Effectiveness of combined Malaysia healthy plate method (half-half quarter) and physical activity intervention at workplace setting among healthcare workers

Introduction; Overweight and obesity are becoming a major health issue which contributes to the increase in morbidity and mortality. This study aimed to evaluate the effect of the diet intervention and exercise for weight reduction among obese but healthy adults. Methods; This was a quasi-experimental study using designed Structured Diet with Program adapted from Malaysia Healthy Plate method (half-half quarter) with physical exercise for weight reduction. The anthropometry and biochemistry parameters were monitored and collected pre- and post-program. The body mass index (BMI) cut off points by World Health Organization (WHO) for Asian population was used to define obesity in this study. Results; 30 healthcare workers (HCWs) were recruited. However, only 27 HCWs completed the program. The pre- and post-program mean BMI was 32.90 kg/m2 and 31.39 kg/m2 and weight was 81.25 kg to 77.37 kg. The total cholesterol reduced significantly with mean 5.65 mmol/l to 5.34 mmol/l. Other blood parameters showed some reduction but not statically significant with mean Fasting Blood Sugar (FBS): 4.82mmol/l to 4.69mmol/l, mean High Density Lipoprotein (HDL): 1.43mmol/l to 1.32mmol/l mean Low Density Lipoprotein (LDL): 3.54mmol/l to 3.42mmol/l and mean TG 1.52mmol/l to 1.31mmol/l. Conclusions; Overall, the programme led to a considerable reduction in body weight, BMI, and total cholesterol. Even though other blood parameters did not show statistically significant reduction but they still showed some reduction in postprogramme. This method was recommended to be implemented among Malaysians for longer duration to achieve significant reduction in blood parameters. However, the commitment and motivation of the HCWs were highly needed to ensure the effectiveness and adherence to the diet method

Proposal of a Clinical Decision Tree Algorithm Using Factors Associated with Severe Dengue Infection.

WHO's new classification in 2009: dengue with or without warning signs and severe dengue, has necessitated large numbers of admissions to hospitals of dengue patients which in turn has been imposing a huge economical and physical burden on many hospitals around the globe, particularly South East Asia and Malaysia where the disease has seen a rapid surge in numbers in recent years. Lack of a simple tool to differentiate mild from life threatening infection has led to unnecessary hospitalization of dengue patients.We conducted a single-centre, retrospective study involving serologically confirmed dengue fever patients, admitted in a single ward, in Hospital Kuala Lumpur, Malaysia. Data was collected for 4 months from February to May 2014. Socio demography, co-morbidity, days of illness before admission, symptoms, warning signs, vital signs and laboratory result were all recorded. Descriptive statistics was tabulated and simple and multiple logistic regression analysis was done to determine significant risk factors associated with severe dengue.657 patients with confirmed dengue were analysed, of which 59 (9.0%) had severe dengue. Overall, the commonest warning sign were vomiting (36.1%) and abdominal pain (32.1%). Previous co-morbid, vomiting, diarrhoea, pleural effusion, low systolic blood pressure, high haematocrit, low albumin and high urea were found as significant risk factors for severe dengue using simple logistic regression. However the significant risk factors for severe dengue with multiple logistic regressions were only vomiting, pleural effusion, and low systolic blood pressure. Using those 3 risk factors, we plotted an algorithm for predicting severe dengue. When compared to the classification of severe dengue based on the WHO criteria, the decision tree algorithm had a sensitivity of 0.81, specificity of 0.54, positive predictive value of 0.16 and negative predictive of 0.96.The decision tree algorithm proposed in this study showed high sensitivity and NPV in predicting patients with severe dengue that may warrant admission. This tool upon further validation study can be used to help clinicians decide on further managing a patient upon first encounter. It also will have a substantial impact on health resources as low risk patients can be managed as outpatients hence reserving the scarce hospital beds and medical resources for other patients in need

Decision tree for severe dengue infection.

<p>Decision tree for severe dengue infection.</p

Percentage of warning signs by dengue severity.

<p>Percentage of warning signs by dengue severity.</p

Significant factors associated with severe dengue (using multiple logistic regressions).

<p>Significant factors associated with severe dengue (using multiple logistic regressions).</p

Comparison of decision tree with actual clinical diagnosis.

<p>Comparison of decision tree with actual clinical diagnosis.</p

Demographic profiles of dengue patients.

<p>Demographic profiles of dengue patients.</p

SLC17A3 rs9379800 and Ischemic Stroke Susceptibility at the Northern Region of Malaysia

Objectives: The relationships of Paired Like Homeodomain 2 (PITX2), Ninjurin 2 (NINJ2), TWIST-Related Protein 1 (TWIST1), Ras Interacting Protein 1 (Rasip1), Solute Carrier Family 17 Member 3 (SLC17A3), Methylmalonyl Co-A Mutase (MUT) and Fer3 Like BHLH Transcription Factor (FERD3L) polymorphisms and gene expression with ischemic stroke have yet to be determined in Malaysia. Hence, this study aimed to explore the associations of single nucleotide polymorphisms (SNPs) and gene expression with ischemic stroke risk among population who resided at the Northern region of Malaysia. Materials and methods: Study subjects including 216 ischemic stroke patients and 203 healthy controls were recruited upon obtaining ethical clearance. SNP genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism assays. Gene expression levels were quantified by real-time polymerase chain reaction assays. Statistical and genetic analyses were conducted with SPSS version 22.2, PLINK version 1.07 and multifactor dimensionality reduction software. Results: Study subjects with G allele, CG or GG genotypes of SLC17A3 rs9379800 demonstrated increased risk of ischemic stroke with the odds ratios ranging from 1.76-fold to 3.14-fold (p<0.05). When stratified study subjects according to the ethnicity, SLC17A3 rs9379800 G allele and CG genotype contributed to 2.14- and 2.96-fold of ischemic stroke risk among Malay population significantly, in the multivariate analysis (p<0.05). However, no significant associations were observed for PITX2, NINJ2, TWIST1, Rasip1, and MUT polymorphisms with ischemic stroke risk in the multivariate analysis for the pooled cases and controls as well as when stratified them according to the ethnicity. Lower mRNA expression levels of Rasip1, SLC17A3, MUT and FERD3L were observed among cases (p<0.05). After FDR adjustment, the mRNA level of SLC17A3 remained significantly associated with ischemic stroke among Malay population (q=0.034). Conclusion: In conclusion, this study suggests that SLC17A3 rs9379800 polymorphism and its gene expression contribute to significant ischemic stroke risk among Malaysian population, particularly the Malay who resided at the Northern Region of the country. Our findings can provide useful information for the future diagnosis, management and treatment of ischemic stroke patients.</p

Validation of the Visual Cognitive Assessment Test (VCAT) for the Early Diagnosis of Cognitive Impairment in Multilingual Population in Malaysia

As Malaysia undergoes a demographic transformation of population aging, the prevalence of dementia is expected to rise, posing a major public health threat issue. Early screening to detect cognitive impairment is important to implement appropriate clinical interventions. The Visual Cognitive Assessment Test (VCAT) is a language-neutral cognitive assessment screening tool suitable for multilingual populations. This study was aimed to validate the VCAT screening tool for the detection of cognitive impairment amongst the population of Malaysia. A total of 184 participants were recruited, comprising 79 cognitively healthy participants (CHP), 46 mild cognitive impairment (MCI) patients, and 59 mild dementia (Alzheimer&rsquo;s disease and Vascular Dementia) patients from five hospitals between May 2018 and December 2019 to determine the usefulness of VCAT. Diagnostic performance was assessed using area under the curve (AUC), and receiver operating characteristic (ROC) analysies was performed to determine the recommended cutoff scores. ROC analyses for the VCAT was comparable with that of MoCA (Montreal Cognitive Assessment) in differentiating between CHP, MCI, and mild dementia (AD and VaD) participants. The findings of this study suggest the following optimal cutoff score for VCAT: Dementia 0&ndash;19, MCI 20&ndash;23, Normal 24&ndash;30. The mean &plusmn; SD time to complete the VCAT was 10.0 &plusmn; 2.75 min in the CHP group and 15.4 &plusmn; 4.52 min in the CI group. Results showed that 76.0% of subjects thought that the instructions in VCAT were similar or easier to understand compared with MoCA. This study showed that the VCAT is a valid and useful screening tool for patients with cognitive impairment in Malaysia and is feasible to be used in the clinical settings