patients’ asthma control and lung function, there was no significant reduction in the number of hospital admission and visits to the emergency department over 12 months and not significantly cost effective. However, there was a significant improvement in the quality of life (95% CI [0.05, 0.29], p = 0.006). Conclusion Although nothing beats the advantage of physically seeing patients face-to-face, this study just supports the knowledge that telemedicine offers promising alternative to promote good communication between patients and caregivers, resulting in adherence to asthma management, which leads to better asthma control, improvement of patients’ quality of life, lung function, better cost-effectiveness and decrease in ER visits and exacerbation.
Telemedicine ; Asthma

Adult ; Carbon Monoxide Poisoning ; complications ; psychology ; Humans ; Male ; Middle Aged ; Nervous System Diseases ; chemically induced ; diagnosis ; physiopathology ; Suicide, Attempted ; psychology

Transduodenal ampullectomy (TDA) is the treatment of choice for large premalignant lesions of the ampulla of Vater (AoV). With the development of surgical techniques, various methods, including the open, laparoscopic, and robotic approaches, for performing TDA have emerged. Herein, we report four consecutive cases treated with open, laparoscopic, and robotic TDA, with technical pitfalls and future perspectives of TDA in treating premalignant lesions of the AoV. The surgical techniques and principles for TDA were the same regardless of the surgical approaches. After surgery, none of the patients showed any abnormal findings or complications, except for digestive problems. All these surgical approaches are appropriate for patients requiring TDA; however, minimally invasive TDA, particularly the robotic approach is ideal. Considering the surgical complexity of TDA, the robotic approach is considered to be effective.