The Medical Journal Of Malaysia[JOURNAL]
Sun
200 papers
Moving from tobacco control to tobacco endgame in Malaysia.
Rampal L
Med J Malaysia · 2025 Jul · PMID 40740077
Abstract loading — click title to view on PubMed.
Artificial intelligence in healthcare: A call for strategic implementation to maximize impact and minimize costs.
Chew KS
Med J Malaysia · 2025 May · PMID 40437729
Artificial Intelligence (AI) is transforming healthcare by improving diagnostics, decision-making, and patient outcomes. This commentary emphasizes the need for strategic AI implementation to maximize benefits while mini...
Artificial Intelligence (AI) is transforming healthcare by improving diagnostics, decision-making, and patient outcomes. This commentary emphasizes the need for strategic AI implementation to maximize benefits while minimizing costs. Although AI can automate routine tasks and freeing clinicians to focus more on patient care, challenges like costs and medicolegal concerns must be addressed. A two-dimensional impact-effort framework is proposed to prioritize AI tools implementation based on their impact and costs.
Exploring the factors leading to tiered referrals of pregnant women until tertiary healthcare facilities: An in-depth analysis.
Rizal MM, Pranadyan R, Izza A … +3 more , Dharmayanti HE, Habibie PH, Musyarrofah A
Med J Malaysia · 2025 May · PMID 40437728
INTRODUCTION: Maternal mortality in Indonesia remains a significant health issue, with a mortality rate of 305 per 100,000 live births, the highest in Southeast Asia. Prolonged referral processes and delays in receiving...
INTRODUCTION: Maternal mortality in Indonesia remains a significant health issue, with a mortality rate of 305 per 100,000 live births, the highest in Southeast Asia. Prolonged referral processes and delays in receiving medical assistance are major factors contributing to the high maternal mortality rate. OBJECTIVE: This study aims to explore the factors influencing tiered referrals of pregnant women to tertiary healthcare facilities. MATERIALS AND METHODS: This descriptive analytical study uses secondary data from medical records of patients admitted to the Obstetrics and Gynecology Maternity Room at Dr. Soetomo Hospital, Surabaya, from July to September 2023, with ethical clearance number 2813/104/4/III/2024. Sampling was done using the total sampling method, with the dependent variable being the referral source (hospital and non-hospital) and independent variables including the number of Antenatal Care (ANC) visits, BMI, gravidity, residence, occupation, and education. Data analysis was performed using multiple logistic regression with SPSS Software. RESULTS: Among the 280 patients studied, the majority were referred from hospitals (196 patients), and most had abnormal BMI (193 patients). Logistic regression analysis showed that women from rural areas had significantly higher delays in referrals compared to urban residents (p=0.004), while other variables such as age, number of ANC visits, BMI, gravidity, occupation, and education did not show significant influence. CONCLUSION: Place of origin is a critical factor influencing referral outcomes, highlighting the significant role of geographical and socio-economic determinants in the accessibility and quality of maternal healthcare services. This study underscores the necessity of an effective and timely referral system to mitigate maternal mortality rates in Indonesia, particularly emphasizing the need for enhanced referral infrastructure in rural areas to ensure prompt access to maternal care and ultimately reduce maternal mortality. SUMMARY: Indonesia's maternal mortality rate remains high (305 per 100,000 live births), influenced by prolonged referral processes. Secondary data from 280 medical records at Dr. Soetomo General Hospital, Surabaya (July- September 2023), revealed that most patients were referred from hospitals (196), predominantly exhibiting abnormal BMI (193). Logistic regression analysis identified residential location (rural vs. urban) as significantly impacting referral outcomes (p=0.004), whereas other factors (age, ANC visits, BMI, gravidity, occupation, education) showed no significant influence. These findings highlight the critical role of geographic and socioeconomic conditions in maternal healthcare accessibility and emphasise the importance of an efficient and timely referral system to reduce maternal mortality in Indonesia.
High concordance between Immunohistochemistry and RT-PCR in diagnosing ALK rearrangement in lung adenocarcinoma cytologic samples.
Heriyanto DS, Rachmadi L, Trisnawati I … +10 more , Tenggara JB, Cempaka R, Aribowo H, Kurnia Y, Lau V, Gunawan AN, Halim BN, Yuliani FS, Laiman V, Chuang HC
Med J Malaysia · 2025 May · PMID 40437727
INTRODUCTION: Lung cancer, predominantly lung adenocarcinoma, remains a major health challenge in Indonesia, with late-stage detection being common. This study explores the use of quantitative real-time polymerase chain...
INTRODUCTION: Lung cancer, predominantly lung adenocarcinoma, remains a major health challenge in Indonesia, with late-stage detection being common. This study explores the use of quantitative real-time polymerase chain reaction (qRT-PCR) for assessing ALK rearrangement from smear samples, a significant shift towards less invasive diagnostic methods, by assessing its concordance with immunohistochemistry (IHC) in detecting Anaplastic Lymphoma Kinase (ALK) rearrangements in lung adenocarcinoma patients. MATERIALS AND METHODS: This observational cross-sectional study analyzed 175 lung adenocarcinoma samples lacking EGFR mutations collected between 2018 and 2022. IHC was performed with the Ventana ALK D5F3 clone antibody on cell blocks or core needle biopsy specimens. The EML4-ALK fusion rearrangement status was determined using quantitative RNA qRT-PCR analysis on the smear specimen from transthoracic needle aspiration (TTNA) from the same sample. Only specimens with viable tumor cells were included, ensuring the exclusion of metastatic or necrotic samples. RESULTS: ALK rearrangements were identified in 16.2% (23/142) of samples via IHC and 14.8% (21/142) via qRT-PCR. Prevalence did not significantly differ by age and sex. The study found a 98.5% concordance rate between the two methods, with a κ coefficient of 0.95 (95% CI, 0.91-0.98), indicating almost perfect agreement. CONCLUSION: The high concordance between IHC and qRTPCR underscores their reliability in detecting ALK rearrangements, crucial for the precise diagnosis and treatment of lung adenocarcinoma in Indonesia. These findings support the use of either method, depending on available resources and expertise, to enhance lung cancer management.
Challenges in setting up the first cyto-reductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC) service in Malaysia.
Aziz MRA, Aziz NA, Xavier RG … +2 more , Khong TL, Roslani AC
Med J Malaysia · 2025 May · PMID 40437726
INTRODUCTION: Cyto-Reductive Surgery (CRS) with Hyperthermic Intra-Peritoneal Chemotherapy (HIPeC) improves survival in selected patients with peritoneal surface malignancies (PSM) of various tumour entities. This treatm...
INTRODUCTION: Cyto-Reductive Surgery (CRS) with Hyperthermic Intra-Peritoneal Chemotherapy (HIPeC) improves survival in selected patients with peritoneal surface malignancies (PSM) of various tumour entities. This treatment was not available in the Malaysian public health sector prior to 2018, due to lack of expertise, funding and accessibility. We report our challenges in establishing the first such service. MATERIALS AND METHODS: Patients referred for CRS-HIPeC between February 2018 and November 2023 were discussed in a multidisciplinary team meeting. Prospectively collected data, including patient demographics, extent of disease (radiological stage, peritoneal carcinomatosis index - PCI), pre-operative workup, completeness of cytoreduction (CCR) score and surgical outcomes, were analysed. RESULTS: Of 162 patients referred, 47 (30.0%) underwent CRS-HIPeC. The median age was 59 years (range 20-76 years). Median PCI was 11 (range 1-39). CCR distribution was as follows: CCR 0 - 40 (85.1%), CCR 1 - 2 (4.3%), CCR 2 - 2 (4.3%) and CCR 3 - 3 (6.3%). Median operative time was 645 minutes (range 360 -1575 minutes) with a median length of in-hospital stay of 11 days (range 6-146 days). All patients were initially managed in the intensive care unit. Sixteen (34.0%) patients developed complications of Clavien-Dindo Class 3 and above, with three operative mortalities (6.3%). CONCLUSION: CRS-HIPeC requires adequate clinical expertise, facilities and volume. Its labour and resourceintensive nature mean that centralization of services is necessary for sustainability. Further evaluation of its costbenefit in our setting will be required.
Mental state classification based on electroencephalogram (EEG) using multiclass support vector machine.
Purnami SW, Karimah S, Andari S … +5 more , Wulandari DP, Hadiwidodo YS, Islamiyah WR, Maramis MM, Zain JM
Med J Malaysia · 2025 May · PMID 40437725
INTRODUCTION: Mental state refers to a person's state of mind from various perspectives, including consciousness, intention, and functionalism. Mental states closely related to everyday life include the concentrating sta...
INTRODUCTION: Mental state refers to a person's state of mind from various perspectives, including consciousness, intention, and functionalism. Mental states closely related to everyday life include the concentrating state, neutral state, and relaxation state. Concentration is vital for cognitive tasks, while relaxation is crucial for comfort. However, individuals with mental disorders or neurological conditions often struggle to achieve these states, requiring effective detection and intervention. One method for detecting mental states is by using brainwave signals obtained through electroencephalogram (EEG). EEG has been widely used in neuroscience and clinical settings to objectively assess mental states by analyzing brainwave signals. Previous studies have demonstrated the potential of EEG-based mental state classification in stress detection, cognitive workload analysis, or depression detection. MATERIALS AND METHODS: The data used in this research is secondary data in the form of recorded brainwave signals using EEG from 2018. and utilises self-reported data obtained from locally validated personal stress inventory questionnaires. The data used was obtained from four participants, including two females and two males. For preprocessing, this study uses the Hamming Windows Finite Impulse Response filtering method to extract features from each wave band. Additionally, feature selection methods are applied to choose the most relevant predictor features. Multiclass Support Vector Machine (SVM) with One-Against- One (OAO) and One-Against-All (OAA) approaches are used for classification. RESULTS: The feature selection process reduced the number of predictor variables from 160 to 40, focusing on minimum and maximum feature values. Multiclass SVM classification using 40 predictor variables achieved an AUC range of 0.907-0.922 (OAA) and 0.854-0.927 (OAO), while classification using all predictor variables yielded an AUC range of 0.898-0.927 (OAA) and 0.917-0.941 (OAO). Comparative performance analysis indicates that the OAA approach is superior to the OAO approach. CONCLUSION: This study highlights the effectiveness of EEGbased classification of mental states using the Multiclass SVM method. The findings reinforce the role of EEG as an objective tool for mental state assessment, supporting its potential application in clinical and cognitive research for early detection of mental health disorders.
Credentialing & privileging an important factor for diagnostic accuracy of diabetic retinopathy screening in the health clinics of Penang.
Nasim AK, Ahmad Taufik J, Khalid I … +3 more , Rohana T, Ang EL, Farzaana A
Med J Malaysia · 2025 May · PMID 40437724
INTRODUCTION: Early detection and management of diabetic retinopathy (DR) is crucial in preventing blindness. Screening is recommended at diagnosis and yearly for Type 2 diabetes patients. DR screening using non-mydriati...
INTRODUCTION: Early detection and management of diabetic retinopathy (DR) is crucial in preventing blindness. Screening is recommended at diagnosis and yearly for Type 2 diabetes patients. DR screening using non-mydriatic fundus cameras (NMFC) has been extended to Health Clinics since 1997, but competency and experience of the medical officers (MOs) remain an issue in Primary Care. This study aims to assess the accuracy of the eye examination using NMFC for DR screening done by MOs and identify the factors associated with the accuracy. MATERIALS AND METHODS: This is a cross-sectional study using secondary data obtained from the Penang State Health Department, which conducted clinical audits of fundus images from health clinics in 2019. The audit involved two consultant ophthalmologists to comment on the accuracy of the interpretation of retinal images and the quality of the images sampled from all health clinics with NFMC. Sampling was performed on the audited data set to include diagnosis by the MOs and diabetic retinopathy spectrum of disease. The subject of the study was the images with the corresponding reports. The outcome of this study was the accurate interpretation of the images, as commented by the ophthalmologists. The independent variables studied were the demographic of the MOs who interpreted the images, their training background and the quality of the images. RESULTS: The Universal sampling method was used, and the final 1129 images fulfilled the eligible criteria. The sensitivity, specificity, PPV and NPV were found to be 80.6%, 92.7%, 76.4% and 94.2%, respectively. Overall accuracy was 83.8%. After missing values were managed, 997 samples were analysed using logistic regression. The final model shows that significant factors associated with accuracy are foreign graduates MOs (Adjusted OR 1.98, 95% CI: 1.35-3.07), MOs with Credentialing & Privileging (Adjusted OR 2.32, 95% CI:1.32-2.88) and Good Image Quality (Adjusted OR 3.62,95% CI:2.37-5.71). CONCLUSION: MO with C&P showed better accuracy than MO without C&P. This study suggests that MOH should emphasise the C&P when performing this procedure in health clinics. As image quality showed the highest association with accuracy, strengthening the C&P among the paramedics who perform the procedure using NMFC to get the retinal images is also necessary. This study also indicates that evaluating DR screening programs in health clinics is necessary nationwide.
Development and validation of a questionnaire assessing disease knowledge and self-care (ARKSc) level among allergic rhinitis patients.
Ahmad Nizar AHH, Aziz A, Abdullah B … +3 more , Azidah AK, Zahiruddin WM, Abd Mutalib NS
Med J Malaysia · 2025 May · PMID 40437723
INTRODUCTION: Understanding a patient's knowledge and selfcare level regarding allergic rhinitis (AR) is essential these factors significantly influence treatment outcomes. Currently, there is a lack of validated measure...
INTRODUCTION: Understanding a patient's knowledge and selfcare level regarding allergic rhinitis (AR) is essential these factors significantly influence treatment outcomes. Currently, there is a lack of validated measurement tools specifically designed to assess disease knowledge and selfcare among patients with AR. Therefore, this study aimed to develop and validate a new questionnaire - the Allergic Rhinitis Knowledge and Self-care (ARKSc) questionnairefor this purpose. MATERIAL AND METHODS: A questionnaire development and validation study was conducted in two phase. The first phase involved developing a self-administered questionnaire through literature review and consultations with an expert panel. Content validation was evaluated by a group of content experts using the content validity index (CVI), while face validity was assessed by AR patients using the Face Validity Index (FVI). In the second phase, construct validity of the final ARKSc questionnaire was examined at Hospital Sultan Abdul Halim, Kedah, Malaysia and Universiti Sains Malaysia Specialist Hospital (HPUSM), Kelantan, Malaysia involving 136 AR patients. Exploratory factor analysis (EFA) and reliability analysis were performed to assess the factorial structure and internal consistency of the questionnaire. RESULTS: The preliminary questionnaire included 16 questions (22 items) assessing AR knowledge and 11 questions on self-care. During content validation, three items with low item-CVI (I-CVI) score were removed. The average Scale-CVI (S-CVI/Ave) for both knowledge and selfcare domains was 0.83. The scale-level face validity index value (S-FVI/Ave) 0.95, indicating excellent clarity and comprehensibility. Following construct validation, the final version of questionnaire consisted of 11 items in the knowledge section and 4 items in self-care section. The Cronbach's alpha was 0.659 for the knowledge section, and 0.663 for the self-care section, reflecting acceptable internal consistency. CONCLUSION: The newly developed and validated ARKSc questionnaire is a valid and reliable instrument for assessing disease knowledge and self-care among patients with allergic rhinitis. This study provides a foundation for future development of more refined tools and underscores the importance of evaluating these domains to enhance disease management and patient outcomes.
Effect of oral colostrum application every 2 hours and 4 hours in order to achieve trophic feeding in preterm infants: A randomized controlled trial.
Indriani AT, Wandita S, Haksari EL … +3 more , Wibowo T, Anggraini A, Natalia H
Med J Malaysia · 2025 May · PMID 40437722
INTRODUCTION: Enteral feeding in preterm neonates starts with trophic feeding, which is the practice of feeding minute volumes of enteral feeds (starting at 10-25mL/kg/day) through an orogastric tube. Colostrum has prote...
INTRODUCTION: Enteral feeding in preterm neonates starts with trophic feeding, which is the practice of feeding minute volumes of enteral feeds (starting at 10-25mL/kg/day) through an orogastric tube. Colostrum has protective effects, such as anti-inflammatory, immunomodulatory, and antimicrobial effects. The oral colostrum application is a safe, effective and economical therapy. However, the most optimal frequency of the oral colostrum application is not yet conclusive. This study aims to evaluate the effects of applying colostrum orally every 4 and 2 hours in order to achieve trophic feeding in preterm infants. MATERIALS AND METHODS: In this randomized controlled trial with an open-label design, very-low-birth-weight neonates admitted to RSUP Dr. Sardjito from March to August 2023 were allocated to receive oral colostrum applications either every two hours or every four hours. Subjects were randomized into study groups using a random block size of four through computer-generated in a 1:1 ratio. The primary outcome was the time to achieve trophic feeding. The extraneous variables were necrotizing enterocolitis, sepsis, hemodynamically significant Patent Ductus Arteriosus (hsPDA) and gender. Data analysis was conducted using SPSS. RESULTS: A total of 40 neonates were analyzed for primary outcome. Of these, 20 neonates received oral colostrum applications every 2 hours, and the other 20 subjects were fed every 4 hours. Bivariate analysis showed that colostrum application given every 4 hours achieved the trophic feeding 0.47 day faster than the colostrum application every 2 hours. However, the difference between the two feeding methods was not statistically significant (p=0.703). CONCLUSION: There is no significant difference in achieving trophic feeding in preterm neonates (less than 34 weeks) whether the colostrum was given every 2 or 4 hours.
Mild cognitive impairment and its associated factors amongst the older people attending government health clinics in Kuantan.
Atri Roop Y, Shalihin MSE, Mohammad Aidid E
Med J Malaysia · 2025 May · PMID 40437721
INTRODUCTION: Malaysia is undergoing a demographic transition towards an aging population, resulting in an anticipated rise in the number of older individuals at risk of developing dementia. Mild cognitive impairment (MC...
INTRODUCTION: Malaysia is undergoing a demographic transition towards an aging population, resulting in an anticipated rise in the number of older individuals at risk of developing dementia. Mild cognitive impairment (MCI) represents an intermediate clinical stage between normal cognition and dementia, characterized by cognitive decline that does not significantly impair daily functional activities. Early detection of MCI is critical, as early-stage interventions and modifications of risk factors can yield promising outcomes. MATERIALS AND METHODS: This cross-sectional study evaluated the prevalence of MCI and its associated factors among 327 older adults attending healthcare clinics. Data were collected using the Elderly Cognitive Assessment Questionnaire, Geriatric Depression Scale, and Barthel Index. Binary logistic regression analysis was performed to identify significant factors of MCI. RESULTS: The prevalence of MCI in the study population was 18.7%, with the majority demonstrating poor control of comorbid conditions. Significant factors of MCI included being a widower (OR 0.4; 95%CI: 0.18, 0.94), increasing age (OR 0.92; 95% CI: 0.88, 0.97), and having diabetes (OR 3.49; 95% CI: 1.81, 6.73). CONCLUSION: The findings highlight that a significant proportion of older adults are at risk of progressing to dementia but remain underdiagnosed during the early stages. Optimizing blood sugar control emerges as a crucial strategy to mitigate the progression of MCI to irreversible dementia. Implementation of active cognitive screening programs is essential for early identification and timely intervention.
The impact of facial acne scars on quality of life, anxiety, depression and its associated risk factors.
Heah MM, Ng RS, Low DW … +2 more , Mohd Ali N, Jamil A
Med J Malaysia · 2025 May · PMID 40437720
INTRODUCTION: Acne scars negatively impact psychosocial and emotional wellbeing. However, data on the impact of acne scarring on anxiety and depression as well as quality of life are limited. This study assessed the effe...
INTRODUCTION: Acne scars negatively impact psychosocial and emotional wellbeing. However, data on the impact of acne scarring on anxiety and depression as well as quality of life are limited. This study assessed the effects of facial acne scars on quality of life, anxiety, and depression, and identifies risk factors associated with scar severity. MATERIALS AND METHODS: We conducted an observational cross-sectional study between February 2023 and January 2024 at dermatology clinics in two public hospitals. A total of 175 patients with facial acne scars were recruited. Data collection included patient demographics, acne severity, scar severity (SCAR-S) and questionnaires such as Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS). The association between scar severity, quality of life, anxiety, and depression was analyzed using Chi-square tests and ordinal logistic regression. RESULTS: The median age of participants was 26.9 years and 56% were female. Most patients had mild (37.7%) to moderate (28.6%) acne scars. Among patients with severe/very severe scars, 69.2% reported a significant impact on quality of life (DLQI>10). A significant association was observed between scar severity and anxiety (p=0.009) as well as depression (p<0.001). There was a positive correlation between HADS and DLQI scores (r=0.602, p<0.001). Delayed or absent treatment after acne onset was a significant risk factor for acne scar severity. CONCLUSION: Facial acne scars are associated with impairment in quality of life and increased anxiety and depression. Timely and effective acne treatment is essential to reduce the severity of scarring and its psychosocial burden.
Treating newly diagnosed Diffuse Large B-cell Lymphoma in the elderly patient with R-mini-CHOP: A single centre analytical retrospective observational study.
Lai NL, Bee PC
Med J Malaysia · 2025 May · PMID 40437719
INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) forms the bulk of non-Hodgkin lymphoma (NHL) cases encountered in clinical practice among the elderly. For the majority of cases of DLBCL, treatment comprising of Ritux...
INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) forms the bulk of non-Hodgkin lymphoma (NHL) cases encountered in clinical practice among the elderly. For the majority of cases of DLBCL, treatment comprising of Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone (R-CHOP) is suggested as first line chemotherapy. However, chemotherapy in the elderly population may be hampered by multiple factors, including reduced bone marrow reserves, significant comorbidities, and greater side effects from chemotherapy. Treatment as such aims to offer disease control and prolong life whilst minimising treatment related complications in this group of patients. Treatment with R-mini-CHOP, a reduced dose form of R-CHOP offers survival benefits and is recommended for treatment of elderly DLBCL patients and those who are frail. Our study examined local Malaysian experience of treating the newly diagnosed elderly DLBCL patient with R-mini- CHOP. MATERIALS AND METHODS: We retrieved retrospective data of all DLBCL patients aged >65 years old from the electronic medical records in Pusat Perubatan Universiti Malaya who received R-mini-CHOP. Treatment response was assessed by the overall response rate (ORR), defined as the proportion of patients attaining complete and partial remission after six cycles of treatment. We excluded patients with transformed lymphomas and relapsed refractory disease. For secondary analysis, we examined patients' treatment response according to their baseline demographic characteristics, development of complications during therapy as well as their survival in months from diagnosis. RESULTS: Our study identified 33 patients in the period of January 2017 till June 2023. The mean age of the sample cohort was 78 years old (Range from 66 to 86 years old). Majority of the samples had advanced stage lymphoma at initial diagnosis with n=21/33 (63.6%) having stage III and IV disease. At the end of treatment, one patient did not have assessment scans and hence was excluded from analysis. n=16/32 patients (50.0%) had attained ORR when analysed by intention to treat, n=14/32 (43.7%) attained complete response and n=2/32 (6.25%) attained partial response. When analysed for treatment response, those who attained ORR were more likely to have Stage 1 or 2 disease (p value = 0.028) and had statistically significant increased progression free survival (28.5 vs 5.5 months, p value <0.01) and overall survival (28.5 vs 9.0 months, p value = 0.03) compared to those who did not attain ORR. In terms of treatment associated complications, n=9/32 (28.1%) of patients developed severe infection necessitating hospitalization, n=14/32 (43.7%) developed at least Grade 2 and above cytopenias, and n=13/32 (41.6%) developed some other adverse side effects, most of which were mild to moderate in terms of severity. CONCLUSION: The ORR for our patients treated with R-mini- CHOP was lower than other cohorts. We hypothesise that Rmini- CHOP alone may not offer adequate lymphoma control in our sample, especially for treatment of advanced stage DLBCL. Age alone is not an objective assessment of suitability for treatment; therefore, we suggest the use of geriatric prognostication tools to better ascertain patient groups who would benefit from full dose R-CHOP chemotherapy to improve response and survival.
Evaluation of dry eye pre and post phacoemulsification in diabetic patients.
Nur Faizah H, Mohd Feendi Y, Siti Zakiah MK … +1 more , Wan-Hazabbah WH
Med J Malaysia · 2025 May · PMID 40437718
INTRODUCTION: Dry eye is a common condition influenced by various factors, including cataract surgery and systemic diseases like diabetes. Phacoemulsification, a widely used cataract procedure, often leads to increased p...
INTRODUCTION: Dry eye is a common condition influenced by various factors, including cataract surgery and systemic diseases like diabetes. Phacoemulsification, a widely used cataract procedure, often leads to increased postoperative dry eye symptoms due to inflammation and changes in tear film stability. Diabetic patients, already prone to dry eye, may experience further worsening after surgery. This study evaluates dry eye status in diabetic patients before and after phacoemulsification. MATERIALS AND METHODS: This study included 126 patients, divided into diabetic and non-diabetic groups from Hospital Melaka and Hospital Pakar Universiti Sains Malaysia between September 2022 and July 2024. Patient demographics and dry eye parameters, including the Ocular Surface Disease Index (OSDI), Tear Break-Up Time (TBUT), and Schirmer's test, were evaluated at baseline, one week, and three months after surgery. Only patients who underwent uncomplicated phacoemulsification were included, while those undergoing extracapsular cataract extraction, intracapsular cataract extraction, or lens aspiration were excluded. The mean values of OSDI, TBUT, and Schirmer's test across the three time points were compared among groups with diabetic retinopathy, without diabetic retinopathy and non-diabetic patients using repeated measures ANOVA. RESULTS: 126 patients were studied: 44 non-diabetic, 40 diabetic without retinopathy (no DR), and 42 diabetics with retinopathy (DR). The mean ± SD (standard deviation) age was 64.06 ± 5.30 years, with males comprising 54.0% of the cohort. Hypertension was the highest proportion of comorbidity (75.4%), particularly in the DR group (90.5%). Dry eye parameters showed significant temporary changes post-cataract surgery. OSDI scores improved significantly from baseline to three months in all groups, with diabetic groups showing higher scores at three months than nondiabetics (p < 0.05). TBUT declined significantly at one week in the diabetic groups (DR, p = 0.028; no DR, p = 0.019) but showed substantial recovery by three months, with significant improvements across all groups. In all groups, Schirmer's test values improved significantly between one week and three months (p < 0.05), although baseline and one-week differences were not statistically significant. CONCLUSION: Three months after cataract surgery, significant improvements in OSDI scores, TBUT, and Schirmer's test values were observed, indicating a recovery in dry eye status. Diabetic patients experienced more pronounced early postoperative changes but demonstrated comparable recovery trends to non-diabetics by three months. These findings highlight the importance of monitoring dry eye parameters in diabetics, particularly during the early postoperative period, to optimise outcomes and patient satisfaction.
Factors associated with depression among the community-dwelling elderly In Kudat, Malaysia.
Azhar N, Alias A, Wan Mohamad Lotfi WHN … +8 more , Omar A, Mokti K, Syed Abdul Rahim SS, Jeffree MS, Ibrahim MY, Musa M, Hassan MR, Shobugawa Y
Med J Malaysia · 2025 May · PMID 40437717
INTRODUCTION: The burden of elderly depression is rising with the growing ageing population, particularly in rural areas with limited healthcare access. In Malaysia, 27.8% of the elderly experience depression, with 16.5%...
INTRODUCTION: The burden of elderly depression is rising with the growing ageing population, particularly in rural areas with limited healthcare access. In Malaysia, 27.8% of the elderly experience depression, with 16.5% of depressive symptoms reported among community-dwelling older adults. This study aimed to determine the prevalence of depression and its associated factors among the elderly in Kudat, a rural area in Sabah. MATERIALS AND METHODS: A cross-sectional study was conducted using the Malay version of the Geriatric Depression Scale (M-GDS-14). Logistic regression analyses were used to analyse the relationships between elderly depression and sociodemographic, socioeconomic, physical health, lifestyle, and psychosocial factors. RESULTS: A total of 310 participants were involved, with a mean age of 69.4 years. Most were of Rungus ethnicity (78.7%) and married (73.9%). About 72% had a household income below RM 1,000; half were retirees, while 43.2% were still working. The prevalence of depression was high at 73.2% (95% CI: 70.7, 75.7). Comorbidities and moderate-topoor self-rated health were significantly associated with higher odds of depression, with adjusted odds ratios of 1.99 and 2.09, respectively. CONCLUSION: The findings highlight the high level of depression among the elderly in Kudat and the significant association with comorbidities and self-rated health status. Public health programs should focus on managing comorbidities and promoting positive self-perceived health to reduce depression in this population.
Mortality and risk factors in post-operative pancreatic fistula following pancreatoduodenectomy: A single centre experience.
Ong GH, Leow VM, Manisekar S
Med J Malaysia · 2025 May · PMID 40437716
Abstract loading — click title to view on PubMed.
Eye cases that widened the vision on medical negligence.
Tharmaseelan NKS
Med J Malaysia · 2025 May · PMID 40437715
Abstract loading — click title to view on PubMed.
An overview of hyperacute stroke services and National Stroke Registry in Malaysia - Improving stroke care through evidence.
Chin CJ, Albart SA, Yusof Khan AHK … +5 more , Wan Zaidi WA, Sidek NN, Schee JP, Looi I, Hoo FK
Med J Malaysia · 2025 Mar · PMID 40145171
INTRODUCTION: Stroke is a leading cause of death and disability in Malaysia. This paper provides an overview of the stroke burden, hyperacute stroke services, importance, and challenges of stroke registries. It also deta...
INTRODUCTION: Stroke is a leading cause of death and disability in Malaysia. This paper provides an overview of the stroke burden, hyperacute stroke services, importance, and challenges of stroke registries. It also details findings from the National Stroke Registry (NSR) Malaysia that have advanced knowledge on local patterns, inequalities and temporal trends in stroke presentation, care processes and outcomes. MATERIALS AND METHODS: A recent survey that involved all the government (Ministry of Health, MOH) and university hospitals in Malaysia was conducted by a group of neurologists and researchers to provide insights into the hyperacute stroke services in Malaysia from 2012 to 2023. RESULTS: The results from the survey found that out of 142 MOH hospitals, 29 (20%) hospitals offer only intravenous thrombolysis (IVT) service, and seven (5%) hospitals offer both IVT and mechanical thrombectomy (MT) services. The majority or two-thirds of MOH hospitals still offer office hour services for both IVT and MT. For university hospitals, four (67%) out of six university hospitals provide both IVT and MT services and one (16%) university hospital provides only IVT service. Most university hospitals offer 24-hour services for IVT and MT. The availability of IVT service across MOH hospitals has increased significantly from 2012 to 2023. Thus, there was a substantial increase in the number of IVT cases treated in MOH hospitals. The growth in MT service has been more gradual. Only 22% of the MOH hospitals that provide hyperacute stroke services are equipped with acute stroke unit (ASU). Whereas ASU is available in 80% of the university hospitals that offer hyperacute stroke services. The higher availability of ASU in university hospitals compared to MOH hospitals may be due to better resources, specialised expertise, and advanced facilities in the university hospitals. The National Stroke Registry (NSR) Malaysia was established in 2009 to monitor stroke management practices, patient outcomes and promote quality improvement initiatives. CONCLUSION: Despite suboptimal adherence on several key performance indicators, the NSR reports recent improvements in thrombolysis rates, reduced mortality, and better functional outcomes. Key recommendations center on promoting greater participation, feedback systems, adequate funding, and governance structures to translate registry findings into national policies and targeted interventions for equitable access to quality stroke care.
Non-statin therapy in patients with elevated LDL-C and high platelet reactivity: a narrative review.
Nurmukhammad FN, Zhangelova Sh B, Кapsultanova DA … +5 more , Musagaliyeva AT, Danyarova LB, Rustamova FE, Sugraliyev AB, Ospanova GE
Med J Malaysia · 2025 Mar · PMID 40145170
INTRODUCTION: Evidence of an association between elevated LDL-C levels and HRPR - which are highly prevalent separately and both lead to rapid progression of atherosclerosis on ineffective hypolipidaemic therapy - is sca...
INTRODUCTION: Evidence of an association between elevated LDL-C levels and HRPR - which are highly prevalent separately and both lead to rapid progression of atherosclerosis on ineffective hypolipidaemic therapy - is scarce. MATERIALS AND METHODS: We searched electronic databases. All available randomized controlled trials (RCTs) were included, and we considered the scientific novelty of the study, the reliability of the reported study results; the high methodological level of the study of non-statin therapy in patients with dyslipidemia and high residual platelet reactivity, with no language or date restrictions. We did separate random-effects meta-analyses for LDL-С, HRRP on their effects on LDL-С levels and outcomes, taking into account the reliability of the reported study results and the high methodological level of the study. The challenge of achieving target LDL-С levels, their impact on high residual platelet reactivity, and the choice of optimal antiplatelet and lipid-lowering therapy remains unresolved. RESULTS: The integration of newer therapies, such as inclisiran and PCSK9 inhibitors, may play a critical role in achieving optimal outcomes for patients at high cardiovascular risk. CONCLUSION: The necessity of applying an individual multidisciplinary approach in order to determine the best regimen of antiplatelet and lipid-lowering therapy in patients with coronary heart disease, including after revascularization, is shown. This approach will reduce the risk of recurrent cardiovascular events. Few studies on the relationship between LDL-С and HRPR dictate the need for more detailed research in this area.
Uterine torsion in pregnancy: a case report and systematic review.
Zahar AZ, Mazrin Nur MA
Med J Malaysia · 2025 Mar · PMID 40145169
INTRODUCTION: Uterine torsion in pregnancy is a rare condition but is associated with significant negative outcomes to the pregnant women and their babies. This study is to systematically review the literatures and analy...
INTRODUCTION: Uterine torsion in pregnancy is a rare condition but is associated with significant negative outcomes to the pregnant women and their babies. This study is to systematically review the literatures and analyse the clinical presentations, management and complications of uterine torsion in pregnancy. MATERIALS AND METHODS: We searched across multiple databases (PubMed, Google Scholar, ScienceDirect, Academia.edu, ResearchGate and Semantic Scholar) and suitable articles from 1993 to 2022 were systematically chosen according to PRISMA guideline. The analysis was performed on the maternal characteristics, signs and symptoms of the uterine torsion, management, complications and outcomes of both the mothers and infants. All case reports or case series reporting uterine torsion in pregnancy from English language journals were included without restriction on the geographical origin. RESULTS: A total of 149 cases from 146 publications and one from our centre were included for analysis. Most of the cases were seen in the third trimester and presented with acute abdominal symptoms and signs. It presented a challenge in diagnosis and had a myriad of complications to the mothers and infants. The maternal mortality is 2.0% while the perinatal mortality stands at 38.2%. CONCLUSION: Uterine torsion in pregnancy is a rarely encountered but serious condition with no specific precipitating factor or diagnostic criteria. It can occur at any gestation, has a wide range of non-specific clinical presentations, and carries a significant risk to the mother and child.
Frequency of computer vision syndromes among students during COVID-19 lockdown - a single school study in Malaysia.
Liew JY, Yong PT, Lee HN … +2 more , Loo AVP, Subrayan V
Med J Malaysia · 2025 Mar · PMID 40145168
INTRODUCTION: To determine the frequency of computer vision syndromes among students during COVID-19 lockdown in Malaysia. MATERIALS AND METHODS: This is a cross-sectional survey study. A total of 145 subjects studied in...
INTRODUCTION: To determine the frequency of computer vision syndromes among students during COVID-19 lockdown in Malaysia. MATERIALS AND METHODS: This is a cross-sectional survey study. A total of 145 subjects studied in secondary school and pre-university programme were involved in this study. An exploratory survey questionnaire was used to assess the symptoms of computer vision syndromes encountered by the students and their electronic device usage behavior before and during fully remote learning started. RESULTS: Average time spent by students on outdoor activities reduced from one to two hours per day (40.7%) to less than an hour per day (56.6%) after fully remote learning. Average time spent on entertainment activities using electronic devices increased from one to two hours per day (38.6%) to four hours and above per day (40.0%) after fully remote learning. The majority of time spent on school assignments using electronic devices increased from one to two hours (44.8%) to three to four hours per day (33.8%) after fully remote learning. Increased frequency of students experienced eye pain (44.1%), eye fatigue (57.2%), headache (56.6%), eye itchiness (18.6%), glare (31.7%), dry eye (40.0%), blurry vision (31.7%) and double vision (7.6%) after fully remote learning began. CONCLUSION: An observed increase frequency of computer vision syndrome was noted in relation to the reduction of time spent on outdoor activities and increased usage of electronic devices for entertainment activities and completing school assignment during COVID-19 lockdown in Malaysia.
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