Author: John Paul Judson

ABSTRACT

The relationship between anatomy and surgery has been historic and epic, spanning many centuries, complementing each other in medical education and being independent as well as interdependent in many ways. However, curricular changes that have happened globally in recent years with the introduction of several contemporary styles of medical teaching have subtly downplayed the importance of anatomy in medicine, allowing young doctors with poor knowledge of anatomy to become surgeons. With a whimsical introduction that metaphorically hints at the strained relationship that exists between anatomy and surgery, the article attempts to explore the ‘anatomy’ of anatomy itself, examining its origins in recorded ancient history, evolution along the centuries in tandem with surgery and its current status in medical education.

Keywords: Anatomy, surgery, medical education, curriculum, history of medicine.

Citation: IeJSME 2012: 6 (Suppl 1): S48-52

DOI: https://doi.org/10.56026/imu.6.Suppl1.S48

Author: Siang-Tong Kew

ABSTRACT

Melanosis coli denotes brownish discoloration of the colonic mucosa found on endoscopy or histopathologic examination. The condition has no specific symptom on its own. It is a fairly frequent incidental finding of colonic biopsies and resection specimens. The pigmentation is caused by apoptotic cells which are ingested by macrophages and subsequently transported into the lamina propria, where lysosomes use them to produce lipofuscin pigment, not melanin as the name suggests. Melanosis coli develops in over 70% of persons who use anthraquinone laxatives (eg cascara sagrada, aloe, senna, rhubarb, and frangula), often within 4 months of use. Long-term use is generally believed to be necessary to cause melanosis coli. The condition is widely regarded as benign and reversible, and disappearance of the pigment generally occurs within a year of stopping laxatives. Although often due to prolonged use of anthraquinone, melanosis can probably result from other factors or exposure to other laxatives. It has been reported as a consequence of longstanding inflammatory bowel disease. Some investigators suggested that increase in apoptosis of colonic mucosa by anthraquinone laxatives increased the risk of colonic cancer. Recent data, including those from large-scale retrospective, prospective and experimental studies, did not show any increased cancer risk.

Keywords: melanosis coli, anthraquinone, lipofuscin, colorectal adenoma/carcinoma risk, complementary and alternative medicine.

Citation: IeJSME 2012: 6 (Suppl 1): S53-60

DOI: https://doi.org/10.56026/imu.6.Suppl1.S53

Author: Geok-Lin Khor

ABSTRACT

It is estimated that more than 1.1 billion adults and 115 million children worldwide are overweight. In Malaysia, the second and third National Health and Morbidity Surveys in 1996 and 2006 respectively reported a three-fold increase in obesity prevalence among adults, surging from 4.4% to 14% over the 10-year period. Evidence of rising childhood obesity has also emerged. The aim of this article is to gather evidence from food availability data for an insight into population shifts in dietary patterns that may help explain the rising obesity in this country. The nutrition transition was delineated in conjunction with the epidemiologic transition in order to explain the convergence of dietary practices, and the high prevalence of obesity and diet-related non-communicable diseases worldwide. The Food Balance Sheets for Malaysia from 1967 to 2007 were used to provide estimates and trends for the availability of foods and calories. Evidence is generated that indicate at least two major upward shifts in the dietary patterns in Malaysia in the past 4 decades. These shifts have led to the rising availability of calories from animal products, and from sugar and sweeteners. These major dietary shifts, together with increased sedentariness, constitute core public health challenges faced in addressing the country’s obesity and noncommunicable diseases (NCD) conundrum.

Keywords: Obesity, nutrition transition, Food Balance Sheets, animal products, sugar and sweeteners.

Citation: IeJSME 2012: 6 (Suppl 1): S61-S68

DOI: https://doi.org/10.56026/imu.6.Suppl1.S61

Author: Pek-Hong Lim

ABSTRACT

Nurse education is undergoing a process of transition. Nurses worldwide are working towards achievement of higher levels of education and training through an improved education system. Current trends and innovations in nursing education are emerging to prepare more nurses and to deliver education to students across geographical boundaries while taking into consideration their work and family responsibilities. The current trends and innovations in nursing education range from full time face-to-face interactions to distance education programmes. Teaching approaches such as blended learning, online or e-Learning have provided nurses with an avenue for continuing education for development and progression in their career pathways. Every nurse aspires to reach her highest potential. While the current trends and innovations in nursing education provides the flexibility for nurses to continue learning and upgrade their professional qualifications, there are issues to be considered in catering to the needs of the bottom billion nurses. An exploration of related issues will include views from different perspectives, such as that of the institution/provider, instructor/facilitator and student/learner involved in the development and implementation of the related education programmes.

Keywords: Trends, Innovations, Issues, Nursing Education, Nurses.

Citation: IeJSME 2012: 6 (Suppl 1): S69-S74

DOI: https://doi.org/10.56026/imu.6.Suppl1.S69

Author: Victor Lim

ABSTRACT

The discovery of antibiotics had been one of the most significant events in the history of medicine. Antibiotics had saved countless number of lives and had contributed significantly to the health of mankind. The emergence of resistance is however a major threat to the continued usefulness of antibiotics. There are now strains of bacteria which are resistant to virtually all available antibiotics and these strains are increasingly being encountered in clinical practice. The development of new agents had not kept pace with resistance and it is unlikely that there will be major breakthroughs in the near future. The world needs to conserve and prolong the useful lives of the existing agents. This can only be achieved through good antibiotic stewardship programmes. As antibiotic resistance is a global threat all major stakeholders have to work together to meet this challenge.

Keywords: antibiotic, resistance, stewardship.

Citation: IeJSME 2012: 6 (Suppl 1): S75-S79

DOI: https://doi.org/10.56026/imu.6.Suppl1.S75

Author: Joon-Wah Mak

ABSTRACT

Developing and adult worms of the human lymphatic filarial parasites (Wuchereria bancrofti, Brugia malayi, and Brugia timori) are located mainly in the lymphatic system and occasionally in aberrant sites like subcutaneous and conjunctival cysts. Lymphatic pathology ranging from dilatation of lymphatic channels and lymphangiectasia are detected on ultrasonography in apparently healthy, amicrofilaraemic, but filarial antigen positive individuals in endemic areas. Microfilariae are distributed in various organs and may be associated with immune mediated pathology at these sites; tropical pulmonary eosinophilia is characterized by intense immune mediated destruction of microfilariae in the lung parenchyma. In the spleen and other sites, nodular granulomatous lesions can occur where microfilariae are trapped and destroyed. The finding of Wolbachia endosymbionts in all stages of lymphatic filarial parasites has provided new insight on the adverse reactions associated with anti-filarial chemotherapy. Inflammatory molecules mainly lipopolysaccharide (LPS)-like molecules released from endosymbionts on death of the parasites are largely responsible for the adverse reactions encountered during anti-filarial chemotherapy. Prenatal tolerance or sensitization to parasite derived molecules can immune-modulate and contribute to both pathology and susceptibility/resistance to infection. Pathological responses thus depend not only on exposure to filarial antigens/infection, but also on host-parasite-endosymbiont factors and to intervention with antifilarial treatment. Treatment induced or host mediated death of parasites are associated with various grades of inflammatory response, in which eosinophils and LPS from endosymbionts play prominent roles, leading to death of the parasite, granulomatous formation, organization and fibrosis. The non-human primate (Presbytis spp.) model of Brugia malayi developed for the tertiary screening of anti-filarial compounds has provided unique opportunities for the longitudinal study of the pathology associated with lymphatic filariasis. The pathology in this non-human primate model closely follows that seen in human lymphatic filarial infections and correlates with clinical evidence of lymphatic pathology as detected with ultrasonography. These studies also show that successful treatment as detected by loss of motility and calcification of worms on ultrasonography is associated with reversal of early dilatations of lymphatic channels.

Keywords: lymphatic filariasis, pathology, immunopathology, Brugia, Wuchereria.

Citation: IeJSME 2012: 6 (Suppl 1): S80-S86

DOI: https://doi.org/10.56026/imu.6.Suppl1.S80

Author: Sivalingam Nalliah

ABSTRACT

This is a cross sectional study conducted in July 2010 at the International Medical University, Seremban, Malaysia. The objective of this study was to ascertain the relationship between working memory capacity of final MBBS medical students using the digit span backward test and their academic achievement based on the total score at the modified essay questions (MEQ) which was the principal component of the theory examination. Seventy eight final year medical students were recruited, 41 (52.6%) were females and remaining 37 (47.4%) were males. Working memory capacity was measured by digit span backward test (DSBT) which ranged from 3 to 8 digits. The mean digit score was 6.6 ± 1.1 falling under the category of ‘above average’ score. There was no significant difference between working memory capacity and gender (p>0.05). There was no significant difference in the MEQ mean score and the different categories of working memory capacity (p>0.05). The DBST shows uniformity in working memory adequate to pass the modified essay questions. Medical students appear to use encoding and retrieval process in problem solving based on functionality and pattern recognition in tackling the problems in the MEQ.

Keywords: Working memory, digit span backward test, academic performance, modified essay question.

Citation: IeJSME 2012: 6 (Suppl 1): S87-S102

DOI: https://doi.org/10.56026/imu.6.Suppl1.S87

Author: Kandasami Palayan

ABSTRACT

The only potential curative therapy for gastric cancer is the resection of both the tumor and the regional lymph nodes at the early stage of the disease. The majority of patients with gastric cancer in Malaysia have an advanced disease at initial diagnosis, and curative surgery is possible in less than 20% of operated cases. Acurate preoperative staging is crucial in determining the most suitable therapy and avoiding unnecessary attempts at curative surgery. While computed tomography remains as the most widely used imaging modality for gastric cancer staging, its ability to detect local invasion, peritoneal and liver metastases is limited. In the recent years laparoscopy has become an important component in the staging algorithm of gastric cancer. The aim of this review is to evaluate the efficacy of routine preoperative laparoscopic staging in the management of gastric cancer, and in particular describe the Malaysian experience.

Keywords: Gastric cancer, staging, laparoscopy.

Citation: IeJSME 2012: 6 (Suppl 1): S103-105

DOI: https://doi.org/10.56026/imu.6.Suppl1.S103

Author: Allan Kah-Heng Pau

ABSTRACT

Oral health diseases are common in all regions of the world and their impact on anatomical and social functioning is widely acknowledged. Their distributions are unequal between and within countries, with the greatest burden falling on disadvantaged and socially marginalized populations. The risk factors and social determinants for oral diseases have been comprehensively documented, and the evidence base for their prevention is growing. However, decisions on health care are still often made without a solid grounding in research evidence. Translation of research into policy and practice should be a priority for all. Both community and individual interventions need tailoring to achieve a more equal and person-centered preventive focus and reduce any social gradient in health. The major challenges of the future will be to translate knowledge and experiences in oral disease prevention and health promotion into action programmes. The international oral health research community needs to engage further in research capacity building and in strengthening the work so that research is recognized as the foundation of oral health policy at global level.

Keywords: dental public health, oral epidemiology, oral health promotion.

Citation: IeJSME 2012: 6 (Suppl 1): S106-S112

DOI: https://doi.org/10.56026/imu.6.Suppl1.S106

Author: Ammu Kutty Radhakrishnan

ABSTRACT

The immune system is the host natural defence against cancer. Cancers are caused by progressive growth of the progeny of a single transformed host cell. The immune system is generally not able to mount immune responses to “self-antigens”, due to various mechanisms of immunological tolerance that are in place. This means that despite possessing a natural defence against tumours, many of the cancer patients may not be able to mount an effective immune response to fight the tumours. Dendritic cells (DC) are highly specialised in antigen presenting that can initiate and stimulate immune responses. These cells have the ability to stimulate naïve T cell proliferation and perform specific stimulatory and tolerogenic functions respectively. When the DC are activated by antigens, these cells undergoes further maturation and migrate to secondary lymphoid tissues, present antigen to T cells and finally
induce an immune response. The ability of the DC to activate naïve and primed T-lymphocytes makes these cells a good candidate to be explored as a potential immunotherapeutic agent that can modulate antitumour immune responses in the affected host.

Keywords: dendritic cells, immunotherapy, anti-tumour.

Citation: IeJSME 2012: 6 (Suppl 1): S113-S117

DOI: https://doi.org/10.56026/imu.6.Suppl1.S113