Introduction: Exposure to excessive noise is the major avoidable cause of permanent hearing impairment. Sawmill is one of the workplaces where workers are exposed to hazardous noise level. This study was conducted to determine the reliability and validity of noise-induced hearing loss questionnaire among sawmill workers. Materials and Methods: This cross sectional study was conducted in March 2007 among 35 consented sawmill workers. A total of 40 items; 10 items for knowledge (8 areas), 20 items for attitude (7 areas) and 10 items for practice (2 areas) were assessed. Statistical analysis for reliability analysis was test by internal consistency and construct validity by exploratory factor analysis using principal components and Varimax rotation method. Results: Cronbach’s alpha coeffi cients were acceptable for attitude (0.90) and practice
(0.75). However, it was low for knowledge (0.67). Exploratory factor analysis showed three meaningful exploratory factors that could explain the three dimensions in the questionnaire. Conclusion: The results of the validation study suggested that the noise-induced hearing loss questionnaire is reliable and valid tool for assessing knowledge, attitude and practice among sawmill workers.
Introduction: This study aimed to explore the associated factors related to causes of stress and coping strategies among university students. Materials and Methods: As a focus group discussion, it was universal sampling, conducted among 39 of Medical Science and Biomedicine students on their second semester from Management and Science University (MSU), Shah Alam, Malaysia. Three issues were discussed: firstly, how they define the stress; secondly, what the most important causes of stress in their life are; and thirdly, how they cope with stress. Verbal consent was obtained from all participants. Due to the small sample size, the data was analyzed manually. Results: Total of participants were 39 students, their age ranged from 21 to 26 years. Seventeen (43.6%) of the students were 21 years old and the majority were female 31 (79.5%). The
most important causes of stress reported by the students were financial, lack of sleep, and family problems. In terms of coping with stress, the students were able to describe a variety of strategies to cope with their stressful situations. These included counseling services, doing meditation, sharing of problems, getting adequate sleep, and going out with friends. Conclusion: Most of the students defined stress as “a mental condition”. Lack of sleep, financial, and family problems were the most causes of stress among students. The students were able to identify some strategies to cope with stress.
Introduction: Reduced cerebral blood fl ow is associated with neurodegenerative disorders and dementia, in particular. Experimental evidence has demonstrated the initiating role of chronic cerebral hypoperfusion in neuronal damage to the hippocampus, the cerebral cortex, the white matter areas and the visual system. Permanent, bilateral occlusion of the common carotid arteries of rats (two vessel occlusion - 2VO) has been introduced for the reproduction of chronic cerebral hypoperfusion as it occurs in Alzheimer’s disease and human aging. Increased generation of free radicals through lipid peroxidation can damage neuronal cell membrane. Markers of lipid peroxidation have been found to be elevated in brain tissues and body fl uids in neurodegenerative diseases, including Alzheimer’s disease, Parkinson disease and amyotrophic lateral sclerosis. Materials and Methods: Malondialdehyde (MDA), fi nal product of lipid peroxidation, was estimated by thiobarbituric acid-reactive substances (TBARS) assay kit at eight weeks after induction of 2VO in the rats and control group. Results: Our study revealed a highly signifi cant (p
Introduction: Insulin has been viewed as a treatment option of last resort in type 2 diabetes management. The decision to start insulin therapy is often diffi cult. Patients are usually reluctant to begin insulin and many cases delay the initiation of insulin therapy. The aim of this study is to determine the magnitude of insulin refusal or recognize as psychological insulin resistance (PIR) and to identify its predictors. Materials and Methods: This is a cross-sectional study and data was collected from two primary public health clinics in Kuala Lumpur and Putrajaya. The study sample consisted of 404 insulin naive patients with type 2 diabetes. A self-administered questionnaire was used to obtain demographic and clinical information. Results: Fifty-one percent of patients with type 2 diabetes were found to be unwilling to take insulin. Regression analysis revealed that females were 2.7 times more likely to resist insulin treatment compared to males and those with uncontrolled diabetes were 1.8 times more likely to resist insulin treatment compared to controlled diabetics. Patients will refuse insulin if they perceived their diabetes worsen with insulin use. After controlling for other attitudinal belief factors in the model, an increase in one unit of perceived disease severity will increase the likelihood of PIR around 2 times. Conclusion: Several misconceptions regarding insulin therapy were identified and specifi c education intervention is recommended for successful transition to insulin therapy.
Introduction: Melioidosis, an infection caused by Burkholderia pseudomallei is endemic in South East Asia and Northern Australia. It can affect many organs in the body such as lung, liver, spleen, bone, prostate, brain and soft tissues. Objective: This study aims to detect the presence of prostatic abscess in patients with a positive blood culture for Burkholderia pseudomallei with computed tomography (CT) of the abdomen and pelvis and to correlate it with the clinical presentation. Materials and Methods: This is a prospective observational study conducted in all melioidosis patients who had CT scan of the abdomen and pelvis. The location and size of any focal lesions seen on CT were recorded. Clinical data such as fever and urinary symptoms were also recorded. Results: 15 patients had CT scan of the abdomen and pelvis. Five patients were diagnosed to have prostatic abscess. Out of the five patients, only two had urinary symptoms. The other three had prolonged high grade fever without any urinary symptoms. Conclusions: Melioidosis prostatic abscess is not uncommon in patients with positive blood culture of Burkholderia Pseudomallei (33% in this series). Most patients do not present with any urinary symptoms.
Background: The Medical Faculty of the International Islamic University Malaysia (IIUM) runs an undergraduate medical programme which is a combination of the traditional and the newer trends of medical curriculum. The IIUM curriculum in Phase I (Years 1, 2: preclinical) is integrated organ system based, with lectures being the main method of curriculum delivery and also incorporating problem-based learning (PBL) as one of the teaching-learning approaches. Methods: The aim of this study is to examine the effectiveness of PBL teaching-learning method in IIUM in achieving the aims of the medical school as viewed by the students. A total of 287 students from Phase I and Phase II (Year 3: clinical) participated in this study at the end of academic session 2006/2007. The questionnaires distributed consisted of 33 items with four different aspects of PBL being evaluated namely; i) PBL objectives, ii) assessment of performance of the facilitators, iii) assessment of the PBL packages and iv) preferred teaching-learning approach. Results: An average of 86.4 % of students agreed that PBL sessions achieved its aims of preparing students for professional training in the clinical years. Also approximately 80% of students felt that the facilitators fulfilled their roles as PBL tutors. Students were generally satisfied with the PBL packages prepared. However about 50% of Year 2 students did not look forward to PBL sessions and only about 20% of preclinical students wanted more PBL sessions to be scheduled. This latter finding differed as 60% of the clinical (Year 3) students wanted more PBL sessions to be implemented. A significant proportion of the students also believed that they needed some prior information about the PBL case in question in order to generate lively exchange of ideas in the first sessions. Preclinical students preferred lectured-based approach as compared to PBL in contrast to the clinical (Year 3) students of whom 57% (62) preferred the PBL teaching-learning approach. Nearly 80% of the Year 3 students found the exposure to PBL sessions during their preclinical years beneficial during the clinical year. Discussion: Although our findings supported the effectiveness of PBL as one of the teaching-learning approaches (as perceived by our students) there are a few areas of concern. These include believing that a prior knowledge of the topic in question is needed to generate a lively discussion; the group not being motivated; the group members confining themselves to individual assignments only; PBL not being supportive of on-going self- assessment; the consequence of a facilitator being too dominant; and cases constructed do not reflect real clinical scenarios. Despite agreeing to its effectiveness preclinical students still preferred lecture-based approach to the PBL as they are more confident with the knowledge as obtained through the former learning modality. Conclusion: PBL is an effective learning strategy and it contributes to the teaching-learning process of IIUM undergraduate preclinical medical programme which implements a non-Problem Based Curriculum. We are of the opinion that a combination of lecture sessions and PBL best suit the IIUM medical students.
Background: Historically, more men enrolled in medical schools than women. However, during the last few decades, there has been an increase in the number of women attending medical schools worldwide. Although a similar trend is seen, there is no documentation found in Malaysia. In this present study, we investigated if such gender enrolment differences occurred at our medical school. Methods: Information was obtained from Kulliyyah of Medicine student statistic for 2006/2007 section and graduates from 2001/2002 (1st batch) to 2006/2007. Results: Our study showed that more than half (60%)of our students are female and all students who received distinction in final year exam from 2002 till now are females although the number of males who needed to sit for the supplementary examination outnumbered the females during that period. Discussion: The feminization of medicine in International Islamic University Malaysia (IIUM) was similar to other studies worldwide. Further research should be aimed on comparison of the academic performance of male and female medical students and also choice of specialty chosen by men and women in our university.
Background: The approach to the teaching of ethics and professionalism in the Faculty of Medicine (FM) of International Islamic University Malaysia (IIUM) is unique. A specifically designed package is incorporated designated as the Islamic Input into the Medical Programme (IIMP). The IIMP spans over the entire 5 years of the medical programme. In the Faculty of Allied Health Sciences (FAHS) students do not go through a similar Islamic Input module but exposed to ethical issues specific to health sciences. Method: The aim of this study is to assess the impact of the teaching of ethics through the IIMP. A cross-sectional study was conducted in medical and allied health sciences faculties of IIUM. In total 259 students volunteered and were allocated to 4 groups, Years 2 and 5 students of FM and Years 2 and 4 of FAHS. A set of questionnaire consisting of 20 vignettes related to medical ethics was distributed to all students. An independent t-test was used to compare the mean total scores between the groups. Results: A significant difference (p < 0.05) was seen between the mean total scores for the Year 2 and Year 5 students of FM; Year 2 students of FM and Year 2 students of FAHS; and between the Year 5 students of FM and Year 4 students of FAHS. Also there was significant difference between the two medical and allied health sciences groups as a whole. Discussion: This study suggests that the IIMP of the IIUM has a positive impact on the medical students when dealing with ethical issues. The Year 5 medical students were expected to have obtained a higher mean total score. The probable reason for the lower mean total score include the teaching-learning approach utilized which is mainly lecture with minimal small group approach. Also the allocation of marks for medical ethics in summative assessment in the IIUM medical curriculum is minimal compared to the core medical subjects which would have some influence on the weight given by students. Conclusion: The Medical Faculty of IIUM believes that the approach to the teaching of medical ethics by incorporating the Islamic Input module is effective, practical and relevant. However the teaching-learning method and the assessment will have to be re-addressed to achieve greater impact.
Introduction: With an increase in national nursing shortage, organizational commitment is extremely
important for retention of nurses. This predictive study determines the level of organizational commitment and the predictive ability of perceived organizational support, components of job satisfaction, including pay, task requirement, organizational policies, autonomy, interaction and professional status as well as years of experience on organizational commitment. Method: Data were collected from 416 nurses in four state hospitals in Malaysia, using self-administered questionnaires. The hospitals were selected from each region in Peninsular Malaysia and samples were selected by a random sampling method. Questionnaires, including demographic data, Organizational Commitment Questionnaires, Survey of Perceived Organizational Support,and Index Work Satisfaction were distributed by researcher and research assistants. Stepwise multiple regression technique was used to analyze the data. Results: The results discovered that (1) nearly half of the subjects (48.07%) reported high level of organizational commitment. (2) Professional status, autonomy, interaction, task requirement and years of experience could predict the organizational commitment (ß = 0.52, 0.17, p < 0.01); ß= 0.13, 0.11, 0.09, p < 0.05 respectively). Overall, all predictors explained 33% of variability
in the organizational commitment among nurses in state hospitals. Conclusions: This study found that nurses in state hospitals were highly committed to their organizations. Results of this study provide information for nurse administrators to consider and maintain these factors in nursing practice to foster a high level of organizational commitment among Malaysian nurses.
We report a-56-year old army pensioner who presented initially to a peripheral hospital with acute ST-elevation inferior myocardial infarction thrombolysed with streptokinase. He was subsequently referred to the National Heart Institute (Institut Jantung Negara, Malaysia) for coronary revascularization. Coronary angiogram revealed an ectatic right coronary artery with discrete lesions at the proximal and distal segments stented with bare metal stents (BMS). Post dilatation shots revealed a wire-induced, distal dissection at the posterior left ventricular artery remedied by balloon angioplasty but resulting in balloon-induced crumpling of the distal BMS. We discuss the importance of sequential, distal-to-proximal coronary intervention, stent crumpling and remedial strategies.
Monoamniotic twin pregnancy is a rare type of twin pregnancy which poses risk of cord entanglement and
sudden death of either one or both fetuses. The role of antenatal surveillance by Ultrasound Doppler for
umbilical cord and ultrasonic evidence of cord entanglement or knotting may predict the pregnancy outcome
but yet unavoidable. The discussion will include antenatal surveillance in this rare type of pregnancy.
Introduction: The study was conducted to look for the effects of polycythaemia on Glycosylated Haemoglobin (GHb) levels and to the see the correlations between the levels of haemoglobin, GHb, blood glucose, and lipid profi les including Atherogenic Index of plasma (AIP), in type 2 diabetics living 5800ft above sea level at Gangtok in Sikkim, India. GHb is used to predict the risk of long term complications of Diabetes mellitus (DM) like coronary artery disease (CAD). Materials and Methods: The study group consisted of Group I (Type 2 DM male patients with PPG levels 200mg/dl) and age matched healthy males formed the control group. Results: In Group I, GHb levels correlated positively with AIP, but not with TC/HDL-C ratio. In Group II, both PPG and GHb levels correlated positively with Total cholesterol (TC), LDL Cholesterol, TC /HDL-C ratio and AIP. This shows that higher PPG levels are associated with more Atherogenic lipid profi les. Study also showed higher GHb levels in controls at 7.61%, and correlated positively with postprandial glucose (PPG) levels (r = 0.92). Conclusion: In predicting risk for future CAD, PPG levels and AIP can be used as an adjunct parameter.
A 43-year-old man presented with acute extensive anterior ST-segment elevation myocardial infarction. During coronary angiogram, a segment of myocardial bridging was noted in the mid-segment of left anterior descending artery. The association of myocardial bridging and an anterior ST segment elevation is rarely reported in the medical literature. Myocardial bridging is caused by systolic compression of a coronary artery by overlying myocardium tissue. It is a rare coronary artery anomaly, which usually has a benign prognosis despite some case reports of myocardial ischemia leading to myocardial infarction, lethal arrhythmias and sudden cardiac death. We report one such case of myocardial bridging that was complicated with acute extensive anterior myocardial infarction.
Hepatic adenomatosis is a rare, benign tumour of the liver. It was first described by Flejou et al as multiple adenomas in an otherwise normal liver parenchyma. Although benign, it can present as a diagnostic
challenge because the lesions can be diffi cult to distinguish from other hepatic tumours. Patients can be
asymptomatic and the diagnosis may only be made incidentally. We describe the case of 40-year-old Malay lady who was incidentally found to have hepatomegaly. Radiological examinations revealed a complex left ovarian cyst with multiple liver lesions. Biopsy of the liver lesion showed features of hepatic adenomatosis. Literature review was done and the dilemma in managing her was discussed.
Glaucoma is a major cause of permanent visual loss in patients with sarcoid uveitis.In this case glaucoma occurred early in the course of the disease and IOP started to rise up after one month from the initial presentation. Uveitic glaucoma can be extremely difficult to treat; pilocarpine is not normally used in eyes with active inflammation. Patients with uveitis respond poorly to laser trabeculoplasty, and filtering procedures usually fail. Success of modified goniotomy, trabeculectomy and Molteno valve implantation were reported. More drastic therapy, such as cyclodestructive procedures, may be required in the most severe cases. In this case the challenge in preserving the vision. by keeping the balance between the need to control the inflammation and the necessity to avoid the treatment related complications.
Meningiomas with intracranial haemorrhage is a rare occurrence and carries a high mortality rate. We present here a case we encountered, where intratumoural, subdural and intraventricular haemorrhage occurred. The pathophysiology and mechanism of intracranial tumoural haemorrhage, is discussed.
Introduction: In the past, patients with previous abdominal surgery were discouraged from laparoscopic surgery because of perceived increased risk of bowel injury caused by needle and trocar insertion. However, data on the feasibility and safety of surgery of this nature is increasing. We aim to evaluate the surgical outcome of laparoscopic ovarian cystectomy/oophorectomy in previous abdominal surgery. Methods: This is a cross-sectional study with descriptive analysis of retrospective data collection from the electronic medical records of women with laparoscopic ovarian cystectomy/ oophorectomy from January 2000 until Dec 2008. Results from patients with previous abdominal surgery were compared with those of women without prior abdominal surgery. Results: Three hundred and seventeen (317) laparoscopic cystectomies/ oophorectomies were performed during the study period. 71 patients (22.5%) had previous history of abdominal surgery. Adhesions were found in 72% of patients versus 40% (p=0.001) who had previous abdominal surgery but the conversion to open surgery rate was similar (3%, p < 0.05). There was no significant difference in blood loss (134.1 ml ±18.6 vs 119.0 ml ± 9.5), operating time (107 min ± 42.0 versus 102.6 min ± 42.6) and postoperative hospital stay (1.92 days ± 1.0 vs 1.91 days ± 0.7 ). The incidence of peri-operative and post-operative complication showed no significant difference in those who had undergone previous abdominal surgery than those without prior abdominal surgery (p=0.7). The overall complication rate in this series was 0.32 %. Conclusion: Laparoscopic cystectomy/ oophorectomy in the previous abdominal surgery is safe with no increase in morbidity.
Introduction: There is an increasing trend in smoking among rural adolescents compared to urban adolescents in Malaysia. This study was to determine the relationship between religious personality and smoking among form two students from the rural schools in Malacca. Methods: This was an unmatched case-control study conducted from May 2010 to August 2010 among form two school children from rural area in Malacca. There were 484 cases, and 444 controls selected using randomized cluster sampling. The dependent variable was smoking, and the independent factors were religious personality. Validated and reliability-tested questionnaires were used for data collection. Results: The mean age (year) at which smoking was first tried among the cases was 11.39 + 2.107. There were eleven out of twenty three significant differences between religious personality statements in the cases and control group. Those were: reciting the Quran/Holy book/Scriptures even when busy, making efforts to deepen the understanding of the religion, trying to understand the teachings of the religion in the Holy book/Quran, inviting others to perform solat/prayer/religious service, making sure all the family members are following the teachings according to the religion, referring to the learned people when feeling uncertain about the rulings/teachings of the religion, performing work duties enthusiastically because of the religion/God, making efforts to remember death and afterlife often, making efforts to internalize the ethical conduct of the religion in daily life, setting aside money every year for religious purposes and looking for opportunities to give charity. Conclusion: Religious personality is an important factor which may influence adolescents volved in smoking.
The normal aortic valve has three leaflets, which are almost equal in size. A bicuspid aortic valve developed as a result of abnormal aortic cusp formation during early embryogenesis. Complications such as valvular stenosis or incompetence are well known. Delayed in identifying the congenital abnormality or the complications may cause morbidity and mortality. We report two cases of congestive cardiac failure as the results of undiagnosed bicuspid aortic valve with severe aortic incompetence. Both young men in their productive age without cardiac risk factors, were unfortunate to present too late. Although one of them was lucky to survive the ordeal, most late presentation ends up gravely. Aortic valve replacement can be offered if early detection is made. Those with severe disease at diagnosis may require a heart transplant.
Introduction: The purpose of this study was to determine the prevalence of defaulters of immunization, and their associated risk factors among children age 12 to 24 months. Materials and Methods: A cross-sectional study was conducted in all government's maternal child health clinics in District of Kota Kinabalu, Sabah. Data was collected using a standardised questionnaire from July to November 2006. Results: The prevalence rate for defaulting immunization was 16.8% from the 315 respondents. Bivariable analysis showed various significant factors associated with defaulters such as mother’s employment status, family mobility, transportation and cost. Nonetheless, multivariable analysis showed only mother’s age, mother employment status and family size were the significant predictors for defaulting immunization. Immunization that had the highest rate of defaulters was DPT–OPV booster dose (56.6%), followed by MMR immunization (43.4 %) and
DPT-Hib/OPV and Hep B third dose (37.7%).Conclusion: Employed mothers with bigger family size should be more closely monitored and advised to reduce the chance of defaulting on the immunization. Health promotion activities also should focus to these groups of mothers.