Glycemic patterns and factors associated with post-hemodialysis hyperglycemia among end-sStage-renal disease patients undergoing maintenance hemodialysis

Introduction. Chronic and post-prandial hyperglycemia are independent risk factors for diabetic complications. Glycemic patterns among hemodialysis end-stage-renal-disease (ESRD) differ as glucose metabolism changes with declining kidney function with more pronounced glycemic fluctuations. The objectives of this study are to determine glycemic patterns on hemodialysis days, the magnitude of post-hemodialysis rebound hyperglycemia (PHH) and their associated factors. Methodology. 148 patients on hemodialysis were analysed, 91 patients had end-stage-diabetic-renal disease (DM-ESRD), and 57 patients had end-stage-non-diabetic renal disease (NDM-ESRD). Glycemic patterns and PHH data were obtained from 11-point and 7-point self-monitoring blood glucose (SMBG) profiles on hemodialysis and non-hemodialysis days. PHH and its associated factors were analysed with logistic regression. Results. Mean blood glucose on hemodialysis days was 9.33 [SD 2.7] mmol/L in DM-ESRD patients compared to 6.07 [SD 0.85] mmol/L in those with NDM-ESRD (p<0.001). PHH occurred in 70% of patients and was more pronounced in DM-ESRD compared to NDM-ESRD patients (72.5% vs 27.5%; OR 4.5). Asymptomatic hypoglycemia was observed in 18% of patients. DM-ESRD, older age, previous IHD, obesity, high HbA1c, elevated highly-sensitive CRP and low albumin were associated with PHH. Conclusion. DM-ESRD patients experienced significant PHH in our cohort. Other associated factors include older age, previous IHD, obesity, high HbA1c, elevated hs-CRP and low albumin

Assessment of health-related quality of life in the elderly on maintenance hemodialysis

Introduction: Health-related quality of life (HRQOL) is one of the main indicators of health and wellbeing among dialysis patients which has attracted mounting interest in recent years in the initiation of intervention measures. Thus, this study aimed to determine the correlations between socio-demographic factors and medical characteristics with HRQOL among elderly on maintenance hemodialysis (HD). Methods: A cross-sectional study was conducted in nine HD centers in Selangor. Socio-demographic data and HRQOL were assessed using structured questionnaire and Kidney Disease Quality of Life Instrument (KDQOL-36), respectively whilst medical profile and laboratory data were collected from subjects’ medical record. Results: The mean age of subjects was 67±6 years where majority (57%) of the subjects was on maintenance HD for less than 5 years. The mean physical component summary and mental component summary scores were 33.89±11.83 and 50.23±8.88, respectively. Symptoms/problems subscale, effects of kidney disease on daily life subscale and burden of kidney disease subscale scores were 73.37±17.01, 72.63±19.74 and 54.62±30.42, respectively. There was a significant correlation between serum sodium with physical component summary (r=0.237, p<0.01) and symptoms/problems subscale (r= 0.245, p<0.01). Conclusion: Subjects perceived their mental health better than physical health but felt burdened by kidney disease the most. Serum sodium was found to be positively associated with physical functioning and symptoms/problems subscales. There is a need for routine assessment on HRQOL and appropriate intervention to enhance the quality of life among elderly on HD

Glycemic patterns and factors associated with post-hemodialysis hyperglycemia among end-stage renal disease patients undergoing maintenance hemodialysis

Introduction: Chronic and post-prandial hyperglycemia are independent risk factors for diabetic complications. Glycemic patterns among hemodialysis end-stage-renal-disease (ESRD) differ as glucose metabolism changes with declining kidney function with more pronounced glycemic fluctuations. The objectives of this study are to determine glycemic patterns on hemodialysis days, the magnitude of post-hemodialysis rebound hyperglycemia (PHH) and their associated factors. Methodology: 148 patients on hemodialysis were analysed, 91 patients had end-stage-diabetic-renal disease (DM-ESRD), and 57 patients had end-stage-non-diabetic renal disease (NDM-ESRD). Glycemic patterns and PHH data were obtained from 11-point and 7-point self-monitoring blood glucose (SMBG) profiles on hemodialysis and non-hemodialysis days. PHH and its associated factors were analysed with logistic regression. Results: Mean blood glucose on hemodialysis days was 9.33 [SD 2.7] mmol/L in DM-ESRD patients compared to 6.07 [SD 0.85] mmol/L in those with NDM-ESRD (p<0.001). PHH occurred in 70% of patients and was more pronounced in DM-ESRD compared to NDM-ESRD patients (72.5% vs 27.5%; OR 4.5). Asymptomatic hypoglycemia was observed in 18% of patients. DM-ESRD, older age, previous IHD, obesity, high HbA1c, elevated highly-sensitive CRP and low albumin were associated with PHH. Conclusion: DM-ESRD patients experienced significant PHH in our cohort. Other associated factors include older age, previous IHD, obesity, high HbA1c, elevated hs-CRP and low albumin

Detection of pulmonary tuberculosis manifestation in chest x-rays using different Convolutional Neural Network (CNN) models

Tuberculosis (TB) is airborne infectious disease which has claimed many lives than any other infectious disease. Chest X-rays (CXRs) are often used in recognizing TB manifestation site in chest. Lately, CXRs are taken in digital formats, which has made a huge impact in rapid diagnosis using automated systems in medical field. In our current work, four simple Convolutional Neural Networks (CNN) models such as VGG-16, VGG-19, RestNet50, and GoogLenet are implemented in identification of TB manifested CXRs. Two public TB image datasets were utilized to conduct this research. This study was carried out to explore the limit of accuracies and AUCs acquired by simple and small-scale CNN with complex and large-scale CNN models. The results achieved from this work are compared with results of two previous studies. The results indicate that our proposed VGG-16 model has gained highest score overall compared to the models from other two previous studies

Medicinal potentials of Strobilanthes crispus (l.) and Orthosiphon stamineus benth. in the management of kidney stones: a review and bibliometric analysis

Introduction In Malaysia, the consumption of tea made from the leaves of Strobilanthes crispus, Orthosiphon stamineus, and their combination is believed by the local people to alleviate kidney stone disease. Therefore, this review was conducted to validate the traditional claims based on the scientific evidences of kidney stones remedies using S crispus and O stamineus. The scientific progress that has evolved over a period of time will be examined using bibliometric analysis. Methodology The data for S crispus and O stamineus related to kidney stones were searched using the Scopus database. A total of 59 publications from 2009 to 2022 were retrieved and analysed using visualisation of similarities viewer software based on the keywords, authors, countries, institutions, and journals. The World Flora Online was used to confirm the identity of the plant species. Results The publications related to O stamineus (50) were found to be higher than S crispus (9). ‘Strobilanthes crispus, Orthosiphon stamineus, and diuretic’ were identified as the most frequently mentioned keywords. Ahmad, M. and Malaysia were the most productive author and country, respectively. Whereas Université de Metz in France and Universiti Putra Malaysia were identified as the most prominent institutions. A number of isolated compounds, including rosmarinic acid and sinensetin, were identified as diuretic agents. While eupatorine and 3′-hydroxy-5,6,7,4′-tetramethoxyflavone were discovered to prevent the formation of calcium oxalate crystals. Conclusions This study offers fresh insights into S crispus and O stamineus plants as a herbal combination for future studies in the treatment of kidney stones

Rapid decline of renal function in patients with type 2 diabetes with heavy proteinuria: a report of three cases

Background: Although there is a large volume of literature regarding the definition and epidemiology of type 2 diabetes nephropathy (T2DN). There has been a paucity of data focused on the rate of transition of T2 DN. Based on our personal observation a certain percentage of our incident end stage renal disease (ESRD) patients from T2DN experienced a rapid decline of renal function. Their rapid decline nature of glomerular filtration rate (GFR) of 46 to 60 mL/min per 1.73m2 per year have far exceeded the KDIGO definitions of acute kidney injury (abrupt decrease in kidney function occurring over 7 days or less), acute kidney disease (acute or subacute damage and/or loss of kidney function for a duration of between 7 and 90 days after exposure to an acute kidney injury initiating event (Chawla et al Nat Rev Nephrol 241–57 2017) or even rapid decliner (eGFR declines > 5 mL/min per 1.73m2 per year) (Chawla et al Nat Rev Nephrol 241–57 2017; Andrassy Kidney Int 622–623 2013). Case presentation: We describe here three cases of type 2 diabetic patients that have rapid renal deterioration with rate of decline 46 - 60 mL/min per 1.73m2 per year. All the patients are heavily nephrotic. All of the renal biopsies done showed the classical diabetic changes, hypertensive changes, diffuse tubulointerstitial damage, and interstitial nephritis. All of the patients admitted to taking various form of traditional medications in hope of curing their renal disease. Conclusion: We wish to highlight that type 2 diabetics with massive nephrotic range proteinuria have enhanced risk of rapid renal function deterioration. The patients should be educated about the risks of rapid renal function deterioration when there is presence of heavy proteinuria. High grade proteinuria is likely to inflict the diffuse tubulointerstitial inflammation. The interstitial nephritis could be further worsened by traditional supplements consumption. Timely health education and advice must be undertaken to retard this unwanted rapid renal disease progression

In vitro and in vivo assessments on nutraceutical and safety of herb-fruit based drink on female Wistar Rats

INTRODUCTION: The study aimed to assess the safety and nutraceutical properties of ALLURATM related to women’s health and skin beautification. MATERIALS AND METHODS: Determinations of total phenolic (TPC) and flavonoid contents (TFC) were done using the colorimetric method, followed by the identification of gallic acid via high-performance liquid chromatography (HPLC). Antioxidant activity was analyzed using 2,2-diphenyl-2-picrylhydrazyl (DPPH) and 2,2’-azino-bis(3-ethylbenzthiazoline-6-sulphonic acid (ABTS) radicals while its anti-inflammatory activity was measured using enzyme-linked immunosorbent assay (ELISA). Anti-aging and whitening effects were determined by porcine elastase and mushroom tyrosinase activities, respectively. Skin cell growth promotion and rejuvenation were evaluated using in vitro scratch assay. Cytotoxicity assay was done using HSF1184 and 3T3 BALB/c cell lines. While, acute toxicity test was done on two groups (control and treatment) of six Wistar rats each. The nutraceutical properties were evaluated based on proximate analysis. RESULTS: ALLURATM exhibited DPPH-IC50 values of 180.40 μg/mL and ABTS-IC50value of 174.40 μg/mL. TPC and TFC were 67.31 mg GAE/g extract and 43.21 mg CE/g extract, respectively while 10.98 mg/g of gallic acid were quantified. ALLURATMreduced pro-inflammatory cytokines of TNF-α and IL-6 and showed anti-aging (IC50-162.40 μg/mL) and whitening effects (IC50-167.70 μg/mL). ALLURA™ also increased the proliferation of HSF1184 (≤ 1000 μg/mL), producing significant secretion of epidermal growth factor (EGF) and shown to be non-cytotoxic. No mortality was observed at the highest dose of 2000 mg/kg b.w.t. nor the behavioral and morphological changes in rats. The proximate analysis resulted in high content of moisture and low calories. CONCLUSION: These findings provided preliminary reports for the first time on the functionality of ALLURA™ for its anti-inflammatory, antioxidant, and nutraceutical properties

Investigating physical and nutritional changes during prolonged intermittent fasting in hemodialysis patients: a prospective cohort study

Objective: Studies investigating the health effects of prolonged intermittent fasting during Ramadan among Muslim patients on hemodialysis (HD) are limited and reported heterogeneous findings. This study aimed to evaluate the effects of intermittent fasting during Ramadan on nutritional and functional status of patients on maintenance HD. Design and methods: This was a 12-week, multicenter, prospective observational study. The study setting included three HD centers. Adult Muslim patients, who were undergoing HD session thrice weekly and planned to fast during Ramadan, were screened for eligibility and recruited. Nutritional and functional status assessments were carried out 2 weeks before (V0), at the fourth week of Ramadan (V1), and 4 weeks after Ramadan (V2). Nutritional status parameters included anthropometry (body mass index, interdialytic weight gain, waist circumference), body composition (mid-arm circumference, triceps skinfold, body fat percentage), blood biochemistry (albumin, renal profile, lipid profile, and inflammatory markers), blood pressure, dietary intake, and handgrip strength. Changes in nutritional and functional status parameters across study timepoints were analyzed using repeated-measures analysis of variance. Results: A total of 87 patients completed the study, with 68 patients (78.2%) reporting fasting ≥20 days. Ramadan fasting led to significant reductions (all P .05). Significant improvement was observed in serum phosphate levels, but serum albumin, urea, and creatinine were also reduced significantly during Ramadan (P < .05). There were no significant changes in lipid profile and inflammatory markers. Interestingly, energy and protein intakes remain unchanged during Ramadan. Handgrip strength improved significantly during Ramadan and further improved after Ramadan. Conclusion: Intermittent Ramadan fasting leads to temporary changes in nutritional status parameters and poses nondetrimental nutritional risk for patients on maintenance HD

Impulse control behaviours in a Malaysian Parkinson’s disease population

Background: Impulse control behaviours are repetitive and excessive activities that may be sub-syndromal and not fulfill the criteria for impulse control disorder. These activities have potential to negatively impact on the daily lives of sufferers. We conducted a study to investigate the prevalence of impulse control behaviors and its associated features in Parkinson’s disease in our population. Methods: We conducted a prospective cross-sectional study on consecutive patients attending neurology clinic. Inclusion criteria include idiopathic Parkinson’s disease patients with Hoehn & Yahr stage I-IV. Eighty patients were enrolled and screened for impulse control behaviors using the Questionnaire for Impulsive-Compulsive Disorder for Parkinson’s disease (QUIP). Results: Prevalence of impulse control behaviors among our cohort was 11.3%; the features significantly associated with it were higher level of education (p=0.02), advanced stage of disease (p=0.03) and higher levodopa dosage (p= 0.01). The commonest impulse control behavior in our cohort was compulsive medication use (7.5%), followed by hobbyism (6.3%), hypersexuality (5%), compulsive buying (3.75%), punding (2.5%), walkabout (2.5%), compulsive eating (1.25%) and pathological gambling (1.3%). Conclusions: There is an association between impulse control behavior and higher levodopa dosage in a study on patients with Parkinson’s disease in Malaysia. We also found a low prevalence of pathological gambling as compared to studies performed in the West

Traditional and complementary medicine use among chronic haemodialysis patients: a nationwide cross-sectional study

Background: In the era of digital and improved conventional medicine, many continue to use traditional and complementary medicine (TCM). The prevalence of its usage is not well reported, especially in patients with end-stage kidney disease (ESKD) receiving haemodialysis, thus its benefits and adverse effects are not widely known. This study determines the prevalence, types, perceptions and factors associated with TCM use by chronic haemodialysis patients in Malaysia. Methods: This is a multi-centre cross-sectional study involving patients undergoing haemodialysis treatment in Malaysia. A validated face-to-face questionnaire-based interview was conducted. Sociodemographic and clinical profiles of the patients, factors associated with TCM use, perceptions, sources of information, and disclosures to treating doctors were obtained. Data were analysed using SPSS software. Results: A total of n = 329 participants were recruited. The mean age of the participants was 54.9 ± 12.5 years. The majority were Malays (72%) and females (54.7%). A total of 64.7% (n = 213) reported TCM use; n = 132 used TCM before the initiation of dialysis, while n = 81 used TCM after initiation. In the post-hoc analysis, patients who had never used TCM had a higher mean age (56.7 ± 12.3 years) than the patients who used TCM (51.1 ± 13.1) (p = 0.015) and were likely to have received primary education (p = 0.011). Unemployment was more likely to be associated with non-TCM use; with odds ratio 1.85 (95% CI: 1.15, 2.98). Biologically based therapy was found to be the most popular (97.2%) type of TCM, including herbal medicine (67.6%) and supplements (58.0%). Most respondents did not disclose their TCM use to their doctors (72.3%), and 41.8% had the perception that they felt better. Conclusions: TCM is widely used among chronic haemodialysis patients in Malaysia, mainly herbal medicine and supplements. Non-disclosure to healthcare professionals and a poor monitoring and regulation of its use in ESKD patients could be detrimental. Awareness needs to be raised among healthcare professionals and the general population