Displaying publications 1 - 20 of 33 in total

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  1. Nanchappan NS, Chopra S, Samuel A, Therumurtei L, Ganapathy SS
    Malays Orthop J, 2021 Jul;15(2):136-142.
    PMID: 34429834 DOI: 10.5704/MOJ.2107.020
    Introduction: Mortality following traumatic femoral neck fractures in the elderly (age >60 years) is influenced by many factors. Addressing some of them may reduce the mortality rate thus improving patient survival and quality of life.

    Materials and methods: This study was a retrospective research using data collected from Hospital Sultanah Bahiyah, Kedah between the years 2008-2018. We measured outcomes such as age, gender, hospital stay, default rate, ambulation post-surgery, American Society of Anaesthesiologists score (ASA) and surgical timing in correlation with mortality rate and 10-year survival of elderly patients treated with Total Hip Arthroplasty for femoral neck fractures in this centre.

    Results: A total of 291 traumatic femoral neck fractures aged above 60 years post total hip arthroplasty performed were included. There was higher number of female (n =233) compared to male (n=53) Estimated 10 years survival from Kaplan Meier was 42.88% (95% CI: 33.15, 52.54). One year mortality rate in our study was found to be 18.9%. The average time to event was 7.1 years (95% CI:33.15, 52.24) with a mean age group of 75.

    Discussion: Total hip arthroplasty patients not ambulating after surgery had a 4.2 times higher hazard ratio compared to ambulators. Those with pre-existing systemic disease (ASA III and IV) were found to have the highest hazard ratio, almost five times that of healthy patients, after adjusting for confounding factors. Delay of more than seven days to surgery was found to be a significant factor in 10-year survival with a hazard ratio of 3.8, compared to surgery performed earlier.

    Conclusion: Delay of more than 7 days to surgery in 10 years survival was significant with high hazard ratio. It is a predictor factor for survival in 10 years. A larger sample size with a prospective design is required to confirm our findings regarding "unacceptable surgical timing" for femoral neck fractures in patients above 60 years of age.

  2. Wong WK, Chan WK, Ganapathy SS, Lim SK
    Semin Dial, 2023 Mar;36(2):107-116.
    PMID: 35821201 DOI: 10.1111/sdi.13117
    BACKGROUND: Metabolic-dysfunction-associated fatty liver disease (MAFLD) and end stage kidney disease (ESKD) are complications of the metabolic syndrome. Our aim is to study the prevalence of MAFLD and advanced liver fibrosis and the associated factors among hemodialysis patients in a multiracial urban population in Malaysia.

    METHODS: A cross-sectional study of hemodialysis patients from 10 hemodialysis centers was used. FibroTouch examination was performed on all patients. Fatty liver was diagnosed based on ultrasound attenuation parameter ≥248 dB/m while advanced liver fibrosis was diagnosed based on liver stiffness measurement ≥10 kPa.

    RESULTS: This study included 447 hemodialysis patients (median age 59 [50-67], male 55%, Chinese 61%, Malay 20%, Indian 18%). Dialysis vintage was 49 (22-93) months. The prevalence of MAFLD was 43.4%. Independent factors associated with MAFLD were elevated waist circumference (aOR = 10.1, 95% CI = 5.3-19.4, p 

  3. Ganapathy SS, Sooryanarayana R, Mohammad NM, Abdul Manaf R
    Glob Pediatr Health, 2022;9:2333794X221113820.
    PMID: 35859886 DOI: 10.1177/2333794X221113820
    The belief in the effectiveness of physical punishment is an important predictor for its use. The objectives of this study was to describe the factors associated with the belief for physical punishment toward children 1 to 5 years of age among Malaysian parents. Data was collected as part of the Malaysian National Health and Morbidity Survey (NHMS) 2016. The respondents were asked if they believed that physical punishment is needed to raise a child properly. A total of 60.0% of Malaysian parents believed in the need for physical punishment, with 54.3% practising it. Parents who believed in physical punishment had more than 2 times a higher likelihood of practising it (odds ratio 2.57) than those who did not. Parents need to be taught to respond positively to children's behavior and anger management strategies in difficult parenting situations.
  4. Chong CT, Lai WK, Mohd Sallehuddin S, Ganapathy SS
    PLoS One, 2023;18(8):e0283270.
    PMID: 37531379 DOI: 10.1371/journal.pone.0283270
    The World Health Organization has reported that the prevalence of overweight is a growing problem in many countries, including middle- and lower-income countries like Malaysia. This study aimed to determine the prevalence of overweight and its associated factors among Malaysian adults. A total of 9782 Malaysian adults aged 18 and above were included in this study, representing states and federal territories from the National Health and Morbidity Survey 2019. Sociodemographic data (sex, locality, age, marital status, ethnicity, educational level, income level, and health literacy), non-communicable disease status (hypertension, diabetes, and hypercholesterolemia), and lifestyle behaviours (physical activity level, smoking status, and also fruit and vegetable consumption) were collected and analysed to identify factors associated with overweight. The study found that the prevalence of overweight among Malaysian adults was 50.1%. Multivariate analyses showed that several factors, including female gender [aOR (95% CI) = 1.33 (1.11, 1.58); p = .002], ages 30-59 years [aOR (95% CI) = 1.61 (1.31, 1.97); p < .001], being Malay [aOR (95% CI) = 1.68 (1.36, 2.07); p < .001], Indian [aOR (95% CI) = 2.59 (1.80, 3.74); p < .001] or other Bumiputera [aOR (95% CI) = 1.82 (1.38, 2.39); p < .001], being married [aOR (95% CI) = 1.23 (1.00, 1.50); p = .046], and having adequate health literacy [aOR (95% CI) = 1.19 (1.01, 1.39); p = .033], were significantly associated with an increased risk of overweight. Additionally, overweight individuals had a significantly higher risk of non-communicable diseases such as diabetes [aOR (95% CI) = 1.47 (1.23, 1.75); p < .001] and hypertension [aOR (95% CI) = 2.60 (2.20, 3.07); p < .001]. The study suggests that intervention programs should be implemented in an equitable and cost-effective manner to target these high-risk populations and address the burden of overweight in Malaysia.
  5. Letchumanan M, Anour AA, Ganapathy SS, Harry S, Nik Lah NSH, Arsad N, et al.
    Med J Malaysia, 2021 03;76(2):131-137.
    PMID: 33742618
    OBJECTIVES: To recognize the radiographic patterns of coronavirus disease 2019 (COVID-19) in Malaysia.

    MATERIALS AND METHODS: Chest radiographs of patients confirmed with COVID-19 in Hospital Tawau, Sabah, Malaysia were retrospectively analyzed by two radiologists. The radiographic pattern, distribution among subgroups and evolution of the disease over time were determined.

    RESULTS: Among the 82 patients studied, 65 (79.3%) were males. Mean age of our cohorts was 37 ± 15 years. Baseline chest radiographs were abnormal in 37 patients (45.1%). Over half (52.9%) of the symptomatic patients had abnormal baseline radiograph. Among the children, patients with comorbidities, and patients 60 years of age and above, the abnormal radiographs were 14.3%, 71.4% and 69.3% respectively. Ground glass opacities were the commonest abnormal radiographic feature (35.4%), were peripherally located (35.4%) with predilection for the lower zones (29.3%). Most radiographic abnormalities were multifocal (20.7%) and frequently located in the left lung (19.5%). Radiographic recovery was observed in 15 of 18 patients (83%). Computed tomography (CT) scan demonstrated greater extent of the disease than observed in radiographs of the same patient.

    CONCLUSIONS: COVID-19 pneumonia presented with a specific radiographic pattern in our cohort of patients, comprising of ground glass opacities in peripheral and basilar distribution, affecting a single lung field and was observed in both symptomatic and asymptomatic patients. Chest radiograph is a useful adjunct screening tool, and in combination with clinical and epidemiological assessment may facilitate in early diagnosis of COVID-19 pneumonia.

  6. Sooryanarayana R, Ganapathy SS, Wong NI, Rosman A, Choo WY, Hairi NN
    Geriatr Gerontol Int, 2020 Dec;20 Suppl 2:85-91.
    PMID: 33370859 DOI: 10.1111/ggi.13989
    AIM: Elder abuse is a significant public health problem. This study aims to estimate its prevalence and associated factors, using representative national Malaysian data.

    METHODS: A nationwide population-based survey involving 3977 community-dwelling older persons aged ≥60 years was conducted via face-to-face interview, of whom 3466 older persons were eligible for screening using a locally validated tool. Elder abuse was defined as any one occurrence of neglect, financial, psychological, physical or sexual abuse perpetrated by someone in a position of trust that was experienced in the past 12 months.

    RESULTS: About 9.0% of older persons in Malaysia have experienced elder abuse in the past 12 months, with neglect being the commonest type experienced (7.5%; 95% confidence interval [CI]: 5.54, 10.07). There is no significant difference by age group and geographical location. Males (adjusted odds ratio [aOR] 1.7; 95% CI: 1.06, 2.60), poorer social support (aOR 5.0; 95% CI: 2.25, 11.22), dependency in activities of daily living (aOR 2.1; 95% CI: 1.23, 3.44) and a previous history of abuse (aOR 10.1; 95% CI: 4.50, 22.86) show higher odds of experiencing elder abuse. Almost 5% of abused older persons reported experiencing multiple types of abuse. Reporting is low at 19.3% with none reporting to healthcare personnel.

    CONCLUSIONS: The prevalence of elder abuse in this study is lower than global estimates, but similar to local studies. Preventive measures and programs are crucial to overcoming elder abuse and need to be carried out at multiple levels - the individual, community, healthcare and other stakeholders. Geriatr Gerontol Int 2020; 20: 85-91.

  7. Chong CT, Lai WK, Zainuddin AA, Pardi M, Mohd Sallehuddin S, Ganapathy SS
    Asia Pac J Public Health, 2022 Nov;34(8):786-792.
    PMID: 36196901 DOI: 10.1177/10105395221129113
    In 2016, World Health Organization (WHO) estimated more than 650 million obese adults, resulting in a country's health burden. This study aims to determine the prevalence of obesity and its associated factors among Malaysian adults. A total of 5820 respondents, aged 18 to 59 years, from the National Health and Morbidity Survey 2019, were included for the data analysis. The prevalence of obesity was described and multivariate analyses were conducted to determine the factors associated with obesity. The prevalence of obesity among Malaysian adults was 20.1%, based on the findings from this study. Multivariate analyses showed that women, being Malays, Indians, and other Bumiputeras, were significantly associated with a higher risk of obesity. Besides, those diagnosed with diabetes mellitus and hypertension were also significantly associated with greater risk of obesity. This information is crucial for policy makers in formulating effective strategies or targeted programs in preventing obesity among Malaysian adults.
  8. Lau WP, Ng KP, Ganapathy SS, Tah PC, Ismail R, Jalalonmuhali M, et al.
    Transplant Proc, 2022 Feb 03.
    PMID: 35125235 DOI: 10.1016/j.transproceed.2021.12.019
    BACKGROUND: Proteinuria and metabolic acidosis adversely affect long term renal allograft outcome and are highly prevalent in reported studies. The role of dietary intake in influencing proteinuria and metabolic acidosis remained uncertain. This study aims to determine the prevalence rate of proteinuria and metabolic acidosis among kidney transplant recipients (KTRs) and to study their relationship with dietary intake.

    METHODS: We performed a cross-sectional study on KTRs with functioning renal allograft and at least 3 months post transplant. Dietary protein, salt, and dietary acid load were estimated using 24-hour urine collection. Demographic characteristics, concomitant medications, medical history, and laboratory results were obtained from electronic medical records.

    RESULTS: A total of 204 KTRs were recruited with median age of 48 years (interquartile range [IQR], 18 years); male to female ratio was 61:39. A total of 79.9% (n = 163) were living related kidney transplants. The median duration after transplant was 71 months (IQR, 131 months), and median eGFR was 65 mL/min/1.73 m2 (IQR, 25 mL/min/1.73 m2). The prevalence rates of proteinuria (defined as ≥ 0.5 g/d) and metabolic acidosis (defined as at least 2 readings of serum bicarbonate ≤ 22 mmol/L in the past 6 months) were 17.7 % and 6.2%, respectively. High dietary protein of > 1.2 g/kg ideal body weight (adjusted odds ratio, 3.13; 95% CI, 1.35-7.28; P = .008) was significantly associated with proteinuria. Dietary protein, salt, and acid load did not correlate with chronic metabolic acidosis.

    CONCLUSIONS: The prevalence rate of proteinuria is consistent with published literature, but metabolic acidosis rate is extremely low in our cohort. High protein intake (> 1.2 g/kg ideal body weight) is a risk factor of proteinuria and may have negative impact on KTR outcome.

  9. Ganapathy SS, Yi Yi K, Omar MA, Anuar MFM, Jeevananthan C, Rao C
    BMC Public Health, 2017 08 11;17(1):653.
    PMID: 28800758 DOI: 10.1186/s12889-017-4668-y
    BACKGROUND: Mortality statistics by age, sex and cause are the foundation of basic health data required for health status assessment, epidemiological research and formation of health policy. Close to half the deaths in Malaysia occur outside a health facility, are not attended by medical personnel, and are given a lay opinion as to the cause of death, leading to poor quality of data from vital registration. Verbal autopsy (VA) is a very useful tool in diagnosing broad causes of deaths for events that occur outside health facilities. This article reports the development of the VA methods and our principal finding from a validation study.

    METHODS: A cross sectional study on nationally representative sample deaths that occurred in Malaysia during 2013 was used. A VA questionnaire suitable for local use was developed. Trained field interviewers visited the family members of the deceased at their homes and conducted face to face interviews with the next of kin. Completed questionnaires were reviewed by trained physicians who assigned multiple and underlying causes. Reference diagnoses for validation were obtained from review of medical records (MR) available for a sample of the overall study deaths.

    RESULTS: Corresponding MR diagnosis with matched sample of the VA diagnosis were available in 2172 cases for the validation study. Sensitivity scores were good (>75%) for transport accidents and certain cancers. Moderate sensitivity (50% - 75%) was obtained for ischaemic heart disease (64%) and cerebrovascular disease (72%). The validation sample for deaths due to major causes such as ischaemic heart disease, pneumonia, breast cancer and transport accidents show low cause-specific mortality fraction (CSMF) changes. The scores obtained for the top 10 leading site-specific cancers ranged from average to good.

    CONCLUSION: We can conclude that VA is suitable for implementation for deaths outside the health facilities in Malaysia. This would reduce ill-defined mortality causes in vital registration data, and yield more accurate national mortality statistics.

  10. Teh HL, Selvaratnam V, Low WJ, Kassim AF, Ganapathy SS, Chopra S
    Indian J Orthop, 2023 Nov;57(11):1842-1849.
    PMID: 37881276 DOI: 10.1007/s43465-023-00983-7
    INTRODUCTION: Acetabular impaction bone grafting (AIBG) has been used widely to reconstruct acetabular defects in complex primary and revision cases. The aim of this study was to look at the outcomes AIBG using either frozen irradiated femoral head allografts or autografts with uncemented acetabular cups.

    METHOD: We retrospectively reviewed 38 patients who had AIBG and uncemented cup reconstruction of the acetabulum performed between 2008 and 2021 for complex primary and revision surgery. Graft incorporation, radiological loosening and cup migration were evaluated in follow-up X-rays.

    RESULT: There were 24 complex primary and 14 revision total hip arthroplasty. Autografts were used in 10 hips with smaller defects, while 28 hips with larger defects required frozen irradiated femoral head allografts. Using Paprosky classification to evaluate acetabular defects; 8 patients were classified as 2A, 12 as 2B, 7 as 2C, 8 as 3A and 3 as 3B. The Kaplan-Meier survival rate for AIBG with uncemented cups in our series is 89.70% in 10 years. Acetabular cup position was anatomically restored in all autograft AIBG cases and in 25 out of 28 in the allograft group. The mean pre-operative Oxford Hip Score (OHS) was 19 (range 10-24) and post-operative OHS was 39 (range 21-48) (p 

  11. Khaw WF, Chan YM, Nasaruddin NH, Alias N, Tan L, Ganapathy SS
    BMC Public Health, 2023 Jul 18;23(1):1383.
    PMID: 37464344 DOI: 10.1186/s12889-023-16309-z
    BACKGROUND: In Malaysia, the previous mortality burden has been a significant concern, particularly due to the high prevalence of noncommunicable diseases (NCDs) as the leading cause of death. Estimates of mortality are key indicators for monitoring population health and determining priorities in health policies and health planning. The aim of this study was to estimate the disease burden attributed to 113 major diseases and injuries in Malaysia in 2018 using years of life lost (YLL) method.

    METHODS: This study included all deaths that occurred in Malaysia in 2018. The YLL was derived by adding the number of deaths from 113 specific diseases and multiplying it by the remaining life expectancy for that age and sex group. Data on life expectancy and mortality were collected from the Department of Statistics Malaysia.

    RESULTS: In 2018, there were 3.5 million YLL in Malaysia. Group II (NCDs) caused 72.2% of total YLL. Ischaemic heart disease was the leading cause of premature mortality among Malaysians (17.7%), followed by lower respiratory infections (9.7%), road traffic injuries (8.7%), cerebrovascular disease (stroke) (8.0%), and diabetes mellitus (3.9%).

    CONCLUSIONS: NCDs are a significant health concern in Malaysia and are the primary contributor to the overall burden of disease. These results are important in guiding the national health systems on how to design and implement effective interventions for NCDs, as well as how to prioritise and allocate healthcare resources. Key strategies to consider include implementing health promotion campaigns, adopting integrated care models, and implementing policy and regulatory measures. These approaches aim to enhance health outcomes and the managements of NCDs in Malaysia.

  12. Ahmad AA, Abdullah S, Thavamany AS, Tong CY, Ganapathy SS
    J Hand Surg Glob Online, 2023 Jul;5(4):498-502.
    PMID: 37521562 DOI: 10.1016/j.jhsg.2023.03.001
    PURPOSE: The lacertus fibrosus or bicipital aponeurosis is a sheet of ligamentous tissue just distal to the elbow joint and can be a compression point for the median nerve. Essentially, lacertus syndrome is a subset of pronator syndrome and an uncommon diagnosis by itself. Surgical release of the lacertus consists of a small 2-cm incision that can be performed under local anesthesia. This study aimed to evaluate the outcome of lacertus release in resolving median nerve symptoms.

    METHODS: This retrospective study was performed at Prince Court Medical Centre, Kuala Lumpur, Malaysia, from January 2020 until June 2021. Ninety-three patients who presented with numbness of fingers, hand, or upper limb; forearm pain; and muscle weakness. They were diagnosed with lacertus syndrome on the basis of local tenderness at the lacertus fibrosus with either weakness of flexor pollicis longus and flexor digitorum profundus of the index finger or paresthesia over the thenar eminence. The patients underwent 3 months of hand therapy, and those with no symptom improvement were offered lacertus release performed by a single surgeon. The surgical technique consists of a surgical incision starting from a point 2 cm distally and 2 cm radially to the medial epicondyle. The incision projects 2 cm distally in an oblique fashion toward the radial styloid. A wide-awake local anesthesia no tourniquet (WALANT) technqiue was utilized and 20 mL of local anesthesic was injected subcutaneously around this region at least 20 minutes before the surgery. Careful dissection was made subcutaneously, and the lacertus fibrosus was identified as a thickened, shiny white structure and released. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, grip strength, and pinch strength were tested before and after surgery. At 6 months after surgery, the QuickDASH score was again assessed with a WALANT satisfactory questionnaire.

    RESULTS: A total of 93 patients were included in the study. The mean age of the patients was 38.7 years, and most were women (77.4%). The mean operating time was 70 minutes. The mean preoperative QuickDASH score was 53, which significantly reduced immediately after surgery to 7.8 (P < .001) and remained low at 6 months after surgery (10.6). The mean grip strength showed a significant increase from a preoperative mean of 16 kg to a postoperative mean of 24 kg (P < .001). Pinch strength also significantly increased from a preoperative mean of 9 kg to 13 kg after surgery (P < .001).

    CONCLUSIONS: Lacertus syndrome remains an underdiagnosed disease that can be treated efficiently with a directed minimal surgical incision under wide-awake local anesthesia. Lacertus release appears to significantly reduce pain and numbness with markedly improved hand grip and pinch strength. The corresponding QuickDASH scores also improved significantly after surgery. This study is vital to our understanding of proximal median nerve entrapment and to accurately diagnose it.

    TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

  13. Cheong SM, Ambak R, Othman F, He FJ, Salleh R, Mohd Sallehudin S, et al.
    J Health Popul Nutr, 2021 05 31;40(Suppl 1):5.
    PMID: 34059162 DOI: 10.1186/s41043-021-00231-4
    BACKGROUND: Excessive intake of sodium is a major public health concern. Information on knowledge, perception, and practice (KPP) related to sodium intake in Malaysia is important for the development of an effective salt reduction strategy. This study aimed to investigate the KPP related to sodium intake among Malaysian adults and to determine associations between KPP and dietary sodium intake.

    METHODS: Data were obtained from Malaysian Community Salt Survey (MyCoSS) which is a nationally representative survey with proportionate stratified cluster sampling design. A pre-tested face-to-face questionnaire was used to collect information on socio-demographic background, and questions from the World Health Organization/Pan American Health Organization were adapted to assess the KPP related to sodium intake. Dietary sodium intake was determined using single 24-h urinary sodium excretion. Respondents were categorized into two categories: normal dietary sodium intake (< 2000 mg) and excessive dietary sodium intake (≥ 2000 mg). Out of 1440 respondents that were selected to participate, 1047 respondents completed the questionnaire and 798 of them provided valid urine samples. Factors associated with excessive dietary sodium intake were analyzed using complex sample logistic regression analysis.

    RESULTS: Majority of the respondents knew that excessive sodium intake could cause health problems (86.2%) and more than half of them (61.8%) perceived that they consume just the right amount of sodium. Overall, complex sample logistic regression analysis revealed that excessive dietary sodium intake was not significantly associated with KPP related to sodium intake among respondents (P > 0.05).

    CONCLUSION: The absence of significant associations between KPP and excessive dietary sodium intake suggests that salt reduction strategies should focus on sodium reduction education includes measuring actual dietary sodium intake and educating the public about the source of sodium. In addition, the relationship between the authority and food industry in food reformulation needs to be strengthened for effective dietary sodium reduction in Malaysia.

  14. Teh HL, Abounouh M, Haibock P, Selvaratnam V, Ganapathy SS, Graichen H
    J Orthop, 2024 Apr;50:42-48.
    PMID: 38162260 DOI: 10.1016/j.jor.2023.11.068
    BACKGROUND: Varus or valgus malposition of uncemented femoral stems have been described to have detrimental effects for long term implant survival. Various pre- and intra-OP factors have been suggested to be relevant, one of them being the approach to the hip. The aim was to investigate several pre- and intra-OP factors associated with femoral stem malpositioning in a large series of DAA hips.

    METHODS: A series of 400 consecutive patients (416 hips) who underwent navigated (Brainlab) cementless Total Hip Arthroplasty (THA) in 2022 (Corail or Actis stem DePuy Synthes) via a direct anterior approach (DAA) was analyzed. Preoperative data were collected based on patients' demographics, radiographic information [critical trochanteric angle (CTA), centrum collum diaphyseal (CCD) angle, greater trochanter overhang, femoral neck resection angle, femoral neck resection height and Door classification], and these were correlated with the postoperative stem position. Univariable and multivariable linear regression were carried out to determine significant factors that contribute to varus and valgus stem malalignment.

    RESULTS: With the DAA approach, 56.5 % of stems were placed in an optimal neutral position, 38.4 % were in acceptable position of 0.1°-2° varus/valgus and only 5 % had a deviation larger than 2° varus/valgus. The critical trochanteric angle (CTA) was statistically significant in determining varus stem placement whereas centrum collum diaphyseal angle (CCD) was found to affect valgus stem malpositioning. All other factors have shown no relevant effect on stem placement using stepwise regression method.

    CONCLUSION: In DAA, 95 % of stems were found in a varus/valgus position of 2° or less. In pre-operative measurement, only femoral morphology (e.g. CTA & CCD) were found to be relevant, affecting varus/valgus stem malposition. All other tested modifiable and non-modifiable factors had no significant effect. Therefore, pre-OP templating including measurement of CTA and CCD, intra-operative assessment as well as proper operative techniques are paramount to prevent excessive varus/valgus mal-position of femoral stem in DAA.

  15. Hee NKY, Lim QH, Paramasivam S, Lim LL, Vethakkan S, Ganapathy SS, et al.
    Clin Endocrinol (Oxf), 2024 Mar;100(3):221-229.
    PMID: 38031259 DOI: 10.1111/cen.14999
    OBJECTIVE: Once daily prednisolone taken at predawn has been proposed to be the glucocorticoid replacement of choice in patients with adrenal insufficiency (AI) who intend to fast for the month of Ramadan. However, the effects of prednisolone on metabolic parameters and quality of life during fasting for Ramadan are unknown.

    DESIGN, PATIENTS AND MEASUREMENTS: Patients with AI on twice-daily hydrocortisone, who had low or moderate risk and intended to fast, were recruited. Patients were converted to prednisolone 5 mg once daily taken at sahur (predawn) and Ramadan education given. Weight, sleep duration, biochemical parameters and quality of life measures (SF-36 questionnaire) were analysed at the end of Ramadan and compared against baseline.

    RESULTS: Twenty patients (13 men) were recruited, with a mean age of 59.9 ± 15.0 years. All patients were on hydrocortisone 15 mg daily (in divided doses) as pre-Ramadan glucocorticoid replacement. Half had type 2 diabetes with low IDF-DAR risk. Eighty-five percent of patients completed the full 29 days of fasting with no complications. There was a significant reduction in weight (-1.1 ± 1.6 kg, p = .005), with no significant change in blood pressure or sleep duration. There was a significant increase in urea (0.80 ± 1.1 mmol/L, p = .005) and haematocrit, (0.011 ± 0.019 L/L, p = .019) and decrease in serum sodium (-1.6 ± 3.0 mmol/L, p = .028), with no change in serum creatinine or liver function. Quality of life measures were preserved in all domains with significant improvement in role limitation due to physical health (15.3 ± 21.6, p = .005) and bodily pain (8.8 ± 16.3, p = .031).

    CONCLUSIONS: This study has demonstrated that converting patients with AI who are fasting for Ramadan from twice-daily hydrocortisone to prednisolone 5 mg daily at sahur was safe, with no major short-term adverse effects. Despite the higher equivalent glucocorticoid doses, patients experienced weight loss and no clinically significant change in blood pressure, sleep, biochemical parameters or quality of life. This study paves the way to trial even lower doses of prednisolone once daily in patients fasting for Ramadan with AI.

  16. Tan L, Ganapathy SS, Sooryanarayana R, Hasim MH, Saminathan TA, Mohamad Anuar MF, et al.
    Asia Pac J Public Health, 2019 Nov;31(8_suppl):18S-29S.
    PMID: 31470742 DOI: 10.1177/1010539519870665
    This study aimed to assess the prevalence and factors associated with bullying victimization from a nationwide school-based survey among 27 458 students aged 13 to 17 years. The overall prevalence of having been bullied in the past 30 days was 16.2%; this decreased with age. Multivariate logistic regression analysis revealed that factors most strongly associated with bullying victimization were exposure to physical attacks (adjusted odds ratio [aOR] = 2.46, 95% confidence interval [CI] = 2.17-2.79), illicit drug use (aOR = 2.44, 95% CI = 1.78-3.34), involvement in physical fights (aOR = 1.97, 95% CI = 1.74-2.23), being younger than 14 years (aOR =1.95, 95% CI = 1.59-2.38), and having ever attempted suicide (aOR = 1.83, 95% CI = 1.51-2.21). Other significantly associated factors include loneliness, truancy, making suicidal plans, and symptoms of depression, anxiety, and stress. Exposure to bullying victimization can result in negative lifelong sequelae and important associated factors should be considered in planning effective school-based anti-bullying interventions.
  17. Omar A, Ganapathy SS, Anuar MFM, Khoo YY, Jeevananthan C, Maria Awaluddin S, et al.
    BMC Public Health, 2019 Jan 24;19(1):110.
    PMID: 30678685 DOI: 10.1186/s12889-018-6384-7
    BACKGROUND: Mortality indicators are essential for monitoring population health. Although Malaysia has a functional death registration system, the quality of information on causes of death still needs improvement, since approximately 30% of deaths are classified to poorly defined causes. This study was conducted to verify registered causes in a sample of deaths in 2013 and utilise the findings to estimate cause-specific mortality indicators for Malaysia in 2013.

    METHODS: This is a cross-sectional study involving a nationally representative sample of 14,497 deaths distributed across 19 districts. Registered causes of deaths were verified using standard medical record review protocols for hospital deaths, and locally adapted international standard verbal autopsy procedures for deaths outside hospitals. The findings were used to measure the validity and reliability of the registration data, as well as to establish plausible cause-specific mortality fractions for hospital and non-hospital deaths, which were subsequently used as the basis for estimating national cause-specific mortality indicators.

    RESULTS: The overall response rate for the study was 67%. Verified causes of 5041 hospital deaths and 3724 deaths outside hospitals were used to derive national mortality estimates for 2013 by age, sex and cause. The study was able to reclassify most of the ill-defined deaths to a specific cause. The leading causes of deaths for males were Ischaemic Heart Disease (15.4%), Cerebrovascular diseases (13.7%), Chronic Obstructive Pulmonary Disease (8.5%) and Road Traffic Accident (8.0%). Among females, the leading causes were Cerebrovascular diseases (18.3%), Ischaemic Heart Disease (12.7%), Lower Respiratory Infections (11.5%) and Diabetes Mellitus (7.2%).

    CONCLUSIONS: Investigation of registered causes of death using verbal autopsy and medical record review yielded adequate information to enable estimation of cause-specific mortality indicators in Malaysia. Strengthening the national mortality statistics system must be made a priority as it is a core data source for policy and evaluation of the public health and healthcare sectors in Malaysia.
  18. Ramasamy P, Kumarasamy V, Singh ASM, Abu Bakar MZB, Narayanan P, Ganapathy SS, et al.
    Obes Surg, 2021 08;31(8):3749-3757.
    PMID: 34046825 DOI: 10.1007/s11695-021-05492-w
    PURPOSE: The effect of altered subsphincteric gastric volume and pressure after bariatric surgery on laryngopharyngeal reflux (LPR) remains largely unknown. This was a cross-sectional pilot study conducted between January 2018 and January 2019 to identify changes in LPR symptoms and signs in bariatric surgery patients presurgery and postsurgery.

    MATERIALS AND METHODS: Thirty-four patients listed for bariatric surgery in a single tertiary referral center were recruited, where 31 (77.4% female, mean age 46.3 ± 8.9 years) fulfilled the eligibility criteria. Of the eligible patients, 54.8% and 45.2% underwent sleeve gastrectomy (SG) and gastric bypass (GB), respectively. LPR symptoms were assessed using the self-reported reflux symptom index (RSI). Video-recorded endolaryngeal signs were scored using the reflux finding score (RFS) by two blinded otolaryngologists. Patients' presurgical and 3-month postsurgical body mass index (BMI), RSI, and RFS were determined. Patients were deemed as having LPR when RSI > 13 or RFS > 7.

    RESULTS: There was a significant correlation between the postsurgical RSI and RFS changes (Pearson's r = 0.474, p = 0.007). Of the 31 patients, 12.9% (RSI) and 6.4% (RFS) recovered from preexisting LPR, whereas 22.6% (RSI) and 3.2% (RFS) developed new de novo LPR postsurgery. The postsurgical mean RFS change improved significantly in the GB group compared with that of the SG group (p < 0.05).

    CONCLUSION: LPR is best assessed clinically using a multimodal approach (RSI and RFS). Bariatric surgery may worsen or lead to de novo LPR. Recognizing the LPR outcomes in these patients is paramount for optimal voice, speech, and swallowing functions.

  19. Ganapathy SS, Tan L, Sooryanarayana R, Hashim MH, Saminathan TA, Ahmad FH, et al.
    Asia Pac J Public Health, 2019 11;31(8_suppl):38S-47S.
    PMID: 31617372 DOI: 10.1177/1010539519879339
    Body weight is a factor, with body weight perception a mediator, toward being a victim of bullying. This study aimed to explore the association between body weight, body weight perception, and bullying among students 13 to 17 years of age in Malaysia. Data were collected using a self-administered questionnaire. A 2-stage stratified cluster sampling design was used, and 212 schools across Malaysia were selected for this survey. Body weight was measured and body weight perception was the student's reflection of their body weight. The prevalence of being bullied among adolescents in Malaysia was 16.2%. Being too thin or being obese increased the probability of being bullied. Students with a normal body mass index, but with a misperception of their body weight, also had increased odds of being bullied. Obesity prevention, together with instilling positive body weight perception, should be part of all programs directed toward tackling the problem of bullying.
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