Management of prediabetes in Malaysian population: An experts' opinion.

INTRODUCTION: Prediabetes, typically defined as blood glucose levels above normal but below diabetes thresholds, denotes a risk state that confers a high chance of developing diabetes. Asians, particularly the Southeast Asian population, may have a higher genetic predisposition to diabetes and increased exposure to environmental and social risk factors. Malaysia alone was home to 3.4 million people with diabetes in 2017; the figure is estimated to reach 6.1 million by 2045. Developing strategies for early interventions to treat prediabetes and preventing the development of overt diabetes and subsequent cardiovascular and microvascular complications are therefore important. METHODS: An expert panel comprising regional experts was convened in Kuala Lumpur, for a one-day meeting, to develop a document on prediabetes management in Malaysia. The expert panel comprised renowned subject-matter experts and specialists in diabetes and endocrinology, primary-care physicians, as well as academicians with relevant expertise. RESULTS: Fifteen key clinical statements were proposed. The expert panel reached agreements on several important issues related to the management of prediabetes providing recommendations on the screening, diagnosis, lifestyle and pharmacological management of prediabetes. The expert panel also proposed changes in forthcoming clinical practice guidelines and suggested that the government should advocate early screening, detection, and intensive management of prediabetes. CONCLUSION: This document provides a comprehensive approach to the management of prediabetes in Malaysia in their daily activities and offer help in improving government policies and the decision-making process.

Identification of genetic variants associated with anterior cruciate ligament rupture and AKC standard coat color in the Labrador Retriever.

Canine anterior cruciate ligament (ACL) rupture is a common complex disease. Prevalence of ACL rupture is breed dependent. In an epidemiological study, yellow coat color was associated with increased risk of ACL rupture in the Labrador Retriever. ACL rupture risk variants may be linked to coat color through genetic selection or through linkage with coat color genes. To investigate these associations, Labrador Retrievers were phenotyped as ACL rupture case or controls and for coat color and were single nucleotide polymorphism (SNP) genotyped. After filtering, ~ 697 K SNPs were analyzed using GEMMA and mvBIMBAM for multivariate association. Functional annotation clustering analysis with DAVID was performed on candidate genes. A large 8 Mb region on chromosome 5 that included ACSF3, as well as 32 additional SNPs, met genome-wide significance at P < 6.07E-7 or Log10(BF) = 3.0 for GEMMA and mvBIMBAM, respectively. On chromosome 23, SNPs were located within or near PCCB and MSL2. On chromosome 30, a SNP was located within IGDCC3. SNPs associated with coat color were also located within ADAM9, FAM109B, SULT1C4, RTDR1, BCR, and RGS7. DZIP1L was associated with ACL rupture. Several significant SNPs on chromosomes 2, 3, 7, 24, and 26 were located within uncharacterized regions or long non-coding RNA sequences. This study validates associations with the previous ACL rupture candidate genes ACSF3 and DZIP1L and identifies novel candidate genes. These variants could act as targets for treatment or as factors in disease prediction modeling. The study highlighted the importance of regulatory SNPs in the disease, as several significant SNPs were located within non-coding regions.

Underreporting and Underrepresentation of Racial and Ethnic Minority Patients in Lymphedema Clinical Trials: A Systematic Review.

The generalizability of findings from Clinical Trials (CTs) investigating lymphedema treatment modalities requires an accurate representation of the target population. This study aims to evaluate racial and ethnic reporting and representation in lymphedema CTs. A comprehensive systematic literature search was conducted during May 2023 using multiple databases, following the PRISMA guidelines. All CTs published from 2018 to 2023 were included. A total of 84 articles were included in this review, from which 6,546 participants were included in the analysis. Seventy-four (88.1%) articles addressed secondary lymphedema, of which 60 (81.1%) were related to breast cancer. Only 12 (13%) of CTs reported at some extend race or ethnicity. Of these, five (41.6%) reported race and two (16.6%) reported ethnicity according to FDA guidelines. White race had the highest pooled prevalence (80%; 95% CI 72-86%; I2=90%), followed by Black (7%; 95% CI 2- 15%; I2= 94.3%) and Asian (4%; 95% CI 1-8%; I2= 89.9%). In studies reporting ethnicity, participants were predominantly non-Hispanic (92.1%; 95% CI 90 - 94%). There is an underreporting and underrepresentation of racial and ethnic minorities among lymphedema CTs, limiting their generalizability. It is imperative to future development of strategies to enhance diversity in the study sample.

The APOL1 genotype of African American kidney transplant recipients does not impact 5-year allograft survival.

Apolipoprotein L-1 (APOL1) gene variants are associated with end-stage renal disease in African Americans (AAs). Here we investigate the impact of recipient APOL1 gene distributions on kidney allograft outcomes. We conducted a retrospective analysis of 119 AA kidney transplant recipients, and found that 58 (48.7%) carried two APOL1 kidney disease risk variants. Contrary to the association seen in native kidney disease, there is no difference in allograft survival at 5-year posttransplant for recipients with high-risk APOL1 genotypes. Thus, we were able to conclude that APOL1 genotypes do not increase risk of allograft loss after kidney transplantations, and carrying 2 APOL1 risk alleles should not be an impediment to transplantation.

Forced vital capacity paired with Framingham Risk Score for prediction of all-cause mortality.

Forced vital capacity (FVC) measures lung function and predicts coronary heart disease (CHD); whether it provides additive prediction over CHD risk factors has not been established. We examined whether FVC adds to the prediction of all-cause mortality provided by Framingham Risk Score (FRS) alone. We examined 5,485 (61.1 million projected) nonsmoking adults from the USA who were aged 20-79 yrs. Subjects were from the Third National Health and Nutrition Examination Survey, were without obstructive lung disease, had FVC measurements and had ≤ 12 yrs (mean 8.8 yrs) mortality follow-up. We performed Cox regression analysis to examine whether FVC and forced expiratory volume in 1 s (FEV(1)) (categorised as low ≤ 85% predicted, borderline 86-94% predicted and normal ≥ 95% predicted) within FRS groups (10-yr risk of cardiovascular disease low <10%, intermediate 10-20%, high 20%) predict mortality. Receiver operator characteristic analysis examined whether FVC and FEV(1) added to the prediction provided by FRS. Low-, intermediate- and high-risk FRS groups had 79.5% (n = 4,361), 10.1% (n = 555) and 10.4% (n = 569) persons, respectively. Only the intermediate FRS group showed a graded increase in mortality (10.7, 18.2 and 42.8% per 1,000 person-yrs from highest to lowest FVC categories, respectively); those with low FVC had an almost three-fold greater risk of mortality (hazard ratio 2.64; p<0.01) than those with normal FVC. FVC provided incremental additive value for predicting mortality in addition to FRS for only this group (area under curve 0.65 versus 0.58; p<0.05). Similar results were obtained for FEV(1). Evaluation of lung function may be useful to improve risk stratification in persons with intermediate CHD risk where it adds to prediction of mortality over global risk assessment.

Life-threatening coagulopathy associated with use of Campath (alemtuzumab) in maintenance steroid-free renal transplant given before surgery.

We report a case in which an alarming coagulopathy occurred during the operation in a patient receiving a kidney from his spouse. Campath was used for induction of immunosuppression immediately before surgery. There was catastrophic intra-abdominal bleeding associated with severe hypotension, respiratory failure, prolonged partial thrombin time (PTT), normal prothrombin time (PT) and absence of signs of disseminated intravascular coagulation. Multiple tranfusions of blood and blood products were given. Repeated explorations were carried out to secure hemostasis and removal of intra-abdominal blood clots. The coagulopathy improved after 24 h, but recurred within 3 h after the second dose of Campath, given exactly 24 h after the first dose. The coagulopathy also resulted in graft dysfunction, bilateral basal pneumonia, pleural effusions and prolonged abdominal ileus. In spite of the above, the patient went into diuresis and was discharged well after 3 weeks. He was on Prograf (tacrolimus), the sole maintenance immunosuppressor. The pathogenesis of the Campath-related coagulopathy is unclear. We wish to alert the transplant community to this unusual, but catastrophic, complication. We also advocate administering intravenous Campath following the operation, when surgical wounds are more secure and the patient is in a more stable environment.

Genetic analysis of radiation sensitive and chemical-mutagen sensitive mutants of Pseudomonas aeruginosa.

Thirty-five mutants of Pseudomonas aeruginosa sensitive to methyl methanesulfonate (MMS) have been genetically characterized. They constitute ten separable groups as defined by transduction and conjugation. Three of the groups have been shown to be cotransducible with auxotrophic markers.

High-resolution electron microscopy of technegas and pertechnegas.

Once inhaled, technegas remains in the lungs for a long period of time, whereas pertechnegas rapidly disappears. To investigate this difference, the morphology of technegas and of pertechnegas was investigated using high-resolution transmission electron microscopy. The technegas and pertechnegas were generated in an atmosphere of pure argon and in 3% oxygen in argon, respectively, using a commercially available technegas generator. For the technegas, the technetium crystals were observed to be covered with carbon, whereas they were found to have no carbon coating with the pertechnegas. Whether or not the technetium is coated with carbon appears to be responsible for the differences in behaviour of technegas and pertechnegas after deposition on the lung epithelium following inhalation.

Injectable cartilage using polyethylene oxide polymer substrates.

This study demonstrates that polyethylene oxide gels, which are biocompatible and biodegradable synthetic polymers, can be utilized for the encapsulation of isolated chondrocytes and maintenance of three-dimensional spatial support for new tissue development. Chondrocytes isolated from the glenohumeral and humeroradioulnar joints of a calf were added to a 20% polyethylene oxide solution in Ham's F-12 medium to generate a final cellular density of 10 x 10(6)/mL. The polymer-chondrocyte constructs were injected through a 22-gauge needle in 500-microliters aliquots subcutaneously in 12 nude mice and incubated for 6 and 12 weeks in vivo. Histologic and biochemical analyses including deoxyribonucleic acid and glycosaminoglycan quantitative analyses confirmed the presence of actively proliferating chondrocytes with production of a well-formed cartilaginous matrix in the transplanted samples. Control specimens from eight implantation sites consisting of chondrocytes alone or polyethylene oxide substrates did not demonstrate any gross or histologic evidence of neocartilage formation. These findings demonstrate the potential use of an injectable and moldable polymer substrate that can support cell proliferation and matrix synthesis after subcutaneous transplantation for neocartilage generation. The use of functional biologic tissue substitutes may serve as an alternative solution to current methods of augmentation or reconstruction of structural craniofacial contour deformities.

Leadership in action: students learn with resource persons.

The faculty maintain close contact with the resource persons and are aware of their interaction with students on a weekly basis. Faculty and resource persons exchange observations, assessments, suggestions and problems they have either anticipated or experienced. The resource persons report that as students gain from the experiences, so do they. In particular, resource persons state interactions with students have stimulated them to increase their own clinical inquiry. A head nurse, functioning as a resource person, recently told the members of the Nursing Curriculum Committee she wished she had had such a course seven years ago when she was a senior in the program (S. Collier, personal communication, October 1987). She further elaborated that the learning opportunities she sees students experiencing today would have been invaluable to her and her peers as they began their professional nursing careers. We, the authors, believe individual learning opportunities with nurse leaders as resource persons is a unique, invaluable experience for nursing leadership students. These interactions provide a variety of learning opportunities sufficient for undergraduate students to develop beginning leadership skills, while also narrowing the education-practice gap. These experiences enhance the students' orientation to "real-world" nursing leadership and management. Students recognize the uniqueness of this teaching-learning strategy and value the time spent with resource persons. They frequently report never dreaming "that such problems have to be dealt with." They agree that learning with resource persons provides an essential ingredient for reinforcing the theoretical concepts of nursing leadership and putting classroom lectures into action.

Leadership: by the pros, for the novice.

Leadership, communication, motivation and conflict resolution strategies shared during Leadership Day gave new meaning to these theoretical concepts. Leadership Day proved to be an effective teaching strategy for socializing our nursing leadership students into the real world of today's nursing. This united effort between leaders in practice and leaders in education enhanced the success of this proactive approach. The presenters' personification of nursing leadership and management concepts, as well as the descriptions of specific "how to" strategies, provided a valuable ingredient for reinforcing the theoretical concepts. Leadership Day was so successful that we began making plans immediately to expand the event to include all senior nursing students the following year.

Nutriquest: a fun way to reinforce nutrition knowledge.

Gaming is an educational strategy that facilitates and reinforces student learning in a stimulating and dynamic format. The authors describe the creation and use of a nutrition review board game. The game, NUTRIQUEST, was used to reinforce the theoretical concepts of nutrition and the principles of dietary management.

Creative strategies for updating knowledge on sexually transmitted diseases.

Updating knowledge is important in maintaining effective nursing competency. The hectic pace of health care delivery in the 1990s does not always allow for attending day-long continuing education sessions. This article presents creative teaching-learning strategies that are self-paced, interesting, and less time intensive, designed to update nurses on sexually transmitted diseases.