搜索结果：The Medical journal of Malaysia

Congenital sensorineural hearing loss associated with cochleovestibular malformations (CVM) and/or cochlear nerve deficiency (CND) presents distinct surgical and audiological challenges. Patients with CVM face elevated risks of intraoperative cerebrospinal fluid (CSF) gushers and aberrant facial nerve courses, while those with CND have historically been viewed as poor candidates for cochlear implantation (CI) due to concerns regarding neural sufficiency. This study aims to bridge this gap by evaluating the surgical safety and audiological outcomes of CI in a focused cohort of patients with CVM and CND at a tertiary referral centre in northern Malaysia. A retrospective cohort study was conducted on 20 cases with CVM and/or CND performed between January 2009 and December 2024 at Hospital Sultanah Bahiyah, Kedah, Malaysia. The study population included patients with radiologically confirmed CVM classified according to the Sennaroglu classification and CND. Surgical outcomes, including the incidence of CSF gushers, were analysed by Fisher's exact test following stratification into high-risk and low-risk gusher group. Primary audiological outcomes were assessed using the aided average pure tone audiometry (PTA), analysed longitudinally using a linear mixed-effects model. Secondary functional audiological outcomes were evaluated by comparing pre-implantation and 12-month post-implantation Categories of Auditory Performance-II (CAP-II) scores using the Wilcoxon signed-rank test. The cohort was predominantly prelingual (90.0%). Surgical analysis revealed a shift in technique over the 16- year period, moving from cochleostomy to round window insertion. Intraoperative CSF gushers were encountered in 12 of 20 ears (60%). We found no statistically significant difference in the incidence of gushers between the "high risk" group (enlarged vestibular aqueduct and incomplete partition type II) and to the "low risk" group (p=0.559). There were no incidences of facial nerve injury. In terms of audiology outcome, the linear mixed-effects model revealed a highly significant improvement in aided PTA over time for all ears (p<0.001). Crucially, comparing CND versus non- CND ears revealed no statistically significant difference in outcomes, with both groups following a parallel trajectory of auditory improvement. Functional analysis confirmed that these gains translated into real-world benefits, with CAP-II scores improving significantly from a median of 2.0 preoperatively to 4.5 at 12 months (p=0.003). Cochlear implantation is a safe and effective intervention for children with CVM and/or CND. Our findings indicate that the risk of intraoperative CSF gushers extends beyond specific high-risk groups, underscoring the need for broad surgical readiness across the spectrum of malformations. The audiological outcomes observed, irrespective of the presence of CND, support the expansion of CI candidacy to this challenging population, provided there is requisite surgical expertise and thorough family counselling.

Hypertension remains a leading global health concern due to its high prevalence and serious health complications. Nowadays, home blood pressure monitoring (HBPM) has emerged as a valuable non-pharmacological intervention to control blood pressure (BP). Numerous studies have demonstrated the pattern of HBPM practice among hypertensive patients. However, information on optimal practice of HBPM instruction by the healthcare providers (HCPs) is still lacking. Therefore, the main objective of this study is to assess the prevalence of optimal practice of HBPM instruction methods by the HCPs to their hypertensive patients and factors associated with it. This is a cross-sectional study, conducted among HCPs with working experience of more than a year, from all four government primary health clinics in Putrajaya between March 2023 and September 2024. The validated Malay-version i-HBPM questionnaire, also known as "the practice of HBPM instruction methods for hypertensive patients" questionnaire was used in this study. A total of 285 HCPs were recruited in this study. The prevalence of optimal practice of HBPM instruction methods by the HCPs to their hypertensive patients was 14.4%. The most frequently reported barriers to HBPM recognition among HCPs were a lack of understanding of HBPM (28.8%), a lack of HBPM guidelines (17.2%) and the high cost of devices (16.5%). From the HCPs' thought and perspective, the top three most significant patient-related barriers were a lack of understanding of HBPM (42.1%), followed by high device cost (33.0%) and low education level (29.5%). Attending HBPM training was the only significant factor associated with the optimal practice of HBPM instruction methods given by HCPs to their patients (adjusted OR 3.48, 95.0% CI 1.29, 9.34, p = 0.013). This study demonstrated a low prevalence of optimal practice of HBPM instruction methods provided by HCPs to their hypertensive patients despite high recognition and recommendation of HBPM among HCPs. HBPM training for HCPs is very crucial to improve their knowledge and consultation skills on HBPM.

Currently, several countries have implemented regulations governing the use of medical cannabis. Recreational use of cannabis is illegal under Malaysian laws and it is unclear what medical practitioners think of cannabis when it is used for medical purposes. We conducted a nationwide survey in Malaysia to study the attitudes, beliefs and willingness of public medical practitioners to prescribe medical cannabis. A 23-item online questionnaire was administered to 420 medical practitioners working in government institutions. Participant demographics, clinical specialities, employment history, exposure to knowledge of medical cannabis and case vignettes related to the use of medical cannabis were collected and analysed. Sixty-five percent of medical practitioners agreed that medical cannabis should be available for certain conditions, particularly pain (87%). Most medical practitioners in the case vignettes were willing to recommend medical cannabis to treat pain due to cancer (74.3%) and chronic pain (66.9%). Logistic regression indicated that both gender and exposure to information on medical cannabis are significant factors (p<0.05) in predicting the willingness of medical practitioners to prescribe medical cannabis. Medical practitioners in the public institutions showed favourable attitudes towards prescribing medical cannabis for chronic pain and cancer pain. However, further work is required to examine factors that drive these attitudes, and potential prescribing behaviour including those in private and university settings. A thorough evaluation of the scientific evidence and related legislation is essential, especially if a regulated pathway is to be adopted. In this situation, medical practitioners must have a clear understanding of clinical practice guidelines regarding pain indications, dosing and monitoring protocols as well as effective pharmacovigilance. Additionally, this should be combined with targeted evidence-based training on medical cannabis for medical practitioners.

Chest X-ray (CXR) remains one of the most commonly used diagnostic imaging tools in clinical practice. However, the accuracy and competency in reading and interpreting CXRs can vary significantly across different levels of medical practitioners, ranging from house officers to senior specialists. The purpose of this study was to assess competency in CXR interpretation among doctors at different stages of their medical careers. This is a cross-sectional study conducted using CXRs, which were displayed digitally. A total of 305 participants were recruited, including house officers, medical officers, and registrars in specialty training. A standard set of ten radiographs was chosen, and the participants were required to interpret the CXR in multiple-choice format. Data analysis was performed via IBM SPSS Statistics software, version 25. Clinical history improved the ability to accurately interpret CXR, with the percentage of participants who accurately interpreted CXRs increasing from 21% of participants who achieved high scores without clinical history to 63.6% of participants who achieved high scores with clinical history. The participants' field of interest and confidence level when reporting a CXR without history were associated with higher accuracy (p<0.05) when interpreting a CXR. However, when the clinical history was given to the participant, only the confidence level of the participant affected the final score of the CXR. There is no significant difference in the ability of doctors to interpret CXR despite the difference in seniority in practice; moreover, undergraduate exposure does not play a significant role. Structured teaching, continuous practice, feedback and integration into clinical decision-making are the keys that translate to greater competency in CXR interpretation. Future researches should emphasize on multicenter approach as it enhances the generalizability of findings to a broader national context.

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. 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. 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. 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.

Referrals from Primary Health Facilities (PHF) to hospitals occur due to clinical needs for speciality care in managing the presenting illness, social factors such as poor compliance or lack of family support, and are requested by patients. The journey for any patients transferred from PHF to hospitals has three major components, which are (a) the PHF intervention and activation of ambulances; (b) the Prehospital Care Services (EMS) deployment, care of the patient and transportation to the hospital; and (c) the process of review or admission at the destination hospital. We detail the journey, processing time, and outcomes of patients referred from PHFs via EMS to a tertiary referral hospital in Selangor, Malaysia. This is a retrospective study analysing data from 980 referred patients from PHFs transported by Klang Valley Ambulance Service (KVAS) to Hospital Sungai Buloh between 1st January 2023 and 30th June 2023. Data collected includes PHF classification, KVAS activation details, patient demographics, Emergency Department length of stay (EDLOS), and the patient's outcome in the ED. Patient's outcome in ED is categorised as (a) admitted; (b) discharged; or (c) discharged against medical advice (DAMA). Out of the 980 referred patients, 83.3% were triaged as Priority 1 by PHFs. The majority were males (56.8%), with a mean age of 28 years. The median waiting time for ambulance arrival was 54-58 minutes. The percentage of referred patients who were admitted to the ward was 65.8%. The median EDLOS was 540 minutes (9 hours), with discharged patients having a shorter median EDLOS of 321 minutes (approximately 5 hours). The median total patient waiting time from PHF to final disposition was 605 minutes (10 hours) for admitted patients and 382 minutes (6 hours) for discharged patients. A significant proportion of referred patients experienced prolonged EDLOS, whereas only 22.4% of referred patients were discharged within eight hours. Average EDLOS of 12 hours suggests the need for a "Fast- Track Referral System" to improve efficiency and reduce unnecessary gatekeeping processes.

Essential Newborn Care (ENC) is crucial for neonatal survival, which is known to be very significant for the objective of Sustainable Development Goals in 2030 as an attempt to decrease neonatal morbidity and mortality. Mothers play an important role in ENC. This study aimed to delve into the relationship between mothers' knowledge, parity, education level, age, occupation, economic status, and ENC practices in post-partum mothers. A cross-sectional design was conducted in Jambi, Indonesia from June to August 2021. There were 152 post-partum mothers who had neonates aged 0-28 days, consisting of 76 primiparous and 76 multiparous mothers. A questionnaire on ENC knowledge and practice was utilized to collect the data from the instrument of the previous study. The data were examined using univariate, bivariate, and multivariate analyses. Multivariate analysis on ENC practices revealed that mothers with low knowledge had a higher risk of performing poor ENC practices with OR 10.6 than those with high knowledge, and it was significantly different. Mothers with low educational level had more risks of practicing poor ENC with OR 2.9 than those with high educational level, which was significantly different. Meanwhile, parity, age, occupation, and economic status of post-partum mothers did not present a statistically significant correlation (p>0.05) with ENC practices. There was a significant difference in ENC practices, with high risk in those who had low knowledge followed by low education. There was no association between ENC practices and parity, age, occupation, and economic status of post-partum mothers. These findings highlight the importance of improving the knowledge of post-partum mothers in supporting ENC practices. The result of the study should nevertheless be interpreted in such a way by considering the limitations of the study design and the instruments used.

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. 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)). A total of 277 participants were included (mean age 24.2 years, 67% female). Internal consistency was excellent (&#x3b1;=0.964 for symptoms; &#x3b1;=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 &#x2265;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). The DESRIL-27 demonstrated excellent reliability and diagnostic performance, with an empirically derived cut-off of &#x2265;14.5. These findings support its use as a screening tool for digital eye strain in university settings.

Measles remains a persistent public health concern in Malaysia. Despite sustained high vaccination coverage in states such as Selangor, reported cases continue to increase. This trend suggests a possible shifting age-distribution of measles, a pattern that has been observed in countries with a high vaccination rate. Understanding the epidemiology and clinical characteristics of measles between adults and children is critical in guiding targeted public health interventions aimed at control and elimination of measles. This study aimed to describe the incidence of measles in adults and children in Selangor, and to compare their sociodemographic, clinical, vaccine, and exposure-related differences. This comparative cross-sectional study used secondary data from the Selangor e-Measles Registry from 2015 to 2024. Confirmed cases were classified as adults (&#x2265;18 years) and children (<18 years). The incidence of each group was calculated annually over ten years. Descriptive statistics, chi-square test, Fisher's exact test, and Mann-Whitney U test were used to describe and compare the differences between the two groups. Data were analysed using SPSS version 29. A total of 3954 confirmed measles cases were included in the study, with 540 (13.7%) adult cases and 3414 (86.3%) cases in children. Between 2015 and 2024, the incidence of measles was consistently higher in children as compared to adults, with risk ratios ranging from 14.43 (95% CI: 11.25, 18.73) in 2017 to 87.65 (95% CI: 27.39, 278.66) in 2022. With the exception of 2019-2022, adults showed a gradual increase in number over the study period, with the highest proportion in 2023 (16.4%). Significant differences between adults and children were observed (p<0.05) according to nationality, ethnicity, clinical symptoms, hospitalisation, complications, vaccination status, and duration since the last vaccination. The findings suggest that despite the increase in adult cases, measles predominantly affects children in Selangor. The findings highlight the need to strengthen vaccination efforts through the National Immunisation Programme (NIP) and prioritising Supplementary Immunisation Activities (SIAs) among children aged below 6 years old. Additionally, the gradual rise in cases in adults and children aged 7-12 years old should be monitored closely to detect emerging epidemiological shifts. Significant clinical differences between adults and children highlight the need for training of healthcare providers and public education to support diagnosis, prevent outbreaks, and avoid complications. Digitalisation of health records, such as the documentation of vaccination history, is needed. Measles in Selangor showed age-specific trends and differences. Addressing these issues through strengthened childhood immunisation, targeted interventions and continuous surveillance is essential to achieve measles control and elimination in Selangor and Malaysia.

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. 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. 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. 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.

Schizophrenia is a complex mental disorder involving genetic, environmental, and neurodevelopmental factors. Despite significant progress in identifying several genetic contributors to schizophrenia, the role of apolipoprotein in lipid metabolism, neurodevelopment, and neuroprotection remains underexplored. This systematic review aims to synthesise existing genetic studies on apolipoproteins associated with schizophrenia to clarify their potential role in the disorder's pathogenesis. A comprehensive literature review was conducted using the PubMed and Scopus databases, involving studies published from 2004 to 2023, and limited to English. Keywords included "schizophrenia," "apolipoprotein," "genetic," and "genetics." Non-research publications such as books, reviews, editorials, letters to editors, short communications, book series, chapters, and conference proceedings were excluded from this review. Only peer-reviewed journal articles were selected to ensure the reliability and credibility of the systematic review. A total of 41 articles were included in the review, with four key themes identified. The themes addressed specific aspects of apolipoproteins in schizophrenia, including their role in schizophrenia susceptibility, lipid metabolism, and cognitive functions within the disorder. This review presents a novel synthesis of these studies, focusing on the underexplored roles of apolipoprotein genes, including APOE, APOL, APOD, APOA, APOC, APOER2, and APOBEC, in schizophrenia. This systematic review provides a comprehensive understanding of the genetics of apolipoprotein in schizophrenia, particularly in relation to lipid metabolism. The findings suggest future research directions to enhance the understanding of schizophrenia pathogenesis and highlight the importance of targeted research to identify specific genetic biomarkers for therapeutic interventions.

Measles remains a persistent public health concern in Malaysia. Despite sustained high vaccination coverage in states such as Selangor, reported cases continue to increase. This trend suggests a possible shifting age-distribution of measles, a pattern that has been observed in countries with a high vaccination rate. Understanding the epidemiology and clinical characteristics of measles between adults and children is critical in guiding targeted public health interventions aimed at control and elimination of measles. This study aimed to describe the incidence of measles in adults and children in Selangor, and to compare their sociodemographic, clinical, vaccine, and exposure-related differences. This comparative cross-sectional study used secondary data from the Selangor e-Measles Registry from 2015 to 2024. Confirmed cases were classified as adults (&#x2265;18 years) and children (<18 years). The incidence of each group was calculated annually over ten years. Descriptive statistics, chi-square test, Fisher's exact test, and Mann-Whitney U test were used to describe and compare the differences between the two groups. Data were analysed using SPSS version 29. A total of 3954 confirmed measles cases were included in the study, with 540 (13.7%) adult cases and 3414 (86.3%) cases in children. Between 2015 and 2024, the incidence of measles was consistently higher in children as compared to adults, with risk ratios ranging from 14.43 (95% CI: 11.25, 18.73) in 2017 to 87.65 (95% CI: 27.39, 278.66) in 2022. With the exception of 2019-2022, adults showed a gradual increase in number over the study period, with the highest proportion in 2023 (16.4%). Significant differences between adults and children were observed (p<0.05) according to nationality, ethnicity, clinical symptoms, hospitalisation, complications, vaccination status, and duration since the last vaccination. The findings suggest that despite the increase in adult cases, measles predominantly affects children in Selangor. The findings highlight the need to strengthen vaccination efforts through the National Immunisation Programme (NIP) and prioritising Supplementary Immunisation Activities (SIAs) among children aged below 6 years old. Additionally, the gradual rise in cases in adults and children aged 7-12 years old should be monitored closely to detect emerging epidemiological shifts. Significant clinical differences between adults and children highlight the need for training of healthcare providers and public education to support diagnosis, prevent outbreaks, and avoid complications. Digitalisation of health records, such as the documentation of vaccination history, is needed. Measles in Selangor showed age-specific trends and differences. Addressing these issues through strengthened childhood immunisation, targeted interventions and continuous surveillance is essential to achieve measles control and elimination in Selangor and Malaysia.

Virtual ward (VW) is a hospital-led alternative to inpatient care enabled by technology where patients are looked after in their usual residence. Such a service may not be familiar to many. This survey aims to explore the views and acceptability of VW among hospitalised patients. This study was conducted among patients aged &#x2265;18 years admitted to medical wards of a tertiary hospital in Malaysia. The survey questions were adapted from existing questionnaires and piloted before use. Participants were provided with a clinical vignette and description of a VW service before completing the questionnaire. It collated data on respondents' demographics, admission details, VW acceptability and their views on VW-related telehealth. The next of kin or main caregiver provided responses if the person was unable to participate. Responses were collected from 120 participants (95 patients, 25 caregivers), of which 108 respondents (90.0%) agreed to be managed by a VW service if such a service was available and able to meet their needs. Being at home, supported by family members, and the ability to maintain independence were the most common reasons cited for its acceptance. Among those unwilling, participants preferred to have the medical and nursing team close by. In terms of telehealth readiness, 95% of patients have internet access, and 97.5% possess the appropriate devices for video consultation. However, only 20% of patients have utilised online video consultations before to seek medical advice. The majority of people surveyed were willing to accept a virtual ward service. The findings provide useful information towards the planning of virtual ward programmes in Malaysia.

Assessing health-related quality of life (HRQOL) promotes understanding well-being of people living with HIV (PLHIV). This study aims to determine factors influencing HRQOL. The cross-sectional study used a self-administered questionnaire among PLHIV receiving treatment in HIV clinic of a state hospital in Perlis, Malaysia. Potential subjects were approached in the waiting areas during routine clinic visits. The Malay questionnaire consists of WHOQOL-HIV BREF, EQ-5D-5L and EQ-VAS. Multiple linear regressions (MLRs) were used to identify independent predictors of HRQOL, and Spearman's correlations assessed the relationships between instruments. There were 88 participants in this study (mean age 43.5&#xb1;13.1 years; 63.6% male). All were on antiretroviral therapy with undetectable viral loads. The mean overall WHOQOL score was 74.9&#xb1;13.1 (on a 0-100 scale), EQ-5D index 0.90&#xb1;0.13, and EQ-VAS 88.5&#xb1;13.2. Each one-year increase in age was associated with a 3.3-point (&#x3b2;&#x2248;+3.3) higher WHOQOL score and middle-range household income of MYR3171-3970 (&#x2248;USD757-948 as of 1 USD=4.188 MYR) was linked to higher WHOQOL(&#x3b2;&#x2248;+8.7). In contrast, part-time employment corresponded to a lower WHOQOL(&#x3b2;&#x2248;-7.4). Having tertiary education and high income >MYR4850 (&#x2248;USD1158) were associated with lower EQ-VAS (&#x3b2;&#x2248;-10.3 and -16.0, respectively). An HIV transmission mode other than sex and intravenous drug use predicted significantly lower scores across all three HRQOL indicators. WHOQOL had a moderate positive correlation with EQ-5D (r=0.421) and a weaker correlation with EQ-VAS (r=0.265). PLHIV in Perlis, Malaysia reported generally good HRQOL despite the COVID-19 pandemic. Higher age and moderate income were associated with better WHOQOL, whereas higher education and income paradoxically lowered self-rated health (EQ-VAS). Multi-dimensional assessment (WHOQOL, EQ-5D, EQ-VAS) revealed consistent trends and underscores the importance of holistic care for PLHIV in pandemic conditions.

Patients with end-stage renal disease (ESRD) have compromised immune systems, possibly reducing their vaccine-induced antibody responses compared to the general population. COVID-19 remains a persistent threat, with the virus continuing to mutate into new variants. Similar to influenza, there is a possibility that COVID-19 could resurge significantly, underscoring the importance of understanding vaccine-induced immunity in vulnerable populations. This study aims to determine the immunogenicity of this group to the COVID-19 vaccine. Haemodialysis patients receiving the Pfizer-BioNTech mRNA vaccine were followed for at least 13 months. Blood samples were collected prior to every vaccine dose and at multiple intervals thereafter. Neutralising antibodies (nAb) against SARS-CoV-2 were measured. Patients voluntarily reported any COVID-19 infection. Between April 2021 and January 2023, 271 patients received at least one dose of the vaccine; 212 of these had at least one blood sample tested for nAb. Booster doses were given 26.2 weeks after the second dose. nAbs were detected in 16.8% of patients before vaccination. The nAb levels were higher than the non-convalescent patients after the first dose, but it was not statistically significant. Breakthrough infections were self-reported in 29.3% of patients. A significant association between breakthrough infections and history of COVID-19 infection cannot be established (p=0.188). There were 34 deaths (16.0%); 2 related to COVID-19. Younger age was associated with higher nAb reactivity post-first dose, but this difference diminished after the second dose. Almost complete seropositivity (98.4%) was achieved after two doses of vaccine. Sustained antibody levels after the third dose suggest the value of a booster dose in protecting this vulnerable population. However, the occurrence of breakthrough infections highlights the need for continued monitoring, preventive measures, and further research to optimise vaccination strategies in haemodialysis patients.

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

Hirschsprung disease (HSCR) is a genetic disorder leading to gastrointestinal obstruction due to the absence of ganglion cells in the submucosal and myenteric plexuses. Treatment typically involves a pull-through surgery, sometimes starting with a colostomy. The COVID-19 pandemic has resulted in restrictions on general patient services, i.e., non-COVID-19 patients, at health facilities, leading to reduced hospital visits, including HSCR patients with stomas. This study aimed to determine whether there were differences in the quality of life (QoL) of HSCR patients with stomas before and after the COVID-19 pandemic. This research was a descriptive study comparing the quality of life (QoL) of HSCR patients with stomas before and after the COVID-19 pandemic. It utilized a cross-sectional study design and assessed QoL using the PedsQL Generic Core Scales 4.0 questionnaire. There was no significant difference in the QoL of HSCR patients before COVID-19 and after COVID-19, as indicated by parent reports (p=0.88) and child reports (p=0.12). However, there was a statistically significant difference in scores on the social dimension of child reports (p=0.04). Furthermore, there was no statistically significant relationship between parent and child reports (p>0.05). The QoL of HSCR patients with a stoma before and after the COVID-19 pandemic is similar, except for the social dimension in the child's report. Further studies with more cases are necessary to clarify the findings of this study.

The global obesity epidemic threatens health systems worldwide and is associated with severe health complications such as cardiovascular disease, type 2 diabetes, and cancers, imposing substantial economic burdens. Globally, over 1.9 billion adults are classified as overweight, with 650 million identified as obese. A review was conducted using academic databases and authoritative reports from organizations such as the WHO and the Institute for Public Health. Studies published between 2002 and 2024 were selected based on methodological rigor and relevance to obesity in Malaysia. Malaysia has the highest obesity rate in Southeast Asia and has classified obesity as a chronic disease. Currently, 21.8% of Malaysian adults are affected by obesity - a fivefold increase from 4.4% in 1996 - with projections reaching 41% by 2040. Obesity-related healthcare costs consume 10-20% of Malaysia's national budget. Malaysia joined the Obesity Policy Engagement Network (OPEN) and implemented a model-of-care survey to gather healthcare professional insights and identify critical obesity management gaps. This initiative aimed to provide evidencebased recommendations to enhance patient outcomes and alleviate economic strain on the healthcare system. The Malaysian OPEN survey indicated that only one-third view obesity as a disease, resulting in underinvestment in necessary infrastructure and treatment options such as pharmacotherapy and bariatric surgery. These prevailing misconceptions among healthcare professionals and decision-makers hinder progress. A collaborative, multidisciplinary strategy supported by robust policies and evidence-based research is thus vital in managing obesity as a chronic disease. Addressing obesity in Malaysia requires a collaborative, multidisciplinary approach that integrates lifestyle, behavioural, medical, and surgical strategies. Policy reform, stakeholder engagement, and evidencebased planning are essential to improve patient outcomes, reduce economic burdens, and ensure equitable access to care. A unified national effort is vital for sustainable and effective obesity management.

Riboflavin, as flavin mononucleotide and flavin adenine dinucleotide, is essential for numerous metabolic pathways. However, the prevalence of riboflavin deficiency worldwide remains unclear, because status biomarkers are very rarely measured in human studies. This study aimed to investigate riboflavin status in females of reproductive age and children from several regions of the world, representing both high-income countries and low/middle-income countries (HICs and LMICs). We measured riboflavin status in population-representative samples from Ireland, United Kingdom, Cambodia, and Democratic Republic of the Congo, and in cohort samples from HICs (Northern Ireland, Spain, Canada) and LMICs (Malaysia, Lao People's Democratic Republic, Cambodia, Uganda) using the functional assay, erythrocyte glutathione reductase activation coefficient (EGRac), with higher values indicating lower status and EGRac &#x2265; 1.40 indicative of deficiency. In Irish (n = 251) and British (n = 163) populations, among unsupplemented females of 18-45 y, median (95% confidence interval) EGRac values were 1.39 (1.36, 1.42) and 1.40 (1.36, 1.49), and 48% and 50%, respectively, had riboflavin deficiency. In Irish females, biomarker status declined progressively(P < 0.002) with decreasing quintiles of dietary riboflavin intakes, from >2.1 in Q1 to <1.1 mg/d in Q5.. Females in LMICs had much higher rates of riboflavin deficiency: Malaysia (72%); Cambodia (82%); and Uganda (90%). In British children (n = 307), riboflavin status declined markedly with age, with median EGRac values of 1.25 (1.20, 1.28) at age 1-5 y compared with 1.40 (1.35, 1.44) at 15-17 y. In children from LMICs, 39%-75% had riboflavin deficiency, and in Ugandan children aged 5-17 y, median EGRac was 1.77 (1.39, 2.15), corresponding with clinical deficiency signs observed in this cohort. Riboflavin deficiency is highly prevalent in females and children across many regions worldwide. Given the wide-ranging adverse health consequences of deficiency, population-based strategies to improve riboflavin status in both LMICs and HICs are urgently needed.