Displaying publications 1 - 20 of 173 in total

  1. Tze, Hao Wong, Gupta, Esha Das, Radhakrishnan, Ammu K., Suk, Chyn Gun, Chembalingam, Gandhi, Swan, Sim Yeap
    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.
  2. 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).
  3. 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.
  4. 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).
  5. 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.
  6. 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.
  7. 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.
  8. 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
  9. Chai, Win Lin, Phang, Yuen Hoong, Chong, Hwee Cheng
    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.
  10. 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.
  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. 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.
  16. 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
  17. Kavitha Nagandla, Sharifah Sulaiha, Sivalingam Nalliah, Norfadzilah Mohd Yusof
    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.
  18. Tang, Wai Mun, Wong, Tze Yee, Cherish Chai
    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.
  19. Mohd Razaleigh Yusof, Tony Yong Yee Kong, Andee Dzulkarnaen Zakaria
    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.
  20. Tai, Yong-Ting, Tong, Chin-Voon
    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
    are discussed.
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