Enhancing diabetic care in the community in Malaysia: need for a paradigm shift

Efforts towards improving the management of diabetes mellitus has grown and progressed. Clinical studies and new drug discoveries have led to better treatment for patients. Most healthcare budgets devote an enormous amount of expenditure for the treatment of diabetes. However, despite all these efforts, the disease continues to grow and has been predicted to be unmanageable in the near future. Thus, there is a dire need to relook the current approaches and policies. “Prevention is better than cure” is definitely the precise solution to this catastrophe. A paradigm shift in strategies for the prevention of diabetes and treatment of its risk factors is an imperative

A community-based study on the prevalence and factors affecting smoking in Terengganu state, Malaysia, 2004

Introduction: It is estimated that 4.9 million people worldwide died in 2000 as a result of their addiction to nicotine, about half of them prematurely. This huge death toll is rising rapidly, especially in low and middle income countries where most of the world’s 1.2 billion tobacco users live. Objectives: This study aimed to determine (i) the prevalence of smoking among the community aged 18 and above in Terengganu state, and (ii) the relationship between smoking and age, sex, educational level, family and peer influence. Methods: A cross-sectional study design was used in this study and data was collected using a standardised pre-tested structured questionnaire. Results: The overall mean age of the respondents was 38.9 (95% CI= 37.7 – 40.2) years. The majority of the respondents were Malays (99.1%). Of the 653 respondents, 32.2% and 23.6% were ever and current smokers respectively. Of this, 211 ever smokers, 199 (94.3%) were males and only 12 (5.7%) were females. The prevalence of ever and current smokers for males was 73.2% and 53.7% respectively compared to the females (3.1% and 2.1% respectively). There was a significant association between smoking status and sex (p<0.001). The prevalence of ever smokers was lowest amongst respondents with college or university educational level. However, for current smokers, those with college or university education had the highest prevalence. The overall mean initiation age of ever smokers was 19.7 years (95% CI = 18.8 – 20.7). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001). The mean duration of smoking for the current smokers was 21.6 (95% CI= 19.1 – 24) years. There was also no significant difference in the mean duration of current smoking for males compared to the females (p = 0.5). The majority (93.4%) of the ever smokers started either because their friends asked them to try or they were trying for fun. The quit ratio was 27%. Conclusion : The prevalence of ever and current smokers in males is very high (73.2% and 53.7% respectively) compared with the females (3.1% and 2.1% respectively). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001)

Novel method to estimate the length of palmaris longus tendon

Palmaris longus is tendon of choice in reconstructive, plastic and cosmetic surgeries. Thus, a suitable length is required and it would be more convenient if the length of the tendon of the palmaris longus could be estimated before harvesting. This study was carried out to determine the relationship between the length and width of the palmaris longus tendon and the length of forearm and hand, the relationship between the length and the width of the palmaris longus tendon and wrist width and wrist circumference, as well as to identify a technique to estimate the length of the tendinous part of palmaris longus before harvesting it. A standardized proforma was used to collect the data of each of the 31 cadavers upper limbs. These data were analysed using SPSS software version 17. It is important to note that p value less than 0.05 is considered as statistically significant in this study. Out of the 31 upper limbs, palmaris longus tendon was absent in 3 (9.68%). Meanwhile, the mean length and width of the palmaris longus tendon was found to be 16.20 cm and 0.48 cm, respectively. The mean length of the forearm and hand was 26.6 cm and 21.2 cm, respectively. The mean width of the wrist and wrist circumference was 8.2 cm and 14.82 cm, respectively. These indicate a significant and moderate relationship between the length of palmaris longus tendon and the length of forearm (r = 0.49, r2=0.24, p < 0.01). In addition, there was also a significant relationship between the length of palmaris longus tendon and the length of hand (r = 0.56, p < 0.01). This paper presents the technique used to estimate the length and width of the tendinous part of palmaris longus before harvesting. The length of palmaris longus can be estimated pre-operatively by measuring the length of the hand by using the technique explained in this paper

Prevalence, awareness, treatment and control of hypertension in Malaysia: A national study of 16,440 subjects.

Study design: A cross-sectional study was conducted in all states of Malaysia to determine the prevalence, awareness, treatment and control of hypertension. A stratified two-stage cluster sampling design with proportional allocation was used. Methods: Trained nurses obtained two blood pressure measurements from each subject. Hypertension was defined as mean systolic blood pressure 4140 mmHg, diastolic blood pressure490 mmHg, or a self-reported diagnosis of hypertension and taking antihypertensive medication. All data were analysed using Stata 9.2 software and took the complex survey design into account. A two-sided P-value of o0.05 was considered to be statistically significant. Results: The overall prevalence of hypertension for subjects aged X15 years was 27.8% (95% confidence interval (CI) 26.9–28.8). The prevalence of hypertension was significantly higher in males (29.6%, 95% CI 28.3–31.0) compared with females (26.0%, 95% CI 25.0–27.1). Multivariate logistic regression showed that the odds of having hypertension increased with increasing age, in males, in subjects with a family history of hypertension, with increasing body mass index, in non-smokers and with decreasing levels of education. Only 34.6% of the subjects with hypertension were aware of their hypertensive status, and 32.4 were taking antihypertensive medication. Amongst the latter group, only 26.8% had their blood pressure under control. The prevalence of hypertension amongst those aged X30 years has increased from 32.9% in 1996 to 40.5% in 2004. Conclusion: In Malaysia, the prevalence of hypertension is high, but levels of awareness, treatment and control are low. There is an urgent need for a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension in Malaysians

Predicting coexistence of plants subject to a tolerance-competition trade-off

Ecological trade-offs between species are often invoked to explain species coexistence in ecological communities. However, few mathematical models have been proposed for which coexistence conditions can be characterized explicitly in terms of a trade-off. Here we present a model of a plant community which allows such a characterization. In the model plant species compete for sites where each site has a fixed stress condition. Species differ both in stress tolerance and competitive ability. Stress tolerance is quantified as the fraction of sites with stress conditions low enough to allow establishment. Competitive ability is quantified as the propensity to win the competition for empty sites. We derive the deterministic, discrete-time dynamical system for the species abundances. We prove the conditions under which plant species can coexist in a stable equilibrium. We show that the coexistence conditions can be characterized graphically, clearly illustrating the trade-off between stress tolerance and competitive ability. We compare our model with a recently proposed, continuous-time dynamical system for a tolerance-fecundity trade-off in plant communities, and we show that this model is a special case of the continuous-time version of our model.Comment: To be published in Journal of Mathematical Biology. 30 pages, 5 figures, 5 appendice

A population-based study on the prevalence and factors associated with obesity in Selangor

Objective: This study was conducted to determine prevalence and factors associated with obesity in Selangor, Malaysia. Methods: A population-based cross-sectional study was conducted in all districts of Selangor State. All individuals, 15 years and above in the selected households, were included. A pre-tested structured questionnaire was used to collect the data. Weight was recorded using TANITA model HD-309 and height was measured using SECA Body meter Model 208. Statistical analysis was performed using Stata 8.2 taking into account the complex survey design. Results: The overall mean age of the 2219 respondents was 36.6(95% CI 35.7 – 37.6) years. There was no significant difference in the mean age of the males and females (p=0.697). The majority of the respondents were Malays (52.9%), followed by Chinese (30.9%), Indians (15.4%) and other races (0.9%). The overall mean BMI was 24.1 kg/m2 (95% CI=23.8- 24.4). The overall prevalence of obesity was 12.2% (95% CI 10.6%, 14.0%). There was no significant difference in the prevalence of obesity in the males compared to females (p>0.05). The prevalence of obesity increased with age up to the ages of 40-59 years and then decreased after 60 years. The highest prevalence of obesity was in the 40-59 years age groups in both sexes. The overall prevalence of obesity was significantly higher amongst the Malays (15.2%) compared to the Indians (11.6%) and Chinese (7.3%). Multivariate logistic regression analysis showed that only age and ethnicity were associated with obesity. Sex and educational level were not associated with obesity

A national study on the prevalence and factors associated with smoking amongst Malaysians aged 18 years and above

A cross-sectional study was conducted in Malaysia with the objectives of determining the prevalence of smoking in Malaysia, reasons for starting to smoke, age first started to smoke, duration of smoking and to determine the relationship between smoking and age, sex, race, education level, peer influence and parental smoking status. Methods: All residents aged 18 years and above from selected households were included in this study. A standardised pre-tested structured questionnaire was used in this study. Results: The results showed that the overall mean age of the 17, 246 respondents was 38.8 (95% CI= 38.5 - 39.2) years with a range of 18 - 100 years. The majority were Malays (55.5%) followed by Chinese (21.2%) and Indians (11.2%). The age, sex and ethnicity adjusted prevalence of ever and current smokers were 32.0% and 24.9% respectively. The prevalence of ever and current smokers for males was 59.3% and 47.2% respectively. For the females, the prevalence of ever and CUlTentsmokers was 4.8% and 2.7% respectively. The highest ethnicity adjusted prevalence of current smokers was in Malays (28.9%), followed by the Chinese (18.7%). The lowest prevalence was amongst the Indians (16.8%). The highest prevalence of current smokers was found in Kelantan (30.2%), Terengganu (29.7%), Pahang (28.7%) and Kedah (26.9%); the lowest prevalence was in Kuala Lumpur, Federal Teritory (20.4%). The overall mean initiation age of current smokers was 19.2 years (95% CI = 19.1, 19.4 years). The mean initiation age of male current smokers was significantly lower (18.9 years) compared to female current smokers (24.1 years). The mean duration of smoking amongst the current smokers was 18.6 years. Males smoked significantly more cigarettes than the females ( p < 0.00 I). D isc u ssio n : Multivariate logistic regression analysis showed that smoking was significantly associated with age, sex, ethnicity, educational level and peer and family influence

DYNAMIC CONTAINER NETWORK AND SERVICE MESH POLICY ACTIONS BASED ON MALWARE AND INTRUSION DETECTION

A closed loop solution is provided for dynamically enforcing container network and service mesh policies based on dynamic malware detection. This may be integrated with existing enterprise firewalls, intrusion detection systems, and other similar malware detection appliances

Unmanned Surveillance

Guest Editoia

Genetic Polymorphism Of Glutathione S-Transferase P1 (GSTP1) Gene and Its association with Bladder Cancer Susceptibility

INTRODUCTION: Bladder cancer is one of the most common urological malignancies. As per the Indian cancer registry data, it is the ninth most common cancer in men accounting for 3.9% of all cancer cases. In the middle-aged and elderly men; bladder cancer is the second most prevalent malignancy after prostate cancer. It is well documented that the tobacco smoke and occupational carcinogens promote epithelial cell dysplasia and they are the most common environmental cause of urothelial carcinoma of the bladder. Most of these carcinogens are detoxified by phase II metabolic enzymes like Glutathione S transferase. It is hypothesized that polymorphisms in genes encoding these enzymes, affects susceptibility to develop urothelial cancers (UC). One of the extensively studied genes in this group is glutathione S-transferase P1 [GSTP1]. Studies of the relationship of polymorphisms of GSTP1 and UC of bladder have been equivocal, with some studies claiming positive associations with GSTP1 polymorphism while the others claiming a negative association. This present study aims to assess the association between genetic polymorphism of GSTP1 gene and development of UC of bladder in patients presenting to Christian Medical College and Hospital, Vellore. AIM / OBJECTIVES: This study aims to assess the association between genetic polymorphism of GSTP1 gene and development of UC of bladder in patients presenting to our hospital. MATERIAL AND METHODS: Prospective case control study from July 2012 - July 2013. We included cases with histological proven diagnosis of TCC bladder and excluded patients with cancer metastasized to bladder from any other origin, prior history of radiotherapy or chemotherapy. Controls individuals were patients with non-malignant urological diseases and a normal cystoscopy. Sample size of 45 in each group was calculated using power of 80%, expected frequency of risk allele in the control population of 0.28 and genetic effect for odds ratio 2.5. The genetic polymorphism of GSTP1 gene was compared in both the groups using SPSS 18. RESULTS: Most patients with UC of bladder were smokers. There was no significant association with the GSTP1 polymorphism and UC of bladder. No association was found even after a subset analysis was performed by stratifying population data into various geographical regions. CONCLUSIONS: Although lack of association between GSTP1313 G/G polymorphism and UC of bladder was seen in our study, it might be due to a small sample size or the effect of complex interaction between polymorphisms of other glutathione enzymes. It is also possible that the polymorphism is not associated with UC of bladder in our population. For further confirmation, large scale population-based studies are required