The present study reports the performance of final year medical students from the Universiti Malaysia Sabah (UMS) in the end of the senior surgical posting examination (SSP) with the aim to demonstrate the medical students graduating from this newly established university are of good standing and of improving quality. A study on the outcome of the method of teaching conducted on this study was performed by measuring the students’ performance continuously and at the end of their posting. The present data analyses demonstrate that there have been improvements in the medical students’ performance between the last two batches of students graduating from UMS. However, the students appear to be weaker in their MCQs, demonstrating a decline in theoretical knowledge. The analyses also demonstrate that there is a poor positive correlation between theoretical knowledge, clinical skills and/or continuous assessments, demonstrating the importance of emphasis in these 3 areas amongst medical students. Further studies may be required to determine the reason for this poor correlation since these may lead to better understanding on how to improve the overall performance of future medical student. CONCLUSION: The present study demonstrates that UMS medical student appears to continue to improve in their SSP performance although there are concerns about the decline in theoretical knowledge.
Background: Those with increased dynamic knee valgus are vulnerable to increased risk of non-contact knee
injuries. However, studies on the top down kinetic chain of lower limb mechanics during dynamic motions
such as single leg squat (SLS) among trained males were scarce.
Objective: The objective of the study was to evaluate the relationship between isokinetic hip and knee strength
and frontal plane projection angle (FPPA) of the knee joint during SLS.
Methods: Thirty-two male junior athletes (twelve cyclists, ten runners and ten squash players) were screened
for excessive dynamic knee valgus (DKV) prior to participation. Only those within the normal value of DKV were
included. Their hip and knee isokinetic strength in sagittal plane were evaluated at 60º/s of angular velocity
for both legs using dynamometer. Two dimensional knee FPPA was evaluated during SLS at 60º of knee flexion.
Pearson correlation was evaluated between knee FPPA during SLS and isokinetic leg strength.
Results: Correlations between knee FPPA and hip and knee isokinetic strength were not statistically significant
except between knee flexion peak torque/body weight (r = -0.35, p = 0.05) and hamstring to quadriceps ratio
(r = -0.39, p = 0.03) of non-dominant leg.
Conclusions: Isokinetic hip and knee strength and knee FPPA during SLS was correlated only for non-dominant
leg during SLS among male junior athletes. DKV during SLS may be reduced through strengthening the muscles
around hip and knee joints.
Typhoid fever is a systemic infection caused by Salmonella typhi, which may be associated with extra-intestinal
complications. Neurological manifestations, particularly Parkinsonism, are rarely reported. We report a
17-year-old patient with relapsed culture-proven Salmonella typhi infection who developed septic shock and
subsequently Parkinsonism. Lumbar puncture revealed acellular cerebrospinal fluid with raised protein level.
Magnetic resonance imaging revealed cerebral petechial haemorrhages resulted from small vessels vasculitis.
His symptoms resolved spontaneously after 3 months.
This article presents a brief overview on the importance of adopting healthy behavior during and after the completion of primary cancer treatment. Increasing evidences are advocating physical activity engagement in cancer survivors due to its convincing beneficial outcomes. Today, outcomes from numerous trials confirmed the need to examine beyond physical activity engagement, into physical inactivity as an independent factor for cancer recurrences. Reducing cancer-risk related behaviors via increase physical activity and reduce inactivity is now receiving much attention in the field of cancer survivorship. Both realms of activity and inactivity are now acknowledged as influential independent factors contributing to better care in the field of cancer survivorship.
The aim of this study was to determine the prevalence and extent of diseases present among migrant workers. A total of 809 migrant workers were examined. The mean BMI (Body Mass Index) was 22.3 kg/m2. Only 4.9% of the respondents had blood pressure greater than 140/90 mmHg. Generally the migrant workers examined were healthy, except for subjects with abnormal eosinophilia coutns, which may indicate occult parasitic infestation. Non-communicable disease in particular hypertension and diabetes mellitus are not major problems among migrant workers. Perhaps the target to aim at are the illegal migrant workers where more illness could be detected.
Aim: A once-daily formulation of tacrolimus, Advagraf®, is increasingly being used in place of twice-daily
tacrolimus, Prograf®, as a standard immunosuppressive agent for transplant patients. In this study, the
clinical safety and efficacy of Advagraf® were compared with Prograf®, among multi-ethnic Malaysian renal
transplanted population.
Method: This retrospective study identified renal transplant patients who were converted from Prograf® to
Advagraf® at the University Malaya Medical Centre (UMMC) (n=69). Clinical notes and laboratory records,
including tacrolimus daily dose and trough levels, were obtained for one-year, pre-and post-conversion. Causality
assessment of suspected adverse events were based on the WHO-Uppsala Monitoring Center criteria. Renal
biopsy records were re-evaluated based on the updated Banff 2007 classification for biopsy-confirmed acute
rejection (BPAR).
Results: Following conversion to Advagraf®, the mean tacrolimus trough level and daily dose decreased
significantly (p
Background: The adoption of technologically advanced medical devices assisted healthcare providers to
examine and treat diseases. However, technological advancements could increase the threats to safety,
security, and reliability of the devices from complications associated with manufacturing, functionality, and
the clinical application of the devices.
Aim: To examine the safety threats, cost implication, and bioethical standards of the manufacturing processes
and the functionality of advanced medical devices.
Subject and Methods: The study was a narrative review through a qualitative research methodology. The
secondary data was gathered from online databases including ProQuest, ResearchGate, CINAHL/EBSCOhost,
PubMed, and ScienceDirect, from books, journals, conference proceedings, and other web publications
between 2007 and 2017.
Results:There were safety hazards from human errors in the interpretation and the use of the advanced medical
devices. Equipment imperfections and poor processes of maintenance and procurement affected the effective
functionality of these medical devices. Healthcare expenditure was high, Social and bioethical considerations,
users’ complaints and post-market surveillance were essential in ensuring the safety of the devices and the
maintenance of quality life for the users.
Conclusion: Safety hazards and cost implications of the use of technologically advanced medical devices were
significantly high Social and bioethical standards in the manufacturing of medical devices contributed towards
the production of safer devices.
Priapism is a urological emergency. The treatment for ischaemic priapism is usually cavernosal aspiration with or without cavernosal irrigation. Some patients may need surgical intervention -the various shunt procedures. We report a 21-year-old man with priapism secondary to chronic myeloid leukemia who needed a combined medical and surgical management. He underwent a spongiocavernosal shunt as well as cytoreductive chemotherapy to achieve complete detumescence. Therefore, cytoreductive chemotherapy is an adjunct in difficult cult to treat priapism associated with chronic myeloid leukemia.
Genetic mutations in endometrial cancer (EC) have been extensively studied in the Western population but not much in Asian cohorts. This study has demonstrated that PTEN and PIK3CA mutations are commonly found in EC among Malaysian women. Following RNA extraction from 20 cancerous and 18 non-cancerous tissues, the presence of mutations in 9 exons of PTEN and 3 exons of PIK3CA genes were detected using real-time PCR, accompanied by High Resolution Melt (HRM) analysis. Sequencing confirmed specificity of each PCR product. The mutations for both genes were detected in the samples with varying frequencies. Notably, all samples expressed mutation of PTEN at exon 7 but none in exon 4. Further analysis demonstrated that strong concurrent mutations occurred between exons 7 of PTEN with exon 20 region 1 of PIK3CA gene (90%). Our data showed mutations are present in EC and not the non-cancerous tissues. Larger samples are being collected to validate this observation.
Rectal delivery of drugs has been proven to be effective in terms of drug absorption and distribution comparable with other routes such as oral, buccal, sublingual or even nasal. In this study, two new suppository bases were developed using combinations of locally sourced hydrogenated palm kernel oil, hydrogenated palm kernel stearin and hydrogenated palm kernel olein with mixtures of stearic acid and glyceryl monostearate. When formulated with aspirin, these bases produced suppositories with acceptable characteristics. These aspirin suppositories were tested on twelve healthy subjects after an approval from the Medical Ethics Committee, University of Malaya had been procured. We quantified aspirin from the urine samples of the subjects to determine the relative availability of the different suppository preparations relative to an oral dose. The excretion of salicylic acid, one of the metabolite of aspirin in human urine taking aspirin was quantified. The F value was found to range from 1.16 to 1.38. Hence, the excretion results showed that these palm kernel oil blends are suitable suppository bases.
Assisted Reproductive Technology (ART) is a suite of laboratory techniques designed to rescue infertile phenotypes. While ART has led to the birth of 5 million ART babies worldwide, success rates rarely exceed 40%. One potential factor for this could be iatrogenic (‘clinician-induced’) damage to critical sperm proteins, such as phospholipase C zeta (PLCζ) and protamine, which are fundamental for oocyte activation and sperm DNA integrity, respectively. This report describes how we have begun to investigate the adverse effects of ART techniques upon these key sperm proteins. We also describe the pathway taken by Miss Suseela Yelumalai to acquire a scholarship from the Malaysian Government and her postgraduate experience at the University of Oxford. We introduce the facilities and learning opportunities available at the Institute of Reproductive Sciences (IRS) which houses Dr Kevin Coward’s research laboratory, and finally, highlight the potential for collaborative development between the Universities of Oxford and Malaya.
INTRODUCTION: Despite the various methods described in producing platelet-rich plasma (PRP), it is well established that this biological product in its many preparations have been proven to enhance wound healing. However, very little have been known about the efficacy of these methods hence there is a lack of evidence in the superiority of one method over another. Thus, a study was conducted to compare these different protocols to determine which produces the highest concentration of platelets.
METHODS: Peripheral blood was obtained from 24 healthy volunteers. Four different protocols using similar 2 step centrifugation methods of preparing PRP were applied to an equal number of samples in this study. Platelet counts were performed on whole blood (without processing), PRP preparations and platelet-poor plasma (PPP).
RESULTS: All protocols produced higher amounts of platelet concentrates in PRP preparations than plasma. However, centrifugation at 150g for 10 minutes followed by another at 450g at 10 minutes produces significantly higher amount of platelets concentration (p<0.05)
CONCLUSION: Optimizing the protocols to produce PRP appears to be important in obtaining a maximal yield of platelet concentrate. Here the protocol described has shown to provide significant concentration yield over all others.
Keywords: platelet-rich-plasma, growth factors, centrifugal forces
Introduction: Ureteric obstruction commonly presents as a urological emergency requiring urgent intervention with urinary diversion. Double J stenting (DJS) is the preferred option to relieve ureteric tract obstruction in our centre.
Objective: Our study aims to determine the feasibility and outcomes of DJS by general surgeons and medical officers in a hospital without a resident urologist and to identify the possible predictive factors for successful DJS.
Methods: This is a clinical audit of all patients scheduled for DJS in Hospital Bintulu, Sarawak, from January 2017 to March 2020. A total of 57 patients were included. Socio-demographic data and factors predicting success rate, i.e., level of ureteric obstruction and its causes (intrinsic or extrinsic), diagnosis, size and nature of stone(s), degree of hydronephrosis and pre-operative renal profile, were collected. Success rate and postoperative outcomes for all successful cases were evaluated. Bivariate statistical analyses were used to investigate the association of predictive factors with the success rate of DJS.
Results: Double J stenting was successful in 63.2% (36 cases) of our total samples of 57 cases. Out of 36 successful cases, 82.1% of the cases were able to return to baseline renal profile within 14 days and 83.3% did not develop fever within 3 days post-operative. The post-operative mean length of stay was 3.16 days and post-operative day 1 mean pain score was 0.72. Causes of obstruction by intrinsic factors, urolithiasis, pre-operative normal serum creatinine (
The use of steroid therapy and its treatment impact on children hospitalised with viral croup between 1994-1998 were reviewed by comparing 30 patients who received steroid therapy with 65 patients who did not. There was no difference in the socio-demographic and clinical profile between the two groups. The hospital stay (2.8 ± 1.3 vs 3.5 ± 1.2 days, p = 0.02) and duration of documented stridor (1.3 ±0.5 vs 2.8 ± 1.0 days, p = 0.001) were shorter for patients who received steroid therapy although they appeared to have more severe respiratory distress. There were no complications associated with steroid therapy use. Despite reluctance in administering steroid therapy for viral croup, patients who received the treatment had a shorter hospital stay and duration of stridor. KEYWORDS: Croup, steroid therapy, hospital stay.
Background: South Sulawesi is one of the most successful provinces in Indonesia to develop Healthy Cities. This can be characterized by awards Swasti Saba, an award given by the central government to the districts/cities that successfully held Healthy Cities.
Aims: The purpose of this paper is to understand the meaning of Healthy Cities Awards and to identify the expectations and challenges towards Healthy Cities Awards in South Sulawesi, Indonesia.
Method: This study used a qualitative approach. The research method was in-depth interviews. The informants were 22 people consisting of healthy district/city advisors including the head of the districts/cities planning agency, health office, transportation agency, food and nutrition security agency, public works office and head of the healthy citiy/district and province forum.
Results:This paper found that the award of Healthy Cites isimportant. Seven expectations and several challenges have been identified. This paper suggests that the implementation of Healthy Cities emphasizes the essence of achieving Healthy City goals.
Conclusion: Many healthy district/city managers are oriented towards the awards rather than the essence of healthy districts/cities goals.
Demographic, economic and social changes have had major impact on health and illness globally, including in Malaysia, and present significant challenges to the structure and delivery of health services. While these changes have influenced the epidemiology of disease, the diagnosis, experience and response to changes in health status for individuals and their families are influenced by additional environmental and personal factors. We describe these factors in relation to our ongoing research program on personal and social aspects of impairment and disability. The Resilience study aims to understand how people with impairments and their families live with chronic health conditions, how these conditions impact on self-esteem, social relationships and societal participation, and how structure, context and environment affect individual functioning, disability and well-being. We described our methodology and summarize the baseline data that will inform our future enquiries.
Anomalies of the genitourinary tract occur in approximately 10% of the population and account for about one third of all congenital malformations in children (1). Congenital malformations involving the genitourinary system are major therapeutic challenges faced by the practising urologist.