Widespread over-prescription of proton pump inhibitors (PPIs) without an appropriate indication has financial and potentially adverse clinical consequences.
The needs of family members of patients have often been neglected. Many investigations have presented that meeting the needs of families and helping them cope with the period of hospitalization will improve the well-being of relatives of patients admitted to the Intensive Care Unit (ICU). The aim of this study was to identify the needs of family members of patients admitted to the ICU at Queen Elizabeth Hospital, Kota Kinabalu, Sabah. This cross-sectional study recruited 60 family members, and a validated Critical Care Family Needs Inventory in Bahasa Malaysia was used to verify the needs of these families. The outcomes disclosed that family members ranked “assurance” as their utmost need. “support” was ranked the least important. The differences in mean values of gender, education level, history of admission and types of relationships among the family members were trivial. The results of this research will help us prepare guidelines to educate ICU healthcare providers, as well as information pamphlets for the relatives of admitted patients.
Dengue is a viral infection caused by four types of viruses (DENV-1, DENV- 2, DENV-3, DENV-4) and transmitted through the bite of infected Aedes aegypti and Aedes albopictus female mosquitoes that feed both indoors and outdoors during the daytime (from dawn to dusk). These mosquitoes thrive in areas with standing water, including puddles, water tanks, containers and old tyres. There were a total of 35 dengue outbreaks under PKK KK with four active outbreaks in the year 2017. One uncontrolled outbreak occurred at Ibu Pejabat Kontigen (IPK) Kota Kinabalu from 16 November 2017 to 21 December 2017.
Tobacco products can be classified into combustible and smokeless types. It kills up to half of the users and globally around 5 million deaths every year. There are strong associations between smoking and health-related quality of life (HRQOL) measures.
Escherichia coli sequence type 131 (ST131) carries multiple drug resistance (MDR) genes as well as virulence genes. Drug resistant characteristics give a management problem to health care personnel. Four MDR Escherichia coli ST131 H30-Rx subclones were identified among 80 Uropathogenic E. coli (UPEC) isolates by using 4 allelic-specific Polymerase Chain Reactions (PCR) in two hospitals of Kota Kinabalu, Sabah, Malaysia. There is emergence of multidrug resistant E. coli in Kota Kinabalu.
The three plasmid borne alternative dihydropteroate synthetase (DHPS) genes namely sul1, sul2 and sul3 genes were heterologous in amino acid sequence and have about 40 – 50% identity. However, they have same DHPS activity with disc diffusion zone size of 6 mm with suphamethoxazole disc in our previous study. Sul1, sul2 and sul3 genes were observed in sulphamethoxazole resistant uropathogenic Escherichia coli (UPEC). In this study, all the three genes were cloned into E. coli host and minimum inhibitory concentration (MIC) was investigated for each sul gene to compare the activities of sul genes. The MIC values of E.coli containing sul2, sul1 and sul3 genes inserted recombinant plasmid were observed to have 18.5 mg/ml, 18 mg/ml and 17.5 mg/ml respectively as mean value of five experimental results. Although comparable MICs were obtained as a result, the MIC value was highest in E. coli carrying sul2 gene indicating that this DHPS enzyme activity of sul2 was strongest among three sul genes.
Inaccessibility to clinical supervision is an issue faced by solo clinical psychologist practitioners. Combination use of web-based instant messaging and video call application were tried by 28 clinical psychologists in conducting a peer-led group tele-supervision to address ethical dilemmas, discuss case management, provide technical instruction, explore resistance and analyse countertransference, provide emotional support, and share knowledge and updated guidelines. Despite facing challenges including difficulty in face-to-face session scheduling, limited time for in-depth discussion, internet connection issues, and documentation dilemma, we believe it has potential to influence supervision practice for clinicians working in isolation in rural or remote locations.
Dengue and malaria infections are common mosquito-borne infectious diseases in tropical and subtropical regions. The clinical manifestations of dengue and malaria often mimic each other, causing the predicament of early diagnosis without laboratory investigations. Concurrent dengue and malaria infection are often rare scenarios when both diseases occur in a particular patient at the same time. A high index of suspicion is therefore required to establish an early diagnosis to ensure complete success in its management. This case report is about concurrent dengue and malaria infection in a 54-year-old Pakistani man who presented with high-grade fever for three days before admission. On examination, he was febrile (38.8°C) with no other findings. His blood investigations were positive for NS1 antigen and IgM but negative for IgG. His peripheral blood film revealed the presence of Plasmodium vivax. He was treated for dengue fever with supportive management and started with oral Riamet (artemether and lumefantrine) along with oral primaquine 30 mg daily for two weeks’ duration. Following treatment, the patient demonstrated progressive clinical improvement and was subsequently discharged back to the community clinic for the continuation of care.
Strongyloides stercoralis is an intestinal nematode which is endemic in tropical and subtropical countries. The global prevalence of Strongyloides is unknown. Strongyloidiasis is found more frequently in the socioeconomically disadvantaged, in institutionalized populations, and in rural areas. The spectrum of disease varies. It may cause asymptomatic infection, mild eosinophilia or hyperinfection syndrome in the most severe form. Here we reported a case of Strongyloides hyperinfection syndrome in an immunosuppressed patient. This patient is a 54-year-old man with myasthenia gravis on long term azathioprine and prednisolone. He presented with fever associated with diarrhoea and was in septic shock. His blood culture was positive forKlebsiella pneumoniae.Strongyloides stercoralis larvae were detected in his sputum and stool sample. He was diagnosed to have Strongyloides hyperinfection and was treated with subcutaneous ivermectin. He recovered well. Our case demonstrated the association of Strongyloideshyperinfection with superimposed gram-negative sepsis as a consequence of prolonged immunosuppression. A high index of suspicion is needed in approaching patient with risk factors of hyperinfection syndrome.
Cigarette smoking is considered as the symbol of adulthood and as a friend during stress and loneliness. The developing countries in South Asia where the largest segment of the population is comprised of adolescents are more susceptible to smoking epidemic and its consequences. A cross sectional survey among 304 randomly selected medical students was carried out to determine their smoking habit of a selected medical college in Dhaka, from 1st October to 31st December 2014. The respondents were from 16 to 20 years of age, with mean (±SD) of 16.8 (±1.9) years. Among them (including 28 girl students), 96(31.5%) were non-smokers. The remaining 208(68.4%) were smokers, among them 43(20.6%) were regular smokers, and 165(79.3%) were occasional smokers. All 28 female students were non-smokers. Regarding duration of smoking, 42(20.2%) respondents smoked for less than 6 months, 64(30.8%) for 6 months to 1 year, 88(42.3%) for 1 to 4 years, 11(5.3%) for 5 to 10 years and a least 3(1.4%) smoked for more than 10 years. Thirty six percent of current smokers smoked more than 10 sticks per day compared
with thirty percent who smoked 6 to 10 a day. Significantly more users knew that it causes tuberculosis, heart attack, cancer and development of hypertension. Overall, students’ major sources of information were doctors (69.7%), medias (47.7%), parents (9.2%) and friends (3.3%). As the prevalence of smoking among medical students was found very high hence, the multi-pronged intervention strategy is needed to tackle the problem. Anti-tobacco education and awareness should be adopted in the curriculum of schools and colleges. All forms of tobacco advertising and promotional activities should be banned, and parents should be encouraged to adopt more responsible attitudes toward smoking in the home.
Besides the common respiratory symptoms or viral pneumonia, COVID-19 is also presented with different neurological symptoms. Olfactory dysfunction (OD) or impairment of the sense of smell is one of the common neurological symptoms being reported in infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The severity varies from anosmia to microsmia or hyposmia. OD could have a potential early screening and diagnostic value besides other neurological and common respiratory symptoms. In our descriptive concise review, we aimed to elicit the manifestation of olfactory dysfunction as an early predictor of SARS-CoV-2 infection. We are also aiming to establish, OD as a quick and reliable assessment tool of COVID-19 risk, among the healthcare workers and contact tracers, which can justify self-quarantine of the person as well as recommendation for testing on a priority basis. We have also focused on, any effect to produce this symptom by the drug used for treatment in COVID-19, and if the old age of the patient showing any extra influence to develop OD in COVID-19.
An Objective Structured Clinical Examination (OSCE) is a tool of assessing the clinical school often used
in the education system of the healthcare system. Traditional Oral Examination (TOE) is also a clinical
examination where students are being tested by an examiner panel (1 or 2 members) on their clinical
activities and knowledge. It is designed to objectively test competence in skills such as history taking,
clinical examination, communication and clinical procedures. The Faculty of Medicine and Health Sciences
of Universiti Malaysia Sabah (UMS) also use OSCE for assessing clinical students. The aim of this study
was to compare the performance between the traditional oral examination (TOE) and OSCE among
undergraduate medical students. Study populations were the 3rd year MBBS students of the Faculty of
Medicine and Health Sciences of Universiti Malaysia Sabah (UMS). Number of students was 87. All
students underwent traditional oral examination after finishing a 2 months module. The same students
participated in the OSCE on the same day evening. Scores of each student were collected. Mean of the
scores were calculated. P value was measured by Student’s t test to evaluate the significant difference
between both the variables (traditional examination mean and OSCE mean) at 5% confidence interval (CI).
P-value was 0.00015 in 5% confidence level in two tailed hypotheses. As the value was less than 0.05 so
null hypothesis was rejected and alternate hypothesis was accepted. There was significant difference between the means of both the examinations. So it could be concluded that students’ performance was
significantly better in the OSCE over the traditional oral examination.
Since December 2019, COVID-19 is impacting the health, economy, education, and well-being of every country in the world. The total number of reported COVID-19 cases will soon surpass 100 million and the death toll will be more than 20 million. At this moment, the top 10 countries with the most reported number of cases currently are the USA, India, Brazil. Russia, UK, France, Turkey, Italy, Spain, and Germany. These countries altogether represent 31.7% of the world’s population. However, they reported 65.5% of the total COVID-19 cases and 58.9% of total deaths. For containing the spread of SARS-CoV-2, the virus that causes COVID-19, Malaysia was one of the most successful countries in the world. However, since September 2020, the situation in Malaysia started changing, and at this moment Malaysia is reporting more than 2,500 new cases per day. During the past year, all the countries in the world acted fast and took different initiatives to reduce transmission of SARS-CoV-2, find effective drugs that can improve the clinical outcomes of COVID-19, and invent vaccines that can give immune protection. The first vaccine that was approved was invented by Pfizer/BioNTech and in December 2020, within one year of the beginning of the pandemic, the UK was the first country to start mass vaccination. As reported by the World Health Organization (WHO) in January 2021, more than 50 COVID-19 vaccines were in different phases of clinical trial and five vaccines received certain national regulatory approval for mass vaccination. However, given all these developments the COVID-19 pandemic is still making a devastating impact on the whole world and the pandemic is not going to over soon. Therefore, we need to discuss what we can do now to deal with the pandemic and ensure the health and wellbeing of the citizens of the world.
Non-cirrhotic portal hypertension (NCPH) is clinically defined as the presence of portal hypertension in the background of non cirrhotic liver. It is diagnosed by the findings in ultrasound of the hepatobiliary system and also oesophagogastroduodenoscopy (OGDS) that consistent with that of a portal hypertension, but otherwise has a relatively normal liver function and echotexture. The treatment mainly focuses on primary and secondary prophylaxis of variceal bleeding both pharmacologically like non-selective beta-blockers and octreotide, and non-pharmacologically like endoscopic band ligation of varices and sclerotherapy. In advance cases, sometimes surgery such as Porto systemic shunt or splenectomy may be required especially in patients with uncontrolled variceal bleeding or with symptomatic hypersplenism. Here we report a case of a young man who presented with upper gastro-intestinal bleeding, which was initially thought from a bleeding ulcer but was found to be secondary to oesophageal and gastro-oesophageal varices. Apart from having mild ascites, he has no other features of portal hypertension. His liver biochemistry and echotexture were also normal. Unfortunately, the patient was lost to follow up while he was still in the early stage of investigating the condition. The purpose of this case report is to share an uncommon occurrence of NCPH in East Malaysia, where liver cirrhosis predominates the aetiology of portal hypertension. Also, to the best of our knowledge, there is a very limited reporting of a similar case in this region.
hildhood undernutrition while being a preventable condition remains a major public health issue because it contributes to the mortality and morbidity of children globally. Intervention to improve the nutritional status of children includes supplementary feeding, fortified foods, cash transfers and nutritional education.
Keywords:
As general population of obese patients in Malaysia rapidly increases, more obese patients are requiring anaesthesia for various operative procedures. Obesity is associated with anatomical and physiological differences and co-morbidities that influence on the choices of anaesthesia care. A surgical case with general anaesthesia is used as a basis of discussion. A 37-year-old female, history of untreated hypertension and gastrooesophageal reflux disease (GORD), BMI of 41 admitted for laparoscopic cholecystectomy for symptomatic cholelithiasis under general anaesthesia. She presented with pain at the upper right abdomen and associated with bloated abdomen, nausea and vomiting after intake of meals. General anaesthesia and right ultrasound-guided transversus abdominis plane (TAP) block for abdominal wall blocks via subcostal approach was performed. Operation was removal gallstones in the common bile duct via laparoscopic approach. Post-operation patient was extubated successfully. She was prescribed paracetamol 1g 4 hourly and started on fentanyl patient-controlled analgesia (PCA) for next 2 days. In this case report, there is the description of the application of TAP block which when used in obese abdominal surgical procedure, can provide excellent postoperative pain relief, early mobilization and recovery.
Post-operative complications are well known to impair the functional outcomes of total knee arthroplasty (TKA). Patella subluxations post-TKA is a grim complication rendering patients disable post-surgery. Howbeit, medial patella subluxation is a rarely recorded incident altogether. This case report describes a patient post successful TKA two years ago, who was incidentally diagnosed with a medial patellofemoral subluxation during a recent routine yearly follow up. This gentleman, however, had no complaints and the only evident clinical sign was anterior knee skin puckering. A radiograph of the knee confirmed our clinical suspicion of medial patella subluxation. The patient’s symptoms, his expectations, radiological findings, what went wrong during surgery and management of this rare entity were analysed. This rarely reported entity requires a high degree of suspicion especially if the patient complains of instability and peculiar anterior knee pain. Diagnosis is customarily clinical and revision surgery is almost invariably necessary.
This systematic review was aimed to evaluate the effectiveness of technology-enhanced learning (TEL) used in medical teaching for undergraduate medical students. The objectives are to (a) identify various teaching modalities which are used to enhance TEL; (b) evaluate whether TEL is more effective than traditional learning (TL) in cognitive and affective learning domain outcome. The empirical studies were searched in the following databases: Google Scholar, MEDLINE, ERIC, ProQuest, Cochrane Library and Scopus. All papers published from 2008 to 2018 were included. From eligible studies, the study design, study field, study population, intervention methods, type of assessment and learning achievement were abstracted and summarized the information. The search results were independently reviewed by two authors. From a pool of 1384 articles, 43 eligible articles were identified, enrolling 7292 undergraduate medical students examining comparative study between TEL and traditional learning. The results showed that there was a high degree of heterogeneity seen amongst the included studies in terms of TEL modalities used. The majority of intervention studies favoured online resources, while the rest used various offline multimedia electronic devices, virtual simulations and blended modes. Overall findings showed promising data that TEL is better than TL with regards to knowledge gain and skill acquisition, as well as providing higher student satisfaction. In all, the findings present blended learning in a positive and promising light in time, particularly where systematic reviews on technology-enhanced learning in the field of the undergraduate medical programme have produced mixed result.REVIEW ARTICLEA Systematic Literature Review on Technology-Enhanced Learning in Medical EducationMay Honey Ohn1*, Bareth Ravindran2, Chan Zhi Wei3, Khin Maung Ohn4, Ng Pey Luen5Borneo Journal of Medical Sciences 14 (1) January, 2020: 3 – 171 Emergency Department, Sandwell & West Birmingham NHS Trust, United Kingdom2 Surgical Department, Hospital Tuanku Ja’afar Seremban, Kuala Lumpur, Malaysia3 Orthopaedics Department, Hospital Sungai Buloh, Kuala Lumpur, Malaysia4 Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia5 Radiology Department, Hospital Queen Elizabeth II, Sabah, Malaysia* Corresponding author’s email: mayhoney.ohn@gmail.com Received: 14 July 2019 Accepted: 5 November 2019Borneo Journal of Medical SciencesBJMSKeywords: blended learning, technology-enhanced learning, medical education, hybrid learning, undergraduate medical students
Slum children are at risk for serious mental health problems because of their economic and social
environments. Little is known about their mental health. This cross sectional study was carried out to
know the extent of mental health problems among slum-dweller children in Dhaka city, Bangladesh. One
hundred and twenty students of four different primary schools were selected. In the first stage of the study,
socio-demographic data as well as information about mental health problems were collected through
socio-demographic questionnaire and validated Bengali version of Rutter B2 scale respectively, from the
teachers of the schools. In the second stage, all the students were assessed again personally by the both
authors with the help of Diagnostic and Statistical Manual of Mental Disorders- fourth edition (DSMIV).
High prevalence of mental health problems was found among slum children (70.8%). Emotional,
conduct and undifferentiated disorders were detected in 14.17%, 45.83% and 10.83%, respectively.
Conduct disorder was 3.23 times more prevalent in the children than was emotional disorder. It was more
prevalent in boys than in girls (57.90% vs 34.90%). Significant relationships were found among gender
and emotional disorder (p < 0.030), father’s employment status and undifferentiated disorder (p < 0.010),
substance abuse by father and child’s emotional disorder(p
Getting appropriate healthcare is a challenge to the citizens in Malaysia due to the limited facilities, healthcare providers, and cost of healthcare. Uberization of healthcare will help fill this gap. Uberization helps modify the market or economic model with the introduction of a cheaper and more effective alternative service by introducing a different way of buying or using it, with the use of mobile technology. With powerful artificial intelligence engines operating on cloud servers, mobile apps can provide a better healthcare experience for patients. With uberization application, the patient need not come to the hospital to see a doctor before a treatment can be planned. Once a request is made by the patient, the healthcare providers can come to see the patient at an agreed place. This article aims to explore the possible uberization of healthcare in Malaysia.