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ISLAMIC MEDICAL EDUCATION RESOURCES 04

0004-MANAGEMENT OF DISEASE

Background reading material for the medicine & fiqh panel held on 29th April 2000 at the Kulliyah of Medicine, International Islamic University, Kuantan, MALAYSIA by Professor Omar Hasan Kasule Sr.

OUTLINE

14.5.1 EXAMINATION AND INVESTIGATION

A. History

B. Clinical And Mental State Examination

C. Laboratory Investigations

D. Radiological/Imaging Investigations

E. Invasive Investigations

 

14.5.2 MEDICAL TREATMENT

A.  Destruction

B.  Replacement

C.  Modification of Biological Response

D.  Psycho-active

E.   Supportive

 

14.5.3 SURGICAL TREATMENT

A. Resection

B. Restorative/Reconstructive

C. Replacement

D. Anesthesia And Critical Care

E. Emergency Treatment/Critical Care

 

14.5.4 PSYCHOTHERAPY

A.

B.

C.

D.

E.

 

14.5.5 OTHER TREATMENT

A. Spiritual, Traditional, Alternative, And Complementary Therapy

B. Supportive Treatment

C. Irradiation

D. Immunotherapy

E. Genetic Therapy

 

14.5.1 EXAMINATION AND INVESTIGATION

A. HISTORY

Consent & Confidentiality

Ibadat: history as a form of taubat

Munakahaat: discovering foster relations during history-taking

Muamalaat: discussing costs of medical care with the patient

Jinayat: patient volunteering information about crimes

 

B. CLINICAL and MENTAL STATE EXAMINATION

Consent & confidentiality

Situations in which consent is not obtained because of necessity, dharurat

Examination by a care giver of the opposite gender

 

C. LABORATORY INVESTIGATIONS

PURPOSE

(a) Provide base-line information. (b) Establish diagnosis and exclude alternative diagnosis. Process of decision making. Decision tree. Provisional diagnosis and final/discharge diagnosis. (c) Evaluate severity. (d) Plan treatment. (e) Predict prognosis

 

TYPES OF INVESTIGATIONS

Hematological: anemia, hemoglobinopathies, bleeding disorders, blood grouping, blood compatibility

Histopathological:

Microbiological: bacteriological, virological, parasitological, etc

Biochemical: RFT, LFT, fluids, electrolytes, acid-base balance

Genetic/chromosomal analysis

Biological markers: Trophoblastic tumors & HCC: hCG; Germ cell tumors: AFP, hCG, HBD, PLAP; GIT tumors: CEA; Ovarian cancer: CA125; Prostate cancer: PSA; Breast cancer: CA and S-3; and Skin cancer: SCC

 

D. RADIOLOGICAL/IMAGING INVESTIGATIONS

X-ray, MRI, ultra-sound, radio-imaging

 

E. INVASIVE INVESTIGATIONS

Endoscopy (GIT, Colposcopy, peritoneal)

Coronary angiography

Biopsy

Autopsy

Diagnostic laparatomy

 

14.5.2 MEDICAL TREATMENT

A.  DESTRUCTION

Antibiotics

Cytotixics

Anti-metabolites

Antagonists

Antitoxins

Binding and removal

Detoxification

 

B. REPLACEMENT

Hormones

Stimulation of natural secretion

Fluids and electrolytes

 

C. BIOLOGICAL MODIFICATION & MODULATION

Modification of biological response by interferons

 

D. PSYCHOACTIVE

 

E. OTHER

Diet

 

14.5.3 SURGICAL TREATMENT

A. RESECTION

SURGERY: curative or palliative

Physiological response to surgery: sympathetic nervous system, acute phase response, endocrine, vascular

 

B. RESTORATIVE/RECONSTRUCTIVE

PLASTIC SURGERY

Close wounds that fail to heal. Hand surgery for  reconstruction, reduction, and augmentation

COSMETIC SURGERY

SEX CHANGE

 

C. REPLACEMENT

TRANSPLANTATION

Organs: kidney, heart, kidney

Rejection: hyperacute, acute, chronic; prevention: hla tissue typing & immune suppression

Ethical issues: definition of death, commercial and criminal exploitation, cost

 

TRANSFUSION

Types: RBC transfusion, plasma substitutes,  platelets transfusion

Problems of transfusion: immune complications & transfer of infection

 

D. ANESTHESIA and CRITICAL CARE

PRE-OPERATIVE TESTS:

biochemical, CBC, CXR, HIV, ECG

ASSESSMENT OF RISK FOR SURGERY:

CVS, Respiration, obesity, diabetes mellitus

PRE-MEDICATION:

anxiolytics, drying secretions, analgesia

GENERAL ANESTHESIA:

induction, maintenance, reversal and recovery

LOCAL ANESTHESIA:

local infiltration, field block of nerves, spinal, epidural, para-vertebral

OPERATING THEATER:

antiseptic environment, mixing of male and female in confined space

 

E. EMERGENCY TREATMENT/CRITICAL CARE

SITUATIONS

Respiratory failure: Adult RDS is sue to sepsis, trauma, emboli, severe head injury, aspiration, near drowning, irritant gas or chemical, drug overdose, liver failure, transfusion reaction, diabetic keto-acidosis

Multiple organ failure:

Cardiac failure:

Circulatory shock:

 

CARDIO-RESPIRATORY SUPPORT

Mechanical ventilation. Intubation. Arterial gas monitoring.

 

14.5.4 PSYCHOTHERAPY

 

14.5.5 OTHER TREATMENT

A. SPIRITUAL, TRADITIONAL, ALTERNATIVE, and COMPLEMENTARY THERAPY

Blood-letting in Ramadhan, hukm al haajim wa al mahjuum fi ramadhan (KS 333)

 

B. SUPPORTIVE TREATMENT

FLUIDS and ELECTROLYTES

 

NUTRITIONAL SUPPORT:

Enteral & parenteral

Patient can not be forced to eat, la yukrahu al mariidh ala al ta’am wa al sharaab (KS 505). The patient should be given any food that they like, idha ishtaha marridh ahadukum shai’an faliyuti’imuhu (KS 505)

Some food should be avoided, ma yajibu tajannubuhu min al ta’am (KS 506)

 

MONITORING NUTRITION: diet charts, weight, hematology, biochemistry, anthropometry

EXERCISE

The best medicine is walking, khayru ma tadaawaytum bihi al mashyu

 

C. IRRADIATION

 

D. IMMUNOTHERAPY

 

E. GENETIC THERAPY

 

DISCUSSION

EXAMINATION and INVESTIGATION

Consent and confidentiality

Ruling on patient volunteering information about past criminal activity

Ruling about a patient revealing information about anticipated criminal activity

Ruling on medical examination by a person of the opposite gender

 

MEDICAL TREATMENT

1. Shariat guidelines for assessing comparative benefits and disadvantages of medications

 

SURGICAL TREATMENT

Rulings on cosmetic surgery

Rulings on sex change surgery

Ruling on the ethical issue of definition of death in transplantation

Ruling on possible criminal actions encouraged by wide-spread availability of transplantation

 

OTHER TREATMENTS


1. Ruling on forcing a patient to eat or drink

Professor Omar Hasan Kasule Sr. April 2000