Displaying publications 1 - 20 of 173 in total

  1. Lokman Hakim Sulaiman
    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).
  2. Wong TH, Das Gupta E, Radhakrishnan AK, Gun SC, Chembalingam G, Yeap SS
    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.
    Study site: Rheumatology clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, and Klinik Pakar Puchong, Kuala Lumpur, Malaysia
  3. Htar Htar Aung, Nilar Shwe, Tin Tin Myint, Tin Moe Nwe
    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
  4. Chai WL, Phang YH, Chong HC
    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.
  5. Mansharan Kaur Chaincel Singh
    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
    Entamoeba histolytica.
  6. Lim, Swee Geok, Lim, Aun Cyi, Wong, Xiao Jing
    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).
  7. Kow, Ren Yi, Aziah Abdul Aziz, Muhammad Firdaus Abas, Low, Chooi Leng, Akmal Azim Ahmad Alwi
    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.
  8. Kamarul Izham Kamarudin, Then, Jun Wei, Yeoh, Ching Wooi, Ooi, Ying Jing, Chopra, S.
    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.
  9. Sunil Pazhayanur Venkateswaran, Rafiq Abdul Karim Vasiwala, Norfadzilah Mohd Yusof
    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.
  10. Mohd Bakrynizam Abu Bakar Siddiq, Kamarul Izham Kamarudin, Kamarul Al Haq, Suresh Chopr
    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.
  11. Ho, Siew Eng, Tee, Sok Ching
    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.
  12. Kow, Ren Yi, Hazwan Ab Wahid, Ed Simor Khan Mor Japar Khan, Colin Komahen, Low, Chooi Leng, Ruben Jaya Kumar
    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
    cervical injury.
  13. Koh, Kwee Choy, Shanmugan Goonasakaren, Ng, Lam Kean, Chua, Yi Lin, Lee, Jia Ying, Alaric Ding Tian Ang
    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.
  14. Siew, Wei Fern, Kazuya Jian Yong Choo, Lim, Zi Xuan, Azlan Kok Vui Tsia
    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
  15. Surenthiran Ramanathan, Tong, Chin Voon
    Papillary thyroid microcarcinoma is not uncommon
    and constitutes almost one third of all differentiated
    thyroid carcinomas. It is generally regarded as low risk
    and usually an incidental finding from histopathology
    examination. Some areas of management of this entity
    remains uncertain and requires a multidisciplinary
    approach. We present a patient who initially came to
    us with symptoms of hyperthyroidism, later underwent
    thyroidectomy for a suspicious lesion but was found to
    have micropapillary thyroid carcinoma in another part
    of her thyroid gland.
  16. Kamarul Izham Kamarudin, Nur Dini Mohd Yusof, Suresh Chopra
    Open reduction and internal fixation using
    conventional lateral distal femur locking plate is a
    standard operative method for distal femur fracture.
    This case series describes medial plating of distal
    femur fracture using proximal tibia locking plate that
    is anatomically fit to the medial aspect of distal femur,
    by the minimally invasive plate osteosynthesis (MIPO)
    technique which gives a stable construct with good
  17. Kwa, Siew Kim, Zainab Majeed, Shane Varman
    Introduction: Assessment is an integral aspect of
    teaching. One-best-answer (OBA) items, if properly
    constructed are able to drive learning. In-house OBA
    items are notoriously poorly-constructed. The role of
    a central vetting committee is to review test items and
    ensure that they adhere to expected standards. Hence,
    the objective of this audit is to determine whether
    central vetting has improved the construct quality of
    OBA items.
    Methods: We audited the psychiatry end-of posting
    OBA items from before and after central vetting to
    compare the quality of the items before and after
    central vetting was instituted. Quality was evaluated
    on appropriateness of test content, items with higher
    cognition and items without flaws. A standard was not
    set for this first audit.
    Results: Seventy six of 181 psychiatry OBAs items
    retrieved from 2011 to August 2012 had undergone
    first level (department) vetting only and the remainder
    105 (58.0%) had two levels of vetting; department and
    central vetting committee (CVC).
    Appropriateness of content increased from 92.1% to
    98.1%. Items with higher order thinking doubled from
    21.1% to 42.9%. Items with clinical scenario increased
    by 8.4% to 78.1%. Logical ordering of options however,
    remained around 50%.

    Two-level vetting markedly reduced problematic
    lead-in questions (67.1 to 13.3%), non-homogenous
    options (42.1 to 9.5%), vague and implausible options
    (39.5 to 6.7%), and spelling and grammar mistakes
    (19.7 to 5.7%).
    Conclusion: Two-level vetting had improved the
    quality of OBAs and should be continued. This could
    be enhanced by training all Faculty on writing quality
    OBA items and careful selection and empowerment
    of CVC members. A re-audit is to be conducted after
    Faculty training.
  18. Lim, Swee Geok, Low, Chian Yi
    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
    the patients.
  19. Thiruselvi Subramaniam, Ann Jee Tan
    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
  20. Ren Yi Kow, Zamri Ab Rahman, Ruben Jaya Kumar, Zaharul Azri Mustapha@Zakaria, Low, Chooi Leng
    Femoral nailing is the overall “gold standard” in
    treating femoral shaft fractures. However, plate
    osteosynthesis at the femoral shaft is still being done
    in selected patients. We report a case of right femoral
    implant failure after a broad limited contact dynamic
    compression plate (LC-DCP) insertion and its
    subsequent management using our minimally invasive
    technique. Our technique is biologically compliant
    as well as cosmetically friendly. We converted a loadbearing
    implant into a load-sharing implant in view that
    obesity is a significant predictive factor of non-union in a
    femoral fracture treated with locking plate. The patient
    subsequently recovered well with no complication.
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