Introduction: Many studies have investigated the effects of music on perioperative anxiety and its implication on anaesthetic practice, however there are limited number of studies reported for religious or spiritual intervention in this aspect. We investigated the effects of listening to Islamic praises (Dzikr) and nature-based sounds delivered via headphones as non-pharmacological interventions for perioperative anxiety. Materials and Methods: Sixty-three Muslim patients scheduled for elective lower limb surgery under regional anaesthesia were randomly assigned to listen to Dzikr (Group A), nature-based sounds (Group B) or given headphones without any sounds (Group C). Anxiety levels were assessed using a visual analogue scale for anxiety (VAS-A). Physiological responses (mean arterial pressure, heart rate and respiratory rate) as well as patients’ overall satisfaction level were documented. Results: Patients in Group A demonstrated statistically significant lower VAS-A scores compared to those in Group B and C at 30-minutes after skin incision (p=0.002 and p=0.001 respectively) and at the end of the surgery (p=0.028 and p<0.001 respectively). Patients in Group A recorded significantly higher satisfaction levels compared to those in Groups B (p=0.038) and C (p=0.001). No significant differences were seen for the physiological responses, nor was there any additional anxiolytic requirement among the three groups. Conclusion: Listening to Dzikr among Muslim patients was more effective in reducing perioperative anxiety levels when compared to nature -based sounds, in patients who had undergone lower limb surgery under regional anaesthesia. ><0.001 respectively). Patients in Group A recorded significantly higher satisfaction levels compared to those in Groups B (p=0.038) and C (p=0.001). No significant differences were seen for the physiological responses, nor was there any additional anxiolytic requirement among the three groups. Conclusion: Listening to Dzikr among Muslim patients was more effective in reducing perioperative anxiety levels when compared to nature -based sounds, in patients who had undergone lower limb surgery under regional anaesthesia.

Porto-spleno-mesenteric vein thrombosis is a rare, life-threatening condition of extrahepatic portal venous system thrombosis. We report a rare case of a 49-year-old lady with late presentation of acute portal vein thrombosis in a non-cirrhotic liver with an incidental finding of left adnexal teratoma. She presented with a one-week history of severe abdominal pain associated with vomiting and diarrhea. She gave no history of prior risk for venous thromboembolism or liver diseases. Physical examination revealed a tender mass extending from suprapubic to left iliac fossa. Abdominal computed tomography scans showed a well-defined fat-containing left adnexal mass, likely a benign teratoma, with no involvement of surrounding structures or calcification. There was evidence of porto-splenic-mesenteric vein thrombosis with liver infarction, bowel and splenic ischemia. Management of the extensive thrombosis causing multi-organ failure includes resuscitation, supportive care and treatment of thrombosis. Treatment options include early anticoagulation and if feasible, thrombolysis.