The Sultanah Aminah Hospital (HSA; Malay: Hospital Sultanah Aminah) is a government-funded multi-specialty hospital located in Johor Bahru, Johor, Malaysia. It is the largest hospital in Johor and the main referral and tertiary health centre for the state. HSA is also one of the busiest hospitals in Malaysia based on patient load. However, budget cuts have affected its level of service.
The ASC4OPT non-comparative phase 3b study (NCT04948333) evaluates asciminib once daily (QD) or twice daily (BID) in chronic myeloid leukemia in chronic phase (CML-CP) treated with ≥2 tyrosine kinase inhibitors (TKIs). This study enrolled 169 patients not in major molecular response (MMR), with unsatisfactory response (intolerant, warning or failure) as defined by European LeukemiaNet (ELN) 2020 criteria. Patients intolerant to their most recent TKI and in MMR at baseline (n = 30) were also enrolled. The primary endpoint was the MMR rate at Week 48 for patients not in MMR at baseline. Results showed an overall MMR rate of 39.4% at Week 48 (40 mg BID, 43.4%; 80 mg QD, 35.4%) and 43.6% at Week 96 (40 mg BID, 45.8%; 80 mg QD, 41.5%) in patients not in MMR at baseline. Among 40 patients who had their asciminib dose escalated to 200 mg QD, 17.5% were in MMR at Week 96. Most patients in MMR at baseline remained in MMR at 48 and 96 weeks (93.3% and 86.7%, respectively). Safety for both dosing regimens was consistent with that of previous studies. Findings support asciminib as a potential standard of care for patients with CML-CP who have not responded optimally to prior TKI therapy.
IntroductionSurgery-related muscle loss (SRML) is common after major upper gastrointestinal (GI) surgery and is associated with worse recovery and survival, and prehabilitative parenteral nutrition (PN) has been proposed to attenuate it, yet data from Southeast Asian populations are absent. We set out to characterise perioperative muscle change and to test whether the amount of protein and energy delivered per kilogram body weight was associated with muscle preservation.MethodsWe conducted a single-centre observational cohort study of 115 adults who underwent elective major upper GI surgery at Hospital Sultanah Aminah, Johor Bahru, and received 800 kcal/day premixed prehabilitative PN (38 g amino acids), as a supplement to oral or enteral intake, for 7 days before surgery. Body composition was measured by segmental bioimpedance analysis (InBody 770) at admission and on postoperative days (PODs) 3, 7, 30, and 90. The primary outcome was clinically relevant SRML, defined as a decrease in skeletal muscle mass (SMM) of 10% or more from admission to POD 7; 111 patients had an evaluable POD 7 measurement.ResultsPatients had a median age of 61 years, 58.3% were male, 70.4% had malignant disease, and 19.1% were underweight; median total protein delivery (PN plus oral or enteral intake) was 1.4 g/kg/day. From admission to POD 7, SMM decreased by a mean of 2.6%, phase angle by 6.2% and body mass index by 3.1% (all p < 0.001). Clinically relevant SRML occurred in 18 of 111 evaluable patients (16.2%). Protein delivered per kilogram was not associated with the change in SMM (Spearman rho = 0.05, p = 0.59), and energy per kilogram showed only a weak, non-significant trend (Spearman rho = 0.16, p = 0.09). In exploratory multivariable models limited by only 18 events, only a higher baseline SMM predicted greater relative loss, and no delivery variable predicted SRML.DiscussionIn a real-world prehabilitative PN cohort, clinically relevant muscle loss was relatively infrequent, but protein delivery was not independently associated with muscle preservation, consistent with anabolic resistance during surgical stress. The single-arm design precludes causal inference, and the narrow range of protein exposure may have left the study underpowered to detect a dose-response relationship. Controlled studies with contemporaneous non-PN comparators, wider exposure contrasts and functional endpoints are required.
Background: Tuberculous pleural effusion (TBE) and malignant pleural effusion (MPE) are the most common causes of exudative pleural effusion in tuberculosis-endemic regions. This study evaluates transthoracic ultrasound (TUS) features of TBE vs. MPE and incorporates clinical and pleural fluid (Pf) parameters into a machine learning-based random forest (RF) model for differentiation. Methods: This prospective observational study was conducted over 6 months across six tertiary hospitals in Malaysia, involving patients undergoing diagnostic medical thoracoscopy (MT). Diagnostic confidence for TBE and MPE was determined based on final thoracoscopic diagnosis. Logistic regression and RF models were applied to predefined clinical, imaging, and laboratory variables. Results: Among 187 recruited patients, 132 (70 TBE and 62 MPE) subjects with at least moderate diagnostic confidence were analyzed. On TUS, TBE was more likely to be non-hyperechoic, complex, and loculated, with the presence of fibrin and less pleural thickening, while MPE showed hyperechoic effusion and hemidiaphragm nodules. Independent predictors for TBE included younger age [adjusted odds ratio (aOR) =0.94], presence of fibrin (aOR =2.86), lower Pf lactate dehydrogenase (LDH) (aOR =0.996), and higher Pf adenosine deaminase (ADA) (aOR =1.10). Without Pf ADA, these parameters, along with the absence of hemidiaphragm nodules (aOR =0.33), remained significant for TBE prediction. The RF model outperformed logistic regression (92.6% vs. 87.9% accuracy), even without Pf ADA. Conclusions: TUS parameters can aid in differentiating TBE from MPE. The RF model demonstrated superior diagnostic performance, offering a potential point-of-care tool, even in the absence of Pf ADA.
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.
