Amutha Ramadas

Web-based interventions for the management of type 2 diabetes mellitus: A systematic review of recent evidence

INTRODUCTION The Internet has emerged as a potentially effective medium for information exchange. The Internets potential has been recognised and web-based education programmes have been steadily adopted in recent years in preventing and managing chronic diseases such as diabetes mellitus. This review provides a descriptive discussion of web-based behavioural interventions for the management of type 2 diabetes mellitus. METHOD Systematic literature searches were performed using MEDLINE, EMBASE, PUBMED, PsycINFO, Web of Science and Cochrane Library to retrieve articles published between 2000 and June 2010 which fulfilled all inclusion criteria. Methodological quality assessment and data synthesis were then performed. RESULTS Twenty articles representing 13 different studies were reviewed. None of the studies were ranked as low in the methodological quality. Goal-setting, personalised coaching, interactive feedback and online peer support groups were some of the successful approaches which were applied in e-interventions to manage type 2 diabetes mellitus. Strong theoretical background, use of other technologies and longer duration of intervention were proven to be successful strategies as well. CONCLUSION The web-based interventions have demonstrated some level of favourable outcomes, provided they are further enhanced with proper e-research strategies.

Risk factors and clinical outcome of profound thrombocytopenia in adult patients with DENV infections

Abstract Severe thrombocytopenia is common in dengue virus (DENV) infections. However, studies focusing on the role of profound thrombocytopenia (PT) (nadir platelet counts ≤ 20 000/mm3) in DENV infections are scarce. This study aims to identify the associated features and outcome of DENV patients with PT. It involves 237 adult hospitalized patients who were DENV PCR positive. The presence of comorbidity (AOR = 4.625; 95% CI = 1.113–19.230), higher admission hematocrit (AOR = 1.213; 95% CI = 1.067–1.379), lower admission albumin (AOR = 0.870; 95% CI = 0.766–0.988) and lower admission platelets (AOR = 0.980; 95% CI = 0.969–0.991) was associated with platelets ≤ 20 000/mm3 in multivariate logistic regression. PT was not affected by DENV serotypes, coinfections and secondary DENV infections. Patients with PT had significantly higher risk of experiencing warning signs (AOR = 3.709, 95% CI = 1.089–12.634) and longer hospital stay (AOR = 1.943, 95% CI = 1.010–3.774). However, severe dengue disease, hemorrhagic manifestations and need for intensive care were not significantly associated with PT.

A pilot study: the development of a culturally tailored Malaysian Diabetes Education Module (MY-DEMO) based on the Health Belief Model

BackgroundDiabetes education and self-care remains the cornerstone of diabetes management. There are many structured diabetes modules available in the United Kingdom, Europe and United States of America. Contrastingly, few structured and validated diabetes modules are available in Malaysia. This pilot study aims to develop and validate diabetes education material suitable and tailored for a multicultural society like Malaysia.MethodsThe theoretical framework of this module was founded from the Health Belief Model (HBM). The participants were assessed using 6-item pre- and post-test questionnaires that measured some of the known HBM constructs namely cues to action, perceived severity and perceived benefit. Data was analysed using PASW Statistics 18.0.ResultsThe pre- and post-test questionnaires were administered to 88 participants (31 males). In general, there was a significant increase in the total score in post-test (97.34 ± 6.13%) compared to pre-test (92.80 ± 12.83%) (p < 0.05) and a significant increase in excellent score (>85%) at post-test (84.1%) compared to pre-test (70.5%) (p < 0.05). There was an improvement in post-test score in 4 of 6 items tested. The remaining 2 items which measured the perceived severity and cues to action had poorer post-test score.ConclusionsThe preliminary results from this pilot study suggest contextualised content material embedded within MY DEMO maybe suitable for integration with the existing diabetes education programmes. This was the first known validated diabetes education programme available in the Malay language.

The association between obesity and dengue virus (DENV) infection in hospitalised patients

Both obesity and DENV infections are growing public health concerns that have far-ranging socioeconomic effects, especially in developing countries. Despite the increasing prevalence of these conditions, there is a scarcity of data investigating the potential relationships between these two entities. Our study aims to examine the influence of obesity on various clinical and laboratory parameters amongst patients with DENV infections. A total of 335 hospitalized patients aged >12 years who were DENV non-structural protein 1 (NS1) antigen-positive were enrolled in this study. Clinical and laboratory variables were compared between patients with and without obesity. Multivariate analysis showed that the following admission clinical findings and laboratory results were independently associated with obesity; chills and rigors (AOR:2.653, 95% CI: 1.286–5.474), higher temperature (AOR:1.485, 95% CI: 1.080–2.042), higher systolic BP (AOR:1.057, 95% CI:1.037–1.078), raised haematocrit (AOR: 1.953, 95% CI: 1.010–3.778), elevated creatinine (AOR:3.504, 95% CI:1.351–9.008) and elevated ALT (AOR: 4.146, 95% CI:1.878–9.154). Obesity was found to be significantly associated with hospitalization >3 days (AOR: 1.990, 95% CI: 1.134–3.494) and the presence of increasing haematocrit with decreasing platelets (AOR: 2.134, 95% CI = 1.235–3.688). Serial assessment of laboratory data revealed that peak haematocrit was significantly higher and nadir platelets levels were significantly lower in obese patients. Both peak and admission levels of leukocyte counts, AST, ALT and creatinine were significantly higher in the obese group. Conversely, both admission and nadir albumin levels were lower for the obese group, although only nadir albumin levels achieved statistical significance. These findings support closer clinical monitoring of obese patients who present with DENV infections, as this patient cohort may possess an increased tendency towards developing more severe clinical manifestations of DENV infections as compared to non-obese patients.

High cut-off hemofiltration versus standard hemofiltration: a pilot assessment of effects on indices of apoptosis.

Objectives: To measure plasma pro-apoptotic and pro-necrotic activity in severe acute kidney injury (AKI) patients within a randomized controlled trial of continuous veno-venous hemofiltration with high cut-off filters (CVVH-HCO) versus standard filters (CVVH-Std). Methods: We measured pro-apoptotic and pro-necrotic plasma activity by trypan blue exclusion cell viability assay, detection of DNA fragmentation, and by determination of caspase-3 activity and annexin V-based apoptosis and necrosis detection assay. Results: Compared to no apoptosis or necrosis after incubation with healthy plasma, 14-18% of cells showed apoptosis and 4-8% showed necrosis after incubation with plasma from AKI patients. When comparing different measures of pro-apoptotic or pro-necrotic activity, CVVH-HCO and CVVH-Std showed no differential effects on such activity, which remained high over the first 3 days of treatment. However, using annexin V-FITC, there was a significant drop in pro-apoptotic activity across the filter for the CVVH-HCO group (p = 0.043) but not for the CVVH-Std group (p = 0.327) and a significant difference between the two groups (CVVH-HCO vs. CVVH-Std p = 0.006). Conclusions: Patients with severe AKI have increased pro-apoptotic and pro-necrotic activity. Although on single-pass effect assessment, CVVH-HCO was superior to CVVH-Std in decreasing annexin V-FITC-assessed pro-apoptotic activity, there was no overall attenuation of such activity during the first 3 days of treatment.

Treatments with Low Glycaemic Index Diets in Gestational Diabetes

Diet therapy, the cornerstone of gestational diabetes mellitus (GDM) management aims to promote adequate weight gain and ensure glycaemic control in the pregnant mother. Achievement of these maternal goals improves pregnancy and neonatal outcomes. The advocacy of low-GI foods is based on slower rate of carbohydrate absorption of these foods, which subsequently lowers postprandial glycaemic and insulinaemic responses. Glycaemic load (GL), a concept that merges carbohydrate quality and quantity of foods, accurately predicts postprandial glycaemia for single foods or mixed meals. Low-GI/GL diets have shown to improve management of body weight, glycaemia and cardiovascular risks, especially in hyperinsulinaemic and insulin-resistant populations. A 15% reduction in dietary GI bestows clinically significant health benefits, and this magnitude of GI reduction is made possible by substituting usual high-GI staples with lower GI alternatives, while maintaining their prescribed serving size. In this review, we assess the evidence for the treatment of GDM, a condition closely associated with hyperinsulinaemia and insulin resistance, with low-GI/GL diets.

The Usefulness and Challenges of Big Data in Healthcare

Big data in healthcare is important as it can be used in the prediction of outcome of diseases prevention of co-morbidities, mortality and saving the cost of medical treatment. In many countries, big data has becoming an important database where information generated could be used for treatment and management of diseases. In Malaysia, the focus on big data has started and some initiatives have been put in place to share information patient’s medical records and knowledge among general public, private hospitals and clinics. Nevertheless there are many challenges in implementing big data in healthcare especially in relation to privacy, security, standards, governance, integration of data, data accommodation, data classification, incorporation of technology etc. It is imperative that these challenges to be overcome before big data can be implemented successfully in healthcare.

Changes in Health- Related Quality of Life and Psychosocial Well-being of Breast Cancer Survivors: Findings from a Group- Based Intervention Program in Malaysia

Background There is a lack of evidence on the effectiveness of multifaceted group-based interventions to improve psychological well-being and health-related quality of life (HRQOL) of breast cancer (BCa) survivors in Malaysia. This study is aimed at assessing the effectiveness of such intervention program among the BCa survivors. Materials and Methods This was a group-based intervention program with pre- and post-test design, carried out among BCa survivors (n=37) who were members of Breast Cancer Support Group Centre, Johor Bahru. A validated self-administered questionnaire was used to assess the impact of the program on psychosocial well-being and HRQOL of the participants. Results The mean age of BCa survivors was 58.1 years (SD=9.7), with mean age at diagnosis of 49.9 years (SD=9.6). Majority of them were of Chinese ethnicity, married and had secondary level education, but were unemployed. More than 86% of them were diagnosed to have early BCa diagnosis and have since completed the treatment. There were significant decreases in median depression (p=0.001), anxiety (p<0.001) and stress (p<0.001) scores at post-intervention. More than 85% of the participants rated themselves to have a good or very good QOL at post-intervention, as opposed to 75.9% at pre-intervention. Significant improvements in several HR-QOL domain scores were seen, with psychological score improving the most (p<0.001), followed by social relationship (p=0.002) and physical health (p=0.004). Conclusions Group-based multifaceted intervention can be a viable solution to improve psychosocial well-being of BCa survivors.

Potential of Mobile Applications in Prevention and Management of Cardio-Metabolic Diseases

Background: The pervasive use of mobile computing and communication technologies in healthcare and public health is expanding even in low and middle income countries. Among all types of mobile phones, smartphones are a more recent development, with features such as computing capability, capacious memories, large screens and open operating systems. Besides delivering interventions and education programs, smart phone applications (apps) are also being used to monitor progress and act as knowledge database. This review explored the current evidence of smart phone technology in prevention and management of cardio-metabolic diseases. Methods: A systematic search was done using the keywords [‘mobile Applications’ OR ‘telemedicine’ OR ‘smartphone’] and [OR ‘cardiovascular’ OR ‘obes*’OR ‘metabolic syndrome’ OR diabetes OR dyslipid* OR hypertensi*], with limitation to ‘reviews’, English publications and the last 5 years. Databases searched include OVID MEDLINE, PUBMED, COCHRANE, CINAHL, SCOPUS and PROQUEST. The shortlisted reviews including meta-analysis, narrative and systematic reviews were qualitatively evaluated and findings were compared. Results: Twenty-six articles (n=26) comprised of apps inventory, narrative and systematic reviews were included in the following areas: nutrition (n=3), physical activity (n=4), tobacco smoking (n=1) and cardiovascular (n=1), type 2 diabetes (n=8) and obesity/weight loss (n=9). Conclusion: Although there is limited evidence, we can now see a shift towards development and investigation of existing and new apps in prevention and management of cardio-metabolic diseases. Future studies could explore the feasibility and long-term effectiveness of theorysupported apps that were developed with newest evidence.

Clinicopathological review of 565 cases of lymph node biopsies

Aim: To study the spectrum of diseases in lymphadenopathy and identify features that help predict malignant lymphadenopathy. Methods: A 3-year retrospective study was conducted to analyse the spectrum of diagnoses with respect to age, gender, site and size of the lymph nodes. Results and Discussion: There were 565 patients with isolated excised lymph nodes for histopathological examination. Their age ranged from 1.0 to 80.0 years old. The most frequent diagnoses were reactive lymphoid hyperplasia (33.3%), granulomatous inflammation (26.2%), lymphomas (23.5%), metastatic carcinomas (14.0%) and lymphadenitis of other causes. When a node was malignant, it was twice as likely to be a lymphoma as a metastatic carcinoma. A significantly higher proportion of cases were benign in patients who were younger than 40 years old and conversely a significantly higher proportion of cases were malignant in the older age group (p < 0001, OR = 6.209). The best discriminating size of nodes between benign from malignant conditions was 32 mm. Similarly, the size best to differentiate between diagnoses of known and unknown aetiology was 32 mm. However, the site of the node was not correlated to the pathology. Conclusion: The most frequent lymphadenopathy was reactive lymphoid hyperplasia. Age and size of the node were useful for predicting malignant lymphadenopathy.