Hospital Universiti Sains Malaysia Research Articles

Seroprevalence and sociodemographic characteristics of Toxoplasma gondii infection in patients with psychiatric disorders in Malaysia

Toxoplasma gondii is a neurotropic protozoan parasite that affects neuronal processing in the brain. This study aimed to investigate the prevalence of T. gondii infection in psychiatric disorder patients. We also investigated the potential association between sociodemographic, clinical manifestation, and behavior of Toxoplasma-seropositive patients with psychiatric disorders. Commercial ELISAs (IgG, IgM, and IgG avidity) using serum and PCR using buffy coat were performed on samples from 54 individuals in each of the following groups: patients diagnosed with depressive disorder, bipolar disorder, and schizophrenia, as well as psychiatrically healthy subjects (control group). They were recruited from the Hospital Universiti Sains Malaysia in Kelantan, Malaysia. Of 54 patients with depressive disorder, 24/54 (44.4 %) were seropositive for IgG, and four (16.7 %) were IgG+/IgM+. Among the latter, a high avidity index indicating a past infection was observed in half of the samples (50.0 %), and the other half (50.0 %) showed a low avidity index, indicating a possible recent infection. Meanwhile, 30/54 (55.6 %) patients with bipolar disorder were seropositive for IgG+, five (16.7 %) were IgG+/IgM+, and four of them had a high avidity index, and one had a low avidity index. Patients with schizophrenia showed 29/54 (53.7 %) seropositive for IgG, two of them (6.9 %) were IgG+/IgM+; one of latter had a high avidity index, and one had a low avidity index. Of 54 people in the control group, 37.0 % (20/54) were seropositive for T. gondii IgG antibodies. However, no significant difference was observed in seroprevalence between the control group and each patient group. No PCR-positive results were documented. A Chi-Square and multiple logistic regression showed that age (p = 0.031), close contact with cats/pets (p = 0.033) and contact with soil (p = 0.012) were significantly associated with Toxoplasma seropositivity in patients with psychiatric disorders. Additional research is needed to elucidate the causal relationships and underlying mechanisms.

Evaluating the Impact of Intensifying Treatment from Human to Analogue Insulin on Glycaemic Control and Insulin Expenditure in Patients with Type 2 Diabetes: A Retrospective Cohort Study.

Achieving good glycaemic control is essential to reducing the risk of diabetes complications. Insulin is the most effective therapy for achieving good glycaemic control; however, it is associated with a higher risk of hypoglycaemia, especially with human insulin. This study aimed to evaluate the efficacy of intensification from human to analogue insulin and its added cost. This retrospective study was conducted at the Hospital Universiti Sains Malaysia (HUSM). Patients with type 2 diabetes mellitus (T2DM) who underwent intensification for at least 3 months from human to analogue insulin were included in this study. The patients' medical records, haemoglobin A1c (Hba1c) and fasting blood sugar (FBS) were retrieved. The total cost pre- and post-intensification of insulin was obtained from the pharmacy database. Differences in HbA1c, FBS and total insulin cost pre- and post-intensification were analysed. A total of 163 patients with T2DM who had intensification from human to analogue insulin were included in this study. HbA1c and FBS levels were significantly lower in analogue insulin. However, the differences were not clinically significant, as the mean reduction in HbA1c was less than 0.5%. Meanwhile, the total costs of analogue insulin for 3 months were higher. There were no clinically significant improvements in patients' HbA1c and FBS after the intensification of insulin, despite the extra costs spent. Hence, it is vital to choose the right group of patients to receive an insulin analogue to maximise its benefit but at the most optimal cost.

Detection of Macrolide-Resistant Streptococcus pneumoniae Genes and Its Clinical Outcomes in a Tertiary Teaching Hospital in Malaysia.

Streptococcus pneumoniae is one of the leading causes of mortality and morbidity worldwide. The dramatic increase in in-vitro resistance of antimicrobial agents, particularly beta-lactams and macrolides, makes pneumococcal infections difficult to treat. The aim of this study was to describe the drug resistance rate, assess the prevalence of macrolide-resistant genes and review the clinical complications of pneumococcal infections among patients presented to Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia. This is a descriptive cross-sectional study. All S. pneumoniae isolates collected from clinical specimens within a 1-year period were subjected to selected antimicrobial susceptibility testing using E-test strips. Polymerase chain reaction (PCR) analysis was conducted to detect macrolide-resistant determinants. The patient's clinical data were obtained from clinical notes. A total of 113 patients with a positive growth of S. pneumoniae were included in the study. The most common predisposing factors among them were bronchopulmonary diseases (15.9%). The penicillin-resistant rate was 7.1%, with minimal inhibitory concentration (MIC) ranging between 0.012 μg/mL and >32 μg/mL, and the erythromycin-resistant rate was 26.5%, with a MIC range of 0.03 μg/mL-> 256 μg/mL. Most of the erythromycin-resistant isolates were found to have the mef(A) gene (50.4%) and the erm(B) gene (20%); 16.7% had a combination of genes mef(A) and erm(B), and 13.3% had none of the two genes. Community-acquired pneumonia is the predominant type of pneumococcal infection. There was no significant association between the presence of macrolide resistance determinants and mortality (P = 0.837) or complications (P > 0.999 for empyema and cardiac complication; P = 0.135 for subdural abscess). The majority of erythromycin-resistant isolates were found to have the mef(A) gene, followed by the erm(B) gene and a combination of genes mef(A) and erm(B).

Association of single nucleotide polymorphism at BMP2 gene with iron deficiency status among anaemic patients in Hospital Universiti Sains Malaysia

BackgroundIron deficiency contributes for over half of all anaemia cases, especially among women and children. Iron deficiency anaemia remains a serious public health concern worldwide. The aim of this study is to determine the association between the single nucleotide polymorphism rs235756 in the bone morphogenetic protein 2 (BMP2) gene and iron deficiency status.Results104 total anaemic samples were selected from Hospital Universiti Sains Malaysia. ARMS-PCR was performed to genotype the rs235756 SNP in the 104 samples. The genotype distribution of BMP2 rs235756 showed that AG genotypes had the highest frequency 51(86.4%) followed by GG 6(10.2%) and AA 2(3.4%) in IDA group, whereas AG 42(93.3%), AA 2(4.4%) and GG 1(2.2%) were found in the other anaemia group. The minor allele frequency in BMP 2 rs235756 from this study (0.514) was not similar to the East Asian (EAS) population (0.135); however, the allelic frequency showed significant association between these two. The mean of total iron binding capacity level differed significantly between homozygous-dominant AA and AG + GG genotypes (P < 0.05) but no significant difference for the mean of haematological parameter, ferritin and serum iron.ConclusionsIn future clinical settings, this finding can potentially be as a guide in the early prediction for IDA patients through the genetic testing.

A Study of Hippocampal T2 Relaxometry Value in Temporal Lobe Epilepsy Patient

In the advancement of the current imaging technique for detection of mesial temporal sclerosis in temporal lobe epilepsy patient, there are multiple Magnetic resonance imaging (MRI) quantitative techniques. One of the long known to be valuable quantitative technique is T2 relaxometry where it has overall better accuracy for detection of mesial temporal sclerosis compared with the qualitative assessment only. A comparative cross-sectional study was conducted in Hospital Universiti Sains Malaysia from August 2021 to January 2023 which include 51 participants, 19 (36.5%) were temporal lobe epilepsy patient and 33 (63.5%) were control. The hippocampal T2 relaxometry was calculated for temporal lobe epilepsy patient and control. The mean T2 relaxometry reading for these groups were compared using Independent T-test.  The correlation of T2 relaxometry value  with age, duration of epilepsy and seizure frequency were analysed using Pearson correlation. Cohen Kappa inter-rater reliability was done for MR qualitative assessment. The participant age range was from 15 to 65 years old. Total of 23 samples were male (44.2%). The mean T2 relaxometry for epilepsy patient was higher than control. For correlation, moderate to good positive correlation was seen between the duration of epilepsy with T2 relaxometry of right hippocampus. Whereas poor positive correlation between the right hippocampus T2 relaxometry with age (P&gt;0.01), as well poor positive correlation between both hippocampus T2 relaxometry with seizure frequency (P&gt;0.01). There was one patient (5.2%) reported to be negative for mesial temporal sclerosis by qualitative assessment, but the T2 relaxometry reading however was raised.  As a conclusion, T2 relaxometry sequence can be use as adjunct to the current qualitative assessment to increase sensitivity and specificity in detecting mesial temporal sclerosis.&#x0D; Keywords: Temporal lobe epilepsy, Mesial temporal sclerosis, T2 relaxometry, MRI epilepsy protocol

6-Parts Haematology Parameters Evaluation Using Abbott Alinity H

Nowadays, there are variety of automated hematology analyzers available in the market. However, the new product of diagnostic equipment should be evaluated and validated to ensure their capability.  Thorough process of testing on all new hematology analyzers must be performed to certify that reliable result will be released and for patient safety. This study was carried out to evaluate automated hematology analyzers; Abbott Alinity H, in the Hospital Universiti Sains Malaysia setting.  Blood samples send for complete blood count were selected randomly (n = 50) from healthy subjects and those who have different blood disorders. Blood specimens and quality control materials were analysed on the Abbott Alinity H to evaluate the precision. For correlation, the Sysmex XN-1000 was used as the comparative method. The study showed very good correlation between Abbott Alinity H and Sysmex, XN-1000 in the parameters such as white blood cell (WBC), red blood cell (RBC), hemoglobin (HGB), mean cell volume (MCV), platelet (PLT), neutrophil (NEU), lymphocyte (LYM), monocyte (MONO), eosinophil (EOS), and basophil (BASO). For the precision, all the parameters are performed well within allowable limits of performance for Abbott Alinity H. In conclusion, the Abbott Alinity H demonstrated an acceptable performance in term of precision and the analyzer was equivalent with the Sysmex XN-1000.

Assessing the Recordkeeping Quality at the School of Dental Sciences, Universiti Sains Malaysia.

Dental records are an essential part of dental practice. The quality of dental recordkeeping is paramount in ensuring the delivery of high-quality dental care and is also important for medico-legal reasons. Should there be any dispute or need for review, detailed and well-maintained records can provide evidence of the care provided and the decision-making process. The study aimed to assess the quality of dental recordkeeping and dental charting practice at the dental clinic School of Dental Sciences. The study was conducted in a retrospective manner reviewing dental records of patients treated by specialists, dental officers, and postgraduate and undergraduate students at the Hospital Universiti Sains Malaysia over a five-year period. Eight key components of clinical dental records i.e.date of charting, legibility on the odontogram, no blank on the odontogram, whether any mistakes have been strikethrough and initials, medical history, dental history, investigation, and treatment plan were assessed. A modified CRABEL scoring system was used to assess the quality of data retrieved from dental records. The study involved the analysis of 324 case files. Among these, 90 files obtained scores ranging from 60% to 80%, with 7.7% attributed to undergraduates, 9.6% to dental officers, 6.8% to postgraduates, and 3.7% to specialists. The remaining 234 files achieved scores between 80% and 100%, with a breakdown of 17% from undergraduates, 15.4% from dental officers, 18.2% from postgraduates, and 21.3% from specialists. Even though the overall quality of recordkeeping in this study is good,with most records achieving a CRABEL score of 80% and above, it's important to acknowledge that ideally, each component assessed should achieve a perfect score of 100%, as it will reflectthe practitioners's work.

The Blood Donor Deferral Rate and the Reasons for Deferral at a Tertiary Care Teaching Institute in Northeastern Malaysia.

A deferral takes place when donors fail to meet the eligibility criteria for donating blood during their visit to a blood collection site. Deferral periods, which can be either permanent or temporary, are implemented to protect the well-being of both the donor and the recipient.This study aimed to investigate the frequency of deferrals and the various factors contributing to them.A retrospective analysis was conducted at the Transfusion Medicine Unit of Hospital Universiti Sains Malaysia (USM), utilizing data obtained from blood donors during the period from January 2022 to June 2023. The research included a cohort of 18,751 donors who visited our transfusion unit for blood donation. Data, including gender, age, and reasons for deferral, were collected by reviewing the records of donors who were deferred. Descriptive statistics were employed to analyze the data of deferral blood donors.Out of 18,751 blood donors, 3,533 (18.84%) were deferred, consisting of 1,267 males (35.86%) and 2,266 females (64.14%). The age group of 18-25 years accounted for the highest number, comprising 1,875 donors (53.07%). Among the deferred cases, 53.33% were first-time donors, followed by 25.28% regular donors and 21.40% lapsed donors. The deferral of blood donors resulted from various reasons. The most common cause of overall deferral among blood donors was low hemoglobin (38.33%), followed by upper respiratory tract infections (8.38%), chronic medical illness (7.08%), and high blood pressure (7.02%). Temporary deferrals were more prevalent than permanent deferrals, accounting for 91.57% of cases compared to 8.43% for permanent deferrals.Voluntary non-remunerative blood donors constitute the backbone for a safe and reliable blood supply in transfusion services. Utilizing a comprehensive database will enable effective counseling of temporarily deferred donors, providing insights into the reasons for their deferral, the expected duration, and the appropriate treatments. This information is crucial for motivating these donors to recruit again in the donor pool. Public education initiatives aimed at raising awareness about the causes of deferral and promoting regular health check-ups can play a pivotal role in minimizing these deferrals.

The Evaluation of Ordinal Regression Model's Performance Through the Implementation of Multilayer Feed-Forward Neural Network: A Case Study of Hypertension.

Background Hypertension, or high blood pressure, is a common medical condition that affects a significant portion of the global population. It is a major risk factor for cardiovascular diseases (CVD), stroke, and kidney disorders. Objective The objective of this study is to create and validate a model that combines bootstrapping, ordered logistic regression, and multilayer feed-forward neural networks (MLFFNN) to identify and analyze the factors associated with hypertension patients who also have dyslipidemia. Material and methods A total of 33 participants were enrolled from the Hospital Universiti Sains Malaysia (USM) for this study. In this study, advanced computational statistical modeling techniques were utilized to examine the relationship between hypertension status and several potential predictors. The RStudio (Posit, Boston, MA) software and syntax were implemented to establish the relationship between hypertension status and the predictors. Results The statistical analysis showed that the developed methodology demonstratesgoodmodel fitting through the value of predicted mean square error (MSE), mean absolute deviance (MAD), and accuracy. To evaluate model fitting, the data in this study was divided into distinct training and testing datasets. The findings revealed that the results strongly support the superior predictive capability of the hybrid model technique. In this case, five variables are considered: marital status, smoking status, systolic blood pressure, fasting blood sugar levels, and high-density lipoprotein levels. It is important to note that all of them affect the hazard ratio: marital status (β1, -17.12343343; p < 0.25), smoking status (β2, 1.86069121; p < 0.25), systolicblood pressure (β3, 0.05037332; p < 0.25), fasting blood sugar (β4, -0.53880322; p < 0.25), and high-density lipoprotein (β5, 5.38065556; p < 0.25). Conclusion This research aims to develop and extensively evaluate the hybrid approach. The statistical methods employed in this study using R language show that regression modeling surpasses R-squared values in predicting the mean square error. The study's conclusion provides strong evidence for the superiority of the hybrid model technique.

Optic Nerve Head and Retinal Nerve Fiber Layer Analysis in Emmetropic Malay Children.

The study aims to investigate the normal reference values for optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters in emmetropic Malay children, utilizing measurements obtained through Cirrus SD-OCT (Carl Zeiss Meditec, Dublin, CA). A cross-sectional study was conducted on 95 Malay children, aged between seven and 17 years, with no ocular abnormalities. It was held at Hospital Universiti Sains Malaysia, Malaysia, from January 2014 to December 2015. All children underwent a full ocular examination, including refraction and calculation of axial length. ONH and retinal nerve fiber layer thickness (RNFLT) parameters were measured using the Cirrus SD-OCT machine. One eye of each subject was selected randomly for study. The associations between the parameters and the effect of age, gender,axial length, and spherical equivalent (SE) on the measurements were statistically validated. Ninety-five children were involved in the study, with 65 females (68.4%) and 30 males (31.6%). The mean age was 10.6 (2.82) years, the mean intraocular pressure (IOP) was 14.8 (2.81) mmHg, the mean SE-refraction was 0.12 (0.28) diopters, and the mean axial length was 23.03 (0.76) mm. The mean disc area, rim area, and cup volume were 2.32 (0.40) mm2, 1.53 (0.33) mm2, and 0.204 (0.16) mm3, respectively. The average cup-to-disc ratio (SD) (CDR) and the vertical CDR were 0.55 (0.13) and 0.50(0.14). Mean (SD) RNFLT was 102.08 (11.08) μm for all patients. There was a strong positive correlation between the average, superior, and inferior RNFLT with the optical disc area. The rim area and the average, superior, inferior, and nasal RNFLT alsoshowed a significant correlation. The inferiorRNFLT was negatively correlated with the average CDR. There was also a major influence of gender on the disc area. There were no major age, axial length, and SE influences on the measurements. This study provided normative information for ONH and RNFLT parameters in emmetropic Malay children. It was observed that emmetropic Malay males exhibited a significantly larger optical disc area. The increase in RNFLT is correlated with a significant increase in disc and rim areas.

The Clinicopathological Characteristics of Young-Onset Versus Adult-Onset Colorectal Cancer: A Tertiary Hospital-Based Study.

The prevalence of colorectal cancer (CRC) among young individuals is rising worldwide, especially in Malaysia. Investigations are currently employed to distinguish the features of young-onset CRC (YOCRC) from adult-onset CRC (AOCRC). This study aimed to compare the characteristics of patients with YOCRC and AOCRC diagnosed at Hospital Universiti Sains Malaysia (HUSM). This was a retrospective study of CRC cases from January 2013 to December 2021. The details of YOCRC (< 50 years old) and AOCRC (≥ 50 years old) patients were retrieved from the laboratory system and medical records. The Pearson's chi-square test, Fisher's exact test and multiple logistic regression were used to compare the AOCRC and YOCRC cases. Statistical significance was defined at a P-value of ≤ 0.05. The AOCRC (254/319, 79.6%) was more prevalent than YOCRC (65/319, 20.4%), with a predominance of males (53.9%) and Malay sub-population (90.2%). AOCRC and YOCRC shared similarities in left-sided location, high occurrence of adenocarcinoma with moderately differentiated histology and advanced stage of diagnosis. More patients with YOCRC (23.1%) had a family history of cancer than patients with AOCRC. YOCRC also differed from AOCRC by having more specific histological subtypes, such as mucinous adenocarcinoma (15.4%) and signet ring carcinoma (6.2%). In addition, patients with YOCRC commonly presented with a low density of tumour-infiltrating lymphocytes (TILs) (60%). Multiple logistic regression showed a family history of CRC (adjusted odds ratio [AOR] = 3.75, P = 0.003) and histological type (AOR = 15.21, P < 0.001) are more likely to cause YOCRC than diabetes (AOR = 0.06, P < 0.001) and hypertension (AOR = 0.14, P < 0.001) comorbidities, which are associated with AOCRC. Our descriptive study presented the epidemiological and histopathological characteristics of AOCRC and YOCRC in HUSM, providing current information on distinguishing features between the groups.

P 030: A retrospective study on the association of HAS-BLED score with risk of gastrointestinal bleeding among patients on warfarin in Hospital Universiti Sains Malaysia

P 030: A retrospective study on the association of HAS-BLED score with risk of gastrointestinal bleeding among patients on warfarin in Hospital Universiti Sains Malaysia

The impact of a nursing spiritual care module on nursing competence: an experimental design

PurposeThis study aimed to assess the impact of the Nursing Spiritual Care Module on the competence of nurses in providing spiritual care in the context of Malaysia.MethodThis study employed an experimental design and involved a total of 122 nurses, with 59 in the experimental group and 63 in the control group. Participants were selected from palliative care wards associated with Hospital Universiti Sains Malaysia. Nurses in the experimental group underwent a two-week educational module on nursing spiritual care, while nurses in the control group attended a single lecture on spiritual care provided by the hospital.ResultsThe results indicated no significant differences in sociodemographic characteristics between the two groups. A significant difference in spiritual care competence within the intervention group and the control group over time (p-value = 0.001), between the two groups (p-value = 0.038), and in the interaction between time and group (p-value = 0.001).ConclusionThe Nursing Spiritual Care Module is crucial in aiding nurses and healthcare professionals in cultivating the appropriate and wholesome attitudes and practices necessary to address the spiritual needs of patients.

Association between Self-Esteem and Dietary Changes among Cancer Patients: A Cross-Sectional Study

Introduction: Cancer diagnosis may shift an individual’s food choices as well as self-esteem mainly due to the side effects of treatment, which will influence their nutritional status and perception about themselves. The aim of this study was to explore the association between dietary changes and self-esteem among cancer patients. Methods: A cross-sectional study was conducted among 113 cancer patients in Hospital Universiti Sains Malaysia. Among the data collected were socio-demographic background, clinical characteristics, Karnofsky Performance Status Scale, dietary changes questionnaire before and after cancer diagnosis, self-esteem. Spearman correlation was employed for determining the relationship between dietary changes and self-esteem. Results: Out of 113 subjects, 98 subjects (86.7%) made changes in their dietary intake after being diagnosed with cancer. A total of 58.4% and 45.1% of the subjects reported a decrease in their intake of sugar and condensed milk, while 52.2% stopped consuming red meat. The mean self-esteem score was reported to be average (29.33 ± 3.52). However, no statistically significant association was found between socio-demographic, clinical parameters, and self-esteem with dietary changes. Conclusion: The findings of this study demonstrated that cancer patients had made drastic dietary changes following cancer diagnosis especially consumption of red meat and food high in sugar. Most cancer patients had average self-esteem level. Although no association had been found between dietary changes and self-esteem level, it is suggested for more studies should be carried out to provide clear understanding of the factors affecting dietary changes among cancer patients.

Hypospadias Repair: Outcome and Objective Evaluation with Hypospadias Objective Scoring Evaluation (HOSE), Hypospadias Objective Penile Evaluation (HOPE) and Pediatric Penile Perception Score (PPPS) from Parents Perspective and Preference in COVID-19 Era

Introduction. Hypospadias is a common congenital abnormality. It may also be associated with other urogenital tract abnormalities. Literature has described more than 300 techniques being used. An objective evaluation is useful for attending doctor and parents to ensure both understands detection of complication and to assess post operative satisfaction from both sides are similar. Thus study sought to assess the outcome of hypospadias repair with objective scoring evaluation from parents’ perspective during COVID-19 era. Methods. This was a retrospective study of all patient post-hypospadias repair in Urology Unit, Hospital Universiti Sains Malaysia from January 2020 to December 2022 during the Covid-19 period. All patient medical records were reviewed. Data analyzed for demographic, surgical treatment, complications, and objective evaluation with HOSE, HOPE and PPPS questionnaire and parents preferred questionnaire to be used using Microsoft Excel for Windows 2003 and qualitative variables were presented as frequencies and simple percentages. Result. Hypospadias A total of 21 pediatric patients operated. The mean age during surgery was 7.2 years old. Distribution of glanular 6 patients, distal 3 patients and majority are proximal hypospadias with 12 patients (57.2%). Proximal hypospadias, 6 proximal penile and 6 penoscrotal. Single stage repair 18 patients and 2 patients had scrotoplasty performed and 3 patients had two stage repairs. Majority of single stage surgery performed was TIP and two stage repairs done with Bracka’s technique. Overall mean follow-up time 16.78 month. Three patients had UCF with 14.3%. Questionnaire with HOSE showed mean score 14.38. The HOPE questionnaire showed mean score of 54.71 and PPPS mean score was 10.2. Majority of parents preferred to use HOPE with 66.7% as compared to HOSE 14.3% and PPPS 19%. Discussion. This study has a small sample size possible due to very low rate for hypospadias in Malaysia and Covid-19 pandemic. Due to the pandemic, European Association of Urology recommended for repair before 18 months. However, if done after 2 years old showed significant predictor for complications. Validated questionnaires are useful and comparable to assess objectively both functional and patient satisfaction. However, HOPE might overestimate quality of cosmetic outcome compared with PPPS. Despite many available evaluation scoring systems were compared, reports show similar conclusions with none being more superior. Conclusion. Hypospadias requires complex surgery and complications are expected but should be within acceptable standards. In COVID-19 era, hypospadias repair had to be delayed and causes negative impact to patients. Despite many various techniques available, surgeons experience and technique preference are very important. There is no evaluation score more superior than another. It has its advantages and disadvantages. Parents satisfaction and functional outcome after repair should be routinely done for objective assessment.

The Prevalence of Anaemia and Its Associated Risk Factors in Children Admitted To General Paediatric Ward At Hospital Universiti Sains Malaysia, Kelantan

Introduction: Anaemia is a common medical condition among children worldwide, yet a commonly overlooked health problem if not life-threatening. This study aimed to determine the prevalence of anaemia in hospitalized children and identify its associated risk factors. Methods: A retrospective study was conducted from January to December 2021 on 792 patients aged 6 months to less than 12 years old with acute illnesses, who were admitted to the general paediatric ward in Hospital Universiti Sains Malaysia. We analysed socioeconomic and demographic data, and risk factors associated with anaemia. Result: The overall prevalence of anaemia among children aged 6 months to less than 12 years old was 16.4%. The age group of 6 to 59 months has a significant association with anaemia with 3.73 odds compared to the age group of 5 to 11 years (Adj OR 3.73, 95% CI 2.53-5.49). Birth weight of more than 2.5kg has a significant association with anaemia with 1.80 odds compared to weight less than 2.5kg (Adj OR 1.79, 95% CI 1.12-2.88). Conclusion: The prevalence of anaemia in the studied population was considered as a mild public health problem according to WHO severity classification. Children aged 6 to 59 months and those with birth weight more than or equivalent to 2.5kg were more likely to be anaemic. Early iron supplementation should be taken into consideration to reduce anaemia in this population.

Characteristics of Paediatric Death Cases at a Malaysian University Hospital

Introduction: Auditing of paediatric deaths has rarely been evaluated in hospitals especially in low and middle-income countries. The aim of the study is to describe the characteristics of paediatric death in hospitalised children and determine the predictors of death location in Hospital Universiti Sains Malaysia (USM). Method: Paediatric mortality cases for children aged between 29 days and 18 years old at the time of death were analyzed. These were documented cases between the year 2013 and 2020 at Hospital USM. Case notes were reviewed, and data were captured retrospectively. Multiple Logistic Regression was used to assess predictors of the location of death especially in the ward setting.Results: Out of 841 paediatric deaths identified during the period of the study, 544 cases were enrolled. The male gender has a higher proportion (1.4:1). The median age was 56 months, with infancy being the predominant age group. The median length of hospital stay was 10.5 days. More than half of the cases (58.3%) had underlying life-limiting illnesses. The majority of the patients had “Do Not Resuscitate” orders. A longer length of stay (prevalence odds ratio (POR 0.99, 95% CI 0.98, 0.99), being on ventilator (POR 3.42,95% CI 1.95, 6.01), being terminally ill (POR 0.40,95% CI 0.23, 0.70) and having underlying life limiting illness (POR 0.50, 95% CI 0.33, 0.75) were the significant predictors for the ward death. Conclusion: Understanding the characteristics of child death and the factors associated with death location is critical for improving paediatric care and treatment.

Prognostic factors of first-ever stroke patients in suburban Malaysia by comparing regression models

&lt;b&gt;Introduction:&lt;/b&gt; The aim of this study was to compare regression models based on the parameter estimates of prognostic factors of mortality in first-ever stroke patients.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; A retrospective study among 432 first-ever stroke patients admitted to Hospital Universiti Sains Malaysia, Kelantan, Malaysia, was carried out. Patient’s medical records were extracted using a standardized data collection sheet. The statistical analyses used for modelling the prognostic factors of mortality were Cox proportional hazards regression, multinomial logistic regression, and multiple logistic regression.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; A total of 101 (23.4%) events of death were identified and 331 patients (76.6%) were alive. Despite using three different statistical analyses, the results were very similar in terms of five major aspects of parameter estimates, namely direction, estimation, precision, significance, and magnitude of risk assessment. It was reported slightly better in Cox proportional hazards regression model, especially in terms of the precision of the results.&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Given that this study had compared the findings from three different types of advanced statistical methods, this research has clearly yielded that with data of high quality, the selection of appropriate statistical method should not be a worrisome problem for researchers who may not be of expertise in the field of medical statistics.

Preparing Malaysia for Population Aging through the Advanced Memory and Cognitive Service in Hospital Universiti Sains Malaysia

Improving healthcare and living conditions has led to an increase in life expectancies and challenges of population aging in Malaysia. The Advanced Memory and Cognitive Service builds on integrated healthcare among multidisciplinary specialists to provide holistic and patient-centred healthcare. The service treats older adults experiencing neurocognitive impairment as well as young individuals with complex neurocognitive disorders and thoroughly screens asymptomatic individuals at high risk of developing neurocognitive disorders. This early intervention strategy is a preventive effort in the hope of reducing disease burden and improving quality of life to prepare Malaysia for the forthcoming population aging.

Study of Haematocrit Level in Obstructive Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome can lead to oxyhaemoglobin desaturation and has the possibility of stimulating erythropoiesis, leading to an increased haematocrit. The aim of this study is to identify the level of haematocrit in obstructive sleep apnea syndrome (OSAS) patients and to determine the correlation between haematocrit levels and the severity of obstructive sleep apnea syndrome (OSAS). This is a descriptive cross-sectional study at Hospital Universiti Sains Malaysia. All consented patients were interviewed and underwent a polysomnography (PSG) study. The severity of OSAS was based on the apnea–hypopnea index (AHI) and average oxygen desaturation. The blood haematocrit level was also obtained. Thirty-six OSAS patients were in the study group, and 17 patients were in the control group. The mean haematocrit level in the control group was 41.6 (2.5 SD), whereas in the study group the mean haematocrit level was 44.0 (3.27 SD). Pearson correlation analysis showed there was no significant correlation between AHI and haematocrit level (p-value: 0.392), however, there is a significant correlation between haematocrit levels and average oxygen saturation level (P-value: 0.022). The independent t-test between mean haematocrit level between OSAS group and control group showed that there was a significant difference between the mean haematocrit level among the control and OSAS groups. The increased level of haematocrit is significantly correlated with average oxygen desaturation but not with AHI in OSAS patient. Average oxygen desaturation can be considered as a parameter to assess severity and hypoxic stress in OSA patients.