University Malaya Medical Centre Research Articles

Abnormalities Detection in Apert Syndrome using Hierarchical Clustering Algorithms

Craniosynostosis syndrome is a congenital condition occurring due to the abnormal development of the skull, leading to abnormalities in skull morphology. Apert syndrome is one of common craniosynostosis syndrome in Malaysia and this syndrome can be categorized as the severe craniofacial disorders. The abnormalities of skull morphological in Apert syndrome patient can be identified as outliers which are investigated in this study. This study presents a skull morphological analysis based on a case study involving six paediatric patients diagnosed with Apert syndrome, alongside 22 control patients aged 0 to 12 years, all of whom underwent treatment at the University Malaya Medical Centre (UMMC). The computerized tomography scan (CTSCAN) data is provided by UMMC recorded from year 2012 until 2020 and the data is measured using MIMICS software by taking the measurement of cranial angles. The clustering-based procedures will be applied to identify the abnormalities in skull angle dataset. There are 12 skull angles and these angles are analysed using hierarchical clustering algorithms for identifying the outliers or abnormalities. The objective is to detect the abnormalities and determine the skull angles that associated with Apert syndrome (AS) in Malaysia population using clustering-based procedure. The abnormalities in Apert syndrome datasets are successfully detected by the algorithms and this study found that there are skull angles with specific location of angles are associated with Apert syndrome. This study also found that the location of skull angles for patients age 0-24 months old and >24 months old are different. The findings of this study can assist the surgical team in directing additional focus towards specific regions of the skull during the planning of interventions. This guidance has the potential to optimize surgical outcomes and reduce the risk of potential complications.

Erdosteine in children and adults with bronchiectasis (BETTER trial): study protocol for a multicentre, double-blind, randomised controlled trial

IntroductionBronchiectasis is a worldwide chronic lung disorder where exacerbations are common. It affects people of all ages, but especially Indigenous populations in high-income nations. Despite being a major contributor to...

Prevalence and predictors of post-acute COVID syndrome among infected healthcare workers at University Malaya Medical Centre.

Post Acute COVID Syndrome (PACS), a complex and poorly understood condition characterised by persistent symptoms following the acute phase of COVID-19 infection, has emerged as a significant global health concern. Healthcare workers who had been at the forefront of the pandemic response are at heightened risk of contracting the virus and subsequently developing PACS. Therefore, we aim to determine the prevalence and risk factors for PACS among healthcare workers infected with COVID-19. A cross-sectional study was conducted between October 2022 and August 2023 using an online REDCap electronic data capture tool questionnaire. PACS was defined as new or persistent symptoms lasting more than 28 days after a positive SARS-CoV-2 polymerase chain reaction or rapid test kit antigen test. Multivariable logistic regression was performed to determine predictors associated with PACS. Among 609 infected healthcare workers, they were predominantly female (71.8%), Malays (84.6%), and aged 18-39 years (70.1%). 50.7% of infected healthcare workers experienced PACS. The most common PACS symptoms experienced were fatigue (27.9%), cough (25.1%), decreased physical strength (20.5%), and musculoskeletal pain (19.2%). Those who are more likely to develop PACS were females, underlying asthma, and COVID-19 severity category 3. On the other hand, those who received booster vaccinations were less likely to develop PACS. PACS is prevalent among healthcare workers with COVID-19 at the University Malaya Medical Centre. These findings emphasise the critical need for those with higher risk to receive regular health monitoring and checkups to detect any early signs of PACS. It underscores the need for continuous support and healthcare interventions to mitigate the impacts of PACS and ensure the physical and mental well-being of healthcare workers.

A study of hospitalized COVID-19 patients with AKI in a setting of multiracial developing country

BackgroundThe commonest indication for hospitalization in COVID-19 patients is hypoxemia or severe respiratory symptoms. However, COVID-19 disease may result in extrapulmonary complications including kidney-related pathology. The reported incidence of renal involvement related to COVID infection varies based on geographical location.ObjectiveThis study aimed to assess the incidence rate of AKI in hospitalized COVID-19 patients and identify risk factors and prognostic predictors.MethodIn this retrospective study, we recruited hospitalized COVID-19 patients from January 2021 until June 2021 at the University Malaya Medical Center. The inclusion criteria were hospitalized for ≥ 48 h with confirmed COVID-19 infection and at least 18 years old. Patient demographic and clinical data were collected from electronic medical records. The staging of AKI was based on criteria as per KDIGO guidelines.ResultsOne thousand five hundred twenty-nine COVID patients fulfilled the inclusion criteria with a male-to-female ratio of 759 (49.6%) to 770 (50.3%). The median age was 55 (IQR: 36–66). 500 patients (32.7%) had diabetes, 621 (40.6%) had hypertension, and 5.6% (n = 85) had pre-existing chronic kidney disease (CKD). The incidence rate of AKI was 21.1% (n = 323). The percentage of COVID patients in different AKI stages of 1,2 and 3 were 16.3%, 2.1%, and 2.7%, respectively. Fifteen hospitalized patients (0.98%) required renal replacement therapy. 58.8% (n = 190) of AKI group had complete recovery of kidney function.Demographic factors included age (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.012), CKD (p < 0.001), and vaccination status (p = 0.042) were associated with an increased risk of developing AKI. We found that the AKI cohort had statistically significant lower platelet counts and higher ferritin levels than the non-AKI cohort. AKI is a risk predictor of prolonged hospitalization (p < 0.001) and higher mortality rates (P < 0.001).ConclusionAKI is a common clinical complication among hospitalized COVID-19 patients. The etiology of AKI is multifactorial and may have an adverse impact on patient morbidity and mortality.

Financial Impact on Malaysian Families with Children Admitted with Community Acquired Pneumonia

Introduction: Hospitalisation following community-acquired pneumonia (CAP) among children may cause considerable burden to a family. This study was conducted to determine the financial impact on the parents and risk factors for prolonged hospitalisation. Methods: A prospective, cross-sectional hospital-based study was conducted at the University Malaya Medical Centre (UMMC) among patients aged between 3 months and 12 years old with CAP. Parents were interviewed and medical records were reviewed. Results: A total of 95 patients were enrolled in this study with a median age of 13 months, of whom 52 were boys (54.7%) and 43 were girls (45.3%). The median (IQR) total expenses incurred by the parents was RM546.90 (USD 128.23), which constituted 12.6% of total household income. The median workday loss was 9 (4 – 29) days. Pre-existing chronic illness and underweight were found to be strong predictors of prolonged hospitalisation with odds ratio of 3.97 and 4.5, respectively. Conclusion: CAP resulted in a significant financial burden in terms of loss of productivity and costs incurred by parents.

Comparative retrospective analysis: exploring the quality of life of people with epilepsy in two cohorts

People with epilepsy (PWE) are reported to have a lower quality of life (QOL). QOL among PWE were primarily observed through cross-sectional studies, and there is little information about the progression of QOL among PWE over the years. This study aimed to investigate the changes in QOL among PWE at a tertiary referral centre. A retrospective observational study was conducted among PWE from the Neurology clinic at the University Malaya Medical Centre. Data were extracted from the Quality of Life in Epilepsy Inventory (QOLIE-31) database for 2016, 2017, and 2020. A total of 88 subjects were included in Cohort 1 (2016 vs. 2017) and Cohort 2 (2017 vs. 2020), respectively. There was a significant improvement in mean scores of QOLIE-31 in Cohort 1 (57.7±12.2 vs. 63.2±14.2; p&lt;0.001), in terms of seizure worry, emotional well-being, cognitive functioning, medication effects and social function (p&lt;0.05, respectively). However, significant deterioration was observed in Cohort 2 (67.1±15.6 vs. 63.1±14.9; p=0.008), in terms of seizure worry and cognitive functioning (p&lt;0.05, respectively). Based on the calculated Jacobson Reliable Change Index (RCI) for the QOLIE-31 score, 28.4% from Cohort 2 experienced deterioration of QOL as compared to those from Cohort 1 (8%) (p&lt;0.001), which was most likely attributed to the COVID-19 pandemic. This study provides insights into the change of QOL among PWE in Malaysia over time, encompassing the COVID-19 pandemic period.

Routine vaginal examination to assess labor progress at 8 compared to 4 hours after early amniotomy following Foley balloon ripening in the labor induction of multiparas: a randomized trial

BackgroundVaginal examination to monitor progress in labor is recommended at least every 4 hours but it can cause pain and embarrassment to women. Trial data is limited on the best intensity for vaginal examination. Vaginal examination is not needed for oxytocin dose titration after amniotomy has been performed and oxytocin infusion started. The Foley balloon commonly ripens the cervix without strong contractions; amniotomy and oxytocin infusion is usually required to drive labor. ObjectiveTo evaluate the first vaginal examination at 8 vs 4 hours after amniotomy-oxytocin following Foley ripening in multiparous labor induction. MethodsA randomized controlled trial was conducted from October 2021 to September 2022 in University Malaya Medical Center. Multiparas at term were recruited at admission for labor induction. Participants were randomized to a first routine vaginal examination at 8 or 4 hours after Foley balloon ripening and amniotomy. Titrated oxytocin infusion was routinely commenced after amniotomy to initiate contractions. The two primary outcomes were the time from amniotomy to delivery (non-inferiority hypothesis) and maternal satisfaction (superiority hypothesis). Data were analyzed with the Student t-test, Mann-Whitney U test, Chi square test (or Fisher exact test) as suitable for the data. Results204 women were randomized, 102 to each arm. Amniotomy to birth interval was mean±standard deviation 4.97±2.47 vs 5.79±3.17, mean difference -0.82, 97.5% CI (-1.72 to 0.08) hours p=0.041 (Bonferroni correction), which was non-inferior within the pre-specified 2 hour upper margin and maternal satisfaction score with allocated labor care was median[interquartile range] 9[8-9] vs 8[7-9] p=0.814 (11-point 0-10 NRS) for 8 vs 4 hours arms respectively. Oxytocin infusion to birth interval difference was also non-inferior within the 97.5% CI (-1.59 to 0.23) margin of 2 hours. Of the maternal outcomes, amniotomy to first vaginal examination intervals were 3.9±1.8 vs 3.4±1.3hours p=0.026 and number of vaginal examinations was 2[2-3] vs 3[2-3.25] p<0.001 for 8 vs 4 hours arms respectively. For the 8 hours arm, first vaginal examination was less likely to be as scheduled and more likely to be indicated by sensation to bear down (p<0.001) and epidural analgesia rate was lower 13/102 (12.7%) vs 28/102 (27.5%) RR 0.46 95% CI 0.26–0.84 p=0.009. Other outcomes of mode of delivery, indications for cesarean and delivery blood loss were not different. Neonatal outcomes were not different. ConclusionRoutine first vaginal examination at 8 hours compared to 4 hours is non-inferior for the time to birth but does not improve maternal satisfaction.

Robotic Precision vs. Human Dexterity—Benchtop Comparative Study of Free-Hand vs. Robotic-Assisted Puncture in Fluoroscopy-Guided Percutaneous Nephrolithotomy

Introduction: Percutaneous nephrolithotomy (PCNL) is the standard procedure for treating large kidney stones, especially those measuring over 20 mm or staghorn stones. Accurate placement of the tract into the renal collecting system of interest is crucial. Objective: To compare the free-hand puncture technique with robotic-assisted puncture during fluoroscopy-guided PCNL on a phantom kidney model in terms of efficiency and safety. A self-assessment of confidence levels after each puncture was recorded. Study Design: This prospective single-center benchtop study was conducted at the University Malaya Medical Centre (UMMC). Four urological residents participated and performed phantom punctures using both the free-hand bull’s eye technique and the automated needle targeting system with X-ray (ANT-X). Each resident performed a total of 60 punctures on the renal phantom models, with 30 punctures using the free-hand technique and 30 punctures using the ANT-X robotic-assisted system. Results: A total of 240 needle insertions were conducted, with 120 in the ANT-X group and 120 in the free-hand group. The success rate of needle insertions was 100% in both groups. However, the study revealed that the ANT-X group required, on average, an additional 51 s for needle puncture compared to the free-hand group (p &lt; 0.001). In terms of fluoroscopic exposure, the ANT-X group exhibited significantly lower radiation exposure compared to the free-hand group (p &lt; 0.001). Sub-analysis showed that puncture time remained consistent regardless of the technique used, but fluoroscopic screening time decreased with increasing participant experience. The ANT-X group also resulted in significantly lower radiation exposure during initial sessions compared to the free-hand technique. Surgeons’ self-assessment of confidence levels indicated a high level of confidence in needle puncture. Conclusions: Our benchtop study comparing the efficacy and safety between free-hand and ANT-X phantom punctures revealed comparable results. The needle puncture technique facilitated by the ANT-X system showed promising results in terms of reducing fluoroscopic exposure, albeit at the cost of longer operative times. This technology holds promise for novice surgeons who are in the early stages of their learning curve and might be useful for experienced surgeons looking to reduce radiation exposure.

Exploring Guolin Qigong (Mind-Body Exercise) for Improving Cancer Related Fatigue in Cancer Survivors: A Mixed Method Randomized Controlled Trial Protocol.

Cancer-related fatigue and its associated symptoms of sleep disorder and depression are prevalent in cancer survivors especially among breast, lung, and colorectal cancer survivors. While there is no gold standard for treating cancer-related fatigue currently, studies of mind-body exercises such as Qigong have reported promise in reducing symptoms. This study was designed to evaluate the feasibility and effect of Guolin Qigong on cancer-related fatigue and other symptoms in breast, lung and colorectal cancer survivors while exploring their perceptions and experiences of Guolin Qigong intervention. This is an open-label randomized controlled trial with 60 participants divided into 2 study groups in a 1:1 ratio. The intervention group will receive 12 weeks of Guolin Qigong intervention with a 4-week follow-up while control will receive usual care under waitlist. The primary outcome will be feasibility measured based on recruitment and retention rates, class attendance, home practice adherence, nature, and quantum of missing data as well as safety. The secondary subjective outcomes of fatigue, sleep quality and depression will be measured at Week-1 (baseline), Week-6 (mid-intervention), Week-12 (post-intervention), and Week-16 (4 weeks post-intervention) while an objective 24-hour urine cortisol will be measured at Week-1 (baseline) and Week-12 (post-intervention). We will conduct a semi-structured interview individually with participants within 3 months after Week-16 (4 weeks post-intervention) to obtain a more comprehensive view of practice adherence. This is the first mixed-method study to investigate the feasibility and effect of Guolin Qigong on breast, lung, and colorectal cancer survivors to provide a comprehensive understanding of Guolin Qigong's intervention impact and participants' perspectives. The interdisciplinary collaboration between Western Medicine and Chinese Medicine expertise of this study ensures robust study design, enhanced participant care, rigorous data analysis, and meaningful interpretation of results. This innovative research contributes to the field of oncology and may guide future evidence-based mind-body interventions to improve cancer survivorship. This study has been registered with ANZCTR (ACTRN12622000688785p), was approved by Medical Research Ethic Committee of University Malaya Medical Centre (MREC ID NO: 2022323-11092) and recognized by Western Sydney University Human Research Ethics Committee (RH15124).

Poor HIV-related Knowledge, Perceived Risks and Attitudes Among Urban-dwelling Malaysian Older Adults: Key Barriers to Zero HIV Transmission by 2030.

Globally and in Malaysia, there are increasing rates of HIV infection among older adults but a corresponding decline in other younger age groups. We aimed to investigate the HIV-related knowledge, perceived risks, attitudes, and risk behaviours among multi-ethnic urban-dwelling older adults in Malaysia. A cross-sectional, questionnaire-based study was conducted among 320 adults aged 50 years and above residing in urban Klang Valley, Malaysia. Participants were recruited via convenience sampling in the community and in the outpatient clinics and pharmacy of University Malaya Medical Centre, Malaysia, from April 2021 to January 2022. The median (IQR) age of participants was 58 (55-64) and 42.5% were males. The median (IQR) knowledge score was 10 (8-12) out of 14. Significant knowledge gaps were noted and ethnic Chinese, higher education levels and better HIV-related attitudes were associated with better scores. The median (IQR) attitude score was 49 (41-55) out of 65. Ethnic Chinese and Indian, knowing people living with HIV (PLHIV), and better HIV-related knowledge were associated with better attitude scores. Many (43.8%) older adults were sexually active however rates of consistent condom use was low (19%) and the majority (89.9%) of participants had low self-perceived risk of HIV. These findings highlight underlying drivers for HIV transmission and delayed treatment among older adults in Malaysia and indicate a need for targeted HIV prevention programs for this population.

ANALYSIS OF HARDWARE REMOVAL IN MAXILLOFACIAL TRAUMA: A RETROSPECTIVE STUDY IN A MILITARY HOSPITAL IN SANA'A, YEMEN

Background and objective: Dental trauma is a significant problem for total dental health in terms of expenses, frequency, and age (young patients). Collaboration between various professionals, including oral surgeons, maxillofacial surgeons, dentists, orthodontists, and periodontists, frequently results in the treatment process. Surgical treatment may entail placing plates for fractures and shattered bones for long or permanent periods, and may require their removal for many reasons. Therefore, this study sought to ascertain the reasons for plate removal in individuals referred to the Department of Oral and Maxillofacial Surgery at Military Hospital in Sana'a, Yemen during a period of 3 years. Method: The study included 57 Yemeni patients who visited the Department of Oral and Maxillofacial Surgery at the Military Hospital in Sana’a during the period 2021-2023. Cases of hardware removal were extracted from the medical records to include sex, age, medical history, accident history, type of fracture, primary complaint, period from the date of the first operation, approach to the operation, tooth in the fracture line, and extracted tooth. Results: Gunshot injuries (40.4%) and explosive injuries (31.6%) were the most common causes of maxillofacial fractures. Mandibular fractures (68.4%) were the most frequent, followed by orbital and zygomatic fractures (12.3% each). The main reason for hardware removal was infections (29.8%), followed by patient preference (22.8%) and visible exposed hardware (15.8%). Mini-plates (68.4%) were the most commonly removed hardware, and the extra-oral approach (56.1%) was the most frequently used for removal. There was a significant association between orbital fractures and the incidence of positive discharge, as well as between reconstructive plates and the incidence of positive discharge. Longer plate usage, exceeding 24 months, increased the probability of positive discharge. Tooth involvement and extraction were minimal. Conclusion: Gunshot and explosive injuries were the main causes of maxillofacial fractures, while infections, patient preferences, visible exposed devices, and pain and discomfort were the main reasons for removal of devices. Mandibular fractures were the most common and orbital fractures carry a higher risk of infection, while small plates have shown lower rates of infection. Prolonged panel use beyond 24 months increased the probability of positive discharge. Peer Review History: Received: 25 October 2023; Revised: 18 November; Accepted: 24 December, Available online: 15 January 2024 Academic Editor: Dr. Gehan Fawzy Abdel Raoof Kandeel, Pharmacognosy Department, National Research Centre, Dokki, 12622, Giza, Egypt, gehankandeel9@yahoo.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com Dr. Hasniza Zaman Huri, University of Malaya Medical Centre, Kuala Lumpur, hasnizazh@ummc.edu.my

Tumours of the foot: A 10 years retrospective analysis.

The foot is a complex structure composed of several tissues, each of which can be the origin of the proliferation and development of the tumour. Most lesions about the foot are reactive or inflammatory, but some are true neoplasms. This is a retrospective analysis of 4997 patient records treated in the Orthopaedic Oncology Unit of University Malaya Medical Centre, Malaysia, between 1 January 2010 to 31 December 2020. Demographic data of 195 patients with foot tumours were analysed out of 4997 neoplasm patients. There were 195 cases of foot tumours: 148 were benign, and 47 were malignant. 47 were bone tumours, 4 were metastases, and 144 were soft tissue tumours. Six patients succumbed to the disease, two cases of giant cell tumour (GCT) and one patient with synovial sarcoma had a recurrence. Treatment of foot tumours was wide resection in general. However, in metastasis cases, amputation was done. The majority of tumours were in the toes and dorsum of the foot. Soft tissue tumours of the foot occur in the elderly population in contrast to bone tumours, mainly in the second decade of life. The gender distribution was almost equal for foot tumours. Ganglion and Giant Cell Tumour of the bone are the commonest benign soft tissue and bone tumours. The most common malignant soft tissue and bone tumours are malignant melanoma and chondrosarcoma. The amputation rate is 5.64% the recurrence rate is 1.54%. Mortality rate is 3.08%. The MSTS score is 79%, and the TESS score is 76.23%. Foot tumours are relatively rare, mostly originating from soft tissue and exhibiting a benign nature. Nonetheless, a noteworthy proportion-approximately a quarter of these tumours-demonstrate malignancy. The surgical interventions undertaken in managing these tumours and associated functional outcomes generally yield acceptable results.

Pre-operative psoas muscle index, a surrogate for sarcopenia; as a predictor of post-esophagectomy complications.

Esophagectomy is the standard of care for curative esophageal cancer. However, it is associated with significant morbidity and mortality. Esophageal cancer is known to negatively affect the nutritional status of patients and many manifest cancer sarcopenia. At present, measures of sarcopenia involve complex and often subjective measurements. We assess whether the Psoas Muscle Index (PMI); an inexpensive, simple, validated method used to diagnose sarcopenia, can be used to predict adverse outcomes in patients after curative esophagectomy. Multi-centre, retrospective cohort between 2010-2020, involving all consecutive patients undergoing curative esophagectomy for esophageal cancer in University Malaya Medical Centre, Sungai Buloh Hospital, and Sultanah Aminah Hospital. The cut-off value differentiating low and normal PMI is defined as 443mm2/m2 in males and 326326mm2/m2 in females. Complications were recorded using the Clavien-Dindo Scale. There was no statistical correlation between PMI and major post-esophagectomy complications (p-value: 0.495). However, complication profile was different, and patients with low PMIs had higher 30-day mortality (21.7%) when compared with patients with normal PMI (8.1%) (p-value: 0.048). Although PMI did not significantly predict post-esophagectomy complications, low PMI correlates with higher 30-day mortality, reflecting a lower tolerance for complications among these patients. PMI is a useful, inexpensive tool to identify sarcopenia and aids the patient selection process. This alerts healthcare professionals to institute intensive physiotherapy and nutritional optimization prior to esophagectomy.

Knowledge, attitude, and practice of virtual consultation among outpatients at a teaching hospital in Malaysia.

During the coronavirus disease 2019 (COVID-19) pandemic, the use of virtual consultations has accelerated to ensure continued access to healthcare despite lockdowns and physical distancing measures. We aimed to determine the knowledge (awareness) of, attitude (acceptability) to, and practice (exposure) [KAP] of virtual consultations (VC), the demographic factors associated with poor KAP, and the correlation between the three KAP domains. A cross-sectional study, using a convenience sampling technique, was conducted from 13 September, 2021 to 28 November, 2021. We designed a 45-item VC KAP questionnaire. This was distributed to outpatient users attending cardiovascular, dermatology, geriatrics, haematology, endocrine, respiratory, gastroenterology, rheumatology, or neurology clinics at the University Malaya Medical Centre. It was completed during face-to-face, online, or telephone interviews. The data were analysed using SPSS version 24.0. Binary logistic regression was used to determine the demographic factors associated with KAP. Correlation between KAP domains was determined using Spearman's rho (r). A p-value of <0.05 was considered statistically significant. A total of 366 questionnaires were completed. Knowledge (awareness), attitude (acceptability), and practice (exposure) were considered good in 69.7%, 80.9%, and 24.6% of participants, respectively. There were no significant relationships between age, gender, ethnicity, and duration of hospital attendance (years) with knowledge (awareness), attitude (acceptability), and practice (exposure). A moderate positive correlation was seen between knowledge (awareness) and attitude (acceptability) (Attitude total [Atotal]) (r = 0.48, p<0.001), with no significant correlation between knowledge (awareness) and practice (exposure) (r = 0.04, p = 0.45), and attitude (acceptability) (Atotal) and practice (r = 0.01, p = 0.82). Overall, outpatient clinic users had good knowledge (awareness) of and were receptive towards VC but had poor practice (exposure). More opportunities for VC use in healthcare can increase exposure and subsequent utilisation. Interventions to increase the effectiveness of VC use should be explored in future studies.

Perceptions and practices of self-management among adult patients with gout at a primary care clinic: A qualitative study.

Gout is a chronic disease commonly associated with other comorbidities. Patients' perceived quality of life empowers them in managing their health. Self-management is imparted as part of management among patients with chronic disease. This study aimed to explore the perceptions and practices of self-management among patients with gout from different ethnic groups in Malaysia. A qualitative study was conducted among Malay, Chinese and Indian patients with gout via semi-structured in-depth interviews at the primary care clinic of University Malaya Medical Centre in either English or Malay language. All participants had a gout duration of more than 6 months and were either taking urate-lowering drugs or not using them at all. A total of 20 participants were successfully recruited for the study. Among the participants, 18 were men, while two were women. Further, nine were Malays; six, Chinese; and four, Indians. The age ranged from 29 to 81 years, while the gout duration ranged from 1 to 30 years. From the interviews, three themes emerged: experiences with gout, types of self-management of gout and factors influencing self-management of gout. Diet control is the main self-management practice of patients with gout. Traditional medicine practices include natural methods such as consumption of different types of vegetable juices, pineapple and papaya. Each ethnicity has its own unique beliefs and food cultures. By understanding the self-management practices of patients from diverse ethnic backgrounds, healthcare practitioners can tailor the treatment of gout to individual needs.

Significant loss of retinal nerve fibre layer and contrast sensitivity in people with well controlled HIV disease: implications for aging with HIV

ObjectiveAntiretroviral therapy has decreased the prevalence of retinal opportunistic infections in people living with HIV (PLWH). However, abnormalities in visual function are evident and may be associated with an early onset of aging in PLWH. In this study, we examined the Retinal Nerve Fibre Layer (RNFL) thickness and visual function in PLWH and HIV non-infected controls in Malaysia.DesignCross-sectional studyMethodsTwo hundred and two (202) PLWH without retinal opportunistic infection and 182 age-matched, HIV seronegative individuals were enrolled. PLWH were recruited from the Infectious Disease clinic at the University Malaya Medical Centre. Controls were recruited among the hospital staff and community volunteers. RNFL thickness was measured with spectral domain optical coherence tomography (SDOCT). Visual functions include visual acuity using LogMAR chart and contrast sensitivity using Pelli- Robson Chart.ResultsAll PLWH (mean age 46.1 years ± 9.9 years) in the study were on ART and 61.2% had a CD4+ T-cell count more than 500 cell/μl. The mean visual acuity was similar between the two groups (LogMAR 0.05 vs. 0.07, p = 0.115). Contrast sensitivity was lower in PLWH compared to HIV seronegative individuals (1.90 vs 1.93, p = 0.032). RNFL thickness was significantly thinner in the temporal quadrant for PLWH compared to controls (68.89 μm vs 74.08 μm, p = 0.001).ConclusionChanges in RNFL thickness and contrast sensitivity were seen in PLWH despite their relatively young age and well controlled HIV disease. The changes reflect structural and functional deficits, and could have long-term implications on their health trajectory.

A predictive analytics model using machine learning algorithms to estimate the risk of shock development among dengue patients

Dengue is a common viral disease in tropical and subtropical countries. The clinical manifestation of dengue has a wide spectrum, from asymptomatic seroconversion to severe dengue infection. Severe dengue is defined as dengue with the presence of specific symptoms, including severe plasma leakage leading to shock or the accumulation of fluids with respiratory distress, severe bleeding, and severe organ impairment. Examining the progression of shock with the integration of patients’ physiological information and biochemical parameters would help in understanding the progression of the disease and early detection of shock. In this study, physiological patient data diagnosed with dengue are collected from a University Malaya Medical Centre’s electronic record. A prediction model learned from the measurement of a patient’s physiological data is the basis for effective treatment and prevention of shock development in critically ill patients. Hence, this study presents the predictive performance of machine learning algorithms to estimate the risk of shock development among dengue patients. Logistic regression, decision trees, support vector machines and neural networks are evaluated. Lastly, ensemble learnings of bagging and boosting are also applied to the weak learner to optimize performance. The experimental results show that the bagging algorithm outperforms other competing methods with a 14.5% improvement from the individual decision tree. The full blood count (FBC) specifically haemoglobin (Hb) on day 2 is found to be a strong predictor for severe dengue occurrence.

Isotonic balanced fluid versus 0.9% saline in patients with moderate to severe traumatic brain injury: A double-blinded randomised controlled trial

Background and importanceTraumatic brain injury (TBI) is a global health concern with significant economic impact. Optimal fluid therapy aims to restore intravascular volume, maintain cerebral perfusion pressure and blood flow, thus preventing secondary brain injury. While 0.9% saline (NS) is commonly used, concerns about acid-base and electrolyte imbalance and development of acute kidney injury (AKI) lead to consideration of balanced fluids as an alternative. ObjectivesThis study aimed to compare the outcomes of patients with moderate to severe TBI treated with Sterofundin (SF) versus NS. Design, settings and participantsA double-blinded randomised controlled trial of patients aged 18 to 65 years with TBI was conducted at the University Malaya Medical Centre from February 2017 to November 2019. Intervention or exposurePatients were randomly assigned to receive either NS or SF. The study fluids were administered for 72 h as continuous infusions or boluses. Participants, investigators, and staff were blinded to the fluid type. Outcomes measure and analysisThe primary outcome was in-hospital mortality. Relative risk (RR) with 95% confidence interval (CI) was calculated. Main resultsA total of 70 patients were included in the analysis, with 38 in the NS group and 32 in the SF group. The in-hospital mortality rate were 3 (7.9%) in the NS group vs. 4 (12.5%) in the SF group, RR = 1.29 (95% CI, 0.64 to 2.59; p = 0.695). No patients developed AKI and required renal replacement therapy. ICP on day 3 was significantly higher in the SF group (18.60 ± 9.26) compared to 12.77 ± 3.63 in the NS group, (95% CI, −11.46 to 0.20; p = 0.037). There were no significant differences in 3-day biochemical parameters and cerebral perfusion pressure, ventilator-free days, length of ICU stay, or Glasgow Outcome Scale-Extended (GOS-E) score at 6 months. ConclusionsIn patients with moderate to severe TBI, the use of SF was not associated with reduced in-hospital mortality, development of AKI, or improved 6-month GOS-E when compared to NS.

#24 : The Effect of the COVID-19 Pandemic on Levels of Stress, Anxiety, and Depression Among Infertile Couples. A Cross-Sectional Study

Background and Aims: Many infertile couples require assisted conception and success rate depends on patient’s age. Hence, time is a huge factor. Therefore, due to postponement of fertility services and fear of COVID-19 during the pandemic, we hypothesized that these couple would experience a heightened level of stress, anxiety and depression. Method: This cross-sectional study was done in the reproductive unit, University Malaya Medical Centre, Kuala Lumpur, between July 16, 2021, and December 17, 2021. 165 patients were included in the final analysis. Couples who were planned for fertility treatment were recruited and asked to answer an anonymous electronic survey that contained depression, anxiety, and stress scales (DASS-21). Results: From univariate analysis, stress was found to be significant in 20–30-year-old, Chinese patients, degree and postgraduate degree holders, patients with endometriosis, and those that have had infertility for 5 years. Anxiety was significant in 20–30-year-old, males, Chinese and Indian patients, diploma, degree, and postgraduate degree holders, and couples with infertility for at least 5 years and between 5–10 years. Depression was also prevalent among males, Chinese and Indian patients, degree holders, and patients with endometriosis. Multivariate logistic regression was subsequently performed, taking into account potential confounders in the prediction of clinically significant psychological distress. Mild 1.3E7 (2.2E6-8.0E7), p = 0.001 and moderate 2.7E7 (4.9E6-1.4E8), p = 0.001 stress levels were found to be significant among the 20–30-year-old age group. Other background variables, however, did not contribute significantly to the psychological distress. Conclusion: Disruption of fertility treatment during the COVID-19 pandemic was associated with a significant psychological impact on patients’ mental health, especially among the younger age group. Psychological assessment and counselling should be mandatory if there are prolonged unscheduled disruption in provision of fertility treatment to infertile couples.

#23 : Correlation of Multinucleated Embryo and Pregnancy Outcome

Background and Aims: Single embryo transfer is increasingly done in practice to avoid multiple pregnancy. Therefore, it is important to ensure the embryo with the best pregnancy outcome is selected. Although new criteria involving genomic, transcriptomic, and proteomic have been developed to predict embryo outcome, morphology of the embryo remains as the main indicator because it is easy to implement and less controversial. To study the correlation of multinucleated embryos and pregnancy outcomes Method: This is a retrospective review of a total of 411 embryos from 225 women undergoing their first IVF or ICSI cycle in University Malaya Medical Centre, Kuala Lumpur between January 2019 and October 2021. Multinucleation was defined as the presence of more than one nucleus within at least one of the blastomeres of a 2-cell embryo and a time-lapse imaging system was used to observe embryo development (Embryoscope; Unisense Fertilitech). Group allocation was based on the presence or absence of multinucleation on day 2 after egg retrieval. Embryos with evidence of one or more blastomere having multinucleation were included in the studied group (n = 67 embryos). Embryos without any blastomere exhibiting multinucleation were included in the control group (n = 344 embryos). Results: The data were based on 225 transfers of 411 embryos consisting of 16.3% (n = 67) from studied group and 83.7% (n = 344) from the control group. The biochemical pregnancy rate and implantation rate is lower in the studied group compared to the control group although not statistically significant (Table 1). Conclusion: Multinucleated embryos reduce the implantation rate and clinical pregnancy rate although not statistically significant.