Browse publications by year: 2021

Factors predicting clinical outcomes of continuous ambulatory peritoneal dialysis associated peritonitis - A single centre study

Tan YL, Ooi GS, Vaithilingam I

Med J Malaysia, 2021 05;76(3):382-389.
PMID: 34031338

BACKGROUND: Peritonitis is the common complication among Continuous Ambulatory Peritoneal Dialysis (CAPD) patients. This study is aimed to identify the factors predicting clinical outcomes of peritonitis in patients undergoing CAPD and the demographic, clinical and microbiological features of CAPD patients who were diagnosed with peritonitis.
MATERIALS AND METHODS: This is a retrospective observational study conducted to identify factors predicting clinical outcomes of CAPD associated peritonitis over a four-year period in Taiping Hospital, Malaysia.
RESULTS: A total of 109 episodes of CAPD associated peritonitis in 54 patients was enrolled with a median age being 56.5 years. In all 43.1% of these were complicated peritonitis. About half (n=54, 49.5%) of the peritonitis was caused by a single gram-positive organism. Coagulase negative Staphylococcus (CoNS) and Escherichia coli was the most often isolated gram-positive and gram-negative microorganism, respectively. We observed that less likelihood of developing complicated peritonitis in presence of abdominal pain (Odd ratio, OR 0.25, 95% confidence interval, 95%CI: 0.10, 0.63). In contrast, presence of more than one previous episode of peritonitis (OR 2.79, 95%CI: 1.11, 7.04) and previous migration and readjustment of Tenkchoff catheter (OR 7.48, 95%CI: 1.39, 40.41), were factors significantly associated with complicated peritonitis.
CONCLUSION: Presence of abdominal pain, more than one previous episode of peritonitis, and previous migration and readjustment of Tenkchoff catheter, were found as significant factors in predicting clinical outcomes of CAPD associated peritonitis.
Reconsideration of planned vaginal breech delivery in selected cases

Achanna S, Nanda J, Paramjothi P

Med J Malaysia, 2021 05;76(3):390-394.
PMID: 34031339

INTRODUCTION: The debate surrounding the management of term breech presentation (BP) has resulted in the presence of a multitude of guidelines, reviews, and directives. The vaginal delivery of a breech baby requires sound obstetric skills since approximately 3-4% of babies at term are breech presentations. BP is the commonest of all malpresentations. However, expertise required to deliver breech babies vaginally has virtually disappeared. There is no convincing evidence that Caesarean Section (CS) is better than assisted vaginal delivery when conducted in appropriate settings, with experienced obstetricians and strict prevailing protocols. Unfortunately, planned vaginal breech delivery (VBD) is becoming an uncommon event. This has led to fewer opportunities for obstetric residents to master the skills of vaginal birth of breech presentations.
MATERIALS AND METHODS: The BP has always been a challenge for obstetricians, due to special skills required to deliver the breech safely. In addition, the immediate perinatal outcome, in terms of APGAR scores and acid-base status of the breech babies is of great concern. Thus, in 2000, in order to provide more evidence-based data, the Term Breech Trial (TBT) was published which compared the outcome of VBD with planned CS. In their 2003 Clinical Guideline, the National Institute for Health and Clinical Excellence (NICE) recommended external cephalic version (ECV) for breech presentation at 36 weeks of gestation a ns elective CS if the procedure is declined or failed. The first edition, Green-top Guidelines by the Royal College of Obstetricians and Gynaecologists (RCOG) regarding the breech delivery was first published in 1999 and revised in 2001, 2006 (Nos. 20a and 20b) and March 2017. In 2020, the Guideline Committee meeting decided on a further revision and deferred the decision for further 3 years (2023). The aim of this Guideline is to aid decision making regarding the route of delivery and choice of various techniques used during delivery. In March 2005, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) issued a formal statement concerning breech delivery at term. Through their Committee on Obstetric Practice, the American College of Obstetricians and Gynecologists (ACOG) issued a Committee Opinion paper on "Mode of term singleton breech delivery" in 2006.
RESULTS: Almost immediately, the medical community all over the world embraced the conclusions of the trial highlighting the superiority of outcomes in planned CS compared to VBD in terms of maternal, neonatal mortality and morbidity. Clinicians, in consultation with their patients, must make the final decisions regarding mode of breech delivery in the light of the updated clinical guidelines and committee opinions for a rational choice for the mode of delivery.
CONCLUSION: There is a place for planned VBD, the prerequisites are: strict case selection, operator skills and vigilant intrapartum monitoring. Provision of basic skills training by utilizing birthing pelvic models and mannikins, hands-on practice of External Cephalic Version (ECV) in clinical settings, may result in larger reduction in the risk of CS.
Gut microbes - Early immunity and health

Prameela KK

Med J Malaysia, 2021 05;76(3):395-400.
PMID: 34031340

INTRODUCTION: Microbes in the human gut impact holistic health. Modifiable events can steer immunity through commensal microbial action. This protects from acute diseases and lays foundation for enduring health benefits. Timely modulation of immune development by correct feeding choices negate consequences of microbial dysequilibrium.
MATERIALS AND METHODS: Review and critical analysis of relevant literature integrated to the core understanding of facets of microbial existence in the gut , their roles in early immunity , and impact on health were done. Known deficiencies in newborn immunity integrated to the actions of microbes in human milk permitted some conclusions to be drawn through logical extrapolations.
RESULTS: Deficiencies in early immunity can, at least partially, be surmounted by an optimal gut microbial milieu provided for by human milk which also enhances gut immunity and holistic health.
LIMITATIONS: This is a narrative review and articles chosen were subjectively analysed for suitability according to relevance, however, analysis by statistical methods was not done.
CONCLUSIONS: There are clear pathways linking gut microbes, intestinal epithelia, microbial metabolites and early immune maturation. The immature immune system is guided towards proper development and maturation by breastmilk factors and milk microbes for immediate and enduring holistic health. Utilising this knowledge, research must be energised on possible mutualistic benefits of gut microbes to counter the current health challenges. The counselling of breastfeeding must not overlook the unique microbial environment endowed by the mother as a gift of health.
Electroencephalography-detected neurophysiology of internet addiction disorder and internet gaming disorder in adolescents - A review

Sharifat H, Suppiah S

Med J Malaysia, 2021 05;76(3):401-413.
PMID: 34031341

INTRODUCTION: Internet Addiction Disorder (IAD) is an umbrella term for various types of Internet-based behavioural addiction, whereas Internet Gaming Disorder (IGD) addresses a specific type of IAD that is postulated to be due to a lack of control in impulse inhibition. IGD is an area of concern in the Diagnostic and Statistics Manual of Mental Disorders (DSM-5), which can be objectively assessed by dysfunctional behaviour and the increasing time of being online, particularly during the COVID-19 pandemic. Electroencephalography (EEG) identifies amplitude changes in the evoked response potential (ERP) among IGDs, correlated with underlying comorbidities.
MATERIALS AND METHODS: A scoping review was performed to elaborate on the research regarding resting-state EEG and task-based EEG, particularly for Go/No-go paradigms pertaining to subjects with IAD or specifically IGD. The role of EEG was identified in its diagnostic capability to identify the salient changes that occurred in the response to reward network and the executive control network, using restingstate and task-based EEG. The implication of using EEG in monitoring the therapy for IAD and IGD was also reviewed.
RESULTS: EEG generally revealed reduced beta waves and increased theta waves in addicts. IGD with depression demonstrated increased theta and decreased alpha waves. Whereas increased P300, a late cognitive ERP component, was frequently associated with impaired excessive allocation of attentional resources of the IAD towards addiction-specific cues. IGD had increased whole brain delta waves at baseline, which showed significant reduction post therapy.
CONCLUSION: EEG can identify distinct neurophysiological changes among Internet Addiction Disorder and Internet Gaming Disorder that are akin to substance abuse disorders.

MeSH terms: Adolescent; Attention/physiology*; Brain/physiopathology*; Electroencephalography*; Humans; Reward*; Video Games*; Executive Function/physiology*
Fluctuation of BCR-ABL1 qPCRIS level beyond 0.1%IS after stopping tyrosine kinase inhibitor in chronic myeloid leukaemia patients with deep molecular response for at least two years

Kuan JW, Chang KM, Phan CL, Wong SP, Lim SM, Toh SG, et al.

Med J Malaysia, 2021 May;76(3):414-416.
PMID: 34031342

Fluctuation of BCR-ABL1 real-time quantitative polymerase chain reaction in International Scale (qPCRIS) level below major molecular response (MMR) (0.1%IS) is a known phenomenon after stopping tyrosine kinase inhibitor (TKI) in chronic myeloid leukaemia (CML) patients who are attempting treatment free remission (TFR). We report here four cases of fluctuation beyond MMR during conduct of a Malaysia Stop TKI Trial (MSIT) to examine the validity of the commonly used relapse criterion - loss of MMR for one reading - aiming to provide evidence in setting relapse criteria for future CML patients who want to attempt TFR.

MeSH terms: Humans; Neoplasm Recurrence, Local; Treatment Outcome; Protein Kinase Inhibitors/therapeutic use
Fertility preservation opportunities for cancer patients in Malaysia

Abdul Karim AK, Ahmad MF, Abdul Hamid H

Med J Malaysia, 2021 05;76(3):417-418.
PMID: 34031343

Fertility preservation is significant for oncology patients to maintain their ability to start a family when they are ready. Onco-fertility, as a discipline, exists at the intersection of oncology and reproductive medicine that safeguards and expands the fertility options for cancer survivors, by facilitating early intervention and suitable treatment with favourable outcomes. Successful fertility preservation requires a comprehensive networking among the gynaecologists, oncologists, pathologists, imaging and other specialists, involved in diagnosing and treating cancer in the reproductive age group. There are several ways in which fertility can be preserved, like role of gonadotrophin releasing hormone analogues, in vitro maturation, and cryopreservation.
Scrofuloderma: A diagnostic dilemma in primary care

Md Rifin S, Shalihin MSE, Mat Jidin M

Med J Malaysia, 2021 05;76(3):419-421.
PMID: 34031344

A 35-year-old lady presented at the Klinik Kesihatan Bandar 32 Bera, Pahang with a one-month history of multiple cervical swelling and ulcers over her neck area. The lesions began as papules and later progressively developed into nodules and pustules. She also had low grade fever associated with weight loss for one month duration. Chest xray revealed normal findings and sputum direct smear for acid fast bacilli was noted to be negative. Histopathologic finding of skin biopsy revealed central epidermal necrosis surrounded by granulomatous tissue forming an abscess and histiocyte infiltrates, confirming the diagnosis of Scrofuloderma. In view of the report of the fine needle aspiration cytology (FNAC) of the cervical lymph nodes suggestive for tuberculous lymphadenitis, the patient was given anti-tuberculosis therapy. Fortunately, six months later, the ulcers began to solve and heal gradually.
Long term outcome of Omalizumab Therapy in childhood severe allergic asthma

Mariana D

Med J Malaysia, 2021 05;76(3):422-425.
PMID: 34031345

Childhood severe asthma is different from adult asthma and little is known about the use of biologics in children in Malaysia. Uncontrolled severe asthma has significant morbidity and impact on the quality of life of the children and their families as well as increase healthcare burden. Anti-IgE therapy is known for its efficacy and safety for severe allergic asthma phenotype, both in adults and children. We describe our experience using omalizumab therapy in two pediatric cases of severe allergic asthma and the journey of these patients before and after omalizumab therapy.
Intestinal adaptation in fluid restricted cardiac failure following extensive bowel resection

Jothinathan M, Gan YY, Qayyum A

Med J Malaysia, 2021 05;76(3):426-428.
PMID: 34031346

Acute mesenteric ischemia (AMI) is an emergency associated with a high mortality rate. A high index of clinical suspicion, prompt diagnosis and treatment is necessary to improve the patient outcome. The principle of damage control surgery should be adopted in the management of critically ill surgical patients with AMI. Strategic planning by resecting the ischemic bowel, physiological restoration and planned reassessment of remnant bowel with a definitive procedure is recommended. The resection of a long segment ischemic bowel may result in morbidity such as that of short bowel syndrome. We report here a case of decompensated cardiac failure in a 56-year-old lady, presented with one-day history of severe acute epigastric pain and abdominal distension. She presented with extensive bowel ischemia involving most of the superior mesenteric artery distribution. Damage control surgery followed by entero-colic anastomosis was performed 48 hours later. The patient recovered with remarkable intestinal adaptation without exhibiting short bowel syndrome symptoms despite the postulated theory of altered intestinal permeability in decompensated cardiac failure.
Anterior tibial artery pseudoaneurysm

Nair N, Suhania M

Med J Malaysia, 2021 05;76(3):429-431.
PMID: 34031347

A pseudoaneurysm, or false aneurysm, is a haematoma that is formed secondary to a leaking hole in an artery. This haematoma is contained by surrounding fascia. In contrast, a true aneurysm contains all three layers of vessel wall, namely intima. Pseudoaneurysms are scarce and can arise consequential of numerous iatrogenic influences, including but not limited to, blunt or penetrating trauma, orthopedic procedures like tibial nailing or ankle arthroscopy, and sports injury. A thorough history taking focusing on the recent history of trauma or instrumentation and clinical examination should raise the suspicion of a pseudoaneurysm. In doubtful cases, imaging modalities such as an ultrasound and doppler examination of the lower limb can be utilized to confirm the diagnosis. Our case was a 37-year-old gentleman presented with progressive swelling in the anterior aspect of his left leg for the past two weeks. The patient had a atypical presentation, with absence of classic signs of a pseudoaneurysm such as a pulsatile mass, absence distal pulses or a thrill or bruit. However, these injuries albeit rare can be sinister and prompt diagnosis is critical, so that pertinent treatment can be delivered. Our case highlights the importance of sonographic approaches for suspected vascular injuries.
Right ureteric reconstruction with vascularised interpositional appendix graft in retroperitoneal leiomyosarcoma

Sohail M, Loke SN, Sim SK, Nik Azim NA

Med J Malaysia, 2021 05;76(3):432-435.
PMID: 34031348

We present here a case of a 66-year-old lady who was diagnosed with right iliac fossa retroperitoneal leiomyosarcoma at Hospital Umum Sarawak. The challenge in this case was the extension of tumour with the involvement of her right ureter causing proximal hydroureter and hydronephrosis. After resection of tumour en-block with the involved segment of ureter, it was not possible to repair the ureteric defect directly. We used interpositional vascularized appendix graft to repair this large (7 cm) ureteric defect. We describe here this uncommon technique of ureter reconstruction.
Immature ovarian teratoma with anti-NMDA-receptor encephalitis in a 13-year-old Japanese female patient

Imataka G, Yoshihara S

Med J Malaysia, 2021 05;76(3):436-437.
PMID: 34031349

We report a 13-year-old Japanese female with ovarian teratoma due to anti-NMDAR encephalitis. The patient was admitted with psychiatric symptoms, including memory impairment, insomnia, binge eating and mouth and hand twisting, associated with constipation. Serum alphafetoprotein and neopterin levels were elevated 102 ng/mL and 19 pmol/mL, respectively. Electroencephalography showed epileptic spikes in frontal and temporal regions. Cerebrospinal fluid (CSF) examination exhibited a pleocytosis. Thereafter, her consciousness level immediately worsened. Brain magnetic resonance imaging (MRI) noted hyper intense lesions in bilateral hippocampi, she was diagnosed with limbic encephalitis. Abdominal echogram showed a solid right ovarian tumour. and also confirmed as a tumour by abdominal MRI. The next day, right ovariectomy was performed and she treated two courses of methyl-prednisolone steroid pulse with high-dose immunoglobulins. Later days, CSF analysis revealed anti- NMDAR antibodies. Pathological diagnosis of the tumour was immature round shaped grade 3 ovarian teratoma, measuring 11cm. Two years follow up after admission, she completely recovered and no neurological sequelae.
Internal jugular vein thrombosis in a child

Thong PL, Yusoff NA, Nunis MA, Khairoonnisa MN

Med J Malaysia, 2021 05;76(3):438-440.
PMID: 34031350

Venous thrombosis is a potentially life-threatening condition with varied aetiology. First described in 1912 as a complication of peritonsillar abscess, internal jugular vein (IJV) thrombosis is a rare entity in children with very few cases reported until now. Among the leading causes of this condition are prolonged use of IJV for venous access and central venous catheterisation, acute mastoiditis and Lemierre's syndrome.1 IJV thrombosis can also occur as a complication of head and neck infections, but rarely appears as its first presentation. The clinical manifestations are often vague and ambiguous, thus requiring a high index of suspicion to diagnose IJV thrombosis. We describe here a case of internal jugular vein thrombosis (IJVT) and the management of this rare condition in an otherwise healthy 8- year-old boy. The patient was investigated thoroughly to rule out possible pathological causes of IJV thrombosis and managed holistically with a multidisciplinary team approach. Although the occurrence is rare, it should be recognised as a complication of deep neck infections in order to initiate prompt and accurate therapy.
Severe central airway stenosis and tracheomalacia in hunter syndrome

Tan HL, Abd Rahman R, Md Tarekh NA, Kassim M, Sathiamurthy N, Nik Mohamad Kamil A, et al.

Med J Malaysia, 2021 05;76(3):441-445.
PMID: 34031351

Hunter Syndrome is a genetic disease characterized by deficiency of Iduronate-2-Sulfatase enzyme activity, resulting in accumulation of glycoaminoglycans in various organs including the central airways. We report a case of severe tracheomalacia and airway stenosis at Hospital Sultanah Aminah, Johor Bahru, Malaysia requiring mechanical ventilation in a middle aged gentleman who was previously undiagnosed of mucopolysaccharidosis. The patient underwent emergency tracheostomy for failed intubation, when he presented with shortness of breath and acute respiratory failure. A contrast-enhanced computed tomography of the neck and thorax revealed that the trachea distal to the tracheostomy tube had collapsed with narrowed right and left main bronchus. These findings were confirmed via direct visualization of the airway through a flexible bronchoscopy. Eventually, a tracheal stenting were performed to maintain the airway patency and assist in weaning off from mechanical ventilation. Further investigations to identify the aetiology of the central airway stenosis revealed elevated urinary glycoaminoglycans and the absence of iduronate-2-Sulfatase activity tested on dried blood spots, thus confirming the diagnosis of Hunter Syndrome. Managing mucopolysacharidosis with central airway obstruction requires multidisciplinary team effort in handling the difficult airway, anaesthesiology risk, potential comorbidities and providing genetic counselling.
Coinfection between SARS-CoV-2 and HIV with a low CD4+ T-cells count

Suryana K CS

Med J Malaysia, 2021 05;76(3):446-448.
PMID: 34031352

Coronavirus Disease 2019 (COVID-19) is an acute respiratory infectious disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection that started in Wuhan, China in December 2019 and has spread rapidly worldwide. It's critical to take extra precautions if a person has chronic illnesses (comorbidities), such as human immunodeficiency (HIV) infection. Concerns about people living with HIV (PLHIV) having a higher risk of serious COVID-19 disease may be based on the assumption that PLHIV are more likely to be immunocompromised. On the other hand, limited information is available in such people about the characteristics of co-infection between SARS-CoV-2 and Human Immunodeficiency Virus (HIV) who are at greater risk than the general population. Our findings, is of a 32 year old patient who came to Emergency Unit of Wangaya Hospital, Medical Faculty, Udayana University in Denpasar, Bali with complaint of fever, dry cough, and shortness of breath since prior 3 days and had also the past history prolonged fever, weight loss more than 10% 4 weeks. Diagnosis of COVID-19 was confirmed by nasopharyngeal swab sample was used for RT-PCR assay and PITC to confirm HIV infection. He had prolonged hospitalized and discharge after 18 days.

MeSH terms: Adult; Humans; Male; Biomarkers/blood; CD4-Positive T-Lymphocytes/metabolism*; HIV Infections/blood; HIV Infections/diagnosis*; HIV Infections/immunology; Coinfection/blood; Coinfection/diagnosis*; Coinfection/immunology
Fulltext Delayed surgery for localised and metastatic renal cell carcinoma: a systematic review and meta-analysis for the COVID-19 pandemic

Chan VW, Tan WS, Leow JJ, Tan WP, Ong WLK, Chiu PK, et al.

World J Urol, 2021 Dec;39(12):4295-4303.
PMID: 34031748 DOI: 10.1007/s00345-021-03734-1

PURPOSE: The COVID-19 pandemic has led to the cancellation or deferment of many elective cancer surgeries. We performed a systematic review on the oncological effects of delayed surgery for patients with localised or metastatic renal cell carcinoma (RCC) in the targeted therapy (TT) era.
METHOD: The protocol of this review is registered on PROSPERO(CRD42020190882). A comprehensive literature search was performed on Medline, Embase and Cochrane CENTRAL using MeSH terms and keywords for randomised controlled trials and observational studies on the topic. Risks of biases were assessed using the Cochrane RoB tool and the Newcastle-Ottawa Scale. For localised RCC, immediate surgery [including partial nephrectomy (PN) and radical nephrectomy (RN)] and delayed surgery [including active surveillance (AS) and delayed intervention (DI)] were compared. For metastatic RCC, upfront versus deferred cytoreductive nephrectomy (CN) were compared.
RESULTS: Eleven studies were included for quantitative analysis. Delayed surgery was significantly associated with worse cancer-specific survival (HR 1.67, 95% CI 1.23-2.27, p

MeSH terms: Carcinoma, Renal Cell/mortality*; Carcinoma, Renal Cell/pathology; Carcinoma, Renal Cell/surgery*; Communicable Disease Control; Humans; Kidney Neoplasms/mortality*; Kidney Neoplasms/pathology; Kidney Neoplasms/surgery*; Nephrectomy; Survival Rate; Time-to-Treatment*
Fulltext Effectiveness and safety profiling of zolpidem and acupressure in CKD associated pruritus: An interventional study

Rehman IU, Ahmed R, Rahman AU, Wu DBC, Munib S, Shah Y, et al.

Medicine (Baltimore), 2021 May 28;100(21):e25995.
PMID: 34032717 DOI: 10.1097/MD.0000000000025995

BACKGROUND: Chronic kidney disease (CKD)-associated pruritus (CKD-aP) contributes to poor quality of life, including reduced sleep quality and poor sleep quality is a source of patient stress and is linked to lower health-related quality of life. This study aimed to investigate the effectiveness of zolpidem 10 mg and acupressure therapy on foot acupoints to improve the sleep quality and overall quality of life among hemodialysis patients suffering from CKD-aP.
METHOD: A multicenter, prospective, randomized, parallel-design, open label interventional study to estimate the effectiveness of zolpidem (10 mg) oral tablets versus acupressure on sleep quality and quality of life in patients with CKD-aP on hemodialysis. A total of 58 hemodialysis patients having sleep disturbance due to CKD-aP completed the entire 8-week follow-up. The patients were divided into a control (acupressure) group of 28 patients and an intervention (zolpidem) group of 30 patients.
RESULTS: A total of 58 patients having CKD-aP and sleep disturbance were recruited. In the control group there was a reduction in the PSQI score with a mean ± SD from 12.28 ± 3.59 to 9.25 ± 3.99, while in the intervention group the reduction in PSQI score with a mean ± SD was from 14.73 ± 4.14 to 10.03 ± 4.04 from baseline to endpoint. However, the EQ5D index score and EQ-visual analogue scale (VAS) at baseline for the control group with a mean ± SD was 0.49 ± 0.30 and 50.17 ± 8.65, respectively, while for the intervention group the values were 0.62 ± 0.26 and 47.17 ± 5.82, respectively. The mean EQ5D index score in the control group improved from 0.49 ± 0.30 to 0.53 ± 0.30, but in the intervention group there was no statistical improvement in mean EQ5D index score from 0.62 ± 0.26 to 0.62 ± 0.27 from baseline to week 8. The EQ 5D improved in both groups and the EQ-VAS score was 2.67 points higher at week 8 as compared to baseline in the control group, while in the intervention group the score was 3.33 points higher at week 8 as compared to baseline. Comparing with baseline, the PSQI scores were significantly reduced after week 4 and week 8 (P =

MeSH terms: Adolescent; Adult; Female; Foot; Renal Dialysis/adverse effects; Humans; Sleep Initiation and Maintenance Disorders/etiology; Sleep Initiation and Maintenance Disorders/psychology; Sleep Initiation and Maintenance Disorders/therapy*; Male; Middle Aged; Pruritus/diagnosis; Pruritus/etiology; Pruritus/psychology; Pruritus/therapy*; Quality of Life; Severity of Illness Index; Acupuncture Points; Treatment Outcome; Acupressure/adverse effects; Acupressure/methods*; Renal Insufficiency, Chronic/complications*; Renal Insufficiency, Chronic/therapy; Young Adult; Visual Analog Scale
Fulltext Elucidating variations in outcomes among older end-stage renal disease patients on hemodialysis in Fukuoka Prefecture, Japan

Jamal A, Babazono A, Li Y, Fujita T, Yoshida S, Kim SA

PLoS One, 2021;16(5):e0252196.
PMID: 34033671 DOI: 10.1371/journal.pone.0252196

Variations in health care outcomes and services potentially indicate resource allocation inefficiency. Therefore, this study was conducted to examine variations in mortality and hospitalization cases among end-stage renal disease (ESRD) patients receiving hemodialysis (HD) care from medical facilities located in 13 secondary medical care areas (SMAs) of Fukuoka prefecture, Japan. The research was designed as a retrospective, cross-sectional study using insurance claims data. The subjects of the study were older patients (over 65 years old) insured by the Fukuoka prefecture's Latter-Stage Elderly Healthcare Insurance. Using an electronic claims database, we identified patients with chronic kidney disease (CKD) who had received HD care from April 1, 2017 to March 31, 2018. The CKD status was identified using International Classification of Disease, 10th revision code, and HD maintenance status was ascertained using specific insurance procedure codes. A total of 5,243 patients met our inclusion criteria and their records were subsequently reviewed. About 73% (n = 3,809) of patients had admission records during the period studied. Thus, the data regarding hospital length of stay (LOS) and admission costs were analyzed separately. Significant differences in terms of increased risks in hospitalization were evident in a number of SMAs. An increase in mortality risk due to heart failure and malignancy was observed in two separate SMAs. Also, analyzed LOS, total hospitalization cost, and cost per day according to SMAs showed statistically significant variations. The findings highlight the magnitude of the burden of CKD and ESRD in the community. The high prevalence of ESRD, associated mortality, and hospitalized HD patients signal the need for clinicians to assume broader roles in measures against chronic kidney disease through involvement in community awareness programs. To improve patient outcomes, improvement of regional health care provision, the level of medical care, and the development of existing human resources are needed.

MeSH terms: Cross-Sectional Studies; Female; Renal Dialysis; Humans; Japan/epidemiology; Kidney Failure, Chronic/epidemiology; Length of Stay; Male; Retrospective Studies; Renal Insufficiency, Chronic/epidemiology*
Spatiotemporal microplastic occurrence study of Setiu Wetland, South China Sea

Ibrahim YS, Hamzah SR, Khalik WMAWM, Ku Yusof KMK, Anuar ST

Sci Total Environ, 2021 Sep 20;788:147809.
PMID: 34034173 DOI: 10.1016/j.scitotenv.2021.147809

This study reports the distribution of microplastics (MPs) in surface water and estuarine sediments in South and North Setiu Wetland in the South China Sea. Sampling was conducted bimonthly for one year from November 2016 to November 2017, including the northeast and southwest monsoons. Water surface and sediment samples were collected from six different sampling stations (STs). Samples were sorted based on physical analysis (optical observation) and selected particles were further analyzed by chemical characterizations. The findings of this study indicate that a total of 0.36 items/L and 5.97 items/g particles of MPs were found from characterizations surface water and dry sediment, respectively. Among the selected stations included in this research, ST3 (1.375 ± 0.347 items/L) and ST2 (14.250 ± 4.343 items/g) were individually identified as high potential MP sinking areas, exacerbated during the northeast and southwest monsoons. Transparent, film, and filament MP types were consistently found across all stations. Microplastic filaments revealed a functional group of polypropylenes based on the main peak spectrum at 2893-2955 cm-1 (CH alkyl stretching), 1458 cm-1 (CH2 bending), and 1381 cm-1 (CH3 bending). Microplastic materials were thermally decomposed by pyrolysis-gas chromatography-mass spectrometry (Pyr-GC/MS) and identified as cyclohexane and cyclohexene derivatives, as well as precursors of polymer blends. The distribution of MPs in both matrices varied according to different seasons. These findings provide useful baseline information on the distribution of MPs from the estuarine area in Malaysia and South China Sea waters.
Micro (nano) plastic pollution: The ecological influence on soil-plant system and human health

Allouzi MMA, Tang DYY, Chew KW, Rinklebe J, Bolan N, Allouzi SMA, et al.

Sci Total Environ, 2021 Sep 20;788:147815.
PMID: 34034191 DOI: 10.1016/j.scitotenv.2021.147815

Global plastic pollution has been a serious problem since many years and micro (nano) plastics (MNPs) have gained attention from researchers around the world. This is because MNPs able to exhibit toxicology and interact with potentially toxic elements (PTEs) in the environment, causing soil toxicity. The influences of MNPs on the soil systems and plant crops have been overlooked despite that MNPs can accumulate in the plant root system and generate detrimental impacts to the terrestrial environments. The consumption of these MNPs-contaminated plants or fruits by humans and animals will eventually lead to health deterioration. The identification and measurement of MNPs in various soil samples is challenging, making the understanding of the fate, environmental and ecological of MNPs in terrestrial ecosystem is limited. Prior to sample assessment, it is necessary to isolate the plastic particles from the environment samples, concentrate the plastic particles for analysis purpose to meet detection limit for analytical instrument. The isolation and pre-concentrated steps are challenging and may cause sample loss. Herein, this article reviews MNPs, including their fate in the environment and toxic effects exhibited towards soil microorganisms, plants and humans along with the interaction of MNPs with PTEs. In addition, various analysis methods of MNPs and management of MNPs as well as the crucial challenges and future research studies in combating MNPs in soil system are also discussed.

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