Using Inspiratory Muscle Training to Improve Respiratory Strength, Functional Capacity, Fatigue, and Stress in Breast Cancer Patients Undergoing Surgery.

Purpose: The main aim of the trial was to assess the effectiveness of inspiratory muscle training on respiratory muscle strength, functional capacity, fatigue, and stress in post-surgical breast cancer survivors. Methods: Forty-seven females who had undergone unilateral post-mastectomy were randomly assigned to an intervention group (IG; n = 24) and a control group (CG; n = 23). Both groups received aerobic exercise training. In addition, the intervention group received inspiratory muscle training 3 days a week for 8 weeks. Maximum inspiratory and expiratory pressure (Pimax) (Pemex), 6-minute walk test, Handgrip strength by hand-held dynamometer, Fatigue Assessment Scale (FAS), and Perceived Stress Scale pss 10 values were measured before the training and then at the eighth week for both groups. Results: No differences were detected between the groups in terms of sample and clinical characteristics 8 weeks post-intervention. In favor of the intervention group, a significant difference with medium to high effect size was found in terms of Pimax, Pemax, FAS, PS, and 6MWT (p < 0.05). However, there was no difference in terms of handgrip strength (p-value: 0.072), with a medium effect size (0.070). Regarding within-group comparisons, IG exhibited substantial differences in all outcome measures (p < 0.05) compared to CG, with the exception of PImax and 6MWT. Conclusion: In post-operative breast cancer survivors, respiratory muscle training combined with aerobic training increases respiratory muscle strength and functional ability while lowering stress and tiredness.

Short-Term and Long-Term Impact of COVID-19 on Quality of Life and Psychological Outcomes in Saudi Arabia: A Comparative Cross-Sectional Study.

Background: Prior research has revealed notable declines in health-related quality of life (HRQoL) and substantial psychological impacts among individuals infected with COVID-19. However, there is a noticeable gap in studies addressing the enduring long-term effects of COVID-19 on HRQoL and psychological well-being. Objective: The current study investigated and compared short and long-term effects of COVID-19 on HRQoL and psychological outcomes among the Saudi population. Methods: The Arabic version of the SF-36 questionnaire was used to assess HRQoL while Anxiety and depression were evaluated by the Hamilton Anxiety (HAM-A) and Depression Scales (HDRS). Participants (n=292) were categorized into three groups: the "never-been-infected" group (n=134), the "one-year infected group" (n=43), and the "more than one year infected" group (n=115). Descriptive statistics were presented using numerical values and frequencies. To compare the groups, a one-way analysis of variance (ANOVA) test was used. Results: Most SF-36 domains exhibited lower values while HAM-A and HDRS values were higher in individuals infected during last year compared to those who never infected. Social functioning subscale of the SF-36 showed a significant difference between the groups (F (2.289) = 6.094, p = 0.01) and the effect size was d = 0.95. Pairwise comparison showed a significant reduction in the social functioning component of SF-36 in "one-year group" compared to both groups "never-been-infected" group (mean difference -13.58 (4.40-22.76) p < 0.01) and "more than one year infected" group (mean difference -10.80 (1.44-20.16) p = 0.02). HAM-A and HDRS scores showed mild levels of anxiety (<17 score) and depression (8 to 16 score) in all groups. Conclusion: The influence of COVID-19 on psychological well-being and HRQoL is significant regardless of whether individuals infected with the virus. Overall, the consistent presence of mild anxiety and depression across all groups highlights the need for a holistic approach to mental health.

The Effect of Kinesio Taping on Balance and Dynamic Stability in College-Age Recreational Runners with Ankle Instability.

(1) Background: Running is one of many sports that have increased in popularity since it can be conducted at any time or anywhere. Ankle instability is a common injury that usually occurs during running and is usually associated with abnormalities in postural stability. Recently, kinesio taping has gained increasing interest as a tool that can be used in rehabilitation, to improve stability, and to help in injury prevention. This study aimed to investigate the effect of Kinesio taping on balance and dynamic stability in recreational runners with ankle instability. (2) Methods: This randomized controlled trial recruited 90 RRs with ankle instability. The participants were randomly divided into three equal groups: a KT group (KTG) who received Kinesio taping on their ankle joints; a mixed group (MG) who received Kinesio taping and exercises; and an exercise group (EG) who received exercises only. Outcome measures (balance and dynamic stability) were assessed before and after the end of an 8-week treatment program using a Biodex balance system and a star excursion balance test, respectively. (3) Results: Within-group comparisons showed statistically significant improvements in most of the outcome values when compared to baseline. Overall stability index was statistically significantly better (with a high effect size) in the MG compared to KTG or EG (p = 0.01, Cohen's d = 1.6, and p < 0.001, Cohen's d = 1.63, respectively). A similar finding was evident in the anteroposterior stability index (p = 0.02, Cohen's d = 0.95, and p < 0.001, Cohen's d = 1.22, respectively). The mediolateral stability index of the KTG was statistically significantly better with a high effect size when compared to MG or EG (p = 0.04, Cohen's d = 0.6, and p < 0.01, Cohen's d = 0.96, respectively). The star excursion balance test values were statistically significant with high effect sizes in the posterior (p = 0.002, Cohen's d = 1.2) and lateral (p < 0.02, Cohen's d = 0.92) directions in the MG compared to KTG and EG. (4) Conclusions: Kinesiotape with exercises is superior to either kinesiotape alone or exercises alone in improving postural stability indices and dynamic stability in recreational runners with ankle instability. Recreational runners with ankle instability should be educated about practicing balance exercises and applying kinesiotape.

Prevalence and management of hyperkalemia in chronic kidney disease and heart failure patients in the Gulf Cooperation Council (GCC).

Hyperkalemia is a frequent complication in patients with chronic kidney disease (CKD) or heart failure (HF) and associated with neuromuscular manifestations, changes in the electrocardiogram, and increased risk of mortality. While data on the prevalence and management of hyperkalemia in the gulf region are scarce, risk factors such as preference for potassium-rich foods (e.g., dates and dried fruits/vegetables), periods of intense fasting (e.g., Ramadan), and diabetes (an ancestor of CKD and HF) are common. Therefore, a panel of nephrologists and cardiologists from countries of the Gulf Cooperation Council (GCC) convened to collate and review available data on the prevalence, regional drivers, and current practice in the management of hyperkalemia in the region. Eventually, this review provides consensus recommendations on a balanced utilization of dietary and pharmacological options including new potassium binders for achieving and sustainably maintaining desirable serum potassium levels in countries of the GCC region. Alignment with regional habits and practice was a key aspect to facilitate the uptake of the recommendations into physicians' practice and patients' lives.

Short term effect of spinal mobilization with movement (MWM) on pulmonary functions in nonsmokers with thoracic hyperkyphosis: a randomized single-blinded controlled trial.

OBJECTIVES: To investigate the effect of mobilization with movement (MWM) on pulmonary functions in subjects with thoracic hyperkyphosis. METHODS: This randomized single-blinded controlled trial included a sample of 50 subjects (age 18 - 25 years old) with thoracic hyperkyphosis. Subjects were randomly allocated into two groups; the Real MWM group (n = 25) which received thoracic MWM plus standard postural correction exercises, and the Sham MWM group (n = 25) which received sham MWM plus standard postural correction exercises. Digital X-ray and handheld spirometer were used to measure selected pulmonary function tests (FVC, FEV1/FVC ratio, MVV) respectively. RESULTS: Within-group comparisons demonstrated a statistically significant improvement in all outcome measures in both groups. The between-group comparisons demonstrated significant improvement in the MWM compared to the Sham group regarding the value of FVC, FEV1/FVC ratio, and MVV (P < .05). CONCLUSION: In young adults with thoracic hyperkyphosis, MWM plus postural exercise produces better improvements in FVC, FEV1, FEV1/FVC, and MVV compared to sham MWM plus postural exercise.

A Single-Blind Randomized Controlled Trial Investigating Changes in Electrical Muscle Activity, Pain, and Function after Shockwave Therapy in Chronic Non-Specific Low Back Pain: Pilot Study.

BACKGROUND: To investigate the effect of adding r-ESWT to a standard exercise program of chronic non-specific LBP on electrical muscle activity (EMG), pain and function. MATERIALS AND METHODS: Our single-blind randomized controlled trial enrolled 30 patients with chronic non-specific LBP randomly allocated to an r-ESWT (n=15) group and a control group (n=15). All patients received a standard exercise program, while r-ESWT was additionally administered in the r-ESWT group. EMG activity, pain and function were assessed before and after 6 weeks of treatment. RESULTS: After treatment, all outcome measures were significantly different (p < 0.05). The addition of r-ESWT produced a significant increase in EMG activity (of all muscles tested) and a reduction in pain intensity and functional disability scores (p < 0.05) compared to the control group. CONCLUSIONS: 1. A standard intervention offered either alone or with r-ESWT increased EMG activities, reduced pain, and enhanced function in patients with chronic non-specific LBP. 2. Adding r-ESWT to the standard intervention program might produce better results.

Mechanical traction from different knee joint angles in patients with knee osteoarthritis: A randomized controlled trial.

OBJECTIVE: To compare the effect of mechanical traction from different knee angles on pain, physical function, and range of motion in patients with knee osteoarthritis. DESIGN: A single-blinded, randomized controlled trial. SETTING: Outpatient public and governmental Hospital clinics. PARTICIPANTS: One hundred and twenty patients with knee osteoarthritis were randomly assigned into 4 equal groups with 30 patients in each group. INTERVENTIONS: Group (A) received conventional physiotherapy(CPT) treatment; group (B) received CPT with knee traction from full extension, group (C) received CPT with knee traction from 90° flexion, while group (D) received CPT with knee traction from 20° flexion. Interventions were applied 3 sessions a week for 4 weeks. OUTCOME MEASUREMENTS: Visual analog scale (VAS), knee passive range of motion and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured at baseline, immediately after 4 weeks of intervention, and after 4 weeks of no intervention as a follow-up. RESULTS: After eight weeks, the mean (SD) for VAS scores were 30.97 ± 8.68, 24.0 ± 8.8, 15.43 ± 6.31, and 16.17 ± 6.11 mm; for total WOMAC scores were 26.77 ± 9.19, 20.3 ± 8.52, 13.27 ± 6.25, and 13.43 ± 7.14 for groups A, B, C and D, respectively. The three traction groups showed statistically significant changes in pain scores, physical function, and total WOMAC, but not for knee passive range of motion, in favor of traction groups C and D than the conventional group (P < 0.05). CONCLUSIONS: Traction from 90°and 20° of knee flexion was found superior to full extension knee in improving pain and physical function, but not for knee passive range of motion, in patients with knee osteoarthritis.

A Systematic Review and Meta-analysis Investigating the Pain-Relieving Effect of Interferential Current on Musculoskeletal Pain.

BACKGROUND: Interferential current is one of the most common electrotherapeutic modalities used in the treatment of painful conditions. Patients seeking medical help to reduce their musculoskeletal pain can be treated using interferential current. OBJECTIVE: The current review aimed to analyze the recently available information regarding the efficacy of interferential current in alleviating the pain of musculoskeletal origin. METHODS: This study used Scopus, CINAHL, Cochrane Library, Web of Science, MEDLINE, Embase, and EBSCOas as data sources. The initial selection of the studies, thorough assessment of the full articles, and extraction of the necessary study characteristics were carried out by two independent reviewers. Another two independent reviewers assessed the methodological quality of each included trial against 39 criteria. These criteria were integrated from several popular scales. Pain intensity-measured using the visual analog scale, numeric pain rating scale, or McGill Pain Questionnaire-was the outcome of interest. RESULTS: This review included 35 trials of variable methodological quality from which 19 trials were selected for the meta-analysis. In general, interferential current alone versus placebo demonstrated a significant pain-relieving effect. On the other hand, interferential current showed no significant difference when added to standard treatment compared with placebo plus standard treatment or standard treatment alone. Similarly, interferential current showed no significant difference when compared with other single interventions (laser, transcutaneous electrical nerve stimulation, cryotherapy). CONCLUSIONS: Interferential current alone is better than placebo at discharge. However, the low number of studies raises suspicions about this conclusion. Interferential current alone or added to other interventions is not more effective than comparative treatments in relieving musculoskeletal pain.

A systematic review of trials investigating the efficacy of exercise training for functional capacity and quality of life in chronic kidney disease patients.

OBJECTIVE: To investigate the efficacy of exercise training on functional capacity and quality of life in chronic kidney disease. DATA SOURCES: SCOPUS, CINAHL, Science Direct, Web of Science, MEDLINE, ProQuest, Physiotherapy Evidence Database (PEDRO), and Google Scholar databases were searched between 2010 and December 2020. METHODS: Randomized controlled trials were included if they involved any types of exercise training (aerobic, resisted and respiratory ex.) conducted with chronic kidney disease patients. Three authors independently screened articles, extracted data, and assessed the methodological quality using PEDro scale, and two authors released any confliction. Modified Sackett Scale was used to determine the level of evidence for each outcome. RESULTS: Out of 130 papers screened, 13 studies with 619 participants met the inclusion criteria. The frequency of the treatment ranged from three to four sessions per week for a period ranging from 8 to 24 weeks. According to the Pedro scale, the quality of studies ranged from good (three studies) to fair (ten studies). All included studies showed positive effects on the measured outcomes (functional capacity and quality of life in chronic kidney disease). CONCLUSION: Exercise programs for chronic kidney disease patients provide beneficial clinical outcomes and optimize functional capacity and quality of life in those patients. Future studies still need to focus on high-quality evidence and studies evaluating the adverse effects of exercise.

Expectant management in delayed presentation of war casualties with penetrating abdominal trauma.

INTRODUCTION: While the management of acute civilian abdominal injuries is well established, The literature regarding the management of battle-related abdominal injuries presented in a delayed fashion is scarce. The objective of this study was to investigate the safety of non-operative management approach in delayed evacuation of battle-related abdominal injuries. METHODS: Clinical records of thirty-seven hemodynamically normal patients with battle related injuries and Computed Tomography (CT) findings of penetrating abdominal trauma were retrospectively studied. RESULTS: All 37 patients suffered penetrating abdominal injuries during the civil war in Syria. In this complex scenario, the casualties presented after a minimum 12-hour delay to our hospital. All patients had abnormal abdominal CT scans with no clinical peritoneal signs. Twenty-one [of the 37] patients exhibited 29 hard signs on CT scan. Of these, 17 patients were treated non-operatively and 4 underwent exploratory laparotomy (of which 2 were non-therapeutic). Sixteen patients exhibited a total of 75 soft signs on CT scan; 15 were treated non-operatively and one underwent non-therapeutic laparotomy. No complications were recorded in either the operative or non-operative groups. In total, 32 patients (86%) were treated non-operatively. Five patients (14%) underwent exploratory laparotomy (3 of which were non-therapeutic). Length of stay was dependent on the unique requirements of each individual patient as determined by the state department for returning across the border. CONCLUSION: We propose that in battle related casualties, acute survivable penetrating abdominal trauma may be safely treated non-operatively in selected patients who are hemodynamically normal and in whom there is an absence of abdominal pain or tenderness on repeated clinical assessment.

The immediate effect of sustained natural apophyseal glide on postural stability and pain in individuals presenting with flexion-dominant chronic low back pain: A randomized single-blinded placebo-controlled trial.

BACKGROUND: Low back pain (LBP) is a common musculoskeletal problem, which commonly affects balance. Sustained natural apophyseal glide (SNAG) is a successful treatment approach for LPB. However, its influence on balance problems has not been studied before. OBJECTIVE: To investigate the immediate effect of SNAG on postural stability and pain in individuals with flexion-dominant chronic low back pain (FCLBP). METHODS: Randomized placebo-controlled trial in which 64 participants with FCLBP were randomly allocated into two groups (SNAG and sham). SNAG group (n= 32) received central lumbar SNAG on the symptomatic lumbar level(s). Sham group (n= 32) received sham SNAG. The outcome measures were postural stability indices; overall stability index (OSI), anteroposterior stability index (APSI), and mediolateral stability index (MLSI) in addition to pain intensity. Outcomes were assessed using the Biodex Balance System and visual analog scale respectively. Measures were taken before and immediately after interventions. RESULTS: There were statistical significance and high effect size (ES) in favor of the SNAG group regarding OSI, APSI, and pain (p< 0.01, cohen's d ES =1.3, 1.4, 1.1 respectively). MLSI showed moderate ES (cohen's d= 0.7) but did not reach a statistically significant level (p= 0.05). CONCLUSION: Lumbar SNAG produces an immediate improvement in postural stability and pain in individuals with FCLBP.

Spontaneous Coronary Artery Dissection: Does Being Unemployed Matter? Insights from the GSCAD Registry.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) and sudden cardiac death. Physical or emotional stressors are the most commonly reported triggers for SCAD. Unemployment has been identified as a source of emotional stress and is linked to poor mental and physical health. OBJECTIVE: To examine the association between employment status and in-hospital and follow-up adverse cardiovascular events in patients with SCAD. METHODS: We conducted a retrospective, multi-center, observational study of patients undergoing coronary angiography for ACS between January 2011 and December 2017. The total number of patients enrolled was 198,000. Patients were diagnosed with SCAD based on angiographic and intravascular imaging modalities whenever available. There were 83 patients identified with SCAD from 30 medical centers in 4 Arab gulf countries. In-hospital (myocardial infarction, percutaneous intervention, ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, internal cardioverter/ defibrillator placement, dissection extension) and follow-up (myocardial infarction, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were compared among those who were employed and those who were not. RESULTS: The median age of patients in the study was 44 (37- 55) years. There were 42 (50.6%) female patients, and 41 (49.4) male patients. Of the cohort, 50 (60%) of the patients were employed and the remaining 33 (40%) were unemployed. 66% of all men were employed and 76% of all women were unemployed. After adjusting for gender unemployment was associated with worse in- -hospital and follow-up cardiac events (adjusted OR 7.1, [1.3, 37.9]), p = 0.021. CONCLUSION: Adverse cardiovascular events were significantly worse for patients with SCAD who were unemployed.

Outcomes of patients with Killip class III acute myocardial infarction after primary percutaneous coronary intervention.

OBJECTIVES: Little is known about the outcomes of patients with Killip class III acute ST-segment elevation myocardial infarction in the reperfusion era. This study investigated the short- and long-term outcomes of these patients who underwent primary percutaneous coronary intervention. METHODS: Between January 2002 and November 2009, a total of 1,278 consecutive patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention. Of these patients, 230 (17.0%) with Killip III, 216 (16.9%) with Killip II, and 832 (65.1%) with Killip I upon presentation were prospectively recruited. RESULTS: Angiographic study showed significantly lower final thrombolysis in myocardial infarction 3 flow in patients with Killip III compared with those with Killip II and I (83.5% vs. 94.9% vs. 95.7%, p<.0001). The incidence of multiple vessel disease was also notably higher in Killip III than in Killip II and I (65.7% vs. 13.9% vs. 53.8%, p<.001). Besides, the incidence of advanced congestive heart failure (defined as greater than or equal to New York Heart Association functional class 3) during hospitalization was remarkably higher in Killip III compared to Killip II and I (71.3% vs. 13.9% vs. 6.6%, p<.001). Furthermore, the 30-day mortality and 1-yr cumulative mortality were notably higher in Killip III than in Killip II and I (20.0% vs. 4.2% vs. 1.7%, p<.001 and 31.7% vs. 7.9% vs. 4%, p<.001, respectively). Multivariate analysis showed that Killip III was independently predictive of 30-day and 1-yr mortality (all p < .04). CONCLUSION: Killip III remains strongly and independently predictive of 30-day and 1-yr mortality in ST-segment elevation myocardial infarction patients even undergoing primary percutaneous coronary intervention.

Comparison of 30-day mortality between anterior-wall versus inferior-wall ST-segment elevation myocardial infarction complicated by cardiogenic shock in patients undergoing primary coronary angioplasty.

OBJECTIVES: In this study, 30-day mortality from cardiogenic shock caused by left anterior descending artery (LAD) occlusion was compared with that caused by left circumflex (LCX) or right coronary artery (RCA) occlusion after primary percutaneous coronary intervention (PCI). METHODS: Between May 2001 and December 2009, 212 consecutive patients with anterior-wall ST-elevation myocardial infarction complicated by cardiogenic shock due to LAD (n = 97) occlusion (group 1) and LCX or RCA (n = 115) occlusion (group 2) undergoing primary PCI were enrolled. RESULTS: The results showed a higher mean peak level of creatine phosphokinase and incidence of extracorporeal membrane oxygenation in group 1 than group 2 (all p < 0.01). However, no significant difference was noted in the achievement of normal blood flow in the infarct-related artery (p = 0.461) and 30-day morality (p = 0.338). Univariate analysis demonstrated a significant association of 30-day morality with age, lower left-ventricular ejection fraction, advanced congestive heart failure and unsuccessful reperfusion (all p < 0.02). Multivariate analysis revealed unsuccessful reperfusion as the most independent predictor of 30-day mortality (p = 0.002). CONCLUSION: No significant difference was noted in 30-day mortality between patients with acute myocardial infarction and cardiogenic shock caused by LAD occlusion and by either RCA or LCX occlusion undergoing primary PCI.

Can a penetration catheter (Tornus) substitute traditional rotational atherectomy for recanalizing chronic total occlusions?

The efficacy of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has improved dramatically due to the development of new devices. Severe calcification of coronary lesions may be encountered even when the guidewire crosses the CTO, preventing the balloon from penetrating the lesion. A new "Tornus" penetration catheter has been developed for CTO recanalization. The purpose of this study was to evaluate the feasibility and safety of the Tornus catheter compared with traditional rotational atherectomy for CTO lesions. From August 2002 to July 2009, 77 patients with CTO of the coronary artery were selected to undergo PCI. Forty-one patients were treated with rotational atherectomy before the availability of the Tornus catheter when the smallest balloon failed to pass the CTO lesion. Later, 36 patients were treated with a Tornus catheter. Device and angiographic success rates as well as procedural complications were assessed. Device success was defined when the Tornus or Rota burr passed through the lesion. Major complications included death, Q-myocardial infarction, or emergency bypass surgery. Minor complications included perforation, cardiac tamponade, no reflow phenomenon, or long spiral dissection.The mean procedural time was significantly longer in the Tornus group (144 minutes versus 115 minutes, P = 0.01), while the device success rate was significantly lower (77% versus 95%, P = 0.024). Rotational atherectomy was subsequently performed in 3 of 8 Tornus failure cases. There were no between group differences in major complication rate (6% Tornus versus 5% rotational atherectomy). There was an insignificant trend for lower minor complication rates in the Tornus group (17% versus 20%).Use of the Tornus catheter was associated with significantly longer procedural duration and lower device success rates compared to rotational atherectomy. Major and minor complications were not different between the groups. Our findings suggest that Tornus catheter penetration is not superior to conventional rotational atherectomy for CTO recanalization.

Transradial and transbrachial arterial approach for simultaneous carotid angiographic examination and stenting using catheter looping and retrograde engagement technique.

BACKGROUND: The purpose of this study was to introduce a novel and safe technique with high procedural success for carotid artery stenting (CAS). METHODS: From April 2004 to May 2009, 161 patients underwent CAS using either a high transradial arterial approach (TRA, defined as 10 cm above styloid process) or a transbrachial arterial approach (TBA) with a 7F arterial sheath. Selective carotid angiography was performed using a 6F Kimny guiding catheter and Teflon wire (260 cm in length) by Catheter Looping And Retrograde Engagement Technique (CLARET) with the guiding catheter seated on the right coronary cusp and its tip engaged into the common carotid artery (CCA). Teflon wire was introduced into the CCA again after the diagnostic procedure, followed by replacement of the 6F Kimny guiding catheter by a 7F Kimny catheter for CAS using one of the following techniques: (1) direct-engagement method, i.e., from right innominate artery into the right CCA; (2) looping method plus double-wire technique (utilized two Teflon wires to provide an adequate support) for both the right and left CCA; and (3) looping method plus a PercuSurge balloon anchoring at the external carotid artery. RESULTS: This distinctive technique offered 100% diagnostic success and 99.4% CAS success. Two patients (1.2%) experienced major ischemic stroke after CAS and two (1.2%) died during hospitalization. CONCLUSION: The results of the present study showed that high TRA/TBA using CLARET for CAS in patients with severe carotid artery stenosis is safe and technically feasible with an extremely high success rate.

The HIV/AIDS epidemic country paper: Malaysia.

Since the first case of HIV/AIDS was identified in 1986 in Malaysia, the number of infected individuals has increased steadily each year, so that by the end of 2002 the cumulative number of people living with HIV/AIDS was 57,835 (51,256 with HIV and 6,579 with AIDS), with 5,676 AIDS deaths. The epidemic in Malaysia, currently in a concentrated epidemic stage, is primarily fueled by drug use, but there is ample evidence that heterosexual transmission has increased over the last few years. A strategic plan that includes prevention, care, support, and treatment run by both the government and nongovernmental organizations has been in place since the beginning of the epidemic. However, Malaysia will need to take a more pragmatic approach to reduce new infections (which numbered 19 each day in 2002) among the youth on whom the country relies for development. Leaders need to recognize that HIV/AIDS is not just a health issue, but also a socioeconomic concern that can eliminate all the developmental gains achieved over the years. Working together, Malaysians can overcome the epidemic, but there is a need to act quickly and to act in effective ways so that the devastating effects (already evident in the number of AIDS orphans and widows) can be reduced.