Kuala Lumpur Hospital (Malay: Hospital Besar Kuala Lumpur, abbr: HKL) is a Malaysian government-owned public hospital in Kuala Lumpur, the capital city of Malaysia. Founded in 1870, HKL is a not-for-profit institution and serves as the flagship hospital of the Malaysian public healthcare system. This hospital serves as a tertiary and referral hospital. It is located on 150 acres of prime land in the city with 84 wards and 2,300 beds, making it one of the largest hospitals in the world. More than 90 per cent of the beds in HKL are allocated for subsidized patients, providing access to an internationally established standard of affordable healthcare.The Kuala Lumpur Hospital or HKL has 54 different departments and units. These include 29 clinical departments and 15 clinical support services. HKL has approximately 11,000 staff with almost 2,300 professionals in various fields and disciplines. Out of the total number of staff, there are 300 medical consultants and specialists, 1,300 medical officers, 72 matrons, 253 sisters (ward managers) and 3,500 registered nurses and 258 community nurses.
Clustering is a fundamental technique for identifying structures within datasets, with Fuzzy C-Means (FCM) being widely used due to its simplicity and ease of implementation. However, FCM suffers from sensitivity to noise, outliers, and initialization issues. This study introduces an enhanced model, IFCM with Chebyshev, which integrates fuzzy Chebyshev distance and intuitionistic fuzzy sets. Data are first normalized using MinMax scaling, and dimensionality reduction is applied to handle high-dimensional datasets. The optimal cluster number is determined using the Elbow method. The proposed algorithm is evaluated against standard FCM, FCM with Chebyshev, and IFCM. A genomic dataset related to prostate cancer is used as a numerical example. Results show that IFCM with Chebyshev achieves the highest clustering accuracy (88.9%), outperforming IFCM (85.7%), FCM with Chebyshev (81.2%), and FCM (78.5%). It also yields superior cluster validity indices, recording the highest Partition Coefficient (0.74) and the lowest Partition Entropy (0.52), indicating clearer cluster separation. Although IFCM with Chebyshev incurs higher computational cost (1.58s), sensitivity analysis demonstrates faster convergence around five clusters, suggesting an optimal structure. Memory consumption remains consistent at 295 MB across cluster settings, highlighting efficiency for large-scale applications. Overall, combining Chebyshev distance and IFCM enhances clustering robustness and accuracy, particularly in noisy or complex data environments, making it a promising approach for advanced data analysis tasks.
The autosomal dominant CACNA1A gene encompasses episodic neurological disorders likely related to calcium-channelopathy. We report on an 8-year-old boy with a pathogenic heterozygous CACNA1A mutation (c.4067C>T) who developed seizures, encephalopathy, and left hemiplegia. Brain magnetic resonance imaging showed restricted diffusion in the right parieto-temporo-occipital lobes with concomitant narrowing of the proximal segments of the right middle cerebral artery. Flow velocities were elevated on transcranial doppler evaluation, confirming vasospasm as a mechanism for the stroke-like episode. Treatment with the calcium channel blocker verapamil resulted in normalisation of TCD flow velocities as well as ischaemic changes on brain magnetic resonance imaging. Our patient is the youngest reported paediatric patient to benefit from the utilisation of serial TCD studies in the detection and management of cerebral vasospasm within the reported CACNA1A population.
BACKGROUND & AIMS:Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent and increasingly recognized as a multisystem cardiometabolic disorder. The global burden, incidence and prognostic implications of coexisting chronic kidney disease (CKD) in MASLD remain uncertain. METHODS:In this meta-analysis, we searched MEDLINE and EMBASE from inception through September 25, 2025, for observational studies reporting CKD prevalence and/or incidence among adults (≥ 18 years) with MASLD. The primary outcomes were pooled CKD prevalence, estimated using random-effects models on the logit scale with the Hartung-Knapp adjustment, and pooled CKD incidence (per 1000 person-years), estimated using random-effects models with exact Poisson confidence intervals. Secondary outcomes included all-cause mortality and cardiovascular, renal and cancer outcomes. RESULTS:From 2811 records, 36 observational studies met the inclusion criteria. Twenty-three studies contributed prevalence estimates (575 615 participants; 56 248 CKD cases) and thirteen studies contributed incidence estimates (27 996 new events). The pooled global CKD prevalence among individuals with MASLD was 15.22% (95% CI 9.69-23.12). The pooled CKD incidence was 22.17 per 1000 person-years (95% CI 11.44-32.89) in the MASLD population. Hypertension (OR 1.49, 95% CI 1.29-1.72), dyslipidaemia (OR 1.22, 95% CI 1.20-1.24) and diabetes (OR 1.94, 95% CI 1.69-2.22) were associated with higher odds of CKD in the MASLD population. All-cause mortality rates were 18.28 per 1000 person-years (95% CI 3.45-33.11) in coexistent MASLD and CKD, more than double those in the MASLD-only population (7.26 per 1000 person-years (95% CI 2.97-11.56)). CONCLUSIONS:Coexistent CKD affects one in seven individuals with MASLD worldwide, conferring a more than two-fold increased risk of all-cause mortality compared with individuals with MASLD alone.
BACKGROUND:The advent of new biologic agents in recent years has increased treatment options for patients with psoriasis. OBJECTIVES:To evaluate the prescribing and switching patterns of biologic agents used for psoriasis in Malaysia. METHODS:Data were obtained from the Malaysian Psoriasis Registry from January 2011 to September 2022. All patients treated with biologic agents were included. Those with at least two entries were selected for subgroup analysis to evaluate switching patterns. 'Continuous therapy' was defined as those who continued with the same biologic in the subsequent follow-up, whereas those who switched to another type of biologic were defined as 'switching therapy'. RESULTS:Of 25 468 patients, 555 (2.2%) received at least 1 biologic agent. The mean age of patients on biologics was 42.6 years, with a male-to-female ratio of 1 : 0.8. Of 645 biologic prescriptions, secukinumab was the most common (37.8%), followed by ustekinumab (27.9%), adalimumab (18.3%) and guselkumab (4.5%). Etanercept had the longest mean usage duration at 46.2 months. Eighty patients (14.4%) had their biologic agent switched. The most frequent switch pattern was from anti-interleukin (IL)-12/23 to anti-IL-17 (20 of 80, 25%), followed by tumour necrosis factor inhibitors to either anti-IL-17 (13 of 80, 16%) or anti-12/23 (11 of 80, 14%). Anti-IL-17 was the preferred agent on switching (37 of 80, 46%). Primary and secondary lack of efficacy were the most common reasons for switching (46% and 25%, respectively). Concurrent systemic therapy was reported in 21.6% of cases (120 of 555). Of these, 76.6% (92 of 120) had received methotrexate. CONCLUSIONS:Up to 2% of the patients with psoriasis received treatment with biologics. Anti-IL-17 was the preferred first- and second-line biologic agent used in Malaysia.
Intentional celiac artery (CA) coverage during thoracic endovascular aortic repair (TEVAR) may be required to achieve an adequate distal landing zone; however, this strategy remains controversial owing to concerns regarding visceral ischemia, particularly in patients with infective native aortic aneurysms with compromised physiology and hostile anatomy. We retrospectively reviewed three patients who underwent TEVAR with planned CA coverage after angiographic assessment of collateral circulation using balloon occlusion testing and selective superior mesenteric artery angiography, with CA embolization. All patients demonstrated robust collateral perfusion, underwent CA embolization, and subsequently TEVAR with intentional CA coverage. One patient developed a type Ib endoleak on surveillance imaging without sac expansion. No hepatic, gastric, or splenic ischemic events occurred during follow-up. This case series suggests that intentional CA coverage may be feasible in carefully selected patients when guided by meticulous collateral assessment, offering a pragmatic option in urgent or anatomically constrained settings.
