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  1. Kamauzaman THT, Ngu JTH, Arithra A, Noh AYM, Siti-Azrin AH, Nor J
    Med J Malaysia, 2021 03;76(2):171-176.
    PMID: 33742624
    BACKGROUND: Maintaining good quality CPR while transporting out-of-hospital cardiac arrest patients is very challenging. We aim to determine how different ambulance speed can affect the quality of chest compression performed either manually or mechanically.

    METHODS: This was an observational manikin-based study. A total of 96 participants as well as two types of mechanical compression devices: Lucas-2 and AutoPulse, performed one minute of continuous chest compression on BT-CPEA programmed manikin while the ambulance travelled at different speeds, i.e., idle state, 30km/hr and 60km/hr. Seven outcome variables of chest compression were measured. Performance data of different groups of compressor were compared and analysed using repeated measures analysis of variance (ANOVA).

    RESULTS: In manual chest compression, significant variation were noted among different speeds in term of average compression rate (p<0.001), average compression depth (p=0.007), fraction of adequate/insufficient compression depth and fraction of normal hands positioning with p=0.018, 0.022 and 0.034 respectively. Overall, AutoPulse and Lucas-2 were not affected by ambulance speed. Lucas- 2 showed more consistent average compression rate, higher fraction of adequate compression depth and reduced fraction of insufficient compression depth as compared to manual compression with p<0.001, 0.001 and 0.043 respectively.

    CONCLUSION: In this study we found that ambulance speed significantly affected certain aspects of manual chest compression most notably compression depth, rate and hand positioning. AutoPulse and Lucas-2 can improve these aspects by providing more consistent compression rate, depth and fraction of adequate compression depth during transport.

  2. Seak YS, Nor J, Tuan Kamauzaman TH, Arithra A, Islam MA
    J Clin Med, 2021 Sep 02;10(17).
    PMID: 34501425 DOI: 10.3390/jcm10173978
    Due to overcrowding, personnel shortages, or problematic intravenous (IV) cannulation, acute pain management is often sub-optimal in emergency departments (EDs). The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of intranasal (IN) ketamine for adult acute pain in the emergency setting. We searched and identified studies up to 21 May 2021 via PubMed, Scopus, Web of Science, Cochrane Database, and Google Scholar. The random-effects model with 95% confidence intervals (CIs) was used to estimate mean differences (MDs) and odds ratios (ORs). The I2 statistic and Cochran's Q test were used to determine heterogeneity. The protocol was registered in PROSPERO (CRD42020213391). Seven randomised controlled trials were included with a total of 1760 patients. There was no significant difference in pain scores comparing IN ketamine with IV analgesics or placebo at 5 (MD 0.94, p = 0.26), 15 (MD 0.15, p = 0.74), 25 (MD 0.24, p = 0.62), 30 (MD -0.05, p = 0.87), and 60 (MD -0.42, p = 0.53) minutes. There was also no significant difference in the need for rescue analgesics between IN ketamine and IV analgesics (OR 1.66, 95% CI: 0.57-4.86, p = 0.35, I2 = 70%). Only mild adverse effects were observed in patients who received IN ketamine. Our results suggest that IN ketamine is non-inferior to IV analgesics and may have a role in acute pain management among adults in the ED.
  3. Wan Jaafar WA, Arithra A, Fauzi MH, Wan Mohamad WS, Nor J
    Med J Malaysia, 2022 Nov;77(6):704-712.
    PMID: 36448388
    INTRODUCTION: Sexual assault is a serious social problem. Due to its stigma, it is severely underreported with the survivors delay in seeking treatment. We aim to study the patterns, clinical characteristics, and time taken to manage sexual assault cases in our One Stop Crisis Centre (OSCC), and determine the factors associated with delayed presentation.

    MATERIALS AND METHODS: This was an observational case review study of all sexual assault cases from 2012-2017 at the OSCC of a suburban, tertiary hospital in Malaysia. A total of 304 cases were analysed.

    RESULTS: The median age of the survivors was 15 years old. Majority were females (n=291, 95.7%), single (n=290, 95.4%), students (n=235, 77.3%), and from low socio-economic class (n=230, 75.7%). Rape constitutes the majority (n=246, 80.6%) with 153 cases (62.1%) were statutory rape. The most common perpetrator was the victim's boyfriend (n=107, 35.2%) while only 60 cases (19.7%) involved strangers. Delayed presentations were more likely among victims who previously knew their perpetrators (AOR 2.53, 95% CI: 1.37 to 4.68, p<0.01). The median duration for management at OSCC was 6.48 hours.

    CONCLUSION: Majority of sexual assault survivors were females, teenagers, and from low socio-economic class. Rape, mainly statutory rape, made the majority of cases. Therefore, sexual and safety education targeting primary intervention should be started early. Multidisciplinary teams must work together to optimise the management of sexual assault.

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