Background: Colorectal cancer (CRC) is one of the major malignancies in the world. In Malaysia, CRC isfast becoming the commonest cause of cancer death. Its etiology is complex, involving both environmental andgenetic factors. This study looked at the profile and outcome of five-year follow-up of patients with CRC. Materials and Methods: Retrospective case review study done on CRC patients at Universiti Kebangsaan Malaysia MedicalCentre (UKMMC), Kuala Lumpur, Malaysia. Patients’ socio-demographic characteristics, modalities oftreatment, cancer characteristics and outcome at 5-year follow up were extracted from the case records. Results:A total of 107 case records of patients were analyzed. Peak age of CRC presentation was 40-69 years (71.1%).Male to female ratio was 1.2:1 with Chinese predominance (52.3%). Anaemia and its related symptoms includingper rectal bleeding was the commonest clinical presentation. The median duration of clinical presentation was13 weeks (IQR 21.8). More than two-thirds presented as non-emergency cases (69.2%). Most patients presentedwith Dukes C stage(40.2%). The overall 5-year survival rate was 40% with local recurrence rate of 19.6%.Metastasis after curative-intend treatment (surgery with adjuvant therapy) developed in 26% of patients. Lowerrecurrence (p = 0.016, OR = 0.205) and metastatic disease (p = 0.02, OR = 0.24) found among the Chinesepatients. Almost half of the patients defaulted follow up care (43%), most often within the first year of treatment(22.4%) and the Chinese were the least likely to default (p= 0.04, OR = 0.45). Conclusion: Socio-demographicprofile of CRC patients in UKMMC is comparable to Asia pacific region. Apparent delay in seeking treatmentgives rise to poor overall survival and local recurrence rates.

Background Influenza is a contagious respiratory illness that can cause life-threatening complications among high-risk groups. Estimating the economic burden of influenza is essential to guide policy-making on influenza vaccination programmes, especially in resource-limited settings. This study aimed to estimate the economic burden of influenza on older adults (those aged 60 years) in Malaysia from the provider’s perspective. Methods The main data source in this study was the MY-DRG Casemix database of a teaching hospital in Malaysia. Cases with principal and secondary diagnoses coded in the International Classification of Diseases version 10 (ICD-10) as J09, J10.0, J10.1, J10.8, J11.0, J11.1, J11.8, J12.8, and J12.9, which represent influenza and its complications, were included in the study. The direct cost of influenza at all severity levels was calculated from the casemix data and guided by a clinical pathway developed by experts. The effect of the variations in costs and incidence rate of influenza for both the casemix and clinical pathway costing approaches was assessed with sensitivity analysis. Results A total of 1,599 inpatient and 407 outpatient influenza cases were identified from the MYDRG Casemix database. Most hospitalised cases were aged <18 years (90.6%), while 77 cases (4.8%) involved older people. Mild, moderate, and severe cases comprised 56.5%, 35.1%, and 8.4% of cases, respectively. The estimated average annual direct costs for managing mild, moderate, and severe influenza were RM2,435 (USD579), RM6,504 (USD1,549), and RM13,282 (USD3,163), respectively. The estimated total annual economic burden of influenza on older adults in Malaysia was RM3.28 billion (USD782 million), which was equivalent to 10.7% of the Ministry of Health Malaysia budget for 2020. The sensitivity analysis indicated that the influenza incidence rate and cost of managing severe influenza were the most important factors influencing the total economic burden. Conclusions Overall, our results demonstrated that influenza imposes a substantial economic burden on the older Malaysian population. The high cost of influenza suggested that further efforts are required to implement a preventive programme, such as immunisation for older people, to reduce the disease and economic burdens.

This study tested a newly-developed clinical pathway (CP) to manage periodontitis patients against patients managed using usual care. This study was a multi-center quasi-experimental involving newly-diagnosed chronic periodontitis patients. Five dental schools at Malaysian public universities participated in the study. A total of 36 patients participated as a test group and received non-surgical periodontal treatment based on the CP and reviewed at 6, 12 and 24 weeks. Treatment outcomes at each review were compared with data of 36 patients who had been treated without CP and matched as historical controls. Outcome variables were clinical parameters namely probing pocket depth (PPD), clinical attachment level (CAL), gingival bleeding index and visible plaque index. Improvements in these parameters for both groups were compared using independent t-test for normally distributed data and Mann–Whitney U test for non-normally distributed data. Both groups showed statistically significant post-treatment improvements for all clinical parameters. The CP group had significantly reduced number of sites for PPD ≥ 7mm and CAL gain compared to control group at 12th week (p=0.040) and 24th week (p=0.041), as well as between baseline to 24 weeks (p=0.039) with Cohen’s effect size 0.87, respectively. The use of a CP could lead to significant clinical improvement for patients with chronic periodontitis. Its use could be recommended in dental settings involving multiple operators to ensure best outcomes based on standardized optimal care and shared guidelines for clinical decision-making.

Introduction: The lack of evidence that proves the benefit of traditional and complementary medicines (T & CM) in treating chronic medical conditions does not deter its usage among patients worldwide. Prevalence of usage among post-stroke patients in Malaysia especially is unknown. This study aims to determine the prevalence, practice and perception of T & CM use among stroke survivors attending an outpatient rehabilitation program in a teaching hospital. Methods: A cross-sectional study was conducted among 104 post stroke patients attending an outpatient rehabilitation program. A structured self-administered questionnaire was used to collect data on sociodemographic and clinical profile of patients, as well as types of therapy used and perception on T & CM usage. Descriptive analysis was done, and bivariate analysis was used to determine associations between categorical data. Results: Mean age of patients was 62 years (SD 12.2), 54% were Chinese and 75% of the patients had ischaemic stroke. Mean age of T & CM users was younger compared to non- T & CM users (61 years vs. 66 years, p=0.04). Two-thirds (66%) of patients admitted to concurrent T & CM usage while attending conventional post stroke rehabilitation. Acupuncture (40.4%), massage (40.4%) and traditional Chinese medicine (11.5%) were the most common T & CM used. Positive perception was recorded in terms of ability of T & CM usage to relieve post stroke symptoms (68%), and it was safe to use because it was made from 'natural sources'. Negative perception recorded: T & CM caused significant adverse effects (57.6%) and was not safe to be used in combination with other conventional medicines (62.5%). Conclusions: Concurrent T & CM usage among post-stroke patients attending structured outpatient rehabilitation program is widely practised especially acupuncture, massage and traditional Chinese medicines. Overall the perception towards its use is favourable.