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  1. Yip WK, Choo CW, Leong VC, Leong PP, Jabar MF, Seow HF
    APMIS, 2013 Oct;121(10):954-66.
    PMID: 23992303 DOI: 10.1111/apm.12152
    Molecular alterations in KRAS, BRAF, PIK3CA, and PTEN have been implicated in designing targeted therapy for colorectal cancer (CRC). The present study aimed to determine the status of these molecular alterations in Malaysian CRCs as such data are not available in the literature. We investigated the mutations of KRAS, BRAF, and PTEN, the gene amplification of PIK3CA, and the protein expression of PTEN and phosphatidylinositol 3-kinase (PI3K) catalytic subunit (p110α) by direct DNA sequencing, quantitative real-time PCR, and immunohistochemistry, respectively, in 49 CRC samples. The frequency of KRAS (codons 12, 13, and 61), BRAF (V600E), and PTEN mutations, and PIK3CA amplification was 25.0% (11/44), 2.3% (1/43), 0.0% (0/43), and 76.7% (33/43), respectively. Immunohistochemical staining demonstrated loss of PTEN protein in 54.5% (24/44) of CRCs and no significant difference in PI3K p110α expression between CRCs and the adjacent normal colonic mucosa (p = 0.380). PIK3CA amplification was not associated with PI3K p110α expression level, but associated with male cases (100% of male cases vs 56% of female cases harbored amplified PIK3CA, p = 0.002). PI3K p110α expression was significantly higher (p = 0.041) in poorly/moderately differentiated carcinoma compared with well-differentiated carcinoma. KRAS mutation, PIK3CA amplification, PTEN loss, and PI3K p110α expression did not correlate with Akt phosphorylation or Ki-67 expression. KRAS mutation, PIK3CA amplification, and PTEN loss were not mutually exclusive. This is the first report on CRC in Malaysia showing comparable frequency of KRAS mutation and PTEN loss, lower BRAF mutation rate, higher PIK3CA amplification frequency, and rare PTEN mutation, as compared with published reports.
    Matched MeSH terms: Tertiary Care Centers
  2. Noor Aini Hussain, Mohamed Rusli Abdullah, Abdul Rahman Esa, Muzaimi Mustapha, Nasir Yusoff
    ASEAN Journal of Psychiatry, 2014;15(2):164-175.
    MyJurnal
    Objective: The involvement of families in assisting health professionals in providing care for their family members who suffer a stroke during hospitalization is common in Malaysia. Family caregivers are accountable in providing for the first-ever stroke survivor’s needs, including maintaining functional improvements gained in rehabilitation and the long-term well-being of the stroke survivors. The objective of this study was to determine the predictors of life satisfaction among family caregivers of hospitalized first-ever stroke patients. Methods: This was a cross-sectional community research design study with purposive sampling. It involved 102 family caregivers of hospitalized first-ever stroke patients of two tertiary hospitals in Kelantan. The Bakas Caregiving Outcomes Score (BCOS) was used to measure life satisfaction. Multiple linear regression was used to determine the predictors of life satisfaction. Results: Out of 102 respondents, 21 were males and 81 were females with age range of 16 to 76 years. Significant predictors of life satisfaction of caregivers while caring for their hospitalized first-ever stroke family members were caregivers’ health (β: -2.875, 95%CI: -5.725, -0.025, p = 0.048), patients’ age (β: - 4.251, 95% CI: - 6.379, -2.123, p
    Matched MeSH terms: Tertiary Care Centers
  3. de Vries B, Narayan R, McGeechan K, Santiagu S, Vairavan R, Burke M, et al.
    Acta Obstet Gynecol Scand, 2018 Jun;97(6):668-676.
    PMID: 29450884 DOI: 10.1111/aogs.13310
    INTRODUCTION: Cesarean section rates continue to increase globally. Prediction of intrapartum cesarean section could lead to preventive measures. Our aim was to assess the association between sonographically measured cervical length at 37 weeks of gestation and cesarean section among women planning a vaginal birth. The population was women with a low-risk pregnancy or with gestational diabetes.

    MATERIAL AND METHODS: This was a prospective cohort study conducted in a tertiary referral hospital in Sydney, Australia. In all, 212 women with a low-risk pregnancy or with gestational diabetes were recruited including 158 nulliparous and 54 parous women. Maternal demographic, clinical and ultrasound characteristics were collected at 37 weeks of gestation. Semi-Bayesian logistic regression and Markov chain Monte Carlo simulation were used to assess the relation between cervical length and cesarean section in labor.

    RESULTS: Rates of cesarean section were 5% (2/55) for cervical length ≤20 mm, 17% (17/101) for cervical length 20-32 mm, and 27% (13/56) for cervical length >32 mm. These rates were 4, 22 and 33%, respectively, in nulliparous women. In the semi-Bayesian analysis, the odds ratio for cesarean section was 6.2 (95% confidence interval 2.2-43) for cervical length 20-32 mm and 10 (95% confidence interval 4.8-74) for cervical length >32 mm compared with the lowest quartile of cervical length, after adjusting for maternal age, parity, height, prepregnancy body mass index, gestational diabetes, induction of labor, neonatal sex and birthweight centile.

    CONCLUSIONS: Cervical length at 37 weeks of gestation is associated with intrapartum cesarean section.

    Matched MeSH terms: Tertiary Care Centers
  4. Ashworth J, Flaherty M, Pitz S, Ramlee A
    Acta Ophthalmol, 2015 Mar;93(2):e111-7.
    PMID: 25688487 DOI: 10.1111/aos.12607
    Purpose: The mucopolysaccharidoses (MPS) are a group of rare lysosomal storage disorders, characterized by the accumulation of glycosaminoglycans within multiple organ systems including the eye. This study aimed to determine the prevalence of glaucoma in patients with MPS, as well as the characteristics, diagnosis and management of patients with MPS and glaucoma.
    Methods: A multicentre retrospective case-note review was carried out by ophthalmologists from four tertiary referral centres to identify patients with MPS who had been treated for glaucoma. Clinical ophthalmological data were collected using standardized data collection forms.
    Results: Fourteen patients were identified (27 eyes) of 294 patients with MPS. The prevalence of glaucoma ranged from 2.1% to 12.5%. The median age at diagnosis of glaucoma was 8 years. Diagnostic evaluation of glaucoma was incomplete in many patients: intraocular pressure was documented in all eyes, but optic disc appearance was only assessed in 67%, central corneal thickness in 26%, visual fields in 19% and iridocorneal angle in 15%.
    Conclusions: Patients with MPS need regular assessment for possible glaucoma including during childhood. Multiple factors contribute to the challenges of assessment, diagnosis and monitoring of glaucoma in these patients.
    Keywords: Hunter; Hurler; Hurler-Scheie; Maroteaux-Lamy; Morquio; Scheie; glaucoma; mucopolysaccharidosis; prevalence.
    Matched MeSH terms: Tertiary Care Centers
  5. Xiong J, Domnic Jacob GA, Xiong JG
    Am J Health Behav, 2023 Feb 28;47(1):165-172.
    PMID: 36945091 DOI: 10.5993/AJHB.47.1.17
    Objectives: In this study, we analyzed negative online public opinion in tertiary hospitals and evaluated corresponding risk by applying the Kaiser Model. Methods: Through data and expert group discussion, combined with the hospital's actual negative online public opinion management, we determined the opinions posing higher risk. The hospital's risk questionnaire for negative opinion was designed based on the Kaiser Model. The whole hospital staff was then trained and investigated. An Excel worksheet was used for statistical analysis and risk calculation.Results: According to the ranking of risk value, the top 5 negative online public opinions were drug supply and demand, in-hospital parking, handling of public health emergencies, the service attitude of hospital guidance staff, and interpretation of medical insurance policies. Conclusion: The hospital needs to revise and improve the emergency response plan for negative online public opinion based on the analysis results and reports of opinion risks. This is helpful for strengthening hospital-level emergency training, improving the hospital's ability to manage negative opinion risks, and promoting the hospital to become passive about negative online public opinion.
    Matched MeSH terms: Tertiary Care Centers
  6. Yan Hung SK, Hiew FL, Viswanathan S
    Ann Indian Acad Neurol, 2019 1 30;22(1):102-103.
    PMID: 30692769 DOI: 10.4103/aian.AIAN_232_18
    Multiple co-infections can predispose a patient to autoimmune encephalitis. Out of thirty cases of N-methyl-D-aspartate receptor (NMDAR) encephalitis seen at a single tertiary referral center, only two cases of co-infection with NMDAR encephalitis were identified. One of these cases was highly interesting due to the presence of more than one co-infections along with the presence of cortical dysfunction, seizures, and orofacial dyskinesias at the onset in a male in the absence of tumors, which was refractory to initial treatment.
    Matched MeSH terms: Tertiary Care Centers
  7. Sunil M, Hieu HQ, Arjan Singh RS, Ponnampalavanar S, Siew KSW, Loch A
    Ann Clin Microbiol Antimicrob, 2019 Dec 17;18(1):43.
    PMID: 31847847 DOI: 10.1186/s12941-019-0341-x
    BACKGROUND: Staphylococcus has replaced streptococcus as the most common cause of infective endocarditis (IE) in developed health care systems. The trend in developing countries is less clear.

    AIM: To examine the epidemiological trends of infective endocarditis in a developing nation.

    METHODS: Single-centre, retrospective study of patients admitted with IE to a tertiary hospital in Malaysia over a 12-year period.

    RESULTS: The analysis included 182 patients (n = 153 Duke's definite IE, n = 29 possible IE). The mean age was 51 years. Rheumatic heart disease was present in 42%, while 7.6% were immunocompromised. IE affected native valves in 171 (94%) cases. Health-care associated IE (HCAIE) was recorded in 68 (37.4%). IE admission rates increased from 25/100,000 admissions (2012) to 59/100,000 admissions (2017). At least one major complication on admission was detected in 59 (32.4%) patients. Left-sided IE was more common than right-sided IE [n = 159 (87.4%) vs. n = 18 (9.9%)]. Pathogens identified by blood culture were staphylococcus group [n = 58 (40.8%)], streptococcus group [n = 51 (35.9%)] and Enterococcus species [n = 13 (9.2%)]. staphylococcus infection was highest in the HCAIE group. In-hospital death occurred in 65 (35.7%) patients. In-hospital surgery was performed for 36 (19.8%) patients. At least one complication was documented in 163 (85.7%).

    CONCLUSION: Staphylococcus is the new etiologic champion, reflecting the transition of the healthcare system. Streptococcus is still an important culprit organism. The incidence rate of IE appears to be increasing. The rate of patients with underlying rheumatic heart disease is still high.

    Matched MeSH terms: Tertiary Care Centers
  8. Wong RS, Ismail NA, Tan CC
    Ann Acad Med Singap, 2015 Apr;44(4):127-32.
    PMID: 26041636
    INTRODUCTION: Intensive care unit (ICU) prognostic models are predominantly used in more developed nations such as the United States, Europe and Australia. These are not that popular in Southeast Asian countries due to costs and technology considerations. The purpose of this study is to evaluate the suitability of the acute physiology and chronic health evaluation (APACHE) IV model in a single centre Malaysian ICU.

    MATERIALS AND METHODS: A prospective study was conducted at the single centre ICU in Hospital Sultanah Aminah (HSA) Malaysia. External validation of APACHE IV involved a cohort of 916 patients who were admitted in 2009. Model performance was assessed through its calibration and discrimination abilities. A first-level customisation using logistic regression approach was also applied to improve model calibration.

    RESULTS: APACHE IV exhibited good discrimination, with an area under receiver operating characteristic (ROC) curve of 0.78. However, the model's overall fit was observed to be poor, as indicated by the Hosmer-Lemeshow goodness-of-fit test (Ĉ = 113, P <0.001). Predicted in-ICU mortality rate (28.1%) was significantly higher than the actual in-ICU mortality rate (18.8%). Model calibration was improved after applying first-level customisation (Ĉ = 6.39, P = 0.78) although discrimination was not affected.

    CONCLUSION: APACHE IV is not suitable for application in HSA ICU, without further customisation. The model's lack of fit in the Malaysian study is attributed to differences in the baseline characteristics between HSA ICU and APACHE IV datasets. Other possible factors could be due to differences in clinical practice, quality and services of health care systems between Malaysia and the United States.

    Matched MeSH terms: Tertiary Care Centers
  9. Huan NC, Ng KL, Tang JT, Kua HN, Daut UN, Muhammad NA, et al.
    Ann Acad Med Singap, 2020 12;49(12):1013-1017.
    PMID: 33463660 DOI: 10.47102/annals-acadmedsg.2020364
    The ongoing pandemic of COVID-19 has presented multiple challenges to global healthcare services, dictating changes in almost every aspect of daily medical practice. Performing aerosol generating procedures (AGPs) in the field of interventional pulmonology can lead to profound formation of aerosols, leading to a high risk of infection among healthcare workers (HCWs). We share our experiences on performing AGPs in the midst of a COVID-19 pandemic by focusing on changes in AGP practices. In a pandemic, HCWs ought to adapt to the ever-changing situation and use available resources to provide the best possible healthcare to patients, ensure safety of staff, and continue medical education of future pulmonologists.
    Matched MeSH terms: Tertiary Care Centers
  10. Ahmad Hatib NA, Chong CY, Thoon KC, Tee NW, Krishnamoorthy SS, Tan NW
    Ann Acad Med Singap, 2016 Jul;45(7):297-302.
    PMID: 27523510
    INTRODUCTION: Enteric fever is a multisystemic infection which largely affects children. This study aimed to analyse the epidemiology, clinical presentation, treatment and outcome of paediatric enteric fever in Singapore.

    MATERIALS AND METHODS: A retrospective review of children diagnosed with enteric fever in a tertiary paediatric hospital in Singapore was conducted from January 2006 to January 2012. Patients with positive blood cultures for Salmonella typhi or paratyphi were identified from the microbiology laboratory information system. Data was extracted from their case records.

    RESULTS: Of 50 enteric fever cases, 86% were due to Salmonella typhi, with 16.3% being multidrug resistant (MDR) strains. Sixty-two percent of S. typhi isolates were of decreased ciprofloxacin susceptibility (DCS). Five cases were both MDR and DCS. The remaining 14% were Salmonella paratyphi A. There were only 3 indigenous cases. Ninety-four percent had travelled to typhoid-endemic countries, 70.2% to the Indian subcontinent and the rest to Indonesia and Malaysia. All patients infected with MDR strains had travelled to the Indian subcontinent. Anaemia was a significant finding in children with typhoid, as compared to paratyphoid fever (P = 0.04). Although all children were previously well, 14% suffered severe complications including shock, pericardial effusion and enterocolitis. None had typhoid vaccination prior to their travel to developing countries.

    CONCLUSION: Enteric fever is largely an imported disease in Singapore and has contributed to significant morbidity in children. The use of typhoid vaccine, as well as education on food and water hygiene to children travelling to developing countries, needs to be emphasised.

    Matched MeSH terms: Tertiary Care Centers
  11. Al Khalaf MS, Al Ehnidi FH, Al-Dorzi HM, Tamim HM, Abd-Aziz N, Tangiisuran B, et al.
    Ann Thorac Med, 2015 Apr-Jun;10(2):132-6.
    PMID: 25829965 DOI: 10.4103/1817-1737.150731
    RATIONALE: Sepsis is a leading cause of intensive care unit (ICU) admissions worldwide and a major cause of morbidity and mortality. Limited data exist regarding the outcomes and functional status among survivors of severe sepsis and septic shock.
    OBJECTIVES: This study aimed to determine the functional status among survivors of severe sepsis and septic shock a year after hospital discharge.
    METHODS: Adult patients admitted between April 2007 and March 2010 to the medical-surgical ICU of a tertiary hospital in Saudi Arabia, were included in this study. The ICU database was investigated for patients with a diagnosis of severe sepsis or septic shock. Survival status was determined based on hospital discharge. Patients who required re-admission, stayed in ICU for less than 24 hours, had incomplete data were all excluded. Survivors were interviewed through phone calls to determine their functional status one-year post-hospital discharge using Karnofsky performance status scale.
    RESULTS: A total of 209 patients met the eligibility criteria. We found that 38 (18.1%) patients had severe disability before admission, whereas 109 (52.2%) patients were with severe disability or died one-year post-hospital discharge. Only one-third of the survivors had good functional status one-year post-discharge (no/mild disability). After adjustment of baseline variables, age [adjusted odds ratio (aOR) = 1.03, 95% confidence interval (CI) = 1.01-1.04] and pre-sepsis functional status of severe disability (aOR = 50.9, 95% CI = 6.82-379.3) were found to be independent predictors of functional status of severe disability one-year post-hospital discharge among survivors.
    CONCLUSIONS: We found that only one-third of the survivors of severe sepsis and septic shock had good functional status one-year post-discharge (no/mild disability). Age and pre-sepsis severe disability were the factors that highly predicted the level of functional status one-year post-hospital discharge.
    KEYWORDS: Disability; functional status; septic shock; severe sepsis
    Matched MeSH terms: Tertiary Care Centers
  12. Lee YF, McLaws ML, Ong LM, Amir Husin S, Chua HH, Wong SY, et al.
    PMID: 31798841 DOI: 10.1186/s13756-019-0644-x
    Background: Hand hygiene compliance can be improved by strategies fostering collaborative efforts among healthcare workers (HCWs) through change agents. However, there is limited information about how change agents shape the social networks of work teams, and how this relates to organisational culture. The objectives of this study were to describe the influence of peer-identified change agents (PICAs) and management-selected change agents (MSCAs) on hand hygiene, perception of their leadership style by peers, and the role of the organisational culture in the process of hand hygiene promotion.

    Methods: This study, stratified in pre-, during, and post-intervention periods, was conducted between February 2017 and March 2018 in two wards at a tertiary care hospital in Malaysia. Hand hygiene promotion was facilitated either by PICAs (study arm 1) or MSCAs (study arm 2), and the two wards were randomly allocated to one of the two interventions. Outcomes were: 1) perceived leadership styles of PICAs and MSCAs by staff, vocalised during question and answer sessions; 2) the social network connectedness and communication patterns between HCWs and change agents by applying social network analysis; and 3) hand hygiene leadership attributes obtained from HCWs in the post-intervention period by questionnaires.

    Results: Hand hygiene compliance in study arm 1 and study arm 2 improved by from 48% (95% CI: 44-53%) to 66% (63-69%), and from 50% (44-55%) to 65% (60-69%), respectively. There was no significant difference between the two arms. Healthcare workers perceived that PICAs lead by example, while MSCAs applied an authoritarian top-down leadership style. The organisational culture of both wards was hierarchical, with little social interaction, but strong team cohesion. Position and networks of both PICAs and MSCAs were similar and generally weaker compared to the leaders who were nominated by HCWs in the post-intervention period. Healthcare workers on both wards perceived authoritative leadership to be the most desirable attribute for hand hygiene improvement.

    Conclusion: Despite experiencing successful hand hygiene improvement from PICAs, HCWs expressed a preference for the existing top-down leadership structure. This highlights the limits of applying leadership models that are not supported by the local organisational culture.

    Matched MeSH terms: Tertiary Care Centers
  13. Ngoi ST, Chong CW, Ponnampalavanar SSS, Tang SN, Idris N, Abdul Jabar K, et al.
    Antimicrob Resist Infect Control, 2021 04 23;10(1):70.
    PMID: 33892804 DOI: 10.1186/s13756-021-00936-5
    BACKGROUND: Knowledge on the epidemiology, genotypic and phenotypic features of antimicrobial-resistant (AMR) ESKAPEE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli) and their association with hospital-acquired infections (HAIs) are limited in Malaysia. Therefore, we evaluated the AMR features and resistance mechanisms of the ESKAPEE pathogens collected in a tertiary hospital located in the capital of Malaysia.

    METHODS: A total of 378 AMR-ESKAPEE strains were obtained based on convenience sampling over a nine-month study period (2019-2020). All strains were subjected to disk diffusion and broth microdilution assays to determine the antimicrobial susceptibility profiles. Polymerase chain reaction (PCR) and DNA sequence analyses were performed to determine the AMR genes profiles of the non-susceptible strains. Chi-square test and logistic regression analyses were used to correlate the AMR profiles and clinical data to determine the risk factors associated with HAIs.

    RESULTS: High rates of multidrug resistance (MDR) were observed in A. baumannii, K. pneumoniae, E. coli, and S. aureus (69-89%). All organisms except E. coli were frequently associated with HAIs (61-94%). Non-susceptibility to the last-resort drugs vancomycin (in Enterococcus spp. and S. aureus), carbapenems (in A. baumannii, P. aeruginosa, and Enterobacteriaceae), and colistin (in Enterobacteriaceae) were observed. Both A. baumannii and K. pneumoniae harbored a wide array of extended-spectrum β-lactamase genes (blaTEM, blaSHV, blaCTX-M, blaOXA). Metallo-β-lactamase genes (blaVEB, blaVIM, blaNDM) were detected in carbapenem-resistant strains, at a higher frequency compared to other local reports. We detected two novel mutations in the quinolone-resistant determining region of the gyrA in fluoroquinolone-resistant E. coli (Leu-102-Ala; Gly-105-Val). Microbial resistance to ampicillin, methicillin, and cephalosporins was identified as important risk factors associated with HAIs in the hospital.

    CONCLUSION: Overall, our findings may provide valuable insight into the microbial resistance pattern and the risk factors of ESKAPEE-associated HAIs in a tertiary hospital located in central Peninsular Malaysia. The data obtained in this study may contribute to informing better hospital infection control in this region.

    Matched MeSH terms: Tertiary Care Centers
  14. Redzuan NS, Engkasan JP, Mazlan M, Freddy Abdullah SJ
    Arch Phys Med Rehabil, 2012 Dec;93(12):2177-83.
    PMID: 22789773 DOI: 10.1016/j.apmr.2012.06.025
    To evaluate the effectiveness of an intervention using video to deliver therapy at home for patients with stroke.
    Matched MeSH terms: Tertiary Care Centers
  15. Nathan AM, de Bruyne J, Khalid F, Arumugam K
    Asian Pac J Allergy Immunol, 2012 Sep;30(3):204-8.
    PMID: 23156850
    Birth cohort studies in some countries have shown a link between caesarean section and asthma.
    Matched MeSH terms: Tertiary Care Centers
  16. Sharifa Ezat WP, Fuad I, Hayati Y, Zafar A, Wanda Kiyah GA
    Asian Pac J Cancer Prev, 2014;15(2):695-701.
    PMID: 24568481
    The main objective of palliative treatment for cancer patients has been to maintain, if not improve, the quality of life (QoL). There is a lack of local data on satisfaction and QoL among cancer patients receiving palliative treatment in Malaysia. This study covers patients with incurable, progressive cancer disease receiving palliative treatment in a teaching hospital in Kuala Lumpur, comparing the different components of QoL and correlations with patient satisfaction. A cross-sectional survey using Malay validated SF36 QoL and PSQ-18 (Short Form) tools was carried out between July 2012 -January 2013 with 120 cancer patients receiving palliative treatment, recruited into the study after informed consent using convenient sampling. Results showed that highest satisfaction were observed in Communication Aspect (50.6±9.07) and the least in General Satisfaction (26.4±5.90). The Mental Component Summary (44.9±6.84) scored higher when compared with the Physical Component Summary (42.2±7.91). In this study, we found that patient satisfaction was strongly associated with good quality of life among cancer patients from a general satisfaction aspect (r=0.232). A poor significant negative correlation was found in Physical Component (technical quality, r=-0.312). The Mental Component showed there was a poor negative correlation between time spent with doctor (r=-0.192) and accessibility, (r=-0.279). We found that feeling at peace and having a sense of meaning in life were more important to patients than being active or achieving good physical comfort. More studyis needed to investigate patients who score poorly on physical and mental component aspects to understand their needs in order to achieve better cancer care.
    Matched MeSH terms: Tertiary Care Centers
  17. Mohamad Pakarul Razy NH, Wan Abdul Rahman WF, Win TT
    Asian Pac J Cancer Prev, 2019 Jan 25;20(1):277-282.
    PMID: 30678450
    Introduction: Vascular endothelial growth factor (VEGF) is an angiogenic factor that plays an important role in
    thyroid cancer. VEGF is known to have high affinity to VEGF receptors such as VEGFR-1 (Flt-1) and VEGFR-2 (KDR).
    Papillary thyroid carcinoma (PTC) is the most common thyroid cancer and studies showed the increasing incidence of
    PTC arising in nodular hyperplasia. Targeted therapy on these growth factors and receptors are used in management
    of both differentiated and undifferentiated thyroid carcinoma. This study aims to determine the expression of VEGF
    and VEGF receptors (VEGFR) in thyroid nodular hyperplasia and PTC. Methods: A cross-sectional study based on
    paraffinized archival tissue blocks of 113 nodular hyperplasias and 67 PTC from the thyroidectomy specimens in
    the year of 2003 to 2014. The tissue sections were then stained by immunohistochemistry for VEGF, VEGFR-1 and
    VEGFR-2. The lymph node involvement and extrathyroid extension also were determined. Results: The mean age of
    PTC patients was 44.7±15.8 years and nodular hyperplasia were 42.2±13.6 years. There was a statistical difference
    of VEGFR-1 (p=0.028) and VEGFR-2 (p=0.003) expression between nodular hyperplasia and PTC. However, no
    significant difference of VEGF expression (p=0.576) between both diseases. Co-expression of VEGF and VEGFR-1
    was significant in both nodular hyperplasia (p=0.016) and PTC (p=0.03), meanwhile no relevant relationship for VEGF
    and VEGFR-2 expression (p>0.05). No significant association (p>0.05) between lymph node status and extrathyroid
    extension with age groups, gender, VEGF and VEGFR expression. Conclusions: VEGF, VEGFR-1 and VEGFR-2
    showed overexpression in both nodular hyperplasia and PTC. The expression of VEGFR-1 and VEGFR-2 are more
    significant in PTC with relevant co-expression of VEGF and VEGFR-1. Therefore, the inhibition of VEGFR offers a
    promising prospect for tumour management in thyroid carcinoma.
    Matched MeSH terms: Tertiary Care Centers
  18. Rahman FA, Naidu J, Ngiu CS, Yaakob Y, Mohamed Z, Othman H, et al.
    Asian Pac J Cancer Prev, 2016;17(8):4037-41.
    PMID: 27644658
    BACKGROUND: Hepatocellular carcinoma (HCC) is a common cancer that is frequently diagnosed at an advanced stage. Transarterial chemoembolisation (TACE) is an effective palliative treatment for patients who are not eligible for curative treatment. The two main methods for performing TACE are conventional (c-TACE) or with drug eluting beads (DEB-TACE). We sought to compare survival rates and tumour response between patients undergoing c-TACE and DEB-TACE at our centre.

    MATERIALS AND METHODS: A retrospective cohort study of patients undergoing either treatment was carried out from January 2009 to December 2014. Tumour response to the procedures was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Kaplan-Meier analysis was used to assess and compare the overall survival in the two groups.

    RESULTS: A total of 79 patients were analysed (34 had c-TACE, 45 had DEB-TACE) with a median follow-up of 11.8 months. A total of 20 patients in the c-TACE group (80%) and 12 patients in the DEB-TACE group (44%) died during the follow up period. The median survival durations in the c-TACE and DEB-TACE groups were 4.9 ± 3.2 months and 8.3 ± 2.0 months respectively (p=0.008). There was no statistically significant difference noted among the two groups with respect to mRECIST criteria.

    CONCLUSIONS: DEB-TACE demonstrated a significant improvement in overall survival rates for patients with unresectable HCC when compared to c-TACE. It is a safe and promising approach and should potentially be considered as a standard of care in the management of unresectable HCC.

    Matched MeSH terms: Tertiary Care Centers
  19. Lim YM, Eng WL, Chan HK
    Asian Pac J Cancer Prev, 2017 07 27;18(7):1925-1930.
    PMID: 28749622
    Background: In Malaysia, the treatment for chronic myeloid leukemia (CML) has long been delivered under the
    Malaysian Patient Assistance Program (MYPAP), but research on identifying factors contributing to non-adherence to
    tyrosine kinase inhibitors (TKIs) is still limited. The current study explored understanding and challenges of Malaysian
    CML patients in taking imatinib and nilotinib. Methods: Semi-structured, face-to-face interviews were conducted
    with 13 CML patients receiving treatment at a public tertiary care center, and were analyzed using the content analysis
    approach. Results: The patients generally demonstrated inadequate knowledge, particularly of the natural history and
    staging of CML, the function of TKIs, and the methods used for monitoring the effectiveness of treatment. A number of
    them also had experiences of withholding, skipping or altering the treatment, mainly due to the life-disturbing adverse
    drug effects (ADRs), forgetfulness, and religious and social issues. Besides, most of them were found having limited
    skills in managing the ADRs, and not using prompts as reminders to take the medications. Furthermore, even though
    nilotinib was generally perceived as better tolerated as compared with imatinib, the inconvenience caused by the need
    to take it twice daily and on an empty stomach was constantly highlighted by the patients. Conclusion: While TKIs
    are widely used for CML treatment in Malaysia, the findings have revealed a lack of patient education and awareness,
    which warrants an integrated plan to reinforce medication adherence.
    Matched MeSH terms: Tertiary Care Centers
  20. Nair N, Ng CG, Sulaiman AH
    Asian J Psychiatr, 2021 Feb;56:102548.
    PMID: 33454562 DOI: 10.1016/j.ajp.2021.102548
    The mental wellbeing of doctors is becoming an increasing concern in the world today. In Malaysia, residency is a challenging period in a doctor's life, with many changes professionally and possibly in their personal lives as well. This study aims to determine the prevalence of depressive symptoms and the socio-demographic correlates among residents in a tertiary training hospital in Malaysia. It is a cross sectional study and all residents were approached to participate in the study. The instruments used were a socio-demographic questionnaire and the Patient Health Questionnaire 9 (PHQ-9). Chi-square test was used to explore the association between the socio-demographic correlates, and those that were found to have significant associations were further tested using multivariate logistic regression. The prevalence of depression among residents was 25.1 %. Longer working hours, missing meals, and working in Department of Surgery and Department of Anaesthesia was significantly positively associated while having protected study time, CME/lectures, leisure/hobbies and exercise were negatively associated with depression. The Department of Rehabilitation Medicine had a significantly negative association with depression. After logistic regression, longer working hours and a lack of protected study time was significantly associated with depression in the respective departments. In summary, the prevalence of depression among residents is high and is associated with longer working hours, missing meals and a lack of protected study time are significantly associated with depression. Remedial steps should be taken to improve the mental health among residents.
    Matched MeSH terms: Tertiary Care Centers
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