METHODS: The medical records of all patients who underwent breast lump excision under AAA in combination with electrical stimulation at traditional acupuncture points in 2016 were examined. All of them (n = 17) received electrostimulation (2-4 Hz) using single needles inserted at bilateral LI4 and PC6. They also underwent insertion of four acupuncture needles at the lump site, which were electrically stimulated at 30 Hz frequency.
RESULTS: All surgical procedures were successful with minimal use of analgesics and local anesthetic. The median pain score reported was 1/10 (interquartile range (IQR) = 2/10) at the first hour, and slightly increased to 2/10 (IQR = 2/10) between 24 and 48 h of the surgery. No major postoperative adverse events were documented, except for drowsiness in one case.
CONCLUSION: AAA was found to be generally safe and effective for anaesthesia and analgesia in breast lump excision. However, a large-scale randomized controlled study is required to verify the findings.
MATERIALS AND METHODS: This was a single-center, cross-sectional study. A face-to-face interview guided by a structured questionnaire with cancer patients admitted to receive repeated cycles of chemotherapy was conducted. Information collected included chemotherapy-related side effects after last chemotherapy experience, the most worrisome side effects, the side effects overlooked by healthcare professionals and the preferred method, amount and source of receiving related information.
RESULTS: Of 99 patients recruited, 90 participated in this survey (response rate: 90.9%). The majority were in the age range of 45-64 years (73.3%) and female (93.3%). Seventy-five (83.3%) and seventy-one (78.9%) experienced nausea and vomiting, respectively. Both symptoms were selected as two of the most worrisome side effects (16.7% vs. 33.3%). Other common and worrisome side effects were hair loss and loss of appetite. Symptoms caused by peripheral neuropathies were perceived as the major symptoms being overlooked (6.7%). Most patients demanded information about side effects (60.0%) and they would like to receive as much information as possible (86.7%). Oral conversation (83.3%) remained as the preferred method and the clinical pharmacist was preferred by 46.7% of patients as the educator in this aspect.
CONCLUSIONS: The high prevalence of chemotherapy-related side effects among local patients is of concern. Findings of their perceptions and informational needs may serve as a valuable guide for clinical pharmacists to help in side effect management in Malaysia.
METHODS: This was a registry-based, cross-sectional study. All the CRC cases reported by 18 hospitals to the National Cancer Patient Registry - Colorectal Cancer (NCPR-CC) between January 2007 and December 2017 were included in the analysis. The patients were categorized by age into the above-50 and under-50 groups. The changes in the age-standardized incidence and mortality rates of both the age groups were determined using the time-series analysis, and the impact of age on the mortality risk was assessed using the Cox regression analysis.
RESULTS: Of the 6,172 CRC patients enrolled in the NCPR-CC, 893 (14.5%) were in the under-50 group. As compared with their older counterparts, the patients in the under-50 group were more likely to be female, be of Malay ethnicity, be non-smokers, have a family history of CRC, and present late for treatment. The age-standardized incidence and mortality rates of CRC in the under-50 group remained stable over the years, while a decreasing trend was clearly seen in the mortality rates of CRC in the above-50 group (p=0.003). Nevertheless, the two age groups also did not differ in the mortality risk (adjusted hazards ratio: 1.10; 95% CI: 0.90, 1.36).
CONCLUSION: Young-onset CRC constituted a considerable proportion of CRC cases in Malaysia. However, in contrast with the findings of most studies, it demonstrated neither an uptrend in age-standardized incidence rates nor a higher mortality risk. Our findings suggest the need to upscale and lower the recommended age for CRC screening in Malaysia.
OBJECTIVE: This study aims to evaluate the efficacy of the M2PK Quick Stool Test (ScheBo®) in detecting colorectal adenoma and adenocarcinoma in high-risk Malaysian populations using colonoscopy as the comparison.
METHODS: A prospective, cross-sectional, multicenter study was conducted from December 2017 to December 2019 in four hospitals in Malaysia. Participants were eligible if they met any of the following criteria: personal or family history of colorectal polyps or cancer, inherited syndromes, altered bowel habits, rectal bleeding, unintended weight loss, loss of appetite, abdominal pain or cramps, or unexplained iron deficiency, or an Asia-Pacific Colorectal Screening score of 4-7. Participants provided a stool sample that was tested for M2PK using the M2PK Quick Test. Participants then underwent a colonoscopy, and any lesions found were biopsied and sent for histopathological examination.
RESULTS: A total of 562 participants were included in the study, of whom 89 had a positive M2PK test. Presence of adenoma and/or dysplastic lesions were confirmed in 14.4% and adenocarcinoma in 3.0% of the participants. The M2PK Quick Stool Test showed a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 58.8%, 85.5%, 11.2% and 98.5%, respectively in detecting colorectal adenocarcinoma. For detection of colorectal adenoma, this test yielded a sensitivity, specificity, PPV and NPV of 27.3%, 86.3%, 27.0% and 86.5%, respectively.
CONCLUSIONS: The M2PK Quick Stool Test showed a moderate accuracy in detecting colorectal adenocarcinoma and adenomas in the studied population.
RESULTS: Of the 141 participants, most were mothers (90.8%) and had a full-time job (55.3%). Most of them had adequate medication-related knowledge (71.6%) and an appropriate administration practice (83.0%). The majority of them (83.0%) also rated themselves as adherent to medication administration. The participants with a child above 5 years of age (91.2%) were found to have a better practice than those with younger children (75.3%) in medication administration (p = 0.012). However, those with a child taking two (adjusted OR: 12.53) or three (adjusted OR: 8.29) medications, getting their refills from private health institutions apart from this hospital (adjusted OR = 7.06) and having multiple illnesses (adjusted OR = 21.25) were more likely to be not adherent to medication administration.
CONCLUSION: Caregivers of chronically ill children in Malaysia generally have sufficient knowledge and an appropriate practice of medication administration at home. Yet, strategies to improve the adherence to medication administration, particularly in those who care for children with complicated health conditions, are warranted.
METHODS: This observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients.
RESULTS: During the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001).
CONCLUSIONS: This study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.
METHODS: The findings for a few outcome indicators, ranging from the iFOBT uptake to the CRC and polyp detection rates, were generated from the data contributed by 583 public health clinics between 2014 and 2018. The trends in their changes were also evaluated.
RESULTS: The iFOBT uptake constantly increased over the years (p < 0.001), totaling 2.29 % (n = 127,957) as at 2018. Nearly 10 % (n = 11,872) of the individuals screened had a positive test result. Of those who underwent colonoscopy (n = 6,491), 4.04 % (n = 262) and 13.93 % (n = 904) were found to have CRC and polyps, respectively.
CONCLUSION: An uptrend in the CRC screening uptake was witnessed following the introduction of the iFOBT in public health clinics.
Materials and Methods: Data collection was performed retrospectively on a total of 293 cases from Hospital Sultanah Bahiyah, Kedah, Malaysia. The data consisted of personal information, treatment history, and investigation findings, including blood results, USG abdomen results, and CT scan results. The site of culture and sensitivity were also obtained. The total direct medical cost was based on the antibiotics/treatments received by the patients, diagnostic test and investigations performed. The trend analysis used to see the pattern of costs from 2014 to 2017. All the costs were compared based on patients' status and duration of stay at the hospital using the independent t-test.
Results: The overall mean of direct medical cost for melioidosis amounted to US $233.61 (RM931.33). Overall, the finding confirms a huge reduction (44.7%) of direct medical cost from 2014 to 2017 (P = 0.001). From 2015 to 2016, there was a 19.1% reduction of direct medical cost (P>0.95), followed by a 38.8% reduction in costs from 2016 to 2017 (P = 0.019). In the case of the duration of stay, the mean of total direct medical cost among patients with ≥14 duration of stay was higher compared to those with <14 duration of stay (p < 0.001). There was no significant mean difference of direct medical cost between patients who were cured and died.
Conclusion: Despite the higher mortality of melioidosis cases compared to other infectious diseases, there is a limitation in the amount of published data on the management cost of melioidosis. The importance of cost in managing this disease should be underlined to perform a fully prepared management toward the disease.
OBJECTIVE: Here, we investigated the ability of Palmatine to reduce the up-regulation of chaperone proteins Glucose Regulatory Protein 78 (GRP78), and Calreticulin (CALR) protein in a Streptozotocin (STZ)-induced diabetic rat model.
METHODS: Streptozotocin (STZ) induced diabetes in Sprague Dawley rats treated with 2mg/kg of Palmatine for 12 weeks after the elevation of plasma glucose levels above 11mmol/L post-STZ administration. Proteins were extracted from the pancreas after treatment and Two-Dimensional gel electrophoresis (2-DE), PDQuest 2-D analysis software genomic solutions and mass spectrometer were used to analyze differentially expressed protein. Mass Spectrometry (MS/MS), Multidimensional Protein Identification Technology (MudPIT) was used for protein identification.
RESULTS: There was an up-regulation of the expression of chaperone proteins CALR and GRP78 and down-regulation of the expression of antioxidant and protection proteins peroxidoxin 4 (Prdx4), protein disulfide isomerase (PDIA2/3), Glutathione-S-Transferase (GSTs), and Serum Albumin (ALB) in non-diabetic rats. Palmatine treatment down-regulated the expression of chaperone proteins CALR and GRP78 and up-regulated the expression of Prdx4, PDIA2/3, GST, and ALB.
CONCLUSION: Palmatine may have activated antioxidant proteins, which protected the cells against reactive oxygen species and endoplasmic stress. The result is in consonance with our previous report on Palmatine.
METHOD: Newly diagnosed CRC cases between 2010 and 2016 in Malaysia were identified from the National Cancer Registry. Residential addresses were geocoded. Clustering analysis was subsequently performed to examine the spatial dependence between CRC cases. Differences in socio-demographic characteristics of individuals between the clusters were also compared. Identified clusters were categorized into urban and semi-rural areas based on the population background.
RESULT: Most of the 18 405 individuals included in the study were male (56%), aged between 60 and 69 years (30.3%) and only presented for care at stages 3 or 4 of the disease (71.3%). The states shown to have CRC clusters were Kedah, Penang, Perak, Selangor, Kuala Lumpur, Melaka, Johor, Kelantan, and Sarawak. The spatial autocorrelation detected a significant clustering pattern (Moran's Index 0.244, p< 0.01, Z score >2.58). CRC clusters in Penang, Selangor, Kuala Lumpur, Melaka, Johor, and Sarawak were in urbanized areas, while those in Kedah, Perak and Kelantan were in semi-rural areas.
CONCLUSION: The presence of several clusters in urbanized and semi-rural areas implied the role of ecological determinants at the neighbourhood level in Malaysia. Such findings could be used to guide the policymakers in resource allocation and cancer control.
METHODS: A pilot study was conducted in four primary healthcare (PHC) centers in Malaysia. The model's key features included on-site HCV ribonucleic acid (RNA) testing using a shared GeneXpert® system; noninvasive biomarkers for cirrhosis diagnosis; and extended care to PWID referred from nearby PHC centers and outreach programs. The feasibility assessment focused on three aspects of the model: demand (i.e., uptake of HCV RNA testing and treatment), implementation (i.e., achievement of each step in the HCV care cascade), and practicality (i.e., ability to identify PWID with HCV and expedite treatment initiation despite resource constraints).
RESULTS: A total of 199 anti-HCV-positive PWID were recruited. They demonstrated high demand for HCV care, with a 100% uptake of HCV RNA testing and 97.4% uptake of direct-acting antiviral treatment. The rates of HCV RNA positivity (78.4%) and sustained virologic response (92.2%) were comparable to standard practice, indicating the successful implementation of the model. The model was also practical, as it covered non-opioid-substitution-therapy-receiving individuals and enabled same-day treatment in 71.1% of the participants.
CONCLUSIONS: The modified same-day test-and-treat model is feasible in improving HCV care for rural PWID. The study finding suggests its potential for wider adoption in HCV care for hard-to-reach populations.
MATERIALS AND METHODS: This was a 12-month randomized controlled trial, in which adults with a controlled attenuation parameter (CAP) score >250 dB/m and a fibrosis score <10 kPa were randomly assigned to receive a standardized P. niruri extract at a dose of 3,000 mg daily (n = 112) or a placebo (n = 114). The primary outcomes were changes in CAP score and liver enzyme levels, while the secondary outcomes were changes in other metabolic parameters. The analysis was performed on an intention-to-treat basis.
RESULTS: After 12 months, there was no significant difference in the change of CAP score between the intervention and control groups (-15.05 ± 36.76 dB/m vs. -14.74 ± 41.08 dB/m; p = 0.869). There was also no significant difference in the changes of liver enzyme levels between the two groups. However, the intervention group showed a significant reduction in fibrosis score, which was not observed in the control group (-0.64 ± 1.66 kPa versus 0.10 ± 1.61 kPa; p = 0.001). No major adverse events were reported in either group.
CONCLUSION: This study showed that P. niruri did not significantly reduce CAP score and liver enzyme levels in patients with mild-to-moderate NAFLD. However, a significant improvement in fibrosis score was observed. Further research is needed to determine its clinical benefits at different dosages for NAFLD treatment.