Hospital Tengku Ampuan Afzan

Naja species bites and envenomation are common in Malaysia. This is a retrospective cohort study of diagnosed Naja species cases consulted to Remote Envenomation Consultancy Services (RECS) from 2020 to 2023. This study aimed to identify the frequency, geographical distribution, clinical features, treatments, and outcomes of Naja species-related injuries. Data was extracted following the approval of the institutional research ethics committee and all patient's information were kept anonymous. From 4474 RECS consultations, 512 were diagnosed as caused by Naja species. Naja kaouthia cases were mostly from the northern and central Peninsular Malaysia, while Naja sumatrana was recorded nationwide. There were 184 (35.9%) cases diagnosed as undifferentiated Naja species bites, 144 (28.1%) N. sumatrana bites, 121 (23.6%) N. kaouthia bites, 61 (11.9%) venom ophthalmia and 2 (0.4%) involved bites and venom ophthalmia from N. sumatrana. The mean age was 36.2 years old (SD ± 20.7), and 69.9% were male. The median bite to door time was 1 h (IQR: 0-2 h). The most frequent anatomical region involved was the lower limb (52.1%). Local envenomation is the commonest manifestation (n = 366, 81.2%). Pain (n = 386) and swelling (n = 310) were frequent signs of local envenomation, while vomiting (n = 54) and ptosis (n = 37) were commonest signs of systemic envenoming. Antivenom was administered in 157 (30.7%) cases and 78.3% were Thai Red Cross Cobra antivenom. The median time interval for door to receiving the first dose of antivenom was 12 h (IQR: 5.5-14.5 h). Surgical intervention was performed in 53 (11.8%) cases, mostly were for wound debridement. Four deaths were documented and were due to secondary complications. No antivenom usage, morbidity or death following venom ophthalmia incident. These findings highlight the importance of expert support for healthcare professionals for early clinical decision-making to reduce complications and enhance outcomes.

BackgroundEffective Cataract Surgical Coverage (eCSC) is one of the Universal Health Coverage (UHC) indicators recommended by the World Health Organization (WHO). It is calculated from a population survey and measures access and quality of eye care services in the community. We conducted simultaneous population-based eye surveys in two regions in Malaysia in 2023 to estimate eCSC and compare the results with the survey in 2014 following the implementation of a mobile cataract program.MethodsThe surveys were simultaneously done in Eastern and Sarawak administrative regions using the Rapid Assessment of Avoidable Blindness (RAAB) technique. It involved a multistage cluster sampling method, each cluster comprising 50 residents aged 50 years and older. Presenting visual acuity (PVA) was checked, and subjects with cataracts were identified. The corrected VA (Pinhole) of those who had undergone cataract surgery was measured. eCSC was calculated at all levels of cataract surgical thresholds according to the protocol. The findings were compared with the previous survey.ResultsA total of 10,184 subjects were enumerated, with 9,709 examined and 475 non-respondents. Females had a significantly lower Cataract Surgical Coverage (CSC) than males for cataract surgical threshold of < 3/60 for both regions in National Eye Survey (NES) II in 2014, [Eastern female 82.0%, 95% Confidence Interval (CI) (72.5, 91.5) vs. male 97.8%, 95% CI (92.8, 100.0), Sarawak female 76.9%, 95% CI (66.4, 87.3) vs. male 96.4%, 95% CI (91.6, 100.0)]. However, there was no significant gender difference in eCSC. Comparing NES II (2014) and NES III (2023) at various levels of cataract surgical threshold, eCSC improved within the range of 13.8-19.2% and 18.6-23.8% for Eastern and Sarawak, respectively.ConclusionThe improvement in eCSC could likely be attributed to both quality outcome enhancement and increased coverage, possibly due to the impact of the mobile cataract services in both regions. However, a coordinated approach is necessary to further strengthen and expand the coverage of the program to enable the country to achieve the 30% increase in eCSC as targeted by WHO.

Background and AimMetabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and is strongly linked to metabolic comorbidities such as diabetes mellitus, hypertension, dyslipidemia, and coronary artery disease. Despite their cardiovascular benefits, statins are historically underused in patients with MASLD because of concerns regarding hepatotoxicity. This study aimed to evaluate the impact of statins on liver transaminase levels in patients with MASLD and assess whether statin type or dose influences these outcomes.Materials and MethodsWe conducted a retrospective review of 104 patients with MASLD who attended outpatient clinics between January 2023 and December 2024. Patients on statins for ≥12 months were included, while those with viral hepatitis, autoimmune liver disease, or significant alcohol intake were excluded. The data collected included comorbidities, statin type/dose, and liver transaminase levels at baseline, 3, 6, and 12 months. Patients without baseline transaminase levels available at the time of statin initiation were excluded. Of the 104 patients recruited, only 21 underwent transient elastography, of which two had advanced chronic liver disease.ResultsThe mean BMI was 34.26 kg/m2. Most patients had diabetes mellitus (86%), hypertension (88.5%), and dyslipidemia (98.1%). Transaminase levels remained stable over 12 months (ALT, χ2(3)=0.340, p=0.952; AST, χ2(3)=0.342, p=0.926). Statin type and dose had no significant effects on transaminase levels.ConclusionStatins of different types and doses did not significantly affect transaminases in patients with MASLD, indicating that statins are safe for use in patients with MASLD who meet the criteria for lipid-lowering therapy. Further studies are warranted to explore the long-term hepatic effects of statins in patients with metabolic dysfunction-associated steatohepatitis (MASH), focusing on histological outcomes.

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Rapid economic growth in Indonesia and Malaysia has widened the gap in emergency care supply and demand, intensifying challenges. Our study, from August to November 2022, assesses current diverse challenges in both countries' emergency care systems from frontline staff perspectives. The online survey involved emergency department (ED) personnel from 11 hospitals in Indonesia and Malaysia, drawing from an existing network. The survey collected data on respondents’ characteristics, factors affecting prehospital and ED care quality, missing clinical information, and factors influencing patients’ ED stay duration. With 83 respondents from Indonesia and 109 from Malaysia, the study identified common challenges. In both countries, inadequate clinical information from ambulances posed a primary challenge in prehospital care quality, while crowdedness during night shifts affected ED care quality. Frequent gaps in essential clinical information, such as family and medication history, were observed. Prolonged ED stays were associated with diagnostic studies and their turnaround time. This study offers insights into shared challenges in Indonesia and Malaysia's emergency care systems. Our findings stress recognizing common and country-specific challenges for enhanced emergency care quality in Southeast Asia, supporting tailored interventions.

INTRODUCTION: Patient falls during hospitalisation can cause catastrophic injuries and remain one of the major patient-safety issues faced by hospitals. This study was designed to determine the inpatient falls rate and the association between fall-related injury and sociodemographic variables. MATERIALS AND METHODS: A retrospective record review was conducted for a one-time inpatient fall in a single centre between January 2017 and December 2019. Pearson chi-square or Fisher's exact test were performed to assess association between the categorical variables. RESULTS: There were 44 inpatient falls who fell one time between January 2017 and December 2019. The inpatients fall rate was 3.0 per 10000 patient-days from 2017 to 2019. Overall, the patients who fell experienced an injury (n=24, 55%). There was no significant difference between age group, gender, time of fall, assisted type, history of fall, fall risk assessment, mental status, the department involved, and injurious fall outcome. CONCLUSION: Our study showed a low incidence of fall rate per 10000 patient-days for 2017-2019. More than half of the fallers experienced an injurious fall. The highest fall rate was noted in the surgical based departments. However, there was no significant difference between injurious fall outcomes and sociodemographic variables. Risk assessments and management strategies should focus on education, particularly bed safety.