Metabolic syndrome study among malay national service trainees in Kelantan

Metabolic syndrome is a constellation of risk factors which increases the risk for diabetes and cardiovascular diseases consisting of obesity, hypertension, hypertriglyceridemia, low level of high density lipoprotein cholesterol and hyperglycemia. As the prevalence of obesity increases, the prevalence of metabolic syndrome is also increasing at an alarming trend in numerous populations. C-reactive protein and adiponectin are two important biochemical markers which is said to have association with the development of metabolic syndrome, however the exact mechanism is not yet well understood. The objectives of this study were to describe the prevalence of metabolic syndrome among National Service trainees in Kelantan and determine the association between components of metabolic syndrome (BMI, WC, WHtR, SBP, DBP, TG, HDL-C, fasting blood glucose and fasting insulin), C-reactive protein and adiponectin levels. A cross-sectional study was conducted in 2009 involving 156 National Service trainees in Kelantan. As no single ‘gold standard’ criteria is available to diagnose metabolic syndrome in Asian adolescents, we describe the prevalence using four different criteria namely the International Diabetes Federation definition of metabolic syndrome for children and adolescents, the modified NCEP ATP III criteria for Asians, the criteria used previously in Indian adolescents population (Vikram et al., 2006) and criteria previously used in Korean adolescents population (Kim et al., 2007). Association between components of metabolic syndrome with C-reactive protein and adiponectin was studied using simple and multiple linear regression and correlation between adiponectin and C-reactive protein was studied using Pearson Correlation. The prevalence of metabolic syndrome among National Service trainees in Kelantan is 1.28% when IDF criteria and NCEP ATP III criteria was used and 0.64% when criteria by Vikram et al. and Kim et al. was used. There is significant positive linear association between C-reactive protein levels and Body Mass Index in overall, both male and female adolescents. Significant negative linear association was observed between adiponectin levels, Body Mass Index and waist to hip ratio in overall subjects. When analysis was divided according to gender, there is a significant negative association between adiponectin and Body Mass Index while in female there is a significant positive linear association between adiponectin and high density lipoprotein cholesterol. No significant correlation was found between Creactive protein and adiponectin levels. We conclude that the prevalence of metabolic syndrome among National Service trainees in Kelantan is low compared to other study population, however in view of ethnicity-related characteristics, the cut-off points used might not be suitable for our study population. Adiponectin and C-reactive protein was proven to have significant association with several components of metabolic syndrome. Further study need to be conducted to better understand the exact mechanism of metabolic syndrome especially among Malaysian adolescents

Evaluation of HbA1c using high performance liquid chromatography and capillary electrophoresis in Type 2 Diabetes Mellitus patients suspected to have haemoglobin variant

BACKGROUND: High-Performance Liquid Chromatography (HPLC) is widely used for HbA1c measurement. However, it is prone to haemoglobin (Hb) variant interference. Capillary electrophoresis (CE) is believed to have better performance in patients with Hb variant. This study aimed to compare HbA1c level between HPLC and CE among Type 2 Diabetes Mellitus (T2DM) patients suspected to have Hb variant, determine the type of Hb variant among those patients, and evaluate the agreement between both methods.METHODS: A cross-sectional study conducted at Endocrine Laboratory, Hospital Universiti Sains Malaysia, from June till December 2020. HbA1c results of adults T2DM from HPLC with suspected Hb variant were re-analysed using CE. The comparisons of HbA1c were made using paired t-test and Wilcoxon Signed Rank Test. The correlation and method comparison were made using Pearson correlation, Bland Altman (BA) and Passing-Bablok (PB), whereas the agreement using Intraclass Coefficients Correlation (ICC).RESULTS: 250 patients were included with a median (IQR) age of 52.19 (11.11) years. For reportable results (?3.8% to ?18.5%), both methods showed no difference (p=0.382) whereas the results were difference for HbA1c >18.5% (p=0.048). 26 patients had Hb analysis with majority having Hb E trait 14 (5.6%). HPLC overestimated HbA1c in patients with Hb J and alpha Hb variant while CE able to report. Pearson correlation and PB regression analysis showed good correlation (r=0.987, p<0.001) and good agreement [slope of 1.0 (95% CI: 1.00 to 1.03); intercept of -0.3 (95% CI: ?0.61 to 0.30)]. BA plot revealed a mean difference of 0.30% (95% CI:0.00 to 0.50) with limits of agreement from ?0.54 to +1.14. ICC showed excellent reliability (0.983 (p<0.001).CONCLUSION: HPLC and CE can be used interchangeably for HbA1c analysis across the measurement range. CE is the preferred in T2DM with certain Hb variant.peer-reviewe

Randomized clinical trial between Fluoxetine and Dapoxetine for premature ejaculation and its effect on marital relationship

INTRODUCTION: Premature ejaculation(PE) decreases sexual pleasure and quality of life, and both Fluoxetine and Dapoxetine were used in PE therapy. Dapoxetine is the first SSRI with a short half-life and fewer side effects, primarily designed for PE therapy. The aim is to evaluate and compare the effects of Fluoxetine and Dapoxetine on PE symptoms and marital satisfaction. MATERIALS AND METHODS:44 participants aged between 18 and 64 with a PEDT score of ≥9 from Hospital USM's Primary-Care-Clinic, Kelantan Malaysia were selected and randomized into two groups: Fluoxetine(FG) and Dapoxetine Group(DG), and administered for 8 weeks with either regular Fluoxetine(20mg) or Dapoxetine (30mg) on-demand at least once a week. Premature Ejaculation Diagnostics Tool(PEDT) score was used to assess PE symptoms and Dyadic Satisfaction-Dyadic Adjustment Scale(DS-DAS) used to evaluate marital satisfaction at baseline and the 8thweek. RESULT: 22 and 21 participants in FG and DG completed the study. For both groups, PEDT scores decreased substantially [from 11.41 to 5.45(P<0.001) among FG, from 13.43 to 3.10(P<0.001) among DG]. After adjustment of the baseline PEDT score, PEDT scores in DG(6.03 vs 2.49, P<0.001) were lower at the 8th week. All groups showed significantly improved DS-DAS scores [from 34.50 to 40.68(P<0.001) in FG, from 36.57 to 44.33(P<0.001) in DG]. No marked difference in DS-DAS was scored after adjustment of the baseline DS-DAS score(41.13 vs 43.86, P=0.055) at the end of the assessment. CONCLUSION:Treatment of PE with either Fluoxetine or Dapoxetine decreases PE symptoms and increases marital satisfaction

Prognostic Factors for Bladder Cancer Patients in Malaysia: A Population-Based Study

Background: Malaysia has the third highest crude mortality rates of bladder cancer within Southeast Asia. We aimed to identify the prognostic factors for bladder cancer patients in Malaysia. Methods: A retrospective population-based study was conducted among patients diagnosed between 2007 and 2011. Death date until 31 December 2016 was updated. Cox proportional hazard regression analysis was performed to examine clinical variables as prognostic factors of death. Results: Identified prognostic factors of 1828 analyzed patients were age groups, ethnicity, morphology, stage, and surgery. As compared to patients aged 15–44, the adjusted Hazard Ratio for those aged 45–54, 55–64, 65–74, and ≥75 were 1.59, 1.87, 2.46, and 3.47, respectively. Malay and other ethnic groups had 1.22- and 1.40-times the risk of death compared to Chinese. Patients with squamous cell carcinoma were at 1.47-times the hazard of death compared to urothelial carcinoma patients. Stages II, III and IV patients had 2.20-, 2.98-, and 4.12-times the risk of death as compared to stage I. Patients who did not receive surgery were at 50% increased hazard of death. Conclusion: Early detection and/or surgery, especially for those more than 75 years old, Malay, and squamous cell carcinoma could potentially improve survival. The findings could inform national cancer control programs

AST, ALT, Bilirubin and AST/ALT Ratio role; Covid- 19 Patients

Background Impaired liver function upon admission has been linked to the severity of COVID-19 infection, yet the data is debated [1]. Therefore, this retrospective study aimed to evaluate the liver function among COVID-19 patients during hospitalization and its association with the disease severity. Methodology The patient aged 18 to 80 with positive COVID-19 at Hospital Raja Perempuan Zainab II (HRPZ II), Kota Bharu, Kelantan, with available AST, ALT, Bilirubin, and AST/ALT ratio data on admission, were retrospectively evaluated from March 2021 to March 2022. Disease severity was categorized based on Annex 2e guidelines by Malaysia's Ministry of Health, which further classified them into mild to moderate disease (Stage 1-3) and severe to critical illness (Stage 4-5). The AST, ALT, Bilirubin, and AST/ALT ratio levels on Day 1 admission were archived from the electronic medical record system and compared between the two groups. The statistical analysis was using SPSS version 27. This study was approved by (JEPeM-USM) protocol code USM/JEPeM/21100691 and Ministry of Health Malaysia NMRR-21-762-58458 (IIR). Results and Discussion The study included a total of 168 COVID-19 patients with a mean (SD) age of 46.67(16.10) for mild to moderate and 56.66(12.41) for severe to critical. There is a significant age group for both groups (p-value=0.002). During hospitalization, 16(14.41%) patients progressed to death from severe to critically ill patients. Upon admission, the median (IQR) of AST and ALT were significantly higher in the severe to critical group compared to in the mild to moderate group, [AST; 39.0(49.0) and 24.0(14.0), ALT 38.0(43.0) and 21.0(18.0)], p<0.05. However, no significant difference between both groups for bilirubin level and AST/ALT ratio. Non-survivors had a higher AST and ALT level compared to survivors, with a median (IQR) of [AST 98.0(88.0) and 32.0 (26.0), ALT of 67.5(90.0) and 28.0(31.0), (p<0.05). Similarly, no significant difference between non-survivors and survivors for bilirubin and AST/ALT ratio. Our study support that, abnormal liver function at admission has been shown to be associated with the disease severity and mortality of COVID-19 infection. However, there is also a need to observe the COVID-19 survivors' hepatobiliary sequelae and dynamic liver function changes following hospital discharge. Conclusion Abnormal AST and ALT level at admission has been shown to be associated with the disease severity and mortality of COVID-19 infection. Further study needed to evaluate liver damage in COVID-19 post-discharge

Net survival differences of breast cancer between stages at diagnosis and age groups in the east coast region of West Malaysia: a retrospective cohort study

Objective Estimation of the net survival of breast cancer helps in assessing breast cancer burden at a population level. Thus, this study aims to estimate the net survival of breast cancer at different cancer staging and age at diagnosis in the east coast region of West Malaysia.Setting Kelantan, Malaysia.Participants All breast cancer cases diagnosed in 2007 and 2011 identified from Kelantan Cancer Registry.Design This retrospective cohort study used a relative survival approach to estimate the net survival of patients with breast cancer. Thus, two data were needed; breast cancer data from Kelantan Cancer Registry and general population mortality data for Kelantan population.Primary and secondary outcome measures Net survival according to stage and age group at diagnosis at 1, 3 and 5 years following diagnosis.Results The highest net survival was observed among stage I and II breast cancer cases, while the lowest net survival was observed among stage IV breast cancer cases. In term of age at diagnosis, breast cancer cases aged 65 and older had the best net survival compared with the other age groups.Conclusion The age at diagnosis had a minimal impact on the net survival compared with the stage at diagnosis. The finding of this study is applicable to other populations with similar breast cancer profile

Factors Influencing Visual Improvement after Phacoemulsification Surgery among Malaysian Cataract Patients

Blindness and visual impairment are part of the global burden of eye disease, with cataract being one of the leading causes of blindness. This study aimed to determine the factors affecting visual acuity (VA) improvement among cataract patients after phacoemulsification surgery in Malaysia. Cataract patients aged over 18 who underwent phacoemulsification surgery between January 2014 and December 2018 were included in this retrospective cohort study. Patients&rsquo; sociodemographic, comorbidities, surgical, and related complication factors were extracted from the National Eye Database. The outcome was measured by the difference in visual acuity before and after the operation and was categorized as &ldquo;improved&rdquo;, &ldquo;no change&rdquo;, and &ldquo;worse&rdquo;. A total of 180,776 patients were included in the final analysis. Multinomial logistic regression analysis showed &ldquo;no changes in VA&rdquo; was significantly higher in patients aged less than 40 years old (OR: 1.66; 95% CI: 1.22, 2.26), patients with ocular comorbidities (OR: 1.65; 95% CI: 1.53, 1.77), patients who had undergone surgery lasting more than 60 min (OR: 1.39; 95% CI: 1.14, 1.69), patients who had surgery without an intraocular lens (IOL) (OR: 1.64; 95% CI: 1.20, 2.26), and patients with postoperative complications (OR: 8.76; 95% CI: 8.13, 9.45). Worsening VA was significantly higher among male patients (OR: 1.11; 95% CI: 1.01, 1.22), patients who had ocular comorbidities (OR: 1.76; 95% CI: 1.59, 1.96), patients who had undergone surgery lasting more than 60 min (OR: 1.94; 95% CI: 1.57, 2.41), patients who had surgery without an IOL (OR: 2.03; 95% CI: 1.48, 2.80), and patients with postoperative complications (OR: 21.46; 95% CI: 19.35, 23.80). The factors impacting &ldquo;no changes&rdquo; in and &ldquo;worsening&rdquo; of VA after cataract surgery were the following: older age, male gender, ethnicity, ocular comorbidities, surgeon grade, absence of IOL, intraoperative complication, and postoperative problems

Increased circulating oxidised low-density lipoprotein and antibodies to oxidised low-density lipoprotein in preeclampsia

Enhanced oxidative stress is involved in the pathogenesis of endothelial dysfunction in preeclampsia (PE). Circulating oxidised LDL (oxLDL) and antibodies to oxLDL (Ab-oxLDL) have been found to be associated with atherosclerosis. The objectives of this study were to investigate the association of oxLDL and Ab-oxLDL with PE and to assess the association between oxLDL and Ab-oxLDL. The levels of oxLDL and Ab-oxLDL were measured by enzyme-linked immunoassay in 78 women with preeclampsia (PE group) and 78 women with normal pregnancy (control group). The PE group had higher oxLDL and Ab-oxLDL levels than the control group (485.1vs.145.9 ng/ml, p < .001) and (578.7 vs 216.2 mU/ml, p < .001), respectively. However, Ab-oxLDL levels were not associated with the levels of oxLDL, age, BMI, gestational age, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both the groups. In conclusion, our study showed that PE was associated with increased oxLDL and Ab-oxLDL, which may reflect the enhanced oxidative stress in PE.Impact Statement Preeclampsia (PE) is a potentially life-threatening condition and both maternal and foetal complications can develop if it is not monitored appropriately. The pathogenesis of endothelial dysfunction in PE is related to the enhanced oxidative stress and oxidation of LDL. However, more studies were required as previous studies had not shown a consistent association of oxLDL and Ab-oxLDL with PE. Our study showed significant association of oxLDL and Ab-oxLDL with PE, indicating that their levels may be reliable indicators of oxidation stress and of the risk of PE. Levels of oxidative stress markers may have implications for clinical practice, such as their association with intrauterine growth restriction (IUGR), HELLP syndrome or eclampsia, foetal birth weight and premature delivery. Further research is still needed, ideally as a prospective cohort study to investigate the association of oxLDL and Ab-oxLDL with such outcome parameters

An open labelled randomized clinical trial of fluoxetine versus dapoxetine treatment among men with premature ejaculation and its effect on marital satisfaction

Premature ejaculation (PE) reduces sexual satisfaction and quality of life. Both SSRI Fluoxetine and Dapoxetine have been used in the treatment of PE. Fluoxetine is used as off-label treatment meanwhile Dapoxetine is the first SSRI specifically designed for PE with short half-life and few side effects

Translation, Cross-Cultural Adaptation and Validation of Movement Behaviour Questionnaire into Malay Language (MBQ-M) for Measuring Movement Behaviors among Preschool Children in Kelantan, Malaysia

Measuring movement behaviours such as physical activity, sedentary behaviour, and sleep throughout 24 h is critical for assessing early childhood development. A valid tool based on cultural adaptation is required to achieve an appropriate result. Thus, this study aims to translate, culturally modify, and validate the movement behaviour questionnaire (MBQ) into Malay (MBQ-M) for preschool children in Kelantan, Malaysia. Permission to translate was obtained and the MBQ was translated using a ten-step process. Ten independent experts evaluated the content validity in terms of the content validity ratio (CVR), scale-level content validity index-average (SCVI-average), item-level content validity index (I-CVI), and the modified kappa statistic. The original questionnaire had modest adjustments: CVR 0.91, SCVI-average 0.93 for clarity, 0.95 for simplicity, and 0.93 for ambiguity. The SCVI-average relevance was 0.95, and the majority kappa value was excellent (>0.74). All the data imply that the overall content validity of the MBQ items is appropriate. Thirty parents assessed face validity, and the scale-level face validity index (S-FVI/Ave) for clarity (0.95) and comprehension (0.95) was satisfactory. In conclusion, the MBQ-M has satisfactory and acceptable content validity and face validity. Thus, it can be used as a valid tool to measure 24-h movement behaviours among preschool children in Malaysia