IIUM Medical Journal Malaysia (IMJM)
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Misplacement of the Nasogastric Tube into the Anterior Neck Potential Space
Get PDFNasogastric tube insertion is a very common procedure performed in intensive care settings which require a basic skill. In mechanically ventilated patients, the blind technique may lead to inadvertent placement of the tube into the lung even when the endotrachial cuff was inflated. The preferred technique is using a laryngoscopy for direct vision during the insertion. The gold standard of NGT placement confirmation in mechanically ventilated patient is with chest radiograph. Other clinical confirmation tests are not as reliable in intubated patients. A 44 year old lady came in with huge anaplastic carcinoma of the thyroid with compression symptoms. Otherwise, she had an unremarkable other medical problem. She underwent palliative debulking surgery to remove part of the tumor. The tumor was very aggressive, few days postoperatively it caused tracheal erosion with subcutaneous emphysema around the neck and upper chest. Urgent tracheostomy was done. Following this operation, NGT was reinserted. The nasogastric insertion was uneventful and the placement of the tube was confirmed by aspiration of gastric content and syringe test. Enteral feeding was resumed afterward. A few hours later the patient complained of neck pain and tense swelling developed on her neck and upper chest. Whitish secretion was noted to seep out around the tracheostomy wound. Enteral feeding was withheld and chest radiograph showed coiled NGT in the potential space of the anterior neck. The NGT was removed and surgical debridement was performed to evacuate the milk contamination. The case illustrates the importance of radiological confirmation of NGT placement in the ventilated patient
Sperm DNA Fragmentation Among Smokers and Non-Smokers as Measured by Sperm Chromatin Dispersion Test
Get PDFIntroduction: Traditionally, seminal fluid analysis is done to assess male infertility particularly sperm concentration, morphology and motility. Sperm chromatin dispersion test explores the quality of the sperm DNA structures. High sperm DNA fragmentation is associated with unexplained infertility, failure of assisted reproduction and recurrent miscarriages. Smoking has been associated with high sperm DNA fragmentation in some studies but not in others. Materials and Methods: A comparative cross-sectional study, involving 32 smokers and 32 non-smokers to determine the association between cigarette smoking and sperm DNA fragmentation. Semen samples were collected from patients undergoing seminal fluid analysis (SFA) at the IIUM Fertility Centre and IIUM Medical Centre O&G Clinic from January 2017 to June 2018. Sperm chromatin dispersion test was done and level of 15% is considered upper limit of normal. Results: 53.1% in the smoker group have abnormal level of sperm DNA fragmentation compared to 34.4% of nonsmokers. The median and interquartile range for smokers were 15.30 and 19.0 (10.425 - 29.375) respectively while for non-smokers were 8.25 and 17.8 (4.075 - 21.850) which was statistically significant (p= 0.012). It was also noted that three participants in the smoker group (9.4%) has very high sperm DNA fragmentation index of more than 80% even though they have normal seminal fluid analysis. Conclusion: There is an association between smoking and high sperm DNA fragmentation. There is a trend of increased in DNA fragmentation in smokers even though their SFA results were normal
The Effects of Paternal Perinatal Depressive and Anxiety Symptoms on Newborn Low Birth Weight
Get PDFIntroduction: Despite significant improvement in health status in Malaysia, the prevalence of low birth weight (LBW) in newborns remained unchanged over the past 12 years. In the past decade, there have been assumptions regarding the potential etiologic association of psychosocial factors with LBW. It is widely believed that only mothers are affected by depression and anxiety during pregnancy. However, this study aimed to investigate the independent effects of paternal antepartum depressive and anxiety symptoms on LBW newborns in Kuantan, Pahang. Materials and Methods: A prospective cohort study of 450 expectant fathers was carried out in six conveniently selected government health clinics in Kuantan, Pahang. Paternal antepartum depressive symptoms were assessed using Edinburgh Postpartum Depression Scale (EPDS) and anxiety symptoms using Depression Anxiety Stress Scale-21 (DASS-21) and they were followed-up until delivery. Newborn birth weight of singleton live babies delivered at term (≥37 weeks) were recorded to the nearest 0.1kg from Infant and Child Health Record. Descriptive analysis along with chi-square and independent sample t-test were carried out together with multiple logistic regression model to identify predictors of LBW. Results: After adjusting for potential cofounders, paternal depressive (OR=4.29; 95% CI 1.17-15.72) and paternal anxiety (OR= 4.62; 95% CI 1.74-12.26) symptoms were significantly associated with LBW (≤2.5kg). Conclusion: This study showed that paternal depressive and anxiety symptoms increased the risk of newborn LBW. Therefore, it is crucial to detect and manage the depressive and anxiety symptoms for expectant fathers during antenatal care to reduce the burden of LBW
A Study on the Reasons for Retirement: A Focus on Age as a Major Factor
Get PDFThis study was carried out to investigate the reasons that influence individuals to plan for retirement. A survey was conducted among employees of the International Islamic University Malaysia in Kuantan. Reasons to retire are almost similar across the globe, given that the basic needs of human beings are similar. There are many studies and literatures that investigate the factors that influence retirement which relates to the socio-economic factor such as retirement age, income, and gender. De Vaney identified that age and income are the important factors that act as a guide to pre-retirees in their retirement planning process.1 In this study, attaining the retired age is the main factor that relate to the individual’s planning for retirement. Other factors include household income, family and health. The findings of this study are parallel to the other research based on the analysis of the available literature review. Several implications emerge from these empirical findings. First, employees should prepare a proper retirement planning in their life and second, the authorities should provide better care and facilities to retirees
Ethical Responses to Modern Clinical Trials on Human Subjects: A Comparative Perspective
Get PDFWith the modern advances and technological breakthroughs in biomedicine, scientific experiments involving human subjects had increased. Since the American gynecologist Marion Sims (d.1883), who conducted a scientific research on some selected African women suffering from prolapsed uterus disease, or American physician Walter Reed’s (d.1902) team who gave germs of yellow fever to 22 human subjects to test if fever is transmitted by particularly mosquito species, as well as the Tuskegee Syphilis Study that was conducted from 1932 until 1972, or the scientific experiments conducted by Nazis of Germany on large numbers of prisoners, clinical trials on human subjects have become part of the scientific activities. These and many other scientific experiments conducted on human subjects had shown the extent of potential threats of unregulated scientific experiments on human life. Serious moral and legal concerns are then raised towards the morality of these activities. These concerns covered four major areas; safety, sanctity of the human body, consent and validity of experiment. This paper uses textual and analytical methods and aims to review Muslim jurists’ opinions on the permissibility of conducting clinical researches that uses human subjects. The opinions of the Muslim jurists are then compared to that of bioethical codes and declarations such as the Nuremberg Code, coined in (1947) and the Helsinki Declaration that was formulated by World Medical Organization in 1964. Fiqh and legal literature on this subject is exposed, and the moral contents of such writings are analyzed. The study is expected to come up with a comparative account of conventional and Islamic responses to modern clinical trials on human subjects
Spermatogonial Stem Cells Protein Marker Identification from in vitro Differentiation of NonObstructive Azoospermia (NOA) Testes Biopsies Cells: An approach In Line with Maqasid Shariah to Maintain the Heredity
Get PDFAzoospermia is present in 15% of infertile cases and it is a major concern due to inability to produce sperm. Most of IVF (in-vitro fertilization) clinics abroad has been using sperm donation via sperm bank facilities as a solution for infertile couple to have their own offspring. In Islam, it is forbidden to use sample from male other than their spouse. It is according to maqasid syari’ah to ensure the heredity of the human being. Based on the latest technology, one approach of stem cell differentiation process had been established to produce mature cells from primitive or immature cells (stem cells). This technology is in line with the concept of maqasid syari’ah since we are using the cells from one person. We try to adopt this technology to study the potential of testicular cells from non-obstructive azoospermic (NOA) patient to undergo in vitro spermatogenesis. Samples were cultured in modified human embryonic stem cells (HESC) media with specific growth factors; basic fibroblast growth factor (bFGF) and leukemia inhibitory factor (LIF). Protein expressions were analyzed by immunofluorescent staining on day 49 and 90 of culture. Results show spermatogonial stem cell-like cells (SSC-like cells) colonies formed after 14 to 21 days, the cells were expanding successfully and were stable for 49 days duration. Then SSCs differentiated into later stage of spermatogenesis on day 90. Four specifics SSCs protein markers were identified on day 49; ITGA1, ITGB1, CD9 and GFRA1 whereas SCP3 and TP1 proteins were expressed on day 90. This in vitro spermatogenesis suggests a possible approach for future for Muslim NOA patients in order to have their own children
A Pilot Survey on Knowledge,Attitude and Practice Towards the Islamisation of Knowledge As Perceived by the Staff of Kulliyyah of Allied Health Sciences, International Islamic University Malaysia
Get PDFThis preliminary study investigated the: (i) level of knowledge, attitude and practice (KAP) among members of Kulliyyah of Allied Health Sciences (KAHS), International Islamic University Malaysia (IIUM) regarding Islamisation of knowledge (IOK); (ii) correlation of KAP and IOK with the duration of service and level of exposure to IOK-related activities; (iii) comparison of KAP between departments in KAHS towards the understanding of IOK, and (iv) level of KAP in IOK between KAHS academics and non-academic staff. Since studies on the integration of religious worldview in health sciences faculties are scarce, this study will be investigating the effectiveness of IOK programmes at the faculty level. A total of 74 staff participated in the study. The response rate was 65.5% out of 113 distributed questionnaires. All respondents have average knowledge (50±28%) in IOK and showed positive attitude (78±32.5%) towards IOK. The knowledge of Islamisation in KAHS correlates positively with the duration of service (p<0.05) and the level of exposure to IOK-related activities (p<0.05). However, answers given to some questions indicated that the staff perceptions and knowledge of IOK are ambiguous and may suggest a misunderstanding of the Islamisation term. Furthermore, an average score was found among the academic respondents with regards to their integration of IOK into practice. These shortcomings may affect the integration and implementation of IOK either in classrooms, clinics or offices and lead to a poor integration of the Islamisation agenda to the students as well as the patients. Hence, there is a need to design workshops and programmes more towards practical approaches of IOK into health-based sciences as well as the implementation of IOK agenda at the workplace, rather than the theoretical aspects per se. In conclusion, most of the respondents have positive attitude towards the IOK movement in KAHS despite the high level of knowledge among some members, in particular the academic staff, is not yet translated into practice
Islamic Ethics of Waste Management towards Sustainable Environmental Health
Get PDFIslam is a religion that prescribes a way of life that goes beyond the rituals. It provides a holistic guide to human beings in almost every aspect of life in this world. However, the modernization and economic growth have taken the leads in the society governance and therefore tarnished some of the Muslim society’s perceptions on the holistic guidance of Islamic teachings. One of the consequences was readily displayed through attitudes and inefficient waste management practice of the majority of the Islamic country that lead to the environmental health problem. The paper discusses the existing waste management practice and positive roles of true Islamic understanding through the Qur’an and the Sunnah in terms of avoiding wasteful consumption and manners of cleanliness to resolve global environmental health problem caused by poor waste management
Islamic Perspectives of Reproductive and Maternal Health: What Role Can Nigerian Muslim Religious Leaders Play in the Prevention of Maternal Mortality? –With Particular Reference to Zamfara State NorthWest Nigeria
Get PDFReproductive and Maternal health are an important components of public health and medicine which are concerned with the complete state of physical, mental and social wellbeing in all matters regarding reproductive system and health of mother especially during pregnancy.It implies ensuring that all women receive the care they need to be safe and healthy throughout pregnancy, childbirth and beyond. However, according to World Health Organization, millions of women all over the world do not have access to good quality health services during pregnancy and childbirth resulting in mortalities. Islam is a complete way of life. The Qur’an and Hadith consider pregnancy and child bearing as signs among other signs of the divine existence of Allah.The importance of maternal and reproductive is thus not unexplained in the Islamic perspectives. The study look at what role Muslim religious leaders can play in the prevention of maternal deaths and morbidities in developing countries. A qualitative study was conducted through in-depth interviews and focus groups discussion with a purposive sample of some Muslim religious leaders from Gusau local government area of Zamfara state northwest Nigeria in order to elicit information about the Islamic perspectives of reproductive and maternal health and the roles they can play in the prevention of maternal deaths among the Muslim communities. Muslim Religious leaders have a crucial role and contribution for the attainment and maintenance of good heath of women and children among Muslim communities through public enlightenment in the context of ‘ilm’, providing guidance through ‘Fatwah’ and community mobilization in the spirit brotherhood ‘ukhuwah. Islam does not accept the “preventable death of a woman” due to childbirth or pregnancy. Thus, Islam encourages attendance of antenatal care visits and health care seeking
The Essential Dimensions of Health According to the Maqasid al-Shariʿah Frameworks of Abu Ishaq al-Shatibi and Jamal-al-Din-ʿAtiyah
Get PDFContemporary Muslim thinkers have shown increasing interest in the higher objectives of Islamic law, maqaṣid al-shariah for reasons of utility and flexibility. Inductively derived from scriptural source-texts and the inherited legal canon, the maqasd have proven to be useful in interfaith dialogue and in addressing modern contexts because they are rationally accessible and can incorporate knowledge coming from the natural and social sciences as well as the humanities. In this paper, I examine the maqasid for applicability to the healthcare context. Specifically, I will describe the maqaṣid formulae of Islamic scholars Abu Ishaq al-Shatibi and Jamal-al-Din-ʿAṭiyah (Gamal Eldin Attia) and use them to generate theoretical models of the essential dimensions of human health. During my analyses of these authors’ frameworks, I will examine their views on how the maqaṣid are discovered, and on focus on their discussions regarding the preservation of human life and intellect. I will also compare the relative relevance of their models to modern biomedicine in terms of their “openness” to data coming from the health sciences and in light of contemporary knowledge about the determinants of health