Comparing risk factors for hepatitis B infection between indigenous and non-indigenous population in Pahang based on a 5-year database

INTRODUCTION

Despite substantial progress in reducing hepatitis B prevalence in the general population, the indigenous population in Malaysia continues to face a significant burden of infection, with high seroprevalence rates. It is hypothesised that transmission patterns differ between the indigenous and non-indigenous populations. This study aimed to compare key risk factors for hepatitis B transmission in indigenous and non-indigenous cases.

MATERIALS AND METHODS

This is a comparative crosssectional study using secondary data from the eNotifikasi system and hepatitis B case investigation forms between 2018 and 2022 from four district health offices in Pahang, Malaysia. Demographic data, hepatitis B vaccination status and risk factors were assessed. Data analysis employed were independent chi-squared tests, t-tests and binary logistic regression.

RESULTS

The study included 285 cases (141 indigenous and 145 non-indigenous). Among the indigenous cases, 72.3% were unvaccinated and 59.6% reported a history of infected mother, followed by percutaneous exposure, multiple sexual partners, and sharing syringe. The odds for those with a history of an infected mother being indigenous group is 2.5 times (95% CI: 1.4-4.4) compared to those with a history of an infected mother being non-indigenous group.

CONCLUSION

Significant difference exists in hepatitis B risk factors between indigenous and non-indigenous populations. The main risk factor for indigenous community is history of infected mother. Thus, the necessity of incorporating hepatitis B screening into the current practice of antenatal HIV screening, specifically targeting the indigenous community, should be given consideration.

Cardiovascular risk factors of Alzheimer's disease and other neurocognitive disorders in Malaysia

INTRODUCTION

Risk factors for cardiovascular disease (CVD) have been increasingly implicated in the development of dementia but little is known about the effects in a Malaysian population. We aimed to determine the interaction between sociodemographic and CVD risk factors among the dementia and mild cognitive impairment (MCI) patients in Malaysia.

MATERIALS AND METHODS

A cross-sectional study was conducted in the memory clinic at Hospital Kuala Lumpur (HKL). Medical records data from 2014 to 2019 were extracted. Mini Mental State Examination (MMSE) test was used to assess the neurocognitive function of patients.

RESULTS

A total of 298 patients (30 MCI, and 268 dementia) were evaluated, with dementia patients consisting of 78 Alzheimer's disease (AD), 93 Vascular dementia (VaD), 94 Mixed dementia, 2 early-onset Alzheimer's disease (EOAD) and 1 Logopenic Progressive Aphasia type of AD (LPA). MCI and dementia were significantly associated with a history of CVD, particularly stroke (p=0.023).

CONCLUSION

Given that stroke significantly predicted the risk of developing vascular dementia among the patients in a central Malaysian population, lifestyle modifications are recommended to alleviate these risk factors of CVD.

The Mediating Effect of Job Satisfaction on Employee Loyalty: A Case Study of a Developer Company in Malaysia

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The development of an abbreviated version of the Cornell scale for depression in dementia (CSDD) for the assessment of depression in palliative care inpatients

Introduction

In the palliative care setting, accurate identification of depression is important to allow delivery of appropriate treatments.

Aims:

– 1. To assess rates of depression in palliative care inpatients using the CSDD, comparing with formal clinical diagnosis based on diagnostic and statistical manual of mental disorders (DSM-IV) criteria;

– 2. To identify items of the CSDD that most distinguish depressive illness in a palliative care setting.

Methods

We measured rates of depression in patients admitted into a palliative care inpatient unit with the CSDD. DSM-IV clinical diagnosis of major depressive disorder (MDD) was achieved using all available clinical information by an experienced independent rater. We calculated Cohen's Kappa to measure concordance between the CSDD and DSM-IV diagnosis.

Results

We assessed 142 patients (56.3% male; mean age: 69.6 years), the majority of which had a cancer diagnosis (93.7%). 18.3% (n = 26) met DSM-IV criteria for MDD, while 12% scored ≥6 on the CSDD with 15 cases of depression common to these two methods (K = 0.65). Discriminant analysis identified five CSDD items that were especially distinguishing of MDD; sadness, loss of interest, pessimism, lack of reactivity to pleasant events and appetite loss. An abbreviated version of the CSDD, based on these 5 items, proved highly accurate in identifying DSM-IV MDD (AUC = 0.94), with sensitivity of 89% and specificity of 84% at a cut-off score ≥2.

Conclusions

There was good level of concordance between the CSDD and DSM-IV diagnosis of MDD. We identified five depressive symptoms that are especially discriminating for depression in palliative care patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Relationship between dyslipidaemia and glycaemic status in patients with Type 2 diabetes mellitus

The risk of coronary heart disease (CHD) is dramatically increased in diabetic patients due to their atherogenic lipid profile. The severity of CHD in diabetic patients has been found to be directly associated with glycated haemoglobin (HbA1c). According to the Malaysian Clinical Practice Guidelines on diabetes mellitus (DM), HbA1c level less than 6.5% reduces the risk of microvascular and macrovascular complications. Hence, this study aimed to determine the relationship between dyslipidaemia and glycaemic status in patients with type 2 DM (T2DM) patients in Hospital Putrajaya, a tertiary endocrine centre in Malaysia. This was a cross sectional, retrospective study of 214 T2DM patients with dyslipidaemia who had visited the endocrine clinic between January 2009 and December 2012. Significant correlations were found between fasting blood glucose (FBG) and HbA1c with total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL), non-high density lipoprotein cholesterol (non-HDL), LDL/HDL ratio and TC/HDL ratio; greater correlation being with HbA1c than FBG. In patients with HbA1c ≥ 6.5%, TC, TG, non-HDL and TC/HDL ratio were significantly higher than in patients with HbA1c < 6.5%. Non-HDL, LDL/HDL ratio, TC/HDL ratio and HbA1c were significantly lower in patients on statin treatment than nontreated patients (p<0.05). This significant association between glycaemic status and dyslipidaemia emphasises the additional possible use of HbA1c as a biomarker for dyslipidaemia as well as a potential indirect predictor of cardiovascular disease (CVD) risk in T2DM patients.

Phylogenetic relationships of Malaysian monkeys, Cercopithecidae, based on mitochondrial cytochrome c sequences

Mitochondrial DNA cytochrome c oxidase II (COII) gene sequences of Malaysian Cercopithecidae were examined to ascertain their phylogenetic relationships. Colobinae were represented by the genera Presbytis, Trachypithecus and Nasalis, while the genus Macaca represented Cercopithecinae. DNA amplification and sequencing of the COII gene was performed on 16 samples. Symphalangus syndactylus (Hylobatidae) was used as the outgroup. Data were analyzed using both character (maximum parsimony) and distance (neighbor-joining) methods. Tree topologies indicated that Colobinae and Cercopithecinae have their own distinct monophyletic clade. This result was well supported by bootstrap values and genetic distances derived from the Kimura-2-parameter algorithm. Separation of Macaca nemestrina from M. fascicularis was also well supported by bootstrap values. In addition, tree topologies indicate a good resolution of the Colobinae phylogenetic relationships at the intergeneric level, but with low bootstrap support. The position of Nasalis remained problematic in both trees. Overall, COII is a good gene candidate for portraying the phylogenetic relationships of Malaysian primates at the inter- and intra-subfamily levels.

Evaluating the sensitivity of a commercial dengue NS1 antigen-capture ELISA for early diagnosis of acute dengue virus infection

INTRODUCTION

The aim of this report is to establish an accurate diagnosis of acute dengue virus infection early, in order to provide timely information for the management of patients and early public health control of dengue outbreak.

METHODS

224 serum samples from patients with a clinical diagnosis of acute dengue infection, which were subsequently confirmed by laboratory tests, were used to evaluate the performance of a commercially-available dengue NS1 antigen-capture ELISA kit.

RESULTS

The dengue NS1 antigen-capture ELISA gave an overall sensitivity rate of 93.3 percent (209/224). The sensitivity rate was significantly higher in acute primary dengue (97.4 percent) than in acute secondary dengue (68.8 percent). In comparison, the virus isolation gave an overall positive isolation rate of 64.7 percent, with a positive rate of 70.8 percent and 28.1 percent, for acute primary dengue and acute secondary dengue, respectively. Molecular detection of dengue RNA by RT-PCR gave an overall positive detection rate of 63.4 percent, with a positive rate of 62.5 percent and 68.8 percent, for acute primary dengue and acute secondary dengue, respectively. Of the 224 acute serum samples from patients with laboratory-confirmed acute dengue infection, dengue IgM was detected in 88 specimens, comprising 68 acute primary dengue specimens and 20 acute secondary dengue specimens. NS1 antigen-capture ELISA kit gave an overall sensitivity rate of 88.6 percent in the presence of anti-dengue IgM and 96.3 percent in the absence of anti-dengue IgM.

CONCLUSION

Of the 224 acute serum samples, the sample ages of 166 acute serum samples are known. The positive detection rate of dengue NS1 antigen-capture ELISA, on the whole, was higher than the other three established diagnostic test methods for laboratory diagnosis of acute dengue infection.

Evaluation of a commercial dengue NS1 antigen-capture ELISA for laboratory diagnosis of acute dengue virus infection

A commercial dengue NS1 antigen-capture ELISA was evaluated to demonstrate its potential application for early laboratory diagnosis of acute dengue virus infection. Dengue virus NS1 antigen was detected in 199 of 213 acute serum samples from patients with laboratory confirmation of acute dengue virus infection but none of the 354 healthy blood donors' serum specimens. The dengue NS1 antigen-capture ELISA gave an overall sensitivity of 93.4% (199/213) and a specificity of 100% (354/354). The sensitivity was significantly higher in acute primary dengue (97.3%) than in acute secondary dengue (70.0%). The positive predictive value of the dengue NS1 antigen-capture ELISA was 100% and negative predictive value was 97.3%. Comparatively, virus isolation gave an overall positive isolation rate of 68.1% with a positive isolation rate of 73.9 and 31.0% for acute primary dengue and acute secondary dengue, respectively. Molecular detection of dengue RNA by RT-PCR gave an overall positive detection rate of 66.7% with a detection rate of 65.2 and 75.9% for acute primary dengue and acute secondary dengue, respectively. The results indicate that the commercial dengue NS1 antigen-capture ELISA may be superior to virus isolation and RT-PCR for the laboratory diagnosis of acute dengue infection based on a single serum sample.

Anemia in remote interior communities in Sarawak, Malaysia

A cross-sectional survey of 365 individuals, (51.9% males, 48.1% females; ages 5-85 years), from five remote interior communities in upper Rejang River basin Sarawak, Malaysia, found 24.4% were anemic. The range and mean of Hb concentration in male and female were: 7.2-17.0 mg/ml and 13.7 mg/ml and 7.9-15.7 mg/ml and 12.9 mg/ml respectively. Amongst the five tribes surveyed, the prevalence of anemia (range: 10.6-46.7%), was higher among the Penans (46.7%), Kenyahs (31.1%), Kajangs (27.8%) and Kayans (19.3%), than amongst the Ukits (10.6%). Anemia is more common among males >40 years and among adolescents and young reproductive females, as well as elderly females > 61 years old. Of the 83 anemic individuals, 6.0% and 3.6% had Trichuris trichiura or hookworm respectively; however there is no clear association with intestinal worm infection.

Early results of a non-heartbeating donor (NHBD) programme with machine perfusion

Freeman Hospital, Newcastle upon Tyne restarted their non-heartbeating donor (NHBD) programme in September 1998 using machine perfusion, due to early poor results with conventional cold storage (45% graft survival, phase II). Since then, 15 NHBD kidneys have been transplanted. The retrieval protocol consisted of in situ perfusion with a double balloon triple lumen cannula in Maastricht category II male donors age range 13-59 years. Mean primary warm ischaemic time was 24.8 min (range 10-44). All kidneys were machine perfused through a locally developed perfusion system. The viability was assessed by serial measurements of total GST (maximum acceptable limit of 200 units/l) and intrarenal vascular resistance (IRVR) was recorded. Fifteen of the 22 kidneys (68.62%) were transplanted. Delayed graft function (DGF) was seen in ten recipients (66.6%), two kidneys had immediate function (IF), one organ was exported, two recipients died of unrelated causes and a further seven kidneys were discarded (two had high tGST, two were infected and three had poor flow characteristics). In phase III, a success rate of 91.7% was thus achieved, which was better than the phase II period (P = 0.027, Fisher 2-tail test). Machine perfusion has been successfully introduced in phase III to the Newcastle NHBD programme and facilitates viability assessment of NHBD kidneys.

Multiple-dose pharmacokinetic study of proguanil and cycloguanil following 12-hourly administration of 100 mg proguanil hydrochloride

A pharmacokinetic study with 12-hourly doses of 100 mg proguanil hydrochloride over 15 days has been conducted in six adult male Malaysian volunteers. Steady state for proguanil was established after the fourth dose on Day 2, for the active metabolite cycloguanil as from Day 3 inclusive. The steady state mean peak concentration of proguanil was 1201.6 +/- 132.4 nmol/l, the mean trough concentration 650.0 +/- 58.1 nmol/l. The corresponding values for cycloguanil were 317.0 +/- 44.4 nmol/l (mean peak) and 230.8 +/- 35.1 nmol/l (mean trough). The profiles and peak/trough ratios of proguanil and cycloguanil with 12-hourly dosing offer better prospects for protection against malaria than those obtained with 24-hourly doses of 200 mg proguanil hydrochloride, the current routine in malaria chemoprophylaxis.

Chemosuppression of malaria by the triple combination mefloquine/sulfadoxine/pyrimethamine: a field trial in an endemic area in Malaysia

Malaria, particularly that due to chloroquine-resistant Plasmodium falciparum, which requires management with antimalarial drugs capable of protecting against multiresistant strains, has emerged in Malaysia. A study was carried out to assess the efficacy and tolerability of 2 dosages of mefloquine/sulfadoxine/pyrimethamine (MSP; RO 13-5112) compared to Fansidar in a malaria endemic area. 914 subjects in 3 random groups were studied. Occurrence of malaria was assessed both clinically as well as by blood films. Plasma drug levels were also measured. The results showed that the low dose of MSP was completely effective in suppressing parasitaemia. 2.7% of the study population reported adverse drug reactions, the lowest incidence being in subjects on the low dose; their blood chemical profiles were also the least affected. The plasma levels of pyrimethamine and sulfadoxine achieved in the low dose group were slightly higher than expected, but there was no significant difference in bioavailability. The study showed that, for chemoprophylaxis, a low dose of MSP provided effective protection with minimal side effects.

Single dose kinetic study of the triple combination mefloquine/sulphadoxine/pyrimethamine (Fansimef) in healthy male volunteers

A single dose pharmacokinetic study of a combined antimalarial formulation of mefloquine, sulphadoxine and pyrimethamine (Fansimef) has been performed in 10 healthy adult male Malaysian volunteers. The dose consisted of two tablets containing 250 mg mefloquine base, 500 mg sulphadoxine base and 25 mg pyrimethamine base each. Plasma concentrations of mefloquine and pyrimethamine were measured by GC-ECD, those of sulphadoxine by h.p.l.c. Time to peak concentrations (mean +/- s.d. for mefloquine (5.70 +/- 0.95 h), sulphadoxine (3.75 +/- 2.03 h) and pyrimethamine (3.30 +/- 1.98 h) were similar to those observed by others after administration of the single compounds. This was also true for elimination half-lives (t1/2). The t1/2s for mefloquine, sulphadoxine and pyrimethamine were 387 +/- 98 h, 255 +/- 61 h and 114 +/- 42 h, respectively.

Relative bioavailability of the hydrochloride, sulphate and ethyl carbonate salts of quinine

The hydrochloride, sulphate and ethylcarbonate salts of quinine were given in single oral doses (600 mg base equivalent) to nine healthy male subjects according to a cross-over design. No statistically significant differences were noted in the plasma drug concentration-time profiles although inter- and intra-subject variation in AUC, Cmax and tmax values was appreciable. The ethylcarbonate salt may be preferred for use in paediatric patients because of its neutral taste.