Effectiveness and Safety of Shorter-Term Regimen (STR) for Multidrug-Resistant Tuberculosis (MDR-TB) Treatment: A Systematic Review of Cohort Studies

The multidrug-resistant tuberculosis (MDR-TB) remains a significant public health burden in term of the successful TB treatment because of the lack awareness of TB drugs administration. Patients infected with MDR-TB are resistant to isoniazid (INH) and rifampicin (RMP) due to genotypic mutation, thus could not adequately treated by the first-line regimen standards. The management of MDR-TB using Short-Term Regimen (STR) is a crucial topic to be discussed due to low success rate of conventional therapy and its long duration. This systematic review aims to further examine the effectiveness and safety of STR to manage MDR-TB. In this systematic review, various cohort studies were searched using standardized Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The keywords were arranged based on Problem, Intervention, Comparison, and Outcome (PICO). Key terms consisted of multidrug-resistant tuberculosis and short regimen therapy. Seven cohort studies were selected from 314 studies. STR has better therapeutic efficacy and shorter duration than the 2011 WHO regimen for MDR-TB with therapy success rates for each study above 50%. The most effective regimen according to studies in this review is kanamycin-high dose isoniazid-clofazimine-ethambutol-prothionamide- pyrazinamidegatifloxacin (KM-INH-CFZ-EMB-PTH-PZA-GFX) in the intensive phase for 4 months and clofazimine-ethambutol-pyrazinamide-gatifloxacin-prothionamide (CFZ-EMBPZA-GFX-PTH) in the continuation phase for 8 months. The four most reported side effects were gastrointestinal problems, ototoxicity, dysglycemia, and liver problems. In conclusion, STR provides good effectiveness in MDR-TB treatment, in terms of treatment success rate and short therapy duration. Therapy with STR is relatively safe, with minimal side effects that can be tolerated in the majority of individuals.

DNA Methylation Profiling of MYC, SMAD2/3 and DNMT3A in Colorectal Cancer

Epigenetic modifications particularly DNA methylation is a common place and remarkable factor in carcinogenesis transformation. Conspicuously, previous findings have presented a cluster of irregular promoter methylation alterationsrelated with silencing of TSG (tumor suppressor genes), little is accepted regarding their sequential DNA methylation (Hypo and Hyper) modifications during the cancer progression. In this way, fluctuations of DNA methylation of many certain genes especially MYC, SMAD2/3 and DNMT3A have an impressive central key role in many different cancers like colorectal (CRC)one. CRC is distinguished by DNA methylation, which is related with tumorigenesis and also genomic instability. Importantly, molecular heterogeneity between multiple adenomas in different patients with CRC may show diverse developmental phenotypes for these kinds of tumors. Conclusively, studying of factors which are involved in CRC carcinogenesis, especially the alterations in epigenetic elements, such as DNA methylation besides the RNA remodeling, histone modification, histone acetylation and histone phosphorylation can be influential in order to find new therapeutic and diagnostic biomarkers in this type of malignancy. In this account, we tried to discuss and address the potential significant methylated modifications of these genes and their importance during the development of CRC carcinogenesis.

Diet Adherence among Adults with Type 2 Diabetes Mellitus: A Concept Analysis

Aim: To analyze the concept of diet adherence in type 2 diabetes mellitus (T2DM). Background: Different healthcare providers widely use the concept of adherence. In the 1970s, the term compliance was commonly used as the patients' views on treatment decisions were neglected. With consideration of patients' perspectives in treatment choices and treatment management, the concept of "compliance" has been increasingly replaced by "adherence." Adhering to a healthy diet is very challenging among patients with T2DM, and empirical studies show a low adherence rate to a healthy diet. Methods: The Walker and Avant (2011) method of concept analysis was implemented. Scientific databases were probed for research articles in the English language published between 2010-2020 using the search terms: compliance, adherence, treatment adherence, diet adherence, T2DM, and concept analysis. Results: Diet adherence as a concept includes, following diet recommendations, self-monitoring, maintenance, and relapse prevention. Antecedents include motivation, understanding of diet recommendations, health beliefs, self-efficacy, goal setting, and social support. Consequences include overall health promotion, health-related quality of life, and improved disease-specific parameters such as lower body mass index, HbA1c, a better level of triglycerides, LDL-cholesterol, non-HDL-cholesterol, and lower diastolic blood pressure. Diet adherence is frequently measured using the Perceived Dietary Adherence Questionnaire, Patient Diet Adherence in Diabetes Scale, the Compliance Praxis Survey-Diet, multiday food diaries, 24-hour recalls, and food frequency questionnaires. Conclusion: Adherence to a healthy diet for patients with T2DM is a primary determinant of management, but diet adherence is frequently inadequate. Poor diet adherence attenuates optimum expected outcomes; hence more research is needed to promote diet adherence.

Development and Validation of a Risk Score for Diabetes Screening in Oman

Objective: To develop and validate a diabetic risk score model, as a non-invasive and selfadministered screening tool, to be used in the general Omani population. Methods: The World Health Survey (WHS) 2008 data from Oman (n=2,720) was used to develop the risk score model. Multivariable logistic regression with backward stepwise method was implemented to obtain risk factors regression coefficients for gender, age, educational attainment, marital status, place of residence, hypertension, body mass index, waist circumference, tobacco use, daily fruits and vegetables intake and weekly physical activity. The model coefficients were multiplied by a factor of five to allocate each variable category a risk score. The total score was calculated as the sum of these individual scores. The score was validated using another Omani cohort (Sur Survey 2006 dataset, n=1,355) Page 2 of 24 by calculating the area under the receiver-operating characteristic (ROC) curve (AUC) and optimal score sensitivity and specificity were determined. Results: A robust diabetes risk score model was produced, which composed of eight variables (age, gender, education level, marital status, place of residence, hypertension, smoking status and body mass index) with an optimal cutoff point of ≥15 to classify persons with possible prevalent T2DM. At this cutoff point, the model had a sensitivity of 71.1%, specificity of 74.4% and AUC of 0.80 (95% CI) 0.7–0.82, when internally validated (in the WHS 2008 cohort). When the model was externally validated (using the Sur 2006 cohort), the optimal cutoff point for the score was ≥13, with a lower sensitivity (54%), higher specificity (79%) and an AUC of 0.74 (95% CI 0.70–0.78). In contrast, test of the old Omani, Kuwaiti, Saudi and Finnish diabetes risk scores, in both of our study populations, showed poor performance of these models among Omanis with poor sensitivity (29% to 63.5%) and reasonable specificity (70% to 80%). Conclusion: The developed diabetes risk score for screening prevalent T2DM, provides an easy-to-use self-administered tool to identify most individuals at risk of this condition in Oman. The score incorporates eight diabetes-associated risk factors that can also act as a tool to increase people’s awareness about the importance of diabetes-related risk factors and provide information for policy makers to establish a diabetes prevention programs.

Seroepidemiological Studies on Japanese Encephalitis: A Systematic Review

Background Japanese encephalitis (JE) is one of the major mosquito-borne infectious diseases in the Western Pacific region, accounting for 20-30% of mortality cases. The JE virus (JEV) seroprevalence fluctuations indicate that continuous research is important for prevention and control activities. By mapping JEV seroprevalence by age stratification, the population profile for immunity and susceptibility can be identified to aid in vaccination programme planning. Thus, the aim of this study is to determine the trend of age-specific JEV seroprevalence. Method Systematic search was conducted on all studies conducted on JEV seroprevalence between the years 2010 until 2019. The two search engines used were PubMed and Web of Science. Eligible criteria were set and articles were screened according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Three investigators cross-checked all articles assigned. Data were extracted into Excel sheet and results were tabulated in tables and graphs accordingly. Result Four studies from four countries (Taiwan, Sri Lanka, South Korea, India) met the eligibility criteria. The papers show an increasing trend of JEV seropositivity in all countries as their populations reach older age cohorts. Nonetheless, there were slight downtrend notches seen among young adults in Taiwan and India before increasing again after reaching more mature ages. South Korea has the highest seroprevalence rate (97.8% to 98.3%) among the compared countries; this is most likely because it was the earliest to introduce the JEV vaccine in 1967 which was later made mandatory in early 1980s, while India has the lowest seroprevalence rate (12.9% to 18.1%). Among the old-vaccination-naïve population, seropositivity is commonly derived from natural infection. Conclusion Decreases in reported JE cases are mainly due to immunisation. As JEV is expected to remain in nature and the zoonotic chains, the risk of infection will persist. Hence, it is important to apply JEV vaccination protocols in national immunisation programmes with priority given to those at the young childhood stages.

A Questionnaire-based Survey on Depression and Anxiety among Rheumatology Patients during the COVID-19 Pandemic: Patient’s Perspective

Objectives: The Coronavirus Disease 2019 (COVID-19) outbreak is a global pandemic and has caught the attention of the rheumatology fraternity, where patients are thought to be at higher risk of infection. We aimed to study the incidence of COVID-19 infection and depression and anxiety symptoms among patients with rheumatic disease (RD) in Hospital Selayang, Malaysia, during the COVID-19 pandemic. Methods: A crosssectional study was conducted via phone interview using a structured questionnaire in patients with RD aged > 18 years old scheduled for clinic appointments from 4 to 28 May 2020, which coincided with the second wave of COVID-19 cases in Malaysia. The questionnaire included demographics, COVID-19 screening questions, depression and anxiety symptoms screening using questions derived from the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2). Results: Among the 361 patients enrolled, the majority were females (83.1%), and over half (54.3%) were ethnic Malays, 41.6% had rheumatoid arthritis, 34.6% had systemic lupus erythematosus, 12.2% had spondyloarthropathy, and only one (0.3%) patient had COVID-19 infection. The mean age of patients was 48.2 years (range: 16–80 years). The frequency of patients with depression and anxiety symptoms was 8.6% and 6.9%, respectively. Married patients reported feeling more anxious (p = 0.013), while patients with tertiary education levels reported feeling more depressed (p = 0.012). Conclusions: The incidence of COVID-19 infection is low, probably due to the low rate of testing. Depression and anxiety symptoms reported by patients in our cohort were modest. Our findings suggest that the COVID-19 pandemic has a greater impact on married patients with RD and those with a higher education level.