Use Of HbA 1 C In The Diagnosis of Diabetes mellitus Type 2 In High Risk Patient Attending Outpatient Clinic (KRK)HUSM

Introduction : For many years diagnosis of diabetes mellitus has dependent primarily on results of OGTT. Fasting hyperglycaemia, a late manifestation of diabetes is not generally useful for evaluating the presence or severity of glucose tolerance. OGTT for the diagnosis of diabetes is inconvenient and require a great deal of patient cooperation. It is known to be poorly reproducible and is often not performed. To improve patient compliance with testing, use ofHbA1c to diagnose diabetes has been suggested. Objectives : To evaluate the use of HbA1c as a diagnostic test for diabetes in high risk groups attending Klinik Rawatan Keluarga, HUSM. It is also to determine the sensitivity and specificity of HbA1c as compared to FPG and OGTT to diagnose type 2 diabetes and the optimal cutoff point of HbA 1 c for the diagnosis of type 2 diabetes. Methodology : This was a cross sectional study conducted from March 2005 to January 2006. Patient age 35 years and above with one or more risk factors for type 2 diabetes which includes BMI 2: 23, hypertension, history of GDM or big baby (2: 4.0 kg), family history of diabetes in first degree relatives, hyperlipidaemia and dyslipidaemia, who consented for the study were included. OGTT and HbAlc were performed in 402 asymptomatic high-risk subjects with positive screen using capillary blood glucose ~ 5.6mmol/l. Data was analyzed using SPSS version 11.5. Result :The mean age and BMI for study samples were 51.6 ±_9.2 and 26.8 ±._ 4.8 respectively. The mean FPG level was 5.6 ± 2.2mmo/l, mean 2h-PP level was 9.6 ± 5.3mmol/l and mean HbA1c was 6.0 ±1.5%. Of 402 patients, 45.3% (n = 182), was diagnosed as normal glucose tolerance, 22.6% (n = 91) had impaired glucose tolerance or impaired fasting glucose and 32.1% (n = 129) had diabetes mellitus. Patients with abnormal glucose tolerance had a higher percentage of HbA 1 c than subjects with normal glucose tolerance (p< 0.001). HbA1c of 7.0% gave an optimal sensitivity of 81% and specificity of 91% to predict a FPG of 7.0mmo/l. Whereas; HbA1c of 6.4% with sensitivity and specificity of 68% and 89% respectively was an optimal value to predict 2h-PP 1l.lmmol/l. Finally, HbA1c of 6.4% gave an optimal sensitivity of 68% and specificity of90% to predict FPG 7.0mmol/l and/or 2h-PP ll.lm.mol/1. Conclusion : HbA 1 c measurement in high risk group of patients is a highly specific test and convenient alternative to fasting plasma glucose or oral glucose tolerance test for diagnosis oftype 2 diabetes

The prevalence and risk factors of sexual dysfunction among diabetic and non diabetic female patient in HUSM penyelidik

Objective To determine the prevalence of female sexual dysfunction among diabetes and non diabetes women, compare the sexual dysfunction domain in the two group and also to determine the risk factors of female sexual dysfunction in both diabetic and non diabetic group Research Design and Methods Data were collected from 178 diabetic women and 175 non diabetic women using Malays Version of Female Sexual Function Index. The socio demographic characteristic, marital profile, medical illness and husband health status of the participants were recorded. Glyceamic control was recorded based on HbA 1 c. Results The prevalence of sexual dysfunction among diabetic women was 26.4 % and among non diabetic women was 20.0 %. Arousal disorder was reported in 28.7% of diabetic women and only 17.1 % of non diabetic women have the same problems. (p value 0.040). Sexual satisfactions disorder found in diabetic female and non diabetic female were 15.2% and 8.0% respectively (p value 0.042). Age more than 40 years, unhappy marriages, duration of marriage more than 20 years, lower HDL level, married to husband with hypertension and duration of diabetes more than 1 0 years were the significant associated factors for sexual dysfunction among diabetic women. Among non diabetic women, unhappy marriage, less sexual intercourse ( < 2 time per week) and presence of hypertension were the significant associated factors of sexual dysfunction. Conclusion The prevalence of sexual dysfunction was not significantly different between diabetic and non diabetic women. Diabetic women significantly reported more sexual arousal and satisfaction problems compared with non diabetic women. The duration of diabetic was inversely correlated with women sexual function. Unhappy marriages have negative effect on sexual function in both diabetic and non diabetic women

Sexual pain disorders among Malay women with type 2 diabetes mellitus in Malaysia

Objectives: This study aims to determine the prevalence and associated factors of sexual pain disorders among Malay women in Malaysia with type 2 diabetes mellitus. Methods: This is a cross-sectional study involving 347 women (174 nondiabetic and 173 diabetic subjects) who attended the diabetic clinic in a university hospital. Sexual pain disorders were assessed using the Pain sub scale of Malay Version of the Female Sexual Function Index (MVFSFI). Sociodemographic information of the subjects was collected with a pre-designed questionnaire. Results: Prevalence of sexual pain disorders among Malay women with type 2 diabetes mellitus was 10.4% and the control group was 9.2% but the difference was not statistically significant (p > 0.05). Multivariate logistic regression analysis did not find any relevant associated factor with sexual pain disorder. Conclusion: Sexual pain disorders among Malay women were not dependent on the diabetic status. Further studies with different population of diabetic patients are needed to confirm the results

Glycemic control among insulin-treated Type 2 diabetes in Kelantan

Objective: To determine the prevalence of good glycemic control and its associated factors that contribute to good glycemic control among insulin-treated Type 2 diabetes mellitus. Design: Cross sectional study. Materials and Methods: The study was conducted on 236 insulin-treated T2DM at Diabetic Clinic, Hospital Universiti Sains Malaysia using systematic random sampling. A set of case report form (CRF) was used. Data was entered and analyzed by SPSS 12.0 using descriptive and Multiple Logistic Regression analyses. Results: The percentage of good glycemic control (HbA1C less than7.0%) was 21.2 percent. The factors that contribute to good glycemic control were female gender (Adjusted OR 5.06; 95%CI 1.64, 15.59), high education (Adjusted OR 16.44; 95%CI 3.68, 73.58), combination of insulin and oral anti-diabetic drugs regime (Adjusted OR 3.11; 95%CI 1.01, 9.55), basal bolus insulin (Adjusted OR 5.18; 95%CI 1.61, 16.70) and fasting plasma glucose less than 6.1mmol/l (Adjusted OR 8.30; 95%CI 3.24, 21.27). Conclusion: Majority of our patients did not achieve the target of HbA1C less than 7.0% as recommended by the American Diabetes Association. Physicians should be aware of the associated factors that may influence the glycemic control among insulin treated type 2 diabetic patients. Future studies are needed to explore the patient's skills and knowledge on how to adjust the insulin dose during the treatment

Female sexual dysfunction among contraceptive user in Malaysia

Background: Women in reproductive age are at risk of getting female sexual dysfunction (FSD). Contraception has been recognized as one of the causes of FSD. This study aims to determine the prevalence of FSD and types of FSD among contraceptive user. Methods: This is a cross-sectional study involving 262 women who were on contraception in eleven primary care clinics in Malaysia. Malay version of Female Sexual Function Index (MVFSFI) was used in this study. Results: The prevalence of FSD among contraceptive user in Malaysia was 9.5% (n=25). The highest types of female sexual dysfunction in this study were sexual dissatisfaction (29.8%, n=78) and sexual desire disorder (29.4%, n=77). Majority of the participants were Malay (83.6%). Of twenty-five women with FSD, one-third of them was Indian ethnic. Most of the women (11.2%) with FSD had received education up to secondary school and non- employed (11.6%). Twenty-two (9.9%) women with FSD were practising hormonal contraception and most of them were dissatisfied with their marital relationship (35.7%, n=5). Conclusions: The result indicates that one in ten contraceptive users had FSD. The highest percentage of female sexual dysfunction domain was sexual dissatisfaction and sexual desire disorder. Hormonal contraception was the most common method used among women with FSD. Further research is needed to determine the associated factor of female sexual dysfunction among women using contraception

Factor analysis study on sexual responses in women with Type 2 diabetes mellitus

Aims: This study compared the components of sexual responses between Malaysian women with Type 2 diabetes mellitus and those without the disease. Methods: This cross-sectional study measured sexual responses by using the validated Malay version of Female Sexual Function Index. A factor analysis with varimax rotation method was employed using principal component analysis to explore the correlation structure of the different domains of sexual responses between the two groups. Components of sexual responses were obtained using Kaiser's criteria and compared between those in the diabetic and non-diabetic groups. Results: A total of 353 women (178 with diabetes and 175 without diabetes) were recruited. Three components of sexual responses emerged from the analysis in the study and control groups. Sexual pain was found to form a component together with lubrication and orgasm domains among the women with diabetes, unlike those without diabetes, where pain stood on its own. Sexual desire and arousal formed one component and satisfaction formed another in both groups. Conclusions: The domains in the sexual responses of Malaysian women were highly overlapping. It is concluded that the presence of pain as part of lubrication and orgasm component in women with diabetes indicates the importance of intact genital sensation, even though an adverse type of sensation, for vaginal congestion and orgasm to occur in this group of women

The prevalence and risk factors of sexual dysfunction among diabetic and non diabetic female patient in HUSM

Objective To determine the prevalence of female sexual dysfunction among diabetes and non diabetes women, compare the sexual dysfunction domain in the two group and also to determine the risk factors of female sexual dysfunction in both diabetic and non diabetic group Research Design and Methods Data were collected from 178 diabetic women and 175 non diabetic women using Malays Version of Female Sexual Function Index. The socio demographic characteristic, marital profile, medical illness and husband health status of the participants were recorded. Glyceamic control was recorded based on HbA 1 c. Results The prevalence of sexual dysfunction among diabetic women was 26.4 % and among non diabetic women was 20.0 %. Arousal disorder was reported in 28.7% of diabetic women and only 17.1 % of non diabetic women have the same problems. (p value 0.040). Sexual satisfactions disorder found in diabetic female and non diabetic female were 15.2% and 8.0% respectively (p value 0.042). Age more than 40 years, unhappy marriages, duration of marriage more than 20 years, lower HDL level, married to husband with hypertension and duration of diabetes more than 1 0 years were the significant associated factors for sexual dysfunction among diabetic women. Among non diabetic women, unhappy marriage, less sexual intercourse ( < 2 time per week) and presence of hypertension were the significant associated factors of sexual dysfunction. Conclusion The prevalence of sexual dysfunction was not significantly different between diabetic and non diabetic women. Diabetic women significantly reported more sexual arousal and satisfaction problems compared with non diabetic women. The duration of diabetic was inversely correlated with women sexual function. Unhappy marriages have negative effect on sexual function in both diabetic and non diabetic women

Stigma among patients with HIV/AIDS: a cross-sectional study in Malaysia

Introduction:HIV stigma refers to negative beliefs, feelings and attitudes towards people living with HIV (PLWH), groups associated with PLWH and other key populations at higher risk of HIV infection, such as people who inject drugs, sex workers, men who have sex with men and transgender people. Despite the advancement made in the knowledge and treatment of HIV, PLWH continues to be stigmatized. Objective: To determine the level of HIV stigma and its predictors among people living with HIV/AIDS in a tertiary hospital in Malaysia. Methods: A cross sectional study was conducted among HIV/AIDS patients aged 18 and above at infectious disease clinic in Hospital Sungai Buloh, Gombak, Malaysia. HIV stigma was assessed using Berger’s HIV stigma scale, which is available in Bahasa Malaysia and English.A self-administered questionnaire was used to determine their demographic and clinical characteristics. Multiple linear regression analysis was used to identify the predictors. Results: 526 subjects participated in this study. The mean age of the study population was 33.5± 8.4 years. The majority of the participants were male (90.9%) and contracted HIV through sexual activities (87.8%). The mean score of HIV stigma was 104.7 ± 19.5. Based on multiple linear regression analysis, patients who were unemployed (B = -8.00, 95% confidence interval (CI) = -12.12,-3.88, p = < 0.001) and being on antiretroviral treatment (B = 4.95, 95% (CI) = 0.30, 9.60, p = < 0.037) had higher level of HIV stigma. Conclusions: The level of HIV stigma was high (mean score =104.7 ± 19.5). HIV/AIDS patients who are unemployed and on antiretroviral agents were at risks of having higher level of HIV stigma. Future study is needed urgently to implement intervention that can minimize the stigmatization among patients with HIV/AIDS

Combined use of Luzstre cleanser and moisturizer product for skin rejuvenation

Background : A combination of facial cleanser and moisturizer is necessary to maintain healthy skin. Objective : This study aimed to evaluate the effects of Luzstre facial cleanser and moisturizer on skin rejuvenation. Methods : A study was conducted with man and woman participants aged 20 to 60 years for 8 weeks. Luzstre facial cleanser and moisturizer were used twice a day (morning and night), and skin assessments of skin pores, wrinkles, elasticity, sebum, and hydration, were performed at baseline, week 3, and week 8. Participant satisfaction surveys were administered at the end of the study, and the adverse effects of both products were assessed based on the participants’ reports. Results : After 8 weeks of using Luzstre facial cleanser and moisturizer, there was a significant increase in skin hydration (p<0.05) compared to baseline. However, there were no significant changes in the participants’ skin pores, wrinkles, elasticity, or sebum levels from baseline to week 8. Most of the participants were satisfied with the products (86.9%). They reported that their skin felt hydrated and did not feel itchy. The participants perceived that the products provided a soothing sensation; their skin felt soft, did not feel dry or sticky, and became more radiant. However, 3 participants withdrew from the study because of skin irritation and rashes after using the products. They also reported that their skin felt dry and that they experienced a stinging sensation after using the facial cleanser. None of the participants reported any other adverse effects. Conclusion : Using Luzstre facial cleanser and moisturizer in combination significantly increased skin hydration, resulting in high satisfaction. This result also indicates the need for potential research, such as a randomized controlled trial with a larger sample size and longer follow-up, for other skin conditions such as acne, eczema, and psoriasis

A review of teenage pregnancy research in Malaysia

Objective: To summarise the published research on teenage pregnancy in Malaysia, discuss the impact of the findings on clinical practice, and identify gaps in teenage pregnancy research in Malaysia. Methods: There were 31 articles related to teen pregnancy found after searching a database dedicated to indexing all original clinical research data published in Malaysia from year 2000 to 2014. Twenty-seven articles (including reports from the National Obstetrics Registry) were selected and reviewed on the basis of clinical relevance and future research implications. This literature review has been divided into eight sections: epidemiology, age at first marriage, adolescent fertility rate, unmarried childbearing, risk factors, maternal risks and neonatal outcome, future plan after delivery, and contraceptive use. Results: More than 19,000 births to teenage mothers were recorded each year between 2009 and 2011. Adolescent fertility rates were recorded at 6 births per 1000 women ages 15-19 years in 2013. Many of these births were from unwed pregnancies, which accounted for 1.99% of total deliveries. A majority of young mothers were willing to take care of their baby, although some of them planned to put their baby up for adoption. Risk factors for teenage pregnancy were found to be similar to those published in studies worldwide. Conclusion: More research is needed to better understand the issue of teen pregnancy. For the best results, collaborative studies among nationwide hospitals and institutions should be the way forward