Publications by authors named "Wan Mohd Nazaruddin Wan Hassan"

24 Publications

  • Page 1 of 1

Quantum and Electromagnetic Fields in Our Universe and Brain: A New Perspective to Comprehend Brain Function.

Brain Sci 2021 Apr 28;11(5). Epub 2021 Apr 28.

Department of Physics, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia.

The concept of wholeness or oneness refers to not only humans, but also all of creation. Similarly, consciousness may not wholly exist inside the human brain. One consciousness could permeate the whole universe as limitless energy; thus, human consciousness can be regarded as limited or partial in character. According to the limited consciousness concept, humans perceive projected waves or wave-vortices as a waveless item. Therefore, human limited consciousness collapses the wave function or energy of particles; accordingly, we are only able to perceive them as particles. With this "limited concept", the wave-vortex or wave movement comes into review, which also seems to have a limited concept, i.e., the limited projected wave concept. Notably, this wave-vortex seems to embrace photonic light, as well as electricity and anything in between them, which gives a sense of dimension to our brain. These elements of limited projected wave-vortex and limitless energy (consciousness) may coexist inside our brain as electric (directional pilot wave) and quantum (diffused oneness of waves) brainwaves, respectively, with both of them giving rise to one brain field. Abnormality in either the electrical or the quantum field or their fusion may lead to abnormal brain function.
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http://dx.doi.org/10.3390/brainsci11050558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146693PMC
April 2021

A Clinical Test for a Newly Developed Direct Brain Cooling System for the Injured Brain and Pattern of Cortical Brainwaves in Cooling, Noncooling, and Dead Brain.

Ther Hypothermia Temp Manag 2021 Jan 29. Epub 2021 Jan 29.

Collaborative Microelectronic Design Excellence Center (CEDEC), Universiti Sains Malaysia, Bayan Lepas, Malaysia.

To ensure the direct delivery of therapeutic hypothermia at a selected constant temperature to the injured brain, a newly innovated direct brain cooling system was constructed. The practicality, effectiveness, and safety of this system were clinically tested in our initial series of 14 patients with severe head injuries. The patients were randomized into two groups: direct brain cooling at 32°C and the control group. All of them received intracranial pressure (ICP), focal brain oxygenation, brain temperature, and direct cortical brainwave monitoring. The direct brain cooling group did better in the Extended Glasgow Outcome Scale at the time of discharge and at 6 months after trauma. This could be owing to a trend in the monitored parameters; reduction in ICP, increment in cerebral perfusion pressure, optimal brain redox regulation, near-normal brain temperature, and lessening of epileptic-like brainwave activities are likely the reasons for better outcomes in the cooling group. Finally, this study depicts interesting cortical brainwaves during a transition time from being alive to dead. It is believed that the demonstrated cortical brainwaves follow the principles of quantum physics.
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http://dx.doi.org/10.1089/ther.2020.0033DOI Listing
January 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

Comparison of the Baska mask and the i-gel supraglottic airway devices in patients undergoing elective surgery.

Anaesthesiol Intensive Ther 2020 ;52(5):383-388

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

Introduction: The Baska mask and i-gel are two new types of second-generation supraglottic airway devices. The aim of this study was to compare these two devices in terms of quality of insertion, quality of ventilation and post-insertion complications.

Material And Methods: A total of 80 adult patients who were scheduled for elective surgery under general anaesthesia were randomised to two groups: Group BM: Baska mask (n = 40) and Group IG: i-gel (n = 40). The assessment focused on ease of insertion, number of attempts, insertion time, number of corrective manoeuvres, oropharyngeal leak pressure, tidal volume, peak airway pressure (PAP) and post-insertion complications.

Results: Group IG showed a significantly shorter median insertion time (13.3 [interquartile range, IQR 7.8] vs. 17.0 [IQR 9.6] s; P < 0.001), a higher percentage in the 'very easy' ease of insertion category (62.5% vs. 10.0%; P < 0.001), a higher percentage in the no corrective manoeuvre category (92.5% vs. 72.5%; P = 0.003) and a higher percentage in the no post-operative throat pain category (67.5% vs. 32.5%; P = 0.011) than Group BM. However, Group BM showed a significantly higher generated PAP than Group IG (12.7 [1.8] and 11.5 [2.2] cm H2O, respectively; P = 0.010). There were no significant differences in other parameters.

Conclusions: The i-gel was better than the Baska mask in terms of ease of insertion, speed of insertion, fewer corrective manoeuvres and less post-operative throat pain. However, the Baska mask had a better cuff seal, as shown by a higher generated PAP.
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http://dx.doi.org/10.5114/ait.2020.101407DOI Listing
January 2020

Comparison of the Parker flex tip and the unoflex reinforced endotracheal tube for orotracheal fibreoptic intubation in simulated difficult intubation patients.

Anaesthesiol Intensive Ther 2020 ;52(5):377-382

Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia (USM), Kubang Kerian, Kelantan, Malaysia.

Introduction: The choice of endotracheal tube (ETT) is important for successful orotracheal fibreoptic intubation (OFI). The aim of this study was to compare the use of the Parker flex tip (PFT) with the unoflex reinforced (UFR) ETT during OFI.

Material And Methods: A total of 58 patients who underwent elective surgery under general anaesthesia were randomised to two ETT groups, the PFT group (n = 29) and the UFR group (n = 29), for OFI in simulated difficult intubation patients using a rigid cervical collar. After successful standardised induction and relaxation, OFI and railroading of selected ETT were subsequently performed by a similarly experienced practitioner. Ease of insertion, degree of manipulation, time to successful intubation, post-intubation complications and haemodynamic changes were recorded for both groups.

Results: he percentage of easy intubation was comparable between both groups with a slightly higher percentage in the UFR group than the PFT group (69.0% vs. 62.0%; P = 0.599). Degree of manipulation was also comparable between the two groups; the percentage of cases in which manipulation was not required was slightly higher in the UFR group than the PFT group (69.0% vs. 62.1%; P = 0.849). Time to successful intubation was also comparable between the groups, although the time was slightly shorter for the UFR group than the PFT group (56.9 s ± 39.7 s vs. 63.9 s ± 36.9 s; P = 0.488). There were also no significant differences in other parameters.

Conclusions: The Parker flex tip ETT was comparable to the unoflex reinforced ETT for OFI in simulated difficult airway patients.
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http://dx.doi.org/10.5114/ait.2020.101387DOI Listing
January 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

COVID-19 Pandemic and Its Impact on Neurosurgery Practice in Malaysia: Academic Insights, Clinical Experience and Protocols from March till August 2020.

Malays J Med Sci 2020 Oct 27;27(5):141-195. Epub 2020 Oct 27.

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

The newly discovered coronavirus disease 2019 (COVID-19) is an infectious disease introduced to humans for the first time. Following the pandemic of COVID-19, there is a major shift of practices among surgical departments in response to an unprecedented surge in reducing the transmission of disease. With pooling and outsourcing of more health care workers to emergency rooms, public health care services and medical services, further in-hospital resources are prioritised to those in need. It is imperative to balance the requirements of caring for COVID-19 patients with imminent risk of delay to others who need care. As Malaysia now approaches the recovery phase following the pandemic, the crisis impacted significantly on neurosurgical services throughout the country. Various emergency measures taken at the height of the crisis may remain as the new normal in the provision of neurosurgical services and practices in Malaysia. The crisis has certainly put a strain on the effective delivery of services and as we approach the recovery era, what may have been a strain may prove to be a silver lining in neurosurgical services in Malaysia. The following details are various measures put in place as the new operational protocols for neurosurgical services in Malaysia.
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http://dx.doi.org/10.21315/mjms2020.27.5.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605837PMC
October 2020

Challenges Faced During the Ventilation of a Child With Bronchobiliary Fistula: A Case Report.

A A Pract 2020 Jul;14(9):e01281

From the Department of Anaesthesiology & Intensive Care, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Hepatoblastoma is the most frequently occurring malignant tumor of the liver in children (ages ≤5 years). The formation of bronchobiliary fistula is a rare complication. We present a case report that describes the associated anesthetic challenges that we encountered for the treatment of this pathology.
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http://dx.doi.org/10.1213/XAA.0000000000001281DOI Listing
July 2020

Anastomotic Leak after Bariatric Surgery from a Critical Care Perspective: A Lesson Shared.

Malays J Med Sci 2018 Sep 30;25(5):158-159. Epub 2018 Oct 30.

Department of Anaesthesiology and Critical Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Anastomotic leak after bariatric surgery is a rare complication with a recent prevalence ranging from 0.8% to 1.5%. The complication nevertheless can result in morbidity and even mortality. The purpose of this paper is to present a patient who suffered from an anastomotic leak presenting 2 days after laparoscopic sleeve gastrectomy in our intensive care unit. Review of the current literature regarding this complication from critical care perspective is also attempted.
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http://dx.doi.org/10.21315/mjms2018.25.5.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419880PMC
September 2018

Language Mapping in Awake Surgery: Report of Two Cases with Review of Language Networks.

Asian J Neurosurg 2018 Apr-Jun;13(2):507-513

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

The role of language in communication plays a crucial role in human development and function. In patients who have a surgical lesion at the functional language areas, surgery should be intricately planned to avoid incurring further morbidity. This normally requires extensive functional and anatomical mappings of the brain to identify regions that are involved in language processing and production. In our case report, regions of the brain that are important for language functions were studied before surgery by employing (a) extraoperative methods such as functional magnetic resonance imaging, transmagnetic stimulation, and magnetoencephalography; (b) during the surgery by utilizing intraoperative awake surgical methods such as an intraoperative electrical stimulation; and (c) a two-stage surgery, in which electrical stimulation and first mapping are made thoroughly in the ward before second remapping during surgery. The extraoperative methods before surgery can guide the neurosurgeon to localize the functional language regions and tracts preoperatively. This will be confirmed using single-stage intraoperative electrical brain stimulation during surgery or a two-stage electrical brain stimulation before and during surgery. Here, we describe two cases in whom one has a superficial lesion and another a deep-seated lesion at language-related regions, in which language mapping was done to preserve its function. Additional review on the neuroanatomy of language regions, language network, and its impairment was also described.
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http://dx.doi.org/10.4103/ajns.AJNS_176_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898145PMC
April 2018

Comparison of the Effects of Dexmedetomidine on the Induction of Anaesthesia Using Marsh and Schnider Pharmacokinetic Models of Propofol Target-Controlled Infusion.

Malays J Med Sci 2018 Feb 28;25(1):24-31. Epub 2018 Feb 28.

Department of Anaesthesiology, School of Medical Sciences, Jalan Sultanah Zainab II, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Background: The study aimed to determine the effects of dexmedetomidine on the induction of anaesthesia using different models (Marsh and Schnider) of propofol target-controlled infusion (TCI).

Methods: Sixty-four patients aged 18-60 years, American Society of Anaesthesiologists (ASA) class I-II who underwent elective surgery were randomised to a Marsh group ( = 32) or Schnider group ( = 32). All the patients received a 1 μg/kg loading dose of dexmedetomidine, followed by TCI anaesthesia with remifentanil at 2 ng/mL. After the effect-site concentration (Ce) of remifentanil reached 2 ng/mL, propofol TCI induction was started. Anaesthesia induction commenced in the Marsh group at a target plasma concentration (Cpt) of 2 μg/mL, whereas it started in the Schnider group at a target effect-site concentration (Cet) of 2 μg/mL. If induction was delayed after 3 min, the target concentration (Ct) was gradually increased to 0.5 μg/mL every 30 sec until successful induction. The Ct at successful induction, induction time, Ce at successful induction and haemodynamic parameters were recorded.

Results: The Ct for successful induction in the Schnider group was significantly lower than in the Marsh group (3.48 [0.90] versus 4.02 [0.67] μg/mL; = 0.01). The induction time was also shorter in the Schnider group as compared with the Marsh group (134.96 [50.91] versus 161.59 [39.64]) sec; = 0.02). There were no significant differences in haemodynamic parameters and Ce at successful induction.

Conclusion: In the between-group comparison, dexmedetomidine reduced the Ct requirement for induction and shortened the induction time in the Schnider group. The inclusion of baseline groups without dexmedetomidine in a four-arm comparison of the two models would enhance the validity of the findings.
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http://dx.doi.org/10.21315/mjms2018.25.1.4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862048PMC
February 2018

The First Awake Clipping of a Brain Aneurysm in Malaysia and in ASEAN: Achieving International Standards.

Malays J Med Sci 2018 Feb 28;25(1):1-4. Epub 2018 Feb 28.

Department of Anaesthesia, School of Medical Sciences, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia.

World-renowned neurosurgeon, Professor Saleem Abdulrauf, has been featured in several medical journals for his successful "Awake Brain Aneurysm Surgery". Regarded as a "world first", this surgery, involves clipping un-ruptured brain aneurysms while patients are awake. Only one or two neurosurgery centres worldwide are capable of this. Performing the surgery while the patient is awake lowers risks of brain ischemia with neurological deficits and ventilator associated morbidities. The technique has been viewed as the start of a new era in brain surgery. Physicians from the Universiti Sains Malaysia (USM) School of Medical Sciences, at the Health Campus in Kelantan, headed by Professor Dr Zamzuri Idris (neurosurgeon) and Dr Wan Mohd Nazaruddin Wan Hassan (neuroanaesthetist), recently performed a similar procedure, the first such surgery in Malaysia and Southeast Asia. The USM team can therefore be considered to be among the first few to have done this brain surgery and achieved successful patient outcomes.
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http://dx.doi.org/10.21315/mjms2018.25.1.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862045PMC
February 2018

Balanced Fluid Versus Saline-Based Fluid in Post-operative Severe Traumatic Brain Injury Patients: Acid-Base and Electrolytes Assessment.

Malays J Med Sci 2017 Oct 26;24(5):83-93. Epub 2017 Oct 26.

Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Background: Normal saline (NS) is a common fluid of choice in neurosurgery and neuro-intensive care unit (ICU), but it does not contain other electrolytes and has the potential to cause hyperchloremic metabolic acidosis with prolonged infusion. These problems may be reduced with the availability of balanced fluid (BF), which becomes a more physiological isotonic solution with the presence of complete electrolyte content. This study aimed to compare the changes in electrolytes and acid-base between NS and BF (Sterofundin® ISO) therapy for post-operative severe traumatic brain injury (TBI) patients in neuro-ICU.

Methods: Sixty-six severe TBI patients who required emergency craniotomy or craniectomy and were planned for post-operative ventilation were randomised into NS ( 33) and BF therapy groups ( 33). The calculation of maintenance fluid given was based on the Holliday-Segar method. The electrolytes and acid-base parameters were assessed at an 8 h interval for 24 h. The data were analysed using repeated measures ANOVA.

Results: The NS group showed a significant lower base excess (-3.20 versus -1.35, 0.049), lower bicarbonate level (22.03 versus 23.48 mmol/L, 0.031), and more hyperchloremia (115.12 versus 111.74 mmol/L, 0.001) and hypokalemia (3.36 versus 3.70 mmol/L, 0.001) than the BF group at 24 h of therapy. The BF group showed a significantly higher level of calcium (1.97 versus 1.79 mmol/L, 0.003) and magnesium (0.94 versus 0.80 mmol/L, 0.001) than the NS group at 24 h of fluid therapy. No significant differences were found in pH, pCO, lactate, and sodium level.

Conclusion: BF therapy showed better effects in maintaining higher electrolyte parameters and reducing the trend toward hyperchloremic metabolic acidosis than the NS therapy during prolonged fluid therapy for postoperative TBI patients.
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http://dx.doi.org/10.21315/mjms2017.24.5.9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772818PMC
October 2017

Target-controlled Infusion Propofol Versus Sevoflurane Anaesthesia for Emergency Traumatic Brain Surgery: Comparison of the Outcomes.

Malays J Med Sci 2017 Oct 26;24(5):73-82. Epub 2017 Oct 26.

Department of Anaesthesiology, School of Medical Sciences, Jalan Sultanah Zainab II, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Background: The choice of anaesthetic techniques is important for the outcome of traumatic brain injury (TBI) emergency surgery. The objective of this study was to compare patient outcomes for target-controlled infusion (TCI) of propofol and sevoflurane anaesthesia.

Methods: total of 110 severe TBI patients, aged 18-60, who underwent emergency brain surgery were randomised into Group T (TCI) ( = 55) and Group S (sevoflurane) ( = 55). Anaesthesia was maintained in Group T with propofol target plasma concentration of 3-6 μg/mL and in Group S with minimum alveolar concentration (MAC) of sevoflurane 1.0-1.5. Both groups received TCI remifentanil 2-8 ng/mL for analgesia. After the surgery, patients were managed in the intensive care unit and were followed up until discharge for the outcome parameters.

Results: Demographic characteristics were comparable in both groups. Differences in Glasgow Outcome Scale (GOS) score at discharge were not significant between Group T and Group S ( = 0.25): the percentages of mortality (GOS 1) [27.3% versus 16.4%], vegetative and severe disability (GOS 2-3) [29.1% versus 41.8%] and good outcome (GOS 4-5) [43.6% versus 41.8%] were comparable in both groups. There were no significant differences in other outcome parameters.

Conclusion: TCI propofol and sevoflurane anaesthesia were comparable in the outcomes of TBI patients after emergency surgery.
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http://dx.doi.org/10.21315/mjms2017.24.5.8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772817PMC
October 2017

Epilepsy Surgery in Hospital Universiti Sains Malaysia: Our Experiences since 2004.

Malays J Med Sci 2017 Dec 29;24(6):97-102. Epub 2017 Dec 29.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.

Epilepsy surgery has been performed by a few centres in Malaysia, including Hospital Universiti Sains Malaysia (HUSM). To date, a total of 15 patients have undergone epilepsy surgery in HUSM. The epilepsy surgery included anterior temporal lobectomy (ATL) with amygdalohippocampectomy (AH) and Vagal nerve stimulation (VNS). The surgical outcomes of the patients were assessed using the International League Against Epilepsy (ILAE) outcome scale. The ILAE scores for patients who underwent ATL with AH were comparatively better than those who underwent VNS. One of the patient who underwent ATL with AH and frontal lesionectomy was found to have psychosis during follow up. Epilepsy surgery has proven to be an important treatment for medically resistant epilepsy. Thus it is important to raise public awareness regarding epilepsy and its treatment.
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http://dx.doi.org/10.21315/mjms2017.24.6.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771521PMC
December 2017

Comparison of Single-Shot Intrathecal Morphine Injection and Continuous Epidural Bupivacaine for Post-Operative Analgaesia after Elective Abdominal Hysterectomy.

Malays J Med Sci 2017 Dec 29;24(6):21-28. Epub 2017 Dec 29.

Department of Anaesthesiology, School of Medical Sciences, Jalan Sultanah Zainab II, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Background: Abdominal hysterectomy (AH) is painful. The aim of this study was to compare intrathecal morphine (ITM) and epidural bupivacaine (EB) for their analgaesia effectiveness after this surgery.

Methods: Thirty-two patients undergoing elective AH were randomised into Group ITM (ITM 0.2 mg + 2.5 mL 0.5% bupivacaine) ( = 16) and Group EB (0.25% bupivacaine bolus + continuous infusion of 0.1% bupivacaine-fentanyl 2 μg/mL) ( = 16).The procedure was performed before induction, and all patients subsequently received standard general anaesthesia. Both groups were provided patient-controlled analgaesia morphine (PCAM) as a backup. Visual analogue scale (VAS) scores, total morphine consumption, hospital stay duration, early mobilisation time and first PCAM demand time were recorded.

Results: The median VAS score was lower for ITM than for EB after the 1st hour [1.0 (IqR 1.0) versus 3.0 (IqR 3.0), < 0.001], 8th hour [1.0 (IqR 1.0) versus 2.0 (IqR 1.0), = 0.018] and 16th hour [1.0 (IqR1.0) versus (1.0 (IqR 1.0), = 0.006]. The mean VAS score at the 4th hour was also lower for ITM [1.8 (SD 1.2) versus 2.9 (SD 1.4), = 0.027]. Total morphine consumption [11.3 (SD 6.6) versus 16.5 (SD 4.8) mg, = 0.016] and early mobilisation time [2.1 (SD 0.3) versus 2.6 (SD 0.9) days, = 0.025] were also less for ITM. No significant differences were noted for other assessments.

Conclusions: The VAS score was better for ITM than for EB at earlier hours after surgery. However, in terms of acceptable analgaesia (VAS ≤ 3), both techniques were comparable over 24 hours.
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http://dx.doi.org/10.21315/mjms2017.24.6.3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771512PMC
December 2017

Life-Threatening Dyskalaemia after Barbiturate Coma Therapy: The Strategy of Management.

Malays J Med Sci 2017 Mar 14;24(2):100-105. Epub 2017 Apr 14.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Barbiturate coma therapy (BCT) is a treatment option that is used for refractory intracranial hypertension after all other options have been exhausted. Although BCT is a brain protection treatment, it also has several side effects such as hypotension, hepatic dysfunction, renal dysfunction, respiratory complications and electrolyte imbalances. One less concerning but potentially life-threatening complication of BCT is dyskalaemia. This complication could present as severe refractory hypokalaemia during the therapy with subsequent rebound hyperkalaemia after cessation of the therapy. Judicious potassium replacement during severe refractory hypokalaemia and gradual cessation of the therapy to prevent rebound hyperkalaemia are recommended strategies to deal with this complication, based on previous case series and reports. In this case report, we show that these strategies were applicable in improving severe hypokalaemia and preventing sudden, life-threatening rebound hyperkalaemia. However, even with use of these strategies, BCT patients could still present with mild, asymptomatic hyperkalaemia.
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http://dx.doi.org/10.21315/mjms2017.24.2.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566068PMC
March 2017

Deep Brain Stimulation (DBS) for Movement Disorders: An Experience in Hospital Universiti Sains Malaysia (HUSM) Involving 12 Patients.

Malays J Med Sci 2017 Mar 14;24(2):87-93. Epub 2017 Apr 14.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Deep brain stimulation (DBS) was first introduced in 1987 to the developed world. As a developing country Malaysia begun its movement disorder program by doing ablation therapy using the Radionics system. Hospital Universiti Sains Malaysia a rural based teaching hospital had to take into consideration both health economics and outcomes in the area that it was providing neurosurgical care for when it initiated its Deep Brain Stimulation program. Most of the patients were from the low to medium social economic groups and could not afford payment for a DBS implant. We concentrated our DBS services to Parkinson's disease, Tourette's Syndrome and dystonia patients who had exhausted medical therapy. The case series of these patients and their follow-up are presented in this brief communication.
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http://dx.doi.org/10.21315/mjms2017.24.2.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566066PMC
March 2017

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

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

Passive Warming using a Heat-Band versus a Resistive Heating Blanket for the Prevention of Inadvertent Perioperative Hypothermia during Laparotomy for Gynaecological Surgery.

Malays J Med Sci 2016 Mar;23(2):28-37

Department of Anaesthesia and Intensive Care Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Background: Inadvertent perioperative hypothermia (IPH) is a common problem, despite advancements in a variety of warming systems. The use of a resistive heating blanket (RHB) is a common but costly approach to patient warming. We have introduced the use of a heat-band in our centre as a cost-effective alternative to the RHB for patient warming. The efficacy of the heat-band in preventing IPH during laparotomy for gynaecological surgeries was compared with that of the RHB.

Methods: Thirty-two patients undergoing surgeries under combined general-epidural anaesthesia, with an expected duration of surgery of 2-4 h, were randomised to receive either the heat-band or RHB. The core body temperatures of the two groups were compared at several perioperative times, in addition to the incidence of post-anaesthesia shivering, time to extubation and intraoperative blood loss.

Results: The core body temperatures were comparable between the two groups in the pre-operative period, immediately after the induction of anaesthesia and skin incision, 1 h after the incision, at the time of complete skin closing, at extubation, upon arrival to the recovery room and 1 h post-operatively. There were no significant between-group differences in the incidence of post-anaesthesia shivering, time to extubation and intra-operative blood loss.

Conclusion: The heat-band is as effective as the RHB in preventing IPH and its complications in gynaecological laparotomies.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976711PMC
March 2016

A rare complication of tracheal intubation.

Indian J Crit Care Med 2016 May;20(5):299-301

Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Accidental endobronchial intubation is a frequent complication in critically ill patients requiring tracheal intubation (TI). If such complication occurs, it is more often the right main bronchus that is intubated due to anatomical reasons. Left main bronchus (LMB) intubation is rare. Here, we report a case with auscultatory, bronchoscopic, and radiographic evidence of accidental LMB intubation in a pregnant woman with dengue shock syndrome. We highlight this case to increase awareness about this possible-but-rare complication of TI.
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http://dx.doi.org/10.4103/0972-5229.182209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876653PMC
May 2016

Refractory hypokalemia during barbiturate coma therapy used for treating refractory intracranial hypertension in traumatic brain injury.

Asian J Neurosurg 2015 Jan-Mar;10(1):59

Department of Neurosciences, School of Medical Sciences and P3 Neuro Center, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Barbiturate coma therapy (BCT) is a choice treatment for refractory intracranial hypertension after all surgical or medical managements have failed to control the intracranial pressure (ICP). It helps to reduce cerebral blood flow, cerebral metabolic rate of oxygen consumption and ICP. However, this therapy can also cause many complications. One of the underreported, but life-threatening complications is refractory hypokalemia, which can lead to subsequent rebound hyperkalemia after sudden cessation. We report our experience of managing unusual complication of refractory hypokalemia during BCT with thiopentone in postdecompressive craniectomy patient.
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http://dx.doi.org/10.4103/1793-5482.151528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352648PMC
March 2015

The history of awake craniotomy in hospital universiti sains malaysia.

Malays J Med Sci 2013 Oct;20(5):67-9

Department of Anaesthesiology & Intensive Care, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Awake craniotomy is a brain surgery performed on awake patients and is indicated for certain intracranial pathologies. These include procedures that require an awake patient for electrocorticographic mapping or precise electrophysiological recordings, resection of lesions located close to or in the motor and speech of the brain, or minor intracranial procedures that aim to avoid general anaesthesia for faster recovery and earlier discharge. This type of brain surgery is quite new and has only recently begun to be performed in a few neurosurgical centres in Malaysia. The success of the surgery requires exceptional teamwork from the neurosurgeon, neuroanaesthesiologist, and neurologist. The aim of this article is to briefly describe the history of awake craniotomy procedures at our institution.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957358PMC
October 2013
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