1.Method comparison studies in medicine
Rafdzah Z ; Bulgiba A ; Ismail NA
Journal of University of Malaya Medical Centre 2013;16(1):1-7
Most of important variables measured in medicine are in numerical forms or continuous in nature. New
instruments and tests are constantly being developed for the purpose of measuring various variables, with the aim
of providing cheaper, non-invasive, more convenient and safe methods. When a new method of measurement
or instrument is invented, the quality of the instrument has to be assessed. Agreement and reliability are both
important parameters in determining the quality of an instrument. This article will discuss some issues related
to methods comparison study in medicine for the benefit of medical professional and researcher.
METHOD:
This is a narrative review and this article review the most common statistical methods used to assess agreement
and reliability of medical instruments that measure the same continuous outcome. The two methods discussed
in detail were the Bland-Altman Limits of Agreement, and Intra-class Correlation Coefficient (ICC). This article
also discussed some issues related to method comparison studies including the application of inappropriate
statistical methods, multiple statistical methods, and the strengths and weaknesses of each method. The
importance of appropriate statistical method in the analysis of agreement and reliability in medicine is also
highlighted in this article.
CONCLUSION:
There is no single perfect method to assess agreement and reliability; however researchers should be aware
of the inappropriate methods that they should avoid when analysing data in method comparison studies.
Inappropriate analysis will lead to invalid conclusions and thus validated instrument might not be accurate
or reliable. Consequently this will affect the quality of care given to a patient.
Costs and Cost Analysis
2.Effectiveness of Ultrasound as a Triage Tool in Ruling out Fractures among Non-Critical Emergency Department Patients
Nik Muhamad NA ; Ganesan Murthi j ; Nik Ismail NA
Medicine and Health 2015;10(2):103-111
The popularity of ultrasound for acute diagnosis of fractures in the Emergency
Department (ED) has increased over the recent years. This present study aimed to
determine the sensitivity and specificity of ultrasound use for detection of fractures
in a different environment, which is at the triage area of the ED. We compared
the results of bedside ultrasound in detecting non-critical fractures to the current gold standard of X-rays in the triage area. The design was a single centered crosssectional
study. From August 2014 till November 2014, a total of 46 patients were
recruited, creating 75 image pairs. Following consent, a bedside ultrasound was
performed and subsequently compared with X-ray reporting regarding the presence
or absence of fractures. SPSS analysis was used to determine the sensitivity and
specificity of ultrasound in diagnosing fracture as compared to X-rays. Ultrasound
had a sensitivity of 72% (95% CI, 50.6% - 87.9%) and a specificity of 80% (95%CI:
66.3 – 90%) when compared to X-rays in fracture diagnosis. The kappa analyses
showed moderate inter observer agreement (0.5) between ultrasound and X-rays in
diagnosing fractures. This study suggests that the use of ultrasound as a triage tool
yet has unacceptable sensitivity and needs further evaluation and consideration.
Ultrasonography
3.Development of the Pelvic and Lower Limb Immobilization Device: A Universiti Kebangsaan Malaysia (UKM) Innovation Project
Ismail MS ; Johar MJ ; Bala Krishnian M ; Mohd Radhi A ; Saadah NA ; Gan KB
Medicine and Health 2012;7(1):1-11
Uncontrolled bleeding due to pelvic fractures contributes to trauma-related morbidity and mortality. Three main strategies that have been outlined to combat this condition which include reduction of pelvic volume that lead to tamponade-like effect, arresting haemorrhage through angioembolization of the major vessels, and stabilization of the pelvic bone with external fixation need to be initiated early. A prehospital device that allow these strategies will aid significantly in the management of the patient. At present most devices used to treat pelvic fractures in the pre-hospital setting do have its’ own advantages but also have some limitations. A characteristic ‘wish-list’ of a good pelvic and lower limb immobilization device was created and the research team from UKM takes the challenge to design and produce a device that concurs to it. A two phase development project that incorporate anthropometric, biomechanical, cadaveric and radiological study was carried out over a period of seven years. Finally, BRIMTM immobilizer, a new pelvic and lower limb immobilization device that is user friendly, tough, cost effective, radiolucent, light and reusable that answers most of the requirement of a good device was invented.
4.Adverse Drug Reaction with Midazolam Use in Emergency Department
Nik Muhamad NA ; Ismail AK ; Kaharuddin H ; Miao Ching H ; Qamarul Ariffin S ; Syazwani azwa S ; Nazurah MS
Medicine and Health 2016;11(1):2-10
Midazolam is one of the most commonly used drugs for sedation in Emergency
Department (ED). This was a retrospective study conducted on 380 patients from December 2012 to May 2014 in ED of Universiti Kebangsaan Malaysia Medical
Centre (UKMMC). The objective was to elicit the frequency of side effects and
correlation to various factors i.e. socio-demography, co-morbidities, age groups
and underlying illnesses. Out of 380 patients, 35 patients experienced side effects
(20 patients with midazolam alone, 15 patients with combination of drugs). The
average age was 42 years and the average dose of midazolam was 3.5mg. The
most common other drug combined was fentanyl. The overall complication rate
for midazolam was 5.3%. The most common side effect recorded was excessive
somnolence (1.6%). Other side effects included local skin reactions (1.1%), vomiting
(0.8%), headache (0.8%) and hypotension (0.5%). There was no significant
association between the socio-demographic factors and drugs combination with
the side effects of midazolam on patients. It was concluded that midazolam was a
safe drug due to absence of any life-threatening side effects. There are possibilities
that most side effects recorded could be caused by other comfounding factors e.g.
underlying injuries or disease and combination with other drugs.
Midazolam
5.Doing Less is Better: Challenges in Complex Polytrauma Management - Case Report
Farah NA ; Johar MJ ; Ismail MS
Medicine and Health 2018;13(1):251-258
Damage control resuscitation, characterized by hemostatic resuscitation with blood products, rapid arrest of bleeding and when possible, permissive hypotension with restricted fluid load form a structured approach in managing a polytrauma patient. When complicated with traumatic rhabdomyolysis however, permissive hypotension strategy may cause more harm resulting in subsequent ischaemic-reperfusion injury and acute kidney injury. We present a case involving a 20-year-old man who was rolled over by a lorry and sustained an open unstable pelvic fracture with vascular injury and left lower limb ischaemia. Permissive hypotension strategy was pursued for 4 hours prior to bleeding control in OT. This was followed by protracted surgery of 6 hours. Coagulopathy, acute kidney injury and rhabdomyolysis ensued in the post-operative period and patient succumbed to his injury on Day 3 post-trauma. Challenges and pitfalls in managing a complex polytrauma patient and recent evidences on damage control resuscitation is discussed.
6.THE EFFECT OF PIPER SARMENTOSUM AQUEOUS EXTRACT ON BUCCAL ULCER HEALING
Md Ismail NH ; Nik Mohd Alwi NA
Journal of University of Malaya Medical Centre 2019;22(1):13-19
Oral ulcer is a lesion with multifactorial causes and occurs worldwide. The lesion usually resolved within 14 days, but the pain may have an impact on the quality of patient’s life. Therefore, having a natural derived remedy that can reduce healing time would be a great advantage. This study aims to investigate histological sections of buccal ulcer on rats treated with aqueous extract of Piper sarmentosum (AEPS).Glacial acetic acid was used to induce buccal ulcer on male Sprague Dawley rats. Control group received normal saline while the experimental group received AEPS for treatment. On certain days of post-ulcer induction, buccal ulcer tissue samples were harvested, sectioned and stained with Hematoxylin and Eosin (H&E). Histological slides were examined for inflammation and scored. The inflammation severity reduced from day 2 to day 12. In the experimental group there was a statistically significant differences of inflammation score, particularly on day 2 with a score of (2.8 + 0.2). Neutrophils were less in the experimental group and the tissue debris clearance was faster compared to control group. Full reepithelization was observed on both treated tissue sections on day 12 with less severe inflammation. Topical application of AEPS is proven to have anti-inflammatory effect by reducing the number of neutrophils during inflammation phase of oral ulcer healing
7.The Incidence and Variation of Corona Mortis in Multiracial Asian: An Insight from 82 Cadavers
Khirul-Ashar NA ; Ismail II ; Hussin P ; Nizlan NM ; Harun MH ; Mawardi M ; Lingam R
Malaysian Orthopaedic Journal 2024;18(No.1):26-32
Introduction: Corona Mortis (CMOR) is a term used to
describe an anatomical vascular variant of retropubic
anastomosis located posterior to superior pubic ramus. We
aim to provide sufficient data on the incidence, morphology
and mean location of ‘crown of death’ in Asian population.
Other objectives include to assess the relationship between
CMOR incidence with gender, race and age.
Materials and methods: This is a cross-sectional cadaveric
study involving 164 randomly selected fresh multiracial
Asian hemipelves (82 cadavers). Hemipelves were dissected
to expose and evaluate the vascular elements posterior to
superior pubic rami. Data were analysed using Chi-Square, ttest and with the help of IBM SPSS Statistics v26 software.
Results: CMOR was found in 117 hemipelves (71.3%). No
new morphological subtype was found. The mean distance of
CMOR to symphysis pubis was 54.72mm (SD 9.35). Based
on the results, it is evident that precaution needed to be taken
at least within 55mm from symphysis pubis during any
surgical intervention. The lack of statistically significant
correlation between CMOR occurrence and gender, race and
age suggest that the incidence of CMOR could be sporadic in
manner.
Conclusion: We conclude that CMOR is not just aberrant
vessel as the incidence is high and this finding is comparable
to other studies. The mean location of CMOR obtained in
this study will guide surgeons from various disciplines in
Asia to manage traumatic vascular injury and to perform a
safe surgical procedure involving the pelvis area.