Prevalence of Latent Tuberculosis Infection and its Associated Factors Among Diabetic Patients Availing Primary Health Care in Terengganu State, Malaysia.

Objectives: Diabetes mellitus (DM) patients are considered to be at high risk for contracting latent tuberculosis infection (LTBI). This study aimed to determine the prevalence of LTBI and its associated factors among diabetic patients attending primary care clinics in Terengganu state, Malaysia. Methods: This cross-sectional study was conducted among diabetic patients attending 11 health clinics in the Terengganu region from June 2017 to November 2018. The selected participants were administered a tuberculin skin test (TST). Simple and multivariate logistic regressions were applied to evaluate the significant associated factors of LTBI. Results: The total number of participants were 703 DM patients. The factors found associated with LTBI were poor diabetic control status (odds ratio (OR) = 8.53; p=0.008), being a healthcare worker (OR = 7.91; p=0.001), history of contact with TB patients (OR = 5.69; p < 0.001), bronchial asthma (OR = 5.28; p=0.019), coronary heart disease (OR = 3.45; p=0.026), and nephropathy (OR = 0.34; p=0.040). The presence of LTBI was found in 34 (4.8%) participants. Conclusions: At 4.8%, the prevalence of LTBI among DM patients in Terengganu is relatively low. Diabetics with poorly controlled blood glucose levels, nephropathy, bronchial asthma, coronary heart disease, history of TB patient contact, or working in the healthcare profession should be periodically tested for LTBI.

Development of COVID-19 Health-Risk Assessment and Self-Evaluation (CHaSe): a health screening system for university students and staff during the movement control order (MCO).

COVID-19 has triggered a global health crisis. Death from severe respiratory failure and symptoms, including fever, dry cough, sore throat, anosmia, and gastrointestinal disturbances, has been attributed to the disease. Development of screening and diagnosis methods prove to be challenging due to shared clinical features between COVID-19 and other pathologies, such as Middle Eastern respiratory syndrome, severe acute respiratory syndrome, and common colds. This study aims to develop a comprehensive one-stop online public health screening system based on clinical and epidemiological criteria. The immediate target populations are the university students and staff of University Sultan Zainal Abidin and the civil servants of the Malaysian Ministry of Science, Technology, and Innovation. Forty-nine (49) clinical and epidemiological factors associated with COVID-19 were identified and prioritized based on their prevalence via rigorous review of the literature and vetting sessions. A pilot study of 200 volunteers was conducted to assess the extent of risk mitigation of COVID-19 infection among the university students and civil servants using the prototyped model. Consequently, twelve (12) clinical parameters were identified and validated by the medical experts as essential variables for COVID-19 risk-screening. The updated model was then revalidated via real mass-screening of 5000 resulting in the final adopted CHaSe system. Principal component analysis (PCA) was used to confirm the weightage of risk level toward COVID-19 to procures the optimal accuracy, reliability, and efficiency of this system. Twelve (12) factor loadings accountable for 58.287% of the clinical symptoms and clinical history variables with forty-nine (49) parameters of COVID-19 were identified through PCA. The variables of the clinical and epidemiological aspects identified are the C6 (History of joining high-risk gathering (where confirmed cases had been recorded), CH11 [History of contact with confirmed cases (close contact)], CH13 [Duration of exposure with confirmed cases (minutes)] with substantial positive factors of 0.7053, 0.706 and 0.5086, respectively. The contribution toward high-risk infection of COVID-19 was firmly attributable to the variables CH14 [Last contact with confirmed cases (days)], CH13 [Duration of exposure with confirmed cases (minutes)], and S1 (Age). The revalidated PCA for 5000 respondents also yielded twelve significant PCs with a cumulative variance of 58.288%. Importantly, the medical experts have revalidated the CHaSe system for accuracy of all clinical aspects (clinical symptoms and clinical history) and epidemiological links to COVID-19 infection. After revalidating the model for 5000 respondents, the PC variance for PC1, PC2, PC3, and PC4 was 27.36%, 11.79%, 10.347%, and 8.785%, respectively, with the cumulative explanation of 58.288% in data variability. The level of risks detected using the CHaSe system toward COVID-19 provides optimal accuracy, reliability, and efficiency to conduct mass-screening of students and government servants for COVID-19 infection.

Prevalence and Risk Factors of Latent Tuberculosis Infection (LTBI) in Patients with Type 2 Diabetes Mellitus (T2DM).

Type 2 diabetes mellitus (T2DM) and tuberculosis (TB) together impose a high disease burden in terms of both mortality and health economics worldwide. The objective of this study was to estimate the prevalence and risk factors of latent TB infection (LTBI) in patients with T2DM in Malaysia. A cross-sectional study was performed, and adult T2DM patients (n = 299) were included. Simple and multiple logistic regression analyses were performed to identify the LTBI-associated risk factors in patients with T2DM. Multiple logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CIs) between T2DM and LTBI and was adjusted for potential confounders. The prevalence of LTBI in patients with T2DM was 11.4% (95% CI: 8.0-15.0%). There was no significant difference in the socio-demographic characteristics between LTBI and non-LTBI subjects. No significant difference in the smoking status, the duration of smoking, and the duration of T2DM, HbA1c, or treatments was observed. Interestingly, a higher level of education was observed to be associated with a lower prevalence of LTBI in T2DM patients (aOR: 0.08, 95% CI: 0.01-0.70, p = 0.02). Although the prevalence of LTBI in T2DM was low, it is important to screen for it in T2DM patients due to the risk of developing severe active TB.

Leptin and calorie intake among different nicotine dependent groups.

BACKGROUND: Exposure to nicotine via tobacco smoking may influence leptin release and decrease food intake among smokers. However, the effect of nicotine exposure on leptin and food intake among different nicotine dependent groups is unclear. OBJECTIVE: We aimed to measure leptin and calorie intake among different nicotine dependent groups. DESIGN: Cross-sectional study. SETTING: Research department in school of medical sciences. PATIENTS AND METHODS: Subjects were selected by purposive (non-probability) sampling and categorized as having low, moderate and high nicotine dependency based on the Fagerstrom Test for Nicotine Dependence (FTND) score. Diet was recorded by interview. Anthropometry, blood pressure, body composition, lipid profile, and physical activity level were measured accordingly. Fasting serum leptin was measured using a commercial ELISA kit. MAIN OUTCOME MEASURE(S): Nicotine dependency, 24-hour diet, clinical anthropometric and clinical measurements. RESULTS: In 107 Malay male smokers leptin concentration was inversely correlated with nicotine dependence. However, body weight, smoking period, blood pressure, body composition, lipid profile and physical activity level were not significantly different among low, moderately and highly dependent smoking groups. Leptin concentration and total calorie intake were also not significantly different among these groups. CONCLUSION: Leptin concentration was inversely correlated with nicotine dependence, but leptin concentration and total calorie intake status were not significantly different among our different nicotine dependency subjects. LIMITATIONS: Purposive sampling for subject recruitment and inaccurate information in the self-administered questionnaire.

The effects of Secondhand Smoke (SHS) exposure on microvascular endothelial function among healthy women.

BACKGROUND: Studies have demonstrated that secondhand smoke (SHS) exposure could impair endothelial function. However, the effect of SHS exposure specifically on microvascular endothelial function is not well understood. This study aimed to determine the effects of SHS exposure on microvascular endothelial function among non-smoking, generally healthy women. FINDINGS: We studied 127 women; and based on their hair nicotine levels measured using gas chromatography-mass spectrometry, 25 of them were categorized as having higher hair nicotine levels, 25 were grouped as having lower hair nicotine and 77 women were grouped into the non-detected group. The non-detected group did not have detectable levels of hair nicotine. Anthropometry, blood pressure (BP), lipid profile and high-sensitivity C-reactive protein (hsCRP) were measured accordingly. Microvascular endothelial function was assessed non-invasively using laser Doppler fluximetry and the process of iontophoresis involving acetylcholine and sodium nitroprusside as endothelium-dependent and endothelium-independent vasodilators respectively. The mean hair nicotine levels for higher and lower hair nicotine groups were 0.74 (1.04) and 0.05 (0.01) ng/mg respectively. There were no significant differences in anthropometry, BP, lipid profile and hsCRP between these groups. There were also no significant differences in the microvascular perfusion and endothelial function between these groups. CONCLUSION: In this study, generally healthy non-smoking women who have higher, lower and non-detected hair nicotine levels did not show significant differences in their microvascular endothelial function. Low levels of SHS exposure among generally healthy non-smoking women may not significantly impair their microvascular endothelial function.

Participation and barriers to colorectal cancer screening in Malaysia.

In Malaysia, colorectal cancer is the most common cancer in males and the third most common in females. Mortality due to colorectal cancer can be effectively reduced with early diagnosis. This study was designed to look into colorectal cancer screening participation and its barriers among average risk individuals in Malaysia. A cross sectional study was conducted from August 2009 till April 2010 involving average risk individuals from 44 primary care clinics in West Malaysia. Each individual was asked whether they have performed any of the colorectal cancer screening methods in the past five years. The barrier questions had three domains: patient factors, test factors and health care provider factors. Descriptive analysis was achieved using Statistical Program for Social Sciences (SPSS) version 12.0. A total of 1,905 average risk individuals responded making a response rate of 93.8%. Only 13 (0.7%) respondents had undergone any of the colorectal cancer screening methods in the past five years. The main patient and test factors for not participating were embarrassment (35.2%) and feeling uncomfortable (30.0%), respectively. There were 11.2% of respondents who never received any advice to do screening. The main reason for them to undergo screening was being advised by health care providers (84.6%). The study showed that participation in colorectal cancer screening in Malaysia is extremely low and multiple factors contribute to this situation. Given the importance of the disease, efforts should be made to increase colorectal cancer screening activities in Malaysia.