INTRODUCTION:Recurrence of tuberculosis (TB) is a major challenge to its control in Asia, even though there is a high treatment success rate of drug-susceptible diseases. TB recurrence contributes to ongoing disease transmission in the community, increases drug resistance and leads to higher TB mortality rates. The study aimed to examine and synthesise the current evidence on determinants of TB recurrence occurring after completed treatment in the Asian setting. MATERIALS AND METHODS:The PRISMA 2020 framework is used as a guide for this systematic review. A systematic search in PubMed/MEDLINE, Scopus and Web of Science (WOS) until September 30, 2025 was conducted. The eligible studies were cohort studies implemented in Asian countries and reported post-treatment TB recurrence and adjusted risk estimates. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Since the methodological heterogeneity is rather significant, a narrative synthesis was conducted. RESULTS:The review included a total of 15 cohort studies with sample sizes ranging from 508 to more than 10 million individuals. TB recurrence was 1.5 to 15.1% or 0.47 to 6.5 per 1,000 person-years, with the highest rates seen within two years of post-treatment. Recurrence risk was higher when there were comorbidities like diabetes, chronic lung or kidney disease, low body mass index and behavioural factors like smoking. Additionally, environmental exposure to fine particulate matter (PM2.5) and socioeconomic disadvantage were also significant variables. Protective variables observed were high levels of treatment compliance, extended treatment period, the use of fixeddose combination (FDC) therapy, treatment during the directly observed therapy (DOT) era, smoking cessation, and residential greenness. The quality of the included study was moderate to high. CONCLUSION:Multiple determinants drive TB recurrence; thus, improving post-treatment surveillance as well as integrating clinical, behavioural and environmental interventions are important to reduce the incidence and mortality of TB recurrence cases.
INTRODUCTION:Hepatitis B virus remains a major global public health concern, with mother-to-child transmission contributing substantially to chronic infection, cirrhosis and hepatocellular carcinoma. In 2019, the Ministry of Health Malaysia initiated pilot universal antenatal hepatitis B screening in four selected states, namely Kedah, Pahang, Terengganu and Sabah, to strengthen prevention of motherto- child transmission (PMTCT). This study reviewed the implementation of the PMTCT hepatitis B pilot project in Kedah by evaluating the transmission rate of HBV to infants, antenatal screening coverage of HBV and the prevalence of hepatitis B among pregnant mothers. MATERIALS AND METHODS:A cross-sectional review of secondary data was conducted using programme registers from 17 participating health clinics in Kedah. Data were extracted and analysed. The key outcomes were antenatal screening coverage, maternal HBsAg prevalence and mother-to-child transmission rate. RESULTS:A total of 54,682 antenatal attendees were screened for HBV during the study period, giving an overall screening coverage of 95.8%. Maternal HBsAg prevalence was 0.16%, with 92 confirmed HBsAg-positive mothers. Of these, 91 were referred for further assessment and 83 received antiviral therapy during pregnancy. Among exposed infants with documented follow-up, no HBsAg-positive cases were detected, resulting in a mother-to-child transmission rate of 0%. CONCLUSION:Overall, the mother-to-child transmission rate of the pilot project in Kedah was satisfactory at 0% among antenatal mothers who were treated and completed the follow-up plan. In addition, the prevalence of HBV among antenatal mothers was relatively low at 0.16%, with high HBV screening coverage of 95.8% among antenatal attendees.
INTRODUCTION:Polygenic risk scores (PRS) are used to aggregate single-nucleotide polymorphisms (SNPs) effects across the genome to estimate an individual's risk of coronary heart disease (CHD). However, most PRS models were developed mainly in Caucasian populations, limiting their applicability to Malaysia's diverse populations. This study aimed to develop a PRS to predict CHD mortality among individuals with type 2 diabetes (T2D) in The Malaysian Cohort (TMC). MATERIALS AND METHODS:In Phase 1, 224 CHD-death cases and 625 controls were genotyped using Illumina's Infinium Asian Screening Array, followed by genetic imputation. From the genome-wide association analysis, 56 SNPs were identified at suggestive genome-wide significance (P < 5 × 10-5), with 15 SNPs selected to construct the PRS. In Phase 2, 806 T2D participants without known CHD at baseline were followed until death. RESULTS:The PRS distinguished cases from controls across all ethnicities, with an area under the receiver operating characteristic curve (AUC) indicating good discriminative ability. At 0.85 cut-off score, the PRS achieved 64.7% sensitivity and 73.1% specificity. Those in the high-PRS category had significantly shorter mean survival than those in the low-risk group: observed among Malays (6.60 vs 8.92 years), Chinese (6.20 vs 8.66 years), and Indians (7.21 vs 8.60 years). After adjusting for covariates, high-PRS individuals had increased CHD mortality risk, with hazard ratios of 3.23 (Malays), 9.59 (Chinese), and 9.65 (Indians) (all p<0.05). CONCLUSION:This study demonstrates the utility of a population-specific PRS in predicting CHD mortality among Malaysian T2D patients, supporting its potential role in precision medicine and long-term risk stratification.
INTRODUCTION:Episiotomy is a surgical incision of the perineum performed during vaginal delivery. Although previously routine, current evidence supports a selective approach due to associated maternal morbidity. Despite this, episiotomy remains common among primiparous women. This study aimed to determine the prevalence and contributing factors for episiotomy among primiparous women in a tertiary hospital in Perak, Malaysia. MATERIALS AND METHODS:A cross-sectional study was conducted using secondary data from the obstetric delivery registry of Hospital Raja Permaisuri Bainun, Ipoh. Records of primiparous women who underwent vaginal delivery with episiotomy between 1 January and 31 December 2024 were reviewed. Maternal demographics and clinical indications were analysed. Associations between demographic variables and type of episiotomy were assessed using chisquare tests. RESULTS:Of 346 eligible cases, 311 were analysed. Routine episiotomy accounted for 76.5% of cases, while 23.5% were selective. The most common indications for selective episiotomy were cord around the neck (45.2%) and preterm delivery (39.7%). No significant association was found between type of episiotomy and maternal age (p=0.378) or ethnicity (p=0.981). CONCLUSION:Routine episiotomy remains the predominant practice among primiparous women in this tertiary Malaysian hospital. These findings highlight the need for institutional review and adherence to evidence-based selective episiotomy guidelines.
INTRODUCTION:Shariah-compliant and ibadah-friendly hospitals have been established in the Malaysian healthcare system for nearly two decades to support the religious needs of Muslim patients. In parallel, the Islamic input in the medical program curriculum has been designed to train healthcare professionals, particularly doctors, to integrate Islamic principles into their medical expertise, as they are expected to incorporate Islamic values into their daily practice. However, the practice of doctors with this Islamic integrated medical curriculum has not been thoroughly investigated. Thus, to what extent they embodied the Islamic values within their practice and the challenges they faced in realising this is not known. Therefore, this study aimed to explore the experiences of doctors and patients related to the integration of Islamic principles within Shariahcompliant hospital services. MATERIALS AND METHODS:A single-site qualitative case study design was employed, recruiting 20 doctors and 18 adult patients receiving treatment in the Orthopaedic wards and clinic of a Shariah-compliant teaching hospital. In addition, 19 relevant documents have been sampled and included. The study was conducted using multiple data collection methods including individual in-depth interviews, nonparticipant observations and document analysis between June 2023 and February 2024. The data analysis was done according to framework technique facilitated by NVivo software version 5. RESULTS:Four key themes emerged: (1) fulfilling religious and spiritual needs through clinical interactions and services; (2) practising therapeutic communication guided by Islamic values such as compassion, honesty, and patience; (3) upholding privacy, dignity, and autonomy in patient care; and (4) the importance of an effective training program and a sustainable working environment. Doctors expressed varying levels of confidence and consistency in applying Islamic principles, often influenced by personal understanding, workload, and institutional support. Patients generally appreciated the effort to integrate religious values but noted inconsistencies in delivery and expectations. CONCLUSION:This study highlights both the perceptions and actual practices of doctors in integrating Islamic principles into their clinical roles, as well as how patients perceive and respond to such efforts. While both groups value the integration of Islamic values, variations in interpretation and practice reveal gaps between the intended Shariahcompliant model and its implementation on the ground.
INTRODUCTION:Chest drainage remains an important intervention for pneumothorax when conservative or ambulatory management is not suitable. Although chest drain techniques have been widely studied, contemporary real-world data from Southeast Asia remain limited, particularly in populations with a high burden of secondary pneumothorax related to infectious lung disease. MATERIALS AND METHODS:We conducted a retrospective cohort study of adult pneumothorax patients who underwent intercostal chest drain insertion at Sibu Hospital, Sarawak, Malaysia, between January 2021 and February 2024. Patients were managed with either conventional trocar chest tubes or Seldinger wire-guided drains. The primary outcome was chest drain-related complications. Secondary outcomes included chest drain duration, hospital length of stay, persistent air leak (PAL >5 days) and mortality. Continuous variables were analysed using independent ttests and categorical variables using chi-square or Fisher's exact tests. Multivariate logistic regression was performed to identify predictors of subcutaneous emphysema, and multiple linear regression was used to evaluate factors associated with chest drain duration. RESULTS:A total of 123 patients were included (86 conventional and 37 Seldinger). Subcutaneous emphysema occurred significantly less frequently in the Seldinger group (5.4% vs 55.8%, p<0.001). Mean chest drain duration was shorter in the Seldinger group (8.86 ± 7.10 vs 10.34 ± 11.96 days, p=0.032). Differences in insertion failure (0% vs 8.1%, p=0.074), tube dislodgement (2.7% vs 11.6%, p=0.112), persistent air leak >5 days (67.6% vs 54.7%, p=0.182) and mortality (10.8% vs 15.1%, p=0.518) were not statistically significant. Multivariate logistic regression identified conventional chest drainage as an independent predictor of subcutaneous emphysema (OR 27.6, 95% CI 5.24-145.94; p<0.001). Multiple linear regression demonstrated that conventional drainage, non-tension pneumothorax, smoking and persistent air leak were independently associated with longer chest drain duration. CONCLUSION:In this retrospective cohort, the Seldinger technique was associated with lower complication rates and shorter drainage duration compared with conventional chest drainage. Prospective multicentre studies are required to confirm these findings.
INTRODUCTION:Complex High-risk Indicated Percutaneous Coronary Intervention (CHIP-PCI) addresses complex coronary artery disease in patients unsuitable for or declining surgery. Performing CHIP-PCI in non-surgical centres presents unique challenges requiring robust risk mitigation. CHIP-PCI was defined as PCI in any patient meeting at least one of the following criteria: PCI to left main stem, chronic total occlusion, severe coronary artery calcification (CAC), bifurcation lesions, left ventricular ejection fraction (LVEF) < 30%, serum creatinine > 200μmol/L, chronic dialysis, intra-aortic balloon pump use, previous coronary artery bypass graft, or age ≥ 80 years. Locally, the outcomes of major adverse cardiovascular events (MACE) - a composite of myocardial infarction, stroke, and cardiovascular mortality - and their associated factors after CHIP-PCI remain poorly understood. This study aims to evaluate 30-day MACE, patient characteristics and variables associated with mortality in CHIP-PCI. MATERIALS AND METHODS:This single-centre retrospective cohort study with 30-day follow-up utilised anonymous secondary data from CHIP-PCI patients treated at the Department of Cardiology, Hospital Raja Permaisuri Bainun between 1st January and 31st December 2024. Data extracted included demographics, comorbidities, laboratory investigations (low-density lipoprotein [LDL], serum creatinine, echocardiography findings), and intra- and postprocedural findings. Patients with missing data for ≥ 3 variables of interest were excluded. A multivariate binary logistic regression analysis was conducted to identify the variables associated with mortality post CHIP-PCI. RESULTS:Of the 161 total patients, 146 (90.7%) were included in the analysis. Among these, 71.9% were male, and the mean age was 63.03 ± 10.19 years. Common comorbidities included hypertension (83.6%), diabetes mellitus (66.4%), elevated LDL (51.6%), serum creatinine > 200μmol/L (38.4%), prior Acute Coronary Syndrome (37.0%), chronic dialysis (30.1%), and LVEF < 30% (9.6%). Radial access was the most common approach (72.6%), and PCI was most frequently performed for severe CAC (46.6%). Intracoronary imaging was used in 43.8% of cases, and 39.0% required advanced calcium modification technique (atherectomy or intravascular lithotripsy). Most were single-lesion PCI (80.8%), with the left anterior descending artery (80.8%) being the most treated vessel. The 30-day MACE rate was 5.5% (4.8% mortality, 0.7% stroke, and 0% recurrent myocardial infarction). Multivariate analysis demonstrated that LVEF < 30% (AOR: 41.1, 95% CI: 1.1-1563.8, p = 0.04), severe CAC (AOR: 28.2, 95% CI: 1.3-619.3; p = 0.03), elevated LDL (AOR: 28.7, 95% CI: 1.2-701.1; p = 0.04), and readmission (AOR: 81.7, 95% CI: 4.1-1618.3, p < 0.001) were exploratory variables associated with 30-day mortality. CONCLUSION:This study demonstrates that the 30-day MACE rate for CHIP-PCI was 5.5%, suggesting the procedure may be feasible with acceptable short-term outcomes in a nonsurgical centre. Severely reduced LVEF, severe CAC, elevated LDL levels, and hospital re-admission showed potential associations with 30-day mortality highlighting the need for optimised strategies for patient risk mitigation.
INTRODUCTION:Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality, with cervical insufficiency being a major contributor. While transvaginal ultrasound is the gold standard, concerns over invasiveness, resource requirements, and acceptability limit its universal use. Transabdominal cervical length measurement may offer a pragmatic alternative, particularly in conservative populations. We aim to compare transabdominal versus transvaginal cervical length measurement for screening of short cervix during the mid-trimester, and to determine the feasibility and clinical utility of using transabdominal ultrasound as a primary screening tool, especially in populations with reservations about undergoing transvaginal scans. MATERIALS AND METHODS:This was a prospective observational cohort diagnostic accuracy study involving pregnant women undergoing routine mid-trimester anomaly scans. Cervical length was measured using transabdominal and transvaginal ultrasound by experienced sonographers. STATISTICAL ANALYSIS:correlation assessed with Spearman's coefficient. Agreement evaluated with intraclass correlation and Bland-Altman plots. Diagnostic accuracy metrics (sensitivity, specificity, PPV and NPV) were calculated for transabdominal thresholds. Confounding factors, including bladder filling, maternal body mass index (BMI), and prior caesarean delivery on visualisation, were also evaluated. RESULTS:Of the 266 women eligible to participate in the study, 6.0% were excluded as they declined a transvaginal scan. Postvoid transabdominal (TA) measurements demonstrated better agreement with transvaginal (TV) values but were associated with higher rate of nonvisualization (10.0%). Bland-Altman plots showed good agreement without systematic bias. The mean prevoid TA cervical length and postvoid TA cervical length were 35.7 mm and 35.6 mm respectively, compared to 39.3 mm on TV measurement. Non-visualization occurred more often postvoid (10%) than prevoid (6.4%), while postvoid TA measurements showed stronger agreement with TV (ICC=0.818). Agreement of measurements was higher among Maternal-Fetal Medicine (MFM) consultants than among MFM fellows. Body mass index (BMI) and prior caesarean section scars did not significantly affected visualization or measurement accuracy. CONCLUSION:TA cervical length measurement is a reliable initial screening approach for identifying women at risk of short cervix during mid-trimester when performed by experienced operators. It serves as a pragmatic alternative in settings where TV scans are declined or not feasible, facilitating timely referral for TV confirmation and early initiation of preventive interventions such as progesterone therapy or cerclage. However, its application may be limited in untrained hands.
INTRODUCTION:Chest radiography is a commonly performed examination for screening, clinical assessment, and preintervention evaluation. Image quality plays an important role in supporting diagnostic interpretation. After image acquisition, radiographers decide whether the image should be accepted or repeated. Variation in these decisions may affect patient radiation exposure and radiology workflow. This study aimed to evaluate variation and agreement among radiographers in accepting or rejecting chest radiographs. MATERIALS AND METHODS:This cross-sectional study involved 91 certified radiographers in Indonesia. Thirty de-identified chest radiographs representing technical-quality categories were selected by an expert panel, and 12 duplicate images were added to assess intra-observer consistency. The resulting 42 images were presented in random order. The acceptance and rejection criteria were classified into 8 factors: accepted, artifact, blurring, mispositioning, incorrect body part, body part cut-off, exposure failure, and under/over exposure. Data were analysed using Cohen's kappa for duplicated image pairs and Fleiss' kappa for interobserver agreement. RESULTS:There were radiographer's perception variations in accepting or rejecting X-ray chest images. Intra-observer agreement for duplicated image pairs ranged from κ=0.027 to κ=0.727, with a simple mean Cohen's kappa of κ=0.525, indicating moderate agreement. Overall inter-observer agreement across the 42 images was fair (Fleiss' κ=0.337). Category-specific Fleiss' kappa values were highest for artifact-related rejection (κ=0.474) and image acceptance (κ=0.436), and lowest for blurring (κ=0.068), exposure failure (κ=0.076), incorrect body part (κ=0.107), and incorrect positioning (κ=0.173). CONCLUSION:Radiographers showed moderate intraobserver consistency but only fair inter-observer agreement when evaluating chest radiograph quality. The findings demonstrate variation in accepting or rejecting chest X-ray image. Collaboration between radiographers and radiologists is recommended to align evaluation standards.
INTRODUCTION:Otomycosis is a common fungal infection of the external auditory canal, particularly in tropical regions. Aspergillus and Candida are the main causative agents, yet their clinical differentiation remains challenging due to overlapping manifestations. This study aimed to identify the distribution of fungal etiologies, and to compare clinical manifestations and predisposing factors between Aspergillus and Candida infections in a tertiary hospital in Central Java, Indonesia. MATERIALS AND METHODS:A cross-sectional study was conducted at a tertiary hospital, including patients aged 17 years and above with clinically and microbiologically confirmed otomycosis. Demographic data, symptoms, physical findings, and predisposing factors were collected. Fungal identification was performed using culture and microscopy. Comparative analyses were conducted using chi-square or Fisher's exact test. RESULTS:A total of 41 patients (56 fungal isolates) were included. Aspergillus spp. accounted for 58.9% of isolates, while Candida spp. comprised 41.1%, with mixed infections observed in 16.1%. Itching, hearing loss, and ear fullness were the most common symptoms in both groups. No statistically significant differences were found in clinical manifestations or physical examination findings between Aspergillus and Candida infections (all p>0.05). Although whitish debris was more frequent in Candida and brownish debris in Aspergillus, these patterns were not discriminatory. Ear drop use and cotton bud manipulation were significantly associated with Aspergillus infections (p<0.05). CONCLUSION:Substantial clinical overlap exists between Aspergillus and Candida otomycosis, underscoring the importance of microbiological confirmation for accurate diagnosis.
INTRODUCTION:Treatment adherence remains a major challenge in tuberculosis (TB) control and may be influenced by psychosocial and health system factors that remain underexplored in many settings. This study aimed to examine the association between psychosocial and health system factors and treatment adherence among TB patients in Kota Kinabalu, Sabah. MATERIALS AND METHODS:A cross-sectional study was conducted among 351 TB patients registered in the National TB Registry between 2023 and 2024. Data were collected using structured, validated, and translated questionnaires, including the TB Stigma Scale and the Patient Health Questionnaire-9 (PHQ-9). Variables included sociodemographic characteristics, TB knowledge, treatment-related factors, and healthcare system factors. Simple and multivariable logistic regression analyses were performed to identify factors of treatment adherence. RESULTS:Stigma was negatively associated with treatment adherence (AOR=0.90; 95% CI: 0.86-0.95; p<0.001), whereas higher TB knowledge was associated with higher treatment adherence (AOR=1.20; 95% CI: 1.06-1.35; p=0.004). Compared with video directly observed therapy (VDOT), healthcare worker (HCW)-supervised direct observed treatment short-course (DOTS) was associated with lower treatment adherence (AOR=0.23; 95% CI: 0.06-0.90; p=0.030). Longer clinic waiting time was associated with higher treatment adherence (AOR=1.09; 95% CI: 1.05-1.13; p<0.001). Depression was negatively associated with adherence in univariate analysis but was not statistically significant in the multivariable model (AOR=0.58; 95% CI: 0.21-1.58; p=0.285). CONCLUSION:Stigma, TB knowledge, DOTS modality, and clinic waiting time were independently associated with TB treatment adherence in this setting. These findings highlight the importance of integrated, patient-centered TB care that addresses stigma, strengthens patient education, and incorporates digital approaches such as VDOT. Strengthening multifaceted interventions targeting both psychosocial and health system factors may improve TB treatment outcomes in Malaysia and similar high-burden settings.
INTRODUCTION:Palliative care is a human right and key to universal health coverage, yet remains inaccessible for many cancer patients. By 2030, Malaysia is expected to experience a 240% surge in demand for palliative care, with Sarawak, its largest state, projected to bear the greatest burden of unmet need. A novel statewide domiciliary palliative care (DPC) program was implemented to meet this growing demand across a culturally diverse and geographically dispersed region. This study characterizes the patterns of DPC service use during the inaugural year of this novel statewide program to inform future planning. MATERIALS AND METHODS:This retrospective cohort study included adults with advanced illnesses referred to DPC services at eight health clinics across Malaysia's largest state of Sarawak from July 1, 2023, to June 30, 2024. Descriptive analysis was utilized. RESULTS:A total of 113 patients with terminal illness were seen, the majority (89%; n=101) of whom had advanced cancer. The commonest cancer types were gastrointestinal (25%; n=28) and thoracic (17%; n=19). Median time from referral to first DPC encounter was 4 days (IQR 2-7). Median time to death was 28 days (IQR 11-53). Most patients (72%; n=82) received care in urbanized locations. CONCLUSION:This study demonstrates the wide reaching implementation of DPC across a geographically and culturally diverse region, particularly to cancer patients. Opportunities for strategic growth include expanding rural outreach, strengthening engagement with indigenous populations, and community engagement to enable more timely, inclusive, and equitable access to palliative care.
INTRODUCTION:Staphylococcus aureus is a commonly known causative agent of catheter related bloodstream infections (CRBSI) and complicated CRBSI. This study aimed to detect prevalence of S. aureus and complicated S. aureus CRBSI, their virulence genes and evaluate their association with development of complicated CRBSI, patient risk factors and outcomes. MATERIALS AND METHODS:A cross-sectional study involving retrospective record review of CRBSI cases was conducted from January 2019 to December 2021. A total of 139 CRBSI cases were identified. Patients' clinical data, risk factors and outcomes of S. aureus CRBSI were analyzed. Nineteen isolates from patients with complicated S. aureus CRBSI were selected for detection of Cna, Chp and Cap8 gene using PCR. The association between the development of complicated S. aureus CRBSI and the presence of virulence genes was analyzed. RESULTS:Forty-three (31%, n=43) of CRBSI cases were caused by S aureus. Among these, nineteen cases (44.2%) were complicated. Patients with chronic kidney disease (CKD) or end-stage renal failure (ESRF) (adjusted OR 11.11, 95% CI: 2.86-33.33, p<0.001) were at significant risk of S.aureus CRBSI. Virulence genes detected were Cap8 (89.5 %, n=17), Cna (47.4%, n=9) and Chp (26.3%, n=5). The presence of these genes was not significantly associated with the development of complicated S.aureus CRBSI. S. aureus CRBSI were associated with higher mortality (p=0.035). CONCLUSION:S. aureus was the predominant agent for CRBSI and 44.2% of them were complicated. CKD/ESRF were the comorbidities associated with S. aureus CRBSI. Although cap8 was the most frequently detected virulence gene, it was not associated with the development of complicated S. aureus CRBSI.
INTRODUCTION:COVID-19, caused by SARS-CoV-2 virus, is a respiratory infection that led to the 2020 pandemic. During the pandemic, mortality directly related to COVID-19 infection were classified as COVID-19 death based on case definition. However, excess mortality would be a more comprehensive method to look at the true impact of the pandemic rather than focusing only on COVID-19 deaths alone. The objective of this study was to determine the excess mortalities and top 5 causes of mortality that occurred during and after the COVID-19 pandemic in Perak. MATERIALS AND METHODS:Total and age-specific mortality data tabulated by the Department of Statistics Malaysia (DOSM) for the years 2010-2023 for the state of Perak was obtained. Data for the years 2010-2019 was re-grouped according to clustered age groups. This was used to generate the linear prediction line for mortality in 2020-2023 using Microsoft Excel 2010. Excess mortalities were calculated for 2020-2023 by subtracting the actual deaths from the predicted deaths. The top 5 common causes of mortality and COVID-19 deaths were also re-tabulated for the years 2020-2023 for the clustered age groups. "Positive Excess Mortality" (PEM) meant that the number of actual deaths were higher than predicted and "Negative Excess Mortality" (NEM) meant that the actual deaths were lower than the predicted number. Significant PEM meant that the value of the actual mortality was above the upper limit of the 95% confidence interval of the predicted mortality. RESULTS:All clustered age groups showed NEM for the year 2020. For the years 2021-2022, there was a PEM for all clustered age groups except those in the group "19 and below". The highest excess mortality was in the "65 and above" group with 343.44 and 685.56 per 100,000 agespecific population for 2021 and 2022 respectively. The mortality rate returned to the predicted value in 2023. In 2021 and 2022, there was a PEM for the "20-39" and "40-64" clustered age groups, however they were lower compared to the "65 and above" groups. Significant PEM was seen for all deaths in the "65 and above" in 2021 (237 per 100,000) and in 2022, 596 per 100,000. There was also a significant PEM after the removal of COVID-19 deaths in 2022 for the "65 and above" age groups- 366 per 100,000. Significant PEM was also seen in the "20-39" age groups and "40-64" age groups in 2021- 14 per 100,000 and 36 per 100,000 respectively. The other values that passed the 95%CI were deemed to be negligible. There were a few changes in the top 5 ranking for causes of death in Perak, the only obvious inclusion was deaths due to COVID-19 infections in 2021 in all groups except the "19 and below". CONCLUSION:There was a PEM in all groups except "19 and below" after the year 2020, with the highest in the "65 and above" group. COVID-19 deaths were included in the top 5 causes of death and contributed only partly to the excess mortality across all groups except "19 and below".
INTRODUCTION:Chronic hand eczema is a debilitating skin disease. The aetiology of hand eczema can be due to irritant contact, allergic contact or a manifestation of endogenous eczema. Identification of sensitisers and subsequent avoidance of relevant sensitisers may improve care of chronic hand eczema patients. We aimed to study the prevalence and pattern of sensitisation, factors associated with sensitisation and severity of hand eczema. MATERIALS AND METHODS:A cross sectional study was conducted over a six month period between January to June 2025 at the Department of Dermatology in a tertiary hospital located in the capital of Selangor. Patients with predominantly hand eczema aged above 18 years old were interviewed, examined and patch tested with Standard European Baseline Series from Chemotechnique Diagnostics. Patients with contraindications for patch test and uncertain diagnosis were excluded. Hand eczema morphology was classified according to the Danish Contact Dermatitis Group classification. Hand eczema severity was determined using Hand Eczema Severity Index (HECSI). Patch test results were interpreted according to International Contact Dermatitis Research Group (ICDRG) guidelines. RESULTS:A total of 54 patients aged 44± 15.29years old participated. Female to male ratio was 2.6:1 and 79.6% had positive patch test. The most common sensitisers were nickel sulphate (29.63%), fragrance mix 1 (25.93%), potassium dichromate (14.8%) and formaldehyde (14.8%). Polysensitisation was seen in 41.6%. Sensitisation was not associated with age, history of atopy, hand washing >10 times/day, hand wetting activities > two hours/day, use of non-permeable gloves, hand sanitiser use, fragrances and smoking. Cosmetic use showed seven times increased odds of polysensitisation (p=0.033). Hand eczema morphology was not associated with sensitisation. HECSI was significantly higher with use of non-permeable gloves. HECSI was not associated with atopy, frequency of hand washing and duration of wet hands. CONCLUSION:Patch test sensitisation was common in hand eczema patients. Polysensitisation was associated with use of cosmetics. Use of non-permeable gloves may worsen hand eczema.
INTRODUCTION:Inadequate medication adherence is a significant problem globally, affecting up to 50% of chronic illness patients. The complications can also be significant, with increased rates of disease complications and hospitalisations due to lack of adherence. This research study seeks to find the medication adherence rate across select suburban areas in Johor, Malaysia, and to identify the relationship between medication adherence and treatment concordance. MATERIALS AND METHODS:A community-based cross-sectional study was conducted among patients with chronic diseases across various locations in Johor. A validated questionnaire, the Malaysia Medication Adherence Assessment Tool (MyMAAT) and a Modified Concordance Scale were used to explore the study objectives. RESULTS:Medication adherence is defined as a MyMAAT score of ≥54. A total of 82 chronic illness patients participated in this study, with males (48.8%) and females (51.2%). The mean age of the participants is 57.5 years old. The study reported 41.5% adherence (MyMAAT ≥54). Female vs male OR was calculated via logistic regression adjusting for confounding factors, with adherence (MyMAAT≥54) as a binary factor (OR=4.23; 95% CI 1.38-12.91; p=0.011). A statistically significant weak correlation was found between the MyMAAT score and the Modified Concordance Scale score (SR ρ=0.286, p=0.009). CONCLUSION:In conclusion, the study shows a potential relationship between medication concordance and improved patient adherence in the Malaysian setting. More research should be conducted to further verify these findings.
INTRODUCTION:The Agatston coronary artery calcium (CAC) score is a widely used screening tool. However, its negative predictive value (NPV) in the Southeast Asian population, prone to premature non-calcified atherosclerosis, is not well defined. MATERIALS AND METHODS:We analysed paired data from 5,375 asymptomatic patients who underwent concurrent CAC scoring and Coronary CT Angiography (CCTA) at a tertiary center in Kuala Lumpur over 20 years. This cohort was selected to study plaque missed by CAC. A validated automated pipeline (weighted Cohen's Kappa = 0.978) was used to determine stenosis severity. RESULTS:Zero CAC yielded a negative predictive value of 76.1% for any plaque; 23.9% of calcium-negative patients harboured hidden atherosclerosis, including 3.5% with obstructive disease. While odds increased linearly with age (OR 1.22 per decade, p=0.004), missed disease peaked in males aged 40-44 and peri-menopausal women aged 55-59. These age groups represent a window during which lipidrich plaques accumulate before calcifying. CONCLUSION:Zero CAC can mask a "pre-calcific window" of active, radiolucent atheroma accumulation. Rather than a state of biological protection, this Zero CAC cohort harbours hidden risk driven by the same demographic engines as calcified disease, simply operating at an earlier phenotypic stage. Confirmatory CCTA is critical for high-risk younger males and peri-menopausal women to bridge this inherent diagnostic blind spot.
INTRODUCTION:In recent years, there has been an exponential rise in students inbound to Malaysia to pursue their postgraduate studies. In particular, Chinese international postgraduate students (CIPS) represent a rapidly growing student population in this country, which is postulated to lead to substantial psychological distress resulting from academic, cultural, and financial adjustments that are required of the students immersing themselves in a new environment. Nevertheless, quantitative evidence regarding depression, anxiety, and stress among CIPS in Malaysian public universities remains limited. MATERIALS AND METHODS:A cross-sectional study was conducted among 347 Chinese international postgraduate students at Universiti Putra Malaysia (UPM) using mixedmode convenience sampling. Data were collected using a structured questionnaire that included sociodemographic variables, stressors, stress-relieving activities, and the Depression Anxiety Stress Scales-21 (DASS-21). For the statistical analysis, we performed descriptive statistics, group comparisons, Pearson correlations, and hierarchical regression analyses. RESULTS:The prevalence of mild-to-extremely severe symptoms was 61.1% for depression, 67.1% for anxiety, and 56.2% for stress. Psychological distress was significantly associated with perceived discrimination, financial concerns, poorer self-rated health, and depression history. In the final hierarchical regression model, perceived discrimination emerged as the strongest predictor of distress (β = .270, p < .001). Furthermore, financial concerns, poorer self-rated health, and participation in artistic activities such as calligraphy classes were also positively associated with increasing DASS-21 scores, whereas positive future outlook scores showed a negative association. The final model explained 53.1% of the variance in psychological distress. CONCLUSION:Psychological distress among CIPS at UPM was substantial and appeared to be strongly related to acculturative stress and resource-related pressures. A proposed model to overcome this should include universitydriven, culturally responsive mental health services, antidiscrimination support, and financial and academic assistance to ensure the successful onboarding and orientation of international postgraduate students.
INTRODUCTION:Tuberculosis (TB) contact screening is a key strategy for early case detection and prevention of transmission. However, non-attendance at initial TB screening among contacts remains a persistent challenge, particularly in high-burden settings such as Sabah, Malaysia. This study aimed to determine factors associated with non-attendance at initial TB screening among contacts in Kudat, Sabah. MATERIALS AND METHODS:A case-control study was conducted using primary and secondary data from the National Tuberculosis Registry involving 468 TB contacts registered between June and December 2023. Cases were contacts who failed to attend initial screening within one month, while controls attended screening within the same period. Data were analysed using descriptive statistics and multiple logistic regression. RESULTS:Multivariable logistic regression analysis revealed that factors associated with lower odds of non-attendance included contacts of male TB index patients (OR: 0.30, 95% CI: 0.194-0.470), contacts of extrapulmonary TB index patients (OR: 0.09, 95% CI: 0.050-0.179), and higher attitude scores (OR: 0.88, 95% CI: 0.818-0.952). In contrast, contacts with secondary education had higher odds of nonattendance compared to those with no formal education (OR: 1.86, 95% CI: 1.080-3.209). CONCLUSION:Non-attendance at initial TB screening among contacts was associated with index case sex and TB form, contact education level, and attitudes towards TB. Targeted interventions addressing behavioural and structural barriers are essential to improve TB contact screening uptake in high-burden settings.
