Search Results

Abstract : This study explores the challenges in adopting Occupational Safety and Health Management Systems (OSHMS) and Critical Success Factors (CSFs) for Management Standards (MS) implementation in public universities in Malaysia. Using a qualitative, grounded theory approach, six public universities were studied—three with OSHMS certification and three without. Purposive sampling and in-depth interviews with nine key informants were conducted. Thematic analysis approach guided by socio-technical theory were used for synthesising the results. This study protocol has obtained approved from an Institutional Review Board. This study identified barriers such as limited budgets, lack of competence, management awareness, employee participation and the absence of performance metrics. Key CSFs includes internal and external factors namely top management commitment, leadership, competence, resources and directives from authorities. The study concludes that both internal and external authority play critical roles in driving MS adoption. University management must address challenges and leverage existing CSFs within the OSHMS framework to ensure the health and well-being of all interested parties. External policy shifts towards integrating OSH into benchmarking metrics could further support these efforts, aligning with national sustainable development goals.

Abstract : Bronchopulmonary dysplasia (BPD) remains a major cause of morbidity and mortality in preterm neonates, necessitating the exploration of novel preventive strategies. Azithromycin, with its anti-inflammatory and antimicrobial properties, has shown potential in this context. This study systematically evaluates the effectiveness and safety of azithromycin in preventing BPD in preterm neonates. Following PRISMA guidelines, Medline, Cochrane, and Embase databases were searched for studies assessing azithromycin therapy in preterm infants, with BPD as the primary outcome and safety as the secondary outcome. Two reviewers independently screened studies, extracted data, and assessed bias using the Cochrane Risk-of-Bias Tool and MINORS scale. A fixed-effect model was applied to compute pooled risk ratios (RRs) with 95% confidence intervals (CIs), complemented by subgroup analyses. Ten studies involving 1,523 preterm neonates were included. Meta-analysis revealed no significant difference in the incidence of BPD (RR 1.00, 95% CI 0.94–1.06), death before discharge (RR 0.84, 95% CI 0.64–1.11), death after discharge (RR 1.03, 95% CI 0.42–2.55), or respiratory morbidity (RR 0.96, 95% CI 0.54–1.69). However, in the ureaplasma-negative subgroup, azithromycin significantly reduced the risk of death before discharge (RR 0.58, 95% CI 0.38–0.89). No studies reported pyloric stenosis or QT prolongation, and neurodevelopmental outcomes showed no significant difference. In conclusion, azithromycin therapy is safe but ineffective in reducing the risk of BPD in preterm neonates. These findings emphasize the need for multifaceted therapeutic approaches to address the complex, multifactorial nature of this disease.

Abstract : Dorsal wrist ganglion is the most common soft tissue mass of the wrist and hand, originating from the joint capsule or tendon sheath. While surgical excision is considered the gold standard due to its definitive nature, aspiration combined with corticosteroid injection is an attractive, minimally invasive alternative. However, the efficacy of these treatments, particularly in terms of recurrence, remains debated. This meta-analysis was conducted in accordance with the PRISMA guidelines and included seven studies involving 434 patients published between 2019 and 2024. A systematic search was performed using Google Scholar, MEDLINE, and Cochrane databases. Studies were assessed for quality using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for cohort studies. The primary outcome was the recurrence rate, analyzed with a random-effects model and heterogeneity evaluated by the I² statistic. The results indicated that aspiration with corticosteroid injection was associated with a higher recurrence rate compared to surgical excision, with an odds ratio of 3.63 (95% CI 1.25 to 10.54, p = 0.02). Moderate heterogeneity (I² = 69%) was noted, potentially due to variations in corticosteroid types, patient characteristics, and follow-up periods. Surgical excision offers a long-term solution with lower recurrence rates but involves a higher procedural burden. Aspiration with corticosteroid injection, while minimally invasive and quicker, carries a higher risk of recurrence, making it more suitable for patients prioritizing less invasive treatment or with contraindications to surgery. This analysis highlights the need for individualized treatment based on patient preferences, clinical presentation, and resource availability.

Abstract : Midshaft clavicle fractures are common orthopedic injuries often requiring surgical intervention, with plate fixation (PF) and intramedullary fixation (IMF) being the primary treatment options. PF provides good stability but is associated with complications such as hypertrophic scars, painful scars, implant protrusion, and the need for hardware removal. Intramedullary fixation (IMF) offers a less invasive alternative, though its comparative effectiveness remains debated. This meta-analysis aimed to compare clinical outcomes between IMF and PF for midshaft clavicle fractures, incorporating studies published in the last five years. We systematically searched Google Scholar, MEDLINE, and the Cochrane Library for comparative studies. Primary outcomes included functional assessments (DASH and Constant scores), while secondary outcomes focused on VAS scores, surgical parameters, and complications. Nine studies were included. Functional outcomes were similar between groups for the DASH score, but IMF demonstrated a significant advantage in the Constant score, with the maximum improvement observed at 24 weeks (MD 4.38, 95% CI 3.47 to 5.28). IMF also resulted in lower VAS scores, indicating reduced pain, particularly at 1 and 7 days post-surgery. No significant difference was found in major complications, but IMF had a higher risk of implant irritation (OR 2.37, 95% CI 1.09 to 5.14) and a lower risk of hypertrophic scarring (OR 0.12, 95% CI 0.03 to 0.42). IMF has better improvement in all surgical parameters. In conclusion, IMF offers superior surgical efficiency, a more favorable pain profile, and fewer complications, making it an effective treatment option for midshaft clavicle fractures.

Abstract : The symptoms of celiac disease and irritable bowel syndrome (IBS) are similar, and could be confusing; however, a correct diagnosis is highly important because the treatment is different. Literature assessing celiac disease among patients with IBS is scarce. We assessed the prevalence of celiac disease among patients with IBS. We searched PubMed/MEDLINE, Cochrane Library, and Google Scholar during March and April 2024. All articles investigating celiac disease/irritable bowel syndrome overlapping from 2011 to April 2024 were eligible. The terms celiac disease, gluten enteropathy, gluten sensitivity, and irritable bowel syndrome were applied. The author's name, year of publication, country, and patient number in the control and interventional group were collected using predetermined tables, and the RevMan system version 5.4 was used for meta-analysis. Out of the 978 articles retrieved, 30 full texts were screened, and 10 studies with 9395 patients and 410 events were included in the final analysis. Celiac disease was higher among patients with IBS compared to control subjects, odd ratio, 0.28, 95% CI, 0.14-0.54, I2 for heterogeneity, 78%, P <0.001, and the P-value for overall effect, 0.0002. The results did not change after addressing the heterogeneity, odd ratio, 0.31, 95% CI, 0.22-0.43, I2 for heterogeneity, 33%, P-value, 0.17, and the P-value for overall effect <0.0001. Celiac disease was higher among patients with irritable bowel syndrome compared to their counterparts without IBS and it should be thought of among patients with irritable bowel syndrome, especially in refractory cases. Further studies investigating the management of celiac/IBS overlap are recommended.