Objective To explore the predictive value of QT interval dynamicity for sudden death in patients with idiopathic dilated cardiomyopathy ( DCM ). Methods Fifty-five patients with DCM ( DCM group) and 27 healthy subjects (Control group, Con) were enrolled. Investigations included history collection, clinical examination, echocardiography, electrocardiogram and 24 h ambulatory electrocardiogram. Following indexes were determined: left ventricle end diastolic dimension ( LVEDD), left ventricle ejection fraction (LVEF), QT dispersion (QTd), SDNN, the slope of QT/RR plots of the linear regression, ventricular premature beats (VPB) and non-sustained ventricular tachycardia (NSVT). Primary end point for patients with DCM was all cause death. Results LVEDD, QTd, VPB/24 h, NSVT/24 h,QTe/RR slope and QTp/RR slope were significantly higher while LVEF and SDNN were significantly lower in DCM group than in Con group (all P＜0.05). LVEDD, LVEF, QTd, SDNN, QTe/RR slope and QTp/RR slope were significantly different among DCM sudden death group, DCM non sudden death group and Con group (P ＜ 0. 05 ). LVEF, SDNN, QTe/RR slope and QTp/RR slope were significantly different between DCM sudden death and non sudden death group (P ＜ 0. 05). LVEF, QTd, VPB/24 h, QTe/RR slope and QTp/RR slope were significantly different between DCM with NSVT and DCM without NSVT group (P ＜0. 05). The sudden death rate of DCM patients with QTe/RR slope ≥ 0. 210 was significantly higher than DCM patients with QTe/RR slope ＜ 0. 210 (54. 5% vs. 21.1%, P ＜ 0. 05 ). Sudden death rate of QTp/RR slope≥0. 190 was also higher than those ＜0. 190 (52. 2% vs. 21.9%, P ＜0. 05). The sudden death rate of DCM patients with both LVEF≤35% and NSVT + was 62. 5%. Combining QTe/RR≥0. 210 with NSVT + or LVEF ≤ 35%, the sudden death rates were 62. 5% or 66.7%. Combining QTp/RR ≥0. 190 with NSVT + or LVEF≤35%, the sudden death rates were 66. 7% or 61.5%. Combining QTe/RR ≥0. 210 or QTp/RR ≥0. 190 with NVST + and LVEF≤35%, the sudden death rates were 77. 8% or 70. 0%. Conclusions High QT/RR slope is a risk factor for sudden death of DCM patients. QT/RR slope is a useful predictor for sudden death in DCM patients either independently or combined with NSVT or LVEF.

Objective To investigate the value of QT hysteresis index during treadmill exercise test (TET) in diagnosing coronary heart disease (CHD).Methods One hundred consecutive patients suspected for CHD were referred for TET and selective coronary angiography (CAG). Patients were divided into positive [n=55,age (56.0 ±7.9)years] and negative [n =45,age (53.2±6.7)years] group based on their CAG results.For each TET recording,50 points were selected for the RR,QTp,and QTe interval measurements.QTp and QTe interval was plotted against corresponding RR interval.QT/RR curve was constructed by connect all point,QT hysteresis index was calculated for each patient.Results The QTp [(22.4±10.3) msvs.(6.7±4.6) ms,P＜0.001] andQTe [(27.1 ±11.1) ms vs.(7.6±4.6)ms,P ＜ 0.001 ] hysteresis index of patients in positive group were significantly higher than those in negative group.The sensitivity of QTp and QTe hysteresis index for diagnosing CHD was 89.1％ (49/55) and 94.5 ％ ( 52/55 ),respectively,and the specificity was 82.2 ％ ( 37/45 ) and 80.0％ (36/45),respectively.If the patient fulfilled both the classical TET and QT hysteresis criteria,the sensitivity for diagnosing CHD increased to 94.3％ (33/35,QTp) and 94.6％ (35/37,QTe),and the specificity were both 100％ (26/26,26/26).Moreover,QTp ( r =- 0.399,P ＜ 0.001 ) and QTe ( r =- 0.547,P ＜ 0.001 ) hysteresis index highly correlated to Duke treadmill score.Conclusion QT hysteresis index is useful parameter for CHD diagnosis and which could improve the diagnostic value of TET for CHD in combination with the classical TET criteria for diagnosis of CHD.

OBJECTIVENucleic acid amplification (PCR) fluorogenic quantitative assay is used for the diagnosis of respiratory syncytial virus (RSV) infection. This study was designed to explore the sensitivity of PCR fluorogenic quantitative assay for ascertaining respiratory RSV infection and RSV infection conditions by detecting the presence of RSV-RNA related sequences in children.

METHODSBronchial and nasopharyngeal secretions specimens from 261 hospitalized children with respiratory tract infections from January 2007 to October 2008 were collected. Respiratory syncytial virus nucleic acid (RNA) in the specimens was measuredby PCR fluorogenic quantitative assay. Blood RSV-IgM was detected by enzyme linked immunosorbent assay (ELISA). The sensitivity for ascertaining respiratory RSV infection was compared between the two assays.

RESULTSThe RSV-RNA positive rate ascertained by PCR fluorogenic quantitative assay (38.7%) was significantly higher than blood RSV-IgM positive rate (21.1%) (p<0.01). The RSV-RNA positive rate (43.6%) in children at ages of less than 6 months was significantly higher than that in children at ages of 1 to three years (32.1%) (p<0.01). The RSV-RNA positive rate in children with bronchiolitis (58.5%) was the highest, followed by bronchopneumonia (38.2%) and acute bronchitis (20.0%).

CONCLUSIONSThe sensitivity of PCR fluorogenic quantitative assay for ascertaining respiratory RSV infection is higher. RSV is a major pathogen of lower respiratory tract infections in infants and young children. A higher rate of RSV infection is associated with a younger age. RSV infection is the most common in children with bronchiolitis.

Antibodies, Viral ; blood ; Child ; Child, Preschool ; Enzyme-Linked Immunosorbent Assay ; Female ; Fluorescence ; Humans ; Immunoglobulin M ; blood ; Infant ; Male ; Polymerase Chain Reaction ; methods ; RNA, Viral ; analysis ; Respiratory Syncytial Viruses ; genetics ; immunology ; isolation & purification ; Respiratory Tract Infections ; virology ; Sensitivity and Specificity ; Sputum ; virology

Objectives: Osteoporotic fracture is a significant public health burden associated with increased mortality risk and substantial healthcare costs. Accurate and early identification of high-risk individuals and mitigation of their risks is a core part of the treatment and prevention of fractures. Here we introduce a digital tool called 'BONEcheck' for personalized assessment of bone health. Methods: The development of BONEcheck primarily utilized data from the prospective population-based Dubbo Osteoporosis Epidemiology Study and the Danish Nationwide Registry. BONEcheck has 3 modules: input data, risk estimates, and risk context. Input variables include age, gender, prior fracture, fall incidence, bone mineral density (BMD), comorbidities, and genetic variants associated with BMD. Results: Based on the input variables, BONEcheck estimates the probability of any fragility fracture and hip fracture within 5 years, subsequent fracture risk, skeletal age, and time to reach osteoporosis. The probability of fracture is shown in both numeric and human icon array formats. The risk is also contextualized within the framework of treatment and management options on Australian guidelines, with consideration given to the potential fracture risk reduction and survival benefits. Skeletal age was estimated as the sum of chronological age and years of life lost due to a fracture or exposure to risk factors that elevate mortality risk. Conclusions BONEcheck is an innovative tool that empowers doctors and patients to engage in wellinformed discussions and make decisions based on the patient's risk profile. Public access to BONEcheck is available via https://bonecheck.org and in Apple Store (iOS) and Google Play (Android).

Purpose: This study identified factors predicting malignant upgrade for atypical ductal hyperplasia (ADH) diagnosed on core-needle biopsy (CNB) and developed a nomogram to facilitate evidence-based decision making. Methods: This retrospective analysis included women diagnosed with ADH at the National Cancer Centre Singapore (NCCS) in 2010–2015. Cox proportional hazards regression was used to identify clinical, radiological, and histological factors associated with malignant upgrade. A nomogram was constructed using variables with the strongest associations in multivariate analysis. Multivariable logistic regression coefficients were used to estimate the predicted probability of upgrade for each factor combination. Results: Between 2010 and 2015, 238,122 women underwent mammographic screening under the National Breast Cancer Screening Program. Among 29,564 women recalled, 5,971 CNBs were performed. Of these, 2,876 underwent CNBs at NCCS, with 88 patients (90 lesions) diagnosed with ADH and 26 lesions upgraded to breast malignancy on excision biopsy. In univariate analysis, factors associated with malignant upgrade were the presence of a mass on ultrasound (p = 0.018) or mammography (p = 0.026), microcalcifications (p = 0.047), diffuse microcalcification distribution (p = 0.034), mammographic parenchymal density (p = 0.008). and ≥ 3 separate ADH foci found on biopsy (p = 0.024). Mammographic parenchymal density (hazard ratio [HR], 0.04; 95% confidence interval [CI], 0.005–0.35; p = 0.014), presence of a mass on ultrasound (HR, 10.50; 95% CI, 9.21–25.2; p = 0.010), and number of ADH foci (HR, 1.877; 95% CI, 1.831–1.920; p = 0.002) remained significant in multivariate analysis and were included in the nomogram. Conclusion Our model provided good discrimination of breast cancer risk prediction (C-statistic of 0.81; 95% CI, 0.74–0.88) and selected for a subset of women at low risk (2.1%) of malignant upgrade, who may avoid surgical excision following a CNB diagnosis of ADH.

PURPOSE: Amongst the ASEAN countries, Malaysia has the highest road fatality risk (>15 fatalities per 100 000 population) with 50% of these fatalities involving motorcyclist. This contributes greatly to ward admissions and poses a significant burden to the general surgery services. From mild rib fractures to severe intra-abdominal exsanguinations, the spectrum of cases managed by surgeons resulting from motorcycle accidents is extensive. The objective of this study is to report the clinical characteristics and identify predictors of death in motorcycle traumatic injuries from a Malaysian trauma surgery centre. METHODS: This is a prospective cross-sectional study of all injured motorcyclists and pillion riders that were admitted to Hospital Sultanah Aminah and treated by the trauma surgery team from May 2011 to February 2015. Only injured motorcyclists and pillion riders were included in this study. Patient demography and predictors leading to mortality were identified. Significant predictors on univariate analysis were further analysed with multivariate analysis. RESULTS: We included 1653 patients with a mean age of (35 ± 16.17) years that were treated for traumatic injuries due to motorcycle accidents. The mortality rate was 8.6% (142) with equal amount of motorcycle riders (788) and pillion riders (865) that were injured. Amongst the injured were male predominant (1 537) and majority of ethnic groups were the Malays (897) and Chinese (350). Severity of injury was reflected with a mean Revised Trauma Score (RTS) of 7.31 ± 1.29, New Injury Severity Score (NISS) of 19.84 ± 13.84 and Trauma and Injury Severity Score (TRISS) of 0.91 ± 0.15. Univariate and multivariate analysis revealed that age≥35, lower GCS, head injuries, chest injuries, liver injuries, and small bowel injuries were significant predictors of motorcycle trauma related deaths with p < 0.05. Higher trauma severity represented by NISS, RTS and TRISS scores was also significant for death with p < 0.05. CONCLUSION Age, lower GCS, presence of head, chest, liver, small bowel injuries and higher severity on NISS, RTS and TRISS scores are predictive of death in patients involved with motorcycle accidents. This information is important for prognostic mortality risk prevention and counselling.
Accidents, Traffic ; mortality ; statistics & numerical data ; Adult ; Age Factors ; Cross-Sectional Studies ; Female ; Forecasting ; Humans ; Malaysia ; epidemiology ; Male ; Middle Aged ; Motorcycles ; statistics & numerical data ; Trauma Severity Indices ; Wounds and Injuries ; epidemiology ; Young Adult

Introduction: In Malaysia, the adolescent health studies conducted in 2012 and 2017 revealed an increasing trend of adolescent health risk behaviours and protective factors. This current study aims to determine health risk behaviours and protective factors among adolescents in the country. Methods: The current nationwide cross-sectional study of Malaysian secondary school students used multistage stratified sampling to select 240 nationally representative schools. This study was conducted from June to July 2022 among the students in forms 1, 2, 3, 4, and 5 in all Malaysian states by 34 data collection teams. A validated self-administered questionnaire was used, similar to those used in the NHMS 2012 and NHMS 2017. The quality control was done twice, once at the field level and once at the central level. Sample weighting and analysis were conducted using SPSS statistical software version 28.0. Results: A total of 239 schools out of 240 schools took part in the study (response rate, 99.6%) and total of 33,523 students were involved in this study (response rate, 89.4%). In terms of ethnicity, the highest number of students who participated in the study were Malay (63.0%), followed by Chinese (18.1%) and Indian (6.0 %). While the distribution of sex and form among the students were almost the same. Conclusion To obtain an accurate representation of the nation's adolescent population for this study, samples from public and private schools that are governed by the Ministries of Education and Rural and Regional Development were deemed to be the most reliable.

Introduction: Distal radial fracture is a commonly encountered fracture. This study aims to study the epidemiology of distal radial fracture and factors affecting the patients’ functional outcome one to two years after the injury. Materials and methods: This is a retrospective cohort study. The records of patients, fulfilling the radiographical diagnosis of distal radial fracture, and aged 18 and above, who presented to our Emergency Department from 1st January 2018 to 31st December 2018 were retrieved. According to AO classification, we grouped our patients into A (extra-articular), B (partial articular) and C (complete articular). Patients with congenital abnormalities were excluded. Epidemiological data and relevant medical history were obtained and tabulated. A Malaysian language translation of Disability of the Arm, Shoulder and Hand (DASH) questionnaire was used to assess the functional outcome. Results: Out of 168 patients’ data retrieved, only 110 patients’ data were found complete for purposes of this study. The mean DASH score was 13.7 ± 7.87 approximately one to two years post-injury regardless of treatment method. Increasing age was associated with higher DASH score with r=0.407(p<0.001). Several variables had significantly better functional outcome: male gender (p=0.01), Type A fracture configuration (p=0.007) and non-operational treatment (p=0.03). There was no significant difference between treatment modalities in Type A fracture (p=0.094), but Type B (p=0.043) and Type C (p=0.007) had better outcome without surgery. There was no significant difference between different ethnic groups, open or closed fracture and mechanism of injury. Conclusion: Better functional outcome after sustaining distal radial fracture was associated with young age, male gender, type A fracture and treated non-operatively. Interestingly, more complex fracture pattern had better functionality were observed without surgery.

Malaysia has one of the highest total numbers of COVID-19 infections amongst the Southeast Asian nations, which led to the enforcements of the Malaysian "Movement Control Order" to prohibit disease transmission. The overwhelming increasing amount of infections has led to a major strain on major healthcare services. This leads to shortages in hospital beds, ventilators and critical personnel protective equipment. This article focuses on the critical adaptations from a general surgery department in Malaysia which is part of a Malaysian tertiary hospital that treats COVID-19 cases. The core highlights of these strategies enforced during this pandemic are: (1) surgery ward and clinic decongestions; (2) deferment of elective surgeries; (3) restructuring of medical personnel work force; (4) utilization of online applications for tele-communication; (5) operating room (OR) adjustments and patient screening; and (6) continuing medical education and updating practices in context to COVID-19. These adaptations were important for the continuation of emergency surgery services, preventing transmission of COVID-19 amongst healthcare workers and optimization of medical personnel work force in times of a global pandemic. In addition, an early analysis on the impact of COVID-19 pandemic and lockdown measures in Malaysia towards the reduction in total number of elective/emergent/trauma surgeries performed is described in this article.
Betacoronavirus ; Coronavirus Infections ; epidemiology ; prevention & control ; Elective Surgical Procedures ; Emergency Treatment ; Humans ; Malaysia ; epidemiology ; Pandemics ; prevention & control ; Pneumonia, Viral ; epidemiology ; prevention & control ; Wounds and Injuries ; surgery