Background: Hypertension is estimated to cause4.5% of the global disease burden. The prevalence of hypertension in Malaysia is 32.2%.
Objective: To determine the prevalence of hypertension and its associated risk factors in two rural communities in Penang, Malaysia.
Methods: This cross sectional study was conducted among all consenting residents aged 18 years and above from two villages in Penang. Besides the baseline demographic information, blood pressure was measured using a manual sphygmomanometer according to the American Heart Association Guidelines.
Results: 50 out of 168 people were hypertensive, giving a prevalence rate of 29.8%. 50.0% of those found with hypertension were undiagnosed and 48.0% of those who were diagnosed with hypertension had uncontrolled blood pressure. Logistic regression analysis showed that age, history of alcohol consumption and BMI were found to be independently associated with hypertension.
Conclusions: Age, education level, alcohol consumption and BMI are important risk factors associated with the prevalence of hypertension among the villagers. These risk factors are comparable to those reported in National Health and Morbidity Survery 2006 in Malaysia.
Objective: To evaluate the factors that contributes to the decision for termination of pregnancy in prenatally diagnosed fetal anomaly cases.
Methods: A retrospective analysis of all cases of prenatally diagnosed fetal anomaly who delivered between 1 January 2007 and 30 June 2009 in two tertiary hospitals in Malaysia.
Results: A total of seventy-two (72) prenatally diagnosed pregnancies with fetal anomalies were identified. Mean maternal age was 29.8 ± 5.5 years and mean parity 1.47 ± 1.8. 70.8% of patients were ethnic Malay, 15.3% Chinese and 12.5% ethnic Indian. 22 (30.6%) fetuses were lethally abnormal. The overall pregnancy termination rate was 29.2%. 50% of pregnancies with lethally abnormal fetuses were terminated compared to 20% of pregnancies with non-lethal abnormality (p
Academic performance is still primarily judged on publications. Not surprisingly, pressure to publish for the purpose of academic standing or promotion can be huge. People have been put off from an academic career simply because of this necessity. This is unfortunate because publishing our research findings or knowledge is our core business and why we become academicians. The notion that teaching is the academician’s chief duty is only half correct. We should and can enjoy publishing if we accept this as an inseparable part of our job. (Copied from article).
Since the outbreak of the novel influenza H1N1 in April 2009 in Mexico, more then half a million cases have been recorded with more then 6000 deaths.In contrast to seasonal flu, this virus appears to have a predilection for the young, obese and pregnant.It’s most important and almost fatal complication is Acute Respiratory Distress Syndrome (ARDS). Intensive care units (ICU) around the world have scrambled to upgrade various treatment modalities including high frequency oscillation ventilation, inotropes, antivirals and antibiotics in an effort to reduce the mortality arising out of this complication. More importantly, this complication appears reversible if adequate and early therapy is instituted. In particular, rescue therapies that allow the lung to rest appear to have brought success in some clinical settings. This article describes the experiences of seven centers that have used various modalities as rescue therapy in patients having Acute Respiratory Distress Syndrome (ARDS). The experiences in 13 patients at the University of Michigan, 58 in Mexico, 168 in Canada, 180 patients at Leicester UK, 194 in Australia and New Zealand and case reports from Hong Kong and Singapore are described.
Bacillus thuringiensis is an anaerobic, spore forming bacterium that produces various toxic proteins both during its vegetative stage and sporulative stage. During its sporulative stage, it produces parasporal proteins that have long been used in the agriculture fields as insecticides. Although anticancer effect of Bacillus thuringiensis parasporal proteins can be dated back to the 1970s, research in this area went through a giant leap in the late 1990s, with much of the work being done in Japan. It has been found that some strains of non-insecticidal Bacillus thuringiensis produce parasporal proteins that exhibit anticancer activity. Due to their selectivity against human cancer cells but not normal cells, some of these proteins have been extensively studied for their anticancer effect and the mechanism of action by which these proteins kill cancer cells have also been widely explored in Japan and Malaysia with sporadic reports from other parts of the world. The abundance of these bacilli in nature and their selectivity have made them potential candidates for cancer treatment. However, literature on the in vivo effect of these proteins is scarce. Since different Bacillus thuringiensis strains produce different cytotoxic proteins with wide variations in their anticancer effect and mechanism of action, further investigations are necessary and their effect in vivo must be well established before they can be used in human subjects.
Background: Nosocomial infection is among the leading problem in many major hospitals resulting in soaring cost expenditure in managing its affect.Hand washing practice is a crucial preventive way to contain such mischief but many ignored its importance. This is perhaps due to lack of appropriate role modeling from senior practitioners.
Subjects and methods: Our study examined the prevalence of hand washing practice among medical students from year 3 to 5 and compared it to their knowledge and level of awareness on its importance in clinical practice. 142 students were randomly observed during their clinical work in the wards on this practice and questionnaires were later distributed to 268 students from all semesters on their knowledge on the technique and awareness on its importance.
Results: Out of 142, almost 80% washed their hands but only 41.6% performed effective hand washing. In contrary, 80 to 90% showed good level of knowledge and awareness as well as perception about its importance in clinical practice.
Conclusions: The contradictory findings between the actual practice of hand washing and knowledge as well as awareness suggest that enforcement on the practice is necessary. This requires motivation and cooperation from all health alliances and higher authority in the health system. Remedial measures are much needed in order to contain high incidence of nosocomial infection in our local practice.
Introduction: Undergraduate medical education should be broad-based, holistic, integrated and should promote a framework for the development of higher order cognitive skills like communication, professionalism and teamwork to prepare the student for a life-long challenging medical career. Recent calls for a competency-based medical education require, in addition, competency in clinical and procedural skills prior to graduation. This study investigates how often opportunities exist for medical students to perform four common ward procedures prior to graduation.
Method: A prospective cross-sectional study to assess the opportunities a medical student have in performing four common ward procedures, comprising intravenous cannulation, nasogastric tube insertion, urinary catheterisation and chest tube insertion, in a State General hospital in Malaysia was done.
Results: A medical student has sufficient opportunity to perform only intravenous cannulation prior to graduation. He has a remote chance to insert a urinary catheter and is unlikely to have the opportunity to insert a nasogastric tube or insert a chest tube prior to graduation.
Conclusion: Although competency in clinical skills and procedural skills prior to graduation are desirable, this is increasingly difficult to achieve due to shortage of clinical material, teachers to supervise, the large numbers of medical students and house officers, the short time spent on the main disciplines and the failure of many universities to invest heavily in skills laboratories staffed by full time clinicians. The calls to introduce competency-based medical education in undergraduate medical education, particularly in procedural competence, should take into account the challenges in delivery and the realities in the hospitals today. This is necessary to avoid demoralising students who are unable to achieve their quota of procedures through no fault of theirs.
Keywords: procedural competency, medical education, Malaysia
The International Medical University, Kuala Lumpur (IMU) has just completed 20 years of success and had a series of events to celebrate its 20th anniversary as well as its achievements in 2012. As part of the 20th anniversary celebrations, IMU successfully co-hosted the Ottawa conference with the European Medical Education Association in Kuala Lumpur. This was the first time this conference was hosted in Asia and it was one of the biggest and most successful of the Ottawa Conference series ever held. This conference focuses on medical education with the major emphasis on assessment.
This cross sectional study was done to identify the areas of lack of knowledge, practice and awareness of students about the effective use of personal protective equipment (PPE). A total of 40 students were selected when they were posted to the accident and emergency unit (A&E) in Seremban Hospital; all of them answered a questionnaire and were observed unaware on the effective use of PPE in the A&E.
This study examined the trend of major congenital anomalies (CA) in the state of Penang using the ICD 10 database from 1999 to 2004. The data was collected from various health centres and hospitals. The aim was to study the magnitude of the problem for congenital anomalies in the state of Penang in terms of trends and also to calculate the incidence rate by districts. If a trend was noticed, this in turn will determine whether to carry out further in-depth studies in the future and to find out the linkages to the environment if any.
Solitary adrenal metastasis is a rare presentation in breast cancer and it presents the clinician with a difficult therapeutic dilemma as there are no existing guidelines for optimal management. On literature review, we only found one published case report of solitary adrenal metastasis from infiltrating ductal carcinoma of the breast. Here we present a case of a 75 year-old lady who presented with a right breast lump which was subsequently confirmed to be infiltrating ductal carcinoma. She underwent a right mastectomy and axillary clearance. Computerised tomography (CT) staging revealed a solitary adrenal metastasis. She was treated with aromatase inhibitors and her tumour markers which were initially raised has now normalised.
Urethral catheterisation is a common and safe procedure performed routinely. The small size of the urethra in a child necessitates the use of an infant feeding tube (Size 5 to 8 F) for catheterisation. Knotting within the bladder is a rare complication with significant morbidity often necessitating surgical or endoscopic removal. Insertion of an excessive length of tube contributes to coiling and knotting. We report an instance of knotting of an infant feeding tube in the proximal penile urethra of a 4 year-old male child requiring urethrotomy to remove it. Awareness of the risk and proper technique can reduce this complication.
The nature, extent and definition of a collaboration varies between individuals, disciplines, departments and institutions. It depends upon such factors as the people involved, the nature of the research problem, the research environment, the institutional culture and demographic factors. This paper will examine the concept of collaborative research and discuss its place and position in an evolving university.
We previously evaluated the biochemical changes induced by the local product TCM for diabetes (TCM-D™) on blood glucose levels and other biochemical changes in normal mice fed orally with the recommended human dose (30 ml/kg daily) and ten times this dose for eight weeks. TCM-D™ is an aqueous extract of the roots of Trichosanthes kirilowii Maxim, Paeonia lactiflora Pall, Glycyrrhiza uranlensis Fisch. and Panax ginseng Meyer (red) combined at the dry weight proportions of 36%, 28%, 18% and 18% respectively. The study showed that at these dosages the blood glucose levels as well as the body weights in treated mice were significantly reduced when compared with pretreatment values and control animals. The present study evaluated the effect of the extract in a mouse model of Type 1 diabetes mellitus.
Preclinical drug testing is an important area in new drug development where animals are used. An ideal animal model for this is one which is simple, reliable and can be extrapolated to humans. Topical drugs for inflammation are conventionally tested on the skin of animals after induction of inflammation. A gingival model would be simple as inflammation can be induced naturally by the action of plaque. Rats are a popular animal model for testing drugs as well as to study various diseases of the periodontium. Periodontal disease including gingival inflammation develops in
rats in relation to indigenous plaque or experimentally induced bacterial products. A number of features of rats ranging from anatomy, histology and response to bacterial insult can be seen mirrored to a great extent in humans. There is a lot similarity in the development and resolution of inflammation as well as the gingival wound healing of rats and humans. This paper tries to explore the feasibility of using the rat gingival model for preclinical testing of drugs acting on or influencing inflammation and concludes by identifying potential areas of research using this model. The addition of such a simple and inexpensive model for preclinical testing of drugs will be welcomed by the drug developers.
Shock is a clinical challenge to neonatal intensivists and pediatricians alike. It occurs in critically ill babies for many reasons, but the main cause is sepsis that kills more than a million newborn globally every year. This article is designed to help young doctors and trainees have a better understanding of shock in the neonatal period and its management. The paper reviews the basic pathophysiology, risk factors, clinical investigation, management, supportive care, and complications in the common types of shock seen in neonates. Treatment is governed largely by the underlying cause, with the ultimate goal of achieving adequate tissue perfusion with delivery of oxygen and substrates to the cells, and removal of toxic metabolic waste products. Intervention needs to be anticipatory and urgent to prevent progression to uncompensated and irreversible shock respectively. Early recognition and urgent effective management are crucial to successful outcomes.
Building on two decades as a private health professional university, the International Medical University prepares for the third decade, taking stock of the challenges in changing epidemiology and pattern of disease, changing demography and healthcare, as well as explosion in knowledge and information technology. The Global Independent Commission1 provided a framework for instructional and institutional reforms, and the IMU will use its 3 I’s (insight, imagination & innovation) in adopting these measures. Some of the instructional reforms are already in place, others need to be further nurtured and promoted. In its third decade, competency based curriculum, inter-professional learning, IT, global collaboration, educational resources, new professionalism and emphasis on quality improvement will help ensure IMU train and produce competent, caring and ethical health professionals fit to tackle 21st century challenges.
Surgeries are seen as stressors that trigger preoperative anxiety. Preparing the patients for surgery through preoperative teaching becomes crucial to allay anxiety level. In a cross sectional descriptive study conducted on eighty patients (age: 18–65 yr) who had undergone open abdominal surgery, 78.8% (n=63) stated that they experienced anxiety prior to surgery. Among these anxious respondents, 47.5% (n=38) experienced high state anxiety. Three of the top information that patients perceived as important to allay anxiety towards major surgery were: details of surgery, details of nursing care to surgery and information on anaesthesia. Nurses working in the surgical wards need to proactively address patients’ psychological concerns towards surgery and provide preoperative information based on patients’ needs to allay anxiety.
Pain and anxiety management is of paramount importance in dentistry especially for child patients. The term “Medicated Oxygen” or “Magic Air” refers to a mixture of nitrous oxide and oxygen gases that is commonly used for partial sedation in pediatric dental populations. The gas is colorless and virtually odorless with a faint, sweet smell. Nitrous oxide sedation is administered by inhalation, absorbed by diffusion through the lungs, and eliminated via respiration. In children, sedation may accelerate the delivery of dental treatment that requires patient serenity and may allow the patient to tolerate unpleasant procedures by reducing anxiety, discomfort, or pain.
Consent is defined as the “voluntary agreement to or acquiescence in what another person proposes or desires”. In the context of medical practice it is now universally accepted that every human being of adult years and of sound mind has the right to determine what shall be done with his or her own body. Informed consent is now a central part of medical ethics and medical law. There has been a change in the public’s expectations of their role in medical decision making. The paternalistic approach by doctors is no longer acceptable. Today the patient has the right to receive and the doctor the obligation to give sufficient and appropriate information so that the patient can make an informed decision to accept or refuse a treatment option. This has led to higher standards of practice in the process of informed consent taking. Consent taking is both a legal and moral requirement. Failure to comply with standards of practice can result in criminal prosecution, civil litigation or disciplinary action by the relevant professional authority. Consent taking is a process and not merely a one-off affixation of the patient’s signature on consent form. It involves a continuous discussion to reflect the evolving nature of treatment from before the treatment is given to the post-operative or discharge period. The regulatory authorities in many countries have established standards for consent taking which would include the capacity of the patient, the person who should seek consent, the information to be provided and the necessary documentation.