AIM: This study aimed to compare the incidence and associated risk factors of pDDIs among a public and private sector hospital in Khyber Pakhtunkhwa, Pakistan.
METHOD: A retrospective cross-sectional study design was conducted to compare pDDIs among public and private sector hospitals from January 2023 to February 2023. Patients profile data for the full year starting from January 1 2022 to December 302022, was accessed All adult patients aged 18 years and above, of both genders, who currently have or have previously been diagnosed with end-stage renal disease (ESRD) were included. For assessing pDDIs, patient data was retrieved and checked using Lexicomp UpToDate® for severity and documentation of potential drug-drug interactions.
RESULTS: A total of 358 patients' data was retrieved (with n = 179 in each hospital); however, due to incomplete data, n = 4 patients were excluded from the final analysis. The prevalence of pDDIs was found to be significantly higher in private hospitals (84.7%) than in public hospitals (26.6%), with a p-value <0.001. Patients in the age category of 41-60 years (AOR = 6.2; p = 0.008) and those prescribed a higher number of drugs (AOR = 1.2; p = 0.027) were independently associated with pDDIs in private hospitals, while the higher number of prescribed drugs (AOR = 2.9; p = <0.001) was an independent risk factor for pDDIs in public hospitals. The majority of pDDIs (79.0%) were of moderate severity, and a significant number of patients (15.1%) also experienced major pDDIs, with a p-value <0.001. The majority of pDDIs had fair documentation for reliability rating in both public and private hospitals.
CONCLUSION: The prevalence of pDDIs was higher among CKD patients at private hospitals, and most of the pDDIs were of moderate severity. A considerable number of patients also experienced major pDDIs. The risk of experiencing pDDIs was found to be higher in older patients and among those prescribed a higher number of drugs.
OBJECTIVE: This review examined the survival rate and prognostic factors of patients with Pca in Southeast Asia (SEA).
METHODS: We conducted a systematic search of three databases (PubMed, Scopus, Web of Science) and a manual search until April 1, 2022. The selected papers were evaluated using the Newcastle-Ottawa Quality Assessment Form for Cohort Studies. The review protocol was registered with PROSPERO (CRD42022326521). Pooled prevalence rates were calculated using the programme R version 4.2.1. Heterogeneity was assessed using the I2 statistic and p-value. A narrative approach was used to describe prognostic factors. Studies were selected and finalised based on the review question. The quality of the included studies was assessed.
RESULTS: A total of 11 studies were included in this review. The 1-, 3-, 5- and 10-year survival rates of SEA Pca cases were 80.8%, 51.9%, 66.1% (range 32.1-100) and 78% (range 55.9-100), respectively. Prognostic factors for Pca were discussed in terms of sociodemographic, disease-related and treatment-related aspects. The predictors of significantly lower survival were age more than 75 years, cancer detected during transurethral resection of the prostate, Gleason score more or equal to eight, high-risk group, metastases and no adjuvant radiotherapy. A meta-analysis on the pooled HR of prostate cancer could not be performed due to the heterogeneity of prognostic factors. The pooled prevalence of localised and metastatic prostate cancer in SEA countries was 39% 95% CI [20-62] and 40% 95% CI [28-53], respectively.
CONCLUSION: The survival rate in SEA countries can be determined by prognostic factors, which can be divided into sociodemographic, disease-related and treatment-related factors. Therefore, further studies are needed to improve the understanding and treatment of Pca in the region SEA.
AIM: Our objective was to investigate the potential of AOC3 and LRRC17 as biomarkers for fibroblast activation thus predicting their roles in CRC progression.
METHODS: Immunofluorescence (IF) staining of AOC3 and LRRC17 was performed on myofibroblast line (CCD-112CoN), primary fibroblasts from colorectal tumor (CAFs), and adjacent normal tissue (normal fibroblasts-NFs). SW620 (epithelial CRC cell line) was used as a control. Conventional CAF biomarker (alpha-smooth muscle actin - α-SMA) was included in the IF analysis. Fluorescence intensity was compared between groups using ImageJ software. Proliferation and contractility of treated cells were assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) and collagen gel contraction assays, respectively. Fibroblast contraction under TGF-β1 treatment was compared to those treated with complete medium (addition of 10% serum) and serum free (SF) medium.
RESULTS: Positive AOC3, LRRC17, and α-SMA expression were observed in colonic fibroblasts, more prominent in CAFs, whereas negative staining was found in SW620. Significant downregulation of AOC3, and upregulations in LRRC17 and α-SMA expression was found in TGF-β1-treated fibroblasts compared to SF medium treatment (p-value<0.05). All fibroblasts exhibited higher proliferation in complete medium and under treatment with conditioned medium from SW620 than SF medium. Significant contraction of NFs was recorded in complete medium and TGF-β1 (p-value<0.01).
CONCLUSION: Our results demonstrate AOC3 and LRRC17 as the potential markers of CAF activation which promote CRC progression.
OBJECTIVE: This study aims to evaluate the efficacy of the M2PK Quick Stool Test (ScheBo®) in detecting colorectal adenoma and adenocarcinoma in high-risk Malaysian populations using colonoscopy as the comparison.
METHODS: A prospective, cross-sectional, multicenter study was conducted from December 2017 to December 2019 in four hospitals in Malaysia. Participants were eligible if they met any of the following criteria: personal or family history of colorectal polyps or cancer, inherited syndromes, altered bowel habits, rectal bleeding, unintended weight loss, loss of appetite, abdominal pain or cramps, or unexplained iron deficiency, or an Asia-Pacific Colorectal Screening score of 4-7. Participants provided a stool sample that was tested for M2PK using the M2PK Quick Test. Participants then underwent a colonoscopy, and any lesions found were biopsied and sent for histopathological examination.
RESULTS: A total of 562 participants were included in the study, of whom 89 had a positive M2PK test. Presence of adenoma and/or dysplastic lesions were confirmed in 14.4% and adenocarcinoma in 3.0% of the participants. The M2PK Quick Stool Test showed a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 58.8%, 85.5%, 11.2% and 98.5%, respectively in detecting colorectal adenocarcinoma. For detection of colorectal adenoma, this test yielded a sensitivity, specificity, PPV and NPV of 27.3%, 86.3%, 27.0% and 86.5%, respectively.
CONCLUSIONS: The M2PK Quick Stool Test showed a moderate accuracy in detecting colorectal adenocarcinoma and adenomas in the studied population.
METHOD: This is a cross-sectional study in the neurology clinic in a tertiary teaching hospital in Kuala Lumpur. The screening tools used were the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the General Anxiety Disorder Form (GAD-7).
RESULTS: Five hundred and eighty-five patients were recruited in this study, and 50.8% of them were male, predominantly Chinese (46.7%), with a mean age of seizure onset of 21.8 ± 16.1 years. The majority had focal seizures (75.0%), and 41.9% had seizure remission. There were 15.5% who scored ≥15 in the NDDI-E, and 17.0% had moderate or severe anxiety (scored ≥10 in the GAD-7). In a regression model to predict the NDDI-E score, the age of seizure onset recorded a higher beta value (β = -0.265, p =
METHODS: Postoperative CT scans of 200 propensity score-matched patients who underwent TKA with either an anatomic (ATC) or symmetrical tibia component (STC) were analyzed. Rotation was measured using four axes: surgical transepicondylar axis (sTEA), Berger's protocol, medio-lateral (ML) axis and posterior borders of the tibial plateau, while coverage was assessed by measuring fit and surface area. The relationship between coronal deformity, tibial torsion, rotation, and coverage was investigated.
RESULTS: Overall, STCs had more internal rotation when measured using the sTEA (-0.6° ± 3.5 vs 0.5° ± 3.6, p = 0.03), Berger's protocol (-21.6° ± 7.1 vs -17.9° ± 6.2, p = 0.000) and ML axes (2.9° ± 3.9 vs 8.1° ± 5.1, p = 0.000) compared to ATCs. STCs also had more posteromedial underhang (-3.3 mm ± 2.4 mm vs -1.7 mm ± 2.5 mm, p = 0.000) but smaller change in tibial torsion postoperatively (-18.4° ± 9.9° vs -13.1° ± 9.4°, p = 0.000). Tibial torsion was more pronounced in valgus than varus knees both preoperative (-25.4° ± 6.5° vs -20.2° ± 9.3°, p = 0.02) and postoperatively (-19.7° ± 7.2° vs -14.7° ± 10.3°, p = 0.04), but there was no difference in postoperative tibial torsion between ATCs and STCs in this subgroup.
CONCLUSION: The use of an anatomic tibial baseplate optimizes coverage by reducing posterolateral overhang and posteromedial underhang. It also achieved better rotational profiles compared to STCs. However, it resulted in a larger change in tibial torsion after TKA.
METHODS: Point prevalence survey (PPS) of HAIs in the children's wards of 19 public sector secondary- and tertiary-care hospitals of Pakistan and associated key drivers.
RESULTS: A total of 1147 children were included in the PPS. 35.7% were neonates with 32.8% aged >1-5 years. 35.2% were admitted to the intensive care units (ICUs). Peripheral, central venous and urinary catheters were present in 48%, 2.9% and 5.6% of the patients, respectively. A total of 161 HAIs from various pathogens were observed in 153 cases, giving a prevalence of 13.3%. The majority of HAIs were caused by Staphylococcus aureus (31.7%) followed by Klebsiella pneumoniae (22.9%) and Escherichia coli (17.4%). Bloodstream infections were identified in 42 cases followed by lower-respiratory-tract infections in 35. Increased length of hospital stays and being admitted to the ICU, 'rapidly fatal' patients under the McCabe and Jackson criteria, central and peripheral catheterization, and invasive mechanical ventilation were, associated with higher HAIs (P<0.001). 99.7% of HAI patients fully recovered and were discharged from the hospital.
CONCLUSION: There is a high prevalence of HAIs among neonates and children admitted to health facilities in Pakistan. Infection prevention and control measures should be implemented to help prevent future HAIs.
MATERIAL AND METHODS: A cross-sectional study was done in Kuching, Sarawak, involving 173 randomly selected respondents among manufacturing factory workers. Data collected were respondents' workplace monitoring data and their audiometry records obtained from the factory record, and the otoscopy examinations performed. In addition, respondents were required to fill up an interviewer-guided questionnaire.
RESULTS: The prevalence of NIHL was high (49.7%). The factors which were found to have a significant association with NIHL in bivariate analysis were age (p < 0.05, 95% CI), male gender (p < 0.05; OR - 7.60; CI 3.34 -18.38), duration of employment (p <0.05), knowledge of noise level (p < 0.05; OR - 4.11; CI 1.10 - 15.28), working at polishing department (p < 0.05; OR - 4.23; CI 2.13 - 8.43), and smoking (p < 0.05; OR - 39.6; CI 16.5 - 94.8). Pack-years of smoking were also found to have a significant association with p < 0.05. However, only smoking was statistically significant in multivariate analysis, where the risk of developing NIHL was 27.55 (p < 0.005; CI 10.74 - 70.64) among smokers.
CONCLUSION: The high prevalence of NIHL despite the existing Hearing Conservation Program (HCP) may indicate that there may be some elements in HCP that require close monitoring by the factory management, and the importance of smoking cessation among the workers exposed to noise at the workplace should be highlighted.
MATERIAL AND METHODS: Patients with Spastic CP with Gross Motor Function Classification System (GMFCS) I-III that underwent lower limb surgical intervention in our centre from 2008-2018 were retrospectively reviewed for The Spinal Alignment and Range of Motion Measure ROM subscale (SAROMM) scores and Functional Mobility Scale (FMS) 18 months after surgery. Changes in SAROMM, FMS scores and minimal clinically important difference (MCID) were determined.
RESULTS: 19 patients were included in the study with mean age of 12.58. All patients underwent muscle tendon procedures. Box plot analysis of SAROMM showed reduction of median scores at 6(26.3%) and 12(47.4%) months which plateaus at 18 months post-surgery. Repeated measure ANOVA analysis showed there was a statistically significant effect of time on SAROMM scores (p <0.001) with MCID of 13.4. Improvement of FMS scores was the most at 50m with 13 children (p < 0.05), one at 5m and five at 500m. None reported worsening of FMS scores at 18 months. There were no changes of GMFCS levels by the end of 18 months.
CONCLUSION: Surgeries performed on GMFCS I-III patients with the aim of gait improvement translates into improved mobility with results comparable to other countries.
MATERIALS AND METHODS: We reviewed the medical records of all patients that underwent bullectomy from 1st June 2017 to 31st May 2022. Mann Whitney U-test was completed for all variables. Primary objective was to compare operating time (OT), global operating time (GOT), post-operative length of stay (LOS) and complication rate.
RESULTS: A total of 90 bullectomies performed in which 36 were approached via iVATS and 54 NiVATS. It was found that the post-operative LOS, GOT, and OT were significantly shorter in the NiVATS as compared to iVATS. Complication rate between both groups showed no significant difference.
CONCLUSION: NiVATS bullectomy demonstrated a safe and reliable alternative surgical approach with superior surgical outcome than iVATS bullectomy.
MATERIALS AND METHODS: This study consists of two parts. First, a cross-sectional study on the knowledge of and attitude towards leprosy using an online quesitonnaire was conducted among doctors working in the primary care clinics and hospitals in Sabah and Labuan. Subsequently, the participants were asked to watched an online prerecorded video lecture on leprosy and to answered the same questionnaire.
RESULTS: Of the 310 participants, one fifth (20.6%) had good knowledge and 36.5% had positive attitude towards leprosy. Being a specialist (adjusted odds ratio [aOR] 4.55, 95% confidence interval [CI] 2.17-9.57, p < 0.001), managed ≥ 5 leprosy cases (aOR 3.37, 95% CI 1.52-7.47, p = 0.003), and involved in educational activities related to leprosy within last year (aOR 4.7, 95% CI 1.69-13.04, p < 0.001) were the significant predictors of good knowledge. Working in tertiary care was significantly associated with good attitude towards leprosy (OR 2.19, 95% CI 1.22-3.94, p = 0.025). There was a significant improvement in participants' knowledge post-intervention (87.0% participants post-lecture vs 20.6% participants pre-lecture with good knowledge, p < 0.001).
CONCLUSION: The proportion of doctors in Sabah and Labuan with good knowledge and attitude towards leprosy was low. Knowledge of leprosy improved significantly postintervention. This highlights the need for educational and training programmes to improve doctors' knowledge of leprosy.
MATERIALS AND METHODS: This is a 5-year retrospective study of patients who developed positive reactions to fragrance allergens at the Department of Dermatology, Hospital Kuala Lumpur, Malaysia between January 2017 and December 2021. Patch tests were performed with European Baseline Series and relevant extended series. Patch test readings were recorded according to the International Contact Dermatitis Research Group recommendation.
RESULTS: A total of 854 patients underwent patch test during the study period with 133 (15.6%) patients developing at least one positive reaction to fragrance allergens. The median age of patients at presentation was 40 years (range 16-79) old with 78.2% females. The most common initial presentation was hand eczema (55.6%). Other commonly involved sites include face (38.3%), leg (35.3%) and trunk (22.6%). The most frequent sensitising fragrance allergens were Fragrance Mix I (10.5%), Balsam of Peru (7.1%) and Fragrance Mix II (4.9%). Sixty patients (45%) developed positive reaction to more than one fragrance allergens. Twelve patients (9%) developed positive patch test reactions to their own products such as skincare, hair dye and hand wash. Current relevance was recorded in 96 patients (72.2 %).
CONCLUSION: Contact sensitisation to fragrance allergens was detected in about 15% of our patients who underwent patch test. The most common sensitising allergens were Fragrance Mix I and II and Balsam of Peru.
MATERIALS AND METHODS: A retrospective repeated crosssectional study was conducted by recruiting patients with cochlear implants presenting to the Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia between 2017 and 2021. Basal (b1, b2) and apical (a1, a2) electrodes, representing the outermost and innermost parts of the cochlear implant electrodes, were measured at switch on and at 1 year post-implantation.
RESULTS: A total of 123 patients, with a total of 123 cochlear implant samples, were included in the analysis. We found a substantial change in electrical impedance between switch on and follow-up periods, where the impedance levels of basal electrodes decreased (b1: mean difference (MD) -1.13 [95% confidence interval (CI): -1.71, -0.54], p<0.001; b2: MD -0.60 [95%CI: -1.17, -0.03], p=0.041) and those of apical electrodes increased (a1: MD 0.48 [95%CI: -0.28, 0.99], p=0.064; a2: MD 0.67 [95%CI: 0.12, 1.22], p=0.017). We also found that the choice of surgical approaches for implant insertion may affect the electrode impedance. Cochleostomy approach resulted in a higher impedance than round window in basal (b1) and apical (a2) electrodes both at switch on and follow-up (b1 at switch on and at follow-up: p=0.019 and p=0.004; a2 at follow-up: p=0.012). Extended round window approach also resulted in a higher impedance than round window in basal (b1) and apical (a2) electrodes at follow-up (p=0.013 and p=0.003, respectively).
CONCLUSION: Electrical impedance of cochlear implant electrodes may change over time, highlighting the importance of regular impedance assessments for cochlear implant users to ensure optimal device function. The round window approach resulted in better initial and long-term impedance levels compared to cochleostomy, and better long-term impedance levels than extended round window. Extended round window approach also gives better impedance level than cochleostomy. Further research should investigate the potential interplay between surgical approach and other factors that may impact impedance levels to confirm our findings.
MATERIALS AND METHODS: We conducted a multi-centre cohort study involving 5 PSCs and 7 ASRHs in Malaysia. Through review of medical records of AIS patients who received IVT from 01 January 2014 to 30 June 2021, real-world data was extracted for analysis. Univariate and multivariate regression models were employed to evaluate the role of PSCs versus ASRHs in post-IVT outcomes and complications. Statistical significance was set at p<0.05.
RESULTS: A total of 313 multi-ethnic Asians, namely 231 from PSCs and 82 from ASRHs, were included. Both groups were comparable in baseline demographic, clinical, and stroke characteristics. The efficiency of IVT delivery (door-toneedle time), functional outcomes (mRS at 3 months post- IVT), and rates of adverse events (intracranial haemorrhages and mortality) following IVT were comparable between the 2 groups. Notably, 46.8% and 48.8% of patients in PSCs and ASRHs group respectively (p=0.752) achieved favourable functional outcome (mRS≤1 at 3 months post-IVT). Regression analyses demonstrated that post-IVT functional outcomes and adverse events were independent of the role of PSCs or ASRHs.
CONCLUSION: Our study provides real-world evidence which suggests that IVT can be equally safe, effective, and efficiently delivered in ASRHs. This may encourage the establishment of more ASRHs to extend the benefits of IVT to a greater proportion of stroke populations and enhance the regional stroke care.