Tag: nevin manimala

Med J Malaysia. 2025 Mar;80(2):191-198.

ABSTRACT

INTRODUCTION: Statins are one of the most commonly used drugs in primary care. Both hyperlipidaemia and diabetes have independently shown statistically significant association with depression. Conversely, patients with depression have also been shown to have increased comorbidity with and poorer control of both diabetes and hyperlipidaemia.

MATERIALS AND METHODS: A retrospective cross-sectional study was conducted for about 7 months (from 23 January 2024 to 9 August 2024) among adult Type 2 diabetic patients in the non-communicable disease section of Seremban Health Clinic to determine the association between statin use and depression. The data was collected via interviewerguided questionnaire that consisted of 5 sections: Section A (Participant Information), Section B (Depression, Anxiety and Stress Scale 21 [DASS-21]), Section C (Beliefs about Medicines Questionnaire [BMQ]), Section D (Malaysia Medication Adherence Assessment Tool [MyMAAT]) and Section E (Patient Health Questionnaire-9 [PHQ-9]). Consecutive patients that met inclusion and exclusion criteria who consent to be involved in the study were sampled. Although the ideal sample size that was required is 242, only 82 participants were enrolled in this study. These participants were also part of the Seremban Diabetes cohort study.

RESULTS: Since only 82 participants consented to be part of this study, the response rate was 33.9%. About 25% of patients had depression. As the statin dosage intensity increased, the prevalence of depression also increased but this was not statistically significant. Based on Pearson’s chi square test, only stress (p<0.001), anxiety (p=0.002), beliefs about medicines (p=0.010) and marital status (p=0.039) had a statistically significant association with depression. Upon adjusted logistic regression of the 4 factors (marital status, stress, anxiety and belief about medicines), only stress (OR 14.000, 95% CI 2.682 – 73.076, p=0.002) was statistically significant.

CONCLUSION: The association between depression and statin use among patients with Type 2 diabetes mellitus is not statistically significant. Further studies are needed to confirm the cause of depression in this group of patients.

PMID:40145162

Med J Malaysia. 2025 Mar;80(2):183-190.

ABSTRACT

INTRODUCTION: Young adults’ engagement in sexual risk behaviour (SRB) is a growing concern worldwide. Addressing this issue is crucial as it can lead to various detrimental effects on individuals, including psychological, behavioural, and, in severe cases, suicidal tendencies and mortality. This nationwide study aimed to determine the mediating roles of depressive, anxiety, and stress symptoms in the relationship between adverse childhood experiences (ACE), religiosity, knowledge on sexuality, attitude towards premarital sex, and SRB among young Malaysian adults using structural equation modelling (SEM).

MATERIALS AND METHODS: A quantitative, cross-sectional design was employed in this study. Respondents were recruited from June to December 2021 among students attending higher education institutions in Malaysia. Institutions were sampled using stratified random sampling and the respondents were selected via convenience sampling. Data were collected via an online survey that inquired about respondents’ socio-demographic characteristics, ACE, religiosity, knowledge on sexuality, attitude towards premarital sex, mental health status (MHS), and engagement in SRB. The data were analysed using SPSS version 27 for descriptive analysis, and SPSS AMOS version 27 for structural equation modelling (SEM) analysis.

RESULTS: A total of 1171 respondents were recruited in this study. From the SEM analysis, the proposed model indicated a good fit, and it explained 26% of the SRB variance. There was a partial mediation effect of the relationship between ACE on SRB through MHS (p<0.05), as well as religiosity on SRB through MHS (p<0.05). There was no significant mediation effect was found for the other variables.

CONCLUSION: This study highlighted the mediation effect of MHS between ACE on SRB, as well as between religiosity and SRB. Apart from addressing ACE and religiosity of the young adults, MHS should also need to be explored when dealing with SRB issues and vice versa. Preventive measures should be considered at younger stage to prevent high risk behaviour among young adults.

PMID:40145161

Med J Malaysia. 2025 Mar;80(2):161-167.

ABSTRACT

INTRODUCTION: Dengue is a major public health issue, with 3,900,000 people living in 129 dengue-endemic countries globally facing a risk of contracting dengue fever. Dengue incidence in Sabah is among the highest in Malaysia. In 2022, Kota Kinabalu District reported 22% of the total number of dengue cases in Sabah. The objective of this study was to develop a prediction model for dengue incidence using meteorological, entomological, and environmental parameters in Kota Kinabalu, Sabah.

MATERIALS AND METHODS: An ecological study was conducted from 2016 to 2021 using the dengue database and meteorological data. The forecasting model for dengue incidence was performed with R software using the seasonal autoregressive integrated moving average (SARIMA) model. The model was fitted based on the reported weekly incidence of dengue from 2016 to 2020 and validated using data collected between January and December 2021.

RESULTS: SARIMA (1,1,1) (1,1,0)52 with the external regressor maximal temperature, Aedes index, and vacant lot were the models with minimal measurement errors, as indicated by the Mean Absolute Error (MAE) values of 3.04, Root Mean Squared Error (RMSE) of 4.43, and Akaike Information Criterion (AIC) of 1354.82.

CONCLUSIONS: The predicted values in 2021 accurately forecasted the capability to serve as an early warning system for proactive dengue measures. This information is deemed valuable to healthcare administrators for enhancing the level of preparedness.

PMID:40145157

Med J Malaysia. 2025 Mar;80(2):147-152.

ABSTRACT

INTRODUCTION: IOut-of-hospital cardiac arrest (OHCA) is globally a critical, time-sensitive emergency with varying outcomes. In Asia, the Pan Asian Resuscitation Outcome Study reported survival rates between 0.5% to 8.5%. We aim to describe the characteristics and outcomes of OHCA cases responded to by Emergency Medical Services (EMS) across several cities in Sarawak, Penang and Klang Valley in Malaysia.

MATERIALS AND METHODS: This retrospective observational study analysed EMS data from Sarawak, Penang and Klang Valley from 2010 to 2019. All OHCA cases where EMS performed cardiopulmonary resuscitation (CPR) were included, regardless of age or aetiology. The primary outcome was survival to hospital admission with the secondary outcome a return of spontaneous circulation (ROSC) prior to Emergency Department arrival.

RESULTS: A total of 2,435 OHCA cases were analysed. Median patient age was 58 years, 70% of them are male with 63% had underlying medical conditions, with hypertension being the most common. Out of all cases, 71% of arrests occurred at home, 60% witnessed. Median time from arrest to 999 call was 20 minutes, median time for ambulance arrival thereafter is 17 minutes. Bystander CPR rate was 38%, bystander Automated External Defibrillator (AED) use 1.5- 2.6%. Detection of shockable rhythm on first analysis by EMS was 3.9 to 7.7%. Overall survival to admission rate was 4.76%. ROSC rate before Emergency Department arrival was 2.8%. Survival to admission among bystander-witnessed arrests with shockable rhythm was 14.7%.

CONCLUSION: Survival to admission rates for OHCA patients in the studied Malaysian regions (1.3-6.7%) are lower compared to some Asian countries. Areas for improvement include reducing time from arrest to 999 calls, decreasing time to EMS arrival, and increasing bystander CPR and AED use rates. Implementing the Utstein ten-step implementation strategy, focusing on community-based interventions and improving EMS response, could potentially enhance survival rates in Malaysia.

PMID:40145155

Med J Malaysia. 2025 Mar;80(2):118-126.

ABSTRACT

INTRODUCTION: Cirrhosis is common in Malaysia, but no questionnaire in the local language (Malay) has been developed to assess patients’ knowledge of this disease. This study aimed to adapt and validate the Malay Adult cirrhosiS Knowledge Questionnaire (ASK-QM).

MATERIALS AND METHODS: ASK-QM was translated from English to Malay according to international guidelines. It was validated among cirrhotic patient who understand Malay language from two major liver centers in Klang Valley, Malaysia (University of Malaya and Hospital Selayang) from January 2021 to March 2022, at week 0 and 2. Patients with hepatic encephalopathy were excluded.

RESULTS: 121 out of 132 patients with cirrhosis agreed to participate (response rate=91.7%). The overall median score of the ASK-QM was 54.5 [38.6-68.2] and the difficulty factor was 0.5 (range: 0.1-0.8 for each domain). Confirmatory factor analysis showed a good model fit with results of Comparative fit index (CFI) ranging from 0.836 to 1.000, whilst, the Tucker-Lewis index (TLI) ranged from 0.690 to 1.004 across all four domains. The root mean square error of approximation (RMSEA) value was reported from 0.000 to 0.100. For standardized root mean squared residual (SRMR) was from 0.008 to 0.015. Patients with tertiary education scored higher compared to those without (63.6 [45.5-77.3] vs 52.3 [36.4-63.6], p<0.05). The overall Kuder-Richardson (KR) coefficient was 0.761 indicating adequate internal consistency. Test-retest among 82 out of 121 patients (response rate=67.7%) demonstrated adequate reliability with eighteen out of 22 items having Wilcoxon signed-rank test values that were statistically not significant, p>0.005.

CONCLUSION: The ASK-QM was found to be a valid and reliable questionnaire for evaluating knowledge of liver cirrhosis amongst Malay-speaking adults.

PMID:40145151

Clin J Pain. 2025 Mar 27. doi: 10.1097/AJP.0000000000001290. Online ahead of print.

ABSTRACT

OBJECTIVES: The assessment of the spatial characteristics of pain, such as location and extent, is essential in the clinical evaluation of pain syndromes, especially when managing patient’s with chronic musculoskeletal pain. This study evaluated the convergent validity of pain drawings (PDs) and anatomical checklists (ACLs) in measuring pain location (PL) and pain extent (PE) in individuals with chronic musculoskeletal pain.

METHODS: Twenty volunteers participated, each completing a PD and an ACL in a randomized order following standardized training. PDs were digitized and analyzed using a custom algorithm on a web platform. PL was categorized across 45 anatomical areas. PE was assessed using a region-weighted approach by means of the Margolis rating scale and a pixel-based method. Statistical analyses included Spearman’s rho and the Jaccard Index to compare the obtained PD metrics.

RESULTS: A strong correlation was found between a PDs and ACLs for PE (Spearman’s rho=0.823), suggesting similar capabilities in quantifying the spatial distribution of pain. However, a significant discrepancy in PL measurements, with a mean Jaccard Index of 0.54, indicated poor agreement between methods.

DISCUSSION: These results highlight the non-interchangeability of these instruments for PL identification and underscore the importance of each tool’s unique advantages and limitations. The study also highlighted the potential benefits of incorporating innovative pain metrics into current health questionnaires to enhance their clinimetric properties. These findings advocate for continued research with larger and more diverse patient cohorts to further validate PDs and ACLs and to explore additional psychometric properties for pain assessment.

PMID:40145148 | DOI:10.1097/AJP.0000000000001290

Front Immunol. 2025 Mar 12;16:1526318. doi: 10.3389/fimmu.2025.1526318. eCollection 2025.

ABSTRACT

BACKGROUND: Relevant studies have demonstrated the poor treatment outcomes and prognosis for double-expressor diffuse large B cell lymphoma (DE-DLBCL) in the rituximab era. Zanubrutinib plus R-CHOP (rituximab, cyclophosphamide, doxorubicin/liposomal doxorubicin, vincristine, prednisone; ZR-CHOP) has shown efficacy in untreated non-GCB DLBCL patients with extranodal involvement. However, its efficacy in newly diagnosed DE-DLBCL remains uncertain.

OBJECTIVE: This retrospective study sought to assess the efficacy and safety of ZR-CHOP in comparison to R-CHOP in treatment-naïve patients with DE-DLBCL.

METHOD: This study assessed 78 patients with newly diagnosed DE-DLBCL who were admitted between June 2017 and January 2024. Among them, 55 patients received the R-CHOP regimen, while 23 patients were treated with the ZR-CHOP regimen. The clinical characteristics were well balanced between the two groups.

RESULTS: The complete response rates (CRR) were higher in the ZR-CHOP group than the R-CHOP group, regardless of whether patients completed 4 or 6 treatment cycles (P= 0.019; P= 0.025). ORR in the ZR-CHOP group showed a higher trend than that in the R-CHOP group (P= 0.624; P= 0.219). The median follow-up period was 23.3 months, and the predicted median progression free survival (PFS) in the R-CHOP group was 22.8 months, whereas the median PFS in the ZR-CHOP group was not reached. The 1-, 2-, and 3-year PFS rates in the ZR-CHOP group showed a beneficial trend compared with the R-CHOP group, but there was no statistical difference (P= 0.072). However, the PFS of the ZR-CHOP group was longer than that of the R-CHOP group in patients with Ki67 index >75% (P= 0.034) and p53 expression >50% (P= 0.0033). The predicted median overall survival (OS) in the ZR-CHOP and R-CHOP groups were not reached. The 1-, 2- and 3-year OS rates were not significantly different between the two groups (P= 0.29). The most common adverse event in both groups was hematotoxicity, but there was no significant difference in the incidence of all adverse events between the two groups.

CONCLUSION: First-line treatment with the ZR-CHOP regimen improved CRR in the untreated patients with DE-DLBCL and prolonged PFS in the Ki67 index >75% subgroup and the p53 expression >50% subgroup.

PMID:40145086 | PMC:PMC11936942 | DOI:10.3389/fimmu.2025.1526318

N Am Spine Soc J. 2025 Feb 13;21:100594. doi: 10.1016/j.xnsj.2025.100594. eCollection 2025 Mar.

ABSTRACT

BACKGROUND: Adjacent segment disease (ASD) is one of the most common complications after spinal fusion. There are several risk factors for ASD, but recently the quality of the paraspinal musculature has been implicated as a potential risk factor. The purpose of this study is to examine the association between paraspinal muscle degeneration and risk of surgery for ASD.

METHODS: We conducted a retrospective review of spinal fusion patients at our institution from 2009 to 2022 who underwent subsequent surgery for ASD. Inclusion criteria included patients aged 18 and older at time of index operation. Control cohort included patients who did not undergo subsequent surgery for adjacent segment disease with a minimum one year follow up. Patients were matched based on age, gender, and BMI. We measured paraspinal fat percentage and circumferential surface area (CSA) at L3 and at the proximal end of their future construct. Paraspinal fat percentage and CSA were measured using ImageJ (National Institutes of Health, Bethesda, Maryland, USA). Student T-test was used to evaluate for statistically significant differences with p-value ≤ .05.

RESULTS: A total of 154 patients were reviewed with 77 patients in each cohort. The average age and BMI in the control group was 61.3 and 30.0 versus 61.2 and 29.6 in patients who underwent subsequent surgery. Overall, patients who underwent surgery for adjacent segment disease had 24% higher paraspinal fat percentage at L3 (13.8 ± 7.7% vs. 11.1 ± 6.5%, p-value = .02) and 22% higher paraspinal fat percentage at the top end of their construct (16.0 ± 9.0% vs. 13.1 ± 7.1%, p-value = .03).

CONCLUSIONS: Our study found that patients who undergo surgery for adjacent segment disease have 24% higher fat percentage in their paraspinal musculature at L3 and 22% higher fat percentage at the proximal end of their fusion construct.

PMID:40145066 | PMC:PMC11938154 | DOI:10.1016/j.xnsj.2025.100594

JHLT Open. 2024 Aug 12;6:100147. doi: 10.1016/j.jhlto.2024.100147. eCollection 2024 Nov.

ABSTRACT

BACKGROUND: Combined heart-liver transplantation (CHLT) is a complex procedure with rising demand and is subject to ongoing assessment. Here, we provide an update on indications, patient outcomes, and risk factors.

METHODS: This retrospective study utilized CHLT data from the United Network for Organ Sharing registry between 1990 and 2023. Recipient and donor characteristics, and risk factors for mortality were analyzed using Cox regression hazard models. Recipient and graft survival at 30 days, 1 year, and 5 years were analyzed using the Kaplan-Meier method.

RESULTS: This cohort included 532 patients with median survival of 16.9 years (SD: 1.09). The most common indications for CHLT were congenital heart disease (36%) and dilated cardiomyopathy (31%). Patient survival at 30 days, 1 year, and 5 years were 94%, 85%, and 77%, respectively. Combined heart-liver graft survival was 93%, 85%, and 77%, respectively. Diabetes (hazard ratio [HR]: 1.74; p = 0.04) was associated with multigraft failure and mortality in multivariate analysis. Compared to congenital heart disease, dilated (HR: 0.55; p = 0.03) and restrictive myopathies (HR: 0.5; p = 0.03) were associated with improved graft and overall survival. Higher donor left ventricular ejection fraction (EF) was also associated with improved graft and overall survival (HR: 0.96; p = 0.008).

CONCLUSIONS: CHLTs are being performed at increasingly higher rates with comparable survival to single-organ transplants. Diabetes was associated with increased mortality. Recipient dilated or restrictive myopathies and higher donor EF were correlated with improved survival compared to congenital heart disease. Further studies are needed to better understand these observations.

PMID:40145062 | PMC:PMC11935517 | DOI:10.1016/j.jhlto.2024.100147

JHLT Open. 2024 Sep 5;6:100154. doi: 10.1016/j.jhlto.2024.100154. eCollection 2024 Nov.

ABSTRACT

BACKGROUND: Heart transplantation is the gold standard treatment for end-stage heart failure patients. However, the shortage of donor hearts limits its applicability. This study aims to evaluate the risk factors associated with survival within 1-year after heart transplantation.

METHODS: A single-center retrospective cohort study evaluated 299 adult patients who underwent transplantation at the Heart Institute (Incor) between January 2013 and December 2019. Univariate and multivariate Cox regression analyses were conducted to identify independent predictors of 1-year survival among well-established prognostic clinical characteristics described in the literature. Patients were followed until death or the last observation on October 12, 2022. A Simple Risk Index was created based on the hazard ratio of each factor.

RESULTS: Chagas disease was the most common cause of cardiomyopathy (36%). Most patients were male (65%) with a median age of 50 (39-58) years. Four variables observed during the last clinical assessment in the intensive care unit before surgery were found to be statistically significant: maximum Sequential Organ Failure Assessment (SOFA) score, creatinine clearance in 3 quartile categories, C-reactive protein in 3 categories, and white blood cell count in 3 categories. The model demonstrated good discrimination (C-index = 0.74) and calibration. The group at high risk (>20 points) exhibited significantly higher mortality rates at 1 year (p < 0.001).

CONCLUSIONS: The study introduces a risk prediction score for 1-year post-transplant mortality in a reference center in Brazil. The score is based on four variables: maximum SOFA score, creatinine clearance, C-reactive protein, and white blood cell count.

PMID:40145057 | PMC:PMC11935338 | DOI:10.1016/j.jhlto.2024.100154