ABSTRACT
INTRODUCTION: To evaluate the effectiveness of team-based self-directed learning (SDL) in the teaching of the undergraduate Year 5 surgical posting. MATERIALS AND METHODS: A quasi-experimental study was conducted to develop and administer a team-based SDL versus a conventional SDL to teach undergraduate surgical topics. One hundred and seventy-four medical students who underwent the Year 5 surgical posting were recruited. They were assigned to two groups receiving either the teambased SDL or the conventional SDL. Pre- and post-SDL assessments were conducted to determine students' understanding of selected surgical topics. A selfadministered questionnaire was used to collect student feedback on the team-based SDL. RESULTS: The team-based SDL group scored significantly higher than the conventional SDL group in the post-SDL assessment (74.70 ± 6.81 vs. 63.77 ± 4.18, t = -12.72, p < 0.01). The students agreed that the team-based SDL method facilitated their learning process. CONCLUSION: The study demonstrated that the use of a teambased SDL is an effective learning strategy for teaching the Year 5 surgical posting. This method encouraged peer discussion and promoted teamwork in completing task assignments to achieve the learning objectives.
Subject(s)
Education, Medical, Undergraduate , Students, Medical , Humans , Education, Medical, Undergraduate/methods , Learning , Curriculum , Educational MeasurementABSTRACT
A 60-year-old lady presented with lower abdominal discomfort and a huge palpable intra-abdominal mass for 4 months, with significant weight loss over half a year. Transvaginal ultrasonography and computed tomography (CT) abdomen showed a large right solid cystic mass likely ovarian in origin. The CA-125 was raised. With the provisional diagnosis of ovarian cancer patient underwent laparotomy at Hospital Umum Sarawak, Malaysia. However intraoperative findings showed that uterus and both ovaries were normal. The tumour was arising from the jejunum and adherent to the dome of the urinary bladder and right broad ligament. The tumour was resected and final diagnosis was jejunal gastrointestinal stromal tumour (GIST). We described this case which was misinterpreted as an ovarian cancer.
Subject(s)
Gastrointestinal Stromal Tumors , Ovarian Neoplasms , Female , Gastrointestinal Stromal Tumors/diagnosis , Gastrointestinal Stromal Tumors/pathology , Gastrointestinal Stromal Tumors/surgery , Humans , Jejunum , Laparotomy , Middle Aged , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
We present here a case of a 66-year-old lady who was diagnosed with right iliac fossa retroperitoneal leiomyosarcoma at Hospital Umum Sarawak. The challenge in this case was the extension of tumour with the involvement of her right ureter causing proximal hydroureter and hydronephrosis. After resection of tumour en-block with the involved segment of ureter, it was not possible to repair the ureteric defect directly. We used interpositional vascularized appendix graft to repair this large (7 cm) ureteric defect. We describe here this uncommon technique of ureter reconstruction.
Subject(s)
Appendix , Hydronephrosis , Leiomyosarcoma , Plastic Surgery Procedures , Ureter , Aged , Female , Humans , Leiomyosarcoma/diagnostic imaging , Leiomyosarcoma/surgery , Ureter/diagnostic imaging , Ureter/surgeryABSTRACT
INTRODUCTION: Healthcare workers serve as the frontliners against the coronavirus 2019 disease (COVID-19) and this puts them most at risk of infection as they attend to numerous patients with unknown status. This study aimed to examine stress, anxiety, and depression among healthcare workers caring for COVID-19 patients in Sarawak General Hospital (SGH), Malaysia. MATERIALS AND METHODS: This cross-sectional observational study conducted in SGH during the pandemic with an online self-administered questionnaire composed of two parts, the socio-demographic characteristics, and the Depression Anxiety Stress Scale (DASS). RESULTS: A total of 105 healthcare workers responded to this study. A questionnaire in both Bahasa Melayu and English was used. The findings showed that all healthcare workers had mild anxiety, with the majority experiencing mild stress (57.1%), and almost half of the respondents experiencing mild depression (41%). Female subjects had a significant higher mean score in anxiety level and stress level compared to male subjects (10.0±3.20 vs. 8.6±2.93, p<0.05; 14.1±4.76 vs. 10.7±3.70, p<0.05, respectively). Staff who were transferred from other units to handle COVID-19 cases experienced more psychological symptoms. There were significant correlations between the depression, anxiety and stress levels among the healthcare workers and the number of children they had (r=0.739, p=0.001; r=0.642, p=0.001; r=1, p =0.001 respectively). However, the stress level among the healthcare workers was reversely correlated with their years of working experience (r=-0.199, p=0.042). CONCLUSION: This study identified some socio-demographic factors associated with increased levels of stress, anxiety and depression among the healthcare workers during pandemic, which may lay ground for future interventions.
Subject(s)
Anxiety/epidemiology , COVID-19/psychology , COVID-19/therapy , Depression/epidemiology , Health Personnel/psychology , Stress, Psychological/epidemiology , Adult , Cross-Sectional Studies , Female , Humans , Malaysia , Male , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
Ileo-ileal knotting is a rare cause of intestinal obstruction. In this condition, one bowel loop makes a knot with an adjacent bowel loop, resulting in mechanical obstruction and even gangrene of the bowel. We present a case of a young girl with ileo-ileal knotting resulting in a closed-loop obstruction and gangrene of the small bowel loop. This is a difficult condition to diagnose; a high index of suspicion and early surgical intervention are essential to reduce morbidity and mortality.
Subject(s)
Intestinal Obstruction/diagnosis , Intestine, Small/physiopathology , Intestine, Small/surgery , Adolescent , Female , Gangrene/etiology , Humans , Intestinal Obstruction/complications , Intestinal Obstruction/surgery , Plastic Surgery Procedures , Surgical Procedures, Operative/methods , Treatment OutcomeABSTRACT
INTRODUCTION: Cerebral venous sinus thrombosis (CVST) is a potentially fatal neurological condition. However, due to the non-specific clinical and radiological features of CVST, it can sometimes result in a delay in the diagnosis and subsequent management. The aim of this study was to evaluate the demography, risk factors and one-year outcome of CVST patients treated in Hospital Universiti Sains Malaysia. METHODS: In this retrospective study, we reviewed the cases diagnosed with CVST admitted to our centre from January 2011 until November 2015. RESULTS: A total of 15 patients were included in this review. The patterns of imaging findings as well as risk factors for CVST is discussed with a review of the literature and current management practices. One year followed-up showed full recovery (Glasgow Outcome Scale (GOS) of 5) in 10 cases (66.7%), whereas 4 cases (26.7%) with GOS of 4 (three cases with neurological deficits, and 1 case with mild symptom. There was one case of mortality in this study secondary to sepsis during hospitalisation. The presenting symptoms were mainly headache, focal neurology deficits, seizure and altered sensorium. Risk factors identified were oral contraceptive pills usage, chronic sinuses or ear infections, and obesity. Initial computed tomography (CT) scan showed various findings and haemorrhagic infarct was one of the common findings. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) revealed majority of the patients had occlusion at two or more venous sinus sites. No patients had new or recurrent intracranial haemorrhage following initiation of anticoagulation therapy. CONCLUSION: Thus it is considerable safe to start anticoagulation therapy in CVST patients including those with intracranial haemorrhage. We propose further neuroimaging to avoid missed diagnosis of CVST in patient presented with recent onset headache and CT evidence of unusual cerebral infarction.
Subject(s)
Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/drug therapy , Adolescent , Adult , Anticoagulants/administration & dosage , Female , Humans , Malaysia , Male , Medical Audit , Middle Aged , Outcome Assessment, Health Care , Retrospective Studies , Risk Factors , Sinus Thrombosis, Intracranial/etiology , Young AdultABSTRACT
We reported a case of cauda equina myxopapillary ependymoma in a patient who presented with atypical history of progressive blurring of vision. Ophthalmology examination revealed relative afferent pupillary defect, binasal hemianopia and papilloedema. This case report serves as a reminder that the intraspinal tumour could be a cause of papilloedema, despite rare, should be considered in a hydrocephalus patient who presented with no intracranial pathology and minimal spinal symptoms.
Subject(s)
Cauda Equina , Ependymoma/diagnosis , Hydrocephalus/etiology , Papilledema/etiology , Peripheral Nervous System Neoplasms/diagnosis , Adult , Ependymoma/complications , Humans , Hydrocephalus/diagnosis , Male , Papilledema/diagnosis , Peripheral Nervous System Neoplasms/complicationsABSTRACT
Large intracranial tumour may present only with psychiatric symptoms without any neurological deficits. Delay in surgical treatment may significantly affect the quality of life in these patients. We report a case of a young engineering student who was diagnosed as treatment-resistant depression without initial neuroimaging study. Further neuroimaging studies revealed he has a large falcine meningioma. His psychiatric symptoms resolved following surgical resection of the tumour. We emphasized the importance of initial neuroimaging study in young patients presenting with psychiatric symptoms.
Subject(s)
Depressive Disorder, Treatment-Resistant/etiology , Meningeal Neoplasms/diagnosis , Meningioma/diagnosis , Adult , Dura Mater , Humans , Magnetic Resonance Imaging , Male , Meningeal Neoplasms/complications , Meningeal Neoplasms/diagnostic imaging , Meningeal Neoplasms/psychology , Meningioma/complications , Meningioma/diagnostic imaging , Meningioma/psychology , NeuroimagingABSTRACT
Subtentorial subdural empyema is a rare and life threatening intracranial suppuration. It is usually an intracranial complication of otogenic infections. Early diagnosis and surgical drainage are the most important factors determining prognosis. The high mortality reported in the literature reflects the severity of subtentorial subdural empyema if proper management is delayed. Intracranial infections usually require between 4 to 6 weeks of intravenous antibiotics therapy. However, the prolonged duration of hospitalization as well as requirement for neurosurgically inserted indwelling devices may predispose these patients to new nosocomial infections.
ABSTRACT
Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.
Subject(s)
Brain Injuries/therapy , Critical Care , Hospitals, General , Patients' Rooms , Adolescent , Adult , Aged , Brain Injuries/diagnosis , Brain Injuries/mortality , Cohort Studies , Female , Humans , Malaysia , Male , Middle Aged , Treatment Outcome , Young AdultABSTRACT
The association of membranous nephropathy with Fanconi syndrome and anti-tubular basement antibodies appears to be a distinct subset of familial membranous nephropathy. We studied two Chinese families with four affected boys to evaluate the mode of inheritance of disease. HLA haplotype analysis of the family members in these two pedigrees did not reveal any significant linkages. However, microsatellite analysis of both pedigrees using markers on the X chromosome suggested linkage to the long arm of the X chromosome between the microsatellite markers DXS1001 and DXS1227. Identification and analysis of additional pedigrees may allow more precise mapping of the disease gene for anti-tubular basement membrane antibody-associated membranous nephropathy.
Subject(s)
Autoantibodies/analysis , Glomerulonephritis, Membranous/genetics , Glomerulonephritis, Membranous/immunology , Kidney Tubules/immunology , X Chromosome , Basement Membrane/immunology , Basement Membrane/pathology , China , Chromosome Mapping , DNA Primers , Female , Genetic Markers , Glomerulonephritis, Membranous/pathology , HLA Antigens/genetics , Haplotypes , Humans , Infant , Kidney Glomerulus/pathology , Kidney Tubules/pathology , Kidney Tubules, Proximal/physiopathology , Male , Microsatellite Repeats , PedigreeABSTRACT
Enzymatic dissolution of haemothorax is highly effective in the evacuation of proteinaceous material from the pleural space. Its use in postcardiotomy haemothorax has not been described. We report the case of a 4-year-old girl with Fallot's Tetralogy diagnosed at birth. She underwent a total correction of Fallot's Tetralogy at 4 years of age. Chest X-ray taken post-operatively showed a large pleural collection in her right haemithorax. Repeated intraplueral infusion of purified streptokinase into the right upper pleural chest tube greatly reduced the extent of the right haemothorax. Enzymatic dissolution of haemothorax by purified streptokinase has proven to be a rapid and successful method of therapy. It has provided an alternative which is less invasive and has a low morbidity.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Fibrinolytic Agents/administration & dosage , Hemothorax/drug therapy , Streptokinase/administration & dosage , Tetralogy of Fallot/surgery , Child, Preschool , Female , Hemothorax/etiology , Humans , Injections, Intralesional , Postoperative Complications/diagnostic imaging , Postoperative Complications/drug therapy , Radiography , Tetralogy of Fallot/diagnosis , Treatment OutcomeABSTRACT
Idiopathic nephrotic syndrome of childhood is thought to be associated with T lymphocyte dysfunction often triggered by viral infections, with the production of circulating factor(s) resulting in proteinuria. In view of the conflicting evidence of T cell activation and Th1 or Th2 pattern of cytokine synthesis in this disease, this study examined the mRNA expression of interleukin-2 (IL-2), interferon-gamma, IL-4, and IL-13 from CD4+ and CD8+ T cells in steroid-responsive nephrotic patients in relapse and remission. Fifty-five children with steroid-responsive nephrotic syndrome were included in this study, together with 34 normal controls and 24 patient controls with viral infections. RNA was isolated from purified CD4+ or CD8+ cells from peripheral blood and subjected to reverse transcription-PCR. Cytokine mRNA expression was measured semiquantitatively, and a cytokine index was derived from densitometric readings, with cyclophilin as the housekeeping gene. Both cross-sectional and paired data showed an increased CD4+ and CD8+ IL-13 mRNA expression in patients with nephrotic relapse as compared to remission, normal, and patient controls (P < 0.008). This was also associated with increased cytoplasmic IL-13 expression in phorbol myristate acetate/ionomycin-activated CD3+ cells (6.66+/-3.39%) from patients with nephrotic relapse compared to remission (2.59+/-1.35%) (P < 0.0001). However, there was no significant difference in CD4+ or CD8+ IL-2, interferon-gamma and IL-4 mRNA expression. IL-13 is an important T cell cytokine with anti-inflammatory and immunomodulatory functions on B cells and monocytes. It is conceivable that IL-13 may act on monocytes to produce vascular permeability factor(s) involved in the pathogenesis of proteinuria in patients with relapse nephrotic syndrome.
Subject(s)
Interleukin-13/genetics , Nephrotic Syndrome/genetics , Nephrotic Syndrome/immunology , RNA, Messenger/analysis , Th1 Cells/immunology , Th2 Cells/immunology , Adolescent , Base Sequence , CD8 Antigens/immunology , Child , Child, Preschool , Cytokines/analysis , Cytokines/biosynthesis , Cytokines/genetics , Female , Gene Expression Regulation/drug effects , Humans , Interferon-gamma/analysis , Interferon-gamma/biosynthesis , Interleukin-13/analysis , Interleukins/analysis , Interleukins/biosynthesis , Male , Molecular Sequence Data , Nephrotic Syndrome/drug therapy , Nephrotic Syndrome/pathology , Polymerase Chain Reaction , Prednisolone/pharmacology , Prednisolone/therapeutic use , RNA, Messenger/drug effects , Recurrence , Reference Values , Statistics, Nonparametric , Th1 Cells/drug effects , Th2 Cells/drug effectsABSTRACT
A retrospective study of all children who had undergone renal transplantation at the National University Hospital was undertaken in order to investigate the types and frequency of infections in paediatric renal transplant recipients. A total of 13 children ranging in age from 3 to 17 years were transplanted over a 7-year period from 1989 to 1996. The mean follow-up period was 40.5 months. Ten patients (77%) had at least one episode of infection post-transplant, 70% of which occurred within the first 6 months post-transplant. These infections included urinary infections (8), disseminated cytomegalovirus (CMV) disease (4), Pneumocystis carinii pneumonia (1) and mycoplasma pneumonia (1). Urinary tract infections were significantly associated with the presence of ureteral stents. CMV disease was significantly associated with the use of mycophenolic acid in the early post-transplant period. Infection therefore continues to be a major cause of morbidity in paediatric renal transplant recipients.
Subject(s)
Infections/etiology , Kidney Transplantation , Postoperative Complications , Adolescent , Child , Child, Preschool , Follow-Up Studies , Humans , Immunosuppressive Agents/adverse effects , Kidney Failure, Chronic/surgery , Retrospective Studies , Risk Factors , Stents/adverse effects , Transplantation, Homologous , Urinary Tract Infections/etiologyABSTRACT
Congenital communications between the coronary artery and cardiac chambers are rare. The majority of cases present in adulthood. We report a patient with a coronary cameral fistula in which surgical closure of the fistula was performed at 10 weeks of age at a weight of 3.9 kg. We recommend early closure of coronary cameral fistula in symptomatic patients. Low weight or young age at presentation should not be a limiting factor.
Subject(s)
Arteriovenous Fistula/surgery , Coronary Aneurysm/surgery , Coronary Vessel Anomalies/surgery , Female , Humans , Infant, NewbornABSTRACT
Blood-filled cysts of the heart valves are commonly reported at postmortem examination of infants but are rarely seen in older children and adults. These cysts appear to be benign lesions and should be removed only if they cause problems. We present the case of a patient with a tricuspid valve blood cyst that was surgically removed and then discuss the differential diagnosis and management of these cysts. When a cardiac mass has features suggestive of a blood cyst, radical resection should not be performed unless histologic confirmation of tumor is obtained.
Subject(s)
Cysts/surgery , Tricuspid Valve , Child, Preschool , Heart Septal Defects, Atrial/surgery , Heart Valve Diseases/surgery , Humans , Male , Tricuspid Valve/surgeryABSTRACT
The reduced antitumor antibiotic mitomycin C in aqueous solution exposed to air gives a 36-line electron spin resonance spectrum of the semiquinone identified by computer simulation. Incubation of this radical with the spin trap N-tert-butyl-alpha-phenylnitrone (PBN) gives the PBN.OH nitroxide radical identified by independent generation. This nitroxide radical is also formed from similar treatment of a DNA to which mitomycin C is covalently attached. Incubation of the semiquinone from mitomycin C, mitomycin B, or streptonigrin (SN) with catalase or with superoxide dismutase inhibits the generation of OH, implying the intermediacy of H2O2 and O2 in its formation. The formation of the spin-trapped nitroxide radical is similarly inhibited by EDTA, suggesting the intermediacy of trace metal ions in the generation of hydroxyl radicals from SN. The results are consistent with the generation by the aminoquinone antibiotics in vivo of OH. already implicated in the degradation of DNA.