Malaysian Journal of Medical Sciences最新文献

Objectives: The increasing mortality rate of COVID-19 has remained an international public health concern. Limited studies on clinical treatment and morbidity in hospital settings are available in Indonesia. This present study aims to analyse demographic characteristics, clinical signs and treatment in COVID-19 patients and their association to the mortality case in Sulianti Saroso Infectious Disease Hospital.

Methods: The study applied a retrospective cohort approach to all COVID-19 inpatients confirmed by polymerase chain reaction (PCR) testing in Sulianti Saroso Infectious Disease Hospital from 1 June 2020 to 30 September 2021. Overall survival rates until the end of the study were calculated using the Kaplan-Meier method and compared using the log-rank test. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors.

Results: We collected 1,970 inpatient data that met our inclusion and exclusion criteria. Most of them were 19 years old-59 years old (73.2%) and male (52.6%), and 966 (49%) patients had comorbidities. Approximately 63.9%, 89.2%, 89.8%, 82%, and 14.1% of the patients had ferritin levels ≤ 800, received antiviral treatment, were treated in non-intensive wards, had a moderate or mild clinical stage and did not survive, respectively. In the adjusted analysis, mortality was associated with sex (hazard ratio [HR]: 1.12; 95% CI: 1.02, 1.23), presence of comorbidity (HR: 1.19; 95% CI: 1.08, 1.30) and favipiravir (FPV) plus azithromycin treatment (HR: 1.21; 95% CI: 1.06,1.39). FPV treatment (HR: 1.35; 95% CI: 1.04, 1.75) was associated with higher mortality.

Conclusion: Tailored approaches to treatment, considering individual risk factors and comorbidities, are crucial in improving patient outcomes.

Diarrhoeal diseases are the second leading cause of death for children under 5 years old in 69 low- and middle-income countries, with an annual economic burden of US$ 4 billion and over 525,000 lives lost. Cholera and enterotoxigenic Escherichia coli (ETEC) traveller's diarrhoea are major diarrhoeal diseases caused by Vibrio cholerae (O1 and O139 serogroups) and ETEC, which have similar pathogeneses and can co-infect. There is no exclusive vaccine for ETEC, but cholera vaccines containing the cholera toxin B (CT-B) component offer short-term cross-protection. However, licensed oral cholera vaccines are expensive due to cold-chain supplies and the need for multiple doses. A cost-effective, dual-protection, live, cold-chain-free vaccine is, therefore, required for vaccination campaigns in low-resource settings, and MyChol - a prototype cold-chain-free live attenuated cholera vaccine, targeting V. cholerae O139 and ETEC H10407 - was developed in this context. The vaccine was evaluated in three animal models (Sprague Dawley [SD] rats, BALB/c mice and New Zealand white rabbits) for safety, colonisation capacity, reactogenicity and immunogenicity against challenge strains. In suckling mice, MyChol displayed high colonisation potential compared to unformulated VCUSM14P (the vaccine candidate) and wild-type O139. In the acute toxicity assessment, the SD rats with the highest MyChol dose (1 × 10⁷ colony-forming unit [CFU]/kg) demonstrated no adverse effects or mortality. Mice vaccinated with MyChol exhibited elevated antibody levels, including anti-CT, anti-heat-labile enterotoxin (LT), anti-CT-B and anti-LT-B. Anti-CT antibodies neutralised LT toxin in ETEC H10407 in challenge studies and cross-protected against ETEC H10407 in both mice and rabbits, preventing weight loss and diarrhoea. Ileal loop experiments in rabbits and BALB/c mice showed no reactogenicity. This review, based on our previous research, therefore provides valuable insights into improving the selection of animal models to advance preclinical evaluations of diarrhoeal vaccines.

Background: Emergency departments (EDs) have had to cope with various pandemics, such as HIN1, Ebola and the currently ongoing COVID-19. This study aimed to determine the elements of the new norm that has introduced changes into healthcare systems, particularly EDs, during the COVID-19 pandemic and to obtain consensus from the experts, the Emergency physicians in EDs across Malaysia. No previous study has been conducted on this topic.

Methods: This study used the fuzzy Delphi method (FDM) to acquire expert consensus. There were two phases in this study. The first involved extracting the elements to be assessed by the selected experts from a literature review. Three major domains were considered: infrastructure, governance and human resources. A total of 35 items were identified and divided into the three domains. In the second phase, the selected items were sent to a group of 15 ED physicians, who were asked to rate the items on a Likert-type scale. The data were then analysed using FDM.

Results: A total of 35 items were identified as possible new norms from a literature search for the three domains (governance, infrastructure and human resources). The first step of the FDM analysis showed that 9 out of the 35 items did not fulfil the initial requirement of the FDM, since the threshold value (d) must be lower than 0.2 (d 75%. Regarding the third requirement for FDM, only 1 out of the 35 items did not meet the criteria of an average fuzzy number (A value) of > 0.5. Finally, 25 items fulfilled all three requirements of FDM, so these were retained and the remaining 10 items were discarded.

Conclusion: The FDM used in this study had identified 25 items achieved the required level of agreement by the chosen experts. The results of this study can be used to guide EDs in Malaysia to utilise the new norms items in mitigating major outbreak affecting the ED services.

Background: Leptospirosis, a global zoonotic disease, causes serious morbidity and mortality generally in low-income societies. This study aimed to investigate the prevalence of Leptospira serovars in cattle and high-risk human populations.

Methods: This study investigated the presence of pathogenic Leptospira serogroups in the blood and kidney samples of cattle arriving at the Erzurum Meat and Milk Institution for slaughter between April and July, and between September and December 2022, and in the serum samples of humans. Kidney and serum samples from 289 cattle and serum samples from 100 individuals from at-risk occupational groups (58 farmers, 25 veterinarians and 17 butchers) were collected. As a control, 100 human blood samples were collected from civil servants who had no contact with animals. Microagglutination testing was used to investigate Leptospira serogroups in bovine sera, real-time polymerase chain reaction (PCR) for Leptospira DNA in kidney samples, and microagglutination testing and enzyme-linked immunosorbent assays for Leptospira antibodies in human blood serum samples.

Results: Microagglutination test in 4.5% of cattle; Leptospira DNA was positive in 0.7%. Six strains of Leptospira interrogans, two of Bratislava, one of Pomana and one of Icterohaemorrhagiae were found in cattle, as well as one strain of Leptospira kirschneri Dadas. In humans, two Icterohaemorrhagiae, one Hebdomadis and one Dadas serovar were detected in both the risk group and the control group. Using ELISA, antibody positivity was found to be 14.0% in the risk group and 11.0% in the control group.

Conclusion: The seroprevalence of Leptospira spp. in cattle in Erzurum, Türkiye, is relatively high. In this region, the risk of encountering Leptospira in the normal population is as high as in the risk group.

Ethnomedicinal uses of honey value its nutritional and medicinal properties to attain general health, diseases prevention or treatment for particular illness. Madu kelulut or stingless bee honey is produced by Meliponini species and the honey referred as superfood in Malaysia. The honey is a complete natural food product that provide safe source of energy via low GI trehalulose sugar, nourished with nutrients, vitamins, amino acids and good bacteria that is formed via unique natural pot-bioreactor processing. The honey is gaining attention for its high antioxidant levels, antimicrobial properties, anti-inflammatory, unique composition and taste. Studies revealed multiple foundations and evidence-based that the madu kelulut is highly beneficial for human possessing a promising niche in the health supplement industry with economic importance projected up to USD700 million in local markets. Honeyomics of madu kelulut aims at understanding the economic importance factors that contribute to the entire mark-up of madu kelulut as general guides for standards and the functional properties of madu kelulut. Several milestones (2005-2023) have been achieved which acknowledge the strategic development and ecosystem for the madu kelulut industry in Malaysia. Further efforts to safeguards the quality and authenticity of stingless bee honey via modernisation, capacity building and market expansion could encourage for scale-up and solidifying Malaysia's position as a key player in the global stingless bee honey industry, providing economic benefits while preserving natural resources for future generations.

Background: Stroke ranks as the second leading cause of death globally, contributing to 15.2 million deaths in 2016. In Malaysia, stroke has emerged as a significant cause of mortality and disability. This study aims to evaluate the survival time and rate of stroke patients in Malaysia.

Methods: In this retrospective cohort study, we reviewed secondary data from the National Stroke Registry (NSR) of Malaysia. The study included all Malaysian residents over the age of 12 years old diagnosed with either ischaemic or haemorrhagic stroke between 1 January 2009 and 31 December 2013. Patients with a transient ischaemic attack were excluded. We updated the death status up to 31 December 2018 using mortality data from the Malaysian National Registry Department. We used Kaplan-Meier Survival Analysis to determine the overall median survival time and log-rank test to compare the median time by ethnicity, sex and stroke type. The survival rates at 1 year, 3 years and 5 years were obtained using the life-table method.

Results: The analysis included a total of 5,777 stroke patients. The mean age at diagnosis was 63.15 years old (with a standard deviation of 12.46 years old). The overall median survival time was 51 months (95% CI: 47.4, 54.6). Non-Malay patients and those with ischaemic strokes experienced a longer median survival time (65.2 months [95% CI: 56.6, 73.7] and 56.3 months [95% CI: 52.2, 60.3]), respectively. The survival rates at 1 year, 3 years and 5 years were 66.7% (95% CI: 65.5%, 68.0%), 55.6% (95% CI: 54.3%, 56.9%) and 46.9% (95% CI: 45.6%, 48.2%), respectively.

Conclusion: There are significant differences in median survival time in relation to ethnicity and stroke types. Compared to other developed countries, Malaysia's 5-year survival rate is notably lower.

Cancer prehabilitation, defined as a process occurring between cancer diagnosis and the onset of acute treatment, is highlighted for its ability to enhance physical and mental health results while decreasing overall healthcare costs. This summary introduces the concept of cancer prehabilitation and emphasises the crucial role of oncology nurses in rehabilitation care. The cancer treatment plan of prehabilitation requires timely and efficient assessment across the care continuum, focusing on enhancing outcomes at every stage of cancer. The battle with cancer involves three different assessments with distinct goals: i) prehabilitation evaluation before treatment, ii) early post-treatment evaluations of rehabilitation and iii) final evaluations of health promotion. Analyses and treatments for significant side effects or complications associated with the treatment specifically for prehabilitation are recommended. The roles of coordination, counseling, preparing for discharge and teaching are outlined as integral components of a cancer nurse's responsibilities in the prevention of cancer. A literature search from March 2016 to June 2023 was conducted using the keywords 'neoplasms,' 'cancer,' 'prehabilitation,' 'continuum of care,' 'care continuum,' 'patient care continuity,' 'epidemiology,' 'therapeutics,' 'health,' 'prevention and control' and 'guidelines as topic.' The findings suggest that care coordinators or navigators for cancer should be educated to assess the physical and psychological status of patients once a cancer diagnosis is confirmed, particularly for those awaiting surgery at home. To enhance their competence in prehabilitation care, oncology nurses are encouraged to gain knowledge of certain tumours' outcomes and cancer-related treatments. Additionally, improving the ability to evaluate patients' functional status and emotional distress is crucial for oncology nurses involved in cancer prehabilitation.

Oral cancer is one of the most common types of cancer and has become a global health concern. Oral squamous cell carcinoma (OSCC) is the most prevalent form of oral cancer worldwide. Eugenol, an aromatic phenolic compound, exhibits various pharmacological activities, including anticancer effects. Several studies have reported the anticancer activity of eugenol against OSCC via different pathways. However, no current review has discussed the extent of eugenol anticancer research on oral cancer cell lines using in vitro studies. This systematic review aimed to discuss the anticancer potential of eugenol against oral cancer cell lines in vitro. Articles were selected from PubMed, ScienceDirect, SpringerLink and EBSCOhost databases based on specified inclusion and exclusion criteria. Additional articles were identified through manual hand searching. The selection process followed PRISMA guidelines. A risk-of-bias assessment was performed to evaluate the reliability and relevance of the in vitro studies. Thirteen articles with high-quality results were assessed and analysed for further investigation. These studies investigated the ability of eugenol to induce cell death through apoptotic and non-apoptotic pathways, inhibit cell proliferation and affect oxidative stress, contributing to cell death in several oral cancer cell lines. Therefore, eugenol is a potential anticancer agent for OSCC, as it exhibited anticancer activity in oral cancer cell lines in vitro studies.

Background: Acutely sick patients can receive emergency intravenous access through central venous cannulation to administer fluids and medicines, perform haemodynamic monitoring and extracorporeal therapies, including plasmapheresis or haemodialysis. Using the Seldinger procedure, access is gained by percutaneous puncture, frequently guided by ultrasonography into the femoral, subclavian or internal jugular veins. This study aimed to identify ergonomic risk factors for musculoskeletal disorders (MSDs) in operators performing ultrasonography-guided internal jugular vein (IJV) cannulation at various table heights and probe orientations.

Methods: Sixty emergency medicine residents participated in a cross-sectional study conducted by the Emergency and Trauma Department of Hospital Universiti Sains Malaysia, Kelantan. Participants were instructed to perform the cannulation at two distinct table heights and with two distinct probe orientations. To compute the ergonomic risk score, the Rapid Entire Body Assessment (REBA) method was used.

Results: The table height of 0.5 elbow factor with varied probe resulted in a median REBA score of 5.0, whereas the table height of 0.7 elbow factor with varied probe had a median REBA score of 4.0. All four positions exhibited medium risk for MSDs.

Conclusion: This study showed that the table height of 0.7 elbow factor is more ergonomically favourable while still imposed medium risk for MSDs.

Background: Complicated grief is characterised by persistent low mood, intense distress and cognitive impairment. This study aimed to explore coping strategies (i.e. emotion-, problem- and meaning-centred) used by bereaved individuals facing complicated grief and how these strategies may predict psychological and cognitive outcomes.

Methods: In a cross-sectional study, 20 bereaved individuals (5 males, 15 females) that aged 27 years old-65 years old (mean = 42.25, standard deviation [SD] = 9.30) were recruited following the loss of a loved one due to physical illness. Participants were screened for complicated grief and subsequently completed self-report assessments of coping strategies and depressive symptoms using Brief Grief Questionnaire (BGQ), Brief Coping Orientation to Problems Experienced (COPE) Questionnaire, Meaning-Centered Coping Scale (MCCS) and Patient Health Questionnaire-9 Items (PHQ-9). Following that, participants underwent a neurocognitive assessment of working memory using the 2-Back task.

Results: Caregivers with complicated grief suffered from moderate severity of depressive symptoms (mean = 17.45, SD = 4.43) as they were coping with the losses. Furthermore, the findings showed that MCC significantly predicted lower levels of depressive symptoms (b = -0.50, t (16) = -2.25, P = 0.04). However, coping strategies did not significantly predict working memory performance.

Conclusion: These findings highlight the potential benefits of MCC in alleviating depressive symptoms in bereaved individuals and underscore its contribution to the development of grief interventions. Grief therapists can emphasise this coping strategy to promote healing and resilience in patients in the grief work.