MATERIALS AND METHODS: A cross-sectional study was conducted by recruiting normal-hearing children aged 3-8 years old with ASD presenting to a national referral ENT clinic between October and December 2023. The severity of ASD was assessed using the Childhood Autism Rating Scale (CARS), while hyperacusis was diagnosed using Modified Check List for Autism in Toddlers, Revised (M-CHAT-R).
RESULTS: A total of 26 children with ASD, 23 of whom were male (88%), aged 3-8 years, were included in the analyses. Among these children, 18 (69.2%) had hyperacusis. Analysis of ABR click revealed a prolonged interpeak latency wave I and III (88.5%), followed by a prolonged latency in wave III (42.3%) and V (21.2%). Neither ABR wave latencies nor hyperacusis were correlated with the severity of ASD, although there was a marginally significant association between wave III latency and CARS score in the left ear (r=0.359, p=0.072). However, wave V latency and interpeak wave I-V latency were significantly longer in children without hyperacusis (right ear: p=0.042 and p=0.050; left ear: p=0.005 and p=0.004), while interpeak wave III-V only in the left ear (p=0.006) and wave III only in the right ear (p=0.029).
CONCLUSION: There was no significant correlation between ABR wave latencies or hyperacusis and the severity of ASD, while ABR wave latencies were generally longer in children without hyperacusis. Further large studies involving a broader spectrum of children with ASD are warranted to confirm our findings.
MATERIALS AND METHODS: 18 patients with histologically confirmed early NSCLC (stage I-IIIA) were recruited from October 2019 to January 2021. The serum CEA was measured pre-operatively, and then at 6, 12, 18 and 24 months post-operatively, in conjunction with routine CT and/or CT-PET surveillance scans.
RESULTS: All patients had a curative R0 anatomical resection (lobectomy) with concurrent systematic mediastinal nodal dissection via a uniportal minimally invasive approach under single lung ventilation general anaesthesia. There was no operative, in-hospital or 30-day mortality. 7 patients (39%) had an elevated pre-operative baseline CEA level > 5.0ng/ml. The mean number of nodes sampled intraoperatively was 15. At median follow-up of 42 months, 11/18 (61.1%) patients were recurrence-free. There were no deaths and two recurrences (18.2%) amongst patients with a CEA < 5 (n=11). In the CEA > 5 subgroup (n=7), there were two deaths (28.5%) and 5/7 (71.4%) patients had a radiological recurrence. There was no difference in overall survival however disease-free survival (DFS) was significantly inferior in patients with a baseline CEA > 5. Median DFS was not reached in patients with CEA < 5 and 18 months in those with an elevated CEA > 5 (p<0.001) Conclusion: Almost 40% of local NSCLC patients had an elevated baseline CEA suggesting this is a useful prognostic and surveillance biomarker to incorporate in the routine work-up for any newly diagnosed NSCLC. Despite curative R0 resection and extensive intra-operative mediastinal lymph node sampling, an elevated pre-operative CEA was associated with a significantly reduced DFS and may be a surrogate for more aggressive tumour biology. Such patients will benefit from meticulous post resection surveillance and adjuvant therapy beyond conventional TNM criteria.
MATERIALS AND METHODS: The clinical data and scintigraphy findings of patients referred to the Department of Nuclear Medicine, Hospital Kuala Lumpur for Tc-99m TRODAT-1 SPECT-CT from July 2022 to July 2023 were retrospectively reviewed. Follow-up with primary team was conducted to determine the clinical implications and subsequent therapeutic management of the patients.
RESULTS: Tc-99m TRODAT-1 SPECT-CT was performed on sixteen patients (10 females and 6 males) with a mean age of 55.2 years (range 26 to 75 years). Five patients exhibited normal scintigraphy findings, while eleven patients showed abnormal Tc-99m TRODAT-1 SPECT-CT results. The scintigraphy findings led to changes in therapeutic management for 81.3% of the patients. Additionally, 19% of the patients were referred for further evaluation with Fluorine-18 fluorodeoxyglucose PET to assist in diagnosing atypical Parkinsonian disease.
CONCLUSIONS: Tc-99m TRODAT-1 SPECT-CT is a readily available tool for assessing presynaptic dopamine transporters in patients with parkinsonism. This study demonstrated that Tc-99m TRODAT-1 SPECT-CT significantly impacts the diagnostic and therapeutic outcomes for patients with parkinsonism.
MATERIALS AND METHODS: In this case-control study, we examined 294 patients over the age of 18 who were using synthetic cathinones and opioids. All patients underwent electrocardiography and transthoracic echocardiography.
RESULTS: Our study involved 183 patients using synthetic cathinones and 111 patients reporting opioid use. The average age of the patients was 32.4 ± 8.5 years. In patients using synthetic cathinones, electrocardiography showed a lengthening in the average duration of the ventricular QRS complex (70.5 ± 13.3 ms vs. 69.6 ± 11.7 ms), T wave (154.1 ± 27.5 ms vs. 140.4 ± 24.1 ms), and QT interval (338.2 ± 28.5 ms vs. 334.8 ± 33.5 ms), as well as a shortening of the P wave (79.1 ± 12.2 ms vs. 82.6 ± 14.4 ms) and PQ interval (146.4 ± 19.6 ms vs. 148.3 ± 20.1 ms). Echocardiography confirmed left ventricular hypertrophy in 10.9% of the synthetic cathinones group and 17.1% of the opioid group. Transmitral left ventricular diastolic dysfunction was diagnosed in 23.5% of patients in both groups. Additionally, 31.1% of patients using synthetic cathinones and 44.1% of those using opioids had a reduced ejection fraction on echocardiography.
CONCLUSION: In patients using synthetic cathinones the QT interval was longer compared to those using opioids. The ejection fraction was lower in the opioid group. Electrocardiographic and echocardiographic screening should be conducted for all patients with post-acute withdrawal syndrome to prevent life-threatening arrhythmias and heart failure.
MATERIALS AND METHODS: A quasi-experimental study employing a one-group pre- and post-intervention was carried out involving 142 male firefighter recruits from a Fire and Rescue Academy in Malaysia. Various aspects of physical fitness changes, including speed, agility, and coordination (SAC), muscle strength, endurance, and power, were evaluated at baseline (Week 1) and upon completion of the first phase (Week 5). Changes in health parameters, such as blood pressure, resting heart rate, body weight, muscle mass, body fat percentage, and body mass index, were also assessed. A paired sample t-test was conducted with the significance level set at 0.05. The magnitude of changes was assessed using the following criteria: values of 0.3 were considered a small effect size, 0.5 indicated a moderate effect size, and 0.8 signified a large effect size.
RESULTS: Upon completion of the first phase of the physical training regimen, there was a statistically significant improvement in cardiorespiratory fitness, with a mean increment of VO2max was 9 mL/kg/min (95% CI: 8.33, 9.58, p<0.001, large effect size of 2.40). Both pre-and postintervention assessments of abdominal and upper body muscle strength and endurance showed statistically significant improvement with the mean difference of 11 situps (95%CI: 10.08, 12.01; p<0.001, large effect size of 1.89) and 1.5 pull-ups (95%CI: 1.07, 1.86; p<0.001, moderate effect size of 0.63), respectively. Health parameters showed similar, except for systolic BP (SBP). There was a small increment in recruits' SBP following the 4-week training period with a mean difference of 4.3 mmHg (95%CI: 2.37, 6.24; effect size = 0.37, p<0.001).
CONCLUSION: The first phase of the newly introduced fourweek physical training regimen has proven effective in enhancing cardiorespiratory fitness, as well as abdominal and upper body muscle strength and endurance. Additionally, the regimen has positively influenced several health parameters, except for systolic blood pressure. The observed increase in average systolic blood pressure indicates a necessity for continuous monitoring at the academy to address this issue effectively. confirm our findings.
MATERIALS AND METHODS: This was a pilot study of N=50 women, who were planning for IVF treatment in University Malaya Medical Centre, Kuala Lumpur, Malaysia from July to December 2023. Women without prior nutritional treatment were consented and assigned to either the multinutrient supplementation (Omega 3, coenzyme Q10, folic acid, selenium, vitamin E, catechins) as the study group or 5mg folic acid daily as control group for at least a month prior to their IVF treatment. All women were treated using an antagonist protocol and ovarian stimulation was started with 200 -300IU of urinary HMG and or recombinant FSH. Antagonists (Ganirelix) commenced when the leading follicle reached a diameter of 11 mm. Triggering with hCG or GnRH agonist when at least 3 follicles of 17 mm in diameter were achieved. Oocyte retrieval was performed 36th hour after trigger. Conventional IVF/ICSI was used for fertilisation. All parameters recorded and analysed using SPSS.
RESULTS: The mean age (36.44 ± 3.33 vs 35.32 ± 3.47 years) and body mass index (25.28 ± 4.12 vs 24.80 ± 4.36 kg/m2) of women in multinutrient supplementation group was similar to control group. The Follicular Output Rate (FORT) in women on multinutrient supplementation showed a trend towards benefit compared to control group, although it is not statistically significant (68.12 ± 19.47 vs 64.91 ± 20.06, p=0.493). The mean number of MII oocytes retrieved from mature follicles and number of good quality embryo on day 3 after fertilisation were not statistically significant between the two groups (6.65 ±3.84 vs 6.09 ± 3.01, p=0.626 and 4.00 ± 3.10 vs 3.45 ± 2.30, p=0.549, respectively). In addition, there were no differences in endometrial thickness before embryo transfer in both groups (10.35 ± 1.32mm vs 10.36 ± 2.04mm, p=0.320). However, the total dose of follicle stimulating hormone and duration of controlled ovarian stimulation were lower in the study group compared to control group (2410 ± 656.82 IU vs 2706.82 ± 536.15 IU, p= 0.119 and 8.90 ± 2.13 days vs 9.68 ± 1.29 days, p=0.164, respectively).
CONCLUSION: A multinutrient supplementation given for a minimum of 28 days, may have a positive effect on FORT and lower use of gonadotropin. More and larger sample research is warranted to prove this effect.
MATERIALS AND METHODS: An interview-based qualitative study was conducted in a public university hospital in Malaysia, utilizing in-depth interviews. Audio recordings of the interviews were transcribed verbatim. The transcript data were coded, and the codes were then organized into themes using a thematic analysis approach.
RESULTS: Data from twelve mothers and three fathers among a total of fifteen children with CP were acquired. Nine themes were derived from transcript data namely : HT is a simple home prescription,HT empowers and enhances experiences of care, Negative experience, goal-directed positive attitude, External Support System, physical health as a barrier, psychological health as barrier, limited time and limited external support system.
CONCLUSION: Real-life experiences of parents with CP children regarding HT was explored and valuable outcomes were derived from this study to help clinicians to manage children with CP more efficiently and understand their family dynamics better in the local context. Overall, parents perceived HT as doable and it provided physical, functional, and psychological benefits for them as well as improved their confidence and skills to perform exercises on their children and empowered them to monitor their children's progression.
MATERIALS AND METHODS: We conducted a retrospective cross-sectional study on the VNS done in Malaysia. We included DRE patients from all age groups who underwent VNS from 1st January 2000 to 31st December 2022. We analysed the efficacy of VNS for patients with at least one year of implantation.
RESULTS: A total of 62 implantations were performed from 2000 to 2022. Most patients (52.5%) had implantation at <18 years old, 54.0% had focal seizures, 34.4% had Lennox Gastaut Syndrome and 23.0% had developmental epileptic encephalopathy. A total of 22.6%, 42.8%, and 63.3% of patients achieve ≥ 50% seizure reduction at three months, six months, and one-year post-implantation, respectively. At their last follow-up, 73.5% of patients had ≥ 50% seizure reduction. The majority of responders were at a current intensity of ≥ 2mA (98.0%) and 81.6% were at a duty cycle of ≥35%. No significant difference was found between responders and non-responders by age at implantation, duration of epilepsy, and seizure type.
CONCLUSION: VNS is effective for patients with refractory epilepsy in Malaysia with two-third achieving more than 50% seizure reduction at one year and the last follow-up.
MATERIALS AND METHODS: A prospective, observational crosssectional survey was conducted from 1st May 2022 to 31st December 2022 at the University of Malaya Medical Centre, Kuala Lumpur. This survey included all neurosurgical patients aged 18 and above requiring urgent and semiemergency surgery. The next of kin were interviewed using a standardised questionnaire to obtain their perspectives on the effectiveness of the current consenting process, as well as to explore potential alternative methods for obtaining consent. Data were analysed using IBM SPSS Statistics.
RESULTS: The survey had 103 responses. The analysis revealed that the most common semi-emergency surgical procedures were craniotomy (22 cases) and external ventricular drain insertion (18 cases), followed by burr hole and drainage (14 cases). The most common primary diagnosis that needed urgent intervention was acute hydrocephalus. Interestingly, more than half of the patients (58 cases, 56.3%) had to wait for over 30 minutes to obtain consent from their next of kin prior to surgery. The next of kin interviewed had an age range of 25 to 72 years. The relationships of the next of kin were children (33 subjects), spouses (26 subjects), siblings (25 subjects), and parents (16 subjects) of the patients. Additionally, 96.1% of the respondents owned a smartphone with a mobile internet data connection, and 85.4% had internet connectivity at home. The most preferred method of telecommunication for this exercise was via WhatsApp. An interesting finding was the association between the level of trust in medical professionals and the preferred consent method. It was discovered that individuals who preferred physical consent had lower trust in the hospital and doctors, while those who preferred remote consent had higher trust.
CONCLUSION: The urban Malaysian population are ready to embrace telecommunication for next-of-kin consent in semiemergency neurosurgical scenarios. These findings form a precursor to further studies to develop algorithms for a secure remote digital surgical consenting platform for urgent or semi-emergency surgical cases.
MATERIALS AND METHODS: This descriptive retrospective study featured 221 patients diagnosed with clinically critical COVID-19 from August 2021 to March 2022 in the Intensive Care Unit (ICU) of RSUP Dr. M. Djamil, Padang, Indonesia. The study employed a total sampling technique to collect data from medical records in the hospital. Patients aged 18 years or older who underwent testing for leukocytes, platelets, neutrophils, and lymphocytes were included in the study. We analysed the data using descriptive univariate analysis. Then, the NLR and PLR of the patients were statistically compared based on comorbidities and coincidence.
RESULTS: According to the study, most patients with critically ill COVID-19 exhibited high levels of NLR (88.2%) and PLR (71.1%). The severe COVID-19 patients with comorbidity of kidney disease had the highest NLR (Mean ± SD) of 31.74 ± 27.95 (p-value <0.001) and the highest mean PLR (Mean ± SD) of 469.33 ± 362.95 (p-value 0.001).
CONCLUSION: Our findings showed a significantly higher NLR and PLR in patients with critically ill COVID-19, particularly in patients with comorbidity of kidney disease. Thus, elevated levels of NLR and PLR were identified as potential prognostic markers for predicting disease severity in COVID-19 patients, especially those with kidney comorbidity.
MATERIALS AND METHODS: A total of 119 AA patients had been identified from hospital records of the involved sites, namely Queen Elizabeth Hospital in Sabah, Sarawak General Hospital, Sibu Hospital, Miri Hospital and Bintulu Hospital in Sarawak from Jan 2006 to Dec 2017.
RESULTS: The median age at diagnosis was 46 years, and native ethnic group from Sabah, Kadazan-Dusun, recorded the highest percentage of 41.2%, which could be explained by higher frequency of HLA-DRB1*15:01, an alelle linked to increased risk of AA, among this ethnic group. The majority of patients (59.7%) received cyclosporine (CsA) as monotherapy or in combination with other non-IST agents such as danazol, which was instituted in 48.7% of the patients, while a third of them (33.7%) received antithymocyte globulin (ATG) therapy with or without CsA, and 12.4% underwent allogenic SCT. The five-year overall survival (OS) for all AA patients was 76.1%. Elderly patients >60 years old and those with severe disease had more inferior 5-year survival.
CONCLUSION: A prospective study is warranted to determine the true incidence rate, epidemiological distributions, treatment outcome and overall survival of AA patients in Malaysia. Establishment of allogenic SCT in East Malaysia is imperative to make this curative therapy more accessible to patients with severe disease and improve the outcome.
MATERIALS AND METHODS: This is a retrospective unmatched case-control study. The required data was obtained from the medical records maintained by the University Tanjungpura Hospital, Pontianak City, Indonesia. Simple random sampling was used to select and equally divide the 60 chosen respondents into LBW case and normal birth weight control groups.
RESULTS: Mothers with low educational levels had a 1.5 times greater chance of giving birth to LBW babies. The results of the multivariate analysis also revealed a correlation between gestational age (GA), incidence of premature rupture of membranes (PROM), and intrauterine growth restriction (IUGR) and that their combined effects that contributed to 56% of LBWIs.
CONCLUSION: Low maternal education level, low gestational age, IUGR, and premature rupture of membranes contribute to LBW babies. This study recommends that it is necessary to educate women of childbearing age about routine antenatal care checks to identify risk factors that can lead to LBW.
MATERIALS AND METHODS: A total of 38 anaesthesiology trainees, following 24-hour ICU on-call shifts, were recruited for this single-centre cross-sectional clinical trial. The participants were required to complete two 24-hour on-call duties. Demographic data and baseline sleep quality assessments were collected following the first on-call duty. Upon completion of the second on-call shift, participants underwent 20 minutes of TEAS at bilateral PC6 (Neiguan), LI4 (Hegu), LR3 (Taichong), and ST41 (Jiexi) points. Heart rate variability (HRV) parameters, blood pressure, and heart rate were recorded before and after TEAS. Post-TEAS sleep quality was assessed following an overnight rest.
RESULTS: The results demonstrated a significant reduction in systolic blood pressure compared to baseline (109.5±8.9 vs 111.9±10.1 mmHg, p = 0.006), as well as a significant decrease in diastolic blood pressure (69.3±8.0 vs 70.9±9.0 mmHg, p = 0.037) and heart rate (65.8±9.2 vs 67.4±9.8 bpm, p = 0.034). There was significant improvement in all aspects of sleep quality (p < 0.001). However, no statistically significant changes were observed in heart rate variability (HRV) parameters, including high-frequency (HF) power, lowfrequency (LF) power, and the LF/HF ratio.
CONCLUSION: TEAS may offer potential benefits in managing cardiovascular stress and improving sleep quality in highstress environments, such as post-call recovery. Nevertheless, its impact on autonomic nervous system regulation, as reflected by HRV, appears limited.
MATERIALS AND METHODS: Participants from the governmental departments were recruited and divided into intervention group and control group. A translated and validated questionnaire on awareness and knowledge related to glaucoma were used. Educational interventions were given for both groups. Post-test assessments were completed at one month and three months post intervention.
RESULTS: A total of 202 participants enrolled for the study (102 intervention group and 100 control group). 64.9% of the participants were aware of glaucoma and 49% of the participants had good knowledge score on glaucoma. Higher educational attainments (bachelor and diploma holders) were the only factors significantly associated with good glaucoma knowledge (p <0.001). There was significant increase in the proportion of good glaucoma knowledge in the intervention group one month after the educational intervention (p < 0.001) and the effect persisted after three months (p < 0.003). There was also significantly higher proportion of good post-test glaucoma knowledge between intervention and control group (p = 0.003).
CONCLUSION: Although the public was well aware of glaucoma, there was relatively little understanding of the condition. Educational interventions can be effective to bridge the gap in promoting the glaucoma awareness and better understanding of glaucoma.
MATERIALS AND METHODS: Eighty-eight patients diagnosed with AS were enrolled from the Rheumatology Unit at Baghdad Teaching Hospital. Participants were categorized into two groups based on disease status: inactive (n = 44) and active (n = 44). Additionally, 44 matched healthy individuals were included as controls. Comprehensive medical histories were obtained, including disease duration, body mass index, sex, and age. Laboratory parameters related to the disease-such as C-reactive protein, human leukocyte antigen (HLA-B27), and rheumatoid factor-were also measured. Serum IL-41 levels were quantified using an enzyme-linked immunosorbent assay.
RESULTS: The study revealed a significant difference in levels of IL-41 in patients with AS (17.721±0.705 ng/L) compared to controls (8.495±0.984 ng/L; P = 0.009). The mean serum IL-41 concentration was highest in the active group (23.037±5.268 ng/L), followed by the inactive group (12.411±1.672 ng/L; p = 0.001) and controls (8.495±0.984 ng/L). Serum IL-41 levels demonstrated strong validity for diagnosing AS, with a cutoff value of ≥ 9.35 ng/mL and an area under the curve of 0.991. The sensitivity, specificity, and accuracy were 97.7%, 79.5%, and 92.38%, respectively (p = 0.002).
CONCLUSIONS: IL-41 is a potential new diagnostic biomarker for AS and associated with patient's disease activity. These insights could potentially transform the way we diagnose and manage AS, offering new avenues for improved patient care and outcomes.
MATERIALS AND METHODS: Articles from Scopus, Web of Science and PubMed databases were collected following PRISMA guidelines. Key term searches included "video recording," "ethical issues," and "patients." Inclusion criteria encompassed video and audio recording interactions between healthcare providers and patients in any clinical setting, final publications, and the English language. Exclusions were imaging or photography recording and non-clinical settings. The qualitative synthesis involved iterative reading, thematic coding analysis in Excel, and specific analysis to address the research question.
RESULTS: Initial database search, identified 363 records. After screening, a total of 22 articles were included for analysis. Five themes were identified from the selected articles: i) privacy and confidentiality, ii) informed consent, iii) beneficence and non-maleficence, iv) integrity and professionalism and v) governance, policy and legal framework. Majority of the reviewed articles concentrate on backgrounds within the fields of psychiatry, neurology and surgical-based medical specialities. The identified themes have demonstrated consistency across the majority of the articles analysed. Among the most frequently discussed themes, it's evident that ethical concerns extend beyond just the patient's realm to encompass the responsibilities of the healthcare provider (HCP) as well. Both patients and HCPs have their respective rights and responsibilities in ensuring the ethical use of video recording in clinical settings.
CONCLUSION: In conclusion, this review has highlighted the multifaceted ethical challenges surrounding the integration of video recording in healthcare settings. While video recording offers benefits for patient care, education, and quality improvement, its adoption presents complexities. Ethical dilemmas concerning patient privacy, consent, and data management must be addressed alongside practical barriers like technological limitations and resource constraints. Collaboration among healthcare providers, policymakers, and stakeholders is crucial to navigating these challenges ethically. Future research should delve into patient perspectives, develop ethical guidelines, and assess the impact of video recording on patient outcomes. By understanding these implications, healthcare can effectively leverage video recording to improve patient care while maintaining ethical standards.
METHODS: Dietary habits were assessed using a validated semi-quantitative, investigator-administered food frequency questionnaire from the International Study of Asthma and Allergies in Childhood. We derived an amount-based dietary index to estimate fiber intake while studying its correlation with probiotic drinks intake. AD status was determined by skin prick tests for HDM and symptomatic histories of eczema. Multivariable logistic regression analysis, adjusting for demographic, genetic predisposition, body mass index and lifestyle factors, and synergy factor analysis were used to explore the association and interaction of dietary factors on disease outcomes.
RESULTS: High fiber intake (approximately 98.25 g/serving/week) significantly lowered the associated risks for HDM allergy (Adjusted Odds Ratio [AOR]: 0.895; 95% Confidence Intervals [CI]: 0.810-0.989; adjusted p-value