Medical Journal of Malaysia最新文献

{"title":"Pulmonary tuberculosis diagnostic test using fluorescence immunoassay-based interferon gamma release assay with IchromaTM IGRA-TB.","authors":"B Bermawi, D W Kurniasari, A Imaniar, N Hidayatih, D A Lisnawati, I F Rofananda, P Prihatini","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organisms causing community-acquired bloodstream infection in medical department: A single centre retrospective observational study.","authors":"R Suganthini, T Suvintheran, Z A Nor Zanariah","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse event following immunisation of adsorbed-inactivated Coronavac (Sinovac) and ChAdOx1 nCOV-19 (Astra Zeneca) of COVID-19 vaccines.","authors":"A Simatupang, Y R M B Sitompul, B Simanungkalit, K Kurniyanto, L N Achmad, F Sitompul, S M Mahmud, E Suarthana","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Countries around the world organised mass vaccinations using various types of vaccines against COVID-19, like inactivated viruses and mRNA. The study aimed to look at adverse events following immunisation (AEFI) of Coronavac® (SIN) and ChAdOx1 nCOV-19 ® (AZ) COVID-19 vaccines in Indonesia.</p><p><strong>Materials and methods: </strong>Subjects who received SIN or AZ vaccines were sent questionnaires twice: after they received the first and the second doses of vaccine, respectively. AEFI data on the first- and second-day post-vaccination were collected and analyzed descriptively.</p><p><strong>Results: </strong>A total of 1547 people vaccinated with SIN vaccine, 529 (33.3%) responded to the first-dose and 239 (47%) to the second-dose questionnaires, whereas 936 people vaccinated with AZ vaccine, 483 (51.6%) answered the firstdose and 123 (25%) to the second-dose questionnaires. Some important AEFIs on the first- and second-day post receiving SIN vs. AZ vaccination were as follows: fever 4% vs 59%; pain at the injection site 27% vs 87%; redness and swelling at the injection site 4% vs 18%; nausea 5% vs 30%; diarrhea 1.8% vs 5.7%, respectively.</p><p><strong>Conclusion: </strong>SIN seemed to have fewer AEFIs than AZ. Apart from different vaccine materials and excipients, the gap in AEFIs between SIN and AZ could be caused by the distinct population where AZ recipients were more exposed to COVID-19.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world efficacy and safety of intravenous ferric carboxymaltose for the management of iron deficiency anaemia in Malaysia: A single centre cohort study.","authors":"H N B Kamarul","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Up to 24.2% Malaysians are estimated to be affected by anaemia. Iron deficiency is the most common nutritional deficiency leading to anaemia. Oral iron therapy may not be well tolerated or efficient. Ferric carboxymaltose (FCM), a non-dextran intravenous iron formulation, may be an appealing alternative for iron replacement therapy. This retrospective study aimed to investigate the efficacy and safety of intravenous FCM infusion for the management of iron deficiency anaemia in a single centre in Malaysia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;All patients who received at least one dose of 500 mg intravenous FCM infusion from January to December 2023 in Bukit Tinggi Medical Centre (BTMC) were identified from the electronic medical record database. Inclusion criteria were patients: (1) ≥ 14 years old and (2) with iron deficiency anaemia. The primary outcome was the mean change in haemoglobin level before treatment and 30 day after treatment. Secondary outcomes included reasons for intravenous FCM infusion, median dose, adverse drug reactions, mean change in haemoglobin levels for different subgroups and percentage of patients with normalised haemoglobin after treatment. The efficacy outcome was analysed using per-protocol analysis while the safety outcome used intention-to-treat analysis. Paired t-test was used to compare the mean difference between the haemoglobin measurements before and 30-day after treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 144 administrations were given to 141 patients requiring intravenous iron replacement therapy during the 1-year study period in BTMC. Intravenous FCM infusion was administered for the management of iron deficiency related to: (1) increased blood loss, including menorrhagia, haemorrhoids and GI-related surgery, (2) low iron intake, including poor nutrition and gastrointestinalrelated malabsorption and (3) haematological disorders, including autoimmune haemolytic anaemia, myelodysplastic syndrome, diffuse large B-cell lymphoma and idiopathic thrombocytopaenia purpura. The median dose of intravenous FCM infusion was 1000 mg. At 30 day post-infusion, the mean haemoglobin level increased significantly from 8.9 g/L to 11.6 g/L (p &lt; 0.05), an increase of 2.68 g/L (95% CI: 2.45 - 2.90 g/L). No adverse drug reactions were reported. Subgroup analysis showed that patients with haematological disorders had significantly higher improvement in haemoglobin levels after intravenous iron infusion compared to those without. At 7-day, 14-day, 21-day post-infusion, 33% (33/99), 34% (34/99) and 36% (36/99) patients had a normalised haemoglobin level, respectively. The proportion of patients with a normalised haemoglobin level increased to 36% (36/99) and 42% (42/99) at 30-day and 90-day post-infusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Within the limit of this single-centre retrospective study, intravenous FCM infusion was well tolerated and effective in increasing the haemoglo","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of outcomes in epithelial ovarian cancer, fallopian tube cancer and primary peritoneal serous carcinoma between a multidisciplinary and a single-speciality centre.","authors":"M N Senin, C M Yong, J Omar, W N A Wan Fadzil Adlan, B C Lim","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Epithelial ovarian cancer (EOC) is the fourth most common malignancy among Malaysian women. This study aims to evaluate the outcomes of EOC, fallopian tube cancer and primary peritoneal serous carcinoma (PPSC) between a centre managed by both clinical oncologists and gynaecologic oncologists, Institut Kanser Negara (IKN) and a centre managed solely by gynaecologic oncologists, Hospital Ampang (HA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This retrospective cohort study involved data review of all the newly diagnosed patients with EOC, fallopian tube cancer and PPSC who received treatment in IKN and HA from January 2015 to December 2019, with follow-up continuing until December 2022. The primary outcome is overall survival (OS) and the secondary outcome is progression free survival (PFS) rates; estimated using the Kaplan-Meier method and compared using the logrank test. Another secondary outcome is to determine the prognostic factors affecting the OS of patients from these two cohorts using Cox regression analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 256 patients from both centres were recruited (106 and 150 patients from IKN and HA respectively) and at the time of diagnosis, more than half of the patients were diagnosed with advanced stage disease (67.5% and 62% from IKN and HA respectively). The median OS for patients with EOC was significantly longer for HA compared to IKN (69 months vs 39 months, p &lt; 0.042). There was no significant difference in the median PFS for both centres. Furthermore, when the comparison was made based on the disease staging, there was no difference in the median OS and median PFS. Multivariate analysis identified that patients aged between 41 and 60 years (Hazard ratio [HR]: 2.83; 95% CI: 1.11, 7.25, p = 0.030), patients with medical illness (HR 1.51; 95% CI: 1.04, 2.21, p = 0.033), patients with advanced-stage disease (HR: 3.63; 95% CI: 2.20, 6.00, p &lt; 0.001) and patients with ECOG ≥ 1 (HR: 2.00; 95%CI: 1.38, 2.91, p &lt; 0.001) as independent risk factors for adverse outcome. Meanwhile, optimal surgery is found to be a protective factor (HR 0.60; 95% CI: 0.41, 0.89, p = 0.011). Patients with optimal surgery had reduced the risk of adverse outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our findings confirmed that the median OS was significantly longer for patients with EOC in HA compared to IKN. However, there was no significant difference in the median OS based on the disease staging; therefore, we could not establish the non-inferiority outcome between the two centres. Furthermore, there was no significant difference in median PFS for both centres. This could be due to small sample size to be able to detect any difference. In addition, it could also be contributed by the different treatment options available and unequal volume of patients treated in both centres. Thus, further study with larger sample size and longer time period is needed to provide better guidance and treatm","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the relationship between the frequency of attention deficit, hyperactivity disorder symptoms and nutritional habits in children.","authors":"Ö D Elvin, Ç V Aydan, E Ç Güzel, B Topçu","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Attention deficit and hyperactivity disorder (ADHD) is a common chronic neurodevelopment disorder characterised by inattention, hyperactivity and impulsivity at levels that are not compatible with age. ADHD is one of the high social and individual costs for the population of the country. In the present study, it was aimed to investigate the relationship between some sociodemographic characteristics, nutrition and sleep patterns, certain habits and various factors with ADHD in primary school children aged between 6 to 10 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;In the study, a total of 600 children's parents were asked to fill in the Conners Parent Rating Scale - Short Form (CPRS-48), which consists of 48 questions. The questions in the scale are answered by the parents on a four-point Likert scale. The responses were scored as 0, 1, 2 and 3 for 'never', 'rarely', 'often' and 'always', respectively. It was accepted that the children who scored at least 18 for the behaviour problem subscale, at least five for the learning problem subscale, at least six for the aggression, hyperactivity subscale, and at least seven for the defying subscale were considered to be in the problematic category. In order to determine the eating habits of the children included in the study, their parents filled out the food consumption frequency form. Foods in the form of food consumption frequency are divided into two groups as healthy and unhealthy foods. Individuals were given scores between 0 and 6 according to the frequency of food consumption. The healthy food group and unhealthy food group scores were collected separately.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the children included in the study, 312 (52%) were male, with a mean age of 8.24±1.30 (range: 6 10) years. The mean CPRS-48 score was 23.88±19.71. The Cronbach's Alpha value of the CPRS-48 scale, which consists of 48 questions in total, was obtained as 0.957. The mean CPRS-48 score was significantly higher in boys (p = 0.014), in those whose mothers smoked during pregnancy (p = 0.008), those who did not receive breast feeding at birth or those who received less than 2 months (p = 0.035), those who frequently skipped meals (p &lt; 0.001), those who do not have breakfast regularly (p = 0.002), those who spend more than four hours a day using a tablet/computer (p = 0.007), those who watch television more than 2 hours a day (p = 0.003), those who do not have regular sleep (p = 0.012), those who sleep less than 8t hours a night (p = 0.031), those who do not spend quality time with their families at least 2 days a week (p = 0.002) and those who do not have a hobby or sport that they were constantly interested in (p = 0.007).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The finding of the present study show that CPRS score in children is associated with some factors such as mother's habits in pregnancy, behaviours in having meals, daily habits and regular sleep. Although eating habits ar","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Halal pharmaceuticals: Views from outpatients in a Malaysian state hospital.","authors":"W C Ang, N A Khadir, N A S Lahazir, A H Baharudin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Halal pharmaceuticals are paramount in healthcare settings catering to Muslim patients. The COVID- 19 pandemic ignited discussions on the Halal status of pharmaceuticals, especially vaccines. This study aims to explore the understanding and views of hospital outpatients regarding Halal pharmaceuticals.</p><p><strong>Materials and methods: </strong>A qualitative study by in-depth interviews was undertaken among adult Muslim outpatients. Utilising a semi-structured interview guide in Malay, content reliability of the guide was ensured through expert reviews. Potential participants were approached in the outpatient pharmacy waiting area. All interviews were audio recorded and transcribed verbatim. These Malay transcripts were translated into English and subjected to thematic content analysis.</p><p><strong>Results: </strong>Data saturation was achieved through interviewing ten outpatients. The findings indicated that patients were vigilant in checking labels to confirm the correctness of their medications. Yet, the terms 'Halal pharmaceuticals' and 'Shariah-compliant hospital' were unfamiliar to all and did not evoke curiosity. The respondents expressed trust in the government's commitment to dispense safe and Halalcertified drugs. The majority of the participants did not consider Halal status as a primary factor when selecting medications. Nevertheless given a choice, many voiced a preference for Halal-certified drugs, irrespective of their cost or efficacy. For life-threatening situations, participants were willing to accept non-Halal treatments.</p><p><strong>Conclusion: </strong>Despite non-familiarity, the general sentiment towards Halal pharmaceuticals remain positive. This study underscores the need for enhanced education and awareness regarding Halal pharmaceuticals for better align healthcare practices with the cultural and religious values of Muslim patients.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractive error and amblyopia among primary school children in remote islands of East Coast of Peninsular Malaysia.","authors":"H J Wardati, W Karimmah, M Khadijah, M Ahmad-Sharmizi, W Y Wan-Julyatee, A S Ain-Nasyrah, M Shahidatul-Adha, H Waheeda-Azwa, K S Ng, H S Jesspreet-Kaur, N A Abdullah, H Hanizasurana, I Shatriah","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known about the prevalence of refractive errors and amblyopia among school children on the islands of East Coast Malaysia. This study aimed to investigate the prevalence of these conditions and their associated factors in this unique and remote geographical location.</p><p><strong>Materials and methods: </strong>This multicentre cross-sectional school-based study included 480 children aged 7 to 12 year from primary schools on the islands of the East Coast of Malaysia. All children underwent visual acuity assessment, orthoptic evaluation, anterior and posterior segment examinations and manifest refraction. Demographic data, history of parental refractive error, parental education level, duration of digital screen time and time spent outdoors were documented in a questionnaire distributed to the parents.</p><p><strong>Results: </strong>The mean age was 9.53 ± 1.69 years, with an equal distribution of genders. The ethnic composition of the subjects was 99.4% Malay and 0.6% Orang Asli. The overall prevalence of refractive errors was 11.9% (95% CI: 9.1 to 15.1%), with myopia at 7.1% (95% CI: 5.0 to 9.8%), hyperopia at 2.5% (95% CI: 1.3 to 4.3%), astigmatism at 2.3% (95% CI: 1.1 to 4.1%) and amblyopia at 2.5% (95% CI: 1.3 to 4.3%). Older age, an absence of parental history of refractive error and reduced daily outdoor time were significantly associated with refractive errors (p < 0.05).</p><p><strong>Conclusion: </strong>The prevalence of refractive error is 11.9% and amblyopia is 2.5% among primary school children on the islands of the East Coast of Peninsular Malaysia. Older age, an absence of parental history of refractive error and reduced daily outdoor time are associated with refractive error.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitude and practices of indigenous people towards non-communicable disease in Bera, Malaysia: A community-based study.","authors":"F Abdullah, N A A Rahman, V Kumaran, N Fazam, C E Wong","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>With the current trend of increasing noncommunicable diseases (NCD), like hypertension, diabetes and dyslipidaemia worldwide and in Malaysia, a comprehensive study is essential to find the local population's knowledge, attitude and practice towards NCD. Little is known about the indigenous people of Orang Asli's health conditions and health-seeking behaviours towards these chronic diseases. The study aimed to assess knowledge, attitudes and practices (KAP) status towards non-communicable disease and its association with demographic background among Orang Asli adults of the Semelai subgroup in central Pahang, Malaysia.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted among 251 adult Semelai people in Bera district, Pahang. Data was collected through face-to-face interviews to obtain socio-demographic data, KAP towards NCD. Bivariate analysis was performed to test the association between the socio-demographic factor and the KAP score.</p><p><strong>Results: </strong>Among respondents, 57.4% were female, 82.5% were married, and 46.2% completed primary school. The majority were animism believers (83.3%), self-employed (75.3%) and earning less than RM1000 (87.6%). The respondents' ages ranged from 18 to 77, with a mean age of 41.1 (S.D ± 13.9). The prevalence of known type-2 diabetes mellitus (T2DM), hypertension, and dyslipidaemia was 9.6%, 20.7%, and 8.8%, respectively. About 23.1% of respondents have a family history of chronic disease. Regarding KAP parameters, only 12.7% have good knowledge, and 35.5% have good practice in prevention and treatment. However, more than half (59.8%) have a positive attitude towards chronic diseases. This study also showed that higher household income and education levels were positively associated with higher scores of KAP (p < 0.001).</p><p><strong>Conclusion: </strong>This study presented a low-to-moderate percentage of Orang Asli who have good KAP towards NCD. KAP levels were significantly associated with education levels and household income. Hence, improving education and poverty in the Orang Asli community may successively increase the knowledge level, impart a positive attitude towards NCDs, and improve the practice level toward treatment and prevention.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Do-Not-Attempt-Resuscitation decisions in emergency department in Malaysia: A retrospective study.","authors":"K S Chew, H T M Kho, X Y Yang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The practice of Do-Not-Attempt-Resuscitation (DNAR) aims to respect patient autonomy and acknowledge medical futility. Despite its global acceptance, there is limited research on DNAR in many Asian countries, including Malaysia. This study addressed this gap by exploring DNAR decision-making processes in a Malaysian tertiary hospital.</p><p><strong>Materials and methods: </strong>A mixed-method retrospective study was conducted in the emergency and trauma department (ETD) of Sarawak General Hospital, Malaysia, from February to July 2023. Data were collected from 115 DNAR cases using a surveillance form to document the patient demographics, types of DNAR orders, initiating physicians, reasons for DNAR, surrogate decision-makers, specific types of procedures withheld or withdrawn and outcomes. Thematic analysis was used for qualitative data, while inferential statistical analysis was applied to quantitative data.</p><p><strong>Results: </strong>The mean age of patients was 71.32 years, with a male predominance (63.5%). The primary reasons for DNAR included \"critical illness with poor prognosis\" (33.9%), \"advanced age with frailty and poor prognosis\" (20.9%) and \"massive haemorrhagic or ischemic stroke\" (16.5%). Most DNAR decisions involved withholding resuscitation (90.4%) and were initiated mainly by internal medicine (52.2%) and emergency medicine teams (34.8%). Surrogate decisionmakers were predominantly adult children (63.5%). Only one case had an advance directive. Majority of patients (80.9%) were admitted to wards, while 16.5% died in the emergency department. The median age of patients was significantly older when adult children (78 years) and spouses (76 years) were the surrogates, compared to when they were not involved (64.5 years and 62.5 years, respectively; p < 0.001 and p = 0.003, respectively). Conversely, the median age was significantly younger when parents (41.5 years) and siblings (64 years) were the surrogates, compared to when they were not involved (75 years and 74 years, respectively; p < 0.001 for both).</p><p><strong>Conclusion: </strong>Advanced directives are rarely applied in Malaysia. DNAR decisions are typically made by surrogates when patients are critically ill, which is a common trend in many Asian cultures where discussing death is taboo. Cultural norms often lead families to withhold terminal diagnoses from patients, posing challenges for end-of-life care. The most frequent surrogates were adult children, who face dilemmas balancing aggressive treatment and their parents' wishes. The study underscores the need for better communication and decision-making support in emergency departments.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}