Roadblocks to Integration; Faculty's perspective on transition from Traditional to Integrated Medical Curriculum.

OBJECTIVE: This study was conducted to explore the faculty's opinion regarding factors impeding practical transition from traditional to integrated medical curriculum at the outset and a few years after the process. METHODS: This qualitative exploratory study was conducted from April 2018 to October 2018 at two undergraduate medical colleges; one where integrated curriculum was at the outset and the second running it successfully. A total of 12 semi-structured interviews (six from each college) were recorded and transcribed. Thematic content analysis was carried out and faculty's perceptions about factors impeding practical transition to integrated curriculum were explored at two stages, i.e., at the outset and after its implementation. RESULTS: Four impediments identified at the outset were deemed genuine by faculty who had gone through the experience including, faculty's resistance, lack of training, lack of incentives, and insufficient resources. Four more impediments were identified after the experience including lack of leadership, lack of attention to faculty's concerns, lack of communication and difficulties in setting appropriate assessment. CONCLUSIONS: Several factors if ignored can result in failure of integration of curriculum in undergraduate medical colleges. Relevantly appropriate policies should be outlined by the regulatory body to ensure the control on the impediments.

Group B Streptococcus infection: epidemiology, serotypes, and antimicrobial susceptibility of selected isolates in the population beyond infancy (excluding females with genital tract- and pregnancy-related isolates) at the University Malaya Medical Centre, Kuala Lumpur.

Group B Streptococcus (GBS) infection was studied in 49 patients collected at convenience (convenience sampling), excluding infants and women with genital tract- and pregnancy-related isolates, according to the availability of stocked isolates and easy accessibility to epidemiological data. The data were examined both prospectively and retrospectively from 2003-2005 at a tertiary-level multidisciplinary hospital in Kuala Lumpur, Malaysia. Skin and soft-tissue infections in 35 patients (71.4%) were the most common clinical presentation, while diabetes mellitus was the most common underlying condition (35 patients, 71.4%). All GBS isolates were sensitive to penicillin, and most isolates tested were sensitive to erythromycin (97.7%). Serotyping of 45 GBS isolates using a commercial serotyping kit revealed that the most common serotype was Ia (22.2%), followed by VI (17.8%), III and V (13.3% each). Others included Ib, II, IV, VIII, and VII; 13.3% were nontypeable. The findings of this pilot study are limited by the small sample size, the sampling method and the possibility that the cases are not wholly representative of the University Malaya Medical Centre population. Further studies from our hospital with larger numbers and using probabilistic sampling techniques are required to confirm the relatively high occurrence of serotype VI (the second most common serotype) in the population studied.

A comparative histological study of the surface epithelium and high endothelial venules in the subepithelial compartments of human nasopharyngeal and palatine tonsils.

OBJECTIVE: To compare the thickness and organization of surface epithelium, and high endothelial venules in subepithelial compartments of human nasopharyngeal and palatine tonsils, with reference to functional differences. STUDY DESIGN: Comparative cross-sectional. PLACE AND DURATION OF STUDY: The Anatomy Department of CPSP Regional Centre, Islamabad, from January to December 2005. METHODOLOGY: Thirty samples each of human nasopharyngeal, right palatine and left palatine tonsils were collected by convenience sampling technique. Haematoxylin and eosin stained paraffin sections were examined for surface epithelium. Thickness of stratified squamous and pseudostratified ciliated columnar epithelium was measured, while organization was observed in case of stratified squamous. The high endothelial venules in subepithelial lymphoid compartments were counted. RESULTS: The surface epithelium of nasopharyngeal tonsils (stratified squamous and pseudostratified columnar inclusive) was 63.21+1.93 microm, and that of palatine (stratified squamous) was 143.99+5.94 microm thick (p<0.001). The mean count of high endothelial venules in subepithelial compartments of nasopharyngeal was 1.15+/-0.06 and that of palatine tonsil was 0.93+0.08 (p=0.042). Organization of stratified squamous epithelium was poor in 26 out of 30 nasopharyngeal, and well in all palatine tonsils (p<0.001). CONCLUSION: The surface epithelium of nasopharyngeal tonsil being thinner and poorly organized than that of palatine tonsil might act as a less effective barrier between the antigenic stimulus and subepithelial lymphoid compartments. This may contribute towards higher level of immune response by these compartments of the former, which is endorsed by higher number of high endothelial venules as compared to the latter.

Recurrent candidaemia in a neonate with Hirschsprung's disease: fluconazole resistance and genetic relatedness of eight Candida tropicalis isolates.

The incidence of candidaemia among immunocompromised patients in Malaysia is increasing at an alarming rate. Isolation of clinical strains that are resistant to fluconazole has also risen markedly. We report here the repeated isolation of Candida tropicalis from the blood of a neonatal patient with Hirschsprung's disease. In vitro fluconazole susceptibility tests of the eight isolates obtained at different time points showed that seven of the isolates were resistant and one isolate was scored as susceptible dose-dependent. Random amplification of polymorphic DNA fingerprinting of the isolates using three primers and subsequent phylogenetic analysis revealed that these isolates were highly similar strains having minor genetic divergence, with a mean pairwise similarity coefficient of 0.893+/-0.041. The source of the infectious agent was thought to be the central venous catheter, as culture of its tip produced fluconazole-resistant C. tropicalis. This study demonstrates the utility of applying molecular epidemiology techniques to complement traditional mycological culture and drug susceptibility tests for accurate and appropriate management of recurrent candidaemia and highlights the need for newer antifungals that can combat the emergence of fluconazole-resistant C. tropicalis strains.

Rhodococcus equi--an emerging human pathogen in immunocompromized hosts: a report of four cases from Malaysia.

Rhodococcus equi, a recognized pathogen in horses, is emerging as a human opportunistic pathogen, especially in immunocompromized hosts. We describe four immunocompromized patients who had serious R. equi infections with an overall mortality of 75%. The natural habitat of R. equi is soil, particularly soil contaminated with animal manure. Necrotizing pneumonia is the commonest form of infection but extrapulmonary infections, such as wound infections and subcutaneous abscess, have also been described in humans. R. equi is cultured easily in ordinary non-selective media. Large, smooth, irregular colonies appear within 48 hours. It is a facultative, intracellular, nonmotile, non-spore forming, gram-positive coccobacillus, which is weakly acid-fast staining and bears a similarity to diphtheroids. It forms a salmon-colored pigment usually after 48 hours incubation. A particular characteristic of this organism is that it undergoes synergistic hemolysis with some bacteria on sheep blood agar. R. equi may be misidentified as diphtheroids, Mycobacterium species, or Nocardia. In vitro R. equi is usually susceptible to erythromycin, ciprofloxacin, vancomycin, aminoglycosides, rifampin, imipenem and meropenem. The organism can be difficult to eradicate, making treatment challenging. Increased awareness of the infection may help with early diagnosis and timely treatment.

Salmonellosis in persons infected with human immunodeficiency virus: a report of seven cases from Malaysia.

Persons infected with human immunodeficiency virus (HIV) have an increased risk of salmonellosis when compared to the general population. We describe seven such patients with Salmonella bacteremia, of whom two had recurrent salmonellosis. In the latter two cases the infection was unusually severe, characterized by widespread infection, bacteremia and relapse, despite standard antimicrobial therapy. HIV-infected individuals will benefit from education on the source of Salmonella, mode of acquisition and prevention through safe food handling and food preparation practices. Because of the difficulty of eradicating Salmonella infection in patients with acquired immunodeficiency syndrome, long-term suppressive treatment with antimicrobials is warranted.