Rheumatoid arthritis (RA) is a chronic
inflammatory condition that can be associated with
abnormal bone turnover and hence osteoporosis.
Osteocalcin (OC) levels are increased in conditions
with high bone turnover, including high RA disease
activity. Thus, OC levels could possibly be used as a
marker to assess bone health and disease activity in RA
patients. As there have been no previous studies looking
at serum OC levels in Malaysian RA patients, this study
was performed to examine possible correlations between
OC, bone mineral density (BMD) and disease activity
in this population. A cross-sectional study of 75 female RA
patients and 29 healthy controls was performed. Serum
OC was measured using a Quantikine® ELISA kit. Dualenergy
x-ray absorptiometry (DXA) was used to assess
BMD. Serum OC levels were not significantly
different between RA patients (median 14.44 ng/mL,
interquartile range [IQR 12.99]) compared to healthy
controls (median 11.04 ng/mL IQR 12.29) (p=0.198).
Serum OC increased with age (Spearman’s rho r=0.230,
p=0.047). There was no significant correlation between
serum OC and body mass index (BMI), menopause status,
BMD, DAS28, swollen or tender joint counts. Overall,
there were 11 (14.7%) patients with osteoporosis and
27 (36.0%) with osteopenia. Menopause status was
significantly associated with BMD at all sites (lumbar
spine p=0.002, femoral neck p=0.004, total hip p=0.002).
Serum OC were similar in RA patients
compared to healthy controls. In RA patients, serum
OC did not correlate with RA disease activity or BMD.
Menopause status remains an important influence on
BMD. Thus, measuring serum OC levels in Malaysian
RA patients was not useful in identifying those at risk
of low BMD.
Dengue is the most rapidly increasing arthropodborne
disease globally. The disease burden has increased
exponentially, doubling almost every decade from the
estimated 8.3 million cases in 2010 to about 58.4 million
cases in 2013.1
The number of countries reporting
dengue has also increased. Before 1970, less than 9
countries reported dengue but now it has been reported
in more than 100 countries worldwide. It is transmitted
by two species of Aedes mosquito, Aedes aegypti and Ae.
albopictus. (Copied from article).
Amoebiasis is a parasitic infection caused by the
intestinal protozoan Entamoeba histolytica, most
prevalent in developing countries. It results in 40,000 to
100,000 deaths each year from amoebic colitis and extra
intestinal infections. Amoebic liver abscess (ALA)
is the most common extra intestinal site of infection
with an incidence of between 3% and 9% of all cases of
amoebiasis. Ultrasound which has a sensitivity of more
than 90% for detecting ALA is highly recommended
as an initial investigation followed by serological
demonstration of circulating antibodies specific to
Introduction: The prevalence of cataract surgeries
ranges from 7 to 12 million cases in 2000, 20 million
in 2010 and an estimation of 32 million cataract
surgeries annually by the year 2020 worldwide (WHO,
2015). Traditionally, the healthcare providers were
only able to give health education before the patient
is discharged from the healthcare setting while followup
can only be done when the patient comes for their
follow-up. But most of the patients will remain confused
or had forgotten about the post-operative care even
after receiving a comprehensive discharge preparation.
However, with the advancement of technologies in
this modern era, nurse-led telephone follow-up can be
considered as a tool to assist healthcare providers in the
follow-up care in Malaysia. On the same note, a private
eye specialist organisation with centres throughout
Malaysia, had taken the initiative to provide telephone
follow-up service for their patients with three main
objectives namely, to provide pre- and post-education
on cataract surgery, to detect early post cataract surgery
complications as well as to minimise anxiety among
their patients. However, till date no patient feedback
regarding the service was conducted.
Objective: The research objective for this study was to
determine patient’s level of satisfaction with the nurseled
telephone follow-up after cataract surgery at a private
eye specialist centre in Penang.
Method: A cross sectional quantitative descriptive study
design was used to study ninety post cataract patients in
a private hospital, Penang through universal sampling
method. A validated self-developed questionnaire based
on the three main objectives of the telephone follow-up
service was used for this study.
Results: Overall, the level of patient’s satisfaction with
nurse-led telephone follow-up after cataract surgery at
a private eye specialist centre in Penang was high (49.9
±4.85) especially for the health education provided
(4.18 ±0.21) followed by the effort to detect early
complications (4.16 ±0.12) and to minimise patients’
anxiety level (4.16 ±0.12).
Primary sinonasal Non-Hodgkin’s Lymphoma’s
(NHLs) are quite rare and emulate the presentation
of benign inflammatory diseases. It is challenging to
distinguish them morphologically and radiologically
from other malignant neoplasms.
We report a 37-year-old male patient who presented
with obstruction of the nasal passages, rhinorrhoea,
epistaxis, post nasal drip, facial swelling, orbital
symptoms and pyrexia. The mass was a nasal diffuse large
B-cell lymphoma confirmed by immunohistochemistry.
After the first cycle of chemotherapy was started, the
patient improved with resolution of the facial swelling,
pain and visual defects.
A high index of suspicion is required to differentiate
sinonasal lymphomas from other lesions.
Limb length discrepancy (LLD) is quite common.
Lower limb shortening is one of the causes of limb
length discrepancy. The common treatment that is
used is the llizarov technique for bone lengthening.
The new technique uses an intramedullary nail with
a monoplanar external fixator. Using this technique,
bone lengthening duration in patients can be reduced
and knee joint mobility can be improved without
jeopardizing bone regeneration. We report a case of a
27-year-old gentleman who had right femur shortening
from childhood and was referred to us for corrective
deformity. He underwent bone lengthening on the nail
which lenghthens and equalizes the leg while avoiding
stiffness and reduces joint mobility which leads to good
patient satisfaction outcome. The use of the external
fixator with intramedullary nailing to lengthen the
femur is one method that can reduce patient burden
mentally and physically. However although it has many
advantages we must watch out for the complications
during the regular visits to ensure good outcome.
Bone transport using the Ilizarov technique has been
one of the most popular techniques in treating fracture
with significant bone defect. However, pain and joint
stiffness following Ilizarov fixation are few of the wellknown
complications. We report a case of a 23-year-old
gentleman with a closed left humeral diaphyseal fracture
following a traffic accident who underwent plating of the
left humerus which was later complicated with infected
nonunion. He was then treated with corticotomy and
bone lengthening using the semicircular Ilizarov ring
fixator. Good clinical and functional outcomes were
observed during transportation period (elbow flexion
10̊ to 90̊) with minimal complications.
Introduction: It is still a challenge that the
dissecting room has a place in learning gross anatomy.
Understanding the students’ preference of learning
tools is important to devise alternative teaching aids
for improvement in learning anatomy. This study was
conducted to assess student’s preference of learning tools
available in the anatomy laboratory of an integrated
Methods: A cross-sectional comparative study was
carried out for 4 weeks among 741 medical and dental
students of International Islamic University Malaysia
(IIUM), Universiti Teknologi MARA (UiTM),
University Sabah Malaysia (UMS) and University
Malaysia Sarawak (UNIMAS). Pre-tested, semistructured,
self-administrated questionnaires including
open-ended questions were distributed. The data were
analyzed by using SPSS 17.
Results: Most of the participants were Malays (86%) and
female (67%). The students from IIUM, UiTM, UMS
and UNIMAS preferred the plastic model in terms of
handability and application in examination (OSPE). It was
statistically significant (p
Tumoral calcinosis is an uncommon condition which
has been described to exist in primary and secondary
forms. A lack of awareness of this entity can lead to
unnecessary procedures and incorrect management.
We report a case of a patient on peritoneal dialysis who
presented with multiple painful joint swellings to the
orthopaedic department. An initial diagnosis of septic
arthritis was made, then revised to chronic tophaceous
gout and referred to the rheumatology unit.
The human foot serves as an important part to support
the body weight and accounts for the majority of our
movements. A mangled limb involves injury to at least
three out of four systems, namely the soft tissues, nerves,
blood supply and bone. While amputation is indicated in
some cases of mangled limb, with proper planning, limb
salvaging surgical management is also a viable option.
Special consideration to the skeletal stabilization, control
of infection, vascular status and soft tissue coverage is
paramount to the success of limb salvaging surgery. We
present a case of mangled limb which was successfully
treated with limb salvaging surgical management. Initial
debridement, Kirschner wires insertion and cross ankle
external fixation were used for skeletal stabilization. An
antibiotic spacer was inserted for local antibiotic and to
maintain the length left due to the loss of medial and
intermediate cuneiform bones. The anterior tibialis
artery and its venae comitantes were utilized for free
vascularized fibular graft to provide bony reconstruction
as well as soft tissue coverage for the mangled foot.
Introduction: Nurses are obligated to respond
competently in the event of cardiac arrest. Nurses could
be hesitant to intervene due to low self-efficacy in their
ability to manage cardiac arrest patients.
Objective: The objective of this study was to
determine the level of nurses' perceived self-efficacy
in cardiopulmonary resuscitation (CPR) at a private
hospital in Kuala Lumpur.
Method: A cross-sectional descriptive study was
conducted with 112 respondents who fulfilled the
inclusion criteria. A 19 item questionnaire on
Resuscitation Self-Efficacy Scale (RSES) was adapted
and scored using a 5-point Likert scale.
Results: The total mean score and standard deviation
of perceived self-efficacy score in resuscitation was (M
= 77.68; SD ± 11.77) which indicated a high degree
of self-efficacy among nurses. There were significant
differences between respondents’ age groups with (t
= -2.520; p = 0.013), unit of working (t = -4.086; p =
0.001), real experiences in resuscitation (t = 2.532; p =
0.013), and the number of participations in resuscitation
(t=-6.668; p=0.001) and nurses perceived self-efficacy
in CPR. There were also significant differences between
respondents' years of working experience with (F
= 7.286; p =0.001) and types of last resuscitation
training (F= 7.088; p = 0.001). However, there was no
significant difference between the nurses' time of their
last resuscitation training (F = 1.225; p = 0.298) and the
nurses perceived self-efficacy in CPR.
Conclusion: In conclusion, nurses were deemed to possess
a high sense of self-efficacy in CPR. This study concluded
that nurses' age groups, years of working experience,
unit of working, real experiences in resuscitation and
the number of participations in resuscitation and types
of last resuscitation training are factors contributing
towards self-efficacy in CPR performances. However, the
time of last resuscitation training reported no significant
difference towards nurses' perceived self-efficacy in
CPR. Therefore, repetitive CPR and ACLS certification
training are pivotal in order to strengthen nurse’s self-efficacy in resuscitation and team collaboration through
training in this private hospital.
Cervical spine injury is commonly associated with
road-traffic accidents. The true incidence of cervical
spine injuries is unknown due to under-reporting of
such injuries. Cervical spine injury is associated with
high morbidity and mortality if it is missed. With the
advancement of imaging modalities, the number of
missed cervical injuries has reduced. Nevertheless, some
clinicians are dependent solely on imaging tools to rule
out cervical spine injury in a trauma victim. We report
two cases of “near miss” C6 fracture to highlight the
importance of a detailed clinical history and clinical
examination with imaging as an adjunct to rule out
Background: Medical schools are escalating changes
to meet the need for doctors competent to work in the
era of precision medicine. Information on the current
level of awareness of precision medicine among medical
students can help effect the necessary changes in the
medical curriculum. A cross-sectional comparative
study was done to assess the knowledge, attitude and
perception toward the practice of precision medicine
among junior and senior medical students in a medical
school in Malaysia.
Materials and Method: A survey instrument measuring
attitude toward precision medicine, perceived
knowledge of genomic testing concepts, and perception
toward ethical consideration related to precision
medicine, was distributed to junior and senior medical
students. Comparisons were made between senior and
junior medical students.
Results: Only about one-third of the 356 respondents
had heard of precision medicine although 92.7%
expressed interest to learn more about precision
medicine. Overall, junior and senior medical students
had positive attitude toward the adoption of genomeguided
prescribing and precision medicine but were
uncomfortable with their knowledge of genomic testing
concepts. Both junior and senior students were largely
well grounded in their understanding of ethical issues
related to precision medicine.
Conclusions: Knowledge of precision medicine was low
among junior and senior medical students. Although
the students supported the use of precision medicine,
they did not feel adequately prepared to apply genomics
to clinical practice. Their perceptions on ethical issues
related to precision medicine were sound. Seniority did
not appear to influence the perceptions of the students.
Background: It is an undeniable fact that exposure to
tobacco smoke from the ambiance poses harmful effects
to human health. Although many countries including
Malaysia have imposed smoking bans and restrictions
in indoor and outdoor public places, yet, to achieve a
zero exposure to tobacco smoke from one’s surroundings
remains a challenge.
Objective: The objectives of this study were to
determine the second-hand smoke (SHS) knowledge
and percentage of exposure among adults of rural Pedas,
Negeri Sembilan and assess the association between
socio-demographics and knowledge of SHS among these
Methods: A cross sectional study with convenient
sampling was carried out on 485 adults in Pedas,
Negeri Sembilan. The instrument used was a validated
questionnaire which was adapted with permission to suit
the sample under study. The data collected were analysed
with SPSS Statistics for Windows, Version 24.0.
Results: The percentage of SHS exposure among the
non-smoking adults in rural Pedas, Negeri Sembilan
was high (95.5%). More than 30% of the non-smoking
respondents reported a daily exposure to SHS. The
adults from this study however have good knowledge of
SHS effects on health. A Mann-Whitney U test result
revealed that knowledge on SHS scores was significantly
higher for the non-smokers than that of smokers
(U=17645, p < .001, r=.18). The top three locations
identified as the most common places for SHS exposure
were restaurants (38.9%), followed by workplace
(26.2%) and home (19.4%).
Conclusions: The percentage of SHS exposure among
the non-smoking adults of rural Pedas, Negeri Sembilan
is high. Although the adults in this study have good
knowledge of SHS health consequences, yet they are
unavoidably exposed to SHS because smoking still
occurs within their home, workplaces and public places.
Our findings suggest the need for more comprehensive,
assertive and strongly enforced policies to ban smoking
in public areas, not only in this community but all across
Introduction: Perioperative care is nursing care provided
by perioperative nurses to surgical patients during the
perioperative period. Its role is important as patients
especially those who had undergone coronary artery
bypass graft (CABG) surgery encounter high levels of
psychological and physical stress.
Objective: To determine the needs of CABG patients
throughout the perioperative period and how well those
needs were met.
Methods: This is a cross sectional descriptive survey.
A total of 88 patients who had undergone coronary
artery bypass graft were recruited through census
sampling. The instrument which was adapted and used
with permission for this study was “Survey of Patient
Needs and Experiences during the Perioperative Period’
questionnaire (Davis et al., 2014).
Results: The patients perceived the perioperative
needs in the post-anaesthesia care unit area to be the
most important (M = 2.89, SD = 0.06). Perioperative
needs which were rated the highest for each of the
four time periods were “Having information about the
surgical procedure itself”, “Having your family member
or significant other with you in the pre-surgical area
complications”, “Being treated with respect and with
dignity by hospital personnel” and “Having your family
member or significant other visit you in the recovery
room”. Overall, patients perceived their needs during
perioperative period to be partly met (M = 2.73, SD =
0.07) with post-anaesthesia care unit area being rated
the highest (M = 2.81, SD = 0.06).
Conclusion: The results of this study highlighted the
perceived needs of patients undergoing coronary artery
bypass graft surgery throughout their perioperative
period. In order to improve the quality of perioperative
care for patients, nurses need to take into consideration
the important needs identified by the patients and
address the items which were not meeting the needs of
Background: House-officers and medical officers are at
the forefront during medical emergencies in the ward
and casualty which impose cognitive, communication,
social and system challenges and yet, training in this
area is commonly lacking. A workshop was conducted
using simulation to provide training on some acute
medical emergencies like cord prolapse, post- partum
haemorrhage with collapse, poly-trauma and acute
exacerbation of asthma.
Objective: To determine the effectiveness of simulation
in developing competency in managing selected clinical
Methodology: There were 22 participants consisting
of house-officers, junior medical officers and nursing
clinical instructors. Only doctors were included in
the study. Four medical emergencies were chosen viz.:
Cord prolapse; post- partum haemorrhage with collapse;
poly-trauma and acute exacerbation of asthma. The
simulated sessions were conducted using high fidelity
manikins and simulated patients. Simulated patients
were trained and moulage was applied accordingly. The
skills stations were on airway equipment and techniques
of application, latest cardiac life support algorithm and
hands on chest compression using manikins.
Results: A 5 point Likert scale used to rate the
sessions. The skills station had 65% (n=13) rating as
excellent and 35% (n=7) good. The skills simulation
was rated excellent by 75% (n=15) and good by 25%
(n=5) of participants. Verbal feedback was that it was
very refreshing, informative, and helpful in terms of
improving their skills.
Conclusion: The simulated skills training for the junior
doctors was very well received and maybe beneficial for
work preparedness and in the long run address patient
Neuroendocrine carcinoma of the female
reproductive tract are a heterogeneous group of rare
neoplasms posing both diagnostic and therapeutic
challenges. The recent classification by WHO
includes neuroendocrine carcinomas (NECs) and
neuroendocrine tumours (NETs). NECs are the poorly
differentiated small cell carcinoma (SCNEC) and
large cell neuroendocrine carcinoma (LCNEC), while
well-differentiated NETs include typical carcinoids
(TC) and atypical carcinoids (AC). Majority of
these tumours have an aggressive clinical course and
published data is supportive of multi-modal therapeutic
strategies. Etoposide/platinum based chemotherapy is
commonly advocated. Histopathological categorisation
and diagnosis are paramount to guide therapy.
Well-differentiated carcinoid and atypical
carcinoid tumours should be managed similar to
gastroenteropancreatic neuroendocrine tumours.
This review discusses the current classification, clinicpathologic
characteristics and advances in the diagnostic
evaluation and the treatment options of neuroendocrine
carcinoma of the cervix.
Background: Positive physician-nurse collaborative
relationship is the key determinant for patients’
Objective: The purpose of the study was to investigate
registered nurses’ attitude towards physician-nurse
collaboration and its association with demographic
Methodology: The study was descriptive and crosssectional.
The data of the study was collected using
the “Jefferson Scale of Attitudes toward Physician-
Nurse Collaboration”. The sample size of the study was
127 registered nurses recruited using convenience
sampling. Descriptive statistics and inferential statistics
t-test were used for data analysis.
Results: The results showed that nurses’ attitude towards
physician-nurse collaboration was positive (M=3.25,
SD±0.29). The attitude of the participants was highly
positive towards “shares education and collaboration”
(M=3.42, SD±0.36), “nurse’s autonomy” (M=3.42,
SD±0.44), and “caring vs. curing” subscales (M=3.41,
SD±0.41). However, the participants rated lowest for
“physician’s authority” subscale (M=2.12, SD±0.83) and
particularly on the item “doctors should be dominant
authority in all health care matters” (M=2.11, SD±0.99).
Furthermore, t-test analysis revealed no significant
association between nurses’ attitude towards physiciannurse
collaboration and demographic characteristics
such as age, gender, and educational level (p > 0.05).
Conclusion: The results of the study provided some
crucial evidences on nurses’ attitude towards physiciannurse
collaboration. The evidences are useful for the
relevant stakeholders to initiate relevant strategies to
improve and strengthen the relationship gap between
physicians and nurses.
There has been an increase in the number of Motor
Vehicle Accidents (MVA) in Malaysia throughout
the years. Although blunt neck injury is uncommon,
it is associated with severe, permanent neurological
deficit with risk of mortality. This case is a classical
presentation of a young male involved in a MVA who
sustained head and neck injuries of varying severity.
After a short symptom free interval, the patient
started to develop neurological signs. Presenting signs
and symptoms include Horner’s syndrome, dysphasia,
hemiparesis, obtundation or monoparesis. A computed
tomography (CT) scan of brain must be done and if the
findings showed that there is no intracranial bleeding
(ICB), high suspicions with further evaluation should
be done. Confirmation can be obtained by Doppler
ultrasonography, magnetic resonance imaging, magnetic
resonance angiography (MRA), CT angiography (CTA)
or catheter angiography to rule out carotid artery injury.
We report a case of occult primary spontaneous
pneumothorax in a 30 years-old woman. She
developed symptoms and signs that were suggestive of
pneumothorax. However, chest radiograph failed to
reveal pneumothorax. Therefore, we proceeded with
computed tomography (CT) thorax which revealed
significantly moderate right pneumothorax. The
diagnostic approach and the management of this case