INTRODUCTION: Identifying peripheral arterial disease (PAD) during diabetic foot screening (DFS) is crucial in reducing the risk of diabetic foot ulcerations and lower limb amputations. Screening assessments commonly used include absolute systolic toe pressure (ASTP) and toe-brachial index (TBI). There is a lack of research defining the threshold values of both assessment methods. We aimed to compare the accuracy of ASTP and TBI and establish optimal threshold values of ASTP and TBI with reference to the internationally accepted ankle-brachial pressure index (ABPI) screening test, for a multiethnic diabetic population in Singapore. METHODS: A retrospective, observational study of DFS results from January 2017 to December 2017 was conducted. Receiver operating characteristic analysis was conducted for ASTP and TBI using the internationally accepted ABPI cut-off value of ≤0.9 to indicate PAD. RESULTS: A total of 1,454 patients with mean (standard deviation) age of 63.1 (12.4) years old were included. There were 50.8% men and 49.2% women, comprising 69.7% Chinese, 13.5% Indian, 10.1% Malay and 6.7% other ethnicities. Areas under the curve for ASTP and TBI were 0.89 (95% confidence interval [Cl] 0.85-0.94) and 0.94 (95% Cl 0.90-0.98), respectively, and the difference was statistically significant (P<0.001). Derived optimal threshold values to indicate ABPI≤0.9 for ASTP and TBI were <95.5mmHg (specificity 0.86, sensitivity 0.84) and <0.7 (specificity 0.89, sensitivity 0.95), respectively. CONCLUSION ASTP or TBI may be used to detect ABPI-determined PAD in DFS. The optimal threshold values derived from a multiethnic Asian diabetic population were <95.5mmHg for ASTP and <0.7 for TBI.
Ankle Brachial Index/methods* ; Diabetes Mellitus/epidemiology* ; Diabetic Foot/diagnosis* ; Female ; Humans ; Male ; Middle Aged ; Peripheral Arterial Disease/diagnosis* ; Retrospective Studies ; Toes

Introduction: Treatment adherence with antiretroviral therapy (ART) and its related factors have hitherto been the subject of clinical concern. However, research focusing on the relationships between ART adherence and the presence of psychological distress and selected personality traits have yet to be concluded. Therefore, our study aimed to remedy this. Methods: A multicentre hospital-based cross-sectional study was conducted in northwest Peninsular Malaysia on HIV outpatients given ART from July 1st, 2018, till April 31st, 2020. Participants were recruited via purposive sampling. Data were collected through an interviewer-guided questionnaires: Hospital Anxiety and Depression Scale (HADS) and Zuckerman-Kuhlman personality test (ZKPQ-M-40-CC), and interviewer-guided Timeline Follow-back (TLFB) for the assessment of adherence to ART. Results: A total of 229 patients completed the study. Majority (n=220, 96.1%) were considered adherent to ART. Among those who were non-adherent, two (22.2%) had anxiety disorder and five (55.6%) had depressive disorder. There was no significant association between treatment adherence and the presence of anxiety nor depression. However, sociodemographic factors determined that age group (p=0.033) and marital status (p=0.044) were significantly associated with treatment adherence. Multivariate analysis determined that ‘Active’ personality trait increases the likelihood to better treatment adherence by 1.14 times (95% CI: 1.02, 1.28, p=0.018). Conclusion: We did not find any association between treatment adherence and the presence of anxiety or depression. However, higher scores in ‘Active’ personality trait increases the likelihood of better treatment adherence among adult HIV on ART.