Objective: Ovarian clear cell carcinoma (OCCC) is associated with chemoresistance. Limited data exists regarding the efficacy of targeted therapies such as immune checkpoint inhibitors (ICI) and bevacizumab, and the role of secondary cytoreductive surgery (SCS). Methods: We retrospectively analyzed genomic features and treatment outcomes of 172 OCCC patients treated at our institution from January 2000 to May 2022. Next-generation sequencing (NGS) was performed where sufficient archival tissue was available. Results: 64.0% of patients were diagnosed at an early stage, and 36.0% at an advanced stage.Patients with advanced/relapsed OCCC who received platinum-based chemotherapy plus bevacizumab followed by maintenance bevacizumab had a median first-line progressionfree survival (PFS) of 12.2 months, compared with 9.3 months for chemotherapy alone (hazard ratio=0.69; 95% confidence interval [CI]=0.33, 1.45). In 27 patients who received an ICI, the overall response rate was 18.5% and median duration of response was 7.4 months (95% CI=6.5, 8.3). In 17 carefully selected patients with fewer than 3 sites of relapse, median PFS was 35 months (95% CI=0, 73.5) and median overall survival was 96.8 months (95% CI=44.6, 149.0) after SCS. NGS on 58 tumors revealed common mutations in ARID1A (48.3%), PIK3CA (46.6%), and KRAS (20.7%). Pathogenic alterations in PIK3CA, FGFR2, and NBN were associated with worse survival outcomes. Median tumor mutational burden was 3.78 (range, 0–16). All 26 patients with available loss of heterozygosity (LOH) scores had LOH <16%. Conclusion Our study demonstrates encouraging outcomes with bevacizumab and ICI, and SCS in select relapsed OCCC patients. Prospective trials are warranted.

Objective: Ovarian clear cell carcinoma (OCCC) is associated with chemoresistance. Limited data exists regarding the efficacy of targeted therapies such as immune checkpoint inhibitors (ICI) and bevacizumab, and the role of secondary cytoreductive surgery (SCS). Methods: We retrospectively analyzed genomic features and treatment outcomes of 172 OCCC patients treated at our institution from January 2000 to May 2022. Next-generation sequencing (NGS) was performed where sufficient archival tissue was available. Results: 64.0% of patients were diagnosed at an early stage, and 36.0% at an advanced stage.Patients with advanced/relapsed OCCC who received platinum-based chemotherapy plus bevacizumab followed by maintenance bevacizumab had a median first-line progressionfree survival (PFS) of 12.2 months, compared with 9.3 months for chemotherapy alone (hazard ratio=0.69; 95% confidence interval [CI]=0.33, 1.45). In 27 patients who received an ICI, the overall response rate was 18.5% and median duration of response was 7.4 months (95% CI=6.5, 8.3). In 17 carefully selected patients with fewer than 3 sites of relapse, median PFS was 35 months (95% CI=0, 73.5) and median overall survival was 96.8 months (95% CI=44.6, 149.0) after SCS. NGS on 58 tumors revealed common mutations in ARID1A (48.3%), PIK3CA (46.6%), and KRAS (20.7%). Pathogenic alterations in PIK3CA, FGFR2, and NBN were associated with worse survival outcomes. Median tumor mutational burden was 3.78 (range, 0–16). All 26 patients with available loss of heterozygosity (LOH) scores had LOH <16%. Conclusion Our study demonstrates encouraging outcomes with bevacizumab and ICI, and SCS in select relapsed OCCC patients. Prospective trials are warranted.

Objective: Ovarian clear cell carcinoma (OCCC) is associated with chemoresistance. Limited data exists regarding the efficacy of targeted therapies such as immune checkpoint inhibitors (ICI) and bevacizumab, and the role of secondary cytoreductive surgery (SCS). Methods: We retrospectively analyzed genomic features and treatment outcomes of 172 OCCC patients treated at our institution from January 2000 to May 2022. Next-generation sequencing (NGS) was performed where sufficient archival tissue was available. Results: 64.0% of patients were diagnosed at an early stage, and 36.0% at an advanced stage.Patients with advanced/relapsed OCCC who received platinum-based chemotherapy plus bevacizumab followed by maintenance bevacizumab had a median first-line progressionfree survival (PFS) of 12.2 months, compared with 9.3 months for chemotherapy alone (hazard ratio=0.69; 95% confidence interval [CI]=0.33, 1.45). In 27 patients who received an ICI, the overall response rate was 18.5% and median duration of response was 7.4 months (95% CI=6.5, 8.3). In 17 carefully selected patients with fewer than 3 sites of relapse, median PFS was 35 months (95% CI=0, 73.5) and median overall survival was 96.8 months (95% CI=44.6, 149.0) after SCS. NGS on 58 tumors revealed common mutations in ARID1A (48.3%), PIK3CA (46.6%), and KRAS (20.7%). Pathogenic alterations in PIK3CA, FGFR2, and NBN were associated with worse survival outcomes. Median tumor mutational burden was 3.78 (range, 0–16). All 26 patients with available loss of heterozygosity (LOH) scores had LOH <16%. Conclusion Our study demonstrates encouraging outcomes with bevacizumab and ICI, and SCS in select relapsed OCCC patients. Prospective trials are warranted.

ABSTRACT Inappropriate antibiotic prescribing in dentistry has been widely reported but local studies are scarce. We aimed to evaluate antibiotic prescribing practices among dental officers in a public dental primary care clinic against current guidelines: specifically assessing the number, appropriateness, accuracy of prescriptions, type of antibiotics prescribed and repeated prescribing of the same type of antibiotics within a specific duration. A retrospective audit consisting of two cycles (1st cycle: July to September 2018, 2nd cycle: July to September 2019) was carried out by manually collecting relevant data of patients (aged 18 and above) who were prescribed antibiotics from carbon copies of prescription books. Between each cycle, various interventions such as education through a continuous professional development (CPD) session, presentation of preliminary findings and making guidelines more accessible to dental officers were implemented. When the 1st and 2nd cycles were compared, the number of antibiotic prescriptions issued reduced from 194 to 136 (–30.0%) whereas the percentage of appropriate prescriptions increased slightly by 4.1%. Inaccurate prescriptions in terms of dosage and duration decreased (–0.5% and –13.7%, respectively) whilst drug form and frequency of intake increased (+15.7% and +0.7%, respectively). Repeated prescribing of the same antibiotics by the same officer within a period of ≤6 weeks no longer occurred. Amoxicillin and metronidazole were most commonly prescribed in both cycles. Overall, the antibiotic prescribing practices did not closely adhere to current guidelines. However, clinical audit in conjunction with targeted interventions resulted in improvement in the antibiotic prescribing patterns. Thus, further intervention and re-audit is necessary.
Anti-Bacterial Agents--administration & ; dosage ; Dental Clinics ; Clinical Audit

The outbreak of COVID-19 has affected the world with over two million cases globally. Malaysia has witnessed over 5,000 with almost 100 deaths as of 22 April 2020. Knowledge on the incubation period of COVID-19 is scarce due to the novelty of the virus. The aim of this study was to determine the incubation period of COVID-19 infection in the district of Petaling in Malaysia. A cross-sectional study was conducted using secondary data from the Petaling District Health Office. We analysed data of laboratory-confirmed COVID-19 cases notified to the Petaling District Health Office between 3 February 2020 and 13 April 2020. Our study included 219 cases. The median incubation period of COVID-19 among the cases was five days (interquartile range 3.0-8.0). Four main clusters were identified, with significant difference found between two of the clusters. Cluster A has a shorter incubation period 3.5 (3.0-6.8) compared to cluster B as most of the confirmed cases knew the source of infection. COVID-19 incubation period in Petaling, Malaysia fits within the range estimated by the World Health Organization. Based on the upper value of the incubation period interquartile range in our study, the length of quarantine and period of contact tracing should be at least 8 days. This finding is in accordance with our current practice to control the spread of COVID-19

BACKGROUND: Classical Hodgkin lymphoma (cHL) is a clinicopathologically unique, aggressive lymphoma arising from germinal center B-cells and is one of the most curable hematological malignancies. This study aimed to determine the clinical course, treatment regimens, response rates, and survival data of patients diagnosed with cHL in a tertiary center. METHODS: A retrospective review was conducted to include patients with a diagnosis of cHL from 2013 to 2017. Data of demographic and clinical characteristics, treatment regimens, and outcomes were collected and analyzed. RESULTS: We recruited 94 patients with a median age of 27.0 [interquartile range (IQR), 12] years. Most of the patients were male (61.7%) and 73.4% were ethnic Malay. Nodular sclerosis was the most common histology (77.6%), followed by mixed cellularity (6.4%) and others (16%). The median follow-up time was 28.0 (IQR, 32) months. All patients received chemotherapy but only 13.8% received radiotherapy as consolidation. The doxorubicin-bleomycin-vinblastine-dacarbazine regimen was the most common (85.1%), followed by the escalated bleomycin-etoposide-doxorubicin-cyclophosphamide-vincristineprednisolone-procarbazine regimen (14.9%). Following treatment, 76.1% of patients achieved complete response. The 2-year overall survival (OS) and progression-free survival (PFS) of the entire cohort were 96.5% and 71.1%, respectively. The 2-year OS and PFS for advanced-stage disease were 93.9% and 62.8%, compared to 100% and 82.7% for early-stage disease, respectively (P=0.252 and P=0.052, respectively). CONCLUSION: This study provides insight into the clinical presentation and treatment outcomes among patients with cHL in Malaysia. A longer study duration is required to identify OS and PFS benefits and treatment-related complications for different chemotherapeutic regimens.
B-Lymphocytes ; Cohort Studies ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Germinal Center ; Hematologic Neoplasms ; Hodgkin Disease ; Humans ; Lymphoma ; Malaysia ; Male ; Radiotherapy ; Retrospective Studies ; Sclerosis ; Tertiary Care Centers

PURPOSE: Supracondylar fractures of the humerus cause significant morbidity in children. Nerve damage and loss of fracture reduction are common recognised complications in patients with this injury. Uncertainty surrounds the optimal Kirschner wire configuration and diameter for closed reduction and pinning of these fractures. This study describes current practice and examined the association between wire configuration or diameter and outcomes (clinical and radiological) in the operative management of paediatric supracondylar fractures. METHODS: Children presenting with Gartland II or III supracondylar fractures at five hospitals in south-west England were eligible for inclusion. Collaborators scrutinised paper and electronic case notes. Outcome measures were maintenance of reduction and iatrogenic nerve injury. RESULTS: Altogether 209 patients were eligible for inclusion: 15.7% had a documented neurological deficit at presentation; 3.9% who were neurologically intact at presentation sustained a new deficit caused by treatment and 13.4% experienced a clinically significant loss of reduction following fixation. Maintenance of reduction was significantly better in patients treated specifically with crossed ×3 Kirschner wire configuration compared to all other configurations. The incidence of iatrogenic nerve injury was not significantly different between groups treated with different wire configurations. CONCLUSION We present a large multicentre cohort study showing that crossed ×3 Kirschner wires are associated with better maintenance of reduction than crossed ×2 or lateral entry wires. Greater numbers would be required to properly investigate nerve injury relating to operative management of supracondylar fractures. We found significant variations in practice and compliance with the British Orthopaedic Association Standard for Trauma (BOAST) 11 guidelines.

PURPOSE: To determine deep optic nerve head structure changes after transient intraocular pressure elevation during laser in situ keratomileusis (LASIK) for myopia. METHODS: Enhanced depth imaging-optical coherence tomography was performed in each myopic eye that underwent LASIK surgery. Enhanced depth imaging-optical coherence tomography images were created at postoperative 1 day, 1 week, 2 weeks, and 1 month. Lamina cribrosa (LC) thickness, LC depth and prelaminar thickness at the superior, middle and inferior portions of the optic nerve head were measured by two investigators. RESULTS: Forty eyes in 40 patients were included in the present study. During follow-up, there were no significant differences in prelaminar thickness or LC depth. The LC demonstrated increased thickness at postoperative 1 day at all three locations (superior, middle, and inferior) (p < 0.001, p < 0.001, p < 0.001, respectively). However, no significant changes were observed at postoperative 1 week, 2 weeks, and 1 month. CONCLUSIONS: The LC thickness could increase at 1 day after LASIK surgery. However, the thickness will gradually return to baseline morphology. Temporary intraocular pressure increase during LASIK does not appear to induce irreversible LC thickness changes.
Follow-Up Studies ; Humans ; Intraocular Pressure ; Keratomileusis, Laser In Situ* ; Myopia ; Optic Disk ; Research Personnel

Deep brain stimulation (DBS) was first introduced in 1987 to the developed world. As a developing country Malaysia begun its movement disorder program by doing ablation therapy using the Radionics system. Hospital Universiti Sains Malaysia a rural based teaching hospital had to take into consideration both health economics and outcomes in the area that it was providing neurosurgical care for when it initiated its Deep Brain Stimulation program. Most of the patients were from the low to medium social economic groups and could not afford payment for a DBS implant. We concentrated our DBS services to Parkinson's disease, Tourette's Syndrome and dystonia patients who had exhausted medical therapy. The case series of these patients and their follow-up are presented in this brief communication.

OBJECTIVE: The study aimed to determine whether or not an association exists between leptospirosis-related knowledge and the practices of pedicab drivers in Manila.

METHODS: An analytic, cross-sectional study was done among 174 male pedicab drivers. Face-to-face interviews were conducted using an interview schedule containing 12 questions covering knowledge of transmission and prevention, and 8 questions covering preventive occupation-related practices against leptospirosis. Logistic regression was employed to examine association while controlling for the confounding effects of other variables.

RESULTS: Forty-nine percent were found to have good knowledge on the transmission and prevention of leptospirosis while 21% had satisfactory preventive and health-seeking practice. After controlling for the confounding effect of pedicab ownership, the odds of having unsatisfactory practices among those with low knowledge were found to be 13 times higher than those with good knowledge. Education was found to be an effect measure modifier.

CONCLUSION: The results suggest that a low level of education combined with poor leptospirosis-related knowledge has a magnified effect on practices. Increasing the knowledge of pedicab drivers especially those with a low level of education is necessary to improve their practices. Information dissemination on leptospirosis should be further intensified. Collaboration between health workers and organizations of pedicab drivers can be done to organize health information seminars.