Conservative Spine Surgery: The True Minimally Invasive Spine Surgery

Inaugural Lecture

Conservative Spine Surgery: The True Minimally Invasive Spine Surgery

Professor Dr. Dharmendra Ganesan

In his inaugural lecture entitled Conservative Spine Surgery – The True “Minimally Invasive” Spine Surgery delivered on 3 September 2020, Prof. Dr. Dharmendra Ganesan shared his experience as a neurosurgeon. A synopsis of this talk is as below: 

“Conservative spine surgery” is a concept or perhaps a philosophy that I coined after 12 years of practicing as a consultant neurosurgeon with a subspecialized interest in spinal neurosurgery. UM deals with a plethora of patients with spinal conditions, where degenerative spinal disorder (DSD) is the one most commonly diagnosed.

In managing DSD, it is imperative to understand that the symptom of pain could emanate from various anatomical structures from the spine and its surrounding structures. It is also important to appreciate the natural history of these conditions as it is equally important, to be cognizant of the immediate, short and long-term risk and benefits related to the treatment, as well as the short and long-term effects of the intervention on the inherent spine adjacent to the treatment area, which undergoes wear and tear as we age. By reflecting on the management of these cohorts of patients, I would like to discuss the importance of clinico-radiological features in identifying a clinically relevant, surgical pathology when strategizing treatment. Thence, determining the appropriate choice of “minimally invasive” surgical management, in treating that one, individual patient with the background belief that “less is more” in spine surgery.

In the quest of moving with the times, we have to embrace new technology and treatment modalities, however the onus is on us surgeons to do the critical appraisal prior to practicing it and this is an area I wish to expound on. In addition to that, I will also highlight the conundrums in the application of evidence-based surgical treatment in a patient-centred management.

A full video of Prof. Dr. Dharmendra’s  inaugural lecture is available at: https://www.youtube.com/watch?v=byzvkTy-9xk


Knowlesi Malaria

Inaugural Lecture

Knowlesi Malaria

Professor Dr. Lau Yee Ling

Since 2009, Prof Lau has established a research team working in medical parasitology. In her inaugural lecture, she shared with us her journey in research associated with the fifth human malaria parasite, Plasmodium knowlesi, which originated from macaque. Although history of P. knowlesi infection in humans is relatively short, its zoonotic nature hinders malaria elimination efforts. To grasp the current perspective of knowlesi malaria, her talk explored different aspects of the disease, including risk factors, diagnosis, treatment, molecular and functional studies.

Like other Plasmodium species, P. knowlesi parasite is transmitted through the bite of female Anopheles mosquitoes, which eventually propagates in humans to cause severe parasitemia. The infection has been an area of interest over the past few years, given its medical importance. The increased incidence was suggested being associated with deforestation and agricultural activities that resulted in the shifts of human settlement and changes in the macaque and mosquito habitat. Besides, the infection is deadly due to the relatively short asexual cycle of P. knowlesi (24-h), where the infection can progress rapidly and cause death. Thus, early diagnosis and prompt treatment are very much needed. 

With the support of research grants, she ventured into malaria diagnostics, given current limitations in differentiating various Plasmodium species, which is important for the choice of treatment. She and her team successfully developed and patented a sensitive, specific, rapid, and easy-to-use molecular diagnostics – loop-mediated isothermal amplification (LAMP), applicable for bedside use. She mentioned that the diagnosis of all five human malaria species remains challenging, and an ideal molecular point-of-care diagnosis is in urgent need. Today, malaria has been managed cautiously, mainly due to drug resistance in treatment. Although the current state of P. knowlesi treatment shows no resistance towards antimalarials, she reiterated that the research on new therapeutic candidates should not be halted as multiple antimalarials resistant Plasmodium sp. strains are emerging in Southeast Asia countries. In line with the effort to combat the challenges, she and her team has also successfully established a model culture of P. knowlesi using human erythrocytes. The breakthrough allows P. knowlesi studies to be conducted in vitro, useful for validation vaccine and drug targets. Additionally, various molecular studies have also been carried out in identifying genetic polymorphisms and molecular markers in P. knowlesi to provide a deeper understanding of its pathophysiology. 

At the end of her talk, she highlighted that malaria control and elimination are greatly impeded by the uncontrollable passage of P. knowlesi in macaque populations, which could lead to human malaria outbreak via zoonotic transmission. It is hoped that the current knowledge on P. knowlesi along with the availability of effective vaccines can better prevent, control, and eliminate the parasites.

Video: https://www.youtube.com/watch?v=X06frgJiVKM&feature=youtu.be


Seeking the Hidden Heart

Inaugural Lecture

Training The Modern Surgeon:
Lesson Learnt From Professional Athletics

Professor Dato’ Dr Yang Faridah Abdul Aziz

The Inaugural Lecture is an avenue for professors to share their knowledge and thoughts in their respective fields of expertise with their colleagues, students and the public. It also marks the culmination of the lifework and milestones of a lecturer’s journey in academia.  On the 13th of November 2020, the Faculty of Medicine conducted the first full online delivery of an inaugural lecture by Professor Dato’ Dr. Yang Faridah Abdul Aziz, titled ‘Seeking the Hidden Heart. The change in the style of conduct of this ceremonious event was due to the Covid-19 pandemic and the rising number of cases within the Klang Valley. While a less exuberant affair, the pomp and circumstance of the inaugural lecture was maintained with strict standard operating procedures.

The lecture was hosted by Professor Dr. Anushya Vijayananthan and chaired by Professor Dato’ Dr Adeeba Kamarulzaman, the Dean of the Faculty of Medicine. Yang Faridah delivered her lecture in three chapters: First, as a clinical specialist, with a niche in cardiac imaging. Second, as an administrator, balancing and managing expectations of the university as well as the heart of any organisation, its human resource. Third and lastly, as an academic, aiding in strategising and improving the learning experiences of students with the hope to produce future doctors that are in touch with their hearts. She ended the lecture by urging everyone to seek the hidden hearts in their lives, wherever they may be.

An event like this could not have been possible without the hard work and dedication of the people behind the scene. Acknowledgements and gratitude were extended to the staff at the Office of the Dean and the Visibility Unit of the Faculty of Medicine. The online lecture is available on YouTube with the link: https://www.youtube.com/watch?v=0FZoeH1IyDk&t=126s


Training The Modern Surgeon: Lesson Learnt From Professional Athletics

Inaugural Lecture

Training The Modern Surgeon:
Lesson Learnt From Professional Athletics

Professor Dr. April Camilla Roslani

On 14th July 2020, Prof. Dr. April Camilla Roslani delivered an inaugural lecture entitled, “Training the Modern Surgeon: Lessons learnt from Professional Athletics.”  A synopsis of this lecture is as follows:

Surgery is a craft specialty, an art with scientific underpinnings. From the earliest examples in Ancient Egypt, to barber surgeons performing crude operations bereft of anaesthesia, to present day highly complex procedures utilizing state-of-the-art technologies, the technical aspects have evolved tremendously. However, the ideal surgeon must master more than technical skills. The profession, patients and society now demand perfection – and training programmes must now include professional behaviours – leadership, communication, teamwork, situational awareness – while still emphasizing value-based practices. The ability to understand the evidence-base, contextualize it to local culture, healthcare settings and individual needs, needs to be honed with care, and often requires many years of rigorous training.

Challenges abound. Although Malaysia aspires to developed nation status, the surgeon to population ratio is woefully low, particularly in the public sector, where most trainers reside. Socioeconomic disparities further drive brain drain. Sub-optimal trainer-trainee ratios, training opportunities, increasingly technical and high-risk surgeries, lack of resources and rising medicolegal challenges, accentuated by the recent pandemic, mean that trainers must adopt novel strategies to ensure surgical standards are not compromised. The physical and mental health of trainees and surgeons has also gained prominence as factors affecting patient outcomes. This lecture will address how the surgical profession has risen to these challenges, adapting strategies from the spheres of professional athletics, aviation and the military. 

A full video of Prof. Dr. April’s inaugural lecture is available at: https://www.youtube.com/watch?v=iaSlbTjCZiM