MATERIALS AND METHODS: This cross-sectional study was conducted in three Malaysian public hospitals using a multilevel sampling technique to recruit 630 respondents. A validated self-developed four-domain questionnaire which includes one domain for health insurance was used to collect the relevant data.
RESULTS: Approximately 31.7% of the respondents owned PHI. The PHI usage was significantly higher among male respondents (p=0.035), those aged 18-40 years old (p<0.001), Indian and Chinese ethnicities (p=0.002), with tertiary education level (p<0.001), employed (p<0.001), working in the private sector (p<0.001), high household income (T20) (p<0.001), home near to the hospital (p=0.001) and medium household size (p<0.001). The significant predictive factors were age 18-40 years aOR 3.01 (95% CI: 1.67-5.41), age 41-60 years aOR 2.22 (95% CI 1.41-3.49), medium (M40) income aOR 2.90 (95% CI: 1.92-4.39) and high (T20) income aOR 3.86 (95% CI: 1.68-18.91), home near to the hospital aOR 1.68 (95% CI: 1.10-2.55), medium household size aOR 2.20 (95% CI: 1.30-3.72) and female head of household aOR 1.79 (95% CI: 1.01-3.16). The type of cancer treatment, the location of treatment, prior treatment in private healthcare facilities and existence of financial coping mechanisms also were significant factors in determining PHI usage among cancer patients in this study.
CONCLUSION: Several factors are significantly associated with PHI usage in cancer patients. The outcome of this study can guide policymakers to identify high-risk groups which need supplementary health insurance to bear the cost for their cancer treatment so that a better pre-payment health financing system such as a national health insurance can be formulated to cater for these groups.
MATERIALS AND METHODS: This qualitative study involved five public healthcare clinics in the Kuching district with indepth interviews (IDI) conducted on 14 primary care doctors (PCDs). Semi-structured interviews and in-depth discussions were conducted via videoconferencing. One representative was selected from each clinic at initiation, followed by snowball method for subsequent subject selection until saturation of themes. Interviews were transcribed verbatim, and analysis based on framework analysis principles via NVivo software. Themes were analysed deductively according to study objectives and evidence from literature.
RESULTS: Three main themes emerged from the IDI: (1) The perception of depression in elderly patients, (2) The perceived barriers to screening, and (3) The screening processes. Majority of the PCDs perceived depression as part of ageing process. Time constraints, lack of privacy in consultation rooms, dominant caregivers and failure to recognise recurrent somatic symptoms as part of depression influenced PCDs decision to screen. Screening was technically challenging for PCDs to use the DASS-21, which was not socio-culturally validated for local native population. Only 21.4% of respondents (3/14) reported screening at least three out 10 elderly patients seen over 1- month period. During the covid pandemic, due to the same human resource support and practices, most participants thought their screening for depression in elderlies had not changed.
CONCLUSION: Awareness of depression among PCDs needs to be re-enforced via continuous medical education programs to use appropriate screening tools, address infrastructure related barriers to optimise screening practices. The use of appropriate locally validated and socio-culturally adapted tool is vital to correctly interpret the screening test for patients.
MATERIALS AND METHODS: This was a cross-sectional, observational study on empathy among doctors practicing in the private, public hospital sector and faculty at a medical university in Negeri Sembilan, Malaysia that utilised convenience sampling for data collection. The Toronto Empathy Questionnaire (TEQ) a validated tool was used to measure empathy.
RESULTS: The questionnaire was completed by 127 doctors, 52% (n= 66) were males and 48% (n=61) females. There was no significant difference in empathy between male (M=46.44; SD=6.01) and female (M=45.05, SD=5.69) doctors; t (123) = 1.326, p=0.187. Pearson correlation coefficient was computed to assess the linear relationship between age and empathy and revealed no correlation between the two variables: r (125) =0.15, p=0.099. Medical-based doctors (M= 47.47, SD=5.98) demonstrated more empathy than surgicalbased (M=44.32, SD=5.41); t (123) =-3.09, p=0.002. Those already specialised in their fields (M=47.38, SD=4.57) had more empathy than those who had not (M= 44.36, SD=6.52); t (123) =-2.96, p = 0.004. Doctors in the university (M=47.97, SD=4.31) tended to have more empathy than those in the public hospitals (M= 44.63, SD=6.27); t (117) =-2.91, p=0.004. Academicians had more empathy than non-academicians but there was no difference between those who were in clinical practice and not.
CONCLUSION: Our findings indicate that medical-based doctors demonstrate more empathy than surgical-based doctors, and there appeared to be no correlation between age and empathy. However, clinical experience and growth within the specialty seem to improve empathy. Doctors teaching in the university setting demonstrated more empathy than those practicing in the hospital setting. Inclusion of empathy-related sessions in the undergraduate and post-graduate curriculum could bridge the gap in empathy noted with age, discipline, and experience in practice. Further research on empathy among doctors using a wider population in Malaysia and a TEQ questionnaire validated to the Asian population would provide better insight regarding this area of medical practice. Future research on outcomes of inclusion of programmes targeted at improving empathy to create awareness during practice would support patient satisfaction and safety.
MATERIALS AND METHODS: All suspected cases of COVID-19 that self-presented to hospitals or were cluster screened from 1st April to 31st May 2020 were included. Positive SARS-CoV-2 rRT-PCR was used as the diagnostic reference for COVID-19.
RESULTS: 540 individuals with suspected COVID-19 were recruited. Two-third of patients were identified through contact screening, while the rest presented sporadically. Overall COVID-19 positivity rate was 59.4% (321/540) which was higher in the cluster screened group (85.6% vs. 11.6%, p<0.001). Overall, cluster-screened COVID-19 cases were significantly younger, had fewer comorbidities and were less likely to be symptomatic than those present sporadically. Mortality was significantly lower in the cluster-screened COVID-19 cases (0.3% vs. 4.5%, p<0.05). A third of all chest radiographs in confirmed COVID-19 cases were abnormal, with consolidation, ground-glass opacities or both predominating in the peripheral lower zones. The WHO suspected case definition for COVID-19 accurately classified 35.4% of all COVID-19 patients, a rate not improved by the addition of baseline radiographic data. Misclassification rate was higher among the cluster-associated cases (80.6%) compared to sporadic cases (35.3%).
CONCLUSION: COVID-19 cases in Malaysia identified by active tracing of community cluster outbreaks had lower mortality rate. The WHO suspected COVID-19 performed poorly in this setting even when chest radiographic information was available, a finding that has implications for future spikes of the disease in countries with similar transmission characteristics.
MATERIALS AND METHODS: We conducted this retrospective cross-sectional study in Hospital Tengku Ampuan Rahimah, Selangor, Malaysia. Patients admitted in April 2021 and May 2021 with concomitant COVID-19 infection and PTE disease were included. Demographic, clinical and laboratory data were retrieved, whilst CTPA images were analysed by a senior radiologist.
RESULTS: A total of 150 patients were recruited, comprising 45 geriatric patients and 105 non-geriatric patients. The prevalence rate of hypertension, diabetes mellitus and dyslipidaemia were higher among the geriatric cohort. Evidently, the percentage of patients with fever and diarrhoea were significantly higher among the non-geriatric cohort. The geriatric cohort also recorded a significantly lower absolute lymphocyte count at presentation and albumin level during admission. Despite earlier presentation, the geriatric cohort suffered from more severe diseases. Analysis of the CT features demonstrated that the most proximal pulmonary thrombosis specifically limited to the segmental and subsegmental pulmonary arteries in both cohorts. The elderly suffered from a significantly higher inhospital mortality rate and their cumulative probability of survival was significantly lower.
CONCLUSION: Typical COVID-19 symptoms may be absent among the elderly, prompting a lower threshold of suspicion during the COVID-19 pandemic. Additionally, the elderly demonstrated a higher probability of adverse outcomes despite earlier presentation and treatment.
RESULT: The results showed no statistically significant differences between groups regarding the respondents' characteristics (socio-demographic and occupational/officerelated ergonomic factors) and the outcome variables KAP towards WSC at baseline. For practices towards WSC, both intervention (β 6.8, 95%CI 4.85, 8.72) and time (β 6.2, 95%CI 4.49, 7.94) significantly improved the respondents' practices towards WSC in the per-protocol analysis. In the secondary outcomes, both knowledge of WSC, intervention (β 3.5, 95%CI 2.8, 4.2) and time (β 3.4, 95%CI 2.7, 5.9); and attitudes towards WSC, intervention (β1.7, 95%CI 1.25, 2.23) and time (β 2.3, 95%CI 1.92, 2.76) significantly improved the respondents' level of knowledge and attitudes respectively towards WSC.
CONCLUSION: The intervention, WSCHEM, was effective in improving the administrative workers' KAP towards WSC, as demonstrated by the significance between and within-group differences.
MATERIALS AND METHODS: A cross-sectional study was conducted in Luyang Health Clinic from 1st June 2020 to 3rd September 2020. A self-interviewed questionnaire comprises of three sections; sociodemographic, Wake Forest Physician Trust Scale (WFS) and Adherence to Refills and Medications Scale (ARMS) was completed by 281 respondents. Glycaemic control is based on the latest Hba1c profile of the respondents. Descriptive and nonparametric bivariate analysis were performed using IBM SPSS version 26.
RESULTS: The median (IQR) level of trust in physician was 43(8) out of a possible score range of 10 to 50. Trust in physician was correlated with treatment adherence (r=-0.12, p=0.048). There was no significant association between trust in physician with sociodemographic factors, which include age (p=0.33), gender (p=0.46), ethnicity (p=0.70), education level (p=0.50), and household income (p=0.37). Similarly, there was no significant association between the level of trust in physician with glycaemic control (p=0.709).
CONCLUSION: In conclusion, trust in physician was associated with treatment adherence but not with glycaemic control. In our local context, the glycaemic control could be due to other factors. Further studies should include a multicentre population to assess other potential factors that could contribute to glycaemic control.
METHOD AND MATERIALS: The electronic search was carried out using PubMed/MEDLINEⓇdatabases with the keywords "tissue engineering AND meniscus" spanning the period of publications from Jan 1980 until Dec 2022.
RESULTS: The literature search identified 405 references in PubMed/MEDLINE, and 179 were selected following the eligibility requirements. The research analysis showed that the existing meniscal tissue engineering studies used a wide variety of seed cells, cytokines, bioactive materials and 3D structures. Each showed distinct advantages and disadvantages in terms of biocompatibility, degradability, mechanical strength, porosity, and etc. It was noted that 3D printing technology is promising for tissue engineering meniscus research. In addition, the optimal use of compression and hydrostatic pressure to markedly improve the functional properties of tissue-engineering meniscal can serve as an useful strategy.
CONCLUSION: This review analysed the different approaches employed for meniscus tissue engineering and regeneration. Meniscal tissue engineering still faces several major challenges in terms of seed cells, choice of materials and 3D printing strategies, which should be effectively overcome to harness the full potential of this technology.
MATERIAL AND METHODS: Thirty Sprague Dawley rats (3-monthold, 200 to 300 gm) were randomly divided into six groups, namely control (C), 4 weeks diabetes mellitus (DM1), 8 weeks DM (DM2) and three DM1 groups (VD1, VD2, and VD3) who received Vitamin D doses of 0.125, 0.25 and 0.50 μg/kg BW, respectively. After 4 weeks, daily VD was administered intraperitoneally for 30 days. Lung tissues were taken for IL- 6, MCP-1, NFKB and CD68 mRNA expression analysis and paraffin embedding. Immunohistochemical staining against CD68 and MCP-1 was conducted. Data were analysed using one-way ANOVA. p < 0.05 was considered statistically significant.
RESULTS: DM2 group represented significantly higher IL6, MCP1, NFKB and CD68 mRNA expression than Control group (p < 0.05). Meanwhile, VD2 and VD3 groups revealed significantly lower mRNA expression of IL-6, MCP1, NFKB and CD68 than DM2 (p < 0.05). Immunostaining revealed the spreading of MCP1 protein expression in lung tissue along with macrophage infiltration in the DM2 group, which was reduced in the VD2 and the VD3 groups.
CONCLUSION: VD shows a protective effect on diabetesinduced lung damage by regulating inflammation factors.
MATERIALS AND METHODS: This was a randomised post-testonly study. A total of 28 rats were assigned into four groups: Group 1 is control group (C), samples had bile duct ligation and UDCA monotherapy 20 mg; Group 2, bile duct ligation + UDCA 10 mg + glutathione 10 mg (P1); Group 3, bile duct ligation + UDCA 20 mg + glutathione 15 mg (P2); Group 4, bile duct ligation + UDCA 30 mg + glutathione 20 mg (P3). Serum AST, ALT, ALP activity, total, direct and indirect bilirubin were collected. Shapiro-Wilk test was used for the normality test. All groups' data were compared using Kruskall-Wallis and Mann-Whitney tests.
RESULTS: There was a significant difference in the ALP level in all rats and between the C and P2 groups. ALP level of all groups decreased significantly compared to the control group. Combination therapy group showed lower bilirubin levels. ALT levels significantly differed between the C-P1, P1-P2, and P1-P3 groups.
CONCLUSION: UDCA-GSH therapy improves liver function in BDL rats' models compared to UDCA monotherapy.
MATERIALS AND METHODS: Our study used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. The literature search approach used publications between 2013 and 2023 using Pubmed and SagePub databases. Studies were included if they contained reports of the best timing for emergency surgery for CHD repair. We did not include review articles and unpublished data.
RESULTS: Five articles met the criteria. The overall result, the first pre-operative 24-hour oxygenation index mean, was temporally reliable and representative (intraclass correlation coefficient = 0.70, 95% CI = 0.61-0.77). Within any severity level, there were no differences in 90-day survival or mortality rate between delayed repair and early repair (p = 0.002). As a result, there is no optimal timing for surgery in severe cases of CDH. A delay in repair did not predict an increased risk of death, nor did it suggest an increased need for post-operative extracorporeal membrane oxygen therapy.
CONCLUSION: Regardless of the severity of the illness, the timing of CDH repair does not affect the mortality rate.Surgery is done after the physiology index achievement.
MATERIALS AND METHODS: This cross-sectional analytic study used patients' medical records between 2015 to 2020. Demographic data, surgery data and the used antimicrobial data were extracted and written in case report form. Identification of risk factors for inappropriate use of prophylactic antibiotics was done using logistic regression.
RESULTS: We identified 55 inappropriate times of preoperative prophylactic antibiotic therapy cases out of 80 cases and 63 cases in post-operative antibiotics were different from the guideline. Statistical analysis did not find any factor related to inappropriate therapy time.
CONCLUSION: The misuse of prophylactic antibiotics was frequently found regarding the duration of prophylactic antibiotics in both pre- and post-surgery setting. Nonetheless, no risk factor was identified with the inappropriate use of prophylactic antibiotics.
MATERIALS AND METHODS: This was a retrospective descriptive study. All medical records of conjoined twins who were admitted to Hasan Sadikin Bandung General Hospital from January 1st, 2015, to June 30th, 2023, were reviewed for gender, conjoined type, birth order, risk factor and treatment.
RESULTS: Of the 28 conjoined twins, 21 were girls (75%), and 7 were boys (25%); 19 (67,85%) were of the thoracoomphalopagus type; 11 (39,28%) were born as first children; 18 (64,28%) were born at 37 weeks of gestational age; and 22 twins' (78,57%) parents were aged between 21 and 35 years. None of the mothers had used medication, 13 (46,42%) took folic acid on occasion, five (17,85%) used traditional herbs, nine (32,14%) smoked and none drank alcohol. Parents who live in industrial areas were 18 (64.28%). There was no history of conjoined twins in previous pregnancies or deliveries or in the parent's family. Liver separation had been done in four (14.28%). Emergency separation in one twin. Nine (21.42%) patients died before surgery due to a worsening condition.
CONCLUSION: The conjoined twins were more common in girls, predominantly of the thoracoomphalopagus type. Risk factors that were commonly found were the first child, a gestational age of less than 37 weeks, and living in an industrial area.
MATERIALS AND METHODS: A retrospective cohort study was conducted between January 2017 and July 2023 in Yogyakarta, Indonesia. A total of 85 children diagnosed with intussusception underwent hydrostatic reduction, which employed water-soluble contrast administered into the rectum. Cases that were unsuccessful in reduction underwent immediate surgical intervention.
RESULTS: Among the 85 children with intussusception underwent reduction, 22 children underwent the SR procedure and 63 underwent NSR procedure. We found a successful outcome in 17 cases (77%) of SR procedure with one recurrent and the other five (23%) got surgical reduction such as anastomosis resection (3 cases) due to Meckel- Diverticula. On the other hand, we found 24 successful cases (38.0%) in NSR procedure with one recurrent after case. 39 others who failed with NSR continued to surgical reduction. Manual reduction was done for 31 patients with one case mortality due to pulmonary bleeding. Anastomosis resection (4 cases) and, stoma (4 cases) were decided for others surgical reduction. The relative risk (RR) on this study was 2.02 (p value < 0.05, CI 95%).
CONCLUSION: Implementation of the SR procedure may reduce surgery rates in paediatric intussusception, thereby enhancing patient management. Furthermore, the success rate of hydrostatic reduction higher in under sedation procedure. We contribute to evolve insight of non-operative approaches of paediatric intussusception management, particularly in the Yogyakarta.
MATERIALS AND METHODS: The study included Hirschsprung patients aged ≥3 and <18 years who underwent Yancey- Soave surgery at our hospital. The functional outcomes were evaluated using the Krickenbeck classification to determine voluntary bowel movement (VBM), constipation and soiling.
RESULTS: Most (82.6%) patients showed VBM, 26.1% had constipation and 4.3% suffered from soiling. Among 23 patients who received Yancey-Soave surgery, 8 (34.8%) had eosinophilia and 5 (21.7%) had lymphocytosis. However, no significant differences were observed between eosinophilia and non-eosinophilia groups for VBM (p=1.0), constipation (p= 0.621) or soiling (p=0.738). Similarly, no significant differences were found between lymphocytosis and nonlymphocytosis groups for VBM (p=1.0), constipation (p=0.545) or soiling (p=0.973). Moreover, no other prognostic factors affected the functional outcomes after Yancey- Soave surgery (p>0.05).
CONCLUSION: Our study shows that eosinophilia and lymphocytosis might not affect the functional outcome of patients with HSCR following Yancey-Soave surgery. In addition, sex, aganglionosis type, age at definitive surgery and nutritional status might not influence the functional outcome after definitive surgery. Further, a more extensive study is essential to clarify our findings.