METHODS: 200 patients with heart failure and reduced ejection fraction (HFrEF) admitted into two hospitals in Malaysia due to worsening of HF were surveyed using the EQ-5D-5 L questionnaire. The primary outcomes were utility values at admission, discharge and 1-month post-discharge (1MPD). Secondary outcomes included the visual analogue scores (VAS) and the proportion of patients reporting each EQ-5D-5 L dimension levels. Missing data were imputed using multiple imputation, and generalised linear mixed models were fitted.
RESULTS: At admission, the unadjusted mean utility values and VAS scores for HFrEF patients in Malaysia were as low as 0.150 ± 0.393 and 38.2 ± 20.8, respectively. After a median hospital stay of 4 days, there was a significant improvement in utility values and VAS scores by 0.510 (95% CI: 0.455-0.564) and 28.8 (95% CI: 25.5-32.1), respectively. The utility value and VAS score at 1-month post-discharge were not significantly different from discharge. The proportion of HFrEF patients reporting problems and severe problems in mobility, self-care, usual activities, and anxiety/depression, pain/discomfort reduced at varying degree from admission to discharge and 1MPD.
CONCLUSION: HF is a progressive condition with substantial variation in HRQoL during the disease trajectory. During hospitalisation due to worsening of HF, HFrEF population has unfavourable HRQoL. Rapid and significant HRQoL improvement was observed at discharge, which sustained over one month. The study findings can inform future cost-effectiveness analyses and policies.
METHOD: s. A prospective cohort observational study was performed on patients who underwent prostate biopsy under LA. Visual Analogue Scale (VAS) was used during the procedure. International Prostate Symptoms Score (IPSS) and International Index of Erectile dysfunction (IIEF) were assessed before the procedure and in 14 days after the procedure. Complication for each procedure was recorded.
RESULT: A total of 128 patients with 64 patients for each group underwent prostate biopsy by TP and TR under LA. TP targeted biopsy group had comparable pain scores to those who underwent the procedure using the TR routes. The median pain score for the TP group was 2 and TR was 3, (IQR=2, range 0-10 for both groups)with no significant pain difference between both groups (P=0.48). Furthermore, there was no significant difference in urinary function(p=0.68) and sexual function (p=0.19) between the two groups post-procedure. Both groups have similar rates of complications, with no significant difference observed. Urinary tract infection incidents that did occur were rare and did not significantly differ between the groups (p=0.21). None of the patients experienced sepsis postoperatively. AUR was reported in both groups, slightly higher with 9.4%(N=6) in the TP group and 6.3%(N=4) in the TR group however no significant difference(p=0.112) was noted. Haematuria is common in both groups with TP (66%) and TR (59%) but self-limiting with Clavien-Dindo grade I without significant difference (p=0.589).
CONCLUSION: Our results showed that both Transperineal and transrectal approaches have similar tolerability with no significant difference in functional outcome or complications. Further studies are mandatory to verify our results.
DESIGN AND STUDY SAMPLE: Study 1 (normal hearing, n = 20) examined masker-level effects on TFS using a manual threshold determination method from an earlier study. Study 2 (normal hearing, n = 21; hearing loss, n = 5) evaluated the reliability of a self-administered TFS test using a new automated threshold determination procedure.
RESULTS: Moderate masker levels (30-40 dB SPL) were suitable for the TFS measurements, with 40 dB SPL being optimal. Lower level (20 dB SPL) led to floor effects, while higher level (50 dB SPL) broadened cochlear tuning and reduced TFS values. The self-administered test demonstrated ±9 dB limit of agreement, with intra-subject absolute mean differences of 1.8-2.7 dB across test frequencies, indicating greater variability compared to the manual method.
CONCLUSIONS: The self-administered TFS test is a candidate for hearing screening, particularly for mild sensorineural hearing loss. However, further research is needed to reduce measurement variability and optimise testing for real-world use.
MATERIAL AND METHODS: We have analyzed 4341 culture-positive urine samples received by microbiology laboratory during the year 2021. The bacterial identification was done by matrix-assisted laser desorption ionization-time of flight mass spectrometry. The antibiotic sensitivity was tested by automated VITEK-2® COMPACT (bioMérieux) system.
RESULTS: Among 4341 culture-positive samples, Enterococcal species were isolated from 159 samples. A total of 64.7% of the isolates were identified as Enterococcus faecalis and 28.3% of the strains as Enterococcus faecium. All the enterococci were sensitive to linezolid, teicoplanin, and vancomycin, whereas 59.1%, 30.9%, and 23.3% of the strains exhibited resistance to high-level gentamicin, benzylpenicillin, and nitrofurantoin, respectively. 33.67 % of the isolates were identified as multidrug-resistant (MDR) strains as they exhibited resistance to high-level gentamicin, benzylpenicillin, and nitrofurantoin.
CONCLUSION: Our study shows the prevalence of Enterococcus faecalis and high-level gentamicin-resistant enterococcal strains. The MDR pattern of enterococci requires careful consideration of antimicrobial therapy to treat UTIs. The reserved drugs such as linezolid, vancomycin, and teicoplanin should be cautiously used for the treatment of enterococcal UTI.
METHODS AND RESULTS: This was a retrospective review of 198 patients who underwent VA-ECMO after congenital cardiac surgeries at our institute between 2004 and 2023. Patients were divided into pre-ECMO protocol (2004-2017) and post-ECMO protocol (2018-2023) implementation. There were 107 patients in the preprotocol era and 91 in the postprotocol era. We compared weaning from ECMO and survival to hospital discharge between the two eras. An analysis of the factors influencing survival to hospital discharge was also done. ECMO was initiated through the central cannulation technique through median sternotomy in all patients. The median age and weight at initiation were 4 months (interquartile range [IQR] 1-33.5 months) and 4.4 kg (IQR 3.3-10.1 kg), respectively. The successful weaning of the ECMO (n = 67/91, 73.6%) and survival to discharge (n = 43/91, 47.3%) were higher in patients of the postprotocol era. However, it was not statistically significant. Higher risk adjustment for congenital heart surgery-1 >3 and acute kidney injury were independent predictors of poorer survival to hospital discharge.
CONCLUSIONS: A protocol-based ECMO program may improve outcomes of successful weaning and survival to discharge in patients undergoing congenital cardiac surgeries.
METHODS: Adult PLHIV in care at five Asia-Pacific HIV clinics were enrolled at routine clinic visits between July 2019 and June 2020. Depression, substance use, sexual practice and socio-demographic data were collected using PHQ-9, ASSIST, and a study-specific questionnaire. Clinical data were accessed from medical records. Risk factors for medium- to high-risk sexual practices, defined based on total scores from the sexual practice questionnaire assessing number of sexual partners and condom use, were analyzed using logistic regression. Moderate to severe depression was defined as a PHQ-9 score >9, and moderate- to high-risk substance use as an ASSIST score ≥11 for alcohol or ≥4 for other substances.
RESULTS: Among 723 participants, median age was 38 years, 89% were male, 99% were on ART and 37% had medium- to high-risk sexual practices. Medium- to high-risk sexual practices were more common among those ≤30 years old, unemployed, and HIV status disclosed, and were more likely in participants with moderate to severe depression (aOR 2.09, 95%CI 1.17-3.74) compared to none to minimal depression, and moderate- to high-risk substance use (aOR 1.73, 95%CI 1.23-2.44) compared to those without.
CONCLUSIONS: Further integration of comprehensive sexual risk reduction strategies, mental health services and substance use harm reduction within HIV clinical settings in the region is needed.
METHODS: Conducted at Universiti Sains Malaysia, this cross-sectional study involved 234 medical students from the 1st, 3rd, and 5th years of the MBBS program. Data were collected via five validated survey instruments: DASS-9, TEQ, Dundee, Brief COPE, and CBI, through Google Forms. Participants were selected using purposive sampling. The surveys assessed mental well-being (burnout, anxiety, depression, stress), coping strategies, and medical professionalism attributes. Model fit was evaluated using established indices.
RESULTS: Findings indicated that professional behavior reduces burnout and negatively impacts negative coping strategies (NCSs). Additionally, medical professionalism indirectly enhances empathy and positively influences CSs. Conversely, psychological distress increases NCSs and reduces empathy. Positive coping strategies (PCSs) enhance empathy levels, while MWB issues elevate NCSs.
DISCUSSION: The study underscores the vital role of professional behavior in mitigating burnout and fostering positive coping mechanisms among medical students. Addressing MWB issues through targeted interventions can enhance empathy and professional behavior, ultimately improving the quality of patient care.
METHODS: The SUNRISE Study recruited 429, 3-4-year-old child/parent dyads from 10 LMICs. Children wore activPAL accelerometers continuously for at least 48 h to assess their physical activity and sleep duration. Screen time and time spent restrained were assessed via parent questionnaire. Differences in prevalence of meeting guidelines between urban- and rural-dwelling children were examined using chi-square tests.
RESULTS: Physical activity guidelines were met by 17% of children (14% urban vs. 18% rural), sleep guidelines by 57% (61% urban vs. 54% rural), screen time guidelines by 50% (50% urban vs. 50% rural), restrained guidelines by 84% (81% urban vs. 86% rural) and all guidelines combined by 4% (4% urban vs.4% rural). We found no significant differences in meeting the guidelines between urban and rural areas.
CONCLUSIONS: Only a small proportion of children in both rural and urban settings met the WHO 24-h movement guidelines. Strategies to improve movement behaviours in LMICs should consider including both rural and urban settings.
METHODS: A mandibular complete denture was scanned by a desktop scanner to create a digital STL reference file (control). Fifteen identical scans were created by using an intraoral scanner and exported as STL files (test group). These 15 files were saved at 100% of the original scan resolution then reduced to 75%, 50%, 25%, and 10% of their original quality. These 75 scans were statistically analyzed by calculating The Hausdorff Distance (HD) and Dice Similarity Coefficients (DSC) to assess the variation between the mean reduced intraoral scanner files test and the control desktop scanner file and eventual inconsistencies. The volumes of the reduced mesh files were also compared with the 100% resolution intraoral mesh files to evaluate precision and trueness of the intraoral scanner.
RESULTS: Reduced mesh files of 10%, 25%, 50%, 75% of the original scan yielded a percentage similarity average of 99.7%, indicating a very high precision value for the intraoral scanner. Also, the volumes of each associated mesh reduction slightly decreased with non-statistically significant results.
CONCLUSIONS: This study concluded that the chosen intraoral scanner for this study provided very high trueness (98.34%) and precision (99.7%), and also the volumes of reduced mesh files slightly decreased but were not statistically significant.
METHODS: A systematic literature search was conducted using PubMed, Google Scholar, Web of Science, Scopus, and Embase, focusing on studies published in the last fifteen years from 2009 to 2023. Keywords included "uveitis," "infectious uveitis," "viral uveitis," and others. Rigorous inclusion and exclusion criteria were applied, and data were synthesized thematically. Gene symbols related to infectious uveitis were analyzed using protein-protein interaction (PPI) networks and pathway analyses to uncover molecular mechanisms associated with infectious uveitis.
RESULTS: The search from different databases yielded 97 eligible studies. The review identified a significant rise in publications on infectious uveitis, particularly viral uveitis, over the past fifteen years. Infectious uveitis prevalence varies geographically, with high rates in developing regions due to systemic infections and limited diagnostic resources. Etiologies include viruses (39%), bacteria (17%), and other pathogens, substantially impacting adults aged 20-50 years. Pathogenesis involves complex interactions between infectious agents and the ocular immune response, with key roles for cytokines and chemokines. The PPI network highlighted IFNG, IL6, TNF, and CD4 as central nodes. Enriched pathways included cytokine-cytokine receptor interaction and JAK-STAT signaling. Clinical manifestations range from anterior to posterior uveitis, with systemic symptoms often accompanying ocular signs. Diagnostic strategies encompass clinical evaluation, laboratory tests, and imaging, while management involves targeted antimicrobial therapy and anti-inflammatory agents.
CONCLUSION: This review underscores the complexity of infectious uveitis, driven by diverse pathogens and influenced by various geographical and systemic factors. Molecular insights from PPI networks and pathway analyses provide a deeper understanding of its pathogenesis. Effective management requires comprehensive diagnostic approaches and targeted therapeutic strategies.