Nerve conduction study is essential in the diagnosis of focal neuropathies and diffuse polyneuropathies. Age, height and body mass index (BMI) can affect nerve velocities as reported by previous studies. We studied the effect of these factors on median, ulnar, common peroneal and sural nerves among healthy Malay subjects. We observed slowing of nerve conduction velocities (NCVs) with increasing age and BMI (except ulnar sensory velocities). No demonstrable trend can be seen across different height groups except in common peroneal nerve.
MeSH terms: Nerve Tissue; Neural Conduction; Peroneal Nerve; Polyneuropathies; Sural Nerve; Body Mass Index
The clinicopathological conference, popularly known as CPC primarily relies on case method of teaching medicine. It is a teaching tool that illustrates the logical, measured consideration of a differential diagnosis used to evaluate patients. The process involves case presentation, diagnostic data, discussion of differential diagnosis, logically narrowing the list to few selected probable diagnoses and eventually reaching a final diagnosis and its brief discussion. The idea was first practiced in Boston, back in 1900 by a Harvard internist, Dr. Richard C. Cabot who practiced this as an informal discussion session in his private office. Dr. Cabot incepted this from a resident, who in turn had received the idea from a roommate, primarily a law student.
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.
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 CISR showed 100% sensitivity and 96.15% specificity at a cut off score of 9. The CISR can be a useful instrument for clinical and research use in the Malaysian population for diagnosing common mental disorders like depression and anxiety.
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 4th National Youth Camping and Motivation Program in Pasir Puteh, Kelantan from 30th July until the 3rd 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.
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.
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.
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.
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.
Emotional incontinence is a disorder of emotional control following brain damage. It refers to the heightened tendency to cry or less commonly laugh, out of proportion to the underlying mood. Recognition of this phenomenon is often lacking as it is confused with other related sequelae of brain damage such as depressions. This is a case report of an elderly female exhibiting poststroke emotional incontinence.
Two hundred and seventeen diabetic patients attending the eye clinic were examined to determine the prevalence of retinal changes, and the association between diabetic retinopathy and risk factors. A detailed fundus examination was done, after dilating the pupils, using 90 D lens and slitlamp biomicroscope. Diabetic retinopathy was detected in 112 patients (51.6%). Background retinopathy was seen in 40 out of 217 (18.4%), pre-proliferative retinopathy in 11 (5.1%), proliferative retinopathy in 61 (28.1%) and maculopathy in 58 (26.7%) patients. Factors significantly associated with occurrence of retinopathy were duration of diabetes, presence of hypertension and presence of systemic complications (diabetic foot ulcer, lower limb amputation, nephropathy and peripheral neuropathy).
Systemic Lupus Erythematosus (SLE) is a multi-systemic autoimmune disease with renal involvement being one of the most frequent and serious manifestations of the disease. The aim of the study is to analyze the treatment and renal outcome of patients with lupus nephritis (LN) WHO class III and IV on cyclophosphamide (CYC). We retrospectively identified 41 patients with biopsy proven LN who was given either oral or intravenous CYC. The male : female ratio was 4:37; with a mean age of 31.7 ± 9.8 years at presentation. 36 patients (87.8%) had LN class IV and only five patients (12.2%) with LN class III. The mean serum creatinine at presentation was 87.4 ± 37.2 μmol/L with mean follow-up of 84 ± 78 months. A total of 30 patients (73.2%) completed 12 courses (CR), 25.8% (n = 8) had partial response and 3.2% (n = 1) had no response (NR). Of the remaining 11 patients, two patients (4.9%) died during the treatment, three patients (7.3%) defaulted treatment and five patients (12.2%) are still receiving on-going treatment. Presence of hypertension (p < 0.003) and evidence of chronicity on renal biopsy (p < 0.016) were significantly correlated with the progressive deterioration of renal function in our population. In conclusion, hypertension and evidence of chronicity on renal biopsy, proved to be risk factors for progressive renal impairment in our study population. The achieved global outcome can be considered good.
The aim of this paper is to describe the impact of oral conditions on the quality of life of the adult population of Malaysia. The adapted Malaysian Oral Health Impact Profile (L-OHIP-M) questionnaire was used. A total of 220 respondents completed the L-OHIP(M). Overall, slightly more than 50% of the sample had at least one impact reported as either "very often" or "often". The younger age group, Indian ethnic and those who had tertiary education reported more impacts. The preliminary results revealed that a substantial proportion of the sample included in this study experienced frequent psychosocial impacts associated with oral conditions.
MeSH terms: Adult; Ethnic Groups; Humans; Malaysia; Mouth Diseases; Oral Health; Quality of Life; Surveys and Questionnaires
A cross-sectional survey on pattern and perception of herbal use among medical patients in Penang Hospital was conducted. Among 250 patients surveyed, 67.9% were using herbal medicine and conventional medicine concomitantly. Majority of the patients used herbs for health maintenance (51.3%) purpose. More than 90% of herbal users did not disclose herbal use to their physician and "doctor never asked" was the major reason given (54.2%). The Chinese reported the highest rate of herbal use but was least likely to disclose. These findings are important for health professionals to ensure medication safety and recognize potential drug herb interaction.
Aim of the study was to audit patients who had undergone parathyroidectomy in the University of Malaya Medical Centre (UMMC) and compare surgical outcomes with that in the literature. Data on demography, aetiology, surgical indications, pre-operative localization, surgery and complications was obtained retrospectively from medical records of patients undergoing parathyroidectomy between 1st October 2000 to 31st October 2005. Twelve patients were identified. Mean age was 50.6 years. 67% were females. The ratio of Chinese, Malays and Indians was 7:4:1. Most surgeries were performed in the last two years (91.7%). Aetiology was mainly tertiary hyperparathyroidism (83%). All patients had pre-operative ultrasound localization. Half underwent total parathyroidectomy without autotransplantation. There were no re-do operations. Mean duration of surgery was 1.96 hours. All patients had abnormal calcium levels at some point following surgery, but 90% were normocalcaemic at last follow-up. Other complications were recur ent laryngeal nerve injury (one) and wound infection (one). There were no peri-operative mortalities. The mean duration of hospital stay was 7.75 days (range 3-17 days). The median duration of follow up was 11 months. The outcome of parathyroidectomy in UMMC is satisfactory with few major complications. Despite this, intensive effort is needed to further improve these results to match those obtained in specialist endocrine centres.
This survey was intended to gauge the management of pain in palliative cancer patients by the doctors in Melaka Hospital. It also sought to identify possible barriers to adequate pain management among doctors and gauge their response to the adequacy of medical school teaching on cancer pain issues. A 39 item survey was used to cover the issues involved. Overall, the doctors displayed a lack of systematic approach to cancer pain management with inadequate knowledge of analgesia handling. Medical school exposure to cancer pain issues was lacking. Formulation of accepted clinical practice guidelines and new education strategies can improve cancer pain management.