Challenges and strategies for implementing Chinese medicine during COVID-19 in Malaysia.

BACKGROUND: Implementing Chinese medicine (CM) for COVID-19 in Malaysia is challenging for local CM practitioners. The successful experience of CM in China can only be partially adopted in Malaysia due to differences in the national health care system and legislation, geographical health disparities and cultural diversity. Despite all the challenges, Malaysian CM practitioners have managed to thrive and found a Malaysian CM solution amid COVID-19. METHODS: A literature review was conducted using various databases and gray literature from inception to August 15, 2021, to evaluate the challenges faced by Malaysian CM practitioners and the corresponding strategies in Malaysia's country context during COVID-19. RESULTS: A total of 9 challenges and issues faced by Malaysian CM practitioners during COVID-19 were identified. Their corresponding strategies were further categorized into 3 phases, namely, preparation, development and implementation. The strategies were appraised using the SWOT analysis method, and 17 factors were identified. Strength analysis includes personalized CM prescriptions with online consultations in Malaysia. Limited research input for CM in COVID-19 and the inadequate research capacity of local CM institutions are discussed in threat analysis. CONCLUSION: Various approaches have been implemented by Malaysian CM practitioners to provide safe, qualified and effective CM services for COVID-19 at the community level, aiming to reduce the national health care burden. A public-private partnership initiative can bridge the knowledge gap and optimize the role of CM in the health emergency system. This Malaysian CM solution can provide insights to interested countries to capitalize on the potential contribution of Traditional and Complementary Medicine (T&CM) in the era of COVID-19.

The predictive and diagnostic accuracy of vascular endothelial growth factor and pentraxin-3 in severe dengue.

This study aimed to evaluate vascular endothelial growth factor (VEGF) and pentraxin 3 (PTX-3) as predictive and diagnostic markers in differentiating severe dengue from non-severe dengue. The study was conducted in Ampang Health Clinic, Ampang Hospital and Serdang Hospital. The plasma levels of VEGF and PTX-3 were compared between severe dengue and non-severe dengue by ELISA from the day of presentation until discharged. Multiple logistic regression was used to develop predictive and diagnostic models by incorporating other clinical parameters. The receiver operating characteristics (ROC) analysis was used to assess the accuracy of the biomarkers and the developed models. Eighty-two patients were recruited, 29 with severe dengue and four died. The Area Under the Curve (AUC) was statistically significant in VEGF as diagnostic marker at Day 2 and 3 of illness with sensitivity of 80.00%-100.00% and specificity of 76.47%-80.00%. The predictive model with AUC of 0.84 (p < 0.01) has a sensitivity of 100.00% and specificity of 79.25% for predicting severe dengue. The diagnostic model with AUC of 0.71 (p < 0.01) has a sensitivity of 76.19% and specificity of 73.58% for diagnosing severe dengue. The AUC for PTX-3 was not statistically significant. VEGF may be used in combination with other clinical parameters to predict the severity of the disease. As a single biomarker, it may be used as an adjunct investigation to support the diagnosis of severe dengue. PTX-3 was not able to differentiate severe dengue from non-severe dengue.

Geographical distribution and spatio-temporal patterns of hospitalization due to dengue infection at a leading specialist hospital in Malaysia.

Increasing numbers of dengue infection worldwide have led to a rise in deaths due to complications caused by this disease. We present here a cross-sectional study of dengue patients who attended the Emergency and Trauma Department of Ampang Hospital, one of Malaysia's leading specialist hospitals. The objective was to search for potential clustering of severe dengue, in space and/or time, among the annual admissions with the secondary objective to describe the spatio-temporal pattern of all dengue cases admitted to this hospital. The dengue status of the patients was confirmed serologically with the geographic location of the patients determined by residency, but not more specific than the street level. A total of 1165 dengue patients were included in the analysis using SaTScan software. The mean age of these patients was 27.8 years, with a standard deviation of 14.2 years and an age range from 1 to 77 years, among whom 54 (4.6%) were cases of severe dengue. A cluster of general dengue cases was identified occurring from October to December in the study year of 2015 but the inclusion of severe dengue in that cluster was not statistically significant (P=0.862). The standardized incidence ratio was 1.51. General presence of dengue cases was, however, detected to be concentrated at the end of the year, which should be useful for hospital planning and management if this pattern holds.