Medical Journal of Malaysia最新文献

{"title":"Diagnostic accuracy of zero Coronary Artery Calcium (CAC) score in a Malaysian cohort: A 20-year retrospective analysis.","authors":"J T Lee, M M Md Hazali, J P Siew","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The Agatston coronary artery calcium (CAC) score is a widely used screening tool. However, its negative predictive value (NPV) in the Southeast Asian population, prone to premature non-calcified atherosclerosis, is not well defined.</p><p><strong>Materials and methods: </strong>We analysed paired data from 5,375 asymptomatic patients who underwent concurrent CAC scoring and Coronary CT Angiography (CCTA) at a tertiary center in Kuala Lumpur over 20 years. This cohort was selected to study plaque missed by CAC. A validated automated pipeline (weighted Cohen's Kappa = 0.978) was used to determine stenosis severity.</p><p><strong>Results: </strong>Zero CAC yielded a negative predictive value of 76.1% for any plaque; 23.9% of calcium-negative patients harboured hidden atherosclerosis, including 3.5% with obstructive disease. While odds increased linearly with age (OR 1.22 per decade, p=0.004), missed disease peaked in males aged 40-44 and peri-menopausal women aged 55-59. These age groups represent a window during which lipidrich plaques accumulate before calcifying.</p><p><strong>Conclusion: </strong>Zero CAC can mask a \"pre-calcific window\" of active, radiolucent atheroma accumulation. Rather than a state of biological protection, this Zero CAC cohort harbours hidden risk driven by the same demographic engines as calcified disease, simply operating at an earlier phenotypic stage. Confirmatory CCTA is critical for high-risk younger males and peri-menopausal women to bridge this inherent diagnostic blind spot.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"447-454"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713935","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":"Prevalence of contact sensitisation among patients with hand eczema and factors associated with contact sensitisation and disease severity.","authors":"C S Liong, A Jamil, T G Ng, N Mohamad","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic hand eczema is a debilitating skin disease. The aetiology of hand eczema can be due to irritant contact, allergic contact or a manifestation of endogenous eczema. Identification of sensitisers and subsequent avoidance of relevant sensitisers may improve care of chronic hand eczema patients. We aimed to study the prevalence and pattern of sensitisation, factors associated with sensitisation and severity of hand eczema.</p><p><strong>Materials and methods: </strong>A cross sectional study was conducted over a six month period between January to June 2025 at the Department of Dermatology in a tertiary hospital located in the capital of Selangor. Patients with predominantly hand eczema aged above 18 years old were interviewed, examined and patch tested with Standard European Baseline Series from Chemotechnique Diagnostics. Patients with contraindications for patch test and uncertain diagnosis were excluded. Hand eczema morphology was classified according to the Danish Contact Dermatitis Group classification. Hand eczema severity was determined using Hand Eczema Severity Index (HECSI). Patch test results were interpreted according to International Contact Dermatitis Research Group (ICDRG) guidelines.</p><p><strong>Results: </strong>A total of 54 patients aged 44± 15.29years old participated. Female to male ratio was 2.6:1 and 79.6% had positive patch test. The most common sensitisers were nickel sulphate (29.63%), fragrance mix 1 (25.93%), potassium dichromate (14.8%) and formaldehyde (14.8%). Polysensitisation was seen in 41.6%. Sensitisation was not associated with age, history of atopy, hand washing >10 times/day, hand wetting activities > two hours/day, use of non-permeable gloves, hand sanitiser use, fragrances and smoking. Cosmetic use showed seven times increased odds of polysensitisation (p=0.033). Hand eczema morphology was not associated with sensitisation. HECSI was significantly higher with use of non-permeable gloves. HECSI was not associated with atopy, frequency of hand washing and duration of wet hands.</p><p><strong>Conclusion: </strong>Patch test sensitisation was common in hand eczema patients. Polysensitisation was associated with use of cosmetics. Use of non-permeable gloves may worsen hand eczema.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"438-446"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714127","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":"Service utilization of a novel statewide domiciliary palliative care program in Malaysia.","authors":"Y Y Leong, Y L Choo, S L K Wong, D S C Law, A J Y Teo, S Z Kong, N Salamon, R Bau, S A P Wyan, K M Sii, A K Wong","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Palliative care is a human right and key to universal health coverage, yet remains inaccessible for many cancer patients. By 2030, Malaysia is expected to experience a 240% surge in demand for palliative care, with Sarawak, its largest state, projected to bear the greatest burden of unmet need. A novel statewide domiciliary palliative care (DPC) program was implemented to meet this growing demand across a culturally diverse and geographically dispersed region. This study characterizes the patterns of DPC service use during the inaugural year of this novel statewide program to inform future planning.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included adults with advanced illnesses referred to DPC services at eight health clinics across Malaysia's largest state of Sarawak from July 1, 2023, to June 30, 2024. Descriptive analysis was utilized.</p><p><strong>Results: </strong>A total of 113 patients with terminal illness were seen, the majority (89%; n=101) of whom had advanced cancer. The commonest cancer types were gastrointestinal (25%; n=28) and thoracic (17%; n=19). Median time from referral to first DPC encounter was 4 days (IQR 2-7). Median time to death was 28 days (IQR 11-53). Most patients (72%; n=82) received care in urbanized locations.</p><p><strong>Conclusion: </strong>This study demonstrates the wide reaching implementation of DPC across a geographically and culturally diverse region, particularly to cancer patients. Opportunities for strategic growth include expanding rural outreach, strengthening engagement with indigenous populations, and community engagement to enable more timely, inclusive, and equitable access to palliative care.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"483-488"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714105","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":"Profile, risk factors, genotype and outcome of Staphylococcus aureus catheter related blood stream infection in a Malaysian tertiary hospital.","authors":"J T Nian, W C Chua, B Intan Baiduri, H Habsah, H Abdul Razak, H Siti Asma","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Staphylococcus aureus is a commonly known causative agent of catheter related bloodstream infections (CRBSI) and complicated CRBSI. This study aimed to detect prevalence of S. aureus and complicated S. aureus CRBSI, their virulence genes and evaluate their association with development of complicated CRBSI, patient risk factors and outcomes.</p><p><strong>Materials and methods: </strong>A cross-sectional study involving retrospective record review of CRBSI cases was conducted from January 2019 to December 2021. A total of 139 CRBSI cases were identified. Patients' clinical data, risk factors and outcomes of S. aureus CRBSI were analyzed. Nineteen isolates from patients with complicated S. aureus CRBSI were selected for detection of Cna, Chp and Cap8 gene using PCR. The association between the development of complicated S. aureus CRBSI and the presence of virulence genes was analyzed.</p><p><strong>Results: </strong>Forty-three (31%, n=43) of CRBSI cases were caused by S aureus. Among these, nineteen cases (44.2%) were complicated. Patients with chronic kidney disease (CKD) or end-stage renal failure (ESRF) (adjusted OR 11.11, 95% CI: 2.86-33.33, p<0.001) were at significant risk of S.aureus CRBSI. Virulence genes detected were Cap8 (89.5 %, n=17), Cna (47.4%, n=9) and Chp (26.3%, n=5). The presence of these genes was not significantly associated with the development of complicated S.aureus CRBSI. S. aureus CRBSI were associated with higher mortality (p=0.035).</p><p><strong>Conclusion: </strong>S. aureus was the predominant agent for CRBSI and 44.2% of them were complicated. CKD/ESRF were the comorbidities associated with S. aureus CRBSI. Although cap8 was the most frequently detected virulence gene, it was not associated with the development of complicated S. aureus CRBSI.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"497-503"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714093","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":"Clinical characteristics and outcomes of myocardial infarction, stroke, and cardiovascular mortality among patients undergoing complex high-risk indicated percutaneous coronary intervention: A one-year review in a single non-surgical centre.","authors":"Y Shen, H S Arvinder-Singh, C Hui-Yi, A Jian-Gang, C Tai-Meng, C Hsin-Wei, C Wee-Lee, L Chun-Liang, D Philip-Rajan, J S Gurpreet-Pal-Singh, S Ramachandran, K Yew-Fung, M H Hazleena, M A Nor-Hanim","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Complex High-risk Indicated Percutaneous Coronary Intervention (CHIP-PCI) addresses complex coronary artery disease in patients unsuitable for or declining surgery. Performing CHIP-PCI in non-surgical centres presents unique challenges requiring robust risk mitigation. CHIP-PCI was defined as PCI in any patient meeting at least one of the following criteria: PCI to left main stem, chronic total occlusion, severe coronary artery calcification (CAC), bifurcation lesions, left ventricular ejection fraction (LVEF) &lt; 30%, serum creatinine &gt; 200μmol/L, chronic dialysis, intra-aortic balloon pump use, previous coronary artery bypass graft, or age ≥ 80 years. Locally, the outcomes of major adverse cardiovascular events (MACE) - a composite of myocardial infarction, stroke, and cardiovascular mortality - and their associated factors after CHIP-PCI remain poorly understood. This study aims to evaluate 30-day MACE, patient characteristics and variables associated with mortality in CHIP-PCI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This single-centre retrospective cohort study with 30-day follow-up utilised anonymous secondary data from CHIP-PCI patients treated at the Department of Cardiology, Hospital Raja Permaisuri Bainun between 1st January and 31st December 2024. Data extracted included demographics, comorbidities, laboratory investigations (low-density lipoprotein [LDL], serum creatinine, echocardiography findings), and intra- and postprocedural findings. Patients with missing data for ≥ 3 variables of interest were excluded. A multivariate binary logistic regression analysis was conducted to identify the variables associated with mortality post CHIP-PCI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 161 total patients, 146 (90.7%) were included in the analysis. Among these, 71.9% were male, and the mean age was 63.03 ± 10.19 years. Common comorbidities included hypertension (83.6%), diabetes mellitus (66.4%), elevated LDL (51.6%), serum creatinine &gt; 200μmol/L (38.4%), prior Acute Coronary Syndrome (37.0%), chronic dialysis (30.1%), and LVEF &lt; 30% (9.6%). Radial access was the most common approach (72.6%), and PCI was most frequently performed for severe CAC (46.6%). Intracoronary imaging was used in 43.8% of cases, and 39.0% required advanced calcium modification technique (atherectomy or intravascular lithotripsy). Most were single-lesion PCI (80.8%), with the left anterior descending artery (80.8%) being the most treated vessel. The 30-day MACE rate was 5.5% (4.8% mortality, 0.7% stroke, and 0% recurrent myocardial infarction). Multivariate analysis demonstrated that LVEF &lt; 30% (AOR: 41.1, 95% CI: 1.1-1563.8, p = 0.04), severe CAC (AOR: 28.2, 95% CI: 1.3-619.3; p = 0.03), elevated LDL (AOR: 28.7, 95% CI: 1.2-701.1; p = 0.04), and readmission (AOR: 81.7, 95% CI: 4.1-1618.3, p &lt; 0.001) were exploratory variables associated with 30-day mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study demonstrates that the 30-day","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"430-437"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713976","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":"Mortality trends from 2010-2023 and excess mortalities in Perak during the COVID-19 pandemic.","authors":"H S Arvinder-Singh, D Lay-Ming, N Shih-Hang, A R Nur-Ashikin, S S K David-Raj, B S Raja-Mangeet-Singh, K Siti-Fatimah, D Philip-Rajan, P N Jeyaseelan","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;COVID-19, caused by SARS-CoV-2 virus, is a respiratory infection that led to the 2020 pandemic. During the pandemic, mortality directly related to COVID-19 infection were classified as COVID-19 death based on case definition. However, excess mortality would be a more comprehensive method to look at the true impact of the pandemic rather than focusing only on COVID-19 deaths alone. The objective of this study was to determine the excess mortalities and top 5 causes of mortality that occurred during and after the COVID-19 pandemic in Perak.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Total and age-specific mortality data tabulated by the Department of Statistics Malaysia (DOSM) for the years 2010-2023 for the state of Perak was obtained. Data for the years 2010-2019 was re-grouped according to clustered age groups. This was used to generate the linear prediction line for mortality in 2020-2023 using Microsoft Excel 2010. Excess mortalities were calculated for 2020-2023 by subtracting the actual deaths from the predicted deaths. The top 5 common causes of mortality and COVID-19 deaths were also re-tabulated for the years 2020-2023 for the clustered age groups. \"Positive Excess Mortality\" (PEM) meant that the number of actual deaths were higher than predicted and \"Negative Excess Mortality\" (NEM) meant that the actual deaths were lower than the predicted number. Significant PEM meant that the value of the actual mortality was above the upper limit of the 95% confidence interval of the predicted mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All clustered age groups showed NEM for the year 2020. For the years 2021-2022, there was a PEM for all clustered age groups except those in the group \"19 and below\". The highest excess mortality was in the \"65 and above\" group with 343.44 and 685.56 per 100,000 agespecific population for 2021 and 2022 respectively. The mortality rate returned to the predicted value in 2023. In 2021 and 2022, there was a PEM for the \"20-39\" and \"40-64\" clustered age groups, however they were lower compared to the \"65 and above\" groups. Significant PEM was seen for all deaths in the \"65 and above\" in 2021 (237 per 100,000) and in 2022, 596 per 100,000. There was also a significant PEM after the removal of COVID-19 deaths in 2022 for the \"65 and above\" age groups- 366 per 100,000. Significant PEM was also seen in the \"20-39\" age groups and \"40-64\" age groups in 2021- 14 per 100,000 and 36 per 100,000 respectively. The other values that passed the 95%CI were deemed to be negligible. There were a few changes in the top 5 ranking for causes of death in Perak, the only obvious inclusion was deaths due to COVID-19 infections in 2021 in all groups except the \"19 and below\".&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;There was a PEM in all groups except \"19 and below\" after the year 2020, with the highest in the \"65 and above\" group. COVID-19 deaths were included in the top 5 causes of death and contributed only par","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"421-429"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714046","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":"Contributing factors for episiotomy in primiparous women in a tertiary hospital in Perak, Malaysia.","authors":"A Aruku Naidu, S Lwin, H S Harpreet Kaur, H Mohamad, M Mustafa, M Anusar, D Hamid, H Shaharani","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Episiotomy is a surgical incision of the perineum performed during vaginal delivery. Although previously routine, current evidence supports a selective approach due to associated maternal morbidity. Despite this, episiotomy remains common among primiparous women. This study aimed to determine the prevalence and contributing factors for episiotomy among primiparous women in a tertiary hospital in Perak, Malaysia.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted using secondary data from the obstetric delivery registry of Hospital Raja Permaisuri Bainun, Ipoh. Records of primiparous women who underwent vaginal delivery with episiotomy between 1 January and 31 December 2024 were reviewed. Maternal demographics and clinical indications were analysed. Associations between demographic variables and type of episiotomy were assessed using chisquare tests.</p><p><strong>Results: </strong>Of 346 eligible cases, 311 were analysed. Routine episiotomy accounted for 76.5% of cases, while 23.5% were selective. The most common indications for selective episiotomy were cord around the neck (45.2%) and preterm delivery (39.7%). No significant association was found between type of episiotomy and maternal age (p=0.378) or ethnicity (p=0.981).</p><p><strong>Conclusion: </strong>Routine episiotomy remains the predominant practice among primiparous women in this tertiary Malaysian hospital. These findings highlight the need for institutional review and adherence to evidence-based selective episiotomy guidelines.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"473-476"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713243","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":"Determinants of oral health-related quality of life among undergraduate university students: A cross-sectional study.","authors":"N Zahrulsham, N Saddki, K Kamarazaman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Young adulthood is a critical period for establishing lifelong health behaviours, yet oral health is often neglected. This study investigated factors associated with oral health-related quality of life (OHRQoL) among Malaysian university students.</p><p><strong>Materials and methods: </strong>A cross-sectional survey was conducted among 395 undergraduate students aged 18 to 25 years. Data were collected using a structured questionnaire assessing sociodemographic characteristics, perceived oral health status, oral healthcare seeking behaviour, and OHRQoL via the short Malay version of the Oral Health Impact Profile (S-OHIP(M)). Multiple linear regression was used to identify predictors of OHRQoL.</p><p><strong>Results: </strong>The prevalence of OHRQoL impact was 41.0%, with a mean S-OHIP(M) score of 9.15 (SD=6.39). Significant predictors of poorer OHRQoL included having at least one oral health problem, dissatisfaction with oral health status, and visiting the dentist due to an oral health issue. Dental and medical students reported significantly better OHRQoL compared to health sciences students. Oral health care seeking behaviour, although generally favourable, was not significantly associated with OHRQoL.</p><p><strong>Conclusion: </strong>OHRQoL among young adults is influenced by both subjective perceptions and behavioural patterns. Promoting routine dental visits and enhancing oral health awareness may improve quality of life outcomes. These findings inform strategies for preventive care and service delivery targeting young adult populations.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"540-547"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713887","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":"Interobserver and intra-observer agreement among radiographers in assessing the quality of chest radiograph.","authors":"D Rochmayanti, A Kusworo, E W Catur, A H Sulistiyadi, S Daryati","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Chest radiography is a commonly performed examination for screening, clinical assessment, and preintervention evaluation. Image quality plays an important role in supporting diagnostic interpretation. After image acquisition, radiographers decide whether the image should be accepted or repeated. Variation in these decisions may affect patient radiation exposure and radiology workflow. This study aimed to evaluate variation and agreement among radiographers in accepting or rejecting chest radiographs.</p><p><strong>Materials and methods: </strong>This cross-sectional study involved 91 certified radiographers in Indonesia. Thirty de-identified chest radiographs representing technical-quality categories were selected by an expert panel, and 12 duplicate images were added to assess intra-observer consistency. The resulting 42 images were presented in random order. The acceptance and rejection criteria were classified into 8 factors: accepted, artifact, blurring, mispositioning, incorrect body part, body part cut-off, exposure failure, and under/over exposure. Data were analysed using Cohen's kappa for duplicated image pairs and Fleiss' kappa for interobserver agreement.</p><p><strong>Results: </strong>There were radiographer's perception variations in accepting or rejecting X-ray chest images. Intra-observer agreement for duplicated image pairs ranged from κ=0.027 to κ=0.727, with a simple mean Cohen's kappa of κ=0.525, indicating moderate agreement. Overall inter-observer agreement across the 42 images was fair (Fleiss' κ=0.337). Category-specific Fleiss' kappa values were highest for artifact-related rejection (κ=0.474) and image acceptance (κ=0.436), and lowest for blurring (κ=0.068), exposure failure (κ=0.076), incorrect body part (κ=0.107), and incorrect positioning (κ=0.173).</p><p><strong>Conclusion: </strong>Radiographers showed moderate intraobserver consistency but only fair inter-observer agreement when evaluating chest radiograph quality. The findings demonstrate variation in accepting or rejecting chest X-ray image. Collaboration between radiographers and radiologists is recommended to align evaluation standards.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"572-576"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714006","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":"Transabdominal cervical length measurement as primary screening method for short cervix in the mid-trimester: A prospective observational cohort diagnostic accuracy study.","authors":"L P Sii, H Y Voon, B Adam, L N Tan, R Amin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality, with cervical insufficiency being a major contributor. While transvaginal ultrasound is the gold standard, concerns over invasiveness, resource requirements, and acceptability limit its universal use. Transabdominal cervical length measurement may offer a pragmatic alternative, particularly in conservative populations. We aim to compare transabdominal versus transvaginal cervical length measurement for screening of short cervix during the mid-trimester, and to determine the feasibility and clinical utility of using transabdominal ultrasound as a primary screening tool, especially in populations with reservations about undergoing transvaginal scans.</p><p><strong>Materials and methods: </strong>This was a prospective observational cohort diagnostic accuracy study involving pregnant women undergoing routine mid-trimester anomaly scans. Cervical length was measured using transabdominal and transvaginal ultrasound by experienced sonographers.</p><p><strong>Statistical analysis: </strong>correlation assessed with Spearman's coefficient. Agreement evaluated with intraclass correlation and Bland-Altman plots. Diagnostic accuracy metrics (sensitivity, specificity, PPV and NPV) were calculated for transabdominal thresholds. Confounding factors, including bladder filling, maternal body mass index (BMI), and prior caesarean delivery on visualisation, were also evaluated.</p><p><strong>Results: </strong>Of the 266 women eligible to participate in the study, 6.0% were excluded as they declined a transvaginal scan. Postvoid transabdominal (TA) measurements demonstrated better agreement with transvaginal (TV) values but were associated with higher rate of nonvisualization (10.0%). Bland-Altman plots showed good agreement without systematic bias. The mean prevoid TA cervical length and postvoid TA cervical length were 35.7 mm and 35.6 mm respectively, compared to 39.3 mm on TV measurement. Non-visualization occurred more often postvoid (10%) than prevoid (6.4%), while postvoid TA measurements showed stronger agreement with TV (ICC=0.818). Agreement of measurements was higher among Maternal-Fetal Medicine (MFM) consultants than among MFM fellows. Body mass index (BMI) and prior caesarean section scars did not significantly affected visualization or measurement accuracy.</p><p><strong>Conclusion: </strong>TA cervical length measurement is a reliable initial screening approach for identifying women at risk of short cervix during mid-trimester when performed by experienced operators. It serves as a pragmatic alternative in settings where TV scans are declined or not feasible, facilitating timely referral for TV confirmation and early initiation of preventive interventions such as progesterone therapy or cerclage. However, its application may be limited in untrained hands.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"461-465"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714083","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}