Browse publications by year: 2024

  1. Boon WJ, Yee LW, Kin FS, Tang IP, Awang Basry NS, Kevin Ng BH
    Indian J Otolaryngol Head Neck Surg, 2024 Dec;76(6):5459-5463.
    PMID: 39559016 DOI: 10.1007/s12070-024-05001-2
    Ceruminous adenoma is a rare and benign tumor of the external auditory canal and present with a nonspecific symptom. Biopsy with histopathology examination is required to establish the diagnosis. Wide local excision of tumour shows favourable outcome with a low recurrence rate. Here, we present a case of ceruminous adenoma masquerading as a furunculosis.
  2. Salim I, Mohd Saad MS, Ahmad Kailani AAA, Md Daud MK
    Indian J Otolaryngol Head Neck Surg, 2024 Dec;76(6):6009-6012.
    PMID: 39559024 DOI: 10.1007/s12070-024-05054-3
    Skull base osteomyelitis (SBO) is a rare and lethal infection of temporal bone, uncommonly caused by purulent otitis media. Although uncommon, a young and immunocompetent person is not exceptional to develop SBO as in our case. We reported a case of SBO in a young, immunocompetent gentleman who presented with right otorrhea associated with fever, trismus, headache, and neck stiffness, which was unresponsive to oral and topical antibiotics. Examination revealed fullness at the right mastoid tip with no evidence of mastoid abscess, trismus, with restrictions of neck movements. Otoscopy of right ear showed mucopus with 10% anterosuperior tympanic membrane perforation without keratin or granulation tissue. Pus for culture and sensitivity grew Klebsiella pneumonia and computed tomography (CT) showed osteomyelitic changes with associated parapharyngeal collection. The patient was started on intravenous antimicrobial therapy and responded well to the treatment.
  3. Razuan NA, Baghawi A, Mohd Tamrin MI, Raja Gopal N, Saniasiaya J
    Indian J Otolaryngol Head Neck Surg, 2024 Dec;76(6):6046-6050.
    PMID: 39559026 DOI: 10.1007/s12070-024-05080-1
    Anaplastic thyroid carcinoma (ATC) has been regarded as the rarest form of thyroid malignancy, which entails around 2% of thyroid malignancies. It traditionally presents with rapidly enlarging anterior neck swelling with obstructive symptoms. Due to its rich blood supply and lymphatic drainage, the thyroid gland is resistant to infection. Parallel to that, the presentation of thyroid abscess frequently points towards an underlying upper respiratory tract infection. We present a case involving an elderly female presenting with a thyroid abscess, which later turned out to be ATC following a histopathological diagnosis of the thyroid gland. The initial cytology workout was negative for malignancy. We highlight the relatively uncommon presentation along with its management.
  4. Md Ali SRA, Mohd Nor K, Abu Bakar S, Sheikh Ab Hamid S
    Indian J Otolaryngol Head Neck Surg, 2024 Dec;76(6):5861-5863.
    PMID: 39559060 DOI: 10.1007/s12070-024-04924-0
    We present a case report of congenital nasal pyriform aperture stenosis, in which the child was managed with a series of less invasive surgical procedures, which were eventually followed by repair via a sublabial approach. This case report aims to highlight that in severe stenosis, earlier open surgical intervention with bone drilling is suggested, as dilatation alone will result in recurrent stenosis. Open surgery with bone drilling not only facilitates faster recovery but also aids in oxygen weaning, shortens hospitalization duration, and reduces the risk of complications.
  5. Ghauth S, Yew Toong L
    Indian J Otolaryngol Head Neck Surg, 2024 Dec;76(6):5847-5851.
    PMID: 39559073 DOI: 10.1007/s12070-024-04847-w
    Mastoid fistula is a rare condition, its causes include chronic suppurative otitis media and repeated ear surgeries. Management is challenging, simple closure typically leads to recurrence due to surrounding necrotic skin edges. Several surgical techniques have been described. In this paper, we present a case of a 60 year old lady who presented with chronic right ear discharge post radical mastoidectomy due to acquired cholesteatoma. At presentation, there was a mastoid opening found over her auricular sulcus, endoscopic examination showed a well epithelized mastoid cavity with mucopurulent discharge, CT of temporal bone correlated with physical findings. The fistula was surgically closed with a three-layer pedicled flap and the fistula was fully healed at the 1-month follow up.
  6. Hayat J, Ali Y, Hussain S, Ramadhan M, Al-Gilani M
    Indian J Otolaryngol Head Neck Surg, 2024 Dec;76(6):5009-5024.
    PMID: 39559074 DOI: 10.1007/s12070-024-04972-6
    To discuss the prevalence of amaurosis post-bilateral radical neck dissections; and to provide a management algorithm that highlights the approaches undertaken in available literature to minimize incidence and maximally improve outcomes. This objective will be achieved by systematically reviewing and highlighting current literature. We systematically reviewed Pubmed, EMBASE, and Web of Science for articles pertaining to the management of amaurosis post-bilateral neck dissection. A comprehensive search of available literature was conducted by two independent authors to yield 23 articles to be included in the review. Due to the heterogeneity of study designs and outcome measures, findings were summarized and analyzed descriptively. 23 cases were reported between 1960 and 2021; n = 21 were reported through case reports. Neck dissection type alongside pharyngectomy (n = 7) and laryngectomy (n = 13) status were documented. Mean symptomatic onset was 7.3 ± 5.561 days; median onset n = 3. Seven reported symptoms post-operative day (POD) 0. n = 17 patients underwent bilateral radical neck dissections. n = 16 patients reported intraoperative hypotension. Investigations the patients underwent were documented. The most common causes of the disease included posterior ischaemic optic neuropathy (PION) (n = 8) and anterior ischaemic optic neuropathy (AION) (n = 5). The mean transfused amount of blood was 750 ml. The most common management of amaurosis post-bilateral neck dissection were through high dose corticosteroids. Mannitol and acetazolamide were also documented managements of the condition. Overall, there is a paucity of evidence pertaining to the management of amaurosis post-bilateral neck dissection; highlighting the importance of reviewing the available literature and proposing a management algorithm.
  7. Yee LW, Jumastapha H, Tang CL, Tang IP
    Indian J Otolaryngol Head Neck Surg, 2024 Dec;76(6):5833-5838.
    PMID: 39559088 DOI: 10.1007/s12070-024-05113-9
    Sinonasal carcinoma, a rare and challenging malignancy, originating in the nasal cavity and paranasal sinuses, poses diagnostic and management complexities. This 8-year retrospective analysis at Sarawak General Hospital aims to elucidate demographic trends, histopathological entities, and management outcomes, shedding light on this multifaceted malignancy. Emphasizing the significance of accurate histopathological classification, the study explores the impact on prognostication and treatment strategies. Spanning 2013 to 2021, the study involved 54 patients with sinonasal malignancies. Demographic, clinical, and histopathological details were examined, adhered to the AJCC staging criteria. Analysis involved demographic distributions, tumour characteristics, treatment modalities, and instances of treatment failure. Statistical analysis was done using SPSS version 29.02. The cohort, predominantly male (57.4%) and of Iban ethnicity (44.4%), with a mean age of 52.8 years, exhibited diverse histopathologies, with squamous cell carcinoma as the most common (38.9%). Epistaxis and nasal blockage were common clinical presentations. Advanced stages (III and IV) were prevalent, with the nasal cavity as the primary site. Surgical interventions, mainly endoscopic endonasal excision, were complemented by adjuvant therapies. Complications occurred in 24% of cases. The study highlights a male predilection, occupational risk factors, and a significant association between tobacco smoking and sinonasal cancers. Surgical interventions predominantly utilized the endoscopic approach. Despite a mean survival of 46.6 months, treatment failure occurred in 29.6% of cases, with recurrence and metastasis. Histopathological analysis revealed comparable 5-year disease survival rates between squamous and non-squamous histologies. Treatment failure was significantly associated with the mode of surgery, with open surgery showing a lower incidence. However, nodal status, histopathology types, T staging, and overall staging did display positive associations with treatment failure. This 8-year review provides comprehensive insights into sinonasal carcinoma, addressing demographic, clinical, and histopathological dimensions. The study underlines the complexity of managing this challenging malignancy, emphasizing the need for a holistic approach to patient care. The findings contribute to the understanding of sinonasal carcinoma, guiding clinical decision-making and fostering further research.
  8. Zakir NNM, Lazim NM, Zin AAM, Haron A, Abdullah B
    Indian J Otolaryngol Head Neck Surg, 2024 Dec;76(6):5470-5477.
    PMID: 39559137 DOI: 10.1007/s12070-024-05007-w
    AIMS: This study aimed to investigate the relationship between human papillomavirus (HPV) infection and the development of salivary gland tumour (SGT) by evaluating the expression of p16 and the oncoproteins HPV16-L1 and HPV18-E6 using immunohistochemical (IHC) staining. Additionally, we assess the agreement between these oncoproteins and p16 in diagnosing HPV-infected SGT.

    METHODS: This cross-sectional study included all SGT cases undergoing surgical resection at Hospital Universiti Sains Malaysia (HUSM) and Hospital Raja Perempuan Zainab II (HRPZ) in Malaysia from April 2022 to April 2023. IHC staining was performed on paraffin-embedded tissues at the Pathology Laboratory, HUSM, to evaluate the expression of p16, HPV16-L1, and HPV18-E6 oncoproteins. The clinicopathological data were correlated with the staining results.

    RESULTS: 49 SGT cases were identified, mainly in middle-aged Malay women, with most tumours originating from the parotid gland. Malignant tumours included mucoepidermoid carcinoma (22.4%), adenoid cystic carcinoma (4.1%), acinic cell carcinoma (4.1%), and adenocarcinoma (2%). Benign tumours primarily consisted of pleomorphic adenoma (49%) and Warthin tumours (16.3%). Positive p16 expression was detected in 67% of cases, while HPV16 and HPV18 were detected in 65% and 90% of tumours, respectively. HPV16-L1 exhibited 75.8% sensitivity and 56.3% specificity, while HPV18-E6 showed 100% sensitivity and 31.2% specificity compared to p16.

    CONCLUSION: The study findings suggest a correlation between the presence of high-risk HPV types 16 and 18 and the development of SGT, as evidenced by the overexpression of p16, HPV16-L1, and HPV18-E6 oncoproteins. Both HPV16-L1 and HPV18-E6 tests are acceptable, reliable, and sensitive for detecting high-risk HPV in SGT.

  9. Apandi A, Gendeh HS, Zakaria SNA, Mohamad A, Borian ND
    Indian J Otolaryngol Head Neck Surg, 2024 Dec;76(6):5839-5842.
    PMID: 39559145 DOI: 10.1007/s12070-024-04779-5
    Extraluminal foreign bodies are rare. Fish bone is the most common foreign body ingested by adults, while coin is the most common foreign body ingested among children. Sharp pricking pain is a sign of sharp foreign body (FB) ingestion. If the symptom persists, one should keep in mind the possibility of a migratory foreign body, even if the esophagoscopy results are negative. In order to ensure that foreign bodies are not missed radiologically, there is the role of consultation from a second radiologist to correlate with the patient's symptoms. Here we present an atypical case of recurrent neck abscess due to a migrating fishbone that penetrated the left thyroid lobe and settled in the left lower third neck subcutaneous tissue within two months.

    SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-024-04779-5.

  10. Nath H, Adhikary SK, Alsulamy S, Kafy AA, Rahaman ZA, Roy S, et al.
    Heliyon, 2024 Nov 15;10(21):e40005.
    PMID: 39559207 DOI: 10.1016/j.heliyon.2024.e40005
    Urban noise pollution poses significant challenges to public health and environmental sustainability, particularly in rapidly developing tourist destinations. Noise pollution and associated annoyance level in five major intersections of Cox's Bazar City, Bangladesh, was assessed in this study during the peak tourist season. Noise measurements were conducted using various indices (L10, Leq, and TNI) across morning, midday, and afternoon time slots. TNI scores were compared with Mean Dissatisfaction Score (MDS) standards to assess traffic-induced noise annoyance levels. Additionally, a survey of 675 respondents was conducted to assess their perceptions of noise pollution. Statistical analyses included linear regression for noise indices, multinomial logistic regression for TNI-related dissatisfaction, and ordinal logistic regression for respondents' perceived annoyances. Results revealed significant noise pollution issues, with Leq scores consistently exceeding national guidelines across all intersections and time periods, particularly on weekends during afternoon timeslots. TNI values frequently surpassed standard dissatisfaction regulations, with 19 out of 105 time slots exhibiting extreme dissatisfaction levels. Link Road and Kolatoli Circle intersections consistently showed higher noise levels and dissatisfaction. Over 95% of survey respondents perceived increased noise pollution during peak tourist seasons, with 87.11% describing it as "extremely" or "very" noisy. Longer exposure duration and awareness of health risks were significantly associated with reported perceived annoyance levels. Respondents reported various health impacts, including annoyance (84.44%), headaches (62.37%), and cognitive impairment (44.44%). This comprehensive study provides valuable insights for policymakers, city planners, and environmentalists to develop sustainable urban strategies that balance the acoustic environment with the well-being of residents and tourists alike.
  11. Gan EH, Woo WW, Seng KF, Singh P, Lee MY, Kong VY, et al.
    Clin Ophthalmol, 2024;18:3249-3262.
    PMID: 39559252 DOI: 10.2147/OPTH.S476779
    BACKGROUND: Ocular surface disease (OSD) severity varies among glaucoma patients and is exacerbated by intraocular pressure (IOP)-lowering medications.

    PURPOSE: To determine OSD prevalence and dry eye severity among glaucoma patients at nine private clinics in Malaysia.

    METHODS: This multicentre, cross-sectional observational study recruited glaucoma patients undergoing routine eye examinations, with IOP ≤21mmHg receiving anti-glaucoma eye drops. OSD was assessed through National Eye Institute (NEI) scoring, tear film break-up time (TBUT), hyperaemia grading, Schirmer's tests and questionnaires on symptom evaluation, OSD index and quality of life (QoL).

    RESULTS: Our cohort (n = 406, mostly male, ethnically Chinese, mean 63.5 ± 11.5 years, mean IOP 15.34 ± 2.95mmHg) frequently used prostaglandin analogues or PGA/beta-blockers and had cornea total NEI scores of 3.64 ± 2.76, mostly with minimal (51.2%) or mild (40.4%) epitheliopathy. Mean TBUT was 6.59 ± 3.08s (25.0%) in patients with severe lipid deficiency dry eye (DE). Bulbar conjunctiva hyperemia (70.4%) and palpebral conjunctiva hyperemia (68.0%) were mild. Schirmer's test showed that most had tear deficiency (70.2%) with severe DE (38.9%). Questionnaires reported ocular symptoms in few patients, but 69.2% had DE symptoms (13.1% moderate/severe). While QoL was good, several patients had QoL and OSD index scores suggesting some adaptation to ocular symptoms and discomfort, with most patients being unconcerned (43-60%) by the occurrence of eye drop side effects (75.4%).

    CONCLUSION: Normal-mild DE or OSD can be asymptomatic, and the symptoms are unlikely to bother most patients. However, as OSD severity varies in patients with glaucoma, it should be evaluated using questionnaires and clinical tests to ensure that subjectively asymptomatic individuals are not missed.

  12. Chellapan T, Mat Daud N, Narayanasamy S
    Int J Ophthalmol, 2024;17(11):2093-2099.
    PMID: 39559302 DOI: 10.18240/ijo.2024.11.16
    AIM: To determine the smartphone use patterns and effects of smartphone use on accommodation and convergence system of the eyes among Malaysian teenagers.

    METHODS: A total of 62 participants aged between 13 and 17y were involved. A self-administered questionnaires containing 12 items was used to evaluate the smartphone usage patterns. This was followed by an eye examination, involving a battery of accommodation and convergence assessments before and after the smartphone use. The data analysis comprised descriptive statistics, paired t-test, and correlation coefficients.

    RESULTS: The use of smartphones is at a high level and at an optimal distance daily, with more than 6h a day watching video films, games, and completing school projects. Majority of the participants not reported eye strain factors and eye prescription changes with the use of digital devices. The use of a smartphone continuously for 30min was found to significantly decrease amplitude of accommodation, accommodative facility, and positive relative accommodation (P<0.001). Meanwhile, the lag of accommodation parameters and negative relative accommodation increased with the use of smartphones significantly (P<0.001). The near point of convergence (NPC) and distance and near negative fusional vergence decreased significantly (P<0.001). The NPC parameter was found to have a weak negative association with the frequency of smartphone use (R=-0.276, P<0.05).

    CONCLUSION: Frequent and continuous use of smartphones have increased visual stress and resulted in weakness of accommodation and vergence functions. Therefore, frequent break is mandatory when using a smartphone and appropriate visual hygiene, the 20-20-20 rule (every 20min, view something 20 feet away for 20s) are required during smartphone use to maintain visual function.

  13. Chimplee S, Mitsuwan W, Zulkifli M, Eawsakul K, Ongtanasup T, Sangkanu S, et al.
    PeerJ, 2024;12:e18452.
    PMID: 39559326 DOI: 10.7717/peerj.18452
    BACKGROUND: Acanthamoeba spp. is a waterborne, opportunistic protozoan that can cause amebic keratitis and granulomatous amebic encephalitis. Knema retusa is a native tree in Malaysia, and its extracts possess a broad range of biological activities. Niosomes are non-ionic surfactant-based vesicle formations and suggest a future targeted drug delivery system. Copolymer micelle (poly(ethylene glycol)-block-poly(ɛ-caprolactone); PEG-b-PCL) is also a key constituent of niosome and supports high stability and drug efficacy. To establish Knema retusa extract (KRe) loading in diverse nanocarriers via niosome, PEG-b-PCL micelle, and their combination and to study the effect of all types of nanoparticles (NPs) on Acanthamoeba viability, adherent ability, elimination of adherence, and cytotoxicity.

    METHODS: In this study, we characterized niosomes, PEG-b-PCL, and their combination loaded with KRe and tested the effect of these NPs on Acanthamoeba triangularis stages. KRe-loaded PEG-b-PCL, KRe-loaded niosome, and KRe-loaded PEG-b-PCL plus niosome were synthesized and characterized regarding particle size and charge, yield, encapsulation efficiency (EE), and drug loading content (DLC). The effect of these KRe-loaded NPs on trophozoite and cystic forms of A. triangularis was assessed through assays of minimal inhibitory concentration (MIC), using trypan blue exclusion to determine the viability. The effect of KRe-loaded NPs was also determined on A. triangularis trophozoite for 24-72 h. Additionally, the anti-adhesion activity of the KRe-loaded niosome on trophozoites was also performed on a 96-well plate. Cytotoxicity activity of KRe-loaded NPs was assessed on VERO and HaCaT cells using MTT assay.

    RESULTS: KRe-loaded niosome demonstrated a higher yielded (87.93 ± 6.03%) at 286 nm UV-Vis detection and exhibited a larger size (199.3 ± 29.98 nm) and DLC (19.63 ± 1.84%) compared to KRe-loaded PEG-b-PCL (45.2 ± 10.07 nm and 2.15 ± 0.25%). The EE (%) of KRe-loaded niosome was 63.67 ± 4.04, which was significantly lower than that of the combination of PEG-b-PCL and niosome (79.67 ± 2.08). However, the particle charge of these NPs was similar (-28.2 ± 3.68 mV and -28.5 ± 4.88, respectively). Additionally, KRe-loaded niosome and KRe-loaded PEG-b-PCL plus niosome exhibited a lower MIC at 24 h (0.25 mg/mL), inhibiting 90-100% of Acanthamoeba trophozoites which lasted 72 h. KRe-loaded niosome affected adherence by around 40-60% at 0.125-0.25 mg/mL and removed Acanthamoeba adhesion on the surface by about 90% at 0.5 mg/mL. Cell viability of VERO and HaCaT cells treated with 0.125 mg/mL of KRe-loaded niosome and KRe-loaded PEG-b-PCL plus niosome exceeded 80%.

    CONCLUSION: Indeed, niosome and niosome plus PEG-b-PCL were suitable nanocarrier-loaded KRe, and they had a greater nanoparticle property to test with high activities against A. triangularis on the reduction of adherence ability and demonstration of its low toxicity to VERO and HaCaT cells.

    MeSH terms: Animals; Antiprotozoal Agents/pharmacology; Antiprotozoal Agents/chemistry; Cell Adhesion/drug effects; Humans; Liposomes*; Micelles; Plant Extracts/pharmacology; Plant Extracts/chemistry; Polyesters/pharmacology; Polyesters/chemistry; Drug Delivery Systems/methods; Nanoparticles/chemistry
  14. Mahmud AA, Mohamad Rom FZ, Suain Bon R, Miskan M, Haque M
    Cureus, 2024 Nov;16(11):e73676.
    PMID: 39559433 DOI: 10.7759/cureus.73676
    BACKGROUND:  This cross-sectional study among the employees of the National Defense University of Malaysia (NDUM) assessed the levels of depression, anxiety, and fear related to COVID-19 and its association with psychosocial factors. It was conducted during the strict lockdown period imposed by the Malaysian government due to the COVID-19 pandemic.

    METHODS:  A stratified sampling method was used, and 277 employees were randomly selected to participate in the study. Generalized anxiety disorder (GAD-7) was used to measure anxiety symptoms. Patient health questionnaire (PHQ-9) was utilized to assess depression. The fear of COVID-19 (FOC) was calculated using the Fear of COVID-19 Scale (FCV), while the psychosocial factors affecting psychological impact were measured using a self-generated questionnaire.

    RESULTS:  The study obtained a response rate of 46.2% (n=128). Most respondents were female, married, permanent employees, and from the non-academic group. Depressive and anxiety symptoms were reported by 47% (n=55) and 32.5% (n=38) of the respondents, respectively. Statistically, a higher level of fear related to COVID-19 was found among non-academic employees (p=0.015) and those with permanent employment status (p=0.030). Anxiety was significantly correlated with depression (r=0.70, p≤0.001), while no correlations were found between these factors and fear related to COVID-19. Taking over school lessons was the most troubling factor that affected the respondents' level of distress, followed by working from home and worrying about their family member's health.

    CONCLUSIONS:  This study identified significant psychological effects of the pandemic on university employees, with anxiety and depression being notably correlated. While the generalizability of the findings is limited due to a low response rate, several key psychosocial distress factors were identified. These findings emphasize the necessity of addressing psychosocial factors to mitigate the mental health impact of pandemics. Further research with a higher response rate is required to confirm these findings and to design targeted interventions to support affected employees.

  15. Shrestha S, Sapkota S, Paudyal V, Moon Z, Horne R, Gan SH
    J Pain Res, 2024;17:3741-3753.
    PMID: 39559457 DOI: 10.2147/JPR.S455852
    BACKGROUND: Adherence to pain medication is crucial for cancer patients, since non-adherence can lead to increased suffering, reduced quality of life and increased healthcare costs. Although the five-item Medication Adherence Report Scale (MARS-5) is a validated tool for assessing medication adherence, but it has not been translated and validated into the Nepalese language. This study aimed to translate, culturally adapt and validate the MARS-5 in Nepalese language for Nepalese cancer patients who were experiencing pain.

    MATERIALS AND METHODS: The cross-sectional validation study utilized a convenience sampling method. Initially, a pre-test was conducted with 25 patients. The MARS-5 was then forward and backward translated following the EORTC QLG translation procedure. The final translated version was reviewed by experts and subjected to a second pre-test. Construct validity was assessed through principal component analysis, and internal consistency was measured using Cronbach's alpha coefficient. Inter-rater reliability was evaluated using the Intra-Class Correlation coefficient (ICC).

    RESULTS: The study included 204 cancer patients (ages 18-86, 55% female). The Nepalese version of the MARS-5 was translated without significant issues and underwent pre-testing with participants. Participants discussed the scale during these pre-tests, providing feedback on its clarity and comprehensibility. While formal assessment tools were not employed, the iterative nature of the pre-testing process allowed for the refinement of the translation based on participant feedback, indicating a robust understanding of the scale among participants. The ICC of test-retest reliability was found to be 0.860. The Kaiser Meyer Olkin's value was 0.690, and Cronbach's alpha was 0.72, indicating good construct validity and high internal consistency. The medication non-adherence rate was 11.3%.

    CONCLUSION: The MARS-5 was successfully translated, culturally adapted, and validated in Nepalese for use among Nepalese cancer patients experiencing pain. The Nepalese version of MARS-5 is a reliable tool for evaluating medication adherence in this population.

  16. Abdul Aziz A, Yusoff M, Yaacob WFW, Mustaffa Z
    MethodsX, 2024 Dec;13:103013.
    PMID: 39559463 DOI: 10.1016/j.mex.2024.103013
    Forecasting COVID-19 cases is challenging, and inaccurate forecast values will lead to poor decision-making by the authorities. Conversely, accurate forecasts aid Malaysian government authorities and agencies (National Security Council, Ministry of Health, Ministry of Finance, Ministry of Education, and Ministry of International Trade and Industry) and financial institutions in formulating action plans, regulations, and legal acts to control COVID-19 spread in the country. Therefore, this study proposes Repeated Time-Series Cross-Validation, a new data-splitting strategy to identify the best forecasting model that is capable of producing the lowest error measures value and a high percentage of forecast accuracy for COVID-19 prediction in Malaysia. Some of the highlights of the proposed method are:•A total of 21 models, five data partitioning sets, and four error measures to improve the forecast accuracy of daily COVID-19 cases in Malaysia.•The best model selected produces the lowest error measure value for the Root Mean Squared Error (RMSE), Mean Absolute Error (MAE), Mean Absolute Percentage Error (MAPE), and Mean Absolute Scaled Error (MASE).•The average 8-day forecast accuracy is 90.2 %. The lowest and highest forecast accuracy was 83.7 % and 98.7 %.
  17. Zhu W, Ann Chai C, Ma J, İlker Gökce M, Gadzhiev N, Kalathia J, et al.
    Eur Urol Open Sci, 2024 Dec;70:167-173.
    PMID: 39559532 DOI: 10.1016/j.euros.2024.10.014
    Guidelines recommend percutaneous nephrolithotomy (PCNL) for larger renal stones, but advances in flexible ureteroscopy (f-URS) with a tip-bendable suction ureteral access sheath (S-UAS) have prompted further investigation. Our multicenter, international, randomized controlled trial is investigating whether f-URS with S-UAS is noninferior to mini-PCNL (mPCNL) for renal stones of 2-3 cm. The primary objective is the immediate stone-free rate (SFR). Secondary outcomes include the 3-mo SFR, complication rates, surgical time, hospital stay, auxiliary procedures, and improvements in quality of life. A total of 720 patients from 12 urological centers will be randomized to either f-URS with S-UAS or PCNL. Statistical analyses will include intention-to-treat and per-protocol approaches, with specific methods for normally and non-normally distributed data. Subgroup analyses will focus on stone location and lithotripter types. The significance threshold will be set at p 
  18. Cheong XP, Lim LM, Chang CY
    Cureus, 2024 Oct;16(10):e71814.
    PMID: 39559649 DOI: 10.7759/cureus.71814
    Invasive Klebsiella syndrome is a potentially life-threatening condition primarily caused by hypervirulent strains of Klebsiella pneumoniae. It is characterized by severe infections that metastasize to various organs, including the liver, lungs, eyes, and brain. We present a case of invasive K. pneumoniae syndrome in Malaysia, highlighting the aggressiveness of the disease. The case involves a 44-year-old woman with diabetes mellitus who developed cavitary pneumonia, pulmonary embolism, and pleural effusion, requiring prolonged antibiotic treatment and drainage. This case highlights the need for early diagnosis and extended antibiotic therapy to improve patient outcomes.
  19. Rawindran H, Khoo KS, Satpati GG, Maity S, Chandran K, Lim JW, et al.
    J Sci Food Agric, 2024 Nov 19.
    PMID: 39559900 DOI: 10.1002/jsfa.14038
    Microalgae are widely recognized for their capacity to generate value-added products in a variety of sectors, including the pharmaceutical and food industries, bioenergy industries and wastewater industries. The quality of a microalga is significantly influenced by its proliferation. Along with growth, the biochemical profile may also vary based on the nutrient that is supplemented. The majority of the supplemented nutrients utilized are not in a functional state, as they are typically extracted in liquid form or pretreated prior to use. Parallel to numerous commonly applied pretreatment processes, including chemical, mechanical and biological, thermal pretreatment appears to receive less attention. Hence it is crucial to comprehend the potential for thermal pretreatment as well as its mechanism in militating the solid waste to release additional nutrients in order to enhance the biochemical profile of microalgae. The current review takes a closer look at the impact of various thermal pretreatments on solid waste on influencing microalgal performance in terms of their overall biochemical profiles such as carbohydrates, proteins and lipids. This approach is likely to enhance the circular economy by utilizing waste products and effectively closing the loop on waste. © 2024 Society of Chemical Industry.
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