University Malaya Medical Centre Research Articles

The effect of a single session of 30-min mindful breathing in reducing fatigue among patients with haematological cancer \u2013 a randomised controlled trial

BackgroundPatients with haematological cancer had considerable symptom burden, in which fatigue was the most prevalent. Almost 70% of haematological cancer patients reported fatigue.MethodsWe conducted a parallel-group, non-blinded, randomised control trial at the haemato-oncology unit of University Malaya Medical Centre, from 1st October 2019 to 31st May 2020. Patients included were ≥ 18 years, had histopathological diagnosis of haematological cancer, and fatigue score of ≥4 based on the fatigue subscale of Edmonton Symptom Assessment System (ESAS). Patients allocated to the intervention group received standard care plus a guided 30-min mindful breathing session, while those in control group received standard care. The study outcomes include fatigue severity according to the fatigue subscale of ESAS, visual analogue scale of 0 – 10, and Functional Assessment of Chronic Illness Therapy Fatigue Scale Version 4, at minute 0 and minute 30.ResultsOf 197 patients screened, 80 were eligible and they were equally randomised into 30-min mindful breathing versus standard care. Lymphoma (58.9%) was the commonest haematological malignancy, followed by multiple myeloma (13.8%), acute leukaemia (11.3%), myeloproliferative neoplasm (6.3%), chronic leukaemia (5.0%) and myelodysplastic syndrome (5.0%). There was no difference in the demographic and clinical characteristics between the 2 groups.At minute 0, both arms of patients had similar ESAS-fatigue score (median, 5) and FACIT-fatigue score (mean ± SD, 24.7 ± 10.6 for intervention group versus 24.7 ± 9.7 for control group). At minute 30, intervention group had lower ESAS-fatigue score (median, 3 versus 5) and FACIT-fatigue score (mean ± SD, 17.1 ± 10.5 versus 24.8 ± 11.3) compared to control group. Both the ESAS-fatigue score reduction (median, − 2 versus 0, p = 0.002) and FACIT-fatigue score reduction (mean ± SD, − 6.7 versus + 0.8; p < 0.001) for the intervention group were statistically significant. The calculated effect size Cohen’s d was 1.4 for between-group comparison of differences in total FACIT-fatigue score.ConclusionsOur results provide evidence that a single session of 30-min mindful breathing was effective in reducing fatigue in haematological cancer patients. On top of all the currently available methods, 30-min mindful breathing can prove a valuable addition.Trial registrationNCT 05029024, date of registration 15th August 2021. (Retrospectively registered).

THE IMPACT OF MOVEMENT CONTROL ORDER DURING COVID-19 PANDEMIC ON HEALTHCARE UTILISATION: HOW DOES THE PROJECTED PATIENT WORKLOAD COMPARED TO THE ACTUAL NUMBER OF PATIENTS IN CARE?

The rising healthcare demand during COVID-19 outbreak may endanger patients and forces hospital to plan for future needs. Predictive analyses were conducted to monitor hospital resources at one of the gazetted COVID-19 hospitals in Malaysia. Simultaneously, a real-time observation on patient’s volume was conducted to understand the actual trend of healthcare resource utilisations. All the projections were directly compared to the actual number of patients in-care. This predictive study was done at University Malaya Medical Centre (UMMC) using various sources of data. The projections revealed a steady increase in the number of cumulative cases until April 2020 followed by an exponential increase in the number of cumulative positive cases in Malaysia. When a comparison between the projection and actual data was done, it was found that the initial projections estimated a range that is 50% to 70% higher during the first three phases of Movement Control Order (MCO) compared to the actual number of COVID-19 patients at UMMC. Subsequent projections were done by using recent estimations from the national database and it was estimated that the number of patients treated will be less than 10 each day up until the end of May 2020. The accuracy of this estimation is 95% when compared to the actual number of COVID-19 patients in care. In conclusion, the practice of continuous projections and real-time observation through predictive analysis using mathematical calculations and algorithms is one of the useful tools to facilitate hospital management to allocate adequate resource allocations.

COMPARISON OF SMARTPHONE-BASED AND AUTOMATED REFRACTION WITH SUBJECTIVE REFRACTION FOR SCREENING OF REFRACTIVE ERRORS

ABSTRACT Purpose To compare Netra smartphone-based and automated refraction with subjective refraction for screening of refractive errors. Methods Cross-sectional study at the University of Malaya Medical Centre, Kuala Lumpur. Subjects underwent subjective refraction, then automated refraction, and finally Netra smartphone-based refraction. All results were converted to power vectors (M, J0 and J45) and were analysed using repeated-measures ANOVA and Bland-Altman plots. Sensitivity and specificity were determined. The best cut-off points were determined from ROC curve analysis. P < .05 was considered statistically significant. Results Data from the right eyes of 204 subjects were analysed. Mean age was 36.6 ± 15.7 years (range 16–78 years). Spherical equivalent [mean (95% CI)] from Netra and automated refraction were similar, and both more myopic than subjective refraction; −2.87 (−3.23 to −2.51), −2.85 (−3.21 to −2.49) and −2.46 (−2.83 to −2.10) respectively (p < .001). Differences in J0 and J45 between Netra and subjective refraction were not statistically significant (0.10 vs 0.11 and 0.01 vs −0.02 respectively, both p > .05), but those between automated and subjective refraction were (0.06 vs 0.11 and 0.07 vs −0.02, p = .004 and p < .001 respectively). Bland Altman plots showed the 95% limits of agreement with Netra refraction were wider than with automated refraction (−2.21D to 1.42D vs. −1.90D to 1.16D respectively). Conclusion Netra smartphone-based refraction gives similar readings to automated refraction, and both show myopic overestimation when compared to subjective refraction. However, due to non-insignificant practical usage issues, its use as a screening tool for refractive errors is limited.

Reliability Testing of Self-Care of Heart Failure Index v6.2 Chinese Instrument Among Heart Failure Patients

Objective: Self-Care of Heart Failure Index (SCHFI) v6.2 Chinese is an instrument used to assess the ability of self-care behaviour among heart failure patients. It has been validated in Taiwan, however, it is yet to be validated in Malaysia. As a multi-ethnic country, Chinese language has been one of the major languages in Malaysia. Therefore, this study was conducted to examine the reliability of Self-Care of Heart Failure Index (SCHFI) v6.2 Chinese among Malaysian population. Design: A successive independent sample design was used throughout a 4-months data collection period. Setting: Eighty heart failure patients from University of Malaya Medical Centre and National Heart Institute were recruited through purposive sampling. The two hospitals were chosen because they have specialized heart clinics that eased the data collection. The out-patients were screened by the cardiologists for their eligibility to participate in this study. Measures: The samples were administered with SCHFI v6.2 Chinese. The item endorsement index, internal consistency and item-total correlation of SCHFI v6.2 Chinese were examined. Results: The maintenance subscale of SCHFI showed a low internal consistency (Cronbach α = .52) while the management and confidence subscales showed an acceptable internal consistency (Cronbach α = .67 and .90 respectively). Conclusion: SCHFI v6.2 Chinese is a reliable instrument to be used among the Malaysian population.

POISONING CASES OF NOXIOUS SUBSTANCES EATEN AS FOOD: A RETROSPECTIVE STUDY AT A TEACHING HOSPITAL IN MALAYSIA

There is limited information regarding the epidemiology of food poisoning in Malaysia as the issue of food poisoning is often perceived as not as huge as compared to other poisoning cases like intoxication by drugs and chemicals. Patients who experience severe food poisoning require hospitalisation, aggressive hydration, and some even require antibiotic treatment. In this study, we aimed to determine an overview of food poisoning cases reported in UMMC. A 10-year retrospective study on the poisoning of other noxious substances eaten as food (ICD10: T62.0-T62.9) in the University of Malaya Medical Centre (UMMC) was performed. A total of 23 medical records of patients, admitted from January 2009 to December 2019 were reviewed. The greatest proportion of food poisoning occurred between the ages of 0 and 9 years, with a predominance of the male gender. Malay patients accounted for most food poisoning cases. All cases of poisoning, including a mushroom poisoning case (T62.0), were accidental. The mushroom poisoning case was then carefully reviewed. To conclude, this study revealed that the most common cause involved in the poisoning was unspecified food poisoning, followed by ingestion of poisonous mushroom. Most patients were given symptomatic and supportive treatments. All patients had favourable outcomes and were discharged with full recovery.

An Artificial Intelligence-Enabled Pipeline for Medical Domain: Malaysian Breast Cancer Survivorship Cohort as a Case Study.

Automated artificial intelligence (AI) systems enable the integration of different types of data from various sources for clinical decision-making. The aim of this study is to propose a pipeline to develop a fully automated clinician-friendly AI-enabled database platform for breast cancer survival prediction. A case study of breast cancer survival cohort from the University Malaya Medical Centre was used to develop and evaluate the pipeline. A relational database and a fully automated system were developed by integrating the database with analytical modules (machine learning, automated scoring for quality of life, and interactive visualization). The developed pipeline, iSurvive has helped in enhancing data management as well as to visualize important prognostic variables and survival rates. The embedded automated scoring module demonstrated quality of life of patients whereas the interactive visualizations could be used by clinicians to facilitate communication with patients. The pipeline proposed in this study is a one-stop center to manage data, to automate analytics using machine learning, to automate scoring and to produce explainable interactive visuals to enhance clinician-patient communication along the survivorship period to modify behaviours that relate to prognosis. The pipeline proposed can be modelled on any disease not limited to breast cancer.

P-PN022. Transthyretin familial amyloid polyneuropathy in multi-ethnic Malaysians

Introduction . Familial amyloid polyneuropathy (FAP) is a rare autosomal dominant peripheral neuropathy. We report a case series of Malaysian FAP patients. Methods . Patients with definite (genetically confirmed) FAP seen at the University of Malaya Medical Centre between 2008 till 2019 were included in the series. The patients’ demographic and clinical features and investigations including nerve conduction studies and electromyography (NCS/EMG), echocardiography, sural nerve biopsy and hATTR mutation are reported. Results . A total 21 index cases were seen. Nineteen (90%) were ethnic Chinese, one ethnic (5%) Malay and one (5%) ethnic Indian; Fourteen (67%) were men. Mean age of onset of symptoms was 56.1 ± 10.5 years (range: 31-73). Nineteen (90%) patients presented with numbness and weakness of the limbs while two had postural hypotension. Fifteen (71%) patients had positive family history. NCS/EMG showed sensorimotor polyneuropathy in 19 (90%) patients; fifteen (71%) showing axonal neuropathy. Amyloid deposits were seen on nerve biopsy in ten patients and rectal, leptomeningeal and endomyocardial biopsies in 1 patient respectively. The latter was diagnosed as familial amyloid cardiomyopathy (FAC). Sixteen patients (76%) had abnormal cardiac echocardiogram with amyloid deposits. Fifteen Chinese patients (71%) carried the Ala97Ser hATTR mutation while the FAC patient has Asp39Val mutation. Our Malay patient had Glu54Lys mutation and Indian patient had Gly67Val mutation. Two patients carried Val30Met mutation. Autonomic function test was abnormal in all 7 patients in whom they were carried out. Conclusion . FAP in Malaysians is seen mainly among ethnic Chinese, in whom Ala97Ser may be a common mutation. This is also the reported “hotspot” mutation for FAP reported in Taiwan but not in China. Similar to Taiwan, Chinese-Malaysians are descended from immigrants from Southern China. Similar to Taiwanese patients, our FAP patients with Ala97Ser mutation, present with late-onset progressive sensorimotor polyneuropathy and cardiac involvement was common.

P-PN009. Photobiomodulation promoting recovery from traumatic nerve injury secondary to supracondylar fracture of humerus: A case report

Introduction. Photobiomodulation using low level laser therapy (LLLT-produced by low to mid- powered coherent lasers ranging from 1 mW to 500 mW) has been researched extensively in animal experiments and is shown to enhance nerve healing; however, few clinical studies report effectiveness of photobiomodulation in humans. Recent understanding suggests that LLRT-induced mitochondrial activity leads to increased ATP production, transcription factor induction, pro and anti-inflammatory gene expression causing cell biostimulation, cytokine modulation, growth factors release and increased tissue oxygenation ameliorating nerve injury. This clinical case report aims to highlight clinical nerve injury recovery after LLLT in a 7-year- old girl following a traumatic Gartland type 3 supracondylar fracture of the right humerus sustained in May 2019. Clincal examination of patient NS suggested right median and ulnar axonometsis evidenced by wasting of intrinsic muscles, thenar and clawing of all digits. After undergoing Closed Manual Reduction and K-wiring there was minimal recovery of motor function below the right wrist. Results. Center based physio and occupational therapy was instituted together with home based therapy - NMES (Neuromuscular electrical stimulation) immediately following injury and surgical management. Typically 86-100% of supracondylar fracture associated nerve injuries resolve spontaneously within 6 months with recovery mean time between 2 and 3 months and in this case, there was some recovery (index finger extension) but stagnated at 5 months. At University Malaya Medical Center (UMMC) she underwent 10 sessions of LLLT at the Rehabilitation Medicine clinic, over a 2 week period resulted in remarkable improvement in motor function especially wrist extension (beyond 90 degrees), extension of 3rd to 5th fingers and 5th finger abduction. Conclusion. Our findings suggest that a structured, intensive course of LLLT has the potential to enhance nerve recovery. Further research is required to determine the duration, intensity and dosage of LLLT to streamline prescription and clinical outcomes.

P-NU004. Nerve ultrasound in multifocal motor neuropathy: Correlation with electrophysiology and functional disability

Introduction . Increased nerve cross-sectional area (CSA) on ultrasound is associated with conduction block in multifocal motor neuropathy (MMN). We investigated the ultrasound features of peripheral nerves in MMN and their correlation with electrophysiology and functional disability. Methods . MMN patients fulfilling the EFNS/PNS criteria were recruited from University Malaya Medical Centre, Kuala Lumpur, Malaysia. All patients underwent neurological assessment with MRC sumscore, grip strength, INCAT disability score, and had nerve conduction studies. Each patient also underwent nerve ultrasound study using a standardized protocol. Age- and gender-matched healthy controls were recruited for comparison. Results . Three MMN patients (2 men) aged 46.3±10.6 years and three normal controls were included. Mean disease duration was 4.3±2.5 years (ranged 1.5-6.0). CSF protein ranged 0.25-0.50 g/L with a mean 0.40±0.13 g/L. One patient was positive for anti-GM1 IgM. Mean MRC was 55.0±5.3 (range 49-59), handgrip (right: 13.2±8.1 kg; left: 21.7±11.9 kg) and INCAT 3.7±1.1 (range 3-5). Nerve CSAs were significantly larger in MMN patients than normal controls in median (forearm: p=0.043), ulnar (forearm: p=0.047), tibial (knee: p=0.002), radial (p=0.002) and sural (p<0.001) nerves. The side-to-side difference ratio of intranerve CSA variability (ICSAV) for ulnar nerve (p=0.046) was significantly larger in MMN patients. The nerve CSAs were significantly correlated with MRC [median midarm/forearm ratio (p=0.004); ulnar ICSAV (p=0.037)] and INCAT [median: elbow (p=0.029), midarm (p=0.030) and midarm/forearm ratio (p=0.007); ulnar ICSAV (p=0.029)]. Correlation analysis with electrophysiology found increased nerve CSAs significantly correlated with distal motor latency [median: wrist (p=0.042), ICSAV (p=0.005)]; and inversely correlated with motor conduction velocity [median ICSAV (p=0.042)] and proximal/distal CMAP ratio [tibial knee (p=0.005)]. Conclusion . In MMN, nerve enlargement was focal, at non-entrapment sites, asymmetrical and can involve the sensory nerve. Nerve ultrasound significantly correlates with functional disability and electrophysiological parameters suggesting that it may be useful as an additional diagnostic biomarker in MMN.

P-EP020. Mortality in adult epilepsy patient in Malaysia: Hospital-based study

Introduction. The reported mortality rate of epilepsy in Asia ranged from 2.5-5.1, but there was no published data in Malaysia. This study aimed to find out the mortality rate of patient with epilepsy in University Malaya Medical Centre (UMMC), a tertiary hospital in Malaysia. Methods. There were 2389 patients with epilepsy recruited retrospectively from 2009-2018 in this study. Fatal cases were identified from National Registry Department Malaysia. Age- specific and gender-specific Standardized Mortality Ratio (SMR) were calculated. Results. There were 175 deaths (7.33%). The all-cause overall SMR is 1.6 (CI 95% 1.4-1.8). The SMR in the younger age groups (15- 19, 20-29, 30-39 and 40-49) were higher than the older age groups. Overall SMR for male patients (1.8, CI 95% 1.5-2.2) was higher than female (1.3, CI 95% 1.0-1.6). However, in specific age groups (15-19, 20-29 and 30-39), the SMR in female was higher. Conclusion. The mortality rate of epilepsy in Malaysia is higher than the general population in Malaysia but lower than other Asian countries. Specifically, the rate is higher among the males and younger age group.

P-EP021. Impact of COVID-19 on people with epilepsy: Understanding their needs

Introduction. The Coronavirus disease 2019 (COVID-19) pandemic with the implementation of the movement control order (MCO) resulted in unprecedented loss of access to healthcare in Malaysia. This study aimed to identify the impact of COVID-19 on people with epilepsy (PWE) in terms of their clinical, logistics and psychological aspects. Methods. This is a cross-sectional anonymized web-based study on PWE in University Malaya Medical Centre (UMMC) and Malaysia Epilepsy Society. An online questionnaire was used to assess the direct and indirect impact of COVID-19 to the epilepsy patients, including Hospital Anxiety Depression Scale (HADS) and Quality of Life in Epilepsy Inventory (QOLIE- 31). Results. 461 patients were included in this study, with a mean age of 39.21±15.88 years, majority female (50.1%), with focal epilepsy (54.0%), and experienced seizures at least once yearly (62.5%). There were 11.1% reported increased seizure frequency during COVID period. The associated factors of increased seizure frequency during COVID period included focal seizures, baseline seizures frequency >1 per month, unemployed status, lower education, and precipitating factors such as inadequate sleep and stress. There were 30.2% worried of seizure worsening due to difficulty in re-scheduling clinic appointments, 28.9% were afraid of going to the emergency unit, 11.5% had self-adjusted medication dosages to avoid running out of supply. A significant number experienced anxiety (27.6%) and depression (18.8%), which were correlated with poorer quality of life (p = 0.01). Conclusion. This study highlights the clinical and psychological impacts of the COVID-19 on PWE in Malaysia.

O-NE004. Distinguishing GBS with treatment-related fluctuations from acute-onset CIDP: A neurophysiological and ultrasonographic perspective

Introduction . Distinguishing Guillain-Barré syndrome (GBS) with treatment-related fluctuations (TRF) from acute-onset chronic inflammatory demyelinating polyneuropathy (A- CIDP) in the early phase can be challenging. Distinguishing features in clinical aspect have been reported previously. We aim to identify the neurophysiological and ultrasonographic features that might differentiate between patients with GBS-TRF and A-CIDP. Methods . Patients with GBS-TRF and A-CIDP were identified from an existing cohort of GBS patients presenting to University Malaya Medical Centre, Kuala Lumpur, Malaysia from 2011 to 2019. The clinical, neurophysiological and nerve ultrasound data were recorded and analysed. Results . Five GBS-TRF (mean age 42 ± 23 years old) and five A-CIDP (mean age 66 ± 13 years old) patients were included. The mean time to first neurological deterioration was significantly longer in the A-CIDP patients compared to GBS-TRF (11 vs 5 weeks; p = 0.028). Based on two sets of nerve conduction studies (NCS), both GBS-TRF and A-CIDP patients fulfilled the electrodiagnostic criteria for demyelination. At first study, A-CIDP patients had significantly prolonged ulnar minimal F-wave latencies (40.7 vs 28.6 ms; p = 0.020) and slower tibial nerve motor conduction velocities (32.1 vs 38.0 m/s; p = 0.050) when compared to GBS-TRF. The sural nerve conduction velocities were slower in A-CIDP compared to GBS-TRF during the second study (26.3 vs 41.4 m/s; p = 0.015). The sural potentials were also more likely to be unrecordable in A-CIDP patients in the second study. On nerve ultrasound, A-CIDP patients had significantly larger cross-sectional area of the ulnar nerve at the wrist (7 vs 5 mm 2 ; p = 0.039), forearm (8 vs 5 mm 2 ; p = 0.025), below elbow (9 vs 6 mm 2 ; p = 0.031) and above elbow (9 vs 7 mm 2 ; p = 0.037) compared to GBS-TRF patients. Conclusion . Other than distinguishing clinical features, we found that there were neurophysiological and ultrasonographic features that can be useful in differentiating between GBS-TRF and A-CIDP.

P-NU006. Longitudinal evaluation of fasciculation through ultrasonography in amyotrophic lateral sclerosis

Introduction . Muscle fasciculation in amyotrophic lateral sclerosis (ALS) is typically evaluated through needle electromyography. In recent years, ultrasound has been increasingly used to detect fasciculation particularly as this procedure is non-invasive. We aimed to longitudinally evaluate muscle fasciculation in ALS patients through neuromuscular ultrasound. Methods . ALS patients fulfilling the revised El-Escorial and Awaji criteria presenting to University Malaya Medical Centre were consecutively recruited. Neuromuscular ultrasound was performed at 6-monthly intervals. Two sets of 30-second recordings were obtained from three cervical region muscles (biceps brachii, brachioradialis, first dorsal interosseus) and two lumbosacral region muscles (vastus medialis, tibialis anterior). Fasciculation was considered present when there were ≥ two involuntary contractions. These findings were correlated with disease duration and the revised ALS Functional Rating Scale (ALSFRS-R). Results . A total of 40 patients were recruited. The diagnosis of ALS was definite in 42.5%, probable in 40.0% and possible in 17.5%. The mean onset age was 56.5±8.8 years. Most patients were limb-onset ALS (77.5%). The mean ALSFRS-R was 33.7±9.7 (baseline) and 28.3±11.0 (6 months). At baseline, 17/40 (42.5%) patients had fasciculations in one region, 19/40 (47.5%) in two regions while 4/40 (10.0%) had none. At 6 months, the regions affected remained unchanged in 21 (52.5%) patients. In eight (20.0%) patients, fasciculation was further detected in additional region/s. In five (12.5%) patients, fasciculation could no longer be detected. The disease duration was negatively correlated with the number of muscles with fasciculation detected (R=-0.319 p=0.045 at baseline, R=-0.361 p=0.020 at 6 months). There was, however, no correlation between ALSFRS-R and the number of muscles with fasciculation. Conclusion . Our findings support the role of neuromuscular ultrasound as a diagnostic tool in detecting fasciculation in ALS. However, its role as a prognostic biomarker remains less clear as fasciculation can be less frequently detected with progressive motor neurons loss.

Mindful gratitude journaling: psychological distress, quality of life and suffering in advanced cancer: a randomised controlled trial

ContextNumerous studies have shown that gratitude can reduce stress and improve quality of life.ObjectiveOur study aimed to examine the effect of mindful gratitude journaling on suffering, psychological distress and quality...

Ophthalmic features of craniosynostosis: A Malaysian experience.

This study aims to collect local Malaysian data regarding the ophthalmic features and complications in craniosynostosis patients who attended the Combined Craniofacial Clinic (CFC) in University Malaya Medical Centre (UMMC). Retrospective study of medical notes of craniosynostosis patients who attended the CFC in UMMC from 2014 to December 2020. Out of 37 patients, 29 had syndromic craniosynostosis, and 8 had non-syndromic craniosynostosis. Visual impairment was present in 32.1% of patients. Causes for visual impairment were as follows - amblyopia (25.0%), exposure keratopathy (3.6%), and optic atrophy (3.6%). Hypermetropia and myopia were each seen in 20.6% of patients. Astigmatism was seen in 47.1% of patients, and 29.1% had anisometropia. Proptosis was present in 78.6% and lagophthalmos in 53.3% of patients. Strabismus in primary position occurred in 51.7% of patients. Thirty-one percent of the patients had exposure keratopathy. Optic disc atrophy was seen in 13.7% of patients, and 8.3% had optic disc swelling. Optic disc swelling was resolved in all patients who underwent craniofacial surgery. Our experience in Malaysia was consistent with previously reported data on ophthalmic features of craniosynostosis patients. Additionally, we found that non-syndromic craniosynostosis patients are also at risk of ocular complications just as much as syndromic patients. Appropriate treatment of amblyogenic risk factors, ocular complications, and timely detection of papilledema, and prompt surgical intervention are crucial in preserving long-term visual function in these patients.

Psychosocial Factors Associated with Depression and Anxiety During COVID-19 Pandemic Among Outpatients with Depression.

Long-term social distancing, isolation, and economic fallout may be significant psychological triggers during pandemic, such as COVID-19, especially for those with underlying psychiatric illness. This study was conducted to address the psychological impact of COVID-19 pandemic among patients with depression based at a teaching hospital in Malaysia. This is a cross-sectional online study among patients with depression from University Malaya Medical Centre, using Generalized Anxiety Disorder-7 (GAD-7), Montgomery-Åsberg Depression Rating Scale-Self Assessment (MADRS-S), Insomnia Severity Index (ISI), Multidimensional Scale of Perceived Social Support (MSPSS), Knowledge, Attitudes, and Practices (KAP), and Social Media Addiction during COVID-19 Pandemic (SMACOP). One hundred seventy-eight patients participated in this study. The mean total of the KAP score is 12.65 (SD = 2.65), with knowledge section (mean = 7.34 [SD = 2.13]), attitudes section (mean = 2.63 [SD = 0.58]), and practices section (mean = 2.69 [SD = 1.00]). They scored moderately on the MADRS-S (mean = 21.03 [SD = 4.62]) and ISI (mean = 20.25 [SD = 4.62]) but had high GAD-7 scores (mean = 16.8 (SD = 6.27]). From the multiple logistic regression analyses, depressive symptoms of greater severity (MADRS-S 18-34) are significantly associated with more severe insomnia (P < .001, adjusted OR = 9.101, 95% CI: 3.613-22.924). Furthermore, the high anxiety level is associated with the younger age group (P = .029, Adjusted OR = 2.274, 95% CI: 1.090-4.746), greater severity of insomnia (P < .001, Adjusted OR = 22.9, 95% CI: 6.145-85.343), and higher risk of COVID-19 related social media addiction (P = .011, adjusted OR = 2.637, 95% CI: 1.253-5.550). This study demonstrates the high levels of sleep disturbances and anxiety symptoms experienced by outpatients with depression during the COVID-19 pandemic. These are closely linked to the younger age group and at-risk social media addiction related to COVID-19.

Paediatric radiation dose and cancer risk associated with body effective diameter during CT thorax examination

Paediatric patients are considered vulnerable to radiation exposure and have a greater risk of developing radiation-induced cancers due to active growth cells. Radiation dose from a CT examination is the highest among other imaging modalities and can become harmful if unoptimised. Thus, the aim of this study is to evaluate the influence of paediatric size on SSDE value and to estimate cancer risk occurrence in specific organs of paediatric patients receiving CT chest examination. Data such as volume-weighted CT dose index (CTDIvol), dose length product (DLP) and patient's demography were retrospectively collected from a 64-slice CT scanner (Siemens Somatom Definition AS+) at University Malaya Medical Centre. A total of 120 patients were categorised into four age groups: G1 (0 – < 1 years), G2 (1 – < 5 years), G3 (5 – < 10 years), and G4 (10 – < 15 years). SSDE value was estimate in accordance with the American Association of Physicists, 2011 in Medicine (AAPM) report 204. The effective dose (E) and SSDENCICT obtained from National Cancer Institute Dosimetry System (NCICT) were then compared to the conventional SSDE value. The highest value of CTDIvol, DLP and E were found in group G4 with 4.9 ± 2.5, 185.0 ± 140.8, and 4.2 ± 2.0, respectively. Moreover, there is only slightly different of SSDE value between the G1 and G2 groups with a factor of 0.91. No significant difference (p > 0.05) was observed between the SSDEAAPM and SSDENCICT across all age groups. The cancer risk estimated shows thyroid organs receives the highest probability of cancer incidence in both the genders, which was calculated to be 2.1 for males and 3.9 for females per 100,000 procedures, respectively. Nevertheless, adequate justification of paediatric CT scans and dose optimisation are required to reduce unnecessary exposure and radiation-induced risks.

Preoperative embolization of Intracranial meningioma with Histoacryl through Middle meningeal artery: The effect on intraoperative blood loss and complications related to the procedures.

Introduction: This study aims to evaluate the effectiveness of preoperative embolization of intracranial meningioma using N-Butyl-2-Cyanoacrylate (Histoacryl) in reducing intraoperative blood loss and also to assess the complications related to this procedure. Materials and methods: This is a single-centered retrospective cross-sectional study of 106 patients with histologically proven meningioma underwent open surgical resection in University Malaya Medical Centre (UMMC) from 1st of January 2010 till 31st of May 2020. Out of the 106 samples, 29 of them underwent Histoacryl embolization prior to the surgery and 77 of them were subjected to surgery without preoperative embolization. The demographic data, mean comparison and correlation testing were performed using Statistical Package for the Social Sciences(SPSS).Result: The majority of patients were female gender (68%). Most of the tumour were WHO grade 1 meningioma (86%). 48% of patients in the embolized group were transfused. Female gender had a longer duration of operation (280min vs 234min) and required higher amount of blood transfusion (1.3pint vs 0.6pint) compared to male gender (P&lt;0.05). No statistical significance was found in the mean intraoperative blood loss, duration of operation and amount of blood transfused between the embolized and non-embolized group (P&gt;0.05). No statistical difference was observed in the mean intraoperative blood loss, duration of operation and amount of blood transfused in patient embolized with Histoacryl in comparison with non-Histoacryl group (P&gt;0.05). No post-embolization complication encountered in our centre. The meningo-opthalmic branch is seen in 4% of our study population.Conclusion: Preoperative embolization of meningioma is a safe procedure with careful patient selection. No significant difference is observed in the intraoperative blood loss, duration of operation and amount of blood transfused between the embolized and the non-embolized group. However, we find that female has a significant longer duration of operation and requires higher amount of blood transfusion.

Parental Experiences in the Management of Children with Syndromic Craniofacial Diagnoses in Malaysia

INTRODUCTION: Patients with syndromic craniofacial diagnoses (SCD) require coordinated overall management and remain a parental challenge. This study assessed the parental experience and psychological outcome, as well as the evaluation of professional and community support, received in Malaysia. MATERIAL AND METHODS: The Craniofacial Experiences Questionnaire (CFEQ) was used to assess parents of SCD children registered with the Combined Oro-Craniomaxillofacial Clinic in University Malaya Medical Centre, Kuala Lumpur. RESULTS: Thirty parents participated in this study with their children’s age ranged from 2 months to 14 years old diagnosed with Apert, Crouzon, and Pfeiffer syndromes, as well as other SCD such as Goldenhar, Pierre Robin, and Nager. The majority of parents felt anxious whenever their child underwent an operation despite having positive perceptions of the outcome. Most respondents did not see the condition as handicap although 6.7% of parents were embarrassed by their child’s appearance. The majority of the respondents were worried about the financial implication, had to be occasionally absent from work due to their child’s regular appointments, and felt depressed while only a quarter of respondents socialised less and struggled to meet parenting needs. Most respondents received positive comments, were treated with respect, and obtained adequate support from both health professionals and the community with regards to their childcare. CONCLUSIONS: Although most parents were concerned about their children’s condition, only minimal social stigmatisation was noted. Parents were satisfied with the emotional and physical support received from healthcare professionals and the community. Understanding parental experience may contribute to the improvement of multidisciplinary syndromic craniofacial management.

Management of Asthma Exacerbations in Southeast Asian Tertiary Care.

BackgroundThere have been limited reports looking into the care of patients with asthma exacerbations admitted to tertiary hospitals in Southeast Asia. This study aims to determine the extent in which the 2019 Global Initiative for Asthma (GINA) guidelines were being met.MethodsA retrospective study of patients with asthma exacerbations admitted to the University of Malaya Medical Centre (UMMC) and Pantai Hospital Kuala Lumpur (PHKL), Malaysia from 1 July 2019 to 31 December 2019.ResultsThere were significant numbers of patients with previous admissions for asthma in both centres, with almost 50% experiencing an exacerbation in the previous year. Approximately 75% of the patients considered their asthma to be controlled when asked, despite many of them having had a history of acute exacerbations in the previous year. When cross-checked, the level of GINA-defined asthma control remained low, with only 6.4% of the patients deemed to have good control, while asthma was partially controlled in 25.6% of the patients and uncontrolled in 68% of the patients. About 72.1% of the patients reported daytime symptoms, 65.1% of the patients reported night-time symptoms, 70.9% of the patients required frequent usage of rescue inhalers and 72.1% of the patients reported some limitation in their activity prior to the current asthma exacerbation. Almost a quarter of the patients who were admitted had severe or life-threatening exacerbations as defined by GINA. These patients had more hospitalizations in a year and were more likely to have previous admissions requiring non-invasive and invasive ventilation. They were also more likely to be on GINA Step 5 treatment, had a lower mean percent predicted FEV1 and a higher baseline blood eosinophil count. Multivariate analysis revealed that baseline eosinophil count were independently associated with severe or life-threatening asthma exacerbations (odds ratio: 1.01, 95% confidence interval: 1.00–1.01, p=0.001). Failure to adhere to daily controller medications was high in this study (37.2%).ConclusionAlthough the management of asthma exacerbations in tertiary hospitals in Southeast Asia is largely congruous with international guidelines, there is room for improvement. As there is a marked discrepancy between patient-perceived and guideline-defined asthma control, efforts to increase awareness on the dangers of uncontrolled asthma are warranted.