Authors: Syer Ree Tee, Xin Yun Teoh, Wan Abdul Rahman Wan Mohd Aiman, Ahmad Aiful, Calvin Siu Yee Har, Zi Fu Tan, Abdul Rashid Khan.

ABSTRACT

Background: Hypertension is estimated to cause 4.5% of the global disease burden. The prevalence of hypertension in Malaysia is 32.2%.

Objective: To determine the prevalence of hypertension and its associated risk factors in two rural communities in Penang, Malaysia.

Methods: This cross sectional study was conducted among all consenting residents aged 18 years and above from two villages in Penang. Besides the baseline demographic information, blood pressure was measured using a manual sphygmomanometer according to the American Heart Association Guidelines.

Results: 50 out of 168 people were hypertensive, giving a prevalence rate of 29.8%. 50.0% of those found with hypertension were undiagnosed and 48.0% of those who were diagnosed with hypertension had uncontrolled blood pressure. Logistic regression analysis showed that age, history of alcohol consumption and BMI were found to be independently associated with hypertension.

Conclusions: Age, education level, alcohol consumption and BMI are important risk factors associated with the prevalence of hypertension among the villagers. These risk factors are comparable to those reported in National Health and Morbidity Survery 2006 in Malaysia.

Keywords: Blood pressure, Hypertension, Penang, Prevalence, Risk factor, Rural.

Citation: IeJSME 2010: 4(2): 27-40

DOI: https://doi.org/10.56026/imu.4.2.27

Authors: Nazimah I, Noor Sham Y L, Khairun Niza C N, Mohd Ikhsan S, Nadzratulaiman N, Juliana Y.

ABSTRACT

Objective: To evaluate the factors that contributes to the decision for termination of pregnancy in prenatally diagnosed fetal anomaly cases.

Methods: A retrospective analysis of all cases of prenatally diagnosed fetal anomaly who delivered between 1 January 2007 and 30 June 2009 in two tertiary hospitals in Malaysia.

Results: A total of seventy-two (72) prenatally diagnosed pregnancies with fetal anomalies were identified. Mean maternal age was 29.8 ± 5.5 years and mean parity 1.47 ± 1.8. 70.8% of patients were ethnic Malay, 15.3% Chinese and 12.5% ethnic Indian. 22 (30.6%) fetuses were lethally abnormal. The overall pregnancy termination rate was 29.2%. 50% of pregnancies with lethally abnormal fetuses were terminated compared to 20% of pregnancies with non-lethal abnormality (p<0.05). There were no significant differences seen in the decision for pregnancy termination with regards to mean maternal age, parity and between mothers of different ethnic backgrounds.

Conclusion: Severity of fetal anomaly is the main determinant in the decision for pregnancy termination. Maternal age, parity and ethnic background did not significantly influence the decision.

Keywords: Prenatal diagnosis, Fetal anomaly, Termination of pregnancy, Determining factors.

Citation: IeJSME 2010: 4(2): 41-46

DOI: https://doi.org/10.56026/imu.4.2.41

Authors: Amirthalingam Sasikala Devi, Gnanajothy Ponnudurai, Su Yui Chen.

ABSTRACT

Background: Problem based learning (PBL) is a student – centered curriculum delivery tool believed to promote active student participation. Though the PBL is student – centered, the facilitator plays an important role in maintaining the integrity of this system by providing balance in group interaction and discussion of learning issues. In International Medical University (IMU) one of the strategies to ensure the quality of the facilitators was the pre and post PBL meetings. This study aimed to gauge its usefulness in ensuring the quality of PBL facilitation.

Method: The questionnaire to study the perceptions of PBL facilitators on the pre and post PBL meetings included close ended questions on pre and post PBL meeting’s attendance and their scored opinion in improving PBL facilitation skills, open ended questions inviting suggestions to improve these meetings and PBL facilitation in IMU as a whole and self-evaluation as an effective PBL facilitator using a six point Likert scale to a list of statements.

Results: 84.2% of facilitators agreed the meetings were beneficial. Self-evaluation of their facilitator effectiveness showed on average ratings of seven out of ten indicating strong confidence in facilitating skills. Suggestions ensuring facilitator quality included content expert briefing in pre PBL meetings and student appraisals of facilitators given weightage in staff appraisal.

Conclusion: Pre and post PBL meetings enhanced facilitator comfort with the triggers, adding to their confidence and provided a venue to obtain feedback on the triggers.

Keywords: Problem based learning, PBL facilitator, Pre and post PBL meeting.

Citation: IeJSME 2010: 4(2): 47-53

DOI: https://doi.org/10.56026/imu.4.2.47

Authors: Muneer Gohar Babar, Ma Angela Gonzalez.

ABSTRACT

Background: The importance of tooth sectioning is realized in disasters such as earthquake, airplane crash investigation, terror, micro leakage studies, age estimation etc. The objective of this study was to develop a simple method to make thin sections (approximately 100 mm) from freshly extracted teeth.

Methods: One hundred and twenty human premolars recently extracted for orthodontic purpose were used for this study. The teeth were stored in 0.5% chorlaramine for 2 weeks and were not allowed to dry at any stage of the experiment. The teeth were thoroughly washed in distilled water teeth and then were sectioned buccolingually from crown to the root portion.

Results: A detailed embedding-cutting-mounting procedure is described. The prepared thin ground sections were then examined under a Polarised light microscope for the enamel and the dentine, as well as the caries lesions can clearly be distinguished.

Conclusion: This is an effective and efficient method for preparation of ground sections in which the hard tissue details are preserved.

Keywords: Teeth Sectioning, Dental Caries, Forensic Dentistry, Enamel, Dentine, Secondary caries.

Citation: IeJSME 2011: 5 (1): 27-30

DOI: https://doi.org/10.56026/imu.5.1.27

Authors: Toh Peng Yeow, Wai Sun Choo, Amir S Khir, Li Cher Loh.

ABSTRACT

Background: Clinical clerkship in a busy hospital environment forms an important part of undergraduate medical training. Regular objective assessment of this activity with feedback would be expected to improve outcome.

Methods: We implemented fortnightly clinical assessments using modified OSLER (Objective Structured Long Examination Record), and over a 6-week clinical rotation. Modifications included provision of individualized feedback. The assessment process was evaluated by both students and teachers via a questionnaire measuring their perceived educational impact, feasibility and acceptability.

Results: Students agreed that the patient spectrum was appropriate and fair, resulting in improved history taking and presentation skills (96.6%), clinical examination skills (89%) and clinical reasoning skills (90.7%). It was graded to have helped learning “tremendously” and “moderately” by 64.7% and 32.8% of students respectively. Perceived improvement was attributable mainly to the repetitive nature of the assessments since only 63% of students were provided with feedback. 96.6% of students and 94.1% of assessors perceived the format created a stressful but positive learning environment. 52.9% of assessors agreed that the exercise consumed significant time and resources but 88.2% rated it as manageable and supported its continuation.

Conclusion: Frequent and regular in-course clinical assessments with emphasis on individual feedback is feasible, acceptable and has significant positive educational impact.

Keywords: long case assessment, successive, feedback.

Citation: IeJSME 2011: 5 (2): 3-11

DOI: https://doi.org/10.56026/imu.5.2.3

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

ABSTRACT

Background: Database on hospital records like discharge data, birth and death certificates are widely used for epidemiological and research studies. However there are a very few validation studies on these data. The aim of this study was to validate and assess the accuracy of the ICD 10 database on congenital anomalies in the state of Penang. This study was carried out for three years, from 2002 to 2004.

Methods: The list of cases coded under the general coding “Q” was extracted and approximately 30% of cases were randomly selected from the list. Medical records for the selected cases were checked and discrepancies for the diagnoses between the medical records and the ICD 10 data base were recorded for three years. Verification was done for basic demographic variables and the coding of the diseases. Discrepancies, sensitivity and specificity were calculated.

Results: The ICD 10 database for congenital anomalies are classified into two types: Type 1 and Type 2. Discrepancies on demographic information were found among the age of patients (babies with congenital anomalies). In Type 1, there was a discrepancy of about 0.02 % to 0.05% probability that a congenital anomaly case can be recorded as non congenital anomaly in the ICD 10. In Type 2 there was a discrepancy that a non-congenital anomaly was classified as congenital anomaly and this ranged from 26.7% to 50.0%. The sensitivity ranged from 96.85% to 97.98%, thus it can be concluded the ICD 10 database is highly sensitive while the specificity ranged from 50.00% to 78.57 %. In other words the ICD 10 is not accurate when classifying the non- congenital anomaly cases. A fair percentage of non-congenital anomaly cases were classified as CA in the ICD 10 database.

Conclusion: Even though hospital databases are used as a baseline data for a number of research and epidemiological studies it cannot be used at face value. Validation of these data is necessary before any conclusions can be drawn or intervention measures are undertaken.

Keywords: Congenital Anomalies, Validation , ICD 10.

Citation: IeJSME 2011: 5(2): 12-17

DOI: https://doi.org/10.56026/imu.5.2.12

Authors: Ramon Chin Beng Ong, Patricia Kim Chooi Lim, Joon Wah Mak.

ABSTRACT

Background: Many proteins released by cells to the blood and other fluids are glycoproteins. One set of glycoproteins carry the ABO blood group determinants and glycoproteins have been shown to be vital in determining the structure and organization of plasma membranes. There is evidence suggesting their important role in cell-to-cell contact, adhesion, hormone interaction and vital transformation. Differences in proteins and glycoproteins in the different human blood groups may influence the invasion process of Plasmodium falciparum. The objectives of the study were to determine whether there are any changes in proteins and glycoproteins of red blood cells upon infection by P. falciparum and whether these protein and glycoprotein changes differ in the various ABO blood groups.

Methods: A Malaysian strain of P. falciparum was cultured in vitro in red blood cells from A, B, O and AB blood groups. Protein and glycoprotein profiles of uninfected and P. falciparum-infected red blood cells from the different human ABO blood groups were analyzed by SDS-PAGE. For protein bands, the gels were stained with Coomassie blue while glycoproteins were visualized following staining of gels using GelCode® Glycoprotein Staining Kit.

Results: Cell membranes of P. falciparum infected erythrocytes from different ABO blood groups have different glycoprotein profiles compared to uninfected cells. All the infected samples showed a prominent protein band of molecular weight 99 kDa which was not present in any of the uninfected samples while a 48 kDa band was seen in four out of the seven infected samples. The erythrocyte cell membranes of A and AB blood groups showed different glycoprotein profiles upon infection with P. falciparum when compared to those from blood groups B and O.

Conclusion: The two glycoproteins of molecular weights 99 kDa and 48 kDa should be further studied to determine their roles in the pathogenesis of malaria and as potential targets for drug and vaccine development.

Keywords: Plasmodium falciparum, proteins, glycoproteins, SDS-PAGE, ABO blood groups.

Citation: IeJSME 2011: 5 (2): 18-28

DOI: https://doi.org/10.56026/imu.5.2.18

Author: Velayudhan Menon

ABSTRACT

Background: Facebook is a popular social networking site with more than five hundred million users. This study assessed whether Facebook Groups can be used to teach clinical reasoning skills.

Methods: Sixty-seven final year medical students from the International Medical University, Malaysia, were exposed to interactive online learning through a Facebook Group for a period of six months in this study. The purpose was to determine if supervised interactive online learning could be used to augment the deep learning that comes from learning medicine at the bedside of patients. The interactive online discussions were entirely triggered by clinical problems encountered in the medical wards of the general hospital to which these students were attached.

Results: A total of 10 topics were discussed in this forum during the duration of this study and an example of one such discussion is provided to illustrate the informal nature of this kind of learning. The results showed a high degree of student involvement with 76 percent of students actively participating in the discussions.

Conclusion: The high degree of voluntary participation in the clinical discussions through the Facebook Group in this study tells us that Facebook Groups are a good way of engaging students for learning and can be used in medical education to stimulate creative clinical thinking.

Keywords: e-learning, interactive learning, online learning, medical students.

Citation: IeJSME 2012 : 6(1) 21-23

DOI: https://doi.org/10.56026/imu.6.1.21

Authors: Wilkinson Yoong Jian Tan, Jo Wearn Yeap, Sharifah Sulaiha Syed Aznal.

ABSTRACT

Background: Peripheral venous catheterisation is indispensable in modern practise of medicine. The indications of venous access should be weighed against the risk of complications, the commonest being thrombophlebitis. Thrombophlebitis causes patient discomfort and the need for new catheter insertion and risk of developing further widespread infections.

Methodology: This observational study was conducted on adult patients admitted to the surgical and medical ward of a tertiary hospital in Negeri Sembilan Malaysia in 2011. Four researchers visited patients daily and examined for signs of thrombophlebitis; warmth, erythema, swelling, tenderness or a palpable venous cord. Risks factors that were studied in this research were patient/s age and gender, duration of catheterization, use of catheter for infusion, size of catheter, site of catheter insertion and types of infusate. Thrombophlebitis was graded using a scale adapted from Bhandari et al. (1979).

Results: In total, 428 patients were recruited with an incidence rate of thrombophlebitis of 35.2%. Among those who developed thrombophlebitis, 65% had mild thrombophlebitis, 19% moderate and 8% severe thrombophlebitis. Results showed that female patients had a significant increased risk of developing thrombophlebitis. Also risk increased significantly with increased duration of catheterization and usage of the catheter for infusion. The age of a patient, types of infusate use, size of catheter and site of catheter insertion did not significantly influence the development of thrombophlebitis.

Conclusion: The study showed that risk of developing thrombophlebitis is significantly increased among female patients, and also with increased duration of catheterization and use of the peripheral venous catheter for infusion. We recommended elective replacement of catheter every 72 hours and daily examination of catheters for signs of thrombophlebitis by a healthcare personnel.

Keywords: Thrombophlebitis, Catheter, Catheter-Related Infections, Intravenous Infusions, Patient Care.

Citation: IeJSME 2012 : 6(1) 24-30

DOI: https://doi.org/10.56026/imu.6.1.24

Authors: Ammu Kutty Radhakrishnan, Nagarajah Lee, Mei-Ling Young.

ABSTRACT

Background: Medical schools have long been concerned with establishing a suitable process of admission. The criteria used to select students have traditionally focussed on high academic achievement.

Method: The International Medical University (IMU) accepts students from a wide range of pre-university entry qualifications for admission into the medical programme. The criteria for the various pre-university entry qualifications used by the IMU were agreed and accepted by the IMU Academic Council (AC), which consist of deans of the IMU’s partner medical schools (PMS). In this study, the various entry qualifications were first grouped into five categories based on the educational pedagogy. Then, this was aligned with the entry qualification data of all students who had been admitted into the IMU medical programme for the period of December 1993 to March 2000. During this period 1,281 students were enrolled into the IMU medical programme. The relationship between the five groups of pre-university entry qualifications and the students’ academic achievement in three end-of-semester (EOS) examinations namely EOS 1, EOS 3, and EOS 5 were analysed.

Results: Students with better grades in their pre-university examinations showed better performance in their EOS examinations, regardless of the subjects that they took at the pre-university level. Cluster analysis revealed that students who came in with certain pre-university qualifications generally performed poorly than the more conventional qualifications. However, after their first year in medical school, there were no significant differences in the clustering of the students.

Conclusion: Students with better grades in their pre-university examinations showed better performance in their EOS examinations, regardless of the science subjects that they took at the pre-university level.

Keywords: pre-university, entry qualifications, examinations, criteria for entry.

Citation: IeJSME 2012 6(2): 10-17

DOI: https://doi.org/10.56026/imu.6.2.10