Methemoglobinemia is a rare condition that caused impairment of oxygen delivery manifested as spectrum of features ranging from mild desaturations to severe cyanosis and even death. It is rarely seen in the operative theatre and its incidence is scarcely reported. Even low risk patients are susceptible despite having no significant exposure to commonly reported precipitating oxidizing agents. We described a case of perioperative methemoglobinemia in a 10-year-old child, which was planned for foreign body removal in left ear. The operation went successfully; however, the child developed desaturation postoperatively. Arterial blood gas was measured, and methemoglobin levels were noticeably high at 27.1%. The child remained hemodynamically stable, monitored conservatively, and was successfully treated with intravenous methylene blue. We postulated that the cause of methemoglobinemia was intravenous fentanyl usage, as other oxidising agents were excluded. Clinicians must be aware of the possibility of perioperative methemoglobinemia causing unanticipated desaturations and unexplained cyanosis.

Acquired hemophilia is a rare but potentially life-threatening disorder characterized by the development of acquired hemophilia A, leading to bleeding complications. Spontaneous, mild-to-life-threatening bleeding in typically elderly individuals without a personal or family history of bleeding is the hallmark of acquired hemophilia A (AHA), a rare autoimmune bleeding illness caused by the formation of auto-antibodies against endogenous factor VIII (FVIII). This hallmark represents our present case, with no obvious history related to the bleeding issue. Prompt detection and treatment of bleeding are essential for the best outcomes. We present a case of a 66-year-old male who had acute-onset severe abdominal pain and with constipation for five days, associated with nausea and loss of appetite. On physical examination, the patient appeared pale, and abdominal examination revealed diffuse tenderness with guarding. Initial evaluation revealed tachycardia and hypotension. Initial abdomen X-rays revealed features suggestive of small bowel obstruction. The patient was stabilized with intravenous fluids, referred to a surgical team, and admitted to the acute bed in the general ward for further management.

Bank kulit manusia merupakan salah satu isu kontemporari yang semakin berkembang di abad ini. Namun perbahasan dan teknologi yang ada khususnya di Malaysia, belum mampu mengorak ke arah yang lebih mendalam akan keperluannya secara lebih meluas. Masih terdapat hukum berkaitan perkara ini yang perlu dirungkai agar kedatangannya secara meluas di negara ini tidak akan dipertikaikan kelak. Oleh yang demikian, tujuan kajian ini adalah untuk membincangkan secara menyeluruh berkaitan bank kulit manusia ini dan keperluannya. Dalam artikel ini juga, kami menggariskan hukum pelaksanan bank kulit manusia yang mungkin memberi polemik berterusan. Kajian itu menggunakan metodologi berasaskan perpustakaan (library-based methodology) dan mengumpulkan data daripada pelbagai sumber, termasuk buku, laman web dan jurnal. Penemuan menunjukkan bahawa bidang bank kulit manusia ini telah digunakan secara meluas di luar negara dengan teknologi yang hebat. Namun, Malaysia agak ketinggalan dalam membina teknologi ini. Keperluan kepada bank kulit manusia ini juga sangat meluas dan banyak digunakan dalam bidang perubatan terapeutik. Kajian ini juga cuba membahaskan perspektif hukum berkaitan pelaksanaan bank kulit manusia yang telah dibahaskan oleh para fuqaha kontemporari. Kesimpulannya, kami melihat akan adanya keperluan kepada bank kulit manusia ini sekiranya digunakan khususnya dalam bidang perubatan. Bidang teknologi yang semakin meluas harusnya diambil manfaat bagi menjaga maqasid syariah, khususnya menjaga kesemua konsep Daruriyat, Hajiyat mahupun Tahsiniyat.

A septic abortion is an infection of the uterus and its contents prior to, during, or following an abortion (either spontaneous or induced). In these circumstances, sepsis may develop suddenly and progress rapidly to septic shock. A fatal outcome could happen if the situation is not treated promptly and efficiently. We present the unfortunate mortality of a pregnant woman who was treated for incomplete miscarriage and postpartum haemorrhage. Despite multiple procedures performed within three days and broad-spectrum antibiotic therapy, the condition is not getting better but rather getting worse. The cultures showed tissue-derived Streptococcus agalactiae and Burkholderia cepacia bacteremia. We discuss the case while addressing the flaws of the present management and probable future steps for an immediate plan of action.

Introduction: The question as to whether epidural analgesia during labour can cause chronic low backpain has become a concern lately but this association has not been tested locally and remains controversial. This retrospective study aimed to ascertain the relationship between labour epidural analgesia and development of subsequent chronic low backpain. Methods: We contacted 200 primiparous women who had delivered by normal vaginal delivery via telephone at six months after delivery. While 100 of them had previously received epidural analgesia for labour, the other 100 had not. The women had to quantify their backpain by yes/no responses, numeric rating score, and impairment of daily function. Both the epidural and the non-epidural groups were compared using independent t-test and Chi-squared test while logistic regression was used to control for confounding factors. Results: The two groups had similar baseline characteristics except for body mass index, employment status and labour duration. The women who received epidural analgesia had significantly higher prevalence of low backpain at six months after delivery than those who had not (28% versus 9%, P = 0.001). However, the two groups did not show any difference in terms of numeric rating score or level of impairment of daily function. The low back pain at six months (epidural versus non-epidural) had an adjusted odds ratio of 8.1 (95% confidence interval 2.7 to 24.0, P <0.001). Conclusion: While epidural analgesia during labour was shown to be associated with chronic low back pain, this association may not be causal, suggesting the need for a randomized-controlled study in this area.

The sedative-analgesic drugs frequently are used to relieve pain and anxiety of patients in intensive care units (ICU). An ideal agent would be rapidly metabolized, and facilitate desirable level of sedation without compromising hemodynamic and respiratory function. This makes opioids and benzodiazepines to be the most commonly prescribed drugs in intensive care. However, weaning off from these drugs may be associated with withdrawal effects. We present a case report of febrile seizure following airway pediatric surgery and opiate and benzodiazepine discontinuation. The weaning off process from these drugs should be meticulously done especially in pediatric age group to avoid subsequent complications. © 2021 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.

Pulmonary embolism (PE) risk is greater in women during pregnancy or puerperium. If indeed the peripartum pulmonary embolism is not recognized early and treated appropriately, it could have catastrophic consequences. We therefore present a case of a pregnant woman who unfortunately went from undiagnosed peripartum pulmonary embolism and had a crisis during delivery. She eventually had cardiac arrest and hypoxic-ischemic encephalopathy as complications. We emphasize early recognition and prompt treatment of pulmonary embolism in order to prevent such serious complications in pregnant women. We discuss about the clinical condition of our patient and make contrasts based on previous literature.

Melioidosis and leptospirosis are common tropical infectious diseases, but confirmed co-infection by both is rare. We describe a fulminant case of Burkholderia pseudomallei and Leptospira co-infection in a 29-year-old Malay lady with underlying uncontrolled type 2 diabetes mellitus, who had no obvious exposure to either organism. Despite close monitoring and aggressive treatment in the Intensive Care Unit (ICU), this patient eventually succumbed to death from the disease progression. As co-infections of melioidosis and leptospirosis can lead to a high mortality, suspicion of the diagnosis must always be raised especially in diabetic patients from endemic area, who present with sepsis of unknown origin, to allow for prompt initiation of appropriate treatment.

Dengue is a public health concern with an economic burden that is currently unmet by approved vaccinations, particular treatment medicines, or effective vector-control methods. It can be challenging to identify in an early stage, and if not treated properly, it can have disastrous effects. We, therefore, present a case of an unfortunate man diagnosed with severe dengue. He eventually had a multiorgan failure and required renal replacement therapy and inotropic support. We emphasize early recognition and investigation of dengue fever to prevent such serious complications later. We also discuss the clinical condition with radiological intervention such as assessing gallbladder wall thickness as a tool when in doubt of a diagnosis of severe dengue infection.

Stem cells have unprecedented promise for treating disorders that are not amenable to conventional treatment because of their special capacity to maintain, replenish, and repair all tissue types. Stem cell research is currently surrounded by several pressing ethical and challenges as a result of the quick development of biotechnology. Therefore, the purpose of this study is to find out the ethical issues regarding the use of stem cells and correlate from an Islamic perspective, focusing on Malaysia. In this review, we outline an overview of the most significant ethical issues with stem cell application that the community especially Muslimsshould be aware of. The study applied a library-based methodology and gathered data about stem cells, their use, ethical concerns, and Islamic law with an emphasis on Malaysia from a range of sources, including books, websites and journals. The findings demonstrated that there are three main areas of ethical concern for stem cell technology from an Islamic perspective: human embryonic stem cells, stem cells used for aesthetic purposes, and stem cells used for therapeutic medicine. We attempted to correlate Malaysia's perspective with some of the Islamic perspective's points on all ethical concerns. We discovered that there are certain arguments towards every ethical issue from an Islamic perspective, and we tried to compare it to the perspective from Malaysia. Both the use of current ethical frameworks and careful evaluation from an Islamic perspective are important as this vast and diverse area of stem cell technology progresses, especially in Malaysia.

Stem cells have unprecedented promise for treating disorders that are not amenable to conventional treatment because of their special capacity to maintain, replenish, and repair all tissue types. Stem cell research is currently surrounded by several pressing ethical and challenges as a result of the quick development of biotechnology. Therefore, the purpose of this study is to find out the ethical issues regarding the use of stem cells and correlate from an Islamic perspective, focusing on Malaysia. In this review, we outline an overview of the most significant ethical issues with stem cell application that the community especially Muslims should be aware of. The study applied a library-based methodology and gathered data about stem cells, their use, ethical concerns, and Islamic law with an emphasis on Malaysia from a range of sources, including books, websites and journals. The findings demonstrated that there are three main areas of ethical concern for stem cell technology from an Islamic perspective: human embryonic stem cells, stem cells used for aesthetic purposes, and stem cells used for therapeutic medicine. We attempted to correlate Malaysia's perspective with some of the Islamic perspective's points on all ethical concerns. We discovered that there are certain arguments towards every ethical issue from an Islamic perspective, and we tried to compare it to the perspective from Malaysia. Both the use of current ethical frameworks and careful evaluation from an Islamic perspective are important as this vast and diverse area of stem cell technology progresses, especially in Malaysia.

Stem cells have unprecedented promise for treating disorders that are not amenable to conventional treatment because of their special capacity to maintain, replenish, and repair all tissue types. Stem cell research is currently surrounded by several pressing ethical and challenges as a result of the quick development of biotechnology. Therefore, the purpose of this study is to find out the ethical issues regarding the use of stem cells and correlate from an Islamic perspective, focusing on Malaysia. In this review, we outline an overview of the most significant ethical issues with stem cell application that the community especially Muslims should be aware of. The study applied a library-based methodology and gathered data about stem cells, their use, ethical concerns, and Islamic law with an emphasis on Malaysia from a range of sources, including books, websites and journals. The findings demonstrated that there are three main areas of ethical concern for stem cell technology from an Islamic perspective: human embryonic stem cells, stem cells used for aesthetic purposes, and stem cells used for therapeutic medicine. We attempted to correlate Malaysia's perspective with some of the Islamic perspective's points on all ethical concerns. We discovered that there are certain arguments towards every ethical issue from an Islamic perspective, and we tried to compare it to the perspective from Malaysia. Both the use of current ethical frameworks and careful evaluation from an Islamic perspective are important as this vast and diverse area of stem cell technology progresses, especially in Malaysia.

Argininemia is a rare autosomal recessive metabolic disorder characterized by a deficiency of arginase, a vital enzyme in the urea cycle. This metabolic defect results in the accumulation of arginine and its metabolites, leading to hyperammonemia and associated neurological symptoms. We present a case detailing the perioperative management of an 11-year-old male child diagnosed with argininemia undergoing circumcision. The perioperative management of patients with argininemia presents unique challenges due to the risk of hyperammonemia and neurological decompensation triggered by physiological stress, fasting, and the catabolic state associated with surgery. This case report highlights the importance of individualized anesthetic strategies for patients with rare metabolic disorders like argininemia. A multidisciplinary approach involving collaboration among anesthesiologists, endocrinologists, dietitians, and surgeons is essential to ensuring a safe perioperative experience for these patients. Further research is essential to refine perioperative protocols and optimal anesthetic interventions for individuals with argininemia undergoing surgical procedures.

Withholding and withdrawal of life-sustaining treatments is one of the hot topics discussing in intensive care unit as most of the death occurs as a result of it. This point of transition from active intervention to the palliation process required a crucial decision-making process. The decision conveys information to families to be well prepared beforehand especially during the process of withdrawing life-sustaining treatment. Once the final decision to withdraw the treatment has been made, procedure of cessation of care, treatment withdrawal and nature of follow-up support will be informed to the family members. This article aims to explore the relationship between decision in withholding and withdrawal of life-sustaining treatment based on Malaysian intensive care unit protocol and the related fatwa in Malaysia. The methodology chosen for this study is content analysis of the relevant published literatures. This study reveals the decision for withholding and withdrawal life sustaining treatment in intensive care unit has correlation between the protocol and related fatwa in Malaysia.

With changes in lifestyle habits and reduced diagnostic thresholds for hypertension, the prevalence of hypertension among young individuals is expected to rise. We become aware of the adverse effects of pharmacological interventions related to anaesthesia. We present a case in which refractory hypotension emerged after the induction of anaesthesia for orthopaedic surgery. The procedure went smoothly, and there were no issues with the extubation in the intensive care unit. The patient required significantly more pharmacological support over an extended period of the procedure after developing refractory hypotension following an induction phase of anaesthesia that was resistant to fluid resuscitation. We present the case while addressing the current management and potential future management for a foreseeable future strategy.

Severe Acute Respiratory Distress Syndrome (ARDS) with Pneumocystis jirovecii pneumonia (PJP) is a rare and life-threatening condition predominantly observed in immunocompromised individuals, particularly those with human immunodeficiency virus (HIV) infection. Here, we present a case report of a 22-year-old previously healthy male who developed severe ARDS with PJP with an active background of man-to-man sexual relations. This case report highlights the occurrence of severe ARDS with PJP that can happen to individuals engaged in man-to-man sexual relations. The transmission of PJP through sexual contact in the absence of traditional risk factors presents a unique diagnostic and management challenge. Healthcare providers should be vigilant in considering PJP as a potential cause of severe respiratory distress in patients with a history of high-risk sexual behaviours, regardless of their immune status. Further research is needed to better understand the transmission dynamics and risk factors associated with PJP, especially in sexually active man-to-man individuals. Increased awareness of atypical presentations of PJP is essential to ensuring early diagnosis and appropriate management in such cases.