Irfhan Ali

Treatment outcome of new smear positive pulmonary tuberculosis patients in Penang, Malaysia

BackgroundAccording to the World Health Organization’s recent report, in Malaysia, tuberculosis (TB) treatment success rate for new smear positive pulmonary tuberculosis (PTB) patients is still below the global success target of 85%. In this study, we evaluated TB treatment outcome among new smear positive PTB patients, and identified the predictors of unsuccessful treatment outcome and longer duration of treatment (i.e., > 6 months).MethodsThe population in this study consisted of all new smear positive PTB patients who were diagnosed at the chest clinic of Penang General Hospital between March 2010 and February 2011. During the study period, a standardized data collection form was used to obtain socio-demographic, clinical and treatment related data of the patients from their medical charts and TB notification forms (Tuberculosis Information System; TBIS). These data sources were reviewed at the time of the diagnosis of the patients and then at the subsequent follow-up visits until their final treatment outcomes were available. The treatment outcomes of the patients were reported in line with six outcome categories recommended by World Health Organization. Multiple logistic regression analysis was used to find the independent risk factors for unsuccessful treatment outcome and longer treatment duration. Data were analyzed using the PASW (Predictive Analysis SoftWare, version 19.0. Armonk, NY: IBM Corp).ResultsAmong the 336 PTB patients (236 male and 100 female) notified during the study period, the treatment success rate was 67.26% (n = 226). Out of 110 patients in unsuccessful outcome category, 30 defaulted from the treatment, 59 died and 21 were transferred to other health care facilities. The mean duration of TB treatment was 8.19 (SD 1.65) months. In multiple logistic regression analysis, risk factors for unsuccessful treatment outcome were foreign nationality, male gender and being illiterate. Similarly, risk factors for mortality due to TB included high-grade sputum and presence of lung cavities at the start of treatment, being alcoholic and elderly. Likewise, concurrent diabetes, presence of lung cavities at the start of the treatment and being a smoker were the significant predictors of longer treatment duration.ConclusionOur findings indicated that the treatment success rate among the new smear positive PTB patients was less than the success target set by World Health Organization. The proportion of patients in the successful outcome category may be increased by closely monitoring the treatment progress of the patients with aforementioned high risk characteristics. Similarly, more aggressive follow-up of the treatment defaulters and transferred out patients could also improve the TB treatment success rate.

WHO guidelines for treatment of tuberculosis: the missing links

Worldwide, the treatment of tuberculosis is based on evidence-based guidelines developed by the World Health Organization (WHO) for national tuberculosis programs. However, the importance of health related quality of life, the adequate management of side effects associated with antituberculosis drugs and the elaboration of tuberculosis treatment outcome categories are a few issues that need to be addressed in forthcoming WHO guidelines for the treatment of tuberculosis.

Tracing contacts of TB patients in Malaysia: costs and practicality

Tuberculin skin testing (TST) and chest X-ray are the conventional methods used for tracing suspected tuberculosis (TB) patients. The purpose of the study was to calculate the cost incurred by Penang General Hospital on performing one contact tracing procedure using an activity based costing approach. Contact tracing records (including the demographic profile of contacts and outcome of the contact tracing procedure) from March 2010 until February 2011 were retrospectively obtained from the TB contact tracing record book. The human resource cost was calculated by multiplying the mean time spent (in minutes) by employees doing a specific activity by their per-minute salaries. The costs of consumables, Purified Protein Derivative vials and clinical equipment were obtained from the procurement section of the Pharmacy and Radiology Departments. The cost of the building was calculated by multiplying the area of space used by the facility with the unit cost of the public building department. Straight-line deprecation with a discount rate of 3% was assumed for the calculation of equivalent annual costs for the building and machines. Out of 1024 contact tracing procedures, TST was positive (≥10 mm) in 38 suspects. However, chemoprophylaxis was started in none. Yield of contact tracing (active tuberculosis) was as low as 0.5%. The total unit cost of chest X-ray and TST was MYR 9.23 (2.90 USD) & MYR 11.80 (USD 3.70), respectively. The total cost incurred on a single contact tracing procedure was MYR 21.03 (USD 6.60). Our findings suggest that the yield of contact tracing was very low which may be attributed to an inappropriate prioritization process. TST may be replaced with more accurate and specific methods (interferon gamma release assay) in highly prioritized contacts; or TST-positive contacts should be administered 6H therapy (provided that the chest radiography excludes TB) in accordance with standard protocols. The unit cost of contact tracing can be significantly reduced if radiological examination is done only in TST or IRGA positive contacts.

Hospitalisation of multi-ethnic older patients with AECOPD: Exploration of the occurrence of anxiety, depression and factor associated with short term hospital readmission.

The elderly, with chronic obstructive pulmonary disease (COPD), are at a higher risk of hospitalisation due to acute exacerbation of COPD (AECOPD). They also often encounter multiple co‐morbidities.

An assessment of adherence to asthma medication guidelines: findingsfrom a tertiary care center in the state of Penang, Malaysia.

BACKGROUND/AIM Multiple asthma guidelines have been developed to reduce asthma mortality, morbidity, and cost associated with asthma worldwide. In Malaysia, within this context, it is relatively unknown to what extent doctors adhere to the asthma guidelines. This study aimed to assess guideline adherence and calculate the cost of adhered and nonadhered prescriptions by medical doctors in a public tertiary health care facility. MATERIALS AND METHODS A cross-sectional study was carried out at Hospital Pulau Pinang, Malaysia. One hundred and eighty patients, a total of 30 patients per doctor, were enrolled to assess guideline adherence. The patients were followed for a second visit to assess their lung function. The costs of adhered and nonadhered prescriptions were calculated. RESULTS One hundred and forty-three patients (79%) received guideline (Global Initiative for Asthma 2011)-adhering pharmacotherapy. In the majority of patients (n = 133, 73.9%) asthma control was classified as partially controlled. There was no significant association observed between patient asthma control and patient demographics; however, there was a significant difference (P < 0.001) between lung function values from the first and second visits. The cost of adhered prescription was higher (70.1 Malaysian ringgit) than that of nonadhered prescription (13.74 Malaysian ringgit). CONCLUSION Fair levels of guideline adherence were observed. Emphasis should be placed on identifying appropriate cost-effective medication regimens based on patient asthma control and constant feedback from patients.

Physicians’ Adherence to Asthma Guidelines: A Prospective Prescription Review from Tertiary Care Hospital, Malaysia

RESEARCH ARTICLE Physicians’ Adherence to Asthma Guidelines: A Prospective Prescription Review from Tertiary Care Hospital, Malaysia Raja Ahsan Aftab, Amer Hayat Khan, Syed Azhar Syed Sulaiman and Irfhan Ali Department of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, 11800 Penang, Malaysia School Of Pharmacy, Taylor’s University, Subang Jaya, Selangor, Malaysia Department of Respiratory Medicine, Penang General Hospital, Penang, Malaysia

Addressing tuberculosis management in context of default and side effects associated with anti tuberculosis drugs: A case report from Malaysia

A 22 year hotel waitress with history of productive cough was registered as sputum smear confirmed case of pulmonary tuberculosis. Time delay between onset of symptoms and start of treatment was two months. During the first month of treatment, patient suffered from itchiness and skin rashes associated with anti tuberculosis drugs, which were treated with chlorpheniramine (oral; 4 mg), citrizine (oral; 5 mg) and betamethasone (local application; 0.122% w/w). Patient missed 16 (out of 32) doses of anti TB drugs in continuation phase claiming that she was very busy at work place and forgot to take medication. Although, at the end of treatment, patient’s perception of mental and physical health was improved but ‘social functioning’ and ‘role emotion’ scores were still below Malaysian norms suggesting perceived stigma and lack of tuberculosis knowledge. Patient was classified as cured, though, she did not complete full course of chemotherapy, which is the preliminary requirement for a case to be classified as “cured” or “treatment completed”. Patients working in crowded areas like restaurants, bus stations or market should be isolated from community until they are non-infectious. Use of non sedative anti histamines like fexofenadine, or loratidine should be preferred over first generation anti histamines (chlorpheniramine) in patients with such a lifestyle. Anti tuberculosis treatment should be stopped until rashes are completely resolved. World Health Organization (WHO) has recommended applying “Patient Centered Approach” to cope with the defaulters. There is need for more inclusive efforts of National Tuberculosis Control Programs to improve health related quality of the life of tuberculosis patients.