Obstructive sleep apnea and vitamin D level : Has the dust settled?

Obstructive sleep apnea and vitamin D deficiency are associated with multiple complications with increased morbidity and mortality. However, the relationship between these two entities remains unclear, with clinical studies demonstrating contradictory results. This narrative review aims to present the current evidence and understanding of this relationship and discuss the possible mechanisms linking these two disease entities. Finally, we summarize and propose areas of opportunity for future research

Associations between primary aldosteronism and diabetes, poor bone health, and sleep apnea—what do we know so far?

Primary aldosteronism (PA), the most common cause of secondary hypertension, is a well-recognized condition that can lead to cardiovascular and renal complications. PA is frequently left undiagnosed and untreated, leading to aldosterone-specific morbidity and mortality. In this review we highlight the evidence linking PA with other conditions such as (i) diabetes mellitus, (ii) obstructive sleep apnea, and (iii) bone health, along with clinical implications and proposed underlying mechanisms

Living in rural areas of Peninsular Malaysia: risk factor for goitre

Introduction: Thyroid disorders are among common medical conditions encountered in clinical practice. However, the disease burden among Malaysian population has not been established. This study was aimed to determine the prevalence of goitre and its associated factors among adult population in Peninsular Malaysia. Materials and Methods: A cross-sectional study was performed in 5 pre-assigned regions in Peninsular Malaysia. Participants’ sociodemographic profile and medical history were recorded. Physical examinations were done looking for abnormalities of the thyroid gland and signs of thyroid dysfunctions. The diagnosis of goitre was made by palpation and corroborated by the repeat examination by another investigator. The World Health Organization (WHO) goitre grading system was used. Fifteen millilitre of blood were withdrawn and analysed at a central laboratory. Results: Among 2190 respondents, the prevalence of goitre was 9.3%. Goitre was associated with positive anti-thyroperoxidase and anti-thyroglobulin antibodies. Females were at higher risk of goitre (adjusted OR = 2.4; 95% CI 1.6–3.5; p<0.001). The other risk factors of goitre were Indian ethnicity (adjusted OR=2.0; 95%CI 1.2–3.3; p=0.006), positive anti-thyroperoxidase (adjusted OR=1.8; 95% CI 1.1-3.1; p=0.024) and living in rural area (adjusted OR = 1.7; 95% CI 1.2–2.5; p=0.002). These areas had been shown to suffer from some degree of iodine insufficiency in the past. Conclusions: The prevalence of goitre in Peninsular Malaysia was comparable with other studies. The main predictors of thyroid disorders are female gender and thyroid antibodies. Living in rural areas was associated with goitre

Comparative studies of dipeptidyl peptidase 4 inhibitor vs sulphonylurea among Muslim Type 2 diabetes patients who fast in the month of Ramadan: A systematic review and meta-analysis

Aim To systematically review the literature to compare the use of DPP4 inhibitors vs sulphonylurea in type 2 diabetic Muslim patients who fast in Ramadan, with regards to its safety, tolerability, glycemic control, and body weight changes. Methods All English-language medical literature published from inception till October 2014 which met the inclusion criteria were reviewed and analyzed. Results A total of nine papers were included, reviewed and analyzed. The total sample size was 4276 patients. All studies used either of the two DPP4 inhibitors - Vildagliptin or Sitagliptin, vs sulphonylurea or meglitinides. Patients receiving DPP4 inhibitors were less likely to develop symptomatic hypoglycemia (risk ratio 0.46; 95% CI, 0.30-0.70), confirmed hypoglycemia (risk ratio 0.36; 95% CI, 0.21-0.64) and severe hypoglycemia (risk ratio 0.22; 95% CI, 0.10-0.53) compared with patients on sulphonylureas. There was no statistically significant difference in HbA1C changes comparing Vildagliptin and sulphonylurea. Conclusion DPP4 inhibitor is a safer alternative to sulphonylurea in Muslim patients with type 2 diabetes mellitus who fast during the month of Ramadan as it is associated with lower risk of symptomatic, confirmed and severe hypoglycemia, with efficacy comparable to sulphonylurea

High prevalence of thyroid antibodies in urban population of peninsular Malaysia

Thyroid antibodies are closely related to autoimmune thyroid disorders. To date, there are no data on the prevalence of these antibodies among the Malaysian population. This study aimed to determine the prevalence of thyroid antibodies; and the factors associated with thyroid antibodies in the Malaysian adult population. MATERIALS AND METHODS: A cross-sectional study was performed in 5 pre-assigned regions in Peninsular Malaysia. Participants' sociodemographic profile and medical history were recorded. Physical examinations were done looking for abnormalities of the thyroid gland and signs of thyroid dysfunctions. Fifteen mils of blood were withdrawn and analysed for thyroid function, anti-thyroperoxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies at a central laboratory. RESULTS: Among the total of 2190 respondents, the overall prevalence of positive anti-TPO and anti-TG antibodies were 12.2% and 12.1%, respectively; mainly found in urban and coastal areas. Only 7% to 9% of those with positive anti-TPO or anti-TG antibodies had either hypo- or hyperthyroidism. The predictors for positive anti-TPO antibody were female [adjusted OR 1.7 (95%CI: 1.2-2.4); p=0.001], Indian [adjusted OR 1.9 (95%CI: 1.1-3.1); p=0.020], and having a goitre [adjusted OR 1.8 (95%CI: 1.2-2.8), p=0.004]. The predictors of positive anti-TG antibody was female [adjusted OR 2.3 (95%CI: 1.6-3.3); p<0.001], and having a goitre [adjusted OR 2.0 (95%CI: 1.3-3.4), p=0.001]. Those living in rural areas had 38% lower risk of having positive anti-TG. CONCLUSIONS: The prevalence of positive anti-TPO and anti-TG antibodies were 12.2% and 12.1%, respectively; were higher among the urban and coastal populations. Those living in rural areas had lower risks of anti-TG antibody. (258 words). © 2020 International Islamic University Malaysia

Payment methods and patient satisfaction among type-2 diabetes patient at a teaching hospital in Malaysia

Diabetes mellitus is a costly chronic disease related to medication, physician consultation and laboratory investigation. The main means of financing healthcare include direct out-of-pocket (OOP) payment and government subsidisation in some countries, or public/private health insurance schemes, or a mix of all. Patient satisfaction is critical in ensuring the use of healthcare services, continuity of care and treatment adherence. In this study, we determined the satisfaction of type 2 diabetes mellitus (T2DM) patients regarding the healthcare services and payment methods at Universiti Kebangsaan Malaysia (UKM) Teaching Hospital, Malaysia. This cross-sectional study involved 313 T2DM patients aged ≥18 years who were included after clinical consultations. We used convenience sampling at the outpatient and inpatient medical centres of Hospital Canselor Tuanku Muhriz and UKM Specialist Centre. A survey consisting of sociodemographic, socioeconomic and payment method types as well as a validated patient satisfaction questionnaire scale were used. The mean age was 59.6 years (SD=13.151), 53.0% of the patients were female, 78.3% were Malay, 76.4% were uninsured, 39.6% were covered by government subsidies, while 36.7% paid OOP. Around 86% were generally satisfied with the overall services. Patients were most satisfied with technical quality (84%), communication skills (83%) and accessibility (80%), but satisfaction was lower in doctors’ service orientation, particularly the interpersonal manner (73%), financial aspect (73%) and time spent with the doctor (70%). Over 86% of patients were satisfied with healthcare services and payment methods; however, patients who paid OOP reported low satisfaction. Full insurance and extending benefits to partially cover both inpatients and outpatients with low co-payment is recommended to increase satisfaction

Influence and implications of the renin–angiotensin–aldosterone system in obstructive sleep apnea : An updated systematic review and meta-analysis

Obstructive sleep apnea is a chronic, sleep-related breathing disorder, which is an independent risk factor for cardiovascular disease. The renin–angiotensin–aldosterone system regulates salt and water homeostasis, blood pressure, and cardiovascular remodelling. Elevated aldosterone levels are associated with excess morbidity and mortality. We aimed to analyse the influence and implications of renin–angiotensin–aldosterone system derangement in individuals with and without obstructive sleep apnea. We pooled data from 20 relevant studies involving 2828 participants (1554 with obstructive sleep apnea, 1274 without obstructive sleep apnea). The study outcomes were the levels of renin–angiotensin–aldosterone system hormones, blood pressure and heart rate. Patients with obstructive sleep apnea had higher levels of plasma renin activity (pooled wmd+ 0.25 [95% confidence interval 0.04–0.46], p = 0.0219), plasma aldosterone (pooled wmd+ 30.79 [95% confidence interval 1.05–60.53], p = 0.0424), angiotensin II (pooled wmd+ 5.19 [95% confidence interval 3.11–7.27], p < 0.001), systolic (pooled wmd+ 5.87 [95% confidence interval 1.42–10.32], p = 0.0098) and diastolic (pooled wmd+ 3.40 [95% confidence interval 0.86–5.94], p = 0.0086) blood pressure, and heart rate (pooled wmd+ 3.83 [95% confidence interval 1.57–6.01], p = 0.0009) compared with those without obstructive sleep apnea. The elevation remained significant (except for renin levels) when studies involving patients with resistant hypertension were removed. Sub-group analysis demonstrated that levels of angiotensin II were significantly higher only among the Asian population with obstructive sleep apnea compared with those without obstructive sleep apnea. Body mass index accounted for less than 10% of the between-study variance in elevation of the renin–angiotensin–aldosterone system parameters. Patients with obstructive sleep apnea have higher levels of renin–angiotensin–aldosterone system hormones, blood pressure and heart rate compared with those without obstructive sleep apnea, which remains significant even among patients without resistant hypertension

A prevalence of elevated ARR in rural Selangor

Abstract The objective of this study was to determine the prevalence of elevated Aldosterone Renin Ratio (ARR) in Rural Selangor. Methods This was a cross sectional study involving subjects in Kuala Selangor and Tanjung Karang. The World Health Survey Kish tables were used to select eligible subjects (≥18 years old) from each household. Their social demography, past medical history, anthropometric measurement and blood pressure were recorded. Blood were withdrawn for Aldosterone (ALD), Plasma Renin Activity (PRA), Creatinine (creat) and potassium (K). Raised ARR is defined as aldosterone/renin ratio of more than 20. Results A total of 392 subjects (age 55 +/- 14.1) were enrolled. Fourty three (11%) subjects showed an ARR > 20. Out of those with raised ARR, 16 (38%) were hypertensive, 2 of which were not taking any anti-hypertensive drugs and 27 subjects (62.8%) were normotensive. Only 2 (4.7%) of them were hypokalemic, one of them being hypertensive. Conclusion The prevalence of raised ARR in Rural Selangor was 11%, and only 4.7% of them were hypokalemic