Diabetic ketoacidosis at diagnosis of type 1 diabetes mellitus in Malaysian children and adolescents

Background: Diabetic ketoacidosis (DKA) is a late presentation of newly diagnosed type 1 diabetes mellitus (DM) in children. The aim of this study was to determine the clinical characteristics of type 1 DM at presentation so that appropriate actions can be taken to promote early diagnosis. Methods: This was a retrospective cohort review from a patient registry database. Data on all patients younger than 20 years old diagnosed with type 1 DM who had been registered with the Malaysian Diabetes in Children and Adolescents Registry (DiCARE) from its inception in 2006 until 2009 were analysed. Results: The study included 490 children and adolescents, out of which 57.1% were female. The mean (SD) age at diagnosis was 7.5 (3.7) years, which increased from year 2000 to 2009 [6.6 (3.3) years to 9.6 (3.5) years; p = 0.001]. An increasing percentage of DKA at diagnosis was observed from year 2000 (54.5%) to year 2009 (66.7%), which remained high and leveled between 54.5% and 75.0%. DKA was more common in patients with normal weight (p = 0.002) with no significant association with age, gender, ethnicity and status of family history of diabetes mellitus. Conclusion: An increasing trend of age at diagnosis of patients with type 1 DM was observed. Besides that, proportion of DKA at diagnosis had remained high over the past decade. This study found that normal weight was associated with status of DKA, thus more detailed investigations are required to determine the risk factors for DKA.

New Politics, an Opportunity for Maternal Health Advancement in Eastern Myanmar: An Integrative Review.

Myanmar (formerly Burma) is a southeast Asian country, with a long history of military dictatorship, human rights violations, and poor health indicators. The health situation is particularly dire among pregnant women in the ethnic minorities of the eastern provinces (Kachin, Shan, Mon, Karen and Karenni regions). This integrative review investigates the current status of maternal mortality in eastern Myanmar in the context of armed conflict between various separatist groups and the military regime. The review examines the underlying factors contributing to high maternal mortality in eastern Myanmar and assesses gaps in the existing research, suggesting areas for further research and policy response. Uncovered were a number of underlying factors uniquely contributing to maternal mortality in eastern Myanmar. These could be grouped into the following analytical themes: ongoing conflict, health system deficits, and political and socioeconomic influences. Abortion was interestingly not identified as an important contributor to maternal mortality. Recent political liberalization may provide space to act upon identified roles and opportunities for the Myanmar Government, the international community, and non-governmental organizations (NGOs) in a manner that positively impacts on maternal healthcare in the eastern regions of Myanmar. This review makes a number of recommendations to this effect.

Reliability and validity of the Malay translated version of diabetes quality of life for youth questionnaire

Many studies reported poorer quality of life (QoL) in youth with diabetes compared to healthy peers. One of the tools used is the Diabetes Quality of Life for Youth(DQoLY) questionnaire in English. A validated instrument in Malay is needed to assess the perception of QoL among youth with diabetes in Malaysia. To translate the modified version, i.e., the DQoLY questionnaire,into Malay and determine its reliability and validity. Translation and back-translation were used. An expert panel reviewed the translated version for conceptual and content equivalence. The final version was then administered toyouths with type 1 diabetes mellitus from the universities and Ministry of Health hospitals between August 2006 and September 2007. Reliability was analysed using Cronbach’s alpha, while validity was confirmed using concurrent validity (HbA1c and self-rated health score). A total of 82 youths with type 1 diabetes (38 males) aged 10-18 years were enrolled from eight hospitals. The reliability of overall questionnaire was 0.917, and the reliabilities of the three domains ranged from 0.832 to 0.867. HbA1c was positively correlated with worry (p=0.03). The self-rated health score was found to have significant negative correlation with the “satisfaction” (p=0.013) and “impact” (p=0.007) domains. The Malay translated version of DQoLY questionnaire was reliable and valid to be used among youths with type 2 diabetes in Malaysia.

Reliability and Validity of the Revised Summary of Diabetes Self-Care Activities (SDSCA) for Malaysian Children and Adolescents

Background: Self-care plays an important role in diabetes management. One of the instruments used to evaluate self-care in patients with diabetes is the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. A validated instrument in the Malay language is used to assess self-care practice among children and adolescents with diabetes in Malaysia. Objective: To translate and evaluate the psychometric properties of the revised version of the SDSCA questionnaire in the Malay language. Methods: Forward and backward translations were performed. An expert panel reviewed all versions for conceptual and content equivalence. The final version was administered to paediatric patients with diabetes between August 2006 and September 2007. Reliability was analysed using Cronbach’s alpha and validity was assessed using exploratory factor analysis. Results: A total of 117 patients aged 10–18 years were enrolled from nine hospitals. The reliability of overall core items was 0.735 (with item 4) while the reliabilities of the four domains were in the range of 0.539–0.838. As core item number 4 was found to be problematic and it was subtituted by item 5a (from the expanded SDSCA) to suit local dietary education and practice; and the reliabilities of the overall core item (0.782) and the four domains (0.620 – 0.838) improved. Factor loadings of all the items were greater than 0.4, loaded into the original domains, and accounted for 73% of the total variance. Conclusion: The Malay translation of the revised English SDSCA is reliable and valid as a guide for Malaysian children and adolescents suffering from diabetes.

Erythroderma - A retrospective study with special emphasis on good prognosis

Background Erythroderma is a serious condition in itself, quite apart from hazards associated with the underlying disease, and is sometimes fatal. Prognostic studies are rare in the literature and to date there are no published studies to identify the factors that can determine good prognosis. Objectives The aim of the study is to determine the factors that can prognosticate the good outcome of erythroderma. Methodology Cross sectional study from patients diagnosed to have erythroderma between 2003 and 2007 were analyzed with regard to age, sex, race, underlying medical illness, aetiology, duration of rash before diagnosis of erythroderma, response to topical therapy and prognosis. Results Four variables (aetiology, gender, duration of rash before being diagnosed as erythroderma and response to topical therapy) were associated with good prognosis. These variables were statistically significant from univariate analysis. When these variables were included into the binary logistic model, the study did not have enough evidence to proof that ‘aetiology’ and ‘gender’ can determine good prognosis. Response to topical therapy and shorter duration of rash (equal and less than 120 days) were significant with odds ratio (CI) of 4.11 (1.556, 10.885) and 4.608 (1.903, 11.155) respectively. Conclusion Shorter duration of rash and response to topical therapy are important factors to determine a good prognosis.