Synthesis of molecularly imprinted polymers of vanillic acid and extraction of vanillic acid from spiked blood serum

Vanillic acid (4-hydroxy-3-methoxybenzoic acid) is a phenolic acid found in many plant extracts. It is used as aflavoring and scent agent and produces a pleasant, creamy odor. It is widely used in many applications for therapeuticpurposes to flavoring agent. Molecularly imprinted polymers of vanillic acid were synthesized by precipitationpolymerization with a noncovalent approach for the extraction from blood serum. Three different imprinted polymershave been synthesized with varying molar ratio of monomer. The synthesized polymer particles were characterizedusing Fourier-transform infrared spectroscopy and scanning electron microscopy. The extraction efficiency of highlyselected imprinted polymer of vanillic acid from spiked blood serum was about 80%.

Demographic profiles and sleep quality among patients on methadone maintenance therapy [MMT] in Malaysia

Poor sleep quality was frequently reported by opioid dependence patients during methadone maintenance therapy [MMT]. The study investigated a sample of patients on MMT to investigate the severity and prevalence of sleep problems in MMT patients. We evaluated sleep quality and disturbances of 119 Malay male patients from MMT clinics in Kelantan, Malaysia between March and July 2013 using the Pittsburgh Sleep Quality Index [PSQI]-Malay version. Patients' demographic, clinical data, past drug history and methadone treatment variables were recorded. Patients averaged 37.5 years of age [SD 6.79] and their mean age of first time illicit drug use was 19.3 years [SD 4.48]. Their mean age of entering MMT was 34.7 years [SD 6.92] and the mean duration in MMT was 2.8 years [SD 2.13]. The mean current daily dosage of methadone was 77.8 mg [SD 39.47] and ranged from 20 to 360 mg. The mean global PSQI score was 5.6 [SD 2.79] and 43.7% patients were identified as 'poor sleepers' [global PSQI scores >5]. This study confirms the poor overall sleep quality among patients on MMT. The prevalence and severity of sleep problems in MMT patients should not be underestimated

Pattern of QTc prolongation in methadone maintenance therapy [MMT] subjects receiving different methadone dosages: a prospective cohort study

Objectives: This study aimed to compare the QTc interval between low and high dose methadone groups and evaluate the pattern of QTc variation

Methods: This is a prospective cohort study conducted from December 2010 till August 2011 at Malaysian University of Science's Hospital. Forty six subjects, grouped in high dose [>80mg] and low dose [<80mg] oral methadone, were followed-up at 4-weekly for QTc measurements. Relevant demographic and biochemical profiles were taken at intervals with concurrent QTc measurements

Results: No significant QTc differences between methadone dosage groups were found at Week 0 [434ms vs 444ms, p = 0.166] and week 8 [446.5ms vs 459ms, p = 0.076], but not at week 4[435ms vs 450ms, p = 0.029]. However, there were significant associations between the groups with QTc prolongation at week 0 and 4 [OR 4.29[95% CI 1.01, 18.72] p=0.044 and OR 5.18 [95% CI 1.34, 20.06] p =0.013, respectively] but not at week 8 [OR 2.44 [95% CI 0.74, 8.01] p=0.139]. On multivariate analysis, dose group was the sole significant factor for QTc prolongation for week 0 and 4 [p values 0.047 and 0.017, respectively], but not at week 8

Conclusion: High-dose methadone group is more likely to develop prolonged QTc than low-dose group. However, such effects were inconsistent and occurred even during chronic methadone therapy, mandating judicious QTc and serum methadone monitoring

Assessing Patient Pain Scores in the Emergency Department

Background: Pain management in the Emergency Department is challenging. Do we need to ask patients specifically about their pain scores, or does our observational scoring suffice? The objective of this study was to determine the inter-rater differences in pain scores between patients and emergency healthcare (EHC) providers. Pain scores upon discharge or prior to ward admission were also determined. Methods: A prospective study was conducted in which patients independently rated their pain scores at primary triage; EHC providers (triagers and doctors) separately rated the patients’ pain scores, based on their observations. Results: The mean patient pain score on arrival was 6.8 ± 1.6, whereas those estimated by doctors and triagers were 5.6±1.8 and 4.3±1.9, respectively. There were significant differences among patients, triagers and doctors (P< 0.001). There were five conditions (soft tissue injury, headache, abdominal pain, fracture and abscess/cellulites) that were significantly different in pain scores between patients and EHC providers (P<0.005). The mean pain score of patients upon discharge or admission to the ward was 3.3 ± 1.9. Conclusions: There were significant differences in mean patient pain scores on arrival, compared to those of doctors and triagers. Thus, asking for pain scores is a very important step towards comprehensive pain management in emergency medicine.

A Study on the Magnitude and the Effectiveness of the Observation Ward of Hospital Universiti Sains Malaysia

Background: The observation ward (OW) allows patients to be reassessed and monitored before deciding either to admit or to discharge them. This is a six-month descriptive cross-sectional study conducted in the observation ward of the Emergency Department (ED) of Hospital Universiti Sains Malaysia, Kelantan. The objective of this study was to examine the demographic characteristics and clinical profiles of adult observed patients and to determine the effectiveness of OW management. Methods: Patients were selected randomly by convenience sampling. One hundred and twenty-four patients were included in the study. The mean age was 40.3 ± 18.5 years (95% CI: 37.2 to 43.8). Results: Among the common clinical problems were abdominal discomfort (23%), diarrhoea and vomiting (13%) and fever (13%). Reasons for OW admission included diagnostic uncertainty (63%) and short course of treatment (33%). The mean length of stay was 4.1 ± 1.8 hours (95% CI=3.8 to 4.4 hours). Most of the patients (85%) were discharged. Conclusions: The OW of HUSM is effective in managing adult patients as determined by the hospitalisation rate and the length of stay.

Theophylline toxicity: A case report of the survival of an undiagnosed patient who presented to the emergency department

Theophylline toxicity is a life-threatening toxidrome that can present to an emergency department. To ascertain an immediate provisional diagnosis in toxicology at the emergency department is very challenging, especially when the patient presents with altered mental status, because the clinical features of several toxidromes overlap. We report a case of survival of undiagnosed theophylline toxicity that required intubation for two days in the intensive care unit. This was the first case to have been reported from our department. Accurate diagnosis of a toxidrome by gaining adequate history and conducting a thorough physical examination and early serum toxicology screening, coupled with good knowledge of toxicology, will lead to better patient outcomes.

Health major incident: The experiences of mobile medical team during major flood

Disaster is a sudden event that associated with ecological changes, disruption of normal daily activities, destruction of infrastructures, loss of properties, and medical disabilities. In disaster, there is a mismatch between available resources and patients need for healthcare service. During flood disaster, the victims were predisposed to different type of illnesses for various reasons such as inadequate supply of clean water, poor sanitation or drainage system, unhealthy foods, and over-crowded relief centers. Mobile clinic is an option for delivering medical care for the disaster victims who often have a difficulty to access to the medical facilities. In this article we would like to share our experiences during the provision of humanitarian services for flood victims at District of Muar Johor. Common illnesses among the flood victims at visited relief centers and advantages of Mobile Medical Relief Team were also highlighted and discussed.

Post-impact disaster surveillance - A medical reconnaissance team at tsunami-struck Sri Lanka

Emergency Medicine and Disaster Medicine are two specialties which are similar in the multidisciplinary involvement during the acute phase of the disaster. Recently, there was an increase in the number of disasters in the world but not many physicians are familiar with the principles for dealing with such situations, the unique organizational demands, coordination and the urgent need for medical assistance and relief. This case report delineates our experiences at a tsunami disaster area and the approach to setting up a medical relief team in the affected area. A medical reconnaissance team comprising of an emergency doctor from Hospital Universiti Sains Malaysia (H.U.S.M) and two MERCY Malaysia members was assembled. The team flew to Colombo on day 5 after the tsunami with medical supplies and related materials. The mission started from December 31st 2004 until January 8th 2005. Our surveillance area covered the Southern and Eastern Province with a total distance of 1700 km along the coast. The strategies employed during this medical reconnaissance included risk analysis, devising a resources matrix, developing lines of communication and rapport with other relief teams, Sri Lankan government agencies, and local and international non-government organizations. As a result, our team was able to set up a medical relief camp and distribute the relief items to the tsunami victims. In conclusion, the Disaster Emergency Medical Assistant Team (DEMAT) from H.U.S.M and MERCY Malaysia were able to set up and provide medical relief with our limited resources to a large scale disaster situation.