Antithrombotics prescription pattern and clinical outcomes in atrial fibrillation patients with type 2 diabetes mellitus

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) and Diabetes mellitus (DM) often coexist. As DM is considered while calculating the thromboembolic risk for AF patients, little is known about the prescription pattern of antithrombotic therapies in patients with AF and DM and their clinical outcomes.

Purpose

In this subsidiary study, we examined the prescription patterns of antithrombotic therapies and clinical outcomes of AF patients with type 2 DM.

Methods

We analyzed data from a single-center cohort of patients with a primary diagnosis of AF in a tertiary cardiac referral hospital in Malaysia from 1st January 2018 to 31st December 2020. Patients' clinical data and information related to antithrombotic therapy were traced through electronic Hospital Information system. A data collection form was used for data collection. The primary endpoint of the study was a composite cardiovascular (CV) event which consists of all-cause mortality, acute coronary syndrome (ACS), ischemic stroke and transient ischemic attack (TIA). The safety endpoint of the study was a bleeding event, defined as hemoglobin drop more than 2 g/dl, blood transfusion and bleeding at critical area.

Results

Of the 1006 AF patients (59.2% male; mean age 64.2 (12.1) years), 400 (39.8%) had a history of DM. Of these, 45.8% (n=183) were using warfarin; 46.5% (n=159) used direct oral anticoagulant (DOAC), 54.0% (n=216) used a single antiplatelet, 11.5% (n=46) used a double antiplatelet, 8.0% (n=32) used triple therapy which consists of two antiplatelet agents with one anticoagulant. The use of single antiplatelet agent (54.0% vs 46.4%, p=0.018) and double antiplatelet agents (11.5% vs 7.1%, p=0.016) was significantly associated with AF with DM patients, whereas there was no association between anticoagulant use and AF patients with or without DM (85.5% vs 82.5%, p=0.209). There was no association in composite CV events between AF patients with or without DM (12.0% vs 10.4%, p=0.427). The proportion of subjects who reported having bleeding events were also did not differ by the presence of AF patients with or without DM. (4.5% vs 2.8%, p=0.151).

Conclusion

Diabetes was associated with increased use of antiplatelet agents; however, DM was not associated with increased risk of composite CV events and bleeding events in patients with concurrent AF. The lack of an association between diabetes and CV risk contrasts with previous research, which could be due to improved diabetes treatment in this cohort of patients with relatively low fasting sugar readings. Further study on the degree of blood glucose as measured by glycosylated hemoglobin (HbA1c) is needed to confirm the finding.

Translation, validation and cross-cultural adaptation of the Malay emotion regulation checklist (ERC-M): A preliminary study

INTRODUCTION

Emotion Regulation Checklist (ERC) has been used globally and translated to several languages, including Brazilian Portuguese, Italian and Persian. The aim of this study is to translate and validate ERC to the Malay language and to measure the reliability and validity of the translated version of this scale among Malaysian parents.

METHODS

This study involved forward and back translation method. The translated questionnaire was then pretested and piloted among 10 parents and 50 participants, respectively. The procedure was repeated using the same questionnaire to evaluate the test-retest reliability.

RESULTS

The ERC-Malay (ERC-M) has excellent qualitative and quantitative measurements in both item-level content validation index (I-CVI) and scale-level content validation index (S-CVI). In addition, the ERC-M demonstrated good internal consistency from Cronbach's alpha and test-retest reliability based on the Intraclass Correlation Coefficient (ICC) in all domains.

CONCLUSION

ERC-M can potentially be used as a tool to evaluate emotion for the population with emotional dysregulation issue, such as autism spectrum disorder.

Does Dietary Adequacy Reflect the Cognitive Performance of Children? A Study among the Homeless Children in Klang Valley, Malaysia

Introduction: Homeless children are prone to inadequate energy and nutrient intake which may highly influence their cognitive performance. However, few studies have been done in assessing diet adequacy and cognitive performance among homeless children in Malaysia. Materials and Methods: This cross-sectional study aims to assess the dietary adequacy and cognitive performance of 120 homeless children age 7-12 years living in Klang Valley. The dietary adequacy of these homeless children was assessed through two days of 24 hours of dietary recall. Dietary adequacy achievement was determined by fulfilling at least 50% of Recommended Nutrients Intake (RNI). Raven’s Coloured Progressive Matrices (RCPM) test was used to assess their cognitive performance. Results: The homeless children had an adequate intake of energy, iron, zinc, and vitamin B12. Seventy percent of homeless children had a poor cognitive performance. This study shows that there was no association between energy, iron, and vitamin B12 adequacy with cognitive performance, whereas there was a significant (p=0.028) association between zinc adequacy and children’s cognitive performance. Conclusion: These findings provide solid evidence-based for dietary adequacy and cognitive performance of the homeless children in Klang Valley. It is clear from the findings that both dietary intake and cognitive of these children require improvement for a better quality of life in the future. This study suggests that dietary adequacy does not relatively reflect the cognitive performance of these homeless children in Malaysia.

The transcript level of interleukin-6 in the cartilage of idiopathic osteoarthritis of knee

AIMS

The mRNA level for interleukin-6 (IL-6) is an important marker of osteoarthritis (OA). The present study aimed to investigate the level of IL-6 mRNA in the cartilage of OA knee while comparing it to the normal cartilage obtained from the same patient.

MATERIALS AND METHODS

A total of 21 patients who underwent total knee replacement were recruited for this study. Sectioning of the destructive cartilage was performed in the medial part of the proximal tibiofemoral cartilage. The unaffected lateral part of the knee in the same patient, served as a control. The mRNA level for IL-6 was assessed using LightCycler 2.0 quantitative real-time polymerase chain reaction (qRT-PCR). actin mRNA was used as an endogenous control.

RESULTS

Twelve out of 21 patients (57.1%) exhibited up regulation of IL-6 mRNA in the OA cartilage as compared to the normal cartilage. The rest of the patients (42.9%) showed down regulation of IL-6 mRNA. The statistical analysis showed there was insignificant level of IL-6 mRNA in the OA (1.91 +/- 0.45) as compared to the normal cartilage (1.13 +/- 0.44) (p > 0.05). The inter-individual variation in the level of IL-6 mRNA in the cartilage of idiopathic knee was in accordance with previous findings.

CONCLUSIONS

These observations suggest IL-6 could also act as a catabolic agent in some patients or its expression might be influenced by other cytokines.