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Myocardial infarction false alarm: initial electrocardiogram and cardiac enzymes

Gupta ED, Sakthiswary R

Asian Cardiovasc Thorac Ann, 2014 May;22(4):397-401.
PMID: 24771726 DOI: 10.1177/0218492313484917

The objectives of this study were to determine the incidence of a myocardial infarction "false alarm" and evaluate the efficacy of the initial electrocardiogram and cardiac enzymes in diagnosing myocardial infarction in Malaysia.
Fulltext A tile factory worker presenting with breathlessness and dry cough

Khajotia R, Gupta ED

Aust Fam Physician, 2009 Oct;38(10):803-4.
PMID: 19893821

Jenny, a nonsmoker, 54 years of age, presents with 3 years of dry cough, progressive breathlessness and reducing exercise tolerance. Two years ago she was diagnosed with asthma and treated with inhaled bronchodilators (which have been marginally effective). Jenny has worked in a tile factory for 22 years; 15 years in the grinding department, transferring to the chipping department 7 years ago. On examination she is tachypnoeic with a prolonged expiratory phase. There are bilateral rhonchi and a few fine crepitations at the left infrascapular region. Jenny's full blood count and electrocardiogram are normal. Arterial blood gas show mild hypoxia with respiratory alkalosis. Spirometry demonstrates mixed moderate obstructive and restrictive impairment. The diffusion capacity for carbon monoxide is reduced. Mantoux is negative and erythrocyte sedimentation rate is 10 mm/hour. A chest X-ray is taken.
Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism: epidemiology, metabolism and the associated diseases

Liew SC, Gupta ED

Eur J Med Genet, 2015 Jan;58(1):1-10.
PMID: 25449138 DOI: 10.1016/j.ejmg.2014.10.004

The Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism is associated with various diseases (vascular, cancers, neurology, diabetes, psoriasis, etc) with the epidemiology of the polymorphism of the C677T that varies dependent on the geography and ethnicity. The 5,10-Methylenetetrahydrofolate reductase (MTHFR) locus is mapped on chromosome 1 at the end of the short arm (1p36.6). This enzyme is important for the folate metabolism which is an integral process for cell metabolism in the DNA, RNA and protein methylation. The mutation of the MTHFR gene which causes the C677T polymorphism is located at exon 4 which results in the conversion of valine to alanine at codon 222, a common polymorphism that reduces the activity of this enzyme. The homozygous mutated subjects have higher homocysteine levels while the heterozygous mutated subjects have mildly raised homocysteine levels compared with the normal, non-mutated controls. Hyperhomocysteinemia is an emerging risk factor for various cardiovascular diseases and with the increasing significance of this polymorphism in view of the morbidity and mortality impact on the patients, further prevention strategies and nutritional recommendations with the supplementation of vitamin B12 and folic acid which reduces plasma homocysteine level would be necessary as part of future health education. This literature review therefore focuses on the recent evidence-based reports on the associations of the MTHFR C677T polymorphism and the various diseases globally.
Fulltext Oral hyperpigmented lesions--a case study

Kwa SK, Gupta ED

Aust Fam Physician, 2013 Jul;42(7):490-1.
PMID: 23826603

An overweight woman, aged 58 years, presented for follow up of hypertension, diabetes and dyslipidaemia. She was noted to have hyperpigmented brown macules on the inner surface of the lower lip and buccal mucosa (Figure 1). She stated that she had first noticed these lesions when aged in her 40s. Her mother died at age 58 years from gastric cancer with extensive metastases, and her brother died at age 45 years from colon cancer with spread to the liver and lungs.
Fulltext Performance of medical students in final professional examination: Can in-course continuous assessments predict students at risk?

Nagandla K, Gupta ED, Motilal T, Teng CL, Gangadaran S

Natl Med J India, 2019 7 4;31(5):293-295.
PMID: 31267998 DOI: 10.4103/0970-258X.261197

Background: Assessment drives students' learning. It measures the level of students' understanding. We aimed to determine whether performance in continuous assessment can predict failure in the final professional examination results.
Methods: We retrieved the in-course continuous assessment (ICA) and final professional examination results of 3 cohorts of medical students (n = 245) from the examination unit of the International Medical University, Seremban, Malaysia. The ICA was 3 sets of composite marks derived from course works, which includes summative theory paper with short answer questions and 1 of the best answers. The clinical examination includes end-of-posting practical examination. These examinations are conducted every 6 months in semesters 6, 7 and 8; they are graded as pass/fail for each student. The final professional examination including modified essay questions (MEQs), 1 8-question objective structured practical examination (OSPE) and a 16-station objective structured clinical examination (OSCE), were graded as pass/fail. Failure in the continuous assessment that can predict failure in each component of the final professional examination was tested using chi-square test and presented as odds ratio (OR) with 95% confidence interval (CI).
Results: Failure in ICA in semesters 6-8 strongly predicts failure in MEQs, OSPE and OSCE of the final professional examination with OR of 3.8-14.3 (all analyses p< 0.001) and OR of 2.4-6.9 (p<0.05). However, the correlation was stronger with MEQs and OSPE compared to OSCE.
Conclusion: ICA with theory and clinical examination had a direct relationship with students' performance in the final examination and is a useful assessment tool.
Fulltext Concordance in the Assessment of Effectiveness of Palliative Care between Patients and Palliative Care Nurses in Malaysia: A Study with the Palliative Care Outcome Scale

Koh KC, Gupta ED, Poovaneswaran S, Then SL, Teo MJ, Gan TY, et al.

Indian J Palliat Care, 2017 Jan-Mar;23(1):46-52.
PMID: 28216862 DOI: 10.4103/0973-1075.197961

CONTEXT: The Palliative Care Outcome Scale (POS) is an easy-to-use assessment tool to evaluate the effectiveness of palliative care. There is no published literature on the use of POS as an assessment tool in Malaysia.

AIM: To define the concordance in the assessment of quality of life between patients with advanced cancers and their palliative care nurses using a Malay version of the POS.

SETTINGS AND DESIGN: This study was conducted in the palliative care unit of the Hospital Tuanku Ja'afar Seremban, Malaysia, from February 2014 to June 2014.

SUBJECTS AND METHODS: We adapted and validated the English version of the 3-day recall POS into Malay and used it to define the concordance in the assessment of quality of life between patients and palliative care nurses. Forty patients with advanced stage cancers and forty palliative care nurses completed the Malay POS questionnaire.

STATISTICAL ANALYSIS USED: The kappa statistical test was used to assess the agreement between patients and their palliative care nurses.

RESULTS: Slight to fair concordance was found in all items, except for one item (family anxiety) where there was no agreement.

CONCLUSIONS: The Malay version of the POS was well accepted and reliable as an assessment tool for evaluation of the effectiveness of palliative care in Malaysia. Slight to fair concordance was shown between the patients and their palliative care nurses, suggesting the needs for more training of the nurses.