Introduction: Plasma D-dimer levels rise progressively during pregnancy, so one cannot apply normal reference ranges, or the usual cut-off value (500ng/mL), for the exclusion of venous thromboembolism (VTE), in pregnant women. This study was carried out in pregnant Malaysian women in order to build applicable reference ranges for D-dimer. Materials and Methods: A cross-sectional study was conducted to measure D-dimer in healthy pregnant women, and a non-pregnant control group, using the quantitative HaemosIL D-dimer HS500 assay. Reference ranges were derived using CLSI ‘Robust’ methods, and differences between group medians were tested using the Kruskal-Wallis and Mann-Whitney U tests. Results: Plasma D-dimer levels were measured in 92 pregnant women (distributed across the three trimesters)and 31 control women. The medians (and reference ranges) in ng/mL were: control 265 (<799); first trimester 481 (<1070); second trimester 1073 (357–1748); 3rd trimester 1533 (771–2410). There were significant differences between the D-dimer levels of each group and each of the other groups (P<0.001). Conclusions: Reference ranges for D-dimer in pregnant Malaysian women have been establised by this study. Whether these ranges can be used to determine cut-off levels for the exclusion of VTE at different stages of pregnancy is doubtful, as the levels rise continuously through pregnancy, and some very high outlying values occur in apparently normal near-term pregnancy.
venous thromboembolism

Introduction: Consumers are advised to read the nutrition labeling when purchasing packaged food. To what extent consumers read nutrition labeling and understand what they read is not well established among Malaysian older persons. Methods: Data from the National Health and Morbidity Survey III (NHMS III) undertaken in 2006 was analysed to determine the use and understanding of nutrition labeling and its associated factors among free living elderly men and women aged >60 years. Descriptive analysis and binary Logistic Regression were used to analyse the data. Results: A total of 4,898 respondents provided self-reported information on their use and understanding of nutrition labeling when they bought or received food. Use of nutrition labeling was higher among elderly men [61.9% (95% CI: 59.6-64.1)] than for women [36.6% (95% CI: 34.5-38.8)]. Nutrition labeling use was significantly associated with age, formal education, higher household income levels and marital status among both elderly men and women. Understanding of nutrition labeling among elderly men and women was 91.8% (95% CI: 90.1-93.2) and 89.7% (95% CI: 87.4- 91.7) respectively and was significantly associated with formal education for both elderly men and women. Conclusion: Overall, the reading of nutrition labeling among Malaysian elderly is moderate. Elderly men and women with formal education were more likely to understand nutrition labeling. The importance of reading nutrition labels should be inculcated in consumers including older persons so that they choose foods that are nutritious and safe.

Primitive neuroectodermal tumours (PNETs) are malignant tumours composed of small round cells of neuroectodermal origin that affect soft tissue and bone. PNETs originating in the pancreas are extremely rare; previous to this report, only 14 cases were reported worldwide, making this case the fifteenth in the world and the second in Asia. We present the case of a painful pancreatic lump diagnosed as PNET of the pancreas after a thorough workup. The diagnosis of PNET is made according to the overall clinical picture, imaging, histopathology, cytogenetics, and immunohistochemistry, as in the case we present. It is essential to differentiate primary pancreatic PNET from a secondary involvement. A review of all of the cases diagnosed worldwide thus far is also provided.

The objective of this study was to determine the prevalence and factors associated with the awareness, treatment and control of hypertension among the elderly population in Malaysia.

he increased use of health care services by elderly has placed greater pressure to an already strained health care resources. Thus, an accurate economic cost estimation for specific age-related diseases like dementia is essential. The objectives of this project are to estimate costs of treating patient dementia among Malaysian elderly in the hospital settings. Two types of data were collected: Hospital costing data (using costing template) and patient clinical data (using questionaire). The cost analysis for hospital setting was carried out using a step-down costing methodology. The costing template was used to organize costing data into three levels of cost centers in hospitals: overhead cost centers (e.g. administration, consumables, maintenance), intermediate cost centers (e.g. pharmacy, radiology), and final cost centers (all wards and clinics). In estimating the cost for each cost center, both capital cost (building, equipment and furniture cost) and recurrent cost (staff salary and recurrent cost except salary) were combined. Information on activities which reflects the workload such as discharges, inpatient days, number of visit, floor space etc., are gathered to determine an appropriate allocation factor. In addition, for each final cost center, the fully allocated costs are then divided by the total unit of in-patient days to obtain the cost of providing services on a per-patient per-day of stay basis, referred as unit cost. The unit cost is finally multiplied with the individual patient’s length of stay to obtain the cost of care per patient per admission. All these steps were simplified by using the Clinical Cost Modeling Software Version 3.0 (CCM Ver. 3.0). The mean cost of dementia cases per episode of care was RM 12,806 (SD=10,389) with the length of stay of 14.3 (SD=9.9) days per admission. The top three components of cost for the treatment of dementia were the ward services 8,040 (SD=7,512), 62.78% of the total cost, followed by the pharmacy 1,312(SD=1,098), 10.25% of the total cost and Intensive Care Unit 979 (SD=961), 7.64% of the total cost. A multivariable analysis using multiple linear regressions showed that factors which significantly influence (p<0.05) the treatment costs of dementia cases were the length of stay (p<0.001), followed by age (p=0.001), case type severe (p=0.005) and study location (p=0.032). However, the factor length of stay is the tremendous parameter. In conclusion, data collection from selected hospitals as well as patient level data from medical record unit were successfully used to estimate the provider costs of hospital for the elderly with dementia disease. Results from the project will enable an assessment on the economic impact and consequences of cognitive impairment in an aged population. A cost quantification and distributive mapping of the burden of care can assist in policy implementation through targeted intervention for at-risk groups, which will translate into savings by means of delayed onset or progression of dementia.
dementia ; Provider Cost ; CCM ; Step-down costing

Purpose: The aim of this study is to determine the mean central corneal thickness (CCT) and mean intraocular pressure (IOP) in children with type 1 diabetes mellitus (T1DM) and to determine the relationship between CCT and IOP on the one hand and age, sex, retinopathy hemoglobin A1c (HbA1c), and duration of diabetes on the other. Methods: This is a case-control, hospital-based study conducted at Hospital Universiti Sains Malaysia between January and November 2022. Thirty-eight children with T1DM were recruited as cases, and 38 healthy children were recruited as controls. The cases and controls then underwent ophthalmic examination, IOP measurement, and CCT measurement using optical coherence tomography (OCT) of the right eye. The IOP measurements were adjusted for CCT for further analysis. Results: The means of CCT and IOP values were significantly higher in the T1DM group than in the control group (all p = 0.02). The mean CCT was 542.18 ± 20.40 μm in the T1DM group, and 529.52 ± 26.17 μm in the control group. The mean IOP was 14.68 ± 1.98 mmHg in the T1DM group, and 13.52 ± 1.66 mmHg in the control group. The mean HbA1c was 10.68% ± 2.49% in the T1DM group. Age and duration of DM were found to have a significant association with CCT in children with T1DM. The duration of DM was also found to be significantly associated with the IOP. Sex and HbA1c levels were found to have no significant relationship with either CCT or IOP. Conclusions Children with T1DM have significantly higher CCT and IOP than the average child. The duration of DM is a significant factor that impacts both CCT and IOP. In addition, age is another factor that affects CCT in children with T1DM.

As the Malaysian population ages, the burden of age-related cognitive disorders such as dementia and Alzheimer’s disease will increase concomitantly. This is one of the sub-study under a research project titled by quantify the cost of age-related cognitive impairment in Malaysia, which was undertaken to develop a clinical pathway for Mild Cognitive Impairment (MCI) and Dementia. The clinical pathway (CP) will be used to support the costing studies of MCI and Dementia. An expert group discussion (EGD) was conducted among selected experts from six (6) government hospitals from different states of Malaysia, Ministry of Health, and United Nations University, International Institute for Global Health, UKM and UPM. The expert group includes psychiatrist specialists and public health medicine specialists. A total of 15 participants took part in the EGD. The group was presented with the different approach in managing MCI and Dementia. Finally, the group came to the consensus agreement on the most appropriate and efficient ways of managing the two conditions. In the EGD, an operational definition for MCI and Dementia was agreed upon and a pathway was developed for the usual practice in the Malaysian health system. A typical case used, as a reference is a 60-year-old patient referred to a memory clinic with complaint of “forgetfulness”. After three outpatient visits in the clinic, the diagnosis of MCI and Dementia could be clinically established. The clinical pathways covered all active clinical and non-clinical management of the patient over a period of one year. The experts identified the additional resources required to manage these patients for the whole spectrum of lifetime based on the expected life expectancy. The Clinical pathway (CP) for MCI and Dementia was successfully developed in EGD with strong support from practitioners in the health system. The findings will help the researchers to identify all-important clinical activities and interventions that will be included in the costing study.

Introduction: Increase in the number of opioids seized in the recent year may indicate increased opioid use in Malaysia. In counteracting opioid abuse, Methadone Maintenance Therapy (MMT) was introduced in Malaysia but relapse following MMT has become an important issue. This study aimed to determine the prevalence and patient factors that served as predictors of opioid relapse among MMT patients. Method: A cross-sectional study involving 159 MMT patients who have reached dose stabilization (eight weeks at a constant dose of methadone) was conducted in Johor Bahru Health District. The dependent variable was opioid relapse, while the independent variables include socio-demographic characteristics, MMT history, crime history, cognitive and interpersonal factors, and social-environment influence. Face-to-face interviews using structured questionnaires and secondary data collection using data collection sheets were done. Multiple logistic regression was used to determine the predictors. Significant level set at alpha less than 5%. Result: The response rate was 86.9% with majority of them were Malay, male, and Muslim. The prevalence of opioid relapse was 11.9%. Those who were non-polydrug users (AOR=3.701, 95%CI=1.182, 11.587, p=0.025), classified as having moderate (AOR=5.869, 95%CI=1.524, 22.595, p=0.010) and high (AOR=5.952, 95%CI=1.000, 35.445, p=0.050) relapse risk response after given hypothetical situation whether respondent been offered drug or not, were more likely to have relapsed. Respondents with higher cognitive and behavioral problem-solving response scores were less likely to have relapsed (AOR=0.949, 95%CI=0.909, 0.991, p=0.008). Conclusion: About 1 in 5 MMT clients had relapsed after they reach dose stabilization. The predictors of opioid relapse were non-polydrug users, having moderate to high relapse risk, and cognitive and behavioral problem-solving responses.