Medical Journal of Malaysia最新文献

{"title":"Exploring the integration of Islamic practice in a tertiary shariah-compliant hospital: A qualitative study.","authors":"N Mohd Yusof, S Saidi, M A Mahmood, S S Suhaimey, A Anuar, A Padela","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Shariah-compliant and ibadah-friendly hospitals have been established in the Malaysian healthcare system for nearly two decades to support the religious needs of Muslim patients. In parallel, the Islamic input in the medical program curriculum has been designed to train healthcare professionals, particularly doctors, to integrate Islamic principles into their medical expertise, as they are expected to incorporate Islamic values into their daily practice. However, the practice of doctors with this Islamic integrated medical curriculum has not been thoroughly investigated. Thus, to what extent they embodied the Islamic values within their practice and the challenges they faced in realising this is not known. Therefore, this study aimed to explore the experiences of doctors and patients related to the integration of Islamic principles within Shariahcompliant hospital services.</p><p><strong>Materials and methods: </strong>A single-site qualitative case study design was employed, recruiting 20 doctors and 18 adult patients receiving treatment in the Orthopaedic wards and clinic of a Shariah-compliant teaching hospital. In addition, 19 relevant documents have been sampled and included. The study was conducted using multiple data collection methods including individual in-depth interviews, nonparticipant observations and document analysis between June 2023 and February 2024. The data analysis was done according to framework technique facilitated by NVivo software version 5.</p><p><strong>Results: </strong>Four key themes emerged: (1) fulfilling religious and spiritual needs through clinical interactions and services; (2) practising therapeutic communication guided by Islamic values such as compassion, honesty, and patience; (3) upholding privacy, dignity, and autonomy in patient care; and (4) the importance of an effective training program and a sustainable working environment. Doctors expressed varying levels of confidence and consistency in applying Islamic principles, often influenced by personal understanding, workload, and institutional support. Patients generally appreciated the effort to integrate religious values but noted inconsistencies in delivery and expectations.</p><p><strong>Conclusion: </strong>This study highlights both the perceptions and actual practices of doctors in integrating Islamic principles into their clinical roles, as well as how patients perceive and respond to such efforts. While both groups value the integration of Islamic values, variations in interpretation and practice reveal gaps between the intended Shariahcompliant model and its implementation on the ground.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"533-539"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713881","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":"Precision medicine in Malaysia: Aligning genomics research, policy and translation.","authors":"W N S Shahidan, M N A Patar, S Sulong, M N Hassan, I Mohamad, B A Zilfalil","doi":"","DOIUrl":"","url":null,"abstract":"<p><p></p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"409-412"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714157","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":"Quantifying the risk of tuberculosis recurrence in Asia: A systematic review of hazard estimates.","authors":"M R Isa","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Recurrence of tuberculosis (TB) is a major challenge to its control in Asia, even though there is a high treatment success rate of drug-susceptible diseases. TB recurrence contributes to ongoing disease transmission in the community, increases drug resistance and leads to higher TB mortality rates. The study aimed to examine and synthesise the current evidence on determinants of TB recurrence occurring after completed treatment in the Asian setting.</p><p><strong>Materials and methods: </strong>The PRISMA 2020 framework is used as a guide for this systematic review. A systematic search in PubMed/MEDLINE, Scopus and Web of Science (WOS) until September 30, 2025 was conducted. The eligible studies were cohort studies implemented in Asian countries and reported post-treatment TB recurrence and adjusted risk estimates. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Since the methodological heterogeneity is rather significant, a narrative synthesis was conducted.</p><p><strong>Results: </strong>The review included a total of 15 cohort studies with sample sizes ranging from 508 to more than 10 million individuals. TB recurrence was 1.5 to 15.1% or 0.47 to 6.5 per 1,000 person-years, with the highest rates seen within two years of post-treatment. Recurrence risk was higher when there were comorbidities like diabetes, chronic lung or kidney disease, low body mass index and behavioural factors like smoking. Additionally, environmental exposure to fine particulate matter (PM_2.5) and socioeconomic disadvantage were also significant variables. Protective variables observed were high levels of treatment compliance, extended treatment period, the use of fixeddose combination (FDC) therapy, treatment during the directly observed therapy (DOT) era, smoking cessation, and residential greenness. The quality of the included study was moderate to high.</p><p><strong>Conclusion: </strong>Multiple determinants drive TB recurrence; thus, improving post-treatment surveillance as well as integrating clinical, behavioural and environmental interventions are important to reduce the incidence and mortality of TB recurrence cases.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"610-620"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714139","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 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":"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":"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":"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}