Two hundred fifty seven articles related to HIV/AIDS were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000–2013. One hundred seventy one articles were selected and reviewed on the basis of clinical relevance and future research implications. This review of literature has been divided into six sections, namely, epidemiology, risk behaviour, clinical features and opportunistic infections, management, diagnosis and discussion. Wherever possible, the reviewed articles have been presented in a chronological order to provide a historical perspective to the reader as many of the results of earlier publications, which are common knowledge now, were relatively unknown then. Since the early days of the HIV epidemic in Malaysia, there have been rapid advances in the understanding and the management of the epidemic in Malaysia based on the insights derived from the results of these research. These insights are invaluable tools for policy makers, advocators, healthcare providers, researchers and everyone and anyone who are involved in the care of individuals with HIV/AIDS. Attempts have been made to identify gaps in certain research areas with the hope of providing directions for future research in HIV/AIDS in Malaysia.

Cardiovascular symptoms presenting in a patient with dengue fever may post a diagnostic dilemma. We describe a case of dengue myocarditis mimicking an acute myocardial infarction in a 56-year-old woman.

Background: The International Medical University (IMU) has an outcome-based curriculum defined by eight major curriculum outcome domains. The attributes, qualities and competencies expected of a health care professional form the basis for these outcome domains. Community service is an effective curriculum delivery tool widely practised by medical universities around the world. We present the results of a survey among IMU students to explore the effectiveness of community service as a curriculum delivery tool in enabling activities defined within the major curriculum outcome domains of IMU. Methods: A self-administered 6-point Likert scale questionnaire was used to survey student participants of 20 community service events held in a rural village between 2007 – 2012. The survey tool included questions on demographic data as well as the perception of the students on whether participation in the events enabled them to experience activities defined under the eight major curriculum outcome domains of IMU. The one sample Student t-test was used to test for statistical significance while regression analysis was done to look for significant predictors. Results: A total of 255 students were surveyed, of which 229 (90.5%) were medical students while the rest were nursing students. Most of the students were in the 3 rd (48.2%) and 4 th (43.8%) year of their studies and have completed the surgery, internal medicine and family medicine posting. Six out of the 8 curriculum outcomes domains were achieved through participation in the community service programme. Conclusion: Community service is an effective curriculum delivery tool for the outcome-based curriculum of IMU where activities defined in six out of eight outcome domains were achieved.
Education, Medical

Background: Misinterpretation of abbreviations by healthcare workers has been reported to compromise patient safety. Medical students are future doctors. We explored how early medical students acquired the practice of using abbreviations, and their ability to interpret commonly used abbreviations in medical practice. Method: Eighty junior and 74 senior medical students were surveyed using a self-administered questionnaire designed to capture demographic data; frequency and reasons for using abbreviations; from where abbreviations were learned; frequency of encountering abbreviations in medical practice; prevalence of mishaps due to misinterpretation; and the ability of students to correctly interpret commonly used abbreviations. Comparisons were made between senior and junior medical students. Results: Abbreviation use was highly prevalent among junior and senior medical students. They acquired the habit mainly from the clinical notes of doctors in the hospital. They used abbreviations mainly to save time, space and avoid writing in full sentences. The students experienced difficulties, frustrations and often resorted to guesswork when interpreting abbreviations; with junior students experiencing these more than senior students. The latter were better at interpreting standard and nonstandard abbreviations. Nevertheless, the students felt the use of abbreviations was necessary and acceptable. Only a few students reported encountering mishaps in patient management as a result of misinterpretation of abbreviations. Conclusion: Medical students acquired the habit of using abbreviations early in their training. Senior students knew more and correctly interpreted more standard and non-standard abbreviations compared to junior students. Medical students should be taught to use standard abbreviations only.
Students, Medical

Introduction: Misinterpretation of abbreviations by healthcare professionals has been reported to compromise patient safety. This study was done to determine the prevalence of abbreviations usage among medical doctors and nurses and their ability to interpret commonly used abbreviations in medical practice. Methods: Seventy-seven medical doctors and eighty nurses answered a self-administered questionnaire designed to capture demographic data and information regarding abbreviation use in medical practice. Comparisons were made between doctors and nurses with regards to frequency and reasons for using abbreviations; from where abbreviations were learned; frequency of encountering abbreviations in medical practice; prevalence of medical errors due to misinterpretation of abbreviations; and their ability to correctly interpret commonly used abbreviations. Results: The use of abbreviations was highly prevalent among doctors and nurses. Time saving, avoidance of writing sentences in full and convenience, were the main reasons for using abbreviations. Doctors learned abbreviations from fellow doctors while nurses learned from fellow nurses and doctors. More doctors than nurses reported encountering abbreviations. Both groups reported no difficulties in interpreting abbreviations although nurses reported often resorting to guesswork. Both groups felt abbreviations were necessary and an acceptable part of work. Doctors outperformed nurses in correctly interpreting commonly used standard and non-standard abbreviations. Conclusion: The use of standard and non-standard abbreviation in clinical practice by doctors and nurses was highly prevalent. Significant variability in interpretation of abbreviations exists between doctors and nurses.

Introduction: In Malaysia, the prevalence of missed opportunities for HIV-testing is unknown. Missed opportunities have been linked to late diagnosis of HIV and poorer outcome for patients. We describe missed opportunities for earlier HIV-testing in newly-HIV-diagnosed patients. Methods: Cross sectional study. Adult patients diagnosed with HIV infection and had at least one medical encounter in a primary healthcare setting during three years prior to diagnosis were included. We collected data on sociodemographic characteristics, patient characteristics at diagnosis, HIV-related conditions and whether they were subjected to risk assessment and offered HIV testing during the three years prior to HIV diagnosis. Results: 65 newly HIV-diagnosed patients (male: 92.3%; Malays: 52.4%; single: 66.7%; heterosexual: 41%; homosexual 24.6%; CD4 <350 at diagnosis: 63%). 93.8% were unaware of their HIV status at diagnosis. Up to 56.9% had presented with HIV-related conditions at a primary healthcare facility during the three years prior to diagnosis. Slightly more than half were had risk assessment done and only 33.8% were offered HIV-testing. Conclusions: Missed opportunities for HIV-testing was unacceptably high with insufficient risk assessment and offering of HIV-testing. Risk assessment must be promoted and primary care physicians must be trained to recognize HIV-related conditions that will prompt them to offer HIVtesting.

We present a rare case of post-antiretroviral therapy (ART) paradoxically worsening of radiological findings in a patient with advanced HIV-infection on treatment for Rhodococcus pneumonia who was misdiagnosed with pulmonary tuberculosis. Despite clinical improvement, serial chest radiographs showed deteriorations a month after starting ART. This was attributed to Immune Reconstitution Inflammatory Syndrome (IRIS) which spontaneously resolved without any treatment.

COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can result in multiple complications such as long COVID syndrome, pulmonary fibrosis, and organizing pneumonia (OP). Although OP is a well-known complication of COVID-19, several challenges remain; from suspecting and confirming the diagnosis to its management. These challenges are aggravated further in patients who are critically ill and when surgical biopsy is not feasible. Post-COVID-19 OP is a subset of secondary organizing pneumonia that shares similar clinical and radiological characteristics and similar computerized tomography (CT) scan features with OP of various etiologies. In this review, we propose a clinical approach based on current available evidence for the management of COVID-19 patients with suspected OP. Typical CT findings such as consolidations, perilobular opacity, reversed halo sign and ground-glass opacities are highly suggestive of OP, but are not pathognomonic. Confirmation by histopathology should be done but when not possible, a trial of corticosteroid therapy may be considered. However, biopsy should be done if corticosteroid therapy fails or when there is clinical deterioration and worsening of hypoxia while on corticosteroid therapy especially if the onset of the symptoms is longer than two weeks.
COVID-19 ; SARS-CoV-2 ; Organizing Pneumonia ; Adrenal Cortex Hormones

Background: Pre-exposure prophylaxis (PrEP) is an evidence-based strategy recommended for at-risk populations for prevention of HIV transmission. However, the level of PrEP awareness and acceptance among Malaysian undergraduate students is currently unknown. Objectives: To assess the sexual activities, sexual behaviors, risk perception, awareness, and acceptance of PrEP of medical compared to non-medical students in a private medical university. Method: Demographic data, sexuality, sexual activity and behaviors, source of HIV knowledge, self- perceived risk of HIV, awareness and acceptance of PrEP were collected using an online anonymous survey among medical and non-medical students at a private medical university. Descriptive, comparative and regression analyses were performed where applicable. A p-value < 0.05 was considered statistically significant. Results: A total of 369 (187 medical, 182 non-medical) students responded. The median age was 22 with female:male ratio of 2:1. Eighty-one (22%) were sexually active of which 54% used condoms inconsistently, 58% had condomless sex in the preceding six months and 35% had casual or transactional sex. Despite this, 33 perceived themselves to be at low risk of HIV. Most learned about HIV from their coursework. PrEP awareness was 40% versus 20% while PrEP acceptance was 69% versus 67%, between medical and non-medical students, respectively. Conclusion Awareness of PrEP among medical students was low and even lower among non-medical students. PrEP acceptance was fair after viewing an introductory video on PrEP. PrEP must be included in the course curriculum. Studies to identify reasons for PrEP-hesitancy should be conducted to help guide policies and initiatives toward promoting PrEP as an additional tool in HIV prevention.
Malaysia ; HIV ; Awareness

Introduction: The COVID-19 pandemic in 2020 resulted in a complete lockdown of educational institutions in Malaysia necessitating an immediate shift from conventional face-to-face teaching to online teaching-learning (OTL). This invariably affected the work-life balance and mental health of medical lecturers. This study was done to assess the adequacy of training of lecturers to conduct OTL and the challenges faced, and the impact of transitioning to OTL on the work-life balance and mental health of medical lecturers. The mental health status of lecturers was compared according to age categories of Gen-X, Gen-Y and Baby Boomer (BB) generations. Methods: An online survey was conducted between August and October 2021. Participants were asked to answer a series of questions designed to assess adequacy of training received, impact on work life balance, and score themselves with validated scoring tools to assess for anxiety, depression, and stress levels. Results: A total of 179 lecturers participated in the study. Training for OTL was deemed to be adequate and prepared the lecturers well for OTL. The transition to OTL negatively disrupted work-life balance causing extra work hours, disruption to family life, sleep issues, exhaustion, and stress but were positive in many other aspects. Gen-X and Gen-Y lecturers had higher perceived stress compared to BB. Conclusions Transitioning to online teaching during COVID-19 pandemic impacted work-life balance positively and negatively. Moderate to high perceived stress were reported, especially among younger lecturers. Training to equip lecturers to conduct online teaching and support for mental health and wellbeing should be provided.
COVID-19 ; Mental Health ; Work-Life Balance