Increase of visceral fat area in Indonesians and Japanese with normal BMI

We compared the visceral fat accumulation between Indonesians and Japanese. Non-obese (25>BMI> or =18.5) men aged between their 20s and 50s were collected in Toban including moderately populated middle-sized cities of Hyogo Prefecture in Japan, and Sangsit town and Pedawa village in Indonesia. Their visceral fat accumulation was assessed by determination of visceral fat area (VFA) that was measured through bio-electrical impedance analysis. VFA as well as VFA per body weight in those aged in their 20s did not vary significantly among Toban, Sangsit and Pedawa. In these three districts, they increased with age. Compared with VFA as well as VFA per body weight among those aged in their 20s, they increased in their 30s and over in the urban area of both Japan and Indonesia, whereas it did in their 40s and over in Pedawa, economically poor district. The inhabitants in their 40s and over in Sangsit and those in their 30s and over in Pedawa had less VFA than those with the corresponding age in Toban, while those in the 30s and 40s in Pedawa and those in their 40s in Sangsit had less VFA per body weight than those with corresponding age in Toban. In conclusion, the visceral fat appears to accumulate progressively with aging and urbanization of lifestyle even in those with normal body mass index. It is recommended that some preventive measures against visceral fat accumulation should be taken in their 20s or under for urban dwellers and in their 30s or under for rural inhabitants.     

Deep-Stacked Convolutional Neural Networks for Brain Abnormality Classification Based on MRI Images

Journal of Digital Imaging - An automated diagnosis system is crucial for helping radiologists identify brain abnormalities efficiently. The convolutional neural network (CNN) algorithm of deep...     

Use of basal insulin in the management of adults with type 2 diabetes: An Asia-Pacific evidence-based clinical practice guideline

The objective of this study was to provide recommendations regarding effectiveness, safety, optimal starting dose, optimal maintenance dose range, and target fasting plasma glucose of five basal insulins (glargine U-300, degludec U-100, glargine U-100, detemir, and insulin protamine Hagedorn) in insulin-naïve adult patients with type 2 diabetes in the Asia-Pacific region. Based on evidence from a systematic review, we developed an Asia-Pacific clinical practice guideline through comprehensive internal review and external review processes. We set up and used clinical thresholds of trivial, small, moderate, and large effects for different critical and important outcomes in the overall certainty of evidence assessment and balancing the magnitude of intervention effects when making recommendations, following GRADE methods (Grading of Recommendations, Assessment, Development, and Evaluation). The AGREE (Appraisal of Guidelines, Research and Evaluation) and RIGHT (Reporting Items for practice Guidelines in HealThcare) guideline reporting checklists were complied with. After the second-round vote by the working group members, all the recommendations and qualifying statements reached over 75% agreement rates. Among 44 contacted external reviewers, we received 33 clinicians' and one patient's comments. The overall response rate was 77%. To solve the four research questions, we made two strong recommendations, six conditional recommendations, and two qualifying statements. Although the intended users of this guideline focused on clinicians in the Asia-Pacific region, the eligible evidence was based on recent English publications. We believe that the recommendations and the clinical thresholds set up in the guideline can be references for clinicians who take care of patients with type 2 diabetes worldwide.     

Combined panel of serum human tissue kallikreins and CA-125 for the detection of epithelial ovarian cancer

Objective

To determine the predictive accuracy of the combined panels of serum human tissue kallikreins (hKs) and CA-125 for the detection of epithelial ovarian cancer.

Methods

Serum specimens collected from 5 Indonesian centers and 1 Vietnamese center were analyzed for CA-125, hK6, and hK10 levels. A total of 375 specimens from patients presenting with ovarian tumors, which include 156 benign cysts, 172 epithelial ovarian cancers (stage I/II, n=72; stage III/IV, n=100), 36 germ cell tumors and 11 borderline tumors, were included in the study analysis. Receiver operating characteristic analysis were performed to determine the cutoffs for age, CA-125, hK6, and hK10. Sensitivity, specificity, negative, and positive predictive values were determined for various combinations of the biomarkers.

Results

The levels of hK6 and hK10 were significantly elevated in ovarian cancer cases compared to benign cysts. Combination of 3 markers, age/CA-125/hk6 or CA-125/hk6/hk10, showed improved specificity (100%) and positive predictive value (100%) for prediction of ovarian cancer, when compared to the performance of single markers having 80-92% specificity and 74-87% positive predictive value. Four-marker combination, age/CA-125/hK6/hK10 also showed 100% specificity and 100% positive predictive value, although it demonstrated low sensitivity (11.9%) and negative predictive value (52.8%).

Conclusion

The combination of human tissue kallikreins and CA-125 showed potential for improving prediction of epithelial ovarian cancer in patients presenting with ovarian tumors.     

Activity of tamarindus indica pulp water extract in high carbohydrate diet rats as a treatment for obesity and insulin resistance

Obesity is often identified as a nutritional disorder, and this condition continues to be one of the most important yet preventable health hazards. It may be a complex group of diseases and should be characterized as a syndrome that results from an imbalance between energy intake and expenditure. Furthermore, obesity is associated with several diseases such as diabetes mellitus, atherosclerosis, cardiovascular diseases, osteoarthritis, and hypertension. In previous studies, we found that in Asia, especially in the Asean region, carbohydrates are heavily represented in the diet. Therefore, we used a high carbohydrate diet to induce obesity in rats. The aim of this study was to evaluate the potency of Tamarindus indica pulp as an anti-obesity agent in a high carbohydrate diet animal model. The antiobesity effect was evaluated in this in vivomodel at doses of 75 mg/kg·bw and 225 mg/kg·bw. Treatment was started in week 3 and week 9, and biochemical characteristics were measured every 3 weeks. In the end of the study period, insulin resistance and adiponectin levels were measured. TIWE (Tamarindus indica water extract) at a dose of 75 mg/kg·bw showed better efficacy than at a dose of 225 mg/kg·bw, and treatment started on week 3 was better than treatment started on week 9. TIWE has an anti-obesity effect associated insulin resistance by increasing adiponectin levels and insulin sensitivity, which can impact body weight, triglyceride levels, blood glucose levels, and body fat.     

First insulinization with basal insulin in patients with Type 2 diabetes in a real-world setting in Asia

Background: The First Basal Insulin Evaluation (FINE) Asia study is a multinational, prospective, observational study of insulin‐naïve Type 2 diabetes mellitus (T2DM) patients in Asia, uncontrolled (A1c ≥ 8%) on oral hypoglycemic agents, designed to evaluate the impact of basal insulin initiation. Methods: Basal insulin was initiated with or without concomitant oral therapy and doses were adjusted individually. All treatment choices, including the decision to initiate insulin, were at the physician’s discretion to reflect real‐life practice. Results: Patients (n = 2679) from 11 Asian countries were enrolled (mean [±SD] duration of diabetes 9.3 ± 6.5 years; weight 68.1 ± 12.7 kg; A1c 9.8 ± 1.6%). After 6 months of basal insulin (NPH insulin, insulin glargine, or insulin detemir), A1c decreased to 7.7 ± 1.4%; 33.7% patients reached A1c <7%. Fasting blood glucose (FBG) decreased from 11.7 ± 3.6 to 7.2 ± 2.5 mmol/L and 36.8% of patients reached FBG <6.1 mmol/L. The mean daily insulin dose prescribed increased marginally from 0.18 to 0.23 U/kg per day at baseline to 0.22–0.24 U/kg per day at Month 6. Mean changes in body weight and reported rates of hypoglycemia were low over the duration of the study. Conclusions: Initiation of insulin therapy is still being delayed by approximately 9 years, resulting in many Asian patients developing severe hyperglycemia. Initiating insulin treatment with basal insulin was effective and safe in Asian T2DM patients in a real‐world setting, but insulin needs may differ from those in Western countries.     

Amiodarone-induced pulmonary toxicity

AIMS

A number of factors have been hypothesized to increase the risk of amiodarone-induced pulmonary toxicity (AIPT). This study aimed to confirm these risk factors and determine whether a cohort of tertiary hospital patients diagnosed with AIPT demonstrated comparable characteristics.

METHODS

Phase I of this study involved compilation of a database of adverse reactions to amiodarone reported to the Australian and US drug agencies, and identification of risk factors for AIPT using logistic regression analysis. In Phase II, AIPT cases were identified via a retrospective review of medical records of patients discharged from Fremantle Hospital and Health Service, Western Australia (FHHS) between 2000 and 2005 with diagnosed interstitial lung disease. Data were collected regarding these patients’ risk factors for AIPT and compared with those previously identified in Phase I.

RESULTS

A total of 237 cases of AIPT were identified from agency data. Patients aged > 60 years and those on amiodarone for 6–12 months (odds ratio 18.28, 95% confidence interval 6.42, 52.04) were determined to be at the highest risk of AIPT. Australian data also suggested increased risk in patients who had received cumulative doses of 101–150 g. The seven AIPT cases identified among the FHHS patients were all at high risk of AIPT based on their age and duration of amiodarone therapy.

CONCLUSION

Contrary to previous findings, only patient age and the duration of amiodarone therapy were confirmed as significant risk factors for AIPT. Targeted monitoring of these patients may facilitate early identification and management of AIPT.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• A number of factors have been hypothesized to increase the risk of amiodarone-induced pulmonary toxicity (AIPT), although there remains some controversy in the literature as to their relative significance.
• This study aimed to clarify this situation to permit better characterization of patients at risk of AIPT and thus guide the development of guidelines for the monitoring for AIPT in patients receiving the drug.

WHAT THIS STUDY ADDS

• Via compilation and analysis of a database of 237 AIPT cases, it was demonstrated that only patient age and duration of therapy significantly affected the risk of AIPT.
• A small cohort of hospital AIPT patients demonstrated these ‘at-risk’ characteristics, suggesting that targeted monitoring of patients aged >60 years and those on amiodarone for 6–12 months may enhance the safety of these patients and minimize their risk of morbidity and mortality secondary to AIPT.

     

Balinese women in a changing society

Balinese women face the dilemma of maintaining their vital role amid a rapidly changing society. In Bali, the primary female role is one of fostering balance and harmony within families. The Balinese people view women not from the vantage of career success but rather from the vantage of whether they can produce good quality children, and can work as part of a family team. Balinese men and women work together as partners. Indeed, men are not enemies; the genders help and need each other. Values underlying emancipation for women clash with traditional values, leading to frequent misunderstandings. Emancipation advocates neglect those elements necessary for complementing Balinese values. Applying educational and preventative methods, as well as therapeutic innovations to such problems, is helpful at all levels of society.     

Relationship between creatinine clearance and plasma homocysteine levels in predialytic chronic renal failure patients

In order to determine the relationship between homocysteine levels and renal function, a cross-sectional study was carried out at out-patients clinic division of Nephrology and Hypertension Sanglah General Hospital Denpasar. Patients selected for the study were those with creatinine levels of 1.5-8.0 mg/dl aged 18 to 60 years. All eligible patients were examined for serum creatinine levels. At the same time blood samples were drawn for the examinations of total fasting Homocysteine levels. Creatinine clearance was calculated by Cockcroft-Gault formula, serum creatinine levels were examined by Jaffe method and total fasting Homocysteine levels were examined by fluorescence polarization immunoassay method (FPIA) method. If fasting plasma homocysteine levels were correlated with some related factors including creatinine clearance, reciprocal creatinine levels, age and gender, it was shown that only age (r=0.39, p=0.04) and creatinine clearance (r=0.39, p=0.04) had moderate and significant correlation with homocysteine levels. If both creatinine clearance and age as independent factors were correlated with fasting plasma homocysteine levels using multiple regression analysis, it was shown that both variable had strong (r=0.5) and significant relationship (p=0.03), yielding regression equations: Hcy (mmol/L) = -0.20 Cct (ml/mnt) + 0.21 age (ys) + 12.8. In conclusions, in patients with pre-dialytic chronic renal failure both creatinine clearance and age are strong predictors to plasma homocysteine levels.