TABLE OF CONTENTS
Adakah darah yang didermakan selamat untuk pesakit? Anemia in Pregnancy
Are you anaemic? Being Aware Of Your Blood Group
Komponen Darah Dan Kegunaan Bagi Pesakit Pendermaan Sel Stem Darah: Antara Mitos Dan Realiti
Pecah/Potong Ubat, Boleh Atau Tidak? Apakah itu ‘Blood Crossmatching’ atau Ujian keserasian darah?
The comeback of cold storage platelets. Will it gain momentum? Keseimbangan Emosi: Cara Jururawat Berhadapan dengan Pesakit dan Keluarga yang Sedang Marah di Kawasan Hospital
I'm RH Negative Sejarah dan Perkembangan Makanan Berfungsi
Edaran Maklumat Drug Edisi Ramadhan 2024 : Ubat-ubatan yang TIDAK membatalkan puasa Tingkah-laku kanak-kanak : Apa yang perlu kita tahu?
Enhancing Wellness in Hospital Settings: A Dual Approach to Supporting Staff and Patient Well-being Primary Immunodeficiency Diseases: A brief review (in conjunction with Primary Immunodeficiency Disease Awareness Week 2024)
Robot Haiwan Sebagai Sokongan Emosi Untuk Demensia Pemakanan Ketika Hamil bagi Wanita di Malaysia
Virtual Fitness: Revolutionizing Health and Wellness Through Immersive Exercise Kesunyian Dalam Kalangan Warga Emas
Sindrom Cushing Innovative Healthcare: The Rise of Augmented Reality (AR) and Virtual Reality (VR)
Potensi Seni Kaligrafi dalam Kesihatan Kognitif Warga Tua Astatine-211: Novel targeted therapy against cancer
Hiking in Malaysia: Embrace Nature and Enhance Your Muscle Fitness Sistem imun badan dan demensia
Precision Cancer Therapy - Boron Neutron Capture Therapy (BNCT) Blood Transfusion Process: From Vein to Vein
Gum Bleeding: Beyond dental problems The Wonders of Our Immune System: Nature’s Remarkable Defense
Platelet Transfusion Kultur Sel di Era Moden: Mengubah Landskap Perubatan dan Penyelidikan
Pre-Deposit Blood Donation: A Lifesaver Before Surgery Potensi Penggunaan Tokotrienol sebagai Terapi Baharu untuk Kesakitan disebabkan Kanser Tulang Metastatik
Thalassemia through time: The cure is here, prevention remains key Knowledge and Attitude Towards Blood Donation Among Non-Donors in Kuala Terengganu
Anaemia in Young Adulthood and Blood Donation: What You Need to Know Polycythemia: Penyakit Darah Pekat yang Kurang Dikenali
Boosting Blood Health! A Quick Dive into Patient Blood Management and Iron Therapy in Malaysia Navigating the Challenges of an Aging Population, Healthcare, and Blood Transfusion Services in Malaysia
The Pulse of Healthcare: Innovative Strategies to Attract and Retain Blood Donors Organ Donation in Malaysia: A Gift of Life


Adakah darah yang didermakan selamat untuk pesakit?



Dr Hairunnisa Arshad, Dr Sharifah Azdiana binti Tuan Din,
Jabatan Perubatan Klinikal,  Institut Perubatan dan Pergigian Termaju, USM

Pada keadaan yang tertentu, ada sesetengah pesakit memerlukan penambahan darah atau komponen darah. Ini dapat dilakukan melalui proses yang disebut sebagai transfusi darah. Sering menjadi pertanyaan kepada pesakit mahupun keluarga pesakit sebelum transfusi darah dijalankan, adakah darah yang didermakan ini selamat? Mari saya jelaskan.

Proses derma darah.

Sebelum proses derma darah dijalankan, para penderma darah akan mengisi borang terlebih dahulu. Di sini penderma akan menigisi butiran peribadi dan menjawab beberapa soalan yang berkaitan. Antara soalan yang perlu dijawab, adakah penderma darah sedang menerima rawatan untuk sebarang penyakit, sedang mengambil ubat untuk sebarang rawatan, sejarah operasi dan lain-lain. Setelah itu, tekanan darah, berat badan dan paras hemoglobin juga akan diperiksa sebelum penderma dibenarkan untuk menderma darah. Selain menyediakan darah yang selamat kepada pesakit, kami juga memastikan proses pendermaan darah adalah selamat untuk penderma darah.

Keadaan kulit pada lengan penderma darah akan diperiksa terlebih dahulu bagi memastikan tiada jangkitan kuman di sekitar kawasan yang akan dilakukan pendermaan darah. Setelah itu, disinfektan dilakukan menggunakan alcohol swab dengan tujuan mengurangkan risiko jangkitan kuman pada darah seperti Staphylococcus aureus.

Bagaimana proses darah di makmal?

Dari pusat pendermaan, beg darah akan dibawa ke makmal untul diproses. Beg darah yang telah dilabel dengan kumpulan darah A, B, AB atau O serta Rh positif atau negatif akan melalui ujian saringan penyakit berjangkit seperti Human immunodeficiency virus (HIV), Hepatitis B, Hepatitis C dan Syphilis. Sementara menunggu keputusan ujian saringan, beg darah tadi akan dikuarantin di dalam peti sejuk yang berasingan dengan beg darah yang sudah sedia untuk digunakan oleh pesakit. Setelah mendapat keputusan bagi ujian saringan, barulah beg darah dibenarkan untuk diberikan kepada pesakit yang memerlukan.

Beg darah juga akan diproses dan umumnya akan menghasilkan tiga produk iaitu packed red blood cells, platelets dan fresh frozen plasma.  Oleh sebab itu, lahirlah slogan yang selalu anda dengar “satu beg darah menyelamatkan tiga nyawa”.

Penyimpanan darah dan komponen darah.

Tahukah anda bahawa kuman mudah membiak pada suhu 20°C sehingga 45°C. Oleh itu, bagi memastikan kualiti darah dan komponen darah terjamin, ia akan disimpan di dalam peti sejuk khas di makmal Unit Perubatan Transfusi pada suhu yang optimum. Sebagai contoh, packed red blood cells akan disimpan pada suhu 2-6°C, manakala fresh frozen plasma disimpan pada suhu -18°C sehingga -25°C bagi mengelakkan pembiakan kuman.

Selain penyimpanan pada suhu yang optimum, pemeriksaan beg darah dan komponen darah secara fizikal akan dilakukan. Sebagai contoh, beg darah diperiksa untuk melihat adakah terdapat perubahan warna pada darah, adakah terdapat buih atau ketulan di dalam beg darah atau adakah terdapat kebocoran pada beg darah. Proses ini akan dilakukan dari semasa ke semasa.

Adakah darah itu serasi?

Apabila seorang pesakit memerlukan darah, lebih kurang 3-5ml sampel darah dari pesakit akan diambil dan diuji untuk memastikan kumpulan darah pesakit. Kemudian, beg darah yang bersesuaian dengan kumpulan darah pesakit akan diambil dari simpanan peti sejuk khas dan dilakukan ujian keserasian darah. Jika keputusannya adalah serasi, barulah beg darah tadi dilabel atas nama pesakit dan transfusi darah dapat dijalankan.

Rujukan

1.    Portal rasmi Pusat Drah Negara https://pdn.gov.my
2.    Portal rasmi World Health Organization https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability
3.    Dulong C, Brett K, Argáez C. Skin Preparation for Injections: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2020 Mar. PMID: 33074639.










 




Anemia in Pregnancy



Dr Puteri Sollehah Azlan, Dr Sharifah Azdiana Binti Tuan Din
Department of Clinical Medicine, Advanced Medical and Dental Institute, USM

Have you ever wondered why pregnant women are prone to anaemia?

Anaemia is a common occurrence in pregnancy. According to the World Health Organization (WHO), 14.7%–59% of pregnant women in different regions were anaemic in 2019. In Malaysia, it was 31%. During pregnancy, there is a significant rise in plasma volume with a lower increment in red blood cell (RBC) mass. These changes, which result in an increase in total blood volume, are important to meet the increased demands of blood flow for the foetus and may protect pregnant women against blood loss during childbirth. However, the disproportion in volume expansion between the plasma and RBC mass results in haemodilution.

Causes

Iron deficiency anaemia (IDA) is a common culprit causing anaemia in pregnancy as iron stores are often inadequate to meet the increasing demands of pregnancy due to the increase in RBC mass, foetal growth, and blood loss during delivery.

Although iron deficiency is the commonest cause of anaemia in pregnancy, other aetiologies such as nutritional deficiencies of vitamin B12 and folate, hemoglobinopathies, and infections should be considered.

Consequences

IDA results in decreased oxygen transport to tissues, causing women to develop symptoms such as fatigue, decreased ability to concentrate, palpitations, reduced immunity which leads to an increased frequency of infections, and pica (the tendency to eat things that are not considered food).

Pregnant women have also been associated with an increased risk of premature delivery due to iron depletion. Moreover, IDA may affect foetal growth and development inside the womb.

Detection

In order to provide enough time for treatment in the event that anaemia is discovered, the National Institute for Health and Care Excellence (NICE) in the UK advises that screening for anaemia in pregnancy be made available at booking and at 28 weeks.

Prevention

Pregnancy-related iron deficiency anaemia (IDA) can be prevented by taking iron supplements, fortifying staple foods with iron and other vitamins and minerals, and providing health and nutrition information. The WHO recommends daily supplementary iron for all pregnant women in all circumstances; it should be initiated as soon as pregnancy is confirmed and continued for the full duration of the pregnancy.

As for folic acid, it is recommended to start prior to conception for the prevention of neural tube defects.

The World Health Organization strongly advises oral iron and folic acid supplements during pregnancy. However, there are currently no specific recommendations for vitamin B12 supplementation in pregnancy.

Treatment: Iron therapy

The primary treatment in cases of IDA is oral iron therapy; it should be taken on an empty stomach. Intravenous iron preparation can be beneficial in certain cases, such as in mothers who do not respond to oral iron, are not compliant, or are unable to tolerate oral iron preparations.

Treatment: Red blood cell transfusion

It is unclear whether blood transfusions are beneficial to pregnant women who are not actively bleeding. Furthermore, there are risks involved with blood transfusions. Therefore, blood transfusions should be reserved for those who have symptoms, pose a risk of further bleeding, or have a serious heart condition. 

References

WHO The Global Health Observatory; Prevalence of anaemia in pregnant women (aged 15-49) (%)
ACOG (2008) American College of Obstetricians and Gynecologists practice Bulletin no. 95: Anemia in pregnancy. Obstetrics and Gynecology, 112, 201–207
NICE (2008) Antenatal Care for Uncomplicated Pregnancies.NICE Guidelines [CG62]. National Institute for Health and Care Excellence, London, UK.
Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement (Muñoz et al., 2017)
AFRICA 89 physiological changes in pregnancy; Soma-Pillay P, Nelson-Piercy C, Mebazaa A; Cardiovascular Journal of Africa• 27(2) 89-94





Are you anaemic?


Dr. Chang Shi Ya, Dr. Sharifah Azdiana Binti Tuan Din
Jabatan Perubatan Klinikal, Institut Perubatan dan Pergigian Termaju, USM

Anaemia is a condition when someone has insufficient healthy red blood cells to transport oxygen throughout the body. The optimal hemoglobin concentration required to meet physiologic needs varies by age, gender, elevation of residence, smoking habits, and pregnancy status. (1)
 
Anaemia is a serious global public health problem that particularly affects young children, menstrual adolescent girls and women, and pregnant and postpartum women (1). According to the Malaysia National Health Morbidity Survey 2019, approximately 20% of Malaysians had anaemia (Figure 1). higher frequency among women with reproductive age, with 3 out of 10 anaemic. It is comparable to hypertension prevalence up to 30% and greater than diabetes mellitus, with a prevalence of 18.3% (2).

 
 
Iron deficiency is the most common nutritional deficiency that causes anaemia. Iron deficiency can occur as a result of (i) insufficient dietary iron intake, such as vegan diet restrictions or a lack of iron-rich foods; (ii) excessive iron loss, such as internal bleeding, haemorrhage associated with childbirth, or menstrual loss; (iii) impaired iron absorption; (iv) low iron stores at birth; and (v) nutrient interactions affecting iron bioavailability (3).
 
If you are experiencing these symptoms, it is important to talk to your doctor.
 

Figure 2: Signs and symptoms of iron deficiency Source: https://maltofer.co.nz/iron-deficiency/
 
Why is it dangerous? It can cause serious problems for the heart (2).
It also has an impact on school performance due to developmental delays and behavioral disturbances such as decreased motor activity, social interaction, attention to tasks, productivity in adult life, and overall quality of life. Anaemia during pregnancy has been linked to poor maternal and birth outcomes, such as early birth and low birth weight.
 
Iron-deficiency Anaemia may be avoidable if causes of blood loss or problems with iron absorption that can lead to the condition are treated. Maintaining a balanced diet rich in iron and vitamin C will help the body maintain iron levels.

a)    Good sources of iron. Iron is primarily stored in the red blood cells. The majority of the iron is recycled from broken-down red blood cells, with the recommended intake for an adult being 8 mg/day, while premenopausal women are recommended a daily intake of 18 mg (4) to meet the daily requirement of 1-3mg/day. (5) The type of iron consumed can influence iron adsorption. Iron is classified into two types:heme and non-heme (Figure 3). Heme iron can be found in meat, shellfish, and eggs. This iron is more easily absorbed by the human body, up to around 30% of total dietary consumption. Plant-based foods, on the other hand, such as vegetables, fruits, and nuts, are high in non-heme iron. Only around 10% of non-heme iron is readily absorbed by the human body, and this can be enhanced by eating vitamin C-rich foods such as citrus fruits, peppers, and tomatoes (6).
b)    Vitamin C-rich foods such as oranges, strawberries, and tomatoes help boost iron absorption. (4-6)
c)    Avoid dietary restrictions that diminish iron availability.

Calcium is a well-known inhibitor of iron absorption; consequently, dairy products such as milk or calcium supplements should be consumed at a different time than the main meals (7). Tannins, found in tea and coffee, are another inhibitor of iron absorption. As a result, they should be avoided in conjunction with iron-rich foods as well. Various timing recommendations have been offered, such as avoiding foods that reduce iron absorption for at least 2 hours prior to or after a main meal that should consist of iron-rich food. (7)
 
 
Figure 3: Sources of Heme Iron and Non-Heme Iron
Source: https://vegansfirst.com/best-vegan-iron-supplements/
 
If you’ve been advised to take iron supplements, they should be taken on an empty stomach (at least an hour prior to a meal) and best taken with a vitamin C-rich drink like orange juice. Keep in mind that dark-colored or black stools are common side effects of oral iron supplements. If you are unable to tolerate nausea, vomiting, constipation, or diarrhea as a result of the side effects of oral iron supplements, consult your doctor.
 

References


1. Anaemia, World Health Organization. Available at: https://www.who.int/news-room/factsheets/detail/anaemia#:~:text=Iron%20deficiency%2C%20primarily%20due%20to,haemoglobin%20and%2F or%20erythrocyte%20production. (Accessed: 17 November 2023).  
2.    Healthcare Demand - Institute for Public Health. Available at:
https://iku.gov.my/images/IKU/Document/REPORT/NHMS2019/Fact_Sheet_NHMS_2019-English.pdf (Accessed: 18 November 2023).  
3.    Iron deficiency (no date) Maltofer NZ. Available at: https://maltofer.co.nz/iron-deficiency/ (Accessed: 17 November 2023).  
4.    The Blood Safety and Conservation Team. Taking Iron Supplements: Information for Patients. Oxford University Hospitals, NHS Trust [Internet]. 2015 [cited 2023 Aug 13]. Available from: https://www.ouh.nhs.uk/patient-guide/leaflets/files/11903Piron.pdf
5.    Hoffbrand, A.V. and Steensma, D.P. (2020) Hoffbrand’s essential haematology. Chichester: Wiley Blackwell.  
6.    Baart AM, Van Den Hurk K, De Kort WL. Minimum donation intervals should be reconsidered to decrease low hemoglobin deferral in whole blood donors: an observational study. Transfusion. 2015 Nov;55(11):2641-4.
7.    Milman, N.T. (2020) A review of nutrients and compounds, which promote or inhibit intestinal iron absorption: Making a platform for dietary measures that can reduce iron uptake in patients with genetic haemochromatosis, Journal of nutrition and metabolism. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509542/ (Accessed: 27 November 2023).
8.    Department of Health & Human Services (2003) Iron and iron deficiency, Better Health Channel. Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/iron (Accessed: 27 November 2023).  




Being Aware Of Your Blood Group


                                               Dr. Engku Hamidah Binti Engku Muhammad Azmi, Dr Sharifah Azdiana Binti Tuan Din
                                                      Department of Clinical Medicine, Advanced Medical and Dental Institute, USM

Do You Know Your Blood Group?

When you hear about blood group, what comes to your mind? Do you imagine blood group A, B, O, AB, positive and negative? Or do you only know the blood group and A, B, AB or O without knowing whether it is positive or negative? What does "positive" and "negative" in your blood group mean?  The International Society of Blood Transfusion (ISBT) reports that there are more than 40 different types of human blood groups have been identified to date. ABO and Rh blood groups are two of the most widely used blood group types. Besides, other blood group system that are commonly used and important in the field of medicine are the 'Kell', 'Duffy', 'MNS' and 'Kidd' systems. An individual's blood type is inherited from their parents.

Blood group types are categorised according to the antigens found on the surface of red blood cells. This antigen is in the form of proteins, carbohydrates, glycoproteins or glycolipids. If this antigen is not present, the body will produce a protein that will fight this antigen, known as antibody. This antibody either naturally occurring or produced when the body is exposed to this antigen. This antibody will attack the antigen and will destroy it. When this occurs, the red blood cell will destroy and the condition called haemolysis.
Blood groups A, B, O, and AB make up the ABO system. While there are Rh-positive and Rh-negative groups in the Rh system. It is common practice to combine these two systems. As a result, blood group A positive, A negative, and so forth are frequently mentioned.

ABO Blood System.

For the ABO blood system, antigens and antibodies are produced naturally. Individuals of blood group A, have antigen A and antibody B while blood group B has antigen B and antibody A. Individuals with blood group AB, have antigen A and antigen B. This individual does not have antibodies against A or B antigen. Individuals of blood group O do not have antigen A or antigen B but it has antibody towards antigen A and B.

In ABO blood group system, each blood group can only accept the same blood group. However, there are privileges for blood groups O and AB. Blood group O can be accepted by all blood groups A, B, O and AB. Therefore, blood group O is known as a universal donor. Whereas an individual with blood group AB can receive all blood groups, namely blood groups A, B, AB and O. Blood group AB is known as a universal recipient.




Rh Blood System.

Rh blood group system have RhD and RhCE system. The most common used and important is RhD system. The RhD system categorised based on the present or absent of antigen D. Present of D antigen termed as RhD positive, while the absent of D antigen termed as RhD negative. In RhD system, RhD negative blood did not have D antigen, but it can developed D antibody when exposed to D antigen. Thus, RhD negative blood only can receive RhD negative blood, but RhD positive can receive both RhD positive or RhD negative blood.\

What is the relation of ABO blood system and Rh blood system? Both blood group system is independently controlled by specific gene. However, these two blood group system commonly used together in determining an individual blood group as it is clinically important. Not to say other blood groups less important, but these two blood groups are important in the transfusion service in order to supply the specific blood group in case of blood transfusion needed.

Why Knowing Your Blood Group Is Important?

As previously stated, when transfusion safety is a concern, certain blood groups can receive specific blood groups. It's critical that you are aware of your blood type so that you can alert medical professionals as needed.

Apart from that, the RhD blood group is crucial for the management of both the mother and the foetus in a pregnant woman. For instance, a RhD negative blood individu who is pregnant with RhD positive baby, they susceptible to developing D antibody when sensitised. The antibody then will transfer to the foetus trough placenta and cause the fetal blood haemolysed. To prevent it, these pregnant ladies will be given an injection with immunoglobulin which may help interfere with the process and prevent antibody development. If the individual already has antibody towards D antigen, the doctor will monitor closely the fetus and mother and specific precautions will be taken.

In general, knowing about blood group is useful. It is one of your special identities. In clinical setting, the blood group is a critical information. The information is used in many areas such as identification, in transfusion, and also transplant.

References

1.    ISBT resource library. https://www.isbtweb.org/resource/tableofbloodgroupsystems.html
2.    Rosenkrans D, Zubair M, Doyal A. Rh Blood Group System. [Updated 2023 Aug 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK594252/
3.    Denise M. Harmening, PhD, MT(ASCP) and Beth L. Manning, BS, MT(ASCP)SBBCM, Modern Blood Banking & Transfusion Practice, 7th edition 2019.




Komponen Darah Dan Kegunaan Bagi Pesakit


Dr. Mohammad Izzad Bin Ishak, Dr Sharifah Azdiana Binti Tuan Din
Jabatan Perubatan Klinikal, Institut Perubatan dan Pergigian Termaju, USM

Keperluan darah merupakan produk teraputik yang penting dalam sistem kesihatan untuk perawatan pesakit. Darah hanya boleh didapati daripada pendermaan sesama insan sahaja dan sehingga kini masih belum ada bahan sintetik yang boleh menggantikan produk darah sepenuhnya. Merujuk kepada Pertubuhan Kesihatan Sedunia (WHO), sebanyak 11.7 pendermaan per 1000 penduduk diperlukan untuk menderma darah bagi negara-negara sedang membangun. Budaya menderma darah secara berterusan adalah perlu untuk memastikan darah yang selamat, berkualiti dan mencukupi dapat dibekalkan kepada pesakit yang memerlukan.

APAKAH TUJUAN PENDERMAAN DARAH?

Pendermaan darah diperlukan untuk merawat dan menyelamatkan nyawa pesakit di hospital. Satu unit darah utuh (Whole Blood) sama ada 350ml atau 450ml akan diambil setiap kali seseorang itu menderma darah. Pendermaan darah boleh dilakukan setiap 3 bulan sekali atau maksimum 4 kali dalam masa setahun.

BAGAIMANA PROSES KOMPONEN DARAH DIJALANKAN?

Setiap unit darah yang diderma akan didaftarkan ke dalam sistem makmal. Maklumat pendermaan dan pemprosesan seperti tarikh penyediaan komponen darah, tarikh luput setiap komponen yang dihasilkan, berat dan isipadu komponen akan direkodkan. Darah utuh akan diproses dan diletak di dalam mesin pengemar menggunakan kelajuan tinggi bagi mengasingkan darah kepada tiga bahagian utama iaitu cecair plasma yang berwarna kuning muda berada diatas, lapisan nipis sebatian platelet dan sel darah putih, manakala sel darah merah mendap di bahagian bawah. Cecair plasma dan platelet akan disalurkan ke beg lain manakala sel darah merah akan dikekalkan dalam beg asal.

Setiap unit darah yang didermakan akan menjalani ujian saringan darah bagi memastikan darah tersebut selamat untuk tujuan transfusi serta bebas dari penyakit seperti Human immunodeficiency Virus (HIV), Hepatitis B, Hepatitis C dan Syphilis.
Komponen darah yang telah disaring akan disimpan mengikut jenis komponen darah, suhu penyimpanan dan ruang penyimpanan/peralatan yang bersesuaian berdasarkan garis panduan yang sedia ada.


 
Gambar Rajah 1: Darah utuh

Darah Utuh adalah produk darah yang tidak menjalani proses pengasingan. Produk ini mengandungi semua komponen iaitu darah merah, platelet dan plasma. Darah utuh disimpan pada suhu 2°C ke 6°C dan boleh bertahan selama 28 ke 35 hari. Darah utuh digunakan untuk kes-kes yang tertentu sahaja seperti kes bayi yang mengalami penyakit kuning teruk atau kes kemalangan yang mengalami pendarahan banyak.  

 
Gambar Rajah 2: Sel Darah Merah

Sel darah merah adalah produk darah yang mengandungi hanya sel darah merah sahaja dan ia dihasilkan dari darah utuh. Produk ini disimpan pada suhu 2°C ke 6°C dan boleh bertahan selama 35 ke 42 hari. Tujuan utama penggunaan sel darah merah adalah bagi meningkatkan kapasiti oksigen diberikan dalam merawat pesakit. Contoh pesakit yang kerap mendapatkan transfusi sel darah merah adalah pesakit Talasemia. Talasemia adalah penyakit genetik sel darah merah iaitu kandungan protein (haemoglobin) yang berfungsi untuk membawa oksigen ke seluruh badan adalah kurang berbanding orang sihat. Pesakit seperti talasemia major, memerlukan transfusi sel darah merah secara kerap bagi memastikan mereka dapat menjalani aktiviti harian seperti biasa. Contoh pesakit lain yang memerlukan transfusi sel darah merah adalah seperti pesakit buah pinggang, pesakit anemia (Kekurangan darah), pesakit kehilangan darah semasa pembedahan dan kes tumpah darah selepas bersalin.

 
Gambar Rajah 3: Platelet

Platelet adalah sel kecil yang terlibat dalam proses pembekuan darah dan ia dihasilkan darah darah utuh. Platelet disimpan pada suhu 20°C ke 24°C dan perlu sentiasa digerakkan (agitated). Jangka hayat platelet adalah tidak lama, hanya boleh bertahan 5 hari sahaja dari tarikh pendermaan darah. Risiko pendarahan tanpa henti adalah tinggi jika kita tidak mempunyai bilangan platelet yang mencukupi di dalam badan kita. Oleh itu, transfusi platelet akan diberi kepada pesakit yang mempunyai platelet rendah seperti pesakit leukemia, pesakit demam denggi berdarah, pesakit barah dan pesakit yang mengalami kes pendarahan yang teruk.

 
Gambar Rajah 4: Plasma

Plasma adalah produk darah yang mengandungi factor-faktor pembekuan yang diperlukan bagi proses pembekuan darah dan ia dihasilkan dari darah utuh. Plasma (Fresh Frozen Plasma) disimpan pada suhu di bawah sejuk beku iaitu -25°C dan boleh bertahan selama 3 tahun. Produk plasma diberikan kepada pesakit yang mempunyai faktor pembekuan rendah seperti kes-kes pendarahan teruk, mangsa melecur akibat kebakaran, kes demam denggi berdarah serta kes-kes yang mengalami kegagalan hati.






Pendermaan Sel Stem Darah: Antara Mitos Dan Realiti


                                                                                          
                                                                             Dr. Nurarnida Binti Said & Dr. Sharifah Azdiana Bt Tuan Din
                                                                    Jabatan Perubatan Klinikal, Institut Perubatan dan Pergigian Termaju, USM

Pendermaan organ lebih sinonim dalam kalangan masyarakat kita namun begitu bagaimana pula dengan pendermaan sel stem darah.  Adakah anda tahu kewujudan Daftar Sel Stem Malaysia (Malaysian Stem Cell Registr y, MSCR) dimana anda boleh mendaftar sekiranya ingin menderma sel stem kepada pesakit yang memerlukan?

MSCR telah ditubuhkan pada Disember 2000 hasil dari usahasama antara Kementerian Kesihatan Malaysia (KKM) dengan Majlis Kanser Negara (MAKNA). MSCR adalah sebuah badan pendaftaran untuk sukarelawan Malaysia menderma sel stem darah. Ia turut bertanggungjawab mempromosikan, mengenalpasti, mengumpul data dan menjalankan carian penderma berdaftar yang berpotensi untuk pesakit yang memerlukan. Sehingga tahun 2021, sebanyak 34,286 orang telah berdaftar sebagai penderma.

Kini, terdapat 13 hospital menawarkan perkhidmatan pemindahan sel stem darah yang terdiri daripada hospital Kerajaan, hospital swasta dan hospital pengajar universiti di seluruh Malaysia. Namun begitu, terdapat banyak mitos disebalik pendermaan sel stem darah yang menimbulkan salah faham dalam kalangan masyarakat dari menjadi penderma sel stem.
Sebelum itu, adalah lebih baik jika anda mengetahui sedikit sebanyak mengenai sel stem darah.

Apakah sel stem darah?
Sel stem darah adalah sel induk yang terdapat di dalam darah periferal, tali pusat dan sumsum tulang. Ia berupaya untuk berkembang, membiak kepada sel stem darah yang baru dan mampu membeza kepada sel yang lebih khusus seperti sel darah merah, sel darah putih dan platelet.
 

                                                                    
                                                                                   (sumber dari http://mscr.moh.gov.my/index.php/blog)


Apakah kegunaan sel stem darah dalam bidang perubatan?

Di Malaysia, penggunaan sel stem darah adalah untuk pesakit leukemia dan talasemia. Selain itu, turut digunakan untuk merawat penyakit darah yang lain seperti limfoma, anemia aplastik, imunodefisiensi primer (PID) dan lain-lain.
Pendermaan sel stem darah ini lebih dikenali sebagai pendermaan sumsum tulang dalam kalangan masyarakat Malaysia. Proses pemindahan sel stem melibatkan penggantian sel stem darah pesakit dengan sel stem penderma yang sihat. Dengan sel baru ini, ianya mampu untuk menghasilkan sel-sel darah yang sihat dan sel darah ini akan dapat berfungsi dengan lebih baik.

Oleh itu, pendermaan sel stem darah amat penting bagi memberi peluang kedua untuk kumpulan pesakit-pesakit ini untuk hidup secara normal.

Mitos pendermaan sel stem darah
1.    Keserasian sel stem hanya terdapat dalam kalangan adik beradik sahaja.
Pemindahan sel stem perlu sepadan di antara penderma dengan pesakit agar ia tiada kesan tindak balas, penolakan atau kegagalan graf berlaku. Meskipun penderma di kalangan adik beradik adalah pilihan utama tetapi hanya 30% pesakit mempunyai adik beradik yang sepadan untuk pemindahan sel stem darah.
Oleh itu, sebanyak 70% pesakit lagi memerlukan pencarian di MSCR bagi mendapatkan sel stem yang sepadan iaitu daripada perderma yang tiada hubungan dengan pesakit.

2.    Pendermaan sel stem darah adalah proses yang sangat menyakitkan.
Proses pendermaan bukanlah sakit seperti yang disangkakan. Ia boleh dilakukan dalam 2 kaedah iaitu pendermaan sel stem darah periferal melalui prosedur aferesis (sama seperti proses pendermaan darah) atau pendermaan melalui sumsum tulang yang dijalankan secara bius penuh di bilik pembedahan.

Biarpun kedengaran seperti menyakitkan, anda tidak akan sedar ketika proses pendermaan sumsum tulang sedang berlangsung. Namun ianya mungkin akan menimbulkan rasa sengal di bahagian pinggul untuk beberapa hari selepas pendermaan dan ia dapat dirawat dengan pengambilan ubat tahan sakit.

Pendermaan sel stem darah melalui prosedur aferesis


(Sumber dari https://together.stjude.org/en-us/diagnosis-treatment/procedures/peripheral-blood-stem-cell-pbsc-donation.html dan   http://mscr.moh.gov.my/index.php/blog)

                                                      
                                                                       Proses pendermaan sumsum tulang di dewan pembedahan
                                                               (Sumber dari https://healthjade.net/bone-marrow-transplant/)

3.    Perdermaan sel stem darah adalah dari saraf tulang belakang

Mitos ini sama sekali tidak benar, memandangkan kawasan pendermaan sel stem sumsum tulang terletak di bahagian belakang tulang pinggul (Posterior Iliac Crest) maka ia tidaklah melibatkan di bahagian tulang belakang mahupun saraf yang terdapat di bahagian tersebut.

                                                                                       

                                                                                                 Posterior Iliac Crest
                                                                               (Sumber dari http://www.myhealth.gov.my )

4.    Cebisan tulang di ambil semasa pendermaan sel stem

Prosedur aferesis adalah kaedah pendermaan yang lebih kerap digunakan bagi pengumpulan sel stem darah. Walaubagaimanapun, untuk keadaan tertentu kaedah pendermaan sumsum tulang juga turut dilakukan. Namun, ia hanya diperolehi daripada proses suntikan jarum dan sedutan sel stem darah pada rongga belakang tulang pinggul (Posterior Iliac Crest) sahaja.
 

                                                                         
                                                     Pengambilan sumsum tulang dibahagian belakang tulang pinggul (Posterior Iliac Crest).
                                                                                   (Sumber dari https://www.mayoclinic.org/)

5.    Proses pendermaan mengambil masa yang sangat lama

Seperti proses pendermaan darah, pendermaan sel stem darah melalui kaedah aferesis hanya mengambil masa 4 jam dan penderma boleh pulang setelah selesai proses pendermaan. Manakala, sekiranya kaedah sumsum tulang di lakukan, proses pendermaan adalah selama 2 hingga 4 jam dan penderma boleh pulang pada hari yang sama atau sehari selepas prosedur berlangsung.

Apakah syarat kelayakan untuk mendaftar sebagai penderma?
Anda layak mendaftar sekiranya warganegara Malaysia, berumur di antara 18 hingga 50 tahun, sihat tubuh badan dan bebas dari penyakit berkaitan darah. Semakin ramai sukarelawan berikrar dan mendaftar, semakin tinggi peluang untuk mendapat penderma yang sepadan.
Bagi yang berkeinginan untuk menjadi penderma sel stem atau mendapatkan keterangan lebih lanjut, anda boleh menghubungi MSCR Institut Penyelidikan Perubatan (IMR) seperti maklumat di bawah;

No. Telipon     : 03-33628384
Emel        : malaysianstemcellregistry@gmail.com
Facebook    : Malaysian Stem Cell Registry

References

1.    Norashikin Saidon. Evolution of Hematopoietic Stem Cell Transplant Programs in Malaysia. Blood Cell Therapy-The official journal of APBMT. 2019
2.    Ministry of Health Malaysia. (2009). National Guideline for Haemopoietic Stem Cell Therapy. https://nih.gov.my/mrec/wp-content/uploads/2016/10/haemopoietic.pdf
3.    Leukemia & Lymphoma Society. (2019). Blood and Marrow Stem Cell Tranplantation Guide.
https://www.lls.org/sites/default/files/National/USA/Pdf/Publications/PS95_Blood_and_Marrow_Guide_2019.pdf
4.    https://mscr.makna.org.my/
5.    https://www.urthecure.com.au/bone-marrow-donation





Pecah/Potong Ubat, Boleh Atau Tidak?


17 January 2024 by MOHAMAD FIRDAUS BIN HARUN



Mohamad Firdaus bin Harun, Penolong Pegawai Farmasi

Unit Farmasi, Pusat Perubatan USM Bertam

Ubat-ubatan tablet dan kapsul merupakan produk farmaseutikal yang paling banyak digunakan di dalam perawatan pesakit. Namun begitu, bagi pesakit yang tidak boleh menelan ubat, ia memerlukan pengubahsuaian di dalam perawatan yang menggunakan tablet dan antaranya adalah memotong/menghancurkan tablet menjadi lebih kecil atau mengubah bentuk farmaseutikalnya ke dalam bentuk cecair.

Tidak semua tablet boleh dipotong atau dihancurkan. Bentuk-bentuk tablet tersebut ada dinyatakan dalam poster grafik yang disediakan. 

Antara sebab-sebab tablet tersebut perlu kekal diambil secara penuh dalam bentuk asal : 

1. Bahan aktif ubat dapat sampai ke sasaran lokasi penyerapan tanpa dirosakkan oleh asid perut.

2. Mengelakkan iritasi di dalam perut.

3. Memastikan dos ubat diserap secara konsistan.

4. Mengurangkan kesan sampingan ubat kepada pesakit.

5. Mengelakkan kesan toksik akibat penguraian ubat lebih awal.

6. Meningkatkan kepatuhana perawatan kepada pesakit.

7. Menyadurkan rasa pahit ubat.

8. Mengelakkan kerosakan ubat akibat terdedah kepada suhu dan udara.

Adalah penting untuk pesakit, penjaga dan ahli perawatan untuk membaca dan memahami semua arahan penggunaan ubat dengan betul. 

Sekiranya tidak pasti, hubungi ahli farmasi untuk mendapatkan nasihat dan maklumat terperinci berkaitan bentuk ubat, formulasi, kestabilan ubat-ubatan atau alternatif ubat yang boleh disediakan kepada pesakit.




Apakah itu ‘Blood Crossmatching’ atau Ujian keserasian darah?


17 January 2024 by NUR ARZUAR BIN ABDUL RAHIM

Apakah itu ‘Blood Crossmatching’ atau Ujian keserasian darah?

“Doktor, darah yang saya dermakan ni akan terus beri pada pesakit ke?” atau “Doktor, nak transfusi darah kepada saya?, perlukah kumpulan darah yang sama atau perlu matching-matching ke?’’

Dialog diatas merupakan sebahagian persoalan orang ramai berkaitan proses pendermaan darah. Adakah satu beg darah yang di peroleh dari seorang penderma darah akan terus diberi kepada pesakit yang memerlukan? Adakah beg darah yang di simpan di dalam peti penghawa dingin yang bersuhu 2 - 6oc akan diberikan terus untuk kegunaan pesakit tanpa memerlukan sebarang ujian?

Untuk pengetahuan pembaca sekalian, satu beg darah yang didermakan oleh seorang penderma sukarela akan diproses dan menghasilkan produk beg darah yang dipanggil ‘Packed red cell’, platelet dan plasma. Penghasilan produk beg darah ini bergantung kepada jumlah isipadu beg darah  yang didapati dari penderma iaitu 350ml atau 450ml. Bagi menjamin keselamatan pesakit yang akan menerima transfusi darah terutamanya produk “Packed red cell’ , satu prosedur yang dikenali sabagai ‘Blood Crossmatching’ atau ujian keserasian darah perlu dilakukan di antara darah pesakit dan sample darah penderma yang akan diterima oleh pesakit. Ujian ini amat penting bagi mengelakkan kesan sampingan kepada pesakit atau penerima transfusi darah yang boleh membawa maut jika komplikasi ketidakserasian darah berlaku antara darah tubuh badan pesakit atau penerima transfusi darah dengan darah penderma. Objektif utama ujian keserasian darah ini ialah satu prosedur makmal atau ujian yang dilakukan terhadap sampel dari beg darah yang dipilih untuk di transfusi kepada seseorang pesakit adalah selamat ,memberi manfaat dan tanpa memberi kesan mudarat. Ujian keserasian darah ini, amatlah penting. Jika tidak dilakukan dan darah terus diberikan kepada pesakit, akan mengakibatkan sistem immuniti pesakit akan bertindak balas dan menentang darah penderma yang dianggap sebagai bendasing luar oleh badan penerima yang seterusnya menyebabkan sel darah merah akan pecah atau di panggil “hemolysis” darah. Pesakit seterusnya akan mengalami kekurangan sel darah merah atau anemia.

Pengambilan sampel dari pesakit

Sebelum ujian keserasian darah dilakukan, sampel darah pesakit akan diambil terlebih dahulu. Jarum yang bersesuaian akan digunakan untuk mengambil sampel darah di bahagian urat darah lengan pesakit . Sampel darah seterusnya di masukkan ke dalam tiub EDTA dalam isipadu yang mencukupi sekurang-kurangnya 5 ml dan seterusnya di hantar ke makmal untuk dilakukan ujian.

Ujian Keserasian Darah atau ‘Blood Crossmatching’


‘Blood crossmatching’ atau Ujian keserasian darah melibatkan beberapa prosedur. Prosedur pertama yang akan dilakukan adalah melibatkan ujian ‘ABO grouping’ atau mengenal pasti kumpulan darah bagi pesakit. Melalui prosedur ini, 4 kumpulan darah yang utama iaitu kumpulan A, B, AB dan O akan dikenalpasti. Seterusnya ujian ‘Rhesus D’ akan dilakukan untuk mengetahui jenis rhesus D positif atau negatif. Prosedur ujian ‘ABO grouping’ dan ‘Rhesus D’ ini juga perlu dilakukan pada beg darah penderma.

Selain itu, ujian saringan antibodi sampel darah bakal penerima transfusi darah akan dilakukan bagi memastikan tiada antibodi yang boleh menganggu proses ujian keserasian. Jika terdapat antibodi dikesan pada sampel darah bakal penerima transfusi darah, proses mengenalpasti antibodi perlu dilakukan untuk memastikan darah yang bersesuaian dari penderma diberikan kepada bakal penerima transfusi darah. Setelah mengetahui kumpulan darah dan rhesus D pesakit , ujian keserasian darah akan di lakukan. Sel darah merah penderma akan diuji bersama serum darah pesakit yang akan di empar pada suhu bilik dan  mengikut prosedur yang ditetapkan. Jika tiada reaksi berlaku bermakna darah pesakit dan darah penderma adalah serasi dan selamat untuk di berikan kepada pesakit. Keserasian kumpulan darah dan rhesus D di antara pesakit dan penderma adalah sangat penting untuk mengelakkan kesan sampingan semasa dan selepas proses transfusi darah.

Prosedur kedua adalah inkubasi sampel ujian pada suhu 37oc mengikut tempoh yang ditetapkan dan sampel akan diempar semula. Jika tiada reaksi berlaku bermakna darah pesakit dan darah penderma adalah serasi. Prosedur ketiga adalah melibatkan ujian bersama ‘antihuman globulin’ di mana reaksi akan lebih jelas dilihat sekiranya ketidakserasian berlaku.Terdapat 2 jenis Ujian keserasian darah iaitu ‘Major crossmatch’ dan ‘Minor crossmatch’. Ujian ’Major crossmatch’ melibatkan serum pesakit dan sel darah merah penderma darah manakala ‘Minor crossmatch’ melibatkan serum penderma darah dan sel darah pesakit. ‘Major crossmatch’ dapat mengenal pasti antibodi yang didapati pada pesakit manakala ‘Minor crossmatch’ dapat mengenal pasti antibodi dari penderma darah. Walau bagaimanapun Perkhidmatan Transfusi Darah di Malaysia menggunakan kaedah ‘Major crossmatch’

Ujian keserasian darah secara elektronik

Selain daripada teknik manual, ujian keserasian darah secara eletronik sudah di praktikkan di Malaysia namun masih belum meluas digunakan di pusat perkhidmatan transfusi. Ujian keserasian darah secara elektronik memberi banyak manfaat dari segi penjimatan masa, sampel dapat diuji dengan banyak,mengurangkan beban kerja pada staf dan darah dapat dibekalkan dengan segera dalam kes kecemasan. Walaubagaimanapun masih ada kekangan dari teknik ini.

Apakah kesan kepada pesakit yang menerima darah yang tidak serasi

Jika seseorang menerima darah yang tidak serasi, kesan sampingan akan dialami  pesakit. “Acute hemolytic transfusion” akan terjadi apabila sel darah dari penderma akan diserang oleh hos antibodi. Simptom yang dapat kita lihat adalah seperti demam, tekanan darah rendah, sakit dada dan sesak nafas . Selain itu juga , ‘acute hemolytic transfusion’ boleh menyebabkan organ organ dalaman menjadi tidak berfungsi terutamanya buah pinggang. Amatlah penting bagi kita untuk mengelakkan kejadian ini dari berlaku kerana ia boleh mengancam nyawa pesakit. Oleh itu Ujian keserasian darah ini adalah mandatori sebelum proses transfusi darah dilakukan.

References

1. Harmening 7th Modern Blood Banking Transfusion Practices

2. Rossi’s Principles of Transfusion Medicine

3. Fatih Demirkan,MD, Veli Gunal, Yasar Dereli, A New Method For Electronic Crossmatch: ABO/ ABO /Rh Blood Group Confirmation and Antibody Screening Concomitantly With Serologic Crossmatch Blood (2013) 122 (21): doi.org/10.1182/blood.V122.21.4833.4833

4. B. Armstrong, R.Wilkinson,E.Smart ISBT Science series (2008)3, 197-215

5. J.F. Chapman, C.Milkins, D.Voak The computer crossmatch: A safe alternative to the serological crossmatch, 2001 doi.org/10.1046/j.1365-3148.2000.00274.x

6.Onder Arslan(2006) Electronic crossmatching, 20(1),75-79.doi:10.1016/j.tmrv.2005.08.007

Penulis artikel:

Dr. Nurul Shairah Binti Shahidan, Pelajar Sarjana Perubatan (Perubatan Transfusi), Dr. Nur Arzuar Abdul Rahim, Pensyarah Perubatan/Pakar Pediatrik, Jabatan Perubatan Klinikal, IPPT.




The comeback of cold storage platelets. Will it gain momentum?


17 January 2024 by NUR ARZUAR BIN ABDUL RAHIM
Platelets are normally transfused either prophylactically for oncology and hematology patients, or to help stop severe bleeding. Since the mid-1980s, platelets have been stored at room-temperature with constant agitation.  However, recent and past research suggests that the cold storage of platelets actually preserves their hemostatic function, which may be best for actively bleeding patients. The FDA defines cold-stored platelets as those stored continuously at 1 to 6 degrees Celsius within a specified time after collection. It is stored for up to 14 days from the date of collection when such apheresis platelets are intended for the treatment of active bleeding when conventional platelets are not available or their use is not practical.

Cold-stored platelets (CPs) are not a new product. Prior to the late 1970s, all platelet units used for transfusions were stored at 4 °C. However, it was recognized in 1969 that CPs were quickly cleared from circulations, whereas room-temperature stored platelets (RPs) had significantly longer circulation times [1] The rapid clearance of CPs is attributed to one of the significant physiological changes that occur when platelets are exposed to old temperature. It was discovered that cold storage induces the clustering of platelet surface glycoprotein GPIb?, which has been shown to mediate phagocytosis by macrophages in short-term (<48 h) CPs [2,].  Long-term cold-stored platelets (>48 h) are cleared by hepatocytes in the liver through interaction of the Ashwell–Morell receptor with the exposed ?-GlcNAc moieties on CPs

Efforts to prevent the rapid clearance of CPs by galactosylation of the ?-GlcNAc moieties have not been successful in humans. Since the majority of platelet transfusions were given to patients with hematological disorders or thrombocytopenic patients in the late 1970s, there was a complete shift in platelet storage methodology from CPs to RPs. Cold temperatures also induce activation of the platelets in the form of platelet granule content release and the exposure of phosphatidylserine. One possible mechanism of cold-induced platelet activation is the significant accumulation of intracellular calcium during cold storage.Furthermore, cold temperatures have significant effects on the metabolism of stored platelets. CPs have reduced glucose consumption and lactate production. Storage in the cold has also been associated with the preservation of the mitochondrial functions of the platelets.

Despite the rapid in vivo clearance, there has been a renewed interest in bringing back CPs as a product. This recent resurgence can be attributed to three main reasons. First, cold storage significantly reduces the growth of microorganisms, such as bacteria, in the platelet units. This allows the platelet units to have a longer shelf life, thus reducing the wastage due to outdating. Second, CPs are shown to be hemostatically superior to RPs. Lastly, while RPs require constant mechanical agitation during storage, CPs do not seem to require agitation. This eliminates the cost of mechanical shakers and improves logistics handling during platelet shipping. Furthermore, recent investigations into the utilization of platelets for transfusion have shown that there is a significant increase in the need for therapeutic platelet transfusions compared to prophylactic transfusions. With superior hemostatic functions and a longer potential shelf life, CPs could be a promising product for actively bleeding patients.

During the late 1960s, when the platelet storage practice was switched from CPs to RPs, it was known that CPs were better for bleeding patients, as they showed superior correction in bleeding time. The latest in vitro models have revealed new information about the storage characteristics of CPs. Scanning electron microscopy was used to examine the characteristics of clots formed by CPs versus RPs. The microscopy images suggested that CPs had significantly more crosslinking with denser fibers compared to clots formed by RPs. In vitro analysis of CPs stored for 5 days also showed similar clot stiffness to that of fresh platelets. The superior fiber crosslinking in CPs could be mediated by factor XIII through binding to the activated glycoprotein IIb/IIIa on the CPs surfaces. In addition, clot histology showed that CPs had higher porosity and a more well-defined structure in their clots, similar to fresh platelets. On the other hand, RPs formed clots with altered structure and decreased porosity.

Furthermore, CPs maintained mitochondrial respiration capabilities, whereas RPs had decreased mitochondrial respiration after 7 days of storage. Finally, cold storage has also been discovered to induce significant changes in the ADP receptors of platelets. In particular, P2Y1 and P2X1 receptors decreased in CPs compared to RPs. The changes in the ADP receptors of CPs could provide an explanation as to why CPs are less responsive to inhibitory signals, such as nitric oxide and prostaglandin E1, compared to RPs. Recently, “omics” technology, such as proteomics and metabolomics, has become more accessible. This is facilitated by the decreased cost of performing these assays and the increased recognition that a large repertoire of information about platelet storage biology can be generated.

Changes in the platelet proteomes during cold storage were also examined. Different storage temperatures of platelets led to differentially expressed proteins important in platelet degranulation, blood coagulation vesicle transport, protein activation cascade, and response to stress. Storage temperature also had a significant impact on the microRNA (miRNA) expression profile of platelets. The significance of this miRNA correlation with platelet quality is still being investigated. In conclusion, cold-stored platelets are becoming an interesting research topic for many. More clinical trials are being conducted to prove the efficacy compared to room-temperature-stored platelets.

References


1.The Missing Pieces to the Cold-Stored Platelet Puzzle Hanqi Zhao1,2,3 and Dana V. Devine1,2,3,* Int J Mol Sci. 2022 Feb; 23(3): 1100.Published online 2022 Jan 20. doi: 10.3390/ijms23031100
2. Transfusion News journal , Cold-Storage for Platelets December 6, 2017



Keseimbangan Emosi: Cara Jururawat Berhadapan dengan Pesakit dan Keluarga yang Sedang Marah di Kawasan Hospital


07 February 2024 by DIVANEE A/P CHANDRASEGAR

                                                                                                         

Divanee a/p Chandrasegar, Jururawat U32 (KUP),
(Pelajar Sarjana Kaunseling PPIP, USM)
Profesor Madya Dr. Nik Rosila Binti Nik Yaacob
(Pensyarah Kanan, Pusat Pengajian Ilmu Pendidikan, Universiti Sains Malaysia)


Dalam bidang penjagaan kesihatan, jururawat memegang peranan penting dalam menyediakan penjagaan holistik kepada pesakit. Kehadiran emosi yang intens seperti kemarahan dapat mencipta cabaran dalam memberikan penjagaan yang efektif, seperti yang dinyatakan oleh Smith et al. (2018) dan Morrison (2019). Kemarahan yang ditunjukkan oleh pesakit atau keluarga sering timbul dari rasa frustrasi, ketakutan, atau ketidakpastian, mungkin akibat dari tahap penolakan oleh pesakit atau tanggungjawab ahli keluarga dalam merawat penyakit kronik seperti kanser. Bahkan, ahli keluarga sendiri mungkin mengalami tekanan emosi yang mendalam. Dalam keadaan ini, kemarahan mungkin ditunjukkan kepada kakitangan kesihatan di barisan hadapan, termasuk jururawat, doktor, ahli farmasi, dan profesional kesihatan lainnya.

Mereka sering dihadapkan dengan situasi yang tidak dijangka, seperti menenangkan pesakit yang marah atau kecewa, yang merupakan cabaran semasa syif harian mereka (Karimi & Masoudi Alavi, 2015). Jururawat dan golongan profesional kesihatan lainnya perlu menyedari bahawa pesakit dan keluarga mereka mungkin berhadapan dengan situasi yang sukar, dan respon emosi yang muncul adalah sesuatu yang semulajadi. Fenomena ini dapat mencetuskan cabaran besar bagi jururawat di barisan hadapan, memerlukan kepekaan dan kemahiran keseimbangan emosi yang tinggi untuk menangani situasi dengan bijak. Oleh itu, perlunya untuk mengembangkan strategi yang sesuai untuk mengelola emosi ini menjadi sangat penting (Jones & Brown, 2020). Pertimbangan etika, pemahaman emosi, dan kemahiran komunikasi yang cemerlang akan menjadi aspek penting dalam mengelola kemarahan pesakit dan keluarga.


Gambar oleh; UNITA
Pesakit Sedang Marah /Tidak Puas Hati

Menurut kajian yang dilakukan oleh Richard et al. (2022), terdapat kaitan antara pengurusan kemarahan dan peningkatan kepuasan pesakit. Kesedaran dan kemahiran dalam menguruskan kemarahan juga telah ditemui berkaitan dengan penurunan tingkahlaku agresif dalam kalangan pesakit. Sebagai anggota kesihatan yang memang berhadapan dengan orang awam, penting sangat untuk mahir dalam cara mengendalikan pesakit atau keluarga yang marah adalah kemahiran berharga yang boleh kita kembangkan untuk menyokong amalan klinikal kita.

Dengan mematuhi prinsip-prinsip asas seperti mengenal pasti punca kemarahan, mengiktiraf perspektif pesakit, menggalakkan penyelesaian masalah secara kolaboratif, mengekalkan empati dan ketenangan, serta memberikan permohonan maaf yang ikhlas, kakitangan penjagaan kesihatan dapat mengubah detik-detik ketegangan menjadi peluang untuk membina kepercayaan dan mencapai kecemerlangan dalam amalan perubatan.

Contoh sebab mengapa pesakit/keluarga menjadi marah:

•    Mereka telah dibiarkan menunggu lama sebelum dilayan di klinik atau Unit Kecemasan
•    Kesilapan telah dibuat oleh pasukan perubatan/pembedahan.
•    Terdapat kelewatan dalam diagnosis atau rawatan.
•    Mereka baru menerima berita buruk.
•    Harapan pesakit/keluarga tidak dipenuhi.

Artikel ini bertujuan memberikan informasi untuk meningkatkan kecekapan jururawat dalam menjaga keseimbangan emosi dan meningkatkan kualiti penjagaan di hospital. Berhadapan dengan pesakit yang meluahkan kemarahan atau saudara mereka adalah aspek tidak dapat dielakkan dalam amalan perubatan.

Strategi Mengatasi Kemarahan Pesakit/Keluarga:

1.    Ketahui Tanda-Tanda Awal: 
Jururawat perlu mengamalkan latihan kesedaran diri untuk mengenal pasti tanda-tanda awal kemarahan dalam diri mereka sendiri. Kesedaran ini membolehkan jururawat bertindak lebih awal sebelum situasi menjadi terlalu tegang. Ini membolehkan anda mengesan isu sejak awal. Anda mungkin merasa marah dengan cara pesakit bercakap perkara yang mereka katakan. Cubalah untuk mengawal emosi anda dan kekal profesional. Anda mungkin merasa berhak untuk marah, tetapi menunjukkan ini kepada pesakit yang sudah marah mungkin akan lebih menyakitkan mereka yang akan menyebabkan keadaan lagi tegang.

2.   Latihan Diri dalam Teknik De-eskalasi:
Melatih diri dalam teknik de-eskalasi termasuk cara-cara untuk meredakan kemarahan sebelum ia mencapai tahap yang kritikal. Ini boleh melibatkan teknik pernafasan atau memberikan ruang peribadi.

3.   Komunikasi Efektif:
Membuka komunikasi dengan ayat seperti "Saya faham bahawa ini boleh membuat anda marah" boleh membuka pintu kepada perbualan yang lebih baik dan memberi pesakit atau keluarga ruang untuk meluahkan perasaan mereka. Dengar dengan teliti dan tunjukkan empati. Biarkan pesakit atau keluarga meluahkan perasaan mereka tanpa gangguan. Mengaplikasikan teknik mendengar secara aktif seperti menumpukan sepenuh perhatian kepada pesakit dan saudara mara. Mengajukan soalan terbuka dan memberi mereka ruang untuk berkongsi perasaan mereka boleh membantu mengurangkan kemarahan.


Gambar oleh: UNITA
Teknik Komunikasi Terapeutik

 Mengenal Pasti Punca Kemarahan Mereka:
•    ‘Beritahu saya lebih lanjut?’
•    ‘Mengapa anda berasa begitu?’
•    ‘Adakah ada perkara lain yang berlaku yang membuatkan anda marah?’
•    Tunjukkan kemahiran mendengar secara aktif seperti kontak mata, mengangguk, respon lisan (contohnya, 'mmm').
•    Benarkan pesakit meluahkan perasaan sepenuhnya kepada anda jika perlu - mereka mungkin perlu memberitahu sesuatu yang menyusahkan mereka. Berikan mereka banyak ruang untuk bercakap.

4. Jangan Ambil Secara Peribadi:

Ingatlah bahawa kemarahan pesakit atau keluarga mungkin bukan terarah kepada anda secara peribadi, tetapi lebih kepada keadaan atau situasi kesihatan mereka. Jangan melibatkan perasaan peribadi dalam respons anda.

5. Tawarkan Penjelasan dan Klarifikasi:

Jelaskan secara jelas apa yang berlaku dan berikan maklumat tentang langkah-langkah seterusnya. Kadang-kala ketidakpastian atau kurangnya penjelasan boleh menambah kemarahan.

6. Pemberian Kontrol /pilihan kepada Pesakit:

Mempertimbangkan untuk memberi lebih banyak kawalan kepada pesakit dalam keputusan berkaitan dengan rawatan mereka. Di mana mungkin, berikan pesakit atau     keluarga pilihan atau alternatif yang boleh membantu memenuhi keperluan mereka. Ini     dapat memberi mereka rasa kawalan dalam situasi yang mungkin membuat mereka     berasa tidak terkawal.

7. Balas kemarahan (Respond to the anger)

Setelah anda mengumpul maklumat tentang kemarahan pesakit dan anda rasa mereka telah menyatakan apa yang perlu mereka katakan, mulakan perbualan dengan fasa Empati. Pada peringkat ini, berguna untuk menunjukkan empati terhadap pesakit. Pada dasarnya, ini adalah pengakuan dan penghargaan terhadap emosi seseorang yang lain.

Fasa empati yang boleh anda gunakan adalah:
•    ‘Dengan segala yang anda beritahu saya, adalah dapat difahami mengapa anda berasa begitu’
•    ‘Nampaknya anda mempunyai banyak perkara yang berlaku pada masa ini, dan adalah wajar jika anda berasa marah’
Apabila anda menunjukkan empati, ia dapat membantu pesakit merasa diambil berat dan didengar. Ini membantu membina hubungan antara anda dan pesakit - mungkin meredakan kemarahan mereka dan mencipta persekitaran yang selamat untuk pesakit/keluarga bercakap secara terbuka.

8. Ucapkan terima kasih kepada pesakit
Mengucapkan terima kasih kepada pesakit (contohnya, 'Terima kasih kerana berkongsi perasaan anda dengan saya, ini penting bagi saya untuk memahami bagaimana anda berasa agar kita boleh bekerjasama untuk membantu anda'). Dengan menggabungkan kesemua strategi/teknik dalam mengatasi kemarahan pesakit dan keluarga, jururawat dapat mencapai keseimbangan emosi yang diperlukan untuk berurusan dengan pesakit dan keluarga yang sedang marah.

Gambar oleh: UNITA
Tawarkan Penjelasan dan Klarifikasi Photo By UNITA Author
 
Ini bukan hanya membantu dalam memberikan rawatan yang lebih efektif, tetapi juga mencipta persekitaran yang tenang dan penuh empati di kawasan hospital.
Jangan abaikan bagaimana anda merasa ...
Sebagai anggota kesihatan, adalah penting untuk menjaga emosi kita juga. Mengendalikan konflik boleh mencabar dan berpotensi untuk meningkatkan tahap stres kita. Adalah penting untuk peka terhadap respons emosi kita dalam situasi seperti itu dan mengambil langkah-langkah aktif untuk mengatasinya. Contohnya, berbual dengan rakan sekerja atau mengambil rehat sebentar dari persekitaran klinikal. Selain itu, mengamalkan latihan pernafasan ke dalam rutin harian kita terbukti menjadi kaedah yang berkesan untuk menguruskan stres dan mengawal kemarahan.




REFERENCES

Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic     communication in nursing students: A Walker & Avant concept analysis. Electronic Physician, 9(8), 4968–4977. https://doi.org/10.19082/4968 ?

Chipidza, F., Wallwork, R. S., Adams, T. N., & Stern, T. A. (2016). Evaluation and treatment of     angry patients. The Primary Care Companion for CNS Disorders, 18(3).
https://www.psychiatrist.com/pcc/evaluation-and-treatment-of-the-angry-patient/

Karimi, H., & Masoudi Alavi, N. (2015). Florence Nightingale: The mother of nursing. Nursing     and Midwifery Studies, 4(2), e29475.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557413/. ?

Morrison, E. (2019). Empathetic Communication in Healthcare.
https://www.emorrisonconsulting.com/wp-content/uploads/2021/04/Empathic-Communication-in-Health-Care-Workbook.pdf

Richard, Y., Tazi, N., Frydecka, D., Hamid, M. S., & Moustafa, A. A. (2022). A systematic review of neural, cognitive, and clinical studies of anger and aggression. Current Psychology. Advance online publication. https://doi.org/10.1007/s12144-022-03143-6

Williams, R. (2017). Anger as a Basic Emotion and Its Role in Personality Building and Pathological Growth: The Neuroscientific, Developmental and Clinical Perspectives.  Frontiers in Psychology, 8, 1950. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5681963/pdf/fpsyg-08-01950.pdf






 



I'm RH Negative


28 February 2024 by NURUL IZAINIE BINTI OMAR
What is Rh Blood group system?

The Rh blood group was previously known as the “Rhesus” blood group system. The term “Rhesus” was chosen after the rhesus monkey, which were used in the early research to produce antiserum for typing of red blood cells. There are many antigens that fall under the Rh blood group system with the clinically significant antigens being D, C, E, c and e antigens.

Who is Rh positive and Rh negative?

Of all the Rh antigens, D antigen is the most significant, and its presence or absence is used to determine whether an individual is Rh positive or Rh negative. Those who have D antigen on the surface of red cells are termed Rh positive, while those who lack the D antigen are term Rh negative.

How do you know a donor is Rh positive or Rh negative?

This is done by adding antibody against the D antigen (Anti-D antiserum) to the donor’s red cells. If the red cells show clumping, it means the donor is Rh negative. This Rh testing only carried out in the laboratory after the donor has donated his or her blood. If the donor is found to be Rh negative, he or she will be notified by the Blood Transfusion Service. If no notification is received, it means the donor is Rh positive. A special laminated card is given to this rare donor indicating their Rh negative status.

How common is Rh negative donors in Malaysia?


About 99% of Malaysians have been found to be Rh positive. In other words, only about 1% of Malaysian are Rh negative. It has also been found that Rh negative is higher among Indians and Punjabis, about 5%, compared to other ethnic groups.

How often can Rh negative donor donate blood?


Same like Rh positive donors. Whole blood can be donated 4 times in a year.

Can Rh negative patient receive Rh positive blood?

An Rh negative patient that requires red cell transfusion should only be transfuse with Rh negative blood. However, in life saving situation where Rh negative blood is not available, Rh positive may be given (only if the patient does not have antibody against the D antigen).

Is there any problem being Rh D negative?

The health of an Rh negative person is not affected in any way. However, an Rh negative female in her second and subsequent pregnancies, is at risk of having a baby with a neonatal jaundice if she conceives a baby with an Rh positive father and the baby inherits the father’s Rh positive blood type.

 

 



Sejarah dan Perkembangan Makanan Berfungsi


21 March 2024 by RABETA BINTI MOHD SALLEH

Pada awal abad kedua puluh, bidang sains makanan dan pemakanan lebih terfokus kepada pencegahan kekurangan beberapa nutrien utama dan nutrien yang menyokong pertumbuhan badan. Strategi bagi mengatasi masalah terbantut misalnya, dan kekurangan makro dan mikronutrien harus diambil kira ketidaksamaan di mana penyakit ini berakar umbi.

Sains makanan dan pemakanan telah beralih daripada mengenalpasti dan memperbaiki kekurangan pemakanan kepada merancang makanan yang boleh mempromosikan kesihatan optima dan mengurangkan risiko penyakit. Bidang sains makanan berfungsi berasal daripada gabungan sains dan keperluan komuniti.
 
Pada tahun 1984, istilah "makanan berfungsi" pertama kali diciptakan di Jepun. Pada tahun 1991, Kementerian Kesihatan Jepun menubuhkan Food for Specified Health Use (FOSHU), merujuk kepada makanan yang mengandungi bahan berfungsi untuk kesihatan dan secara rasmi diperakukan untuk menyatakan manfaat fisiologisnya pada manusia. Syarat untuk kelulusan FOSHU: i. Keberkesanan makanan/minuman berfungsi itu kepada manusia telah terbukti dengan jelas. ii. Tiada masalah keselamatan makanan dalam makanan/minuman berfungsi iii. Makanan/minuman berfungsi menggunakan bahan-bahan yang sesuai dengan pemakanan (misalnya tiada penggunaan garam, gula, dll.) secara berlebihan. iv. Jaminan keserasian dengan spesifikasi produk ketika digunakan. v. Kaedah pengawalan kualiti yang ditetapkan, seperti spesifikasi produk dan bahan, proses, dan kaedah analisis.

                                                                                         Sumber : www.google.com
 
Sejak awal 1980-an, makanan berfungsi telah menjadi bidang penyelidikan dan pembangunan aktif di Jepun, dan bantuan serta sokongan penyelidikan ini ditaja oleh Kementerian Pendidikan, Kebudayaan, Olahraga, Ilmu Pengetahuan dan Teknologi Jepun (MEXT). Alasan lain penguatkuasaan FOSHU adalah kerana peningkatan populasi warga emas dan peningkatan penyakit berkaitan gaya hidup seperti kanser dan sebagainya.

Sejarah juga menunjukkan pada tahun 1991, seorang lelaki berusia 5000 tahun ditemukan di Pergunungan Alpen membawa herba-herba perubatan dan kulat antibakteria dan penduduk Mesir dan Yunani menggunakan banyak tumbuhan perubatan. Banyak peneliti telah merungkai, terutama di kawasan pedalaman yang tiada pegawai perubatan dan ahli farmasi, masyarakat di sana kebiasaannya menggunakan perubatan tradisional nenek moyang mereka sebagai ubat.

Makanan berfungsi tidak dapat digunakan untuk menggantikan ubatan/dadah kerana berbeza sasaran pada tubuh manusia. Sebahagian besar negara mendefinisikan makanan berfungsi sebagai mengandungi bahan bioaktif dan bahan-bahan yang memberikan manfaat kesihatan tambahan selain keperluan asas tubuh dan mampu mengurangkan keterukan beberapa penyakit kronik.

Di Malaysia, definisi makanan berfungsi adalah "kumpulan makanan yang memiliki sifat meningkatkan tahap kesihatan". Ia juga memainkan peranan dalam perubatan alternatif dan mungkin mencegah beberapa penyakit. Kini, definisi makanan berfungsi adalah makanan semulajadi atau makanan yang telah dimodifikasi untuk memberi kesan positif kepada kesihatan melalui penambahan, penyingkiran, atau modifikasi bahan bioaktif tertentu.

“Sesungguhnya bandingan kehidupan dunia hanyalah seperti air hujan yang Kami turunkan dari langit, lalu (tumbuhlah dengan suburnya) tanaman-tanaman di bumi dari jenis-jenis yang dimakan oleh manusia dan binatang - bercampur-aduk dan berpaut-pautan (pokok-pokok dan pohonnya) dengan sebab air itu hingga apabila bumi itu lengkap sempurna dengan keindahannya dan berhias (dengan bunga-bungaan yang berwarna-warni), dan penduduknya pun menyangka bahawa mereka dapat berbagai-bagai tanaman serta menguasainya (mengambil hasilnya) datanglah perintah Kami menimpakannya dengan bencana pada waktu malam atau pada siang hari lalu Kami jadikan dia hancur-lebur, seolah-olah ia tidak ada sebelum itu. Demikianlah Kami menjelaskan ayat-ayat keterangan Kami satu persatu bagi kaum yang mahu berfikir (dan mengambil iktibar daripadanya)”. Surah Yunus ayat 24.


                                                                                          Sumber : www.google.com

Bahan berasaskan tumbuhan berasal daripada bahagian pokok, seperti kulit kayu, daun, bunga, akar, buah-buahan, biji-bijian dan sebagainya iaitu, setiap bahagian pokok mungkin mengandungi komponen aktif, lebih dikenali sebagai metabolit sekunder yang bertindak sebagai bahan berfungsi. Kesan ubatan yang mujarab dari bahan berasaskan tumbuhan biasanya terhasil daripada kombinasi beberapa metabolit sekunder.
Bahan berasaskan haiwan seperti asid lemak omega-3 daripada ikan laut terutamanya juga sangat popular sebagai makanan berfungsi. Ikan dan minyak ikan adalah sumber yang kaya dengan asid lemak omega-3 iaitu sebanyak 39 % - 50 % bagi kedua-dua ikan laut dan air tawar. Bahan buangan daripada haiwan seperti dakwat sotong juga telah menunjukkan beberapa kebaikan semulajadi seperti tinggi kandungan antioksidan.

Rujukan:


1.    Mozaffarian, D., Rosenberg, I. and Uauy R. 2018. History of modern nutrition science—implications for current research, dietary guidelines, and food policy. BMJ. 2018; 361: k2392. Published online 2018 Jun 13. doi: 10.1136/bmj.k2392.
2.    Perez-Escamilla, R., Bermudez, O., Buccini, G.S., Kumanyika, S., Lutter, C.K., Pablo Monsivais, P. and Victora, C. Nutrition disparities and the global burden of malnutrition. BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2252 (Published 13 June 2018).
3.    Kohlmeier, M. 2018. Nutrition is a hard science. BMJ Nutrition, Prevention and Health. View Full Text.
4.    Abdel-Salam, A.M. 2010. Functional foods: hopefulness to good health. american journal of food technology. Volume 5 (2): 86-99.
5.    Martirosyan, D.M. and Singh, J. 2015. A new definition of functional food by FFC: What makes a new definition unique? functional foods in health and disease; 5(6):209-223.
6.    Ministry of Health, Labour and Welfare of Japan, 2019. Food for specified health uses (FOSHU).
https://www.mhlw.go.jp/english/topics/foodsafety/fhc/02.html.
7.    Nagata, J. and Yamada, K. 2008. Foods with Health Claims in Japan.  Food Sci. Technol. Res., 14 (6), 519 – 524.
8.    Ohamaa, H., Ikedaa, H. and Moriyama, H. 2006. Health foods and foods with health claims in Japan. Toxicology. Vol 221 (1): 95-111.
9.    Amiri Ardekani, E., Askari, H. & Mohagheghzadeh, A. 2020. Memorial functional foods: a new concept from Bavi tribe. J. Ethn. Food 7, 9 (2020). https://doi.org/10.1186/s42779-020-00046-4
10.    Institute of Food Technologists. 2019. Introduction to functional foods. Chicago, IL.
11.    Siro, I., Kapolna, E., Kápolna, B. and Lugasi, A. 2008. functional food. product development, marketing and consumer acceptance—a review. Appetite 51(3):456-67.
12.    Dwyer, J.T., Coates, P.M. and Smith, M.J. 2018. Dietary supplements: regulatory challenges and research resources. Nutrients. 10(1): 41.
13.    Sloan, A.E. 2016. Top 10 functional foods trends. Institute of Food Technologist.
14.    Al-Quran, Surah Yunus (24).
15.    Zhao, Y., Wu, Y.Z. and Wang, M. 2015. Bioactive Substances of Plant Origin in Handbook of Food Chemistry. Springer-Verlag Berlin Heidelberg: 967-1008.
16.    Hossain, M.P., Rabeta, M.S*. and Husnul Azan, T. 2019. Medicinal and therapeutic properties of cephalopod ink: a short review. Food Research. 3 (3): 188 – 198.








Edaran Maklumat Drug Edisi Ramadhan 2024 : Ubat-ubatan yang TIDAK membatalkan puasa


18 November 2024 by NUR JAYIZAH BINTI MOHD ISMAIL

Apabila berpuasa, secara lahirnya kita mengelakkan diri daripada memasukkan sesuatu melebihi had tertentu pada rongga-rongga badan seperti mulut, hidung, telinga, saluran dubur dan faraj. Walau bagaimanapun, terdapat beberapa perkara yang dibenarkan ketika berpuasa selagi tidak melebihi had yang ditetapkan.

Salah satu ubat yang ingin diberi perhatian dan sering kali pesakit keliru adalah : alat sedutan (inhaler) untuk rawatan lelah (asma) atau penyakit paru-paru kronik.

Para ulama berbeza pandangan tentang penggunaan Inhaler bagi orang yang berpuasa dan pandangan yang dipilih adalah tidak membatalkan puasa.  Beberapa penjelasan untuk mengukuhkan pendapat ini adalah :

1. Sebahagian besar dari cecair inhaler akan masuk ke anggota pernafasan dan akan kekal di dinding kerongkong, sebahagian yang kecil lain dalam  kuantiti yang amat sedikit akan turun ke dalam perut. Jumlah yang amat sedikit ini termasuk perkara yang dimaafkan.

2. Masuknya sesuatu ke dalam perut hasil dari penggunaan inhaler bukan sesuatu yang pasti, sebaliknya ia sekadar sangkaan, barangkali ia masuk ke dalam perut dan barangkali juga tidak, kerana kadar cecair yang digunakan terlalu sedikit. Oleh itu, puasa orang yang menggunakan inhaler dikira SAH dan TIDAK batal.

3. Penggunaan inhaler tidak menyamai makan dan minum.

Bagi ubat-ubatan lain yang akan membatalkan puasa. pengubahsuaian cara pengambilan ubat-ubatan boleh dilakukan oleh pesakit.

Pesakit juga harus peka terhadap tahap kesihatan diri dan perlu bersedia untuk berbuka puasa sekiranya keadaan memerlukan. Perkara ini penting bagi mengelak sebarang kesan mudarat yang tidak diingini.

Dapatkan nasihat doktor dan ahli farmasi terlebih dahulu sebelum membuat pengubahsuaian dos serta waktu pengambilan ubat-ubatan.

Rujukan :


    1. https://muftiperlis.gov.my/index.php/panduan-hukum/634-hukum-puasa-bagi-pesakit-lelah-yang-menggunakan-inhaler
    2. https://pku.upm.edu.my/artikel/puasa_ubat-49315


Any enquiries, feel free to reach out to us, Pharmacy Unit. :)

Nur Jayizah Mohd Ismail
Pharmacist
Pusat Perubatan Universiti Sains Malaysia,
Institut Perubatan & Pergigian Termaju,
Bertam, 13200, Kepala Batas,
Penang, Malaysia.
Tel : +604 562 2625




Tingkah-laku kanak-kanak : Apa yang perlu kita tahu?


18 November 2024 by NUR ARZUAR BIN ABDUL RAHIM

Dr Nur Arzuar Abdul Rahim, Pensyarah Perubatan/Pakar Pediatrik, Institut Perubatan dan Pergigian Termaju, Universiti Sains Malaysia

Sebagai seorang pakar kanak-kanak saya berkesempatan bertemu dengan ramai kanak-kanak, remaja, ibu bapa , guru-guru , penjaga dan sebagainya. Isu masalah tingkah-laku kanak-kanak yang mencabar merupakan isu yang sering diadukan kepada saya. Bagi saya, sudah pastinya masalah tingkah-laku kanak-kanak ini suatu isu yang besar dan dibimbangi oleh mereka yang terlibat. Ia menjadi punca nombor satu tekanan kepada guru-guru yang menguruskan kanak-kanak di bilik darjah, juga kepada ibu bapa di rumah. Ia boleh menjadi penyebab guru berasa tidak bersemangat mengajar di kelas. Ibu bapa juga stress memikirkan apa yang akan dilakukan oleh anak-anak mereka. Dan faktor masalah tingkah-laku ini juga merupakan faktor kanak-kanak ini dirujuk kepada saya.

Tingkah laku kanak-kanak merujuk kepada tindak balas yang ditunjukkan oleh mereka dalam pelbagai situasi dan persekitaran. Perkembangan tingkah laku kanak-kanak merentasi sepanjang hayat daripada tingkah laku yang asas kepada tingkah laku yang lebih kompleks. Ia merangkumi corak tingkah laku yang tipikal atau tidak tipikal yang berkembang dari peringkat bayi sehingga remaja. Tingkah laku yang tidak tipikal atau kesukaran tingkah laku adalah suatu keadaan tingkah laku yang mengganggu kehidupan kanak-kanak itu sendiri atau orang lain.

 

Perkembangan tingkah laku ini penting kerana ia adalah asas interaksi sosial contohnya kemahiran tingkah laku sosial yang bersesuaian, kemahiran berkomunikasi dan memahami isyarat sosial atau “social cues”. Kemahiran ini penting bagi membentuk perhubungan sesama manusia dan kebolehan untuk mengambil bahagian atau “participating in social contexts”. Sebenarnya tingkah laku ini dipengaruhi oleh gabungan pelbagai faktor seperti , warisan genetik, ciri-ciri kongenital, persekitaran sosial, dinamik keluarga, konteks norma dan budaya di sekeliling dan pengalaman kanak-kanak itu sendiri yang memberi kesan kepada mereka. Kesan teknologi contohnya sosial media, “screen time” bersama smart phone juga telah mempengaruhi perkembangan kognitif dan sosial kanak-kanak. Ada kajian yang menunjukkan penggunaan sosial media dan smartphone tanpa kawalan telah meningkatkan kadar kemurungan, anxiety dan low confident dalam kalangan kanak-kanak terutamanya remaja. (1) Amat penting bagi kita untuk memahami dan mentafsir tingkah laku mereka untuk menyokong perkembangan mereka.

 

Antara tingkah laku yang tipikal bagi seorang kanak-kanak (1)

Tingkah laku meneroka :

Bayi dan kanak-kanak kecil sering meneroka semasa mereka sedang belajar tentang persekitaran mereka dan cuba berinteraksi dengan objek dan manusia.

Tingkah laku sosial:

Kanak-kanak belajar mengembangkan kemahiran sosial melalui interaksi dengan rakan sebaya, ahli keluarga atau orang yang lebih dewasa. Ini termasuk bermain dan bekerjasama, berkongsi , bergilir-gilir dan membina persahabatan

Tingkah laku ekspresi emosi:

Kanak-kanak meluahkan pelbagai emosi, termasuk kegembiraan, kesedihan, kemaharan, ketakutan atau kekecewaan. Kemahiran memahami dan menguruskan emosi mereka adalah penting dlam pembangunan sosial dan emosi.

Tingkah Laku mengikut peraturan (regulation) :

Apabila kanak-kanak makin membesar, mereka belajar mengawal tingkah laku dan dorongan (impulsive) mereka, mengikut peraturan dan norma yang telah ditetapkan oleh penjaga dan masyarakat.

Perkembangan bahasa :

Kemahiran bahasa memainkan peranan penting dalam komunikasi & interaksi sosial. Mereka belajar secara beransur-ansur kebolehan bahasa, perbendaharaan kata, tatabahasa dan kemahiran perbualan.

Kemahiran kognitif:

Tingkah laku kanak-kanak juga termasuk kebolehan kognitif seperti memori, fokus ( perhatian), penyelesaian masalah dan membuat keputusan. Kemahiran ini akan berkembang secara progresif apabila kanak-kanak matang.

 

Bagi tingkah laku yang tidak tipikal, kanak-kanak mungkin menunjukkan perkembangan yang berbeza dari kanak-kanak lain (1)

Tingkah laku membangkang atau “agresif”:

Melakukan pencerobohan fizikal secara berterusan contohnya suka memukul, menggigit, menendang

Melakukan pencerobohan lisan contonya suka menjerit, memanggil nama, ugutan terhadap rakan sebaya, orang dewasa ataupun haiwan.

 

Kerap menentang atau bertengkar dengan orang dewasa, enggan mematuhi peraturan atau permintaan dengan sengaja.

 

Menentang orang lain yang lebih dewasa atau rakan sebaya mungkin menunjukkan  gangguan tingkah laku atau “conduct disorder”.

Tingkah laku “Destructiveness”

 

Suka memusnahkan harta benda dengan sengaja, seperti memecahkan mainan, merosakkan perabot, atau merosakkan barang-barang.

Tingkah laku suka berbohong & mencuri

Suka melakukan pembohongan, ketidakjujuran, atau penipuan yang berterusan.

Mencuri barang daripada ahli keluarga, rakan sebaya atau dari kedai.

Tingkah laku yang mengasingkan diri atau menyendiri dari sosial :

Menyendiri , enggan mengambil bahagian dalam aktiviti kumpulan

Sukar menjalinkan atau mengekalkan persahabatan.

 

Hiperaktif atau tidak dapat fokus :

Melakukan aktiviti secara berlebihan, impulsif dan kesukaran mengekalkan fokus atau perhatian, mungkin gejala ADHD atau gangguan berkaitan fokus/perhatian yang lain

Regresi perkembangan :

Regresi perkembangan yang telah progres seperti kencing malam atau betwetting selepas berjaya, hilang kemahiran yang diperolehi sebelum ini, mungkin memberi gambaran tekanan atau trauma yang menyebabkan regresi perkembangan

Tingkah laku berisiko atau memudaratkan diri sendiri :

Tingkah laku mencederakan diri sendiri, penyalahgunaan bahan terlarang atau terlibat dengan aktiviti berisiko

 

 

Sebenarnya, pembaca sekalian, saya percaya, anak-anak kita boleh bertingkah-laku baik jika mereka mahu melakukannya. Jarang kita berjumpa kanak-kanak yang benar-benar suka melakukan tingkah laku yang buruk, melainkan ada yang menghalang mereka berkelakuan baik. Ini kerana sepanjang proses perkembangan mereka, ada banyak kemahiran yang perlu mereka belajar contohnya kemahiran bersikap fleksible seperti bertoleransi menghadapi kekecewaan dan menyelesaikan masalah. Kita sebagai ibu bapa harus belajar mengenalpasti faktor tersebut. Kita sebagai ibu bapa juga, selalu juga menggunakan kaedah memberi ganjaran atau “reward” jika berkelakuan baik, memberikan hukuman jika tidak berkelakuan seperti yang dikehendaki. Semua ini pada kita, bertujuan untuk memberikan motivasi kepada anak-anak supaya berkelakuan baik. Kadang-kadang kaedah ini tidak berkesan kerana ada sesuatu yang mungkin menghalang mereka.

Anak-anak dapat belajar dengan terbaik “the best”, apabila mereka berada di zon dimana tugas yang diberikan tidak terlalu mudah dan tidaklah terlalu sukar.Di mana matlamat boleh dicapai dengan kesungguhan, keazaman dan semangat. Apakah peranan kita sebagai ibubapa atau penjaga sentiasa berasaskan perasaan ehsan, kebaikan dan murah hati? Atau kita lebih senang dengan sikap kritikal dan mewujudkan perasaan “tidak sukaanak-anak-anak pada kita dengan pelbagai alasan. Apa sebenarnya tabiat fikiran kita? Apa yang kita cari? Apakah kita mencari perkara yang boleh kita hargai dari anak-anak kita, atau sebenarnya kita sedang mencari kesilapan mereka?

Percayalah, perasaan ehsan dan kebaikan yang kita berikan pada anak-anak kita akan menyebabkan anak-anak berasa disayangi, bukan tingginya tingkat sijil akademia atau profesion kita, bukan segala kebimbangan dan kerisauan kita kepada mereka, bukan berapa banyak aktiviti kita bersama kita bersama mereka atau berapa kerap kita sering menyemak “homework” sekolah mereka.

Percayalah, ehsan dan kebaikan itulah “memori” anak-anak kita. Saya pasti, anda mesti ingat berapa ramai guru yang hadir dalam  perjalanan hidup kita dan mungkin menjadi agen merubah kehidupan anda atau padangan anda tentang dunia ini. Saya juga ada. Bayangkan bagaimana dunia kita akan berbeza tanpa kehadiran mereka dalam hidup kita.

Cukup dahulu sedikit motivasi tips ibu bapa dalam mendidik anak-anak

Conduct Disorder – Kecelaruan Tingkah laku

Di kesempatan dan peluang penulisan ini, saya ingin berkongsi kepada semua berkaitan satu keadaaan yang kita kenali sebagai Conduct Disorder ataupun Kecelaruan Tingkah laku. Ia merupakan masalah tingkah laku dan emosi yang boleh berlaku kepada kanak-kanak atau remaja. Mereka mempunyai corak tingkah laku seperti anti-sosial, suka melanggar hak orang lain atau kebiasaan setempat. Biasanya mereka mempamerkan pelbagai tingkah laku yang mengganggu, menceroboh, engkar, tidak mengendahkan peraturan atau takut pada orang.

Beberapa gejala berkaitan dengan “conduct disorder” ini termasuklah, tingkah laku agresif terhadap manusia atau haiwan. Mereka sering terlibat dengan buli, pergaduhan secara fizikal dan kejam terhadap haiwan. Mereka kurang empati atau tidak menyesal setelah menyakiti orang lain. Sifat impulsif dan kesukaran mengawal emosi menyebabkan mereka terdedah kepada aktiviti vandalisme, suka musnahkan harta benda, penipuan dan kecurian seperti suka berbohong, mencuri di kedai atau lebih teruk lagi pecah masuk rumah atau kenderaan. (3)

Tidak semestinya kanak-kanak yang menunjukkan tingkah laku ini mempunyai masalah tingkah laku. Melanggar peraturan, degil dan melawan adalah perkara biasa dalam kalangan kanak-kanak dan remaja. Walau bagaimana pun jika tingkah laku ini teruk, berterusan dan menjejaskan fungsi kanak-kanak tersebut dengan ketara atau menyebabkan kemudaratan kepada orang lain. Ini merupakan “red flag” untuk kanak-kanak tersebut berjumpa dengan profesional kesihatan untuk dinilai.

Perlu diingatkan masalah kecelaruan tingkah laku atau “conduct disorder” ini boleh menjadi serius kepada individu, keluarga dan sekeliling. Ia sering dikaitkan dengan masalah akademik, konflik dengan sekeliling, pelanggaran peraturan atau undang-undang, kesukaran membina hubungan sosial yang sihat atau lebih teruk lagi terlibat dengan penyalahgunaan bahan terlarang. Intervensi awal amat penting untuk membantu mereka, supaya mereka dapat menyesuaikan dan membangunkan kemahiran mengawal tingkah laku. Terapi “cognitive behavioral therapy” – CBT dan “family therapy” amat berkesan, namun ia amat memerlukan sokongan dan bimbingan dari ibu bapa dan juga penjaga. (3)

Sebagai kesimpulannya, terdapat banyak jenis masalah tingkah laku dalam kalangan kanak-kanak dan faktor penyebab yang pelbagai. Antaranya mungkin berkaitan masalah pembelajaran, lewat perkembangan. Kadang-kadang kanak-kanak hanya bertindak- balas terhadap situasi yang sukar atau tekanan yang dihadapi di persekitaran mereka

 

Jika anda mengesyaki anak anda mempunyai corak tingkah-laku yang luar biasa atau tidak tipikal contohnya susah untuk tidur, tidur banyak, “moody” atau reaksi negatif pada perkara-perkara kecil, kemurungan, atau sering gelisah, mereka mungkin menyendiri, pencapaian akademik yang “down”, atau sukar untuk disiplin. Jika ada mula melihat gejala-gejala yang saya sebutkan ini, silalah berjumpa doktor untuk mendapatkan bantuan. Jadi, cuba lihat insan-insan di sekeliling anda. Ada tak sesiapa yang anda rasa perlukan bantuan? Boleh jadi andalah yang seharusnya menjadi jambatan untuk mereka melalui jalan hidup yang lebih sejahtera.

 

Buangkan prejudis dan hulurkan tangan…

 

RUJUKAN:


1.Child Behavior; https://childdevelopment.com.au/areas-of-concern/behaviour/. Retrieved 1 April 2024
2.Conduct Disorder; https://www.youtube.com/watch?v=GkgtDmCuMDg/ Retrieved 27 Mac 2024
3.Masalah Tingkah-laku kanak-kanak; http://www.myhealth.gov.my/kelakuantingkahlaku/; Myhealth Kementerian Kesihatan Malaysia / Retrieved 23 Mac 2024




Enhancing Wellness in Hospital Settings: A Dual Approach to Supporting Staff and Patient Well-being


18 November 2024 by DIVANEE A/P CHANDRASEGAR


  1. Divanee a/p Chandrasegar, Nurse U32 (KUP),
    (PPIP Counseling Master Student, USM)
    Dr. Nor Hernamawarni Abdul Majid
    (Lecturer, School of Education, Universiti Sains Malaysia)

    Hospital environments inherently place high demands on both staff and patients, creating a need for effective wellness strategies that extend beyond traditional pharmacological interventions. This article explores simple, non-pharmacological techniques aimed at improving the well-being of hospital staff and patients alike. These strategies not only enhance the overall quality of healthcare by reducing stress and anxiety but also contribute to a more supportive and healing atmosphere. By implementing these easily accessible techniques, hospitals can improve staff productivity and patient satisfaction, ultimately fostering a healthier environment conducive to recovery and professional fulfilment. The high-stakes nature of hospital settings imposes significant emotional and physical demands on all occupants, from healthcare providers to patients. The urgency and intensity inherent in such environments often lead to heightened stress levels, which can adversely affect both health outcomes and workplace efficiency. To address these challenges, it is crucial to implement straightforward, non-pharmacological wellness strategies that support the mental and physical well-being of everyone within the hospital.

    Part A: Enhancing Staff Wellness

    Breathing Exercises During Shifts

    Breathing exercises are a vital, easily integrated practice for hospital staff to manage stress and maintain mental acuity during shifts. Deep breathing techniques, such as diaphragmatic or abdominal breathing, can be performed during routine tasks or brief pauses in the day. The act of focusing on the breath helps divert attention from stressors, leading to physiological benefits such as lowered heart rate and reduced cortisol levels, which are markers of stress (Rogerson et al., 2024). According to Anderson (2018), engaging in these brief sessions of deep breathing not only significantly lowers stress levels but also enhances mental clarity and emotional resilience. This improved state of mind is essential for healthcare professionals who must remain attentive and empathetic, ensuring they provide the best care possible while also safeguarding their own well-being.

    Stress balls for maintaining focus

    Stress balls are not only effective in managing patient discomfort during medical procedures but also provide benefits for nurses, particularly in maintaining focus and managing work-related stress. The tactile stimulation from squeezing a stress ball can help nurses to momentarily divert their attention from the high-stress environment of medical settings, leading to reduced stress and muscle tension. This simple act can enhance mental clarity and attention span, which are crucial for nurses who need to remain alert and focused throughout their shifts.

    Physical Activity Breaks

    Physical activity breaks are an essential strategy for combating fatigue and maintaining energy levels among hospital staff, especially those working long shifts. Implementing 5-minute breaks every hour for simple activities such as stretching, walking, or light exercises can make a significant difference in overall stamina and alertness. Martin et al. (2020) highlights the benefits of these short, regular bursts of physical activity, noting that they not only improve stamina but also effectively reduce fatigue. This approach ensures that healthcare professionals can sustain their performance throughout their shifts, enhancing both their health and their ability to provide high-quality care. Simple stretching routine that hospital staff can easily perform during a 5-minute break to reduce fatigue and improve energy during long shifts:

    Neck Stretch: Gently tilt your head toward your shoulder and hold for 15-20 seconds on each side. This stretch helps relieve tension in the neck and shoulders, areas that often get stiff from prolonged standing or sitting.

    Shoulder Shrugs: Lift your shoulders up towards your ears and then release them back down. Repeat this 5-10 times to reduce shoulder tension and improve circulation.

    Wrist and Finger Stretches: Extend your arm in front, palm up, and gently pull the fingers back toward your body with the other hand. Hold for 10-15 seconds, then switch hands. This is particularly useful for those who frequently use computers or write.

    Each of these stretches can be done quickly and does not require special equipment, making them ideal for busy healthcare professionals during their breaks. Regularly performing these stretches helps maintain flexibility, reduce stress, and prevent muscle stiffness associated with long periods of inactivity or repetitive movement.

    Part B: Enhancing Patient Wellness


    Nurses, who spend considerable time with patients, are ideally positioned to assess and effectively respond to their needs. Their prolonged interaction allows    for a deeper understanding of patients' conditions, enabling them to provide tailored health education and wellness strategies. Here are some techniques nurses can use to enhance patient wellness:

    Breathing and Relaxation Techniques to Manage Anxiety

    Breathing and relaxation techniques are critical tools that nurses can teach patients to help manage anxiety and palpitations effectively. One such method involves deep breathing exercises, which are simple yet profoundly impactful in alleviating acute stress responses. For example, nurses might instruct patients to slowly inhale through their nose for a count of five, hold that breath for three seconds, and then exhale slowly through the mouth for a count of seven. This controlled breathing technique helps to regulate the autonomic nervous system, which controls heart rate and can trigger anxiety responses. Smith (2021) supports the efficacy of these breathing exercises, noting that they not only help stabilize the heart rate but also significantly reduce levels of anxiety. This practice can be particularly beneficial during hospital stays, where patients may feel overwhelmed or anxious due to the unfamiliar environment or their medical condition. By incorporating these breathing techniques into patient care, nurses provide patients with a practical tool to manage their anxiety effectively, enhancing their overall comfort and experience during their hospitalization.

    Advocating for Supplementary Therapies


    Nurses play a pivotal role in advocating for supplementary therapies due to their extensive patient interaction, which is considerably more than other healthcare professionals. Their continuous monitoring and the strong relationships they develop allow them to gain deep insights into patients' conditions and needs. This comprehensive understanding enables nurses to assess care from a holistic perspective, considering not just medical but also emotional and social factors. By recommending additional services like physiotherapy or nutritional support during doctors' rounds, nurses ensure integrated, patient-centered care. Their position as care coordinators and patient advocates is crucial in enhancing recovery and satisfaction, effectively bridging the gap between various specialists and the patient’s daily experiences and needs in the healthcare setting (Lee, Choi, & Kim ,2020).

    Stress balls for Comfort and Pain Management   

    Stress balls are simple, yet effective tools for managing stress and anxiety. Research supports their use in various settings, showing benefits such as reduced muscular tension and increased attention spans. For instance, using a stress ball during medical procedures like endoscopy has been found to significantly lower patients' pain and anxiety levels post-procedure, even though it doesn't impact pain during the procedure itself (Rogerson et al., 2024).

    The use of stress balls during intravenous line (IV) insertion can effectively reduce pain and discomfort. For example, a pilot randomized controlled trial investigated the effectiveness of using a stress ball during vascular access cannulation in hemodialysis patients. The study found that patients who used a stress ball experienced significantly lower pain scores compared to those who did not use any distraction techniques. This suggests that the distraction provided by squeezing a stress ball can effectively mitigate pain during such procedures (Rogerson et al., 2024).


    Conclusion

    By implementing these straightforward, non-pharmacological strategies, hospital staff can significantly enhance both their wellness and that of their patients. Nurses, in particular, are well-placed to tailor care approaches through close patient interactions, suggesting integrative therapies that extend beyond traditional medicine. These cost-effective techniques not only improve patient outcomes but also reduce hospital stays, thereby making hospitals more conducive to healing. Additionally, for the staff, these wellness strategies increase overall health and wellness, which can lead to enhanced productivity and job satisfaction. By fostering a healthier work environment and promoting quicker patient recovery, hospitals can see a reduction in staff burnout and turnover, further enhancing the caregiving process. This not only improves patient outcomes but also enriches the caregiving process, thereby making hospitals more conducive to healing.


    References


    1. Anderson, J. (2018). Effects of breathing exercises on cortisol levels and mental health. Journal of Nursing Studies.

    2. Lee, C., Choi, M., & Kim, S. (2020). The effectiveness of guided imagery on pain and anxiety in health care settings: A systematic review. Journal of Pain     Research.

    3. Martin, L., Smith, T., & Kumar, P. (2020). Physical activity in the workplace: A systematic review. Workplace Health & Safety.

    4. Rogerson, O., Wilding, S., Prudenzi, A., & O'Connor, D. B. (2024). Effectiveness of stress management interventions to change cortisol levels: A systematic     review and meta-analysis. Psychoneuroendocrinology, 159, 106415. https://doi.org/10.1016/j.psyneuen.2023.106415

    5. Smith, J. (2021). Controlled breathing therapies as a tool for health enhancement. Journal of Integrative Medicine.

    6. Taylor, E., Jones, L., & Thomas, V. (2019). Mindfulness training for healthcare professionals and its role in burnout prevention: A literature review. Journal of Health Psychology.






Primary Immunodeficiency Diseases: A brief review (in conjunction with Primary Immunodeficiency Disease Awareness Week 2024)


10 May 2024 by ZARINA THASNEEM BINTI ZAINUDEEN

Primary immunodeficiency diseases (PID) is a disease caused by defective immune system leading to increased susceptibility to infection and maybe fatal. It involves diverse phenotype which may include susceptibility to infections, allergy, immune dysregulations and auto-inflammation. With the advance of exome and genome sequencing, more than 500 identified genetic defect causing PID worldwide.

Each individual has his or her own blueprint, a map made up of millions of bits of information called genes. The gene-map of each individual is a unique mix of genes from the mother and father. This map instructs the body how to build and how to maintain itself. Sometimes there are malfunctions in this map. When it fails to produce a functioning immune system, the disease resulting is called a primary immune deficiency (PI). Sometimes there may be a history of such a malfunction in the family, but often there is not.  It all depends upon how the genes of the parents have come together to make up the blueprint for a unique and distinct individual.

Looking at the local data, as of 2020, a prevalence of 0.37 per 100,000 people was reported from a systematic review of 34 publications. No further description on PID genotypes or survival outcome reported from this cohort. There is a major discrepancy compared to registry data reported from other countries in the world. We postulated the main reason of low PID cases in Malaysia is due to many patients were undiagnosed and undetected.          

 What are some types of PID?


 1.     Severe Combined Immunodeficiency (SCID)

SCID is a group of rare, life-threatening disorders caused by mutations in different genes involved in the development and function of infection-fighting T and B cells. Infants with SCID appear healthy at birth but are highly susceptible to severe infections.

2.     Chronic granulomatous disease (CGD)

It is defined as an inherited phagocyte disorder causing defective superoxide generation and intracellular killing. Reduced or missing burst activity (nicotinamide dinucleotide phosphate (NADPH) oxidase complex) is observed in this inborn defect that usually manifests itself during the first two years of life.  It can be inherited either by X-linked inheritance or autosomal recessive inheritance.  Most patients with CGD develop failure to thrive, severe bacterial adenitis, abscesses, osteomyelitis or hyperinflammatory manifestations.

3.     Common Variable Immunodeficiency (CVID)

This PI is marked by lower blood levels of two immune-globulins, IgG and IgA, and in about half the cases, of a third immune-globulin, IgM. People with CVID do not make sufficient or effective antibodies to fight bacterial and viral infections. The most common symptoms initially are recurrent and difficult to clear infections of ear, nose, sinuses, bronchi and lungs. CVID affects males and females in equal number. Some display symptoms early in life, and some not until their twenties or later.

 4.     X-Linked Agammaglobulinemia

XLA is a PI affecting males, caused by an inability to produce B cells or immunoglobulins (antibodies), which are made by B cells. People with XLA develop frequent infections of the ears, throat, lungs, and sinuses.

10 Warning Signs of Primary Immunodeficiency

If your child has two or more of these signs, ask your doctor about Primary Immunodeficiency. It could save your child’s life.

How is PID diagnosed and treated?

1.     Laboratory Testing


Laboratory studies are necessary to determine the presence of a PID. This is usually prompted by an individual experiencing some clinical problems, particularly recurrent and/or chronic infections.  The patient’s medical history and physical exam direct the appropriate choice of laboratory tests.

 a)     Primary Immunodeficiency Diseases Unit at USM Medical Centre Bertam (PPUSMB)

The Primary Immunodeficiency Disease Unit caters for clinical referrals from Northern and Eastern Malaysia (Kelantan and Terengganu). The centre comprises a diagnostic lab which does some immunological and allergy tests.

The team is headed by Dr Intan Juliana Abd Hamid, a consultant Paediatric Immunology & Allergy, supported by scientists working on functional and molecular/genetic aspects of PID and staff nurses. This centre is also listed on Jeffrey Modell Foundation website.

There are other specialised centres for PID Care with clinical immunologists in our country, like Pantai Hospital, Kuala Lumpur (Dr Amir Hamzah), Hospital Pengajar UPM (Assoc Prof Dr Intan Hakimah, Dr Azri), UKM Specialist Children's Hospital (Assoc Prof Dr Adli Ali) and Hospital Kuala Lumpur (Dr Sangeetha, Dr Marina) / Institut Medical Research (HKL/IMR).

2.     The need for Newborn Screening in Malaysia

Severe Combined Immune Deficiency (SCID) leads to life-threatening infections unless the immune system can be restored through a bone marrow transplant, enzyme replacement or gene therapy. Infants with SCID who lack a family history have been diagnosed in the past only after developing serious infections. Early identification of SCID through screening of all newborns can make possible life-saving intervention before infections occur.

Looking back in current local situation, there is no available report or published evidence of newborn screening for PID patients in Malaysia to date. The dearth of local evidence is striking. It is timely to further the research work in characterization of thymic output in Malaysian PID cohort prior to therapeutic intervention.

3.     How PID is treated?


A patient with a PI will be treated for any current infection with specific antibiotics, anti-viral or antifungal medications. In some PIs, to prevent permanent organ damage from recurrent infections, low or moderate doses of antibiotics may be recommended.

Around 30% of PID cases consist of antibody-deficiency types, like X-linked agammaglobulinaemia. These patients who although they lack immunoglobulin and so they are prone to infections, there is such a thing as commercially prepared immunoglobulin.

Patients can lead a relatively normal life with intravenous immunoglobulin, (IVIg). IVIg usually is scheduled every three to four weeks, and once started, treatment is usually lifelong. In Malaysia, IVIg is subsidised in public hospitals for patients of all ages who need it to stay alive.

Another type of PID involves defects in the innate immune system, which covers the cells and mechanisms that defend the body in a non-specific manner. In these most severe cases, where the immune system is completely non-functional (SCID), or chronic granulomatous disease (CGD), where there is a defect in the patient’s neutrophils, a bone marrow transplant may be required. Currently, the transplant is only available in a handful of hospitals in Malaysia.

What is the future of PID in Malaysia?

Among the challenges PID patients face is the lack of awareness about the condition. One of the solutions to this problem is to have more clinical immunologists. Ideally, there should be one in every regional hospital, so that other doctors can call them for consultation.

Finally, in conjunction with the ongoing Primary Immunodeficiency Disease Awareness Week Programme 2024, come and support us to celebrating life and what keeps the PID community moving forward. There are health and research exhibitions, webinars on introduction and current advances in managing the disease and PID book launch. This event was made possible through collaboration between PPUSMB, IPPT USM and Immunocare Sdn Bhd, with MPA (Penang state branch) and MyPOPI.

 

 




Robot Haiwan Sebagai Sokongan Emosi Untuk Demensia


25 November 2024 by SYAMIMI BINTI SHAMSUDDIN


Syamimi Shamsuddin1, Lim Thiam Hwee2 dan Winal Zikril Zulkifli3
 1Jabatan Kesihatan Komuniti, Institut Perubatan dan Pergigian Termaju,
Universiti Sains Malaysia, 13200 Kepala Batas, Pulau Pinang.
2Jabatan Psikososial, Pusat Rehabilitasi PERKESO Sdn. Bhd., Lot PT7263, Bandar Hijau, Hang Tuah Jaya, Durian Tunggal 75450, Melaka.
3Pusat Pengurusan Penyelidikan, Universiti Tun Hussein Onn Malaysia, 86400 Parit Raja,
Batu Pahat, Johor.

 
Pernahkah anda berada dalam satu situasi bersama seorang saudara anda yang telah mencapai usia emas dan di dalam situasi tersebut beliau mengadu kerap terlupa lokasi beliau menempatkan sesuatu barang. Beliau juga menunjukkan tanda-tanda gangguan daya ingatan dengan sering kali meletakkan barang di tempat yang salah. Beliau keliru berkenaan tarikh dan masa serta cenderung terlupa perkataan harian yang biasa digunakan dalam perbualan. Untuk makluman anda, kesemua gejala ini boleh dikaitkan dengan tanda-tanda awal penyakit demensia. Kajian Kesihatan dan Morbiditi Kebangsaan Tahun 2018 yang memfokuskan pada “Kajian Kesihatan Warga Emas” telah memberikan maklumat asas terperinci mengenai populasi warga emas di Malaysia. Kajian ini melaporkan prevalens demensia yang tinggi iaitu 8.5% dalam kalangan warga emas di negara ini.

Masyarakat Melayu lebih mengenali penyakit demensia sebagai nyanyuk. Demensia merupakan penyakit berkaitan dengan penurunan fungsi kognitif dan kehilangan ingatan yang kerap kali mempengaruhi kehidupan harian individu yang menghidapnya. Fenomena ini ketara dalam kalangan individu berumur 60 tahun ke atas. Demensia berlaku secara berterusan (progresif). Organisasi Kesihatan Sedunia (WHO) mengenal pasti Malaysia sebagai negara yang tua pada tahun 2030. Fenomena ini berlaku apabila bilangan penduduk yang berumur 60 tahun dan ke atas mencapai 15 peratus daripada jumlah penduduk dalam sesebuah negara. Justeru, pemahaman terhadap faktor-faktor yang menyumbang kepada terjadinya penyakit demensia dan kesannya terhadap pemulihan pesakit adalah amat penting. Pengurangan kualiti hidup dalam kalangan pesakit dan peningkatan beban kepada penjaga (caregiver) adalah antara cabaran utama yang dihadapi dalam penjagaan individu yang menghidapi demensia. Dalam usaha untuk meningkatkan kualiti hidup mereka, penggunaan teknologi seperti robot berbentuk haiwan kesayangan, telah muncul sebagai satu pendekatan yang berpotensi memberikan sokongan emosi kepada pesakit demensia.


Photo By https://joyforall.com/products/companion-cats
Gambar menunjukkan robot berbentuk kucing yang digunakan untuk terapi pesakit demensia.

Proses untuk memahami berkenaan penyakit demensia berkait rapat dengan usaha memupuk masyarakat yang penyayang serta berempati tinggi. Dalam konteks ini, pemahaman tentang penyakit ini membolehkan kita saling tolong-menolong di antara satu sama lain dan memahami cabaran demensia daripada sudut pesakit. Proses ini amat penting dari sudut psikologi kerana proses pemulihan demensia melibatkan bukan sahaja pasukan perubatan dan rehabilitasi malahan sokongan ahli keluarga dan komuniti amat diperlukan. Tambahan pula, sokongan ahli keluarga walaupun kadang kala adalah mencabar disebabkan oleh kekangan aktiviti kerja di luar, tetapi proses pemulihan tetap dijalankan dengan menggunakan pelbagai kaedah yang berkesan seperti penggunaan robot haiwan yang turut dapat memberikan perasaan rasa selamat dan juga menjadi sokongan emosi kepada pesakit.

Belum ada ubat khusus yang boleh menyembuhkan penyakit demensia namun aktiviti-aktiviti yang merangsang intelek boleh membantu dalam mengurangkan tanda-tanda penyakit ini. Selain itu, terdapat juga ubat-ubatan yang boleh mengawal gejala demensia dan berfungsi mengelakkan penyakit ini menjadi semakin teruk. Di negara-negara maju seperti Jepun dan Amerika Syarikat, terapi haiwan kesayangan telah terbukti berkesan dalam meningkatkan suasana hati (mood) dan tingkah laku warga emas, termasuklah dalam kalangan pesakit demensia. Namun begitu, kaedah ini mempunyai kekangan disebabkan terdapatnya risiko alergi dan jangkitan zoonotic daripada haiwan terhadap manusia. Intervensi robot haiwan kesayangan (pet-robot intervention (PRI)) adalah alternatif kepada terapi haiwan kesayangan dengan potensi untuk menggantikan kesan positif haiwan peliharaan sebenar dan memberi manfaat kepada kesihatan psikososial individu yang berisiko dengan dementia. Kajian ilmiah menunjukkan penggunaan robot haiwan peliharaan untuk individu menghidapi demensia telah menyebabkan pengurangan gejala tingkah laku dan psikologi demensia, menyusutkan kegelisahan, meningkatkan suasana hati yang positif, serta menggalakkan interaksi sosial. Robot ini didapati menjadi ejen yang mencetuskan perbualan dan komunikasi antara pesakit. Terdapat warga emas yang berkongsi pengalaman menarik bahawa peluang mereka untuk berhubung dengan orang lain adalah meningkat melalui perkongsian haiwan robotic yang mereka gunakan mereka di ruang awam di pusat-pusat komuniti. Haiwan robotik merupakan sejenis robot sosial yang mempunyai penampilan dan tingkah laku mirip kepada haiwan kesayangan. Justeru itu, didapati ciri-ciri interaktif robot ini seperti bulu yang boleh mengesan sentuhan, pergerakan dan bunyi yang semulajadi telah memudahkan interaksi antaras pesakit dengan robot haiwan tersebut atau dengan individu lain.

Salah satu contoh robot haiwan kesayangan yang menonjol dalam intervensi penyakit demensia adalah PARO, sebuah robot berbentuk anak anjing laut yang direka bentuk khas untuk memberikan sokongan emosi kepada individu menghidapi demensia. PARO telah terbukti memberikan manfaat yang signifikan, termasuk merangsang emosi positif, mengurangkan tekanan dan kebimbangan, serta meningkatkan interaksi sosial. Selain daripada itu, robot berbentuk kucing juga menjadi pilihan yang menarik, dengan keupayaan untuk memberikan ketenangan dan keselesaan seperti haiwan sebenar tanpa memerlukan penjagaan yang rumit. Kedua-dua jenis robot ini menawarkan potensi yang besar dalam menyokong pesakit dan merangsang interaksi yang bermakna dalam lingkungan penjagaan mereka. Dengan menggabungkan teknologi ini ke dalam program penjagaan demensia, kita dapat memperluas lagi pilihan sokongan emosi yang tersedia untuk memenuhi keperluan unik setiap pesakit.

Walaupun kebanyakan kesan positif yang dilaporkan kajian terdahulu adalah tidak signifikan secara statistik disebabkan oleh saiz sampel yang kecil dan kepelbagaian protokol intervensi, robot haiwan kesayangan menunjukkan potensi sebagai penyelesaian bukan farmakologi untuk meningkatkan kesihatan psikososial pesakit. Walau bagaimanapun, bukti kukuh berkaitan potensi pelaksanaan kaedah ini dalam amalan dunia sebenar di rumah pesakit dan rumah kebajikan masih memerlukan kajian terperinci.

Kajian terdahulu di negara-negara maju telah menunjukkan hasil yang positif berkaitan penggunaan robot haiwan sebagai sokongan emosi bagi individu dengan demensia dan seterusnya meningkatkan kualiti hidup mereka. Sungguhpun begitu, kajian menyeluruh diperlukan bagi membuktikan keberkesanan robot berbentuk haiwan kesayangan dalam meningkatkan tingkah laku, suasana hati dan simptom psikologi warga emas penghidap demensia di Malaysia. Langkah seterusnya termasuklah kajian lanjutan untuk mengukur kesan jangka panjang serta penambahbaikan dalam reka bentuk dan interaksi antara warga emas dengan robot haiwan bagi memenuhi keperluan yang khusus pesakit demensia. Dengan kesinambungan peningkatan teknologi, pendekatan ini boleh menjadi sebahagian daripada strategi holistik dalam penjagaan pesakit demensia pada masa depan.

Tidak banyak yang diketahui tentang penuaan dengan demensia dalam masyarakat Asia, khususnya di Malaysia. Di penghujung tempoh Rancangan Malaysia Ke-13, Malaysia dijangka menjadi negara yang menua. Oleh itu penyelesaian inovatif diperlukan untuk memastikan rakyat negara ini terus produktif di semua peringkat umur. Penggunaan teknologi robotik akan menyumbang kepada masyarakat yang lebih sihat dan aktif. Intervensi berasaskan teknologi robotik akan dapat melegakan beban sosial dan ekonomi terhadap individu, keluarga, dan kerajaan dalam pengurusan penyakit demensia.

REFERENCES

 
1.“Penyakit nyanyuk sukar dikawal, namun boleh dikurangkan”, Sinar Harian, 21 Mei 2019,

2.https://www.sinarharian.com.my/article/29103/sinar-aktif/rawatan-penyakit-nyanyuk

3.W. Q. Koh, D. Casey, V. Hoel, and E. Toomey, “Strategies for implementing pet robots in care homes and nursing homes for residents with dementia: protocol for a modified Delphi study,” Implement Sci Commun, vol. 3, no. 1, Dec. 2022, doi: 10.1186/s43058-022-00308-z.

4.H. L. Bradwell, K. J. Edwards, R. Winnington, S. Thill, and R. B. Jones, “Companion robots for older people: Importance of user-centred design demonstrated through observations and focus groups comparing preferences of older people and roboticists in Southwest England,” BMJ Open, vol. 9, no. 9, Sep. 2019, doi: 10.1136/bmjopen-2019-032468.

5.National Institutes of Health. “National health and morbidity survey 2018: Elderly Health”, Institute of Public Health, National Institutes of Health, Ministry of Health Malaysia, vol. 1, 2019.

 

 




Pemakanan Ketika Hamil bagi Wanita di Malaysia


25 November 2024 by RABETA BINTI MOHD SALLEH
Wanita adalah makhluk ciptaan Allah yang sangat kuat dan istimewa berbanding lelaki. Wanita memiliki organ dalaman yang dinamakan rahim yang membenarkan wanita hamil dengan izin Allah. Wanita yang melahirkan anak juga diberi peluang menyusukan anak melalui organ buah dada. Unik kan wanita! Oleh itu, wajarlah jika wanita dihargai dan diraikan melalui sambutan Hari Wanita dan Hari Ibu Sedunia.

Di antara penekanan Islam terhadap pemakanan ketika hamil adalah membolehkan mereka berbuka puasa pada bulan Ramadan jika bimbang terhadap keadaan kesihatan bayi jika mereka berpuasa. ?Wahai orang-orang yang beriman! Janganlah kamu mengharamkan apa yang baik yang telah dihalalkan Allah kepadamu, dan janganlah kamu melampaui batas. Sesunguhnya Allah tidak menyukai orang-orang yang melampaui batas” (Surah Al-Maidah ayat 87).

Wanita akan mengalami perubahan dinamik sepanjang tempoh kehamilan, di mana wanita memerlukan bukan sahaja perhatian dan sokongan moral malah juga sokongan fizikal daripada orang tersayang. Sokongan moral yang boleh dilakukan adalah dengan memberikan bayi makanan sihat sejak daripada janin lagi. Ini selaras dengan Matlamat Pembangunan Mampan (SDG) kedua iaitu Kelaparan Sifar dan yang ketiga iaitu Kesihatan Baik dan Kesejahteraan. Penekanan pemakanan wanita hamil juga berkaitan dengan Matlamat Pembangunan Mampan (SDG) kelima dan sepuluh.

Sepanjang tempoh kehamilan, janin atau fetus bergantung sepenuhnya kepada si ibu untuk mendapatkan bekalan makanan dan oksigen. Bekalan makanan tersebut samada daripada diet harian mahupun suplemen harian yang diambil oleh ibu. Proses perkumuhan juga bergantung pada si ibu melalui organ yang dinamakan tali pusat. Pemakanan ketika hamil sangat penting bagi memastikan bayi yang dilahirkan sihat dan sempurna dengan izin Allah. Selain itu, makanan merupakan salah satu aspek budaya yang mencerminkan cara penggunaan sumber-sumber makanan tempatan, daya cipta, makna dan penghargaan sesuatu makanan.

Pengambilan nutrien seperti vitamin B12, asid folik, iodin, kalsium dan ferum perlu diberi perhatian bukan sahaja ketika hamil malah kesemua nutrien ini perlu ditingkatkan pengambilannya sebelum kehamilan lagi bagi mengurangkan risiko melahirkan bayi cacat. Ia juga penting untuk meningkatkan sistem imun ibu dan bayi yang bakal lahir.

Menurut Kementerian Kesihatan Malaysia, Pengambilan Nutrien Saranan (RNI) bagi kobalamin atau vitamin B12 yang memainkan peranan penting dalam metabolism folat adalah sebanyak 4.5 µg/hari berbanding 4.0 µg/hari bagi wanita yang tidak hamil. Sumber utama kobalamin adalah daripada haiwan sahaja. Wanita hamil berisiko untuk mengalami kekurangan folat atau vitamin B9 kerana ketika tempoh kehamilan, keperluan folat akan meningkat secara signifikan terutama ketika trimester kedua dan ketiga. Folat memainkan peranan penting dalam proses hematopoiesis dan pengeluaran sel darah merah. Kekurangan folat sepanjang tempoh kehamilan akan menyebabkan kecacatan pada saraf tulang belakang bayi yang bakal lahir (NTD). Biasanya doktor akan memberikan wanita hamil suplemen asid folik kerana pengambilan diet harian tidak mampu menampung jumlah keperluan harian ibu dan janin.  

Kalsium memainkan peranan sebagai struktur tulang dan gigi manusia. Simpanan kalsium daripda ibu akan diserap dengan banyak oleh janin terutamanya ketika trimester kedua dan ketiga bagi pembentukan tulang dan gigi janin itu sendiri. Disebakan kalsium mudah hilang melalui air kencing, doktor akan memberikan suplemen kalsium kepada ibu hamil bagi menampung jumlah keperluan harian ibu dan janin. Jumlah Pengambilan Nutrien Saranan (RNI) bagi kalsium wanita hamil adalah 1000 mg/hari.

Iodin adalah adalah mineral penting yang diperlukan untuk sintesis hormon tiroid. Wanita hamil yang berusia 29 tahun perlu mengambil iodin sebanyak 200 µg/hari berbanding wanita sama usia yang tidak hamil hanya perlu mengambil iodin sebanyak 105.8 µg/hari. Ini untuk mengelakkan penyakit beguk atau pembesaran di bahagian leher pada bayi yang bakal lahir. Ibu hamil yang ada beguk berisiko tinggi untuk melahirkan bayi beguk juga. Untuk memastikan keperluan iodin harian wanita hamil mencukupi, klinik kesihatan akan membekalkan garam beriodin kepada wanita hamil yang datang memeriksa kandungannya.

Masalah yang sering dialami oleh wanita hamil ialah anemia akibat kekurangan pengambilan ferum dalam diet harian. Data pada 2015 menunjukkan prevalens anemia di Malaysia adalah sebanyak 29.3% telah dilaporkan dalam National Health and Morbidity Survey. Ujian makmal yang dilakukan untuk mengesan anemia di kalangan wanita hamil adalah melalui aras kandungan hemoglobin dalam darah. Jumlah Pengambilan Nutrien Saranan (RNI) bagi ferum wanita hamil adalah 840 mg sehari.

Rujukan:

1.Abdul Basith M.A-S. 2009. Cara Makan Rasulullah (S.A.W): Makanan Sihat dan Berkualiti. Penterjemah: Hamzah, R.A. Al-Hidayah Publications: Kuala Lumpur.

2.Khairuddin, M.Y. 2000. Anda Hamil? Panduan lengkap tentang kehamilan dan kelahiran. Times Books International: Kuala Lumpur.

3.Ministry of Health Malaysia. 2017. Recommended Nutrients Intake for Malaysian. National Coordinating Committee on Food and Nutrition (NCCFN), Ministry of Health Malaysia.

4.Institute of Public Health. 2015. National Health and Morbidity Survey 2015 (Vol. 2). Ministry of Health Malaysia.




Virtual Fitness: Revolutionizing Health and Wellness Through Immersive Exercise


10 June 2024 by NURDIANA BINTI HAJI ZAINOL ABIDIN
In recent years, the incorporation of virtual reality (VR) into fitness routines has gained significant traction. As technology continues to advance, VR-based exercise is proving to be a powerful tool for enhancing physical health and overall wellness. This article explores the various impacts of virtual reality-based exercise on health, highlighting its benefits, potential challenges, and future directions.

What is Virtual Reality-Based Exercise?

Virtual reality-based exercise leverages immersive, computer-generated environments to simulate real or imagined worlds. Participants can engage in a wide range of physical activities, such as running, cycling, or even practicing yoga, all within a virtual setting. This method capitalizes on the immersive nature of VR to make exercise more engaging and enjoyable, potentially boosting adherence to fitness routines.

Can it Boost My Physical Fitness?

One of the primary advantages of VR-based exercise is its ability to enhance physical fitness. Research indicates that VR exercise can significantly improve cardiovascular health, muscular strength, and overall physical performance (Qian, McDonough & Gao, 2020). For example, a study by Deutch et al. (2013) demonstrated a 13% improvement in VO2 among individuals post-stroke when using VR-augmented cycling, underscoring the efficacy of VR in achieving sufficient training duration and intensity to promote fitness.

McClure and Schofield (2020) conducted a study that analyzed the effects of VR on heart rate and bodily sensations during exercise. The study found that participants who used VR headsets while riding an exercise bike exhibited higher heart rates and burned more calories compared to those who exercised without VR. Additionally, these participants were able to pay less attention to their bodily sensations, allowing them to exercise for longer durations (McClure & Schofield, 2020). This finding supports the idea that VR can enhance physical exertion and endurance by diverting attention from discomfort.

Another study by McDonough et al. (2020) who explored the effect of cycling in VR found that the exercise not only led to higher enjoyment and self-efficacy but also resulted in lower perceived exertion (RPE) during sessions, despite similar or higher increases in systolic blood pressure. These findings emphasize VR cycling's potential to enhance physical performance while making workouts more enjoyable and less monotonous. 

Further, VR-based exercise has been found to significantly enhance functional fitness in older adults. Wang's study (2020) demonstrated that community-dwelling older adults who participated in a 12-week VR exercise program showed marked improvements in upper and lower body flexibility, strength, cardiorespiratory fitness, balance, and agility. These improvements persisted for up to 12 weeks post-intervention, indicating the long-term benefits of VR exercise for maintaining functional fitness in older adults (Wang, 2020).

The immersive nature of VR allows users to experience diverse environments and challenges, reducing the monotony often associated with conventional workouts, thereby significantly enhancing physical performance while providing a more engaging workout experience.

Can VR Improve My Mental Health?

Beyond physical health, VR-based exercise offers substantial mental health benefits. Engaging in VR workouts can alleviate symptoms of anxiety, depression, and stress. Research by Chan et al. (2023) demonstrated that exposure to virtual nature can significantly improve mood and reduce stress. In a study involving both young adults and senior citizens, walking in a virtual forest reduced negative affect and stress levels among young adults, as measured by heart rate, and enhanced positive affect among senior citizens. The immersive nature of VR environments promotes a sense of connectedness to nature, thereby improving psychological well-being. These findings highlight the potential of virtual nature experiences as effective interventions for enhancing mental health.

Can VR Be Used for Pain Therapy?

Virtual reality-based exercise also shows promise in pain management and rehabilitation. VR can be used as a tool for distraction, reducing the perception of pain during physical therapy sessions. Viderman et al. (2023) umbrella review encompassing 21 systematic reviews and meta-analyses, concluded that VR can be successfully applied in pain control across various settings, including perioperative, periprocedural, and chronic pain. The review also suggests that VR can serve as an effective alternative therapy for pain management in both children and adults. Similarly, a systematic review by Qian et al. (2020) found that VR-based exercise significantly improved physiological and rehabilitative outcomes in patients with chronic conditions like stroke, spinal cord injury, and cerebral palsy (Qian et al., 2020).

Can VR Make Me Stick to Exercise?

One of the significant challenges in maintaining a regular exercise routine is adherence. Traditional exercise programs often suffer from high dropout rates due to boredom and lack of motivation. VR-based exercise addresses this issue by providing a more engaging and enjoyable experience. The interactive nature of VR workouts can enhance motivation, making participants more likely to stick with their fitness regimes.

A study by Hoolahan (2020) found that the gamification aspects of VR exercises significantly increased user engagement and adherence to exercise programs. The study involved 20 participants who played 36 VR games over an 18-week program. Heart rate monitoring and questionnaires on perceived exertion were used to measure adherence, which was recorded at 90%, with only a 10% dropout rate, indicating success. Participants' heart rates were higher than their perceived exertion levels, suggesting they felt less effort during VR exercise. Various health benefits were also reported. Overall, the study demonstrates that gamified VR can enhance exercise adherence, reduce perceived exertion, and improve health.

Additionally, VR exercise has shown comparable improvements in fatigue, cognitive function, and sleep quality to conventional treadmill exercise in post-COVID-19 subjects, with participant satisfaction significantly higher in the VR group (Ahmad et al., 2024). This suggests that VR can enhance user experience and adherence to exercise programs.

Furthermore, the use of VR in exercise has been shown to positively influence motivation, affect, enjoyment, and engagement. A scoping review by Mouatt et al. (2020) summarized the existing literature and found that highly immersive VR had more beneficial effects compared to low immersive VR or exercise without VR. The review highlighted that VR strategies, such as the use of virtual avatars and agents/trainers, were particularly effective in enhancing motivation and engagement during exercise.

Can VR Create Stronger Communities?

Another exciting aspect of VR-based exercise is its potential for fostering social interaction and community building. Many VR fitness platforms offer multiplayer modes, allowing users to exercise with friends or join virtual fitness communities. This social aspect can provide additional motivation and support, enhancing the overall exercise experience. Dwivedi et al. (2022) examine the transformative potential of the metaverse, which extends the physical world through extended, augmented, and virtual reality technologies. Interactive virtual environments and immersive games are seen as precursors to the metaverse, providing insight into its potential impacts. The study highlights the significant societal effects and changes in social interactions resulting from widespread adoption of the metaverse.

What Are the Challenges of Using VR?

Despite the numerous benefits, there are challenges and considerations associated with VR-based exercise. One major concern is the cost and accessibility of VR equipment. High-quality VR systems can be expensive, potentially limiting access for some individuals. Additionally, there are potential risks related to motion sickness and eye strain, which can affect the user experience. It is essential for developers to address these issues to ensure VR fitness programs are safe and accessible to a broader population.

Future Directions?

The future of VR-based exercise looks promising, with ongoing advancements in technology and increased adoption. Future research should focus on long-term studies to evaluate the sustained benefits of VR exercise on health and wellness. Moreover, the integration of biometric feedback and artificial intelligence can further personalize VR fitness experiences, tailoring workouts to individual needs and goals.

Conclusion

Virtual reality-based exercise is revolutionizing the landscape of fitness and health. By providing immersive, engaging, and enjoyable workout experiences, VR has the potential to enhance physical fitness, improve mental health, aid in pain management, and increase exercise adherence. While challenges remain, the future of VR-based exercise is bright, promising a new era of innovative and effective health and wellness solutions. By embracing this technology, we can look forward to a future where exercise is not only more effective but also more enjoyable, fostering a healthier and happier society.

References


1. Qian, J., McDonough, D. J., & Gao, Z. (2020). The Effectiveness of Virtual Reality Exercise on Individual’s Physiological, Psychological and Rehabilitative Outcomes: A Systematic Review. International Journal of Environmental Research and Public Health, 17(11), 4133. https://consensus.app/papers/ijerp-2020/PMC7312871
2. Deutsch, J., Myslinski, M., Ranky, R., Sivak, M., Mavroidis, C., & Lewis, J. (2012). Fitness improved for individuals post-stroke after virtual reality augmented cycling training. In Proceedings of the 9th International Conference on Disability, Virtual Reality & Associated Technologies (pp. 10–12). Laval, France: ICDVRAT. ISBN 978-0-7049-1545-9.
3. McClure, C., & Schofield, D. (2020). Running virtual: The effect of virtual reality on exercise. Journal of Human Sport and Exercise, 15(4), 861-870. https://doi.org/10.14198/jhse.2020.154.13
4. McDonough, D., Pope, Z., Zeng, N., Liu, W., & Gao, Z. (2020). Comparison of College Students' Blood Pressure, Perceived Exertion, and Psychosocial Outcomes During Virtual Reality, Exergaming, and Traditional Exercise: An Exploratory Study. Games for health journal. https://doi.org/10.1089/g4h.2019.0196.
5. Wang, L. (2020). Effectiveness of Virtual Reality Exercise for Functional Fitness in Community-Dwelling Older Adults: A 12-Week Follow-Up Study. https://doi.org/10.1177/21582440231218515
6. Chan, S.H.M., Qiu, L., Esposito, G. et al. Nature in virtual reality improves mood and reduces stress: evidence from young adults and senior citizens. Virtual Reality 27, 3285–3300 (2023). https://doi.org/10.1007/s10055-021-00604-4
7. Viderman, D., Tapinova, K., Dossov, M., Seitenov, S., & Abdildin, Y. G. (2023). Virtual reality for pain management: an umbrella review. Frontiers in medicine, 10, 1203670. https://doi.org/10.3389/fmed.2023.1203670
8. Hoolahan, K. J. (2020). A preliminary investigation into the effects of gamified virtual reality on exercise adherence, perceived exertion, and health. International Journal of Virtual and Augmented Reality, 4(2), 14-31. https://doi.org/10.4018/IJVAR.2020070102
9. Ahmad, M. A., Awad Allah, S. A. M., Abd Elhaseeb, G. A., Elsharawy, D. E., Ahmed, H. S., & Abdelwahab, M. A. M. (2024). Effects of conventional versus virtual reality-simulated treadmill exercise on fatigue, cognitive function, and participant satisfaction in post-COVID-19 subjects: A randomized trial. Journal of Exercise Science & Fitness, 22(4), 316-321. https://doi.org/10.1016/j.jesf.2024.04.003
10. Mouatt, B., Smith, A. E., Mellow, M. L., Parfitt, G., Smith, R. T., & Stanton, T. R. (2020). The Use of Virtual Reality to Influence Motivation, Affect, Enjoyment, and Engagement During Exercise: A Scoping Review. Frontiers in Virtual Reality, 1, 564664. https://doi.org/10.3389/frvir.2020.564664
11. Dwivedi, Y. K., Hughes, L., Baabdullah, A. M., Ribeiro-Navarrete, S., Giannakis, M., Al-Debei, M. M., Dennehy, D., Metri, B., Buhalis, D., Cheung, C. M. K., Conboy, K., Doyle, R., Dubey, R., Dutot, V., Felix, R., Goyal, D. P., Gustafsson, A., Hinsch, C., Jebabli, I., ... Wamba, S. F. (2022). Metaverse beyond the hype: Multidisciplinary perspectives on emerging challenges, opportunities, and agenda for research, practice and policy. International Journal of Information Management, 66, 102542. https://doi.org/10.1016/j.ijinfomgt.2022.102542




Kesunyian Dalam Kalangan Warga Emas


26 June 2024 by ROHAYU BINTI HAMI


1. Pengenalan

Jumlah orang warga emas meningkat setiap tahun. Jumlah penduduk Malaysia yang berusia 65 tahun ke atas pada 2022 adalah 7.2%, meningkat daripada 7% pada tahun sebelumnya. Malaysia mempunyai penduduk yang semakin tua. Statistik terkini menunjukkan bahawa negara ini akan menjadi negara tua pada tahun 2030 (Jabatan Perangkauan Malaysia, 2023). Kesunyian warga emas adalah fenomena sosial yang semakin mendapat perhatian dalam masyarakat hari ini. Keadaan kesunyian ini menunjukkan kekurangan interaksi sosial dan juga perasaan terpencil, terasing, dan terputus dari hubungan sosial. Oleh itu, memahami konteks di sebalik kesunyian warga emas adalah penting supaya strategi pengurangan kesunyian dapat dirancang dengan efektif (National Academy of Science, 2020).

 
2. Faktor-faktor Penyumbang kepada Kesunyian Warga Emas

Banyak faktor menyumbang kepada kesunyian yang dialami oleh warga emas. Ini termasuk kehilangan teman sebaya dan pasangan, sokongan sosial yang kurang dari keluarga atau komuniti, interaksi sosial yang terbatas akibat dari keterbatasan mobiliti, serta kesan negatif dari elemen-elemen psikososial seperti kecemasan, depresi, atau hilangnya kemampuan untuk bergerak bebas (Bakri et al, 2021). Tambahan lagi, kekurangan dalam kemahiran komunikasi, kekurangan aktiviti sosial yang sesuai dengan keadaan fizikal, serta hilangnya status sosial dalam masyarakat juga turut menjadi penyumbang kepada rasa kesunyian di kalangan mereka.


3. Kesan Kesunyian terhadap Kesihatan Mental dan Fizikal

Kesan kesunyian ke atas kesihatan mental para warga emas amatlah kritikal, membawa kepada meningkatnya risiko kemurungan, keresahan dan tekanan emosi yang lebih hebat. Selain itu, kesunyian membawa kepada penurunan dalam kepandaian kognitif dan kehilangan memori. Secara fizikal pula, kesunyian boleh mengakibatkan kelemahan otot, masalah dalam pola tidur, serta meningkatkan risiko penyakit kardiovaskular. Kajian menunjukkan bahawa individu warga emas yang kesunyian dapat mengalami penurunan dalam fungsi imuniti dan adanya inflamasi dalam tubuh. Oleh kerana itu, pengaruh kesunyian terhadap kesihatan mental dan fizikal warga emas harus diberikan perhatian serius dalam usaha meningkatkan mutu kehidupan mereka (Donovon et al, 2020).

 
4. Strategi dan Intervensi untuk Mengurangkan Kesunyian

Banyak strategi dan intervensi boleh diaplikasikan bagi mengurangkan kesunyian di kalangan warga emas. Salah satu strategi efektif adalah dengan meningkatkan interaksi sosial menerusi penyertaan dalam aktiviti komuniti atau kelab untuk warga emas. Ini memungkinkan warga emas berinteraksi dengan teman sebaya dan membentuk hubungan sosial yang kuat. Tambahan pula, program sokongan emosional dan psikososial sangat penting dalam membantu para warga emas dalam menghadapi kesunyian. Aktiviti-aktiviti seperti kelas kecergasan, permainan yang merangsang otak, serta bengkel kreatif memberikan peluang bagi mereka untuk berkomunikasi dan berkongsi cerita. Selanjutnya, terapi tingkah laku kognitif juga dapat membantu warga emas memahami dan mengatasi perasaan kesunyian, merancang strategi yang lebih efektif dalam menghadapinya.

 
5. Peranan Masyarakat dan Institusi dalam Mengatasi Kesunyian Warga Emas

Peranan masyarakat adalah kritikal dalam menangani masalah kesunyian di kalangan warga emas. Adalah penting bagi masyarakat untuk menyediakan ruang bagi warga emas untuk berinteraksi dan bersosialisasi melalui pelbagai aktiviti komuniti seperti kelas yoga, acara keagamaan, atau kerja-kerja sukarela. Di samping itu, institusi seperti rumah-rumah penjagaan bagi warga emas juga harus menawarkan program-program sosial dan kesihatan mental yang merangkumi kemudahan untuk mereka berkomunikasi dan mengembangkan hubungan sosial yang sihat. Keperluan untuk memastikan warga emas dapat berinteraksi dalam lingkungan yang membina adalah penting untuk institusi tersebut.

 
6. Kesimpulan

Kesunyian adalah suatu masalah dalam kalangan warga emas yang perlu di ambil berat oleh keluarga, komuniti setempat dan masyarakat umum. Pihak  berwajib berperanan untuk mengadakan aktiviti- aktiviti tertentu untk warga emas supaya masalah kesunyian dalam kalangan warga emas dapat di atasi.

 

References


1.  Jabatan Perangkauan Malaysia, 2023. Department of Statistics Malaysia (dosm.gov.my)

2. Bakri NA, Rose RAC. Gangguan Sindrom Kesepian Terhadap Warga Emas di Sabah. Jurnal Wacana Sarjana. 2021. ukm.my

3. National Academies of Sciences, Division of Behavioral, Medicine Division, Board on Behavioral, Sensory Sciences, Board on Health Sciences Policy, Committee on the Health, Medical Dimensions of Social Isolation, Loneliness in Older Adults. Social isolation and loneliness in older adults: Opportunities for the health care system. National Academies Press; 2020 Jun 14. nationalacademies.org

4. Donovan NJ, Blazer D. Social isolation and loneliness in older adults: review and commentary of a national academies report. The American Journal of Geriatric Psychiatry. 2020. nih.gov




Sindrom Cushing


02 July 2024 by SALBIAH BINTI ISA

Pengenalan

Sindrom Cushing adalah keadaan kesihatan yang disebabkan oleh tahap hormon kortisol yang tinggi dalam tubuh untuk tempoh masa yang lama. Kortisol adalah salah satu hormon yang dihasilkan oleh kelenjar adrenal (Gambarajah 1) yang berfungsi untuk mengatur pelbagai proses dalam tubuh manusia seperti metabolisme, tekanan darah, dan respons terhadap tekanan atau stres. Keadaan ini boleh terjadi dalam semua peringkat umur dan jantina.

Punca

Sindrom Cushing boleh berlaku disebabkan oleh dua punca utama:

Punca Luaran (Eksogen): Ini berlaku apabila seseorang mengambil steroid dalam dos yang tinggi untuk tempoh yang lama, sama ada sebagai rawatan untuk keadaan seperti asma, allergi kronik, rheumatoid arthritis, penyakit kerangan usus atau sebagai sebahagian daripada rawatan kanser.
Punca Dalaman (Endogen): Ini berlaku apabila kelenjar adrenal menghasilkan terlalu banyak kortisol. Punca dalaman yang paling biasa adalah adenoma hipofisis, iaitu tumor kecil yang berkembang di dalam kelenjar pituitari yang berupaya mengawal fungsi kelenjar adrenal untuk merembeskan kortisol dalam amaun yang berlebihan.

Tanda dan Gejala

Orang yang mengalami sindrom Cushing mungkin mengalami beberapa tanda dan gejala berikut (Gambarajah 2):

Gambarajah 2 : Tanda dan gejala sindrom Cushing


Peningkatan berat badan: Pengumpulan lemak berlaku terutamanya di bahagian perut, wajah, dan leher. Ini menyebabkan obesiti abdomen, wajah yang bulat (moon face) dan bonggol kerbau (buffalo hump) di bahagian belakang pangkal leher.
Kulit tipis dan mudah berdarah: Kulit mungkin menjadi nipis dan mudah mendapat lebam atau luka.
Peningkatan risiko jangkitan: Oleh kerana kortisol yang tinggi boleh melemahkan sistem imun, maka individu yang mengalami sindrom Cushing akan lebih berisiko tinggi untuk mendapat jangkitan kuman.
Gangguan keseimbangan glukosa dalam darah: Kortisol yang tinggi boleh mengganggu pengaturan (homeostasis) glukosa dalam darah, dengan itu boleh menyebabkan terjadinya penyakit diabetes jenis 2 (type 2 diabetes mellitus).

Diagnosa

Terdapat 2 jenis ujian yang boleh dilakukan untuk mengesan sindrom Cushing.

·        Ujian makmal

Pemeriksaan paras kortisol dalam air kencing dan kortisol dalam air liur pada lewat malam merupakan ujian saringan untuk mengesan sindrom Cushing. Jika ujian saringan positif, ujian pengesahan seperti ujian penindasan deksametason semalaman (dexamethasone suppression test) perlu dilakukan. Pengukuran paras ACTH dalam darah juga akan dilakukan bagi membantu menentukan punca rembesan kortisol yang tinggi.

·        Ujian imbasan imejan

Ujian pengimejan seperti MRI dan CT scan juga diperlukan untuk melihat keadaan kelenjar pituitari atau adrenal jika terdapat ketumbuhan atau kanser yang menjadi punca rembesan kortisol yang berlebihan.

Adalah penting untuk ambil perhatian bahawa tafsiran ujian ini harus dilakukan oleh ahli profesional penjagaan kesihatan yang berpengalaman dalam menguruskan sindrom Cushing. Ini kerana diagnosis boleh menjadi rumit dan memerlukan pertimbangan yang teliti terhadap konteks klinikal dan keputusan ujian.

Rawatan

Rawatan bagi Sindrom Cushing bergantung kepada punca sindrom tersebut:

·        Punca Luaran: Biasanya melibatkan pengurangan dos steroid secara berperingkat atau menggunakan alternatif rawatan lain jika mungkin. Pengurangan dos steroid secara berperingkat adalah penting bagi mengelakkan paras kortisol menurun secara mendadak selain memastikan badan pesakit dapat menyesuaikan diri terhadap perubahan yang berlaku.

·        Punca Dalaman: Boleh melibatkan pembedahan untuk membuang tumor, terapi radiasi, atau pengurusan lain yang ditentukan oleh pakar endokrinologi.

Prognosis dan Pengurusan Jangka Panjang

Dengan rawatan yang betul, kebanyakan individu dengan Sindrom Cushing mempunyai harapan yang cerah untuk pulih. Walau bagaimanapun, pengurusan jangka panjang diperlukan untuk memantau tahap hormon dan mencegah komplikasi jangka panjang seperti osteoporosis atau penyakit kardiovaskular.

 

Kesimpulan

Sindrom Cushing adalah keadaan endokrin yang kompleks yang disebabkan oleh pengeluaran kortisol yang berlebihan dalam badan. Pemahaman tentang punca, gejala, prosedur pengesanan, dan pilihan rawatan adalah penting untuk pengurusan dan pemulihan kesihatan individu yang mengalaminya.





Innovative Healthcare: The Rise of Augmented Reality (AR) and Virtual Reality (VR)


02 July 2024 by NURDIANA BINTI HAJI ZAINOL ABIDIN


The health and wellness sector is on the brink of revolution, thanks to Augmented Reality (AR) and Virtual Reality (VR) (Shaikh, Dar, & Sofi, 2022). These technologies offer immersive experiences that can significantly enhance various aspects of healthcare, from training medical professionals to treating patients. This article explores the future integration of AR and VR in health, focusing on current technologies, innovations, potential applications, and future research directions.

The convergence of AR and VR for holistic health


The integration of AR and VR is creating holistic health solutions that were once the stuff of science fiction. This convergence allows for a more comprehensive approach to healthcare, addressing both physical and mental well-being. So, what is AR and VR? At their core, AR and VR are transformative technologies that alter our interaction with the world. AR overlays digital information onto the real world, enhancing the user's perception and interaction with their environment. Imagine looking at a patient and seeing their vital signs, medical history, and even potential treatment options displayed in real-time over their body. In contrast, VR immerses users in a completely virtual environment, enabling experiences that are otherwise inaccessible. For instance, patients undergoing physical rehabilitation can use VR to engage in simulated exercises that feel real, thereby increasing motivation and adherence to treatment protocols.

One promising application of AR and VR is in the field of medical training. AR can provide real-time data and visualizations during surgeries, enhancing the surgeon's precision and reducing the likelihood of errors (Brockmeyer et al., 2023). VR, on the other hand, offers immersive simulation environments for medical students to practice procedures without the risk of harming real patients (Pottle, 2019). This hands-on training is invaluable, providing a level of preparedness that traditional methods cannot match.

Potential applications in health and wellness


The potential applications of AR and VR in health and wellness are vast and varied (Javvaji et al., 2024). One significant area is mental health. VR therapy is currently being used to treat conditions such as PTSD, anxiety, and phobias by exposing patients to controlled virtual environments where they can confront their fears in a safe space (Maples-Keller et al., 2017). AR can complement these treatments by providing mindfulness exercises and real-time biofeedback during everyday activities, helping patients manage stress and anxiety more effectively.

Another promising application of AR and VR is in physical rehabilitation. AR and VR can gamify physical therapy, making exercises more engaging and motivating for patients. This can be particularly beneficial for children and elderly patients who might find traditional rehabilitation methods monotonous and challenging (Aderinto et al., 2023). Additionally, AR can provide real-time feedback on posture and movement, helping patients perform exercises correctly and avoid further injury (Chang, Song & Cen, 2022).

Beyond professional applications, AR and VR have profound implications for patient empowerment. Individuals can use AR to manage their health more effectively, such as through applications that provide real-time feedback on exercise form or dietary choices. VR can offer patients immersive educational experiences, helping them understand complex medical procedures or conditions through interactive simulations.

The next frontier in immersive health tech


The future of AR and VR in health lies in their ability to create increasingly immersive and personalized experiences. As technology advances, we can expect more sophisticated and realistic simulations that can replicate complex medical scenarios. This will be particularly useful in surgical training, where VR can provide detailed simulations of rare and complicated procedures (Tene et al., 2024).

Furthermore, the integration of AI with AR and VR will enable the development of adaptive learning systems that can tailor training programs to the individual needs of medical professionals. These systems can track progress and provide personalized feedback, ensuring that learners receive the support they need to master their skills (Tene et al., 2024).

Future research directions and potential breakthroughs

The future of AR and VR in health will be shaped by ongoing research and technological advancements. One key area of research is the development of more accurate and responsive AR and VR systems. This includes improving the resolution and field of view of VR headsets, enhancing the realism of virtual environments, and developing more precise AR overlays that can be used in real-time medical applications (Taghian et al., 2023).

Another important research direction is the exploration of the long-term effects of AR and VR use in healthcare. While these technologies offer many benefits, it is crucial to understand their potential risks and limitations. This includes studying the psychological and physiological impacts of prolonged AR and VR use, as well as developing guidelines for their safe and effective implementation in healthcare settings (Baniasadi, Ayyoubzadeh, & Mohammadzadeh, 2020).

Finally, future research should focus on the accessibility and affordability of AR and VR technologies. To ensure that these innovations benefit as many people as possible, it is essential to develop cost-effective solutions that can be widely adopted in various healthcare settings, including low-resource environments (Baniasadi, Ayyoubzadeh, & Mohammadzadeh, 2020).

Conclusion

The integration of AR and VR in health and wellness represents a significant advancement in medical technology. These immersive technologies have the potential to transform medical training, enhance mental health treatments, and improve physical rehabilitation. As research and technology continue to evolve, we can expect even more innovative applications and breakthroughs in the field of AR and VR healthcare. The future holds great promise for these technologies, making healthcare more effective, engaging, and accessible for all.



References:


1.    Shaikh, T. A., Dar, T. R., & Sofi, S. (2022). A data-centric artificial intelligent and extended reality technology in smart healthcare systems. Social network analysis and mining, 12(1), 122. https://doi.org/10.1007/s13278-022-00888-7
2.    Brockmeyer, P., Wiechens, B., & Schliephake, H. (2023). The Role of Augmented Reality in the Advancement of Minimally Invasive Surgery Procedures: A Scoping Review. Bioengineering (Basel, Switzerland), 10(4), 501. https://doi.org/10.3390/bioengineering10040501
3.    Pottle J. (2019). Virtual reality and the transformation of medical education. Future healthcare journal, 6(3), 181–185. https://doi.org/10.7861/fhj.2019-0036
4.    Javvaji, C. K., Reddy, H., Vagha, J. D., Taksande, A., Kommareddy, A., & Reddy, N. S. (2024). Immersive Innovations: Exploring the Diverse Applications of Virtual Reality (VR) in Healthcare. Cureus, 16(3), e56137. https://doi.org/10.7759/cureus.56137
5.    Maples-Keller, J. L., Bunnell, B. E., Kim, S. J., & Rothbaum, B. O. (2017). The Use of Virtual Reality Technology in the Treatment of Anxiety and Other Psychiatric Disorders. Harvard review of psychiatry, 25(3), 103–113. https://doi.org/10.1097/HRP.0000000000000138
6.    Aderinto, N., Olatunji, G., Abdulbasit, M. O., Edun, M., Aboderin, G., & Egbunu, E. (2023). Exploring the efficacy of virtual reality-based rehabilitation in stroke: a narrative review of current evidence. Annals of medicine, 55(2), 2285907. https://doi.org/10.1080/07853890.2023.2285907
7.    Chang, H., Song, Y., & Cen, X. (2022). Effectiveness of Augmented Reality for Lower Limb Rehabilitation: A Systematic Review. Applied bionics and biomechanics, 2022, 4047845. https://doi.org/10.1155/2022/4047845
8.    Tene, T., Vique López, D. F., Valverde Aguirre, P. E., Orna Puente, L. M., & Vacacela Gomez, C. (2024). Virtual reality and augmented reality in medical education: an umbrella review. Frontiers in digital health, 6, 1365345. https://doi.org/10.3389/fdgth.2024.1365345
9.    Taghian, A., Abo-Zahhad, M., Sayed, M. S., & Abd El-Malek, A. H. (2023). Virtual and augmented reality in biomedical engineering. Biomedical engineering online, 22(1), 76. https://doi.org/10.1186/s12938-023-01138-3
10.    Baniasadi, T., Ayyoubzadeh, S. M., & Mohammadzadeh, N. (2020). Challenges and Practical Considerations in Applying Virtual Reality in Medical Education and Treatment. Oman medical journal, 35(3), e125. https://doi.org/10.5001/omj.2020.43





Potensi Seni Kaligrafi dalam Kesihatan Kognitif Warga Tua


03 July 2024 by NOOR MASTURA BINTI MOHD MUJAR


Ketika dunia bergelut dengan cabaran populasi yang semakin tua, mencari kaedah yang inovatif dan berkesan untuk mengekalkan dan meningkatkan kesihatan kognitif di kalangan warga tua menjadi keutamaan. Salah satu pendekatan yang berpotensi adalah seni kaligrafi. Seni purba yang dihormati kerana keindahan dan ketepatannya kini dikenalpasti berpotensi untuk menggalakkan kesejahteraan kognitif di kalangan warga tua.

 

Kaligrafi, adalah seni tulisan tangan yang indah dengan ciri-ciri estetik. Ianya melibatkan kemahiran motor halus, daya tumpuan dan ingatan. Unsur-unsur ini adalah penting untuk mengekalkan fungsi kognitif bagi meningkatkan kemahiran psikomotor dan koordinasi. Seni kaligrafi memerlukan pergerakan tangan yang tepat dan kawalan motor halus dimana ianya membantu meningkatkan ketangkasan dan koordinasi tangan-mata yang sering terkesan dan merosot terutamannya warga tua. Seni ini memerlukan tumpuan yang tinggi dan perhatian yang berterusan juga mampu meningkatkan konsentrasi dan tumpuan di kalangan warga tua. Amalan lukisan kaligrafi yang tetap dan berkala ini berpotensi meningkatkan kejelasan mental secara keseluruhan. Proses pembelajaran dan mengingati sapuan dan gaya kaligrafi yang berbeza boleh merangsang pengekalan dan ingatan. Ini mampu memberi manfaat terutamanya dalam memerangi kemerosotan ingatan yang berkaitan dengan usia, seperti Demensia dan Alzheimer. Selain itu, seni kaligrafi juga berkait rapat dengan dimensi kerohanian dan meditasi. Maksud sesebuah perkataan, pergerakan berirama dan tumpuan yang diperlukan boleh membawa kepada keadaan kesedaran, mengurangkan tekanan dan menggalakkan kesejahteraan emosi.

 

Seni kaligrafi berpotensi sebagai inovasi sosial dengan penyediakan ruang untuk berinteraksi dalam aktiviti berkumpulan. Penglibatan sosial adalah faktor utama dalam mengekalkan kesihatan kognitif dan mencegah perasaan kesunyian dan pengasingan, yang biasa berlaku dalam kalangan warga tua dan berpencen. Melalui aktiviti berkumpulan seperti bengkel kaligrafi boleh memupuk semangat kemasyarakatan dan kekitaan. Interaksi sosial boleh meningkatkan kesejahteraan emosi dan memberikan rangsangan kognitif melalui pengalaman pembelajaran yang dikongsi secara berkumpulan, selain memupuk pembelajaran antara dua generasi; tua dan muda bagi mewujudkan hubungan bermakna bersama.

 

Kajian terbaru mendedahkan asas saintifik faedah kaligrafi. Penyelidikan telah menunjukkan bahawa melibatkan diri dalam aktiviti yang memerlukan kemahiran motor halus dan penglibatan daya tumpuan boleh membawa kepada peningkatan dalam fungsi kognitif. Kajian mendapati bahawa individu warga emas yang kerap melakukan aktiviti rangsangan mental seperti kaligrafi, menunjukkan kadar penurunan kognitif yang lebih perlahan berbanding mereka yang tidak melakukan aktiviti sedemikian. Kajian itu menekankan kepentingan pembelajaran sepanjang hayat dan penglibatan mental dalam menggalakkan kesihatan kognitif. Satu lagi kajian yang diterbitkan dalam satu lagi kajian mendapati bahawa peserta yang mengamalkan kaligrafi mempamerkan tahap kebimbangan yang berkurangan dan meningkatkan kesejahteraan mental. Penemuan ini mencadangkan bahawa seni kaligrafi boleh menjadi alat yang berharga dalam pendekatan holistik untuk penjagaan warga tua, dengan menyepadukan dimensi kognitif, emosi, sosial dan rohani.

 

Keunikan seni kaligrafi melangkaui keindahan visualnya. Ia merangkumi faedah kognitif, emosi, sosial dan rohani yang mendalam, sesuai dengan warga tua. Seiring kemajuan yang menumpukan pada penyelesaian berteknologi tinggi, amalan seni kaligrafi yang ringkas dan praktikal mengingatkan kita tentang kesan mendalam seni tradisional terhadap kesihatan dan kesejahteraan moden. Potensi seni kaligrafi sama ada Islam, Cina atau lain-lain, menawarkan gabungan unik ekspresi artistik, rangsangan kognitif, dan pengayaan rohani, menjadikannya amalan yang berharga untuk mempromosikan kesihatan kognitif dan kesejahteraan dalam kalangan warga tua.


REFERENCES

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3.    Dahlan A, Ungku Mohd Zam UAA, Kandayah T, Nurhidayah N. Effects of Malaysian Cognitive Stimulation Therapy (CST-M) for older people with mild dementia. Environ Proc J [Internet]. 2022;7(21):187–93. Available from: http://dx.doi.org/10.21834/ebpj.v7i21.3737
4.    Zilidou V, Petsani D, Billis A, Bamidis P. Creative Art Therapy as an Efficient Way to Improve the Well-Being of People Living with Dementia. Stud Health Technol Inform. 2023;305:553–7.
5.    Liu Q, Wang F, Tan L, Liu L, Cheng H, Hu X. Comparative efficacy of various art therapies for patients with dementia: A network meta-analysis of randomized controlled trials. Front Psychiatry. 2023;14(January):1–8.
6.    The Star. Embracing an ageing population. The Star [Internet]. 2022;8–11. Available from: https://www.thestar.com.my/business/business-news/2022/10/08/embracing-an-ageing-population
7.    Jin M, Cai SQ. Mechanisms Underlying Brain Aging Under Normal and Pathological Conditions. Neurosci Bull [Internet]. 2023;39(2):303–14. Available from: https://doi.org/10.1007/s12264-022-00969-9
8.    Wolf A, Tripanpitak K, Umeda S, Otake-Matsuura M. Eye-tracking paradigms for the assessment of mild cognitive impairment: a systematic review. Front Psychol. 2023;14(July):1–24.
9.    Ruiz-Garcia R. The growing evidence of neurodegenerative diseases risk factors. Rev Mex Neurocienc. 2023;24(1):1–2.
10.    Masika GM, Yu DSF, Li PWC, Lee DTF, Nyundo A. Visual Art Therapy and Cognition: Effects on People with Mild Cognitive Impairment and Low Education Level. Vol. 77, Journals of Gerontology - Series B Psychological Sciences and Social Sciences. 2022. 1051–1062 p.




Astatine-211: Novel targeted therapy against cancer


18 November 2024 by YING CHEE KEAT


Targeted alpha therapy (TAT) is an emerging and highly promising form of radiopharmaceutical therapy that involves the use of alpha-emitting isotopes to target and destroy cancer cells in the human body by injecting alpha particle-emitting radionuclides into the tumor tissue. Astatine-211, an alpha particle-emitting radionuclide, has a high energy to kill tumor cells but low penetrating power, so the risk of damage to surrounding healthy tissue is reduced [1].

The Research Center for Nuclear Phsyics (RCNP) at Osaka University’s Suita Campus has the largest cyclotron accelerator on a university campus in Japan. Researchers utilise the RCNP cyclotron facility to perform various types of experiments, such as studying the structure and response of atomic nuclei, as well as investigating the mechanism of nucleosynthesis using light and heavy ions such as protons, alphas and oxygen ions. Astatine-211 is made by bombarding bismuth with helium followed by extraction using the accelerator. RCNP has the capability to mass-produce astatine-211 (211At), a radioisotope used in targeted alpha therapy (TAT) [2].

Photo:The accelerator located in RCNP. The pictures were taken by the author during a visit to RCNP at Osaka University


In Japan, Osaka University is set to begin the first clinical trial using astatine-211, marking the first in-human, investigator-initiated clinical trial for refractory thyroid cancer patients. This phase I trial will evaluate the safety, pharmacokinetics, and efficacy of astatine-211 for use in alpha therapy in patients with refractory differentiated thyroid cancer who have responded inadequately to the standard of care [3-4]. Compared to other alpha particle-emitting isotopes, astatine-211 offers several advantages, including a shorter half-life of 7.2 hours compared to Actinium-225's 10 days. Targeted Alpha Therapy (TAT), which can be used in patients with advanced refractory cancer in an outpatient setting, has immense potential to improve patients' quality of life and is expected to spur medical innovation in Japan and abroad.

Traditionally, radioactive iodine (¹³¹I) is used clinically for patients with differentiated thyroid cancer in isolated hospital rooms dedicated to radionuclide treatment. However, because radioactive iodine (¹³¹I) emits gamma rays, which have a long range, patients need to be admitted alone to special hospital rooms to protect others from radiation exposure. Compared to beta particles from ¹³¹I, alpha particles emitted from ²¹¹At have higher linear energy transfer, translating to better therapeutic effects by inducing DNA double strand breaks and free radical formation. Additionally, alpha rays emitted from ²¹¹At have a short range and do not travel outside the body, thus allowing for outpatient cancer treatment. ²¹¹At is poised to be a breakthrough treatment for metastatic thyroid cancer, especially in cases where conventional ¹³¹I therapy is ineffective. Additionally, ²¹¹At has the potential to be used as a therapeutic agent for other types of cancer.

Photo: Targeted alpha therapy using astatine (211At): [211At]NaAt accumulates in the metastatic lesions through sodium-iodide (NaI) symporter in patients with differentiated thyroid cancer. Alpha rays emitted from 211At induce DNA double strand breaks, leading to cancer cell death. Source: https://www.med.osaka-u.ac.jp/eng/archives/7164


The author visited RCNP and the Department of Nuclear Medicine at Osaka University Hospital as part of a collaboration between the Advanced Medical & Dental Institute, Universiti Sains Malaysia, and the Osaka University Graduate School of Medicine, Japan, through the Osaka University International Certification Program (OUICP). The author expresses sincere appreciation to the program manager, Associate Professor Dousatsu Sakata from the Division of Health Science, Graduate School of Medicine, for the opportunities provided.

Photo: The photo taken during visitation to the Osaka University Hospital’s Nuclear Medicine department



References


1. Astatine-211: Japan’s strategic weapon against cancer https://www.nature.com/articles/d42473-023-00447-4

2. Mass production of Astatine at Cyclotron Facility at RCNP will promote advances in targeted alpha therapy https://www.osaka-u.ac.jp/en/news/topics/2024/02/29002

3. First in-human investigator-initiated clinical trial started for refractory thyroid cancer patients: Novel targeted alpha therapy using astatine. https://www.med.osaka-u.ac.jp/eng/archives/7164

4. Albertsson P, Bäck T, Bergmark K, Hallqvist A, Johansson M, Aneheim E, Lindegren S, Timperanza C, Smerud K, Palm S. Astatine-211 based radionuclide therapy: Current clinical trial landscape. Front Med (Lausanne). 2023 Jan 6;9:1076210. doi: 10.3389/fmed.2022.1076210. PMID: 36687417; PMCID: PMC9859440.




Hiking in Malaysia: Embrace Nature and Enhance Your Muscle Fitness


18 November 2024 by EVA NABIHA BINTI ZAMRI

Hiking is booming in Malaysia! Our nation’s rich and varied landscape, especially the stunning highlands, offers the ultimate adventure for nature lovers. From towering peaks to winding trails, Malaysia’s mountains beckon hikers to explore their breathtaking beauty.

 
Hiking is the activity of walking in natural environments, taking you through forests, hills, mountains, and scenic trails, while providing a fulfilling form of physical exercise. And the best part? You don’t have to be an athlete to enjoy it! Hiking is a fantastic activity for everyone, from kids to healthy seniors. Plus, hiking is a low-cost and accessible way to garner numerous health benefits.


Beyond enjoying breathtaking scenery and making new friends, hiking also provides an essential benefit to overall happiness: improved health. Extensive research has highlighted the numerous health advantages of hiking, particularly for muscle fitness and cardiovascular health.

 
Hiking is an awesome way to build strong muscles while enjoying nature. Every hike, whether it’s up a gentle slope or a steep hill, makes you use different muscle groups, giving your body a full workout. When you hike uphill, you strengthen your lower limb muscles such as quads, hamstrings, glutes, and calves (Rodio & Fattorini 2014). Going downhill is great for your knees and hip flexors. Carrying a backpack? That’s extra training for your shoulders, arms, and back. Plus, your core muscles get activated, helping you stay balanced on uneven ground.

 
Hiking isn’t just great for your muscles; it’s also fantastic for your bones. Activities like hiking help improve bone density and strength, reducing the risk of bone diseases as you age. Want to boost your balance? Hiking helps with that too! It makes your hips and core stronger, keeping you steady on tricky trails. As you get better, try more challenging hikes with steeper climbs and rocky paths.


Recent studies show that having weak muscles can lead to poorer cardiovascular health and even higher risk of death as we get older. In particular, hiking can boost muscle endurance, which helps manage your heart health. Cardiovascular exercises like hiking make your muscle heart work harder, increasing blood flow to your heart's small vessels and helping prevent blockages. This improved blood flow lowers your risk of heart disease and helps maintain healthy blood pressure and cholesterol levels (Kang 2014).

 
So, hitting the trails not only strengthens your muscles but also promotes a healthy heart and overall wellness. Embarking on hikes could be your ticket to a longer, healthier life. So, let’s hike!



Breathtaking Sunrise View from the Summit of Mount Kerunai, Perak.



References


1) Kang, S. J. (2014). Trekking exercise promotes cardiovascular health and fitness benefits in older obese women. J Exerc Rehabil, 10(4), 225-229. doi:10.12965/jer.140110

2) Rodio, A., & Fattorini, L. (2014). Downhill walking to improve lower limb strength in healthy young adults. European journal of sport science, 14(8), 806-812.



 




Sistem imun badan dan demensia


18 November 2024 by SITI MARDHIANA BINTI MOHAMAD

Penyakit demensia

Demensia adalah istilah umum yang digunakan untuk merujuk kepada sekumpulan gejala yang berkaitan dengan penurunan fungsi kognitif yang cukup serius sehingga mengganggu aktiviti harian seseorang. Demensia bukanlah penyakit itu sendiri, tetapi sebaliknya, ia adalah tanda-tanda atau gejala yang boleh disebabkan oleh pelbagai penyakit dan keadaan.

 

Gejala utama demensia termasuk:

1. Kehilangan Ingatan: Kesukaran mengingat maklumat baru dan kehilangan ingatan tentang kejadian atau orang dalam hidup mereka.

2. Gangguan Fikiran dan Pemikiran: Kesukaran dalam merancang, menyelesaikan masalah, atau membuat keputusan.

3. Masalah Bahasa: Kesukaran dalam bercakap, memahami, atau menulis.

4. Kehilangan Kemahiran Motor dan Koordinasi: Kesukaran dalam melaksanakan tugas-tugas harian seperti berpakaian atau menggunakan peralatan.

5. Kekeliruan dan Disorientasi: Kesukaran mengenal pasti lokasi, masa, atau identiti orang lain.

6. Perubahan Perwatakan dan Mood: Perubahan dalam keperibadian, emosi, atau tingkah laku yang tidak biasa.

 

Terdapat beberapa jenis demensia iaitu:

1. Penyakit Alzheimer: Jenis demensia yang paling biasa, dicirikan oleh pembentukan plak amiloid dan benang neurofibrillary di otak, yang menyebabkan kehilangan sel otak.

2. Demensia Vaskular: Dihasilkan oleh gangguan aliran darah ke otak, sering akibat daripada strok atau masalah vaskular lain.

3. Demensia Lewy Body: Dikenali dengan kehadiran badan Lewy dalam sel otak, yang boleh menyebabkan gangguan dalam fungsi kognitif, pergerakan, dan halusinasi.

4. Demensia Fronto-temporal: Melibatkan kerosakan pada lobus frontal dan temporal otak, menyebabkan perubahan dalam keperibadian, tingkah laku, dan bahasa.

5. Penyakit Parkinson dengan Demensia: Dalam beberapa kes, orang dengan penyakit Parkinson boleh mengalami demensia sebagai sebahagian daripada keadaan mereka.

6. Demensia Campuran: Apabila seseorang mengalami lebih daripada satu jenis demensia, seperti penyakit Alzheimer dan demensia vaskular.

 

Demensia adalah keadaan yang progresif, yang bermaksud gejala-gejalanya akan menjadi semakin teruk dari masa ke masa. Walau bagaimanapun, rawatan dan intervensi dapat membantu memperlambat perkembangan gejala dan meningkatkan kualiti hidup individu yang terjejas.

 

Sistem Imun Badan

Sistem imun adalah jaringan kompleks yang melibatkan berbagai jenis sel, organ, dan protein yang bekerjasama untuk melindungi tubuh daripada penyakit dan jangkitan. Sistem ini berfungsi untuk mengenal pasti dan menyerang patogen seperti bakteria, virus, dan kulat, serta sel-sel yang rosak atau tidak normal.

 

Berikut adalah beberapa komponen utama sistem imun:

1.     Sel-Sel Imun: Ini termasuk sel-sel seperti limfosit (termasuk sel T dan sel B), makrofaj, dan neutrofil. Sel-sel ini bertindak untuk mengenali, menyerang, dan memusnahkan patogen dan sel-sel yang tidak normal.

2.     Organ-Imun: Organ-organ seperti limpa, kelenjar getah bening, dan timus memainkan peranan penting dalam menghasilkan dan menyimpan sel-sel imun, serta dalam pengawalan tindak balas imun.

3.     Antibodi: Protein ini dihasilkan oleh sel B dan berfungsi untuk mengikat dan meneutralkan patogen, serta menandai mereka untuk dihancurkan oleh sel-sel imun lain.

4.     Sistem Komplemen: Ini adalah kumpulan protein dalam darah yang membantu memusnahkan patogen dan merangsang tindak balas imun.

5.     Tisu dan Organ: Tisu seperti tonsil dan adenoid, serta organ-organ seperti hati, juga memainkan peranan dalam sistem imun dengan menghasilkan sel-sel imun dan mengawal tindak balas imun.

 

Sistem imun mempunyai dua komponen utama:

·       Sistem Imun Semula Jadi (Innate Immunity): Ini adalah pertahanan awal yang memberikan perlindungan umum terhadap patogen. Ia termasuk kulit, mukosa, dan beberapa jenis sel imun yang bertindak dengan cepat tetapi tidak khusus terhadap patogen tertentu.

·       Sistem Imun Adaptif (Acquired Immunity): Ini adalah pertahanan yang lebih khusus dan melibatkan limfosit T dan B. Sistem ini mengenali patogen tertentu dan memberikan perlindungan jangka panjang dengan memori imun, yang membolehkan tubuh bertindak lebih cepat jika patogen yang sama menyerang semula.

 

Sistem imun berfungsi secara berterusan untuk memastikan tubuh kekal sihat dan bebas daripada penyakit. Namun, kadang-kadang sistem imun boleh mengalami gangguan, seperti dalam penyakit autoimun, di mana sistem imun menyerang tisu tubuh sendiri, atau dalam imunodefisiensi, di mana sistem imun tidak berfungsi dengan baik. Terdapat juga bukti dalam bidang penyeldikan menunjukkan bahawa sistem imun juga mungkin memberi kesan yang lebih buruk daripada baik dalam penyakit demensia.

 

 

Hubung kait sistem imun dan penyakit demensia

Sistem imun dan demensia mempunyai hubungan yang kompleks dan saling berkaitan.

 

Berikut adalah beberapa aspek utama mengenai hubungan antara sistem imun dan demensia:

1. Keradangan: Dalam beberapa jenis demensia, seperti Alzheimer, terdapat peningkatan keradangan di dalam otak. Sistem imun, yang biasanya melindungi tubuh daripada jangkitan dan kerosakan, boleh menjadi terlalu aktif atau tidak berfungsi dengan baik, menyebabkan keradangan kronik yang boleh merosakkan sel-sel otak.

2. Penyakit Alzheimer: Dalam penyakit Alzheimer, sistem imun boleh memainkan peranan dalam pembentukan plak amiloid dan benang neurofibrillary, yang merupakan ciri utama penyakit ini. Sel-sel imun seperti mikroglia terlibat dalam proses ini, dan tindak balas imun yang tidak normal boleh menyumbang kepada kemerosotan kognitif.

3. Penuaan: Semasa penuaan, sistem imun sering mengalami penurunan fungsi, yang dikenali sebagai imunosenesens. Penurunan ini boleh mempengaruhi cara tubuh bertindak balas terhadap kerosakan dan jangkitan, serta mempengaruhi risiko dan perkembangan demensia.

4. Kesan Imun yang Salah: Kadang-kadang, sistem imun boleh menyerang tisu otak sendiri dalam keadaan autoimun, menyebabkan kerosakan dan menyumbang kepada perkembangan demensia.

5. Genetik dan Faktor Risiko: Penyelidikan menunjukkan bahawa faktor genetik dan risiko tertentu, seperti gen APOE ?4, boleh mempengaruhi bagaimana sistem imun berfungsi dan bagaimana ia berkaitan dengan demensia.

 

Secara keseluruhan, hubungan antara sistem imun dan demensia adalah kawasan aktif dalam penyelidikan, dan memahami bagaimana sistem imun mempengaruhi perkembangan demensia boleh membuka jalan kepada rawatan dan pencegahan yang lebih baik.

 

Cara mengatasi masalah sistem imun dalam penyakit demensia

Bagi mengatasi masalah sistem imun dalam penyakit demensia,ia melibatkan pendekatan dalam pelbagai aspek, kerana hubungan antara sistem imun dan demensia adalah kompleks.

 

Berikut adalah beberapa cara yang boleh membantu:

1. Rawatan dan Pengurusan Keradangan

2. Pengurusan Penyakit yang Berkaitan

3. Sokongan dan Terapi Kognitif

4. Penyelidikan dan Terapi Eksperimental

5. Gaya Hidup Sihat

6. Pencegahan Jangkitan

7. Rawatan Bersepadu

 

Setiap individu memerlukan pendekatan yang disesuaikan dengan keadaan spesifik mereka, dan bekerjasama dengan pasukan penjagaan kesihatan yang berpengalaman dalam demensia adalah penting untuk merancang rawatan yang sesuai.

Photo By Siti Mardhiana Binti Mohamad
Gambar menunjukkan bentuk otak manusia




References

1. National Institute on Ageing. What is Dementia? Symptoms, Types and Diagnosis. 

https://www.nia.nih.gov/health/alzheimers-and-dementia/what-dementia-symptoms-types-and-diagnosis

2. Mayo Clinic. Diseases and Condition.Dementia.

https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013








 




Precision Cancer Therapy - Boron Neutron Capture Therapy (BNCT)


18 November 2024 by YING CHEE KEAT



Introduction

Under the collaboration between the Advanced Medical & Dental Institute, Universiti Sains Malaysia, and the Osaka University Graduate School of Medicine, Japan, the author visited the Kansai Boron Neutron Capture Therapy (BNCT) Medical Center and the Institute of Integrated Radiation Research at Kyoto University (KURNS) in the summer of 2024. The author would like to share the latest techniques in precision cancer therapy developed at KURNS, Japan.


Photo By Kansai BNCT Medical Center
Figure 1: Visit to the Kansai BNCT Medical Center on June 19, 2024 (left to right: Kansai BNCT Medical Center Physicist Associate Prof.Dr. Naonori, Associate Prof. Dr. Kazumasa from Osaka University Graduate School of Medicine, the author from Advanced Medical and Dental Institute, Malaysia, Anna from Budapest Semmelweis University, Dr. Aliz from Budapest National Institute of Oncology and, Associate Prof. Dr. Sakata from Osaka University Graduate School of Medicine)


Boron Neutron Capture Therapy (BNCT) was first proposed by American physicist Gordon Locher in 1936, using neutron capture reactions to destroy cancerous tumors, four years after Sir James Chadwick discovered the neutron in 1932. Japan has made great progress in the development of BNCT, leading to significant advancements in the field today. BNCT, which uses a boron target bombarded by a neutron beam, kills cancer cells more precisely than conventional radiotherapy. This advanced technique provides another hope for end-stage cancer patients, especially those suffering from head and neck cancer.

The treatment of BNCT is positioned between chemotherapy and external particle therapy. It uses the nuclear reaction between boron and neutrons to selectively destroy cancer cells, providing safe and precise treatment modalities for cancer patients. Pre-administered boron compounds containing the stable isotope boron-10 are given to the patient and are selectively absorbed by the cancer cells. The cancer cells are then exposed to thermal neutron beams, causing a nuclear reaction with boron-10 as shown in the equation below. This reaction generates lithium nuclides and short-range alpha particles, with a range almost similar to the cell diameter, which destroy the cancerous cells from the inside while minimizing damage to surrounding normal tissues. [1-3]

10B5 + 1N0  -> [11B5]* -> 4He2 (aplha)+7Li3 + gamma            equation (1)

Photo By Pioneered by Japanese Brainpower
Figure 2: Boron neutron capture reaction generates lithium nuclides and short-range alpha particles (Source: Pioneered by Japanese Brainpower: New Horizons in Cancer Treatment - Boron Neutron Capture Therapy [3])



Neutron Source and Clinical Research

There are two methods for producing a neutron source for BNCT: reactor-based and accelerator-based. Accelerator-based sources have many advantages over reactor-based sources, such as being easier to handle, safer, having lower set-up costs, and being smaller in size, which allows for installation within hospitals. Additionally, the installation and maintenance of accelerators are easier than those of reactors, the neutron flux produced by the accelerator is much higher than that produced by the reactor because the efficacy of BNCT depends heavily on the ability to deliver sufficient boron to the cancer cells and tissues selectively [2-3]. Technological improvements in neutron sources and boron delivery are pivotal. The shift from reactor-based to accelerator-based neutron sources is a significant trend. Accelerator-based neutron sources have become more feasible due to advances in accelerator technology, offering a safer and more reliable alternative to nuclear reactors.

The Institute of Integrated Radiation Research at Kyoto University (KURNS) developed the world's first accelerator-based BNCT in 2009, in collaboration with Sumitomo Heavy Industries. KURNS had been conducting clinical research on BNCT using a research reactor since 1990. After successfully developing an accelerator neutron source using a cyclotron, the clinical study using this reactor-based system was stopped in the year 2018. Other than KURNS, reactor-based BNCT is also performed at the National Atomic Energy Commission in Argentina, the National Tsing Hua University in Taiwan [4]. Shifting from reactor-based BNCT to accelerator-based BNCT is highly recommended and promoted due to its many advantages.  At present, BNCT clinical studies are also being carried out in several countries, including the United States, the Netherlands, Germany, Italy, the Czech Republic, and Sweden. [2].

Photo By Ying Chee Keat
Figure 3 (a): Accelerator based of Neutron Source located in the KURNS, Osaka, Japan. The pictures were taken by the author visited the facilities on July 12, 2024.

Photo By Ying Chee Keat
Figure 3 (b): Reactor based of Neutron Source located in the KURNS, Osaka, Japan.

Kansai BNCT Medical Center

In 2018, the Kansai BNCT Medical Center, located in Osaka, Japan was completed. In 2020, Japan became the first country to approve BNCT for unresectable advanced or recurrent head and neck tumours, with coverage provided by the national insurance program, requiring patients to pay only 30% of the treatment cost. Clinical trials are ongoing for relapsed brain tumours and head and neck cancer in Kansai BNCT Medical Center. Researchers from Japan and many other countries are visiting the Kansai BNCT Medical Center for various types of research.

The author visited the Kansai BNCT Medical Center for two days in 2024 to observe the treatment operations under the Osaka University International Certificate Program (OUICP). During the first day, the author observed the entire treatment process for a patient with a recurrent neck tumour. BNCT requires only a single fraction, and the radiation time is approximately 40 to 60 minutes. The total treatment time can extend to two hours or more including the time needed for patient positioning and preparing. The patient must maintain their position during the beam time, which can be somewhat uncomfortable for the patient compared to conventional radiation therapy. However, the advantage of BNCT is that it only requires a single fraction, whereas conventional radiation therapy requires multiple fractions.

During the second visit, the author observed the weekly quality assurance (QA) of the BNCT irradiation system. Similar to conventional radiotherapy, the BNCT irradiation system must conduct daily, weekly, monthly, and yearly quality assurance to ensure safety, accuracy, and overall quality management. During the weekly QA, physicists perform dose measurements using gold wire. The gold wire is cut into square shapes and attached at three positions on the Perspex inside a water phantom. After the gold wire is irradiated by neutrons, the induced radioactivity is measured. Besides the gold wire, the physicists also demonstrated other types of dosimeters for different purposes, such as semiconductor detectors and Thermoluminescent Dosimeter (TLD) detectors. In the same visit, the author also observed the setup for patient positioning, mask making, CT simulation for target localisation, and treatment planning for the upcoming treatment. These procedures are also similar to those in conventional radiotherapy.

Photo By Ying Chee Keat
Figure 4: Physicist performing quality assurance of the BNCT irradiation system, the pictures were taken by the author visited the Kansai BNCT Medical Center on July 11, 2024



Conclusion

BNCT is a treatment method that combines radiation, nuclear physics, chemistry, biology, and medicine. It represents an emerging targeted therapy with promising results and acceptable toxicity in clinical studies. BNCT has many advantages, such as substantially less damage to normal tissues, applicability for recurrent cancer after radiotherapy, and a short treatment period with only a single fraction. At present, the BNCT treatment modality is used to treat malignant glioma and recurrent head and neck tumors in patients who have not responded to conventional treatment [5-8]. This treatment modality is also being investigated for other target cancers, such as lung cancer, liver cancer, breast cancer, metastatic disease, and more. More clinical trials are needed to evaluate the safety and efficacy of BNCT.

References


1.   Malouff TD, Seneviratne DS, Ebner DK, Stross WC, Waddle MR, Trifiletti DM, Krishnan S. Boron Neutron Capture Therapy: A Review of Clinical Applications. Front Oncol. 2021 Feb 26;11:601820. doi: 10.3389/fonc.2021.601820. PMID: 33718149; PMCID: PMC7952987.


2.   He, H., Li, J., Jiang, P. et al. The basis and advances in clinical application of boron neutron capture therapy. Radiat Oncol 16, 216 (2021). https://doi.org/10.1186/s13014-021-01939-7

3.    Pioneered by Japanese Brainpower: New Horizons in Cancer Treatment (Boron Neutron Capture Therapy)


4.   Sakurai, Y., Tanaka, H., Takata, T. et al. Advances in boron neutron capture therapy (BNCT) at kyoto university - From reactor-based BNCT to accelerator-based BNCT. Journal of the Korean Physical Society 67, 76–81 (2015). https://doi.org/10.3938/jkps.67.76

5.   Kankaanranta L, Saarilahti K, Makitie A, et al. Boron neutron capture therapy (bnct) followed by intensity modulated chemoradiotherapy as primary treatment of large head and neck cancer with intracranial involvement. Radiother Oncol. 2011;99(1):98–9.

6.  Kankaanranta L, Seppala T, Koivunoro H, et al. Boron neutron capture therapy in the treatment of locally recurred head-and-neck cancer: final analysis of a phase I/II trial. Int J Radiat Oncol Biol Phys. 2012;82(1):e67-75.

7.   Kimura Y, Ariyoshi Y, Shimahara M, et al. Boron neutron capture therapy for recurrent oral cancer and metastasis of cervical lymph node. Appl Radiat Isot. 2009;67(7–8 Suppl):S47–9

8.   Xu D, Zhang YC, Zhou QY, et al. Boron neutron capture therapy of cancers: principles and recent research progress. Chin J Radiol Med Prot. 2021;41(1):74–7.





Blood Transfusion Process: From Vein to Vein


04 December 2024 by SITI SALMAH BT NOORDIN

Blood transfusions are lifesaving medical procedures commonly used to replace blood lost due to surgery, injury, or illness. Although it is routine in medical settings, many people may feel anxious or uncertain about what happens during the process. In Malaysia, it is estimated about 2,000 blood bags are transfused daily.

Patients may receive different blood products depending on their specific medical needs. The most common blood product transfused is red blood cell (RBC), which is used to treat severe anaemia or massive bleeding. Meanwhile, platelet product is used to treat individuals with bleeding issue due to platelet problem, while plasma is usually administered to individual with blood clotting disorder.

The blood transfusion process can take place in a daycare or inpatient setting. In the daycare setting, the recipients usually have underlying chronic blood disorders that required regular blood transfusions, sometimes on a monthly basis, and possibly for life, as in the case of patients with thalassaemia major. These patients are generally stable and can return home after completing their transfusions. In the inpatient setting, transfusions are performed for hospitalised patients. Overview of the blood transfusion process is shown in Figure 1.

Photo By Siti Salmah binti Noordin
Figure 1: Overview of blood transfusion process

Before the Transfusion: Consent and Pre-Transfusion Testing

Prior to any blood transfusion, informed consent will be obtained from the patient by the doctor in charge. During this process, the doctor will explain the indications, risks, and potential complications related to the blood transfusion. The patients must sign the informed consent form to indicate their agreement for blood transfusion.

Once the informed consent is obtained, a blood sample will be drawn from the patient. In a fully conscious patient, the phlebotomist will confirm the patient's identity by asking them to state their full name and identification card number before labelling the blood sample tube. Therefore, it is essential for the patient to clearly state their full name and identification number and address any potential issues with name spelling (Figure 2).

Photo By https://www.utmb.edu/health-resource-center/two-forms-of-identification
Figure 2: Similar name but different date of birth (DOB)

The blood sample will be sent to the blood bank laboratory for pre-transfusion testing. The tests include are the determination of the patient's ABO and RhD blood group - whether A, B, AB, or O, and RhD positive or RhD negative. In addition to ABO and RhD blood grouping, if the patient requires an RBC transfusion, the sample will also be tested for the presence of any unexpected RBC antibodies (antibody screening) and crossmatched with the donor's blood. Crossmatching is important to determine the compatibility between the patient’s and donor’s blood. However, for platelet and plasma transfusions, antibody screening and crossmatching are usually not performed.

Following the pre-transfusion testing, the requested blood product will be issued to the ward or to the inpatient staff.

Before transfusion: Intravenous Line and Patient Identifications

A suitable intravenous (IV) line will be inserted into the patient before the blood product administration. In addition, the doctor will verify the blood bag and will reconfirm the patient's identity to ensure that the correct blood product is transfused to the correct patient. This identification check is typically performed by two healthcare personnel, such as a doctor and a staff nurse.

During Blood Transfusion: What Happens When You Receive Blood

Blood transfusion administration takes approximately 1 to 4 hours, depending on the volume and types of the blood products. Throughout the procedure, the patient's vital signs will be monitored, and any clinical signs of adverse transfusion reactions will be assessed (Figure 3).

Photo By Image generated by Bing Ai
Figure 3: Blood administration

Symptoms of adverse transfusion reactions may include itchiness, rashes, chills, fever, nausea, vomiting, or difficulty in breathing. These reactions could be caused by allergens or proteins in the blood products that may provoke an allergic reaction, passively transfused cytokines in the blood bag that may cause febrile non-haemolytic transfusion reaction, or by the presence of RBC antibodies, thay may cause haemolytic transfusion reaction. If any signs or symptoms occur, the transfusion will be stopped immediately, and appropriate treatment will be administered.

After the Transfusion: Recovery and What to Expect

After the blood transfusions, the patient will be monitored for a period of time to ensure they do not develop any signs and symptoms of transfusion reactions. In addition to acute reactions, delayed transfusion reactions may also occur, such as delayed haemolytic transfusion reaction (DHTR), which is due to the presence of RBC antibodies that may not have been detectable during the pre-transfusion testing. However, DHTR is rare. Symptoms of DHTR may include yellowish skin discolouration, a drop in haemoglobin levels, muscle or joint pain, and fever

Typically, a single unit of RBC transfusion will increase the patient's haemoglobin level by about 1 g/dL, with anaemia symptoms improving within 24 hours post-transfusion. For platelet transfusion, a single unit of random platelet transfusion will increase the patient's platelet count by 5 to 10 x 109/L. For plasma transfusion, an improvement in clotting tests is usually observed, with clotting factors may increasing by approximately 30%.

While blood transfusions are lifesaving procedures, it is essential to establish appropriate transfusion indications and adhere to safety protocols to minimise the risk of errors or adverse events, ensuring the best possible care for the patient.

 

References:

  1. Transfusion Practices Guidelines for Clinical and Laboratory Personnel. National Blood Centre, Ministry of Health. 4th edition. 2016
  2. Ling LM, Hui TS, Tan AK, Ling GS. Determinants Of Blood Donation Status in Malaysia: Profiling The Non-Donors, Occasional Donors And Regular Donors. Kajian Malaysia: Journal of Malaysian Studies. 2018 Jan 1;36(1)




Gum Bleeding: Beyond dental problems


03 December 2024 by SITI SALMAH BT NOORDIN

Most of us have experienced gum bleeding at some point in our lives, and while we may tend to ignore it - especially if it’s painless and doesn’t interfere much with daily activities – it should never be dismissed. While occasional gum bleeding can resolve on its own, persistent or profuse bleeding could indicate underlying health concerns that go beyond dental issues. Gum bleeding, medically referred to as gingival hemorrhage, occurs when the gum tissue surrounding the teeth bleeds. This can happen for various reasons, many of which are related to both oral hygiene and systemic health conditions. In addition to common dental health causes, such as periodontal disease and poor oral hygiene, gum bleeding may also be linked to systemic disorders, medications, and nutritional deficiencies.


Causes of Gum Bleeding: Beyond dental problems

1.Vitamin Deficiencies: Nutritional deficiencies, particularly in vitamin C and vitamin K, can weaken gum health and lead to bleeding. Vitamin C is essential for collagen production and gum repair, while vitamin K is crucial for blood clotting. A well- balanced diet rich in fruits, vegetables, and whole grains is key to maintaining healthy gums.

2.Medications: Certain medications, especially blood thinners (e.g., anticoagulants like warfarin or heparin), can increase the risk of bleeding. Additionally, some pain relievers, such as aspirin, can also affect blood clotting. If you're taking medications that could impact your gum health, it’s important to discuss them with your healthcare provider.

3.Systemic Conditions: Several health conditions, often overlooked, can lead to gum bleeding. Some notable conditions include: 

    i.Blood Disorders: Conditions such as thrombocytopenia (low platelet count), platelet disorders (e.g.,  Bernard-Soulier syndrome), and blood clotting disorders (e.g., hemophilia, von Willebrand disease) can     cause easy bleeding, including from the gums. These conditions require thorough investigation and management by healthcare professionals. Additionally, blood cancers like leukemia can impact blood cell     production, leading to symptoms like gum bleeding, easy bruising, or petechial rashes.

    ii.Liver Disease: The liver produces clotting factors essential for proper blood coagulation. Any liver dysfunction can disrupt this process, leading to a bleeding tendency, where even minor injuries or irritations     can cause significant bleeding.

    iii.Autoimmune Diseases: Autoimmune disorders, where the immune system mistakenly attacks own healthy cells, can also affect gum health. Conditions like idiopathic thrombocytopenic purpura (ITP) and     systemic lupus erythematosus (SLE) may cause bleeding gums along with other systemic symptoms, necessitating a comprehensive medical evaluation.

What Should You Do If Your Gums Are Bleeding? 

 If you notice persistent gum bleeding, consider taking the following steps:

1.Improve Your Oral Hygiene: Prioritize regular brushing and flossing. Use a soft-bristled toothbrush to avoid irritating the gums. You may also consider incorporating an antibacterial mouthwash to help reduce plaque buildup.

2.Consult a Dentist: Schedule an appointment with a dental professional to determine the cause of the bleeding. A dentist can assess your oral health, address any dental issues, and refer you to a medical specialist if systemic disorders are suspected.

3.Watch Your Diet: Adopt a well-balanced and nutritious diet. Make sure you're getting sufficient vitamins, especially vitamin C and vitamin K, which are essential for gum health. Incorporate foods like citrus fruits, leafy greens, and whole grains into your meals. 

4.Review Your Medications: If you're taking blood thinners or other medications that could cause bleeding, discuss your treatment plan with your doctor. They may adjust your medications or suggest alternatives. Avoid purchasing over-the-counter medications without consulting your healthcare provider first. 

5.Seek Medical Advice for Systemic Symptoms: If gum bleeding is accompanied by other symptoms, such as unusual bruising, fatigue, frequent infections, or unexplained weight loss, it’s important to see a healthcare provider. These could indicate a more serious underlying health issue that requires attention. Don’t hesitate to seek help - ignoring these signs could lead to more severe complications. 

In summary, gum bleeding should never be ignored. By understanding its potential causes - ranging from simple oral issues to serious systemic disease - and knowing the steps to take, you can protect both your oral and overall health. If in doubt, always consult a healthcare professional. After all, it’s better to be safe than sorry!


References:

1) Hoffbrand V, Collins G, Loke J. Hoffbrand's essential haematology. John Wiley & Sons; 2024;9th ed.

2) Dan Brennan. Bleeding Gums and Your Health. 2023.  https://www.webmd.com/oral-health/bleeding-gums-other-conditions




The Wonders of Our Immune System: Nature’s Remarkable Defense


03 December 2024 by SITI SALMAH BT NOORDIN
The human immune system is nothing short of ordinary. It functions like an invisible shield, protecting us from countless germs, viruses, and even rogue cells that could turn into diseases such as cancer (Figure 1). This remarkable defense system has fascinated scientists for centuries. Early civilizations noticed that people who survived certain diseases rarely contracted them again. What makes the immune system truly remarkable isn’t just its complexity; it’s also its intelligence and adaptability.

Two Levels of Defense: A Dual-Wonder System
The immune system is a “team effort,” with two major groups working together to protect our bodies: innate immunity and adaptive immunity.
i. Innate Immunity: This is the body’s first line of defense, acting immediately after the physical barrier of skin or mucosa is breached. It includes immune cells like macrophages and dendritic cells (Figure 2a). The term "innate" reflects that this system is found in all animals. Some components of the innate immune system, such as macrophages, have existed for over 500 million years! In fact, the way macrophages ingest invaders is a refined version of the feeding process used by amoebas for about 2.5 billion years - showing that certain immune mechanisms have ancient roots.
ii. Adaptive Immunity: This system provides a more tailored defense. When a new germ enters the body, adaptive immunity takes longer to react, but it creates a highly targeted response. B cells and T cells are key players in this process, capable of adapting to nearly any invader (Figure 2b). While many animals rely on natural barriers and innate immunity alone, vertebrates like humans have this additional, specialized defense. The concept of adaptive immunity became clearer in the late 1700s, when Edward Jenner developed the first smallpox vaccine by exposing a young boy to cowpox, a virus related to smallpox. Jenner’s work showed that exposure to a mild pathogen could protect against a more deadly one, laying the foundation for modern vaccination. This legacy lives on in the word "vaccine," which comes from "vacca," the Latin word for cow.


Immune Memory: A Marvel of Learning and Remembering
One of the immune system’s most remarkable features is its ability to remember. After encountering a pathogen for the first time, the immune system "remembers" how to fight it, providing lasting immunity. This memory response, which is the basis of how vaccines work, was first demonstrated in the 1880s when Louis Pasteur created vaccines for rabies and anthrax, laying the groundwork for immune memory in medicine.
Both the innate and adaptive immune systems have their own forms of memory. The innate immune system’s memory is "hard-wired," relying on pattern recognition receptors that evolved over millions of years. In contrast, adaptive immunity creates a more personalized memory through B and T cells, which learn from each unique exposure during a person’s life. This makes adaptive immune memory highly specific and unique to everyone.

Imagine the immune system as a vast library, constantly updating its catalog of pathogens and storing detailed instructions on how to defeat each one. This "library" is always on standby, ready to defend the body whenever needed.

A Beautiful Distinction: Self vs. Not-Self
While the immune system's memory is awe-inspiring, its ability to distinguish "self" from "non-self" is just as crucial. Every cell in our body carries markers - like little ID cards - that signal it belongs to us. Any cell without these markers is flagged as a potential invader.

In the early 20th century, scientists like Paul Ehrlich helped shape the "self vs. non-self" principle, which remains a cornerstone of immunology. Though the immune system is usually precise in its recognition, mistakes can occur. When the immune system attacks its own cells, autoimmune diseases such as lupus or rheumatoid arthritis can develop. Our understanding of “self” recognition has also played a critical role in transplantation science, helping to develop strategies to prevent organ rejection.

Cancer Defense: The Immune System’s Secret Surveillance
A lesser-known but equally remarkable aspect of the immune system is its ability to prevent cancer through immune surveillance. Certain immune cells are constantly on the lookout for abnormal cells, identifying and destroying them before they can grow and spread. In the 1970s, scientists began investigating how immune cells recognize and eliminate cancer cells—a discovery that ultimately led to the development of immunotherapy treatments. These treatments boost the immune system's natural ability to target and fight cancer, offering new hope for diseases that have been difficult to treat.

This surveillance system that catches harmful cells before they can take hold is another testament to the immune system’s intelligence and adaptability.

The Future of Immunity: New Frontiers
Scientists continue to uncover new aspects of the immune system. Recently, researchers have been studying the gut microbiome—the trillions of bacteria in our digestive system—to understand how it influences immune function. In addition, groundbreaking treatments like gene editing and personalized immune therapies are on the horizon, potentially offering breakthroughs for chronic diseases and cancers.

Conclusion: A Constant Guardian
Our immune system is truly one of the body’s greatest wonders. Its ability to adapt, remember, protect, and even heal wounds makes it a vigilant guardian of our health. Despite occasional overreactions or mistakes, its resilience and intelligence are awe-inspiring.
From the early observations of healers to the discoveries of modern immunology, our understanding of this system has evolved, revealing layer upon layer of complexity. Supporting our immune system through healthy lifestyle choices and appreciating its remarkable functions can help us live longer, healthier lives. So, the next time you experience a sneeze or sniffle, remember that your immune system is hard at work, performing extraordinary feats every day to keep you safe.


References:

1.Sompayrac LM. How the immune system works. John Wiley & Sons; 2022.

2.Abbas AK, Lichtman AH, Pillai S. Basic immunology: functions and disorders of the immune system. Elsevier Health Sciences; 2015.

3.Hausmann E. The Song of the Cell. The Story of Life Siddhartha Mukherjee. 2024.





Platelet Transfusion


03 December 2024 by SITI SALMAH BT NOORDIN
What Are Platelets?
Platelet is the smallest blood cell in our body, typically measuring 2-3 µm in diameter, which is about one fourth the size of red blood cells (RBC). Platelets are derived from megakaryocytes, which are produced in the bone marrow. Their production is regulated by thrombopoietin, a glycoprotein hormone predominantly produced by the liver (95%), as well as the kidney and bone marrow. An estimated 1011 platelets are produced daily and released into the bloodstream, with a lifespan of 8 to 10 days. The typical range of circulating platelets in adults is between 150 × 109/L and 450 × 109/L. Platelets play a crucial role in primary hemostasis after exposure to the subendothelial extracellular matrix, particularly collagen, following vessel wall damage. Once activated, platelets secrete mediators that facilitate platelet aggregation and the coagulation cascade.

Preparation of Platelet Products
Platelet concentrates can be prepared from whole blood or apheresis collection.
1. Whole blood-derived platelets (referred to as random platelet concentrates):
      One unit typically contains > 60 x 109 platelets, with a volume of approximately 50–70 mL.
One unit of random platelet concentrates can increase the platelet count by 5–10 x 109/L in a 70 kg adult.
An adult therapeutic dose typically requires 4 to 6 units of random platelet concentrate.
2. Apheresis platelets (plateletpheresis):
One unit of apheresis platelets contains 200 x 109 platelets and can increase the platelet count by 20–40 x 109/L in a 70 kg adult.
One unit of plateletpheresis is sufficient to provide one adult therapeutic dose.
Plateletpheresis is generally preferred when there is a need to limit exposure to multiple donors, such as in immunosuppressed patients or those with a history of allergic transfusion reactions.

Platelet Storage Requirements
Platelet concentrates must be stored at room temperature (20–24°C) in a platelet agitator to allow oxygenation and prevent platelet activation and clumping before transfusion to a patient. They should not be refrigerated or placed on ice to maintain their hemostatic function. As a result, platelet products have a higher risk of bacterial contamination compared to other blood components. The expiry date for platelet components is only 5 days after collection, often leading to issues with platelet shortages.

Indications for Platelet Transfusion
Platelet transfusion is primarily indicated to treat or prevent bleeding in cases of thrombocytopenia (low platelet count) or platelet function disorders. In hematological malignancies, platelet transfusion is indicated when the platelet count is below 10 x 109/L, except in certain conditions, such as fever, bleeding, or coagulopathy. If the patient requires chemotherapy or bone marrow aspiration and trephine (BMAT), the platelet count should be above 20 x 109/L.

In cases of acute bleeding, trauma, disseminated intravascular coagulation (DIC), or patients undergoing minor surgery or invasive procedures (e.g., lumbar puncture, oesophagogastroduodenoscopy (OGDS), or biopsy), the platelet count should be maintained to at least 50 x 109/L.
For patients with intracerebral, pulmonary, or ophthalmic hemorrhages, or those undergoing critical-site surgeries (e.g., eye, brain, or epidural procedures), platelet transfusion is indicated when the platelet count falls below 100 x 109/L.

Certain conditions contraindicate platelet transfusion, such as thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and heparin-induced thrombocytopenia (HIT), as transfused platelets can exacerbate the condition. In these disorders, thrombi consume the transfused platelets, increasing the risk of thrombosis at critical sites. Platelet transfusion is also controversial in autoimmune thrombocytopenic purpura (ITP) and post-transfusion purpura (PTP), as transfused platelets are rapidly cleared by circulating antibodies, providing no clinical benefit.
Platelet transfusion in patients with renal disease (e.g., creatinine >265 µmol/L) is also controversial because transfused platelets may acquire the same metabolic and uremic defects causing platelet dysfunction. In these cases, platelet transfusion may be beneficial only during life-threatening bleeding.

Key Considerations for Platelet Transfusion
The decision to transfuse platelets must balance the potential benefits and risks. Repeated platelet transfusions can lead to platelet refractoriness, where the post-transfusion platelet count does not increase as expected. This occurs due to the development of antibodies against the human platelet antigen (HPA) or human leukocyte antigen (HLA), which destroy both patient and donor platelets. In such cases, HPA/HLA-compatible platelet transfusion or platelet crossmatching is recommended.
ABO-identical platelet transfusion is preferable to avoid the risk of alloimmunization due to the possible presence of PBC. However, it can be challenging for transfusion services to provide ABO-identical platelets to all patients due to the limited availability of platelet stock.



References

1. Handbook on Clinical Use of Blood. National Blood Centre, Ministry of Health, Malaysia. 3rd edition. 2020.

2. Agarwal A, Khan AI, Anwer F. Platelet transfusion. StatPearls Publishing. InStatPearls [Internet] 2024. https://www.ncbi.nlm.nih.gov/books/NBK560632/.

3. Dunbar NM. Does ABO and RhD matching matter for platelet transfusion?. Hematology 2014, the American Society of Hematology Education Program Book. 2020;2020(1):512-7.





Kultur Sel di Era Moden: Mengubah Landskap Perubatan dan Penyelidikan


05 December 2024 by NURDIANAH BINTI HARIF FADZILAH

Pengenalan 

Kultur sel atau cell culture merujuk kepada proses membiakkan sel dalam persekitaran buatan yang dikawal dengan teliti. Teknik ini telah menjadi asas kepada kebanyakan penyelidikan saintifik dalam bidang perubatan dan biologi, sejak lebih 100 tahun lalu. Kultur sel adalah kaedah yang sangat penting dalam kajian awal dan rawatan penyakit (Cox, 2023). Sel pertama yang telah berjaya dikultur pada awal tahun 1900-an adalah hasil kajian oleh saintis Amerika, iaitu G. Ross Harrison. Kajian beliau menunjukkan kemampuan untuk menghidupkan tisu haiwan di luar organisma menggunakan embrio katak. Kejayaan berkenaan telah membuka laluan kepada lebih banyak penemuan berkaitan kultur sel (Virology Research Services, 2024). Penemuan sel HeLa di Hospital Johns Hopkins pada tahun 1950-an menjadi batu loncatan penting dalam bidang ini. Sel HeLa adalah sel kanser manusia yang boleh membiak tanpa batasan, dan berasal dari wanita bernama Henrietta Lacks. 


Kemajuan Teknologi Kultur Sel dalam Era Moden

Kemajuan teknologi kultur sel dalam era moden telah membawa perubahan besar dengan cara penyelidikan dijalankan, terutama dalam memahami penyakit dan mengembangkan rawatan yang lebih berkesan. Pada peringkat awal, sel biasanya dikultur dalam lapisan dua dimensi (2D) di atas permukaan plastik atau kaca, tetapi kini teknologi kultur 3D menjadi amalan biasa. Teknologi kultur sel 3D telah diperkenalkan dan kini semakin banyak digunakan dalam penyelidikan moden. Kultur sel 3D ini menawarkan simulasi yang lebih tepat bagi persekitaran semulajadi sel di dalam tisu, meningkatkan ketepatan dalam kajian penyakit serta pembangunan rawatan (Habanjar et al., 2021). Biopercetakan 3D adalah salah satu inovasi terbesar dalam bidang ini, di mana tisu boleh dibina di atas lapisan demi lapisan yang menyerupai struktur sebenar dalam badan manusia. Teknologi ini bukan sahaja membantu dalam pengujian vaksin dan ubatan, tetapi juga berupaya mengurangkan kebergantungan terhadap ujian haiwan.

Photo By Saydé et al., 2021
Rajah 2: 2D vs. 3D kultur sel


Aplikasi dalam Perubatan dan Penyelidikan Masa Depan

Aplikasi kultur sel dalam bidang perubatan dan penyelidikan terus berkembang dengan pesat, membuka jalan kepada pelbagai inovasi rawatan yang berpotensi menyelamatkan nyawa serta meningkatkan kualiti hidup. Sel stem pluripoten, yang mampu berkembang kepada pelbagai jenis sel di dalam tubuh, kini dikultur untuk merawat penyakit degeneratif seperti penyakit Parkinson dan Alzheimer serta memperbaiki tisu yang rosak (Ford et al., 2020). Teknologi masa depan seperti organ-on-a-chip, di mana organ kecil dicipta pada cip mikro, berpotensi mengubah cara penyelidik menguji penyakit dan ubatan (Ingber, 2022). Dengan adanya organ miniatur ini, para penyelidik dapat menjalankan ujian terhadap penyakit dan ubatan dengan lebih tepat dalam persekitaran yang menyerupai keadaan fisiologi manusia. Ini akan mengurangkan keperluan untuk penggunaan haiwan sebagai subjek ujian, serta dapat mempercepatkan proses pembangunan ubatan memandangkan data yang diperoleh adalah lebih relevan kepada manusia. Sebagai kesimpulan, penyelidikan masa depan akan terus meneroka kaedah alternatif berkaitan kultur sel, seperti media kultur yang berasaskan tumbuhan atau protein rekombinan.

Photo By Ingber, 2022
Rajah 3: Contoh reka bentuk cip organ mikrobendalir

Rujukan:

Cox E. Performing HeLa: theatrical bodies and living remains. Medical Humanities. 2023;49(3):447-56.

Ford E, Pearlman J, Ruan T, Manion J, Waller M, Neely GG, Caron L. Human pluripotent stem cells-based therapies for neurodegenerative diseases: current status and challenges. Cells. 2020;9(11):2517.

Habanjar O, Diab-Assaf M, Caldefie-Chezet F, Delort L. 3D cell culture systems: tumor application, advantages, and disadvantages. International journal of molecular sciences. 2021;22(22):12200.

Ingber DE. Human organs-on-chips for disease modelling, drug development and personalized medicine. Nature Reviews Genetics. 2022;23(8):467-91.

Saydé T, El Hamoui O, Alies B, Gaudin K, Lespes G, Battu S. Biomaterials for three-dimensional cell culture: From applications in oncology to nanotechnology. Nanomaterials. 2021;11(2):481.

Tang, J. Papillomaviruses. Molecular Virology of Human Pathogenic Viruses. 1st ed. Elsevier; 2017. p. 97-109. doi:10.1016/B978-0-12-800838-6.00007-2

Virology Research Services. (2024). What is cell culture, and how has it evolved? | VIROLOGY RESEARCH SERVICES. Virologyresearchservices.com. https://virologyresearchservices.com/2024/07/07/what-is-cell-culture-and-how-has-it-evolved/





Pre-Deposit Blood Donation: A Lifesaver Before Surgery


04 December 2024 by SITI SALMAH BT NOORDIN

Pre-deposit autologous donation (PAD) is a process in which patients donate their own blood before elective surgery, where significant blood loss is anticipated, such as in major orthopaedic, vascular, cardiac or thoracic surgery2.


PAD is typically indicated for patients with rare or multiple red blood cells antibodies that make crossmatching with allogenic blood difficult. It is also performed for patients whose religious beliefs prohibit allogenic transfusions. The donated blood is transfused only to the intended patient, reducing the risk of adverse transfusion reactions such as alloimmunisation and transfusion-transmitted infections. Furthermore, PAD provides fully compatible blood for patients with alloantibodies, offers reassurance to patients concerned about blood transfusion risks, and may also help conserve blood resources3.


Blood collection in PAD occurs three to five weeks before the planned surgical procedure. If more than one unit is required, donations can be made every seven days, and as frequently as every three days, up to 72 hours before surgery. The maximum number of units that can be collected is five. If the surgery is postponed, transfusion using the oldest autologous blood can be made and fresh blood can be collected3.


The treating doctor will determine the amount of blood to be collected and, consequently, the number of units required. The patient will be counselled by the treating doctor about PAD procedure and the risk that their donated blood may be discarded if unused. The patient must provide informed consent before donating blood. Subsequently, the doctor will issue a referral letter to the Blood Bank doctor for the donation process1,3.


The patient’s pre-donation haemoglobin level must be at least 11 g/dL for both men and women. Iron supplements, preferably administered via the intravenous route, should be prescribed before the first donation, and haemoglobin levels should be monitored before each subsequent donation to ensure they remain above 11 g/dL1,2,3.


Once the blood has been withdrawn from the patient, it will be tested for routine blood investigations, including ABO and RhD grouping, antibody screening, and transfusion microbiology screening (testing for HIV, hepatitis B, hepatitis C, and syphilis). If the blood tests positive for any microbiological agent, the PAD programme will be terminated. If the blood is non-reactive, it will be labelled with a green tag, and a tag stating "For autologous use only" will be attached to the blood bag. The blood bag will then be stored on a dedicated shelf or in a fridge within the Blood Bank to prevent it from being mixed with other blood bags in the inventory1,2.


The treating doctor must inform the Blood Bank and send the blood request form on the day of the operation so that the donated blood can be released to the patient. If the blood bag is not used, it will be discarded, leading to wastage1,2,3.


PAD collection is contraindicated in patients with certain underlying medical conditions, such as seizures, active systemic infections, a history of serious reactions to donations, and heart disease. Additionally, patients who test positive for infectious diseases, such as hepatitis B, hepatitis C, HIV, or other relevant infections, are not eligible for PAD1,4.


Currently, there is a reduced demand for PAD due to the availability of medications to treat anaemia and alternative techniques to conserve the patient’s own blood during surgery, such as blood salvage machine. However, PAD remains a valuable option in special cases where other approaches are insufficient4.


References:
1.Howard, Paula R.. (2017). Basic and Applied Concepts of Blood Banking and Transfusion Practices 5th Edition (5). Missouri: Elsevier Limited.
2.Harmening, Denise M.. (2019). Modern Blood Banking and Transfusion Practices (7). Philadelphia: F.A Davis.
3.Handbook on Clinical Use of Blood. National Blood Centre, Ministry of Health, Malaysia. 3rd edition. 2020.
4.Lynne Uhl, MD (2024). Surgical blood conservation: Preoperative autologous blood donation. UpToDate. https://www.uptodate.com/contents/surgical-blood-conservation-preoperative-autologous-blood-donation






Potensi Penggunaan Tokotrienol sebagai Terapi Baharu untuk Kesakitan disebabkan Kanser Tulang Metastatik


03 December 2024 by SHARLINA BINTI MOHAMAD

Pengenalan

Kanser tulang metastatik adalah komplikasi serius bagi pesakit kanser, terutamanya mereka yang menghidap kanser payudara, prostat, atau paru-paru. Ia berlaku apabila sel-sel kanser merebak ke tulang, menyebabkan kerosakan serius seperti patah tulang, kesakitan kronik, dan penurunan kualiti hidup.

 Walaupun terapi sedia ada seperti bifosfonat dan radioterapi membantu mengawal simptom, ia sering disertai dengan kesan sampingan yang signifikan dan kos yang tinggi. Dalam usaha mencari alternatif yang lebih baik, tokotrienol, sejenis vitamin E, berpotensi dijadikan sebagai agen terapeutik (Aggarwal & Sung, 2009; Nesaretnam et al., 2012). 

Apa itu Tokotrienol dan Keunikannya

Vitamin E terdiri daripada dua kumpulan utama: tokoferol dan tokotrienol, dengan empat isoform dalam setiap kumpulan (alpha, beta, gamma, dan delta). Tokotrienol, yang boleh didapati dari sumber semula jadi seperti kelapa sawit, beras, dan annatto, dikatakan mempunyai aktiviti antioksidan dan antiradang yang lebih tinggi berbanding tokoferol (Kannappan et al., 2012; Lee et al., 2020). 

Keunikan tokotrienol terletak pada strukturnya yang membolehkan ia menembusi membran sel dengan lebih cekap. Kajian juga menunjukkan bahawa tokotrienol lebih berkesan dalam menyasarkan sel kanser tanpa merosakkan sel normal, menjadikannya sesuai untuk terapi kanser yang lebih selamat (Aggarwal & Sung, 2009; Yu & Simmons-Menchaca, 2005). 

Tokotrienol dalam Rawatan Kanser Tulang

Beberapa penyelidikan telah menunjukkan bahawa tokotrienol mampu memberikan kesan terapeutik melalui pelbagai mekanisme, termasuk:

i)               Menghalang Pertumbuhan Sel Kanser

Tokotrienol mengganggu laluan isyarat penting dalam sel kanser, seperti STAT3 dan NF-kB, yang terlibat dalam pertumbuhan hidup sel-sel kanser (Kannappan et al., 2012). 

ii)             Mengurangkan Kesakitan yang disebabkan Kanser

Tokotrienol didapati mengawal ekspresi gen yang berkaitan dengan kesakitan seperti CGRP dan Substance P, sekali gus mengurangkan kesakitan yang dialami oleh pesakit (Aggarwal & Sung, 2009).  

iii)           Meningkatkan Ketahanan Tulang

Tokotrienol membantu mengurangkan aktiviti osteoklas yang menyebabkan tulang rapuh, serta menyokong pembentukan semula tulang (Lee et al., 2020). Kajian kami pula mendapati tokotrienol memodulasi laluan RANKL/RANK/OPG dalam model tikus, yang penting untuk keseimbangan pembentukan dan resorpsi tulang (Baharuddin et al., 2023).

 

Potensi Tokotrienol dalam Terapi Klinikal

Tokotrienol bukan sahaja menjanjikan keberkesanan, tetapi turut mempunyai kelebihan lain termasuk:

i)               Kos yang Lebih Rendah: Sumber tokotrienol seperti minyak sawit adalah murah dan mudah diperoleh, menjadikan rawatan lebih mampu milik (Lee et al., 2020).

ii)             Kesan Sampingan yang Minima: Tokotrienol lebih selektif terhadap sel kanser, mengurangkan risiko toksisiti terhadap tisu normal (Kannappan et al., 2012).

iii)           Penghantaran tokotrienol juga boleh dipertingkatkan menggunakan teknologi moden seperti mesoporous silica nanoparticles (MSNs). Pendekatan ini membolehkan penghantaran ubatan yang disasarkan, meningkatkan keberkesanan rawatan sambil mengurangkan dos dan kesan sampingan (Yu & Simmons-Menchaca, 2005).

 

Kesimpulan

Tokotrienol menawarkan harapan baru dalam rawatan kanser tulang metastatik. Dengan keberkesanannya dalam mengurangkan kesakitan dan melindungi tulang, ia berpotensi untuk melengkapi atau menggantikan terapi sedia ada.

Kajian tentang potensi tokotrienol perlu diteruskan dan kerjasama antara saintis, doktor, dan pihak industri perlu diterapkan untuk merealisasikan penggunaannya dalam rawatan klinikal.

 

Rujukan

1.Aggarwal, B. B., & Sung, B. (2009). Tocotrienols: Molecular targets and therapeutic potential. Frontiers in Bioscience, 14, 1957–1971.

2.Baharuddin, N. S., Nasir, N. S., Mansor, M. S., Shahpudin, S. N. M., Saifuddin, S. N., & Mohamad, S. (2023). Vitamin E action on bone signaling pathways, RANKL/RANK/OPG in a rat model of breast cancer-induced bone pain: Received 2023-01-12; Accepted 2023-03-15; Published 2023-06-06. Journal of Health and Translational Medicine (JUMMEC), 9-22.

3.Lee, K. H., Lee, D. E., & Ko, J. Y. (2020). Advances in tocotrienol research: A promising natural compound for cancer prevention and therapy. Critical Reviews in Food Science and Nutrition, 60, 189–206.

4.Nesaretnam, K., Gomez, P. A., & Palanisamy, U. D. (2012). Tocotrienols and cancer: Beyond antioxidant activity. Molecules, 17, 2229–2245.

5.Kannappan, R., Gupta, S. C., Kim, J. H., & Aggarwal, B. B. (2012). Tocotrienols fight cancer by targeting multiple cell signaling pathways. Genes & Nutrition, 7, 43–52.

6.Yu, W., & Simmons-Menchaca, M. (2005). Differential signaling pathway regulation by tocotrienols and tocopherols in mammalian cells. Annals of the New York Academy of Sciences, 1055, 110–117.




Thalassemia through time: The cure is here, prevention remains key


02 December 2024 by NUR ARZUAR BIN ABDUL RAHIM

                           Dr. Adilah Zulkifli                                            Dr. Nur Arzuar Abdul Rahim


Early Days but Still Relevant: Blood Transfusions and Iron Chelation Therapy
Thalassemia is the most common inherited blood disorder and is an important public health problem in Malaysia. Infants with thalassemia major experience health problems around 3 to 6 months of age due to severe anaemia, poor weight gain and enlargement of abdominal organs such as the liver and spleen. The treatment of thalassemia in the early days but still relevant today is regular blood transfusions and iron chelation therapy. Chelation therapy prevents iron overload, a common side effect of frequent transfusions, while blood transfusions help control anaemia. Access to effective iron chelation therapy has significantly increased life expectancy, with some patients living into their 60s. This is a significant improvement, as previously, thalassaemia patients would often die in their teens due to heart failure.

Screening and Prevention
In 2004, Malaysia initiated a national Thalassaemia Prevention and Control Programme to decrease the incidence of severe thalassaemia and its associated complications. This programme involved mass public education campaigns, public awareness, and health education1. Concerned by the alarming statistics of one carrier in every 20 Malaysians, the Ministry of Health Malaysia initiated screening programs in 2008 with the goal of reducing the number of babies born with thalassemia2. The screening initiatives at the start targeted mainly the family members of thalassemia major patients (cascade screening) and antenatal women. The screening initiatives also included the option to screen before marriage. In 2016, Malaysia strengthened the screening program further by implementing a national policy on school-based thalassaemia screening programs, specifically targeting upper secondary adolescents aged 16 years old. These continuous efforts have overall seen a declining trend in affected births from 2015 onwards3.

Introduction of Bone Marrow Transplantation: Curative
A bone marrow transplant (BMT) is a procedure that infuses healthy, blood-forming stem cells into a patient's bone marrow to replace one that is not producing enough healthy blood cells. BMT to date is considered the only well-established curative treatment for thalassemia. While it can potentially cure thalassemia, transplant-related complications such as severe infection, graft rejection, graft-versus-host disease and death could occur. This procedure is also not suitable for thalassemia patients who have had complications like iron overload. As of 2015, around 13 hospitals in Malaysia offer this procedure4. However, it is not widely accessible due to high costs, limited funding, and difficulty in finding fully matched stem cell donors. Many patients struggle to find a compatible sibling donor, and the availability of matched unrelated donors is scarce. The establishment of the Malaysian Stem Cell Registry in 2000 has aimed to increase the pool of available donors, but as of 2020, the number of registered donors remains relatively small4. We need to make more efforts to raise awareness and motivate volunteer donors.

Advances in Haploidentical Transplants and Gene Therapy
With the advancement of technologies, increased knowledge and experience in transplants, and the recognition of the challenges in finding fully-matched donors, the use of partially-matched donors (haplo-identical related donors) has increased. It also has the advantages of lower costs and outcomes have also greatly improved over the years with better steps taken at preventing graft-versus-host disease which is a complication that develops when the donor stem cells start to become a threat and attack the recipient’s body. All patients can now find a donor thanks to this alternative stem cell source, which expands the donor pool beyond siblings. This approach has significantly increased access to curative treatment for thalassemia in Malaysia. On the other hand, a lack of a proper regulatory framework has prevented local adoption of gene therapy, which focuses on correcting the genetic mutation responsible for thalassaemia by adding a functional gene to defective blood stem cells.


Conclusion
Treatment for thalassemia in Malaysia has advanced significantly, moving from basic transfusions and chelation therapy to advanced curative interventions such as bone marrow transplants. Despite these advancements, the most effective approaches still involve prevention through screening programs to identify carriers in the community and raising awareness and knowledge about the genetic inheritance of thalassaemia. It will take a long, continuous effort to further reduce the incidence of thalassaemia, while at the same time, the ever-growing medical innovations will make more treatment options available to those affected by the disease in the near future.


References:
1.Tan HY, Hussein N, Lee YK, Abdul Malik TF. Adolescents' experiences and views of the national school-based thalassaemia screening programme in Malaysia: a qualitative study. J Community Genet. 2023;14(4):361-369. doi:10.1007/s12687-023-00656-w
2.Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia. "A systematic review on thalassaemia screening and birth reduction initiatives: cost to success." The Medical Journal of Malaysia Vol 79 No 3 (2024): 349.
3.Mohd Ibrahim H, Muda Z, Othman IS, et al. Observational study on the current status of thalassaemia in Malaysia: A report from the Malaysian Thalassaemia Registry. BMJ Open 2020;10:e037974. doi:10.1136/ bmjopen-2020-037974
4.Saidon N, Anuar NA, Meng CK, et al. Evolution of Hematopoietic Stem Cell Transplant Programs in Malaysia. Blood Cell Ther. 2020;3(3):44-47. Published 2020 Jun 10. doi:10.31547/bct-2019-017





Knowledge and Attitude Towards Blood Donation Among Non-Donors in Kuala Terengganu


02 December 2024 by HAFIZUDDIN BIN MOHAMED FAUZI
Introduction

Blood shortages continue to pose a critical challenge in healthcare systems globally. Malaysia, like many other countries, faces persistent issues with maintaining an adequate blood supply. The state of Terengganu, located on the east coast of Peninsular Malaysia, consistently reports some of the lowest blood donation rates in the country. Between 2011 and 2015, the state recorded only 14 to 16 donations per 1,000 population, compared to 92 to 99 donations in Kuala Lumpur. This disparity reflects not only a lack of awareness but also various cultural, educational, and attitudinal barriers that deter people from donating blood.

The study, conducted at Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu, aims to investigate the knowledge and attitudes towards blood donation among non-donor residents. Understanding the reasons behind the low donation rates, especially among those who have never donated blood, could provide valuable insights into designing targeted interventions to increase participation in blood donation activities.

Study Overview

This research was carried out in February 2017 through a cross-sectional survey involving 320 non-blood donors residing in Kuala Terengganu. The participants were selected using systematic random sampling from hospital attendees who visited HSNZ during the study period. The inclusion criteria were Malaysian citizens aged between 18 and 60, who resided in Kuala Terengganu and had no history of blood donation. Participants with documented medical or psychiatric illnesses, healthcare workers, and individuals unfamiliar with blood donation were excluded to ensure the focus remained on the general population.

The questionnaire used in the study was adapted from a validated instrument that measures knowledge and attitudes about blood donation. The survey consisted of two sections: one assessing knowledge with eight questions and another evaluating attitudes with 20 items on a Likert scale. Scores in the knowledge section ranged from 0 to 8, with participants scoring five or more considered to have good knowledge. Attitudes were rated on a scale of 20 to 100, with scores of 61 and above reflecting positive attitudes towards blood donation.

Key Findings

Knowledge and Attitude Levels
The results revealed a relatively high level of awareness about blood donation among the participants, despite their status as non-donors. Around 64.69% of respondents had good knowledge, with an average score of 5.19 out of 8. This suggests that a majority of non-donors in Kuala Terengganu are well-informed about the basic aspects of blood donation. The attitude scores were even more encouraging, with 92.81% of participants showing a positive attitude towards blood donation, reflected in a mean score of 70.79 out of 100.

However, it is important to note that while knowledge and attitude were generally favorable, they did not necessarily translate into practice. This indicates that there are other factors, beyond awareness, that influence the decision to donate blood.

Influencing Factors
Several demographic factors were found to significantly impact knowledge and attitudes towards blood donation:
Gender: Males were more likely to have better knowledge about blood donation than females. The study found that females were 43.6% less likely to have good knowledge compared to their male counterparts. This could be attributed to societal roles, as many women in the region may have less exposure to information or social opportunities related to health matters.
Education Level: Participants with higher education, particularly those who attended college or university, were significantly more knowledgeable about blood donation. In fact, individuals with a college or university education were 11 times more likely to have good knowledge compared to those with a lower education level. This highlights the importance of educational outreach in raising awareness about blood donation.
Occupation: Those working in the private sector were more knowledgeable and had better attitudes towards blood donation compared to government employees. Self-employed individuals also had better knowledge compared to those in government sectors, which could be due to their exposure to more diverse sources of information and health promotion campaigns in private settings.

Barriers to Blood Donation
Despite the generally positive attitudes towards blood donation, the study identified several barriers that prevent individuals from donating blood. The most prominent obstacles were cultural and religious concerns. Approximately 73.1% of participants expressed reluctance to donate blood if it would be given to someone of a different religion, and 67.8% felt similarly about donating to people of other races. These findings highlight deep-seated cultural beliefs that act as significant barriers to increasing blood donation rates in the region.

Other common barriers included fear of needles (55.9%) and concerns about the pain associated with blood donation (55.0%). Some participants also cited lack of time and modesty as reasons for not donating.

The Role of Media and Information Sources
The study found that social media was the primary source of information about blood donation for 42.2% of participants. This underscores the potential of digital platforms in raising awareness and dispelling myths about blood donation. However, the persistence of cultural and religious misconceptions suggests that more targeted educational campaigns, possibly involving religious and community leaders, are needed to address these specific barriers.

Conclusion
The study highlights that while a majority of non-donors in Kuala Terengganu have good knowledge and attitudes towards blood donation, cultural and religious barriers, as well as misconceptions about the process, prevent them from donating. To increase the blood donation rate in this region, health authorities should focus on addressing these barriers through culturally sensitive education campaigns. Collaboration with religious institutions and leveraging social media could help dispel myths and promote a more inclusive and informed perspective on blood donation. Additionally, targeted efforts to engage women and unemployed individuals could further broaden the donor pool in the region.


Reference:

Malaysian Journal of Medicine and Health Sciences, 2019;15(1):53-62




Anaemia in Young Adulthood and Blood Donation: What You Need to Know


05 December 2024 by NUR ARZUAR BIN ABDUL RAHIM

Photo By IPPT
Dr. Gowri Ganason (Master of Medicine (Transfusion Medicine) and Dr. Nur Arzuar Abdul Rahim (Pediatrician)

What is Anaemia?
Anaemia is a condition characterized by a deficiency in the number or quality of red blood cells or in the amount of haemoglobin (the protein in red blood cells that carries oxygen throughout the body)1. For young adults, anaemia can be particularly concerning, as this phase of life often includes rapid growth, busy schedules, and high energy demands. When someone has anaemia, they may experience symptoms like fatigue, weakness, shortness of breath, and pale skin2. Young adults with anaemia often have less stamina, which can impact both their studies and their work lives.

Why Does Anaemia Happen in Young Adults?
While there are many different causes of anaemia in young adults, the following are common ones2:
Nutritional Deficiencies: Iron-deficiency anaemia is common due to inadequate intake of iron-rich foods, often seen with poor diets or restrictive eating practices.
Blood Loss: Menstruating individuals, especially those with heavy periods, are at a higher risk of iron-deficiency anaemia.
Genetic Conditions: Disorders like thalassemia and sickle cell disease can cause chronic anaemia.
Malabsorption Disorders: Diseases like Crohn's disease or coeliac disease can interfere with the absorption of nutrients, resulting in deficiencies that cause anaemia

Who is Affected?
Young adults, especially women, are at higher risk. Globally, anaemia impacts around one-quarter of the population, with young women often more affected due to both biological and lifestyle factors3. Athletes, vegetarians, vegans, and individuals who follow specific diets may also be more prone to anaemia if they don’t plan their nutrition carefully.

How is Anaemia Detected?
Anaemia is diagnosed through blood tests. A complete blood count (CBC) is typically the first step because it provides information about haemoglobin levels and the number of red blood cells. A normal haemoglobin level for male are 14-18 g/dL and female are 12-16g/dL3. Further tests, such as the following, may aid in determining the underlying cause of anaemia2
Iron Studies: These tests check iron levels, ferritin, and transferrin saturation to determine if iron deficiency is present.
Vitamin Levels: Tests for vitamin B12 and folate, essential for red blood cell production, can reveal deficiencies.
Other Tests: If a genetic cause is suspected, further tests like haemoglobin electrophoresis might be recommended.

When Should Young Adults Be Concerned About Anaemia?
Young adults should be aware of their risk and symptoms of anaemia. If your haemoglobin level is less than 7g/dL it is a must to seek immediate medical attention2. Experiencing symptoms such as persistent tiredness, shortness of breath, dizziness, or pale skin are also a concern and it’s worth discussing these with a healthcare provider. Routine check-ups or screenings can help identify anaemia early1.
Anaemia can also impact other activities, such as blood donation. Blood donation centres screen all donor’s haemoglobin levels to ensure they have sufficient iron stores to donate safely4. If you are anaemic or at risk of anaemia, it’s essential to address these concerns before donating blood, as this can further reduce your iron levels, potentially worsening the condition.

Why is Anaemia Relevant to Blood Donation?
Blood donation is a generous act, but it involves removing red blood cells from the body, which can lead to a decrease in iron stores. This reduction can affect young adults who are already at risk of anaemia or have lower iron reserves. Blood centres have strict guidelines to protect donors, particularly regarding haemoglobin levels, but individuals need to manage their own health proactively.
Young adults who are frequent blood donors, particularly women, may be more susceptible to anaemia if they don’t take steps to replenish iron after donation. This is why most blood centres ask individuals to wait several months between donations to allow the body to recover. In some cases, iron supplementation might be recommended for frequent donors, especially if dietary intake alone isn’t sufficient to meet iron needs.

How Can Anaemia Be Prevented or Managed?
The good news is that lifestyle changes and proper nutrition can often prevent or manage anaemia in young adults5. Here’s how:
1.Eat a Balanced Diet: Consuming iron-rich foods is key. Red meat, poultry, seafood, beans, and leafy greens are great sources of iron. Pairing iron-rich foods with vitamin C sources, like citrus fruits or tomatoes, can improve iron absorption.
2.Consider Iron Supplements: If dietary intake is insufficient or if you’re at higher risk; vegetarian and athletes, iron supplements may help maintain optimal iron levels. Consult a healthcare provider before starting supplementation to avoid unnecessary side effects or excess iron.
3.Manage Menstrual Health: For those with heavy periods, managing menstrual health with a healthcare provider can be beneficial in preventing anaemia.
4.Regular Check-ups: Routine blood tests can help you monitor iron and haemoglobin levels, particularly if you’re a frequent donor, athlete, or have other risk factors.
5.Educate Yourself on Blood Donation: If you’re a regular blood donor, be aware of your haemoglobin levels and iron needs. It’s also wise to follow recommended waiting periods between donations and to consider iron-rich foods or supplements post-donation if advised by a healthcare professional.

When is it Safe for Anaemic Individuals to Donate Blood?
Blood centres generally advise individuals with anaemia to refrain from blood donation until their haemoglobin levels fall within the acceptable range4. Blood centres will screen potential donors, but if you know you’re at brisk of anaemia, it’s essential to monitor your health and discuss with your doctor before donating. 
After receiving treatment and once haemoglobin levels have stabilized, it may be safe to consider donating blood. If you’re someone who needs frequent donations due to medical or personal reasons, working with a healthcare provider to keep track of iron stores can be a sustainable approach.

Why Should Young Adults Care About Anaemia and Blood Donation?
Understanding anaemia is critical for young adults who wish to stay healthy and contribute to blood donation efforts. Awareness of anaemia and management strategies can help individuals prevent it from becoming a limiting factor in their lives. Donating blood is a significant community service, but it's crucial to conduct it responsibly to safeguard your health. By understanding the causes, prevention methods, and impacts on blood donation, young adults can take charge of their health and make informed choices5. Blood donation centres have protocols to ensure donor safety; personal health management is equally important. Through balanced nutrition, responsible blood donation practices, and regular check-ups, young adults can stay healthy and continue supporting life-saving blood donation efforts5.




References:
1.https://www.mayoclinic.org/diseases-conditions/anemia
2.Hoffbrand’s Essential Haematology, 9th Edition
3.https://www.who.int/health-topics/anaemia
4.https://www.lifeservebloodcenter.org/donate-blood/blood-donor-eligibility/iron-levels
5.https://www.webmd.com/diet/iron-rich-foods




Polycythemia: Penyakit Darah Pekat yang Kurang Dikenali


06 December 2024 by NUR ARZUAR BIN ABDUL RAHIM

Photo By IPPT
Dr. Nurmusfirah Binti Ahmad (Master of Medicine (Transfusion Medicine) dan Dr. Nur Arzuar Abdul Rahim (Pakar Pediatrik)

Polycythemia atau penyakit darah pekat adalah keadaan di mana jumlah sel darah merah di dalam badan meningkat secara abnormal. Ini menyebabkan darah menjadi lebih pekat dan likat, menghalang aliran darah yang lancar dalam saluran darah. Keadaan ini boleh meningkatkan risiko pelbagai komplikasi, termasuk serangan jantung, strok, dan masalah pembekuan darah. Meskipun polycythemia bukanlah penyakit yang lazim dibicarakan di Malaysia, kesedaran mengenainya amat penting bagi membolehkan rawatan awal dijalankan.

Simptom-Simptom Polycythemia

Polycythemia sering kali sukar dikesan kerana simptom-simptomnya boleh muncul secara perlahan-lahan dan sering kali disalah anggap sebagai tanda-tanda penyakit lain. Walau bagaimanapun, beberapa simptom utama yang boleh diperhatikan adalah:

1. Keletihan Berpanjangan: Walaupun penghidapnya mungkin kelihatan sihat, mereka sering merasa sangat letih dan lemah tanpa sebab yang jelas.
2. Sakit Kepala: Pesakit sering mengadu sakit kepala yang teruk, yang boleh menjadi tanda tekanan darah tinggi akibat peningkatan sel darah merah.
3. Pening dan Sesak Nafas: Polycythemia boleh menyebabkan aliran darah menjadi kurang lancar, mengakibatkan pesakit merasa pening atau sesak nafas.
4. Kulit Kemerahan: Kulit, terutamanya di wajah, tangan, dan kaki, mungkin kelihatan kemerahan atau lebam akibat peningkatan jumlah sel darah.
5. Gatal-Gatal: Sesetengah pesakit mengalami gatal-gatal yang teruk, terutama selepas mandi air panas.
6. Pembesaran Limpa: Dalam kes yang lebih serius, pesakit mungkin mengalami pembesaran limpa, yang dikenali sebagai splenomegali.


Simptom-simptom ini mungkin kelihatan biasa, tetapi jika anda mengalami beberapa daripada tanda-tanda ini secara berterusan, adalah penting untuk mendapatkan pemeriksaan perubatan.

Cara Pengesanan Polycythemia

Penyakit ini boleh dikesan melalui beberapa ujian perubatan. Antara kaedah pengesanan yang biasa digunakan ialah:
1. Ujian Darah: Ujian darah lengkap (complete blood count - CBC) dilakukan untuk mengukur bilangan sel darah merah, hemoglobin, dan hematokrit. Peningkatan ketara dalam ketiga-tiga komponen ini boleh menunjukkan adanya polycythemia.
2. Ujian Erythropoietin (EPO): EPO adalah hormon yang merangsang pengeluaran sel darah merah. Ujian ini dilakukan untuk mengenal pasti tahap EPO dalam darah. Tahap EPO yang rendah biasanya menunjukkan polycythemia vera, sejenis polycythemia yang berpunca dari masalah sumsum tulang.
3. Ujian Oksigen Darah: Polycythemia sekunder boleh disebabkan oleh keadaan di mana tubuh tidak mendapat cukup oksigen, seperti penyakit paru-paru kronik. Oleh itu, ujian oksigen darah boleh membantu mengenal pasti punca polycythemia.
4. Ujian Sumsum Tulang: Jika terdapat kecurigaan polycythemia vera, ujian sumsum tulang mungkin dilakukan untuk memeriksa jika terdapat pertumbuhan sel darah yang tidak normal di dalam sumsum tulang.
Pengesanan awal amat penting bagi mengelakkan komplikasi yang lebih serius.

Kadar Prevalen Polycythemia di Malaysia

Setakat ini, tiada data khusus mengenai prevalen polycythemia di Malaysia. Namun, di peringkat global, polycythemia vera berlaku dalam kadar kira-kira 1 hingga 3 orang bagi setiap 100,000 orang setiap tahun (1). Purata umur sewaktu diagnosis penyakit ini adalah dalam lingkungan umur 60 sehingga 65 tahun (1, 2), namun penyakit ini masih boleh berlaku dalam mana-mana peringkat umur terutamanya kepada individu berumur lebih 50 tahun (1). Memandangkan polycythemia vera adalah penyakit yang jarang berlaku, kesedaran mengenainya di kalangan masyarakat umum masih rendah. Kebanyakan kes polycythemia sekunder pula sering dikaitkan dengan faktor gaya hidup atau penyakit lain seperti penyakit paru-paru atau jantung.

Walaupun tiada statistik tepat untuk Malaysia, polycythemia sekunder mungkin lebih kerap berlaku, terutamanya di kalangan individu yang menghidap penyakit paru-paru kronik atau yang tinggal di kawasan dengan pencemaran udara yang tinggi.


Photo By Internet source
Sample darah Polycythemia Vera Berbanding Sample Darah Normal

Rawatan Polycythemia

Rawatan polycythemia bergantung kepada jenis dan tahap keparahannya. Terdapat dua jenis utama polycythemia:
1. Polycythemia Vera (PV): Ini adalah keadaan di mana sumsum tulang menghasilkan terlalu banyak sel darah merah. Rawatan untuk PV termasuk:
Phlebotomy: Prosedur ini melibatkan pengeluaran darah secara berkala untuk mengurangkan jumlah sel darah merah dan mencegah komplikasi seperti pembekuan darah. Ia serupa dengan proses menderma darah.
Hydroxyurea: Ubat ini membantu mengurangkan pengeluaran sel darah merah dalam sumsum tulang.
Aspirin: Penggunaan dos aspirin yang rendah boleh membantu mengurangkan risiko pembekuan darah dengan menipiskan darah.
Interferon Alfa: Bagi pesakit yang tidak boleh menerima hydroxyurea, interferon alfa boleh digunakan untuk mengawal pengeluaran sel darah merah.

2. Polycythemia Sekunder: Ini disebabkan oleh masalah asas lain seperti penyakit paru-paru atau jantung. Rawatan bagi polycythemia sekunder melibatkan:
Mengatasi Punca Asal: Contohnya, jika polycythemia disebabkan oleh penyakit paru-paru, rawatan untuk memperbaiki fungsi paru-paru adalah keutamaan.
Oksigen Tambahan: Sesetengah pesakit mungkin memerlukan rawatan oksigen tambahan untuk meningkatkan bekalan oksigen dalam badan mereka.
Phlebotomy: Seperti PV, pesakit dengan polycythemia sekunder juga mungkin memerlukan phlebotomy untuk mengurangkan kelikatan darah.

Komplikasi Polycythemia

Polycythemia yang tidak dirawat boleh membawa kepada pelbagai komplikasi serius, termasuk:
1. Trombosis: Kelikatan darah yang tinggi boleh menyebabkan pembentukan darah beku (trombosis), yang boleh menghalang aliran darah ke organ penting seperti otak, jantung, atau paru-paru. Ini boleh membawa kepada strok atau serangan jantung.
2. Gout: Polycythemia meningkatkan tahap asid urik dalam badan, yang boleh menyebabkan gout, sejenis artritis yang sangat menyakitkan.
3. Penyakit Jantung: Tekanan darah yang tinggi dan kelikatan darah yang meningkat boleh meningkatkan risiko penyakit jantung.
4. Myelofibrosis: Ini adalah keadaan di mana sumsum tulang menjadi parut dan berhenti menghasilkan sel darah dengan betul. Polycythemia vera boleh berkembang menjadi myelofibrosis jika tidak dirawat.
5. Leukemia: Dalam kes yang jarang berlaku, polycythemia vera boleh berubah menjadi leukemia myeloid akut, sejenis kanser darah.

Kesimpulan

Polycythemia adalah penyakit darah yang kurang dikenali tetapi mempunyai potensi komplikasi yang serius jika tidak dirawat. Simptom-simptomnya mungkin kelihatan ringan pada peringkat awal, tetapi jika tidak diberi perhatian, ia boleh menyebabkan masalah kesihatan yang serius. Pengesanan awal melalui ujian darah dan rawatan yang betul boleh membantu mengawal penyakit ini dan mencegah komplikasi.

Kesedaran tentang polycythemia di Malaysia masih rendah, tetapi dengan peningkatan pemahaman tentang penyakit ini, lebih ramai individu yang berisiko dapat mendapatkan rawatan awal dan menjalani kehidupan yang lebih sihat. Meskipun polycythemia adalah penyakit yang jarang berlaku, pengetahuan mengenainya adalah penting bagi setiap individu supaya dapat mengenali tanda-tandanya dan mendapatkan rawatan yang sewajarnya.


Rujukan:


1.Palandri F, Mora B, Gangat N, Catani L. Is there a gender effect in polycythemia vera? Ann Hematol. 2021;100(1):11-25. doi:10.1007/s00277-020-04287-w https://rdcu.be/d0hd2
2.Polycythemia vera facts.  The Leukemia & Lymphoma Society. https://www.lls.org/sites/default/files/file_assets/FS13_PolycythemiaVera_FactSheet_final5.1.15.pdf
3.https://www.mayoclinic.org/diseases-conditions/polycythemia-vera/symptoms-causes/syc-20355850




Boosting Blood Health! A Quick Dive into Patient Blood Management and Iron Therapy in Malaysia


05 December 2024 by NUR ARZUAR BIN ABDUL RAHIM

Photo By IPPT
Dr. Nur Izuani Zainuddin (Master of Medicine (Transfusion Medicine) and Dr. Nur Arzuar Abdul Rahim (Pediatrician)


What is Patient Blood Management ?

Patient Blood Management (PBM) is an evidence-based, multidisciplinary approach aimed at improving patient outcomes by refining the use of blood and blood products. PBM focuses on 3 main pillars which are detection and management of anemia, minimizing blood loss and optimizing patient specific physiological tolerance of anemia. This approach has become an integral part of modern transfusion medicine, particularly in managing patients with conditions such as anemia, surgical blood loss, trauma, and chronic diseases.

The Role of Iron in Patient Blood Management

A central component of PBM is addressing anemia, which is common in hospitalized patients, especially those undergoing surgery or dealing with chronic conditions. Iron deficiency is one of the most prevalent causes of anemia. Iron is essential for the production of hemoglobin, the protein in red blood cells that carries oxygen throughout the body. When iron levels are low, hemoglobin production is impaired, leading to reduced oxygen delivery and overall fatigue and weakness.

Available Iron Preparations in Malaysia

In Malaysia, the management of iron deficiency anemia can be achieved through both oral and intravenous iron preparations. These options vary in terms of absorption rates, side effects, and clinical indications.


Oral Iron Preparations

Oral iron supplements are typically the first-line treatment for iron deficiency anemia due to their convenience and lower cost. However, their effectiveness can be limited by gastrointestinal side effects and reduced absorption in certain conditions.

Some commonly available oral iron preparations in Malaysia include:
    1.Ferrous Sulfate (Iberet Folic)
    • Iron content: 525 mg tablet provides about 105 mg of elemental iron.
    • Common side effects: Constipation, nausea, and abdominal discomfort.

    2.Ferrous Fumarate (New Obimin, Iron Tablet)
    • Iron content: 200 mg tablet provides about 66 mg of elemental iron.
    • Common side effects: Less gastrointestinal irritation compared to ferrous sulfate.

    3.Ferrous Gluconate (Sangobion)
    • Iron content: 250 mg tablet provides about 30 mg of elemental iron.
    • Common side effects: Fewer gastrointestinal side effects compared to other iron salts but still can cause mild nausea or constipation.

    4.Iron Polysaccharide Complex (Maltofer)
    • Iron content: 370 mg tablet provides about 100 mg of elemental iron.
    • Common side effects: Less likely to cause gastrointestinal upset.


Intravenous Iron Preparations

For patients who cannot tolerate oral iron or when rapid increment of hemoglobin level is necessary, intravenous iron preparations are used. Some intravenous iron preparations available in Malaysia include:
    1.Iron Sucrose (Venofer)
    • Iron content: 100 mg of elemental iron per 5ml ampoule.
    • Indication: Used in patients with chronic disease-related anemia or iron deficiency anemia that does not respond to oral therapy. Test dose needed.
    • Administration: IV injection/infusion.
    • Maximum dosage: 7mg/kg. Often given as 200mg three times per week or 500mg per week as a single infusion.

    2.Iron Dextran (Cosmofer)
    • Iron content: 100 mg of elemental iron per 2ml ampoule.
    • Indication: Suitable for patients with significant iron deficiency anemia, particularly in pregnancy. Test dose needed.
    • Administration: IV injection/infusion or IM.
    • Maximum dosage: 20mg/kg

    3.Iron Isomaltoside (Monofer)
    • Iron content: 500 mg of elemental iron per 5ml vial.
    • Indication: Typically used in patients with chronic kidney disease or those undergoing dialysis. Test dose NOT needed.
    • Administration: Given via slow intravenous infusion.
    • Maximum dosage: 20mg/kg

Ganzoni Formula for Calculating Intravenous Iron

In patients requiring intravenous iron, a common method for calculating the correct dose of iron is the Ganzoni Formula, which helps estimate the total iron deficit. This formula is particularly useful for determining the iron dose needed by the patient.

The formula is as follows:

Iron Deficit (mg) = Body Weight (kg) × [Target Hb ? Actual Hb (g/dL)] × 2.4 + Iron Store (mg)

Where; Iron Store is the amount of iron already available in the body, which can be estimated as 500 mg for most adults.


In a nutshell, both oral and intravenous iron preparations are widely available in Malaysia, with a variety of options to suit different clinical needs. The Ganzoni formula offers a reliable method for calculating the required dose of intravenous iron, ensuring that patients receive the optimal amount for repletion.

Patient Blood Management aims to optimize the care of patients through better blood utilization and the judicious use of iron preparations plays a key role in managing iron deficiency anemia. Healthcare providers must carefully consider the patient’s condition, comorbidities, and response to therapy when selecting the most appropriate iron preparation and determining the correct dosage. By adopting a comprehensive approach to PBM, we can enhance patient outcomes, reduce reliance on blood transfusions and improve the overall quality of care in transfusion medicine.

References:
1.The Urgent Need to Implement Patient Blood Management: Policy Brief. WHO, 2021.
2.Intravenous Iron for Iron Deficiency Anemia Full Report. Ministry of Health Malaysia, 2019. 
3.Das SN, Devi A, Mohanta BB, Choudhury A, Swain A, Thatoi PK. Oral versus intravenous iron therapy in iron deficiency anemia: An observational study. J Family Med Prim Care, 2020.
4.New Obimin, Iron Tablet 200 mg, Maltofer and Iberet Folic Product Insert.







Navigating the Challenges of an Aging Population, Healthcare, and Blood Transfusion Services in Malaysia


06 December 2024 by NUR ARZUAR BIN ABDUL RAHIM

Photo By IPPT
Dr. Chuah Sean Yew (Master of Medicine (Transfusion Medicine)) and Dr. Nur Arzuar Bin Abdul Rahim (Medical Lecturer)

Introduction
As Malaysia’s population ages and non-communicable diseases (NCDs) become more prevalent, our healthcare system faces unprecedented challenges. This essay explores Malaysia’s progress in healthcare, the impact of demographic shifts, and the critical need for forward-looking policies that meet the evolving demands of the nation, particularly in blood transfusion services. By addressing these challenges, Malaysia can build a healthcare system that supports the needs of all generations.

Progress in Malaysian Healthcare
Since gaining independence, Malaysia’s public health system has made remarkable strides. Life expectancy has increased from 53 years in the 1950s to 76 years in 20241. The reduction in maternal mortality rates is also commendable, decreasing from 282.2 per 100,000 live births in 1957 to 25.7 in 20242. Malaysia was also the first country in the World Health Organization’s Western Pacific Region to eliminate mother-to-child transmission of HIV and syphilis3. These milestones underscore our strong commitment to public health and the well-being of all Malaysians.

Malaysia’s Changing Demographics
While we celebrate these accomplishments, new challenges loom. More Malaysians are now living well into their 70s and 80s, while the fertility rate has declined from 6.3 births per woman in 1960 to just 1.9 in 20244. This sharp reduction results in an increasing proportion of older Malaysians and a shrinking younger population.


The “Silver Tsunami” in Malaysia
The United Nations defines a “super-aged” society as one in which over 20% of the population is aged 65 or older. Japan is currently the world’s oldest super-aged society, with projections that one-third of its population will be over 65 by 20365. In Malaysia, the Department of Statistics projects that by 2040, 14.5% of the population will be 65 or older, reaching 20.5% by 20576. Scholars use the term “silver tsunami” to describe the rapid expansion of the elderly population, which will require strategic healthcare planning and resource allocation7.


Current and Future Healthcare Challenges
The increased life expectancy in Malaysia is a direct result of socioeconomic progress and an urban shift in economic activities. As more Malaysians live in cities, sedentary lifestyles and high-calorie diets have contributed to rising obesity rates. In 2023, Malaysia topped the obesity list in Southeast Asia, with half of Malaysians classified as overweight or obese7. This trend is closely linked to Type II diabetes, affecting one in five Malaysians8. Together, these conditions mean that while Malaysians are living longer, many are experiencing more health complications associated with NCDs.
In 2019, ischemic heart disease (20.6%) and cerebrovascular disease (13.9%) were the leading causes of death9. However, by 2023, pneumonia had emerged as the top cause of death, reflecting the long-term effects of COVID-1910. Although ischemic heart disease remains the main cause of death among individuals aged 40–59, pneumonia has overtaken it in those aged 60 and above. As the effects of COVID-19 subside, NCDs are likely to return as the primary mortality drivers among older adults.
The burden of NCDs, combined with an aging population, places significant pressure on Malaysia’s healthcare system. Dementia, for example, is now a major cause of disability among older adults11. Obesity is heavily linked to Type II diabetes, which in turn increases the risk for conditions like dementia, coronary artery disease, and cerebrovascular disease12. As the saying goes, “prevention is better than cure”—by preventing obesity and diabetes, Malaysia can save valuable healthcare resources and improve quality of life.
The Ministry of Health has taken steps, such as implementing a sugar-sweetened beverage (SSB) tax of RM0.40 per litre in 2019, increasing to RM0.90 in January 202513. Studies show that SSB taxes reduce consumption, particularly among low-income groups. Additionally, the Fit Malaysia campaign, launched in 2014, promotes physical activity14. However, despite these efforts, obesity and diabetes rates remain high.

Learning from Singapore
Singapore faces similar challenges with an aging population and rising obesity and diabetes rates. To address this, Singapore established the Health Promotion Board in 2001, promoting healthy lifestyle choices15. By 2018, surveys showed Singaporeans were consuming fewer calories and more whole grains, fruits, and vegetables16. Programs like the Healthier Choice Symbol (HCS) on packaged foods and the Healthier Dining Programme (HDP), which subsidises healthier menu options, have contributed to these positive trends. Singapore’s National Steps Challenge™, which incentivises physical activity with rewards, has also encouraged healthier living17.
Malaysia has adopted some similar measures, like the Healthier Choice Logo in 201718. However, the Malaysian government could further incentivise healthy choices, as Singapore has done. Singapore’s lower obesity and diabetes rates demonstrate the effectiveness of these initiatives.

Transfusion Services and the Aging Population
As Malaysia’s population ages, the demand for blood transfusion services rises. Older adults in developed countries are more likely to require transfusions due to conditions such as anaemia—often secondary to chronic diseases like diabetic nephropathy, congestive heart failure, and cancer—and age-related surgeries like joint replacements and cardiac procedures19. These demands will place greater strain on the blood supply, which will require sustained donations to keep pace with demand.
Currently, only 2.2% of Malaysians donate blood annually, compared to 3.5–5% in developed countries20. In the past year, only 46,000 new donors were aged 17–24, while just 32,000 were aged 25–3421. As younger donors are crucial to sustaining blood donation programs, our demographic shift to silver tsunami poses a serious risk to the stability of Malaysia’s blood supply. To address this, transfusion services must readily target to retain and recruit more older donors. However, without large pool of healthy adults, we will never succeed in enlarging our donor base. Hence, reducing obesity and diabetes rate should be the common quest for transfusion medicine and public health fraternity. Transfusion medicine staff should always promote healthy lifestyle to existing and potential blood donors.
Malaysia’s healthcare system is known for affordability, with nominal fees in public facilities. Regular blood donors receive incentives such as waived inpatient and outpatient fees, but these may be less appealing given the already low fees for non-donors. Rather than offering financial incentives, which could conflict with voluntary donation principles, raising awareness about blood donation’s importance can foster a sense of altruism.

Leveraging Technology in Transfusion Services
Artificial intelligence and digital platforms can enhance blood donor recruitment and retention. For instance, the Ministry of Health’s new Rekod Saya app, which tracks personal health information, could also educate and promote blood donation. Artificial intelligence could be utilised to analyse the existing big data to help forecast the best time and place to hold blood donation drives. Real time data on blood demand and stock can help to manage blood stock effectively and avoid wastage. For example, surplus blood supply at a particular blood centre can be easily redistributed to centre which is facing shortage. Without AI, the process of coordinating blood stock is time consuming and laborious. 
While advanced technology is valuable, a culture of altruism remains key to a safe, sustainable blood supply. Malaysians are known for our generosity; with the right policies and effective implementation, our donation rates can match those of developed nations

Conclusion
Malaysia’s aging population presents unique healthcare challenges, particularly in transfusion services and public health. While we have made notable progress, sustaining these achievements requires proactive, innovative healthcare strategies. By strengthening transfusion services, enacting adaptable policies, and fostering community support, Malaysia can ensure a healthcare system that remains equitable, efficient, and compassionate for all citizens. Through foresight and collaboration, we can secure a healthy future for the entire nation.


Reference:


1. https://datacommons.org/tools/timeline#&place=country/MYS&statsVar=LifeExpectancy_Person
2. https://open.dosm.gov.my/data-catalogue/deaths_maternal?visual=rate
3. https://www.who.int/news/item/07-10-2018-malaysia-eliminates-mother-to-child-transmission-of-hiv-and-syphilis#:~:text=Malaysia eliminates mother-to-child transmission of HIV and syphilis,-7 October 2018&text=Malaysia was today certified by,Region to achieve this milestone.
4. https://open.dosm.gov.my/data-catalogue/fertility?age_group=tfr&visual=fertility_rate
5. https://www.oecd-ilibrary.org/docserver/f7ebe745-en.pdf?expires=1731308775&id=id&accname=guest&checksum=3F78AF5941A429E3DC03BA1B7EF75E2F#:~:text=Definition and comparability&text=In this report, we qualify,share is 21% or higher.
6. https://www.malaymail.com/news/malaysia/2024/09/06/dosm-malaysia-to-become-aged-nation-by-2040-with-population-over-60-set-to-surge/149508#
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC7908089/#:~:text=Among Southeast Asian countries, Malaysia,from 4.4% to 17.7%.
8. https://www.moh.gov.my/moh/resources/Penerbitan/Rujukan/NCD/Diabetes/National_Diabetes_Registry_Report_2013-2019_26082021.pdf
9. https://iku.nih.gov.my/images/poster2023/84.pdf
10. https://www.bernama.com/en/general/news.php?id=2357696#:~:text=Mohd Uzir further said that,deaths, or 16.4 per cent.
11. https://www.who.int/news-room/fact-sheets/detail/dementia
12. https://pmc.ncbi.nlm.nih.gov/articles/PMC9408882/
13. https://www.malaymail.com/news/malaysia/2024/10/18/crave-a-sweet-drink-heres-how-much-will-you-can-expect-to-pay-for-sodas-and-sweet-teas-in-2025/154083
14. https://www.bharian.com.my/taxonomy/term/3/2014/09/4994/fitmalaysia-gelombang-ubah-gaya-hidup-rakyat-bersukan
15. https://www.hpb.gov.sg/about/about-us
16. https://www.moh.gov.sg/newsroom/speech-by-mr-ong-ye-kung-minister-for-health-at-world-diabetes-day-2021
17. https://www.ourcommons.ca/Content/Committee/421/HESA/Brief/BR10093093/br-external/MinistryOfHealth-Singapore-e.pdf
18. https://www.moh.gov.my/moh/resources/Pemakanan/Buku_Guidelines_on_Healthier_Choice_Logo_Malaysia1.pdf
19. https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability
20. https://pmc.ncbi.nlm.nih.gov/articles/PMC8260069/
21. https://data.moh.gov.my/dashboard/blood-donation





The Pulse of Healthcare: Innovative Strategies to Attract and Retain Blood Donors


06 December 2024 by NUR ARZUAR BIN ABDUL RAHIM


Photo By IPPT
Dr. Ashwini a/p Rajagopal [Master of Medicine (Transfusion Medicine)] andDr. Nur Arzuar Bin Abdul Rahim (Medical Lecturer)


Transfusion Medicine is a rapidly evolving medical specialty. Wolf aptly describes the unique nature of blood transfusion services, asserting that "unlike other clinical laboratories, the blood bank provides a parenteral therapeutic agent." The World Health Organisation (WHO) characterizes blood donation as the voluntary donation of blood for transfusions or medication production.  The WHO's goal is for all countries to obtain their blood supplies through voluntary, unpaid donors. As the transfusion service is dependent on community support and the goodwill and generosity of the public, continuing meaningful publicity programs at national and local levels, combined with well-organized expert bleeding teams, are essential to ensuring the ready availability and supply of blood.  Over the years, we have applied innovative strategies to both attract more new donors and retain the existing population of blood donors.

Leveraging technology and digital platforms in this digital age provides unparalleled opportunities to engage with potential and existing blood donors. Developing user-friendly mobile applications with features such as appointment scheduling, donor eligibility checks, personalized reminders for upcoming donation drives and also including geolocation services to notify donors of nearby donation centers or mobile drives can streamline the donor experience. Digital health solutions have been instrumental in enhancing donor recruitment. For example, studies show that mobile apps with gamification features can increase donor retention by engaging younger demographics effectively.(1) We can use social media platforms like Facebook, TikTok, and Instagram as powerful tools to share compelling experiences from blood and blood product recipients, thereby motivating potential donors. Regular live sessions, Q&A interactions, and donor testimonials on these platforms can foster a sense of community and connection.

Partnerships with corporations and educational institutions can significantly expand the donor base. Corporate social responsibility (CSR) programs can encourage companies to organise blood donation drives. For instance, CSR initiatives not only address critical health needs but also enhance corporate reputation and employee engagement. Successful strategies include fostering employee participation, collaborating with healthcare professionals, and using feedback to continuously improve these campaigns. These dual benefits demonstrate hoe businesses can contribute to society while strengthening their internal culture and public image, as highlighted by Corporate Wellness Magazine’s insights on effective corporate wellness programs. (2) Offering incentives such as employee recognition, certificates, or small gifts can motivate participation. Educational institutions, including universities and colleges, are prime locations to recruit young and healthy donors. Integrating blood donation awareness into health courses or hosting annual campus drives can create lifelong donors.

We always consider the donor experience during and after the donation process, as it can either encourage or deter further donations. Therefore, enhancing the donor experience through initiatives such as air-conditioned donation suites, comfortable seating, free Wi-Fi, providing refreshments, personalized donor badges, or any other form of special appreciation can create a memorable and positive experience that encourages repeat donations. Research by Martin-Santana et al. highlights the role of block leaders in motivating existing donors to return, emphasizing the importance of personalized communication and community trust in fostering donor loyalty.(3) Post-donation follow-ups are also crucial. We can foster a sense of accomplishment and reinforce the value of donors' contributions by sending a simple thank-you message or notifying them when their blood has helped someone. These personalized gestures are effective for turning one-time donors into regular contributors.
Organizing themed blood drives, such as holiday or festival drives, can create a sense of excitement and celebration around the act of donating blood. These events can include entertainment, food stalls, and partnerships with local celebrities to attract crowds. Themed blood drives like holiday events are shown to attract 20% more participants compared to non-themed campaigns, primarily due to added community engagement and festive atmosphere. Additionally, community-focused events such as health fairs, offering free health screenings and wellness talks, can incorporate blood donation into a wider health initiative. We should also hold educational campaigns to dispel various myths and misconceptions about blood donation. These campaigns can help clear the hesitation among multiple potential donors that arises due to unfounded fears related to pain, safety, or perceived adverse effects.


Targeted recruitment and inclusion strategies can guarantee the reach of diverse demographics. For example, collaborating with cultural and religious organizations can help overcome specific barriers and promote blood donations within particular communities. As discussed in the article ‘Blood Donation for all: Inclusivity is Important to the blood supply,’ fostering inclusivity not only ensures equitable participation but also addresses the need for diverse blood types to meet the growing demand for rare and unique blood profiles.(4) Engaging community leaders as advocates can build trust and encourage participation. Recruiting donors from all communities can also help meet the demand for rare blood types. We can incorporate customized messages that resonate with particular groups or initiatives, emphasizing the significance of diverse blood donations. 
Adapting to the lifestyle and schedules of potential donors can increase participation. We can accommodate individuals who cannot donate during traditional working hours by extending our operating hours and offering weekend donation slots. Mobile blood collection units that travel to high-traffic areas, such as shopping centers or business districts, can also make donation more convenient. Flexible donation hours and mobile blood units have been shown to improve accessibility, particularly for working professionals, increasing donation rates by up to 25%. While these methods can increase the number of turnouts in urban areas, donors from rural areas may lack access to these donation sites. This is especially common among the Orang Asli community in Malaysia. Organizing blood donation campaigns in the rural areas at a more accessible location to these communities at regular intervals can help to handle this situation efficiently.


Last but not least, utilizing the power of data analytics can improve donor engagement strategies. The power of data analytics has been further demonstrated by Li et al. (2023), whose study highlighted how advanced computational techniques can significantly enhance blood demand forecasting and supply chain management, addressing inefficiencies and shortages.(5) By analyzing donors' demographics, habits, and feedback, blood centers can develop targeted campaigns and tailor their outreach efforts. Predictive analytics can also help identify optimal times for reaching out to previous donors and scheduling donation drives to maximize turnout. Managing donation intervals is critical to ensuring the safety and health of frequent blood donors. In Malaysia, it is recommended that the minimum interval between whole blood donation in 8 weeks and the maximum number of donations per year is 6 times for males and 4-times for females to allow sufficient time for haemoglobin and iron levels to recover. Educating donors on the importance of these intervals prevents risks like iron deficiency anaemia. Alongside scheduling guidance, transfusion services should provide nutritional recommendations to support donors in maintaining adequate iron levels. Emphasizing iron-rich diets, including red meat, leafy green vegetables, and fortified cereals, can help replenish iron levels. Vitamin C rich food such as oranges and bell peppers, can be suggested to increase iron absorption. In some cases, especially for frequent donors, oral iron supplements may be advised under medical supervision. By implementing such strategies, blood donation programs can foster long-term donor health while maintaining a stable blood supply.

Attracting and retaining blood donors requires a multifaceted approach that combines technological advancements with community engagement, personalized experiences, and strategic partnerships. By implementing these innovative strategies, transfusion services in Malaysia can create a robust, sustainable and motivated donor base. This not only ensures a consistent blood supply but also fosters a culture of compassion and community resilience. All these continuous adaptations, efforts and approaches can help meet the growing demands for blood and contribute to saving countless lives.


References


1. Niklas N, Loimayr C, Lenz J, Süßner S, Schuster G, Jungwirth D, Watzinger W, Federsel S. The Impact of Digital Transformation on Blood Donation and Donor Characteristics. Transfus Med Hemother. 2023 Jun 5;50(6):531-538. doi: 10.1159/000530270. PMID: 38089492; PMCID: PMC10712983.
2. https://www.corporatewellnessmagazine.com/article/best-corporate-blood-donation-drives-and-health-campaigns?query=best+corporate+blood+donation+drives+and+health+campaigns
3. Josefa D. Martín-Santana, Asunción Beerli-Palacio, Achieving donor repetition and motivation by block leaders among current blood donors, Transfusion and Apheresis Science, Volume 47, Issue 3, 2012, Pages 337-343, ISSN 1473-0502,
https://doi.org/10.1016/j.transci.2012.05.015.
4. Delaney M. Blood donation for all: inclusivity is important to the blood supply. Blood Transfus. 2021 Jan;19(1):1-2. doi: 10.2450/2020.0303-20. Epub 2020 Oct 9. PMID: 33085597; PMCID: PMC7850919.
5. Na Li, Tho Pham, Calvino Cheng, Duncan C. McElfresh, Ryan A. Metcalf, W. Alton Russell, Rebecca Birch, James T. Yurkovich, Celina Montemayor-Garcia, William J. Lane, Aaron A.R. Tobian, Nareg Roubinian, Jansen Seheult, Ruchika Goel, Blood Demand Forecasting and Supply Management: An Analytical Assessment of Key Studies Utilizing Novel Computational Techniques, Transfusion Medicine Reviews, Volume 37, Issue 4, 2023, 150768, ISSN 0887-7963, https://doi.org/10.1016/j.tmrv.2023.150768.
6. Szariannie Sulaiman, Sohela Mustari, & Iyad M. Y. Eid. (2023). Socio-Cultural Perceptions toward Blood Donation Practice Among Young Blood Donors. Malaysian Journal of Social Sciences and Humanities (MJSSH), 8(11), e002603. https://doi.org/10.47405/mjssh.v8i11.2603
7. Abd Rahman, Nur & Ali, Muhammad & Yusof, Mohammed. (2018). Blood Donation Program in Malaysia: Government Initiatives towards Attracting Volunteer Blood Donors. International Journal of Engineering & Technology. 7. 240. 10.14419/ijet.v7i4.15.22997.
8. Nursyafiqah Izzati Zainal Abidin, & Duangta Shet. (2021). KNOWLEDGE, ATTITUDE, AND PRACTICE TOWARDS BLOOD DONATION AMONG UNDERGRADUATE STUDENTS OF HEALTH CAMPUS, UNIVERSITI SAINS MALAYSIA. The Malaysian Journal of Nursing (MJN), 12(3), 3-7. https://doi.org/10.31674/mjn.2021.v12i03.001




Organ Donation in Malaysia: A Gift of Life


06 December 2024 by NUR ARZUAR BIN ABDUL RAHIM

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Photo By IPPT
Dr. Noor Aqilah Binti Ashamuddin (Master of Medicine (Transfusion Medicine), Dr. Nur Arzuar Abdul Rahim (Pediatrician)


“Ikrar kita, harapan dunia”

Organ donation is a noble act that has the potential to save lives and significantly improve those in need. Yet, despite its benefits, organ donation faces complex challenges globally, including in Malaysia. This newsletter aims to shed light on the current state of organ donation in Malaysia, the laws and ethical considerations that guide it, and the crucial need for increased awareness and involvement from all citizens according to our local considerations. 

The Importance of Organ Donation
The gap between organ demand and availability is substantial. In Malaysia, the number of patients awaiting organ transplants far exceeds the available donors, leading to prolonged suffering for those on waiting lists and, unfortunately, preventable deaths. This urgent need highlights the importance of promoting organ donation awareness and encouraging Malaysians to consider becoming donors.

Current State of Organ Donation in Malaysia
In Malaysia, organ donation started in the 1970s, yet the number of deceased organ donors remains less than 500. According to the Malaysian Ministry of Health, the number of individuals waiting for organ transplants, particularly kidneys, has been steadily rising in recent years due to the high incidence of kidney failure which is primarily caused by rising rates of diabetes and hypertension in the country. As of today, the registration listed 11171 adults, 309 children as kidney transplant recipients, 1 adult and 5 children as liver transplant recipients, 15 heart recipients, 2 lungs and 5 heart and lung recipients. According to INTERNATIONAL REGISTRY IN ORGAN DONATION AND TRANSPLANTATION (IRODAT) 2023 report, Malaysia is one of the lowest rates of deceased organ donation in the region which is 1.5 per million population (pmp), compared to 49.38 pmp in Spain, 48.03 pmp in USA, 4.08 pmp in Saudi Arabia (Islamic country), 6.21 pmp in Thailand, 0.15 pmp in Vietnam and 0.13 pmp in Philippines of our neighboring countries. Latest national statistics show that total organ donor pledges since 1997 are 392,839, with the rate varying according to the states. The highest is in Wilayah Persekutuan Kuala Lumpur (2.32%) and the lowest in Borneo (0.6%), indicating a significant urban-rural disparity. This warrants increased awareness campaigns in rural areas, especially in states with lower pledge rates. Targeted rural campaigns would highlight how Malaysia's outreach efforts can be expanded, as Malaysia's diverse ethnic disparity might exhibit organ transplant compatibility due to genetic variation. Since 1976, there have been about 942 deceased organ donations, resulting in 2,973 organs and tissues donated. Since 1975, 3,250 transplant surgeries have been performed. For this year, 2024, we are very proud of 12,301 new organ donor pledges and 64 deceased organ donations and remain optimistic for the coming years.

Photo By Internet source
Deceased Organ Donor Rate Among Worldwide

Legal and Ethical Framework
To ensure safe, ethical and respectful conduct of the organ donation process, Malaysia has established a legal and ethical framework. The Human Tissues Act 1974 governs organ donation from deceased persons, while the Private Healthcare Facilities and Services Act 1998 regulates organ transplants. These laws guarantee the dignity of donors and recipients, transparency in the process, and freedom from exploitation. However, there is an urgent need to amend the 50-year-old Human Tissue Act to strengthen the legal framework for organ donation and address ethical concerns. Looking to the future, Malaysia could adopt a soft opt-out system and prioritize advancements in organ preservation techniques by exploring new sources of organs through the donation after circulatory death program.
The country recognizes two types of organ donation: living and deceased. In a living donation, a person donates an organ, typically a kidney, to a relative or someone in need. The ethical issues of live organ donation should be considered in the light of the four basic principles of biomedical ethics which are respect for autonomy, non-maleficence, beneficence and justice. Deceased donation, on the other hand, occurs when a person consents (or their family consents) to donate their organs after death. Individuals who pass away at home have the option to donate their eyes and corneas, and this process can also take place there. Ethical guidelines mandate voluntary donation and strictly prohibit any form of payment for organs.

Barriers to Organ Donation
While Malaysia has a legal framework to facilitate organ donation, cultural and religious beliefs pose barriers. In a multi-ethnic, multi-religious society like Malaysia, there are varying views on organ donation. Some communities may be hesitant to consider donation due to beliefs surrounding the afterlife and bodily integrity. Misunderstandings about religious teachings also play a role, though many religions generally support organ donation as a life-saving act.
Lack of awareness is another major barrier. Additionally, common arguments that discourage people from registering as organ donors include misinformation about the organ donation process, concern over medical procedures, fear of medical misuse, disfigurement of the body after donation, and bias in hospital treatment. These myths could be countered through education and providing evidence-based responses or insights from medical experts to gain the public's trust. Perhaps, if we emphasize the life-changing impact of organ donation through direct testimonials, case studies from recipients and donors, and personal stories it would create an emotional appeal to inspire more people to pledge as donors. For example, 15th Dec 1975 marked the first ever living kidney transplant in Malaysia where the recipient Mr Martin Rinyeb form Sarawak became the first person to undergo a renal transplant surgery in Malaysia after he received a kidney from his brother Mr Augustine Rinyeb. Mr Martin continues to enjoy normal renal function and survived for thirty years before succumbing to a major infection. Another renowned figure, Mr Mohd Afiq Ikmal underwent the liver transplant in 1993 in Subang Jaya Medical Centre when he was 14 months old after Mr Wan Mohd Hafizam, 23 years old at that time, who is now an Associate Officer with the Civil Defence Force, expressed his readiness to donate part of his liver. However, the recipient succumbed in 2021 at 23 years of age due to complications from the procedure. The tagline, "satu hati, dua jasad," will always be remembered among Malaysians who witnessed the miracle.

Religious Perspectives on Organ Donation
In Malaysia, understanding the religious context of organ donation is essential. Various religious authorities have issued statements supporting organ donation as an act of compassion and charity. The National Fatwa Council of Malaysia declared in 1970 that organ donation is permissible in Islam, as long as it adheres to specific ethical guidelines. This fatwa supports the idea that saving lives aligns with Islamic principles of mercy and altruism.
Other religious groups, including Christian, Hinduism, Sikhism and Buddhist communities, have similarly expressed that organ donation is in line with their values of compassion and selflessness. Such endorsements from religious authorities help to reassure communities and can play a key role in encouraging more people to consider organ donation.

The Role of Awareness Campaigns
Increasing awareness about organ donation is critical to addressing these barriers. The Ministry of Health Malaysia, along with non-governmental organizations (NGOs), has been working to spread information and dispel myths surrounding organ donation. Through campaigns, social media outreach, and community events, these organizations aim to educate the public on the benefits of organ donation and address misconceptions. 
One prominent campaign is the National Organ Donation Awareness Campaign, which emphasizes the importance of donation and encourages Malaysians to pledge as donors. By showcasing testimonials from donors, recipients, and medical professionals, these campaigns bring a personal, relatable perspective to the issue, highlighting the life-changing impact of organ donation. The Ministry of Youth and Sports should seize this opportunity to promote organ donations and a healthy lifestyle, as the youth represent our future.

How to Become an Organ Donor in Malaysia
Easy peasy! For those interested in becoming an organ donor, the process is straightforward. Malaysians can pledge their organs by registering online via MySejahtera or filling out a donor pledge form available from the Ministry of Health Malaysia. Once registered, it is advisable to inform family members of this decision, as family consent is required in the event of deceased organ donation.

Don't worry! Registration as an organ donor is not legally binding, which means donors or their families can withdraw consent if they change their minds. This flexibility ensures that individuals are free to make choices in line with their personal and family beliefs.

The Future of Organ Donation in Malaysia
To bridge the gap between organ demand and supply, Malaysia must continue to address cultural, religious, and informational barriers. Increasing public education, enhancing trust in the healthcare system, and further engagement with religious leaders can all contribute to more Malaysians embracing organ donation. More importantly, the development of medical infrastructure and training is vital. Enhancing support for transplant centers and providing advanced training to healthcare providers will guarantee the efficient and effective use of donated organs. Malaysia has also been exploring partnerships with international organ donation networks to improve outcomes for patients on waiting lists.

Conclusion
A gift of life. Organ donation is a gift that transforms lives, offering recipients a second chance to enjoy life’s moments with their loved ones. Becoming an organ donor is a deeply personal choice, but it is one that can have far-reaching positive impacts. Let us come together to make organ donation a priority, giving hope and life to those who need it most. Ikrar kita, harapan dunia.


REFERENCES:


1. https://www.moh.gov.my/moh/resources/auto%20download%20images/589d7a9b94f34.pdf
2. https://data.moh.gov.my/dashboard/organ-donation
3. https://www.dermaorgan.gov.my/
4. Mail, M. (1970, January 1). Malaysia’s first liver recipient laid to rest in Sungai Petani. Malay Mail. https://www.malaymail.com/news/malaysia/2021/03/02/malaysias-first-liver-recipient-laid-to-rest-in-sungai-petani/1954309#:~:text=SUNGAI%20PETANI%2C%20March%202%20%E2%80%94%20Malaysia's%20first,died%20of%20liver%20complications%20this%20morning%20was
5. National Organ, Tissue and Cell Transplantation Policy by Ministry Of Health Malaysia, June 2007.





The Role of Applied Muscle Tension : Enhancing Blood Donation Experience


06 December 2024 by NUR ARZUAR BIN ABDUL RAHIM

Photo By IPPT
Dr. Alia bt Mohd Nasir (Master of Medicine (Transfusion Medicine)), Dr. Nur Arzuar Bin Abdul Rahim (Pediatrician)

"20 years of celebrating giving: thank you blood donors!" is the theme for this year's 20th World Blood Donor Day (WBDD) celebration. The World Health Organization (WHO) claims that the purpose of the annual worldwide celebration is to honour the voluntary, unpaid service of blood donors in preserving lives, enhancing health and increasing public awareness of the value of blood donation.

The National Blood Centre in Kuala Lumpur reports that blood donors currently make up about 2.3% of the population which is far from the WHO recommendation of 5%. By 2030, our national transfusion medicine services hope to raise the nation's blood donation rate to between 35 and 40 donors for every 1000 people.
A healthy and willing blood donor is the first step toward collecting enough blood in a safe and high-quality manner. We should take precautions during the donation process to ensure a convenient and safe environment for blood donors. Blood donation process places physiological and psychological impact on blood donors (see Figure 2). Blood donation is generally a safe procedure. Nevertheless, any medical procedure cannot be excluded from hundred percent risk free. Some donors experience vasovagal reaction in response to seeing blood or a needle, which could cause harm in the event of a fall.   
Blood donation decreases blood pressure which then causes cerebral hypoperfusion and lead to vasovagal reaction such as giddiness, vomiting, fainting and seizures. The procedure of donating blood can be negatively impacted and viewed by a negative donor reaction, especially for young and first-time donors.

                                                                                                                            Photo By internet source
                                       Figure 2 : France, C., France, J.L. (2013). Blood Donation. In: Gellman, M.D., Turner, J.R. (eds) Encyclopedia of Behavioral Medicine. Springer, New York, NY.

One technique that most donors overlook is the application of applied muscle tension (AMT) in order to prevent vasovagal reactions by increasing blood pressure levels through venous output (vascular mechanism) and cardiac output (cardiac mechanism) and eventually leads to brain perfusion. 
You can use this technique both at the donation site and after the donor leaves. It is essential that the personnel at the blood collection centre provide instructions and directions.

Application Techniques of AMT
In order to facilitate the return of blood flow to the brain, AMT entails repeated, rhythmic contractions (tensing) and relaxation of the muscles in the hands, upper limbs, chest, abdomen, buttocks, lower limbs, and foot. 
When should I perform? Begin prior to blood donation. Continue until the donation is complete; you can also use it after the blood donation. Although there are several approaches, our National Blood Centre recommends 5 seconds of muscular tensing followed by 10 seconds of relaxation. We carry out the process five times for each muscle.
To learn how to use applied muscle tension to help prevent fainting, see the American Red Cross's YouTube video.

                                                                                                                

Photo By internet source
Figure 3: Applied Muscle Tension Technique (Resource: National Blood Centre Education Notice)


Applied Muscle Tension for Reducing Blood Donor Vasovagal Reactions: A Meta-Analysis of Randomizes is reviewed by JM Ganem et al. Controlled trials published in the Haematology, Transfusion, and Cell Therapy Journal in October 2023 confirmed that AMT is a proven method for lowering vasovagal symptoms after blood donation. In addition to perhaps improving the donor's overall experience, the intervention may raise donor retention rates.

Afif Alam Faizli et al. conducted a local study that demonstrated that AMT was a successful tactic in lowering the incidence of VVR among young blood donors in Kelantan. The National Blood Centre advises donors at high risk of acquiring VVR to implement AMT. The National Blood Centre recommends the application of AMT as a physiological support to minimise vasovagal reaction and prevent its recurrence during the next blood donation.
Furthermore, low blood donation rates are caused by a number of factors, including public misconceptions about the consequences of blood donation, logistical obstacles which demotivates the donors to come and donate, young people's lack of awareness, donors with health conditions such anaemia and heart conditions, and ignorance and fear of blood.



                                                                 

Photo By internet source
Figure 4 : Category of Vasovagal Reaction in 2020-2021 ( Resource : Hemovigilance Report 2020-2021 National Transfusion Medicine Service in Malaysia, Published by National Hemovigilance Coordinating Centre, National Blood Centre (e-ISSN : 2735 - 2277 MOH/P/PDN/02.23(AR)-e)


Involving blood donors in the planning of a blood campaign in collaboration with the relevant blood bank may will encourage them to donate again. A more sustainable blood donation habit and supply could be supported by regular, special events or activities that show gratitude to donors, like WBDD Donor Day, or by celebrating the joyous festival together and regularly reaching out to the public on social media. These activities not only satisfy donors but also promote a channel for efficient and regular communications between donors and transfusion services.

In conclusion, ensuring the safety of blood donors is paramount in fostering a positive and sustainable blood donation culture. By implementing rigorous protocols, providing thorough education, and utilizing techniques like applied muscle tension (AMT), we can significantly reduce the risks associated with blood donation. Prioritizing donor comfort and well-being not only enhances the donation experience but also encourages greater participation and retention. Together, we can foster a safer and healthier society where everyone celebrates and embraces the act of giving blood. Thank you to every blood donor—your generosity makes a profound difference in the lives of many. 
We invite everyone to donate blood at PPUSM Bertam, National Blood Centre, Kuala Lumpur, or the respective blood bank in the country! See you there! 


References :


1. Applied Muscle Tension (AMT) Education Notice, National Blood Centre , Kuala Lumpur 
2. Garasi Bernama : Meeting The Country's Need For “New Blood”. Available from https://garasi.bernama.com/stories/malaysias-need-for-new-blood
3. World Health Organization (WHO) World Blood Donor Day. Available from: https://www.who.int/westernpacific/news-room/events/world-blood-donor-day
4. American Red Cross: Say Goodbye To Fainting When Donating Blood. Available from https://www.redcrossblood.org/local-homepage/news/article/fainting-donating-blood-rcbs.html
5. Applied Muscle Tension For Reducing Blood Donor Vasovagal Reactions: A Meta-Analysis Of Randomized Controlled Trials. Jm Ganem et.al
6. The Effectiveness of Applied Muscle Tension in reducing Vasovagal Reaction among Young Blood Donors in Kota Bharu Afif .Alam Faizli et.al
7. Hemovigilance Report 2020-2021 National Transfusion Medicine Service in Malaysia, Published by National Hemovigilance Coordinating Centre, National Blood Centre (e-ISSN : 2735 - 2277 MOH/P/PDN/02.23(AR)-e)
8. France, C., France, J.L. (2013). Blood Donation. In: Gellman, M.D., Turner, J.R. (eds) Encyclopedia of Behavioral Medicine. Springer, New York, NY. 





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