Authors: Sin Wei Tang, Zhi Hang Wong, Ket Li Ho, Dahlya Qasryna Binti Zulkifli, Jia Wen Koo, Yung Chein Yong.

ABSTRACT

Introduction: Chinese medicine (CM) external therapy is commonly used to treat rheumatoid arthritis (RA) in combination with conventional drug. This study aims to provide a comprehensive synthesis on the efficacy of CM external therapy combined with conventional drug treatment in RA.

Methods: Randomised controlled trials (RCTs) experimenting the efficacy of CM external therapy (acupuncture, moxibustion and CM fumigation) combined with conventional drug in comparison with conventional drug only in RA patients were collected from PubMed, Medline, Cochrane Central of Controlled Trials (CENTRAL), ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), and Wanfang databases. Quality was assessed using the Cochrane Risk of Bias Tool. The outcome measures which include Disease Activity Score-28 (DAS28), Visual Analogue Scale (VAS), Swollen Joint Count (SJC), Tumour Necrosis Factor (TNF-α), serum levels of C-reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) were analysed using Review Manager 5.4.1 and GRADEpro GDT online software.

Results: Fifty RCTs fulfilling the criteria were included. Although some level of efficacy was statistically noted on the use of CM external therapies, their certainty levels are mixed, ranging only in between moderate and low.

Conclusions: Mixed levels of certainty has hindered the drawing of conclusion. The addition of CM external therapies to conventional drug treatment may provide some benefits in RA. Further clinical trials with considerations in minimising the risk of bias are recommended to provide more high-quality evidence in the effect of CM external therapies as a complementary treatment in RA.

Keywords: Chinese medicine, fumigation, meta-analysis, moxibustion, rheumatoid arthritis, systematic review

Citations: IeJSME 2024 Vol 18 (1): 40-65

Authors: Sinali Gunathilake, Chenadee Pathirage, Shivasankarie Kanthasamy, Sameera A Gunawardena.

ABSTRACT

The increased usage of digital platforms for communication and networking, particularly after the pandemic has caused concern about exposure to bullying and sexual harassment, particularly among young children and adolescents. Cyberbullying (CB) and cyber sexual harassment (CSH), although considered less harmful by many, may cause graver psychological manifestations than their physical forms, due to their potential for wider reach, easier access to private and sensitive information, ability to conceal perpetrator identity and continuous exposure of the victim to the harmful acts. Among the various characteristics, there were differences between age groups and gender, as well as varied psychological and behavioral features among victims and perpetrators which included low self-esteem, low academic performance and interestingly, some victims who themselves, later engage in perpetrating CB on others.

The strategies for the prevention of CB and CSH are similar to that of the traditional forms, which predominantly include raising awareness among students, teachers and parents. This article reviews the characteristics of CB and CSH and discusses the limitations in existing laws and statutes in combating CB and CSH while highlighting the need for improving the policies and guidelines on CB and CSH among educational institutions and workplaces.

Keywords: Adolescent psychology; technology facilitated sexual violence; gender-based violence; cybervictimisation experiences.

Citations: IeJSME 2024 Vol 18 (1): 66-80

Authors: Shamala Ramasamy, Joo Hou Ng, Cheryl Sin Yi Tham, Serena In

Citations: IeJSME 2023 Vol 17(3): 09-12

DOI: https://doi.org/10.56026/imu.17.3.9

Authors: Eunice Chieu Teng Yap, Sushela Devi Somanath, Saatheeyavaane Bhuvanendran, Ammu Kutty Radhakrishnan

ABSTRACT

Vaccines are vital tools in public health as they play critical roles in preventing and controlling infectious diseases. Vaccine technology has advanced from virus-infected lesions to live attenuated, inactivated or killed pathogens, toxoids, and subunits that consist of only specific pathogen parts needed to elicit an immune response. The progression of virus-like particle vaccines, recombinant viral-vectored vaccines, toxoids, protein or polysaccharide-based vaccines designed to conjugate with a distinct carrier protein to enhance immune reaction is a significant milestone. However, some infectious pathogens can avoid the adaptive immune system, while traditional methods may be unsuitable against non-infectious diseases like cancer. Recent studies have demonstrated the potential of messenger RNA (mRNA) vaccines as an alternative to traditional vaccine approaches. mRNA vaccines contain mRNA that encodes the specific antigen and triggers a directed immune response. The two main forms of mRNA used in the study of mRNA vaccines are conventional non-amplifying mRNA and self-amplifying mRNA (saRNA). This article discusses the mRNA vaccine structure, delivery strategies, and protective functions, focusing on mRNA vaccines’ safety and therapeutic potential. Pre-clinical research has demonstrated the broad utility of mRNA vaccines in animal models. Human clinical trials, however, are still under validation. Hence, further studies will need to focus on adapting reliable results of preclinical trials to human applications. The evidence to date suggests that mRNA vaccines are promising next-generation vaccines and, in the future, clinical trials would transform basic research into mRNA therapeutics in medical practices.

Keywords: COVID-19, mRNA vaccine, safety, therapeutic potential, vaccination

Citations: IeJSME 2023 Vol 17(3): 13-25

DOI: https://doi.org/10.56026/imu.17.3.13

Author: Pei Kuan Lai

ABSTRACT

Introduction: Travel medicine is an emerging branch of medicine concerned with the well-beings of travellers before, during, and after travel. Pre-travel health advice and medical services are important to keep travellers healthy and ensure a safe and pleasant journey by minimising impact of illness and accidents.

Objective: This paper serves as a literature review paper on the pre-travel health advice seeking behaviours amongst travellers as well as the pre-travel health advice and medical services provided by the health professionals.

Methodology: An extensive online literature search using the search terms of “pre-travel”, “health advice”, “medical services”, and “health professionals” was done on electronic bibliographic databases including PubMed and Scopus supplemented by Google Scholar.

Results: Twenty original studies as retrieved from the online databases which fulfilled the inclusion criteria were included in the review. Prevalence of pre-travel advice seeking behaviour is reportedly low in Malaysia (36.8% – 40.5%). Studies done amongst pharmacists in Malaysia revealed that the Malaysian
pharmacists have been actively involved in providing pre-travel health advice and medical services (76.6% – 85%). High percentages of healthcare professionals in Europe and American (68% – 94.7%) provide pre-travel advice and medical services, followed by 79.5% in Saudi and 44.7% in Qatar. The top 5 topics of health advice most frequently cited were on malaria, travel insurance, sexually transmitted disease/HIV, vaccinations and first aid kit. The average duration spent for pre-travel consultation range from 5 to 30 minutes.

Conclusion: Travellers should be educated on the importance of seeking pre-travel advice and vaccinations to raise their awareness. Healthcare practitioners should be well-trained and informed to
provide good pre-travel advice and services.

Keywords: Pre-travel, health advice, medical services, travellers.

Citations: IeJSME 2022 16 (3): 12-21

DOI: https://doi.org/10.56026/imu.16.3.12

Authors: Kok Wei Poh, Shobhana Sivandan, Kwee Choy Koh.

ABSTRACT

COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can result in multiple complications such as long COVID syndrome, pulmonary fibrosis, and organizing pneumonia (OP). Although OP is a well-known complication of COVID-19, several challenges remain; from suspecting and confirming the diagnosis to its management. These challenges are aggravated further in patients who are critically ill and when surgical biopsy is not feasible. Post-COVID-19 OP is a subset of secondary organizing pneumonia that shares similar clinical and radiological characteristics and similar computerized tomography (CT) scan features with OP of various etiologies. In this review, we propose a clinical approach based on current available evidence for the management of COVID-19 patients with suspected OP. Typical CT findings such as consolidations, perilobular opacity, reversed halo sign and ground-glass opacities are highly suggestive of OP, but are not pathognomonic. Confirmation by histopathology should be done but when not possible, a trial of corticosteroid therapy may be considered. However, biopsy should be done if corticosteroid therapy fails or when there is clinical deterioration and worsening of hypoxia while on corticosteroid therapy especially if the onset of the symptoms is longer than two weeks.

Keywords: COVID-19; SARS-CoV-2; organizing pneumonia; corticosteroid; computerized tomography scan

Citations: IEJSME 2022 16 (2): 9-27

DOI: https://doi.org/10.56026/imu.16.2.9

Authors: Shivani Harikrishnan, Sangeetha Shyam, Suan Phaik Khoo.

ABSTRACT

Recent studies have theorised that visfatin plays a significant role in the development and progression of Type 2 Diabetes Mellitus (T2DM). Some studies indicate that levels of serum visfatin are increased in subjects with T2DM whereas other studies dispute this claim. Since the results of these studies remain inconsistent, a systematic review and meta-analysis were performed. A search of PubMed, Ebsco-MEDLINE, Scopus, ScienceDirect, and Cochrane was conducted up till February 2019. Data analysis was performed using Review Manager 5.3. The standardised mean difference (SMD) with a 95% confidence interval (CI) was used to pool the effect size. The Newcastle Ottawa scale (NOS) was used to evaluate bias in the selected studies and a funnel plot was used to assess publication bias. A total of 17 studies were included in this systematic review and meta-analysis. Overall, levels of serum visfatin in subjects with T2DM were significantly higher when compared to the healthy adults (SMD: 1.68 95% CI [1.22,2.14], p<0.00001, I2=92%). Sensitivity and subgroup analyses did not decrease heterogeneity. Among subjects with T2DM, those with additional comorbidity showed moderately increased levels of serum visfatin when compared to the subjects without comorbidity (SMD: 0.73 95% CI [0.14,1.32], p< 0.00001, I2=92%). Sensitivity and subgroup analyses performed did not significantly decrease heterogeneity. Levels of serum visfatin are increased in subjects with T2DM when compared to healthy adults. Levels of serum visfatin are increased in subjects with T2DM with comorbidity when compared to subjects with T2DM without comorbidity. However, these findings must be interpreted with caution as high heterogeneity (I2=92%) was observed.

Keywords: Serum visfatin, Type 2 Diabetes Mellitus, Systematic Review, Meta-Analysis.

Citation: IeJSME 2021 15 (3): 5-20

DOI: https://doi.org/10.56026/imu.15.3.5

Author: John Ruedy

ABSTRACT

The recent elaboration of the range of physician competencies upon which the quality of health care is dependent has fostered the development of a variety of methods of assessing medical student competencies and performance. Such assessments are essential in providing feedback to students to guide their learning and to faculty on the success of the curriculum in achieving competency outcomes. In addition they provide evidence that students have achieved minimum requirements for progressing. Well-designed Observed Structured Clinical Examinations (OSCEs), Mini-Clinical Examinations (Mini-CEXs) and some forms of Multi-Source Feedback (MSF) can meet acceptable standards of validity and reliability and are feasible. Competency assessments are limited in predicting how a student will actually act in the work situation particularly in humanistic skills. More emphasis needs to be placed on student performance, in such competencies as communication and professionalism, in a variety of settings by a number of observers.

Keywords: assessment, evaluation, clinical competence, performance, multi-source feedback.

Citation: IeJSME 2007: 1 (1): 15-21

DOI: https://doi.org/10.56026/imu.1.1.15