Knowledge and practices on i-Ta'aleem and other educational technologies among International Islamic University Malaysia Kulliyyah of Medicine lecturers

Technologies in the classroom require teacher’s knowledge and skills in utilizing it. Teaching for medical student can be different in some areas. To date, no studies has been conducted on the use of technologies among medical lecturer in International Islamic University Malaysia (IIUM). Thus, the objective of this survey is to determine the level of awareness, practice and perception of learning management system (i-Ta’aleem) and educational technologies among Kulliyyah of Medicine (KOM) lectures. Materials and Methods: This cross-sectional study was conducted among all IIUM KOM lecturers. Only 26.1% responded to the self-administered questionnaire which was distributed via google form for one month. Descriptive analysis was used to analyze the background information and their awareness, practice and perception. Results: Majority of the respondents were male (56.8%), permanent staff (94.6%) with mean years of service at IIUM was6.7. Most of them owned technology tools [smartphone (100%), personal computer (73.0%), tablet (54.1%) and laptop (97.3%)]. All of them heard about i-Ta’aleem. However, 78.4% never use i-Ta’aleem and only a small percentage of them always uses other technologies for their teaching and learning (2.7% to 5.4%) except the usage of laptop (48.6%) and projector (59.5%). Conclusion: Although the lecturers were aware about i-Ta’aleem and owned high technology tools and gadget, only a small percentage of them use it in teaching activities

Inadvertent puncture of right vertebral artery during central venous line catheter insertion

The 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

Ethical justification in medical futility and advanced medical directive from the Islamic perspective

Introduction: 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

Role Of ultrasound In central neuraxial blockade

Standard practice central neuraxial blocks (CNB) commonly performed in sitting position involves using surface landmark technique (identification of Tuffier’s line), operators feeling of tactile sensation and or seeing free flow of cerebrospinal fluid (CSF). Although identification of spinous process are very reliable, surface anatomy landmarks sometimes are not always easily identified, especially in patients with spinal deformity, for example kyphoscoliosis, obesity, oedema or previous back surgery.1,2 Tuffier’s line, a line drawn between the highest point of iliac crests is widely used as estimation of L3 - L4 interspace, but the correlation is inconsistent.3 The precision of identification varies and inaccurate in many patients may end up needle placement one or two spinal levels higher.1,2,4-7 Surface landmark technique does not give the anaesthesiologist reliability to locate the space for needle insertion, predict ease of needle placement and avoiding accidental dural puncture during epidural insertion. Ultrasound imaging can be used to preview the underlying spinal anatomy (pre-procedural scan) or guide the spinal needle in real-time during performing CNB. The ultrasound can 60% correctly identified L2 - L3 interspace, with margin of error 7 - 9% either one space above or below, in comparison with clinical assessment 9 - 18% up to 2 spaces higher or lower (more significant variability).10 With pre-procedural ultrasound scan, the reliability of identification of the L3-L4 interspace increases to almost 70 - 80%. An anaesthesiologist can identify the midline of the spine accurately, identify the correct lumbar interspace, measure and predict skin to space distance and identify patients with potentially difficult CNB.1,2,8,9,1

Benefits of Curl Catheter for continuous interscalene block on postoperative pain scores and reduction of dislocation rate during physiotherapy

This case is about the employment of curl interscalene catheter which is rarely documented in local setting. A 35-year-old gentleman with bone cyst of right humerus underwent manipulation under anaesthesia, ultrasound guided biopsy, extended bone curettage and bone grafting of right humerus in the beach chair position. A postoperative interscalene nerve block consisting of 8ml Chirocaine 0.25% was given, followed by placement of interscalene nerve curl catheter using 100mm SonoLong Curl Echo 18G with 50cm catheter under direct ultrasound guidance while patient was under general anaesthesia. The purpose of the interscalene nerve curl catheter was to facilitate physiotherapy of right shoulder by providing analgesia. Self limiting Horner’s Syndrome developed with bolus 8ml Chirocaine 0.25% over 10 minutes,however it resolved with a lower dose of 5ml Chirocaine 0.25% over 15 minutes. The curl catheter was placed in the patient for a duration of 5 days and no other catheter related complication occurred. 5 days of physiotherapy with low pain scores was achieved. After 5 days, the catheter was removed. In the use of straight catheter, there is a risk of catheter tip migration regardless of anterior or posterior approach and whether there are changes at the skin markings. In patients with catheter migration, worse pain scores were reported

Diagnostic and prognostic performance of serial creatinine, Cystatin c and Neutrophil Gelatinase-associated Lipocalin in for acute kidney injury in critically ill patients with sepsis

Introduction Acute kidney injury (AKI) is an independent risk factor that contributes to morbidity and mortality in critically ill patients. Plasma Creatinine is the current marker used to diagnose AKI; however, it is delayed biomarker. Newer marker has been shown to have a faster diagnostic utility. Plasma Cystatin (CysC) is a new functional marker, whereas Neutrophil Gelatinase-Associated Lipocalin (NGAL) is injury marker for AKI. We evaluated the diagnostic and prognostic performance of Creatinine, Cystatin C, and NGAL in critically ill patients with sepsis. Methods This is a secondary analysis of a prospective observational study of critically ill pa- tients. Inclusion criteria were patients older than 18 years old with sepsis, defined as clinical infection and increase in SOFA score>2, and plasma procalcitonin>0.5 ng/ml. Plasma creatinine, Cystatin C and NGAL were measured on ICU admission and daily for 3 days. Results A total of 70 patients were recruited, of which 39 (55.7%) had AKI. Plasma Creati- nine had the highest diagnostic performance for AKI throughout the first 3 days of ICU admission with AUC of 0.72 to 0.85. Plasma CysC was diagnostic on Day-1 and Day-2 only, with AUC of 0.76 and 0.77, respectively. Plasma NGAL was diagnostic for AKI throughout the 3 days, with AUC of 0.67 to 0.75. Day-2 Plasma NGAL were in- dependently predictive of 30 days mortality with odds ratio of 9.76 (1.02 to 93.13), p=0.048. Conclusions Plasma Creatinine, CysC and NGAL measured during the first 3 days of ICU admission were diagnostic of AKI. However, only Day-2 Plasma NGAL was independently pre- dictive of 30-day mortality, with optimal cut-off point of 435 ng/ml

High frequency oscillatory ventilation in leptospirosis pulmonary haemorrhage: A case series

Hypoxemia in severe leptospirosis-associated pulmonary hemorrhage syndrome (LPHS) is a challenging clinical scenario not usually responsive to maximal support on mechanical ventilation. We described the efficacy and safety of high frequency oscillatory ventilation (HFOV) as rescue therapy in acute respiratory failure secondary to LPHS. This is a retrospective case study of five patients with diagnosis of severe LPHS, who were admitted to Intensive Care Unit from October 2014 to January 2015. They developed refractory hypoxemia on conventional mechanical ventilation and rescue therapy was indicated. All patients responded rapidly by showing improvements in oxygen index and PaO2/FiO2 ratio within first 72 h of therapy. Despite severity of illness evidenced by high Simplified Acute Physiological II and Sequential Organ Failure Assessment scores, all patients were discharged from hospital alive. In view of the rapid onset and extent of hemorrhage which may culminate quickly into asphyxiation and death, HFOV may indeed be lifesaving in severe LPHS

A cardiopulmonary resuscitation guide for healthcare providers

Cardiopulmonary resuscitation or CPR is the term used to describe a series of action that comprises of artificial respiration and chest compressions to patients in cardiorespiratory arrest. It has to be initiated promptly to improve the chance of survival before advanced medical care is available. CPR is an important clinical skill, almost mandatory for every healthcare personnel. The CPR procedure is an essential component of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS). This book covers the important aspects of Basic Life Support (BLS) and serves as a guide to participants of the CPR course. Participants are required to read this book before attending the course. Its main objective is to provide a simple and comprehensive reference to participants of our CPR workshops. It has been updated according to the latest 2015 guidelines published by recognised bodies such as The International Liaison Committee on Resuscitation (ILCOR), and the American Heart Association (AHA). We have also incorporated a chapter on Islamic Ethics, in line with the IIICE (Integration, Islamisation, Internationalisation and Comprehensive Excellence) mission of our university

Medical futility: a major ethical issue in end of life care: an outlook from medical and Islamic legal rulings

Aims / Background: The ethical issues surrounding end of life care are recent subjects of heated discussions. While issues like brain death has been thoroughly deliberated and well responded by Islamic authorities; some remain far from certainty and requires further exploration. This study aimed to identify various clinical situations with ethical implications related to selected major issues in end of life care followed by in-depth analysis on the medical aspects and Islamic legal rulings. Methodology: A qualitative study was conducted involving the followings: 1. Literature review gathering relevant materials performed using various search engines and databases. 2. Content analysis on the collected materials performed to identify various clinical situations related to end of life care. Major issues were subsequently shortlisted. 3. In-depth interviews of medical experts and religious scholars conducted to gather views and understanding on the major issues. Their responses recorded, transcribed and analysed using Nvivo 11. 4. Series of roundtable discussions attended by medical professionals and Islamic Studies academicians conducted to establish research framework, questionnaire formulations and elaborate the findings. Results: We found that one of the major issues in end of life care is the determination of death based on the diagnosis of brain death and medical futility. In contrast to brain death, there is neither clinical guidelines nor official Islamic legal rulings for the diagnosis of medical futility. Although the concept of medical futility for discontinuation of care for the terminally ill has been introduced in the 1980s, no consensus on accepted diagnostic criteria are available to date. From Islamic legal perspectives, the diagnosis of death based on the establishment of medical futility is ‘permissible’ as it conforms to the principles of qawaid al fiqhiyyah and maqasid al shari’ah. Conclusion: Medical futility is one of the major ethical issues in end of life care. It warrant in depth analysis from both medical and Islamic viewpoints