In Malaysia, medical specialisation training is mainly carried out by the public universities. Methods: A survey was carried out to explore the views of medical specialists in the country on issues such as structure of medical specialty training, availability of human resource, public/private sector competition, competency and apprenticeship, and its impact on assurance and quality of medical specialty training. Results: Altogether 238 medical specialists from 30 hospitals and medical institutions in the country participated in the survey. Conclusion: Among the findings, competition for human resource between public and private sector and lack of uniformity on medical specialty training across universities in the country are among the issues found to be of concern. There is also a need to address governance issue which necessitates to clearly delineating what constitutes medical specialty and what constitutes a subspecialty so that an agreed uniformed nomenclature is exercised across all stakeholders. The respondents also strongly agreed on the need to ensure competence in medical specialist training.

We report a case of delayed diagnosis of osteomyelitis of the scapula extending to glenoid, with secondary septic arthritis of glenohumeral joint in a 6-month-old female infant. We performed urgent arthrotomy of the shoulder joint through an anterior approach with drainage of pus from the scapula through a posterior approach and prescribed intravenous antibiotics. Diagnosis was delayed as the patient initially presented with pneumonia, for which she was treated in the neonatal intensive care unit; at that time, all medical efforts were directed toward saving her life. Had the diagnosis been made earlier, septic arthritis of the shoulder might have been prevented. Diagnosis of septic shoulder arthritis is rare and difficult, requiring a high index of suspicion.

Adolescent ; Adult ; Age Factors ; Cardiology ; trends ; Diet ; Health Behavior ; Humans ; Myocardial Infarction ; diagnosis ; epidemiology ; Pakistan ; Prevalence ; Risk Factors ; Smoking ; adverse effects

We report here a rare case of bilateral pure gonadoblastoma which accounts for only 0.2% of all ovarian tumours seen at Universiti Kebangsaan Malaysia from 1980 to 1987. This tumour occurred in an 18 year old Chinese "female" who presented with primary amenorrhoea. Examination showed a phenotypic female with poorly developed external gentalia. Exploratory laparotomy revealed a hypoplastic uterus, rudimentary fallopian tubes and streak gonads. Histological examination of the gonads showed a mixed tumour comprising large germ cells and smaller sex cord derivatives arranged in characteristic nests or islands containing hyaline material.
Right and left ; Gonadoblastoma ; Gonads ; Female ; Case Report

Introduction The total number of patients, especially the non-urgent cases (Priority 3) attending the Accident and Emergency Department (AED) of the RIPAS Hospital have increased from 1996 to 2003. This questionnaire study looked at the reasons for attending the AED of RIPAS Hospital instead of the outpatient peripheral clinics or health centres. Materials and Methods The study was conducted using prepared survey questions (17 questions) from 15th May to 15th June 2004 (32 days) on patients/care-givers/accompanying persons (Priority 3 - non-urgent/not serious cases) who attended the AED for various reasons. A total of 398 respondents participated in the study. Results Most of the respondenta were Bruneian (88.9%) with the rest consisting of permanent residents 4.6% and expatriates (7.2%). The majority of respondents were in the age group between 16 to 45 years (32.8%). Reasons for going the AED RIPAS hospital included complete facilities (Radiology, Laboratory and etc, 87.7%), provision of a 24 hours service (89.8%), patients' perception of their illnesses being serious (81.9%), more comprehensive check-ups (66%) and less traffic leading to the AED at certain times of the day (61.2%). Interestingly, some were unaware of available specified health services in their area and that extended services were available in Ong Sum Ping Health Centre. Conclusion A majority of responders attended the AED for various reasons. Patient education is important to increase awareness so that priority 3 cases can be directed to peripheral clinics to reduce congestions at the AED RIPAS Hospital.

Motorcyclists are particularly vulnerable when compared to large vehicles on the road. This study was conducted to gather feedbacks from motorcycle deliveryman regarding their riding conditions. A self-rated questionnaire was used to determine prevalence of riding symptom and its association with Whole Body Vibration and other associated factors among motorcycle deliveryman in Malaysia. A set of questionnaire was developed, pilot tested for its reliability and validity and distributed to 100 respondents. An interview was conducted after gathering the data from the respondents through the questionnaire. Survey findings show majority of the respondents preferred to ride according to the standard riding posture. Large majority of them agreed handlebar and foot peg/rest exposed them directly to the vibration. In addition, majority of them felt discomfort at the lower back and felt fatigue after long hours of riding. These findings are in-line with past studies regarding the road users.

Antrochoanal polyps are rare lesions. We report a series of 40 consecutive cases of antrochoanal polyps treated in our tertiary centre over a period of ten years between May 1998 and April 2008. The median age of the patients was 37 years. The most common clinical symptom was nasal obstruction (92.5%) followed by rhinorrhoea (45%), postnasal drip (35%) and snoring (22.5 %). The median period of follow-up of these patients was 30 months. Various surgical approaches were used; the commonest was powered endoscopic polypectomy and middle meatal antrostomy in 28 patients (70%), followed by endoscopic polypectomy and middle meatal antrostomy in seven patients (17.5%). Five patients (12.5%) underwent powered endoscopic polypectomy without middle meatal antrostomy. In addition, two patients had septoplasty and one had a frontal sinustomy. There were six patients (15%) who had combined sublabial antrostomy. No major complications occurred; four patients relapsed; three patients had initial operation performed elsewhere and one patient developed recurrence after the first surgery. The median hospitalization period was three days. We conclude that, the use of powered instrumentation in the removal of antrochoanal polyps is safe, effective and associated with minimal morbidity.

The working environment of intensive care unit (ICU) nurses is a constant source of stress. Researchers have described ICU as a stressful environment because of the complex nature of patients’ health problems requiring an extensive use of very sophisticated technology. This study aimed to identify the prevalence of stress among staff nurses working in ICU, Hospital Universiti Kebangsaan Malaysia (HUKM), factors influencing stress and to explore the symptoms of stress experienced. This descriptive study was conducted on 67 staff nurses working in ICU, HUKM. Data was collected using selfadministered questionnaires. The questionnaires included sections on socio-demographic data, factors influencing stress and symptoms of stress experienced. Data was analysed using frequency and percentage. The Chi square test was used to examine the relationship between socio-demographic data and factors influencing stress. Findings indicated that stress symptoms were experienced by 100 per cent (n =67) of staff nurses. Knowledge, working experience, critically ill patients, and environmental factors were one of the many factors contributing to the stress experienced by the ICU nurses in HUKM. Nurses working in ICU, HUKM are found to have a high level of stress. Recommendations like encouraging ICU nurses to take up post basic ICU courses and increasing the nurses quota can reduce the prevalence of stress among ICU nurses. Hospital management has an important role to play in reducing the stress levels of nurses working in ICU as stress has an effect on job performance and quality of nursing care.

Healthy dietary practice is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing the rate of diabetes complication development. It is, therefore, important at all levels of diabetes prevention. The objective of this study was to determine the association of dietary practice with glycaemic control among Type 2 diabetes mellitus (T2DM) patients, who received treatment from an urban Health Clinic in Kuala Lumpur. A total of 307 patients with T2DM aged 18 years and above participated in this study. A pre-tested structured questionnaire with guided interview was used to collect information on socio-demographic, clinical and dietary practice. Anthropometric and biological measurements were also taken. Descriptive statistics and Chi-square were used in the data analysis. Good glycaemic control was defined as HbA1c level less than 6.5%. The prevalence of good glycaemic control was only 27% (n=83). The highest percentage of good glycaemic control were among male patients (29.1%), aged 60 and above (33.3%), educational level of primary school (35.4%) and those with monthly income group between RM1001 to RM1500 (32.0%). About three quarter of T2DM patient (n=224) had poor control of HbA1c (≥6.5%). Age (p=0.045) and working status (p=0.039) had significant relationship with the level of HbA1c. Dietary practice showed no significant relationship with the HbA1c level. Effective interventional health education strategies are needed, focussing on modification of dietary behaviour in order to achieve glycaemic control among diabetic patients.​
Diabetes Mellitus, Type 2 ; Diet ; Primary Health Care ; Patients