OBJECTIVES: To examine 5-year trends and variations in dual antiplatelet therapy (DAPT) prescription among multiethnic Malaysian patients aged 60 years and older. METHODS: Using the Malaysian National Cardiovascular Disease-Acute Coronary Syndrome (NCVD-ACS) registry, DAPT 5-year temporal trends prescribing patterns at discharge were examined. Multivariate logistic regression was used to calculate the adjusted odds ratio (aOR) of DAPT prescription. The 1-year all-cause mortality by Cox proportional hazard regression model (adjusted hazard ratio, aHR) using inverse proportional weighting covariates adjustment was performed to assess DAPT prognostic impacts. RESULTS: Data of patients aged 60 years and older were extracted from 2013 to 2017 (n = 3718, mean age: 68 ± 6.74 years, men: 72%, and Malay ethnicity: 43%). The majority of patients were diagnosed with non-ST-segment elevation acute coronary syndrome (63%), predisposed hypertension (76%) and were overweight (74%), while only 35% of patients underwent percutaneous coronary intervention. Over the five years, there was a significant increasing trend in DAPT prescriptions (P < 0.001), with the aspirin-clopidogrel combination being the most common. Aspirin-ticagrelor prescriptions have also increased over the years. Variations in DAPT prescriptions were observed based on patient characteristics. Patients who underwent percutaneous coronary intervention were more likely to be prescribed DAPT in general (aOR = 2.53, 95% CI: 1.95-3.28, P < 0.001) and aspirin-ticagrelor specifically (aOR = 7.76, 95% CI: 5.65-10.68, P < 0.001). Patients with chronic lung disease (aOR = 0.62, 95% CI: 0.42-0.92, P = 0.02) and a history of angina within two weeks (aOR = 0.69, 95% CI: 0.56-0.85, P < 0.001) were approximately 30% less likely to be prescribed DAPT. Approximately 15% of 1-year all-cause mortality were reported. Older patients prescribed DAPT showed significantly higher survival rates than those who were not (aHR < 1.0, P < 0.001). Aspirin-ticagrelor was associated with higher survival rates than aspirin-clopidogrel (aHR = 0.21, 95% CI: 0.11-0.40, P < 0.001). CONCLUSIONS Despite the optimal prescription rate and variation of DAPT in the older Malaysian population, there is room for investigation and improvement in the prescription of newer DAPT combinations that have been suggested to improve patient survival.

Introduction: Adequate daily intake of fruits and vegetables is crucial for the prevention of chronic diseases. This study aimed to determine the effects of My Body is Fit and Fabulous at School (MyBFF@school) with nutrition education intervention (NEI) on the stages of change for fruit and vegetable intake among overweight and obese secondary school children based on the trans-theoretical model (TTM). Methods: This was a cluster randomised controlled trial involving 15 out of 415 eligible government secondary schools in central Peninsular Malaysia, which were randomly assigned into intervention (six schools; 579 school children) and control (nine schools; 462 school children). The intervention group was given NEI for 24 weeks, while the control group followed the existing school programme by the Ministry of Education. Results: There was no significant difference between the intervention and control groups for the stages of change, with majority at the maintenance stage after six months (intervention: 34.9%; control: 39.0%). The within group analysis showed a significant reduction after six months for those at the action stage (action and maintenance stage) from 68.0% to 60.4% in the intervention group and from 71.4% to 65.6% in the control group. However, there was a significant increase among those with adequate fruit and vegetable intake in the intervention group and no significant increase in the control group. Conclusion: MyBFF@school with NEI based on TTM provided acceptable changes in fruit and vegetable intake among overweight and obese secondary school children.

INTRODUCTION: Endocrine dysfunction due to iron overload secondary to frequent blood transfusions is a common complication in children with transfusion-dependent thalassaemia (TDT). We ascertained the prevalence of endocrine dysfunction in children with TDT seen in a hospital setting in Malaysia. METHODS: We reviewed all patients with TDT who had ≥ 8 blood transfusions per year. Patients who had a history of stem cell transplantation, concurrent autoimmune diseases or were newly diagnosed to have TDT were excluded. Standard diagnostic criteria were used in the diagnosis of various endocrine dysfunctions. RESULTS: Of the 82 patients with TDT, 65% had at least one endocrine dysfunction. Short stature was the commonest (40.2%), followed by pubertal disorders (14.6%), hypoparathyroidism (12.3%), vitamin D deficiency (10.1%), hypocortisolism (7.3%), diabetes mellitus (5.2%) and overt hypothyroidism (4.9%). Subclinical hypothyroidism and pre-diabetes mellitus were seen in 13.4% and 8.6% of the patients, respectively. For children aged < 10 years, the prevalence of both thyroid dysfunction and hypoparathyroidism was 9.1%. CONCLUSION Two-thirds of children with TDT experienced at least one endocrine dysfunction. Thyroid dysfunction and hypoparathyroidism may be missed if endocrine screening is only performed in children with TDT > 10 years of age. Close monitoring for endocrine dysfunction and hormonal therapy is essential to prevent long-term adverse outcomes.