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Current trends in morbidity and mortality of children in Malaysia

Lin, Hai Peng, Mohd Sham Kasim

Malaysian Journal of Child Health, 1997;9(2):104-132.
MyJurnal

Malaysia is a rapidly developing country with a very young population, about 36% of which are below the age of 15 years. The standard of child health has improved greatly. However, there are great changes in the morbidity and mortality patterns of childhood diseases relating mainly to an improved standard of living; availability of safe water supply and adequate sanitary latrines; a higher literacy rate; rapid industrialisation and urban migration. The infant mortality rate has droppedfrom 50.1 per 1,000 livebirths in 1986 to 10.4 in 1995, and similar trends apply also to neonatal, perinatal and toddler mortality rates. Nevertheless, current major child health problems are those relating to events in the perinatal period and to infections. Despite improvements in the standard of neonatal care with the use ofhigh technology, the commonest cause of certified deaths still occur in the neonatal period. A rapid and inexpensive screening test for G6PD deficiency, a disease present in 2-3% of the population, is now widely available and, together with the use of phototherapy is largely responsible for the declining incidence of kernicterus in the country. Infections remain an important cause of morbidity and mortality although their patterns have changed. The very high (>95%) WHO-EPI-vaccines coverage rate is linked to the great reduction in the incidence of diphtheria, pertussis, tetanus, poliomyelitis and measles. Childhood tuberculosis is less common now, with about 250 - 300 reported cases per year and TB meningitis is rare with about 30-40 reported cases/year. The hepatitis B carrier rate is high (5%) and the introduction of routine newborn hepatitis B vaccination in 1989 is expected to have a positive impact as is the immunisation of young girls against rubella introduced in 1985 in reducing the incidence of congenital rubella syndrome. The incidence of malaria has declined but remains prevalent in the interiors of PeninsularMalaysia and in Sabah and Sarawak. Filariasis is largely under control. Unfortunately, despite great efforts at mosquito control, dengue virus infection remains a major problem with thousands of cases reported every year. Children are most susceptible to dengue haemorrhagic fever with many dying from the shock syndrome. The incidence of acute gastroenteritis has also dropped with most cases being due to a viral aetiology. Acute respiratory infections, mostly viral in origin, account for most attendances at paediatric outpatient services. Although staphylococcal and streptococcal impetigo and pneumonia are common, the incidence of streptococcal related diseases like rheumatic fever and acute glomendonephritis is rapidly declining. The nutritional status of children has improved in tandem with the rise in the standard of living, but subclinical malnutrition is prevalent, particularly among urban squatters and the rural poor. There is a disturbing decline in breastfeeding among urban working mothers. Poor weaning practices and food habits are responsible for the common occurrence of nutritional anaemia (5%) among infants and young children. Greater prosperity, rapid industrialisation and urbanisation have resulted in changes in the childhood disease pattern where non-communicable diseases assume greater importance as the problems of malnutrition and infection are gradually overcome. Road traffic accidents are a major killer and home accidents, largely preventable, are an important cause of morbidity and mortality. Childhood cancer, with about 550 new cases a year, is an important cause of death beyond infancy. Major congenital malformations, with a 1% prevalence rate, cause much ill-health. Thalassaemia is a particularly common genetic disease with fl thalassaemia gene frequency of about 5%. The prevalence of asthma is increasing, with a rate of 13.9% in the Kiang Valley but the prevalence of asthma-related symptoms is much higher. Physical, sexual child abuse and neglect, abandoned babies, substance abuse are but signs of stress of modern city living and peoples inability to cope with it. Although the general standard of child health has greatly improved, there are several states where it is still not satisfactory. In Sabah where there is a large illegal immigrant population, the infant mortality and infection rates are relatively high. In Kelantan and Trengganu, it is common for parents to refuse permission for a lumbar puncture required to treat meningitis. Other still deeply entrenched, culturally-related adverse health practices include : a fatalistic attitude to illness; a preference for traditional practitioners of medicine resulting in late treatment; and 'doctor-hopping' with unrealistic expectations of 'instant cure'. Childhood illnesses that are uncommon in Malaysia include: cystic fibrosis, coeliac disease, ulcerative colitis, Crohns disease, Sudden Infant Death Syndrome, Encopresis, enuresis and epiglottitis due to Haemophilus Influen:ae.

Matched MeSH terms: Asthma
Clinical features of allergic rhinitis and skin prick test analysis based on the ARIA classification: a preliminary study in Malaysia

Asha'ari ZA, Yusof S, Ismail R, Che Hussin CM

Ann Acad Med Singap, 2010 Aug;39(8):619-24.
PMID: 20838703

INTRODUCTION: Allergic rhinitis (AR) is a prevalent disease worldwide but is still underdiagnosed in many parts of Asia. We studied the clinical profiles of AR patients in our community based on the new ARIA classification and investigated the aetiological allergens using a skin prick test.
MATERIALS AND METHODS: In 2008, 142 newly diagnosed patients with AR were seen and underwent skin prick testing with 90 patients completing the study.
RESULTS: Intermittent mild and moderate/severe AR were evident in 10% and 21.1% of the patients, while persistent mild and moderate/severe were seen in 20% and 48.9%, respectively. Rhinitis and asthma co-morbidity occurred in 28.8% with asthma incidence significantly higher in persistent AR (P = 0.002). There was no significant association between AR severity, city living and asthma co-morbidity. Nasal itchiness and sneezing were the main presenting complaints and were more common in intermittent AR (P <0.05). Sleep disturbance was associated with moderate-severe AR (P <0.05). Polypoidal mucosa was associated with asthma co-morbidity (P <0.05). Monosensitivity reaction occurred in 12.2% of patients and was associated with fungi sensitivity (P <0.05). Majority of patients were oligosensitive (52.8%) and polysensitive (34.4%) and were significantly associated with moderate-severe persistent AR (P <0.01). The highest positive skin prick reaction and the largest average wheal diameter were for the house dust mites and cat allergen (P <0.05).
CONCLUSION: Our results reflected the AR profiles in our country, which was comparable with typical profiles of the neighbouring country and other Mediterranean countries with a similar temperate climate.

Matched MeSH terms: Asthma
Objective cough frequency, airway inflammation, and disease control in asthma

Marsden PA, Satia I, Ibrahim B, Woodcock A, Yates L, Donnelly I, et al.

Chest, 2016 06;149(6):1460-6.
PMID: 26973014 DOI: 10.1016/j.chest.2016.02.676

BACKGROUND: Cough is recognized as an important troublesome symptom in the diagnosis and monitoring of asthma. Asthma control is thought to be determined by the degree of airway inflammation and hyperresponsiveness but how these factors relate to cough frequency is unclear. The goal of this study was to investigate the relationships between objective cough frequency, disease control, airflow obstruction, and airway inflammation in asthma.

METHODS: Participants with asthma underwent 24-h ambulatory cough monitoring and assessment of exhaled nitric oxide, spirometry, methacholine challenge, and sputum induction (cell counts and inflammatory mediator levels). Asthma control was assessed by using the Global Initiative for Asthma (GINA) classification and the Asthma Control Questionnaire (ACQ). The number of cough sounds was manually counted and expressed as coughs per hour (c/h).

RESULTS: Eighty-nine subjects with asthma (mean ± SD age, 57 ± 12 years; 57% female) were recruited. According to GINA criteria, 18 (20.2%) patients were classified as controlled, 39 (43.8%) partly controlled, and 32 (36%) uncontrolled; the median ACQ score was 1 (range, 0.0-4.4). The 6-item ACQ correlated with 24-h cough frequency (r = 0.40; P < .001), and patients with uncontrolled asthma (per GINA criteria) had higher median 24-h cough frequency (4.2 c/h; range, 0.3-27.6) compared with partially controlled asthma (1.8 c/h; range, 0.2-25.3; P = .01) and controlled asthma (1.7 c/h; range, 0.3-6.7; P = .002). Measures of airway inflammation were not significantly different between GINA categories and were not correlated with ACQ. In multivariate analyses, increasing cough frequency and worsening FEV1 independently predicted measures of asthma control.

CONCLUSIONS: Ambulatory cough frequency monitoring provides an objective assessment of asthma symptoms that correlates with standard measures of asthma control but not airflow obstruction or airway inflammation. Moreover, cough frequency and airflow obstruction represent independent dimensions of asthma control.

Matched MeSH terms: Asthma
Fulltext Effect of Ocimum sanctum (Tulsi) aqueous leaf extract on prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) of human plasma

Gunendren, M., Noordin S.S., Muggundha, R., Nozlena A.S.

Journal of Biomedical and Clinical Sciences, 2017;2(1):62-68.
MyJurnal

Conventional anticoagulant therapy is the mainstay of medical treatment for deep vein thrombosis disorders. However,there are many complications associated with these agents such as bleeding. Hence, the search for novel anticoagulant derived from natural substances such as plants origin is in high demand nowadays. Ocimum sanctum(O.sanctum) also known as Ocimum tenuiform (OT), tulsi or holy basil from the family of Lamiaceae has been widely used for thousands of years in Ayurveda and Unani systems to cure or prevent a number of illnessessuch as headache, malaria, ulcers, bronchitis, cough, flu, sore throat and asthma. The objective is to investigate theeffect ofO. sanctum(Tulsi) aqueous leaf extract on prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) in human plasma. Coagulation activity of O. sanctum was measured via PT, APTT and TT assay in citrated plasma collected from thirty-six healthy regular blood donors. The plasma was tested against different concentrations of O. sanctum aqueous extract as follows: 0.1mg/ml, 0.5 mg/ml and 1.0 mg/ml. Result shows the aqueous extract of O. sanctum prolonged the PT and APTT assays (p0.05). The gas chromatography-mass spectrometry (GC-MS) analysis had identified the linolenic acid at 1-10% of ethanol and aqueousconcentration at different retention time which was responsible for the coagulation activities of O. sanctumin human plasma. This study suggests that O. sanctum does affect coagulation activity in human plasma and can be potentially used as naturally derived anticoagulant products in the future.

Matched MeSH terms: Asthma
Granulocyte-Macrophage colony stimulating factor in asthmatic patients infected with respiratory syncytial virus

Abdullah SF

Med J Malaysia, 2021 03;76(2):177-182.
PMID: 33742625

INTRODUCTION: It is estimated that at least 30 to 40% of asthma attacks in adults are related to respiratory infections with viruses. The majority of asthma-related viruses include respiratory syncytial virus (RSV), rhinovirus, and parainfluenza. Inflammatory cytokines are supposed to play a vital role in causing inflammation of the respiratory tract as regulators of proliferation, chemotaxis, and activation of inflammatory cells.
OBJECTIVES: The aim of this study is to assess the role of Granulocyte Macrophage-Colony Stimulating Factor (GMCSF) in asthmatic airway hyper-responsiveness associated with RSV infections.
MATERIALS AND METHODS: Forty five asthmatic cases and 45 healthy individuals were studied in a cross-sectional design. All asthmatics underwent symptom score assessment.GMCSF concentrations in sputum and RSV-IgM/IgG in serum samples were measured for all participants by Enzyme Linked Immuno-Sorbent Assay (ELISA).
RESULTS: The GM-CSF concentration level was significantly higher in asthmatics (270.27± 194.87pg/mL) especially among moderate and severe disease with mean concentration of 197.33±98.47 and 521.08± 310.04 respectively, compared to healthy controls (22.20±21.27 pg/ mL) (p =0.0001). The sputum level of GM-CSF in asthmatics is highly significant associated with positive anti-RSV IgG sera which represents 35/45(77.8%) with mean GM-CSF concentration of (276.99± 86.42) compared with controls at about 31/45 (68.9%) with GM-CSF mean concentration of (22.84±23.47). On the other hand, positive anti-RSV IgM in asthma cases was 8 out of 45(17.8 %) with GM-CSF mean concentration of (307.25± 306.65). Furthermore, GM-CSF sputum level was significantly correlated with eosinophil count especially in moderate and severe asthma.
CONCLUSIONS: This study revealed that GM-CSF level is associated with eosinophilia and indicates asthma severity that might be evident during RSV infection .The distinctive GM-CSF features observed in the sputum from asthmatics with RSV may be useful as a diagnostic methods to help match patients with antibody therapy.

Matched MeSH terms: Asthma
Fulltext Prevalence of non-steroidal anti-inflammatory drugs (NSAIDs) use in Malaysian adults and associated factors: a population-based survey

Maria Awaluddin S, Noor Ani Ahmad, Balkish Mahadir Naidu, Muslimah Yusof, Mohamad Aznuddin Abd Razak, Mohd Kamal Ariff Abdul Ghani

Malaysian Journal of Public Health Medicine, 2017;17(3):58-65.

Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with adverse effects. However, NSAIDs are among the most popular pain killers and easily available over the counter. This study aimed to determine the prevalence of NSAIDs use in Malaysian adults and among those with chronic diseases such as arthritis, kidney disease, hypertension, heart disease and asthma. It also examined the factors associated with NSAIDs use. Data from the National Health Morbidity Survey (NHMS) 2011, a nation-wide survey was analysed. A total of 18231 respondents aged 18 years and above responded to this module. Multivariate logistic regression was used to investigate the association between NSAIDs use and associated factors. The overall prevalence of NSAIDs use among Malaysian adults was 14.2% (95%CI 13.3-15.1). Of the respondents, 4.2% (95%CI 3.8-4.7) took NSAIDs once daily. NSAIDs use was highly associated with those who were ever-told to have arthritis (aOR: 3.03; 95%CI 2.60-3.52) and have difficulty of performing daily activities or work (aOR: 2.06; 95%CI 1.86-2.28). Those who were ever-told to have kidney disease (aOR: 2.36; 95%CI 1.74-3.20), ever-told to have asthma (aOR: 1.36; 95%CI 1.17-1.58), ever-told to have heart disease (aOR: 1.34; 95%CI 1.08-1.65), known hypertension (aOR: 1.22; 95%CI 1.08-1.37) also were associated with NSAIDs use. By socio-demographic profiles, NSAIDs use was positively associated with those who have government benefit scheme or private health insurance (aOR: 1.44; 95%CI 1.31-1.58), higher education level (aOR: 1.35; 95%CI 1.20-1.51), higher household income (aOR: 1.26; 95%CI 1.11-1.44, aOR: 1.12; 95%CI 1.02-1.24), currently working (aOR: 1.25; 95%CI 1.13-1.39) and female (aOR: 1.17; 95%CI 1.07-1.28). NSAIDs use was less likely among those aged 60 years and above (aOR: 0.83; 95% CI 0.72-0.97), Chinese (aOR: 0.41; 95% CI 0.36-0.47) and ‘Others’ ethnicity (aOR: 0.82; 95% CI 0.67-0.99) compared to Malay ethnicity. NSAIDs use is prevalent in Malaysian adults and associated with co-morbidities and higher socio-demographic status, thus appropriate awareness should be promoted and highlighted in the community.
Study name: National Health and Morbidity Survey (NHMS-2011)

Matched MeSH terms: Asthma
Practice patterns for chronic respiratory diseases in the Asia-Pacific region: a cross-sectional observational study

Wang Y, Cho SH, Lin HC, Ghoshal AG, Bin Abdul Muttalif AR, Thanaviratananich S, et al.

Int Arch Allergy Immunol, 2018;177(1):69-79.
PMID: 29874659 DOI: 10.1159/000489015

BACKGROUND: Allergic rhinitis (AR), asthma, chronic obstructive pulmonary disease (COPD), and rhinosinusitis are common and little studied in the Asia-Pacific region.

OBJECTIVES: We sought to investigate real-world practice patterns for these respiratory diseases in India, Korea, Malaysia, Singapore, Taiwan, and Thailand.

METHODS: This cross-sectional observational study enrolled adults (age ≥18 years) presenting to general practitioners (GP) or specialists for physician-diagnosed AR, asthma, COPD, or rhinosinusitis. Physicians and patients completed study-specific surveys at one visit, recording patient characteristics, health-related quality of life (QoL), work impairment, and healthcare resource use. Findings by country and physician category (GP or specialist) were summarized.

RESULTS: Of the 13,902 patients screened, 7,243 (52%) presented with AR (18%), asthma (18%), COPD (7%), or rhinosinusitis (9%); 5,250 of the 7,243 (72%) patients were eligible for this study. Most eligible patients (70-100%) in India, Korea, Malaysia, and Singapore attended GP, while most (83-85%) in Taiwan and Thailand attended specialists. From 42% (rhinosinusitis) to 67% (AR) of new diagnoses were made by GP. On average, patients with COPD reported the worst health-related QoL, particularly to GP. Median losses of work productivity for each condition and activity impairment, except for asthma, were numerically greater for patients presenting to GP vs. specialists. GP prescribed more antibiotics for AR and asthma, and fewer intranasal corticosteroids for AR, than specialists (p < 0.001 for all comparisons).

CONCLUSIONS: Our findings, albeit mostly descriptive and influenced by between-country differences, suggest that practice patterns differ between physician types, and the disease burden may be substantial for patients presenting in general practice.

Matched MeSH terms: Asthma
Fulltext Neurocysticercosis

Visuvanathan VV, Somawera N, Koh KC

Malays Fam Physician, 2013;8(3):46-48.
PMID: 25893060 MyJurnal

A 19-year-old Chinese man presented with progressive ascending weakness of his left lower limb for 1 week. There was no loss of sensation. His other limbs were unaffected. He also complained of progressive, painless blurring of vision in his left eye for the past 1 month. He has an affinity for wild boar meat from local Chinese restaurants, which he has been consuming on a daily basis for the last 2 years. He denied any fever, headache, high risk behaviour for acquisition of human
immunodeficiency virus (HIV) infection or recent travels. He had bronchial asthma in childhood, but the symptoms are minimal now and there was no recent acute exacerbations. Physical examination was unremarkable except for the left lower limb power of 3/5 and bilateral papilloedema on direct ophthalmoscopy. A Contrast-enhanced computed tomography (CECT) scan of the brain (Image 1) and Magnetic resonance imaging (MRI) of the brain (Images 2 and 3) were performed. The
total leucocyte count was 9.2x109/L, C-reactive protein was 1.2 and erythrocyte sedimentation
rate was 6 mm/h. Human immunodeficiency virus screening was negative, anti-toxoplasma antibodies were not detected and serological testing for anti-cysticercal antibodies via enzymelinked
immunosorbent assay (ELISA) did not produce a positive yield. He was treated with oral albendazole for 28 days and corticosteroids, which led to rapid and total resolution of his neurological deficits and CT findings within 6 weeks.

Matched MeSH terms: Asthma
Fulltext The Third National Health and Morbidity Survey 2006 (NHMS III)

ISBN: 978-983-3887-27-9

Citation: National Health Morbidity Survey 2006. Kuala Lumpur: Ministry of Health, Malaysia, 2008
Study name: National Health and Morbidity Survey (NHMS-2006)

Matched MeSH terms: Asthma
Fulltext Satisfaction level and asthma control among Malaysian asthma patients on Symbicort Maintenance and Reliever Therapy (SMART) in the primary care setting (SMARTEST study)

Liam CK, Pang YK, Chua KT

Asian Pac J Allergy Immunol, 2014 Jun;32(2):145-52.
PMID: 25003728 DOI: 10.12932/AP0359.32.2.2013

OBJECTIVE: To evaluate Malaysian patients' satisfaction levels and asthma control with Symbicort SMART® in the primary care setting.
METHOD: This is a cross-sectional, multicentre study involving adult patients with persistent asthma who were prescribed only Symbicort SMART in the preceding one month prior to recruitment. Patients' satisfaction with Symbicort SMART and asthma control were evaluated using the self-administered Satisfaction with Asthma Treatment Questionnaire (SATQ) and the Asthma Control Test (ACT).
RESULTS: Asthma was controlled (ACT score >20) in 189 (83%) of 228 patients. The mean overall SATQ score for patients with controlled asthma was 5.65 indicating a high satisfaction level, which was positively correlated with high ACT scores. There were differences in asthma control based on ethnicity, number of unscheduled visits and treatment compliance.
CONCLUSIONS: Symbicort SMART resulted in a high satisfaction level and asthma control among Malaysian patients treated in the primary care setting and it is an effective and appealing treatment for asthmatic patients.
Study site: General practice clinics, Malaysia

Matched MeSH terms: Asthma/drug therapy*; Anti-Asthmatic Agents/administration & dosage*; Anti-Asthmatic Agents/adverse effects
Fulltext Inhibition of Epithelial CC-Family Chemokine Synthesis by the Synthetic Chalcone DMPF-1 via Disruption of NF-κB Nuclear Translocation and Suppression of Experimental Asthma in Mice

Rajajendram R, Tham CL, Akhtar MN, Sulaiman MR, Israf DA

Mediators Inflamm, 2015;2015:176926.
PMID: 26300589 DOI: 10.1155/2015/176926

Asthma is associated with increased pulmonary inflammation and airway hyperresponsiveness. The interaction between airway epithelium and inflammatory mediators plays a key role in the pathogenesis of asthma. In vitro studies evaluated the inhibitory effects of 3-(2,5-dimethoxyphenyl)-1-(5-methylfuran-2-yl)prop-2-en-1-one (DMPF-1), a synthetic chalcone analogue, upon inflammation in the A549 lung epithelial cell line. DMPF-1 selectively inhibited TNF-α-stimulated CC chemokine secretion (RANTES, eotaxin-1, and MCP-1) without any effect upon CXC chemokine (GRO-α and IL-8) secretion. Western blot analysis further demonstrated that the inhibitory activity resulted from disruption of p65NF-κB nuclear translocation without any effects on the mitogen-activated protein kinase (MAPK) pathway. Treatment of ovalbumin-sensitized and ovalbumin-challenged BALB/c mice with DMPF-1 (0.2-100 mg/kg) demonstrated significant reduction in the secretion and gene expression of CC chemokines (RANTES, eotaxin-1, and MCP-1) and Th2 cytokines (IL-4, IL-5, and IL-13). Furthermore, DMPF-1 treatment inhibited eosinophilia, goblet cell hyperplasia, peripheral blood total IgE, and airway hyperresponsiveness in ovalbumin-sensitized and ovalbumin-challenged mice. In conclusion, these findings demonstrate the potential of DMPF-1, a nonsteroidal compound, as an antiasthmatic agent for further pharmacological evaluation.

Matched MeSH terms: Asthma/drug therapy*
Prevalence and Risk Factors of Caregiver Dependence among Older Adults in a Southeast Asian Population

Picco L, Abdin E, Vaingankar JA, Pang S, Shafie S, Sambasivam R, et al.

Ann Acad Med Singap, 2016 Nov;45(11):486-494.
PMID: 27922142

INTRODUCTION: Currently very little is known about the prevalence or magnitude of caregiver dependence in Singapore and thus, there is a need to fill this gap in this multiethnic ageing population. This study aims to determine the prevalence and risk factors of caregiver dependence among older adults in Singapore.
MATERIALS AND METHODS: Data were used from the Well-being of the Singapore Elderly (WiSE) study, a nationally representative, cross-sectional survey among Singapore residents aged 60 years and above. Caregiver dependence was ascertained by asking the informant (the person who knows the older person best) a series of open-ended questions about the older person's care needs.
RESULTS: The older adult sample comprised 57.1% females and the majority were aged 60 to 74 years (74.8%), while 19.5% were 75 to 84 years, and 5.7% were 85 years and above. The prevalence of caregiver dependence was 17.2% among older adults. Significant sociodemographic risk factors of caregiver dependence included older age (75 to 84 years, and 85 years and above, P <0.001), Malay and Indian ethnicity (P <0.001), those who have never been married (P = 0.048) or have no education (P = 0.035), as well as being homemakers or retired (P <0.001). After adjusting for sociodemographic variables and all health conditions in multiple logistic regression analyses, dementia (P <0.001), depression (P = 0.011), stroke (P = 0.002), eyesight problems (P = 0.003), persistent cough (P = 0.016), paralysis (P <0.001), asthma (P = 0.016) and cancer (P = 0.026) were significantly associated with caregiver dependence.
CONCLUSION: Various sociodemographic and health-related conditions were significantly associated with caregiver dependence. Dependent older adults will put greater demands on health and social services, resulting in greater healthcare expenditures. Hence, effective planning, services and support are crucial to meet the needs of dependent older adults and their caregivers.

Matched MeSH terms: Asthma/epidemiology*
Secrets of omega-3 oil

Suvarna BS

Kathmandu Univ Med J (KUMJ), 2008 7 1;6(23):406-11.
PMID: 20071830
Matched MeSH terms: Asthma/diet therapy
Fulltext Pulmonary function in symptom-free asthmatics

Yaacob I, Mohammad M

Singapore Med J, 1993 Dec;34(6):522-3.
PMID: 8153715

Seventy-five adult asthmatic patients with clinical remission underwent spirometry. Only 8.3% of the subjects demonstrated normal spirometry. The others had reduced vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum mid-expiratory flow rate (MMF) and peak flow rate (PEFR). This study demonstrates that asthma can cause irreversible airflow obstruction and there is a poor relationship between symptoms in asthmatics and their respiratory function test results.
Study site: Chest clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia

Matched MeSH terms: Asthma/physiopathology*
Endotoxin, ergosterol, muramic acid and fungal DNA in dust from schools in Johor Bahru, Malaysia--Associations with rhinitis and sick building syndrome (SBS) in junior high school students

Norbäck D, Hashim JH, Markowicz P, Cai GH, Hashim Z, Ali F, et al.

Sci Total Environ, 2016 Mar 1;545-546:95-103.
PMID: 26745297 DOI: 10.1016/j.scitotenv.2015.12.072

This paper studied associations between ocular symptoms, rhinitis, throat and dermal symptoms, headache and fatigue in students by ethnicity and in relation to exposure to chemical microbial markers and fungal DNA in vacuumed dust in schools in Malaysia. A total of 462 students from 8 randomly selected secondary schools in Johor Bahru, Malaysia, participated (96% response rate). Dust was vacuumed from 32 classrooms and analysed for levels of five types of endotoxin as 3-hydroxy fatty acids (C10, C12, C14, C16 and C18 3-OH), muramic acid, ergosterol and five sequences of fungal DNA. Multiple logistic regression was applied. Totally 11.9% reported weekly ocular symptoms, 18.8% rhinitis, 15.6% throat and 11.1% dermal symptoms, 20.6% headache and 22.1% tiredness. Totally 21.1% reported pollen or furry pet allergy (atopy) and 22.0% parental asthma or allergy. Chinese students had less headache than Malay and Indian had less rhinitis and less tiredness than Malay. Parental asthma/allergy was a risk factor for ocular (odds ratio=3.79) and rhinitis symptoms (OR=3.48). Atopy was a risk factor for throat symptoms (OR=2.66), headache (OR=2.13) and tiredness (OR=2.02). There were positive associations between amount of fine dust in the dust samples and ocular symptoms (p<0.001) and rhinitis (p=0.006). There were positive associations between C14 3-OH and rhinitis (p<0.001) and between C18 3-OH and dermal symptoms (p=0.007). There were negative (protective) associations between levels of total endotoxin (LPS) (p=0.004) and levels of ergosterol (p=0.03) and rhinitis and between C12 3-OH and throat symptoms (p=0.004). In conclusion, the amount of fine dust in the classroom was associated with rhinitis and other SBS symptoms and improved cleaning of the schools is important. Endotoxin in the school dust seems to be mainly protective for rhinitis and throat symptoms but different types of endotoxin could have different effects. The ethnic differences in symptoms among the students deserve further attention.

Matched MeSH terms: Asthma
Prevalence of Toxocara canis antibody among children with bronchial asthma in Klang Hospital, Malaysia

Hakim SL, Thadasavanth M, Shamilah RH, Yogeswari S

Trans R Soc Trop Med Hyg, 1998 2 17;91(5):528.
PMID: 9463657 DOI: 10.1016/s0035-9203(97)90010-9
Matched MeSH terms: Asthma
The effects of indoor environmental factors on respiratory illness in primary school children in Kuala Lumpur

Azizi BH, Henry RL

Int J Epidemiol, 1991 Mar;20(1):144-50.
PMID: 2066213 DOI: 10.1093/ije/20.1.144

The effects of indoor environmental factors on respiratory illness were studied in 15017-12 year old school children in Kuala Lumpur. Exposure to mosquito coil smoke for at least three nights a week was independently associated with asthma and persistent wheeze. Passive smoking, defined as sharing a bedroom with an adult smoker, was independently associated with a chest illness in the past year. No relationships were found between exposure to kerosene stoves, wood stoves, fumigation mat mosquito repellents or aerosol insecticides and respiratory illness. Host factors predictive of at least one respiratory outcome included family history of chest illness, history of allergy, male sex, hospitalization in the neonatal period and low paternal education. With 95% confidence, avoidance of regular exposure to mosquito coil smoke and passive smoking could reduce the prevalences of persistent wheeze, asthma and chest illness by up to 29%. Measurements of lung function confirmed the validity of questions pertaining to wheezing and asthma in the study questionnaire.

Matched MeSH terms: Asthma
Fulltext Docking based screening and molecular dynamics simulations to identify potential selective PDE4B inhibitor

Al-Nema M, Gaurav A, Lee VS

Heliyon, 2020 Sep;6(9):e04856.
PMID: 32984588 DOI: 10.1016/j.heliyon.2020.e04856

Inhibition of phosphodiesterase 4 (PDE4) is a promising therapeutic approach for the treatment of inflammatory pulmonary disorders, i.e. asthma and chronic obstructive pulmonary disease. However, the treatment with non-selective PDE4 inhibitors is associated with side effects such as nausea and vomiting. Among the subtypes of PDE4 inhibited by these inhibitors, PDE4B is expressed in immune, inflammatory and airway smooth muscle cells, whereas, PDE4D is expressed in the area postrema and nucleus of the solitary tract. Thus, PDE4D inhibition is responsible for the emetic response. In this regard, a selective PDE4B inhibitor is expected to be a potential drug candidate for the treatment of inflammatory pulmonary disorders. Therefore, a shared feature pharmacophore model was developed and used as a query for the virtual screening of Maybridge and SPECS databases. A number of filters were applied to ensure only compounds with drug-like properties were selected. Accordingly, nine compounds have been identified as final hits, where HTS04529 showed the highest affinity and selectivity for PDE4B over PDE4D in molecular docking. The docked complexes of HTS04529 with PDE4B and PDE4D were subjected to molecular dynamics simulations for 100ns to assess their binding stability. The results showed that HTS04529 was bound tightly to PDE4B and formed a more stable complex with it than with PDE4D.

Matched MeSH terms: Asthma
Fulltext Association of children’s BMI and physical activity: a cross sectional study

Lily Shuzeen Kimin, Wenda Riona Lamiri, Alvin Oliver Payus, Constance Liew Sat Lin, Mohd Firdaus Mohd Hayati, Rhanye Mac Guad, et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):61-61.
MyJurnal

Introduction:The increasing prevalence of childhood obesity among primary school children is a growing public health concern worldwide. Previous study in West Malaysia showed a prevalence of obesity with an estimated of 6.6% among 7-year-olds children and rising to 13.8% among 10-year-olds children. However, no study has ever been conducted in East Malaysia on childhood obesity. This study was aimed to determine the prevalence of child-hood obesity and to investigate the association of physical activity levels with obesity and its intervention among primary school children in Kota Kinabalu. Methods: A cross-sectional study involving 484 students (aged 7-12 years old) was conducted in five primary schools at Kota Kinabalu, Sabah. The schools were selected based on cluster sampling method and simple random sampling method. Primary school children with a known medical condition such as bronchial asthma, type-1 diabetes mellitus or those with a prolonged use of oral steroids was excluded from the study. Self developed questionnaires were used to record sociodemographic details and anthropometric mea-sures both parents and children, and physical activity was measured using a Children Physical Activity Questionnaire (C-PAQ). The intervention involved 3 components; I) motivational interviewing, ii) brief and focused advice, iii) ac-tivity session. Follow up was done 3 months after the intervention was conducted. Results: The prevalence of child-hood obesity among primary school children is 13.2%. There is a negative correlation between children’s BMI and amount of physical activity (-0.347) and positive correlation between children’s BMI and amount of non-physical activity (0.339). Little changes in the BMI of the children after intervention, t(127)= 2.866, p=0.005. Conclusion: This study provides evidence that childhood obesity is not a prevalent health problem in Kota Kinabalu and has proved that physical activity levels have significant associations with children’s body mass indices.

Matched MeSH terms: Asthma
Prevalence of Atopic Dermatitis and Pattern of Drug Therapy in Malaysian Children

Goh YY, Keshavarzi F, Chew YL

Dermatitis, 2018 5 16;29(3):151-161.
PMID: 29762208 DOI: 10.1097/DER.0000000000000376

BACKGROUND: Atopic dermatitis (AD) is a chronic relapsing, noncontagious skin inflammation characterized by dry skin and itch. Mutation in filaggrin gene leads to defective skin barrier, allowing entry of allergen and eliciting immunological response.
OBJECTIVES: The aims of this study were to investigate the prevalence of AD in Malaysian children and to understand the pattern of drug therapy. Such information could be useful to establish the relationship between ethnicity and family history of atopy and the development of associated signs and symptoms.
METHODS: A cross-sectional survey was conducted among children attending kindergartens and nurseries. Standardized questionnaires were filled out by parents.
RESULTS: Overall prevalence of AD was 13.4%. Of 384 participants recruited, the highest prevalence was observed in males, Malays, participants younger than 2 years, and those with atopic background such as asthma, hay fever, and family history of atopic diseases. Calamine and white soft paraffin were the preferred choice of nonprescription drugs, whereas topical hydrocortisone seemed to be the preferred choice of prescription drug in the management of AD.
CONCLUSIONS: The overall prevalence is comparable to that reported in the International Study of Asthma and Allergies in Childhood Phase One. There is an association between ethnicity and AD prevalence. Topical corticosteroids and emollients are the mainstay of AD management among Malaysians.

Matched MeSH terms: Asthma

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