Etiologies of tropical acute febrile illness in West Pahang, Malaysia: A prospective observational study

Objective: To determine the etiologies of tropical acute febrile illness(TAFI) in West Pahang, Malaysia and to investigate morbidity and mortality factors in relation to TAFI. Methods: A multicenter prospective cohort study was conducted between January and June 2016 in six district hospitals throughout the western part of Pahang State in Peninsular Malaysia. A total of 336 patients answered a standardized questionnaire and blood samples were collected for laboratory confirmation of infectious etiology. Descriptive analysis and logistic regression were performed to identify factors associated with TAFI. Results: A total of 336 patients were included. The patients were mainly Malays(70.2%), males(61.3%), aged(44.6±17.4) years, with more than half(58.9%) presenting with gastrointestinal symptoms. The majority were diagnosed with dengue(35.7%) while malaria(4.5%) was the least frequent. The in-hospital mortality due to TAFI was 9.2%. Patients with meliodosis had five times higher mortality [Adjusted OR: 5.002, 95% CI:(1.233, 20.286)]. Patients with comorbidities such as cardiovascular symptoms(P<0.001) and renal replacement therapy initiation(P<0.001) were significantly associated with in-hospital mortality in all TAFI. Conclusions: The etiology of TAFI in the western Pahang includes dengue, leptospirosis, malaria and melioidosis, which carry the highest risk of in-hospital mortality. The presence of cardiovascular symptoms may be used to assess the disease severity in TAFI, but more studies are needed in the future.

Ambient Air Pollution and Pulmonary Tuberculosis in Malaysia

Introduction: The possible impact of ambient air pollution exposure on the development of active tuberculosis (TB) remains obscure. This study investigated the potential role of ambient air pollution in activating pulmonary TB (PTB) compared to extrapulmonary TB (EPTB). Materials and Methods: Data on TB cases were obtained from national surveillance data in Malaysia during 2013 and air pollution data were obtained from 52 air-monitoring stations around the country for the 3-year period of 2011-2013. Analyses were performed to estimate the odds of PTB vs. EPTB with changes in the 3-year (2011-2013) average Air Pollutant Index (API) and specific ambient air pollutants. Results: Results showed that the 95th-percentile of API levels during 2011-2013 was moderate and it was not associated with PTB. However, the odds of active PTB compared to EPTB was significantly elevated with the 95th-percentile levels for particulate matter with an aerodynamic diameter of 10 μm or less (aOR = 1.006, 95% CI: 1.002, 1.011), p-value Conclusions: These results provide suggestive evidence of the effects of ambient air pollution on development of active pulmonary TB compared to extrapulmonary TB. Additional research on the impacts of ambient air pollution on TB is warranted.

Impact of Palm Oil versus Other Oils on Weight Changes: A Systematic Review

Objective: The present review aimed to determine the effect of palm oil versus other oils on changes in body weight or Body Mass Index (BMI). Design: A systematic review was conducted. Studies were identified by database searching (EMBASE, PUBMED, CENTRAL, SCOPUS, PROQUEST, Web of Science [ISI Web of Knowledge], Cumulative Index to Nursing and Allied Health Library (CINAHL Plus), LILAC and ClinicalTrials.gov. Searching, selecting and reporting were done according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) Statement. Setting: Palm oil vs other oils intervention study on weight or BMI changes. Subjects: Individuals participating in palm oil vs other oil intervention study. Results: A total of 182 studies were screened for eligibility, five studies were finally included. Three studies compared the effect of palm oil vs sunflower oil on weight changes and BMI. One study examined the effect of hybrid palm oil vs extra virgin olive oil on weight changes. The last study examined the effect of palm oil vs olive oil vs lard on weight changes. Out of 292 participants in five studies, only one study (Iggman, 2014) had a low risk of bias. In this study, there was no significant difference between the group that received sunflower oil and palm oil (SMD: 0.04, 95% CI: -0.59 to 0.66). Other four studies had unclear risk of bias. Conclusions: Based on the review, there is insufficient evidence to suggest the impact of palm oil intake on weight changes or BMI.

Association between Comorbidities and Selected Sociodemographic Factors with Complications of Diabetes: Results from the National Diabetic Registry Malaysia

Background: This study aims to determine the hazard ratio of having any complication from diabetes mellitus, and the associations between comorbidities and risk of having any complications from diabetes mellitus among diabetic patients who have attended government primary care clinics. Methods: Secondary data were retrieved from the Malaysian National Diabetic Registry which included all patients who received care. The data from the study on the socio-demographic, diabetes complications, clinical and treatment characteristics were analyzed using descriptive statistics. Cox regression was performed to estimate the hazard ratio for comorbidities, tobacco use, duration of diabetes and socio-demography characteristics upon time to diabetic complications. Results: Adjusted for other covariates, increase number of comorbidities contributed the highest hazard ratio risk: 1 comorbid (aHR: 2.47, 95% CI: 2.39, 2.55), 2 comorbidities (aHR: 4.34, 95% CI: 4.22, 4.47), 3 comorbidities (aHR: 6.56, 95% CI: 6.31, 6.81) and 4 comorbidities (aHR: 9.13, 95% CI: 8.20, 10.17). Other factors: age > 40 years (8%) Malays (27%) and smokers (10%) have hazard risks to develop diabetic complications. Conclusions: Increase in number of comorbidities will increase the risk of getting diabetes complications. Other factors such as age, gender, race, smoking status and duration of diabetes are also noted to contribute to increase risk for diabetes complications.