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Displaying publications 41 - 44 of 44 in total

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Association between bone characteristics and cardiovascular risk factors among adults in selected urban areas in Selangor, Malaysia

Mohamad Ismuddin S, Thambiah SC, Appannah G, Samsudin IN, Md Said S, Yeap SS, et al.

Malays J Pathol, 2022 Dec;44(3):477-490.
PMID: 36591715

INTRODUCTION: Cardiovascular disease and osteoporosis (OP) have been shown to have similar risk factors but studies have demonstrated contradictory results with regards to their associations. This study evaluated relationships between bone characteristics and cardiovascular risk factors among adults in selected urban areas in Malaysia.
MATERIALS AND METHODS: A cross-sectional study was performed involving 331 subjects between 45-90 years recruited at a health screening programme. Sociodemographic and clinical characteristics were recorded. Biochemical analyses on fasting blood samples and dual energy X-ray absorptiometry scan to determine bone mineral density (BMD) were performed.
RESULTS: Increased waist circumference (WC) was protective for abnormal BMD status (osteopenia and OP). Males with increased high-density lipoprotein cholesterol (HDL) were more likely to be osteoporotic. WC, fasting blood glucose (FBG) and triglyceride (TG) were positively associated with BMD at all sites but was gender specific. In contrast, WC was negatively associated with trabecular bone score (TBS) for females but this association became attenuated when adjusted for fat percentage. HDL and MetS were negatively and positively associated with BMD, respectively in males.
CONCLUSION: The cardiovascular risk factors of raised WC, FBG, TG and low HDL were significantly associated with increased BMD with skeletal site and gender specific differences after adjusting for confounders. However, a higher WC was associated with a weaker skeletal microstructure reflected by lower TBS in females driven by fat percentage. A higher BMD was demonstrated among MetS individuals. These findings suggest that adiposity may have a protective effect on BMD.
A study of hospitalized COVID-19 patients with AKI in a setting of multiracial developing country

Ooi SH, Ng KP, Sthaneshwar P, Lim SK, Khor PY, Lim JY, et al.

BMC Nephrol, 2024 Apr 05;25(1):122.
PMID: 38580977 DOI: 10.1186/s12882-024-03498-x

BACKGROUND: The commonest indication for hospitalization in COVID-19 patients is hypoxemia or severe respiratory symptoms. However, COVID-19 disease may result in extrapulmonary complications including kidney-related pathology. The reported incidence of renal involvement related to COVID infection varies based on geographical location.
OBJECTIVE: This study aimed to assess the incidence rate of AKI in hospitalized COVID-19 patients and identify risk factors and prognostic predictors.
METHOD: In this retrospective study, we recruited hospitalized COVID-19 patients from January 2021 until June 2021 at the University Malaya Medical Center. The inclusion criteria were hospitalized for ≥ 48 h with confirmed COVID-19 infection and at least 18 years old. Patient demographic and clinical data were collected from electronic medical records. The staging of AKI was based on criteria as per KDIGO guidelines.
RESULTS: One thousand five hundred twenty-nine COVID patients fulfilled the inclusion criteria with a male-to-female ratio of 759 (49.6%) to 770 (50.3%). The median age was 55 (IQR: 36-66). 500 patients (32.7%) had diabetes, 621 (40.6%) had hypertension, and 5.6% (n = 85) had pre-existing chronic kidney disease (CKD). The incidence rate of AKI was 21.1% (n = 323). The percentage of COVID patients in different AKI stages of 1,2 and 3 were 16.3%, 2.1%, and 2.7%, respectively. Fifteen hospitalized patients (0.98%) required renal replacement therapy. 58.8% (n = 190) of AKI group had complete recovery of kidney function. Demographic factors included age (p p p p p = 0.042) were associated with an increased risk of developing AKI. We found that the AKI cohort had statistically significant lower platelet counts and higher ferritin levels than the non-AKI cohort. AKI is a risk predictor of prolonged hospitalization (p P
MACB CKD Task Force updated recommendations for reporting estimated glomerular filtration rate and albuminuria in adults

Sthaneshwar P, Lai LC, Thambiah SC, Lim SK, Zulkely A, Lee LY, et al.

Malays J Pathol, 2024 Dec;46(3):395-400.
PMID: 39731488

Chronic kidney disease (CKD) is a common clinical condition with significant health risks for patients and is widely recognised as a major public health concern. Laboratory medicine plays a crucial role in both diagnosing and managing CKD, as diagnosis and staging rely on estimated glomerular filtration rate (GFR) and evaluating albuminuria (or proteinuria). It was evident that the laboratory assessment of CKD in Malaysia is not standardised. In light of this, the Malaysian Association of Clinical Biochemistry CKD (MACB-CKD) Task Force issued a national recommendation for laboratory diagnosis of CKD in 2019. Recently, Kidney Disease: Improving Global Outcomes (KDIGO) updated its recommendations for the diagnosis, evaluation, management, and treatment of CKD. These guidelines incorporate the most recent evidence-based practices to support laboratory professionals in delivering optimal care for individuals with CKD, focusing on critical areas such as estimated GFR (eGFR), albuminuria assessment, and risk stratification. The latest National Institute for Health and Care Excellence (NICE) guidelines on CKD has also incorporated the Kidney Failure Risk Equation (KFRE) as a tool for predicting the likelihood of progression to end-stage kidney disease (ESKD) in CKD patients. Hence, the MACB-CKD Task Force has reviewed and updated its recommendations for laboratory reporting of eGFR and urine albumin in alignment with the latest guidelines.
Fulltext Are the 2009 Institute of Medicine gestational weight gain recommendations applicable in a contemporary South-East Asian pregnancy cohort? Results of a prospective analysis

Tai YT, Khoo JK, Lim QH, Lim LL, Paramasivam SS, Ratnasingam J, et al.

PLoS One, 2025;20(1):e0316837.
PMID: 39761286 DOI: 10.1371/journal.pone.0316837

Gestational Weight Gain (GWG) modulates pregnancy outcomes and long-term offspring metabolic health. The 2009 Institute of Medicine (IOM) GWG recommendations have largely been validated in Caucasian and mono-ethnic East Asian cohorts. Asians are at higher metabolic risk at a lower body mass index (BMI), and this has prompted the World Health Organization (WHO) to identify lower BMI cut-offs for risk evaluation amongst Asians. This prospective observational cohort study aimed to determine if 2009 IOM GWG thresholds are applicable in a contemporary multi-ethnic South-East Asian cohort. We recruited 875 mothers from an urban Malaysian tertiary clinic during screening for gestational diabetes mellitus (GDM) from 2014-2021. Data collected included measures of insulin-sensitivity, total GWG (maternal weight at delivery-self-reported pre-gravid weight), and neonatal anthropometrics (birthweight and skinfold-thickness measured with Harpenden calipers). BMI was stratified by Caucasian (overweight ≥25kg/m2, obese ≥30kg/m2) as well as Asian (overweight ≥23kg/m2, obese ≥27.5kg/ m2) cut-offs, and patients categorized by 2009 IOM GWG reference ranges. The cohort comprised 67% Malay-, 23% Chinese- and 10% Indian-descent mothers with a high prevalence of overweight/obesity (Asian cut-offs 56.9% vs Caucasian 44%). When Asian BMI cut-offs were deployed, excessive GWG incidence increased (34.1% → 40.6%) whilst inadequate GWG declined (30% → 24.8%) (p<0.05). Upon multivariate-analysis (adjusting for age, parity, race, GDM, insulin-sensitivity, baby-gender) excessive GWG categorized with Caucasian BMI cut-offs was significantly associated with increased risk of macrosomia (adjusted odds ratio (aOR) 8.65, 95% confidence interval (CI) 1.07-70.01), Neonatal-Fat-Mass (NFM) >90th centile (aOR 2.14, 95% CI 1.02-4.45) and Sum-of-Skinfold Thickness (SSFT) >90th centile (aOR 3.88, 95% CI 1.77-8.51). Excessive GWG by Asian cut-offs was also associated with increased risk of SSFT >90th centile (aOR 5.75, 95% CI 2.35-14.10). Inadequate GWG by both Caucasian and Asian BMI cut-offs was associated with Small-for-Gestational-Age (SGA) status (aOR 4.30, 95% CI 2.48-7.45 and aOR 3.66, 95% CI 2.13-6.30 respectively). In conclusion, the 2009 IOM GWG recommendations, using either Caucasian or regional Asian BMI cut-offs, are applicable in a contemporary Malay majority South-East Asian cohort in terms of predicting abnormal neonatal adiposity. Importantly, the association with neonatal adiposity is independent of increased maternal insulin resistance characteristic of Asians.