Teaching Hospital In Malaysia Research Articles

Anxiety among hospitalized COVID-19 patients: a case-control study from a tertiary teaching hospital in Malaysia.

Anxiety has been increasingly recognized as part of the psychosocial health issues in COVID-19 patients. However, the impact of this topic may be underestimated in low- and middle-income countries. This study aimed to estimate the prevalence of and risk factors of anxiety in COVID-19 patients compared to controls in a local tertiary teaching hospital in Malaysia. In this case-control study, we analyzed data on adult patients aged 18 years and above hospitalized for COVID-19 infection with matched hospitalized controls. The demographic, clinical data and anxiety measures using the Generalized Anxiety Disorder-7 questionnaire were analyzed using univariate and multivariate analysis. 86.6% in the COVID-19 group had anxiety, significantly higher than 13.4% in the control group (p = 0.001). The COVID-19 group was significantly associated with the GAD-7 severity (p = 0.001). The number of COVID-19 patients in the mild, moderate, and severe anxiety groups was 48 (84.2%), 37 (86%), and 18 (94.7%), respectively. Multiple logistic regression showed significant predictors for anxiety, including COVID-19 diagnosis and neurological symptoms. Anxiety was found 36.92 times higher in the patients with COVID-19 compared to those without COVID-19 (OR 36.92;95% CI 17.09, 79.78, p = 0.001). Patients with neurological symptoms were at risk of having anxiety (OR 2.94; 95% CI 1.03, 8.41, p = 0.044). COVID-19 patients experience a significant disruption in psychosocial functioning due to hospitalization. The burden of anxiety is notably high, compounded by a diagnosis of COVID-19 itself and neurological symptomatology. Early psychiatric referrals are warranted for patients at risk of developing anxiety symptoms.

Fragility fracture care gap at a tertiary teaching hospital in Malaysia

This study aimed to investigate the clinical burden and secondary fracture prevention of fragility fractures at a tertiary teaching hospital in Malaysia. Electronic medical records of all patients admitted with fragility fractures between 1 January 2017-31 December 2018 were reviewed. Patients < 50years old, with non-fragility fractures, restricted access to medical records, transferred to another hospital or who passed away during admission were excluded. Descriptive statistics were used to summarise patients' characteristics, frequency of fragility fractures, and secondary fracture prevention details. Binomial logistic regression was performed to analyse predictive factors for post-fracture bone health assessments and treatment initiation. 1030 patients [female (767/1030, 74.5%)] presented with 1071 fractures [hip fractures (378/1071, 35.3%)]. 170/993 (17.1%) patients were initiated on anti-osteoporosis medications (AOMs) and 148/984 (15.0%) had bone mineral density (BMD) performed within 1-year post-fracture. Less than half (42.4%) of the patients remained on treatment at 1-year post-fracture.Older patients [65-74 years old: odds ratio (OR) = 2.18, 95%CI 1.05-4.52, p = 0.04; ≥ 75 years: OR = 3.06, 95%CI 1.54-6.07, p < 0.01], hip fractures (OR = 1.95, 95%CI 1.23-3.11, p < 0.01), Chinese ethnicity (OR = 1.90, 95%CI 1.07-3.35, p = 0.03),previously diagnosed with osteoporosis (OR = 2.65, 95%CI:1.32-5.31, p < 0.01) and a BMD test performed (OR = 12.48, 95%CI 8.04-19.37, p < 0.01) were found to have higher AOM initiation. Patients with past diagnosis of osteoporosis(OR = 4.45, 95%CI 2.25-8.81, p < 0.01) and initiated on AOM (OR = 11.34, 95%CI 7.57-16.97, p < 0.01) had a higherlikelihood to undergo BMD testing. The AOM initiation and BMD testing rates were low. There is a need to address the fragility fracture care gap with strategies such as Fracture Liaison Service.

The Impact of Potentially Inappropriate Medications and Polypharmacy on 3-Month Hospital Readmission among Older Patients: A Retrospective Cohort Study from Malaysia.

Potentially inappropriate medications (PIMs) use and polypharmacy are two issues that are commonly encountered among older people. They are associated with several negative outcomes including adverse drug reactions and medication-related hospitalization. There are insufficient studies regarding the impact of both PIMs and polypharmacy on hospital readmission, especially in Malaysia. To investigate the possible association between polypharmacy and prescribing PIMs at discharge and 3-month hospital readmission among older patients. A retrospective cohort study involved 600 patients ≥60 years discharged from the general medical wards in a Malaysian teaching hospital. The patients were divided into two equal groups: patients with or without PIMs. The main outcome was any readmission during the 3-month follow-up. The discharged medications were assessed for polypharmacy (≥five medications) and PIMs (using 2019 Beers' criteria). Chi-square test, Mann-Whitney test, and a multiple logistic regression were conducted to study the impact of PIMs/polypharmacy on 3-month hospital readmission. The median number for discharge medications were six and five for PIMs and non-PIMs patients, respectively. The most frequently prescribed PIMs was aspirin as primary prevention of cardiovascular diseases (33.43%) followed by tramadol (13.25%). The number of medications at discharge and polypharmacy status were significantly associated with PIMs use. Overall, 152 (25.3%) patients were re-admitted. Polypharmacy and PIMs at discharge did not significantly impact the hospital readmission. After applying the logistic regression, only male gender was a predictor for 3-month hospital readmission (OR: 2.07, 95% CI: 1.022-4.225). About one-quarter of the patients were admitted again within three months of discharge. PIMs and polypharmacy were not significantly associated with 3-month hospital readmissions while male gender was found to be an independent risk factor for readmission.

Suicide and Violent Behavior in Psychotic Inpatients

Introduction: This study compares the association between psychosis, suicide, and violent behavior in patients admitted and discharged from the psychiatric ward. Methods: This study used a cross-sectional design. The experimental study was done with all the psychotic patients fulfilling the inclusion criteria upon admission and discharge from a teaching hospital in Malaysia. The study was conducted for a duration of five months from March to July 2022. Psychotic patients with various diagnoses based on the DSM-5 were interviewed. PANSS score was used upon admission and discharge to look at the severity of psychosis. Suicide behavior was assessed using SBQ-R while violent behavior was assessed using MOAS. Sample size consist of 100 consecutive psychotic patients. Results: Suicide behavior was noted to be present in patients no matter the severity of psychosis. Upon discharge, even after the improvement of psychosis, patients were still at risk of suicide behavior. Violent behavior was noted to be present in most of the patients in the PANSS group (except for the moderately ill patients) no matter the severity of psychosis. However, upon discharge from the psychiatric ward, we can see that all patients went home not having violent behavior. This concludes that, when psychosis improves, the risk of having violent behavior reduces. Conclusions: Further exploration on the reasons of why suicide behavior persists in psychotic patients has to be done by clinicians. It is dangerous for clinicians to make assumptions that psychotic patients presenting with suicide behavior are solely due to the psychosis.

Evaluation of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia: Epidemiology, clinical characteristics, and outcomes in the older patients in a tertiary teaching hospital in Malaysia

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) bacteremia is a major concern in the global healthcare system. However, data from Asian regions dealing with the singularity of this infection in older persons is lacking. We aimed to identify the differences in the clinical characteristics and outcomes of MRSA bacteremia between adults aged 18–64 and ≥ 65 years.MethodsA retrospective study cohort was conducted at the University Malaya Medical Centre (UMMC) on cases of MRSA bacteremia from 2012 to 2016. Patient demographic and clinical data were collected for risk factors analyses.ResultsNew cases of MRSA bacteremia showed a trend of increase from 0.12 to 100 admissions in 2012 to 0.17 per 100 admissions in 2016 but a drop was observed in 2014 (0.07 per 100 admissions). Out of the 275 patients with MRSA bacteremia, 139 (50.5%) patients were aged ≥ 65 years old. Co-morbidities and severity at presentation were significantly higher among older adults, including diabetes mellitus (p = 0.035), hypertension (p = 0.001), and ischemic heart disease (p < 0.001), as well as higher Charlson Comorbidity Index (p < 0.001) and Pitt bacteremia scores (p = 0.016). Central line-associated bloodstream infections were more common among younger patients (37.5% vs. 17.3% in older patients, p < 0.001), while skin and soft tissue infections are more frequent among older adults (20.9% vs. 10.3% in younger patients, p = 0.016). All-cause mortality and in-hospital mortality were significantly higher in older patients (82.7% and 56.1% vs. 63.2% and 28.7% in younger patients, p < 0.001). Multivariate analysis revealed age ≥ 65 years (adjusted odds ratio: 3.36; 95% confidence interval: 1.24–9.13), Pitt score ≥ 3 (2.15; 1.54–3.01), hospital (6.12; 1.81–20.72) and healthcare (3.19; 1.30–7.81) acquisition of MRSA, indwelling urinary catheters (5.43; 1.39–21.23), inappropriate targeted treatment (8.08; 1.15–56.86), lack of infectious disease team consultation (2.90; 1.04–8.11) and hypoalbuminemia (3.31; 1.25–8.79), were significant risk factors for 30-day mortality.ConclusionOlder patients’ risk of mortality from MRSA bacteremia was three times higher than younger patients. Our data will contribute to developing and validating a robust scoring system for risk-stratifying patients to achieve better management and improved clinical outcomes.

SG-APSIC1207: Effectiveness of a surgical-site infection bundle in reducing postoperative infection in cesarean deliveries in a tertiary-care teaching hospital in Malaysia

Objectives: Surgical-site infections (SSIs) cause significant increases in mortality, morbidity, and prolonged hospitalization after cesarean deliveries. We assessed the effectiveness of the implementation of an SSI bundle in reducing postoperative infections in cesarean deliveries in a tertiary-care teaching hospital in Malaysia. Method: We conducted a quality-improvement study on all women who underwent labor and scheduled cesarean sections at the University Malaya Medical Center (UMMC) between May and December 2020. The preintervention period was May–June 2020 and the postintervention period was September–December 2020. Patients were followed for 90 days after their operation. Before the intervention, SSI rates and compliance with prevention practices were documented. A multidisciplinary team was formed, and education regarding the elements of the SSI prevention bundle was conducted before they were implemented. The care bundle focused on monitoring compliance with preoperative bathing, contact time for skin preparation, hair management, and antibiotics prophylaxis given within 60 minutes prior to incision, as well as patient education. Result: With the implementation of the SSI bundle, we observed a significant reduction in the SSI rate by 50%, from 7 per 100 procedures to 2 per 100 procedures. Compared with the preintervention period, overall compliance with bundle elements improved greatly for preoperative bathing (0 vs 95.7%) and contact time for skin preparation (0 vs 98.8%). In the postintervention period, the method of hair removal was documented, compared to no documentation during the preintervention period. The administration of prophylactic antibiotics within 60 minutes prior incision decreased from 99% to 92.3%. Conclusion: Implementation of an SSI prevention bundle successfully reduced the rate of SSI after cesarean section. The SSI prevention bundle together with improvements by multidisciplinary teams and a good patient-safety culture helped reduce SSI rates. Patient education on pre- and postoperative infection prevention also played an important role in reducing this infection rate.

SG-APSIC1208: Association between severity of COVID-19 pneumonia and vaccination status in a tertiary-care teaching hospital in Malaysia

Background and objectives: Since the introduction of the COVID-19 vaccine through the National COVID-19 Immunization Program in Malaysia in February 2021, the number of cases of severe COVID-19 and mortality have progressively decreased. We explored the association between vaccination status, type of vaccine, and the highest COVID-19 clinical category. Methods: Patients were recruited via the electronic medical record (EMR) at University Malaya Medical Centre (UMMC) from July 2021 onward. Included patients were aged ≥18 years old with positive SARS-CoV-2 RT-PCR results from respiratory samples (naso-oropharyngeal swab, saliva, or sputum). Patient demographic data, COVID-19 clinical category, vaccination status, and type of vaccine received were recorded. Results: In total, 1,391 positive SARS-CoV-2 PCR results were reviewed; 1,188 patients (85%) with complete data were analyzed. These patients’ median age was 50 years. The proportions of patients COVID-19 clinical categories were as follows: category 1 (4.04%), category 2 (28.37%), category 3 (10.7%), category 4 (30.6%), and category 5 (2.6%). The mortality rate was 21.5%. As of July 2021, only 16.8% of patients were fully vaccinated, 30.3% were vaccinated, 31.5% unvaccinated, and 21.5% had unknown vaccination status. In total 364 patients with category 4 COVID-19 (4.4%; P &lt; .001) were fully vaccinated and no patients who were fully vaccinated had category 5 COVID-19 (P = .011). Furthermore, 40.8% of patients who died had unknown vaccination status (P &lt; .01); 28.1% of patients who died were unvaccinated (P = .015); 25.3% of patients who died were partially vaccinated (P = .036); and 0.4% of patients who died were fully vaccinated (P &lt; .001). For category 4 and 5 illness and death, there were no significant differences between the type of vaccine received (Pfizer-BioNTechR, Astra ZenecaR and Coronavac/SinovacR) and severe COVID-19. Conclusions: The completion of 2 doses of government-approved COVID-19 vaccination is paramount in preventing severe COVID-19 disease and death. Rapid rollout and equitable distribution of vaccination should be initiated. Vaccine hesitancy should be promptly addressed to ensure vaccination uptake.

SG-APSIC1209: Risk factors associated with mortality among carbapenem-resistant Enterobacteriaceae inpatient in a tertiary-care teaching hospital in Malaysia

Objectives: Carbapenem-resistant Enterobacteriaceae (CRE) is a multidrug-resistant gram-negative bacteria (MDR-GNB) that is rapidly emerging as a life-threatening nosocomial disease in many countries. We sought to identify the risk factors associated with mortality for carriage of CRE in patients at a tertiary-care teaching hospital. Methods: A retrospective observational study was conducted between January 2020 to December 2021 in a tertiary-care teaching healthcare facility, University Malaya Medical Centre in Malaysia. The study included all inpatients aged ≥18 years who had a CRE infection or were colonized during the study period. The genotype was identified by polymerase chain reaction (PCR). Statistical analysis of data including a multivariate logistic regression analysis was conducted using SPSS version 23.0 software. Results: In total, 176 cases of CRE (130 infection and 46 colonized) were identified, and the mortality rate was 31.8%. The main sources of CRE were rectal swab (61.9%), blood (11.9%), and respiratory sources (11.9%). Klebsiella pneumoniae (55.7%) was the predominant species, followed by Escherichia coli (21.6%). Among the isolates, 17.7% were non–CPE-CRE and 82.3% were CPE-CRE: NDM (69.3%) and OXA (10.8%). In multivariate analysis, the factors associated with mortality were older age (OR, 1.040; 95% CI, 1.012–1.069), longer length of stay (OR, 0.974; 95% CI, 0.955–0.994), use of central venous catheter (OR, 0.287; 95% CI, 0.094–0.878), and arterial lines (OR, 0.292; 95% CI, 0.095–0.891). Conclusion: Patients with CRE had a high mortality rate. Older age, longer duration of stay, indwelling CVC and arterial line were independent risk factors for death. Infection prevention and control measures to reduce CRE, such as active surveillance, contact precautions, compliance to intravenous catheter care bundles, healthcare worker education, and hand hygiene adherence, should be implemented.

Emergence Of Dengue Virus Type 4 During COVID-19 Pandemic In Patients Admitted to a Teaching Hospital In Malaysia

Prior to COVID-19, dengue was an important public health problem in Malaysia. Due to the movement control order imposed by the Malaysian government to curb the COVID-19 transmission, a study predicted that mosquito-borne diseases would increase during lockdown and partial lockdown seasons. Thus, this study aims to determine the current situation of dengue incidence during the pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020 and 2021). We compared the number of laboratory-confirmed cases in the pre-COVID19 year (2019) and during the COVID-19 pandemic (2020 and 2021). In addition to that, we characterized the clinical manifestation, dengue serotype and viremia levels of dengue patients that were admitted to the Hospital Cancelor Tuanku Muhriz. We found a significant decrease in the number of laboratory-confirmed cases between COVID-19 pandemic and the pre-covid period (p2020=0.064; p2021&lt;0.001). In this study, we found DENV 4 serotype was the most common serotype in dengue patients admitted to our hospital. There was no significant correlation between DENV serotype/viremia level with clinical manifestation of dengue fever and dengue with warning signs. However, patients infected with DENV4 had the highest viral load compared to patients infected with other serotypes. We also found high viremia levels were significantly associated with the febrile phase. Keywords dengue; clinical manifestation; dengue in Malaysia

Analysis of Health Profile and Treatment Needs of Patients with Special Health Care Needs at a Malaysian Teaching Hospital: A 6-Year Observation.

Special care dentistry (SCD) provides oral health care to disabled individuals in an environmental, cultural or social setting that supports their oral health. This study aimed to analyze the profiles of patients managed at an SCD clinic in a teaching hospital based on their sociodemographic background, medical condition or disability, dental diagnosis and treatment provided. This retrospective audit study included patients seen from the clinic's inception in January 2017 until June 2022, retrieved from the faculty's record management system. The pattern of patients seen was arranged on an Excel sheet and analyzed using SPSS. Quantitative data were analyzed via descriptive analysis (frequency) and chi-square test (P < 0.05). A 220% surge in the number of patients treated between January 2017 and June 2022, from two to 91 years old, with more male patients seen. Most patients had an intellectual disability (49.7%), followed by medical compromised (16.4%) and genetic conditions or syndromes (12.0%). 43% of had caries, which is more prevalent in women, and 31.6% had periodontal disease, with the majority being between the ages of 21 and 40. Periodontal treatment accounted for most of the dental treatment (76.1%). Even though only a small percentage of endodontic therapy was performed (2.4%), a significant association was found between the treatment, gender and age group of patients seen in the clinic. Considering their health profile, oral diagnosis and therapy, this study demonstrated the varied sorts of patients encountered in an SCD specialist clinic. This useful information will be beneficial in the development of a comprehensive care dentistry center for this community.

Prevalence of Tuberculosis among Health Care Workers in A Tertiary Teaching Hospital in Malaysia

Health care workers are at increased risk of nosocomial transmission of tuberculosis (TB). This study aimed to determine the prevalence of TB among health care workers and its associated factors. A retrospective analysis was conducted using database of TB screening program at Hospital Canselor Tuanku Mukhriz (HCTM) over the period of three years (2018-2020). The prevalence rate of TB showed increasing trend, from 1.54 per 100 health care workers in 2018 to 5.02 per 100 health care workers in 2020. Aged group of 31-40 had higher risk for contracting TB (p&lt;0.001), health support workers had significant association with TB acquisition (p=0.008), workers in Diagnostic Laboratory Department had the high risk of getting infected with TB (p&lt;0.001) and the workplace with the highest prevalence was in laboratory (45.9%). In terms of TB index cases among health care workers, 16 cases (69.5%) were pulmonary tuberculosis (PTB), 6 cases (26.1%) were extrapulmonary tuberculosis (EPTB) and 1 case (4.4%) had both PTB and EPTB. It was crucial for health care workers to be aware of these significant associations and for relevant authorities to carry out protective measures.

Comparison of clinical characteristics, mode of reperfusion therapy and mortality in STEMI patients admitted during office hours and after office hours to a tertiary teaching hospital in Malaysia

Previous studies have established that primary PCI as a mode of reperfusion in STEMI has better outcome compared to fibrinolytic therapy. In the past, studies have shown that admissions during weekend/off hour is associated with a higher mortality rate. Identification of the “off-hour” effect on the mode of reperfusion therapy and mortality in STEMI patients may provide room for service improvement.

Draft Genome Sequences of Four Methicillin-Resistant Staphylococcus aureus Strains (M080_2017, M106_2017, M181_2017, and M191_2017), Isolated from a Malaysian Teaching Hospital.

Draft genome sequences were obtained for four methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from various wards of the Hospital Canselor Tuanku Muhriz (HCTM), Kuala Lumpur, Malaysia, in 2017. Using different bioinformatics tools, we annotated the draft genomes and identified multiple antimicrobial resistance genes.

Characterisation of Non-Carbapenemase-Producing Carbapenem-Resistant Klebsiella pneumoniae Based on Their Clinical and Molecular Profile in Malaysia.

Non-carbapenemase-producing carbapenem-resistant Klebsiella pneumoniae (NC-CRKP) confers carbapenem resistance through a combination of chromosomal mutations and acquired non-carbapenemase resistance mechanisms. In this study, we aimed to evaluate the clinical and molecular profiles of NC-CRKP isolated from patients in a tertiary teaching hospital in Malaysia from January 2013 to October 2019. During the study period, 54 NC-CRKP-infected/colonised patients' isolates were obtained. Clinical parameters were assessed in 52 patients. The all-cause in-hospital mortality rate among NC-CRKP patients was 46.2% (24/52). Twenty-three (44.2%) patients were infected, while others were colonised. Based on the Charlson Comorbidity Index (CCI) score, 92.3% (48/52) of the infected/colonised patients had a score of ≥ 1. Resistance genes found among the 54 NC-CRKP isolates were blaTEM, blaSHV, blaCTX-M, blaOXA, and blaDHA. Porin loss was detected in 25/54 (46.3%) strains. None of the isolated strains conferred carbapenem resistance through the efflux pumps system. In conclusion, only 25/54 (46.3%) NC-CRKP conferred carbapenem resistance through a combination of porin loss and the acquisition of non-carbapenemase resistance mechanisms. The carbapenem resistance mechanisms for the remaining strains (53.7%) should be further investigated as rapid identification and distinction of the NC-CRKP mechanisms enable optimal treatment and infection control efforts.

Evaluation of Antibiotic Prescribing Pattern and Appropriateness among Hospitalized Pediatric Patients: Findings from a Malaysian Teaching Hospital.

Background: Antibiotics are commonly prescribed for hospitalized children. However, only a limited number of studies have evaluated antibiotic use in this population. The current work assessed the indication, prescribing pattern and appropriateness of antibiotics among pediatric inpatients. Methods: A retrospective cross-sectional study was conducted at the pediatric wards of a teaching hospital in Malaysia. Electronic charts of inpatients (≤12 years old) admitted in 2019 were reviewed. Antibiotic indication, selection, dosing regimen, route of administration and duration of treatment were evaluated using the national antibiotic guidelines (NAG). A binomial logistic regression was applied to test potential predictors of inappropriate antibiotic prescribing (IAP) incidence. Results: Out of 702 pediatric inpatients, 292 (41.6%) patients were given antibiotics and met the inclusion criteria. More than half of the patients (57.9%) were males, with a median age of 2.5 years. A total of 385 and 285 antibiotics were prescribed during hospitalization and at discharge, respectively. Azithromycin, co-amoxiclav and cefuroxime were the top three prescribed agents. Out of 670 prescriptions, IAP was identified in 187 (28%) prescriptions that were issued for 169 (57.9%) out of the 292 patients included in the study. Improper antibiotic selection, wrong dose and unnecessary antibiotic prescribing accounted for 41%, 34% and 10% of the identified IAP, respectively. Giving lower-than-recommended doses (28%) was more prevalent than prescribing higher doses (5%). The use of two antibiotics and treating upper respiratory tract infections were independent risk factors for IAP incidence. Conclusions: Prescribers did not adhere to the NAG in more than one quarter of the prescriptions. This may increase the risk of treatment failure, adverse drug reactions and the development of antibiotic resistance.

Impact of a digital educational program on the health literacy and perceived drug teratogenic risk of diabetic pregnant women attending a Malaysian teaching hospital

Impact of a digital educational program on the health literacy and perceived drug teratogenic risk of diabetic pregnant women attending a Malaysian teaching hospital

Laser ablation of anal fistulae: a 6-year experience in a tertiary teaching hospital in Malaysia.

Several studies have investigated the role of laser ablation of anal fistulae in the European setting. However, long-term follow-up results following laser fistula ablations are not widely investigated and no study was performed in the Asia-Pacific, a region with a distinctive prevalence of tuberculosis. The primary objective of this study is to report a single-centre experience with laser ablation of anal fistulae in Malaysia over a period of 6years. This was a retrospective observational study assessing the outcomes following 70 laser ablations of anal fistulae from February 2014 till December 2019. All cases were assessed using endoanal ultrasound. The laser ablation procedures were performed using laser systems and fibres from Endoteq Medizinische Laser GmBH, Germany, and Biolitec AG, Jena, Germany. Laser fibres were introduced into the fistula tract and laser energy was emitted radially in continuous mode when activated during the procedure. Pre-defined post-procedural outcomes (primary healing, healing failure or recurrence) were recorded as either present or absent during subsequent follow-up appointments and the data was analysed. Over a median follow-up period of 10months, primary healing was reported following 42 procedures (60.0%). Healing failure was reported following 28 procedures (40.0%) whilst recurrence was seen after 16 procedures (22.86%). No new cases of incontinence were reported following the procedure. The reported primary healing rate following laser ablation of anal fistulae in this study appears consistent with existing literature published by other international centres. The most apparent clinical advantage of this procedure is sphincter-function preservation. However, the primary healing rate after isolated laser fistula ablation is still suboptimal. Judicious patient selection and application in anal fistulae with suitable characteristics could potentially improve the post-procedural outcomes.

Patient Experience of Inpatient Care and Services Received at a Teaching Hospital in Malaysia: A Cross-Sectional Study

Background: Patients’ experience reflects the quality of healthcare services from the end user’s perspective and therefore is an essential indicator of healthcare quality. This study aimed to measure patient experience of inpatient care and services received at a teaching hospital. Methods: A total of 321 patients were enrolled in this quantitative, cross-sectional study during their discharge. Data were collected from May to September 2018 through a validated self-administered questionnaire adapted from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Analysis of patient experience and overall hospital quality rating was conducted using SPSS version 25. Results: The majority of the patients (91%) reported a positive experience of inpatient care and perceived a high quality of service provided by the hospital. Further analysis revealed that the patients’ experiences varied significantly with their age, ethnicity, religion, employment status, type of ward, and perceived health status (all p < 0.05). Meanwhile, the level of patient experience was significantly correlated with the overall rating of the hospital (r = 0.804, p < 0.001). Conclusions: The findings served as benchmark data for hospital management to address issues related to hospital services. Future studies should be extended to patients from multidisciplinary wards and outpatient units to provide a significant reflection of hospital service quality.

Risk Factors for Heart Disease in Pet Dogs Attended At a Veterinary Teaching Hospital in Malaysia

The distribution and risk factors of canine heart disease in Malaysia are still not widely studied. This retrospective study examined the distribution of common canine heart diseases and the role of gender, age group, and breed size as risk factors of the dogs in a teaching hospital in Malaysia. Medical records of all dogs presented between 2013 and 2020 with a heart disease diagnosed were reviewed and analyzed. Univariate and multivariate logistic regression was carried out to identify the risk factors for canine heart diseases in general and based on specific disease. In a duration of 7 years, a total of 9255 dog cases were presented and 7.9% (n=734, 95% CI: 0.07-0.09) of the dogs were diagnosed with heart disease. Majority of heart disease cases were valvular disease (n=528, 95% CI: 0.05-0.06), followed by heartworm disease (n=113. 95% CI: 0.01-0.01), dilated cardiomyopathy (DCM) (n=90, 95% CI: 0.01-0.01). Senior (OR 3.54, 95% CI: 2.32-5.37) and small breed (OR 6.74, 95% CI: 4.51-10.1) dogs had higher risk for valvular disease, while large breed (OR 7.18, 95% CI: 4.00-13.01) dogs were at risk for heartworm disease. Male (OR 1.83, 95% CI:1.11-3.04) and large breed dogs (OR 3.12, 95% CI: 1.80-5.39) had greater risk for DCM, respectively. Gender, age group and breed size play important role in predicting the likelihood of heart diseases in dogs and are best to be applied in the context of specific heart diseases. Information obtained would assist clinicians with their clinical diagnosis of the heart disease.

COVID-19 Pandemic: Two-year Experience and Response of a Teaching Hospital in Malaysia and the Effect on Postgraduate Orthopaedic Training.

As the number of COVID-19-related infections and deaths increased exponentially in the during 2020, few countries were equipped to manage and curb this novel coronavirus. Initially there was no proven cure or vaccine to this novel virus (SARS-Cov-2), leaving the authorities with no choice but to impose quarantines at the short-term expense of their economies. As we gain more knowledge on this novel virus, the tried-and-tested method of selective testing of the symptomatic patients, used successfully in almost all infectious respiratory diseases, has been replaced with trace-and-test method, as most of the infected patients remained asymptomatic. In early 2021, the availability of vaccines provided a shed of light out from this pandemic. Nevertheless, we faced an enormous task in juggling between vaccination of the population, managing patients with COVID-19 infection as well as non-COVID-19 patients. Here, we share our experience and response in managing this healthcare crisis across a two-year period during the pandemic and we hope other centres can learn from what we went through and help them derive a protocol to navigate through a future pandemic.