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Satisfaction levels and asthma control amongst Malaysian asthmatic patients on budesonide/formoterol maintenance and reliever therapy: experience in a real-life setting
Abdul Manap R,Loh LC,Tengku Ismail TS,Muttalif AR
Patient Related Outcome Measures , 2012,
Abstract: Roslina Abdul Manap,1 Li Cher Loh,2 Tengku Saifudin Tengku Ismail,3 Abdul Razak Muttalif,4 George Kutty Simon,5 Rosalind Beng Hong Toh,6 Mohd Razali Norhaya,7 Noor Aliza Md Tarekh,8 Che Wan Aminuddin Hashim,9 Mohammad Fauzi Abdul Rani,10 Aziah Ahmad Mahayiddin111Department of Medicine, UniversitiKebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; 2Department of Medicine, Penang Medical College, Penang, Malaysia; 3Department of Medicine, Faculty of Medicine UniversitiInstitutTeknologi MARA, Selangor, Malaysia; 4Department of Respiratory Medicine, Penang Hospital, Penang, Malaysia; 5Department of Respiratory Medicine, Hospital SultanahBahiyah, Alor Star, Kedah, Malaysia; 6Hospital Ipoh, Ipoh, Malaysia; 7Hospital SultanahNurZahirah, Kuala Terengganu, Malaysia; 8Hospital SultanahAminah, Johor Bahru, Malaysia; 9Hospital UniversitiSains Malaysia, Kelantan, Malaysia; 10Hospital TengkuAmpuanAfzan, Kuantan, Malaysia; 11Institute of Respiratory Medicine, Kuala Lumpur, MalaysiaBackground: Budesonide/formoterol used for both maintenance and reliever therapy has been shown to benefit patients with persistent asthma. We evaluated patient satisfaction and asthma control among Malaysian patients prescribed budesonide/formoterol as single maintenance and reliever therapy in a real-life clinical practice.Methods: Adult patients diagnosed with partially controlled or uncontrolled asthma were recruited in a 6-month, prospective, open-label study involving ten hospital-based chest clinics in Malaysia. Patients were prescribed one or two inhalations of budesonide/formoterol Turbuhaler (160/4.5 μg per inhalation) twice daily as maintenance therapy and additional inhalation as reliever therapy. Maintenance doses were decided by physicians based on Global Initiative for Asthma-defined treatment objectives. The primary outcome measure was the change in mean Satisfaction with Asthma Treatment Questionnaire (SATQ) scores from baseline to an average of 3 months and 6 months. Secondary outcome was the change in mean Asthma Control Questionnaire 5-item version (ACQ-5) scores from baseline to an average of 3 months and 6 months and the proportion of patients achieving the minimum clinically important difference.Results: Of 201 eligible patients recruited, 195 completed the study. Overall, SATQ mean (standard deviation) score was significantly improved from 5.1 (0.76) at baseline to 5.5 (0.58) (P < 0.001). The increase was observed in all domains of SATQ and had occurred at 3 months for most patients. ACQ-5 mean (standard deviation) score was significantly reduced from 2.2 (1.1
Applying patient centered approach in management of pulmonary tuberculosis: A case report from Malaysia
Atif M,Sulaiman SAS,Shafie AA,Muttalif AR
Journal of Basic and Clinical Pharmacy , 2011,
Abstract: A 24 year university student with history of productive cough was registered as sputum smear confirmed case of pulmonary tuberculosis. During treatment, patient suffered from itchiness associated with anti tuberculosis drugs and was treated with chlorpheniramine (4mg) tablet. Patient missed twenty eight doses of anti tuberculosis drugsin continuation phase claiming that he was very busy in his studies and assignments. Upon questioning he further explained that he was quite healthy after five months and unable to concentrate on his studies after taking prescribed medicines. His treatment was stopped based on clinical improvement, although he did not complete six months therapy. Two major reasons; false perception of being completely cured and side effects associated with anti TB drugs might be responsible for non adherence. Non sedative anti histamines like fexofenadine, citrizine or loratidine should be preferred over first generation anti histamines (chlorpheniramine) in patients with such lifestyle. Patient had not completed full course of chemotherapy, which is preliminary requirement for a case to be classified as “cure” and “treatment completed”. Moreover, patient had not defaulted for two consecutive months. Therefore, accordingto WHO treatment outcome categories, this patient can neither be classified as “cure” or “treatment completed” nor as “defaulter”. Further elaboration of WHO treatment outcome categories is required for adequate classification of patients with similar characteristics. Likelihood of non adherence can be significantly reduced by applying the WHO recommended “Patient Centered Approach” strategy. Close friend, class mate or family member can be selected as treatment supporter to ensure adherence to treatment.
Health-Related Quality of Life (HRQoL) in Co-Morbid Tuberculosis Relapse Patient: A Case Report from Malaysia
M Atif, SAS Sulaiman, AA Shafie, AR Muttalif, MA Hassali, F Saleem
Tropical Journal of Pharmaceutical Research , 2012,
Abstract: Purpose: To describe changes in HRQoL of pulmonary tuberculosis (PTB) patient and illustrate impact of malnutrition and Type II diabetes on relapse of PTB. Case: A Chinese male patient with complaints of productive cough, and loss of weight and appetite was registered; sputum smear confirmed that patient had PTB. Diagnosis was also supported by routine investigations. Patient had past history of PTB and Type II diabetes mellitus. For management of secondary tuberculosis, he was prescribed WHO recommended therapy. Elevated HbA1c levels and history of drop-off serum albumin concentration at the start of treatment demonstrated inappropriate glycaemic control and malnutrition over the past months. SF-36v2 was used to estimate HRQoL scores at start, after two months and at the end of TB therapy. Although patient’s perception of mental and physical health improved with progress of treatment, vitality (VT), social functioning (SF) and role emotion (RE) scores were still lower than Malaysian norms. Patient was declared ‘cured’ but state of ‘health’ as defined by WHO was not achieved. Conclusion: Relapse of PTB might be a consequence of inappropriate glycaemic control and malnutrition. This case report demonstrates the need for more comprehensive efforts at TB programs to improve HRQoL of TB patients.
Satisfaction levels and asthma control amongst Malaysian asthmatic patients on budesonide/formoterol maintenance and reliever therapy: experience in a real-life setting
Abdul Manap R, Loh LC, Tengku Ismail TS, Muttalif AR, Simon GK, Toh RB, Norhaya MR, Md Tarekh NA, Hashim CW, Abdul Rani MF, Ahmad Mahayiddin A
Patient Related Outcome Measures , 2012, DOI: http://dx.doi.org/10.2147/PROM.S19211
Abstract: tisfaction levels and asthma control amongst Malaysian asthmatic patients on budesonide/formoterol maintenance and reliever therapy: experience in a real-life setting Original Research (709) Total Article Views Authors: Abdul Manap R, Loh LC, Tengku Ismail TS, Muttalif AR, Simon GK, Toh RB, Norhaya MR, Md Tarekh NA, Hashim CW, Abdul Rani MF, Ahmad Mahayiddin A Published Date November 2012 Volume 2012:3 Pages 71 - 78 DOI: http://dx.doi.org/10.2147/PROM.S19211 Received: 01 March 2011 Accepted: 15 August 2011 Published: 07 November 2012 Roslina Abdul Manap,1 Li Cher Loh,2 Tengku Saifudin Tengku Ismail,3 Abdul Razak Muttalif,4 George Kutty Simon,5 Rosalind Beng Hong Toh,6 Mohd Razali Norhaya,7 Noor Aliza Md Tarekh,8 Che Wan Aminuddin Hashim,9 Mohammad Fauzi Abdul Rani,10 Aziah Ahmad Mahayiddin11 1Department of Medicine, UniversitiKebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; 2Department of Medicine, Penang Medical College, Penang, Malaysia; 3Department of Medicine, Faculty of Medicine UniversitiInstitutTeknologi MARA, Selangor, Malaysia; 4Department of Respiratory Medicine, Penang Hospital, Penang, Malaysia; 5Department of Respiratory Medicine, Hospital SultanahBahiyah, Alor Star, Kedah, Malaysia; 6Hospital Ipoh, Ipoh, Malaysia; 7Hospital SultanahNurZahirah, Kuala Terengganu, Malaysia; 8Hospital SultanahAminah, Johor Bahru, Malaysia; 9Hospital UniversitiSains Malaysia, Kelantan, Malaysia; 10Hospital TengkuAmpuanAfzan, Kuantan, Malaysia; 11Institute of Respiratory Medicine, Kuala Lumpur, Malaysia Background: Budesonide/formoterol used for both maintenance and reliever therapy has been shown to benefit patients with persistent asthma. We evaluated patient satisfaction and asthma control among Malaysian patients prescribed budesonide/formoterol as single maintenance and reliever therapy in a real-life clinical practice. Methods: Adult patients diagnosed with partially controlled or uncontrolled asthma were recruited in a 6-month, prospective, open-label study involving ten hospital-based chest clinics in Malaysia. Patients were prescribed one or two inhalations of budesonide/formoterol Turbuhaler (160/4.5 μg per inhalation) twice daily as maintenance therapy and additional inhalation as reliever therapy. Maintenance doses were decided by physicians based on Global Initiative for Asthma-defined treatment objectives. The primary outcome measure was the change in mean Satisfaction with Asthma Treatment Questionnaire (SATQ) scores from baseline to an average of 3 months and 6 months. Secondary outcome was the change in mean Asthma Control Questionnaire 5-item version (ACQ-5) scores from baseline to an average of 3 months and 6 months and the proportion of patients achieving the minimum clinically important difference. Results: Of 201 eligible patients recruited, 195 completed the study. Overall, SATQ mean (standard deviation) score was significantly improved from 5.1 (0.76) at baseline to 5.5 (0.58) (P < 0.001). The increase was observed in al
A survey on tuberculosis cases in Penang hospital: preliminary findings
Elfatih Ibrahim Elamin,Abdul Razak Muttalif,Mohamed Izham Mohamed Ibrahim,Syed Azhar Syed Sulaiman
Malaysian Journal of Pharmaceutical Sciences , 2004,
Abstract:
Sputum Bacteriology And In-Vitro Antibiotic Susceptibility In Hospitalized Patients With Community Acquired Pneumonia In A State Tertiary - Referral Hospital – A Retrospective Study
Yow-Wen Chin,Li-Cher Loh,Thim-Fatt Wong,Abdul Razak Muttalif
International e-Journal of Science, Medicine & Education , 2007,
Abstract: Introduction: To review the sputum bacteriology and itsin-vitro antibiotic susceptibility in patients hospitalizedwith community-acquired pneumonia (CAP) in a statetertiary-referral Hospital (Penang hospital, Malaysia) inorder to determine the most appropriate empiricantibiotics.Methods: From September 2006 to May 2007,68 immunocompetent adult patients [mean age: 52years (range 16-89); 69% male] admitted to respiratorywards for CAP with positive sputum isolates within 48hours of admission were retrospectively identified andreviewed.Results: 62 isolates were Gram(-) bacilli (91%) &6 were Gram(+) cocci (9%). The two commonestpathogens isolated were Pseudomonas aeruginosa(n=20) and Klebsiella pneumoniae (n=19)together constituted 57% of all positive isolates.Among the Pseudomonas isolates, 84.2% were fullysensitive to cefoperazone and cefoperazon/sulbactam;95% to ceftazidime, cefepime, piperacillin/tazobactam,ciprofloxacin and amikacin, and 100% to gentamycin,netilmycin, imipenem and meropenem. Among theKlebsiella isolates, 5.3% were fully sensitive toampicillin; 84.2% to amoxicillin, ampicllin/sulbactam,cefuroxime and ceftriazone; 89.5% to piperacillin/tazobactam; 93.3% to cefoperazon/sulbactam and 100%sensitive to ceftazidime, cefepime, ciprofloxacin,all aminoglycosides and carbopenems.Conclusion: In view of the high prevalence ofrespiratory Pseudomonas aeruginosa, ampicillin/sulbactam, currently the most prescribed antibiotic totreat CAP in our respiratory wards, may not be the mostappropriate empiric choice. Higher generationcephalosporins with or without beta-lactamaseinhibitors, ciprofloxacin or carbapenem may be themore appropriate choices. The lack of information onpatients’ premorbidities such as recent hospitalizationand prior antibiotic exposure, limits the interpretationof our findings and may have biased our results towardshigher rates of Gram negative organisms.
Tuberculosis-HIV Coinfection: The Relationship Between Manifestation Of Tuberculosis And The Degree Of Immunosuppression (CD4 Counts)
C K Ong,W C Tan,K N Leong,A R Muttalif
International e-Journal of Science, Medicine & Education , 2008,
Abstract: The incidence of tuberculosis (TB) iscurrently increasing. HIV induced immuno-suppressionmodifies the clinical presentation of TB. Our aim is todetermine the differences in clinical presentation ofHIV-TB co-infection based on their CD4 counts.This retrospective study looked at cases of adult activeTB and HIV-1 co-infection treated in Penang Hospitalfrom January 2004 to December 2005. Of the820 patients treated for active TB, HIV-1 seropositivityrate was 12.6% (103 patients). Majority of HIV-1co-infected patients presented with prolonged insidiousand non-specific symptoms like weight loss, fever andnight sweats. The clinical presentation of TB dependedon the stage of HIV-1 infection and associateddegree of immunodeficiency. Compared to the lessimmuno-compromised HIV-1 and TB co-infectedpopulation (CD4 > 200/mm3), patients with CD4counts 2 200 are more likely to have atypical chestradiographs (P = 0.009). During active TB, theMantoux test was positive in 12 (14.5%) HIV-1 infectedpatients with a CD4 counts 2 200/mm3 and in 16 (80%)of those with CD4 counts > 200/mm3 (P = 0.0001).In our series, the AFB smear / AFB culture and typeof TB did not show obvious correlation withCD4 counts. Therefore to diagnose TB in severelyimmuno-compromised HIV patients, we need to have ahigh index of suspicion.
Gender differences in the prevalence of Tuberculous Lymphadenitis at the State of Penang, Malaysia: Findings from a cross-sectional study
Amer Hayat Khan*, Syed Azhar Syed Sulaiman,Abdul Razak Muttalif,Mohamed Azmi Hassali,Ridhwan Abdullah
Archives of Pharmacy Practice , 2010,
Abstract: Objective: To evaluate the prevalence of tuberculous lymphadenitis on the basis of gender in the northern state of Malaysia.Materials and Methods: Current study was divided into two phases (Retrospective and Prospective), which was conducted at the Department of Chest in General Hospital Penang. Patient records were reviewed retrospectively, and prospectively to identify patients with confirmed diagnosis of tuberculous lymphadenitis under the clinical signs and symptoms, and laboratory tests from January 2006 to December 2008. Data were analyzed using SPSS version 16.Results: One hundred and nine patients (7.2%) with confirmed tuberculosis lymphadenitis cases were found,among 1516 of total TB cases. The mean age of the patients was 36.4±12.87. The male to female ratio was 1.4:1. Ethnically,45 (41.3%) were Malay followed by Chinese 37 (33.9%).Among the risk factors were, HIV and diabetes mellitus, 17(15.6%) and 11(10.0%) respectively. Cough and fever were the most common symptoms in both gender groups. Night sweat,cough, shortness of breathing were observed more in male than female, while swelling of lymph nodes, loss of appetite,loss of weight, haemoptysis, and chest pain were higher in female. In the majority, 90 (82.5%) positive results were obtained by fine needle aspiration (FNA) cytology. Overall sixtytwo (56.9%) patients were successfully treated, 5 (4.6%)patients died during the treatment, while male were higher in successfully treated (59.7%).Conclusion: Incidence of TB Lymphadenitis was found higher among Malay men. Diabetes mellitus and HIV are the most commonly reported risk factors and co-morbidities playing an important role in treatment success while, 12 months treatment were observed among 10 (9.2%) of cases. Treatment successful rate were higher in male as compare to female.
Seizure precipitated during long haul flight
AR Devkota,AR Karki
Journal of Institute of Medicine , 2010, DOI: 10.3126/joim.v32i3.4962
Abstract: We report three diagnosed cases of epilepsy under medication that were on long haul flight from Kathmandu to different destinations in USA with different clinical outcomes during flight. The first case had brief seizure like episode during flight and was given oral benzodiazepine. The second case was put on prophylactic oral benzodiazepine to induce sleep and reduce seizure threshold and had an uneventful flight. The third case developed generalized tonic clonic seizure and was managed accordingly. Key words: Epilepsy; long haul flight; seizure. DOI: http://dx.doi.org/10.3126/joim.v32i3.4962 Journal of Institute of Medicine , December, 2010; 32:3 59-61
Economic Analysis of Biodiesel and Glycerol Carbonate Production Plant by Glycerolysis  [PDF]
Nghi Nguyen, Ya?ar Demirel
Journal of Sustainable Bioenergy Systems (JSBS) , 2013, DOI: 10.4236/jsbs.2013.33029
Abstract: Techno-economic analysis of an indirect use of carbon dioxide within the route of glycerolysis of glycerol with urea is investigated. The results show that the net present value of the biodiesel-glycerol carbonate production by glycerolysis is higher than the biodiesel-glycerol carbonate production by direct carboxylationat at the end of the 12-year operation with similar capacities. The stochastic model has predicted that using glycerolysis route for the synthesis of glycerol carbonate production might increase the probability of getting positive net present value by about 15%.
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