Methodology: A total of 205 patients who fit eligibility criteria were included in the study. A questionnaire was completed, and blood was drawn to study vitamin B12 levels. Vitamin B12 deficiency was defined as serum B12 level of ≤300 pg/mL (221 pmol/L).
Results: The prevalence of vitamin B12 deficiency among metformin-treated patients with type 2 DM patients was 28.3% (n=58). The median vitamin B12 level was 419 (±257) pg/mL. The non-Malay population was at a higher risk for metformin-associated vitamin B12 deficiency [adjusted odds ratio (OR) 3.86, 95% CI: 1.836 to 8.104, p<0.001]. Duration of metformin use of more than five years showed increased risk for metformin-associated vitamin B12 deficiency (adjusted OR 2.06, 95% CI: 1.003 to 4.227, p=0.049).
Conclusion: Our study suggests that the prevalence of vitamin B12 deficiency among patients with type 2 diabetes mellitus on metformin in our population is substantial. This is more frequent among the non-Malay population and those who have been on metformin for more than five years.
CASE REPORT: A 31-year-old lady with underlying hyperthyroidism, dilated cardiomyopathy with severe mitral regurgitation presented with shortness of breath. She was intubated and admitted due to decreasing Glasgow Coma Score. Her blood investigations revealed increased white cell count, raised free thyroxine with suppressed thyroid stimulating hormone, deranged liver, renal and coagulation profiles. As her condition did not improve with initial treatment, plasmapheresis was commenced on day 4. Biochemically, her thyroid function test (TFT) showed improvement; however, she succumbed due to multi-organ failure.
DISCUSSION: Plasmapheresis is considered in TS if there is no clinical improvement within 24-48 hours of initial treatment. The improvement in patient's TFT post plasmapheresis signifies its role in treating TS. Unfortunately, there was a delay in commencing plasmapheresis due to haemodynamic instability in this patient.
METHODS: This was a prospective cohort study in a single diabetes centre in Malaysia. Empagliflozin group were on study drug for at least three months. For control group, subjects not receiving SGLT2 inhibitors were recruited. Follow-up were performed before and during Ramadan fasting. Anthropometric measurements, blood pressure, renal profile, and blood ketone were recorded during visits. Hypoglycaemia symptoms were assessed via hypoglycaemia symptom rating questionnaire (HypoSRQ).
RESULTS: We recruited a total of 98 subjects. Baseline anthropometry, blood pressure, and renal parameters were similar in two groups. No significant changes in blood pressure, weight, urea, creatinine, eGFR, or haemoglobin levels during Ramadan was found in either group. Likewise, no difference was detected in blood ketone levels (empagliflozin vs control, 0.17 ± 0.247 mmol/L vs 0.13 ± 0.082 mmol/L, p = 0.304) or hypoglycaemia indices (empagliflozin vs control, 19.1% vs 16%, p = 0.684).
CONCLUSIONS: Ramadan fasting resulted in weight loss and reduction in eGFR levels in patients with T2D. Empagliflozin use during Ramadan is safe and not associated with increased risk of dehydration, ketosis, or hypoglycaemia. Therefore, empagliflozin is a viable glucose-lowering drug for patients with T2D planning for Ramadan fasting.
METHODS: Young shoots of E. crassipes, L. flava, and N. oleracea were collected from shallow channels of Puchong (3°00'11.89″N, 101°42'43.12″E), Ladang 10, Universiti Putra Malaysia (2°58'44.41″N, 101°42'44.45″E), and Kampung Alur Selibong, Langgar (06°5'50.9″N, 100°26'49.8″E), Kedah, Peninsular Malaysia. The nutritional values of these macrophytes were analysed by using a standard protocol from the Association of Official Analytical Chemists. Eight replicates of E. crassipes and L. flava and four replicates of N. oleracea were used for the subsequent analyses.
RESULTS: In the proximate analysis, N. oleracea possessed the highest percentage of crude protein (29.61%) and energy content (4,269.65 cal g-1), whereas L. flava had the highest percentage of crude fat (5.75%) and ash (18.31%). The proximate composition trend for each species was different; specifically, all of the species possessed more carbohydrates and fewer crude lipids. All of the species demonstrated a similar mineral trend, with high nitrogen and potassium and lower copper contents. Nitrogen and potassium levels ranged from 12,380-40,380 mg kg-1 and from 11,212-33,276 mg kg-1, respectively, and copper levels ranged from 16-27 mg kg-1. The results showed that all three plant species, i.e., E. crassipes, N. oleracea, and L. flava are plant-based sources of macro- and micronutrient beneficial supplements for human consumption.
METHODS: Five seagrass species, Enhalus acoroides, Thalassia hemprichii, Halophila ovalis, Halophila major, and Halophila spinulosa were collected at an Ulva reticulata-colonized site (MA) shoal and a non-Ulva reticulata-colonized site (MC) shoal at Sungai Pulai estuary, Johor, Malaysia. Morphometry of shoots comprising leaf length (LL), leaf width (LW), leaf sheath length (LSL), leaflet length (LTL), leaflet width (LTW), petiole length (PL), space between intra-marginal veins (IV) of leaf, cross vein angle (CVA) of leaf, number of the cross vein (NOC), number of the leaf (NOL) and number of the leaflet (NOLT) were measured on fresh seagrass specimens. Moreover, in-situ water quality and water nutrient content were also recorded. Seagrass extracts in methanol were assessed for total phenolic content (TPC), total flavonoid content (TFC), 2,2-diphenyl-1-picrylhydrazyl radical scavenging activity (DPPH), 2,2'-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid radical cation scavenging activity (ABTS), and ferric reducing antioxidant power (FRAP).
RESULTS: Seagrasses in the U. reticulata-colonized site (MA) had significantly higher (t-test, p < 0.05) leaf dimensions compared to those at the non-U. reticulata colonized site (MC). Simple broad-leaved seagrass of H. major and H. ovalis were highly sensitive to the colonization of U. reticulata, which resulted in higher morphometric variation (t-test, p < 0.05) including LL, PL, LW, and IV. Concerning the biochemical properties, all the seagrasses at MA recorded significantly higher (t-test, p < 0.05) TPC, TFC, and ABTS and lower DPPH and FRAP activities compared to those at MC. Hydrocharitaceae seagrass experience positive changes in leaf morphology features and metabolite contents when shaded by U. reticulata. Researching the synergistic effect of anthropogenic nutrient loads on the interaction between seagrasses and macroalgae can provide valuable information to decrease the negative effect of macroalgae blooms on seagrasses in the tropical meadow.