Comparison of Carboxyhaemoglobin Concentrations between Low-flow and Minimal-flow Anaesthesia with Desflurane

This was a prospective randomised study comparing carboxyhaemoglobin concentrations between low-flow anaesthesia (fresh gas flow 1.0 L/min) and minimal-flow anaesthesia (0.5 L/min) using desflurane. Sixty (ASA 1 or 2) adult patients undergoing elective surgery under general anaesthesia were randomly allocated to receive either low-flow (Group 1) or minimal flow anaesthesia (Group 2). Venous blood samples for carboxyhaemoglobin levels were taken at baseline and at 10 mins intervals for 40 mins. Both groups showed significant increase in carboxyhaemoglobin concentrations within the first 10 mins when fresh gas flow of 4.0 L/min was used. Reduction in carboxyhemoglobin levels was seen after 20 mins of minimal or low flow anaesthesia. However, there was no significant difference in the magnitude of reduction of carboxyhemoglobin concentrations between the groups. The fractional inspired of oxygen (FiO2) showed no significant changes in either group. In conclusion, desflurane usage in anaesthesia with either low-flow or minimal-flow was not associated with increased carboxyhaemoglobin concentrations

Expressed breast milk feeding: knowledge and attitude of employed mothers

Appropriate knowledge on expressing, storing and use of breast milk are essential for mothers to continue breastfeeding when they return to work. The objective of this study was to assess the knowledge and attitude of employed mothers towards breast milk expression, storage and usage. This cross-sectional study was conducted among 300 full-time employed mothers who delivered at a tertiary hospital in Kuala Lumpur, Malaysia. A content-validated questionnaire consisting of 28 questions testing knowledge and nine questions assessing attitude was used. The highest possible scores for knowledge and attitude were 28 and 45, respectively. The mean score for knowledge was 20.47 (SD 4.06). Mothers who scored ≥ 21 (≥75% of maximum score) were categorized as having “good knowledge” while those who scored <21 were considered to have “poor knowledge”. One hundred and seventy (57%) mothers had good knowledge. Good knowledge was significantly associated with Malay ethnicity, tertiary education, multiparity status and prior breastfeeding experience. Two hundred and nineteen (73%) mothers had a positive attitude (scored ≥34). Malay ethnicity, tertiary education, multiparity status, prior experience in giving expressed milk and feasibility of expressing breast milk at the workplace were significantly associated with a positive attitude. More than half of the mothers had good knowledge, and a higher proportion had a positive attitude towards breast milk expression, storage and usage. Additional support and education should be given to mothers who are: non-Malay, non-tertiary educated and having their first child as these factors were associated with poor knowledge and negative attitude

The Effect of Single, Binary and Ternary Anions of Chloride, Carbonate and Phosphate on the Release of 2,4-Dichlorophenoxyacetate Intercalated into the Zn–Al-layered Double Hydroxide Nanohybrid

Intercalation of beneficial anion into inorganic host has lead to an opportunity to synthesize various combinations of new organic–inorganic nanohybrids with various potential applications; especially, for the controlled release formulation and storage purposes. Investigation on the release behavior of 2,4-dichlorophenoxyacetate (2,4-D) intercalated into the interlayer of Zn–Al-layered double hydroxide (ZAN) have been carried out using single, binary and ternary aqueous systems of chloride, carbonate and phosphate. The release behavior of the active agent 2,4-D from its double-layered hydroxide nanohybrid ZANDI was found to be of controlled manner governed by pseudo-second order kinetics. It was found that carbonate medium yielded the highest accumulated release of 2,4-D, while phosphate in combination with carbonate and/or nitrate speeds up the release rate of 2,4-D. These results indicate that it is possible to design and develop new delivery system of latex stimulant compound with controlled release property based on 2,4-D that is known as a substance to increase latex production of rubber tree,Hevea brasiliensis

Intraoperative glycaemic control in Non insulin dependent Diabetes Mellitus: a comparison between normal saline and ringer’s lactate

Fifty Non Insulin Dependent Diabetes Mellitus (NIDDM) patients undergoing surgery under epidural anaesthesia were studied. All patients received dextrose 5% infusion at 100 ml/hr from the period of fasting until upon arrival to the operation room. Patients were randomly divided into two groups. Patients in Group 1 (n=25) received normal saline while patients in Group 2 (n=25) were given Ringer’s lactate. Both groups received their infusion throughout the operative period up to four hours postoperatively. Blood glucose level was measured at baseline, 45 minutes intra operatively and postoperatively at 30 minutes and four hours by using a glucometer. Patients in Group 2 has a larger mean increase in blood glucose level of 1.5 mmol/L between 4 hours postoperatively and baseline compared to 0.96 mmol/L inGroup 1. However, this was not statistically significant. There was no difference in the increase of mean glucose level at 30 minutes when compared to baseline. There was a significant increase in mean blood glucose level in both groups in the postoperative period when compared to baseline. This study demonstrated that patients with NIDDM receiving Ringer’s lactate has a larger increase in mean blood glucose level compared to those receiving normal saline, but the magnitude is not statistically significan

The effectiveness of Tocotrienol rich fraction and αlpha Tocoferol with combination of vitamin C in the management of systemic inflammatory response syndrome (SIRS)

The pathophysiology of systemic inflammatory response syndrome (SIRS) had been described to involve various strong oxidative reactions affecting the status and progress of the patients. Antioxidant therapy had been suggested in many studies involving SIRS management. The objective of this study was to compare the role of vitamin E Tocotrienol and vitamin E Tocopherol combined with vitamin C as antioxidant therapy in the management of critically ill patients diagnosed with SIRS, admitted to the intensive care unit and high dependency wards of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). It was a single blind randomized clinical trial with a total of 72 patients in which 44.4% Malays, 34.7% Chinese, 19.4% Indians and 1.4% others with 59.7% males and 40.3% females were recruited. Patients in TRI E group received Tocotrienol with Vitamin C while TOCO group received Tocopherol with Vitamin C and a control group did not receive any antioxidant. The clinical parameters (heart rate, respiratory rate, systolic blood pressure) showed improvements with significant difference at the end of study (post-intervention) as compared to admission (pre-intervention).Whereas, the sepsis (temperature, PCT, CRP and WBC) and oxidative stress (8-OHdG/Creatinine) parameters showed improvements with significant difference at the end of study (post-intervention) as compared to admission (pre-intervention). The TRI E group showed obvious improvement in clinical, sepsis and oxidative stress parameters, as compared to TOCO and control groups. This study showed that Vitamin E Tocotrienol and Vitamin E Tocopherol in combination with Vitamin C demonstrated significant improvement in the clinical and laboratory parameters during the management of SIRS. Therefore, Vitamin E in combination with Vitamin C had therapeutic benefits in the treatment of critically ill patients with SIRS

The Impact of a Patient Education Package on Outcomes of Pain Management Following Orthopaedic Surgery in a Tertiary Hospital in Malaysia

Kepercayaan pesakit terhadap pengurusan kesakitan boleh menjejaskan hasil pengurusan kesakitan dan kualiti hidup. Tujuan kajian ini dijalankan adalah untuk menentukan kesan pakej pendidikan pra-operasi sakit ke arah kepercayaan kesakitan dalam kalangan pesakit-pesakit yang menjalani pembedahan ortopedik di hospital tertiari. Reka bentuk kajian ‘pre-test pos-test’ satu-kumpulan dijalankan pada pesakit-pesakit untuk menentukan impak pakej pendidikan tentang kesakitan terhadap skor ‘post-test’ kepercayaan tentang kesakitan dalam kalangan pesakit yang menjalani pembedahan ortopedik. Tiga puluh responden telah diambil menggunakan ‘convenience sampling’. Pendidikan tentang kesakitan sebelum pembedahan berkaitan dengan pengurusan kesakitan diberikan kepada respons.Skor kepercayaan pra-operasi dan pos-operasi sakit, pengurusan markah dan kesan-kesan sampingan telah diukur dengan menggunakan borang soal-selidik halangan (BQ-13). Keputusan melaporkan perbezaan yang signifikan antara skor ‘pre-test’ (Mean = 41.87, Standard Deviation = 11.467) dan ‘post-test’ (Mean = 34,80, Standard Deviation = 13.026) kepercayaan terhadap kesakitan (t = 2.84, p =0.004). Terdapat juga perbezaan yang signifikan antara skor ‘pre-test’ (Mean = 37.10, Standard Deviation = 10.610) dan skor ‘post-test’ (Mean = 30.80, Standard Deviation = 11.424), pengurusan kesakitan (t = 3.856, p =0.0005). Responden dan jantina (t =-2.403, p =0.023) dan bangsa (F = 5.038, p =0.014) melaporkan perbezaan yang signifikan iaitu p 0.05. Kesimpulannya, terdapat kesan positif daripada pakej pendidikan kesihatan berkenaan kepercayaan kesakitan dan pengurusan kesakitan responden yang telah menjalani pembedahan ortopedik di hospital tertiari. Pengukuhan program pendidikan kesakitan adalah penting untuk mencapai matlamat pengurusan kesakitan pos-operasi yang optimum