Displaying publications 81 - 100 of 173 in total

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  1. Nalliah S
    MyJurnal
    Mentoring in academic medicine requires the trained mentor to commit time, purpose and dedication for the personal and professional development of three categories of protégés or mentees i.e. medical students, the clinician-trainee and the clinical-educator. Conventionally, assigned mentors monitor the progress of the first two categories of personnel as their career pathway is clearly defined. On the other hand the clinician–educator in academic medicine could be a scientist or a career clinician expected to contribute to medical education activities and research. The clinician educator has grown in complexity as he multitasks in providing clinical care, assists in delivering the medical curriculum and is expected to do research and publish. Although there is dearth of research in mentoring the clinician-educator, it is clear that mentored clinicaleducators are more productive by way of scientific publications. Trained mentors are expected to identify the needs of the mentee with regards to the level of his career development and his aptitude to move up the academic ladder, successfully nurturing the maturation process. Processes of mentoring in the clinical setting, attributes of the successful mentor and facilitating the mentee in overcoming challenges in academic medicine are discussed.
  2. Davendralingam Sinniah, Thiruselvi Subramaniam, Myint Myint Soe-Hsiao
    MyJurnal
    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.
  3. Ong, C.K., Tan, W.C., Leong, K.N., Muttalif, A.R.
    MyJurnal
    The incidence of tuberculosis (TB) is currently increasing. HIV induced immuno-suppression modifies the clinical presentation of TB. Our aim is to determine the differences in clinical presentation of HIV-TB co-infection based on their CD4 counts. This retrospective study looked at cases of adult active TB and HIV-1 co-infection treated in Penang Hospital from January 2004 to December 2005. Of the 820 patients treated for active TB, HIV-1 seropositivity rate was 12.6% (103 patients). Majority of HIV-1 co-infected patients presented with prolonged insidious and non-specific symptoms like weight loss, fever and night sweats. The clinical presentation of TB depended on the stage of HIV-1 infection and associated degree of immunodeficiency. Compared to the less immuno-compromised HIV-1 and TB co-infected population (CD4 > 200/mm3 ), patients with CD4 counts ≤ 200 are more likely to have atypical chest radiographs (P = 0.009). During active TB, the Mantoux test was positive in 12 (14.5%) HIV-1 infected patients with a CD4 counts ≤ 200/mm3 and in 16 (80%) of those with CD4 counts > 200/mm3 (P = 0.0001). In our series, the AFB smear / AFB culture and type of TB did not show obvious correlation with CD4 counts. Therefore to diagnose TB in severely immuno-compromised HIV patients, we need to have a high index of suspicion.
  4. Lim, Swee Geok, Muhamad Asyraf Muhtar
    MyJurnal
    Background: Nurses are the “front line” staff in most
    health systems and their contribution is recognised as
    essential in meeting development goals and delivering
    safe and effective care (ICN, 2007). Nurses are in high
    demand not only in developed countries but also in
    developing countries like Malaysia. However, more
    than 70% of Malaysian hospitals currently do not have
    adequate nursing staff. At least 174,000 nurses need to
    be trained by 2020 to meet WHO’s nurse-to-patient
    ratio of 1:200. The purpose of this study is to identify
    the main factors that influence the nursing students’
    decision to choose nursing as their career.

    Method: A descriptive study guided by Self
    Determination Theory was used for this study. A 29-
    item questionnaire adapted from McCabe, Nowak
    and Mullen (2005) was distributed to all students in a
    nursing college (n=117).

    Results: The five main reasons for choosing nursing
    as a career were “ability to help others”, “training was
    provided on the job”, “ability to work closely with
    people”, “parental advice”, and “accommodation was
    provided while training”. The top three main domains
    that influenced the nursing students’ decision to choose
    nursing as their career include “travel opportunities
    of nursing”, “intrinsic attraction of nursing” and
    “immediacy of support on entry to nursing”. A total of
    19 (0.2%) will not choose nursing if given a chance.
    The main reasons were “want to take another course”,
    “no time to spend with family” and “nursing is a stressful
    job”.

    Conclusion: The findings of this study provided valuable
    information regarding motivating factors which attract
    the current generation to join nursing. It is of concern
    that items representing nurses’ image were not rated
    highly.
  5. Mohan, Jai
    MyJurnal
    The importance of incorporating medical (or health) informatics into the education of medical students and medical practitioners is being increasingly recognised. The advances in information and communication technology and the pervasion of the Internet into everyday life have important implications for healthcare services and medical education. Students and practitioners should learn to utilise biomedical information for problem solving and decision making based on evidence. The extensive introduction of electronic health information systems into hospitals and clinics and at the enterprise level in Malaysia and elsewhere is driving a demand for health professionals who have at least basic skills in and appreciation of the use of these technologies. The essential clinical informatics skills have been identified and should be incorporated into the undergraduate medical curriculum. It is recommended that these be introduced in stages and integrated into existing programmes rather than taught as a separate module. At the same time, medical schools should support the integration of e-learning in the educational process in view of the numerous potential benefits.
  6. Tong, Chin Voon, Mohamad Rafie Md Kaslan
    MyJurnal
    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
  7. Michael John Rathbone
    MyJurnal
    The nature, extent and definition of a collaboration varies between individuals, disciplines, departments and institutions. It depends upon such factors as the people involved, the nature of the research problem, the research environment, the institutional culture and demographic factors. This paper will examine the concept of collaborative research and discuss its place and position in an evolving university.
  8. Menon V
    MyJurnal
    Background: Facebook is a popular social networking site with more than five hundred million users. This study assessed whether Facebook Groups can be used to teach clinical reasoning skills.
    Methods: Sixty-seven final year medical students from the International Medical University, Malaysia, were exposed to interactive online learning through a Facebook Group for a period of six months in this study. The purpose was to determine if supervised interactive online learning could be used to augment the deep learning that comes from learning medicine at the bedside of patients. The interactive online discussions were entirely triggered by clinical problems encountered in the medical wards of the general hospital to which these students were attached.
    Results: A total of 10 topics were discussed in this forum during the duration of this study and an example of one such discussion is provided to illustrate the informal nature of this kind of learning. The results showed a high degree of student involvement with 76 percent of students actively participating in the discussions.
    Conclusion: The high degree of voluntary participation in the clinical discussions through the Facebook Group in this study tells us that Facebook Groups are a good way of engaging students for learning and can be used in medical education to stimulate creative clinical thinking.
  9. Mansharan Kaur Chaincel Singh
    MyJurnal
    Amoebiasis is a parasitic infection caused by the
    intestinal protozoan Entamoeba histolytica, most
    prevalent in developing countries. It results in 40,000 to
    100,000 deaths each year from amoebic colitis and extra
    intestinal infections. Amoebic liver abscess (ALA)
    is the most common extra intestinal site of infection
    with an incidence of between 3% and 9% of all cases of
    amoebiasis. Ultrasound which has a sensitivity of more
    than 90% for detecting ALA is highly recommended
    as an initial investigation followed by serological
    demonstration of circulating antibodies specific to
    Entamoeba histolytica.
  10. Mak, Joon-Wah
    MyJurnal
    The research mentorship programme is unique in that it is a planned journey undertaken by the mentor and mentee, preferably with well-defined milestones along the journey. During the journey, familiar landmarks will be pointed out by the mentor. In path-finding situations the experience and wisdom of the mentor and the critical appraisal of both mentor and mentee will contribute to learning from the encounter. In most mentor-mentee partnerships, a formal acceptance to the relationship, well-defined landmarks measuring progress in the journey, regular appraisal of the skills developed and acquired, and phased, judicious modification in the individual roles of that relationship will be required. Although there is no consensus on the elements of mentorship, there are some strategies which can contribute to the success of the relationship. Critical success factors include convergence of the research area within the broad expertise of the research mentor. The research mentor should have a proven research track record and is committed to serve in that official capacity. The research mentoring process is dynamic and characteristics of both mentor and mentee contribute to the robustness of that relationship. The mentee would have identified some attributes of the mentor that are desirable and is willing to work hard to achieve, build on, and improve upon. In the research setting endpoint measurements of success will be based on recognition of the research standing of the mentee, measurable outcomes such as number of papers in top tier journals, citation indices, etc. consultancies attracted as well as invitations to deliver plenaries in scientific conferences, patents filed and research findings translated and applied, and other measures of research productivity. In the pursuit of research excellence the mentee would have imbibed values of professionalism and ethics in research and would have constantly kept in mind that to be successful, the mentee would be able to excel beyond his mentor and that the next generation of researchers will seek mentorship from him.
  11. Mak, Joon-Wah
    MyJurnal
    The International Medical University (IMU) has encouraged and facilitated research activities since 2001. Research activities by undergraduates, postgraduates, and faculty members have increased substantially since then. The governance aspects of research activities are closely monitored by the Institutional Review Board which is the IMU-Joint Committee on Research and Ethics. (Copied from article)
  12. Ong, Chin-Eng, Yan, Pan, Tiong, Kai-Hung, Yiap, Beow-Chin, Tan, Eng-Lai, Pook, Peter, et al.
    MyJurnal
    Pharmacogenomics (or pharmacogenetics), the study of the effects of genetic differences on a person’s response to drugs, can help in optimizing drug efficacy and minimizing adverse drug reactions. Interperson difference in drug metabolism is one of the important consequences of such genetic variation. This variation is determined in part by mutations in cytochrome P450 enzymes (CYPs). IMU is part of a major collaborative research project in the area of phamacogenetics and drug metabolism. Working together with USM and UiTM, our group has, since 2000, generated useful population database on genetic polymorphism of various CYP isoforms. We have successfully genotyped three major ethnic groups, Malay, Indian and Chinese for their allelic frequency of important isoforms. These include CYP2D6, CYP2C9, CYP2C8 and CYP2A6. Data generated so far collectively have contributed to our effort in mapping and constructing genomic database for Malaysian population.
    Since early 2002, our research has been focusing on developing in vitro methods in studying the functional consequences of genetic polymorphism of CYP enzymes. Using site-directed mutagenesis, CYP mutants, carrying nucleotide changes as reported in known alleles in human populations, were generated and expressed in E. coli system, and the expressed recombinant proteins were characterized using enzyme assays to determine the functional consequences of mutations. We have established a series of HPLC (high performance liquid chromatography)-based and fluorescence-based assays to investigate CYP activities. Assays that have been developed include tolbutamide methylhydroxylase, paclitaxel 6α-hydroxylase, dextromethorphan O-demethylation, testosterone 6β-hydroxylation and coumarin 7-hydroxylase assays. These assays serve as activity markers allowing comparison of catalytic activities of mutant proteins generated. Another focus of our work is to use the developed assays as a screening tool to investigate drug-herb interactions. This was achieved by co-incubation of herbal extracts and active constituents with the probe substrates in the assays followed by characterization of the kinetic behaviors of the enzymes involved using various pharmacokinetic parameters such as Km, Vmax, IC50 and Ki. This work is currently carried out with collaboration from the Institute for Medical Research (IMR) and is supported by MOSTI’s eScienceFund under RM9. It is envisaged that this screening work will give us insights on the potential of the commonly used herbs to cause pharmacokinetic interactions with other drug substrates, and allow us to elucidate the mechanisms involved in the interactions.
  13. Teo, Keat Seong, Cheah, Cheong Wooi, Mak, Joon Wah
    MyJurnal
    Background: Sensitisation to house dust mite (HDM) has been regarded as a major risk factor for development of asthma. This study was carried out to investigate the profiles of HDM sensitisation among Malaysian children with asthma.
    Material and Methods: The association between HDM sensitisation and control and severity of asthma was investigated. The salivary HDM specific IgE levels were quantified in different grades of control and severity of asthma in 125 unselected asthmatic children aged 5-12 years old attending the asthma follow-up clinic in Hospital Tuanku Ja’afar Seremban. An additional 29 non-asthmatic patients were selected as control. The skin prick test to assess sensitisation to Dermatophagoides pteronyssinus (DP) and Dermatophagoides farinae (DF) was performed on all the participants. A questionnaire regarding the control and severity of asthmatic symptoms of the subject was administered. Saliva was collected by voluntary spitting and ELISA was used to quantify the IgE specific to HDM antigen.
    Results: There was a significant association between sensitisation to DP and DF and the control of asthma. The association between DP sensitisation and severity of asthma just failed to reach a significant level although there is a clear trend for this. Significant association was found between DF sensitisation and severity. The HDM specific IgE in the saliva was significantly higher in asthmatic patients compared to non-asthmatic patients. There was no significant difference between the specific IgE levels in patients with different severity status of asthma.
    Conclusion: Salivary IgE levels may not be an appropriate indicator of the patients’ asthmatic condition in this study. However, it can be concluded that there is significant association between the sensitisation of HDM and the control and severity of asthma.
    Study site: Asthma clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
  14. Mak JW
    MyJurnal
    There is no substantial difference in conducting research that is both ethical and responsive to the health needs in developing and developed nations. Differences are in financial constraints, technological expertise in identification and addressing needs, and in the perception of equal partnership of all stakeholders. There will be differences in emphasis of research but this is slowly blurred due to globalisation. Public health emergencies in developing countries need timely and effective global collaborative research to implement control strategies. Research needs should be based on predictive models with learning from past emergencies, technological advances, strategic critical appraisal of local and global health information, and dialogue with all stakeholders. Adequate funding will be challenging and resources from national, international and aid
    foundations will be needed. Issues associated with such funding include deployment of international rapid response teams, collaborating researchers, transfer of technology, and intellectual property ownership. While all types of research ranging from basic, applied, clinical
    studies, meta-analysis, and translational research are relevant, the relative importance and specific allocation of resources to these may differ. Is the choice related to responsiveness or based on researchers’ perception of their contributions to evidence-based practice and research? Ethical issues relating to vulnerable groups, risk distribution, quality issues, research integrity and oversight are just as important. Internationally funded
    research including clinical trials must be sensitive to such issues to avoid allegations of exploitation. Thus the potential of utilisation and buy-in of research findings and recommendations must be considered.
  15. Mak JW
    MyJurnal
    Developing and adult worms of the human lymphatic filarial parasites (Wuchereria bancrofti,
    Brugia malayi, and Brugia timori) are located mainly in the lymphatic system and occasionally in aberrant sites like subcutaneous and conjunctival cysts. Lymphatic
    pathology ranging from dilatation of lymphatic channels and lymphangiectasia are detected on ultrasonography in apparently healthy, amicrofilaraemic, but filarial antigen positive individuals in endemic areas. Microfilariae are distributed in various organs and may be associated with immune mediated pathology at these sites; tropical pulmonary eosinophilia is characterized by intense immune mediated destruction of microfilariae in the lung parenchyma. In the spleen and other sites, nodular granulomatous lesions can occur where microfilariae are trapped and destroyed. The finding of Wolbachia endosymbionts in all stages of lymphatic filarial parasites has provided new insight on the adverse reactions
    associated with anti-filarial chemotherapy. Inflammatory molecules mainly lipopolysaccharide (LPS)-like molecules released from endosymbionts on death of the
    parasites are largely responsible for the adverse reactions encountered during anti-filarial chemotherapy. Prenatal tolerance or sensitization to parasite derived molecules can immune-modulate and contribute to both pathology and susceptibility/resistance to infection. Pathological responses thus depend not only on exposure to filarial antigens/infection, but also on host-parasiteendosymbiont factors and to intervention with antifilarial treatment. Treatment induced or host mediated death of parasites are associated with various grades of inflammatory response, in which eosinophils and LPS from endosymbionts play prominent roles, leading to death of the parasite, granulomatous formation, organization and fibrosis. The non-human primate (Presbytis spp.) model of
    Brugia malayi developed for the tertiary screening of anti-filarial compounds has provided unique opportunities for the longitudinal study of the pathology associated with lymphatic filariasis. The pathology in this non-human primate model closely follows that seen in
    human lymphatic filarial infections and correlates with clinical evidence of lymphatic pathology as detected with ultrasonography. These studies also show that successful treatment as detected by loss of motility and calcification of worms on ultrasonography is associated with reversal of early dilatations of lymphatic channels.
  16. Kow, Ren Yi, Dhiauddin Hai Ismail, Jamaluddin Shafie, Ruben Jaya Kumar, Nor Hafliza Md Salleh, Low, Chooi Leng
    MyJurnal
    Marjolin’s ulcer is a malignant cutaneous ulcer
    that undergoes transformation from a previously
    traumatized or chronically inflammed skin.1 Causes
    leading to ulcerations can be burn injury, trauma,
    chronic osteomyelitis and varicose ulcers.2 It is named
    after a French surgeon, Jean Nicolas Marjolin, who
    first described the condition in patients who developed
    malignant ulcers from burn scars.3 We report a case of
    a chronic non-healing foot ulcer that has become a
    Marjolin’s ulcer after 12 years. (Copied from article).
  17. Ren Yi Kow, Zamri Ab Rahman, Ruben Jaya Kumar, Zaharul Azri Mustapha@Zakaria, Low, Chooi Leng
    MyJurnal
    Femoral nailing is the overall “gold standard” in
    treating femoral shaft fractures. However, plate
    osteosynthesis at the femoral shaft is still being done
    in selected patients. We report a case of right femoral
    implant failure after a broad limited contact dynamic
    compression plate (LC-DCP) insertion and its
    subsequent management using our minimally invasive
    technique. Our technique is biologically compliant
    as well as cosmetically friendly. We converted a loadbearing
    implant into a load-sharing implant in view that
    obesity is a significant predictive factor of non-union in a
    femoral fracture treated with locking plate. The patient
    subsequently recovered well with no complication.
  18. Lim, Swee Geok, Low, Chian Yi
    MyJurnal
    Introduction: Perioperative care is nursing care provided
    by perioperative nurses to surgical patients during the
    perioperative period. Its role is important as patients
    especially those who had undergone coronary artery
    bypass graft (CABG) surgery encounter high levels of
    psychological and physical stress.

    Objective: To determine the needs of CABG patients
    throughout the perioperative period and how well those
    needs were met.

    Methods: This is a cross sectional descriptive survey.
    A total of 88 patients who had undergone coronary
    artery bypass graft were recruited through census
    sampling. The instrument which was adapted and used
    with permission for this study was “Survey of Patient
    Needs and Experiences during the Perioperative Period’
    questionnaire (Davis et al., 2014).

    Results: The patients perceived the perioperative
    needs in the post-anaesthesia care unit area to be the
    most important (M = 2.89, SD = 0.06). Perioperative
    needs which were rated the highest for each of the
    four time periods were “Having information about the
    surgical procedure itself”, “Having your family member
    or significant other with you in the pre-surgical area
    complications”, “Being treated with respect and with
    dignity by hospital personnel” and “Having your family
    member or significant other visit you in the recovery
    room”. Overall, patients perceived their needs during
    perioperative period to be partly met (M = 2.73, SD =
    0.07) with post-anaesthesia care unit area being rated
    the highest (M = 2.81, SD = 0.06).

    Conclusion: The results of this study highlighted the
    perceived needs of patients undergoing coronary artery
    bypass graft surgery throughout their perioperative
    period. In order to improve the quality of perioperative
    care for patients, nurses need to take into consideration
    the important needs identified by the patients and
    address the items which were not meeting the needs of
    the patients.
  19. Looi, Collin Seng-Kim
    MyJurnal
    Background: To assess the effect of cement vertebroplasty on the activity of daily living of elderly patients who have sustained a vertebral osteoporotic fracture.
    Patients and Methods: Seven patients with clinically significant and radiologically proven osteoporotic vertebral compression fractures suitable to be treated with percutaneous cement vertebroplasty were recruited. Evaluation was based on pre- and postprocedure activity by clinical documentation (including interview) and by a self-developed questionnaire (including quality of life).
    Results: Following the procedure, 54% of patients resumed their activities of daily living with minimal pain while 46% of patients were able to do so without any pain (p
  20. Lokman Hakim Sulaiman
    MyJurnal
    Dengue is the most rapidly increasing arthropodborne
    disease globally. The disease burden has increased
    exponentially, doubling almost every decade from the
    estimated 8.3 million cases in 2010 to about 58.4 million
    cases in 2013.1
    The number of countries reporting
    dengue has also increased. Before 1970, less than 9
    countries reported dengue but now it has been reported
    in more than 100 countries worldwide. It is transmitted
    by two species of Aedes mosquito, Aedes aegypti and Ae.
    albopictus. (Copied from article).
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