1.WHO 2009 guidelines for anti-retroviral therapy: its implication for primary care physician
Malaysian Family Physician 2010;5(2):77-82
o The HIV epidemic in Malaysia is slowing down but has now spread to spouses and sexual partners of traditional at risk populations, via heterosexual transmission.
o The WHO 2009 guideline advocates starting HAART at CD4 level of 350 cells/mm3, marking a significant departure from starting at CD4 level of 200 cells/mm3 previously.
o The WHO 2009 guideline recommended replacing stavudine with either zidovudine or tenofovir as part of the first line HAART regimen due to the former’s adverse effects.
o Early detection of HIV infection and earlier initiation of HAART translates into better quality of life and lower risk of Tuberculosis co-infection.
o Earlier detection of HIV infection requires picking up on subtle signs of the infection as well as employing a host of available diagnostic tests in cases where HIV infection is strongly suspected.
o HIV test should be offered as a part of a routine health check screening. This facilitates early detection of HIV infection and early referral to the hospital for further management.
o Collaboration and communications with non-governmental organizations involved in care of HIV infected people can be a good mean of providing support and counselling to newly diagnosed HIV infected individuals.
o Asymptomatic undiagnosed HIV infected patients may pose a risk for disease transmission to health care workers in the primary care setting. Steps must be taken to minimize the risk of transmission and easy access to post-exposure
prophylaxis.
o The primary care physician should be well versed with the many possible drug interactions between HAART and other
commonly used medications for other illnesses in order to avoid potentially fatal adverse reactions or treatment failure in patients taking HAART.
2.THE BLUE MAN WHO PRESENTED WITH A STROKE
Malaysian Family Physician 2011;6(1):29-31
A 19-year-old man presented with sudden onset of right eye ptosis, diplopia and giddiness. He had no previous medical
illnesses with negative history of exertional dyspnoea, epistaxis, haemoptysis, palpitations, chest pain and chronic cough.
Examination revealed central cyanosis, digital clubbing, polycythaemia, partial ptosis of right eye, diplopia on right gaze and
dilated right pupil. Examination of the chest revealed pectus excavatum but no cardiac murmurs were heard. Investigations
revealed a solitary right pulmonary arteriovenous malformation with two feeder vessels which were successfully embolized
surgically.
3.The Impact of Education Reform: An Asian Medical School's Experience.
Gerald Ch KOH ; Jeremy Ne LEE ; Neelima AGRAWAL ; John Kc TAM ; Dujeepa SAMARASEKERA ; Dow Rhoon KOH ; John El WONG ; Chay Hoon TAN
Annals of the Academy of Medicine, Singapore 2016;45(5):198-204
This study assessed the effectiveness of education reforms on student-reported learning outcomes at the end of the 5-year medical school (M5) and 1-year internship (HO) in 2006, 2007 and 2008. A self-administered anonymous survey with 17 learning outcomes assessed, derived from Harden's Three-Circle Outcomes Model for outcomes-based education, was administered to 683 students at the end of medical school (M5) and internship (HO) from 2006, 2007 and 2008. We identified learning outcomes which changed significantly for internship (Cohorts A, B and C) and medical school (Cohorts B, C and D) between cohorts from 2006 to 2008, and compared learning outcomes between medical school and internship within cohorts (i.e. Cohort B which was M5 in 2006 and HO in 2007; Cohort C which was M5 in 2007 and HO in 2008). The proportion of students who agreed that medical school helped them achieve learning outcomes increased significantly from 2006 to 2008 for 15 out of 17 learning outcomes assessed. The proportion of students who agreed that internship helped them achieve learning outcomes increased significantly from 2006 to 2008 for 6 learning outcomes assessed. For Cohorts B and C, internship was more effective than medical school in achieving 8 learning outcomes. Cohort C reported that internship was more effective than medical school in 3 additional learning outcomes than Cohort B: patient management, humility and dedication. We conclude that a successful journey of education reform is an ongoing process that needs to comprehensively address multifaceted components such as faculty, administration and curriculum.
Clinical Competence
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Curriculum
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Education, Medical, Graduate
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Education, Medical, Undergraduate
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Humans
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Internship and Residency
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Schools, Medical
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Singapore
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Surveys and Questionnaires
4.Concomitant Ulnar Styloid Fractures in Distal Radius Osteosynthesis Does Not Impact Radiographic Outcomes, Ulnar Sided Symptoms and Patient Outcomes
Wong KC ; Wu MWF ; Zai QJJ ; Wong MK ; Howe TS ; Koh SBJ ; Soeharno H
Malaysian Orthopaedic Journal 2023;17(No.1):142-148
Introduction: Current literature reports varied significance
of ulnar styloid fractures (USF) associated with distal radius
fractures. Our study assesses the role of ulnar styloid
fractures and fragment size in surgically managed distal
radius fractures.
Materials and methods: We reviewed patients who
underwent surgical fixation of distal radius fractures between
January 2004 to June 2006. Patients were divided into those
with (Group 1) and without (Group 0) USFs. Post-operative
radiographic parameters, clinical outcomes and overall wrist
function were analysed. Outcomes included ulnar-sided
wrist pain, extensor carpi ulnaris (ECU) tendinitis, triangular
fibrocartilage complex (TFCC) grind test, distal radioulnar
joint (DRUJ) instability and pain. Overall wrist function was
assessed with range of motion and Disabilities of the Arm,
Shoulder and Hand (DASH) score.
Results: Our study cohort included 31 males and 23 females,
and 38.9% of these patients had concomitant USFs. There
was no difference in terms of demographic data and fracture
configuration between groups. Radiographic parameters
were similar, except for palmar tilt, which was significantly
higher in Group 1 (4.6º vs 9.4º, p=0.047). At 24 months,
there were no differences in clinical outcomes and overall
wrist function. A sub-group analysis showed that mean USF
fragment size was larger in patients with a positive TFCC
grind test (3.9mm vs 7.3mm, p=0.033).
Conclusion: The presence of USFs in surgically managed
distal radius fractures does not compromise clinical and
functional outcome. Similarly, the size of USFs does not
impact clinical and functional outcome but is associated with
the presence of a positive TFCC grind test.
5.Inhibition of Ceramide Accumulation in Podocytes by Myriocin Prevents Diabetic Nephropathy
Chang-Yun WOO ; Ji Yeon BAEK ; Ah-Ram KIM ; Chung Hwan HONG ; Ji Eun YOON ; Hyoun Sik KIM ; Hyun Ju YOO ; Tae-Sik PARK ; Ranjan KC ; Ki-Up LEE ; Eun Hee KOH
Diabetes & Metabolism Journal 2020;44(4):581-591
Ceramides are associated with metabolic complications including diabetic nephropathy in patients with diabetes. Recent studies have reported that podocytes play a pivotal role in the progression of diabetic nephropathy. Also, mitochondrial dysfunction is known to be an early event in podocyte injury. Thus, we tested the hypothesis that ceramide accumulation in podocytes induces mitochondrial damage through reactive oxygen species (ROS) production in patients with diabetic nephropathy. We used Otsuka Long Evans Tokushima Fatty (OLETF) rats and high-fat diet (HFD)-fed mice. We fed the animals either a control- or a myriocin-containing diet to evaluate the effects of the ceramide. Also, we assessed the effects of ceramide on intracellular ROS generation and on podocyte autophagy in cultured podocytes. OLETF rats and HFD-fed mice showed albuminuria, histologic features of diabetic nephropathy, and podocyte injury, whereas myriocin treatment effectively treated these abnormalities. Cultured podocytes exposed to agents predicted to be risk factors (high glucose, high free fatty acid, and angiotensin II in combination [GFA]) showed an increase in ceramide accumulation and ROS generation in podocyte mitochondria. Pretreatment with myriocin reversed GFA-induced mitochondrial ROS generation and prevented cell death. Myriocin-pretreated cells were protected from GFA-induced disruption of mitochondrial integrity. We showed that mitochondrial ceramide accumulation may result in podocyte damage through ROS production. Therefore, this signaling pathway could become a pharmacological target to abate the development of diabetic kidney disease.