The Medical Journal Of Malaysia[JOURNAL]
Sun
200 papers
Factors associated with hypertension among the elderly in Kudat, Malaysia.
Lotfi WHNM, Azhar N, Alias A … +8 more , Mokti K, Zali SMRRM, Rahim SSSAR, Jeffree MS, Ibrahim MY, Musa M, Hassan MR, Shobugawa Y
Med J Malaysia · 2025 Nov · PMID 41328821
INTRODUCTION: Hypertension among the elderly population aged 60 years and above in Malaysia was estimated to be around 69.2%. The high association of hypertension with morbidity and mortality among older communities warr...
INTRODUCTION: Hypertension among the elderly population aged 60 years and above in Malaysia was estimated to be around 69.2%. The high association of hypertension with morbidity and mortality among older communities warranted targeted public health interventions. Hence, this study aimed to determine the prevalence of hypertension and its related factors among the elderly in a rural area in Kudat, Sabah. MATERIALS AND METHODS: This cross-sectional study was carried out to determine the prevalence of hypertension, including previously known and newly diagnosed cases, and the associated factors among the elderly aged 60 and older living in the rural part of Sabah. The study was conducted on 700 elderly people living in Kudat using selfadministered and interviewer-assisted JAGES questionnaires and physical status measurements from January to March 2023. Multivariate logistic regression analysis was applied to determine the association between sociodemographic and physical factors with hypertension among the elderly. RESULTS: The prevalence of hypertension among elderly dwelling in Kudat, Sabah was approximately 80.3% (95% CI: 77.35, 83.25), slightly higher than the national prevalence. The findings also indicated that older age group (aOR=3.2; 95% CI: 1.548, 6.489), higher BMI (aOR=1.9; 95% CI: 1.170, 2.997) abnormal waist circumference (aOR=2.5; 95% CI: 1.573, 4.022), and active smoking (aOR=2.4; 95% CI: 1.281, 4.626) were significantly associated with hypertension among the elderly community. CONCLUSION: Focused and targeted prevention, intervention, and management of hypertension for the elderly, especially those dwelling in rural areas, should be constructed to tackle the issue of high prevalence of hypertension among them, thus reducing morbidity and mortality related to elderly hypertension towards healthy ageing.
Determinants of autism spectrum disorder in children: A case-control study in Pontianak, West Kalimantan, Indonesia.
Fathmawati F, Damayanti DF, Chitra F … +2 more , Rafiony A, Ardhini I
Med J Malaysia · 2025 Nov · PMID 41328820
INTRODUCTION: Children with Autism Spectrum Disorder (ASD) who use the government's service facilities for children with special needs in Pontianak are increasing. This study aims to find out the determinants of ASD in P...
INTRODUCTION: Children with Autism Spectrum Disorder (ASD) who use the government's service facilities for children with special needs in Pontianak are increasing. This study aims to find out the determinants of ASD in Pontianak. MATERIAL AND METHODS: This study investigates the determinants of ASD in children in Pontianak, West Kalimantan, using a case-control design. The study included 49 children diagnosed with ASD and 100 age-matched controls, with data collected through maternal questionnaires. The risk factors examined included gender, genetic factors, parental age, maternal health during pregnancy, perinatal risk factors, environmental exposures, and maternal habits. Data analysis using logistic regression. RESULTS: The results indicate a significantly higher likelihood of ASD in boys. Higher maternal education levels were also associated with increased ASD risk. Family history, particularly having siblings or relatives with ASD, emerged as a significant risk factor. Maternal anxiety during pregnancy doubled the risk of ASD, while frequent fruit consumption during pregnancy and exclusive breastfeeding were identified as protective factors. Exposure to vehicle fumes during pregnancy increased ASD risk. Turning off cell phones during sleep was also protective. CONCLUSION: These findings highlight the need to address both genetic and environmental factors in ASD aetiology. Promoting healthy maternal habits and reducing harmful environmental exposures could potentially reduce ASD risk. Future research should focus on larger sample sizes and longitudinal studies to validate these findings and develop targeted interventions.
Cerebral hemodynamics and vascular dementia: Identifying opportunities for early intervention.
Liew BS, Suppiah S
Med J Malaysia · 2025 Nov · PMID 41328819
Vascular dementia (VaD), unlike Alzheimer's disease, is often preventable and can be slowed down or halted with early intervention. VaD results from impaired cerebral blood flow due to conditions like atherosclerosis or...
Vascular dementia (VaD), unlike Alzheimer's disease, is often preventable and can be slowed down or halted with early intervention. VaD results from impaired cerebral blood flow due to conditions like atherosclerosis or Moyamoya disease, leading to repeated small strokes and, consequently, cognitive decline. VaD can exist separately or co-exist with Alzheimer's disease, with the latter commonly being of a more insidious onset and involving beta amyloid protein depositions in the brain. VaD may be missed due to the focus on treating the stroke symptoms, and sometimes be interpreted as normal age-related cognitive decline. Thus, patients with vascular risk factors, who present with acute or acute-on-chronic neurological deficits that co-exist with features of subtle memory or executive functional changes, should have prompt vascular evaluation using neuroimaging.
Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios can only predict the severity of COVID-19 if the criteria for a biomarker are met.
Finsterer J
Med J Malaysia · 2025 Sep · PMID 41016008
Abstract loading — click title to view on PubMed.
Assessing male involvement in family planning: A scoping review of prevalence and its associated factors.
Alias A, Mokti K, Azhar N … +5 more , Wan Mohamad Lotfi WHN, Hidrus A, Sidek Ahmad ZN, Mohd Zali SMIR, Ibrahim MY
Med J Malaysia · 2025 Sep · PMID 41016007
INTRODUCTION: Family planning (FP) is a key component of the Safe Motherhood Program, aimed at reducing maternal mortality and morbidity. Male involvement in FP is increasingly recognized as essential for improving repro...
INTRODUCTION: Family planning (FP) is a key component of the Safe Motherhood Program, aimed at reducing maternal mortality and morbidity. Male involvement in FP is increasingly recognized as essential for improving reproductive health outcomes through shared decisionmaking and spousal collaboration. This scoping review aimed to assess the prevalence of male involvement in family planning and identify the factors that influence their participation. MATERIALS AND METHODS: A literature search was conducted in ProQuest, PubMed, and Scopus for peer-reviewed articles published between 2014 and 2024. Eligible studies reported on the prevalence and determinants of male involvement in FP. Two reviewers independently screened articles and extracted data. Findings were synthesised descriptively and thematically. RESULTS: Eight studies met the inclusion criteria. Reported male involvement in FP varied widely, ranging from 8.4% to 80%. Key influencing factors included education level, access to FP information, number of children, spousal communication, and attitudes towards contraception. Barriers included cultural norms, limited male-targeted services, and misconceptions about FP. CONCLUSION: Male involvement in family planning remains inconsistent across regions. Targeted educational and community-based interventions are essential to enhance men's engagement in reproductive health and improve FP outcomes.
Changes in fundus by optical coherence tomography in patients with chronic obstructive pulmonary disease: A systematic review.
Kim A, Erb C, Kapanova G
Med J Malaysia · 2025 Sep · PMID 41016006
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) exerts a negative impact on various tissues and organs throughout the body due to chronic hypoxia. The retina and choroid are implicated in this process, and the...
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) exerts a negative impact on various tissues and organs throughout the body due to chronic hypoxia. The retina and choroid are implicated in this process, and the application of optical coherence tomography (OCT) enables the detection of potential changes in the fundus. This study aims to explore and discuss OCT-assisted fundus alterations in individuals with COPD by undertaking a systematic review. MATERIALS AND METHODS: A systematic review of the literature was conducted in adherence to the PRISMA checklist. Exclusion criteria encompassed articles published in non- peer-reviewed journals or unpublished literature. Consistent criteria were applied during both the title-and-abstract screening and full-text screening phases. Inclusion criteria comprised research conducted in the English language and published after 1993. Selection criteria were articulated in accordance with PICOS. Articles falling within the purview of meta-analyses, systematic reviews, guidelines, case reports, pilot studies, and non-human studies (e.g., laboratory research) were excluded from consideration. RESULTS: A total of 68 articles were initially identified, 10 reports met inclusion criteria and were included in qualitative analysis. In Turkey were conducted 8 studies and 2 studies in Egypt. All the studies included are case-control designed. Above-mentioned changes in retina were studied in 10 cases and found in 8 of them. In the same time changes in choroid were studied in 9 cases and found in 6 of them. CONCLUSIONS: The findings of this systematic review indicate that, as observed through OCT, chronic hypoxia and systemic inflammation resulting from COPD predominantly impact the retina and choroid.
Patient satisfaction and experience for virtual consultation services in the Malaysian government health clinics: A review.
Nasim AK, Khalid I, Isa MR
Med J Malaysia · 2025 Sep · PMID 41016005
INTRODUCTION: Virtual consultation (VC) has emerged as a vital mode of healthcare delivery, particularly accelerated by the COVID-19 pandemic. The Ministry of Health (MOH) has progressively implemented VC services across...
INTRODUCTION: Virtual consultation (VC) has emerged as a vital mode of healthcare delivery, particularly accelerated by the COVID-19 pandemic. The Ministry of Health (MOH) has progressively implemented VC services across government health clinics in Malaysia, guided by national digital health strategies. As VC becomes integral to primary care, evaluating patient satisfaction and experience becomes essential to ensure service quality. Despite the global availability of various tools, a lack of validated instruments remains in the context of Malaysian primary care, particularly in Malay. This narrative review aims to identify existing instruments used to assess patient satisfaction and experience with VC, evaluate their relevance and psychometric robustness, and highlight gaps in measurement, particularly for public primary care in Malaysia. MATERIALS AND METHODS: A systematic search was conducted using PubMed, employing a comprehensive search strategy combining MeSH terms and text words related to "patient satisfaction," "patient experience," "surveys and questionnaires," and "telemedicine." The search was restricted to English-language publications involving adult populations and returned 876 articles. After applying the free full-text filter, 397 articles were screened. Title and abstract screening yielded 83 potentially eligible studies, from which only eight were found to involve original development or adaptation of relevant instruments and were included for further analysis. RESULTS: Among the seven included studies, most questionnaires were focused primarily on domains related to usability and acceptability, such as interface ease, access, and convenience. However, few instruments addressed core components of clinical care quality, including communication, diagnostic confidence, care continuity, and coordination. Furthermore, none of the reviewed questionnaires underwent complete validation and reliability assessment within the context of Malaysian primary care. Four studies were conducted in Malaysia; however, these either lacked robust validation processes or focused solely on acceptability. Additionally, no tools were validated in Malay or tailored specifically to the cultural and healthcare delivery context of Malaysia's government clinics. CONCLUSION: The findings reveal a significant methodological gap in assessing patient satisfaction and experience with VC in Malaysian primary care. Existing tools largely derive from models focused on technology usability or service acceptability, with limited attention to the clinical dimensions of virtual care. Instruments such as the Telemedicine Satisfaction Questionnaire (TSQ), the Telemedicine Usability Survey (TUS) and the Service User Technology Acceptability Questionnaire (SUTAQ) offer partial frameworks but lack comprehensive validation or contextual adaptation. In Malaysia, while efforts have been made to develop VC-related surveys, these are insufficiently validated and often lack specificity for primary care. Moreover, tools currently in use do not capture the broader service quality domains emphasised by frameworks like SERVQUAL or Picker's Patient Experience Principles. As VC services expand in Malaysian public healthcare, there is an urgent need to develop and validate culturally appropriate, linguistically accessible, and psychometrically sound questionnaires to assess patient satisfaction and experience. These instruments must integrate both technological usability and the core clinical components of healthcare delivery. Such efforts are essential to guide quality improvement and ensure that VC services align with patients' needs and expectations in the primary care setting.
Job satisfaction among public health and primary care physicians: A systematic review.
Siti NMA, Ghaneshinee S, Faiz D … +2 more , Nazarudin S, Azmawati MN
Med J Malaysia · 2025 Sep · PMID 41016004
INTRODUCTION: Job satisfaction among physicians involved in public health services including public health physicians and primary care physicians is critical for their performance, motivation, and retention. These profes...
INTRODUCTION: Job satisfaction among physicians involved in public health services including public health physicians and primary care physicians is critical for their performance, motivation, and retention. These professionals address systemic health challenges and ensure effective health promotion at the population level. Despite their significance, they face challenges such as high workloads, administrative burdens, and insufficient resources, adversely affecting their satisfaction. This systematic review aims to examine the levels and determinants of job satisfaction among physicians engaged in public health roles. MATERIALS AND METHODS: This review followed PRISMA guidelines and was registered in PROSPERO (CRD42024613843). Articles were retrieved from PubMed, Scopus, and Web of Science databases. Fourteen eligible studies were selected based on strict criteria. Data synthesis employed an emerging clusters approach to identify factors influencing job satisfaction, categorised into four themes: job characteristics and role clarity, organisational support and leadership, work environment and culture, and rewards and career development. RESULTS: Data from 7313 physicians highlighted high workloads (60%) and administrative burdens (53%) as key sources of dissatisfaction. Approximately 44.7% reported high satisfaction, driven by autonomy in decision-making, supportive environments, doctor-patient relationships, and work-life balance. In contrast, 32% experienced moderate satisfaction, linked to manageable administrative tasks and fair remuneration. However, 20% reported low satisfaction, primarily due to excessive workloads, poor leadership support, financial insecurity, and limited career progression opportunities. CONCLUSION: Job satisfaction among physicians in public health roles is moderate through a combination of high and low satisfaction factors. These professionals face demanding environments requiring them to balance administrative responsibilities, staff issues, community satisfaction, and resource allocations. Enhancing job satisfaction is essential for improving workforce morale and achieving effective public health outcomes. Implementing targeted interventions to address these challenges can foster long-term workforce stability and organisational success.
Systematic review of challenges of telehealth-based intervention in managing cancer pain.
Mogan S, Samprith A, Muthusamy V … +4 more , Samuganathan D, Zaigham MT, Idrees Z, Mogan L
Med J Malaysia · 2025 Sep · PMID 41016003
INTRODUCTION: Understanding the challenges of telehealth interventions is essential to determining their future direction in cancer pain management, as these are considered complex interventions. This systematic review a...
INTRODUCTION: Understanding the challenges of telehealth interventions is essential to determining their future direction in cancer pain management, as these are considered complex interventions. This systematic review aimed to identify the challenges associated with telehealthbased interventions in cancer pain management. MATERIALS AND METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A systematic search was conducted from January 19 to February 2, 2022, covering the past 10 years. Databases searched included PubMed and EBSCO. Inclusion criteria were articles published in English focusing on cancer pain in patients with any cancer diagnosis. Data were extracted on participants, interventions, and outcomes, with a particular focus on challenges reported in each study. A total of 320 publications were retrieved and screened; 38 articles met the inclusion criteria. RESULTS: The most reported challenge was limited or slow Internet access, followed by lack of technological expertise among healthcare teams and low computer literacy. Human resource-related challenges were also frequently reported, including inadequate reimbursement mechanisms, concerns over malpractice, increased staff workload, and absence of formal organisational structures. In studies conducted after the COVID-19 pandemic, data-related issues such as data security and management were also highlighted. CONCLUSION: Telehealth is a rapidly growing technology with the potential to transform healthcare delivery. Addressing the challenges identified in this review may help guide the development and implementation of more effective telehealth interventions in cancer pain management.
Carotid endarteretomy: A single vascular centre experience in Malaysia.
Idris MS, Ling DY, Carol FF … +1 more , Ramli ARH
Med J Malaysia · 2025 Sep · PMID 41016002
INTRODUCTION: Carotid artery stenosis remains one of the leading causes of major stroke. Carotid endarterectomy (CEA) has proven effective in preventing debilitating major stroke. However, the data on CEA in Malaysia is...
INTRODUCTION: Carotid artery stenosis remains one of the leading causes of major stroke. Carotid endarterectomy (CEA) has proven effective in preventing debilitating major stroke. However, the data on CEA in Malaysia is still lacking. University of Malaya Medical Centre, Kuala Lumpur, Malaysia first embarked on CEA since 2017. We are reporting the outcomes of CEA performed in our centre. MATERIALS AND METHODS: This was a retrospective case series of 20 patients who underwent CEA from the year 2017 until 2024. Patients having asymptomatic (≥60-99%) and symptomatic carotid artery stenosis (≥50-99%) were selected for the procedure. All patients received best medical treatment, which include antithrombotic medications, lipid lowering therapy, blood pressure management, diabetes mellitus management and lifestyle modifications especially smoking cessation. All the patients underwent CEA under general anaesthesia. Shunting was done routinely. Preoperative, intraoperative, and postoperative data were collected and evaluated. Mortality, myocardial infarction, stroke, postoperative bleeding, surgical site infection and cranial nerve injury at 30 days were the outcomes investigated. We also evaluated restenosis after CEA. RESULTS: Most patients in our series were males 70% (n = 14) compared to 30% (n = 6) females. There were more symptomatic patients (n = 14) than asymptomatic patients (n = 6). There was one 30-day mortality among the symptomatic patients, while there was no 30-day mortality in the asymptomatic patients. The 30-day myocardial infarction was 5% (n = 1), which was the same symptomatic patient who died. In this cohort, only one patient had 30-day stroke (5%), which was a symptomatic patient. The patient recovered from the stroke after two weeks. Cranial nerve injuries happened in four patients (20%), where the commonest nerve injured was recurrent laryngeal nerve (n = 3). Only one patient had postoperative bleeding which did not need any reintervention. No surgical site infection was noted on all patients. Three patients developed restenosis, which was noted at two to six months post CEA. Two of the patients had symptomatic restenosis (more than 50% stenosis) which resulted in them being reoperated. CONCLUSION: The uptake of CEA in Malaysia is still slow. By sharing the outcomes data, hopefully it will create awareness among medical practitioners on the importance of early referral for carotid artery stenosis. Long term outcomes are very much needed.
Evaluating the efficacy of transrectal povidone-iodine application for infection prevention in transrectal ultrasound-guided prostate biopsy: A single-center retrospective study.
Azizi MH, Mohd Hashim MH, Lim LY … +3 more , Khoo HC, Md Zainuddin Z, Che Razali NS
Med J Malaysia · 2025 Sep · PMID 41016001
INTRODUCTION: Prostate cancer diagnosis via transrectal ultrasound-guided (TRUS) biopsy carries a significant risk of infectious complications due to potential contamination from the rectal microbiome. This study aimed t...
INTRODUCTION: Prostate cancer diagnosis via transrectal ultrasound-guided (TRUS) biopsy carries a significant risk of infectious complications due to potential contamination from the rectal microbiome. This study aimed to evaluate the efficacy of transrectal 10% povidone-iodine application, in combination with antibiotic prophylaxis, in reducing infectious complications following TRUS biopsy. MATERIALS AND METHODS: A retrospective analysis was conducted on 643 patients who underwent TRUS biopsy at a single center in a tertiary hospital in Kuala Lumpur between January 2017 and December 2023. Patient records were reviewed for demographic data, biopsy indications, type of antibiotic prophylaxis, and post-biopsy complications. Patients were categorized into two groups: those who received antibiotic prophylaxis alone and those who received both antibiotic prophylaxis and transrectal povidone-iodine. Statistical analyses, including chi-square tests and logistic regression, were performed to compare outcomes and assess the impact of povidone-iodine on infection rates. RESULTS: Of the 643 patients, 285 received antibiotic prophylaxis combined with transrectal povidone-iodine, was associated with a significantly lower infection rate from 2.23% to 0.7% (P < 0.05). There were no significant differences between the povidone-iodine and non- povidone-iodine groups in terms of patient demographics, including age, prostate volume, Prostate Specific Antigen (PSA) levels, and histopathological findings. Logistic regression analysis further confirmed the significant effect of povidone-iodine in reducing post-biopsy infections presenting as fever >37.5 within 30 days after TRUS biopsy. CONCLUSION: The results indicate that the use of transrectal 10% povidone-iodine alongside antibiotic prophylaxis is an effective approach for reducing infectious complications following TRUS biopsy.
Exploring prenatal risk factors associated with congenital anomalies among newborns in national referral hospital, Indonesia.
Novianti L, Irwinda R
Med J Malaysia · 2025 Sep · PMID 41016000
INTRODUCTION: Congenital anomalies (CAs) account for approximately 8 to 15% of perinatal deaths and 13 to 16% of neonatal deaths. Congenital anomalies are a significant public health issue in Indonesia, affecting approxi...
INTRODUCTION: Congenital anomalies (CAs) account for approximately 8 to 15% of perinatal deaths and 13 to 16% of neonatal deaths. Congenital anomalies are a significant public health issue in Indonesia, affecting approximately 59.3 per 1,000 live births. The three most frequent malformations were hydrocephalus (21%), cleft lip and cleft palate (9.2%) and Down Syndrome (9.2%). MATERIALS AND METHODS: A retrospective case-control study was conducted at Dr. Cipto Mangunkusumo General Hospital, Jakarta, between September 2023 and October 2024. Data from 552 births were analysed, including 97 cases of congenital anomalies (CAs). Maternal, fetal, and environmental factors were assessed using medical records and documented clinical histories. Statistical analyses included descriptive statistics, cross-tabulations, binary logistic regression, and multivariable logistic regression. RESULTS: The prevalence of CAs was 17.6%. Significant maternal risk factors included a history of congenital anomalies (OR = 3.7, 95% CI: 0.88-16.00) and severe anemia (OR = 4.37, 95% CI: 2.48-7.69). Environmental risks, such as drug use in the first trimester (OR = 3.43, 95% CI: 2.01-5.86), passive smoking (OR = 4.10, 95% CI: 1.89-8.90), and pesticide exposure (OR = 3.92, 95% CI: 1.26-12.17), were also significant. Folic acid supplementation showed a significant protective effect against congenital anomalies (OR = 0.56, p = 0.001), although the usage rate remained low (35.5%). CONCLUSION: This study found a significant association between congenital anomalies and risk factors such as passive smoking, exposure to pesticides, and chemicals. It highlights the importance of ongoing community health education to prevent and manage these predisposing risk factors.
Autologous serum skin test in chronic spontaneous urticaria: Evaluation of the relationship with disease activity and autoimmune antibodies.
Lai FY, Sarkan MM
Med J Malaysia · 2025 Sep · PMID 41015999
INTRODUCTION: Chronic spontaneous urticaria (CSU) is a multifactorial, mast cell driven disorder characterized by wheals, angioedema, or both, lasting for more than six weeks. Autoimmunity, particularly Type IIb autoimmu...
INTRODUCTION: Chronic spontaneous urticaria (CSU) is a multifactorial, mast cell driven disorder characterized by wheals, angioedema, or both, lasting for more than six weeks. Autoimmunity, particularly Type IIb autoimmunity, involving IgG autoantibodies directed against either IgE or its high affinity receptor (FcεRI) on mast cells and basophils, plays a significant role in CSU pathogenesis. The Autologous Serum Skin Test (ASST) is a practical tool for detecting IgG autoantibodies and may be associated with the disease severity and the presences of autoimmune antibodies. Nonetheless, previous studies on ASST responses and the clinical features of patients with CSU have conflicting results. MATERIALS AND METHODS: This study aimed to establish the relationship between ASST positivity and disease activity, assessed by the Urticaria Activity Score 7 (UAS7) and to determine the associations with autoimmune antibodies including anti-thyroid peroxidase (anti-TPO), antithyroglobulin antibodies, and antinuclear antibodies (ANA). This cross- sectional study was conducted over a five months period, from January to May 2024, at the Department of Dermatology, in the tertiary hospital located in the capital city of Malaysia. Participants underwent ASST, laboratory evaluation for autoimmune antibodies, and assessment of disease activity using UAS7. RESULTS: In this study, 24 of the 59 patients were ASST positive, resulting in a prevalence rate of 41%. ASST positive patients demonstrated significantly higher disease activity, with a mean UAS7 score of 23.96 ± 10.55, compared to 13.51 ± 10.88 in ASST negative individuals (p = 0.001). A significant association was also found between ASST positivity and higher UAS7 severity categories (p = 0.011). Furthermore, a significant gender difference was observed with females more likely to exhibit ASST positivity (p = 0.016). Nevertheless, no significant associations were found between ASST results and presence of angioedema (p =1.0), atopy (p = 0.968), or autoimmune antibodies including ANA, anti-TPO, and anti-thyroglobulin antibodies (p > 0.05) CONCLUSION: The significant association between ASST positivity and increased UAS7 scores heightened interplay between autoimmunity, disease severity, and clinical characteristics in CSU, particularly Type IIb autoimmunity subtype. Hence, ASST is a practical clinical tool for identifying autoimmune profile in CSU patients, and aids dermatologist in prognosis assessment and treatment strategies.
Sleep Goal Index (SGI) - A new success outcome criteria on 618 OSA patients.
Pang KP, Olszewska E, Braverman I … +22 more , Yang HC, Alkan U, Chan YH, Vicini C, Cammarato G, Bovolenta E, Cheong RCT, Unadkat S, Siow JK, Shochat I, Bahgat A, Kishore S, Chandra S, Carrasco-Llatas M, Baptista P, Casale M, Pang SB, Lim JW, Montevecchi F, Pang E, Pang CE, Rotenberg B
Med J Malaysia · 2025 Sep · PMID 41015998
INTRODUCTION: Sleep-Goal Index (SGI) comprises of Blood Pressure, AHI (number of apnoea and hypopnea events per hour), T90 (duration of oxygen below 90% and BMI (body mass index). This study aims to demonstrate SGI as a...
INTRODUCTION: Sleep-Goal Index (SGI) comprises of Blood Pressure, AHI (number of apnoea and hypopnea events per hour), T90 (duration of oxygen below 90% and BMI (body mass index). This study aims to demonstrate SGI as a holistic, comprehensive and practical measurement of treatment outcomes in OSA (obstructive sleep apnoea) management. MATERIALS AND METHODS: A prospective 10-center clinical trial of 618 OSA patients, who underwent nose, palate and/or tongue surgery. Pre- and post-operative data were analyzed and compared with the Sher's criteria (AHI reduction 50% and <20) and the Sleep Goal Index. RESULTS: There were 514 males and 104 females, mean age of 45.8±13.1 years. Mean snore VAS improved from 7.6±1.9 to 2.8±2.1 (p<0.001), mean Epworth score (ESS) improved from 11.5±4.8 to 5.4±3.5 (p<0.001), mean BMI decreased from 28.6±4.8 to 27.3±5.3 (p<0.001), gross weight decreased from 82.4±14.2kg to 78.1±13.3kg (p<0.001). Mean AHI decreased 37.4±25.7 to 16.4±14.6 (p<0.001), mean LSAT improved 74.5±18.4% to 85.4±7.6% (p<0.001), and mean T90 (time spent <90%) decreased from 27.7±8.9 minutes to 9.7±2.1 minutes (p<0.001). Mean SBP decreased from 130.4±19.4 to 121.1±14.6mmHg, mean DBP decreased from 84.7±13.4 to 79.5±12.3mmHg. The overall success rate (Sher's criteria) was 55.7%. Based on McNemar's test, comparing Sher's criteria and SGI (4 parameters - BP, BMI, T90, AHI), it was demonstrated that fulfilling any 2 out of 4 SGI parameters would be just as sensitive as Sher's criteria, whilst being more holistic and representative of the patients' oxidative stress. From McNemar's test, the overall duo-paired combination and permutations of these 4 SGI parameters ranged from 41.8% to 60.9%. DISCUSSION: AHI as a single parameter to measure OSA treatment success can be unreliable. The SGI is a holistic, comprehensive, easily measured and better patient appreciated measurement index reflecting true end-organ function/improvement.
A national survey on percutaneous tracheostomy practice in Malaysian adult general intensive care units.
Teah KM, Ibrahim NA, Ganesh S … +1 more , Jamil J
Med J Malaysia · 2025 Sep · PMID 41015997
INTRODUCTION: Percutaneous tracheostomy (PT) has gained increasing acceptance over surgical tracheostomy (ST) in the last few decades due to lower rates of postoperative infections, less bleeding, and cost-effectiveness....
INTRODUCTION: Percutaneous tracheostomy (PT) has gained increasing acceptance over surgical tracheostomy (ST) in the last few decades due to lower rates of postoperative infections, less bleeding, and cost-effectiveness. However, there has been little information regarding the PT practice in Malaysian adult general intensive care units (ICU). The objective of the study was to assess the current practice of PT in Malaysia. MATERIALS AND METHODS: This observational cross-sectional study used a validated questionnaire with 15 items. A total of 61 ICUs consisting of adult general ICUs under Ministry of Health (MOH) hospitals and adult general ICUs in university teaching hospitals were recruited into the study whereas ICUs in private hospitals and specialist ICUs were excluded from this study. The questionnaire was subsequently distributed to the heads of those 61 ICUs through existing WhatsApp or Telegram groups and the data collection period lasted four months. RESULTS: Fifty-three out of 61 ICUs participated. Ninety point six percent of the responses came from MOH hospitals, whereas 9.4% came from university hospitals. The heads in participating ICUs comprised 35.8% intensivists and 64.2% anaesthetists. At the time of the survey, 45.3% of ICUs were still practicing PT, 13.2% had performed PTs in the past but stopped whereas 41.5% were not. The rate of PT (both actively practising and formerly practised combined) in intensivist-led ICUs was 94.7% compared to 38.2% in anaesthetist-led ICUs. Intensivists performed PTs in almost two-thirds of ICUs, while anaesthetists did so in another two-thirds. The vast majority of assistants were medical officers at 96.8%. The Ciaglia Blue Rhino technique was the predominant technique (71.0%) while airway management during the technique was solely via endotracheal tube. Ninety-six point eight percent of the ICUs employed routine infiltration of local anaesthetics prior to PT. Thirty-eight point seven percent of performers of PT routinely used fibreoptic bronchoscopy but only 6.4% used ultrasonography. Seventy-four point two percent used tracheostomy tubes with inner cannulae and 83.9% routinely followed up with patients post-discharge from the ICU. Seventy-nine point two percent of respondents believed PT was the method of choice for elective tracheostomy in the ICU but only 49.1% perceived PT to be safer compared to ST. CONCLUSION: PT is commonly practised in intensivist-led ICUs. PT is generally preferred for elective tracheostomy but there is a variability in perceptions regarding its safety compared to ST.
Adaptation and validation of the Sleep Quality Scale among Saudi population (A-SQS).
Alghamdi M
Med J Malaysia · 2025 Sep · PMID 41015996
INTRODUCTION: The quality of sleep has a significant impact on an individual's health and overall well-being. Given the variability of factors that impact sleep quality and their varying degrees of significance between i...
INTRODUCTION: The quality of sleep has a significant impact on an individual's health and overall well-being. Given the variability of factors that impact sleep quality and their varying degrees of significance between individuals, the utilization of a self-report approach becomes necessary. The Sleep Quality Scale (SQS) is a widely used self-report measure designed to evaluate sleep quality. It consists of six distinct techniques and encompasses a total of 28 items. The aim of this study was to translate and validate the SQS in the Saudi population. MATERIALS AND METHODS: A cross-sectional approach was applied to evaluate the reliability, validity, and cross-cultural suitability of the Arabic adaptation of the Sleep Quality Scale (A-SQS) in a sample consisting of 402 individuals, with 33.9% representing females. RESULTS: The test-retest reliability was found to be significant, with a coefficient of 0.88 at a 15-day interval. Additionally, the principal component factor (PCF) analysis revealed five factors, that accounted for 56.29 % of the total variance. The Cronbach's alpha coefficient was 0.90 for internal consistency. CONCLUSION: This result determined that the A-SQS possesses a valid and reliable 5-factor structure when applied to the Saudi population. These therefore renders the scale a valid and reliable instrument in both clinical practice and clinical research.
Unmasking nasal basal cell carcinoma: Strategies for defect coverage.
Halim AS, Lim MC, Shawaltul HNR
Med J Malaysia · 2025 Sep · PMID 41015995
INTRODUCTION: Many reconstruction methods have been introduced for the reconstruction of basal cell carcinoma (BCC) post excision however no study has described the preferred reconstruction method in the Malaysia setting...
INTRODUCTION: Many reconstruction methods have been introduced for the reconstruction of basal cell carcinoma (BCC) post excision however no study has described the preferred reconstruction method in the Malaysia setting. Variations in resource availability and surgical training between regions may affect reconstructive choices. This study intends to find out our preferred method for reconstruction in nasal BCC patients post excision in our centre. MATERIALS AND METHODS: We conducted a retrospective chart review of patients undergoing different reconstruction methods and assessing outcomes for a series of patients with BCC post-resection, conducted in Hospital Universiti Sains Malaysia (HUSM) and Hospital Raja Perempuan Zainab II, Kelantan, from 2012 to 2024. RESULTS: A total of seven patients were identified in this retrospective study, comprising five females and two males. The ages of these seven patients range from 60 to 77 years old. All seven patients who underwent excision postoperatively underwent immediate soft tissue reconstruction with either a local or regional flap, a free flap, or a combination of flaps. Among those seven patients, only one developed flap-related complications. All patients were followed up for at least 3 months, with a range of 3-38 months. Functional and cosmetic assessments over the resected area post-reconstruction were good. CONCLUSION: Local flaps remain the preferred option for small and medium nasal BCC defects, while forehead flaps and free flaps are reserved for larger or complex defects. In Asian patients, thicker skin and pigmentation influence flap design and thinning to optimize outcomes.
Velopharyngeal function and nasalance score in post-radiation nasopharyngeal carcinoma patients.
Handayani T, Airlangga TJ, Zizlavsky S … +4 more , Rachmawati EZK, Mayangsari ID, Kodrat H, Prihartono J
Med J Malaysia · 2025 Sep · PMID 41015994
INTRODUCTION: Voice production and speech impairment in head and neck cancer patients can be experienced due to tumors or therapy such as radiotherapy. Velopharyngeal fibrosis in post-radiation nasopharyngeal carcinoma (...
INTRODUCTION: Voice production and speech impairment in head and neck cancer patients can be experienced due to tumors or therapy such as radiotherapy. Velopharyngeal fibrosis in post-radiation nasopharyngeal carcinoma (NPC) patients can disrupt the velopharyngeal closure during speech, causing hypernasality. This study aims to determine the characteristics and proportions of the nasalance score in post-radiation NPC patients with or without resonance disorder. MATERIALS AND METHODS: This research is a descriptive study using cross-sectional techniques, followed by retrospective data collection of post-radiation NPC patients at Dr. Cipto Mangunkusumo General Hospital for the period July-August 2023. The parameter assessed is the nasalance score using a nasometer, the velopharyngeal dysfunction assessed with flexible laryngoscopy, and the hypernasality assessed by a 15 years' experienced speech therapist. RESULTS: The nasalance score in the Gajah 1 test obtained a median of 14 (7-22), for the mean value of Hantu 1 test was 39.8% ± 4.5, and for the mean value of Sengau test was 62.2 ± 6.9, with a nasalance score cut point in Gajah 1 test between normal resonance and hypernasal was 15.5% and in Hantu 1 test was 42.5%. Gender and radiation dose to the pharyngeal constrictor muscle tend to have a significant relationship with resonance disorder in post-radiation NPC patients. CONCLUSION: A prospective study is needed in NPC patients with pre- and post-radiation assessment and follow-up evaluation to assess the effects of radiation which includes all relevant functional aspects of voice and speech.
Correlation of bacterial biofilm profile based on optical density cut-off with clinical severity in patients with chronic suppurative otitis media tubotympanic type.
Setiawan M, Gaffar M, Wartati S … +2 more , Qanitha A, Sjahril R
Med J Malaysia · 2025 Sep · PMID 41015993
INTRODUCTION: Chronic suppurative otitis media (CSOM) is a middle ear infection with a high incidence in ear cases, is often recurrent, and causes hearing impairment. Bacteria in the CSOM frequently form biofilms, which...
INTRODUCTION: Chronic suppurative otitis media (CSOM) is a middle ear infection with a high incidence in ear cases, is often recurrent, and causes hearing impairment. Bacteria in the CSOM frequently form biofilms, which enhance antibiotic resistance and contribute to disease progression. The aim of this study was to determine the correlation of bacterial biofilm profiles based on optical density cut-off with the clinical picture of patients with tubotympanic type CSOM. MATERIALS AND METHODS: This was a cross-sectional study using a descriptive analytical design. The study was conducted at the tertiary teaching hospital of Hasanuddin University and the network hospital in Makassar, Indonesia, from July 2023 to July 2024. The study population consisted of patients with the CSOM tubotympanic type who met the inclusion criteria. Bacterial cultures and biofilm examinations were performed using the tissue culture plate method. Data were analyzed using SPSS® version 28. RESULTS: A total of 53 patients with the CSOM tubotympanic type were included in this study. The mean age of the patients was 30±14 years. Pseudomonas aeruginosa was the most dominant bacterium (32.1%), with 20 other bacteria, and all these bacteria formed biofilms with either weak or moderate strength. There was a significant association between biofilm formation and nature of secretion (r=0.395, p=0.003). The chronicity of the disease (r=0.407, p=0.002) and the degree of hearing impairment (r=0.294, p=0.032) were also significant. A significant positive association was found between total clinical score and biofilm formation (r=0.429, p=0.001). CONCLUSION: All bacteria found in the tubotympanic CSOM formed biofilms. The correlation analysis revealed a significant positive relationship between several clinical variables and biofilm formation. The substantial formation of biofilms may account for the fact that patients with elevated scores frequently experience infections that are challenging to manage with conventional antibiotic treatments.
What is the difference between Metabolic Dysfunction-Associated Steatotic Liver Disease, Eosinophilic Esophagitis and Gastroesophageal Reflux Disease?
Koo TH, Chowdhary R, Lee YL … +2 more , Leong XB, Zakaria AD
Med J Malaysia · 2025 Sep · PMID 41015992
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is emerging as a key hepatic manifestation of metabolic syndrome that affects nearly 40% of the global population. While links between MASLD and conditions...
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is emerging as a key hepatic manifestation of metabolic syndrome that affects nearly 40% of the global population. While links between MASLD and conditions such as type 2 diabetes and cardiovascular disease are well recognized, recent evidence suggests a potential connection with eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD). This editorial explores overlapping pathophysiology and inflammatory mechanisms shared by MASLD, EoE, and GERD, drawing from the current global literature and a multicenter U.S. cohort study. This editorial highlights how systemic inflammation, oxidative stress, and gut microbiota imbalance may drive these associations. Notably, MASLD was associated with a 2.38-fold increased risk of EoE and a modest but significant association with GERD independent of obesity. These findings underscore the importance of considering MASLD beyond liver-specific pathology and call for further research on shared immunometabolic pathways. An improved awareness of these relationships may guide diagnostic and therapeutic strategies in clinical practice.
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