The WHO has updated their Guidelines for the treatment of malaria. The main changes from the first edition of the guidelines, which was originally published in 2006, are the emphasis on testing before treating and the addition of a new artemisinin-based combination therapy (ACT) to the list of recommended treatments.
You can download the guideline here (PDF format)

Spotted in Science Blog (via Dr. Anas Younes in Facebook)

The humble papaya is gaining credibility in Western medicine for anticancer powers that folk cultures have recognized for generations.
University of Florida researcher Nam Dang, M.D., Ph.D., and colleagues in Japan have documented papaya’s dramatic anticancer effect against a broad range of lab-grown tumors, including cancers of the cervix, breast, liver, lung and pancreas. The researchers used an extract made from dried papaya leaves, and the anticancer effects were stronger when cells received larger doses of the tea.
In a paper published in the Feb. 17 issue of the Journal of Ethnopharmacology, Dang and his colleagues also documented for the first time that papaya leaf extract boosts the production of key signaling molecules called Th1-type cytokines. This regulation of the immune system, in addition to papaya’s direct antitumor effect on various cancers, suggests possible therapeutic strategies that use the immune system to fight cancers.

A word of caution. Anti-cancer effects observed against cancer cell lines in the laboratory does not automatically translate into positive clinical results. Clinical studies still need to be done but this is intruiging laboratory data nevertheless.
Another thing to note is that assumptions about beta-carotene (the precursor vitamin A compound rich in papayas and carrots) being beneficial in the prevention of cancer have failed the test, and generally speaking, taking “anti-oxidant supplements” also does not necessarily mean health benefits, indeed they may be associated with premature death.
So instead of artificial supplements, it’s back to nature with truly natural fruits and veggies. Beware about consuming too much papaya as you could get Carotenemia. We see this now and then in the clinic where patients present with increased yellow-orange discolouration of their skin and palms. They are not jaundiced and the liver function is typically normal. Carotenemia is harmless and the skin colour will revert to normal once you stop taking papayas and carrots for some months.

I notice some of the alternative centres in town including “foot reflexology” centres offer Ear Candling as a service. I can’t imagine how “lighting one end of a hollow candle and placing the other end in the ear canal” can improve one’s well being other than it being a placebo effect.
Now the FDA has come out with a warning to Stay Away from Ear Candling

FDA believes that injuries associated with ear candles are likely underreported, and encourages consumers and health care professionals to report such injuries to FDA’s MedWatch Adverse Event Reporting program
Over the past decade, FDA has received reports of burns, punctured eardrums, and blockage of the ear canal which required outpatient surgery from the use of ear candles.
In its testing, Health Canada found that ear candles produce no measurable effect in the ear and have no therapeutic value.

Masli wrote in to inform you all:

Invitation to all Doctors or Meducationist

ACMS - Online Library (ebsco host) open to all Doctors for the first year. Either by online registration or facebook account connectivity

http://www.acms-lib.com/

Mei Ching writes in:

In recognition of March 9th which marks the anniversary of the day Max Rivarola lost his battle with leukemia, we ask that you join us in lighting a candle in his remembrance and for all of our loved ones who are no longer with us. Let us take solace in their courage and pledge to honor their lives through our actions to fight cancer.

Add your loved one to our Memorial Wall.

Max’s legacy lives on in everything we do at The Max Foundation. To every partner, sponsor, donor, physician, community leader, advocate, caregiver, and to all the survivors who maximize their lives in honor of Max, thank you from the bottom of our hearts. Together we renew our commitment towards cancer control. We pledge not to give up until every person diagnosed with cancer has access to the best treatment and support no matter where they live.

–
Mei Ching, Ong
The Max Foundation
(MMR: you can view postings in the Max Foundation Memorial Wall )

Just a heads up that Standup has resumed blogging and you might want to read the latest post regarding going On Call

Many doctors dread on calls. Despite doing it for many years, on calsl would always stress up anyone. The anticipation of working alone, at night with no sleep never bring joy to anyone. However, in Malaysia, doctors still do it for the sake of service. As for our director general of ministry of health, the working hours and doing it for 8 times a month is more than fair. Its a doctor’s duty in view of lack of doctors. Mainly because they leave for greener pastures to avoid having this lifestyle and working environment

I agree that working 36 hours at a stretch is no joy and if the call is very busy, it is hard to concentrate the following day and mistakes are bound to happen. For a long time, this has been necessary, since there are just insufficient numbers of doctors to do real “shift work”. The scenario may change over the coming years when it has been predicted there will be a surplus of doctors.
As for those who argue that going “on call” is part and parcel of training, I think it is more the case of actual hands on experience managing patients and whether or not there is adequate supervision.

This a YouTube clip of 16-year-old Sarah Phillips’ emotional tribute to her dying mother which has become an internet sensation (via Digg.com, Daily Telegraph)

After saying an emotional farewell to her dying mother, Sarah Phillips, 16, decided to produce a personal tribute to Debbie Phillips’s four-year battle against cancer.
Alone in her bedroom, Sarah read the words of the song “Autumn”, by Scottish singer Paulo Nutini, from the internet.
Then, holding her mobile phone in her left hand and using it as a recording device, she sang the song pitch perfect without any music – and without a single mistake or hesitation.
Four and a half hours later, Sarah and the rest of her family were at Mrs Phillips’ bedside in the family home when she took her final breath. She was 48.

While advances have been made in cancer prevention, early detection and in treatment, the reality is that many patients still succumb to the disease. In Malaysia, the Cancer Statistics (pdf format) are still grim and cancer as a whole is still a leading killer in our society. Many of you would have had a loved one lost to this dreaded disease. The registry data suggests that 1:4 Malaysians will get cancer during their lifetime. Frightening isn’t it?
What can you do to help? Here are some links to websites of organisations where you can donate as they are charitable causes in the fight against cancer:

National Cancer Society (Makna)
Hospis Malaysia
Kasih-Hospice Society
Hospice Klang

If you have more links to Malaysian cancer related charitable websites please let us know and we shall put the links in the MMR.

Related link:
Malaysian Oncological Society

Ahh the mysteries of life. Apparently it hasn’t stopped some scientists from speculating on the reason (Kumar and Kumar. Swinging high and low: why do the testes hang at different levels? A theory on surface area and thermoregulation. Med Hypotheses. 2008;70(3):698. Epub 2007 Aug 10)
The “researchers” hypothesize that the vertical displacement difference is beneficial for thermo-regulatory purposes. In layman’s language, it results in cooler balls.

In our view, one additional, yet overlooked cause for the naturally displaced level could be, simply, to expose more surface area of the active organ to cooler environs. While it is an accepted fact that suspension of the scrotum outside the abdominal cavity is paramount to the functional efficiency of testes in a preferred lower temperature – it still does not address the question – why hang at different levels?… In effect, just by suspension at two levels, nearly one entire extra surface is available for thermoregulation and cooling. That is, the surface area available now becomes two lateral, plus two halves of the two medial. This extra area available to the testes, probably is, yet another a significant but overlooked embryonic factor that dictates differential rates of descent and displacement of anatomical levels of twin reproductive male organs.

My theory is it helps prevent your nuts being squashed together when you sit with your legs crossed, but I could be wrong here.
(from Discover Magazine Blog via Digg)

The Star reports Doctors wanted at 162 health clinics

The Health Ministry invites application from private doctors who are registered with the Malaysian Medical Council and fulfil the service requirement to serve at the 162 government health clinics nationwide.
Its director-general Tan Sri Dr Mohd Ismail Merican said they could work at the clinics on “sessional” or “locum” basis and be paid RM80 per hour.
The working hours is from 8am to 5pm on normal working days (sessional), while the extended time is from 5pm to 9.30pm on Monday to Friday and 8am to noon on Saturday (locum), he said in a statement.

You can download the application form here (Word format)

Service requirements:

3.3 Kelayakan dan syarat perkhidmatan

Doktor-doktor Swasta yang ingin berkhidmat di klinik kerajaan perlu memenuhi syarat-syarat berikut :
• Warganegara Malaysia atau bertaraf pemaustatin tetap.
• Had umur tidak melebihi 65 tahun. Jika melebihi 65 tahun masih boleh dipertimbangkan oleh jawatankuasa negeri dengan pertimbangan yang sewajarnya.
• Mempunyai ijazah MBBS, MD atau setaraf dengannya yang diiktiraf oleh Majlis Perubatan Malaysia.
• Telah berkhidmat dengan kerajaan atau Universiti sekurangkurangnya 3 tahun.
• Calon-calon yang mempunyai latihan lanjutan di bidang yang diceburi dan diiktiraf oleh Kementerian Kesihatan Malaysia digalakkan memohon .

RM80/hour is indeed above the current private locum rates and the MOH sounds generous. What about the patient load and working conditions? How many will respond?

MKA writes in:

Hello,

I was wondering about the matter not so long time ago, about 1 year time. I just came back from a medical school in Ireland, currently continuing my last 2 years in northern Malaysia.

I went to blood bank to donate blood, then I saw in the from, anyone who have been to UK, Eire and some other european countries around 1986 and after, are not allowed to donate blood.

I was wondering about any update or revision done on the regulation. As we all known, yes there was some studies suggesting a long incubation period about the virus. But is there any ‘active’ revision or studies about the chance of spreading it when you consume/ingest meats over there 2-3
times 5-6 years ago, asymptomatic, came back, donate blood.

Cant there be any screening done on the donated blood for CJD like what’s done for HIV?

Till when will this be going on? I would say we are all so keen to donate blood, as we are all aware of the low level in our blood bank, but just couldnt do so coz no one is revising the rule..which could have been outdated.

Hi MKA. Thanks for your comment. The concern about blood donation from people residing in UK is that variant Creutzfeldt–Jakob disease more popularly known as “Mad Cow Disease” has a very long incubation period and there is no reliable blood test at present to detect this. Hence this measure to preclude donors who resided in UK in the 80’s until about 1990 (when the use in the food chain of bovine offals was banned).
To date, there has been no known Mad Cow Disease reported in Malaysia, though there was an Mad Cow-like incidence in Penang some time ago

A recent population study on Singaporeans suggests an association with soft drink consumption and pancreatic consumption. The data is from the Singapore Chinese Health Study (study size 60,524, over 14 years) which looked at the consumption of soft drinks, juice, other dietary items, lifestyle factors and environmental exposures, collected at recruitment to the study. Medscape reports:

At 14 years and a cumulative 648,387 person-years of follow-up, 140 incident pancreatic cancers developed in people who were cancer free at baseline. After adjustment for confounders such as BMI, type 2 diabetes mellitus, and fruit juice intake, the authors found that those consuming 2 or more soft drinks per week experienced a statistically significant increased risk for pancreatic cancer (hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.10 - 3.15).
Although people who consumed 2 or more juice drinks a week had an increased risk for pancreatic cancer of approximately 30%, elevated HR was not statistically significant after adjustment for variables.
However, in an age-adjusted analysis, smoking was also a risk factor. After excluding former smokers, the authors found that current smokers had a 49% increased risk for pancreatic cancer, compared with never smokers (HR, 1.49; 95% CI, 0.98 - 2.27). This risk factor remained unaffected after adjustment for diabetes and BMI.

A word of caution is that studies like these can only determine statistical association, which is not quite the same as cause and effect. However it does make sense to curb smoking and the consumption of excessive sugary drinks like soft drinks. Diet coke anyone?

Now in many hospitals in Bolehland, we still rely a lot on paper and when it comes to our unfortunate nurses, there are a lot of charts, forms and reports to fill. They may need red ink, blue ink, green ink, pencils, highlighters etc.
One enterprising nurse came out with this excellent solution. The super duper combo pen!

Picture taken with a Palm Pre