Work disability and employment status among advanced chronic kidney disease patients.

INTRODUCTION: Chronic kidney disease (CKD) is a major public health issue with significant socioeconomic impacts. In Malaysia, the prevalence of CKD in 2018 was 15%. Complications of CKD such as anaemia, mineral bone disease, and infections led to frequent hospitalizations resulting in work disability and unemployment. To date, there is no data of employment status of CKD patients in Malaysia. METHODS: A cross-sectional study of patients with advanced CKD (stage 4 and 5 non-dialysis) treated in our centre. We interviewed those aged 18 to 60 years old who were selected based on random sampling of their employment status and associated factors. Work disabilities and quality of life were assessed using work productivity and activity impairment (WPAI-GH) questionnaire and kidney disease and quality of life (KDQOL-36) questionnaire. These questionnaires were assisted by the main investigators to aid participants in facilitating their response process. RESULT: A total of 318 patients recruited, 53.5% were males, with a mean age of 49.0 ± 9.0 years old. The main cause of CKD was diabetes (67.0%) followed by hypertension (11.3%). Majority of them were obese (55.3%) with a mean body mass index of 28.81 ± 6.3 kg/m2. The mean household income was RM 4669.50 ± 3034.75 (USD1006.27 ± 653.99). The employment rate was 50% (n = 159). 86% of the unemployed patients were in B40 income category. Multiple Logistic Regression was performed on the significant factors affecting employment status showed one year increase in age increased 6.5% odds to be unemployed. Female and dyslipidaemia had 2.24- and 2.58-times higher odds respectively to be unemployed. Meanwhile, patients with tertiary level of education were 81% less odds to be unemployed. Patients with advanced CKD had a mean percentage of 24.35 ± 15.23 work impairment and 13.36 ± 32.34 mean percentages of face absenteeism due to the disease burden. Furthermore, patients who were unemployed had significant perceived symptoms and problem lists, effects, and burden of kidney disease (p<0.01) and showed poor mental and physical composites (p<0.01) as compared with those who were employed. CONCLUSION: The employment rate of advanced CKD patients was low with half of patients lost their jobs due to the disease burden and had poor mental and physical composites of quality of life. This raises the concern for financial support for long term renal replacement therapy.

Challenges in the Management of Sarcopenia in the Primary Care Setting: A Scoping Review.

BACKGROUND: Sarcopenia is a disease associated with the loss of muscle mass, strength, and function. It affects the elderly in various ways, such as reduced mobility, compromising their daily activities, and even deteriorating metabolic health. Primary care serves as the first point of contact for patients and plays an important role in health promotion and disease prevention. Hence, this review is conducted to identify the challenges in the management of sarcopenia in the primary care setting. METHOD: In December 2022, a scoping review was conducted using PubMed, SCOPUS, Web of Science, and a manual search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. We used articles that have been written in English, and relevant articles were then screened, duplicates were removed, eligibility criteria were applied, and studies that met the criteria were reviewed. The keywords challenges, management, sarcopenia, and primary care were included. RESULT: The initial search generated 280 publications, and 11 articles were included after inclusion and exclusion criteria for this review. In this review, challenges in the management of sarcopenia in a primary care setting are reviewed based on the screening and diagnosis. CONCLUSIONS: With an increasing aging population, it is important to understand the challenges in the management of sarcopenia in a primary care setting. Identification of elderly at risk of sarcopenia, followed by referring the affected elderly for confirmation of the diagnosis, is essential to preventing the adverse health effects. The initiation of treatment that comprises resistance exercise training and nutrition should not be delayed, as they are salient in the management of sarcopenia.

Systematic review and meta-analysis of prognostic models in Southeast Asian populations with acute myocardial infarction.

Background: The cultural and genetic diversity of the Southeast Asian population has contributed to distinct cardiovascular disease risks, incidence, and prognosis compared to the Western population, thereby raising concerns about the accuracy of predicted risks of existing prognostic models. Objectives: We aimed to evaluate the predictive performances of validated, recalibrated, and developed prognostic risk prediction tools used in the Southeast Asian population with acute myocardial infarction (AMI) events for secondary events. Methods: We searched MEDLINE and Cochrane Central databases until March 2022. We included prospective and retrospective cohort studies that exclusively evaluated populations in the Southeast Asian region with a confirmed diagnosis of an AMI event and evaluated for risk of secondary events such as mortality, recurrent AMI, and heart failure admission. The CHARMS and PRISMA checklists and PROBAST for risk of bias assessment were used in this review. Results: We included 7 studies with 11 external validations, 3 recalibrations, and 3 new models from 4 countries. Both short- and long-term outcomes were assessed. Overall, we observed that the external validation studies provided a good predictive accuracy of the models in the respective populations. The pooled estimate of the C-statistic in the Southeast Asian population for GRACE risk score is 0.83 (95%CI 0.72-0.90, n = 6 validations) and for the TIMI risk score is 0.80 (95%CI: 0.772-0.83, n = 5 validations). Recalibrated and new models demonstrated marginal improvements in discriminative values. However, the method of predictive accuracy measurement in most studies was insufficient thereby contributing to the mixed accuracy effect. The evidence synthesis was limited due to the relatively low quality and heterogeneity of the available studies. Conclusion: Both TIMI and GRACE risk scores demonstrated good predictive accuracies in the population. However, with the limited strength of evidence, these results should be interpreted with caution. Future higher-quality studies spanning various parts of the Asian region will help to understand the prognostic utility of these models better. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?%20RecordID=228486.

The effect of vitamin D treatment on clinical and biochemical outcomes of primary aldosteronism.

INTRODUCTION: Primary aldosteronism (PA) contributed to the cardiovascular disease and metabolic alterations independent of the blood pressure level. Evidence exists that aldosterone excess also affects calcium and mineral homeostasis. PA subjects have been shown to have greater prevalence of vitamin D deficiency. However, the impact of vitamin D treatment in this population has never been assessed. OBJECTIVE: This study aimed to evaluate the effect of vitamin D treatment on clinical and biochemical outcomes of PA patients. METHODS: Two hundred forty hypertensive subjects were screened, 31 had positive ARR, and 17 patients with newly confirmed PA following positive confirmatory test that has not been subjected for definitive treatment were enrolled. Clinical parameter (blood pressure) and biochemical parameters (renal profile, plasma aldosterone concentration, plasma renin activity, serum calcium, vitamin D, intact parathyroid hormone, 24-hour urinary calcium) were measured at baseline and 3 months of treatment with Bio-D3 capsule. Primary outcomes were the changes in the blood pressure and biochemical parameters. RESULTS: About 70% of our PA subjects have low vitamin D levels at baseline. Three months following treatment, there were significant: (a) improvement in 25(OH)D levels; (b) reduction in systolic blood pressure and plasma aldosterone concentration; and (c) improvement in the eGFR. The vitamin D deficient subgroup has the greatest magnitude of the systolic blood pressure reduction following treatment. CONCLUSIONS: This study demonstrated significant proportion of PA patients has vitamin D insufficiency. Vitamin D treatment improves these interrelated parameters possibly suggesting interplay between vitamin D, aldosterone, renal function and the blood pressure.

Tissue and Serum Trace Elements Concentration among Colorectal Patients: A Systematic Review of Case-Control Studies.

BACKGROUND: Trace elements play a pivotal role in Colorectal Cancer (CRC) inhibition and development process. This systematic review provides the basic comparison of case-control studies focusing on concentration of trace elements between those with CRC and controls. METHODS: The systematic review searched through two databases of Medline and Cochrane up to 24th June 2017. The search strategy focused on Population, Intervention, Comparison, and Outcomes (PICO). We searched the role of trace elements in cancer and focusing on case-control studies in CRC to obtain an insight into the differences in trace element concentrations between those with and without cancer. RESULTS: The serum concentrations of Ca, Cu, Mg, Mn, Se, Si, and Zn were lower in CRC patients but for Co and S the levels were higher in CRC patients. The concentrations of Cd, Cr, Cu, Mg, Mn, Pb, and Zn were increased in patients with metastasis, but not in Se. As for colon tissue specimens, inconsistent levels were reported between studies, notably in Cu, Se, and Zn. No changes were reported for B and Ca levels. Most of the trace elements in the tissue specimens showed higher concentrations of Cr, Fe, K, Mg, P, Rb, S, and Si compared to Br. CONCLUSION: With the growing interest to understand the link between trace elements in carcinogenesis and the possible interactions, multi assessment analysis of a larger cohort of samples is necessary.

Relationship between Serum Cytokeratin-18, Control Attenuation Parameter, NAFLD Fibrosis Score, and Liver Steatosis in Nonalcoholic Fatty Liver Disease.

BACKGROUNDS: The aim of this study was to appraise the relationship between serum fragmented cytokeratin-18(CK-18), controlled attenuation parameter (CAP), and liver steatosis assessed by ultrasound (US) in nonalcoholic fatty liver disease (NAFLD) patients. METHODS: Patients who underwent abdominal US were recruited, followed with measurement of CAP using Fibroscan® and serum fragmented CK-18 using enzyme-linked immunosorbent assay. The degree of liver steatosis assessed by US was categorized into mild (S1), moderate (S2), and severe (S3). RESULTS: A total of 109 patients were included in our study. CAP and fragmented CK-18 level were significantly correlated with liver steatosis grade with rs = 0.56 and 0.68, p=0.001, respectively. NAFLD Fibrosis Score was poorly correlated with liver steatosis grade (rs=-0.096, p=0.318). Using fragmented CK-18 level, area under receiver operating characteristic (AUROC) curves for S≥2 and S≥3 were excellent (0.82 and 0.84, respectively). Using CAP, AUROC curves for detection of S≥2 and S≥3 were good (0.76, 0.77, respectively). We also proposed cut-off value of CAP to detect S≥2 and S≥3 to be 263 and 319db/m, respectively, and fragmented CK-18 level to detect S≥2 and S≥3 (194 and 294 U/L, respectively). CONCLUSIONS: Both the fragmented CK-18 level and the CAP, but not NAFLD Fibrosis Score, were well correlated with hepatic steatosis grade as assessed by US.

Perceived Risk of Developing Cancer in a Suburban Community in Malaysia

Objective: To determine the perceived risk of developing cancer in a suburban community in Malaysia. Methods: A cross sectional study using a simple random sampling was conducted among residents aged 18 years old and above (n=520) who had never been diagnosed with cancer, in selected households in a suburban area of Pahang state in Malaysia. The study instruments were a validated questionnaire on risk perception, an automatic blood pressure monitor, a weighing scale and a measuring tape. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 and the p value was taken at p <0.05 as significant. Result: This study revealed that only 5.0 percent individuals perceived they were at risk cancer, whilst the perceived severity was 41.3 percent. Multivariable analysis showed a significant association only for a family history of cancer (adjusted OR of 4.80; 95% CI = 1.45-15.82) (p=0.010) among this population. Conclusion: The perceived risk of developing cancer in the selected suburban community of Pahang state in Malaysia is low as compared to that for other non-communicable diseases in this country, whilst the perceived severity was higher than for other diseases. Thus, considering the importance of correct perceptions for behavioral changes, more health education and promotion is needed to make the community better aware of the actual threat of cancer.

The validation of the malay version of binge eating scale: a comparison with the structured clinical interview for the DSM-IV.

BACKGROUND: The Binge Eating Scale (BES) questionnaire is a self-administered instrument developed to identify binge eaters. The aim of this study was to assess the validity of the Malay language version of BES as a screening instrument for binge eating. A cut-off point of 17 is taken as comparable to the Structured Clinical Interview for the DSM-IV patient version (SCID-I/P), the gold standard for the diagnosis of Binge Eating Disorder. METHOD: The questionnaire was structured from the English version of the original scale which has 16 items. The sample was obtained from outpatients and healthy adult volunteers at a teaching hospital. After completion of BES, the participants were interviewed with the SCID-I/P. The interviewer was blinded to the BES score. RESULTS: The Malay version of BES yielded a sensitivity of 84.6%, specificity of 94.9%, a positive predictive value of 81.8%, a negative predictive value of 95.7%. Area under the curve was 0.95 (95% confidence interval: 0.90-0.99). The results of factor analysis indicated a two factor structure of feelings/cognition and behavioural manifestation of binge eating. Internal consistency, Cronbach's alpha was 0.89. CONCLUSION: The BES performed satisfactorily as a valid instrument for screening of binge eating among Malay-speaking population.

Clinical and high resolution computed tomography characteristics of patients with rheumatoid arthritis lung disease.

INTRODUCTION: Rheumatoid arthritis (RA) is a systemic disease of unknown cause. A variety of pulmonary disorders have been described in association with RA. Among the most common are interstitial lung disease (ILD) and bronchiectasis. OBJECTIVES: This study aims to determine the characteristics of RA patients with lung disease in relation to clinical characteristics, pulmonary function test (PFT) and high resolution computed tomography (HRCT) thorax. METHOD: This is a 6-months cross-sectional study involving 63 consecutive RA patients in an outpatient rheumatology clinic. Patients had a mean disease duration of 5 years and above. Disease activity and severity was assessed by Disease Activity Score 28 (DAS28), Health Assessment Questionnaire (HAQ) and Rheumatoid Arthritis Articular Damage (RAAD) score. Full pulmonary function test (PFT) and HRCT of thorax were performed. CONCLUSIONS: The prevalence of RA-ILD is 44% and 67% of patients are asymptomatic. There was significant higher proportion (68%) in patients of Chinese ethnicity who have ILD. Diffusion capacity of carbon monoxide was abnormal in all patients and forced expiratory flow (FEF)(25-75%) was low in 16%. Restrictive pattern was 66.7% by PFT. The most common HRCT findings were reticulation (46%) followed by ground glass opacities (38.1%) and bronchiectasis (28.6%). There was no association between ILD and male gender, duration of the disease, smoking, rheumatoid factor, extra-articular manifestations, disease activity or severity.