Heroes of Stem Cell Research

By Azilleo Kristo Mohinim

The Nobel Prize is considered globally to be the most prestigious accolade that can be awarded to a person or an institution for contributing to specific fields of human endeavour. One of these fields is Medicine or Physiology. The Nobel Prize for Physiology or Medicine is annually awarded to people who have immensely contributed to the advancement of Physiology or Medicine. It represents the zenith of intellectual originality and creativity in the field of Physiology or Medicine. For the year 2012, the Nobel Prize of Medicine or Physiology was awarded to and shared by two distinguished scientists who are Shinya Yamanaka and Sir John Gurdon for their peerless contribution in stem cell research.

Shinya Yamanaka (right) and John B Gurdon (left), the winners of the 2012 Nobel prize in Physiology or Medicine. Photograph: The Guardian

Shinya Yamanaka

Shinya Yamanaka was born on the 4^th of September 1962 in Osaka, Japan. He obtained his MD from Kobe University in 1987 and his PhD from Osaka City University in 1993. From 1993 to 1996 he was a postdoctoral fellow in the Gladstone Institute of Cardiovascular Disease in San Francisco. After that he went back to Osaka City University Medical School to assume the position of an assistant professor and became an associate professor at Nara Institute of Science and Technology in 1999 which led to a full professorship in 2003. In 2008, he became the Director of Centre for Induced Pluripotent Stem Cell Research and Application (CiRA). He is also the member of the International Society of Stem Cell Research (ISSCR) Board of Directors.

Sir John B. Gurdon

Sir John B. Gurdon was born at Dippenhall, United Kingdom on 2^nd October 1933. He attended Eton College before undertaking Classics at Christ Church, Oxford. During his course of studying Classics, he decided to switch to Zoology. He obtained his doctorate from the University of Oxford in 1960. He did his postdoctoral research at California Institute of Technology and in 1962 he returned to England and was given a teaching post at the Department of Zoology of the University of Oxford. He is currently at the Gurdon Institute in Cambridge.

Removal of a cell from a dividing fertilised animal egg.
Photograph: The Telegraph

The Nobel Prize for Physiology or Medicine was awarded for reprogramming mature differentiated cells into pluripotent stem cells. In 2007, Yamanaka managed to induce mature human skin cells to become stem cells. These stem cells which are were artificially derived from mature cells are called induced pluripotent stem (iPS) cells. He managed to accomplish such a feat by introducing four pieces of genetic material which are now called Yamanaka factors into the genome of the cell. The Yamanaka factors in actuality are four distinct transcription factors called Oct 3/4, Sox2, Klf 4 and c-Myc. These transcriptions factors regulate cellular gene expressions and are highly expressed in embryonic stem cells.

For John B. Gurdon, his main concern was regarding the genes which were present in the nucleus of specialised cells. He was wondering whether cellular specialisation involved the loss of unwanted genes from the genome of cell or merely the inactivation of the unneeded genes. In 1962, he did an experiment which involved the removal of the nucleus of an egg of a frog and transferring the nucleus of a tadpole’s intestinal cells into the enucleated frog egg. Instead of differentiating into intestinal cells, the egg developed into a normal tadpole. The result gave concrete evidence that the nucleus of mature differentiated cells still contain the genes required to develop into a fully functional organism.

Our understanding of cell biology and the discovery of new experimental techniques to form iPS have opened many to avenues to improve the quality of life of mankind as well as give us a glimmer of hope in curing previously incurable disease. An example of the incurable disease is cardiovascular disease. It is the main killer disease in the world currently with, according to the World Health Organisation (WHO), an estimated 7.3 million people died of ischemic heart disease in 2008 alone. Heart cells cannot regenerate and once they are dead due to restricted supply of blood, they are replaced with fibrous tissues which cannot function as heart muscle. With iPS, it is possible to replace these dead heart cells by substituting with heart cells differentiated from iPS. In the near future, it is possible that stem cell therapy for many currently incurable diseases will become routine clinical practice.

One of the main concerns when it comes to stem cell research is the usage of embryos in order to obtain the stem cells. Many religious bodies are fervently against the usage of embryos in stem cell research since it violates the concept of sanctity of life espoused by them. Religious opposition to stem cell research significantly impeded the advancements in stem cell research. However, with the new technique discovered by Yamanaka, the ethical controversy shrouding stem cell research can be circumvented considering the fact that the stem cells obtained are derived from mature cells instead of from embryos. With the absence of religious opposition, stem cell research can be elevated to greater heights more quickly.

We are a species of curiosity. We strive to understand the world as well as ourselves. The achievements of the two great men mentioned in this article and their benefits are just a few out of many that exist. As humans accumulate more knowledge, we are able to manipulate nature in accordance of our will in order to improve our quality of life. However, bear in mind that we should do so within ethically acceptable boundaries. 

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Dr. Richard Teo: What His Story Means For Us

By Benjamin Oh

‘Life is inconvenient. Life is lumpy. A lump in the oatmeal, a lump in the throat, and a lump in the breast are not the same kind of lump.’-Robert Fulghum, Uh Oh: Some Observations from Both Sides of the Refrigerator Door (2001)

We are drawn to tales of people dying in their prime. Lives cut short; candles extinguished when the wicks are still fresh—these stories strike a chord in all of our hearts, like the hollow sounds of dismal church bells at a funeral.

No doubt, you’d have heard the story of the late Dr. Richard Teo, had you been on the internet or within reach of a newspaper lately. Delivered at the Dental Christian Fellowship, 8 months after his diagnosis, his story is a testimony of a prominent cosmetic surgeon with a future of promising plans wiped out by a small black-and-white section of an MRI scan; that day, he was revealed to have stage 4 lung cancer, which had spread to his liver and adrenal glands. He had three to six months left.

Dr. Teo had much to live for. The nip-and-tuck jobs were raking in cash, and paid for fast cars, nice houses, and the company of the beautiful and the connected. To be struck with a disaster of this magnitude—that his life would be over in less than half a year—is almost incomprehensible. One wonders if the day he received his diagnosis he drove home in his slick Ferrari, walked onto the cold tiles of his designer bathroom, and then disrobed and put his hand on his torso; perhaps trying to feel the malignancy spreading and multiplying inside, chewing up everything he had built. He concluded his testimony to his silent, sober audience, with a lesson; a reminder to all that life owes you nothing, and that a life lived for oneself may end sooner than you think.

As medical students, we have much more to learn from Dr. Teo’s life story. We will soon be doctors, professionals in a field unlike any other. A doctor doesn’t really dispense services the same way a mechanic fixes cars or an engineer builds a skyscraper.  True enough, money changes hands in medicine, and sometimes the money can be substantial. However, there’s no denying that medicine represents an art and a field more complex and profound than just a lucrative job. Perhaps Dr. Teo, at the pinnacle of his career, saw himself as a glorified beautician, servicing the human need to appear attractive and defy the onset of decay and degradation. But no doubt at the beginning of his medical education, and most probably upon being struck by the worst of bad news, he thought of his calling as being something else entirely.

To be a doctor is to submit to a higher plane of conduct, competence, and professionalism. Medicine deals with the most fundamental of human needs, the only commodity—aside from time and life itself—with which we trade for other, lesser things like money and influence. Medicine deals with health. It deals with the human body, complex and sometimes confusing, springing new surprises that may not always be pleasant. Almost seven billion human bodies populate the earth, and every single one of them at some point will require a doctor. Not every one of them gets access to one. To this day, no one has yet died from a lack of accountants or finance managers. To be a doctor, then, is to submit totally and unreservedly to doing everything humanly possible—and then some—to alleviate pain, and bring relief and health to as many people as possible, most of the time at great personal cost.

Small wonder then, that so much is expected of us as medical students, even before we begin our career. We are held to a code of ethics and professionalism to which we commit our conduct and behaviour for thirty, forty, fifty years. People think much of us, and expect much more in return; the rising popularity of malpractice suits and litigation bear testimony to the gravitas of medicine in today’s society, and the expectations that come with it. Today, we are taught of ethical compasses the four principles by Beauchamp and Childress; we are indoctrinated in words like confidentiality, informed consent, and primum non nocere (first, do no harm); we are subject to guidelines and the rulings of ethics committees. All these tell us what we are expected to do, and govern the actions of doctors around the globe. They tell us what our job is to be.

None of these guidelines, however, tell us the way we are to direct our future careers. It is that inner drive, that spark of originality, that guides the way we direct our careers and the manner we treat our professions. And there lies perhaps the most important component of a medical career: our reason. What does being a doctor mean to us? The reason we choose to pursue medicine; the reason we subject ourselves to deprivation and a spartan lifestyle, to a field where our hands never stay clean and our eyes will behold some of the worst the world has to offer—that reason will dictate our values and our moral compass.

 Dr. Teo testified that his reason was to gain prestige and financial security. To an extent, he succeeded. And by his testimony, none of it was worth it. Only too late did he discover his true calling: to help others in want. The genuine joy and purpose he gained in rendering compassion to those who needed it desperately was only tempered by the regret that he had spent the bulk of his years chasing after an entirely different agenda. ‘True joy comes from helping others in hardship,’ he had said. ‘When you start to build up wealth and when the opportunity comes, do remember that all these things do not belong to us.’ In pursuit of material wealth and fast cars, it is sobering to remember that the last car you will ride is a hearse.

If we truly decide to leave lasting legacies and dedicate ourselves to the service of others, there is no better place to start than in medical school. We may not have opportunities to perform complex medical procedures, or to have patients open themselves up to us in the same way as doctors; that will come in many years’ time. But the values to which we commit ourselves, the drive and direction we muster to attain our goal to be good doctors—we have plenty of opportunities to put these values to the test. We earn trust and develop reliability by doing things as simple as turning up to classes on time and handing in assignments punctually. We hone our ability to work well with others by cooperating with the members of our small group and doing our best to ensure that the entire group succeeds—even if we need to clean up others’ messes to do so. We learn humility and respect, vital qualities in our future careers, by doing things as simple as giving our lecturers a smile and a greeting. Most importantly, above any and all things, we must learn compassion; not only to know it, but to so embrace it as to make it inseparable from who we are and what we do. Skills can be taught, knowledge can be crammed in before the exam—but compassion takes years to understand and longer still to practice. It must be evident in the way we speak to and interact with our study patients or families; it must remind us that we deal with people, with lives and stories and hopes and dreams, people that feel and people that are just like us. Our studies and our lectures, seminars and projects—all of them prepare us for the real thing, when we finally don the white coat and stethoscope as true doctors and not simply observers or students. Lives will be in our hands. Happiness and dreams rest upon our efforts. Do we owe our future patients anything less than our full effort to excel, to learn all we can?

As a Christian, like Dr. Teo, I feel drawn to his profound observation that the most enduring legacy one can leave is to have lived a life in service of others—‘he who would be greatest among you is to be the servant of all’. Life is fleeting, death is sure, and, as someone has remarked astutely, the mortality rate for being born is one hundred percent. The path to becoming a good doctor starts right from day one of medical school. Were that journey suddenly cut short—were the examination suddenly halted and your half-finished test paper collected—what would you be left with? Would you be found to have lived your best and given your all to the accomplishment of a worthy goal?

I am reminded of story as poignant as that of Dr. Teo. As the 1980’s dawned, one commercial giant arose among others in the microcomputer market—Eagle Computer. Its CEO, Dennis Barnhart, steered his company towards great repute and high praise, earning rave reviews in computer magazines with the company’s cutting edge operating systems. On June 8, 1983, Eagle Computer’s initial public offering, the shares closed at 7 million dollars by the end of the day. That same June afternoon, Dennis Barnhart drove his Ferrari off a cliff.

What do we have in our hands? Dreams, ambitions, hopes. Goals to accomplish, wishes we are yet to fulfill. But when death seizes us by the collar and our plans suddenly become irrelevant, what remains of us? How have we lived our lives so far, how much have we adhered to the altruism and selflessness so required of us in this profession? (Com)passion and the heart of a servant—they are not simply words, they are the core of what we do. Dr. Teo found his true calling months before his passing. God willing, we will find ours far, far sooner.

‘What we have done for ourselves alone dies with us; what we have done for others and the world remains and is immortal.’

-Albert Pike

Dedicated to Dr. Richard Teo Keng Siang (1972-2012)

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The Reality Behind MUM

By Wong Khung Ming

Not All Rainbows and Butterflies

Having watched the reality show of Miss Universe Malaysia 2012, the contestants made being glamorous and beautiful seemed so easy and effortless. This year, my friend joined the competition and has made it to become one of the finalists. 

    I went up to her, jokingly telling her how great it must have been to have people make you beautiful all the time. She suddenly became very defensive, giving me insights of life as a beauty contestant which totally changed my view. ALL the effort in making the show a success, I suddenly feel the contentment of being a medical student! 

   The girls begin their day at 5am in the morning as they rush to shower, dress up and get their hair and make-up done. On certain occasions where make-up artist and hairstylist are brought in, getting ready could take up to HOURS – (which makes sense as there are 17 girls in line). The promotion video for Miss Universe Malaysia 2013 which lasted for a mere 30 seconds, took a total of 12 hours to shoot (including make-up time) !

   The amount of effort put into each shoot is so tremendous; every small detail has to be PERFECT! For example, while shooting, the competitors’ ‘baby hair’ has to be carefully gelled down to ensure no stray hairs can be seen on camera as the lightings are so detailed; and not to mention the amount of retakes! Thus, even a scene that lasts one second can take around one hour to film!

Since most events, shootings and challenges only finish by 12midnight, the competitors will only get to sleep at 2am as they have to clean up before bed – No clogged pores! 

   Their hectic schedule means they barely have any free time. And even if they do, it will be spent at the gym working out that perfect figure. This is not surprising as body image is so crucial for all beauty competitors. This also means that their diet is tightly restricted with meals consisting of a low fat and low calorie diet. Such a gruelling schedule combined with the tough diet led to some health troubles with the girls as they had constipation in the first few days of the competition due to trouble adjusting with the lifestyle. Even though most competitors were not used to the hectic schedule they knew all these were preparing them  for things to come.

 Difficulties of the Inexperienced and Short

As this is the first time my friend has entered a beauty pageant, she did not really know what to expect from the competition. She thought she could balance both her life as a medical student as well as a MUM competitor but it turns out to be really hectic for her. Nearly every weekend she has to rush back to KL after classes to attend events/shootings while her friends and coursemates spend the weekend relaxing or studying. 

   She also encountered many challenges in the competition. She had to go up against competitors who were more experienced in this field and thus knew more catwalk techniques while she had problems balancing alone. Talking to people and in front of the camera was difficult even for an outspoken person like her as being outspoken and loud is considerably different from saying and doing the right things, especially on TV. Living with so many other strangers with different character and personalities also posed a problem at first as everyone wasn’t used to it.

   One of the more interesting aspects of this year’s MUM was that they started accepting shorter candidates into the competition. It might seem as an improvement to an industry that only accepts individuals of 170cm and above but even so, shorter participants are at a disadvantage as most designer clothes are made to fit those who are taller and thus it can be difficult for them to fit into it and make the clothes look good even with heels on. But what is most important when faced with this problem is to maintain your confidence and to try your best as quoted from finalist Trisha Kuck, “I accept being short as my shortcoming; I regret that I cannot improve it but I carry the confidence that I represent the majority of Malaysian woman with an average height of 153.3cm.”

8TV is airing the 5-episode reality show, The Next Miss Universe Malaysia 2013 every Sunday, 10.30pm. 

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NBA's First Victory!

By Tay Jia Chyi

It was a drizzly evening when the group in red arrived at ISV. Their jerseys have the word "BROTHERS" printed on them. They were the opposing team, members of the basketball team from Renaissance College, Johor Bahru.

The date of the friendly match was set to be on 12th of November, 2012 at the ISV basketball court but due to the "flooding" of the court, we had to change the venue to the basketball court just opposite of the NUMed campus. Eight Stage 1 members of the NUMed Basketball Association (NBA) were present to meet the equal number of challengers.

The match started at around 8.30pm and ended at 9.30pm. Our team was led by Captain Gregory Low who is also the president of NBA. It was a tough 5 vs 5 match but we emerged victorious. The score was 42 - 22. We were overjoyed with our first triumph as it is a promising sign that we may one day compete with other varsities all over Malaysia representing NUMed. Although we were ecstatic, we still promised ourselves to strive even harder so that we may make NUMed well known not only for its medical studies but also for its basketball team. We also sincerely hope that this win will allow us to receive unwavering support from the big family of NUMedians so that we can play even better for you in the future! NUMed Nukes!

President/Captain: Gregory Low Jia Hao

Vice president/Vice Captain: Syamlan Ali

Secretary/Social secretary: Tay Jia Chyi

Treasurer: Anwar Kamal Shaikh

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Coming on with A BIG BANG

By Paik Hwa

Newcastle University Medicine Malaysia (NUMed) in its fourth year of running, finally has its own Student Council. The very first Student Council is formed by members of The Big Bang team who won the election on the 31st of October after two weeks of campaigning alongside another equally competitive team, Nerves.

Teh Jin Zhe (Stage 2), now President of the Student Council stated:

   “The team is really happy the student body has chosen us. This will be a great learning opportunity for us to run the Student Council, and we are more than pleased to be able to serve both the university and students!

  

   “The Council aims to serve as a bridge between NUMed and the student body. As representative of the students, we wish to enhance NUMed’s student experience which has been lacking in the past few years through organising various activities, events and services. 

   “All the newly formed student societies would also be able to get funding after consultation with the Council.”

   As promised in their manifesto during their campaign, the Student Council has officially introduced to the students two of their new services via the university’s email. They are the monthly Book Ordering Service and the Nightline Programme. 

   The Education Representative will be responsible in regulating the Book Ordering Service where students are required to email Mr.Ng Zee Yong their purchases along with their details. The deadline of the service is at 12noon on the 28th of every month and the books will be delivered to the campus approximately 7 days after order has been made.

   The Nightline Programme serves as a student support service where students can talk to an anonymous Nightliner who would listen to their problems (examination stress, relationship issue, homesickness and so on), and they promised to be good listeners. This service is non-advisory, non-judgmental, non-directive and will maintain the customer’s confidentiality and anonymity.

  “The Student Council will be organising a Christmas Ball in the coming December for NUMed students. This should happen after Stage 3 and 4 students have finished their examinations.” Trisha Kuck, the Social Representative added.

   The Student Council is also in the process of setting up a website and creating official university emails for themselves. Meanwhile, they will be utilising the NUMed Students Group on the social network site, Facebook for relevant announcements or to receive feedbacks from the student body.

The new Student Council has since finalised their board of members:

• President: Teh Jin Zhe (Stage 2)

• Vice President: Soo Xi Ying (Stage 2)

• Secretary: Eng Sze Lynn (Stage 2)

• Treasurer: Gan Chia Ee (Stage 2)

• Stage 4 Representative: Ho Ka Liang (Stage 4)

• Stage 3 Representative: Tan Yeong Chinn (Stage 3)

• Education Representative: Ng Zee Yong (Stage 2)

• Social Representative: Trisha Kuck Siew Boon (Stage 2)

• Sports Representative: Muhammad Shakir bin Mazalan (Stage 2)

• Welfare Officer: Adiel Haqiq bin Hussein (Stage 2)

• Designing Officer: Andrea Lim Pei Wern (Stage 2)

• IT Officer: Vun Jun Kent (Stage 2)

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The Sin of Gastronomic Indulgence

By Azilleo Kristo Mozihim

Fatty foods. From: The Food Advice Centre

           In our modernised society, it seems that food is everywhere and is available anytime. People nowadays have the huge tendency to overeat and, with the advancement of technology, decrease the frequency of physical activities. This is the reality of the modern world and there is no doubt it has contributed to the occurrence many human illnesses.

   On the 23rd of October 2012 at Jordan Lecture Theatre, Professor Alastair Burt, a pathologist from Newcastle University in the UK presented a lecture entitled ‘Fatty Liver Disease: The Pathology of Gluttony’.

   He starts off the lecture by describing the spectrum of alcoholic diseases which includes, in increasing order of severity, steatosis, steatohepatitis, ciirhosis and heptacellular carcinoma. 

   One of the most common liver disease is alcohol-induced steatosis or alcohol-induced fatty liver disease. He then goes on to explain about the pathogenesis or the mechanism of steatosis in alcohol-induced liver disease (ALD). It basically involves the increase of the NADH to NAD ratio which represents the reductive potential of the cell which leads to the increase in fatty acid synthesis. 

   After that he explains the consequence of alcohol metabolism on the liver cells which includes oxidative stress and mitochondrial dysfunction. He also describes the usage of animal models such as guinea pigs and primate to study ALD but none of them fully mimic the spectrum of human ALD. 

  From his lecture, it seems that there is a positive relationship between BMI (Body Mass Index) and the occurrence of steatosis and non-alcohol induced steatohepatitis (NASH). He continues on by describing  paediatric fatty liver disease. 

   He then describes the ALIOS (American Lifestyle-Induced Obesity Syndrome) model. In this model, the diet mainly consist of fat and partially hydrogenated vegetable oil. Imaging for the assessment of fatty liver disease was also presented. Ultrasound, ultrasound with microbubbles and transient elastography are the few out of many ways to assess fatty liver disease. 

   The other way of assessment is a scoring system based on the biopsy of the patient’s liver. According to him, the scoring is quite unreliable and inaccurate. 

  He ends his lecture by emphasising on the risk factor of ALD and its link with obesity.

From his lecture, it is quite obvious that fatty liver disease is on the rise and it mainly is due to the increase in the occurrence of obesity. Hence, it pays to give attention to our diet. Eat less fatty food such as fried chicken and consume more leafy vegetables. Exercising regularly is important in improving our overall health and losing weight. 

       Do not let the sin of gluttony dominate and make you regret of not resisting from taking a bite of that supersized Mcdonald’s hamburger.

Exercise and eating healthy foods. From:Howstuffworks and Children’s Healthy Food

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Touching Hearts

By Sabyasachi Chowdhury

“Volunteering has been my passion. Being able to contribute and seeing how those you have helped improving and getting better simply brings immense satisfaction. I believe many people share this very idea, if not, at least the 50 people who joined VOLTAGE (Volunteer To Aspire Generations) do.” 

  This is what Soo Xi Ying, President of VOLTAGE had to say when asked about the VOLTAGE Project Guide.

Residing in a Calvary home, without the guidance of their parents, the children are less fortunate than most of us, to have to grow up in such an environment.

 Project Guide aims to get to know the children staying in a welfare home and guide them in their academic and personal development.

   Lack of guidance and opportunities, most of the children are not having enough help with their studies. This is what motivated Xi Ying and the rest of VOLTAGE to organise Project Guide. Xi Ying says “education is vital to provide the children with a brighter future. 

  Project Guide aims to kindle the children’s interest and confidence to learn. This can be achieved through a good 1 to 1 volunteer-kid ratio, teaching and guiding the children using books, stories, games and crafts.” 

   But that is assuming the kids are comfortable with the volunteers and are ready to accept their help. That is why, the first few visits were made to let the kids know their future “guides”.  

  On 3rd November 2012, 27 volunteers had their first visit to the home; that Saturday started early for the volunteers. 

 By 9.00 am, VOLTAGE arrived at the Calvary home, a three storey complex with the second floor being the living rooms/ dormitories for the children, whilst the 3rd floor was the common area. 

  Some of the volunteers were pleased when they saw the children, but for some like Yi Yan Fen, a Stage 1 student, it made them thought about how they should  deal with these kids, since they have no experience of taking care of children.  

   But soon, the tension dispersed as an Ice-breaking session started. The various ice breaker games were VOLTAGE’s idea of successfully building a rapport between the volunteers (teachers) and the children.  

   At 11.00am, the kids were asked to sit down with the volunteers and design their Progress Books. Its purpose is to record the kids’ performance with a mini scrap-book in the first page to let the teachers know about the kids. 

   The session ended at about late noon with another session of games. This time, the children were awarded if they successfully identified the name of a volunteer. Chong Yan Mei, a 1st year, mentioned her “child” Stephanie won the prize and she felt happy for her.

   At the end of the day, at around 12 noon, it was time for the volunteers to leave. The children were reluctant to see the volunteers leave so soon. The children can only look forward to their next visit.

Soo Xi Ying commented, “With more helping hands, the impact attained is certainly wider. Together, we are making a difference, volunteering to aspire coming generations (the children). Keep a count on how many hearts have you touched."

 Project Guide comprises of weekly visits to the home (every Saturday), 9am to 12pm. Feel free to join VOLTAGE and to have fun with helping the children.

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Medical Text References

By Sze Lynn

“Worried and unsettled, your eyes scanned through the racks. Each book with a different title constitutes a dilemma within the mind – Which of these do I need?”

However, fear not. It’s time to get those questions answered.

Books Suitable For All Stages – Recommended by Dr. Sabih

Clinical Anatomy: Applied anatomy for students and junior doctors

Written by: Harold Ellis, Vishy Mahadevan

It provides a short overview of anatomy, definitely a place to start for the first years. Are you in need of a memory trigger? The third and fourth years would find this particular book great and handy for revision. One of the best parts about the book is that it caters not just all the way to stage 5 but also through your years of a junior doctor, providing essential anatomical information within a clinical setting.

“Provides you with a detailed, easy-to-follow structured text suitable for anatomy students and trainees of all levels with; Illustrations, new images of normal anatomy (Radiographs, CTs and NMRs) to aid understand, a revised neuroanatomy section to provide greater clarity and an expansion of the lower limb section.” – Amazon

Medical Pharmacology At A Glance

Written by: Michael J. Neal

Amazing book. It is thin, concise, and very much easy to understand. The subheadings of each paragraph provides the reader a very idea as to what the text is going to be about next. Key words have been bolded within the text and diagrams and short notes are given as to how the each mechanism operates. In the midst of all the pharmacology, a tinge of physiology has been added to the mix. It is a must-have, a visual learners would be most appreciative towards the book. 

“Key principles are supported by coloured schematic diagrams; Introduces principles with chapters based on disease and syndromes, for clinically-focused learning, including references to the pathophysiology of disease to aid understanding of drug choice and action.” – Amazon.

Tuesdays With Morrie

By Mitch Albom

Based on a true story, a reunion between a lecturer and a student. Their rekindled relationship has led them to one final thesis – Life’s greatest lesson. Perhaps it is in which the way it is written, different individuals would perceive and receive the “message” differently.

With each page you flip, deep thoughts tend to settle as to how one dealt with a degenerating neuromotor dysfunction. The book writes the chronological order in which you witness the progression of a disease, the struggles of an old man, and how he coped with it.

At the other end of the spectrum, is Mitch, a young man who burrowed his way through the society. Molded into something in constant pursuit of more, yet never happy. Through witnessing death, sparked a change in his life.

The book imparts themes of acceptance, communication, love, values, openness, and happiness. It would be a good resource as part of your medical career.

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Stage 1 Hospital Visit

Stage 1 Hospital Visit 

By: Sonia Susiman

On the 24^th of October 2012, the Stage 1 students made their first visit to Hospital Sultan Ismail. There was a lot of excitement in the air as this was a chance to communicate with the patients and the feeling of walking into the hospital as a medical student for first time was even more exciting and encouraging. The main purpose of the visit was to introduce Stage 1 students to the hospital and the ward environment as well as interviewing patients on the ward as assigned to each group. Furthermore, it was a requirement to be able to describe a patient’s experience which includes their illness and experience of being in hospital. Another essential learning outcome was to apply communication skills knowledge in the real atmosphere.

All students gathered at Medical Student Office (MSO) at around 7.45am, the stage 3 seniors recorded attendance and groups got into their respective buses. Leaving NUMed at 8am allowed the buses to arrive at our destination, Hospital Sultan Ismail (HSI) at around 9am. Upon arriving, all NUMed students were given each a tag which was stated “pelatih” which means trainee and every Stage 1 student assembled in the auditorium of HSI. At around 9.45 am, the stage 3 students were assigned to identify suitable patient on respective wards. The orientation was done by the HSI management. At 10.15, the staff nurse assigned to each group took all the groups around the hospital. Then at 10.30, all students were allowed to start a 1 hour interview with a patient. In total, all the students were divided into groups which were assigned to different wards as follows:

Group 1: Paediatrics, involving children with many medical complications.

Group 2 and Group 6: Medical, involving patients with general medical complication without surgeries.

Group 3: Surgical, involving with patients who have undergone operations.

Group 4: Orthopaedics, involving the human musculoskeletal system.

Group 5: Obstetrics and Gynaecology, involving maternity and babies.

At 11.30am, a feedback session was scheduled in the respective wards. The Stage 1 students managed to share their first-time experience while the Stage 3 students reciprocated with feedback on how to improve communication skills with patients and other health care professionals. There was also one academic staff assigned to each group to give general feedback based on their observations. 12.30pm was the scheduled departure by bus back to NUMed. On the whole, Stage 1 students learned a lot on how to improve communication skills and the right ways in which to interact with our patients. As an overall view, all students were satisfied and benefited from the trip.

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Eid Weekend Experiences

By Teo Shanan

Eid al-Adha, more commonly referred to as Hari Raya Haji in Malaysia, is an auspicious religious occasion honouring the Prophet Abraham’s devotion to God. The start of this holy feast of sacrifice is marked by the end of the hajj pilgrimage. Eid al-Adha began in the evening of Thursday, 25 October 2012, and ended in the evening of Friday, 26 October 2012. Many muslim NUMed students celebrated this festival at home, and here we draw up on the experiences of both those who did and others who were stuck in their second home – the ISV. 

   One muslim student who observed the occasion related the experience of his weekend as follows:

   “I went home on Thursday afternoon as Friday was a public holiday. When I reached home, I was really happy and excited. This was the first time I’d been home since university started. The next morning, we went to perform prayers in the neighbourhood mosque, and we sacrificed a cow. After that, we had a family feast, as we had invited our relatives and neighbours over to enjoy delicious home-cooked traditional Malay fare prepared by my mother and my grandmother. “

   However, there were also others who were not so lucky. An international student tells of his experience staying in for the long weekend – “My weekend was quite unexciting...To be honest, I didn’t really expect much, as most of my friends were going back home for the long break, but being an international student, I did not know life was going to get more difficult – on Hari Raya Haji day, THERE WAS NO FOOD!!!! I slept in, and by the time I woke up at 2pm, I was hungry and dragged myself down to the ISV cafeteria, to find it closed. Needless to say, my   next three or four meals were instant noodles from the sundry shop and I waited to carpool with my friends who had cars. I don’t ever want to repeat this experience again.”

   A third student approached by our TNT team describes her relaxing weekend at home in the city: I spent the Hari Raya Haji weekend at home. We don’t celebrate this occasion, so I went shopping and spent quite a lot at the newly-opened H&M store in Kuala Lumpur. I did initially plan to go to Kamal Bookstore to stock up on some books for the coming exams but when I got home I realized I’d left my shopping list in my ISV room...and it was just as well, as Kamal was closed for Hari Raya Haji!

   All in all, the dawn of the long break was a very welcome seeing as the first month in NUMed was a time of drastic and demanding change for most, if not all, students. However, the experiences drawn up over this weekend leave something to take away, and that is of course, that we can only attempt to adapt to new environments, a seemingly insane amount of work, as well as the pressure of being far away from home. It would surely do us some grace to deal with what lies ahead in the following weeks, months and years of medical school.                                                 

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Unravelling the mysteries of unpleasant scrapping sounds

Unravelling the mysteries of unpleasant scrapping sounds.

A team of researchers led by Professor Tim Griffiths from Newcastle University have found out that higher activation in the brain regions which processed emotion and sound, and the correlation between these two are the main reason why the sound of knife on the bottle or nails on the blackboard are so unpleasant.

In their recent study published in the Journal of Neuroscience October 2012, the scientists at Institute of Neuroscience, Newcastle and Wellcome Trust Centre, London explained the model of interaction between the auditory cortex, the part of the brain that processes sound, and the amygdala which processes negative emotions. 

When we hear a nasty noise, the sound is first processed to a high level in the auditory cortex. The information is then relayed to the amygdala where not only it determines the acoustic features of the stimulus, it will also decide how unpleasant the noise is. If the unpleasantness of the sound is perceived as higher, the amygdala will then return the information to the auditory cortex causing a heightened activity in the auditory cortex in response to this sound compared to a less unpleasant sound.

A total of sixteen volunteers participated in the study where functional magnetic resonance imaging (fMRI) was used to examine their brain activity in response to unpleasant sounds played in the MRI scanner. The choices of sounds were based on the scientists’ previous work in 2008 in which 50 volunteers were recruited to rank a set of 74 sounds according to their unpleasantness. These included the most unpleasant knife on a bottle, chalk scratched on blackboard, and bubbling water which was deemed least unpleasant.

The MRI data collected was then analysed and a connectivity analysis was conducted to determine the interactions between different brain regions, how a brain area may respond to a change in activity another area. For the purpose of this research, four brain regions were specifically studied which were the right and left auditory cortex and right and left amygdala.

Image 1: MRI image showing the response in amygdala which correlates with acoustic features and rating of unpleasantness. The red areas indicate where the acoustic features are processed while blue areas indicate the valence (or degree of unpleasantness). 

 The study found that sounds in the frequency range of 2000 to 5000 Hz were found to be unpleasant. Based on the relationship models tested in this research, it was also found that the brain parts did not work independently from one another, but in a very integrated manner. Stimulus received by the auditory cortex was processed and forwarded to the amygdala. A backward connection from amygdala to the auditory cortex subsequently takes place in accordance to the interpretation of the amygdala of the characteristic of the stimulus.

 Although the study is rather limited in the sense that there is very small sample size, such findings is significant to pave our ways to a better understanding of certain medical conditions in which there is lack of tolerance to sound. This includes hyperacusis (decreased sound tolerance), misophonia (“hatred” of sound) and phonophobia (fear of sound).

"This work sheds new light on the interaction of the amygdala and the auditory cortex. This might be a new inroad into emotional disorders and disorders like tinnitus and migraine in which there seems to be heightened perception of the unpleasant aspects of sounds," says Professor Tom Griffiths in a press release in last October.

Future studies are necessary to gain more understanding regarding the subject and to investigate further on the effect of different sounds, both pleasant and unpleasant and to answer whether similar pathway plays the role in processing nice sounds compared to these nasty scraping noises that makes us grind our teeth.

(This article is adapted from The Institute of Neuroscience press release, Nasty noises: Why do we recoil at unpleasant sounds?, published on 10^th October 2012, accessible at http://www.ncl.ac.uk/ion/news/news/item/nasty-noises-why-do-we-recoil-at-unpleasant-sounds-copy)

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Interview with Stage 1 students on the Progress 1 Examination

By Devina Siaw

The transition to university is undoubtedly a daunting experience, where one has to assimilate themselves into peer groups to avoid social isolation, achieve independence in terms of managing education and funds, and most importantly be able to feed oneself and wash one’s clothes without turning their labcoat pink (something I have yet to achieve).   

   Besides all this, the first year students of NUMed are also subjected to the Progress 1 examinations after barely a month into the course. Below are some thoughts and experiences of four members (Bob*, Sue*, Tom* and Will*) of Stage 1 on the exam and coming to NUMed.

How are you finding coming into Stage 1 of medicine and living here in general?

Bob: Living alone is fun! I like to be alone in general, so coming here to study was quite interesting and exciting for me. Medicine is general is quite demanding, and it requires us to study continuously, which the only part I don't like about uni.

Sue: It’s quite exciting. I mean, when I first started I was definitely more excited than now, but there’s so much to look forward to even now. 

   About living here, it’s very hard for me. Firstly, the whole being independent and living away from home thing is pretty new to me. 

  Other than that, I’m not very used to the living conditions here at ISV. Being a vegetarian, it makes it even harder to adjust but I am adjusting slowly. I’m sure it’ll take a while but I’ll start to learn how to live here better.

Will: Stage 1 is good so far, I think NuMed is great and the teaching is good. Life here is ok, but there is not much to do if you don’t have a car.

How did you prepare for the stage one exams? 

Bob: I did make some notes for MTD, extracts from different books and the lecture notes. I also read an embryology book. To be entirely honest, I didn't study much aside from that. I would definitely study for the next exam. 

Tom: I usually prepare for the beginning. I read lecture notes and I read additional materials.

Sue: Well, I just basically went through my notes. I didn’t really start studying till the  last few days but all in all I think I managed to cover a lot before the paper.

Will: Just went through the lecture notes. Didn’t do much reading, although I think I should have. 

How did you find the stage one exams and did you feel sufficiently prepared for it?

Bob: I was not prepared for it, so it was just like jumping into a big ocean without knowing how to swim, or what to expect. I should've done more. But oh well, what is done is done. I know that we all can do better. 

Tom: I found it moderately difficult. I felt that I was ill-prepared.

Sue: It was definitely a new experience. During the exam, I felt like I didn’t know anything at all and I kept second-guessing myself. The structure of the questions was very different from what I’m used to and it was quite a challenging paper. 

   With the vast ocean of information we need to know to pass the exams, it can be difficult to even know where to start. After every exam, it’s almost certain that most of us will express regret over not revising more.

    Hopefully all the Stage 1 students achieved the results they were aiming for and many thanks to the four who graciously gave their time to answer these questions. 

*Names have been changed in the interest of privacy

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