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End of life care preference among hemodialysis population: Revisit Q methodology

Maniam R, Tan MP, Chong MC

Patient Educ Couns, 2021 Sep 29.
PMID: 34625322 DOI: 10.1016/j.pec.2021.09.026

OBJECTIVE: End-of-life care is often overlooked in the dialysis unit despite high mortality rates. This study aimed to understand the diverse subjectivity of opinions on end-of-life care preferences, feelings, needs, value and goals in life among a haemodialysis population.
METHODS: The Q methodology was used where 37 opinion statements were ranked in order of importance in a unimodal shaped grid. Results were explored using the Centroids factor extraction and Varimax rotation.
RESULTS: Four-three persons living with haemodialysis, mean age± SD= 56.58 ± 10.22 years, participated in the study. Five-factors were identified: living in the present, family preference, self preservation, power vs. control and autonomy in decision making, loaded by eleven, four, four, three and three participants with 16 individuals not loading significantly and two were confounded. Preferences for remaining positive in the face of illness through a healthy lifestyle and preserving relationships and autonomy were demonstrated.
CONCLUSIONS: End-of-life discussions are potentially inhibited by preferences to live for the present which should be explored in future studies.
PRACTICE IMPLICATION: Statement sets may be used to help facilitate end-of-life discussions through identification of opinion groups. Establishing preferences may guide identification of those willing to initiate discussions.
Fulltext Habenula GPR139 is associated with fear learning in the zebrafish

Roy N, Ogawa S, Maniam R, Parhar I

Sci Rep, 2021 03 10;11(1):5549.
PMID: 33692406 DOI: 10.1038/s41598-021-85002-1

G-protein coupled receptor 139 (GPR139) is an evolutionarily conserved orphan receptor, predominantly expressing in the habenula of vertebrate species. The habenula has recently been implicated in aversive response and its associated learning. Here, we tested the hypothesis that GPR139 signalling in the habenula may play a role in fear learning in the zebrafish. We examined the effect of intraperitoneal injections of a human GPR139-selective agonist (JNJ-63533054) on alarm substance-induced fear learning using conditioned place avoidance paradigm, where an aversive stimulus is paired with one compartment, while its absence is associated with the other compartment of the apparatus. The results indicate that fish treated with 1 µg/g body weight of GPR139 agonist displayed no difference in locomotor activity and alarm substance-induced fear response. However, avoidance to fear-conditioned compartment was diminished, which suggests that the agonist blocks the consolidation of contextual fear memory. On the other hand, fish treated with 0.1 µg/g body weight of GPR139 agonist spent a significantly longer time in the unconditioned neutral compartment as compared to the conditioned (punished and unpunished) compartments. These results suggest that activation of GPR139 signalling in the habenula may be involved in fear learning and the decision-making process in the zebrafish.
Fulltext Pulmonary papillary adenocarcinoma with Aspergillus versicolor infection in a dog

Maniam R, Selvarajah GT, Mazlan M, Lung Than LT

Med Mycol Case Rep, 2018 Mar;19:25-29.
PMID: 29234587 DOI: 10.1016/j.mmcr.2017.11.005

Papillary adenocarcinoma of the lungs is the most common primary lung adenocarcinoma, with the feature of papillary-like structure formation by cells. A dog was presented with the primary complaint of vomiting, hyporexia and increased respiratory effort. Thoracic radiography revealed increased soft tissue radiopacity of the right cranial lung lobe suggestive of possible consolidation or collapsed lung lobe, with generalised miliary nodular pattern throughout the other lung fields. The dog was euthanized humanely and necropsy was performed. Histopathology confirmed the diagnosis of primary pulmonary lung neoplasm (papillary adenocarcinoma) with Aspergillus versicolor infection identified through fungal culture and PCR. There have been several reports on humans and dogs with fungal infections that often mimic or coexist with pulmonary neoplasm. This is the first documented report of A. versicolor isolated from a lung neoplasm in a dog in Malaysia.
Fulltext Advanced care planning among persons living with haemodialysis: a qualitative study

Maniam R, Tan MP, Chong MC, Subramanian P

Singapore Med J, 2024 Apr 01.
PMID: 38567793 DOI: 10.4103/singaporemedj.SMJ-2021-463
Factors associated with hypertension and its management among older rural Australians

Betts JM, Gao C, Brown D, Ikin J, Maniam R, Stub D, et al.

Aust J Rural Health, 2020 Aug;28(4):399-407.
PMID: 32463177 DOI: 10.1111/ajr.12634

OBJECTIVES: Hypertension is a leading risk factor for death and disability. We aimed to estimate the prevalence of hypertension in an older rural Australian cohort and identify predictors of hypertension management.
DESIGN: Analysis of cross-sectional data collected from participants in a prospective cohort study.
SETTING: The Victorian rural towns of Morwell and Sale in 2018-2019.
PARTICIPANTS: A weighted random sample of 1119 eligible participants from Morwell or Sale, aged ≥55-90 years for men and ≥60-90 years for women, was drawn from the Hazelwood Health Study's Adult Survey cohort.
MAIN OUTCOME MEASURES: Blood pressure, body mass index, left ventricular hypertrophy by electrocardiogram, estimated glomerular filtration rate and glycosylated haemoglobin (HbA1c ) were measured. Participants with hypertension were categorised as managed, undermanaged or unmanaged.
RESULTS: Testing undertaken of 498 participants estimated the weighted prevalence of hypertension (defined as blood pressure ≥ 140/90 mm Hg, a self-reported doctor diagnosis of hypertension or taking antihypertensive medication) to be 79.9% (95% confidence interval: 75.7-83.4). Of those, 54.5% (49.4-60.0) had managed hypertension (<140/90 mm Hg), 37.1% (32.3-42.1) undermanaged hypertension and 8.4% (5.9-11.9) a new finding of hypertension (unmanaged hypertension). Current employment (relative risk 1.47, 95% confidence interval: 1.06-2.02) and single marital status (relative risk 1.45, 1.4-1.84) were associated with under- or unmanaged hypertension. Compared with no hypertension, the hypertensive groups were more likely to demonstrate markers of end-organ damage such as left ventricular hypertrophy and impaired renal function.
CONCLUSION: Hypertension is a highly prevalent condition among older rural Australians which is suboptimally identified and managed.
Fulltext Preliminary study of an exercise programme for reducing fatigue and improving sleep among long-term haemodialysis patients

Maniam R, Subramanian P, Singh SK, Lim SK, Chinna K, Rosli R

Singapore Med J, 2014 Sep;55(9):476-82.
PMID: 25273932

INTRODUCTION: Fatigue and quality of sleep are the main factors that contribute to a poor quality of life among patients on long-term haemodialysis. Studies have also emphasised the importance of exercise for improving the wellbeing of dialysis patients. This study aimed to determine the effectiveness of a predialysis low-to-moderate-intensity exercise programme for reducing fatigue and improving sleep disorders among long-term haemodialysis patients.

METHODS: In this quasi-experimental study, an exercise programme was conducted three times a week for 12 weeks before long-term haemodialysis patients underwent dialysis at two centres. The patients were categorised into either the exercise group (n = 28) or control group (n = 27). The latter was asked to maintain their current lifestyles. Assessments of fatigue and sleep disorder levels were performed for both groups using self-reported questionnaires at baseline and after intervention. The patients' perception of the exercise programme was also determined using self-reported questionnaires.

RESULTS: Paired sample t-test indicated improvements in fatigue level in the exercise group (mean fatigue score: post-treatment 40.5 ± 7.9 vs. pre-treatment 30.0 ± 10.9). Improvements in sleep disorders were also observed in the exercise group (mean score: post-treatment 7.6 ± 3.3 vs. pre-treatment 10.1 ± 3.8). However, sleep quality deteriorated in the control group (mean score: post-treatment 10.7 ± 2.9 vs. pre-treatment 9.3 ± 2.9).

CONCLUSION: Simple low-to-moderate-intensity exercise is effective for improving fatigue, sleep disorders and the overall quality of life among haemodialysis patients.