Personalised management of Chronic Obstructive Pulmonary Disease (COPD): Malaysian consensus algorithm for appropriate use of inhaled corticosteroid (ICS) in COPD patients

@#Background: Regarding the long-term safety issues with the use of inhaled corticosteroids (ICS) and the clinical predominance of dual bronchodilators in enhancing treatment outcomes in chronic obstructive pulmonary disease (COPD), ICS is no longer a “preferred therapy” according to the Global Initiative for Chronic Obstructive Lung Disease except on top of a dual bronchodilator. This has necessitated a change in the current therapy for many COPD patients. Objective: To determine a standardised algorithm to reassess and personalise the treatment COPD patients based on the available evidence. Methods: A consensus statement was agreed upon by a panel of pulmonologists in from 11 institutes in Malaysia whose members formed this consensus group. Results: According to the consensus, which was unanimously adopted, all COPD patients who are currently receiving an ICS-based treatment should be reassessed based on the presence of co-existence of asthma or high eosinophil counts and frequency of moderate or severe exacerbations in the previous 12 months. When that the patients meet any of the aforementioned criteria, then the patient can continue taking ICS-based therapy. However, if the patients do not meet the criteria, then the treatment of patients need to be personalised based on whether the patient is currently receiving long-acting beta-agonists (LABA)/ICS or triple therapy. Conclusion: A flowchart of the consensus providing a guidance to Malaysian clinicians was elucidated based on evidences and international guidelines that identifies the right patients who should receive inhaled corticosteroids and enable to switch non ICS based therapies in patients less likely to benefit from such treatments.

Assessing Airflow Limitation among Smokers in a Primary Care Setting

Background: Many smokers have undiagnosed chronic obstructive pulmonary disease(COPD), and yet screening for COPD is not recommended. Smokers who know that they haveairflow limitation are more likely to quit smoking. This study aims to identify the prevalence andpredictors of airflow limitation among smokers in primary care.Methods: Current smokers ≥ 40 years old who were asymptomatic clinic attendees in aprimary care setting were recruited consecutively for two months. We used a two-step strategy.Step 1: participants filled in a questionnaire. Step 2: Assessment of airflow limitation using apocket spirometer. Multiple logistic regression was utilised to determine the best risk predictorsfor airflow limitation.Results: Three hundred participants were recruited. Mean age was 58.35 (SD 10.30) yearsold and mean smoking history was 34.56 pack-years (SD 25.23). One in two smokers were found tohave airflow limitation; the predictors were Indian ethnicity, prolonged smoking pack-year historyand Lung Function Questionnaire score ≤ 18. Readiness to quit smoking and the awareness ofCOPD were low.Conclusions: The high prevalence of airflow limitation and low readiness to quit smokingimply urgency with helping smokers to quit smoking. Identifying airflow limitation as an additionalmotivator for smoking cessation intervention may be considered. A two-step case-finding methodis potentially feasible.

Management of asthma in adults in primary care

@#Asthma is a chronic inflammatory disease of the airway which is often misdiagnosed and undertreated. Early diagnosis and vigilant asthma control are crucial to preventing permanent airway damage, improving quality of life and reducing healthcare burdens. The key approaches to asthma management should include patient empowerment through health education and selfmanagement and, an effective patient-healthcare provider partnership.

Oral submucous fibrosis: successful management of fifty cases with interpositioning buccal Fat Pad Flap

Objective: The aim of this study was to evaluate the clinical and anatomical application of buccal fat pad as an interpositional material in the surgical treatment of oral submucous fibrosis [OSMF] for improvement of mouth opening and its movements

Methods: OSMF has become a chronic, distressing condition of uncertain aetiology in Pakistan which rapidly involves the oral structures along with other parts of upper gastrointestinal tract

The study was conducted in Department of Oral and Maxillofacial Surgery, Ziauddin College of Dentistry, Ziauddin University, Karachi, from December 2013 till July 2015. We evaluated 50 diagnosed OSMF patients, with history of chewing areca/betal nut or other similar products, with burning sensation on having spicy ingredient, trismus 4-25mm with palpable fibrous bands on the buccal mucosa intraorally with rigidity and blanching were included in the study. Good clinical improvement with minimal morbidity by the use of buccal fat pad was noticed in patients with severe limited mouth opening along with regular and vigorous physiotherapy

Results: In 50 patients, the range of preoperative mouth opening was 4-24mm [14 +/- 4.90], the intra operative mouth opening was 25-38mm [33.25 +/- 4.17]. The patients were discharged after 72 hours at this time mouth opening was 25-36mm [0.63 +/- 3.82]

Comparison of pre-operative with intra and post-operative mouth opening was statistically significant

Conclusion: This study has shown that use of interpositioning buccal fat pad flap improves the mouth opening and movement in OSMF patients

Age of menarche in relation to socioeconomic status, BMI, physical activity and stress among high school girls

Over the past 50 years, the average age of onset of menarche has significantly declined and found to be a risk factor for breast cancer

Objectives: The research objective is to assess the effect of socioeconomic status, BMI, physical activity and stress on the age of menarche of school girls of urban and peri-urban communities in Lahore

Methods: This cross-sectional study estimated the age at menarche and investigated its relationship with socioeconomic status, BMI, physical activity and stress. It was carried out in 2 schools of peri-urban and urban communities of Lahore, selected through convenience sampling. The data was collected from adolescent girls [aged 13-17 years] from grades 9 and 10 through self-constructed questionnaire. All 199 adolescent girls experiencing menstruation were enrolled in the study

Results: The estimated average age at menarche was 12.66 +/- 1.12 years collectively and 12.92il.21 and 12.37 +/- 1.59 in girls of peri-urban and urban schools respectively. Mean age of menarche was not significantly different in categories of BMI, levels of physical activity and stress but showed statistically significant difference in categories of socio-economic status

Conclusion: It was concluded that mean age of menarche is influenced by socio-economic status

A Pilot Randomized Control Cross over Study Evaluating the Effectiveness and Safety of Mechanical Percussor Compared with Conventional Chest Physiotherapy in Adults with Productive Cough

Introduction: Conventional Chest Physiotherapy (CCPT) remains the mainstay of treatment for sputum mobilization in patients with productive cough such as bronchiectasis and “Chronic Obstructive Airway Disease” (COPD). However CCPT is time consuming requires the assistance of a physiotherapist and limits the independence of the patient. Mechanical percussors which are electrical devices used to provide percussion to the external chest wall might provide autonomy and greater compliance. We compared safety and efficacy of a mechanical chest percusser devised by Formedic Technology with conventional chest percussion. Methods: Twenty patients (mean age 64years) were randomly assigned to receive either CCPT or mechanical percussor on the first day and crossed over by “Latin square randomisation” to alternative treatment for 6 consecutive days and the amount of sputum expectorated was compared by dry and wet weight. Adverse events and willingness to use was assessed by a home diary and a questionnaire. Results: There were 13 males and 7 females, eight diagnosed as bronchiectasis and 12 COPD. The mean dry weight of sputum induced by CCPT (0.54g + 0.32) was significantly more compared with MP (0.40g + 0.11); p-value = 0.002. The mean wet weight of sputum with CCPT (10.71g + 8.70) was also significantly more compared with MP (5.99g + 4.5); p-value < 0.001. There were no significant difference in adverse events and majority of patients were willing to use the device by themselves. Conclusion: The mechanical percussor although produces less sputum is well tolerated and can be a useful adjunct to CCPT

Modified decomposition method for nonlinear volterra-fredholm integrodifferential equation

The purpose of this work is to provide the reliable solution for the nonlinear Volterra-Fredholm Integrodifferential equation by using the modified decomposition method. Moreover, three particular examples are discussed to show the reliability and the performance of the modified decomposition method

Estimation of nicotine content in popular Indian brands of smoking and chewing tobacco products.

OBJECTIVES: To estimate the nicotine content of some popular Indian brands of smoking tobacco (cigarettes and bidis) and pan masalas (chewable tobacco). MATERIALS AND METHODS: Commercially available cigarettes, bidis, and pan masalas (chewable tobacco) were obtained from local retail outlets for the study. Nicotine was estimated using gas-liquid chromatography. RESULTS: The analyses showed relatively higher levels of nicotine in tobacco from bidis (26.9 mg gm) as compared to cigarettes(15 mg/gm); the difference is statistically significant ( P P > 0.01). Nicotine concentration in chewing tobacco was 3.4 mg/gm. CONCLUSION: The study concludes that the nicotine content of Indian brands of smoking tobacco was slightly high compared to other international brands. Higher concentration of nicotine was found in bidis compared to cigarettes. The nicotine content in commercially available chewing tobacco products was found to be much lower than in the smoking form of tobacco, but the average daily consumption made it comparable to the smoking form.

A comparative study of the efficacy of four different bristle designs of tooth brushes in plaque removal.

BACKGROUND: The aim of the study was to compare the efficacy of four most commonly used bristle designs of toothbrushes in plaque removal. MATERIALS AND METHODS: The study was a randomized 4 cell, examiner blind cross-over design assessing the plaque removal efficacy of all four brushes on a single occasion. Sixteen subjects aged 14-15 years participated in the study. On day 1 of each test period, the subjects were rendered plaque free and were asked to suspend oral hygiene practices for 24 hours. On day 2, the subjects were scored for plaque prior to brushing using the Turesky-Gilmore modification of Quigley-Hein plaque index. The subjects then brushed with the allocated toothbrush for 2 minutes and the post-brushing plaque scores were assessed. A wash-out period of 4 days was allowed between the test periods. RESULTS : All the brushes showed a significant reduction in the post-brushing plaque scores ( p < 0.001). The mean reduction in the plaque scores for all the brushes was around 53%. The percentage plaque reduction was greater in the anterior surface than the posterior surface (59.6 +/- 7.45% vs. 49.83 +/- 4.35%). The percentage plaque reductions in the upper, lower, buccal and lingual surfaces were similar. No significant difference in the reduction of plaque scores between the four brushes was seen. CONCLUSION: The data derived from the study supports the contention of many researchers that there is no single superior design of manual toothbrush. Though minor and some site differences in favor of the brushes were seen, they were not statistically significant.

Gender difference in metacarpal descent of fifth metacarpal

To determine the difference in metacarpal descent of fifth metacarpal between men and women. Descriptive study. The outpatient department of plastic, reconstructive and hand surgery at Liaquat National Hospital, Karachi, from August 2005 to February 2006. Skyline of the 2nd and 3rd metacarpals were used as reference line, from which the descent of the 5th metacarpal head was measured. The position of 5th metacarpal head was documented as angle X. Metacarpal descent was defined as the difference between angle "X" in relaxed and clenched fist position. The relaxed position was standardized by placing the forearm, wrist and palm on a shaped woodblock such that the wrist would be held in 25 - 30 degree in extension by a triangular spur, supported the 3rd metacarpal only. It was ensured that the movement of 4th and 5th metacarpals were not impaired. Analysis of variance was performed to compare the significance of means between genders at p < 0.05 level of significance. Metacarpal descent of the 5th metacarpal of both hands was significantly greater for women, with a mean of 7 degree as compared with a mean of 4 degree for the men. This decrease in angle "X" was significant for the right 5th metacarpal relaxed and fist position and the fist position on the left. In contrast, women showed no significant differences between the various age groups for any of the variables tested.There was no relationship between metacarpal descent and hand dominance. Difference in metacarpal descent between men and women is significant and must be kept in mind when hand function is evaluated in both genders to assess the outcome of treatment and rehabilitation

Analysis of fifteen hundred psychiatric cases: an outpatient study of two years [1975 and 1976] at Hyderabad, Sind

In mental hospital, Hyderabad all new psychiatric out-patient referrals were studied during two years period. Male consultation rate was higher than that of females, more than 50% consulted with 20-39 years of age. The largest diagnosis group was that of schizophrenia. Illiterate and unemployed patients out numbered the other groups. The data provides startling information towards more advanced studies