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  1. Faisham WI, Mat Saad AZ, Alsaigh LN, Nor Azman MZ, Kamarul Imran M, Biswal BM, et al.
    Asia Pac J Clin Oncol, 2017 Apr;13(2):e104-e110.
    PMID: 25870979 DOI: 10.1111/ajco.12346
    AIM: Osteosarcoma is a highly malignant primary bone tumor. The study aim to evaluate the prognostic factors influencing the survival rate in our center.

    METHODS: This was a retrospective cohort study of all patients treated between January 2005 and December 2010.

    RESULTS: We included 163 patients with an age range of 6-59 years (median = 19). The median follow-up was 47 months (range 36-84). The overall survival in patients who completed chemotherapy and surgery (n = 117) was 72% at 2 years and 44% at 5 years. Histologically, 99 (85%) had osteoblastic, 6 (5%) had chondroblastic and 3 (2.5%) had telangiectatic osteosarcoma. Limb salvage surgery was performed in 80 (49%) and 41 (25%) underwent amputation. However, 46 patients (28%) underwent no surgical intervention and incomplete chemotherapy. In total, 38/79 patients had a good chemotherapy response. There was a significantly better survival rate for limb salvage versus amputation. Independent prognostic factors for survival are compliance to treatment and presence of lung metastasis.

    CONCLUSION: The overall survival of osteosarcoma patients was influenced by the presence of pulmonary metastases and compliance to treatment. Histological subtype, different chemotherapy regimens and histological necrosis after chemotherapy did not significantly influence survival. The patients who did not complete treatment had significantly poorer survival.

    Matched MeSH terms: Young Adult
  2. Shanmuganathan R, Subramaniam ID
    Glob J Health Sci, 2015;7(4):110-20.
    PMID: 25946947 DOI: 10.5539/gjhs.v7n4p110
    INTRODUCTION: The main aim of this study was to describe the clinical manifestation of tuberculosis infection cases in Malaysia and to determine the individual risk factors for their occurrence.
    METHODOLOGY: The study adopted a quantitative research approach with use of descriptive statistical approach. The study setting was a community clinic which treats walk in patients who are mainly living and working in the surrounding areas. The study was conducted for a period of one year. All tuberculosis patients who sought treatment in the clinic during the time were included in this study. The total number of cases was 40. Data was collected from the medical records of the tuberculosis patients. The risk factors selected for investigation were demographic characteristics of age and sex, personal habits such as smoking, drug use and alcohol and presence of diseases such as human immunodeficiency virus positive (HIV+), diabetes mellitus, cancer, cyanotic heart disease, renal failure and steroid use.
    RESULTS: Patients in the age group ranging from 41 to 50 years had the highest incidence of the infection. Smoking appears to be the most important risk factor for contracting followed by drug abuse, HIV+ infection and diabetes mellitus.
    CONCLUSIONS: People with diseases such as diabetes mellitus and HIV that are high risk factors for TB should be screened for TB so that early detection and intervention is possible. Educational programs should be carried out to create awareness among the at risk groups.
    Matched MeSH terms: Young Adult
  3. Campa D, Rizzato C, Stolzenberg-Solomon R, Pacetti P, Vodicka P, Cleary SP, et al.
    Int J Cancer, 2015 Nov 01;137(9):2175-83.
    PMID: 25940397 DOI: 10.1002/ijc.29590
    A small number of common susceptibility loci have been identified for pancreatic cancer, one of which is marked by rs401681 in the TERT-CLPTM1L gene region on chromosome 5p15.33. Because this region is characterized by low linkage disequilibrium, we sought to identify whether additional single nucleotide polymorphisms (SNPs) could be related to pancreatic cancer risk, independently of rs401681. We performed an in-depth analysis of genetic variability of the telomerase reverse transcriptase (TERT) and the telomerase RNA component (TERC) genes, in 5,550 subjects with pancreatic cancer and 7,585 controls from the PANcreatic Disease ReseArch (PANDoRA) and the PanScan consortia. We identified a significant association between a variant in TERT and pancreatic cancer risk (rs2853677, odds ratio = 0.85; 95% confidence interval = 0.80-0.90, p = 8.3 × 10(-8)). Additional analysis adjusting rs2853677 for rs401681 indicated that the two SNPs are independently associated with pancreatic cancer risk, as suggested by the low linkage disequilibrium between them (r(2) = 0.07, D' = 0.28). Three additional SNPs in TERT reached statistical significance after correction for multiple testing: rs2736100 (p = 3.0 × 10(-5) ), rs4583925 (p = 4.0 × 10(-5) ) and rs2735948 (p = 5.0 × 10(-5) ). In conclusion, we confirmed that the TERT locus is associated with pancreatic cancer risk, possibly through several independent variants.
    Matched MeSH terms: Young Adult
  4. Shaik MM, Hassan NB, Tan HL, Bhaskar S, Gan SH
    J Headache Pain, 2015 Mar 14;16:22.
    PMID: 25903056 DOI: 10.1186/s10194-015-0509-5
    BACKGROUND: The Structured Migraine Interview (SMI) is a valid and reliable instrument for migraine diagnosis. However, a Malay version of the SMI is not available to be applied to the local Malaysian population. This study was designed to access the validity and reliability of a new Malay version of the SMI questionnaire.
    METHODS: Patients with headache attending the Neurology Clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia, were screened against the inclusion/exclusion criteria before recruitment. A standard translation procedure was used to translate and adapt the questionnaire into the Malay language. The translated version was tested for face, content and construct validities. Subsequently, validity and reliability studies were conducted (1(st) compilation), followed by retesting seven days later (2(nd) compilation).
    RESULTS: A total of 157 patients between 15 and 60 years of age were enrolled in this study. The kappa value was 0.70 (p 
    Matched MeSH terms: Young Adult
  5. Mookiah MR, Acharya UR, Chandran V, Martis RJ, Tan JH, Koh JE, et al.
    Med Biol Eng Comput, 2015 Dec;53(12):1319-31.
    PMID: 25894464 DOI: 10.1007/s11517-015-1278-7
    Diabetic macular edema (DME) is one of the most common causes of visual loss among diabetes mellitus patients. Early detection and successive treatment may improve the visual acuity. DME is mainly graded into non-clinically significant macular edema (NCSME) and clinically significant macular edema according to the location of hard exudates in the macula region. DME can be identified by manual examination of fundus images. It is laborious and resource intensive. Hence, in this work, automated grading of DME is proposed using higher-order spectra (HOS) of Radon transform projections of the fundus images. We have used third-order cumulants and bispectrum magnitude, in this work, as features, and compared their performance. They can capture subtle changes in the fundus image. Spectral regression discriminant analysis (SRDA) reduces feature dimension, and minimum redundancy maximum relevance method is used to rank the significant SRDA components. Ranked features are fed to various supervised classifiers, viz. Naive Bayes, AdaBoost and support vector machine, to discriminate No DME, NCSME and clinically significant macular edema classes. The performance of our system is evaluated using the publicly available MESSIDOR dataset (300 images) and also verified with a local dataset (300 images). Our results show that HOS cumulants and bispectrum magnitude obtained an average accuracy of 95.56 and 94.39% for MESSIDOR dataset and 95.93 and 93.33% for local dataset, respectively.
    Matched MeSH terms: Young Adult
  6. Bakar SM, Shamim M, Salam A, Sultana SA
    Ir J Med Sci, 2016 Feb;185(1):249-57.
    PMID: 25894278 DOI: 10.1007/s11845-015-1287-4
    BACKGROUND: The anatomy of the vermiform appendix shows variations in its macroscopic dimensions and microscopic features, some of which have potentials of influencing the clinical aspects of the appendix.

    AIM: The aim of this study was to find out some microscopic features of appendix and evaluate the correlation between the microscopic features of the appendix and the age of the subjects and to determine whether these findings should influence the clinical implications of appendix.

    METHODS: In this cross-sectional observational study, thirty adult males' (age from 18 to 67 years) postmortem appendices and adnexa from Bangladeshi victims of road traffic accidents were sectioned at the base, midzone and tip stained with H+E stain and examined under microscope. Measurements were taken at the base, at the midzone and at the tip of the appendix, and the mean of the three measurements was considered as the overall value.

    RESULTS: The overall number of mucosal glands in a section ranged from 42.33 to 130.00 and the number of the germinal centres varied between 2.33 and 10.00. The overall luminal diameter ranged between 1764.58 and 3208.33 µm. The overall luminal diameter in more than 52 % of cases was between 2700.00 and 3299.99 µm with a median value of 2750 µm.

    CONCLUSION: The overall number of mucosal glands showed a tendency towards a positive correlation with age. The overall luminal diameter and the overall number of germinal centres showed a tendency towards a negative correlation with the age. However, none of the tendencies of correlation reached statistically any significant level.

    Matched MeSH terms: Young Adult
  7. Gan GG, Leong YC, Bee PC, Chin E, Teh AK
    Support Care Cancer, 2015 Aug;23(8):2399-406.
    PMID: 25876158 DOI: 10.1007/s00520-015-2614-z
    BACKGROUND: Complementary and alternative medicine (CAM) is often used by cancer patients, but not many studies had been published on the prevalence of CAM use in patients with hematological cancers. This study aims to determine the prevalence of CAM and type of CAM used in this group of patients in a multiracial and multicultural country.

    PATIENTS AND METHODS: This is a cross-sectional survey carried out in two hospitals in Malaysia. Patients with underlying hematological cancers were asked to complete the questionnaires on CAM and the Hospital Anxiety and Depression Scale.

    RESULTS: A total of 245 patients participated. The prevalence of CAM use was 70.2 %. The most common types of CAM used are biological-based therapies (90.2 %) and mind-body interventions (42 %). Vitamin and diet supplements (68.6 %) and folk/herb remedies (58 %) are the most common biological-based therapies used. There is no significant association of CAM use with age, gender, education level, and household income. Female patients are more likely to use more than one CAM therapies. The most common reason reported for CAM use was to boost immunity (57 %) and cure (24 %). Majority of patients (65 %) felt CAM was effective, and 60 % did not inform their physicians regarding CAM usage.

    CONCLUSION: In view of the high prevalence of CAM use in patients with hematological cancers, it is important that the physicians play an active role in seeking information from patients and to monitor possible drug-vitamin-herbal interactions.

    Matched MeSH terms: Young Adult
  8. Watabe M, Kato TA, Teo AR, Horikawa H, Tateno M, Hayakawa K, et al.
    PLoS One, 2015;10(3):e0120183.
    PMID: 25836972 DOI: 10.1371/journal.pone.0120183
    Maladaptive social interaction and its related psychopathology have been highlighted in psychiatry especially among younger generations. In Japan, novel expressive forms of psychiatric phenomena such as "modern-type depression" and "hikikomori" (a syndrome of severe social withdrawal lasting for at least six months) have been reported especially among young people. Economic games such as the trust game have been utilized to evaluate real-world interpersonal relationships as a novel candidate for psychiatric evaluations. To investigate the relationship between trusting behaviors and various psychometric scales, we conducted a trust game experiment with eighty-one Japanese university students as a pilot study. Participants made a risky financial decision about whether to trust each of 40 photographed partners. Participants then answered a set of questionnaires with seven scales including the Lubben Social Network Scale (LSNS)-6 and the Patient Health Questionnaire (PHQ)-9. Consistent with previous research, male participants trusted partners more than female participants. Regression analysis revealed that LSNS-family (perceived support from family) for male participants, and item 8 of PHQ-9 (subjective agitation and/or retardation) for female participants were associated with participants' trusting behaviors. Consistent with claims by social scientists, our data suggest that, for males, support from family was negatively associated with cooperative behavior toward non-family members. Females with higher subjective agitation (and/or retardation) gave less money toward males and high attractive females, but not toward low attractive females in interpersonal relationships. We believe that our data indicate the possible impact of economic games in psychiatric research and clinical practice, and validation in clinical samples including modern-type depression and hikikomori should be investigated.
    Matched MeSH terms: Young Adult
  9. Abdollahi A, Talib MA, Yaacob SN, Ismail Z
    PLoS One, 2015;10(4):e0122222.
    PMID: 25830229 DOI: 10.1371/journal.pone.0122222
    Recent evidence suggests that suicidal ideation is increased among university students, it is essential to increase our knowledge concerning the etiology of suicidal ideation among university students. This study was conducted to examine the relationships between problem-solving skills appraisal, hardiness, and suicidal ideation among university students. In addition, this study was conducted to examine problem-solving skills appraisal (including the three components of problem-solving confidence, approach-avoidance style, and personal control of emotion) as a potential mediator between hardiness and suicidal ideation.
    Matched MeSH terms: Young Adult
  10. Butt MA, Ahmad M, Fatima A, Sultana S, Zafar M, Yaseen G, et al.
    J Ethnopharmacol, 2015 Jun 20;168:164-81.
    PMID: 25818693 DOI: 10.1016/j.jep.2015.03.045
    Medicinal plants represent one of the most accessible resources available for snake and scorpion bite among the rural communities of Northern Pakistan. This first ethno-botanical study aimed to document the indigenous knowledge and practices of using plants for snake and scorpion bite disorders in Northern Pakistan.
    Matched MeSH terms: Young Adult
  11. Norhalifah HK, Zafarina Z, Sundararajulu P, Norazmi MN, Edinur HA
    Int. J. Immunogenet., 2015 Jun;42(3):200-3.
    PMID: 25809422 DOI: 10.1111/iji.12189
    In this survey, we have successfully genotyped 22 single nucleotide polymorphisms in the 13 cytokine genes for five Malay subethnic groups (Kelantan, Acheh, Mandailing, Minangkabau and Patani Malays) using polymerase chain reaction-sequence-specific primer cytokine genotyping kit (Invitrogen, Carlsbad, CA, USA). Most of the cytokine genes showed similar pattern of allelic spectra with wild-type alleles (e.g. ILIa-889/C, ILIB+3962/C and IL6 nt565/G) that represent more than 80% in the studied Malay subethnic groups. These newly observed cytokine alleles and subsequent analyses clearly indicate genetic contribution from Asia in the studied Malay subethnic groups with evidence of admixture from neighbouring populations in Patani Malays. The cytokine data sets for the five Malay subethnic groups deposited in this report can also be used as reference standard for searching suitable donor for allograft transplant and diseases association study. This is particularly relevance as our analyses showed differences between the Malay subethnic groups and other populations screened for cytokine genes.
    Matched MeSH terms: Young Adult
  12. Basri R, Zueter AR, Mohamed Z, Alam MK, Norsa'adah B, Hasan SA, et al.
    Nagoya J Med Sci, 2015 Feb;77(1-2):59-68.
    PMID: 25797971
    To describe the clinical characteristics and the risk factors associated with mortality in patients with meningitis. This is a retrospective review of patients diagnosed to have meningitis with positive culture of the cerebrospinal fluid (CSF) specimen. All cases aged 19 > years who were admitted to Hospital USM between January 2004 and December 2011 were included in the study. The CSF results database were obtained from the Department of Medical Microbiology and Parasitology, Hospital USM, Kelantan. A checklist was used to record the clinical characteristics. A total of 125 cases met the inclusion criteria. The age of patients ranged between newborn and 19 years old (Mean±SD, 74.5±80.6 months). The majority of them were males (65.6%). Fever was the most common presentation (73.6%) followed by poor oral intake (48.0%), seizure (36.0%) and headache (24.8%). The mortality rate was 31.2%. Coagulase negative staphylococcus was the most frequent pathogens isolated (21.6%), followed by Acinetobacter spp. (17.6%), Staphylococcus aureus (13.6%), Streptococcus spp. (11.2%) and Klebsiella pneumoniae (6.4%). There were significant association of in-hospital death with age (p=0.020) and conscious level (p=0.001). Infectious meningitis is a big health concern, especially among children. We found that coagulase negative staphylococcus, Acinetobacter species, S. aureus, Streptococcus spp and K. pneumoniae were prevalent in our hospital. These microorganisms were hospital associated pathogens. The 31% mortality linked to hospital acquired meningitis specifies the need for focused physician attention especially among younger aged patients.
    Matched MeSH terms: Young Adult
  13. Al-Darraji HA, Tan C, Kamarulzaman A, Altice FL
    Occup Environ Med, 2015 Jun;72(6):442-7.
    PMID: 25794506 DOI: 10.1136/oemed-2014-102695
    OBJECTIVES: Although prison employees share the same tuberculosis (TB) risk environment with prisoners, the magnitude of TB problems among prison employees is unknown in most resource-limited prisons. This survey was conducted to investigate the prevalence and correlates of tuberculin skin test (TST) positivity among employees in Malaysia's largest prison.

    METHODS: Consented, full-time prison employees were interviewed using a structured questionnaire that included sociodemographic data, history of working in the correctional system and TB-related risk. TST was placed intradermally and read after 48-72 h. Induration size of ≥10 mm was considered positive. Logistic regression analyses were conducted to explore associations with TST positivity.

    RESULTS: Of the 445 recruited prison employees, 420 (94.4%) had complete data. Most were young (median=30.0 years) men (88.8%) who had only worked at this prison (76.4%) for a median total employment period of 60 months (IQR 34.5-132.0). The majority were correctional officers, while civilian employees represented only 7.6% of the sample. Only 26 (6.2%) reported having ever been screened for TB since employment. Prevalence of TST positivity was 81% and was independently associated with longer (≥12 months) prison employment (AOR 4.9; 95% CI 1.5 to 15.9) and current tobacco smoking (AOR=1.9, 95% CI 1.2 to 3.2).

    CONCLUSIONS: Latent TB prevalence was high in this sample, approximating that of prisoners in this setting, perhaps suggesting within prison TB transmission in this facility. Formal TB control programmes for personnel and prisoners alike are urgently needed within the Malaysian correctional system.

    Matched MeSH terms: Young Adult
  14. Ng CJ, McCarthy SA
    Med J Malaysia, 2002 Dec;57 Suppl E:44-51.
    PMID: 12733193
    BACKGROUND: Taking a sexual history and discussing sexual health issues with patients form an important part of a medical consultation. These specific communication skills can be acquired through various teaching methods.
    OBJECTIVE: This paper describes the communication skill workshops conducted for undergraduate medical students on how to talk to patients about sex.
    METHODOLOGY: 198 medical students participated in a series of workshops conducted in the University of Malaya in 2001-2002. Pre- and post-workshop evaluations of the programme were carried out to find out the students' difficulties and to assess the usefulness of the workshop. The workshop consisted of a short lecture, role-plays and discussion.
    RESULTS: Only 34% of the participants had received some informal training during their clinical years. The main barriers encountered were gender and age differences, language and choice of words, patients and doctors feeling shy, and cultural differences. The workshop was felt to be useful (mean score 4.38, maximum 5.0), most students felt comfortable during the workshop (mean score 4.10, maximum 5.0) and there was significant improvement in the "comfort level" when talking to patients about sex after attending the workshop (P < 0.001).
    CONCLUSION: Gender, language and cultural differences were the main barriers in taking a sexual history and discussing sexual health issues among the medical students. Communication workshop was felt to be a useful and comfortable method of learning these specific.
    Matched MeSH terms: Young Adult
  15. Barkeh HJ, Muhaya M
    Med J Malaysia, 2002 Dec;57(4):490-2.
    PMID: 12733176
    Systemic lupus erythematosus (SLE) is a common multisystem disorder. However, retinal vasculitis as a primary manifestation of SLE is uncommon, accounting for only 4% of causes of retinal vasculitis. The postulated mechanism appeared to be vaso-occlusion of the retinal arterioles by thrombosis, with resultant ischaemia. Optic neuropathy in SLE is also rare, with a prevalence of 1%. This is a case report of a young lady who presented to us with retinal vasculitis as her initial presentation of SLE. Interestingly, the pathologic mechanism appeared to be inflammatory and not vaso-occlusive.
    Matched MeSH terms: Young Adult
  16. Choon SE, Mathew M, Othman BS
    Med J Malaysia, 2000 Jun;55(2):174-9.
    PMID: 19839145
    The demographic characteristics, risk behaviourand prevalence of other sexually transmitted diseases (STDs) were determined in 132 HIV-infected individuals seen in a Dermatology cum Genitourinary Clinic, Hospital Sultanah Aminah Johor Bahru. Sixty-one (46.2%) were Malays, 37.9% Chinese, 10.6% Indians and 5.3% were of other ethnic groups. The male to female ratio was 4.5:1. Most of the patients (82.5%) were between 20 to 40 years-old. Seventy (53.0%) were single, 34.1% were married and 7.5% were divorcees. The majority of them (97.7%) were heterosexual. Fifty seven (53.3%) of our male patients patronised commercial workers. Eighty-one (61.8%) were not intravenous drug users (IVDU). Of the 50 IVDUs, 24 had multiple sexual exposures. Fifty-three (48.2%) of the 109 patients screened for STDs had one or more other STDs. Thirty-four patients (31.9%) reported one STD in the past and 3.6% reported two STDs in the past. Fifty-six patients (42.4%) had developed AIDS. Thirteen had passed away. The main mode of transmission of HIV infection in this population is through heterosexual intercourse and the prevalence of STDs is high. These findings indicate a need to advocate responsible sexual behaviour and to detect as well as treat STDs early to prevent the sexual transmission of HIV.

    Study site: Dermatology cum Genitourinary Clinic, Hospital Sultanah Aminah Johor Bahru
    Matched MeSH terms: Young Adult
  17. Ravindran J, Jayadev R, Lachmanan SR, Merican I
    Med J Malaysia, 2000 Jun;55(2):209-19.
    PMID: 19839149
    Liver disease is an important and serious condition in pregnancy. The Confidential Enquiries Into Maternal Deaths in Malaysia showed that there were 23 maternal deaths attributed to liver disease between 1991-1994. Over the same period, there were 1066 reported maternal deaths with 929 of them being due to direct and indirect causes. Thus 2.15% of such deaths were due to liver disease in Malaysia. The three main causes of maternal deaths due to liver disease in pregnancy were hepatitis (6 cases), acute fatty liver in pregnancy (6 cases) and septicaemia (4 cases). Liver disease is common at a mean of thirty weeks of gestation with a preponderance to women of low parity. Only two patients in this series had no antenatal care. The majority of cases (45.8%) presented between 28-37 weeks of gestation. All cases delivered by spontaneous vaginal delivery. Remediable factors that were identified included failure to appreciate the severity of disease. Case summaries of all the cases of maternal deaths due to liver disease are discussed and a guideline to management of liver disease in pregnancy presented.
    Matched MeSH terms: Young Adult
  18. Zaini Anuar, Asrar M, Ngan A
    Med J Malaysia, 1982 Mar;37(1):78-9.
    PMID: 7121353
    A young Chinese female presented with severe bilateral chemosis without any other systemic evidence ofoedema or systemic lupus erythematosus (SLE). Investigations confirmed the diagnosis of SLE with early diffuse proliferative glomerulonephritis. The condition improved with steroid therapy.
    Matched MeSH terms: Young Adult
  19. Doets AY, Verboon C, van den Berg B, Harbo T, Cornblath DR, Willison HJ, et al.
    Brain, 2018 10 01;141(10):2866-2877.
    PMID: 30247567 DOI: 10.1093/brain/awy232
    Guillain-Barré syndrome is a heterogeneous disorder regarding the clinical presentation, electrophysiological subtype and outcome. Previous single country reports indicate that Guillain-Barré syndrome may differ among regions, but no systematic comparative studies have been conducted. Comparative studies are required to identify factors determining disease susceptibility, variation and prognosis, and to improve diagnostic criteria. The International Guillain-Barré Syndrome Outcome Study is a prospective, observational cohort study including all patients within the diagnostic spectrum, aiming to describe the heterogeneity of Guillain-Barré syndrome worldwide. The current study was based on the first 1000 inclusions with a follow-up of at least 1 year and confirmed the variation in clinical presentation, course and outcome between patients. The full clinical spectrum of Guillain-Barré syndrome was observed in patients from all countries participating in the International Guillain-Barré Syndrome Outcome Study, but the frequency of variants differed between regions. We compared three regions based on geography, income and previous reports of Guillain-Barré syndrome subtypes: 'Europe/Americas', 'Asia' (without Bangladesh), and 'Bangladesh'. We excluded 75 (8%) patients because of alternative diagnoses, protocol violations, or missing data. The predominant clinical variant was sensorimotor in Europe/Americas (n = 387/562, 69%) and Asia (n = 27/63, 43%), and pure motor in Bangladesh (n = 74/107, 69%). Miller Fisher syndrome and Miller Fisher-Guillain-Barré overlap syndrome were more common in Asia (n = 14/63, 22%) than in the other two regions (Europe/Americas: n = 64/562, 11%; Bangladesh: n = 1/107, 1%) (P < 0.001). The predominant electrophysiological subtype was demyelinating in all regions (Europe/Americas: n = 312/573, 55%; Asia: n = 29/65, 45%; Bangladesh: n = 38/94, 40%). The axonal subtype occurred more often in Bangladesh (n = 34/94, 36%) than in Europe/Americas (n = 33/573, 6%) and other Asian countries (n = 4/65, 6%) (P < 0.001). In all regions, patients with the axonal subtype were younger, had fewer sensory deficits, and showed a trend towards poorer recovery compared to patients with the demyelinating subtype. The proportion of patients able to walk unaided after 1 year varied between Asia (n = 31/34, 91%), Europe/Americas (n = 334/404, 83%) and Bangladesh (n = 67/97, 69%) (P = 0.003). A similar variation was seen for mortality, being higher in Bangladesh (n = 19/114, 17%) than in Europe/Americas (n = 23/486, 5%) and Asia (n = 1/45, 2%) (P < 0.001). This study showed that factors related to geography have a major influence on clinical phenotype, disease severity, electrophysiological subtype, and outcome of Guillain-Barré syndrome.
    Matched MeSH terms: Young Adult
  20. Tan CY, Shahrizaila N, Yeoh KY, Goh KJ, Tan MP
    Clin Auton Res, 2019 06;29(3):339-348.
    PMID: 29654380 DOI: 10.1007/s10286-018-0525-z
    OBJECTIVE: The current study aimed to investigate autonomic dysfunction in Guillain-Barré syndrome (GBS) patients and describe the results of computational heart rate variability (HRV)/baroreflex sensitivity (BRS) and autonomic challenge tests.

    METHODS: GBS patients were consecutively recruited and the results were compared to age- and gender-matched healthy controls. A series of autonomic function tests including computation-dependent tests (power spectrum analysis of HRV and BRS at rest) and challenge maneuvers (deep breathing, eyeball compression, active standing, the Valsalva maneuver, sustained handgrip, and the cold pressor test) were performed.

    RESULTS: Ten GBS patients (six men; mean age = 40.1 ± 13.9 years) and ten gender- and age-matched healthy controls were recruited. The mean GBS functional grading scale at disease plateau was 3.4 ± 1.0. No patients required intensive care unit admission or mechanical ventilation. Low-frequency HRV (p = 0.027), high-frequency HRV (p = 0.008), and the total power spectral density of HRV (p = 0.015) were significantly reduced in patients compared to controls. The mean up slope (p = 0.034), down slope (p = 0.011), and total slope (p = 0.024) BRS were significantly lower in GBS patients. The diastolic rise in blood pressure in the cold pressor test was significantly lower in GBS patients compared to controls (p = 0.008).

    INTERPRETATION: Computation-dependent tests (HRV and BRS) were more useful for detecting autonomic dysfunction in GBS patients, whereas the cold pressor test was the only reliable challenge test, making it useful as a bedside measure of autonomic function in GBS patients.

    Matched MeSH terms: Young Adult
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