METHODS: A literature search was conducted on MEDLINE, Embase, and PubMed using the search terms "trachea AND adenoid cystic carcinoma AND (surgery OR resection)" and articles from 2000 to August 2021 were identified. A total of 29 journal articles were included in the review.
RESULTS: A total of 403 patients underwent surgery for tracheal ACCs. The mean age was 48.1 years and 54.7% were female. The commonest anatomical location was the lower trachea (46.9%). The mean time from symptom onset to diagnosis was 16.6 months with the commonest symptom being dyspnoea (52%). Fifty-eight percent of the patients had intraluminal growth. Tracheal resection (46.2%) and access via thoracotomy (41.4%) were the commonest procedures described. The mean length of trachea resected was 39.2 mm and the mean tumour size was 31.5 mm. 16.8% of lymph nodes were involved and 73.8% of cases had positive resection margins. The overall complication rate was 1.4-5.4% and the in-hospital mortality rate was 9.8%. The overall survival reported was 61.7% at 5 years and 54.6% at 10 years.
CONCLUSION: Surgical resection followed by adjuvant radiotherapy is the mainstay in the treatment of tracheal ACC, notwithstanding the high rates of involved margins. Achieving tension-free anastomosis should be the first priority given the favourable response of adjuvant therapies in reducing recurrence rate and improving overall survival.
METHODS: Relevant articles were identified from databases (PubMed, Google Scholar, and Science Direct) using keywords related to honey, hydrogel, and polymers. Relevant data from selected studies were synthesized narratively and reported following a structured narrative format.
RESULTS: The importance of honey's roles and mechanisms of action in wound dressings were discussed. Notable studies concerning honey hydrogels with diverse polymers were also included in this article to provide a better perspective on fabricating customized hydrogel wound dressings for various types of wounds in the future.
CONCLUSION: Honey's incapability to stand alone in hydrogel requires the incorporation of natural and synthetic polymers into the hydrogel. With this review, it is hoped that the fabrication and commercialization of the desired honey composite hydrogel for wound treatment could be brought forth.
METHODS: This cross-sectional study was conducted across higher educational institutions in Peninsular Malaysia. Convenience sampling was applied to recruit full-time university students. A reliable and validated instrument was used to evaluate demographic data, migraine symptoms, triggers, coping strategies and clinical characteristics of migraine (frequency, intensity, severity and duration) during COVID-19 diagnosis.
RESULTS: The response rate was 98.3%, where 485 out of 493 responses were analysed. The prevalence of migraine was 35.9% (n=174). None of the triggers, coping strategies and clinical characteristics of migraine were significantly associated with COVID-19 diagnosis.
CONCLUSION: The university students in Peninsular Malaysia showed a considerable prevalence of migraine symptoms. During the pandemic, the common triggers for existing symptoms were stress and a lack of sleep (combined triggers). The coping strategy adopted by most of the university students was lifestyle changes and in the COVID-19 positive group maladaptive coping strategies were adopted indicating the need for further investigation.
METHODS: A cost-utility analysis was performed using a validated Markov model, which modelled a cohort of adult patients through health states related to symptom severity and functional impairment, to estimate costs and quality-adjusted life-years (QALYs). The influence of model inputs and assumptions, sensitivity, scenario, and subgroup analyses were explored. All costs were expressed in 2022 Malaysian ringgits (RM). Costs and QALYs were discounted at an annual rate of 3.0% as per local pharmacoeconomic guideline.
RESULTS: The base-case incremental cost-effectiveness ratio (ICER) for HF patients with EF>40% was RM 40,454 per QALY gained. At a cost-effectiveness threshold of RM 47,439/QALY gained, empagliflozin was cost-effective in 57% of replications. The model outcomes were sensitive to inputs related to the treatment effect of empagliflozin in reducing HF-related hospitalisation and cardiovascular mortality, and empagliflozin cost. For the overall HF population, the ICER was RM 29,463/QALY gained.
CONCLUSION: The findings suggest that empagliflozin is a cost-effective treatment option for the Malaysian HF population, including those with EF>40%. As such, the intervention warrants consideration by the Malaysian healthcare provider to mitigate the burden of HF and address the unmet needs of the EF>40% population.
AIM: This study investigates how perceived stress (PS) impacts the QoL of Malaysian academicians during the COVID-19 pandemic, focusing on the mediating role of WLB.
SETTING: Academics working in Malaysia during COVID-19 pandemic.
METHODS: A cross-sectional study, using a voluntary response sampling method, was conducted among 417 academicians from universities in Malaysia in September 2021. A self-reported online questionnaire, measuring PS, WLB and QoL, was distributed.
RESULTS: The QoL scored a mean of 50 (standard deviation [s.d.] = 9.84), PS scored a mean of 24.26 (s.d. = 8.19) and WLB had a mean score of 51.12 (s.d. = 18.73). Work-life balance was a significant mediator of PS and QoL (β = -0.43, 95% confidence interval [CI] = -0.52 to -0.35, p = 0.0001). Perceived stress was a significant predictor of WLB (β = 1.62, p = 0.0001).
CONCLUSION: Institutions should consider implementing flexible working arrangements, and providing workshops on crisis management, time management, and resilience. Stress coping methods are recommended for enhancing WLB among academicians.
CONTRIBUTION: This study contributes to the pool of evidence to support intervention strategies and policy recommendations aimed to enhance well-being.
METHODS: A Microsoft Excel-based cost calculator was developed for such comparison. The estimated size of eligible population, uptake rates for dapagliflozin, as well as costs related to drugs, clinical events, and adverse events were based on published data, official tariffs, and databases, and expert opinion. Clinical data from the DAPA-HF trial were used to inform efficacy and safety inputs (i.e., hospitalization for heart failure (hHF), cardiovascular death, and adverse events). Results were reported as total annual and cumulative costs (in 2023 Malaysian Ringgits [RM], United States Dollars [USD], and European Union Euros, [EUR]; with exchange rates of 1 USD = RM 4.40 and 1 EUR = RM 4.90]), as well as the number of clinical events. Sensitivity and scenario analyses were also conducted.
FINDINGS: The base-case analysis estimated that over a five-year period, the adoption of dapagliflozin for HFrEF treatment would result in a cumulative cost-saving of RM 2.6 million (USD 0.6 million/EUR 0.5 million), representing a 0.3% reduction in costs, driven primarily by reduced expenditure on hHF. Moreover, dapagliflozin treatment would lead to 731 fewer hHF and 366 fewer cardiovascular deaths. Sensitivity and scenario analyses revealed that the results were most sensitive to assumptions regarding loop diuretic requirements and the cost of dapagliflozin. Although cost savings or a net-zero balance were projected for the first four years, an anticipated 2.5% annual increase in dapagliflozin uptake in the longer term would lead to additional costs for the MOH, starting from the fifth year.
IMPLICATIONS: Incorporating dapagliflozin into the SoC can improve health outcomes for HFrEF patients and may generate cost savings, potentially easing the economic strain of HFrEF management on Malaysia's public healthcare system in the short term. Nonetheless, a modest increase in budget should be anticipated as more patients gain access to the treatment over time.
METHODS: A cross-sectional study was conducted in four universities. A self-administered questionnaire was developed and validated. During clinical examination, acne severity was determined using the Comprehensive Acne Severity Scale (CASS) and psychosocial impact using the Cardiff Acne Disability Index (CADI).
RESULTS: Four hundred students with acne aged 20±1.62 years participated, among whom 62.5% were women. The self-perceived acne severity matched the CASS score in 54.4% of the participants but was worse in 37.5%. Approximately 80.5% correctly recognised acne as a disease, while beliefs about its chronicity varied. The aggravating factors were food (92.8%), genetic predisposition (92.8%), stress (91.3%), hygiene (86.3%) and menstruation (84.8%). The information sources were families (79.7%), online social media platforms (60.2%) and friends (58.5%). Doctor consultation was significantly associated with correct disease perception, severe disease and higher psychosocial impact. Cost was the commonest deterrent for seeking (63.8%) and discontinuing treatment (43.2%). The psychosocial impact was predominantly mild (71%). The CADI domains mostly affected were feelings and psychological state. The clinical (odd ratio [OR] =2.29, 95% confidence interval [CI] = 1.45, 3.61) and self-perceived acne severity (OR=4.83, 95% CI=2.79, 8.35) predicted a higher psychosocial impact.
CONCLUSION: Misconceptions about acne as a disease were not prevalent, and aggravating factors other than food were correctly identified. Common information sources may further perpetuate misconceptions. Financial treatment barriers should be addressed especially in patients with severe acne and psychosocial impacts.