The COVID-19 pandemic has resulted in unprecedented global disruption, affecting every aspect of life including education. For medical schools and health sciences institutions, the restrictions imposed by the pandemic have resulted in the cessation of onsite classes, suspension of clinical attachments and restructuring of the students’ examination. Students of medicine and health sciences have always been considered an available resource in terms of volunteerism during a health crisis. Students at Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah (PAPRSB) Institute of Health Sciences have been volunteering in both non-direct patient contact and direct patient contact activities. During the pandemic, most of these students’ conventional university study and learning have been put on hold as a result of the restrictions. The need to continue learning is important, the students can therefore use the volunteerism during the pandemic as a learning opportunity looking to maintain and broaden their skills. It is however imperative that appropriate and adequate support, advice and training are provided to these students, not allowing them to undertake any activity beyond their level of competence, and with continuous supervision and adequate protection with personal protection equipment throughout their volunteerism during the pandemic.

Eccrine porocarcinoma is an extremely rare malignant cutaneous neoplasm. This tumour has an indolent behavior and misleading clinical diagnosis often leading to a delay in definitive treatment. The definitive diagnosis is made by histopathology since clinical findings often vary. The tumour must be considered in the differential diagnosis of elderly patients presenting with long standing skin lesion with a recent history of accelerated growth rate. Because of its reported high rate of local recurrence, a wide excision of the tumour with clear resection margins is mandatory. Close long term follow up is required. We present herein two cases of eccrine porocarcinoma.

Snake venom ophthalmia is an acute reaction of the ocular surface tissues to venom ejected into the eyes of spitting cobra victims. The condition is uncommon and the victim may be frightful of going blind. However permanent vision loss is rare. This case (40-year-old man) is reported to discuss the management protocol in such cases. Immediate copious irrigation of the eye is the most important management measure. Topical antibiotics may be prescribed to prevent secondary keratitis. Local or systemic anti-venom, topical heparin or corticosteroids are contraindicated in the management of this uncommon form of envenoming.

Introduction: The management of blunt and penetrating liver trauma continues to pose a tremendous challenge to surgeons. This study reviews the pattern of liver trauma and its management, both operative and non-operative, in RIPAS Hospital, the only tertiary referral center in Brunei Darussalam. Material and Methods: A retrospective study of patients admitted with liver trauma, with and without other associated injuries between January 2002 and December 2006 to RIPAS Hospital was undertaken. The patients' case records were retrieved. Details on age, sex, mode of injury, pre-operative imaging, severity of liver injury based on the Liver Injury Scale (LIS, grades I to VI), presence of other associated injuries, overall management, complications and outcome were collected and analysed. Results: Twenty patients (male, n = 12) with a mean age of 36 years old (range 20 to 75) were treated for liver trauma (median LIS grade of III, range I to V) during the study period. Road traffic accidents accounted for 75% of the injuries. Thirteen (65%) had high grade injuries (≥ LIS grade III). Seventeen (85%) patients underwent surgical procedures for liver and other associated injuries. Four patients (20%) had non-operative management with one failure (5%). This patient subsequently required surgery. There were six post-operative deaths (mortality 30%). There were three major morbidities (15%): right hepatic artery aneurysm, a right hepatic duct bile leak and left hemiplegia secondary to cerebrovascular accident. Conclusions In our local setting, blunt liver trauma is often due to road traffic accidents and is associated with a high mortality rate. A majority was of high grades and required urgent surgical interventions. Non-operative management is an option for those with low grade injuries and who are stable.
Abdominal Injuries ; Accident, Traffic ; Treatment Outcome