Impaired vasocontractile responses to adenosine in chorionic vessels of human term placenta from pregnant women with pre-existing and gestational diabetes

Background: There is clinical and experimental evidence for altered adenosine signalling in the fetoplacental circulation in pregnancies complicated by diabetes, leading to adenosine accumulation in the placenta. However, the consequence for fetoplacental vasocontractility is unclear. This study examined contractility to adenosine of chorionic vessels from type 1 diabetes mellitus, gestational diabetes mellitus and normal pregnancies. Methods: Chorionic arteries and veins were isolated from human placenta from normal, gestational diabetes mellitus and type 1 diabetes mellitus pregnancies. Isometric tension recording measured responses to adenosine and the thromboxane A2 analogue U46619 (thromboxane A2 mediates adenosine fetoplacental vasoconstriction). Adenosine and thromboxane prostanoid receptor protein expression was determined by immunoblotting. Results: Adenosine elicited contractions in chorionic arteries and veins which were impaired in both gestational diabetes mellitus and type 1 diabetes mellitus. Contractions to potassium chloride were unchanged. Adenosine A2A and A2B receptor protein levels were not different in gestational diabetes mellitus and normal pregnancies. Contractions to U46619 were unaltered in gestational diabetes mellitus arteries and increased in type 1 diabetes mellitus arteries. Overnight storage of vessels restored contractility to adenosine in gestational diabetes mellitus arteries and normalized contraction to U46619 in type 1 diabetes mellitus arteries. Conclusion: These data are consistent with the concept of aberrant adenosine signalling in diabetes; they show for the first time that this involves impaired adenosine contractility of the fetoplacental vasculature

The impact of reduced red and processed meat consumption on cardiovascular risk factors; an intervention trial in healthy volunteers

Meat represents an important part of the diet for many adults, supplying essential amino acids and micronutrients. However, high red and processed meat (RPM) intake is implicated in the development of cardiovascular disease and dyslipidemia. This study aimed to reduce RPM consumption in healthy, nonobese omnivores (21–48 years), who ate RPM ≥4 times per week, and to investigate its effect on cardiovascular risk factors using a single-group longitudinal study design (comprising an initial 4-week baseline period, followed by a 12-week intervention). Participants (16M : 21F) were assessed before (BL) and after (T0) the pre-intervention period and before (T0), at week 6 (T6) and at the end of intervention (T12). In a subset (8M : 15F), haematological parameters were measured at BL, T6 and T12. Compared with BL, protein intake from RPM reduced by 67% at T6 and 47% at T12 (4-day dietary records). BMI, body fat mass, and blood pressure did not change over the intervention in the whole cohort, but mean total, LDL and HDL cholesterol were reduced in males at T12 (effect sizes −0.52, −0.41 and −0.15 mmol l−1, respectively; each P < 0.01), with no change in total : HDL ratio observed. In the study sub-set, haemoglobin concentration, plus red and white cell count fell during the intervention (estimated effect size ηp2 0.300, 0.301 and 0.354, respectively; each P ≤ 0.001). It was possible for omnivores to approximately halve their RPM intake, and in males this dietary change appeared to reduce blood lipid concentrations. However, acute dietary changes to RPM intake may have had an unfavourable impact on haematological parameters

Responsive and Equitable Health Systems-Partnership on Non-Communicable Diseases (RESPOND) study: a mixed-methods, longitudinal, observational study on treatment seeking for hypertension in Malaysia and the Philippines.

INTRODUCTION: Hypertension is a leading contributor to the global burden of disease. While safe and effective treatment exists, blood pressure control is poor in many countries, often reflecting barriers at the levels of health systems and services as well as at the broader level of patients' sociocultural contexts. This study examines how these interact to facilitate or hinder hypertension control, taking into account characteristics of service provision components and social contexts. METHODS AND ANALYSIS: The study, set in Malaysia and the Philippines, builds on two systematic reviews of barriers to effective hypertension management. People with hypertension (pre-existing and newly diagnosed) will be identified in poor households in 24-30 communities per country. Quantitative and qualitative methods will be used to examine their experiences of and pathways into seeking and obtaining care. These include two waves of household surveys of 20-25 participants per community 12-18 months apart, microcosting exercises to assess the cost of illness (including costs due to health seeking activities and inability to work (5 per community)), preliminary and follow-up in-depth interviews and digital diaries with hypertensive adults over the course of a year (40 per country, employing an innovative mobile phone technology), focus group discussions with study participants and structured assessments of health facilities (including formal and informal providers). ETHICS AND DISSEMINATION: Ethical approval has been granted by the Observational Research Ethics Committee at the London School of Hygiene and Tropical Medicine and the Research Ethics Boards at the Universiti Putra Malaysia and the University of the Philippines Manila. The project team will disseminate findings and engage with a wide range of stakeholders to promote uptake and impact. Alongside publications in high-impact journals, dissemination activities include a comprehensive stakeholder analysis, engagement with traditional and social media and 'digital stories' coproduced with research participants

Patient pathways for cardiovascular diseases in Malaysia and the Philippines: a systematic review

Background: Cardiovascular diseases (CVDs) are the leading cause of premature mortality in the world and are a growing public health concern in low- and middle-income countries (LMICs), including those in South East Asia. Their management requires coordinated responses by a range of healthcare providers, which should preferably be based on knowledge of the national context. We systematically review evidence on the pathways followed by patients with CVD in Malaysia and the Philippines to understand patient journeys, along with the barriers at each stage. Methods: We searched seven bibliographic databases and grey literature sources to identify material focused on the pathways followed by patients with CVD in Malaysia and the Philippines, and performed a narrative synthesis. Results: The search yielded 25 articles, 3 focused on the Philippines and 22 on Malaysia. Most articles were quantitative analyses that focused on hypertensive patients. Three examined secondary prevention post myocardial infarction, and one each examined acute myocardial infarction, heart failure, and atrial fibrillation. Reported barriers reflected capability (knowledge of behaviours to achieve control or the capacity to conduct these behaviours), intention (attitudes or motivations toward the behaviours to achieve control), and aspects of the health care system (availability, accessibility, affordability and acceptability of services). Conclusions: There are large gaps in our understanding of patient pathways in Malaysia and the Philippines that limit the development of evidence-based strategies to effectively address the CVD burden in South East Asian countries and in LMICs more broadly. Addressing these evidence gaps will require longitudinal mixed-methods studies following patients from initial diagnosis to long-term management.</ns3:p

ASEAN Orthopaedic Association Education Committee - Orthopaedic curriculum for residency training 2019

In November 2013, Dr Dohar Tobing, who was the President of the ASEAN Orthopaedic Association at that time, organized a Seminar on Orthopaedic Education in Yogyakarta to discuss residency training in ASEAN. At this initial meeting the training program in each country was presented by representatives from each ASEAN country. Subsequently the ASEAN Orthopaedic Association established the Education Committee under the chairmanship of Professor Lee Eng Hin to develop a common syllabus/curriculum for all ASEAN countries based on minimum standards required to practice competently as a general orthopaedic surgeon. The main objective of having a common curriculum is to facilitate exchanges of residents and fellows amongst the ASEAN countries to increase their exposure to orthopaedic conditions in the region and improve their breadth and depth of knowledge and skills. The first meeting of the Education Committee was held in Cebu in November 2014 and the Committee has since met twice a year in May and November. Training programs in the ASEAN countries were discussed and a consensus was reached on the structure and length of the training program for the AOA curriculum. In May 2016, three workgroups were formed under the leadership of Professor David Choon, Dr Dohar Tobing and Professor Lee Eng Hin to develop the detailed curriculum in the following areas: a) General Orthopaedics/Trauma/Infection/Sports/Pathophysiology/Basic Science Lead: David Choon Members: Arturo C. Canete, Jean Pierre F. Leung, Apipop Kritsaneephaiboon, Maung Mg Htwe, Sabarul A. Mokhtar b) Adult Orthopaedics/Spine/Upper Limb/Foot & Ankle/Biomaterials/Biomechanics Lead: Dohar Tobing Members: Myint Thaung, Peter Lee, Yeo Sing Jin, Kamarul Ariffin Khalid, Khin Mg Myint, Azlina Abbas c) Pediatrics/Oncology Lead: Lee Eng Hin Members: Edward HM Wang, Kanyika Chamniprasas, Pornchai Mulpruek, Istan Irmansyah Irsan, Abdul Razak Sulaiman, Wan Faisham Nu’man Wan Ismail In addition to their contributions as workgroup members, the following individuals made substantial contributions in the following areas: Pathophysiology/Basic Science: Vivek Ajit Singh and David Choon General Ortho: Wan Faisham Nu’man Wan Ismail and Kamarul Ariffin Khalid Trauma: Arturo Cañete and Jean Pierre Leung Sports Medicine: Aung Myo Win Adult-Hip & Knee: Maung Mg Htwe and Myint Thaung Spine: Dohar Tobing Upper limb/Hand: Khin Mg Myint Foot & Ankle: Inderjeet Singh Paediatrics: Lee Eng Hin and Abdul Razak Sulaiman Oncology: Edward Wang and Istan Irmansyah Irsa