Development and validation of estimates of Glomerular Filtration Rate (GFR) equations in the Malaysian setting

Introduction: Accurate assessment of glomerular filtration rate (GFR) in perioperative and intensive care patients is very important for diagnostic and therapeutic intervention. Clinically, GFR is estimated from plasma creatinine using equations such as Cockcroft-Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. However, these were developed in the Western population. There was no equation that has been developed specifically in our population. Objectives: We developed a new equation based on the gold standard of 99mTc-DTPA imaging measured GFR. We then performed an internal validation by comparing the bias, precision and accuracy of the new equation, and the other equations with the gold standard of 99mTc-DTPA imaging measured GFR. Methods: This was a cross sectional study using the existing record of patients that was referred for 99mTc-DTPA imaging at the Nuclear Medicine Centre, International Islamic University Malaysia. As this is a retrospective study utilizing routinely collected data from the existing pool of data ethical committee has waived the need for informed consent. Results: Data of 187 patients was analysed from January 2016 to March 2021. Of these, 94 were randomized to the development cohort, and 93 to the validation cohort. A new equation of eGFR was determined as 16.637 * 0.9935Age * (SCr/23.473)-0.45159. In the validation cohort, both CKD-EPI and the new equation had the highest correlation to 99mTc-DTPA with correlation coefficient of 0.81 (p<0.0001). However, the new equation had the least bias and was the most precise (mean bias of -3.58 ± 12.01) and accurate (P30 of 64.5% and P50 of 84.9%) compared to the other equations. Conclusion: The new equation which was developed specifically using our local data population was the most accurate and precise, with less bias compared to the other equations. Further study validating this equation in the perioperative and intensive care patients is needed

MRI of corpus callosum in patients with autism spectrum disorder in Kuantan

OBjective: To study the integrity of the corpus callosum among autistic children population in Kuantan, Pahang, Malaysia, which is determined by MRI’s diffusion tensor imaging (DTI) parameters, fractional anisotropy (FA) and radial diffusivity (RD). These param- eters represent the direction dependence of water molecules diffusion within the measured tissues. As corpus callosum is saturated with brain white matter tracts, the water molecules diffusion here will be direction dependent. Studies involving foreign populations have shown that there is distortion in the corpus callosum’s DTI parameters in autistic population indicative of microstructural distor- tion. Whether similar findings will be observed in our local autistic population still remains a question. Other gross corpus callosum parameters such as its thickness, length and size are also studied. Materials & Methods: 28 randomly selected autistic children under the International Islamic University Malaysia Medical Centre (IIUMMC), Kuantan follow-up are subjected to MRI scan. Limited MRI sequences including DTI are obtained and analysed. FA, RD, midsagittal thickness at the genu, body and splenium of the corpus callosum as well as its midsagittal length and size are measured. Data are tabulated according to age followed by statistical analysis. Results: A weak negative correlation is found between the age and the FA of the corpus callosum. Other parameters such as the thickness, length and size show weak positive correlation with age. Conclusion: Although the correlation is weak, our study shows that there is evidence of distortion of corpus callosum white matter microstructure in children with autism spectrum disorder in Kuantan, Pahang

Ethical justification in medical futility and advanced medical directive from the Islamic perspective

Introduction: Medical futility and advanced medical directive are related issues in end-of-life medical decisions that present challenge to doctors and patients in terminal condition and to doctors and family members of patients who are critically ill in the ICU. Materials and Methods: A qualitative study comprises of literature search and an in-depth interview of experts was carried out to determine the clinical situations in medical futility and the ethical considerations from the Islamic perspective that justify forgoing medical treatment and also the practice of advanced medical directives in the country. Results: In such scenarios, clinical data must be interpreted alongside patient values, as well as the physicians’ ethical commitments. From the Islamic perspective, doctors are the authorised person to diagnose medical futility and forgo medical treatment. Forgoing treatment is permissible as long as it conforms to the maqasid and qawaid al-shariah principles that guide the decision-making process. The practice of advanced medical directive is still at its infancy in this country. From the Islamic perspective, upon considering the maqasid and qawaid al-shariah principles, it should be permissible and its practice should be encouraged as it assists the doctors and the surrogate decision-maker to decide to the withdrawal of treatment. Conclusion: Ethical justification on medical futility conforms to the maqasid and qawaid al-shariah principles and forgoing medical treatment is permissible in Islam. Advanced medical directive assists in the decision-making of forgoing treatment in the presence of utility and thus its practice should be promoted

Comparison of various creatinine-based estimates of glomerular filtration rate equations in the Malaysian setting

Introduction: Kidney disease is a worldwide health concern with an increasing mortality in the past 10 years. The Kidney Disease Improving Global Outcomes (KDIGO) guideline advocates the use of estimated glomerular filtration rate equation (eGFR) to estimate renal function. Objectives: We evaluated the performance of Cockroft Gault (CG), Modified Diet of Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations to measured GFR 99mTc-DTPA taking into account of body mass index (BMI) and age group. Methods: This is a cross sectional study of patients referred for 99mTc-DTPA scan at the Nuclear Medicine Centre of International Islamic University Malaysia. The record was taken from patients visiting the centre from January 2016 to December 2019. Results: The mean measured GFR by 99mTc-DTPA scan was 42.2 ± 20.38 ml/min, these was lower than that estimated by CG, MDRD and CKD-EPI equations. CKD-EPI had the highest correlation of 0.72, least bias (mean bias of 11.08 ± 23.08) and was more precise (r2 of 0.4) as compared to MDRD and CG. In patients 30 and with highest correlation for all classes of BMI. Conclusion: CKD-EPI has the best estimation of GFR taking into account the effect of BMI and age. A further study can be done to determine the correlation of estimated GFR equations with different ethnicity in Malaysia

Development and Validation of Creatinine-Based Estimates of the Glomerular Filtration Rate Equation from 99mTc-DTPA Imaging in the Malaysian Setting

Introduction. Accurate assessment of glomerular filtration rate (GFR) is very important for diagnostic and therapeutic intervention. Clinically, GFR is estimated from plasma creatinine using equations such as Cockcroft–Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equations. However, these were developed in the Western population. To the best of our knowledge, there was no equation that has been developed specifically in our population. Objectives. We developed a new equation based on the gold standard of 99mTc-DTPA imaging measured GFR. We then performed an internal validation by comparing the bias, precision, and accuracy of the new equation and the other equations with the gold standard of 99mTc-DTPA imaging measured GFR. Methods. This was a cross-sectional study using the existing record of patients who were referred for 99mTc-DTPA imaging at the Nuclear Medicine Centre, International Islamic University Malaysia. As this is a retrospective study utilising routinely collected data from the existing pool of data, the ethical committee has waived the need for informed consent. Results. Data of 187 patients were analysed from January 2016 to March 2021. Of these, 94 were randomised to the development cohort and 93 to the validation cohort. A new equation of eGFR was determined as 16.637 ∗ 0.9935Age ∗ (SCr/23.473)−0.45159. In the validation cohort, both CKD-EPI and the new equation had the highest correlation to 99mTc-DTPA with a correlation coefficient of 0.81 (). However, the new equation had the least bias and was the most precise (mean bias of −3.58 ± 12.01) and accurate (P30 of 64.5% and P50 of 84.9%) compared to the other equations. Conclusion. The new equation which was developed specifically using our local data population was the most accurate and precise, with less bias compared to the other equations. Further study validating this equation in the perioperative and intensive care patients is needed

OSCE Year 4 IIUM (MBBS) Department of Radiology Kulliyyah of Medicine -Set 2

The article is a past year OSCE questions for end od posting, examination for undergraduate medical students during, their specialised postin

OSCE for year 4 MBBS IIUM set 1

The article is a past year OSCE questions for end of posting examination

Osce for medical students: radiology book 1

This ebook contains compilation of OSCE questions prepared for undergraduate MBBS examinations as part of assessment after Radiology posting

Perceptions of the online learning experience among medical students during COVID-19

Social gatherings have been limited during the COVID 19 pandemic to reduce the transmission of viruses. Many academic institutions have shifted their classes from traditional methods into online remote teaching and learning sessions. Since neither the students nor lecturers were familiar with this setting, the delivery of medical education has undoubtedly impacted as the lectures, clinical placements and key examinations were discontinued. Many adjustments need to be made in order to make sure that the online teaching is held properly. This study was conducted to investigate the perceptions of online learning experience among medical students during the pandemic. An online survey was distributed to 158 medical students from Year 1 and Year 2 of International Islamic University Malaysia (IIUM) from July 2021 till August 2021. The Learning Community Scale and Student Support Scale based on Course Experience Questionnaire (CEQ) were applied to measure the participants' perceptions. The data were analysed using Statistical Package for the Social Sciences (SPSS) version 26. Based on the Learning Community scale, higher response values signified better feelings towards the learning community. The average scores of all five questions were high level (3.68-4.36 on 5-Likert scale), suggesting that the participants were feeling well towards their learning community. Likewise, higher response values in the Student Support scale indicated that better student support is perceived. The average scores of all five questions were also high (3.11-4.31 on 5-Likert scale), indicating that the respondents perceived an adequate amount of student support. In conclusion, the study conjectured positive perceptions towards their learning experience during COVID-19 pandemic among the students despite the sudden shift from physical to online teaching and learning sessions. However, broader ethnic groups and larger sample sizes might be useful for more precise and reliable future results

Perceptions of the online learning experience among medical students during covid-19

Social gatherings have been limited during the COVID 19 pandemic to reduce the transmission of viruses. Many academic institutions have shifted their classes from traditional methods into online remote teaching and learning sessions. Since neither the students nor lecturers were familiar with this setting, the delivery of medical education has undoubtedly impacted as the lectures, clinical placements and key examinations were discontinued. Many adjustments need to be made in order to make sure that the online teaching is held properly. This study was conducted to investigate the perceptions of online learning experience among medical students during the pandemic. An online survey was distributed to 158 medical students from Year 1 and Year 2 of International Islamic University Malaysia (IIUM) from July 2021 till August 2021. The Learning Community Scale and Student Support Scale based on Course Experience Questionnaire (CEQ) were applied to measure the participants' perceptions. The data were analysed using Statistical Package for the Social Sciences (SPSS) version 26. Based on the Learning Community scale, higher response values signified better feelings towards the learning community. The average scores of all five questions were high level (3.68-4.36 on 5-Likert scale), suggesting that the participants were feeling well towards their learning community. Likewise, higher response values in the Student Support scale indicated that better student support is perceived. The average scores of all five questions were also high (3.11-4.31 on 5-Likert scale), indicating that the respondents perceived an adequate amount of student support. In conclusion, the study conjectured positive perceptions towards their learning experience during COVID-19 pandemic among the students despite the sudden shift from physical to online teaching and learning sessions. However, broader ethnic groups and larger sample sizes might be useful for more precise and reliable future results