Medical Journal of Malaysia最新文献

Introduction: Acute Appendicitis is typically felt in the right lower abdomen. Despite existing diagnostic methods to differentiate between complicated and non-complicated cases, achieving accurate diagnoses remains challenging. This study highlights the need for a reliable diagnostic tool to improve patient outcomes and inform surgical strategies, demonstrating the accuracy of the Banjarmasin Prediction Score for Appendicitis (BPSA).

Materials and methods: This observational cross-sectional study involved patients diagnosed with acute Appendicitis at Ulin, Sultan Suriansyah, and Damanhuri Hospital in Banjarmasin, Indonesia. Data were collected through consecutive sampling and analysed using SPSS to ensure robust findings. The collected data were then compared between complicated and non-complicated appendicitis cases to evaluate the diagnostic accuracy of the BPSA and Alvarado scores.

Results: Among the 62 cases evaluated, 28 were classified as non-complicated and 34 as complicated Appendicitis. The BPSA showed a sensitivity of 71.4% and a specificity of 70.6%. The Alvarado score demonstrated lower sensitivity but a higher specificity of 79.4%. There was no significant difference in the Alvarado score (P > 0.05), while the BPSA score revealed a significant difference (P < 0.05) between complicated and non-complicated Appendicitis. Variations in histamine levels were also noted (P = 0.002), further underscoring the efficacy of the BPSA scoring system.

Conclusion: The Alvarado score is key for diagnosing acute Appendicitis, and the BPSA score helps differentiate between complicated and non-complicated cases, enhancing treatment strategies. The study's limitation was confined to a single region and a relatively small sample size, which may affect the generalisability of the findings.

Introduction: Psoriasis is a chronic immune mediated inflammatory disease often involving nails, presenting significant physical and psychological impacts. Onychomycosis, frequently coexists with psoriatic nail manifestations, complicating diagnosis and treatment. This study aims to evaluate the prevalence, etiology, and risk factors for onychomycosis among psoriasis patients in a tertiary public hospital in Malaysia.

Materials and methods: A prospective cross-sectional study was conducted involving 191 psoriasis patients from October 2023 to August 2024. Nail involvement was assessed using the Nail Psoriasis Severity Index (NAPSI), and fungal diagnostics included potassium hydroxide microscopy, fungal cultures, and polymerase chain reaction. Associations between clinical variables and onychomycosis were analyzed.

Results: The prevalence of onychomycosis was 13.6%, with dermatophytes being the most common etiological agent (69%), followed by moulds (23%) and yeasts (8%). Higher NAPSI scores were significantly associated with increased odds of onychomycosis (Adj. OR: 1.02, p=0.001). Smoking also emerged as a potential risk factor (p=0.054). Other variables, including diabetes, treatment for psoriasis and BMI, were not significantly associated with onychomycosis in this study.

Conclusion: Onychomycosis is prevalent among psoriasis patients, particularly those with severe nail involvement. Dermatophytes remain the primary pathogens, although moulds account for a notable proportion in this tropical setting. These findings underscore the importance of incorporating fungal diagnostics in psoriasis management to optimize outcomes and break the cycle of worsening disease.

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.

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.

Introduction: Postoperative spondylodiscitis (POSD) is not uncommon. The incidence of POSD varies between 0.21- 3.6% In this study, it was aimed to examine the clinical findings, diagnosis and treatment of postoperative spondylodiscitis (POSD).

Materials and methods: Between September 2017 and October 2022, 37 patients were included in the study, who applied to the Infectious Diseases and Clinical Microbiology Clinic of the XXX Hospital and had POSD infection and were followed-up/treated as outpatients or inpatients. The following were examined: symptoms, physical examination findings, contrast-enhanced spinal MRI (magnetic resonance imaging) findings of the patients, laboratory findings, PPD (purified protein derivative) and QuantiFERON TB-Gold test and blood cultures. The antibiotics that were started and the clinical and radiological response of the patients to the treatment were evaluated.

Results: Of the patients 25 (67.6%) were female and 12 (32.3%) were male. The mean time to develop POSD after surgery was 44.8 months. In our study, we found that laboratory tests were not significant in diagnosing POSD other than C-reactive protein(CRP). Teicoplanin and ciprofloxacin were given to all patients except one patient with positive brucella slide and tube agglutination. With this treatment, clinical and radiological improvement was observed in 24 patients. The treatment of 13 patients, including the patient who was given Brucella treatment, was changed due to the lack of clinical and radiological improvement, and anti-tuberculosis treatment was started and recovery was achieved. The mean duration of the treatment was 3.5 months in the pyogenic POSD group and 9.5 months in the POSD patient group that recovered with anti-tuberculosis therapy.

Conclusion: It Should be kept in mind that in cases where the POSD patients do not benefit from empirical treatment, the causative agent may be an agent other than the common microorganisms, for example M. tuberculosis, and if the agent cannot be detected, finding the diagnosis from treatment is also an option.

Introduction: The Patient Blood Management (PBM) program provides optimal stewardship of limited blood resources using evidence-based practice. PBM applies evidencebased strategies for reducing costs and improving patient outcomes while conserving scarce blood bank resources. However, implementing a PBM program requires multidisciplinary collaboration, organizational support, organizational change, and motivating a wide range of stakeholders. The COVID pandemic has abridged blood donations globally to the point that there is a chronic critical shortage in many locations.

Materials and methods: This paper explored the application of the Getting To Outcomes® (GTO) implementation science framework to support effective PBM implementation. GTO integrates Readiness Assessment and Empowerment Evaluation techniques to assess local needs, build capacity, and ensure stakeholder alignment. These methods are particularly useful for adapting programs to dynamic healthcare environments.

Results: Evidence from the literature indicates that GTO enhances organizational readiness, engages diverse stakeholders, and promotes sustainable implementation. The structured 10-step process of GTO enables PBM programs to be tailored to local settings. A hub-and-spoke peer-mentoring model is also proposed to support wider adoption.

Conclusion: Systematic execution and sustainability of PBM Programs is facilitated by structural approach of the implementation of science in adapting PBM programs to local needs, using framework such as the Readiness Assessment and Empowerment Evaluation from the Getting to Outcomes model. Successful implementation guided by this framework could support the development of hub-andspoke networks of peer mentorship and help fulfill the World Health Organization's call to strengthen patient blood management worldwide.

Introduction: Postpartum blues is a mild adaptation disorder in postpartum mothers that affects psychological and physiological conditions, including breast milk production. This condition significantly impacts maternal health and infant development. This study aimed to examine the association between oxytocin massage, oxytocin hormone levels, and breast milk production in mothers with postpartum blues.

Materials and methods: A quasi-experimental pre-test and post-test design with treatment and control groups was used. The study was conducted at Siti Fatimah Special District Hospital for Maternal and Child Makassar and Pertiwi Mother and Child Hospital Makassar, from February to November 2024. A total of 68 postpartum mothers with postpartum blues were divided into two groups (34 participants per group). Screening was performed using the EPDS scale, oxytocin levels were measured using the ELISA method, and Breast milk production was assessed using a composite scoring system based on three main indicators: (1) infant weight gain, evaluated using the mean value (X̄) and standard deviation (SD); (2) breastfeeding frequency, recorded through maternal reports and structured observation; and (3) breastfeeding duration, assessed based on the average time per feeding session. Each indicator was assigned a score ranging from 1 to 3, corresponding to low (score 1), moderate (score 2), and high (score 3) levels. The total score from these three components was used to classify overall breast milk production into three categories: high production (total score 7-8), moderate production (total score 5-6), and low production (total score 3-4). Statistical analysis was conducted using SPSS.

Results: The baseline characteristics were evenly distributed across between the groups. The reduction in EPDS scores was greater in the treatment group (13.44 ± 2.765 to 12.12 ± 3.832) than in the control group (13.97 ± 3.196 to 13.26 ± 2.864), with a significant between-group difference (p = 0.000). Moreover, oxytocin levels increased significantly in the treatment group (47.57 ± 10.42 pg/mL to 52.62 ± 11.33, p = 0.001), whereas no significant change was observed in the control group, except for the comparison of the difference in oxytocin levels between the two groups confirming that this difference is statistically significant (p = 0.007).

Conclusion: This study suggests that oxytocin massage may serve as a complementary approach therapy for reducing postpartum blues symptoms and enhancing breast milk production. Its integration into clinical practice can support maternal postpartum care by promoting emotional well-being and improving lactation outcomes.

Introduction: Prescribing errors are a significant issue in healthcare systems globally and represent an imminent risk to patient safety. These errors have the potential to result in increased morbidity and mortality. This study seeks to investigate the perceptions of House Officers (HOs) in Malaysia regarding their prescribing skills and competencies, as well as their views on the adequacy of clinical pharmacology and therapeutics training received during their undergraduate medical education.

Materials and methods: A cross-sectional study was conducted among HOs in 9 hospitals across Malaysia. The study utilized a survey comprising 26 items to assess the HOs' perceptions of their knowledge in clinical pharmacology and therapeutics, as well as their prescribing practices during housemanship training. Data was analysed using descriptive and inferential statistics.

Results: A total of 319 HOs participated in the study, which was conducted between June 2019 and June 2021. The findings revealed that the majority of participants perceived themselves as possessing adequate knowledge to prescribe most commonly used classes of medications. Nevertheless, 45% of respondents reported feeling adequately prepared for prescribing tasks based on their undergraduate medical training. Additionally, 51% expressed confidence in their therapeutic knowledge for prescribing, while approximately 50% reported confidence in preparing and administering medications.

Conclusion: The findings indicate that HOs generally perceive themselves as confident and knowledgeable in prescribing and preparing prescriptions. However, limitations in undergraduate education on prescribing contribute to feelings of inadequate preparedness as they transition into clinical practice. Strengthening educational support in this area is essential to improving prescribing competence, ensuring patient safety, and enhancing overall clinical outcomes.