IIUM Medical Journal Malaysia (IMJM)
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Deteriorating Patients and Risk Assessment among Nurses and Junior Doctors: A Review
Get PDFThe presence of nurses and junior doctors in the ward environment are crucial, especially in detecting deteriorating patients. However, there is consistent evidence that warning signs may not always be identified or acted upon. This paper aimed to analyse the incidence of deteriorating patients, and the concept of risk assessment of these patients by nurses and junior doctors in general ward, through a review on relevant literature. An extensive literature search was conducted through online research databases, i.e. CINAHL, MEDLINE (Ovid), Science Direct and ProQuest. Professional journals were hand searched for relevant literature based on reference lists and citations made in key publications, and attempts were also made to obtain any relevant grey literature (unpublished materials). A total of eleven papers which focused on patient’s assessment, response to deteriorating patients and knowledge in medication, and a guideline were reviewed. Most of the studies were carried out in the United Kingdom (n=4), followed by Australia (n=2), Sweden (n=2), the Netherlands (n=1) and Taiwan (n=1). Meanwhile, among these studies, the chosen research designs include, qualitative (n=6), quantitative (n=3) and systematic review (n=1). This review concluded that nurses and junior doctors in general ward have a lack of knowledge in risk assessment of deteriorating patients
Bone and Joint Reconstruction Using Ilizarov Circular External Fixation Device
Get PDFIntroduction: Ilizarov circular external fixation device is a versatile external fixation device which can be used for bone and joint reconstruction such as fracture fixation, bone transport, lengthening, shortening, and correction of deformity and contracture. It is a complex procedure and requires patients understanding, motivation, pin site care and rehabilitation to ensure successful treatment and avoiding complication. The aim of this study was to review cases of bone and joint reconstruction using Ilizarov external fixation device. Materials and Methods: From 2006 till 2018, 59 patients with the mean age of 34.8 (10-69) years old underwent these procedures. There were 49 tibias, three femurs, one humerus, three elbows, two knees and one ankle reconstruction. 18 open fractures, 16 non- union, seven tibial plateau fractures, 10 implant related infections, one valgus mal-union and one shortening. There were also 4 dislocations and two flexion contracture. The procedure that were done include 31 bone transport, 18 fracture fixation, three joint reduction, two correction of flexion contracture, two shortening of tibia and one each for lengthening, deformity correction and arthrodesis. Results: Forty seven (80%) patients achieved the objective of operation: 41 fractures united, three joints were reduced, two achieved knee extension and one deformity corrected. Five developed non-union, of which two not compliant to treatment, two had failed bone transport and one died during the treatment due to medical problem not related to the Ilizarov fixation. Conclusion: Ilizarov circular external fixation is an effective device for joint and bone reconstruction in majority of patients
Comparison between High Frequency and Low Frequency Portable Transcutaneous Electrical Nerve Stimulation in Patients with Knee Osteoarthritis: A prospective Randomized Study
Get PDFIntroduction: Knee osteoarthritis has been an increasing problem in the society causing significant morbidity. The current trend of medical treatment is moving from pharmacological to non pharmacological methods of treatment thereby reducing the side effect and the cost burden of the pharmacological means. TENS therapy has been studied in the past to treat pain knee osteoarthritis related pain, however that is a mix report on its success. After careful understanding and various literature review on the mechanism of TENS therapy, the author narrowed down the success of the therapy may be frequency related (inappropriate frequency used). Materials and Methods: The first 100 patient who attended the outpatient department diagnosed with knee osteoarthritis (based on Kellgren and Lawrence grade 2-4) who willingly consented, were selected and randomly allocated to two arms (high- frequency and Low- frequency). A baseline score was taken based on the Oxford knee score, WOMAC, Lesquene index and Visual Analog Score. They were followed up on the 1 st and 3rd month for assessment. Results: There was a significant improvement in the activities of daily living in the high frequency group (p0.95). However, both groups showed significant improvement in the Visual Analog score with no statistical difference. Conclusion: TENS therapy is a good non-pharmacological alternative to treat knee osteoarthritis, provided the right method and frequency is used
Inadvertent Puncture Of Right Vertebral Artery During Central Venous Line Catheter Insertion
Get PDFThe use of ultrasound has been proposed to reduce the number of complications and to increase the safety and quality of central venous catheter (CVC) placement. In this report, we recommend the structures approach for US-guided to insert venous access for clinical practice. To achieve the best skill for CVC placement, the knowledge from anatomic landmark techniques and knowledge from US-guided CVC placement need to be combined and integrated. 59 years old lady, planned for total abdominal hysterectomy for pelvic tumour excision. Anticipate massive bleeding with major fluids shift during intraoperative, invasive monitoring with CVC was inserted preoperative at right internal jugular vein. The procedure of insertion was done using US-guided with out-of-plane method. While connected to CVP monitoring noted to have arterial wave. Decided to keep the central venous line in-situ and referral to radiologist for imaging was arranged. CT angiogram's findings of a catheter were seen to transverse the right internal jugular vein through-and-through and seen to lie within the right vertebral artery coursing into the right subclavian artery. No evidence of carotid artery injury. Referred to intervention radiology and vascular surgery team for the best method of removal the central line catheter. Removal of CVC for inadvertent injury to right verterbral artery under guided contrast study by intervention radiologist. The case illustrates the importance of ultrasound-guided CVL insertion
Knowledge, Attitude and Practice on Smoking Cessation Guideline among Medical Doctors attending Family Medicine Scientific Conference 2016
Get PDFIntroduction: Prevalence of active smokers in Malaysia remains high despite the availability of stop-smoking services. Rather than focussing on patients’ demotivating factors, possible poor performance from providers should be evaluated. Thus, knowledge, attitude and practice of the healthcare professional on smoking cessation intervention needs to be assessed, especially among primary care doctors. Materials and Methods: A cross-sectional study was conducted among primary care medical doctors attending the 19th Family Medicine Scientific Conference 2016 held at the Grand Dorsett, Subang on the 10th to the 13th August 2016. Validated questionnaire of Knowledge, Attitude and Practice (KAP) of Medical Doctors on Smoking Cessation Guidelines consisting 17 questions were used to determine the KAP score. The difference between the median KAP scores between age, gender, ethnicity, religion, profession, location of clinic, availability of specialist in clinic, numbers of smokers seen and presence of smoking cessation training were assessed using Mann-Whitney U Test and Kruskal Wallis H Test. Results: A total of 145 primary care doctors involved in the study. Majority were female (84.1%), Malay (73.1%) and haven’t undergone any kind of smoking cessation training (47.6%). The KAP score were statistically associated with presence of specialist, type of profession, history of attending training program, ethnicity and religion (p<0.05). Conclusion: Majority of the involved primary care doctors had low KAP score. Being a family medicine specialist, in charge of stop smoking clinic and having attended smoking cessation training program were significantly associated with high KAP score. Therefore, more smoking cessation training should be provided to the primary care doctors
Normal Saccadic Responses Using Video Head Impulse Test In Healthy Young Adults
Get PDFIntroduction: Vertigo and dizziness are common symptoms reported in audiology and ENT clinics. One of the objective assessments includes the video head impulse test (vHIT) where gain & amp; velocity responses of eye movements relative to the head movements are recorded using an infrared camera. Materials and Methods: Thirty normal hearing subjects age between 18 to 25 years old participated in this study. Exclusion factors include those with the history of head or neck injury and vertigo. At least ten lateral, left anterior right posterior (LARP), and right anterior left posterior (RALP) responses were recorded for each participant by making small unpredictable head movements. Results: The average velocity gain for lateral responses at 40 ms, 60 ms and 80 ms were 1.05 ± 0.003, 1.03 ± 0.002 and 1.01 ± 0.003 respectively. The LARP and RALP average velocity regression were 1.01 ± 0.24 for left anterior and 1.05 ± 0.25 for right posterior, 1.08±0.31 for right anterior and 1.12 ± 0.30 for left posterior. One sample T-test was conducted to compare lateral responses to a previous study by Mossman et al. 2015. There were significant differences in velocity gain at 60 ms and 80 ms where, t (59) = 5.56, p < 0.01 and t (59) = 2.86, p < 0.01, respectively. Conclusion: This indicates the importance of establishing norms for clinics as various factors could affect the results such as techniques used and equipment differences. A follow-up study on subjects with vestibular disorders is required to validate this data as a normative reference
Periodic Assessment Of Antenatal And Post Natal Serum Endothelin1 and Nitric Oxide Levels In Hypertensive Disorders Of Pregnancy
Get PDFIntroduction: Hypertensive Disorder of Pregnancy (HDP) is an independent risk factor of cardiovascular (CVS) disease with persistent endothelial dysfunction, that occurs after the initial insult during pregnancy and persists post partum postulated to be the pathophysiology. Endothelin-1 (ET-1), a potent vasoconstrictor, has been identified as a pivotal mediator in both essential hypertension and HDP. Disturbances in Nitric Oxide (NO) bioavailability found in endothelial dysfunction may increase susceptibility to cardiovascular diseases such as hypertension. Materials and Methods: Thirty six pregnant women at 30-36 weeks period of gestation from the following categories (i) pregnancy induced hypertension (PIH) (ii) chronic hypertension during pregnancy (CH) and (iii) normal pregnant women (Control). Blood pressure indices measurements and sample collection was done at antepartum (30-36 weeks), post partum (8 weeks and 12 weeks). Endothelin-1 was measured using the Human ET-1 (Endothelin-1) ELISA Kit and serum NO was measured using the Nitric Oxide (total) detection kit. Results: All blood pressure indices were significantly higher in HDP patients compared to control during antenatal and post partum periods. Serum ET-1 was significantly higher in patients with HDP compared to control during antenatal until 3 months post partum. This was accompanied by significantly lower levels of serum NO in HDP patients. Conclusion: ET-1 levels in patients with history of HDP irrespective of post partum blood pressure contributes to persistent endothelial dysfunction
The Effects of Tamarindus Indica Seed Extract On Mice Kidney, Liver and Skin Following Envenomation with Daboai Russelli And Naja Kaouthia
Get PDFIntroduction: Tamarindus indica seed extract (TSE) has anti-snake-venom properties. This study examined the histological changes of kidney, liver and skin of mice envenomed with either Daboai russelli and Naja kaouthia and treated with TSE. Materials and Methods: ICR mice were used. Group 1 mice (n=8) were given subcutaneous (SC) venom only of either species. Group 2 (n=8) envenomed mice were treated with SC TSE 30mg/20g at the same site 30 minutes after envenomation with either species. Tissue samples were harvested at 24 hours and 1 week. Transversely cut kidney, biggest liver lobe, and skin sample from the venom injection site were fixed in 10% formal-saline and stained with Haematoxylin-Eosin for light-microscopy analysis. Results: Group 1 mice exposed to D.russelli venom, all died within 48hours. Hence, no comparison was made between Groups 1 and 2 at 1 week. However histological comparison was made within Group 2 at 24 hours and 1 week. Kidney histological changes of envenomed mice showed mild nephropathy; liver showed inflammation and mild liver injury. Skin samples showed disruption of the skin architecture. These changes, worsened after 1 week. However, changes in the skin were unaltered after 1 week for N.kaouthia. When TSE 30mg/20g was administered, there was restoration of tissue architecture in mice envenomed with either species. Conclusion: When mice were exposed to LD100 of either snake venoms, histological changes took place within 24 hours. This study showed that TSE 30mg/20g was able to restore tissue architecture within 24 hours
The Quality of Life and Functional Outcome of Hindfoot Reconstructive Surgery in Charcot Foot
Get PDFIntroduction: Charcot foot problem is devastating and a difficult condition to treat. There are limited data and study regarding the quality of life and functional outcome of Charcot foot being treated surgically. This study evaluates the outcome of Charcot foot treated with reconstructive surgery. Materials and Methods: This is a cross-sectional study that compares the quality of life and functional outcome of patient with Charcot foot pre and post tibio-talar-calcaneal (TTC) arthrodesis surgery at Hospital Tengku Ampuan Afzan and International Islamic University Malaysia Medical Centre between 2016 and 2018. Patients were evaluate using SF-36 scores and AOFAS scores pre and post-operative at average of 6 months (range between 3 to 9 months). Results: Thirty patients had undergone reconstructive foot and ankle surgery using hindfoot arthrodesis nail (HAN) for TTC arthrodesis. The outcome was assessed using paired t-test comparing pre and postoperative for both SF-36 and AOFAS scores. The SF-36 components had significant improvement with a mean of 35 to 45.6 for physical component (PCS) and 46.6 to 52.5 for mental component (MCS) (p<0.0001). The overall AOFAS score had significant improvement from average of 36 to 57.8 out of 100 (p<0.0001). Pain component of AOFAS shows lower score of improvement. Two patients had suffered ulceration post operatively that requires multiple debridement and exostectomy with one patient requires removal of HAN eventually. Conclusions: Tibio-talo-calcaneal arthrodesis using HAN surgery improves the quality of life and functional outcome of Charcot foot
Compilation of Quranic Verses Related To Visual Function
Get PDFIslam provides a comprehensive way of life where the revelations bestowed by Allah from the Quran and Hadith cover all aspects that leads to a well-balanced life. This study compiles all the Quranic verses related to visual functions which may serve as a reference for Muslims as well as non-Muslim primary eye care practitioners during their patients’ treatment and consultation. A website named “Search Truth” on http://www.searchtruth.com/was used as a tool to identify the Quranic verses related to visual function by typing in the keywords “eye/eyes”, “see”, “light”, “sight” and “vision” in the search boxes provided in the website. The program embedded in the website then listed the Quranic verses based on their English translation containing the respective keywords. The listed Quranic verses and their translations were verified manually using the Holy Quran Tafseer. The frequency of Quranic verses for each chosen keyword was determined. There were 34 Quranic verses related to visual function and could be explained scientifically. The frequency of Quranic verses related to visual function under the classification of “eye/eyes”, “light”, “see”, “sight” and “vision” were 15, 8, 3, 7 and 1 respectively. The fundamentals of visual functions may be explained scientifically based on the Quranic verses