A survey of career choices was conducted for two batches of physicians applying for a medical speciality course in Malaysian medical schools. There were a total of 952 applications, with 477 males and 475 females. Surgery ranked highest, followed by obstetrics and gynaecology, fanlily medicine and orthopaedic surgery. The minor specialities of otorhinolaryngology, psychiatry and pathology were the least popular choices. Questionnaires were sent to a random sample of 250 physicians in each batch to note factors affecting their choices of speciality. A total of 359 physicians responded, giving a response rate of 71.8%. Fixed hours of work and the ability to have direct contact with patients were relatively important factors for choice of speciality. Working as a clinical consultant was the nlost popular nature of employment while worliing in the health office, service consultant in a public hospital, a non-clinical lecturer in a university hospital and working in a private clinic were less popular choices for these physicians. KEYWORDS: Career choice; medical speciality; doctors; Malaysia.
Angioedema due to whatever cause is potelltially life threatening, especially if it involves the head and neck region. Patients at risk need to be identified and precautionary measures are necessary. The use of Angiotensin Converting Enzyme Inhibitors (ACEIs) has been associated with angioedenia of the face and tongue. Its widespread use has resulted in an increased awareness of this rare but important camplication. We report liere a case of angioedenla secondary to ACEls developing a few months after initiation of therapy and discuss its clinical importance. KEYWORDS: Angioedema, Angiotensin Converting Enzyme Inhibitor.
A restropective study on a case of recurent salmonellosis in a 3 month old child due to Salmonella bovismorbificans and Salmonella matopeni was carried out using pulsed field gel electrophoresis (PFGE) and antibiotic susceptibility analysis. PFGE clearly distinguished the two serovars and that the recurrent infection was shown to associated with variant forms of Salmonella bovismorbificans. The chromosomal changes detected among the seqential isolates of Salmonella bovismorbificans appeared to be associated with varing antibiogram patterns. The study also showed that the recurrent infection in the patient could be related to prolonged antibiotic therapy. KEYWORDS: Recurrent salmonellosis, PFGE typing, Antibiograms, Salmonella bovismorbificans.
Activation of the synlpathetic nervous system (SNS) and renin-angiotensin system (RAS) plays a pivotal role in the pathophysiology and progression of the disease in chronic heart failure (CHF). Blocking the activation of the RAS with angiotensin converting enzyme inhibitors not only improves sylnptonls but also prolongs life in symptomatic CHF. Does a similar analogy hold true for the use of ß-blockers in CHF? Evidence from a number of small trials and several recent large prospective trials show that b-blockers may improve ventricular function and symptoms in CHF. In a combination of trials investigating the use of carvedilol (an α, and ß-blocker) in congestive heart failure a mortality benefit appears to be evident. There are still a number of key questions that relnaill unanswered regarding the tolerability, patient type and stage of CHF in which ß-blockers should be advocated. Several large scale trials are in progress to answer some of these questions and also to add further information regarding its efficacy and impact on survival. KEYWORDS: Beta-adrenoreceptor antagonist, congestive heart failure.
Anaemia in patients on renal replacement therapy is a cornmon problem and response to treatment with erythropoietin may be limited by functiollal iron deficiency. We recently studied prospectively for 22 weeks the effect of iron supplemetltation via intramuscular and oral vs intramuscular vs oral routes in 16 patients on chronic haemodialysis with renal anaenlia treated with erythropoietin injections. The rise in haemoglobin was significant in all patients except those on intramuscular iron only. This study supports unconfirmed observations that oral iron supplementation may be effective in patients with renal anaemia associated with functional iron deficiency. KEYWORDS: Renal, Anaemia, Erythropoietin, Iron deficiency, Oral, Parenteral.
Dengue 2 New Guinea C (NGC) virus NS3 protein, a potentially important virulence factor was cloned to the N-terminus of the Aeqirorea victoria enhanced green fluorescent protein (EGFP) using the pEGFP-N1 mammalian expression vector. During amplification of the recombinant plasmid in E. coli, transformants expressing the EGFP were detected in vivo when viewed using fluorescence microscopy. This inadvertent expression of the recombinant fusion protein was confirmed further by detection of the T7.Tag peptide cloned to the aluino terminal of the fusion protein using T 7.Tag specific monoclonal antibody. These findings represent perhaps the first reported expression of the T7.Tag-NS3-EGFP fusion protein using the pEGFP-N1 mammalian expression vector in E. coli. KEYWORDS: Dengue, NS3, pEGFP-N1, fusion protein.
The requirement of the medical graduate, tabled in the objectives of undergraduate medical education, as envisaged by the Malaysian Medical Council, call for the all round basic doctor to be able to handle any medical emergency, as well as meet the requirements of law in examining, documenting and reporting on the common offences of the Penal Code, where medical documentation is required of law for the purposes of dispensing justice. However, in tabling the amended requirements of the undergraduate syllabus on the lines of those followed in sollie of the more developed nations, we seem to have lost this perspective. The authors discuss, based on his previous experience from another former colonial country viz. India, where the objectives of the undergraduate training is the same, and the influences 011 the legal profession bear a common origin and governance, the relevance of some of these topics, coming under the antbit of Forensic Medicine and Toxicology as an undergraduate subject, in the day-to-day practise of medicine in and out of government service. While this issue has been the frequent topic of discussion in international confereilces and symposia, where the decline in the standards of medico-legal work in the coulltries attending have been blanled on the fall in the standard of undergraduate teaching, due recognition of the pitfalls of the deletion or whittling down of the course content, independent of the overall overhauling of the syllabi of medical schools, to keep up to the trends of overseas universities, has not been accorded in the planing of the coursc revisions, resulting in a deletion of a vital aspect of daily practise of medicine. KEYWORDS: Medico-legal; Undergraduates
100 consecutivnee wly diagnosed patients with nasopharyngeal carcinoma (NPC) since January 1994 were the subjects for studying various factors related to the delay in the confirmation of the diagnosis. 79 of them were ttlales and the peak age of incidence was the 5th decade. 92% of them were Chinese, 7% Malay and 1% Indian. 76% were agriculture worker or labourers with 66% having either no formal education (16%) or only primary level education (50%). For 50% of patients neck swelling was the first symptom, 26% had nasal symptoms, 12% ear symptoms and 11% hads symptoms due to intracranial extension of tumour. As many as 80% were at UICC Stage IV at the time of diagnosis. While the median delay, on the part of patients, in consulting a doctor was 2.5 days, the median delay on the part of the doctors to confirm the diagnosis of NPC was as long as 127 days, which was particularly worse when the patients presented with ear symptoms (266 days) followed by those with neck swelling (94 days). For those patients who were required to undergo more than one nasopharyngoscopy and biopsy the median doctor's delay was 144 days. Since 82% of patients had consulted general practitioners who remained the first-line health-service provider, it is suggested that their level of awareness with regards to NPC be significantly raised so that the delay on their part be greatly minimized. KEYWORDS: Nasopharyngeal carciuotna, delay in diagnosis, patient's delay, doctor's delay.
Adults with Growth hormone (GH) deficiency is now being recognised to display many distinct clinical, metabolic and psychological abnormalities. It has been demonstrated that GH deficient (GHD) adults display features of multiple insulin resistant syndrome (MIRS) which predispose the GHD adults to increased cardiovascular morbidity and mortality. These features include central obesity, insulin resistance and glucose intolerance, hypertension, dyslipidaemia that includes a reduced level of high density lipoprotein cholesterol, an elevated triglyceride level and sniall low density lipoprotein cholesterol size. Furthermore, GHD adults are found to have a lower bone mass and a reduced sense of well-being. Replacement of G H in these GHD adults has brought about a major itnproveliient in psychological well-being and central obesity. The improvement of some of the lipid abnornialities is however more modest. Insulin resistance, the corner stone of MIRS, is however not altered by G H replacement. Long term data is as yet unavailable to assess if GH replacement reduces cardiovascular mortality and morbidity in these subjects. KEYWORDS: Growth hormone, Horlnoiie deficiency, Diabetes niellitus, Central obesity, Hyperlipidaemia, Hypertension.
This paper involves the obtained results of an "Elective Program" project which was carried out by Phase I Medical Students of the 1998-1999 academic year at the Faculty of Medicine (FOM), University of Malaya (UM). A questionnaire was designed to survey the attitudes of teachers at FOM-UM, the subject of choice of a 4-student group who were supervised by a faculty member. Students obtained a list of faculty members (teachers) of all academic departments from the Dean's Office and rehearsed their interviewing skills prior to collecting the data of the questionnaire, within a 1-week period. Respondents were 146 out of 275 in total (53%), which included all academic ranks and clinical and non-clinical teachers. Results showed that respondents were well qualified, have enough teaching experience and teach in a variety of forms. All teachers liked to teach and were motivated; however, 15% felt unhappy about their teaching and 6% did not think that their teaching was effective. The nlajority (96%) of teachers liked their teaching to be evaluated and many revealed several means to assist and 111otivate students. Teachers felt that there was room for improvenlent in the aspect of student-teacher interactions. Results of this project revealed that FOM-UM is well endowed by qualified, motivated and caring teachers who wish for better interactions with their students. I
In vitro lymphocyte proliferative response of peripheral blood leucocytes (PBL) to purified Toxoplasma gondii antigen were evaluated by 3[H] methyl thymidine incorporation in patients acutely and chronically infected with Toxoplama gondii. PBL from three patients with acute sylnptonlatic toxoplaslnosis showed no response to T. gondii antigen during the emergence of anti-Toxoplasma 1gM antibodies and the response returned as the infection became chronic. Lymphocytes of twelve chronically-infected patients responded positively to the antigen. In all patients the lymphocyte proliferative response to the mitogen, Concanavalill A (Con A) was normal. Analysis of Toxoplasma proliferative response of PBL from a patient with acute toxoplasrnosis showed that CD8+ cells were responsible for induction of suppression while the response during the chronic infection was lnediated by CD4+ cells. In human toxoplasmosis there was antigen-specific lymphocyte unresponsiveness during the acute phase of the infection and it appears that the initnunesuppression was mediated by CD8+ cells. KEYWORDS: Toxoplasmosis-lymphocyte blastogenesis-antigen specific-CD4+, CD8+
Hypomanic episodes have been reported in two patients who were known to have abused cannabis. The nature of its presentation, possible association and treatment modalities are discussed herewith. A greater awareness of such a condition can put clinicians in a better position to give appropriate treatment imediately, and thus prevent any kind of re-occurrence of such a condition especially in vulnerable patients. KEYWORDS: Cannabis, hypomania.
The aim of this review is to critically analyse the available literature and to propose a rational, safe and cost-effective clinical pathway to provide nutritional support in acute pancreatitis. This pathway is proposed based on assessment of peer reviewed literature and existing generally accepted knowledge. Acute pancreatitis is a heterogeneous disease and the outcome is variable. The role of nutritional support is controversial. Acute mild pancreatitis (80%) usually does not require nutritional support unless the pre-existing nutritional is poor or complications occur. Contrary to this acute severe pancreatitis is associated with severe catabolism and a high complication rate. Nutritional depletion rapidly occurs. It is logical to support the nutrition once the patient is haemodynamically stable. Although enteral nutrition should be administered whenever feasible, it is not always possible or advisable. Aggressive, hypercaloric parenteral nutrition administered via central venous line is not recommended. A combination of initial peripheral parenteral nutrition with fat in appropriate amount, and gradually switching over to enteral feedings is safer and cost-effective. It also avoids central line associated sepsis. The roles of newer specific therapeutic diets to enhance the immune status in patients with acute pancreatitis are not well established. KEYWORDS: Acute pancreatitis, Enteral nutrition, Parenteral nutrition, Immunonutrition.
The rapid aging of populations worldwide demands major changes across all aspects of health care for older persons. Geriatric medicine which is that branch of of medicine which is concerned with the clinical, preventive and rehabilitative aspects of care of older persons, has much to offer in relieving the suffering and increasing the disability free years they can enjoy. Recent advances in Geriatric Medicine based on well designed randomised trials and meta-analysis that are clinically significant to the practicing physician are reviewed in this article. KEYWORDS: Recent advances, Geriatric Medicine, Older persons.
Problem-based learning (PBL) i s an educational reform that is now becoming a household word in higher education, particularly in medical schools. Many medical schools have implemented a full problem-based learning curriculum (PBLC) whiIe some have included PBL into selected units of the course in an otherwise conventional cumculum (embedded PBL) and others run their tutorials in a PBL manner within a modified conventional curriculum (hybrid curriculum). Yet there are others who claim that small components of PBL in a conventional curriculum are not PBL at all. Thus amateurs in the subject matter find difficulty in evaluating the logistics and outcome of these variations. This article focuses or, the general characteristics of PBL and how this learning method can help enhance independent learning and critical thinking, whether in a full, embedded or hybrid curriculum. The extent of PBL to be included and which of the three types is to be adopted depends on the objective of the undergraduate medical course as determined by the faculty, resources available, limitations, feedback on the existing curriculum and various other factors. KEYWORDS: Problem-based Learning (PBL); Embedded PBL; Hybrid PBL; New Integrated Curriculum (NIC).
A thirty two year old taxi driver presented with cotnplaints of headache, nausea, vomiting and blurring of vision of the left eye of two days duration. He was found to have an acute anterior uveities and secondary glaucoma. On further examination patient was also found to have a neuroretinitis and phlebitis in the same eye. A worm was found in the anterior chamber and it was removed via a limbal incision under local anaesthesia. The worm-like structure sent to the Department of Parasitology was identified as Gnathostoma spinigerum. he patient was treated with topical eye drops and oral steroids at the same time to reduce the inflammation. No neurological symptoms were seen. The patient was not available for further evaluation and followup. KEYWORDS: Blurring of vision, Gnathostomiasis