MATERIALS AND METHODS: An online, anonymous, voluntary survey was conducted to assess the level of knowledge and understanding about EAPs among Malaysian oncologists using SurveyMonkey® between April 2020 and June 2020. Oncologists who had enquired about EAP in the past, were invited at random to participate in the survey. Participants who did not provide consent or failed to complete the survey were excluded.
RESULTS: A total of 15 oncologists participated in the survey, from both public (46.6%) and private (46.6%) practices. Most respondents (80%) had filed between 1 to 10 EAP applications in the past 12 months. For 73.3% respondents, resources or training were not provided for EAPs from institutions. Around 53% of the respondents reported that their knowledge of EAPs and application processes including country regulations is 'good'. The majority of respondents (73.3%) reported that the educational modules on an overview of EAPs, country regulations and the EAP application process will be beneficial. Most participants received information about the existing EAPs either by reaching out to a pharmaceutical sponsor or through another health care provider and some received information about the existing EAPs through their institutions or patients/caregivers. Most of the respondents recommended that pharmaceutical companies should have readily available information related to the availability and application of EAPs for all pipeline products on their websites.
DISCUSSION: EAPs are crucial treatment access pathways to provide investigational drugs to patients who have exhausted their treatment options and are not eligible for participation in clinical trials. Malaysian oncologists have a fair understanding about the EAPs and the application processes.
CONCLUSION: Additional training and awareness are needed for Malaysian oncologists to upscale the utilisation of EAPs.
MATERIALS AND METHODS: The authors conducted a literature search in four databases (Scopus, Web of Science, Science Direct, and IEEE Xplore) and completed it in December 2022. Articles that do not directly address the application of drones for surveillance and control of mosquito breeding sites were excluded.
RESULTS: The initial search using the keywords yielded 623 documents. After screening abstracts and reviewing the full text, only 17 articles met the inclusion criteria. Most of the studies were in the proof-of-concept stage. Many studies have also incorporated drone technologies and machine learning techniques into surveillance efforts. The authors have highlighted seven key issues related to the operational aspects of using drones. Those are hardware, software, law and regulation, operating time, expertise, geography, and community involvement.
CONCLUSION: With rapid developments in drone technologies and machine learning techniques, the viability of drones as surveillance tools can be enhanced, thus effectively responding to global public health concerns.
MATERIALS AND METHODS: This was a single-centre, evaluatorblinded, split-face, randomised study investigating the effects of thermal spring water (TSW) in improving efficacy and tolerability of standard acne therapy. Total of 31 participants with mild-to-moderate acne were recruited and subjected to TSW spray to one side of the face 4 times daily for 6 weeks in addition to standard therapy. The other side received standard therapy only.
RESULTS: Six (19.4%) males and 25 (80.6%) female with mean age 25.1±6.13 participated, 15 (48.4%) had mild acne while 16 (51.6%) had moderate acne. Seven (22.6%) were on oral antibiotics, 25 (80.6%) used adapalene, 6 (19.4%) tretinoin and 21 (67.7%) benzoyl peroxide. Skin hydration improved and better on spring water treated side with mean difference12.41±30.31, p = 0.04 at the forehead, 39.52±65.14, p < 0.01 at the cheek and 42.172±71.71, p < 0.01 at the jaw at week 6. Participants also report significant reduction in dryness at the treated side at week 6, mean difference 0.93±0.10, p < 0.001. TEWL, sebum and pH were comparable on both sides with no significant differences. Tolerability towards standard therapy improved as early week 2 with reduction of stinging following application of topical therapy (mean difference 0.62±1.43, p = 0.03), increase in skin feeling good (-1.79±1.70, p < 0.001) and skin suppleness (0.62±1.43, p < 0.001). These improvements were significantly maintained till week 6. Cardiff acne disability index significantly improved at week 6 (p<0.001) despite no significant changes in Comprehensive Acne Severity Scale score before and after treatment.
CONCLUSION: TSW may have a role as an adjunct to standard acne therapy by improving hydration, acne disability index and tolerability towards standard topical treatment.
MATERIALS AND METHODS: A literature search was performed to analyze studies that focused on plant-based extracts used for larvicidal purposes using databases such as Science Direct. Springer, PubMed, and Scopus. The inclusion criteria for publications were larvicidal effects, published in English from the year 2017 and availability of full-text articles. The available literature was further characterized by the value of larvicidal activities of LC50 and LC90 (< 50 ppm), of 22 different parts of plant species from 7 plant families namely Apiaceae, Asteraceae, Lauraceae, Magnoliaceae, Myrtaceae, Piperaceae and Rubiaceae.
RESULTS: When comparing the values of LC50, 12 plants species (Artemisia vulgaris, Crassocephalum crepidioides, Echinops grijsii, Melaleuca leucadendra, Neolitsea ellipsoidea, Pavetta tomentosa, Piper betle, Piper caninum, Piper Montium, Piper muntabile, Piper ovatum, Tarenna asiatica) showed promising larvicidal efficacies with LC50 < 10 ppm.
CONCLUSION: This review emphasizes the effective alternatives of plant extracts for the potential production of larvicides. Piper betle extract and chloroform extract of Tarenna asiatica reported the most significant larvicidal activity (LC50 < 1 ppm) against mosquito vectors. Further reviews focusing on the mode of actions of its phytochemically constituents are essential for the future development of potentially significant plant-based larvicides.
MATERIALS AND METHODS: This was a cross-sectional study involving the parents or guardians of 50.6% (44/87) government schools in the whole of Kuching Division of Sarawak. The sampling method was multistage cluster sampling, whereby stage one involved random sampling of 49.2% (30/61) primary schools and 53.8% (14/46) secondary schools in the Kuching Division, followed by stage two cluster sampling of one class per non-examination standard in each randomly sampled school. All students in the sampled classes were asked to bring a face-validated questionnaire (MAQ) back home to be answered by one of their parents or a guardian. A total of 2559 out of 3661 distributed questionnaires were collected, with a response rate of 70%. The data collection period was between April and June of 2022 so as the recall bias of the information collected, especially on the actual spending on the face masks for the school going students, was minimised. The relevant summary statistics for self-perceived face masks characteristics, face mask expenses, affordability and willingness to pay were calculated. We regress separately the monthly affordability and willingness to pay amount against age, occupation, marital status, total number of children, monthly income and monthly saving to build predictive models for affordability and willingness to pay amount per child per month.
RESULTS: The average Scale-level Face Validity Indexes for all aspects of validity (clarity, comprehension, relevancy, representativeness) are high (0.91 to 1.00) for MAQ. Most of the respondents were mothers, married, working as private employees with a mean age of 41 and belonged to the B40 and M40 group. The average monthly saving per family was RM540, which was about 15% of the total income. The average actual monthly spending to purchase face masks for one child is RM24. On average, a family can afford to pay RM23.80 for one child per month to purchase face masks. The willingness to pay for the same was RM25.27. The median affordability, willingness to pay and actual spending for face masks per child was RM16.67 per month. Taking 75th percentile as the reasonable maximum expenses per child for face masks per month, the affordable amount by most parents is RM30, with the willingness to pay at 10% higher. Affordability to purchase a face mask is influenced by the marital status, occupation, income, saving and the number of dependent of the breadwinner of a household. The most important face mask characteristics expected by the parents are better filtration efficiency and easier breathability.
CONCLUSION: The affordability and willingness to pay the amount to purchase face masks amongst parents of government students in Sarawak were RM30 and RM33 per child per month, respectively.
MATERIALS AND METHODS: A cross-sectional study was conducted at Klinik Kesihatan Seremban in Seremban district, Negeri Sembilan. Data were collected using the Malay version of the Pittsburgh Sleep Quality Index (PSQI-M) with a cut-off point of >5 as poor sleep quality. The Depression Anxiety Stress Scale-21 (DASS-21) was used to measure level of psychological distress. Data were collected between July 2022 until January 2023.
RESULTS: A total of 319 patients with T2DM participated. Their mean age was 63 (11) years, 58% were women and 42.9% were of Indian ethnicity. The mean total score of PSQI was 4.04 (2.21) and 23% of the participants had poor sleep quality. Multivariate logistic regression analysis revealed that poor sleep quality was significantly associated with Indian ethnicity (Adj. OR = 2.25; 95%CI: 1.05, 4.82; p = 0.037), separated or widowed (Adj. OR = 2.16; 95%CI = 1.15, 4.05; p = 0.016), having nocturia (Adj. OR = 2.13; 95%CI = 1.18, 3.84; p = 0.012) and depressive symptoms (Adj. OR = 3.41; 95%CI: 1.01, 11.48; p = 0.048).
CONCLUSION: Poor sleep quality was prevalent in almost a quarter of T2DM patients studied. Indian ethnicity, separated or widowed, having nocturia, and depressive symptoms were independently associated with poor sleep quality. Despite lower prevalence of poor sleep quality compared to other studies, identification of those at higher risk warrants further exploration in lifestyle management of patients with T2DM.
MATERIALS AND METHODS: We conducted a multi-centre cohort study involving 5 PSCs and 7 ASRHs in Malaysia. Through review of medical records of AIS patients who received IVT from 01 January 2014 to 30 June 2021, real-world data was extracted for analysis. Univariate and multivariate regression models were employed to evaluate the role of PSCs versus ASRHs in post-IVT outcomes and complications. Statistical significance was set at p<0.05.
RESULTS: A total of 313 multi-ethnic Asians, namely 231 from PSCs and 82 from ASRHs, were included. Both groups were comparable in baseline demographic, clinical, and stroke characteristics. The efficiency of IVT delivery (door-toneedle time), functional outcomes (mRS at 3 months post- IVT), and rates of adverse events (intracranial haemorrhages and mortality) following IVT were comparable between the 2 groups. Notably, 46.8% and 48.8% of patients in PSCs and ASRHs group respectively (p=0.752) achieved favourable functional outcome (mRS≤1 at 3 months post-IVT). Regression analyses demonstrated that post-IVT functional outcomes and adverse events were independent of the role of PSCs or ASRHs.
CONCLUSION: Our study provides real-world evidence which suggests that IVT can be equally safe, effective, and efficiently delivered in ASRHs. This may encourage the establishment of more ASRHs to extend the benefits of IVT to a greater proportion of stroke populations and enhance the regional stroke care.
MATERIALS AND METHOD: The initial phase involved a review of previous interventions, validation from field experts, and the process of developing video. Then the module pilot was tested among 30 diploma students from a public university. They were given access to the newly developed videos posted on a private YouTube channel and asked to evaluate the videos quantitatively and qualitatively by using the acceptability of the intervention module (AIM), intervention appropriateness measure (IAM) and feasibility of the intervention measure (FIM). The minimum and maximum scores of each measure were 12 and 24 respectively whereby a higher score indicated greater acceptability, appropriateness and feasibility.
RESULTS: The intervention consisted of five sections addressing the constructs of PWM, namely attitude, perceived norm, prototype perception, as well as intention and willingness of sexting. The contents were then converted into five videos with a total duration of 23 minutes. Based on the pilot test, the scores of AIM, IAM and FIM were not normally distributed and their median and the interquartile range values were 20 (4), 21 (4) and 22 (4) respectively. Most of the respondents gave favourable opinions on the intervention besides providing some input for improvement.
CONCLUSION: This animated sexting intervention module based on PWM to reduce the intention and willingness was novel. The module was acceptable, appropriate and feasible to be implemented among undergraduate students. Further evaluation of this intervention module can be performed to provide more comprehensive evidence of its effectiveness.
MATERIAL AND METHODS: Patients with Spastic CP with Gross Motor Function Classification System (GMFCS) I-III that underwent lower limb surgical intervention in our centre from 2008-2018 were retrospectively reviewed for The Spinal Alignment and Range of Motion Measure ROM subscale (SAROMM) scores and Functional Mobility Scale (FMS) 18 months after surgery. Changes in SAROMM, FMS scores and minimal clinically important difference (MCID) were determined.
RESULTS: 19 patients were included in the study with mean age of 12.58. All patients underwent muscle tendon procedures. Box plot analysis of SAROMM showed reduction of median scores at 6(26.3%) and 12(47.4%) months which plateaus at 18 months post-surgery. Repeated measure ANOVA analysis showed there was a statistically significant effect of time on SAROMM scores (p <0.001) with MCID of 13.4. Improvement of FMS scores was the most at 50m with 13 children (p < 0.05), one at 5m and five at 500m. None reported worsening of FMS scores at 18 months. There were no changes of GMFCS levels by the end of 18 months.
CONCLUSION: Surgeries performed on GMFCS I-III patients with the aim of gait improvement translates into improved mobility with results comparable to other countries.
MATERIALS AND METHODS: The study included 99 patients with SLE who attended the Rheumatology Unit at Baghdad Teaching Hospital. These subjects were divided into three subgroups according to disease status: inactive, n = 33; active moderate, n = 33; and active severe, n = 33. Additionally, 33 matched controls were studied. Full medical histories, body mass index, gender and clinical disease activity, the latter evaluated with the SLE disease activity index, were collected. Laboratory parameters measured included anti-dsDNA antibodies, C3 and C4 levels, erythrocyte sedimentation rate and C-reactive protein titres. Serum IL-40 levels were quantified using an enzyme-linked immunosorbent assay.
RESULTS: IL-40 levels were significantly higher in patients (12.5420 ± 3.00575 ng/L) than in controls (6.1138 ± 0.59452 ng/L; p < 0.01). Mean serum IL-40 concentration was highest in the active severe group (15.2291 ± 2.26540 ng/L) and decreased, in order of disease severity, in the remaining cohorts: active moderate, 13.0643 ± 1.23927 ng/L; inactive, 9.3325 ± 1.62807 ng/L (P < 0.01); controls, 6.1138 ± 0.59452 ng/L. Serum IL-40 levels showed excellent validity for the diagnosis of SLE with a cut-off value of ≥ 9.3 ng/ml and area under the curve of 0.987. Sensitivity, specificity and accuracy were 99%, 90.9% and 96.97%, respectively (P < 0.001).
CONCLUSIONS: Serum IL-40 levels were elevated in SLE patients. It is therefore proposed that IL-40 is a novel cytokine which is associated with SLE and positively linked with disease severity.
MATERIALS AND METHODS: A systematic search of observational studies conducted in ASEAN countries between 1 January 2010 and 31 December 2020 was performed in the Medline, PubMed and Google Scholar databases. The quality of studies was evaluated based on The Joanna Briggs Institute Checklist. The analysis was performed with Review Manager software version 5.4. Metaanalysis of the estimates from primary studies was conducted by adjusting for possible publication bias and heterogeneity.
RESULTS: Twenty-five studies including 19924 postnatal mothers were included in this review. The pooled prevalence of PPD is 22.32% (95% CI: 18.48, 26.17). Thailand has the highest prevalence of PPD with a pooled prevalence of 74.1% (95% CI: 64.79, 83.41). The prevalence of PPD was highest when the assessment for PPD was conducted up to 6 weeks postpartum with a pooled prevalence of 25.24% (95% CI: 14.08, 36.41). The identified determinants of PPD were unplanned pregnancy, term pregnancy, lack of family support and physical violence. There were limited studies done and high heterogeneity in terms of quality, methodology, culture, screening method and time of PPD measurement.
CONCLUSIONS: Approximately one in five postpartum women in ASEAN countries had PPD. The risk factor that lowers the risk of PPD is unplanned and term pregnancies, while women with a lack of family support and experienced physical violence increase the risk of PPD. Robust prevalence studies are needed to assess the magnitude of this problem in ASEAN countries.
MATERIALS AND METHODS: This is a retrospective analysis of histopathological records in a public tertiary health care centre in Malaysia. The computerised laboratory information system from the histopathology department of the hospital was retrieved for the period of 2005-2018. Descriptive analysis was done using Microsoft Excel.
RESULTS: There was a total of 233 histologically confirmed GC cases. The burden of GC was observed to be an increasing trend from 2016 onwards. Among them, 64% were male and 36% were female. The youngest age of diagnosis was 19, while the oldest one was 93. Malaysian Chinese were found to have the highest incidences (41.63%), followed by Malays (32.19%) and Malaysian Indians (23.61%). All cases were of adenocarcinoma cell types and were found to have poorly differentiated in majority at the time of diagnosis.
CONCLUSION: Although this report only represents one tertiary health care centre in Malaysia, the Indian Enigma was still observed, as stated in other literatures. Over time, the incidence of GC in Malays has increased. Consideration of lifestyle modifications, health education and Helicobacter pylori eradication in various nations' National Health Insurance plans, are encouraged as prevention is always better than treatment or cure, including the cost load.
MATERIALS AND METHODS: A retrospective repeated crosssectional study was conducted by recruiting patients with cochlear implants presenting to the Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia between 2017 and 2021. Basal (b1, b2) and apical (a1, a2) electrodes, representing the outermost and innermost parts of the cochlear implant electrodes, were measured at switch on and at 1 year post-implantation.
RESULTS: A total of 123 patients, with a total of 123 cochlear implant samples, were included in the analysis. We found a substantial change in electrical impedance between switch on and follow-up periods, where the impedance levels of basal electrodes decreased (b1: mean difference (MD) -1.13 [95% confidence interval (CI): -1.71, -0.54], p<0.001; b2: MD -0.60 [95%CI: -1.17, -0.03], p=0.041) and those of apical electrodes increased (a1: MD 0.48 [95%CI: -0.28, 0.99], p=0.064; a2: MD 0.67 [95%CI: 0.12, 1.22], p=0.017). We also found that the choice of surgical approaches for implant insertion may affect the electrode impedance. Cochleostomy approach resulted in a higher impedance than round window in basal (b1) and apical (a2) electrodes both at switch on and follow-up (b1 at switch on and at follow-up: p=0.019 and p=0.004; a2 at follow-up: p=0.012). Extended round window approach also resulted in a higher impedance than round window in basal (b1) and apical (a2) electrodes at follow-up (p=0.013 and p=0.003, respectively).
CONCLUSION: Electrical impedance of cochlear implant electrodes may change over time, highlighting the importance of regular impedance assessments for cochlear implant users to ensure optimal device function. The round window approach resulted in better initial and long-term impedance levels compared to cochleostomy, and better long-term impedance levels than extended round window. Extended round window approach also gives better impedance level than cochleostomy. Further research should investigate the potential interplay between surgical approach and other factors that may impact impedance levels to confirm our findings.
MATERIALS AND METHODS: A two-arm prospective cohort study was conducted among adult patients with COVID-19 categories 2 and 3 treated with Paxlovid® and a matched control group. A standard risk-stratified scoring system was used to establish Paxlovid® eligibility. All patients who were prescribed Paxlovid® and took at least one dose of Paxlovid® were included in the study. The control patients were selected from a centralised COVID-19 patient registry and matched based on age, gender and COVID-19 stage severity.
RESULTS: A total of 552 subjects were included in the study and evenly allocated to the treatment and control groups. There was no statistically significant difference in 28-day hospitalisation after diagnosis [Paxlovid®: 26 (9.4%), Control: 34 (12.3%), OR: 0.74; 95%CI, 0.43-1.27; p=0.274] or all-cause death [Paxlovid®: 2 (0.7%), Control: 3 (1.1%), OR 1.51; 95%CI, 0.25-9.09; p=0.999]. There was no significant reduction in hospitalisation duration, intensive care unit admission events or supplementary oxygen requirement in the treatment arm. Ethnicity, COVID-19 severity at diagnosis, comorbidities and vaccination status were predictors of hospitalisation events.
CONCLUSION: In this two-arm study, Paxlovid® did not significantly lower the incidence of hospitalisation, all-cause death and the need for supplemental oxygen. Adverse effects were frequent but not severe. Paxlovid® efficacy varied across settings and populations, warranting further real-world investigations.
MATERIALS AND METHODS: We reviewed the medical records of all patients that underwent bullectomy from 1st June 2017 to 31st May 2022. Mann Whitney U-test was completed for all variables. Primary objective was to compare operating time (OT), global operating time (GOT), post-operative length of stay (LOS) and complication rate.
RESULTS: A total of 90 bullectomies performed in which 36 were approached via iVATS and 54 NiVATS. It was found that the post-operative LOS, GOT, and OT were significantly shorter in the NiVATS as compared to iVATS. Complication rate between both groups showed no significant difference.
CONCLUSION: NiVATS bullectomy demonstrated a safe and reliable alternative surgical approach with superior surgical outcome than iVATS bullectomy.
MATERIALS AND METHODS: We conducted a descriptive, retrospective study among epilepsy patients treated with perampanel. We aimed to assess the efficacy and safety of perampanel as an adjunctive in our hospital.
RESULTS AND CONCLUSIONS: From our cohort of 25 patients, most of the patients were either on one or three anti-seizure medications (ASMs) prior to initiation of perampanel. Perampanel was added in 88% of them due to persistent seizures. Twenty-two (88%) patients experienced reduction in seizure frequency. 12% experienced mild side effects, which were leg cramps, hyponatremia and drowsiness. Only 1 patient stopped perampanel due to its side effects.
CONCLUSION: Perampanel is a well-tolerated ASM that should be widely used as an adjunctive. More studies with regards to its efficacy and safety involving more centres are encouraged in Malaysia.