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Quality Indicators of Pediatric Asthma Care in the Emergency Department; a Systematic Review and Meta-Analysis

Alkhazali IE, Alrawashdeh A, Hashairi Fauzi M, Nik Ab Rahman NH

Arch Acad Emerg Med, 2024;12(1):e26.
PMID: 38572217 DOI: 10.22037/aaem.v12i1.2214

INTRODUCTION: The quality of healthcare for pediatric asthma patients in the emergency department (ED) is of growing importance. This systematic review aimed to identify and describe existing quality indicators (QIs) designed for use in the ED for pediatric asthma care.
METHODS: We systematically searched three main electronic databases in May 2023 for all English-language qualitative and quantitative publications that suggested or described at least one QI related to pediatric asthma care in the ED. Two reviewers independently selected the included studies and extracted data on study characteristics, all relevant QIs reported, and the rates of compliance with these indicators when available. The identified QIs were classified according to Donabedian healthcare quality framework and the Institute of Medicine (IOM) framework. When feasible, we aggregated the compliance rates for the QIs reported in observational studies using random effects models. The quality assessment of the included studies was performed using various Joanna Briggs Institute (JBI) tools.
RESULTS: We identified twenty studies, including six expert panels, 13 observational studies, and one trial. Together, these studies presented 129 QIs for use in EDs managing pediatric asthma. Among these QIs, 66 were pinpointed by expert panel studies, whereas 63 were derived from observational studies. Within the Donabedian framework, most indicators (86.8%) concentrated on the process of care. In contrast, within the Institute of Medicine (IOM) domain, the predominant focus was on indicators related to effectiveness and safety. Observational studies reported varying compliance rates for the 36 QIs identified in the expert studies. The included studies showed a wide range of bias risks, suggesting potential methodological variances.
CONCLUSIONS: A significant number of QIs in pediatric asthma care have been proposed or documented in literature. Although most of these indicators prioritize the process of care, there is a conspicuous absence of outcome and structure indicators. This meta-analysis uncovered significant disparities in compliance to the identified QIs, highlighting the urgent necessity for targeted interventions to enhance pediatric asthma care in ED.
The use of an In House Scoring System Scale versus Glasgow Coma Scale in non-traumatic altered states of consciousness patients: can it be used for triaging patients in Southeast Asian developing countries?

Maheswaran M, Adnan WA, Ahmad R, Ab Rahman NH, Naing NN, Abdullah J

Southeast Asian J Trop Med Public Health, 2007 Nov;38(6):1126-40.
PMID: 18613557

Non-traumatic Altered States of Consciousness (ASC) are a non-specific consequence of various etiologies, and are normally monitored by Glasgow Coma Scale (GCS). The GCS gives varriable results among untrained emergency medicine personel in developing countries where English is not the first language. An In House Scoring System (IHSS) scale was made by the first author for the purpose of triaging so as to quickly asses patients when seen by medical personel. This IHSS scale was compared to the GCS to determine it's specificity and sensitivity in the accident and emergency department (ED) of Hospital University Sains Malaysia (HUSM). All patients with non-traumatic ASC were selected by purposive sampling according to pre-determined criteria. Patients were evaluated by the two systems, IHSS and GCS, by emergency physicians who were on call. Patient demographics, clinical features, investigations, treatment given and outcomes were collected and followed for a period of 14 days. A total of 221 patients with non-traumatic ASC were studied, 54.3% were males. The mean age of the patients was 56 years old. The mean overall GCS score on presentation to the ED was 10.3. The mean duration of ASC was 11.6 hours. One hundred thirty patients (58.8%) experienced ASC secondary to general or focal cerebral disorders. The mortality rate was 40.3% 2 weeks after the ED visit. Fifty-four point three percent of the patients were awake and considered to have good outcomes while 45.7% of the patients had poor outcomes (comatose or dead) 2 weeks after the ED visit. The mean overall GCS score, verbal and motor subscores as well as the IHSS had significantly decreased (worsened) after treatment in the ED. A poor IHSS scale, hypertension, current smoking, abnormal pupillary reflexes and acidosis were associated with a worse 2-week outcome. The mean age and WBC count was lower and the mean overall GCS score and eye, verbal and motor subscores were higher as well as those having a lower IHSS scale for the good outcome category. Multivariate analysis revealed that smokers and hypertensives were at higher risk for a poor outcome. Higher eye scores on the GCS were associated fewer poor outcomes. There was significant agreement between the IHSS scale and GCS scores in the assessment of non-traumatic ASC. The sensitivity and specificity of the IHSS score versus GCS were 71.9% and 100.0%, respectively.
Innovative biocatalyst synthesis of pectinolytic enzymes by cross-linking strategy: Potentially immobilised pectinases for the production of pectic-oligosaccharides from pectin

Abd Rahman NH, Rahman RA, Rahmat Z, Jaafar NR, Puspaningsih NNT, Illias RM

Int J Biol Macromol, 2024 Jan;256(Pt 1):128260.
PMID: 38000618 DOI: 10.1016/j.ijbiomac.2023.128260

Pectinases are outstanding multienzymes, which have the potential to produce new emerging pectic-oligosaccharides (POS) via enzymatic hydrolysis of pectin. However, free pectinase is unable to undergo repeated reaction for the production of POS. This study proposed a sustainable biocatalyst of pectinases known as cross-linked pectinase aggregates (CLPA). Pectinase from Aspergillus aculeatus was successfully precipitated using 2 mg/mL pectinase and 60 % acetone for 20 min at 20 °C, which remained 36.3 % of its initial activity. The prepared CLPA showed the highest activity recovery (85.0 %), under the optimised conditions (0.3 % (v/v) starch and glutaraldehyde mixture (St/Ga), 1.5: 1 of St/Ga, 25 °C, 1.5 h). Furthermore, pectin-degrading enzymes from various sources were used to produce different CLPA. The alteration of pectinase secondary structure gave high stability in acidic condition (pH 4), thermostability, deactivation energy and half-life, and improved storage stability at 4 °C for 30 days. Similarly to their free counterpart, the CLPA exhibited comparable enzymatic reaction kinetics and could be reused eight times with approximately 20 % of its initial activity. The developed CLPA does not only efficaciously produced POS from pectin as their free form, but also exhibited better operational stability and reusability, making it more suitable for POS production.
Fulltext Emergency medical services key performance measurement in Asian cities

Rahman NH, Tanaka H, Shin SD, Ng YY, Piyasuwankul T, Lin CH, et al.

Int J Emerg Med, 2015;8:12.
PMID: 25932052 DOI: 10.1186/s12245-015-0062-7

One of the key principles in the recommended standards is that emergency medical service (EMS) providers should continuously monitor the quality and safety of their services. This requires service providers to implement performance monitoring using appropriate and relevant measures including key performance indicators. In Asia, EMS systems are at different developmental phases and maturity. This will create difficultly in benchmarking or assessing the quality of EMS performance across the region. An attempt was made to compare the EMS performance index based on the structure, process, and outcome analysis.
Fulltext Intravenous parecoxib sodium as an analgesic alternative to morphine in acute trauma pain in the emergency department

Baharuddin KA, Rahman NH, Wahab SF, Halim NA, Ahmad R

Int J Emerg Med, 2014;7(1):2.
PMID: 24386899 DOI: 10.1186/1865-1380-7-2

BACKGROUND: Parecoxib sodium is the first parenteral COX-2 inhibitor used for pain management licensed for postoperative pain. However, no study has assessed the usage of parecoxib for acute traumatic pain in the emergency department (ED). The objective of this study was to investigate a potential alternative analgesic agent in the ED by determining the mean reduction of pain score between acute traumatic pain patients who were administered with intravenous (IV) parecoxib sodium versus IV morphine sulfate. The onset of perceptible analgesic effect and side effects were also evaluated.
METHODS: A randomized, double-blinded study comparing IV parecoxib 40 mg versus IV morphine at 0.10 mg/kg was conducted in adult patients presented with acute traumatic pain with numeric rating scale (NRS) of 6 or more within 6 hours of injury. Patients were randomized using a computer-generated randomization plan. Drug preparation and dispensing were performed by a pharmacist. Periodic assessment of blood pressure, pulse rate, oxygen saturation, and NRS were taken at 0, 5, 15, and 30 minute intervals after the administration of the study drug. The primary outcome was the reduction of NRS. Side effect and drug evaluation was conducted within 30 minutes of drug administration.
RESULTS: There was no statistically significant difference in the reduction of mean NRS between patients in the IV parecoxib group or IV morphine group (P = 0.095). The mean NRS for patients treated with IV morphine were 7.1 at 0 minutes, 4.5 at 5 minutes, 3.1 at 15 minutes, and 2.0 at 30 minutes. Whereas mean NRS for patients who received IV parecoxib were 7.8 at 0 minutes, 5.7 at 5 minutes, 4.7 at 15 minutes, and 3.9 at 30 minutes. The onset of perceptible analgesic effects could be seen as early as 5 minutes. Dizziness was experienced in 42.9% of patients who received IV morphine compared to none in the parecoxib group.
CONCLUSIONS: There was non-significant trend toward superiority of IV morphine over IV parecoxib. Looking at its effectiveness and the lack of opioid-related side-effects, the usage of IV parecoxib sodium may be extended further to a variety of cases in the ED.
Study site: Emergency department, Hospital Universiti Sains Malaysia (HUSM)
Fulltext Assessing patient pain scores in the emergency department

Baharuddin KA, Mohamad N, Nik Abdul Rahman NH, Ahmad R, Nik Him NA

Malays J Med Sci, 2010 Jan;17(1):17-22.
PMID: 22135521 MyJurnal

BACKGROUND: Pain management in the Emergency Department is challenging. Do we need to ask patients specifically about their pain scores, or does our observational scoring suffice? The objective of this study was to determine the inter-rater differences in pain scores between patients and emergency healthcare (EHC) providers. Pain scores upon discharge or prior to ward admission were also determined.
METHODS: A prospective study was conducted in which patients independently rated their pain scores at primary triage; EHC providers (triagers and doctors) separately rated the patients' pain scores, based on their observations.
RESULTS: The mean patient pain score on arrival was 6.8 ± 1.6, whereas those estimated by doctors and triagers were 5.6±1.8 and 4.3±1.9, respectively. There were significant differences among patients, triagers and doctors (P< 0.001). There were five conditions (soft tissue injury, headache, abdominal pain, fracture and abscess/cellulites) that were significantly different in pain scores between patients and EHC providers (P<0.005). The mean pain score of patients upon discharge or admission to the ward was 3.3 ± 1.9.
CONCLUSIONS: There were significant differences in mean patient pain scores on arrival, compared to those of doctors and triagers. Thus, asking for pain scores is a very important step towards comprehensive pain management in emergency medicine.
KEYWORDS: emergency medicine; neurosciences; pain assessment; pain management; pain score
Study site: Emergency department, Hospital Kuala Lumpur
Fulltext Cardiopulmonary resuscitation : the short comings in Malaysia

Sheng CK, Zakaria MI, Rahman NH, Jaalam K, Adnan WA

Malays J Med Sci, 2008 Jan;15(1):49-51.
PMID: 22589616

This short review explores the current status of cardiopulmonary resuscitation in Malaysia and highlights some of the factors that have a negative impact on its rate of success. Absence of a unifying body such as a national resuscitation council results in non-uniformity in the practice and teaching of cardiopulmonary resuscitation. In the out-of-hospital setting, there is the lack of basic skills and knowledge in performing bystander cardiopulmonary resuscitation as well as using an automated external defibrillator among the Malaysian public. The ambulance response time is also a significant negative factor. In the in-hospital setting, often times, resuscitation is first attended by junior doctors or nurses lacking in the skill and experience needed. Resuscitation trolleys were often inadequately equipped.
A study on the magnitude and the effectiveness of the observation ward of hospital universiti sains malaysia

Ahmad R, Nik Abdul Rahman NH, Mohd Noh AY, Nik Abdul Rahman NA, Mohamad N, Baharudin KA

Malays J Med Sci, 2010 Jan;17(1):38-43.
PMID: 22135524 MyJurnal

BACKGROUND: The observation ward (OW) allows patients to be reassessed and monitored before deciding either to admit or to discharge them. This is a six-month descriptive cross-sectional study conducted in the observation ward of the Emergency Department (ED) of Hospital Universiti Sains Malaysia, Kelantan. The objective of this study was to examine the demographic characteristics and clinical profiles of adult observed patients and to determine the effectiveness of OW management.
METHODS: Patients were selected randomly by convenience sampling. One hundred and twenty-four patients were included in the study. The mean age was 40.3 ± 18.5 years (95% CI: 37.2 to 43.8).
RESULTS: Among the common clinical problems were abdominal discomfort (23%), diarrhoea and vomiting (13%) and fever (13%). Reasons for OW admission included diagnostic uncertainty (63%) and short course of treatment (33%). The mean length of stay was 4.1 ± 1.8 hours (95% CI=3.8 to 4.4 hours). Most of the patients (85%) were discharged.
CONCLUSIONS: The OW of HUSM is effective in managing adult patients as determined by the hospitalisation rate and the length of stay.
Fulltext Induction of cytotoxicity by Bruguiera gymnorrhiza in human breast carcinoma (MCF-7) cell line via activation of the intrinsic pathway

Chaudhry GE, Rahman NH, Sevakumaran V, Ahmad A, Mohamad H, Zafar MN, et al.

J Adv Pharm Technol Res, 2020 10 10;11(4):233-237.
PMID: 33425710 DOI: 10.4103/japtr.JAPTR_81_20

Breast cancer is among the frequently occurring cancer worldwide. The foremost underline aim of this study was to determine the growth inhibitory effect along with mechanistic study of a Bruguiera gymnorrhiza extract on MCF-7. The cytotoxicity activity was determined by using the MTS assay. Butanol extract exhibited the maximum cytotoxicity activity against the MCF-7 cells with IC50 of 3.39 μg/mL, followed by diethyl ether and methanol extract (IC50 at 16.22 μg/mL and 37.15 μg/mL, respectively) at 72 h. The DeadEndTM Colorimetric Apoptosis Detection System confirmed the induction of apoptosis (via DNA fragmentation) in MCF-7 cells. Both butanol and diethyl ether extracts of B. gymnorrhiza significantly increase the caspase-3 level. However, the diethyl ether extract induced higher caspase-9 levels compared to caspase-8, suggesting that the intrinsic pathway was the major route in the process of apoptosis. Thin-layer chromatography profiling demonstrated the presence of phenolic, terpene, and alkaloid compounds in crude methanol, diethyl ether, and butanol extracts. The phytochemicals present in the extracts of B. gymnorrhiza might have the potential to be a future therapeutic agent against breast cancer.
Novel cross-linked enzyme aggregates of levanase from Bacillus lehensis G1 for short-chain fructooligosaccharides synthesis: Developmental, physicochemical, kinetic and thermodynamic properties

Abd Rahman NH, Jaafar NR, Abdul Murad AM, Abu Bakar FD, Shamsul Annuar NA, Md Illias R

Int J Biol Macromol, 2020 Sep 15;159:577-589.
PMID: 32380107 DOI: 10.1016/j.ijbiomac.2020.04.262

Short-chain fructooligosaccharides (scFOSs) can be produced from the levan hydrolysis using levanase. Levanase from Bacillus lehensis G1 (rlevblg1) is an enzyme that specifically converts levan to scFOSs. However, the use of free levanase presents a lack of stability and reusability, thus hindering the synthesis of scFOSs for continuous reactions. Here, CLEAs for rlevblg1 were prepared and characterized. Cross-linked levanase aggregates using glutaraldehyde (CLLAs-ga) and bovine albumin serum (CLLAs-ga-bsa) showed the best activity recovery of 92.8% and 121.2%, respectively. The optimum temperature of CLLAs-ga and CLLAs-ga-bsa was increased to 35 °C and 40 °C, respectively, from its free rlevblg1 (30 °C). At high temperature (50 °C), the half-life of CLLAs-ga-bsa was higher than that of free rlevblg1 and CLLAs-ga. Both CLLAs exhibited higher stability at pH 9 and pH 10. Hyperactivation of CLLAs-ga-bsa was achieved with an effectiveness factor of more than 1 and with improved catalytic efficiency. After 3 h reaction, CLLAs-ga-bsa produced the highest total scFOSs yield of 35.4% and total sugar of 60.4% per gram levan. Finally, the reusability of CLLAs for 8 cycles with more than 50% activity retained makes them as a potential synthetic catalyst to be explored for scFOSs synthesis.
Efficient substrate accessibility of cross-linked levanase aggregates using dialdehyde starch as a macromolecular cross-linker

Abd Rahman NH, Jaafar NR, Shamsul Annuar NA, A Rahman R, Abdul Murad AM, El-Enshasy HA, et al.

Carbohydr Polym, 2021 Sep 01;267:118159.
PMID: 34119133 DOI: 10.1016/j.carbpol.2021.118159

Cross-linked enzyme aggregates (CLEAs) are influenced by mass diffusion limitations such as the degree of molecular cross-linking attained, which affects substrate accessibility. Thus, this study seeks to improve substrate accessibility using macromolecular cross-linkers in cross-linked levanase aggregates (CLLAs) formation for levan-type fructooligosaccharides (L-FOS) production. Dialdehyde starch-tapioca (DAST) was successfully developed and used to cross-link levanase to form CLLAs-D and with bovine serum albumin (BSA) to form CLLAs-DB which showed activity recoveries of 65.6% and 81.6%, respectively. After cross-linking, the pH (6-10) and thermal stability (30-40 °C) increased, and organic solvent tolerance resulted in the activation of CLLAs. Likewise, CLLAs-DB had higher substrate affinity and accessibility and a higher effectiveness factors than CLLAs-D. The total L-FOS yield of CLLAs-DB (78.9% (w/v)) was higher than that of CLLAs-D (62.4% (w/v)). Therefore, as a cross-linker, DAST may have application prospects as a promising and green biocatalyst for product formation.
Fulltext Effects of home visits on quality of life among older adults: a systematic review protocol

Tay YL, Abu Bakar NS, Tumiran R, Ab Rahman NH, Mohd Ma'amor NAA, Yau WK, et al.

Syst Rev, 2021 Dec 06;10(1):307.
PMID: 34872589 DOI: 10.1186/s13643-021-01862-8

BACKGROUND: Home visiting services for older adults have been offered for decades to maintain and promote health and independent functioning, thus enhancing quality of life. Previous systematic reviews have provided a mixed picture of the benefits of home visiting programmes in older adults, primarily because of heterogeneity in study designs, targeted populations, and intervention strategies. These reviews may also become out of date; thus, an updated synthesis of relevant studies is warranted. Our objective is to perform a systematic review of recently published primary studies on the effectiveness of multi-professional home visits on quality of life among older adults.
METHODS: We will perform a comprehensive search for studies investigating the effect of a multi-professional home visit approach on quality of life among older adults. We will conduct the literature search in selected electronic databases and relevant research websites from January 2010 onwards. We will include randomised controlled trials (RCTs), cluster randomised controlled trials (cluster RCTs), and observational studies that enrolled older adults without dementia over 60 years old, along with studies involving multi-professional preventive-promotive home visit approaches not related to recent hospital discharge. We will report our planned review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will retrieve and record relevant data in a standardised data extraction form and evaluate the quality of the included articles using the Cochrane risk of bias tool and the quality assessment tool for studies with diverse designs (QATSDD). Where appropriate, outcomes will be pooled for meta-analysis using a random-effects model. The main outcomes include quality of life, incidence of falls, depression, dementia, and emergency department admissions.
DISCUSSION: This review may provide evidence for the effectiveness of home visits in improving older adults' quality of life. It will potentially benefit health care professionals, policymakers, and researchers by facilitating the design and delivery of interventions related to older generations and improve service delivery in future.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021234531 .
Fulltext The impact of radiofrequency exposure on Aedes aegypti (Diptera: Culicidae) development

Nik Abdull Halim NMH, Mohd Jamili AF, Che Dom N, Abd Rahman NH, Jamal Kareem Z, Dapari R

PLoS One, 2024;19(2):e0298738.
PMID: 38412167 DOI: 10.1371/journal.pone.0298738

INTRODUCTION: Wireless communication connects billions of people worldwide, relying on radiofrequency electromagnetic fields (RF-EMF). Generally, fifth-generation (5G) networks shift RF carriers to higher frequencies. Although radio, cell phones, and television have benefitted humans for decades, higher carrier frequencies can present potential health risks. Insects closely associated with humans (such as mosquitoes) can undergo increased RF absorption and dielectric heating. This process inadvertently impacts the insects' behaviour, morphology, and physiology, which can influence their spread. Therefore, this study examined the impact of RF exposure on Ae. aegypti mosquitoes, which are prevalent in indoor environments with higher RF exposure risk. The morphologies of Ae. aegypti eggs and their developments into Ae. aegypti mosquitoes were investigated.
METHODS: A total of 30 eggs were exposed to RF radiation at three frequencies: baseline, 900 MHz, and 18 GHz. Each frequency was tested in triplicate. Several parameters were assessed through daily observations in an insectarium, including hatching responses, development times, larval numbers, and pupation periods until the emergence of adult insects.
RESULTS: This study revealed that the hatching rate for the 900 MHz group was the highest (79 ± 10.54%) compared to other exposures (p = 0.87). The adult emergence rate for the 900 MHz group was also the lowest at 33 ± 2.77%. A significant difference between the groups was demonstrated in the statistical analysis (p = 0.03).
CONCLUSION: This work highlighted the morphology sensitivity of Ae. aegypti eggs and their developments in the aquatic phase to RF radiation, potentially altering their life cycle.
Post-impact disaster surveillance - a medical reconnaissance team at tsunami-struck sri lanka

Mohamad N, Abu Bakar NH, Mohamed NA, Baharudin KA, Noh AY, Ahmad R, et al.

Malays J Med Sci, 2007 Jan;14(1):79-83.
PMID: 22593659 MyJurnal

Emergency Medicine and Disaster Medicine are two specialties which are similar in the multidisciplinary involvement during the acute phase of the disaster. Recently, there was an increase in the number of disasters in the world but not many physicians are familiar with the principles for dealing with such situations, the unique organizational demands, coordination and the urgent need for medical assistance and relief. This case report delineates our experiences at a tsunami disaster area and the approach to setting up a medical relief team in the affected area. A medical reconnaissance team comprising of an emergency doctor from Hospital Universiti Sains Malaysia (H.U.S.M) and two MERCY Malaysia members was assembled. The team flew to Colombo on day 5 after the tsunami with medical supplies and related materials. The mission started from December 31(st) 2004 until January 8(th) 2005. Our surveillance area covered the Southern and Eastern Province with a total distance of 1700 km along the coast. The strategies employed during this medical reconnaissance included risk analysis, devising a resources matrix, developing lines of communication and rapport with other relief teams, Sri Lankan government agencies, and local and international non-government organizations. As a result, our team was able to set up a medical relief camp and distribute the relief items to the tsunami victims. In conclusion, the Disaster Emergency Medical Assistant Team (DEMAT) from H.U.S.M and MERCY Malaysia were able to set up and provide medical relief with our limited resources to a large scale disaster situation.
Characteristics and outcomes of young adults who suffered an out-of-hospital cardiac arrest (OHCA)

Chia MY, Lu QS, Rahman NH, Doctor NE, Nishiuchi T, Leong BS, et al.

Resuscitation, 2017 02;111:34-40.
PMID: 27923113 DOI: 10.1016/j.resuscitation.2016.11.019

BACKGROUND: There is paucity of data examining the incidence and outcomes of young OHCA adults. The aim of this study is to determine the outcomes and characteristics of young adults who suffered an OHCA and identify factors that are associated with favourable neurologic outcomes.
METHODS: All EMS-attended OHCA adults between the ages of 16 and 35 years in the Pan-Asian Resuscitation Outcomes Study (PAROS) registry were analysed. The primary outcome was favourable neurologic outcome (Cerebral Performance Category 1 or 2) at hospital discharge or at 30th day post OHCA if not discharged. Regression analysis was performed to identify factors associated with favourable neurologic outcomes.
RESULTS: 66,780 OHCAs were collected between January 2009 and December 2013; 3244 young OHCAs had resuscitation attempted by emergency medical services (EMS). 56.8% of patients had unwitnessed arrest; 47.9% were of traumatic etiology. 17.2% of patients (95% CI: 15.9-18.5%) had return of spontaneous circulation; 7.8% (95% CI: 6.9-8.8%) survived to one month; 4.6% (95% CI: 4.0-5.4%) survived with favourable neurologic outcomes. Factors associated with favourable neurologic outcomes include witnessed arrest (adjusted RR=2.42, p-value<0.0001), bystander CPR (adjusted RR=1.57, p-value=0.004), first arrest shockable rhythm (adjusted RR=27.24, p-value<0.0001), and cardiac etiology (adjusted RR=3.99, p-value<0.0001).
CONCLUSIONS: OHCA among young adults are not uncommon. Traumatic OHCA, occurring most frequently in young adults had dismal prognosis. First arrest rhythms of VF/VT/unknown shockable rhythm, cardiac etiology, bystander-witnessed arrest, and bystander CPR were associated with favourable neurological outcomes. The results of the study would be useful for planning preventive and interventional strategies, improving EMS, and guiding future research.
Fulltext Mathematical epidemiologic and simulation modelling of first wave COVID-19 in Malaysia

Ariffin MRK, Gopal K, Krishnarajah I, Che Ilias IS, Adam MB, Arasan J, et al.

Sci Rep, 2021 Oct 20;11(1):20739.
PMID: 34671103 DOI: 10.1038/s41598-021-99541-0

Since the first coronavirus disease 2019 (COVID-19) outbreak appeared in Wuhan, mainland China on December 31, 2019, the geographical spread of the epidemic was swift. Malaysia is one of the countries that were hit substantially by the outbreak, particularly in the second wave. This study aims to simulate the infectious trend and trajectory of COVID-19 to understand the severity of the disease and determine the approximate number of days required for the trend to decline. The number of confirmed positive infectious cases [as reported by Ministry of Health, Malaysia (MOH)] were used from January 25, 2020 to March 31, 2020. This study simulated the infectious count for the same duration to assess the predictive capability of the Susceptible-Infectious-Recovered (SIR) model. The same model was used to project the simulation trajectory of confirmed positive infectious cases for 80 days from the beginning of the outbreak and extended the trajectory for another 30 days to obtain an overall picture of the severity of the disease in Malaysia. The transmission rate, β also been utilized to predict the cumulative number of infectious individuals. Using the SIR model, the simulated infectious cases count obtained was not far from the actual count. The simulated trend was able to mimic the actual count and capture the actual spikes approximately. The infectious trajectory simulation for 80 days and the extended trajectory for 110 days depicts that the inclining trend has peaked and ended and will decline towards late April 2020. Furthermore, the predicted cumulative number of infectious individuals tallies with the preparations undertaken by the MOH. The simulation indicates the severity of COVID-19 disease in Malaysia, suggesting a peak of infectiousness in mid-March 2020 and a probable decline in late April 2020. Overall, the study findings indicate that outbreak control measures such as the Movement Control Order (MCO), social distancing and increased hygienic awareness is needed to control the transmission of the outbreak in Malaysia.
Fulltext A multicenter controlled trial on knowledge and attitude about cardiopulmonary resuscitation among secondary school children in Malaysia

Rahman NH, Keng Sheng C, Kamauzaman TH, Md Noh AY, Wahab SF, Zaini IZ, et al.

Int J Emerg Med, 2013;6(1):37.
PMID: 24135122 DOI: 10.1186/1865-1380-6-37

We performed a multicenter controlled trial to assess the knowledge and attitude (KA) about cardiopulmonary resuscitation (CPR) among secondary school children in a district in Malaysia.
Fulltext The record-setting flood of 2014 in kelantan: challenges and recommendations from an emergency medicine perspective and why the medical campus stood dry

Baharuddin KA, Abdull Wahab SF, Nik Ab Rahman NH, Nik Mohamad NA, Tuan Kamauzaman TH, Md Noh AY, et al.

Malays J Med Sci, 2015 Mar-Apr;22(2):1-7.
PMID: 26023289

Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a 'tsunami-like disaster'. Hospital Universiti Sains Malaysia was the only fully functioning hospital in the state and had to receive and manage cases from the hospitals and clinics throughout Kelantan. The experiences, challenges, and recommendations resulting from this disaster are highlighted from an emergency medicine perspective so that future disaster preparedness is truly a preparation. The history of how the health campus was constructed with the collaboration of Perunding Alam Bina and Perkins and Willis of Chicago is elaborated.
Ambulance services at hospital universiti sains malaysia and hospital kota bharu: a retrospective study of calls

Shah Che Hamzah MS, Ahmad R, Nik Abdul Rahman NH, Pardi KW, Jaafar N, Wan Adnan WA, et al.

Malays J Med Sci, 2005 Jul;12(2):34-42.
PMID: 22605956

This retrospective study attempted to identify the pattern of ambulance calls for the past two years at the Hospital Universiti Sains Malaysia (HUSM) and Hospital Kota Bharu (HKB). This study will provide a simple method of acquiring information related to ambulance response time (ART) and to test whether it met the international standards and needs of the client. Additionally, this paper takes into account the management of emergency calls. This included ambulance response time, which was part of Emergency Medical Services (EMS) episode: onset of ART, which started when details like phone number of the caller, exact location of the incident and the nature of the main complaint had been noted. ART ended when the emergency team arrived at the scene of incident. Information regarding ambulance calls from the record offices of HUSM and HKB was recorded for the year 2001 and 2002, tabulated and analyzed. There was a significant difference in the total number of calls managed by HUSM and HKB in the year 2001. It was noted that 645 calls were managed by HUSM while 1069 calls were recorded at HKB. In the year 2002, however, HUSM led with 613 extra numbers of calls as compare to HKB with 1193 numbers of calls. The pattern of ambulance calls observed is thought to possibly be influenced by social activities like local festivities, school holidays and the seasons. Further, it is observed that no studies were previously undertaken to compare the ART at both the HUSM and HKB to that of the international standards. In fact, a literature review undertaken so far showed no similar studies have been done for the whole Malaysia.
Refinement of Synthetization Parameters for High Laccase-Like Activity of Imidazole-Copper (II) Nitrate Trihydrate Nanozyme Towards an Efficient Biomimetic Nanozyme

Mat Alewi NA, Rahman RA, Md Illias R, Jaafar NR, Abd Rahman NH, Chia BJ, et al.

Appl Biochem Biotechnol, 2025 Mar 26.
PMID: 40138139 DOI: 10.1007/s12010-025-05229-w

Laccase's industrial application is hindered by its sensitivity and low stability to extreme conditions. To overcome these limitations, the development of biomimetic nanozymes is gaining momentum. Nevertheless, developing multifunctional nanozymes with high laccase-like activity poses several challenges. This study focused on optimizing the synthesis of imidazole-copper (II) nitrate trihydrate (I-Cu) nanozymes and characterizing its physicochemical properties. Key synthesis parameters (precursor amount, incubation time, and oven temperature) were optimized. I-Cu nanozymes were synthesized in a Teflon-lined autoclave via water-induced precipitation of Cu2+ and imidazole, mimicking the N-Cu coordination found in laccase's active sites. Initial screenings revealed the superior catalytic activity of I-Cu nanozymes synthesized using methanol compared to ethanol, and a smaller nano-scale size than laccase. FTIR analysis confirmed the presence of similar chemical components as laccase (C44H69N11O20), verifying I-Cu nanozyme's capability to degrade phenolic compounds, and imidazole did not decompose throughout the synthesis process. The optimized I-Cu nanozyme demonstrated higher catalytic activity (6.569 UA), oxidation efficiency (Vmax of 0.00893 mM/min and Km of 2.4020 mM), and greater stability under varying pH, temperature, and storage conditions, compared to laccase. Conclusively, the optimized I-Cu nanozyme, with a 6.00-fold increase in catalytic activity compared to previous studies, as well as 1.69-fold higher Km, and 2.08-fold higher Vmax compared to laccase, shows promise as a wastewater treatment alternative. Its enhanced performance, achieved with fewer precursors through synthesis optimization, highlights the potential of lesser-known biomimetic nanozymes and underscores the importance of refining the synthesis parameters.

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