The Sealed Nectar

alhamdulillahi rabbil alamin

We had finished our block exam on Saturday last week.

Apart from the rushing-ness to read all the lecture notes and in the end still couldn't finish them all, and despite the fact that we deprived of study week, alhamdulillah, I think the exam went well. And guess what, I think I love this blog contract thing, cause it really helped me during the exam! *nerd*

syukur. syukur.

How/what ever the result might turn out, I will leave that to Allah.

p/s: will continue to write about medical stuff in this blog, inshaAllah. :)

Friday, September 24, 2010-12-09

Star: GEORGE TOWN: A Malaysia-based Biotech Company is set to develop a vaccine in eight years for the EV71 virus, which causes the infectious and potentially fatal hand, foot and mouth disease (HFMD).

The company embarking on this ambitious task is Sentinext Therapeutics Sdn Bhd with its laboratory in Universiti Sains Malaysia (USM), Penang. Its chief scientific officer Prof Dr Jane Cardosa said there was currently no vaccine or anti-viral agent to prevent or treat EV71 infection. She added that the lab had found a vaccine candidate and was going through pre-clinical tests.

“Hopefully after 18 months, we can move to Phase 1 where we will test its safety on humans followed by efficacy trials (Phase 2). If the vaccine is taken up when it is (fully) developed, children can be protected from EV71, HFMD and some other diseases,” she said at a media briefing in USM yesterday.

“However, we won’t see the end of HFMD as it can still be caused by other viruses.”
The 59-year-old professor retired as Universiti Sarawak Malaysia Institute of Health and Community Medicine director in late August and is now a visiting professor at USM. The vaccine being developed by Sentinext Therapeutics is a significant breakthrough because the EV71 virus has been consistently causing outbreaks of HFMD in many countries in the Asia-Pacific region.
Prof Cardosa said the Singapore government had funded a company to research and develops a vaccine for the virus but it ceased operations after running out of funds. The China government has also invested in a similar project but has a different approach from what Prof Cardosa’s lab is doing.

“Our vaccine is formulated from empty capsids to mimic the virus particle but there is no genome. So, it is not infectious,” she said. Sentinext Therapeutics received a RM40mil fund from the Malaysian Life Sciences Capital Fund and Malaysian Technology Development Corp.
Besides developing and researching a vaccine for EV71, the company is also looking at vaccines for other tropical infectious diseases like malaria and dengue.

Scenario: Pandemic Preparedness

A patient came. After performing physical examinations, blood test, chest radiograph and viral examination, the doctor suspect that this patient suffer a serious viral infectious disease that may spread to community. After reporting to municipal health agency, the agency performs an outbreak and pandemic preparedness measures. Before this incidence, WHO has already declares several emerging and reemerging diseases that occur due to genetic evolution of viruses.

INFLUENZA

Influenza A, B and C all have segmented genome. The two major proteins of influenza are the surface glycoprotein - haemaglutinin (HA) and neuraminidase (NA). HA is the major antigen for neutralizing antibodies and is involved in the binding of virus particles to receptors on host cells. Pandemics are a result of novel virus subtypes of influenze A, created by reassortment of the segmented genome (antigenic shift), whereas annual epidemics are a result of evolution of surface antigens of influenza A and B virus (genetic drift). NA is involved in the release of progeny virions from the cell surface and prevents clumping of newly formed virus. (Epidemiology and pathogenesis of influenza, Maria C. Zambon, 1999)

Type A and B influenzaviruses regularly cause outbreaks of respiratory disease and general malaise during winter and spring in large parts of the world’s population. Influenzaviruses have a wide animal reservoir, and, by the mechanism of reassortment, animal type A influenzaviruses have contributed genes, for instance coding for the haemagglutinin (HA) H3, to viruses which became human pandemic viruses.

It has been shown that human H1N1 and also H3N2 influenza A viruses can infect pigs, and, vice versa, that related pig viruses can infect humans. By contrast, avian influenzaviruses, representing by far the biggest diversity and reservoir of influenza A viruses, were thought to circulate only within their original host or closely related species. Contribution of avian genes into viruses able to replicate in humans was thought to be possible only by reassortment, with pigs being the likely host, as these animals were shown to replicate avian influenzaviruses to a certain extent (“mixing vessel” theory of Scholtissek et al.136; Scholttissek and Naylor137).

How is flu spread?

The flu virus is spread from person to person through respiratory secretions and typically sweeps through large groups of people who spend time in close contact.

Flu is spread when you inhale droplets in the air that contain the flu virus, make direct contact with respiratory secretions through sharing drinks or utensils, or handle items contaminated by an infected person. In the latter case, the flu virus on your skin infects you when you touch or rub your eyes, nose, or mouth. That's why frequent and thorough hand washing is a key way to limit the spread of influenza.

One of many examples of influenza outbreak,



InshaAllah, later I'll talk about surveillance and response system done by health sector to control the outbreak and preventing morbidity and mortality due to influenza outbreak.

References:

1. Student book block 4.2: Health System and Disaster

2. Emerging and Re-emerging Infectious Diseases, U. Desselberger, 2000

3. Epidemiology and pathogenesis of influenza, Maria C. Zambon, 1999

2.

MedNews

Salam everyone. Just to add up our general knowledge that I try to integrates with what we already learnt in this block. We should know about medical news around the world, especially in Malaysia as some of us will go back and serve Malaysia after we finish our medical studies from Gadjah Mada University. We don’t want to be left behind knowing nothing about the ‘in’ medical gossips when our colleagues talk to each other later, do us? ;)

Friday, October 29, 2010

Star: KUALA LUMPUR: About 2,000 to 3,000 children in Malaysia need to undergo cardiothoracic surgery every year but both public and private hospitals can only cater to 1,200 of them due to the lack of specialists in the field, said Health Minister Datuk Seri Liow Tiong Lai.

He said there were about 180 cardiologists and 58 cardiothoracic surgeons in Malaysia, of whom only 26 cardiologists and 14 cardiothoracic surgeons were in ministry hospitals. “Treatment for heart diseases is almost unreachable to some due to the rising cost of heart operations and the scarcity of cardiologists and cardiothoracic surgeons,” he said. Due to these reasons, the Government had been sending children from poor families to the Naraya Hrudayalaya Hospital in Bangalore, India, for cardiothoracic surgery.

“From July 2008 until Oct 5, 138 children, the majority aged between one and five, have successfully undergone surgery,” he told a press conference after witnessing a joint venture signing ceremony between AriyaDana Equities Sdn Bhd and Narayana Hrudayalaya Pvt Ltd here yesterday.

The deal is a business plan to invest in an existing specialist medical centre in Nilai and collaboration to manage and operate the hospital, which will be known as the Narayana International Medical Centre.
AriyaDana Equities director Nathan Mahalingam said the hospital would initially be refurbished to have 100 beds in six months and upgraded in stages.

“An investment of more than RM250mil will be made within the first five years to achieve this objective,” he said. Narayana Hrudayalaya chairman Dr Devi Prasad Shetty said a team of cardiologists and cardiothoracic surgeons would be brought in from Bangalore to join the existing 160 medical staff at the medical centre. He said the medical centre would be able to conduct cardiothoracic surgery that would cost between 20% and 25% cheaper than other hospitals here.

p/s: Alhamdulillah. If I read this news before this block, I would have said: “oh, I see.” But after studying Health System block, my monologue would be: “I see consumption abroad and commercial presence here!” Hehe’

Tuesday, November 09, 2010

Star: IPOH: Malaysia is running short of psychiatrists. Health Ministry technical adviser on psychiatry Datuk Dr Suaran Singh Jasmit Singh said the country only has 233 psychiatrists to treat the population, which works out to a ratio of 0.8:100,000. “The ideal ratio is 1:50,000,” he said after the opening of a public forum on handling stress at Ipoh City Hall yesterday.

Dr Suaran, who is Hospital Bahagia Ulu Kinta director, said of the 233 psychiatrists available, 15 were attached with the Health Ministry and three with the Defence Ministry.
He added that there were 22 psychiatrists in Perak. “Their number is just enough to cope with the workload,” he said, reiterating the need for more psychiatrists.

Dr Suaran, however, said that more people were willing to take up psychiatry, which was quite a new medical discipline in Malaysia. “The ministry is working to increase the number of psychiatrists in the country,” he added. He noted that the country also had 55 private psychiatrists, but almost 45% of them were based in the Klang Valley.

On the public forum, Dr Suaran said it was organised in conjunction with Hospital Bahagia Ulu Kinta’s 100th anniversary to educate the public on coping with stress.
Perak executive council member Datuk Dr Mah Hang Soon, who opened the forum, said mental illness must be treated. “People with such illnesses need help and there are a lot of new treatments available,” he said, adding that psychiatric patients also required good care and support from their family members.

p/s: Prevention is always better than cure. *GPs and future GPs, sharpen your communication and anamnesis skills so that patients who come with psychological problems can be recognized and treated efficiently from patients who come with physical problems solely. You are the first line health worker after all. :)

*general practitioner

I was inspired by both Dr Yodi Mahendradhata’s lectures; 1. Globalization of Trade in Health Services and Workforce 2. Global Health and Decentralization. He gave us a clear view of what is happening to our health system around the globe, improvement of health sector, problems that occur due to these improvements, ways to overcome the problems, together with sufficient information and statistics as an example.

One of the phenomenons in health system right now is the international trades in health services, which can be divided into four categories;

1. Cross border trade

"the buying and selling of goods and services between two countries"

In the year of 2005, the most popular cross border revenues are customer interaction center, medical transcription and financial/accounting services.

2. Consumption abroad

"the freedom for the citizens of one country's to purchase services in the territory of another country."

Countries in Southeast Asia have interests in developing different kinds of surgeries based on available specialist and equipments in each country. For example, Singapore is well known for their cardiac and neurosurgery, joint replacements and liver transplants, Malaysia is famous for its cardiac and cosmetic surgery while Thailand can be recognized by its cosmetic and sex exchange surgery. The origin of patients for each country also differs, but sometimes overlapping as for example, Indonesia’s patients ranked number one as the origin of patients in both Malaysia and Singapore.

3. Commercial presence

"the opportunities for foreign service suppliers to establish, operate or expand a commercial presence in the other country, such as a branch, agency, or wholly-owned subsidiary."

4. Natural presence

"the possibilities offered for the entry and temporary stay in the country of foreign individuals in order to supply a service."

What are the problems then?

Globalization in health causes imbalanced in global distribution of health workforce, due to shortage of doctors in certain regions (e.g. Africa and Southeast Asia), in sense that there are outflow of health workers (doctors, nurses, midwives) from especially developing countries to the more developed countries.

Reasons for brain drain

• Better remuneration
• more favorable working environment
• Location of facilities in towns and cities
• Bureaucracy in own country
• Heavy workload in own country

As I mentioned in the previous posts, besides the migration to other countries, doctors especially prefer to work in urban rather than rural area. Thus, these are some policy options that can be taken into consideration by the government:

- In case there are a lot of commercial presences inside one’s country (which is usually private hospitals), publicly employed specialists mandated to work specific number of hours in public sector before treating private patients.

- pro poor financing mechanism in place. (e.g. private hospitals mandated to provide certain percentage of services to poor patients)

- in case of often consumption abroad, imply tax on medical tourist revenues.

You might be shocked upon reading the title. Culture? In Medicine? What are the connections? Yes, you see the right title. Medicine has the cultural aspect, because physicians do not deal with machines only. In most of our work field, we deal with human beings who are tied by their culture, especially people of the East.

I read the lecture note on Cultural Aspects of Medicine by Dr. Retna Siwi Padmawati , and select this out of so many definitions of culture:

“A set of ideas and skills which are transmitted socially from one generation to the next and which regulates people’s lives and their society.”

It includes knowledge, belief, art, morals, law, custom, and any other capabilities and habits acquired by man as a member of society. What interest me is that, culture is not only discussed about ideas, beliefs, and meanings, but also in what people do, as actual practices often reflect beliefs.

What benefits will physician get when they integrate cultural values with patients condition and understanding?

Surely, patients will be more open to discuss their health condition with you, due to your understandings in what they are going through. In this way, patient will listen to your advices on treatments and what they can do to achieve better health level.

Here are some of the tips to communicate between people of different cultures (race, ethnic group, socio-economic, etc.), besides good communication skills that had been taught during our first year (active listening, to be helpful and empathy, putting patient at ease, etc):

- A - avoid ethnocentrism - seeing his/her own culture to judge practices by other culture

- A - avoid chauvinism - seeing his/her own culture as the best culture for the people to adapt to

- A - avoid stereotyping - seeing the negative practices that is done by all the people in the ethnic groups

La Last but not least,

“An ideal/competence doctor, they not only owned the knowledge, skill, and experience in medicine BUT also focused on values, beliefs and integrating patients experience and world views in the caring and curing of their patients."

Cool, right?;)