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  1. Hisamuddin NA, Hamzah MS, Holliman CJ
    J Emerg Med, 2007 May;32(4):415-21.
    PMID: 17499697
    Once a very slowly developing country in a Southeast Asia region, Malaysia has undergone considerable change over the last 20 years after the government changed its focus from agriculture to developing more industry and technology. The well-known "Vision 2020," introduced by the late Prime Minister, set a target for the nation to be a developed country in the Asia region by the year 2020. As the economy and standard of living have improved, the demand from the public for a better health care system, in particular, emergency medical services (EMS), has increased. Despite the effort by the government to improve the health care system in Malaysia, EMS within the country are currently limited, best described as being in the "developing" phase. The Ministry of Health, Ministry of Education, Civil Defense, and non-governmental organizations such as Red Crescent and St. John's Ambulance, provide the current ambulance services. At the present time, there are no uniform medical control or treatment protocols, communication systems, system management, training or education, or quality assurance policies. However, the recent development of and interest in an Emergency Medicine training program has gradually led to improved EMS and prehospital care.
  2. Nik Hisamuddin NAR, Wan Mohd Zahiruddin WN, Mohd Yazid B, Rahmah S
    Med J Malaysia, 2019 Oct;74(5):418-424.
    PMID: 31649219
    INTRODUCTION: The purpose of this study was to investigate the effect of hyperbaric oxygen therapy (HBOT) towards diabetic foot ulcer (DFU) patients in addition to the standard wound care management.

    METHODS: Fifty-eight diabetic patients with ulcers at Wagner Grade 2 and above involved in this study after presented at two study centres of tertiary teaching hospitals. The assigned patients received conventional wound care with additional HBOT given at 2.4 ATA for 90 minutes. Patients in the control group who received conventional wound care only were treated and observed for 30 days. The progress of wound healing was observed and measured at day 0, 10, 20 and 30 of study. The data collected were analysed using SPSS software (ver. 22) to study the association of HBOT towards healing of the diabetic foot ulcers.

    RESULTS: Repeated Measures ANOVA analysis with Greenhouse-Geisser correction indicated that the means of wound size over time points (Day 0, 10, 20 and 30) among patients under HBOT group were statistically significantly different [F(1,61)=30.86, p<0.001)] compared to conventional therapy group. Multiple logistic regression analysis showed that HBOT group has nearly 44 times higher odds to achieve at least 30% wound size reduction within the study period (95%CI: 7.18, 268.97, p<0.001).

    CONCLUSION: The results obtained in this study indicated that as an adjunctive therapy to conventional wound care, HBOT affected the rate of healing in diabetic foot ulcers significantly in terms of wound size reduction when compared to administering the conventional wound care alone.

  3. Shaik Farid AW, Mohd Hashairi F, Nik Hisamuddin NA, Chew KS, Rashidi A
    Med J Malaysia, 2013 Dec;68(6):465-8.
    PMID: 24632914 MyJurnal
    According to the class of hypovolaemic shock, a blood loss less than 750 ml is not associated with the physiological changes. As a result it may cause a delay in fluid resuscitation. We postulate inferior vena cava (IVC) diameter reduction in inspiration and expiration may resemble the significant volume of blood loss in a healthy adult. We conducted a study to examine the changes of the IVC diameter pre and post blood donation.The inferior vena cava diameter during inspiration (IVCi) and expiration (IVCe) were measured using ultrasound (GE HEALTH) in supine position before and after blood donation of 450 ml. Paired t-test and Wilcoxin rank test were used to analyse the data. Forty two blood donors enrolled during the study period. The mean age of blood donors was 32.3 +/- 8.9 and mainly male blood donors. The mean IVCe of pre and post blood donation was 18.5 +/- 6.2 mm (95%CI 18.23, 18.74) and 16.6 +/- 6.6 mm (95%CI 16.35, 16.76) respectively. Meanwhile, the mean IVCi of pre and post blood donation was 17.1 +/- 8.6 mm (95%CI 16.89,17.30) and 15.6 +/- 6.6 mm (95%CI 15.43,15.81) respectively. The mean difference of IVCe pre and post blood donation was 1.9 +/- 0.5 mm (95%CI 1.75, 2.13) (p<0.001). In contrast, the mean difference of IVCi pre and post blood donation was 1.5 +/- 0.5 mm (95%CI 1.34, 1.68) (p<0.001). As a conclusion, the measurement of IVC diameter by ultrasound can predict the volume of blood loss in simulated type 1 hypovolaemia patient.
  4. Chew KS, Mohd Hashairi F, Jusoh AF, Aziz AA, Nik Hisamuddin NAR, Siti Asma H
    Med J Malaysia, 2013 Aug;68(4):323-5.
    PMID: 24145260 MyJurnal
    Although a vital test, blood culture is often plagued with the problem of contamination and false results, especially in a chaotic emergency department setting. The objectives of this pilot study is to find out the level of understanding among healthcare staffs in emergency department, Hospital Universiti Sains Malaysia (HUSM) regarding good blood culture sampling practice.
  5. Nik Hisamuddin NA, Rashidi A, Chew KS, Kamaruddin J, Idzwan Z, Teo AH
    Int J Emerg Med, 2009;2(2):83-9.
    PMID: 20157449 DOI: 10.1007/s12245-009-0088-9
    BACKGROUND: The usual method for initial assessment of an acute asthma attack in the emergency room includes the use of peak flow measurement and clinical parameters. Both methods have their own disadvantages such as poor cooperation/effort from patients (peak flow meter) and lack of objective assessment (clinical parameters). We were looking into other methods for the initial asthma assessment, namely the use of capnography. The normal capnogram has an almost square wave pattern comprising phase 1, slope phase 2, plateau phase 3, phase 4 and angle alpha (between slopes 2 and 3). The changes in asthma include decrease in slope of phase 2, increase in slope 3 and opening of angle alpha.
    AIMS: Our objective was to compare and assess the correlation between the changes in capnographic indices and peak flow measurement in non-intubated acute asthmatic patients attending the emergency room.
    METHODS: We carried out a prospective study in a university hospital emergency department (ED). One hundred and twenty eight patients with acute asthma were monitored with peak flow measurements and then had a nasal cannula attached for microstream sampling of expired carbon dioxide. The capnographic waveform was recorded onto a PC card for indices analysis. The patients were treated according to departmental protocols. After treatment, when they were adjudged well for discharge, a second set of results was obtained for peak flow measurements and capnographic waveform recording. The pre-treatment and post-treatment results were then compared with paired samples t-test analysis. Simple and canonical correlations were performed to determine correlations between the assessment methods. A p value of below 0.05 was taken to be significant.
    RESULTS: Peak flow measurements showed significant improvements post-treatment (p < 0.001). On the capnographic waveform, there was a significant difference in the slope of phase 3 (p < 0.001) and alpha angle (p < 0.001), but not in phase 2 slope (p = 0.35). Correlation studies done between the assessment methods and indices readings did not show strong correlations either between the measurements or the magnitude of change pre-treatment and post-treatment.
    CONCLUSION: Peak flow measurements and capnographic waveform indices can indicate improvements in airway diameter in acute asthmatics in the ED. Even though the two assessment methods did not correlate statistically, capnographic waveform analysis presents several advantages in that it is effort independent and provides continuous monitoring of normal tidal respiration. They can be proposed for the monitoring of asthmatics in the ED.
    KEYWORDS: Asthma; Capnography; Emergency room; Peak flow measurement
    Study site: Emergency department, Hospital Universiti Sains Malaysia (HUSM)
  6. Chew KS, Idzwan ZM, Hisamuddin NA, Kamaruddin J, Wan Aasim WA
    Med J Malaysia, 2008 Mar;63(1):4-8.
    PMID: 18935723 MyJurnal
    Despite the progresses made in the science of cardiopulmonary resuscitation, there is lack of published works on this area in the Malaysian context. This survey was done to look at the outcomes of all cardiopulmonary resuscitation performed in Emergency Department (ED), Hospital Universiti Sains Malaysia (HUSM). This is a one year cross-sectional study from March 2005-March 2006. All adult cardiac arrest cases with CPR performed in ED, HUSM were included in the survey. The end points are return of spontaneous circulation (ROSC) and survival to ward admission. Out of the total 63 cases of cardiac arrest with CPR performed, only 19 cases (30.2%) had ROSC after CPR performed on them. Eventually only six patients (9.5%) had survival to ward admission. Patients with shockable intial arrest rhythm has a significantly higher chance to achieve ROSC (60.0%) compared to non-shockable rhythms (24.5%) (p = 0.025). However, there was no different in survival to ward admission between shockable and non shockable rhythms groups. The survival after cardiac arrest is still dismally poor. Perhaps we should be more selective in initiating CPR especially for out of hospital cardiac arrest.
  7. Anisah A, Chew KS, Mohd Shaharuddin Shah CH, Nik Hisamuddin NA
    Singapore Med J, 2008 Aug;49(8):631-5.
    PMID: 18756347
    Little is known regarding public opinion of prehospital care in Malaysia. This study was conducted to find out the public's perception and expectations of the ambulance services in one of the university hospitals in Malaysia.
  8. Chew F Z A W M N KS, Mohd Hashairi F, Ida Zarina Z, Shaik Farid AW, Abu Yazid MN, Nik Hisamuddin NA
    Med J Malaysia, 2011 Mar;66(1):56-9.
    PMID: 23765145 MyJurnal
    Junior doctors are often the "first line" doctors called to attend to patients in cardiac arrest. We performed an anonymous questionnaire study from October 2008 to December 2008 to assess the knowledge, attitude and skill of cardiopulmonary resuscitation among junior doctors in Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II. Out of the 100 questionnaire forms sent out, 70 were returned completed. The majority (85.8%) stated that they were not confident of managing a resuscitation case. There was a statistically significant (p<0.001) association between duration of clinical practice and confidence level. Up to 77.1% said that BLS should be re-certified every two years.
  9. Chew KS, Wan Masliza WM, Nik Hisamuddin NA, Mohd Hashairi F, Shaik Farid AW, Tuan Hairulnizam TK, et al.
    Med J Malaysia, 2015 Feb;70(1):6-11.
    PMID: 26032522 MyJurnal
    BACKGROUND: Good coronary care begins from the patient's home, including early transportation. As such, it is recommended that the patients activate ambulances, rather than to use their own transportations to reach the hospitals. It is not known whether Malaysian patients prefer to use private transportations or ambulances when they develop chest pain.

    OBJECTIVES: This study is conducted to explore the question of the choice of transportation modes among patients with acute coronary syndrome and the reasons behind their choices.

    METHODS: This is a structured interview survey on patients diagnosed with acute coronary syndrome (ACS) in emergency department of Hospital Universiti Sains Malaysia from April 2012 to September 2012.

    RESULTS: Out of the 110 patients surveyed, 105 (95.5%) patients chose to use own transportation when they developed symptoms suggestive of ACS. Only 3 patients (2.7%) came to the emergency department within 1 hour of onset, and all these 3 patients chose to use ambulances as their modes of transportation. None of the patients who chose own transportation came within the first hour of symptoms onset. This is shown to be statistically significant (p<0.001). The level of education as well as past history of ischemic heart disease did not significantly influence the patients' choice of transportation.

    CONCLUSION: The admonishment by various international resuscitation councils that patients with chest pain should be transported via ambulances may not be as straightforward as it seems. Numerous local and regional socio-cultural and logistic factors may need to be addressed.
  10. Kamarudin N, Hisamuddin N, Ong HM, Ahmad Azmi AF, Leong SW, Abas F, et al.
    Molecules, 2018 Aug 21;23(9).
    PMID: 30134576 DOI: 10.3390/molecules23092099
    Curcuminoids derived from turmeric rhizome have been reported to exhibit antinociceptive, antioxidant and anti-inflammatory activities. We evaluated the peripheral and central antinociceptive activities of 5-(3,4-dihydroxyphenyl)-3-hydroxy-1-(2-hydroxyphenyl)penta-2,4-dien-1-one (DHHPD), a novel synthetic curcuminoid analogue at 0.1, 0.3, 1 and 3 mg/kg (intraperitoneal), through chemical and thermal models of nociception. The effects of DHHPD on the vanilloid and glutamatergic systems were evaluated through the capsaicin- and glutamate-induced paw licking tests. Results showed that DHHPD significantly (p < 0.05) attenuated the writhing response produced by the 0.8% acetic acid injection. In addition, 1 and 3 mg/kg of DHHPD significantly (p < 0.05) reduced the licking time spent by each mouse in both phases of the 2.5% formalin test and increased the response latency of mice on the hot-plate. However, the effect produced in the latter was not reversed by naloxone, a non-selective opioid receptor antagonist. Despite this, DHHPD decreased the licking latency of mice in the capsaicin- and glutamate-induced paw licking tests in a dose response manner. In conclusion, DHHPD showed excellent peripheral and central antinociceptive activities possibly by attenuation of the synthesis and/or release of pro-inflammatory mediators in addition to modulation of the vanilloid and glutamatergic systems without an apparent effect on the opioidergic system.
  11. Ayumi RR, Shaik Mossadeq WM, Zakaria ZA, Bakhtiar MT, Kamarudin N, Hisamuddin N, et al.
    Planta Med, 2020 May;86(8):548-555.
    PMID: 32294786 DOI: 10.1055/a-1144-3663
    The antinociceptive property of Centella asiatica extracts is known but the analgesic activity of its bioactive constituent asiaticoside has not been reported. We evaluated the antinociceptive activity of orally (p. o.) administered asiaticoside (1, 3, 5, and 10 mg/kg) in mice using the 0.6% acetic acid-induced writhing test, the 2.5% formalin-induced paw licking test, and the hot plate test. The capsaicin- and glutamate-induced paw licking tests were employed to evaluate the involvement of the vanilloid and glutamatergic systems, respectively. Asiaticoside (3, 5, and 10 mg/kg, p. o.) reduced the rate of writhing (p 
  12. Ayumi RR, Shaik Mossadeq WM, Zakaria ZA, Bakhtiar MT, Kamarudin N, Hisamuddin N, et al.
    Planta Med, 2020 May 08.
    PMID: 32384548 DOI: 10.1055/a-1170-9487
  13. Hisamuddin N, Shaik Mossadeq WM, Sulaiman MR, Abas F, Leong SW, Kamarudin N, et al.
    Molecules, 2019 Jul 18;24(14).
    PMID: 31323775 DOI: 10.3390/molecules24142614
    Curcumin, derived from the rhizome Curcuma longa, has been scientifically proven to possess anti-inflammatory activity but is of limited clinical and veterinary use owing to its low bioavailability and poor solubility. Hence, analogs of curcuminoids with improved biological properties have been synthesized to overcome these limitations. This study aims to provide the pharmacological basis for the use of 5-(3,4-dihydroxyphenyl)-3-hydroxy-1-(2-hydroxyphenyl)penta-2,4-dien-1-one (DHHPD), a synthetic curcuminoid analog, as an anti-edematogenic and anti-granuloma agent. The carrageenan-induced paw edema and the cotton pellet-induced granuloma assays were used to assess the anti-inflammatory activity of DHHPD in mice. The effects of DHHPD on the histaminergic, serotonergic, and bradykininergic systems were determined by the histamine-, serotonin-, and bradykinin-induced paw edema tests, respectively. DHHPD (0.1, 0.3, 1, and 3 mg/kg, intraperitoneal) evoked significant reductions (p < 0.05) in carrageenan-induced paw edema at different time intervals and granuloma formation (p < 0.0001) by 22.08, 32.57, 37.20, and 49.25%, respectively. Furthermore, DHHPD significantly reduced paw edema (p < 0.05) induced by histamine, serotonin, and bradykinin. The present study suggests that DHHPD exerts anti-edematogenic activity, possibly by inhibiting the synthesis or release of autacoid mediators of inflammation through the histaminergic, serotonergic, and bradykininergic systems. The anti-granuloma effect may be attributed to the suppression of transudative, exudative, and proliferative activities associated with inflammation.
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