METHODS: A total of 335,060 women participating in the European Prospective Investigation into Nutrition and Cancer (EPIC) Study, completed a dietary questionnaire from 1992 to 2000, and were followed-up until 2010 for incidence of breast cancer. Hazard ratios (HR) of breast cancer by country-specific, as well as cohort-wide categories of beverage intake were estimated.
RESULTS: During an average follow-up of 11 years, 1064 premenopausal, and 9134 postmenopausal breast cancers were diagnosed. Caffeinated coffee intake was associated with lower risk of postmenopausal breast cancer: adjusted HR=0.90, 95% confidence interval (CI): 0.82 to 0.98, for high versus low consumption; Ptrend=0.029. While there was no significant effect modification by hormone receptor status (P=0.711), linear trend for lower risk of breast cancer with increasing caffeinated coffee intake was clearest for estrogen and progesterone receptor negative (ER-PR-), postmenopausal breast cancer (P=0.008). For every 100 ml increase in caffeinated coffee intake, the risk of ER-PR- breast cancer was lower by 4% (adjusted HR: 0.96, 95% CI: 0.93 to 1.00). Non-consumers of decaffeinated coffee had lower risk of postmenopausal breast cancer (adjusted HR=0.89; 95% CI: 0.80 to 0.99) compared to low consumers, without evidence of dose-response relationship (Ptrend=0.128). Exclusive decaffeinated coffee consumption was not related to postmenopausal breast cancer risk, compared to any decaffeinated-low caffeinated intake (adjusted HR=0.97; 95% CI: 0.82 to 1.14), or to no intake of any coffee (HR: 0.96; 95%: 0.82 to 1.14). Caffeinated and decaffeinated coffee were not associated with premenopausal breast cancer. Tea intake was neither associated with pre- nor post-menopausal breast cancer.
CONCLUSIONS: Higher caffeinated coffee intake may be associated with lower risk of postmenopausal breast cancer. Decaffeinated coffee intake does not seem to be associated with breast cancer.
DESIGN: A retrospective analysis of STEMI patients from 18 hospitals across Malaysia contributing to the Malaysian National Cardiovascular Database-acute coronary syndrome) registry (NCVD-ACS) year 2006-2013.
PARTICIPANTS: 16 517 patients diagnosed of STEMI from 18 hospitals in Malaysia from the year 2006 to 2013.
PRIMARY OUTCOME MEASURES: In-hospital and 30 day post-discharge mortality.
RESULTS: CS complicates 10.6% of all STEMIs in this study. They had unfavourable premorbid conditions and poor outcomes. The in-hospital mortality rate was 34.1% which translates into a 7.14 times mortality risk increment compared with STEMI without CS. Intravenous thrombolysis remained as the main urgent reperfusion modality. Percutaneous coronary interventions (PCI) in CS conferred a 40% risk reduction over non-invasive therapy but were only done in 33.6% of cases. Age over 65, diabetes mellitus, hypertension, chronic lung and kidney disease conferred higher risk of mortality.
CONCLUSION: Mortality rates of CS complicating STEMI in Malaysia are high. In-hospital PCI confers a 40% mortality risk reduction but the rate of PCI among our patients with CS complicating STEMI is still low. Efforts are being made to increase access to invasive therapy for these patients.
DESIGN: This is a retrospective analysis of women with ST-elevation MI (STEMI) and non-STEMI (NSTEMI) from 18 hospitals across Malaysia using the Malaysian National Cardiovascular Database registry-acute coronary syndrome (NCVD-ACS).
PARTICIPANTS: Women patients diagnosed with acute MI from year 2006 to 2013 were identified and divided into young (age ≤ 45, n=292) and older women (age >45, n=5580).
PRIMARY OUTCOME MEASURE: Comparison of demographics, clinical characteristics and in-hospital management was performed between young and older women. In-hospital and 30-day all-cause mortality were examined.
RESULTS: Young women (mean age 39±4.68) made up 5% of women with MI and were predominantly of Malay ethnicities (53.8%). They have a higher tendency to present as STEMI compared with older women. Young women have significantly higher rates of family history of premature coronary artery disease (CAD) (20.5% vs 7.8% p<0.0001). The prevalence of risk factors, such as hypertension, diabetes and dyslipidaemia was high in both groups. The primary reperfusion strategy was thrombolysis with no significant differences observed in the choice of intervention for both groups. Other than aspirin, rates of prescriptions for evidence-based medications were similar with >80% prescribed statins and aspirin. The all-cause mortality rates of young women were lower for both in-hospital and 30 days, especially in those with STEMI with adjusted mortality ratio to the older group, was 1:9.84.
CONCLUSION: Young women with MI were over-represented by Malays and those with a family history of premature CAD. Preventive measures are needed to reduce cardiovascular risks in young women. Although in-hospital management was similar, short-term mortality outcomes favoured young compared with older women.
METHODS: A prospective, multi-centre, multi-country study including patients hospitalized with AHF was conducted. Clinical characteristics, echocardiogram, BNP (B-type natriuretic peptide), socioeconomic status, management, 1-month, and 1-year outcomes are reported.
RESULTS: Between April 2019 and June 2020, a total of 1258 adults with AHF from 16 Arab countries were recruited. Their mean age was 63.3 (±15) years, 56.8% were men, 65% had monthly income ≤US$ 500, and 56% had limited education. Furthermore, 55% had diabetes mellitus, 67% had hypertension; 55% had HFrEF (heart failure with reduced ejection fraction), and 19% had HFpEF (heart failure with preserved ejection fraction). At 1 year, 3.6% had a heart failure-related device (0-22%) and 7.3% used an angiotensin receptor neprilysin inhibitor (0-43%). Mortality was 4.4% per 1 month and 11.77% per 1-year post-discharge. Compared with higher-income patients, lower-income patients had a higher 1-year total heart failure hospitalization rate (45.6 vs 29.9%, p=0.001), and the 1-year mortality difference was not statistically significant (13.2 vs 8.8%, p=0.059).
CONCLUSION: Most of the patients with AHF in Arab countries had a high burden of cardiac risk factors, low income, and low education status with great heterogeneity in key performance indicators of AHF management among Arab countries.
METHODS: This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center.
CONCLUSION: The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.
METHODS: This retrospective cohort study included data of 1,632 cataract surgeries performed from 2007 to 2010 which was obtained from the cataract registry of the Malaysian National Eye Database. Demographic features, ocular and systemic comorbidites, grade of surgeon expertise and duration of surgery, type of anesthesia, intraoperative and postoperative complications, and the type of intraocular lens were recorded. Best corrected visual acuities were compared before and after the operation.
RESULTS: Mean patient age was 66.9 years with equal gender distribution. The majority of subjects had age related cataracts. Phacoemulsification was done faster than other surgeries, especially by specialist surgeons. History of prior ocular surgery and operations performed under general anesthesia were associated with greater complications. Phacoemulsification was associated with less complications and better visual outcomes. The age and etiology of cataract did not affect complications. Malays, absence of ocular comorbidities, left eyes and eyes operated under local anesthesia were more likely to experience more visual improvement. Gender, age, cause of cataract, systemic comorbidities and surgeon expertise as well as intra-and postoperative complications did not affect the visual outcomes.
CONCLUSION: Phacoemulsification had good visual outcomes in cataract surgery. Duration of surgery, expertise of the surgeon and complications did not affect the visual outcomes.
METHOD: This retrospective study utilised the Malaysian National Cardiovascular Disease- ACS (NCVD-ACS) registry. Consecutive patient data of those ≥80 years old admitted with ACS at 24 participating hospitals from 2008 to 2017 (n = 3162) were identified. Demographics, in-hospital intervention, and evidence-based pharmacotherapies over the 10-years were examined and compared across groups of interests using the Chi-square test. Multivariate logistic regression was used to calculate the adjusted odds ratio of receiving individual therapies according to patients' characteristics.
RESULTS: Octogenarians made up 3.8% of patients with ACS in the NCVD-ACS registry (mean age = 84, SD ± 3.6) from 2008 until 2017. The largest ethnic group was Chinese (44%). Most octogenarians (95%) have multiple cardiovascular risk factors, with hypertension (82%) being the main. Non-ST-elevation myocardial infarction (NSTEMI) predominated (38%, p
Methods: In 2018, a retrospective cohort study stretching from January to April was conducted. This study involved a review of data obtained from the National AIDS Registry. A total of 1,073 AIDS cases diagnosed from 1 January 2010 to 31 December 2014 were selected, and follow-up procedures were conducted until 31 March 2015 (a 3-month follow-up). The Kaplan-Meier plot and Cox's proportional hazard regression were used for data analyses.
Results: 564 (52.5%) patients died due to AIDS, while the remaining 509 (47.4%) were censored. The overall median survival time was 11 months. The probability of survival in 1-year, 2-year, 3-year, 4-year and 5-year periods were 49.1%, 47.8%, 47.3%, 47.0% and 46.7%, respectively. Multiple Cox regression revealed that the significant prognostic factors were age 30-49 years [adjusted hazard ratio (Adj. HR) 1.57; 95% CI: 1.14, 2.16; P = 0.006], male (Adj. HR 1.39; 95% CI: 1.07, 1.79; P = 0.012), unemployed (Adj. HR 1.40; 95% CI: 1.12, 1.75; P = 0.003) and HIV-TB co-infection (Adj. HR 1.78; 95% CI: 1.37, 2.31; P < 0.001).
Conclusion: The overall median survival time among AIDS patients in North-East Peninsular Malaysia was revealed to be short, in comparison to the other studies. The chances for survival can be improved with more emphasis on early detection (to ensure early treatment) and social support, particularly for HIV-TB co-infected patients, as well as for younger and unemployed patients.
METHOD:: The retrospective study was performed in a referral wound care clinic in Hospital Kuala Lumpur. Data was collected from January 2014 to October 2016 on DFU patients who attended this clinic.
RESULTS:: Of the 340 patients (216 male and 124 female) DFU patients who attended the clinic (mean age: 58.1±10.8 years old), 41.5% presented with infection with a mean cross-sectional ulcer area of 21.5±33.2cm2. Binary logistic regression analysis revealed that patients of Chinese ethnicity (OR: 3.39; 95%CI 1.49 to 7.70), with fasting blood glucose ≥7mmol/l (OR: 3.41; 95%CI 1.57 to 7.39), ulcer size ≥10cm2 (OR: 2.90; 95%CI 1.45 to 5.82) and blood pressure ≥140/90mmHg (OR: 2.52; 95%CI 1.54 to 4.14) were more likely to develop DFI. The median healing time for patients with DFUs was three months. There were six variables identified as significantly associated with prolonged healing time of DFU, namely presence of infection (p<0.001), poor glycaemic control with fasting blood glucose ≥7mmol/l (p<0.001), high blood pressure ≥140/90mmHg (p<0.001), large DFU size ≥2cm2 (p<0.001), history of amputation (p<0.005) and plantar location of the DFU (p<0.05).
CONCLUSION:: Large DFU size, poor glycaemic and blood pressure control are common risk factors for both DFU and DFI. Unexpected high prevalence and ethnicity risk factor for DFI urge more comprehensive primary and secondary preventative strategies to reduce its incidence.