Giant cell tumour in the metatarsal of a skeletally immature person is uncommon. Adequate surgical resection in this region can be difficult to achieve as there is little space between the rays of the foot. Furthermore, there is the challenge of restoring the metatarsophalangeal articulation after resection of the tumor. We describe a technique using non-vascularised fibular graft for reconstructing the 2nd metatarsal after en-bloc resection for giant cell tumour in a 14 year old adolescent female.
Chondrosarcoma of the spine is rare; it presents predominantly in very young males and presentation with neurological deficit is uncommon. Treatment of this type of tumour is mainly through surgery as adjuvant therapy is ineffective. En bloc resection of tumours in the spine are difficult although it remains the recommended treatment for chondrosarcoma. We report here presentation of a female with paresis (Frankel C) whom was diagnosed with a large chondrosarcoma of the T2 vertebra extending to the right upper thoracic cavity. The patient underwent radical xcision through an anterior and posterior approach to the spine.
This report describes an unusual case of multidrug resistant tuberculosis (MDR-TB), involving the right clavicle and multicentric aytpical spine involvement without any neurological deficit. The female patient presented with acute onset of right clavicular pain associated with a one-monthhistory of lower backache with constitutional symptoms. The clavicular lesion and MRI spine findings were highly suggestive of TB. Anti TB drugs (ATD) were started empirically as Sabah, Malaysia the patient’s home, is anendemic area for TB. Despite, 2 months of ATD administration, the patient did not respond well clinically and developed left sided chest wall abscesses arising from the left 3rd and 6th ribs. She was then treated for MDR-TB infection and has responded well to this treatment.
The importance of incorporating medical (or health) informatics into the education of medical students and medical practitioners is being increasingly recognised. The advances in information and communication technology and the pervasion of the Internet into everyday life have important implications for healthcare services and medical education. Students and practitioners should learn to utilise biomedical information for problem solving and decision making based on evidence. The extensive introduction of electronic health information systems into hospitals and clinics and at the enterprise level in Malaysia and elsewhere is driving a demand for health professionals who have at least basic skills in and appreciation of the use of these technologies. The essential clinical informatics skills have been identified and should be incorporated into the undergraduate medical curriculum. It is recommended that these be introduced in stages and integrated into existing programmes rather than taught as a separate module. At the same time, medical schools should support the integration of e-learning in the educational process in view of the numerous potential benefits.
Bacillus thuringiensis is an anaerobic, spore forming bacterium that produces various toxic proteins both during its vegetative stage and sporulative stage. During its sporulative stage, it produces parasporal proteins that have long been used in the agriculture fields as insecticides. Although anticancer effect of Bacillus thuringiensis parasporal proteins can be dated back to the 1970s, research in this area went through a giant leap in the late 1990s, with much of the work being done in Japan. It has been found that some strains of non-insecticidal Bacillus thuringiensis produce parasporal proteins that exhibit anticancer activity. Due to their selectivity against human cancer cells but not normal cells, some of these proteins have been extensively studied for their anticancer effect and the mechanism of action by which these proteins kill cancer cells have also been widely explored in Japan and Malaysia with sporadic reports from other parts of the world. The abundance of these bacilli in nature and their selectivity have made them potential candidates for cancer treatment. However, literature on the in vivo effect of these proteins is scarce. Since different Bacillus thuringiensis strains produce different cytotoxic proteins with wide variations in their anticancer effect and mechanism of action, further investigations are necessary and their effect in vivo must be well established before they can be used in human subjects.
Preferred body sizes appear to decrease markedly with increasing exposure to contemporäry notions of slimness and economic modernity, and reduce even further in industrial settings as socio-economic status increases. Recently a study examining physical attractiveness preferences in Britain and Malaysia, shows that preference for slim ideals varies according to socio-economic status. Malaysians in
Britain and Kuala Lumpur preferred slimmer female bodies than observers in semiurban Kota Kinabalu, who in turn preferred slimmer figures than rural observers in East Malaysia. This study has important implications for the study of body image and eating disorders in Malaysia.
The vital importance of the mental health of a nation for the overall well being of the population and socioeconomic development is increasingly recognized. In Malaysia, psychiatric disorders were responsible for 8.6% of the total Disability Adjusted Life Years and were ranked fourth as the leading cause of burden of disease by disease categories. More and more evidence shows that physical illnesses are strongly associated with psychiatric disorders. Those with physical illnesses have much higher risk of developing psychiatric disorders compared to that without. The mechanisms of co-morbidity of psychiatric and physical illness are complex. It is a two-way interaction and there are five different possible ways to describe this.
The problem of illicit drug use has been a long standing problem in Malaysia. It is well recognized that drug mis-use is associated with many social, economic and health problems, including mental health problems. Anxiety disorders have consistently been cited as the commonest type of psychiatric disorder in drug users. In Malaysia, many drug users are incarcerated in rehabilitation centres and prison. They form a different type of population as compared to the drug user in the general population, due to the effects of incarceration. With this in mind, a study was carried out in a rehabilitation centre, looking at anxiety disorders. Utilizing the SCID, we found current and lifetime diagnoses for anxiety disorders at 63.4% and 67.6% respectively. Suggestions are made in regards to our findings.
The aim of this paper was to study hand washing practices in the Neonatal Intensive Care Unit (NICU), Hospital Universiti Sains Malaysia. All medical personnel handling babies in the NICU were observed without their knowledge for a total of three times before and after an educational intervention between November 1, 1993 and December 31, 1993. Hand washing techniques with both Hibisol Spray and Chlorhexidine were scored from 1-4. The results of the study are shown as follows: the number of personnel observed were: before educational intervention -paediatric doctors (PD) 14, non-paediatric doctors (ND) 13 and nurses (N) 48; after educational intervention - PD 10 , ND 12 and N 42. PD and N washed hands significantly more often than ND (p < 0.001), before and after intervention. PD but not ND or N improved their rate of hand washing after educational intervention PD (p= 0.02). The Hibisol handwashing technique was poor in all groups (77.1% of all observations). The Chlorhexidine hand washing technique was better than Hibisol (p<0.0001). However only 15% of observed washes with Chlorhexidine were well done and almost one third were done poorly. Both Hibisol and Chlorhexidine techniques did not improve after educational intervention. Hand washing was performed more often in the Level III than Level II nursery [85% of all observations in Level III and 73% of all observations in Level II, p=0.002]. In conclusion, the present educational program is not sufficient and more direct means should be taken to improve the frequency of hand washing among all medical personnel. All medical personnel in the NICU should be educated in the use of the Hibisol, otherwise Hibisol should be removed from the nursery.
Keywords: Handwashing, doctors, neonatal intensive care unit, nurses
Study site: Hospital Universiti Sains Malaysia, Kelantan, Malaysia
Congenital varicella syndrome is a rare outcome of early primary maternal varicella zoster infection. The neuromuscular anomalies, skeletal defects and skin lesions of such a case are described in our case report. The diagnosis of congenital varicella syndrome, the prenatal risk and management of primary maternal varicella infection in pregnancy are also discussed.
The earliest report of a dengue epidemic in the Malaysian Peninsula was from Singapore in 1901 (More, 1904). S. Kae' in 1902 described the next epidemic in Penang. In March 1954, an outbreak of febrile illness was reported at the Methodist Girls' School, Kuala Lumpur, from which dengue viruses were first isolated in Malaysia and identified as dengue type 1.2 However, the first report of the sinister dengue fever with haemorrhagic manifestations was made only in 1962 from Penang Island (Rudnick et al, 1965).3Parameswaran4 in 1965 described the clinical features seen in 41 cases admitted into the children's ward in the Penang General Hospital. Several of the early isolates were of dengue type 2. (Copied from article).
The paper discusses on the complexity of the issues surrounding a patient with subluxation of cervical spine in a Down syndrome child. Several relevant issues are discussed including consent in a minor, conflicting decision making between parents and doctors, end-of-life issues, supporting handicapped child with minimal co-morbidities, community ethics, neglect of care by the caregiver and decision making after allowing zonal of parental discretion. Despite the difficulties surrounding parental actions, there are still ethical priorities which have to be considered individually to alleviate the suffering of the patients and the family members. Dealing with patients with chronic illnesses is a challenge for any medical doctors. The case warrants sensitive approach to allow appropriate respect for parental decision despite in disagreement with the clinical team. The term ‘zone of parental discretion’ refers to a controversial area of decision making; and has still many potential conflicts on day to day clinical cases, especially among the conservative society in the East Coast of Peninsular Malaysia.
Objective: The objectives of this study were to determine the effect of a one and a half year educational intervention on the job dissatisfaction of teachers in 30 Community Based Rehabilitation (CBR) centres in Kelantan, Malaysia, and to identify the factors influencing changes in job dissatisfaction following the intervention. Method: Ten educational modules were administered to the teachers. A validated Malay version of Job Content Questionnaire (JCQ) was used pre intervention, mid intervention and post intervention. Result: Repeated Measure ANOVA revealed there was a statistically significant reduction in the mean of job dissatisfaction (p = 0.048). Multiple Linear Regression revealed that co- worker support (β= 0.034 (95% CI = 0.009, 0.059)), having less decision authority (β: -0.023; 95% CI: -0.036, -0.01) and being single (β: -0.107; 95% CI: -0.176,-0.038) were significantly associated with decreases in job dissatisfaction. Conclusion: The intervention program elicited improvement in job satisfaction. Efforts should be made to sustain the effect of the intervention in reducing job dissatisfaction by continuous support visits to CBR centres.
Introduction: Peer mentoring is one of the mentoring essential components in any higher institution of learning. In the Medical Faculty of Universiti Malaysia Sarawak (UNIMAS), this mentoring system has existed long but has not undergone any formal evaluation. Objective: The main objective of this study is to determine the perception of peer mentoring among medical students of Faculty of Medicine and Health Sciences (FMHS), UNIMAS. Method: It was a cross-sectional study using self-administered questionnaire. All medical undergraduate students of FMHS were recruited. Data was analyzed using SPSS version 22. Result: A total of 234 respondents participated in this study. Peer mentoring system was preferred against other mentoring system. Majority of the respondents reported that academic gain was the main benefits they gained from peer mentoring system. Negative attitude of the mentee and poor time management for the meeting were the top two worst experience encountered by both mentors and mentees respectively. More than half of the mentor and mentee perceived that peer mentoring system was beneficial to them compared to other systems, with reason that the interaction between student themselves were more easier and comfortable. Nevertheless, there should be more interaction between the mentors and mentees. Conclusion: The findings indicated there is a positive contribution of peer mentoring towards the mentoring system of the faculty. There is a need to relook at the current mentoring system and consider peer mentoring to improve the student support.
Feedback and students’ perception towards it has gained increasing attention in the educational literature recently, yet it is an underresearched area. The importance of feedback has not been perceived in a positive manner among medical students. This may be due to students’ lack of knowledge on the concept of feedback and their awareness of the benefits of feedback. This study focused on students’ knowledge on the concept of feedback and their perception towards the feedback system practiced in School of Medical Sciences, University Sains Malaysia. Methods: This was a cross-sectional study involving 433 numbers of students from year 1, 3 and 5 medical students. The variables that were included in this were the gender and their year of study. A validated questionnaire was used to perform this study. School and ethical committee clearance were obtained prior to the start of the study. Data obtained was analysed using Statistical Package for Social Sciences (SPSS) version 20. Results: Findings revealed that students have an average level of knowledge on the concept of feedback and have a neutral perception towards the feedback system that is practiced in School of Medical Sciences, USM. There was no association between students’ knowledge level on feedback and their perception with their year of study and gender differences. However, although there was not much difference in students’ perception level about feedback with their year of study but it was found those students’ perception level decreases as their year of study progresses. It was also found that there was a poor correlation between medical students’ knowledge level on feedback with their perception towards the feedback system in School of Medical Sciences, USM. Conclusions: The area in which it raised concern in students’ perception about feedback was the factors that are involved in feedback practice, which are the givers of feedback, timing of feedback and the mode of feedback. Further study addressing students’ poor engagement and involvement in feedback can be done and issues identified from this study can be included in together for further improvements of the feedback system.
Nuclear technology has found a great need for use in medicine, industry, and research. Smoke
detectors in our homes, medical treatments and new varieties of plants by irradiating its seeds are just a few examples of the benefits of nuclear technology. Portable neutron source such as Californium-252, available at Industrial Technology Division (BTI/PAT), Malaysian Nuclear Agency, has a 2.645 year half-life. However, 252 Cf is known to emit gamma radiation from the source. Thus, this chamber aims to provide a proper gamma shielding for samples to distinguish the use of mixed neutron with gamma-rays or pure neutron radiation. The chamber is compatible to be used with other portable neutron sources such as 241 Am-Be as well as the reactor TRIGA PUSPATI for higher neutron dose. This chamber was designed through a collaborative effort of Kulliyyah Engineering, IIUM with the Bahagian Teknologi Industri (BTI) team, Agency Nuklear Malaysia.
Previous studies have shown that carbamazepine-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) patients is associated with the HLA-B*1502 allele. Screening for HLA-B*1502 before using carbamazepine can prevent SJS/TEN particularly in populations with high frequency of the allele. The objective of this paper was to describe how the UKM Medical Centre, Malaysia was able to set up a cost effective screening of HLA-B*1502 for patients taking carbamazepine. The cost of in-house HLA-B⁄1502 screening was less than those commercially available, and was sensitive and specific.
Mitochondrial DNA (mtDNA) deletions are a major cause of chronic progressive external ophthalmoplegia (CPEO) and Kearns-Sayre syndrome (KSS). We analyzed single mtDNA deletions in 11 CPEO and one KSS patients by means of Southern blot and long polymerase chain reaction (PCR) assays. The deletion sizes ranged from 3.4 kb to 6.9 kb whereas the heteroplasmy level varied from 18.8% to 85.5%. Two unique deletions sized 4320 bp and 4717 bp were found. This study represents the first genetic screen of mtDNA disorders in Malaysia, and it follows the data seen in other published reports on CPEO and KSS genetic aetiology.
Ultraviolet radiation is at shorter wavelengths than the visible spectrum (400 to 700 nm) and is divided into three components: UV-A (315 to 400 nm), UV-B (280 to 315 nm), and UV-C (less than 280 nm). Global increases in UV-B fluxes from decreasing stratospheric ozone amounts caused by anthropogenic chlorine releasing gases (mostly chlorofluorocarbons) have been a matter of public concern for the past 20 years. This surface UV irradiance data retrieved from Ozone Monitoring Instrument (OMI) from AURA spacecraft with the filename OMUVB. OMUVB contains surface UV irradiance data along with supplementary information generated using the OMI global mode measurements. In this mode each file contains the sunlit portion of a single orbit from pole-to-pole, with an approximately 2600 km wide swath composed of 60 ground pixels. The OMI measurements are used to estimate the ultraviolet (UV) radiation reaching the Earth’s surface. The product contains spectral irradiances at 305.1, 310.1, 324.1, and 380.1 nm corresponding to both the overpass time and the local solar noon. Using the correspondence latitude and longitude of Peninsular Malaysia, we can develop the pattern of distribution of UV irradiance interpolations using Sigma Plot and Adobe Photoshop.
Background: Cardiovascular disease is the number one cause of death globally and is projected to remain the leading cause of death. If the trend is allowed to continue, by 2015 an estimated 20 million people will die from cardiovascular disease (mainly because of myocardial infarction and strokes). The number of cardiovascular disease cases in Malaysia has increased to 14% in five years from 96,000 cases in 1995 to 110,000 cases in 2000.
Methods: The cost to treat patients admitted to Universiti Kebangsaan Malaysia Medical Center (UKMMC) Malaysia, diagnosed with Acute Uncomplicated ST Elevated Myocardial Infarction (STEMI) was calculated by using two different methodologies, namely step down costing methodology and activity based costing using clinical pathway.
Results: Cost for each stay per day at the cardiology ward using the step down methodology is RM596.42. The treatment cost is estimated from RM1, 789.26 to RM 4,771.36. The average cost per episode for STEMI care with the average length of stay for 5.6 days is RM3, 340(SD ±596.42. The cost of coronary PCI procedure in step costing is RM 13,950.00. Hence, the total cost incurs for STEMI with PCI is RM 17,290.00(SD ±596.42) by using step down method. (an average cost per episode is RM3,340, plus the cost of coronary procedure of RM 13,950.00 . However by using the ABC the cost of STEMI (PCI) with an average length of stay for 5.6 days is RM 20,431.39. The study showed the ABC method was higher by 15.3% than the step down costing.
Conclusion: The cost in managing STEMI (PCI) with the average length of stay of 5.6 days was calculated by using two different methodologies, namely step down costing methodology and activity based costing. Cost of treatment calculated by using activity based costing are higher because all resources used are incorporated in detail. The ABC method was higher by 15.3% than the step down costing. The difference is within 80-20 rules and the biggest percentage of cost in both methodsis procedure or PCI cost.