Kenaf seed oil-in-water nanoemulsions (KSON) and kenaf seed oil-in-water macroemulsions were produced to access their gastroprotective effect against indomethacin- and ethanol-induced ulcers in comparison with non-emulsified kenaf seed oil (KSO). Emulsifier mixture (EM) that used to emulsify KSO was also included in the study. Ulcer index, stomach tissue oxidative status, and histopathological changes in indomethacin-induced and ethanol-induced ulcer models were both evaluated. KSON had demonstrated good gastroprotective effect against both ulcer models than non-emulsified KSO and KSOM. In addition, the gastroprotective effect of KSON was comparable to the standard drug, Omeprazole. EM also exhibited gastroprotective effect, especially in indomethacin-induced ulcers. This may be attributed to its high antioxidant activity and cytoprotective effect of sodium caseinate contained in the EM. Results supported that KSON enhanced the bioavailability of native KSO; therefore it offers gastroprotective effect for the prevention of gastric ulceration as a natural alternative to the synthetic drug.
In this article, five variables including type of substrates, sizes of substrates, mass ratio of spawn to substrates (SP/SS), temperature and pretreatment of substrates were used to model mycelium growth in Pleurotus sp. (oyster mushroom) cultivation by using agricultural wastes via two level factorial analysis. Two different substrates which were empty fruit bunch (EFB) and sugarcane bagasse (SB) were used. Analysis of Variance (ANOVA) for both mycelium extension rate (M) and nitrogen concentration in mycelium (N) showed that the confidence level was greater than 95% while p-value of both models were less than 0.05 which is significant. The coefficient of determination (R2) for both M and N were 0.8829 and 0.9819 respectively. From the experiment, the best condition to achieve maximum M (0.8 cm/day) and N (656 mg/L) was by using substrate B, 2.5 cm size of substrate, 1:14 for SP/SS, incubated at ambient temperature and application of steam treatment. The data showed that EFB can be used to replace sawdust as a media for the oyster mushroom cultivation. Data analysis was performed using Design Expert version 7.0.
Malignant melanoma (MM) of parotid gland is a rare condition. This pathology is often a result of secondary metastasis from primary lesions in the head and neck skin. A MM arising de novo in parotid gland is very rare. This malignant tumour is more prevalent in adults rather than children and it tends to have several distinct features. Treatment options are limited especially for an advanced lesion. Despite best treatments this condition carries a poor prognosis. This case details our experience in treating a child with MM of parotid gland without other primary cutaneous lesions.
Anaplastic thyroid carcinoma (ATC) is a particularly fearsome form of thyroid cancer due to its extreme aggressiveness and dismal prognosis. Patients with ATC typically present with a rapidly enlarging neck mass with compressive symptoms. We report a case of ATC, mimicking a thyroid abscess; in a 52-year-old Chinese male with one month history of enlarging neck mass. Ultrasound of the neck was suggestive of a thyroid cyst and fine needle aspiration cytology was negative for malignancy. He presented again 2 weeks later with increased swelling and pain suggestive of right neck abscess. An incision and drainage was performed and histopathology result of a proximal isolated enlarged lymph node biopsied revealed metastatic carcinoma. Subsequent right thyroid wedge biopsy finding 1 month later were confirmatory of ATC.
Thoracolumbar burst fractures are common entity in polytraumatized patients. The retropulsed burst vertebral fracture may result in spinal canal invasion with or without neurological deficit. In this situation, early surgical stabilization with decompression is vital to restore neurological function. We employed a posterior approach with a unique transpedicular reduction technique at the level of fracture for decompression and stabilisation.
Aedes aegypti (L.) (Diptera: Culicidae) is the primary vector of several arthropod-borne viral infectious diseases globally. Relentless vector control efforts are performed to curtail disease transmissions, insecticides remain as the first line of defense in Indonesia. With a dearth of publication on the efficacy of mosquito coil in Indonesia, this is the first report related to mosquito coil despite its common use in households. Ae. aegypti mosquitoes were sampled from nine regencies in Indonesia and tested using the glass-chamber method against three commercially available local pyrethroid-based mosquito coils containing d-allethrin, transfluthrin, and metofluthrin. The 50% knockdown time of female Ae. aegypti tested with d-allethrin, transfluthrin, and metofluthrin containing coils ranged from 0.65 to 14.32; 0.8 to 16.4; and 0.78 to 20.57 min, respectively. Mortality rates in accordance with WHO resistance indicators showed that strains from Denpasar, Mataram, Kuningan, Padang, Samarinda, and Sumba Timur were resistant (<80% mortality rate), whereas strains from Manggarai Barat, Dompu, and Pontianak were susceptible (>98% mortality rate) to the active ingredients assayed. Moreover, the knockdown rates between d-allethrin and transfluthrin, d-allethrin and metofluthrin, as well as transfluthrin and metofluthrin displayed significant associations, portraying the presence of cross-resistance within pyrethroid insecticides. The minimal insecticidal effect of mosquito coils against some Indonesian Ae. aegypti also pointed out the development of pyrethroid resistance, prompting a revamping of the vector control system.
Biscuit is a popular food product where it is produced using wheat flour, sugar and fat as its main ingredients. Wheat flour is the major material used in biscuit production and within the flour starch is the principal component. The details of starch properties such as pasting properties, gelatinisation properties, crystallinity were discussed in this review. Starch is the major structural element in many foods, with the fat or sugar also playing key roles. Sugar gives sweetness, colour, add volumes and influence the texture of a biscuit. Besides that, it shows significant impact on starch gelatinization properties. Fat plays an important role in biscuit production and the type of fat used determines the quality of the final product. In this article, the functional properties of major ingredients of biscuit were also reviewed with emphasis on wheat flour, sugar and fat.
Planning a validation study of a questionnaire or measurement tool requires consideration for testing
the validity and reliability aspects of the measurement tool. When it comes to the reliability aspect,
a number of commonly used statistical coefficients such as Cronbach’s alpha, intraclass correlation,
kappa and Pearson’s correlation coefficients would be considered to provide empirical evidence of the
reliability of the tool during the validation process. To ensure that the reliability is accurately assessed,
a researcher must consider the sample size requirement for the statistical analyses. In this article, I will
introduce a newly developed web-based sample size calculator, which includes the ability to calculate
the sample sizes of these four important coefficients. I will also show how to use the calculator for each
of the coefficients.
Medical knowledge, skills, and social requirements for patient care are quickly changing, thus, doctors
are anticipated to be life-long learners to provide effective care for the patients. This paper addresses
instructional issues how to prepare medical students to be self-directed learners and how to improve
medical school and postgraduate training curricula. Now the big question is self-directed learning
(SDL) an agent in cultivating lifelong learning skills for medical students as claimed by educational
experts? This will be the focus of my critical reflection on lifelong learning.
Phy-Antastic is the pioneering horizontally-integrated pedagogy that adopts physiology-oriented
anatomy teaching. A decline in time allocation for basic medical sciences (BMS) modules triggers
the conflict of interests among educators. “Physiology-then-Anatomy” temporal synchronisation
(and therefore Phy-Antastic) facilitates deep learning. The five highlighted features of Phy-Antastic
are: (i) explicit declaration of learning outcomes and prerequisite knowledge as groundwork for
the forthcoming topics; (ii) explanation of subject-related glossary to improve comprehension;
(iii) elucidation of the related physiological mechanism to calibrate the learners into appreciating
the cardinal anatomical features; (iv) the creative utilisation of multimodal teaching aids to simulate
consolidated learning experience; (v) lesson was concluded by revisiting learning objectives, reflection
on principal inquiry questions and recapitulating fundamental elements. The strength of Phy-Antastic
depends on homeostatic teaching with rigorous educational outcome set-point and interdisciplinary
feedback mechanisms. Small group discussion, problem-based learning and technology-assisted
teaching can easily incorporate Phy-Antastic. Inertia among BMS educators in embracing
interdisciplinary collaborative teaching remains the institutional barrier to the implementation of
Phy-Antastic. This article proposes a prospective advancement in anatomical education for the
contemplation of educators.
Educational environment is an important determinant of medical students’ behaviour. It impacts their
academic performance, motivation, and psychological well-being. Quantitative evidence have shown
that there is a decrease in the positive perception of clinical medical students towards the educational
environment. The primary focus on this study was to explore the clinical education environment
through the lived experience of clinical medical students during medical training. Using hermeneutic
phenomenology we aimed to interpret participants’ experience of personal clinical learning journey
through free text input. Thematic analysis was performed to analyse the written texts. Various
measures were taken to enhance the trustworthiness of the findings. A total of 154 (74.8%) fourth year
students and 144 (74.6%) final year students participated in the study. We identified six overarching
themes of education environment in clinical setting that are personal development, teaching and
learning, assessment for learning, facility, support and nurturing curriculum. The overlapping
relationship of the themes is illustrated in the Clinical Education Environment Framework. While
many themes were consistent with existing framework, our findings also proposed assessment as an
important component to influence perception on education environment. The themes in this study
finding conform to the definition of education environment which covers physical, social, and
psychological aspects of students learning. Medical schools should take active measures to incorporate
a nurturing education environment especially in clinical year where students struggle with the hidden
curriculum.
Histology, a branch of anatomy is a correlational science between structure of tissues and their
functions. Knowledge of histology is emphasised for undergraduate medical students as a basic for
clinical knowledge and research. To impart retainable and reproducible knowledge in histology, a new
laboratory manual with images and clinical correlates was introduced to the Year I MBBS students
in the Academic Session 2017/2018 during their general anatomy module. The objective structured
practical examination marks between 101 students of Batches 2016/17 and 2017/18 were analysed.
The difference in marks between both the batches were analysed using SPSS 20. Batch 2017/18
students who used the new lab manual scored better than the previous batch who used the old
manual. Independent t-test was not statistically significant. The students who used the new manual
fared better than their seniors. Since the difference was not statistically significant, it can be concluded
that if existent, drawbacks in the lab manual should be improved and adequate usage of the manual by
the students should be emphasised. Nevertheless, usage of the new lab manual shows that the students
could understand the subject and score better with less study hours.
Lecturers are expected to teach effectively and evaluating their teaching effectiveness are essential to
ensure students get the best learning experience. A systematic evaluation of teaching behaviours with a
proper feedback mechanism will help to improve their teaching effectiveness. Improvement of teaching
effectiveness will result in better students’ learning experience, and thus attaining the intended
educational outcomes. This study aimed to evaluate teaching effectiveness among lecturers by
assessing their teaching behaviours during lectures. A cross-sectional study was conducted on lecturers
in a Malaysian public medical school. Their teaching behaviours were rated by 30 trained pre-clinical
medical students using Teacher Behaviour Inventory (TBI) on seven aspects – organisation, speechpacing,
clarity, enthusiasm, interaction, rapport, and disclosure. A total of 55 lecturers were rated
by the medical students. The organisation and speech-pacing aspects were highly rated as the mean
scores were 4.02 and 4.15, respectively. The clarity, enthusiasm, interaction, and rapport aspects
attained satisfactory level as the mean scores ranged from 3.10 to 3.59. The disclosure aspect was
poorly rated as the mean score was 2.20. Eventhough all lecturers in this school are considered expert
in their area, findings from this study suggest that some teaching behaviour need some improvement.
Findings from this study also provide useful data for the medical school to chart direction of faculty
development activities to improve their lecturers’ teaching effectiveness during lectures.
This paper describes a systematic and practical guide on manuscript writing. A step-by-step approach
as easy as learning ABC to facilitate authors to plan their manuscript writing. Research has shown that
experienced writers plan extensively, in which a writing plan is a road map, without it we will probably
lose our way in circles. Generally, authors start writing a manuscript by introduction, methods, results,
discussion and conclusion. However, this paper proposes a different approach to start writing a
manuscript based on the ABC of manuscript writing worksheet.
Palliative care for life limiting conditions usually starts at birth. In neonatal period, planning,
discussion and goal of care should focus towards improving the baby quality of life. It does not mean
palliative care in this age group mainly as end of life care. We illustrate a complex 30 weeks baby
who was born with genetic abnormality complicated with intracranial bleeding and acute myeloid
leukaemia. There were various ethical issues related to the approach of death and dying infant and
psychosocial challenges surrounding the case.
Situated learning characterises the learning that takes place in the clinical environment. Learning in the workplace is characterised by transferring classroom knowledge into performing tasks and this may take various forms. In the medical education field, the cognitive apprenticeship instructional model developed by Collins (2016) supported this learning in the workplace setting due to its common characteristics of apprenticeship. This paper analysed two concrete learning situations in a Malaysian undergraduate and an Omani postgraduate learning environment. Both learning situations occurred in the primary healthcare outpatient setting. The cognitive apprenticeship model was used to identify characteristics of the individual learning environments and discusses factors that stimulate learning. Attention was paid to the role of reflection in stimulating learning in the described settings. The paper provided the context in both institutes, described the learning situation and provided an analysis based on the theoretical framework. Based on the analysis of the situations, solutions to problems in the two settings were suggested.
MeSH terms: Ambulatory Care Facilities; Comparative Study; Education, Medical; Humans; Learning; Malaysia; Oman; Primary Health Care; Models, Educational; Problem-Based Learning
Nurses’ job performance is defined as the effectiveness of a person in carrying out his or her duties related to patient care. Aim of this study is to measure job performance among nurses in a tertiary hospital and its associated factors. A cross-sectional study was conducted among nurses selected from four departments, which were Obstetrics & Gynecology (O&G), medical, surgical and Cardiac Care Unit (CCU)/High Dependency Unit (HDU). A Malay validated Six-Dimension Scale of Nursing Performance (6-DSNP) questionnaire was used to measure job performance. Nurses who have one child more compared to other nurses had significantly lower total mean score of job performance by -0.06 (95% CI 0.11, 0.01). Nurses working in medical department [adj.β=0.16 (95% CI 0.01, 0.30)] and CCU/HDU [adj.β= 0.33(95% CI: 0.17, 0.50)] had significantly higher total mean scores of jobs performance compared to O&G department. Effective strategies and re-examining work conditions are imperative for better job performance.
Study site: Department of
Medical, Department of Surgical, Department of
Obstetrics & Gynecology (O&G) and Cardiac Care
Unit/ High Dependency Unit (CCU/HDU) of Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
MeSH terms: Cross-Sectional Studies; Hospitals, University
The overweight and obese population may affect the population health which can lead to economic stability and development of the countries to be compromised. Thus, this study estimates the burden of disease attributable to overweight and obesity in Malaysia for adults aged 20-59 years old. Population attribution fraction (PAF) and disability-adjusted life year (DALY) have been used to quantify years of life lost from premature death and number of years lost due to disability resulting from obesity and overweight. The burden of disease attributable to overweight was 1582 and 1146 PYs per 1000 persons for male and female, respectively. Meanwhile, the burden of disease attributable to obesity was 2951 PYs per 1000 persons with women in the lead at 1657 PYs per 1000 persons. The burden of overweight and obesity among Malaysian adults is substantial. The outcome of this study is crucial as it gives a comprehensive information on the burden of overweight and obesity in Malaysia. The information from this study also enables the authorities to develop activities and programs to combat obesity and tomaintain healthy lifestyle among Malaysian.
Tuberculosis (TB) is known as a disease that prone to spatial clustering. Recent development has seen a sharp rise in the number of epidemiologic studies employing Geographical Information System (GIS), particularly in identifying TB clusters and evidences of etiologic factors. The aim of this systematic review is to determine evidence of TB clustering, type of spatial analysis commonly used and the application of GIS in TB surveillance and control. A literature search of articles published in English language between 2000 and November 2015 was performed using MEDLINE and Science Direct using relevant search terms related to spatial analysis in studies of TB cluster. The search strategy was adapted and developed for each database using appropriate subject headings and keywords. The literature reviewed showed strong evidence of TB clustering occurred in high risk areas in both developed and developing countries. Spatial scan statistics were the most commonly used analysis and proved useful in TB surveillance through detection of outbreak, early warning and identifying area of increased TB transmission. Among others are targeted screening and assessment of TB program using GIS technology. However there were limitations on suitability of utilizing aggregated data such as national cencus that were pre-collected in explaining the present spatial distribution among population at risk. Spatial boundaries determined by zip code may be too large for metropolitan area or too small for country. Nevertheless, GIS is a powerful tool in aiding TB control and prevention in developing countries and should be used for real-time surveillance and decision making.
We investigated the association between housing conditions with a primary focus on basic housing infrastructure and WHOQOL BREF score among the Orang Asli and non-Orang Asli populations. A cross–sectional study was conducted between August 2014 and May 2015 among the Orang Asli and non-Orang Asli populations in Kuala Langat, Selangor. Sampling of the population was done through multistage sampling while eligible respondents participated conveniently. The socio-demographic information collected consisted of age, ethnicity, marital status, educational level, and employment status. Basic housing infrastructure variables including the types of housing unit, wall construction material, availability and types of toilet, availability of electricity, source of water supply, and availability of garbage collection facilities were obtained. Among the Orang Asli respondents, having the pour type of toilet in the house was significantly (p=0.003) associated with a reduction in the physical health domain score by 0.36 (95% CI: -0.61,-0.12). Conversely, having no toilet in the house and living in a semi-detached house had significantly (p=0.023 and p=0.026 respectively) increased the social relationships domain score by 0.81 (CI: 0.11, 1.51) and 3.90 (CI: 0.47, 7.34) respectively. Unavailability of garbage disposal facilities was found to be significantly (p