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  1. Masoomi MA, Al-Shammeri I, Kalafallah K, Elrahman HMA, Ragab O, Ahmed E, et al.
    Medicine (Baltimore), 2019 Jan;98(4):e14207.
    PMID: 30681596 DOI: 10.1097/MD.0000000000014207
    Many discrepancy in selection of proper filter and its parameters for individual cases exists. The authors investigate the impact of the most common filters on patient NM images with coronary artery disease (CAD), and compare the results with the computerized tomography (CT)-Angio and angiography for accuracy.The investigation initiated by performing various single photon emission computerized tomography (SPECT)/CT scan of the national electrical manufacturers association chest phantoms having hot and cold inserts. Data acquired on GE 670 PRO SPECT/CT; 360Ø, 64 frames, 60 seconds, low energy high resolution (LEHR) 128, low energy general purpose (LEGP) with CT attenuation (120 kV and 170 mA). The images reconstructed with filtered back projection and ITERATIVE ordered-subset expectation maximization utilizing filters; Hann, Butterworth, Metz, Hamming, and Wiener. The Image contrast was calculated to assess absolute nearness of the inserts. Based on the preliminary results, then scans of 92 patients with CAD; 64 males and 28 females, age 41 to 77 years old, who had been reported earlier reprocessed with the nominated filter and were reported by 2 NM expert. The results compared to the earlier reports and to the CT-Angio and angiography.The optimization suggested 3 filters; Wiener (Wi), Metz and Butterworth (But) provide the highest contrast (99- 66.4%) and (81- 32%) for the cold and hot inserts respectively, with the (Wi) filter to be the better option. The reprocessed patients scan with the (Wi) presented an elevated diagnostic accuracy, correlated well with the CT-Angio and angiography results (P 
  2. Krackhardt F, Kočka V, Waliszewski M, Toušek P, Janek B, Trenčan M, et al.
    Medicine (Baltimore), 2020 Feb;99(8):e19119.
    PMID: 32080086 DOI: 10.1097/MD.0000000000019119
    Stent designs with ultrathin struts may further increase the procedural success of challenging lesion subsets. The objective of this study was to assess the safety and efficacy of ultrathin strut, polymer-free sirolimus eluting stent (PF-SES) implantations in a large scale, unselected patient population.Adult patients underwent percutaneous coronary interventions (PCI) with a thin-strut PF-SES. Data from two all-comers observational studies having the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled. The accumulated target lesion revascularization (TLR) rate at 9-12 months was the primary endpoint. All dual antiplatelet therapy strategies according to the applicable guidelines were permissible.In total, 7243 patients were prospectively enrolled for PCI with PF-SES in stable coronary artery disease or acute coronary syndrome (ACS). Major risk factors in the overall cohort were diabetes (37.3%), ST elevation myocardial infarction (18.1%) and non-ST myocardial infarction (24.6%). The follow-up rate was 88.6% in the overall population. The TLR rate in the overall cohort was 2.2% whereas definite/probable stent thrombosis (ST) occurred in 0.7%. In patients with in-stent restenosis lesions, the major adverse cardiac events rate was 6.4% whereas the corresponding rate for isolated left main coronary artery (LMCA) disease was highest with 6.7% followed by patients with culprit lesions in vein bypasses (VB, 7.1%). The mortality rate in patients treated in VB lesions was highest with 5.4%, followed by the isolated LMCA subgroup (3.4%) and ACS (2.6%).PCI with PF-SES in an unselected patient population, is associated with low clinical event and ST rates. Furthermore, PF-SES angioplasty in niche indications demonstrated favorable safety and efficacy outcomes with high procedural success rates.
  3. Seak CJ, Goh ZNL, Wong AC, Seak JC, Seak CK
    Medicine (Baltimore), 2019 Sep;98(38):e17229.
    PMID: 31567985 DOI: 10.1097/MD.0000000000017229
    RATIONALE: Abdominal pain in pregnancy represents a demanding diagnostic challenge in the emergency department (ED) due to the extensive list of differential diagnoses to be considered, coupled with the possibility of each disease having nonclassical, atypical signs and symptoms, resultant from the patient's pregnant state. Additionally, emergency physicians (EPs) face limitations on investigative imaging modalities because of the need to minimize fetal radiation exposure. EPs have to tackle this diagnostic challenge while performing a balancing act to maximize both maternal and fetal outcomes in a time-sensitive manner, becauser any delays in decision-making at the ED may threaten the safety of mother and child. Two common causes of abdominal pain in pregnancy presenting to the ED are acute appendicitis and ectopic pregnancy. The latter is almost always diagnosed by 10 weeks of gestation. Here, we report an extremely rare case of unilateral live spontaneous twin tubal ectopic pregnancy presenting past 12 weeks of gestation, diagnosed after magnetic resonance imaging (MRI) of the abdomen.

    PATIENT CONCERNS: A 37-year-old gravida 2 para 1 at 12 weeks and 6 days of gestation presented to our ED with a 2-day history of right iliac fossa pain, not associated with vaginal bleeding, fever, diarrhea, and vomiting. On examination, she was tachycardic (pulse rate 124 beats/min) and hypertensive (blood pressure 142/88 mm Hg). There was marked tenderness and guarding at the lower abdomen.

    DIAGNOSES: Blood investigations were unremarkable, while abdominal ultrasonography found a live twin gestation with foetal heartbeats of 185 and 180 beats/min. MRI of the abdomen revealed an empty uterine cavity; 2 amniotic sacs and fetuses of diameter 10 cm, and a single placenta were noted in the right uterine adnexa. The patient was diagnosed with right live monochorionic diamniotic twin tubal pregnancy.

    INTERVENTION: Our patient underwent emergency laparoscopic right salpingectomy.

    OUTCOMES: The operation was successful and her postoperative care remained uneventful up to discharge.

    LESSONS: Ectopic pregnancy cannot be ruled out based on prior normal antenatal examinations and gestational age of >10 weeks. EPs should not hesitate to order MRI scans for further evaluation if ultrasonography and laboratory findings are equivocal.

  4. Ibrahim AA, Ahmad Zamzuri M'I, Ismail R, Ariffin AH, Ismail A, Muhamad Hasani MH, et al.
    Medicine (Baltimore), 2022 Jul 29;101(30):e29627.
    PMID: 35905245 DOI: 10.1097/MD.0000000000029627
    The Teleprimary Care-Oral Health Clinical Information System (TPC-OHCIS) is an updated electronic medical record (EMR) that has been applied in Malaysian primary healthcare. Recognizing the level of patient satisfaction following EMR implementation is crucial for assessing the performance of health care services. Hence, the main objective of this study was to compare the level of patient satisfaction between EMR-based clinics and paper-based clinics. The study was a quasi-experimental design that used a control group and was conducted among patients in 14 public primary healthcare facilities in the Seremban district of Malaysia from May 10, to June 30, 2021. Patient satisfaction was assessed using the validated Short-Form Patient Satisfaction Questionnaire, which consisted of 7 subscales. All data were analyzed using the IBM Statistical Package for Social Sciences version 21. A total of 321 patients consented to participate in this study, and 48.9% of them were from EMR clinics. The mean score for the communication subscale was the highest at 4.08 and 3.96 at EMR-adopted clinics and paper-based record clinics. There were significant differences in general satisfaction and communication subscales, with higher patient satisfaction found in clinics using EMR. With the utilization of EMR, patient satisfaction and communication in delivering healthcare services have improved.
  5. Wong HS, Subramaniam S, Alias Z, Taib NA, Ho GF, Ng CH, et al.
    Medicine (Baltimore), 2015 Feb;94(8):e593.
    PMID: 25715267 DOI: 10.1097/MD.0000000000000593
    Web-based prognostication tools may provide a simple and economically feasible option to aid prognostication and selection of chemotherapy in early breast cancers. We validated PREDICT, a free online breast cancer prognostication and treatment benefit tool, in a resource-limited setting. All 1480 patients who underwent complete surgical treatment for stages I to III breast cancer from 1998 to 2006 were identified from the prospective breast cancer registry of University Malaya Medical Centre, Kuala Lumpur, Malaysia. Calibration was evaluated by comparing the model-predicted overall survival (OS) with patients' actual OS. Model discrimination was tested using receiver-operating characteristic (ROC) analysis. Median age at diagnosis was 50 years. The median tumor size at presentation was 3 cm and 54% of patients had lymph node-negative disease. About 55% of women had estrogen receptor-positive breast cancer. Overall, the model-predicted 5 and 10-year OS was 86.3% and 77.5%, respectively, whereas the observed 5 and 10-year OS was 87.6% (difference: -1.3%) and 74.2% (difference: 3.3%), respectively; P values for goodness-of-fit test were 0.18 and 0.12, respectively. The program was accurate in most subgroups of patients, but significantly overestimated survival in patients aged <40 years, and in those receiving neoadjuvant chemotherapy. PREDICT performed well in terms of discrimination; areas under ROC curve were 0.78 (95% confidence interval [CI]: 0.74-0.81) and 0.73 (95% CI: 0.68-0.78) for 5 and 10-year OS, respectively. Based on its accurate performance in this study, PREDICT may be clinically useful in prognosticating women with breast cancer and personalizing breast cancer treatment in resource-limited settings.
  6. Gopala Krishna Pillai S, Mohd Nordin NA, Mohamed Ibrahim N
    Medicine (Baltimore), 2023 Jul 14;102(28):e33966.
    PMID: 37443466 DOI: 10.1097/MD.0000000000033966
    BACKGROUND: Training caregivers and persons with Parkinson Disease (PwPD) is crucial to provide them with adequate knowledge and care skills in preparation for the Parkinson disease (PD) progression. This review will systematically evaluate the effect of structured training programs on the mobility and quality of life (QoL) of PwPD. In addition, the effect of such training programs on the QoL, burden of caregiving, and knowledge of PD among adult caregivers of PwPD will also be evaluated.

    METHODS: Systematic and comprehensive search of relevant studies will be conducted using electronic databases such as Cochrane Library, EBSCOhost, PubMed, SCOPUS, and Web of Science. The title, abstract, keywords, and full texts will be screened for eligibility. Studies to be selected are randomized controlled trials (RCT) from inception until April 2023. Studies based on structured PD training either in the form of training, education, program, multidisciplinary approach, or self-management targeted at both PwPD and their adult caregivers will be selected. Only full-text articles available in the English language will be included. Full-text articles will be inspected by 2 independent reviewers to produce the final set of articles that meet the eligibility criteria. A third reviewer will be engaged if no consensus is achieved between the first and second reviewers. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) will be used to evaluate the quality of papers and inform the risk of bias.

    RESULTS: This review will provide an outlook on the effects of structured PD training programs on mobility and QoL of PwPD. In addition, it will provide insight into the effects of such training on the caregivers' burden, knowledge of PD, and QoL.

    CONCLUSION: This review findings may help clinicians and researchers to understand the effect of structured and comprehensive PD training programs for PwPD and their adult caregiver.

  7. Rasiah R, Manikam R, Chandarsekaran SK, Thangiah G, Puspharajan S, Swaminathan D
    Medicine (Baltimore), 2014 Nov;93(23):e126.
    PMID: 25415665 DOI: 10.1097/MD.0000000000000126
    The growing shortage in human organs has raised serious concerns. To address this problem, we examine in this article the association between demographic and socioeconomic factors, and respondents' willingness to donate cadaveric organs using a large survey of Malaysian adults aged 18 years and above.A convenience sampling method was used to extract information from a total of 10,350 participants from Metropolitan Kuala Lumpur over the period of April 2, 2013 to February 29, 2014. In addition to analyzing the data using incidence of willingness to donate by demographic and socioeconomic factors, we carried out logistic regression analysis to estimate the odds ratio of respondents' willingness to become cadaveric organ donors controlling for age.About less than a third of the participants pledged to donate their organs upon death with women (35.6%) showing a higher incidence compared with men (33.2%). The Chinese (35.7%) and Malays (35.0%) pledged to contribute more than the Indians (31.6%) and the logistic regressions show that Malays (adjusted odds ration [OR] = 1.18) and Chinese (adjusted OR = 1.21) are more likely to donate than Indians (reference group). The results by religion were significant among Muslims and Hindus but not Buddhists. The likelihood of Muslims donating was the lowest (adjusted OR = 0.26). Income was also highly significant but the relationship with willingness to donate was negative. Against tertiary education, all other occupations were significant. However, the respondents with primary education enjoyed the highest adjusted OR (5.46) whereas that of secondary (0.48) and higher secondary (0.83) education was low. Among occupations (against supervisory, clerical, and direct workers), it was significant only among the unemployed and managers with adjusted OR of 1.50 and 1.58, respectively.Sex, education, ethnicity, religion, and income are important demographic and socioeconomic influences on the likelihood of Malaysians willing to become cadaveric organ donors. The Malaysian evidence suggests that awareness programs should be targeted at men, Muslims, Hindus, Malays, and the rich more than the others.
  8. Kim YJ, Qian L, Aslam MS
    Medicine (Baltimore), 2020 Nov 13;99(46):e23203.
    PMID: 33181701 DOI: 10.1097/MD.0000000000023203
    Substance use disorder (SUD) is associated with a high risk of physical and mental illness such as anxiety, depression, personality disorders, eating disorders, and abnormal mood changes. During the pandemic, SUD, a significant problem related to Coronavirus disease 2019 (COVID-19), is affecting adolescents. The recent available literature also emphasizes understanding the relationship between mental illness and SUD. Hence, it is essential to evaluate the scientific approach and examine the presented findings of articles published on SUD during the COVID-19 pandemic. A systematic review will be conducted using PubMed, PubMed Central, and Scopus bibliographic databases. The grey literature on the impact of SUD on mental health during the COVID-19 pandemic among adolescents will be identified using scholar google. The dependability and credibility of the findings will be examined using the ConQual approach. The methodologies of the included studies will be compared using ROBIS (risk of bias in systematic reviews tool), a measurement tool to assess systematic reviews (AMSTAR), and the JBI critical appraisal tool. The systematic review will be carried out on published articles, so it is exempt from ethics approval. The Center for Open Science (OSF) will be used as a data repository during the preparation of the protocol and completion of the systematic review. The research findings will be published in a related peer-reviewed journal.
  9. Ismail NFF, Neoh CF, Lim SM, Abdullah AH, Mastuki MF, Ramasamy K, et al.
    Medicine (Baltimore), 2017 Jul;96(30):e7511.
    PMID: 28746195 DOI: 10.1097/MD.0000000000007511
    INTRODUCTION: Asian countries have a variety of ethnic groups and culture that provide their own traditional treatment in health care. Facial candling appears to be one of the popular traditional treatments in Southeast Asian. The complementary medicine practitioners promote that the facial candling treatment would help in reducing the symptoms of allergic rhinitis and other problems related to sinus. Due to the lack of evidence available, the effectiveness of this treatment method and its mechanism, however, remains unknown. The objective of this research is therefore to study impact of facial candling on inflammatory mediators, substance P (SP), symptoms severity, and quality of life (QoL) in allergic rhinitis patients.

    METHOD AND ANALYSIS: A randomized, nonblinded, controlled trial will be carried out by recruiting a total of 66 eligible allergic rhinitis patients who fulfill the inclusion criteria from a university health center. The subjects will be randomly assigned into 2 groups: intervention group receiving facial candling treatment and control group (no treatment given). Samples of blood and nasal mucus will be collected right before and after intervention. Samples collected will be analyzed. The primary outcomes are the changes in the level of SP in both blood and mucus samples between both groups. The secondary outcomes include the levels of inflammatory mediators (ie, tumor necrosis factor alpha, interleukin (IL)-3, IL-5, IL-6, IL-10, and IL-13) and the severity of allergic rhinitis symptoms as measured by a visual analogous scale and QoL using the Rhinitis Quality of Life Questionnaire (RQLQ).

    ETHICAL AND TRIAL REGISTRATION: The study protocols are approved from the Ethical and Research Committee of the Universiti Teknologi MARA (REC/113/15). The trial is registered under the Australia New Zealand Clinical Trial Registry (ACTRN12616000299404). The trial was registered on 03/07/2016 and the first patient was enrolled on 10/12/2016.

    CONCLUSION: Facial candling is one of the unique treatments using candles to reduce the severity of symptoms and inflammation. This is the first ever study conducted on facial candling that will give rise to new knowledge underlying the effects of facial candling on severity of symptoms and inflammation relief mechanism mediated by substance P and inflammatory mediators.

    Matched MeSH terms: Medicine, East Asian Traditional*
  10. Krisdiyanto, Bin Raja Ghazilla RA, Azuddin M, Bin Ahmad Hairuddin MKF, Muflikhun MA, Risdiana N, et al.
    Medicine (Baltimore), 2022 Dec 09;101(49):e31812.
    PMID: 36626504 DOI: 10.1097/MD.0000000000031812
    A syringe is used to inject fluid or medicine into the patient's soft tissue. The main components of the syringe were the needle, barrel, and plunger. The use of syringes in the medical world is relatively high, and especially since the COVID-19 pandemic, the use of hypodermic syringes increased sharply due to vaccination. The syringe used must be effective and of good quality, so the International Organization for Standardization (ISO) has published test procedures and minimum specifications for hypodermic syringes. The performance of the syringe can be observed from the dead space, force piston operation, water and air leakage, and fitting position of the plunger in the barrel. This review shows that most researchers use the weighing method to measure the dead space, although some use other methods. The researchers found that most of the products met the minimum specifications of the ISO, and that the dimensions and shape of the syringe affected the dead space. Researchers have not examined other performance measures recommended by the ISO. Researchers have focused more on force injection than force piston operation, leakage after injection or back spray than air and water leakage, and reduction the friction of the plunger without considering the fitting position of the plunger in the barrel.
  11. Pui Kei C, Mohd Nordin NA, Abdul Aziz AF
    Medicine (Baltimore), 2020 Nov 20;99(47):e23296.
    PMID: 33217861 DOI: 10.1097/MD.0000000000023296
    INTRODUCTION: Stroke survivors are commonly at risk of functional decline following discharge from rehabilitation, which increase their susceptibility to falls, dependency in activities of daily living and emotional disturbances. To combat these, continued therapy is important. Home-based therapy (HBT) has been shown to be useful in maintaining functional performance and quality of life of chronic stroke survivors. However, evidence on its effectiveness remains limited, while no studies are available to date which report the benefit of HBT on stroke survivors self-efficacy and emotional status. Therefore, this study aims to assess the effectiveness of post-discharge HBT in comparison to usual practice on functional outcome (mobility and gait speed), self-efficacy and anxiety level among stroke survivors.

    METHODS: This is an assessor-blinded randomized control trial comparing 2 types of intervention which are HBT (experimental group) and usual practice (UP) (control group). Based on sample size calculation using GPower, a total number of 42 participants will be recruited and allocated into either the HBT or the UP group. Participants in HBT group will receive a set of structured exercise therapy consisting of progressive strengthening, balance and task-related exercises. While participants in UP group will receive a usual "intervention" practised by rehabilitation professional prior to discharging stroke patients from their care. Both groups are advised to perform the given interventions for 3 times per week for 12 weeks under the supervision of their caregiver. Outcomes of interventions will be measured using timed up and go test (for mobility), ten-meter walk test (for gait speed), stroke self-efficacy questionnaire (for self-efficacy) and hospital anxiety and depression scale (for anxiety level). All data will be analyzed using descriptive and inferential statistics.

    DISCUSSION: This study will provide the information on the effectiveness of HBT in comparison to UP among stroke population who are discharged from rehabilitation. Findings from the study will enable rehabilitation professionals to design effective discharge care plan for stroke survivors in combating functional decline when no longer receiving hospital-based therapy.

    TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12619001182189 (last updated 22/11/2019).

  12. Appalasamy JR, Tha KK, Quek KF, Ramaiah SS, Joseph JP, Md Zain AZ
    Medicine (Baltimore), 2018 Jun;97(22):e10876.
    PMID: 29851804 DOI: 10.1097/MD.0000000000010876
    INTRODUCTION: A substantial number of the world's population appears to end with moderate to severe long-term disability after stroke. Persistent uncontrolled stroke risk factor leads to unpredicted recurrent stroke event. The increasing prevalence of stroke across ages in Malaysia has led to the adaptation of medication therapy adherence clinic (MTAC) framework. The stroke care unit has limited patient education resources especially for patients with medication understanding and use self-efficacy. Nevertheless, only a handful of studies have probed into the effectiveness of video narrative at stroke care centers.

    METHOD: This is a behavioral randomized controlled trial of patient education intervention with video narratives for patients with stroke lacking medication understanding and use self-efficacy. The study will recruit up to 200 eligible stroke patients at the neurology tertiary outpatient clinic, whereby they will be requested to return for follow-up approximately 3 months once for up to 12 months. Consenting patients will be randomized to either standard patient education care or intervention with video narratives. The researchers will ensure control of potential confounding factors, as well as unbiased treatment review with prescribed medications only obtained onsite.

    RESULTS: The primary analysis outcomes will reflect the variances in medication understanding and use self-efficacy scores, as well as the associated factors, such as retention of knowledge, belief and perception changes, whereas stroke risk factor control, for example, self-monitoring and quality of life, will be the secondary outcomes.

    DISCUSSION AND CONCLUSION: The study should be able to determine if video narrative can induce a positive behavioral change towards stroke risk factor control via enhanced medication understanding and use self-efficacy. This intervention is innovative as it combines health belief, motivation, and role model concept to trigger self-efficacy in maintaining healthy behaviors and better disease management.

    TRIAL REGISTRATION: ACTRN (12618000174280).

  13. Johar MN, Mohd Nordin NA, Abdul Aziz AF
    Medicine (Baltimore), 2022 Jan 14;101(2):e28580.
    PMID: 35029235 DOI: 10.1097/MD.0000000000028580
    INTRODUCTION: Stroke survivors are commonly at risk of functional decline, which increase their dependency in activities of daily living and eventually affects their motivation level, self-efficacy, and quality of life. Circuit exercise has been shown to be useful in enhancing functional performance and quality of life of chronic stroke survivors. There is a need to review the existing "usual circuit exercise" and develop a better approach, such as game-based circuit exercise. Training in enriched and fun environment may possibly further promote neuroplasticity. However, evidence on inducing fun element in the existing circuit exercise among stroke survivors is limited. Also, no studies are available to date which report the benefit of circuit exercise on stroke survivors' self-efficacy and motivation level. Therefore, this study aims to assess the effectiveness of game-based circuit exercise in comparison to conventional circuit exercise on functional outcome (lower limb strength, postural stability and aerobic endurance), motivation level, self-efficacy and quality of life among stroke survivors. This study also aims to assess whether the outcomes gained from the 2 interventions could be sustained at week 12 and 24 post-trial.

    METHODS: This is an assessor-blinded randomized control trial comparing 2 types of intervention which are game-based circuit exercise (experimental group) and conventional circuit exercise (control group). Based on sample size calculation using GPower, a total number of 82 participants will be recruited and allocated into either the experimental or the control group. Participants in the experimental group will receive a set of structured game-based exercise therapy which has the components of resistance, dynamic balance and aerobic exercises. While participants in the control group will receive a conventional circuit exercise as usually conducted by physiotherapists consisting of 6 exercise stations; cycling, repeated sit to stand, upper limb exercise, lower limb exercise, stepping up/down and walking over obstacles. Both groups will perform the given interventions for 2 times per week for 12 weeks under the supervision of 2 physiotherapists. Outcomes of the interventions will be measured using 30-second chair rise test (for lower limb strength), Dynamic Gait Index (for postural stability), 6-minute walk test (aerobic capacity), Intrinsic Motivation Inventory questionnaire (for motivation level), stroke self-efficacy questionnaire (for self-efficacy) and Short Form-36 quality of life questionnaire (for quality of life). All data will be analyzed using descriptive and inferential statistics.

    DISCUSSION: This study will provide the information regarding the effectiveness of including game elements into circuit exercise training. Findings from this study will enable physiotherapists to design more innovative exercise therapy sessions to promote neuroplasticity and enhance functionality and quality of life among stroke survivors under their care.

    TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN 12621001489886 (last updated 1/11/2021).

  14. Kong YC, Bhoo-Pathy N, O'Rorke M, Subramaniam S, Bhoo-Pathy NT, See MH, et al.
    Medicine (Baltimore), 2020 Feb;99(6):e19093.
    PMID: 32028433 DOI: 10.1097/MD.0000000000019093
    Percutaneous biopsy in breast cancer has been associated with an increased risk of malignant cell seeding. However, the importance of these observations remains obscure due to lack of corroborating evidence from clinical studies. We determined whether method of biopsy is associated with breast cancer survival. This hospital registry-based cohort study included 3416 non-metastatic breast cancer patients diagnosed from 1993 to 2011 in a tertiary setting. Factors associated with biopsy methods were assessed. Multivariable Cox regression analysis was used to determine the independent prognostic impact of method of biopsy. Overall, 990 patients were diagnosed by core needle biopsy (CNB), 1364 by fine needle aspiration cytology (FNAC), and 1062 by excision biopsy. Excision biopsy was significantly associated with more favorable tumor characteristics. Radiotherapy modified the prognostic impact of biopsy method (Pinteraction 
  15. Rehman IU, Chan KG, Munib S, Lee LH, Khan TM
    Medicine (Baltimore), 2019 Sep;98(36):e16812.
    PMID: 31490367 DOI: 10.1097/MD.0000000000016812
    Chronic kidney disease (CKD)-associated pruritus is one of the most common symptoms found in patients who undergo dialysis for CKD, leading to a compromised quality of life. This study aimed to investigate the association between CKD-associated pruritus and the quality of life in patients undergoing hemodialysis in Pakistan.A cross-sectional multicenter study was carried out from July 2016 to April 2017 in 2 tertiary care hospitals in Pakistan. Patients aged 18 years and above of both genders, undergoing hemodialysis, understood the Urdu language, and were willing to participate; were included.Of 354 recruited patients with a response rate of 100%, majority (66.1%) of the patients were males. The median (intra-quartile range [IQR]) age of patients was 42.0 [34.0-50.0] years. The prevalence of pruritus was 74%. The median [IQR] score for pruritus was 10.0 (out of possible 25) [8.0-12.0]. Multivariate linear regression revealed a statistically significant association between CKD-associated pruritus with age of patients (β = 0.031; 95% confidence interval [CI] = 0.002-0.061; P = .038), duration of CKD (β = -0.013; 95% CI = -0.023 --0.003; P = .014) and quality of life (β= -0.949; 95% CI = -1.450; -0.449). The median [IQR] score for health-related quality of life was 52.00 [43.00-58.00].Prevalence of CKD-associated pruritus was reported to be 74% and it negatively affected the patient's quality of life. Patients with moderate to severe CKD-associated pruritus have poor quality of life. With an increase in intensity of pruritus, the QOL score decreased among the patients undergoing hemodialysis.
  16. Kim YJ
    Medicine (Baltimore), 2023 Sep 29;102(39):e35143.
    PMID: 37773837 DOI: 10.1097/MD.0000000000035143
    The objective of this study was to investigate the impact of the problem-based learning (PBL) method on Neurology education for Traditional Chinese Medicine (TCM) undergraduate students. This observational study was conducted during the 2020/02 and 2020/04 intakes of the third year TCM undergraduate students at School of Traditional Chinese Medicine, Xiamen University Malaysia. A total of 86 students were enrolled in the study and randomly assigned to either conventional learning groups or PBL groups. Students who missed more than 1 session of the course or did not complete the questionnaires during the evaluation periods were excluded from the study (n = 0). An independent sample t test was used to compare the results between the 2 groups, with a significance level set as P 
    Matched MeSH terms: Medicine, Chinese Traditional
  17. Naing C, Sandhu NK, Wai VN
    Medicine (Baltimore), 2016 Apr;95(14):e3205.
    PMID: 27057848 DOI: 10.1097/MD.0000000000003205
    Malaria and human immunodeficiency virus (HIV) infections are globally important public health concerns. The objectives of this study were (i) to determine the prevalence of malaria and HIV co-infections in people living in endemic countries, and (ii) to assess the effect of co-infection on anemia.Studies were searched on electronic databases including PubMed, Embase, Medline, Google Scholar, and African Journals Online. Observational studies, assessing the prevalence of co-infection and reporting its association with anemia, were included. The methodological quality of included studies was assessed using a tool called the risk of bias assessment for non-randomized studies. Heterogeneity among studies was investigated with the I-square test. Pooled prevalence of the co-infection and its 95% confidence interval (CI) were estimated using the random-effect model, reflected on heterogeneity among studies. Summary odds ratio (OR), summary standardized mean difference (SMD), and their corresponding 95% CIs were estimated, as appropriate. Subgroup analysis and meta-regression were performed for robustness of results. Publication bias was assessed by visualization of a funnel plot.Twenty-three studies were included in the present study. Overall, the pooled prevalence of co-infection was 19% (95% CI: 15-23%, I: 98.1%), showing 26% (95% CI: 20-32%, I: 98.7%) in adults, 12% (95% CI: 7-17%, I: 95.0) in pregnant women, and 9% (95% CI: 6-11%, I: 68.6%) in children. Anemia was comparable between the monoinfected and co-infected adults (summary OR: 1.49, 95% CI: 0.93-2.37) and increased by 49% in co-infected pregnant women (summary OR: 1.49, 95% CI: 1.14-1.94). The mean hemoglobin concentration was significantly lower in the co-infected group than the monoinfected group (summary SMD: -0.47, 95% CI: -0.61 to -0.33). The results of meta-regression on the prevalence of co-infection using the publication year and total population as covariates showed the I value remained high implying a de facto random distribution of heterogeneity. An asymmetrical funnel plot indicated the presence of publication bias. Due to heterogeneity of the studies in this review, the results have to be interpreted with caution.The findings of this study suggest that the prevalence of malaria and HIV co-infection, particularly in pregnant women, requires special attention from healthcare personnel. Better understanding of the co-infection is crucial for designing treatment strategies. Future well-powered, prospective designs assessing the interaction between malaria and HIV are recommended.
  18. Mardhiah K, Wan-Arfah N, Naing NN, Hassan MRA, Chan HK
    Medicine (Baltimore), 2021 Jun 25;100(25):e26160.
    PMID: 34160382 DOI: 10.1097/MD.0000000000026160
    Melioidosis is an infectious disease that is initiated by a bacteria recognized as Burkholderia pseudomallei. Despite the high fatality rate from melioidosis, there is a minimal published study about the disease in Malaysia.This study aimed to identify the prognostic factors of mortality among melioidosis patients in northern Malaysia.All inpatient patients who were admitted to Hospital Sultanah Bahiyah, Kedah and Hospital Tuanku Fauziah, Perlis with culture-confirmed melioidosis during the period 2014 to 2017 were included in the study. The study retrospectively collected 510 melioidosis patients from the Melioidosis Registry. Hazard ratio (HR) used in advanced multiple Cox regression was used to obtain the final model of prognostic factors of melioidosis. The analysis was performed using STATA/SE 14.0 for Windows software.From the results, among the admitted patients, 50.1% died at the hospital. The mean age for those who died was 55 years old, and they were mostly male. The most common underlying disease was diabetes mellitus (69.8%), followed by hypertension (32.7%). The majority of cases (86.8%) were bacteremic. The final Cox model identified 5 prognostic factors of mortality among melioidosis patients. The factors were diabetes mellitus, type of melioidosis, platelet count, white blood cell count, and urea value. The results showed that bacteremic melioidosis increased the risk of dying by 3.47 (HR: 3.47, 95% confidence intervals [CI]: 1.67-7.23, P = .001) compared to non-bacteremic melioidosis. Based on the blood investigations, the adjusted HRs from the final model showed that all 3 blood investigations were included as the prognostic factors for the disease (low platelet: HR = 1.76, 95% CI: 1.22-2.54, P = .003; high white blood cell: HR = 1.49, 95% CI 1.06-2.11, P = .023; high urea: HR = 2.92, 95% CI: 1.76-4.85, P 
  19. Naing C, Sitt T, Aung AT, Aung K
    Medicine (Baltimore), 2015 Jul;94(30):e1234.
    PMID: 26222859 DOI: 10.1097/MD.0000000000001234
    In Myanmar, hepatitis C virus (HCV) infection prevalence is 2%. A combination therapy of pegylated interferon alfa-2a and ribavirin (PEG-IFNa/RBV) is a standard treatment, but the effect of this antiviral therapy needs evaluation as to determine the efficacy and safety of dual PEG-IFNa/RBV therapy in treating patients infected with HCV in Myanmar.This was a retrospective analysis of data from a single clinic exclusively for gastrointestinal diseases in Yangon, Myanmar. We assessed treatment responses at the defined time points and stratified by genotypes of HCV. We also determined incidences of adverse events (AEs). We investigated independent predictors of sustained virologic response (SVR) in the participants.A total of 362 HCV-infected cases were included in this study. The majority were females (51.7%) with mean age of 47.12 years (±11.6) and noncirrhosis patients (82%). Rapid virologic response (RVR), early virologic response (EVR), end of treatment response (ETR), and SVR 24 weeks after completion of the dual treatment were 50.3% (178/362), 88% (314/357), 80.1% (286/357), and 85.6% (167/195), respectively. The most frequently reported AEs were nausea/anorexia (72.8%) and flu-like symptoms (62.4%). In multivariate analysis, 4 factors were independently associated with SVR; SVR to genotype 3 (odds ratio [OR] 2.4, 95% CI: 1.24-4.62), EVR (OR 0.54, 95% CI: 0.3-0.95), and duration of treatment (OR 1.52, 95% CI: 1.18-1.98). Study limitations were acknowledged.The efficacy and safety of the dual therapy in treating HCV-infected patient in Myanmar was acceptable. We recommend a prospective randomized control trial looking at duration of therapy and rates of achieving SVR, which could significantly impact the care of HCV-infected patients in Myanmar and perhaps other countries as well.
  20. Lee SW, Lee JY, Tan CS, Wong CP
    Medicine (Baltimore), 2016 Jan;95(2):e2457.
    PMID: 26765440 DOI: 10.1097/MD.0000000000002457
    Ramadan is the holy month for Muslims whereby they fast from predawn to after sunset and is observed by all healthy Muslim adults as well as a large population of type 2 diabetic Muslims.To determine the comparative effectiveness of various strategies that have been used for type 2 diabetic Muslim who fast during Ramadan.A systematic review and network meta-analysis of randomized controlled studies (RCT) as well as observational studies for patients with type 2 diabetes who fasted during Ramadan was conducted. Eight databases were searched from January 1980 through October 2015 for relevant studies. Two reviewers independently screened and assessed study for eligibility, assessed the risk of bias, and extracted relevant data. A network meta-analysis for each outcome was fitted separately, combining direct and indirect evidence for each comparison.Twenty-nine studies, 16 RCTs and 13 observational studies each met the inclusion criteria. The most common strategy used was drug changes during the Ramadan period, which found that the use of DPP-4 (Dipeptidyl peptidase inhibitor -4) inhibitors were associated with a reduction in incidence of experiencing hypoglycemia during Ramadan in both RCTs (pooled relative risk: 0.56; 95% confidence interval: 0.44-0.72) as well as in observational studies (pooled relative risk: 0.27; 0.09-0.75). Ramadan-focused education was shown to be beneficial in reducing hypoglycemia in observational studies but not RCTs (0.25 versus 1.00). Network meta-analyses suggest that incretin mimetics can reduce the risk of hypoglycemia by nearly 1.5 times.The newer antidiabetic agents appear to lower the risk of hypoglycemia and improved glycemic control when compared with sulfonylureas. Ramadan-focused education shows to be a promising strategy but more rigorous examination from RCTs are required.
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