Background: Peer assessment has been shown to complement both formative and summative evaluations in education and used in some medical programmes. The study was aimed to find correlation between group work peer assessment score and final examination mark among four batches of International Islamic University Malaysia (IIUM) first year MBBS students.
Method: A set of four questions was constructed and tested to assess students’ overall role in their group research project. The difference in distribution according to years was tested by using one-way ANOVA or Kruskal-Wallis, depending on the data distribution. Pearson correlation coefficient test was done to test the linear association between peer score and final examination mark. Partial correlation test was used to adjust the correlation for four academic years.
Results: From the analysed data of 502 students, there was moderate, significant positive correlation (0.366) between peer assessment score and the final examination mark (P < 0.001). Adjustment to the academic years resulted in correlation coefficient of 0.371.
Conclusion: The results provide an important insight on the influence of peers’ perception in predicting the medical student academic performance.
Muslim doctors are those qualified doctors who practise their professional knowledge and skills in line with Islam and upholds the highest standards of ethical and professional behaviour. The medical curriculum of the Faculty of Medicine and Health Sciences of Universiti Sains Islam Malaysia (USIM) was designed with the integration of Islamic input which aims at producing doctors who are able to practise medicine that is integrated with Islamic, moral and ethical values. Halaqah Studies and Fundamental Islamic Knowledge (FIK) courses such as History of Medicine in Islam, Science and Medicine in Quran and Sunnah, Akhlak and Tasawuf, Islamic Jurisprudence and Medical Ethics and Fiqh Issues are taught to students during the pre-clinical and clinical phases. Memorization of selected Quranic verses throughout the programme aim to get the students to apply the verses of the al-Quran into practice in everyday life and especially in their clinical practice. Islamic values are emphasised during doctor-patient interactions in all clinical postings. Islamic knowledge and values integrated in the curriculum are assessed in written and clinical examinations. The outcome of the integration of the Naqli component in the medical curriculum has been demonstrated positively by the students in the patient management problems and clinical consultations. Studies on the outcome of the integrated Islamic input in the medical curriculum among the clinical students and graduates are being carried out.
Introduction: Auditory hallucination (AH) is often unexplored in depth in clinical practice. This study sought
to ascertain the relationship between AH, depressive symptoms and quality of life (QOL) and its association
with socio-demographic and clinical variables.
Methods: This was a cross sectional study done in a
psychiatry unit involving 60 schizophrenic patients between 18 to 60 years old. Psychotic Symptom Rating
Scale – Auditory Hallucination subscale (PSYRATS-AH), Calgary Depression Scale for Schizophrenia (CDSS)
and World Health Organization Quality of Life-Brief scale (WHOQOL-BREF) were used as instruments.
Results: Alcohol intake was found to be significantly associated with the severity of AH. A significant
moderate positive correlation was found between AH total score and CDSS (r=0.53, p
Background: Morbidity post hepatectomy still remain persistent throughout decades compared to other
surgery. Modern approach have been introduced to improve safety and reduce morbidity whilst at the same
time enhance patient recovery. Thus, enhanced recovery after surgery or fast track recovery program for
liver resection was initiated.
Objective: The aim of this study was to achieve discharge by postoperative
day 3 for minor resection and day 5 for major resection.
Design and Setting: This is a prospective study
conducted in Hospital Universiti Kebangsaan Malaysia (HUKM) from September 2014 till April 2015.
Material
and Methods: All patients undergoing open liver resection were included in the study. They were then
managed post operatively according to ERAS protocol that was drawn up based on previous studies. Patient’s
demographics data, intra operative parameters, postoperative complications and adherence to
postoperative recovery protocol were recorded.
Results: Seventeen patients (7 major and 10 minor
resection) were recruited. The mean length of hospital stay for minor resection was 5.9 and major resection
was 9.6 .With regards to the targets, 4 out of 10 (40%)patients in minor resection group and 4 out 7 (57.1%)
in the major group were discharged on time. 9 patients had postoperative complications with no mortality
recorded. In terms of the ERAS protocol targets, the PCA morphine discontinuation target was achieved in
15 patients (88.3%) ,nasogastric tube removal (13 patients -76.5%) , urinary cathether removal (6 patients -
35.3%), abdominal drains removal (9 patients-52.9%) and resumption of full diet was achieved by 82.4% (14
patients).
Conclusion: From these overall achievement, most of our targets have been met and this shows
that our ERAS protocol is safe to be applied to patient undergoing hepatectomy.
Limitations: Some patients
had achieved their target but not discharged for unknown reason.
Introduction: According to the Youth Behaviour Risk Factor Surveillance (YBRFSS, 2011) in Malaysia, the prevalence of smokers nationally among Form 1, 2 and 4 students government secondary school students was 9.1% (ever smokers) and 8.7% (current smokers). However, there is limited information on the prevalence of smoking among religious secondary school students and self-esteem as risk factor. Thus, this study was conducted to determine the prevalence and factors associated with smoking among the religious secondary school students in Petaling district, Selangor.
Methods: A cross-sectional study was conducted among 899 students. The schools were selected using cluster sampling and self-administered questionnaire was used. Data was analyzed using chi-square test and multivariate logistic regression to identify the independent factors for smoking.
Results: The response rate was 94%. The prevalence of ever smoking was 10.1%; 3.9% among female and 18.6% among male. The median age (interquartile range) of smoking initiation was 12.00 (4.01) years. The results showed that independent factors for smoking were: males (OR= 5.47); age group 14-15 years (OR=2.82) and 16-17 years (OR=3.63) and having low self -esteem (OR=6.24).
Conclusion: prevalence of ever smokers is higher when compared to YBRFSS, (2011) and it was revealed that most of the smokers started smoking even before secondary school. The results also revealed the importance of promoting self-esteem. Efforts in smoking prevention should therefore be focused on curbing the initiation of the acts and improving students’ self-worth.
Introduction: The aim of this study is to determine the most common organisms isolated in diabetic foot infection and the most utilised antibiotic regimes as the first line of treatment.
Methods: This is a retrospective record review of the National Orthopaedic Registry Malaysia among diabetes mellitus type 2 patients who had foot infections. All identified cases admitted to 18 government hospitals in Malaysia from the 1st January 2008 until the 31st December, 2009 were included in the study.
Results: A total of 416 patients were included in the study. The most common organisms cultured were Proteus species (17.5%), Klebsiella species (17.1%) and Staphylococcus aureus (17.9%), while the most commonly used antibiotic was ampicillin/sulbactam (67.5%). None of the patients was appropriately treated with metronidazole, cefoperazone or fucidic acid. All patients were given appropriate antibiotics to treat Serratia infection.
Conclusion: Significant number of patients with diabetic foot infections were not treated using appropriate antibiotics as the first line treatment.
The development of treatment strategies for periodontitis that maximise the
effectiveness of antibiotics is highly desirable. Azithromycin is proving to be an effective antibiotic
for treatment of refractory periodontitis which works by binding to the outer membrane of Gramnegative bacteria and subsequently inhibits protein synthesis. Lactoferrin is a membrane-active
host antimicrobial protein and so the objective of this study was to determine whether the effect
of azithromycin (AZM) against example periodontopathogens (Porphyromonas gingivalis and
Tannerella forsythia) could be potentiated by lactoferrin. (Copied from article).
Introduction: Despite general acknowledgement of the importance in assessing family needs in critical care
patients, there is no psychometric instrument to measure the family needs within Malaysian settings. This
study aimed to perform factorial validation and establish psychometric properties of Malay translated
Critical Care Family Need Inventory (CCFNI-M) for Malaysians. Methods: This study consisted of four
protocols: Forward-Backward translation, validity, internal reliability and inter domain correlations phases.
The factorial validation of the CCFNI-M was based on its administration to 109 family members of critical
care patients admitted to the Intensive Care Unit of Hospital Universiti Sains Malaysia, Kelantan, Malaysia.
At validity phase, factorial validation was performed using Exploratory Factor Analysis using Principal
Component Analysis with Varimax rotation. The internal consistency and inter domain correlations were
calculated using Cronbach’s alpha and Pearson correlation coefficient respectively. Results: Preliminary
analyses reported the suitability of data for factorial validation. With reference to the original CCFNI, five
factors were extracted which explained 49.4% of the total variance. After removal of several items for
different reasons, the final items in CCFNI-M were 42. The internal consistency values for five dimensions
ranged from 0.72 to 0.87 with inter domain correlation values (r) among the dimensions ranged between
0.36 and 0.61. Conclusion: The high measures of factorial validity, internal consistency and inter domain
correlations values of the CCFNI-M make it suitable measure for assessing the family needs of critical care
patients.
Oral health care during pregnancy is greatly important as it is crucial to the health
and well-being to both pregnant mother and baby. Studies showed that mothers with oral health
problem have greater risk of prematurity and low birth weight babies. This study aimed to measure
the associated factors of oral health problem among pregnant mothers. (Copied from article).
Background: With increasing number of dengue cases in Malaysia, it’s of utmost importance that immediate
action be taken to limit the epidemic. Since dengue control is a behavioral problem, the knowledge,
attitude and practice in population needs to be studied in order to control the disease. Hence, the aim of
this study is to assess knowledge, attitude and practice regarding dengue and its associated factors among
adult residents of Felda Sungai Panching Timur (SPT), Kuantan, Pahang, 2014.
Method: A cross sectional
study was carried out involving 265 adult respondents. A face to face interview questionnaire which was
divided into 2 parts (Part A: Sociodemoghraphic; Part B: Knowledge, Attitude and Practice) was used. Data
was analyzed using descriptive statistics, simple and multiple logistic regression.
Results: 53.2% of the
respondents had good knowledge about dengue and it was found that the main source of information from
mass media (76.6%). However, only 43.4% were found to have good attitude towards dengue. Multiple
Logistic Regression analysis showed there was no association between sociodemographic characteristics with
the level of knowledge and attitude towards dengue. There was also no association found between
knowledge of dengue and the attitude of the respondents towards dengue. Descriptive analysis on the
practice of dengue showed majority of the respondents who had possible breeding site for Aedes mosquitos
(water container, drains/gutter roof/flower pots/tires) in their compound practiced good habit in
preventing the Aedes mosquitoes from breed.
Conclusion: Although knowledge and practice towards dengue
is good, their attitude require improvement.
Temporomandibular joint dysfunction (TMD) is regarded as multifactorial in origin
and this may influence the diagnosis and treatment plan. Early detection of TMD with suitable
management may provide good response. This study was to relate demographic factors, signs and
symptoms, diagnosis, stage of detection and treatment modalities on review outcome. (Copied from article).
Traditional medicine which includes Islamic faith healing centre is still an important place to seek treatment whether for psychiatric reasons or others. This study aims to determine the prevalence of psychiatric illness among attenders of an Islamic spiritual healing centre and to understand patients’ illness attribution and their religiosity.
Runt-related transcription factor 2 (RUNX2) plays important roles in osteoblast
differentiation, tooth development and chondrocyte maturation; hence its involvement in
craniofacial development is paramount. Mutation in RUNX2 is implicated with cleidocranial
dysplasia; a bone development disorder, while single nucleotide polymorphism (SNP) in RUNX2 is
associated with Class II/2 malocclusion. This study aimed to determine RUNX2 SNP of DNA marker
(rs6930053) in malocclusion patients from local population. (Copied from article).
Neck abscess is still common in developing countries. Often the presentation is late especially when the pain becomes intolerable or the airway is compromised. Intramuscular abscess in the neck is very rarely encountered. We report a case of an abscess of the right sternocleidomastoid. The culture grew Proteus mirabilis. The outline of management is discussed.
Pterygium is a common external eye problem. It is more frequently seen in tropical areas regions where exposure to ultraviolet sunlight is high. Clinically, a pterygium is a wing shaped fibrovascular growth arising from the bulbar conjunctiva onto the superficial cornea. Complications of pterygium include decreased in visual acuity, dryness, foreign body sensation and persistent redness. Surgical management is the mainstay of treatment for this condition. Numerous surgical techniques have been described in the treatment of pterygium. They include the bare sclera technique, simple direct conjunctival closure, rotational conjunctival graft and conjunctival autograft. Additional treatment to some of these techniques may include the use of beta particle therapy and antimetabolite therapy. Despite the wide range of surgical procedures described for its treatment, the main concern from these procedures has been the recurrence, which could be as high as 30% to 70%. Recurrent pterygium is often accompanied by increased conjunctival inflammation and accelerated corneal involvement. Repeated surgical procedures often only worsen the situation, as loss of conjunctival tissue and scarring can result in obliteration of the fornices and mechanical restriction of extraocular movements, with clinically significant diplopia. In Hospital Tengku Ampuan Afzan, pterygium excision is the most common surgical procedure after cataract extraction. We reviewed patients who had undergone pterygium surgery in HTAA in order to determine the most effective surgical method that could minimize recurrence. PURPOSE: To compare success rates of various excision techniques performed for primary and recurrent pterygium in Hospital Tengku Ampuan Afzan, Kuantan, Pahang.
METHODS: The outcome of 47 cases of pterygia (44 primary and 3 recurrent) excised with various techniques between January 2004 to September 2004 was retrospectively reviewed. Six clinical specialists and four trainees performed the surgical procedures. Outcome was evaluated in terms of recurrence of pterygia onto the cornea. RESULTS: The mean follow up was 3.04 months (range, 1-7 months). All pterygia were morphologically graded as intermediate or fleshy type except one. Four types of pterygium excision techniques were performed. Twenty-four cases had bare sclera, seventeen cases had conjunctival autograft transplantation, six cases had direct conjunctival closure and one had amniotic membrane transplantation done. Recurrence of pterygia occurred in thirteen eyes. Twelve cases from primary pterygia group and one case from recurrent group recurred. Recurrence rate was noted to be higher in direct conjunctival closure (4 out of 6 cases) and lowest in conjunctival autograft transplantation (2 out of 17 cases). Recurrence rate for bare sclera technique was noted to rank second in this study (6 out of 24 cases). In five cases of recurrence, subconjunctival tissue invasions were more than 1 mm but further surgical interventions were not needed at the time of this review was done. CONCLUSIONS: Conjunctival autografting was found to have less recurrent rate when compared with other techniques. The bare sclera technique was quoted to be associated with higher recurrence rate in other literatures. Interestingly in our series, recurrence rate for direct conjunctival closure technique was higher when compared to the former technique. This may be related to inadequate excision of pterygia tissue, which led to direct apposition of abnormal tissue to the cornea in the direct conjunctival closure technique. Even though the bare sclera technique is associated with a higher recurrence rate, it is still the preferred excision technique. This could be because it is less time consuming and technically easier to perform. Based on this study, conjunctival autografting should be the surgical procedure of choice for pteryigum in order to minimise the risk of recurrence.
Replacement therapy for toxoplasmosis was not a clear-cut choice since most of anti-parasitic agents available are also associated with Steven Johnson Syndrome. Further more the therapy has to be effective to control infection, which was previously achieved by oral Fansidar in this patient. Oral Azithromycin was seen as a drug of choice for these reasons. Corticosteroids were maintained since it was relatively indicated in both toxoplasmosis and SJS. Both conditions can results in visual impairment. SJS can be a life threathening condition and its ocular complications include conjunctivitis, ectropion or entropion, symblepharon, vascularization of the cornea, chronic dry eyes, and ankylosymblepharon. Proper management in dealing with both diseases is mandatory in order to prevent mortality and minimize the ocular complications. It has been shown in this case that the challenging part in managing patient with both diseases is to balance out between prevention of fatal consequences and the need control to the infection and preserving vision. Decisions on medical treatment for both conditions will remain controversial till reliable prospective randomized control trials are done to address the issues
We present a case of a 45-year-old female who presented with blurring of right vision associated with constitutional symptoms. Examinations revealed right optic disc swelling with inferior exudative retinal detachment and hepatomegaly. Gynaecological examination showed a fungating cervical mass. Histopathological reports of cone biopsy confirmed the presence of large B cell non-Hodgkin lymphoma. HIV screening was positive. A diagnosis of HIV related lymphoma was made. Chemotherapy and antiretroviral treatment were instituted. The ocular signs resolved. However, the patient could not tolerate the side effects of medical therapy and opted for palliative treatment.
Distraction osteogenesis allows superior skeletal advancement compared to conventional surgical osteotomy. It can be considered as a reliable and predictable surgical procedure and is widely used to correct the craniomaxillofacial bone discrepancy. Nevertheless, the outcome is technically dependent and requires comprehensive peri-operative assessment, preparation, and precision in application. The objective of this study is to highlight some important technical issues in distraction osteogenesis when the technique is indicated in various craniomaxillofacial regions and at the same time to discuss the options of preventing and overcoming these technical complications based on our experience and relevant literature. Important technical issues on the application of distraction osteogenesis in 5 different craniomaxillofacial regions were selectively highlighted based on the completed cases in one centre. Potential complications and its prevention methods were documented and discussed. The 5 highlighted regions of craniomaxillofacial distraction osteogenesis were alveolar, mandibular, cleft maxilla, craniofacial and facial cleft. Technical issues and complications were mostly device related and associated with anatomical limitations and surgical technique. Nevertheless, these complications are preventable and can be appropriately managed. From the literature and our experience, the technical aspects vary according to its application in different craniomaxillofacial regions. Preventing the potential complications contribute to the success of its application. This article also discussed the concept of Ihsan application in the medical field, to achieve the best of treatment in terms of delivery and technical preparation for the patients.
Neer first popularised the use of primary hemiarthroplasty to treat complex proximal
humerus fractures, especially when the humeral head is nonviable or not
reconstructable with internal fixations, and with younger patients. (Copied from article).
Background: (13) C – urea breath test (UBT) is sensitive and specific for detection of Helicobacter pylori (H. pylori) infection. Gastric biopsy culture for H. pylori confirms the diagnosis. Here, we analyzed data of all patients who were investigated for H. pylori infection using both tests throughout the year 2005. Materials and Methods : Retrospective data of 377 patients between the ages of 17 – 88 were identified through endoscopy records from January to December 2005. Upper endoscopy, UBT and gastric biopsy culture were performed on all patients simultaneously during each endoscopy session. Patients who had positive UBT and biopsy culture for H. pylori were treated with triple therapy of PPI, amoxicillin and clarithromycin for one week. A repeat of UBT was done at one-month post therapy. Results and Analysis: Twenty-eight patients on the list had no available data on UBT and were omitted from the analysis. Ethnic group Chinese comprised of 45.4% (n=163), followed by Malay, 37.3% (n=134), Indian, 10.6% (n=38) and others, 3.9% (n=14). UBT was positive in 23.7% (n=85)(figure1). H. pylori culture was positive in 19.2% (n=69)(figure1). Sixteen patients with UBT positive had H. pylori culture negative, 18.8% (n=16/85)(figure2). Five patients with H. pylori culture positive had UBT negative, 7.2% (n=5/69)(figure3). Ethnic group Indian had the highest incidence of UBT positive, 47.4% (n=18/38), followed by Others (Sikhs and foreigners) 42.8% (n=6/14), the Chinese 27.6% (n=45/163) and the Malays 11.6% (n= 16/138). UBT positive was the highest in the age group of 50 and above, 64.7% (n=55/85), followed by the age group between 30 to 49, 21.2% (n=18/85) and the age group of 29 and below, 14.5% (n=12/85). Out of the 85 UBT positive patients 91.8% (n=78/85)(figure4) of them responded to the conventional one week of triple therapy (PPI, amoxicillin, clarithromycin) with negative UBT at one-month post therapy compared to only 8.2% (n=7/85)(figure4) who failed with positive UBT at one-month post therapy.