METHODS: We searched databases Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Google Scholar up to January 2021 and identified randomised controlled trials comparing ketorolac to any other medications in treating patients presenting with migraine headache.
RESULTS: Thirteen trials were included in our review, comprising of 944 participants. We derived seven comparisons; ketorolac versus phenothiazines, metoclopramide, sumatriptan, dexamethasone, sodium valproate, caffeine, and diclofenac. There were no significant differences in the reduction of pain intensity at 1-hour under the comparisons between ketorolac and phenothiazines (standard mean difference (SMD) 0.09, P 0.74), or metoclopramide (SMD 0.02, P 0.95). We also found no difference in the outcome recurrence of headache [ketorolac vs phenothiazines (risk ratio (RR) 0.98, P 0.97)], ability to return to work or usual activity [ketorolac vs metoclopramide (RR 0.64, P 0.13)], need for rescue medication [ketorolac vs phenothiazines (RR 1.72, P 0.27), ketorolac vs metoclopramide (RR 2.20, P 0.18)], and frequency of adverse effects [ketorolac vs metoclopramide (RR 1.07, P 0.82)]. Limited trials suggested that ketorolac offered better pain relief at 1-hour compared to sumatriptan and dexamethasone, had lesser frequency of adverse effects than phenothiazines, and was superior to sodium valproate in terms of reduction of pain intensity at 1-hour, need for rescue medication and sustained headache freedom within 24-hour.
CONCLUSIONS: Ketorolac may have similar efficacy to phenothiazines and metoclopramide in treating acute migraine headache. Ketorolac may also offer better pain control than sumatriptan, dexamethasone and sodium valproate. However, given the lack of evidence due to inadequate number of trials available, future studies are warranted.
METHODS: PCOS was induced in rats except for normal control by administering LTZ at 1 mg/kg/day for 21 days. Methanolic extract of F. deltoidea leaf was then orally administered to the PCOS rats at the dose of 250, 500, or 1000 mg/kg/day, respectively for 15 consecutive days. Lipid profile was measured enzymatically in serum. The circulating concentrations of reproductive hormone and antioxidant enzymes were determined by ELISA assays. Ovarian and uterus histomorphometric changes were further observed by hematoxylin and eosin (H&E) staining.
RESULTS: The results showed that treatment with F. deltoidea at the dose of 500 and 1000 mg/kg/day reduced insulin resistance, obesity indices, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL), malondialdehyde (MDA), testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) to near-normal levels in PCOS rats. The levels of high-density lipoprotein cholesterol (HDL), estrogen, and superoxide dismutase (SOD) are also similar to those observed in normal control rats. Histomorphometric measurements confirmed that F. deltoidea increased the corpus luteum number and the endometrial thickness.
CONCLUSIONS: F. deltoidea can reverse PCOS symptoms in female rats by improving insulin sensitivity, antioxidant activities, hormonal imbalance, and histological changes. These findings suggest the potential use of F. deltoidea as an adjuvant agent in the treatment program of PCOS.
Context: The survey is nationally representative and community based and is conducted by the Institute for Public Health, part of the National Institutes of Health, to generate health-related evidence and to support the Malaysian Ministry of Health in policy-making. Its planned scope for 2020 was the seroprevalence of communicable diseases such as hepatitis B and C.
Action: Additional components were added to the survey to increase its usefulness, including COVID-19 seroprevalence and facial anthropometric studies to ensure respirator fit. The survey's scale was reduced, and data collection was changed from including only face-to-face interviews to mainly self-administered and telephone interviews. The transmission risk to participants was reduced by screening data collectors before the survey and fortnightly thereafter, using standard droplet and contact precautions, ensuring proper training and monitoring of data collectors, and implementing other administrative infection prevention measures.
Outcome: Data were collected from 7 August to 11 October 2020, with 5957 participants recruited. Only 4 out of 12 components of the survey were conducted via face-to-face interview. No COVID-19 cases were reported among data collectors and participants. All participants were given their hepatitis and COVID-19 laboratory test results; 73 participants with hepatitis B and 14 with hepatitis C who had been previously undiagnosed were referred for further case management.
Discussion: Preparing and conducting the National Health and Morbidity Survey during the COVID-19 pandemic required careful consideration of the risks and benefits, multiple infection prevention measures, strong leadership and strong stakeholder support to ensure there were no adverse events.
MATERIALS AND METHODS: A MATLAB platform was used to develop software of algorithms based on image segmentation techniques to automate the calculation of patient size and SSDE. The algorithm was used to automatically estimate the individual size and SSDE of four CT dose index phantoms and 80 CT images of pediatric patients comprising head, thorax, and abdomen scans. For validation, the American Association of Physicists in Medicine (AAPM) manual methods were used to determine the patient's size and SSDE for the same subjects. The accuracy of the proposed algorithm in size and SSDE calculation was evaluated for agreement with the AAPM's estimations (manual) using Bland-Altman's agreement and Pearson's correlation coefficient. The normalized error, system bias, and limits of agreement (LOA) between methods were derived.
RESULTS: The results demonstrated good agreement and accuracy between the automated and AAPM's patient size estimations with an error rate of 1.9% and 0.27% on the patient and phantoms study, respectively. A 1% percentage difference was found between the automated and manual (AAPM) SSDE estimates. A strong degree of correlation was seen with a narrow LOA between methods for clinical study (r > 0.9771) and phantom study (r > 0.9999).
CONCLUSION: The proposed automated algorithm provides an accurate estimation of patient size and SSDE with negligible error after validation.
OBJECTIVE: This study aims to develop and refine items of a quantitative instrument measuring the critical success factors influencing acceptance of Casemix system implementation within the Ministry of Health's Total Hospital Information System (THIS).
METHODS: A cross-sectional pilot study collected data from medical doctors at a hospital equipped with the THIS in the federal territory of Putrajaya, Malaysia. This pilot study's minimum sample size was 125, achieved through proportionate stratified random sampling. Data were collected using a web-based questionnaire adapted from the human, organization, and technology-fit evaluation framework and the technology acceptance model. The pilot data were analyzed using exploratory factor analysis (EFA), and the Cronbach α assessed internal reliability. Both analyses were conducted in SPSS (version 25.0; IBM Corp).
RESULTS: This study obtained 106 valid responses, equivalent to an 84.8% (106/125) response rate. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.859, and the Bartlett test of sphericity yielded statistically significant results (P0.6, leading to the removal of 1 item for the final instrument for the field study. EFA ultimately identified 8 main constructs influencing Casemix implementation within the THIS: system quality, information quality, service quality, organizational characteristics, perceived ease of use, perceived usefulness, intention to use, and acceptance. Internal reliability measured using the Cronbach α ranged from 0.914 to 0.969, demonstrating high reliability.
CONCLUSIONS: This study provides insights into the complexities of EFA and the distinct dimensions underlying the constructs that influence Casemix system acceptance in the THIS. While the findings align with extensive technology acceptance literature, the results accentuate the necessity for further research to develop a consensus regarding the most critical factors for successful Casemix adoption. The developed instrument is a substantial step toward better understanding the multidimensional challenges of health care system transformations in Malaysia, postulating an underpinning for future fieldwork and broader application across other hospitals.
OBJECTIVE: This study aims to evaluate the performance of Putralytica and Qure.ai software for CXR screening and PTB diagnosis among the Malaysian population.
METHODS: We will conduct a retrospective case-control study at the Respiratory Medicine Institute, National Cancer Institute, and Sungai Buloh Health Clinic. A total of 1500 CXR images of patients who completed treatments or check-ups will be selected and categorized into three groups: (1) abnormal PTB cases, (2) abnormal non-PTB cases, and (3) normal cases. These CXR images, along with their clinical findings, will be the reference standard in this study. All patient data, including sociodemographic characteristics and clinical history, will be collected prior to screening via Putralytica and Qure.ai software and readers' interpretation, which are the index tests for this study. Interpretation from all 3 index tests will be compared with the reference standard, and significant statistical analysis will be computed.
RESULTS: Data collection is expected to commence in August 2023. It is anticipated that 1 year will be needed to conduct the study.
CONCLUSIONS: This study will measure the accuracy of Putralytica and Qure.ai software and whether their findings will concur with readers' interpretation and the reference standard, thus providing evidence toward the effectiveness of implementing AI in the medical setting.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/36121.
METHODS: A total of 51 M. tuberculosis acid fast bacilli (AFB) smear-positive sputum specimens were inoculated directly into drug-free and serial dilutions of drug-containing Middlebrook 7H9 broth media. With this direct resazurin micro plate assay (REMA) method, resazurin dye was used as a growth indicator in microplate wells. The minimum inhibitory concentrations (MIC) of isoniazid (INH) and rifampicin (RIF) were compared with those of the 'gold standard' absolute concentration method (ACM). The turnaround time (TAT) of the direct REMA and the ACM were also determined.
RESULTS: At the selected cut-off points (INH: 0.0625 μg/mL; RIF: 0.125 μg/mL), good drug susceptibility test results were obtained for INH and RIF with an average sensitivity, specificity and accuracy of 90%, 100% and 97%, respectively, with a TAT of 15 days. The REMA method also correctly classified the resistant isolates with positive predictive values of 95% and negative predictive values of 98% for the two drugs.
CONCLUSIONS: The direct REMA was reliable in routine diagnostic laboratories for the drug susceptibility testing of M. tuberculosis and the rapid detection of multi-drug-resistant tuberculosis.
METHODS: This study utilised data from the 2016 National Health and Morbidity Survey (NHMS). Multiple logistic regression was used to determine the factors associated with malnutrition among non-stunted and stunted children.
RESULTS: The proportion of stunting among children below 5 years old in this East Coast region was 26.2%. When divided by state, Kelantan had the highest proportion of stunting, followed by Pahang and Terengganu, at 28.8%, 26.2% and 23.4%, respectively. In this study, the factors associated with stunting were children aged 24 months old-59 months old (adjusted odds ratio [aOR]: 1.52; 95% CI: 1.26, 1.83; P < 0.001), male children (aOR: 1.47; 95% CI: 1.23, 1.76; P < 0.001), Orang Asli children (aOR: 2.84; 95% CI: 1.86, 4.32; P < 0.001), children with low birth weight from 1,500 g to 2,499 g (aOR: 1.86; 95% CI: 1.36, 2.55; P < 0.001) and children from households that practice unsanitary waste disposal (aOR: 1.42; 95% CI: 1.16, 1.74; P = 0.001).
CONCLUSION: Stunting among children under the age of 5 years old on the East Coast of Peninsular Malaysia remains a public health problem. To reduce the prevalence of stunting in this region, intervention programmes should be intensified. Emphasis should be placed on public health programmes that target the associated factors, such as dietary habits, Orang Asli children, low birth weight and unsanitary waste disposal.