Plenary Lectures and Symposia

Optical technologies using laser spectroscopy and imaging offer the ability to non-invasively diagnose and monitor early cancers in-vivo. For many precancers and early cancers the current standard of care relies on histopathological assessment of directed biopsies in order to obtain a final diagnosis. With optical technologies, optical biopsy based diagnosis can be achieved in real time, using automated techniques, insitu. Fluorescence imaging and spectroscopy is an emerging optical technology that offers particular promise for the diagnosis of disease, in part because of a large number of endogenous biological fluorophores. Some of the more common tissue fluorophores include the aromatic amino acids (trytophan, tyrosine and phenylalanine), the cofactor reduced nicotinamide adenine dinucleotide (NADH), flavins, porphyrins, collagen and elastin. Autofluorescence and drug induced fluorescence imaging and spectroscopy offer a means of assessing both the structural and the biochemical progression of the disease, hence, interest in its use to detect precancers has been increasing. Clinical studies at the NCC have achieved promising results in the bladder, oral cavity and cervix using exogenous porphyrin and perylene quinonoid based fluorescent markers. It is conceivable in the near future that highly sensitive endoscopic and non-endoscopic tumour detection methods can be successfully complemented by online staging and grading, thus finally fully justifying the term ‘optical biopsy’. In vivo confocal endomicroscopy is a non-invasive method in digital imaging of hollow organs that enables visible detection of abnormal cells on the surface and sub-surface of any hollow organ. The development of a such a method for both macroscopic and microscopic assessment was posible with a recent invention of the Optiscan fibre confocal endomicroscope by the FDA in 2002. Real time image acquisition and digistisation of optical biopsies allows for further image processing to enable derivation of menaingful real time information of the inspected site This technique would be immensely useful in the determination of tumour margins and tumour staging during surgery. Fibre-optic fluorescence endoscopic confocal imaging technology could potentially be applied to a number of oragns systems to detect eraly disease or predisposing conditond causing premaliganat changes Photodynamic Therapy (PDT) has been defined as the combined effect of light and a photosensitising drug to produce biological damage of therapeutic value, under conditions where either the light or the drug alone have little effect. Most PDT drugs are closely related to naturally occurring compounds and therefore have very low toxicity Whilst the concept itself is not new, developments in laser and fibreoptic technology have permitted the drug and light to be brought together within tissue in such a way as to be clinically useful. This has also been facilitated by the fact that several other ‘second generation’ compounds now in clinical trials, concentrate in certain hyperproliferative tissues relative to the surrounding healthy tissue, thus giving a favourable therapeutic ratio. Benefits of PDT include the relative lack of trauma and pain for patients. Even where normal tissue damage does occur around the target tissue, a remarkably effective natural healing process when compared with apparently equivalent injury produced by other modalities. PDT also offers the possibility of repeat treatment, without apparent limitation. Compared to conventional chemotherapy, surgery or radiotherapy, the side-effects of PDT are minimal and largely consist of a period of skin photosensitivity, as the excess drug is excreted from the body over a period of hours to days. However, even this drawback will become unimportant as the next generation photosensitisers gain regulatory approval for widespread clinical use, since several of these exhibit much shorter optimal tissue accumulation times and excretion times. Indeed, more rapid treatment offers the possibility of PDT becoming an outpatient modality, at least for some indications. In the past decade several thousand cancer patients have received PDT worldwide although the majority have not been part of a prospective clinical trials. It has been extremely difficult to compare results because different photosensitizers, light sources and treatment parameters have been used. Furthermore, comparison of these reports with standard cancer modalities is limited by the paucity of either long-term follow –up data or histological confirmation of complete response. The coming year will undoubtedly see a substantial expansion in the range of indications for this novel for of therapy for both oncological and non-oncological conditions. Objective To determine the effect of epidural analgesia on the progress of labour in the perspective of duration of labour and modes of delivery. Methodology One hundred and ninety two (192) uncomplicated full term gravida 2 – 5 women with tested pelvis in spontaneous labour were randomized to receive either epidural ropivacaine 0.2 % with fentanyl 2 μg.ml−1 or intramuscular pethidine analgesia. Epidural catheter was inserted at first request of pain relief during active phase of labour at cervical dilatation of 3 to 5 cm. Results Epidural analgesia significantly provides good analgesia after 15 minutes (Mean Visual Analogue Score 15 minutes was 11.3 mm vs. 68.6 mm, P = 0.001) and at full dilatation (25.1 mm vs. 94.4 mm, P = 0.001). 86% of patients experienced no motor block in the epidural group. There were significant associations between epidural administration and prolongation of first stage (506.6 min vs 392.1 min; P = 0.001) and second stage (24.0 min. vs.10.1 min; P = 0.001) of labour. Instrumental delivery but not the caesarean section rates were increased. (11.7% vs. 2.1%, P = 0.008), (11.7% vs. 7.1%, P = 0.186) respectively. No difference in neonatal outcome as shown by Apgar score at 1 and 5 minutes. Patient satisfaction was statistically significant whereby 84% of patient opted for epidural analgesia for next delivery. Conclusions Epidural ropivacaine 0.2% with fentanyl 2 μg.ml−1 provides better labour analgesia than intramuscular pethidine despite prolongation of labour and increased instrumentation. It was not associated with increased incidence of caesarean delivery when compared with intramuscular pethidine analgesia. Affective disorders involves disruption of intrinsic biological rhythms, like sleep-wake cycle, body temperature rhythms, hormonal rhythms, rest-activity cycle etc. Some of these are phase advanced both in endogenous depression as well as in bipolar affective disorders where in patients exhibit both manic and depressive phases during the course of their illness. Melatonin, the chief hormone secreted form the pineal gland has been shown to be of major importance for establishing the correct phase position of various bodily rhythms, the disturbance of which only causes INTERNAL DESYNCHORINIZATION, the major reason for the occurrence of bipolar affective disorders. Some of the bodily rhythms are phase advanced in both endogenous depression as well as in Bipolar affective disorders. In contrast to this, bodily rhythms are phase delayed in seasonal affective disorders (SAD) or winter depression. Melatonin being a CHRONOBIOTIC has been used successfully to set right the disturbed biological rhythms in patients suffering from affective disorders and is being used as a therapeutic tool for treating these disorders. In addition to this, bright light also is being used successfully to treat endogenous depressives, bipolar patients and patients suffering from winter depression. Since light acts mainly by altering both rhythm and amplitude of melatonin secretion, and is able to set right the disturbed bodily rhythms, an interaction between light and melatonin is very important not only in understanding the pathogenesis of affective disorders but also in employing LIGHT as a useful therapeutic tool in treating affective disorders. Recent aspects on this line of research will be discussed. The 80% (v/v) methanolic extracts from 20 species of Araceae were screened for their anticancer activities against Human Hepatocellular Carcinoma (HepG2) cell line and the cell survival was determined using Methylene Blue Assay. All the plant extracts exhibited dose-dependent inhibition on the growth of HepG2 cell line. The most significant inhibition was produced by Alocasia macrorrhiza extract with EC50 (effective concentration that can kill 50% of cancer cells) of 15.11mg/ml. In addition, three other extract that have been identified as potential anti-cancer agents are Amydrium media (EC50= 17.116 mg/ml), Ariseama waryi (EC50= 19.626 mg/ml) and Scindapsus aureus (EC50=18.083 mg/ml. Alocasia macrorrihiza was further fractioned using three different solvents i.e. hexane, chloroform and 80% (v/v) methanol. Only the hexane and chloroform fractions exhibited significant cytotoxic effect on HepG2 cells with EC50 value of 11.018 mg/ml and 4.217 mg/ml, respectively. The chloroform extract was subsequently fractioned and from the 17 fractions obtained, fraction F8 was considered the most potent fraction with EC50 value of 3.695 mg/ml against HepG2 cells. DeadEnd Colometric Apoptosis Detection System and DNA Fragmentation ELISA indicated that the chloroform extract and fraction F8 triggered the HepG2 cell death via apoptosis mechanism. Introduction: Tonsillectomy in children is done on a regular basis in ENT. The indications are chronic recurrent sore throat and URTI, odynophagia, sleep apnea and access to deeper structures. Objective The natural history of tonsilllar hypertrophy is regression when a child is 6 years old or older. In children with obstructive symptoms we study the use of laser as an alternative procedure to reduce the bulk of the tonsils mass. Naturally, the remnants of the tonsils will regress as the child grows older. Method Children with obstructive symptoms of tonsillar hypertrophy underwent laser tonsillotomy. The tonsils were dissected using laser from anterior pillar to posterior pillar. The tonsils bed were left untouched. Intraoperative and postoperative conditions were noted. Result Intraoperatively, blood loss was negligible. Postoperatively, all of the patients were able to swallow with minimal discomfort and discharged the following day after observation. Conclusion Laser tonsillotomy is an alternative procedure in children having obstructive tonsillar hypertrophy. Introduction It is crucial to assess patient’s satisfaction in order to improve the quality of services and to maintain patient load so that students and researchers will have sufficient number and variety of patients to sustain medical expertise. Objectives To assess factors associated with patient satisfaction toward medial ward services in two hospitals. Method Cross-sectional design with prospective recruitment of subjects of systematic random sample of inpatients admitted to HUSM and HKB. Interviewer-assisted validated questionnaires were administered to 188 inpatients from each hospital. Results Satisfaction was assessed on seven domains. Four items under nurse-services domain were higher for HKB.. Out of 13 items under doctor-services domain, 11 scored higher for HKB. Four items under other staff-services domain were more favoured for HKB. Six out of nine items under clean-and-comfort domain were higher for HUSM with significant p-values on furniture, ventilation and space items. Under miscellaneous domain, item on car-parking was highly scored for HUSM. Regarding financial issues, all 3 items were more in favour for HKB. Multivariate analysis for each domain using demographic and other variables related to current admission, adjusted satisfaction scores for HKB were significantly higher than those for HUSM for all domains except clean-and-comfort. Conclusion The patients admitted to HKB scored more favourably than those admitted to HUSM. Being hospital-based survey, it is not appropriate to compare two hospitals head to head. It is recommended that each hospital administration should assess areas for improvement to gain higher satisfaction and better utilization of their services. Background Lecture handouts are widely used instructional tools. Handouts supplement rather than substitute students’ regular reading. It is now a common practice to supply PowerPoint handouts and publish lecture handouts on the web for students’ access. Methods A questionnaire survey was conducted among the first year medical students (n=142) of School of Medical Sciences (SMS), Universiti Sains Malaysia (USM) in order to determine their perceptions and expectations with regards to lecture handouts provided to them. Results A majority of the students reported that they read the lecture handouts as a reference and found them useful as a guide for future learning. However, more than half (68%) of the students have shown their dissatisfaction with overall presentation format of the handouts which is mainly technology-related i.e. PowerPoint and photocopying. Discussion This study indicated that students’ expectations and experiences were positive towards the use of handouts. They used handouts as a means of supplementing rather than substituting their learning. Much care is needed when educators supply computer-based handouts, as this study shows some limitations when students use them. Medical schools should consider publishing web-based handouts with online and other facilities to make it interesting and effective.