METHODS: This qualitative study examined the experiences of cancer patients with the CCTI program in Malaysia. Semi-structured interviews were conducted with 23 respondents, both CCTI recipients and non-applicants, from eight public hospitals. Data were anlaysed using the RE-AIM framework, focusing on the dimensions of reach, adoption, and implementation.
RESULTS: Patients' awareness of the CCTI varied, with recipients mostly informed through acquaintances, media, or healthcare providers. Non-recipients lacked awareness, with limited information provided by healthcare personnel. While the CCTI was perceived as valuable for alleviating financial burdens, particularly transportation costs, it did not appear to significantly influence treatment-seeking behaviours, as most patients expressed willingness to continue treatment even without financial aid. Implementation challenges included a burdensome application process requiring mandatory health screening, lack of clarity regarding procedures, and inadequate communication about claim approvals. Patients frequently encountered delays and confusion, exacerbated by insufficient support from healthcare providers. Additionally, many were unaware that transport incentives could be claimed for every hospital visit, further limiting the program's usefulness.
CONCLUSIONS: The study highlights critical gaps in the CCTI program's design and delivery, including inadequate communication strategies, complex administrative processes, and a lack of transparency. Addressing these challenges are essential to improve program reach and ensuring equitable access to CCTI. Policymakers should prioritise streamlining application process, enhancing information dissemination, and leveraging digital tools to improve patient experiences. Future studies should assess the program's long-term sustainability and impact on treatment adherence and outcomes. The findings underscore the importance of adopting patient-centred approaches in designing financial aid programs to enhance healthcare equity and access.
METHODS: The model was tested on participants newly admitted between June 2022 and December 2023 to one of the two selected prisons, one for pretrial detention and the other for serving sentences. It features a streamlined test-and-treat procedure within prisons, encompassing anti-HCV (exposure) testing, HCV ribonucleic acid (RNA) (current infection) testing, pretreatment assessments, and treatment initiation. The outcome assessment focused on (I) screening coverage, (II) implementation success across the HCV care cascade, ranging from anti-HCV detection, HCV RNA confirmation, treatment initiation, and completion to a sustained virological response rate and (III) practicality within resource-limited prison environments.
RESULTS: All 18,811 (100%) newly admitted participants were screened for HCV during the study period, with 4,054 (21.6%) of them testing positive for anti-HCV (HCV exposure). A total of 793 (19.6%) participants underwent HCV RNA testing, with 655 (82.6%) confirmed to have HCV infection. Those with HCV RNA test results were mainly male (98.1%), with nearly half (48.2%) aged 40-49 years. A vast majority (95.7%) reported at least one HCV risk factor, primarily injection drug use (95.2%). Of the 655 participants with a positive HCV RNA test, 648 (98.9%) completed pretreatment assessments. Antiviral treatment was initiated in 319 (49.2%) of them, with 165 (51.7%) completing the full course. Among those who completed treatment, 80 (48.5%) underwent HCV RNA testing 12 weeks after treatment, with 77 (96.3%) achieving a sustained virologic response.
CONCLUSION: This new prison-based test-and-treat model for HCV infection demonstrates promising feasibility, as indicated by high screening coverage and successful implementation across the HCV care cascade using existing resources. These findings suggest the potential for broader adoption of this model in correctional facilities. Further research is needed to improve treatment completion and address factors contributing to dropout.
METHODS: Eighty-two extracted premolar teeth with single canals, infected with Enterococcus faecalis (E. faecalis) and cultured for two weeks, were randomly assigned to four groups: negative control, 4% sodium hypochlorite (NaOCl), 60 s HIFU, and 120 s HIFU (operated at 250 kHz/20W). Post-treatment, biofilm samples were collected from the root canals to assess viable bacterial cells using colony-forming unit (CFU) and 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assays. The root canal surfaces were subsequently examined using scanning electron microscopy, confocal laser scanning microscopy (CLSM), microhardness, and Raman spectroscopy. Acoustic wave penetration, distribution, and temperature changes within the RCS were examined using CLSM and thermal camera.
RESULTS: HIFU at 60 s and 120 s consistently demonstrated superior anti-bacterial efficacy against E. faecalis biofilms compared to 4% NaOCl. MTT and CFU assays revealed a significant reduction in biofilm viability, particularly at 120 s of HIFU exposure (p<0.05). CLSM and SEM analyses demonstrated enhanced penetration and detachment of biofilms, as well as improved smear layer removal and preservation of dentinal tubules, especially at 120 s of HIFU exposure. HIFU treatment did not adversely affect the amide/mineral content of root dentine or its surface microhardness. Additionally, HIFU enhanced acoustic wave propagation and resulted in a controlled increase in temperature within the root canal over time.
CONCLUSION: This minimally invasive approach shows promise for removing bacterial biofilms in the RCS, positioning HIFU as a valuable adjunctive treatment for enhancing root canal disinfection. (EEJ-2024-08-123).
MATERIALS AND METHODS: The present systematic review followed PRISMA guidelines and involved a thorough search of three scientific databases: PubMed, Scopus, and Cochrane. We used specific algorithms related to the keywords "antioxidant" and "Oral leukoplakia" to identify randomized controlled trials (RCTs) that have explored the utility of antioxidants in the management of OL. The risk of bias assessment was conducted using the Cochrane risk of bias tool (ROB 2.0), ensuring the reliability of our findings.
RESULTS: Out of 2490 articles retrieved, only thirteen RCTs involving 1147 participants fulfilled the inclusion criteria. Lycopene was found to be the most consistently effective antioxidant, showing significant effectiveness in reducing lesion size, both in oral and topical forms. The trials incorporating other antioxidants, including vitamin A, vitamin C, β-carotene, and curcumin, demonstrated mixed results. Severe heterogeneity was detected in treatment forms, dosage, administration frequency, treatment duration, and follow-up time among all included trials.
CONCLUSION: Lycopene may play a significant role in the non-surgical management of OL. Future research with large-scale, well-designed, randomized controlled trials with standardized dosing, delivery methods, and outcome measures is mandatory to provide more robust evidence on the available antioxidant therapy for OL.
MATERIALS AND METHODS: ASK-QM was translated from English to Malay according to international guidelines. It was validated among cirrhotic patient who understand Malay language from two major liver centers in Klang Valley, Malaysia (University of Malaya and Hospital Selayang) from January 2021 to March 2022, at week 0 and 2. Patients with hepatic encephalopathy were excluded.
RESULTS: 121 out of 132 patients with cirrhosis agreed to participate (response rate=91.7%). The overall median score of the ASK-QM was 54.5 [38.6-68.2] and the difficulty factor was 0.5 (range: 0.1-0.8 for each domain). Confirmatory factor analysis showed a good model fit with results of Comparative fit index (CFI) ranging from 0.836 to 1.000, whilst, the Tucker-Lewis index (TLI) ranged from 0.690 to 1.004 across all four domains. The root mean square error of approximation (RMSEA) value was reported from 0.000 to 0.100. For standardized root mean squared residual (SRMR) was from 0.008 to 0.015. Patients with tertiary education scored higher compared to those without (63.6 [45.5-77.3] vs 52.3 [36.4-63.6], p<0.05). The overall Kuder-Richardson (KR) coefficient was 0.761 indicating adequate internal consistency. Test-retest among 82 out of 121 patients (response rate=67.7%) demonstrated adequate reliability with eighteen out of 22 items having Wilcoxon signed-rank test values that were statistically not significant, p>0.005.
CONCLUSION: The ASK-QM was found to be a valid and reliable questionnaire for evaluating knowledge of liver cirrhosis amongst Malay-speaking adults.
MATERIALS AND METHODS: A pre-experiment design was used to obtain data regarding 180 mothers who participated in this study. The complementary feeding based on local- food was conducted for 9 weeks, comprising 2 weeks preintervention, 6 weeks of intervention, and one-week postintervention. The intervention consists of 12 sets of recipes to be made by mothers and given to their children 4 times daily over 6 weeksinstrument using Infant and Young Children Feeding Practice and Structure questionnaire. Data analysis in this study used Wilcoxon Signed Rank Test.
RESULTS: The result of this study showed that complementary feeding based on local- food could give the impact mothers ability in food preparation and processing before complementary feeding (Z=11.644 and pvalue= 0.000), supplemental feeding (Z=-11.641 and p-value 0.000), and responsive feeding (Z-11.640 and p-value 0.000). The role of feeding responsiveness in accelerated growth. These results prove that self-feeding and maternal verbal responsiveness can be increased by targeting specific behaviours with appropriate behaviour change modeling and coaching practice strategies.
CONCLUSION: These results provide evidence that focusing on specific behaviours and implementing modification techniques such as modeling and coached practice, complementary feeding based on local food, self-feeding, and maternal verbal responsiveness can be improved.
MATERIALS AND METHODS: A total of 333 patients from the Family Medicine Specialist Clinic at Hospital Sultan Abdul Aziz Shah were recruited between March 2022 and February 2023. Blood samples were taken after a 12-hour fasting period, and levels of fasting blood sugar (FBS), triglycerides (TG), total cholesterol (TC), HDL cholesterol, and LDL cholesterol were measured. 150 plasma samples were randomly selected for cytokine analysis of CCL2 and TNF-α using the Human Magnetic Luminex Assay. Patients' cardiovascular risk was assessed using the FRS calculator. The Kruskal-Wallis test was used to analyze the relationship between cytokine levels and FRS categories, followed by a post hoc test with Bonferroni correction. A logistic regression model was implemented to assess the independent effects of these variables.
RESULTS: The results demonstrated a significant association between the level of chemokines CCL2 and proinflammatory TNF-α, and FRS categories (low-risk, moderate-risk, and high-risk). CCL2 levels were notably higher in the high-risk group, as were TNF-α levels, with both biomarkers showing increasing trends with higher risk categories, (p<0.001, effect size=0.32) and (p<0.001, effect size-0.29), respectively. Multiple logistic regression analysis showed that dyslipidaemia, FBS, and TNF-α remained significant after adjusting for other variables. Specifically, dyslipidaemia had lower odds of being in the high-risk group (AOR: 0.04), while FBS (AOR: 3.19) and TNF-α (AOR: 1.18).
CONCLUSION: This study highlights the potential of CCL2 and TNF-α as biomarkers for CVDs risk assessment. Integrating these biomarkers into CVDs risk prediction models may enhance the precision of identifying individuals at elevated risk. However, the study's cross-sectional design and small sample size for cytokine analysis constrain the findings. Future research should explore the long-term predictive value of these cytokines in larger, longitudinal cohorts and explore more advanced techniques for improving CHD risk prediction models.
MATERIALS AND METHODS: We conducted a retrospective evaluation of paediatric patients (less than 12-years-old) who underwent keratoplasty in Hospital Kuala Lumpur, from January 2008 to December 2022. We analysed demographic data, preoperative diagnoses, types of keratoplasty performed, and the 1-year graft survival rate.
RESULTS: 100 eyes from 95 patients were included in the study, with a mean age of 4.39 ±3.32 years. The indications for keratoplasty included limbal dermoid (45%), anterior segment dysgenesis/Peter's anomaly (22%), infective keratitis (14%), congenital glaucoma (4%), and other pathologies (15%). 31/100 (31%) had corneal perforation. Of the patients, 56% underwent lamellar keratoplasty (LK), while 44% underwent penetrating keratoplasty (PK). Complications included wound dehiscence (4%) and graft melting (3%). 77% completed 1-year follow-up, and the overall 1-year graft survival rate was 54.5%. Limbal dermoid showed a better graft survival rate (72.2%) compared to other pathologies (39%), with a p-value of 0.004. LK has a higher 1-year graft survival rate of 66% compared to PK (36.7%) with a p-value of 0.003. Among the cases of perforated corneas, an overall 1-year graft survival rate of 25.8% (8/31) was observed, which was significantly lower compared to eyes without corneal perforation 73.9% (34/46) with a p-value of 0.008.
CONCLUSIONS: Limbal dermoid was the most common indication for paediatric keratoplasty, and it exhibited a better graft survival rate compared to other pathologies. A one-year graft survival rate varies among different indications of keratoplasty. Perforated cornea has a lower graft survival rate compared to non-perforated corneal pathology.
MATERIALS AND METHODS: This retrospective observational study analysed EMS data from Sarawak, Penang and Klang Valley from 2010 to 2019. All OHCA cases where EMS performed cardiopulmonary resuscitation (CPR) were included, regardless of age or aetiology. The primary outcome was survival to hospital admission with the secondary outcome a return of spontaneous circulation (ROSC) prior to Emergency Department arrival.
RESULTS: A total of 2,435 OHCA cases were analysed. Median patient age was 58 years, 70% of them are male with 63% had underlying medical conditions, with hypertension being the most common. Out of all cases, 71% of arrests occurred at home, 60% witnessed. Median time from arrest to 999 call was 20 minutes, median time for ambulance arrival thereafter is 17 minutes. Bystander CPR rate was 38%, bystander Automated External Defibrillator (AED) use 1.5- 2.6%. Detection of shockable rhythm on first analysis by EMS was 3.9 to 7.7%. Overall survival to admission rate was 4.76%. ROSC rate before Emergency Department arrival was 2.8%. Survival to admission among bystander-witnessed arrests with shockable rhythm was 14.7%.
CONCLUSION: Survival to admission rates for OHCA patients in the studied Malaysian regions (1.3-6.7%) are lower compared to some Asian countries. Areas for improvement include reducing time from arrest to 999 calls, decreasing time to EMS arrival, and increasing bystander CPR and AED use rates. Implementing the Utstein ten-step implementation strategy, focusing on community-based interventions and improving EMS response, could potentially enhance survival rates in Malaysia.
MATERIALS AND METHODS: A mixed-methods explanatory sequential design was employed in this study. Initially, a quantitative survey was conducted for 3 months from May to July 2022 on 167 young women using the Psychological Needs Inventory to identify their psychosocial needs. Secondly, a qualitative, semi-structured interview was conducted for 6 months from July to December 2022 with 11 participants to explore the challenges faced in meeting these needs.
RESULTS: The quantitative results showed that three items, "Help with financial matters", "Advice about food and diet", and "Help with transport", were identified as significant unmet psychosocial needs. All three items fall within the category of practical needs. The qualitative results identified five themes: (1) challenges of adequate information needs with five subthemes (inadequate communication with the health professionals, lack of educational programs and awareness campaigns, inadequate number of nurses, need for nutritionists, and effects of unmet informational needs); (2) psychological challenges with five subthemes (uncertainty of the future, fear concerning the children, fear of death, treatment-related effects and the loss of a woman's identity, and inadequate psychosocial care); (3) financial challenges with 2 subthemes (treatment not available and expensive, low incomes and high cost of living); (4) social influences with 2 subthemes (society's view and stigma, lack of marriage choices); and (5) environmental stressors with 2 subthemes (stressful hospital environment and situational factors).
CONCLUSION: These psychosocial needs identified were found to align with Maslow's hierarchy of needs, underscoring a cascading effect of the Syrian crisis across various dimensions of well-being. Young breast cancer women living in countries with crises have high levels of unmet psychosocial needs.
MATERIALS AND METHODS: An ecological study was conducted from 2016 to 2021 using the dengue database and meteorological data. The forecasting model for dengue incidence was performed with R software using the seasonal autoregressive integrated moving average (SARIMA) model. The model was fitted based on the reported weekly incidence of dengue from 2016 to 2020 and validated using data collected between January and December 2021.
RESULTS: SARIMA (1,1,1) (1,1,0)52 with the external regressor maximal temperature, Aedes index, and vacant lot were the models with minimal measurement errors, as indicated by the Mean Absolute Error (MAE) values of 3.04, Root Mean Squared Error (RMSE) of 4.43, and Akaike Information Criterion (AIC) of 1354.82.
CONCLUSIONS: The predicted values in 2021 accurately forecasted the capability to serve as an early warning system for proactive dengue measures. This information is deemed valuable to healthcare administrators for enhancing the level of preparedness.
MATERIALS AND METHODS: A retrospective review was conducted on patient data from those who underwent pleuroscopy at Hospital Canselor Tuanku Muhriz from January 2021 to December 2023. We included patients with pleural effusion who underwent both cell block and pleural biopsy with a confirmed diagnosis of malignancy through histopathological examination. At least 200 ml of pleural fluid was collected, followed by the biopsy of six or more pleural tissue samples.
RESULTS: Out of the 196 pleuroscopy procedures analysed, 91 patients were diagnosed with malignant pleural effusion. Malignancy was diagnosed in 50 (54.9%) cases using cell block analysis, whereas pleural biopsy identified malignancy in 81 (89%) cases. The diagnostic yield was significantly higher for pleural biopsy compared to pleural fluid cell block [89% (81/91) vs. 54.9% (50/91); p < 0.001]. Among patients with negative results on pleural fluid cell block, 33 (36.3%) had positive results on pleural biopsy. The definitive diagnoses of malignancy included 64 (70.3%) cases of lung adenocarcinoma, 4 (4.4%) cases of lung squamous carcinoma, 2 (2.2%) cases of small cell lung cancer, 2 (2.2%) cases of mesothelioma, and 19 (20.9%) cases of metastatic carcinoma. Eight (8.8%) patients exhibited negative findings on both pleural fluid cell block and pleural biopsy. Further diagnoses were achieved through computed tomography-guided needle tru-cut biopsy of the lung in 6 patients (6.6%), transbronchial lung biopsy in 1 patient (1.1%), and cervical lymph node biopsy in 1 patient (1.1%).
CONCLUSION: Pleural biopsy exhibits superior diagnostic accuracy compared to pleural fluid cell block analysis for malignant pleural effusion. In cases where cell block results are negative but suspicion remains high, pleural biopsy remains a crucial diagnostic tool.