The only potential curative therapy for gastric cancer is the resection of both the tumor and the regional lymph nodes at the early stage of the disease. The majority of patients with gastric cancer in Malaysia have an advanced disease at initial diagnosis, and curative surgery is possible in less than 20% of operated cases. Acurate preoperative staging is crucial in determining the most suitable therapy and avoiding unnecessary attempts at curative surgery. While computed tomography remains as the most widely used imaging modality for gastric cancer staging, its ability to detect local invasion, peritoneal and liver metastases is limited. In the recent years laparoscopy has become an important component in the staging algorithm of gastric cancer. The aim of this review is to evaluate the efficacy of routine preoperative laparoscopic staging in the management of gastric cancer, and in particular describe the Malaysian experience.
Oral health diseases are common in all regions of the world and their impact on anatomical
and social functioning is widely acknowledged.Their distributions are unequal between and within countries, with the greatest burden falling on disadvantaged and socially marginalized populations. The risk factors and social determinants for oral diseases have been comprehensively documented, and the evidence base for their prevention is growing. However, decisions on health care are still often made without a solid grounding in research evidence. Translation of research into policy and practice should be a priority for all. Both community and individual interventions need tailoring to achieve a more equal and person-centered preventive focus and reduce any social gradient in health. The major challenges of the future will be to translate knowledge and experiences in oral disease prevention
and health promotion into action programmes.The international oral health research community needs to engage further in research capacity building and in strengthening the work so that research is recognized as the foundation of oral health policy at global level.
MeSH terms: Accidental Falls; Health Policy; Health Promotion; Oral Health; Risk Factors; Socioeconomic Factors; Vulnerable Populations; Capacity Building; Social Marginalization
The immune system is the host natural defence against cancer. Cancers are caused by progressive growth of the progeny of a single transformed host cell. The immune system is generally not able to mount immune responses to “self-antigens”, due to various mechanisms of immunological tolerance that are in place. This means that despite possessing a natural defence against tumours, many of the cancer patients may not be able
to mount an effective immune response to fight the tumours. Dendritic cells (DC) are highly specialised in antigen presenting that can initiate and stimulate immune responses. These cells have the ability to stimulate naïve T cell proliferation and perform specific stimulatory and tolerogenic functions respectively. When the DC are activated by antigens, these cells
undergoes further maturation and migrate to secondary lymphoid tissues, present antigen to T cells and finally induce an immune response. The ability of the DC to activate naïve and primed T-lymphocytes makes these cells a good candidate to be explored as a potential immunotherapeutic agent that can modulate antitumour immune responses in the affected host.
This article presents an overview of long acting products used in animal health, production
and reproduction. The topic represents a niche field of controlled release that few formulation scientists become specialists and experts in, but it is a field which has made significant contribution to the area of controlled release technology, and one which is of major importance to human kind due to their dependence on farmed animals as a source of hide, protein, milk and eggs.
Shock, a major cause of morbidity and mortality in children, is the the most anxiety-provoking emergency that needs to be addressed urgently and effectively by the attending paediatrician. It is a state where the metabolic demands of the tissue are not met due to circulatory dysfunction. Unlike adults, hypotension is a very late feature of shock in children. As the child’s condition worsens, the clinical presentation of the different causes of shock become similar, and nullify any aetiological differences. Regardless of the type of shock, the final common pathway is inadequate tissue perfusion and oxygen supply to meet cellular demands. Delayed recognition and treatment result in progression from compensated reversible shock to uncompensated irreversible shock with widespread multiple system
organ failure to death. This paper reviews the physiological basis, and pathophysiological classification of the various types of shock and their respective aetiologies. The clinical features of the different types of shock are described, and current diagnostic and therapeutic strategies are applied for the most effective and appropriate treatment for resuscitating the child in shock. A strong index of suspicion, early recognition, timely intervention and transfer to an intensive care unit are critical for successful outcomes in the management of paediatric shock.
MeSH terms: Adult; Anxiety; Child; Humans; Hypotension; Intensive Care Units; Multiple Organ Failure; Oxygen; Shock; Treatment Outcome
In the developing world, clinical knowledge management in primary care has a long way to go. Clinical decision support systems, despite its promise to revolutionise healthcare, is slow in its implementation due to the lack of financial investment in information technology. Point-of-care resources, such as comprehensive electronic textbooks delivered via the web or mobile devices, have yet to be fully utilised by the healthcare organisation or individual clinicians. Increasing amount of applicable knowledge of good quality (e.g. clinical practice guidelines and other pre-appraised resources) are now available via the internet. The policy makers and clinicians need to be more informed about the potential benefits and
limitations of these new tools and resources and make the necessary budgetary provision and learn how best to harness them for patient care.
MeSH terms: Delivery of Health Care; Patient Care; Humans; Investments; Primary Health Care; Point-of-Care Systems; Decision Support Systems, Clinical; Internet; Knowledge Management
There has been a significant decline in maternal mortality from 540 per 100,000 live births
in I957 to 28 per 100,000 in 2010. This decline is due to several factors. Firstly the introduction of the rural health infrastructure which is mainly constructing health centres and midwife clinics for the rural population. This provided the accessibility and availability of primary health care and specially, antenatal care for the women. This also helped to increase the antenatal coverage for the women to 98% in 2010 and it increased the average number of antenatal visits per women from6 in 1980 to 12 visits in 2010 for pregnant women. Along with the introduction of health centres, another main feature was the introduction of specific programmes to address the needs of the women and children. In the 1950s the introduction of Maternal and Child Health (MCH) programme was an important
step. Later in the late 1970s there was the introduction of the High Risk Approach in MCH care and Safe Motherhood in the 1980s. In 1990, an important step was the introduction of the Confidential Enquiry into Maternal Deaths (CEMD). Another significant factor in the reduction is the identification of high risk mothers and this is being done by the introduction of the colour coding system in the health centres. Other factors include the increase in the number of safe deliveries by skilled personnel and the reduction in the number of deliveries by the Traditional Birth Attendants (TBAs). The reduction in fertility rate from 6.3 in 1960 to 3.3 in 2010 has been another important factor. To achieve the 2015 Millennium Development Goals (MDG) to further reduce maternal deaths by 50%, more needs to be done especially to identify maternal deaths that are missed by omission or misclassification and also to capture the late maternal deaths.
MeSH terms: Child Health; Adult; Birth Rate; Child; Color; Female; Health Promotion; Humans; Malaysia; Maternal Mortality; Midwifery; Mothers; Pregnancy; Prenatal Care; Primary Health Care; Rural Health; Rural Population; Review; Delivery, Obstetric; Live Birth; Maternal Death
IMU is one of 17 institutions of higher learning conducting the Bachelor of Pharmacy course
in Malaysia. The White paper on pharmacy student professionalism by the Task Force of the American Pharmaceutical Association Academy of Students of Pharmacy together with the American Association of Colleges of Pharmacy Council of Deans mentioned10 essential traits of a professional, recommending their early development. Since the beginning of theIMU Bachelor of Pharmacy (BPharm) (Hons) course in July 2004 on Registration Day, IMU has adopted the concept of developing professionalism in the pharmacy student from the very first day of university, by having the White Coat Ceremony where the entire class takes the Pledge of Professionalism (adapted from the Task Force) against the “Code of Conduct for Pharmacists and Bodies Corporate” by the Pharmacy Board of Malaysia in the presence of the Senior Director of the Pharmaceutical Services Division of the Ministry of
Health, Malaysia and the President of the Malaysian Pharmaceutical Society (MPS). Throughout their 4 years in IMU, the pharmacy students are exposed to various aspects of professionalism in different subjects in their curriculum. On 23rd April 2012, when the fifth cohort of BPharm students received their final examination results, “Pharmacy Professional Day” was launched. The graduating students took the Oath of a Pharmacist (adapted from the American Association of Colleges of Pharmacy’s Oath with slight amendment). Talks by alumni and speakers from MPS aimed to facilitate the transition of the new graduate to working life as a pharmacist.
Chinese medicine is one of the most famous traditional medicines in the world with a glorious and long written history of at least 2000 years. Recently, acupuncture and the use of other herbal medicine are being gradually accepted globally. In 2011,the International Medical University (IMU) started the Chinese Medicine programme which is the first of its kind in a western medicine university in Malaysia.The author introduced the background of Chinese medicine and the curriculum of the Chinese Medicine programme established in IMU, analyzed the situation regarding the quality of lectures given by internal and
external lecturers in this programme and also discussed on ways to integrate western and traditional medicine in IMU or in Malaysia. The launching of Chinese medicine in IMU is a great step in the development of IMU and also an important step in the development of medical education in Malaysia or even in South-east Asia.
This review explores the digestibility of lactose by Malaysians, and the value of milk and other milk-derived products as sources of appropriate nutrition for Malaysians. Increased calcium intake through consumption of milk is an effective mechanism for increasing calcium uptake from the diet and thereby minimising the risk of development of osteoporosis in later life. Detailed information about rates of lactose intolerance, and adaptation to dietary lactose and its consequences for Malaysians, will help in the formulation of dietary advice, and improve commerial food manufaturing practice and Government policy
directed to the minimization of rates of osteoporosis, which presents a substantial morbidity risk to elderly female Asians in particular.
Microalgae are important biological resources that have a wide range of biotechnological
applications. Due to their high nutritional value, microalgae such as Spirulina and Chlorella are being mass cultured for health food. A variety of high-value products including polyunsaturated fatty acids (PUFA), pigments such as carotenoids and phycobiliproteins, and bioactive compounds are useful as nutraceuticals and pharmaceuticals, as well as for industrial applications. In terms of environmental biotechnology, microalgae are useful for bioremediation of agro-industrial wastewater, and as a biological tool for assessment and monitoring of environmental toxicants such as heavy metals, pesticides and pharmaceuticals. In recent years, microalgae have attracted much interest due to their potential use as feedstock for biodiesel production. In Malaysia, there has been active research on microalgal biotechnology for the past 30 years, tapping into the potential of our
rich microalgal resources for high-value products and applications in wastewater treatment and assessment of environmental toxicants. A culture collection of microalgae has been established, and this serves as an important resource for microalgal biotechnology
research. Microalgal biotechnology should continue to be regarded as a priority area of research in this country.
This paper traces the evolution of PBL in the International Medical University over a period
of twenty years; since its inception in 1992 till 2012. It is a record of the reasons for the evolution, the people involved and the strategies adopted. The PBL in IMU has metamorphosed over the years from a paper-based complete case history into its present form of staggered release of information, paper-based or otherwise (videos, web-based, newspaper cuttings, debates). Strategies to improve student and facilitator buy-in, strengthening of facilitator training, adoption of PBL templates, innovations to improve student participation are discussed.
MeSH terms: Metamorphosis, Biological; Students; Universities; Videotape Recording; Internet
The relationship between anatomy and surgery has been historic and epic, spanning many centuries, complementing each other in medical education and being independent as well as interdependent in many ways. However, curricular changes that have happened globally in recent years with the introduction of several contemporary styles of medical teaching have subtly downplayed the importance of anatomy in medicine, allowing young doctors with poor knowledge of anatomy to become surgeons. With a whimsical introduction that metaphorically hints at the strained relationship that exists between anatomy and surgery, the article attempts to explore the ‘anatomy’ of anatomy itself, examining its origins in recorded ancient history, evolution along the centuries in tandem with surgery and its current status in medical education.
Melanosis coli denotes brownish discoloration of the colonic mucosa found on endoscopy
or histopathologic examination. The condition has no specific symptom on its own. It is a fairly frequent incidental finding of colonic biopsies and resection specimens. The pigmentation is caused by apoptotic cells which are ingested by macrophages and subsequently transported into the lamina propria, where lysosomes use them to produce lipofuscin pigment, not melanin as the name suggests. Melanosis coli develops in over 70% of persons who use anthraquinone laxatives (eg cascara sagrada, aloe, senna, rhubarb, and frangula), often within 4 months of use. Long-term use is generally believed to be necessary to cause melanosis coli.The condition is widely regarded as benign and reversible, and disappearance of the pigment generally occurs within a year of stopping laxatives. Although
often due to prolonged use of anthraquinone, melanosis can probably result from other factors or exposure to other laxatives. It has been reported as a consequence of longstanding inflammatory bowel disease. Some investigators suggested that increase in apoptosis of
colonic mucosa by anthraquinone laxatives increased the risk of colonic cancer. Recent data, including those from large-scale retrospective, prospective and experimental studies, did not show any increased cancer risk.
It is estimated that more than 1.1 billion adults and 115 million children worldwide are overweight. In Malaysia, the second and third National Health and Morbidity Surveys in 1996 and 2006 respectively reported a three-fold increase in obesity prevalence among adults, surging from 4.4% to 14% over the 10-year period. Evidence of rising childhood obesity has also emerged. The aim of this article is to gather evidence from food availability data for an insight into population shifts in dietary patterns that may help explain the rising obesity in this country. The nutrition transition was delineated in conjunction with the epidemiologic transition in order to explain the convergence of dietary practices, and the high prevalence of obesity and diet-related non-communicable diseases worldwide. The Food Balance Sheets for Malaysia from 1967 to 2007 were used to provide estimates and trends for the availability of foods and calories. Evidence is generated that indicate at least two major upward shifts in the dietary patterns in Malaysia in the past 4 decades.
These shifts have led to the rising availability of calories from animal products, and from sugar and sweeteners. These major dietary shifts, together with increased sedentariness, constitute core public health challenges faced in addressing the country’s obesity and noncommunicable diseases (NCD) conundrum.
MeSH terms: Financial Statements; Adult; Energy Intake; Carbohydrates; Child; Diet; Humans; Malaysia; Public Health; Surveys and Questionnaires; Sweetening Agents; Prevalence; Overweight; Pediatric Obesity
Nurse education is undergoing a process of transition. Nurses worldwide are working towards
achievement of higher levels of education and training through an improved education system. Current trends and innovations in nursing education are emerging to prepare more nurses and to deliver education to students across geographical boundaries while taking into
consideration their work and family responsibilities. The current trends and innovations in nursing education range from full time face-to-face interactions to distance education programmes. Teaching approaches such as blended learning, online or e-Learning have provided nurses with an avenue for continuing education for development and progression in their career pathways. Every nurse aspires to reach her highest potential. While the current trends and innovations in nursing education provides the flexibility for nurses to continue learning and upgrade their professional qualifications, there are issues to be considered in catering to the needs of the bottom billion nurses. An exploration of related issues will include views from different perspectives, such as that of the institution/provider, instructor/facilitator and student/learner involved in the development and implementation of the related education programmes.
The discovery of antibiotics had been one of the most significant events in the history of medicine. Antibiotics had saved countless number of lives and had contributed significantly to the health of mankind.The emergence of resistance is however a major threat to the continued usefulness of antibiotics. There are now strains of bacteria which are resistant to virtually all available antibiotics and these strains are increasingly being encountered in clinical practice. The development of new agents had not kept pace with resistance and it is unlikely that there will be major breakthroughs in the near future. The world needs to conserve and prolong the useful lives of the existing agents. This can only be achieved through good antibiotic stewardship programmes. As antibiotic resistance is a global threat all major stakeholders have to work together to meet this challenge.
MeSH terms: Anti-Bacterial Agents; Drug Resistance, Microbial
Developing and adult worms of the human lymphatic filarial parasites (Wuchereria bancrofti,
Brugia malayi, and Brugia timori) are located mainly in the lymphatic system and occasionally in aberrant sites like subcutaneous and conjunctival cysts. Lymphatic
pathology ranging from dilatation of lymphatic channels and lymphangiectasia are detected on ultrasonography in apparently healthy, amicrofilaraemic, but filarial antigen positive individuals in endemic areas. Microfilariae are distributed in various organs and may be associated with immune mediated pathology at these sites; tropical pulmonary eosinophilia is characterized by intense immune mediated destruction of microfilariae in the lung parenchyma. In the spleen and other sites, nodular granulomatous lesions can occur where microfilariae are trapped and destroyed. The finding of Wolbachia endosymbionts in all stages of lymphatic filarial parasites has provided new insight on the adverse reactions
associated with anti-filarial chemotherapy. Inflammatory molecules mainly lipopolysaccharide (LPS)-like molecules released from endosymbionts on death of the
parasites are largely responsible for the adverse reactions encountered during anti-filarial chemotherapy. Prenatal tolerance or sensitization to parasite derived molecules can immune-modulate and contribute to both pathology and susceptibility/resistance to infection. Pathological responses thus depend not only on exposure to filarial antigens/infection, but also on host-parasiteendosymbiont factors and to intervention with antifilarial treatment. Treatment induced or host mediated death of parasites are associated with various grades of inflammatory response, in which eosinophils and LPS from endosymbionts play prominent roles, leading to death of the parasite, granulomatous formation, organization and fibrosis. The non-human primate (Presbytis spp.) model of
Brugia malayi developed for the tertiary screening of anti-filarial compounds has provided unique opportunities for the longitudinal study of the pathology associated with lymphatic filariasis. The pathology in this non-human primate model closely follows that seen in
human lymphatic filarial infections and correlates with clinical evidence of lymphatic pathology as detected with ultrasonography. These studies also show that successful treatment as detected by loss of motility and calcification of worms on ultrasonography is associated with reversal of early dilatations of lymphatic channels.
Climate change is a product of human actions. The extreme events such as flash floods, droughts, heat waves, earthquakes, volcano eruptions and tsunamis seen in the world today are the result of indiscriminate human intrusion into the environment. Vulnerable countries and populations are the most affected by these climatic events. This places a burden on the resources of these countries. The Kyoto Protocol is a milestone in environmental management and the impetus created by it must be maintained by carrying out the much needed research into appropriate mitigating measures that will alleviate the climate
change impact globally. A paradigm shift is needed in addressing the associated risks on human health to assess socioeconomic determinants and the related impacts on disease burden. Some wealthy nations emphasize economic benefits and downplay sustainability goals, health and equality. However the rising cost of energy is beginning to influence their outlook towards this issue. The implications on economics, human health and wellbeing are implicit. In order to strike a balance between disadvantaged and privileged nations, many
international agencies are spearheading various research agenda to improve adaptation programmes on effects of changing climatic conditions on health. Malaysia too has such programmes initiated under its 5-year development plans.
MeSH terms: Acclimatization; Disasters; Environment; Goals; Hot Temperature; Humans; International Agencies; Malaysia; Social Change; Socioeconomic Factors; Vulnerable Populations; Droughts; Earthquakes; Floods; Tsunamis; Climate Change
Lightning strikes have been known to cause fatal injuries. However, these cases have not been adequately highlighted in Malaysia. This paper reports on three cases of military personnel who lost their lives after being struck by lightning while on operational duties. It is extremely important to implement adequate safety measures and ensure that all military personnel are adequately trained on emergency procedures, such as Cardio Pulmonary Resuscitation (CPR) to prevent casualties of lightning strikes in future. This paper addresses several issues to avoid similar occurrences; the importance of taking extra safety precautions and recognizing signs of lightning strikes, as well as the immediate administration of CPR on victims.