Incidence Of Pneumococcal Meningitis In Children Less Than 5 Years Age In Malaysia, Singapore And Thailand: Review

Streptococcus pneumoniae (pneumococcus) is the most common cause of community-acquired pneumonia, meningitis, and bacteremia in children and adults, including the elderly, and is responsible for high rates of morbidity and mortality worldwide. Aim of this paper to review published articles on incidence of pneumococcal meningitis in children less than 5 years of age in Malaysia, Singapore and Thailand, and compare the incidence of pneumococcal meningitis among the children in the three courtiers. Literature searches were conducted using google scholar, PubMed, the World Health Organization (WHO) website of the Weekly Epidemiological Record, and the countries’ Ministry of Health (MOH) website, and were limited to articles written in English. All relevant publications/abstracts published/presented during the period December 2000 through March 2014. Searches were conducted from April 1, 2014, till July 11, 2014 using various combinations of the following search terms “ Pneumococcal diseases” OR “meningococcal” OR “pneumococcal meningitis” OR “meningococcus”. A total of five articles and abstracts described the incidence of pneumococcal meningitis among children 5 years old. These five documents include two conference abstracts from Malaysia, one published paper from Singapore and two published papers from Thailand. The Malaysian, Singaporean and Thai pneumococcal meningitis incidence rate was 3.8-8.6, 2.3 and 0.10-1.8 per 100,000 children respectively. Our review confirmed that the incidence rate of pneumococcal meningitis was vary among the countries. The highest incidence rate of pneumococcal meningitis was found in Malaysia followed by Singapore and Thailand.

Development Of Clinical Pathway For Mild Cognitive Impairment And Dementia To Quantify Cost Of Age-Related Cognitive Disorders In Malaysia

As the Malaysian population ages, the burden of age-related cognitive disorders such as dementia and Alzheimer’s disease will increase concomitantly. This is one of the sub-study under a research project titled by quantify the cost of age-related cognitive impairment in Malaysia, which was undertaken to develop a clinical pathway for Mild Cognitive Impairment (MCI) and Dementia. The clinical pathway (CP) will be used to support the costing studies of MCI and Dementia. An expert group discussion (EGD) was conducted among selected experts from six (6) government hospitals from different states of Malaysia, Ministry of Health, and United Nations University, International Institute for Global Health, UKM and UPM. The expert group includes psychiatrist specialists and public health medicine specialists. A total of 15 participants took part in the EGD. The group was presented with the different approach in managing MCI and Dementia. Finally, the group came to the consensus agreement on the most appropriate and efficient ways of managing the two conditions. In the EGD, an operational definition for MCI and Dementia was agreed upon and a pathway was developed for the usual practice in the Malaysian health system. A typical case used, as a reference is a 60-year-old patient referred to a memory clinic with complaint of “forgetfulness”. After three outpatient visits in the clinic, the diagnosis of MCI and Dementia could be clinically established. The clinical pathways covered all active clinical and non-clinical management of the patient over a period of one year. The experts identified the additional resources required to manage these patients for the whole spectrum of lifetime based on the expected life expectancy. The Clinical pathway (CP) for MCI and Dementia was successfully developed in EGD with strong support from practitioners in the health system. The findings will help the researchers to identify all-important clinical activities and interventions that will be included in the costing study.

Health System Reform From The People’s Point Of View: Development Of Reliable And Valid Questionnaire

Health system reform has been a major concern for different countries. The aim of this research was to develop a reliable and valid questionnaire suitable to assess the consequences of health reform process from people’s perspective. An extensive literature review used to extract a set of statements as possible indicators for health system reform. Expert panel used to determine the content validity rate (CVR) and the content validity index (CVI). The first version produced in Turkish language and pre-piloted with 20 heads of household. Qualified committee used to translate the Turkish version to English version. Group of eighteen academics and graduate students recruited to tests both versions for parallel test validity. The construct validity of the questionnaire was determined using principal components analysis with Varimax rotation method (PCA). Internal consistency and questionnaire’s reliability were calculated by Cronbach’s alpha and the test–retest reliability test. A 17- items questionnaire was developed through the qualitative phase. The Bartlett’s test was significant (p < 0.001), and the KMO value (0.842) showed that using principal component analysis (PCA) was suitable. Eigenvalues equal or higher than 1 were considered significant and chosen for interpretation. By PCA, 4 factors were extracted (accessibility, attitude and preference, quality of care and availability of resources) that jointly accounted for 85.2% of observed variance. The Cronbach’s alpha coefficient showed excellent internal consistency (alpha=0.97), and test-retest of the scale with 2-weeks intervals indicated an appropriate stability for the scale (Intra-class coefficient = 0.96). The findings showed that the designed questionnaire was valid and reliable and can be used easily to assess the consequences of health reform process by comparing the situation before and after the reform from people’s perspective.

Non-Compliance With Inhaled Corticosteroid (Ics) Among Asthma Patients In Yazd City, Iran

Asthma is one of the most common chronic diseases in the world. It is estimated that around 300 million people in the world currently have asthma. The prevalence of asthma is increasing in most of countries, especially among children. The burden of severe asthma is considerable high in the Middle East courtiers including Iran. This study to investigate the effect of patients’ knowledge about Inhaled Corticosteroids (ICS), attitude and health beliefs toward ICS, and behavioral intention to adhere to prescribed ICS in adult asthmatic patients in Yazd city, Iran. A cross sectional study was conducted from August 2008 to January 2009 in three private allergy and asthma clinics, located in Yazd city of Iran, using Structured face to face interviews using a questionnaire by the researcher. The results showed that the majority of patients (55.5%) were not adherent to their prescribed ICS. Patients’ knowledge toward ICS did not have effect on medication adherence behavior, while patients with positive attitude toward ICS were better adherent with their medication. Linear regression model identifies intention to comply with treatment and positive attitude toward ICS as predictors for adherence behavior. This study shows the relationship between medications beliefs, attitude, behavioral intention, and medication adherence. A better understanding of patient’s medication beliefs, and attitude and their effect on compliance may help health care system to promote adherence.

Peoples Expectations From Healthcare Providers – A Turkish Perspective

There is high expectation from the population on part of the healthcare providers. These include; skilful and timely medication administration; and knowledge, honesty, listening skills, availability and professional attitude. The aim of this paper is to evaluate the expectation of population with regards to the healthcare providers in Turkey. A cross- sectional study was conducted in Turkey, including both rural and urban population, carried out from October 2011 till January 2012. A total of 540 household heads were selected using multistage random sampling technique. Data was collected using modified self-administered 16-items QUOTE (Quality of Care Through the Patients’ Eyes) questionnaire. The questionnaire measures communication/ accessibility, organizational skills and professional skills. The response rate was (77.1%) and data was analyzed by using SPSS version 16.0. All the aspects measured using QUOTE questionnaire were found to be important by the majority of respondents, but with varying degrees of priority. The quality aspects related to the professional skills of physicians was ranked first followed by communication/ accessibility and last but not the least is the organizational skills of health care providers. This study explored the Turkish people priorities and expectations regarding healthcare providers. The public priorities and expectation were different across population. This may reflect the need to understand people’s expectations before providing the services to avoid complaints that may occur after the services have been rendered.

The Effects of Hospital Based Respiratory Physiotherapy an Intervention Study among COPD Patient in Al-Zawia City, Libya

Chronic obstructive pulmonary disease (COPD) is a one of the major cause of death and disability worldwide. This study aimed to compare the quality of life (QOL), Activity of Daily Living (ADL), Pulmonary Function Test (PFT) and general health symptoms pre and after hospital-based respiratory physiotherapy program among COPD patients. Pre and post intervention study was conducted between January and July 2010. A total of 54 subjects aged between 30 to 40 years old were recruited for this study using universal sampling method from Alzawia Teaching Hospital, Libya. Data collected were socio-demographic data, QOL (before and after the intervention) using the Short Form-36 (SF-36) questionnaire, ADL using the Barthel Index and the General Health Symptoms. The mean SF-36 score for QOL is 30.13 (SD = 8.06) and 63.46 (SD = 13.53) before and after the physiotherapy respectively (with the p <0.0001). Patients’ Activity of Daily Living mean scores are 70.18, (SD = 16.50) and mean = 88.89 (SD = 13.28) before and after program (p< 0.0001). The general medical condition mean score after respiratory physiotherapy is 3.72 as compared to 4.96 before the respiratory physiotherapy (p< 0.0001). Pulmonary Function Test shows improvement in actual/predicted FEV1 ratio in all 54 cases with mean improvement from 55.85 before to 81.67 after the pulmonary physiotherapy (with the p <0.0001). Hospital based respiratory physiotherapy program had significantly improved QOL, pulmonary function and activities of daily living among the subjects.

Antenatal care and the occurrence of low birth Weight delivery among women in remote mountainous region of Chitral, Pakistan

Low birth weight [LBW] is closely associated with perinatal morbidity and bears an increased risk for subsequent infant morbidity. The study aimed to assess low birth weight delivery factors among women in Chitral, Pakistan. Mixed Methodology was adopted. Structured data collection tool was used to collect information from medical records of 1316 mothers, followed by interviews and focus group discussions to understand the causes and their remedies. The main outcome measure was infants born with low birth weight LBW [<2.5kg]. There was a significant association between the occurrence of low birth weight and maternal education, paternal education, and paternal occupation. Mothers who received antenatal care were more likely to deliver normal weight babies compared to those who did not. Women with more than four antenatal visits were six times as likely to deliver normal weight babies. Key facilitators for using antenatal services include information received from health center staff during home visits, advice from mothers and mother in-laws, and programs on media. Barriers include high cost for antenatal care, non-availability of transport, particularly in emergencies, and lack of awareness about benefits of antenatal care. The study suggested proper strategies for antenatal care to increase the awareness among women living in remote locations. The limitations are needed to be identified and considered when designing interventions to reduce LBW deliveries in Pakistan.

Two novel mutations in exon 3 and 4 of low density lipoprotein [LDL] receptor gene in patients with heterozygous familial hypercholesterolemia

To determine the common mutation of low density lipoprotein receptor in hypercholesterolemja patients requiring screening for heterozygous familial hypercholesterolemia [HeFH] in Karachi. Case-series. Dr. Ziauddin Hospital Laboratory and Dr. Rubina Ghani's Pathological and Molecular Laboratories, Karachi, for the PCR bench work from June 2008 to October 2009. All the patients selected for this study were from Dr. Ziauddin Hospital and National Institute of Cardiovascular Diseases. All the patients having high total cholesterol and LDL-cholesterol were included in this study with premature coronary artery diseases or a family history of hypercholesterolemia. Exclusion criteria included Diabetes mellitus, hypertension, renal disease, hypothyroidism and steroid therapy. After lipid profile with overnight fasting, DMA was extracted from whole blood collected in EDTA [ethylenediamine tetra acetic acid] tube and multiplex PCR [polymerase chain reaction] using forward and reverse primers of exons 3, 4, 9 and 14 of base pairs 162, 431, 550 and 496 respectively. Out of total of 120 hypercholesterolemia cases, 42 patients were classical cases of HeFH [heterozygous familial hypercholesterolemia] with xanthomas, xanthelasmas and LDL-C > 160 mg/dl. The total cholesterol [260 +/- 57 mg/dL] and LDL-C [192 +/- 39 mg/dL] of cases was significantly high as compared to, controls having total cholesterol [184 +/- 27 mg/dL] and LDL-C [105 +/- 22 mg/dL], p > 0.001. Two novel point mutations were noted in exon 3 and exon 4. The other 78 cases were probable with raised LDL-C [low density lipoprotein cholesterol] and family history of premature coronary heart diseases. The frequency of HeFH was 35% classical and 65% probable cases out of total 120 hypercholesterolemia patients from two tertiary care hospitals in Karachi. The point mutation on exon 3 and exon 4 of LDLR gene was the most common. PCR is useful for the detection of large re-arrangements in the LDL-receptor gene and is a rapid and reliable method for diagnosis of familial hypercholesterolemia

Carotid intima-media thickness correlation with lipid profile in patients with familial hypercholesterolemia versus controls

To determine the variations in carotid intima-media thickness [CIMT] in familial hypercholesterolemia [FH] patients and its use as predictive marker for premature cardiovascular diseases. National Institute of Cardiovascular Diseases and Dr. Ziauddin Hospital, Karachi, from June 2008 to October 2009. Familial hypercholesterolemia was clinically diagnosed by premature coronary diseases, xanthomas, arcus cornealis and family history of premature coronary heart diseases. Controls were age matched normal individuals without hypercholesterolemia. Their lipid profile was tested after overnight fasting. CIMT was measured in mm using B-mode ultrasonography using linear probe. Student t-test was applied to compare mean CIMT of cases and the control. The mean CIMT values of the FH cases were correlated with LDL using Pearson's correlation test. Forty cases with hypercholesterolemia gave consent to participate in the study. These patients had total cholesterol >200 mg/dL and LDL >/= 160 mg/dL as compared to twenty controls of similar age with total cholesterol

Parameters of metabolic syndrome are markers of coronary heart disease - an observational study

This study was undertaken to identify the parameters of metabolic syndrome which can predict cardiovascular and peripheral vascular disease. A total of 260 subjects were selected from Ibrahim Cardiac Hospital and Research Institute [ICHRI], who reported for coronary angiogram as per advice of a cardiologist. Each subject undergoing angiogram was interviewed with a preset structured questionnaire. The study subjects were screened for PVD [peripheral vascular disease] by examining peripheral pulses and ankle brachial index measured. Subjects with absent pulse or non-recordable ankle brachial index was considered as ankle brachial index <0.9. Positive angiographic finding was defined by presence of mild to severe degree of coronary vascular narrowing of one or multiple of three coronary arteries. Among the study subjects 64.6% had metabolic syndrome, 79.2% had positive and 20.8% had normal angiographic finding. Among the CAG positive subjects 38.8% had single vessel disease, 30.0% had double vessel disease and 31.08% had triple vessel disease. CAG positive subjects are mostly 40-60 years of age, 78.6% male, 54.8% smoker, 62.1% had waist circumference above normal, and about 90% have dyslipidemia and dysglycemia [DM/IGT/IFG] In this study subjects 83.9% of diabetic and 69.7% of non-diabetic had positive angiographic finding. Among the CAG positive subjects 16.6% had low ABI [<0.9]. This study reveals that hypertriglyceridemia, waist circumference and hypertension are significantly related with angiographic positivity. Peripheral vascular disease was not significantly higher among CAG positive subjects and no association was observed between metabolic syndrome and PVD

Hepatitis - control in dental practice

Hepatitis infection is a silent epidemic. It has high morbidity and mortality in different countries. It is a public health problem in developing countries with limited resources and health budgets. The aim of this review paper is to revisit the hepatitis infection, its epidemiology, its modes of spread, diagnosis, prevention, especially in relation to Pakistan. Special emphasis is laid on hepatitis infection in the dental, and medical practices. The recommendations have been highlighted in the light of latest developments, understanding of hepatitis infection, treatment modalities and need of cost effective preventive regimens to control the infectious disease. The observance and practice of "Universal Precautions" for infection control has been emphasized. It is hoped that the paper will be of great help to health care professionals, those who are active in rendering their services to improve the quality of life of their patients. Further, it would be helpful to dental practitioners to protect themselves, their team and the patients in general, and may minimize the risk with better understanding of the public health problem

Antinociceptive effects of poly herbal oil extract [PHOE]

A number of drugs are used widely in the traditional system of medicine or Tibb-e-Unani [Unani medicine] in the management of many diseases but these drug mostly, have not been investigated for their described effects. This study aimed to investigate antinociceptive and anti-inflammatory effects of Herbal Oil [1, 5 and 10 ml/kg] administered orally in mice and rats, using standard behavioral paradigms. It is a poly herbal preparation used in traditional medicine as a remedy for pains and other ailments. The data show that orally administered herbal oil promotes antinociceptive activity against Acetic Acid induced writhing and Formalin induced pain models. The oil also produced a dose dependent inhibition of carrageenin-induced rat paw edema. These effects were significant when compared with saline control group. The results indicate potent antinociceptive component in oil, which justify at least partially the folkloric use of oil in relieving pains

Complications of total laryngectomy

To find out various complications after total laryngectomy, with reference to their presentation, diagnosis, and management. It was a prospective descriptive study. Otolaryngology, Head and Neck Surgery department, Pakistan Institute of Medical Sciences Islamabad, from 1st July 1999 to 31st June 2001. 25 patients undergoing total laryngectomy for proven carcinoma larynx [Ca larynx] were included in this study. Patients were reviewed after surgery and any complication that occurred was recorded. The presentation, diagnosis, and management of these complications are discussed, along with voice rehabilitation after total laryngectomy. There were 23 males and 2 females. Age of patients ranged from 40 - 65 years. Complications included wound infection [06], pharyngocutaneous fistula [03], pharyngeal stenosis [03], and nodal metastasis [02]. Wound infection and pharyngocutaneous fistula are most common complications after total laryngectomy. Preoperative radiotherapy and low postoperative haemoglobin level are important risk factors for development of pharyngocutaneous fistula in total laryngectomy patients. Postoperative radiotherapy to the neck reduces the risk of nodal metastasis after total laryngectomy

survey of multiple prescriptions dispensed in Saudi Arabia

A study of out-patient prescriptions in King Fahad Hospital, Al-Baha, Saudi Arabia was undertaken. Prescribing patterns of 200 doctors were surveyed. For each doctor ten out-patient prescriptions were randomly selected for analysis during month of January 2000. The prescriptions were coded and analysed. Multivitamins and antibiotics were the drugs most frequently prescribed: a finding that suggests either a high degree of malnutrition and infectious disease or misuse of those drugs. Other commonly prescribed drugs are also discussed

Microbiology and drug sensitivity patterns of chronic suppurative otitis media

To identify the commonest microorganisms associated with chronic discharging ears and their antimicrobial sensitivities. Design: Descriptive study. Place and Duration of Study: This study was carried out from August 2003 to February 2004 at the Department of Otorhinolaryngology and Head and Neck Surgery, Fauji Foundation Hospital, Rawalpindi. Materials and A total of 124 patients with unilateral or bilateral active chronic suppurative otitis media attending the outpatient clinic were included in the study. All patients were evaluated through detailed history and clinical examination. Pus samples were collected from the discharging ear[s] and sent to the hospital laboratory where culture and sensitivity studies were done for aerobes, anaerobes and fungi and antibiotic sensitivity patterns. Overall microbiology of 142 samples was studied. Among them, 108 [76%] were pure cultures and 34 [23.9%] were mixed. There were 186 isolates including 182 [97.8%] aerobes, nil anaerobes and only 4 [2.1%] fungi. Pseudomonas aeruginosa 94[50.5%] was the most common isolate, followed by Staphylococcus aureus 44 [23.6%]. Drug sensitivities pattern of Pseudomonas aeruginosa showed that ciprofloxacin was active against majority 95.8% of isolates followed by amikacin 83.3%, gentamicin and tobarmycin 60% and cefotaxime 41.6%. Staphylococcus aureus isolates were resistant to penicillin, ampicillin and amoxicillin in 77.2% whereas majority was sensitive to coamoxiclav 81.8% and cephradine 86.3%. Commonest organisms isolated from chronic discharging ears were Pseudomonas aeruginosa and Staphylococcus aureus. Majority of isolates of Pseudomonas aeruginosa were sensitive to ciprofloxacin. Majority of strains of Staphylococcus aureus were resistant to penicillin. Cephradine and coamoxiclav were effective against most of the isolates of Staphylococcus aureus

Serum cardiac troponin-1 and ST segment elevation in patients with acute pericarditis

This study was designed to assess myocardial lesion in idiopathic acute pericarditis. The troponine-I a sensitive and specific marker of myocardial injury was used to assess myocardial lesion in a idiopathic acute pericarditis. ST segment elevation in acute pericarditis also reflects associated superficial myocardial injury. The relationship of tropinine-I and ST segment elevation in idiopathic acute pericarditis was also established. Out of 60 patients selected cardiac troponine-I was detected in 30 patients and was beyond the 1.5 ng/ml threshold in 12 ST-segment elevation was observed in 93% of the patients with cardiac troponin-I levels more than 1.5 ng/ml. So pericardial associated minor myocardial injury may be picked up by troponine-I which is likely to be mixed by ST segment elevation to troponine-I is more specific and sensitive marker for detection of pericardial associated myocardial injury than ST segment elevation. The patients who have tropinine-I threshold more than 1.5 ng/ml were likely to have more recent infarction

Role of cardiac markers in evaluation of suspected myocardial infarction

Current cardiac marker for evaluation of suspected myocardial infarction include CK-MB, myoglobin, CK-MB isoforms and troponins, recommended use for each marker vary according to its cardiac specificity, sensitivity, ease of measurements, turn around time for test results and diagnostic and prognostic uses. CK-MB is an effective marker for reinfarction because it return to normal level within 48 hours after the initial episode. Myoglobin is less specific and sensitive and its pattern of response to infarction is widely variable. CK-MB isoform are good indicator of early stage infarction but technical problems can affect the precision of test result. Because troponin levels remain elevated after onset of chest pain they are good marker for late stage infarction. No single panel consisting of CK-MB and troponin assays is recommended