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Craniofacial obesity in patients with obstructive sleep apnea

Banabilh SM, Suzina AH, Dinsuhaimi S, Samsudin AR, Singh GD

Sleep Breath, 2009 Mar;13(1):19-24.
PMID: 18763003 DOI: 10.1007/s11325-008-0211-9

INTRODUCTION: Obstructive sleep apnea (OSA) and obesity are serious, widespread public health issues.
OBJECTIVE: To localize and quantify geometric morphometric differences in facial soft tissue morphology in adults with and without OSA.
MATERIALS AND METHODS: Eighty adult Malays, consisting of 40 patients with OSA and 40 non-OSA controls, were studied. Both groups were evaluated by the attending physician and through ambulatory sleep studies. 3-D stereophotogrammetry was used to capture facial soft tissues of both groups. The 3-D mean OSA and control facial configurations were computed and subjected to principal components analysis (PCA) and finite-element morphometry (FEM).
RESULTS: The body mass index was significantly greater for the OSA group (32.3 kg/m(2) compared to 24.8 kg/m(2), p < 0.001). The neck circumference was greater for the OSA group (42.7 cm compared to 37.1 cm, p < 0.001). Using PCA, significant differences were found in facial shape between the two groups using the first two principal components, which accounted for 50% of the total shape change (p < 0.05). Using FEM, these differences were localized in the bucco-submandibular regions of the face predominantly, indicating an increase in volume of 7-22% (p < 0.05) for the OSA group.
CONCLUSION: Craniofacial obesity in the bucco-submandibular regions is associated with OSA and may provide valuable screening information for the identification of patients with undiagnosed OSA.

Matched MeSH terms: Severity of Illness Index
Fulltext Admission to hospital with childhood acute gastroenteritis in Kuala Lumpur, Malaysia

Izzuddin Poo M, Lee WS

Med J Malaysia, 2007 Aug;62(3):189-93.
PMID: 18246904 MyJurnal

Mortality from acute diarrhoea in developed countries is low, but the morbidity and financial cost remains significant. A one-year prospective, descriptive, non-interventional, hospital-based study of acute gastroenteritis (AGE) was conducted in the year 2002 in the paediatric unit of University of Malaya Medical Centre, Kuala Lumpur, an urban hospital in Malaysia, to determine its morbidity and management. During the study period, 393 children with AGE were admitted, utilizing 0.50% of total patient-bed-day of the hospital. The median duration of symptoms before admission was two days. Seventy-seven percent of patients had consulted family physicians before admission. Antidiarrhoeal drugs (57%) and anti-emetics (48%) were commonly prescribed, but oral rehydrating solution (36%) was rarely advised. Upon admission, severe vomiting (24%) and severe diarrhea (24%) were not common, while 17% had moderate or severe dehydration. Rotavirus (22%) was the commonest pathogen identified. Electrolyte derangement, secondary septicaemia and chronic diarrhoea were all rare. Eighty-nine percent of patients received intravenous fluid therapy whilst in the hospital. No death was noted. The morbidity and mortality of children with AGE requiring hospital care in this study was low. However, preadmission management and fluid therapy after admission was not ideal. Efforts to encourage better adherence to established management protocol of AGE among family physicians and hospital clinicians should be instituted.

Matched MeSH terms: Severity of Illness Index
The Female Sexual Function Index (FSFI): validation of the Malay version

Sidi H, Abdullah N, Puteh SE, Midin M

J Sex Med, 2007 Nov;4(6):1642-54.
PMID: 17608666

Female sexual dysfunction (FSD) is a prevalent sexual health problem that has been inadequately investigated in Malaysia, a nation with a conservative multiethnic society.

Matched MeSH terms: Severity of Illness Index
Study of prevalence, treatment-seeking behavior, and risk factors of women with lower urinary tract symptoms in Northern Malaysia

Low BY, Liong ML, Yuen KH, Chong WL, Chee C, Leong WS, et al.

Urology, 2006 Oct;68(4):751-8.
PMID: 17070347

To determine the prevalence, severity, and quality-of-life (QOL) impact of female lower urinary tract symptoms (FLUTS); to determine the patterns, reasons, and factors contributing to the women's treatment-seeking behavior; and to describe the relationship between the social demographic characteristics and FLUTS.

Matched MeSH terms: Severity of Illness Index
Fulltext Blood pressure variability and arterial elasticity in hypertensive subjects

Rafidah HM, Azizi A, Noriah MN

Med J Malaysia, 2006 Jun;61(2):189-98.
PMID: 16898310 MyJurnal

Apart from the mean 24 hour ambulatory blood pressure (ABP), the blood pressure variability (BPV) also bears an independent relationship with target-organ damage in hypertension. A reduction in arterial compliance has been demonstrated in hypertension but its relation to BPV is still unknown. The aim of the study is to compare BPV and arterial compliance between hypertensive and normotensive subjects. Eighteen hypertensives and 18 controls were enrolled. Noninvasive 24-hour ABP monitoring was performed with BR-102 monitor (Schiller Inc. Germany). Arterial compliance was determined by the HDI/Pulsewave Research Cardiovascular Profiling Instrument (Hypertension Diagnostic Inc. USA). There were significantly higher systolic, diastolic and mean arterial BPV in hypertensives as compared to normotensive group. Only systolic BPV remained significantly high in hypertensives during night time. There were lower arterial compliances in hypertensive as compared to normotensive group. No significant relationship however was found between BPV and arterial compliance in hypertensive subjects. In conclusion, there were higher BPV and lower arterial compliances in hypertensive subjects as compared to normotensive subjects.

Matched MeSH terms: Severity of Illness Index
Fulltext Malignant myeloid transformation in a child with severe congenital neutropenia (Kostmann's syndrome)

Chong LA, Josephine P, Ariffin H

Med J Malaysia, 2006 Jun;61(2):236-8.
PMID: 16898320 MyJurnal

We report a case of a child with severe congenital neutropenia (Kostmann's syndrome) who was treated with daily prophylactic subcutaneous granulocyte colony-stimulating factor (G-CSF) from the age of eight to sixteen years before being discontinued for poor haematological and clinical response. She did not have a HLA-matched sibling to enable bone marrow transplantation. She subsequently developed acute megakaryoblastic leukemia at the age of 17 years and succumbed during induction chemotherapy. The role of G-CSF in the pathogenesis of her malignant transformation to AML is complicated as this disorder has a propensity for myelodysplasia or AML as part of its natural history.

Matched MeSH terms: Severity of Illness Index
Pain symptoms in Malay patients with major depression

Razali SM, Khalib AQ

Asian J Psychiatr, 2012 Dec;5(4):297-302.
PMID: 23174436 DOI: 10.1016/j.ajp.2012.02.015

There is a strong association between depression and pain, which is influenced by various biological and psychological mechanisms. The objectives of this study were to assess the prevalence and severity of pain symptoms among patients with major depression; and to determine the correlation between pain with clinical variables, neurotic pathology and severity of depression.

Matched MeSH terms: Severity of Illness Index
Socio-demographic and psychosocial correlates of erectile dysfunction among hypertensive patients

Fadzil MA, Sidi H, Ismail Z, Hassan MR, Thuzar K, Midin M, et al.

Compr Psychiatry, 2014 Jan;55 Suppl 1:S23-8.
PMID: 23453753 DOI: 10.1016/j.comppsych.2012.12.024

OBJECTIVE:
The main aim of the study was to estimate the prevalence of ED and the associated socio-demographic and psychological correlates among hypertensive patients from a rural multiethnic community in Malaysia.

METHODS:
A cross-sectional study was conducted among hypertensive patients attending rural primary care clinics. The socio-demographic, health characteristics, erectile function and levels of depression, anxiety and stress were recorded and analysed. The International Index of ErectileFunction-5 (IIEF-5) questionnaire and the Depression, Anxiety and Stress Scale (DASS-21) were used to assess erectile function and the levels of depression, anxiety and stress, respectively.

RESULTS:
A total of 253 hypertensive patients comprising 178 (70.4%) Malays, 56 (22.1%) Chinese and 18 (7.5%) Indians participated. The mean age of participants was 59.8 ± 10.62 years. Overall, the prevalence rate of ED was 62%: 90 (35%) with moderate and 69 (27%) with severe ED. The prevalence rate of ED among those aged 65 years or older (83.1%) was significantly higher than those less than 65 years (51.8%), (p<0.001). Higher prevalence rates were also noted among the Chinese (78.6%) compared to Malays (59.6%) and Indians (50%) (p=0.021); lower education level (69.1%) (p=0.026), among hypertensive patients with concomitant diabetes mellitus (70.6%) (p=0.026) and WHR ≥ 0.9 (31.3%) (p=0.021). However, no significant association was found between depression, anxiety and stress scores with IIEF-5 score.

CONCLUSION:
The prevalence rate of ED among Malaysian hypertensive patients is high. The rate increases significantly with age, Chinese ethnicity, concomitant diabetes mellitus, lower education level, WHR and the number of pack years of smoking. ED should be properly recognized and managed in hypertensive patients.

Matched MeSH terms: Severity of Illness Index
Fulltext The clinical features and outcomes of acute liver failure associated with dengue infection in adults: a case series

Tan SS, Bujang MA

Braz J Infect Dis, 2013 Mar-Apr;17(2):164-9.
PMID: 23453417 DOI: 10.1016/j.bjid.2012.09.007

OBJECTIVE: To describe the clinical manifestations and outcome of acute liver failure (ALF) associated with dengue viral infection, a rare but severe complication.
METHODS: One hundred and fifty five consecutive patients with ALF admitted to the national liver centre from 2001 to 2009 were reviewed retrospectively. Eight cases due to dengue infection were identified and their clinical characteristics are described.
RESULTS: All patients had severe dengue with one dengue shock syndrome. The median (minimum, maximum) age was 33.5 (17, 47) years with 50% female. The median (minimum, maximum) duration from the onset of fever to development of ALF was 7.5 (5, 13) days and the maximum hepatic encephalopathy (HE) grade were III in five patients and II in three patients. Three patients had systemic inflammatory responses (SIRS) on admission and were in grade III HE. The presence of SIRS on admission was associated with higher grade of HE and its development during the course of hospitalization was associated with worsening HE grade. The hepatitis was characterized by marked elevations in: alanine transaminase [median admission 1140.5 u/L (639, 4161); median peak 2487 u/L (998, 5181)], serum bilirubin [median admission 29 μmol/L (23, 291); median peak 127 μmol/L (72, 592)], and prothrombin time [median admission 16.8s (15.3, 26.2); median peak 22s (15.3, 40.7)]. The survival rate with standard medical therapy alone was 100%.
CONCLUSIONS: Dengue associated ALF manifest about one week after the onset of fever with severe hepatitis and encephalopathy. In our experience, the outcome with standard medical therapy alone is excellent.

Matched MeSH terms: Severity of Illness Index
Effects of a probiotic fermented milk on functional constipation: a randomized, double-blind, placebo-controlled study

Mazlyn MM, Nagarajah LH, Fatimah A, Norimah AK, Goh KL

J Gastroenterol Hepatol, 2013 Jul;28(7):1141-7.
PMID: 23432408 DOI: 10.1111/jgh.12168

Evidence suggests that probiotics reduce certain constipation-related symptoms. Lactobacillus casei strain Shirota has never been tested as treatment for functional constipation in otherwise-healthy subjects. To evaluate the efficacy of this probiotic among adults with functional constipation was aimed.

Matched MeSH terms: Severity of Illness Index
A retrospective study of periodontal disease severity in smokers and non-smokers

Razali M, Palmer RM, Coward P, Wilson RF

Br Dent J, 2005 Apr 23;198(8):495-8; discussion 485.
PMID: 15849588

Smoking has been associated with increased risk of periodontitis. The aim of the present study was to compare the periodontal disease severity of adult heavy smokers and never-smokers referred for assessment and treatment of chronic periodontitis.

Matched MeSH terms: Severity of Illness Index
Low prevalence of obstructive lung disease in a suburban population of Malaysia: A BOLD collaborative study

Loh LC, Rashid A, Sholehah S, Gnatiuc L, Patel JH, Burney P

Respirology, 2016 Aug;21(6):1055-61.
PMID: 27061596 DOI: 10.1111/resp.12793

BACKGROUND AND OBJECTIVE: As a Burden of Obstructive Lung Disease (BOLD) collaboration, we studied the prevalence of chronic obstructive pulmonary disease (COPD) and its associated risk factors in a suburban population in Malaysia.

METHODS: Nonhospitalized men or women of age ≥ 40 years from a Penang district were recruited by stratified simple random sampling. Participants completed detailed questionnaires on respiratory symptoms and exposure to COPD risk factors. Prebronchodilator and post-bronchodilator spirometry conducted was standardized across all international BOLD sites in device and data quality control.

RESULTS: Of the 1218 individuals recruited for the study, 663 (340 men and 323 women) had complete questionnaire data and acceptable post-bronchodilator spirometry. The estimated population prevalence of Global Initiative for Chronic Obstructive Lung Disease (GOLD) ≥ stage I was 6.5% or 3.4% based on either fixed forced expiratory volume in 1 s/forced vital capacity ratio of <0.7 or National Health and Nutritional Examination Survey-derived lower limit of normal ratio while the prevalence of GOLD ≥ stage II was either 4.6% or 3.1%, respectively. Multivariate logistic regression analysis showed independent association between all stages of COPD with cigarette smoking pack years (adjusted odds ratio per 10-year increase: 1.73; 95% confidence interval: 1.09-2.75), use of biomass fuel for cooking (1.61; 1.10-2.36) and exposure to dusty job (1.50; 1.09-2.06).

CONCLUSION: This study represented the first robust population-based epidemiology data on COPD for Malaysia. Compared with other sites globally, our estimated population prevalence was relatively low. In addition to cigarette smoking, use of biomass fuel and exposure to dusty job represented significant risk to the development of COPD.

Matched MeSH terms: Severity of Illness Index
Triglyceride glucose index as a surrogate measure of insulin sensitivity in obese adolescents with normoglycemia, prediabetes, and type 2 diabetes mellitus: comparison with the hyperinsulinemic-euglycemic clamp

Mohd Nor NS, Lee S, Bacha F, Tfayli H, Arslanian S

Pediatr Diabetes, 2016 09;17(6):458-65.
PMID: 26251318 DOI: 10.1111/pedi.12303

BACKGROUND: There is a need for simple surrogate estimates of insulin sensitivity in epidemiological studies of obese youth because the hyperinsulinemic-euglycemic clamp is not feasible on a large scale.
OBJECTIVE: (i) To examine the triglyceride glucose (TyG) index (Ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]) and its relationship to in vivo insulin sensitivity in obese adolescents (OB) along the spectrum of glucose tolerance and (ii) to compare TyG index with triglyceride/high-density lipoprotein TG/HDL and 1/fasting insulin (1/IF ), other surrogates of insulin sensitivity.
PATIENTS AND DESIGN: Cross-sectional data in 225 OB with normal glucose tolerance (NGT), prediabetes (preDM), and type 2 diabetes (T2DM) who had a 3-h hyperinsulinemic-euglycemic clamp and fasting lipid measurement.
RESULTS: Insulin-stimulated glucose disposal (Rd) declined significantly across the glycemic groups from OB-NGT to OB-preDM to OB-T2DM with a corresponding increase in TyG index (8.3 ± 0.5, 8.6 ± 0.5, 8.9 ± 0.6, p index to Rd was -0.419 (p index for diagnosis of insulin resistance was 8.52 [receiver operating characteristic-area under the ROC curves (ROC-AUC) 0.750, p index, 1/IF , body mass index (BMI) z-score, glycemic group, and sex.
CONCLUSION: The TyG index affords an easily and widely available simple laboratory method as a surrogate estimate of insulin sensitivity that could be used repeatedly in large-scale observational and/or interventional cohorts of OB. Although not superior to 1/IF , TyG index offers the advantage of having a standardized method of measuring triglyceride and glucose, which is not the case for insulin assays.

Matched MeSH terms: Severity of Illness Index
Fulltext Cardiovascular Risk Factors and Ethnicity Are Independent Factors Associated with Lower Urinary Tract Symptoms

Lim J, Bhoo-Pathy N, Sothilingam S, Malek R, Sundram M, Tan GH, et al.

PLoS One, 2015;10(6):e0130820.
PMID: 26098884 DOI: 10.1371/journal.pone.0130820

To determine the lower urinary tract symptoms (LUTS) profile and factors affecting its degree of severity including cardiovascular risk profile, age, ethnicity, education level and prostate volume in a multiethnic Asian setting.

Matched MeSH terms: Severity of Illness Index
Quality of life of community-based chronic schizophrenia patients in Penang, Malaysia

Mubarak AR, Baba I, Chin LH, Hoe QS

Aust N Z J Psychiatry, 2003 Oct;37(5):577-85.
PMID: 14511086

This is a study of the quality of life (QOL) of 174 community-based chronic schizophrenia patients in Penang, Malaysia.

Matched MeSH terms: Severity of Illness Index
Paediatric intensive care in Kuala Lumpur, Malaysia: a developing subspecialty

Goh AY, Lum LC, Chan PW

J Trop Pediatr, 1999 Dec;45(6):362-4.
PMID: 10667007

Paediatric intensive care in Malaysia is a developing subspecialty with an increasing number of specialists with a paediatric background being involved in the care of critically ill children. A part prospective and part retrospective review of 118 consecutive non-neonatal ventilated patients in University Hospital, Kuala Lumpur was carried out from 1 June 1995 to 31 December 1996 to study the clinical epidemiology and outcome in our paediatric intensive case unit (PICU). The mean age of the patients was 33.9 +/- 6.0 months (median 16 months). The main mode of admission was emergency (96.6 per cent) with an overall mortality rate of 42 per cent (50/118). The mean paediatric risk of mortality (PRISM) score was 20 +/- 0.98 SEM, with 53 per cent of patients having a score of over 30 per cent. Multiorgan dysfunction (MODS) was identified in 71 per cent of patients. Admission efficiency (mortality risk > 1 per cent) was 97 per cent. Standardized mortality rate using PRISM was an acceptable 1.06. The main diagnostic categories were respiratory (32 per cent), neurology (22 per cent), haematology-oncology (18 per cent); the aetiology of dysfunction was mainly infective. Non-survivors were older (29.5 vs. 13.8 months, p < 0.0001), had more severe illness (mean PRISM score 30 vs. 14, p < 0.0001), were more likely to develop MODS (96 vs. 53 per cent, p < 0.0001) and required more intervention and monitoring. Paediatric intensive care in Malaysia differs widely from that in developed countries in patient characteristics, severity of illness, and care modalities provided.

Matched MeSH terms: Severity of Illness Index
Fulltext Did we do it right?--an evaluation of the colour coding system for antenatal care in Malaysia

Ravindran J, Shamsuddin K, Selvaraju S

Med J Malaysia, 2003 Mar;58(1):37-53.
PMID: 14556325

Identification of pregnancies that are at greater than average risk is a fundamental component of antenatal care. The objective of this study was to assess the level of appropriate management and outcomes among mothers with hypertensive disorders of pregnancy, postdates and anemia in pregnancy, and to determine whether the colour coding system had any effect on the maternal mortality ratios. A retrospective follow-through study confined to users of government health services in Peninsular Malaysia was carried out in 1997. The study areas were stratified according to their high or low maternal mortality ratios. The study randomly sampled 1112 mothers out of 8388 mothers with the three common obstetric problems in the selected study districts. The study showed that the prevalence of anemia, hypertensive disorders in pregnancy and postmaturity among mothers with these conditions were according to known international standards. There was no significant difference in the colour coding practices between the high and low maternal mortality areas. Inappropriate referrals were surprisingly lower in the areas with high maternal mortality. Inappropriate care by diagnosis and by assigned colour code were significantly higher in the areas with high maternal mortality. The assigned colour code was accurate in only 56.1% of cases in the low maternal mortality areas and in 55.8% of the cases in the high maternal mortality areas and these two areas did not differ significantly in their accurate assignment of the colour codes. The colour coding system, as it exists now should be reviewed. Instead, a substantially revised system that takes cognisance of evidence in the scientific literature should be used to devise a more effective system that can be used by health care personnel involved in antenatal care to ensure appropriate level of care and referrals.

Matched MeSH terms: Severity of Illness Index
Severe bronchiolitis in Malaysian children

Chan PW, Goh AY, Lum LC

J Trop Pediatr, 2000 Aug;46(4):234-6.
PMID: 10996986

Twenty-two (42 per cent) out of 52 patients admitted with severe bronchiolitis to our Paediatric Intensive Care Unit required ventilation. Risk factors associated with ventilation included a younger mean age, female sex, low birthweight, failure to thrive and the presence of an underlying illness. Ventilated patients were also more likely to have a higher respiratory distress assessment index (RDAI) score, pneumonic infiltration on chest X-ray, lower serum sodium and a positive respiratory syncytial virus isolation in the tracheal secretion.

Matched MeSH terms: Severity of Illness Index
Clinical characteristics of ulcerative colitis in Singapore, a multiracial city-state

Ling KL, Ooi CJ, Luman W, Cheong WK, Choen FS, Ng HS

J Clin Gastroenterol, 2002 Aug;35(2):144-8.
PMID: 12172359

Ulcerative colitis (UC) is rare in Asia. Singapore is an ethnically heterogeneous city-state with a population made up of Chinese (77%), Indians (7.5%), and Malays (14%). This study describes and compares the characteristics of Chinese, Malay, and Indian patients with UC.

Matched MeSH terms: Severity of Illness Index
Fulltext Chronic HCV histology is predictable from HCV RNA and IgM anti HCV results

Sachithanandan S, Fielding JF

Med J Malaysia, 1999 Mar;54(1):110-3.
PMID: 10972013

The aim of this study was to determine if knowledge of both the serum HCV RNA and serum anti core IgM antibody status enabled one to predict the histological severity in chronic hepatitis C. We studied 45 female patients with chronic hepatitis C infection. The presence or absence of IgM antibodies to HCV and HCV RNA by PCR in each patient's serum was determined. Liver biopsies performed were scored according to a modified Desmet's histological activity index. Negative HCV RNA patients had least histological change. HCV RNA positive patients who were also IgM antibody positive had lower scores than their IgM negative counterparts. The grade of histological severity is more accurately predictable from knowledge of both the HCV RNA and IgM anti HCV status of the patient.

Matched MeSH terms: Severity of Illness Index

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