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.

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 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.

Redefining indications and evaluation of dissection versus diathermy method of tonsillectomy.

The current availability of randomized clinical trials have assessed the efficacy of the most common presumed indications for tonsillectomy, but the controversery still exists So, the present study was conducted to assess (1) Whether tonsillectomy leads to any significant benefits as compared to watchful waiting (2) evaluating the two most commonly used techniques for tonsillectomy i.e; cold dissection & diathermy. 170 patients were included,104 were assigned to the surgical group (Group A) & 66 patients acted as control (Group B).The surgical group underwent tonsillectomy.The efficacy of tonsillectomy viz-a-viz chronic tonsillitis related morbidity, school absenteeism, & work absenteeism, Group A beta hemolytic streptococcal pharyngitis, otitis media, Rhinosinusitis, obstructive sleep apnea & psoriasis was studied.The results of our study were as; Majority among children (7-15 years)& the mean age of adult population was 23.02 years.Tonsillectomy definitely provided benefit in case of chronic tonsillitis, mild to moderate obstructive sleep apnea on polysomnographic findings where as the Patients who had been included in this study to redefine otitis media & rhinosinusitis as an indication for tonsillectomy did not benefit much when compared to the watchful waiting groupThe three most commonly used techniques of tonsillectomy i.e; cold steel using ties & packs, cold steel using monopolar diathermy for hemostasis & using monopolar diathermy exclusively were evaluated.The operating time was least for the diathermy alone method. The intraoperative blood loss was minimal for the monopolar diathermy method. The primary hemorrhage rate was maximum in technique of cold steel with ties & packs as hemostasis.The secondary hemorrhage rate was maximum in monopolar diathermy method. The postoperative pain measured by using the verbal rating scale was considerable after using monopolar diathermy alone with 33% complaining of severe pain & 67% complaining of moderate pain.

Seroprevalence of HIV infection among the foreign students at Agra during a fifteen year period (1988-2002).

The present study reports a retrospective analysis of data of HIV testing of foreign students from Sub-Saharan Africa, South-East Asia and Europe, studying as well as staying at Agra, over a period of 15 yr (1988 to 2002). Of the 2653 [2092 (78.85%) were from the Sub-Saharan African countries, 377 (14.21%) from the South-East Asian countries, and 184 (6.93%) from the European countries], foreign students tested for HIV, only 26 were found to be positive for HIV-1/2 antibodies by the ELISA, rapid and Western Blot assays. Out of 26 HIV-positive, 17 males and 7 females were from Sub-Saharan Africa and 2 males were from the European countries. The range of HIV-positivity over a period of 15 yr varied greatly. When the five-year (1988-1992, 1993-1997 and 1998-2002) results were compared, the HIV-seropositivity showed a decline from 1.85, 0.50 to 0.36 per cent in the first, second and third 5 yr slots, respectively. While the data were not representative of all foreign students in India, this reflected the population tested in this centre was not a growing focus of HIV infection in this part of the country.