Longitudinal Association between Sarcopenia and Cognitive Impairment among Older Adults in Rural Malaysia

Sarcopenia is a condition that is highly prevalent among older adults. This condition is linked to numerous adverse health outcomes, including cognitive impairment that impairs healthy ageing. While sarcopenia and cognitive impairment may share a common pathway, limited longitudinal studies exist to show the relationship between these two conditions. Therefore, this study aimed to examine the longitudinal association between sarcopenia and cognitive impairment. This is a cohort study among older adults residing in Kuala Pilah District, Negeri Sembilan, Malaysia. There were 2404 respondents at the baseline and 1946 respondents at one-year follow-up. Cognitive impairment was determined using Mini-mental State Examination scores. Sarcopenia was identified using the Asian Working Group for Sarcopenia 2019 criteria, gait speed was measured using a 4-meter gait test, handgrip strength was assessed using Jamar handheld dynamometer, and appendicular skeletal muscle mass was measured using bioelectrical impedance analysis. Generalized estimating equation (GEE) was used to determine the longitudinal association between sarcopenia and cognitive impairment, presented as relative risk (RR) and its 95% confidence interval. The prevalence of sarcopenia was 5.0% (95% CI 4.00–5.90), and severe sarcopenia was 3.60% (95% CI 2.84–4.31). Upon adjusting for covariates, older adults with sarcopenia have an 80 per cent increased risk of cognitive impairment compared to those without (RR 1.80; 95% CI 1.18–2.75). Similarly, severe sarcopenia was found to significantly increase the risk of cognitive impairment by 101 per cent in the adjusted model (RR 2.01; 95% CI 1.24–3.27). Our study showed that sarcopenia, severe sarcopenia, low physical activity, depressive symptoms, hearing impairment and chronic pain were associated with a higher risk of cognitive impairment among community-dwelling older adults. Therefore, early intervention to prevent sarcopenia, depressive symptoms, hearing impairment, chronic pain, and higher physical activity among older adults is recommended.

Cervical Cancer Screening in a Human Immunodeficiency Virus Treatment Centre in Zaria North-Western Nigeria

INTRODUCTION

Low awareness and lack of adequate services for cervical cancer screening and treatment of premalignant lesions of the cervix have been identified as some of the reasons for the high burden of cervical cancer in Sub-Saharan Africa. Women living with HIV infection are at a higher risk of developing cervical cancer than HIV negative women.

OBJECTIVE

The study sought to assess the awareness of cervical cancer and screening services among women living with HIV in a HIV treatment centre. Factors that affect uptake of screening were also explored.

METHODS

It was a qualitative study conducted from 26th August to 9th September 2019, in a HIV treatment centre in Zaria. A total of 61 HIV positive women participated in ten focus group discussions. Two key informant interviews were conducted with health care providers in the center.

RESULTS

Majority of the participants have heard about cervical cancer and cervical cancer screening during routine health talk in the clinic, however, most of them were not aware of the increased risk of cervical cancer among women living with HIV. Uptake of screening was low. Stigma, cost and lack of screening facility within the treatment center were the main barriers to screening uptake.

CONCLUSION

From our study, uptake of cervical cancer screening among women living with HIV was low. There is need to integrate cervical cancer screening services within the compact of care offered to all women living with HIV within HIV treatment centres.

A review of heart valve disease research in Malaysia

INTRODUCTION

Heart valve disease comprises a cluster of conditions affecting the aortic, mitral, pulmonary and tricuspid valves. This paper reviews all the research on heart valve disease in Malaysia published between the years 2000- 2016.

METHODS

The methodology was based on the search process described in the paper, "Bibliography of clinical research in Malaysia: methods and brief results". The search databases included PubMed, Scopus and several Malaysian journals such as MyJurnal and UKM Journal Repository, by using the following keywords: (heart valve disease OR infective endocarditis OR rheumatic heart disease) and (Malaysia).

RESULTS

In all 94 papers were identified of which 39 papers were selected and reviewed on the basis of their relevance. The local studies contributed to the knowledge and understanding of the epidemiology, aetiology, pathophysiology, clinical presentations, investigations, treatment, and outcomes of heart valve disease in the country.

DISCUSSION

The clinical relevance of the studies performed in the country is discussed along with recommendations for future research.

Maternal lipids are associated with newborn adiposity, independent of GDM status, obesity and insulin resistance: a prospective observational cohort study

OBJECTIVE

To determine the association between maternal lipaemia and neonatal anthropometrics in Malaysian mother-offspring pairs.

DESIGN

Prospective observational cohort study.

SETTING

Single tertiary multidisciplinary antenatal clinic in Malaysia.

POPULATION

A total of 507 mothers: 145 with gestational diabetes mellitus (GDM); 94 who were obese with normal glucose tolerance (NGT) (pre-gravid body mass index, BMI ≥ 27.5 kg/m² ), and 268 who were not obese with NGT.

METHODS

Maternal demographic, anthropometric, and clinical data were collected during an interview/examination using a structured questionnaire. Blood was drawn for insulin, C-peptide, triglyceride (Tg), and non-esterified fatty acid (NEFA) during the 75-g 2-hour oral glucose tolerance test (OGTT) screening, and again at 36 weeks of gestation. At birth, neonatal anthropometrics were assessed and data such as gestational weight gain (GWG) were extracted from the records.

MAIN OUTCOME MEASURES

Macrosomia, large-for-gestational-age (LGA) status, cohort-specific birthweight (BW), neonatal fat mass (NFM), and sum of skinfold thickness (SSFT) > 90th centile.

RESULTS

Fasting Tg > 95th centile (3.6 mmol/L) at screening for OGTT was independently associated with LGA (adjusted odds ratio, aOR 10.82, 95% CI 1.26-93.37) after adjustment for maternal glucose, pre-gravid BMI, and insulin sensitivity. Fasting glucose was independently associated with a birthweight ratio (BWR) of >90th centile (aOR 2.06, 95% CI 1.17-3.64), but not with LGA status, in this well-treated GDM cohort with pre-delivery HbA1c of 5.27%. In all, 45% of mothers had a pre-gravid BMI of <23 kg/m² and 61% had a pre-gravid BMI of ≤ 25 kg/m² , yet a GWG of >10 kg was associated with a 4.25-fold risk (95% CI 1.71-10.53) of BWR > 90th centile.

CONCLUSION

Maternal lipaemia and GWG at a low threshold (>10 kg) adversely impact neonatal adiposity in Asian offspring, independent of glucose, insulin resistance and pre-gravid BMI. These may therefore be important modifiable metabolic targets in pregnancy.

TWEETABLE ABSTRACT

Maternal lipids are associated with adiposity in Asian babies independently of pre-gravid BMI, GDM status, and insulin resistance.

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

BACKGROUND

The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.

METHODS

ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.

RESULTS

The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.

CONCLUSIONS

This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.

CLINICAL TRIAL REGISTRATION

NCT03044899.

Abstract P5-08-39: Low risk of contralateral breast cancer rates in Asian women- A case for not recommending contralateral prophylactic mastectomy

Introduction

The rates of contralateral prophylactic mastectomy (CPM)appears to be higher in the west as compared to the east.1,2There is a suggestion of an improved survival benefit of CPM. 1The trends are increasing in the west and little is known in Asia. In western data a rate of 0.5 to 1% per year is often quoted. However, There is scarcity of epidemiological data on rates of contralateral breast cancer (CBC) in Asia.

Known predictors of CBC in the west include high stage at diagnosis, early age at diagnosis, presence of family history, genetic predisposition, time from first diagnosis and hormone receptor status. Little is known in Asia. Population based registries are not available in Malaysia as in many Southeast Asian countries. This study aims to provide CBC rates to provide evidence for informed decision making of CPM in Asians.

Method

A prospective database of newly diagnosed Stage I and II breastcancer patients diagnosed in University Malaya Medical Centre between 1993 to 2012 were analysed. Data on CBC were obtained from institutional database and medical records. Multivariate analysis used Cox regression was applied to observe for any associations with multiple variables such as age at diagnosis, time from diagnosis, presence of family history, menopausal status, ethnic groups, parity and hormone status.

Results

A total of 3060 Stage I and II patients were prospectively followed up. 127 (4.2%) women developed contralateral breast cancer.At 5 years, 57 (1.9%) and at 10 years, 100(3.4%) developed CBC. Using a multivariate model, the only independent predictor of developing contralateral breast cancer at 5 years was a positive family history OR 1.97(CI 1.02-3.80).

However, at 10 years we found the effect of positive family history diminished OR1.57 (CI 0.94-2.64) and younger women were more likely to develop cancer, those aged 51 to 64 years OR 0.29 (CI 0.11-0.73) , &gt;65 years OR 0.20 (CI 0.07-0.60)compared to those less than 35 years. The other factors in the model were not significant.

Discussion

There is an increasing rate of CPM at 22% from 9% in the west1. A study in Singapore showed a low CPM rate of 1.25%2 . Although uptake of CPM in Asia has not been reported extensively and appears low, the trends may rise and that evidence is needed to counsel patients on the benefits and harms of CPM if patients request for CPM. Given the lower incidence of breast cancer in Malaysia ie 5% average risk compared to 10% in the west, an urgent need to document the risk of contralateral breast cancer, and this data from a single institution is the first to report this rates in Southeast Asia.

Conclusion

The data shows that risk of contralateral breast cancer is low in this Southeast Asian country. Any recommendations or practice of CPM should be dealt with extreme caution.

References

1. Kauffmann R, Nelson R, Smith D, et al: Improved survival with contralateral prophylactic mastectomy. Abstract in 2014 Society of Surgical Oncology Cancer Symposium.

2. Sim Y, Tan VK, Ho GH, Wong CY, Madhukumar P, Tan BK, Yong WS, Ng YY, OngKW.Contralateral prophylactic mastectomy in an Asian population: a single institution review. Breast. 2014 Feb;23(1):56-62. doi: 10.1016/j.breast.2013.10.008. Epub 2013 Nov 23.

Citation Format: Taib NA, See MH, Bhoo Pathy N, Yahya A, Tan GH, Jamaris S, Yip CH. Low risk of contralateral breast cancer rates in Asian women- A case for not recommending contralateral prophylactic mastectomy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-08-39.

Longitudinal evaluation of the metabolic response of a tumor xenograft model to single fraction radiation therapy using magnetic resonance spectroscopy

Proton magnetic resonance spectroscopy (MRS) was used to evaluate the metabolic profile of human glioblastoma multiform brain tumors grown as xenografts in nude mice before, and at multiple time points after single fraction radiation therapy. Tumors were grown over the thigh in 16 mice in this study, of which 5 served as untreated controls and 11 had their tumors treated to 800 cGy with 200 kVp x-rays. Spectra were acquired within 24 h pre-treatment, and then at 3, 7 and 14 d post-treatment using a 9.4 T animal magnetic resonance (MR) system. For the untreated control tumors, spectra (1-2 per mouse) were acquired at different stages of tumor growth. Spectra were obtained with the PRESS pulse sequence using a 3  ×  3 × 3 mm(3) voxel. Analysis was performed with the LCModel software platform. Six metabolites were profiled for this analysis: alanine (Ala), myo-inositol (Ins), taurine (Tau), creatine and phosphocreatine (Cr + PCr), glutamine and glutamate (Glu + Gln), and total choline (glycerophosphocholine + phosphocholine) (GPC + PCh). For the treated cohort, most metabolite/water concentration ratios were found to decrease in the short term at 3 and 7 d post-treatment, followed by an increase at 14 d post-treatment toward pre-treatment values. The lowest concentrations were observed at 7 d post-treatment, with magnitudes (relative to pre-treatment concentration ratios) of: 0.42  ±  24.6% (Ala), 0.43  ±  15.3% (Ins), 0.68  ±  27.9% (Tau), 0.52  ±  14.6% (GPC+PCh), 0.49  ±  21.0% (Cr + PCr) and 0.78  ±  24.5% (Glu + Gln). Control animals did not demonstrate any significant correlation between tumor volume and metabolite concentration, indicating that the observed kinetics were the result of the therapeutic intervention. We have demonstrated the feasibility of using MRS to follow multiple metabolic markers over time for the purpose of evaluating therapeutic response of tumors to radiation therapy. This study provides supporting evidence that metabolite/water concentration ratios have the potential to be used as biomarkers for the assessment of the response to therapy.

Characteristics of developed granules containing selected decolourising bacteria for the degradation of textile wastewater

Textile wastewater, one of the most polluted industrial effluents, generally contains substantial amount of dyes and chemicals that will cause increase in the COD, colour and toxicity of receiving water bodies if not properly treated. Current treatment methods include chemical and biological processes; the efficiency of the biological treatment method however, remains uncertain since the discharged effluent is still highly coloured. In this study, granules consisting mixed culture of decolourising bacteria were developed and the physical and morphological characteristics were determined. After the sixth week of development, the granules were 3-10 mm in diameter, having good settling property with settling velocity of 70 m/h, sludge volume index (SVI) of 90 to 130 mL/g, integrity coefficient of 3.7, and density of 66 g/l. Their abilities to treat sterilised raw textile wastewater were evaluated based on the removal efficiencies of COD (initial ranging from 200 to 3,000 mg/L), colour (initial ranging from 450 to 2000 ADMI) of sterilised raw textile wastewater with pH from 6.8 to 9.4. Using a sequential anaerobic-aerobic treatment cycle with hydraulic retention time (HRT) of 24 h, maximum removal of colour and COD achieved was 90% and 80%, respectively.

Geochemical features of topsoils in the Gaza Strip: natural occurrence and anthropogenic inputs

The aims of this study were to establish the current contents of trace metals and major elements in agricultural soils of the Gaza Strip and to identify the main anthropogenic inputs affecting trace metal contents. An extensive soil survey was conducted in agricultural and nonagricultural areas. One hundred and seventy sites that represent a broad range of soil types and locations were selected. The results revealed that soils in the Gaza Strip fall within the range of uncontaminated to slightly contaminated. Up to 90% of the tested soils had trace metal contents equal to the international background values. Ten percent showed slight contamination, primarily by Zn, Cu, As, and Pb, due to anthropogenic inputs, and the mean concentrations of these elements were 180, 45, 13, and 190 mg/kg, respectively. The trace metal contents varied, with the highest contents detected in the southern regions (where one finds clay soil and low precipitation) and the lowest in the northern areas (where are sandy soil and high precipitation). The soil geochemistry is dependent on soil type and location and to a lesser extent on crop pattern and fertilizer and fungicide application. Anthropogenic inputs lead to the enrichment of Zn, Pb, Cu, and Cd in the agricultural soils. The pollution of several investigated sites was found to be most severe for Zn, Pb, Cu, Cd, and, to a somewhat lesser extent, for As, whereas anthropogenic input of Hg, Ni, and Co seemed to be less important. The application of Cd-containing phosphate fertilizers coupled with Cu-containing fungicides may be an important source of Cd and Cu in several soils. High Zn levels (1000 ppm) in several soils may be caused by sewage sludge, which has an average Zn content of 2000 ppm. Saline-sodic soils were found in the central and southern regions, where the soils are characterized by high contents of Na and salty groundwater. Elevated Cl, Na, Zn, and Pb contents in some areas need further investigation to determine their ecological and health implications.

Fluorides in groundwater, soil and infused black tea and the occurrence of dental fluorosis among school children of the Gaza strip

The purpose of this study was to determine the fluoride levels in water, soil and tea, and to identify the major fluoride minerals in soil that supply water with fluoride ions. Another aim was to study the prevalence of dental fluorosis in permanent dentition of the school children of the Gaza Strip. Monitoring of fluoride levels in 73 groundwater wells and 20 topsoil samples for the last three years revealed a general trend of increasing from north to south of the Gaza Strip. A linear regression analysis found a correlation coefficient of r=0.93 between the fluoride concentrations in groundwater and soil for the same geographic areas. However, the X-ray diffraction technique (XRD) results showed that none of the four major fluoride minerals were detected in the tested soil samples; the PHREEQC model showed that fluorite (CaF2) was the main donating mineral of fluoride ions to groundwater. A high positive correlation was found between fluoride concentrations in groundwater and occurrence of dental fluorosis. Among 353 school children of the five geographic areas of the Gaza Strip the prevalence of dental fluorosis was 60%, and 40% had no signs of fluorosis in their permanent dentitions. The highest occurrence, 94%, was in Khan Yunis, followed by 82% in Rafah, 68% in the middle area, 29% in Gaza and the lowest occurrence of 9% was in the northern area. These percentages were directly proportional to the average content of fluoride in groundwater of each area: 2.6, 0.9, 1.7, 1.2, and 0.7 ppm, respectively. The exception was Rafah where people drank from new groundwater wells that have been dug in the last 10 years. The occurrence of the disease was due to intake of high amounts of fluorides in drinking water, tea and fish. Communication with population indicated a heavy intake of tea starting from a very young age; not uncommonly tea is put in nursing bottles. No significant correlation was found between prevalence figures and gender or age groups. This high prevalence indicates a need to examine other sources of F including diet.

Standardized particle size for monitoring, inventory, and assessment of metals and other trace elements in sediments: <20 microm or <2 microm?

Despite the manifold factors that determine the composition of a river sediment (e.g., geology, soil type, rural or highly industrialized and densely populated, as well as forested areas, concentration of carbonates and organic matter), the linear regressions between the 9 metals determined in the fractions <2 microm and <20 microm have high coefficients (R2 after Pearson) for Cr and Cu (both 0.94), followed by Pb (0.90), Cd (0.82), Zn (0.81), Ni (0.76), and Mn (0.72). Low and very low coefficients are found for Hg (0.51) and Fe (0.22). In addition, the histograms of the metal ratios <2 microm:<20 microm (i.e. the slope of a linear regression) show that--with the exception of Cd (1.47)--all median ratios of the other metals fall within a narrow range (1.24-1.35). Both "fine" (<2 microm and <20 microm) fractions are able to fulfil the requirements for monitoring, inventory, and assessment of metals in sediments. Preference should be given to the rapid, simple, and economic <20 microm separation by sieving; this fraction corresponds fairly closely to the former suspended load of a riverine transport.

Sociobiological risk factors for spontaneous abortion in Malaysia

OBJECTIVE

To evaluate the risk factors of spontaneous abortion.

METHODS

A case-control study was conducted by interviewing 350 women who were admitted to the university gynaecological unit for spontaneous abortion and 350 women who delivered normally at the university obstetric unit. Odds ratios, as the estimators of relative risks, were calculated.

RESULTS

The relative risk for spontaneous abortion among women in the age-group 30 to 39 years was 1.61 and among women above 40 years of age was 3.68 when compared to those below 30 years of age. In relation to career women, the relative risk of spontaneous abortion for housewives was 0.45. Ethnic group, parity, subfertility, previous induced abortion, ectopic pregnancy, contraception and menarcheal age did not influence the risk of spontaneous abortion.

CONCLUSION

Increasing age and a woman's career are significant risk factors of spontaneous abortion.

Ultrasound guided percutaneous biopsies of suspected mediastinal lesions

Realtime ultrasonography with general purpose sector transducer was used to guide 87 percutaneous biopsies on 82 patients with lesions suspected to be mediastinal masses on plain chest radiographs. In seven patients who had dyspnea the biopsies were done in erect or semi-erect sitting positions. Definitive diagnosis was obtained from 66 lesions (80.5%) where 46 (70.0%) were mediastinal and the remaining 20 lesions (30.0%) arising from the lung. Of the 46 mediastinal lesions where specific diagnosis were made, 42 (91.0%) were anterior and four (0.9%) posterior mediastinal lesions. The majority of these anterior mediastinal masses were lymphomatous nodes followed by germ cell tumours whereas all four posterior mediastinal masses were neurogenic. Of the lung lesions, 19 were primary malignancies. The remaining lung lesion which was located posteriorly was cryptococcus infection. One patient developed massive hemothorax, but subsequently recovered. No significant complications were encountered in the remaining patients. Surgery was carried on 11 patients. There is correlation between definitive diagnosis from percutaneous biopsy and final diagnosis after surgery in 80% of patients. It is proposed that all percutaneous biopsies for thoracic masses which abut the chest wall and cause mediastinal widening on a plain chest radiograph be guided by ultrasound. It can be effectively accomplished with ease and safety even without the use of dedicated biopsy ultrasound probes or biopsy attachments, and on patients in erect or semi-erect positions.

Comparative study of cytologic and colposcopic findings in preclinical cervical cancer

Seventy-seven patients who had PAP smear cytology and colposcopic examination in a 2-year period between 1988 and 1989 were reviewed. Those with findings indicative or suspicious of malignancy were subjected to biopsy. All 50 patients thus biopsied were confirmed to have preclinical cancer on histological examination. Compared against histology, PAP smear cytology gave an accuracy rate of 90% (5 false negatives) and colposcopy gave an accuracy rate of 94% (3 false negatives). These results demonstrate that the two techniques are useful as screening tests for preclinical cervical cancer. The results are improved if they are used complementarily. However, there was poor specificity in the categorisation of cervical cancer by both methods. This was probably due to the subjectiveness of the two procedures. The study also raised the possibility of a higher incidence of preclinical cervical cancer in the Chinese ethnic group.