Introduction: It is still a challenge that the dissecting room has a place in learning gross anatomy. Understanding the students’ preference of learning tools is important to devise alternative teaching aids for improvement in learning anatomy. This study was conducted to assess student’s preference of learning tools available in the anatomy laboratory of an integrated curriculum.Methods: A cross-sectional comparative study was carried out for 4 weeks among 741 medical and dental students of International Islamic University Malaysia (IIUM), Universiti Teknologi MARA (UiTM), University Sabah Malaysia (UMS) and University Malaysia Sarawak (UNIMAS). Pre-tested, semi-structured, self-administrated questionnaires including open-ended questions were distributed. The data were analyzed by using SPSS 17.Results: Most of the participants were Malays (86%) and female (67%). The students from IIUM, UiTM, UMS and UNIMAS preferred the plastic model in terms of handability and application in examination (OSPE). It was statistically significant (p<0.05). In terms of understanding and information, the students of IIUM, UiTM and UMS preferred the plastic model while UNIMAS students preferred the prosected wet specimen over the plastic models. In terms of overall preference, students of IIUM and UiTM preferred the plastic model (85.8% and 44.1% respectively). In UNIMAS, their preference for the prosected wet specimen (90.7%) was slightly higher than for the plastic model (87.8%). UMS students preferred both cadaver (51.9%) and plastic model (50%). Conclusion: Most of the students preferred the plastic model as the best learning tool in studying gross anatomy. This study suggests that plastic model may hold a role in enhancing students’ learning of gross anatomy in an integrated curriculum.

Objective: Rheumatoid arthritis (RA) is a chronic inflammatory condition that can be associated with abnormal bone turnover and hence osteoporosis. Osteocalcin (OC) levels are increased in conditions with high bone turnover, including high RA disease activity. Thus, OC levels could possibly be used as a marker to assess bone health and disease activity in RA patients. As there have been no previous studies looking at serum OC levels in Malaysian RA patients, this study was performed to examine possible correlations between OC, bone mineral density (BMD) and disease activity in this population.Methods: A cross-sectional study of 75 female RA patients and 29 healthy controls was performed. Serum OC was measured using a Quantikine® ELISA kit. Dual-energy x-ray absorptiometry (DXA) was used to assess BMD.Results: Serum OC levels were not significantly different between RA patients (median 14.44 ng/mL, interquartile range [IQR 12.99]) compared to healthy controls (median 11.04 ng/mL IQR 12.29) (p=0.198). Serum OC increased with age (Spearman’s rho r=0.230, p=0.047). There was no significant correlation between serum OC and body mass index (BMI), menopause status, BMD, DAS28, swollen or tender joint counts. Overall, there were 11 (14.7%) patients with osteoporosis and 27 (36.0%) with osteopenia. Menopause status was significantly associated with BMD at all sites (lumbar spine p=0.002, femoral neck p=0.004, total hip p=0.002). Conclusions: Serum OC were similar in RA patients compared to healthy controls. In RA patients, serum OC did not correlate with RA disease activity or BMD. Menopause status remains an important influence on BMD. Thus, measuring serum OC levels in Malaysian RA patients was not useful in identifying those at risk of low BMD.

Tumoral calcinosis is an uncommon condition which has been described to exist in primary and secondary forms. A lack of awareness of this entity can lead to unnecessary procedures and incorrect management. We report a case of a patient on peritoneal dialysis who presented with multiple painful joint swellings to the orthopaedic department. An initial diagnosis of septic arthritis was made, then revised to chronic tophaceous gout and referred to the rheumatology unit.

ervical spine injury is commonly associated with road-traffic accidents. The true incidence of cervical spine injuries is unknown due to under-reporting of such injuries. Cervical spine injury is associated with high morbidity and mortality if it is missed. With the advancement of imaging modalities, the number of missed cervical injuries has reduced. Nevertheless, some clinicians are dependent solely on imaging tools to rule out cervical spine injury in a trauma victim. We report two cases of “near miss” C6 fracture to highlight the importance of a detailed clinical history and clinical examination with imaging as an adjunct to rule out cervical injury.

moebiasis is a parasitic infection caused by the intestinal protozoan Entamoeba histolytica, most prevalent in developing countries. It results in 40,000 to 100,000 deaths each year from amoebic colitis and extra intestinal infections. Amoebic liver abscess (ALA) is the most common extra intestinal site of infection with an incidence of between 3% and 9% of all cases of amoebiasis. Ultrasound which has a sensitivity of more than 90% for detecting ALA is highly recommended as an initial investigation followed by serological demonstration of circulating antibodies specific to Entamoeba histolytica.

Background: The importance of tooth sectioning is realized in disasters such as earthquake, airplane crash investigation, terror, micro leakage studies, age estimation etc. The objective of this study was to develop a simple method to make thin sections (approximately 100 mm) from freshly extracted teeth. Methods: One hundred and twenty human premolars recently extracted for orthodontic purpose were used for this study. The teeth were stored in 0.5% chorlaramine for 2 weeks and were not allowed to dry at any stage of the experiment. The teeth were thoroughly washed in distilled water teeth and then were sectioned buccolingually from crown to the root portion. Results: A detailed embedding-cutting-mounting procedure is described. The prepared thin ground sections were then examined under a Polarised light microscope for the enamel and the dentine, as well as the caries lesions can clearly be distinguished. Conclusion: This is an effective and efficient method for preparation of ground sections in which the hard tissue details are preserved.

Morning surge in blood pressure is an independent cardiovascular risk factor in the middleaged and the elderly. Whether such a surge occurs in young subjects is not known. Eighty normotensive subjects (age: 21.8 ± 1.3 yr) measured their own blood pressure (BP) using an automatic device (Omron HEM-7080,) on going to bed and on waking up, for 2 consecutive days. In contrast to large morning BP surges reported for older age groups, there was much smaller but significant (P<0.002) rise only in the DBP (1.9 ± 5 mm Hg) on waking up on day 2 in young subjects. The duration of sleep and the time the subjects slept influence the sleep-wake BP change.

Background: Clinical clerkship in a busy hospital environment forms an important part of undergraduate medical training. Regular objective assessment of this activity with feedback would be expected to improve outcome. Methods: We implemented fortnightly clinical assessments using modified OSLER (Objective Structured Long Examination Record), and over a 6-week clinical rotation. Modifications included provision of individualized feedback. The assessment process was evaluated by both students and teachers via a questionnaire measuring their perceived educational impact, feasibility and acceptability. Results: Students agreed that the patient spectrum was appropriate and fair, resulting in improved history taking and presentation skills (96.6%), clinical examination skills (89%) and clinical reasoning skills (90.7%). It was graded to have helped learning “tremendously” and “moderately” by 64.7% and 32.8% of students respectively. Perceived improvement was attributable mainly to the repetitive nature of the assessments since only 63% of students were provided with feedback. 96.6% of students and 94.1% of assessors perceived the format created a stressful but positive learning environment. 52.9% of assessors agreed that the exercise consumed significant time and resources but 88.2% rated it as manageable and supported its continuation. Conclusion: Frequent and regular in-course clinical assessments with emphasis on individual feedback is feasible, acceptable and has significant positive educational impact.

Background: Database on hospital records like discharge data, birth and death certificates are widely used for epidemiological and research studies. However there are a very few validation studies on these data. The aim of this study was to validate and assess the accuracy of the ICD 10 database on congenital anomalies in the state of Penang. This study was carried out for three years, from 2002 to 2004. Methods: The list of cases coded under the general coding “Q” was extracted and approximately 30% of cases were randomly selected from the list. Medical records for the selected cases were checked and discrepancies for the diagnoses between the medical records and the ICD 10 data base were recorded for three years. Verification was done for basic demographic variables and the coding of the diseases. Discrepancies, sensitivity and specificity were calculated. Results: The ICD 10 database for congenital anomalies are classified into two types: Type 1 and Type 2. Discrepancies on demographic information were found among the age of patients (babies with congenital anomalies). In Type 1, there was a discrepancy of about 0.02 % to 0.05% probability that a congenital anomaly case can be recorded as non congenital anomaly in the ICD 10. In Type 2 there was a discrepancy that a non-congenital anomaly was classified as congenital anomaly and this ranged from 26.7% to 50.0%. The sensitivity ranged from 96.85% to 97.98%, thus it can be concluded the ICD 10 database is highly sensitive while the specificity ranged from 50.00% to 78.57 %. In other words the ICD 10 is not accurate when classifying the non- congenital anomaly cases. A fair percentage of non-congenital anomaly cases were classified as CA in the ICD 10 database. Conclusion: Even though hospital databases are used as a baseline data for a number of research and epidemiological studies it cannot be used at face value. Validation of these data is necessary before any conclusions can be drawn or intervention measures are undertaken.

Background: Many proteins released by cells to the blood and other fluids are glycoproteins. One set of glycoproteins carry the ABO blood group determinants and glycoproteins have been shown to be vital in determining the structure and organization of plasma membranes. There is evidence suggesting their important role in cell-to-cell contact, adhesion, hormone interaction and vital transformation. Differences in proteins and glycoproteins in the different human blood groups may influence the invasion process of Plasmodium falciparum. The objectives of the study were to determine whether there are any changes in proteins and glycoproteins of red blood cells upon infection by P. falciparum and whether these protein and glycoprotein changes differ in the various ABO blood groups. Methods: A Malaysian strain of P. falciparum was cultured in vitro in red blood cells from A, B, O and AB blood groups. Protein and glycoprotein profiles of uninfected and P. falciparum- infected red blood cells from the different human ABO blood groups were analyzed by SDS-PAGE. For protein bands, the gels were stained with Coomassie blue while glycoproteins were visualized following staining of gels using GelCode® Glycoprotein Staining Kit. Results: Cell membranes of P. falciparum infected erythrocytes from different ABO blood groups have different glycoprotein profiles compared to uninfected cells. All the infected samples showed a prominent protein band of molecular weight 99 kDa which was not present in any of the uninfected samples while a 48 kDa band was seen in four out of the seven infected samples. The erythrocyte cell membranes of A and AB blood groups showed different glycoprotein profiles upon infection with P. falciparum when compared to those from blood groups B and O. Conclusion: The two glycoproteins of molecular weights 99 kDa and 48 kDa should be further studied to determine their roles in the pathogenesis of malaria and as potential targets for drug and vaccine development