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  1. Fulltext Task Integrated Objective Structured Clinical Examination (TIOSCE): A modified version of OSCE
    Shahid Hassan
    Education in Medicine Journal, 2012;4(1):115-128.
    MyJurnal
    The impact of good assessment in medical education depends on how appropriately the tools measure the clinical performance and how reliable, valid and feasible they are to achieve the logical decision. The traditional methods of clinical examination using long and short cases and orals are often argued for its subjectivity, low reliability and inadequate context specificity. Oral test though comparatively more valid due to its face-to-face questions are considered less reliable for problems of unstandardized questions, inconsistent marking and lack of sufficient testing time. Development of an “objective structured clinical examination” (OSCE) was sought as a solution to these problems. But the fragmented representation of the context in a number of stations in OSCE makes it less authentic for an integrated judgment of performance. Yet another method to thought of, was the workplace-based assessment (WPBA) but it takes a snapshot as a predefined attribute of a more complex integrated assessment such as long case. However due to the problem of feasibility it is less likely that high stakes examination as summative assessment will ever be able to attain workplace-based assessment such as Mini-CEX and DOPS. A TOACS (task oriented assessment of clinical skills) format currently used in high stakes fellowship examination in one of the center and claimed to have more active role for examiners was analyzed and compared with OSCE. Author however, did not find a difference except the difference of acronyms of the two formats. Both have multiple, fragmented static or interactive stations of 5-10 minutes duration with or without examiners, patients or exhibits and a marking scheme comprising of checklist or global rating. In the backdrop of this context a new assessment format named the ‘task integrated objective structured clinical examination” or TIOSCE modified from OSCE is currently developed in School of Medical Sciences (SMS) at USM. However, it is a different version of OSCE in which though the principle concept is the same as that of an OSCE, the continuum of clinical skill’s work up of the same patient’s is followed through to test multiple short attributes of clinical competences. As it retains most of the favorable features, TIOSCE also addresses some of the odds features of OSCE.
  2. Fulltext Faculty development: mini-CEX as workplace-based assessment
    Shahid Hassan
    Education in Medicine Journal, 2011;3(1):12-21.
    MyJurnal
    Background: Competence-based curriculum has become the need of medical education to meet the objectives of institutions aiming to produce skilled physicians. To achieve the optimal competence and performance of graduates a number of traditional evaluation exercises have been practiced. Some of these e.g. OSCE although meet the acceptable standard of reliability and validity is the assessment done in a controlled environment. This leaves the room for performance-based assessment in real clinical situation such as mini clinical evaluation exercise (Mini-CEX). To practice and meet the challenges of Mini-CEX it is vital to undertake faculty development program with a comprehensively chalked down Mini-CEX protocol and its objectives to achieve the intended outcome. Objective: To undertake faculty development on Mini-CEX for its feasibility and acceptability as a method of formative assessment to evaluate the clinical competence of trainees in postgraduate program of Otolaryngology and Head-Neck Surgery. Method: 25 trainees from the four classes of master of surgery program of 2009 in Otolaryngology and Head-Neck Surgery (ORL-HNS) undertook Mini-CEX encounters and assessed by 9 supervisors in a 12-week period of study. Faculty development program was carried out through prior lectures deliberating on background, concept and procedure of Mini-CEX followed by demonstrations using video clip of Mini-CEX encounter recorded in own clinical environment. Students were also exposed to similar settings to take up the Mini-CEX encounter without any hesitation. Trainees were assessed in outpatient clinical setting. Program was evaluated for its feasibility and acceptability with respect to patient’s factors, clinical attributes, supervisor and trainee’s performance and their reported level of satisfaction.
    Result: Faculty development and trainees orientation in Min-CEX was achieved as feasible and acceptable. Higher rating of satisfaction was reported by majority assessors and trainees as they found Mini-CEX acceptable for formative assessment. Among clinical skills highest rating was received in physical examination and lowest rating in therapeutic skills. Conclusion: A motivated faculty and organized approach towards a comprehensive knowledge on Mini-CEX for its background communication, demonstration of procedure and method to complete the rating forms is the useful guide to adopt Mini-CEX. The faculty and trainees in department of ORL-HNS found Mini-CEX as feasible and acceptable assessment tool to monitor educational activity of postgraduate program through performance-based evaluation in a real clinical situation.
  3. Fulltext Faculty development: DOPS as workplace-based assessment
    Shahid Hassan
    Education in Medicine Journal, 2011;3(1):32-43.
    MyJurnal
    Background: In order to achieve the desired performance of graduates a number of traditional evaluation exercises have been practiced to assess their competence as medical students. Many of these assessments are done in a controlled environment and mostly reflect on tests of competence than performance. Mini-CEX or direct observed procedural skills (DOPS) are the real performance-based assessment of clinical skills. Increased opportunity for observation and just-in-time feedback from the role model superiors produce a positive educational impact on students learning. This also provides trainees with formative assessment to monitor their learning objectives. However, to implement assessment strategies with Mini-CEX or DOPS needs to develop institution’s clear policy for a different teaching and learning culture of workplace based assessment. It also needs to develop user friendly rating form, checklist, elaboration of clinical competence and its attributes and procedural guidelines for practice. A precise role of these tools in the assessment of postgraduate program must be established before practicing them to evaluate and monitor trainee’s progress.
    Objective: To determine DOPS for its acceptability and feasibility as a method of formative assessment of clinical skills in postgraduate program of Otolaryngology and Head-Neck Surgery.
    Method: A total of 25 trainees were assessed for DOPS by 8 supervisors in this 12-weeks pilot study. A faculty development program for faculty members and trainees was run for DOPS. Trainees were advised to undertake at least one DOPS encounter out of 42 shortlisted procedures. Assessors were asked to mark trainees by completing a rating form using a checklist developed for each procedure. Trainees and assessors were asked to endorse their opinion on feasibility and acceptance of DOPS for practice of formative assessment in future. Data was analyzed to determine feasibility and acceptability of DOPS in assessment program. Result: Faculty development and trainees orientation in DOPS were found satisfactory for its acceptance and feasible for its practice. Trainees were mostly assessed in outpatient clinical setting. Majority reported higher rating of satisfaction by assessors and trainees. Among clinical skills higher rating was received in procedural skills performed by the senior trainees. Conclusion: DOPS was found feasible for practice of formative assessment of trainees in postgraduate program of Otolaryngology and Head-Neck Surgery in School of Medical Sciences (SMS) at Universiti Sains Malaysia (USM). It was well accepted by the trainees to help monitor their quality of procedural skills as self-directed learning.
  4. Fulltext Commitment of medical graduates educated with and without community-based medical education towards community health care-A study from Malaysia
    Shahid Hassan
    Education in Medicine Journal, 2013;5(4):42-50.
    MyJurnal
    Context: Community-based medical education (CBME) has become widely accepted as an important innovation in undergraduate medical education. In curriculum featuring CBME, students are acquainted with the community early in their studies however; the impact of this training can be judged best to see them practice the required aspects of CBME. Malaysia is a multiracial country with a very strong community dependant life style. Main national health problems have called for a change in health profession education from traditional hospital based health care to community-based delivery system. Three major university's medical schools that either practice community oriented or community based medical education in undergraduate medical curriculum are evaluated. Universiti Sains Malaysia (USM) has a community based medical education (CBME) curriculum as Community and Family Case Study (CFCS) compared to a community oriented education curriculum (COE) adopted by Universiti Malaya (UM) and Universiti Kebangsaan Malaysia (UKM). However, UM at the time of undertaking this study back in 2005 was though practicing COE has also later opted CBME as CFCS.

    Objective: To determine whether medical graduates from USM with a community-based medical education in its curriculum for more than 25 years are inspired to have stronger commitment towards community health as shown in their on-job practice of medicine compared to other graduates from UM and UKM, who have adopted community-oriented medical education program.

    Method: A questionnaire-based pilot study with 12 items (variables) was designed to obtain supervisor's opinion on commitment of interns towards the health of community they serve. The questionnaire was administered to a randomized group of 85 specialists supervising the internship training program in five major disciplines including internal medicine, surgery, orthopaedic, gynaecology and obstetrics and paediatric medicine. The data received from 62 respondents from five major disciplines was analyzed utilizing SPSS version 12.0.1.

    Result: The responses received from 62 supervisors on an inventory in which 9 out of 12 variables were directly related to community commitments of interns. It was shown that the USM graduates who were taught through a CBME curriculum have performed better than the graduates from UM and UKM who followed a COE curriculum. P-value (< 0.001) was highly significant and consistent with higher mean score in those variables.

    Conclusion: The graduates taught through a CBME curriculum performed better in community commitments towards patients care compared to graduates from COE curriculum.
  5. Efficacy and safety of cefepime in late-onset ventilator-associated pneumonia in infants: a pilot randomized and controlled study
    Shahid SK
    Ann Trop Med Parasitol, 2008 Jan;102(1):63-71.
    PMID: 18186979 DOI: 10.1179/136485908X252151
    Multidrug-resistant organisms cause late-onset ventilator-associated pneumonia (VAP). In a pilot, randomized and controlled study, the efficacy and safety of cefepime, in late-onset VAP in infants, have now been evaluated in Malaysia. Thirty children aged <1 year with late-onset VAP (i.e. VAP occurring 5 or more days after intubation) were randomized to receive cefepime or, as a control, ceftazidime. The clinical responses and the microbiological clearance of tracheal aspirates were evaluated in each arm. Adverse events, if any, were monitored clinically and by blood tests. Ten of the 15 children given cefepime and five of the 15 given ceftazidime showed a satisfactory clinical response (P<0.1). Cefepime appeared significantly better at clearing polymicrobial infections from tracheal aspirates. There were no fatalities in the cefepime arm but three in ceftazidime (P<0.1). The mean (S.E.) durations of antibiotic use were 9.4 (1.5) days for cefepime and 7.6 (1.0) days for ceftazidime (P>0.05). No serious adverse effects were observed in either arm. In conclusion, in late-onset VAP in infants, cefepime monotherapy appears to be at least as effective and safe as ceftazidime monotherapy, with better microbiological clearance.
  6. Fulltext Use of structured portfolio in surgical training of postgraduate medical education
    Hassan S
    Education in Medicine Journal, 2011;3(2):32-43.
    MyJurnal
    Background: Reflection on the process of learning is an essential ingredient in transforming novice into expert learners. Learning to compile portfolio encourages reflective skills, which help students to work systemically in translating metacognition into self-regulatory control in order to adjust their action and monitor their learning objectives. Introducing to compile portfolio in the early years of postgraduate training is an effective tool to stimulate students’ reflective abilities. Reflective learners are better motivated than the conventional learners to take the responsibilities as researcher in future. Reflective skills achieve both learning in right direction and learning for whole life. However, use of formal methods of reflective portfolio to monitor the learning objectives is an uncommon practice in postgraduate training, primarily due to intensive time and labor required. Challenged with those constraints in Master’s of Surgery Program of Otolaryngology and Head-Neck Surgery in School of Medical Sciences at Universiti Sains Malaysia, a structured self-reflective portfolio was introduced to determine its feasibility and acceptance among supervisors and trainees. Portfolio was practiced as one of the tool for formative assessment and for making recommendations to certify independent thyroid surgery allowed to practice in future. Methodology: A self-reflective structured portfolio was introduced to monitor the learning objectives in trainees of 2007 cohort, using a model as "mentor-system for authentic and structured learning with self-reflective assessment" (MASSRA). Initially a semi-structured portfolio comprising of 12 items and guidelines to compile a portfolio was followed by a structured format in training of thyroid module in sub-specialty of Head and Neck Surgery. Mentoring was organized by putting one-mentor verses 9 students to provide general pastoral guidance to compile portfolio as two entries a year. Mentors held the counseling session with student twice a year after evaluating the portfolios to monitor their progress. Besides, candidates were also observed for their performance in thyroid surgery during a 4-years training program. Those identified with problems for their level of training were referred to "Joint Committee for Surgical Training" comprising of 3 supervisors from Head and Neck Surgery Sub-specialty and a chairman supposedly the head of the department. 7 randomly selected students were also interviewed for direct feedback to evaluate this model. Result: 28 trainees at different level of their training compiled a self-reflection structured portfolio minimum twice a year with instructional feedback from the mentor, which was used as a tract for their personal development plan (produced by each trainee) for training in thyroid surgery. Initial analysis of portfolio revealed interesting feedback from the trainees reflecting on their knowledge, surgical skills and attitude towards thyroid surgery seen in tables 2-4. Conclusion: Self-reflections about each structured items in portfolio-helped trainees to identify their problems, seek mentors guidance and work systemically to help adjust their actions by revising learning objectives. Though time and labor intensive, portfolio was rated as feasible and practical.
  7. Fulltext Appraisal of weekly conducted clinical pathologic case conference (CPC)
    Hassan S
    Education in Medicine Journal, 2011;3(2):15-23.
    MyJurnal
    Background: The weekly held clinical pathologic case conference popularly known as CPC provides an effective and regular educational media of collaborative learning for inter-disciplinary exchange of knowledge among the faculty members of an institution. CPC has been routinely practiced for the last two decades in School of medical Sciences (SMS) at Universiti Sains Malaysia (USM). An hour session primarily involves a case presentation hiding the diagnosis followed by discussion on differential diagnosis and floor interaction on interesting clinical cases. It also gives an opportunity to new teaching staff in the institution to experience an in-house practice of presenting the clinical cases; witch can readily be reproduced as a case report for publication. An effort to follow the original format of CPC is comprehended as an essential outcome of this study to keep up the sanctity of CPC as a case method of learning medicine in future. Methodology: A questionnaire-based survey was recently conducted to evaluate the weekly held CPC in SMS. It was a cross sectional survey in which a questionnaire comprising of 23 items was administered to a targeted population of faculty members of School of Medical Sciences. The items in questionnaire were grouped into 5 clusters. All respondents were adequately briefed through a letter addressing the objectives and importance of survey and its appraisal aiming to revamp the CPC guided by the out-come of study. Questionnaires were administered to 240 academic staff, covering > 80% of the target population of 294 faculty members. 159 (66.2%) members of sample population completed the questionnaires. Total non-responses were 81 (33.7%) and item non-responses were 320 (8.7%) Result: All the items in questionnaire were found significant (p 0.016) except those two items related to, observing a difference in preparing for a case presentation verses a formal CPC presentation and its promotion (p 0.556 and 0.197 respectively). It was also established that the major respondents were unaware of the original format of CPC (p 0.003) in which a presenter select and prepares a case, which is discussed with participating faculty members for its differential diagnoses. 51.6% faculty members did not follow the formal CPC format (p 0.016) in their presentations. A lack of awareness about the format of CPC was shown by (61.0%) faculty members (p 0.003). Conclusion : It was concluded that emphasis to discuss the differential diagnosis by a competent discussant was lacking, as presenters did not follow the formal CPC format. It was critically observed that a number of presentations made in this weekly program deviate from the original format adapted by SMS in USM. However, the out-come appraisal of this survey was the pledge shown by the majority faculty members to adapt the guidelines as a reverence to the formal CPC format.
  8. Fulltext How to develop a core curriculum in clinical skills for undergraduate medical teaching in the school of medical sciences at Uiversiti Sains Malaysia?
    Hassan S
    Malays J Med Sci, 2007 Jul;14(2):4-10.
    PMID: 22993486 MyJurnal
    Clinical skills program as a laboratory method is a valuable adjunct to other forms of undergraduate medical training. This article describes the process of developing a core curriculum in clinical skills based on the Dundee model for a clinical skills centre. The School of Medical Sciences, in Universiti Sains Malaysia (USM) has been provided with a well equipped skills centre. However, the PBL curriculum in the undergraduate medical program in the school needs to be integrated with a clinical skills lab program. This is to counter the general feeling that the contribution of PBL is insignificant in terms of building clinical competency in an integrated system such as that used in USM compared to the traditional curriculi of other medical teaching institutions in Malaysia. Integrating clinical skills laboratory training with the PBL curriculum will provide evidence of PBL as an effective and innovative method for teaching and learning in Malaysia.
  9. Fulltext About clinicopathological conference and its' practice in the School of Medical Sciences, USM
    Hassan S
    Malays J Med Sci, 2006 Jul;13(2):7-10.
    PMID: 22589598
    The clinicopathological conference, popularly known as CPC primarily relies on case method of teaching medicine. It is a teaching tool that illustrates the logical, measured consideration of a differential diagnosis used to evaluate patients. The process involves case presentation, diagnostic data, discussion of differential diagnosis, logically narrowing the list to few selected probable diagnoses and eventually reaching a final diagnosis and its brief discussion. The idea was first practiced in Boston, back in 1900 by a Harvard internist, Dr. Richard C. Cabot who practiced this as an informal discussion session in his private office. Dr. Cabot incepted this from a resident, who in turn had received the idea from a roommate, primarily a law student.
  10. Fulltext Use of item analysis to improve the quality of single best answer multiple choice question in summative assessment of undergraduate medical students in Malaysia
    Shahid Hassan, Rafidah Hod
    Education in Medicine Journal, 2017;9(3):33-43.
    MyJurnal
    Background: Single best answer (SBA) as multiple-choice items are often advantageous to use for
    its reliability and validity. However, SBA requires good number of plausible distractors to achieve
    reliability. Apart from psychometric evaluation of assessment it is important to perform item analysis
    to improve quality of items by analysing difficulty index (DIF I), discrimination index (DI) and
    distractor efficiency (DE) based on number of non-functional distractors (NFD). Objective: To
    evaluate quality of SBA items administered in professional examination to apply corrective measures
    determined by DIF I, DI and DE using students’ assessment score. Method: An evaluation of post
    summative assessment (professional examination) of SBA items as part of psychometric assessment
    is performed after 86 weeks of teaching in preclinical phase of MD program. Forty SBA items and
    160 distractors inclusive of key were assessed using item analysis. Hundred and thirty six students’
    score of SBA was analysed for mean and standard deviation, DIF I, DI and DE using MS Excel 2007.
    Unpaired t-test was applied to determine DE in relation to DIF I and DI with level of significance.
    Item-total correlation (r) and internal consistency by Cronbach’s alpha and parallel-form method was
    also computed. Result: Fifteen items had DIF I = 0.31–0.61 and 25 items had DIF I (≤ 0.30 or ≥
    0.61). Twenty six items had DI = 0.15 – ≥ 0.25 compared to 14 items with DI (≤ 0.15). There were 26
    (65%) items with 1–3 NFD and 14 (35%) items without any NFD. Thirty nine (32.50%) distractors
    were with choice frequency = 0. Overall mean DE was 65.8% and NFD was 49 (40.5%). DE in
    relation to DIF I and DI were statistically significant with p = 0.010 and 0.020 respectively. Item-total
    correlation for most items was < 0.3. Internal consistency by Cronbach’s alpha in SBA Test 1 and 2
    was 0.51 and 0.41 respectively and constancy by parallel-form method was 0.57 between SBA Test 1
    and 2. Conclusion: The high frequency of difficult or easy items and moderate to poor discrimination
    suggest the need of items corrective measure. Increased number of NFD and low DE in this study
    indicates difficulty of teaching faculty in developing plausible distractors for SBA questions. This has
    been reflected in poor reliability established by alpha. Item analysis result emphasises the need of
    evaluation to provide feedback and to improve quality of SBA items in assessment.
  11. Mortality in rheumatoid arthritis: time to take it seriously
    Arshad A, Shahid MS
    APLAR Journal of Rheumatology, 2005;8(3):154-158.
    DOI: 10.1111/j.1479-8077.2005.00158.x
    Rheumatoid arthritis (RA) is often regarded as benign and not a serious disease. Yet patients with RA have a substantially reduced life expectancy. Patients with RA are particularly at risk of death from cardiovascular disease, infection and renal disease. A few variables are now recognized as important predictive markers, such as disease duration, severity, sex, educational level and treatment., Copyright (C) 2005 Blackwell Publishing Ltd
  12. Fulltext Surgery for massive paediatric head and neck neurofibroma: two case reports
    Asha’ari, Z.A., Kahairi, A., Shahid, H.
    International Medical Journal Malaysia, 2012;11(2):54-57.
    MyJurnal
    We report two paediatric patients with massive head and neck plexiform neurofibromas who underwent surgical excision. We wish to highlight issues and implications pertaining to the surgery, in particular, the management of intraoperative bleeding often encountered in these cases.
  13. Fulltext Students perceptions about the immediate feedback assessment technique (If-At) in team based learning using pre-test versus post-test evaluation
    Hassan, Shahid, Begum, Imtiaz, Hassan, Nabiha Gul
    Education in Medicine Journal, 2018;10(1):25-34.
    MyJurnal
    Immediate feedback assessment technique (IF-AT) are self-scoring answer sheets, based on the
    concepts of immediate feedback for choosing the correct answer in multiple choice questions (MCQs)
    during group readiness assurance tests (GRATs) in team-based learning (TBL). IF-AT scratch card
    system rewards a student with partial credit for proximate knowledge. This technique motivates
    students to pursue learning with just-in-time feedback and gives them the opportunity for collaborative
    learning and analytic reasoning among group members. A rubric for partial credit is decided pre-hand
    depending upon the number of options used in MCQs. In this study, we assessed students’ perception
    about immediate feedback assessment technique before and after the training. To determine students’
    perception of the IF-AT scratch card system in instruction and assessment. Students perceptions
    about the IF-AT system has been explored using a 25-item questionnaire administered to 60 students
    assigned randomly to control and training groups using pre-test and post-test analysis. Paired-sample
    t-test and independent-sample t-test statistics were employed and the data was analysed. Descriptive
    statistics observed for mean (SD) was found greater in trained group = 58.48 (4.87) vs. control group
    = 66.43 (5.81) with t-statistics significant at p = < 0.001. A significant difference in mean (SD) of
    pre-test minus post-test scores (5.16) of control and trained group = 5.37 (4.85) and 10.53 (8.36)
    respectively was also found with independent t-test analysis. It was found highly significant with
    t = –2.92, p < 0.05 and the effect size of 78.1%, established by Cohen’s d criteria. The IF-AT system
    provides an individualised and instantaneous instruction as feedback in an assessment, which is
    marked with collaborative learning as in team-based learning. The IF-AT system promotes analytic
    reasoning with problem solving skills through partial credit for proximate knowledge. Students’
    perceive the concept of immediate feedback and partial credit for proximate knowledge as the most
    important features of the IF-AT scratch card system.
  14. Fulltext Double series resonant dc-dc converter with uniform voltage stress on high voltage transformers
    Nor Azura, Soib, Taib, Shahid, Iqbal
    Pertanika Journal of Science & Technology, 2017;25(101):187-196.
    MyJurnal
    This paper proposes a novel double series resonant dc-dc converter with uniform voltage stress on a
    transformer. It consists of a half-bridge inverter with two power switches (IGBTs), two series resonant
    tank, two high-voltage transformers and a symmetrical voltage multiplier circuit. A symmetrical voltage
    multiplier circuit is connected at the secondary side of the high voltage transformer to generate desired
    high voltage dc output. Due to use of voltage multiplier circuit, the proposed converter requires smaller
    turns ratio of the high voltage transformer, leading to reduction in size and volume of the transformer.
    The proposed converter operates in discontinuous current mode by varying the switching frequency of
    the converter. In a discontinuous current mode operation, all the power switches and output diodes of the
    rectifier circuit turn-on and turn-off under zero current switching conditions. Therefore, it has features
    of low switching losses and possibility of light-load operation. Besides, it costs less and is smaller in
    size compared with conventional double series resonant dc-dc converter. It also has a simple operating
    principle and suitable for high voltage and high power applications. Experimental results confirm the
    proposed converter performs better than the others.
  15. Fulltext LLC resonant converter with series-connected primary windings of transformer for PEV battery charging
    Shahid Iqbal, Imran Shahzad, M., Soib Taib
    Pertanika Journal of Science & Technology, 2017;25(101):85-94.
    MyJurnal
    This paper proposes a half-bridge LLC resonant converter with two resonant tanks for plug-in electric
    vehicle (PEV) battery charging. Each resonant tank is connected with one of the centre-tapped primary
    windings of the power transformer. Both resonant tanks are fed alternately by a half cycle of the switching
    pulse in one period. The converter is designed to operate below resonance zero-voltage switching (ZVS)
    region to reduce switching losses and to achieve output DC voltage range 250V-420V with 400V input
    DC voltage for depleted PEV battery. MATLAB Simulink is used to simulate the circuit with 1.5 kW
    maximum power and the simulation results show that the converter can meet the constant-current,
    constant-voltage (CC-CV) charging requirements of the depleted PEV battery.
  16. Fulltext Unilateral adductor vocal cord palsy treated with the titanium vocal fold medializing implant (TVFMI)
    Irfan M, Shahid H, Baharudin A, Friedrich G
    Med J Malaysia, 2009 Mar;64(1):89-90.
    PMID: 19852333 MyJurnal
    Vocal cord palsy secondary to recurrent laryngeal nerve injury may be attributable to trauma, infiltrating neoplasm, congenital cardiac anomaly and others. Regardless the causes, majority of unilateral adductor palsy cases are usually managed by speech rehabilitation in order to allow compensation. In selected cases, medialization procedure may be required to achieve a complete glottal closure during phonation. Multiple techniques have been developed to achieve this goal. This case report illustrates the recent advancement in vocal fold medialization procedure, which has not been widely practiced in Malaysia.
  17. Fulltext Serum high-sensitivity C-reactive protein and lipoprotein(a) levels: a comparison between diabetic and non-diabetic patients with coronary artery disease
    Shahid HS, Kurdi MI, Zohair AA
    Med J Malaysia, 2011 Jun;66(2):113-6.
    PMID: 22106689
    OBJECTIVE: The aim of this study was to compare high-sensitivity C-reactive protein (hsCRP) and Lipoprotein(a) levels [Lp(a)] levels between diabetic and non-diabetic patients with coronary artery disease (CAD).
    STUDY DESIGN: Cross sectional Study.
    PLACE AND DURATION OF STUDY: This study was conducted in the department of Physiology of College of Medicine & King Khalid University Hospital, King Saud University, Riyadh between August 2006 and December 2007.
    METHODS: One hundred and three individuals with CAD and 30 healthy individuals matched for age and BMI were studied. CAD patients were divided into two groups based on presence (n=62) and absence (n=41) of type 2 diabetes mellitus. Overnight fasting blood samples were collected, and analyzed for total cholesterol (TC), Triglycerides (TG), Low density Lipoprotein (LDL) and High density lipoprotein (HDL), Lp(a) and hsCRP. Data about CAD severity was obtained from medical records.
    RESULTS: Both groups of CAD without and with DM had significantly higher levels of Lp(a) [mg/dl] (25.58 +/- 25.99, 25.90 +/- 24.67 respectively) and hsCRP [mg/dl] (0.52 +/- 0.71, 0.82 +/- 0.78 respectively) when compared with healthy control subjects (Lp(a) =16.93 +/- 15.34 & hsCRP=0.27 +/- 0.21) [p<0.05]. Lp(a) levels between the two CAD groups were non significant. While, hsCRP levels were significantly high in CAD with DM compared to those without DM [p<0.05]. Gensini Score of CAD severity was also higher in CAD with DM [67.60 +/- 45.94] than those without DM [52.05 +/- 42.27, p<0.05].
    CONCLUSION: Elevated Lp(a) and hsCRP levels are associated specifically with angiographically defined CAD. However, hsCRP elevation but not Lp(a) is also associated with CAD in type 2 diabetes mellitus. Measurement of hsCRP and Lp(a) may be considered optional markers for better prediction of cardiovascular risk.
  18. Fulltext Intermaxillary tooth size discrepancy in a Pakistani population: A stereomicroscope versus digital caliper
    Shahid F, Alam MK, Khamis MF
    Eur J Dent, 2016 4 21;10(2):176-182.
    PMID: 27095892 DOI: 10.4103/1305-7456.178299
    OBJECTIVE: Comprehensive diagnosis and treatment planning are essential in a successful orthodontic practice. The purpose of this study is to determine and compare intermaxillary tooth size discrepancy (IMTSD) using traditional digital caliper (DC) measurement on plaster dental models and stereomicroscopic digital dental models (SM).

    MATERIALS AND METHODS: The samples were randomly selected from different states of Pakistan. Total 7168 variables were measured on plaster dental casts (128) and SM digital dental models (128) according to the selection criteria. For IMTSD, the 6 variable measured as for anterior tooth size (maxilla, mandibular), overall tooth size (maxilla, mandibular), Bolton's anterior ratios (BAR), and Bolton's overall ratios (BOR). The independent t-test and ANOVA were used for statistical analyses.

    RESULTS: Significant sexual disparities in the sum of anterior tooth size and overall tooth size via DC and SM methods. No significant sexual disparities for BAR and BOR. No statistically significant differences were found in BAR and BOR between DC and SM. No significant differences were found on IMTSD ratio among different arch length and arch perimeters groups.

    CONCLUSIONS: Norms were developed based on DC and SM for IMTSD. Sexual disparities were observed in the sum of teeth size. However, no significant differences in BAR and BOR for IMTSD between the two methods.

  19. Fulltext New prediction equations for the estimation of maxillary mandibular canine and premolar widths from mandibular incisors and mandibular first permanent molar widths: A digital model study
    Shahid F, Alam MK, Khamis MF
    Korean J Orthod, 2016 May;46(3):171-9.
    PMID: 27226963 DOI: 10.4041/kjod.2016.46.3.171
    The primary aim of the study was to generate new prediction equations for the estimation of maxillary and mandibular canine and premolar widths based on mandibular incisors and first permanent molar widths.
  20. Tropical stormwater nutrient degradation using nano-TiO2 in photocatalytic reactor detention pond
    Rad S, Shamsudin S, Taha MR, Shahid S
    Water Sci Technol, 2016;73(2):405-13.
    PMID: 26819397 DOI: 10.2166/wst.2015.465
    The photo-degradation of nutrients in stormwater in photocatalytic reactor wet detention pond using nano titanium dioxide (TiO2) in concrete was investigated in a scale model as a new stormwater treatment method. Degradation of phosphate and nitrate in the presence of nano-TiO2 under natural ultra violet (UV) from tropical sunlight was monitored for 3 weeks compared with normal ponds. Two types of cement, including ordinary Portland and white cement mixed with TiO2 nano powder, were used as a thin cover to surround the body of the pond. Experiments with and without the catalyst were carried out for comparison and control. Average Anatase diameter of 25 nm and Rutile 100 nm nano particles were applied at three different mixtures of 3, 10 and 30% weight. The amounts of algae available orthophosphate and nitrate, which cause eutrophication in the ponds, were measured during the tests. Results revealed that the utilization of 3% up to 30% weight nano-TiO2 can improve stormwater outflow quality by up to 25% after 48 h and 57% after 3 weeks compared with the control sample in normal conditions with average nutrient (phosphate and nitrate) removal of 4% after 48 h and 10% after 3 weeks.
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