Association between lung function impairment with urinary heavy metals in a community in Klang Valley, Malaysia

Lung function status can be directly or indirectly affected by exposure to pollutants in the environment. Urinary heavy metals may be an indirect indicator of lung function impairment that leads to various diseases such as chronic obstructive pulmonary disease (COPD). This study aimed to explore the prevalence of lung function impairment as well as its association with urinary heavy metal levels and other influencing factors among the community in Klang Valley, Malaysia. Urinary sampling was done during various community events in the housing areas of Klang Valley between March and October 2019. Only respondents who consented would undergo a lung function test. Urine samples were obtained and sent for Inductively Coupled Plasma Mass Spectrometry (ICP-MS) analysis for heavy metal cadmium (Cd) and lead (Pb) concentration. Of the 200 recruited respondents, 52% were male and their ages ranged from 18 years old to 74 years old with a mean age of 38.4 ± 14.05 years. Urinary samples show high urinary Cd level in 12% of the respondents (n = 24) whereas none recorded a high urinary Pb level. There was a positive correlation between the levels of urinary Cd and urinary Pb (r = 0.303; p = 0.001). Furthermore, a negative correlation was detected between urinary Cd level and forced vital capacity (FVC) (r =  − 0.202, p = 0.004), force expiratory volume at the first second (FEV1) (r =  − 0.225, p = 0.001), and also force expiratory flow between 25–75% of FVC (FEF 25–75%) (r =  − 0.187, p = 0.008). However, urinary Pb did not show any correlation with lung function parameters. Multiple linear regression analysis showed that urinary Cd had a significant negative effect on FVC (p = 0.025) and FEV1 (p = 0.004) based on the predicted value. Additionally, other factors such as education level (p = 0.013) also influenced lung function. However, no interaction was detected between heavy metals or other factors. In short, there was a significant negative linear relationship between urinary Cd and lung function, whereas urinary Pb was not associated with lung function. Beside acting as a biomarker for cadmium exposure level, urinary Cd may also be applied as indirect biomarker for asymptomatic chronic lung function deterioration among the healthy population

Preliminary Study on Associated Risk Factors of Mortality Due to COVID-19 Pandemic in Malaysia

The COVID-19 pandemic has claimed numerous lives worldwide. Malaysia documented about 118 mortalities during the second wave of the outbreak. This study aims to assess associated risk factors of the COVID-19 mortalities from 18 March until 22 May 2020. The majority of patients were above 60 years old (69.0%), male (78.0%), and Malaysian citizens (98.0%). The mean age of the mortalities was 64.01 years old (±SD 14.91 years). The major risk factors consist of hypertension (52.0%), diabetes mellitus (43.0%), cardiovascular diseases (21.0%), extra-pulmonary solid malignancies (5.0%), cerebrovascular diseases (3.0%), pulmonary diseases (1.0%) and pulmonary malignancies (1.0%). About 23.0% of mortalities were related to established clusters while 5.0% had a history of travelling overseas. The mean survival time was 11.87 days (±SD 9.32 days). Approximately 50.0% of the patients survived until day 10 post-admission. The probability of the patients surviving beyond 30 days post-admission was less than 10.0%. There is a significant difference between groups for having a shorter duration to death for risk factors including age group, history of travelling overseas, attending mass gatherings, and having pulmonary malignancies. The hazard ratio (HR) for pulmonary malignancy is 5.512 (95% CI 0.662, 45.899), mass gathering; 3.434 (95% CI 1.375, 8.579), pulmonary disease is 2.442 (95% CI 0.314, 18.983), travelling overseas; 2.251 (95% CI 0.657, 7.711), extra-pulmonary solid malignancy; 2.165 (95% CI 0.767, 6.112), and despite the significant result only applied for mass gathering (p-value = 0.008). COVID-19 screening should be mandatory for those who attend mass gatherings as they are the main source of COVID-19 spread in the community during the second wave outbreak in Malaysia

Long COVID active case detection initiative among COVID-19 patients in Port Dickson, Malaysia: a retrospective study on the positive outcomes, the proportion of patients with long COVID and its associated factors

Background Long COVID is new or ongoing symptoms at four weeks or more after the start of acute COVID-19. However, the prevalence and factors associated with long COVID are largely unknown in Malaysia. We aim to determine the proportion and factors associated with long COVID among COVID-19 patients in Port Dickson, Malaysia. The positive outcomes of our long COVID active detection initiative were also described. Methods This was a retrospective analysis of long COVID data collected by the Port Dickson District Health Office between 1 September 2021 to 31 October 2021. Monitoring long COVID symptoms was our quality improvement initiative to safeguard residents’ health in the district. The study population was patients previously diagnosed with COVID-19 who resided in Port Dickson. The inclusion criteria were adults aged 18 years and above and were in the fifth week (day 29 to 35) post-COVID-19 diagnosis during the data collection period. We called all consecutive eligible patients to inquire regarding long COVID symptoms. Long COVID was defined as new or ongoing symptoms lasting more than 28 days from the date of positive SARS-CoV-2 by polymerase chain reaction test. Binary multivariate logistic regression was conducted to determine factors associated with long COVID. Results Among 452 patients, they were predominantly male (54.2%), Malays (68.8%) and aged 18–29 years (58.6%). A total of 27.4% (95% CI [23.4–31.8]) of patients experienced long COVID symptoms and were referred to government clinics. The most frequent long COVID symptoms experienced were fatigue (54.0%), cough (20.2%), muscle pain (18.5%), headache (17.7%) and sleep disturbance (16.1%). Females, patients with underlying cardiovascular disease, asthma and chronic obstructive airway disease, those who received symptomatic care, and patients with myalgia and headaches at COVID-19 diagnosis were more likely to have long COVID. Three patients with suspected severe mental health problems were referred to the district psychologist, and ten patients with no/incomplete vaccination were referred for vaccination. Conclusion Long COVID is highly prevalent among COVID-19 patients in Port Dickson, Malaysia. Long-term surveillance and management of long COVID, especially among the high-risk groups, are needed as we transition to living with COVID-19