Guidelines from an expert panel for the management of diabetic macular edema in the Malaysian population

AIM:To derive a Malaysia guideline and consensus as part of the Malaysia Retina Group's efforts for diagnosis,treatment,and best practices of diabetic macular edema(DME).The experts'panel suggests that the treatment algorithm to be divided into groups according to involvement the central macula.The purpose of DME therapy is to improve edema and achieve the best visual results with the least amount of treatment load.METHODS:On two different occasions,a panel of 14 retinal specialists from Malaysia,together with an external expert,responded to a questionnaire on management of DME.A consensus was sought by voting after compiling,analyzing and discussion on first-phase replies on the round table discussion.A recommendation was deemed to have attained consensus when 12 out of the 14 panellists(85%)agreed with it.RESULTS:The terms target response,adequate response,nonresponse,and inadequate response were developed when the DME patients'treatment responses were first characterized.The panelists reached agreement on a number of DME treatment-related issues,including the need to classify patients prior to treatment,firstline treatment options,the right time to switch between treatment modalities,and side effects associated with steroids.From this agreement,recommendations were derived and a treatment algorithm was created.CONCLUSION:A detail and comprehensive treatment algorithm by Malaysia Retina Group for the Malaysian population provides guidance for treatment allocation of patients with DME.

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.

Fenofibrate for the prevention of progression of non-proliferative diabetic retinopathy:review,consensus recommendations and guidance for clinical practice

The prevalence of diabetic retinopathy(DR),and associated morbidity is high in the Asia-Pacific region.Emerging evidence suggests a potential role for fenofibrate in the prevention of progression of DR,especially in patients with cardiovascular risk,and pre-existing mild-to-moderate DR.Fenofibrate has also been found to reduce maculopathy,and the need for laser treatment in these patients.Considering these benefits of fenofibrate,a group of experts from the fields of endocrinology and ophthalmology convened in May 2017,to discuss on the the mechanism of action,and clinical efficacy of fenofibrate in DR.The findings from key clinical studies on fenofibrate in DR were reviewed by the experts,and consensus statements were derived to define the role of fenofibrate in the prevention and treatment of DR.The statements were rated based on the GRADE criteria.An algorithm was also developed for the screening and treatment of DR in patients with type 2 diabetes(T2D),and the place of fenofibrate was defined in the algorithm.The expert recommendations,and the algorithm provided in this review will serve as a guide to the clinicians to reconsider the adjunctive use of fenofibrate for preventing the progression of DR in selected T2D patients.

Descriptive assessment on diabetic retinopathy screening in an awareness programme in Malaysia

AIM:To determine the prevalence of diabetic retinopathy(DR)among diabetic patients at the primary health clinics in Selangor,Malaysia.METHODS:All diabetic patients were screened in Retinal Disease Awareness Programme(RDAP)and those who had significant DR changes were referred to the hospital for further management.Descriptive analyses were done to determine the prevalence of DR and sociodemographic characteristics among patients with diabetic.Univariate and multivariable analysis using Logistic regression were performed to find association and predictor factors in this screening.RESULTS:A total of 3305 patients aged 40y and above were screened for DR.Ofthe patients screened,9%patients were found to have DR and other visual complication such as maculopathy(0.9%),cataract(4.8%)and glaucoma(0.4%).The mean age of patients without retinopathy was 57.82±8.470y and the mean age of patients with DR was 63.93±9.857y.About 61.5%of the patients screened were aged below 60y and 38.5%were aged 60y and above.Majority of the patients screened were women 58.5%and Malay in the age group of 50-59y,while 27%were aged 60-69y.Significant association were found between age,sex,race,visual loss and DR.CONCLUSION:Although the prevalence of DR among patients is not alarming,effective interventions need to be implemented soon to avert a large burden of visual loss from DR.

Translation, Cross-Cultural Adaptation, Reliability and Validity of the Malay Version of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) V3.1

Introduction: A psychoactive substance has become an overwhelming public health burden globally. It causes social problems for the user and surrounding people which may affect work or study and cause negative economic impact. Objective: This study aims to translate and culturally adapt the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) into Malay and to assess its reliability and validity. Methods: The Malay version of the ASSIST v 3.1 was developed after the translation and back-translation, which included the stages recommended by Beaton. The ASSIST v 3.1 was administered to 125 respondents. The Malay ASSIST v 3.1 was completed twice by each respondent 7 to 14-day intervals to assess test-retest reliability based on the intra-rater and interrater correlation coefficient. Results: Majority of the respondents were male, Malay and currently employed. The intra-rater reliability is 0.84 and the test-retest reliability (ICC = 0.97) were excellent. Conclusion: Malay ASSIST v3.1 was a valid and reliable tool to screen substances abuse at varying degree. Nonetheless, further studies are needed to assess its responsiveness.

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.