Purpose This systematic review aimed to determine the rate and identify correlates of adherence and persistence over five years of treatment with adjuvant endocrine therapy in female breast cancer patients. Methods Relevant articles were identified from Medline, Embase, AMED, PsycINFO, International Pharmaceutical Abstracts, and APA PsycArticles. Studies that measured patient adherence in the implementation or persistence phase for a period of at least five years using objective or multiple measures of adherence and investigated correlates of adherence were included. The titles, abstracts and full articles were screened and reviewed by two authors and any discrepancies were discussed with a third author. Results Twenty-six studies were included. Mean rate of adherence at five-year for implementation phase was 66.2% (SD = 17.3%), and mean persistence was 66.8% (SD = 14.5%). On average, adherence decreased by 25.5% (SD = 9.3%) from the first to fifth year. Higher rate of adherence was observed through self-report in comparison to database or medical record. Older age, younger age, higher comorbidity index, depression and adverse effects were associated with lower adherence. Treatment with aromatase inhibitors, received chemotherapy, and prior medication use were associated with improved adherence. Conclusion Adherence to adjuvant endocrine therapy decreased from the first to fifth year of treatment. On average, one-third of patients were not adherent to treatment by the fifth year. Nineteen recurring factors were found to be significantly associated with long-term adherence in multiple studies. Further research using objective or multiple measures of adherence are needed to improve validity of results.

Background The objective of this study was to compare the performance of cystatin C- and creatinine-based estimated glomerular filtration rate (eGFR) equations in predicting the clearance of vancomycin. Methods MEDLINE and Embase databases were searched from inception up to September 2019 to identify all studies that compared the predictive performance of cystatin C- and/or creatinine-based eGFR in predicting the clearance of vancomycin. The prediction errors (PEs) (the value of eGFR equations minus vancomycin clearance) were quantified for each equation and were pooled using a random-effects model. The root mean squared errors were also quantified to provide a metric for imprecision. Results This meta-analysis included evaluations of seven different cystatin C- and creatinine-based eGFR equations in total from 26 studies and 1,234 patients. The mean PE (MPE) for cystatin C-based eGFR was 4.378 mL min −1 (95% confidence interval [CI], −29.425, 38.181), while the creatinine-based eGFR provided an MPE of 27.617 mL min −1 (95% CI, 8.675, 46.560) in predicting clearance of vancomycin. This indicates the presence of unbiased results in vancomycin clearance prediction by the cystatin C-based eGFR equations. Meanwhile, creatinine-based eGFR equations demonstrated a statistically significant positive bias in vancomycin clearance prediction. Conclusion Cystatin C-based eGFR equations are better than creatinine-based eGFR equations in predicting the clearance of vancomycin. This suggests that utilising cystatin C-based eGFR equations could result in better accuracy and precision to predict vancomycin pharmacokinetic parameters.

PurposeTo estimate the vitamin D status of participants residing in Malaysia.MethodsPubMed, Scopus, Web of Science, and MyJurnal were searched up to June 2022 without language restrictions. Studies that reported the 25-hydroxyvitamin D [25(OH)D] concentrations and defined their cut-off for deficiency or insufficiency from healthy participants residing in Malaysia were included. The random effects model was used to pool vitamin D status using established cut-offs of <30, <50, and <75 nmol/L according to age group.ResultsFrom 299 studies screened, 32 studies were included in the meta-analysis. The pooled proportion for <30 nmol/L was 21% (95% CI 9–36, n = 2,438 from 10 studies), while the pooled proportion <50 nmol/L was 64% (95% CI 56–72, n = 13,977 from 30 studies), and <75 nmol/L was 85% (95% CI 61–100, n = 1,376 from five studies). Heterogeneity was high (I2 ranged from 98–99%). Higher proportions of vitamin D insufficiency (defined as <50 nmol/L) were found in participants living in the urban areas (compared to rural areas), in females (compared to males), and in Malays and Malaysian Indians (compared to Malaysian Chinese) ethnicities.ConclusionMore than half of Malaysians have insufficient vitamin D levels, despite being a country that is close to the equator. We strongly urge prompt public health measures to improve the vitamin D status in Malaysia.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021260259].

Introduction The prevalence of non-adherence to antidiabetic treatment remains high despite various efforts. Thus, the positive effects of the antidiabetic treatment cannot be optimised and the disease progresses to complications. This present systematic review and meta-analysis aimed to evaluate the effects of mobile applications (apps) intervention on medication adherence and type 2 diabetes mellitus (T2DM) control. Methods This research was conducted following the PRISMA guidelines. The databases that had been searched included Web of Science, PubMed, Scopus, Cochrane Library and Ovid from 2017 to 2022. Study characteristics were retrieved and study outcomes such as adherence status and diabetes control were extracted and quantitatively analysed through meta-analysis. Results Eight studies met the final inclusion criteria and were included in the analysis, contributing to a total of 884 subjects. The methodological quality of the included studies was variable. Three studies reported statistically significant improvement in medication adherence through mobile apps intervention. Additionally, the mobile apps intervention proved effective in reducing glycaemic outcomes. As compared to non-mobile apps users, glycated haemoglobin (HbA1c) significantly decreased by 0.36% (95% CI −0.47% to −0.25%), whereas fasting plasma glucose (FPG) significantly decreased by 16.75 mg/dL (95% CI −17.60 mg/dL to −15.80 mg/dL). Conclusion Mobile apps intervention had beneficial impacts on medication adherence and glycaemic parameters. Future research should explore the best practical approach for real-world settings.

Vitamin D plays an important role in the immune system and many non-communicable diseases. The prevalence of vitamin D deficiency for the overall population of Malaysia is unknown. This study systematically reviewed and pooled studies that report vitamin D status from participants residing in Malaysia. PubMed, Scopus, Web of Science and MyJurnal were searched up to June 2021 without language restrictions. We include studies that reported the 25-hydroxyvitamin D (25(OH)D) concentrations and defined their cut-off for deficiency or insufficiency from healthy participants residing in Malaysia. Random effects model was used to pool vitamin D status using established cut-offs of < 30nmol/L, < 50nmol/L, and < 75nmol/L according to age group. We identified 203 studies, of which we included 31 studies in the meta-analysis. The pooled proportion for < 30nmol/L was 21% (95% CI 9–36, n = 2,438 from 10 studies), while the pooled proportion < 50nmol/L was 64% (95% CI 55–72, n = 13,927 from 29 studies), and < 75nmol/L was 85% (95% CI 61–100, n = 1,376 from 5 studies). Heterogeneity was high (I² ranged from 98–99%). Higher proportions of vitamin D insufficiency (defined as < 50nmol/L) were found in participants living in the urban areas (compared to rural areas), in females (compared to males), and in Malays and Malaysian Indians (compared to Malaysian Chinese) ethnicities. In conclusion, vitamin D insufficiency is highly prevalent in Malaysia, despite being a country that is close to the equator. We strongly urge prompt public health measures to improve the vitamin D status in Malaysia.

Dabigatran etexilate is an oral direct thrombin inhibitor used in preventing thromboembolism in patients with atrial fibrillation and several other conditions. Routine dabigatran concentration monitoring is not recommended in clinical practice; however, measurement of dabigatran concentration may be required in several conditions. This study aims to pool the peak and trough dabigatran concentration from real‐world studies. A systematic review was performed to identify studies that measured the peak and trough dabigatran concentrations. Observational studies reporting dabigatran peak or trough concentrations and patients' clinical characteristics of either sex, age or weight were included. Random‐effect meta‐analyses and metaregression were conducted to pool dabigatran concentrations and to identify the correlation between factors affecting dabigatran concentrations. Fifteen studies with a total of 1226 patients were included. The pooled peak dabigatran concentration was 133 ng/mL (95% CI: 113–154, I2 = 86%, n = 655), while the pooled dabigatran trough concentration was 80 ng/mL (95% CI: 69–91, I2 = 93%, n = 1010). Metaregression analyses suggested that age is significantly correlated to trough concentration, while body weight and creatinine clearance significantly correlated to peak concentration. Subgroup results revealed that dabigatran concentration when measured with liquid chromatography–tandem mass spectrometry was higher than haemoclot thrombin inhibitor assay. Several guidelines have proposed dabigatran concentrations target range and the pooled dabigatran concentrations were in line with the suggested range. Further studies to correlate dabigatran concentrations and clinical outcomes is warranted to improve the safety and efficacy monitoring of dabigatran therapy.

Background: Cystatin C-based equations have been proposed as an alternative for creatinine-based equations in the estimation of Glomerular Filtration Rate (eGFR). Limited studies were available with regards to the Asian population to evaluate the agreement of eGFR measured based on both biomarkers. This study aimed to evaluate the agreement between various cystatin C-and creatinine-based eGFR equations. Methods: Patients were recruited from the Nephrology Clinic Universiti Kebangsaan Malaysia Medical Centre. Serum cystatin C and creatinine levels were analysed by particle-enhanced immunoturbidimetry assay and kinetic alkaline picrate method, respectively. Various cystatin C-based (Hoek, Larsson, Grubb, Flodin, cystatin C-based Chronic Kidney Disease Epidemiology (CKD-EPI)) and creatinine-based eGFR equations (Cockcroft-Gault, Modification of Diet in Renal Disease, creatinine-based CKD-EPI) were compared by using the Pearson's correlation and Bland-Altman plot. Results: A total of 118 patients included in this study have a mean age of 61±15 years and 57.6% were female. The mean serum cystatin C and creatinine levels were 2.00±1.06 mg/L and 2.21±1.63 mg/dL, respectively. The correlation between serum cystatin C and creatinine level was significant (r=0.78, P<0.01). All cystatin C-based eGFR correlated significantly with the creatinine-based eGFR equations. The strongest correlation was between creatininebased and cystatin C-based CKD-EPI equation (r=0.93, P<0.01). The Bland-Altman plot shows that cystatin C-based CKD-EPI equation had the least mean difference when compared with creatinine-based CKD-EPI equation. Conclusion: Significant correlation and good agreement were demonstrated between various cystatin C-based and creatininebased eGFR equations. The cystatin C-based equations are appropriate alternative for GFR measurement among Malaysian patients with renal impairment.

<b><i>Background/Aims:</i></b> G73A polymorphism in the CST3 gene of cystatin C has been associated with Alzheimer’s disease, age-related macular degeneration, and cardiovascular disease. However, studies investigating the influence of this genetic variability on serum cystatin C and cystatin-based renal function estimate are limited. Therefore, the aim of this study is to investigate the possible association of single-nucleotide polymorphism (rs1064039) of the CST3 gene on the serum cystatin C level and cystatin C-based estimated glomerular filtration rate (eGFR). <b><i>Methods:</i></b> Study subjects include patients with various levels of renal function recruited from the nephrology clinic and wards of a tertiary hospital. The blood samples collected were analyzed for serum cystatin C and creatinine levels by particle-enhanced turbidimetric immunoassay and kinetic alkaline picrate method, respectively. DNA was extracted using a commercially available kit. ­Polymerase chain reaction results were confirmed by direct DNA Sanger sequencing. <b><i>Results:</i></b> The genotype percentage (G/G = 73%, G/A = 24.1%, and A/A = 2.9%) adhere to the Hardy-Weinberg equilibrium. The dominant allele found in our population was CST3 73G allele (85%). The regression lines’ slope of serum cystatin C against creatinine and cystatin C-based eGFR against creatinine-based eGFR, between G and A allele groups, showed a statistically significant difference (z-score = 3.457, <i>p</i> &#x3c; 0.001 and z-score = 2.158, <i>p</i> = 0.015, respectively). Patients with A allele had a lower serum cystatin C level when the values were extrapolated at a fixed serum creatinine value, suggesting the influence of genetic factor. <b><i>Conclusion:</i></b> Presence of CST3 gene G73A polymorphism affects serum cystatin C levels.