The Medical Journal Of Malaysia[JOURNAL]
Sun
200 papers
Association between phenotypes and genotype of developmental and epileptic encephalopathy in next-generation sequencing methods in infants: A scoping review.
Triono A, Herini ES, Mooiindie KH … +2 more , Iskandar K, Gunadi
Med J Malaysia · 2025 Jul · PMID 40740097
INTRODUCTION: Developmental and epileptic encephalopathy (DEE) is epilepsy related to developmental impairment that may be caused by both the underlying etiology (developmental encephalopathy) and superimposed epileptic...
INTRODUCTION: Developmental and epileptic encephalopathy (DEE) is epilepsy related to developmental impairment that may be caused by both the underlying etiology (developmental encephalopathy) and superimposed epileptic activity (epileptic encephalopathy). The origin of DEE and the causes of its variations remain unknown. Owing the lack of clarity regarding the role of genetic variables in DEE, we conducted a scoping review to qualitatively identify the genes most important in the development of DEE to provide an up-to-date review. MATERIAL AND METHODS: We searched all published studies related to the genetic factors of DEE. The identified publications were screened and selected by the authors on basis of on inclusion and exclusion criteria and assessed for methodological quality. Eighteen articles were included. The extracted data included age of onset, sex, gene mutations and inheritance (e.g. nucleotide change, protein change, and family testing), clinical manifestation, electroencephalogram, imaging, medication, and outcomes. RESULT: A total of 18 studies were included in this scoping review. The most frequently reported gene variants were STXBP1 in Ohtahara Syndrome, SLC1A2 in Early Myoclonic Encephalopathy (EME), CDKL5 in West Syndrome, SCN1A in Dravet Syndrome, and KCNT1 in Epilepsy of Infancy with Migrating Focal Seizures (EIMFS). Each gene was associated with distinct electroclinical features, including differences in age of onset, seizure type, EEG patterns, and developmental outcomes. While genotype and phenotype associations were heterogeneous, certain variants showed consistent patterns indicative of more severe disease courses. CONCLUSIONS: This review identified key gene variants commonly associated with early-onset DEE in infants, particularly STXBP1, SLC1A2, CDKL5, SCN1A, and KCNT1, each linked to unique clinical presentations and outcomes. These findings support the clinical utility of next-generation sequencing (NGS) for early diagnosis and tailored treatment planning in DEE. Understanding genotype-phenotype correlations may enhance prognostication and highlight potential avenues for targeted therapy in future research.
Impact of structured physical exercise during pregnancy on maternal health and fetal outcomes: A systematic review.
MohdNor FH, Jamani NA, AbdAziz KH
Med J Malaysia · 2025 Jul · PMID 40740096
INTRODUCTION: Current guidelines recommend that pregnant women engage in physical activity. Exercise during pregnancy has been shown to positively impact both maternal and fetal outcomes. Therefore, we conducted a system...
INTRODUCTION: Current guidelines recommend that pregnant women engage in physical activity. Exercise during pregnancy has been shown to positively impact both maternal and fetal outcomes. Therefore, we conducted a systematic review to evaluate the impact of structured physical activity during pregnancy on maternal health and fetal outcomes. MATERIALS AND METHODS: A systematic search was conducted on relevant articles published between 2015 and 2020 using PubMed, Google Scholar, ScienceDirect, Scopus, and the Cochrane Library. Studies on pregnant women, comparative study designs with concurrent controls, structured physical intervention and health outcomes for both maternal and fetal were targeted. Maternal outcomes include gestational weight gain, lumbopelvic pain, gestational diabetes and preeclampsia, while fetal outcomes include prematurity and birth weight. Only original studies with published data were included. This review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analysis. RESULTS: A total of 3441 published articles were retrieved from different databases. After assessing the obtained papers, studies that did not meet the inclusion criteria were excluded. Twenty studies involving 5188 populations that met the inclusion criteria were included in this review. However, due to the heterogeneity of the studies, metaanalysis was not done. Structured physical activity significantly reduced the risk of gestational diabetes (OR: 0.57; 95% CI: 0.40-0.81; p = 0.002), but had no statistically significant effect on lumbopelvic pain (OR 0.98 (95% CI: 0.49 to 1.93) p=0.95), gestational weight gain (OR 0.88 95% CI: (0.44, 1.76) p=0.71), pre-eclampsia (OR 0.78, 95% CI: 0.41, 1.49, p=0.46) causing preterm delivery (OR 0.91, 95% CI (0.69, 1.20), p=0.50) or affecting fetal birth weight (mean difference 0.93, 95% CI (-42.67, 44.53), p=0.97) CONCLUSION: Structured physical activity during pregnancy, three times a week, 30 minutes per day of moderate intensity, is safe and benefits pregnant women and the fetus. Our findings challenge the view that physical exercise during pregnancy is not helpful and can be harmful. To generate further evidence, there is a need for high-quality, standardised trials that assess specific types of structured exercise program with better reporting of adherence and outcomes.
A systematic review of water-soluble contrast use in videofluoroscopic examination of dysphagia.
Almardini MK, Alshipli M, Maniam P … +1 more , Mohd Ibrahim H
Med J Malaysia · 2025 Jul · PMID 40740095
INTRODUCTION: The Videofluoroscopic Swallow Study (VFSS) is a key diagnostic tool for evaluating swallowing function, providing dynamic visualization of bolus transit and swallowing mechanism. Traditionally, barium is us...
INTRODUCTION: The Videofluoroscopic Swallow Study (VFSS) is a key diagnostic tool for evaluating swallowing function, providing dynamic visualization of bolus transit and swallowing mechanism. Traditionally, barium is used as the contrast medium due to its effectiveness in highlighting anatomical and functional aspects of swallowing. However, water-soluble contrast (WSC) agents, which differ in osmolarity, viscosity, and iodine atom-particle ratio, have emerged as alternatives and their optimal use in VFSS remains unclear. This systematic review investigates the utilization of WSC agents in VFSS. MATERIALS AND METHODS: This systematic review was conducted following the PRISMA 2020 guidelines, extensively analyzing WSC agents use in VFSS. Searches were conducted across PubMed, Scopus, and Google Scholar using keywords "Water-Soluble Contrast, Videofluoroscopic, High-Osmolar Water-Soluble Contrast, and/or Low-Osmolar Water-Soluble Contrast". A total of 574 papers were initially identified. RESULTS: Nine studies (2013-2021) investigated the use of WSC agents in VFSS. The studies varied in methodology and WSC agents used, with no standardized protocols identified. Findings indicated that low-osmolar WSCs may reduce the risk of complications, such as aspiration and pulmonary edema, compared to barium sulfate. WSC agents were utilized in high-risk populations, such as those with head and neck surgeries or neurological conditions. CONCLUSION: WSC agents may serve as a viable alternative to barium sulfate in VFSS, particularly for high-risk patients. However, further research is needed to compare their diagnostic accuracy, patient outcomes, and safety profiles, as well as to establish standardized protocols for their use in dysphagia evaluation.
Poor waste disposal and effect on health- an insight and review.
Devaraj NK
Med J Malaysia · 2025 Jul · PMID 40740094
INTRODUCTION: The generation of waste products, including urine, faeces, and household items such as glass and plastic, has increased in line with the growth of the world's population. Physical, psychological, and social...
INTRODUCTION: The generation of waste products, including urine, faeces, and household items such as glass and plastic, has increased in line with the growth of the world's population. Physical, psychological, and social issues can invariably arise if these wastes are not properly managed, which has a direct effect on the population's health and is the source of the nation's productivity. Waste dumping has been a persistent problem, despite the government's efforts to educate consumers on proper waste dumping. Despite regular enforcement activities, this socially unacceptable habit persists. METHODOLOGY: Various studies on waste disposal and its potential deleterious effects on the health of humans, animals, and the environment were reviewed and included in this narrative review to summarise the nature of the problem and its health effects. These include both local and international articles on this subject. This is to ensure that various strategies can be developed to manage this important and ever-persisting issue. RESULTS AND CONCLUSION: The literature reviewed have been able detailed the physical, psychological, and social issues of improper waste disposal that may affect the health of the population. Taking care of the environment is a top priority, as are modern issues of climate change and its effects on the nation's coffers. Enhancing public education, promoting community-based environmental activities such as gotongroyong, using modern technology or methods, and stricter enforcement will ensure that waste is disposed properly. In turn, this will ensure the sustainability of Mother Earth for future generations.
Assessment of mutagenic effects: Combined impact of nitrogen-fixing compounds and phenol on plant and animal organisms.
Abdukadirova LK, Salomova FI, Rakhimov BB … +2 more , Akhmadalieva NO, Sadullaeva K
Med J Malaysia · 2025 Jul · PMID 40740093
INTRODUCTION: Rapid industrialisation, urbanisation, and increased use of agricultural chemicals have significantly contributed to environmental pollution, particularly affecting air, water, and soil quality. These pollu...
INTRODUCTION: Rapid industrialisation, urbanisation, and increased use of agricultural chemicals have significantly contributed to environmental pollution, particularly affecting air, water, and soil quality. These pollutants, including nitrogen-containing compounds and phenol, pose mutagenic risks, potentially leading to genetic alterations and health issues in exposed populations. This study aims to evaluate the mutagenic potential of sodium nitrate, sodium nitrite, phenol, and their combinations on plant and animal cells. MATERIALS AND METHODS: The study utilised two experimental models: Triticum aestivum (soft wheat) and albino mice. Wheat seeds were treated with ten different solutions, including sodium nitrate (0.5%), sodium nitrite (0.5%), phenol (0.1% and 0.01%), and their combinations. Chromosomal aberrations in the wheat root tips were assessed using the acetocarmine staining method. For the animal model, albino mice were divided into control and experimental groups, receiving varying concentrations of sodium nitrate and phenol, both individually and in combination. Bone marrow smears were analysed for chromosomal aberrations, including fragments and rings, using metaphase plates. RESULTS: In wheat, the combined exposure to sodium nitrate (0.5%), sodium nitrite (0.5%), and phenol (0.1%) caused a significant increase in genetic alterations compared to individual treatments, with a mutation frequency 4.5 times higher than the control. In albino mice, combined exposure to high doses of phenol and nitrates induced cytogenetic changes, with the mutation frequency reaching 12.7%-1.5 times higher than the control group. Individual exposures to phenol and nitrates did not produce statistically significant mutations compared to controls. CONCLUSION: The combination of phenol, sodium nitrate, and sodium nitrite had a synergistic mutagenic effect in both plants and animals, leading to more significant genetic damage than individual exposures. These findings highlight the need for careful management of environmental pollutants, as their combined impact may pose serious risks to ecological and human health. Further clinical studies are necessary to assess these effects in human populations.
Impact of challenging-to-treat areas on quality of life and mental health among plaque psoriasis patients from Sabah, Malaysia.
Ong EYL, Voo SYM
Med J Malaysia · 2025 Jul · PMID 40740092
INTRODUCTION: Patients with psoriasis with involvement of challenging-to-treat-areas often have higher disease burden. We studied the impact of the challenging-to-treat areas namely scalp, face, nail, palms, soles and ge...
INTRODUCTION: Patients with psoriasis with involvement of challenging-to-treat-areas often have higher disease burden. We studied the impact of the challenging-to-treat areas namely scalp, face, nail, palms, soles and genitalia on the quality of life and mental health of psoriatic patients. MATERIALS AND METHODS: We conducted a cross-sectional study involving 120 patients aged 18 years and above with plaque psoriasis. Those with challenging-to-treat-areas were compared to those without. RESULTS: The prevalence of challenging-to-treat-areas were scalp (35.8%), face (26.7%), nails (38.3%), palms (6.7%), soles (5.0%) and genitalia (15.0%). Psoriasis Area and Severity Index (PASI) was higher in patients with challenging-to-treat areas, with a median of 4.55 (IQR: 3.00, 7.80) compared to 1.80 (IQR: 0.60, 2.85) in those without (p < 0.001). Patients with these areas demonstrated a significantly higher Disease Life Quality Index (DLQI) scores compared to those without (mean ± SD: 5.13 ± 6.17 vs 11.02 ± 7.19; p < 0.001). Overall the prevalence of depression, anxiety and stress, scored using Depression, Anxiety and Stress Scale-21 Item (DASS-21), were 19.2%, 28.3% and 14.2% respectively with two thirds of patients had challenging-to-treat areas. Significantly more patients with challenging-to-treat-areas suffered from moderate to extremely severe depression (8.4% vs 5.0%, p = 0.034) and anxiety (33.4% vs 16.7%, p = 0.001). Patients with challenging-to-treat areas had higher mean itch Numeric Rating Scale (NRS) (4.28 ± 2.90) compared to those without (1.45 ± 1.58) (p < 0.001). CONCLUSION: Patients with psoriasis with challenging-totreat- areas reported greater impairment in quality of life and higher risk of depression and anxiety.
High-fidelity simulation vs video-assisted teaching for early ECG learning - Randomised controlled trial.
Saha R, Pal B, Harinarayan R … +5 more , Aranan A, Swe KMM, Kumarasamy P, Kaur G, Wijegunathileke PALS
Med J Malaysia · 2025 Jul · PMID 40740091
INTRODUCTION: Electrocardiography (ECG) interpretation is a vital yet challenging competency for preclinical medical students due to limited clinical exposure. While high-fidelity simulation teaching (HFST) offers immers...
INTRODUCTION: Electrocardiography (ECG) interpretation is a vital yet challenging competency for preclinical medical students due to limited clinical exposure. While high-fidelity simulation teaching (HFST) offers immersive, experiential learning, video-assisted teaching (VAT) provides scalable, consistent instruction. Despite growing interest in both methods, comparative evidence remains limited. This study aimed to evaluate the effectiveness of HFST versus VAT in enhancing ECG knowledge and retention among preclinical students using a Multiple-Choice Question (MCQ) assessment for knowledge cognition. MATERIALS AND METHODS: It was a randomised controlled trial study where 136 first year undergraduate medical students were randomised into control (VAT) and intervention (HFST) groups. The intervention group received a 20-minute simulation session using SimMan, demonstrating ECG lead placement, interpretation, and basic management, followed by a 20-minute interactive discussion whereas the control group underwent a VAT session mirroring the HFST content with a 20-minute pre-recorded video followed by a 20-minute faculty-led discussion. MCQs were used to assess the acquisition and retention of knowledge, both as a pre-test (week 1) and a post-test (week 12). The outcomes were measured using the mean and standard deviation of the total scores of MCQ. Intragroup analyses were conducted using a dependent sample t-test, whereas intergroup analyses were performed using an independent samples t-test. ANCOVA was used to assess the difference in post-test MCQ scores among the groups after adjusting the Pre-test scores. The Pvalue was set at 0.05. "Institutional research trial registration number": RMC_NUIR_2024_21 RESULTS: Both groups demonstrated significant enhancement in knowledge gain and retention from the pretest to the post-test. The VAT group showed a greater mean score improvement compared to the HFST group. While the VAT group outperformed the HFST group in the post-test, this difference was not statistically significant. Adjusting for pre-test scores using ANCOVA further confirmed the nonsignificance of post-test score differences between the two groups. Two-way mixed ANOVA revealed no significant interaction between group and time point, indicating comparable patterns of knowledge gain across both teaching methods. CONCLUSION: Both HFST and VAT significantly increased knowledge and retention among preclinical medical students. The VAT group showed a slightly higher knowledge gain than the HFST group, although the difference was statistically insignificant. The study demonstrated that both VAT and HFST were effective in midterm knowledge acquisition and may offer a viable alternative for inclusion in undergraduate preclinical curricula.
Psychometric validation of a healthcare professionals' attitude assessment scale toward maternal vaccination: A rasch model analysis.
Muhd Helmi MA, Ismail N, Abu Bakar A
Med J Malaysia · 2025 Jul · PMID 40740090
INTRODUCTION: Maternal vaccination is a proven strategy to protect newborns from vaccine-preventable diseases, yet its success depends heavily on healthcare professionals' attitudes and recommendations. In Malaysia, a va...
INTRODUCTION: Maternal vaccination is a proven strategy to protect newborns from vaccine-preventable diseases, yet its success depends heavily on healthcare professionals' attitudes and recommendations. In Malaysia, a validated and culturally appropriate tool to measure these attitudes is lacking. This study aimed to develop and validate a culturally relevant, reliable tool to assess healthcare professionals' attitudes toward maternal vaccination MATERIALS AND METHODS: The items were initially developed based on an extensive review of literature, vaccination guidelines, and expert reviews, followed by content and face validity involving nine and 30 reviewers, respectively. A pilot study was conducted on 196 respondents, and the reliability and validity were assessed using Rasch analysis (RA). RESULTS: Initially, 26 items were developed. However, only half of the items passed the content validity phase, with another two items removed post face validation. Eleven items were piloted for assessment of reliability and validity. Three items were removed due to concerns over their fit indices, and one item for redundancy. The final refined questionnaire consisted of seven items, demonstrating good reliability (person reliability = 0.80, separation index = 1.98), unidimensionality, and appropriate rating scale functioning, confirming its suitability for assessing healthcare professionals' attitudes toward maternal vaccination. CONCLUSION: This study presents a psychometrically sound tool to measure healthcare professionals' attitudes toward maternal vaccination.
Artificial Intelligence (AI) in a Singaporean Emergency Department: Detecting fractures and reducing recalls.
Chan HY, Tang YP, Wong ZY … +4 more , Koh SH, Nickalls O, Steven W, Tan MO
Med J Malaysia · 2025 Jul · PMID 40740089
INTRODUCTION: There has been rapid increase in the number of artificial intelligence and machine learning (ML) algorithms in recent years. In our local emergency department (ED), after-hours, radiographs are read by the...
INTRODUCTION: There has been rapid increase in the number of artificial intelligence and machine learning (ML) algorithms in recent years. In our local emergency department (ED), after-hours, radiographs are read by the ED doctor, with formal reporting by the radiology department performed on the subsequent day. Discrepant diagnoses between the ED doctor and radiologist potentially result in recalls of discharged patients for additional treatment, leading to greater monetary and manpower costs. To the authors' knowledge, no Singapore based study has utilized local data to analyse the performance of an AI fracture detection solution in the Singapore ED. The objective of this study is to evaluate the diagnostic performance of an AI radiograph fracture tool compared to ED doctors. MATERIALS AND METHODS: A retrospective study was conducted on 42 discrepant radiographic studies. In these studies, the final radiology report by the radiology department (the "ground truth") had a different diagnosis from bedside radiographic assessment by an ED Doctor. RESULTS: There were 20 studies with fractures and 22 studies with no fractures. The AI solution correctly diagnosed 15 fractures (75.0% of cases with fracture) (Figure 1), missed 5 fractures (25.0% of cases with fracture) and overcalled 1 fracture (4.5% of cases with no fracture) (Figure 2). The AI solution sensitivity is 75.0%, specificity is 95.5%, positive predictive value (PPV) is 93.8% and the negative predictive value (NPV) is 80.8%. CONCLUSION: Having a fracture detection AI solution has the potential of reducing discrepant cases by up to 73.7% in the ED setting. Further large-scale studies should be performed to quantify the economic, manpower and healthcare outcome benefits of such an AI solution.
Vitamin D status and its association with asthma control and severity in children.
Fatin WMWN, Mariana D, Hasniah AL
Med J Malaysia · 2025 Jul · PMID 40740088
INTRODUCTION: Vitamin D has an immunomodulatory effect on innate and adaptive immunity within the body, which partially explains its links to inflammation-induced epithelial changes seen in asthma. Various evidence sugge...
INTRODUCTION: Vitamin D has an immunomodulatory effect on innate and adaptive immunity within the body, which partially explains its links to inflammation-induced epithelial changes seen in asthma. Various evidence suggest a potential link between vitamin D deficiency and asthma control and severity. This study aimed to determine the vitamin D levels in asthmatic children and their association with asthma severity and control. MATERIALS AND METHODS: A cross-sectional prospective study was conducted on 72 children with persistent asthma aged 5 to 18 years old in a tertiary hospital in Kelantan. Asthma severity was assessed using the Global Initiative for Asthma (GINA) guidelines based on treatment given. Asthma control was evaluated using both parent/patient self-administered Asthma Control Test (ACT) or Children's Asthma Control Test (c-ACT) scores accordingly to their age and asthma control GINA classification. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured, with <52 nmol/L defined as deficient and 52-73 nmol/L as insufficient. RESULTS: Of the 72 children with persistent asthma, 40.3% had vitamin D deficient and 38.9% had vitamin D insufficient with a mean 25(OH)D level of 58.74 nmol/L. Being female, older age group and higher body mass index (BMI) were associated with vitamin D deficiency (p =<0.05). Lower vitamin D levels were significantly associated with increased asthma severity (p =0.020). There was no significant association between vitamin D levels and asthma control based on GINA classification (p =0.470) and c-ACT/ACT scores (p =0.052). CONCLUSION: High prevalence of vitamin D deficient and insufficient was found among children with persistent asthma. Vitamin D deficiency was significantly associated with increased asthma severity. This group of children needs further evaluation for intervention. We recommend routine assessments of vitamin D levels among children with moderate to severe asthma.
Comparing the effectiveness of retina funduscopy using direct ophthalmoscope and handheld non-mydriatic digital retina fundus camera in medical practice.
Hussein SH, Abdul Muna'aim M, Mokhtar A … +2 more , Zainol N, Tengku Mohd TAM
Med J Malaysia · 2025 Jul · PMID 40740087
INTRODUCTION: Retinal examination plays an essential role in ocular assessment and serves as a key tool for diagnosing various eye conditions. The traditional direct ophthalmoscope (DO) remains widely used due to its aff...
INTRODUCTION: Retinal examination plays an essential role in ocular assessment and serves as a key tool for diagnosing various eye conditions. The traditional direct ophthalmoscope (DO) remains widely used due to its affordability, accessibility, and rapid application. However, it presents several limitations, including a steep learning curve, narrow field of view, and strong dependence on user expertise. In contrast, the handheld fundus camera (HFC) is a newer innovation that provides high-resolution digital imaging and is more user-friendly. This study compared the usability, diagnostic confidence, and user preference between the DO and HFC among medical students and practitioners. MATERIALS AND METHODS: This quasi-experimental study was conducted among 70 participants comprising medical students and practitioners. All participants had prior exposure to the DO and were recruited through convenience sampling. The study took place at the Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia (USIM), Negeri Sembilan and USIM's mobile eye screening sites. Participants received a 15-minute hands-on training with both the DO (Welch Allyn) and HFC (New Eyes) before performing non-mydriatic retinal examinations on separate patients. A structured questionnaire was used to assess device usability, comfort, diagnostic confidence, ability to identify retinal structures, and System Usability Scale (SUS) scores. Data were analysed using paired t-tests, Fisher's exact test, and chi-square tests. RESULTS: Among the participants, 70% were female and 62.9% were medical students. The mean(SD) time to identify retinal structures was significantly shorter with the HFC (2.8(1.84) minutes) compared to the DO (6.4(5.77) minutes; p<0.001). While red reflex detection was higher with the DO (97.1%), the HFC significantly outperformed in locating key structures: optic nerve (88.6% vs. 42.9%, p<0.001) and fovea (82.9% vs. 41.4%, p<0.001). No significant difference was found in identifying retinal vessels. Confidence in findings (92.9% vs. 32.9%) and image clarity (94.3% vs. 45.7%) favoured the HFC, with both differences being statistically significant (p<0.001). The HFC scored higher in usability with a mean SUS score of 64.0(9.37) versus 58.6(9.91) for the DO (p<0.001). Notably, 97.1% of participants preferred the HFC over the DO. CONCLUSION: Our findings show that the HFC offers clear advantages over the traditional DO, especially in ease of use, diagnostic confidence, and user experience. These strengths make it a more effective tool in clinical practice and medical education.
Clinical review of laryngomalacia in a tertiary hospital.
Ghazali L, Hamid SSA, Mohamad H … +1 more , Aziz A
Med J Malaysia · 2025 Jul · PMID 40740086
INTRODUCTION: Laryngomalacia is the most common cause of stridor in infants, with severity ranging from mild to severe forms. Accurate classifications of severity is essential for guiding management and improving outcome...
INTRODUCTION: Laryngomalacia is the most common cause of stridor in infants, with severity ranging from mild to severe forms. Accurate classifications of severity is essential for guiding management and improving outcomes. MATERIAL AND METHODS: We conducted a retrospective study of paediatric patients under two years of age diagnosed with laryngomalacia at a tertiary referral centre between January 2010 and December 2020. Data collected included demographic details, clinical presentation, comorbidities, endoscopic findings, treatment, and follow-up duration. Severity was classified using a symptoms-based scoring system by Shah et al, while laryngomalacia types were determined according to Olney et al's endoscopic classification. Association between severity, endoscopic findings, comorbidities and treatment choice were analysed using logistic regression. RESULTS: A total of 148 patients were included (59.49% male). Mild, moderate, and severe laryngomalacia were observed in 45.27%, 35.14%, and 19.59% of patients, respectively. Type 3 laryngomalacia, identified via endoscopy, was significantly associated with severe disease (p<0.001). Comorbidities, particularly gastroesophageal reflux disease, cardiac, pulmonary, syndromic, neurological conditions and synchronous airway lesions, were significantly linked to higher severity (p<0.05). A strong association was found between severity and treatment: moderate cases had 89.6 times, and severe cases 133.3 times, the odds of receiving surgical intervention compared to mild cases (p<0.001). CONCLUSION: Mild laryngomalacia was most prevalent, but severity increased with specific comorbidities and endoscopic findings. Objective symptom scoring and endoscopic classification are valuable for assessing severity and guiding appropriate management in laryngomalacia.
Echocardiography detection rate of newly diagnosed valvular heart disease amongst patients 12 years old and beyond, referred for transthoracic echocardiography in tertiary care settings.
Chen TM, Ang JS, Josephine P … +17 more , Siti Nabilah MZ, Philip R, Sanmuga V, Cheah WK, Ang CM, Shaibdat NS, Eileen Toh SS, Jeannie Yik Tien P, Wong QY, Yee SY, Zarrin K, Kengeswari R, Gurpreet Pal Singh JS, Ramachandran S, Kwan YF, Hazleena MH, Nor Hanim MA
Med J Malaysia · 2025 Jul · PMID 40740085
INTRODUCTION: Valvular heart disease (VHD) is a significant contributor to cardiovascular morbidity and mortality. Despite global awareness, data on the epidemiology and clinical profile of VHD in Malaysia remain limited...
INTRODUCTION: Valvular heart disease (VHD) is a significant contributor to cardiovascular morbidity and mortality. Despite global awareness, data on the epidemiology and clinical profile of VHD in Malaysia remain limited. This study aimed to determine the echocardiographic detection rate of newly diagnosed VHD in tertiary care centres in Perak, Malaysia, as well as to examine its clinical characteristics, aetiologies, severity, associated comorbidities, and the rate of patient acceptance for valve intervention. MATERIALS AND METHODS: A retrospective, multi-center study was conducted involving patients who underwent echocardiography over a six-month period. The data were then analysed to address the study objectives. Statistical analysis was performed using SPSS version 25.0. RESULTS: Of the 12,610 patients who underwent echocardiography, 946 were newly diagnosed with VHD, yielding a detection rate of 7.5%. The median age of VHD patients was 67 years, with a slight female predominance. The median left ventricular ejection fraction (LVEF) was 57%. Approximately 66% of patients were symptomatic, with dyspnoea being the most common symptom (46.85%). Pulmonary hypertension was observed in 35.3% of patients. Atrial fibrillation (AF) was present in 12.2% of cases. Mitral regurgitation (MR) was the most common valve lesion (34.1%), followed by tricuspid regurgitation (TR, 32.3%) and aortic regurgitation (AR, 19.2%). Functional aetiology was the most frequent cause of VHD, accounting for 59%. Rheumatic heart disease (RHD) was responsible for 51.7% of mitral stenosis (MS) cases, while degenerative causes predominated in AR (74.9%), aortic stenosis (AS) (84.6%), and primary MR (71.4%). The majority of VHD cases were mild (65.6%), with 29.2% moderate and 5.1% severe. Among VHD patients, 34.7% had clinically significant moderate or severe disease. In this subgroup, the predominant aetiologies were functional for MR (52.1%), TR (96.7%), and pulmonary regurgitation (PR, 100%), while degenerative causes were prevalent in AR (63.6%) and AS (84.3%), and RHD was the leading cause of MS (57.1%). Multiple valve involvement was observed in 72.6% of cases. Two-valve involvement accounted for 52.5%, with MR and TR being the most common combination (68.7%), mainly due to functional causes. AS was significantly associated with hypertension and dyslipidaemia. MR showed strong associations with AF, chronic kidney disease (CKD), and ischemic heart disease (IHD), while TR was more common in females. Despite 6.7% of patients requiring valve intervention, only 24.2% consented. A total of 36.4% declined intervention, primarily due to concerns about advanced age (62.5%) and fear of surgery (29.2%), while 39.4% remained undecided. CONCLUSION: The echocardiographic detection rate of newly diagnosed VHD was 7.5%, with functional MR being the most common lesion (20.7%). The majority of patients refused valve intervention, primarily due to old age. This study provides valuable insight into the burden and management challenges of VHD in Malaysia.
Accuracy of age estimation method by panoramic radiographic examination in paediatric dental patients: A diagnostic study in Indonesia.
Laksmiastuti SR, Tanjung R, Farizka I
Med J Malaysia · 2025 Jul · PMID 40740084
INTRODUCTION: Cases of violence and criminality in children continue to increase, with implications for the increasing need for identification measures, especially for living victims for judicial or law enforcement purpo...
INTRODUCTION: Cases of violence and criminality in children continue to increase, with implications for the increasing need for identification measures, especially for living victims for judicial or law enforcement purposes. Teeth are one of the indicators that determine a child's identity. The methods often used to estimate a child's age through dental radiographic examination during the period of deciduous and mixed teeth are the Al Qahtani, Demirjian, and Blenkin & Evans methods. MATERIALS AND METHODS: An analytical cross-sectional study was conducted. The children's ages were estimated using dental examination and 103 digital panoramic radiographs. Descriptive statistics, normality test followed by difference test based on five parameters: p-value Wilcoxon test, Intraclass Correlation Coefficient (ICC), Spearman correlation coefficient, and Bland-Altman analysis by looking at % out of Limit of Agreement and looking at Mean Difference. RESULTS: Wilcoxon's p-value showed that Blenkin's method and Demirjian's method vs. chronological age were significantly different, whereas Al Qahtani's method was not significantly different. The Demirjian method had the highest ICC. Spearman's correlation coefficient was strongly correlated between Blenkin's and Demirjian's methods and the chronological age (r ≥ 0.8). The Bland-Altman analysis showed that the Demirjian Method had the best % out of LOA = 5.8, while the Al Qahtani Method had the most minor differences. CONCLUSION: The Demirjian method showed results closest to the patient's chronological age.
Procedural safety and outcome of rigid bronchoscopy in malignant central airway obstruction.
Ho RL, Kho SS, Chai CS … +4 more , Eng S, Chan SK, Yong MC, Tie ST
Med J Malaysia · 2025 Jul · PMID 40740083
INTRODUCTION: Malignant central airway obstruction (CAO) affects 20-30% of patients with primary lung cancer and is associated with poor prognosis without treatment. Therapeutic rigid bronchoscopy (RB) is an essential di...
INTRODUCTION: Malignant central airway obstruction (CAO) affects 20-30% of patients with primary lung cancer and is associated with poor prognosis without treatment. Therapeutic rigid bronchoscopy (RB) is an essential diagnostic and therapeutic tool in this group of patients. We aimed to assess the overall procedural outcomes and safety of RB for symptomatic malignant CAO at our institution. MATERIALS AND METHODS: Retrospective chart review included 57 patients with malignant CAO who underwent RB between March 2016 and June 2022. RESULTS: Our cohort comprised 75.4% males with a median age of 60 years. Isolated right and left main bronchus involvement was observed in 50% and 41.7% of the patients, respectively, with 21.1% experiencing concurrent tracheal involvement. In our cohort, 80% had primary lung cancer, with 35.1% of these cases being squamous cell carcinoma. The re-canalization success rate was 98%, with no intraoperative or immediate postoperative mortality. More than half of the patients (54.4%) required airway stenting to maintain patency after re-canalization. Patients with tracheal involvement, non-intrinsic type of CAO, and right main bronchus involvement had a higher likelihood of requiring airway stenting. There were 24 cases with mild, self-limiting complications and 3 cases with severe procedure-related complications. The 30-day survival rate of our cohort was 91.6%. CONCLUSION: RB is a safe and effective procedure in patients with malignant CAO. Long term prospective data from multiple centers in our region are anticipated to determine long-term safety and outcomes.
Determinants of measles cases with complications in Selangor, Malaysia from year 2014 to 2023 using e-Measles registry.
Shahriman Teruna MM, Azhar ZI, Ahmad Saman MS … +1 more , Kusnin F
Med J Malaysia · 2025 Jul · PMID 40740082
INTRODUCTION: Measles is a highly contagious vaccinepreventable disease endemic to Malaysia. This study aimed to determine the determinants of measles cases with complications in Selangor, Malaysia, from 2014 to 2023. MA...
INTRODUCTION: Measles is a highly contagious vaccinepreventable disease endemic to Malaysia. This study aimed to determine the determinants of measles cases with complications in Selangor, Malaysia, from 2014 to 2023. MATERIALS AND METHODS: This was a cross-sectional study of confirmed measles cases in Selangor using the secondary surveillance database, Sistem Maklumat Siasatan Measles (SM2). The data were reviewed from April 2024 to June 2024. All registered measles cases in Selangor from 2014 to 2023 were analyzed to determine the determinants of measles cases with complications, the type of measles complications, and the characteristics of those who developed measles complications. RESULTS: Of 3074 measles cases, 479 (15.6%) developed measles complications, of which diarrhea was the most common complication (87.6%), followed by pneumonia (11.6%), otitis media (0.6%), and subsclerosing panencephalitis (0.2%). The majority of those who developed measles complications were aged less than one year old (42.1%) and 1-6 years (31.4%). The significant determinants of measles cases with complications were non-Malaysian nationality (aOR: 2.1, 95% CI: 1.44, 3.05), cases from urban areas (aOR: 1.8, 95% CI: 1.22, 2.76), cases that fulfilled the measles clinical case definition (aOR: 2.1, 95% CI: 1.59, 2.76), cases with a history of contact with other measles cases (aOR: 4.4, 95% CI: 3.43, 5.67), cases from the measles outbreak (aOR: 1.5, 95% CI: 1.10, 2.19), and cases that were hospitalized (aOR: 5.6, 95% CI: 4.49, 7.07). CONCLUSION: Strengthening immunization coverage, particularly among high-risk groups, such as non- Malaysians and young children, is essential. Enhanced surveillance, targeted health education, and improved outbreak response strategies are crucial to reduce measles complications in the community. Further research is needed to explore additional factors contributing to measles complications and to assess the effectiveness of intervention measures.
Human T-lymphotropic virus-1 proviral load among patients on maintenance hemodialysis.
Al-Jubouri ZS, Abdullah SF
Med J Malaysia · 2025 Jul · PMID 40740081
INTRODUCTION: Human T-lymphotropic virus type 1(HTLV-1) is a complicated leukemogenic retrovirus, it is the first oncogenic virus discovered and identified as the leading cause of T-cell malignancy and HTLV related myelo...
INTRODUCTION: Human T-lymphotropic virus type 1(HTLV-1) is a complicated leukemogenic retrovirus, it is the first oncogenic virus discovered and identified as the leading cause of T-cell malignancy and HTLV related myelopathy with a long latency period. Transmission via infected blood products is one of the common routes of HTLV-1 infection, and hemodialysis patients are potentially more vulnerable to blood-borne viral infections such as HTLV. This study aimed to determine the factors associated with HTLV-1 proviral load among hemodialysis patients. MATERIALS AND METHODS: A cross-sectional study of 130 patients undergoing hemodialysis was conducted between November 2023 and January 2024. After HTLV-1 RNA extraction, complementary DNA (cDNA) was synthesized. HTLV-1 pro-viral load (PVL) was quantified by real-time PCR (qRT-PCR). RESULTS: HTLV-proviral load was detected in 57 (43.84%) blood samples, with a mean ± standard deviation (SD) of 16.3×103 ± 5.4×104(copies/μL), including 34 (26.2%) males and 23 (17.7%) females. The highest percentage of infection (22.3%) was detected in the 40-59 age group and married patients (39.2%); however, a high viral load was observed in the 20-39 age group. Frequent blood transfusions associated with HTLV-1 infection were observed in 42 patients (32.3%). Myelopathy-related muscle spasms and paresthesia were significantly associated with the HTLV-1 viral load (p<0.05). A statistically significant relationship was observed between asymptomatic patients and high HTLV-1 proviral load (p=0.004). CONCLUSION: These findings show that a significant number of dialysis patients were infected with HTLV-1. Therefore, hemodialysis patients should be frequently screened for HTLV-1 infections.
Limitation of cane sugar solution as a tissue fixative for glycogen preservation in mouse liver.
Babar IM, Oo PS, Cheoh JS … +4 more , Aye LM, Kyaw MT, Aye SN, Krishnappa P
Med J Malaysia · 2025 Jul · PMID 40740080
INTRODUCTION: Sugar-based natural fixatives have been proposed as substitutes for formalin in histopathological practice because of their promising results in preserving tissue structures. However, they have not yet been...
INTRODUCTION: Sugar-based natural fixatives have been proposed as substitutes for formalin in histopathological practice because of their promising results in preserving tissue structures. However, they have not yet been applied. This study aimed to determine the optimal concentration of cane sugar solution (CSS) for tissue fixation, histochemical staining, and glycogen storage in mouse liver tissues. MATERIALS AND METHODS: A total of 24 mouse liver tissues from six mice were divided into four groups and fixed with 10% neutral buffered formalin (NBF), 30%, 50% and 70% CSS, respectively, for 24 h at room temperature. After tissue processing and sectioning, the samples were stained with hematoxylin and eosin (H&E), methyl green pyronin Y (MGPY) and peroxidase acid-Schiff (PAS). The tissue sections were evaluated under a light microscope by two blinded pathologists. Data were analyzed using one-way analysis of variance (ANOVA) and a post-hoc test to assess the differences among the experimental groups. RESULTS: The gross morphology of all the samples showed minimal shrinkage without color changes. Microscopic examination revealed that the 50% and 70% CSS groups showed comparable efficacy in cytoplasmic and nuclear staining, H&E staining intensity, deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) staining, and collagen staining with the 10% NBF group. The 30 percent CSS group showed significantly poorer nuclear and DNA staining than the 10% NBF group. All CSS groups failed to preserve glycogen in mouse liver tissues (p < 0.001) compared with the 10% NBF. CONCLUSIONS: Our study concluded that 50% and 70% CSS are potentially replaceable, eco-friendly fixatives for 10% NBF in small tissue samples for tissue fixation and histochemical staining. However, 10% NBF was still superior to CSS for glycogen preservation in mouse liver tissue.
Learning from the plain film competency assessment in the Singapore radiology residency programme.
H'ng MWC, Wong JGX, Sia DSY … +2 more , Lim WEH, Wong DES
Med J Malaysia · 2025 Jul · PMID 40740079
INTRODUCTION: The national Plain Film Competency Assessment (PFCA) was held to allow passing Residents to report plain radiographs independently and thus perform on-call night duties. Our study aimed to investigate facto...
INTRODUCTION: The national Plain Film Competency Assessment (PFCA) was held to allow passing Residents to report plain radiographs independently and thus perform on-call night duties. Our study aimed to investigate factors influencing performance in this exam. METHODS: This was a retrospective study of data from 2012- 20. Training data included previous experience in radiology as well as number of reported films (total and by body regions) whilst examination data comprised these scores as well as error analysis (classified as False Positives, False Negatives or Incorrect Abnormality) for the main and repeat sittings. RESULTS: Up to 222 residents were included for statistical analysis. Those with previous radiology exposure were more likely to pass, 85.1% compared to 68.9% (χ=0.03) and had higher scores, 85.1 versus 81.3 (p<0.01). The number of co-reported films did not affect passing even after excluding those with previous experience. Chest and limb radiographs made up at least three-quarters of the reported films, with residents passing these whilst failing those from the abdominal, skull and spine regions. There was no significant difference between their improved scores after undergoing remediation of either one or four months in duration. However, error analysis after remediation revealed a lower combined percentage of False Positives and Negatives. CONCLUSIONS: Experience in a radiology posting after graduation facilitated passing. Although we could not establish an association between the number of reported films and passing, there was an imbalance in the variety of reported films, which should first be resolved.
A single centre study on prevalence of anemia in children and adolescents with atopic dermatitis and its associated factors.
Ravindran N, Krishnasamy S, Jamil A … +1 more , Preamala G
Med J Malaysia · 2025 Jul · PMID 40740078
INTRODUCTION: Chronic inflammation, food avoidance, and the use of systemic immunosuppressants are associated with anemia in patients with atopic dermatitis (AD). This study aimed to determine the prevalence of anemia am...
INTRODUCTION: Chronic inflammation, food avoidance, and the use of systemic immunosuppressants are associated with anemia in patients with atopic dermatitis (AD). This study aimed to determine the prevalence of anemia among children and adolescents with AD, the type of anemia, and its predisposing factors. MATERIALS AND METHODS: This is a cross-sectional study. Patients aged ≤18 years with AD were included in the study. The exclusion criteria were malignancy, chronic organ failure, and haematological diseases. Dietary patterns and nutrient intake were determined using a 3-day dietary recall. AD severity was assessed using a scoring tool known as Scoring Atopic Dermatitis (SCORAD). Peripheral blood counts, iron studies, and serum B12 and folate levels were determined. RESULTS: A total of 77 patients were recruited for this study. The mean age was 8.58±5.26 years with 43(55.8%) boys and 34(44.2%) girls. Most (58.4%) were from economic bottomtier households with incomes below RM4850. Food avoidance was common (55.8%), primarily for shellfish (37.7%), nuts (33.8%), and eggs (22.1%). The prevalence of anemia was 58.4%, and 71.1% was due to iron deficiency. Younger age, male sex, underweight, and lower intakes of iron, protein, and fat were significantly associated with anemia. There was no association between the severity with anemia. CONCLUSION: The high prevalence of iron deficiency anemia in patients with AD was likely due to the lower intake of food restrictions compounded with chronic inflammation in AD.
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