Dengue virus infection has been endemic in Malaysia and in the region for decades and the disease caused by the virus has led to increased morbidity and mortality each year. Dengue is now endemic in more than 110 countries worldwide with two-fifths of the world's population at risk. Dengue fever is a flu-like illness and clinical features vary with the age of the patient. Dengue haemorrhagic fever on the other hand, is characterized by high fever, haemorrhagic phenomena and in severe cases, circulatory failure. There is no specific treatment for dengue fever but careful clinical management frequently saves the lives of these patients. Vaccine development has been difficult as protection against one or two dengue viruses could actually increase the risk of more serious diseases. At present, the only method of preventing dengue is to combat the vector mosquitoes. Dengue is diagnosed by viral isolation and or serology. Current methods, some in-house and others commercial, are far from satisfactory. My laboratory has developed, evaluated and validated tests for dengue that now enable detection on the first day of illness in most cases. At the same time an important aspect of dengue prevention is protection. To this end, we have been investigating the various immune parameters such as T-cells, cytokines and antibody neutralizing activities to show that specific immune responses do occur in a selected Malaysian population which are HLA restricted, cytokine mediated and directed specifically at certain regions of the virus.
The crux of the current health problem is the alarming increase of dengue cases in the country. Dengue fever is endemic in Southeast Asia with Malaysia seeing dengue cases surge since 2003. The Health Minister of Malaysia has reported that the acute increase in dengue cases is worrying and could hit the country's productivity, tourism industry and economy.(Copied from article).
MeSH terms: Asia, Southeastern; Clergy; Dengue; Equipment Failure; Industry; Malaysia
Malaysia is a country consisting of people of Malay, Chinese and Indian ethnic origin and also of some Indonesian and Thai population. In this study of acute pancreatitis, the age group, sex incidence, clinical
features, complications and treatment were compared between different ethnic groups. A total of fifty-four consecutive patients admitted in Sungai Petani Hospital, Kedah, Malaysia with acute pancreatitis from 2002 to 2004 were taken for this study. There were 29 males and 25 females. The 40–60 years age group was more commonly involved. The common factors associated with acute pancreatitis were alcohol intake in males and biliary disease in females. Two females suffered from acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). One of the 54 cases died due to multi-organ failure.
MeSH terms: Alcohols; Cholangiopancreatography, Endoscopic Retrograde; Ethnic Groups; Female; Gallbladder Diseases; Humans; Malaysia; Male; Multiple Organ Failure; Pancreatitis; Incidence; Asian Continental Ancestry Group
The presenting signs of acute leukaemia occur as a result of bone marrow failure and organ infiltration. Increased bleeding tendencies are seen on the skin, gums and mucosal lining. Bleeding in the posterior segment of the eye, namely the retina and vitreous, may occur, but do not usually cause any visual disturbances. This case demonstrates visual loss as a result of premacular subhyaloid haemorrhage in acute leukaemia.
Substance abuse is one of the leading and most complicated health and social problems faced by our country. Unfortunately, after three decades of managing these problems, outcomes are unpromising and poor.(Copied from the article).
MeSH terms: Face; Social Problems; Substance-Related Disorders
A retrospective cross-sectional study of injury patients who attended the Accident and Emergency Unit was conducted at the University of Malaya Medical Centre. Demographic data with regards to age, sex, race, occupation and the relevant data such as type of accident, type of injury sustained and also severity seen during the month of January 2005 were selected retrospectively from medical record. The objectives were to review road traffic accidents and their severity of injuries among the patients. There were two hundred and forty-three (197 males and 46 females) patients involved: 60% Malays, 16% Chinese, 21% Indians and 3% other ethnic groups. Peak accidents occurred among the 21 to 30 years age group. Among the type of accidents, 65.8% involved motorbike riders, 10.3% car drivers, 8.6% pillion riders, 7.8% car passengers, 5.8% pedestrians and 1.6% were bicycle rider injuries. About 57.6% sustained minor injuries and 42.4% major injuries. There was no significant association between outcome of road traffic accidents and sex, age group and race. However, there was a significant association between type of accidents and severity of injuries (p = 0.014). Males sustained more major injuries and motorbike accidents were the highest among road injuries. Therefore, further prevention and control with emphasis on behavioural changes, education and law enforcement may reduce the number of road traffic accidents in the future.
MeSH terms: Accidents, Traffic; Pedestrians; Bicycling; Cross-Sectional Studies; Demography; Emergency Service, Hospital; Ethnic Groups; Female; Humans; Male; Medical Records; Motorcycles; Occupations; Retrospective Studies; Off-Road Motor Vehicles; Law Enforcement
Over the years, the emphasis on research practices in healthcare has received more recognition than the emphasis on teaching practices. Also, in contrast to the strong focus on aligning care-giving practices with evidence of effectiveness; aligning educational practices with evidences of effectiveness has continued to be neglected. This creates a chasm that hinders the delivery of effective health practices. Many challenges in the current healthcare delivery system warrant a call for a revamp of health professionals' education, and for a greater focus in effective teaching, assessment and supervision. This paper highlights the current challenges in health professional education (as revealed by the Institute of Medicine, IOM, 2003). It focusses on five key issues for promoting teaching excellence, and supports the move for new lecturers to be educationally trained so that 'teaching for learning' becomes current, effective and enjoyable. More importantly, the vision for health professional education that "all health professionals are educated to deliver patient-centred-care as members of an interdisciplinary team, emphasising evidence-based practice, quality improvement approaches, and informatics" can be attained. This vision has important implication for medical lecturers as it means they have to be better educated to teach in order to be prepared to meet the demands of a reformed healthcare system.
MeSH terms: Academies and Institutes; Education, Professional; Health Personnel; Humans; United States; Institute of Medicine (U.S.); Patient-Centered Care; Interdisciplinary Studies; Quality Improvement
Educational environment of an institution is the environment experienced or perceived by students and teachers. Individual students and teachers will respond differently to these subtle elements in their learning experience. Curriculum's most significant manifestation and conceptualisation is the environment. There is a proven connection between the environment and the valuable outcomes of students' achievement, satisfaction and success. If one wants to describe, assess or get a handle on the curriculum in a medical school, then the educational and organisational environment or total milieu associated with the curriculum and the medical school needs to be studied. Educational environment is one of the most important determinants of an effective curriculum. Educational environment fosters scholarly or intellectual activities; it encourages friendliness, co-operation and supportiveness. It also fosters the learning, growth and development of students. Students' perceptions of their educational environment are a useful basis for modifying and improving the quality of educational environment. Several research groups over the years have attempted to identify and quantify the presence and impact of rather intangible aspects of a learning environment. Each study has used different survey questionnaires to solicit student reactions.
MeSH terms: Achievement; Curriculum; Learning; Perception; Personal Satisfaction; Surveys and Questionnaires; Research; Schools, Medical; Students; Problem-Based Learning; Growth and Development
Priapism is a urological emergency. The treatment for ischaemic priapism is usually cavernosal aspiration with or without cavernosal irrigation. Some patients may need surgical intervention -the various shunt procedures. We report a 21-year-old man with priapism secondary to chronic myeloid leukemia who needed a combined medical and surgical management. He underwent a spongiocavernosal shunt as well as cytoreductive chemotherapy to achieve complete detumescence. Therefore, cytoreductive chemotherapy is an adjunct in difficult cult to treat priapism associated with chronic myeloid leukemia.
MeSH terms: Health Services; Humans; Male; Priapism; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Prostheses and Implants; Cytoreduction Surgical Procedures
What does this term medical education conjure up? Does it refer to the teaching and learning of medicine and therefore relates to students and the curriculum? Does it refer to the process of teaching and therefore relates to teachers? Perhaps it is both, since teaching and learning go hand in hand.(Copied from article).
MeSH terms: Curriculum; Education, Medical; Learning; Malaysia; Medicine; Students
Oral cavity malignancy reconstructive surgery has advanced from pedicle flaps to microvascular free tissue transfer. Previously, reconstruction of these defects were done using radial forearm free flaps in this centre. We report our experience using anterolateral thigh free flap in a 49 year old lady with squamous cell carcinoma of the tongue. Excision of tumour left a defect which was later reconstructed using microvascular free tissue transfer using the right anterolateral thigh free flap. The flap was well taken up at the recepient site and no evidence of flap failure noted post operatively and on completion of radiotherapy. She was able to maintain comprehensible speech and swallowing ability.
Desmoplastic ameloblastoma (DA) is a relatively rare histological variant of ameloblastoma. DA do not present with radiographic or clinical features that are typical of other variants of ameloblastoma. On gross examination, DA appears as a solid mass, unlike the conventional ameloblastoma that contains fluid-filled spaces. Although radiographic examination of ameloblastomas usually reveals unilocular or multilocular radiolucency, DA may appear as a mixed radiopaque-radiolucent lesion. Histologically, DA is characterized by small nests and strands of “compressed” odontogenic epithelium supported by pronounced collagenized stroma. This report describes the case of a 30-year-old male with DA of the left mandible.
Follicular adenoma defined as a well encapsulated benign neoplastic condition of thyroid follicles. We describe this interesting case of a boy presented with right sided neck swelling that was diagnosed as a branchial cyst but later after excision, the histopathology revealed follicular adenoma of the thyroid with hemorrhage and degenerative changes in the centre. To our knowledge, this is the first reported case of follicular thyroid adenoma presented as branchial cyst.
MeSH terms: Adenoma; Branchioma; Head and Neck Neoplasms; Humans; Male; Neck; Thyroid Neoplasms; Viscera
Leiomyomas are the most common benign tumour of the uterus, occurring in 20-40% of women in reproductive age.Most of the myomas arise in the uterus, however extrauterine sites include fallopian tubes, cervix, round ligament, ovary and urethra. A single or polypoidal mass in the vagina is usually a leiomyomatous polyp arising from the cervix or from the cavity of the uterus. Leiomyoma developing de novo from the fibromuscular elements of the vagina is a rare entity. When such a tumour arises from anterior wall of the vagina it is often mistaken for a cervical fibroid. Parasitic leiomyoma is the rarest type of leiomyoma and develop when a leiomyoma attaches itself to another organ. Vaginal leiomyomas usually arise from anterior vaginal wall. We report a case of parasitic leiomyoma in the vagina together with uterine leiomyoma in a 48 year old lady presented with palpable mass perabdomen and anaemic symptoms. The size and location of the tumours necessitated abdominal and vaginal approach for better surgical access.
Meningiomas with intracranial haemorrhage is a rare occurrence and carries a high mortality rate. We present here a case we encountered, where intratumoural, subdural and intraventricular haemorrhage occurred. The pathophysiology and mechanism of intracranial tumoural haemorrhage, is discussed.
Glaucoma is a major cause of permanent visual loss in patients with sarcoid uveitis.In this case glaucoma occurred early in the course of the disease and IOP started to rise up after one month from the initial presentation. Uveitic glaucoma can be extremely difficult to treat; pilocarpine is not normally used in eyes with active inflammation. Patients with uveitis respond poorly to laser trabeculoplasty, and filtering procedures usually fail. Success of modified goniotomy, trabeculectomy and Molteno valve implantation were reported. More drastic therapy, such as cyclodestructive procedures, may be required in the most severe cases. In this case the challenge in preserving the vision. by keeping the balance between the need to control the inflammation and the necessity to avoid the treatment related complications.
Background: The approach to the teaching of ethics and professionalism in the Faculty of Medicine (FM) of International Islamic University Malaysia (IIUM) is unique. A specifically designed package is incorporated designated as the Islamic Input into the Medical Programme (IIMP). The IIMP spans over the entire 5 years of the medical programme. In the Faculty of Allied Health Sciences (FAHS) students do not go through a similar Islamic Input module but exposed to ethical issues specific to health sciences. Method: The aim of this study is to assess the impact of the teaching of ethics through the IIMP. A cross-sectional study was conducted in medical and allied health sciences faculties of IIUM. In total 259 students volunteered and were allocated to 4 groups, Years 2 and 5 students of FM and Years 2 and 4 of FAHS. A set of questionnaire consisting of 20 vignettes related to medical ethics was distributed to all students. An independent t-test was used to compare the mean total scores between the groups. Results: A significant difference (p < 0.05) was seen between the mean total scores for the Year 2 and Year 5 students of FM; Year 2 students of FM and Year 2 students of FAHS; and between the Year 5 students of FM and Year 4 students of FAHS. Also there was significant difference between the two medical and allied health sciences groups as a whole. Discussion: This study suggests that the IIMP of the IIUM has a positive impact on the medical students when dealing with ethical issues. The Year 5 medical students were expected to have obtained a higher mean total score. The probable reason for the lower mean total score include the teaching-learning approach utilized which is mainly lecture with minimal small group approach. Also the allocation of marks for medical ethics in summative assessment in the IIUM medical curriculum is minimal compared to the core medical subjects which would have some influence on the weight given by students. Conclusion: The Medical Faculty of IIUM believes that the approach to the teaching of medical ethics by incorporating the Islamic Input module is effective, practical and relevant. However the teaching-learning method and the assessment will have to be re-addressed to achieve greater impact.
Background: Historically, more men enrolled in medical schools than women. However, during the last few decades, there has been an increase in the number of women attending medical schools worldwide. Although a similar trend is seen, there is no documentation found in Malaysia. In this present study, we investigated if such gender enrolment differences occurred at our medical school. Methods: Information was obtained from Kulliyyah of Medicine student statistic for 2006/2007 section and graduates from 2001/2002 (1st batch) to 2006/2007. Results: Our study showed that more than half (60%)of our students are female and all students who received distinction in final year exam from 2002 till now are females although the number of males who needed to sit for the supplementary examination outnumbered the females during that period. Discussion: The feminization of medicine in International Islamic University Malaysia (IIUM) was similar to other studies worldwide. Further research should be aimed on comparison of the academic performance of male and female medical students and also choice of specialty chosen by men and women in our university.
Background: The Medical Faculty of the International Islamic University Malaysia (IIUM) runs an undergraduate medical programme which is a combination of the traditional and the newer trends of medical curriculum. The IIUM curriculum in Phase I (Years 1, 2: preclinical) is integrated organ system based, with lectures being the main method of curriculum delivery and also incorporating problem-based learning (PBL) as one of the teaching-learning approaches. Methods: The aim of this study is to examine the effectiveness of PBL teaching-learning method in IIUM in achieving the aims of the medical school as viewed by the students. A total of 287 students from Phase I and Phase II (Year 3: clinical) participated in this study at the end of academic session 2006/2007. The questionnaires distributed consisted of 33 items with four different aspects of PBL being evaluated namely; i) PBL objectives, ii) assessment of performance of the facilitators, iii) assessment of the PBL packages and iv) preferred teaching-learning approach. Results: An average of 86.4 % of students agreed that PBL sessions achieved its aims of preparing students for professional training in the clinical years. Also approximately 80% of students felt that the facilitators fulfilled their roles as PBL tutors. Students were generally satisfied with the PBL packages prepared. However about 50% of Year 2 students did not look forward to PBL sessions and only about 20% of preclinical students wanted more PBL sessions to be scheduled. This latter finding differed as 60% of the clinical (Year 3) students wanted more PBL sessions to be implemented. A significant proportion of the students also believed that they needed some prior information about the PBL case in question in order to generate lively exchange of ideas in the first sessions. Preclinical students preferred lectured-based approach as compared to PBL in contrast to the clinical (Year 3) students of whom 57% (62) preferred the PBL teaching-learning approach. Nearly 80% of the Year 3 students found the exposure to PBL sessions during their preclinical years beneficial during the clinical year. Discussion: Although our findings supported the effectiveness of PBL as one of the teaching-learning approaches (as perceived by our students) there are a few areas of concern. These include believing that a prior knowledge of the topic in question is needed to generate a lively discussion; the group not being motivated; the group members confining themselves to individual assignments only; PBL not being supportive of on-going self- assessment; the consequence of a facilitator being too dominant; and cases constructed do not reflect real clinical scenarios. Despite agreeing to its effectiveness preclinical students still preferred lecture-based approach to the PBL as they are more confident with the knowledge as obtained through the former learning modality. Conclusion: PBL is an effective learning strategy and it contributes to the teaching-learning process of IIUM undergraduate preclinical medical programme which implements a non-Problem Based Curriculum. We are of the opinion that a combination of lecture sessions and PBL best suit the IIUM medical students.
Introduction: Melioidosis, an infection caused by Burkholderia pseudomallei is endemic in South East Asia and Northern Australia. It can affect many organs in the body such as lung, liver, spleen, bone, prostate, brain and soft tissues. Objective: This study aims to detect the presence of prostatic abscess in patients with a positive blood culture for Burkholderia pseudomallei with computed tomography (CT) of the abdomen and pelvis and to correlate it with the clinical presentation. Materials and Methods: This is a prospective observational study conducted in all melioidosis patients who had CT scan of the abdomen and pelvis. The location and size of any focal lesions seen on CT were recorded. Clinical data such as fever and urinary symptoms were also recorded. Results: 15 patients had CT scan of the abdomen and pelvis. Five patients were diagnosed to have prostatic abscess. Out of the five patients, only two had urinary symptoms. The other three had prolonged high grade fever without any urinary symptoms. Conclusions: Melioidosis prostatic abscess is not uncommon in patients with positive blood culture of Burkholderia Pseudomallei (33% in this series). Most patients do not present with any urinary symptoms.