Medical Journal of Malaysia最新文献

{"title":"An overview of hyperacute stroke services and National Stroke Registry in Malaysia - Improving stroke care through evidence.","authors":"C J Chin, S A Albart, A H K Yusof Khan, W A Wan Zaidi, N N Sidek, J P Schee, I Looi, F K Hoo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a leading cause of death and disability in Malaysia. This paper provides an overview of the stroke burden, hyperacute stroke services, importance, and challenges of stroke registries. It also details findings from the National Stroke Registry (NSR) Malaysia that have advanced knowledge on local patterns, inequalities and temporal trends in stroke presentation, care processes and outcomes.</p><p><strong>Materials and methods: </strong>A recent survey that involved all the government (Ministry of Health, MOH) and university hospitals in Malaysia was conducted by a group of neurologists and researchers to provide insights into the hyperacute stroke services in Malaysia from 2012 to 2023.</p><p><strong>Results: </strong>The results from the survey found that out of 142 MOH hospitals, 29 (20%) hospitals offer only intravenous thrombolysis (IVT) service, and seven (5%) hospitals offer both IVT and mechanical thrombectomy (MT) services. The majority or two-thirds of MOH hospitals still offer office hour services for both IVT and MT. For university hospitals, four (67%) out of six university hospitals provide both IVT and MT services and one (16%) university hospital provides only IVT service. Most university hospitals offer 24-hour services for IVT and MT. The availability of IVT service across MOH hospitals has increased significantly from 2012 to 2023. Thus, there was a substantial increase in the number of IVT cases treated in MOH hospitals. The growth in MT service has been more gradual. Only 22% of the MOH hospitals that provide hyperacute stroke services are equipped with acute stroke unit (ASU). Whereas ASU is available in 80% of the university hospitals that offer hyperacute stroke services. The higher availability of ASU in university hospitals compared to MOH hospitals may be due to better resources, specialised expertise, and advanced facilities in the university hospitals. The National Stroke Registry (NSR) Malaysia was established in 2009 to monitor stroke management practices, patient outcomes and promote quality improvement initiatives.</p><p><strong>Conclusion: </strong>Despite suboptimal adherence on several key performance indicators, the NSR reports recent improvements in thrombolysis rates, reduced mortality, and better functional outcomes. Key recommendations center on promoting greater participation, feedback systems, adequate funding, and governance structures to translate registry findings into national policies and targeted interventions for equitable access to quality stroke care.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 2","pages":"266-274"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721802","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":"Diagnostic utility of pleuroscopic guided pleural biopsy versus pleural fluid cell block in the diagnosis of malignant pleural effusion.","authors":"B H Ng, H J Low, N N N Abeed, C I Soo, M I Azmi, N S Sharil, R A Osman, M F A Hamid, A Y L Ban","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Pleural biopsy using flex-rigid pleuroscopy or pleural effusion cell block analysis is useful for diagnosing malignant pleural effusion. However, the current literature lacks documented comparisons between pleural biopsies and cytological cell blocks. This study aims to compare the diagnostic accuracy of pleural biopsy and cytological cell block in identifying malignant pleural effusion.</p><p><strong>Materials and methods: </strong>A retrospective review was conducted on patient data from those who underwent pleuroscopy at Hospital Canselor Tuanku Muhriz from January 2021 to December 2023. We included patients with pleural effusion who underwent both cell block and pleural biopsy with a confirmed diagnosis of malignancy through histopathological examination. At least 200 ml of pleural fluid was collected, followed by the biopsy of six or more pleural tissue samples.</p><p><strong>Results: </strong>Out of the 196 pleuroscopy procedures analysed, 91 patients were diagnosed with malignant pleural effusion. Malignancy was diagnosed in 50 (54.9%) cases using cell block analysis, whereas pleural biopsy identified malignancy in 81 (89%) cases. The diagnostic yield was significantly higher for pleural biopsy compared to pleural fluid cell block [89% (81/91) vs. 54.9% (50/91); p < 0.001]. Among patients with negative results on pleural fluid cell block, 33 (36.3%) had positive results on pleural biopsy. The definitive diagnoses of malignancy included 64 (70.3%) cases of lung adenocarcinoma, 4 (4.4%) cases of lung squamous carcinoma, 2 (2.2%) cases of small cell lung cancer, 2 (2.2%) cases of mesothelioma, and 19 (20.9%) cases of metastatic carcinoma. Eight (8.8%) patients exhibited negative findings on both pleural fluid cell block and pleural biopsy. Further diagnoses were achieved through computed tomography-guided needle tru-cut biopsy of the lung in 6 patients (6.6%), transbronchial lung biopsy in 1 patient (1.1%), and cervical lymph node biopsy in 1 patient (1.1%).</p><p><strong>Conclusion: </strong>Pleural biopsy exhibits superior diagnostic accuracy compared to pleural fluid cell block analysis for malignant pleural effusion. In cases where cell block results are negative but suspicion remains high, pleural biopsy remains a crucial diagnostic tool.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 2","pages":"168-173"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721823","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":"A 15-year experience with keratoplasty in the management of paediatric corneal diseases: indications and clinical outcomes in Malaysia.","authors":"Y Z Wai, R Alias, N A Bahari, T Umapathy, S I Hosnaliza, J Rahmat","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Corneal blindness is a leading yet preventable cause of childhood blindness worldwide. Despite the need for corneal transplantation in paediatric cases, comprehensive data on its aetiology, clinical outcomes, and graft survival in Malaysia remain scarce. This study reviews the indications and outcomes of paediatric keratoplasty at Hospital Kuala Lumpur over the past 15 years.</p><p><strong>Materials and methods: </strong>We conducted a retrospective evaluation of paediatric patients (less than 12-years-old) who underwent keratoplasty in Hospital Kuala Lumpur, from January 2008 to December 2022. We analysed demographic data, preoperative diagnoses, types of keratoplasty performed, and the 1-year graft survival rate.</p><p><strong>Results: </strong>100 eyes from 95 patients were included in the study, with a mean age of 4.39 ±3.32 years. The indications for keratoplasty included limbal dermoid (45%), anterior segment dysgenesis/Peter's anomaly (22%), infective keratitis (14%), congenital glaucoma (4%), and other pathologies (15%). 31/100 (31%) had corneal perforation. Of the patients, 56% underwent lamellar keratoplasty (LK), while 44% underwent penetrating keratoplasty (PK). Complications included wound dehiscence (4%) and graft melting (3%). 77% completed 1-year follow-up, and the overall 1-year graft survival rate was 54.5%. Limbal dermoid showed a better graft survival rate (72.2%) compared to other pathologies (39%), with a p-value of 0.004. LK has a higher 1-year graft survival rate of 66% compared to PK (36.7%) with a p-value of 0.003. Among the cases of perforated corneas, an overall 1-year graft survival rate of 25.8% (8/31) was observed, which was significantly lower compared to eyes without corneal perforation 73.9% (34/46) with a p-value of 0.008.</p><p><strong>Conclusions: </strong>Limbal dermoid was the most common indication for paediatric keratoplasty, and it exhibited a better graft survival rate compared to other pathologies. A one-year graft survival rate varies among different indications of keratoplasty. Perforated cornea has a lower graft survival rate compared to non-perforated corneal pathology.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 2","pages":"141-146"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721799","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":"Non-statin therapy in patients with elevated LDL-C and high platelet reactivity: a narrative review.","authors":"F N Nurmukhammad, B Zhangelova Sh, D A Кapsultanova, A T Musagaliyeva, L B Danyarova, F E Rustamova, A B Sugraliyev, G E Ospanova","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence of an association between elevated LDL-C levels and HRPR - which are highly prevalent separately and both lead to rapid progression of atherosclerosis on ineffective hypolipidaemic therapy - is scarce.</p><p><strong>Materials and methods: </strong>We searched electronic databases. All available randomized controlled trials (RCTs) were included, and we considered the scientific novelty of the study, the reliability of the reported study results; the high methodological level of the study of non-statin therapy in patients with dyslipidemia and high residual platelet reactivity, with no language or date restrictions. We did separate random-effects meta-analyses for LDL-С, HRRP on their effects on LDL-С levels and outcomes, taking into account the reliability of the reported study results and the high methodological level of the study. The challenge of achieving target LDL-С levels, their impact on high residual platelet reactivity, and the choice of optimal antiplatelet and lipid-lowering therapy remains unresolved.</p><p><strong>Results: </strong>The integration of newer therapies, such as inclisiran and PCSK9 inhibitors, may play a critical role in achieving optimal outcomes for patients at high cardiovascular risk.</p><p><strong>Conclusion: </strong>The necessity of applying an individual multidisciplinary approach in order to determine the best regimen of antiplatelet and lipid-lowering therapy in patients with coronary heart disease, including after revascularization, is shown. This approach will reduce the risk of recurrent cardiovascular events. Few studies on the relationship between LDL-С and HRPR dictate the need for more detailed research in this area.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 2","pages":"258-265"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721871","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":"Cross-cultural adaptation and validation of the Malay Adult cirrhosiS Knowledge Questionnaire (ASK-QM).","authors":"H K Leung, S Mahadeva, R B Rajaram, H Omar, P S M Lai","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Cirrhosis is common in Malaysia, but no questionnaire in the local language (Malay) has been developed to assess patients' knowledge of this disease. This study aimed to adapt and validate the Malay Adult cirrhosiS Knowledge Questionnaire (ASK-QM).</p><p><strong>Materials and methods: </strong>ASK-QM was translated from English to Malay according to international guidelines. It was validated among cirrhotic patient who understand Malay language from two major liver centers in Klang Valley, Malaysia (University of Malaya and Hospital Selayang) from January 2021 to March 2022, at week 0 and 2. Patients with hepatic encephalopathy were excluded.</p><p><strong>Results: </strong>121 out of 132 patients with cirrhosis agreed to participate (response rate=91.7%). The overall median score of the ASK-QM was 54.5 [38.6-68.2] and the difficulty factor was 0.5 (range: 0.1-0.8 for each domain). Confirmatory factor analysis showed a good model fit with results of Comparative fit index (CFI) ranging from 0.836 to 1.000, whilst, the Tucker-Lewis index (TLI) ranged from 0.690 to 1.004 across all four domains. The root mean square error of approximation (RMSEA) value was reported from 0.000 to 0.100. For standardized root mean squared residual (SRMR) was from 0.008 to 0.015. Patients with tertiary education scored higher compared to those without (63.6 [45.5-77.3] vs 52.3 [36.4-63.6], p<0.05). The overall Kuder-Richardson (KR) coefficient was 0.761 indicating adequate internal consistency. Test-retest among 82 out of 121 patients (response rate=67.7%) demonstrated adequate reliability with eighteen out of 22 items having Wilcoxon signed-rank test values that were statistically not significant, p>0.005.</p><p><strong>Conclusion: </strong>The ASK-QM was found to be a valid and reliable questionnaire for evaluating knowledge of liver cirrhosis amongst Malay-speaking adults.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 2","pages":"118-126"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721818","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 mediating effect of mental health status between self-system and sexual risk behaviour among university students in Malaysia.","authors":"S M Azlan, F Mohamad, A I N Mohd Nazan, R Dahlan, K N Kamaruddin, N A Shibraumalisi, S N Syed Mohamad, I Z Ismail, H Kadir Shahar, N H Shamsuddin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Young adults' engagement in sexual risk behaviour (SRB) is a growing concern worldwide. Addressing this issue is crucial as it can lead to various detrimental effects on individuals, including psychological, behavioural, and, in severe cases, suicidal tendencies and mortality. This nationwide study aimed to determine the mediating roles of depressive, anxiety, and stress symptoms in the relationship between adverse childhood experiences (ACE), religiosity, knowledge on sexuality, attitude towards premarital sex, and SRB among young Malaysian adults using structural equation modelling (SEM).</p><p><strong>Materials and methods: </strong>A quantitative, cross-sectional design was employed in this study. Respondents were recruited from June to December 2021 among students attending higher education institutions in Malaysia. Institutions were sampled using stratified random sampling and the respondents were selected via convenience sampling. Data were collected via an online survey that inquired about respondents' socio-demographic characteristics, ACE, religiosity, knowledge on sexuality, attitude towards premarital sex, mental health status (MHS), and engagement in SRB. The data were analysed using SPSS version 27 for descriptive analysis, and SPSS AMOS version 27 for structural equation modelling (SEM) analysis.</p><p><strong>Results: </strong>A total of 1171 respondents were recruited in this study. From the SEM analysis, the proposed model indicated a good fit, and it explained 26% of the SRB variance. There was a partial mediation effect of the relationship between ACE on SRB through MHS (p<0.05), as well as religiosity on SRB through MHS (p<0.05). There was no significant mediation effect was found for the other variables.</p><p><strong>Conclusion: </strong>This study highlighted the mediation effect of MHS between ACE on SRB, as well as between religiosity and SRB. Apart from addressing ACE and religiosity of the young adults, MHS should also need to be explored when dealing with SRB issues and vice versa. Preventive measures should be considered at younger stage to prevent high risk behaviour among young adults.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 2","pages":"183-190"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721875","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":"Frequency of computer vision syndromes among students during COVID-19 lockdown - a single school study in Malaysia.","authors":"J Y Liew, P T Yong, H N Lee, A V P Loo, V Subrayan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>To determine the frequency of computer vision syndromes among students during COVID-19 lockdown in Malaysia.</p><p><strong>Materials and methods: </strong>This is a cross-sectional survey study. A total of 145 subjects studied in secondary school and pre-university programme were involved in this study. An exploratory survey questionnaire was used to assess the symptoms of computer vision syndromes encountered by the students and their electronic device usage behavior before and during fully remote learning started.</p><p><strong>Results: </strong>Average time spent by students on outdoor activities reduced from one to two hours per day (40.7%) to less than an hour per day (56.6%) after fully remote learning. Average time spent on entertainment activities using electronic devices increased from one to two hours per day (38.6%) to four hours and above per day (40.0%) after fully remote learning. The majority of time spent on school assignments using electronic devices increased from one to two hours (44.8%) to three to four hours per day (33.8%) after fully remote learning. Increased frequency of students experienced eye pain (44.1%), eye fatigue (57.2%), headache (56.6%), eye itchiness (18.6%), glare (31.7%), dry eye (40.0%), blurry vision (31.7%) and double vision (7.6%) after fully remote learning began.</p><p><strong>Conclusion: </strong>An observed increase frequency of computer vision syndrome was noted in relation to the reduction of time spent on outdoor activities and increased usage of electronic devices for entertainment activities and completing school assignment during COVID-19 lockdown in Malaysia.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 2","pages":"235-244"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721850","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":"Relationship between statin use and depression among diabetic patients in Seremban: a cross-sectional study.","authors":"S V Pannir, Z F Zakaria, K V Surendren, Y S Kok, Q L Phua, Q H Roslan, R H Singh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Statins are one of the most commonly used drugs in primary care. Both hyperlipidaemia and diabetes have independently shown statistically significant association with depression. Conversely, patients with depression have also been shown to have increased comorbidity with and poorer control of both diabetes and hyperlipidaemia.</p><p><strong>Materials and methods: </strong>A retrospective cross-sectional study was conducted for about 7 months (from 23 January 2024 to 9 August 2024) among adult Type 2 diabetic patients in the non-communicable disease section of Seremban Health Clinic to determine the association between statin use and depression. The data was collected via interviewerguided questionnaire that consisted of 5 sections: Section A (Participant Information), Section B (Depression, Anxiety and Stress Scale 21 [DASS-21]), Section C (Beliefs about Medicines Questionnaire [BMQ]), Section D (Malaysia Medication Adherence Assessment Tool [MyMAAT]) and Section E (Patient Health Questionnaire-9 [PHQ-9]). Consecutive patients that met inclusion and exclusion criteria who consent to be involved in the study were sampled. Although the ideal sample size that was required is 242, only 82 participants were enrolled in this study. These participants were also part of the Seremban Diabetes cohort study.</p><p><strong>Results: </strong>Since only 82 participants consented to be part of this study, the response rate was 33.9%. About 25% of patients had depression. As the statin dosage intensity increased, the prevalence of depression also increased but this was not statistically significant. Based on Pearson's chi square test, only stress (p<0.001), anxiety (p=0.002), beliefs about medicines (p=0.010) and marital status (p=0.039) had a statistically significant association with depression. Upon adjusted logistic regression of the 4 factors (marital status, stress, anxiety and belief about medicines), only stress (OR 14.000, 95% CI 2.682 - 73.076, p=0.002) was statistically significant.</p><p><strong>Conclusion: </strong>The association between depression and statin use among patients with Type 2 diabetes mellitus is not statistically significant. Further studies are needed to confirm the cause of depression in this group of patients.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 2","pages":"191-198"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721873","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":"Exploring psychosocial needs of young women with breast cancer in a country with crisis: a mixed-methods study.","authors":"S Hasan, K S Chew, R V Vincent, S S L Wong","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Previous research conducted in politically stable countries showed that the diagnosis and treatment of breast cancer among young women can be very distressing and devastating and may result in a lot of unmet psychosocial needs affecting their quality of life. This study aimed to address the psychosocial needs of young women with breast cancer in war-torn Syria.</p><p><strong>Materials and methods: </strong>A mixed-methods explanatory sequential design was employed in this study. Initially, a quantitative survey was conducted for 3 months from May to July 2022 on 167 young women using the Psychological Needs Inventory to identify their psychosocial needs. Secondly, a qualitative, semi-structured interview was conducted for 6 months from July to December 2022 with 11 participants to explore the challenges faced in meeting these needs.</p><p><strong>Results: </strong>The quantitative results showed that three items, \"Help with financial matters\", \"Advice about food and diet\", and \"Help with transport\", were identified as significant unmet psychosocial needs. All three items fall within the category of practical needs. The qualitative results identified five themes: (1) challenges of adequate information needs with five subthemes (inadequate communication with the health professionals, lack of educational programs and awareness campaigns, inadequate number of nurses, need for nutritionists, and effects of unmet informational needs); (2) psychological challenges with five subthemes (uncertainty of the future, fear concerning the children, fear of death, treatment-related effects and the loss of a woman's identity, and inadequate psychosocial care); (3) financial challenges with 2 subthemes (treatment not available and expensive, low incomes and high cost of living); (4) social influences with 2 subthemes (society's view and stigma, lack of marriage choices); and (5) environmental stressors with 2 subthemes (stressful hospital environment and situational factors).</p><p><strong>Conclusion: </strong>These psychosocial needs identified were found to align with Maslow's hierarchy of needs, underscoring a cascading effect of the Syrian crisis across various dimensions of well-being. Young breast cancer women living in countries with crises have high levels of unmet psychosocial needs.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 2","pages":"153-160"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721775","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":"Characteristics and outcomes of out-of-hospital cardiac arrest cases responded by emergency medical services across three states in Malaysia.","authors":"A K Sarah, M S Mohd Sidqi, J Md Noor, K D Wong, K M Umul, M Y Low, B Y Chia, F S A Sharifah, A W Mahathar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>IOut-of-hospital cardiac arrest (OHCA) is globally a critical, time-sensitive emergency with varying outcomes. In Asia, the Pan Asian Resuscitation Outcome Study reported survival rates between 0.5% to 8.5%. We aim to describe the characteristics and outcomes of OHCA cases responded to by Emergency Medical Services (EMS) across several cities in Sarawak, Penang and Klang Valley in Malaysia.</p><p><strong>Materials and methods: </strong>This retrospective observational study analysed EMS data from Sarawak, Penang and Klang Valley from 2010 to 2019. All OHCA cases where EMS performed cardiopulmonary resuscitation (CPR) were included, regardless of age or aetiology. The primary outcome was survival to hospital admission with the secondary outcome a return of spontaneous circulation (ROSC) prior to Emergency Department arrival.</p><p><strong>Results: </strong>A total of 2,435 OHCA cases were analysed. Median patient age was 58 years, 70% of them are male with 63% had underlying medical conditions, with hypertension being the most common. Out of all cases, 71% of arrests occurred at home, 60% witnessed. Median time from arrest to 999 call was 20 minutes, median time for ambulance arrival thereafter is 17 minutes. Bystander CPR rate was 38%, bystander Automated External Defibrillator (AED) use 1.5- 2.6%. Detection of shockable rhythm on first analysis by EMS was 3.9 to 7.7%. Overall survival to admission rate was 4.76%. ROSC rate before Emergency Department arrival was 2.8%. Survival to admission among bystander-witnessed arrests with shockable rhythm was 14.7%.</p><p><strong>Conclusion: </strong>Survival to admission rates for OHCA patients in the studied Malaysian regions (1.3-6.7%) are lower compared to some Asian countries. Areas for improvement include reducing time from arrest to 999 calls, decreasing time to EMS arrival, and increasing bystander CPR and AED use rates. Implementing the Utstein ten-step implementation strategy, focusing on community-based interventions and improving EMS response, could potentially enhance survival rates in Malaysia.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 2","pages":"147-152"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721805","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}