Medical Journal of Malaysia最新文献

{"title":"Abstracts of the Malaysian Medical Association Congress 2024 on 3rd - 5th May 2024.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"79 Suppl 2","pages":"1-34"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866766","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":"Reasons behind providing care for older persons.","authors":"A Dahlan, N M Dzaki, I S Adeli, N Nurhidayah","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>There is a global increase in the ageing population, and Malaysia is expected to become an ageing country. As elderly individuals experience deterioration in physical and cognitive functions, they often require longterm care from caregivers. This study aims to investigate the reasons why caregivers provide care for older adults at home.</p><p><strong>Materials and methods: </strong>A qualitative phenomenological approach was employed, and semi-structured face-to-face interviews were conducted with 12 caregivers. Thematic analysis was used to identify patterns and themes in the data.</p><p><strong>Results: </strong>Four master themes emerged from the analysis of the reasons for providing care to the older person by caregivers: personal factors needed by the elderly, personal factors of the caregivers, support from family members and friends, and environmental factors. Caregivers were motivated by the medical conditions of the older person, caregivers' sense of duty, and the desire to repay their elderly for their past care. Additionally, religious beliefs also played a role in motivating caregivers. Financial stability, knowledge and experience in caregiving, and the absence of other suitable caregivers were additional factors influencing caregiving decisions. Caregivers received support from family members, friends and sometimes hired help.</p><p><strong>Conclusion: </strong>Cultural values, religious beliefs, and gender roles influence caregiving attitudes, emphasising the need for comprehensive understanding. Invaluable findings highlight the pressing need to comprehend the intricate dynamics, informing the development of tailored support systems. The study reveals that caregiving at home for the elderly is shaped by personal, social and environmental factors. Insight into these dynamics is crucial for robust support systems. By addressing the dimensions of caregiving, policymakers, healthcare professionals and society can better support caregivers in their essential role.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"79 3","pages":"251-256"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141181009","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":"Conventional surgery in colon cancer with comparison to complete mesocolic excision and central vascular ligation: initial experience in a tertiary centre.","authors":"S H Mohd Mydin, Z A Mohd Azman, N A Abdul Rahman, F Hayati, A Hidrus, I Sagap","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The complete mesocolic excision (CME) and central vascular ligation (CVL) is an advanced surgical technique used to treat colon cancer. It combines the removal of the affected portion of the colon and surrounding lymph nodes with an improved method of controlling the vascular supply to the tumour.</p><p><strong>Materials and methods: </strong>A retrospective study of patients with colon cancer underwent right hemicolectomy (either CME and CVL or conventional method) were operated by colorectal surgeons in a tertiary centre in Kuala Lumpur from 2018 to 2020. We review the data to compare the oncological, pathological and surgical outcomes of both techniques. Categorical variables were presented as frequencies and percentages. Continuous variables were compared using an independent t-test or Mann-Whitney Rank U test. The chi-square test was used to determine the association between categorical variables and mortality. Statistical analysis was conducted with IBM SPSS Statistics 25.0, and statistical significance was set at p<0.05.</p><p><strong>Results: </strong>A total of 30 patients (CME and CVL=15 or conventional colectomies=15) were included in this study with mean age of 65 years. There was no statistical difference between the mean age of the two groups (p=0.355). Most of the patients were Malays (46.7%) followed by Chinese (43.3 %) and Indians (10.0%). The mean (SD) = 19 (9) number of lymph nodes harvested is more in CME and CVL groups which however is not statistically significant compared to the mean (SD) = 16 (9), number of lymph nodes in conventional colectomies. The duration of surgery is longer in CME and CVL groups (214 minutes) compared to conventional colectomies (188 minutes) but with no significant statistical difference. Most of the perioperative complications were similar in both groups with no significant statistical differences.</p><p><strong>Conclusion: </strong>CME and CVL are not inferior to conventional surgery in colon surgery in a tertiary centre. It should be considered since the advantages such as lymph node yield and median recurrence free survival are better with similar perioperative morbidity.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"79 3","pages":"326-330"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180958","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":"Identifying an appropriate gene testing tool for inherited retinal dystrophy in Indonesia, a developing country.","authors":"A B I Perdamaian, R N Drupadi, E Aribowo, D K Paramita, M B Sasongko, S Supanji","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Inherited retinal dystrophy (IRD) is a group of untreated genetic ocular diseases that mostly affect young people. The number of patients with IRD worldwide, including in developing countries, is growing each year. This literature review aimed to investigate the current utilised genetic screening of IRD worldwide and to propose the most feasible genetics test and diagnostic method for IRD in developing countries, especially Indonesia.</p><p><strong>Materials and methods: </strong>A literature search was performed in PubMed and Google Scholar databases. Papers conducting wide genome sequencing, including panel sequencing (panel-seq), microarray, whole exome sequencing (WES), whole genome sequencing (WGS) and Sanger sequencing on patients with IRD, were included. Papers were sorted into several groups to visualise the sequencing technology's detection rate. Detection rate comparison analysis was done using the meta-regress protocol in the R program. Whereas the number of novel mutations in each testing tool each year was pooled and compared in the graph.</p><p><strong>Results: </strong>After conducting the literature study, 37 papers were sorted from 451 results. Most studies conducted a panel-seq with 16 records followed by WES with seven records. The detection rate of the WES meta-analysis was 0.66, which was slightly better than the panel-seq with 0.55. The number of novel mutation discoveries fluctuated each year with panel-seq as the most prominent finder. Cost factors and the limitation of sequencing devices make panel-seq a more appropriate tool in Indonesia.</p><p><strong>Conclusion: </strong>The most effective selection for evaluated genetic testing was WES. Therefore, panel-seq is more suitable for first-tier genetic testing in Indonesia.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"79 3","pages":"342-347"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180989","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":"The clinical and geographical characteristics, health-seeking behaviours of ST-segment elevation myocardial infarction patients with their total ischaemic time and short-term cardiac mortality outcomes: a local geographical perspective from a developing country.","authors":"C T Lim, Y H Ho, A Y Y Fong, T K Ong","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Ischaemic heart disease including ST-segment elevation myocardial infarction (STEMI) is the leading cause of death among Malaysians. Total ischaemic time (TIT) which consists of patient delay and systemic delay is a strong predictor of cardiovascular outcome in STEMI. Primary percutaneous coronary intervention (PPCI) is superior to medical thrombolysis in improving STEMI patients' survival outcomes. Our study aims to provide an insight into the clinical and geographical characteristics of STEMI patients, their health-seeking behaviour, TIT, interventions received and short-term cardiac mortality outcomes in the effort to improve the existing coronary care service.</p><p><strong>Materials and methods: </strong>This is a descriptive study looking into patients who were diagnosed with STEMI and presented to or were referred to Sarawak Heart Centre between 1st July 2022 and 31st December 2022.</p><p><strong>Results: </strong>A total of 183 patients were recruited and 33.3% were <50 years old. The majority were in a different division during symptom onset from where the local PPCI centre is located and some underwent one or two transits before arrival at the revascularisation centre. More presented outof- hour and they were more likely to present within the PPCI window. The median TIT for the study population was 3.3 hours. The short-term cardiac mortalities were 9.3% and only the Killip class was found to have a significant association. In this study, TIT was not significantly associated with short-term mortalities but those who died had a longer median TIT.</p><p><strong>Conclusion: </strong>A local STEMI network should be set up using the 'Hub-and-Spoke' model in a staged-wise approach to reduce TIT given that PPCI is now the gold standard of treatment alongside continuous effort in patient education.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"79 3","pages":"257-267"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141181014","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 neonatal outcome associated with maternal tuberculosis in a public tertiary centre: a retrospective cohort study.","authors":"Z Zurina, M A Nunis, A F A Abdulla, M Osman, N Zakaria","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to evaluate a group of infants born to women with tuberculosis (TB) during pregnancy to determine the neonatal morbidities and its outcomes associated with tuberculosis in pregnancy.</p><p><strong>Materials and methods: </strong>Data from January 2007 to December 2021 was collected for analysis as part of a retrospective cohort study. This study was conducted in a tertiary public hospital in Malaysia, Hospital Sultan Idris Shah (HSIS). Cases were identified from the hospital's bacille Calmette-Guerin (BCG) vaccination notification forms and merged with records from the neonatal intensive care unit's census. Controls were infants born to mothers unaffected by TB within the same hospital and year as the index case (1:4 ratio). Descriptive statistics and logistic regression were used to analyse the data. The main outcome measures were the risk of congenital tuberculosis, premature birth, low birth weight, small for gestational age and low APGAR score.</p><p><strong>Results: </strong>Data from January 2007 to December 2021 was collected for analysis as part of a retrospective cohort study. This study was conducted in a tertiary public hospital in Malaysia, Hospital Sultan Idris Shah (HSIS). Cases were identified from the hospital's bacille Calmette-Guerin (BCG) vaccination notification forms and merged with records from the neonatal intensive care unit's census. Controls were infants born to mothers unaffected by TB within the same hospital and year as the index case (1:4 ratio). Descriptive statistics and logistic regression were used to analyse the data. The main outcome measures were the risk of congenital tuberculosis, premature birth, low birth weight, small for gestational age and low APGAR score.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"79 3","pages":"337-341"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180951","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":"Development of ultrasound guided regional anaesthesia in the emergency department, Hospital Kuala Lumpur.","authors":"N S K Shamala, L H Mohd, R J Siti, N S Gopinath, M M Nornadia, S Hidayah, A W Mahathar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Ultrasound guided regional anaesthesia is a fast-rising acute pain management modality in emergency departments worldwide. It is a safe and effective alternative to opioid based systemic analgesia. Establishing a standardised and efficient protocol requires a multidisciplinary approach namely involving collaborations between anaesthesiology and emergency medicine counterparts. In this article, we outline our approach in establishing an end-to-end service which is both patient-centred and sustainable.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"79 3","pages":"370-373"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180980","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":"Factors contributing to patency after aneurysmorrhaphy and outflow repair in arteriovenous fistula aneurysm treatment.","authors":"S P Sunil, N Mohd Ali, H M F Zaid, Z Ismazizi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Vascular access-related aneurysms (VARA) are a complication of arteriovenous fistulas. Repair techniques have been described in the literature with varied outcomes.</p><p><strong>Materials and methods: </strong>We conducted a prospective cohort study on patients who had VARA repair over 41 months. The indication for repair was an aneurysmal arteriovenous fistula (AVF) at risk of haemorrhage or difficulty in cannulation. Pseudoaneurysms, infected AVF and bleeding VARA were excluded. All patients underwent outflow stenosis treatment when present, followed by aneurysmorrhaphy. They were monitored periodically over 12 months, measuring functional primary and cumulative patency and access flow. We studied the patient demography, access flow and presence of outflow stenosis. Access flow was measured from the brachial artery (Qa) as a surrogate using ultrasonography. A Kaplan-Meier survival analysis was used to predict the primary and cumulative patency at 12 months and factors contributing to 12-month patency were analysed.</p><p><strong>Results: </strong>A total of 64 patients were recruited for this study, of whom 58 completed the study. Most of the participants were male (67%) with a median age of 45 years. Forty-six patients (79.3%) had brachiocephalic fistula (BCF) aneurysms. Thirty-nine (67.2%) had preexisting outflow stenoses that required intervention. All patients underwent an aneurysmorrhaphy, of whom 12% had a cephalic arch vein transposition due to severe stenosis. Primary patency at 12 months was 86%, whereas the cumulative patency rate was 95%. Patency was significantly associated with younger age and showed a positive trend with higher preintervention Qa. Symptomatic recurrent stenosis developed in 17.2% of the cohort.</p><p><strong>Conclusion: </strong>Improving the patency of VARA entails the treatment of outflow stenosis and aneurysmorrhaphy. Surveillance is important to detect and treat recurrent outflow stenoses. The outcome is better among younger patients with pre-interventional access flow as measured in the brachial artery as a surrogate.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"79 3","pages":"245-250"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180984","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":"Efficacy of Caprini risk assessment model in predicting venous thromboembolism risks among Asian surgical patients.","authors":"L Lee, N C Liew, Y J Teoh, A A Ahmad-Zaidi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Caprini risk assessment model (RAM) has been validated in Caucasians but evidence of its suitability in Asian surgical patients is still unknown. This study aims to determine the efficacy of Caprini model in venous thromboembolism (VTE) risk assessment among Asian surgical patients.</p><p><strong>Materials and methods: </strong>Consecutive surgical patients with Asian ethnicities admitted to a tertiary public hospital between January 2013 and December 2014, were included. Their demographic details, VTE risk factors and scores based on Caprini RAM were recorded. Primary outcome of this study was symptomatic VTE within 90 days of hospitalisation. Fisher's exact test and Lasso regression were performed for statistical analysis.</p><p><strong>Results: </strong>A total of 4206 patients were included in this study. Distribution of this study population by risk level was very low, 14.7%; low, 44.1%; moderate, 25.6% and high, 15.7%. The overall symptomatic VTE incidence within 90 days was 0.5%. The incidence of deep venous thrombosis (DVT), pulmonary embolism (PE) and both was 0.31%, 0.19% and 0.05% respectively. VTE incidence by risk category was very low, 0%; low, 0.16%; moderate, 0.37% and high, 2.12%. Obesity (BMI >25), history of prior major surgery, history of DVT/PE and high-risk category (scores ≥5) were significant VTE factors with odds ratio > 5.0. Following the Caprini RAM with ACCP preventive recommendations, an estimated 85% of surgical patients would need prophylaxis.</p><p><strong>Conclusion: </strong>The overall VTE incidence among Asian surgical patients is low. Prophylaxis using Caprini RAM may subject a low incidence patient population to over utilisation of thromboprophylaxis and therefore not cost-effective when applied to Asian patients.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"79 3","pages":"320-325"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180983","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":"The outcome of 12-week corticosteroid therapy in COVID-19-related diffuse interstitial lung abnormalities.","authors":"B H Ng, M I Azmi, N N N Abeed, H J Low, C I Soo, M F M Jailaini, A A Azmel, R A Osman, P Periyasamy, H J Tan, S A M Mukari, W N N W Yahya, M F A Hamid, A Y L Ban","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy of long-course corticosteroid therapy in treating COVID-19-related diffuse interstitial lung abnormalities (DILA) needs to be better understood. We aimed to investigate the benefits of 12-week corticosteroid treatment in COVID-19-related DILA by evaluating computed tomography (CT) lung severity scores.</p><p><strong>Materials and methods: </strong>This retrospective, single-centre observational study included patients aged 18 years or older admitted with moderate to severe COVID-19 pneumonia who received 12 weeks of oral prednisolone between January 2021 and December 2021. We recorded clinical parameters, baseline CT scores and post-treatment, modified Medical Research Council (mMRC) dyspnoea scale and pulmonary function tests.</p><p><strong>Results: </strong>A total of 330 patients were analysed. The mean (standard deviation, SD) age was 54.6 (14.2) years, and 43% were females. Three-point nine per cent (3.9%) require noninvasive ventilation (NIV), while 14.6% require mechanical ventilation (MV). On follow-up at 12 weeks, the CT patterns showed improvement in ground-glass opacities, perilobular density and consolidation. There was an improvement in the mean (SD) CT score before and after prednisolone therapy, with values of 17.3 (5.3) and 8.6 (5.5), respectively (p<0.001). The median mMRC was 1 (IQR 0-1), and 98.8% had a radiological response. The common side effects of prednisolone therapy were weight gain (13.9%), hyperglycaemia (1.8%) and cushingoid habitus (0.6%).</p><p><strong>Conclusion: </strong>A 12-week treatment with prednisolone showed significant improvement in CT scores with minimal residual dyspnoea and was relatively safe. Longer duration of steroids may be beneficial in moderate to severe COVID-19- related DILA.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"79 3","pages":"296-305"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141181015","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}