Alternate careers for medical graduates and house officers in Malaysia

@#Introduction: In recent years, many unresolved issues pertaining to house officers in Malaysia have led to a longer waiting time and a ‘glut’ of medical graduates with a surprising 20% dropout amongst those who join the housemanship programme. This appears to reflect the changing times, mindsets and work expectations of millennials who comprise this cohort reflecting a need to consider possibilities of career shifts especially so in these uncertain times. This study explores the perceptions, awareness and interest in alternative career options amongst recent graduates and house officers. Materials and Methods: This was a study done between 2018 and 2019 using a questionnaire which was shared on various social platforms. Data analysis was done using Excel spreadsheet. Results: A total of 450 house officers and 657 medical graduates responded. Expectedly 66.8% claimed lifelong passion whilst another 12.1% claimed family influence as their reason to do medicine. Most were aware of their career challenges and 40% of them were keen to consider career change and reskilling indicating a possible shift from traditional expectations of a medical career. Conclusion: Whilst medicine is often considered a true calling, current challenges will require mental and emotional flexibility to explore other career opportunities. Thus, engagement programmes should be directed at medical graduates and house officers to identify and support those open to career transitions. This will help address current issues of internship bottleneck and rising dropout rates amongst internees. Early career change engagements will give them insight into their true career goals whilst opening up opportunities for those who wish to change.

Candida Species Isolation, Identification and Biofilm Detection at a Tertiary Care Hospital

Introduction: Early diagnosis and accurate treatment ofcandida infected patients helps to reduce the risk of infectionand improves patient outcome. Candida isolation, speciationand its invasiveness can be determined by culture, antigen andantibody estimation, glucan estimation and PCR. The presentstudy aimed at candida isolation, speciation and detection ofbiofilm production among various clinical samples.Material and Methods: Various clinical samples such asurine, pus, blood, cerebrospinal fluid, body fluids, tissue, oraland ear swabs etc. were collected from patients in a sterilecontainer and transported immediately to Microbiologylaboratory and processed according to standard protocols.Results: Out of 64 candida isolates from various clinicalisolates, Majority were Candida albicans (37.5%), followed bycandida tropicalis (32.8%), candida krusei (20.3%), Candidaparapsilosis (6.2%) and Candida glabrata (3.1%).Conclusion: Early diagnosis and accurate treatment ofcandida infected patients helps to reduce the risk of infectionand improves patient outcome. Assessing biofilm productionof candida isolates helps us to plan treatment and identify theniche for production of biofilms

Potential increase in photosynthetic response of taro (Colocasia esculenta L.) to photon flux density and elevated CO2

Aim: The present study was undertaken to study the net photosynthetic rate (Pn), stomatal conductance (gs) and intercellular CO2 (Ci) in five eddoe and four dasheen type taro genotypes under ambient and elevated CO2 , and subjected to different photon flux densities. Methodology: The critical evaluation of Pn was assessed at different photosynthetic photon flux densities (PPFDs) viz., 200, 400, 600, 800, 1000, 1200 and 1500 µmol m-2 hr-1 under ambient CO2 (400 ppm) and at saturation PPFD (1500 µmol m-2 hr-1) at short-term (ten min) exposure of leaves to elevated CO2 (eCO2; 600, 800 and 1000 ppm) at 30oC using portable photosynthesis system LI-6400, LICOR, USA in a controlled-climate cuvette system. Results: The Pn in the leaves of nine taro genotypes persistently augmented upon short-term (10 min) exposure to eCO2 concentrations which ranged between 400 ppm and 1000 ppm. Taro genotypes exhibited 61.80 – 113.3% hike in Pn at eCO2 (1000 ppm) as compared to ambient CO2 (400 ppm). However, the per cent increase in Pn at eCO2 for every 200 ppm between 400 to1000 ppm significantly declined (4.4-18.4%) at 1000 ppm CO2. The differences in gs were statistically significant across taro genotypes (P>0.001) and CO2 concentrations (P>0.001). Further, the Ci was also found to increase constantly at eCO2 concentrations (400 ppm to 1000 ppm). However, there was significant reduction (16.2 - 31.3%) in Ci for every 200 ppm between 400-1000 ppm. Interpretation: Results of the study revealed that the genotypes Muktakeshi, Sree Pallavi and Telia are promising in the context of climate change as they significantly responded to eCO2 concentrations. Response mechanism to eCO2 need to be elucidated.

EPTB diagnosis by GeneXpert MTB/RIF test and its Clinical-epidemiological profile

GeneXpert is a novel, automated diagnostic test that can identify Mycobacterium tuberculosis (MTB) DNA and resistance to rifampicin (RIF) rapidly for Extrapulmonary tuberculosis (EPTB). Incidence of EPTB is increasing in low burden settings in comparison to pulmonary tuberculosis (PTB) & EPTB is relatively neglected. Aim: This study is aimed at knowing the incidence of EPTB and rifampicin sensitivity using an automated rapid detection method, GeneXpert. Methods: 271 EPTB positive patients were included in this retrospective study during a period from January to July 2018. Details regarding TB diagnosis, rifampicin sensitivity, nature of the sample and patient details including age, sex, occupation, address, habits, past history of TB, HIV status and other clinically relevant information was obtained from hospital and laboratory registers. Results: Out of 1290 tuberculosis positive patients, 1019 were of pulmonary tuberculosis (PTB) i.e., 78.9% and remaining 271 were of extrapulmonary tuberculosis (EPTB) i.e., 21.1%. 42.4% (115 out of 271) patients were in the age group of 31-40 years. Female predominance was observed in EPTB patients. Among 271 EPTB patients, 122 (45%) were diagnosed as pleural TB, 95 (35%) patients affected by tuberculosis at lymphnodes, 3(1.1%) had meningeal TB, 9(3.3%) EPTB cases were diagnosed from pus samples of various clinical conditions and remaining 42(15.4%) EPTB cases identified from various samples including tissues, genitourinary, synovial fluid, bones & joints. 247 (91.1%) out of 271 EPTB patients clinical samples showed rifampicin sensitive. 12 (9.8%) out of 122 pleural tuberculosis cases and 5 (5.2%) out of 95 TB lymphadenitis cases showed resistant rifampicin. Conclusion: TB can be diagnosed by various methods, among which GeneXpert is a rapid, reliable, easy to operate, automated system. GeneXpert helps physicians by providing rapid diagnosis within 90 minutes, in turn aid to initiate prompt treatment at the earliest.

Halophilic benthic diatom Amphora coffeaeformis—A potent biomarker for lipid and biomedical application

Biomarkers offer a powerful means to study life and its interaction with the environment. The evolutionary record of eukaryotic phytoplankton has been studied through fossils and molecular biomarkers, such as lipids and nucleic acids. Algal taxonomic groups containing carotenoids serve as age diagnostic biomarkers associated to photosynthetic pigments or fatty acids. Diatoms are known to thrive even in hypersaline conditions which are restricted to higher salinity. Results of this study have revealed the presence of a specific highly branched isoprenoid (HBI) compound, squalene (0.004 g) in the halophilic benthic diatom Amphora coffeaeformis which is considered to be the marker for hyper salinity. It also corresponds to the biomarker of oxidation processes.

Pattern of cervical lesions, with emphasis on precancer and cancer in a tertiary care hospital of Southern India.

Background: Carcinoma cervix is the most common form of cancer in India. Screening is cost-effective but compliance is an issue. Most women present to hospitals at first visit. We studied the pattern of women with carcinoma cervix who presented to the gynecology outpatient department of a large hospital in southern India. Methods: Women attending the gynecology outpatient department of King George hospital were evaluated for the presence of cervical lesions. A complete history was obtained. Biopsies from the cervix were obtained from the aceto-white areas, fixed in 10% buffered neutral formalin. Results: 860 cervical biopsy specimens were received. By routine hematoxylin eosin stains, 180 had precancerous lesions and cancerous lesions with more than two risk factors; in the study period, a total of 253 cervical neoplasms were recorded: 103 were in the pre-cancerous stage (CINU1: 74; 71.84%, CIN II 20/103; 19.41%, CIN III 9/103; 8.73%). Of the 150 cancerous lesions, maximum were SCC non-keratinising (130; 92%). A subset (viz 45/180; 25%) were tested for HPV DNA using Polymerase Cycle Reaction (PCR). The commonest presenting symptom was leucorrhea (40%). Most women reported age of first intercourse below 30 years. On visual examination of cervix, most (25; 55.55%) had exophytic growth and erosion (14; 31.11%). More than 80% (n: 24) presented in stage II and III cancer (n:27). Conclusion: In this hospital based study from a large institution from Southern India, out of 860 cervical biopsy specimens studied, 180 (32.14%) had precancerous lesions and cancerous lesions with more than two risk factors.

Seasonal variations in physico-chemical characteristics of pond and ground water of Tiruchirapalli, India.

The aim of this study was to assess the open pond and groundwater quality of Tiruchirapalli city of Tamil Nadu, India. The groundwater quality viz., pH, electrical conductivity, total hardness, calcium ion, magnesium ion, chloride, carbonate, bicarbonate, inorganic nitrate, nitrite, phosphate, ammonia and reactive silicate were analysed with respect to various seasons and recorded in the range of 7.1 to 8.1, 97.67 to 533.67 mhos cm-1, 7.07 to 186 mg l-1, 4.67 and 112.0 mg l-1, 2.40 to 92.80 mg l-1, 15.23 to 661.73 mg l-1, 60 to 480 mg l-1, 22.7 to 544.9 mg l-1, 15.33 to 68.00 mg l-1, 0.001 to 0.480 mg l-1, 0.01 to 0.42 mg l-1, 0.02 to 0.75 mg l-1 and 1.1 to 2.96 mg l-1 respectively. The present findings concluded that the quality of ground waters can be considered suitable for human consumption. But the pond water available in and around Tiruchirappalli city was not fit for human usage, agricultural or industrial purposes.

Copepod population in Vellar estuary, Parangipettai coast in relation to environmental conditions.

Distribution and abundance of copepods were studied in relation to environmental conditions at two different ecosystems viz: Neritic (Bay of Bengal) and estuarine (Vellar estuary) of Parangipettai coast from September, 1998 to August, 2000. Over the study period, total 85 species of copepods were reported. Among these, the calanoid copepods constituted the major component with 63.52% followed by cyclopoids (29.41%) and harpacticoids (7.05%). The copepods population density was found to be high (2, 53, 000 org l-1) in estuarine water, while the species diversity was higher (5.47) in neritic water. The observed spatio-temporal variations in the population density and species diversity of copepods were more related to the environmental state of respective study area.

Life table of Synthesiomyia nudiseta (Van der Wulp) (Diptera: Muscidae) under uncontrolled laboratory environments – a preliminary study

The life history of the male and female of the indoor forensic fly, Synthesiomyia nudiseta was studied under fluctuating temperature of indoor environments and analysed based on the age-stage and two sex life table. The life cycle of S. nudiseta was 14.0±1.0 days from the egg stage to adult emergence. The population parameters calculated were; net reproduction rate (Ro= 108.6), mean generation time (To= 12.2), intrinsic rate of increase (rm= 0.38), and finite rate of increase (λ= 1.46). The pre-oviposition period (APOP) was 6.0± 0.1 days. All population parameters suggested that S. nudiseta exhibits the r-strategist characteristics.

Evaluation of total plasma homocysteine in Indian newborns using heel-prick samples.

OBJECTIVE: To estimate total plasma homocysteine levels in Indian newborns by modifying the existing SBD-F based High performance liquid chromotography (HPLC) method in order to enable analysis in newborn heel-prick samples and assess the prevalence of hyperhomocysteinemia in Indian newborns who are exclusively breast-fed. METHODS: Reverse-phase HPLC with fluorescence detection for plasma homocysteine estimation and statistical analysis using student t-test. RESULTS: SBD-F based HPLC method was modified and Bland and Altman analysis was carried out to assess agreement between original and modified methods. The correlation co-efficient was 0.994. The limits of agreement (-5.9, 6.3) were small enough to apply new method in place of the old for heel-prick sample analysis. Total plasma homocysteine analysis was carried out on heel-prick samples of 607 randomly selected newborns (331 males and 276 females). The mean plasma homocysteine estimated by this method in Indian newborns was 6.99 (95% CI: 6.48-7.49) with no appreciable gender effect (P=0.74). Elevated homocysteine levels were observed in 31 males and 21 females. CONCLUSIONS: Modified HPLC method is validated and can be used for homocysteine analysis on newborn heel-prick samples. Using this method, the prevalence of hyperhomocysteinemia in Indian newborns is 8.6%.

Newborn screening in India.

Expanded newborn screening (NBS) is aimed for early detection and intervention of treatable inborn errors of metabolism and also to establish incidence of these disorders in this part of the globe. The first expanded NBS programme initiated in the capital city of Andhra Pradesh to screen all the newborns born in four major Government Maternity Hospitals in Hyderabad by heel prick capillary blood collected on S&S 903 filter paper. Chromatographic (TLC and HPLC), electrophoretic (cellulose acetate and agarose) and ELISA based assays have been employed for screening of common inborn errors of metabolism. This study has shown a high prevalence of treatable Inborn errors of metabolism. Congenital hypothyroidsm is the most common disorder (1 in 1700) followed by congenital Adrenal Hyperplasia (1 in 2575) and Hyperhomocystenemia (1 in 100). Interestingly, a very high prevalence of inborn errors of metabolism to the extent of 1 in every thousand newborns was observed. The study reveals the importance of screening in India, necessitating nation wide large-scale screening.

Congenital glaucoma associated with 22p+ variant in a dysmorphic child.

A case of congenital glaucoma with developmental delay and several dysmorphic features showing 22p+ chromosomal variant is reported.

Disseminated histoplasmosis in an AIDS patient diagnosed on bone marrow.

A 29 year old male drug addict, who was HIV positive presented with fever and hepatosplenomegaly. Bone marrow examination revealed Histoplasma capsulatum confirmed by PAS & GMS stains. However patient had a rapid downhill course with multiorgan failure and died before specific treatment could be instituted.

Clinicohaematological profile of two cases of inhibitors to factor VIII.

Bleeding is a common manifestation of inherited and acquired disorders of haemostasis. Acquired disorders of haemostasis can be of varied etiology like liver disease, DIC, haemorrhagic disease of newborn and inhibitors to coagulation factors. Inhibitors to coagulation factors are an unusual cause of bleeding which can be superimposed on inherited factor deficiencies or sometimes resembles them. The clinical and haematological profile to two cases of factor VIII inhibitors are being presented here, one of which was a known haemophiliac receiving factor VIII therapy and another was a elderly lady with no other apparent underlying disorder. Hence any case of factor VIII deficiency who becomes refractory to factor VIII replacement therapy or those who are detected to have factor deficiency late in life should be investigated for inhibitors.

An unusual distribution of glucose-6-phosphate dehydrogenase deficiency of south Indian newborn population.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is seen at a higher frequency in many national and ethnic groups in areas of current or former malaria endemicity. A screening programme undertaken to evaluate the gene frequencies for this deficiency in the highly inbred South Indian population of Karnataka revealed that of the 5140 neonates screened, 7.8% were G6PD deficient with no correlation between the reported level of inbreeding and enzyme deficiency. An interesting finding was the equal number of male (198) and female (207) individuals, with G6PD activity of less than 3 IU. The possible implications of this finding with regard to the expression of G6PD gene is discussed.

Distillery effluent treatment using Artemia.

Artemia functions as living filter for the secondary treatment of distillery effluent, which reduces up to 69% of the total solids and 33.34% of BOD in the saline medium of 60 ppt. Chemical analysis of diluted effluent after treatment with Artemia showed a significant (P less than 0.001) decrease in the electrical conductivity, calcium and potassium values. However, an increase in sodium concentration and pH values, was recorded during experiment.

Hydrophilicity and antigenicity of proteins—A case study of myoglobin and hemoglobin.

Hydrophilicity index is used to locate antigenic determinants on two related groups of proteins—myoglobin and hemoglobin. The data on 41 species (including 34 mammals) of myoglobin show that average hydrophilicity for the complete myoglobin molecules as well as the average hydrophilicity for all hydrophilic regions put together seem to remain constant; the variation in the size and location of the antigenic determinants in these species is very small indicating that the antigenic sites are not shifted during evolution. In the case of both the proteins there is a good agreement between the antigenic sites picked up by using hydrophilicity index and the experimentally determined antigenic sites. The data on 56 species of hemoglobin α-chains and 44 species of hemoglobin β-chains showed that although there are few sites on hemoglobin which have remained invariant during evolution, there is a significant variation in other sites in terms of either a splitting of a site, or a drastic change in the hydrophilicity values and/or a length of the site. Comparison of the hydrophilicity data on these two groups of proteins suggests that hemoglobins which perform a variety of functions as compared to myoglobins are evolving faster than myoglobins supporting the contention of earlier workers.