Augmentation index is a better marker for cardiovascular risk in young Malaysian males. A comparison of involvement of pulse wave velocity, augmentation index, and C-reactive protein

To determine the association between carotid femoral pulse wave velocity PWV[CF] and augmentation index [AI] with future cardiovascular disease [CVD] risk, and to assess whether high sensitivity C-reactive protein [hs-CRP] is an important mediator towards these vascular changes, among young men. This cross-sectional study was conducted at Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia from July 2011 to December 2012. Two hundred and eleven young men were recruited. The PWV[CF] and AI were measured using Vicorder. High sensitivity C-reactive protein was measured by using immunological methods. The future CVD risk was assessed by Framingham risk score [FRS] and age adjusted FRS [A-FRS]. Data for analysis was conducted using the Statistical Package for Social Sciences Version 15 [SPSS Inc., Chicago, IL, USA]. The mean age of the subjects was 27.09 [95% confidence intervals [CI] 26.39-27.79] years old. Those with >/-2 risk factors had significantly higher AI [10.09 [95% CI: 9.06-11.12] versus 6.56 [95% CI: 5.54-7.57] [p=0.001], but not PWV[CF] 7.45 [95% CI: 7.29-7.61] m/s versus 7.29 [95% CI: 7.06-7.51] m/s, [p=0.90] when compared to the healthy subjects. High sensitivity C-reactive protein was not an independent determinant for PWVCF and AI. Only AI was significantly associated with FRS and A-FRS [p=0.0001]. To assess the impact of risk factors on vascular damage and for future assessment of CVD risk among the young men, AI may be a better marker than PWVCF. The increase in AI among these subjects was not related to hs-CRP

High C reactive protein associated with increased pulse wave velocity among urban men with metabolic syndrome in Malaysia

To determine the association between carotid femoral pulse wave velocity [PWV[CF]]; augmentation index [AI]; and high-sensitivity C reactive protein [hs-CRP] with metabolic syndrome [MetS], and to determine the influence of ethnicity on PWV[CF] and AI, and the association between high hs-CRP and increased PWV, and AI in MetS. A cross-sectional study was conducted at Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia from September 2009 to September 2011. Three hundred and eighty men [Chinese and Malays] were recruited from the study. The PWV[CF] and AI were measured by Vicorder [SMT Medical, Wuerzburg, Germany]. The hs-CRP level was also determined. We defined MetS using the International Diabetes Federation [IDF] and harmonized criteria. Malays had higher AI compared to the Malaysian Chinese. Patients with MetS had higher PWV[CF] [IDF criteria: 8.5 [8.3-8.7] versus 8.2 [8.0-8.4] m/s, p=0.03; harmonized criteria: 8.5 [8.4-8.7] versus 8.2 [8.0-8.4] m/s, p=0.007] and hs-CRP [IDF criteria: 0.9 +/- 2.0 versus 0.4 +/- 1.1 mg/L, p=0.0007; harmonized criteria: 0.8 +/- 1.9 versus 0.4 +/- 1.1 mg/L, p=0.002] compared to non-MetS. In subjects with MetS, those with high hs-CRP [>3mg/L] had higher PWV[CF]. Augmentation index values were significantly higher in Malays compared with Malaysian Chinese. Metabolic syndrome was associated with increased PWV[CF] and hs-CRP. Patients with MetS and high hs-CRP were associated with higher PWV[CF]. The measurement of hs-CRP reflects the degree of subclinical vascular damage in MetS

Intestinal microsporidiosis: A new entity in Malaysia?

Intestinal microsporidia is an emerging human disease caused by microsporidia. A study was conducted to determine the prevalence of microsporidia in patients with gastro-intestinal symptoms and to examine the clinical manifestations associated with intestinal microsporidiosis. A descriptive cross-sectional study using a well-structured questionnaire; a review of medical records was also undertaken. Positive stool samples were defined as presence of one or more pinkish-violet ovoid structures with a belt-like stripe under high power field (100x) using modified gram-chromotrope stain (MGC). A total of 353 faecal specimens of patients was examined and 100 patients were found to have positive stool samples for microsporidia. The overall prevalence of microsporidia was 28.3%. Acute and chronic diarrhoea were seen in 49.0% and 36.0% patients, respectively. The commonest clinical presentations were diarrhoea (85.0%) with 83.0% of patients having loose or watery stools, vomiting (75.0%), foul-smelling stools (60.0%), nausea (59.0%) and cramping abdominal pain (39.0%). The least common symptoms were fever (15.0%), mucous in stool (5.0%) and blood in stool (4.0%). This study concludes that the prevalence of microsporidia is still high (28.3%) and the majority of patients (93.0%) are symptomatic; the most common gastro-intestinal symptom is diarrhoea with loose or watery stools. Hence, it is recommended that a stool screening for microsporidia be done in selected patients presented with gastrointestinal symptoms.