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  1. Yunos NM, Osman A, Jauri MH, Sallehudin NJ, Mutalip SSM
    Curr Pharm Biotechnol, 2020;21(1):37-44.
    PMID: 31530258 DOI: 10.2174/1389201020666190917154850
    BACKGROUND: 17βH-neriifolin, a cardiac glycoside compound had been successfully isolated from Cerbera odollam leaves based on the bioassay guided-isolation procedure. The aim of these studies were to determine the in vitro anti-cancer and binding effects of 17βH-neriifolin on Na+, K+-ATPase.

    METHODS: The in vitro anti-cancer effects were evaluated using Sulphorhodamine B and Hoescht 33342 assays. The Na+, K+-ATPase assay was carried out using Malachite Green assay. In silico molecular docking studies and in vitro malachite green assay were used to predict the binding activities of 17βH-neriifolin on Na+, K+-ATPase and ouabain was also included as for comparison studies.

    RESULTS: The compound was tested against breast (MCF-7, T47D), colorectal (HT-29), ovarian (A2780, SKOV-3) and skin (A375) cancer cell lines that gave IC50 values ranged from 0.022 ± 0.0015 to 0.030 ± 0.0018 μM. The mechanism of cell death of 17βH-neriifolin was further evaluated using Hoescht 33342 assay and it was found that the compound killed the cancer cells via apoptosis. 17βHneriifolin and ouabain both bound at α-subunit in Na+, K+-ATPase and their binding energy were - 8.16 ± 0.74 kcal/mol and -8.18 ± 0.48 kcal/mol respectively.

    CONCLUSION: The results had confirmed the anti-proliferative effects exerted by 17βH-neriifolin in the breast, colorectal, ovarian and skin cancer cell lines. 17βH-neriifolin had shown to cause apoptotic cell death in the respective cancer cell lines.17βH-neriifolin and ouabain both bound at α-subunit in Na+, K+-ATPase and their binding energy were -8.16 ± 0.74 kcal/mol and -8.18 ± 0.48 kcal/mol respectively. This is the first report to reveal that 17βH-neriifolin managed to bind to the pocket of α-subunit of Na+.K+-ATPase.

  2. 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.

  3. 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.
  4. Tuan Lonik EA, Tuan Kamauzaman TH, Abdullah AA, Nor J, Ab Hamid SA
    MyJurnal
    This study is to determine the prevalence and the associated factors of low-back pain (LBP), which has multifactorial causes, among ambulance workers in Kelantan, Malaysia. The cross-sectional study involved ambulance workers in the emergency department in all government hospitals in Kelantan. Those who did not consent, complete or return the questionnaire as well as having rheumatic diseases were excluded from the study. The participants were asked to answer a self-administered questionnaire in English. Descriptive analyses and Chi-square test were used. A total of 168 respondents had completed the questionnaires with a response rate of 85.0%. Questionnaires with more than 95.0% items completed were included in the analysis (n=143). The respondents had a higher proportion of male than female (63.6% versus 36.4%). Assistant Medical Officer comprised of 60.0% of all respondents and the rest were nurses. The respondents’ age ranged between 23 to 58 years old with a mean age of 38.27 and standard deviation (SD) of 7.27. The mean duration of involvement in ambulance service was 9.68 years (SD 6.97). The majority (98.5%) of the respondents were Malay. Gender, smoking status and hobbies were the associated factors of LBP among ambulance workers. The modifiable risk factors should be emphasized to the ambulance workers as a measure to prevent the development of LBP.
  5. Marcus M, Abdullah AA, Nor J, Tuan Kamauzaman TH, Pang NTP
    GMS J Med Educ, 2022;39(4):Doc45.
    PMID: 36310890 DOI: 10.3205/zma001566
    Introduction: Bystander cardiopulmonary resuscitation (CPR) training is inconsistent among students and the public. Existing CPR teaching courses are costly, time-consuming, and inconsistent. This study aimed to determine the association between overall CPR competency and two teaching modules, a group-directed video instruction module versus an instructor-led traditional classroom instruction module. Methods: This randomized prospective interventional study involved first year medical students of Universiti Sains Malaysia Health Campus from November 2018 until January 2019. Pass-fail scores representing the overall CPR, individual skill performance, and willingness to perform CPR for strangers and family members were collected. Factors associated with reluctance to perform CPR were assessed in a questionnaire. Results: A total of 99 participants were included, 50 in the group-directed video instruction as the intervention module and 49 in the traditional classroom instruction as the control module. There was no statistical significance between the pass and fail outcomes for both video module (p=0.436). Participants in both modules performed similarly in 8 out of 12 individual CPR skills. There was a significant difference in the distribution of skill scores between the pass and fail outcomes (p=<0.001). The intervention module is non-inferior compared to the control module, in relation to CPR willingness rates for strangers (p=0.999) and family members (p=0.117) after the training. Conclusions: The group-directed video self-instruction method is as effective as the instructor-led traditional classroom method to help participants to be competent and willing to perform CPR. It can be used as an independent or supplementary teaching tool for first-time learners and refreshers, especially in a group setting when teaching materials are limited.
  6. 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.

  7. Ahmad A, Nor J, Abdullah AA, Tuan Kamauzaman TH, Yazid MB
    Malays J Med Sci, 2021 Apr;28(2):72-83.
    PMID: 33958962 DOI: 10.21315/mjms2021.28.2.7
    Background: Emergency departments (EDs) are frequently misused for non-emergency cases such as upper respiratory tract infections (URTIs). Flooding of these cases may contribute to inappropriate antibiotic prescribing. The aim of this study was to determine the patient factors associated with inappropriate antibiotic prescribing for URTIs in the EDs.

    Methods: This cross-sectional study involved patients over age 3 years old who presented with URTI to the green zone of the ED of a tertiary hospital on the east coast of Malaysia in 2018-2019. Convenient sampling was done. The patients were categorised into two groups according to their McIsaac scores: positive (≥ 2) or negative (< 2). Antibiotics given to the negative McIsaac group were considered inappropriate.

    Results: A total of 261 cases were included - 127 with positive and 134 with negative McIsaac scores. The most common symptoms were fever and cough. About 29% had inappropriate antibiotic prescribing with a high rate for amoxycillin. Duration of symptoms of one day or less (OR 18.5; 95% CI: 1.65, 207.10; P = 0.018), presence of chills (OR 4.36; 95% CI: 1.13, 16.88; P = 0.033) and diagnosis of acute tonsillitis (OR 5.26; 95% CI: 1.76, 15.72; P = 0.003) were significantly associated with inappropriate antibiotic prescription.

    Conclusion: Factors influencing inappropriate antibiotic prescribing should be pointed out to emergency doctors to reduce its incidence.

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