A narration of the development of staff, infrastructure and buildings in the various parts of the country is given in this paper. The role of universities and other institutions of learning, public health, palliative care, nuclear medicine and cancer registries is described together with the networking that has been developed between the government, non-governmental organisations and private hospitals. The training of skilled manpower and the commencement of the Master of Clinical Oncology in the University of Malaya is highlighted. Efforts taken to improve the various aspects of cancer control which includes prevention of cancer, early detection, treatment and palliative care are covered. It is vital to ensure that cancer care services must be accessible and affordable throughout the entire health system, from the primary care level up to the centres for tertiary care, throughout the whole country.
MeSH terms: History of Medicine*; Humans; Malaysia; Medical Oncology*; Neoplasms
Tuberculosis (TB) is a well recognised occupational hazard for healthcare workers (HCWs). Concerns on the safety of healthcare settings in Malaysia was raised following a report of 25 HCWs working in 11 general hospitals in Malaysia who were infected with TB in 2004 being publicised in the media recently. As the disease burden in general is high in Malaysia, due attention should be given to this disease in our healthcare facilities including the radiology department, an often neglected area in TB infection control programmes. This article focuses on the key control measures that can be implemented in radiology departments in a developing country with limited resources.
Anomalous origin of the right pulmonary artery is a rare form of congenital heart disease. It usually presents in early infancy with heart failure and rapid development of pulmonary hypertension. There are about 131 cases reported in the literature and we report one such case.
GATEWAY cloning technology (Invitrogen) takes advantage of bacteriophage λ site-specific recombination. The life cycle of λ alternates between the lytic and lysogenic stages. DNA can be inserted or excised from the Escherichia coli host genome by recombination between specific sites, AttB (bacterial) and AttP (phage). This process is mediated by the λ proteins int (integrase) and xis (excisionase), and a host protein IHF (integration host factor). GATEWAY cloning technology uses this process to insert fragments of DNA directionally into specially adapted vectors. These vectors contain a negative selectable marker, the ccdB gene, to select against nonrecombinant clones. Promoter or gene fragments are made GATEWAY compatible with adapter primers and amplified by PCR. These fragments are used in a BP clonase reaction to create ENTRY clones. Usually the pDONR vector used to generate such ENTRY clones is chosen so that the antibiotic selection marker is different from that of the pDEST vector, which finally generates an expression clone. This favors the selection of the expression clone and selects against the pENTRY clone. Now that many pENTRY and pDEST vectors have been generated and made available in stock centers, the antibiotic resistance genes are predetermined and may not always be compatible with each other. This problem is frequently experienced by plant researchers, since many full-length cDNA libraries have been generated using the pDONR-TOPO, pDONR221, or pENTR1A vectors, which are all kanamycin resistant in bacteria, and many pDEST vectors have been adapted from conventional plant transformation vectors, which are also frequently kanamycin resistant in bacteria. The following protocol describes ways in which such difficult vector combinations can be used effectively to obtain the appropriate expression clone without having to convert the pENTRY clone or pDEST clone to vectors with compatible antibiotic resistances.
Intra-operative frozen section plays an important role in the management of surgical patients and yet it must be used prudently to avoid the indiscriminate usage of this important technique. As it is subjected to many limitations in comparison to the paraffin embedded tissue sections, this review aims to highlight the important concepts and principle of intra-operative frozen section consultation as well as discussing the limitations of this technique. This will then allow the endusers of this technique to be more informed and more selective in their decisions when requesting for a frozen section report.
Mycobacterium bovis bacille Calmette-Guèrin (BCG) represents one of the most promising live vectors for the delivery of foreign antigens to the immune system. A recombinant BCG containing a synthetic gene coding for the malarial epitopes namely, the fragment 2 of region II of EBA-175 (F2R(II)EBA) and the repeat sequence of the circumsporozoite protein NANP generated in favour of mycobacterium codon usage using assembly PCR was constructed. Two T-cell epitopes of the 6-kDa M. tuberculosis early-secreted antigenic target (ESAT-6) antigen were also clone in the same construct. Expression of the synthetic gene was driven by the heat shock protein 65 (hsp65) promoter from M. tuberculosis and the signal peptide from the MPT63 antigen of M. tuberculosis. Expression of the composite epitopes was detected by Western blotting of the cell extract and culture supernatant of the recombinant clones using a specific rabbit polyclonal antibody against F2R(II)EBA. This study demonstrates the possibility of cloning and expressing immunogenic epitopes from causative agents of two important diseases: malaria and tuberculosis (TB) in a single recombinant BCG construct.
Psychoanalysts believed that early mother-child relationships form the prototype of all future relationships and the outcome of adolescents development depends on their ego-strength. Object relations theory believed that intrapsychic process mediates interpersonal interaction to develop a sense of secure self and adolescents must relinquish the internalized other in order to develop a more mature sense of self. Social-relation theory believed that mothers and fathers provide different socialization experiences. Self-esteem depends on the functioning of the whole family in which adolescent is intimately related to the dyadic relationship in a family. There is an association between interparental conflict and adolescent's self-esteem and problem behaviour.
This paper investigates the pattern of sexual offence cases attended at the One Stop Crisis Center (OSCC) of the Accident and Emergency Department, Hospital Universiti Sains Malaysia (HUSM), Kelantan. A total of 439 reported sexual offence cases were examined over a period of 4 years from 2000 to 2003. Sexual offence constituted by male partner or boyfriend in 18.9%, by relatives in 27.3% and by "others" in 53.8% of cases. Only 0.7% of victims did not attempt to lodge a police report. There is a significant relationship between occupation and the risk of experiencing sexual violence. Students were mostly targeted by the perpetrator throughout the study period. Among the offences, rape cases were the highest in number, among those who attended at the OSCC, HUSM with a total of 72.7%; followed by 27.3% of incest; 26.4% of child sexual abuse; 4.8% of sodomy and lastly 1.6% of gerontophilia cases. Only 70% of the specimens obtained from sexual offences victims were sent for laboratory analysis. The result remained negative in 82.4% specimens and thus the laboratory analysis result is merely functioning as a supportive evidence for sexual offence cases attended at OSCC. The studies showed that most of the sexual assault perpetrators were known to the victims. The place of crime was also known to the perpetrators. Health sectors of various levels should be working in conjunction to promote a societal changes to improve more of the women's right and thus to reduce the violence crime.
While evidence indicates that early stage disease has better prognosis, the effect of delay in presentation and treatment of patients with non-small cell lung cancer (NSCLC) on survival is debatable. A retrospective study of 122 Malaysian patients with NSCLC was performed to examine the presentation and treatment delay, and its relation with patient survival. Median (25-75% IQR) interval between onset of symptoms and first hospital consultation (patient delay) and between first hospital consultation and treatment or decision to treat (doctor delay) were 2 (1.0- 5.0) and 1.1 (0.6-2.4) months respectively. The median survival rates in patient delay of <1, 1 to 3, and >3 months were 4.1 (9.9-1.7), 5.1 (10.9-3.2) and 5.7 (12.3-2.1) months respectively (log rank p=0.648), while in doctor delay, <30, 30-60, >60 days, the rates were 4.1 (10.8-1.8), 7.6 (13.7-3.2) and 5.3 (16.0-3.0) months respectively (p=0.557). Most patients presented and were treated in a relatively short time, and delays did not appear to influence survival. This Asian data is consistent with those from Western population, reiterating the need for public health measures that can identify disease early..
MeSH terms: Carcinoma, Non-Small-Cell Lung; Health Personnel; Humans; Lung Neoplasms; Physicians; Prognosis; Public Health; Referral and Consultation; Retrospective Studies; Survival Rate; Asian Continental Ancestry Group
Medical standby is the provision of emergency medical care and first aid for participants and/or spectators in a pre-planned event. This article describes the framework and the demographics of a medical standby at the 4(th) National Youth Camping and Motivation Program in Pasir Puteh, Kelantan from 30(th) July until the 3(rd) August 2004. The framework of the medical team is described based on the work process of any medical stand by. A medical encounter form was created for the medical standby defining the type of case seen (medical or trauma), name, age, race and diagnosis of the patient. We concluded that interagency collaboration during the initial planning and during the event itself is needed to ensure the smooth running of the medical standby. Most of the medical encounters were minor illnesses which are similar to previous studies and there was no case transferred to the hospital during that period.
X-ray mammography has been the backbone of early detection of breast cancer. Several large scale systematic studies have shown that judicious use of X-ray mammography can indeed save life. However, though reasonably sensitive, X-ray mammography lacks in specificity leading to many unnecessary biopsies. Scintimammography is a relatively new imaging method to demonstrate cancer tissue in the breast. A radiopharmaceutical agent (Tc-99m Sestamibi) is administered intravenously and images of the breast are taken under a Gamma Camera. There is no need for any manipulation like compression of the breast as required to be done during mammography. The radiopharmaceutical accumulates in the breast in the presence of cancer tissue which can easily be seen in the images. The affinity of the cancer tissue to this radiopharmaceutical is up to 9 times in comparison to normal breast tissue. Several multi centric studies with blinded image interpretation have established the sensitivity and specificity of scintimammography to be above 85 and 90 % respectively as compared to 89 and 14 % respectively for X-ray mammography. The positive and negative predictive values of scintimamography are 70 and 83 % as against 49 and 57 % respectively for X-ray mammography. With the increasing availability of Nuclear Medicine facilities it is expected that more and more patients will benefi with the use of this new imaging modality .
MeSH terms: Biopsy; Breast; Breast Neoplasms; Humans; Mammography; Nuclear Medicine; Radiography; X-Rays; Gamma Cameras; Technetium Tc 99m Sestamibi; Radiopharmaceuticals; Early Detection of Cancer
Use of instruments or questionnaires in different cultural settings without proper validation can result in inaccurate results. Issues like reliability, validity, feasibility and acceptability should be considered in the use of an instrument. The study aims to determine the usefulness of the CIS-R Malay version in detecting common mental health problems specifically to establish the validity. The CIS-R instrument (PROQSY* format) was translated through the back translation process into Malay. Inter rater reliability was established for raters who were medical students. Cases and controls for the study were psychiatric in patients, out patient and relatives or friends accompanying the patients to the clinic or visiting the inpatients. The Malay version of CIS-R was administered to all cases and controls. All cases and controls involved in the study were rated by psychiatrists for psychiatric morbidity using the SCID as a guideline. Specificity and sensitivity of the CIS-R to the assessment by the psychiatrist were determined. The Malay version of CIS-R showed 100% sensitivity and 96.15% specificity at a cut off score of 9. The CIS-R can be a useful instrument for clinical and research use in the Malaysian population for diagnosing common mental disorders like depression and anxiety.
MeSH terms: Anxiety; Depression; Feasibility Studies; Humans; Inpatients; Malaysia; Mental Health; Outpatients; Psychiatry; Surveys and Questionnaires; Sensitivity and Specificity; Students, Medical; Translating; Translations; Reproducibility of Results; Friends
The implementation of problem-based learning started in 1969 and has spread since then throughout different parts of the world with variations in its implementation. In spite of its growth and advantages, there is continuing debate about its effectiveness over the conventional teaching learning methods. In the School of Dental Sciences (SDS), Universiti Sains Malaysia (USM), the Doctor of Dental Sciences (DDS) program follows a 5-year integrated curriculum. Basically the curriculum is problem-based and community oriented. This study was to explore the perception of DDS students about PBL sessions. This questionnaires-based cross sectional descriptive study were carried out on all the 110 students of the SDS who completed their second year of the course and participated in PBL sessions. Ninety five (86%) students responded to the questionnaires. Dental students found PBL session interesting and wanted to maintain PBL from the beginning of year 2 up to the end of year 3. Most students reported their participation in discussion during PBL sessions but the level of participation varied. Some of them worked hard to prepare themselves for discussion while others were relatively passive. PBL helped them with in-depth understanding of certain topics and link their basic science knowledge to clinical classes. They felt that guidance from subject specialists and well-prepared facilitators of the sessions were beneficial. The students believed that repetition of triggers from year to year discouraged their active search for learning issues. Majority of the students were undecided or disagreed about the availability of adequate learning resources Most of the students were undecided or disagreed about the availability of adequate learning resources for their self-study. Reviewing and renewing the PBL triggers, providing guidelines for searching for resource materials and briefing the students and facilitators about the philosophy and principles of PBL may make the PBL sessions more beneficial.
This study investigates the effects of tocotrienol-rich palm vitamin E supplementation on exercise-induced lipid peroxidation and endurance performance in the heat. In a double blind, cross-over study, eighteen healthy, male recreational athletes completed two endurance running trials, until exhaustion, on a motorized treadmill at 70% VO2max on two separate occasions following a 6-week supplementation regimen of either tocotrienol-rich palm vitamin E (E) or placebo (P). Both trials were conducted in the heat (31°C, 70% relative humidity). During the trials, rectal temperature (Trec), ratings of perceived exertion (RPE) and oxygen uptake (VO2) were recorded. Blood samples were collected for the determination of plasma volume changes (PVC), malondialdehyde (MDA), creatine kinase (CK), total antioxidant status (TAS) and vitamin E. After the supplementation regimen, serum alpha-tocopherol increased ~33% but serum concentrations of tocotrienols were negligible. No significant differences were evident in mean Trec, RPE, VO2 or in the time to exhaustion between the E-supplemented and the placebo- supplemented groups. Similarly, mean PVC, CK and TAS were also not different between the two groups. Resting plasma mean MDA concentration in the E-supplemented group was significantly lower than that in the placebo-supplemented group. At exhaustion, plasma mean MDA was higher than the resting values in both groups. Although tocotrienol-rich palm vitamin E supplementation decreased lipid peroxidation at rest and, to some extent, during exercise in the heat, as evident from the lower MDA levels, it however did not enhance endurance running performance or prevent exercise-induced muscle damage or influenced body core temperature or plasma volume changes during exercise in the heat. Key Pointsreduced lipid peroxidation at rest.did not enhance endurance running performance in the heat.did not prevent exercise-induced muscle damage as indicated by CK activity.
The purpose of this study was to assess relative total body fat and skinfold patterning in Filipino national karate and pencak silat athletes. Participants were members of the Philippine men's and women's national teams in karate (12 males, 5 females) and pencak silat (17 males and 5 females). In addition to age, the following anthropometric measurements were taken: height, body mass, triceps, subscapular, supraspinale, umbilical, anterior thigh and medial calf skinfolds. Relative total body fat was expressed as sum of six skinfolds. Sum of skinfolds and each individual skinfold were also expressed relative to Phantom height. A two-way (Sport*Gender) ANOVA was used to determine the differences between men and women in total body fat and skinfold patterning. A Bonferroni-adjusted alpha was employed for all analyses. The women had a higher proportional sum of skinfols (80.19 ± 25.31 mm vs. 51.77 ± 21.13 mm, p = 0. 001, eta(2) = 0.275). The men had a lower proportional triceps skinfolds (-1.72 ± 0.71 versus - 0.35 ± 0.75, p < 0.001). Collapsed over gender, the karate athletes (-2.18 ± 0.66) had a lower proportional anterior thigh skinfold than their pencak silat colleagues (-1.71 ± 0.74, p = 0.001). Differences in competition requirements between sports may account for some of the disparity in anthropometric measurements. Key PointsThe purpose of the present investigation was to assess relative total body fat and skinfold patterning in Filipino national karate and pencak silat athletes.The results seem to suggest that there was no difference between combat sports in fatness.Skinfold patterning was more in line with what was reported in the literature with the males recording lower extremity fat.
In an attempt to test the conceptual model by Lane and Terry, the purposes of this study were 1) to assess mood states in non-depressed and depressed young karate athletes; 2) to assess mood states in relation to performance in young karate athletes. The participants were recruited from the 2004 Malaysian Games (72 males, 19.20 ± 1.16 years; 37 females, 18.78 ± 0.88 years). The athletes were divided into winners (medalists) and losers. The Brunel Mood Scale (BRUMS) was administered prior to the start of competition. MANOVA was employed to treat the data, while Pearson correlations were calculated for mood states in each depressed mood group and by gender. In terms of non-depressed and depressed mood, tension in the females was higher in the depressed group (5.61 ± 3.02 vs. 3.11 ± 1.90, p = 0.026, eta(2) = 0.133), as was fatigue (3.64 ± 2.61 vs. 0.89 ± 1.69, p = 0.006, eta(2) = 0.199). Tension in the males was higher in the depressed group (4.41 ± 2.52 vs. 1.50 ± 1.55, p < 0.001, eta(2) = 0.215), as was anger (1.43 ± 1.88 vs. 0.25 ± 1.00, p = 0.019, eta(2) = 0.076). The highest associations among mood subscales were between anger and depression (r = 0.57), and between depression and fatigue ( r = 0.55) in depressed males. The female winning karateka scored higher on anger (3.08 ± 2.96 vs. 1.29 ± 2.24, p = 0.046, eta(2) = 0.109). The highest correlations between mood dimensions in depressed females were between depression and anger (r = 0.85) and between depression and confusion (r = 0.85). Contrary to previous research on the influence of depression on anger, only the female winners scored higher on anger. Several negative mood dimensions were higher in both male and female depressed groups, lending some support to the conceptual model advanced by Lane and Terry. Key PointsTo date, there is no information about the relationship between mood and martial arts performance in Malaysian athletes.There might be cultural differences in the way Malaysian athletes respond to psychological questionnaires.The mood-performance and depressed mood-non-depressed mood relationships might be mediated by age.