DESIGN AND SETTING: A retrospective secondary data analysis using data from the National Health and Morbidity Survey 2019, a cross-sectional household survey among the population in Malaysia.
PARTICIPANTS: All adults aged 18 years and above.
OUTCOME MEASURES: The two outcome variables were multimorbidity and outpatient services utilisation. Characteristics of respondents and those having multimorbidity were described using complex sample descriptive statistics. We used multivariable logistic regression to determine the associated factors of having multimorbidity and the association between the number of non-communicable diseases and outpatient services utilisation.
RESULTS: Overall, 11 347 respondents were included in the analysis. This study found a prevalence of 11.4 (95% CI=10.43-12.39) for multimorbidity. Age, marital status and working status were the factors associated with multimorbidity. Adults with multimorbidity were high users of outpatient services (20.4%, 95% CI=17.5-23.7), approximately threefold of adults with no non-communicable diseases. In the final model, multimorbidity showed an adjusted OR of 3.28 (95% CI=2.48-4.32) for outpatient services utilisation.
CONCLUSION: Understanding factors associated with multimorbidity and the magnitude of the impact of having multimorbidity towards outpatient services utilisation could help in future planning for healthcare system transformation. The recently launched Health White Paper for Malaysia has emphasised primary healthcare as a critical component to achieve aspirations of the health system, which includes equity and responsiveness. Strengthening primary care services and improving patient navigation across healthcare levels are critical to supporting individuals with multimorbidity. Avenues for further research include exploring a wider range of conditions and assessing the longitudinal impact of multimorbidity on healthcare utilisation and health outcomes.
METHODS: Twenty patients who had previously undergone implant surgery were included in the study. Ten patients had received the allograft (Group 1) and ten had received autogenous connective tissue (Group 2).An independent examiner retrospectively analyzed the patient records at 7, 15, and 60 days, and five years post-procedure. Data from these observations were collected and analyzed using SPSS Statistics, version 25. Descriptive statistical analysis was conducted.
RESULTS: All patients exhibited an increase in KT. For Group 1, the mean KT width measurements were 1.27 ± 0.46 mm at the initial evaluation, increasing to 2.00 ± 0.38 mm, 2.80 ± 0.78 mm, 3.27 ± 0.80 mm, and 3.01 ± 0.68 mm at 7, 15, and 60 days post-surgery (with prosthesis delivery on day 60), and five years after prosthetic rehabilitation, respectively.
CONCLUSIONS: Within the limitations of this retrospective clinical study, both amnion/chorion and connective tissue show significant potential for KT expansion when used in conjunction with implant surgery.
CLINICAL RELEVANCE: The use of allografts, due their low morbidity, and acceptable results should be considered as a viable option for soft tissues augmentations.
METHODS: Adhering the PRISMA 2020 guidelines and registered in the PROSPERO database, we conducted a systematic review and meta-analysis using the PubMed, Embase, and Web of Science databases up to October 2024. Nested Knowledge was used for screening and data extraction. Studies reporting quantitative data on the prevalence or mortality of dengue and leptospirosis co-infections were included. Data extraction and quality assessment were performed independently by two reviewers using the Modified Newcastle-Ottawa Scale. Statistical analyses, including prevalence and mortality estimation, sensitivity analysis were conducted using R, with heterogeneity evaluated by the I² statistic.
RESULTS: Out of 3,982 records, 14 studies met the eligibility criteria, yielding a pooled prevalence of dengue and leptospirosis co-infection at 2.33% (95% CI: 1.41-3.46%) across 16,638 participants, with significant heterogeneity (I² = 90%). The prediction interval for co-infection ranged from 0.05 to 7.27%. The pooled mortality rate among co-infected patients was 9.96% (95% CI: 0-53.49%), with moderate heterogeneity (I² = 71%). The prediction interval for mortality ranged from 0.00 to 100%. Publication bias was indicated by an LFK index of 2.52.
CONCLUSION: This meta-analysis revealed a moderate prevalence and a notable mortality rate for dengue and leptospirosis co-infections, with significant variability observed across different studies. Further research into the immunopathology and the implementation of integrated surveillance systems could enhance the effectiveness of diagnosis and treatment strategies in regions where these diseases are endemic.
METHODS: PubMed, Web of Science and EBSCOHost was systematically searched for empirical studies between 2000 and 2023 that discussed on factors that influenced family planning usage among women with diabetes. This systematic literature review was conducted in accordance to Joanna Briggs Institute's approach for conducting systematic review of associations. Factors were categorised to either individual and non-individual factors. Narrative synthesis approach was adopted that appropriately accommodates the heterogeneity of the reviewed studies.
RESULTS: A total of 29 studies met the inclusion criteria. Studies included in this review mostly reported individual-level factors that influence family planning practice among women with diabetes mellitus which were mainly the presence of diseases and other sociodemographic characteristics. Only six studies reported factors beyond individual variables which include geographic region, access to care, opinion of significant others, healthcare providers' perception, role of doctors and types of service providers.
CONCLUSIONS: This systematic review provides evidences that highlighted the gap in knowledge on variables that were beyond individual-level factors which influence family planning practice among women with diabetes mellitus. Further studies that explored structural and systemic factors may benefit future program planning to identify and target modifiable factors.
METHODS: We retrospectively analyzed eight patients with endobronchial IMT between January 2004 and December 2023.
RESULTS: The median age of our patients was 36 years, and 62.5% were male. Dyspnea was the predominant symptom in cases where the tumor was centrally located (n = 6), whereas hemoptysis was the predominant symptom in peripherally located tumors (n = 2). Most cases had high contrast enhancement and a tumor stalk without bronchial wall invasion on computed tomography (CT) and bronchoscopy. Complete endoscopic resection and laser cauterization via rigid bronchoscopy were possible in five patients. There were only two cases in which tumors remained after the procedure, requiring additional treatment (chemotherapy and surgical resection, respectively). In one patient, surgical resection was performed three weeks after the procedure, and the surgical specimen was free of residual tumor. There was no mortality during the median follow-up duration of 18.8 months.
CONCLUSIONS: Endoscopic resection and laser cauterization using rigid bronchoscopy may serve as a safe and effective alternative treatment modality to surgery for patients with endobronchial IMT.
METHODS: This is a case series of four patients with endobronchial GT who underwent therapeutic rigid bronchoscopy between February 2021 and June 2024.
RESULTS: The ages of the patients in our series ranged from 32 to 75 years, and all patients were male. Cough and blood-tinged sputum were present in all patients with endobronchial GT. The tumor sizes ranged from 1 to 3 cm. Complete endoscopic resection and laser cauterization via rigid bronchoscopy were achieved in two patients. One patient had incomplete resection of a 3-cm tumor in the segmental bronchus that showed radiological evidence of bronchial wall invasion. This patient subsequently underwent lobectomy seven months after bronchoscopic resection. The fourth patient was lost to follow-up. There was no mortality throughout the follow-up periods that ranged from 2.8 to 42.5 months. Factors favoring successful rigid bronchoscopy resection for endobronchial GT include a benign tumor in the central airways without bronchial wall invasion.
CONCLUSION: Endoscopic resection and laser cauterization using rigid bronchoscopy may be a viable option for patients with endobronchial GT when surgery is not practical.
CLINICAL TRIAL NUMBER: Not applicable.
METHODS: One hundred and seventy (170) unique oropharyngeal cancer cases were stained for qualitative analysis by the LBS p16 antibody on BOND III. This assay was compared to Ventana's RTD E6H4 (CINtec) clone on Benchmark XT. A stained core was considered p16 positive if the Histoscore (H score) was ≥ 140 and negative if H
METHOD: A total of 292 married individuals (Mage=42.98; SDage=9.82; 66.4% women; 65.4% Chinese Malaysians, 15.8% Indians Malaysians, 14.7% Others Ethnic Malaysians, and 4.1% Malay Malaysians) participated in the cross-sectional quantitative online survey.
RESULTS: A significant positive association was found between sex life and relationship satisfaction. However, sex life and relationship satisfaction were negatively associated with intention toward infidelity. Meanwhile, relationship satisfaction significantly mediates the link between sex life satisfaction and intention toward infidelity after controlling for the effects of age and gender. These findings support the hypothetical mediating role of relationship satisfaction in the association between sex life satisfaction and intention toward infidelity.
CONCLUSIONS: This study may fill a knowledge gap in Malaysia about the underlying association among these variables as well as the practical implication of the importance of sex life and relationship satisfaction in determining whether one would engage in extramarital affairs.
METHODS: The VCTE-Prognosis Study was a longitudinal study of patients with MASLD who had undergone VCTE examinations at 16 centres from the US, Europe and Asia with subsequent follow-up for clinical events. The primary endpoint was incident liver-related events (LREs), defined as hepatic decompensation and/or hepatocellular carcinoma.
RESULTS: Of 12,950 patients (mean age 52 years, 41% female, 12.1% LSM >12 kPa), baseline FIB-4, at cut-offs of 1.3 (or 2.0 for age ≥65) and 2.67, classified 66.3% as low-risk and 9.8% as high-risk, leaving 23.9% in intermediate-risk zone. After classifying intermediate FIB-4 patients as low-risk if LSM was <8.0 kPa and high-risk if LSM was >12.0 kPa, 81.5%, 4.6%, and 13.9% of the full cohort were classified as low-, intermediate-, and high-risk respectively. At a median (IQR) follow-up of 47 (23-72) months, 248 (1.9%) patients developed LREs. The 5-year cumulative incidence of LREs was 0.5%, 1.0% and 10.8% in the low-, intermediate- and high-risk groups, respectively. Replacing LSM with Agile 3+, Agile 4, and FAST did not reduce the intermediate-risk zone or improve event prediction. Classifying intermediate FIB-4 patients by LSM <10 kPa (low-risk) and >15 kPa (high-risk) reduced the intermediate-risk zone while maintaining prediction performance.
CONCLUSIONS: Non-invasive 2-step approach by FIB-4 followed by LSM is effective in classifying patients at different risks of LREs.
IMPACT AND IMPLICATIONS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is emerging as one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide, but only a minority of patients will develop these complications. Therefore, it is necessary to use non-invasive tests instead of liver biopsy for risk stratification. Additionally, as most patients with MASLD are seen in primary care instead of specialist settings, cost and availability of the tests should be taken into consideration. In this multicentre study, the use of Fibrosis-4 index followed by liver stiffness measurement by vibration-controlled transient elastography effectively identified patients who would later develop liver-related events. The results support current recommendations by various regional guidelines on a clinical care pathway based on non-invasive tests to diagnose advanced liver fibrosis.