The developments in the technology of life support such as mechanical ventilators, dialysis machines and cardiovascular support techniques have provided the means of maintaining organ function for prolonged period of time. However, in many instances, such life-sustaining treatment in intensive care units did not result in desirable outcome where patients return to their normal state of health. Several ethical issues have surfaced from these medical advances mainly on the decision-making process, which physicians have to deal in their daily practice. Withholding and withdrawing life-prolonging treatments that allow patients to die naturally need to be differentiated from physician-assisted suicides and euthanasia that involves the active ending of life. The definition of life and death and the guiding ethical principles that one takes before embarking to a particular conclusion is a pre-requisite to good clinical practice. Islam, as a comprehensive religion provides clear definition of life and death and has guidelines that underlie its own ‘medical ethics’ that one could be guided by to assist in the decision-making process.
The integrated curriculum at the newly established medical school at University Malaysia Sabah is examined from aspects of the objectives of the medical training in achieving development of the required skills and knowledge as well as personal and professional development. The teaching is spread over five years with an emphasis on basic medical sciences in the first two years although the students are exposed to clinical skills right from the onset. A gradual transition to emphasis on the acquisition of clinical skills occurs from the third year onwards. However, community medicine and professional development are incorporated into the programme from the first year and are carried over to the final year. Although there are examinations to be passed in all the courses taught every semester, with a Cumulative Grade Point Average (CGPA) of 3.0 (65 percentile score) and the candidate has to pass all the examinations in that year to clear a particular year, two professional examinations are administered, one at the end of the Third Year (end of the Phase I of the Medical Programme) and another at the end of the Fifth or Final year (end of the Phase II of the Medical Programme). Programmes for Postings, Shadow House Officers (SHOP) and Population Health are also incorporated into the curriculum. Delivery of the courses involve Lectures, Self-Learning Packages (SLP), Small Group Discussions (SGD), Seminars, Debates, Dramas, Video clips, Special Study Modules (SSM), Computer-Aided Instruction (CAI), Problem-based Learning (PBL), Problem-solving Sessions (PSS) and Clinical Skills Learning (CSL). The examination involves elements of continuous assessment and final end of semester or end of phases I and II Professional Examinations. Practical may involve Objective Structured Practical Examinations (OSPE) and/or Objective Structured Clinical Examinations (OSCE). They may also involve viva voce and/or short and long case presentations and assessment of log book entries.
A case control study was conducted in 1996 among primary school student in Terengganu. The objective of the study is to determine the relationship between road traffic accidents and factors such as socio-economic status, distance from school, number of siblings, behavioural problems, knowledge and attitudes of pupil and their parents towards road safety and parents' educational status. A total of 140 cases was obtained from 3 urban schools and 3 from rural schools. Cases were matched with control according to age sex and locality of residence. There were significant associations between road traffic accidents and pupils' knowledge regarding road crossing (OR = 0.40, 95% CI = 0.19-0.85), parental supervision (OR = 0.43, 95% CI = 0.19, 0.64) and parents having driving licences (OR = 0.99, 95% CI = 0.856-0.999). Road safety education for pupils and parental supervision are key measures in preventing road traffic accidents among primary school children.
To examine the risk factors of HIV type-I infection among male drug addicts in Malaysia, a case-control study was conducted on inmates, aged 20-40 years, at a drug rehabilitation centre in January, 1994. Stratified random sampling was performed. A total of 87 cases and 261 controls, chosen by frequency matching for age and ethnicity, answered self-administered questionnaires. About 59.8% of the subjects administered drugs intravenously and of these, 71.2% shared needles. Practices significantly associated with HIV infection were needle-sharing (OR = 8.53; 95% CI = 3.36-5.52), sexual relationship with prostitutes (OR = 3.70; 95% CI = 2.10-6.56), homosexuality (OR = 4.05; 95% CI = 1.49-11.11) and non-condom use while having sex with prostitutes (OR = 2.27; 95% CI = 1.05-4.97).
Response surface methodology (RSM) was used to optimize the concentrations of chitosan and glycerol for coating Berangan banana (Musa sapientum cv. Berangan). The effects of main edible coating components, chitosan (0.5-2.5%, w/w) and glycerol (0-2%, w/w) on weight loss, firmness, total colour difference, total soluble solids content (TSS) and titratable acidity (TA) of coated banana were studied during 10 days of storage at 26±2°C and 40-50% relative humidity. Results showed that the experimental data could be adequately fitted into a second-order polynomial model with coefficient of determination (R 2 ) ranging from 0.745 to 0.930 for all the variables studied. In general, the chitosan concentration appeared to be the most significant (P< 0.1) factor influencing all variables except for TSS. The optimum concentration of chitosan and glycerol were predicted to be 2.02% and 0.18%, respectively. Statistical assessment showed insignificant difference between experimental and predicted values.
There is now increased public awareness of the value and role of cardiopulmonary resuscitation (CPR). It is therefore not surprising that the public expects a reasonable level of expertise of medical doctors in the application of the CPR techniques during emergency situations. Newly qualified doctors often lack confidence and are usually at a loss when faced with such situations as they have never had practical training before graduation. Most doctors are gradually introduced to CPR as part and parcel of their clinical experience. Many begin to attend formal CPR workshops later in their careers. Medical schools are expected to produce well trained doctors who are competent in clinical practice which include the techniques of basic resuscitation. By virtue of their expertise in airway management and clinical resuscitation, anaesthesiologists can significantly contribute to the teaching of CPR in the undergraduate medical curriculum. This is a retrospective review of Basic Life Support programmes conducted at the Department of Anaesthesiology, Faculty of Medicine, Universiti Kebangsaan Malaysia.
Malaria is an infectious disease that remains the main health problem in Tawau, Sabah. A case control study was carried out in the district to determine the influence of seasonal migration on malaria occurrence. Respondents consisted of 142 cases who were randomly selected from the reported cases in 1996 and they were pair-matched with 142 controls from the same villages by age and sex. The results showed that malaria occurrence was significantly associated with movement to the jungle, use of preventive measures during migration and frequency of using treated bednets (p < 0.05). The risk of individuals migrated to the jungle was 6 times as compared to those who do not (unadjusted Odd Ratio = 5.50, 95% CI 1.16-35.89) and they were more likely to get the infection if they did not use bednets (OR = 3.57, 95% CI 1.57-9.06). Health promotion campaign on the use of bednets especially during short term migration should be given priority in any malarial intervention program.
This study was done to determine the anthropometric measurement patterns of Malay children from wealthy families in Malaysia and to make a comparison with NCHS reference population. A population of 900 children aged between 3-12 years old from Taman Tun Dr Ismail, Kuala Lumpur (TDI), were examined but only 871 of them were eligible for the study. Weight, height, mid-arm circumference and skin fold thickness were measured. The increment pattern of anthropometric measurements of TDI children was quite similar to NCHS except for having a lower median weight for age and height for age. There was prepubescent increase in skin folds thickness in both sexes, followed by a midpubescent decrease and a late pubescent increase. The study indicated that Malay children from a wealthy background have growth rates comparable to children in the West, hence NCHS percentile charts are suitable as a reference for comparing the nutritional status of Malay children in Malaysia.
A study was conducted to determine the prevalence of locomotor disability in a Malay Community in Tanjung Karang, Kuala Selangor in 1984. The causes of these disabilities, the mobility and occupational handicaps they caused and the types of treatment received were determined. Fifty percent of the households in this area were selected by stratified random sampling and all persons above seven years of age were included in the sample. The prevalence of locomotor disability was 3.9%. The prevalence among males was 5.2% and among females 2.6%. The prevalence increased with age, being as low as 0.6% in the 7-14 year age group and as high as 20.5% in the above 55 year age group. The disabilities resulted mainly from trauma (49%) and musculoskeletal and neurological problems (46.9%). Ninety percent (44 cases) had difficulty only in performance of daily activity and 20 cases (40.8%) had no mobility handicap whatsoever. Forty two (85.7%) of the 49 cases had received treatment.
Introduction: Despite considerable effort invested for tuberculosis (TB) control, the outcome has not been optimal due to several barriers. Stigma has been an important factor that hinders the completion of full course of TB treat-ment, i.e. it results in poor treatment adherence. This systematic review is aimed to review the interventions target-ing tuberculosis related stigma in order to improve treatment adherence among tuberculosis patients in developing countries. Methods: A systematic electronic database search (PubMed, Google Scholar, ProQuest, Science Direct, Ovid, Spring and Cochrane) covering articles published between 2008 and 2019 had been conducted using truncat-ed search words of “stigma related to tuberculosis”, “TB Stigma”, “Intervention”, “treatment adherence”, “treatment compliance”, and “developing countries”. Only English articles exploring stigma among TB patients and its anti-stig-ma intervention in developing countries were included. Results: A total of 846 articles were retrieved and 346 were excluded due to duplication while another 361 non-relevant articles at the stage of title screening were excluded. Subsequently, 119 articles were excluded for not fulfilling inclusion criteria and only 3 studies remained. Conclu-sion: From the three articles, TB treatment outcomes were improved with the use of stigma intervention, including health education and counselling, self-support, and psychological support interventions. Optimal implementation of stigma interventions may vary by setting, resources, and the local TB epidemiology. More controlled interventional research is needed in stigma reduction that leads to improve TB adherence in developing countries.
Red pitaya juice (RPJ) was subjected to UV-C irradiation and the potential of UV as a pasteurization tool for reducing microbial load in pitaya juice was evaluated. Effectiveness of the hurdle concept, i.e. addition of citric acid (CA) and dimethyl dicarbonate (DMDC) was also studied. Total plate counts (TPC) and yeast and mould counts (YMC) achieved 2.43 log₁₀ and 2.7 log₁₀ reductions respectively after exposure to UV irradiation. Addition of the CA (0.5 - 2.0%) and dimethyl dicarbonate (DMDC) (5 - 20 µL/100mL) to pitaya juice reduced the microbial loads, with 1.5% CA and 15 µL/100mL DMDC being the most effective concentrations. Addition of CA and DMDC into RPJ prior to UV treatment achieved significantly higher microbial reduction compared to UV alone, which were 4.12 log ₁₀ and 4.14 log₁₀ reductions for TPC and for YMC, respectively.
Upper airway ultrasound is a valuable, non-invasive, simple, and portable point of care ultrasound (POCUS) for evaluation of airway management even in anatomy distorted by pathology or trauma. Ultrasound enables us to identify important sonoanatomy of the upper airway such as thyroid cartilage, epiglottis, cricoid cartilage, cricothyroid membrane, tracheal cartilages, and esophagus. Understanding this applied sonoanatomy facilitates clinician to use ultrasound in assessment of airway anatomy for difficult intubation, ETT and LMA placement and depth, assessment of airway size, ultrasound-guided invasive procedures such as percutaneous needle cricothyroidotomy and tracheostomy, prediction of postextubation stridor and left double-lumen bronchial tube size, and detecting upper airway pathologies. Widespread POCUS awareness, better technological advancements, portability, and availability of ultrasound in most critical areas facilitate upper airway ultrasound to become the potential first-line non-invasive airway assessment tool in the future.
Goitre prevalence and mental performance were determined amongst the Aborigines in Sinderut, a remote rural area in Pahang. A total of 196 subjects aged 4 to 60 years old were selected for study. Goitre status was determined by an experienced endocrinologist using classification suggested by World Health Organization; while mental performance was measured using Raven's test (Oxford Psychologists Press). Blood specimen was also taken for thyroxine (T4) and thyroid stimulating hormone (TSH) measurement. It was found that goitre prevalence was 26.5% (52/196); with visible goitre prevalence of 42.3% (22152). The overall mean of goitre volume was 21.4 ± 19.1 ml (range: 3.0 - 90.8 ml), while the prevalence of mental performance for the percentile value of more than 5.0 was 26.5% (range: 5.0 - 50.0). Mean thyroxine levels was 75.4 ± 19.3 nmol/L (range: 19.9 - 138.1 nmol/ L) while mean levels of thyroid stimulating hormone was 4.9 ± 3.2 mU/L (range: 0.4 - 18.9 mU/L). There was no significant correlation between hormone levels and mental performance score (Pearson Correlation; T4 : r=-0.002, p=0.9736; TSH : r=0.10, p=0.1843). goitre volume and mental performance score (Pearson Correlation; r=-0.02, p=0.8395). Goitre prevalence of more than 20% in this area indicates a moderate endemia, while mental performance showed a low thinking level in the Aborigines particularly those who lived in remote areas.
There is an increasing prevalence of diabetes mellitus around the world associated with rapid sociocultural development and changing lifestyles. Increased prevalence of obesity, with a higher consumption of animal products and lower consumption of fruits and vegetables, increases the risk of diabetes mellitus and other chronic degenerative diseases. Insulin-dependent diabetes (IDD) is caused by insulin deficiency, whereas the main feature of non-insulin-dependent diabetes (NIDD) which accounts for more than 90% of diabetics, is hyperinsulinemia and insulin resistance, which may eventually lead to actual insulin deficiency. Hyperinsulinemia is undesirable because it increases the risk of developing vascular disease. In Malaysia, the prevalence of NIDD in some communities now exceeds 5%, and of impaired glucose tolerance 10%. Along with these increases in prevalence of hyperglycemia are increases in prevalence of overweight (BMI>25) and almost certainly abdominal fatness. In terms of management, nutrition is given priority. Insulin and hypoglycemic drugs (sulphonylureas or biguanides), where required, may adversely affect body composition if overused. Newer therapeutic strategies require greater attention to the underlying problem in NIDD of abdominal fatness by attention to the relevant nutritional factors, physical activity and other lifestyle factors like cigarette smoking and alcohol. The greater impact of obesity and diabetes on Malaysian women as opposed to men also needs to be addressed.
Sixty three and fifty nine non-insulin dependent diabetes mellitus (NIDDM) patients in rural (land resettlement scheme) and urban areas respectively were studied to determine factors associated with diabetic control. The anthropometric and metabolic data (HbA1 and fructosamine levels) were analysed. After adjusting for gender, age, body mass index (BMI) and food intake, the fructosamine level which correlates with short term diabetic control, was significantly lower among patients in urban areas compared to patients in rural areas (p < 0.05). However, for longer term diabetic control (HbA1 level) the difference was not statistically significant (p > 0.05). The socio-economic status, level of education, BMI and types of food did not correlate with diabetic control in either group of patients. More diabetes education is needed together with socio-economic development and changes in lifestyles to enhance compliance towards health and dietary regimens and to achieve better metabolic control.
A cross-sectional study was carried out to determine the prevalence of diabetes mellitus and its relationship with age, physical activity, nutritional status and diet amongst rural Malays in Kuala Selangor. By simple random sampling 360 subjects were selected for the study. Besides guided questionnaires, subjects also underwent a 2 hours post prandial (2HPP) test to determine the diabetic status as recommended by WHO. The crude prevalence of diabetes mellitus was 14.6% which increases with age. The prevalence of diabetes adjusted for age was 12.2%. Physical activity status seemed to be a significant risk factor for diabetes. A greater proportion of diabetics was obese and their mean fat intake was higher than normal subjects (p < 0.05). The prevalence of diabetes mellitus in this study was significantly higher compared with data from 1984 (3.9%), representing a marked increment of 212.8 per cent over a 10-year period.
The Text Forum Threads (TFThs) contain a large amount of Initial-Posts Replies pairs (IPR pairs) which are related to information exchange and discussion amongst the forum users with similar interests. Generally, some user replies in the discussion thread are off-topic and irrelevant. Hence, the content is of different qualities. It is important to identify the quality of the IPR pairs in a discussion thread in order to extract relevant information and helpful replies because a higher frequency of irrelevant replies in the thread could take the discussion in a different direction and the genuine users would lose interest in this discussion thread. In this study, the authors have presented an approach for identifying the high-quality user replies to the Initial-Post and use some quality dimensions features for their extraction. Moreover, crowdsourcing platforms were used for judging the quality of the replies and classified them into high-quality, low-quality or non-quality replies to the Initial-Posts. Then, the high-quality IPR pairs were extracted and identified based on their quality, and they were ranked using three classifiers i.e., Support Vector Machine, Naïve Bayes, and the Decision Trees according to their quality dimensions of relevancy, author activeness, timeliness, ease-of-understanding, politeness, and amount-of-data. In conclusion, the experimental results for the TFThs showed that the proposed approach could improve the extraction of the quality replies and identify the quality features that can be used for the Text Forum Thread Summarization.
The study was conducted to compare the prevalence of goitre among Malays and Aborigines in remote inland rural areas to those in coastal areas. All subjects were examined thoroughly by an experienced endocrinologist for the presence of goitre. The overall goitre prevalence in coastal areas was 6.3%; 6.0% (4/67) of Aborigines and 6.7% (4/60) of Malays were affected. However, in remote inland areas, the prevalence of goitre was almost 5 times higher compared to coastal areas. The prevalence of goitre was 30.7% in Baling; 30.2% (19/63) Aborigines and 30.8% (92/299) Malays were affected. Iodine deficiency is the most likely cause for the high prevalence of goitre in the remote inland areas.
Membrane-bound polyphenoloxidase (mPPO) an oxidative enzyme which is responsible for the undesirable browning reaction in Snake fruit (Salacca zalacca (Gaertn.) Voss) was investigated. The enzyme was extracted using a non-ionic detergent (Triton X-114), followed by temperature-induced phase partitioning technique which resulted in two separate layers (detergent-poor phase at the upper layer and detergent-rich phase at the lower layer). The upper detergent-poor phase extract was subsequently fractionated by 40-80% ammonium sulfate and chromatographed on HiTrap Phenyl Sepharose and Superdex 200 HR 10/30. The mPPO was purified to 14.1 folds with a recovery of 12.35%. A single prominent protein band appeared on native-PAGE and SDS-PAGE implying that the mPPO is a monomeric protein with estimated molecular weight of 38kDa. Characterization study showed that mPPO from Snake fruit was optimally active at pH 6.5, temperature 30°C and active towards diphenols as substrates. The K(m) and V(max) values were calculated to be 5.46 mM and 0.98 U/ml/min, respectively, when catechol was used as substrate. Among the chemical inhibitors tested, l-cysteine showed the best inhibitory effect, with an IC(50) of 1.3 ± 0.002 mM followed by ascorbic acid (1.5 ± 0.06 mM), glutathione (1.5 ± 0.07 mM), EDTA (100 ± 0.02 mM) and citric acid (186 ± 0.16 mM).