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Healthcare workers (HCW) are exposed to health-related anxiety in times of pandemic as they are considered to have a high risk of being infected whilst being the vital workforce to manage the outbreak. This study determined the factors that influence health anxiety and its extent in correlations with perceived risk, knowledge, attitude, and practice of HCW. A cross-sectional online survey was conducted on a total of 709 HCW from both public and private healthcare facilities who completed a set of questionnaires on sociodemographic data, knowledge, attitude, and practice of HCW on COVID-19, and health anxiety traits assessed using the short version Health Anxiety Inventory (HAI). Multiple linear regression (adjusted R2 = 0.06) revealed respondents with higher perceived risk for COVID-19 significantly predicted higher HAI scores (beta 1.281, p < 0.001, 95%, CI: 0.64, 1.92), and those with a higher cautious attitude towards COVID-19 significantly predicted higher HAI scores (beta 0.686, p < 0.001, 95%CI: 0.35, 1.02). Healthcare workers’ perceived risk and cautious attitude towards COVID-19 might be potentially influenced by management of the sources and approaches to the dissemination of information of the pandemic. The implementation of certain measures that minimize the infection risk and its related anxiety is important to preserve both their physical and psychological wellbeing.
Hajar Mohd Salleh Sahimi; Nazirah Azman; Nik Nik Jaafar; Tuti Mohd Daud; Azlin Baharudin; Ahmad Ismail; Akramul Abdul Malek; Mohd Hassan; Azmawati Mohammed Nawi. Health Anxiety and Its Correlations with Self-Perceived Risk and Attitude on COVID-19 among Malaysian Healthcare Workers during the Pandemic. International Journal of Environmental Research and Public Health 2021, 18, 4879 .
AMA StyleHajar Mohd Salleh Sahimi, Nazirah Azman, Nik Nik Jaafar, Tuti Mohd Daud, Azlin Baharudin, Ahmad Ismail, Akramul Abdul Malek, Mohd Hassan, Azmawati Mohammed Nawi. Health Anxiety and Its Correlations with Self-Perceived Risk and Attitude on COVID-19 among Malaysian Healthcare Workers during the Pandemic. International Journal of Environmental Research and Public Health. 2021; 18 (9):4879.
Chicago/Turabian StyleHajar Mohd Salleh Sahimi; Nazirah Azman; Nik Nik Jaafar; Tuti Mohd Daud; Azlin Baharudin; Ahmad Ismail; Akramul Abdul Malek; Mohd Hassan; Azmawati Mohammed Nawi. 2021. "Health Anxiety and Its Correlations with Self-Perceived Risk and Attitude on COVID-19 among Malaysian Healthcare Workers during the Pandemic." International Journal of Environmental Research and Public Health 18, no. 9: 4879.
The wide distribution of king cobra (Ophiophagus hannah), a medically important venomous snake in Asia could be associated with geographical variation in the toxicity and antigenicity of the venom. This study investigated the lethality of king cobra venoms (KCV) from four geographical locales (Malaysia, Thailand, Indonesia, China), and the immunological binding as well as in vivo neutralization activities of three antivenom products (Thai Ophiophagus hannah monovalent antivenom, OHMAV; Indonesian Serum Anti Bisa Ular, SABU; Chinese Naja atra monovalent antivenom, NAMAV) toward the venoms. The Indonesian and Chinese KCV were more lethal (median lethal dose, LD50 ~0.5 μg/g) than those from Malaysia and Thailand (LD50 ~1.0 μg/g). The antivenoms, composed of F(ab)’2, were variably immunoreactive toward the KCV from all locales, with OHMAV exhibited the highest immunological binding activity. In mice, OHMAV neutralized the neurotoxic lethality of Thai KCV most effectively (normalized potency = 118 mg venom neutralized per g antivenom) followed by Malaysian, Indonesian and Chinese KCV. In comparison, the hetero-specific SABU was remarkably less potent by at least 6 to10 folds, whereas NAMAV appeared to be non-effective. The finding supports that a specific king cobra antivenom is needed for the effective treatment of king cobra envenomation in each region.
Kae Yi Tan; Tzu Shan Ng; Aymeric Bourges; Ahmad Khaldun Ismail; Tri Maharani; Sumana Khomvilai; Visith Sitprija; Nget Hong Tan; Choo Hock Tan. Geographical variations in king cobra (Ophiophagus hannah) venom from Thailand, Malaysia, Indonesia and China: On venom lethality, antivenom immunoreactivity and in vivo neutralization. Acta Tropica 2019, 203, 105311 .
AMA StyleKae Yi Tan, Tzu Shan Ng, Aymeric Bourges, Ahmad Khaldun Ismail, Tri Maharani, Sumana Khomvilai, Visith Sitprija, Nget Hong Tan, Choo Hock Tan. Geographical variations in king cobra (Ophiophagus hannah) venom from Thailand, Malaysia, Indonesia and China: On venom lethality, antivenom immunoreactivity and in vivo neutralization. Acta Tropica. 2019; 203 ():105311.
Chicago/Turabian StyleKae Yi Tan; Tzu Shan Ng; Aymeric Bourges; Ahmad Khaldun Ismail; Tri Maharani; Sumana Khomvilai; Visith Sitprija; Nget Hong Tan; Choo Hock Tan. 2019. "Geographical variations in king cobra (Ophiophagus hannah) venom from Thailand, Malaysia, Indonesia and China: On venom lethality, antivenom immunoreactivity and in vivo neutralization." Acta Tropica 203, no. : 105311.
W N A Shukri; V H Ng; Ahmad Khaldun Ismail. A case of cough induced rib fracture with subcutaneous emphysema and pneumothorax. 2019, 74, 551 -552.
AMA StyleW N A Shukri, V H Ng, Ahmad Khaldun Ismail. A case of cough induced rib fracture with subcutaneous emphysema and pneumothorax. . 2019; 74 (6):551-552.
Chicago/Turabian StyleW N A Shukri; V H Ng; Ahmad Khaldun Ismail. 2019. "A case of cough induced rib fracture with subcutaneous emphysema and pneumothorax." 74, no. 6: 551-552.
Snakebite management is crucial; inappropriate treatment may lead to death, morbidity, or unnecessary surgical interventions. In Malaysia, the establishment of a Remote Envenomation Consultation Service (RECS) by a group of emergency physicians and clinical toxicologists is for the purpose of assisting healthcare providers in clinics and hospitals to formulate diagnosis and management plan for cases related to envenomation or poisoning from land and marine animals. However, the current method of consultation via phone calls and short messaging system can cause difficulties in analysing patient data and limiting the communication between healthcare providers and experts. This paper proposed a mobile-based clinical decision support model named MyRECS for managing snakebite cases in Malaysia. Furthermore, the mobile application embedded a rules-based model for identifying snake species to obtain an accurate diagnosis. The design includes the workflow of the application, the structure of data entry, the formulation of diagnosis, and the consultation of treatment plans at every stage of clinical management.
Adawiyah Md Ashar; Meng Chun Lam; Suhaila Zainudin; Ahmad Khaldun Ismail. A Mobile-Based Clinical Decision Support Model Design for Remote Snakebite Management Consultation in Malaysia. Journal of Computational and Theoretical Nanoscience 2019, 16, 2223 -2232.
AMA StyleAdawiyah Md Ashar, Meng Chun Lam, Suhaila Zainudin, Ahmad Khaldun Ismail. A Mobile-Based Clinical Decision Support Model Design for Remote Snakebite Management Consultation in Malaysia. Journal of Computational and Theoretical Nanoscience. 2019; 16 (5):2223-2232.
Chicago/Turabian StyleAdawiyah Md Ashar; Meng Chun Lam; Suhaila Zainudin; Ahmad Khaldun Ismail. 2019. "A Mobile-Based Clinical Decision Support Model Design for Remote Snakebite Management Consultation in Malaysia." Journal of Computational and Theoretical Nanoscience 16, no. 5: 2223-2232.
Trimeresurus nebularis is a montane pit viper that causes bites and envenomation to various communities in the central highland region of Malaysia, in particular Cameron’s Highlands. To unravel the venom composition of this species, the venom proteins were digested by trypsin and subjected to nano-liquid chromatography-tandem mass spectrometry (LC-MS/MS) for proteomic profiling. Snake venom metalloproteinases (SVMP) dominated the venom proteome by 48.42% of total venom proteins, with a characteristic distribution of P-III: P-II classes in a ratio of 2:1, while P-I class was undetected. Snaclecs constituted the second most venomous protein family (19.43%), followed by snake venom serine proteases (SVSP, 14.27%), phospholipases A2 (5.40%), disintegrins (5.26%) and minor proteins including cysteine-rich secretory proteins, L-amino acid oxidases, phosphodiesterases, 5′-nucleotidases. The venomic profile correlates with local (painful progressive edema) and systemic (hemorrhage, coagulopathy, thrombocytopenia) manifestation of T. nebularis envenoming. As specific antivenom is unavailable for T. nebularis, the hetero-specific Thai Green Pit viper Monovalent Antivenom (GPVAV) was examined for immunological cross-reactivity. GPVAV exhibited good immunoreactivity to T. nebularis venom and the antivenom effectively cross-neutralized the hemotoxic and lethal effects of T. nebularis (lethality neutralizing potency = 1.6 mg venom per mL antivenom). The findings supported GPVAV use in treating T. nebularis envenoming.
Choo Hock Tan; Kae Yi Tan; Tzu Shan Ng; Evan S.H. Quah; Ahmad Khaldun Ismail; Sumana Khomvilai; Visith Sitprija; Nget Hong Tan. Venomics of Trimeresurus (Popeia) nebularis, the Cameron Highlands Pit Viper from Malaysia: Insights into Venom Proteome, Toxicity and Neutralization of Antivenom. Toxins 2019, 11, 95 .
AMA StyleChoo Hock Tan, Kae Yi Tan, Tzu Shan Ng, Evan S.H. Quah, Ahmad Khaldun Ismail, Sumana Khomvilai, Visith Sitprija, Nget Hong Tan. Venomics of Trimeresurus (Popeia) nebularis, the Cameron Highlands Pit Viper from Malaysia: Insights into Venom Proteome, Toxicity and Neutralization of Antivenom. Toxins. 2019; 11 (2):95.
Chicago/Turabian StyleChoo Hock Tan; Kae Yi Tan; Tzu Shan Ng; Evan S.H. Quah; Ahmad Khaldun Ismail; Sumana Khomvilai; Visith Sitprija; Nget Hong Tan. 2019. "Venomics of Trimeresurus (Popeia) nebularis, the Cameron Highlands Pit Viper from Malaysia: Insights into Venom Proteome, Toxicity and Neutralization of Antivenom." Toxins 11, no. 2: 95.
Most industries have begun adapting mobile technology in their daily work included health domain. A group of clinical toxinology experts intend to adopt the mobile technology to provide the consultation services remotely. Current practice of the consultation service is using the communication application available in market which has limitation and not suitable in their context. Thus, a specific newly design mobile application should be developed for their case. To generate mobile applications and services that meet the user's expectations, the development of applications that emphasize user experience (UX) factor needs to be implemented. UX factors are heavily depending on the different user, system, context and temporal factors. There is lack of research of UX factors in the mobile health domain especially in the remote envenomation consultation mobile application. Therefore, the purpose and scope of this research is to identify UX factors from the perspective of system components for this type of mobile application. This paper gathered the UX definition, UX factor and UX model from the previous researches. The UX factors finding process included literature review and discussion with the clinical toxinology experts. UX factors have been identified and matched with the remote consultation mobile application context. At the end, we have derived a UX model for the remote envenomation consultation mobile application case. The UX model included four product features and seven UX factor. Product features involved information quality, user interface design, functionality and data visualisation. Whereas seven UX factor involved usefulness, effectiveness, efficiency, ease of use, aesthetic, trustworthy and stimulation. The presented UX Model contained specific factor for remote envenomation consultation mobile application. It can be a reference to develop a mobile application to meet the context and user expectation for the remote consultation case.
Rasyida Zainun; Meng Chun Lam; Khairul Azmi Abu Bakar; Ahmad Khaldun Ismail. User Experience Model for Remote Envenomation Consultation Mobile Application with Decision Support Ability. International Journal on Advanced Science, Engineering and Information Technology 2018, 8, 1470 -1479.
AMA StyleRasyida Zainun, Meng Chun Lam, Khairul Azmi Abu Bakar, Ahmad Khaldun Ismail. User Experience Model for Remote Envenomation Consultation Mobile Application with Decision Support Ability. International Journal on Advanced Science, Engineering and Information Technology. 2018; 8 (4-2):1470-1479.
Chicago/Turabian StyleRasyida Zainun; Meng Chun Lam; Khairul Azmi Abu Bakar; Ahmad Khaldun Ismail. 2018. "User Experience Model for Remote Envenomation Consultation Mobile Application with Decision Support Ability." International Journal on Advanced Science, Engineering and Information Technology 8, no. 4-2: 1470-1479.
A total of 15,798 snakebite cases in Malaysia have been recorded between year 2010-2014. The snakebite management is crucial; The inappropriate treatment may lead to death, morbidity unnecessary surgical interventions. In Malaysia, the establishment of a Remote Envenomation Consultation Service (RECS) by a group of emergency physicians and clinical toxinologist aims to assist healthcare providers in clinics and hospitals to formulate diagnosis and management of cases related to envenomation or poisoning from land and marine animals. However, current method of consultation via phone calls and short messaging systems can cause difficulties in analyzing patient data and limiting communications between healthcare providers and experts. This paper discusses the RECS consultation process in managing snakebites cases in Malaysia. Improved work processes involve the transformation of services from manual practice to a more effective mobile application. For the effective administration of snakebite management, the accurate diagnosis of the snake species is crucial. Thus, this study also produced a mobile application framework named MyRECS with a rules-based model for identifying snake species based on morphological features. The framework included the process of formulating diagnosis and treatment plans at every stage of clinical management. It is a base for developing a decision support system in the form of mobile applications for other similar research. The MyRECS mobile application framework together with the method of rules-based model implementation will help to identify snake species and it facilitates the implementation of long-distance consultations between experts and healthcare providers.
Adawiyah Md Ashar; Meng Chun Lam; Suhaila Zainudin; Ahmad Khaldun Ismail. A preliminary study on the decision support mobile application for remote snakebite management consultation in Malaysia. AIP Conference Proceedings 2018, 2016, 020086 .
AMA StyleAdawiyah Md Ashar, Meng Chun Lam, Suhaila Zainudin, Ahmad Khaldun Ismail. A preliminary study on the decision support mobile application for remote snakebite management consultation in Malaysia. AIP Conference Proceedings. 2018; 2016 (1):020086.
Chicago/Turabian StyleAdawiyah Md Ashar; Meng Chun Lam; Suhaila Zainudin; Ahmad Khaldun Ismail. 2018. "A preliminary study on the decision support mobile application for remote snakebite management consultation in Malaysia." AIP Conference Proceedings 2016, no. 1: 020086.
The Asiatic coral snakes are basal in the phylogeny of coral snakes. Although envenoming by the Asiatic coral snakes is rarely fatal, little is known about their venom properties and variability from the American coral snakes. Integrating reverse-phase high performance liquid chromatography and nano-liquid chromatography-tandem mass spectrometry, we showed that the venom proteome of the Malaysian banded or striped coral snake (Calliophis intestinalis) was composed of mainly phospholipases A2 (PLA2, 43.4%) and three-finger toxins (3FTx, 20.1%). Within 3FTx, the cytotoxins or cardiotoxins (CTX) dominated while the neurotoxins' content was much lower. Its subproteomic details contrasted with the 3FTx profile of most Micrurus sp., illustrating a unique dichotomy of venom phenotype between the Old and New World coral snakes. Calliophis intestinalis venom proteome was correlated with measured enzymatic activities, and in vivo it was myotoxic but non-lethal to mice, frogs and geckos at high doses (5–10 μg/g). The venom contains species-specific toxins with distinct sequences and antigenicity, and the antibodies raised against PLA2 and CTX of other elapids showed poor binding toward its venom antigens. The unique venom proteome of C. intestinalis unveiled a repertoire of novel toxins, and the toxicity test supported the need for post-bite monitoring of myotoxic complication. Malaysian banded or striped coral snake (Calliophis intestinalis) has a cytotoxin (CTX)-predominating venom proteome, a characteristic shared by its congener, the Malayan blue coral snake (Calliophis bivirgata). With little neurotoxins (NTX), it illustrates a CTX/NTX dichotomy of venom phenotype between the Old World and the New World coral snakes. The low toxicity and limited antigenicity of the venom imply that C. intestinalis bite envenoming can be managed locally via symptomatic relief of the mild to moderate pain with appropriate analgesia. Systemically, the serum creatinine kinase level of patients should be monitored serially for potential complication of myotoxicity. The limited antigenicity of the venom proteins implies that the empirical use of heterologous antivenom is mostly inappropriate and not recommended.
Kae Yi Tan; Jia Lee Liew; Nget Hong Tan; Evan Quah; Ahmad Khaldun Ismail; Choo Hock Tan. Unlocking the secrets of banded coral snake (Calliophis intestinalis, Malaysia): A venom with proteome novelty, low toxicity and distinct antigenicity. Journal of Proteomics 2018, 192, 246 -257.
AMA StyleKae Yi Tan, Jia Lee Liew, Nget Hong Tan, Evan Quah, Ahmad Khaldun Ismail, Choo Hock Tan. Unlocking the secrets of banded coral snake (Calliophis intestinalis, Malaysia): A venom with proteome novelty, low toxicity and distinct antigenicity. Journal of Proteomics. 2018; 192 ():246-257.
Chicago/Turabian StyleKae Yi Tan; Jia Lee Liew; Nget Hong Tan; Evan Quah; Ahmad Khaldun Ismail; Choo Hock Tan. 2018. "Unlocking the secrets of banded coral snake (Calliophis intestinalis, Malaysia): A venom with proteome novelty, low toxicity and distinct antigenicity." Journal of Proteomics 192, no. : 246-257.
Arboreal pit vipers of the Trimeresurus complex group are medically important species in Indonesia (west of Wallace's line), but there is no specific antivenom produced in the country for treating related envenomation. Instead, the exiting trivalent Indonesian antivenom, Biosave(®) Serum Anti Bisa Ular (SABU, indicated for envenoming by Malayan pit viper, Javan spitting cobra and banded krait) is often misused to treat Trimeresus envenoming resulting in poor therapeutic outcome. Here, we investigated the cross-reactivity and neutralization capability of Thai Green Pit Viper Antivenom (GPVAV) against the venoms of four Indonesian Trimeresurus species. Consistently, the venoms of Trimeresurus (Trimeresurus) insularis, Trimeresurus (Trimeresurus) purpureomaculatus, Trimeresurus (Parias) hageni and Trimeresurus (Craspedocephalus) puniceus of Indonesia showed stronger immunoreactivity on ELISA to GPVAV than to Biosave(®). The findings correlated with in vivo neutralization results, whereby GPVAV was far more effective than Biosave(®) in cross-neutralizing the lethality of the venoms by a potency of at least 15 to 80 times higher. The efficacy of GPVAV is partly attributable to its cross-neutralization of the procoagulant effect of the venoms, thereby mitigating the progression of venom-induced consumptive coagulopathy. The paraspecific effectiveness of GPVAV against Trimeresurus species envenoming in Indonesia await further clinical investigation.
Choo Hock Tan; Jia Lee Liew; Nget Hong Tan; Ahmad Khaldun Ismail; Tri Maharani; Sumana Khomvilai; Visith Sitprija. Cross reactivity and lethality neutralization of venoms of Indonesian Trimeresurus complex species by Thai Green Pit Viper Antivenom. Toxicon 2017, 140, 32 -37.
AMA StyleChoo Hock Tan, Jia Lee Liew, Nget Hong Tan, Ahmad Khaldun Ismail, Tri Maharani, Sumana Khomvilai, Visith Sitprija. Cross reactivity and lethality neutralization of venoms of Indonesian Trimeresurus complex species by Thai Green Pit Viper Antivenom. Toxicon. 2017; 140 ():32-37.
Chicago/Turabian StyleChoo Hock Tan; Jia Lee Liew; Nget Hong Tan; Ahmad Khaldun Ismail; Tri Maharani; Sumana Khomvilai; Visith Sitprija. 2017. "Cross reactivity and lethality neutralization of venoms of Indonesian Trimeresurus complex species by Thai Green Pit Viper Antivenom." Toxicon 140, no. : 32-37.
Prehospital care (PHC) pain evaluation is an essential patient assessment to be performed by paramedics. Pain intensity is frequently assessed using Verbal Numerical Rating Scale (VNRS) or Visual Analog Scale (VAS). Our aim was to evaluate the agreement between VNRS and VAS in measuring acute pain in prehospital setting and to identify the preference among paramedics and patients. This was a 3-month cross-sectional study. Convenience sampling was used to enroll patients with acute pain responded to by the ambulance team. Data from consented patients were analyzed using Bland-Altman method, Spearman's correlation test, and Cohen's κ test. One hundred and thirty-three patients participated in this study (median age 32 years; 72.2% male). The median for pain score at the scene was 7.50 (interquartile range [IQR]: 5.00) for VAS and 7.00 (IQR: 5.00) for VNRS. The median for pain score on arrival at the hospital was 7.00 (IQR: 3.10) for VAS and 7.00 (IQR: 4.00) for VNRS. There was a strong correlation between VNRS and VAS at the scene (r = 0.865; p < 0.001), as well as on arrival at the hospital (r = 0.933; p < 0.001). Kappa coefficient values and Bland-Altman analysis indicates good agreement between both scales for measuring acute pain. VNRS was the preferred method to measure acute pain by patients and paramedics. VAS performs as well as VNRS in assessing acute pain in PHC. VAS and VNRS must not be used interchangeably to assess acute pain; either method should be used consistently.
Ahmad Khaldun Ismail; Muhammad A. Abdul Ghafar; Noor Shaza A. Shamsuddin; Nurul A. Roslan; Hilwani Kaharuddin; Nik A. Nik Muhamad. The Assessment of Acute Pain in Pre-Hospital Care Using Verbal Numerical Rating and Visual Analogue Scales. The Journal of Emergency Medicine 2015, 49, 287 -293.
AMA StyleAhmad Khaldun Ismail, Muhammad A. Abdul Ghafar, Noor Shaza A. Shamsuddin, Nurul A. Roslan, Hilwani Kaharuddin, Nik A. Nik Muhamad. The Assessment of Acute Pain in Pre-Hospital Care Using Verbal Numerical Rating and Visual Analogue Scales. The Journal of Emergency Medicine. 2015; 49 (3):287-293.
Chicago/Turabian StyleAhmad Khaldun Ismail; Muhammad A. Abdul Ghafar; Noor Shaza A. Shamsuddin; Nurul A. Roslan; Hilwani Kaharuddin; Nik A. Nik Muhamad. 2015. "The Assessment of Acute Pain in Pre-Hospital Care Using Verbal Numerical Rating and Visual Analogue Scales." The Journal of Emergency Medicine 49, no. 3: 287-293.
Malaysia is a tropical country and snakes are an essential component of its many ecosystems. A number of medically significant venomous land and marine species have been recorded from Malaysia. Humans are exposed to bites and envenoming from these snakes during their engagement in various activities that bring them into the animal’s natural habitat. Snakebite is an important medical emergency and one of the common causes of hospital admission. There is a clear association between the knowledge and confidence level of healthcare providers managing snakebite with the quality of patient care, the provision of appropriate clinical management, the selection of appropriate antivenom, and the outcome of such treatment. The clinical management of snake bites and envenoming may still be suboptimal due to neglect of this issue and negligence at various levels of medical care. The true scale of mortality and morbidity from snakebite remains uncertain as a result of inadequate documentation. To overcome these deficiencies, snake bite envenoming must be recognized as an important notifiable disease. Awareness programs for the public and specially tailored educational programs for healthcare providers should be encouraged and supported. An appropriate clinical management guideline should be established and the inappropriate ones removed. The establishment of an easily accessible qualified clinical expert assistance in managing snakebites and envenomation is also necessary.
Ahmad Khaldun Ismail. Snakebite and Envenomation Management in Malaysia. Clinical Toxinology in Asia Pacific and Africa 2015, 71 -102.
AMA StyleAhmad Khaldun Ismail. Snakebite and Envenomation Management in Malaysia. Clinical Toxinology in Asia Pacific and Africa. 2015; ():71-102.
Chicago/Turabian StyleAhmad Khaldun Ismail. 2015. "Snakebite and Envenomation Management in Malaysia." Clinical Toxinology in Asia Pacific and Africa , no. : 71-102.
Acute exposure to toxic or poisonous substances can be intentional or accidental. The onset of the toxic effect depends on the degree of absorption of the toxicant. The management of acute exposure to toxicants is generally supportive. Knowledge of the pharmacokinetics and pharmacodynamics of the offending agent is important. The use of pharmacological agents in treating poisoning is to manipulate the pharmacokinetic or pharmacodynamic profiles of the toxicant. These pharmacological agents will minimize the absorption and/or enhance the elimination of the toxicant from the body. Specific antidotes are used to alter the effects of certain known toxicants through neutralization and pharmacological antagonism. Having the ability to identify the effect of specific classes of substances on the body (toxidromes) will facilitate the selection of an appropriate management strategy to optimize the outcome.
Choo Hock Tan; Ahmad Khaldun Ismail. The Poisoned Patient. Pharmacological Basis of Acute Care 2014, 219 -225.
AMA StyleChoo Hock Tan, Ahmad Khaldun Ismail. The Poisoned Patient. Pharmacological Basis of Acute Care. 2014; ():219-225.
Chicago/Turabian StyleChoo Hock Tan; Ahmad Khaldun Ismail. 2014. "The Poisoned Patient." Pharmacological Basis of Acute Care , no. : 219-225.
Malaysia is a tropical country and snakes are an essential component of its many ecosystems. A number of medically significant venomous land and marine species have been recorded from Malaysia. Humans are exposed to bites and envenoming from these snakes during their engagement in various activities that bring them into the animal’s natural habitat. Snakebite is an important medical emergency and one of the common causes of hospital admission. There is a clear association between the knowledge and confidence level of healthcare providers managing snakebite with the quality of patient care, the provision of appropriate clinical management, the selection of appropriate antivenom, and the outcome of such treatment. The clinical management of snake bites and envenoming may still be suboptimal due to neglect of this issue and negligence at various levels of medical care. The true scale of mortality and morbidity from snakebite remains uncertain as a result of inadequate documentation. To overcome these deficiencies, snake bite envenoming must be recognized as an important notifiable disease. Awareness programs for the public and specially tailored educational programs for healthcare providers should be encouraged and supported. An appropriate clinical management guideline should be established and the inappropriate ones removed. The establishment of an easily accessible qualified clinical expert assistance in managing snakebites and envenomation is also necessary.
Ahmad Khaldun Ismail. Snakebite and Envenomation Management in Malaysia. Toxins and Drug Discovery 2014, 1 -27.
AMA StyleAhmad Khaldun Ismail. Snakebite and Envenomation Management in Malaysia. Toxins and Drug Discovery. 2014; ():1-27.
Chicago/Turabian StyleAhmad Khaldun Ismail. 2014. "Snakebite and Envenomation Management in Malaysia." Toxins and Drug Discovery , no. : 1-27.
Context. Non-front-fanged colubroid snakes (NFFC; formerly and artificially taxonomically assembled as “colubrids”) comprise the majority of extant ophidian species. Although the medical risks of bites by a handful of species have been documented, the majority of these snakes have oral products (Duvernoy's secretions, or venoms) with unknown biomedical properties/unverified functions and their potential for causing harm in humans is unknown. Case details. Described are three cases of local envenoming from NFFC bites inflicted respectively by the mangrove or ringed cat-eyed snake (Boiga dendrophila, Colubridae), the Western beaked snake (Rhamphiophis oxyrhynchus, Lamprophiidae) and the rain forest cat-eyed snake (Leptodeira frenata, Dipsadidae). The effects ranged from mild pain, edema and erythema to severe pain, progressive edema, and blistering with slowly resolving arthralgia; there were no systemic effects. Discussion. Although these three taxa occasionally inflict bites with mild to moderate local effects, there is no current evidence of systemic involvement. Two of these cases were reported to one of the authors for medical evaluation, and although verified, thus constitute reliably reported cases, but low-quality evidence. Type-1 local hypersensitivity may contribute to some cases, but most local effects observed or reported in these three cases were consistent with the effects of venom/oral product components.
S. A. Weinstein; Rowland Griffin; Ahmad Khaldun Ismail. Non-front-fanged colubroid (“colubrid”) snakebites: Three cases of local envenoming by the mangrove or ringed cat-eyed snake (Boiga dendrophila; Colubridae, Colubrinae), the Western beaked snake (Rhamphiophis oxyrhynchus; Lamprophiidae, Psammophinae) and the rain forest cat-eyed snake (Leptodeira frenata; Dipsadidae). Clinical Toxicology 2014, 52, 277 -282.
AMA StyleS. A. Weinstein, Rowland Griffin, Ahmad Khaldun Ismail. Non-front-fanged colubroid (“colubrid”) snakebites: Three cases of local envenoming by the mangrove or ringed cat-eyed snake (Boiga dendrophila; Colubridae, Colubrinae), the Western beaked snake (Rhamphiophis oxyrhynchus; Lamprophiidae, Psammophinae) and the rain forest cat-eyed snake (Leptodeira frenata; Dipsadidae). Clinical Toxicology. 2014; 52 (4):277-282.
Chicago/Turabian StyleS. A. Weinstein; Rowland Griffin; Ahmad Khaldun Ismail. 2014. "Non-front-fanged colubroid (“colubrid”) snakebites: Three cases of local envenoming by the mangrove or ringed cat-eyed snake (Boiga dendrophila; Colubridae, Colubrinae), the Western beaked snake (Rhamphiophis oxyrhynchus; Lamprophiidae, Psammophinae) and the rain forest cat-eyed snake (Leptodeira frenata; Dipsadidae)." Clinical Toxicology 52, no. 4: 277-282.
Objective Dengue fever is endemic in Malaysia and poses a significant problem to the national health system. Because of its nonspecific clinical features, it creates clinical and administrative uncertainties. We evaluated the role of an emergency department short-stay ward (EDSSW) in the management of dengue fever in the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Methods A retrospective study was carried out on suspected dengue patients who were admitted to UKMMC EDSSW, between January and March 2010. Data were retrieved from the EDSSW Monthly Census Book and patients’ medical records. Patients were categorized as follows: group 1, which included patients who received treatment in the EDSSW only, and group 2, which included patients who received initial treatment in EDSSW and were subsequently admitted to the inpatient (IP) wards. Results A total of 147 patients’ records were available. The total length of stay was 32.2 h in group 1 and 100.5 h in group 2. For group 2 patients, a median of 21.8 h was spent in EDSSW and 78.8 h was spent in IP. All patients in group 1 and group 2 were discharged well. The total EDSSW stay was 4309 patient-hours; IP stay totalled 5137 patient-hours. The use of the EDSSW reduced the IP burden in managing dengue by 45.6%. Conclusion EDSSW limit the number and burden of dengue patients requiring formal IP admissions while acting as a ‘safety net’ for inappropriate discharges and unnecessary admissions.
Nazhatul M. Ahmad Nasarudin; Ismail Mohd Saiboon; Ahmad K. Ismail. The role of an emergency department short-stay ward in the management of dengue fever. European Journal of Emergency Medicine 2013, 20, 335 -338.
AMA StyleNazhatul M. Ahmad Nasarudin, Ismail Mohd Saiboon, Ahmad K. Ismail. The role of an emergency department short-stay ward in the management of dengue fever. European Journal of Emergency Medicine. 2013; 20 (5):335-338.
Chicago/Turabian StyleNazhatul M. Ahmad Nasarudin; Ismail Mohd Saiboon; Ahmad K. Ismail. 2013. "The role of an emergency department short-stay ward in the management of dengue fever." European Journal of Emergency Medicine 20, no. 5: 335-338.
Ahmad Khaldun Ismail; Nina Ilani Mohd Salleh; Nur Aslina Hamdan; Masmuna Idayu Mohd Jawi; Siti Nailah Abdul Razak; Shamsuriani Md Jamal; Shamsul Azhar Shah. The use of warning lights and siren by the ambulance crew in the Universiti Kebangsaan Malaysia Medical Centre. European Journal of Emergency Medicine 2012, 19, 408 -409.
AMA StyleAhmad Khaldun Ismail, Nina Ilani Mohd Salleh, Nur Aslina Hamdan, Masmuna Idayu Mohd Jawi, Siti Nailah Abdul Razak, Shamsuriani Md Jamal, Shamsul Azhar Shah. The use of warning lights and siren by the ambulance crew in the Universiti Kebangsaan Malaysia Medical Centre. European Journal of Emergency Medicine. 2012; 19 (6):408-409.
Chicago/Turabian StyleAhmad Khaldun Ismail; Nina Ilani Mohd Salleh; Nur Aslina Hamdan; Masmuna Idayu Mohd Jawi; Siti Nailah Abdul Razak; Shamsuriani Md Jamal; Shamsul Azhar Shah. 2012. "The use of warning lights and siren by the ambulance crew in the Universiti Kebangsaan Malaysia Medical Centre." European Journal of Emergency Medicine 19, no. 6: 408-409.
Ahmad Khaldun Ismail; Scott A. Weinstein. Response to Letter entitled “Cardiac toxicity following cobra envenomation”. Clinical Toxicology 2012, 50, 863 -863.
AMA StyleAhmad Khaldun Ismail, Scott A. Weinstein. Response to Letter entitled “Cardiac toxicity following cobra envenomation”. Clinical Toxicology. 2012; 50 (9):863-863.
Chicago/Turabian StyleAhmad Khaldun Ismail; Scott A. Weinstein. 2012. "Response to Letter entitled “Cardiac toxicity following cobra envenomation”." Clinical Toxicology 50, no. 9: 863-863.
Context. Envenoming by some species of cobras (Naja species) may include cardiotoxic effects including various dysrhythmias. However, dysrhythmias leading specifically to ventricular bigeminy have not been previously documented. We report a case of cardiotoxicity and the development of ventricular bigeminy following a cobra envenomation. Case details. The patient was a 23-year-old man who presented to an emergency department following an alleged cobra bite. There was transient episode of nausea, vomiting, hypotension and tachycardia. The ECG showed infrequent ventricular ectopics that progressed to ventricular bigeminy and persisted even after the vital signs normalized. Complete resolution and resumption of normal sinus rhythm occurred following an empirical administration of monovalent antivenom against Naja kaouthia venom. The patient was discharged after 24 hours of uneventful observation. Discussion. The patient's concomitant local effects, episodic cardiovascular instability and evolution of ventricular bigeminy support the likelihood of a venom-induced disease. Ventricular bigeminy can develop following a cobra envenomation. Thorough clinical evaluation, close serial observation of vital signs and early continuous cardiac monitoring are important in Naja spp. bites.
Ahmad Khaldun Ismail; Scott A. Weinstein; Mark Auliya; Prakashrao Appareo. Ventricular bigeminy following a cobra envenomation. Clinical Toxicology 2012, 50, 518 -521.
AMA StyleAhmad Khaldun Ismail, Scott A. Weinstein, Mark Auliya, Prakashrao Appareo. Ventricular bigeminy following a cobra envenomation. Clinical Toxicology. 2012; 50 (6):518-521.
Chicago/Turabian StyleAhmad Khaldun Ismail; Scott A. Weinstein; Mark Auliya; Prakashrao Appareo. 2012. "Ventricular bigeminy following a cobra envenomation." Clinical Toxicology 50, no. 6: 518-521.
The paradise tree snake, Chrysopelea paradisi, is a rear-fanged colubrid. Like other members of the genus Chrysopelea, it is able to glide through the air, and thus, is commonly known as a "flying snake." There are few documented effects of its bite on humans. A 16-year-old military college student presented to the Emergency Department (ED) of an urban teaching hospital 2 h after being bitten by C. paradisi. There were multiple bite marks and the patient reported moderate pain on the left index finger. There was no evidence of significant local or systemic envenomation. A transient prolonged coagulation profile and raised creatine kinase level were noted. The full effects of a bite from C. paradisi remain uncharacterized. This case featured only mild local effect. After the administration of first aid, non-sedating analgesia, anti-tetanus toxoid injection, and broad-spectrum antibiotic coverage, a short stay in the ED observation ward with regular monitoring of vital signs and serial wound inspection are recommended. More effort is required to increase awareness of the prevention and management of snakebite with equal emphasis on conservation of wildlife and their natural habitat.
Toh Leong Tan; Ahmad Khaldun Ismail; Kien Woo Kong; Nor Khatijah Ahmad. Bitten by the “Flying” Tree Snake, Chrysopelea Paradisi. The Journal of Emergency Medicine 2012, 42, 420 -423.
AMA StyleToh Leong Tan, Ahmad Khaldun Ismail, Kien Woo Kong, Nor Khatijah Ahmad. Bitten by the “Flying” Tree Snake, Chrysopelea Paradisi. The Journal of Emergency Medicine. 2012; 42 (4):420-423.
Chicago/Turabian StyleToh Leong Tan; Ahmad Khaldun Ismail; Kien Woo Kong; Nor Khatijah Ahmad. 2012. "Bitten by the “Flying” Tree Snake, Chrysopelea Paradisi." The Journal of Emergency Medicine 42, no. 4: 420-423.
S M Fathil; N S C Soong; N M A Mustafa; A Arith; W N Ng; N A Bahrum; N A Aszeme; Z Ahmad; Ahmad Khaldun Ismail. Audit of pain management in the emergency department. The Medical journal of Malaysia 2011, 66, 1 .
AMA StyleS M Fathil, N S C Soong, N M A Mustafa, A Arith, W N Ng, N A Bahrum, N A Aszeme, Z Ahmad, Ahmad Khaldun Ismail. Audit of pain management in the emergency department. The Medical journal of Malaysia. 2011; 66 (2):1.
Chicago/Turabian StyleS M Fathil; N S C Soong; N M A Mustafa; A Arith; W N Ng; N A Bahrum; N A Aszeme; Z Ahmad; Ahmad Khaldun Ismail. 2011. "Audit of pain management in the emergency department." The Medical journal of Malaysia 66, no. 2: 1.