26 research outputs found
CA19-9 as a non-invasive marker for disease activity in Hepatitis B patients: is there any role?
The combined elevation of tumor markers carbohydrate antigen 19-9 (CA 19-9) and carbohydrate
antigen 125 (CA 125) has been shown to be associated with the severity of liver fibrosis in patients with
liver disease. We assessed the association between CA 19-9 and viral hepatitis B activity which will allow
us to know the usefulness of CA 19-9 as a surrogate marker for the disease activity in hepatitis B patients.
Methods: A prospective study involving 60 patients with hepatitis B surface antigen positive carrier
was performed. These patients were divided into 2 groups according to HBeAg positivity. Tumor marker
CA 19-9 was determined using routine laboratory methods and correlated with the disease activity by
measuring hepatitis B viral DNA (HBV DNA) and serum alanine transaminase (ALT) and aspartate
transaminase (AST) levels.
Results: Eleven (18%) were HBeAg positive and 49 (82%) were HBeAg negative. The mean (standard
deviation) age in the former group was 40.7 (11.7) years and in the latter group was 40.8 (12.5) years (p =
0.98). There was no significance difference between the two groups with respect to the levels of serum
ALT/AST, HBV DNA and CA 19-9. There was no significant correlation seen between CA 19-9 and
serum ALT/AST. It was the same with the levels of HBV DNA.
Discussions and conclusion: The use of CA 19-9 as a non-invasive marker for disease activity in
patients with hepatitis B infection was not useful. There was no role of CA 19-9 in hepatitis B patients to
assess the disease activity
Safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : A 13 year narrative review of literature
Background: Type 2 Diabetes Mellitus (T2DM) is a chronic condition due to insulin resistance or relative insulin deficiency. Although insulin intensification regimens are commonly prescribed for the management of T2DM, there is uncertainty regarding their optimal use. We conducted a 13 Year narrative review to compare outcomes of these regimens in the treatment of T2DM. Method: We searched electronic databases (PubMed, Scopus, Proquest and Google Search), and “grey literature” from January 2000 to December 2013 to identify studies comparing insulin intensification regimens. Results: Out of 17 studies identified, we only included 10 studies specifically comparing Basal-Bolus regimens (BB) versus Pre-mixed Insulin Regimens (PM). Seven trials comparing regimens other than the studied regimens; with study duration lesser than 12 weeks; or involving Type 1 diabetes mellitus patients were excluded. The outcomes measured were divided into safety and efficacy parameters. Among the safety outcomes measured were Hypoglycemia, Weight Gain, Quality of Life (QoL), and other Adverse Events (AE). Whereas, efficacy outcomes measured were Glycosylated Haemoglobin (HbA1c), Fasting Plasma Glucose, Daily Plasma Glucose, Post Prandial Plasma Glucose, Carotid Intima Media Thickness (IMT), Adinopectin Level, 1-5-anhydroglucitol(1,5-AG),Total Daily Insulin (TDI) Dose and Cost. Mixed results were discovered among all the parameters measured favoring in between BB and PM regimens. Conclusion: We found that BB regimens showed better glycemic control especially in terms of the primary endpoint of HbAlc but at the expanse of significantly higher TDI dose, weight gain, and further increase in cost of treatment. Whereas, all other parameters measured were comparable between regimens. Locally, conventional human insulin is still the mainstay of insulin therapy in health facilities nationwide. Yet, none of the identified studies compared head-to-head human insulin in both arms. Thus, future researches comparing non-analogue insulin may be conducted to gather new evidence in the field of diabetes locally
Depression symptoms in patients with thyroid disorder at the tertiary hospital in northern region of Malaysia
Introduction: Thyroid disorder patients have a high risk to experience depression symptoms resulting from the thyroid hormone fluctuations. The aims of this study were to evaluate the occurrence of depression symptoms and to analyze the association between depression symptoms and social-demographic of the patients affected by different thyroid disorders. Methods: This was a cross-sectional study of one of the non-profit hospitals in the northern region of Malaysia. Depression symptoms were measured using the Depression Anxiety Stress Scale-21 (DASS-21). Socio-demographic characteristics of the patients were gathered using the questionnaire. Patients with any thyroid disorders, above 18 years old and did not have any psychiatric disorders were included in this study. Results: The total numbers of subjects in this study were 199. The female consisted of 76.9% (153). The mean age was 46.32±15.16 years. Regarding the thyroid disorder; 35.2% (70) had hyperthyroidism, 23.6% (47) had goitre, 14.1% (28) had hypothyroidism, 14.6% (29) had autoimmune thyroid disorders while thyroid cancer was found in 12.6% (25). Determination of depression symptoms showed that 85.9% (171) had no depression, 6.0% (12) and 4.5% (9) had mild to moderate depression respectively while severe depression was found in 3.5% (7) cases. Age and patients, those not living alone significantly associated with depression symptoms (p<0.05). Conclusions: These findings would suggest that some of the thyroid patients had depression symptoms. In addition, the patients in middle aged and staying with family seem to have depression symptoms. Further studies should be performed, in order to confirm these findings
Bilateral facial nerve palsy secondary to an atypical presentation of Gullain-Barré syndrome
Bilateral simultaneous facial nerve palsy is an extremely rare clinical entity and may occur in association with a variety of neurological, infectious, neoplastic or degenerative disorders. We describe a patient, who presented with facial diplegia and normal reflexes on examination. During the entire hospitalization, he developed no motor weakness and remained ambulatory. Whether treatment is warranted for this and other milder variants of Gullain-Barré syndrome is also discussed. Atypical presentations with preserved or brisk reflexes, can be a diagnostic dilemma
Analgesic synergism of gabapentin and carbamazepine in rat model of diabetic neuropathic pain
Purpose: To evaluate synergy in the analgesic effects of a combination therapy of carbamazepine
(CBZ) and gabapentin (GBP) in diabetic neuropathic pain.
Methods: Neuropathic pain was produced in rats by a single intraperitoneal injection of streptozotocin
(STZ) at 60 mg/kg. CBZ, GBP, and their combination were orally administered at varying doses (GBP
30 - 180 mg/kg; CBZ 20 - 40 mg/kg) comparable to their therapeutic doses in humans. Nociceptive
responses in the diabetic rats were assessed using hot plate test.
Results: Hot plate latency significantly increased with oral administration of GBP at a dose of 180
mg/kg when compared with control group (p < 0.05), while at a dose of 90 mg/kg, the increase was not
significant. Oral administration of CBZ at doses of 20 and 40 mg/kg did not produce any significant
impact on hot plate latency. However, a combination of GBP at 90 mg/kg and CBZ at 20 mg/kg
produced significant increase in latency, compared with control group and other groups (p < 0.05),
except the group that received 180 mg/kg GBP. The combination of low dose GBP 30 mg/kg and
carbamazepine 30 mg/kg had no significant effect on latency (p > 0.05).
Conclusion: The results obtained in this study provide useful information on the combination therapy of
GBP and CBZ, which may be applied in the treatment of pain in diabetic neuropathy
Depression, anxiety and stress levels among frontliners of hospital-based (SASMEC) and university campus (IIUM Kuantan) during covid-19 pandemic and its associated factors
The COVID-19 pandemic or endemic has instigated a substantial physical and psychological burden on the frontliners globally, which lead to harmful consequences on emotional and mental health such as physical and psychiatric disorders, reduction in productivity, loss of commitment and burnout. Hence, assessing their mental health status is essential as an access point in providing appropriate mental
health care. This study aimed to measure depression, anxiety, and stress level and their associated factors among the frontliners working at the International Islamic University Malaysia (IIUM) Kuantan Campus and SASMEC-Hospital during the COVID-19
pandemic
Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial
Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie
Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial
Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials.
Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure.
Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen.
Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049