Cross-cultural adaptation and psychometric evaluation of the Malay version of the Neck Disability Index.

PURPOSE: Translating the Neck Disability Index (NDI) into the Malay language (NDI-M); evaluation of psychometric properties in patients with neck pain. METHODS: The NDI-M was translated according to established guidelines. In the first visit, 120 participants completed the NDI-M, visual analogue scale (VAS) for pain and demographic details. 98 participants returned to complete similar questionnaires and the Global Rating of Change (GRoC) scale. The NDI-M was evaluated for internal consistency, test-retest reliability, content validity, construct validity and responsiveness. RESULTS: The NDI-M demonstrated excellent internal consistency (Cronbach's α = 0.84) and good test-retest reliability (ICC2,1 = 0.79). Content validity was confirmed with no floor or ceiling effects. Construct validity was established revealing three-factor subscales explaining 68% of the total variance. The NDI-M showed a moderate correlation with VAS (Rp = 0.49, p < 0.001). Regarding responsiveness, a moderate correlation between NDI-M change scores and VAS change scores was found (Rp = 0.40, p < 0.001). However, there was no significant correlation between NDI-M with GRoC (Rs = 0.11, p = 0.27). CONCLUSIONS: The NDI-M is a reliable and valid tool to measure functional outcomes in patients with neck pain. It is responsive in detecting changes in pain intensity during a patient's rehabilitation journey.Implications for rehabilitationThe NDI was translated into the Malay language and culturally adapted for Malay-speaking patients with neck pain.The NDI-M demonstrated an excellent level of internal consistency and good test-retest reliability. It demonstrated content and construct validity, with three-factor subscales, and moderate responsiveness for pain intensity.The NDI-M is a reliable, valid and responsive instrument to measure functional limitations in patients with neck pain for rehabilitation.

Demographic characteristics and outcomes of continuous ambulatory peritoneal dialysis related peritonitis in Miri General Hospital, Malaysia.

INTRODUCTION: Sarawak has a population that is geographically and characteristically widely varied. In this study we aimed to determine the demographic characteristics of our patient population who undergo continuous ambulatory peritoneal dialysis (CAPD) and to study the incidence, the microbiology and the outcome of CAPD peritonitis. METHODS: A retrospective record review of all CAPD patients on follow-up at the Miri Hospital, Sarawak, Malaysia from 2014 until 2017 was done. RESULTS AND DISCUSSION: During the 4-year period, the overall peritonitis rate was 0.184 episodes per patient-year. Gram-positive and gram-negative bacteria each constituted one-third of the peritonitis; fungi (2.6%), Mycobacterium tuberculosis (MTB) (5.3%), polymicrobial (2.6%) and sterile culture (26.3%). The most commonly isolated gram-positive bacteria were coagulase-negative Staphylococcus. Our peritonitis rate is comparable to that of other centres i.e., Japan 0.195 and Indonesia 0.25. In comparison, countries like India (0.41), Korea (0.40) and Singapore (0.59) had relatively higher rate of PD-associated peritonitis. Two tuberculosis peritonitis patients died. The rate of catheter removal was approximately 20%. Gram-negative bacteria and MTB have a higher risk of catheter loss. About one-fifth used rainwater to clean their CAPD exit site. Out of this group, 33% did not boil the rainwater prior to usage. CONCLUSION: Patient's characteristics and microbial susceptibility vary in different places of practice. The high rates of culture-negative peritonitis and high mortality risks associated with TB peritonitis warrant special attention. In patients with refractory peritonitis, early catheter removal is warranted in order to reduce mortality and minimize damage to peritoneal membrane.

Intraobserver and interobserver reliability of the computed tomography-based radiographic classification of primary elbow osteoarthritis: comparison with plain radiograph-based classification and clinical assessment.

OBJECTIVES: To develop a staging system that could better reflect symptoms by the spurs quantification in the fossa and joint space narrowing using computed tomography (CT) for elbow arthritis and to evaluate its reproducibility with multiple readers. METHODS: This retrospective study evaluated 81 cases of primary elbow osteoarthritis using both plain radiography and CT. Qualitative and quantitative analyses were independently performed by four orthopedic surgeons using previous and newly proposed staging systems. The reproducibility of the new system was analyzed with intraclass correlation coefficients (ICC). Correlations between symptoms and radiologic classification were assessed using Pearson's correlation coefficient (PCC). RESULTS: The interobserver agreement (1) and intraobserver agreement (2) among the four evaluators was present by ICC. (1) The system of Hastings and Rettig [first observation, 0.544 (95% confidence interval (CI), 0.436-0.649); second observation, 0.582 (95% CI, 0.478-0.682)] and Broberg and Morrey's staging system [first observation, 0.620 (95% CI, 0.521-0.714); second observation, 0.656 (95% CI, 0.562-0.743)] showed substantial and moderate retrospective agreement, whereas the CT-based staging system showed almost perfect agreement [first observation, 0.867 (95% CI, 0.820-0.906); second observation, 0.909 (95% CI, 0.875-0.936)]. (2) The intraobserver agreement was almost perfect in the Brogerg and Morrey's and CT-based staging systems. CT-based staging showed high correlation with visual analogue scale (PCC 0.754, P < 0.001) and Mayo elbow performance score (PCC -0.614, P < 0.001) and moderate correlation with range of motion (PCC -0.458, P < 0.001). CONCLUSIONS: CT-based staging system was highly reproducible and clinically feasible than previous plain radiograph-based staging systems.

Achieving triple treatment goals in multi-ethnic Asian patients with type 2 diabetes mellitus in primary care.

INTRODUCTION: Achieving optimal glycated hemoglobin (HbA1c), blood pressure (BP), and LDL-Cholesterol (LDL-C) in patients mitigates macro- and micro-vascular complications, which is the key treatment goal in managing type 2 diabetes mellitus (T2DM). This study aimed to determine the proportion of patients in an urban community with T2DM and the above modifiable conditions attaining triple vascular treatment goals based on current practice guidelines. METHODS: A questionnaire was distributed to adult Asian patients with dyslipidemia at two primary care clinics (polyclinics) in northeastern Singapore. The demographic and clinical data for this sub-population with both T2DM and dyslipidemia were collated with laboratory and treatment information retrieved from their electronic health records. The combined data was then analyzed to determine the proportion of patients who attained triple treatment goals, and logistic regression analysis was used to identify factors associated with this outcome. RESULTS: 665 eligible patients [60.5% female, 30.5% Chinese, 35% Malays, and 34.4% Indians] with a mean age of 60.6 years were recruited. Of these patients, 71% achieved LDL-C ≤2.6 mmol/L, 70.4% had BP

Study of low salt diet in hypertensive patients with chronic kidney disease.

INTRODUCTION: The efficacy of blood pressure (BP) reduction with salt restriction in CKD subjects and its sustainability is not well established. METHODS: We enrolled 75 hypertensive patients with CKD into one-month salt restricting diet. 24-hour urinary sodium and potassium was measured to verify their salt intake followed by 1½ year follow-up. RESULTS: Their creatinine clearance was 43 ± standard deviation 33ml/min/1.73m2. Urinary Na excretion (24HUNa) was 173±129mmol/day, reducing to 148±81 by 31±6 day. Mean, systolic and diastolic BP (MBP, SBP, DBP) were reduced from 102±9 to 97±11 (p<0.001), 148±10 to 139±16 (p<0.001), 78±12 to 75±12 mmHg (p=0.012) respectively. Moderate correlations were shown between reductions in 24-hour urinary Na and MBP, SBP, DBP: r=0.366, 0.260, 0.365; p=0.001, 0.025, 0.001; whereas 24-hour urinary Na-K ratio showed mild correlation. Subjects have some tendency to drift back to previous Na intake profile in follow-up and thus repetitive education is necessary. In subanalysis, 34 subjects with baseline 24HUNa >150 mmol/day, benefited significantly with MBP, SBP, DBP reduction from 102±9 to 95±9 (p=0.001), 146±10 to 135±14 mmHg (p=0.001), 80±11 to 75±11 mmHg (p=0.002) in line with 24HUNa reduction from 253±154 to 163±87mmol/day (p=0.004) and urinary protein-creation ratio reduction from geometric mean of 95 to 65 g/mol. Thirty five subjects with 24HUNa reduction of >20mmol/day have significant reduction in MBP, SBP, DBP: -8 vs -2, -15 vs -4, -5 vs -2 mmHg (p=0.027, 0.006, 0.218) and urinary protein-creatinine ratio: -82 vs 2g/mol (p=0.030) compared to the other forty subjects. CONCLUSION: Quantification of 24-hour urinary Na helps in predicting potential antihypertensive effect with dietary salt reduction of CKD subjects. Salt restriction reduces BP especially in patients with estimated daily sodium intake of >150mmol/day. Reduction in sodium intake beyond 20mmol/day reduced both BP and proteinuria.

The effect of the intensity of lipid-lowering medications on the LDL cholesterol treatment goals of Asian patients with dyslipidaemia in primary care.

WHAT IS KNOWN AND OBJECTIVE: Dyslipidaemia is the key risk factor for arthrosclerosis, leading to myocardial infarctions and strokes. Achieving LDL cholesterol (LDL-C) treatment goals using lipid-lowering therapy (LLT) mitigates such cardiovascular risks. This study aimed to determine the proportions and factors influencing patients with dyslipidaemia on LLT who achieved their recommended LDL-C treatment goals. METHODS: Adult Asian patients with dyslipidaemia, aged 31-80 years, were enrolled in a questionnaire survey. Using simplified Framingham risk scores, these patients were classified into low (LR), medium (MR) and high (HR) cardiovascular risk groups. Their lipid-lowering therapy was classified into low-intensity (LI), medium-intensity (MI) and high-intensity (HI) groups according to the 2013 American College of Cardiology and American Heart Association (ACC/AHA) Blood Cholesterol Guidelines. Data on their demographic, clinical, self-reported attitude and adherence to LLT were correlated with their latest lipid profiles from their electronic health records. These data were analysed using chi-square test, or independent t-test where appropriate for categorical variables and continuous data. Logistic regression was used to identify factors relating to LDL-C goal attainment. RESULTS AND DISCUSSION: Amongst the 917 patients treated with LLT, 60·9% were females and 56·2% aged >60 years. The commonest statins prescribed were simvastatin (77·7%), atorvastatin (15·3%), rosuvastatin (4·3%) and lovastatin (3·4%). Those who attained LDL-C treatment goals included 89·4%, 77·4% and 70% of the LR, MR and HR groups. Overall, 72·4% of the patients achieved LDL-C treatment goals. Despite 98·4% of them self-reported LLT adherence, only 85·5%, 69·5% and 50% of the LI, MI and HI subgroups attained the desired outcomes, respectively. WHAT IS NEW AND CONCLUSION: Overall, 27·6% of patients with dyslipidaemia, including 30% of the HR group, did not achieve LDL-C treatment goals, despite on LLT. Addressing their concerns and adjusting medication doses of their LLT are needed for better outcomes.

Effect of wrist position on the measurement of carpal indices on the lateral radiograph.

The purpose of this study was to find out whether the carpal indices measured on lateral radiographs with a slightly malpositioned wrist are the same as those measured in the true neutral position. Lateral radiographic views of 25 wrists were taken with 5° intervals from 20° of flexion to 20° of extension. Most carpal indices measured in the flexed or extended position were significantly different from the wrist in zero flexion-extension, except scapholunate angle at 5° of extension and scaphocapitate angle at 5° and 10° of flexion. Starting from the flexed position, there was an average of -4.0° change in radioscaphoid angle, -1.0° in scapholunate angle, -1.0° in scaphocapitate angle, +3.0° in radiolunate angle, and +2.0° in lunocapitate angle for each 5° of extension with linear trends. The results from this study suggest that even minimal degrees of flexion-extension can affect the measurements of carpal indices on lateral radiographs.

Low efficacy of entecavir therapy in adefovir-refractory hepatitis B patients with prior lamivudine resistance.

We determined the virologic response, incidence of entecavir resistance, and evolution of lamivudine and adefovir-resistant mutants during entecavir (ETV) therapy in adefovir-refractory patients with prior lamivudine resistance. Forty adefovir-refractory chronic hepatitis B patients with prior lamivudine resistance who had received entecavir for > or = 6 months were included and monitored for virologic response and entecavir resistance. Ten per cent of patients achieved HBV DNA < 50 copies/mL by PCR after 24 weeks of ETV therapy, and an initial virologic response was observed in 12 of 40 patients (30%). Higher pretreatment ALT (P = 0.039) and the presence of the rtL180M mutation (P = 0.038) were associated with an initial virologic response. During a mean follow-up of 11.4 months, four patients (10%) experienced virologic breakthrough, while ETV-resistant mutants were detected in six patients (15%). YMDD and adefovir-resistant mutants were detected in 57 and 35% of patients at baseline, respectively. At 48 weeks of therapy, 96 and 4% of patients had YMDD and adefovir-resistant mutants, respectively. These data suggest an early development of ETV resistance and low antiviral response during ETV therapy in adefovir-refractory patients with prior lamivudine resistance.

Impact of pre-dilution and flushing on continuous renal replacement therapy.

INTRODUCTION: Infusing the replacement solution before the filter (pre-dilution) and regular flushing have not been accounted for in conventional mathematical equations. Their effects on various continuous renal replacement therapy (CRRT) parameters, such as ultrafiltration fraction and urea clearance, have not been well studied. We incorporated these parameters into mathematical equations to help in understanding and prescribing CRRT. METHODS: We built a mathematical model to evaluate the plasma flow rate, filter fluid inflow rate with pre- and post-dilution and ultrafiltration rate, plasma clearance of urea, and ultrafiltration fraction. RESULTS: In pre-dilutional therapy, the volume of replacement needed to be increased in order to achieve the target plasma clearance rate. The extra volume needed increased exponentially with higher target plasma clearance rate. The higher the targeted plasma clearance in relation to blood flow rate (Qb), the greater the increase. Increasing blood flow rate reduced the ultrafiltration fraction for both pre- and post-dilution therapy. It had no effect on plasma clearance with post-dilution therapy but significantly improved the clearance in pre-dilution therapy. Higher haematocrit resulted in higher ultrafiltration fraction in both pre- and post-dilution therapy. Higher haematocrit had no effect on plasma clearance with post-dilution therapy but slightly reduced clearance in pre-dilution therapy. For a given total volume of ultrafiltration, flushing reduced plasma clearance with both pre- and post-dilution therapy. Flushing slightly reduced ultrafiltration fraction of post-dilution therapy but minimally increased the ultrafiltration fraction of pre-dilution therapy. This mathematical model could be utilised in prescribing Qb and replacement rate based on targeted plasma clearance, ultrafiltration fraction, fluid removal rate and haematocrit. There was close approximation of predicted and measured urea plasma clearance. CONCLUSION: Pre-dilution therapy reduced urea clearance significantly and this needed to be compensated for by increasing the volume of ultrafiltration or Qb. Flushing was of limited benefit and may reduce urea clearance. In prescribing haemofiltration, Qb and replacement rate could be determined with this model.

High-flux haemodialysis treatment as treatment for carbamazepine intoxication.

Acute severe intoxication with carbamazepine is associated with seizures, coma and respiratory depression. Traditionally, charcoal haemoperfusion is used to remove the drug. We present a case of carbamazepine intoxication, successfully treated with three hours of high-flux haemodialysis. Thus, haemodialysis using high-flux membranes is a feasible and effective therapeutic option for carbamazepine intoxication.

Exendin-4 induction of cyclin D1 expression in INS-1 beta-cells: involvement of cAMP-responsive element.

Glucagon-like peptide-1 (GLP-1) and its analog exendin-4 (EX) have been considered as a growth factor implicated in pancreatic islet mass increase and beta-cell proliferation. This study aimed to investigate the effect of EX on cyclin D1 expression, a key regulator of the cell cycle, in the pancreatic beta-cell line INS-1. We demonstrated that EX significantly increased cyclin D1 mRNA and subsequently its protein levels. Although EX induced phosphorylation of Raf-1 and extracellular-signal-regulated kinase (ERK), both PD98059 and exogenous ERK1 had no effect on the cyclin D1 induction by EX. Instead, the cAMP-elevating agent forskolin induced cyclin D1 expression remarkably and this response was inhibited by pretreatment with H-89, a protein kinase A (PKA) inhibitor. Promoter analyses revealed that the cAMP-responsive element (CRE) site (at position -48; 5'-TAACGTCA-3') of cyclin D1 gene was required for both basal and EX-induced activation of the cyclin D1 promoter, which was confirmed by site-directed mutagenesis study. For EX to activate the cyclin D1 promoter effectively, CRE-binding protein (CREB) should be phosphorylated and bound to the putative CRE site, according to the results of electrophoretic mobility shift and chromatin immunoprecipitation assays. Lastly, a transfection assay employing constitutively active or dominant-negative CREB expression plasmids clearly demonstrated that CREB was largely involved in both basal and EX-induced cyclin D1 promoter activities. Taken together, EX-induced cyclin D1 expression is largely dependent on the cAMP/PKA signaling pathway, and EX increases the level of phosphorylated CREB and more potently trans-activates cyclin D1 gene through binding of the CREB to the putative CRE site, implicating a potential mechanism underlying beta-cell proliferation by EX.

Upregulation of rat Ccnd1 gene by exendin-4 in pancreatic beta cell line INS-1: interaction of early growth response-1 with cis-regulatory element.

AIMS/HYPOTHESIS: The aim of this study was to investigate the effect of exendin-4 on the expression of cyclin D1 gene (Ccnd1), which is critical in regulating the progression of the cell cycle in INS-1 cells. MATERIALS AND METHODS: INS-1 cells were stimulated with exendin-4 (10 nmol/l). Transient transfection and luciferase reporter assays were performed to measure promoter activities of rat Ccnd1. Electrophoretic mobility shift and chromatin immunoprecipitation assays were used to examine the binding of transcription factors to sites responsive to exendin-4 in vitro and in vivo, respectively. RESULTS: Exendin-4 increased both Ccnd1 mRNA and its protein levels in a time-dependent manner. The region from -174 to +130 of the promoter was found to contain cis-regulatory elements responsible for exendin-4-mediated gene induction. Early growth response-1 (EGR1) protein was bound to the region from -153 to -134, which includes the putative EGR1 binding site (5'-CACCCCCGC-3'). Moreover, exendin-4 recruited EGR1 protein to the promoter in vivo. CONCLUSIONS/INTERPRETATION: These findings suggest that exendin-4 activates Ccnd1 transcription through induction of EGR1 binding to a cis-regulatory element between -153 and -134 on the rat Ccnd1 promoter. These results provide an important indication that exendin-4 is a growth factor regulating beta cell proliferation.

A retrospective study of malaria infections in an intensive care unit of a general hospital in Malaysia.

AIMS: To study the clinical and demographic aspects as well as the outcomes of severe cases of malaria infections managed in the intensive care unit of the Sarawak General Hospital, Kuching from January 1996 to December 2001. METHODS: All cases of malaria admitted to the intensive care unit of the Sarawak General Hospital from January 1996 to December 2001 were identified from the intensive care records and retrospectively reviewed. RESULTS: A total of 31 cases of malaria were managed in the intensive care unit of the Sarawak General Hospital in the six-year period. Twenty-eight cases were P. falciparum infections; two were P. vivax and one was a mixed infection of P. falciparum and P. vivax. Fever with or without chills and rigors, headache, abdominal pain and vomiting were the four commonest presenting complaints for P. falciparum infections. Patients with both abdominal pain and hepatomegaly have significantly higher mortality. The fatal cases, at presentation, had higher parasite counts, higher bilirubin, aminotransferase, potassium and urea levels, but lower haemoglobin and platelet counts, and more deranged coagulation profiles compared to surviving patients. The major complications include acute renal failure, acute respiratory distress syndrome, cerebral malaria and disseminated intravascular coagulopathy, haemolytic anaemia and liver dysfunction. A single case of vivax malaria, which was complicated by septicaemic shock and disseminated intravascular coagulopathy was also documented. Higher mortality rate was documented if the antimalarial medication was not commenced on the day of admission into hospital. CONCLUSION: Several infections of P. falciparum are still associated with significant mortality. Other confounding factors include the patient's own initiating quinine therapy. Aggressive and appropriate therapy is life saving. Earlier anti-malaria treatment may improve the survival rate for falciparum malaria. The isolated case of death from P. vivax infection argues against complacency in the management of even the "benign" form of the infection.

Bilateral sound propagation characteristics in electronic TMJ sound recording.

Temporomandibular Joint (TMJ) sounds, clicking and crepitation, are important signs of possible TM disorder or dysfunction (TMD). The sound are usually recorded and observed by stethoscope auscultation or palpation. Sound from one TMJ may propagate through head tissues and be recorded on the contra lateral side misleading the examiner to classify both joints as non-silent. Errors in localization of sound source may lead to an erroneous diagnosis. Widmalm et al. (1997) suggested a mathematical model for estimation of the sound propagation characteristics through the head tissues. A modified model applying the auto-spectral density and cross-spectral density of the signal was used to estimate the bilateral sound propagation characteristics of temporomandibular joint sounds from two subjects. The result indicates that the head tissues act as a bandpass filter causing strong attenuation in some frequency areas with little attenuation in others. The phase response of the transfer function provides a good mean to estimate the latency in time between sounds.

Automatic recognition of the source of temporomandibular joint sounds.

Sounds evoked in the temporomandibular joint (TMJ) during jaw movements may indicate pathology. They are in dental clinics usually recorded by auscultation and noted in protocols by verbal, subjective descriptions. Time-frequency analysis of electronically recorded TMJ sounds makes possible a more objective and sophisticated analysis. Such sounds were recorded from four subjects and grouped into two sets. One was used for training a classifier, while the other was used for testing its ability to relate a given sound to the subject from which it was recorded. Both scale and time-shift invariant representations, as well as only time-shift invariant representations of the Reduced Interference Distributions of the TMJ sounds were used for pattern recognition. The nearest neighbor, zero-subspace and nearest constrained linear combination classification methods were employed. It was observed that TMJ sound patterns could be very typical for a given person. This indicates that our classification approach can be developed into a useful diagnostic tool by obtaining training sets from patients where a definitive diagnosis of TMJ pathology has been obtained.

Frequency of micronuclei in lymphocytes following gamma and fast-neutron irradiations.

The dose response of the number of micronuclei in cytokinesis-blocked (CB) lymphocytes after in vitro irradiation with y-rays and neutrons in the 5 dose range was studied in a heterogeneous population of 4 donors. One thousand binucleated cells were systematically scored for micronuclei. Measurements performed after irradiation showed a dose-related increase in micronuclei (MN) frequency in each of the donors studied. The dose-response curves were analyzed by a linear-quadratic model; frequencies per 1000 CB cells were (0.31 +/- 0.049)D + (0.0022 +/- 0.0002)D2 + (13.19 +/- 1.854) (r2 = 1.000, x2 = 0.7074, p = 0.95) following y-irradiation, and (0.99 +/- 0.528)D + (0.0093 +/- 0.0047)D2 + (13.31 +/- 7.309) (r2 = 0.996, x2 = 7.6834, p = 0.11) following neutron irradiation (D is irradiation dose in cGy). The relative biological effectiveness (RBE) of neutrons compared with y-rays was estimated by best fitting linear-quadratic model. In the micronuclei frequency between 0.05 and 0.8 per cell, the RBE of neutrons was 2.37 +/- 0.17. Since the MN assay is simple and rapid, it may be a good tool for evaluating the y-ray and neutron response.

In vivo radioprotective activity of Panax ginseng and diethyldithiocarbamate.

Studies were performed to determine whether the water fraction and the alkaloid fraction of Panax ginseng protect against radiation damage to jejunal crypts of N:GP(s) mice and induction of micronuclei (MN) in cytokinesis-blocked (CB) lymphocytes of C57BL/6 mice after in vivo irradiation with 60Co gamma-rays. The radioprotective effect of ginseng was compared with the effect of diethyldithiocarbamate (DDC). Jejunum was protected by the water fraction (2 mg/ml of drinking water) (P < 0.001) and the alkaloid fraction (5.4 mg/day, P.O.) (P < 0.005), both pre-and post-treatment, and by DDC (1000 mg/kg B.W., single I.P., 30 minutes before 15 Gy irradiation) (P < 0.001). The frequency of radiation (3 Gy)-induced micronuclei in spleen lymphocytes was also reduced by pretreatment of water fraction, alkaloid fraction of ginseng (P < 0.025) and DDC (P < 0.001). The data suggested that the water fraction and alkaloid fraction of Panax ginseng may reduce cell damage caused by gamma-rays, especially damage to DNA molecules, and play a role in the repair or regeneration process of damaged cells.