Islamic perspective on end of life issues in persistent vegetative state patients - a case report

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

Improving health care delivery through Islamization of medical practice

Advances in modern science and technology have not only reduced mortality from communicable diseases but increased physical comfort, life expectancy and quality of life. However its advances have generated changes in the moral values and basic philosophies of mankind, a bi-product being loss of faith in religion as a partner in healing. This has resulted in changes in lifestyle, moral degradation, laxity in sexual behaviours, and disrupting social values. New diseases caused by negative lifestyles such as sexual promiscuity, alcoholism, illicit drug use and smoking, take the greatest toll in terms of deaths and disability among young people. As a consequence, relevant international organizations have supported more novel approaches to health promotion.Good health is the basic requirement of every human being and one of the greatest blessings of ALLAH (SWT) on mankind. The Islamic way of life is a system of divine principles sent by Allah swt through revelation on Prophet Muhammad (saw) which covers physical, intellectual and spiritual needs of human life. It has many constructive ideas to offer in the field of health care and medical practice. It contains many teachings that urge nurturing of one’s health and rejecting any behaviour, which are contradictory to health. Therefore by adopting an “Islamic way of life” we can promote behavioural change. Since Islam encourages adoption of modern technology and science in support of a greater good, we must understand it and adopt all that is good in it and propagate it in the spirit of Tawhid (Unity of God), for the benefit of all humanity. This paper seeks to analyse how medical professionals can promote healthy behaviour to specific target groups and public in general through teachings of Islam

Usefulness of cytological specimens from bronchial brushings and bronchial washings in addition to endobronchial biopsies during bronchoscopy for lung cancer: 3 years data from a chest clinic in a general hospital

retrospective review of all bronchoscopy cases for investigation of lung cancer between January 1997 and December 1999 was done. The cases were included if endobronchial mass was visible (Group A) or when there was an abnormal mucosa and/or bronchial narrowing in the absence of a mass (Group B). All patients in Group A (n = 177) underwent endobronchial biopsy (EB) bronchial brushings (BB) and bronchial washings (BW). All cases in Group B underwent transbronchial biopsy (TBB), BB and BW. Only a small increase in the positive results for cancer was seen when cytology specimens (BB and BW) were added to EB (85.3% vs 88.1%, McNemar's P = 0.06) in Group A but there was a significant increase in Group B (37.3% vs 54.2%. McNemar's, P = 0.001). Therefore although cytology specimens did not significantly add to overall yield of positive results when endobronchial lesions were visible, when mass lesions were not visible, cytology specimens increased the yield by 16.9%

Is autonomy a universal value of human existence? Scope of autonomy in medical practice: a comparative study between Western medical ethics and Islamic medical ethics

The practice of contemporary medicine has been tremendously influenced by western ideas and it is assumed by many that autonomy is a universal value of human existence. In the World Health Report 2000, the World Health Organization (WHO) considered autonomy a “universal” value of human life against which every health system in the world should be judged. Further in Western bioethics, patient autonomy and self-determination prevails in all sectors of social and personal life, a concept unacceptable to some cultures. In principle, there are challenges to the universal validity of autonomy, individualism and secularism, as most non-Western cultures are proud of their communal relations and spiritualistic ethos and, thereby imposing Western beliefs and practices as aforementioned can have deleterious consequences. Religion lies at the heart of most cultures which influences the practice patterns of medical professionals in both visible and unconscious ways. However, religion is mostly viewed by scientists as mystical and without scientific proof. Herein lies the dilemma, whether medical professionals should respect the cultural and religious beliefs of their patients? In this paper we aim to discuss some of the limitations of patient's autonomy by comparing the process of reasoning in western medical ethics and Islamic medical ethics, in order to examine the possibility and desirability of arriving at a single, unitary and universally acceptable notion of medical ethics. We propose a more flexible viewpoint that accommodates different cultural and religious values in interpreting autonomy and applying it in an increasingly multilingual and multicultural, contemporaneous society in order to provide the highest level of care possible

End-of-life: old age in contemporary society, self-perception of aging and ‘An’ Islamic perspective

Population aging is a global phenomenon which has important and far-reaching implications for many facets of human life. Although it is an achievement of public health policies and socioeconomic development; it is generally greeted with alarm as it is assumed that elderly will be ill and dependant due to age-related chronic diseases which will require long term care. Despite the fact that many older adults continue to work and contribute to the society, they are seen as a burden and a drain on resources, rather than as a resource in themselves. Ageism and discrimination towards elderly is prevalent at individual and institutional levels that affect their physical and mental health, putting them at risk of depression and social isolation. According to the World Health Organization’s (WHO) combatting ageism has great potential for achieving healthy ageing for all people as they age. Individual health and longevity is influenced by biological, environmental, and psychosocial factors, however modifiable risk factors are especially relevant as they are amenable to intervention. There is enough evidence that religiosity and spirituality (R/S) are among such factors which allow older adults to age in a more positive way. Further R/S activities are prevalent globally and elderly tend to have high rates of involvement in religious activities. Health benefits that may stem from R/S involvement could be important for the future of global health which suggests that they could be incorporated into the idea of positive ageing. Islamic perspective on old age is deeply rooted in the very texts of revelation and as such is divinely based. This review article intends to create awareness of the elderly on the ageing process, their status in the contemporary society and how by adopting positive attitude toward ageing they can enjoy better functional health, self-esteem and satisfaction in life

Risk factors for anti tuberculous drugs induced hepatitis: a prospective survey from a chest clinic in a general hospital

A prospective survey on 14 consecutive cases with tuberculous drug induced hepatitis was done at our chest clinic in a state general hospital over a period of 15 months. There were 30 controls chosen randomly from the chest clinic register. The cases had lower mean body mass index (P<0.008), serum albumin (P<0.005) and higher serum globulin (P<0.04). Serum liver transaminases and total bilirubin rose significantly during the acute episode of drug induced hepatitis. Among the risk factors studied, only chronic hepatitis B carrier status was found to be more prevalent among the cases. There was one death (7.1%) over the whole study period

Metabolic changes during ramadan fasting in normal people and diabetic patients

Fasting is obligatory on all Muslims every year during the 9th Islamic lunar month of Ramadan with exemption to sick, travelers and pregnant women. In spite of the fact that Islam provides exemption from fasting to people suffering from illnesses like diabetes, many patients still want to fast for personal convictions. Physicians often face a dilemma as to how to advise them. Several studies have been published on the effects of fasting; some of the results are controversial. The present study was undertaken to establish the effects of Ramadan fasting on various physiological parameters in normal people and in diabetic patients. This could be used as basis for advice to such patients. The study group consisted of 53 diabetic patients (31 male and 22 female) and 56 (21 male 35 female) healthy volunteers as controls. Inclusion criteria of diabetic patients were: to be non-insulin dependent, and be stable and under reasonable control on oral hypoglycemic drugs and or diet control alone. The subjects were evaluated 1-2 weeks before commencement of fasting (visit 1), at the 4th week of Ramadan fasting (visit2) and one month after the end of the Ramadan fast (visit3). Blood samples were collected on each occasion at least 8 hours after the last meal. Our results showed statistically significant weight reduction (P<.001) at the end of Ramadan fast in both groups, however it was not maintained in both groups when values were compared before Ramadan and one month after Ramadan. Fasting blood sugar and HBA1C showed significant reduction (P<.001) among diabetics but not in control group. The other parameters e.g. cholesterol, blood urea and creatinine did not show any significant changes before and during Ramadan. There was statistically significant increase in serum cholesterol and triglyceride and uric acid (P<.001) among healthy volunteers (control group) one month after Ramadan compared to before Ramadan; however no such changes were seen among diabetic group. There was no reported case of serious complication due to fasting in both groups. Conclusion: Ramadan fasting lead to significant body weight reduction and improvement of glycaemic control in diabetic patients with out other significant metabolic changes

Update on the management of diabetes during Ramadan fast for healthcare practitioners

Fasting during the month of Ramadan is one of the five pillars of Islam, a recurring annual ritual, which is passionately practiced by most Muslims across the world. It is obligatory on every healthy Muslim; however, the Qur’an and Islamic teachings specifically exempt people with acute or chronic illnesses from this duty, especially if it might have harmful consequences. Muslims with diabetes are exempted from fasting, but many of them still fast during Ramadan, for their personal convictions as revealed by EPIDIAR study which showed that 43% of patients with type 1 diabetes and 79% with type 2 diabetes fasted during Ramadan. Muslims constitute about a quarter of the world’s population who are spread all over the globe. It is inevitable that health care issues peculiar to them will be encountered worldwide and health care providers will have to counsel them regarding medications and whether it is safe to undertake the fast. This paper is an update on the management of Ramadan fasting based on current evidence from published literature and expert opinion

Dementia secondary to a potentially treatable cause - role of GPs

Dementia is tragic mind-wrecking disease, defined as a multifaceted decline in cognitive function severe enough to interfere with activities of daily life. We present herein two patients who presented with loss of memory and altered behaviour. The purpose of these case reports is to alert the health professionals, especially general practitioners, in detection of “potentially treatable " cases of dementia that can be treated effectively to restore normal or nearly normal intellectual function

Self-perception of stigma among epilepsy patients in Malaysia

Introduction: Epilepsy remains a stigmatised disease across geographical and temporal boundaries. Very little is known about epileptic stigma (ES) in cross-cultural settings. The aim of this study was to assess the prevalence of perceived stigma and factors associated with it, among patients with epilepsy (PWE) at a tertiary care referral hospital in East Coast of Malaysia. Methods: A cross sectional survey among 132 consenting PWE using pre-tested, semi-structured questionnaire in Malay/English language to assess their knowledge, attitude and practices (KAPs). Results: Among 132 respondents, 51.5% were male and 48.5 % were female. Their age ranged from 14 to 70 years (mean=31.6±13.41). Majority (53.8%) of them were aged 30 years or younger. The median number of years they had epilepsy was 8.0 (IQR 4.0-18.8) years and average duration of seizure prior to seeking medical attention was 1.0 (IQR 0.3 - 4.5) year. Most of them (90.9%) did not know the cause of epilepsy; however nearly all (91.7%) believed that it was a disease of the brain. Higher education level respondents possessed significantly higher KAP scores compared to lower education level respondents (p<0.001). Respondents with good KAP scores believed that epilepsy was not contagious and they observed greater social tolerance. Conclusion: Our study suggests that there is an inverse relationship between knowledge and ES. Self-perceived stigma was more common among our PWE. The results suggest that there is a critical need to enhance epilepsy education amongst the PWE beyond mere seizure control