Femoral nailing is the overall “gold standard” in treating femoral shaft fractures. However, plate osteosynthesis at the femoral shaft is still being done in selected patients. We report a case of right femoral implant failure after a broad limited contact dynamic compression plate (LC-DCP) insertion and its subsequent management using our minimally invasive technique. Our technique is biologically compliant as well as cosmetically friendly. We converted a loadbearing implant into a load-sharing implant in view that obesity is a significant predictive factor of non-union in a femoral fracture treated with locking plate. The patient subsequently recovered well with no complication.
Obesity

We report a case of occult primary spontaneous pneumothorax in a 30 years-old woman. She developed symptoms and signs that were suggestive of pneumothorax. However, chest radiograph failed to reveal pneumothorax. Therefore, we proceeded with computed tomography (CT) thorax which revealed significantly moderate right pneumothorax. The diagnostic approach and the management of this case are discussed.

A medical narrative is a physician-patient dialogue, where the physician listens carefully to fragments of the patient’s story, while interpreting their hidden messages and word sequences, as well as observing their gestures and body language. This aspect of the therapeutic relationship contributes to deciphering symptoms which are not apparent in the conventional interview and contributes to a much broader perspective of illness and health. The arts and the humanities have always been inseparable from each other in medical education. In this biomedical revolution, the humanities are needed now more than ever before to bridge the divides that separate the physician from the patient, from self, from colleagues, and society. Narrative Medicine (NM) which aims to treat the whole person, and not just the illness, is an emerging patient-centred discipline in medical schools that can humanise medical care and promote empathy. NM helps medical students cope with the suffering of their patients as well as their own emotions by reducing the anxiety and threat that come with illness, thereby providing a psychologically-sound foundation for the development of self-reflection and empathy. NM facilitates medical students’ adoption of patients’ perspectives with the hope of ultimately leading to more humane, ethical and empathetic healthcare for their patients. The discipline of NM is critically examined in this review paper from the perspective of external and internal stakeholders.

Objectives: Health-related quality of life (HRQoL) is an essential dimension of overall human quality of life, in which disparities have been hypothesised between women and men, as well as between citizens and non-citizens of a country in past literatures. This study is to evaluate and compare the HRQoL of citizens and non-citizens living in greater Kuala Lumpur and Johor Bahru, as well as comparing HRQoL between genders. Materials and Methods: The SF-8 questionnaire was used to collect information from 1,708 respondents (1,032 Malaysian citizens and 676 non-citizens), via face-to-face interview between October and December 2015. Results: Overall, respondents reported moderate HRQoL. Non-citizens reported better HRQoL than the Malaysian citizens, while men reported better HRQoL compared to women (for both citizens and non-citizens). Conclusions: The HRQoL of both citizens and noncitizens’ in Malaysia could be improved. Measures should be taken to remove the disparity in HRQoL between men and women, aiming to achieve equal health status for both genders.

There has been an increase in the number of Motor Vehicle Accidents (MVA) in Malaysia throughout the years. Although blunt neck injury is uncommon, it is associated with severe, permanent neurological deficit with risk of mortality. This case is a classical presentation of a young male involved in a MVA who sustained head and neck injuries of varying severity. After a short symptom free interval, the patient started to develop neurological signs. Presenting signs and symptoms include Horner’s syndrome, dysphasia, hemiparesis, obtundation or monoparesis. A computed tomography (CT) scan of brain must be done and if the findings showed that there is no intracranial bleeding (ICB), high suspicions with further evaluation should be done. Confirmation can be obtained by Doppler ultrasonography, magnetic resonance imaging, magnetic resonance angiography (MRA), CT angiography (CTA) or catheter angiography to rule out carotid artery injury.

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.