exudates and Stroke

The rs9958947 single nucleotide polymorphism (SNP) resides in the promoter region of the lipase G (LIPG) gene. This newly discovered SNP increases the risk of stroke in some Asian populations, including Chinese and Korean populations. Stroke is one of the top 5 leading causes of death in Malaysia, so it is of interest to investigate whether this SNP is associated with stroke risk in the Malaysian population. Therefore, this study investigates this association through a case-control study on a Malaysian population along with a comprehensive meta-analysis. Genotyping of LIPG rs9958947 SNP was performed for 241 Malaysians using real-time polymerase chain reaction, and the odds ratios (OR) with 95% confidence intervals were calculated. The meta-analysis was conducted using the software Comprehensive Meta-Analysis ver. 2.2.064. A p value less than 0.05 was considered statistically significant. We observed that the mean age of Malaysian stroke patients was less than that of stroke patients from Korea and China. The meta-analysis showed that the LIPG rs9958947 SNP was significantly associated with an increased risk of ischemic stroke in Asian populations (dominant (CC vs. CT + TT): OR = 1.45, p < 0.001; allelic (C vs. T): OR = 1.21, p = 0.001; heterozygous (CC vs. CT): OR = 1.47, p < 0.001, and homozygous (CC vs. TT): OR = 1.46, p = 0.047). However, there was no evidence to associate this SNP with stroke risk in the Malaysian population (overall CC vs. CT: OR = 1.04, CC vs. TT: OR = 1.25, CC vs. CT + TT, OR = 1.13; all p > 0.05) and blood lipid levels.

Topics: Adult; Aged; Case-Control Studies; Female; Humans; Lipase; Malaysia; Male; Middle Aged; Polymorphism, Single Nucleotide; Stroke

Stroke has emerged as a major public health concern in Malaysia. We aimed to determine the trends and temporal associations of real-time health information-seeking behaviors (HISB) and stroke incidences in Malaysia. We conducted a countrywide ecological correlation and time series study using novel internet multi-timeline data stream of 6,282 hit searches and conventional surveillance data of 14,396 stroke cases. We searched popular search terms related to stroke in Google Trends between January 2004 and March 2019. We explored trends by comparing average relative search volumes (RSVs) by month and weather through linear regression bootstrapping methods. Geographical variations between regions and states were determined through spatial analytics. Ecological correlation analysis between RSVs and stroke incidences was determined via Pearson's correlations. Forecasted model was yielded through exponential smoothing. HISB showed both cyclical and seasonal patterns. Average RSV was significantly higher during Northeast Monsoon when compared to Southwest Monsoon (P < 0.001). "Red alerts" were found in specific regions and states. Significant correlations existed within stroke related queries and actual stroke cases. Forecasted model showed that as HISB continue to rise, stroke incidence may decrease or reach a plateau. The results have provided valuable insights for immediate public health policy interventions.

Topics: Female; Geographic Mapping; Health Knowledge, Attitudes, Practice; Health Policy; Humans; Incidence; Information Seeking Behavior; Malaysia; Male; Middle Aged; Prospective Studies; Public Health Administration; Registries; Search Engine; Seasons; Spatio-Temporal Analysis; Stroke; Weather

In most Asian countries, stroke is one of the major causes of mortality. A stroke event is life-changing for stroke survivors, which results in either mortality or disability. Therefore, this study comprehensively focuses on prevalence, risk factors, and secondary prevention for stroke recurrence identified in South, East, and Southeast Asian countries.. This scoping review uses the methodological framework of Arksey and O'Malley. A comprehensive search of academic journals (English) on this topic published from 2007 to 2017 was conducted. A total of 22 studies were selected from 585 studies screened from the electronic databases.. First-year stroke recurrence rates are in the range of 2.2% to 25.4%. Besides that, modifiable risk factors are significantly associated with pathophysiological factors (hypertension, ankle-brachial pressure index, atherogenic dyslipidaemia, diabetes mellitus, metabolic syndrome, and atrial fibrillation) and lifestyle factors (obesity, smoking, physical inactivity, and high salt intake). Furthermore, age, previous history of cerebrovascular events, and stroke subtype are also significant influence risk factors for recurrence. A strategic secondary prevention method for recurrent stroke is health education along with managing risk factors through a combination of appropriate lifestyle intervention and pharmacological therapy.. To prevent recurrent stroke, health intervention should be geared towards changing lifestyle to embody a healthier approach to life. This is of great importance to public health and stroke survivors' quality of life.

Topics: China; Humans; India; Japan; Malaysia; Prevalence; Republic of Korea; Risk Factors; Secondary Prevention; Singapore; Stroke; Taiwan; Thailand

Over 100 articles related to stroke were found in a search through a database dedicated to indexing all literature with original data involving the Malaysian population between years 2000 and 2014. Stroke is emerging as a major public health problem. The development of the National Stroke Registry in the year 2009 aims to coordinate and improve stroke care, as well as to generate more data on various aspects of stroke in the country. Studies on predictors of survival after strokes have shown potential to improve the overall management of stroke, both during acute event and long term care. Stroke units were shown to be effective locally in stroke outcomes and prevention of stroke-related complications. The limited data looking at direct cost of stroke management suggests that the health economic burden in stroke management may be even higher. Innovative rehabilitation programmes including braincomputer interface technology were studied with encouraging results. Studies in traditional complementary medicine for strokes such as acupuncture, Urut Melayu and herbal medicine were still limited.

Topics: Humans; Malaysia; Registries; Stroke

Stroke is considered the second leading cause of mortality and disability worldwide. The increasing burden of stroke is strong evidence that currently used primary prevention strategies are not sufficiently effective. The Stroke Riskometer™ application (app) represents a new stroke prevention strategy distinctly different from the conventional high-cardiovascular disease risk approach.. This proposed study aims to evaluate the effectiveness of the Stroke Riskometer™ app in improving stroke awareness and stroke risk probability amongst the adult population in Malaysia.. A non-blinded, parallel-group cluster-randomized controlled trial with a 1:1 allocation ratio will be implemented in Kelantan, Malaysia. Two groups with a sample size of 66 in each group will be recruited. The intervention group will be equipped with the Stroke Riskometer™ app and informational leaflets, while the control group will be provided with standard management, including information leaflets only. The Stroke Riskometer™ app was developed according to the self-management model of chronic diseases based on self-regulation and social cognitive theories. Data collection will be conducted at baseline and on the third week, sixth week, and sixth month follow-up via telephone interview or online questionnaire survey. The primary outcome measure is stroke risk awareness, including the domains of knowledge, perception, and intention to change. The secondary outcome measure is stroke risk probability within 5 and 10 years adjusted to each participant's socio-demographic and/or socio-economic status. An intention-to-treat approach will be used to evaluate these measures. Pearson's χ2 or independent t test will be used to examine differences between the intervention and control groups. The generalized estimating equation and the linear mixed-effects model will be employed to test the overall effectiveness of the intervention.. This study will evaluate the effect of Stroke Riskometer™ app on stroke awareness and stroke probability and briefly evaluate participant engagement to a pre-specified trial protocol. The findings from this will inform physicians and public health professionals of the benefit of mobile technology intervention and encourage more active mobile phone-based disease prevention apps.. ClinicalTrials.gov Identifier NCT04529681.

Topics: Adult; Humans; Malaysia; Mobile Applications; Randomized Controlled Trials as Topic; Self-Management; Stroke; Surveys and Questionnaires

Maintaining good oral hygiene is important following stroke. This study aimed to evaluate the effectiveness of two oral health promotion (OHP) programmes to reduce dental plaque levels following stroke. A multi-centre randomised clinical control trial was conducted among patients hospitalised following stroke in Malaysia. Patients were randomly allocated to two OHP groups: (i) control group who received the conventional method for plaque control-daily manual tooth brushing with a standardised commercial toothpaste, (ii) test group-who received an intense method for plaque control-daily powered tooth brushing with 1% Chlorhexidine gel. Oral health assessments were performed at baseline, at 3 months and 6 months post-intervention. Within- and between-group changes in dental plaque were assessed over time. Regression analyses were conducted on dental plaque levels at 6 months controlling for OHP group, medical, dental and socio-demographic status. The retention rate was 62.7% (54 of 86 subjects). Significant within-group changes of dental plaque levels were evident among the test group (P < .001) and the control group (P < .001). No significant between-group changes of dental plaque levels were apparent (P > .05). Regression analyses identified that baseline plaque levels (adjusted ß = 0.79, P < .001) and baseline functional dependency level (adjusted ß = -0.34, P < .05) were associated with dental plaques levels at the end of the trial (6 months). Both, "Conventional" and "Intense" oral health promotion programmes may successfully reduce dental plaque during stroke rehabilitation and are of comparable effectiveness. Baseline dental plaque levels and functional dependency level were key factors associated with dental plaque levels at follow-up at 6 months.

Topics: Adult; Dental Plaque; Female; Health Promotion; Humans; Malaysia; Male; Middle Aged; Mouthwashes; Oral Health; Oral Hygiene; Stroke; Stroke Rehabilitation; Survivors; Toothbrushing; Young Adult

Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking.. Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted. In Phase One, experts chartered current care processes in public healthcare facilities, from acute stroke till discharge and also patients who presented late with stroke symptoms to public primary care health centres. In Phase Two, modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices. Care algorithms were designed around existing work schedules at public health centres.. Indication for patients eligible for monitoring by primary care at public health centres were identified. Gaps in transfer of care occurred either at post discharge from acute care or primary care patients diagnosed at or beyond subacute phase at health centres. Essential information required during transfer of care from tertiary care to primary care providers was identified. Care algorithms including appropriate tools were summarised to guide primary care teams to identify patients requiring further multidisciplinary interventions. Shared care approaches with Specialist Stroke care team were outlined. Components of the iCaPPS were developed simultaneously: (i) iCaPPS-Rehab© for rehabilitation of stroke patients at community level (ii) iCaPPS-Swallow© guided the primary care team to screen and manage stroke related swallowing problems.. Coordinated post stroke care monitoring service for patients at community level is achievable using the iCaPPS and its components as a guide. The iCaPPS may be used for post stroke care monitoring of patients in similar fragmented healthcare delivery systems or areas with limited access to specialist stroke care services.. No.: ACTRN12616001322426 (Registration Date: 21st September 2016).

Topics: Checklist; Critical Care; Critical Pathways; Delivery of Health Care, Integrated; Delphi Technique; Family Health; Health Personnel; Health Services Accessibility; Humans; Malaysia; Patient Care Team; Primary Health Care; Risk Assessment; Specialization; Stroke; Stroke Rehabilitation

Increased total homocysteine (tHcy) is a risk factor for stroke. This study examines whether the efficacy of B-vitamins in reducing tHcy is modified by ethnicity in a Singaporean ischemic stroke population.. 505 patients (419 Chinese, 41 Malays and 45 Indians) with ischemic stroke were randomized to receive placebo or B-vitamins. Fasting blood samples collected at baseline and 1 year were assayed for tHcy. MTHFR polymorphisms were genotyped.. Ethnicity did not independently determine tHcy at baseline. The magnitude of tHcy reduction by B-vitamin treatment was consistent across ethnic groups (Chinese -3.8+/-4.5, Malay -4.9+/-4.2, and Indian -3.3+/-3.6 micromol/L) despite ethnic differences in MTHFR genotype and baseline folic acid (FA) and vitamin B(12) (vitB(12)) concentrations.. Ethnicity does not appear to affect the tHcy-lowering effect of B-vitamins, despite differences in dietary intake and prevalence of MTHFR polymorphisms. This suggests that the effect of B-vitamins in lowering tHcy is generalizable across Asian populations. However, due to relatively small numbers of non-Chinese studied, confirmation in other populations is required.

Topics: Aged; China; Diet; Ethnicity; Female; Folic Acid; Gene Frequency; Genotype; Homocysteine; Humans; India; Malaysia; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Risk Factors; Singapore; Stroke; Vitamin B Complex

Post-stroke complications affect the informal caregivers equally as the stroke survivors, especially those who have a moderate to worst prognosis in functional capacity recovery. Caregiver Assessment of Function and Upset (CAFU) is one of the common tools used in both research and clinical practice to measure the patient's dependency level and the stroke caregivers' upset level.. This study aimed to translate and validate the CAFU instrument into the Malay language and test the validity and reliability of the CAFU among informal stroke caregivers in Malaysia.. A standard forward-backward translation method was employed to translate CAFU. Subsequently, 10 expert panels were included in the validation process, and thereafter reliability testing was conducted among 51 stroke caregivers. The validation of the instrument was determined by computing the content validity indices (CVIs), and we used the Cronbach's alpha method to explore the internal consistency of the overall score and subscales scores of the Malay-CAFU. Finally, the explanatory factor analysis used principal component extraction and a varimax rotation to examine construct validity.. All items of the Malay-CAFU had satisfactory item-level CVI (I-CVI), with values greater than 0.80, and the scale-level CVI (S-CVI) was 0.95. These results indicate that the Malay-CAFU had good relevancy. The internal consistency for the reliability test showed a Cronbach's alpha value of 0.95 for the overall score. The eigenvalues and scree plot supported a two-factor structural model of the instrument. From the explanatory factor analysis, the factor loadings ranged from 0.82 to 0.90 and 0.56 to 0.83, respectively.. The Malay-CAFU questionnaire is a valid and reliable instrument to assess the dependence level of stroke survivors and the upset level of informal stroke caregivers in Malaysia.

Topics: Caregivers; Humans; Language; Malaysia; Psychometrics; Reproducibility of Results; Stroke; Surveys and Questionnaires

In 2016, the World Health Organization (WHO) estimated that approximately 4.2 million premature deaths worldwide were attributable to exposure to particulate matter 2.5 μm (PM

Topics: Air Pollutants; Air Pollution; Environmental Exposure; Humans; Lung Neoplasms; Malaysia; Myocardial Ischemia; Particulate Matter; Pulmonary Disease, Chronic Obstructive; Stroke

Time is the greatest challenge in stroke management. This study aimed to examine factors contributing to prehospital delay and decision delay among stroke patients.. A cross-sectional study involving acute stroke patients admitted to Seri Manjung Hospital was conducted between August 2019 and October 2020 via faceto- face interview. Prehospital delay was defined as more than 120 minutes taken from recognition of stroke symptoms till arrival in hospital, while decision delay was defined as more than 60 minutes taken from recognition of stroke symptoms till decision was made to seek treatment.. The median prehospital delay of 102 enrolled patients was 364 minutes (IQR 151.5, 1134.3) while the median for decision delay was 120 minutes (IQR 30.0, 675.0). No history of stroke (adj. OR 4.15; 95% CI 1.21, 14.25; p=0.024) and unaware of thrombolysis service (adj. OR 17.12; 95% CI 1.28, 229.17; p=0.032) were associated with higher odds of prehospital delay, while Indian ethnicity (adj. OR 0.09; 95% CI 0.02, 0.52; p=0.007) was associated with lower odds of prehospital delay as compared to Malay ethnicity. On the other hand, higher National Institutes of Health Stroke Scale (NIHSS) score (adj. OR 0.86; 95% CI 0.78, 0.95; p=0.002) was associated with lower odds of decision delay.. Public awareness is crucial to shorten prehosital delay and decision delay for better patients' outcomes in stroke. Various public health campaigns are needed to improve the awareness for stroke.

Topics: Cross-Sectional Studies; Emergency Medical Services; Hospitals, District; Humans; Malaysia; Stroke; Time Factors

Stroke is one of the most common noncommunicable diseases, with significant public health implications both globally and in Malaysia. The aim of this study was to evaluate post-stroke survivability as well as the major drug classes prescribed for hospitalized stroke patients.. A 5-year retrospective study was carried out on the survival of stroke patients admitted to Hospital Seberang Jaya, a main stroke center in the state of Penang, Malaysia. Patients admitted for stroke were first identified using the local stroke registry database, and their medical records were then accessed for data collection, which included demographic information, comorbid conditions, and medications prescribed during admission.. The Kaplan-Meier overall survivability analysis performed indicated 50.5% survival for the duration of 10 days (p < 0.001) post-stroke. Ten-day survivability differences (p < 0.05) were observed for the categories of type of stroke (ischemic stroke (60.9%) and hemorrhagic stroke (14.1%)); stroke episodes (first (61.1%) and recurrent (39.6%)); anti-platelets (prescribed (46.2%) and not prescribed (41.5%)); statins (prescribed (68.7%) and not prescribed (28.1%)); anti-hypertensive (prescribed (65.4%) and not prescribed (45.9%)); and anti-infectives (prescribed (42.5%) and not prescribed (59.6%)) respectively. Higher risks of mortality were observed among patients with hemorrhagic stroke (HR: 10.61, p = 0.004); with 3 or more comorbidities (HR:6.60, p = 0.020); and not prescribed with statins and anti-diabetic. Patients prescribed anti-infectives, on the other hand, had a higher risk of mortality when compared to patients who did not receive anti-infectives (HR: 13.10, p = 0.019). The major drug classes prescribed for stroke patients were antiplatelet drugs (86.7%), statins (84.4%), and protein pump inhibitors (75.6%).. The findings of the study are intended to encourage more non-stroke hospitals in Malaysia to increase their efforts in treating stroke patients, as early treatment can help reduce the severity of the stroke. With the incorporation of evidence-based data, this study also contributes to local data for comparison and improves the implementation of regularly prescribed stroke medication.

Topics: Hemorrhagic Stroke; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Malaysia; Retrospective Studies; Stroke

Malaysia is located in the heart of South East Asia with two land masses, Peninsular Malaysia and East Malaysia which are separated by the South China Sea. Stroke or cerebrovascular disease is Malaysia's third leading cause of death. There were 47, 911 incident cases, 19,928 deaths, 443,995 prevalent cases, and 512,726 DALYs lost due to stroke in 2019. Successive national health and morbidity surveys from 2006 demonstrated a continuous rise in the prevalence of risk factors such as diabetes, hyperlipidaemia, and obesity. These risk factors are implicated in an increase in stroke incidence in those under 65 years of age, the largest increase of 53.3% and 50.4% in men and women, respectively, from the age strata of 35-39 years. The neurologist-to-patient ratio is 1:323,000 with the majority of neurologists working in urban centres. The healthcare system is provided predominantly by the public and private sectors. Concurrent use of traditional and complementary medicine is common and widely accepted. Challenges include delivering adequate care to rural communities, the low overall ischaemic stroke thrombolysis rates, and the high cost of thrombectomy devices for use in large vessel occlusions which have to be borne out-of-pocket by patients and their families. Effort is required to continue improving stroke care services in parallel with primary and secondary prevention strategies in the future, given the ageing population and the rising number of strokes in young adults nationally. Strategies include careful planning, inter-hospital cooperation, and increased allocation of resources from the government.

Topics: Adult; Brain Ischemia; Female; Humans; Incidence; Malaysia; Male; Prevalence; Stroke; Young Adult

Rapid deployment of COVID-19 vaccines is challenging for safety surveillance, especially on adverse events of special interest (AESIs) that were not identified during the pre-licensure studies. This study evaluated the risk of hospitalisations for predefined diagnoses among the vaccinated population in Malaysia.. Hospital admissions for selected diagnoses between 1 February 2021 and 30 September 2021 were linked to the national COVID-19 immunisation register. We conducted self-controlled case-series study by identifying individuals who received COVID-19 vaccine and diagnosis of thrombocytopenia, venous thromboembolism, myocardial infarction, myocarditis/pericarditis, arrhythmia, stroke, Bell's Palsy, and convulsion/seizure. The incidence of events was assessed in risk period of 21 days postvaccination relative to the control period. We used conditional Poisson regression to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI) with adjustment for calendar period.. There was no increase in the risk for myocarditis/pericarditis, Bell's Palsy, stroke, and myocardial infarction in the 21 days following either dose of BNT162b2, CoronaVac, and ChAdOx1 vaccines. A small increased risk of venous thromboembolism (IRR 1.24; 95% CI 1.02, 1.49), arrhythmia (IRR 1.16, 95% CI 1.07, 1.26), and convulsion/seizure (IRR 1.26; 95% CI 1.07, 1.48) was observed among BNT162b2 recipients. No association between CoronaVac vaccine was found with all events except arrhythmia (IRR 1.15; 95% CI 1.01, 1.30). ChAdOx1 vaccine was associated with an increased risk of thrombocytopenia (IRR 2.67; 95% CI 1.21, 5.89) and venous thromboembolism (IRR 2.22; 95% CI 1.17, 4.21).. This study shows acceptable safety profiles of COVID-19 vaccines among recipients of BNT162b2, CoronaVac, and ChAdOx1 vaccines. This information can be used together with effectiveness data for risk-benefit analysis of the vaccination program. Further surveillance with more data is required to assess AESIs following COVID-19 vaccination in short- and long-term.

Topics: Bell Palsy; BNT162 Vaccine; ChAdOx1 nCoV-19; COVID-19; COVID-19 Vaccines; Humans; Malaysia; Myocardial Infarction; Myocarditis; Pericarditis; Seizures; Stroke; Thrombocytopenia; Vaccines, Inactivated; Venous Thromboembolism

Cardiovascular disease (CVD) and stroke are global public health problems and cause high mortality, especially in low- and middle-income countries. Knowledge and awareness are critical points in managing the risk in the general population. The Attitudes and Beliefs about Cardiovascular Disease (ABCD) risk questionnaire was developed to evaluate the awareness of stroke and CVD risk. Thus, the government can set up a practical risk assessment and management programme. The initiative will encourage people to seek healthcare timely and reduce the possibilities of developing complications.. This study aimed to translate and validate the ABCD risk questionnaire into the Malay language and evaluate the psychometric properties of the Malay version in the general population in Malaysia.. The questionnaire was translated using a standard forward-backwards translation method. The validation was perfomed by both expert panels and a potential user group. Next, the exploratory factor analysis was conducted to examine factorial validity. The respondents were selected from the government health clinics and according to the study criteria irrespective of the CVD risk. We used Cronbach's alpha and Raykov's rho to explore the internal consistency and composite reliability of the 18 items from three domains. Finally, the confirmatory factor analysis (CFA) was conducted using a robust maximum likelihood estimator.. The Malay version of the ABCD risk questionnaire is a valid and reliable tool to assess the awareness of stroke and CVD risk in the general population in Malaysia.

Topics: Adult; Attitude; Cardiovascular Diseases; Female; Humans; Language; Malaysia; Psychometrics; Reproducibility of Results; Stroke; Surveys and Questionnaires

Apart from maximizing functional abilities and independence after stroke, improving overall health-related quality of life (HRQoL) should also become part of the stroke treatment and rehabilitation process goals. This study aimed to assess the HRQoL profiles and explore the dimension-specific associated factors of HRQoL among stroke survivors.. This was a cross-sectional study of stroke survivors attending post-stroke care clinics in three public hospitals in the states of Pahang and Terengganu, Malaysia. The HRQoL was assessed by EuroQol-5 dimension-5 levels. Data on socio-demographic, clinical profiles, malnutrition risk, and physical activity level were collected through an interviewer-administered survey. Descriptive analyses for HRQoL profiles and multiple logistic regression analyses for its associated factors were performed. Crude and adjusted odds ratios were reported.. A total of 366 stroke survivors were recruited with a mean age of 59 ± 11 years. The most -commonly reported health problems were mobility (85%), followed by usual activities (82%), pain/discomfort (63%), anxiety/depression (51%) and self-care (41%). The mean of the EQ visual analogue scale and the median of the EQ5D summary index was reported at 60.3 ± 14.2 and 0.67 ± 0.37, respectively. Malnutrition risk (mobility, usual activities, and self-care), wheelchair users (self-care and usual activities), speech impairment (usual activities and pain/discomfort), number of stroke episodes (self-care and pain/discomfort), body mass index, physical activity level and types of strokes (usual activities), age and use of a proxy (anxiety/depression), working and smoking status (mobility), were factors associated with either single or multiple dimensions of HRQoL.. Routine malnutrition screening, tailored program for speech therapy, prevention of recurrent stroke, and physical activity promotion should be addressed and further reinforced in current rehabilitation interventions to improve the HRQoL among stroke survivors in Malaysia.

Topics: Adult; Aged; Cross-Sectional Studies; Female; Health Status; Humans; Malaysia; Male; Middle Aged; Quality of Life; Stroke; Stroke Rehabilitation; Surveys and Questionnaires; Survivors

Risk of readmissions is an important quality indicator for stroke care. Such information is limited among low- and middle-income countries. We assessed the trends for 28-day readmissions after a stroke in Malaysia from 2008 to 2015 and evaluated the causes and factors associated with readmissions in 2015.. Using the national hospital admission records database, we included all stroke patients who were discharged alive between 2008 and 2015 for this secondary data analysis. The risk of readmissions was described in proportion and trends. Reasons were coded according to the International Classification of Diseases, 10th Edition. Multivariable logistic regression was performed to identify factors associated with readmissions.. Among 151729 patients, 11 to 13% were readmitted within 28 days post-discharge from their stroke events each year. The trend was constant for ischemic stroke but decreasing for hemorrhagic stroke. The leading causes for readmissions were recurrent stroke (32.1%), pneumonia (13.0%) and sepsis (4.8%). The risk of 28-day readmission was higher among those with stroke of hemorrhagic (adjusted odds ratio (AOR): 1.52) and subarachnoid hemorrhage (AOR: 2.56) subtypes, and length of index admission >3 days (AOR: 1.48), but lower among younger age groups of 35-64 (AORs: 0.61-0.75), p values <0.001.. The risk of 28-day readmission remained constant from 2008 to 2015, where one in eight stroke patients required readmission, mainly attributable to preventable causes. Age, ethnicity, stroke subtypes and duration of the index admission influenced the risk of readmission. Efforts should focus on minimizing potentially preventable admissions, especially among those at higher risk.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Female; Humans; Malaysia; Male; Middle Aged; Odds Ratio; Patient Discharge; Patient Readmission; Pneumonia; Recurrence; Risk Factors; Sepsis; Stroke; Young Adult

Thrombolytic therapy with intravenous alteplase is a well-established treatment for acute ischaemic stroke (AIS). However, in Malaysia, treatment prescription is often limited by the availability of neurologists. The objective was to compare the outcomes of acute stroke thrombolysis therapy prescribed by neurologists in the Seberang Jaya Hospital (SJH) and non-neurologists in the Taiping Hospital (TH).. In this cross-sectional study, all AIS patients who received thrombolytic therapy in SJH and TH between January 2012 and September 2019 were included. Clinical data was extracted from admission records. The outcomes assessed were the percentage of patients who achieved excellent functional outcome at 3 months (modified Rankin scale of 0 to 1), rates of symptomatic intracranial haemorrhage (SICH), and mortality.. A total of 63 AIS patients who received thrombolytic therapy were included, of which 37 patients (58.7%) were treated in SJH. The median NIHSS on admission was 12 in SJH and 11.5 in TH. In all 21.6% of patients from SJH and 30.7% of patients from TH achieved favourable functional outcome at 3 months (p=0.412). There were no significant differences between the two centres in terms of the rates of SICH (10.8% in SJH and 3.8% in TH, p=0.314) and 3-month mortality (24.3% versus 12.5%, p=0.203).. The 3-month functional outcomes and complication rates of stroke thrombolysis in hospitals with or without neurologists are not significantly different. Thus non-neurologist hospitals may be able to provide thrombolysis service to AIS patients safely and effectively.

Topics: Brain Ischemia; Cross-Sectional Studies; Humans; Malaysia; Neurologists; Stroke; Thrombolytic Therapy; Treatment Outcome

Topics: Adult; Brain Ischemia; COVID-19; Cross-Sectional Studies; Humans; Malaysia; Pandemics; SARS-CoV-2; Stroke; Thrombectomy; Thrombolytic Therapy; Time-to-Treatment; Treatment Outcome

Data on nationwide trends for stroke metrics are crucial to understand the extent of the disease burden to a country's health system. Yet, this information remains scarce in low- and middle-income countries.. This study investigated trends of stroke incidence and 28-day all-cause mortality after a stroke from 2008 to 2016 in Malaysia, through linkage across national data sources.. Hospital admissions with a principal diagnosis of stroke or transient ischemic attack were included. Cases with first stroke were identified through linkage of hospital admission registers where age and sex-standardized trends of stroke incidence and its subtypes were calculated. By linking hospital registers to the National Death Register, the 28-day all-cause mortality rates after a stroke were estimated. Mann-Kendall's test was used for trend evaluation.. From 243,765 records, the trend of stroke incidence showed an increase of 4.9% in men and a drop of 3.8% among women. Incidences were higher in men, at 99.1 per 100,000 population in 2008 and 103.9 per 100,000 in 2016 than women (80.3 per 100,000 in 2008 and 77.2 per 100,000 in 2016). There was a substantial increase in stroke incidence among those below 65 years old, with the largest increase of 53.3% in men aged between 35-39 years and 50.4% in women of similar age group. The trend for 28-day all-cause mortality showed a decline for men at -13.1% and women, -10.6%. Women had higher mortality from stroke (22.0% in 2008 and 19.7% in 2016) than men (19.4% in 2008 to 17.2% in 2016).. This first empirical study on stroke trends in Malaysia revealed a worrying increase in stroke incidence among the younger population. Despite a declining trend, mortality rates remained moderately high especially in women. Comprehensive strategies to strengthen the prevention and management of stroke care are warranted.

Topics: Adult; Aged; Cost of Illness; Female; Humans; Incidence; Information Storage and Retrieval; Malaysia; Male; Stroke

Stroke is a public health concern in Malaysia but local beliefs and lay understandings of stroke have not been examined before. Explanatory models provide a way for people to make sense of their illness and influence health seeking behaviors, in a locally relevant way.. Drawing on ethnographic research from rural Malaysia, this descriptive article explores ethnic Malaysian-Chinese stroke survivors' lay understandings of stroke. Eighteen community-dwelling stroke survivors aged 50-83 took part in the study.. Causation of stroke was derived from cultural, biomedical and social sources. Participants also drew simultaneously from both biomedical and traditional explanations of stroke to develop their own understanding of etiology. Similarities with biomedical causation and other studies from different cultures were found. Participants' typically focused on the more immediate effects of stroke and often do not attribute causation and association with their comorbid conditions which are also risk factors of stroke.. Lack of knowledge about stroke and its symptoms was evident in participants' account. Findings emphasize the importance of knowledge based health interventions, especially in health education strategies for stroke survivors to reduce delays to diagnosis and potentially improve health outcomes post-stroke. Implications for rehabilitation Stroke survivors often form explanatory models of stroke that draw from both biomedical and traditional explanations of stroke. Understanding how people derive lay understandings of stroke can contribute towards developing the goals and activities that facilitate recovery and rehabilitation in similar settings. Health practitioners in the community should strengthen communication regarding the identification, etiology and risk factors of stroke with stroke survivors and their carers to improve compliance to medication, exercise and diet for better recovery. Sustained health education which is culturally relevant is recommended. Communication should also include non-physical impact of stroke (such as cognitive deficits and emotional difficulties) as the stroke survivors were unlikely to relate such symptoms to stroke.

Topics: Caregivers; Humans; Malaysia; Stroke; Stroke Rehabilitation; Survivors

To evaluate the incidence and risk factors for carotid artery stenosis amongst asymptomatic type 2 diabetes from a single Malaysian tertiary institution.. This is a prospective cross-sectional study of asymptomatic type 2 diabetics selected from the outpatient ophthalmology and endocrine clinics for carotid duplex ultrasound scanning performed by a single radiologist. The duplex ultrasound criteria were based on the North American Symptomatic Carotid Endarterectomy Trial (NASCET) classification of carotid artery stenosis. Univariate and multivariate analysis was performed to identify possible risk factors of carotid artery stenosis.. Amongst the 200 patients, the majority were males (56%) and Malay predominance (58.5%). There were 12/200 patients (6%) with mean age of 69.2 years identified to have carotid artery stenosis. Univariate analysis of patients with asymptomatic carotid artery stenosis identified older age of 69.2 years (p=0.027) and duration of exposure to diabetes of 17.9 years (p=0.024) as significant risk factors.. Patients with longer exposure of diabetes and older age were risk factors of carotid artery stenosis in asymptomatic type 2 diabetics. These patients should be considered for selective screening of carotid artery stenosis during primary care visit for early identification and closer surveillance for stroke prevention.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Asymptomatic Diseases; Carotid Stenosis; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Diagnostic Screening Programs; Female; Humans; Incidence; Malaysia; Male; Middle Aged; Predictive Value of Tests; Prevalence; Primary Prevention; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Stroke; Time Factors; Ultrasonography, Doppler, Duplex

The delivery of post stroke care is fragmented even in advanced public healthcare systems, globally. Primary care teams are entrusted to provide longer term care for stroke survivors in most developing countries. The integrated Care Pathway for Post Stroke patients (iCaPPS. A pragmatic healthcentre-based cluster randomised controlled trial-within trial on 151 post stroke patients from 10 public primary care facilities in Peninsular Malaysia was conducted to evaluate QALY of patients managed with iCaPPS. Total costs for 6 months treatment with iCaPPS. Management of post stroke patients in the community using iCaPPS. Trial Registration number ACTRN12616001322426. Registered 21 September 2016. (Retrospectively registered).

Topics: Aged; Cost-Benefit Analysis; Delivery of Health Care, Integrated; Female; Humans; Malaysia; Male; Middle Aged; Primary Health Care; Quality-Adjusted Life Years; Stroke

There is scarcity of research information on upper limb (UL) functionality among Malaysian post-stroke population despite the increasing number of stroke survivors. This study intends to evaluate functionality among stroke survivors residing in the community, with a specific focus on the UL.. This cross-sectional study involved 65 stroke survivors with UL dysfunction (mean (SD) age = 64.83 (8.05) years, mean (SD) post-stroke duration 41.62 (35.24) months) who attended community-based rehabilitation program. Upper limb functionality was assessed using the UL items of Stroke Specific Quality of Life Scale (SSQOL), the Lawton Instrumental Activities of Daily Living (IADL) Scale and the Jebsen-Taylor Hand Function Test (JTHFT). The stroke survivors' performance in completing JTHFT using their affected dominant hand was compared with standard norms.. The three most affected UL daily living tasks were writing (64.7%, n=42), opening a jar (63.1%, n=41) and putting on socks (58.5%, n=38). As for IADL, the mean (SD) score of Lawton scale was 3.26 (2.41), with more than 50% unable to handle finance, do the laundry and prepare meals for themselves. Performances of stroke survivors were much slower than normal population in all tasks of JTHFT (p<0.05), with largest speed difference demonstrated for 'stacking objects' task (mean difference 43.24 secs (p=0.003) and 24.57 (p<0.001) in males and females, respectively.. UL functions are significantly impaired among stroke survivors despite undergoing rehabilitation. Rehabilitation professionals should prioritize highly problematic tasks when retraining UL for greater post-stroke functionality.

Topics: Activities of Daily Living; Community Health Services; Cross-Sectional Studies; Humans; Malaysia; Quality of Life; Recovery of Function; Stroke; Stroke Rehabilitation; Survivors; Upper Extremity

Acute ischemic stroke (AIS) and acute ST-elevation myocardial infarction (STEMI) are leading causes of mortality worldwide. Concurrent AIS presentation with STEMI is rare and potentially fatal. Most importantly to date many centres in Malaysia are still not aware on how to treat this condition. We report a case of AIS, which was treated with intravenous tenecteplase (TNK) according to ischemic stroke dosage and lead to improvement of neurological deficit.

Topics: Administration, Intravenous; Adult; Contraindications; Fibrinolytic Agents; Humans; Malaysia; Male; ST Elevation Myocardial Infarction; Stroke; Tenecteplase

On the 18th of March 2020, the Malaysia government declared a movement control order (MCO) due to the unprecedented COVID-19 pandemic. Although the majority of patients presented with respiratory-related symptoms, COVID-19 patients may present atypically with neurological manifestations and may even have an increased risk of stroke. The Malaysia Stroke Council is concerned regarding the level of care given to stroke patients during this pandemic. During the recent National Stroke Workflow Steering Committee meeting, a guide was made based on the currently available evidences to assist Malaysian physicians providing acute stroke care in the hospital setting in order to provide the best stroke care while maintaining their own safety. The guide comprises of prehospital stroke awareness, hyperacute stroke care, stroke care unit and intensive care unit admission, post-stroke rehabilitation and secondary prevention practice. We urge continuous initiative to provide the best stroke care possible and ensure adequate safety for both patients and the stroke care team.

Topics: Betacoronavirus; Coronavirus Infections; COVID-19; Humans; Intensive Care Units; Malaysia; Pandemics; Pneumonia, Viral; Practice Guidelines as Topic; SARS-CoV-2; Stroke; Stroke Rehabilitation; Tomography, X-Ray Computed

Located on the Borneo Island, Sarawak is the largest state of Malaysia and has a population distinctive from Peninsular Malaysia. The ischaemic stroke data in Sarawak had not been reported despite the growing number of patients annually. We aimed to investigate patient characteristics, management, and outcomes of ischaemic stroke in Sarawak and benchmark the results with national and international published data.. We included ischaemic stroke cases admitted to Sarawak General Hospital between June 2013 and August 2018 from Malaysia National Stroke Registry. We performed descriptive analyses on patient demographics, cardiovascular risk factors, prior medications, smoking status, arrival time, thrombolysis rate, Get With The Guidelines (GWTG)-Stroke measures, and outcomes at discharge. We also numerically compared the results from Sarawak with the published data from selected national and international cohorts.. We analysed 1435 ischaemic stroke cases. The mean age was 60.1±13.2 years old; 64.9% were male; median baseline National Institute of Health Stroke Scale was seven points. Hypertension was the most prevalent risk factor of ischaemic stroke; 12.7% had recurrent stroke; 13.7% were active smokers. The intravenous thrombolysis rate was 18.8%. We achieved 80-90% in three GWTG-Stroke performance measures and 90-98% in four additional quality measures in our ischaemic stroke management. At discharge, 57% had modified Rankin Scale of 0-2; 6.7% died during hospitalisation. When compared with selected national and international data, patients in Sarawak were the youngest; Sarawak had more male and more first-ever stroke. Thrombolysis rate in Sarawak was higher compared with most studies in the comparison. Functional outcome at discharge in Sarawak was better than national cohort but still lagging behind when compared with the developed countries. In-hospital mortality rate in Sarawak was slightly lower than the national data but higher when compared with other countries.. Our study described characteristics, management, and outcomes of ischaemic stroke in Sarawak. We achieved high compliance with most of GTWG-Stroke performance and quality indicators. Sarawak had better outcomes than the national results on ischaemic stroke. However, there is still room for improvement when compared with other countries. Actions are needed to reduce the cardiovascular burdens for stroke prevention, enhance healthcare resources for stroke care, and improve intravenous thrombolysis treatment in Sarawak.

Topics: Aged; Aged, 80 and over; Benchmarking; Brain Ischemia; Female; Healthcare Disparities; Hospital Mortality; Humans; Malaysia; Male; Middle Aged; Outcome and Process Assessment, Health Care; Patient Discharge; Practice Patterns, Physicians'; Quality Indicators, Health Care; Recurrence; Registries; Risk Factors; Stroke; Thrombolytic Therapy; Time Factors; Treatment Outcome

Diabetes and obesity are established risk factors for stroke. The current study aimed to assess risk factors of ischemic stroke recurrence in diabetic patients based on their body mass index (BMI).. A total of 4005 diabetic patients who had a history of ischemic stroke were identified in a retrospective cross-sectional dataset from the Malaysian National Neurology Registry. Patients were classified based on BMI, and multivariable regression analysis was used to evaluate the association between risk factors and recurrent ischemic stroke.. Among obese patients, those with ischemic heart disease (aOR, 1.873; 95% CI, 1.131-3.103), received formal education (aOR, 2.236; 95% CI, 1.306-3.830), and received anti-diabetic medication (aOR, 1.788; 95% CI, 1.180-2.708) had a higher stroke recurrence risk, while receiving angiotensin receptors blockers (aOR, 0.261; 95% CI, 0.126-0.543) lowered the odds of recurrence. Overweight patients with hypertension (aOR, 1.011; 95% CI, 1.002-1.019) for over 10 years (aOR, 3.385; 95% CI, 1.088-10.532) and diabetes prior to the first stroke (aOR, 1.823; 95% CI, 1.020-3.259) as well as those received formal education (aOR, 2.403; 95% CI, 1.126-5.129) had higher odds of stroke recurrence, while receiving angiotensin-converting enzyme inhibitors (aOR, 0.244; 95% CI, 0.111-0.538) lowered the recurrence risk. Normal weight East Malaysians (aOR, 0.351; 95% CI, 0.164-0.750) receiving beta-blockers (aOR, 0.410; 95% CI, 0.174-0.966) had lower odds of stroke recurrence.. Ischemic heart disease, hypertension, receiving anti-hypertensive agents, and educational level were independent predictors of recurrent stroke in obese patients. Managing the modifiable risk factors can decrease the odds of stroke recurrence.

Topics: Antihypertensive Agents; Body Mass Index; Brain Ischemia; Diabetes Mellitus, Type 2; Educational Status; Female; Humans; Hypertension; Incidence; Malaysia; Male; Middle Aged; Myocardial Ischemia; Obesity; Recurrence; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Stroke; Time Factors

Topics: Adaptation, Psychological; Developing Countries; Disabled Persons; Economic Status; Female; Humans; Malaysia; Male; Middle Aged; Needs Assessment; Quality of Life; Stress, Psychological; Stroke; Stroke Rehabilitation

Topics: Adaptation, Psychological; Humans; Malaysia; Qualitative Research; Stroke; Stroke Rehabilitation; Survivors

The awareness of symptoms and action towards heart attack and stroke is important to reduce the morbidity and mortality in both developed and developing countries. The aim of this study was to develop a questionnaire on awareness and action towards symptoms and risk factors of heart attack and stroke among lay public in Malaysia. The questionnaire was developed in both English and Bahasa Melayu.. Primarily the questions were generated in English. Face and content validity were performed by five experts in Pharmacy Practice and Medicine. A translation as per guidelines into Malay language was performed; followed by face-to-face interview of 96 lay public in Kuantan, Pahang, Malaysia. For internal consistency, reliability was assessed utilizing Cronbach's alpha.. The mean ± SD of the awareness and action towards heart attack symptoms and risk factors was 65.52 ± 6.3, with a good internal consistency (Cronbach's alpha = 0.75), whereas the mean of the awareness and action towards stroke symptoms and risk factors was 61.93 ± 7.11, with an accepted internal consistency (Cronbach's alpha = 0.86).. The current validation research showed that the developed questionnaire is valid and reliable for assessing the awareness and action towards symptoms and risk factors of heart attack and stroke among lay public in Malaysia.

Topics: Adolescent; Adult; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Myocardial Infarction; Reproducibility of Results; Risk Factors; Stroke; Surveys and Questionnaires; Translations; Young Adult

Information regarding the knowledge on the action to be taken during stroke and good recognition of stroke symptoms is mandatory in helping to plan out educational strategies to deliver health education to the community.. This is a cross-sectional study of adults aged 18 and above attending a blood pressure screening program in community in conjunction with May Measurement Month 2017 in Malaysia. A structured self-administered questionnaire was given to the participants who gave verbal consent. Data analysis was done using SPSS v. 23 and multiple logistic regression was used to identify the determinants of knowledge on actions to be taken during stroke and recognition of stroke symptoms.. Out of 4096 respondents, 82.9-92.1% of them able to recognise the common stroke symptoms. and 74.2% of the study respondents will go to hospital within 4.5 h of stroke onset. According to binomial logistic regression analyses, adults aged 45 years old and above (OR 1.39 95%CI 1.01-1.92), being Malay (OR 1.74, 95% CI 1.27-2.40), being non-smokers (OR = 2.491, 95% CI: 1.64-3.78), hypertensives (OR: 1.57, 95% CI: 1.02-2.42)and diabetics (OR: 2.54, 95% CI:1.38-4.69) are determinants of right actions to be taken during stroke. Meanwhile, respondents aged 45 years old and older (OR = 1.68, 95% CI: 1.39-2.03), being Malay (OR = 1.49, 95% CI: 1.24-1.79), hypertensive (OR = 1.32, 95% CI: 1.04-1.66) and those who had a previous history of stroke (OR = 2.25, 95% CI: 1.01-5.00) are determinants of good recognition of stroke symptoms.. The overall knowledge of stroke in our study population was good. Older age, being Malay, non-smokers, hypertensives and diabetics are determinants of right actions to be taken during stroke. Meanwhile, older age, being Malay, hypertensive and those who had a previous history of stroke are determinants of good recognition of stroke symptoms.

Topics: Adolescent; Adult; Aged; Blood Pressure; Blood Pressure Determination; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Hypertension; Logistic Models; Malaysia; Male; Mass Screening; Middle Aged; Stroke; Surveys and Questionnaires; Symptom Assessment; Young Adult

Diabetes mellitus has been reported as a strong independent risk factor for stroke recurrence. Data on the modifiable factors contributing to the recurrence of stroke in type 2 diabetic Malaysian population with a history of stroke stratified by genders are lacking, and this supports the importance of this study.. The data of 4622 patients with T2DM who had a history of stroke was obtained from the Malaysian National Stroke Registry. Univariate analysis was performed to differentiate between genders with and without stroke recurrence in terms of demographics, first stroke attack presentations, and other clinical characteristics. The significant factors determined from the univariate analysis were further investigated using logistic regression.. Ischemic heart diseases were found significantly associated with the stroke recurrence in males (OR = 1.738; 95% CI: 1.071-2.818) as well as female (OR = 5.859; 95% CI: 2.469-13.752) diabetic patients. The duration of hypertension, as well as the duration of diabetes, has been associated with the recurrence in both male and female subjects (. Most of the predictive factors contributing to the recurrence of stroke in type 2 diabetic Malaysian population with a history of stroke are modifiable, in which IHD was the most prominent risk factor in both genders. The impact of optimizing the management of IHD as well as blood glucose control on stroke recurrence may need to be elucidated. No major differences in recurrent stroke predictors were seen between genders among the Malaysian population with type 2 diabetes mellitus who had a previous history of stroke.

Topics: Aged; Comorbidity; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Female; Health Status; Humans; Life Style; Malaysia; Male; Middle Aged; Recurrence; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors; Stroke; Time Factors

Intravenous (IV) thrombolysis with alteplase (rt-PA) is effective in ischaemic stroke. The primary objective was to evaluate predictors of functional outcome in acute ischaemic stroke (AIS) patients treated with IV rt-PA. The secondary objective was to assess the outcome with the modified Rankin scale (mRS). We also examined the predictive value of the Totaled Health Risks in Vascular Events (THRIVE) score.. AIS patients treated with IV rt-PA from February 2012 to August 2016 were recruited. Demographic data, National Institutes of Health Stroke Scale (NIHSS) scores, timing and neuroradiological findings were recorded. Patients received a dose of 0.9 mg/kg IV rt-PA within 4.5 hours of symptom onset. mRS score was evaluated at discharge and three months, and good and poor clinical outcomes were defined as scores of 0-2 and 3-6, respectively. Baseline THRIVE scores were assessed.. 36 patients received IV rt-PA. 20 (55.6%) patients had an mRS score of 0-2 at three months. Based on THRIVE score, 86.1% had a good or moderately good prognosis. On univariate analysis, poor outcome was associated with NIHSS score before rt-PA (p = 0.03), THRIVE score (p = 0.02), stroke subtype (p = 0.049) and diabetes mellitus (DM; p = 0.06). Multiple logistic regression showed that outcome was significantly associated with NIHSS score before rt-PA (p = 0.032) and DM (p = 0.010).. Our newly developed Malaysian IV rt-PA service is safe, with similar outcomes to the published literature. Functional outcome after thrombolysis was associated with baseline NIHSS score and DM.

Topics: Aged; Brain Ischemia; Cerebral Hemorrhage; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Intracranial Thrombosis; Malaysia; Male; Middle Aged; Neurologic Examination; Outcome and Process Assessment, Health Care; Stroke; Tertiary Care Centers; Thrombolytic Therapy; Tissue Plasminogen Activator

A comprehensive evaluation of interrater reliability is crucial when it comes to multiple coders assessing the stroke outcomes using telephone interview. The reliability between telephone raters is important, as it could affect the accuracy of the findings published.. This study aimed to establish the interrater reliability between multiple telephone interviewers when assessing long-term stroke outcomes.. Patients alive at discharge selected in a retrospective cohort stroke project were recruited in this study. Their contact numbers were obtained from the medical record unit. The patients and/or proxies were interviewed based on a standardized script in Malay or English. Stroke outcomes assessed were modified Rankin Scale (mRS) and Barthel Index (BI) at 1-year post discharge. Fully crossed design was applied and 3 assessors collected the data simultaneously. Data was analysed using the software R version 3.4.4.. Out of 207 subjects recruited, 132 stroke survivors at the time of interview were analysed. We found a significant excellent interrater reliability between telephone interviewers assessing BI, with intraclass correlation coefficient at 0.996 (95% CI 0.995-0.997). Whereas substantial agreement between the telephone interviewers was revealed in assessing mRS, with Fleiss', Conger's and Light's Kappa statistics reporting 0.719 and the Nelson's model-based κm kappa statistic reporting 0.689 (95% CI 0.667-0.711).. It is reliable to get multiple raters in assessing mRS and BI using the telephone system. It is worthwhile to make use of a telephone interview to update clinicians on their acute clinical management towards long-term stroke prognosis.

Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Interviews as Topic; Malaysia; Male; Middle Aged; Observer Variation; Reproducibility of Results; Retrospective Studies; Stroke; Treatment Outcome; Young Adult

Sex differences in cardiovascular diseases generally disadvantage women, particularly within developing regions.. This study aims to examine sex-related differences in stroke metrics across Southeast Asia in 2015. Furthermore, relative changes between sexes are compared from 1990 to 2015.. Data were sourced from the Global Burden of Disease Study. Incidence and mortality from ischemic and hemorrhagic strokes were explored with the following statistics derived: (1) women-to-men incidence/mortality ratio and (2) relative percentage change in rate.. Women had lower incidence and mortality from stroke compared to men. Notable findings include higher ischemic stroke incidence for women at 30-34 years in high-income countries (women-to-men ratio: 1.3, 95% CI: 0.1, 16.2 in Brunei and 1.3, 95% CI: 0.5, 3.2 in Singapore) and the largest difference between sexes for ischemic stroke mortality in Vietnam and Myanmar across most ages. Within the last 25 years, greater reductions for ischemic stroke metrics were observed among women compared to men. Nevertheless, women below 40 years in some countries showed an increase in ischemic stroke incidence between 0.5% and 11.4%, whereas in men, a decline from -4.2% to -44.2%. Indonesia reported the largest difference between sexes for ischemic stroke mortality; a reduction for women whereas an increase in men. For hemorrhagic stroke, findings were similar: higher incidence among young women in high-income countries and greater reductions for stroke metrics in women than men over the last 25 years.. Distinct sex-specific differences observed across Southeast Asia should be accounted in future stroke preventive guidelines.

Topics: Age Factors; Asia, Southeastern; Benchmarking; Cost of Illness; Female; Health Care Costs; Humans; Incidence; Ischemia; Malaysia; Male; Sex Characteristics; Sex Factors; Socioeconomic Factors; Stroke

Topics: Aged; Atrial Fibrillation; China; Chronic Disease; Cognitive Dysfunction; Coronary Artery Disease; Diabetes Mellitus; Female; Heart Failure; Hospitalization; Humans; Hypertension; India; Malaysia; Male; Middle Aged; Mortality; Natriuretic Peptide, Brain; Peptide Fragments; Prevalence; Renal Insufficiency, Chronic; Risk Factors; Singapore; Smoking; Stroke; Troponin T

Stroke outcomes could be a quality indicator across the continuum of care and inform stroke management policymaking. However, this topic has rarely to date been studied directly.. We sought to investigate recent trends in stroke outcomes at hospital discharge among first-ever stroke patients.. This was an analysis of data from the Malaysia National Stroke Registry. Patients aged 18 years or older documented as having a first episode of stroke in the registry were recruited. Subsequently, the comparison of proportions for overall and sex-specific stroke outcomes between years (from 2009 to 2017) was conducted. The primary outcome was modified Rankin Scale score, which was assessed at hospital discharge, and each patient was categorized as follows: 1) functional independence, 2) functional dependence, or 3) death for analysis.. This study included 9361 first-ever stroke patients. Approximately 36.2% (3369) were discharged in an independence state, 53.1% (4945) experienced functional dependence, and 10.8% (1006) patients died at the time of hospital discharge. The percentage of patients who were discharged independently increased from 23.3% in 2009 to 46.5% in 2017, while that of patients discharged in a disabled state fell from 56.0% in 2009 to 45.6% in 2017. The percentage of death at discharge was reduced from 20.7% in 2009 to 7.8% in 2017. These findings suggest that the proportions of stroke outcomes at hospital discharge have changed significantly over time (p < 0.001), and there was a significant sex-related difference in stroke outcomes at hospital discharge following first stroke episode (p < 0.001).. Our data indicate there has been a significant change in stroke outcomes over the past nine years in Malaysia. This information ought to be considered in ongoing efforts of tertiary stroke prevention.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Disability Evaluation; Disabled Persons; Female; Humans; Independent Living; Longitudinal Studies; Malaysia; Male; Middle Aged; Patient Discharge; Registries; Retrospective Studies; Sex Factors; Stroke; Treatment Outcome; Young Adult

This study evaluated the cost-effectiveness of the consumption of a milk powder product fortified with potassium (+1050.28 mg/day) and phytosterols (+1200 mg/day) to lower systolic blood pressure and low-density lipoprotein cholesterol, respectively, and, therefore, the risk of myocardial infarction (MI) and stroke among the 35-75-year-old population in Malaysia. A Markov model was created against a do-nothing option, from a governmental perspective, and with a time horizon of 40 years. Different data sources, encompassing clinical studies, practice guidelines, grey literature, and statistical yearbooks, were used. Sensitivity analyses were performed to evaluate the impact of uncertainty on the base case estimates. With an incremental cost-effectiveness ratio equal to international dollars (int$) 22,518.03 per quality-adjusted life-years gained, the intervention can be classified as very cost-effective. If adopted nationwide, it would help prevent at least 13,400 MIs, 30,500 strokes, and more than 10,600 and 17,100 MI- and stroke-related deaths. The discounted cost savings generated for the health care system by those who consume the fortified milk powder would amount to int$8.1 per person, corresponding to 0.7% of the total yearly health expenditure per capita. Sensitivity analyses confirmed the robustness of the results. Together with other preventive interventions, the consumption of milk powder fortified with potassium and phytosterols represents a cost-effective strategy to attenuate the rapid increase in cardiovascular burden in Malaysia.

Topics: Adult; Aged; Cost-Benefit Analysis; Dairy Products; Humans; Malaysia; Markov Chains; Middle Aged; Models, Biological; Myocardial Infarction; Phytosterols; Potassium; Risk Factors; Stroke

Bleeding risk scores (BRSs) aid in the assessment of oral anticoagulant-related bleeding risk in patients with atrial fibrillation. Ideally, the applicability of a BRS needs to be assessed, prior to its routine use in a population other than the original derivation cohort. Therefore, we evaluated the performance of 6 established BRSs to predict major or clinically relevant bleeding (CRB) events associated with the use of oral anticoagulant (OAC) among Malaysian patients.. The pharmacy supply database and the medical records of patients with non-valvular atrial fibrillation (NVAF) receiving warfarin, dabigatran or rivaroxaban at two tertiary hospitals were reviewed. Patients who experienced an OAC-associated major or CRB event within 12 months of follow-up, or who have received OAC therapy for at least 1 year, were identified. The BRSs were fitted separately into patient data. The discrimination and the calibration of these BRSs as well as the factors associated with bleeding events were then assessed.. A total of 1017 patients with at least 1-year follow-up period, or those who developed a bleeding event within 1 year of OAC use, were recruited. Of which, 23 patients experienced a first major bleeding event, whereas 76 patients, a first CRB event. Multivariate logistic regression results show that age of 75 or older, prior bleeding and male gender are associated with major bleeding events. On the other hand, prior gastrointestinal bleeding, a haematocrit value of less than 30% and renal impairment are independent predictors of CRB events. All the BRSs show a satisfactory calibration for major and CRB events. Among these BRSs, only HEMORR. To the best of our knowledge, this is the first evaluation study of the predictive performance of these 6 BRSs on clinically relevant bleeding events applied to the same cohort consisting of mainly Asian novel oral anticoagulant users. These BRSs show poor to acceptable predictive performance on OAC-induced major or CRB events. An improvement in the existing BRSs for OAC users is warranted.

Topics: Administration, Oral; Aged; Anticoagulants; Atrial Fibrillation; Female; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Logistic Models; Malaysia; Male; Retrospective Studies; Risk Assessment; Risk Factors; Stroke

To investigate oral health knowledge for stroke care and the clinical practices performed for oral hygiene care in Malaysia.. Oral hygiene care following stroke is important as the mouth can act as a reservoir for opportunistic infections that can lead to aspirational pneumonia.. A national cross-sectional survey was conducted in Malaysia among public hospitals where specialist stroke rehabilitation care is provided.. All (16) hospitals were invited to participate, and site visits were conducted. A standardised questionnaire was employed to determine nurses' oral health knowledge for stroke care and existing clinical practices for oral hygiene care. Variations in oral health knowledge and clinical practices for oral hygiene care were examined.. Questionnaires were completed by 806 nurses across 13 hospitals. Oral health knowledge scores varied among the nurses; their mean score was 3.7 (SD 1.1) out of a possible 5.0. Approximately two-thirds (63.6%, n = 513) reported that some form of "mouth cleaning" was performed for stroke patients routinely. However, only a third (38.3%, n = 309) reported to perform or assist with the clinical practice of oral hygiene care daily. Their oral health knowledge of stroke care was associated with clinical practices for oral hygiene care (p < .001).. The clinical practice of providing oral hygiene care is less than ideal, and there are deficiencies in oral health knowledge for stroke care. Oral health knowledge was associated with clinical practice of providing oral hygiene care. This has implications for training and integrating oral hygiene care within stroke rehabilitation.

Topics: Critical Care; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Hygiene; Malaysia; Male; Oral Hygiene; Stroke; Stroke Rehabilitation; Surveys and Questionnaires

No abstract provided.

Topics: Humans; Malaysia; Oral Health; Pneumonia, Aspiration; Risk Factors; Stroke

Data on post stroke outcomes in developing countries are scarce due to uncoordinated healthcare delivery systems. In Malaysia, the national stroke clinical practice guideline does not address transfer of care and longer term post stroke care beyond tertiary care. Hence, post stroke care delivery may be delivered at either tertiary or primary care facilities. This study aimed at describing patients' characteristics and outcomes of post stroke care delivered by the primary care teams at public primary care healthcentres across Peninsular Malaysia. Multi staged sampling was done to select public primary care health centres to recruit post stroke patients. At each health centre, convenience sampling was done to recruit adult patients (≥18 years) who received post stroke care between July-December 2012. Baseline measurements were recorded at recruitment and retrospective medical record review was done simultaneously, for details on medical and / or rehabilitation treatment at health centre. Changes in the measurements for post stroke care were compared using paired t-tests and Wilcoxon Rank test where appropriate. Total of 151 patients were recruited from ten public primary care healthcentres. The mean age at stroke presentation was 55.8 ± 9.8 years. Median duration of follow up was 2.3 (IQR 5.1) years. Majority co-resided with a relative (80.8%), and a family member was primary caregiver (75.%). Eleven percent were current smokers. Almost 71.0% of patients achieved BP ≤ 140/90 mmHg. Only 68.9% of the patients had been referred for neurorehabilitation. Percentage of recorded data was highest for blood pressure (88.1%) while lowest was HbA1c (43.0%). For clinical outcomes, systolic and diastolic blood pressure, triglyceride level and calculated GFR (eGFR) showed statistically significant changes during follow up (p < 0.05). Post stroke care at public primary care healthcentres showed benefits in stroke risk factors control (i.e. hypertension and dyslipidaemia) but deterioration in renal function. A more structured coordination is needed to optimise post stroke care beyond acute phase management for patients who reside at home in the community.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Malaysia; Male; Middle Aged; Outcome Assessment, Health Care; Patient Care; Primary Health Care; Public Health Surveillance; Retrospective Studies; Stroke; Stroke Rehabilitation

Acute stroke results in functional disability measurable using the well-known Barthel Index. The objectives of the study are to describe the change in the Barthel Index score and to model the prognostic factors for Barthel Index change from discharge up to 3 months post-discharge using the random intercept model among patients with acute first ever stroke in Kelantan, Malaysia.. A total 98 in-hospital first ever acute stroke patients were recruited, and their Barthel Index scores were measured at the time of discharge, at 1 month and 3 months post-discharge. The Barthel Index was scored through telephone interviews. We employed the random intercept model from linear mixed effect regression to model the change of Barthel Index scores during the three months intervals. The prognostic factors included in the model were acute stroke subtypes, age, sex and time of measurement (at discharge, at 1 month and at 3 month post-discharge).. The crude mean Barthel Index scores showed an increased trend. The crude mean Barthel Index at the time of discharge, at 1-month post-discharge and 3 months post-discharge were 35.1 (SD = 39.4), 64.4 (SD = 39.5) and 68.8 (SD = 38.9) respectively. Over the same period, the adjusted mean Barthel Index scores estimated from the linear mixed effect model increased from 39.6 to 66.9 to 73.2. The adjusted mean Barthel Index scores decreased as the age increased, and haemorrhagic stroke patients had lower adjusted mean Barthel Index scores compared to the ischaemic stroke patients.. Overall, the crude and adjusted mean Barthel Index scores increase from the time of discharge up to 3-month post-discharge among acute stroke patients. Time after discharge, age and stroke subtypes are the significant prognostic factors for Barthel Index score changes over the period of 3 months.

Topics: Activities of Daily Living; Adult; Age Factors; Aged; Female; Humans; Interviews as Topic; Linear Models; Malaysia; Male; Middle Aged; Patient Discharge; Prognosis; Retrospective Studies; Severity of Illness Index; Sex Factors; Stroke; Stroke Rehabilitation

This study aimed to examine "intention to" and "performance of" oral hygiene care to stroke patients using the Theory of Planned Behavior.. A large scale survey of 13 centers in Malaysia was conducted involving 806 nurses in relation to oral hygiene care intentions and practices. In addition, information on personal and environmental factors was collected.. The response rate was 95.6% (778/806). The domains of the Theory of Planned Behavior were significantly associated with general intention to perform oral hygiene care: attitudes (β = 0.21, p < 0.001), subjective norms (β = 0.38, p < 0.001), perceived behavior control (β = 0.04, p < 0.001); after controlling for personal and environmental factors. Approximately two-thirds (63.4%, 493) reported the performance of some form of oral hygiene care for patients. This behavior was associated with general intention scores (OR =1.13, 95%CI =1.05-1.22, p <0.01), controlling for other factors. Knowledge scores, training, access to oral hygiene guidelines and kits, as well as working ward type were identified as key factors associated with intention and practice of oral hygiene care.. The Theory of Planned Behavior provides understanding of "intention to" and "performance of" oral hygiene care to stroke patients. Several provider and environmental factors were also associated with intentions and practices. This has implications for understanding and improving the implementation of oral hygiene care in stroke rehabilitation. Implications for Rehabilitation Oral hygiene care is crucial for stroke patients as it can prevent oral health problems and potentially life threatening events (such as aspiration pneumonia). Despite oral hygiene care being relative simple to perform, it is often neglected during stroke rehabilitation. A large-scale national survey was conducted to understand "intentions to" and "performance of" oral hygiene care to stroke patients using the Theory of Planned Behavior social cognition model. These study findings may have implications and use in promoting oral hygiene care to stroke patients:i) by understanding the pathways and influences to perform oral hygiene care.ii) to conduct health promotion and health education based on behavioral models such as Theory of Planned Behavior.

Topics: Clinical Competence; Cross-Sectional Studies; Female; Hospitals, Public; Humans; Malaysia; Male; Oral Hygiene; Practice Guidelines as Topic; Practice Patterns, Nurses'; Psychological Theory; Stroke; Stroke Rehabilitation; Surveys and Questionnaires

The current study aims to determine the relationship of long-term visit-to-visit variability of SBP to cardiovascular disease (CVD) in a multiethnic primary care setting.. This is a retrospective study of a cohort of 807 hypertensive patients over a period of 10 years. Three-monthly clinic blood pressure readings were used to derive blood pressure variability (BPV), and CVD events were captured from patient records.. Mean age at baseline was 57.2 ± 9.8 years with 63.3% being women. The BPV and mean SBP over 10 years were 14.7 ± 3.5 and 142 ± 8 mmHg, respectively. Prevalence of cardiovascular event was 13%. In multivariate logistic regression analysis, BPV was the predictor of CVD events, whereas the mean SBP was not independently associated with cardiovascular events in this population. Those with lower SBP and lower BPV had fewer cardiovascular events than those with the same low mean SBP but higher BPV (10.5 versus 12.8%). Similarly those with higher mean SBP but lower BPV also had fewer cardiovascular events than those with the same high mean and higher BPV (11.6 versus 16.7%). Other variables like being men, diabetes and Indian compared with Chinese are more likely to be associated with cardiovascular events.. BPV is associated with an increase in CVD events even in those who have achieved lower mean SBP. Thus, we should prioritize not only control of SBP levels but also BPV to reduce CVD events further.

Topics: Aged; Blood Pressure; China; Coronary Disease; Female; Follow-Up Studies; Heart Failure; Humans; Hypertension; India; Malaysia; Male; Middle Aged; Peripheral Arterial Disease; Prevalence; Primary Health Care; Retrospective Studies; Stroke; Systole; Time Factors

To assess the predicted rate and the factors associated with bleeding events among patients with non-valvular atrial fibrillation (NVAF) receiving dabigatran therapy.. This retrospective cohort study includes adult patients of two tertiary hospitals in Malaysia. Potential study subjects were identified using pharmacy supply database or novel oral anticoagulant (NOAC) registry. Demographics, clinical data and laboratory test results were extracted from the medical records of the patients or electronic databases. The main outcome measure is the occurrence of a bleeding event. Bleeding events were classified into major bleeding, clinically relevant non-major bleeding, or minor bleeding, according to the International Society on Thrombosis and Haemostasis criteria. We consider clinically relevant non-major bleeding events or major bleeding events as clinically relevant bleeding events. An occurrence of any bleeding event was recorded from the initiation of NOAC therapy until the death of a patient, or the date of permanent discontinuation of NOAC use, or the last day of data collection. The predicted rate of dabigatran-induced bleeding events per 100 patient-years was estimated.. During a median follow-up period of 18 months, 73 patients experienced 90 bleeding events. Among these patients, 25 including 4 fatal cases, experienced major bleeding events. The predicted rate per 100 patient-years of follow-up of any bleeding events was 9.0 [95% CI 6.9 to 11.1]; clinically relevant bleeding events 6.0 [95% CI 4.8 to 8.3], and major bleeding events 3.0 [95% CI 1.9 to 4.2]. The independent risk factor for clinically relevant bleeding events is prior bleeding. While prior bleeding or congestive heart failure is linked with major bleeding events.. The predicted rate for dabigatran-induced major bleeding episodes is low but these adverse events carry a high fatality risk. Preventive measures should target older patients who have prior bleeding or congestive heart failure. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Antithrombins; Atrial Fibrillation; Dabigatran; Female; Follow-Up Studies; Hemorrhage; Humans; Malaysia; Male; Middle Aged; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Stroke

Evaluation of secondary stroke prevention in low and middle-income countries remains limited. This study assessed the prescription of secondary preventive drugs among ischemic stroke patients upon hospital discharge in Malaysia and identified factors related to the prescribing decisions.. From Malaysian National Stroke Registry, we included patients with non-fatal ischemic stroke. Prescriptions of antiplatelet, anticoagulants, antihypertensive drugs and lipid-lowering drugs were assessed. Multi-level logistic regressions were performed to determine the relation between potential factors and drug prescriptions.. Of 5292 patients, 48% received antihypertensive drugs, 88.9% antiplatelet and 88.7% lipid-lowering drugs upon discharge. Thirty-three percent of patients with an indication for anticoagulants (n = 391) received it. Compared to patients <=50 years, patients above 70 years were less likely to receive antiplatelet (OR: 0.72, 95% CI: 0.50-1.03), lipid-lowering drugs (OR: 0.66, 95% CI: 0.45-0.95) and anticoagulants (OR: 0.27, 95% CI: 0.09-0.83). Patients with moderate to severe disability upon discharge had less odds of receiving secondary preventive drugs; an odds ratio of 0.57 (95% CI: 0.45-0.71) for antiplatelet, 0.86 (95% CI: 0.75-0.98) for antihypertensive drugs and 0.78 (95% CI: 0.63-0.97) for lipid-lowering drugs in comparison to those with minor disability. Having prior specific comorbidities and drug prescriptions significantly increased the odds of receiving these drugs. No differences were found between sexes and ethnicities.. Prescription of antihypertensive drugs and anticoagulants among ischemic stroke patients in Malaysia were suboptimal. Efforts to initiate regular clinical audits to evaluate the uptake and effectiveness of secondary preventive strategies are timely in low and middle-income settings.

Topics: Aged; Anticoagulants; Antihypertensive Agents; Brain Ischemia; Female; Humans; Malaysia; Male; Middle Aged; Odds Ratio; Patient Discharge; Platelet Aggregation Inhibitors; Registries; Secondary Prevention; Stroke

Atrial fibrillation (AF) is the most common cardiac arrhythmia with significant morbidity and mortality in relation to thromboembolic stroke. Our study aimed to evaluate the safety and efficacy of dabigatran in stroke prevention in elderly patient with nonvalvular AF with regard to the risk of ischemic stroke and intracranial haemorrhage (ICH) in real-world setting.. A retrospective cohort study of 200 patients on dabigatran and warfarin from January 2009 till September 2016 was carried out. Data were collected for 100 patients on dabigatran and 100 patients on warfarin.. Overall bleeding events were significantly lower in dabigatran group compared to warfarin group. In the presence of suboptimal TTR rates and inconveniences with warfarin therapy, non-vitamin-K antagonist oral anticoagulants (NOAC) are the preferred agents for stroke prevention in elderly Asian patients for nonvalvular AF.

Topics: Aged; Aged, 80 and over; Anticoagulants; Antithrombins; Cohort Studies; Dabigatran; Female; Humans; Malaysia; Male; Medical Audit; Retrospective Studies; Stroke; Warfarin

Topics: Adult; Aged; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Middle Aged; Stroke; Tertiary Care Centers; Thrombolytic Therapy; Time-to-Treatment

Gender as an independent predictor in stroke has been well documented. However, data on gender differences among first-ever ischemic stroke in developing country are limited. We aim to describe gender effects on clinical characteristics, thrombolysis treatment received, and outcomes of patients with first-ever ischemic stroke.. Data were extracted from the prospective multiethnic stroke registry, National Neurology Registry (NNEUR). Descriptive analysis and logistic regression were performed.. A total of 4762 first-ever ischemic stroke patients admitted to 13 government hospitals from July 2009 to June 2015 were available for this study. Slightly over half were male (55.1%), and they were 1.7 years younger than female (mean age, 63.6 versus 61.9 years, p < 0.001). Gender-age-adjusted incidence was observed to be higher in females (66.7 per 100,000) compared to males (57.4 per 100,000). First-ever ischemic stroke incidence increased by 24.3 and 11.2% among female and male annually. Female experienced significantly poorer functional outcome and greater 30-day in-hospital mortality compared to male. In subgroup analysis, only 31 (0.65%) patients were treated with thrombolysis.. First-ever ischemic stroke incidence increased by 24.3 and 11.2% among female and male annually. There were distinct symptoms at hospital presentation between genders. All our patients discharged home regardless of genders. In summary, Malaysian female first-ever ischemic stroke was older, present with severe stroke, greater number of risk factors and poorer functional outcome and 30-day in-hospital mortality compared to male.

Topics: Aged; Brain Ischemia; Female; Humans; Logistic Models; Malaysia; Male; Middle Aged; Prospective Studies; Registries; Retrospective Studies; Risk Factors; Sex Characteristics; Stroke; Thrombolytic Therapy

Background Oral anticoagulant therapy is indicated for the prevention of stroke or other thromboembolic events. Premature discontinuation of oral anticoagulants may increase the risk of thromboembolism resulting in adverse sequelae. There are sparse data on the prevalence and the predictors of dabigatran discontinuation in Malaysian patients with atrial fibrillation. Objectives Determine the reasons and identify associated factors for abrupt discontinuation of dabigatran, assess the switching pattern and the occurrence of thromboembolic events after dabigatran discontinuation. Setting A university-affiliated tertiary hospital in Kuala Lumpur, Malaysia. Methods The clinical and demographic data of a cohort who were initiated with dabigatran between 2010 and 2012 at the University of Malaya Medical Centre were reviewed until the date of death or on 31st December 2013. Those patients who discontinued dabigatran were further followed up until 31st December 2015 to determine the occurrence of any thromboembolic event. Main outcome measure Permanent discontinuation of dabigatran for more than 8 weeks. Results 26 (14 %) of a cohort of 192 patients discontinued dabigatran therapy during a median follow-up period of 20 (range 3-45) months. About one-half of the discontinuation occurred within the first 6 months of dabigatran use. The three most cited reasons for discontinuation are bleeding events (19 %), high out-of-pocket drug payment (19 %) and cardioversion (19 %). Heart failure [adjusted odds ratio 3.699 (95 % confidence interval 1.393-9.574)] or chronic kidney disease [adjusted odds ratio 5.211 (95 % confidence interval 1.068-23.475)] were found to be independent risk factors for abrupt dabigatran discontinuation. Patients who discontinued dabigatran received warfarin (38 %), antiplatelet agents (16 %) or no alternative antithrombotic therapy (46 %). Five of the 26 patients who discontinued dabigatran developed an ischaemic stroke within 3-34 months after discontinuation. Conclusion Abrupt dabigatran discontinuation without an alternative oral anticoagulant increases the risk of thromboembolic events. As adverse drug events and renal impairment contribute substantially to the premature discontinuation of dabigatran, it is important to identify and monitor patients at risk to reduce dabigatran discontinuation rate especially during the first six months of dabigatran therapy.

Topics: Aged; Aged, 80 and over; Antithrombins; Atrial Fibrillation; Cohort Studies; Dabigatran; Female; Follow-Up Studies; Hemorrhage; Humans; Malaysia; Male; Medication Adherence; Middle Aged; Risk Factors; Stroke

The increase in angiotensin II (Ang II) formation by selected antihypertensive drugs is said to exhibit neuroprotective properties, but this translation into improvement in clinical outcomes has been inconclusive. We undertook a study to investigate the relationship between types of antihypertensive drugs used prior to a stroke event and ischemic stroke severity. We hypothesized that use of antihypertensive drugs that increase Ang II formation (Ang II increasers) would reduce ischemic stroke severity when compared to antihypertensive drugs that suppress Ang II formation (Ang II suppressors).. From the Malaysian National Neurology Registry, we included hypertensive patients with first ischemic stroke who presented within 48 hours from ictus. Antihypertensive drugs were divided into Ang II increasers (angiotensin-I receptor blockers (ARBs), calcium channel blockers (CCBs) and diuretics) and Ang II suppressors (angiotensin-converting-enzyme inhibitors (ACEIs) and beta blockers). We evaluated stroke severity during admission with the National Institute of Health Stroke Scale (NIHSS). We performed a multivariable logistic regression with the score being dichotomized at 15. Scores of less than 15 were categorized as less severe stroke.. A total of 710 patients were included. ACEIs was the most commonly prescribed antihypertensive drug in patients using Ang II suppressors (74%) and CCBs, in patients prescribed with Ang II increasers at 77%. There was no significant difference in the severity of ischemic stroke between patients who were using Ang II increasers in comparison to patients with Ang II suppressors (OR: 1.32, 95%CI: 0.83-2.10, p = 0.24).. In our study, we found that use of antihypertensive drugs that increase Ang II formation was not associated with less severe ischemic stroke as compared to use of antihypertensive drugs that suppress Ang II formation.

Topics: Adrenergic beta-Antagonists; Aged; Angiotensin II; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Brain Ischemia; Calcium Channel Blockers; Cross-Sectional Studies; Diuretics; Female; Humans; Hypertension; Malaysia; Male; Middle Aged; Multivariate Analysis; Registries; Severity of Illness Index; Stroke

Currently very little is known about the prevalence or magnitude of caregiver dependence in Singapore and thus, there is a need to fill this gap in this multiethnic ageing population. This study aims to determine the prevalence and risk factors of caregiver dependence among older adults in Singapore.. Data were used from the Well-being of the Singapore Elderly (WiSE) study, a nationally representative, cross-sectional survey among Singapore residents aged 60 years and above. Caregiver dependence was ascertained by asking the informant (the person who knows the older person best) a series of open-ended questions about the older person's care needs.. The older adult sample comprised 57.1% females and the majority were aged 60 to 74 years (74.8%), while 19.5% were 75 to 84 years, and 5.7% were 85 years and above. The prevalence of caregiver dependence was 17.2% among older adults. Significant sociodemographic risk factors of caregiver dependence included older age (75 to 84 years, and 85 years and above,. Various sociodemographic and health-related conditions were significantly associated with caregiver dependence. Dependent older adults will put greater demands on health and social services, resulting in greater healthcare expenditures. Hence, effective planning, services and support are crucial to meet the needs of dependent older adults and their caregivers.

Topics: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Asthma; Caregivers; Cough; Cross-Sectional Studies; Dementia; Depression; Educational Status; Ethnicity; Female; Humans; India; Logistic Models; Malaysia; Male; Marital Status; Middle Aged; Multivariate Analysis; Neoplasms; Occupations; Paralysis; Prevalence; Retirement; Risk Factors; Singapore; Stroke; Vision Disorders

This study aimed to investigate the direct cost of outpatient care for patients with stroke, as well as the relationship between the aforementioned cost and the sociodemographic and stroke characteristics of the patients.. This was a cross-sectional study involving patients with first-ever stroke who were attending outpatient stroke rehabilitation, and their family members. Participants were interviewed using a structured questionnaire designed to obtain information regarding the cost of outpatient care. Stroke severity was measured using the National Institute of Health Stroke Scale.. This study comprised 49 patients (28 men, 21 women) with a mean age of 60.2 (range 35-80) years. The mean total cost incurred was USD 547.10 (range USD 53.50-4,591.60), of which 36.6% was spent on attendant care, 25.5% on medical aids, 15.1% on travel expenses, 14.1% on medical fees and 8.5% on out-of-pocket expenses. Stroke severity, age > 70 years and haemorrhagic stroke were associated with increased cost. The mean cost of attending outpatient therapy per patient was USD 17.50 per session (range USD 6.60-30.60), with travelling expenses (41.8%) forming the bulk of the cost, followed by medical fees (38.1%) and out-of-pocket expenses (10.9%). Multiple regression analysis showed that stroke severity was the main determinant of post-stroke outpatient care cost (p < 0.001).. Post-stroke outpatient care costs are significantly influenced by stroke severity. The cost of attendant care was the main cost incurred during the first three months after hospital discharge, while travelling expenses was the main cost incurred when attending outpatient stroke rehabilitation therapy.

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Cross-Sectional Studies; Female; Health Care Costs; Humans; Malaysia; Male; Middle Aged; Neurology; Outpatients; Rehabilitation; Severity of Illness Index; Social Class; Stroke; Stroke Rehabilitation; Surveys and Questionnaires

Anticoagulant responses to warfarin vary among patients, based on genetic factors, diet, concomitant medications, and disease state. We evaluated the effectiveness and safety of a 10mg warfarin initiation nomogram in an Asian population. Retrospective cross-sectional audit studies were conducted from March 2009 to March 2010. The use of a 10mg-loading dose to initiate warfarin treatment resulted in 33(84.6%) patients attaining a therapeutic INR within four days (mean time, 2.6 days). There was no significant correlation between age, gender, race, and serum albumin for the time to reach a therapeutic INR. A significant correlation was noted for patient's baseline INR and time to reach a therapeutic INR (P<0.05). No significant differences were observed in time to reach a therapeutic INR in patients treated with specific class of concomitant drugs or patients with specific disease states. The overall incidence of over-anticoagulation was 35.9%; however, no bleeding episodes were encountered. In conclusion, the use of a 10mg warfarin nomogram was effective in rapidly achieving a therapeutic INR. However, the nomogram's safety is debatable owing to the high over-anticoagulation rate warfarin-administered patients. Caution is recommended in the initiation of warfarin treatment using the 10mg nomogram.

Topics: Adult; Aged; Anticoagulants; Asian People; Atrial Fibrillation; Coronary Thrombosis; Cross-Sectional Studies; Humans; Malaysia; Male; Middle Aged; Nomograms; Pulmonary Embolism; Retrospective Studies; Stroke; Venous Thrombosis; Warfarin

The purpose of this study was threefold. First, it was to determine the relationship between serum vitamin profiles and ischemic stroke. The second purpose was to investigate the association of methylenetetrahydrofolate reductase (MTHFR), endothelial nitric oxide synthase (eNOS), angiotensin converting enzyme (ACE), and apolipoprotein-E (ApoE) gene polymorphisms with ischemic stroke and further correlate with serum vitamin profiles among ischemic stroke patients. The third purpose of the study was to highlight the interaction of MTHFR and eNOS haplotypes with serum vitamin profiles and ischemic stroke risks.. Polymorphisms of these genes were analyzed in age-, sex-, and ethnicity-matched case-controls (n = 594); serum vitamin profiles were determined using immunoassays.. The MTHFR 677C>T, 1298A>C, eNOS intron 4a/b, and ApoE polymorphisms were significantly associated with the increased risk of ischemic stroke. Elevated serum homocysteine and vitamin B12 levels were associated with MTHFR 677C>T and eNOS intron 4a/b polymorphisms. The ApoE and eNOS -786T>C polymorphisms were associated with increased serum vitamin B12 levels. However, none of the polymorphisms influenced serum folate levels except for the MTHFR 1298A>C. Different patterns of MTHFR and eNOS haplotypes tend to affect serum vitamin profiles to different degrees, which contribute to either different susceptibility risk or protective effect on ischemic stroke. Overall, increased levels of serum homocysteine and vitamin B12 levels were associated with higher risk of ischemic stroke in the investigated population.. The present study suggests that the genotypes and haplotypes of MTHFR 677C>T and eNOS intron 4a/b polymorphisms are potential serum biomarkers in the pathophysiological processes of ischemic stroke, by modulating homocysteine and vitamin B12 levels.

Topics: Adult; Apolipoproteins E; Brain Ischemia; Case-Control Studies; Female; Genetic Association Studies; Genetic Predisposition to Disease; Humans; Malaysia; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Nitric Oxide Synthase Type III; Peptidyl-Dipeptidase A; Polymorphism, Single Nucleotide; Stroke; Vitamins

Stroke remains a major health burden worldwide. The incidence and prevalence rates of stroke are decreasing in developed countries, an opposite trend is taking place in the Asia Pacific, where an increasing number of patients are being diagnosed with acute stroke. The results of the present study on acute stroke in multi-ethnic Malaysia will significantly contribute to the global stroke epidemiological data. We aimed to present epidemiological data of stroke including incidence and prevalence rates as well as associated risk factors from a prospective nationwide hospital-based registry from 2010 to 2014.. Patients diagnosed with stroke upon admission at the hospital were prospectively enrolled into the registry from January 1, 2010, to December 31, 2014. Descriptive analyses were performed.. A total of 7668 patients were available for analysis. On average, patients were aged 62.7 years (standard deviation of 12.5). Ischemic stroke accounts for 79.4% of the cohort with a slightly higher proportion of male patients (55%). Ischemic stroke incidence is estimated to increase annually by 29.5% and hemorrhagic stroke by 18.7%. Hypertension is a major risk factor for both ischemic and hemorrhagic strokes regardless of stroke event with an excess of 8.4% hypertensive female compare to male patients (P ≤ .001). Majority of patients with ischemic and hemorrhagic strokes experienced mild and moderate stroke with 11.7% and 21.1%, respectively, documented as severe (P ≤ .001).. The incidence and prevalence of stroke in Malaysia increased dramatically in the 5-year study period. Therefore, implementation of risk factor control strategies is important to prevent further increase of stroke burden in the country.

Topics: Aged; Aged, 80 and over; Brain Ischemia; Female; Humans; Hypertension; Incidence; Intracranial Hemorrhages; Life Style; Malaysia; Male; Middle Aged; Prevalence; Prospective Studies; Registries; Risk Factors; Sex Factors; Stroke

Muslims throughout the world perform salat (prayer) five times a day; salat involves a person reciting the Holy Qur'an while being in several positions. There are several steps that should be carried out before prayer, including wudhu (ablution) and covering one's awrah (body).. To identify educational needs for stroke patients and their caregivers in Malaysia. Another purpose is to report on the needs identified by stroke patients and their families related to salat.. Descriptive qualitative study. Phase 1 involved semi-structured interviews with stroke patients (n = 5), family caregivers (n = 5) and health professionals (n = 12) in Kelantan Malaysia. Phase 2 involved presenting the findings from Phase 1 to the health professionals with the aim of establishing priorities and processes to develop education strategies for stroke patients and their families.. Preparing for and performing salat was challenging for both patient and family carers to do following a stroke. Themes identified were prayer and the meaning of the stroke events for participants, difficulties praying post-stroke, prayer as part of rehabilitation therapy.. Providing culturally safe care should include how nurses assess and support patients and their caregivers post stroke to meet their prayer needs. Nurses have a role in discussing with stroke patients and their families how in addition to its spiritual and customary benefits, prayer and for Muslims reciting the Holy Qur'an can have cognitive and rehabilitation benefits, as well as being a source of psychological support for stroke patients.

Topics: Adolescent; Adult; Culturally Competent Care; Family; Female; Humans; Interviews as Topic; Islam; Malaysia; Male; Middle Aged; Nurse's Role; Patient Education as Topic; Posture; Spirituality; Stroke; Young Adult

NeuroAiD (MLC601, MLC901), a combination of natural products, has been shown to be safe and to aid neurological recovery after brain injuries. The NeuroAiD Safe Treatment (NeST) Registry aims to assess its use and safety in the real-world setting.. The NeST Registry is designed as a product registry that would provide information on the use and safety of NeuroAiD in clinical practice. An online NeST Registry was set up to allow easy entry and retrieval of essential information including demographics, medical conditions, clinical assessments of neurological, functional and cognitive state, compliance, concomitant medications, and side effects, if any, among patients on NeuroAiD. Patients who are taking or have been prescribed NeuroAiD may be included. Participation is voluntary. Data collected are similar to information obtained during standard care and are prospectively entered by the participating physicians at baseline (before initialisation of NeuroAiD) and during subsequent visits. The primary outcome assessed is safety (ie, non-serious and serious adverse event), while compliance and neurological status over time are secondary outcomes. The in-person follow-up assessments are timed with clinical appointments. Anonymised data will be extracted and collectively analysed. Initial target sample size for the registry is 2000. Analysis will be performed after every 500 participants entered with completed follow-up information.. Doctors who prescribe NeuroAiD will be introduced to the registry by local partners. The central coordinator of the registry will discuss the protocol and requirements for implementation with doctors who show interest. Currently, the registry has been approved by the Ethics Committees of Universiti Kebangsaan Malaysia (Malaysia) and National Brain Center (Indonesia). In addition, for other countries, Ethics Committee approval will be obtained in accordance with local requirements.. NCT02536079.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brain; Child; Child, Preschool; Drugs, Chinese Herbal; Female; Humans; Indonesia; Infant; Infant, Newborn; Malaysia; Male; Middle Aged; Neuroprotective Agents; Prospective Studies; Recovery of Function; Registries; Research Design; Stroke; Time Factors; Treatment Outcome; Young Adult

Many stroke research trials do not include assessment of cognitive function. A Very Early Rehabilitation Trial (AVERT) is an international multicenter study that includes the Montreal Cognitive Assessment (MoCA) as an outcome. At the Malaysian AVERT site, completion of the MoCA has been limited by low English proficiency in some participants. We aimed to develop a Bahasa Malaysia (BM) version of the MoCA and to validate it in a stroke population.. The original English version of the MoCA was translated into BM and then back-translated to ensure accuracy. Feasibility testing in a group of stroke patients prompted minor changes to the BM MoCA. In the validation phase, a larger group of bilingual stroke patients completed both the original English MoCA and the finalized BM MoCA, with presentation order counter-balanced.. Forty stroke patients participated, with a mean age of 57.2 (SD = 10.3). Agreement between BM MoCA and English MoCA was strong (intra-class correlation coefficient = 0.81, 95% CI 0.68-0.90). Scores on BM MoCA were slightly higher than scores on English MoCA (median absolute difference = 2.0, IQR 0-3.5), and this difference was present regardless of which version was completed first.. The existence of a validated BM version of the MoCA will be of major benefit to clinicians and researchers in Malaysia and the wider South-east Asian region, where the Malay language is used by over 200 million people.

Topics: Cognition; Cognition Disorders; Female; Humans; Intelligence Tests; Malaysia; Male; Mental Status Schedule; Middle Aged; Neuropsychological Tests; Reproducibility of Results; Stroke; Translations

Provision of post stroke care in developing countries is hampered by discoordination of services and limited access to specialised care. Albeit shortcomings, primary care continues to provide post-stroke services in less than favourable circumstances. This paper aimed to review provision of post-stroke care and related problems among Family Medicine Specialists managing public primary health care services.. A semi-structured questionnaire was distributed to 121 Family Physicians servicing public funded health centres in a pilot survey focused on improving post stroke care provision at community level. The questionnaire assessed respondents background and practice details i.e. estimated stroke care burden, current service provision and opinion on service improvement. Means and frequencies described quantitative data. For qualitative data, constant comparison method was used until saturation of themes was reached.. Response rate of 48.8% was obtained. For every 100 patients seen at public healthcentres each month, 2 patients have stroke. Median number of stroke patients seen per month is 5 (IQR 2-10). 57.6% of respondents estimated total stroke patients treated per year at each centre was less than 40 patients. 72.4% lacked a standard care plan although 96.6% agreed one was needed. Patients seen were: discharged from tertiary care (88.1%), shared care plan with specialists (67.8%) and patients who developed stroke during follow up at primary care (64.4%). Follow-ups were done at 8-12 weekly intervals (60.3%) with 3.4% on 'as needed' basis. Referrals ranked in order of frequency were to physiotherapy services, dietitian and speech and language pathologists in public facilities. The FMS' perceived 4 important 'needs' in managing stroke patients at primary care level; access to rehabilitation services, coordinated care between tertiary centres and primary care using multidisciplinary care approach, a standardized guideline and family and caregiver support.. Post discharge stroke care guidelines and access to rehabilitation services at primary care is needed for post stroke patients residing at home in the community.

Topics: Adult; Cross-Sectional Studies; Family Practice; Female; Health Facilities; Humans; Malaysia; Male; Practice Patterns, Physicians'; Primary Health Care; Public Health; Self Report; Stroke; Surveys and Questionnaires

The Pooled Cohort Risk Equation was introduced by the American College of Cardiology (ACC) and American Heart Association (AHA) 2013 in their Blood Cholesterol Guideline to estimate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk. However, absence of Asian ethnicity in the contemporary cohorts and limited studies to examine the use of the risk score limit the applicability of the equation in an Asian population. This study examines the validity of the pooled cohort risk score in a primary care setting and compares the cardiovascular risk using both the pooled cohort risk score and the Framingham General Cardiovascular Disease (CVD) risk score.. This is a 10-year retrospective cohort study of randomly selected patients aged 40-79 years. Baseline demographic data, co-morbidities and cardiovascular (CV) risk parameters were captured from patient records in 1998. Pooled cohort risk score and Framingham General CVD risk score for each patient were computed. All ASCVD events (nonfatal myocardial infarction, coronary heart disease (CHD) death, fatal and nonfatal stroke) occurring from 1998-2007 were recorded.. A total of 922 patients were studied. In 1998, mean age was 57.5 ± 8.8 years with 66.7% female. There were 47% diabetic patients and 59.9% patients receiving anti-hypertensive treatment. More than 98% of patients with pooled cohort risk score ≥7.5% had FRS >10%. A total of 45 CVD events occurred, 22 (7.2%) in males and 23 (3.7%) in females. The median pooled cohort risk score for the population was 10.1 (IQR 4.7-20.6) while the actual ASCVD events that occurred was 4.9% (45/922). Our study showed moderate discrimination with AUC of 0.63. There was good calibration with Hosmer-Lemeshow test χ2 = 12.6, P = 0.12.. The pooled cohort risk score appears to overestimate CV risk but this apparent over-prediction could be a result of treatment. In the absence of a validated score in an untreated population, the pooled cohort risk score appears to be appropriate for use in a primary care setting.

Topics: Adult; Aged; Antihypertensive Agents; Asian People; Cardiovascular Diseases; Chi-Square Distribution; Comorbidity; Coronary Disease; Diabetes Mellitus; Female; Health Status Indicators; Humans; Malaysia; Male; Middle Aged; Myocardial Infarction; Primary Health Care; Prognosis; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; Stroke

Depression among patients with vascular dementia is frequently overlooked and potentially causes significant morbidity. There is limited data in Malaysia on the subject and this study was conducted to determine the prevalence of depression in vascular dementia (VaD) in UKMMC.. This was a cross-sectional study involving diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) criteria and who had a mini mental state examination (MMSE) score of less than 26. All patients were interviewed, examined clinically and their previous brain computer tomography (CT) were reviewed. The prevalence of depression was determined using the Cornell scale of depression.. A total of 76 patients were recruited with a mean age of 70.5 ± 9.5 years. The median duration of illness was 2.0 (1.0-4.8) years. The prevalence of depression in the study population was 31.6%. The patients with depression had a significant older mean age (74.5±8.7 years old) compared to those without depression (68.6±9.4 years old). Patients with large artery stroke of less than 3 years had significant higher frequency of depression (53.6%) compared to patients with small artery stroke (23.8%) and patients with right sided large artery stroke had significantly higher frequency of depression compared to left (70% vs. 44.4%). Median MMSE score (17.0) for depressed patients was significantly lower compared with median MMSE score (22.5) for non depressed patients. Median Barthel Index (30.0) for depressed patients was significantly lower compared with median Barthel score for non depressed patients.. Depression was prevalent among post stroke patients with VaD in UKMMC particularly for patients with older age, large artery stroke, right sided large artery stroke, low MMSE score and low Barthel Index. Early recognition of high risk patients is important in the holistic management of patients to prevent significant morbidity arising from depression.

Topics: Cross-Sectional Studies; Dementia, Vascular; Depression; Humans; Malaysia; Prevalence; Stroke

Evidence indicates that the continuation of therapy among community-dwelling stroke survivors improves physical function. Community rehabilitation programmes often face limitations in terms of resources. It is imperative to include new motivational interventions to encourage some level of non-clinician management. The aim of this study was to determine whether there were any changes in physical function and activities of daily living when substituting a portion of the standard physiotherapy time with virtual reality games among community-dwelling stroke survivors.. In this controlled trial, the experimental group received 30 minutes of virtual reality balance games in addition to 90 minutes of standard physiotherapy. The control group continued with their two hours of routine standard physiotherapy. Both groups received 12 therapy sessions: two-hour sessions twice per week for six continuous weeks. Changes in physical function, activities of daily living and balance ability were assessed using the Timed Up and Go test, 30-second Sit to Stand test, Timed Ten-Metre Walk test, Six-Minute Walk test and the Barthel Index, and static balance was assessed using a probalance board.. Twenty-eight participants completed post-intervention assessments. The results showed a significant within-subject effect on the Timed Up and Go test: F (1, 26) = 5.83, p = 0.02; and the 30-second Sit to Stand test; F (1, 26) = 13.50, p = 0.001. The between-subject effect was not significant (p > 0.05) for any of the outcome measurements.. Substituting a portion of the standard physiotherapy time with virtual reality games was equally effective in maintaining physical function outcomes and activities of daily living among community-dwelling stroke survivors.. Australia and New Zealand Clinical Trials Register, ACTRN12613000478718.

Topics: Aged; Aged, 80 and over; Analysis of Variance; Female; Games, Experimental; Humans; Malaysia; Male; Middle Aged; Residence Characteristics; Stroke; Stroke Rehabilitation; Survivors; Treatment Outcome; Virtual Reality Exposure Therapy; Walking

This community based incidence study aims to report the stroke incidence in the south-west region of the Penang Island.. All strokes occurring in the population of residents in the southwest region of the Penang Island, Malaysia during a period of 12 months, from April 2010 to March 2011 were screened and assessed. Standard definitions for stroke were used. All stroke cases were ascertained using multiple overlapping sources. Incidence rate was based on first ever in a lifetime stroke cases. All recurrent strokes were excluded from the incidence count.. The overall stroke incidence rate in the study region during the study period was 67 per 100,000 after age adjustment to 2010 Malaysian population.. This study provides the first stroke incidence data in Malaysia and is vital for effective health system planning.

Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Female; Humans; Incidence; Infant; Longitudinal Studies; Malaysia; Male; Middle Aged; Sex Factors; Stroke; Young Adult

This study aimed to estimate cost of in-patient medical care due to stroke in a tertiary hospital in Malaysia. A retrospective analysis of stroke patients admitted to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between January 2005 and December 2008 were conducted. Cost evaluation was undertaken from the health provider's perspective using a top-down costing approach. Mean length of stay (LOS) was 6.4 ± 3.1 days and mean cost of care per patient per admission was MYR 3,696.40 ± 1,842.17 or 16% of per capita GDP of the country. Human resources made up the highest cost component (MYR 1,343.90, SD: 669.8 or 36% of the total cost), followed by medications (MYR 867.30, SD:432.40) and laboratory services (MYR 337.90, SD:168.40). LOS and cost of care varied across different stroke severity levels (p<0.01). A regression analysis shown significant influence of stroke severity on cost of care, with the most severe stroke consumed MYR 1,598.10 higher cost than the mild stroke (p<0.001). Cost of medical care during hospital admission due to stroke is substantial. Health promotion and primary prevention activities need to take priority to minimise stroke admission in future.

Topics: Humans; Length of Stay; Malaysia; Retrospective Studies; Stroke; Tertiary Care Centers

Stroke is one of the top five leading causes of death and one of the top 10 causes for hospitalization in Malaysia. Stroke is also in the top five diseases with the greatest burden of disease, based on disability-adjusted life years. However, prospective studies on stroke in Malaysia are limited. To date, neither the prevalence of stroke nor its incidence nationally has been recorded. Hypertension is the major risk factor for stroke. The mean age of stroke patients in Malaysia is between 54.5 and 62.6 years. Traditional medicine is commonly practiced. With the increasing number of stroke cases annually, more government and nongovernment organizations should be involved in primary and secondary prevention strategies.

Topics: Cost of Illness; Malaysia; Medicine, East Asian Traditional; Quality-Adjusted Life Years; Risk Factors; Stroke; Stroke Rehabilitation

Gastrostomy feeding is superior to long-term nasogastric (NG) feeding in patients with dysphagic stroke, but this practice remains uncommon in Asia. We sought to examine the nutritional adequacy of patients on long term NG feeding and identify barriers to gastrostomy feeding in these patients.. A prospective comparison of subjective global assessment (SGA), and anthropometry (mid-arm muscle circumference, MAMC; triceps skinfold thickness, TST) between elderly stroke patients on long-term NG feeding and matched controls was performed. Selected clinicians and carers of patients were interviewed to assess their knowledge and attitudes to gastrostomy feeding.. 140 patients (70 NG, 70 oral) were recruited between September 2010 and February 2011. Nutritional status was poorer in the NG compared to the oral group (SGA grade C 38.6% NG vs 0% oral, p<0.001; TST males 10.7 + 3.7 mm NG vs 15.4 + 4.6 mm oral, p<0.001; MAMCmales 187.9 + 40.4 mm NG vs 228.7 + 31.8 mm oral, p<0.001). 45 (64.3%) patients on long-term NG feeding reported complications, mainly consisting of dislodgement (50.5%), aspiration of feed content (8.6%) and trauma from insertion (4.3%). Among 20 clinicians from relevant speciliaties who were interviewed, only 11 (55%) clinicians would routinely recommend a PEG. All neurologists (100%) would recommend a PEG, whilst the response was mixed among non-neurologists. Among carers, lack of information (47.1%) was the commonest reason stated for not choosing a PEG.. Elderly patients with stroke on long term NG feeding have a poor nutritional status. Lack of recommendation by clinicians appears to be a major barrier to PEG feeding in these patients.

Topics: Academic Medical Centers; Aged; Aged, 80 and over; Attitude of Health Personnel; Deglutition Disorders; Enteral Nutrition; Female; Gastrostomy; Health Knowledge, Attitudes, Practice; Humans; Intubation, Gastrointestinal; Malaysia; Male; Middle Aged; Neurology; Nutritional Status; Practice Patterns, Physicians'; Prospective Studies; Stroke; Time Factors; Workforce

Topics: Humans; Malaysia; Registries; Stroke

The National Stroke Registry (NSR) was established in 2009 under National Neurology Registry (NNeuR) . The main objectives of NSR were to describe the demographic and disease pattern of stroke patients in Malaysia, to examine the risk factors and evaluate the specified treatment and outcomes. This prospective observational study was carried out from August 2009 until December 2010 using a standardized case report form which involved two participating hospital, namely Hospital Sultanah Nur Zahirah, Kuala Terengganu and Hospital Seberang Jaya, Pulau Pinang. There were 1018 patients registered. Ischemic stroke accounted for the majority of cases (73.3%). The most common risk factor was hypertension (75.5 %), followed by diabetes mellitus, previous stroke or Transient Ischemic Attack (TIA), hyperlipidemia and active smoker: 45.6%, 25.1%, 22.4%, and 19.4%, respectively. Overall, our stroke management, based on nine stroke key performance indicators (KPI) still needs to be improved. There was a total of 121 mortality cases with the main contributing factor was massive cerebral bleed (21.6%). In conclusion, the findings highlight the important of primary and secondary stroke management. Further and continuous observation with more site date provider (SDP) involvement is needed to get a more comprehensive data on stroke in Malaysia.

Topics: Aged; Brain Ischemia; Diabetes Mellitus; Female; Humans; Hyperlipidemias; Hypertension; Ischemic Attack, Transient; Malaysia; Male; Middle Aged; Registries; Smoking; Stroke

Statins can reduce the risk of stroke in at-risk populations and improve survival after acute ischemic stroke (AIS) among patients with previous statin use. This study aimed to investigate the impact of statin use before AIS onset on in-hospital mortality and identify the factors related to in-hospital mortality among patients with and without previous statin use. A retrospective cohort study of all patients with AIS attending hospital from June 1, 2008 to December 31, 2008. Data were collected from medical records including demographic information, diagnostic information, risk factors, previous statin use, and vital discharge status. Chi-square, Fisher's exact tests, student's t-test, and Mann-Whitney U test, whatever appropriate, were used to test the significance between the variables, and multiple logistic regression was used to identify factors associated with in-hospital mortality. Altogether, 386 patients with AIS were studied, of which 113 (29.3%) had a documented previous statin use. A total of 62 (16.1%) patients with AIS died in hospital. In-hospital mortality was significantly lower among previous statin users (P = 0.013). The presence of atrial fibrillation (AF) increased in-hospital mortality among patients with or without previous statin use. The independent predictors for in-hospital mortality among AIS patients without previous statin use were the presence of diabetes mellitus (P = 0.047), AF (P = 0.045), and renal impairment (P < 0.001). The prophylactic administration of statins significantly reduces post-AIS in-hospital mortality. Furthermore, the identification of predictors of in-hospital mortality might reduce death rates and enhance the application of specific therapeutic and management strategies to patients at a high risk of dying.

Topics: Atrial Fibrillation; Brain Ischemia; Chi-Square Distribution; Cohort Studies; Diabetes Complications; Diabetes Mellitus; Female; Hospital Mortality; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Logistic Models; Malaysia; Male; Middle Aged; Renal Insufficiency; Retrospective Studies; Risk Factors; Statistics, Nonparametric; Stroke

The functional point mutation C677T in the methylenetetrahydrofolate reductase (MTHFR) gene, has been reported to contribute to hyperhomocysteinaemia which is a risk factor for atherothrombotic ischaemic strokes. This study evaluated the prevalence of the C677T polymorphism of the gene in Malaysian ischaemic stroke subjects of Malay, Chinese and Indian ethnicities, and its association with homocysteine levels (tHcy).. A total of 292 subjects were recruited, comprising 150 ischaemic stroke patients and 142 control subjects who were age and sex matched. Plasma homocysteine, serum folate and vitamin B12 were measured in all subjects. Genotyping was carried out using PCR-RFLP.. The homocysteine levels were significantly higher (P = 0.001) in the stroke group (11.35 ± 2.75 μmol/L) compared to the control group (10.38 ± 2.79 μmol/L). The MTHFR C677T genotype distribution for the stroke group was 46%, 40% and 14%, respectively for CC, CT and TT genotypes and 59.9%, 33.8% and 6.3%, respectively for the control group. The genotype and allelic frequencies were significantly different between the 2 groups, with P = 0.02 and P = 0.004 respectively. No significant difference was seen in the genotype distribution inter-ethnically. An increasing tHcy was seen with every additional T allele, and the differences in the tHcy for the different genotypes were significant in both the control (P <0.001) and stroke groups (P <0.001).. This study shows that TT genotype of the methylenetetrahydrofolate reductase C677T polymorphic gene is an important determinant for homocysteine levels in Malaysian ischaemic stroke patients.

Topics: China; Ethnicity; Female; Folic Acid; Gene Frequency; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; India; Malaysia; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Point Mutation; Polymorphism, Genetic; Stroke; Vitamin B 12

We describe the prevalence and risk factors for PAD in Asian Malays with diabetes. A population-based study of 3,280 (78.7% response) Malay persons aged 40-80 years in Singapore was conducted. ABI was measured in all participants with a history of diabetes (N=634). PAD was defined to be present if ABI

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Ankle Brachial Index; Asian People; Diabetes Mellitus; Female; Health Surveys; Humans; Hypertension; Logistic Models; Malaysia; Male; Middle Aged; Myocardial Infarction; Odds Ratio; Peripheral Vascular Diseases; Prevalence; Risk Assessment; Risk Factors; Sex Factors; Singapore; Smoking; Stroke

To determine the mortality rate and risk factors for death in a selected population in Songkhla province in southern Thailand.. The southern subjects were part of the Thai cohort which together with the cohort from China comprised the InterASIA survey which was conducted in the year 2000. Collected variables were the conventional ones and included the 2 ethnic groups which are specific for southern Thailand, i.e. Malay Muslims and Thai-Chinese Buddhists. Causes of death were determined by reviewing hospital records, verbal autopsies and a consensus by 2-3 physicians. Kaplan Meier's model was used to evaluate the independent factors related to death.. The follow-up was 5 years. Out of the original 1,006 subjects, the status could be examined in 86% and of these, 50 had died giving the Kaplan Meier 5-year survival rate of 94.3%. Sixteen died from cardiovascular diseases (CVD), 6 from strokes and 10 from coronary heart disease, and 15 died from cancer. Half of the deaths occurred in subjects older than 70 years. Independent risks for death were age, hypertension and diabetes mellitus. Risk for the major causes of death did not include ethnicity. Similar to the only existing prospective report of risk factors for death in Thailand (the Electricity Generating Authority of Thailand study), neither high total cholesterol, high triglyceride nor obesity were independent risks for death from CVD, but the present study differed in that the high density lipoprotein cholesterol was not found to be a protective factor for CVD death.. Risk factors for death in a five-year follow-up in Southern Thailand did not include lipids, ethnicity or urbanization but hypertension and diabetes mellitus did.

Topics: China; Coronary Artery Disease; Female; Health Surveys; Humans; Malaysia; Male; Middle Aged; Mortality; Neoplasms; Risk Factors; Stroke; Thailand; Time Factors

To examine the prevalence and risk factors of retinal arteriolar emboli, a risk predictor of stroke, in an Asian population.. Population-based cross-sectional study.. Retinal emboli were ascertained from retinal photographs obtained from both eyes of 3,265 Asian Malays, aged 40 to 80 years, according to a standardized protocol. Risk factors were assessed from detailed standardized interviews, clinical examinations, and laboratory investigations.. The overall prevalence of retinal emboli was 0.6% (95% confidence interval [CI], 0.58 to 0.62). A finding of retinal emboli was strongly associated with increasing age (P = .005, for trend), but age-stratified prevalence rates were still lower than those reported from previous population-based studies of White persons. After adjusting for age and gender, the presence of retinal emboli was associated with cigarette smoking (odds ratio [OR], 5.96; 95% CI, 1.75 to 20.32), elevated total cholesterol (OR, 5.21; 95% CI, 1.93 to 12.82), low-density lipoprotein cholesterol (OR, 2.98; 95% CI, 1.20 to 7.39), and self-reported history of angina (OR, 5.67; 95% CI, 1.62 to 19.91). These associations remained significant in multivariate analysis with additional adjustment for other risk factors.. Retinal emboli are less common in Asians than in similarly aged White persons, but are associated with similar cardiovascular risk factors.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Arterioles; Cholesterol, LDL; Cross-Sectional Studies; Embolism; Female; Humans; Hypercholesterolemia; Malaysia; Male; Middle Aged; Prevalence; Retinal Artery; Retinal Diseases; Risk Factors; Singapore; Smoking; Stroke

To study the prevalence of dementia in Singapore among Chinese, Malays, and Indians.. A two-phase, cross-sectional study of randomly selected population from central Singapore with disproportionate race stratification.. Community-based study. Subjects screened to have cognitive impairment at phase 1 in their homes were evaluated clinically for dementia at phase 2 in nearby community centers.. Fourteen thousand eight hundred seventeen subjects aged 50 and older (67% participation rate).. The locally validated Abbreviated Mental Test was used to screen for cognitive impairment at phase 1. Dementia was diagnosed at phase 2 as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Possible Alzheimer's disease (AD) and possible vascular dementia (VD) were diagnosed along the National Institute of Neurological and Communicative Disorders-Alzheimer's Disease and Related Disorders Association and National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neuroscienes criteria, respectively.. The overall age- and race-standardized dementia prevalence was 1.26% (95% confidence interval (CI)=1.10-1.45). Prevalence (in 5-year age bands) was 0.08% (50-54), 0.08% (55-59), 0.44% (60-64), 1.16% (65-69), 1.84% (70-74), 3.26% (75-79), 8.35% (80-84), and 16.42% (>/=85). From age 50 to 69, 65% of dementia cases were VD; at older ages, 60% were AD. Logistic regression (adjusted for age, sex, education) showed that Malays had twice the risk for AD as Chinese, and Indians had more than twice the risk for AD and VD than Chinese.. Singapore's dementia prevalence, primarily influenced by its Chinese majority, is lower than seen in the West. The striking interethnic differences suggest a need for a dementia incidence study and further investigation of underlying genetic and cultural differences between the three ethnic groups in relation to dementia risk.

Topics: Aged; Aged, 80 and over; Asian People; China; Cross-Sectional Studies; Dementia; Epilepsy; Female; Humans; India; Malaysia; Male; Middle Aged; Parkinson Disease; Prevalence; Risk Factors; Singapore; Stroke

Computed tomography (CT) perfusion is a new method to diagnose ischaemic stroke especially in developing countries. It identifies the area and is useful to predict the size of final infarction. The aim of this study was to assess cerebral ischaemia with CT perfusion (CTP) among patients with acute ischaemic stroke in Hospital Universiti Sains Malaysia, a tertiary referral centre in a rural setting.. 42 consecutive unenhanced CT and CTP examinations of the brain in adult patients were evaluated prospectively. Unenhanced CT images were divided into normal, suspicious or frank infarction. CTP images was classified as normal or ischaemic. Subgroup analysis was carried out with a limit of six hours from time of ictus.. Out of 42 patients, 20 had frank infarction on unenhanced CT, 15 had suspicious CT studies, while seven were normal. There was no significant association of demographical, clinical and radiological parameters to CTP in the whole group among acute stroke patients without frank infarction. Among the subgroup of patients without frank infarction, there was no significant association between unenhanced CT and CTP in patients who were studied less than six hours after stroke (p-value is 0.063) as well as those after six hours (p-value is 0.317). The prevalence of a normal unenhanced CT and positive CTP for ischaemia was 22.7 percent (95 percent confidence interval 7.8, 45.4).. CTP may be a useful imaging tool for determining cerebral infarction in a rural-based community population, especially in cases where the unenhanced CT is normal. Thrombolysis is a therapeutic option, even when the history of onset of stroke is unclear.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Brain Ischemia; Female; Hospitals, Rural; Humans; Malaysia; Male; Middle Aged; Perfusion; Prospective Studies; Stroke; Tomography, Emission-Computed; Tomography, X-Ray Computed

There are several studies that reported a higher frequency of sleep-disordered breathing (SDB) among ischaemic stroke patients with increasing evidence linking SDB and cardiovascular complications. Many showed prevalence between 43 percent and 72 percent, taking the apnoea-hypopnoea index (AHI) equal to or greater than ten. The main objective of this study was to determine the frequency of SDB in recent ischaemic stroke patients admitted to Hospital Universiti Kebangsaan Malaysia (HUKM) and the relationship between SDB and known risk factors of ischaemic stroke.. This was a cross-sectional, prospective study involving 28 consecutive acute ischaemic stroke patients admitted to HUKM over three months. Sleep studies were done within one to four weeks after stroke onset. Demographical data and associated risk factors were recorded and data were analysed.. There were 20 men and eight women, with mean age of 60.3 +/- 8.9 years. There were eight Malay, 16 Chinese and four Indian patients. The prevalence of SDB in ischaemic stroke depending on the AHI cut-off was: 92.8 percent for AHI greater than or equal to five, 78.5 percent for AHI greater than or equal to ten, 44.5 percent for AHI greater than or equal to 15, and 37.7 percent for AHI greater than or equal to 20. We discovered that diabetes mellitus and smoking history were important factors predicting significant SDB (AHI greater than or equal to 15) in recent ischaemic stroke cases.. There was a high prevalence of SDB in recent ischaemic stroke patients in HUKM, comparable to other studies. Diabetes mellitus and smoking history were strong predictors of the occurrence of SDB after an ischaemic stroke.

Topics: Adult; Brain Ischemia; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Middle Aged; Polysomnography; Prevalence; Prospective Studies; Risk Factors; Sleep Apnea, Central; Stroke; Time Factors

Stroke prevalence data among mixed Asian populations are lacking. Prevalence rates of stroke were studied among Singaporeans aged > or =50 years of Chinese, Malay, and Indian origin.. Study participants were selected by disproportionate stratified random sampling by race. Trained interviewers performed face-to-face interviews with subjects using the World Health Organization screening protocol for neurological diseases. Data were also collected on a self-report of stroke. Subjects suspected to have had a stroke underwent a clinical evaluation to diagnose or exclude stroke. Case notes review was performed for those who were unable to come for clinical evaluation.. The study involved 14 906 participants: 6734 men, 8172 women, age range 52 to 106 years, Chinese:Malay:Indian ratio 3:1:1. Participation rate was 66.9%. Six hundred and six were diagnosed to have a stroke, yielding a crude prevalence rate of 4.05% (95% CI, 3.75 to 4.38) and a World Health Organization world population age-gender-standardized rate of 3.65% (95% CI, 3.36 to 3.96). Prevalence rates rose with age (P<0.001 for trend) and were higher among men compared with women, 4.53% (95% CI, 4.05 to 5.07) versus 2.91% (95% CI, 2.57 to 3.29), P<0.01. Age and gender-standardized rates among Chinese, Malays, and Indians were 3.76% (95% CI, 3.38 to 4.17), 3.32 (95% CI, 2.72 to 4.07), and 3.62% (95% CI, 2.95 to 4.44), respectively, P>0.2. Prevalence was highest among Chinese men at 4.78% (95% CI, 4.14 to 5.50) and lowest among Malay women at 2.81% (95% CI, 2.08 to 3.81), P=0.01.. There is no difference in stroke prevalence among Chinese, Malay, and Indian Singaporeans. Prevalence is highest among Chinese men and lowest among Malay women. The reasons for these differences warrant further investigation.

Topics: Aged; Aged, 80 and over; China; Cross-Sectional Studies; Female; Humans; India; Malaysia; Male; Middle Aged; Population Surveillance; Prevalence; Singapore; Stroke

Stroke is a leading cause of death and disability in most developed countries and developing nations. Majority of the stroke survivors are left with significant physical and cognitive impairments. In addition to the improved acute stroke care, they often benefit from rehabilitation in improving their function. This was the first study done to document function for post stroke patients in Malaysia. It was prospective study conducted to document functional status of acute stroke patients upon admission, discharge and at 3 months post stroke. Assessment of functional status for these patients are based on their activities of daily living and ambulation i.e. self-care, sphincter control, mobility, locomotion, communication and social cognition. It is also aimed to describe their demographic and clinical characteristics. Correlation of functional status at 3 months post stroke with the initial severity of stroke was also explored. A total of fifty-one patients with acute stroke in University Malaya Medical Centre (UMMC) were recruited. The patient's age ranged from 38 to 83 years with a mean of 60.2 years. Thirty-six patients (71%) were first stroke sufferers and fifteen patients (29%) had recurrent stroke. At discharge from acute stay, 13% of patients were able to ambulate with aids and 87% needed assistance for ambulation in varying degrees. Eighty-two percent of patients showed improvement in overall function (both motor and cognition) at 3 months post stroke. Sixty percent of patients were independent in ambulation and 40% required assistance. Significant correlation was seen between the initial severity of stroke and functional status at 3 months post stroke. Functional status of patients with stroke has improved at 3 months post stroke. A comprehensive rehabilitation medicine programme should be incorporated into management of stroke patients to expedite functional recovery and improve patient's independence.

Topics: Academic Medical Centers; Activities of Daily Living; Adult; Aged; Aged, 80 and over; Cognition; Female; Follow-Up Studies; Humans; Malaysia; Male; Middle Aged; Prospective Studies; Recovery of Function; Stroke; Stroke Rehabilitation; Walking

Topics: Aged; Cross-Sectional Studies; Humans; Malaysia; Middle Aged; Prevalence; Retrospective Studies; Risk Factors; Sex Distribution; Stroke

Atherosclerosis is a progressive, disseminated condition that affects all the vascular beds. Peripheral arterial disease (PAD), a manifestation of atherosclerosis, measured non-invasively in the legs by ankle-brachial index (ABI) is associated with increased cardiovascular morbidity and mortality. Though several studies in the western industrialised countries have shown that PAD is widely prevalent in the general older population at risk, not much data are available in the South East Asian developing countries. We have conducted an epidemiological survey on the prevalence of PAD in high-risk patients at an urban hospital in Malaysia. A total of 301 consecutive patients aged 32-90 years were recruited during their follow-up clinic visits for established cardiovascular disease, ischaemic stroke or diabetes mellitus > or = 5 years. All participants underwent ABI measurement and were subjected to the Edinburgh claudication questionnaire to assess leg symptoms. The prevalence of PAD in our high-risk population was 23%, of which only 27% were symptomatic with the classical intermittent claudication. All the patients with PAD were diagnosed at the time of the study. PAD was found in 33% of patients with pre-existent cardiovascular disease, 28% in patients with ischaemic stroke and 24% in diabetic patients. PAD was also highly prevalent among the younger patients. Our study has shown that PAD is highly prevalent among high-risk Malaysian patients and is not necessarily a disease of older age. Only 27% of these patients were symptomatic. All the subjects with PAD were diagnosed at the time of the study, which would suggest it is an unrecognised and underdiagnosed condition, even in patients with atherosclerotic risk factors.

Topics: Adult; Aged; Aged, 80 and over; Arteriosclerosis; Diabetes Complications; Diabetes Mellitus; Female; Humans; Ischemia; Malaysia; Male; Middle Aged; Peripheral Vascular Diseases; Prevalence; Risk Factors; Stroke; Urban Health

In Malaysia, there is limited information on the mortality and morbidity after an acute stroke in hospitalised patients. The objective of the study was to identify the type, time of onset, and frequency of medical and neurological complications following an acute ischaemic stroke. Consecutive patients with acute ischaemic stroke who were admitted to Hospital Universiti Kebangsaan Malaysia from June 2000 to January 2001 were observed. The complication rate was 20.9%. The most common individual complication was pneumonia (12.3%), followed by septicaemia (11.0%), urinary tract infection (4.3%), and upper gastrointestinal haemorrhage (3.7%). The overall mean length of stay was 7.48 days. The independent risk factors for complications were diabetes mellitus (OR 2.87; 95%CI 1.06 to 7.78), middle cerebral artery (MCA) infarcts (OR 10.0; 95%CI 4.1 to 24.3), and Glasgow coma score (GCS) less than 9(OR 3.8; 95%CI 1.03 to 14.3). Infection was the commonest complication observed. Patients with diabetes mellitus, poor GCS and large MCA infarcts had a higher risk of developing complications.

Topics: Acute Disease; Aged; Chi-Square Distribution; Female; Hospitals, University; Humans; Length of Stay; Malaysia; Male; Middle Aged; Prospective Studies; Risk Factors; Stroke

Stroke is the third most common cause of death in Malaysia.The prevalence of risk factors and predictors of mortality of stroke in Malaysia are poorly understood.. To identify the prevalence of major risk factors for stroke and to determine predictors of one-month mortality.. Prospective study of all stroke patients admitted to Penang Hospital between December 1998 and November 1999. All patients were subjected to brain CT. Predictors of one-month mortality: systolic and diastolic hypertension, hyperglycaemia, type of stroke, age > or = 70, poor Glasgow coma score (GCS) on admission and deterioration of score were assessed.. A total of 246 (139 male and 107 female) patients were included. Median age was 65 years. Hypertension was the commonest risk factor (71.5%) followed by diabetes mellitus (40.2%) and hyperlipidaemia (37%). 74.8% of the cases were ischaemic in origin and 25.2% haemorrhagic. Mortality at one month was 20.3%. Using multivariate analysis and logistic regression, deterioration of GCS (OR = 46.04), poor GCS on admission (OR = 12.35) and haemorrhagic stroke (OR = 3.45) were independent predictors of one-month mortality.. Hypertension and diabetes mellitus are the commonest risk factors of stroke among patients admitted to a tertiary hospital in Malaysia. Significant predictors of one-month mortality include the admission GCS, deterioration of GCS and haemorrhagic stroke.

Topics: Aged; Female; Glasgow Coma Scale; Humans; Intracranial Hemorrhages; Malaysia; Male; Predictive Value of Tests; Prevalence; Prospective Studies; Risk Factors; Stroke

This is the first prospective cohort study in Singapore to describe the incidence of ischaemic heart disease (IHD) and stroke among Chinese, Malays and Asian Indians.. The Singapore Cardiovascular Cohort Study is a longitudinal follow-up study on a general population cohort of 5920 persons drawn from 3 previous cross-sectional surveys. Morbidity and mortality from IHD and stroke were ascertained by record linkage using a unique identification number with the death registry, Singapore Myocardial Infarct Registry and in-patient discharge databases.. There were 193 first IHD events and 97 first strokes during 52,806 person-years of observation. The overall incidence of IHD was 3.8/1000 person-years and that of stroke was 1.8/1000 person-years. In both males and females, Indians had the highest IHD incidence, followed by Malays and then Chinese. For males after adjusting for age, Indians were 2.78 times (95% CI 1.86, 4.17; P < 0.0001) and 2.28 times (95% CI 1.34, 3.88; P = 0.002) more likely to get IHD than Chinese and Malays respectively. For females after adjusting for age, Indians were 1.97 times (95% CI 1.07, 3.63; P = 0.03) and 1.37 times (95% CI 0.67, 2.80; P = 0.39) more likely to get IHD than Chinese and Malays respectively. For stroke, male Chinese and Indians had higher incidence than Malays (though not statistically significant). However, in females, Malays had the highest incidence of stroke, being 2.57 times (95% CI 1.31, 5.05; P = 0.008) more likely to get stroke than Chinese after adjustment for age.. This prospective study of both mortality and morbidity has confirmed the higher risk of IHD in Indians. It has also found that Malay females have a higher incidence of stroke, which deserves further study because of its potential public health importance.

Topics: Adult; Age Distribution; Aged; Asian People; China; Cohort Studies; Confidence Intervals; Cross-Sectional Studies; Female; Humans; Incidence; India; Longitudinal Studies; Malaysia; Male; Middle Aged; Myocardial Ischemia; Probability; Registries; Risk Factors; Sex Distribution; Singapore; Stroke; Survival Rate