Sarawak General Hospital (Malay: Hospital Umum Sarawak) is the largest hospital in the state of Sarawak, Malaysia. It is the main tertiary and referral hospital in East Malaysia. In its earlier years it was known as Kuching General Hospital..
While continuous positive airway pressure (CPAP) reduces cardiovascular risk in obstructive sleep apnea (OSA), its effects on renin–angiotensin–aldosterone system (RAAS) modulation remain controversial. This meta-analysis investigates CPAP's differential impacts on RAAS components and identifies responsive patient subgroups. Sixteen studies were included in the systematic review and eight (231 patients) in the meta-analysis. Primary outcomes included plasma aldosterone concentration (PAC), plasma renin activity (PRA), and angiotensin II (AngII) changes. Subgroup analyses examined age, BMI, and CPAP duration thresholds, with meta-regression assessing moderating factors. CPAP significantly reduced PAC (d + of -0.72, 95
Histopathologically detected extranodal extension leads to upstaging and treatment escalation in head and neck squamous cell carcinoma. There is considerable variation in the prevalence of histopathologically detected extranodal extension in comparable studies. The Head and Neck Cancer International Group, which includes 23 organisations managing patients with head and neck cancer, identified several challenges in evaluating histopathologically detected extranodal extension. Thus, the Head and Neck Consensus Language for Ease and Reproducibility (HN-CLEAR) and its global stakeholders prioritised developing diagnostic criteria and uniform terminology for histopathologically detected extranodal extension. The histopathologically detected extranodal extension working group established by WHO, International Collaboration on Cancer Reporting, American Joint Committee on Cancer, Union for International Cancer Control, North American Society of Head and Neck Pathology, and American Academy of Oral and Maxillofacial Pathology committees undertook consensus deliberations using scanned whole slides and a PRISMA literature review-based scoping questionnaire. The guidelines were tested by 30 additional pathologists across six continents and strengthened with prescriptive diagnostic criteria and unifying terminology based on the inter-rater concordance analyses. This Review generates practically useful consensus diagnostic recommendations and aligned terminology for addressing the gaps in the histopathologically detected extranodal extension literature. The recommendations can be used globally and cater to all levels of medical resources, practices, and experiences, thus ensuring equitable patient care.
Introduction: Work-related musculoskeletal disorders (WRMSD) are a significant occupational health concern in the glove manufacturing sector. Despite its prominence, WRMSD prevalence in this sector remains unexplored. This study aims to determine the prevalence and associated risk factors of WRMSD among glove manufacturing workers in Malaysia. Method: A cross-sectional study used secondary data from three glove manufacturing facilities between 30 January and 30 June 2024. 750 production workers (aged 16–55) in similar job roles were included. Workers who had administrative roles or relevant medical histories were excluded. Secondary data included Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), Depression, Anxiety, and Stress Scale–21 Items (DASS-21), medical records, and Rapid Entire Body Assessment (REBA) to assess musculoskeletal discomfort, mental health, WRMSD diagnosis, and ergonomic risk with posture, respectively. The primary outcome was WRMSD with independent variables including ergonomic postures, risk levels, overtime, absenteeism, age, gender, duration of employment, task repetition, and mental health status. Data was analysed using SPSS v.28, employing descriptive statistics, chi-square tests, and logistic regression. Result: The prevalence of WRMSD was 79.2%, with the wrist (35.9%), neck (22.7%), and shoulder (12.1%) being the most affected regions. Significant associated factors included smoking (aOR = 1.34,95% CI [1.21–1.64]), Awkward posture (aOR = 23.66,95% CI [14.28–38.94]), Repetitive Posture (aOR = 13.06,95% CI [12.03–14.11]), task duration (aOR=1.08,95% CI [1.01–1.15]), stress (aOR = 1.61, 95% CI [1.10–2.35]) and anxiety (aOR 1.51, 95% CI [1.42–1.88]). Conclusion: The study highlights a high prevalence of WRMSD in Malaysia’s glove manufacturing industry. Findings emphasize the need for integrated preventive measures including manual handling training, workstation redesign, task rotation, and mental health support to protect worker’s well-being and sustain industry productivity. The results provide a foundation for policy and workplace interventions, with future research recommended to explore causal relationships and evaluate the effectiveness of ergonomic interventions.
BACKGROUND:Antimicrobial resistance (AMR) poses a major global health threat, with health-care-associated infections contributing substantially to mortality. Attributable disease burden remains poorly quantified by relying on cross-sectional and microbiology data. We aimed to characterise AMR epidemiology and disease burden associated with ventilator-associated pneumonia and bloodstream infection in a network of hospitals in Asia. METHODS:This large-scale, prospective, multinational, multicentre cohort study consecutively enrolled patients of any age with microbiologically-confirmed ventilator-associated pneumonia, hospital-acquired bloodstream infections, or health-care-associated bloodstream infections from 41 selected hospitals capable of standardised prospective data collection in 19 Asian countries and regions. Patients with pathogens typically associated with community-acquired infection or not recognised causes of health-care-associated infection were excluded according to predefined protocol criteria, and patients were followed for 28 days. The primary outcome was 28-day mortality from infection onset. Pathogen profiles, antimicrobial prescriptions, attributable mortality, and health-related quality-of-life outcomes were analysed. FINDINGS:Between Sept 1, 2022, and Feb 28, 2025, 10 111 patients were enrolled, and after exclusions, 9496 patients were included in the final analysis. 9642 infection episodes were analysed, comprising 6597 (68·4%) bloodstream infections and 3045 (31·6%) ventilator-associated pneumonia. Of these infections, 7102 (73·7%) of 9642 infection episodes were associated with AMR bacteria, and Gram-negative bacteria were predominant (7599 [78·8%]). Crude 28-day mortality was 2674 (37·7%) of 7102 AMR infection episodes and 1900 (40·6%) of 4683 multidrug resistance infection episodes, with the highest for carbapenem-resistant Acinetobacter spp (CRA; 51·3%) and carbapenem-resistant Enterobacterales (CRE; 48·4%). AMR-attributable mortality was the highest in ventilator-associated pneumonia (16·9%, 95% CI 13·0-20·9), individuals aged 5-14 years (11·7%, 95% CI 1·6-21·8), individuals aged 15-49 years (11·2%, 95% CI 7·2-15·2), and lower-middle-income countries (10·7%, 95% CI 7·0-14·4). By pathogens, CRA and CRE had the highest attributable mortality (19·4%, 95% CI 14·1-24·7 vs 16·2%, 95% CI 12·8-19·6) and also had the poorest quality-of-life outcomes. Most carbapenem-resistant Gram-negative infections were treated with carbapenems (57·8%) or polymyxins (35·6%). INTERPRETATION:AMR bacterial bloodstream infections and ventilator-associated pneumonia were common and associated with high mortality and reduced quality of life in Asia, particularly in infections due to carbapenem-resistant Acinetobacter spp and CRE, and among children and younger adults. The widespread use of suboptimal antimicrobial regimens highlights the urgent need for equitable access to effective therapies and context-specific evidence to guide antimicrobial stewardship. FUNDING:Wellcome Trust, National University of Singapore, Yong Loo Lin School of Medicine, Duke-NUS Medical School, Nanyang Technological University (Lee Kong Chian School of Medicine), Singapore National Centre for Infectious Diseases, and Singapore Medical Research Council.
BACKGROUND:Blood-pressure reduction is the only proven treatment to prevent stroke. Whether a single pill that combines three antihypertensive drugs at low doses, in addition to standard antihypertensive treatment, can lower blood pressure more than standard care alone and reduce the risk of recurrent stroke after intracerebral hemorrhage is uncertain. METHODS:We conducted a multinational, double-blind, randomized, placebo-controlled trial involving patients with a history of intracerebral hemorrhage. Patients were eligible for the trial if they had a systolic blood pressure of 130 to 160 mm Hg at baseline and were in clinically stable condition. After a 2-week active run-in phase during which all the patients received a once-daily pill containing three antihypertensive agents at low doses (telmisartan at 20 mg, amlodipine at 2.5 mg, and indapamide at 1.25 mg; the triple pill), the patients were randomly assigned to continue receiving the triple pill or to receive matching placebo. The primary outcome was the first recurrent stroke. Secondary outcomes included blood-pressure control, major cardiovascular events, death from cardiovascular causes, and safety. RESULTS:Of 1670 patients who underwent randomization, 833 were assigned to receive the triple pill and 837 to receive placebo. The mean age of the patients was 58 years. At a median follow-up of 2.5 years, recurrent stroke had occurred in 38 patients (4.6%) in the triple-pill group and 62 (7.4%) in the placebo group (hazard ratio, 0.61; 95% confidence interval [CI], 0.41 to 0.92; P = 0.02). The mean systolic blood pressure during follow-up was 127 mm Hg and 138 mm Hg, respectively. The incidence of major cardiovascular events was lower with the triple pill than with placebo (6.6% vs. 9.8%; P = 0.04). Serious adverse events occurred in 23.2% of the patients in the triple-pill group and 26.0% of those in the placebo group. Early discontinuation of the trial regimen due to an adverse event occurred in 13.6% and 6.0%, respectively. The most common adverse event leading to discontinuation was an increase of 20% or more in the serum creatinine level. CONCLUSIONS:Among patients with intracerebral hemorrhage, treatment with a combination of three low-dose antihypertensive agents in a single pill, in addition to standard care, was associated with a lower incidence of recurrent stroke and major cardiovascular events than placebo. (Funded by the National Health and Medical Research Council of Australia and the Brazilian Ministry of Health; TRIDENT ClinicalTrials.gov number, NCT02699645; Australian New Zealand Clinical Trials Registry number, ACTRN12616000327482.).
