Emphysematous pyelonephritis is a rare life-threatening condition caused by a severe acute necrotising infection of the renal parenchyma and its perinephric tissues, and it is commonly seen in diabetic patients. There is a rare association between emphysematous pyelonephritis and hepatic portal venous gas. Hepatic portal venous gas is an uncommon radiological finding, which implies a significant underlying abdominal disease. The management of emphysematous pyelonephritis has evolved from prompt nephrectomy to medical therapy. In the present report, we present a case of a diabetic woman diagnosed with bilateral emphysematous pyelonephritis with hepatic portal venous gas that was successfully managed medically despite the presence of poor prognostic factors, such as acute renal failure and thrombocytopenia.
BACKGROUND: There is growing interest in research on patient satisfaction with healthcare provider (HCP) communication as a measure of healthcare quality and HCPs' communication competency. This study aimed to determine the levels of patient satisfaction with healthcare provider-patient communication (HCP-PC) and its associated factors at the outpatient clinic at Hospital Kuala Lumpur.
METHODS: A cross-sectional study was conducted on a convenience sample in July 2012 using self-administered questionnaires for the data collection. Both overall and domain-specific satisfaction were measured, with the three domains being exchanging information (EI), socio-emotional behaviour (SB), and communication style (CS).
RESULTS: The findings show that 92.8% of the 283 respondents were satisfied with overall HCP-PC, 89.5% with EI, 91.3% with SB, and 72.2% with CS. Satisfaction was statistically higher among Malays for CS and higher among those with low education and poor health for EI, SB and CS. EI and overall communication satisfaction were also higher among patients who reported short wait times, and patients who were in gender concordance with their HCPs showed higher SB satisfaction.
CONCLUSION: Basic and continuous communication skills training and patient activation programs should be established to increase patient satisfaction. Health information technology use should be actively promoted to allow for structured and standardised information exchange between HCPs and patients.
KEYWORDS: communication; patient satisfaction; primary care
Study site: outpatient clinic at Hospital Kuala Lumpur
Azizam NA, Shamsuddin K
BACKGROUND: Few studies have employed the item response theory in examining reliability. We conducted this study to examine the effect of Rating Scale Categories (RSCs) on the reliability and fit statistics of the Malay Spiritual Well-Being Scale, employing the Rasch model.
METHODS: The Malay Spiritual Well-Being Scale (SWBS) with the original six; three and four newly structured RSCs was distributed randomly among three different samples of 50 participants each.
RESULTS: The mean age of respondents in the three samples ranged between 36 and 39 years old. The majority was female in all samples, and Islam was the most prevalent religion among the respondents. The predominating race was Malay, followed by Chinese and Indian. The original six RSCs indicated better targeting of 0.99 and smallest model error of 0.24. The Infit Mnsq (mean square) and Zstd (Z standard) of the six RSCs were "1.1"and "-0.1"respectively. The six RSCs achieved the highest person and item reliabilities of 0.86 and 0.85 respectively. These reliabilities yielded the highest person (2.46) and item (2.38) separation indices compared to other the RSCs.
CONCLUSION: The person and item reliability and, to a lesser extent, the fit statistics, were better with the six RSCs compared to the four and three RSCs.
KEYWORDS: analysis; rating scale; reliability; spirituality
16 years have passed since the idea was mooted in 1999 by five neurosurgeons in the corridors of Hotel Perdana, Kota Bharu. They were Dato' Dr Johari Siregar Bin Adnan, Dato' Professor Dr Ahmad Zubaidi Abdul Latif , Dr Azmin Kass Bin Rosman, Dato' Dr Mohammed Saffari Bin Mohammed Haspani and Professor Dato' Dr Jafri Malin Abdullah. They initiated the beginning of the first programme in Neurosurgery in Malaysia. The rest is history.
The workplace environment has a great influence on employees' health. Job dissatisfaction has been widely recognised as a workplace stressor that can influence employees' psychological and physical health statuses. However, job satisfaction is a multi-dimensional concept, and it is necessary to investigate its different facets and their unique consequences. Therefore, the aim of this study was to assess the relationship between the nine facets of job satisfaction and psychological health and somatic complaints (i.e., sleep disorders, headache, gastro-intestinal and respiratory problems).
Stem cell research has been extensively explored worldwide to enhance human health in medical setting. Nevertheless, there is currently no full understanding of the stem cell knowledge and attitude levels among student nurses in Malaysia. This study aimed to assess the level of stem cell knowledge, attitude toward stem cell application in medicine, and its association with years of education, among Universiti Sains Malaysia (USM) undergraduate nursing students.
The management of Enterocutaneous fistula (ECF) is challenging. It remains associated with morbidity and mortality, despite advancements in medical and surgical therapies. Early nutritional support using parenteral, enteral or fystuloclysis routs is essential to reverse catabolism and replace nutrients, fluid and electrolyte losses. This study aims to review the current literature on the management of ECF. Fistulae classifications have an impact on the calories and protein requirements. Early nutritional support with parenteral, enteral nutrition or fistuloclysis played a significant role in the management outcome. Published literature on the nutritional management of ECF is mostly retrospective and lacks experimental design. Prospective studies do not investigate nutritional assessment or management experimentally. Individualising the nutritional management protocol was recommended due to the absence of management guidelines for ECF patients.
Overexpression of beta-human chorionic gonadotropin (β-hCG) is frequently associated with germ cell tumours, especially choriocarcinoma. Ectopic secretion of β-hCG by non-small cell lung cancer is exceptional. We present an exceedingly rare case of pulmonary adenocarcinoma that secretes β-hCG. Our patient is a 62-year-old postmenopausal woman, a nonsmoker, who presented with a six-month history of progressive dyspnoea, associated with decreased appetite and significant weight loss. Her serum β-hCG was very high (11211.9 mIU/ml), which prompted investigations to exclude germ cell tumour. Radiological imaging revealed a 10-cm right lung mass with adrenal metastasis. No other focal lesions were detected. Microscopy of the lung biopsy specimen showed replacement of normal lung tissue by sheets of malignant cells, forming vague glands in some areas. Immunohistochemically, the malignant cells showed focal immunopositivity for thyroid transcription factor 1 (TTF-1), napsin A, cytokeratin 7 (CK7) and β-hCG. A diagnosis of β-hCG-secreting pulmonary poorly differentiated adenocarcinoma was rendered. Serum β-hCG level decreased significantly to 168.6 mIU/ml after the first cycle of chemotherapy. In conclusion, β-hCG expression in lung cancer should be recognised to facilitate prompt diagnosis and initiation of appropriate intervention.
Infective endocarditis (IE) is the one of the most important causes of increased mortality and morbidity among haemodialysis patients. The reason for this increasing prevalence of infection among these patients is the use of haemodialysis catheters during dialysis, as these patients are highly susceptible to infections that are easily transmitted via blood access points. The present case was a geriatric end stage renal disease (ESRD) patient who was readmitted to the hospital two days after her scheduled haemodialysis session with symptoms of nosocomial endocarditis. Her concurrent medical complications were hypertension, non-insulin dependent diabetes mellitus, and ischemic heart disease. Based on her previous medical history and current examination, the patient was suspected to have IE due to catheter related infection. The goal of therapy is to manage the comorbidities and infection by provision of appropriate treatment based on close monitoring of the patient condition.
Papillary thyroid carcinoma (PTC) associated with familial adenomatous polyposis (FAP) is rare. It is usually associated with the cribriform-morular variant of PTC, with unusual patterns on detailed histology examination. This variant is known to have a good prognosis. Papillary thyroid carcinoma associated with FAP commonly occurs in females in their 30s and rarely in the elderly. We report a case of a 69-year-old female presenting with thyroid swelling and a history of FAP.
Sekolah Menengah Sains Tengku Muhammad Faris Petra (SMSTMFP) and Sekolah Kebangsaan Kubang Kerian (3) (SKKK3) were selected by the Department of Neurosciences, Universiti Sains Malaysia (USM), in 2011 to be a 'school-based Neuroscience Club' via the 'Knowledge Transfer Programme (KTP) - Community' project. This community project was known as "The Brain Apprentice Project". The objectives of this project were to promote science and the neurosciences beyond conventional classroom teachings whilst guiding creativity and innovation as well as to assist in the delivery of neuroscience knowledge through graduate interns as part of the cultivation of neuroscience as a fruitful future career option. All of the planned club activities moulded the students to be knowledgeable individuals with admirable leadership skills, which will help the schools produce more scientists, technocrats and professionals who can fulfil the requirements of our religion, race and nation in the future. Some of the activities carried out over the years include the "My Brain Invention Competition", "Mini Brain Bee Contest", "Recycled Melody" and "Brain Dissection". These activities educated the students well and improved their confidence levels in their communication and soft skills. The participation of the students in international-level competition, such as the "International Brain Bee", was one of the ways future professionals were created for the nation. The implementation of Neuroscience Club as one of the organisations in the school's cocurriculum was an appropriate step in transferring science and neuroscience knowledge and skills from a higher education institution, namely USM, to both of the schools, SMSTMFP and SKKK3. The club members showed great interest in all of the club's activities and their performance on the Ujian Pencapaian Sekolah Rendah (UPSR) or Primary School Achievement Test and Sijil Pelajaran Malaysia (SPM) or Malaysian Certificate of Education examinations improved tremendously.
The management of musculoskeletal tumours has progressed tremendously over the past few decades. Limb salvage surgery has become a standard practise without compromising the oncological outcome. Patients generally will benefit with superior function and a better quality of life compared with definitive amputation. The multidisciplinary approach and advancement of surgeries are important to achieve patient survival and optimum function.
The detection and analysis of microsatellites is very important for the mapping of genetic diseases because they are commonly used as genetic markers. Microsatellite marker D19S884 has been associated with polycystic ovary syndrome (PCOS), the most common reproductive endocrine disease of women in their childbearing years. It is responsible for an estimated 70% of cases of anovulatory infertility. In this work, we detected microsatellites in DNA extracted from the blood of PCOS patients.
The endothelium plays a crucial role in maintaining vascular homeostasis by producing several vasodilating factors, including nitric oxide (NO), prostacyclin (PGI2), and endothelium-dependent hyperpolarisation (EDH); however, the balance between endothelial relaxing and contracting factors is disrupted in disease states such as diabetes mellitus and hypertension. Most reported studies of endothelial dysfunction in diabetes focused on the actions of NO; however, there is accumulating evidence demonstrating that in addition to NO, PGI2 and EDH are likely to contribute to the vasodilatation of blood vessels. EDH plays an important role as a regulator of vascular tone and reactivity in resistance and conduit arteries of animal models and humans. PGI2 only plays a minimal role in endothelium-dependent vasodilatation but may serve as an important compensatory mechanism in conditions in which NO and EDH activities are decreased. Further studies are needed to determine the exact roles of EDH and PGI2 in the development of endothelial dysfunction and clinical vasculopathy in humans with type 1 and type 2 diabetes.
Cleft lip and palate (CLP) is the most common orofacial congenital malformation in live births. CLP can occur individually or in combination with other congenital deformities. Affected patients experience a number of dental, aesthetic, speech, hearing, and psychological complications and have a higher incidence of severe dental conditions. The purpose of this study is to characterise the different types of dental anomalies that are frequently associated with CLP patients based on a literature survey.
Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a 'tsunami-like disaster'. Hospital Universiti Sains Malaysia was the only fully functioning hospital in the state and had to receive and manage cases from the hospitals and clinics throughout Kelantan. The experiences, challenges, and recommendations resulting from this disaster are highlighted from an emergency medicine perspective so that future disaster preparedness is truly a preparation. The history of how the health campus was constructed with the collaboration of Perunding Alam Bina and Perkins and Willis of Chicago is elaborated.
Clival chordoma is a rare primary bone tumour that arises from the remnant of the notochord and typically occurs in older adults. Upon imaging, the tumour can be seen arising from the clivus and causes clival destruction. This usually provides insight for a diagnosis. Here we present a case of a non-enhancing, pre-pontine mass that was hypointense on T1W and hyperintense on T2W in an adolescent. No clival bone erosion was observed. Based on the age group, imaging findings, and lack of clival erosion, a provisional diagnosis of epidermoid cyst was made and the tumour was resected. This patient was eventually diagnosed with a clival chordoma based on histopathological examination.
The Malaysian Journal of Medical Sciences and the Orient Neuron Nexus have amalgated to publish a yearly special issue based on neuro- and brain sciences. This will hopefully improve the quality of peer-reviewed manuscripts in the field of fundamental, applied, and clinical neuroscience and brain science from Asian countries. One focus of the Universiti Sains Malaysia is to strengthen neuroscience and brain science, especially in the field of neuroinformatics.