DASS21: A Useful Tool in the Psychological Profile Evaluation of Dialysis Patients

Background

The effect of dialysis treatment is complex, with both clinical and socio-psychological effects. In this study, we aimed to assess the psychological status of this growing population of end-stage renal disease.

Importance of Adopting BMI Classifications Using Public Health Action Points to Delineate Obstetric Risk Factors Resulting in Worsening Obstetric Outcomes Among Asian Population

Aims

The aim of this study is to compare obstetric outcomes between overweight and class 1 obesity among pregnant women in their first pregnancy based on WHO’s BMI cut-offs and the potential public health action points identified by WHO expert consultations specific for high-risk population such as Asians.

Methods

This is a retrospective cohort review of data obtained from the Malaysian National Obstetrics and Gynaecology Registry between the year 2010 and year 2012. All women in their first pregnancy with a booking BMI in their first trimester were included in this study. The association between BMI classifications as defined by the WHO cut-offs and the potential public health action points identified by WHO expert consultations towards adverse obstetric outcomes was compared.

Results

A total of 88,837 pregnant women were included in this study. We noted that the risk of adverse obstetric outcomes was significantly higher using the public health action points identified by WHO expert consultations even among the overweight group as the risk of stillbirths was (OR 1.2; 95% CI 1.0,1.4), shoulder dystocia (OR 1.9; 95% CI 1.2,2.9), foetal macrosomia (OR 1.8; 95% CI 1.6,2.0), caesarean section (OR 1.9; 95% CI 1.8,2.0) and assisted conception (OR 1.9; 95% CI 1.6,2.1).

Conclusion

A specifically lower BMI references based on the potential public health action points for BMI classifications were a more sensitive predictor of adverse obstetric outcomes, and we recommend the use of these references in pregnancy especially among Asian population.

     

Predictors of poor glycaemic control in older patients with type 2 diabetes mellitus

INTRODUCTION

We assessed the predictors of poor glycaemic control among older patients with type 2 diabetes mellitus (T2DM) in Malaysia.

METHODS

This cross-sectional study used the data of 21,336 patients aged ≥ 60 years with T2DM from the Adult Diabetes Control and Management Registry 2008–2009.

RESULTS

Predictors of poor glycaemic control were: age groups 60–69 years (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.66–2.33) and 70–79 years (OR 1.43, 95% CI 1.20–1.71); Malay (OR 1.53, 95% CI 1.41–1.66) and Indian (OR 1.32, 95% CI 1.19–1.46) ethnicities; T2DM durations of 5–10 years (OR 1.46, 95% CI 1.35–1.58) and > 10 years (OR 1.75, 95% CI 1.59–1.91); the use of oral antidiabetic agents only (OR 5.86, 95% CI 3.32–10.34), insulin only (OR 17.93, 95% CI 9.91–32.43), and oral antidiabetic agents and insulin (OR 29.42, 95% CI 16.47–52.53); and elevated blood pressure (OR 1.10, 95% CI 1.01–1.20), low-density lipoprotein cholesterol (OR 1.48, 95% CI 1.38–1.59) and triglycerides (OR 1.61, 95% CI 1.51–1.73). Hypertension (OR 0.71, 95% CI 0.64–0.80), hypertension and dyslipidaemia (OR 0.68, 95% CI 0.61–0.75), pre-obesity (OR 0.89, 95% CI 0.82–0.98) and obesity (OR 0.76, 95% CI 0.70–0.84) were less likely to be associated with poor glycaemic control.

CONCLUSION

Young-old and middle-old age groups (i.e. < 80 years), Malay and Indian ethnicities, longer T2DM duration, the use of pharmacological agents, and elevated blood pressure and lipid levels were associated with poor glycaemic control. The presence of comorbidities, pre-obesity and obesity were less likely to be associated with poor glycaemic control.     

The Implementation of Industrial Byproduct in Malaysian Peat Improvement: A Sustainable Soil Stabilization Approach

Peat is a well-known problematic soil associated with poor engineering properties. Its replacement with an expensive competent foundation material is practiced for road embankment construction which is costly and causes greenhouse gas emissions. Therefore, this paper investigated the effectiveness of a byproduct from a metal industry (silica fume) to stabilize peat along with ordinary Portland cement (OPC) through a series of experimental tests. After peat-indexed characterization, a number of standard compaction and mechanical tests were performed on the stabilized and parent peat. For this purpose, nine designated mixes were prepared possessing various combinations of silica fume (SF) and 10–20% OPC. Unconfined compressive strength (UCS) and California Bearing Ratio (CBR) tests were carried out after 7, 14, and 28 days of curing to assess strength enhancement and binder effectiveness, and the microstructural evolution induced by the binders was examined with scanning electron microscopy (SEM). The analysis revealed a substantial improvement in mechanical properties with the incorporation of SF and OPC, ultimately meeting the minimum strength requirement for highway construction (i.e., 345 kPa). A peak UCS of 1063.94 kPa was recorded at 20% SF, and an unsoaked CBR value of 42.95 was observed using 15% SF and 15% OPC after 28 days of curing. Furthermore, the increasing percentage of hydraulic binders exhibited brittle, collapsible failure, while the microstructural study revealed the formation of a dense matrix with a refined pore structure in the treated peat. Finally, a significant statistical analysis was carried out by correlating the test parameters. In this way, rather than stockpiling and dumping, an industrial byproduct was implemented in peat stabilization in an eco-friendly manner.     

The all-cause mortality and risk factors for mortality within five years among prevalent Type 1 Diabetes Mellitus Patients

Despite new comprehensive approach in diabetes care, type 1 diabetes is still facing considerable premature mortality. This study aims to examine associated risk factors for all-cause mortality among prevalent patients with type 1 diabetes mellitus (T1DM) within 5 years’ period and subsequently develop a logistic regression model to predict the outcome. This was a cohort study where prevalent patients diagnosed with T1DM were notified in a national diabetes registry. Patients’ particulars were recorded between 1 January 2009 and 31 December 2009. Their records were matched with national death record at the end of year 2013 to determine the status of mortality within 5 years. The factors associated with mortality were investigated, and a prognostic model was developed based on logistic regression model. There were 665 patients included in the study, and 105 patients died within 5 years. The mortality rate was 1.6 persons per 100 person-years and the standardized mortality ratio was 10.04. Majority causes of death were due to circulatory system (33.8%) and infection (32.5%). Multivariate analysis suggested that gender, age group, and ischemic heart disease (IHD) were the major contributing factors towards the outcome. Elderly male with IHD has a significant risk of mortality within 5 years with probability of event of 0.755, while elderly female with IHD has probability of event of 0.612. The main causes of death among prevalent T1DM patients were heart disease and infection. Male gender, elderly age group, and having IHD were significant risk factors of mortality in prevalent T1DM patients within 5 years.

     

Age ≥ 60 years was an independent risk factor for diabetes-related complications despite good control of cardiovascular risk factors in patients with type 2 diabetes mellitus

Providing effective medical care for older patients with type 2 diabetes mellitus (T2D) that may contribute to their active aging has always been challenging. We examined the independent effect of age ≥ 60 years on disease control and its relationship with diabetes-related complications in patients with T2D in Malaysia. This was a cross-sectional study using secondary data from the electronic diabetes registry database Adult Diabetes Control and Management (ADCM). A total of 303 centers participated and contributed a total of 70,889 patients from May 2008 to the end of 2009. Demographic data, details on diabetes, hypertension, dyslipidemia and their treatment modalities, various risk factors and complications were updated annually. Independent associated risk factors were identified using multivariate regression analyses. Fifty-nine percent were female. Malay comprised 61.9%, Chinese 19% and Indian 18%. There were more Chinese, men, longer duration of diabetes and subjects that were leaner or had lower BMI in the older age group. Patients aged ≥ 60 years achieved glycemic and lipid targets but not the desired blood pressure. After adjusting for duration of diabetes, gender, ethnicity, body mass index, disease control and treatment, a significantly higher proportion of patients ≥ 60 years suffered from reported diabetes-related complications. Age ≥ 60 years was an independent risk factor for diabetes-related complications despite good control of cardiovascular risk factors. Our findings caution against the currently recommended control of targets in older T2D patients with more longstanding diseases and complications.     

The clinical features and outcomes of acute liver failure associated with dengue infection in adults: a case series

ObjectiveTo describe the clinical manifestations and outcome of acute liver failure (ALF) associated with dengue viral infection, a rare but severe complication.MethodsOne hundred and fifty five consecutive patients with ALF admitted to the national liver centre from 2001 to 2009 were reviewed retrospectively. Eight cases due to dengue infection were identified and their clinical characteristics are described.ResultsAll patients had severe dengue with one dengue shock syndrome. The median (minimum, maximum) age was 33.5 (17, 47) years with 50% female. The median (minimum, maximum) duration from the onset of fever to development of ALF was 7.5 (5, 13) days and the maximum hepatic encephalopathy (HE) grade were III in five patients and II in three patients. Three patients had systemic inflammatory responses (SIRS) on admission and were in grade III HE. The presence of SIRS on admission was associated with higher grade of HE and its development during the course of hospitalization was associated with worsening HE grade. The hepatitis was characterized by marked elevations in: alanine transaminase [median admission 1140.5 u/L (639, 4161); median peak 2487 u/L (998, 5181)], serum bilirubin [median admission 29 μmol/L (23, 291); median peak 127 μmol/L (72, 592)], and prothrombin time [median admission 16.8 s (15.3, 26.2); median peak 22 s (15.3, 40.7)]. The survival rate with standard medical therapy alone was 100%.ConclusionsDengue associated ALF manifest about one week after the onset of fever with severe hepatitis and encephalopathy. In our experience, the outcome with standard medical therapy alone is excellent.     

CYP2C19 genotypes and their impact on clopidogrel responsiveness in percutaneous coronary intervention

Background Cytochrome P450 2C19 (CYP2C19) loss-of-function polymorphisms are more common in Asian populations and have been associated with diminished antiplatelet response to clopidogrel. In this era of ‘personalised medicine’, combining genotyping and phenotyping as a strategy to personalise antiplatelet therapy warrants further exploration. Objective This study aimed to investigate the prevalence and impact of CYP2C19*2, *3 and *17 genotypes on clopidogrel responsiveness in a multiethnic Malaysian population planned for percutaneous coronary intervention. Setting Between October 2010 and March 2011, a total of 118 consecutive patients planned for percutaneous coronary intervention were enrolled in Sarawak General Hospital, Borneo. All patients received at least 75 mg aspirin daily for at least 2 days and 75 mg clopidogrel daily for at least 4 days prior to angiography. Method Genotyping for CYP2C19*2 (rs4244285, 681G > A), *3 (rs4986893, 636G > A) and *17 (rs11188072, ?3402C > T) alleles were performed by polymerase chain reaction-restriction fragment linked polymorphism method. Whole blood ADP-induced platelet aggregation was assessed with multiple electrode platelet aggregometry (MEA) using the Multiplate Analyzer. Main outcome measures The distribution of CYP2C19*2, *3 and *17 among different ethnic groups and the association between genotype, clopidogrel responsiveness and clinical outcome were the main outcome measures. Results The highest prevalence of poor metabolisers (carriers of at least one copy of the *2 or *3 allele) was among the Chinese (53.7 %), followed by the Malays (26.9 %), Ibans (16.4 %) and other races (3.0 %). Poor metabolisers (PMs) had the highest mean MEA (303.6 AU*min), followed by normal metabolisers (NMs) with 270.5 AU*min and extensive metabolisers (EMs) with 264.1 AU*min (p = 0.518). Among poor responders to clopidogrel, 65.2 % were PMs and NMs, respectively, whereas none were EMs (p = 0.350). Two cardiac-related deaths were reported. Conclusion There was a diverse inter-ethnic difference in the distribution of CYP2C19 polymorphism. The findings of this study echo that of other studies where genotype appears to have a limited impact on clopidogrel responsiveness and clinical outcome in low-risk patients.