Background Malaysia has achieved control of leprosy with an incidence rate of 1.1 case per 100,000 population, and a prevalence rate of 0.5 per 10,000 population since 19941. However, recently the incidence has increased with the influx of foreign workers, especially from Indonesia, Nepal and Bangladesh. In order to eliminate leprosy, certain issues of need to be addressed namely, imported cases, default from treatment and drug-resistant cases. Objectives 1. To determine the demography of leprosy patients who attended the Skin Department at Hospital Sultanah Aminah Johor Bahru (HSAJB) for treatment. 2. To determine the clinical subtypes of Hansen’s Disease, the incidence of erythema nodosum leprosum (ENL) and reversal reactions. 3. To review the management, side effects of treatment, and disease surveillance Materials and Methods A 15- year retrospective study of all new cases of Hansen’s disease attending the Skin Clinic from 1992 to 2006 was undertaken. Results A total of 166 patients were treated in the study period, of whom 74.4% were male. The median age at presentation was 37 years (range 4 to 85 years). 33% of the patients were immigrants, 34% local Malays, 27% local Chinese and 6% local Indians. Of the 166 patients, 59% had lepromatous leprosy (LL), 22% tuberculoid leprosy (TT), 9% borderline tuberculoid leprosy (BT), 8% borderline lepromatous leprosy (BL), 1% indeterminate leprosy and 1% neural leprosy. The mean bacteriological index (BI) was 1.63 ± 1.63 std deviations, and the mean morphological index (MI) was 0.77 ± 1.24 std deviations at the time of diagnosis. All patients achieved an MI of zero after three weeks of intensive therapy. 84.6 % of the patients received multiple drug therapy (MBCOMBI) in the blister pack distributed by WHO. The remainder was put on modified regimens, because of side effects or drug resistance. 43% of patients developed reactions. Of these, 21.1% had type I reaction and 22.9% had erythematous nodosum leprosum (ENL). 2 patients developed Lucio’s phenomenon at initial presentation. 53% of these developed reaction at presentation while 47% had reaction after a few months’ treatment. 9.6% of the patients developed side effects secondary to multidrug therapy which necessitated withdrawal of the drugs. The defaulter rate was 15 %. Limitations Retrospective analysis with inadequate documentation is a limitation of this study. In addition, the population studied was limited to referrals being made to the Skin Clinic, which is a tertiary referral center. Conclusions Control and elimination of leprosy still posed a problem as the majority of the foreign patients had lepromatous leprosy, and a high defaulter rate. Although leprosy in Malaysia has reached the elimination target set by the WHO, new cases will continue to be observed in small numbers due to the long incubation period of this disease.

Patient-controlled analgesia (PCA) via an infusion pump enables patient to administer their own analgesia. The aim of this study was to evaluate the effect of an educational programme in managing post-operative pain and satisfaction on PCA following orthopedic surgery. A pre-test and post-test interventional study design with implementation of patient education programme on PCA was provided to 54 respondents. The control group received conventional PCA briefing from the Acute Pain Service protocol. Pain intensity was measured at 2 hrs, 6 hrs and 24 hrs following surgery and pre-test and post-test of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) was administered. There was difference in respondents’ level of pain score among the study respondents’ medians for control group at 2 hrs, 6 hrs and 24 hrs following surgery and they were 7.00 (IQR=3.00), 5.00 (IQR=2.00) and 3.00 (IQR=2.00); intervention group at 2 hrs, 6 hrs and 24 hrs following surgery were 6.00 (IQR=2.00), 3.00 (IQR=1.00) and 1.00 (IQR=1.00) respectively. There were significant differences in median of pain score between intervention and control group at 2 (U=142.0, p<0.05), 6 (U=150.50, p<0.05) and 24 (U=120.00, p<0.05) hrs following surgery. There were statistically significant differences (p<0.05) in the median of patient’s pain severity at all pain levels i.e. least pain, worst pain, and severe pain between intervention and control group (least pain, U=219.50, p<0.05; worst pain, U=117.0, p<0.05; severe pain, U=49.0, p<0.05). In conclusion, patients who received pre-operative structured education programme showed improvement in managing post-operative pain and satisfaction on PCA after orthopedic surgery.
Analgesia, Patient-Controlled

Each human being exhibits their own personality traits and each aspect of stress and coping is essential and related. The relationship between the big five personality traits, coping mechanisms and stress level among final year medical students of Universiti Kebangsaan Malaysia (UKM) was investigated in this study. In this cross-sectional study, 152 final year medical students batch 2017/2018, were randomly selected, excluding those who had chronic diseases, married and repeated final year. The questionnaires used were Big Five Personality Inventory and 12-Item General Health Questionnaire. An open-ended question was used to determine how the respondents cope with their stress. Data was analyzed using SPSS 20.0. Agreeableness was the most common personality trait portrayed among the students, whereas Openness to Experience appeared to be the least. The relationship between the Big Five Personality Traits and coping mechanisms (p=0.016; p<0.05) were significantly related. Students with Neuroticism personality had the highest rate of practicing avoidant coping mechanism, while students with Extraversion personality had the highest rate of practicing active coping mechanism. Total score of stress were significantly difference between the different personality traits (p<0.001; p<0.05). However, the p value of 0.359 (p>0.05) and 0.94 (p>0.05) for the Big Five Personality Traits and level of stress showed no significant results on academic performance. Identified own personality were beneficial for final year medical students as it helps to identify the most effective coping mechanism in reducing stress during studying medicine.