Emergency Medicine and Disaster Medicine are two specialties which are similar in the multidisciplinary involvement during the acute phase of the disaster. Recently, there was an increase in the number of disasters in the world but not many physicians are familiar with the principles for dealing with such situations, the unique organizational demands, coordination and the urgent need for medical assistance and relief. This case report delineates our experiences at a tsunami disaster area and the approach to setting up a medical relief team in the affected area. A medical reconnaissance team comprising of an emergency doctor from Hospital Universiti Sains Malaysia (H.U.S.M) and two MERCY Malaysia members was assembled. The team flew to Colombo on day 5 after the tsunami with medical supplies and related materials. The mission started from December 31(st) 2004 until January 8(th) 2005. Our surveillance area covered the Southern and Eastern Province with a total distance of 1700 km along the coast. The strategies employed during this medical reconnaissance included risk analysis, devising a resources matrix, developing lines of communication and rapport with other relief teams, Sri Lankan government agencies, and local and international non-government organizations. As a result, our team was able to set up a medical relief camp and distribute the relief items to the tsunami victims. In conclusion, the Disaster Emergency Medical Assistant Team (DEMAT) from H.U.S.M and MERCY Malaysia were able to set up and provide medical relief with our limited resources to a large scale disaster situation.
To determine the prevalence of goblet cell metaplasia in endocervical and endometrial adenocarcinomas by histochemial staining and to investigate the most sensitive histochemical staining method to detect this metaplasia, a total of 90 tissue blocks representing 30 non-neoplastic cervix, 30 non-neoplastic endometrium, 30 endocervical and endometrial adenocarcinoma cases were obtained for histochemical staining with Toluidine Blue (TB), Methylene Blue (MB), Mucicarmine (MUC), Periodic Acid Schiff before and after Diastase digestion (PAS, PAS-D), Alcian Blue pH 2.5 (AB), and Periodic Acid Schiff after Alcian Blue pH 2.5 (PAB). The cases were blinded and evaluated by a pathologist [NHO] for the presence of goblet cell metaplasia, the amount of goblet cells present and the histochemical differentiation of the goblet cells compared with its surrounding glandular epithelium. Goblet cell metaplasia was present in 2 out of 30 cases in non-neoplastic cervix, 0 out of 30 cases in non-neoplastic endometrium, 7 out of 15 cases in endocervical adenocarcinoma and in 2 out of 15 cases in endometrial adenocarcinoma. Relatively few goblet cells were seen in endometrial adenocarcinoma, few to moderate amounts were seen in endocervical adenocarcinoma and relatively more goblet cells were seen in non-neoplastic cervix. The differentiation of the goblet cells with its surrounding glandular epithelium was moderate to strong in non-neoplastic cervix and endocervical adenocarcinoma, while the differentiation in endometrial adenocarcinoma was weak to moderate. The various staining methods showed differences in presence, amount and differentiation of the goblet cells. Goblet cell metaplasia of the reproductive organs is not as rare as previously reported. There was no statistical difference in presence, amount and differentiation of goblet cells according to the various cases. The must optimum staining methods for staining goblet cells in non-neoplastic cervix, endocervical adenocarcinoma and endometrial adenocarcinoma were PAS, PASD and AB.
The term breech trial (TBT) has brought about radical changes but it is debatable whether it provides unequivocal evidence regarding the practice of breech deliveries. There is a need to publish the data of a study that was performed before the era of the TBT in a hospital where there was a high rate of breech vaginal delivery. The objectives were to ascertain the incidence, mode of delivery and fetal outcome in singleton breech deliveries. The study design was a retrospective cohort study where 165 consecutive breech and 165 controls (cephalic) were included. Statistical analysis, used were Chi squared and Fischer's exact test. P<0.05 is taken as the level of significance. The incidence of breech deliveries was found to be 3% and has remained fairly constant but the rate of breech vaginal delivery has fallen and the CS rates have increased. Even though more breech compared to controls were significantly sectioned, majority of the breeches {n=137 (83%)} were planned for vaginal delivery and in these patients two-thirds attained vaginal delivery. There was 1 fetal death in the CS group compared to 12 deaths in the vaginally delivered breech. However, most death in the breech delivered vaginally are unavoidable. In conclusion, there is a high rate of breech vaginal delivery in this series of patients and most perinatal deaths were not related to the mode of delivery.
In the present study, the effects of alpha lipoic acid (ALA) supplementation on glycemic control and lipid profile in streptozotocin (STZ)-induced diabetic rats have been evaluated. Sprague Dawley rats were divided into nondiabetic (NDM), diabetic without supplementation (No Suppl) and diabetic with ALA groups. ALA was orally administered once a day for 8 weeks with a dose of 100 mg/kg BW. Supplementation of ALA to STZ-induced rats prevented the severe damage to the islet cells of the pancreas and lowered the plasma glucose and glycated hemoglobin (HbA1c) levels. Supplementation of ALA also suppressed the increased of total cholesterol (TC), triglycerides and low density lipoprotein-cholesterol (LDL-C) levels in the plasma of diabetic rats as well as increased high density lipoproteincholesterol (HDL-C) levels. In conclusion, this study suggest that ALA may be effective in controlling glycemic status and improving dyslipidemia in streptozotocin-induced diabetic rats and has the potential in reducing cardiovascular complications due to diabetes mellitus.
Ninety two male brickfield workers and sixty sedentary individuals of 25-45 years were randomly selected from brickfields of West Bengal, India, to evaluate the body composition and hand grip strength among male brickfield workers and to compare the data with their sedentary counterparts. Assessment of body composition by skinfold measurements and determination of hand grip strength (HGS) by hand grip dynamometer indicated significantly higher (p<0.001) fatness, skinfold values and body mass index (BMI) among the sedentary individuals though HGS and hand grip endurance were significantly higher (p<0.001) among brickfield workers. BMI and %fat values indicated that the subjects were non-obese and non-overweight and regression norms for prediction of %fat from BMI in both the groups were computed as follows : Control Group : Y = 1.647 X - 22.789 (r = 0.92, p<0.001, SEE = 1.01), Brick-field Workers : Y = 0.747 X - 8.398 (r = 0.78, p<0.001, SEE = 1.34). Percentage of lean body mass (%LBM) was significantly higher (p<0.001) among brickfield workers whereas absolute LBM value had insignificant variation because of significant difference (p<0.001) in body mass between the groups. The present investigation revealed that the daily labour of the brick-field workers hindered the accumulation of body fat and extensive use of their hand and finger muscles enabled them to achieve greater arm strength. The proposed norms for prediction of %fat from BMI will also provide a first-hand impression about the body composition in the studied population.
The aim of the study was to assess the outcomes of grandmultiparous women receiving the current obstetric care in Maternity Hospital Kuala Lumpur. Recent data regarding some of the complications are conflicting and the significance of grandmultiparity is now in question. Therefore, a retrospective cohort study of 237 grandmultiparous and 254 multiparous women were undertaken. Chi-squared and t test were used (P<0.05) where appropriate. The results revealed that grandmultiparous women tend to be Malays, age above 35, have late antenatal booking and suffered from anemia and non-proteinuric hypertension. There was no significant difference in diabetes and glucose intolerance, ante partum and post partum hemorrhage. There was a significantly lower risk of first and second-degree perineal tear, and prolonged first stage of labor. There was a significant increased in induction of labor but there was no uterine rupture and no increased in Cesarean Section. There was an increased in meconium stain liquor but there was no increased risk of fetal distress. The fetal outcome was good and there was no tendency to macrosomic infants or shoulder dystocia. With adequate care, the maternal fetal outcome of grandmutiparous women is good and comparable to the multiparous women. Anemia is still common and patient education is important to overcome this problem.
In Malaysia, many patients opted out of cancer-specific treatment for various reasons. This study was undertaken to investigate the survival rate of patients with stages I to III non-small cell lung cancer (NSCLC) who opted out of treatment, compared with those who accepted treatment. Case records of 119 patients diagnosed with NSCLC between 1996 and 2003 in two urban-based hospitals were retrospectively examined. Survival status was ascertained from follow-up medical clinic records or telephone contact with patients or their next-of-kin. Median (25-75% IQR) survival rate for 79 patients who accepted and 22 patients who opted out of treatment, were 8.6 (16.0-3.7) and 2.2 (3.5-0.8) months respectively [log rank p< 0.001, Kaplan-Meier survival analysis]. Except for proportionately more patients with large cell carcinoma who declined treatment, there was no significant difference between the two groups in relation with age, gender, ethnicity, tumour stage, and time delays between symptom onset and treatment or decision-to-treat. We concluded that there was a small but significant survival benefit in accepting cancer-specific treatment. The findings imply that there is no effective alternative therapy to cancer-specific treatment in improving survival. However, overall prognosis for patients with NSCLC remains dismal.
Insulin insensitivity is a common finding in several metabolic disorders including glucose intolerance, dyslipidemia, hyperuricemia and hypertension. Most of the previous studies on insulin sensitivity were performed on diabetic or obese population. So our knowledge about insulin sensitivity of healthy population remains limited. Rising prevalence of obesity, diabetes and metabolic syndrome is a serious issue in Malaysia and some other rapidly developing countries. So it is important to look at the insulin sensitivity status of healthy Malaysian subjects and to compare it in future with those of diabetic, obese or metabolic syndrome patients. In this study we sampled subjects who were independent of confounding factors such as obesity (including abdominal obesity), hypertension and glucose intolerance (diabetes, IGT or IFG) which may influence insulin sensitivity. Fasting plasma glucose, fasting insulin and lipid profile were determined. Insulin sensitivity and secretory status were calculated using the homeostasis model assessment (HOMA) software (HOMA%S, HOMA%B and HOMA-IR). The insulin sensitivity (HOMA%S) of healthy Malay subjects aged between 30-60 years was 155.17%, HOMA-IR was 1.05 and HOMA%B was 116.65% (values adjusted for age, sex, BMI and waist circumference). It was seen that non-obese Malaysians can prevent age related lowering of insulin sensitivity if they can retain their BMI within limit.
The first aim of cancer treatment is to acheive a cure, and when cure is not possible, a good palliation (life prolongation and relief of sufferings) is warranted. This article highlights the aim of cancer treatment and also attempts to assess the issues of quality of life experienced as a result of the disease and its treatment. Palliative therapy should be less intensive than radical treatment and should cause less morbidity than disease itself. It must be effective, completed in a short time and should be tolerable. It is also essential for a physician to give a clear explanation of illness to the patient and realistic advice regarding the likely outcome of therapy and the long and short term morbidities which may occur. The patient may opt for a palliative treatment with a reduced chance of cure but a better quality of life than accepting a radical treatment with a potentially higher degree of morbidity. Quality of life in oncology practice should be seen as a process and as a part of this process it seems sensible to pursue several different lines of questionnaire development rather than constructing one 'perfect" quality of life instrument.
Lecture handouts are widely used instructional tools. Handouts supplement rather than substitute students' regular reading. It is now a common practice to supply PowerPoint handouts and publish lecture handouts on the web for students' access. A study was conducted among the first year medical students (n=142) of School of Medical Sciences (SMS), Universiti Sains Malaysia (USM) in order to determine their perceptions and expectations with regards to lecture handouts provided to them. The majority of the students reported that they read the lecture handouts as a reference and found them useful as a guide for future learning. More than half (68%) of the students expressed dissatisfaction with the overall presentation format of the handouts which is mainly technology-related i.e. PowerPoint and photocopying. This study indicated that students' expectations and experiences were positive towards the use of handouts. They used handouts as a means of supplementing rather than substituting their learning. Much care is needed when educators supply computer-based handouts, as this study shows a number of limitations when students use them. Medical schools should consider publishing web-based handouts with online and other facilities to make it interesting and effective.
The thalamus is one of the structures that receives projections from multiple ascending pain pathways. The structure is not merely a relay centre but is involved in processing nociceptive information before transmitting the information to various parts of the cortex. The thalamic nuclei are involved in the sensory discriminative and affective motivational components of pain. Generally each group of nucleus has prominent functions in one component for example ventrobasal complex in sensory discriminative component and intralaminar nuclei in affective-motivational component. The thalamus is also part of a network that projects to the spinal cord dorsal horn and modulates ascending nociceptive information. In the animal models of neuropathic pain, changes in the biochemistry, gene expression, thalamic blood flow and response properties of thalamic neurons have been shown. These studies suggest the important contribution of the thalamus in modulating pain in normal and neuropathic pain condition.