Displaying publications 81 - 100 of 2133 in total

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  1. Jamalludin, A.R., Razman, M.R., Niza, S.
    MyJurnal
    Background: Peer assessment has been shown to complement both formative and summative evaluations in education and used in some medical programmes. The study was aimed to find correlation between group work peer assessment score and final examination mark among four batches of International Islamic University Malaysia (IIUM) first year MBBS students.
    Method: A set of four questions was constructed and tested to assess students’ overall role in their group research project. The difference in distribution according to years was tested by using one-way ANOVA or Kruskal-Wallis, depending on the data distribution. Pearson correlation coefficient test was done to test the linear association between peer score and final examination mark. Partial correlation test was used to adjust the correlation for four academic years.
    Results: From the analysed data of 502 students, there was moderate, significant positive correlation (0.366) between peer assessment score and the final examination mark (P < 0.001). Adjustment to the academic years resulted in correlation coefficient of 0.371.
    Conclusion: The results provide an important insight on the influence of peers’ perception in predicting the medical student academic performance.
    Matched MeSH terms: Prospective Studies
  2. Chew KW, Chia SR, Show PL, Ling TC, Arya SS, Chang JS
    Bioresour Technol, 2018 Nov;267:356-362.
    PMID: 30029182 DOI: 10.1016/j.biortech.2018.07.069
    The present study investigates the prospective of substituting inorganic medium with organic food waste compost medium as a nutrient supplement for the cultivation of Chlorella vulgaris FSP-E. Various percentages of compost mixtures were replaced in the inorganic medium to compare the algal growth and biochemical composition. The use of 25% compost mixture combination was found to yield higher biomass concentration (11.1%) and better lipid (10.1%) and protein (2.0%) content compared with microalgae cultivation in fully inorganic medium. These results exhibited the potential of combining the inorganic medium with organic food waste compost medium as an effective way to reduce the cultivation cost of microalgae and to increase the biochemical content in the cultivated microalgae.
    Matched MeSH terms: Prospective Studies
  3. Jasmine YS, Lee SL, Kan FK
    Med J Malaysia, 2017 02;72(1):62-64.
    PMID: 28255145
    Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disorder resulting from uncontrolled hyperinflammatory response. There had been increase in cases of one of the secondary form of HLH, i.e., infectionassociated haemophagocytic syndrome (IAHS) in severe dengue in recent years. However, the condition remains under diagnosed due to lack of awareness compounded by the lack of validated diagnostic criteria. Severe hepatitis with prolonged cytopenias, severe hyperferritinemia, hypofibrinogenemia and persistent fever were evident in all four cases reported. All the subjects survived with supportive care and adjuvant steroid therapy. Prospective controlled studies are needed to develop diagnostic criteria and management protocol for IAHS in severe dengue.
    Matched MeSH terms: Prospective Studies
  4. Ahmad A, Mohd-Ali B, Ishak B
    Clin Optom (Auckl), 2018;10:109-113.
    PMID: 30319302 DOI: 10.2147/OPTO.S172272
    Purpose: Soft contact lens wear is most frequently associated with morphologic changes in corneal endothelial cells, but the data are scarce in Asians. This study aimed to evaluate changes in corneal endothelial cell morphology after 6 months of wearing soft hydrogel contact lenses (SH) in young myopic adults living in Kuala Lumpur.

    Patients and methods: Forty-eight subjects were included in the study, 24 were fitted with SH contact lenses (A) and the rest were prescribed with glasses (B). Refraction was conducted subjectively and standard contact lens fitting protocol was followed. Corneal endothelial cell morphology (endothelial cell density, ECD; coefficient of variation, COV; cells' hexagonality, HEX; and central corneal thickness, CCT) was evaluated using specular microscope. Data were collected at baseline and after 6 months of lens wear.

    Results: Mean age of all subjects was 21.23±1.30 years. All results are shown at baseline and 6 months, respectively. Mean refraction for A was -2.16±0.97 diopter sphere (DS) and -2.05±1.03 DS (P=0.49); for B was -2.72±1.51 DS and -2.73±1.51 DS (P=0.58). Mean ECD (cell/mm2) for A: 3104.19±237.30 and 3107.23±237.51 (P=0.07); for B: 3011.56±227.95 and 2983.83±244.55 (P=0.33). COV (%) for A: 46.52±8.63 and 48.53±10.65 (P=0.06); for B: 46.93±9.31 and 46.14±10.65 (P=0.88). HEX (%) for A: 46.21±10.12 and 45.15±10.01 (P=0.08); for B: 46.21±10.12 and 45.15±10.01 (P=0.12). CCT (µm) for A: 520.33±0.04 and 525.70±0.05 (P=0.41); for B: 532.00±0.04 µm and 530.00±0.05 µm (P=0.40).

    Conclusion: This study found no significant change in corneal endothelial cell morphology after 6 months of wearing SH contact lenses. This is probably due to better oxygen permeability of the contact lens material, good compliance, and short wearing period.
    Matched MeSH terms: Prospective Studies
  5. Zreaqat M, Hassan R, Samsudin AR, Stas Y, Hanoun A
    J Contemp Dent Pract, 2021 Jul 01;22(7):850-853.
    PMID: 34615793
    AIM AND OBJECTIVE: The aim of this study was to determine the clinical utility of body mass index (BMI), tonsil size, and Mallampati scoring in predicting both the presence of and severity of pediatric obstructive sleep apnea (OSA).

    MATERIALS AND METHODS: This prospective cross-sectional study comprised 78 growing children in the age range of 11-14 years with polysomnography (PSG)-proven OSA and 86 non-OSA corresponding controls. BMI, tonsil size (Friedman grading scale), and Mallampati score were determined for both groups, and related differences were assessed with a t-test, while their independent association with OSA severity was tested with a regression analysis. Statistical significance was set at p <0.05.

    RESULTS: Male gender, BMI, tonsil size, and Mallampati score were significantly higher in the OSA group (p < 0.05). A significant correlation was recorded between the Mallampati score and OSA severity (p < 0.01), but not with BMI or tonsil size (p > 0.05). For every 1-point increase in the Mallampati scale, the apnea-hypopnea index (AHI) increased by more than five events per hour in the bivariate analysis and by more than three events per hour in the multivariate analysis.

    CONCLUSION: Male gender, increased BMI, high tonsil, and Mallampati scores were clinical indicators of the presence of OSA. However, only Mallampati scale had a significant association with OSA severity. Clinical diagnostic indicators should be established and encouraged especially in community-based studies.

    CLINICAL SIGNIFICANCE: Clinical diagnostic indicators are very useful in examining and screening children who are at risk of developing OSA as PSG is expensive and unsuitable for universal use in the pediatric population.

    Matched MeSH terms: Prospective Studies
  6. Bhoo-Pathy N, Subramaniam S, Khalil S, Kimman M, Kong YC, Ng CW, et al.
    JCO Oncol Pract, 2021 10;17(10):e1592-e1602.
    PMID: 34077232 DOI: 10.1200/OP.20.01052
    PURPOSE: To determine household spending patterns on complementary medicine following cancer and the financial impact in a setting with universal health coverage.

    METHODS: Country-specific data from a multinational prospective cohort study, Association of Southeast Asian Nations Costs in Oncology Study, comprising 1,249 cancer survivors were included. Household costs of complementary medicine (healthcare practices or products that are not considered as part of conventional medicine) throughout the first year after cancer diagnosis were measured using cost diaries. Study outcomes comprised (1) shares of household expenditures on complementary medicine from total out-of-pocket costs and health costs that were respectively incurred in relation to cancer, (2) incidence of financial catastrophe (out-of-pocket costs related to cancer ≥ 30% of annual household income), and (3) economic hardship (inability to pay for essential household items or services).

    RESULTS: One third of patients reported out-of-pocket household expenditures on complementary medicine in the immediate year after cancer diagnosis, accounting to 20% of the total out-of-pocket costs and 35% of the health costs. Risk of financial catastrophe was higher in households reporting out-of-pocket expenditures on complementary medicine (adjusted odds ratio: 1.39 [95% CI, 1.05 to 1.86]). Corresponding odds ratio within patients from low-income households showed that they were substantially more vulnerable: 2.28 (95% CI, 1.41 to 3.68). Expenditures on complementary medicine were, however, not associated with economic hardship in the immediate year after cancer diagnosis.

    CONCLUSION: In settings with universal health coverage, integration of subsidized evidence-based complementary medicine into mainstream cancer care may alleviate catastrophic expenditures. However, this must go hand in hand with interventions to reduce the use of nonevidence-based complementary therapies following cancer.

    Matched MeSH terms: Prospective Studies
  7. Kow CS, Ramachandram DS, Hasan SS
    Hypertens Res, 2022 02;45(2):360-363.
    PMID: 34754084 DOI: 10.1038/s41440-021-00786-z
    We aimed to perform a systematic review and meta-analysis to determine the overall effect of the preadmission/prediagnosis use of calcium channel blockers (CCBs) on the clinical outcomes in hypertensive patients with COVID-19. A systematic literature search with no language restriction was conducted in electronic databases in July 2021 to identify eligible studies. A random-effects model was used to estimate the pooled summary measure for outcomes of interest with the preadmission/prediagnosis use of CCBs relative to the nonuse of CCBs at 95% confidence intervals (CIs). The meta-analysis revealed a significant reduction in the odds of all-cause mortality with the preadmission/prediagnosis use of CCBs relative to the nonuse of CCBs (pooled OR = 0.65; 95% CI 0.49-0.86) and a significant reduction in the odds of severe illness with preadmission/prediagnosis use of CCBs relative to the nonuse of CCBs (pooled OR = 0.61; 95% CI 0.44-0.84), and is associated with adequate evidence to reject the model hypothesis of 'no significant difference' at the current sample size. The potential protective effects offered by CCBs in hypertensive patients with COVID-19 merit large-scale prospective investigations.
    Matched MeSH terms: Prospective Studies
  8. Tan GJ, Tan MP, Luben RN, Wareham NJ, Khaw KT, Myint PK
    Geriatr Gerontol Int, 2021 Aug;21(8):657-663.
    PMID: 34156750 DOI: 10.1111/ggi.14219
    AIM: To evaluate the relationship between habitual alcohol consumption and the risk of falls hospitalization.

    METHODS: The EPIC-Norfolk is a prospective population-based cohort study in Norfolk, UK. In total, 25 637 community dwelling adults aged 40-79 years were recruited. Units of alcohol consumed per week were measured using a validated Food Frequency Questionnaire. The main outcome was the first hospital admission following a fall.

    RESULTS: Over a median follow-up period of 11.5 years (299 211 total person years), the cumulative incidence function (95% confidence interval) of hospitalized falls at 121-180 months for non-users, light (>0 to ≤7 units/week), moderate (>7 to ≤28 units/week) and heavy (>28 units/week) were 11.08 (9.94-12.35), 7.53 (7.02-8.08), 5.91 (5.29-6.59) and 8.20 (6.35-10.56), respectively. Moderate alcohol consumption was independently associated with a reduced risk of falls hospitalization after adjustment for most major confounders (hazard ratio = 0.88; 95% confidence interval 0.79-0.99). The relationship between light alcohol consumption and falls hospitalization was attenuated by gender differences. Alcohol intake higher than the recommended threshold of 28 units/week was associated with an increased risk of falls hospitalization (hazard ratio 1.40 [1.14-1.73]).

    CONCLUSIONS: Moderate alcohol consumption appears to be associated with a reduced risk of falls hospitalization, and intake above the recommended limit is associated with an increased risk. This provides incentive to limit alcohol consumption within the recommended range and has important implications for public health policies for aging populations. Geriatr Gerontol Int 2021; 21: 657-663.

    Matched MeSH terms: Prospective Studies
  9. Jaber M, Al-Samarrai B, Salah A, Varma SR, Karobari MI, Marya A
    Biomed Res Int, 2022;2022:9422299.
    PMID: 35039794 DOI: 10.1155/2022/9422299
    Methods: The study includes all fifth-year dental students registered at the College of Dentistry, Ajman University, in 2019/2020. One hundred and seventy students were invited to complete personality and performance measures using the Big Five Inventory (BFI) scale; the weighted grade point average (GPA) was used to assess students' academic performance.

    Results: Of the 170 participants, 60% were female and 40% were male. Participants ranged in age from twenty-four to twenty-seven years, with an average age of twenty-four years. There was a relationship between personality scores obtained for the students and their subsequent academic performance. The broad conscientiousness, competence, achievement, and dutifulness predicted academic and clinical success. The prediction accuracy of conscientiousness was improved by the inclusion of dutifulness, self-discipline, and deliberation.

    Conclusion: This study confirms that the students' personality profile is a substantial predictor of academic performance and likely to help select future intakes of students, although a prospective study would be required for a definite answer to this question.

    Matched MeSH terms: Prospective Studies
  10. Rivan NFM, Singh DKA, Shahar S, Wen GJ, Rajab NF, Din NC, et al.
    BMC Geriatr, 2021 10 25;21(1):593.
    PMID: 34696720 DOI: 10.1186/s12877-021-02525-y
    BACKGROUND: Cognitive frailty, a combination of physical frailty and cognitive impairment, is associated with functional decline in older adults. However, there is limited information if cognitive frailty predicts the incidence of falls, injuries, and disability. In this study, we aimed to determine the ability of cognitive frailty in predicting the incidence of falls, injuries and disability among multi-ethnic older adults in Malaysia at 5 years follow-up.

    METHODS: In this prospective cohort study, a total of 400 participants aged 60 years and above were successfully followed up at 5 years. Participants' socio-demographic, medical history, psycho-social, physical, cognitive and dietary intake information was obtained. Cognitive frailty was defined as comorbid physical frailty (> 1 Fried criteria) and mild cognitive impairment (Petersen criteria). Univariate analysis was performed for all variables, followed by hierarchical binary logistic regression (BLR) analysis to identify the ability of CF in predicting the incidence of falls, injuries, and disability. The significant value was set at p 

    Matched MeSH terms: Prospective Studies
  11. Marcus M, Abdullah AA, Nor J, Tuan Kamauzaman TH, Pang NTP
    GMS J Med Educ, 2022;39(4):Doc45.
    PMID: 36310890 DOI: 10.3205/zma001566
    Introduction: Bystander cardiopulmonary resuscitation (CPR) training is inconsistent among students and the public. Existing CPR teaching courses are costly, time-consuming, and inconsistent. This study aimed to determine the association between overall CPR competency and two teaching modules, a group-directed video instruction module versus an instructor-led traditional classroom instruction module. Methods: This randomized prospective interventional study involved first year medical students of Universiti Sains Malaysia Health Campus from November 2018 until January 2019. Pass-fail scores representing the overall CPR, individual skill performance, and willingness to perform CPR for strangers and family members were collected. Factors associated with reluctance to perform CPR were assessed in a questionnaire. Results: A total of 99 participants were included, 50 in the group-directed video instruction as the intervention module and 49 in the traditional classroom instruction as the control module. There was no statistical significance between the pass and fail outcomes for both video module (p=0.436). Participants in both modules performed similarly in 8 out of 12 individual CPR skills. There was a significant difference in the distribution of skill scores between the pass and fail outcomes (p=<0.001). The intervention module is non-inferior compared to the control module, in relation to CPR willingness rates for strangers (p=0.999) and family members (p=0.117) after the training. Conclusions: The group-directed video self-instruction method is as effective as the instructor-led traditional classroom method to help participants to be competent and willing to perform CPR. It can be used as an independent or supplementary teaching tool for first-time learners and refreshers, especially in a group setting when teaching materials are limited.
    Matched MeSH terms: Prospective Studies
  12. Stilz I, Freire de Carvalho M, Toner S, Berg J
    J Occup Environ Med, 2022 Dec 01;64(12):1067-1072.
    PMID: 35993607 DOI: 10.1097/JOM.0000000000002684
    OBJECTIVES: This study examines whether the availability of telemedicine on offshore installations reduces medical evacuation rates.

    METHODS: This is a prospective cohort study on offshore platforms in the United States, Malaysia, and the United Kingdom. Emergency evacuation rates were compared between locations with telemedicine (United States) and 2 control groups without telemedicine (Malaysia, United Kingdom).

    RESULTS: Three hundred eighty-four cases in the telemedicine group and 261 cases in the control groups were included. The odds (adjusted and unadjusted) of medical evacuation were significantly higher for assets without telemedicine, contractors, and age older than 60 years. Analysis indicated a shift from emergency evacuation to routine transport for the telemedicine group.

    CONCLUSIONS: Telemedicine reduces emergency medical evacuations from offshore installations. This reduction is likely due to an increased capacity for transforming emergency care into routine care at the offshore location.

    Matched MeSH terms: Prospective Studies
  13. Xinyan Z, Mamun AA, Ali MH, Siyu L, Yang Q, Hayat N
    Front Public Health, 2022;10:1016065.
    PMID: 36388276 DOI: 10.3389/fpubh.2022.1016065
    The world is witnessing an increasing number of senior adult residents who experience health issues. Healthcare innovation facilitates monitoring the health conditions of senior adults and reducing the burden on healthcare institutions. The study explored the effect of health improvement expectancy, effort expectancy, price value, perceived vulnerability, health consciousness, and perceived reliability on the intention and adoption of medical wearable devices (MWD) among senior adults in China. Furthermore, a cross-sectional design was adopted, while quantitative data was collected from 304 senior adults through an online survey. A hybrid approach of partial least square structural equational modeling and artificial neural network-based analysis technique was adopted. The findings demonstrated that health improvement expectancy, perceived vulnerability, price value, and perceived reliability significantly affected the intention to adopt MWDs. Moreover, the intention to adopt MWDs significantly positively affected the actual adoption of MWDs among senior adults. Although the moderating effect of the pre-existing conditions and income between the intention to use MWDs and actual adoption of MWDs was positive, it was not statistically significant. The artificial neural network analysis has proven that perceived reliability, price value, and vulnerability are the most critical factors contributing to the intention to use MWDs. The current study offered valuable insights into the factors affecting the intention and adoption of MWDs among senior adults. Following that, theoretical and practical contributions were documented to improve the ease of use and price value for the prospective users of MWDs. The correct healthcare policies could curtail the influx of senior adults into the hospital and empower these adults to track and manage their health issues at home.
    Matched MeSH terms: Prospective Studies
  14. Yap LB, Choy CN, Navin S, Koh KW, Jeyamalar R, Balachandran K
    Med J Malaysia, 2023 Jan;78(1):7-13.
    PMID: 36715184
    INTRODUCTION: Coronary artery calcification can lead to suboptimal results when performing coronary angioplasty with conventional techniques. The presence of severe coronary artery calcium increases the complications of percutaneous coronary intervention as it may impede stent delivery and optimal stent expansion. The purpose of this study was to determine the procedural success and safety of orbital atherectomy (OA) in calcified lesions.

    MATERIALS AND METHODS: This was a prospective single-centre study regarding the utility of OA in the treatment of calcified coronaries. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was used in all cases to characterise the severity of calcium pre-procedure, guide vessel sizing and assess procedural success. The primary endpoint was procedural success, defined by successful stent implantation following OA treatment. The secondary endpoint was in-hospital and 30-day major adverse cardiovascular event (MACE).

    RESULTS: Ten patients with severely calcified lesions were successfully treated with OA. The primary endpoint was achieved in all patients. All of the lesions were severely calcified with concentric calcium. None of the patients suffered in-hospital or 30-day MACE. The average minimal luminal diameter at baseline was 1.7 ± 0.3 mm and the post- PCI luminal diameter was 3.0 ± 0.3 mm, with a significant luminal gain of 1.3 ± 0.3 mm (p < 0.01). Slow flow during procedure occurred in 2 (20%) cases and dissection occurred in 1 (10%) case during procedure. These were successfully treated with stent delivery to achieve TIMI III flow. There were no cases of stent thrombosis or vessel perforation.

    CONCLUSION: Our experience demonstrates the feasibility and safety of OA in the management of calcified coronary stenosis. Intravascular imaging is an important adjunct to the use of OA to assess the severity of calcified coronary lesions, success of OA treatment and to aid sizing of the vessel for stent implantation. OA is an effective treatment approach to disrupt coronary calcification, facilitating stent implantation with optimal results. It is a safe procedure with good success rate and low rate of complications.

    Matched MeSH terms: Prospective Studies
  15. Salway R, Su TT, Ismail R, Glynis Armstrong ME, Foster C, Johnson L
    J Glob Health, 2021;11:05029.
    PMID: 35003716 DOI: 10.7189/jogh.11.05029
    BACKGROUND: The COVID-19 pandemic prompted movement restrictions in countries worldwide, impacting on physical activity (PA), a major non-communicable disease risk factor, and thus may have unintentional long-term health implications. In semi-rural areas of low-middle-income-countries (LMICs), where occupational activity is the main source of PA, changes in PA associated with COVID-19 restrictions are unknown. We investigated the impact of Movement Control Order (MCO) restrictions in a semi-rural region of Malaysia.

    METHODS: The South East Asia Community Observatory (SEACO) is a dynamic prospective community cohort. We contacted a random sample of 1007 adults (18+) who had previously provided PA data in 2018. We asked about PA during the MCO (March-May 2020) and at the time of interview (June 2020).

    RESULTS: During the MCO, PA reduced by a mean of 6.7 hours/week (95% confidence interval (CI) = 5.3, 8.0) compared to 2018, with the largest reductions among those in employment. By June, PA was 3.4 hours/week (95% CI = 2.0, 4.8) less than 2018, leaving 34% of adults currently inactive (20% in 2018). Reductions in occupational PA were not replaced with active travel or activity at home. Despite these observed reductions, most participants did not think the MCO had affected their PA.

    CONCLUSIONS: Movement restrictions are associated with lower PA lasting beyond the period of strict restrictions; such longer-term reductions in PA may have a detrimental impact on health. Future MCOs should encourage people to be active, but may additionally need targeted messaging for those who don't necessarily realise they are at risk. In particular, policies developed in more affluent countries may not easily translate to LMICs.

    Matched MeSH terms: Prospective Studies
  16. Ahn JM, Kang DY, Yun SC, Ho Hur S, Park HJ, Tresukosol D, et al.
    Circulation, 2022 Nov 22;146(21):1581-1590.
    PMID: 36121700 DOI: 10.1161/CIRCULATIONAHA.122.062188
    BACKGROUND: Long-term comparative outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stents and coronary artery bypass grafting (CABG) are limited in patients with multivessel coronary artery disease.

    METHODS: This prospective, multicenter, randomized controlled trial was conducted in 27 international heart centers and was designed to randomly assign 1776 patients with angiographic multivessel coronary artery disease to receive PCI with everolimus-eluting stents or CABG. After inclusion of 880 patients (438 in the PCI group and 442 in the CABG group) between July 2008 and September 2013, the study was terminated early because of slow enrollment. The primary end point was the composite of death from any cause, myocardial infarction, or target vessel revascularization.

    RESULTS: During a median follow-up of 11.8 years (interquartile range, 10.6-12.5 years; maximum, 13.7 years), the primary end point occurred in 151 patients (34.5%) in the PCI group and 134 patients (30.3%) in the CABG group (hazard ratio [HR], 1.18 [95% CI, 0.88-1.56]; P=0.26). No significant differences were seen in the occurrence of a safety composite of death, myocardial infarction, or stroke between groups (28.8% and 27.1%; HR, 1.07 [95% CI, 0.75-1.53]; P=0.70), as well as the occurrence of death from any cause (20.5% and 19.9%; HR, 1.04 [95% CI, 0.65-1.67]; P=0.86). However, spontaneous myocardial infarction (7.1% and 3.8%; HR, 1.86 [95% CI, 1.06-3.27]; P=0.031) and any repeat revascularization (22.6% and 12.7%; HR, 1.92 [95% CI, 1.58-2.32]; P<0.001) were more frequent after PCI than after CABG.

    CONCLUSIONS: In patients with multivessel coronary artery disease, there were no significant differences between PCI and CABG in the incidence of major adverse cardiac events, the safety composite end point, and all-cause mortality during the extended follow-up.

    REGISTRATION: URL: https://www.

    CLINICALTRIALS: gov; Unique identifiers: NCT05125367 and NCT00997828.

    Matched MeSH terms: Prospective Studies
  17. Doets AY, Lingsma HF, Walgaard C, Islam B, Papri N, Davidson A, et al.
    Neurology, 2022 Feb 01;98(5):e518-e532.
    PMID: 34937789 DOI: 10.1212/WNL.0000000000013139
    BACKGROUND AND OBJECTIVES: The clinical course and outcome of the Guillain-Barré syndrome (GBS) are diverse and vary among regions. The modified Erasmus GBS Outcome Score (mEGOS), developed with data from Dutch patients, is a clinical model that predicts the risk of walking inability in patients with GBS. The study objective was to validate the mEGOS in the International GBS Outcome Study (IGOS) cohort and to improve its performance and region specificity.

    METHODS: We used prospective data from the first 1,500 patients included in IGOS, aged ≥6 years and unable to walk independently. We evaluated whether the mEGOS at entry and week 1 could predict the inability to walk unaided at 4 and 26 weeks in the full cohort and in regional subgroups, using 2 measures for model performance: (1) discrimination: area under the receiver operating characteristic curve (AUC) and (2) calibration: observed vs predicted probability of being unable to walk independently. To improve the model predictions, we recalibrated the model containing the overall mEGOS score, without changing the individual predictive factors. Finally, we assessed the predictive ability of the individual factors.

    RESULTS: For validation of mEGOS at entry, 809 patients were eligible (Europe/North America [n = 677], Asia [n = 76], other [n = 56]), and 671 for validation of mEGOS at week 1 (Europe/North America [n = 563], Asia [n = 65], other [n = 43]). AUC values were >0.7 in all regional subgroups. In the Europe/North America subgroup, observed outcomes were worse than predicted; in Asia, observed outcomes were better than predicted. Recalibration improved model accuracy and enabled the development of a region-specific version for Europe/North America (mEGOS-Eu/NA). Similar to the original mEGOS, severe limb weakness and higher age were the predominant predictors of poor outcome in the IGOS cohort.

    DISCUSSION: mEGOS is a validated tool to predict the inability to walk unaided at 4 and 26 weeks in patients with GBS, also in countries outside the Netherlands. We developed a region-specific version of mEGOS for patients from Europe/North America.

    CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that the mEGOS accurately predicts the inability to walk unaided at 4 and 26 weeks in patients with GBS.

    TRIAL REGISTRATION INFORMATION: NCT01582763.

    Matched MeSH terms: Prospective Studies
  18. Zawiah M, Hayat Khan A, Abu Farha R, Usman A, Bitar AN
    Curr Med Res Opin, 2023 Mar;39(3):475-482.
    PMID: 36710633 DOI: 10.1080/03007995.2023.2174327
    BACKGROUND: Predicting stroke-associated pneumonia (SAP) is crucial for intensifying preventive measures and decreasing morbidity and mortality. This meta-analysis aims to evaluate the association between baseline neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) with SAP and to determine the strength of the association.

    METHODS: The Web of Science, SCOPUS, and PUBMED databases were searched to find eligible studies. The standardized mean difference (SMD) and 95% confidence interval (CI) were used to evaluate the differences in NLR, MLR, and PLR levels between SAP and non-SAP patients. The meta-analysis was conducted using the software "Review Manager" (RevMan, version 5.4.1, September 2020). The random-effect model was used for the pooling analysis if there was substantial heterogeneity. Otherwise, the fixed-effect model was adopted.

    RESULTS: Twelve studies comprising 6302 stroke patients were included. The pooled analyses revealed that patients with SAP had significantly higher levels of NLR, MLR, and PLR than the non-SAP group. The SMD, 95% CI, p-value, and I2 for them were respectively reported as (0.88, 0.70-1.07, .00001, 77%); (0.94, 0.43-1.46, .0003, 93%); and (0.61, 0.47-0.75, .001, 0%). Subgroup analysis of NLR studies showed no significant differences in the effect size index between the severity of the stroke, the sample size, and the period between the stroke onset and the blood sampling.

    CONCLUSION: This systematic review and meta-analysis suggest that an elevated NLR, MLR, and PLR were associated with SAP, indicating that they could be promising blood-based biomarkers for predicting SAP. Large-scale prospective studies from various ethnicities are recommended to validate this association before they can be applied in clinical practice.

    Matched MeSH terms: Prospective Studies
  19. Shastry S, Mohan G, Pa P, Mundkur S, Kurien A, Ahammad J
    Transfus Apher Sci, 2023 Apr;62(2):103583.
    PMID: 36344327 DOI: 10.1016/j.transci.2022.103583
    BACKGROUND: Thromboembolic events are rare but one of the fatal complications in thalassemia. Assessment of the hypercoagulable state is not done regularly, and we have assessed the utility of Thromboelastography (TEG) for monitoring the activation of the coagulation pathway in patients with thalassemia.

    METHODOLOGY: A prospective single-center cohort study was conducted in a tertiary care set-up. Transfusion Dependent Thalassemia patients registered with the pediatric unit were screened for hypercoagulability using TEG during six months of the study period and followed up for three years for the development of thromboembolic events. Patient demographics, history of splenectomy, Serum ferritin levels and annual red cell transfusion requirement (mL/kg/year) were assessed. TEG parameters used were R time, K time, alpha angle, Maximum amplitude, Clot index, and Lysis 30. The thrombin generation test (V Curve) obtained from the first-degree derivate of the TEG velocity curve was also used for analysis.

    RESULTS: A total of 34 patients were recruited during the six months study period with an average age of 10.6 years ( ± 5.47). The average pre-transfusion hemoglobin level and the volume of packed red cells received were 7.24 g/dL and 152.82 mL/kg/year respectively. The TEG tracing was suggestive of a hypercoagulable state in 58.82% of patients. The mean values of angle (70.74), MA (64.16), CI (2.65) and TG (774.43) in TDT patients compared to age matched reference range (62.81, 57.99, 0.8, 577.83 respectively) was suggestive of prothrombotic changes. Annual blood transfusion requirement was negatively correlated with hypercoagulable status (-0.344, CI= -0.68 to 0.08). One out of 34 patients developed corona radiata infarct (with annual blood requirement; 112.7 mL/kg/Year). The risk to develop a hypercoagulable state appeared to be higher when the volume of RBCs transfused was less than 154 mL/kg/Year.

    CONCLUSION: TDT patients are at risk of developing thromboembolism, and screening with TEG may be useful to identify those at high risk.

    Matched MeSH terms: Prospective Studies
  20. Saniasiaya J, Kulasegarah J
    Braz J Otorhinolaryngol, 2023;89(2):329-338.
    PMID: 35659765 DOI: 10.1016/j.bjorl.2022.05.002
    OBJECTIVE: Airway reflux, a member of extra-esophageal reflux, has been linked to countless respiratory pathologies amongst children. The advent of novel instrumentation has enabled the discovery of non-acid reflux which was postulated as the main culprit of airway reflux. The objective of this review is to outline the association between non-acid reflux and airway reflux in children.

    METHODS: A comprehensive review of recent literature on non-acid reflux and airway reflux in children was conducted. Studies ranged from January 2010 till November 2021 were searched over a period of a month: December 2021.

    RESULTS: A total of eleven studies were identified. All studies included in this review revealed a strong link between non-acid reflux and airway reflux in children. 6 of the included studies are prospective studies, 3 retrospective studies, 1 cross-section study, and type of study was not mentioned in 1 study. The most common reported respiratory manifestation of non-acid reflux in children was chronic cough (7 studies). Predominant non-acid reflux was noted in 4 studies. The total number of children in each study ranges from 21 to 150 patients. MII-pH study was carried out in all studies included as a diagnostic tool for reflux investigation.

    CONCLUSION: Non-acid reflux is the culprit behind airway reflux as well as other myriads of extra-esophageal manifestations in children. Multicentre international studies with a standardized protocol could improve scientific knowledge in managing non-acid reflux in airway reflux amongst children.

    Matched MeSH terms: Prospective Studies
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