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Abstract : Tetralogy of Fallot (ToF) cases with late presentation were more common than previously realized and often undetected despite proper screening. This population initially has a small degree of right ventricular outflow obstruction, allowing them to receive better oxygenation. The incidence of ToF in NCCHK from 2019–2021 was 883 cases. The palliative interventions which aim to increase pulmonary blood flow are still considered the first-choice treatment in patients with critical ToF unsuitable for primary repair. RVOT stent (Right Ventricular Outflow Tract Stent) is frequently used to increase pulmonary artery flow in patients with uncorrected ToF in preparation for a ToF repair. It has been advocated as an intermediary step for high-risk patients. To report a case of late-presentation ToF with LV dysfunction which performed non-surgical palliative approach as bridging procedure due to high risk of surgery. A 7-year-old boy presented to the emergency room (ER) with shortness of breath and cyanosis. The patient has been diagnosed as ToF since 2019 but has lost follow-up due to the COVID-19 pandemic. Echocardiography on admission revealed a decreased left ventricular (LV) ejection fraction (LVEF of 39.5%) with global hypokinetic and thrombus at LV. Two days after admission, a joined cardiology–cardiothoracic surgery meeting was decided to do MSCT Cardiac and right ventricle outflow tract (RVOT) stenting for the patient. The day before being scheduled for MSCT and RVOT stenting, the patient suddenly developed a hypercyanotic spell and fell into cardiac arrest. The Code Blue protocol was activated and the patient was promptly given CPR, intubated, and transported to the ICU. He was having episodes of Arrest-ROSC. The patient was promptly delivered to the Cath lab for emergency right ventricular outflow tract (RVOT) stenting. At the end of the procedure, oxygen saturation reached 92% with stable hemodynamics and the RV-PA gradient was substantially decreased from 101 mmHg to 28 mmHg (evaluated by echocardiography). After RVOT stenting, the patient’s clinical condition continued to gradually improve. Echocardiography evaluation showed marked improvement in systolic function (EF 70%). We reported a case with late-presentation ToF patients with LV dysfunction who were treated with a non-surgical palliative approach as a bridging procedure in high-risk for surgery. The patient’s condition gradually improved after the RVOT stent procedure.

Abstract : Medical coding (MC) is the process of converting clinical terminologies and concepts into a list of codes, which may be alphanumeric or numeric, in order to provide well-written patient records and more accurate translation. The purpose of this study was to determine the effectiveness of an online course in increasing the knowledge of medical coding among medical graduates, and to assess their satisfaction towards online education. The study recruited fourteen recent medical graduates. The online course consisted of lectures, quizzes, and interactive activities. The study used a pre-test post-test design to assess the participants' knowledge of medical coding before and after the online course. Participants also completed a questionnaire to assess their satisfaction towards online education. The findings indicated that knowledge of participants about medical coding significantly improved after completing the online course (P=0.001). The results also showed that the majority of the participants (93%) found the online course to be effective for improving learning and all of them reported engagement and satisfaction. This study suggest that online courses can be an effective means of increasing knowledge about medical coding among medical graduates. The findings of this study are important for learners and tutors to improve and fine-tune future course offerings.

Abstract : A quasi-experimental study was conducted in 2019 in 3 (three) districts/cities (Palu City, Sigi Regency, and Donggala Regency) in Central Sulawesi. This research was conducted to increase the knowledge and skills of midwives in the detection of pre-eclampsia, to increase referrals for pregnant women with pre-eclampsia to district/city hospitals, and to improve supervision of midwives in the detection and referral of pre-eclampsia cases by universities (the divisions of Public Health Sciences and Community Medicine). Intervention through education and training on quality of antenatal care focusing on Pre-Eclampsia using updated training modules. There were 75 health center midwives in 3 research locations who participated in the research and were assisted by co-assistant students (junior doctors) who held positions in the Public Health Sciences and Community Medicine departments of the Faculty of Medicine, Tadulako University. In this study, data were collected from patient registers, monthly reports from the community health center, semi-structured questionnaires to obtain knowledge, checklists for observing skills in screening for pre-eclampsia, measuring blood pressure and urine protein (dipstick test), as well as monitoring/observation forms of adherence midwife. The results showed an increase in knowledge before and after the intervention (p <0.001) and an increase in skills (p <0.001), including skills for screening, measuring blood pressure, and checking urine protein. There was an increase in pre-eclampsia cases referred after the intervention, from 2.39% to 3.56% (p <0.001). In this study, data were collected from patient registers, monthly reports from the community health center, semi-structured questionnaires to obtain knowledge, checklists for observing skills in screening for pre-eclampsia, measuring blood pressure and urine protein (dipstick test), as well as monitoring/observation forms of adherence midwife. The results showed an increase in knowledge before and after the intervention (p <0.001) and an increase in skills (p <0.001), including skills for screening, measuring blood pressure, and checking urine protein. There was an increase in pre-eclampsia cases referred after the intervention, from 2.39% to 3.56% (p <0.001).

Abstract :

This guideline presents recommendations for the step-wise management of patients with overt upper gastrointestinal bleeding. Hemodynamic status is first assessed, and resuscitation initiated as needed. Patients are risk-stratified based on features such as hemodynamic status, comorbidities, age, and laboratory tests. Pre-endoscopic erythromycin is considered to increase diagnostic yield at first endoscopy. Pre-endoscopic proton pump inhibitor (PPI) may be considered to decrease the need for endoscopic therapy but does not improve clinical outcomes. Upper endoscopy is generally performed within 24h. The endoscopic features of ulcers direct further management. Patients with active bleeding or non-bleeding visible vessels receive endoscopic therapy (e.g., bipolar electrocoagulation, heater probe, sclerosant, clips) and those with an adherent clot may receive endoscopic therapy; these patients then receive intravenous PPI with a bolus followed by continuous infusion. Patients with flat spots or clean-based ulcers do not require endoscopic therapy or intensive PPI therapy. Recurrent bleeding after endoscopic therapy is treated with a second endoscopic treatment; if bleeding persists or recurs, treatment with surgery or interventional radiology is undertaken. Prevention of recurrent bleeding is based on the etiology of the bleeding ulcer. H. pylori is eradicated and after cure is documented anti-ulcer therapy is generally not given. Nonsteroidal anti-inflammatory drugs (NSAIDs) are stopped; if they must be resumed low-dose COX-2-selective NSAID plus PPI is used. Patients with established cardiovascular disease who require aspirin should start PPI and generally re-institute aspirin soon after bleeding ceases (within 7 days and ideally 1-3 days). Patients with idiopathic ulcers receive long-term anti-ulcer therapy.

Abstract :

Tuberculous pleurisy can result in pleural fibrosis, calcification and thickening. To prevent these complications, corticosteroids are frequently used in addition to antituberculous drugs; however, new therapeutic regimens can control the disease and minimise the sequelae, and there is no convincing evidence of the benefit of the use of corticosteroids as adjuvant therapy. Patients received isoniazid 5 mg/kg and rifampicin 10 mg/kg daily for six months. Additionally, they were randomly assigned to a double blind treatment with either prednisone (1 mg/kg/day for 15 days and then tapering off) or placebo during the first month of treatment. Different clinical, radiological, and functional parameters were evaluated to assess the effect of corticosteroids. Fifty seven patients received prednisone and 60 placebo. At the end of the treatment the clinical outcome, the rate of reabsorption of the pleural fluid, the pleural sequelae, as well as lung capacity were similar in both groups. Corticosteroids do not influence the clinical outcome or the development of long term pleural sequelae in tuberculous pleurisy.