Publications by authors named "Mohd Zulfakar Mazlan"

11 Publications

  • Page 1 of 1

Postoperative Maladaptive Behavior, Preoperative Anxiety and Emergence Delirium in Children Undergone General Anesthesia: A Narrative Review.

Glob Pediatr Health 2021 7;8:2333794X211007975. Epub 2021 Apr 7.

Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Kelantan, Malaysia.

Over the years, the number of pediatric patients undergoing surgeries are increasing steadily. The types of surgery vary between elective to emergency with involvement of multidisciplinary teams. The development of day care surgery unit is expanding where the patients will only come to the hospital on the day of surgery and discharge home after such as satisfactory parameters achieved, minimal to no pain, minimal to no bleeding from surgical site and able to tolerate fluids. Hospitalization and surgery could contribute to significant psychological disturbance to the children. These issues are not being addressed as children have difficulty in conveying their problems and fear. They do however express it through negative behavioral changes.
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http://dx.doi.org/10.1177/2333794X211007975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040608PMC
April 2021

Comparing the Effects of Pre-loading with Gelatine 4% Plasma Volume Expander and 6% Hydroxyethyl Starch Solution Before Spinal Anaesthesia for Lower Limb Orthopaedic Surgery.

Malays J Med Sci 2020 Dec 29;27(6):68-78. Epub 2020 Dec 29.

Department of Anaesthesiology & Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Background: Hypotension is a common complication following spinal anaesthesia. The administration of intravenous fluids prior to spinal anaesthesia, known as pre-loading, has been used to offset the hypotension effect; however, the ideal fluid for pre-loading is still a matter of debate. The objective of this study was to compare the effects of Gelaspan 4% and Volulyte 6% as pre-loading fluids.

Methods: A total of 93 patients with American Society of Anaesthesiologists (ASA) physical status I or II having lower limb orthopaedic surgery under spinal anaesthesia were randomised into two groups that received either Volulyte ( 47) or Gelaspan ( 46). Before the spinal anaesthesia, these patients were pre-loaded with 500 mL of the fluid of their respective group. Blood samples were taken before pre-loading and again after spinal anaesthesia and sent for venous blood gas and electrolyte level measurement. Baseline and intraoperative records of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and the requirement of ephedrine to treat hypotension were also recorded.

Results: Both fluids could not prevent significant reductions in SBP ( 0.011), DBP ( 0.002) and MAP ( 0.001). There was also significant reduction in HR over time ( 0.001). There was no significant difference in terms of ephedrine usage between both groups. Neither Volulyte 6% nor Gelaspan 4% caused significant changes in acid-base status.

Conclusion: The use of 500 mL of either Gelaspan 4% or Volulyte 6% as pre-loading fluids did not significantly prevent the incidence of post-spinal anaesthesia hypotension following orthopaedic lower limb surgery; however, both were useful in the maintenance normal acid-base balance.
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http://dx.doi.org/10.21315/mjms2020.27.6.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785271PMC
December 2020

A case report: Community-acquired necrotizing fasciitis in a morbidly obese diabetic young man can be fatal.

IDCases 2020 2;22:e01001. Epub 2020 Nov 2.

Trauma and Critical Care Research Centre (BTCCRC),University of Queensland, Brisbane QLD 4072, Australia.

We present a case study of a 26-year-old morbidly obese man with a three-day history of right leg pain and swelling. The swelling was associated with low grade fever. He was alert and conscious upon presentation to the hospital. His physical examination showed gross swelling of the entire right lower limb with no systemic manifestations. There was no discharge and bullae from the swelling area of the leg. He had high blood sugar and was newly diagnosed with type 2 diabetes mellitus. He was diagnosed with necrotizing fasciitis. An intravenous imipenem-cilastatin 500 mg every 6 h together with clindamycin 900 mg every 8 h was started empirically. Extensive wound debridement was performed. The swab culture obtained intraoperatively grew He required an above knee amputation due to worsening infection despite wound debridement. Post-operatively, he developed acute kidney injury with severe metabolic acidosis, which required daily hemodialysis. However, the patient deteriorated due to septic shock with multi-organ failure, resulting in his death.
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http://dx.doi.org/10.1016/j.idcr.2020.e01001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649619PMC
November 2020

Lumbar tinea versicolor and spinal anaesthesia.

IDCases 2019 30;16:e00520. Epub 2019 Mar 30.

Department of Anaesthesiology, School of Medical Sciences, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.

Infection to the meningeal layer causing meningitis is one of the most feared complications of spinal anaesthesia. Anaesthetists will avoid spinal anaesthesia for those who are having skin infection at the puncture site. However in obstetric population, anaesthetist will try their best to avoid general anaesthesia due to its unwanted effects and complications. Strict and appropriate antiseptic measures such as chlorhexidine 0.5% with 70% alcohol has been suggested to reduce risk of transmission of microorganisms into subarachnoid space. We reported a parturient who had generalized tinea versicolor at the lumbar area, safely anaesthetized under spinal anaesthesia through meticulous antiseptic skin preparation who required delivery by caesarean section.
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http://dx.doi.org/10.1016/j.idcr.2019.e00520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477118PMC
March 2019

Recombinant activated factor VII (rFVIIa) in refractory haemorrhage for non-haemophiliacs: an eleven-year single-centre experience.

BMC Hematol 2018 23;18:34. Epub 2018 Nov 23.

1Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, PNG Malaysia.

Background: Massive bleeding is one of the commonest salvageable causes of death. The search for an ideal haemostatic agent during massive bleeding is still ongoing. One of the novel haemostatic medications is recombinant activated factor VII (rFVIIa). To date, the usage of rFVIIa during massive haemorrhage among non-haemophiliac patients remains off-label. The aim of this study is to report our experience in using rFVIIa to treat refractory bleeding.

Methods: Medical records of all patients treated with rFVIIa for massive bleeding over an eleven-year period in a single institution were recorded. Treatment indications, 24-h and 30-day mortality, changes in transfusion needs and coagulation profiles after rFVIIa administration were analysed.

Results: rFVIIa were administered in 76 patients. Of these, 41 (53.9%) were non-surgical bleeding, followed by 22 patients (28.9%) with trauma, other surgery bleedings in 9 patients (11.8%) and 4 patients (5.4%) with peripartum haemorrhage. Total survival rate was 78.9% within 24 h and 44.7% over 30 days. Among all these patients who had received rFVIIa due to life-threatening haemorrhage, blood and blood product requirements were significantly reduced ( < 0.001), and the coagulation profiles improved significantly ( < 0.05). Two patients with preexisting thromboembolism were given rFVIIa due to intractable bleeding, both survived. No thromboembolic events were reported after the administration of rFVIIa.

Conclusions: rFVIIa significantly improved coagulation parameters and reduced blood product requirements during refractory haemorrhage. Additionally, usage of rFVIIa in trauma and peripartum haemorrhage patients yield better outcomes than other groups of patients. However, the overall mortality rate remained high.
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http://dx.doi.org/10.1186/s12878-018-0126-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251212PMC
November 2018

Undiagnosed chicken meat aspiration as a cause of difficult-to-ventilate in a boy with traumatic brain injury.

Respir Med Case Rep 2018 8;23:93-95. Epub 2018 Jan 8.

Department of Otorhinolaryngology - Head & Neck Surgery, Universiti Sains Malaysia Health Campus, 16150, Kota Bharu, Kelantan, Malaysia.

Introduction: Bronchoscopy is a commonly used procedure in the context of aspiration in the Intensive Care Unit setting. Despite its ability to remove mucus plug and undigested gastric contents, aspiration of gastric content into the trachea is one of the most feared complications among anesthesiologist.

Discussion: The scenario is made worst if the aspiration causes acute hypoxemic respiratory failure immediately post intubation. However, in the event of desaturation, the quick decision to proceed with bronchoscopy is a challenging task to the anesthesiologist without knowing the causes.

Case Presentation: We present a case of a 12-year-old boy who had a difficult-to-ventilate scenario post transferring and immediately connected to ventilator in operation theatre (OT) from portable ventilator from the emergency department. She was successfully managed by bronchoscopy.

Conclusion: Special attention should be given to the difficult-to-ventilate scenario post intubation of traumatic brain injury patient prior to operation. Prompt diagnosis and bronchoscope-assisted removal of foreign body was found to be a successful to reduce morbidity and mortality.
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http://dx.doi.org/10.1016/j.rmcr.2018.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772507PMC
January 2018

Post-partum streptococcal toxic shock syndrome associated with necrotizing fasciitis.

IDCases 2017 27;9:91-94. Epub 2017 Jun 27.

Department of Obstetrics & Gynaecology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia.

We report a fatal case of post-partum streptococcal toxic shock syndrome in a patient who was previously healthy and had presented to the emergency department with an extensive blistering ecchymotic lesions over her right buttock and thigh associated with severe pain. The pregnancy had been uncomplicated, and the mode of delivery had been spontaneous vaginal delivery with an episiotomy. She was found to have septicemic shock requiring high inotropic support. Subsequently, she was treated for necrotizing fasciitis, complicated by septicemic shock and multiple organ failures. A consensus was reached for extensive wound debridement to remove the source of infection; however, this approach was abandoned due to the patient's hemodynamic instability and the extremely high risks of surgery. Both the high vaginal swab and blister fluid culture revealed Group A beta hemolytic streptococcus infection. Intravenous carbapenem in combination with clindamycin was given. Other strategies attempted for streptococcal toxic removal included continuous veno-venous hemofiltration and administration of intravenous immunoglobulin. Unfortunately, the patient's condition worsened, and she succumbed to death on day 7 of hospitalization.
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http://dx.doi.org/10.1016/j.idcr.2017.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506869PMC
June 2017

Non-invasive ventilation in a pregnancy with severe pneumonia.

Respir Med Case Rep 2017 8;21:161-163. Epub 2017 May 8.

Department of Radiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Introduction: Non-invasive ventilation (NIV) is not proven to be effective in treating respiratory failure in severe pneumonia. However, some clinicians nevertheless attempt NIV to indirectly deliver adequate oxygenation and avoid unnecessary endotracheal intubation.

Case Presentation: In this article, we report the case of a 24-year-old woman at 32 weeks' gestation who presented with hypoxemic respiratory failure requiring mechanical ventilation. She was successfully managed by NIV.

Discussion: However, NIV must be managed by providers who are trained in mechanical ventilation. This is of the utmost importance in avoiding any delay should the patient's condition worsen and require endotracheal intubation. Moreover, in pregnant women, the severity of illness may progress quickly due to the immunosuppression inherent in these patients.

Conclusion: Special attention should be given to the choices of invasive ventilation and NIV to manage community acquired pneumonia patients in third trimester.
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http://dx.doi.org/10.1016/j.rmcr.2017.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435593PMC
May 2017

Significance of a clean-tip catheter closed suctioning system in a high-setting ventilated, super morbidly obese patient with profuse respiratory secretions.

Respir Med Case Rep 2017 19;21:129-131. Epub 2017 Apr 19.

Department of Anesthesiology and Intensive Care, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Introduction: Closed suctioning is commonly used in the context of high-setting mechanical ventilation (MV), given its ability to prevent lung volume loss that otherwise accompanies open suctioning. However, closed suctioning systems (CSS) are not equivalent regarding components and capabilities, and thus this technique may be differentially effective to adequately clear patient secretions from an endotracheal tube (ETT), which is of paramount importance when the tube size makes the ETT particularly vulnerable to block by patient secretions.

Case Presentation: A 25-year-old super morbidly obese female (body mass index = 55 kg/meter) presented with worsening shortness of breath. For MV, pairing of a 6 mm (mm) diameter ETT to accommodate the patient's vocal cord edema, with a CSS not designed to maintain a clean catheter tip, precipitated ETT blockage and respiratory acidosis. Replacement of these devices with a 6.5 mm ETT and a CSS designed to keep the catheter tip clean resolved the complications. After use of the different ETT and CSS for approximately one week, the patient was discharged to home.

Discussion: The clean-tip catheter CSS enabled a more patent airway than its counterpart device that did not have this feature. Use of a clean-tip catheter CSS was an important care development for this patient, because this individual's super morbidly obese condition minimized tolerance for MV complications that would exacerbate her pre-existing tenuous respiratory health status.

Conclusion: Special attention should be given to the choices of ETT size and CSS to manage super morbidly obese patients who have a history of difficult airway access.
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http://dx.doi.org/10.1016/j.rmcr.2017.04.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408147PMC
April 2017

Acute bacteremic pneumonia due to melioidosis developing in the intensive care setting.

IDCases 2017 29;8:63-65. Epub 2017 Mar 29.

Department of Microbiology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia.

In Malaysia, melioidosis is commonly encountered as this infection is known as part of the endemic area for the disease. Managing cases of positive infection can involve multidisciplinary unit mainly, microbiologist, infectious disease team and intensive care as it may be quite difficult to distinguish melioidosis from a number of other diseases on the clinical setting alone. Laboratory diagnosis plays a vital role in determining the direction of management. Investigations such as culture, polymerase chain reaction (PCR) and serology should be evaluated once the disease is suspected. In this particular case, the patient is a young adult involved in a road traffic accident. Unlike any other cases with melioidosis, he had no potential risk factors which may have contributed to the severity of the disease and it is likely that the site of the accident was the source of acquisition of this gram negative bacterium.
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http://dx.doi.org/10.1016/j.idcr.2017.03.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390664PMC
March 2017

12th WINFOCUS world congress on ultrasound in emergency and critical care.

Crit Ultrasound J 2016 Sep;8(Suppl 1):12

Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.

Table Of Contents: A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Mahmoud, Abdelmoneim SuliemanA7 High-frequency ultrasound in determining the causes of acute shoulder joint painMustafa Z. MahmoudA8 Teaching WINFOCUS Ultrasound Life Support Basic Level 1 for Providers in resource-limited countriesAbbas Ali, Alrayah Mustafa, Ihab Abdelrahman, Mustafa Bahar, Osama Ali, H. Lester Kirchner, Gregor ProsenA9 Changes of arterial stiffness and endothelial function during uncomplicated pregnancyAjda Anzic, Paul LeesonA10 Cardiovascular haemodynamic properties before, during and after pregnancyAjda Anzic, Paul LeesonA11 An old man with generalized weaknessMaryam Bahreini, Fatemeh RasooliA12 Ultrasonography for non-specific presentations of abdominal painMaryam Bahreini, Houman HosseinnejadA13 Introduction of a new imaging guideline for suspected renal colic in the emergency department: effect on CT Urogram utilisationGabriel Blecher, Robert Meek, Diana Egerton-WarburtonA14 Transabdominal ultrasound screening for pancreatic cancer in Croatian military veterans: a retrospective analysis from the first Croatian veteran's hospitalEdina Ćatić Ćuti, Stanko Belina, Tihomir Vančina, Idriz KovačevićA15 The challenge of AAA: unusual case of obstructive jaundiceEdina Ćatić Ćuti, Nadan RustemovićA16 Educational effectiveness of easy-made new simulator model for ultrasound-guided procedures in pediatric patients: vascular access and foreign body managementIkwan Chang, Jin Hee Lee, Young Ho Kwak, Do Kyun KimA17 Detection of uterine rupture by point-of-care ultrasound at emergency department: a case reportChi-Yung Cheng, Hsiu-Yung Pan, Chia-Te KungA18 Abdominal probe in the hands of interns as a relevant diagnostic tool in revealing the cause of heart failureEla Ćurčić, Ena Pritišanac, Ivo Planinc, Marijana Grgić Medić, Radovan RadonićA19 Needs assessment of the potential utility of point-of-care ultrasound within the Zanzibar health systemAbiola Fasina, Anthony J. Dean, Nova L. Panebianco, Patricia S. HenwoodA20 Ultrasonographic diagnosis of tracheal compressionOliviero Fochi, Moreno Favarato, Ezio BonanomiA21 The role of ultrasound in the detection of lung infiltrates in critically ill patients: a pilot studyMarijana Grgić Medić, Ivan Tomić, Radovan RadonićA22 The SAFER Lasso; a novel approach using point-of-care ultrasound to evaluate patients with abdominal complaints in the emergency departmentYoungrock Ha, Hongchuen TohA23 Awareness and use of clinician-performed ultrasound among clinical clerkship facultyElizabeth Harmon, Wilma Chan, Cameron Baston, Gail Morrison, Frances Shofer, Nova Panebianco, Anthony J. DeanA24 Clinical outcomes in the use of lung ultrasound for the diagnosis of pediatric pneumoniasAngela Hua, Sharon Kim, James TsungA25 Effectiveness of ultrasound in hypotensive patientsIsa Gunaydin, Zeynep Kekec, Mehmet Oguzhan AyA26 Moderate-to-severe left ventricular ejection fraction related to short-term mortality of patients with post-cardiac arrest syndrome after out-of-hospital cardiac arrestJinjoo Kim, Jinhyun Kim, Gyoosung Choi, Dowon ShimA27 Usefulness of abdominal ultrasound for acute pyelonephritis diagnosis after kidney transplantationJi-Han LeeA28 Lung ultrasound for assessing fluid tolerance in severe preeclampsiaJana Ambrozic, Katja Prokselj, Miha LucovnikA29 Optic nerve sheath ultrasound in severe preeclampsiaGabrijela Brzan Simenc, Jana Ambrozic, Miha LucovnikA30 Focused echocardiography monitoring in the postoperative period for non-cardiac patientsAsta Mačiulienė, Almantas Maleckas, Algimantas Kriščiukaitis, Vytautas Mačiulis, Andrius MacasA31 POCUS-guided paediatric upper limb fracture reduction: algorithm, tricks, and tipsSharad MohiteA32 Point-of-care lung ultrasound: a good diagnostic tool for pneumonia in a septic patientZoltan Narancsik, Hugon MožinaA33 A case of undergraduate POCUS (r)evolutionSara Nikolić, Jan Hansel, Rok Petrovčič, Una Mršić, Gregor ProsenA34 The Graz Summer School for ultrasound: from first contact to bedside application: three-and-a-half-day undergraduate ultrasound training: résumé after two years of continuous developmentSimon Orlob, Markus Lerchbaumer, Niklas Schönegger, Reinhard KaufmannA35 Usefulness of point-of-care ultrasound in the emergency room in a patient with acute abdominal painAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA36 Use of bedside ultrasound in a critically ill patient. A case reportAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA37 Diagnostic yield of clinical echocardiography for the emergency physicianAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA38 Focused cardiac ultrasound in early diagnosis of type A aortic dissection with atypical presentationChun-I Pan, Hsiu-Yung Pan, Chien-Hung WuA39 Detection of imperforated hymen by point-of-care ultrasoundHsiu-yung Pan, Chia-Te KungA40 Developing a point-of-care ultrasound curriculum for pediatric nurse practitioners practicing in the pediatric emergency departmentSarah Pasquale, Stephanie J. Doniger, Sharon Yellin, Gerardo ChiricoloA41 Use of transthoracic echocardiography in emergency setting: patient with mitral valve abscessMaja Potisek, Borut Drnovšek, Boštjan LeskovarA42 A young man with syncopeFatemeh Rasooli, Maryam BahreiniA43 Work-related repetitive use injuries in ultrasound fellowsKristine Robinson, Clara Kraft, Benjamin Moser, Stephen Davis, Shelley Layman, Yusef Sayeed, Joseph MinardiA44 Lung ultrasonography in the evaluation of pneumonia in childrenIrmina Sefic Pasic, Amra Dzananovic, Anes Pasic, Sandra Vegar ZubovicA45 Central venous catheter placement with the ultrasound aid: two years' experience of the Interventional unit, Division of Intensive Care Medicine, KBC ZagrebAna Godan Hauptman, Marijana Grgic Medic, Ivan Tomic, Ana Vujaklija Brajkovic, Jaksa Babel, Marina Peklic, Radovan RadonicA46 Duplicitas casui: two patients admitted due to acute liver failureVedran Radonic, Ivan Tomic, Luka Bielen, Marijana Grgic MedicA47 A pilot survey on an understanding of Bedside Point-of-Care Ultrasound (POCUS) among medical doctors in internal medicine: exposure, perceptions, interest, and barriers to trainingPeh Wee MingA48 Unusual case of defecation syncopeNur hafiza Yezid, Fatahul Laham MohammedA49 A case report of massive pulmonary embolism; a multidisciplinary approachZainal Abidin Huda, Wan Nasarudin Wan Ismail, W.Yus Haniff W.Isa, Hashairi Fauzi, Praveena Seeva, Mohd Zulfakar Mazlan.
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http://dx.doi.org/10.1186/s13089-016-0046-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014769PMC
September 2016