METHODS: Retrospective data on serum calcium and infusion rates was collected from 2011-2015. The relationship between peak calcium efflux (PER) and time was determined using a scatterplot and linear regression. A comparison between regimens was made based on treatment efficacy (hypocalcaemia duration, total infusion amount and time) and calcium excursions (outside target range, peak and trough calcium) using bar charts and an unpaired t-test.
RESULTS: Fifty-one and 34 patients on the original and new regimens respectively were included. Mean PER was lower (2.16 vs 2.56 mmol/h; P = 0.03) and occurred earlier (17.6 vs 23.2 h; P = 0.13) for the new regimen. Both scatterplot and regression showed a large correlation between PER and time (R-square 0.64, SE 1.53, P P = 0.04), and required less calcium infusion (67.7 vs 127.2 mmol, P = 0.02) for a shorter duration (57.3 vs 102.9 h, P = 0.001). Calcium excursions, peak and trough calcium were not significantly different between regimens. Early postoperative high excursions occurred when the infusion was started in spite of elevated peri-operative calcium levels.
CONCLUSION: The new infusion regimen was superior to the original in that it required a shorter treatment period and resulted in less hypocalcaemia. We found that early aggressive calcium replacement is unnecessary and raises the risk of rebound hypercalcemia.
OBJECTIVE: The aim of this audit was to determine the frequency of histological changes compatible with Coeliac disease among patients undergoing elective diagnostic oesaphago-gastro-duodenoscopy (OGDS) under the care of a single practitioner in a Malaysian hospital.
MATERIALS AND METHODS: The archived endoscopically obtained duodenal biopsy specimens of 241 consecutive Malaysian subjects undergoing elective diagnostic (OGDS) were reviewed by a pathologist blinded to the clinical data. Based on intra-epithelial lymphocyte counts, crypt hyperplasia and villous atrophy, each subject was assigned to one of the categories of the Modified Marsh classification for the histological diagnosis of Coeliac disease. The clinical charts of all subjects were reviewed by a single gastroenterologist blinded to the findings of the histological review.
RESULTS: Of the 241 study subjects, 132 (54.8%) were females. There were 56 (23.2%) Malays, 90 (37.3%) Chinese, 88 (36.5%) Indians and seven (2.9%) from the other category. The median age of the study sample was 49 years (range 15- 88 years). The OGDS was done as part of screening in 15(6.2%) subjects while in the remaining it was part of the investigation of a clinical problem. Based on histological findings, none of the subjects could be assigned to a modified Marsh class of >1. The prevalence of histological changes compatible with Coeliac disease in the study was 0% (binomial exact one-sided 97.5 % confidence interval 0- 1.52%).
CONCLUSION: In conclusion, this audit provides no evidence that active Coeliac disease is significantly under-detected among symptomatic patients presenting for diagnostic OGDS. The possibility that a significant number may have potential coeliac disease cannot be excluded.
MATERIALS AND METHODS: Three groups of data were analysed from the BDTR over the 10-year period. Epidemiological data, blood parameters and dialysis are key performance indicators.
RESULTS: There are increments in prevalence and incidence of treated ESKD patients in Brunei over 10 years, especially with haemodialysis (HD). The projected prevalence and incidence showed an anticipated annual increase of 42.2 per million population (pmp) and 9.9 pmp respectively. Diabetes mellitus (DM) (79%) was the main cause of ESKD. HD (86%), peritoneal dialysis (PD) (9%) and transplant (5%) were the main modalities of kidney replacement therapy in 2020. Cumulative results over the decade showed significant improvements in serum phosphate, peritonitis rates and HD blood flow rates. PD patients have better survival rates, lower systolic blood pressure and better adequacy. PD survival (patient survival of 91%, 73% and 56% at 1, 3 and 5 years respectively) was superior to HD survival (86% and 64% at 1 and 2 years, respectively), but patient demographics (age and DM status) were different. The 2020 dataset showed satisfactory anaemia management but mineral bone disease management was sub-optimal. Seventy percent of prevalent HD patients had arteriovenous fistula access. Thirty-two percent and fifty-two percent of HD and PD patients, respectively, achieved target dialysis adequacy. Peritonitis rate was 0.3 episodes per patient year.
CONCLUSION: Brunei has a high incidence and prevalence of treated ESKD in the last decade, especially DM-related ESKD. This study has identified many specific areas to be targeted for improvements and provided evidence for further proliferation of PD and transplant preference policy.
METHODS: A cross-sectional study was conducted among university students in Selangor, Malaysia, using a self-administered questionnaire along with anthropometric measurements. The sample size was calculated using a single proportion formula. The CVD risk was calculated using the non-laboratory-based Inter-Heart Modifiable Risk Score (IHMRS). Participants aged 18 years and above, with no CVD history, were recruited using a convenience sampling method between February and May 2022. CVD risk was classified as low (scores between 0 and 9 points), moderate (scores between 10 and 15 points) and high (scores between 16 and 48 points). The factors associated with the CVD risk were identified using χ2 analysis.
RESULTS: A total of 241 participants were included in this study. The median age was 28 years and the majority were females (75.1%). The IHMRS revealed that 46.5%, 44.4% and 9% of the respondents have low, moderate and high CVD risk, respectively. The CVD risk associated factors were education, the history of heart attacks among parents, feeling sad or depressed for 2 weeks or more in a row, having several episodes/permanent stress, expose to secondhand smoke and consuming meat and poultry more than two times daily.
CONCLUSIONS: This study found that more than 50% of study participants had moderate to high risk of CVD. Family history and lifestyle factors are the most likely determinants of CVD risk among the young age group. These findings support the development and implementation of targeted prevention programmes as well as provide useful information for action planning and policymaking to curb the disease in the future.
METHODS: Saccharide mapping or enzymatic profiling plays a role in quality control of polysaccharides. Whereby, in vitro and in vivo tests as well as toxicity level discriminating polysaccharides biological activities. Extraction and purification methods are performed in obtaining algal derived polysaccharides followed by chromatographic profiles of their active compounds, structural features, physicochemical properties, and reported biological activities.
RESULTS: Marine algae are capable of synthesizing Glycosaminoglycans (GAGs) and non-GAGs or GAG mimetics such as sulfated glycans. The cell walls of algae are rich in sulfated polysaccharides, including alginate, carrageenan, ulvan and fucoidan. These biopolymers are widely used algal-derived polysaccharides for biological and biomedical applications due to their biocompatibility and availability. They constitute biochemical compounds that have multi-functionalization, therapeutic potential and immunomodulatory abilities, making them promising bioactive products and biomaterials with a wide range of biomedical applications.
CONCLUSION: Algal-derived polysaccharides with clearly elucidated compositions/structures, identified cellular activities, as well as desirable physical properties have shown the potential that may create new opportunities. They could be maximally exploited to serve as therapeutic tools such as immunoregulatory agents or drug delivery vehicles. Hence, novel strategies could be applied to tailor multi-functionalization of the polysaccharides from algal species with vast biomedical application potentials.
METHODS: We developed a four-state partitioned survival model which compared treatment with olaparib versus routine surveillance (RS) from a Malaysian healthcare perspective. Mature overall survival (OS) data from the SOLO-1 study were used and extrapolated using parametric models. Medication costs and healthcare resource usage costs were derived from local inputs and publications. Deterministic and probabilistic sensitivity analyses (PSA) were performed to explore uncertainties.
RESULTS: In Malaysia, treating patients with olaparib was found to be more costly compared to RS, with an incremental cost of RM149,858 (USD 33,213). Patients treated with olaparib increased life years by 3.05 years and increased quality adjusted life years (QALY) by 2.76 (9.45 years vs 6.40 years; 7.62 vs 4.86 QALY). This translated to an incremental cost-effectiveness ratio (ICER) of RM 49,159 (USD10,895) per life year gained and RM54,357 (USD 12,047) per QALY gained, respectively. ICERs were most sensitive to time horizon of treatment, discount rate for outcomes, cost of treatment and health state costs, but was above the RM53,770/QALY threshold.
CONCLUSION: The use of olaparib is currently not a cost-effective strategy compared to routine surveillance based upon the current price in Malaysia for people with ovarian cancer with BRCA mutation, despite the improvement in overall survival.