Modelling of risk factors, case-fatalities, survival and functional health status for stroke in Kelantan, Malaysia

Stroke is an important public health problem worldwide. It is a non-communicable disease of increasing importance in the ageing population. There are four major types of stroke: a) ischaemic stroke, b) primary intracerebral haemorrhage, c) subarachnoid haemorrhage and d) undetermined stroke (no computed tomography [CT], magnetic resonance imaging [MRI], autopsy or cerebral angiography). The risk factors and fatalities for stroke vary worldwide and stroke accounts for about 9.7% of all deaths worldwide. Unfortunately, most stroke deaths occur in the less developed countries, where stroke research is scanty. Patients who survive stroke will have a wide range of functional limitations that affect their daily activities. To date, only few reliable data are available for identifying the risk factors and understanding the stroke fatalities in the low- and middle-income countries. The effect of stroke on daily activities is also understudied. Measuring the effect of stroke on daily activities is important to evaluate the recovery process. Understanding the factors affecting daily activities post-stroke helps identify areas where intervention may benefit stroke survivors the most. In this thesis, I have worked on the questions that will improve my knowledge and understanding of the natural history of stroke in the state of Kelantan, Malaysia. In this study, we posed questions to subjects from the population of interest to reflect our results across the greater Kelantan population to develop a model of risk factors for stroke, models of case-fatalities and survival to compare the characteristics and outcomes of two main types of stroke, i.e. ischaemic stroke and haemorrhagic stroke, and lastly to assess the longitudinal change in functional health status using the Barthel Index post-stroke. This thesis includes four draft papers, in which several modelling data collection and data analysis strategies were applied to four datasets: one was provided by the hospitals, two were extracted by us and the final one was based on personal interviews with stroke survivors. The first draft paper is based on an observational study using data from the records offices of two major hospitals in Kelantan. In this paper, I analysed and modelled the risk factors for stroke using a case–control study design. This dataset contained individual-level variables (patient variables from hospitals) and area-level variables supplied by the Department of Statistics, Malaysia, and we utilised logistic regression to model the risk factors for stroke. In the results, we showed the non-linear relationship between age and odds for stroke and the interaction of age with sex in the model. In the second draft paper, we explored the important prognostic factors for in-hospital stroke fatalities. Using Cox proportional hazard regression, we found that the only two independent prognostic factors for stroke fatality in the hospitals were: a) stroke subtype and b) age. To further investigate the different prognostic effect of stroke subtype on admission and on fatality, we recruited consecutive in-hospital stroke patients. In the analysis, we performed Cox proportional hazard regression to quantify the odds of stroke fatality for: a) ischaemic stroke and b) haemorrhagic stroke. In this third draft paper, we showed the prognostic effect of stroke subtype on stroke fatality. In the fourth draft paper, we recruited stroke patients and interviewed them on three occasions. In this longitudinal assessment, we assessed the functional health status of stroke patients until 3 months after hospital discharge. I conducted all interviews and assessed the functional outcome using the well-known Barthel Index. Considering the longitudinal format of the data, we used the linear mixed effect model to model the rate of change of the Barthel Index at the three measurement occasions. We have identified several limitations in this PhD project and have taken several measures to minimize the biases caused by those limitations. The limitations include the need for us to do handsearching for data abstraction, potential informative censoring due to our study design and short follow-up times, limited generalizability of results, small sample sizes, missing observations, missing important variables (to be modelled as covariates), absence of residential coordinates and using data on arrival to Emergency department (no pre-arrival data). If the censoring mechanism provides significant information with time (T), numerical estimates from Kaplan-Meier and Cox proportional hazard regression are biased. The new knowledge stemming from the stroke modelling and outcome assessment developed and analysed in this thesis could help improve our understanding of stroke in Kelantan. The thesis will also improve our understanding and knowledge of the natural history of the disease, i.e. the progression from risk factors to outcome (fatality or functional residuals) after stroke. In conclusion, our data and the four draft papers written based on this PhD project have added new stroke data and knowledge on the progression of stroke, which is understated in the Malaysian and Asian population in general and in Kelantan specifically

The omega -3 and omega-3 index blood levels and their association with demographic, clinical characteristics, fasting blood sugar and lipid profiles among health staffs population

Two important types of Omega 3 fatty acids arc the Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA). The main sources of EPA and DHA come from the marine life species. Both EPA and DHA are linked with the protection from cardiovascular risk factors, inflammatory related diseases and neuro-psychology diseases in human. This study aimed to assess the levels of EPA and DHA in selected marine and fresh-water species of fishes and shellfish found in the east coast of Peninsular Malaysia. Next, the study aimed to measure the blood levels of EPA and DHA in health workers in the state of Kelantan, Malaysia and their important related factors A cross sectional study was done. It was divided into two parts; 1) to assess the level of EPA and DHA in selected marine and fresh water species of fishes and shellfish found along the east coast of Peninsular Malaysia and 2) to measure the blood levels of EPA and DHA in the randomly selected health workers in the state of Kelantan. The relationship between the levels of EPA and DHA with the socio-demography profiles, health status, knowledge level, physical activity, anthropometry measurement and blood biochemical profiles were also assessed. The levels of EPA and DHA were measured from a total of 14 species of marine fish, 3 species of freshwater fish, 4 species of shellfish and 2 commercially canned fish. In addition, a total of 380 randomly selected health workers from 4 selected health premises in the state of Kelantan from the period of June 2010 until September 2010, answered a set of questionnaire, their anthropometry were measured and blood samples were taken. The blood samples were analyzed to determine the level of EPA and DHA and other cardiovascular biomarkers. The fat contents of the marine fish species, the freshwater fish species and shellfish ranged from 1.01% to 15.83%. Most fishes in the study have shown that their fat contents were beyond 10% of their body weight while their DHA levels were higher than the EPA levels. The study on the health workers showed that the mean level of DHA was 25.9 pg/ml (SD 27.07) while the mean level of EPA was 2.3 pg/inl (SD 1.58). Our analysis showed that the EPA level (mean 3.5 pg/ml, SD 1.93) and the DHA level (mean 40.1 pg/ml. SD 25.46) were higher among the medical doctors compared to the other categories of health workers. The levels of EPA (mean 2.8 pg/ml, SD 1.91) and DHA (mean 40.1 pg/ml, SD 25.46) were higher among the health workers with higher level of education. The physical activities, anthropometry measurements and levels of biochemical profiles were not i related with the levels of EPA and DHA. i The level of EPA was significantly higher in the health workers with higher score of knowledge in Omega 3 compounds and their benefits (adjusted mean 2.8 pg/ml) after we have adjusted the effect of the confounding variables. The > level of DHA was also higher in this group of health workers (adjusted mean ) 37.5 pg/ml). All species of fishes and shellfishes found in the east coast region of Peninsular Malaysia selected in our study are the important sources for EPA and DHA. The health workers with higher knowledge of Omega 3 have higher blood level of Omega 3. Health promotion activities to promote the knowledge about the sources of EPA and DHA are important in the future. Healthy lifestyle practice which includes taking sources with high EPA and DHA contents will be beneficial for good health

Diagnostic accuracy of machine learning models on mammography in breast cancer classification:a meta-analysis

In this meta-analysis, we aimed to estimate the diagnostic accuracy of machine learning models on digital mammograms and tomosynthesis in breast cancer classification and to assess the factors affecting its diagnostic accuracy. We searched for related studies in Web of Science, Scopus, PubMed, Google Scholar and Embase. The studies were screened in two stages to exclude the unrelated studies and duplicates. Finally, 36 studies containing 68 machine learning models were included in this meta-analysis. The area under the curve (AUC), hierarchical summary receiver operating characteristics (HSROC) curve, pooled sensitivity and pooled specificity were estimated using a bivariate Reitsma model. Overall AUC, pooled sensitivity and pooled specificity were 0.90 (95% CI: 0.85–0.90), 0.83 (95% CI: 0.78–0.87) and 0.84 (95% CI: 0.81–0.87), respectively. Additionally, the three significant covariates identified in this study were country (p = 0.003), source (p = 0.002) and classifier (p = 0.016). The type of data covariate was not statistically significant (p = 0.121). Additionally, Deeks’ linear regression test indicated that there exists a publication bias in the included studies (p = 0.002). Thus, the results should be interpreted with caution

Editorial:Autoimmunity and cardiovascular diseases

© 2023 The Authors. Published by Frontiers Media. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.3389/fcvm.2023.1249525Published versio

Malnutrition and dietary pattern of children age below 12 years old living in Mukim Kemumin, Kota Bharu, Kelantan.

A study to assess household food insecurity was carried out among 150 n=150) households in Mukim Kemumin, Kota Bharu, Kelantan. Apart from this study, an assessment of nutritional status and dietary pattern of children of the selected household aged below 12 years old was implemented, where a total of 150 households were selected through proportion sampling

Sains-Teknologi dan Ilmu Agama Menurut Bahasa al-Quran dan Hadis

Pada abad ini, sains-teknologi di serata dunia mempunyai banyak pengaruh sama ada dari aspek positif dan negatif. Dari aspek positif mendapati bahawa dengan adanya sains-teknologi kerja dan perbuatan manusia dapat dimudahkan. Walau bagaimanapun, dari aspek negatif, bahawa sains-teknoogi ini dapat mendatangkan masalah dari segi kekerasan, pergaulan bebas, hedonis dan perbuatan tidak bermoral lainnya yang merupakan bentuk nyata dari “manipulasi” konstruksi teori dan aplikasi sains-teknologi yang bebas nilai. Antara cara mengatasi aspek negatif dalam sains-teknologi ini adalah dengan merujuk, memahami, dan mengikut kembali ajaran teks dalam al-Quran dan hadis yang menjadi kesahihannya diyakini benar lagi sahih serta mendalami ilmu agama untuk mengetahui cara reformulasi tujuan sains-teknologi dalam Islam supaya melahirkan manusia yang ulul albab

Validation of the Malay Version of Auditory Verbal Learning Test (MVAVLT) Among Schizophrenia Patients in Hospital Universiti Sains Malaysia (HUSM), Malaysia

Objective: Many studies have emphasized the significance of verbal memory for the functional outcome in schizophrenia. A preserved capability to encode and recall verbal information is essential for the long-term efficacy of psychoeducational programs and other psychological intervention to ensure the successful transfer of newly acquired skills or knowledge into everyday life. Aims of this study aimed to validate the MVALT among schizophrenia patients in HUSM. Methods: The subjects were 15 schizophrenia patients conveniently selected from the patients that attended follow up at the psychiatry clinic in HUSM or inpatients who have been admitted during the study period and 15 healthy control subjects as a comparison. Reliability and validity of the MVAVLT were analyzed. Results: The validation study showed that the Malay version Auditory Verbal Learning Test (MVAVLT) had a good validity (factor analysis 0.66 to 0.98) and test-retest reliability (pearson correlation ranged from 0.24 to 0.84) and has been shown to be sensitive in discriminating between normal and schizophrenia patients. In line with the previous research, the schizophrenia patients performed significantly worse than healthy control in all indexes measured in MVAVLT. Conclusion: The screening of deficits in verbal learning and memory among the schizophrenia patients is important, for early detection and treatment since it can be helpful for clinicians and psychologists in their counseling sessions. Subsequently, it helps patients to reduce such cognitive difficulties and their impact by using specific rehabilitation with the usage of newer antipsychotic agents

Prevalence of undiagnosed metabolic syndrome using three different definitions and identifying associated risk factors among apparently healthy adults in Karachi, Pakistan:a cross-sectional survey in the year 2022

Objective: To determine the prevalence and associated risk factors of undiagnosed metabolic syndrome (MetS) using three different definitions among apparently healthy adults of Karachi, Pakistan. Methods: This community-based cross-sectional survey was conducted in Karachi, Pakistan, from January 2022 to August 2022. A total of 1065 healthy individuals aged 25–80 years of any gender were consecutively included. MetS was assessed using the National Cholesterol Education Program for Adult Treatment Panel (NCEP-ATP) III guidelines, International Diabetes Federation (IDF), and modified NCEP-ATP III. Results: The prevalence of MetS was highest with the modified NCEP-ATP III definition at 33.9% (95% CI: 31–36), followed by the IDF definition at 32.2% (95% CI: 29–35). In contrast, the prevalence was lower at 22.4% (95% CI: 19–25) when using the NCEP ATP III definition. The risk of MetS significantly increases with higher BMI, as defined by the IDF criteria (adjusted OR [ORadj] 1.13, 95% CI 1.09–2.43), NCEP-ATP III criteria (ORadj 1.15, 95% CI 1.11–1.19), and modified NCEP-ATP III criteria (ORadj 1.16, 95% CI 1.12–1.20). Current smokers had significantly higher odds of MetS according to the IDF (ORadj 2.72, 95% CI 1.84–4.03), NCEP-ATP III (ORadj 3.93, 95% CI 2.55–6.06), and modified NCEP-ATP III (ORadj 0.62, 95% CI 0.43–0.88). Areca nut use was associated with higher odds of MetS according to both IDF (ORadj 1.71, 95% CI 1.19–2.47) and modified NCEP-ATP III criteria (ORadj 1.58, 95% CI 1.10–2.72). Furthermore, low physical activity had significantly higher odds of MetS according to the NCEP-ATP III (ORadj 1.36, 95% CI 1.01–1.84) and modified NCEP-ATP III criteria (ORadj 1.56, 95% CI 1.08–2.26). Conclusion: One-third of the healthy individuals were diagnosed with MetS based on IDF, NCEP-ATP III, and modified NCEP-ATP III criteria. A higher BMI, current smoking, areca nut use, and low physical activity were significant factors