Background: The present study describes the morphology of sparganum (larva) of the Malaysian Spirometra spp. collected from naturally infected frogs (Rana cancrivora) from rice fields in Tanjung Karang, Malaysia.
Materials and Methods: Spargana of Spirometra spp. collected from naturally infected frogs (Rana cancrivora) were used for the morphological studies. Stretched on a metal ruler, measurements of the worm were recorded. Specimens were stained in Alum-carmine.
Results: The length of the body ranged from 11-50 mm and the width ranged from 0.5-1.5 mm. Specimens stained with Alum-carmine showed ridges (formation of segments) on the surface of the body, and no sexual organs in the body.
Conclusion: The Malaysian Spirometra spp. are similar in measurement and morphology to Spirometra erinacei but further studies are required for confirmation.
Delay in childbearing, family history of type 2 diabetes mellitus and obesity in childbearing years increases a possibility of glucose intolerance or overt diabetes in pregnancy which may remain unrecognised unless an oral glucose tolerance test is done.The International Association of Diabetes and Pregnancy Study Group (IADPSG, 2010) recommended the detection and diagnosis of hyperglycaemic disorders in pregnancy at two stages of pregnancy, the first stage looking for ‘overt diabetes’ in early pregnancy based on risk factors like age, past history of gestational diabetes and obesity and the second stage where ‘gestational diabetes’ at 24-28 weeks with 75 g oral glucose tolerance test. Although the one step approach with 75 g of glucose offers operational convenience in diagnosing gestational diabetes, there are concerns raised by the National Institute of Health in the recent consensus statement, supporting the two step approach (50-g, 1-hour loading test screening 100-g, 3-hour oral glucose tolerance test) as the recommended approach for detecting gestational diabetes. Medical nutrition therapy (MNT) with well-designed meal plan and appropriate exercise achieves normoglycemia without inducing ketonemia and weight loss in most pregnant women with glucose intolerance. Rapidly acting insulin analogues, such as insulin lispro and aspart are safe in pregnancy and improve postprandial glycemic control in women with pre-gestational diabetes. The long acting analogues (Insulin detemir and glargine) though proven to be safe in pregnancy, do not confer added advantage if normoglycemia is achieved with intermediate insulin (NPH). Current evidence indicates the safe use of glyburide and metformin in the management of Type 2 diabetes and gestational diabetes as other options. However, it is prudent to communicate to the women that there is no data available on the long-term health of the offspring and the safety of these oral hypoglycemic drugs are limited to the prenatal period.
Neuroendocrine carcinoma of the female
reproductive tract are a heterogeneous group of rare
neoplasms posing both diagnostic and therapeutic
challenges. The recent classification by WHO
includes neuroendocrine carcinomas (NECs) and
neuroendocrine tumours (NETs). NECs are the poorly
differentiated small cell carcinoma (SCNEC) and
large cell neuroendocrine carcinoma (LCNEC), while
well-differentiated NETs include typical carcinoids
(TC) and atypical carcinoids (AC). Majority of
these tumours have an aggressive clinical course and
published data is supportive of multi-modal therapeutic
strategies. Etoposide/platinum based chemotherapy is
commonly advocated. Histopathological categorisation
and diagnosis are paramount to guide therapy.
Well-differentiated carcinoid and atypical
carcinoid tumours should be managed similar to
gastroenteropancreatic neuroendocrine tumours.
This review discusses the current classification, clinicpathologic
characteristics and advances in the diagnostic
evaluation and the treatment options of neuroendocrine
carcinoma of the cervix.
Surgeries are seen as stressors that trigger preoperative anxiety. Preparing the patients for surgery through preoperative teaching becomes crucial to allay anxiety level. In a cross sectional descriptive study conducted on eighty patients (age: 18–65 yr) who had undergone open abdominal surgery, 78.8% (n=63) stated that they experienced anxiety prior to surgery. Among these anxious respondents, 47.5% (n=38) experienced high state anxiety. Three of the top information that patients perceived as important to allay anxiety towards major surgery were: details of surgery, details of nursing care to surgery and information on anaesthesia. Nurses working in the surgical wards need to proactively address patients’ psychological concerns towards surgery and provide preoperative information based on patients’ needs to allay anxiety.
Melanosis coli denotes brownish discoloration of the colonic mucosa found on endoscopy
or histopathologic examination. The condition has no specific symptom on its own. It is a fairly frequent incidental finding of colonic biopsies and resection specimens. The pigmentation is caused by apoptotic cells which are ingested by macrophages and subsequently transported into the lamina propria, where lysosomes use them to produce lipofuscin pigment, not melanin as the name suggests. Melanosis coli develops in over 70% of persons who use anthraquinone laxatives (eg cascara sagrada, aloe, senna, rhubarb, and frangula), often within 4 months of use. Long-term use is generally believed to be necessary to cause melanosis coli.The condition is widely regarded as benign and reversible, and disappearance of the pigment generally occurs within a year of stopping laxatives. Although
often due to prolonged use of anthraquinone, melanosis can probably result from other factors or exposure to other laxatives. It has been reported as a consequence of longstanding inflammatory bowel disease. Some investigators suggested that increase in apoptosis of
colonic mucosa by anthraquinone laxatives increased the risk of colonic cancer. Recent data, including those from large-scale retrospective, prospective and experimental studies, did not show any increased cancer risk.
Background: Circumcision though not mentioned in the Quran is believed to be a compulsory practice among the Muslims. In Malaysia, although there are several methods of circumcision available and traditional circumcision is still popular.
Methods: A cross-sectional survey was carried out in a small fishing village of Kedah to study the methods of circumcision available to the villagers. This was followed with an in-depth interview conducted with ‘Tok Mudim’, a practitioner of traditional method of circumcision.
Results: Forty three of the eligible 71 subjects participated in the study giving the response rate as 60.5%. The most common age for circumcision was 9 years old. Despite private clinics being the most common place of circumcisions, there was an increasing number of boys going to the ‘Tok Mudim’ for circumcision. A Mass Circumcision Ceremony is traditionally practiced. The ‘Tok Mudim’ described the procedure in detail and was of the opinion that the reason traditional method is still popular was because of the fear of injections and impotency among the parents. Most common complication faced by the ‘Tok Mudim’ was bleeding and infection.
Discussion and Conclusion: Till the community shifts entirely to using modern medicine, there is a need to integrate traditional practitioners into the system. Training the ‘Tok Mudim’ to use modern instruments and aseptic techniques should be considered.
It is estimated that more than 1.1 billion adults and 115 million children worldwide are overweight. In Malaysia, the second and third National Health and Morbidity Surveys in 1996 and 2006 respectively reported a three-fold increase in obesity prevalence among adults, surging from 4.4% to 14% over the 10-year period. Evidence of rising childhood obesity has also emerged. The aim of this article is to gather evidence from food availability data for an insight into population shifts in dietary patterns that may help explain the rising obesity in this country. The nutrition transition was delineated in conjunction with the epidemiologic transition in order to explain the convergence of dietary practices, and the high prevalence of obesity and diet-related non-communicable diseases worldwide. The Food Balance Sheets for Malaysia from 1967 to 2007 were used to provide estimates and trends for the availability of foods and calories. Evidence is generated that indicate at least two major upward shifts in the dietary patterns in Malaysia in the past 4 decades.
These shifts have led to the rising availability of calories from animal products, and from sugar and sweeteners. These major dietary shifts, together with increased sedentariness, constitute core public health challenges faced in addressing the country’s obesity and noncommunicable diseases (NCD) conundrum.
It is ironical to realize that a perfect and free nutritional product, individually produced and naturally distributed to all families, is not universally used. This product is of course breast milk that nurtures the optimal health, growth and development of the human young. Breast milk also protects infants and young children from and prevents diseases in the short and long term. (Copied from article)
Background: The International Medical University (IMU) has an outcome-based curriculum defined by eight major curriculum outcome domains.The attributes, qualities and competencies expected of a health care professional form the basis for these outcome domains. Community service is an effective curriculum delivery tool widely practised by medical universities around the world. We present the results of a survey among IMU students to explore the effectiveness of community service as a curriculum delivery tool in enabling activities defined within the major curriculum outcome domains of IMU.
Methods: A self-administered 6-point Likert scale questionnaire was used to survey student participants of 20 community service events held in a rural village between 2007–2012. The survey tool included questions on demographic data as well as the perception of the students on whether participation in the events enabled them to experience activities defined under the eight major curriculum outcome domains of IMU.The one sample Student t-test was used to test for statistical significance while regression analysis was done to look for significant predictors.
Results: A total of 255 students were surveyed, of which 229 (90.5%) were medical students while the rest were nursing students. Most of the students were in the 3rd (48.2%) and 4th (43.8%) year of their studies and have completed the surgery, internal medicine and family medicine posting. Six out of the 8 curriculum outcomes domains were achieved through participation in the community service programme.
Conclusion: Community service is an effective curriculum delivery tool for the outcome-based curriculum of IMU where activities defined in six out of eight outcome domains were achieved.
Background: Medical schools are escalating changes
to meet the need for doctors competent to work in the
era of precision medicine. Information on the current
level of awareness of precision medicine among medical
students can help effect the necessary changes in the
medical curriculum. A cross-sectional comparative
study was done to assess the knowledge, attitude and
perception toward the practice of precision medicine
among junior and senior medical students in a medical
school in Malaysia.
Materials and Method: A survey instrument measuring
attitude toward precision medicine, perceived
knowledge of genomic testing concepts, and perception
toward ethical consideration related to precision
medicine, was distributed to junior and senior medical
students. Comparisons were made between senior and
junior medical students.
Results: Only about one-third of the 356 respondents
had heard of precision medicine although 92.7%
expressed interest to learn more about precision
medicine. Overall, junior and senior medical students
had positive attitude toward the adoption of genomeguided
prescribing and precision medicine but were
uncomfortable with their knowledge of genomic testing
concepts. Both junior and senior students were largely
well grounded in their understanding of ethical issues
related to precision medicine.
Conclusions: Knowledge of precision medicine was low
among junior and senior medical students. Although
the students supported the use of precision medicine,
they did not feel adequately prepared to apply genomics
to clinical practice. Their perceptions on ethical issues
related to precision medicine were sound. Seniority did
not appear to influence the perceptions of the students.
Marjolin’s ulcer is a malignant cutaneous ulcer
that undergoes transformation from a previously
traumatized or chronically inflammed skin.1 Causes
leading to ulcerations can be burn injury, trauma,
chronic osteomyelitis and varicose ulcers.2 It is named
after a French surgeon, Jean Nicolas Marjolin, who
first described the condition in patients who developed
malignant ulcers from burn scars.3 We report a case of
a chronic non-healing foot ulcer that has become a
Marjolin’s ulcer after 12 years. (Copied from article).
Cervical spine injury is commonly associated with
road-traffic accidents. The true incidence of cervical
spine injuries is unknown due to under-reporting of
such injuries. Cervical spine injury is associated with
high morbidity and mortality if it is missed. With the
advancement of imaging modalities, the number of
missed cervical injuries has reduced. Nevertheless, some
clinicians are dependent solely on imaging tools to rule
out cervical spine injury in a trauma victim. We report
two cases of “near miss” C6 fracture to highlight the
importance of a detailed clinical history and clinical
examination with imaging as an adjunct to rule out
cervical injury.
The human foot serves as an important part to support
the body weight and accounts for the majority of our
movements. A mangled limb involves injury to at least
three out of four systems, namely the soft tissues, nerves,
blood supply and bone. While amputation is indicated in
some cases of mangled limb, with proper planning, limb
salvaging surgical management is also a viable option.
Special consideration to the skeletal stabilization, control
of infection, vascular status and soft tissue coverage is
paramount to the success of limb salvaging surgery. We
present a case of mangled limb which was successfully
treated with limb salvaging surgical management. Initial
debridement, Kirschner wires insertion and cross ankle
external fixation were used for skeletal stabilization. An
antibiotic spacer was inserted for local antibiotic and to
maintain the length left due to the loss of medial and
intermediate cuneiform bones. The anterior tibialis
artery and its venae comitantes were utilized for free
vascularized fibular graft to provide bony reconstruction
as well as soft tissue coverage for the mangled foot.
Myasthenia gravis (MG) is a rare autoimmune disorder
characterised by fluctuating and variable combination
of muscle weakness and fatigue. Most cases are due to
T-cell mediated autoantibodies against post-synaptic
acetylcholine receptors (AChR-Ab), thus preventing
acetylcholine from binding and signalling skeletal
muscle to contract.1
The annual incidence is 7-23 new cases per million.1
It can occur at any age but with two peaks; an earlyonset
(20-40 years) female-predominant and a late-onset
(60-80 years) male-predominant peak. MG is classified
into ocular and generalised (80%). More than half the
patients initially present with ptosis and diplopia but half
will progress to generalised disease with involvement of
bulbar, limb and respiratory weakness. Those presenting
as generalised MG can also develop eye signs later.1
It is important to recognise MG early because it is
highly treatable. Untreated disease leads to permanent
weakness.2 Treatment reduces mortality from lifethreatening
myasthenic crisis.1,3 Misdiagnosis leads to
potentially harmful interventions and inappropriate
management.4,5 Diagnosis in late-onset MG is easily
missed2,3,4,5 because of overlapping symptoms with
other diseases common in the elderly. We report a case
of delay and misdiagnosis in an elderly patient with
co-morbidities. (Copied from article).
Introduction: Assessment is an integral aspect of
teaching. One-best-answer (OBA) items, if properly
constructed are able to drive learning. In-house OBA
items are notoriously poorly-constructed. The role of
a central vetting committee is to review test items and
ensure that they adhere to expected standards. Hence,
the objective of this audit is to determine whether
central vetting has improved the construct quality of
OBA items.
Methods: We audited the psychiatry end-of posting
OBA items from before and after central vetting to
compare the quality of the items before and after
central vetting was instituted. Quality was evaluated
on appropriateness of test content, items with higher
cognition and items without flaws. A standard was not
set for this first audit.
Results: Seventy six of 181 psychiatry OBAs items
retrieved from 2011 to August 2012 had undergone
first level (department) vetting only and the remainder
105 (58.0%) had two levels of vetting; department and
central vetting committee (CVC).
Appropriateness of content increased from 92.1% to
98.1%. Items with higher order thinking doubled from
21.1% to 42.9%. Items with clinical scenario increased
by 8.4% to 78.1%. Logical ordering of options however,
remained around 50%.
Two-level vetting markedly reduced problematic
lead-in questions (67.1 to 13.3%), non-homogenous
options (42.1 to 9.5%), vague and implausible options
(39.5 to 6.7%), and spelling and grammar mistakes
(19.7 to 5.7%).
Conclusion: Two-level vetting had improved the
quality of OBAs and should be continued. This could
be enhanced by training all Faculty on writing quality
OBA items and careful selection and empowerment
of CVC members. A re-audit is to be conducted after
Faculty training.
This study examined the trend of major congenital anomalies (CA) in the state of Penang using the ICD 10 database from 1999 to 2004. The data was collected from various health centres and hospitals. The aim was to study the magnitude of the problem for congenital anomalies in the state of Penang in terms of trends and also to calculate the incidence rate by districts. If a trend was noticed, this in turn will determine whether to carry out further in-depth studies in the future and to find out the linkages to the environment if any.
Background: Nurses are the highest numbered healthcare professionals who work in a knowledgedriven environment, where accurate and updated information is needed when delivering care to clients. Information literacy has therefore become one of the criteria in determining nurses’ readiness for evidencebased practice in recent years. In the actual day-to-day care practice, are nurses ready for this?
Objective: To determine the information literacy competency in readiness for evidence-based practice among clinical practicing registered nurses in a private hospital in Penang, Malaysia.
Methods: This cross sectional descriptive study was conducted in the selected private hospital. Universal sampling method was used. At the time of study, there were 443 registered nurses who met the eligibility criteria of this study. The registered nurses were asked to complete a self-reporting questionnaire about information literacy for evidence-based practice.
Results: The response rate was 86.2%, with a total of 382 returned questionnaires. Less than half of the participants (47%) stated that they frequently sourced information to support nursing practice. Poor research experiences among these participants were identified where 56% of the registered nurses never identified researchable problems, 59% have not evaluated a research report and 54% have never utilised research into practice. Registered nurses frequently sought information sources from colleagues or peers (65%) rather than from printed resources, where only 43% and 33% respectively make use of CINAHL and MEDLINE bibliography databases as the electronic resources for their practice.
Conclusions: Results demonstrated that information literacy among registered nurses from this hospital was lacking. Organisation efforts are needed to create awareness of information for evidence-based practice as well as to encourage more research activities and the search of bibliography database among its registered nurses.
Study site: Private hospital, Pulau Pinang, Malaysia
Introduction: Bekam, an Islamic variant of cupping, is an ancient form of traditional medicine still practised today in Malaysia. There are published findings indicating that cupping benefits patients with low back pain, other musculoskeletal pain and even pain from cancer, herpes zoster and trigeminal neuralgia when pain is measured on an analogue scale. We proposed to investigate whether in addition to pain improvement on an analogue scale we could show if pain relief might be demonstrated in terms of reduction of analgesic use.
Methods: We carried out a retrospective cross sectional study on subjects who had been for outpatient clinic treatment with chronic pain of at least one month and who completed at least two bekam therapy sessions. In addition to documenting a pain score before and after therapy we documented their analgesic consumption.
Results: A total of 77 respondents, with overlapping symptoms of headache, backache and joint pains were included. The mean pain score before bekam therapy was 6.74±1.78, and was 2.66±1.64 after two sessions of therapy. Twenty eight respondents completed six sessions of bekam therapy and had a mean pain score of 2.25±1.32 after. Thirty-four patients consumed analgesic medication before starting bekam therapy and only twelve did so after. The consumption of analgesics was significantly lower after bekam therapy.
Conclusions: Bekam therapy appears to help patients experience less pain and reduce the amount of analgesic medication they consume. Nevertheless only a randomised prospective study will eliminate the biases a retrospective study is encumbered with and we believe would be worth doing.
The discovery of antibiotics had been one of the most significant events in the history of medicine. Antibiotics had saved countless number of lives and had contributed significantly to the health of mankind.The emergence of resistance is however a major threat to the continued usefulness of antibiotics. There are now strains of bacteria which are resistant to virtually all available antibiotics and these strains are increasingly being encountered in clinical practice. The development of new agents had not kept pace with resistance and it is unlikely that there will be major breakthroughs in the near future. The world needs to conserve and prolong the useful lives of the existing agents. This can only be achieved through good antibiotic stewardship programmes. As antibiotic resistance is a global threat all major stakeholders have to work together to meet this challenge.
Nurse education is undergoing a process of transition. Nurses worldwide are working towards
achievement of higher levels of education and training through an improved education system. Current trends and innovations in nursing education are emerging to prepare more nurses and to deliver education to students across geographical boundaries while taking into
consideration their work and family responsibilities. The current trends and innovations in nursing education range from full time face-to-face interactions to distance education programmes. Teaching approaches such as blended learning, online or e-Learning have provided nurses with an avenue for continuing education for development and progression in their career pathways. Every nurse aspires to reach her highest potential. While the current trends and innovations in nursing education provides the flexibility for nurses to continue learning and upgrade their professional qualifications, there are issues to be considered in catering to the needs of the bottom billion nurses. An exploration of related issues will include views from different perspectives, such as that of the institution/provider, instructor/facilitator and student/learner involved in the development and implementation of the related education programmes.