Shock is a clinical challenge to neonatal intensivists and pediatricians alike. It occurs in critically ill babies for many reasons, but the main cause is sepsis that kills more than a million newborn globally every year. This article is designed to help young doctors and trainees have a better understanding of shock in the neonatal period and its management. The paper reviews the basic pathophysiology, risk factors, clinical investigation, management, supportive care, and complications in the common types of shock seen in neonates. Treatment is governed largely by the underlying cause, with the ultimate goal of achieving adequate tissue perfusion with delivery of oxygen and substrates to the cells, and removal of toxic metabolic waste products. Intervention needs to be anticipatory and urgent to prevent progression to uncompensated and irreversible shock respectively. Early recognition and urgent effective management are crucial to successful outcomes.
Nebulization with B-agonist and administration of systemic corticosteroids are standard treatments for severe asthma exacerbations, but corticosteroids take several hours to become effective. IV magnesium sulphate (MgSO4) acts faster and has both antiinflammatory and bronchodilating properties. It appears to have played a pivotal role in the successful management of a child with severe asthma exacerbation and atelectasis unresponsive to conventional therapy. A literature review reveals that the results of IV MgSO4 are much greater in children than in adults, and can avoid the need to hospitalize 25% of children presenting with severe asthma. Magnesium sulphate appears safe to use.
We previously evaluated the biochemical changes induced by the local product TCM for diabetes (TCM-D™) on blood glucose levels and other biochemical changes in normal mice fed orally with the recommended human dose (30 ml/kg daily) and ten times this dose for eight weeks. TCM-D™ is an aqueous extract of the roots of Trichosanthes kirilowii Maxim, Paeonia lactiflora Pall, Glycyrrhiza uranlensis Fisch. and Panax ginseng Meyer (red) combined at the dry weight proportions of 36%, 28%, 18% and 18% respectively. The study showed that at these dosages the blood glucose levels as well as the body weights in treated mice were significantly reduced when compared with pretreatment values and control animals. The present study evaluated the effect of the extract in a mouse model of Type 1 diabetes mellitus.
Background: A number of Traditional Chinese Medicine (TCM) preparations are being used for the treatment of diabetes mellitus. Some components of these preparations have biochemical effects other than those of lowering blood glucose and indeed have been used for other medical indications in traditional practice. The primary objective of the study was to determine the effect of the oral mixture of Traditional Chinese Medicine for diabetes (TCM-D™ complex) on blood glucose level and the biochemical changes if any, on the liver (ALT, AST, gamma-GT, albumin, globulin) and renal (blood creatinine, urea) functions in normal mice. The oral mixture is an aqueous extract of four wellknown traditional Chinese medicinal herbs and consists of Trichosanthes kirilowii Maxim., Paeonia lactiflora Pall., Glycyrrhiza uranlensis Fisch., and Panax ginseng (red) CA Meyer in the proportion of 36%, 28%, 18%, and 18% respectively of the dry weight. These herbs have
been shown to have blood glucose lowering activity and have been used for other traditional medicinal purposes.The safety of the combination was evaluated in the present study. Methods: Experimental Balb/c mice were treated orally via gastric tube with the extract at daily doses equivalent to 1 and 10 times the recommended human dose for 8 weeks. Blood glucose and other biochemical profiles were monitored at pre-treatment and monthly posttreatment until killed. Results: When compared to pre-treatment levels, the blood glucose levels were significantly lower in treated animals compared to those in the control group. At the recommended TCM-D™ dose the levels in treated animals were significantly lower than that of control animals and at pre-treatment. When compared with pre-treatment, the glucose levels were lowest at Week 8 of treatment, the mean levels being 111.23%, 83.32% and 70.33% in control, and in animals given 1 x and 10 x the recommended TCM-D™ dosage respectively. The blood glucose lowering effect was also associated with a significant weight loss in treated animals. There were transient increases in AST and ALT levels but these reverted to normal at Week 8 of treatment. The levels of bilirubin, g-GT, albumin, creatinine and blood urea were also not significantly different at Week 8 from pre-treatment levels in all groups. Conclusion: Even at 10 times the dosage recommended for humans, TCM-D™ did not affect the liver and renal functions of treated animals. Treated and control animals remained healthy and normal throughout the period of observation.
Realising possible unmet needs of final year medical students we initiated a weekly informal face-toface discussion forum between them and the teaching faculty of the department of medicine. Various academic and non-academic topics, as dictated by the students, were discussed in 19 weekly sessions. Evaluation by the students was subsequently done by means of an on-line questionnaire after the final examinations. The aim of this study was to evaluate this forum, undertaken for the first time in our institution, by assessing student feedback. We conclude that although the number of attendees and responders were small, feedback was generally positive. This type of forum can be improved upon and serve as another portal for benefitting students.
Background: Misinterpretation of abbreviations by healthcare workers has been reported to compromise patient safety. Medical students are future doctors. We explored how early medical students acquired the practice of using abbreviations, and their ability to interpret commonly used abbreviations in medical practice.
Method: Eighty junior and 74 senior medical students were surveyed using a self-administered questionnaire designed to capture demographic data; frequency and reasons for using abbreviations; from where abbreviations were learned; frequency of encountering abbreviations in medical practice; prevalence of mishaps due to misinterpretation; and the ability of students to correctly interpret commonly used abbreviations. Comparisons were made between senior and junior medical students.
Results: Abbreviation use was highly prevalent among junior and senior medical students. They acquired the habit mainly from the clinical notes of doctors in the hospital. They used abbreviations mainly to save time, space and avoid writing in full sentences. The students experienced difficulties, frustrations and often resorted to guesswork when interpreting abbreviations; with junior students experiencing these more than senior students. The latter were better at interpreting standard and non-standard abbreviations. Nevertheless, the students felt the use of abbreviations was necessary and acceptable. Only a few students reported encountering mishaps in patient management as a result of misinterpretation of abbreviations.
Conclusion: Medical students acquired the habit of using abbreviations early in their training. Senior students knew more and correctly interpreted more standard and non-standard abbreviations compared to junior students. Medical students should be taught to use standard abbreviations only.
Background: Fetal surveillance in labour is performed mostly to identify fetuses at risk of hypoxia in order to reduce neonatal morbidity and mortality by initiating timely intervention. While normal and abnormal fetal heart rate (FHR) patterns have been well recognised and characterized for the first stage of labour, FHR patterns during the second stage of labour commonly showed some forms of abnormalities leading to problems in interpretation, particularly in predicting fetal hypoxia and acidosis. This study aims to identify patterns of FHR tracing during the second stage of labour associated with neonatal acidosis. Methods: A prospective cross sectional study was conducted in the Labour Ward of a state referral hospital. The study population were patients with low-risk
singleton pregnancies between 37 to 42 weeks gestation who had normal cardiotocograph (CTG) tracing in the first stage of labour. CTG was recorded during the second stage of labour and neonatal umbilical cord blood was obtained for acid-base analysis immediately after birth prior to the delivery of placenta. FHR patterns were grouped according to modified Melchior and Barnard’s
classification and matched with neonatal acid-base status. Patients with normal FHR pattern in the second stage acted as control. Results: A total of 111 matched pairs were analysed. Ninety nine (89.2%) second stage FHR tracings showed abnormal features when compared to control. There were significantly more neonatal acidosis and hypercapnia in type 1b, type 2a, type 2b and type 3 CTG patterns compared to control, in increasing order of severity. In addition, types 2b and 3 showed significant difference in the base excess. Conclusion: Certain second stage fetal heart rate
patterns were found to be associated with neonatal acidosis.
This paper traces the evolution of PBL in the International Medical University over a period
of twenty years; since its inception in 1992 till 2012. It is a record of the reasons for the evolution, the people involved and the strategies adopted. The PBL in IMU has metamorphosed over the years from a paper-based complete case history into its present form of staggered release of information, paper-based or otherwise (videos, web-based, newspaper cuttings, debates). Strategies to improve student and facilitator buy-in, strengthening of facilitator training, adoption of PBL templates, innovations to improve student participation are discussed.
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.
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
curriculum.
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
Background: The widespread use of multiple choice questions (MCQ) in examinations is attributed to its logistical advantage and broad coverage of content within a short duration. The end-of-semester examinations for several modules in the pharmacy programme previously employed a combination of written examination tools including MCQ, short answer questions (SAQ) or essays for assessing learning outcomes in the cognitive domain. Concerns regarding assessment fatigue and subjectivity in marking have led to a review of the assessment formats in the examinations. Various types of MCQ were consequently introduced as the only assessment tool. This study was conducted to evaluate the performance of students in the examinations as a result of the change.
Methodology: Analyses were carried out on the end-ofsemester examination results of two cohorts of students for each module, one based on a combination of MCQ, SAQ or essay and the other based on MCQ alone. The class means were compared, and t-test was used to determine the difference between the performances.
Results: Although the difference in the mean scores of the two groups is statistically significant in 13 of the 20 modules, the difference is less than 5% in 10 modules.
Conclusion: The findings provide evidence that wellconstructed MCQ can effectively assess cognitive skills.
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.
Since the outbreak of the novel influenza H1N1 in April 2009 in Mexico, more then half a million cases have been recorded with more then 6000 deaths.In contrast to seasonal flu, this virus appears to have a predilection for the young, obese and pregnant.It’s most important and almost fatal complication is Acute Respiratory Distress Syndrome (ARDS). Intensive care units (ICU) around the world have scrambled to upgrade various treatment modalities including high frequency oscillation ventilation, inotropes, antivirals and antibiotics in an effort to reduce the mortality arising out of this complication. More importantly, this complication appears reversible if adequate and early therapy is instituted. In particular, rescue therapies that allow the lung to rest appear to have brought success in some clinical settings. This article describes the experiences of seven centers that have used various modalities as rescue therapy in patients having Acute Respiratory Distress Syndrome (ARDS). The experiences in 13 patients at the University of Michigan, 58 in Mexico, 168 in Canada, 180 patients at Leicester UK, 194 in Australia and New Zealand and case reports from Hong Kong and Singapore are described.
Urethral catheterisation is a common and safe procedure performed routinely. The small size of the urethra in a child necessitates the use of an infant feeding tube (Size 5 to 8 F) for catheterisation. Knotting within the bladder is a rare complication with significant morbidity often necessitating surgical or endoscopic removal. Insertion of an excessive length of tube contributes to coiling and knotting. We report an instance of knotting of an infant feeding tube in the proximal penile urethra of a 4 year-old male child requiring urethrotomy to remove it. Awareness of the risk and proper technique can reduce this complication.
Cancer research is an extremely broad topic covering many scientific disciplines including biology (e.g. biochemistry and signal transduction), chemistry (e.g. drug discover and development), physics (e.g. diagnostic devices) and even computer science (e.g. bioinformatics). Some would argue that
cancer research will continue in much the same way as it is by adding further layers of complexity to the scientific knowledge that is already complex and almost beyond measure. But we anticipate that cancer research will undergo a dramatic paradigm shift due to the recent explosion of new discoveries in cancer biology. This review article focuses on the latest horizons in cancer research concerning cancer epigenetics, cancer stem cells, cancer immunology and cancer metabolism.
Background: The tissue specimens used for extraction of DNA in this study were from rodents trapped in four states in Peninsular Malaysia, namely Kedah, Kelantan, Selangor and Johor. Methods: Histological sections of these rodent muscle tissues stained with hematoxylin and eos in showed infection with Sarcocystis spp. Based on these results, the current study was carried out to determine the phylogenetic relationship among the identified Sarcocystis spp. in these rodents.The formalin fixed paraffin embedded (FFPE) rodent muscle blocks were subjected to DNA extraction and followed with semi nested PCR targeting 5’ and 3’ regions of 18S rRNA of Sarcocystis spp. Results: Phylogenetic analysis showed two distinct groups of Sarcocystis spp. among the rodents in Peninsular Malaysia. Most of the identified Sarcocystis spp. were genetically closely related to Sarcocystis rodentifelis and Sarcocystis muris and were also observed to be genetically closely related to Sarcocystis sp. ex Columba livia and Sarcocystis sp. cyst type I ex Anser albifrons. Conclusion: Further classification to confirm these Sarcocystis spp. was not possible as only partial sequences of 18S rRNA was available and this was insufficient for
optimal differentiation.
The relationship between anatomy and surgery has been historic and epic, spanning many centuries, complementing each other in medical education and being independent as well as interdependent in many ways. However, curricular changes that have happened globally in recent years with the introduction of several contemporary styles of medical teaching have subtly downplayed the importance of anatomy in medicine, allowing young doctors with poor knowledge of anatomy to become surgeons. With a whimsical introduction that metaphorically hints at the strained relationship that exists between anatomy and surgery, the article attempts to explore the ‘anatomy’ of anatomy itself, examining its origins in recorded ancient history, evolution along the centuries in tandem with surgery and its current status in medical education.
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
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.
The only potential curative therapy for gastric cancer is the resection of both the tumor and the regional lymph nodes at the early stage of the disease. The majority of patients with gastric cancer in Malaysia have an advanced disease at initial diagnosis, and curative surgery is possible in less than 20% of operated cases. Acurate preoperative staging is crucial in determining the most suitable therapy and avoiding unnecessary attempts at curative surgery. While computed tomography remains as the most widely used imaging modality for gastric cancer staging, its ability to detect local invasion, peritoneal and liver metastases is limited. In the recent years laparoscopy has become an important component in the staging algorithm of gastric cancer. The aim of this review is to evaluate the efficacy of routine preoperative laparoscopic staging in the management of gastric cancer, and in particular describe the Malaysian experience.