Everolimus-Associated Thrombotic Microangiopathy Following Renal Transplant: A Case Report.

Thrombotic microangiopathy (TMA) is a serious complication that may affect post-renal transplant recipients. De novo TMA has been linked to the use of transplant immunosuppressive agents, including calcineurin inhibitors (CNI) and mammalian target of rapamycin inhibitors (mTORi). We report a case of a 41-year-old female renal transplant recipient who presented with hemolytic anemia, thrombocytopenia, and acute allograft dysfunction.

Human Leukocyte Antigen-G Gene Polymorphism in Peninsular Malaysia: A Preliminary Report.

Expression of the nonclassical human leukocyte antigen () gene is upregulated in placenta during pregnancy. In other cells, HLA-G is upregulated during parasitic infections and allergic reactions. Polymorphism at the gene locus has been reported for many populations, but so far not for any ethnic groups in Malaysia.

Effectiveness of the Stroke e-Learning Module on Malaysian Doctors' Knowledge of Acute Ischaemic Stroke Management.

Background: The Stroke e-Learning Module (SEM) is a nationwide initiative to improve stroke care in Malaysia. This study aimed to assess the module's effectiveness in improving knowledge on acute ischaemic stroke (AIS) management among Malaysian doctors.

Methods: This was a pre-post study design.

Liver dysfunction in adults with COVID-19 infection: A longitudinal study with transient elastography evaluation.

Background And Aim: Abnormal liver biochemistry (ALB) is common among patients with COVID-19 infection due to various factors. It is uncertain if it persists after the acute infection. We aimed to investigate this.

An insight into clinicians' practices in breaking bad news of oral cancer diagnosis.

Communication is an integral component of effective healthcare delivery to patients, and this includes breaking bad news (BBN). However, clinicians in dentistry are rarely exposed to diseases that can negatively and seriously affect an individual's view of their future and pose a mortality risk, except for oral cancer. The aim of this study was to assess clinician practices in BBN of oral cancer diagnosis in Malaysia.

Prevalence of Stroke-Associated Pneumonia and Its Predictors Among Hyperglycaemia Patients During Acute Ischemic Stroke.

Background: Hyperglycaemia (HG) during an acute ischemic stroke (AIS) is not only associated with unfavourable functional outcomes but also associated with stroke-associated pneumonia (SAP). This study aimed to determine the prevalence of SAP among Malaysian patients with AIS and the predictors of SAP among patients with HG during AIS.

Methods: This is a retrospective cross-sectional study that included patients with AIS admitted to Hospital Sultanah Nur Zahirah, Malaysia from 2017 to 2020.

A Parametric Time-to-Event Modelling of Recurrent Ischemic Stroke After Index Stroke Among Patients With and Without Diabetes Mellitus: Implementation of Temporal Validation of the Model.

Objectives Compared with the first stroke, neurological impairment caused by stroke recurrence is more serious, more difficult to treat, and has a higher mortality rate, especially among ischemic stroke (IS) patients with diabetes mellitus (DM). Although there are established correlations between factors and IS recurrence, there were some issues regarding the naive hazard of IS recurrence with no risk factor influence, and how does the baseline hazard differ among patients with DM and non-DM? To answer all these questions, two time-to-event (TTE) models of recurrent IS after the index IS were developed among IS patients with DM and non-DM. Method A total of 7697 patients with an index IS attack were extracted from the Malaysian Registry of Neurology and stratified according to DM status.

Clinical outcomes of children with COVID-19 infection in a low-risk centre in Malaysia.

Introduction: According to WHO, long-COVID or post- COVID-19 condition is defined as the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation. A systematic review and meta-analyses published in 2022, which mainly focus on the Western population, revealed that the prevalence of long COVID was 25.24%.

Understanding Patient Preferences Regarding the Important Determinants of Breast Cancer Treatment: A Narrative Scoping Review.

Objective: Conventionally, optimal treatment strategies for breast cancer have been largely determined by physicians, with a scant understanding of patients' treatment values and preferences. Incorporating patient preferences in the decision-making process for breast cancer treatment is gaining recognition and can potentially improve treatment outcomes and compliance. This scoping review aims to synthesize evidence on the key determinants that are most valued by breast cancer patients when deciding on their treatment options.

Development and validation of patient diabetes knowledge questionnaire (PDKQ).

Background: Evaluation of diabetes knowledge plays a pivotal role in identifying and addressing patients' knowledge gaps. The implementation of a standardized diabetes knowledge assessment tool is important to ensure consistent scoring and facilitating the development of effective and standardized education programs.

Aim: To develop and validate a patient diabetes knowledge questionnaire (PDKQ) to assess knowledge of diabetes mellitus patients.

Development of a Malaysian potentially inappropriate prescribing screening tool in older adults (MALPIP): a Delphi study.

Introduction: Polypharmacy and potentially inappropriate medications (PIM) are common among older adults. To guide appropriate prescribing, healthcare professionals often rely on explicit criteria to identify and deprescribe inappropriate medications, or to start medications due to prescribing omission. However, most explicit PIM criteria were developed with inadequate guidance from quality metrics or integrating real-world data, which are rich and valuable data source.

The impact of pharmacist interventions, follow-up frequency and default on glycemic control in Diabetes Medication Therapy Adherence Clinic program: a multicenter study in Malaysia.

Background: Pharmacist's involvement in optimizing medication adherence among diabetic patients has been implemented for over a decade. Diabetes Medication Therapy Adherence Clinic (DMTAC) was set up to educate diabetic patients, monitor treatment outcomes, and manage drug-related problems. While evidence shows that pharmacist-led DMTAC was effective in reducing HbA1c, there was limited data regarding the impact of different intervention types and default to follow-up on glycemic control.

Management of patent foramen ovale in embolic stroke of undetermined source patients: Malaysian experts' consensus.

Introduction: About 20 to 40% of ischaemic stroke causes are cryptogenic. Embolic stroke of undetermined source (ESUS) is a subtype of cryptogenic stroke which is diagnosed based on specific criteria. Even though patent foramen ovale (PFO) is linked with the risk of stroke, it is found in about 25% of the general population, so it might be an innocent bystander.

Predictive model of recurrent ischemic stroke: model development from real-world data.

Background: There are established correlations between risk factors and ischemic stroke (IS) recurrence; however, does the hazard of recurrent IS change over time? What is the predicted baseline hazard of recurrent IS if there is no influence of variable predictors? This study aimed to quantify the hazard of recurrent IS when the variable predictors were set to zero and quantify the secondary prevention influence on the hazard of recurrent ischemic stroke.

Methods: In the population cohort involved in this study, data were extracted from 7,697 patients with a history of first IS attack registered with the National Neurology Registry of Malaysia from 2009 to 2016. A time-to-recurrent IS model was developed using NONMEM version 7.

Survivability of patients admitted for stroke in a primary stroke center, Penang, Malaysia: a retrospective 5-year study.

Background: Stroke is one of the most common noncommunicable diseases, with significant public health implications both globally and in Malaysia. The aim of this study was to evaluate post-stroke survivability as well as the major drug classes prescribed for hospitalized stroke patients.

Methods: A 5-year retrospective study was carried out on the survival of stroke patients admitted to Hospital Seberang Jaya, a main stroke center in the state of Penang, Malaysia.

Discriminatory Ability and Clinical Utility of the AJCC7 and AJCC8 Staging Systems for Breast Cancer in a Middle-Income Setting.

(1) Background: Differences in access to biomarker testing and cancer treatment in resource-limited settings may affect the clinical utility of the AJCC8 staging system compared to the anatomical AJCC7 system. (2) Methods: A total of 4151 Malaysian women who were newly diagnosed with breast cancer from 2010 to 2020 were followed-up until December 2021. All patients were staged using the AJCC7 and AJCC8 systems.

Volumetric evaluation of the sphenoid sinus among different races in the Southeast Asian (SEA) population: a computerized tomography study.

The fundament of forensic science lies in identifying a body. The morphological complexity of the paranasal sinus (PNS), which varies greatly amongst individual, possess a discriminatory value that potentially contributes to the radiological identification. The sphenoid bone represents the keystone of the skull and forms part of the cranial vault.

Making the case for the Malaysian Medical Association-Junior Doctors Network (MMA-JDN): A report and memorandum of the 2022 MMA-JDN International Conference.

The Malaysian Medical Association-Junior Doctors Network (MMA-JDN) was recently formed via constitutional amendments during the 62nd Annual General Meeting of the Malaysian Medical Association held in 2022. MMA-JDN subsequently went on to organise its first international conference held from 4th to 6th November 2022. This paper documents the rationale behind the establishment of this new section in MMA and the timeline of its formation, reports on the aforementioned conference, as well as lays down the future direction of MMA-JDN.

Near-miss Thoracic Spine Solitary Plasmacytoma with Neurological Deficit during Pregnancy: A Case Report.

Solitary plasmacytoma (SPC) account for only 5% of plasma cell neoplasms, and the literature hardly reports spinal SPC with a neurological deficit. Furthermore, spinal surgical intervention during pregnancy is rarely encountered and often requires multidisciplinary collaboration and management. The objective of this case report is to highlight this near-miss diagnosis and spinal surgical intervention during pregnancy.

Mobility and mortality outcomes among older individuals with hip fractures at a teaching hospital in Malaysia.

Unlabelled: The challenges of hip fracture care in Malaysia is scarcely discussed. This study evaluated the outcomes of older patients with hip fracture admitted to a teaching hospital in Malaysia. We found that one in five individuals was no longer alive at one year after surgery.

Adaptation of a population pharmacokinetic model to inform tacrolimus therapy in heart transplant recipients.

Aim: Existing tacrolimus population pharmacokinetic models are unsuitable for guiding tacrolimus dosing in heart transplant recipients. This study aimed to develop and evaluate a population pharmacokinetic model for tacrolimus in heart transplant recipients that considers the tacrolimus-azole antifungal interaction.

Methods: Data from heart transplant recipients (n = 87) administered the oral immediate-release formulation of tacrolimus (Prograf®) were collected.

Distribution of 22 Single Nucleotide Polymorphisms in 13 Cytokine Genes in Malays, Chinese, and Indians in Peninsular Malaysia.

Cytokines are cell signaling glycoproteins that are particularly important in immunity and inflammatory responses. Therefore, variations, such as single nucleotide polymorphisms (SNPs), in genes encoding for cytokines may have important consequences for their roles in health. A total of 222 unrelated, healthy, and un-admixed Malays ( = 97), Chinese ( = 77), and Indians ( = 48) with a median age of 30 years old (range 21-50) were typed for 22 cytokine gene SNPs: T/C, ( T/C, T/C), T/C, T/C, G/A, C/A, A/T, ( C/T, G/C), ( A/G, A/G) ( G/T, T/G), ( T/G, T/C, - T/C), ( C/G, G/A), and ( G/A, C/T, A/C).