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  1. Current status in decision making to treat acute type A dissection: limited versus extended repair
    Velayudhan BV, Idhrees M, Matalanis G, Park KH, Tang D, Sfeir PM, et al.
    J Cardiovasc Surg (Torino), 2020 Jun;61(3):285-291.
    PMID: 32337940 DOI: 10.23736/S0021-9509.20.11397-1
    Acute type A aortic dissection remains one of the most challenging conditions in aortic surgery. Despite the advancements in the field, the mortality rate still remains high. Though there is a general consensus that the ascending aorta should be replaced, the distal extension of the surgery still remains a controversy. Few surgeons argue for a conservative approach to reduce operative and postoperative morbidity while others considering the problems associated with "downstream problems" support an aggressive approach including a frozen elephant trunk. The cohort in the Indian subcontinent and APAC is far different from the western world. Many factors determine the decision for surgery apart from the pathology of the disease. Economy, availability of the suitable prosthesis, the experience of the surgeon, ease of access to the medical facility all contribute to the decision making to treat acute type A dissection.
    Matched MeSH terms: Risk Factors
  2. Fulltext Cigarette smoking dose-response and suicidal ideation among young people in Nepal: a cross-sectional study
    Sathian B, Menezes RG, Asim M, Mekkodathil A, Sreedharan J, Banerjee I, et al.
    Nepal J Epidemiol, 2020 Mar;10(1):821-829.
    PMID: 32257512 DOI: 10.3126/nje.v10i1.28277
    Background: Worldwide, tobacco smoking is a major risk factor for morbidity and early mortality among adult population. The present study aimed to find out the association between current smoking and suicidal ideation among young people in Nepal.

    Materials and Methods: A cross-sectional questionnaire-based survey was carried out among 452 youths from Pokhara, Nepal. The present study included both genders (age 18-24 years) who were smokers as well as non-smokers.

    Results: Across the study period, 452 participants were identified after matching for age, and sex (226 in the smoking group and 226 in the non-smoking group). The mean age of participants was 21.6±1.2 years and 58.8% were males. The overall rate of suicidal ideation in our cohort was 8.9%. Smokers were slightly more likely to report suicidal ideation than non-smokers (aOR 1.12). The risk of developing suicidal ideation was 3.56 (95% CI 1.26-10.09) times more in individuals who smoked greater than 3.5 cigarettes per week (p=0.01).

    Conclusion: The rate of suicidal ideation was slightly higher among smokers and a dose-response relationship was identified with the number of cigarettes smoked per week. Being aware of the link between smoking and suicidal ideation may help health care professionals working with young people to address more effectively the issues of mental well-being and thoughts about suicide.

    Matched MeSH terms: Risk Factors
  3. Factors associated with poor-to-moderate quality of life among pregnant women with gestational diabetes mellitus: a cross-sectional study in Malaysia
    Lee KW, Ching SM, Hoo FK, Ramachandran V, Chong SC, Tusimin M, et al.
    Qual Life Res, 2020 Oct;29(10):2725-2736.
    PMID: 32430781 DOI: 10.1007/s11136-020-02532-3
    PURPOSE: This study aimed to identify factors associated with poor-to-moderate quality of life (QOL) among women with gestational diabetes mellitus (GDM) in two tertiary hospitals in Malaysia.

    METHODS: A cross-sectional study was conducted among 526 pregnant women with GDM in two tertiary hospitals in Malaysia. Diabetes-related QOL was assessed using the Asian Diabetes Quality of Life Scale (AsianDQoL). Socio-demographic characteristics, glucose monitoring treatments for GDM, past obstetric history, concurrent medical problems and a family history of diseases were captured from patient records. A multiple logistic regression was used for analysis.

    RESULTS: A total of 526 respondents with GDM entered the analysis. The median age of the respondents was 32 (interquartile range = 7) while 82.3% were Malay women. More than half of the respondents (69.5%) received an oral hypoglycaemic agent (OHA), and/or diet modification in controlling their GDM. The study reported that 23.2% of the respondents had poor-to-moderate QOL. Those with a family history of depression and/or anxiety (adjusted Odds ratio [AOR] 6.934, 95% confidence interval [CI] 2.280-21.081), and a family history of GDM (AOR 1.814, 95% CI 1.185-2.778) were at higher odds of suffering from poor-to-moderate QOL compared to those without a family history. Similarly, those who received insulin, with or without OHA, and/or are on diet modification (AOR 1.955, 95% CI 1.243-3.074) were at higher odds of suffering from poor-to-moderate QOL compared to those receiving OHA and/or diet modification.

    CONCLUSION: Nearly one-quarter of Malaysian women with GDM have poor-to-moderate QOL. GDM women with a family history of depression and/or anxiety, family history of GDM, and those who received insulin, with or without OHA, and/or are on diet modification were associated with poor-to-moderate QOL.

    TRIAL REGISTRATION: NMRR-17-2264-37814.

    Matched MeSH terms: Risk Factors
  4. Prevalence and pattern of dyslipidemia in hyperglycemic patients and its associated factors among Pakistani population
    Sarfraz M, Sajid S, Ashraf MA
    Saudi J Biol Sci, 2016 Nov;23(6):761-766.
    PMID: 27872574
    In diabetes mellitus dyslipidemia is one of the major risk factors for cardiovascular disease. In type 2 diabetes mellitus early detection and treatment of dyslipidemia can avoid risk for cardiovascular disorder. The present study was carried to determine the prevalence and pattern of hyperlipidemia in patients with hyperglycemia. The cross sectional study was done in different laboratories of Pakistan, the laboratories served patients referred from different government and private hospitals between July 2014 and June 2015. All known cases of diabetes mellitus were evaluated for their lipid profile. Totally 200 diabetic patients were included in the study in which 120 (60%) were males and 80 (40%) were females. Prevalence of dyslipidemia among diabetic males was 97.18% while for females 87.15%. Among dyslipidemic male the proportion with mixed dyslipidemic patients was 17.5%, combined two parameters dyslipidemia was 47.5% and isolated single parameter dyslipidemia was 35%. In females these proportions in mixed, combined two parameters and isolated single parameter were 16.25%, 51.25% and 32.5%, respectively. Majority of hyperglycemic patients were dyslipidemic. The most prevalent pattern among male was combined dyslipidemia with high triglycerides (TG) and low High Density Lipoprotein (HDL) and in female it was high Low Density Lipoprotein (LDL) and low HDL. The most prevalent lipid abnormality in our study was low HDL followed by high TG.
    Matched MeSH terms: Risk Factors
  5. Fulltext Associations of outdoor fine particulate air pollution and cardiovascular disease in 157 436 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study
    Hystad P, Larkin A, Rangarajan S, AlHabib KF, Avezum Á, Calik KBT, et al.
    Lancet Planet Health, 2020 06;4(6):e235-e245.
    PMID: 32559440 DOI: 10.1016/S2542-5196(20)30103-0
    BACKGROUND: Most studies of long-term exposure to outdoor fine particulate matter (PM2·5) and cardiovascular disease are from high-income countries with relatively low PM2·5 concentrations. It is unclear whether risks are similar in low-income and middle-income countries (LMICs) and how outdoor PM2·5 contributes to the global burden of cardiovascular disease. In our analysis of the Prospective Urban and Rural Epidemiology (PURE) study, we aimed to investigate the association between long-term exposure to PM2·5 concentrations and cardiovascular disease in a large cohort of adults from 21 high-income, middle-income, and low-income countries.

    METHODS: In this multinational, prospective cohort study, we studied 157 436 adults aged 35-70 years who were enrolled in the PURE study in countries with ambient PM2·5 estimates, for whom follow-up data were available. Cox proportional hazard frailty models were used to estimate the associations between long-term mean community outdoor PM2·5 concentrations and cardiovascular disease events (fatal and non-fatal), cardiovascular disease mortality, and other non-accidental mortality.

    FINDINGS: Between Jan 1, 2003, and July 14, 2018, 157 436 adults from 747 communities in 21 high-income, middle-income, and low-income countries were enrolled and followed up, of whom 140 020 participants resided in LMICs. During a median follow-up period of 9·3 years (IQR 7·8-10·8; corresponding to 1·4 million person-years), we documented 9996 non-accidental deaths, of which 3219 were attributed to cardiovascular disease. 9152 (5·8%) of 157 436 participants had cardiovascular disease events (fatal and non-fatal incident cardiovascular disease), including 4083 myocardial infarctions and 4139 strokes. Mean 3-year PM2·5 at cohort baseline was 47·5 μg/m3 (range 6-140). In models adjusted for individual, household, and geographical factors, a 10 μg/m3 increase in PM2·5 was associated with increased risk for cardiovascular disease events (hazard ratio 1·05 [95% CI 1·03-1·07]), myocardial infarction (1·03 [1·00-1·05]), stroke (1·07 [1·04-1·10]), and cardiovascular disease mortality (1·03 [1·00-1·05]). Results were similar for LMICs and communities with high PM2·5 concentrations (>35 μg/m3). The population attributable fraction for PM2·5 in the PURE cohort was 13·9% (95% CI 8·8-18·6) for cardiovascular disease events, 8·4% (0·0-15·4) for myocardial infarction, 19·6% (13·0-25·8) for stroke, and 8·3% (0·0-15·2) for cardiovascular disease mortality. We identified no consistent associations between PM2·5 and risk for non-cardiovascular disease deaths.

    INTERPRETATION: Long-term outdoor PM2·5 concentrations were associated with increased risks of cardiovascular disease in adults aged 35-70 years. Air pollution is an important global risk factor for cardiovascular disease and a need exists to reduce air pollution concentrations, especially in LMICs, where air pollution levels are highest.

    FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).

    Matched MeSH terms: Risk Factors
  6. Fulltext Cardiovascular lifestyle risks and cardiovascular screening activities among healthy government servants in Kuala Terengganu, Malaysia
    Mat Hasan N, Daud N, Shaaban J
    Malaysian Journal of Public Health Medicine, 2016;16(2):1-7.
    MyJurnal
    Lifestyles such as unhealthy dietary habits, physical inactivity and smoking are considered fundamental risk factors for cardiovascular disease. Preventive activities have been shown to reduce mortality and morbidity from cardiovascular disease. This study aimed to determine the prevalence of cardiovascular lifestyle risks and cardiovascular preventive activities among healthy government servants in Kuala Terengganu, Malaysia. A cross-sectional study was done from June to September 2013 among 121 government servants working at the Federal Complex, Kuala Terengganu. A questionnaire which consists of socio-demographic data, International Physical Activity Questionnaire (IPAQ), the dietary component of WHO STEPS and cardiovascular screening activities were used as tools. Clustering of cardiovascular lifestyle risks was defined as the presence of two or more of smoking, physical inactivity and unhealthy diet. Optimal cardiovascular screening is defined as having done the required screening for hypertension, diabetes, dyslipideamia and obesity. The study response rate was 90.9% (110 of 121). Prevalence of smoking, physical inactivity and unhealthy diet were 20%, 50% and 87% respectively. The prevalence of clustering of cardiovascular lifestyle risks was 57%. The prevalence of optimal cardiovascular screening for age was 49%. The prevalence of cardiovascular lifestyle risks among government servants in Kuala Terengganu is still high. About half of them did not have the optimal screening for cardiovascular disease. Measures need to be done to promote healthy lifestyle behaviors in the community. Effort should be made at the primary care level and public health to screen those with multiple cardiovascular lifestyle risks in order to optimize cardiovascular disease prevention.
    Matched MeSH terms: Risk Factors
  7. Fulltext 10-Year Cardiovascular Disease Risk Estimation Based on Lipid Profile-Based and BMI-Based Framingham Risk Scores across Multiple Sociodemographic Characteristics: The Malaysian Cohort Project
    Borhanuddin B, Mohd Nawi A, Shah SA, Abdullah N, Syed Zakaria SZ, Kamaruddin MA, et al.
    ScientificWorldJournal, 2018;2018:2979206.
    PMID: 30111990 DOI: 10.1155/2018/2979206
    Cardiovascular disease (CVD) leads to high morbidity and mortality rate worldwide. Therefore, it is important to determine the risk of CVD across the sociodemographic factors to strategize preventive measures. The current study consisted of 53,122 adults between the ages of 35 and 65 years from The Malaysian Cohort project during recruitment phase from year 2006 to year 2012. Sociodemographic profile and physical activity level were assessed via self-reported questionnaire, whereas relevant CVD-related biomarkers and biophysical variables were measured to determine the Framingham Risk Score (FRS). The main outcome was the 10-year risk of CVD via FRS calculated based on lipid profile and body mass index (BMI) associated formulae. The BMI-based formula yielded a higher estimation of 10-year CVD risk than the lipid profile-based formula in the study for both males (median = 13.2% and 12.7%, respectively) and females (median = 4.3% and 4.2%, respectively). The subgroup with the highest risk for 10-year CVD events (based on both FRS formulae) was the Malay males who have lower education level and low physical activity level. Future strategies for the reduction of CVD risk should focus on screening via BMI-based FRS in this at-risk subpopulation to increase the cost-effectiveness of the prevention initiatives.
    Study name: The Malaysian Cohort (TMC) project
    Matched MeSH terms: Risk Factors
  8. Toxoplasma gondii infection among selected indigenous community in Sarawak, East Malaysia
    Ngui R, Hassan NA, Chang LY, Teh SJC, Chua KH, Kee BP, et al.
    Trop Biomed, 2020 Mar 01;37(1):155-164.
    PMID: 33612726
    Toxoplasma gondii is an obligate intracellular protozoan parasite that causes toxoplasmosis in humans. To date, little is known about T. gondii infection among the indigenous community, particularly in East Malaysia. This study was conducted to determine the status of T. gondii infection and to investigate associated risk factors among the indigenous community of Sarawak, East Malaysia. The sociodemographic data was obtained using a pretested questionnaire. A serological test was done to detect the presence of specific IgM and IgG antibodies against T. gondii in serum samples. A nested polymerase chain reaction (PCR) was used to determine acute infection among seropositive individuals. The overall seroprevalence of T. gondii infection was 50% (95% CI = 43.3 - 56.7). From this subset, 40.1%, 5.7%, and 4.2% were positive for anti-T. Gondii IgG antibodies, IgM, and both IgG and IgM, respectively. Four seropositive samples were amplified through PCR. None of the pregnant women tested positive for T. gondii infection based on the serological and PCR assays. A significant association was found between age, low monthly household income, unemployment, usage of untreated water and close contact with T. gondii seropositive cats. These results provide basic information on T. gondii infection and may be useful for policymakers to initiate prevention and control programs, especially amongst pregnant women and women of childbearing age in the indigenous community.
    Matched MeSH terms: Risk Factors
  9. Risk factors associated with soil transmitted helminth (STH) infection in two indigenous communities in Malaysia
    Nisha M, Aiman M, Asyhira N, Syafiq H, Atiqah N, Kumarasamy V, et al.
    Trop Biomed, 2020 Jun 01;37(2):379-388.
    PMID: 33612807
    Soil-transmitted helminth (STH) could possibly cause mild to severe health effects such as diarrhea, weakness, intestinal blood loss, and impaired cognitive development and growth. In Malaysia, previous studies depicted a high prevalence rate of STH was due to poor hygiene practice and low efficacies of anthelminthic drugs. This study was conducted to investigate hand hygiene practice and WASH criteria's (Water, sanitation and hygiene) related to STH infection among two indigenous tribes in Peninsular Malaysia. A cross-sectional study was carried out to study the relationship among STH infection compared to water quality, sanitation, and hygiene conditions. A total of 190 individuals from two indigenous villages participated in the study, with ages ranging from 5 to 60 years old. In addition, Pearson's Chisquare (X2) test was utilized to test the relationship among STH with demographic socioeconomic and behavioral factors. The confidence interval (CI) of 95% is used to estimate the precision of the odds ratio (OR). Multivariate logistic regression models were also used to identify the risk factors associated with STH infections. The overall findings indicated a prevalence rate of 72% for STH, and distributed mainly among children aged < 12 years. Furthermore, multivariate analyses using logistic regression revealed chronic health problems, incorrect hand washing, and walking bare footed were associated with STH infection. Overall results indicated high prevalence of STH among the indigenous villagers, which aligns with the published literature and proves to be a problem need to be addressed as neglected disease. Interestingly, there was a significant relationship between the presences of chronic diseases and STH infection, which prompted other questions the awareness needs to be educated and the simple and low-cost intervention on the proper way of hand washing may help to reduce STH infection in these indigenous communities.
    Matched MeSH terms: Risk Factors
  10. Seroprevalence of Toxoplasmosis among Hemato-oncology patients in Kelantan
    Kholib-Jati AK, Wan-Ahmad WMA, Mohamad S, Wan-Mahmood WH, Husin A, Wan-Ab-Rahman WS
    Trop Biomed, 2020 Mar 01;37(1):218-226.
    PMID: 33612733
    Toxoplasmosis is a zoonotic disease caused by Toxoplasma gondii that is prevalent in humans and animals. This study was aimed to determine the seroprevalence of T. gondii infection among hemato-oncology patients and its association with sociodemographic and behavioural characteristics. This cross-sectional study was conducted at the Hospital Universiti Sains Malaysia (USM) involving 56 blood samples from hemato-oncology patients. Anti-T. gondii IgG and IgM antibodies and IgG avidity were determined using enzyme-linked immunosorbent assays (ELISA). The association of T. gondii exposure, sociodemographic, and behavioural characteristics were assessed by a questionnaire and face-to-face interviews. Twenty-eight (50%) patients were seropositive for T. gondii antibodies, where 27 (48.21%) patients were IgG+/IgM- and one patient (1.79%) was IgG+/IgM+ with high avidity index, indicating infection of more than 20 weeks. A univariate analysis showed that age, gender, ethnicity, marital status, educational level, employment status, stem cell transplant, blood transfusion, close contact with cats, water supply, and consumption of undercooked meat were not significantly associated with Toxoplasma seropositivity (p < 0.05). Our study has demonstrated, for the first time, the serological evidence of T. gondii exposure among hemato-oncology patients in Hospital USM. Our findings indicated that latent toxoplasmosis was relatively prevalence among our patients. Therefore, serological screening tests should be considered for immunocompromised patients as well as the implementation of health education programmes to encourage a healthy lifestyle and the consumption of healthy food among them.
    Matched MeSH terms: Risk Factors
  11. Prevalence of anaemia and associated risk factors amongst The Malaysian Cohort participants
    Abdullah N, Ismail N, Abd Jalal N, Mohd Radin F, Othman R, Kamalul Arifin AS, et al.
    Ann Hematol, 2020 Nov;99(11):2521-2527.
    PMID: 32975589 DOI: 10.1007/s00277-020-04279-w
    This study was aimed at determining the prevalence of anaemia amongst the Malaysian Cohort participants and the associated risk factors. This was a cross-sectional study that involved 102,388 participants from The Malaysian Cohort (TMC) aged between 35 and 70 years old recruited from April 2006 to September 2012. Venous blood was taken for the full blood count. The prevalence of anaemia was 13.8% with majority having the microcytic-hypochromic type (59.7%). Comparison between the ethnic groups showed that Indians have the highest prevalence of anaemia (19.9%), followed by Malays (13.1%), and Chinese (12.0%). The prevalence of anaemia was substantially higher in females (20.1%) compared to males (4.9%). Amongst the female participants, the prevalence of anaemia was highest amongst those who were younger than 49 years old and decreased as the age increased. In contrast, the prevalence of anaemia in males increased with age. Gender, ethnicity, age, marital status, presence of platelet disorders and kidney disease were significant risk factors associated with anaemia and contributed to 14.9% of the risk of developing anaemia in this population. The prevalence of anaemia amongst the Malaysian Cohort participants is 13.8% with the majority having the microcytic and hypochromic type implying iron deficiency as the main cause. It is important that those who have anaemia be further investigated and treated.
    Study name: The Malaysian Cohort (TMC) project
    Matched MeSH terms: Risk Factors
  12. Fulltext Shisha smoking and associated factors among medical students in Malaysia
    Al-Naggar RA, Bobryshev YV
    Asian Pac J Cancer Prev, 2012;13(11):5627-32.
    PMID: 23317228
    BACKGROUND: The aim of the study was to determine the prevalence of shisha smoking and associated factors among medical students in Malaysia.

    MATERIALS AND METHODS: A cross-sectional study was conducted at the Management and Science University from December 2011 until March 2012. The questionnaire consisted of five sections including socio-demographic, social environment, knowledge about shisha, psychosocial factors, and personal shisha smoking behavior. Obtained data were analyzed using Statistical Package for the Social Sciences (SPSS 13). T-test was used to determine the relationships between shisha smoking and socio-demographic characteristic.

    RESULTS: A total number of 300 medical students participated in this study. Mean age was 22.5±2.5 years. The majority were female, Malay, single, from urban areas (67%, 54%, 97%, 73%; respectively). The prevalence of shisha smoking among medical students was found to be 20%. The study revealed that many students believed that shisha does not contains nicotine, carbon monoxide, does not lead to lung cancer, dental problems and does not lead to cardiovascular diseases (25%, 20.7%, 22.3%, 29%, 26.7%; respectively). Age and sex were found to be significantly associated with smoking shisha status among medical students (p=0.029, p<0.001; respectively). Furthermore, having parents, siblings and friends smokers of shisha were found to be significantly associated with shisha smoking status (p<0.001, p<0.001, p<0.001; respectively). Furthermore, family problems, problems with friends, financial problems and university life were found to significantly associated with shisha smoking status among medical students (p<0.001, p=0.002, p<0.001, p=0.002; respectively).

    CONCLUSIONS: There is a high prevalence of shisha smoking and a poor knowledge about its impact on health among medical students. More attention is needed to focus on medical education in this regard. The policies that are currently employed in order to reduce the cigarettes smoking should be applied to shisha smoking and shisha products.
    Matched MeSH terms: Risk Factors
  13. Current prevalence of Opisthorchis viverrini infection and associated risk factors in Nakhon Phanom Province, Northeastern Thailand
    Chuangchaiya S, Navanesan S, Jaichuang S, Rahim MAFA, Idris ZM
    Trop Biomed, 2020 Dec 01;37(4):986-999.
    PMID: 33612751 DOI: 10.47665/tb.37.4.986
    Opisthorchiasis caused by Opisthorchis viverrini infection is a major public health concern in Thailand. Despite many decades of national campaigns in place to reduce and control opisthorchiasis in Thailand, the infections remain to exist particularly in the northern and northeastern parts of the country. This study aimed to evaluate the current prevalence of O. viverrini infection in rural communities in northeast Thailand. A cross-sectional survey was conducted between February and October 2018 in three districts (Na Kae, That Phanom and Wang Yang) in Nakhon Phanom Province, Thailand. Demographic data were collected using a standardised questionnaire. Stool samples were collected and processed using the Kato-Katz technique to determine the presence of O. viverrini and other intestinal parasites. In total, 564 individuals were enrolled. The overall intestinal helminth infections were 15.2% (95% CI: 12.4-18.5). Species distribution included a majority of O. viverrini mono-infections (12.9%), followed by Strongyloides stercoralis (1.4%) and Taenia spp. (0.4%). The prevalence of O. viverrini was significantly higher in Wang Yang district (P = 0.022), in males (P = 0.004) and those previously positive with helminth infections (P<0.001) and received treatment of anti-helminths (P<0.001), than in their counterparts. Multivariate regression analysis revealed that being male (adjusted odds ratio [aOR] 1.77, P = 0.035) and those who previously tested positive for helminth infections (aOR 8.69, P<0.001) were significantly associated with a higher odd of O. viverrini infections, but lower in those who had previous stool examination (aOR 0.22, P = 0.001). This study demonstrated that the updated prevalence of O. viverrini infection is still high in rural communities in northeast Thailand. The data of this study will be useful to guide and improve strategies for future O. viverrini and other helminths prevention and control in this region.
    Matched MeSH terms: Risk Factors
  14. Fulltext Risk factors for symptomatic Avascular Necrosis (AVN) in a multi-ethnic Systemic Lupus Erythematosus (SLE) cohort
    Shaharir SS, Chua SH, Mohd R, Mustafar R, Noh MM, Shahril NS, et al.
    PLoS One, 2021;16(3):e0248845.
    PMID: 33739994 DOI: 10.1371/journal.pone.0248845
    Avascular necrosis of bone (AVN) is increasingly being recognized as a complication of SLE and causes significant disability due to pain and mobility limitations. We studied the prevalence and factors associated with avascular necrosis (AVN) in a multiethnic SLE cohort. SLE patients who visited the outpatient clinic from October 2017 to April 2019 were considered eligible. Their medical records were reviewed to identify patients who developed symptomatic AVN, as confirmed by either magnetic resonance imaging or plain radiography. Subsequently, their SLE disease characteristics and treatment were compared with the characteristics of patients who did not have AVN. Multivariable logistic regression analyses were performed to determine the independent factors associated with AVN among the multiethnic SLE cohort. A total of 390 patients were recruited, and the majority of them were females (92.6%); the patients were predominantly of Malay ethnicity (59.5%), followed by Chinese (35.9%) and Indian (4.6%). The prevalence of symptomatic AVN was 14.1%, and the mean age of AVN diagnosis was 37.6 ± 14.4 years. Both univariate and multivariable logistic regression analyses revealed that a longer disease duration, high LDL-C (low density lipoprotein cholesterol), positive anti-cardiolipin (aCL) IgG and anti-dsDNA results, a history of an oral prednisolone dose of more than 30 mg daily for at least 4 weeks and osteoporotic fractures were significantly associated with AVN. On the other hand, hydroxychloroquin (HCQ), mycophenolate mofetil (MMF) and bisphosphonate use were associated with a lower risk of AVN. No associations with ethnicity were found. In conclusion, several modifiable risk factors were found to be associated with AVN, and these factors may be used to identify patients who are at high risk of developing such complications. The potential protective effects of HCQ, MMF and bisphosphonates warrant additional studies.
    Matched MeSH terms: Risk Factors
  15. Role of dietary fat on obesity-related postmenopausal breast cancer: insights from mouse models and methodological considerations
    Tan PY, Teng KT
    Breast Cancer, 2021 May;28(3):556-571.
    PMID: 33687609 DOI: 10.1007/s12282-021-01233-0
    The increasing incidence rate of breast cancer in the last few decades is known to be linked to the upward trend of obesity prevalence worldwide. The consumption of high-fat diet in particular has been correlated with postmenopausal breast cancer risk. The underlying mechanisms, using suitable and reliable experimental mouse model, however, is lacking. The current review aims to discuss the evidence available from mouse models on the effects of dietary fats intake on postmenopausal breast cancer. We will further discuss the biochemical mechanisms involved in the occurrence of postmenopausal breast cancer. In addition, the methodological considerations and their limitations in obesity-related postmenopausal breast cancer, such as choice of mouse models and breast cancer cell lines as well as the study duration will be reviewed. The current review will provide a platform for further development of new xenograft models which may offer the opportunity to investigate the mechanisms of postmenopausal breast cancer in a greater detail.
    Matched MeSH terms: Risk Factors
  16. Epidemiology of childhood nocturnal enuresis in Malaysia
    Kanaheswari Y
    J Paediatr Child Health, 2003 Mar;39(2):118-23.
    PMID: 12603800 DOI: 10.1046/j.1440-1754.2003.00105.x
    OBJECTIVES: To estimate the prevalence of nocturnal enuresis in primary school children in Malaysia and to determine the factors associated with primary nocturnal enuresis.

    METHODS: This was a cross-sectional survey. A total of 3371 self-administered questionnaires were distributed to parents of children aged 7, 9 and 12 years attending four primary schools in the city. The ICD-10 definition of enuresis was used.

    RESULTS: From an overall response rate of 73.8%, nocturnal enuresis was reported in 200 children (8%), primary nocturnal enuresis in 156 children (6.2%) and secondary nocturnal enuresis in 44 children (1.8%). Fifty-three percent of those with primary enuresis had a positive family history, and 54% had two or more wet nights per week. Eighty-seven percent had not sought any form of treatment despite 74% admitting to being embarrassed. Using logistic regression analysis, only three factors were significant predictors of primary nocturnal enuresis. These were: (i) younger age (P < 0.001); (ii) male sex (P < 0.033); and (iii) Indian ethnic group (P < 0.044) compared to Chinese.

    CONCLUSION: The prevalence of nocturnal enuresis in urban-dwelling Malaysian children is similar to that reported from Korea and Taiwan but appears to be lower than that reported from developed countries. Predictive factors associated with primary nocturnal enuresis included lower age group, male sex and Indian ethnicity.
    Matched MeSH terms: Risk Factors
  17. Fulltext Tuberculosis among people living with HIV/AIDS in Jazan Region, Southwestern Saudi Arabia
    Darraj MA, Abdulhaq AA, Yassin A, Mubarki S, Shalaby HM, Keynan Y, et al.
    J Infect Public Health, 2021 Nov;14(11):1571-1577.
    PMID: 34656963 DOI: 10.1016/j.jiph.2021.09.009
    BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) infections are leading causes of morbidity and mortality worldwide. People living with HIV/AIDS (PLWHA) are highly susceptible to TB infection and progression to active TB disease. This study aims to determine the proportion and risk factors of TB among PLWHA in Jazan Region, southwestern Saudi Arabia.

    METHODS: A cross-sectional study was conducted among HIV-infected individuals attending the main referral hospital in Jazan Region during the period 2017-2019. The participants' TB status, CD4+ lymphocyte count, and viral load were assessed. In addition, their demographic and clinical information was collected using a structured questionnaire.

    RESULTS: A total of 316 HIV-positive individuals aged between 13 and 81 years (75% male and 25% female) were enrolled in this study. Of them, 30 (9.5%; 95% confidence interval [CI]: 5.2, 10.6%) were diagnosed with TB: 46.7% (14/30) had pulmonary TB and 53.3% (16/30) had extrapulmonary TB. The highest proportion of TB-positive PLWHA was found among participants aged 18-30 years (11.6%) and among non-Saudis (14.0%) when compared to other age groups and Saudi participants (7.4%). Multivariate analysis showed that male gender (adjusted odds ratio [AOR] = 4.79; 95% CI = 1.22, 18.74), past medical history (PMH) of TB (AOR = 29.67; 95% CI = 5.31, 164.32), PMH of other RTIs (AOR = 5.86; 95 % CI = 2.14, 16.06), CD4+ lymphocyte count of <200 cells/mm³ (AOR = 4.33; 95% CI = 1.65, 11.36), and viral load of ≥1 × 103 copies/mL (AOR = 5.46; 95% CI = 2.02, 14.77) were the significant risk factors of TB among the studied PLWHA.

    CONCLUSION: The prevalence of TB/HIV co-infection among the studied population was 9.5%. Therefore, all PLWHA should be screened for TB at every visit to a health facility. The findings highlight that integration of health services for both TB and HIV/AIDS in Saudi Arabia is recommended.

    Matched MeSH terms: Risk Factors
  18. Beyond the Obvious: Smoking and Respiratory Infection Implications on Alzheimer's Disease
    Wadhwa R, Paudel KR, Mehta M, Shukla SD, Sunkara K, Prasher P, et al.
    CNS Neurol Disord Drug Targets, 2020;19(9):698-708.
    PMID: 33109069 DOI: 10.2174/1871527319999200817112427
    Tobacco smoke is not only a leading cause for chronic obstructive pulmonary disease, cardiovascular disorders, and lung and oral cancers, but also causes neurological disorders such as Alzheimer 's disease. Tobacco smoke consists of more than 4500 toxic chemicals, which form free radicals and can cross blood-brain barrier resulting in oxidative stress, an extracellular amyloid plaque from the aggregation of amyloid β (Aβ) peptide deposition in the brain. Further, respiratory infections such as Chlamydia pneumoniae, respiratory syncytial virus have also been involved in the induction and development of the disease. The necessary information collated on this review has been gathered from various literature published from 1995 to 2019. The review article sheds light on the role of smoking and respiratory infections in causing oxidative stress and neuroinflammation, resulting in Alzheimer's disease (AD). This review will be of interest to scientists and researchers from biological and medical science disciplines, including microbiology, pharmaceutical sciences and the translational researchers, etc. The increasing understanding of the relationship between chronic lung disease and neurological disease is two-fold. First, this would help to identify the risk factors and possible therapeutic interventions to reduce the development and progression of both diseases. Second, this would help to reduce the probable risk of development of AD in the population prone to chronic lung diseases.
    Matched MeSH terms: Risk Factors
  19. Fulltext Functional dyspepsia
    Ford AC, Mahadeva S, Carbone MF, Lacy BE, Talley NJ
    Lancet, 2020 11 21;396(10263):1689-1702.
    PMID: 33049222 DOI: 10.1016/S0140-6736(20)30469-4
    Dyspepsia is a complex of symptoms referable to the gastroduodenal region of the gastrointestinal tract and includes epigastric pain or burning, postprandial fullness, or early satiety. Approximately 80% of individuals with dyspepsia have no structural explanation for their symptoms and have functional dyspepsia. Functional dyspepsia affects up to 16% of otherwise healthy individuals in the general population. Risk factors include psychological comorbidity, acute gastroenteritis, female sex, smoking, use of non-steroidal anti-inflammatory drugs, and Helicobacter pylori infection. The pathophysiology remains incompletely understood, but it is probably related to disordered communication between the gut and the brain, leading to motility disturbances, visceral hypersensitivity, and alterations in gastrointestinal microbiota, mucosal and immune function, and CNS processing. Although technically a normal endoscopy is required to diagnose functional dyspepsia, the utility of endoscopy in all patients with typical symptoms is minimal; its use should be restricted to people aged 55 years and older, or to those with concerning features, such as weight loss or vomiting. As a result of our incomplete understanding of its pathophysiology, functional dyspepsia is difficult to treat and, in most patients, the condition is chronic and the natural history is one of fluctuating symptoms. Eradication therapy should be offered to patients with functional dyspepsia who test positive for Helicobacter pylori. Other therapies with evidence of effectiveness include proton pump inhibitors, histamine-2 receptor antagonists, prokinetics, and central neuromodulators. The role of psychological therapies is uncertain. As our understanding of the pathophysiology of functional dyspepsia increases, it is probable that the next decade will see the emergence of truly disease-modifying therapies for the first time.
    Matched MeSH terms: Risk Factors
  20. Fulltext Asymptomatic morphometric vertebral fractures and its associated factors: A cross-sectional study among adults in a selected urban area in Selangor, Malaysia
    Yeap SS, Thambiah SC, Suppiah S, Md-Said S, Appannah G, Samsudin IN, et al.
    PLoS One, 2021;16(7):e0255069.
    PMID: 34293028 DOI: 10.1371/journal.pone.0255069
    OBJECTIVE: This study aimed to determine the prevalence of vertebral fractures (VF) in a selected urban population in Malaysia and to explore possible variables associated with VF in the study population.

    METHODS: A cross-sectional study involving community-living, healthy subjects aged between 45-90 years from the state of Selangor, Malaysia, were invited to attend a bone health check-up. Subjects with diseases known to affect bone metabolism or were on treatment for osteoporosis (OP) were excluded. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DXA). Lateral and antero-posterior view lumbar spine x-rays were performed and VF was determined by the semi-quantitative Genant method.

    RESULTS: A total of 386 subjects were studied. Asymptomatic morphometric VF were found in 44 (11.4%) subjects. T12 was the most common vertebrae to be fractured. The prevalence of VF was significantly higher in menopausal women (12.4%) compared to non-menopausal women, in those above the age of 60 (18.5%), in those of Chinese ethnicity (16.5%), in those with a low body fat percentage (17.1%) and among those with OP (27.0%). The mean (standard deviation) 25-hydroxyvitamin D [25(OH)D] levels were significantly higher in those with VF compared to those without VF, 67.64 (23.50) and 57.47 (21.71) nmol/L, respectively. However, after multiple regression analysis, age over 60 years and OP on DXA BMD measurement were the only significant associated factors for VF.

    CONCLUSION: Overall, 11.4% of a selected Malaysian urban population had asymptomatic morphometric VF. Age over 60 years and OP on DXA BMD measurement, but not 25(OH)D levels, were associated with VF.

    Matched MeSH terms: Risk Factors
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