Healthcare Challenges in the Management of Primary Aldosteronism in Southeast Asia.

OBJECTIVE: While guidelines have been formulated for the management of primary aldosteronism (PA), following these recommendations may be challenging in developing countries with limited healthcare access. Hence, we aimed to assess the availability and affordability of healthcare resources for managing PA in the Association of Southeast Asian Nations (ASEAN) region, which includes low-middle-income countries. DESIGN: We instituted a questionnaire-based survey to specialists managing PA, assessing the availability and affordability of investigations and treatment. Population and income status data were taken from the national census and registries. RESULTS: Nine ASEAN country members (48 respondents) participated. While screening with aldosterone-renin-ratio is performed in all countries, confirmatory testing is routinely performed in only six countries due to lack of facilities and local assays, and cost constraint. Assays are only locally available in four countries, and some centers have a test turnaround time exceeding three weeks. In seven countries (combined population of 442 million), adrenal vein sampling (AVS) is not routinely performed due to insufficient radiological facilities or trained personnel, and cost constraint. Most patients have access to adrenalectomy and medications. In six countries, the cost of AVS and adrenalectomy combined is >30% of its annual gross domestic product per capita. While most patients had access to spironolactone, it was not universally affordable. CONCLUSION: Large populations currently do not have access to the healthcare resources required for the optimal management of PA. Greater efforts are required to improve healthcare access and affordability. Future guideline revisions for PA may need to consider these limitations.

Obesity in South and Southeast Asia-A new consensus on care and management.

Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.

Fasting in Ramadan of Muslim patients with diabetes Mellitus, and knowledge and practice in relation to diabetes control in Brunei.

AIM: To investigate the fasting pattern of patients with Diabetes Mellitus in Brunei Darussalam, specifically, their fasting activities, and knowledge and practice in relation to diabetes control during fasting in Ramadan. METHODS: Cross-sectional study that included 18 years and older, Muslim patients with diabetes Mellitus who attended the main Diabetes Centre in Brunei. A self-administered questionnaire was designed, tested and used to collect the demographic information, fasting duration, knowledge and practice on diabetes control during fasting, and reasons of fasting as a Muslim. RESULTS: 183 participants with a mean age of 53.7 (SD 11.52) years were recruited. Prevalence of fasting during Ramadan was 93.4% with an average number of days of fasting was 24.1 days. Those with age 55 and above had significant higher prevalence of fasting than the younger group (p = 0.010). Only 49.1% of participants had consulted their healthcare professionals of their intentions to fast prior to the Ramadan, and only 38.1% of participants monitored blood glucose levels throughout the month. CONCLUSIONS: Diabetes education and early treatment adjustment especially before and during the month of Ramadan is essential to minimize hypoglycaemic risks and frequency of diabetes complications.