METHODS: A multicenter mixed-design study was performed in which Muslim patients who fasted during Ramadan while receiving TPO-RAs were interviewed between 2015 and 2023. Patient responses before, during, and after Ramadan were evaluated retrospectively. The bleeding tendency was assessed as (1) no bleeding, (2) minor cutaneous/mucosal bleeding, or (3) severe bleeding that involves major organs.
RESULTS: The present study included 100 patients from three Muslim countries, including Qatar, Kuwait, and Saudi Arabia, across four tertiary centers. A complete response was observed in 63% of patients on ROM, 46% on ELT and 37% on AVA. For AVA, the mean platelet (PLT) count before Ramadan was estimated at [146.11 ± 111.76], while during Ramadan, it dropped to [131.7 ± 107.6]. For patients on ELT, the mean PLT count before Ramadan was estimated at [120.02 ± 59.7], while during Ramadan, it dropped to [100.8 ± 68.16] (p = 0.016). For patients on ROM, the mean platelet count before Ramadan was estimated at [122.68 ± 80.57], while during Ramadan, it was [130.94 ± 84.96]. Only 3% (3 patients on ELT) experienced bleeding episodes.
CONCLUSION: This study supports the feasibility of Ramadan fasting for ITP patients receiving TPO-RAs. Further studies with a larger sample size are recommended to investigate the impact of other types of fasting on the efficacy and safety of TPO-RAs.
AIM: The purpose of this systematic review was to assess what best-practice and evidence-based recommendations are available to achieve competency in Neurological Point-of-care ultrasound (NeuroPOCUS).
METHODS: We undertook a structured systematic review of publications and studies on the training of NeuroPOCUS for intensive care.
RESULTS: Our search strategy yielded a total of 4965 publications, reduced to 3551 following de-duplication. Despite this, only 28 publications were relevant following review of title and abstract and only 12 of these on full-text review. We identified three prospective studies, four consensus statements and five publications as posters and published abstracts. Structured analysis of these revealed minimal evidence-based teaching recommendations, and significant variability in teaching method.
CONCLUSION: Compared to other modalities of POCUS (e.g. Cardiac and Lung), NeuroPOCUS lags behind with regards to utilisation and training in the general intensive care setting. Further work is needed to establish how this technique can be effectively taught and assessed for clinical application.
CASE REPORT: We report a case of oral alveolar lymphangioma on the anterior maxillary alveolar ridge of an 11-day-old infant of non-black descent. The lesion presented as a pedunculated, reddish, lobular mass in the anterior maxilla. Given its atypical presentation and the potential for feeding difficulties, an excisional biopsy was performed. The diagnosis was confirmed histologically through biopsy and supported by immunohistochemical staining.
CONCLUSION: This case expands the understanding of alveolar lymphangioma by reporting it in a non-Black neonate with an unusual location and appearance, emphasising the need for excisional biopsy to rule out other potential oral lesions, especially neoplasms.
METHODS: This study employed a cross-sectional, descriptive survey design to assess knowledge, attitudes, and practices (KAP) related to the consumption of salt, oil, and sugar and their use in food preparation amongst campus canteen staff at two Malaysian higher education institutions. Data were collected anonymously from 38 participants, which included representatives from all independent canteen operators on the premises. The study also explored the barriers and enablers vendors encounter in reducing salt and sugar usage.
RESULTS: The study found that most participants were aware of the health risks associated with high salt, oil, and sugar (SOS) consumption and had positive attitudes towards reducing dietary SOS intake in general, though these attitudes did not extend to their own food preparations. However, their knowledge of recommended dietary guidelines was poor, and actual practices related to SOS reduction were inadequate. Barriers to reducing SOS included concerns about taste and customer acceptance, as well as the lack of standardized guidelines and tools for measuring SOS in food preparation.
CONCLUSIONS: This study identifies gaps in knowledge and practices related to SOS reduction among the surveyed food vendors. While vendors acknowledge the health risks of high SOS consumption, there is a lack of awareness of dietary guidelines and practical low-SOS cooking methods, highlighting the need for regular monitoring, vendor education, and support in promoting healthier food options.
METHODS: This study included solid organ cancer patients aged ≥ 18 who attended HCTM and HKL from May 2022 to August 2023. The baseline demographics, and clinical characteristics, were acquired at the cancer diagnosis. Data on cancer treatment, thrombotic events and anticoagulation therapy during the study and its treatment were documented. Multivariable logistic regression analysis was performed to determine the independent factors associated with CAT in solid organ cancer.
RESULTS: A total of 250 solid organ cancer patients were included, with a mean age of 57.7 (13.7) years. This multi-ethnic cohort consisted of mostly Malay patients (55.2%), followed by Chinese (33.2%) and Indian & others (11.6%). The prevalence of CAT at baseline was 4.8%, while the incidence of CAT during follow-up was 12%. Poor performance status and obesity were associated with CAT at baseline. Univariable logistic regression showed platelets ≥ 450 × 109/L and Khorana score ≥ 3 had significantly higher risks of CAT at baseline. Stage IV disease, radiotherapy and chemotherapy, namely platinum-based chemotherapy and antimetabolites were associated with CAT during follow-up. The ROC analysis showed that the KRS significantly predicted CAT (area under the curve, 0.701 (95%CI: 0.594-0.808, p = 0.001).
CONCLUSIONS: This study highlights the prevalence of CAT at baseline and the incidence of CAT during follow-up, similar to other studies. Patients' clinical characteristics were associated with CAT at baseline while disease and treatment factors were associated with CAT at follow-up. These findings emphasise the need for targeted thromboprophylaxis in high-risk populations and highlight the importance of risk stratification tools such as the Khorana score for optimal patient management. Future studies involving larger patient cohorts and longer study duration would be beneficial. These findings provide valuable insights to inform clinical decision-making, optimise patient outcomes, and minimise potential risks.