Category: Review Articles

E-cigarettes: Facts and legal status

Posted Pei Kuan LaiPosted in Review Articles

Authors: Davendralingam Sinniah, Erwin Jiayuan Khoo.

ABSTRACT

The sale of tobacco-based cigarettes has declined in western countries, and ‘Big Tobacco’ is trying to make up the deficit in profits from the developing world. The recent introduction of e-cigarette, in which they have invested both their hopes and their finances, has been a boon to them as it serves to confuse smokers and non-smokers about the real issues relating to the toxicity, dangers, and the promotion of nicotine addiction especially among youths who have not previously smoked cigarettes. E-cigarettes cause inflammation and damage to epithelial cells in human airways and increased risk of infection. E-cigarette vapour contains more carcinogens like formaldehyde and acetaldehyde compared to a regular cigarette. Long-term vaping is associated with an incremental lifetime cancer risk. E-cigarettes are neither safe nor effective in helping smokers quit; there is enough evidence to caution children, adolescents, pregnant women, and women of reproductive age about e-cigarette’s potential for long term consequences to foetal and adolescent brain development that sub-serve emotional and cognitive functions. The nicotine effects that cause modification of late CNS development constitute a hazard of adolescent nicotine use. The American Heart Association (AHA), Food and Drug Administration (FDA), World Health Organisation (WHO) and two-thirds of the major nations in the world discourage the promotion of e-cigarettes as an alternative to proven nicotine-addiction treatments. Doctors, health care workers, and medical students should be armed with the facts about e-cigarettes, its dangers, and the legal status concerning its use, in order to be able to offer proper counselling to patients and adolescents, in particular, with special reference to the Malaysian context.

Keywords: E-cigarettes, nicotine addiction, cancer risk, brain development consequence, legislation.

Citation: IeJSME 2015 9(3): 10-19

DOI: https://doi.org/10.56026/imu.9.3.10

Patient autonomy – what does it mean for clinical decision-making in children and adolescents?

Posted Pei Kuan LaiPosted in Review Articles

Author: Thor Willy Ruud Hansen

ABSTRACT

Autonomy implies the right of a competent patient to make decisions about their own health care. To exercise autonomy a patient must receive an explanation of his/her condition. True autonomy presumes intellectual understanding, the ability to translate theoretical ideas into real-life concepts, and emotional connectedness to the situation.

Children may not be able to understand or process information about treatment choices. Therefore, responsibility for decision-making is vested in the parents. In Norwegian law, this lasts until the child is 12 years old, though the child must be informed and involved commensurate with intellect and maturity. From the ages of 12 until 16, the youngster should increasingly be heard and involved, and from the age of 16 years a youngster is considered medico-legally competent.

Parents who face serious illness in a child are in a life crisis. Yet in spite of this, decision-making competence is often assumed. Decisions with life-or-death or lifetime implications will profoundly influence the life of the family. The best interest of the sick child may not necessarily be compatible with the needs of the family as a unit. As medical caregivers we should be cautious about assuming that our insight into such family realities is adequate. We must sensitively, yet critically, consider decision-making competence, while at the same time supporting the parents’ efforts to cope and make the best decisions possible. However, we must never lose sight of the fact that our primary responsibility is towards the sick child.

Keywords: Bioethics; Autonomy; Children and adolescents; Decision-making competence; Best interest; Parental authority; Emancipation of children.

Citation: IeJSME 2016 10(1): 3-9

DOI: https://doi.org/10.56026/imu.10.1.3

Narrative Medicine: An unexplored perspective in the medical curriculum to enhance patient-centredness and empathy in medical students

Posted Pei Kuan LaiPosted in Review Articles

Authors: Chandramani Thuraisingham, Sivalingam Nalliah.

ABSTRACT

A medical narrative is a physician-patient dialogue, where the physician listens carefully to fragments of the patient’s story, while interpreting their hidden messages and word sequences, as well as observing their gestures and body language. This aspect of the therapeutic relationship contributes to deciphering symptoms which are not apparent in the conventional interview and contributes to a much broader perspective of illness and health.

The arts and the humanities have always been inseparable from each other in medical education. In this biomedical revolution, the humanities are needed now more than ever before to bridge the divides that separate the physician from the patient, from self, from colleagues, and society.

Narrative Medicine (NM) which aims to treat the whole person, and not just the illness, is an emerging patient- centred discipline in medical schools that can humanise medical care and promote empathy. NM helps medical students cope with the suffering of their patients as well as their own emotions by reducing the anxiety and threat that come with illness, thereby providing a psychologically-sound foundation for the development of self-reflection and empathy.

NM facilitates medical students’ adoption of patients’ perspectives with the hope of ultimately leading to more humane, ethical and empathetic healthcare for their patients. The discipline of NM is critically examined in this review paper from the perspective of external and internal stakeholders.

Keywords: Narrative medicine, curriculum, patientcentredness, empathy, medical students.

Citation: IeJSME 2017 11(2): 4-13

DOI: https://doi.org/10.56026/imu.11.2.4

Neuroendocrine carcinoma of the cervix: Review of classification and current developments in diagnosis and management

Posted Pei Kuan LaiPosted in Review Articles

Authors: Kavitha Nagandla, Sharifah Sulaiha, Sivalingam Nalliah, Norfadzilah Mohd Yusof.

ABSTRACT

Neuroendocrine carcinoma of the female reproductive tract are a heterogeneous group of rare neoplasms posing both diagnostic and therapeutic challenges. The recent classification by WHO includes neuroendocrine carcinomas (NECs) and neuroendocrine tumours (NETs). NECs are the poorly differentiated small cell carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC), while well-differentiated NETs include typical carcinoids (TC) and atypical carcinoids (AC). Majority of these tumours have an aggressive clinical course and published data is supportive of multi-modal therapeutic strategies. Etoposide/platinum based chemotherapy is commonly advocated. Histopathological categorisation and diagnosis are paramount to guide therapy. Well-differentiated carcinoid and atypical carcinoid tumours should be managed similar to gastroenteropancreatic neuroendocrine tumours. This review discusses the current classification, clinicpathologic characteristics and advances in the diagnostic evaluation and the treatment options of neuroendocrine carcinoma of the cervix.

Keywords: High grade neuroendocrine tumours, well-differentiated neuroendocrine tumours, carcinoid tumours.

Citation: IeJSME 2017 11(1): 2-11

DOI: https://doi.org/10.56026/imu.11.1.2

Climate change and its impact on public health – A review of the global environment

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Author: Stephen Ambu

ABSTRACT

Climate change is a product of human actions. The extreme events such as flash floods, droughts, heat waves, earthquakes, volcano eruptions and tsunamis seen in the world today are the result of indiscriminate human intrusion into the environment. Vulnerable countries and populations are the most affected by these climatic events. This places a burden on the resources of these countries. The Kyoto Protocol is a milestone in environmental management and the impetus created by it must be maintained by carrying out the much needed research into appropriate mitigating measures that will alleviate the climate change impact globally. A paradigm shift is needed in addressing the associated risks on human health to assess socioeconomic determinants and the related impacts on disease burden. Some wealthy nations emphasize economic benefits and downplay sustainability goals, health and equality. However the rising cost of energy is beginning to influence their outlook towards this issue. The implications on economics, human health and wellbeing are implicit. In order to strike a balance between disadvantaged and privileged nations, many international agencies are spearheading various research agenda to improve adaptation programmes on effects of changing climatic conditions on health. Malaysia too has such programmes initiated under its 5-year development plans.

Keywords: Climate change, environment, human health.

Citation: IeJSME 2012: 6 (Suppl 1): S2-S11

DOI: https://doi.org/10.56026/imu.6.Suppl1.S2

Lactose tolerance and intolerance in Malaysians

Posted Pei Kuan LaiPosted in Review Articles

Author: Peter Michael Barling

ABSTRACT

This review explores the digestibility of lactose by Malaysians, and the value of milk and other milk-derived products as sources of appropriate nutrition for Malaysians. Increased calcium intake through consumption of milk is an effective mechanism for increasing calcium uptake from the diet and thereby minimising the risk of development of osteoporosis in later life. Detailed information about rates of lactose intolerance, and adaptation to dietary lactose and its consequences for Malaysians, will help in the formulation of dietary advice, and improve commerial food manufaturing practice and Government policy directed to the minimization of rates of osteoporosis, which presents a substantial morbidity risk to elderly female Asians in particular.

Keywords: lactose, lactose non-persistence, breath hydrogen test, gastrointestinal symptoms, milk and dairy products.

Citation: IeJSME 2012: 6 (Suppl 1): S12-S23

DOI: https://doi.org/10.56026/imu.6.Suppl1.S12

Biotechnological applications of microalgae

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Author: Wan-Loy Chu

ABSTRACT

Microalgae are important biological resources that have a wide range of biotechnological applications. Due to their high nutritional value, microalgae such as Spirulina and Chlorella are being mass cultured for health food. A variety of high-value products including polyunsaturated fatty acids (PUFA), pigments such as carotenoids and phycobiliproteins, and bioactive compounds are useful as nutraceuticals and pharmaceuticals, as well as for industrial applications. In terms of environmental biotechnology, microalgae are useful for bioremediation of agro-industrial wastewater, and as a biological tool for assessment and monitoring of environmental toxicants such as heavy metals, pesticides and pharmaceuticals. In recent years, microalgae have attracted much interest due to their potential use as feedstock for biodiesel production. In Malaysia, there has been active research on microalgal biotechnology for the past 30 years, tapping into the potential of our rich microalgal resources for high-value products and applications in wastewater treatment and assessment of environmental toxicants. A culture collection of microalgae has been established, and this serves as an important resource for microalgal biotechnology research. Microalgal biotechnology should continue to be regarded as a priority area of research in this country.

Keywords: Bioactive compounds; bioremediation; biotechnology; Chlorella; Dunaliella; microalgae; Spriulina.

Citation: IeJSME 2012: 6 (Suppl 1): S24-S37

DOI: https://doi.org/10.56026/imu.6.Suppl1.S24

Reflections: Evolution of PBL in the International Medical University

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Author: Hla-Yee-Yee

ABSTRACT

This paper traces the evolution of PBL in the International Medical University over a period of twenty years; since its inception in 1992 till 2012. It is a record of the reasons for the evolution, the people involved and the strategies adopted. The PBL in IMU has metamorphosed over the years from a paper-based complete case history into its present form of staggered release of information, paper-based or otherwise (videos, web-based, newspaper cuttings, debates). Strategies to improve student and facilitator buy-in, strengthening of facilitator training, adoption of PBL templates, innovations to improve student participation are discussed.

Keywords: IMU, twenty-year history, PBL, innovations.

Citation: IeJSME 2012: 6 (Suppl 1): S38-S47

DOI: https://doi.org/10.56026/imu.6.Suppl1.S38

The anatomy of anatomy

Posted Pei Kuan LaiPosted in Review Articles

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

Melanosis coli

Posted Pei Kuan LaiPosted in Review Articles

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