Objective: This case report highlights the optimum end-of-life care of an adolescent dying of cancer. Method: We report our experience, as part of a multidisciplinary team in managing the cancers of a female student who died an untimely death at the age of 15. Results: Our role of motivating her for chemotherapy of her initial treatable carcinoma, became that of palliative care upon discovery of a second malignancy. We helped the patient “live life to the fullest” during her last days, she helped us realize that helping her master the tasks of adolescence was optimum “end-of-life care” as well. Conclusion: to help an ill adolescent die with dignity is to help her live whatever time she has left of her life. Allowing her to participate in decisions regarding her treatment and in other bio-psycho-social needs of that stage of life is crucial in helping her prepare for the end of life.
Pregnancy and childbirth are generally regarded as a turning point for women even though it is not an illness. This is because the physiological and psychosocial adaptation can bring about stress and anxiety. Ontologically a pregnant woman is not merely an object that can be classified as a
primigravida or according to her obstetric condition. The contention is that she is also a daughter, a working woman, and a wife with her past, present and future. All these determine who she is and influence how she thinks, acts, feels and behaves during childbirth (Polt, 1999). This journal is about Heideggerian hermeneutic study: Malaysian Chinese women’s expectations and lived experiences of childbirth.
This study aimed to develop and validate an inventory that measures the whole range of basic and integrated science process skills as stipulated in the Malaysian science curricula and that is suitable for Malaysian lower secondary school students. The validated inventory was subsequently utilised to determine the differential acquisition of science process skills by gender, location, and ethnicity. In the instrument development phase which involves item generation and field testing, a reliable 60-item Malaysian-Based Basic and Integrated Science Process Skills Inventory (MB-BISPSI) that has a KR-20 reliability of 0.88, difficulty indices of items that range between 0.25-0.75 and discrimination indices which are above 0.4 was produced. In the main causal-comparative study using a sample of 1021 Form 2 students (548 girls and 473 boys) from seven (four rural and three interior) out of the eight secondary schools in Kapit Division, Sarawak, the findings indicate that the students achieved a mastery level which fell short of the two-third benchmark (e.g., 66.7%) for the overall science process skills, basic and integrated science process skills, and also for each of the 12 science process skills. Additionally, it was found that, while female students generally achieved a markedly higher mean percentage score in the overall Science Process Skills than did the male students, such phenomenon was only observed amongst the Kenyah ethnicity. There were no significant differences in science process skills acquisition between rural and interior students. Implications for a more thoughtful inculcation of science process skills are proffered alongside recommendations for future research using a more nationally representative sample to examine the validity of such generalisation.
This exploratory study is part of an on-going project about digital cultures on ageism, anonymity, and gendering. An avatar is the graphical representation of the online user. The study investigates the avatars drawn by a group of 76 young adults studying in a local university. A face-to-face interview was conducted to ascertain the features drawn. Results show that the avatars are more characterized by the sexual features related to the body, face, clothes, and a major number of context elements. The females tend to represent themselves in greater detail than the males. The former created gendered identities for themselves according to their offline gender identity and social contexts. The study illustrates that the hand drawing is an effective tool that analyses the online representation in an unobtrusive way. The expressions of gendering show that gender is consciously constructed. Gendering of avatars does permeate the virtual world. This study is a valuable addition to the growing body of work on social interaction in cyberspace.
Anti-N-methyl-d-aspartate receptor encephalitis is a recently described neurological disorder and an increasingly recognized cause of psychosis, movement disorders and autonomic dysfunction. We report 20-year-old Chinese female who presented with generalized tonic-clonic seizures, recent memory loss, visual hallucinations and abnormal behavior. Anti-N-methyl-d-aspartate receptor encephalitis was diagnosed and a computed tomography scan of abdomen reviewed a left adnexal tumor. We describe the first such case report of a patient with anti-N-methyl-d-aspartate receptor encephalitis who was given a bilateral transversus abdominis plane block as the sole anesthetic for removal of ovarian tumor. We also discuss the anesthetic issues associated with anti-N-methyl-d-aspartate receptor encephalitis. As discovery of tumor and its removal is the focus of initial treatment in this group of patients, anesthetists will encounter more such cases in the near future.
Fetomaternal haemorrhage (FMH) may occur following a sensitizing event, during pregnancy or at delivery. In cases of rhesus (Rh) incompatibility between mother and the fetus, it can thus subject to the haemolytic disease of the newborn. The Kleihauer test for quantification of FMH lacks standardization and results are less accurate. Furthermore, it cannot differentiate the foetal cell from the adult HbF. Flowcytometry analysis using monoclonal antibodies, is a new technique for the quantification of FMH and it allows larger number of cells to be analysed. It is also able to differentiate the foetal cell from maternal HbF, and thus is more sensitive and accurate. The objective of our study was to determine the FMH using the flowcytometric analysis of anti-HbF antibody and to correlate the FMH using flow cytometry and the standard Kleihauer test. Ninety eight peripheral blood samples from pregnant women at more than 20 weeks of pregnancy and post delivery were analyzed by both methods. The percentage of the foetal cells were recorded and the FMH were calculated. We found a fair correlation between the two methods with the correlation coefficient r = 0.633 (p
Tooth wear is the non-carious loss of tooth tissue due to attrition, erosion and/or abrasion. The amount of wear that accelerates physiological tooth wear is referred as pathological tooth wear. This study aims to determine the prevalence and mean scores according to mouth quadrant of raw tooth wear (RTW) and pathological tooth wear (PTW) and investigate sex association with PTW among 16-year-old secondary school children in Kota Bharu, Kelantan. This cross-sectional study involves 688 participants randomly selected from eight government secondary schools. The Smith and Knight Tooth Wear Index (TWI) was used. Data were analyzed using a simplified Microsoft Excel program developed based on the index to quantify PTW. Bar graphs were plotted to highlight the mean scores according to mouth quadrant. About 44% of participants were male and 56% were female. The prevalence of RTW and PTW among subjects was 100% and 20.1% respectively. It was found that 32.8% of tooth surfaces were affected with RTW and 0.7% of study subjects already had exposed dentine. The most affected quadrant for RTW and PTW was the upper and lower incisal quadrant respectively. Males had 92% more odds of developing tooth wear compared to females. In conclusion, all subjects have some degree of wear. About one-fifth of the study subjects were affected by PTW. The patterns of wear were similar to those encountered in the Western societies. There was statistically significant association between sex and PTW.
The purpose of this study was to identify the most common forms of age-related cataracts and to estimate possible risk factors for age-related cataracts in a sample of cataract patients at the National University of Malaysia Hospital. Thirty five patients (17 males and 18 female) with cataracts were recruited from the ophthalmology ward and clinic at the hospital. The age range of the patients was between 39 to 93 years (mean 64.9 11.5 years). The Lens Opacities Classification System (Locs) III was used to grade nuclear, cortical and posterior subcapsular lens opacities. Grading of the cataract was carried out and the following information was collected: initial visual acuity and best-corrected visual acuity, demographic details, health history, dietary intake of antioxidants and lifetime ocular ultraviolet B exposure. Analyses were conducted using a standard case-control design. T-tests were used to assess the significance of continuous variables and chi-squared tests were used for categorical variables. The overall prevalence of cortical cataract was 34.4% (12 patients), nuclear cataract was 60.0% (21 patients), and posterior subcapsular cataract was 57.1% (20 patients). No significant potential risk factor was found for nuclear cataracts. In the case of posterior subcapsular cataract, hypertension was the only potential significant risk factor (x2 = 4.38, p = 0.036), and in the case of cortical cataract, cigarette smoking was the only significant risk factor. Although lifetime effective ocular UV-B exposure was found to be not a significant potential risk factor, but it was seen that for cortical cataracts, the mean difference of lifetime effective ocular UV-B exposure between those with cortical and those without cortical cataracts was larger compared to others with nuclear and posterior subcapsular cataracts. Hypertension was found to be a potential significant risk factor for posterior subcapsular cataract whereas cigarette smoking was a potentially significant risk factor for cortical cataract. Although not statistically significant, lifetime effective ocular UV-B exposure maybe a potential risk factor for cortical cataract.
Introduction: Breast cancer is the most common cancer among women worldwide and in Malaysia. It has better cure rate if detected early. However, the practice of breast cancer screening in Malaysia is still low. The objective of this study is to determine the knowledge and its associated factors as well as sources of information on breast cancer and breast cancer screening among female staff in a public university in Malaysia. Materials and Methods: This was a cross sectional study conducted in 2005 involving 394 female staff including academic and non-academic staff, which was selected by cluster sampling. A self-administered questionnaire on socioeconomic characteristics and family history of breast cancer was used for data collection. Chi-square Test and Fisher’s Exact Test was used for testing an association using SPSS 12.0. Results: The response rate was 84.3%. Only 50.9% had high knowledge on breast cancer and breast cancer screening and this was significantly associated with occupational status, monthly family income and educational level (p
An aberrant right subclavian artery is the commonest aortic arch anomaly. Majority of them were asymptomatic. An aberrant subclavian artery is a rare cause of dysphagia in adults. This condition is also known as dysphagia lusoria. We report a case of dysphagia in a 49-year-old woman from an aberrant right subclavian artery. Diagnosis of her condition was made with barium swallow and MDCT (multidetector computed tomography) scan. She was managed conservatively.
A Mondor’s disease is a rare, benign and self-limiting condition. It is due to thrombophlebitis of the superficial veins of the breast and chest wall. It usually occurs in middle-aged women who present with a palpable cordlike structure, often painful in the acute phase. The aetiology is unknown, and may be related to trauma, surgery, infection or tight clothing. The finding of a superficial vessel seen as a linear opacity on mammography and a tubular structure on ultrasound is typical. An intra-luminal thrombus may be seen on ultrasound, and there may be absent flow on Doppler imaging. Conservative treatment is usually instituted, although surgery may be indicated in certain circumstances.
We describe a case of a giant pyogenic granuloma affecting the left index finger of a 23-year-old pregnant lady requiring surgical excision. Pyogenic granuloma gravidarum is a benign hyperplastic lesion that commonly presents on oral mucosa, typically the gums, in approximately 5% of pregnant women. Skin lesions over the fingers are an unusual site during pregnancy with only a few cases reported in the literature. The lesion was excised and a diagnosis of lobular capillary haemangioma was made based on histopathological evaluation. We delayed surgery until after parturition since recurrence is likely to be lower due to lower levels of circulating oestrogen and progesterone. The prognosis is usually excellent following resection. However, recurrences have been reported regardless of the treatment method.
A Case Report on Gender Identity Disorder with Recurrent Depressive Disorder is presented. Individuals having this disorder often exhibit discomfort about their actual anatomic gender, and they may have wished to alter their bodies. Sex role-stereotypes adopted during childhood are the beliefs, characteristics and behaviors of individual cultures that are considered normal and appropriate for boys and girls to possess. These "norms" are influenced by one's family and friends, the mass-media, and their community. Since some cultures disapprove of cross-gender behavior, it often results in significant problems for affected individuals and those in close relationships with them. The importance of treatment is not only because of the high rate of mental-health problems, including Depression but with higher suicide rate among untreated transsexual people than in the general population. These problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-deviated individuals. An example which classically illustrates Gender Identity Disorder is the case of a young man from Brunei Darussalam, who was seen and treated. This
contribution will highlight the cultural and religious perspective of this Disorder.
Spinal epidural angiolipomas are rare benign tumors. The tumors contain both vascular and mature adipose components. Typically, they present with a progressive clinical course. Acute presentation is rare. We present a case of a fifteen-year-old girl who presented with a sudden onset of backpain followed by paraparesis with bladder and bowel incontinence. Neurological examination showed sensory loss below T10 with Grade 2 motor power. Spinal MRI showed long segment extradural lesion at T6-T9 level. Multiple laminectomy and excision of the tumor containing areas of hemorrhage was performed. Histopathology report revealed angiolipoma.
Acute appendicitis is the most common extra-uterine surgical emergency encountered during pregnancy, but an accurate diagnosis is still an enigma. Anatomical shifting of the appendix by the enlarging uterus makes the clinical and sonographic diagnosis difficult. Prompt diagnosis and treatment are essential to prevent perforation, which increases the risk of fetal and maternal death. Surgical intervention, either by an open laparotomy or laparoscopy is the most appropriate treatment for appendicitis. This article reviews the epidemiology, clinical diagnosis, investigation, complications and treatment of acute appendicitis in pregnancy.
A rare case of spontaneous bilateral stress fractures of femoral neck leading to coxa vara in a young female with history of chronic renal disease and secondary osteomalacia is described. Once the underlying disease was controlled, the fracture was treated by valgus osteotomy with good result.
The case report describes the presentation of a 19-year old female with tuberous sclerosis who presented with progressive dyspnoea over 2 days.
Chest radiograph revealed bilateral pneumothorax. Computed tomography showed features of pulmonary lymphangioleiomyomatosis and bilateral renal angiomyolipomas. The coexistence of both conditions may cause devastating morbidity and mortality.
Background: At the International Medical University (IMU), a half day cardiac life support teaching session was provided to fourth year medical students which included training on the use of the defibrillator machine, how to handle cardiac or respiratory arrest and drugs used for resuscitation. A new CLS (cardiac life support) training session was introduced and increased to a oneday course where students were given practical training first, which included 5 stations (airway equipment, mega codes, drugs for resuscitation, defibrillator use and cardiac rhythm identification) , MCQ (multiple choice questions) test and a mega code (practical)assessment. Objective: To evaluate the students’ knowledge on cardiac resuscitation after a change in the delivery of the cardiac life support training (CLS).
Methodology: Group I, consisted of 82 students taught using the traditional teaching and Group II consisted of 77 students taught using hands on simulation. The students in both groups had an online manual to read prior to the session, were given an identical written exam six months after the CLS training. Group II, however, had an online pre-test.
Results: There was a statistical difference in the final mean marks between the two groups with group II scoring higher (67.3) than group 1 (62.1). No significant marks difference was noted between male and female students for both the cohorts.
Conclusion: There is a significant difference in medical students’ knowledge when cardiac life support is taught using simulation. IMU has adopted the new teaching method with simulated training for the cardiac life support courses with plans to implement higher fidelity and technology to the existing simulated teaching in other areas of medicine.
Objective: The objective of this study was to assess the relationship between stress score and body mass index (BMI) of students of Science in Kuala Lumpur. Methods: A cross-sectional study was carried out among 126 students. Data about stress score were collected using a questionnaire, the Student-Life Stress Inventory (SLSI) Data about BMI were calculated from height and weight of the respondents. Results: A total of 117 (92.85%) out of 126 students had responded. The mean difference of stress score among first, second and third year students were 87.6 ± 17.0, 83.4 ± 16.9 and 86.7 ± 15.4 respectively. The mean difference of stress scores between the Bumiputra and non-Bumiputra students were 87.9 ± 16.5 and 83.2 ± 15.9 .The mean of body mass Index(BMI) between first, second and third year students were 21.0 ± 3.5, 20.3 ± 2.7 and 21.8 ± 4.3 respectively. Conclusions: This study showed that the stress level is higher in first year, female and bumiputra student. There was no significant relationship between stress score and BMI.
This paper aims at presenting preliminary results of a survey on physical factors, namely tube
potential (kV), tube current exposure time product (mAs) and compressed breast thickness (CBT)
during voluntary mammography screening using Full-Field Digital Mammography (FFDM) System
in Malaysia. Retrospective data were collected from 1128 FFDM images of 282 women from three
major ethnic groups (Malay, Chinese and Indian) who underwent voluntary screening
mammography at Breast Centre, International Islamic University Malaysia from January to March
2008. Results from the present study were then compared with results from the previous study on
Screen-Film Mammography System (SFM) according to the ethnic group for both Cranio-caudal
(CC) and Mediol-Lateral (MLO) views. We found that the mean kV for CC view for the three ethnic
groups are Malay (28), Chinese (28) and Indian (28), and for MLO view are Malay (29), Chinese
(28) and Indian (29). These values are higher than the kV for SFM which were Malay (26), Chinese
(27) and Indian (26) for CC and Malay (26), Chinese (27) and Indian (26) for CC and MLO views
respectively. The mean mAs for CC and MLO views for FFDM were lower compared to SFM
systems. These values were Malay (104), Chinese (108) and Indian (91) for CC views and Malay
(106), Chinese (105), and Indian (94) for MLO views for the FFDM system. The values for SFM
system are for CC and MLO views were Malay (120), Chinese (106) and Indian (126), and Malay
(166), Chinese (132), Indian (183) respectively. The median CBT for CC and MLO views increased
by 27% and 7% respectively on the FFDM compared to the SFM system. In conclusion, the FFDM
operates with higher kV, lower mAs, and higher CBT when compared with SFM system. Median
CBT on CC and MLO view with FFDM system are 27% and 7% higher respectively compared to
the SFM. We are currently collecting data on mean glandular dose with FFDM systems to assess
how the change in local mammography practice influences this value. This will allow comparison
with related data from other parts of the world.