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Putrajaya, Malaysia

Abdul Muizz A.M.,Hospital Seremban | Mohd Shahrir M.S.,National University of Malaysia | Sazliyana S.,National University of Malaysia | Oteh M.,National University of Malaysia | And 2 more authors.
International Journal of Rheumatic Diseases

Aims: The aim of this study was to evaluate the left ventricular (LV) diastolic dysfunction in rheumatoid arthritis (RA) patients without clinically evident cardiovascular manifestations and to estimate whether there is any correlation between RA disease severity and disability and LV diastolic dysfunction. Methods: The study was a cross-sectional study involving 53 patients (47 female and 6 male) with RA without clinically evident heart disease and 53 healthy subjects (47 female and 6 male) who served as a control group. Both groups were matched for age and sex. Echocardiographic and Doppler studies were conducted in all patients with RA and control subjects. Results: Of 17 cardiac parameters assessed, only two were abnormal. None of the specific cardiac diastolic dysfunction parameters were significantly different in RA patients compared to the control group. There was no significant correlation between diastolic function values in RA patients and value of Disease Activity Score 28 (DAS-28) and value of Health Assessment Questionnaires Disability Index (HAQDI). Atrial (A) wave velocity was greater in RA patients compared to the control group (0.71 [0.58-0.83] vs. 0.61 [0.51-0.71]; P<0.04). However, interventricular relaxation time (IVRT) ([73.08±9.92 vs. 70.74±9.02], P=0.207), lower E/A ratio (1.27 [1.02-1.56] vs. 1.42 [1.20-1.68], P=0.102), diastolic dysfunction parameters according to Redfield Classification (25 [47.2%] vs. 27 [50.9%] P=0.56), diastolic dysfunction using E/A (P=0.321) and tissue doppler imaging (E/E') (P=0.148) were not different. Conclusion: Prevalence of diastolic dysfunction in the rheumatoid arthritis group (47.2%) was not different from controls (50.9%). LV diastolic function had no significant correlation with RA disease severity and duration of disease. © 2011 The Authors. International Journal of Rheumatic Diseases © 2011 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd. Source

Latif Z.A.,Bangladesh Institute of Research and Rehabilitation for Diabetes | Hussein Z.,Hospital Putrajaya | Litwak L.,Endocrinology and Nuclear Medicine Diabetes and Metabolism | Naggar N.E.,Internal Medicine | And 2 more authors.
Diabetes Therapy

Introduction: Hypoglycemia is a complication in the management of type 2 diabetes, and elderly people are at greater risk of experiencing hypoglycemia events than younger patients. Insulin analogs achieve glycemic control with minimal risk of hypoglycemia and may therefore be a good treatment option for all patients. Methods: A1chieve was an international, multicenter, prospective, open-label, noninterventional, 24-week study in people with type 2 diabetes who started/switched to therapy with biphasic insulin aspart 30, insulin detemir or insulin aspart (alone/in combination) in routine clinical practice. This sub-analysis evaluated clinical safety and effectiveness of insulin aspart as part of a basal-bolus regimen (±oral glucose-lowering drugs) in three agegroups (B40,[40-65, and[65 years) of insulinexperienced and insulin-naive people with type 2 diabetes. Results: In total, 4,032 patients were included in the sub-analysis. After 24 weeks of insulin aspart treatment, significant improvements versus baseline were observed in all age-groups for: proportion of people with C1 hypoglycemia events (18.3-27.1% and 11.0-12.7%, at baseline and 24 weeks, respectively), C1 major hypoglycemia events (3.3-6.7% and 0-0.2%), and C1 nocturnal hypoglycemia events (9.2-13.7% and 2.9-4.9%); glycated hemoglobin (9.6-9.8% and 7.4%); fasting plasma glucose (change from baseline ranged from -3.6 to -4.4mmol/l); and post-breakfast post-prandial plasma glucose (change from baseline ranged from -5.5 to -5.9mmol/l). Fourteen serious adverse drug reactions were reported. Healthrelated quality of life was significantly improved for all age-groups (all, p\0.001). Conclusion: All age-groups showed improved glycemic control and reduced risk of hypoglycemia when starting/switching to insulin aspart therapy within a basal-bolus regimen; this may be particularly important for elderly patients given their greater risk of hypoglycemia versus younger patients. © The Author(s) 2013. Source

Nik Jaafar N.R.,National University of Malaysia | Selamat Din S.H.,Hospital Tuanku jaAfar | Mohamed Saini S.,National University of Malaysia | Ahmad S.N.A.,Hospital Putrajaya | And 4 more authors.
Comprehensive Psychiatry

Introduction The period of the cancer patients undergoing treatment is also the most stressful time for their family caregivers. This study aimed to determine the rates of major depressive disorder and dysthymia; and their associated factors in the caregivers during this time. Methods One hundred and thirty caregiver-patient dyads attending the oncology centre for breast cancer treatment participated in this cross-sectional study. While the data on the patients' socio-demographic and illness characteristics were obtained from their medical record, the caregivers completed three self-report measures: 1) socio-demography and the caregiving factor questionnaire, 2) Multi-dimensional Perceived Social Support (MSPSS) and 3) Depression, Anxiety and Stress Scale (DASS-21). Subsequently, those with "probable depression" identified from the DASS-21 score were interviewed using The Mini-International Neuropsychiatric Interview (MINI) to obtain the diagnoses of depressive disorders. Results Twenty-three of the 130 caregivers (17.69%) were diagnosed to have depressive disorders, where 12.31% (n = 16) had major depressive disorder and 5.38% (n = 7) had dysthymic disorder. Factors associated with depression include ethnicity, duration of caregiving, the patients' functional status and the caregivers' education level. Logistic regression analysis showed that the patients' functional status (p < 0.05, OR = 0.23, CI = 0.06-0.86) and the caregivers' education level (p < 0.05, CI = 9.30, CI = 1.82-47.57) were significantly associated with depression in the caregivers attending to breast cancer patients on oncology treatment. Conclusions A significant proportion of family caregivers were clinically depressed while caring for their loved ones. Depression in this population is a complex interplay between the patients' factors and the caregivers' factors. © 2014 Elsevier Inc. All rights reserved. Source

Hussein Z.,Hospital Putrajaya | Lim-Abrahan M.A.,University of the Philippines | Jain A.B.,Novo Nordisk AS | Goh S.Y.,Singapore General Hospital | Soewondo P.,University of Indonesia
Diabetes Research and Clinical Practice

Aim: To evaluate the safety and effectiveness of biphasic insulin aspart 30 (BIAsp 30) in ASEAN type 2 diabetes (T2D) patients switched from biphasic human insulin (BHI) in the non-interventional 24-week A1chieve study. Methods: Indonesian, Malaysian, Filipino and Singaporean patients switched from BHI to BIAsp 30 at their physicians' discretion were included. The incidence of serious adverse drug reactions (SADRs), including major hypoglycaemia was the primary endpoint. Changes in hypoglycaemia, glycated haemoglobin A1c (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), lipids, body weight and systolic blood pressure were also evaluated. Quality of life (QoL) was measured using the EQ-5D questionnaire. Results: For the 465 patients included (mean±SD age: 56±10.3 years, diabetes duration: 9.7±7.1 years, baseline HbA1c: 9.4±1.8%), the mean pre-study BHI dose was 0.62±0.28 IU/kg and 63.4% were dosing BHI twice daily (bid). The mean baseline BIAsp 30 dose was 0.65±0.27U/kg, titrated up to 0.71±0.28U/kg over 24 weeks, and most patients continued bid dosing. No SADRs or major hypoglycaemic episodes were reported. The proportion of patients reporting overall hypoglycaemia decreased significantly from 10.8% at baseline to 3.4% at Week 24 (p < 0.0001). Significant improvements in glycaemic control were noted (HbA1c: -1.4±1.7%, FPG: -56.7±72.5 mg/dL, post-breakfast PPPG: -84.8±82.8 mg/dL, p < 0.001). Mean QoL improved by +6.6±14.6 points (p < 0.001). Conclusion: BIAsp 30 was well-tolerated and significantly increased glycaemic control in this ASEAN subgroup poorly controlled on BHI. © 2013 Elsevier Ireland Ltd. Source

Home P.D.,Northumbria University | Latif Z.A.,BIRDEM Hospital | Gonzalez-Galvez G.,Instituto Jalisciense Of Investigacion En Diabetes Y Obesidad | Prusty V.,Novo Nordisk AS | Hussein Z.,Hospital Putrajaya
Diabetes Research and Clinical Practice

Aims: The aim of this A1chieve sub-group analysis was to examine populations beginning insulin aspart together with any basal insulin, all ± oral glucose lowering drugs: insulin aspart added to existing basal insulin (n=519); switched from biphasic insulin (n=947); switched from NPH plus human meal-time insulins (n=586); and insulin-naïve begun with basal plus insulin aspart (n=1594). Methods: A1chieve was a 24-week non-interventional study evaluating insulin analogues in 66,726 people with type 2 diabetes in routine clinical care in 28 non-Western countries. Major endpoints were analysed as change from baseline using Student's paired t-test. Results: Baseline glycaemic control was poor (mean HbA1c: 9.4-10.1% [79-87 mmol/mol]). HbA1c, FPG and PPPG improved significantly from baseline in all groups (mean change from baseline in HbA1c: -2.8 to -1.8% [-31 to -20 mmol/mol]; FPG: -4.9 to -2.9 mmol/L; PPPG: -6.7 to -3.9 mmol/L; p<0.001 for all), resulting in a similar level of blood glucose control for all groups at study end. Unsurprisingly, hypoglycaemia rates increased in those starting insulin, but decreased in the other groups. Clinically significant improvements in serum lipids and quality of life occurred across all groups. Conclusions: These data support the use of basal plus prandial insulin regimens in routine clinical practice in people with type 2 diabetes with inadequate glycaemic control. © 2013 The Authors. Source

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