METHODS: In the first stage, a preliminary list of items measuring socio-cultural and religious beliefs during menstruation was generated. In the second stage, exploratory factor analysis was performed. Finally, confirmatory factor analysis using reflective measurement model and structural equation modelling was performed using partial least squares. The practices of these beliefs were included as mediating effect. Biological symptoms of menstruation were added in as another factor.
RESULTS: A total of 400 female students from the Universiti Malaysia Sarawak, Malaysia were recruited. A preliminary list of 22 items was first generated. From the confirmatory factor analysis, two factors were iteratively removed due to poor factor loadings. Four factors were retained, i.e., i) "religious beliefs"; ii) "unpleasant (or dirty) nature of menstruation"; iii) "personal restrictions (dietary and behavior)"; and iv) "restrictions of interactions with male gender". In structural equation modelling, only 2 factors, i.e., the practices of "personal restrictions (dietary and behavioural)" and "restriction of interactions with males" had significant negative impact on quality of life.
CONCLUSION: Menstruation should not be viewed purely from a biological lens as there are layers of sociocultural and religious beliefs surrounding it.
METHODS: This is a retrospective case control study in Hospital Seri Manjung and Hospital Teluk Intan, Perak, Malaysia. P. aeruginosa bacteraemia cases that occurred between 1st January 2015 to 31st December 2019 were included, whilst E. coli bacteraemia cases that occurred within the same period were recruited successively until 1:2 case control ratio was achieved. Subjects below 12-year-old and those with polymicrobial bacteraemia were excluded. Demographic, clinical and treatment data were collected using pre-tested data collection forms by trained investigators.
RESULTS: A total of 61 patients with P. aeruginosa bacteraemia and 122 patients with E. coli bacteraemia were included. Recent admission in the earlier three months, regular haemodialysis, immunosuppressive therapy in the past 30 days, chronic wound/pressure sore at presentation and indwelling urinary catheter at presentation were identified as independent predictors of CO pseudomonal bacteraemia. Whilst older age was identified as a negative predictor of CO Pseudomonal bacteraemia (all p<0.05). The 30-day mortality rate was 34.4% in subjects with P. aeruginosa bacteraemia and 27.0% in those with E. coli bacteraemia (p=0.302). Predictors of 30-day mortality for community onset gram negative bacteraemia were as follow: older age, underlying solid tumours, neutropaenia at presentation, in-patient mechanical ventilation, and inpatient nasogastric tube insertion. Unexpectedly, receipt of inappropriate empirical antibiotics which was switched later (delayed and non-delayed switching) was identified as the negative predictors of mortality (all p<0.05).
CONCLUSION: It is prudent to restrict the usage of empirical anti-pseudomonal antibiotics among individuals at risk as liberal usage of broad-spectrum antibiotics engenders emergence of drug resistant organism, particularly in district setting where community onset pseudomonal bacteraemia remains scarce. Subjects with elevated risk of mortality should receive early escalation of care as per sepsis management guidelines.
METHODS: This cross-sectional study was based on the data collected from the Hepatitis C Elimination through Access to Diagnostics (HEAD-Start) study in 25 primary healthcare clinics across three regions of Malaysia. The findings of biochemical tests were used to calculate the APRI for each study participant. Transient elastography was used as a standard reference for the diagnosis of cirrhosis. The area under the receiver operating curve (AUROC) was used to determine the discriminative ability of APRI in both HCV mono-infected and HCV/HIV co-infected patients. The diagnostic performance of APRI at three different cutoffs (>1.0, ≥1.5 and >2.0) were also evaluated.
RESULTS: This study included 867 HCV-RNA-positive patients, 158 (16.1%) were co-infected with HIV. For the HCV mono-infected patients, the sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) for the cut-off of >1.0 were 61.8%, 88.7%, 73.8% and 81.9%, and for the cut-off of ≥1.5, 45.6%, 97.0%, 88.7% and 77.6%, respectively. A much lower sensitivity (29.9%) was observed for the cut-off of >2.0. The diagnostic accuracy of APRI at the cut-off of ≥1.5 in the HCV/HIV co-infected patients was relatively suboptimal.
CONCLUSION: APRI, with a cut-off of ≥1.5, can more accurately predict LC among hepatitis C patients in Malaysia. However, additional physical examination and laboratory assessment are likely to be required to support the diagnosis, especially in those with HCV/HIV co-infection.
METHOD: A retrospective observational study amongst AMA mothers was done in Universiti Kebangsaan Malaysia Medical Centre, a Malaysian teaching hospital. The data over a period of three years (January 2013 - December 2016) obtained from the Maternal Foetal Medicine clinic registry was analysed. AMA mothers with singleton pregnancy presenting for foetal structural anomaly scan was included. They were later subdivided into 2 groups (35-39 years and ≥ 40 years). The logistic regression analysis was used to analyse the association of the chromosomal anomalies and the age groups.
RESULTS: In all 486 patients were recruited and 84 patients were identified with foetal anomaly (17.3%). There was no significant difference in the prevalence of foetal anomalies or significant association with a specific structural foetal anomaly identified (p>0.05). However, the number of followups for these patients are significantly higher (p<0.001).
CONCLUSION: The prevalence of structural foetal anomalies identified in detailed ultrasonography was low in AMA mothers. Hence, referral criteria for detailed anomaly ultrasonography need to be re-looked.
MATERIALS AND METHODS: A total of 240 patients (mean age 53.1, 167 males and 73 females) from Hospital Kuala Lumpur and the National Cancer Institute were enrolled in this research. All patients were interviewed individually in which they completed a thorough case history and swallowing screening test, including the water swallow test.
RESULTS: The results revealed that 43.3% of patients had dysphagia. In multivariate logistic regression, occupation of the patients was found to be associated with dysphagia, i.e., working in service and sales sector (adjusted Odds Ratio, aOR=0.36, 95% Confidence Interval, 95%CI: 0.13, 0.99). Compared to patients without treatment, those who had chemoradiotherapy (aOR=4.45; 95%CI: 1.10, 17.99) were at an increased odd of developing dysphagia.
DISCUSSION: This study showed that occupation, cancer stage, and type of treatment received by the head and neck cancer patients were crucial factors associated with the development of dysphagia. These findings guide the clinicians in identifying head and neck cancer patients who are at greater risks of developing dysphagia.
METHODS AND MATERIALS: A retrospective cross-sectional study involving 80 haemodialysis (HD) patients recruited from March 2020 till March 2021. Patients' information and results was retrieved and evaluated. Risk factors affecting the COVID-19 mortality were analysed using a one-way analysis of variance (ANOVA) and binary logistic regression.
RESULTS: The mean age of the patients was 54 years who were predominantly Malays (87.5%) and living in rural areas. Majority of them had comorbidities such as diabetes mellitus (71%) and hypertension (90%). The most common presentations were fever (46%) and cough (54%) with chest radiographs showing bilateral lower zone ground glass opacities (45%). A quarter of the study population were admitted to the intensive care unit, necessitating mechanical ventilation. This study found that 51% of the patients were given steroids and 45% required oxygen supplementation. The COVID-19 infection mortality among the study population was 12.5%. Simple logistic regression analysis showed that albumin, Odd Ratio, OR=0.85 (95% Confidence Interval, 95%CI: 0.73, 0.98)) and absolute lymphocyte count OR=0.08 (95%CI: 0.11, 0.56) have inverse association with COVID-19 mortality. C-reactive protein OR=1.02 (95%CI: 1.01, 1.04), lactate dehydrogenase OR=1.01 (95%CI: 1.00, 1.01), mechanical ventilation OR=17.21 (95%CI: 3.03, 97.67) and high dose steroids OR=15.71 (95%CI: 1.80, 137.42) were directly associated with COVID-19 mortality.
CONCLUSION: The high mortality rate among ESKD patients receiving HD was alarming. This warrants additional infection control measures to prevent the spread of COVID- 19 infection among this vulnerable group of patients. Expediting vaccination efforts in this group of patients should be advocated to reduce the incidence of complications from COVID-19 infection.
MATERIALS AND METHODS: All dengue patients hospitalised at King Chulalongkorn Memorial Hospital, Bangkok, Thailand during 1987-2008 and aged 0-15 years were included. All parameters were compared between patients in two groups: aged 0-2 years and >2-15 years.
RESULTS: Of the 2,221 children who were diagnosed with dengue, 179 were children aged 0-2 years compared with 2,042 children aged >2-15 years. The early childhood group presented significantly more frequently with hepatomegaly, drowsiness, diarrhoea, rash, convulsions, splenomegaly, and unusual manifestations. Dengue fever (DF) was more common in the early childhood group and dengue haemorrhagic fever (DHF) was less common. The mortality rate of the early childhood group was 1.67%, which was significantly higher than that of the comparative group. Approximately 65% of study subjects were serologically proven to have primary infection, compared to 9.8% of older children.
CONCLUSIONS: Clinical manifestations of dengue infection in early childhood are different in some aspects from those of dengue infection in older children, and mortality is higher. To effectively prevent dengue infection morbidity and mortality in children, it is essential that clinicians correctly recognize and diagnose dengue infection, particularly in early childhood.
MATERIALS AND METHODS: We plan to conduct a two-phase exploratory sequential mixed method study to determine the factors affecting compliance of Malaysian healthcare workers towards tuberculosis prevention programmes in their workplace based on the guidelines of the Ministry of Health, Malaysia. Phase one is a qualitative study with a focus group discussion and questionnaire development and phase two is a quantitative study where data will be collected among healthcare workers in government clinics and hospitals in Selangor. The data from phase one will be analysed using Atlas.Ti software for thematic analysis and data from phase two will be analysed using SEM AMOS software for structural equation modelling.
METHODS: A cross-sectional study was conducted by utilising the data from the Cambodia Demographic Health Survey (CDHS). The records of 5901 pregnant women who fulfilled the inclusion criteria were reviewed. Multiple logistic regression was used to identify the association on the influence of health services and pregnancy factors on incomplete TT vaccination while controlling other covariates. Adjusted odds ratio (aOR) and 95% confidence interval (95%CI) was reported.
RESULTS: More than one-third of the respondents had incomplete TT vaccination (38.25%, 95%CI: 37.00, 39.48%). Health services as well as pregnancy factors were statistically associated with incomplete TT vaccination such as received antenatal care (ANC) from other health personnel beside midwife (aOR=1.83; 95%CI: 1.49, 2.24), had
METHODS: This is a cross-sectional study in which patients receiving IV alteplase in Hospital Universiti Sains Malaysia, from January 2017 to April 2020 were recruited. Demographical data, National Institutes of Health Stroke Scale (NIHSS) scores, door-to-needle time were recorded. Modified Rankin scale (mRS) scores were evaluated at 90 days after initial therapy. Good and poor functional outcomes were defined as 0-2 and 3-6, respectively.
RESULTS: A total of 30 patients were included in the study with a mean age of 59±11.47 years old. 76.7% of them were male and the rest were female. From the study, onset-toneedle time was 197.47±51.74 minutes, whereas door-toneedle time was 120.93±53.63 minutes. Seventeen (56.3%) patients achieved a favourable score of 0-2 on the mRS at 90 days after treatment. Haemorrhagic transformation occurred in eight (26.7%) of the patients with a mortality rate of 13.3%.
CONCLUSION: 56.7% of our patients showed improvement in the mRS at 90 days post thrombolysis for AIS. Higher baseline NIHSS scores and diabetes mellitus were associated with poorer functional outcomes after thrombolysis.
METHODS: This is an open labelled interventional study of a virtual brief psychosocial intervention, called SANUBARI. The program was conducted among COVID-19 patients hospitalized in the COVID-19 wards of two centres from May 2020 until August 2020. Inclusion criteria include patients aged eighteen years and above, diagnosed with COVID-19, medically stable, speaking and reading Bahasa Melayu or English. All study subjects attended two sessions on OHP via telecommunication method and answered questionnaires (General Self-Efficacy (GSE) Scale, Patient Health Questionnaire and Generalized Anxiety Disorder Questionnaire) via computer-assisted self-interview. Data collection was done before the start of the intervention, at the end of the intervention and a month post-intervention.
RESULTS: A total of 37 patients were recruited and more than half of the subjects were males (62.2%), single (75.5%) and from the Malay ethnicity (78.4%). Seventy-three per cent of subjects had received tertiary education, and most of them were students reflecting a higher unemployment status (73%). Most subjects have no comorbid chronic medical illness (89.2%), and none has a comorbid psychiatric illness. Comparison of the GSE score across 3-time points (preintervention, immediate post-intervention and a month postintervention) showed statistically significant improvement in the mean total GSE score immediate and a month postintervention as compared to the pre-intervention; from mean total GSE score of 29.78 pre-intervention to 34.73 (mean difference 4.946, 95% Confidence Interval 95%CI: 3.361, 6.531) immediate post-intervention and 33.08 (mean difference 3.297, 95%CI: 1.211, 5.348) a month post intervention. There was no significant association between the socio-demographic or clinical data, depressive and anxiety symptoms, and changes in GSE scores over three time points.
CONCLUSION: COVID-19 patients improved their self-efficacy levels after the virtual brief OHP intervention, and it maintained a month post-intervention, protecting them from psychological stress and ultimately enhances wellbeing during this coronavirus pandemic.
MATERIALS AND METHODS: We performed a prospective cohort study on 103 patients at Wigan Wrightington and Leigh NHS Foundation Trust looking at serum vitamin D levels of patients with positive COVID-19 swabs. Results were collated and correlations were made to compare vitamin D levels with age; severity of illness; hospital outcomes; and frailty. Comparisons were also made between frailty and outcome.
RESULTS: The results showed that there was a significant statistical difference between vitamin D levels and severity of infection: those who were treated in the intensive care units (ICU) (severe symptoms) had lower vitamin D levels than those treated on the ward (p=0.0446). There was also a correlation between vitamin D levels and frailty: those who were more frail had higher vitamin D levels than fitter patients (P=0.005). Vitamin D and frailty had no effect on hospital outcomes of COVID-19 infection.
CONCLUSION: Ultimately, we concluded that low vitamin D can increase susceptibility of contracting COVID-19, increase severity of infection but does not affect mortality.
MATERIALS AND METHODS: A retrospective cohort study of patients who have undergone optical biometry measurement before unilateral phacoemulsification in the Queen Elizabeth Hospital, Sabah, Malaysia from 2018 to 2020. Biometry data of interest includes axial length (AL), keratometry(K), white-to-white (WTW) and central corneal thickness (CCT). The postoperative outcomes of interest were the patient's preoperative refractive target, postoperative best-corrected visual acuity (BCVA), postoperative refractive outcomes, and optical biometry prediction error.
RESULTS: The interocular biometry discrepancies which were associated with higher odds of prediction error >0.5D from the refractive target were Interocular Corneal Power Difference (IKD)-average≥0.8 D (Odds Ratio, OR=1.97; 95% Confidence Intervals, 95%CI: 1.06, 3.67) and Interocular WTW Difference ≥1.5 mm (OR=2.77; 95%CI: 1.11, 6.92). In cases with prediction error >1.0D, the measurements were Interocular AL Difference ≥0.4 mm (OR=2.99; 95%CI: 1.11, 8.06), IKD flat≥0.4D (OR=2.76; 95%CI: 1.31, 5.82) and Interocular CCT Difference ≥15μm (OR=3.53; 95%CI: 1.29, 9.64).
CONCLUSION: Interocular axial length difference ≥0.4mm and interocular central corneal thickness difference ≥15μm are associated with refractive error >1.0D from the pre-operative target. Interocular average corneal power difference ≥0.8D and interocular white-to-white difference ≥1.5mm have higher odds of refractive drift >0.5D from the refractive aim. The above cutoff values help clinicians to identify which patients have a higher risk of refractive shift post-cataract surgery and counsel the patient before cataract operation.