Assessment Of Pictogram Use In Pediatric Oral Liquid Medication Labeling At Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia

Cecair adalah bentuk dos oral yang lazimnya diberikan kepada kanak-kanak. Secara umumnya, penggunaan piktogram untuk menyampaikan arahan ubat-ubatan dianggap sebagai satu pendekatan yang munasabah tetapi maklumat tentang keberkesanannya dalam perubatan pediatrik masih terhad. Liquids are commonly the preferred form of oral medication delivery for children. Generally, using pictograms to illustrate medication instructions is viewed as a feasible approach to improve communication, but limited information is available on its usefulness in pediatric medicine

Short-term Changes in Quality of Life among Women Who had Hysterectomy for Benign Indications at Young Age: A preliminary study

Objectives: The objective of this study was to compare the quality of life scores between younger (≤ 45 years old) and older women (≥ 46 years old) who underwent hysterectomy for benign indications. Materials and Methods: A prospective cohort study was performed at a tertiary hospital over a 12-week period. Younger and older women who underwent elective hysterectomy for benign indications were selected as study and control groups, respectively. Quality of life was measured using the Malay version of the World Health Organisation Quality of Life Assessment-BREF questionnaire. The difference in quality of life scores from pre-surgery to 12 weeks post-hysterectomy between the two age groups were measured using repeated-measures analysis of variance (ANOVA).results: A total of 18 women were enrolled in the study group and 45 in the control group. Except for the environment domain among control group, all other domains showed an improvement in quality of life scores. However, the group–time interaction of the repeated-measures ANOVA showed no difference in quality of life score changes of all domains between younger and older women following hysterectomy. Conclusion: In this preliminary study, younger women demonstrated comparable quality of life scores at 12 weeks after hysterectomy in comparison with older women. The results of this study may assist the gynaecologist and patient during pre-surgery counselling

A quasi-randomised controlled trial of online distribution of home-based hepatitis C self-testing for key populations in Malaysia: a study protocol.

BACKGROUND: Malaysia has an estimated hepatitis C virus (HCV) prevalence of 1.9% among its adult population and a history of providing HCV treatment in the public sector. In 2019, Malaysia launched a 5-year national strategic plan for viral hepatitis control and has been expanding HCV testing and treatment to the primary care and community levels, while actively engaging key populations in services for hepatitis care. The Ministry of Health (MoH) is seeking to specifically understand how to better target HCV services at men who have sex with men (MSM); HCV self-testing could increase the uptake of HCV testing among this group. METHODS: We aim to integrate HCV antibody self-testing into an existing online platform used for HIV self-testing, to evaluate the acceptability and impact of an online HCV self-testing programme in Malaysia. This is a non-blinded parallel group quasi-randomised superiority study comparing HCV self-testing via an online distribution model with the standard care, which involves attending a clinic for facility-based HCV antibody testing (control, 2:1). Participants will be randomised to either the HCV self-testing via online distribution arm, in which either an oral fluid- or blood-based HCV self-test kit will be mailed to them, or the control arm, where they will be provided with information about the nearest centre with HCV testing. The primary outcome is the number and proportion of participants who report completion of testing. Secondary outcomes include the number and proportion of participants who (a) receive a positive result and are made aware of their status, (b) are referred to and complete HCV RNA confirmatory testing, and (c) start treatment. Acceptability, feasibility, attitudes around HCV testing, and cost will also be evaluated. The target sample size is 750 participants. DISCUSSION: This study is one of the first in the world to explore the real-world impact of HCV self-testing on key populations using online platforms and compare this with standard HCV testing services. The outcomes of this study will provide critical evidence about testing uptake, linkage to care, acceptability, and any social harms that may emerge due to HCV self-testing. TRIAL REGISTRATION: ClinicalTrials.gov NCT04982718

Colorectal cancer survival among Malaysia population: data from the Malaysian National Cancer Registry

BackgroundColorectal cancer (CRC) is a major cause of cancer-related mortality worldwide. It is the second leading cause of cancer death in men and women in Malaysia and poses a major burden on society.AimsTo determine the overall survival rate of patients diagnosed with CRC and factors contributing to survival.MethodsData were obtained from the Malaysia National Cancer Registry. All patients with CRC were identified, and a total of 15,515 patients were screened. A total of 5,675 CRC patients were included from January 1, 2012, to December 31, 2016. Sex, age groups, ethnic groups, stage at diagnosis, cancer sites, and status of treatment received were analysed. The Kaplan–Meier analysis was performed to estimate the 1-, 3-, and 5-year survival of CRC. The log-rank test was conducted to compare the survival between sex, age groups, ethnic groups, stage at diagnosis, cancer sites, and status of treatment received. Multiple Cox regression was conducted to determine the risk of CRC death.ResultsOf 5,675, a total of 2,055 had died, 3,534 were censored, and another 86 were still alive within 5 years of CRC diagnosis. The 1-, 3-, and 5-year survival rates were 68.5%, 34.7%, and 18.4%, respectively with a median survival time of 24 months. Significant differences in survival rates of CRC were observed between age groups (p < 0.001), ethnic groups (p < 0.001), stages at diagnosis (p < 0.001), treatment status (p = 0.003), and treatment modalities (p < 0.001). No significant difference was observed in survival rates of CRC between sex (p = 0.235) and cancer sites (p = 0.410). Those who were 80 years old and above were found to be at higher risk of CRC death compared to those below 80 years old (adjusted hazard ratio (HR): 1.24, 95% CI 1.14–1.36). The risk of CRC death was also found four times higher among those with stage IV compared to those with stage 0 (adjusted HR: 4.28, 95% CI 3.26–5.62).ConclusionIn general, Malaysian patients with CRC had low survival rates. National health policies should focus on enhancing awareness of CRC, encouraging early screening, and developing strategies for early detection and management to reduce CRC-associated mortality

Rate and Predictors of Infant Abandonment among Unmarried Mothers at a Public Hospital in Kedah, Malaysia: A retrospective study

Objectives: This study aimed to determine the rate of unmarried mothers who decided to abandon their infants at the Hospital Sultan Abdul Halim, Kedah, Malaysia and the predictors that influenced such decisions. Materials and Methods: A retrospective study was conducted on unmarried mothers who gave birth at the hospital between January 2011 and December 2013. Information about their sociodemographic and clinical characteristics and their decisions on whether to abandon their infants was obtained from medical records. Furthermore, the predictors of infant abandonment were identified through binary logistic regression analysis. Results: Of the 266 unmarried mothers included in this study, nearly half were aged less than 20. Most of them were Malay, unemployed and first-time mothers with a generally low educational level and income. Fifty (18.8%) of them decided to abandon their children, and the predictors of making such decisions included being aged 30 or above (adjusted odds ratio [aOR] 3.33 [95% confidence interval {CI} 1.21–9.15]), having rape-related pregnancy (aOR 5.89 [95% CI 2.10–16.53]) and having unemployed male partners (aOR 3.10 [95% CI 1.50–6.39]). Conclusion: This study revealed that infant abandonment was common in the studied area, particularly among unmarried mothers with complex social factors. The factors that can be used to predict decisions on infant abandonment included the mother’s age, rape-related pregnancy and employment status of the male partner

Prescribing patterns of celecoxib and prescribers′ perceptions among three general hospitals in Northern Malaysia

Objectives: This paper describes the clinical use of celecoxib in three major, government-subsidized hospitals across Northern Malaysia. Doctors′ perceptions of issues related to celecoxib and other nonsteroidal anti-inflammatory drugs (NSAIDs) were assessed concurrently. Materials and Methods: A total of 365 patients receiving prescriptions containing celecoxib in 2012 were recruited. Their medical records were screened for celecoxib-related information including its indications, risk factors for gastrointestinal bleeding and cardiovascular comorbidities. A self-reported, six-item questionnaire was used to investigate the perceptions of 211 doctors. Results: Patients within a wide range of ages had received celecoxib (15-94 years). General acute pain (23.6%), general chronic pain (20.3%), and osteoarthritis (12.3%) were the most common indications. Less than one-third of patients prescribed with celecoxib (31.5%) were found to have one or more risk factors for gastrointestinal complications. Advanced age (≥65 years) was identified as the most common risk factor (14.8%). Approximately one-third of them (32.4%) were having one or more cardiovascular comorbidities including hypertension and chronic heart diseases. Majority of the doctors (53.1%) believed that celecoxib is more efficacious than conventional NSAIDs in reducing pain and inflammation. The awareness of its better gastrointestinal safety profile was exceptionally high (92.4%) and it remained as the most important factor to consider during prescribing (65.9%). Conclusion: Overall, this study revealed the prescribing patterns of celecoxib among the government-subsidized hospitals in Northern Malaysia. Certain issues like its high usage in patients without gastrointestinal risk factors and in those with cardiovascular comorbidities may require a review from clinical perspectives

Prevalence of drug-related problems and complementary and alternative medicine use in Malaysia:A systematic review and meta-analysis of 37,249 older adults

Drug-related problems (DRPs) in the elderly include polypharmacy, potentially inappropriate medications, nonadherence, and drug-related falls. In this systematic review and meta-analysis, the prevalence of DRPs and complementary and alternative medicine (CAM) use among the Malaysian elderly was estimated. PubMed, Scopus, Web of Science, and Google Scholar databases were searched to identify studies published since their inception up to 24 August 2020. A random-effects model was used to generate the pooled prevalence of DRPs along with its corresponding 95% confidence interval (CI). The heterogeneity of the results was estimated using the I2 statistics, and Cochran’s Q test and sensitivity analyses were performed to confirm the robustness of the results. We identified 526 studies, 23 of which were included in the meta-analysis. (n = 29,342). The pooled prevalence of DRPs among Malaysian elderly was as follows: (1) polypharmacy: 49.5% [95% CI: 20.5–78.6], (2) potentially inappropriate medications: 28.9% [95% CI: 25.4–32.3], (3) nonadherence to medications: 60.6% [95% CI: 50.2–70.9], and (4) medication-related falls 39.3% [95% CI: 0.0–80.8]. Approximately one in two Malaysian elderly used CAM. The prevalence of polypharmacy and potentially inappropriate medications among the Malaysian elderly population was high, calling for measures and evidence-based guidelines to ensure the safe medication use

Management and glycemic control of patients with type 2 diabetes mellitus at primary care level in Kedah, Malaysia: A statewide evaluation.

INTRODUCTION:While Kedah has recorded the highest prevalence of diabetes among all the states in Malaysia, the information on the practice and effectiveness of disease management in public health institutions remains limited. This study aimed to evaluate the management and glycemic control of patients with type-2 diabetes mellitus (T2DM) at the primary care level in Kedah. METHODS:All T2DM patients, who made at least one visit to any of the 58 public health clinics in Kedah during August 2016 and July 2017, were included in this study. The sample was selected from the National Diabetes Registry using the stratified random sampling method. The information on the demographic and clinical characteristics, laboratory findings and pharmacological treatment was gathered from medical records of patients. The differences in mean HbA1C levels across subgroups of each variable were tested using the general linear model. The evaluation of the appropriateness of treatment was performed based on the recommendations of the latest Clinical Practice Guidelines for T2DM. RESULTS:The patients (n = 23,557) were mainly female (63.4%), of Malay ethnicity (80.1%) and middle-aged (62.2%), with a mean duration of T2DM of 6.2±7.16 years. Only 15.6% of them had a HbA1C level <6.5%, and 28.6% did not have their HbA1C levels tested over the 12-month period. Yet, the underutilization of combination treatment (≥2 antidiabetic agents) and insulin in the patients with a poor glycemic control was evident. Retinopathy emerged as the most prevalent diabetes-related complication (12.6%). Along with those with a longer duration of T2DM, the patients who were younger, female and of Indian ethnicity were found to generally have a poorer glycemic control. CONCLUSION:This study discloses the suboptimal T2DM management at the primary care level in Kedah, which warrants a statewide plan for improvement

Meta-Analysis of the Association between Dietary Inflammatory Index (DII) and Colorectal Cancer

The Dietary Inflammatory Index (DII) was extensively used to examine the inflammatory potential of diet related to colorectal cancer (CRC). This meta-analysis aimed to update the evidence of the association between the DII and CRC across various culture-specific dietary patterns. Literature search was performed through online databases (Scopus, Web of Science, PubMed, and EBSCOHost). Observational studies exploring the association between the DII and CRC, published between 2017 and 2021, were included. The risk ratio (RR) and 95% confidence interval (CI) were separately computed for 12 studies comparing the highest and lowest DII scores and for 3 studies that presented continuous DII scores. A high DII score was associated with a higher risk of CRC (RR:1.16; 95% CI, 1.05&ndash;1.27). In the subgroup analysis, significant associations were seen in cohort design (RR: 1.24; 95% CI, 1.06&ndash;1.44), those lasting for 10 years or longer (RR: 2.95; 95% CI, 2.47&ndash;3.52), and in adjustment factor for physical activity (RR: 1.13; 95% CI, 1.07&ndash;1.20). An increase of one point in the DII score elevates the risk of CRC by 1.34 (95% CI: 1.15&ndash;1.55) times. The findings call for standardized measurement of the inflammatory potential of diet in future studies to enable the establishment of global guidelines for CRC prevention

Interleukin-28 Polymorphism: Ethnic variations and the response to chronic hepatitis C treatment in Malaysia

We refer to the article by Merican, which provides a comprehensive overview of chronic hepatitis C (CHC) management. The author highlighted the concern over the exorbitant cost of direct-acting antivirals, which is the reason for their limited use in Malaysia currently. Based on the findings of the previous studies, the author also underlined that Asians receiving the conventional, interferon-based treatment generally have a higher sustained virological response (SVR) rate as compared with Caucasians and African Americans, mainly due to the interleukin-28B (IL28) single nucleotide polymorphism (SNP) across different ethnic populations. Nonetheless, to date, information on the variations in IL-28 genotypes among different ethnic groups in Malaysia is still limited