IIUM Medical Journal Malaysia (IMJM)
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Ethical Justification in Medical Futility and Advanced Medical Directive from The Islamic Perspective
Get PDFIntroduction: Medical futility and advanced medical directive are related issues in end-of-life medical decisions that present challenge to doctors and patients in terminal condition and to doctors and family members of patients who are critically ill in the ICU. Materials and Methods: A qualitative study comprises of literature search and an in-depth interview of experts was carried out to determine the clinical situations in medical futility and the ethical considerations from the Islamic perspective that justify forgoing medical treatment and also the practice of advanced medical directives in the country. Results: In such scenarios, clinical data must be interpreted alongside patient values, as well as the physicians’ ethical commitments. From the Islamic perspective, doctors are the authorised person to diagnose medical futility and forgo medical treatment. Forgoing treatment is permissible as long as it conforms to the maqasid and qawaid al-shariah principles that guide the decision-making process. The practice of advanced medical directive is still at its infancy in this country. From the Islamic perspective, upon considering the maqasid and qawaid al-shariah principles, it should be permissible and its practice should be encouraged as it assists the doctors and the surrogate decision-maker to decide to the withdrawal of treatment. Conclusion: Ethical justification on medical futility conforms to the maqasid and qawaid al-shariah principles and forgoing medical treatment is permissible in Islam. Advanced medical directive assists in the decision-making of forgoing treatment in the presence of utility and thus its practice should be promoted
The Correlation of Surgical Margins and Outcome Of Soft Tissue Sarcomas of The Extremities and Trunk in Hospital Sultan Ismail, Johor Bahru
Get PDFIntroduction: Patients with soft tissue sarcoma are treated following the standardized guidelines, however it is not guaranteed patient will remain free from local recurrence (LR) and metastasis. This study was conducted to determine the association between microscopic marginal status with local recurrence, metastasis and the survival of the patient. Materials and Methods: This retrospective study was conducted from January 2015 to December 2017 in Hospital Sultan Ismail, Johor Bahru. All patients underwent complete standadized resection of the tumour and had been follow up for 5 years. An operating and follow-up records of 70 cases who fulfill the inclusion and exclusion criteria were collected and analysed using Pearson chi square test and Kaplan-Meier curves. Results: Of the 70 patients, 52 were males and 18 were females. The age of the patients were between 16 and 73 years with the means age of 48.8 years old. Sixty eight patients underwent limb salvage surgery and 2 had amputation. 42 of them had positive post-operative microscopic surgical margin (PMSM) while 28 were negative. Local recurrence was noted in 28 and metastasis in 30 patients. Patient who had PMSM has higher risk to get local recurrence and metastasis compared to patient with negative margin (p-value <0.001). The overall median survival was 23 months. Overall survival rates for 3 years was 80% and for 5 years was 65%. Conclusion: In our study, patient with positive post-operative microscopic surgical margin had higher possibility to develop local recurrence, metastases and decrease overall survival rate
The Effects of Aquilaria Malaccensis Leaves Aqueous Extract on The Sperm of Sprague Dawley Rats Towards Early Embryogenesis
Get PDFIntroduction: Oxidative stress induced by excessive and unopposed levels of reactive oxygen species in male reproductive system results in impaired sperm quality, fertilization capacity and poor embryo development. Our goal is to assess the potential effects of Aquilaria malaccensis (AM) leaves, a plant with strong antioxidant property on early embryo development in vitro and embryo quality following fertilization with cyclophosphamide (CP) exposed rat sperm. Materials and Methods: Forty eight male Sprague Dawley rats were allocated into eight groups of six rats (n = 6): control, CP only (200 mg/kg), AM only (100 mg/kg, 300 mg/kg and 500 mg/kg) and CP + AM (100 mg/kg, 300 mg/kg and 500 mg/kg). Animals were sacrificed after 63 days of treatment and sperm from caudal epididymis were taken for in vitro fertilization (IVF) with oocytes from untreated female. Fertilization, embryo division and embryo morphology were examined after 24 hours post fertilization and compared between groups. Statistical evaluations were performed using Chi-Square test and Fisher’s exact test and pvalue < 0.05 was considered significant. Results: Co-administration of AM leaves extract at dose 100 mg/kg/day to CP-treated group has significantly increased (p < 0.05) the fertilization rate, early cleavage rate and embryo quality compared to CP only treated group. Conclusion: Overall, the present results indicate the potential of AM leaves extract supplementation to improve the fertility and early embryo development in male rat exposed to CP by inhibiting the oxidative processes and scavenging free radicals
Tumor Necrosis Factor-Related Apoptosis Inducing Ligand Stimulates Migration And Proliferation Of Vascular Smooth Muscle Cells
Get PDFIntroduction: Tumor Necrosis Factor-Related Apoptosis (TRAIL) has the ability to inhibit angiogenesis through programmed cell death, in the same time able to promote pro-angiogenic activity. It seems that TRAIL has an opposite effects make its role in ischemic disease and its function in a normal cell is still unclear. This study determines the effect of TRAIL in Vascular Smooth Muscle Cells (VSMCs). Materials and Methods: In this study, 6 wells in vitro Scratch Assay were conducted for migration and Cellltiter 96® Aqueous One Solution Cell Proliferation Assay (MTS) was performed for proliferation. In both assays, cells were serum arrested for 24, 48 and 72 hours, following stimulation with different concentration (1ng/ml, 20ng/ml, 50ng/ml and 100ng/ml) and different volume (20µL and 100µL) of TRAIL. PDGF-BB was used as positive control. Results of PDGFBB and TRAIL were compared with untreated VSMC. Results: It Is demonstrated that 100µL of 50ng/ml TRAIL-induced VSMC shows significant (p < 0.05) higher migration rate percentage compared to untreated cells, included 100µL of 20ng/ml PDGF-BB after 48 hours. However, in proliferation assay, the lowest concentration of TRAIL (1ng/ml, 20µL) shows significantly higher proliferation rate compared to untreated cells after 24 hours (p < 0.05) meanwhile PDGF-BB (1ng/ml, 20µL) indicates significant higher proliferation after 48 hours. Conclusion: This study demonstrates that TRAIL promotes the VSMC migration and proliferation in vitro. This indicates that migration and proliferation of VSMC upon vascular injury from media to intima not only involves PDGF-BB, but also TRAIL. Therefore, TRAIL contributes to intimal thickening that can lead to the obstruction of the blood vessels and it is a hallmark of atherosclerosis
Islamic Moral Judgement on Resuscitation Issue: Nursing Perspective
Get PDFThe primary goals of resuscitation are to preserve life, restore health, relieve suffering and limit disability. As nurses, executing the cardiopulmonary resuscitation (CPR) to a patient experiencing cardio-pulmonary arrest is essential in preserving life. However nurses face a dilemma in the decision making to either preserve the patient’s life or let the patient die naturally, if the patient’s autonomy as well as his family’s wish for a “do not resuscitate (DNR)” order. In this dilemma, the sanctity of life and the right to die is the main concern of this discussion. Islamic moral judgment, as the major concern here, should be studied as an alternative to analyse and provide a guideline that is in accordance with the Islamic teaching. Thus, this research is to provide the Islamic moral judgment on the resuscitation issue and its implication in nursing practices. The western ethics that represent the current practices on resuscitation is not included. The comparison was then made with the ultimate origin of Islamic teaching ie the Qur’an and Sunnah, as well as the notions of Muslim scholars on the subject. As the physician opines that CPR is to be beneficial to rescue a life, therefore refusing it may be considered as immoral. However, the DNR order is entirely acceptable if the doctor believes that CPR is futile and gives no benefit to the patient. The doctor has the authority to issue a DNR order if he is certain that the patient would not benefit from CPR without getting consent from the patient or his relative. Nursing implications: As nurses facilitate patients and family members in forming a decision about end of life hence engaging a comprehensive view of DNR based on Islamic teaching would provide an informed choice when advising a Muslim patient and family. The area to investigate would be on the degree of knowledge among nurses regarding the Islamic moral judgement on this matter is highly recommended for future management
Islamic Perspective on Importance of Breastfeeding: Two Case Reports
Get PDFBreast milk contains all basic nutrition needed by a child. Exclusive breastfeeding is recommended to all infants in their first 6 months of life. Infants who had been exclusively breastfed have a better health status compared to infants who were introduced with mixed feeding in their early life. Exclusive breastfeeding not only gives benefits to the child, but also to the mother. In infants it offers protective mechanism in lowering risk of gastrointestinal infection and promotes bonding between the mother and the child. The first case was a 2 years and 7 months old girl who was admitted to Hospital Tengku Ampuan Afzan Kuantan due to acute gastroenteritis with some dehydration. She had been admitted a month earlier due to pneumonia. She was breast fed exclusively for 3 months after she was born. Formula feeding was started after she turned 4 months old.. The second case was a 1 year and 4 months old boy who was hospitalized due to acute bronchiolitis. He was not breast fed due to no milk production. Islam views childhood as a critical phase in molding an individual. Parents have been entrusted by Allah to observe and fulfill the rights of the children in providing a conducive environment for them to develop and grow. A good healthcare and proper nutrition are among the child’s rights that need to be filled by the parents. Islam emphasizes the importance of breastfeeding up to 2 years old as a way in providing good nutrition. Islam also provides solution for mothers who are unable to breastfed their child by adopting wet mother. Parents are responsible in providing good health and nutrition for their children. Breastfeeding is also highly encouraged by Islam because it provides medical benefits for both mother and children
Allah’s Wondrous Creatures, the Holy Qur’an and Technological Inventions: Ultrasound Imaging
Get PDFAllah (s.w.t) has created innumerable distinct creatures and mentioned to us about their special qualities through His revelation. The Qur’an is the ultimate source of guidance for its followers for all aspects of life including science. If one is to study nature scientifically there are countless observable facts that are parallel to the teachings of Islam. One of these facts is echolocation found in bats and dolphins. These animals generate ultrasonic signals and detect the echoes reflected back to them to map out their environment and catch prey. Modern health sciences have already adopted this phenomenon in the form of ultrasound imaging for diagnosis of certain diseases. However, there is room for improvement in the overall performance of this technique. This article highlights the technological developments directly inspired by nature i.e., crawfish/crayfish and relates echolocation characteristics of bats and dolphins with basic principles of ultrasound imaging. In-depth studies on the echolocation properties of these creatures can lead to further improvement in the current ultrasound imaging technique. Such as; the construction of a transducer which simultaneously generates multi-frequency ultrasound signals and development of new interpreting software. Moreover, reading verses of the Holy Qur’an heartily and enthusiastically will lead to the development of innovative ideas that can be translated into reality and applied for the betterment of humankind
Assessment of Prophetic Foods Consumption among Lactating Mothers: Combining Quantitative & Qualitative Approaches
Get PDFIntroduction: The phrase ‘Prophetic food and medicine’ reflects the words and actions of the Holy Prophet Muhammad (PBUH) with the bearing of disease, treatment of disease, and care of patients. Among plants mentioned in the Al-Quran, Al-Hadith and Islamic literature are dates, pomegranates, figs, olive and black cumin seeds. These plants are widely used for medicinal purposes, as functional foods and industrial products. However, there are limited studies found regarding their effect on human milk quality and quantity. Thus, this paper aims to describe the methodology to assess knowledge, attitude, and practice of prophetic foods consumption among lactating mothers in Kuantan, Pahang. Methodology: Pregnant Malay mothers aged 18 to 40 years old, at a gestational duration of ≥ 32 weeks, are recruited. During the lactation period, their dietary intake (specifically the consumption of prophetic foods) are assessed using a quantitative method which is food frequency questionnaire. A subsample of these mothers is then interviewed using semi-structured interview method on the prophetic food consumption. Quantitative and qualitative data are analysed using SPSS and NVivo software, respectively. Result: Reports of positive effects of prophetic food consumption on lactation experience namely improving human milk production is anticipated from this study. In addition, it will provide a foundation for further exploration of the role of prophetic food consumption in the lactation process. Conclusion: This research is at the forefront to provide the data on potential practice and application of prophetic foods in positively influencing lactation experience and quality of human milk
Inculcating Halal Values in Seaweed Production for Competitive Positioning
Get PDFSeaweed industry is important in several countries including Malaysia, Japan, Indonesia, and the Philippines. The seaweed, Kappaphycus is widely used in a variety of food products as an excellent nutritional supplement. There are several stages in producing raw Kappaphycus for industry such as cultivation and harvest. Most of these steps follow a traditional way which has been practiced from one generation to another. As seaweed is part of the main ingredients in many final produce, its processing must incorporate cleanliness and quality aspect. Therefore, a focus on Halal is of utmost importance. Halal is a concept that stresses on shariah law and ensuring the utmost quality which benefits most producers especially in food and supplement products. However, the knowledge of Halal is still limited in marine production including seaweed. The seaweed process has gone through numerous stages yet none of them has been checked on its Halalness aspect. This study is to deliberate on the aspect of Halalness for each stage involved, including cultivation and harvesting. To achieve this, observations and literature search were performed and findings showed that there is lack of hygienic practices in handling seaweed production. Therefore, conjoint initiatives among university-industry-government are needed to enhance the value proposition of the seaweed production as it complies with the concept of Halalness. This will contribute towards the development of Halal ecosystem from seed to harvest of quality seaweed production
Reliability and Construct Validity of Knowledge, Attitude, and Practice of Medical Doctors on Smoking Cessation Guidelines
Get PDFIntroduction: Islam forbids any forms of tobacco smoking. Prevalence of active smokers in Malaysia is increasing despite availability of stop-smoking clinics. Thus, the practice of healthcare professionals involved in providing smoking cessation intervention needs to be assessed using validated assessment tool. Objective: This study aimed to develop and validate a questionnaire that assesses the knowledge, attitude, and practice of medical doctors based on the national smoking cessation guideline. In addition, we aimed to evaluate factors that contribute to the score. Methods: The 26 items consists of mixture of true/false choice questions and Likert scaling response based on domain of 5A’s (ask, assess, advice, assist, arrange) and 5R’s (relevant, risks, rewards, roadblocks, repetitions) of the national stop-smoking guideline. The questionnaire was distributed to 141 medical doctors. Reliability was determined using Cronbach’s alpha for internal consistency while construct validity was assessed using factor analysis. Results: A high degree of internal consistency was observed for this 26 items (Cronbach’s alpha= 0.824) and for practice subscale (Cronbach’s alpha 0.83). Subsequently, three items were removed due to poor inter item correlation. Factor analysis extracted seven meaningful components from this remaining 23 items, in which three components with least items were deleted due to overlapping subscale with other components, leaving four meaningful components which consist of (1) practice of ask, advice and assess components and practice of 5R’s (total of 10 items); (2) practice of assist components for those willing to quit (two items); (3) knowledge (two items) and (4) attitude (three items).These final 17 items still demonstrate high internal consistency with Cronbach’s alpha of 0.832. Conclusion: This study indicates that this questionnaire is a reliable and valid tool to assess the knowledge, attitude, and practice of healthcare professionals on stop smoking guidelines