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Fulltext Clinical impact of implementation of a dengue outbreak preparedness and contingency plan in a tertiary hospital

Suraya Hanim Abdullah Hashim, Liew K. Y., Sahadevan M., Shoib M. S., Zainal Abidin H., Abidin N. N., et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):67-67.
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Introduction:Increasing number and the complexity of dengue cases pose a great challenge. The dengue outbreak preparedness and contingency plan is a series of collective intervention or polices put into place via collective agreement between administrative, Medical, Emergency Department and Intensive Care Unit (ICU). The aim of this paper is to evaluate the impact implementation of a dengue contingency plan on the clinical outcome of dengue cases. Methods: Implementation of the dengue outbreak preparedness and contingency plan was commenced in 2017. A pre-intervention (2017) and post-intervention (2018) retrospective review of mortality cases and referral to ICU were undertaken. The interventions included mandatory fast review by Emergency Physician, Medical Physi-cian and Anaesthesist in Emergency Department for ill patients (Dengue Care Pathway), cohorting dengue patient to one ward with mandatory monitoring and review system, clinical management adhering to the Clinical Practice Guideline of Management of Dengue Infection in Adults (2015), referring ill patients to ICU, deployment of nurses and experienced doctors to the dengue ward based on ratio of staff to patients, increasing number of doctors on-call at the dengue ward and a dengue bed manager system led by the Matron and Sisters. The plan was activated by mutual agreement between the Head of Medical Department and the Hospital Director. Results: There was a marked increment of admission of dengue cases into intensive care unit by 59% either directly from emergency department or the dengue wards in 2018 compared to 2017. The mortality rates reduced significantly from 5.4 deaths for every 1000 admission in 2017 to 3.3 in 2018. This is a reduction 2.1 death for every 1000 dengue admission. Conclusion:The implementation of the dengue outbreak preparedness and contingency plan aided the team to provide best care and practice in dengue management especially in the severely ill.
Ethical deliberations on video recording of patients in healthcare facilities- a scoping review

Zainal Abidin H, Razali HYH

Med J Malaysia, 2024 Nov;79(6):785-793.
PMID: 39614799

INTRODUCTION: The modern healthcare landscape with the emergence of video recording, has found applications in research, training, audit, quality improvement, and safety surveillance. Notably, advancements in camera technology have led to the development of smaller, lighter devices, enabling discreet usage and enhancing usability in clinical settings. Its adoption represents more than technological advancement; it entails a complex balance between improving patient care and respecting individual rights. Ethical considerations surrounding patient privacy, ownership of recordings, patient autonomy and healthcare provider responsibilities have garnered significant attention. In Malaysia, the adoption of video recordings in clinical interactions and consultations has been accepted in research, training and several medical fields. However, recording patients during clinical practice can be challenging, as there are scarce ethical guidelines for its practice. This review aims to gather and categorise the ethical challenges associated with recording videos of patients in healthcare facilities globally and identify research gaps specific to Malaysian healthcare settings. By addressing the ethical challenges globally, we can ensure the responsible and ethical use of video recording technology to enhance patient care while respecting individual rights.
MATERIALS AND METHODS: Articles from Scopus, Web of Science and PubMed databases were collected following PRISMA guidelines. Key term searches included "video recording," "ethical issues," and "patients." Inclusion criteria encompassed video and audio recording interactions between healthcare providers and patients in any clinical setting, final publications, and the English language. Exclusions were imaging or photography recording and non-clinical settings. The qualitative synthesis involved iterative reading, thematic coding analysis in Excel, and specific analysis to address the research question.
RESULTS: Initial database search, identified 363 records. After screening, a total of 22 articles were included for analysis. Five themes were identified from the selected articles: i) privacy and confidentiality, ii) informed consent, iii) beneficence and non-maleficence, iv) integrity and professionalism and v) governance, policy and legal framework. Majority of the reviewed articles concentrate on backgrounds within the fields of psychiatry, neurology and surgical-based medical specialities. The identified themes have demonstrated consistency across the majority of the articles analysed. Among the most frequently discussed themes, it's evident that ethical concerns extend beyond just the patient's realm to encompass the responsibilities of the healthcare provider (HCP) as well. Both patients and HCPs have their respective rights and responsibilities in ensuring the ethical use of video recording in clinical settings.
CONCLUSION: In conclusion, this review has highlighted the multifaceted ethical challenges surrounding the integration of video recording in healthcare settings. While video recording offers benefits for patient care, education, and quality improvement, its adoption presents complexities. Ethical dilemmas concerning patient privacy, consent, and data management must be addressed alongside practical barriers like technological limitations and resource constraints. Collaboration among healthcare providers, policymakers, and stakeholders is crucial to navigating these challenges ethically. Future research should delve into patient perspectives, develop ethical guidelines, and assess the impact of video recording on patient outcomes. By understanding these implications, healthcare can effectively leverage video recording to improve patient care while maintaining ethical standards.
Total parenteral nutrition (TPN) and steroid usage in the management of hyperemesis gravidarum

Subramaniam R, Soh EB, Dhillon HK, Abidin HZ

Aust N Z J Obstet Gynaecol, 1998 Aug;38(3):339-41.
PMID: 9761170
Fulltext Cutaneous manifestation mimicking Stevens-Johnson syndrome in a critically ill patient: looks similar but totally different

Lim JA, Chong SE, Zainal Abidin H, Hassan MH

Hong Kong Med J, 2017 12;23(6):653.e3-4.
PMID: 29226836 DOI: 10.12809/hkmj165051
Fulltext A practical genome-enabled legitimacy assay for oil palm breeding and seed production

Teh CK, Lee HL, Abidin H, Ong AL, Mayes S, Chew FT, et al.

BMC Plant Biol, 2019 Nov 05;19(1):470.
PMID: 31690276 DOI: 10.1186/s12870-019-2062-x

BACKGROUND: Legitimacy in breeding and commercial crop production depends on optimised protocols to ensure purity of crosses and correct field planting of material. In oil palm, the presence of three fruit forms permits these assumptions to be tested, although only after field planting. The presence of incorrect fruit forms in a cross is a clear sign of illegitimacy. Given that tenera forms produce 30% more oil for the same weight of fruit as dura, the presence of low levels of dura contamination can have major effect during the economic lifespan of an oil palm, which is around 25 years. We evaluated two methods for legitimacy test 1) The use of SHELL markers to the gene that determines the shell-thickness trait 2) The use of SNP markers, to determine the legitimacy of the cross.
RESULTS: Our results indicate that the SHELL markers can theoretically reduce the major losses due to dura contamination of tenera planting material. However, these markers cannot distinguish illegitimate tenera, which reduces the value of having bred elite tenera for commercial planting and in the breeding programme, where fruit form is of limited utility, and incorrect identity could lead to significant problems. We propose an optimised approach using SNPs for routine quality control.
CONCLUSIONS: Both dura and tenera contamination can be identified and removed at or before the nursery stage. An optimised legitimacy assay using SNP markers coupled with a suitable sampling scheme is now ready to be deployed as a standard control for seed production and breeding in oil palm. The same approach will also be an effective solution for other perennial crops, such as coconut and date palm.
Fulltext Non-invasive ventilation in a pregnancy with severe pneumonia

Mazlan MZ, Ali S, Zainal Abidin H, Mokhtar AM, Ab Mukmin L, Ayub ZN, et al.

Respir Med Case Rep, 2017;21:161-163.
PMID: 28560149 DOI: 10.1016/j.rmcr.2017.05.002

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.
Fulltext Off-Pump Coronary Artery Bypass Grafting Surgery: A Valuable 2-Day Experience

Ishak NH, Chong SE, Zainal Abidin H, Mamat AZ, Mokthar AM, Dimon MZ

Malays J Med Sci, 2022 Dec;29(6):158-163.
PMID: 36818905 DOI: 10.21315/mjms2022.29.6.15

Currently, coronary artery disease (CAD) has been identified as the leading cause of mortality in Malaysia and in other countries worldwide. Genetic predisposition and comorbidities such as hypertension and diabetes mellitus, gender, lifestyle, and several other risk factors can contribute to the development of CAD. Pharmacological and surgical treatments play a vital role in improving the quality of life of patients with CAD. New surgical techniques and continuous interventions have been introduced to improve the treatment outcome. Recently, cardiothoracic teams from Universiti Teknologi MARA (UiTM) and Universiti Sains Malaysia (USM) have conducted a 2-day live workshop on off-pump coronary artery bypass (OPCAB) surgery. In this brief communication, we share the highlights and clinical tips of the OPCAB surgery gained from the collaboration.
Challenges Faced During the Ventilation of a Child With Bronchobiliary Fistula: A Case Report

Zainal Abidin H, Mohd Lutfi N, Phang YY, Zarina FMI, Hamidah I, Saedah A, et al.

A A Pract, 2020 Jul;14(9):e01281.
PMID: 32909720 DOI: 10.1213/XAA.0000000000001281

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

Mazlan MZ, Zainal Abidin H, Wan Hassan WMN, Nik Mohamad NA, Salmuna ZN, Ibrahim K, et al.

IDCases, 2020;22:e01001.
PMID: 33204633 DOI: 10.1016/j.idcr.2020.e01001

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

Zainal Abidin H, Omar SC, Mazlan MZ, Hassan MH, Isa R, Ali S, et al.

Glob Pediatr Health, 2021;8:2333794X211007975.
PMID: 33889680 DOI: 10.1177/2333794X211007975

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

Zainal Abidin H, Muhd Besari A, Nadarajan C, Wan Shukeri WF, Mazlan MZ, Chong SE, et al.

IDCases, 2017;8:63-65.
PMID: 28417070 DOI: 10.1016/j.idcr.2017.03.010

In Malaysia, melioidosis is commonly encountered as this infection is known as part of the endemic area for the disease. Managing cases of positive Burkholderia pseudomallei 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.