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.
Abstract Background Maternal vaccines can reduce the burden of diseases for both mother and neonate. The development and implementation of such vaccines require a thorough interpretation of safety data and standardized disease case definitions. This study aimed to evaluate the current rates for adverse pregnancy outcomes, maternal and neonatal events of interest (EOIs) that will be informative for preparing future phase III clinical trials on maternal vaccines conducted in low- and middle-income countries and further assisting in safety data interpretation (e.g., monitoring potential safety signals in clinical trials, and/or helping with the causality assessments of adverse events following immunization). Methods We performed a prospective cohort study on healthy 18–45-year-old women, with singleton, low-risk pregnancies, with a gestational age of ≥24 0/7 weeks at enrollment and ≤27 6/7 weeks at first visit, and their neonates. The study was conducted between 2019–2021 in 10 countries that were considered low- and middle-income countries by the World Bank Group at the time the study was designed. All pregnancy-related outcomes and maternal EOIs occurring from enrollment up to 42 days post-delivery and neonatal EOIs occurring within the first 28 days after birth were recorded. Results Of 2311 pregnant women and 2181 neonates enrolled, 2222 and 2094 were included in the analyses, respectively. Most livebirths (2088 [94.0%]) were without apparent congenital anomalies. Preterm delivery (166 [7.5%]), non-reassuring fetal status (137 [6.2%]), and hypertensive disorders of pregnancy (125 [5.6%]) were the most frequently reported EOIs related to pregnancy. The most frequent neonatal EOIs were low birthweight (including very low birthweight) (156 [7.4%]), preterm birth (141 [6.7%]), small for gestational age (111 [5.3%]), and congenital anomalies (103 [4.9%], including mainly major external structural defects, as well as detected internal and functional defects). Overall, there were similar frequencies in pregnancy outcomes, pregnancy-related and neonatal EOIs across countries, although some variation in the reporting rate was noted. Conclusion This multicountry study contributes to establishing the most recent background rates for pregnancy outcomes, maternal and neonatal EOIs in low- and middle-income regions. The clinical relevance in the context of the safety assessment in future trials will be applied. Trial registration NCT03614676 (03/08/2018).
Marginal zone lymphoma (MZL) represents a diverse subgroup of non-Hodgkin lymphoma, with limited data to guide therapeutic decision making, particularly in Asian settings. To understand the factors for decision-making and the current management strategies for MZL in Asia, an online survey using a Best-Worst Scaling (BWS) instrument was conducted amongst hemato-oncologists (n = 18) representing eleven countries/territories in Southeast and East Asia. This was followed by a focus group discussion to refine the validity and interpretation of the survey results. Amongst all patients with MZL, approximately one-third are initially managed on a “watch and wait” strategy. The most important clinical characteristics influencing decision making for initiating systemic therapy include the presence of compression syndrome, followed by cytopenia and bulky disease. Both efficacy indicators such as “overall survival”, “overall response rate”, and “progression-free survival” as well as toxicity indicators “treatment-related cardiovascular-related side effects” and “treatment-related death” were rated as the topmost important factors in deciding treatment initiation for patients. In terms of treatment-related toxicities, cardiovascular side effects and death ranked as more important considerations, as compared with bleeding and infection risks. In addition, patient affordability was amongst the top considerations for initiating therapy, with financial barriers presenting as the major challenge for preferred use of BTK inhibitors and other standard therapies. Efficacy outcomes, balanced against treatment-related toxicity, are main considerations for systemic therapy initiation, and should be personalized for each patient. Financial barriers remain as the major challenge for the optimal treatment of patients with MZL in Asia.
