MyMedR (Malaysian Medical Repository) is an open access collection of Malaysian health and biomedical research. The materials are imported from PubMed and MyJurnal. We gratefully acknowledge the permission to reuse the materials from the National Library of Medicine of the United States and the Malaysian Citation Centre. This project is funded by Academy of Family Physicians of Malaysia. The project team members are: CL Teng, CJ Ng, EM Khoo, Mastura Ismail, Abrizah Abdullah, TK Chiew, Thanaletchumi Dharmalingam.

Please note that some citations are non-Malaysian publications. Common reasons are: (1) One or more authors had a Malaysian affiliation; (2) The article abstract mentioned Malaysia; (3) The study subjects included Malay ethnic group.

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  1. Vadioaloo DK, Loo GH, Leow VM, Subramaniam M
    BMJ Case Rep, 2019 May 10;12(5).
    PMID: 31079042 DOI: 10.1136/bcr-2018-228654
    A biliary fistula which may occur spontaneously or after surgery, is an abnormal communication from the biliary system to an organ, cavity or free surface. Spontaneous biliary-enteric fistula is a rare complication of gallbladder pathology, with over 90% of them secondary to cholelithiasis. Approximately 6% are due to perforating peptic ulcers. Symptoms of biliary-enteric fistula varies widely and usually non-specific, mimicking any chronic biliary disease. Cholecystoduodenal fistula causing severe upper gastrointestinal (UGI) bleed is very rare. Bleeding cholecystoduodenal fistula commonly requires surgical resection of the fistula and repair of the duodenal perforation. We describe the case of a previously healthy older patient who initially presented with symptoms suggestive of UGI bleeding. Bleeding could not be controlled endoscopically. When a laparotomy was performed, a cholecystoduodenal fistula was discovered and bleeding was noted to originate from the superficial branch of cystic artery.
    MeSH terms: Aged; Biliary Fistula/complications; Biliary Fistula/diagnosis*; Biliary Fistula/pathology; Duodenal Diseases/complications; Duodenal Diseases/diagnosis*; Duodenal Diseases/pathology; Gastrointestinal Hemorrhage/etiology*; Humans; Intestinal Fistula/complications; Intestinal Fistula/diagnosis*; Intestinal Fistula/pathology; Male
  2. Fu C, Wai JW, Nik Mustapha NR, Irles M, Wong GL, Mahadeva S, et al.
    Clin Gastroenterol Hepatol, 2020 11;18(12):2843-2845.e2.
    PMID: 31574313 DOI: 10.1016/j.cgh.2019.09.027
    Because only a minority of patients with nonalcoholic fatty liver disease (NAFLD) have advanced fibrosis and would eventually develop liver-related complications, current guidelines recommend initial assessment with noninvasive tests of fibrosis.1-3 Most previous studies focused on overweight and obese patients. Despite a strong association between obesity and NAFLD, 3%-30% of people with relatively normal body mass index (BMI) may still have NAFLD.4,5 Hence, this study aims to evaluate the performance of the common noninvasive tests in non-obese (BMI <25 kg/m2) and obese (BMI ≥25 kg/m2) NAFLD patients.
    MeSH terms: Fibrosis; Humans; Obesity; Body Mass Index; Overweight; Non-alcoholic Fatty Liver Disease
  3. Wang S, Liu F, Tan KS, Ser HL, Tan LT, Lee LH, et al.
    J Cell Mol Med, 2020 01;24(1):722-736.
    PMID: 31680470 DOI: 10.1111/jcmm.14780
    Evidence demonstrates that M1 macrophage polarization promotes inflammatory disease. Here, we discovered that (R)-salbutamol, a β2 receptor agonist, inhibits and reprograms the cellular metabolism of RAW264.7 macrophages. (R)-salbutamol significantly inhibited LPS-induced M1 macrophage polarization and downregulated expressions of typical M1 macrophage cytokines, including monocyte chemotactic protein-1 (MCP-1), interleukin-1β (IL-1β) and tumour necrosis factor α (TNF-α). Also, (R)-salbutamol significantly decreased the production of inducible nitric oxide synthase (iNOS), nitric oxide (NO) and reactive oxygen species (ROS), while increasing the reduced glutathione (GSH)/oxidized glutathione (GSSG) ratio. In contrast, (S)-salbutamol increased the production of NO and ROS. Bioenergetic profiles showed that (R)-salbutamol significantly reduced aerobic glycolysis and enhanced mitochondrial respiration. Untargeted metabolomics analysis demonstrated that (R)-salbutamol modulated metabolic pathways, of which three metabolic pathways, namely, (a) phenylalanine metabolism, (b) the pentose phosphate pathway and (c) glycerophospholipid metabolism were the most noticeably impacted pathways. The effects of (R)-salbutamol on M1 polarization were inhibited by a specific β2 receptor antagonist, ICI-118551. These findings demonstrated that (R)-salbutamol inhibits the M1 phenotype by downregulating aerobic glycolysis and glycerophospholipid metabolism, which may propose (R)-salbutamol as the major pharmacologically active component of racemic salbutamol for the treatment of inflammatory diseases and highlight the medicinal value of (R)-salbutamol.
    MeSH terms: RAW 264.7 Cells; Albuterol/pharmacology*; Animals; Gene Expression Regulation/drug effects*; Glycolysis; Lipopolysaccharides/pharmacology*; Macrophage Activation/drug effects*; Macrophages/drug effects; Macrophages/metabolism*; Nitric Oxide/metabolism; Phenotype; Cytokines/metabolism; Cell Polarity*; Reactive Oxygen Species/metabolism; Mice; Metabolome/drug effects*; Adrenergic beta-2 Receptor Agonists/pharmacology
  4. Phua J, Faruq MO, Kulkarni AP, Redjeki IS, Detleuxay K, Mendsaikhan N, et al.
    Crit Care Med, 2020 05;48(5):654-662.
    PMID: 31923030 DOI: 10.1097/CCM.0000000000004222
    OBJECTIVE: To assess the number of adult critical care beds in Asian countries and regions in relation to population size.

    DESIGN: Cross-sectional observational study.

    SETTING: Twenty-three Asian countries and regions, covering 92.1% of the continent's population.

    PARTICIPANTS: Ten low-income and lower-middle-income economies, five upper-middle-income economies, and eight high-income economies according to the World Bank classification.

    INTERVENTIONS: Data closest to 2017 on critical care beds, including ICU and intermediate care unit beds, were obtained through multiple means, including government sources, national critical care societies, colleges, or registries, personal contacts, and extrapolation of data.

    MEASUREMENTS AND MAIN RESULTS: Cumulatively, there were 3.6 critical care beds per 100,000 population. The median number of critical care beds per 100,000 population per country and region was significantly lower in low- and lower-middle-income economies (2.3; interquartile range, 1.4-2.7) than in upper-middle-income economies (4.6; interquartile range, 3.5-15.9) and high-income economies (12.3; interquartile range, 8.1-20.8) (p = 0.001), with a large variation even across countries and regions of the same World Bank income classification. This number was independently predicted by the World Bank income classification on multivariable analysis, and significantly correlated with the number of acute hospital beds per 100,000 population (r = 0.19; p = 0.047), the universal health coverage service coverage index (r = 0.35; p = 0.003), and the Human Development Index (r = 0.40; p = 0.001) on univariable analysis.

    CONCLUSIONS: Critical care bed capacity varies widely across Asia and is significantly lower in low- and lower-middle-income than in upper-middle-income and high-income countries and regions.

    MeSH terms: Adult; Asia; Critical Care; Cross-Sectional Studies; Government; Health Facilities; Hospitals; Humans; Income; Intensive Care Units; Population Density; Poverty; Registries; Developed Countries
  5. Castro-Mejía JL, Khakimov B, Krych Ł, Bülow J, Bechshøft RL, Højfeldt G, et al.
    Aging Cell, 2020 03;19(3):e13105.
    PMID: 31967716 DOI: 10.1111/acel.13105
    When humans age, changes in body composition arise along with lifestyle-associated disorders influencing fitness and physical decline. Here we provide a comprehensive view of dietary intake, physical activity, gut microbiota (GM), and host metabolome in relation to physical fitness of 207 community-dwelling subjects aged +65 years. Stratification on anthropometric/body composition/physical performance measurements (ABPm) variables identified two phenotypes (high/low-fitness) clearly linked to dietary intake, physical activity, GM, and host metabolome patterns. Strikingly, despite a higher energy intake high-fitness subjects were characterized by leaner bodies and lower fasting proinsulin-C-peptide/blood glucose levels in a mechanism likely driven by higher dietary fiber intake, physical activity and increased abundance of Bifidobacteriales and Clostridiales species in GM and associated metabolites (i.e., enterolactone). These factors explained 50.1% of the individual variation in physical fitness. We propose that targeting dietary strategies for modulation of GM and host metabolome interactions may allow establishing therapeutic approaches to delay and possibly revert comorbidities of aging.
    MeSH terms: Gastrointestinal Microbiome/genetics*; Aged; Aged, 80 and over; Aging/physiology; Bacteria/genetics; Body Composition; Energy Intake/physiology*; Cross-Sectional Studies; DNA, Bacterial/genetics; DNA, Bacterial/isolation & purification; Eating/physiology*; Female; Humans; Life Style; Male; Phenotype; Physical Fitness/physiology*; Exercise/physiology; Metabolomics/methods; Metabolome*; Independent Living*
  6. Tiew PY, Ko FWS, Narayana JK, Poh ME, Xu H, Neo HY, et al.
    Chest, 2020 07;158(1):145-156.
    PMID: 32092320 DOI: 10.1016/j.chest.2020.01.043
    BACKGROUND: COPD is a heterogeneous disease demonstrating inter-individual variation. A high COPD prevalence in Chinese populations is described, but little is known about disease clusters and prognostic outcomes in the Chinese population across Southeast Asia. We aim to determine if clusters of Chinese patients with COPD exist and their association with systemic inflammation and clinical outcomes.

    RESEARCH QUESTION: We aim to determine if clusters of Chinese patients with COPD exist and their association with clinical outcomes and inflammation.

    STUDY DESIGN AND METHODS: Chinese patients with stable COPD were prospectively recruited into two cohorts (derivation and validation) from six hospitals across three Southeast Asian countries (Singapore, Malaysia, and Hong Kong; n = 1,480). Each patient was followed more than 2 years. Clinical data (including co-morbidities) were employed in unsupervised hierarchical clustering (followed by validation) to determine the existence of patient clusters and their prognostic outcome. Accompanying systemic cytokine assessments were performed in a subset (n = 336) of patients with COPD to determine if inflammatory patterns and associated networks characterized the derived clusters.

    RESULTS: Five patient clusters were identified including: (1) ex-TB, (2) diabetic, (3) low comorbidity: low-risk, (4) low comorbidity: high-risk, and (5) cardiovascular. The cardiovascular and ex-TB clusters demonstrate highest mortality (independent of Global Initiative for Chronic Obstructive Lung Disease assessment) and illustrate diverse cytokine patterns with complex inflammatory networks.

    INTERPRETATION: We describe clusters of Chinese patients with COPD, two of which represent high-risk clusters. The cardiovascular and ex-TB patient clusters exhibit high mortality, significant inflammation, and complex cytokine networks. Clinical and inflammatory risk stratification of Chinese patients with COPD should be considered for targeted intervention to improve disease outcomes.

    MeSH terms: Cardiovascular System; Diabetes Mellitus; Hong Kong; Hospitals; Humans; Inflammation; Malaysia; Prognosis; Singapore; Comorbidity; Prevalence; Cluster Analysis; Cytokines; Risk Assessment; Pulmonary Disease, Chronic Obstructive; Asian Continental Ancestry Group
  7. Tah PC, Lee ZY, Poh BK, Abdul Majid H, Hakumat-Rai VR, Mat Nor MB, et al.
    Crit Care Med, 2020 05;48(5):e380-e390.
    PMID: 32168031 DOI: 10.1097/CCM.0000000000004282
    OBJECTIVES: Several predictive equations have been developed for estimation of resting energy expenditure, but no study has been done to compare predictive equations against indirect calorimetry among critically ill patients at different phases of critical illness. This study aimed to determine the degree of agreement and accuracy of predictive equations among ICU patients during acute phase (≤ 5 d), late phase (6-10 d), and chronic phase (≥ 11 d).

    DESIGN: This was a single-center prospective observational study that compared resting energy expenditure estimated by 15 commonly used predictive equations against resting energy expenditure measured by indirect calorimetry at different phases. Degree of agreement between resting energy expenditure calculated by predictive equations and resting energy expenditure measured by indirect calorimetry was analyzed using intraclass correlation coefficient and Bland-Altman analyses. Resting energy expenditure values calculated from predictive equations differing by ± 10% from resting energy expenditure measured by indirect calorimetry was used to assess accuracy. A score ranking method was developed to determine the best predictive equations.

    SETTING: General Intensive Care Unit, University of Malaya Medical Centre.

    PATIENTS: Mechanically ventilated critically ill patients.


    MEASUREMENTS AND MAIN RESULTS: Indirect calorimetry was measured thrice during acute, late, and chronic phases among 305, 180, and 91 ICU patients, respectively. There were significant differences (F= 3.447; p = 0.034) in mean resting energy expenditure measured by indirect calorimetry among the three phases. Pairwise comparison showed mean resting energy expenditure measured by indirect calorimetry in late phase (1,878 ± 517 kcal) was significantly higher than during acute phase (1,765 ± 456 kcal) (p = 0.037). The predictive equations with the best agreement and accuracy for acute phase was Swinamer (1990), for late phase was Brandi (1999) and Swinamer (1990), and for chronic phase was Swinamer (1990). None of the resting energy expenditure calculated from predictive equations showed very good agreement or accuracy.

    CONCLUSIONS: Predictive equations tend to either over- or underestimate resting energy expenditure at different phases. Predictive equations with "dynamic" variables and respiratory data had better agreement with resting energy expenditure measured by indirect calorimetry compared with predictive equations developed for healthy adults or predictive equations based on "static" variables. Although none of the resting energy expenditure calculated from predictive equations had very good agreement, Swinamer (1990) appears to provide relatively good agreement across three phases and could be used to predict resting energy expenditure when indirect calorimetry is not available.

    MeSH terms: Adult; Calorimetry, Indirect; Energy Metabolism; Humans; Intensive Care Units; Prospective Studies; Respiration, Artificial; Rest; Critical Illness
  8. Le TT, Lim V, Ibrahim R, Teo MT, Bryant J, Ang B, et al.
    Eur Heart J Cardiovasc Imaging, 2021 May 10;22(6):670-679.
    PMID: 32255186 DOI: 10.1093/ehjci/jeaa040
    AIMS : Hypertensive left ventricular hypertrophy (LVH) is associated with increased cardiovascular events. We previously developed the remodelling index (RI) that incorporated left ventricular (LV) volume and wall-thickness in a single measure of advanced hypertrophy in hypertensive patients. This study examined the prognostic potential of the RI in reference to contemporary LVH classifications.

    METHODS AND RESULTS : Cardiovascular magnetic resonance was performed in 400 asymptomatic hypertensive patients. The newly derived RI (EDV3t, where EDV is LV end-diastolic volume and t is the maximal wall thickness across 16 myocardial segments) stratified hypertensive patients: no LVH, LVH with normal RI (LVHNormal-RI), and LVH with low RI (LVHLow-RI). The primary outcome was a composite of all-cause mortality, acute coronary syndromes, strokes, and decompensated heart failure. LVHLow-RI was associated with increased LV mass index, fibrosis burden, impaired myocardial function and elevated biochemical markers of myocardial injury (high-sensitive cardiac troponin I), and wall stress. Over 18.3 ± 7.0 months (601.3 patient-years), 14 adverse events occurred (2.2 events/100 patient-years). Patients with LVHLow-RI had more than a five-fold increase in adverse events compared to those with LVHNormal-RI (11.6 events/100 patient-years vs. 2.0 events/100 patient-years, respectively; log-rank P 

    MeSH terms: Fibrosis; Heart Failure; Heart Ventricles; Humans; Hypertension; Myocardium; Magnetic Resonance Spectroscopy; Prognosis; Biomarkers; Hypertrophy, Left Ventricular; Risk Assessment; Troponin I; Stroke; Acute Coronary Syndrome
  9. Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M, et al.
    J Hepatol, 2020 07;73(1):202-209.
    PMID: 32278004 DOI: 10.1016/j.jhep.2020.03.039
    The exclusion of other chronic liver diseases including "excess" alcohol intake has until now been necessary to establish a diagnosis of metabolic dysfunction-associated fatty liver disease (MAFLD). However, given our current understanding of the pathogenesis of MAFLD and its rising prevalence, "positive criteria" to diagnose the disease are required. In this work, a panel of international experts from 22 countries propose a new definition for the diagnosis of MAFLD that is both comprehensive and simple, and is independent of other liver diseases. The criteria are based on evidence of hepatic steatosis, in addition to one of the following three criteria, namely overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation. We propose that disease assessment and stratification of severity should extend beyond a simple dichotomous classification to steatohepatitis vs. non-steatohepatitis. The group also suggests a set of criteria to define MAFLD-associated cirrhosis and proposes a conceptual framework to consider other causes of fatty liver disease. Finally, we bring clarity to the distinction between diagnostic criteria and inclusion criteria for research studies and clinical trials. Reaching consensus on the criteria for MAFLD will help unify the terminology (e.g. for ICD-coding), enhance the legitimacy of clinical practice and clinical trials, improve clinical care and move the clinical and scientific field of liver research forward.
    MeSH terms: Alcohol Drinking; Diabetes Mellitus, Type 2; Fatty Liver; Liver Cirrhosis; Liver Diseases; Obesity; Prevalence; Consensus; Overweight
  10. Alqahtani A, Sani SFA, Narissa NHA, Alanazi A, Podolyak Z, Nisbet A, et al.
    Appl Radiat Isot, 2020 Jun;160:109132.
    PMID: 32351224 DOI: 10.1016/j.apradiso.2020.109132
    As a result of the various evolving needs, thermoluminescence dosimetry is constantly under development, with applications intended in environmental and personal radiation monitoring through to the sensing of radiotherapy and radiation processing doses. In radiotherapy dosimetry challenges include small-field profile evaluation, encompassing the fine beams of radiosurgery, evaluations confronting the steep dose gradients of electronic brachytherapy and the high dose rates of FLASH radiotherapy. Current work concerns the thermoluminescent dosimetric properties of commercial low-cost borosilicate glass in the form of thin (sub-mm to a few mm) plates, use being made of microscope cover-slips irradiated using clinical external-beam radiotherapy facilities as well as through use of 60Co gamma irradiators. In using megavoltage photons and MeV electrons, characterization of the dosimetric response has been made for cover-slips of thicknesses up to 4 mm. Reproducibility to within +/5% has been obtained. In particular, for doses up to 10 Gy, the borosilicate cover-slips have been demonstrated to have considerable potential for use in high spatial resolution radiotherapy dosimetry, down to 0.13 mm in present work, with a coefficient of determination in respect of linearity of >0.99 for the thinner cover-slips. Results are also presented for 0.13- and 1.00-mm thick cover slips irradiated to 60Co gamma-ray doses, initially in the range 5- to 25 Gy, subsequently extended to 5 kGy-25 kGy, again providing linear response.
    MeSH terms: Glass*; Microscopy/instrumentation*; Thermoluminescent Dosimetry/instrumentation*
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