Author: Pei Kuan Lai

Decision making in hyperglycaemia seen in pregnancy

Posted Pei Kuan LaiPosted in Review Articles

Authors: Kavitha Nagandla, Sivalingam Nalliah.

ABSTRACT

Delay in childbearing, family history of type 2 diabetes mellitus and obesity in childbearing years increases a possibility of glucose intolerance or overt diabetes in pregnancy which may remain unrecognised unless an oral glucose tolerance test is done. The International Association of Diabetes and Pregnancy Study Group (IADPSG, 2010) recommended the detection and diagnosis of hyperglycaemic disorders in pregnancy at two stages of pregnancy, the first stage looking for ‘overt diabetes’ in early pregnancy based on risk factors like age, past history of gestational diabetes and obesity and the second stage where ‘gestational diabetes’ at 24-28 weeks with 75 g oral glucose tolerance test. Although the one step approach with 75 g of glucose offers operational convenience in diagnosing gestational diabetes, there are concerns raised by the National Institute of Health in the recent consensus statement, supporting the two step approach (50-g, 1-hour loading test screening 100-g, 3-hour oral glucose tolerance test) as the recommended approach for detecting gestational diabetes. Medical nutrition therapy (MNT) with well-designed meal plan and appropriate exercise achieves normoglycemia without inducing ketonemia and weight loss in most pregnant women with glucose intolerance. Rapidly acting insulin analogues, such as insulin lispro and aspart are safe in pregnancy and improve postprandial glycemic control in women with pre-gestational diabetes. The long acting analogues (Insulin detemir and glargine) though proven to be safe in pregnancy, do not confer added advantage if normoglycemia is achieved with intermediate insulin (NPH). Current evidence indicates the safe use of glyburide and metformin in the management of Type 2 diabetes and gestational diabetes as other options. However, it is prudent to communicate to the women that there is no data available on the long-term health of the offspring and the safety of these oral hypoglycemic drugs are limited to the prenatal period.

Keywords: Diabetes, Pregnancy, Medical Nutrition Therapy, Insulin.

Citation: IeJSME 2014 8(1): 8-18

DOI: https://doi.org/10.56026/imu.8.1.8

Conducting research that is both ethical and responsive to the health needs of a developing country

Posted Pei Kuan LaiPosted in Review Articles

Author: Joon Wah Mak

ABSTRACT

There is no substantial difference in conducting research that is both ethical and responsive to the health needs in developing and developed nations. Differences are in financial constraints, technological expertise in identification and addressing needs, and in the perception of equal partnership of all stakeholders. There will be differences in emphasis of research but this is slowly blurred due to globalisation. Public health emergencies in developing countries need timely and effective global collaborative research to implement control strategies. Research needs should be based on predictive models with learning from past emergencies, technological advances, strategic critical appraisal of local and global health information, and dialogue with all stakeholders. Adequate funding will be challenging and resources from national, international and aid foundations will be needed. Issues associated with such funding include deployment of international rapid response teams, collaborating researchers, transfer of technology, and intellectual property ownership. While all types of research ranging from basic, applied, clinical studies, meta-analysis, and translational research are relevant, the relative importance and specific allocation of resources to these may differ. Is the choice related to responsiveness or based on researchers’ perception of their contributions to evidence-based practice and research? Ethical issues relating to vulnerable groups, risk distribution, quality issues, research integrity and oversight are just as important. Internationally funded research including clinical trials must be sensitive to such issues to avoid allegations of exploitation. Thus the potential of utilisation and buy-in of research findings and recommendations must be considered.

Keywords: ethical and responsive research, research needs, developing countries, resource allocation, research stakeholders.

Citation: IeJSME 2014 8(1): 19-23

DOI: https://doi.org/10.56026/imu.8.1.19

Role of community service as a curriculum delivery tool in the outcome-based curriculum of the International Medical University, Malaysia

Posted Pei Kuan LaiPosted in Original Article

Authors: Kwee Choy Koh, Sheila Rani Kovil George, Jun Wee Pak, Ying Tian Liow, Jie Xun Khor.

ABSTRACT

Background: The International Medical University (IMU) has an outcome-based curriculum defined by eight major curriculum outcome domains. The attributes, qualities and competencies expected of a health care professional form the basis for these outcome domains. Community service is an effective curriculum delivery tool widely practised by medical universities around the world. We present the results of a survey among IMU students to explore the effectiveness of community service as a curriculum delivery tool in enabling activities defined within the major curriculum outcome domains of IMU.

Methods: A self-administered 6-point Likert scale questionnaire was used to survey student participants of 20 community service events held in a rural village between 2007 – 2012. The survey tool included questions on demographic data as well as the perception of the students on whether participation in the events enabled them to experience activities defined under the eight major curriculum outcome domains of IMU. The one sample Student t-test was used to test for statistical significance while regression analysis was done to look for significant predictors.

Results: A total of 255 students were surveyed, of which 229 (90.5%) were medical students while the rest were nursing students. Most of the students were in the 3rd (48.2%) and 4th (43.8%) year of their studies and have completed the surgery, internal medicine and family medicine posting. Six out of the 8 curriculum outcomes domains were achieved through participation in the community service programme.

Conclusion: Community service is an effective curriculum delivery tool for the outcome-based curriculum of IMU where activities defined in six out of eight outcome domains were achieved.

Keywords: Medical Education, Medical Students, Community-Based Medical Education, International Medical University.

Citation: IeJSME 2014 8(1): 24-31

DOI: https://doi.org/10.56026/imu.8.1.24

End-of-life attitudes in the Intensive Care Unit (ICU) amongst final year medical students at International Medical University, Malaysia

Posted Pei Kuan LaiPosted in Research Note

Authors: Sangeetha Poovaneswaran, Anuradha Poovaneswaran, Thiruselvi Subramaniam.

ABSTRACT

With recent medical advances and the availability of newer sophisticated technologies, critically ill patients tend to survive longer. Thus, decisions to forgo life-sustaining medical treatment generate challenging issues that all doctors must face. The aim of this pilot study was to assess attitudes towards end-of-life care in ICU which included futile therapy (withholding and withdrawing therapy) among final year medical students who had received the same degree of clinical exposure and training in medical school. The results revealed varying attitudes and views towards end-of-life care in ICU suggesting other factors such as religion, ethnicity and culture may influence decision making.

Keywords: end of life care, education, medical students, ethics.

Citation: IeJSME 2014 8(1): 32-33

DOI: https://doi.org/10.56026/imu.8.1.32

Uncomplicated hyperemesis gravidarum does not alter the course of cardiovascular changes during pregnancy

Posted Pei Kuan LaiPosted in Research Note

Authors: Sheila Rani Kovil George, Sivalingam Nalliah.

ABSTRACT

The purpose of this prospective longitudinal study was to investigate the maternal cardiac haemodynamic and structural changes that occur in pregnancies with uncomplicated hyperemesis gravidarum in a selected Malaysian population. Nine women underwent serial echocardiography beginning at 12 weeks of gestation and throughout pregnancy at monthly intervals. Their echocardiograms were repeated at 6 and 12 weeks following delivery to reflect the pre-pregnancy haemodynamic state. Cardiac output was measured by continuous wave Doppler at the aortic valve. Interventricular septum thickness was determined by M- mode echocardiography and ventricular diastolic function by assessing flow at the mitral valve with Doppler recording. Cardiac output showed an increase of 32.9% at 36 weeks and maintained till 40 weeks of gestation. Heart rate increased from 79 ± 6 to 96 ± 8 beats/min at 36 weeks. Stroke volume increased by 16.4 % at 40 weeks of gestation when compared to the baseline value. Systolic and diastolic blood pressure did not appreciably change but showed a lower reading during the mid-trimester period. Early inflow velocity of left ventricle did not show a rise while peak atrial velocity showed an increasing trend; thus the ratio of early inflow to peak atrial transport showed a declining trend from early pregnancy to term. End diastolic dimension of left ventricle and interventricular septum thickness showed an increased value at term. Uncomplicated hyperemesis gravidarum did not alter the haemodynamic changes throughout pregnancy and concur with established data for normal pregnancy.

Keywords: Normal pregnancy, cardiac changes, echocardiogram, uncomplicated hyperemesis gravidarum.

Citation: IeJSME 2014 8(1): 34-43

DOI: https://doi.org/10.56026/imu.8.1.34

The ethical decision making model in obstetrics and gynaecology practice

Posted Pei Kuan LaiPosted in Case Study & Report

Authors: Nazimah Idris, Sivalingam Nalliah.

ABSTRACT

This paper attempts to utilise clinical scenarios where ethical issues are embedded and requires appropriate application of the steps of the framework mentioned. A step by step sequential approach is adopted to illustrate how the ‘ethical decision model’ can be used to resolve ethical problems to arrive at a reasonable conclusion. The UNESCO ethical method of reasoning is used as the framework for decision making. Physician educators should be competent to use ethical decision models as well as best available scientific evidence to be able to arrive at the best decision for patient care as well as teach health professional trainees how reasonable treatment decisions can be made within the perimeter of medical law and social justice.

Keywords: bioethics, clinical practice, decision-making model, medical education, obstetrics and gynaecology.

Citation: IeJSME 2014 8(1): 44-49

DOI: https://doi.org/10.56026/imu.8.1.44

Applying the learning theories to medical education: A commentary

Posted Pei Kuan LaiPosted in Commentary

Authors: Sivalingam Nalliah, Nazimah Idris.

ABSTRACT

Medical education of today continues to evolve to meet the challenges of the stakeholders. Medical professionals today are expected to play multiple roles besides being experts. Thus, the curriculum has to be developed in a manner that facilitates learners to achieve the intended goal of becoming a medical professional with multiple competencies. The understanding of learning theories will be helpful in designing and delivering the curriculum to meet the demands of producing a medical professional who would meet the CanMEDS model. This commentary explores and reflects on the learning theories of behaviorism, cognitivism and constructivism as they have evolved over time and the application of these learning theories in medical education, particularly in the context of medical education in Malaysia. The authors are convinced that these three theories are not mutually exclusive but should be operationalized contextually and throughout the different stages of learning in the MBBS curriculum. Understanding these theories and their application will enhance the learning experience of students.

Keywords: learning theories, behaviourism, cognitivism, constructivism, medical education.

Citation: IeJSME 2014 8(1): 50-57

DOI: https://doi.org/10.56026/imu.8.1.50

Facilitation of web-based internet PBL: What is an adequate group size?

Posted Pei Kuan LaiPosted in Original Article

Authors: Masayuki Niwa, Satoshi Yoshida, Kazuhiro Takamizawa, Satoshi Nagaoka, Nobumitsu Kawakubo, Yuzo Takahashi, Yasuyuki Suzuki.

ABSTRACT

Background: Development in internet technology enables e-learning at the higher education level. We have developed the Internet PBL-Tutorial System/Rakuichi that allows multi-directional communication among participants with web-based bulletin boards. Although this system has been successful in medical education at the undergraduate level, we sought to encourage “readonly members” to participate more fully in the program.

Methods: To this end, we compared the posting frequency among three strategies: (1) students and tutors had an off-site meeting to promote face-to-face communication during the course, (2) several classes were allowed to watch the discussion in other classes in the second half of the course, (3) three classes (5 – 6 students each) in one topic were combined into one class (16 students) in the second half.

Results: No meaningful effects were observed for strategies (1) or (2). However, the posting frequency increased 50 % for strategy (3).

Conclusion: Facilitation of communication among participants was achieved by increasing the number of student participants. We predicted that an optimal number of students in each class in internet-based PBL would be ~20 people.

Keywords: Web-based, PBL-tutorial, master course, facilitation, education method, group size.

Citation: IeJSME 2014 8(2): 4-11

DOI: https://doi.org/10.56026/imu.8.2.4

Phylogenetic analysis and identification of Sarcocystis spp. found in rodents in Peninsular Malaysia

Posted Pei Kuan LaiPosted in Original Article

Authors: Jenn Haw Fong, Kenny Voon, Stephen Ambu, Joon Wah Mak.

ABSTRACT

Background: The tissue specimens used for extraction of DNA in this study were from rodents trapped in four states in Peninsular Malaysia, namely Kedah, Kelantan, Selangor and Johor.

Methods: Histological sections of these rodent muscle tissues stained with hematoxylin and eosin showed infection with Sarcocystis spp. Based on these results, the current study was carried out to determine the phylogenetic relationship among the identified Sarcocystis spp. in these rodents. The formalin fixed paraffin embedded (FFPE) rodent muscle blocks were subjected to DNA extraction and followed with semi nested PCR targeting 5’ and 3’ regions of 18S rRNA of Sarcocystis spp.

Results: Phylogenetic analysis showed two distinct groups of Sarcocystis spp. among the rodents in Peninsular Malaysia. Most of the identified Sarcocystis spp. were genetically closely related to Sarcocystis rodentifelis and Sarcocystis muris and were also observed to be genetically closely related to Sarcocystis sp. ex Columba livia and Sarcocystis sp. cyst type I ex Anser albifrons.

Conclusion: Further classification to confirm these Sarcocystis spp. was not possible as only partial sequences of 18S rRNA was available and this was insufficient for optimal differentiation.

Keywords: Sarcocystis, rodents.

Citation: IeJSME 2014 8(2): 12-17

DOI: https://doi.org/10.56026/imu.8.2.12

An intestinal parasitological survey among the Jehai Orang Aslis (aborigines) of the Temenggor forest, Perak state, Malaysia

Posted Pei Kuan LaiPosted in Original Article

Authors: Yaya Liliana Hanapian, Joon Wah Mak, Paul Chieh Yee Chen.

ABSTRACT

Background: In Malaysia, the most common soil-transmitted helminth infections are A. lumbricoides, T. trichiura and hookworms. However, as there have been no extensive surveys on these infections, it is difficult to estimate with certainty the current overall incidence of infection with soil-transmitted helminths (STHs) among the Malaysian population including the Orang Aslis.

Materials and Methods: A study was conducted to determine the infection rate of soil-transmitted helminths and intestinal protozoa among the Jehai Orang Aslis (Aborigines). The study was conducted between December 2005 and August 2006, in four Jehai villages of Perak State, Malaysia. A total of 175 stool samples was collected and personal identification such as name, age, household identification, and date of collection were recorded on the spot during collection. Faecal smears were stained with Trichrome for protozoa cysts and trophozoites and the modified Ziehl-Neelsen acid-fast method for the oocyst of Cryptosporidium and Isospora. Wet mounts with tincture of iodine of both stool samples (10% formalin and PVA) were also examined to detect cysts, ova and larva of intestinal helminths.

Results: The prevalence rates of Trichuris trichiura, Ascaris lumbricoides and hookworm among the Jehai were 70.8%, 24.0%, and 10.9% respectively. The prevalence of Entamoeba coli, Entamoeba histolytica, Giardia intestinalis, Blastocystis hominis, and microsporidium was 40.6%, 33.7%, 25.7%, 91.4%, and 27.4% respectively. The difference in prevalence rates among the different age-groups and sex were found not significant. Children aged 0-9 years old had the highest prevalence rate of intestinal parasites and only 2 (1.1%) were free of any intestinal parasites.

Conclusion: Intestinal parasitic infections were therefore still common among these people. Children aged 0-9 years old were found to have the highest infection rate of all the intestinal parasites examined. Further investigations are needed to determine more specific transmission of these infections, so that an attempt to control these infections can be made.

Keywords: Soil-transmitted helminths and intestinal protozoa, intestinal parasitic infections, Orang Asli.

Citation: IeJSME 2014 8(2): 18-23

DOI: https://doi.org/10.56026/imu.8.2.18