Investor Presentaiton

IJMS MMSS 2015 $58 INTERNATIONAL JOURNAL of MEDICAL STUDENTS Abstracts Abstracts Abstracts of Malaysian Medical Student Summit (MMSS) Major postpartum haemorrhage secondary to acute comple- 01 te uterine inversion, a case report. CS Chean 1, Peter Liao, S Shaman, S S Poon', A Soltan 2 1 Faculty of medicine, University of Liverpool, 2 Liverpool Women's Hospital Introduction & Objectives: Obstetric haemorrhage is one of the lea- ding causes of maternal death in developed and developing cou- ntries. Acute uterine inversion is a rare obstetric emergency, esti- mated to occur in 1 of 3500 to 5000 deliveries. Patient/Method: A 35-year-old lady (G2P2) was admitted for induction of labour at 41+3 weeks as per local protocol for the management of postdates preg- nancies. She gave a history of previous postpartum haemorrhage (PPH) following her first pregnancy elsewhere. The plan was active management of third stage with routine precautions (e.g. IV access, blood sample for group and save etc.) to be taken in case recurrent PPH. In theatre, the uterine inversion was corrected manually with no difficulty immediately as the patient was anaesthetised. However, she continued to suffer major (atonic) PPH and the urine started to become blood stained raising concerns about DIC. Results & Dis- cussions: The switching off of volatile anaesthetics and insertion of Bakri Balloon was successful in controlling this patient's major PPH. On day 2 post-operatively, she seemed to have recovered relatively quickly and the Bakri Balloon was removed. The uterus was well contracted with minimal lochia and the patient was discharged home on day 3 postnatal with a healthy baby. Conclusion: Acute uterine inversion is a rare but severe condition and all staff should be aware of PROMPT (Practical Obstetric Multi-Professional Training) and the management of PPH as described in the RCOG green-top guideline No. 52 as delay in treatment is associated with high mortality and morbidity. 02 Clinical Audit on Diagnostic & Treatment Recommendation of Dry Eyes in St. Paul's Eye Unit Liverpool CS Chean, M Aswin ', S S Poon', A Sajjad 1 1 Faculty of Medicine, University of Liverpool, 2 St. Paul's Eye Unit, Royal Liverpool and Broadgreen Univer- sity Objective: Clinical audit of diagnosis and treatment methodologies of dry eyes in St. Paul's eye unit compared to the standard recommen- dations of Dry Eyes Workshop (DEWS) report 2007. Methods: Data are collected from 18 dry eye patients for a total period of 3 months. Pa- tient demographics are analysed and the diagnostic methodologies used in St. Paul's Eye Unit were reviewed. The severity of dry eye of every patient in this audit is then graded according to the standard. Their respective treatment provided in St. Paul's are then compa- red against the standard treatment recommendations. Results: The mean age of patients (N-18) is 70.5 (SD=12.63) whereas all patients in this audit are female. Patients are then divided into subgroups of Primary Sjogren's syndrome dry eye, Secondary Sjogren's syndrome dry eye and nonSjogren's syndrome dry eye. Most patients (55.6%) suffer from Grade 3 severity dry eyes. One-third (33.3%) of patients have adequate treatment which correlates with their dry eye severity grading. Discussion: The standard diagnostic protocol recommended by DEWS report should be followed. Most practitioners in St. Paul Eye Unit appear to be more conservative in their treatment of dry eye patients of varying severity. However, the standard guideline noted that treatment recommendations can be modified by practitioners on the basis of their clinical experience and individual patient pro- file. Conclusion: The standard guidelines of dry eye diagnosis and management is of considerable clinical utility and it is advised to be used by practitioners based on each individual patient profile and clinical experience for the best interests of the patients. 03 Clostridium Perfringens Enterotoxin (CPE) in Clostridium Perfringens Gastroenteritis: A review of recent evidence Goh JE, Lee LH Jeffrey Cheah School of Medicine and Health Sciences, Mo- nash University Malaysia. Introduction: Clostridium Perfringens is referred as a worldwide pathogenic microorganism in nature as well as in humans. Its as- sociated type A food-poisoning has been classified among the most widespread foodborne gastroenteritis diseases in the developed countries globally. Objective: To review existing and novel aspects of C. Perfringens, its toxin Clostridium Perfringens Enterotoxin (CPE) and its associated type A foodborne illness. Methodology: Pubmed, Science Direct and Elsevier were systematically searched using "Clostridium Perfringens", "Clostridium Perfringens Enterotoxin" and "Clostridium Perfringens type A Gastroenteritis" as keywords. Fifty articles published in the past 10 years were selected to be reviewed on prevalence and sources of infection; identification of bacteria and its toxin CPE; treatment and public health measures to curb this issue and CPE as potential medical application. Results: Substantial experimental and epidemiologic studies have provided rigid eviden- ce on the role plays by CPE as the major virulence factor responsible for the pathogenesis of C. Perfringens type A gastroenteritis. Signi- ficant advancement on the knowledge available on C. Perfringens and its associated gastroenteritis has been made. Discussion: Public health measures in preventing further outbreak cases from happe- ning are especially important and much attention is given towards effective disinfection routines and proper food handling practices which aid in removing the presence of any bacteria. Conclusion: Many challenges remain for researchers, including the physiology, genetics and mechanism of action of different cpe positive strains and the reassessment of the current diagnostic tools to more ex- plicit methods in identifying C. Perfringens type A food-poisoning outbreak. Besides that, there is a need for more in-depth views on the sources and reservoirs of C. Perfringens cpe-positive strains for better control of this organism in foods. 04 The role of group II mGluRs in synaptic transmission and plasticity at the CA2 region of the hippocampus Jonathan Lee Chuo Min Introduction: Group II metabotropic glutamate receptors (mGluR) have been known to depress neuronal transmission via inhibition of neurotransmitter release at glutamatergic synapses. They can also mediate long term depression in several regions of the brain in- cluding the lateral amygdala and striatum. However, their roles in the hippocampus, particularly the cornu ammonis 2 (CA2) region is largely unclear. Objectives & Methods: We have used electrophysio- logical techniques on wildtype and mGluR2 deficient rats in com- bination with group II mGluR modulating drugs to tease apart the physiological functions of group II mGluRs on the temporo ammonic pathway input synapse to the CA2. Results & Discussions: Using DCG-IV (group II mGluR agonist), we have identified that activation of group II mGluRs leads to depression of synaptic transmission in the TAP-CA2 synapse in a dose-dependent manner. Washout of DCG-IV resulted in LTD which indicates that group II mGluRs can mediate LTD in the same region. Using LY541850 (mGluR2 agonist, mGluR3 anta- gonist) on wildtype rats, DCG-IV on mGluR2 deficient rats, we have further evidence that activation of mGluR 2/3 alone can induce signi- ficant depression of synaptic response as well as induce LTD. Using these drugs in combination, we have also established that mGluR2 and mGluR3 may have synergistic effects on one another, potentia- ting depression and lowering the threshold for LTD induction. Con- clusion: These results suggest important roles of group II mGluRs as regulators of CA2 activity which may have significant implications in explaining the mechanism behind the clinically beneficial (eg. neu- roprotective/anxiolytic) effects of group II mGluR modulation. These results will also help tease apart the physiological role of the CA2 in the construction of episodic memory in the hippocampus. 05 Pain, itch and quality of life after Herpes zoster: A web-based prospective study Albert JM van Wijck', Yueting Kew² 1 Pain Clinic, Department of Anesthesiology, UMC Utrecht, The Netherlands 2 Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Introduction: Pain and itch are the most common complication in herpes zoster (HZ) patients and are difficult to treat. However, long- term impact on quality of life (QOL) is not known. Aim: To measu- re the incidence of pain and itch after HZ and the impact on QOL. Methods: We performed an observational prospective study in pa- tients above 50 years with HZ. Participants were recruited by internet and by general practitioners within 7 days after onset of the rash. Follow-up was web-based for pain, itch and quality of life at 2 weeks an 1, 3, 6 and 12 months. There were no restrictions in treatment. Significant pain or itch was defined as a score. 30 on a 100 mm VAS. Results: A web-based prospective study was feasible in the 50+ po- pulation. We enrolled 661 patients with a follow-up of at least one month. Mean age was 65 years (range 50-96). Presence of PHN redu- ced Quality of Life to a large degree. Results are displayed in figure 1 and 2. Conclusion: Although the risk of long lasting severe PHN is low, the burden of disease is high. 06 The Frequency of Neuropathic Pain In Low Back Pain Patients Attending A Tertiary Spine Clinic Cheng Yin Tan, Yueting Kew', Sue Sien Thang', Leong Hooi Tan', Yvonne Khaii Khoo', Chong Jing Ng', Jun Ni Lim', Jia Hui Ng', Chris Yin Wei Chan², Mun Keong Kwan², Khean Jin Goh¹ 1 Division of Neurology, Department of Medicine 2 Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia Aim: Chronic back pain may have a combination of both nociceptive and neuropathic pain components. The objective of the study is to evaluate the neuropathic pain component in a group of outpatients with low back pain Methods: The painDETECT neuropathic pain scree- ning questionnaire was used to identify pain mechanisms in a cohort of patients seen at the Spine Clinic, University of Malaya Medical Centre, Kuala Lumpur. Pain mechanisms were classified as nocicep- tive, unclear and neuropathic and were correlated with demographic factors, associated diseases, underlying diagnosis for low back pain as well as pain severity (numerical rating scale), disability (Roland Morris Disability Questionnaire) and anxiety/depression (Hospital Anxiety and Depression Scale). Results: Of the 210 patients recruited, 26 (12.4%) had neuropathic pain, 45 (21.4%) were unclear and 139 (66.2%) were likely nociceptive pain. Subjects with neuropathic pain were more often women, more likely to have leg pain and to have the pain radiate below the knee. There were no differences between ethnic groups, associated diseases, underlying cause or duration of back pain. Patients with neuropathic pain had significantly more se- vere average (6.8 vs. 4.7, P<0.001) and highest (8.4 vs. 5.6, P<0.001) pain score over the last 4 weeks. They also had higher RMDQ scores (16.4 vs. 10.0, P<0.001) and more of them had anxiety (42.3% vs. 12.2%; P<0.001). Conclusions: The frequency of neuropathic pain was 12.4%. Low back pain with neuropathic pain component was more severe and was associated with greater disability and more anxiety in patients. 07 How does educational theory influence the teaching of clini- cal skills Y W Liao University of Liverpool, Liverpool Introduction: From palpating to auscultating, doctors use these clini- cal skills in everyday practice to help diagnose patients. Hence, there is no surprise that the teaching of clinical skills is a fundamental pillar of every medical school. Objective: The objective of a con- temporary medical education aims to produce medical professionals with multiple competencies, one of which is clinical skills. This paper aims to deconstruct the concept of teaching clinical skills and seeks to discuss the types of theories used to teach clinical skills. By re- viewing the fundamentals and history of each theory, this paper will then seek to uncover the education theories used in clinical skills sessions and understand the implications and effects of each theory. Methods: A literature search was performed using online database (Pubmed and Scopus). To refine the search and ensure consistency, a specific set of inclusion and exclusion criteria was agreed on and applied for both databases. Results: A total of 20 papers were se- lected. Discussion: Four key education theories was examined and related to the teaching of clinical skills. These 4 theories are the curriculum theory, behaviourism, cognitivism, and constructivism. Every theory was related to the teaching of clinical skills and its effectiveness is then judged and evaluated. Conclusion: Education theories are not mutually exclusive and can be integrated into a clinical skills session more than one at a time. However, the choice of which theory to be integrated is highly dependent on the specific clinical skill being taught and its perceived effectiveness during the session. 08 Self-Management of Gestational Diabetes Mellitus Y W Liao University of Liverpool, Liverpool Introduction: The prevalence of Gestational Diabetes Mellitus (GDM) has been on the rise globally with studies stating that up to 14% of pregnancies are complicated due to diabetes and 3%-5% of that number is GDM. Hence, it is no surprise that GDM has become a particularly important topic of research within the specialty of obs- tetrics and gynecology. Objective: This paper seeks to investigate the feasibility of self-management of GDM by reviewing various papers recommending different self-management techniques, the effective- ness of self-managing GDM and if the patient is placed in any harm by choosing to selfmanage GDM. Methods: A literature search was performed using online database (Pubmed and Scopus). A specific set of inclusion and exclusion criteria was applied to both databases. Only RCTs and systematic reviews were included. Results: 20 papers were selected. As the prevalence of GDM may differ according to ethnicity, the 20 papers originated from various countries to ensure a diverse sample size was taken into account. Discussion: A few areas were considered to determine the feasibility of self-management of GDM. 1) 2) Patient adherence to self-monitoring of blood glucose. Evi- dence shows that proper pharmacological intervention time is not significantly affected if blood glucose is recorded daily or less frequently. Effectiveness of nutritional management 3) - Studies have shown that proper diet management is effective in mana- ging and even preventing GDM. Self-management techniques in an ambulatory setting - Va- rious studies have recommended different ways to control GDM in an ambulatory setting. Conclusion: Based on current evidence, it is possible to self-manage GDM in an ambulatory setting with proper support from the health care team. This is especially important as GDM will last for the dura- tion of the pregnancy hence self management is needed to ensure proper blood glucose levels are maintained. 09 Effect of music tempo on blood pressure, heart rate and respiratory rate among medical students in Melaka Manipal Medical College: A single blinded randomised controlled trial Aiman A, Amalina N, Malkit S, Salman B, Ikram K Introduction: Music plays a complex role in human beings causing diverse physiological changes, including both neurological and car- dio-respiratory aspects. Studies have shown that different music tempos have contrasting effect on the vitals. Objectives: The aim INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS MMSS 2015 $59