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.

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.

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.