The Penang General Hospital (Malay: Hospital Pulau Pinang) is the main public hospital in the city of George Town in Penang, Malaysia. The largest public hospital in Penang, it also serves as the reference hospital within northern Malaysia.The hospital had its origins as a medical centre founded in 1854 for the poor and opium addicts.
Background In the Asian population, the presence of the CYP2C19 loss-of-function (LOF) allele is a known genetic variation. This allele is associated with a reduced capacity to metabolize clopidogrel into its active forms through the CYP2C19 enzyme, resulting in diminished platelet inhibition and an elevated risk of recurrent cardiovascular events. Regulatory authorities have recommended an alternative P2Y12 inhibitor, ticagrelor, for individuals carrying the LOF allele. Consequently, this study seeks to assess the impact of the CYP2C19 genotype on the Platelet reactivity index (PRI) using a rapid genetic testing approach in Asian patients with chronic coronary syndromes (CCS) who undergo percutaneous coronary intervention (PCI). Methods This prospective study employed a parallel design, single-center design, and randomized approach. Genotyping for the CYP2C19*2 and *3 polymorphisms was conducted using the Nested Allele-Specific Multiplex PCR (NASM-PCR) technique. Patients meeting the inclusion criteria underwent genotyping for CYP2C19 polymorphisms. Following PCI, patients were randomly assigned to receive either ticagrelor or clopidogrel. PRI assessments were performed four hours after loading dose administration. The trial was registered with ClinicalTrials.gov under the identifier NCT05516784. Results Among the 94 patients recruited for the study, 40 (42.55%) were identified as carriers of the LOF allele for CYP2C19*2 and *3 (*1/*2, *2/*2, *1/*3). Out of the 84 patients evaluated for PRI (44 receiving clopidogrel and 40 receiving ticagrelor), 21 (47.7%) of the clopidogrel group and 39 (97.5%) of the ticagrelor group exhibited a favorable response to antiplatelet therapy (PRI < 50). Patients treated with ticagrelor demonstrated superior antiplatelet responses compared to those receiving clopidogrel, regardless of LOF carrier status ( P = 0.005 and < 0.001 for non-LOF and LOF carriers, respectively). Conclusion NASM-PCR as a rapid genetic test holds promise for personalizing antiplatelet therapy in Asian CCS patients.
Introduction: Tuberculosis and cardiovascular disease (CVD) are significant health concerns in developing countries. Evidence indicates a link between tuberculosis infection and CVD development. The immune response to Mycobacterium tuberculosis, involving monocytes, macrophages, lymphocytes, and cytokines, promotes atheroma formation and atherosclerosis, leading to cardiovascular complications. This study aimed to assess mortality patterns among tuberculosis patients due to CVD, describe the proportion and types of CVD-related deaths in a Malaysian tertiary care facility, and examine associated demographic and clinical characteristics. Methods: This retrospective cohort study used an observational analytic design and descriptive mortality analysis at Penang General Hospital, Malaysia. Medical records of adult tuberculosis (TB) patients who died between January 2015 and December 2022 were reviewed. Patients with pre-existing cardiovascular disease were excluded. Causes of death were determined from clinical records and death certificates, with cardiovascular deaths classified based on clinical, laboratory, and imaging findings. Descriptive statistics were used, and exploratory unadjusted associations were assessed using chi-square or Fisher's exact tests as appropriate. Results: Of 657 TB patient deaths analyzed, 82 (12.5%) were attributed to cardiovascular causes. Acute coronary syndrome was the most frequent (8.37%), followed by acute pulmonary embolism (1.37%). Exploratory analyses suggested associations between cardiovascular deaths and clinical factors such as anemia and drug resistance. Discussion: These findings align with global evidence that cardiovascular diseases are a leading cause of death among tuberculosis patients. Prior studies support the elevated risk of CVDrelated mortality in this population. This research provides detailed data on specific cardiovascular disorders, particularly acute coronary syndrome as the primary cause of death. Intravenous drug use showed a strong correlation with CVD mortality (p < 0.001), while anemia was a notable comorbidity despite its low prevalence. The lack of significant associations with diabetes and hypertension suggests that inflammatory or infectious processes may play a greater role in CVD development among TB patients. Regional differences in CVD mortality rates highlight the influence of sociodemographic factors and healthcare resources. The study’s exclusion of patients with pre-existing CVD allows for a focused assessment of TB’s impact on cardiovascular outcomes. Conclusion: In this tertiary-care cohort, cardiovascular disease represented a significant proportion of deaths among tuberculosis patients, with acute coronary syndrome as the leading subtype. These results reinforce the need for cardiovascular risk awareness in TB care and highlight the importance of prospective studies to clarify risk factors and causality.
BACKGROUND:Accurate classification of seizure types guides diagnostic investigations and antiseizure medication (ASM) selection, and is particularly critical in resource-limited settings. We validated a pragmatic three-item focal seizure screening tool (aura, unilateral motor phenomena, oral automatisms) intended for rapid use by non-specialist clinicians. METHODS:Through a multicentre cross-sectional study spanning from 1 August 2024-31 August 2025, we recruited consecutive adults (≥18 years) with neurologist-confirmed seizure types at seven public hospitals in Malaysia. Clinicians applied the tool and finalized the scores (0-3). Diagnostic accuracy was evaluated using receiver operating characteristic analysis and area under the curve (AUC). Sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), positive predictive value (PPV), and negative predictive value (NPV) were calculated at every cut-off score, respectively. RESULTS:Among the 428 participants (mean age 36.4 ± 14.6 years), 83.41% had focal seizures. The tool achieved an AUC of 0.751 (95% CI 0.688-0.815; p < 0.001). A cut-off score of ≥ 1 yielded high sensitivity (84.0%) and fair specificity (59.2%), with LR + of 2.06 and PPV of 91.19%, supporting its role for screening. A cut-off score of ≥ 2 improved specificity to 88.73% and PPV to 94.74%, making it suitable for diagnosis. CONCLUSIONS:The three-item focal seizure screening tool is feasible, rapid to administer, and may assist general clinicians in classifying focal-onset seizures. Cut-off scores can be selected according to clinical priorities, namely, sensitive case-finding versus high-specificity confirmation.
