Critical to improve health literacy

People must learn to modify diets to prevent lifestyle diseases such as diabetes

Image Credit: Created with the assistance of DALL·E 3

 

PRIME Minister Datuk Seri Anwar Ibrahim’s reminder to the people to take health knowledge seriously is timely.

At the launch of the 2024 National Wellness Month celebration last weekend, he reminded people to understand the dangers of excessive sugar consumption, saying that campaigns on health literacy or sugar reduction, as well as health literacy policies, would only be effective if people began changing their eating habits now.

For a start, let’s recall what we ate and drank in the past 24 hours, just to have a perspective of our sugar consumption.

From roti canai to teh tarik and the myriad of kuih, these foods all contain sugar.

When people say that they have cut sugar from their diets, I wonder if they realise that their bodies convert the carbohydrates they consume into sugar.

Staples like rice, bread, noodles and fruits are also high in carbohydrates, so maybe we need to take a good look at our food portions too.

Not long ago, the Health Ministry introduced the Malaysian Healthy Plate campaign with the hashtag #sukusukuseparuh

My friends were talking about it and I thought it was a clever way of introducing the concept of meal portions to the public.

The campaign encourages the public to limit their carbohydrate intake to fit a quarter segment of the plate. Another quarter of the plate should be filled with protein and the remaining half, with fruits and vegetables.

Now the key is making this meal formula part of our lifestyle.

Growing up, I watched my paternal grandmother suffering from diabetes.

She had her first stroke a day before I turned one. She must have been about 53 years old then.

However, I remember my paternal grandmother having a healthy diet. She took me along for her evening walks, took her medications on time and never skipped doctor’s appointments.

Over time, she became bedridden, before she passed away at the age of 70 in 1994.

She was an attractive woman in her youth but everything went downhill when she became sick.

After the stroke, her mobility was limited, preventing her from maintaining her active lifestyle.

My maternal grandmother also suffered from diabetes and her mobility, too, was limited after a stroke.

She had never cared about her diet and was a teh tarik addict. There was always an unlimited supply of condensed milk from my grandfather’s grocery store.

I dare say her enjoyment of this popular drink and her eventual poor physical mobility contributed to her eventual death.

As a child, I watched my grandmothers become weak, lose their speech and become bedridden before their deaths.

They were both diabetics and would have had poor health literacy in their younger days.

Thankfully, both my parents are healthy and my dad just turned 80. I believe this can be attributed to their balanced diets.

I’m also conscious of my own family’s consumption and manage this through my cooking.

Besides food, physical exercise is also necessary. It is no longer an option to say that we have no time to exercise.

A walk in the park may be possible depending on the weather.

However, I believe it is time that more public gyms are created. These gyms could be open from morning to midnight and made accessible to the public for a minimal fee.

The Bangsar Sports Complex at in Bangsar, Kuala Lumpur, has a public gym and it is managed by Kuala Lumpur City Hall. The entrance fee is just RM2.

I hope local councils, especially the ones with city status, will create public gyms with cardio and weight-training equipment.

Cardio activities such as Zumba could also be held at public spaces and should be promoted to the community.

More community-based sports for children, such as football and netball, should also be spearheaded by elected representatives.

Prevention of non-communicable diseases such as diabetes, hypertension and high cholesterol will reduce taxpayers’ funding of the nation’s healthcare services.

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Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood glucose.

Diabetes and insulin

Summary

Read the full fact sheet

• People with type 1 diabetes must inject insulin every day, often up to 4 or 5 times per day.
• There are different ways to inject insulin ranging from a syringe and needle, to an insulin delivery pen, to an insulin pump.
• Your doctor or diabetes nurse educator will teach you about how, where and when to inject insulin, and how to store it safely.
• Even with the help of your doctor and diabetes nurse educator, it may take a while to find the right insulin dose to reduce your blood glucose to your target levels.
• What is Type 2 Diabetes?

Type 2 diabetes is a common metabolic condition that develops when the body fails to produce enough insulin or when insulin fails to work properly, which is referred to as insulin resistance. Insulin is the hormone that stimulates cells to uptake glucose from the blood to use for energy.

Image Credit: Created with the assistance of DALL·E 3

When this is the case, cells are not instructed by insulin to take up glucose from the blood, meaning the blood sugar level rises (hyperglycemia).

Prevalence and Risk Factors

People usually develop type 2 diabetes after the age of 40 years. However, people of South Asian origin are at an increased risk of the condition and may develop diabetes from age 25 onwards. The condition is also becoming increasingly common among children and adolescents across all populations. Type 2 diabetes often develops due to overweight, obesity, and lack of physical activity, and diabetes prevalence is on the rise worldwide as these problems become more widespread.

Heterogeneity and Genetic Factors

Type 2 diabetes is a heterogeneous disorder characterized by varying degrees of beta cell dysfunction in concert with insulin resistance. The strong association between obesity and type 2 diabetes involves pathways regulated by the central nervous system governing food intake and energy expenditure, integrating inputs from peripheral organs and the environment. Genetic susceptibility and environmental factors, including the availability of nutritious food and other social determinants of health, play significant roles in the development of diabetes and its complications.

Global Impact In 2021, the global prevalence of diabetes mellitus was estimated to be 6.1%, representing 529 million people, with prevalence estimates in certain regions as high as 12.3%. Type 2 diabetes accounts for 96% of cases, and greater than 50% of type 2 diabetes is attributable to obesity. The trajectory of the diabetes pandemic is concerning, with an estimated 1.31 billion individuals projected to have diabetes by 2050.

Types of Diabetes

Also known as juvenile diabetes, type 1 diabetes usually occurs in childhood or adolescence. In type 1 diabetes, the body fails to produce insulin, so patients have to be given the hormone. This is why the condition is also known as insulin-dependent diabetes mellitus (IDDM).

Type 2 diabetes mellitus is also called non-insulin-dependent diabetes mellitus (NIDDM) since it can be treated with lifestyle changes and types of medication other than insulin therapy. Type 2 diabetes is significantly more common than type 1 diabetes.

Symptoms of Type 2 Diabetes

The increased blood glucose level seen in diabetes can eventually damage a person’s blood vessels, nerves, and organs. The body attempts to remove the excess glucose through urination, and the most common symptoms of type 2 diabetes include the following:

• Polydipsia (increased thirst)
• Polyphagia (increased hunger)
• Polyuria (increased frequency of urination), especially during the night
• Extreme fatigue, weight loss, and sudden loss of muscle bulk.

Some of these symptoms are also seen in type 1 diabetes, but type 2 diabetes symptoms tend to develop more gradually and can take months or years to manifest. This can make it more difficult for people to tell they have an underlying health condition, and often, people have had type 2 diabetes for a long time before it is finally diagnosed.

Risk Factors

Several factors can increase a person’s risk of developing diabetes. Examples include:

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• Overweight or obesity
• Unhealthy diet
• A waist measurement of 31.5 inches or more among women
• A waist measurement of more than 37 inches among men
• Low levels of physical activity
• Raised cholesterol
• High blood pressure
• South Asian ethnicity
• Smoking

A family history of diabetes also increases a person’s risk of developing the condition. Studies have shown that the offspring of families where one parent has diabetes have a 15% increased risk of developing the condition and that offspring born to two parents with diabetes have a 75% increased risk.

Complications of Type 2 Diabetes

The high blood glucose seen in diabetes can damage blood vessels, nerves, and organs, leading to a number of potential complications. Some examples of the complications caused by diabetes include the following:

Cardiovascular Disease

Persistently high blood glucose levels can lead to atherosclerosis, increasing the risk of heart disease and stroke. This includes narrowing and clogging of blood vessels with fatty plaques, which can disrupt blood flow to the heart and brain.

Nervous System Damage

Excess glucose in the blood can damage small blood vessels in the nerves, causing a tingling sensation or pain in the fingers, toes, and limbs. Nerves outside of the central nervous system may also be damaged, a condition known as peripheral neuropathy. If nerves of the gastrointestinal tract are affected, vomiting, constipation, and diarrhea may occur.

Diabetic Retinopathy

Damage to the retina may occur if tiny vessels in this tissue layer become blocked or leak. The light then fails to pass through the retina properly, which can cause vision loss.

Kidney Disease

Blockage and leakage of vessels in the kidneys can affect kidney function. This usually happens due to high blood pressure, and blood pressure management is an integral part of managing type 2 diabetes.

Foot Ulceration

Nerve damage in the feet can mean minor cuts are not felt or treated, leading to a foot ulcer developing. This happens to around 10% of people with diabetes.

Prevention, Treatment, and Care

Blood sugar should be regularly monitored to detect and treat any problems early. Treatment involves lifestyle changes such as eating a healthy and balanced diet and regular physical exercise. If lifestyle changes alone are not enough to regulate the blood glucose level, anti-diabetic medication in the form of tablets or injections may be prescribed. In some cases, people who have had type 2 diabetes for many years are eventually prescribed insulin injections.

Maintaining a healthy blood glucose level, blood pressure, and cholesterol is essential to preventing the complications of type 2 diabetes. Overweight or obese individuals with diabetes often significantly reduce the extent of their symptoms by making adjustments to their lifestyle.

Recent Therapeutic Advances

Maintaining a healthy blood glucose level, blood pressure, and cholesterol is essential to preventing the complications of type 2 diabetes. Recent advances in therapy include the use of GLP-1 receptor agonists, which have shown positive effects beyond glycemic control, such as weight loss and reduced cardiovascular mortality. These therapies represent a new era in diabetes treatment, impacting both metabolic control and cardiorenal complications.

Gut Microbiota and Type 2 Diabetes

The gut microbiota (GM), comprising trillions of microorganisms in the gastrointestinal tract, plays a crucial role in the development of obesity and related metabolic disorders, such as type 2 diabetes. Studies show that GM dysbiosis is linked to increased energy extraction, altered metabolic pathways, and inflammation, contributing to obesity, metabolic syndrome, and type 2 diabetes. The GM influences nutrient absorption, immune regulation, and energy metabolism.

Impact of Diet and Lifestyle

Dietary habits significantly influence GM composition and microbial metabolites that regulate host metabolism. A Western diet, rich in fat and sugar but low in fiber, is associated with GM dysbiosis. Conversely, adherence to a Mediterranean diet increases short-chain fatty acid (SCFA) levels, promoting metabolic health.

Microbial Diversity and Health

The human GM consists of approximately 100 trillion cells, with the highest diversity found in the colon. A diverse GM is rich in number and variety, playing a key role in maintaining metabolic health. Disruptions to GM diversity due to diet or medication can lead to metabolic diseases.

Emerging Therapies Targeting GM

Potential therapies targeting GM include dietary modification, prebiotics, probiotics, and fecal microbiota transplantation (FMT). These interventions aim to restore a healthy GM composition, improving metabolic health and reducing the risk of type 2 diabetes and obesity.

Sources

1. NHS. “What Is Type 2 Diabetes?” NHS, NHS, 18 Aug. 2020, www.nhs.uk/conditions/type-2-diabetes/.
2. National Institute for Health and Care Excellence. (2022, June 29). Overview | Type 2 diabetes in adults: management | Guidance | NICE. Nice.org.uk; NICE. https://www.nice.org.uk/guidance/ng28
3. http://www.diabetes.ca/files/Prediabetes-Fact-Sheet_CPG08.pdf (no longer active)
4. Diabetes UK. “Type 2 Diabetes.” Diabetes UK, Diabetes UK, 18 May 2023, www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes/type-2.
5. “Type 2 Diabetes - Symptoms and Causes.” Mayo Clinic, www.mayoclinic.org/diseases-conditions/type-2-diabetes/home/ovc-20169860.
6. Sasidharan Pillai, S., Gagnon, C. A., Foster, C., & Ashraf, A. P. Exploring the Gut Microbiota: Key Insights into Its Role in Obesity, Metabolic Syndrome, and Type 2 Diabetes. The Journal of Clinical Endocrinology & Metabolism. DOI:10.1210/clinem/dgae499, academic.oup.com/.../7718329?login=false
7. Diabetes mellitus—Progress and opportunities in the evolving epidemic Abel, E. Dale et al. Cell, Volume 187, Issue 15, 3789 - 3820, https://www.cell.com/cell/fulltext/S0092-8674(24)00703-7

Further Reading

• All Type 2 Diabetes Content
• Diabetes Mellitus Type 2 Pathophysiology
• Type 2 Diabetes Symptoms
• Type 2 Diabetes Diagnosis
• Type 2 Diabetes Screening and Prevention

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It’s almost always flu season

Fighting off infection: Patients waiting to see a doctor amid the rise in influenza cases at a clinic in Wangsa Maju. — AZMAN GHANI/The Star

PETALING JAYA: Although there is a sharp drop in reported influenza cases this year, the highly contagious respiratory illness occurs all year round, says the Health Ministry, while reminding the public to take safety measures against it.

From January to July this year, the ministry logged 158 influenza clusters – compared with 255 clusters during the same period last year.

Of the 158 clusters reported this year, 54% were in schools, followed by kindergartens at 20%.

Health Minister Dr Zaliha Mustafa said the total number of cases reported from the 158 clusters was 4,606, whereas in 2022 the cases were three times higher or 12,876 cases from 255 clusters.

“The ministry still monitors influenza outbreaks and clusters that occur, although individual cases are not required to be notified by clinics and hospitals,” she said in an interview.

This is because influenza, or the flu, is not subject to mandatory notifications under the Prevention and Control of Infectious Diseases Act 1988 (Act 342).

Dr Zaliha said influenza tends to occur all year round and has the potential to attack all ages.

While most people recover within a week without requiring medical attention, some may require admission for close monitoring, she said.

Influenza and the common cold are both contagious respiratory illnesses but caused by different viruses, she added.

“The flu is caused by influenza viruses only whereas the common cold can be caused by a number of different viruses, including rhinoviruses and (human) parainfluenza (viruses),” she said.

Dr Zaliha said the best way to avoid infection is to get the influenza vaccine every year.

She also advised those with symptoms to avoid close contact with others and keep a distance to protect other people from getting sick too.

“Stay home when you are sick. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick,” she said.

Flu viruses, she noted, spread mainly by droplets made when people cough, sneeze or talk.

Dr Zaliha said practising good hand hygiene is also important to curb the spread of the flu.

Germs can also be spread when a person touches something that is contaminated with germs and then touches their eyes, nose or mouth, she said.

Other good health habits – such as cleaning and disinfecting frequently touched surfaces at home, work or school, especially when someone is ill – should also be practised, she added.

“Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids and eat nutritious food. Also seek immediate treatment if symptoms worsen,” she said.

Federation of Private Medical Practitioners’ Associations Malaysia president Dr Shanmuganathan TV Ganeson said the flu season peaks in May to July and November to January.“For the first 24 weeks of 2023 in Malaysia, there was 18.45% positivity for influenza of the specimens sent. The figures for Singapore were quite similar at 20%,” he said.

Dr Shanmuganathan said that as there are pockets of spread, the prevalence would vary from area to area and from time to time.

For example, he said that in May, Klang doctors commented on increased influenza A and B cases, but doctors in Kuala Lumpur did not seem to corroborate that increase.

Symptoms of influenza are fever, flu, cough and chest discomfort, sore throat, lethargy, headache and body aches, respiratory distress, and even vomiting and diarrhoea.

Meanwhile, the symptoms of the common cold are sneezing, stuffy nose, runny nose, sore throat, coughing, mucus dripping down your throat (post-nasal drip), watery eyes and fever.

“However, most people with colds do not have fever,” said Dr Shanmuganathan.

The at-risk groups include children below five years old, the elderly above 65 years old, those with chronic conditions like asthma, diabetes, heart disease or chronic bronchitis, persons with poor immunity like HIV, cancer and chemotherapy patients, healthcare workers and caregivers, he added.

Association of Private Hospitals Malaysia president Datuk Dr Kuljit Singh said Covid-19 has taught the world how to curb the spread of upper respiratory infections, and that the same principles could be applied to flu infections.

“The precautions are pretty similar to Covid-19, such as masking up, social distancing and hand washing – as well as isolation for those infected to control the spread,” he said.

Dr Kuljit also said that in July, private hospitals saw a rise in bed occupancy due to many factors, most notably influenza.

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Understanding neurosurgery, Keeping the mind active

Understanding neurosurgery

 

Developments in the neurosurgical field have enabled safer and less intrusive treatments for brain tumours.

WHEN faced with the possibility of brain surgery, the first emotion we would likely experience is instinctual unease. This is a natural reaction as our personalities, thoughts and other aspects that define us are inextricably linked to brain function. The thought of having our identities being permanently altered can be unsettling.

Fortunately, it is a big misconception that neurosurgical intervention causes sudden personality shifts. The reality is that these drastic changes are more often associated with brain tumours. If left untreated, it carries more severe risks and consequences compared to the relatively low risk of surgery.

Moreover, the field of neurosurgery in Malaysia has made significant advancements in both surgical technique and medical technology, further reducing risk associated with neurosurgical procedures, while enabling more precise and effective treatment.

It is important for Malaysians to develop better understanding of brain tumours and available treatments to help them make more informed decisions and protect the health of both themselves and their loved ones.

Who is at risk?

Brain tumours can affect anyone regardless of age or lifestyle and its effects can range from being relatively benign to potentially life-threatening depending on its size, location and development. The cause for primary tumour growths that originate from the brain is still unknown.

It is generally advisable that individuals undergo an MRI scan if they experience clinical symptoms as described in this article, although this can vary depending on the patient’s condition and situation. Patients with cancer are also more likely to develop secondary brain tumours (caused by the spread of cancer cells from other body organs). An oncologist will recommend these patients undergo serial MRI screenings once every three to six months.

Common symptoms

One of the tell-tale signs of a brain tumour is persistent and severe headaches, especially if the headaches get

progressively worse over time. A sudden change in headache intensity and pattern could also be indicative of a brain tumour but not all headaches are indicative of a tumour.

Other symptoms of brain tumours include an unsteady gait, blurred vision and vomiting. Unfortunately, these symptoms can sometimes be overlooked and mistakenly attributed to other comorbidities, causing brain tumours to remain undiagnosed for many years.

Interventional pain specialist, neurosurgery and spine surgery expert at Sunway Medical Centre, Sunway City, Dr Toh Charng Jeng emphasises the subtle nature of brain tumours and the potential difficulties in identifying them.

“It is common for older patients, for example, to miss signs of brain tumours. They generally have their attention slowed down and maybe talk less than before. Some may think this is just a part of dementia.”

“Patients must always consult a neurologist before jumping to conclusions. You shouldn’t assume psychiatric illness until you rule out red-flag conditions like tumours, especially if their symptoms do not present themselves as typical dementia signs, for example, as it would need to be investigated further.”

Given the difficulty of noticing personal behavioural changes in oneself, we must rely on our loved ones to notice unusual or persistent changes in our attitudes and recommend medical consultations.

Advancement in technology

Thanks to many advancements in the field of neurosurgery over the decades, surgical procedures on brains have become exceedingly safe. The integration of image guidance, imaging dyes and microscope enhancements are great examples of assistive technology and play a key role in enabling surgeons to perform surgeries with improved precision and consistency.

Dr Toh says: “Patients must always consult a neurosurgeon before jumping to conclusions.”

Dr Toh adds, “The advancement of technology is to assist neurosurgeons in treatment. Thanks to assistive machinery, a surgeon’s work has become more consistent. For example, technology has enabled neurosurgeons to take advantage of intraoperative neurophysiology monitoring, which allows surgeons to monitor nerves while performing surgery. This helps with avoiding injury to the nerve as the machine can warn us earlier.”

Other techniques and technology include the ultrasonic aspirator that breaks brain tumours into smaller pieces to be extracted even with small craniotomy opening (keyhole neurosurgery) and the awake craniotomy that keeps the patient awake during surgery to give real-time essential feedback which further reduce the risk of surgery.

There is also the gamma knife (GK), a very powerful, precise and least collateral radiosurgery machine used today and developed by neurosurgeon Lars Leksell in 1967 specifically for cranial pathology. Advancements in cancer treatment have improved survival rates in cancer patients with increased incidences of brain metastasis; but with the GK, cancer tumours can be controlled or reduced dramatically, translating to more improved survivals for patients with stage four brain metastasis. It is also useful when surgical risk is too high for a small tumour situated deep in the brain.

Given the individualistic nature of the human brain as well as tumour development, neurosurgical interventions are typically tailor-made for each patient. Patients can rest easy as doctors guide them through all available treatment options and recommended procedures, empowering them to make a decision that is most suited for their condition.

Overall, the notion that brain surgery is dangerous is largely misconstrued as rapid improvement in neurosurgical techniques and technology alongside the dedication of neurosurgeons, surgery risk has been drastically reduced, enabling former brain tumour patients to continue living long and fulfilling lives. 

For more information, call 03-7491 9191 or Whatsapp 012-635 0113.

Dr Toh Charny Jeng

Dr Toh Charng Jeng - Interventional Pain Specialist .

Assoc. Prof. Dr. Toh Charng Jeng - Secretariat of ...

Dr. Toh Charng Jeng；杜长征

Dr. Toh Charng Jeng

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Keeping the mind active

ACCORDING to the World Health Organization (WHO), approximately 70% of the global burden of neurological and neurodevelopmental conditions affects low- and middle-income countries. Neurological conditions are the leading cause of disability and the second leading cause of death in the world with nine million deaths annually. Stroke, migraine, dementia, meningitis and epilepsy are the top five contributors to neurological disabilities globally. With an increasing ageing population, Alzheimer’s and Parkinson’s disease are also becoming more significant.

According to medical director and consultant neurosurgeon Prof Dr Badrisyah Idris at MSU Medical Centre, “The brain is a unique organ with three important functions that affect our lives which are, sensory interpretation and movement control; cognitive, mental and emotional integrity; and behaviour and social execution.”

Brain health is becoming an important concept in healthy living which encompasses the ability of the brain to rewire in life in response to changes in experience and environment. A healthy brain is capable of slowing down cognitive decline and combating any injury or diseases of the brain. There are several things that we can make a habit to maintain our brain health.

Regular physical activity can benefit the brain by optimising the brain’s blood flow and reducing the loss of brain cells during ageing. Those who exercise regularly can enjoy healthy cognitive abilities and have a lower risk of developing dementia. Exercise helps to lower blood pressure reducing cardiovascular risks of getting a stroke. Some studies have found that regular exercise increases the level of a protein that promotes the growth and maintenance of brain cells. Having an active lifestyle such as taking the stairs, engaging in sports or hobbies or having purposeful exercise such as brisk walking or aerobic training can have a positive impact on brain health.

Quality sleep is important for brain healing and the restoration of mental function. Sleep makes our thinking processes sharp and focused with better decision-making. Seven to eight hours of sleep gives the brain adequate time to clear abnormal proteins that accelerate dementia. Several lifestyle measures can be adopted to ensure no alteration in sleep patterns such as increasing time in the sunlight, consistent sleep routines and being aware of the effects of medications.

The brain is only 2% of the body weight yet it consumes 20% of energy requirements. Without the right energy and nutrients, the brain will start losing its function. Food rich with antioxidants (compounds that have a protective effect on the brain), fibre, unsaturated fats (including omega-3 fatty acids), B vitamins and an adequate amount of complex carbohydrates is important to maintain a healthy brain. A diet rich in processed foods, salt and refined sugars can increase inflammation and free radicals in our body that can negatively impact brain health.  

“The brain is a unique organ with three important functions that affect our lives which are, sensory interpretation and movement control; cognitive, mental and emotional integrity; and behaviour and social execution.” -Prof Dr Badrisyah Idris

Cognitive stimulation by learning new skills or knowledge helps the brain to become constantly healthy with the formation of new circuits between brain cells. Challenging the brain increases its cognitive reserve by creating an adequate backup system. With more reserves, the brain can become more resistant to changes that are associated with neurodegenerative diseases. Education and learning enhance the cognitive reserve which makes the brain less susceptible to the effects of age and brainrelated changes.

Depression and anxiety can be detrimental to brain health with their effects on mood and emotion. These conditions lead to slow thinking, memory and concentration difficulties. Social connectivity helps to get rid of depression and anxiety. Socialising helps the brain expand its cognitive reserve. Engaging in conversation trains the brain to increase attention and concentration, and helps social judgement. Therefore, it is important to stay connected with friends and families to maintain healthy brain functions. 

 

MSUMC | Prof. Dr Badrisyah Bin Idris

 

Neurosurgery

Prof. Dr Badrisyah Bin Idris
Consultant Neurosurgeon

Speciality	:	Neurosurgery
Clinic	:	Level 3
Language (s)	:	Bahasa Malaysia, English
MMC Number	:	39433
NSR Number	:	130127

CERTIFICATION AND QUALIFICATION

• MBBChBAO (National University of Ireland Galway, Ireland)
• Associate Fellow Royal College of Surgeons in Ireland (Dublin, Ireland)
• Master in Surgery (Neurosurgery)(USM)
• Commonwealth Executive MBA (WOU)
• CMIA (NIOSH)Fellowship in Neurosurgical Oncology and Surgical Epileptology (Dublin, Ireland)
• Fellowship in Pain and Spine Intervention (New Delhi, India)

 

CONSULTANT CLINIC HOURS

• Monday - Friday : 8.30 am - 5.30 pm
• Saturday : 8.30 am - 12.30 pm

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