Ludwig’s Angina in A Rural Hospital- An Infection Spreads from Dental Caries

@#Ludwig's angina is one of the emergency cases associated with impending upper airway obstruction. Through this case report, the neglected case of emergency medical diagnosis could be prevented and it will become a piece of evidence for the great importance of collaboration among clinicians. A 17-year old boy admitted to the emergency setting of a rural public hospital, East Belitung, Indonesia with major complaints of progressively swallowing difficulty and breathlessness with fever and chills for two weeks before hospital admission. There was a history of dental caries in mandibular right second molar. Non-surgical and surgical management has been conducted immediately and the patient was discharged after day three postoperatively. In this rural hospital setting, early and proper management based on accurate diagnosis is a pivotal step to prevent medical negligence amid limited resources and equipment.

Serum Ferritin Levels: A Potential Biomarker to Represent Child-Turcotte-Pugh Score among Decompensated Liver Cirrhosis Patients

@#Background: Liver cirrhosis and the child-Turcotte-Pugh (CTP) score are inseparable entities in liver disease. CTP score is largely known as the mortality and prognosis predictor. Nevertheless, ferritin emerges as a simple biomarker related to prognosis. The study aimed to determine whether there was a significant correlation between serum ferritin levels and CTP score. Methods: The study analysed 54 decompensated liver cirrhotic patients including 17 females and 37 males between May 2016 and May 2017 at the Haji Adam Malik General Hospital, Medan, Indonesia. Ferritin levels were, then, divided into trichotomous cut-off value (< 200 ng/ mL, n = 22; 200–400 ng/mL, n = 5; and > 400 ng/mL, n = 27). Data was analysed using SPSS version 12.0 (continuous variables were assessed by the Kruskal-Wallis test and Chi-square test was used for categorical variables). In addition, Spearman correlation test was used to determine any significant correlation between ferritin levels and CTP score. Results: Based on data analysis, gender and CTP score were related to higher ferritin levels (P = 0.002 and P = 0.018, respectively). Furthermore, a significant correlation between serum ferritin levels and CTP score was obtained in to moderate degree (P = 0.000; r = 0.487). Conclusions: There might be a significant role of serum ferritin levels in predicting mortality and prognosis among decompensated liver cirrhosis patients but it still needs further attention.