Objective: To assess postgraduate candidates’ knowledge on basic sciences and to compare their achievement based on two years study in the Department of Psychiatry, National University of Malaysia (UKM), Kuala Lumpur, Malaysia. Methods: This is a study assessing areas of difficulties in basic sciences for the Malaysian postgraduate candidates sitting for mock MCQ examination papers in two consecutive years. Results: The candidates in both years failed on MCQ papers (scoring marks are only 43% and 40% for the year 2006 and 2005 respectively), which is consistent with their final examination outcomes. The candidates in the year 2006 were much superior in neuroanatomy (percentages of median scores: 47% vs. 31%, p<0.05), neurophysiology (54% vs. 47%, p<0.05) and psychology (44% vs. 41%, p<0.05) domains compared to their counterparts taking examination in the year 2005. However, there was no difference in terms of other domains, such as neurochemistry, psychopathology and epidemiology in the examination outcomes for the year 2005 and 2006. Generally, the overall scores of the candidates participating in the year 2006 were much higher than their previous counterparts. However, the scores of the candidates of both years were still low in statistics (34.1% vs. 36.4%, p >0.05) and stress/immunology (38.2% vs. 37.3%, p>0.05). Conclusion: Medical statistics and stress/immunology remain difficult subjects compared to neurophysiology and psychopharmacology. Malaysian postgraduate candidates need more efforts to understand basic sciences, especially statistics.

Introduction: Attention Deficit Hyperactivity Disorder(ADHD) and Tourrete Syndrome(TS) commonly co-occur, imposing a special challenge in the management. Case report: This is a case of a nine year old boy with ADHD and TS, who had been on methylphenidate, risperidone, fluvoxamine and atomoxetine, alone and in combination. Tics worsened with methylphenidate but improved after its withdrawal, and the addition of risperidone and fluvoxamine. Later, atomoxetine was added which worsened the tics, even when it was removed. Significant improvement in the tics were only obvious when fluvoxamine was taken off. Discussion: The possible roles of dopamine and serotonin neurotransmission, and metabolism of cytochrome P450 D26 in the pathophysiology were discussed. Conclusion: The use of multiple medications need cautious consideration and monitoring in a child patient to avoid unwanted complications and risks.
Attention Deficit Disorder with Hyperactivity

INTRODUCTIONThis study aimed to assess maternal and perinatal outcomes following second stage Caesarean sections.

METHODSA retrospective study was conducted in a Singapore-based tertiary referral centre from January 1, 2009 to December 31, 2009. The medical records of all the women who underwent emergency Caesarean sections in the second stage of labour were reviewed.

RESULTSOut of 2,501 emergency Caesarean sections performed, 116 were Caesarean sections in the second stage of labour. Women with non-vertex, twins and preterm deliveries were excluded, and 110 (4.4%, 110/2,501) Caesarean sections were recruited. The majority of the Caesarean sections were determined and performed by registrars or consultants. With regard to maternal outcome, 2.7% (3/110) of patients had primary postpartum haemorrhage and 4.5% (5/110) of patients had vertical or lateral lower uterine segment tears. As for neonatal outcome, although the Apgar scores of newborns were low at birth for 8.2% (9/110) of patients, the Apgar score was > 4 at 5 minutes for all patients.

CONCLUSIONOverall, there was no statistically significant adverse maternal or perinatal outcome.

Adult ; Apgar Score ; Cesarean Section ; adverse effects ; mortality ; Emergency Treatment ; Female ; Humans ; Infant Mortality ; Infant, Newborn ; Labor Stage, First ; Labor, Obstetric ; Postpartum Hemorrhage ; etiology ; Pregnancy ; Pregnancy Outcome ; epidemiology ; Retrospective Studies ; Singapore ; epidemiology ; Uterine Rupture ; etiology

Introduction: Statins have several pleiotropic effects including its primary effect of lipid lowering that is important to prevent cardiovascular disease (CVD). Subjects often have heterogeneous responses to statin. This study aims to determine the biochemical effects of statins on lipid parameters among newly diagnosed dyslipidaemia subjects. Methods: This was a prospective observational study involving 118 newly diagnosed adults with dyslipidaemia from three government health clinics in Selangor, Malaysia. Biochemical analyses including fasting lipid profile [triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] and apolipoproteins (apoA1, apoB) were taken at baseline and follow-up after a month on statin. Results: Majority of subjects (61.9%) were prescribed with lovastatin, with the rest on simvastatin. At baseline, the median values for all lipid profile parameters (TC, LDL-C, HDL-C) and non-conventional lipid parameters (LDL-C:HDL-C ratio, non-HDL-C, TC:HDL-C ratio, apoB:apoA1 ratio) were deranged except for TG and apoA1. On follow up, all parameters showed median values within the reference range except for HDL-C, non-HDL-C and TC:HDL-C ratio. There was significant difference in the effect of statins on lipid parameters including predictors of cardiovascular risk, simvastatin having better effects. Conclusions: Different statinshave varying effects on lipid parameters. Simvastatin showed significantly better effects compared to lovastatin. Non-HDL value should be included in the standard lipid profile report given its ease of use and implementation as it’s both a marker of coronary artery disease (CAD) risk stratification as well as an established determinant of goal attainment during therapy.

ABSTRACT Desquamative gingivitis is characterised by desquamation of the gingiva with painful erosion and ulceration. It is predominantly a manifestation of several vesiculobullous diseases. Delayed diagnosis or misdiagnosis often led to disease progression. Pemphigus vulgaris is a chronic, life-threatening autoimmune disease resulting in blistering of the mucosa and skin. Oral lesions normally preceded skin lesions. Early diagnosis and treatment are important to prevent involvement of the skin, as the treatment and prognosis varies with extraoral involvement. Clinical, histopathological examination and direct immunofluorescent are necessary for the diagnosis of pemphigus vulgaris. Treatment of desquamative gingivitis involves improving oral hygiene, reduce irritation to the lesions and specific therapy to the underlying disease. This paper describes a case of a patient with desquamative gingivitis for one year, whom is ultimately diagnosed as having pemphigus vulgaris.
Gingivitis--pathology ; Pemphigus

Pilomatrixoma is an uncommon benign tumour arising from the matrix and inner sheath of a normal hair follicle as well as hair cortex. It is usually presented as a superficial, solitary, firm mass which is asymptomatic and slowly growing. It accounts for about 0.2% of all routine skin specimens and may poses a diagnostic challenge as it may resemble other common benign lesions found in the head and neck region. We report a case of a 33-year old men presented to us with a pilomatrixoma of the right cheek, surgical management and histological findings.