04 Dec 2023
30 Nov 2023
Cases of pancreatic and duodenal trauma are rare, accounting for 2-4% of all abdominal trauma. A 28-year-old complained of abdominal pain after falling down eight hours before. Physical examinations showed bruises on the right upper quadrant and epigastrium area, tenderness in all abdominal regions, and muscular defense (+). Laboratory results showed leukocytosis 23,500 /uL. USG showed massive intraabdominal free fluid. Contrast-enhanced abdominal CT scan showed complete lacerations of the body of the pancreas (corpus), renal laceration grade 3, features of shock bowel of the duodenal region, hemoperitoneum and pneumoperitoneum. Patients with pancreatic trauma may present with a triad of leukocytosis, increased serum amylase level and upper abdominal pain. CT scan is the modality of choice in detecting signs of solid visceral organ trauma. 3-position abdominal CT scan has a sensitivity and specificity of 80% for pancreatic trauma. The role of imaging is essential in establishing diagnosis and determining treatment in patients with pancreatic trauma, which can lead to rapid treatment and improve life expectancy.
Approximately, 15% to 20% of systemic lupus erythematosus (SLE) patients are children especially from the Asian and African ethnicities. Co-existence of SLE and COVID-19 leads to complex management. We report a case involving an eleven-year-old boy who initially presented with vesico-bullous lesions of his lower lip followed by fever and malar rash. At this stage, viral infection was suspected. Simultaneously the boy was also tested positive for COVID-19. Following that, the disease progressed and the boy was transferred to the Paediatric Intensive Care Unit. A diagnosis of SLE was finally made based on the 2019 EULAR/ACR classification which showed a score of 26. He showed cardiac and pulmonary signs before his kidney deteriorated. A cytokine storm was suspected and he had to be supported with inotropes. The boy finally succumbed to his illness after all efforts failed to resuscitate him. We conclude that in this case, the SLE was complicated by concurrent COVID-19 and it progressed to cytokine storm and hemophagocytic lymphohistiocytosis or macrophage activation syndrome that resulted in fatal outcome.
The Emergency Department (ED) is the frontline of every hospital which is vulnerable to threats of daily overcrowding. The study aims to identify the effect of holidays in ED volume at the Philippine General Hospital (PGH) and show variations with regard to patient profile and disposition, if any. Total enumeration of patients seen in 2019 during holidays, non-holidays and holiday-after was utilized. Chi-square, one-way ANOVA and post-hoc Bonferroni analysis were performed at 95% CI and p value <0.05 was considered statistically significant. There was a reported decrease in the number of ED patient volume during the holidays as compared to non-holiday and holiday after; patients aged 50-59 years were significantly lesser during holidays (p=0.02) while the number of patients classified as Emergency Severity Index 3 (p<0.01), indigent patients (p<0.01) and trauma cases (p=0.01) were significantly higher during holidays. Lastly, the mean number of admitted patients seen during holidays were significantly lower compared to other time periods (p=0.04). The lower ED attendance and greater number of trauma cases during holidays must be considered when allocating resources and deploying workforce. The PGH –ED must ensure logistical requirements are met particularly on declared holidays in anticipation of possible surge of trauma patients and appropriate adjustment in ED staffing must reflect the decrease in the trend of patient volume during holidays. At greater lengths, both macro- and micro-level planning strategies at the ED must weigh these variations to improve services and provide better care.