A thirty two year old taxi driver presented with cotnplaints of headache, nausea, vomiting and blurring of vision of the left eye of two days duration. He was found to have an acute anterior uveities and secondary glaucoma. On further examination patient was also found to have a neuroretinitis and phlebitis in the same eye. A worm was found in the anterior chamber and it was removed via a limbal incision under local anaesthesia. The worm-like structure sent to the Department of Parasitology was identified as Gnathostoma spinigerum. he patient was treated with topical eye drops and oral steroids at the same time to reduce the inflammation. No neurological symptoms were seen. The patient was not available for further evaluation and followup. KEYWORDS: Blurring of vision, Gnathostomiasis
This paper involves the obtained results of an "Elective Program" project which was carried out by Phase I Medical Students of the 1998-1999 academic year at the Faculty of Medicine (FOM), University of Malaya (UM). A questionnaire was designed to survey the attitudes of teachers at FOM-UM, the subject of choice of a 4-student group who were supervised by a faculty member. Students obtained a list of faculty members (teachers) of all academic departments from the Dean's Office and rehearsed their interviewing skills prior to collecting the data of the questionnaire, within a 1-week period. Respondents were 146 out of 275 in total (53%), which included all academic ranks and clinical and non-clinical teachers. Results showed that respondents were well qualified, have enough teaching experience and teach in a variety of forms. All teachers liked to teach and were motivated; however, 15% felt unhappy about their teaching and 6% did not think that their teaching was effective. The nlajority (96%) of teachers liked their teaching to be evaluated and many revealed several means to assist and 111otivate students. Teachers felt that there was room for improvenlent in the aspect of student-teacher interactions. Results of this project revealed that FOM-UM is well endowed by qualified, motivated and caring teachers who wish for better interactions with their students. I
Adults with Growth hormone (GH) deficiency is now being recognised to display many distinct clinical, metabolic and psychological abnormalities. It has been demonstrated that GH deficient (GHD) adults display features of multiple insulin resistant syndrome (MIRS) which predispose the GHD adults to increased cardiovascular morbidity and mortality. These features include central obesity, insulin resistance and glucose intolerance, hypertension, dyslipidaemia that includes a reduced level of high density lipoprotein cholesterol, an elevated triglyceride level and sniall low density lipoprotein cholesterol size. Furthermore, GHD adults are found to have a lower bone mass and a reduced sense of well-being. Replacement of G H in these GHD adults has brought about a major itnproveliient in psychological well-being and central obesity. The improvement of some of the lipid abnornialities is however more modest. Insulin resistance, the corner stone of MIRS, is however not altered by G H replacement. Long term data is as yet unavailable to assess if GH replacement reduces cardiovascular mortality and morbidity in these subjects. KEYWORDS: Growth hormone, Horlnoiie deficiency, Diabetes niellitus, Central obesity, Hyperlipidaemia, Hypertension.
A case of penetrating cardiac injury is reported where cardiorrhaphy is done without cardiopulmonary bypass and via a right thoracotomy even though median stelnotoluy is the usual approach. It is also stressed that all precordial stab wounds must be carefully explored. KEYWORDS: Penetrating cardiac injury, Without cardiopulmonary bypass, Right posterolateral thoracotomy, Centrally placed chest injury.
Problem-based learning (PBL) i s an educational reform that is now becoming a household word in higher education, particularly in medical schools. Many medical schools have implemented a full problem-based learning curriculum (PBLC) whiIe some have included PBL into selected units of the course in an otherwise conventional cumculum (embedded PBL) and others run their tutorials in a PBL manner within a modified conventional curriculum (hybrid curriculum). Yet there are others who claim that small components of PBL in a conventional curriculum are not PBL at all. Thus amateurs in the subject matter find difficulty in evaluating the logistics and outcome of these variations. This article focuses or, the general characteristics of PBL and how this learning method can help enhance independent learning and critical thinking, whether in a full, embedded or hybrid curriculum. The extent of PBL to be included and which of the three types is to be adopted depends on the objective of the undergraduate medical course as determined by the faculty, resources available, limitations, feedback on the existing curriculum and various other factors. KEYWORDS: Problem-based Learning (PBL); Embedded PBL; Hybrid PBL; New Integrated Curriculum (NIC).
Accidental entry of insects and other arthropods is a common aetiology of aural foreign bodies (FB) presenting to accident and emergency departments. A retrospective study revealed that the FB in almost half (148) of 348 cases of aural FB investigated at the Universiti Sains Malaysia Hospital was an arthropod. The most common arthropod encountered was the cockroach, followed by a cattle tick. The high prevalence of tick infestation of the human ear canal (i.e. human otoacariasis) currently appears to be unique to the Malaysian state of Kelantan. The presentation of patients with intra-aural ticks, the methods used to remove the ticks, the complications encountered, and recommendations for an appropriate course of action in such cases are discussed.
Comment on: Yeo CK, Khalid Y. Solitary focal coronary artery aneurysm in a middle aged
male with atypical chest pain. Med J Malaysia. 1999 Mar;54(1):114-6
This study was carried out to determine the nutritional status of 16 elite netball players of the Commonwealth Games 1998, during centralised training at Bukit Jalil. The mean age of the subjects was 21.1 ± 3.1 year. The physical characteristics were assessed through antropometric measurements. The dietary intake was estimated as a mean of 3-days weighed food record while the physical activity pattern was determined by time and motion study which was carried out simultaneously. A biochemical analysis test was carried out to evaluate the haemoglobin status of the athletes. The results indicated that the mean body weight and height were 62.5 ± 7.9 kg and 1.69 ± 0.06 meter, respectively. The percentage average body fat of the subjects was 23.7 ± 2.8. Mean energy intake was recorded as 2726 ± 507 kcal/day while energy expenditure was 3225 ± 409 kcal/d with a negative energy balance of 499 kcal. The contribution of calories from carbohydrate, protein and fat were 59%, 16% and 26%, respectively. Intake of most micronutrients was sufficient and met the Malaysian RDA. The percentage average of the daily physical activity pattern revealed that 74% was spent for light activities, 12% for moderate while 14% for heavy activities. 94% of the athletes took supplements which vitamin C was the most popular (64%).
MeSH terms: Adipose Tissue; Ascorbic Acid; Body Weight; Energy Intake; Energy Metabolism; Hemoglobins; Motor Activity; Nutritional Status; Time and Motion Studies; Micronutrients; Dietary Supplements; Athletes
This comparative study was conducted to determine the anthropometric measurements and body composition of football teams in the UK and Malaysia. A total of 32 footballers from two teams were studied. The teams were the St Mary’s University team (UK) and the Selangor Reserved League team. The height and body weight of the subjects were measured using SECA digital balance with height attachment. Skinfold thickness measurements were taken using Harpenden skinfold callipers at four sites (biceps, triceps, subscapular and suprailiac) and the VO2 max of the subjects was estimated by participation in a multi-stage 20m shuttle-run test. The UK team were significantly heavier (p
MeSH terms: Body Composition; Body Weight; Football; Malaysia; Skinfold Thickness; Soccer; Universities
A longitudinal study was conducted to relate basal metabolic rate (BMR) with growth during adolescence. Subjects comprise 70 boys and 69 girls aged between ten and thirteen years at the time of recruitment. Parameters studied include anthropometric measurements and BMR, which was measured by indirect calorimetry using the Deltatrac metabolic monitor. Measurements were carried out serially once every six months, with a total of 713 BMR data points collected over three years. Mean BMR of boys aged 11, 12, 13 and 14 years were 4.96 ± 0.63 MJ/day, 5.28 ± 0.71 MJ/day, 5.73 ± 0.68 MJ/day and 5.92 ± 0.63 MJ/day, respectively; while mean BMR of girls in the 10, 11, 12 and 13 year age groups were 4.96 ± 0.63 MJ/day, 4.85 ± 0.63 MJ/day, 5.05 ± 0.55 MJ/day and 4.94 ± 0.51 MJ/day, respectively. Comparison of measured BMR with BMR values predicted from the FAO/WHO/UNU (1985) equations shows that the predictive equations overestimated the BMR of Malaysian boys by 3% and that of girls by 5%. The Henry & Rees (1991) equations for populations in the tropics underestimated BMR of boys and girls by 1% and 2%, respectively. Linear regression equations to predict BMR based on body weight were derived according to sex and age groups. It is recommended that these predictive equations be used for the estimation of BMR of Malaysian adolescents.
The effect of nicardipine on fasting plasma lipid profiles was studied in rabbits given a 2% cholesterol diet. Twenty four New Zealand White rabbits (2.2 - 2.8 kg) were divided into 3 groups. Group 1 (control) was fed a normal diet, group II (HC) was fed a 2% cholesterol diet and group III (HC+NICA) was fed a 2% cholesterol diet with nicardipine treatment (0.5mg kg-1 body weight twice daily intramuscularly for 10 weeks). The following parameters which included fasting plasma total cholesterol, triglycerides, HDL cholesterol and apolipoprotein A and B were measured before and after 10 weeks of study. In the present study we observed that a 2% cholesterol diet caused a significant increase in plasma total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. However, the increase in total cholesterol and LDL cholesterol were not prevented by treatment with nicardipine. Nicardipine appeared to cause further increase in HDL cholesterol and prevented further rise in plasma triglycerides after 10 weeks of treatment.
A 47 year old Chinese housewife with a silicone gel-filled implant mammoplasty carried out 10 years ago presented with a palpable painless lump in the right breast. Excision biopsy revealed infiltrating ductal carcinoma. Right simple mastectomy and axillary sampling was done followed by chemotherapy and radiotherapy. The history, safety, potential complications of silicone breast implants are reviewed and discussed.
A morphine-like spasmolytic action (not naloxone reversible; involving the inhibition of acetylcholine release) and also effects on the transmural transport of electrolytes (Na+ and K+) and water have been reported as possible modes of the antidiarrhoeal action of polar fractions of Psidium guajava leaf extractives. Fresh leaves of Psidium guajava collected from the vicinity of the campus of the Universiti Sains Malaysia, Kelantan State of Malaysia, were washed in water and air-dried at a room temperature of 22 0C. The material was then oven-dried at 60 0C for 3 days, machine-ground into a coarse powder, and extracted with methanol (75%) for a total of 48 hours. The extract was centrifuged for 15 min. at 2,000 rev/min, and the supernatant was dried by rotary evaporation. A stock solution of 200 mg/ml in sterile distilled and deionised water was prepared, and the pH was adjusted to 7.2 with 0.01N HCl.The objective for this study was to verify if the reported modes of the antidiarrhoeal action should be broadened to include direct antimicrobial actions on some of the more common bacteria known to cause toxin-induced acute diarrhoea. Serial dilutions of a watersoluble, freeze-dried methanolic extract were tested on 10 such organisms, grown separately on nutrient agar plates, to determine the minimum inhibitory concentration (MIC) for each of these bacteria. These included the causative agents for (i) enteric fever (Salmonella typhi, Salmonella paratyphi A, Salmonella paratyphi B and Salmonella paratyphi C), (ii) food poisoning (Salmonella typhimurium and Staphylococcus aureus), (iii) dysentery (Shigella dysenteriae, Shigella flexneri and Shigella sonnei), and (iv) cholera (Vibrio cholerae). The growth of all these organisms was inhibited at the MIC of 10mg/ml of the extract, which is equivalent to 2.5µg/ml of active extractable flavonoids . The most sensitive organisms (MIC = 1mg/ml) were Staphylococcus aureus, Vibrio cholerae and Shigella flexneri.
The population in Malaysia use various types of health and food supplements. These products are considered safe and are used without any concern for their toxicity. Among the products used as health supplements are products that contain lactic acid bacteria. This project studied the acute and subacute toxicity of a product containing minerals, herbs, vitamins and live lactic acid bacteria, on Sprague- Dawley rats. Acute toxicity was tested 24 hours after a single dose and subacute toxicity was studied 24 hours after 7 days of daily dosing. The parameters that were studied were alanine aminotransferase (AL T,SGPT), aspartate aminotransferase (AST, SGOT), serum urea, ratios of weight of kidney and liver weight to body weight and percentage changes in body weights. The contents of capsules of the product (6, 8 or lO capsules for acute studies and 6, 10 and 12 for subacute studies) were mixed with corn oil and fed orally to rats. Control rats were fed with corn oil alone. In the acute studies, the level of ALT in the rats treated with the contents of the capsule was lower than controls. There were no significant changes in the other parameters of the rats in the treatment groups as compared to controls. There were no significant differences in all the parameters between rats in the treatment groups as compared to controls in the subacute studies. Sprague-Dawley rats fed with high doses of the product did not show signs of toxicity in the parameters that were studied.
Ludwig's angina is a rare type of facial infection usually reported in adults. This paper presents a case of Ludwig's angina infection occurring in a 3 year-old Malay boy. The dentists must be able to detect such presentation early. Hospitalization for monitoring of airway is essential.
Chlorhexidine gluconate and hexitidine have been used in many oral health care products as antiplaque and antigingivitis agents. Based on the clinical observations and the plaque and gingivitis scores, chlorhexidine gluconate has been reported to be a better agent. In this study, the anti-adherence properties of chlorhexidine gluconate and hexitidine on individual bacteria strains isolated from a 3-hour plaque (Streptococcus sanguis, Streptococcus mitis 1 and Actinomyces sp.) and on a whole 6-hour plaque culture were determined and compared. The study showed that chlorhexidine gluconate inhibited almost 100 % the adherence of the individual bacteria strains and 87.7 % the adherence of a whole 6-hour plaque culture to the saliva-coated glass surface. Hexitidine appeared to be more selective in its effect. It was shown to inhibit the adherence of S. sanguis and Actinomyces sp. to saliva-coated glass surface by 86.5 % and 51.4 % respectively. Its effect on the S. mitis 1 strains is comparable to that of a whole 6-hour plaque culture where inhibition to adherence were less than 4 % for both.