MATERIAL AND METHODS: An interventional study was carried out among oesophageal and gastric cancer patients who had undergone surgery at the National Cancer Institute of Malaysia. The prehabilitation process took a maximum of two weeks, depending on the patient's optimisation before surgery. The prehabilitation is based on functional capacity (ECOG performance status), muscle function (handgrip strength), cardio-respiratory function (peak flow meter) and nutritional status (calorie and protein). Postoperative outcomes are measured based on the length of hospital stay, complications, and Clavien-Dindo Classification.
RESULTS: Thirty-one patients were recruited to undergo a prehabilitation intervention prior to gastrectomy (n=21) and esophagectomy (n=10). Demographically, most of the cancer patients were males (67.7%) with an ideal mean of BMI (23.5±6.0). Physically, the majority of them had physical class (ASA grade) Grade 2 (67.7%), ECOG performance status of 1 (61.3%) and SGA grade B (51.6%). The functional capacity and nutritional status showed a significant improvement after one week of prehabilitation interventions: peak expiratory flow meter (p<0.001), handgrip (p<0.001), ECOG performance (p<0.001), walking distance (p<0.001), incentive spirometry (p<0.001), total body calorie (p<0.001) and total body protein (p=0.004). However, those patients who required two weeks of prehabilitation for optimization showed only significant improvement in peak expiratory flow meter (p<0.001), handgrip (p<0.001), and incentive spirometry (p<0.001). Prehabilitation is significantly associated postoperatively with the length of hospital stay (p=0.028), complications (p=0.011) and Clavien-Dindo Classification (p=0.029).
CONCLUSION: Prehabilitation interventions significantly increase the functional capacity and nutritional status of cancer patients preoperatively; concurrently reducing hospital stays and complications postoperatively. However, certain cancer patients might require over two weeks of prehabilitation to improve the patient's functional capacity and reduce complications postoperatively.
MATERIALS AND METHODS: A cross-sectional study was done at Iraqi Communicable Disease Control Center, where all confirmed cases of Salmonella typhi are reported, for a period 2019-2021. All demographic, epidemiological and clinical characteristics of patients, comorbidities, type of samples, distribution of S. typhi by age and gender, time distribution in each year and profile of bacterial resistance and sensitivity to antibiotics were gathered and analysed.
RESULTS: Most samples were taken from blood. The mean age of cases during 2019, 2020 and 2021 was 18.7 ± 6.5, 17.7 ± 14.1 and 17.3 ± 12.8. Males constituted 56.7%, 58.5% and 39.8%, respectively. Some cases had comorbidities. Most cases had headache and fever. Some of them had nausea, diarrhoea, vomiting and epigastric pain. The age and sex were significantly associated with years of reporting. The most months of case reporting were June-July (2019 and 2021), Jan. -Feb. (2020). There was an obvious increase in S. typhi resistance to ceftriaxone (92.2%, 86.1%, 88.8%) and ampicillin (77.1%, 76.9%, 81.27%). There was a gradual increase in sensitivity to tetracycline (83.1%, 88.1%, 94%), cotrimoxazole (86.7%, 86.1%, 92.2%), ciprofloxacin (78.3%, 90.1%, 87.8%) and cefixime (77.7%, 72.3%, 72.7%).
CONCLUSIONS: There was a sharp rise in resistance rates of the S. typhi in Iraq (during 2019-2021) to ceftriaxone and ampicillin, while there were highest sensitivity rates to imipenem, aztreonam and chloramphenicol. The following recommendations were made: (1) Improvement of general hygiene and food safety measures. (2) Emphasis on vaccination and surveillance of Salmonella infection. (3) Rational use of appropriate antibiotics through implementation of treatment guidelines. (5) Educate communities and travelers about the risks of S. typhi and its preventive measures.
MATERIALS AND METHODS: A cross-sectional study was conducted at Klinik Kesihatan Bandar Kuantan, Kuantan, Pahang. Patients were selected using stratified random sampling, and 201 participants were selected. The selected participants were asked to fill up the self-administered validated questionnaires consisting of background characteristics and Patient Satisfaction Questionnaire 18 (PSQ-18). Data collection period was from March 2022 to August 2022. Descriptive analysis was used to describe the background characteristics of respondents and the score of patient satisfaction. Multiple linear regression was used to determine the factors associated with patient satisfaction while adjusting for cofounders.
RESULTS: A total of 201 eligible data points were analysed in the study. The respondent mean age was 47.1 ± 16.9. Most respondents were Malay (68.7%), having secondary education (54.2%) and predominantly from the B40 income class (88.1%). The overall mean patient satisfaction score was 3.83 ± 0.31. There were significant associations between overall satisfaction with patient education level (B = -0.144; 95% CI -0.246, -0.042; p = 0.006), waiting time (B = -0.371; 95% CI -0.534, -0.209; p = 0.001) and consultation duration (B = -0.154; 95% CI -0.253, -0.055; p = 0.0020). It was found that patients with secondary education were less satisfied compared to patients with primary education level on health care services they received. Meanwhile, those who were not happy with the waiting time and consultation duration showed less satisfaction with overall healthcare services.
CONCLUSION: Despite serving the most significant number of patients in Pahang state, most of the patient were satisfied by the health care services at Klinik Kesihatan Bandar Kuantan. However, it is recommended to improve the waiting time and the consultation time in this clinic.
MATERIALS AND METHODS: The research design used a quasiexperiment. The sampling technique used cluster sampling with 76 respondents in intervention group and 76 respondents in control group. The research was conducted in the working area in Public Health Center, Malang Regency. Data analysis in this study used the Wilcoxon Signed Rank Test and Mann-Whitney.
RESULTS: The results of the study found that there were differences in the ability of mothers to fulfill nutrition in stunted children between the intervention group and the control group (p = 0.000). There were mean differences in the ability of mothers to fulfill nutrition for stunted children before and after the intervention in the intervention group with indicators of breastfeeding, food preparation and processing, complementary- feeding and responsive feeding were increased (p = 0.000). However, in the control group, there were no differences in the ability of mothers to fulfill nutrition with indicator breastfeeding (p = 0.462), food preparation and processing (p = 0.721), complementary feeding (p = 0.721), complementary feeding (p = 0.462). (p = 0.054), responsive feeding (p = 0.465) and adherence to stunting therapy (p = 0.722).
CONCLUSION: The women's empowerment model based on self-regulated learning is formed by individual mother factors, family factors, health service system factors, and child factors so that it can increase the mother's ability to fulfill nutrition in children aged 6-24 months who are stunted. The women's empowerment is a learning process about breastfeeding, food hygiene, infant and young children feeding, and responsive feeding by mothers to fulfill nutrition in children with stunting, with a goal and plan to achieve an improvement in mother's ability and nutritional status in children.
MATERIALS AND METHODS: This retrospective cohort study enrolled hospitalised patients between May 2021 and August 2021, aged 18 years and above, with severe respiratory failure defined by a ratio of oxygen saturation to fraction of inspired oxygen (SF ratio) of less than 235. The treatment protocol involved administering high-dose MTP for 3 days, followed by DXM, and the outcomes were compared with those of patients who received DXM alone (total treatment duration of 10 days for both groups).
RESULTS: A total of 99 patients were enrolled, with 79 (79.8%) receiving pulse MTP therapy and 20 (20.2%) being treated with DXM only. The SF ratio significantly improved from a mean of 144.49 (±45.16) at baseline to 208 (±85.19) at 72 hours (p < 0.05), with a mean difference of 63.51 (p < 0.001) in patients who received ≤750 mg of MTP. Additionally, in patients who received >750 mg of MTP, the SF ratio improved from a baseline mean of 130.39 (±34.53) to 208.44 (±86.61) at 72 hours (p < 0.05), with a mean difference of 78.05 (p = 0.001). In contrast, patients who received DXM only demonstrated an SF ratio of 132.85 (±44.1) at baseline, which changed minimally to 133.35 (±44.4) at 72 hours (p = 0.33), with a mean difference of 0.50 (p = 0.972). The incidence of nosocomial infection was higher in the MTP group compared with the DXM group (40.5% vs. 35%, p = 0.653), with a relative risk of 1.16 (95% CI: 0.60-2.23).
CONCLUSION: MTP did not demonstrate a significant reduction in intubation or intensive care unit admissions. Although a high dose of MTP improved gas exchange in patients with severe and critical COVID-19, it did not provide an overall mortality benefit compared to standard treatment.
MATERIALS AND METHODS: This was a cross-sectional study involving 82 asthmatic participants in Hospital Canselor Tuanku Muhriz (HCTM), Universiti Kebangsaan Malaysia (UKM) conducted between December 2020 till January 2022. Participants performed pre- and post-bronchodilator IOS and spirometry within the same day. Correlation between spirometry and IOS parameters and FEF25%-75% with IOS were determined and analysed.
RESULTS: The change of forced expiratory volume in 1 second (FEV1) was statistically correlated with a change of R5 in IOS. A decrement of 14.5% in R5 can be correlated with positive bronchodilator response (BDR) with a sensitivity of 63.9% and specificity of 60.9%, p=0.007. Pre-bronchodilator FEF25%-75% correlated with all parameters of SAD in IOS, e.g., R5-R20, reactance at 5Hz (X5) and area of reactance (AX), p < 0.05. IOS detection for SAD is higher compared to FEF25%-75% in the BDR negative group (91.3% vs 58.7%).
CONCLUSION: IOS detected both bronchodilator reversibility and SAD hence can be considered as an alternative tool to spirometry for diagnosis of asthma in adults. IOS detected SAD more than FEF25%-75%, especially in BDR-negative group.
MATERIALS AND METHODS: This study aims to develop and validate a questionnaire measuring the KAP of clinicians towards maternal medicine. Literature reviews, item generation and multiple experts' reviews were conducted during the questionnaire development phase. Convenient sampling was undertaken for this cross-sectional survey. A total of 168 clinicians from one tertiary hospital and three health clinics participated in thepilot testing using the modified questionnaire. In addition, test-retest was performed on 30 participants to examine its reliability, whilst exploratory factor analysis (EFA) was undertaken to determine its construct validity.
RESULTS: This finalised questionnaire contained 36 items with excellent content validity. Pertaining to test-retest reliability, all knowledge domain items showed Kappa values > 0.20, except item K29; attitude domain items overall Cronbach's alpha was 0.787 with corrected item-total correlation > 0.300 and lastly, all items in practice domain achieved intra-class correlation index > 0.700, except P2.5. EFA supported four factor structures, but six items were removed due to the following reasons: cross loading, negative or poor loading factor (< 0.3).
CONCLUSION: Overall, this instrument has an acceptable psychometric property, content validity, internal reliability and construct validity. It is hope that this questionnaire would be validated in other populations and be used in future research to enrich our understanding of clinicians' KAP towards maternal medicine.
MATERIALS AND METHODS: A total of 154 first-time mothers in the third trimester of pregnancy who attended two health clinics in the state of Sarawak, Malaysia for antenatal care participated in this cross-sectional study. A structured selfadministered questionnaire was used to measure the variables of interest.
RESULTS: Most mothers could correctly identify the aetiological factors of dental caries and strategies for preventing the disease in children. However, a substantial portion could not identify certain cariogenic and noncariogenic foods or drinks. Most pregnant women have appropriate attitudes towards children's oral health although some showed unfavourable attitude about care of primary teeth. Women who were older and had attended a talk on children's oral health were more likely to have higher mean knowledge score than their respective counterparts, and higher mean knowledge score was associated with higher mean attitude score.
CONCLUSION: Most first-time mothers in this study had correct knowledge and favourable attitude about children's oral health, although misunderstandings and misperceptions in several issues were also common. Significant association found between experience of attending oral health talk and oral health knowledge, and between oral health knowledge and attitude, substantiate the importance of an educational intervention program to optimise the mothers' roles in caries prevention in children.
MATERIALS AND METHODS: This consensus statement was formulated by a panel of five experts of primary care and specialist doctors. A lung cancer screening algorithm was proposed for implementation locally.
RESULTS: In an earlier pilot project collaboration, AI-assisted chest radiography had been incorporated into lung cancer screening in the community. Preliminary experience in the pilot project suggests that the system is easy to use, affordable and scalable. Drawing from experience with the pilot project, a standardised lung cancer screening algorithm using AI in Malaysia was proposed. Requirements for such a screening programme, expected outcomes and limitations of AI-assisted chest radiography were also discussed.
CONCLUSION: The combined strategy of AI-assisted chest radiography and complementary LDCT imaging has great potential in detecting early-stage lung cancer in a timely manner, and irrespective of risk status. The proposed screening algorithm provides a guide for clinicians in Malaysia to participate in screening efforts.
MATERIALS AND METHODS: A retrospective study was conducted on all patients who had AAA repair between 2015 and 2019 in Kuala Lumpur Hospital (HKL). Operating logbooks from the study period were digitised, and details of aortoiliac aneurysm surgery were analysed. We compared these findings to a previous study on AAA treatment conducted in HKL between 1993 and 1995.
RESULTS: Over the course of 5 years, 496 abdominal aortic surgery were performed. There were 451 patients (90.9%) with AAA, whereas 41 patients (8.3%) had mycotic aneurysms. Among patients with AAA, the median age was 70 (IQR 11) and was mostly male (89.3%), whereas inlay repair was the most common technique (n = 395, 87.5%) while EVAR was employed in 36 patients (8.0%). A two proportion z test comparing emergency surgery proportions between our study cohort (56.1%) and the 1993-1995 cohort (39.3%) was significant (p = .017).
CONCLUSION: There has been a significant increase in the proportion of emergency surgery in HKL. Open surgery remains the most frequent repair technique. The increase in volume likely reflects the accessibility of healthcare, though other factors may play a role. Improvements in outcomes will benefit from research on the standard of care based on prospective data.
MATERIALS AND METHODS: A cross-sectional design was used in this study involving 245 participants of type 2 diabetes mellitus (T2DM) was conducted at a Kitamura Wound Care Clinic, PKU Muhammadiyah, located in Pontianak, West Kalimantan, Indonesia, between September 2022 and February 2023. The Kruskal-Wallis test was used to assess the relationship between the foot care practices and infection status. A linear regression test to examine the independent risk factors.
RESULTS: Wounds' characteristics regarding foot care practice group were significantly including more than 5 months wound heal from previous wounds (p = 0.045), the percentage of wound site on dorsal was higher in the foot care practice group (p < 0.001), the percentage had no deformity feet was higher in the foot care practice group (p < 0.001), the percentage had no previous amputation feet was higher in the foot care practice group (p < 0.001). Also, the percentage had grade three was higher in the foot care practice group (p < 0.001), the percentage had grade three was higher in the foot care practice group (p < 0.001), and the percentage had mild infection status was higher in the foot care practice group (p < 0.001). The predictors of diabetic foot infection were Wagner and SHID classification and foot care (p < 0.001, p < 0.001, and p < 0.01) respectively.
CONCLUSION: This study demonstrated that foot-care behaviour in diabetic patients in Indonesia is poor. In addition, this study also has shown Wagner grading, SHID grading, and foot-care are predictors of infection in recurrent DFUs.
MATERIAL AND METHODS: This is a retrospective observational study done in Hospital Sg Buloh (HSB), a tertiary referral centre in an urban area located north of Kuala Lumpur, Malaysia's capital city, from January until December 2018, involving 289 patients. All cases with CPR and a sustained return of spontaneous circulation (ROSC) were included in the study and followed up until discharged or died in the hospital.
RESULTS: Out of 236 patients recruited, 25.8% achieved ROSC, 15.7% survived on admission, and 4.2% of patients were discharged alive. Of 74.1% of witnessed OHCA, only 17.5% received bystander CPR. Factors with favourable outcomes include CA in ED (p<0.001), the initial rhythm of ventricular fibrillation (p=0.003), defibrillation (p=0.024), OHCA witnessed by emergency medical services (EMS) (p=0.024) and intravenous adrenaline administration (p=0.001). When using multivariate regression analysis, positive outcomes were associated with the cardiac and respiratory cause of CA (Adjusted Odd Ratio (AOR) 3.66; 95% Confidence Intervals, 95%CI: 2.52 - 12.61 and AOR 8.76; 95%CI: 5.76- 15.46, respectively) as well as OHCA witnessed by EMS (AOR 10.81; 95%CI: 1.84- 19.52).
CONCLUSIONS: Despite being an upper-middle-income country and having advancements in the healthcare system, a relatively lower STD rate among survivors of CA in the ED was observed in this study. There was underutilization of the EMS among patients with CA. The bystander CPR rate among patients with CA in Malaysia is also worryingly low. Aggressive community participation in cardiac arrest awareness programmes is much required. Additionally, in achieving better outcomes, implementing standardized post-resuscitation care protocols with existing resources will be a challenge for physicians managing cardiac arrest cases.
MATERIALS AND METHODS: In this repeated-measures study, 40 Malaysian adults (aged 19-26 years) with normal hearing bilaterally (based on PTA results) were enrolled. They then underwent the SAL test based on the recommended protocol by Jerger and Tillman (1960). The SAL normative data for each ear were obtained by calculating the differences between air conduction (AC) thresholds in quiet and AC thresholds in noise by means of insert earphone, B71 and B81 bone vibrators.
RESULTS: The SAL normative values were comparable between the ears (p > 0.05), and the data were pooled for subsequent analyses (n = 80 ears). Relative to B81 bone transducer, B71 bone vibrator produced statistically higher SAL normative data at all frequencies (p < 0.05). The SAL normative values established by the present study were statistically lower than those of the previous study (that utilised headphones) at most of frequencies tested (p < 0.05).
CONCLUSIONS: The SAL normative data produced by the two bone vibrators were significantly different. The SAL normative values were also affected by the type of earphone used. While conducting the SAL test on Malaysian patients, the information provided by this study can be useful to guide the respective clinicians in choosing the appropriate normative data.
MATERIALS AND METHODS: We retrospectively analysed data from 157 patients who underwent FG-TBLB, with the primary outcome being procedure-related pneumothorax. We assessed several risk factors for pneumothorax following FG-TBLB: patient characteristics, location of biopsy, number of biopsies and computed tomography pattern. Univariate and multivariate logistic regression analyses were performed.
RESULTS: One-hundred fifty-seven patients were included [mean (SD) age 57.9 (16.2) years; 60.5% male]. The most common location for FG-TBLB was the right upper lobe (n=45, 28.7%). The mean (SD) number of biopsy samples was 6.7 (2.1). Radiographic evidence of pneumothorax was reported in 12 (7.6%) patients, with 11 of those requiring intercostal chest tube intervention (mean air leak time: 5.7 days and 1 had persistent air leak requiring autologous blood patch pleurodesis. None experienced pneumothorax recurrence. Female gender and upper lobe location of the biopsy were identified as predisposing factors for pneumothorax. In the multivariable analysis, upper lobe biopsies were associated with a higher risk of pneumothorax (OR 0.120; 95% CI 0.015-0.963; p = 0.046).
CONCLUSION: The overall rate of pneumothorax is low. We recognise the increased risk of pneumothorax associated with upper lobe biopsy. These findings suggest that clinicians should exercise caution when performing FGTBLB in this region and consider alternative biopsy locations whenever feasible. We suggest adequate planning and preparation should be implemented to minimise the risk of pneumothorax following FG-TBLB.
MATERIALS AND METHODS: This study is an analysis of a matched case-control study with a ratio of 1:2. The case group contained 206 respondents, and the control group contained 412. All CRC cases were confirmed with the histological results. The control group was matched for links between age, sex and ethnicity with CRC. The Statistical Package for Social Sciences Statistics (SPSS) IBM version 28.0 was used to conduct descriptive analysis using chi-squared testing and simple logistic regression. The statistical significance was P < 0.05.
RESULT: Overall, 618 respondents took part in this survey, of which 256 (41.4%) were female and 362 (58.6%) were male. The maximum age was 76, with a mean age ± SD of 53.17 ± 11.4. Those of Bajau ethnicity comprised 24.6% (152) of the population, followed by Dusun with 22.8% (141), Kadazan with 17.6% (109%), other North Borneo ethnic groups with 15.5% (96), Bugis with 9.7% (60), Brunei with 4.4% (27) and other predominant races with 5.3% (33). Regression analyses revealed that the incidence of CRC in North Borneo, Malaysia, was substantially correlated with income, occupation, other linked diseases and BMI.
CONCLUSION: Various risk factors are linked to CRC, based on the findings related to socio-demographic characteristics and BMI. Therefore, to lower the nationwide prevalence of CRC, national public health campaigns should include collaboration with the regional authorities to highlight the incidence and risk factors of CRC based on ethnicity.
MATERIALS AND METHODS: This is a comparative crosssectional study using secondary data from the eNotifikasi system and hepatitis B case investigation forms between 2018 and 2022 from four district health offices in Pahang, Malaysia. Demographic data, hepatitis B vaccination status and risk factors were assessed. Data analysis employed were independent chi-squared tests, t-tests and binary logistic regression.
RESULTS: The study included 285 cases (141 indigenous and 145 non-indigenous). Among the indigenous cases, 72.3% were unvaccinated and 59.6% reported a history of infected mother, followed by percutaneous exposure, multiple sexual partners, and sharing syringe. The odds for those with a history of an infected mother being indigenous group is 2.5 times (95% CI: 1.4-4.4) compared to those with a history of an infected mother being non-indigenous group.
CONCLUSION: Significant difference exists in hepatitis B risk factors between indigenous and non-indigenous populations. The main risk factor for indigenous community is history of infected mother. Thus, the necessity of incorporating hepatitis B screening into the current practice of antenatal HIV screening, specifically targeting the indigenous community, should be given consideration.
MATERIALS AND METHODS: A retrospective cross-sectional analysis was performed on patients who presented to our institution from April 2020 until July 2021 for acute stroke and had MRI brain as first-line neuroimaging. A total of 31 subjects were included in this study. Two radiologists assessed the signal patterns in DWI sequence and compared them with SWI and CT Brain, whenever available, as the gold standard for observing the presence of intracranial haemorrhage.
RESULTS: The majority of patients with hyperacute bleed proven to be revealed on SWI or CT, thus showed characteristics of central hyperintensity and peripheral hypointense rim, on DWI. Slightly more than half (51.6%) presented with mild to moderate NIHSS scores (1-15). The sensitivity, specificity, positive predictive value and negative predictive value of DWI in detecting intracranial intra-axial haemorrhages were exceptionally high. There is strong interobserver level of agreement in identifying central haemorrhagic signal intensity [kappa = 0.94 (0.06), p < 0.05].
CONCLUSION: This study supported the DWI sequence as a reliable sequence in MRI, to detect intracranial haemorrhage in hyperacute stroke.
MATERIALS AND METHODS: This is quantitative research with a true experimental approach. Actual bleeding volume was simulated by an acrylic phantom containing Iodine contrast media (5 ml, 10 ml, 15 ml, and 20 ml). The phantom was scanned using routine CT protocol using the helical and sequence technique. Bleeding volume from each technique was measured manually using the Broderick formula and automatic software (ROI based). Accuracy was assessed by comparing the volume measurement result to the actual bleeding volume. Data was analysed using the Friedman test and by Wilcoxon.
RESULTS: The standard deviation of measured bleeding volume from the manual and automatic measurements compared to the actual bleeding volume were (0.220; 0.236; 0.351; 0.057) and (0.139; 0.270; 0.315; 0.329) in helical technique, and (0.333; 0.376; 0.447; 0.476) and (0.139; 0.242; 0.288; 0,376) in sequence technique. There are differences in the measurement results from the helical and sequence techniques (p <0.05) and using manual and automatic methods (p <0.05).
CONCLUSION: The measurement of bleeding volume that has a standard deviation value compared to the actual volume is more accurate in the helical technique using the automatic method, while the sequence technique is the manual method.
MATERIALS AND METHODS: A prospective observational study was conducted between 1st October 2021 till September 2022 in the state of Johor, Malaysia. 300 patients with confirmed SARS-CoV-2 infection were randomly selected and followed up for six months. Data were analysed by using Chi-square test, Fisher's Exact test, Paired t test and Multiple logistic regression.
RESULTS: The prevalence of short-term neuropsychiatric symptoms was 78%, with anosmia being the most prevalent symptom. Long-term symptoms were found in 22.75% of patients, with headache being the most prevalent (p= 0.001). COVID-19 Stage 2 and 3 infections were associated with a higher risk of short-term neuropsychiatric symptoms, OR for Stage 2 infection was 5.18 (95% CI: 1.48-16.97; p=0.009) and for Stage 3 infection was 4.52 (95% CI: 1.76-11.59; p=0.002). Complete vaccination was a significant predictor of longterm symptoms with adjusted OR 3.65 (95% CI 1.22-10.91; p=0.021).
CONCLUSION: This study demonstrated that neuropsychiatric symptoms were common among COVID-19 patients in Johor, Malaysia and the risk of these symptoms was associated with the severity of the infection. Additionally, complete vaccination does not completely protect against long-term neuropsychiatric deficits. This is crucial for continuous monitoring and addressing neuropsychiatric symptoms in COVID-19 survivors.