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Background: Phenylephrine (PE) is one of the vasopressor used to treat hypotension during anaesthesia. The primary aim of this study was to compare the effect of prophylactic infusion and rescue bolus of PE on the haemodynamic changes during spinal anaesthesia (SA) for Caesarean section (CS) in obese parturients. Methods: A total of 74 obese parturients scheduled for elective CS under SA were randomised into two groups; Group A (n = 37) received prophylactic PE infusion starting at 50 μg min-1 and adjusted according to the given algorithm and Group B (n = 37) received 100 μg PE bolus to treat hypotension. The measured parameters were systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), the total requirement of PE and neonatal Apgar score. Results: Six patients were excluded from the analysis due to missing data and only 68 were analysed. Group A showed significantly higher SBP, DBP and MAP than Group B (P < 0.05). The requirement of PE was higher in Group A than Group B [817.7 (265.7) µg versus 360.6 (156.0) µg; P = < 0.05]. Both groups had no difference in terms of the neonatal Apgar score. Conclusion: Prophylactic PE infusion provided better haemodynamic control than therapeutic boluses in obese parturients undergoing CS under SA. [ABSTRACT FROM AUTHOR]

This study aimed to compare the antinociceptive and antioxidative effects of Tualang honey and Vitamin C in formalininduced pain in the rat. About 24 Sprague Dawley male rats were randomized into three groups and each group (n=6) received either distilled water (C) or Tualang honey (1.2 g/kg body weight/day) (TH) or Vitamin C (20 mg/kg body weight/day) (VC) for 10 consecutive days. On the tenth day, intraplantar formalin 1% (0.1 mL) was given one hour after the treatment. Rat's pain behaviour was recorded using a digital camera for an hour. The rats were sacrificed two hours postformalin injection and blood was taken to measure the malondialdehyde (MDA) level, catalase (CAT) and superoxide dismutase (SOD) activities. TH not VC significantly reduced the pain behavior score and improved oxidative stress parameters compared to control. However, MDA level was not significantly different between groups. Interestingly, there was a good inverse correlation between CAT level and mean pain behavior score suggesting the important role of antioxidants in modulating the inflammatory pain responses. In conclusion, TH has better antinociceptive and antioxidative properties compared to VC. The antinociceptive property of TH might be partly contributed by increasing CAT level in this model of inflammatory pain. [ABSTRACT FROM AUTHOR]

Introduction: Procalcitonin (PCT) has attracted significant attention as a novel biomarker of sepsis. This study aimed to assess the agreement between blood results of PCT, obtained using the Finecare™ FIA Meter Plus (FS113), a pointof- care (POC) procalcitonin testing device, and the automated Elecsys® BRAHMS PCT assay on the Cobas e411, among critically ill septic patients. Methodology: This observational study was conducted in the intensive care unit of Hospital Universiti Sains Malaysia, in 2021. Whole blood samples were collected and tested with the Finecare™ FIA Meter Plus (FS113) (Wondfo, China) for PCT measurement. Additionally, the same whole blood samples were centrifuged to produce plasma samples, which were then analyzed using the automated Elecsys® BRAHMS PCT assay on the Cobas e411 (Roche Diagnostics, Germany). Results: A total of 40 samples were analyzed in this study. Both PCT measurement techniques demonstrated a significant correlation, with a correlation coefficient of 0.96. Regression analysis revealed the following results: an Ordinary Least Square (OLS) slope of 0.91 (95% CI 0.83, 1.00) with an intercept of 1.27 (95% CI -0.75, 3.29); a Deming slope of 0.95 (95% CI 0.80, 1.10) with an intercept of 0.77 (95% CI -0.44, 1.85); and a Passing-Bablok slope of 1.16 (95% CI 0.99, 1.36) with an intercept of 0.22 (95% CI 0.08, 0.58). Conclusion: The point-of-care procalcitonin measurement provided by the Finecare™ FIA Meter Plus presents a viable alternative for assessing procalcitonin levels among septic patients in the intensive care unit (ICU). [ABSTRACT FROM AUTHOR]

The usage of epidural infusion for intraoperative and postoperative pain relief is widely used in certain pediatric anesthetic practice because of the effectiveness and advantages. However, there is drawback for these techniques due to its potential complications such as inadvertent intrathecal placement, local anesthetic toxicity, catheter migration, infection, and breakage of epidural catheter. Though occur infrequently, epidural catheters have been known to snap during insertion or removal. The retained catheter tip may lead to multiple complications, including nerve injury, infection, and even catheter migration. Although there are literatures recommend options for management of removal of retained catheter, there are limited reports of these occurrences, especially among children. We report a case of sequestrated sheared epidural catheter segment in a child, aiming to share this experience for the future management of patients under similar condition. [ABSTRACT FROM AUTHOR]

Introduction: The question as to whether epidural analgesia during labour can cause chronic low backpain has become a concern lately but this association has not been tested locally and remains controversial. This retrospective study aimed to ascertain the relationship between labour epidural analgesia and development of subsequent chronic low backpain. Methods: We contacted 200 primiparous women who had delivered by normal vaginal delivery via telephone at six months after delivery. While 100 of them had previously received epidural analgesia for labour, the other 100 had not. The women had to quantify their backpain by yes/no responses, numeric rating score, and impairment of daily function. Both the epidural and the non-epidural groups were compared using independent t-test and Chi-squared test while logistic regression was used to control for confounding factors. Results: The two groups had similar baseline characteristics except for body mass index, employment status and labour duration. The women who received epidural analgesia had significantly higher prevalence of low backpain at six months after delivery than those who had not (28% versus 9%, P = 0.001). However, the two groups did not show any difference in terms of numeric rating score or level of impairment of daily function. The low back pain at six months (epidural versus non-epidural) had an adjusted odds ratio of 8.1 (95% confidence interval 2.7 to 24.0, P <0.001). Conclusion: While epidural analgesia during labour was shown to be associated with chronic low back pain, this association may not be causal, suggesting the need for a randomized-controlled study in this area. [ABSTRACT FROM AUTHOR]

Giant haemangioma of the tongue is a disease which can obstruct the oropharyngeal airway and is presented with obstructive symptoms. Due to its vascularity, inserting laryngoscope for intubation can cause high risks, such as inducing bleeding. Hypoxia and excessive bleeding must be anticipated while securing the airway. We present a case of novel usage of dexmedetomidine as a conscious sedation agent for awake fibre optic intubation in a 9-year-old child with obstructive symptoms secondary to a huge tongue haemangioma, who was presented for interventional sclerotherapy of the lesion. [ABSTRACT FROM AUTHOR]

Background: The role of dedicated Trauma ICU (TICU) in Emergency Department is vital in the chain of trauma care to ensure rehabilitation and sustainable critical care for a better survival outcome. This study is conducted to find out demographic patterns and predictors that can affect the outcomes of trauma patients. Methods: A retrospective review of all patients admitted to TICU, Hospital Universiti Sains Malaysia (HUSM) was carried out from January 1st, 2016 till December 31st, 2018. Data were collected from TICU admission and discharge registers and were analyse using SPSS version 23.0. Results: A total of 108 trauma patients were included in this study. All cases were exclusively blunt trauma (99.1%) and mainly attributed by road traffic injuries (92.6%). In terms of trauma clinical scoring, 25%(p= 0.001) presented with GCS score < 4, 46.9% (p=0.001) with RTS score <5.5 and 15.6% (p=0.012) with APACHE II score > 28had demonstrated prolonged ICU stay (> 7 days). Meanwhile 62.5% (p= 0.000) with GCS < 4, 75% (p= 0.000) with RTS < 5.5 and 75% (p= 0.000) with APACHE II > 28 were died in TICU. Besides that, those who had prolonged ICU stay (> 7 days) were 8.5 times higher odds to get sepsis (adj OR= 8.532; 95% CI: 2.710, 26.863; p= 0.000) and 7 times higher odds to get acute kidney injury (AKI) (adj OR= 7.131; 95% CI: 1.464, 34.733; p= 0.015). Meanwhile, patient who received blood transfusion led to 5 folds higher odds of association with rhabdomyolysis (adj OR= 4.968; 95% CI: 1.821, 13.549; p= 0.002). Conclusion: In the midst of pandemic COVID-19 it is important for ED physician to early identify and prioritise high risk trauma patient based on predictors and allows for targeted monitoring and intervention that may improve their outcome and also optimise resources accordingly. [ABSTRACT FROM AUTHOR]

Background: Existing techniques of predicting difficult laryngoscopy are inadequate requiring evaluation of Maxillopharyngeal Angle (MP-A) on lateral cervical radiograph described. Objectives: This study aimed to compare MP-A test with Modified Mallapati Test (MMT) in predicting their diagnostic values and Area Under Curve of Receiver Operating Characteristic Curve (AUCROCC) of both test. Methods: This is a double blinded interventional study of 93 patients. Each patient's MMT score was assessed during preoperative assessment and subsequent MP-A test done by obtaining lateral cervical radiograph with the head in neutral position. Laryngeal view was assessed using Cormack-Lehane grade after induction of anesthesia, was used as reference standard to determine the diagnostic values of MMT and MP-A respectively. Results: The MP-A compared to MMT in predicting difficult larngoscopy had higher sensitivity (77.78 vs 44.44) specificity (88.10 vs 67.86) and accuracy (87.10 vs 65.59) with higher Odd Ratio(26.12 vs 1.68). The AUCROCC was significantly higher in MP-A test 0.83(95%CI: 0.67, 0.99) (P = 0.001) vs MMT 0.56(95%CI: 0.36, 0.76) (P = 0.546) with LR+ of 6.53 vs 1.38. Conclusion: The Maxillopharyngeal Angle test was superior in predicting difficult laryngoscopy as compared to Modified Mallampati Test. [ABSTRACT FROM AUTHOR]