Search

51 years old female, with invasive left breast cancer stage T3N0M0 developed syncope, hypotension, chest pain, and ST elevation in anterior leads on the next day following Left Mastectomy. The initial diagnosis of AMI revised to massive pulmonary embolism after tranthoracic enchocardiogram. However, IV (intravenous) Metalyse was given as thrombolysis therapy and the patient showed a good initial response. Subsequently, the patient developed massive bleeding from the surgical site. Bleeding was successfully controlled with total of 11 units packed cells, 4 units fresh frozen plasma, 4 units of platelet, and 6 units of cryoprecipitate as well as prothrombin complex concentrate. Local compression bandage and continuous surgical site drainage were applied in this case. Following successful control in bleeding unfractionated heparin infusion was given for 2days followed by low molecular weight heparin for 2days and discharged with a direct oral anticoagulant. On follow up visit, the patient made an excellent recovery and planned for further treatment for breast cancer. Thrombolysis therapy and anticoagulant therapy in post-operative patients with high-risk bleeding posses great challenges. Careful evaluation of bleeding versus clotting is the key to good outcomes.

Introduction: There is widespread use of herbal and dietary supplements worldwide among patients despite robust clinical evidence of its efficacy. This may lead to adverse effects, such as diabetes, hypertension, stroke, cardiovascular risk and kidney problems due to inappropriate self-prescription. This study was performed to determine the prevalence of herbal and dietary supplements usage among patients with chronic kidney disease and its association with the socio-demographic background and the conventional medication adherence. Materials and methods: A survey was conducted among 78 chronic kidney disease patients attending the Nephrology Clinic, Hospital Tengku Ampuan Afzan, Kuantan, Pahang. Data were collected using a questionnaire and analyzed using descriptive statistics, Chi Square Test and Fisher’s Exact Test. The p-value was set to be less 0.05 for its level of significance. Results: Most of the patients aged more than 50 years (89.7%), female (53.8%), unemployed (41%) and from lower socioeconomic earners (75.6%). Only 5.2% of respondents reported using herbal and dietary supplements. There was no association between socio-demographic background with the herbal and dietary supplements usage. Similarly, there was no association between herbal and dietary supplements usage and the conventional medication adherence. Conclusion: This study provides a good baseline on the usage of herbal and dietary supplements use among chronic disease patients. It can be concluded that the level of awareness among the patients is good. Nevertheless, a larger study shall be performed in the future to explore the pattern of association.

Introduction: There has been an increasing awareness on the end of life care for end stage renal disease (ESRD) patients and patients’ factors have been identified as pivotal elements in directing its implementation. Questionnaire has been a useful tool by researchers to assess on patients’ knowledge, perceptions and preferences on end of life care. However, up to date, there is no validated questionnaire developed in Malaysia for such purposes. Thus, this study aims to develop and validate questionnaires on end of life care knowledge, perceptions and preferences among ESRD patients in Kuantan. Materials and method: A cross-sectional study among haemodialysis (HD) patients aged 18 and above from 14 out-patient HD centres was performed. This study was divided into 4 phases i) developing the questionnaire involving related specialists and pre testing, ii) improving and editing the questionnaire and redistribution to 50 respondents for the pilot study, iii) factor analysis and iv) internal consistency reliability testing of the questionnaire. Results: The result of Factor analysis with Varimax rotation performed identified 3 domains for the 41 items, with 10 to 20 items in each domain. All the 41 analyzed items had a good factor loading of more than 0.4 with the lowest value of 0.421 and were nicely fit into 3 respective domains; knowledge, perception and preference. Internal consistency reliability analysis performed indicates that Cronbach’s α was between 0.5 to 0.7 for all factors which were higher than the level set for this study which is 0.5. Conclusion: The questionnaire is successfully validated and considered as a useful tool to be used. Nonetheless, improvement will still be necessary from time to time to ensure its relevance especially if it is to be used by different populations or countries of different background than Malaysia.

Persistent vegetative state (PVS) is a clinical condition of unawareness of self and environment with preserved sleep-wake cycles. Its clinical diagnosis can be a difficult unless a physician has adequate experience and expertise in evaluating neurological syndromes. Outcome is based on aetiology and age. Decisions on limiting life-sustaining treatment (LST) for these patients are emotionally and morally challenging. We present a case of a young boy who went into PVS following traumatic brain injury (TBI) with the aim to review some of the ethical issues regarding its management from Islamic perspective.