Issue: IeJSME 2012 6(Suppl 1)

Author: Joon-Wah Mak

ABSTRACT

Developing and adult worms of the human lymphatic filarial parasites (Wuchereria bancrofti, Brugia malayi, and Brugia timori) are located mainly in the lymphatic system and occasionally in aberrant sites like subcutaneous and conjunctival cysts. Lymphatic pathology ranging from dilatation of lymphatic channels and lymphangiectasia are detected on ultrasonography in apparently healthy, amicrofilaraemic, but filarial antigen positive individuals in endemic areas. Microfilariae are distributed in various organs and may be associated with immune mediated pathology at these sites; tropical pulmonary eosinophilia is characterized by intense immune mediated destruction of microfilariae in the lung parenchyma. In the spleen and other sites, nodular granulomatous lesions can occur where microfilariae are trapped and destroyed. The finding of Wolbachia endosymbionts in all stages of lymphatic filarial parasites has provided new insight on the adverse reactions associated with anti-filarial chemotherapy. Inflammatory molecules mainly lipopolysaccharide (LPS)-like molecules released from endosymbionts on death of the parasites are largely responsible for the adverse reactions encountered during anti-filarial chemotherapy. Prenatal tolerance or sensitization to parasite derived molecules can immune-modulate and contribute to both pathology and susceptibility/resistance to infection. Pathological responses thus depend not only on exposure to filarial antigens/infection, but also on host-parasite-endosymbiont factors and to intervention with antifilarial treatment. Treatment induced or host mediated death of parasites are associated with various grades of inflammatory response, in which eosinophils and LPS from endosymbionts play prominent roles, leading to death of the parasite, granulomatous formation, organization and fibrosis. The non-human primate (Presbytis spp.) model of Brugia malayi developed for the tertiary screening of anti-filarial compounds has provided unique opportunities for the longitudinal study of the pathology associated with lymphatic filariasis. The pathology in this non-human primate model closely follows that seen in human lymphatic filarial infections and correlates with clinical evidence of lymphatic pathology as detected with ultrasonography. These studies also show that successful treatment as detected by loss of motility and calcification of worms on ultrasonography is associated with reversal of early dilatations of lymphatic channels.

Keywords: lymphatic filariasis, pathology, immunopathology, Brugia, Wuchereria.

Citation: IeJSME 2012: 6 (Suppl 1): S80-S86

DOI: https://doi.org/10.56026/imu.6.Suppl1.S80

Author: Sivalingam Nalliah

ABSTRACT

This is a cross sectional study conducted in July 2010 at the International Medical University, Seremban, Malaysia. The objective of this study was to ascertain the relationship between working memory capacity of final MBBS medical students using the digit span backward test and their academic achievement based on the total score at the modified essay questions (MEQ) which was the principal component of the theory examination. Seventy eight final year medical students were recruited, 41 (52.6%) were females and remaining 37 (47.4%) were males. Working memory capacity was measured by digit span backward test (DSBT) which ranged from 3 to 8 digits. The mean digit score was 6.6 ± 1.1 falling under the category of ‘above average’ score. There was no significant difference between working memory capacity and gender (p>0.05). There was no significant difference in the MEQ mean score and the different categories of working memory capacity (p>0.05). The DBST shows uniformity in working memory adequate to pass the modified essay questions. Medical students appear to use encoding and retrieval process in problem solving based on functionality and pattern recognition in tackling the problems in the MEQ.

Keywords: Working memory, digit span backward test, academic performance, modified essay question.

Citation: IeJSME 2012: 6 (Suppl 1): S87-S102

DOI: https://doi.org/10.56026/imu.6.Suppl1.S87

Author: Kandasami Palayan

ABSTRACT

The only potential curative therapy for gastric cancer is the resection of both the tumor and the regional lymph nodes at the early stage of the disease. The majority of patients with gastric cancer in Malaysia have an advanced disease at initial diagnosis, and curative surgery is possible in less than 20% of operated cases. Acurate preoperative staging is crucial in determining the most suitable therapy and avoiding unnecessary attempts at curative surgery. While computed tomography remains as the most widely used imaging modality for gastric cancer staging, its ability to detect local invasion, peritoneal and liver metastases is limited. In the recent years laparoscopy has become an important component in the staging algorithm of gastric cancer. The aim of this review is to evaluate the efficacy of routine preoperative laparoscopic staging in the management of gastric cancer, and in particular describe the Malaysian experience.

Keywords: Gastric cancer, staging, laparoscopy.

Citation: IeJSME 2012: 6 (Suppl 1): S103-105

DOI: https://doi.org/10.56026/imu.6.Suppl1.S103

Author: Allan Kah-Heng Pau

ABSTRACT

Oral health diseases are common in all regions of the world and their impact on anatomical and social functioning is widely acknowledged. Their distributions are unequal between and within countries, with the greatest burden falling on disadvantaged and socially marginalized populations. The risk factors and social determinants for oral diseases have been comprehensively documented, and the evidence base for their prevention is growing. However, decisions on health care are still often made without a solid grounding in research evidence. Translation of research into policy and practice should be a priority for all. Both community and individual interventions need tailoring to achieve a more equal and person-centered preventive focus and reduce any social gradient in health. The major challenges of the future will be to translate knowledge and experiences in oral disease prevention and health promotion into action programmes. The international oral health research community needs to engage further in research capacity building and in strengthening the work so that research is recognized as the foundation of oral health policy at global level.

Keywords: dental public health, oral epidemiology, oral health promotion.

Citation: IeJSME 2012: 6 (Suppl 1): S106-S112

DOI: https://doi.org/10.56026/imu.6.Suppl1.S106

Author: Ammu Kutty Radhakrishnan

ABSTRACT

The immune system is the host natural defence against cancer. Cancers are caused by progressive growth of the progeny of a single transformed host cell. The immune system is generally not able to mount immune responses to “self-antigens”, due to various mechanisms of immunological tolerance that are in place. This means that despite possessing a natural defence against tumours, many of the cancer patients may not be able to mount an effective immune response to fight the tumours. Dendritic cells (DC) are highly specialised in antigen presenting that can initiate and stimulate immune responses. These cells have the ability to stimulate naïve T cell proliferation and perform specific stimulatory and tolerogenic functions respectively. When the DC are activated by antigens, these cells undergoes further maturation and migrate to secondary lymphoid tissues, present antigen to T cells and finally
induce an immune response. The ability of the DC to activate naïve and primed T-lymphocytes makes these cells a good candidate to be explored as a potential immunotherapeutic agent that can modulate antitumour immune responses in the affected host.

Keywords: dendritic cells, immunotherapy, anti-tumour.

Citation: IeJSME 2012: 6 (Suppl 1): S113-S117

DOI: https://doi.org/10.56026/imu.6.Suppl1.S113

Author: Michael John Rathbone

ABSTRACT

This article presents an overview of long acting products used in animal health, production and reproduction. The topic represents a niche field of controlled release that few formulation scientists become specialists and experts in, but it is a field which has made significant contribution to the area of controlled release technology, and one which is of major importance to human kind due to their dependence on farmed animals as a source of hide, protein, milk and eggs.

Keywords: Intravaginal drug delivery, veterinary drug delivery, animal health, controlled release, oestrous control.

Citation: IeJSME 2012: 6 (Suppl 1): S118-S128

DOI: https://doi.org/10.56026/imu.6.Suppl1.S118

Author: Davendralingam Sinniah

ABSTRACT

Shock, a major cause of morbidity and mortality in children, is the the most anxiety-provoking emergency that needs to be addressed urgently and effectively by the attending paediatrician. It is a state where the metabolic demands of the tissue are not met due to circulatory dysfunction. Unlike adults, hypotension is a very late feature of shock in children. As the child’s condition worsens, the clinical presentation of the different causes of shock become similar, and nullify any aetiological differences. Regardless of the type of shock, the final common pathway is inadequate tissue perfusion and oxygen supply to meet cellular demands. Delayed recognition and treatment result in progression from compensated reversible shock to uncompensated irreversible shock with widespread multiple system organ failure to death. This paper reviews the physiological basis, and pathophysiological classification of the various types of shock and their respective aetiologies. The clinical features of the different types of shock are described, and current diagnostic and therapeutic strategies are applied for the most effective and appropriate treatment for resuscitating the child in shock. A strong index of suspicion, early recognition, timely intervention and transfer to an intensive care unit are critical for successful outcomes in the management of paediatric shock.

Keywords: shock, child, aetiology, treatment, management.

Citation: IeJSME 2012: 6 (Suppl 1): S129-S136

DOI: https://doi.org/10.56026/imu.6.Suppl1.S129

Author: Cheong-Lieng Teng

ABSTRACT

In the developing world, clinical knowledge management in primary care has a long way to go. Clinical decision support systems, despite its promise to revolutionise healthcare, is slow in its implementation due to the lack of financial investment in information technology. Point-of-care resources, such as comprehensive electronic textbooks delivered via the web or mobile devices, have yet to be fully utilised by the healthcare organisation or individual \ clinicians. Increasing amount of applicable knowledge of good quality (e.g. clinical practice guidelines and other pre-appraised resources) are now available via the internet. The policy makers and clinicians need to be more informed about the potential benefits and limitations of these new tools and resources and make the necessary budgetary provision and learn how best to harness them for patient care.

Keywords: knowledge management, primary health care, clinical decision support system, point-of-care resources.

Citation: IeJSME 2012: 6 (Suppl 1): S137-S141

DOI: https://doi.org/10.56026/imu.6.Suppl1.S137

Author: Hematram Yadav

ABSTRACT

There has been a significant decline in maternal mortality from 540 per 100,000 live births in I957 to 28 per 100,000 in 2010. This decline is due to several factors. Firstly the introduction of the rural health infrastructure which is mainly constructing health centres and midwife clinics for the rural population. This provided the accessibility and availability of primary health care and specially, antenatal care for the women. This also helped to increase the antenatal coverage for the women to 98% in 2010 and it increased the average number of antenatal visits per women from 6 in 1980 to 12 visits in 2010 for pregnant women. Along with the introduction of health centres, another main feature was the introduction of specific programmes to address the needs of the women and children. In the 1950s the introduction of Maternal and Child Health (MCH) programme was an important step. Later in the late 1970s there was the introduction of the High Risk Approach in MCH care and Safe Motherhood in the 1980s. In 1990, an important step was the introduction of the Confidential Enquiry into Maternal Deaths (CEMD). Another significant factor in the reduction is the identification of high risk mothers and this is being done by the introduction of the colour coding system in the health centres. Other factors include the increase in the number of safe deliveries by skilled personnel and the reduction in the number of deliveries by the Traditional Birth Attendants (TBAs). The reduction in fertility rate from 6.3 in 1960 to 3.3 in 2010 has been another important factor. To achieve the 2015 Millennium Development Goals (MDG) to further reduce maternal deaths by 50%, more needs to be done especially to identify maternal deaths that are missed by omission or misclassification and also to capture the late maternal deaths.

Keywords: Maternal mortality, Risk Approach in MCH Care, Confidential Enquiry, Malaysia.

Citation: IeJSME 2012: 6 (Suppl 1): S142-S151

DOI: https://doi.org/10.56026/imu.6.Suppl1.S142

Author: Peng-Nam Yeoh

ABSTRACT

IMU is one of 17 institutions of higher learning conducting the Bachelor of Pharmacy course in Malaysia. The White paper on pharmacy student professionalism by the Task Force of the American Pharmaceutical Association Academy of Students of Pharmacy together with the American Association of Colleges of Pharmacy Council of Deans mentioned 10 essential traits of a professional, recommending their early development. Since the beginning of the IMU Bachelor of Pharmacy (BPharm) (Hons) course in July 2004 on Registration Day, IMU has adopted the concept of developing professionalism in the pharmacy student from the very first day of university, by having the White Coat Ceremony where the entire class takes the Pledge of Professionalism (adapted from the Task Force) against the “Code of Conduct for Pharmacists and Bodies Corporate” by the Pharmacy Board of Malaysia in the presence of the Senior Director of the Pharmaceutical Services Division of the Ministry of Health, Malaysia and the President of the Malaysian Pharmaceutical Society (MPS). Throughout their 4 years in IMU, the pharmacy students are exposed to various aspects of professionalism in different subjects in their curriculum. On 23rd April 2012, when the fifth cohort of BPharm students received their final examination results, “Pharmacy Professional Day” was launched. The graduating students took the Oath of a Pharmacist (adapted from the American Association of Colleges of Pharmacy’s Oath with slight amendment). Talks by alumni and speakers from MPS aimed to facilitate the transition of the new graduate to working life as a pharmacist.

Keywords: Pharmacy, White-Coat-Ceremony, Professionalism, Oath of a Pharmacist.

Citation: IeJSME 2012: 6 (Suppl 1): S152-S154

DOI: https://doi.org/10.56026/imu.6.Suppl1.S152