Factors associated with improper metered-dose inhaler technique among adults with asthma in a primary care clinic in Malaysia

@#Introduction: Metered-dose inhalers (MDI) are the most used inhalers worldwide. However, improper MDI techniques remain a significant problem and cause uncontrolled asthma. Studies worldwide have reported that the causes of inefficient inhaler technique are multifactorial. However, this topic has been less well studied in the Asian population. This study aimed to evaluate the MDI technique and associated factors among adults with asthma in a primary care setting in Malaysia. Method: This was a cross-sectional study with universal sampling conducted between July and October 2017. A total of 146 patients with asthma aged 18 years and older in a primary care clinic in Putrajaya, Malaysia were recruited. Logistic regressions were used for statistical analysis to examine the association between improper MDI techniques and their related factors. Results: The majority (83%) of respondents were female with a median age of 37 (IQR = 30.75–49.25) years, and the median duration of asthma of 20 (IQR = 10–30) years. An improper MDI technique was observed in 100 (71.9%) patients. The most frequently missed step was exhaling gently and fully before inhalation (51.4%). Respondents who were not on an MDI preventer (adjusted OR: 2.487, 95% CI: 1.121–5.519, p = 0 .025) or had used an MDI 5 years or fewer (adjusted OR: 3.369, 95% CI: 1.425–7.964, p = 0.006) were more likely to employ an improper MDI technique. Conclusion: There was a high proportion of improper MDI techniques among patients with asthma. Patients not using an MDI preventer or who had used an MDI less than 5 years were at higher risk of improper MDI technique.

Comparative Study of External Fixator versus Internal Fixation Using Interlocking Nail in Open Diaphyseal Fractures of Tibia: An Hospital Based Prospective Study

Background: External fixation and internal fixation usingintramedullary nails are two well-accepted and effectivemethods, but each has been historically related tocomplications. We therefore performed a prospective study tocompare the early functional recovery and overall results withthese two methods of management.Materials & Methods: This prospective randomized study wascarried out on the patients admitted in the Department ofOrthopaedics, Dr S.N. Medical College, Jodhpur. The studyincluded 30 patients of Open Diaphyseal Fractures of Tibia. Ofthese, 15 patients were treated by intramedullary interlockingnailing and the remaining 15 patients by External Fixator asprimary fixation method. Patient able to walk without supportwithout pain were considered union clinically. Johner AndWruhs Criteria, 1983 were used to evaluate functionaloutcome.Results: Our study showed that the mean age was 32.4 yearsin ILN group and 34 years in external fixation group. The maleto female ratio was approximate 4:1. In present study showedthat the road traffic accident were most of the injury (80%) ingroup A as compared to group B (93.33%). The farmer & laborwas higher incidence of tibial fractures, which are higherdemanding activity and lower incidence of fractures wasoccurred in low demanding activity occupation. The outcome ofour study showed that excellent in 73.33% cases in group A ascompared to 53.33% in group B. Poor outcome maximum ingroup B was 20% cases as compared to 6.66% in group A.Conclusion: We concluded that in open tibial shaft fractureintramedullary interlocked nailing is excellent modalities,leading to accepted union with a mild delay but permissibleearly weight bearing and low patient morbidity

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.

Assessment of Efficacy of Regular and Probiotic Yogurt in Patients with Acute Watery Diarrhea: A Comparative Study

Background:Diarrhea is the second most common infectious disease in children, and causes a significant number of hospitalizations, morbidity and mortality. Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host while enhancing the properties of intestinal flora. Nowadays, probiotics use is increasingly widespread; however, indication of their use has been evidenced since ancient times. Aim of the study: To compare the efficacy of regular yogurt and probiotic yogurt in patients with acute watery diarrhea. Materials & methods:The study was conducted in the department of general medicine of the Government D.B. General Hospital, Churu, Rajasthan, India.. For the study, we included patients admitting to general medicine ward with acute watery diarrhea. Acute diarrhea was defined as the presence of 3 or more liquid or loose stools per day lasting for less than 14 days. A total of 120 patients were included. The patients were randomly grouped into Group 1 and Group 2. Group 1 patients were advised to consume regular yogurt (250 mg twice a day) and Group 2 patients were advised to consume probiotic yogurt (250 mg twice a day). Results A total of 120 patients were included in the study. Group 1 had 32 males and 28 females. Group 2 had 37 males and 23 females. Mean age of the patients in Group 1 was 32.33 years whereas Group 2 patients were 36.21 years. The duration for significant reduction of stools in group 1 was 2.12 days and in group 2 was 1.32 days. Duration for normalization of stools in group 1 was 4.12 days and in group 2 was 3.18 days. Conclusion: The overall duration of diarrhea in group 2 was shorter as compared to group 1. Normalization of stool composition and frequency was more rapid in the group 2 patients. These results should be confirmed with a large scale placebo controlled clinical trial evaluating the efficacy of probiotic yogurt.

Transport of Pseudomonas aeruginosa via column study trough aquifer at RBF study site, Lubuk Buntar, Kedah, Malaysia 124-130

@#Aims: This study is focused to explore Pseudomonas aeruginosastrain mass transport andassessment of the water quality.Methodology and results:Pseudomonas aeruginosahave been detected in the real location at the RBF study areabyusing molecular method. The bacterium strain was cultivated in the river water sample and column study was performed using soil aquifer collected from the RBF study site.Conclusions, significance and impact of the study:The column experiments show the removal of the bacteria was achieved almost 99%. Concentration of cultured bacteria was detected in range 0.26 g/Lto 0.33 g/Land reduced after flow through the soilpassage in range 0 to 0.148 g/L. This study also examines the water qualities that affected during the transport such as turbidity and color. The range of turbidity for initial concentration for both influents was 84-96 NTU was reduced to range 2.88-49.29 NTU. Meanwhile for color, the initial concentration was 51-58 PtCo was reduced to range 1-18 PtCo

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.

A clinical study on association between hearing loss and inflammatory bowel disease in a population attending a hospital.

Background: Inflammatory bowel disease usually presents with gastrointestinal stigmata of weight loss, anaemia, and rectal bleeding, but may exhibit prominent extra-intestinal manifestations also such as joint symptoms, skin signs and some other auto-immune manifestations. During the last few years many authors have reported serious complications of IBD manifesting in the Ear-Nose-Throat (ENT) and influencing disease morbidity. Methods: Twenty four patients with active ulcerative colitis (mean age 45 years) were recruited prospectively along with 24 healthy age- and sex-matched controls. Otoscopy, tympanometry and pure tone audiometry were performed. Otoscopy and tympanometry were normal in all patients and controls. Pure tone audiometry showed sensorineural hearing loss over all frequencies in patients with inflammatory bowel disease and compared with controls. The otologic data including age of onset, family history of otologic problems, exposure to noise and audiometric findings were also reviewed. Results: Out of 48 patients with a history of IBD, 24 had documented SNHL, 17 of these patients had a diagnosis of ulcerative colitis and 7 had Crohn’s disease. 22 patients had bilateral SNHL, and 2 patients had unilateral SNHL. Tinnitis were the most common associated aural complaint. Conclusion: Sensorineural hearing loss is very unusual finding, possibly of auto-immune aetiology. We recommend steroid or immunosuppressive therapy in such a patient. Evidence for an autoimmune basis for this condition is reviewed and the potential benefit of systemic corticosteroids emphasized.

COPD in Non-smokers-Prevalence and Risk Factors.

Studies on COPD have largely focused on the smoking rather than the non-smoking population. Hence we conducted the study to identify the non-smoking causes of COPD. The study was conducted in the Department of Tuberculosis and Respiratory Diseases, Jawaharlal Nehru Medical College, AMU, Aligarh during 2011-2013 on 450 COPD patients. The aim of the study was to find out proportion of non smokers among all COPD patients, identify risk factors for COPD among non smokers and classify non-smoking COPD patients according to severity. Maximum patients (35.41%) among non smoker COPD group had more than one risk factor for COPD. Most of the patients among non smoker COPD were found to be having severe to very severe disease (63.5%). 34.4% patients had moderate COPD and very few patients had mild COPD (3%). On comparing disease severity among non-smoker and smoker COPD patients, we found that proportion of patients with very severe disease was more in smoker group (39.2% in smoker vs. 29.2% in non smoker), while proportion of patients with mild to moderate disease were more in non smoker group (35.5% in non smoker vs. 24% in smoker). Patients with severe disease in both groups were found to be of equal proportion (33.3% in non smoker vs. 36.7% in smoker).

A case of successful extracorporeal membrane oxygenation for right ventricular failure following pericardiectomy

Extracorporeal membrane oxygenation (ECMO) is a useful but less commonly used technique in right ventricular failure post cardiac surgery in our region. We report a case of successful use of ECMO for right ventricular failure post cardiac surgery. Our patient is a 27-year-old male presented with constrictive pericarditis post completion of treatment for disseminated Tuberculosis. He underwent pericardiectomy that was complicated with acute right ventricular failure. He was placed on extracorporeal membrane oxygenation after few hours post op that lasted for five days. The patient survived to hospital discharge and remained well on follow-up. From our experience, this aggressive management approach is beneficial in right ventricular failure and can be safely utilised in all cardiothoracic centres.

Effect of cyclophosphamide on the microanatomy of liver of albino rats.

Background: Cyclophosphamide is widely used in the treatment of various neoplastic diseases and diseases associated with altered immunity. Higher doses used for longer duration effects many organs like urinary bladder, lungs, liver, heart and male reproductive organs. Methods: To study the effect of cyclophosphamide on the micro anatomy of liver, sixty eight Albino rats were taken and divided into three groups, group A (control group) of 20 animals, were fed with routine diet, group B (low dose group) of 24 animals, were given cyclophosphamide at the dose of 0.5 mg/100 gms in addition to the routine diet and group C (high dose group) of 24 animals, were given high dose of cyclophosphamide at the dose of 0.7 mg/100 gms of weight of animal in addition to the routine diet. The animals were sacrificed at intervals of 3, 6, 9 and 12 weeks, 5 microns sections of the tissue were prepared and stained with Haematoxylin and Eosin stain. Results: Microscopic changes in liver were apparent in the drug treated animals. In group B the changes appeared after 6 weeks while in group C they started appearing after 3 weeks of drug treatment. The changes were in the form of fatty changes, hemorrhages and central vein congestion. Conclusion: Cyclophosphamide induces histological changes like fatty infiltration and central vein congestion in the liver. These changes are with low doses given for longer durations and manifest earlier when larger doses are used. Thus it is advised that patients receiving cyclophosphamide should be periodically evaluated for liver dysfunction.

diagnostic efficacy of adenosine deaminase in tubercular effusion

This study aims to evaluate the diagnostic efficacy of adenosine deaminase in tubercular effusions. This study was conducted at the Department of General Medicine and Cardiovascular and Thoracic Surgery, SKIMS, for a period of two years between November 2008 and November 2010. A total of 57 patients presenting with pleural effusions during the two-year study period, who presented with clinical manifestations suggestive of tuberculosis [i.e., the presence of productive cough, low-grade fever, night sweats, weight loss, and chest pain, especially if these symptoms last >/= 4 weeks] were included in the study. If the patients presented with less than two of these symptoms, and especially if the clinical manifestations were of <4 weeks duration, they were excluded from the study. The mean adenosine deaminase activity level in all the 57 patients was 109 U/L while the mean adenosine deaminase activity levels in pleural TB patients was 80 U/L, and 64 U/L in the controls [p=0.381]. Considering 40 U/L as the cut off, the results were positive in 35 out of 39 tuberculosis patients and 9 out of 18 controls. The sensitivity of adenosine deaminase for tubercular effusions worked out to be 90%, with only 50% specificity. This study suggests that the estimation of adenosine deaminase activity in pleural fluid is a rapid diagnostic tool for differentiation of tubercular and non tubercular-effusions. The sensitivity and specificity of adenosine deaminase for tubercular effusions in this study was 90% and 50% respectively.

Study on the effect of Y2O3 addition to the fluorescent property of dental porcelain

The appearance of dental porcelains is comparable to natural teeth. This study discusses the effect of Y2O3 addition to the fluorescent property of dental porcelains. The composition of dental porcelains contained Y2O3 as the fluorescent agent and base frit. The combinations of Y2O3 added consist of a series with 0.5, 1.0, 1.5, 2.0 and 2.5 wt% respectively, based on the total composition. In the extreme condition, fluorescent agents are added from 5.0 up to 10.0 wt%. In order to enhance the fluorescent property of dental porcelains, an opacifiying agent, cerium oxide (CeO2) was also added to dental porcelains composition. The fluorescent property was determined using Spectroline EF-1400C/F that emits 240 nm wavelength ultraviolet light. The microstructure was examined by Scanning Electron Microscope (SEM). The result shows that, the fluorescent properties displayed are similar to natural teeth when subjected to ultraviolet light. SEM micrograph was able to show the fluorescent agent dispersed in glass phase. Increasing additions of Y2O3 gave the fluorescent properties near to natural teeth.