The Dunning-Kruger effect is a cognitive bias in which unskilled people make poor decisions and reach erroneous conclusions, but their incompetence denies them the metacognitive ability to recognise their mistakes. These unskilled people therefore suffer from illusory superiority, rating their ability as above average, much higher than it actually is, while the highly skilled underrate their own abilities, suffering from illusory inferiority.
Pain, while salient, is highly subjective. A sensation perceived as painful by one person may be perceived as uncomfortable, not painful or even pleasant to others. Within the same person, pain may also be modulated according to its threat value and the context in which it is presented. Imaging techniques, such as functional magnetic resonance imaging and positron emission tomography, have identified a distributed network in the brain, the pain-relevant brain regions, that encode the sensory-discriminative aspect of pain, as well as its cognitive and affective/emotional factors. Current knowledge also implicates the prefrontal cortex as the modulatory area for pain, with its subdivisions forming the cortico-cortical pathway, an alternative pain modulatory pathway distinct from the descending modulatory pathway of pain. These findings from neuroimaging in human subjects have paved the way for the molecular mechanisms of pain modulation to be explored in animal studies.
Genetic Absence Epilepsy Rats from Strasbourg (GAERS) are a prognostic genetic model of absence epilepsy. This model displays the electro-clinical, behavioural, and pharmacological features of absence seizures. Although GAERS share typical characteristics, including spike-and-wave discharges (SWDs) in the electroencephalography (EEG), age-dependent studies with these animals have not yet been reported. The aim of the present study is to perform a systematic comparison contrasting the SWDs of young and older GAERS, in terms of the number, duration, frequency, and waveform morphology of the discharges, as well as the pre-SWD EEG characteristics, using identical measurement and analysis techniques. The number, cumulative total duration and mean duration of SWDs were significantly higher in young GAERS (4 to 6 months) compared to older GAERS (12 to 14 months). Furthermore, the SWD spectra and average SWD waveforms indicated that a single cycle of the SWD contains more energy in faster components, such as increased spikes and higher power, in the SWDs of the young GAERS. Additionally, older GAERS showed weak amplitude spikes in SWDs and higher power pre-SWDs. These clear morphological differences in the EEGs of young and older GAERS rats should be further examined in future studies that explore new dimensions of genetic absence epilepsy.
MicroRNAs (miRNAs) have a crucial role in gene expression regulation and protein synthesis, especially in the central nervous system. In developing mouse embryos a novel miRNA, miR-3099, is highly expressed, particularly in the central nervous system. This study aims to determine the expression of miR-3099 during cellular differentiation of 46C mouse embryonic stem cells after neural induction with N2/B27 medium.
The Malaysian Journal of Medical Sciences and the Orient Neuron Nexus have amalgated to publish a yearly special issue based on neuro- and brain sciences. This will hopefully improve the quality of peer-reviewed manuscripts in the field of fundamental, applied, and clinical neuroscience and brain science from Asian countries. One focus of the Universiti Sains Malaysia is to strengthen neuroscience and brain science, especially in the field of neuroinformatics.
Student-to-student administration of local anesthesia (LA) has been widely used as the teaching modality to train preclinical dental students. However, studies assessing students' outlook towards their first injection were limited. Therefore, this study aims to evaluate students' perception and anxiety levels towards their first LA injection.
In the context of global increases in the prevalence of non-communicable diseases, the objective of the present study is to investigate the factors affecting individuals' decisions to use health-promoting goods and services.
The recent death tolls and morbidities associated with two deadly viral haemorrhagic fevers (VHFs), i.e., Ebola and dengue, are simply shocking. By the end of August 2014, 65 672 people were afflicted with dengue fever (DF) in Malaysia, with 9505 from Kelantan, and there were 128 reported deaths. More astounding are the death tolls associated with Ebola: 3091 deaths from 6574 reported cases so far. It is not difficult to imagine the potential disaster if Ebola spreads beyond Africa. VHFs are characterised by an acute onset of fever, vascular disruption and a rapid progression to shock and death. The revised World Health Organization (WHO) 2012 classification (dengue with and without warning signs and severe dengue) is more clinically relevant and allows more streamlined admission. With good administrative support and public health and governmental efforts, the dengue epidemic in Malaysia is now more contained. However, there should be no laxity with the imminent lethal Ebola threat. Human-to-human transmission is an important mechanism for the spread of Ebola, and this calls for strict precautions regarding contact with any suspected cases. In contrast, the control and elimination of dengue would require successful control of the vectors and their breeding sites.
The current Ebola outbreak, which is the first to affect West African countries, has been declared to have met the conditions for a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO). Thus, the Ministry of Health (MOH) of Malaysia has taken steps to strengthen and enhanced the five core components of preparedness and response to mitigate the outbreak. The National Crisis Preparedness and Response Centre (CPRC) commands, controls and coordinates the preparedness and response plans for disasters, outbreaks, crises and emergencies (DOCE) related to health in a centralised way. Through standardised case definition and mandatory notification of Ebola by public and private practitioners, surveillance of Ebola is made possible. Government hospitals and laboratories have been identified to manage and diagnose Ebola virus infections, and medical staff members have been trained to handle an Ebola outbreak, with emphasis on strict infection prevention and control practices. Monitoring of the points of entry, focusing on travellers and students visiting or coming from West African countries is made possible by interagency collaborations. To alleviate the public's anxiety, effective risk communications are being delivered through various channels. With experience in past outbreak control, the MOH's preparedness and response plans are in place to abate an Ebola outbreak.
The emergence of fungal species as opportunistic pathogens has warranted further studies on their pathogenicity, epidemiology, and transmissibility. Fungal genotyping has been employed to study the genetic relatedness within the organism, in order to obtain answers to epidemiological questions (such as in outbreak confirmation) as well as to provide basis for the improvement for patients care. Various fungal genotyping methods have been previously published, which can be chosen depending on the intended use and the capability of individual laboratory.
Pilomatricomas can be confidently diagnosed cytologically due to their characteristic cytomorphological features. However, these lesions are rarely encountered by cytopathologists and thus pose a diagnostic dilemma to even experienced individuals, especially when the lesions are focally sampled. We describe two cases of histologically confirmed pilomatricoma. The first case is of a 13-year-old boy with posterior cervical 'lymphadenopathy', and the second one is of a 12-year-old girl with a lower cheek swelling. Both aspirates comprised predominantly atypical basal-like cells, with prominent nucleoli. 'Ghost cells' were readily identified by cell block in case two, but cell block in case one yielded no diagnostic material. In case two, pilomatricoma was accurately diagnosed pre-operatively. A cytological suspicion of a neoplastic process was raised in case one. Despite being diagnostically challenging, pilomatricoma can be diagnosed with careful observation of two unique cytological features of the lesions: (1) pathognomonic 'ghost cells' and (2) irregular, saw-toothed, loosely cohesive basaloid cells, with prominent nucleoli. The role of thorough sampling of the lesion, with multiple passes of various sites, cannot be overemphasized.
Hydatid cysts are not endemic in Malaysia and are rarely seen. We hereby report a case of hydatid cyst of the liver in a 55-year-old Chinese-Australian lady who presented with a calcified liver cyst and negative hydatid serology. A liver segmentectomy was performed and revealed a well-circumscribed, calcified liver cyst containing only creamy whitish material without the typical daughter cyst. A histological examination revealed different layers of the cyst wall and the presence of loose, calcified scolices without a daughter cyst. The case highlights the importance of considering hydatid cyst in the differential diagnosis of liver cyst even in non-endemic areas, as the ease of travelling and migration allows the condition to be seen outside the endemic region.
Cerebral amyloid angiopathy (CAA) accounts for approximately 10-20% of spontaneous intracerebral haemorrhage (ICH). This figure is thought to be higher in the elderly population. With the increasing life expectancy of our population, we anticipate that the prevalence of CAA- related ICH will increase in tandem. Although CAA-related ICH and hypertension-related ICH are distinct entities based on histopathology and imaging, the clinical presentation of the two conditions is similar. The use of brain computed tomography (CT) scans remain the ICH imaging modality of choice in Malaysia due to its availability, cost, and sensitivity in detecting acute bleeds. On the other hand, the use of brain magnetic resonance imaging (MRI) with susceptibility-weighted imaging (SWI) sequencing enables the clinician to determine the presence of chronic blood products in the brain, especially clinically silent microbleeds associated with CAA. However, the use of brain MRI scans in our country is limited and leads to a blurring of lines when differentiating between hypertension-related ICH and CAA-related ICH. How this misrepresentation affects the management of these conditions is unclear. In this study, we present two cases of ICH to illustrate this point and to serve as a springboard to question current practice and promote discussion.
Malignant chest wall tumour is rare. The presentation is usually aggressive that requires extensive resection to prevent recurrence. However, the extensive resection is to the expense of causing defect on the chest wall and hence, respiratory mechanics. Two cases of chest wall tumour are discussed including the surgical approach of radical tumour resection which was combined with placement of titanium mesh and Tranverse Rectus Abdominis Myocutaneus (TRAM) flap to cover the defect and preserve respiratory mechanical functions. The morbidity of using titanium mesh demonstrated in the case series were infection and injury to surrounding tissue due to its rigidity and large size which required its removal. However the formation of 'pseudopleura' made the thoracic cage return back as closed cavity even after the removal of the titanium mesh and allow normal respiratory functions.
BACKGROUND: Client characteristics provide useful information for designing programs that target individuals with risk factors for substance use and for determining client retention. Therefore, this study examined the profiles of clients attending a methadone clinic.
METHODS: A cross-sectional analysis of clients of a methadone clinic was conducted through a survey to obtain a profile of methadone clients.
RESULTS: Of the 51 patients who responded (response rate: 66.2%), the mean (SD) age at which they started substance use was 19.8 (5.1) years. Friends were cited as the most regular source of drugs (82.4%), and heroin was the most commonly used drug (98%). Daily substance use was reported by 72.5% of the respondents; 23.5% admitted to having stolen money to purchase drugs; 92.2% tried quitting substance use on their own and 98% stated that the main reason for registering at the clinic was that they wanted to stop their drug dependence. Approximately 60% of clients were receiving methadone doses of less than 60 mg/day.
CONCLUSION: Heroin is still the most popular drug of abuse and most clients still receive methadone doses below the recommended level, despite evidence of poor patient retention rates associated with these low doses.
KEYWORDS: Malaysia; methadone; patient appointments; profile; substance use
Study site: Methadone clinic, hospital, Malaysia.
BACKGROUND: Aspirin resistance has posed a major dilemma in the prevention of cardiovascular disease and stroke. There have been many factors that have been associated with aspirin resistance. Among these factors, the inflammatory processes of diabetes and glycaemic control have been significantly associated with aspirin resistance. Our study evaluated the prevalence of aspirin resistance and its associated factors.
METHODS: This was a cross-sectional, interventional study, which was implemented from October to November 2012 at the Hospital Universiti Sains Malaysia (HUSM). Sixty-nine patients with diabetes who were taking aspirin were enrolled. The glycosylated haemoglobin (HbA1c) and C-reactive protein (CRP) levels were measured in these patients. The thromboelastography (TEG) level was measured using a TEG machine by a trained technician employing standard methods. The variables obtained were analysed for prevalence of aspirin resistance, HbA1c, CRP, and TEG level. The Chi-square test (and Fisher exact test where applicable) were used to evaluate the associations between aspirin resistance with glycaemic control (HbA1c) and inflammatory markers (CRP).
RESULTS: The prevalence of aspirin resistance was 17.4% (95%; CI 9.3, 28.4). Glycaemic control (HbA1c) and inflammatory markers (CRP) were not associated with aspirin resistance. Aspirin resistance was prevalent in our study population and was comparable to other studies. The mean HbA1c in the aspirin-resistant group was 8.9%, whereas the mean HbA1c in the aspirin-sensitive group was 8.6%.
CONCLUSION: There was no significant difference in HbA1c between the two groups. There was no significant association between CRP levels and aspirin resistance.
KEYWORDS: aspirin resistance; diabetes mellitus; thromboelastography
Study site: NeuroMedical Specialist Clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
BACKGROUND: Optimisation of average glandular dose (AGD) for two-dimensional (2D) mammography is important, as imaging using ionizing radiation has the probability to induce cancer resulting from stochastic effects. This study aims to observe the effects of kVp, anode/filter material, and exposure mode on the dose and image quality of 2D mammography.
METHODS: This experimental study was conducted using full-field digital mammography. The entrance surface air kerma was determined using thermoluminescent dosimeter (TLD) 100H and ionization chamber (IC) on three types of Computerized Imaging Reference System (CIRS) phantom with 50/50, 30/70, and 20/80 breast glandularity, respectively, in the auto-time mode and auto-filter mode. The Euref protocol was used to calculate the AGD while the image quality was evaluated using contrast-to-noise ratio (CNR), figure of merit (FOM), and image quality figure (IQF).
RESULTS: It is shown that AGD values in the auto-time mode did not decrease significantly with the increasing tube voltage of the silver filter (r = -0.187, P > 0.05) and rhodium filter (r = -0.131, P > 0.05) for all the phantoms. The general linear model showed that AGD for all phantoms had a significant effect between different exposure factors [F (6,12.3) = 4.48 and mode of exposure F (1,86) = 4.17, P < 0.05, respectively] but there is no significant difference between the different anode/filter combination [F (1,4) = 0.571].
CONCLUSION: In summary, the 28, 29, and 31 kVp are the optimum kVp for 50%, 30%, and 20% breast glandularity, respectively. Besides the auto-filter mode is suitable for 50%, 30%, and 20% breast glandularity because it is automatic, faster, and may avoid error done by the operator.
KEYWORDS: CDMAM; digital mammography; radiation dose
BACKGROUND: Studies from the West have demonstrated that ready-to-eat cereals (RTECs) are a common form of breakfast and more likely to be consumed by children. This study aimed to investigate the breakfast eating pattern and RTECs consumption among schoolchildren in Kuala Lumpur.
METHODS: In this cross-sectional study, a total of 382 schoolchildren, aged 10 and 11 years old, were recruited from seven randomly selected primary schools in Kuala Lumpur. Information on socio-demographics, breakfast eating patterns, and perceptions of RTECs and dietary intake (24-hour dietary recalls) were obtained.
RESULTS: Among the respondents, only 22% of them consumed breakfast on a regular basis. The most commonly eaten food by children at breakfast was bread (27.2%), followed by biscuits (22.2%) and RTECs (20.5%). The majority of them (93%) reported that they consumed RTECs sometimes during the week. Chocolate RTECs (34.1%), corn flake RTECs (30.3%), and RTECs coated with honey (25.1%) were the most popular RTECs chosen by children. Respondents who consumed RTECs showed a significantly higher intake in calories, carbohydrate, vitamin A, vitamin B1, vitamin B2, vitamin B3, folate, vitamin C, calcium, iron, and fibre (P < 0.05), compared to those who skipped breakfast and those who had breakfast foods other than RTECs.
CONCLUSION: The lower levels of breakfast consumption among schoolchildren in Kuala Lumpur need serious attention. RTEC is a nutritious food which is well accepted by a majority of the schoolchildren in Kuala Lumpur. Nutrition intervention should be conducted in the future to include a well-balanced breakfast with the utilisation of RTECs for schoolchildren.
KEYWORDS: Malaysia; breakfast; calorie; cereals; children
Petrol is known to be hazardous to human health and is associated with various health effects, such as haematotoxicity and oxidative stress. Although Malaysia has adopted the European fuel quality standards in recent years in order to reduce petroleum pollutants and to improve air quality, gasoline with research octane number 95 (RON95), believed to contain benzene and other toxic substances, is still widely used all over the country. This study assessed the effect of RON95 gasoline on haemtological parameters of rats after 11 weeks of exposure.
The present study investigated the effects of Quercus infectoria (QI) gall extract on the proliferation, alkaline phosphatase (ALP), osteocalcin, and the morphology of a human fetal osteoblast cell line (hFOB 1.19).