Medical Journal of Malaysia最新文献

{"title":"Routine abdominal drainage versus no drainage after elective hepatectomy: A systematic review and meta-analysis.","authors":"H Zhang, H Xu, D Song, L Ba","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The value of routine abdominal drainage after hepatectomy remains controversial. Although drains have traditionally been used to detect bile leakage or postoperative bleeding and to evacuate intra-abdominal collections, their routine use after elective liver resection has increasingly been questioned.</p><p><strong>Materials and methods: </strong>A systematic review and metaanalysis of randomized controlled trials comparing routine abdominal drainage with no drainage after elective hepatectomy was performed. PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library were searched from inception to 1 April 2026 using predefined terms related to hepatectomy, drainage, and randomized trials. The outcomes of interest included overall postoperative morbidity, postoperative mortality, wound-related complications, bile leakage or biliary fistula, subphrenic or perihepatic fluid collection, and length of hospital stay. Risk of bias was assessed using the Cochrane RoB 2 tool.</p><p><strong>Results: </strong>Six randomized controlled trials involving 1,025 patients were included, with 513 patients allocated to routine drainage and 512 to no drainage. Routine drainage was associated with higher overall postoperative morbidity (RR 1.41, 95% CI 1.16-1.71; I² = 32.5%) and more wound-related complications (RR 2.75, 95% CI 1.56-4.86; I² = 36.1%). Postoperative mortality remained low and did not differ significantly between groups (RR 1.20, 95% CI 0.50-3.00; I² = 0%). Reported bile-leakage events were more frequent in the drainage group (RR 5.02, 95% CI 1.53-16.48; I² = 0%); however, this outcome is highly susceptible to ascertainment bias because the opportunity to detect bile leakage differs according to drain status. Subphrenic/perihepatic collection did not differ clearly between groups (RR 1.02, 95% CI 0.48-2.15; I² = 71.4%). Length of hospital stay showed a small pooled difference favoring drainage (MD -0.35 days, 95% CI -0.50 to -0.20), but between-study heterogeneity was substantial (I² = 82.3%) and the trial-level directions were inconsistent.</p><p><strong>Conclusion: </strong>Current randomized evidence does not support routine abdominal drainage after elective hepatectomy, particularly in uncomplicated or standard-risk cases. A selective rather than routine strategy appears more appropriate, and the apparent bile-leakage signal and hospital-stay result should be interpreted in light of ascertainment bias, outcome-definition differences, and substantial between-study heterogeneity.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"795-802"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081622","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":"Cost analysis of returned medicines at the outpatient pharmacy of a Malaysian state hospital.","authors":"C A Wei, S Sharizan, M N M Mohd Hatta, C L Jurisma","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Returning unused medications to pharmacies is encouraged to reduce environmental pollution and safety hazards. However, this practice can impose financial losses on public health providers due to wasted drug supplies. This study aimed to quantify the costs of returned medicines at a Malaysian state hospital outpatient pharmacy and to characterise the returned items by therapeutic class and procurement category.</p><p><strong>Materials and methods: </strong>This was a prevalence-based, bottom-up cost-analysis study of all solid medicines at the outpatient pharmacy of Hospital Tuanku Fauziah from May to October 2023. Returned items (tablets/capsules) were collected, identified by WHO Anatomical Therapeutic Chemical (ATC) class and hospital's Always Better Control (ABC) inventory group, and recorded. Acquisition costs were obtained from hospital procurement records, and retail values were estimated using the Malaysian Consumer Price Guide. Disposal cost was calculated based on the contracted waste service. Descriptive statistics were used to summarise quantities and costs.</p><p><strong>Results: </strong>The total government acquisition cost for returned medicines was RM18,487, with a retail replacement value of RM101,300. The top five returned medicines by quantity were metformin (14.3%), atorvastatin (6.9%), calcium carbonate (5.3%), ferrous fumarate (3.8%) and trimetazidine MR (3.8%). The top three pharmacological groups returned were cardiovascular system (39.6%), alimentary/endocrine (31.7%), and blood and blood-forming organs (10.9%). Group A medicines, according to ABC analysis, constituted the highest return in both acquisition cost (66.8%) and quantity (34.1%). The median (IQR) acquisition and retail values of medicines returned per month were RM5,429 (8,010) and RM19,609 (12,027), respectively. The monthly disposal cost ranged RM22.32-55.80 (excluding transportation fees).</p><p><strong>Conclusion: </strong>Returned medicines lead to significant financial losses from both medication wastage and disposal for public providers. Shorter refill durations, medication adherence support, deprescribing and controls on highvalue ABC group A items could reduce wastage.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"639-643"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082399","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":"Pharmacological and non-pharmacological interventions of insomnia in geriatrics: A systematic review.","authors":"M S E Shalihin, M A N Abdul Aziz, S I Sharin","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Insomnia is the most prevalent sleep disorder in the geriatric population, affecting 30-48% of communitydwelling older adults and higher proportions in residential care settings. Its management is complicated by age-related pharmacokinetic changes, polypharmacy, and disproportionate risks associated with traditionally prescribed hypnotic agents. This systematic review and meta-analysis synthesise contemporary evidence to address two key clinical questions: (1) what pharmacological agents are effective and safe for treating insomnia in older adults; and (2) what non-pharmacological interventions demonstrate efficacy in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, 215 records were identified across major health databases including PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar. After removing duplicates (n=62), 153 unique records were screened via title and abstract. Full-text evaluation was conducted on 23 articles, which were appraised using the Cochrane Risk of Bias tool (RoB 2) and AMSTAR-2. Following the explicit exclusion of one clinical guideline document to preserve analytical matrix consistency, 22 unique studies were included in the final qualitative synthesis. Quantitative synthesis employed random-effects models with heterogeneity evaluation via Cochrane's Q and I&lt;sup&gt;2&lt;/sup&gt; statistics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For pharmacological management, dual orexin receptor antagonists (DORAs) specifically suvorexant, lemborexant, and daridorexant demonstrated the most favorable efficacy-safety balance across evaluated randomised-control trial (RCT) data, yielding a highly consistent effect size for sleep initiation with low heterogeneity (Subjective Time to Sleep Onset (sTSO) Standardized Mean Difference (SMD): -0.28, 95% Confident Interval (CI): -0.41 to -0.15; I&lt;sup&gt;2&lt;/sup&gt;=22%). Benzodiazepines and Zdrugs were associated with significant fall risks (Risk Ratio ~1.47), cognitive decline, and are classified as potentially inappropriate medications. For non-pharmacological management, face-to-face cognitive behavioral therapy for insomnia (CBT-I) demonstrated clinically significant improvements across 14 RCTs, including sleep efficiency (MD +8.36%; 95% CI: 5.96-10.76) and wake after sleep onset (wake after sleep onset (WASO) Mean Difference (MD) -23.44 min; 95% CI: -32.41 to -14.47), though statistical heterogeneity was high (I&lt;sup&gt;2&lt;/sup&gt;=85%), reflecting variations in Sleep Restriction Therapy adaptation. Digital CBT-I, music therapy (SMD-0.79), and structured exercise also demonstrated substantial benefits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;CBT-I remains the evidence-based first-line treatment for geriatric insomnia. DORAs represent the safest pharmacological option when medication is mandatory, while benzodiazepines and Z-drugs must be actively deprescribed. A multimoda","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 5","pages":"787-794"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082337","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":"Ear, nose and throat foreign bodies: A cross sectional study on incidence, clinical factors and dimensions.","authors":"H S Gendeh, B S Goh","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Ear, nose and throat (ENT) foreign body (FB) is common problem with significant morbidity and mortality. They are classified into organic or inorganic. Aerodigestive FBs are responsible for suffocation and death up to three years old with a 10% mortality up to 14 years old in Europe. Malaysia lacks local data that quantifies FB in dimensions to predict its risk. The study objectives were to determine the incidence of ENT FBs (paediatric and adult) in a Malaysian tertiary referral center; to determine the association between the FB types and factors contributing to its occurrence (largest dimension, volume, witnessed); to determine the treatment required; and association between hand dominance with ENT FBs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Prospective data of all children (&lt;18 years old) and adults (≥18 years old) seen by the ENT physicians presenting with ENT foreign body were included over 12 months at Hospital Canselor Tuanku Muhriz (HCTM) from 1st February 2017 to 31st January 2018. All cases are seen by an ENT doctor (specialist and/or medical officer) during on-call, in hospital and outpatient's referrals. FB dislodged in the lower airways (trachea, bronchus and bronchiole) and upper gastrointestinal (GI) tract (oesophagus) were included. Exclusion criteria were FB dislodged in non-ENT orifices such as the stomach and beyond with no other ENT FBs. Bias was reduced by a proforma after obtaining an informed consent and taking the average of three measurements of FB dimensions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The incidence of ENT FB within HCTM was 3.5% (overall), 1.9% (organic), 1.6% (inorganic); 1.65% (children) and 1.85% (adults). Children have a mean age of 5.34 and adults 49.35 years. Among the patient factors; children FB are often inorganic (73.95%; plastic, metal, graphite), males predominant (56.5%), unwitnessed (66.67%), witnessed incidents were by adults (69.5%) at home (91.3%). Adult FB are often organic (77.1%; fish bone, cotton, tick), male to female ratio 1.4:1; not associated with occupation. Mackerel followed by red snapper and tilapia were common fish bones ingested. Common locations of FB among children and adults were throat (35.3%), ear (32.03%) and nose (26.14%). Less than one fifth required hospitalization due to aerodigestive FBs with 6 (72.7%) of hospitalised patients suffering complications of hypoxic brain injury, lung collapse, pneumonia, esophageal perforation and lacerations. Fifty-seven (37.25%) patients (adults predominant) required endoscopic removal under general or local anaesthesia. The side of ear and nose FB to hand dominance was significant (p&lt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;ENT FB are more common in the ear and nose in children; not witnessed, located in the oropharynx and occurred at home and during playtime. Organic FB and fish bones were common among adults in the Malaysian population. Aerodigestive FBs are associated with hospitalization, compli","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"564-571"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713892","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 self-care and psychosocial readiness among hypertensive patients: Implications for nursing in low-resource settings.","authors":"N P A R Dewi, Nursalam, N L P I B Agustini, N W S Wahyuni, K A N Putra","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Self-care behaviour, motivation, and selfefficacy represent related but distinct dimensions of hypertension self-management. Previous Indonesian studies have generally examined self-care behaviour as the primary outcome or treated motivation and self-efficacy as its explanatory factors. Evidence describing the outcomespecific associations of sociodemographic and clinical characteristics with these three domains remains limited. This study examined the associations of selected sociodemographic and clinical characteristics with self-care behaviour, motivation, and self-efficacy among adults with hypertension.</p><p><strong>Materials and methods: </strong>This analytical cross-sectional study included 120 adults with hypertension attending the Gianyar 1 Community Health Centre, Bali, Indonesia, between August and September 2024. Participants were selected from an eligible patient registry using simple random sampling. Self-care behaviour, motivation, and selfefficacy were measured using the validated Indonesian version of the High Blood Pressure Self-Care Profile. Bivariate comparisons were followed by three separate multiple linear regression models.</p><p><strong>Results: </strong>The mean scores were 44.09 (95% confidence interval [CI] 42.44-45.74) for self-care behaviour, 44.64 (95% CI 42.56-46.72) for motivation, and 42.99 (95% CI 41.21- 44.78) for self-efficacy. The self-care behaviour model was statistically significant (R²=0.375; adjusted R²=0.304; p<0.001). Higher self-care behaviour scores were observed among participants aged 41-50 years and private-sector employees, whereas lower scores were observed among participants with no formal schooling, junior high school education, and a hypertension duration of 1-5 years. The motivation model was also statistically significant but had lower explanatory value (R²=0.186; adjusted R²=0.094; p=0.028). Participants aged 41-50 years had higher motivation scores, whereas those with junior high school education had lower scores. The overall self-efficacy model was not statistically significant.</p><p><strong>Conclusion: </strong>Associations were observed mainly for selfcare behaviour and motivation, whereas the examined characteristics did not collectively explain self-efficacy. These findings support individualised assessment of behavioural, motivational, and confidence-related needs in primary care. Causal relationships cannot be inferred from this cross-sectional study.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"577-585"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713940","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":"Comparing failure rate and complications between Seldinger and conventional chest drainage techniques in pneumothorax: A retrospective cohort study.","authors":"S K Ing, Y H Lee, J S Y Lee, N H Ngu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Chest drainage remains an important intervention for pneumothorax when conservative or ambulatory management is not suitable. Although chest drain techniques have been widely studied, contemporary real-world data from Southeast Asia remain limited, particularly in populations with a high burden of secondary pneumothorax related to infectious lung disease.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study of adult pneumothorax patients who underwent intercostal chest drain insertion at Sibu Hospital, Sarawak, Malaysia, between January 2021 and February 2024. Patients were managed with either conventional trocar chest tubes or Seldinger wire-guided drains. The primary outcome was chest drain-related complications. Secondary outcomes included chest drain duration, hospital length of stay, persistent air leak (PAL >5 days) and mortality. Continuous variables were analysed using independent ttests and categorical variables using chi-square or Fisher's exact tests. Multivariate logistic regression was performed to identify predictors of subcutaneous emphysema, and multiple linear regression was used to evaluate factors associated with chest drain duration.</p><p><strong>Results: </strong>A total of 123 patients were included (86 conventional and 37 Seldinger). Subcutaneous emphysema occurred significantly less frequently in the Seldinger group (5.4% vs 55.8%, p<0.001). Mean chest drain duration was shorter in the Seldinger group (8.86 ± 7.10 vs 10.34 ± 11.96 days, p=0.032). Differences in insertion failure (0% vs 8.1%, p=0.074), tube dislodgement (2.7% vs 11.6%, p=0.112), persistent air leak >5 days (67.6% vs 54.7%, p=0.182) and mortality (10.8% vs 15.1%, p=0.518) were not statistically significant. Multivariate logistic regression identified conventional chest drainage as an independent predictor of subcutaneous emphysema (OR 27.6, 95% CI 5.24-145.94; p<0.001). Multiple linear regression demonstrated that conventional drainage, non-tension pneumothorax, smoking and persistent air leak were independently associated with longer chest drain duration.</p><p><strong>Conclusion: </strong>In this retrospective cohort, the Seldinger technique was associated with lower complication rates and shorter drainage duration compared with conventional chest drainage. Prospective multicentre studies are required to confirm these findings.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"548-553"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713992","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":"Awareness and disposal practices of unused or expired medications among patients with type 2 diabetes in Ipoh, Malaysia.","authors":"M M Theingi, S P Aung, M A Win, R Yusuf, A Z Arman, E S Satar, H N Badrul","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Improper disposal of unused or expired medications poses significant public health and environmental risks. Despite Malaysia's \"Return Your Medicines Program,\" improper disposal practices persist, particularly among Type 2 diabetic patients on long-term therapies. This study aimed to determine awareness and disposal practices of unused or expired medications among Type 2 diabetic patients in Ipoh and identify factors influencing improper disposal.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted at three government clinics in the Kinta District of Ipoh, Malaysia. Data were collected from 241 participants using structured questionnaires and analysed using descriptive statistics and Pearson's chi-square tests.</p><p><strong>Results: </strong>A total of 34.4% of respondents reported having unused or expired medications, primarily due to overprescription (36.1%). Among the diabetic patients surveyed, 68% demonstrated satisfactory awareness regarding the disposal of unused prescribed medications, while 32% showed unsatisfactory awareness. In terms of disposal practices, 43.37% of participants followed proper methods, whereas 56.63% engaged in poor disposal practices. A statistically significant association was observed between the level of awareness and the disposal practices adopted by the participants(p=0.000). It is recommended that health authorities enhance public education campaigns and implement accessible, wellpublicized medication take-back programs to promote proper disposal of unused or expired medicines.</p><p><strong>Conclusion: </strong>The study identifies a strong association between awareness levels and proper disposal practices of unused or expired medications, emphasizing the need for targeted educational initiatives to promote safe disposal among patients.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"455-460"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714021","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":"Psychosocial and health system factors associated with tuberculosis treatment adherence in Kota Kinabalu, Sabah.","authors":"V Ganesan, H G Jastin, S Jayaraman, S Gangatharan, R Avoi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment adherence remains a major challenge in tuberculosis (TB) control and may be influenced by psychosocial and health system factors that remain underexplored in many settings. This study aimed to examine the association between psychosocial and health system factors and treatment adherence among TB patients in Kota Kinabalu, Sabah.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted among 351 TB patients registered in the National TB Registry between 2023 and 2024. Data were collected using structured, validated, and translated questionnaires, including the TB Stigma Scale and the Patient Health Questionnaire-9 (PHQ-9). Variables included sociodemographic characteristics, TB knowledge, treatment-related factors, and healthcare system factors. Simple and multivariable logistic regression analyses were performed to identify factors of treatment adherence.</p><p><strong>Results: </strong>Stigma was negatively associated with treatment adherence (AOR=0.90; 95% CI: 0.86-0.95; p<0.001), whereas higher TB knowledge was associated with higher treatment adherence (AOR=1.20; 95% CI: 1.06-1.35; p=0.004). Compared with video directly observed therapy (VDOT), healthcare worker (HCW)-supervised direct observed treatment short-course (DOTS) was associated with lower treatment adherence (AOR=0.23; 95% CI: 0.06-0.90; p=0.030). Longer clinic waiting time was associated with higher treatment adherence (AOR=1.09; 95% CI: 1.05-1.13; p<0.001). Depression was negatively associated with adherence in univariate analysis but was not statistically significant in the multivariable model (AOR=0.58; 95% CI: 0.21-1.58; p=0.285).</p><p><strong>Conclusion: </strong>Stigma, TB knowledge, DOTS modality, and clinic waiting time were independently associated with TB treatment adherence in this setting. These findings highlight the importance of integrated, patient-centered TB care that addresses stigma, strengthens patient education, and incorporates digital approaches such as VDOT. Strengthening multifaceted interventions targeting both psychosocial and health system factors may improve TB treatment outcomes in Malaysia and similar high-burden settings.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"413-420"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714152","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":"Beyond the treatment episode: Closing gaps across the continuum of care.","authors":"K S Chew, B S Liew","doi":"","DOIUrl":"","url":null,"abstract":"<p><p></p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"407-408"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713981","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 presentation of aspergillus and candida in otomycosis: A cross-sectional study at a tertiary hospital in Central Java, Indonesia.","authors":"A B Darmawan, N Krisniawati, B J Darmayan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Otomycosis is a common fungal infection of the external auditory canal, particularly in tropical regions. Aspergillus and Candida are the main causative agents, yet their clinical differentiation remains challenging due to overlapping manifestations. This study aimed to identify the distribution of fungal etiologies, and to compare clinical manifestations and predisposing factors between Aspergillus and Candida infections in a tertiary hospital in Central Java, Indonesia.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted at a tertiary hospital, including patients aged 17 years and above with clinically and microbiologically confirmed otomycosis. Demographic data, symptoms, physical findings, and predisposing factors were collected. Fungal identification was performed using culture and microscopy. Comparative analyses were conducted using chi-square or Fisher's exact test.</p><p><strong>Results: </strong>A total of 41 patients (56 fungal isolates) were included. Aspergillus spp. accounted for 58.9% of isolates, while Candida spp. comprised 41.1%, with mixed infections observed in 16.1%. Itching, hearing loss, and ear fullness were the most common symptoms in both groups. No statistically significant differences were found in clinical manifestations or physical examination findings between Aspergillus and Candida infections (all p>0.05). Although whitish debris was more frequent in Candida and brownish debris in Aspergillus, these patterns were not discriminatory. Ear drop use and cotton bud manipulation were significantly associated with Aspergillus infections (p<0.05).</p><p><strong>Conclusion: </strong>Substantial clinical overlap exists between Aspergillus and Candida otomycosis, underscoring the importance of microbiological confirmation for accurate diagnosis.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"477-482"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714045","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}