Medical Journal of Malaysia最新文献

Transcranial direct current stimulation (tDCS) has emerged as a potential adjunct therapy for post-stroke motor rehabilitation. While conventional rehabilitation methods remain the primary approach to improving motor function after stroke, many patients experience incomplete recovery, necessitating the exploration of additional interventions. This commentary article examines the role of tDCS in poststroke motor recovery, focusing on its mechanisms, efficacy, and limitations. Herein, the variability in research findings and individual patient responses as well as the recommended methods for optimising tDCS use in local clinical settings are highlighted.

Introduction: Herpes Simplex Keratitis (HSK) is a leading cause of infectious corneal blindness globally. However, clinical data and visual outcomes specific to the Malaysian population are limited. This study aimed to identify common clinical features, visual outcome and its associated factors in patients treated at a Malaysian tertiary hospital.

Materials and methods: A retrospective cohort study was conducted at Hospital Pakar Universiti Sains Malaysia (HPUSM) between June 2013 and June 2024. Medical records of patients diagnosed with HSK and followed for at least six months were reviewed. Sixty-seven patients were included. Data collected included demographics, presenting symptoms, best-corrected visual acuity (BCVA) at presentation and after treatment, ocular findings, subtype of HSK and complications. Statistical analyses were performed using SPSS version 28.0. Paired t-tests was used to analyse changes in BCVA and multiple linear regression was performed to identify factors associated with final visual outcome.

Results: The mean age at presentation was 50.42±17.19 years with a slight male predominance (52.2%). Most cases were unilateral (91.1%). Common presenting symptoms were reduced vision (89.6%) and eye redness (85.1%). Keratouveitis was the most frequent subtype (37.3%). Complications included corneal scarring (73.1%), recurrence (49.3%) and glaucoma (11.9%). BCVA significantly improved post-treatment (p<0.001). Older age, central corneal involvement, elevated intraocular pressure at presentation, and stromal vascularisation were significantly associated with poorer visual outcomes.

Conclusion: This study outlines the clinical spectrum and visual outcomes of HSK at a tertiary hospital in Malaysia and identifying several predictive factors for poor vision. These findings may aid clinicians in risk stratification and optimising management strategies.

Introduction: Epidemiological data regarding major trauma in Malaysia is limited due to the unavailability of a sustainable trauma registry (TR). Recognising its importance, a national TR known as the Malaysian Trauma Registry (MTR) was established in 2020. This study aims to investigate the epidemiology of major trauma in Malaysia utilising data from the MTR.

Materials and methods: A retrospective analysis of the MTR data from 1st January 2021 to 30th April 2024 was conducted. This study focused on major trauma patients who presented at the participating hospitals or were transferred from other healthcare facilities and met the MTR enrolment criteria. A total of 2774 patients were included in the analysis.

Results: The most frequently affected group by major trauma was young males aged 15-44. Road traffic accidents (RTAs) were the leading cause of injury, followed by falls. More than half of the patients arrived at the hospital via ambulance, with a median time of 45 minutes from the emergency call to hospital arrival. In the emergency department (ED), nearly 80% of the patients were treated in a shared resuscitation bay, and the trauma team was activated for only one-third of cases. The most common type of Computed Tomography (CT) performed was CT brain. The median time from arrival to first CT was 95 minutes. Approximately 19.5% of patients were directly sent from the ED to the operating theatre for emergency surgery, while 19.6% required admission to the intensive care unit. The head and neck were the most frequently injured body regions (31.7%), with the head and thorax having the highest severity according to the Abbreviated Injury Scale. The median Injury Severity Score was 13 (IQR 7-19), and the median length of hospital stay was 4.4 days (IQR 1.9-10.6 days). The in-hospital mortality rate was 10.9%, with the highest rates observed among young males aged 15-44 and those involved in RTAs.

Conclusion: This study has highlighted the burden of major trauma and provided insight into the current quality of trauma care in Malaysia. The information gathered will be used to understand the standard of the existing trauma system and assist in designing trauma care enhancement plans.

Introduction: Diabetic retinopathy, a major microvascular complication of type 2 diabetes mellitus, remains a leading cause of preventable blindness worldwide. Early identification of individuals at high risk is essential, yet conventional screening systems are limited by workforce shortages and delayed detection. Artificial intelligence, particularly machine learning, offers substantial potential to support prognostic scoring tools capable of predicting the development of diabetic retinopathy. This review summarises current evidence on AI-driven prognostic models for diabetic retinopathy among adults with type 2 diabetes mellitus.

Materials and methods: A comprehensive PubMed search using Medical Subject Headings and free-text terms related to "Diabetic Retinopathy," "Type 2 Diabetes Mellitus," "Artificial Intelligence," "Machine Learning," and "Prognostic Model" was conducted. Original studies involving adults with T2DM that developed or evaluated AIor ML-based prognostic or risk-scoring tools for DR were included. Extracted data included study design, sample size, artificial intelligence methods, predictors, and model performance, and were synthesised narratively.

Results: From 759 records, five studies met the inclusion criteria. Extreme Gradient Boosting consistently demonstrated the highest predictive performance, with area under the curve values between 0.803 and 0.966. Support Vector Machine also performed well in smaller cohorts. Key predictors across studies included HbA1c, duration of diabetes, renal function markers, blood pressure, lipid profile, and body mass index.

Conclusion: AI-driven prognostic tools show strong potential to enhance early diabetic retinopathy risk prediction. However, broader external validation and population-specific calibration are needed before routine clinical adoption.

Introduction: Cross-border migration presents increasing challenges to healthcare systems globally. Ensuring equitable healthcare access for immigrant populations, particularly in Southeast Asia, requires a thorough understanding of the barriers to effective service delivery. This scoping review aimed to synthesize the existing literature on the challenges related to the delivery of healthcare services to immigrant communities from Southeast Asia. While previous studies (e.g., Brandenberger et al., 2019) applied the 3C framework to migrants and refugees globally, this review generates new insights by focusing specifically on Southeast Asia, a region underrepresented in the literature. By applying the 3C model in this context, our review identifies region-specific challenges, such as immigration policies, financial barriers, and COVID-19 impacts, that extend beyond the findings of earlier global reviews.

Materials and methods: A comprehensive search was conducted in ProQuest, PubMed, ScienceDirect, and Scopus databases on October 13, 2024, for studies published between January 1, 2011, and October 13, 2024. The search strategy used tailored keywords, including "challenges," "healthcare services," "immigrants," and "Asia." Inclusion criteria focused on peer-reviewed, English-language articles reporting on challenges in healthcare service delivery among immigrant populations in Southeast Asia. Data extraction and synthesis were guided by the 3C model: communication, continuation of care, and confidence in the healthcare system.

Results: The search identified 656 records, of which 7 studies met the inclusion criteria after a multi-stage screening process. Key challenges identified across the included studies were: Communication barriers, including language differences, cultural misunderstandings, and limited health literacy; Issues with continuation of care, such as poor health literacy, difficulties navigating healthcare systems, barriers to accessing services (e.g., due to legal status or financial constraints), and lack of coordination between healthcare and social services; and Lack of confidence in the healthcare system, stemming from distrust, lack of understanding, and negative experiences, including perceived discrimination.

Conclusion: This review highlights the complex challenges in delivering healthcare services to immigrants from Southeast Asia. These challenges, encompassing communication, continuation of care, and confidence, necessitate targeted and multifaceted interventions. Addressing these issues through culturally competent care, enhanced communication strategies, and policy reforms that promote equitable access is crucial for improving the health and well-being of immigrant populations and fostering more inclusive healthcare systems within the region.

Introduction: Children with febrile seizures often experience favourable long-term outcomes. However, the outcomes of COVID-19 febrile seizures remain uncertain. The study investigated the developmental and emotional/behavioural outcomes of children with and without COVID-19, presenting with febrile seizures.

Materials and methods: Participants were families of children with febrile seizures admitted from January to April 2022, during the peak of COVID-19 Omicron variant infection cases. The children were assessed 9-18 months after the seizure event, using the Schedule of Growing Skills II developmental screening tool and their parents completed the Strengths and Difficulties Questionnaire, a measure of emotional/behavioural outcome. A child with positive COVID-19 is characterised by the presence of respiratory symptoms and a positive COVID-19 rapid antigen test. We compared the outcomes of children with and without COVID- 19 using Fisher's exact test and Mann-Whitney U test.

Results: Twenty-two families, with 15 (68.2%) COVID-19 and 7 (31.8%) non-COVID-19 febrile seizures participated in the study. A substantial proportion of children from both groups were delayed in various developmental domains (13.6- 27.3%), with 9 (40.9%) delayed in 2 or more domains and 2 (9.1%) experienced emotional behavioural difficulties. Children with COVID-19 febrile seizures were not more likely to have developmental delay and emotional/behavioural difficulties.

Conclusions: Children with COVID-19 febrile seizures were not at greater risk of developmental delay or emotional/behavioural difficulties. Further longitudinal studies with a larger sample size are warranted.

Introduction: Digital eye strain (DES), also known as computer vision syndrome, has become a growing public health issue among students due to prolonged screen exposure. Reliable, locally validated screening tools are essential to estimate prevalence and guide prevention. This study aimed to establish a receiver operating characteristic (ROC)-based cut-off for the Digital Eye Strain and Risk Level Questionnaire (DESRIL-27) against the Computer Vision Syndrome Questionnaire (CVS-Q) as the reference standard, and to estimate the prevalence of DES among university library users.

Materials and methods: A cross-sectional study was conducted between June and September 2024 among users of Universiti Malaysia Sabah libraries. Participants completed the DESRIL-27 and CVS-Q via Microsoft Forms. Data were exported to Excel, cleaned, and analysed in RStudio (version 2025.05.1). Reliability was assessed using Cronbach's alpha. ROC analysis determined the optimal DESRIL-27 cut-off, and diagnostic performance was quantified using sensitivity, specificity, predictive values, and likelihood ratios. Prevalence was estimated based on the optimal threshold with 95% confidence intervals (CI). Ethical approval was obtained from the Medical Research Ethics Committee, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah (JKEtika 3/24 (8)).

Results: A total of 277 participants were included (mean age 24.2 years, 67% female). Internal consistency was excellent (α=0.964 for symptoms; α=0.921 for risk factors). ROC analysis yielded an area under the curve of 0.982 (95% CI: 0.970, 0.994). The optimal cut-off was ≥14.5, demonstrating sensitivity of 90.9% and specificity of 96.7%, with a positive predictive value of 98.3% and a negative predictive value of 83.8%. The likelihood ratios were LR+ =27.6 and LR- =0.09. At this threshold, the prevalence of DES was 62.1% (95% CI: 56.1, 67.8).

Conclusions: The DESRIL-27 demonstrated excellent reliability and diagnostic performance, with an empirically derived cut-off of ≥14.5. These findings support its use as a screening tool for digital eye strain in university settings.

Introduction: Apoptosis is an important pathway for regulating cell proliferation and the occurrence of cancers such as lung cancer. The release of Caspase-9 and activation of Caspase-3 influence the process of apoptosis in lung cancer cells, making these proteins markers of apoptosis in lung cancer cells. Multi-strain probiotics show increased benefits due to the combined effects of different strains. The probiotic metabolites, such as short-chain fatty acids (SCFA), become important metabolites in lung immunity. This study aimed to examine the effectiveness of multi-strain probiotics in increasing apoptosis through increasing Caspase-3 and Caspase-9 expression in A549 cultures.

Material and methods: The study was conducted in vitro using a cytotoxic assay to determine the IC50 value of multistrain probiotics, followed by an In Cell Western assay to assess Caspase-3 and Caspase-9 expression.

Results: The cytotoxic assay IC₅₀ result of the multi-strain probiotic was 58.952 ppm. Based on the result of the cytotoxic assay, the multi-strain probiotic in this study is not toxic to A549 lung cancer cells. In the Cell Western assay results, the multi-strain probiotic at concentrations of 2xIC₅₀ and 0.5xIC₅₀ showed the highest Caspase-3 and Caspase-9 expression, respectively, compared to the control group.

Conclusion: Multi-strain probiotics can stimulate the expression of Caspase-3 and Caspase-9 proteins in A549 lung cancer.

Introduction: As domestic violence (DV) poses a critical threat to public health worldwide, this prompts the need for efficient and effective intervention. In Malaysia, although One Stop Crisis Centres (OSCCs) have been offering multisectoral services to DV victims for many decades, an evaluation of the efficiency of these centres has yet to be conducted. This study aimed to assess the efficiency and effectiveness of three Malaysian OSCCs using a two-stage Data Envelopment Analysis (DEA) approach.

Materials and methods: A total of 153 adult DV victims were recruited from OSCCs in Sarawak General Hospital, Universiti Malaya Medical Centre, and Hospital Universiti Sains Malaysia. The inputs included the number of doctors, nurses, and other personnel whereas the outputs were total response time and service quality, measured via a validated 35-item OSCC-Qual instrument. Stage 1 employed an inputoriented Banker, Charnes, and Cooper (BCC) DEA model to determine how efficiently OSCCs managed resources to minimize response times. Stage 2 used an output-oriented BCC model to evaluate the centre's ability to maximize service quality.

Results: The social workers unit recorded notably long mean response times across three centres. Correlation analysis revealed a strong negative association between the number of personnel and the multisectoral coordination dimension of service quality. While most units showed high pure technical efficiency in the input-oriented DEA, scale inefficiencies were shown to be common in all centres. Pure technical efficiency measures how well resources are utilized regardless of scale, whereas scale efficiency assesses whether an organization operates at its optimal size (neither too large nor too small). In the output-oriented model, all centres similarly demonstrated good pure technical efficiency but continued to grapple with scale inefficiencies, especially at Sarawak General Hospital and Hospital Universiti Sains Malaysia.

Conclusion: These findings highlight the importance of optimizing operational scale in OSCCs. Tailoring resource allocation and strengthening coordination among multidisciplinary teams could reduce response times and improve care for DV victims.

Introduction: Honey is one of the natural ingredients that have long been used in the community to cure certain diseases and to maintain health. Several studies have shown that honey contains many active ingredients that have pharmacological effects, including immunomodulatory effects. The active compound of honey varies depending on the bee that produces honey and also the food source of the bees. Wanagama honey is honey produced in the forest in Gunung Kidul, Yogyakarta, Indonesia. Despite the use of Wanagama honey to improve immune system, there is no study regarding its immunomodulatory effect. This study aimed to study the immunomodulatory effects of Wanagama forest honey.

Materials and methods: Twenty Balb c mice divided into 4 different groups received different treatment which were water (CONTROL), honey 10 mg/kg BW (DOSE 1), honey 25 mg/kg BW (DOSE 2), and honey 50 mg/kg BW (DOSE 3). The immunomodulatory effect evaluation was using the carbon clearance assay. Complete blood count and delta body weight were also measured.

Results: Mice in DOSE 3 group showed lowest delta body weight. the complete blood count parameters were not different significantly between groups of treatment. however, the phagocytic index was higher significantly in the groups receiving honey compare to those without honey treatment.

Conclusion: This study showed the potential of Wanagama honey as immunomodulator.