Author: Pei Kuan Lai

Thyroid disorders in the aged

Posted Pei Kuan LaiPosted in Review Articles

Author: Peter Michael Barling

ABSTRACT

A review of current information related to the likely incidences of thyroid diseases in the aged population of Malaysia, raising issues such as the need for further epidemiological studies of iodine intake in relation to thyroid diseases within different geographical regions and population subtypes, the need for general country-wide iodization of salt, and the screening of elderly Malaysians for so-called “occult” thyroid diseases.

Keywords: Thyroid, iodine, hyperthyroidism, hypothyroidism, co-morbidity, goiter, thyroid nodules, rural population, TSH, atrial fibrillation.

Citation: IeJSME 2013 7(2): 4-7

DOI: https://doi.org/10.56026/imu.7.2.4

Rat gingival model for testing drugs influencing inflammation

Posted Pei Kuan LaiPosted in Review Articles

Authors: Shaju P Jacob, Sonia Nath.

ABSTRACT

Preclinical drug testing is an important area in new drug development where animals are used. An ideal animal model for this is one which is simple, reliable and can be extrapolated to humans. Topical drugs for inflammation are conventionally tested on the skin of animals after induction of inflammation. A gingival model would be simple as inflammation can be induced naturally by the action of plaque. Rats are a popular animal model for testing drugs as well as to study various diseases of the periodontium. Periodontal disease including gingival inflammation develops in rats in relation to indigenous plaque or experimentally induced bacterial products. A number of features of rats ranging from anatomy, histology and response to bacterial insult can be seen mirrored to a great extent in humans. There is a lot similarity in the development and resolution of inflammation as well as the gingival wound healing of rats and humans. This paper tries to explore the feasibility of using the rat gingival model for preclinical testing of drugs acting on or influencing inflammation and concludes by identifying potential areas of research using this model. The addition of such a simple and inexpensive model for preclinical testing of drugs will be welcomed by the drug developers.

Keywords: Animal model; periodontal; preclinical drug testing.

Citation: IeJSME 2013 7(2): 8-16

DOI: https://doi.org/10.56026/imu.7.2.8

Shock in the neonate

Posted Pei Kuan LaiPosted in Review Articles

Authors: Davendralingam Sinniah, Thiruselvi Subramaniam, Myint Myint Soe-Hsiao.

ABSTRACT

Shock is a clinical challenge to neonatal intensivists and pediatricians alike. It occurs in critically ill babies for many reasons, but the main cause is sepsis that kills more than a million newborn globally every year. This article is designed to help young doctors and trainees have a better understanding of shock in the neonatal period and its management. The paper reviews the basic pathophysiology, risk factors, clinical investigation, management, supportive care, and complications in the common types of shock seen in neonates. Treatment is governed largely by the underlying cause, with the ultimate goal of achieving adequate tissue perfusion with delivery of oxygen and substrates to the cells, and removal of toxic metabolic waste products. Intervention needs to be anticipatory and urgent to prevent progression to uncompensated and irreversible shock respectively. Early recognition and urgent effective management are crucial to successful outcomes.

Keywords: neonatal shock, pathophysiology, classification, investigation, management.

Citation: IeJSME 2013 7(2): 17-28

DOI: https://doi.org/10.56026/imu.7.2.17

The practice of PPE amongst fourth year medical students at A&E. Where are we?

Posted Pei Kuan LaiPosted in Original Article

Authors: Thiruselvi Subramaniam, Rosalind Chi Neo Loo, Sangeetha Poovaneswaran.

ABSTRACT

Background: This cross sectional study was done to identify the areas of lack of knowledge, practice and awareness of students about the effective use of personal protective equipment (PPE).

Methods: A total of 40 students were selected when they were posted to the accident and emergency unit (A&E) in Seremban Hospital; all of them answered a questionnaire and were observed unaware on the effective use of PPE in the A&E.

Results: We found that 17.5% of students were unaware of the right technique of removing the gloves after a procedure and 25% of students were unaware of safety of hand washing. During invasive procedures, 12.5% of students did not wash their hands before invasive procedures, 65% did not wear aprons and 57.5% did not wear masks. During non- invasive procedures more than 25% of students did not wash hands before or after the procedures.

Conclusion: There is still significant lack of knowledge in students about the effective use of PPE that needs to be addressed.

Keywords: PPE, Personal protective equipment, effective practice of PPE, A&E.

Citation: IeJSME 2013 7(2): 29-32

DOI: https://doi.org/10.56026/imu.7.2.29

 

A trend analysis of major congenital anomalies in Penang, Malaysia

Posted Pei Kuan LaiPosted in Original Article

Authors: Leela Anthony, Nagarajah Lee, Stephen Ambu, Lokman Hakim S.

ABSTRACT

Background: This study examined the trend of major congenital anomalies (CA) in the state of Penang using the ICD 10 database from 1999 to 2004. The data was collected from various health centres and hospitals. The aim was to study the magnitude of the problem for congenital anomalies in the state of Penang in terms of trends and also to calculate the incidence rate by districts. If a trend was noticed, this in turn will determine whether to carry out further in-depth studies in the future and to find out the linkages to the environment if any.

Methods: This was a retrospective study of congenital anomalies that were registered in the state of Penang and the data was obtained from the ICD10 database from 1999 to 2004. Under ICD 10, congenital anomalies are coded as “Q”. Only major congenital anomalies coded as “Q” from Q1 to Q11 were extracted and analysed. Only new cases were analysed, double and repeat entries were excluded. Trend analysis was than carried out according to districts in Penang.

Results: Incidence rate per 1000 birth was calculated to determine the common congenital anomalies. It was found that there was an increasing trend in the incidence of CA for all the five districts studied; topping the list was Barat Daya while Seberang Perai Selatan had the lowest incidence rate. It is noteworthy to mention that Barat Daya is an industrialised district while Seberang Perai Selatan is mainly an agricultural and residential area. This preliminary study however did not look into the reasons or causative factors for the high or low incidence in the respective districts. In terms of the types of congenital anomalies, the highest was that from malformation of circulatory system while the lowest from respiratory system. The congenital anomalies with the incidence rate at least 3 per 1000 births were malformations from the nervous system, circulatory system, digestive system, genital organs, malformation/ deformation of musculoskeletal system and cleft lip and cleft palate.

Conclusion: This study showed a rising trend in congenital anomalies in all districts in the state of Penang and a high incidence was observed in the district of Barat Daya, where a number of factories are located in the Bayan Lepas Industrial Zone. However further studies need to be carried out to determine the causative factors and their linkage to the environment. The limitation of this study was that the data analysed was only from notified cases to the Penang State Health Department.

Keywords: Trend, ICD, Congenital, Anomalies, Environment.

Citation: IeJSME 2013 7(2): 33-40

DOI: https://doi.org/10.56026/imu.7.2.33

The levels of difficulty and discrimination indices and relationship between them in four-response type multiple choice questions of pharmacology summative tests of Year II M.B.B.S students

Posted Pei Kuan LaiPosted in Original Article

Authors: Bharti N Karelia, Ajita Pillai, Bhavisha N Vegada.

ABSTRACT

Background: Item analysis is the process of collecting, summarising and using information from students’ responses to assess the quality of test items. Difficulty index (P) and discrimination index (D) are two parameters which help to evaluate the standard of MCQ questions used in an examination, with abnormal values indicating poor quality.

Methods: In this study 200 test items of 10 MCQ tests from 2008 to 2012 were selected and analysed to obtain their difficulty and discrimination indices. The relationship between the difficulty index and discrimination index for each test item was determined by Pearson correlation analysis.

Results: Mean difficulty index scores of the individual summative tests were in the range of 47.17% to 58.08%. Twenty nine percent of total test items crossed the difficulty index of 70% indicating that those items were easy for the students. Seventy eight percent of the test items showed acceptable (> 0.2) discrimination index. Forty six percent of the test items showed excellent discrimination index. Discrimination index correlated poorly with difficulty index (r=0.11). The correlation is insignificant at 5% (p>0.10).

Conclusion: A consistent level of test difficulty and discrimination indices was not maintained from 2008 to 2012 in all the ten summative type A MCQ tests.

Keywords: Difficulty index Discrimination index Item analysis, Summative tests, Type A MCQ.

Citation: IeJSME 2013 7(2): 41-46

DOI: https://doi.org/10.56026/imu.7.2.41

“Medicated oxygen” – the wonder drug for anxious children

Posted Pei Kuan LaiPosted in Case Study & Report

Authors: Niekla S Andiesta, Zeinab Abbas Hasan, Chooi Gait Toh.

ABSTRACT

Pain and anxiety management is of paramount importance in dentistry especially for child patients. The term “Medicated Oxygen” or “Magic Air” refers to a mixture of nitrous oxide and oxygen gases that is commonly used for partial sedation in pediatric dental populations. The gas is colorless and virtually odorless with a faint, sweet smell. Nitrous oxide sedation is administered by inhalation, absorbed by diffusion through the lungs, and eliminated via respiration. In children, sedation may accelerate the delivery of dental treatment that requires patient serenity and may allow the patient to tolerate unpleasant procedures by reducing anxiety, discomfort, or pain.

Keywords: “Medicated Oxygen”, nitrous oxide, a 9-year old anxious boy.

Citation: IeJSME 2013 7(2): 47-50

DOI: https://doi.org/10.56026/imu.7.2.47

Changing trends in informed consent

Posted Pei Kuan LaiPosted in Review Articles

Author: Victor Lim

ABSTRACT

Consent is defined as the “voluntary agreement to or acquiescence in what another person proposes or desires”. In the context of medical practice it is now universally accepted that every human being of adult years and of sound mind has the right to determine what shall be done with his or her own body. Informed consent is now a central part of medical ethics and medical law. There has been a change in the public’s expectations of their role in medical decision making. The paternalistic approach by doctors is no longer acceptable. Today the patient has the right to receive and the doctor the obligation to give sufficient and appropriate information so that the patient can make an informed decision to accept or refuse a treatment option. This has led to higher standards of practice in the process of informed consent taking. Consent taking is both a legal and moral requirement. Failure to comply with standards of practice can result in criminal prosecution, civil litigation or disciplinary action by the relevant professional authority. Consent taking is a process and not merely a one-off affixation of the patient’s signature on a consent form. It involves a continuous discussion to reflect the evolving nature of treatment from before the treatment is given to the post-operative or discharge period. The regulatory authorities in many countries have established standards for consent taking which would include the capacity of the patient, the person who should seek consent, the information to be provided and the necessary documentation.

Keywords: informed consent, ethics, medical litigation, medical professionalism.

Citation: IeJSME 2014 8(1): 3-7

DOI: https://doi.org/10.56026/imu.8.1.3