The Medical Journal Of Malaysia[JOURNAL]
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200 papers
Relationship between post-partum mothers' knowledge and essential newborn care practices in Jambi, Indonesia.
Jayanti O, Haksari EL, Ismarwati … +1 more , Ismail D
Med J Malaysia · 2026 Mar · PMID 41914586
INTRODUCTION: Essential Newborn Care (ENC) is crucial for neonatal survival, which is known to be very significant for the objective of Sustainable Development Goals in 2030 as an attempt to decrease neonatal morbidity a...
INTRODUCTION: Essential Newborn Care (ENC) is crucial for neonatal survival, which is known to be very significant for the objective of Sustainable Development Goals in 2030 as an attempt to decrease neonatal morbidity and mortality. Mothers play an important role in ENC. This study aimed to delve into the relationship between mothers' knowledge, parity, education level, age, occupation, economic status, and ENC practices in post-partum mothers. MATERIALS AND METHODS: A cross-sectional design was conducted in Jambi, Indonesia from June to August 2021. There were 152 post-partum mothers who had neonates aged 0-28 days, consisting of 76 primiparous and 76 multiparous mothers. A questionnaire on ENC knowledge and practice was utilized to collect the data from the instrument of the previous study. The data were examined using univariate, bivariate, and multivariate analyses. RESULTS: Multivariate analysis on ENC practices revealed that mothers with low knowledge had a higher risk of performing poor ENC practices with OR 10.6 than those with high knowledge, and it was significantly different. Mothers with low educational level had more risks of practicing poor ENC with OR 2.9 than those with high educational level, which was significantly different. Meanwhile, parity, age, occupation, and economic status of post-partum mothers did not present a statistically significant correlation (p>0.05) with ENC practices. CONCLUSION: There was a significant difference in ENC practices, with high risk in those who had low knowledge followed by low education. There was no association between ENC practices and parity, age, occupation, and economic status of post-partum mothers. These findings highlight the importance of improving the knowledge of post-partum mothers in supporting ENC practices. The result of the study should nevertheless be interpreted in such a way by considering the limitations of the study design and the instruments used.
Attitudes, beliefs and willingness to prescribe medical cannabis among public medical practitioners in Malaysia.
Kamarudin SS, Low EV, Ooi CL … +5 more , Ahamad Fouzi L, Mohd Muharam A, Ahmad Rosdi H, Sharifudin AH, Peariasamy K
Med J Malaysia · 2026 Mar · PMID 41914585
INTRODUCTION: Currently, several countries have implemented regulations governing the use of medical cannabis. Recreational use of cannabis is illegal under Malaysian laws and it is unclear what medical practitioners thi...
INTRODUCTION: Currently, several countries have implemented regulations governing the use of medical cannabis. Recreational use of cannabis is illegal under Malaysian laws and it is unclear what medical practitioners think of cannabis when it is used for medical purposes. We conducted a nationwide survey in Malaysia to study the attitudes, beliefs and willingness of public medical practitioners to prescribe medical cannabis. MATERIALS & METHODS: A 23-item online questionnaire was administered to 420 medical practitioners working in government institutions. Participant demographics, clinical specialities, employment history, exposure to knowledge of medical cannabis and case vignettes related to the use of medical cannabis were collected and analysed. RESULTS: Sixty-five percent of medical practitioners agreed that medical cannabis should be available for certain conditions, particularly pain (87%). Most medical practitioners in the case vignettes were willing to recommend medical cannabis to treat pain due to cancer (74.3%) and chronic pain (66.9%). Logistic regression indicated that both gender and exposure to information on medical cannabis are significant factors (p<0.05) in predicting the willingness of medical practitioners to prescribe medical cannabis. CONCLUSION: Medical practitioners in the public institutions showed favourable attitudes towards prescribing medical cannabis for chronic pain and cancer pain. However, further work is required to examine factors that drive these attitudes, and potential prescribing behaviour including those in private and university settings. A thorough evaluation of the scientific evidence and related legislation is essential, especially if a regulated pathway is to be adopted. In this situation, medical practitioners must have a clear understanding of clinical practice guidelines regarding pain indications, dosing and monitoring protocols as well as effective pharmacovigilance. Additionally, this should be combined with targeted evidence-based training on medical cannabis for medical practitioners.
Biologic drug survival in psoriasis: insights from a multi-center retrospective study in West Malaysia.
Chan KV, Moonyza AAK, Mohd Affandi A … +10 more , Mashor M, Kwan JW, Latha S, Lee HL, Lee SE, Yap EWY, Nazatul Shima AR, Wong SB, Lee CS, Gunabalasingam P
Med J Malaysia · 2026 Mar · PMID 41914584
INTRODUCTION: Psoriasis is a chronic immune-mediated skin disorder with significant impact on patients' quality of life. Biologic therapies have revolutionized the treatment of moderate-to-severe psoriasis, but data on t...
INTRODUCTION: Psoriasis is a chronic immune-mediated skin disorder with significant impact on patients' quality of life. Biologic therapies have revolutionized the treatment of moderate-to-severe psoriasis, but data on their long-term effectiveness, measured through drug survival rates, remains limited in Malaysia. This study aimed to analyze the drug survival of biologic therapies and identify factors influencing treatment discontinuation among psoriasis patients in Malaysia. MATERIALS AND METHODS: This retrospective cohort study analyzed 285 psoriasis patients receiving 437 biologic treatment courses in 10 tertiary hospitals in West Malaysia. Data on demographic characteristics, clinical profiles, and biologic treatments were collected and analyzed. Drug survival was evaluated using Kaplan-Meier analysis, and predictors of treatment discontinuation were identified using Cox proportional hazards modeling. RESULTS: The study cohort had a mean psoriasis onset age of 28 (⊕ 13) years, with biologic initiation at 39 (⊕ 16) years. Secukinumab (53.7%) was the most commonly prescribed first-line biologic, followed by Ustekinumab (28.1%). Loss of efficacy was the leading cause of discontinuation, increasing from 49.6% in the first line to 100% by the fifth. Kaplan-Meier analysis showed Secukinumab had the longest mean survival (45.5 months), followed by Ustekinumab (41.4 months) and Rizankizumab (41.3 months). Cox regression revealed prior biologic use significantly increased discontinuation risk (HR = 1.415, p = 0.049), while diabetes mellitus approached significance increase discontinuation risk (HR = 1.575, p = 0.054). CONCLUSION: Biologic drug survival in Malaysian psoriasis patients reflects global trends, with Secukinumab demonstrating superior durability. Loss of efficacy and funding issues were key barriers to persistence. The findings emphasize the need for optimized treatment strategies with wider access to biological treatment.
Quality of life of Hirschsprung disease patients with a stoma.
Gracia J, Qisthi SA, Rezza AI … +7 more , Harfanie DF, Izzati ZS, Wijayatno QJ, Brahmandoko YG, Iskandar K, Purnomo E, Gunadi
Med J Malaysia · 2026 Mar · PMID 41914583
INTRODUCTION: Hirschsprung disease (HSCR) is a genetic disorder leading to gastrointestinal obstruction due to the absence of ganglion cells in the submucosal and myenteric plexuses. Treatment typically involves a pull-t...
INTRODUCTION: Hirschsprung disease (HSCR) is a genetic disorder leading to gastrointestinal obstruction due to the absence of ganglion cells in the submucosal and myenteric plexuses. Treatment typically involves a pull-through surgery, sometimes starting with a colostomy. The COVID-19 pandemic has resulted in restrictions on general patient services, i.e., non-COVID-19 patients, at health facilities, leading to reduced hospital visits, including HSCR patients with stomas. This study aimed to determine whether there were differences in the quality of life (QoL) of HSCR patients with stomas before and after the COVID-19 pandemic. MATERIALS AND METHODS: This research was a descriptive study comparing the quality of life (QoL) of HSCR patients with stomas before and after the COVID-19 pandemic. It utilized a cross-sectional study design and assessed QoL using the PedsQL Generic Core Scales 4.0 questionnaire. RESULTS: There was no significant difference in the QoL of HSCR patients before COVID-19 and after COVID-19, as indicated by parent reports (p=0.88) and child reports (p=0.12). However, there was a statistically significant difference in scores on the social dimension of child reports (p=0.04). Furthermore, there was no statistically significant relationship between parent and child reports (p>0.05). CONCLUSION: The QoL of HSCR patients with a stoma before and after the COVID-19 pandemic is similar, except for the social dimension in the child's report. Further studies with more cases are necessary to clarify the findings of this study.
Cytopeutics umbilical cord-derived mesenchymal stem cells are associated with earlier clinical improvement compared to bone marrow aspirate concentrate with scaffold in knee cartilage injury: A Phase 1 feasibility and Phase 2 randomized controlled trial.
Md Yusoff BAH, Mohamad N, Chin SP … +10 more , Ramlan MN, Zool Kipele MS, Saffery NSI, Mohd Nasir NA, Mohd Don AF, Lai SK, Hussin H, Yakop MF, Abdul Wahid SF, Cheong SK
Med J Malaysia · 2026 Mar · PMID 41914582
INTRODUCTION: Despite advances in the development of mesenchymal stem cells (MSCs), the ultimate benefits of MSCs against current cell-based therapies are still limited. This study aimed to assess the safety, feasibility...
INTRODUCTION: Despite advances in the development of mesenchymal stem cells (MSCs), the ultimate benefits of MSCs against current cell-based therapies are still limited. This study aimed to assess the safety, feasibility, and efficacy of Cytopeutics® umbilical cord-derived MSCs (Chondrocell-EX) in patients with knee cartilage injury. MATERIALS AND METHODS: The study was conducted in two parts: a phase I feasibility study (PI) followed by a phase II randomized controlled trial (PII). Both studies were approved by UKM Research Ethics Committee (PI: UKM PPI/111/8; PII: UKM PPI/111/8/JEP-2019-304). Six patients were involved in the PI study in which all patients received Chondrocell-EX and 28 patients in the following PII study, where 17 patients received Chondrocell-EX with Hyaluronic acid (HA) (Arm A) and 11 patients received commercially available cell-based therapy, which is Bone Marrow Aspirate Concentrate (BMAC) with Hyaluronic acid-based scaffold (HA-S) (Arm B). Safety was assessed based on the occurrence of adverse events, while clinical outcomes were assessed based on the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Pain Visual Analog Scale (VAS). Second-look arthroscopy and histological assessment were performed to assess their structural outcomes at 12 months. RESULTS: In the PI feasibility study, significant pain reduction began at 3 months, with mean VAS decreasing from 6.83 ± 0.98 at baseline to 4.83 ± 1.17 (p < 0.01), 3.00 ± 0.00 at 6 months (p < 0.01), and 1.83 ± 0.75 at 12 months (p < 0.01). In the PII study, Arm A (Chondrocell-EX + HA) demonstrated significant VAS improvements at all follow-up points compared to baseline (p < 0.001), whereas Arm B (BMAC + HA-S) showed significant reductions only from 3 months onward. After adjustment for baseline age and VAS, Arm A achieved significantly lower pain scores than Arm B at 6 months (2.56 ± 1.41 vs 3.09 ± 1.22; p = 0.015) and 12 months (2.27 ± 1.49 vs 2.50 ± 1.35; p = 0.043), indicating earlier and sustained pain relief with Chondrocell-EX injection. Functional outcomes mirrored pain improvements. In PI, KOOS scores improved significantly from 3 months, reaching 85.83 ± 11.87 at 12 months (p < 0.01). In PII, KOOS increased significantly in both arms (p < 0.001), but Arm A demonstrated earlier gains at 3 months and significantly higher adjusted KOOS scores than Arm B at 6 (p = 0.009) and 12 months (p = 0.037). In KOOS subdomains analysis, it showed significantly greater improvements in Arm A, particularly in symptoms and stiffness, activity of daily living (ADL), pain, sport and recreation, and quality of life (QoL) at key time points. CONCLUSION: Chondrocell-EX+HA treatment is more convenient, feasible, and minimally invasive with the findings suggesting that it is associated with faster functional improvement and pain relief, along with demonstration of hyaline-like cartilage regeneration, compared to the BMAC+HA-S method.
Implementation and clinical audit of a virtual thoracic oncology MDT in a low-resource setting in Malaysia.
Cheo SW, Kho SS, Cheng KJ … +11 more , Yeo GG, Low QJ, Chai CS, Tie ST, Tan PW, Abdul Hamid Z, Lau KS, Soon SY, Chua TFG, Ismail AM, Voon PJ
Med J Malaysia · 2026 Mar · PMID 41914581
INTRODUCTION: Cancer care is increasingly complex, and in Sarawak, Malaysia, geographic and resource limitations further complicate management. This clinical audit describes the implementation, structure and workflow of...
INTRODUCTION: Cancer care is increasingly complex, and in Sarawak, Malaysia, geographic and resource limitations further complicate management. This clinical audit describes the implementation, structure and workflow of a virtual thoracic oncology multidisciplinary tumor board (MDT) in a resource-limited setting, and describe the cases discussed and key issues raised. MATERIALS AND METHODS: A MDT was established in Sarawak, comprising pulmonologists, oncologists, pathologists, thoracic surgeons, and radiologists. Monthly virtual meetings were held to discuss complex cases. This retrospective study analyzed cases from July 2022 to December 2024, focusing on cancer types, challenges, and recommendation. As an audit of clinical practice, no treatment adherence or outcome measures were assessed. RESULTS: A total of 94 cases were discussed (median age 60 years; 59.6% male). Cases per year: 21 (2022), 24 (2023), and 49 (2024). Common diagnoses included lung cancer (48.9%), lung lesions from other solid cancers (26.6%), suspected lung cancer (12.8%), non-malignant respiratory conditions (9.6%), and thymic cancer (2.1%). Among solid cancers with lung lesions, colorectal cancer (36%) was most frequent, followed by breast (12%), gynaecological (12%), sarcoma (8%), and others (32%). The main reasons for MDT discussions were therapeutic issues (58.5%) and diagnostic challenges (41.5%). Imaging review (83%) and management discussions (80.9%) were the most common points of discussion. Among 46 lung cancer patients, 43.5% had early-stage, 30.4% locally advanced, and 19.6% metastatic disease. Key recommendations included surgery (35.1%), surveillance (16%), systemic therapy (13.8%), biopsy (11.7%), PET/MRI (7.4%), EBUS staging (5.3%), radiotherapy (4.3%), and clinical trials (2.1%). CONCLUSION: This audit demonstrates that a virtual thoracic oncology MDT is feasible and can standardize multidisciplinary discussion, and improve access to specialist input in a resource-limited setting. While clinical outcomes were not evaluated, this audit provides insight into operational processes. Future prospective work incorporating structured data collection, MDT adherence and integration of electronic health records will help evaluate the MDT's impact on patient outcomes and guiding service improvement.
Evaluation of analytical performance of blood gases, electrolytes, and metabolites in critical care using the blood gas analyzer cartridge-electrochemical principle.
Fashihah Sherina AHS, Wan Norlina WA, Wan Mohd Saifuhisam WZ … +3 more , Mohd Zulfakar M, Say Koon T, Muhammad Anshorul HZ
Med J Malaysia · 2026 Mar · PMID 41914580
INTRODUCTION: Rapid assessment of blood gases, electrolytes, and metabolites is crucial in critical care settings. This study evaluates the performance and interchangeability of a portable blood gas analyser that operate...
INTRODUCTION: Rapid assessment of blood gases, electrolytes, and metabolites is crucial in critical care settings. This study evaluates the performance and interchangeability of a portable blood gas analyser that operates on the cartridge-electrochemical principle. MATERIALS AND METHODS: This prospective study evaluates the precision of this analyser, which uses an electrochemical sensor within single-use cartridges. We compare its performance to that of a cartridge-based sandwich sensor cassette; the blood gas analyser used in intensive care units (ICU). A total of forty arterial blood samples were collected between July and November 2024. Performance was statistically assessed using Passing-Bablok regression, Bland-Altman plots, and the Intraclass Correlation Coefficient (ICC). RESULTS: The blood gas analysis using the electrochemical sensor method demonstrated excellent within-run imprecision (CV%<5%) across all evaluated analytes, with total imprecision consistent with the manufacturer's specifications. Method comparison revealed a strong correlation (ICC>0.9) and agreement for most parameters between the two methods, including pH, partial pressure of carbon dioxide (pCO), sodium (Na), potassium (K), chloride (Cl), glucose, and lactate. However, Bland Altman showed a systematic bias of 9 mmHg in partial pressure of oxygen (pO) and 0.02mmol/L in ionised calcium (iCa). CONCLUSION: The analyser using the electrochemical sensor provides reliable performance for blood gases and biochemical analytes, with strong agreement with the cartridge-based sandwich sensor cassette principle. Nonetheless, caution is advised for pO and iCa measurements due to observed bias, highlighting the importance of awareness of method-specific differences between analysers in clinical interpretation.
LIVERSTAT for the diagnosis of compensated advanced chronic liver disease in patients with type 2 diabetes.
Lee JSC, Chee NMZ, Lai LL … +2 more , Vethakkan SR, Chan WK
Med J Malaysia · 2026 Mar · PMID 41914579
INTRODUCTION: LIVERSTAT is a non-invasive artificial intelligence-based test that provides risk stratification for metabolic dysfunction-associated steatotic liver disease. We aimed to study the performance of LIVERSTAT...
INTRODUCTION: LIVERSTAT is a non-invasive artificial intelligence-based test that provides risk stratification for metabolic dysfunction-associated steatotic liver disease. We aimed to study the performance of LIVERSTAT compared with the Fibrosis-4 Index (FIB-4) as a stand-alone test and as a first-line test to identify patients for liver stiffness measurement (LSM) for the diagnosis of compensated advanced chronic liver disease (cACLD) in patients with type 2 diabetes (T2D). MATERIALS AND METHODS: This is a cross-sectional study of patients with T2D who underwent transient elastography. cACLD was defined as LSM ≥10 kPa. As a stand-alone test, LIVERSTAT Class D and increased FIB-4 ≥1.3 (≥2.0 if age ≥65 years old) were considered as having cACLD. As a first-line test, LIVERSTAT Class D and increased FIB-4 were considered as requiring LSM. RESULTS: We analysed data for 221 patients (mean age 61 years, 41% male, cACLD 26%). The area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value and misclassification rate for LIVERSTAT were 0.66, 32%, 88%, 47%, 79% and 27%, respectively. The corresponding values for FIB-4 were 0.61, 39%, 81%, 41%, 79%, and 30%, respectively. When using LIVERSTAT as a first-line test, the proportion of patients requiring LSM was 17% (38/221), while the proportion of false negatives was 19% (34/183). The corresponding values for FIB-4 were 24% (54/221) and 19% (31/167), respectively. CONCLUSION: LIVERSTAT has similar accuracy as FIB-4 when used as a stand-alone test or as a first-line test to identify patients for LSM for the diagnosis of cACLD in patients with T2D.
The spectrum of developmental and epileptic encephalopathies and their genetic heterogeneity are much broader than previously thought.
Finsterer J
Med J Malaysia · 2026 Jan · PMID 41617527
No abstract available.
No abstract available.
Diagnostic yield of CTPA and Wells Score utilization in pulmonary embolism assessment: Experience from a Malaysian tertiary hospital.
Fathihah A N, A Razali MR
Med J Malaysia · 2026 Jan · PMID 41617526
Transcranial direct current stimulation (tDCS) has emerged as a potential adjunct therapy for post-stroke motor rehabilitation. While conventional rehabilitation methods remain the primary approach to improving motor fun...
Transcranial direct current stimulation (tDCS) has emerged as a potential adjunct therapy for post-stroke motor rehabilitation. While conventional rehabilitation methods remain the primary approach to improving motor function after stroke, many patients experience incomplete recovery, necessitating the exploration of additional interventions. This commentary article examines the role of tDCS in poststroke motor recovery, focusing on its mechanisms, efficacy, and limitations. Herein, the variability in research findings and individual patient responses as well as the recommended methods for optimising tDCS use in local clinical settings are highlighted.
Accuracy of diagnostic performance of confocal laser endomicroscopy in characterising pancreatic cysts: A systematic review.
Alotaibi AD
Med J Malaysia · 2026 Jan · PMID 41617525
INTRODUCTION: Pancreatic cystic lesions (PCLs) are becoming more frequently diagnosed due to the improved crosssectional imaging. Although some of them are harmless, others are malignant in nature, and proper diagnosis i...
INTRODUCTION: Pancreatic cystic lesions (PCLs) are becoming more frequently diagnosed due to the improved crosssectional imaging. Although some of them are harmless, others are malignant in nature, and proper diagnosis is very crucial. This systematised review evaluates the diagnostic effectiveness of nCLE in characterising pancreatic cysts in terms of sensitivity, specificity, diagnostic yield, as well as its strengths versus conventional diagnostic techniques. MATERIALS AND METHODS: The systematic literature search was performed in PubMed, Scopus, and Google Scholar, including papers published between 2011 and March 2025. The inclusion criteria were randomised, prospective, and retrospective research in which nCLE diagnostic accuracy was reported in PCLs. Meta-analysis was conducted using PRISMA guidelines for data extraction, risk of bias assessment, and sensitivity analyses. RESULTS: The inclusion criteria were met in seventeen studies. As shown, nCLE was usually superior to cytology, cyst fluid carcinoembryonic antigen (CEA), and traditional EUS-FNA. Sensitivity was reported to be between 59-98% and specificity is between 82-100%. Of seven studies (n=216 cases) analysed by meta-analysis, the pooled sensitivity was 0.89 (fixed-effects) and 0.88 (random-effects), the heterogeneity was high (I2=74%). The Funnel plot analysis identified the possibility of publication bias and small-study effects. Robustness was ensured through sensitivity analysis, which was always pooled between 0.86-0.92. CONCLUSION: It has been noted that nCLE improves diagnostic confidence, reduces indeterminate results, and has the potential to positively influence the economy and clinical management. The current evidence is strongly in favour of the clinical utility of nCLE, more large-scale, multicentred, and methodologically sound trials are necessary to determine the diagnostic performance of the technique, develop standardised protocols, and evaluate long-term effects on patient outcomes and healthcare systems.
The role of apolipoproteins as genetic biomarkers in schizophrenia: A systematic review.
Wan Noorainna Fatimi WMZ, Nour El Huda AR, Norlelawati AT … +7 more , Mohd Asyraf AJ, Kaderi MA, Norbaiyah MB, Wan Muhamad Salahudin WS, Rinesh Ram M, Norainin Sofiya A, Rasid SNM
Med J Malaysia · 2026 Jan · PMID 41617524
INTRODUCTION: Schizophrenia is a complex mental disorder involving genetic, environmental, and neurodevelopmental factors. Despite significant progress in identifying several genetic contributors to schizophrenia, the ro...
INTRODUCTION: Schizophrenia is a complex mental disorder involving genetic, environmental, and neurodevelopmental factors. Despite significant progress in identifying several genetic contributors to schizophrenia, the role of apolipoprotein in lipid metabolism, neurodevelopment, and neuroprotection remains underexplored. This systematic review aims to synthesise existing genetic studies on apolipoproteins associated with schizophrenia to clarify their potential role in the disorder's pathogenesis. MATERIALS AND METHODS: A comprehensive literature review was conducted using the PubMed and Scopus databases, involving studies published from 2004 to 2023, and limited to English. Keywords included "schizophrenia," "apolipoprotein," "genetic," and "genetics." Non-research publications such as books, reviews, editorials, letters to editors, short communications, book series, chapters, and conference proceedings were excluded from this review. Only peer-reviewed journal articles were selected to ensure the reliability and credibility of the systematic review. RESULTS: A total of 41 articles were included in the review, with four key themes identified. The themes addressed specific aspects of apolipoproteins in schizophrenia, including their role in schizophrenia susceptibility, lipid metabolism, and cognitive functions within the disorder. This review presents a novel synthesis of these studies, focusing on the underexplored roles of apolipoprotein genes, including APOE, APOL, APOD, APOA, APOC, APOER2, and APOBEC, in schizophrenia. CONCLUSION: This systematic review provides a comprehensive understanding of the genetics of apolipoprotein in schizophrenia, particularly in relation to lipid metabolism. The findings suggest future research directions to enhance the understanding of schizophrenia pathogenesis and highlight the importance of targeted research to identify specific genetic biomarkers for therapeutic interventions.
Closing the gaps in obesity: The need for a strategic, system-wide approach to obesity care in Malaysia.
Zubaidah NH, Masni M, Barakatun Nisak MY … +7 more , Norlaila M, Firdaus M, Wong PF, Nalini MS, Nazrul Hadi I, Feisul IM, Rohana AG
Med J Malaysia · 2026 Jan · PMID 41617523
INTRODUCTION: The global obesity epidemic threatens health systems worldwide and is associated with severe health complications such as cardiovascular disease, type 2 diabetes, and cancers, imposing substantial economic...
INTRODUCTION: The global obesity epidemic threatens health systems worldwide and is associated with severe health complications such as cardiovascular disease, type 2 diabetes, and cancers, imposing substantial economic burdens. Globally, over 1.9 billion adults are classified as overweight, with 650 million identified as obese. MATERIALS AND METHODS: A review was conducted using academic databases and authoritative reports from organizations such as the WHO and the Institute for Public Health. Studies published between 2002 and 2024 were selected based on methodological rigor and relevance to obesity in Malaysia. RESULTS: Malaysia has the highest obesity rate in Southeast Asia and has classified obesity as a chronic disease. Currently, 21.8% of Malaysian adults are affected by obesity - a fivefold increase from 4.4% in 1996 - with projections reaching 41% by 2040. Obesity-related healthcare costs consume 10-20% of Malaysia's national budget. Malaysia joined the Obesity Policy Engagement Network (OPEN) and implemented a model-of-care survey to gather healthcare professional insights and identify critical obesity management gaps. This initiative aimed to provide evidencebased recommendations to enhance patient outcomes and alleviate economic strain on the healthcare system. The Malaysian OPEN survey indicated that only one-third view obesity as a disease, resulting in underinvestment in necessary infrastructure and treatment options such as pharmacotherapy and bariatric surgery. These prevailing misconceptions among healthcare professionals and decision-makers hinder progress. A collaborative, multidisciplinary strategy supported by robust policies and evidence-based research is thus vital in managing obesity as a chronic disease. CONCLUSION: Addressing obesity in Malaysia requires a collaborative, multidisciplinary approach that integrates lifestyle, behavioural, medical, and surgical strategies. Policy reform, stakeholder engagement, and evidencebased planning are essential to improve patient outcomes, reduce economic burdens, and ensure equitable access to care. A unified national effort is vital for sustainable and effective obesity management.
Challenges in delivering healthcare services among immigrants from Southeast Asia: A scoping review.
Alias A, Idrus IAM, Daring D … +4 more , Azhar N, Lotfi WHWM, Ramdzan AR, Rahim AIA
Med J Malaysia · 2026 Jan · PMID 41617522
INTRODUCTION: Cross-border migration presents increasing challenges to healthcare systems globally. Ensuring equitable healthcare access for immigrant populations, particularly in Southeast Asia, requires a thorough unde...
INTRODUCTION: Cross-border migration presents increasing challenges to healthcare systems globally. Ensuring equitable healthcare access for immigrant populations, particularly in Southeast Asia, requires a thorough understanding of the barriers to effective service delivery. This scoping review aimed to synthesize the existing literature on the challenges related to the delivery of healthcare services to immigrant communities from Southeast Asia. While previous studies (e.g., Brandenberger et al., 2019) applied the 3C framework to migrants and refugees globally, this review generates new insights by focusing specifically on Southeast Asia, a region underrepresented in the literature. By applying the 3C model in this context, our review identifies region-specific challenges, such as immigration policies, financial barriers, and COVID-19 impacts, that extend beyond the findings of earlier global reviews. MATERIALS AND METHODS: A comprehensive search was conducted in ProQuest, PubMed, ScienceDirect, and Scopus databases on October 13, 2024, for studies published between January 1, 2011, and October 13, 2024. The search strategy used tailored keywords, including "challenges," "healthcare services," "immigrants," and "Asia." Inclusion criteria focused on peer-reviewed, English-language articles reporting on challenges in healthcare service delivery among immigrant populations in Southeast Asia. Data extraction and synthesis were guided by the 3C model: communication, continuation of care, and confidence in the healthcare system. RESULTS: The search identified 656 records, of which 7 studies met the inclusion criteria after a multi-stage screening process. Key challenges identified across the included studies were: Communication barriers, including language differences, cultural misunderstandings, and limited health literacy; Issues with continuation of care, such as poor health literacy, difficulties navigating healthcare systems, barriers to accessing services (e.g., due to legal status or financial constraints), and lack of coordination between healthcare and social services; and Lack of confidence in the healthcare system, stemming from distrust, lack of understanding, and negative experiences, including perceived discrimination. CONCLUSION: This review highlights the complex challenges in delivering healthcare services to immigrants from Southeast Asia. These challenges, encompassing communication, continuation of care, and confidence, necessitate targeted and multifaceted interventions. Addressing these issues through culturally competent care, enhanced communication strategies, and policy reforms that promote equitable access is crucial for improving the health and well-being of immigrant populations and fostering more inclusive healthcare systems within the region.
The artificial intelligence driven on the development of diabetic retinopathy prognostic scoring tool among type 2 diabetes mellitus patients: A review.
Teruna MMS, Razak TR, Yasin SM … +2 more , Ali AAR, Isa MR
Med J Malaysia · 2026 Jan · PMID 41617521
INTRODUCTION: Diabetic retinopathy, a major microvascular complication of type 2 diabetes mellitus, remains a leading cause of preventable blindness worldwide. Early identification of individuals at high risk is essentia...
INTRODUCTION: Diabetic retinopathy, a major microvascular complication of type 2 diabetes mellitus, remains a leading cause of preventable blindness worldwide. Early identification of individuals at high risk is essential, yet conventional screening systems are limited by workforce shortages and delayed detection. Artificial intelligence, particularly machine learning, offers substantial potential to support prognostic scoring tools capable of predicting the development of diabetic retinopathy. This review summarises current evidence on AI-driven prognostic models for diabetic retinopathy among adults with type 2 diabetes mellitus. MATERIALS AND METHODS: A comprehensive PubMed search using Medical Subject Headings and free-text terms related to "Diabetic Retinopathy," "Type 2 Diabetes Mellitus," "Artificial Intelligence," "Machine Learning," and "Prognostic Model" was conducted. Original studies involving adults with T2DM that developed or evaluated AIor ML-based prognostic or risk-scoring tools for DR were included. Extracted data included study design, sample size, artificial intelligence methods, predictors, and model performance, and were synthesised narratively. RESULTS: From 759 records, five studies met the inclusion criteria. Extreme Gradient Boosting consistently demonstrated the highest predictive performance, with area under the curve values between 0.803 and 0.966. Support Vector Machine also performed well in smaller cohorts. Key predictors across studies included HbA1c, duration of diabetes, renal function markers, blood pressure, lipid profile, and body mass index. CONCLUSION: AI-driven prognostic tools show strong potential to enhance early diabetic retinopathy risk prediction. However, broader external validation and population-specific calibration are needed before routine clinical adoption.
A Malaysian study on COVID-19 (SARS-CoV-2) vaccination immune response in haemodialysis patients: A prospective, multicentre, cohort study.
Tan XF, Ch'ng CC, Cheng JL … +8 more , Teo LK, Ripen AM, Ching CH, Shahnaz SFK, Wan Hasnul Halimi WH, Liew YF, Ong LM, Yoon CK
Med J Malaysia · 2026 Jan · PMID 41617520
INTRODUCTION: Patients with end-stage renal disease (ESRD) have compromised immune systems, possibly reducing their vaccine-induced antibody responses compared to the general population. COVID-19 remains a persistent thr...
INTRODUCTION: Patients with end-stage renal disease (ESRD) have compromised immune systems, possibly reducing their vaccine-induced antibody responses compared to the general population. COVID-19 remains a persistent threat, with the virus continuing to mutate into new variants. Similar to influenza, there is a possibility that COVID-19 could resurge significantly, underscoring the importance of understanding vaccine-induced immunity in vulnerable populations. This study aims to determine the immunogenicity of this group to the COVID-19 vaccine. MATERIALS AND METHODS: Haemodialysis patients receiving the Pfizer-BioNTech mRNA vaccine were followed for at least 13 months. Blood samples were collected prior to every vaccine dose and at multiple intervals thereafter. Neutralising antibodies (nAb) against SARS-CoV-2 were measured. Patients voluntarily reported any COVID-19 infection. RESULTS: Between April 2021 and January 2023, 271 patients received at least one dose of the vaccine; 212 of these had at least one blood sample tested for nAb. Booster doses were given 26.2 weeks after the second dose. nAbs were detected in 16.8% of patients before vaccination. The nAb levels were higher than the non-convalescent patients after the first dose, but it was not statistically significant. Breakthrough infections were self-reported in 29.3% of patients. A significant association between breakthrough infections and history of COVID-19 infection cannot be established (p=0.188). There were 34 deaths (16.0%); 2 related to COVID-19. Younger age was associated with higher nAb reactivity post-first dose, but this difference diminished after the second dose. CONCLUSION: Almost complete seropositivity (98.4%) was achieved after two doses of vaccine. Sustained antibody levels after the third dose suggest the value of a booster dose in protecting this vulnerable population. However, the occurrence of breakthrough infections highlights the need for continued monitoring, preventive measures, and further research to optimise vaccination strategies in haemodialysis patients.
Clinical characteristics and factors affecting visual outcomes in patients with herpes simplex keratitis: A tertiary hospital experience.
Najiza H, Muhammed J
Med J Malaysia · 2026 Jan · PMID 41617519
INTRODUCTION: Herpes Simplex Keratitis (HSK) is a leading cause of infectious corneal blindness globally. However, clinical data and visual outcomes specific to the Malaysian population are limited. This study aimed to i...
INTRODUCTION: Herpes Simplex Keratitis (HSK) is a leading cause of infectious corneal blindness globally. However, clinical data and visual outcomes specific to the Malaysian population are limited. This study aimed to identify common clinical features, visual outcome and its associated factors in patients treated at a Malaysian tertiary hospital. MATERIALS AND METHODS: A retrospective cohort study was conducted at Hospital Pakar Universiti Sains Malaysia (HPUSM) between June 2013 and June 2024. Medical records of patients diagnosed with HSK and followed for at least six months were reviewed. Sixty-seven patients were included. Data collected included demographics, presenting symptoms, best-corrected visual acuity (BCVA) at presentation and after treatment, ocular findings, subtype of HSK and complications. Statistical analyses were performed using SPSS version 28.0. Paired t-tests was used to analyse changes in BCVA and multiple linear regression was performed to identify factors associated with final visual outcome. RESULTS: The mean age at presentation was 50.42±17.19 years with a slight male predominance (52.2%). Most cases were unilateral (91.1%). Common presenting symptoms were reduced vision (89.6%) and eye redness (85.1%). Keratouveitis was the most frequent subtype (37.3%). Complications included corneal scarring (73.1%), recurrence (49.3%) and glaucoma (11.9%). BCVA significantly improved post-treatment (p<0.001). Older age, central corneal involvement, elevated intraocular pressure at presentation, and stromal vascularisation were significantly associated with poorer visual outcomes. CONCLUSION: This study outlines the clinical spectrum and visual outcomes of HSK at a tertiary hospital in Malaysia and identifying several predictive factors for poor vision. These findings may aid clinicians in risk stratification and optimising management strategies.
Genomic profiling of early-stage resectable non-small-cell lung cancer in a Malaysian private healthcare setting: Real-world clinical implications.
Sachithanandan A, Hoh HH, Lam MD … +11 more , Low EC, Yap NY, Hassanudin SA, Ten YY, Tan PK, Naim CK, Lutfi FNM, Yong WWS, Sachithananthan S, Yap XL, Rajadurai P
Med J Malaysia · 2026 Jan · PMID 41617518
INTRODUCTION: The prevalence of oncogenic driver mutations in early-stage resectable non-small-cell lung cancer (rNSCLC) in Malaysia remains unknown. This information may guide treatment decisions, especially tyrosine ki...
INTRODUCTION: The prevalence of oncogenic driver mutations in early-stage resectable non-small-cell lung cancer (rNSCLC) in Malaysia remains unknown. This information may guide treatment decisions, especially tyrosine kinase inhibitor (TKI) use. We characterised the genomic landscape of early-stage NSCLC in a surgical cohort and explored its impact on TKI administration, particularly osimertinib. MATERIALS AND METHODS: 146 patients who underwent curative resection for early-stage rNSCLC were included in this study. Real-time polymerase chain reaction (PCR) and nextgeneration sequencing (NGS) were used to identify genetic alterations in tumour samples. Associations between EGFR status and clinico-pathological characteristics were analysed using uni- and multivariate logistic regression. RESULTS: A majority of patients were female non-smokers of Chinese ethnicity with an incidental adenocarcinoma. EGFR mutations were detected in 62.3% (n=91) of patients, with 93.4% harbouring single-locus mutations, primarily in exons 19 and 21. Co-mutations occurred in 11% (n=10) of EGFRmutant cases, most frequently involving TP53, and less commonly CTNNB1, HER2/ErbB2, and PTEN. Six (6.6%) patients had multi-loci EGFR mutations. Female sex and higher tumour histological grade were independent predictors for EGFR mutations, while former/never smokers showed higher odds on univariate analysis. Among patients tested for PD-L1 (78.8%), 46.6% had negative expression (tumour proportion score <1%), with no correlation to EGFR status. CONCLUSION: This is the first genomic molecular profiling study to report exclusively on early-stage NSCLC in Malaysia. The high prevalence of EGFR mutations observed, predominantly involved sensitizing mutations at exons 19 and 21, and was associated with the female sex, a non- smoking status, higher tumour grade, but not PD-L1 expression. Early reflex genomic testing is vital to guide biomarker-driven peri-operative treatment strategies for rNSCLC.
Survey of virtual ward acceptance among medical patients admitted to hospital.
Yeat NS, Tai MH, Goh A … +3 more , Zulkifli MD, Ko S, Ong T
Med J Malaysia · 2026 Jan · PMID 41617517
INTRODUCTION: Virtual ward (VW) is a hospital-led alternative to inpatient care enabled by technology where patients are looked after in their usual residence. Such a service may not be familiar to many. This survey aims...
INTRODUCTION: Virtual ward (VW) is a hospital-led alternative to inpatient care enabled by technology where patients are looked after in their usual residence. Such a service may not be familiar to many. This survey aims to explore the views and acceptability of VW among hospitalised patients. MATERIALS AND METHODS: This study was conducted among patients aged ≥18 years admitted to medical wards of a tertiary hospital in Malaysia. The survey questions were adapted from existing questionnaires and piloted before use. Participants were provided with a clinical vignette and description of a VW service before completing the questionnaire. It collated data on respondents' demographics, admission details, VW acceptability and their views on VW-related telehealth. The next of kin or main caregiver provided responses if the person was unable to participate. RESULTS: Responses were collected from 120 participants (95 patients, 25 caregivers), of which 108 respondents (90.0%) agreed to be managed by a VW service if such a service was available and able to meet their needs. Being at home, supported by family members, and the ability to maintain independence were the most common reasons cited for its acceptance. Among those unwilling, participants preferred to have the medical and nursing team close by. In terms of telehealth readiness, 95% of patients have internet access, and 97.5% possess the appropriate devices for video consultation. However, only 20% of patients have utilised online video consultations before to seek medical advice. CONCLUSION: The majority of people surveyed were willing to accept a virtual ward service. The findings provide useful information towards the planning of virtual ward programmes in Malaysia.
A descriptive evaluation of referral patterns and patient flow from Primary Health Facilities to the Emergency Department Hospital Sungai Buloh.
Sarah AK, Ahmad Amirin J, Abd-Rahman M … +5 more , Mahathar AW, Azah AS, Majid SA, Norafizan MA, Suhaila Hamzah S
Med J Malaysia · 2026 Jan · PMID 41617516
INTRODUCTION: Referrals from Primary Health Facilities (PHF) to hospitals occur due to clinical needs for speciality care in managing the presenting illness, social factors such as poor compliance or lack of family suppo...
INTRODUCTION: Referrals from Primary Health Facilities (PHF) to hospitals occur due to clinical needs for speciality care in managing the presenting illness, social factors such as poor compliance or lack of family support, and are requested by patients. The journey for any patients transferred from PHF to hospitals has three major components, which are (a) the PHF intervention and activation of ambulances; (b) the Prehospital Care Services (EMS) deployment, care of the patient and transportation to the hospital; and (c) the process of review or admission at the destination hospital. We detail the journey, processing time, and outcomes of patients referred from PHFs via EMS to a tertiary referral hospital in Selangor, Malaysia. MATERIALS AND METHODS: This is a retrospective study analysing data from 980 referred patients from PHFs transported by Klang Valley Ambulance Service (KVAS) to Hospital Sungai Buloh between 1st January 2023 and 30th June 2023. Data collected includes PHF classification, KVAS activation details, patient demographics, Emergency Department length of stay (EDLOS), and the patient's outcome in the ED. Patient's outcome in ED is categorised as (a) admitted; (b) discharged; or (c) discharged against medical advice (DAMA). RESULTS: Out of the 980 referred patients, 83.3% were triaged as Priority 1 by PHFs. The majority were males (56.8%), with a mean age of 28 years. The median waiting time for ambulance arrival was 54-58 minutes. The percentage of referred patients who were admitted to the ward was 65.8%. The median EDLOS was 540 minutes (9 hours), with discharged patients having a shorter median EDLOS of 321 minutes (approximately 5 hours). The median total patient waiting time from PHF to final disposition was 605 minutes (10 hours) for admitted patients and 382 minutes (6 hours) for discharged patients. CONCLUSION: A significant proportion of referred patients experienced prolonged EDLOS, whereas only 22.4% of referred patients were discharged within eight hours. Average EDLOS of 12 hours suggests the need for a "Fast- Track Referral System" to improve efficiency and reduce unnecessary gatekeeping processes.
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