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Fulltext Performance evaluation of the Arkray Adams HA-8160 HbA1c analyser

Thevarajah TM, Nani N, Chew YY

Malays J Pathol, 2008 Dec;30(2):81-6.
PMID: 19291916 MyJurnal

HbA1c measurement is currently routinely used to predict long term outcome of diabetes, thus playing a fundamental role in the management of diabetes. The relationship between HbA1c value and long term diabetic complications has been established by a randomised control Diabetes Control and Complications Trial (DCCT) which used high performance liquid chromatography (HPLC) as a reference method for HbA1c assay. To ensure that HbA1c results from a variety HbA1c assay methods are similar to the DCCT values, the American Diabetes Association (ADA) recommended that all laboratories should use methods certified by the National Glycohemoglobin Standardization Programme (NGSP) with interassay coefficient variation (CV) of < 5% (ideally < 3%). The International Federation of Clinical Chemistry (IFCC) working group on HbA1c standardisation has set a CV < 2.5% as a criteria for its reference laboratories.
The Effects of Manufacturer's Prefit and Real-Ear Fitting on the Predicted Speech Perception of Children with Severe to Profound Hearing Loss

Quar TK, Umat C, Chew YY

J Am Acad Audiol, 2019 05;30(5):346-356.
PMID: 30461383 DOI: 10.3766/jaaa.16150

BACKGROUND: The use of probe microphone measures in hearing aid verification is often neglected or not fully used by practitioners. Some practitioners rely on simulated gain and output provided by manufacturer's fitting software to verify hearing aids.
PURPOSE: This study aims to evaluate the effectiveness of manufacturer's prefit procedure in matching the prescribed real-ear targets. It also aims to study its correlated impact on the predicted speech perception in children with severe and profound hearing loss.
RESEARCH DESIGN: This cross-sectional experiment was carried out by measuring the output of hearing aids based on prefit versus real-ear at low-, moderate-, and high-input levels. The predicted speech perception for different hearing aid fittings was determined based on the Speech Intelligibility Index (SII).
STUDY SAMPLE: Sixteen children (28 ears) aged between 4 and 7 yr, with severe to profound sensorineural hearing loss took part in the study.
METHOD: Two different types of hearing aids (Phonak and Unitron) were programmed based on their respective manufacturers' Desired Sensation Levels (DSL) v5 Child procedure. The hearing aids were then verified using coupler-based measurements and individual real-ear-to-coupler differences. The prefit outputs were compared with the DSL v5 Child-prescribed outputs at low-, moderate-, and high-input levels. The hearing aids were then adjusted to closely match the prescribed output. The SIIs were calculated for the fittings before and after adjustment.
DATA COLLECTION AND ANALYSIS: Sixty four percent of fittings that were based on the prefit procedure achieved the optimal fit-to-targets, with less than 5-dB RMS deviations from the DSL v5 Child targets. After adjusting the hearing aids to attempt to meet the DSL v5 Child targets, 75% of the ears tested achieved the optimal fit-to-targets. On average, hearing aid outputs generated by the manufacturer's prefit procedure had good and reasonable agreement with the DSL v5 Child-prescribed outputs at low- and mid-frequencies. Nonetheless, at 4000 Hz, the hearing aid output mostly fell below the DSL v5 Child-prescribed outputs. This was still the case even after the hearing aid was adjusted to attempt to match with the targets. At low input level, some prefit outputs were found to be higher than the prescribed outputs. The deviations of prefit outputs from the prescribed outputs were dependent on the type of hearing aid and input levels. There was no significant difference between the SII calculated for fittings based on the prefit and adjusted fit.
CONCLUSIONS: Prefit procedure tends to produce outputs that were below the DSL v5 Child-prescribed outputs, with the largest mean difference at 4000 Hz. Even though the hearing aid gains were adjusted to attempt to match with the targets, the outputs were still below the targets. The limitations of hearing aids to match the DSL v5 Child targets at high-frequency region have resulted in no improvement in the children's predicted speech perception.
Interference of hemoglobinA1c (HbA1c) detection using ion-exchange high performance liquid chromatography (HPLC) method by clinically silent hemoglobin variant in University Malaya Medical Centre (UMMC)--a case report

Thevarajah M, Nadzimah MN, Chew YY

Clin Biochem, 2009 Mar;42(4-5):430-4.
PMID: 19026622 DOI: 10.1016/j.clinbiochem.2008.10.015

Glycated hemoglobin, measured as HbA1c is used as an index of mean glycemia in diabetic patients over the preceding 2-3 months. Various assay methods are used to measure HbA1c and many factors may interfere with its measurement according to assay method used, causing falsely high or low results.
Effects of pharmaceutical care on adherence and persistence to bisphosphonates in postmenopausal osteoporotic women

Lai PS, Chua SS, Chew YY, Chan SP

J Clin Pharm Ther, 2011 Oct;36(5):557-67.
PMID: 21916908 DOI: 10.1111/j.1365-2710.2010.01210.x

Studies have shown that comprehensive interventions by pharmacists can improve adherence and persistence to osteoporosis therapy, but the association between adherence and bone turnover markers (BTMs) has never been studied. Therefore, the aim of this study was to evaluate the effects of pharmaceutical care on medication adherence (and its effects on BTMs), as well as persistence of postmenopausal osteoporotic women to prescribed bisphosphonates.
Fulltext Determination of trimester specific reference intervals for thyroid hormones during pregnancy in Malaysian women

Thevarajah M, Chew YY, Lim SC, Sabir N, Sickan J

Malays J Pathol, 2009 Jun;31(1):23-7.
PMID: 19694310 MyJurnal

To establish trimester specific reference intervals for thyroid hormones during pregnancy in Malaysian women.
The prevalence of enamel opacities in permanent teeth of 11-12 year-old school children in Kuala Lumpur, Malaysia

Yusoff N, Jaafar N, Razak IA, Chew YY, Ismail N, Bulgiba AM

Community Dent Health, 2008 Mar;25(1):55-8.
PMID: 18435236

To determine the prevalence, distribution, severity and treatment need of enamel opacities among 11-12 year-old school children in a fluoridated urban community.
Fulltext Evaluation of a urinary metanephrines reagent kit: an automated approach

Thevarajah MT, Nadarajah S, Chew YY, Chan PC

Singapore Med J, 2008 Jun;49(6):454-7.
PMID: 18581016

We report the results of a laboratory evaluation of the BioRad Urinary Metanephrines Reagent Kit. The test was designed for the quantitative measurement of normetanephrine and metanephrine in urine by high performance liquid chromatography. The kit was evaluated in view of improving assay reliability and specificity as compared to the manual method based on cation exchange chromatography and spectrophotometry.
Fulltext Prevalence and Predictors of Left Ventricular Diastolic Dysfunction in Malaysian Patients With Type 2 Diabetes Mellitus Without Prior Known Cardiovascular Disease

Chee KH, Tan KL, Luqman I, Saiful SS, Chew YY, Chinna K, et al.

Front Cardiovasc Med, 2021;8:676862.
PMID: 34646868 DOI: 10.3389/fcvm.2021.676862

Objective: Existing data showed that left ventricular diastolic dysfunction is common in individuals with type 2 diabetes mellitus (T2DM). However, most of the studies included diabetic patients who have prior cardiovascular disease, which might be the compounding factor for ventricular dysfunction. This study aimed to determine the prevalence and predictors of left ventricular diastolic dysfunction in an Asian population with T2DM without prior cardiovascular disease using the latest recommended echocardiographic assessment for left ventricular diastolic dysfunction. Design and Participants: This is a cross-sectional study in which eligible patients with T2DM without history of coronary artery disease, heart failure, or valvular heart disease were recruited. Demographic data, diabetic control, comorbidities, microvascular/macrovascular complications, and medications prescribed were recorded. Venous blood was sent to test for B-type natriuretic peptide, and transthoracic echocardiography was performed to assess left ventricular dysfunction. Setting: This study was performed in a tertiary healthcare center located in Kuala Lumpur, Malaysia. Results: Of the 301 patients, 83.1% have had T2DM for >10 years, with 45.8% being poorly controlled. Comorbidities include hypertension (77.1%), hyperlipidemia (91.0%), and pre-obesity/obesity (72.9%). Majority had absence of microvascular (albuminuria, retinopathy, and neuropathy) and macrovascular (peripheral vascular disease and stroke) complications. None had raised B-type natriuretic peptide levels, and 93.7% had no symptoms of heart failure. On echocardiographic assessment, 70.1% had left ventricular diastolic dysfunction, and 90.5% had Grade 1/mild severity. Age, ethnicity, insulin therapy, presence of hypertension, and hyperlipidemia were significantly associated with left ventricular diastolic dysfunction. Older T2DM patients of Chinese ethnicity and on insulin are about two times more likely to develop left ventricular diastolic dysfunction. Conclusion: There was a high prevalence of asymptomatic left ventricular diastolic dysfunction among patients with T2DM without prior known cardiovascular disease. Older age, insulin therapy, and Chinese ethnicity were risk factors for left ventricular diastolic dysfunction in T2DM.
Association between thyroid function tests and anti-thyroid peroxidase (TPO) antibodies in pregnancy

Loh TP, Tee JC, Tee NW, Cheng WL, Thevarajah M, Sabir N, et al.

Endocrine, 2016 Sep;53(3):865-7.
PMID: 26725315 DOI: 10.1007/s12020-015-0844-y
Fulltext Effects of sun exposure on 25(OH) vitamin D concentration in urban and rural women in Malaysia

Nurbazlin M, Chee WS, Rokiah P, Tan AT, Chew YY, Nusaibah AR, et al.

Asia Pac J Clin Nutr, 2013;22(3):391-9.
PMID: 23945409 DOI: 10.6133/apjcn.2013.22.3.15

Ultraviolet B sunlight exposure is a primary source of vitamin D. There have been reports of low vitamin D status amongst the Malaysian population despite it being a tropical country. This study was conducted to determine the influence of sun exposure on 25(OH)D concentrations in urban and rural women in Malaysia and factors predicting 25(OH)D concentrations. Women aged above 45 years were recruited from urban (n=107) and rural areas (n=293). Subjects were interviewed regarding their outdoor activities and usual outdoor attire over the previous week. 25(OH)D concentrations were analyzed using the vitamin D3 (25-OH) electrochemiluminescence immunoassay. Median (Q1-Q3) age of the participants was 57 (53-61) years old. Median (Q1-Q3) 25(OH)D concentration of rural women was significantly higher [69.5 (59.0-79.1) nmol/L] compared to urban women [31.9 (26.1- 45.5) nmol/L] (p<0.001). Rural women spent more time in the sun compared to urban women (7.83 (3.67-14.7) vs 2.92 (1.17-4.92) hours, p<0.001), although the fraction of body surface area (BSA) exposed to sunlight was significantly higher in the urban group [0.21 (0.21-0.43) vs 0.12 (0.07-0.17), p<0.001]. The calculated sun index (hours of sun exposure per week × fraction of BSA) was significantly higher in rural [0.89 (0.42-1.83)] compared to urban women [0.72 (0.26-1.28)], p=0.018. In the stepwise linear regression, rural dwelling increased the serum 25(OH)D by 31.74 nmol/L and 25(OH)D concentrations increased by 1.93 nmol/L for every unit increment in sun index. Urban women in Malaysia had significantly lower vitamin D status compared to rural women. Rural dwelling and sun index were key factors influencing vitamin D status in Malaysian women.
Fulltext Providing a laboratory diagnostic service for pandemic SARS-CoV-2 in a developing country

Sam IC, Chong J, Kamarudin R, Jafar FL, Lee LM, Bador MK, et al.

Trans R Soc Trop Med Hyg, 2020 08 01;114(8):553-555.
PMID: 32497211 DOI: 10.1093/trstmh/traa037
Fulltext Malaysia Health System Review

Jaafar S, Mohd Noh K, Abdul Muttalib K, Othman NH, Healy J, Maskon K, et al.

ISBN: 978-92-9061-584-2

Citation: Jaafar S, Mohd Noh K, Abdul Muttalib K, Othman NH, Healy J, Maskon K, et al. Malaysia Health System Review. Geneva: World Health Organization; 2013

Malaysia is a federation of 13 states and 2 territories in a parliamentary democracy, with the Prime Minister the head of government and a constitutional monarch elected by the Sultans. Malaysia is a multicultural society and a secular state with Sunni Islam as the official religion. Classified by the World Bank as an upper middle-income country, its society and economy were transformed by rapid economic growth in the latter half of the 20th century. Malaysia’s population (now numbering over 28 million with 70% living in urban areas) has benefited from a well developed health care system, good access to clean water and sanitation, and strong social and economic programmes. Life expectancy at birth is 73 years. Noncommunicable diseases now account for most mortality and morbidity but communicable diseases remain a concern. Section 2 describes the organization and governance of the health system. Health care services consist of tax-funded and governmentrun primary health care centres and hospitals, and fast-growing private services mainly located in physician clinics and hospitals in urban areas. Public sector health services are administered by the Ministry of Health through its central, state and district offices. The Ministry of Health regulates the private sector, pharmaceutical industry and food safety and plans and regulates its own health care services. Legislation governing health care professionals requires them to register with statutory professional bodies. Section 3 reports on health care financing. Malaysia’s public health system is financed mainly through general revenue and taxation collected by the federal government, while the private sector is funded principally through out-of-pocket payments from patients and some private health insurance. Spending on health reached 4.6% of GDP in 2009 with the majority from public spending, reaching 56% of total health expenditure (THE) in 2009. The main sources of THE in 2008 were the Ministry of Health (42%), followed by household out-of-pocket expenditure at nearly 34%. The Ministry of Health funds public facilities through line item budgets and patients pay private physicians and private hospitals on a fee-for-service basis. Physical and human resources are described in Section 4. The number of public primary care facilities (currently 802 centres and over 2000 small community clinics) and dental clinics were expanded steadily in earlier decades, particularly to reach people in under-served rural areas. Secondary care is offered in smaller public hospitals and more complex tertiary care, in regional and national hospitals (including university teaching hospitals run by the Ministry of Higher Education). Growth has slowed in recent years, however, and public services in urban areas have not kept pace with rapid urbanization, while the population ratio of hospital beds has declined slightly. Private clinics and hospitals in urban areas have grown rapidly over the last decade. The supply of health professionals remains seriously below the required number, although the government has increased the number of training places. Section 5 looks at provision of services. National health policies stress public health and health promotion, that is, ‘a wellness’ as well as a ‘disease’ perspective. The Ministry of Health has developed an extensive network of public primary care centres and also dental services especially for children, but these services are under strain and have staff shortages, so patients often encounter long waits. Primary care exerts only a limited gatekeeper function since people can bypass a referral from a general practitioner and for a small additional fee (if in the public sector) can go directly to specialists and hospitals. Government services increasingly serve the poor and private services the better-off people who live in urban areas. Hospital policy currently has three main thrusts: strengthening specialty care in large public hospitals; increasing the number of day surgery centres; and expanding top-end private hospital care to cater to the medical tourism market (with 35 participating hospitals in 2010). Malaysia has a large pharmaceutical manufacturing sector that exports to other countries and also supplies 30% of domestic demand. The principal health care reforms are discussed in Section 6. The government has stepped up its surveillance and early response to infectious disease outbreaks as a result of recent pandemics such as SARS and avian flu, which had a major impact on the country’s economy. The Ministry of Health has maintained its extensive vaccination programmes, has consolidated its primary health care clinics and upgraded its hospitals, and is slowly introducing information communication technology into its public facilities. The government has increased training places to counter shortages of health professionals, has strengthened food and drug safety regulation, is considering price xv regulation of pharmaceuticals, and is positioning the country as a medical tourism destination. Section 7 provides an assessment of the health system. Malaysia has a strong population health tradition and well-established and extensive health care services. Although total health expenditure at 4.6% of GDP in 2008 is in the range for middle-income countries, the government is concerned about future sustainable financing. Successive administrators have prioritized the provision of cost-effective, preventative and mainly free primary health care in public clinics. The rapid growth of private health care means that private spending has risen faster than public spending, including out-of-pocket payments by the public, with the government share (from general revenue) just above half (56%) of health expenditure in 2009. In conclusion, Malaysia has achieved impressive health gains for its population with a low-cost health care system funded through general revenue that provides universal and comprehensive services. Like many other countries in the region, Malaysia has struggled to produce an adequate supply of health professionals, and to integrate and regulate its rapidly growing private health sector. Public services have not kept pace with population growth in urban areas and those with higher purchasing power use private rather than public doctors and hospitals, which leaves the public sector with more poorer and sicker patients. The Malaysian Government recently revived the debate over options for a national social health insurance scheme. The financing challenge is to agree on a scheme for fair and sustainable funding and its respective contributions from general revenue and private payments. The regulatory challenge for the Malaysian Government is to strengthen its governance of both public and private health services in order to ensure high quality and safe services and fair charges. The structural challenge is to determine the balance between public and private sector delivery and to engage in a more productive partnership between public and private sectors. The administrative challenge is to consider whether the community would be better served by more decentralized and responsive services. As Malaysia seeks to attain high income country status, and as demographic and epidemiological transitions continue and new technology expands the possibilities for intervention, the demand for xvi health care by the population will continue to rise. The government will need to address growing concerns about equity, efficiency and budgetary constraints and balance conflicting policy principles. Pressures are building up for health system reform in Malaysia looking towards the year 2020 and beyond.