Medical Journal of Malaysia最新文献

Development of Prostate Specific Membrane Antigen (PSMA)-targeted radiopharmaceuticals for theranostics has changed the treatment landscape for patients with metastatic castration-resistant prostate cancer (mCRPC). The emerging use of [²²⁵Ac]Ac-PSMA-RLT has been effective and safe for the treatment of mCRPC. Nevertheless, challenges with the nuclear recoil of [²²⁵Ac]Actinium radionuclides, which may release the daughter radionuclide from the radiopharmaceutical and lead to unnecessary irradiation of other organs, poses threats such as organ dysfunction. Therefore, this short communication aims to highlight the current situation in Malaysia and explain the solutions by using a risk-based approach analysis for the inhouse preparation.

Introduction: Community acquired bloodstream infection (CA-BSI) is positive blood culture obtained within 48 hours of hospital admission. Bloodstream infections need to be treated with antibiotics. Inappropriate choice of antibiotics will lead to antimicrobial resistance. This is an observational retrospective study to look at the antimicrobial resistance of organisms causing bloodstream infections in patients admitted to the medical wards in our centre. The aim of the study is to determine the appropriate choice of empirical antibiotics for suspected CA-BSI in our hospital.

Materials and methods: All patients admitted to medical wards with blood stream infection during the period January 2021 to June 2021 were enrolled. Identification of organisms and antimicrobial susceptibility testing were obtained. Information regarding the severity of the bacteremia was collected by assessing if the patient needed inotropes, mechanical ventilation or renal replacement therapy. Data on comorbidities which were the presence of end-stage renal failure, diabetic mellitus and immunosuppression were collected.

Results: Total of 269 cases were screened. Out of these 104 communities acquired cases were included. The pathogens frequently isolated were gram negative organisms most commonly Escherichia coli (43%) and Klebsiella species (30%). Staphylococcus aureus accounts for the majority of gram-positive organisms. Only two out of 20 Staphylococcus aureus were methicillin resistant. Bulkholderia pseudomallei accounts for 7.8% cases. All Burkholderia pseudomallei isolates were sensitive to cotrimoxazole. Escherichia coli (46%) isolates demonstrated a higher resistance pattern to Augmentin compared to klebsiella species (17.4%). The overall mortality rate was 22%, with higher rates for those critically ill (39%). Patients with Enterobacteriaceae infection showed no difference in outcome between the groups of patients according to sensitivity to Augmentin and cefotaxime. These groups of patients who were critically ill did not demonstrate any significant difference in terms of resistance pattern to Augmentin (p = 0.3) and cefotaxime (p = 0.7). Patients who are aged 65 or older have a significantly more resistant pattern to Augmentin and cefotaxime.

Conclusion: Antibiogram serves as a guide for clinicians to choose appropriate choices of antibiotics based on local data. Empirical antibiotics of choice for patients with sepsis should be narrow-spectrum beta lactam/beta lactamase inhibitors. Broad spectrum beta lactam/beta lactamase inhibitors such as piperacillin tazobactam should be reserved for patients who are critically ill and elderly patients over 65 years. The antibiotics should be deescalated once the organisms and sensitivity of the antibiotics are known.

Introduction: Tuberculosis (TB) is a serious global health problem in Indonesia, which is the country with the secondhighest TB burden after India. Accuracy in TB diagnosis is the key to effective treatment and decreased transmission rate. One of the latest diagnostic methods is interferon gamma release assay (IGRA), which measures the interferon-γ release associated with Mycobacterium tuberculosis (MTB) infection. This study aims to determine the diagnostic value of IGRA-TB using IchromaTM IGRA-TB diagnostic kit (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]), compared to Ziehl-Neelsen (AFB) staining, nucleic acid amplificationbased test (Xpert-MTB) and chest-X Ray as the gold standard in TB diagnosis.

Materials and methods: A cross-sectional observational study design was used. Patients were recruited through purposive sampling from pulmonology outpatient clinic and inpatient ward at Jemursari Islamic Hospital (RSI Jemursari), Surabaya from July 2023 to December 2023. All enrolled patients should have been previously tested positive or negative for pulmonary TB using AFB staining, Xpert MTB and chest x-ray. Blood samples of the patients were collected and processed using the IchromaTM IGRA-TB diagnostic kit. The results were then compared with gold standard methods for calculating the IGRA-TB diagnostic value.

Results: A total of 56 adult patients were enrolled in this study. The sensitivity, specificity, PPV, NPV and accuracy rate of IGRA-TB using IchromaTM IGRA-TB diagnostic kit were 80.56%, 85%, 90.62%, 70.83% and 82.14%, respectively.

Conclusion: IchromaTM IGRA-TB showed reasonably high diagnostic sensitivity and specificity, indicating that this method can be further utilised as a diagnostic and screening tool for pulmonary TB.

Introduction: Countries around the world organised mass vaccinations using various types of vaccines against COVID-19, like inactivated viruses and mRNA. The study aimed to look at adverse events following immunisation (AEFI) of Coronavac® (SIN) and ChAdOx1 nCOV-19 ® (AZ) COVID-19 vaccines in Indonesia.

Materials and methods: Subjects who received SIN or AZ vaccines were sent questionnaires twice: after they received the first and the second doses of vaccine, respectively. AEFI data on the first- and second-day post-vaccination were collected and analyzed descriptively.

Results: A total of 1547 people vaccinated with SIN vaccine, 529 (33.3%) responded to the first-dose and 239 (47%) to the second-dose questionnaires, whereas 936 people vaccinated with AZ vaccine, 483 (51.6%) answered the firstdose and 123 (25%) to the second-dose questionnaires. Some important AEFIs on the first- and second-day post receiving SIN vs. AZ vaccination were as follows: fever 4% vs 59%; pain at the injection site 27% vs 87%; redness and swelling at the injection site 4% vs 18%; nausea 5% vs 30%; diarrhea 1.8% vs 5.7%, respectively.

Conclusion: SIN seemed to have fewer AEFIs than AZ. Apart from different vaccine materials and excipients, the gap in AEFIs between SIN and AZ could be caused by the distinct population where AZ recipients were more exposed to COVID-19.

Introduction: Halal pharmaceuticals are paramount in healthcare settings catering to Muslim patients. The COVID- 19 pandemic ignited discussions on the Halal status of pharmaceuticals, especially vaccines. This study aims to explore the understanding and views of hospital outpatients regarding Halal pharmaceuticals.

Materials and methods: A qualitative study by in-depth interviews was undertaken among adult Muslim outpatients. Utilising a semi-structured interview guide in Malay, content reliability of the guide was ensured through expert reviews. Potential participants were approached in the outpatient pharmacy waiting area. All interviews were audio recorded and transcribed verbatim. These Malay transcripts were translated into English and subjected to thematic content analysis.

Results: Data saturation was achieved through interviewing ten outpatients. The findings indicated that patients were vigilant in checking labels to confirm the correctness of their medications. Yet, the terms 'Halal pharmaceuticals' and 'Shariah-compliant hospital' were unfamiliar to all and did not evoke curiosity. The respondents expressed trust in the government's commitment to dispense safe and Halalcertified drugs. The majority of the participants did not consider Halal status as a primary factor when selecting medications. Nevertheless given a choice, many voiced a preference for Halal-certified drugs, irrespective of their cost or efficacy. For life-threatening situations, participants were willing to accept non-Halal treatments.

Conclusion: Despite non-familiarity, the general sentiment towards Halal pharmaceuticals remain positive. This study underscores the need for enhanced education and awareness regarding Halal pharmaceuticals for better align healthcare practices with the cultural and religious values of Muslim patients.

Introduction: With the current trend of increasing noncommunicable diseases (NCD), like hypertension, diabetes and dyslipidaemia worldwide and in Malaysia, a comprehensive study is essential to find the local population's knowledge, attitude and practice towards NCD. Little is known about the indigenous people of Orang Asli's health conditions and health-seeking behaviours towards these chronic diseases. The study aimed to assess knowledge, attitudes and practices (KAP) status towards non-communicable disease and its association with demographic background among Orang Asli adults of the Semelai subgroup in central Pahang, Malaysia.

Materials and methods: A cross-sectional study was conducted among 251 adult Semelai people in Bera district, Pahang. Data was collected through face-to-face interviews to obtain socio-demographic data, KAP towards NCD. Bivariate analysis was performed to test the association between the socio-demographic factor and the KAP score.

Results: Among respondents, 57.4% were female, 82.5% were married, and 46.2% completed primary school. The majority were animism believers (83.3%), self-employed (75.3%) and earning less than RM1000 (87.6%). The respondents' ages ranged from 18 to 77, with a mean age of 41.1 (S.D ± 13.9). The prevalence of known type-2 diabetes mellitus (T2DM), hypertension, and dyslipidaemia was 9.6%, 20.7%, and 8.8%, respectively. About 23.1% of respondents have a family history of chronic disease. Regarding KAP parameters, only 12.7% have good knowledge, and 35.5% have good practice in prevention and treatment. However, more than half (59.8%) have a positive attitude towards chronic diseases. This study also showed that higher household income and education levels were positively associated with higher scores of KAP (p < 0.001).

Conclusion: This study presented a low-to-moderate percentage of Orang Asli who have good KAP towards NCD. KAP levels were significantly associated with education levels and household income. Hence, improving education and poverty in the Orang Asli community may successively increase the knowledge level, impart a positive attitude towards NCDs, and improve the practice level toward treatment and prevention.

Introduction: Little is known about the prevalence of refractive errors and amblyopia among school children on the islands of East Coast Malaysia. This study aimed to investigate the prevalence of these conditions and their associated factors in this unique and remote geographical location.

Materials and methods: This multicentre cross-sectional school-based study included 480 children aged 7 to 12 year from primary schools on the islands of the East Coast of Malaysia. All children underwent visual acuity assessment, orthoptic evaluation, anterior and posterior segment examinations and manifest refraction. Demographic data, history of parental refractive error, parental education level, duration of digital screen time and time spent outdoors were documented in a questionnaire distributed to the parents.

Results: The mean age was 9.53 ± 1.69 years, with an equal distribution of genders. The ethnic composition of the subjects was 99.4% Malay and 0.6% Orang Asli. The overall prevalence of refractive errors was 11.9% (95% CI: 9.1 to 15.1%), with myopia at 7.1% (95% CI: 5.0 to 9.8%), hyperopia at 2.5% (95% CI: 1.3 to 4.3%), astigmatism at 2.3% (95% CI: 1.1 to 4.1%) and amblyopia at 2.5% (95% CI: 1.3 to 4.3%). Older age, an absence of parental history of refractive error and reduced daily outdoor time were significantly associated with refractive errors (p < 0.05).

Conclusion: The prevalence of refractive error is 11.9% and amblyopia is 2.5% among primary school children on the islands of the East Coast of Peninsular Malaysia. Older age, an absence of parental history of refractive error and reduced daily outdoor time are associated with refractive error.