1.Hidden Germ of the Immunocompromised: A Case of Fungal Orbital Cellulitis
Medicine and Health 2019;14(2):266-270
Orbital cellulitis is an infection of the orbital soft tissue that could possibly lead
to serious complications if treatment is delayed. It is important to differentiate this
condition from a less life-threatening condition like preseptal cellulitis as orbital
cellulitis would require a more aggressive treatment than the former condition. The
present case discusses about a patient who was diagnosed with orbital cellulitis
and developed complications from the disease. The delayed administration of
the appropriate antibiotic subsequently led to the patient’s death. The delay was
because of the reason that the patient belonged to the immunocompromised
group who harbour different causative organism than the normal population.
2.What Eyes Behold if Missed can be a Life Taking Event: A Case of Orbital Cellulitis
Reza MQ ; Johar MJ ; Ismail MS
Medicine and Health 2013;8(2):89-93
Orbital cellulits is one of the life threatening event that should not be missed out and must be distinguished from preseptal cellulitis. It is an infective process involving ocular adnexal structures posterior to the orbital septum. High index of suspicion is the key to its diagnosis as even experienced physician can miss. Here, we present a case of a 15-year-old female who presented with progressive swelling over right forehead associated with high grade fever, headache and purulent discharge of the swelling. She was diagnosed with sepsis due to right forehead abscess and was treated with intravenous antibiotics followed with admission. However, she suddenly deteriorated in the ward which required intubation and thereby Intensive Care Unit (ICU) admission. Investigations revealed fluid collection at right
retrobulbar space suggestive of an abscess where emergency drainage was carried out. Unfortunately, her condition worsened and patient succumbed at day-10 of admission, despite all efforts.
3.Paramedics’ Perception on Video Assisted Learning Method in Learning Emergency Skills
Bala Krishnian M ; Ahmad Khaldun I ; Hamidah Y ; Johar MJ ; Ismail MS
Medicine and Health 2016;11(1):47-55
Information technology use in healthcare education has become a popular
medium of instruction. One of the medium of instruction is video assisted learning
(VAL). The use of VAL as an instructional method in the teaching and learning of emergency skills is not new. However, there are lack of studies on the perception of
using this method in learning emergency skills. This qualitative study involved four
focused discussion groups following a VAL instruction on emergency skills. A total
of 20 paramedics were divided into four groups. They were involved in a focussed
discussion after a VAL instruction session. Findings reveal that the paramedics
perceived three major themes which were categorized as : i) advantages of video
as teaching tool, ii) barrier in using video as a teaching tool; and iii) suggestions on
using video as teaching tool. The findings indicate that the paramedics perceived
VAL as a potential tool for learning emergency skills. However, they suggested the
language of instruction should be in their mother tongue for better understanding.
This implies that using English language has disadvantage in technology enhanced
learning for better understanding.
Computer-Assisted Instruction
4.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.
5.Functional Status of Post Stroke Survivors
Bala Krishnian M ; Leong JWS ; Lye M ; Johar MJ ; Ismail MS
Medicine and Health 2015;10(1):32-36
Globally, stroke is the commonest cause of long-term disability. The residual
disabilities among post stroke patients affect their daily living activities. The aim
of rehabilitation therapy is to help stroke survivors to gain back their functional ability. The present study aimed to determine the relationship between post stroke
duration with functionality status of post-stroke survivals at a teaching hospital in
Kuala Lumpur. A cross-sectional study involved one hundred nine five post stroke
patients who attended the Rehabilitation Clinic over a 4-month period. The data
on post stroke duration was reveale from patient’s cleckship. Their functional
status was assessed with Modified Barthel Index (MBI). Results showed the mean
age of participants was 61 years (SD=13.86, range:22-87 years), with 118 males
and 81 females having a median duration of 12 months post-stroke (range: 1–79
months). The prevalence 123 (63.1%) of stroke survivors are found to be dependent
in their daily living activity. A Chi-square test for independence indicated there was
significant relationship between post-stroke duration with levels of functioning, χ2
(2 , n=195) = 6.455, p<0.05,phi = 0.182. Patients in post-stroke duration of 13-24
months were independent (52.1) than ≤ 12 months and ≥ 24 months.
Stroke
6.Post-Stroke Survivors: The Relationship between Clinical Characteristics and the Levels of Depression
Bala Krishnian M ; Leong JWS ; Lye MS ; Johar MJ ; Ismail MS
Medicine and Health 2015;10(2):98-102
Stroke is frequently associated with long-term disability. Stroke leads to high risk of
physical and neuropsychological consequences. Residual disabilities among post-stroke survivors can lead them to depression. This study aimed to determine the
relationship between clinical characteristics and the levels of depression among
post-stroke survivors at a teaching hospital in Kuala Lumpur. This cross-sectional
study recruited 195 post-stroke survivors who attended follow-up Rehabilitation
Clinic of a teaching hospital over a study period of 4 months. Information collected
included socio-demographic, clinical characteristics (post stroke duration, stroke
types and stroke severities) and level of depression. Beck’s Depression Inventory
(BDI) was used to assess the level of depression. The mean age of participants was
61 years (SD=13.86, range: 22-87 years), with 118 male and 81 female survivors
having a median duration of post-stroke of 12 months (range: 1–79 months). This
study showed post stroke survivors 116 (59.5%) with depression. A Chi-square
test for level of stroke severity was significantly associated with depression, χ2
(2,
n=195) = 28.724, p<0.001, phi = 0.384. The results of the present study showed
that survivors with mild stroke had less depression (44.0%) compared to moderate
stroke (81.7%) and severe stroke (87.5%).
Stroke
;
Depression
7.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.