Rapid rural appraisal (RRA) is a systematic but semi-structured study used to gain new insight into rural life in a quick manner. The current article describes the RRA conducted in a remote village in Lahad Datu, Sabah. The RRA aimed to address the background of the rural community and identify public health issues. Collection of secondary data, key informants’ interview, field observation and a structured interview with the villagers selected via convenience sampling were applied to obtain necessary data. Findings from informal approaches were summarised. Descriptive analysis was carried out for data collected from structured interview. Water sanitation, sanitation facility, food safety, air pollution, zoonosis and non-communicable diseases were among the potential public health issues identified within the village. A total of 188 villagers participated in the structured interview. The median age was 28.0 (IQR 30.8). The percentage for manual workers were 21.3% while 13.8% were white collars. The illiteracy rate was 12.2% and the poverty rate at 48.9%. A total of 22.3% of respondents reported overcrowded households. The household environment and take-up rate of basic amenities were suboptimal. The highest self-reported chronic disease was hypertension, recording 13 cases. The foremost priority is to fill up the flaws in the public health needs of the villagers. Those challenges require participation from relevant authorities as well as individual empowerment
Rapid Stroke is a common clinical problem. Stroke can be broadly divided into ischaemic and haemorrhagic stroke. Ischaemic stroke can be further classified by TOAST classification into large-artery atherosclerosis, cardioembolism, small vessel occlusion, the stroke of other determined aetiology and stroke of undetermined aetiology. Importantly, we need to be wary of important stroke mimics such as brain tumour, demyelination, intoxication as they can lead to changes in clinical management. Here, we would like to illustrate a case of meningioma which clinically mimics a stroke. This patient is a 78-year-old lady who initially presented with sudden onset right-sided body weakness associated with slurred speech and facial asymmetry. An urgent plain computed tomography (CT) of the brain showed hypodensities at the left middle cerebral artery territory. However, re-evaluation noted her to have a normal Glasgow Coma Scale without any cortical signs, cerebellar sign or dysphasia. In view of these, stroke mimics was suspected. A contrasted CT brain was done which confirmed the diagnosis of meningioma. She was offered surgical intervention for meningioma but she was not keen on it. In conclusion, this case highlighted the importance of clinical evaluation in recognising stroke mimics
Multiple carpometacarpal joint (CMCJ) dislocations are rare and are easily missed. The anatomical configuration renders stability to the joints. As a result, a high-velocity impact is required to dislocate the joint. We present two cases of multiple carpometacarpal joint dislocations with different mechanisms of injury and their subsequent management at our centre. In case 1, a 29-year-old gentleman presented with acute dislocations of the CMCJs involving the right middle, ring, and little fingers. An open reduction and fixation with Kirschner wires were done to stabilize the dislocated CMCJs and he subsequently recovered. In case 2, a 25-year-old gentleman had the CMCJ dislocations detected late due to other more profound injuries. Partial arthrodesis was performed to address the instability of the CMCJs of the right index, middle and ring fingers. He subsequently recovered and returned to work 6-months postoperatively. The diagnosis of carpometacarpal joint dislocation can be easily missed especially when there is a concurrent distracting injury. It is crucial to maintain a high index of suspicion as early diagnosis and prompt treatment is paramount to yield a better outcome
Since the COVID-19 pandemic, Taiwan reported a total of 776 cases of COVID-19 (Dong et al., 2020) in comparison with its neighbouring countries, Japan and the Philippines which reported 210,769 and 465,724 cases of COVID-19 respectively, until 24 December 2020. Looking at the curve of the COVID-19 pandemic among various countries, Taiwan had indeed distinguished herself and stood out considering her well-contained COVID-19 infection despite it being a widespread infection in other countries.
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.
Children’s occupational performance are activities of daily living, play/ leisure, social participation, education, and work. In developed countries, school-based therapy services are being provided for schoolchildren with special needs. The importance of these services in Malaysia is timely to be explored. This exploratory cross-sectional study identified occupational performance levels of primary schoolchildren with special needs in integrated special education programmes in Malaysia; children with intellectual disability, autism, attention deficit hyperactive disorder, Down syndrome, speech impairment, visual impairment, hearing impairment, and specific learning disorder. Researchers conducted Motor-Free Visual Perceptual Test Third Edition (MVPT-3), Beery-Buktenica Developmental Test of Visual-Motor Integration Fifth Edition (Beery-VMI), Test of Gross Motor Development – 2 (TGMD-2), Test of Hand Writing Skills-Revised (THS-R), and School Function Assessment (SFA) for 121 students. Results showed that 69.5% of the students scored very low to low average in MVPT-3 (median standard score = 70.0, Std. IQR = 37); 69.4% were very low to below average in Beery-VMI (mean standard score = 78.8, Std. deviation = 20.5); 73% were below age level raw score in TGMD-2; 72.8% were below average in THS-R (median standard score = 74.0, Std. IQR = 27.0); and 81% were below the criterion cut-off in school function. The children with below-normal MVPT, VMI, TGMD2, and THS scores, compared to the children with normal scores for these tests had significantly lower scores (p < 0.001). All the students had impairment in occupation performance at least in one area. This study recommends school-based occupational therapy and other rehabilitation services in the school system in Malaysia.
Malaria is a major public health problem in tropical and subtropical areas, caused by five
species of Plasmodium (P. falciparum, P. vivax, P. malariae, P. ovale andP. knowlesi) and is the leading cause of morbidity and mortality worldwide. We have developed molecular markers for three genes viz, Cytb, dhfr and Msp-1 gene and designed a protocol for rapid molecular diagnostics of the four malaria parasites prevalent in Southeast Asia. The new primers were used on the blood
samples containing Plasmodium parasites by conventional PCR. The result was compared with
the nested PCR of Singh et al. (2004) and the microscopy method. The result shows that the new
set of primers had successfully amplified all four human malaria parasite species. These primers
were 100% sensitive and more specific than microscopy and PCR identification using these
primers was faster than the nested PCR. These alternative primers should provide powerful and
rapid molecular diagnostic method for detecting Plasmodium species as well as providing reliable
data for epidemiology study. These primers have the potential to be combined and used in
multiplex PCR.
Liver, an important organ of metabolism, is damaged when exposed to chemicals, toxins, infectious agents, drugs and food additives. Arachis hypogaea (peanut) being organic may have free radical scavenging activity, which could protect the liver from damage. Objective: To evaluate the effect of Arachis hypogaea on liver marker enzymes such as serum AST(aspertate transaminase) and
ALT(alanine transaminase) and histology of liver in Wistar albino rats. Methods: Twenty healthy Wistar albino male rats (120 – 150 grams, 90 – 120 days old) were acclimatized for 14 days and divided equally into control group (n = 10) and experimental group (n = 10). Control group received standard pellet for 21 consecutive days. The experimental group received peanut powder 500mg/kg body weight/day; orally) mixed with food for the same period. All the animals were killed on 22nd day. Blood and liver samples were collected. Levels of serum AST, ALT and bilirubin were estimated and the liver was processed for histology. Results were statistically analyzed by
2 sample t-test. Results: Final body weights were significantly (p
Foot shape significantly varies with age, sex and ethnicity. Information on gender and racial differences in foot shape is also useful to forensic scientists identifying isolated remains. Literature survey revealed that there are not enough studies on correlation of foot shape with changes in body weight. Hence this cross-sectional and analytical study was carried out to evaluate the correlation of foot shape with changes in body weight within same race and ethnicity. A total number of 110 male medical students of 3rd and 4th year of Bengali ethnicity were chosen through purposive sampling. Foot index was calculated by dividing the foot length with the foot width. On the basis of foot index, foot shapes were classified into slender, standard and broad. Correlation of the foot shape with the body weight was assessed. Both right and left foot indices showed significant negative correlations with the body weight (r = −0.214, p = .033 and r = −0.282, p = 0.005 respectively). This approach of categorization will help in making best fit footwear for males. It will also serve as a baseline data for forensic investigators.
Assessment method of medical students by conducting examination is to identify the quality and quantity of their academic performance. Essay paper is one of the most common assessment tools in the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah. Double marking is a means by which academic staff attempts to produce fair results for the students. Eighty eight medical students sat for three sets of Essay Papers of Professional I examination in March 2012. The double marking on the essay papers was done by two lecturers of each clinical department concerned for each discipline. Inter-examiner agreement and its effect on the reliability of the final score for the students were calculated by using Kappa statistics and Intra-class Correlation Coefficient (ICC). Reliability coefficient of the scores were also calculated for the different disciplines. In Part A essay paper, Cohan’s Kappa was 0.48 (p
Galactorrhoea is non-lactational milk production and it may or may not be associated with prolactinemia1. It causes embarrassment and distress to a schizophrenic patient, especially, if the patient is male. One study in Germany reported that incidence and prevalence of galactorrhoea in schizophrenia are 14% and 19%, respectively2. Although galactorrhoea is not rare in schizophrenic patients, managing and understanding the a etiology can be problematic. In psychiatric patients, antipsychotics can be a cause but other causes need to be ruled out. Galactorrhoea also needs to be differentiated from pathologic nipple discharge which can be due to breast tumours. Usually, galactorrhoea is bilateral, multiductal, and milky, but discharge can be yellow, green or brown3. This case report describes a 32-year old patient with schizophrenia who visited a government psychiatric hospital in Kota Kinabalu, Sabah, Malaysia. This report highlights the clinical challenges to determine the aetiology of galactorrhoea and to manage it in schizophrenics. It raises the following clinical questions: Why a psychiatric patient develops galactorrhoea? How a schizophrenic patient presents with galactorrhoea? What hormonal imbalances are associated with this psychiatric disorder? How should a doctor handle a schizophrenic patient complaining of galactorrhoea? What is the danger of having galactorrhoea in a male?
A 40 year old, Muslim patient was brought to the clinic for his chronic 20-year long problem alcohol drinking habits. He was treated in the nursing home and was further directed to the in house rehabilitation centre. Psychotherapists after counselling sessions after a detailed behaviour analysis arrived at cognitive behaviour therapy combined with electric shock aversion therapy after consent from the patient. Seven sessions of therapy, relieved the alcohol craving habit. Patient’s insight and preparedness to lead an alcohol free family life was the major positive behavioural asset. Electric shock therapy with psycho-education and counselling found to benefit long term alcohol problem behaviour.
The huge population of persuadable, active, healthy and young students is the potential as blood donors to meet safe blood donation. This study focused on the existing level of knowledge regarding voluntary blood donation among medical (Faculty of Medicine and Health Science) and nonmedical students with science background (Faculty of Engineering) at the Universiti Malaysia Sabah. Four hundred and fifty-five students consisting of medical (231) and nonmedical (224) were selected through stratified random sampling to participate in the study. Data was collected using validated structured questionnaire. Statistical analysis was performed by structural equation modelling using SPSS AMOS Graphics version 22 and SPSS version16. The results showed a significant (pp
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.
Both metformin and gliclazide have been used extensively in the management of type II diabetes mellitus. Metformin and gliclazide overdose can lead to severe hypoglycaemia refractory to intravenous (IV) dextrose rescue therapy. A 21-year-old man complained of vomiting and felt dizzy after four hours of taking 70 tablets of Metformin 500 mg and 40 tablets of Gliclazide 80 mg. He had major depressive disorder and wanted to commit suicide. He was given IV Dextrose 50% 50 cc immediately. Octreotide had been used successfully to reverse the refractory hypoglycaemia caused by gliclazide overdose. Unfortunately, he developed severe lactic acidosis with acute kidney injury. Dialysis had been done by continuous venovenous haemodiafiltrationa and intravenous sodium bicarbonate 8.4% infusion was given. However, the patient succumbed due to the severe lactic acidosis and kidney failure despite of urgent dialysis. Octreotide infusion helps in preventing refractory hypoglycaemia secondary to sulfonylurea overdose by inhibit calcium-mediated insulin release. Metformin overdose causes severe lactic acidosis due to conversion of glucose to lactate. Sodium bicarbonate therapy in metformin induced lactic acidosis is also controversial. Though sulfonylurea and metformin are the most commonly-prescribed anti-hypoglycaemic agents, thus during prescribing everyone has to be careful about the overdoses and side effects of these drugs.
Colonic lipomatosis is relatively a rare tumour of mesenchymal origin, composed of welldifferentiated adipocytes interlaced by fibrous tissues. A 59-year-old lady presented with right iliac fossa pain with positive rebound tenderness, Rovsing’s and obturator signs. Investigation revealed marked leucocytosis suggestive of an acute appendicitis. Diagnostic laparoscopy revealed an inflamed appendix with concomitant caecal mass suspecting of a malignancy. Laparoscopic right hemicolectomy was proceeded following oncologic resection. However, final histopathologic examination was consistent with caecal colonic lipomatosis with concomitant acute appendicitis. Hereby, dual pathologies can be elicited in an acute abdomen.
Fat embolism syndrome is manifested by the fat globule presence in the pulmonary and systemic circulation. A 34-year-old man was involved in a motor vehicle accident with a fracture of the left femur and avulsion fracture of the left posterior cruciate ligaments. He developed signs and symptoms that suggested an early diagnosis of fat embolism syndrome. Intravenous methylprednisolone administration was administered as part of the treatment. The role of methylprednisolone in a patient with fat embolism syndrome is controversial due to unproven effectiveness. In this case, fat embolism syndrome after a femur fracture was treated successfully with methylprednisolone.
Learning anatomy is the basic and essential component of medical study when students start to learn in medical career. Since five hundred years ago, the human cadaver has been used as the silent mentor for students in learning anatomy. Later, pre-dissected specimens were used in addition to hands-on dissection of human cadaver. Current advances promote the use of anatomical models as well as plastinated specimens. This study focused on analyzing the preference of students towards different learning modalities available for anatomy teaching. It was conducted on first year medical students at the Faculty of Medicine and Health Sciences, University Malaysia Sabah (FPSK, UMS). A total of 76 students (27 males and 49 females) participated in this study. Out of 76 students, 57 (75%) students preferred using human cadaver for anatomy learning. Four students (5.3%) opted for plastinated
specimen while 15 students (19.7%) chose the plastic model. Knowledge gained in learning Anatomy was said to be easier from cadaver (67.1%), followed by plastinated specimen (35.5%) and plastic models (52.6%). In the present study, 97.4% responded that plastic model was easier to apply their knowledge in objective structured practical examinations. The present study found that using cadaver was still favoured by medical students. Further studies are required to determine the preference between hands-on cadaveric dissections versus pre-dissected specimens.
Escherichia coli (E. coli) is one of the most frequent causes of many bacterial infections especially
gastroenteritis in developing countries. It is also used as an indicator for faecal pollution in the
surveillance of bacteriological quality of drinking water. This study was conducted to determine the
survival of E. coli in water at room temperature (27oC). E. coli which is cultured in Lactose Peptone Broth
was inoculated into 8 bottles each containing 10 millilitres of distilled water. They were kept at 27oC.
Starting from the day 1, ten-fold dilutions were made from each bottle number and E. coli count was
done from each dilutions by using pour plate method. The colony forming unit/ millilitre (CFU/ml) was
calculated. The same procedure was carried out from bottles number 2 to 8 from day 2 to day 8
consecutively. CFU/ml of E. coli in dilution 10-5was markedly decreased from 3.9 x 106
in day 1to 0 in
day 8. The findings suggest that if the water is contaminated with low number of E. coli, it can be
eliminated by keeping water at room temperature for only few days.
Antimicrobial activity of ethanolic extract of Aloe vera were observed against Staphylococcus
aureus, Staphylococcus pyogenes, Staphylococcus saprophyticus, Streptococcus pneumoniae
and Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae . Aloe vera leaf gel
was used for ethanolic extraction.Zones of inhibition in millimeter was used to measure the
antimicrobial effect. Antimicrobial susceptibility test showed that ethanolic extract has growth
inhibitory effects against the tested pathogens. Ethanolic extract of Aloe vera has growth
inhibitory effects against tested pathogen seen by antimicrobial susceptibility testing.