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  1. Govindarajan MK, Durai B, Sundar VS, Uppupettai Ganeshbabu MB, Chiramel S
    Med J Malaysia, 2025 Jan;80(Suppl 1):77-79.
    PMID: 39773947
    Barotrauma is a medical condition caused by sudden pressure changes in the body causing damage to multiple parts of the body. However, it is an infrequent occurrence when it comes to Colo-rectal perforation, wherein the trauma occurs due to the insufflation of compressed air through the anus. Several factors influence the outcome of a patient with colonic perforation due to barotrauma such as the severity of the injury, hemodynamic status of the patient, the patient's general health and well-being, the time taken for active medical/ surgical intervention since the injury, aggressive intravenous antibiotics administration to prevent sepsis, post-operative complications like surgical site infection, post-op ileus, anastomotic leak, etc. Overall, the patient's prognosis largely depends on early diagnosis, effective initial resuscitation, timely surgical intervention, and intensive post-operative care for a favorable outcome. Recently, we came across 2 cases of extensive pneumoperitoneum with Colo-rectal perforation as a result of the forceful insufflation of compressed air through the anus. Prompt medical intervention was necessary to prevent any further complications and they underwent surgical repair of the colorectal perforation.
  2. Sim SK, Rahman MM, Wong HF
    Med J Malaysia, 2025 Jan;80(1):60-67.
    PMID: 39812430
    INTRODUCTION: Chronic non-specific low back pain (cnLBP) is a common primary care health issue. While acupuncture offers promising potential as a complementary treatment, its acceptance and integration into standard medical care for cnLBP remains inconsistent. This study investigated the predictors of acupuncture referral for cnLBP using the Theory of Planned Behaviour (TPB).

    MATERIALS AND METHODS: This was a cross-sectional observational study. Medical practitioners were recruited from the Malaysian Medical Association via email invitations. Data were collected via a validated online questionnaire and analysed using SPSS, employing bivariate correlation and multiple linear regression analyses to examine the predictors of referral behaviour.

    RESULTS: A total of 389 medical practitioners were recruited. The respondents were predominantly general practitioners aged 35-44 years, with 10-19 years of clinical experience, and approximately 90.0% managed cnLBP. Despite the high awareness of the Traditional and Complementary Medicine Act (92.0%), only 33.2% referred patients to acupuncture. Few had acupuncture training (3.6%) or personal experience (7.7%), and services were available in 12.1% of the workplaces. Medical practitioners possess substantial knowledge about acupuncture treatment for cnLBP; however, misconceptions and uncertainties regarding its mechanisms persist. Using multiple linear regression analysis, the significant predictors of acupuncture referral were self-experience (β=0.151, p<0.01), attitude (β=0.189, p<0.001), and perceived behavioural control (β=0.101, p<0.05).

    CONCLUSIONS: Despite positive attitudes and substantial awareness, barriers hinder the broader integration of acupuncture in cnLBP treatment. Targeted education, institutional support, and enhanced research collaborations are essential for improving referral rates and expanding the treatment options for cnLBP.

  3. Dashuki AR, Ruzlin ANM, Zamzuri MAIA, Chen XW
    Med J Malaysia, 2025 Jan;80(1):50-59.
    PMID: 39812429
    INTRODUCTION: Tuberculosis (TB) is one of the major global health challenges and concerns. Despite the availability of effective treatment in Malaysia, it remained a consistently high notification rate of TB cases. The objective of this study was to determine the proportion of successful TB treatment outcomes and its determinants among TB with comorbidities patients in Negeri Sembilan, Malaysia.

    METHODS: This is a retrospective cohort study among TB with Comorbidities cases in Negeri Sembilan using multiple secondary surveillance databases: National Tuberculosis Registry (NTBR), National Aids Registry (NAR) and National Diabetic Registry (NDR). The data review was from April 2024 until June 2024. All registered TB cases with comorbidities in Negeri Sembilan from the year 2018 to 2023 were analysed to determine the determinants of successful TB treatment among TB with comorbidities patients.

    RESULTS: Out of 712 TB cases with comorbidities, 541 (76.0%) achieved a successful TB treatment outcome, and 171 (24.0%) did not. The successful TB treatment among TB with comorbidities showed predominantly among male (72.5%), Malay ethnicity (65.4%), secondary education level (60.3%), and unemployed working status (70.1%). Diabetes mellitus (DM) was the most common comorbidity (70.4%), followed by hypertension (44.8%), dyslipidaemia (36.0%), HIV (19.5%), and viral hepatitis (18.1%). Factors significantly associated with successful TB treatment were those who had a secondary education level (AOR: 2.222; 95% CI: 1.129, 4.374) and a tertiary education level (AOR: 4.474; 95% CI: 1.428- 14.01), were diagnosed with TB in the government hospital (AOR: 0.053; 95% CI: 0.008-0.376), and were not done Acid- Fast Bacillus sputum in the intensive phase of treatment (AOR: 0.191; 95% CI: 0.046, 0.785), cases followed the Directly Observed Therapy at the intensive phase (AOR: 9.045; 95% CI: 4.604, 17.770), and the treatment duration was more than 6 months (AOR: 6.511; 95% CI: 3.383, 12.532).

    CONCLUSION: The successful treatment outcome for TB with comorbidities still falls short of the target and, if not treated well, could potentially lead to prolonged disease transmission, higher mortality rates, and increased healthcare costs. Identifying the proportion of successful treatment rates and their determinants provides insight into the disease burden and helps the public health sector and medical professionals assess and take appropriate action to improve local integration and collaborative service approaches for TB patients with concurrent comorbidities.

  4. Aung MMT, Naing NN, Hassan MRA, Wan-Arfah N, Chan HK, Harman Shah H, et al.
    Med J Malaysia, 2025 Jan;80(1):43-49.
    PMID: 39812428
    INTRODUCTION: Pancreatic cancer incidence in Malaysia is steadily on the rise, now ranking as the 14th most common malignancy in the country. Despite this upward trend, research on prognostic factors affecting pancreatic cancer survival remains limited, highlighting the need for ongoing investigation to improve patient survival outcomes.

    MATERIALS AND METHODS: This study was conducted retrospectively by reviewing records of pancreatic cancer patients hospitalized between January 2011 and December 2018 across multiple health centres in Malaysia. Using Cox proportional hazards regression analysis, several prognostic factors were identified.

    RESULTS: The study revealed that being Chinese, having a family history of pancreatic cancer, having hepatitis C, presenting with jaundice, experiencing pale stools, having a palpable mass in the abdomen, the presence of ascites, receiving palliative care and end-of-life care were associated with higher mortality risk. Conversely, being female, having hypertension, and higher haemoglobin levels were linked to decreased mortality risk.

    CONCLUSIONS: These study findings offer valuable insights into prognostic factors for predicting patient outcomes and optimizing individual prognosis in pancreatic cancer cases within Malaysia context. Future research should build on these findings, exploring how these factors can be integrated into comprehensive care plans that address the specific needs of diverse patient populations.

  5. Suhasinee S, Sherina MS, Lekhraj R, Kulanthayan KCM, Ismail SIF, Ummavathy P
    Med J Malaysia, 2025 Jan;80(1):72-80.
    PMID: 39812432
    INTRODUCTION: Cancer is one of the leading causes of morbidity and mortality worldwide. Breast cancer risk has risen due to lifestyle choices and genetic factors. Women with breast cancer symptoms experience lower quality of life (QoL), particularly in psychological and physical domains, compared to healthy women. Several studies reveal that poor QoL among breast cancer patients increases the risk of psychological distress. This study aimed to develop, implement, and evaluate the effectiveness of a counselling module in improving the QoL among breast cancer patients undergoing chemotherapy at the Institut Kanser Negara (IKN).

    MATERIALS AND METHODS: A single-blinded Randomized Controlled Clinical Trial was conducted at the IKN between January 2023 and June 2023. The estimated sample size was 120 participants. A sequential numbering system assigned a unique identifier to each participant until a total of 120 participants were recruited, with 60 participants in both the intervention and control groups. The intervention group received chemotherapy counselling using a newly developed module. QoL and depression were assessed at multiple time points using a validated questionnaire. Data were analysed using SPSS version 26, with independent tests and two-way repeated measures ANOVA. A p-value < 0.05 was considered significant, and partial eta squared was used to measure effect size.

    RESULT: Overall, in age distribution, the intervention group had the highest percentage of participants in the 41-60 years category (40.0%), whereas the control group had the highest percentage of participants aged ≥61 years (38.3%). The counselling module was effective in improving QoL and depression among participants at baseline and for three consecutive follow-ups following interventions. The QoL showed improvement in all four domains in the intervention group, which were Physical Health (p < 0.001), Psychological (p < 0.001), Social Relationship (p < 0.001), and Environment (p = 0.001). There was also a moderate effect reduction on depression (p < 0.001).

    CONCLUSION: The newly developed counselling module was effective in improving the QoL and depression among breast cancer patients. Repetitive counselling sessions by pharmacists, which were conducted during the module implementation, played a key role in ensuring the well-being of breast cancer patients throughout the treatment journey.

  6. Nur Faizah H, Nurul Hafizah MN, Juliana J, Wan-Hazabbah WH
    Med J Malaysia, 2025 Jan;80(1):68-71.
    PMID: 39812431
    INTRODUCTION: Cataract is a leading cause of visual impairment globally and in Malaysia, with surgery being the definitive treatment. While intracapsular cataract extraction (ICCE) is now less commonly performed due to advancements in surgical techniques, it remains essential in specific cases, such as those with weak zonular support. This study aims to evaluate the incidence, clinical profiles, and visual outcomes of patients who underwent ICCE, with or without intraocular lens (IOL) implantation, at Hospital Melaka, Malaysia, over the past decade.

    MATERIALS AND METHODS: A retrospective review was conducted on patients who underwent ICCE at Hospital Melaka, Malaysia, from January 2014 to December 2023.

    RESULTS: A total of 143 ICCE surgeries were performed on 135 patients. Most patients were male (n=88, 65.2%), with females comprising 34.8% (n=47). Most surgeries were performed on patients aged 60-69 years (n=48, 35.5%), followed by those aged 50-59 years (n=31, 23.0%) and 70-79 years (n=28, 20.7%). Incidence was lower among patients below 50 years and above 80 years. In terms of ethnicity, the highest incidence was among Malays (n=77, 57.0%), followed by Chinese (n=42, 31.1%) and Indians (n=15, 11.1%). The leading cause of ICCE was senile cataract with weak zonular support (n=58, 40.6%), followed by trauma (n=33, 23.1%), intraoperative complications (n=30, 21.0%), congenital cataracts (n=14, 9.8%), pseudoexfoliation (n=4, 2.8%), and lens-induced glaucoma (n=4, 2.8%). Post-surgery, 76 patients (53.1%) were left aphakic. Among those receiving IOL implants, 21.0% (n=30) had anterior chamber IOL, 14.7% (n=21) received an iris-claw IOL, and 11.2% (n=16) had a scleral-fixated IOL. Twelve weeks after IOL implantation, 60.9% (n=39) achieved good visual acuity of 6/12 or better, while 17.2% (n=11) had moderate vision (6/18 to 6/36), and 21.9% (n=14) had poor vision (worse than 6/60).

    CONCLUSION: The incidence of ICCE was low, accounting for only 0.66% of the 21,596 cataract surgeries performed at Hospital Melaka, Malaysia, during the study period. The primary indication was senile cataracts with weak zonular support. Most patients achieved favourable visual outcomes at 12 weeks postsurgery following IOL implantation, with the iris-claw IOL showing superior postoperative visual results compared to other IOL types.

  7. Aznan N, Murad MS, Zulkifli SN, Abdulmatin U
    Med J Malaysia, 2025 Jan;80(1):37-42.
    PMID: 39812427
    INTRODUCTION: As an occupational therapist, listening and empathy are critical components of practice because they are the foundation for developing therapeutic rapport with patients and their relatives. Currently, there is still no study regarding the level of empathy and listening styles among Occupational therapists in Malaysia. This study investigates the level of empathy and listening styles among occupational therapists in Malaysia and to examine their correlations.

    MATERIALS AND METHODS: A cross-sectional study was conducted with 244 occupational therapy practitioners; 43 males; and 181 females. The level of empathy and listening style were assessed using the Jefferson Scale of Empathy Health Professional version and Listening Styles Profile- Revised questionnaires. Data were collected using Google Form. Analysis data were done using IBM SPSS Statistical Software version 26.

    RESULTS: Statistical analysis showed that Malaysia occupational therapists preferred perspective taking (mean 55.67, Standard Deviation, SD 10.54) in empathy and the analytical listening in listening styles approach (mean 34.71, SD 6.76). In addition, there was a moderate to strong significant correlation between the level of empathy and listening styles (r= 0.419 to 0.648, p<0.05). Furthermore, there is significant difference between listening styles and empathy in relation to gender (male>female) p=0.001-0.038), race (Indian higher than Malay and Chinese) and areas of practice (paediatric higher than psychiatric) (p= 0.016 to 0.039).

    CONCLUSION: The findings are helpful for occupational therapists to improve their quality services by being more listening and empathetic while providing proper intervention to the patients.

  8. Ab Wahab NFN, Wan Hanafi HH, Yaacob NM, Dzarr AA, Azlan H
    Med J Malaysia, 2025 Jan;80(1):31-36.
    PMID: 39812426
    INTRODUCTION: Hodgkin lymphoma (HL) is a hematopoietic malignancy characterized by the presence of Reed Sternberg cells, with generally favourable outcomes compared to other hematological malignancies. This study aims to determine the socio-demographic, clinical and treatment characteristics, as well as the short-term overall survival (OS) and progression-free survival (PFS) rates, of HL patients treated at Hospital Universiti Sains Malaysia (USM), a tertiary centre in northeast peninsular Malaysia.

    MATERIALS AND METHODS: We conducted a retrospective cohort study of HL patients treated from January 1, 2006, to December 31, 2018, with follow-up until December 31, 2021. Data on demographics, clinical features, treatments, and outcomes were analyzed. OS and PFS were estimated using the Kaplan-Meier method.

    RESULTS: Among 126 patients, the median follow up was 41 months. Most were male (55.6%) and of Malay ethnicity (97.6%). Nodular sclerosis was the predominant histology (52.4%), with 77.8% presenting with advanced-stage disease. All patients received chemotherapy, while 23.1% underwent combined modality therapy either with radiotherapy or immunotherapy. Post-treatment, only 34.1% achieved complete response. The 3-year OS and PFS rates were 74.9% and 59.5%, respectively-relatively lower than rates reported in developed countries. Independent adverse prognostic factors for OS and PFS included advanced-stage disease, bulky disease, elevated erythrocyte sedimentation rate.

    CONCLUSION: This study highlights the need for tailored treatment approaches to improve HL outcomes in northeast Peninsular Malaysia. The relatively modest OS and PFS rates compared to developed nations suggest potential benefits from enhanced access to advanced therapied and diagnostic tools like positron emission tomography computed tomography (PET-CT) scan.

  9. Chan KV, Low DW, Kong KK
    Med J Malaysia, 2025 Jan;80(1):25-30.
    PMID: 39812425
    INTRODUCTION: Psoriasis is a chronic inflammatory skin condition often associated with comorbidities that may impact cognitive function. This study aims to determine if psoriasis is associated with the risk of cognitive impairment and to assess the relationship between cognitive impairment and various disease-related factors, including psoriasis severity, disease duration, and the presence of psoriatic arthropathy, using the Virtual Cognitive Assessment Tool (VCAT).

    MATERIALS AND METHODS: A total of 160 individuals were selected, comprising 80 psoriasis patients and 80 controls, matched for age, gender, ethnicity, marital status, education levels, and prevalence of comorbidities. Cognitive function was assessed using the VCAT. The relationship between cognitive impairment and various disease-related factors, including psoriasis severity measured using Psoriasis Area Severity Index (PASI scores), disease duration, and the presence of psoriatic arthropathy, was examined.

    RESULTS: The mean VCAT scores for the psoriasis and control groups were 25.38 (SD = 3.18) and 25.94 (SD = 2.67), respectively, with no significant difference between the two groups (p = 0.227). While most cognitive domains showed no significant differences, the VCAT attention sub-score was significantly lower in psoriasis patients (p < 0.05). There was no significant association between psoriasis and cognitive impairment. No significant association was found between cognitive function and PASI scores nor psoriatic arthropathy. A negative association was found between disease duration and VCAT scores, suggesting longer disease duration correlates with lower cognitive function (p = 0.05).

    CONCLUSIONS: This study did not find broad cognitive impairment in psoriasis patients compared to controls, the specific deficit in attention and its association with the duration of psoriasis warrants further investigation. Understanding and addressing the cognitive aspects of psoriasis could significantly improve the overall quality of life for these patients.

  10. Zakiman Z, Mat Ruzlin AN, Chen XW, Muhamad Robat R
    Med J Malaysia, 2025 Jan;80(1):17-24.
    PMID: 39812424
    INTRODUCTION: Cardiovascular diseases (CVDs) remain to be the leading cause of premature mortality worldwide, and healthcare workers (HCWs) are potentially at risk for developing CVDs. Office-based Globorisk is a ten-year risk prediction tool for CVDs risk scores. This present study aims to determine the prevalence of CVDs risk and risk factors associated with moderate-high CVDs risk among primary HCWs in government health clinics in Selangor.

    MATERIALS AND METHODS: A cross-sectional study was conducted on 543 HCWs from the KOSPEN WOW ("Komuniti Sihat Pembina Negara" or "Healthy Community Builds the Nation-Wellness of Workers") database in three district health offices (DHOs) under the Selangor State Health Department in Malaysia. To estimate the office-based Globorisk model, factors such as age, sex, current smoking status, systolic blood pressure (SBP), and body mass index (BMI) were included. Data analysis employed were Pearson chi-square test, Fisher's exact test, Welch's t-test and binary logistic regression.

    RESULTS: Among 543 participants, 453 (83.4%) were female, 439 (80.8%) were Malay with mean (SD) age of 44.4 (4.38). Majority of moderate-high CVDs risk identified among primary HCWs was male with 26 (86.7%), Malay with 25 (83.3%), and non-clinical group with 17 (56.7%). The prevalence of low CVDs risk was 94.5% (95% CI: 92.2-96.2) and 5.5% (95% CI: 3.8-7.8) for the moderate-high risk category. Factors associated with moderate-high CVDs risk were job category with non-clinical group (95% CI: 1.43, 6.85), elevated blood glucose (95% CI: 3.25, 19.41) and anxiety symptom (95% CI: 1.46, 13.86).

    CONCLUSION: The KOSPEN WOW platform is effective for screening and guiding implementation of intervention programmes to prevent CVDs.

  11. Rameli NAC, Yaacob SS, Ismail N, Azzani M, Harishah T
    Med J Malaysia, 2025 Jan;80(1):9-16.
    PMID: 39812423
    INTRODUCTION: Despite the availability of highly effective treatment for tuberculosis (TB), patients with TB may experience a relapse, which can be either a result of the disease reactivating or a new episode induced by reinfection. In Malaysia, there has been a noticeable rise in relapse TB cases, with a substantial rate of unsuccessful treatment outcomes among this population. This study seeks to examine the trends of unsuccessful treatment outcomes in relapse TB patients and explore how factors such as sociodemographic characteristics, TB disease profile, TB treatment profile, and comorbidities contribute to the outcomes.

    MATERIALS AND METHODS: This is a retrospective cohort study utilising secondary data from the National Tuberculosis Registry (NTBR). The study was conducted in Selangor among relapsed TB patients who were registered in NTBR from 1 January 2015 to 31 December 2019. TB disease profile, TB treatment profile, comorbidities, and sociodemographic data were examined. The determinants of unsuccessful treatment outcomes among relapsed TB patients were identified using multiple (binary) logistic regression analyses.

    RESULTS: 896 patients who experienced relapsed tuberculosis were included in this study. 32.25% were reported to have unsuccessful treatment outcomes. Multiple (binary) logistic regression revealed that the absence of sputum smear examination at 5 months and beyond was a determinant of unsuccessful treatment outcome (AOR 1.70 (95% CI: 1.19, 2.44). Additionally, being treated in government facilities, such as government hospitals and government primary health clinics, was a protective factor (AOR 0.06 (95% CI: 0.03, 0.15) and AOR 0.02 (95% CI: 0.01, 0.04), respectively.

    CONCLUSION: The high proportion of unsuccessful treatment outcomes among relapse TB patients stresses the importance of adherence to routine sputum monitoring and public-private partnerships.

  12. Liew KL, Tan JK, Khoo CS, Ng KY, Wilbert C, Lew YT, et al.
    Med J Malaysia, 2025 Jan;80(1):1-8.
    PMID: 39812422
    INTRODUCTION: Stroke is a major cause of morbidity and mortality worldwide. While electroencephalography (EEG) offers valuable data on post-stroke brain activity, qualitative EEG assessments may be misinterpreted. Therefore, we examined the potential of quantitative EEG (qEEG) to identify key band frequencies that could serve as potential electrophysiological biomarkers in stroke patients.

    MATERIALS AND METHODS: A single-centre case-control study was conducted in which patients admitted with stroke and healthy controls were recruited with consent. EEG was performed within 48 hours of admission for stroke patients and during outpatient assessments for controls. The EEG signals were pre-processed, analysed for spectral power using MATLAB, and plotted as topoplots.

    RESULTS: A total of 194 participants were included and equally divided into patients with ischemic stroke and controls. The mean age of our study cohort was 55.11 years (SD±13.12), with a median National Institute of Health Stroke Scale (NIHSS) score of 6 (IQR 4-6) and lacunar stroke was the most common subtype (49.5%). Spectral analysis, with subsequent topographic brain mapping, highlighted clustering of important channels within the beta, alpha, and gamma bands.

    CONCLUSION: qEEG analysis identified significant band frequencies of interest in post-stroke patients, suggesting a role as a diagnostic and prognostic tool. Topographic brain mapping provides a precise representation that can guide interventions and rehabilitation strategies. Future research should explore the use of machine learning for stroke detection and provide individualized treatment.

  13. Sim SK
    Med J Malaysia, 2025 Jan;80(1):108-110.
    PMID: 39812437
    Transcranial direct current stimulation (tDCS) has emerged as a potential adjunct therapy for post-stroke motor rehabilitation. While conventional rehabilitation methods remain the primary approach to improving motor function after stroke, many patients experience incomplete recovery, necessitating the exploration of additional interventions. This commentary article examines the role of tDCS in poststroke motor recovery, focusing on its mechanisms, efficacy, and limitations. Herein, the variability in research findings and individual patient responses as well as the recommended methods for optimising tDCS use in local clinical settings are highlighted.
  14. Sharma S, Rampal S, Jaiman A, Saravanamuttu SL, Jaiman A, Kamaruzaman L, et al.
    Med J Malaysia, 2025 Jan;80(1):102-107.
    PMID: 39812436
    INTRODUCTION: This study focuses on the association between musculoskeletal disorders and chronic kidney disease (CKD), specifically end-stage kidney disease (ESKD). Its primary objective is to explore the spectrum of musculoskeletal disorders and to identify their prevalence rates and symptoms within diverse CKD subpopulations.

    MATERIALS AND METHODS: The screening process yielded 13 studies conducted in various countries and regions. These studies, employing designs such as cross-sectional, cohort, and clinical trials, focused on CKD patients across different stages, including early and late-stage CKD.

    RESULTS: The study revealed that musculoskeletal disorders are a considerable concern within the CKD population but are insufficiently explored among ESKD patients. Common musculoskeletal disorders identified include osteoarthritis, osteoporosis, fibromyalgia, carpopedal spasm, and chronic musculoskeletal pain syndrome. The prevalence of these disorders varied, with sub-group analysis revealing higher prevalence among hemodialysis patients compared to preand non-dialysis patients. While musculoskeletal pain remains consistent across CKD stages, potential confounding factors, such as palliative care settings and mobility issues warrant careful consideration.

    CONCLUSION: The study underscores the importance of understanding and addressing musculoskeletal disorders in the CKD population, emphasizing the need for tailored interventions and future research endeavors.

  15. Siti Nurul Azimah MJ, Laily Noor Zuliaty A, Sharifah Shafinaz SA, Huzairi S
    Med J Malaysia, 2025 Jan;80(1):96-101.
    PMID: 39812435
    INTRODUCTION: The coronavirus disease of 2019 (COVID-19) predominantly impacts the pulmonary system; however, it also has harmful consequences for the cardiovascular system through the occurrence of myocardial injury.

    MATERIALS AND METHODS: This retrospective study analysed 119 COVID-19 patients admitted to Al-Sultan Abdullah Hospital (HASA) from March until December 2020. Demographics, medical histories, admission laboratory results, electrocardiogram (ECG), echocardiogram (echo), were captured from the hospitals' health records. Myocardial injury is an injury to the myocardium that can be diagnosed by elevated cardiac troponin T or I level above the 99th percentile upper reference limit (URL), an abnormal ECG, and an abnormal echo. Data were analysed using Statistical Package for Social Sciences (SPSS) Version 27.

    RESULTS: From this study, it was founded that the prevalence of myocardial injury is 36.1% (43 subjects out of 119). The risk factors are older age (odds ratio, 2.347; p=0.028), males (odds ratio, 2.019; p=0.125), Indians (odds ratio, 3.659; p=0.296), hypertension (odds ratio, 2.776; p=0.009), diabetes mellitus (odds ratio, 1.732; p=0.155) and category 4 and 5 COVID-19 patients (odds ratio, 2.325; p=0.038).

    CONCLUSION: Myocardial injury is prevalent among patients affected by COVID-19 and is associated with older age, hypertension and category 4 and 5 COVID-19. The researchers suggested conducting a more thorough investigation of the sizable population in multiple settings and conducting a prospective study where all infected COVID-19 patients have to undergo several tests, such as ECG, troponin T, and echocardiogram.

  16. Tian M, Mohamad N, Gao XZ, Mohd Taib NH
    Med J Malaysia, 2025 Jan;80(1):88-95.
    PMID: 39812434
    INTRODUCTION: Contrast-enhanced ultrasound (CEUS), an in vivo imaging tool for evaluating intraplaque neovascularisation (IPN), is an increasingly researched marker of susceptible atherosclerotic plaque. This study aims to assess the feasibility of quantifying carotid IPN using CEUS and to identify and characterise the neovascularisation in carotid plaques. The hospital's ethical committee approved the study, and the informed individual consent form of CEUS was obtained from all patients before the examination.

    MATERIALS AND METHODS: Seventy-one patients with carotid atherosclerotic plaques (95 plaques) were studied on CEUS. Contrast enhancement in the plaque was evaluated with visual interpretation and quantitative analysis. The intraplaque neovascularisation (IPN) test was graded on a 3- point scale. IPN was quantified using dedicated software for CEUS image analysis.

    RESULTS: It was found that the CEUS quantitative parameters were significantly different for plaques with varying types of echoes. The quantitative parameters also differed in soft, hard, and mixed plaques. The quantification of carotid IPN using CEUS was found feasible. The quantitative parameters measured from CEUS provide multiple references for carotid IPN of different echo types. This can help identify and monitor unstable atherosclerotic plaques.

    CONCLUSION: CEUS has the potential to be an important tool in clinical application, specifically for diagnosing carotid atherosclerotic plaque features and vulnerability.

  17. Kim ARJ, Hon YK, Guan CA, Lai WH, Bujang MA, Peter S, et al.
    Med J Malaysia, 2025 Jan;80(1):81-87.
    PMID: 39812433
    INTRODUCTION: Second victim experience (SVE) refers to the emotional and psychological impact experienced by healthcare providers who are involved in patient safety incidents (PSIs). Despite growing awareness of patient safety in healthcare organizations, remedial actions often focus only on the first victim, the patient. Therefore, it is important to recognize and address the emotional and physical toll that PSIs to ensure the well-being of and to promote a culture of safety in healthcare settings. Hence, this study was initiated to determine the prevalence of SVE, assess symptoms related to SVE and evaluate the level of support needed by healthcare providers.

    MATERIALS AND METHODS: The Second Victim Experience and Support Tool for Recovery (SVEST-R) questionnaire was utilized to conduct an anonymous survey on the healthcare providers in Sarawak General Hospital (SGH) from August to October 2018.

    RESULTS: A total of 482 respondents participated in the survey and 46.1% of the respondents reported SVE following their involvement in PSIs. Notably, symptoms such as flashbacks, fear, and stress tend to persist for longer durations compared to other symptoms. It is worth noting that non-work-related support received the highest mean (medical doctors = 3.83; nurses = 3.70), indicating that respondents preferred to seek emotional support from their friends and families. Furthermore, nurses reported a significantly higher experience of absenteeism following PSIs than doctors (p=0.003). In addition, most respondents expressed a desire for discussion or counselling with a respected peer or supervisor following their involvement in PSIs.

    CONCLUSION: Present study reported a relatively high prevalence of SVE among healthcare providers at SGH. Hence, proactive measures, including non-work related and supervisor support, are essential in facilitating their overall well-being and successful recovery.

  18. Kuczkowski KM
    Med J Malaysia, 2003 Mar;58(1):147-54; quiz 155.
    PMID: 14556345
    Maternal use of social drugs in pregnancy continues to increase--worldwide. Although a great deal has been learned regarding the implications of illicit drug abuse in pregnancy (cocaine, amphetamines, hallucinogens), the use of social drug in pregnancy has received far less attention. This article reviews the consequences of the social drug use in pregnancy including ethanol, tobacco and caffeine and offers recommendation for anaesthetic management of these potentially complicated pregnancies.
  19. Bermawi B, Kurniasari DW, Imaniar A, Hidayatih N, Lisnawati DA, Rofananda IF, et al.
    Med J Malaysia, 2024 Sep;79(5):604-607.
    PMID: 39352164
    INTRODUCTION: Tuberculosis (TB) is a serious global health problem in Indonesia, which is the country with the secondhighest TB burden after India. Accuracy in TB diagnosis is the key to effective treatment and decreased transmission rate. One of the latest diagnostic methods is interferon gamma release assay (IGRA), which measures the interferon-γ release associated with Mycobacterium tuberculosis (MTB) infection. This study aims to determine the diagnostic value of IGRA-TB using IchromaTM IGRA-TB diagnostic kit (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]), compared to Ziehl-Neelsen (AFB) staining, nucleic acid amplificationbased test (Xpert-MTB) and chest-X Ray as the gold standard in TB diagnosis.

    MATERIALS AND METHODS: A cross-sectional observational study design was used. Patients were recruited through purposive sampling from pulmonology outpatient clinic and inpatient ward at Jemursari Islamic Hospital (RSI Jemursari), Surabaya from July 2023 to December 2023. All enrolled patients should have been previously tested positive or negative for pulmonary TB using AFB staining, Xpert MTB and chest x-ray. Blood samples of the patients were collected and processed using the IchromaTM IGRA-TB diagnostic kit. The results were then compared with gold standard methods for calculating the IGRA-TB diagnostic value.

    RESULTS: A total of 56 adult patients were enrolled in this study. The sensitivity, specificity, PPV, NPV and accuracy rate of IGRA-TB using IchromaTM IGRA-TB diagnostic kit were 80.56%, 85%, 90.62%, 70.83% and 82.14%, respectively.

    CONCLUSION: IchromaTM IGRA-TB showed reasonably high diagnostic sensitivity and specificity, indicating that this method can be further utilised as a diagnostic and screening tool for pulmonary TB.

  20. Suganthini R, Suvintheran T, Nor Zanariah ZA
    Med J Malaysia, 2024 Sep;79(5):569-574.
    PMID: 39352159
    INTRODUCTION: Community acquired bloodstream infection (CA-BSI) is positive blood culture obtained within 48 hours of hospital admission. Bloodstream infections need to be treated with antibiotics. Inappropriate choice of antibiotics will lead to antimicrobial resistance. This is an observational retrospective study to look at the antimicrobial resistance of organisms causing bloodstream infections in patients admitted to the medical wards in our centre. The aim of the study is to determine the appropriate choice of empirical antibiotics for suspected CA-BSI in our hospital.

    MATERIALS AND METHODS: All patients admitted to medical wards with blood stream infection during the period January 2021 to June 2021 were enrolled. Identification of organisms and antimicrobial susceptibility testing were obtained. Information regarding the severity of the bacteremia was collected by assessing if the patient needed inotropes, mechanical ventilation or renal replacement therapy. Data on comorbidities which were the presence of end-stage renal failure, diabetic mellitus and immunosuppression were collected.

    RESULTS: Total of 269 cases were screened. Out of these 104 communities acquired cases were included. The pathogens frequently isolated were gram negative organisms most commonly Escherichia coli (43%) and Klebsiella species (30%). Staphylococcus aureus accounts for the majority of gram-positive organisms. Only two out of 20 Staphylococcus aureus were methicillin resistant. Bulkholderia pseudomallei accounts for 7.8% cases. All Burkholderia pseudomallei isolates were sensitive to cotrimoxazole. Escherichia coli (46%) isolates demonstrated a higher resistance pattern to Augmentin compared to klebsiella species (17.4%). The overall mortality rate was 22%, with higher rates for those critically ill (39%). Patients with Enterobacteriaceae infection showed no difference in outcome between the groups of patients according to sensitivity to Augmentin and cefotaxime. These groups of patients who were critically ill did not demonstrate any significant difference in terms of resistance pattern to Augmentin (p = 0.3) and cefotaxime (p = 0.7). Patients who are aged 65 or older have a significantly more resistant pattern to Augmentin and cefotaxime.

    CONCLUSION: Antibiogram serves as a guide for clinicians to choose appropriate choices of antibiotics based on local data. Empirical antibiotics of choice for patients with sepsis should be narrow-spectrum beta lactam/beta lactamase inhibitors. Broad spectrum beta lactam/beta lactamase inhibitors such as piperacillin tazobactam should be reserved for patients who are critically ill and elderly patients over 65 years. The antibiotics should be deescalated once the organisms and sensitivity of the antibiotics are known.

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