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.
