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Background: Colorectal cancer (CRC) is a major cause of cancer-related mortality worldwide. It is the second leading cause of cancer death in men and women in Malaysia and poses a major burden on society. Aims: To determine the overall survival rate of patients diagnosed with CRC and factors contributing to survival. Methods: Data were obtained from the Malaysia National Cancer Registry. All patients with CRC were identified, and a total of 15,515 patients were screened. A total of 5,675 CRC patients were included from January 1, 2012, to December 31, 2016. Sex, age groups, ethnic groups, stage at diagnosis, cancer sites, and status of treatment received were analysed. The Kaplan-Meier analysis was performed to estimate the 1-, 3-, and 5-year survival of CRC. The log-rank test was conducted to compare the survival between sex, age groups, ethnic groups, stage at diagnosis, cancer sites, and status of treatment received. Multiple Cox regression was conducted to determine the risk of CRC death. Results: Of 5,675, a total of 2,055 had died, 3,534 were censored, and another 86 were still alive within 5 years of CRC diagnosis. The 1-, 3-, and 5-year survival rates were 68.5%, 34.7%, and 18.4%, respectively with a median survival time of 24 months. Significant differences in survival rates of CRC were observed between age groups (p < 0.001), ethnic groups (p < 0.001), stages at diagnosis (p < 0.001), treatment status (p = 0.003), and treatment modalities (p < 0.001). No significant difference was observed in survival rates of CRC between sex (p = 0.235) and cancer sites (p = 0.410). Those who were 80 years old and above were found to be at higher risk of CRC death compared to those below 80 years old (adjusted hazard ratio (HR): 1.24, 95% CI 1.14-1.36). The risk of CRC death was also found four times higher among those with stage IV compared to those with stage 0 (adjusted HR: 4.28, 95% CI 3.26-5.62). Conclusion: In general, Malaysian patients with CRC had low survival rates. National health policies should focus on enhancing awareness of CRC, encouraging early screening, and developing strategies for early detection and management to reduce CRC-associated mortality.
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AIM: To derive a Malaysia guideline and consensus as part of the Malaysia Retina Group's efforts for diagnosis, treatment, and best practices of diabetic macular edema (DME). The experts' panel suggests that the treatment algorithm to be divided into groups according to involvement the central macula. The purpose of DME therapy is to improve edema and achieve the best visual results with the least amount of treatment load. METHODS: On two different occasions, a panel of 14 retinal specialists from Malaysia, together with an external expert, responded to a questionnaire on management of DME. A consensus was sought by voting after compiling, analyzing and discussion on first-phase replies on the round table discussion. A recommendation was deemed to have attained consensus when 12 out of the 14 panellists (85%) agreed with it. RESULTS: The terms target response, adequate response, nonresponse, and inadequate response were developed when the DME patients' treatment responses were first characterized. The panelists reached agreement on a number of DME treatment-related issues, including the need to classify patients prior to treatment, first-line treatment options, the right time to switch between treatment modalities, and side effects associated with steroids. From this agreement, recommendations were derived and a treatment algorithm was created. CONCLUSION: A detail and comprehensive treatment algorithm by Malaysia Retina Group for the Malaysian population provides guidance for treatment allocation of patients with DME.
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BACKGROUND: Hematological malignancies disturb the blood, lymph nodes, and bone marrow. Taking medications for treating opportunistic infections (OIs) in these individuals may enhance the risk of medication interaction as well as adverse drug reactions. OBJECTIVE: This review aims to evaluate the effectiveness of nondrug interventions in reducing OIs among patients with hematological cancers. METHODS: The PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), and Embase databases were searched on December 26, 2022, for all randomized controlled trials (RCTs). The primary endpoint was OIs. The quality of included studies was assessed by the Cochrane Risk-of-Bias tool. RESULTS: A total of 6 studies were included in this review with 4 interventions: (1) types of mouthwash received, (2) presence of coating on central venous catheters (CVCs), (3) use of well-fitted masks, and (4) types of diet consumed. The results were presented in 8 different comparisons: (1) chlorhexidine-nystatin versus saline mouth rinse, (2) chlorhexidine versus saline mouth rinse, (3) nystatin versus saline mouth rinse, (4) chlorhexidine silver sulfadiazine-coated CVCs versus uncoated catheters, (5) well-fitted masks versus no mask, (6) amine fluoride-stannous fluoride versus sodium fluoride mouthwash, (7) low-bacterial diet versus standard hospital diet, and (8) herbal versus placebo mouthwash. No clear differences were reported in any of the outcomes examined in the first 3 comparisons. There were also no clear differences in the rate of catheter-related bloodstream infection or insertion site infection between the use of chlorhexidine silver sulfadiazine-coated CVCs versus uncoated catheters in the patients. Further, no significant differences were seen between patients who used a well-fitted mask and those without a mask in the incidence of OI. The all-cause mortality and mortality due to OI were similar between the 2 groups. There was no clear difference in all-cause mortality, although common adverse effects were reported in patients who used sodium fluoride mouthwash compared with those using amine fluoride-stannous fluoride mouthwash. There was no evidence of any difference in the incidence of possible invasive aspergillosis or candidemia between patients who consumed a low-bacterial diet and a standard diet. For the last comparison, no significant difference was seen between patients who received herbal and placebo mouthwash. CONCLUSIONS: Very limited evidence was available to measure the effectiveness of nondrug interventions in hematological cancers. The effectiveness of the interventions included in this review needs to be evaluated further in high-quality RCTs in a dedicated setting among patients with hematological malignancies. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020169186; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=169186.
