Myxoid neurofibroma is benign tumours of perineural cell origin that arise from elements in the peripheral nervous system. We report a case of a 60-year-old female patient presented with history of right ear mass which was slowly growing. Her primary complaint was cosmetic deformity but hearing loss was also present. The mass was excised and histologically revealed a myxoid neurofibroma. To the authors' knowledge, this is the first time that a myxoid neurofibroma arising from external auditory canal is reported. It should be included in the differential diagnosis of a mass originating from this location.
Keywords: Kelantan, Hospital Universiti Sains Malaysia
OBJECTIVE: Special Study Module (SSM) is a mandatory research module implemented in Universiti Kebangsaan Malaysia (UKM). The objective of this paper is to provide a brief overview on the student research activities and to find out the outcome measures in terms of publication.
METHODS: It was a retrospective study done on SSM research projects at UKM. The SSM research is conducted from beginning of year-4 until 1(st) seven weeks of year-5. In year-4, students are assigned to a faculty-supervisor in small groups and spend every Thursday afternoon to plan and carry the research. Whole first seven weeks of year-5, students are placed with their supervisor continuously to collect data, do analysis, write report and present in the scientific conference. Outcomes of 5-years SSM research-projects starting from 2008/2009 to 2012/2013 academic session were analyzed.
RESULTS: Total 257 projects were completed and presented in annual scientific meetings from which 57 (22.2%) articles were published in peer reviewed journals.
CONCLUSION: Mandatory undergraduate student research project brings an opportunity to develop students' capacity building from conception to final report writing and thereby narrowing the gap between education and practice. Medical schools should implement research module to bring changes in research and publication culture of undergraduate medical education.
KEYWORDS: Malaysia; Medical education; Publication; Research; Undergraduate
The Malaysian Node of the Human Variome Project (MyHVP) is one of the eighteen official Human Variome Project (HVP) country-specific nodes. Since its inception in 9(th) October 2010, MyHVP has attracted the significant number of Malaysian clinicians and researchers to participate and contribute their data to this project. MyHVP also act as the center of coordination for genotypic and phenotypic variation studies of the Malaysian population. A specialized database was developed to store and manage the data based on genetic variations which also associated with health and disease of Malaysian ethnic groups. This ethnic-specific database is called the Malaysian Node of the Human Variome Project database (MyHVPDb).
Aim. Poor sleep quality due to pain has been reported among opioid-dependent male patients on methadone maintenance therapy (MMT) but objective pain data are lacking. This study aimed to investigate the rate of pain-sensitivity using cold pressor test (CPT) and the relationship between pain-sensitivity and sleep quality in this population.
Methods. A total of 168 male participants were included into the study. Objective pain-tolerance was evaluated at 0 h and at 24 h after the first CPT. Malay version of the Pittsburgh Sleep Quality Index (PSQI) and the subjective opiate withdrawal scale (SOWS) questionnaires were administered to evaluate the quality of sleep and withdrawal symptoms, respectively.
Results. The mean age of study participants was 37.22 (SD 6.20) years old. Mean daily methadone dose was 76.64 (SD 37.63) mg/day, mean global PSQI score was 5.47 (SD 2.74) and mean averaged SOWS score was 5.43 (SD 6.91). The averaged pain-tolerance time ranged from 7 to 300 s with a mean time of 32.16 (SE 2.72) s, slightly below the cut-off score of 37.53 s. More specifically, 78.6% (n = 132) of participants were identified as pain-sensitive (averaged pain-tolerance time ≤37.53 s), and 36 (21.4%) participants were pain-tolerant (averaged pain-tolerance time >37.53 s). The pain-sensitive group reported poorer sleep quality with mean (SD) PSQI of 5.78 (2.80) compared with the pain-tolerant group with mean (SD) PSQI of 4.31 (2.18) (p = 0.005). With analysis of covariance, pain-sensitive group was found to have higher global PSQI scores (adjusted mean 5.76, 95% CI 5.29; 6.22) than pain-tolerant participants (adjusted mean 4.42, 95% CI 3.52; 5.32) (p = 0.010).
Conclusions. Majority of opioid-dependent male patients on methadone treatment are pain-sensitive with CPT. Poor sleep quality is associated with cold pressor pain-sensitivity. Pain and sleep complaints in this male population should not be overlooked.
Study site: Hospital Universiti Sains Malaysia (HUSM) and other MMT clinics (Kota Bharu, Pasir Mas, Pasir Puteh and Bachok), Kelantan, Malaysia
Four new species of semiterrestrial gecarcinucid crabs are described from limestone and sandstone habitats in southwestern Sarawak, Malaysia: Terrathelphusa aglaia n. sp., T. cerina n. sp., T. kundong n. sp., and T. mas n. sp. The taxonomy of T. kuchingensis (Nobili, 1901) is discussed, its precise identity ascertained from fresh material, and its actual distribution determined. This increases the number of Terrathelphusa species in Borneo to eight.
We describe the clinical presentation, investigation and management of an eventually fatal case of hypercalcemic crisis due to primary hyperparathyridism (PHPT). A 60 year-old lady with history of urolithiasis presented with worsening generalized bone pain, spinal scoliosis and a limp. Laboratory data showed hypercalcemia and raised alkaline phosphatase. Left hip x-ray revealed a subcapital femoral neck fracture. Intact parathyroid hormone was elevated, 187.6 pmol/L (1.6 – 6.9) and ultrasound showed an enlarged right parathyroid gland. Despite initial reduction of serum calcium with saline infusion and multiple doses of intravenous pamidronate, her calcium increased to 4.14 mmol/L a week following application of Buck’s traction for persistent left hip pain. She succumbed eventually with serum calcium peaking at 6.28 mmol/L despite multiple therapeutic interventions.
KEY WORDS: Primary hyperparathyroidism, hypercalcemic crisis, pathological fracture, urolithiasis
Leachate collected from the collection ponds of four landfill sites was investigated and compared for total coliforms and E. coli concentration as representatives of fecal pollution. Concentration of total coliforms and E. coli was comparable for leachate obtained from Kulim Landfill Site (KLS) and Ampang Landfill Site (ALS) with little variations. However, the level of indicator bacteria was significantly lower for Kuala Sepetang Landfill Site (KSLS), whereas Pulau Burung Landfill Site (PBLS) had the lowest concentration for both total coliforms and E. coli. Considering the landfills are currently operational, with the exception of ALS, the presence of indicator bacteria implies their inactivation prior to discharge. High concentration of indicator bacteria in ALS is attributed to the run-off entering the leachate pond. Greater concentration of ammonia and salinity level were partly responsible for lower concentration of indicator bacteria in leachate from KSLS and PBLS, indicating that salinty and ammonia could significantly affect the survival of indicator bacteria.
BACKGROUND: Triage of patients in the emergency department is a complex task based on several uncertainties and ambiguous information. Triage must be implemented within two to five minutes to avoid potential fatality and increased waiting time.
OBJECTIVE: An intelligent triage system has been proposed for use in a triage environment to reduce human error.
METHODS: This system was developed based on the objective primary triage scale (OPTS) that is currently used in the Universiti Kebangsaan Malaysia Medical Center. Both primary and secondary triage models are required to develop this system. The primary triage model has been reported previously; this work focused on secondary triage modelling using an ensemble random forest technique. The randomized resampling method was proposed to balance the data unbalance prior to model development.
RESULTS: The results showed that the 300% resampling gave a low out-of-bag error of 0.02 compared to 0.37 without pre-processing. This model has a sensitivity and specificity of 0.98 and 0.89, respectively, for the unseen data.
CONCLUSION: With this combination, the random forest reduces the variance, and the randomized resembling reduces the bias, leading to the reduced out-of-bag error.
KEYWORDS: Decision support system; emergency department; random forest; randomized resampling
The discovery of an additional specimen of Sphenomorphus malayanus Doria, 1888 from Gunung Brinchang, Cameron Highlands, Pahang in Peninsular Malaysia reveals that it is not conspecific with the type specimen from Gunung Singgalan, West Sumatra, 600 km to the south. The new specimen and an additional specimen previously collected from Gunung Gerah, Perak, Peninsular Malaysia, 56 km to the north, are described here as the new species S. senja sp. nov. and differ from S. malayanus by having a larger SVL (60.0-65 mm versus 53 mm); a deeply recessed as opposed to a shallow tympanum; 72 or 73 versus 76 paravertebral scales; eight or nine superciliary scales as opposed to 10; and the posteriormost superciliary scale being large as opposed to small. Cameron Highlands is unique among other upland areas in Peninsular Malaysia in that it harbors an unprecedented number of closely related ecological equivalents living in close sympatry or syntopy.
"Cauliflower Ears" describes the appearance of swelling of the auricular cartilage resulting in gross distortion of the auricle. The underlying pathology is inflammation of the auricular cartilage. We report a case of a patient who presented to the ophthalmology clinic with an ocular inflammation, whose subsequent diagnosis of replapsing polychondritis was clinched with the finding of "Cauliflower Ears". This case emphasizes the importance of an appropriate general examination of ophthalmic patients for early diagnosis and prompt institution of medical treatment, which may prevent life-threatening complications to the patient.
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
The Government's decision to drastically and speedily increase the number of doctors in the country needs to be reviewed. The standard and quality of health care does not depend on the number of doctors, but on the improvement of the health care infrastructure. Increasing the number of government medical schools and increasing the intake of students should be done on a need-to basis, with the above perspective in mind. The selection criteria of candidates must not be compromised and the teaching staff must be adequate and experienced. The number of doctors should be gradually increased over the years in tandem with the development of the health care infrastructure and the deployment of doctors must be directed at providing equitable care to the people at all economic levels and geographic locations. The strength of academic staff in existing government medical schools must be upgraded to provide high level of teaching and research, perhaps reinforced with the recruitment of suitably qualified and experienced foreign teachers. The infrastructure of existing government medical schools must be upgraded to cater for the gradual increasing demand for more doctors as the country develops. The selection of candidates for the government medical schools must be based on merit and without undue emphasis on ethnic considerations, for it is only in the arena of fair competitiveness that excellence can be born. The considerations of merit in selection must include assessment of attitude, self-development, moral ethics and reasoning. If the above perspectives are fully appreciated, then there is really no requirement for private medical colleges in Malaysia.
Issues related to the provision of private education are discussed in relation to the need, clinical teaching, professional standards and financial implications. The advantages and disadvantages are summarised.
The people who are in detention are screened by the Medical Officer of the Prison and if they are found to be unwell, these prisoners will be accommodated in the sickbay and medical treatment will be provided. If their sickness needs further investigations and management, they will be sent to the Government Hospital. If the prisoners are found to have infectious or contagious diseases, steps will be taken to prevent the spread of these diseases to other prisoners in the prison. Prisoners are given time to exercise to maintain good health and their clothing are regularly washed to make sure that they will not contract skin diseases, e.g. scabies, ringworm, etc. The Prison Department since 1989 has increasing numbers of HIV positive prisoners. The Department complies with this problem by sending staff for courses, lectures and seminars so that they will be able to handle these prisoners more efficiently in the prison. When these HIV/AIDS prisoners' condition turns bad, they are usually transferred to a Government Hospital. Another of the Prison Department's prominent medical problem among the prisoners is drug addiction. Staff trained with skill and techniques are counselors for the drug related prisoners. Realizing and in anticipation that the sickbays in the prisons are going to be full of HIV/AIDS prisoners and drug related prisoners, special attention will be given to more allocation to upgrade the sickbays in the prison. White attires will be provided to the sick prisoners in the sickbays so that they will look neat and clean. More doctors, medical assistants and nurses will be employed so that appropriate medical care or rather more appropriate medical care can be provided to the sick prisoners in the prisons. The Prison Department is in the process of privatizing medical care for prisoners in the prison and the Department is also trying to convert some prisons to be medical prisons so that adequate medical care can be given to the sick prisoners.
Gnamptogenys menadensis is an arboreal nester that forages opportunistically almost exclusively on vegetation, sometimes recruiting others to participate in prey retrieval. The three-dimensional characteristics of vegetation suggest that functions describing recruitment decision thresholds or the pattern of recruitment in arboreal species may differ from those predicted by optimal foraging theory. To examine the effects of prey abundance and distance on the recruitment dynamics of G. menadensis, we baited nests with one termite, five termites or a number of termites between 20 and 40 either near to or far from the entrance and observed the ensuing behaviors. G. menadensis recruited others when encountering multiple termites regardless of the termite pile's distance from the nest, although a few individuals remained at the site and defended the resource. The pattern of arrivals at the site indicates that the majority and sometimes all arrivals were recruited from the branch trails. In combination, these results suggest that the architecture of the foraging habitat, which limits available return routes to the nest and thus increases encounter probabilities with potential recruits, shaped the process of information transfer and generated a collective pattern of foraging and prey retrieval.