Tag: pubmed

Med J Malaysia. 2026 Jul;81(4):461-465.

ABSTRACT

INTRODUCTION: Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality, with cervical insufficiency being a major contributor. While transvaginal ultrasound is the gold standard, concerns over invasiveness, resource requirements, and acceptability limit its universal use. Transabdominal cervical length measurement may offer a pragmatic alternative, particularly in conservative populations. We aim to compare transabdominal versus transvaginal cervical length measurement for screening of short cervix during the mid-trimester, and to determine the feasibility and clinical utility of using transabdominal ultrasound as a primary screening tool, especially in populations with reservations about undergoing transvaginal scans.

MATERIALS AND METHODS: This was a prospective observational cohort diagnostic accuracy study involving pregnant women undergoing routine mid-trimester anomaly scans. Cervical length was measured using transabdominal and transvaginal ultrasound by experienced sonographers.

STATISTICAL ANALYSIS: correlation assessed with Spearman’s coefficient. Agreement evaluated with intraclass correlation and Bland-Altman plots. Diagnostic accuracy metrics (sensitivity, specificity, PPV and NPV) were calculated for transabdominal thresholds. Confounding factors, including bladder filling, maternal body mass index (BMI), and prior caesarean delivery on visualisation, were also evaluated.

RESULTS: Of the 266 women eligible to participate in the study, 6.0% were excluded as they declined a transvaginal scan. Postvoid transabdominal (TA) measurements demonstrated better agreement with transvaginal (TV) values but were associated with higher rate of nonvisualization (10.0%). Bland-Altman plots showed good agreement without systematic bias. The mean prevoid TA cervical length and postvoid TA cervical length were 35.7 mm and 35.6 mm respectively, compared to 39.3 mm on TV measurement. Non-visualization occurred more often postvoid (10%) than prevoid (6.4%), while postvoid TA measurements showed stronger agreement with TV (ICC=0.818). Agreement of measurements was higher among Maternal-Fetal Medicine (MFM) consultants than among MFM fellows. Body mass index (BMI) and prior caesarean section scars did not significantly affected visualization or measurement accuracy.

CONCLUSION: TA cervical length measurement is a reliable initial screening approach for identifying women at risk of short cervix during mid-trimester when performed by experienced operators. It serves as a pragmatic alternative in settings where TV scans are declined or not feasible, facilitating timely referral for TV confirmation and early initiation of preventive interventions such as progesterone therapy or cerclage. However, its application may be limited in untrained hands.

PMID:42584432

Med J Malaysia. 2026 Jul;81(4):455-460.

ABSTRACT

INTRODUCTION: Improper disposal of unused or expired medications poses significant public health and environmental risks. Despite Malaysia’s “Return Your Medicines Program,” improper disposal practices persist, particularly among Type 2 diabetic patients on long-term therapies. This study aimed to determine awareness and disposal practices of unused or expired medications among Type 2 diabetic patients in Ipoh and identify factors influencing improper disposal.

MATERIALS AND METHODS: A cross-sectional study was conducted at three government clinics in the Kinta District of Ipoh, Malaysia. Data were collected from 241 participants using structured questionnaires and analysed using descriptive statistics and Pearson’s chi-square tests.

RESULTS: A total of 34.4% of respondents reported having unused or expired medications, primarily due to overprescription (36.1%). Among the diabetic patients surveyed, 68% demonstrated satisfactory awareness regarding the disposal of unused prescribed medications, while 32% showed unsatisfactory awareness. In terms of disposal practices, 43.37% of participants followed proper methods, whereas 56.63% engaged in poor disposal practices. A statistically significant association was observed between the level of awareness and the disposal practices adopted by the participants(p=0.000). It is recommended that health authorities enhance public education campaigns and implement accessible, wellpublicized medication take-back programs to promote proper disposal of unused or expired medicines.

CONCLUSION: The study identifies a strong association between awareness levels and proper disposal practices of unused or expired medications, emphasizing the need for targeted educational initiatives to promote safe disposal among patients.

PMID:42584431

Med J Malaysia. 2026 Jul;81(4):421-429.

ABSTRACT

INTRODUCTION: COVID-19, caused by SARS-CoV-2 virus, is a respiratory infection that led to the 2020 pandemic. During the pandemic, mortality directly related to COVID-19 infection were classified as COVID-19 death based on case definition. However, excess mortality would be a more comprehensive method to look at the true impact of the pandemic rather than focusing only on COVID-19 deaths alone. The objective of this study was to determine the excess mortalities and top 5 causes of mortality that occurred during and after the COVID-19 pandemic in Perak.

MATERIALS AND METHODS: Total and age-specific mortality data tabulated by the Department of Statistics Malaysia (DOSM) for the years 2010-2023 for the state of Perak was obtained. Data for the years 2010-2019 was re-grouped according to clustered age groups. This was used to generate the linear prediction line for mortality in 2020-2023 using Microsoft Excel 2010. Excess mortalities were calculated for 2020-2023 by subtracting the actual deaths from the predicted deaths. The top 5 common causes of mortality and COVID-19 deaths were also re-tabulated for the years 2020-2023 for the clustered age groups. “Positive Excess Mortality” (PEM) meant that the number of actual deaths were higher than predicted and “Negative Excess Mortality” (NEM) meant that the actual deaths were lower than the predicted number. Significant PEM meant that the value of the actual mortality was above the upper limit of the 95% confidence interval of the predicted mortality.

RESULTS: All clustered age groups showed NEM for the year 2020. For the years 2021-2022, there was a PEM for all clustered age groups except those in the group “19 and below”. The highest excess mortality was in the “65 and above” group with 343.44 and 685.56 per 100,000 agespecific population for 2021 and 2022 respectively. The mortality rate returned to the predicted value in 2023. In 2021 and 2022, there was a PEM for the “20-39” and “40-64” clustered age groups, however they were lower compared to the “65 and above” groups. Significant PEM was seen for all deaths in the “65 and above” in 2021 (237 per 100,000) and in 2022, 596 per 100,000. There was also a significant PEM after the removal of COVID-19 deaths in 2022 for the “65 and above” age groups- 366 per 100,000. Significant PEM was also seen in the “20-39” age groups and “40-64” age groups in 2021- 14 per 100,000 and 36 per 100,000 respectively. The other values that passed the 95%CI were deemed to be negligible. There were a few changes in the top 5 ranking for causes of death in Perak, the only obvious inclusion was deaths due to COVID-19 infections in 2021 in all groups except the “19 and below”.

CONCLUSION: There was a PEM in all groups except “19 and below” after the year 2020, with the highest in the “65 and above” group. COVID-19 deaths were included in the top 5 causes of death and contributed only partly to the excess mortality across all groups except “19 and below”.

PMID:42584427

Med J Malaysia. 2026 Jul;81(4):413-420.

ABSTRACT

INTRODUCTION: Treatment adherence remains a major challenge in tuberculosis (TB) control and may be influenced by psychosocial and health system factors that remain underexplored in many settings. This study aimed to examine the association between psychosocial and health system factors and treatment adherence among TB patients in Kota Kinabalu, Sabah.

MATERIALS AND METHODS: A cross-sectional study was conducted among 351 TB patients registered in the National TB Registry between 2023 and 2024. Data were collected using structured, validated, and translated questionnaires, including the TB Stigma Scale and the Patient Health Questionnaire-9 (PHQ-9). Variables included sociodemographic characteristics, TB knowledge, treatment-related factors, and healthcare system factors. Simple and multivariable logistic regression analyses were performed to identify factors of treatment adherence.

RESULTS: Stigma was negatively associated with treatment adherence (AOR=0.90; 95% CI: 0.86-0.95; p<0.001), whereas higher TB knowledge was associated with higher treatment adherence (AOR=1.20; 95% CI: 1.06-1.35; p=0.004). Compared with video directly observed therapy (VDOT), healthcare worker (HCW)-supervised direct observed treatment short-course (DOTS) was associated with lower treatment adherence (AOR=0.23; 95% CI: 0.06-0.90; p=0.030). Longer clinic waiting time was associated with higher treatment adherence (AOR=1.09; 95% CI: 1.05-1.13; p<0.001). Depression was negatively associated with adherence in univariate analysis but was not statistically significant in the multivariable model (AOR=0.58; 95% CI: 0.21-1.58; p=0.285).

CONCLUSION: Stigma, TB knowledge, DOTS modality, and clinic waiting time were independently associated with TB treatment adherence in this setting. These findings highlight the importance of integrated, patient-centered TB care that addresses stigma, strengthens patient education, and incorporates digital approaches such as VDOT. Strengthening multifaceted interventions targeting both psychosocial and health system factors may improve TB treatment outcomes in Malaysia and similar high-burden settings.

PMID:42584426

Adv Sci (Weinh). 2026 Aug 12:e77094. doi: 10.1002/advs.77094. Online ahead of print.

ABSTRACT

Livestock multi-omics integration is key to unraveling complex trait regulation, yet systematic, livestock-specific strategies remain scarce. This review traces the progression from single-omics accumulation to multi-dimensional integration, highlighting how large-scale genomic, epigenomic, and transcriptomic projects lay the foundation for functional dissection. We identify core impediments: extreme species diversity, marked data heterogeneity, limited sample sizes, and a pervasive reduction of multi-omics data to simplistic differential screens, resulting in low translational efficiency. We critically appraise four common pitfalls-overinterpreting correlation as causation, relegating proteomics to corroborating transcriptomics, incomplete microbiome-host integration lacking environmental context, and systematic neglect of metabolic fluxomics-and show how exposomics and fluxomics add necessary causal and dynamic dimensions. To address these, we propose a livestock-adapted three-tier analytical framework: (1) statistical association of cross-omics covariation patterns; (2) machine learning-driven feature mining and integrative modeling; and (3) causal interpretation encompassing Mendelian randomization, prior-knowledge-guided network inference, and physical causal evidence via fluxomics and metabolic control analysis. We further discuss how multimodal sequencing (single-cell, spatial, temporal) and generative AI can fundamentally mitigate heterogeneity and strengthen causal evidence. Finally, we outline future priorities in database standardization, livestock-specific benchmarking, and translational pipelines, charting a path from correlation-centric reporting to mechanistic causality and precision breeding.

PMID:42584423 | DOI:10.1002/advs.77094

Child Dev. 2026 Aug 12:aacag147. doi: 10.1093/chidev/aacag147. Online ahead of print.

ABSTRACT

Through statistical learning (SL), children implicitly extract repeated patterns in their environment. The developmental trajectory of how previously learned statistical information impacts children’s subsequent learning is poorly understood. Furthermore, how SL contributes to other developmental processes, like executive function, has received surprisingly little attention. In an accelerated longitudinal design, we assessed 187 5- to 12-year-olds’ (42.8% = female, 84.6% = White) SL and executive function capacities over 16 months. Cue-based SL and retention of nonadjacent probabilistic sequences were age-invariant. However, while all age groups showed an increased sensitivity to deterministic sequences with each successive time point, 5- to 6-year-olds demonstrated a greater longitudinal increase in sensitivity than older children. This finding suggests enhanced abilities to apply previously learned deterministic sequences to novel scenarios. Regarding SL-executive function links, two latent change score models provided limited evidence for SL-executive function coupling across the time points. While further work is needed to explore SL-executive function links across other modalities and in younger populations, our results suggest that early visual SL capacities may not be a primary driver of executive function change during middle childhood.

PMID:42584404 | DOI:10.1093/chidev/aacag147

J Holist Nurs. 2026 Aug 12:8980101261475446. doi: 10.1177/08980101261475446. Online ahead of print.

ABSTRACT

PurposeGrounded in Watson’s Theory of Human Caring and holistic nursing principles, this study examined relationships among empathy, emotional intelligence, and spiritual care competence in clinical nurses and identified predictors of spiritual care competence.DesignA cross-sectional correlational design was used.MethodsData were collected from 575 hospital nurses in Taiwan using the Jefferson Scale of Empathy, the Wong and Law Emotional Intelligence Scale, and the Spiritual Care Competence Scale. Descriptive statistics, Pearson correlation coefficients, and multiple linear regression analyses were conducted.FindingsNurses demonstrated moderate-to-high spiritual care competence, which was positively correlated with empathy and emotional intelligence. Emotional intelligence (β = .383, p < .001) and empathy (β = .165, p < .001) were significant predictors, in a model that explained 21.7% of the variance (adjusted R² = .217). Spiritual care education was positively associated with competence, whereas years of clinical experience were negatively associated with attitude toward patients’ spirituality and spiritual communication.ConclusionsEmotional intelligence and empathy are key competencies associated with spiritual care competence. These findings support integrating emotional intelligence, empathy, and spiritual care training into nursing education and professional development to strengthen person-centered, holistic care.

PMID:42584397 | DOI:10.1177/08980101261475446

JACC Asia. 2026 Aug 11:S2772-3747(26)00534-X. doi: 10.1016/j.jacasi.2026.06.033. Online ahead of print.

ABSTRACT

BACKGROUND: Individuals with type 2 diabetes (T2D) have increased risk of acute myocardial infarction (AMI). Cardiovascular risk within T2D is heterogeneous and not fully explained by conventional risk factors, highlighting the need for improved biological risk stratification.

OBJECTIVES: The authors aimed to identify circulating proteins associated with incident AMI in T2D, evaluate their incremental predictive value, and explore potential causal relationships.

METHODS: In 1,830 adults with T2D from the prospective SMART2D cohort, 1,457 plasma proteins were quantified at baseline using Olink proximity extension assays. Participants were followed for incident AMI through linkage with the Singapore Myocardial Infarction Registry over a median of 10.2 years (IQR: 9.1-10.7). Multivariable Cox regression assessed protein-AMI association. Incremental predictive performance was evaluated using Harrell’s C-statistic, likelihood ratio tests (LRTs), net reclassification index (NRI), and integrated discrimination index (IDI). Two-sample Mendelian randomization, using cis-protein qualitative-trait loci from SMART2D and outcome data from Biobank Japan (14,992 cases; 146,214 controls), examined causal associations.

RESULTS: During follow-up, 223 participants (12.2%) developed AMI. Seventeen proteins were independently associated with AMI after Bonferroni correction (P < 3.43 × 10^-5), with the strongest associations observed for NEFL (HR: 1.70, 95% CI: 1.43-2.01), EDA2R (HR: 2.25, 95% CI: 1.69-2.97), and CHRDL1 (HR: 2.69, 95% CI: 1.83-3.94). An 8-protein panel improved risk classification beyond clinical variables (LRT P = 0.002; IDI: 0.049, 95% CI: 0.022-0.128, P = 0.002; and NRI: 0.318, 95% CI: 0.112-0.411, P = 0.008). Genetically predicted plasma FGF5 levels were associated with myocardial infarction risk.

CONCLUSIONS: Plasma proteomics improves AMI risk stratification in T2D, and FGF5 may play a role in cardiovascular risk in Asian populations.

PMID:42584388 | DOI:10.1016/j.jacasi.2026.06.033

J Am Coll Cardiol. 2026 Jul 30:S0735-1097(26)07131-7. doi: 10.1016/j.jacc.2026.07.014. Online ahead of print.

ABSTRACT

BACKGROUND: Inhaled cannabis is widely legal in the United States. Data regarding cardiovascular effects are conflicting and generally arise from observational studies.

OBJECTIVES: The goal was to evaluate the acute effects of cannabis inhalation on cardiac ectopy.

METHODS: We conducted a prospective, randomized, crossover trial to assess effects of inhaled cannabis on cardiac ectopy, mean glucose levels, step counts, and sleep durations. Adults who smoked or vaped cannabis on a regular basis without a history of cardiac arrhythmias were enrolled. Participants were randomly assigned each day to inhale vs abstain from cannabis via text messages for 14 days. Adherence was assessed using time-stamped Zio patch button presses at the time of cannabis use, daily surveys, and, in a subset, salivary mass spectrometry. The primary outcome was daily cardiac ectopy (daily premature atrial contractions and premature ventricular contractions).

RESULTS: Of 108 participants (mean age 32 ± 10 years, 59% women, and 37% non-Hispanic White) experiencing a total of 713 days randomized to inhaled cannabis and 616 days randomized to abstinence, randomization adherence was imperfect but generally supportive of assignment adherence. Inhaled cannabis resulted in a statistically significant 9% reduction in ectopic beats (rate ratio [RR]: 0.91; 95% CI: 0.85-0.98; P = 0.02). Daily premature atrial contractions decreased by 10% (RR: 0.90; 95% CI: 0.82-0.97; P = 0.012), whereas premature ventricular contractions showed no significant change. Each cannabis inhalation was associated with a 2% reduction in ectopic beats (RR: 0.98; 95% CI: 0.97-0.99; P = 0.043). No significant differences were observed for step counts, sleep duration, or glucose levels.

CONCLUSIONS: In a pragmatic crossover design including habitual cannabis users, randomization to inhaled cannabis was associated with less cardiac ectopy, driven by fewer premature atrial contractions. Potential withdrawal effects, moderate adherence, and co-intervention limit interpretation of causal mechanism. (Marijuana and Acute Risk of Arrhythmia-Joint Abstinence and Exposure [MARY-JANE]; NCT06021613).

PMID:42584385 | DOI:10.1016/j.jacc.2026.07.014

J Am Coll Cardiol. 2026 Jul 30:S0735-1097(26)07071-3. doi: 10.1016/j.jacc.2026.07.005. Online ahead of print.

ABSTRACT

BACKGROUND: Nicorandil, an adenosine triphosphate-sensitive potassium-channel opener with nitrate-like properties, may reduce reperfusion injury and microvascular obstruction in ST-segment elevation myocardial infarction (STEMI), but large-scale randomized evidence on long-term clinical outcomes is inconclusive.

OBJECTIVES: The CLEAN trial aimed to assess whether adjunctive intravenous nicorandil improves 12-month clinical outcomes in patients with STEMI undergoing primary percutaneous coronary intervention.

METHODS: In this multicenter, randomized, double-blind, placebo-controlled trial conducted at 49 hospitals in China, patients aged 18 to 80 years with STEMI within 12 hours of symptom onset were randomly assigned (1:1) to receive intravenous nicorandil (6 mg bolus before reperfusion followed by 6 mg/h infusion for 48 h) or matching placebo. Oral nicorandil was prohibited during follow-up. The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, target vessel revascularization, or unplanned hospitalization for heart failure within 12 months.

RESULTS: Between January 2021 and December 2023, 1,503 patients were enrolled and randomly assigned to nicorandil (n = 748) or placebo (n = 755). The primary composite outcome occurred in 98 patients (13.1%) in the nicorandil group (113 events over 717.2 person-years) and 99 (13.1%) in the placebo group (136 events over 710.3 person-years), with no significant difference between groups (rate ratio: 0.869; 95% CI: 0.650-1.162; P = 0.3429). Among secondary outcomes, nominal reductions were observed in cardiovascular death (1.9% vs 3.6%; HR: 0.515; 95% CI: 0.269-0.983) and target-vessel revascularization (1.1% vs 3.0%; HR: 0.322; 95% CI: 0.143-0.727), whereas rates of nonfatal myocardial infarction and unplanned hospitalization for heart failure were similar between groups. Adverse events did not differ between groups.

CONCLUSIONS: In patients with STEMI undergoing primary percutaneous coronary intervention, adjunctive intravenous nicorandil did not significantly reduce the 12-month primary composite outcome. These findings do not support routine use of intravenous nicorandil in unselected patients with STEMI. (Clinical Efficacy and sAfety of Intravenous Nicorandil; NCT04665648).

PMID:42584383 | DOI:10.1016/j.jacc.2026.07.005