The simultaneous presence of polycystic ovary syndrome with pelvic endometriosis presents compounded gynecological effects on women with subfertility and pelvic pain as the common symptoms. We describe one such case. The molecular basis for etiology is discussed and the need for individualized treatment is suggested.
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.
Shock, a major cause of morbidity and mortality in children, is the the most anxiety-provoking emergency that needs to be addressed urgently and effectively by the attending paediatrician. It is a state where the metabolic demands of the tissue are not met due to circulatory dysfunction. Unlike adults, hypotension is a very late feature of shock in children. As the child’s condition worsens, the clinical presentation of the different causes of shock become similar, and nullify any aetiological differences. Regardless of the type of shock, the final common pathway is inadequate tissue perfusion and oxygen supply to meet cellular demands. Delayed recognition and treatment result in progression from compensated reversible shock to uncompensated irreversible shock with widespread multiple system
organ failure to death. This paper reviews the physiological basis, and pathophysiological classification of the various types of shock and their respective aetiologies. The clinical features of the different types of shock are described, and current diagnostic and therapeutic strategies are applied for the most effective and appropriate treatment for resuscitating the child in shock. A strong index of suspicion, early recognition, timely intervention and transfer to an intensive care unit are critical for successful outcomes in the management of paediatric shock.
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.
Morning surge in blood pressure is an independent cardiovascular risk factor in the middleaged and the elderly. Whether such a surge occurs in young subjects is not known. Eighty normotensive subjects (age: 21.8 ± 1.3 yr) measured their own blood pressure (BP) using an automatic device (Omron HEM-7080,) on going to bed and on waking up, for 2 consecutive days. In contrast to large morning BP surges reported for older age groups, there was much smaller but significant (P
Background: It is an undeniable fact that exposure to tobacco smoke from the ambiance poses harmful effects to human health. Although many countries including Malaysia have imposed smoking bans and restrictions in indoor and outdoor public places, yet, to achieve a zero exposure to tobacco smoke from one’s surroundings remains a challenge.
Objective: The objectives of this study were to determine the second-hand smoke (SHS) knowledge and percentage of exposure among adults of rural Pedas, Negeri Sembilan and assess the association between socio-demographics and knowledge of SHS among these adults.
Methods: A cross sectional study with convenient sampling was carried out on 485 adults in Pedas, Negeri Sembilan. The instrument used was a validated questionnaire which was adapted with permission to suit the sample under study. The data collected were analysed with SPSS Statistics for Windows, Version 24.0.
Results: The percentage of SHS exposure among the non-smoking adults in rural Pedas, Negeri Sembilan was high (95.5%). More than 30% of the non-smoking respondents reported a daily exposure to SHS. The adults from this study however have good knowledge of SHS effects on health. A Mann-Whitney U test result revealed that knowledge on SHS scores was significantly higher for the non-smokers than that of smokers (U=17645, p < .001, r=.18). The top three locations identified as the most common places for SHS exposure were restaurants (38.9%), followed by workplace (26.2%) and home (19.4%).
Conclusions: The percentage of SHS exposure among the non-smoking adults of rural Pedas, Negeri Sembilan is high. Although the adults in this study have good knowledge of SHS health consequences, yet they are unavoidably exposed to SHS because smoking still occurs within their home, workplaces and public places. Our findings suggest the need for more comprehensive, assertive and strongly enforced policies to ban smoking in public areas, not only in this community but all across Malaysia.
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.
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.
Abstract: Ampicillin-sulbactam combination is the most frequently prescribed antibiotic in diabetic foot ulcers. We conducted a retrospective study to evaluate the antibiotic sensitivity of bacteria isolated to this antibiotic. In 33 patients with diabetic foot ulcer (September 2008-March 2009), 67% were culture positive in which Citrobacter spp accounted for 36% of these isolates. The rest isolated included Pseudomonas aeruginosa (22%), Proteus spp (18%), Acinetobacter spp (9%), Klebsiella pneumoniae (5%), Escherichia coli (5%) and Staphylococcus aureus (5%). These isolates were more likely to be ampicillin-resistant (n=18) than were ampicillin-sensitive isolates (n=4). Ampicillin resistance has raised our concern about current practice of prescribing ampicillin/ sulbactam as monotherapy for majority of our patients with such ulcers.
Background: Peripheral venous catheterisation is indispensable in modern practise of medicine. The indications of venous access should be weighed against the risk of complications, the commonest being thrombophlebitis. Thrombophlebitis causes patient discomfort and the need for new catheter insertion and risk of developing further widespread infections. Methodology: This observational study was conducted on adult patients admitted to the surgical and medical ward of a tertiary hospital in Negeri Sembilan Malaysia in 2011. Four researchers visited patients daily and examined for signs of thrombophlebitis; warmth, erythema, swelling, tenderness or a palpable venous cord. Risks factors that were studied in this research were patient/s age and gender, duration of catheterization, use of catheter for infusion, size of catheter, site of catheter insertion and types of infusate. Thrombophlebitis was graded using a scale adapted from Bhandari et al. (1979). Results: In total, 428 patients were recruited with an incidence rate of thrombophlebitis of 35.2%. Among those who developed thrombophlebitis, 65% had mild thrombophlebitis, 19% moderate and 8% severe thrombophlebitis. Results showed that female patients had a significant increased risk of developing thrombophlebitis. Also risk increased significantly with increased duration of catheterization and usage of the catheter for infusion. The age of a patient, types of infusate use, size of catheter and site of catheter insertion did not significantly influence the development of thrombophlebitis. Conclusion: The study showed that risk of developing thrombophlebitis is significantly increased among female patients, and also with increased duration of catheterization and use of the peripheral venous catheter for infusion. We recommended elective replacement of catheter every 72 hours and daily examination of catheters for signs of thrombophlebitis by a healthcare personnel.
There have been significant achievements in research at IMU as indicated by the increasing amount of external funds obtained, and number of publications and postgraduate students produced since it started its research activities in the year 2000. However, it is a great challenge indeed to ensure sustainability of our research, which is currently heavily dependent on internal funding. There is a need to realign our strategies to further enhance our competitiveness in securing external funding for research. In line with this, the Institute for Research, Development and Innovation (IRDI) was officially established on 18 September 2012. The Institute will serve as a platform to support all research activities at IMU. There are four Centres of Excellence based on the identified thrust areas under
IRDI, namely 1) Centre for Bioactive Molecules and Drug Discovery; 2) Centre for Environmental and
Population Health; 3) Centre for Cancer and Stem Cell Research, and 4) Centre for Health Professional Education Research. Major findings based on research in these four thrust areas are reviewed in this paper. With the strategic planning and establishment of IRDI, it is our aspiration to bring research at IMU to a higher level.
Healthcare investment is critically important for the health and well-being of the population, and different health systems are developed to meet the needs and priorities of each country. What has become clear has been that despite major advances in medicine, science and technology, there are major issues related to access and equity as well as quality and patient safety in healthcare services. The issue of patient safety was highlighted by the reports of the Institute of Medicine, USA1,2 and this had received worldwide attention. It is also an irony that despite being in an age of major advances in medicine, science and technology, with the acceptance of evidence-based medicine, so much of medicine and healthcare delivered is of little or no proven value. This poses a major challenge on health policy, and on how this can be addressed in any health reform process that focuses on improving access, equity, efficiency and effectiveness in healthcare services.
Background: Positive physician-nurse collaborative
relationship is the key determinant for patients’
outcomes.
Objective: The purpose of the study was to investigate
registered nurses’ attitude towards physician-nurse
collaboration and its association with demographic
characteristics.
Methodology: The study was descriptive and crosssectional.
The data of the study was collected using
the “Jefferson Scale of Attitudes toward Physician-
Nurse Collaboration”. The sample size of the study was
127 registered nurses recruited using convenience
sampling. Descriptive statistics and inferential statistics
t-test were used for data analysis.
Results: The results showed that nurses’ attitude towards
physician-nurse collaboration was positive (M=3.25,
SD±0.29). The attitude of the participants was highly
positive towards “shares education and collaboration”
(M=3.42, SD±0.36), “nurse’s autonomy” (M=3.42,
SD±0.44), and “caring vs. curing” subscales (M=3.41,
SD±0.41). However, the participants rated lowest for
“physician’s authority” subscale (M=2.12, SD±0.83) and
particularly on the item “doctors should be dominant
authority in all health care matters” (M=2.11, SD±0.99).
Furthermore, t-test analysis revealed no significant
association between nurses’ attitude towards physiciannurse
collaboration and demographic characteristics
such as age, gender, and educational level (p > 0.05).
Conclusion: The results of the study provided some
crucial evidences on nurses’ attitude towards physiciannurse
collaboration. The evidences are useful for the
relevant stakeholders to initiate relevant strategies to
improve and strengthen the relationship gap between
physicians and nurses.
Outcome and competency-based undergraduate and graduate medical education is the desired standard embraced by many medical educationists worldwide. Reflective capacity is an integral component of that strategy and reflective writing has shown tremendous potential as a delivery tool. But there are various challenges in the implementation of the initiative. Efficacy as a delivery tool, achievement of pedagogical outcomes, reliability issues, challenges in assessment outcomes/tools, and whether it can be taught and learnt, need to be addressed. Many questions are still not satisfactorily answered, and this review attempts to offer some perspective on the issues.
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.
In the last decade or so, Medical education all over the world has been inundated with innovations in education, which include innovations in curricular design, delivery as well as assessments. There is a need to reflect on the effectives of these innovations
on the learner. Hence the theme chosen for the 2009 International Medical Education Conference (IMEC 2009) was “Reflections on Innovations”. The Organising Committee felt that it was timely for medical educators everywhere to reflect and evaluate the effect of the many innovations adopted by their schools. (Copied from article)
The International Medical University, Kuala Lumpur (IMU) has just completed 20 years of success and had a series of events to celebrate its 20th anniversary as well as its achievements in 2012. As part of the 20th anniversary celebrations, IMU successfully co-hosted the Ottawa conference with the European Medical Education Association in Kuala Lumpur. This was the first time this conference was hosted in Asia and it was one of the biggest and most successful of the Ottawa Conference series ever held. This conference focuses on medical education with the major emphasis on assessment.
Preclinical drug testing is an important area in new drug development where animals are used. An ideal animal model for this is one which is simple, reliable and can be extrapolated to humans. Topical drugs for inflammation are conventionally tested on the skin of animals after induction of inflammation. A gingival model would be simple as inflammation can be induced naturally by the action of plaque. Rats are a popular animal model for testing drugs as well as to study various diseases of the periodontium. Periodontal disease including gingival inflammation develops in
rats in relation to indigenous plaque or experimentally induced bacterial products. A number of features of rats ranging from anatomy, histology and response to bacterial insult can be seen mirrored to a great extent in humans. There is a lot similarity in the development and resolution of inflammation as well as the gingival wound healing of rats and humans. This paper tries to explore the feasibility of using the rat gingival model for preclinical testing of drugs acting on or influencing inflammation and concludes by identifying potential areas of research using this model. The addition of such a simple and inexpensive model for preclinical testing of drugs will be welcomed by the drug developers.
In pregnancy, the diagnosis of primary hyperparathyroidism (PHP) may be delayed due to physiological changes that occur during this period. The maternal related complications of PHP during pregnancy has been reported to be as high as 67%, whilst fetal complications up to 80% of cases.1 The therapeutic gold standard and definitive treatment for PHP in pregnancy is minimally invasive parathyroidectomy in the second trimester. We report a case of a 22-year old primidgravida who underwent parathyroidectomy in the third trimester of her pregnancy for PHP with persistent hypercalcemia. She was also found to have Vitamin D deficiency which probably led to secondary hyperparathyroidism and made her hypercalcemia more apparent during pregnancy
Background: The World Health Organization recommends the practice of exclusive breastfeeding of infants for the first 6 months after birth. The objective of present study was to estimate the prevalence and the factors influencing exclusive breastfeeding. The perceptions of mothers about breastfeeding in an urban slum area of Western India were also enquired.
Methods: This cross sectional study was conducted over six months amongst 200 mothers of children in the age group of 6 – 12 months attending the growth and development clinic in one of the urban health centres. Data was collected using a pre-tested, structured questionnaire on breastfeeding practices. Factors related to exclusive breastfeeding were analysed using bivariate and multivariate analysis.
Results: Prevalence of exclusive breastfeeding reported by the participants was 61.5%. Having a male child, maternal age < 30 years, level of education of mother parity, receiving infant feeding advice, initiation of breastfeeding within one hour of birth and administration of colostrum to the baby were associated with exclusive breastfeeding (p