Health-Related Quality of Life (HRQoL) in Co-Morbid Tuberculosis Relapse Patient: A Case Report from Malaysia

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.Keywords: Health-Related Quality of Life, Pulmonary tuberculosis, Malnutrition, Type II diabetes, SF 36v

Pleural Tuberculosis and its Treatment Outcomes

Purpose: To evaluate the incidence, treatment and clinical outcomes of tuberculosis pleuritis at a hospital in the state of Penang, Malaysia.Methods: A retrospective study was conducted in Hospital of Penang, Malaysia. Patient records were reviewed retrospectively to identify patients with confirmed diagnosis of tuberculous pleuritis from January 2006 to December 2008. Chest x-ray (CXR) and pleural biopsy were carried out on all patients. Directly observed therapy (DOT) was given to all patients. Data were analyzed using SPSS version 16.Results: Of 1548 tuberculosis cases, 80 (5.2 %) patients had tuberculous pleuritis. The mean age of the patients was 35.4 ± 12.87 years, with a male to female ratio of 3.4:1. Ethnically, a plurality (n = 30, 37.7 %) of cases among tuberculosis pleuritis patients were Chinese, followed by Malay (31.2 %). Out of the 80 patients with tuberculous pleuritis, 10 (12.5 %) also had diabetes mellitus, and 8 (10.0 %) HIV/AIDS. Fever, cough, chest pain and shortness of breathing were the most frequently reported symptoms. Treatment success rate was 1.558 times higher among TB group than pleuritis TB group (Odds ratio, 95 % CI, 1.06 – 2.59, p = 0.025).Conclusion: The incidence of TB pleuritis was gender- and race-related, with DM and HIV the most commonly reported risk factors. Treatment success rate was higher among pulmonary TB group than in those with TB pleuritis (extra pulmonary TB).Keywords: Tuberculosis, Pleuritis, HIV/AIDS, Biopsy, Pulmonary

Time for a new language for asthma control : Results from REALISE Asia

Acknowledgments: This study was supported and funded by Mundipharma Pte Ltd. Online survey and statistical analysis were performed by Pei-Li Teh, Rachel Howard, Tsin-Li Chua, and Jie Sun of Research Partnership Pte Ltd. Medical writing support was provided by Sen-Kwan Tay of Research2Trials Clinical Solutions Pte Ltd.Peer reviewedPublisher PD

Tobacco use prevalence, knowledge, and attitudes among newly diagnosed tuberculosis patients in Penang State and Wilayah Persekutuan Kuala Lumpur, Malaysia

<p>Abstract</p> <p>Background</p> <p>There is sufficient evidence to conclude that tobacco smoking is strongly linked to tuberculosis (TB) and a large proportion of TB patients may be active smokers. In addition, a previous analysis has suggested that a considerable proportion of the global burden of TB may be attributable to smoking. However, there is paucity of information on the prevalence of tobacco smoking among TB patients in Malaysia. Moreover, the tobacco-related knowledge, attitudes, and behaviors of TB patients who are smokers have not been previously explored. This study aimed to document the prevalence of smoking among newly diagnosed TB patients and to learn about the tobacco use knowledge and attitudes of those who are smokers among this population.</p> <p>Methods</p> <p>Data were generated on prevalence rates of smoking among newly diagnosed TB patients in the State of Penang from January 2008 to December 2008. The data were obtained based on a review of routinely collated data from the quarterly report on TB case registration. The study setting comprised of five healthcare facilities (TB clinics) located within Penang and Wilayah Persekutuan, Kuala Lumpur health districts in Malaysia, which were involved in a larger project, known as SCIDOTS Project. A 58-item questionnaire was used to assess the tobacco use knowledge, attitudes and behaviors of those TB patients who were smokers.</p> <p>Results</p> <p>Smoking status was determinant in 817 of 943 new cases of TB from January to December 2008. Of this, it was estimated that the prevalence rates of current- and ex-smoking among the TB patients were 40.27% (329/817) and 13.95% (114/817), respectively. The prevalence of ever-smoking among patients with TB was estimated to be 54,220 per 100,000 population. Of 120 eligible participants for the SCIDOTS Project, 88 responded to the survey (73.3% response rate) and 80 surveys were analyzed (66.7% usable rate). The mean (± SD) total score of tobacco use knowledge items was 4.23 ± 2.66 (maximum possible score=11). More than half of the participants (51.3%) were moderately dependent to nicotine. A moderately large proportion of the respondents (41.2%) reported that they have ever attempted to quit smoking, while more than half (56.3%) have not. Less than half (47.5%) of the study participants had knowledge about the body system on which cigarette smoking has the greatest negative effect. The majority wrongly believed that smokeless tobacco can increase athletic performance (60%) and that it is a safe and harmless product (46.2%). An overwhelming proportion (>80%) of the patients believed that: smoking is a waste of money, tobacco use is very dangerous to health, and that smokers are more likely to die from heart disease when compared with non-smokers. The use of smokeless tobacco was moderately prevalent among the participants with 28.8% reporting ever snuffed, but the use of cigar and pipe was uncommon.</p> <p>Conclusion</p> <p>Smoking prevalence rate is high among patients with TB in Malaysia. These patients generally had deficiencies in knowledge of tobacco use and its health dangers, but had positive attitudes against tobacco use. Efforts should be geared towards reducing tobacco use among this population due to its negative impact on TB treatment outcomes.</p

Impact of chronic obstructive pulmonary disease (COPD) in the Asia-Pacific region: the EPIC Asia population-based survey.

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Impact of connecting tuberculosis directly observed therapy short-course with smoking cessation on health-related quality of life

<p>Abstract</p> <p>Background</p> <p>With evolving evidence of association between tuberculosis (TB) and tobacco smoking, recommendations for the inclusion of tobacco cessation interventions in TB care are becoming increasingly important and more widely disseminated. Connecting TB and tobacco cessation interventions has been strongly advocated as this may yield better outcomes. However, no study has documented the impact of such connection on health-related quality of life (HRQoL). The objective of this study was to document the impact of an integrated TB directly observed therapy short-course (DOTS) plus smoking cessation intervention (SCI) on HRQoL.</p> <p>Methods</p> <p>This was a multi-centered non-randomized controlled study involving 120 TB patients who were current smokers at the time of TB diagnosis in Malaysia. Patients were assigned to either of two groups: the usual TB-DOTS plus SCI (SCIDOTS group) or the usual TB-DOTS only (DOTS group). The effect of the novel strategy on HRQoL was measured using EQ-5D questionnaire. Two-way repeated measure ANOVA was used to examine the effects.</p> <p>Results</p> <p>When compared, participants who received the integrated intervention had a better HRQoL than those who received the usual TB care. The SCIDOTS group had a significantly greater increase in EQ-5D utility score than the DOTS group during 6 months follow-up (mean ± SD = 0.98 ± 0.08 vs. 0.91 ± 0.14, <it>p </it>= 0.006). Similarly, the mean scores for EQ-VAS showed a consistently similar trend as the EQ-5D indices, with the scores increasing over the course of TB treatment. Furthermore, for the EQ-VAS, there were significant main effects for group [F (1, 84) = 4.91, <it>p </it>= 0.029, η²= 0.06], time [F (2, 168) = 139.50, <it>p </it>= < 0.001, η²= 0.62] and group x time interaction [F (2, 168) = 13.89, <it>p </it>= < 0.001, η²= 0.14].</p> <p>Conclusions</p> <p>This study supports the evidence that an integrated TB-tobacco treatment strategy could potentially improve overall quality of life outcomes among TB patients who are smokers.</p

Spirometry outcomes in survivors of COVID-19 pneumonia

Introduction: Acute COVID-19 infection could lead to long COVID, a heterogenous condition which includes the respiratory system. But data on long-term respiratory complications are scarce and limited especially from our part of the world. Methods: A total of 443 post COVID-19 patients were recruited from post COVID-19 clinic. The following assessments were performed in all patients; symptoms, 6-minute-walk-test (6MWT), 1-minute-sit-to-stand-test (1STST), spirometry, and chest radiograph. Results: Patient’s mean age was 51 (13) years old, majority were male (60%), and Malay ethnicity (73%). Majority were in category severe (n=254, 57%), critical (n=122, 28%) and moderate (n=67, 15%). Abnormal spirometry (FVC 4% during 6MWT and 1STST, OR 1.8 (1.1-2.9) and OR 1.7 (1.1-2.6) respectively, and abnormal chest radiograph, OR 3.9 (2.5-6.2) compared to those with normal spirometry findings. 125 patients have full lung function test and gas transfer done which showed reduced TLC (80%) in majority of cases; 80% (n = 100), 86.4% (n = 108) and 94% (n = 117). Conclusion: Abnormal spirometry findings are common among post COVID-19 patients with pneumonia and are associated with poorer respiratory outcomes; exertional oxygen desaturation and abnormal chest radiograph. Therefore, these groups of patients should be referred for spirometry assessmen

Discrepancy between patient-perception and guideline-defined asthma control in Asia: a survey of over 2400 patients

Open Access JournalThis journal suppl. entitled: Abstracts from the Respiratory Effectiveness Group's inaugural summit, June 2014BACKGROUND/AIM: A recent survey (REALISETM) has revealed that patients in Europe perceive their asthma to be well-controlled despite the presence of symptoms. We report data from a similar survey of patients to assess if such discrepancy is seen in Asia. METHODS: Online surveys were completed by patients (aged 18-50 years, X2 prescriptions for asthma in the past two years), recruited via validated consumer panels from 8 countries in Asia. RESULTS: A total of 2,467 patients participated, split across the following geographies: Mainland China (30%), Hong Kong (8%), Indonesia (7%), Korea (20%), Malaysia (6%), Philippines (6%), Singapore (8%), and Taiwan (12%). Mean age of respondents was 34 years, with relatively equal proportion of males (54%) and females (46%). While 89% considered their asthma to be well-controlled, only 18% were classified as such according to GINA guidelines, the rest being partly controlled (32%) and uncontrolled (50%). In the past 7 days before completing the survey, 35% used their ...postprin