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1.  Breaking into the International Arena: Malaysian Journal of Medical Sciences publishing Report 2013 
The most recent Malaysian Journal of Medical Sciences (MJMS)–MyCite report has shown that it has achieved a level becoming of a leading national medical science journal. This editorial reports on submission and acceptance rates of MJMS throughout the year 2013 and their geographical contributors. Our rejection rate of 29.76% with a 21.95% withdrawal rate because of poor quality of content and data as well as plagiarism indicates the seriousness of this journal to maintain the integrity and quality of it’s scientific data.
PMCID: PMC4163553  PMID: 25246830
audit; report; manuscript; Malaysia; open access; biomedical sciences
2.  Small Circular DNAs in Human Pathology 
In general, human pathogen-related small circular deoxyribonucleic acid (DNA) molecules are bacterial plasmids and a group of viral genomes. Plasmids are extra-chromosomal small circular DNAs that are capable of replicating independently of the host, and are present throughout a variety of different microorganisms, most notably bacteria. While plasmids are not essential components of the host, they can impart an assortment of survival enhancing genes such as for fertility, drug resistance, and toxins. Furthermore, plasmids are of particular interest to molecular biology especially in relation to gene-cloning. Among viruses, genomes of anelloviruses, papillomaviruses, and polyomaviruses consist of small circular DNA. The latter two virus families are known for their potential roles in a number of pathogenic processes. Human papillomaviruses (HPV) are now widely recognised to be associated with a greatly increased risk of cervical cancer, especially oncogenic strains 16 and 18. On the other hand, human cells may contain several types of small circular DNA molecules including mitochondrial DNA (mtDNA). The mitochondrial genome consists of 37 genes that encode for proteins of the oxidation phosphorylation system, transfer ribonucleic acids (tRNAs), and ribosomal RNAs (rRNAs). Though mitochondria can replicate independently of the host; nuclear DNA does encode for several mitochondrial proteins. Mutations in mtDNA contribute to some well characterised diseases; mtDNA is also implicated in several diseases and malignancies with poorly elucidated aetiologies. Furthermore, mtDNA can function as a diagnostic tool. Other extra-chromosomal circular DNAs are usually detected in cancer. This review article is intended to provide an overview of four broad categories of small circular DNAs that are present in non-eukaryotic (plasmids and relevant viral genomes) and eukaryotic (mtDNA and other extra-chromosomal DNAs) systems with reference to human diseases, particularly cancer. For this purpose, a literature search has been carried out mainly from PubMed. Improved understanding of the significance of small circular DNA molecules is expected to have far reaching implications in many fields of medicine.
PMCID: PMC4163554  PMID: 25246831
episomes; cancer; HPV; mitochondrial DNA; plasmids; polyomavirus
3.  The Effects of Soy Extract on Spatial Learning and Memory Damage Induced by Global Ischemia in Ovariectomised Rats 
The effects of soy extract on memory as well as the oxidative damage to brain tissue induced by ischemia was investigated in ovariectomised (OVX) rats.
The rats were divided into: 1) Sham; 2) OVX; 3) Sham‑Ischemia; 4) OVX‑Ischemia; 5) OVX-Ischemia-S 20; and 6) OVX-Ischemia-S 60. The common carotid artery was occluded (30 minutes), and it was then re-perfused. The OVX-Ischemia-S 20 and OVX-Ischemia-S 60 groups received 20 or 60 mg/kg of soy extract for eight weeks before the ischemia.
The Sham-Ischemia and OVX-Ischemia groups took a longer time to reach the platform while, spent a shorter time in the target quadrant (Q1) than the Sham and OVX. The escape latencies in the OVX-Ischemia-S 20 and OVX-Ischemia-S 60 groups were lower while, time spent in the Q1 was higher than that of the OVX-Ischemia. In the rotarod test, there were no significant differences between the groups. The hippocampal concentrations of malondialdehyde (MDA) in the Sham-Ischemia and OVX-Ischemia groups were higher than the Sham and OVX. Pre-treatment by 20 and 60 mg/kg of the extract reduced the MDA.
It is suggested that soy prevents memory impairment and brain tissue oxidative damage due to ischemia in OVX rats.
PMCID: PMC4163555  PMID: 25246832
soy; ischemia; ovariectomy; rat; memory; learning; malondialdehyde
4.  Histopathological Study of the Lungs of Mice Receiving Human Secretory IgA and Challenged with Mycobacterium tuberculosis 
Humoral and cellular immune responses are associated with protection against extracellular and intracellular pathogens, respectively. In the present study, we evaluated the effect of receiving human secretory immunoglobulin A (hsIgA) on the histopathology of the lungs of mice challenged with virulent Mycobacterium tuberculosis.
The hsIgA was purified from human colostrum and administered to Balb/c mice by the intranasal route prior to infection with M. tuberculosis or in a pre-incubated formulation with mycobacteria, with the principal aim to study its effect on qualitative pulmonary histopathology.
The intranasal administration of hsIgA and the pre-incubation of mycobacteria with this preparation was associated with the presence of organised granulomas with signs of immune activation and histological features related to efficient disease control. This effect was highly evident during the late stage of infection (60 days), as demonstrated by numerous organised granulomas with numerous activated macrophages in the lungs of treated mice.
The administration of hsIgA to mice before intratracheal infection with M. tuberculosis or the pre-incubation of the bacteria with the antibody formulation induced the formation of well-organised granulomas and inflammatory lesions in lungs compared with non-treated animals which correlates with the protective effect already demonstrated by these antibody formulations.
PMCID: PMC4163556  PMID: 25246833
colostrums; Mycobacterium tuberculosis; secretory immunoglobulin A
5.  Clinical Determinants of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Differentiated Thyroid Cancer Patients with Elevated Thyroglobulin and Negative 131Iodine Whole Body Scans after 131Iodine Therapy 
A cross-sectional prospective study has been conducted on differentiated thyroid cancer (DTC) patients using negative 131Iodine (131I) whole body scans and elevated thyroglobulin (Tg) levels. The main objective of this research was to determine the prevalence of the conversion of differentiated to dedifferentiated thyroid cancer patients during follow up at the Hospital Kuala Lumpur. It has been demonstrated that fluorodeoxyglucose (FDG) uptake is inversely proportional to the iodine concentration and to differentiation of the cells.
Thirty-five patients with histologically proven DTC that have undergone total or near total thyroidectomy, and post 131I radioactive iodine ablation therapy, were selected and prospectively analysed. The patients also had to show at least one negative whole body scan and Tg levels of 10 μg/L and above. The results of the FDG-Positron Emission Tomography/Computed Tomography (PET/CT) were then studied to determine the association and the predictors influencing the outcome by using univariable and multivariable analyses.
Out of the thirty-five patients, 60% of them (twenty-one) showed positive results and 40% (fourteen) showed negative. Age, gender, and type of histopathology (HPE) showed significant associations with the positive results of the FDG-PET/CT. The results also showed no correlations observed between the Tg levels and standardised uptake value (SUV)max in the DTC patients with positive disease findings in the FDG-PET/CT. The predictor for this study was age.
The prevalence of the conversion of differentiated to dedifferentiated thyroid cancer among patients with negative 131I and elevated Tg was 60%, with age as the predictor. DTC patients aged 45 year-old and older were seven times more likely to have positive results of FDG-PET/CT imaging.
PMCID: PMC4163557  PMID: 25246834
thyroid cancer; iodine; whole body scan; thyroglobulin; fluorodeoxyglucose F18; positron-emission tomography
6.  Prevalence of Bacterial Contamination when using a Diversion Pouch during Blood Collection: A Single Center Study in Malaysia 
The implementation of diversion pouches is to minimise the risk of bacterial contamination as the initial blood flow is prevented from entering primary bag collections as it is diverted into a pouch. This study was carried out to determine the prevalence of bacterial contamination in the diversion pouches used during blood collections in the Transfusion Department of Hospital Seberang Jaya, Penang, Malaysia.
BD Bactec™ Fx instrument detection system was performed on 702 samples of 20 mL of diverting blood in diversion pouch. The inocullum volume was 10 mL for both aerobic and anaerobic bottles cultures and incubated for 5 days in the BD Bactec™ Fx instrument. Positive sample was flagged by BD Bactec™ Fx instrument and subculture to identify the species of organism.
The results showed that of 702 samples, 12 (1.7%) were contaminated. The bacterial species identified were coagulase negative Staphylococcus, Staphylococcus aureus and Gram positive Bacilli.
The results strongly suggest that the usage of diversion pouch is of significant importance in reducing bacterial contamination during blood collection.
PMCID: PMC4163558  PMID: 25246835
BD Bactec™ Fx; blood collection; blood transfusion; blood contamination; bacterial infections
7.  The Dependency of Vitamin D Status on Anthropometric Data 
Hypovitaminosis D appears to parallel several cardiovascular and pulmonary diseases. However, previous findings cannot be considered conclusive, since the association may have been confounded by different anthropometric variables that were not accounted for. The present cross-sectional study was conducted to investigate the association between important explanatory variables and circulation levels of vitamin D.
A total of 553 individuals attending the metabolic and medical lifestyle management clinic of the Burdwan district of India were selected from 1289 people by simple random sampling, and information regarding relevant variables and their blood was obtained. Serum 25-hydroxyvitamin (OH) D level and forced expiratory volume in 1 second were measured. Associations between different explanatory variables and circulatory 25(OH) D were analysed in linear regression models.
Of the population studied, 53% had insufficient vitamin D levels, while approximately 9% were vitamin D deficient. Variables that significantly associated with lower 25(OH)D levels were obesity, current smoking, forced expiratory volume 1 and depression
Lower serum levels of vitamin D were associated with different variables that should be explored in several diseases before a conclusion of hypovitaminosis D is drawn.
PMCID: PMC4163559  PMID: 25246836
vitamin D; confounding variables; vitamin D deficiency; obesity; 25(OH)D
8.  Validation of Malay Version of Snaith-Hamilton Pleasure Scale: Comparison between Depressed Patients and Healthy Subjects at an Out-Patient Clinic in Malaysia 
The Snaith-Hamilton Pleasure Scale (SHAPS) is a self-assessment scale designed to evaluate anhedonia in various psychiatric disorders. In order to facilitate its use in Malaysian settings, our current study aimed to examine the validity of a Malay-translated version of the SHAPS (SHAPS-M).
In this cross-sectional study, a total of 44 depressed patients and 82 healthy subjects were recruited from a university out-patient clinic. All participants were given both the Malay and English versions of the SHAPS, Fawcett-Clark Pleasure Scale (FCPS), General Health Questionnaire 12 (GHQ-12), and the Beck Depression Inventory (BDI) to assess their hedonic state, general mental health condition and levels of depression.
The results showed that the SHAPS-M has impressive internal consistency (α = 0.96), concurrent validity and good parallel-form reliability (intraclass coefficient, ICC = 0.65).
In addition to demonstrating good psychometric properties, the SHAPS-M is easy to administer. Therefore, it is a valid, reliable, and suitable questionnaire for assessing anhedonia among depressed patients in Malaysia.
PMCID: PMC4163560  PMID: 25246837
anhedonia; depression; pleasure; Malaysia; validation; psychiatry; psychology; neuroscience
9.  Thromboprophylaxis and Orthopaedic Surgery: Options and Current Guidelines 
Antithrombotic therapy remains crucial in the peri- and post-operative management of patients who undergo orthopaedic surgical procedures, particularly total joint arthroplasty (TJA) and hip fracture surgery (HFS). Optimal thromboprophylaxis is currently mandatory in most orthopaedic practices to avoid the dreaded complications of venous thromboembolism (VTE). The pathogenesis of VTE is multifactorial and includes the well-known Virchow's triad of hypercoagulability, venous stasis, and endothelial damage. With current advances in orthopaedic surgery, a multimodal approach to thromboprophylaxis, anaesthetic management, and post-operative convalescence have altered the risks of venous thromboembolism after TJA and HFS in the lower extremity. This article reviews the various VTE prophylactic options and current best practice guidelines for orthopaedic TJA and HFS.
PMCID: PMC4163561  PMID: 25246838
thrombolytic therapy; hip fracture; arthroplasty; venous thromboembolism
10.  NEURO.TV: Neuroscience Education on the Internet is a new educational project that seeks to bring advanced concepts in neuroscience to the general public. We film one-hour discussions with leading neuroscientists, philosophers, and psychologists who have had significant impact on our current understanding of brain function, and we publish these discussions on YouTube, iTunes, and other social media outlets. Here, we explain the motivations behind this new program.
PMCID: PMC4163562  PMID: 25246839
education; public; neuroscience; television; brain
11.  Giant Solitary Ileal Polyp Presenting as an Intussusception in a 10-year-old Boy 
This is a case report of a 10-year-old boy who presented with features of acute intestinal obstruction. Clinical examination revealed distended abdomen, visible bowel loops, and a lump in the right upper quadrant of the abdomen. Clinically, the diagnosis of intussusception was suspected and confirmed on sonography examination. Exploration of the abdomen revealed ileo-colic intussusception. Manual reduction of intussusception was possible except the last part that had an intraluminal solitary polyp (3 × 4 cm) occupying the 3/4th of the lumen of the terminal ileum. Segmental resection of the ileum containing polyp was done, and the ileal continuity was restored with ileo-ileal anastomosis. His post-operative recovery was uneventful. Histologically, it was consistent with the inflammatory intestinal polyp without any evidence of malignancy.
PMCID: PMC4163563  PMID: 25246840
children; intestinal polyp; intestinal obstruction; intussusception
12.  Fever with abdominal pain and diabetes - Is it Emphysematous Pyelonephritis? 
Emphysematous pyelonephritis (EPN) is a rare, severe infection of renal parenchyma presenting commonly with fever and flank pain and presence of gas in the renal and/or peri-renal space. EPN can be life threatening if not diagnosed and treated promptly. Air shadows in the renal or peri-renal region on imaging studies of the abdomen are diagnostic features of EPN. However, computed tomography (CT) scan of the abdomen is better than ultrasound for diagnostic classification, prognosis, and treatment options. We treated a young female with uncontrolled type II diabetes mellitus who had severe abdominal and back pain with fever. The CT scan confirmed the diagnosis of EPN. The conservative treatment itself was effective in complete resolution of the disease even though patient had severe type of EPN.
PMCID: PMC4163564  PMID: 25246841
computed tomography; diabetes; emphysematous pyelonephritis; fever; ultrasound
13.  Diffusion-Weighted Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy Features of Abdominal Viscera in a Patient with Gaucher’s Disease 
A 46-year-old woman with Gaucher’s disease (GD) consulted our clinic for abdominopelvic magnetic resonance imaging (MRI), as physical examination had revealed hepatosplenomegaly. Upper abdominal MRI showed massive hepatosplenomegaly and innumerable hypointense splenic nodules on T1-weighted images. Diffusion-weighted MRI (DW-MRI) and magnetic resonance spectroscopy (MRS) were performed to liver parenchyma and splenic nodules. MRS revealed lactate, lipid, acetate, and alanine peaks in splenic nodules, and choline, creatine, lipid, myo-inositol-glycine, and lactate peaks in the liver parenchyma. The DW-MRI showed diffusion restriction in splenic nodules. It was concluded that MRI is a reliable method for the diagnosis and follow up of GD. Coupling DW-MRI and MRS allows quantitative evaluation, thereby increasing the efficacy of the method. This is the first report in the literature presenting advanced abdominal MRI findings in GD.
PMCID: PMC4163565  PMID: 25246842
diffusion magnetic resonance imaging; Gaucher disease; magnetic resonance spectroscopy
14.  Transient Elevation of Cerebrospinal Fluid Protein in a Patient of Mild Encephalitis with Reversible Lesion in the Splenium: A Case Report 
Mild encephalitis with reversible lesion in the splenium (MERS) is a clinicoradiological syndrome presenting as a solitary lesion in the central portion of the splenium of the corpus callosum (SCC) with a radiological finding of restricted diffusion and low apparent diffusion coefficient (ADC) values. Complete resolution of the lesion on follow-up imaging and full clinical recovery are the hallmarks of this syndrome, even with only supportive therapy. MERS is usually associated with normal Cerebrospinal fluid (CSF) findings and an excellent prognosis, even without corticosteroid therapy. Magnetic resonance imaging (MRI) is the ideal modality for initial diagnosis and follow-up. Not many cases of this uncommon clinicoradiological syndrome with transient elevation of CSF proteins have been reported. In the subsequent sections, we present a case report of this unusual clinicoradiological entity with raised CSF protein. We also elaborate on possible differential diagnoses and the syndrome’s proposed pathophysiology.
PMCID: PMC4163566  PMID: 25246843
encephalitis; corpus callosum; reversible lesion; splenium; cerebrospinal fluid protein; diffusion magnetic resonance imaging
16.  Medics and Marine Mammals – An Unlikely but Important Connection for Humanity’s Survival 
Marine mammals, as top predators in the marine food web, are sentinels of changes in the oceans and public health. Pollution in the sea and overfishing of seafood resources affects these organisms just as much as it affects human beings. Medics, especially doctors, have an influential reach to patients, and are in an ideal position to get better acquainted with ongoing marine environmental issues and subsequently disseminating such information to them. While seemingly an out-of-the-box approach, it is one that can help with environmental conservation and preservation for the future of humanity.
PMCID: PMC4028565  PMID: 24876801
conservation; environment; marine mammal; public health
17.  Intra-articular and Peri-articular Tumours and Tumour Mimics- What a Clinician and Onco-imaging Radiologist Should Know 
Definitive determination of the cause of articular swelling may be difficult based on just the clinical symptoms, physical examinations and laboratory tests. Joint disorders fall under the realms of rheumatology and general orthopaedics; however, patients with joint conditions manifesting primarily as intra-articular and peri-articular soft tissue swelling may at times be referred to an orthopaedic oncology department with suspicion of a tumour. In such a situation, an onco-radiologist needs to think beyond the usual neoplastic lesions and consider the diagnoses of various non-neoplastic arthritic conditions that may be clinically masquerading as masses. Differential diagnoses of articular lesions include infectious and non-infectious synovial proliferative processes, degenerative lesions, deposition diseases, vascular malformations, benign and malignant neoplasms and additional miscellaneous conditions. Many of these diseases have specific imaging findings. Knowledge of these radiological characteristics in an appropriate clinical context will allow for a more confident diagnosis.
PMCID: PMC4028566  PMID: 24876802
intra-articular; peri-articular; synovial; tumours
18.  Investigating the Effects of Imputation Methods for Modelling Gene Networks Using a Dynamic Bayesian Network from Gene Expression Data 
Gene expression data often contain missing expression values. Therefore, several imputation methods have been applied to solve the missing values, which include k-nearest neighbour (kNN), local least squares (LLS), and Bayesian principal component analysis (BPCA). However, the effects of these imputation methods on the modelling of gene regulatory networks from gene expression data have rarely been investigated and analysed using a dynamic Bayesian network (DBN).
In the present study, we separately imputed datasets of the Escherichia coli S.O.S. DNA repair pathway and the Saccharomyces cerevisiae cell cycle pathway with kNN, LLS, and BPCA, and subsequently used these to generate gene regulatory networks (GRNs) using a discrete DBN. We made comparisons on the basis of previous studies in order to select the gene network with the least error.
We found that BPCA and LLS performed better on larger networks (based on the S. cerevisiae dataset), whereas kNN performed better on smaller networks (based on the E. coli dataset).
The results suggest that the performance of each imputation method is dependent on the size of the dataset, and this subsequently affects the modelling of the resultant GRNs using a DBN. In addition, on the basis of these results, a DBN has the capacity to discover potential edges, as well as display interactions, between genes.
PMCID: PMC4028567  PMID: 24876803
Bayesian method; DNA microarrays; gene expression; gene regulatory networks; gene expression regulation
19.  Correlation between Degree of Radiologic Signs of Osteoarthritis and Functional Status in Patients with Chronic Mechanical Low Back Pain 
Osteoarthritis is the most intervening factors in producing mechanical low back pain (LBP). We aimed to evaluate the correlation between radiologic signs of osteoarthritis and functional status in patients with chronic mechanical LBP.
Severity of osteoarthritis and disability were evaluated with Kellgren and Lawrence Grading Scale (K&L) by simple lumbar X-ray and Oswestry Disability Questionnaire (ODQ) respectively.
Although there was no significant correlation between ODQ and K&L score in general, the correlation was seen in female group (P = 0.024, r = 0.207).
Mechanical LBP provides more disability in females suffering from more advanced osteoarthritis.
PMCID: PMC4028568  PMID: 24876804
disability; low back pain; osteoarthritis; radiography; spondylosis
20.  A Preliminary Assessment of Asymptomatic Bacteriuria of Pregnancy in Brunei Darussalam 
Asymptomatic bacteriuria describes a condition in which urine culture reveals a significant growth of pathogenic bacteria, specifically greater than 105 of colony-forming units per millilitre of urine. It has a direct bearing on the health of a pregnant woman, her pregnancy and consequently the foetus. Thus, this study investigated the prevalence of asymptomatic bacteriuria of pregnancy in Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, the premiere tertiary hospital in Brunei Darussalam.
A total of 170 pregnant women who were visiting the Department of Obstetrics and Gynaecology at RIPAS Hospital for routine antenatal care between February and March 2011 volunteered for this cross-sectional study. They did not present with any clinical symptoms of bacteriuria or indeed any other illness. They were investigated for bacteriuria by urine microscopy, culture, and sensitivity.
Urine samples from seven of the women produced significant bacterial growth, showing a prevalence of 4.1%. The organisms isolated were Klebsiella species (2.94%) and Escherichia coli (1.18%); these bacteria were both sensitive to amoxicillin, vancomycin, tetracycline, and erythromycin.
Brunei has a similar prevalence of asymptomatic bacteriuria to other South-East Asian countries.
PMCID: PMC4028569  PMID: 24876805
asymptomatic; bacteriuria; infections; pregnancy complications; urinary tract infections
21.  Influence of Age, Weight, and Pirani Score on the Number of Castings in the Early Phase of Clubfoot Treatment using Ponseti Method 
The objectives of this study were to investigate whether severity of clubfoot, age, and weight of the patients at initial manipulation and casting influence the total number of castings required.
This prospective study was conducted on 38 idiopathic clubfoot patients undergoing weekly manipulation and casting using the method recommended by Ponseti. The patients’ age, weight, and foot Pirani score at the start of manipulation and casting were analysed against the total number of castings required to achieve correction to 60° abduction.
Simple linear regression analysis on the influence of weight, age, and Pirani score at the time of cast initiation showed that the Pirani score was the only significant predictor for the total number of castings required.
The total number of castings required to treat clubfoot was determined by the severity of clubfoot but not by the weight and age of patients.
PMCID: PMC4028570  PMID: 24876806
age; clubfoot; plaster cast; weight
22.  The Effect of Second-Hand Smoke Exposure during Pregnancy on the Newborn Weight in Malaysia 
There was strong evidence from studies conducted in developed countries that second-hand smoke (SHS) exposure is detrimental to the birth weight of newborn. This study was conducted to determine the effect of exposure to SHS smoke during pregnancy on the weight of newborns.
A retrospective cohort study was conducted. The exposed group consists of 209 postnatal women who experienced SHS exposure at home because of a husband or other housemate who smoked inside the house throughout the pregnancy. The non-exposed group included 211 women who did not experience SHS exposure at home or at work during pregnancy. We excluded non-Malay ethnicity, multiple births, and congenital defects.
There was a significant difference in the adjusted mean birth weight between exposed infants [2893.0 g (95% confidence interval (CI): 2781.3, 3004.7)] and not exposed infants to SHS [3046.1 g (95% CI 2929.5, 3162.6) (P < 0.001)] after controlling for significant maternal factors. There was a 12.9 g (95% CI: 7.01, 18.96) reduction in birth weight for a corresponding increase in the exposure to the smoke of one cigarette (P < 0.001). The incidence of low birth weight (LBW) was higher in exposed women, [10% (95% CI: 5.94, 14.06)] compared to non-exposed women [4.7% (95% CI: 1.85, 7.55)].
This study found a significant association between SHS exposure during pregnancy and decreased birth weight.
PMCID: PMC4028571  PMID: 24876807
environmental tobacco smoke; low birth weight; passive smoking; prenatal exposure; second-hand smoke
23.  The Implementation of Teleneurosurgery in the Management of Referrals to a Neurosurgical Department in Hospital Sultanah Amninah Johor Bahru 
Telemedicine in neurosurgery or teleneurosurgery has been widely used for transmission of clinical data and images throughout the country since its implementation in 2006. The impact is a reduction of patient number that need to be reviewed in the level III hospitals and an increment in the number of patients that are kept in level II hospitals for observation by the primary team. This translates to reduction of unnecessary transfer of patients and subsequently cost benefits for patients and medical providers. The main aim is to determine the amount of reduction in unnecessary transfer by the implementation of teleneurosurgery in the management of referrals to neurosurgical department in Hospital Sultanah Amninah Johor Bahru (HSAJB). Other factors associated with transfer decision are also evaluated.
This prospective cohort study was conducted in HSAJB, Johor over four months. A total of 349 subjects referred to HSAJB are included with 12 subjects excluded. The subjects are followed up from the time of referral until three months post-referrals. Related data includes the decision before and after reviewing the radiological images on teleconsultation website with clinical data available.
There was a significant reduction in the number of inter-hospital transfer. 37% of transfer is avoided and patients are best kept in their original hospitals. However, there are additional findings in which there are 20.1% of patients that thought does not require transfer based on clinical data alone, would have to be transferred when the clinical data and images are reviewed. This translates to an increment of 20.1% need to be observed in neurosurgical center. Without the images, these patients might be observed in the referral hospitals with higher risk of deterioration. Other factors that are related to transfer decision apart from images include Glasgow Coma Scale (GCS) and diagnosis. The GCS significantly associated with transfer when only clinical data is reviewed. However, in situation where clinical data and images are reviewed together, the GCS and diagnosis are significantly associated with transfer decision. On multi-factorial analysis, more of mild head injury being transferred for observation in neurosurgical unit after images and clinical data reviewed which correlates to an increment from 1.85% to 3.9%. Another finding is reduced of risk of patients transferred for trauma from 1.85% to 0.519% after the data reviewed.
Teleneurosurgery is beneficial in the management of referrals from level II hospitals. The inter-hospital transfer is significantly reduced, however there is an increased in the number of patients that need to be observed in neurosurgery unit for the risk of potential deterioration.
PMCID: PMC4028572  PMID: 24876808
teleconference; remote consultation; neurosurgery; craniocerebral trauma; coma; post-head injury
24.  Present Status and Future Concerns of Expanded Newborn Screening in Malaysia: Sustainability, Challenges and Perspectives 
Newborn screening (NBS) program is an important tool for the early diagnosis and preventive treatment of life-long impairments. NBS is one of the strategies recommended by the World Health Organization to promote the primary prevention of congenital anomalies and the health of children with these conditions. However, NBS initiation and implementation in developing countries, especially South-East Asian and North African regions, are slow and challenging. Expanded NBS is not mandatory and has not yet been incorporated into the public healthcare system in our country. Limited funding, manpower shortages, inadequate support services, low public awareness, and uncertain commitment from healthcare practitioners are the main challenges in establishing this program at the national level. Involvement and support from policy makers are very important to the success of the program and the benefit of the entire population.
PMCID: PMC4028573  PMID: 24876809
newborn screening; inborn error of metabolism; congenital disorders; Malaysia
25.  Amoebic Colitis Presenting as Ileocaecal Intussusception - A Rare Case 
Ileocaecal intussusception is a common cause of acute intestinal obstruction presenting as a surgical emergency. We report a case of amoebic colitis in a 62 years old man complaining of acute colicky pain in the right iliac fossa, associated with a three-day history of constipation but no other gastrointestinal tract symptoms. There was rebound tenderness on palpation of the right iliac fossa. Ultrasound scans revealed free fluid and a loop within a loop image in this area. At laparotomy, we discovered an Ileocaecal intussusception associated with a gangrenous caecum. A right hemicolectomy was performed with satisfactory outcome. The final diagnosis of amoebic colitis was obtained post-operatively using serology and pathology. This rare aetiology must be considered in patients with acute pain in the right iliac fossa in the tropical regions. Tropical surgeons must be aware of this scenario before they label a case of intussusception as idiopathic. The identification and treatment of invasive amoebic infection may reduce the recurrence of idiopathic intussusception.
PMCID: PMC4028574  PMID: 24876810
amoebic; intussusception; ileocaecal; colitis; idiopathic

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