The present study reports the performance of final year medical students from the Universiti Malaysia Sabah (UMS) in the end of the senior surgical posting examination (SSP) with the aim to demonstrate the medical students graduating from this newly established university are of good standing and of improving quality. A study on the outcome of the method of teaching conducted on this study was performed by measuring the students’ performance continuously and at the end of their posting. The present data analyses demonstrate that there have been improvements in the medical students’ performance between the last two batches of students graduating from UMS. However, the students appear to be weaker in their MCQs, demonstrating a decline in theoretical knowledge. The analyses also demonstrate that there is a poor positive correlation between theoretical knowledge, clinical skills and/or continuous assessments, demonstrating the importance of emphasis in these 3 areas amongst medical students. Further studies may be required to determine the reason for this poor correlation since these may lead to better understanding on how to improve the overall performance of future medical student. CONCLUSION: The present study demonstrates that UMS medical student appears to continue to improve in their SSP performance although there are concerns about the decline in theoretical knowledge.
Metastases to the breast from non-mammary malignant neoplasm are relatively rare. We report a case of metastatic disease to the breast from a primary lung adenocarcinoma in a young 22-year-old lady. Computed tomography of the thorax confirmed right upper lobe mass with multiple lung nodules and a breast lump. The diagnosis of breast metastasis was confirmed by fine needle aspiration cytology of the breast lump with histopathological findings and immunohistochemical features consistent with lung adenocarcinoma.
This article presents a brief overview on the importance of adopting healthy behavior during and after the completion of primary cancer treatment. Increasing evidences are advocating physical activity engagement in cancer survivors due to its convincing beneficial outcomes. Today, outcomes from numerous trials confirmed the need to examine beyond physical activity engagement, into physical inactivity as an independent factor for cancer recurrences. Reducing cancer-risk related behaviors via increase physical activity and reduce inactivity is now receiving much attention in the field of cancer survivorship. Both realms of activity and inactivity are now acknowledged as influential independent factors contributing to better care in the field of cancer survivorship.
BACKGROUND:
Laparoscopic cholecystectomy, although is less invasive than open surgery, is not completely pain free. The use of local anaesthesia to relieve pain following this procedure is a common practice. However, it remains debatable whether a pre- or post-operative drug administration is more effective. Here, we investigated the role of preemptive local anaesthetic infiltration given pre- or post-incisional, in relieving the pain during laparoscopic surgery.
METHODOLOGY:
A randomized controlled trial was conducted with 96 patients receiving 0.5% Bupivacaine 100mg. Group A (n=48) received post-incisional skin infiltration whilst Group B (n=48) received pre-incisional infiltration. Incisional (somatic) and intra-abdominal (visceral) pain was assessed using Visual Analog Scale (VAS) at day 0, day 1 and day 7 post-operative days.
RESULT:
Baseline characteristics between the two groups were similar. Incisional pain was lower in Group B as compared to Group A at day 0 (P=0.03) and day 1 (P0.05).
CONCLUSION:
Administration of pre-incisional local anaesthesia offers better pre-emptive pain relief measure than post-incisional administration by reducing somatic and visceral pain in laparoscopic gall bladder surgery.
MRI can be a distressing and traumatic experience in many patients, especially in those with underlying anxiety and/or claustrophobia. We conducted a study to determine if dexmedetomidine as a sedative agent can alleviate these symptoms. Dexmedetomidine is a potent and highly selective α-2 adrenergic receptor agonist which has sedative and analgesic properties. Eleven adult patients (n=11) with a histroy of anxiety and/or claustrophobia undergoing MRI who expressed their desire for sedation were recruited. Dexmedetomidine was infused at 0.5 to 1.0 μg/kg over 10 minutes prior to scanning. Eight patients (n=8) were able to complete the MRI scan comfortably. The findings suggest that dexmedetomidine provides adequate sedation that can allow patients with anxiety and/or claustrophobia to undergo MRI scanning succesfully in a large poproption of the population with anxiety. This result however is still preliminary and will need to be validated in a more robust clinical study.
Human adipose tissue has been recognized as an alternative source of adult stem cells. The abundance and ease of harvest of adipose tissue has made it suitable for use in regenerative medicine and tissue engineering. Adipose-derived stem cells isolated from human adipose tissue are able to differentiate into several mesenchymal lineages and secrete growth factors that exhibit therapeutic potential. Protein profiles have been established using various isolation methods, which has expanded researchers’ understanding of adipose-derived stem cells in clinical applications. This review highlights the properties, isolation methods, immunophenotype and clinical applications of adipose-derived stem cells.
Assisted Reproductive Technology (ART) is a suite of laboratory techniques designed to rescue infertile phenotypes. While ART has led to the birth of 5 million ART babies worldwide, success rates rarely exceed 40%. One potential factor for this could be iatrogenic (‘clinician-induced’) damage to critical sperm proteins, such as phospholipase C zeta (PLCζ) and protamine, which are fundamental for oocyte activation and sperm DNA integrity, respectively. This report describes how we have begun to investigate the adverse effects of ART techniques upon these key sperm proteins. We also describe the pathway taken by Miss Suseela Yelumalai to acquire a scholarship from the Malaysian Government and her postgraduate experience at the University of Oxford. We introduce the facilities and learning opportunities available at the Institute of Reproductive Sciences (IRS) which houses Dr Kevin Coward’s research laboratory, and finally, highlight the potential for collaborative development between the Universities of Oxford and Malaya.
Organ shortage is a major concern in many countries. The objective of this paper was to investigate the factors that contribute to the low quantity of organ donation in Malaysia. The 1311 respondents in this survey came from the three main ethnic groups in Malaysia (Malay, Chinese and Indian). The survey was based on these components: The reason for not pledging to become a donor; the reason of refusing to become a donor; and whether non-fungible incentive would influence decision. The lack of information and trust were the factors that influenced the respondents to remain apathetic to organ donation. The results denote that people are unlikely to become a donor even if non-fungible incentive were provided to them. Thus, it is important for the government bodies to evaluate the programme and strategies of public education in relation to organ donation.
Initiation of Highly Active Anti-Retroviral Therapy (HAART) depends on clinical or immunological criteria. Clinical criteria include the presence of opportunistic infections, categorized by the WHO as stage 3 and 4. Immunological criteria are based on CD4 cell count. The WHO guidelines have changed frequently. All patients with CD4 cell count less than 200 cells/µl and symptomatic HIV or late disease or severe recurrent HIV illnesses or patients with AIDS or tumor at any CD4 count, should start therapy. WHO guidelines in 2013 recommended initiating HAART at CD4 counts less than 500 cells/µl. HAART is usually initiated when CD4 is less than 200 cell/µl because HIV infected patients present at a late stage. Research on factors responsible for this is sorely needed so that interventions can be targeted at this group.
Genetic mutations in endometrial cancer (EC) have been extensively studied in the Western population but not much in Asian cohorts. This study has demonstrated that PTEN and PIK3CA mutations are commonly found in EC among Malaysian women. Following RNA extraction from 20 cancerous and 18 non-cancerous tissues, the presence of mutations in 9 exons of PTEN and 3 exons of PIK3CA genes were detected using real-time PCR, accompanied by High Resolution Melt (HRM) analysis. Sequencing confirmed specificity of each PCR product. The mutations for both genes were detected in the samples with varying frequencies. Notably, all samples expressed mutation of PTEN at exon 7 but none in exon 4. Further analysis demonstrated that strong concurrent mutations occurred between exons 7 of PTEN with exon 20 region 1 of PIK3CA gene (90%). Our data showed mutations are present in EC and not the non-cancerous tissues. Larger samples are being collected to validate this observation.
INTRODUCTION AND OBJECTIVE:
Most of important variables measured in medicine are in numerical forms or continuous in nature. New instruments and tests are constantly being developed for the purpose of measuring various variables, with the aim of providing cheaper, non-invasive, more convenient and safe methods. When a new method of measurement or instrument is invented, the quality of the instrument has to be assessed. Agreement and reliability are both important parameters in determining the quality of an instrument. This article will discuss some issues related to methods comparison study in medicine for the benefit of medical professional and researcher.
METHOD:
This is a narrative review and this article review the most common statistical methods used to assess agreement and reliability of medical instruments that measure the same continuous outcome. The two methods discussed in detail were the Bland-Altman Limits of Agreement, and Intra-class Correlation Coefficient (ICC). This article also discussed some issues related to method comparison studies including the application of inappropriate statistical methods, multiple statistical methods, and the strengths and weaknesses of each method. The importance of appropriate statistical method in the analysis of agreement and reliability in medicine is also highlighted in this article.
CONCLUSION:
There is no single perfect method to assess agreement and reliability; however researchers should be aware of the inappropriate methods that they should avoid when analysing data in method comparison studies. Inappropriate analysis will lead to invalid conclusions and thus validated instrument might not be accurate or reliable. Consequently this will affect the quality of care given to a patient.
The biocompatibility and similarity of hydroxyapatite (HA) to the mineral composition of the bone has made HA a potential candidate in bone tissue engineering (BTE). Over the past few decades, its application as bone graft in combination with stem cells has gained much importance. The use of bone marrow-derived mesenchymal stromal cells (MSCs) will enhance the rate and quality of defect repair. However, application of hydroxyapatite as a material to develop a 3-dimension scaffold or carrier to support MSCs in vitro is still in its infant stage. This review will discuss the source, manufacturing methods and advantages of using HA scaffolds in bone tissue engineering applications.
Autologous chondrocyte implantation (ACI) is a widely accepted procedure for the treatment of large, fullthickness chondral defects involving various joints, but its use in developing countries is limited because of high cost and failure rates due to limited resources and support systems. Five patients (age
The story of clinical genetics is a relatively new one, first spearheaded by paediatrics but increasingly, has taken root in all branches of medicine leading to ‘personalised medicine’. There are expectations that this revolution in genetics will pave the way to genomic medicine and a cure for all inherited disorders. The development of the field of Clinical Genetics and genetic counselling in Malaysia is still in its infancy. Using evidence-based data on genetic disorders such as birth defects, inborn errors of metabolism, genetic syndromes, neurological disorders and hereditary cancers, that hitherto have not been well documented in Malaysia, this review article will focus on findings and issues that will present a unique insight and opportunity to understanding the complex genetic counselling issues related to clinical genetics in Malaysia.
Pulmonary embolism is the obstruction of the pulmonary artery or its branches, commonly by thrombus or
fat. We report an unusual case of double pathology - both pulmonary thromboembolism and fat embolism
syndrome in a patient with bilateral femur and bilateral tibia fractures. This highlights the importance of a high
index of suspicion of these conditions while managing patients with multiple long bone fractures. Morbidity
and mortality can be significantly reduced with prompt and appropriate prevention strategies.
Phyllodes tumour is a rare entity, affecting mainly middle aged women. It consists of a spectrum of disease
from benign tumour to highly aggressive malignant form. We present a case of massive ruptured malignant
Phyllodes tumour, and its subsequent management.
Tuberculosis (TB) is a major public health problem worldwide. It is estimated that 2 billion people, a third of
the world population, have TB infection, but are not down with the disease. Globally, incident cases of TB
showed a rising trend, with a 6.6 million reported in 1990, 8.3 million in 2000, 9.24 million in 2004, and an
estimated 9.27 million incident cases in 2007. The aim of this study was to evaluate the treatment outcome of
TB patients in Nigeria in the state of Jigawa. A cross sectional retrospective study was conducted to evaluate the
treatment outcome in directly observed treatment with a short course for tuberculosis (TB DOTS) in facilities
in the state between the years 2010 to 2014. The study population were all the patients with TB, who had
access to DOTS therapy. Data were collected from the various local governmental areas for tuberculosis control
(LGA TB) register. The LGA TB control registers contained basic information of the patients, and a statistical
software SPSS-V22.0 was used to analyse the data. A total of 963 TB patients were studied. More than half
(57.4%) of the patients were male, and nearly three- fourths (71.2%) of the patients accessed care from urban
local government areas in the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis
(PTB). Among the patients, more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them
were HIV positive. This study revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria
was higher than the overall TSR of Nigeria, and the defaulter rate in this state was lower than the Nigerian
average. The aim of this study was to evaluate the treatment outcome of TB patients in Nigeria in the state
of Jigawa. A cross sectional retrospective study was conducted to evaluate the treatment outcome in directly
observed treatment with a short course for tuberculosis (TB DOTS) in facilities in the state between the years
2010 to 2014. The study population were all the patients with TB, who had access to DOTS therapy. Data were
collected from the various local governmental areas for tuberculosis control (LGA TB) register. The LGA TB
control registers contained basic information of the patients, and a statistical software SPSS-V22.0 was used
to analyse the data. A total of 963 TB patients were studied. More than half (57.4%) of the patients were
male, and nearly three- fourths (71.2%) of the patients accessed care from urban local government areas in
the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis (PTB). Among the patients,
more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them were HIV positive. This study
revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria was higher than the overall TSR
of Nigeria, and the defaulter rate in this state was lower than the Nigerian average.
The anterior cruciate ligament (ACL) deficient knee has been subjected to various research and many conclusions
have been drawn to the loss of function in relation to it. ACL reconstruction is also very commonly done as
this ligament damage is the most common injury in sports. Muscle strength and proprioception have been
postulated to be affected alongside this injury. We conducted a cross sectional study in 19 patients who have
ruptured their ACL. We measured their muscle strength, thigh muscle bulk and proprioception in comparison
to their contralateral normal knee. The Biodex Isokinetic machine was used to measure the muscle strength
and proprioception. The thigh circumference was measured manually using a measuring tape. There was
significant reduction of muscle strength and thigh circumference in the ACL deficient limb as compared to the
normal side, p
The study aimed to assess whether sharing of health services improved service quality in health centers in Kampala Capital City Authority (KCCA). With multi-stage sampling, data was gathered by face to face interviews, via translators from residents in the five divisions of KCCA, using a questionnaire. Schedules were made with Local Council I chairmen, and support to fill in the questionnaire was given to the respondents. The statistical methods used for analysis included a Chi-square, Spearman correlations and hierarchical regression. The study found that regarding tangibility, sharing health services significantly determines the number of modern medical equipments (p=0.000) and the number of medical personnel that had a neat and professional appearance (p=0.000) but did not determine the number of visually appealing health facilities (p=0.386). Recentralizing health care changed the mode of delivery. Health workers were responsive, reliable and provide better care for patients. There was increased availability of basic medical equipment, and health workers were neater in appearance with increased confidence and hence were better able to provide for the safety of residents.
Study site: clinic, Kampala, Uganda
There is a high incidence of 36% to 83% of respiratory dysfunction in patients with acute cervical spinal cord
injury. Complications arising from respiratory dysfunction remain one of the most common causes of morbidity
and mortality in the spinal cord injured population. Specialized pulmonary care and therapy can help individuals
with tetraplegia to maintain a stable respiratory status allowing active participation in active rehabilitation.
This would allow them to achieve rehabilitation goals of independent function and community reintegration.
Mechanical insufflation-exsufflation (MIE) therapy is an option for secretion management in individuals with
acute spinal cord injury. In this paper, we present our experience using MIE as an adjunct to management of
secretions in the spinal cord injured population at the University of Malaya Medical Centre.