The popularity of ultrasound for acute diagnosis of fractures in the Emergency Department (ED) has increased over the recent years. This present study aimed to determine the sensitivity and specificity of ultrasound use for detection of fractures in a different environment, which is at the triage area of the ED. We compared the results of bedside ultrasound in detecting non-critical fractures to the current gold standard of X-rays in the triage area. The design was a single centered crosssectional study. From August 2014 till November 2014, a total of 46 patients were recruited, creating 75 image pairs. Following consent, a bedside ultrasound was performed and subsequently compared with X-ray reporting regarding the presence or absence of fractures. SPSS analysis was used to determine the sensitivity and specificity of ultrasound in diagnosing fracture as compared to X-rays. Ultrasound had a sensitivity of 72% (95% CI, 50.6% - 87.9%) and a specificity of 80% (95%CI: 66.3 – 90%) when compared to X-rays in fracture diagnosis. The kappa analyses showed moderate inter observer agreement (0.5) between ultrasound and X-rays in diagnosing fractures. This study suggests that the use of ultrasound as a triage tool yet has unacceptable sensitivity and needs further evaluation and consideration.
Ultrasonography

Midazolam is one of the most commonly used drugs for sedation in Emergency Department (ED). This was a retrospective study conducted on 380 patients from December 2012 to May 2014 in ED of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The objective was to elicit the frequency of side effects and correlation to various factors i.e. socio-demography, co-morbidities, age groups and underlying illnesses. Out of 380 patients, 35 patients experienced side effects (20 patients with midazolam alone, 15 patients with combination of drugs). The average age was 42 years and the average dose of midazolam was 3.5mg. The most common other drug combined was fentanyl. The overall complication rate for midazolam was 5.3%. The most common side effect recorded was excessive somnolence (1.6%). Other side effects included local skin reactions (1.1%), vomiting (0.8%), headache (0.8%) and hypotension (0.5%). There was no significant association between the socio-demographic factors and drugs combination with the side effects of midazolam on patients. It was concluded that midazolam was a safe drug due to absence of any life-threatening side effects. There are possibilities that most side effects recorded could be caused by other comfounding factors e.g. underlying injuries or disease and combination with other drugs.
Midazolam

Oral ulcer is a lesion with multifactorial causes and occurs worldwide. The lesion usually resolved within 14 days, but the pain may have an impact on the quality of patient’s life. Therefore, having a natural derived remedy that can reduce healing time would be a great advantage. This study aims to investigate histological sections of buccal ulcer on rats treated with aqueous extract of Piper sarmentosum (AEPS).Glacial acetic acid was used to induce buccal ulcer on male Sprague Dawley rats. Control group received normal saline while the experimental group received AEPS for treatment. On certain days of post-ulcer induction, buccal ulcer tissue samples were harvested, sectioned and stained with Hematoxylin and Eosin (H&E). Histological slides were examined for inflammation and scored. The inflammation severity reduced from day 2 to day 12. In the experimental group there was a statistically significant differences of inflammation score, particularly on day 2 with a score of (2.8 + 0.2). Neutrophils were less in the experimental group and the tissue debris clearance was faster compared to control group. Full reepithelization was observed on both treated tissue sections on day 12 with less severe inflammation. Topical application of AEPS is proven to have anti-inflammatory effect by reducing the number of neutrophils during inflammation phase of oral ulcer healing