Challenges of status epilepticus management in a resource-limited setting: A review.

Status epilepticus (SE) is a life-threatening neurological condition with significant mortality. Rapid management is essential to minimize the mortality and disability of SE. Two recent trials provided evidence to guide SE management in early and established stages. The Rapid Anticonvulsant Medication Prior To Arrival Trial (RAMPART, 2011) showed that intramuscular midazolam is a better alternative for early convulsive SE in prehospital settings. The Established Status Epilepticus Treatment Trial (ESETT, 2020) supported the use of sodium valproate and levetiracetam as second-line treatment for its efficacy and shorter administration time. However, there are challenges to revising the status epilepticus management in resource-limited settings, in pre-hospital, first- and second-line treatment, as well as management of refractory and super-refractory SE. These challenges included restrictions or lack of training in the administration of benzodiazepine in the prehospital setting, limited availability and accessibility of newer antiseizure medications (ASMs) in emergency departments and smaller hospitals, and low clinicians' awareness of the latest evidence. A collaborative effort to educate, improve awareness, and make certain ASMs more readily available is recommended to achieve a better clinical outcome in SE.

A Case of Cobra Bite Complicated with Basilar Artery Occlusion.

Snakebite is one of the most common complaints related to wilderness medicine. Venomous snakebite manifestation is divided into local and systemic envenomation. For the Elapidae group, the most feared complication is respiratory muscle paralysis due to neurotransmitter malfunction at the neuromuscular junction level which leads to respiratory insufficiency. However, there is a lack of evidence or case report incidence to suggest that it can potentially associate with the development of stroke disorder. We present a rare case of massive posterior circulation infarct in a middle-aged gentleman following a cobra bite. He was brought to our center few hours later following the bite and antivenom was administered. He improved shortly after receiving it. However, he had an abrupt drop in his conscious level several hours later. Noncontrast-enhanced computed tomography (NCCT) brain was performed immediately, but stroke disorder was excluded prematurely. Repeated NCCT imaging which was done 12 h apart showed massive posterior circulation infarction with hydrocephalus. He succumbed to death 3 days later. Given its rarity, the evolution of his clinical condition warrants clinician's early suspicion of potential stroke-related complications that can occur following a cobra bite.

Prevalence and associated factors of stress, anxiety and depression among emergency medical officers in Malaysian hospitals.

BACKGROUND: Demanding profession has been associated with poor psychological health due to multiple factors such as overworking hours and night shifts. This study is to determine prevalence and associated factors of depression, anxiety and stress among medical officers working at emergency department in Malaysian hospitals. METHODS: A cross-sectional study was conducted on 140 emergency department medical officers working at general hospitals from seven Malaysia regions. They were randomly selected and their depression, anxiety and stress level were measured by the 21-item Depression, Anxiety, Stress Scale. RESULTS: The highest prevalence was anxiety (28.6%) followed by depression (10.7%) and stress (7.9%). Depression, anxiety and stress between seven hospitals were not significantly different (P>0.05). Male medical officers significantly experienced more anxiety symptoms than female medical officers (P=0.0022), however depression and stress symptoms between male and female medical officers were not significantly different (P>0.05). Depression, anxiety and stress were not associated with age, working experience, ethnicity, marital status, number of shifts and type of system adopted in different hospitals (P>0.05). CONCLUSION: The prevalence of anxiety was high, whereas for depression and stress were considerably low. Gender was the only factor significantly associated with anxiety. Other factors were not associated with depression, anxiety and stress. Future research should aim to gain better understanding on unique factors that affect female and male medical officers' anxiety level in emergency setting, thus guide authorities to chart strategic plans to remedy this condition.