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.

     

Comparison of the effectiveness of major trauma services provided by tertiary and secondary hospitals in malaysia

BACKGROUND: The effectiveness of trauma services provided by three hospitals operating at different levels of care, district general (DGH), tertiary care, and central tertiary, were compared in Malaysia. METHODS: Cases were recruited prospectively for 1 month. Outcome measures included death or, among survivors, disability at discharge. RESULTS: Leading causes of injuries were road traffic (72%), falls (9%), industrial (6%), and assaults (5%). Fifty-nine percent of cases were direct admissions and 41% were interhospital transfers. Of the 286 direct admissions, 12% arrived by ambulance and the remainder mostly by private car. For direct admissions, logistic regression identified an increased odds of dying associated with admission to DGH (compared with central tertiary) (odds ratio [OR], 9.8; 95% confidence interval [CI], 1.3-73.7), severe injuries (Injury Severity Score > 15) (OR, 33.1; 95% CI, 7.5-146.7), and older age (> or = 55 years) (OR, 10.8; 95% CI, 2.0-56.8). Disability at discharge was associated with being severely injured (OR, 6.4; 95% CI, 2.4-17.1). CONCLUSION: In this study in Malaysia, admission to DGH, older age, and severe injuries are associated with increased odds of fatality.     

Quality of life in Malaysian colorectal cancer patients: a preliminary result

Objective: Rapidly increasing colorectal cancer (CRC) incidence in Malaysia and the introduction of cutting edge new treatments, which prolong survival, mean that treatment outcome measures meed to be evaluated, including consideration of patient’s quality of life (QoL) assessment. There are limited data on QoL in CRC patients, especially in Malaysia. Therefore, this study was performed focusing on cancer stages and age groups. Methods: The cross sectional study was conducted from June to September 2011 at three public tertiary hospitalswith the EORTC QLQ C-30 questionnaire in addition to face to face interview and review of medical records of 100 respondents. Results: The mean age was 57.3 (SD 11.9) years with 56.0% are males and 44.0% females, 62% of Malay ethnicity, 30% Chinese, 7% Indian and 1% Sikh. Majority were educated up to secondary level (42%) and 90% respondents had CRC stages III and IV. Mean global health status (GHS) score was 79.1 (SD 21.4). Mean scores for functional status (physical, emotional, role, cognitive, social) rangeds between 79.5 (SD 26.6) to 92.2 (SD 13.7). Mean symptom scores (fatigue, pain, nausea/vomiting, constipation, diarrhea, insomnia, dyspnoea, loss of appetite) ranged between 4.00 (SD 8.58) to 20.7 (SD 30.6). Respondents role function significantly deteriorates with increasing stage of the disease (p=0.044). Females had worse symptoms of pain (p=0.022), fatigue (p=0.031) and dyspnoea (p=0.031). Mean insomnia (p=0.006) and diarrhea (p=0.024) demonstrated significant differences between age groups. Conclusion: QOL in CRC patients in this study was comparable to that in other studies done in developed countries. Pain, fatigue and dyspnoea are worse among female CRC patients. Given that functions deteriorates with advanced stage of the disease at diagnosis, a systematic screening programme to detect cases as early as possible is essential nationwide.