Background:: Upper gastrointestinal bleeding (UGIB) is a common cause for hospitalizations and remains an important cause of morbidity and mortality. This study reports on our experience with UGIB in a tertiary center. Material and Methods:: All patients with UGIB (hematemesis, coffee ground vomitus, melena, with significant drop of hemoglobin >2gm/dL or needing blood transfusion) admitted between July 2017 and November 2018 were included. Results:: There were 151 patients (male 62.3%) with mean age 62.1 ± 15.2 years included in the study. Majority had comorbid conditions and one in five were using medications associated with UGIB. Over 88.1% required transfusions and 88.7% had early endoscopy (<24 hours) from time of admissions/referrals. Most common etiology was ulcers and 45% required endoscopic interventions. The median Rockall score was 4.6 ± 2.1. Rebleeding occurred in 9.9% and mortality in 20.9% (inpatient [12.6%] and post-discharge [7.3%]). Female patients had less H. pylori infection (p=0.001), but higher post-discharge mortality (p=0.030) and older group (>60 years) had lower H. pylori infection (p=0.002) and higher Rockall score (p=0.016). Higher Rockall score (>2) was associated with higher rates of rebleeding (p=0.027) and mortality (p=0.035). The Rockall score positively correlated with length of hospitalization. There was no correlation between treatment modalityand rebleeding rate, and there was no correlation between time of endoscopy and treatment modality with morality. Conclusion: Among our patients with UGIB, rebleeding rate and mortality rates remains high. High post-discharge mortality rates are due to significant comorbid conditions. Higher Rockall score was associated with higher rates of rebleeding and mortality and correlated with length of hospitalization.

From late December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in Wuhan, China and has spread globally resulting in a pandemic. Brunei Darussalam reported its first case of COVID-19 on 9 March 2020. Several measures were implemented to prevent a national outbreak. We report our experience with surveillance of patients requiring admission in all government hospitals. We detected one positive case, and through contact tracing two further cases were detected. Therefore, without this screening programme, these cases would likely have been missed, leading to further nosocomial and community spread.

Ovarian cancer is the second most common cancer in women and up to a fifth of all ovarian tumours are metastatic in origin. Among these metastatic tumors, the most common primaries are the gastroin- testinal tract and breast. We report the case of a 66-year-old lady who presented with recent onset vague lower abdominal pain and distension who on evaluation was diagnosed to have bilateral ovarian metastases from a pancreatic primary. This case highlights the importance of considering metastasis and to include a pancreatic primary in the differential diagnosis of patients with bilateral ovarian tu- mours.

A young lady presented with recurrent abdominal distention and pain. Over the past few years, she had been admitted several times with similar complaints. Each time the symptoms settled with conservative management. Abdominal radiography (Panel) on admission is shown above. What does the radiograph show and what is the syndrome ? Answer: refer to page 187 Images of Interest Brunei Int Med J. 2011; 7 (3): 165 Correspondence

(Refer to page 165) Answer: Chilaiditi’s sign and Chilaiditi’s syndrome Chilaiditi’s sign is defined by the asymptomatic interposition of part of the intestine (commonly the hepatic flexure of the colon) between the right hemi-diaphragm and the liver. It is usually an incidental finding. When symptomatic, it is referred to as the Chilaiditi’s syndrome. Presentations may range from intermittent recurrent mild abdominal pain to acute intestinal volvulus, though the symptoms reported so far have been inconsistent between different patients and can be nonspecific.