Displaying publications 1 - 20 of 22 in total

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  1. Edre MA, Muhammad Adil ZA, Jamalludin AR
    MyJurnal
    Coronavirus disease (COVID-19) is a novel pandemic that affects every other country in the world. Various countries have adopted control measures involving restriction of movement. Several studies have used mathematical modelling to predict the dynamic of this pandemic. Forecasting techniques can be used to predict the incidence cases for the short term. The study aims to forecast the COVID-19 incidence using the Auto Regressive Integrated Moving Average (ARIMA) method. MATERIALS AND METHODS:Using publicly available data, we performed a forecast of Malaysia COVID-19 new cases using Expert Modeler Method in SPSS and ARIMA model in R to predict COVID-19 cases in Malaysia. We compare 3 different time frames based on different Movement Control Order (MCO) period. We compare the model fit and prediction across models.RESULTS:All models show static cases for each MCO 7-day prediction. For prediction until 12 May, the third MCO time frame shows the best model fit for both techniques. Both software shows a stationary trend of cases of below 100. CONCLUSION:These MCO models have shown to stabilize the rate of new cases. Further sub analysis and quality of data is needed to improve the accuracy of the model.
  2. Shahida S, Nor Zamzila A, Norlelawati AT, Jamalludin AR, Azliana AF, Zunariah Buyong
    MyJurnal
    Introduction: Over the decades, organic arsenic has been thought to be less toxic than inorganic arsenic.
    Monosodium methylarsonate (MSMA) is a potent organoarsenical herbicide that is still being used in most
    Asian countries. Reported studies on the effects of organic arsenic are mainly to the gastrointestinal system,
    however there are limited research on its impacts to the liver. Therefore, this study aimed to investigate the
    effect of MSMA exposure on hepatocytes and liver sinusoidal endothelial cells (LSEC). Materials and Methods:
    Fourteen Sprague Dawley rats (n=14) were divided equally into arsenic-exposed (n=7) and control (n=7)
    groups. The rats in arsenic-exposed group were given MSMA at 63.20 mg/kg daily for 6 months through oral
    gavage. While the rats in control group were given distilled water ad libitum. At the end of the duration,
    they were euthanized and underwent liver perfusion for tissue preservation. Liver tissues were harvested and
    processed for light microscopy, scanning and transmission electron microscopy. The findings were analysed
    descriptively. Results: MSMA had caused necrotic and apoptotic changes to the liver. Normal organelles
    morphology were loss in the hepatocytes while LSEC revealed defenestration. Conclusion: In this study,
    chronic low dose organic arsenic exposure showed evidence of toxicity to hepatocytes. Interestingly, LSEC
    demonstrated capillarization changes.
  3. Shahida S, Zunariah B, Nor Zamzila A, Norlelawati AT, Azliana AF, Jamalludin AR
    MyJurnal
    Over the decades, organic arsenic has been thought to be less toxic than inorganic arsenic. Monosodium methylarsonate (MSMA) is a potent organoarsenical herbicide that is still being used in most Asian countries. Reported studies on the effects of organic arsenic are mainly to the gastrointestinal system, however there are limited research on its impacts to the liver. Therefore, this study aimed to investigate the effect of MSMA exposure on hepatocytes and liver sinusoidal endothelial cells (LSEC). Materials and Methods: Fourteen Sprague Dawley rats (n=14) were divided equally into arsenic-exposed (n=7) and control (n=7) groups. The rats in arsenic-exposed group were given MSMA at 63.20 mg/kg daily for 6 months through oral gavage. While the rats in control group were given distilled water ad libitum. At the end of the duration, they were euthanized and underwent liver perfusion for tissue preservation. Liver tissues were harvested and processed for light microscopy, scanning and transmission electron microscopy. The findings were analysed descriptively. Results:MSMA had caused necrotic and apoptotic changes to the liver. Normal organelles morphology were loss in the hepatocytes while LSEC revealed defenestration. Conclusion:In this study, chronic low dose organic arsenic exposure showed evidence of toxicity to hepatocytes. Interestingly, LSEC demonstrated capillarization changes
  4. How SH, Ng KH, Jamalludin AR, Shah A, Rathor Y
    Med J Malaysia, 2005 Dec;60(5):606-13.
    PMID: 16515112
    We conducted a retrospective review of 135 patients with melioidosis in Pahang from January 2000 to June 2003. Patients were mostly male (78.5%) and Malay (83%) with a median age of 51 years. Seventy four percent of patients were diabetic. Common presentations were pneumonia (40.7%), septicaemic without obvious source of infection (19.3%) and multiple organ involvement (15.6%). Only 32.7% were given appropriate antibiotics empirically. The overall mortality was 54% with most deaths (65%) occurring within 48 hours of admission. Patients with pneumonia, multiple organ involvement and septicaemic of unknown source had higher mortality as compared to patients with subcutaneous, musculoskeletal or single internal organ involvement without pneumonia (p < 0.001). The relapse rate was 19.2%.
  5. Nusee Z, Rusly A, Jamalludin AR, Abdulwahab DF, Ismail R
    Malays J Med Sci, 2016 May;23(3):57-63.
    PMID: 27418870
    BACKGROUND: Urinary incontinence (UI) demonstrates major prevalence in women of different population groups. Reduced quality of life (QOL) is observed due to incontinence problems. Urogenital Distress Inventory (UDI-6) and Incontinence Impact Quality of Life (IIQ-7) are useful disease-specific questionnaires evaluating the impact of urinary incontinence on the QOL of women which is accepted internationally.

    OBJECTIVE: This study aims to translate and validate UDI-6 and IIQ-7 in Malay language.

    METHODS: A cross sectional study, which recruited 100 participants from two urogynecology clinics. Both questionnaires were initially translated from English to Bahasa Malaysia followed by back translation and final correction done by the professional translators. The participants were requested to maintain a urinary record of the upcoming week for three days that assisted in quantifying the severity of symptoms. None of the subjects were assigned any treatment during the study period. Validity and reliability of the translated questionnaires were determined by checking the internal consistency and also by doing test-retest.

    RESULTS: The internal consistency levels of the UDI-6 and IIQ-7 Bahasa Malaysia questionnaires were 0.73 and 0.90 respectively with good test-retest (0.86 and 0.95). Incontinence episodes were strongly associated with obstructive, irritative, and stress symptoms. The factor of day time voiding had strong correlation with obstructive and irritative symptoms.

    CONCLUSION: UDI-6 and IIQ-7 did not measure similar outcomes; however, both questionnaires have their strengths in clinical settings. Analysis has also revealed that the Malaysian versions of both questionnaires had appropriate test-retest validity and reliability. Thus, it can be said that both of the questionnaires had great importance for screening patients with urinary incontinence in Malaysia.

  6. How SH, Ng TH, Kuan YC, Jamalludin AR, Fauzi AR
    Asia Pac J Clin Oncol, 2015 Sep;11(3):221-7.
    PMID: 24575820 DOI: 10.1111/ajco.12179
    Data on lung cancer survival are lacking in developing countries. Our objectives were to describe the survival of our lung cancer patients and to determine independent prognostic factors affecting survival.
  7. Mohamed MS, Khair MT, How SH, Rajalingam R, Sahhir K, Norazah A, et al.
    Med J Malaysia, 2012 Jun;67(3):293-7.
    PMID: 23082420 MyJurnal
    We analyzed the epidemiological data of all people who were involved in the search and rescue operation in Lubuk Yu, a natural recreational forest with waterfall and stream. The hospital admission records of the cases who fulfilled the case definition and the environmental samples result taken at Lubuk Yu recreational area were studied. 153 people were exposed to this outbreak, 85 (55.5%) were professional rescuers from various government agencies and 68 (44.5%) were villagers. 21 fulfilled the case definition. Ten cases were confirmed melioidosis, six melioidosis alone and four coinfected with leptospirosis. There were eight deaths in this outbreak, seven were villagers and one professional rescuer. Overall case fatality was 70%. All confirmed melioidosis cases and seven who died had diabetes mellitus. The morbidity rate were higher among the villagers, 23.5% compared to professional rescuers, 5.9%. The case fatality rate were also higher in this group which was 100% compared to 33.3% in professional rescuers. The soil and water samples in Lubuk Yu recreational area were positive for leptospira and Burkholderia pseudomallei. The presence of co-infection and co-morbidities especially diabetes mellitus among the exposed led to the high mortality in this outbreak hence a high index of suspicion is important among the healthcare professionals in the management of melioidosis cases. To avoid similar incident in future, search and rescue operation should be only conducted by professional rescuers with appropriate personal protective equipment. A register of rescuers should be maintained for surveillance and follow up if necessary.
  8. Radhiana H, Azian AA, Mubarak MY, Saat A, Mohd Amran AR, Jamalludin AR
    Med J Malaysia, 2012 Jun;67(3):316-22.
    PMID: 23082425 MyJurnal
    Multislice computed tomography (MSCT) is the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. This study assessed the role of MSCT in the detection of intra abdominal injury caused by blunt trauma in our centre within a two-year-period (2008-2009). A total of 151 patients had MSCT abdomen for blunt abdominal trauma within this study period. Positive scan were seen in 126 patients (83.4%). Out of these positive scans, liver, spleen and renal injuries were seen in 42.1% (n = 53), 34.9% (n = 44) and 30.0% (n = 34) of cases respectively. Laparotomies were performed in 45 patients. Out of these 45 laparotomies, 10 patients had surgically significant injuries that were missed on CT scan findings. The injuries were bowel perforation (n = 4), serosal tear of bowel (n = 1), mesenteric injuries with active haemorrhage (n=3), spleen injury (n = 1) and liver injury (n = 1).
  9. Tee HP, How SH, Jamalludin AR, Safhan MN, Sapian MM, Kuan YC, et al.
    Med J Malaysia, 2009 Dec;64(4):316-20.
    PMID: 20954558 MyJurnal
    A retrospective study was conducted to investigate 183 serologically-confirmed cases of dengue fever (DF) admitted from October 2004 to March 2005 in a large hospital in Pahang. Clinical and laboratory features, progress and outcome of these patients were analysed in order to identify risk factors associated with development of dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Individually, we found that older patients, secondary dengue infection, high baseline haematocrit levels, low platelet levels and prolonged activated partial thromboplastin time (APTT) ratio were significant associations with bleeding tendencies. Of these risk factors, haematocrit and APTT ratio were two independent significant risk factors on multivariate analysis. Older patients with primary infection and younger patients with secondary infection had significant bleeding tendencies. We also verified the validity of the haematocrit levels suggested as cut-off levels for plasma leakage for the Malaysian population by Malaysian Clinical Practice Guidelines for Dengue Infection in Adults (2003).
  10. How SH, Liam CK, Jamalludin AR, Chin SP, Zal AB
    Med J Malaysia, 2006 Dec;61(5):558-63.
    PMID: 17623956 MyJurnal
    We studied the prevalence of raised serum CA125 in patients with pleural effusions and explored factors affecting its level. Sixty four patients with benign effusions and 36 patients with malignant effusions admitted to the University Malaya Medical Centre from May 2001 to January 2002 were included in the study. There were no significant differences in age, gender and ethnicity of the patients with benign and malignant effusions. There was also no difference in the frequency of the side of pleural effusion between the two groups but compared to benign effusions, a higher proportion of malignant effusions was moderate to large in size (66% versus 39%, p = 0.011). Serum CA125 levels were above 35U/dL in 83.3% and 78.1% of patients with malignant and benign effusions, respectively (p = 0.532). All patients with underlying malignancy and 95.3% of patients with benign effusions had pleural fluid CA125 levels above 35U/dL (p = 0.187). The median levels of CA125 were higher in the pleural fluid than in the serum in all aetiological groups. Higher serum CA125 levels were more likely to be found in patients with moderate to large effusions (p = 0.015), malignant effusions (p = 0.001) and in female patients (0.016). Serum CA125 level showed significant correlation with pleural fluid CA125 level (r = 0.532, p < 0.001) but not with pleural fluid total white blood cell count (r = -0.092, p = 0.362), red blood cell count (r = -0.082, p = 0.417) and lactate dehydrogenase level (r = 0.062, p = 0.541). We conclude that serum CA125 is commonly elevated in patients with benign and malignant pleural effusions.
  11. Shahedah KK, How SH, Jamalludin AR, Mohd Faiz MT, Kuan YC, Ong CK
    Tuberc Respir Dis (Seoul), 2019 Jul;82(3):217-226.
    PMID: 30841021 DOI: 10.4046/trd.2018.0048
    BACKGROUND: Depression is a recognized complication of lung cancer underreported in developing countries such as Malaysia. Treating and identifying depression in cancer patients increases survival and quality of life. Our objectives are to study prevalence of depressive symptoms in newly diagnosed lung carcinoma, and examine the relationship of depressive symptoms with other influencing risk factors.

    METHODS: A 2-year, cross sectional study February 2015-February 2017, was conducted at Hospital Tengku Ampuan Afzan, and Penang General Hospital. One hundred and three patients with newly diagnosed, biopsy confirmed primary lung carcinoma were recruited. Self-rated patient's identification sheet, validated Center for Epidemiologic Studies Depression (CES-D), and Dukes University Religion Index score from three different main languages were used.

    RESULTS: Prevalence of current depressive symptoms (CES-D total score ≥16) is 37.9%. The result suggests prevalence of those at high risk of moderate to major depression, may need treatment. Multivariate analysis reveals those with good Eastern Cooperation Oncology Group factor (η2=0.24, p<0.001) married (η=0.14, p<0.001) with intrinsic religiosity (IR) (η=0.07, p<0.02) are more resistant to depression.

    CONCLUSION: One in three of lung carcinoma patients, are at increased risk for depression. Clinicians should be aware that risk is highest in those with poor performance status, single, and with poor IR. We suggest routine screening of depression symptoms as it is feasible, to be performed during a regular clinic visit with immediate referral to psychiatrist when indicated.

  12. Shahrin TCA, Azarisman Shah MS, Melor PAM, Jamalludin AR, How SH
    MyJurnal
    Introduction: Smoking is prevalent among Muslims in this country despite public knowledge regarding smoking as haram (unlawful). This may be due to ignorance of the consensus of the ' mufti ' on the ' fatwa ' on smoking or a result of poor education and understanding of health-related risks of smoking.
    Methods: A cross-sectional, questionnaire-based survey was carried out among the public who attended the IIUM Faculty of Medicine open day in Kuantan, Pahang on June 12th, 2004. Knowledge of smoking-related illnesses and the religious ' fatwa '(edict) on smoking was assessed.
    Results: Seventy four muslims participated in the survey. 46(63%) were smokers (including ex-smokers) and 28(37%) were non–smokers. There was no statistically significant difference between the knowledge of smoking-related illnesses and their knowledge of the religious edict which regards smoking as haram between smokers and non-smokers. Only 6.7% of smokers perceive smoking as haram compared to 48% of non-smokers (p<0.001).
    Conclusion: The conviction that smoking is haram among smokers is still poor among smokers. This could be one of the main reasons contributing to the high prevalence of smoking in our society. There was no difference between smokers and non-smokers concerning their knowledge on the religious edict on smoking and the health-related hazards of smoking.
  13. Rathor MY, Rani MF, Jamalludin AR, Amran M, Shahrin TC, Shah A
    J Res Med Sci, 2012 Nov;17(11):1056-62.
    PMID: 23833581
    BACKGROUND: Primary intracerebral hemorrhage (PICH) remains the deadliest and most disabling form of stroke. The aim of our study was to determine the potential predictors for survival and neurological recovery in PICH patients by clinical-computed tomographic (CT) correlation.

    MATERIALS AND METHODS: A prospective study conducted among PICH patients at a tertiary care hospital. The clinical and CT scan findings were correlated with the functional outcome using modified Rankin scores (mRS) of 0-5 at discharge and during six months follow-up.

    RESULTS: The clinical and CT findings in 160 (93 male and 67 female) eligible adult patients with age range from 25 to 85 years (mean age 58.30 ± 11.44 years) were analyzed. The mean Glasgow Coma Scale [GCS] score was significantly higher among survivors. (12.8 ± 0.4 vs. 8.5 ± 0.5, P < 0.001) Based upon the pattern of the CT findings, the best outcome in terms of survival was for the patients with ICH in basal ganglia/internal capsule region (86.7 %), followed by lobar hemorrhage (67.1%). Good functional outcome was associated with a hematoma volume of less than 30 ml. At discharge majority of the survivors were functionally dependent 76 (70.4%) and only 32 (29.6%) achieved functional independence. The significant independent predictors of in- hospital survival were GCS score > 9 (OR 10.8; 95% CI 4.061 to 28.719), basal ganglia/internal capsule bleed (OR 9.750; 95% CI 2.122 to 45.004), hematoma volume <30 ml (OR 11.476; 95% CI 4. 810 to 27.434), no mid line shift (OR 4.901; 95% CI 2.405 to 9.987) and no intraventricular extension of hemorrhage (OR 7.040; 95% CI 3.358 to 14.458).

    CONCLUSION: Outcome and functional status at discharge were well correlated with the initial CT scan findings and GCS score.

  14. Rathor MY, Abdul Rani MF, Shahar MA, Jamalludin AR, Che Abdullah ST, Omar AM, et al.
    J Family Med Prim Care, 2014 Jul;3(3):230-7.
    PMID: 25374860 DOI: 10.4103/2249-4863.141616
    INTRODUCTION: Due to globalization and changes in the health care delivery system, there has been a gradual change in the attitude of the medical community as well as the lay public toward greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As euthanasia has gained world-wide prominence, the objectives of our study therefore were to explore the attitude of physicians and chronically ill patients toward euthanasia and related issues. Concomitantly, we wanted to ascertain the frequency of requests for assistance in active euthanasia.
    MATERIALS AND METHODS: Questionnaire based survey among consenting patients and physicians.
    RESULTS: The majority of our physicians and patients did not support active euthanasia or physician-assisted suicide (EAS), no matter what the circumstances may be P < 0.001. Both opposed to its legalization P < 0.001. Just 15% of physicians reported that they were asked by patients for assistance in dying. Both physicians 29.2% and patients 61.5% were in favor of withdrawing or withholding life-sustaining treatment to a patient with no chances of survival. Among patients no significant differences were observed for age, marital status, or underlying health status.
    CONCLUSIONS: A significant percentage of surveyed respondents were against EAS or its legalization. Patient views were primarily determined by religious beliefs rather than the disease severity. More debates on the matter are crucial in the ever-evolving world of clinical medicine.
    KEYWORDS: Attitude; euthanasia; legalization; multi-cultural; physician-assisted suicide
  15. Fadzil Abdullah AA, Jamalludin AR, Norrashidah AW, Norzila MZ, Asiah Kassim K, Rus Anida A, et al.
    Med J Malaysia, 2012 Apr;67(2):181-5.
    PMID: 22822640 MyJurnal
    Sleep disordered breathing (SDB) is increasingly being diagnosed in children. However, there is no prevalence study done in Malaysia. The study objective was to evaluate the prevalence of SDB symptoms based on parental reports and associated risk factors among Malay school children aged 6 to 10 years old in a primary school using a translated University Michigan Paediatric Sleep Questionnaire (Malay UM-PSQ). The children whose parents responded to the questionnaire and consented were examined, documenting height, weight, skin fold thickness, neck and abdominal circumference, tonsillar size, nostril examination and presence of micrognathia or retrognathia. There were 550 respondents. The prevalence of parental report of SDB symptoms was 14.9 % (95 % CI 11.9, 17.9). Two hundred and eighty-five (51.8%) school children were males with mean age of 8.5 years (SD 1.1). The associated risk factors for SDB symptoms are male, obesity, large neck and waist circumference, positive history of asthma, history of recurrent tonsillitis, enlarged tonsil (> 4+) and enlarged nasal turbinate. Multivariate analysis showed that male gender is the only significant independent risk factor of SDB symptoms
  16. Hasniah AL, Jamalludin AR, Norrashidah AW, Norzila MZ, Asiah K, Anida AR, et al.
    World J Pediatr, 2012 Feb;8(1):38-42.
    PMID: 22105571 DOI: 10.1007/s12519-011-0279-3
    Sleep-disordered breathing (SDB) is common but often underdiagnosed in children. The Pediatric Sleep Questionnaire developed by University of Michigan, USA (English UM PSQ) has high sensitivity and specificity in identifying children with sleep-disordered breathing. This study aimed to translate and adapt the English UM PSQ into Malay language as a screening tool to assess SDB among the Malay speaking population. The second objective was to determine the psychometric measurements of the translated UM PSQ (Malay UM PSQ).
  17. How SH, Ng TH, Jamalludin AR, Tee HP, Kuan YC, Alex F, et al.
    Med J Malaysia, 2009 Mar;64(1):27-30.
    PMID: 19852316 MyJurnal
    Melioidosis has a high annual incidence and mortality rate in Pahang, Malaysia. We initiated the first melioidosis registry in the country on 1st July 2005 to improve the management of melioidosis in the state. Continuous medical education on melioidosis was carried out in all hospitals in the state to highlight the magnitude of the disease and to educate the doctors on the treatment of the disease. All culture confirmed cases were registered and analysed. During the one-year study period from 1st July 2005 till 30th June 2006, a total of 63 patients had positive culture for Burkholderia pseudomallei. The calculated annual incidence of melioidosis in Pahang state was 4.3 per 100,000 population per year (Adult, 6.0 per 100, 000 population per year and paediatric, 1.6 per 100,000 population per year). There were 55 Malays (87.3%), three Chinese (4.8%), four aborigines (6.3%) and one Indonesian. Nine (14.3%) were less than 18 years old. The median age was 49 years (range: 1-68 years). Only one patient (1.6%) had a previous history of confirmed melioidosis. With this programme, we had observed a decline in adult mortality from 54% to 44%, although this was not statistically significant. However, culture-confirmed relapses had dropped from 19% to nil. Several measures need to be taken to decrease mortality from melioidosis in endemic countries.
  18. Shakirah MS, Jamalludin AR, Hasniah AL, Rus Anida A, Mariana D, Ahmad Fadzil A, et al.
    Med J Malaysia, 2019 04;74(2):138-144.
    PMID: 31079125
    INTRODUCTION: Uncontrolled asthma may cause an increase in healthcare utilisation, hospital admission and productivity loss. With the increasing burden of asthma in Malaysia, strategies aimed at reducing cost of care should be explored.

    OBJECTIVE: This study aims to determine if a clinical pathway (CPW) for inpatient paediatric asthma would reduce average length of stay (ALOS), improve asthma management and decrease cost.

    METHODS: A quasi-experimental, pre-post study was used to evaluate the CPW effectiveness. Paediatric inpatients aged 5-18 years old, admitted for acute asthma exacerbation from September 2015 to April 2016 were prospectively recruited. Data from patients admitted from January-July 2015 were used as control. CPW training was carried out in August 2015 using standardised modules. Direct admission cost from the provider's prospective was calculated. Outcomes compared were differences in ALOS, discharge medication, readmission within 28 days of discharge and cost.

    RESULTS: ALOS is 26 hours lower in the CPW group for severe exacerbations and underlying uncontrolled asthma (19.2 hours) which is clinically significant as patients have shorter hospital stay. More newly-diagnosed intermittent asthmatics were discharged with relievers in the CPW group (p-value 0.006). None of the patients in the CPW group had readmissions (p-value 0.16). Mean treatment cost for patients in the intervention group is higher at RM843.39 (SD ±48.99, versus RM779.21 SD±44.33).

    CONCLUSION: This study found that management using a CPW may benefit asthmatic patients with uncontrolled asthma admitted with severe exacerbation. Further studies will be needed to explore CPW's impact on asthma management starting from the emergency department.

  19. Azarisman SM, Aszrin A, Marzuki AO, Fatnoon NN, Hilmi A, Hadzri MH, et al.
    PMID: 21073073
    Three hundred thirty-one consecutive patients presenting with hypertension to the outpatient medical clinic of Tengku Ampuan Afzan Hospital, Kuantan, Malaysia were screened and 150 patients with concurrent diabetes were enrolled into a cross-sectional study. The majority of patients were male (60.6%) with a mean age of 60.0 +/- 11.0 years. The mean systolic blood pressure (SBP) was 140.9 +/- 20.1 mmHg and the mean diastolic blood pressure (DBP) was 81.7 +/- 9.8 mmHg. Only 38.0% (57/150) of patients had blood pressures within recommended guidelines (130/80 mmHg). The mean blood pressure in this group was 123.7 +/- 8.5/76.4 +/- 5.6 mmHg. The majority of patients were on either 2 (41.3%) or 3 (31.3%) anti-hypertensives. Females had a significantly higher SBP 145.4 +/- 22.7 vs. 138.0 +/- 17.8 mmHg in males (p = 0.026). The level of blood pressure control in diabetics was unsatisfactory, especially in females and the elderly. A reassessment of priorities in the management of patients with concurrent hypertension and diabetes is therefore, urgently needed.

    Study site: outpatient medical clinic of Tengku Ampuan Afzan Hospital,
  20. Kee CC, Jamaiyah H, Geeta A, Ali ZA, Safiza MN, Suzana S, et al.
    Med J Malaysia, 2011 Dec;66(5):462-7.
    PMID: 22390102 MyJurnal
    Generalised obesity and central obesity are risk factors for Type II diabetes mellitus and cardiovascular diseases. Waist circumference (WC) has been suggested as a single screening tool for identification of overweight or obese subjects in lieu of the body mass index (BMI) for weight management in public health program. Currently, the recommended waist circumference cut-off points of > or = 94cm for men and > or =80cm for women (waist action level 1) and > or = 102cm for men and > or = 88cm for women (waist action level 2) used for identification of overweight and obesity are based on studies in Caucasian populations. The objective of this study was to assess the sensitivity and specificity of the recommended waist action levels, and to determine optimal WC cut-off points for identification of overweight or obesity with central fat distribution based on BMI for Malaysian adults. Data from 32,773 subjects (14,982 men and 17,791 women) aged 18 and above who participated in the Third National Health Morbidity Survey in 2006 were analysed. Sensitivity and specificity of WC at waist action level 1 were 48.3% and 97.5% for men; and 84.2% and 80.6% for women when compared to the cut-off points based on BMI > or = 25kg/m2. At waist action level 2, sensitivity and specificity were 52.4% and 98.0% for men, and 79.2% and 85.4% for women when compared with the cut-off points based on BMI (> or = 30 kg/m2). Receiver operating characteristic analyses showed that the appropriatescreening cut-off points for WC to identify subjects with overweight (> or = 25kg/m2) was 86.0cm (sensitivity=83.6%, specificity=82.5%) for men, and 79.1cm (sensitivity=85.0%, specificity=79.5%) for women. Waist circumference cut-off points to identify obese subjects (BMI > or = 30 kg/m2) was 93.2cm (sensitivity=86.5%, specificity=85.7%) for men and 85.2cm (sensitivity=77.9%, specificity=78.0%) for women. Our findings demonstrated that the current recommended waist circumference cut-off points have low sensitivity for identification of overweight and obesity in men. We suggest that these newly identified cut-off points be considered.
    Study name: National Health and Morbidity Survey (NHMS-2006)
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