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Fulltext Therapeutic aerosol: principles and practices

Zainudin BM

Med J Malaysia, 1993 Sep;48(3):259-68.
PMID: 8183136

Delivering a drug direct to the site of disease has several advantages. In the case of aerosols, it only requires about one-twentieth of the oral dose of the drug to exert its effect, thus resulting in less or minimal systemic side-effects. The onset of action is fast and the efficacy is superior to the oral drug. Because of the anatomy of the airways which are protective against the inhalation of foreign substances, the aerosol particles must be inhaled in an optimal way in order to reach the sites of action which are the peripheral airways. The particle size must be small and the aerosol must be inhaled in a coordinated manner, especially when a pressurised metered dose inhaler is used. Because of the high pressure of the propellants used in the canister, the particles will travel at a rapid speed upon actuating, causing great impaction in the throat. Only a small percentage reaches the peripheral airways and this percentage is even smaller if the coordination between actuation and inhalation is poor. Spacers have been shown to be able to overcome this problem of incoordination and to reduce throat impaction. Alternatively, the breath-actuated dry powder inhaler can be effectively used. The nebuliser, which is another aerosol delivery system, needs proper setting of the flow rate of compressed air and an appropriate volume of solution in order to optimise the drug delivery.
Fulltext Steroid therapy in obstructive airway diseases

Zainudin BMZ

Respirology, 1997 Mar;2(1):17-31.
PMID: 9424402 DOI: 10.1111/j.1440-1843.1997.tb00051.x

Asthma and chronic obstructive pulmonary disease (COPD) are two common illnesses that cause significant morbidity and mortality. Steroids are widely used in both conditions. They act through steroid or glucocorticoid receptors (GR) causing up or down regulation of protein synthesis resulting in an increase in lipocortin 1 and beta 2 adrenergic receptors, and decreased levels and activities of cytokines or cytokine receptors, which reduces the inflammatory process in the airways and decreases bronchial hyperreactivity. Consequently symptoms of airway obstruction are alleviated and lung function is improved. In asthma, steroids have been convincingly shown to be effective in the treatment of both acute exacerbations and chronic condition. In COPD, however, only a subset of patients seem to respond favourably to steroid therapy. Therapeutic trials are therefore recommended before committing to a long-term treatment in order to determine this subset of patients, as no markers of steroid responsiveness can be identified. The inhaled steroids currently available have a good safety profile with significant side effects occurring only occasionally. Such side effects are usually confined to the oropharynx, causing local irritation, candidiasis and dysphonia, which can be easily overcome. Biochemical abnormalities involving bone, adrenal, carbohydrate and lipid profiles have been noted with high doses of inhaled steroids; however, these have no significant clinical effects.
Fulltext Cryptogenic pulmonary eosinophilia--a case report

Zainudin BM, Ismail O

Singapore Med J, 1990 Dec;31(6):629-31.
PMID: 2281365

A 44-year-old Indian housewife presented with prolonged cough, intermittent fever, loss of weight and shortness of breath on exertion. Physical examination revealed a thin lady with fine crackles on both lungs. Marked eosinophilia and elevated erythrocyte sedimentation rate were noted on peripheral blood. Chest radiograph showed characteristic bilateral infiltrates affecting the periphery of both lungs. Treatment with corticosteroid resulted in dramatic improvement in symptoms, signs and radiographic changes within a few days.
Fulltext Combination chemotherapy for small cell lung cancer

Sufarlan AW, Zainudin BM

Med J Malaysia, 1993 Jun;48(2):166-70.
PMID: 8394502

Small cell lung cancer (SCLC) disseminates early and has poor prognosis. However, SCLC is highly chemosensitive, thus chemotherapy has been established as the primary mode of treatment. Seventeen patients (15 males and 2 females) with median age of 60 years (range 49 to 74 years) were treated with combination cyclophosphamide 750 mg/m2, adriamycin 40 mg/m2, vincristine 1.4 mg/m2 on day 1 and etoposide (VP 16) 75 mg/m2 on days 1 to 3 (CAVE). This combination was given in 6 courses at 3 weekly intervals. The response to the chemotherapy and the quality of life of patients was assessed at the third cycle and after the completion of therapy (sixth cycle). The overall response rate was 76.4%; 52.9% achieved complete response and 23.5% had partial response. The survival rate at 6 months was 70.8% and 4 patients (23.5%) were still alive after 1 year of chemotherapy. The median survival after therapy was 36 weeks. There was a 30% overall improvement in the Karnofsky performance score at the completion of chemotherapy. This study illustrated that the CAVE regimen is effective and beneficial in the majority of our patients with small cell lung cancer.
Fulltext Effect of adding aminophylline infusion to nebulised salbutamol in severe acute asthma

Zainudin BM, Ismail O, Yusoff K

Thorax, 1994 Mar;49(3):267-9.
PMID: 8202885

BACKGROUND: The benefit of adding theophylline to beta 2 agonists in acute asthmatic attacks has been debated frequently.
METHODS: In an open randomised study 25 patients with severe acute asthma who presented to the emergency department were treated with either a combined nebulised salbutamol (5 mg/dose) and aminophylline infusion (0.6-0.9 mg/kg/hour), or nebulised salbutamol alone.
RESULTS: The responses to treatment as measured by peak expiratory flow (PEF) and the time taken to achieve maximum PEF were similar in both groups. Side effects were observed more commonly in patients receiving the combined treatment.
CONCLUSIONS: Nebulised salbutamol is equally efficacious in acute asthma when given alone or in combination with aminophylline.
Study site: Emergency department, Hospital Kuala Lumpur, Malaysia
Fulltext Incorrect use of pressurised metered dose inhaler by asthmatic patients

Zainudin BM, Sufarlan AW

Med J Malaysia, 1990 Sep;45(3):235-8.
PMID: 2152085

The use of pressurised metered dose inhalers was assessed among 93 asthmatic patients attending the respiratory out patient clinic between January to October 1989. They were regular users of the inhalers prior to the assessment. 62.4% of the patients were found to use the inhalers incorrectly. Forty three percent made more than one error. The commonest error observed was the failure to actuate and inhale the aerosol together in 41.9%. There was no difference in the occurrence of incorrect performance between different sexes, age groups, duration of inhaler used and previous supervision or no supervision by the doctors.
Study site: Respiratory clinic, Hospital Kuala Lumpur (UKM), Malaysia
Addition of inhaled salmeterol to inhaled corticosteroids in patients with poorly controlled nocturnal asthma

Norhaya MR, Yap TM, Zainudin BM

Respirology, 1999 Mar;4(1):77-81.
PMID: 10339734 DOI: 10.1046/j.1440-1843.1999.00153.x

The effect of adding inhaled salmeterol to inhaled corticosteroids was studied in patients with poorly controlled nocturnal asthma. In a double-blind, cross-over study, 20 patients were randomized to receive either salmeterol 50 micrograms twice daily or placebo via a Diskhaler after a 1-week run-in period. After 4 weeks of treatment, patients were subsequently crossed over to receive the other treatment for a further 4 weeks with a 2-week wash-out period in between. The response to treatment was assessed by peak expiratory flow rates (PEF) measured in the morning and evening, symptom scores of asthma, number of bronchodilators used, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) at regular intervals. Patients' preference for the Diskhaler or metered-dose inhaler was assessed at the last visit. The results showed that morning PEF was significantly higher while on salmeterol than on placebo (296.9 +/- 70.2 vs 274.6 +/- 77.4 L/min). Evening PEF showed a trend towards a higher value while on salmeterol than on placebo (321.1 +/- 73.4 vs 288.7 +/- 79.4 L/min), but the difference was not significant. There was no statistically significant improvement in symptom scores, number of rescue bronchodilators used and FEV1 or FVC between the two treatment groups. The occurrence of side effects in terms of tremors and palpitations between treatment and placebo were similar. There were more patients who preferred Diskhaler to metered-dose inhaler (70% vs 30%). We conclude that salmeterol 50 micrograms twice daily produces significant improvement in morning PEF and is well tolerated in patients with nocturnal asthma. Diskhaler is a device which is easy to use and preferred to a metered-dose inhaler.
Study site: Respiratory Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Bronchodilator response to inhaled beta-2 agonist and anticholinergic drugs in patients with bronchiectasis

Hassan JA, Saadiah S, Roslan H, Zainudin BM

Respirology, 1999 Dec;4(4):423-6.
PMID: 10612580 DOI: 10.1046/j.1440-1843.1999.00215.x

OBJECTIVE: An increase in incidence of reversible airflow obstruction and bronchial hyperresponsiveness occurs in patients with bronchiectasis. We conducted a study to assess the efficacy of bronchodilators in the treatment of bronchiectasis.
METHODOLOGY: Twenty-four patients with confirmed bronchiectasis were studied. Each patient inhaled fenoterol 400 microg administered by metered dose inhaler via a spacer after a baseline lung function and a lung function test was repeated 30 min later. This was followed by a second dose of fenoterol 5 mg via nebulizer and another lung function test 30 min later. A repeat study was done at least 24 h later with ipratropium bromide 40 microg by metered dose inhaler and 500 microg by a nebulizer.
RESULTS: The results showed a significant improvement from baselines (mean percentage change +/- SD) of peak expiratory flow rate (PEF) by 8.5 +/- 8.72% and 15.3 +/- 11.63%, forced expiratory volume in 1 s (FEV1) by 8.77 +/- 9.69% and 10.2 +/- 12.2% and forced vital capacity (FVC) by 10.25 +/- 11.61% and 10.09 +/- 10.88% after low- and high-dose fenoterol, respectively. The improvements after low- and high-dose ipratropium bromide for PEE FEV1 and FVC were 9.89 +/- 9.35% and 14.39 +/- 12.82%, 9.38 +/- 10.41% and 13.52 +/- 17.09%, and 8.03 +/- 10.85% and 9.63 +/- 13.85%, respectively. Eleven patients (45.8%) responded to one or both bronchodilators significantly (> 15% improvement in FEV1). Five patients (20%) responded to both, three (12%) to fenoterol alone and another three (12%) to ipratropium bromide alone.
CONCLUSION: There is significant bronchodilator response in a subset of patients with bronchiectasis and patients with bronchiectasis should therefore undergo bronchodilator testing. Skin prick testing against a panel of nine allergens done on each individual yielded a positive result in 13 patients (54.2%).
Causative organisms in acute exacerbation of chronic airways disease and response to ofloxacin therapy

Sufarlan AW, Zainudin BM, Pit S, Ishak I

Drugs, 1995;49 Suppl 2:442-5.
PMID: 8549394
Fulltext Idiopathic pulmonary haemosiderosis occurring in a Malaysian patient

Hanip MR, Isa MR, Zainudin BM

Singapore Med J, 1994 Oct;35(5):535-7.
PMID: 7701382

A young East Malaysian lady presented with haemoptysis in 1989. Since then she had recurrent episodes of dyspnoea and two occasions of respiratory failure requiring assisted ventilation. An open lung biopsy showed intra-alveolar haemorrhage with diffuse interstitial fibrosis consistent with idiopathic pulmonary haemosiderosis after excluding secondary causes of pulmonary haemorrhage. She failed to respond to corticosteroid and continued to depend on oxygen until she succumbed to the illness 2 years after the presentation.
Fulltext Topical nasal anaesthesia for fibreoptic bronchoscopy: lignocaine spray or gel?

Zainudin BM, Rafia MH, Sufarlan AW

Singapore Med J, 1993 Apr;34(2):148-9.
PMID: 8266157

Lignocaine spray for anaesthetising the nasal mucosa for fibreoptic bronchoscopy often causes discomfort to the patient. We compared two techniques of applying nasal topical anaesthesia using either lignocaine spray (group A: 25 patients) or gel (group B: 30 patients) to assess patients' tolerance to the procedure. Both groups received 100 mg of lignocaine in the nostril, 40-50 mg to oropharynx, 120 mg to vocal cords and 40-100 mg to trachea and bronchi. Throat anaesthesia was the most common unpleasant part experienced by both groups of patients (34.5%), followed by examination of bronchi (30.6%) and nasal anaesthesia (21.8%). Significantly more patients in group A experienced discomfort or pain during nasal anaesthesia as compared to group B (p < 0.001). Patients' tolerance to the bronchoscopy was similar in both groups and the examination was performed satisfactorily in all patients. Thus, lignocaine gel is a simple technique, effective and less irritating as compared to lignocaine spray for topical nasal anaesthesia.
Fulltext The prevalence of Trichuris, Ascaris and hookworm infection in Orang Asli children

Norhayati M, Zainudin B, Mohammod CG, Oothuman P, Azizi O, Fatmah MS

Southeast Asian J. Trop. Med. Public Health, 1997 Mar;28(1):161-8.
PMID: 9322301

A community study on the age and sex related prevalence, intensity infection and frequency distribution of Ascaris, Trichuris and hookworm was carried out in 205 Orang Asli (Aborigines) children (95 boys, 110 girls) aged 1-13 years. The overall prevalence of Ascaris, Trichuris and hookworm was 62.9%, 91.7% and 28.8%, respectively. Almost two-thirds of the children were infected with moderate and severe intensity infection of Trichuris, 46.3% had moderate to severe intensity infection of Ascaris. However only 1.5% had moderate intensity of hookworm infection. The prevalence and mean intensity infection (measured by eggs per g) of Ascaris was age-dependent; lower in age group 1-4 years reached peak and stable at age group 5 years and above. The prevalence of Trichuris was high in all age groups and it fluctuated with age; the mean intensity of infection of Trichuris (measured by eggs per g) was age-dependent. Hookworm infection also rose with age and reached peak at 5-6 years, following that the prevalence declined. The frequency distributions of Ascaris, and hookworm were overdispersed. A strong positive correlation (p < 0.001) were observed between Ascaris and Trichuris and between hookworm and Trichuris. A positive correlation (p < 0.01) were also observed between Ascaris and hookworm.
Fulltext Nutrient intake and socio-economic status among children attending a health exhibition in Malaysian rural villages

Norhayati M, Noor Hayati MI, Oothuman P, Fatmah MS, Zainudin B, Fatimah A

Med J Malaysia, 1995 Dec;50(4):382-90.
PMID: 8668061

A dietary survey was carried out in 216 children (109 males, 107 females) aged 1-7 years, living in rural villages in Selangor, Malaysia to assess their nutrient intake and to determine the association between nutrient consumption and socio-economic background. All the children studied had inadequate intakes of energy, iron and niacin according to Recommended Daily Intake (RDI). Children aged of 4-9 years showed inadequate intake of calcium, thiamine and riboflavin. However, the intake of protein, vitamin A and ascorbic acid were above the recommended value. The mean percentage requirements of protein, iron and niacin were significantly higher in children from small families compared with children from large families. However the employment status of mothers had a significantly effect on the mean percentage requirements of niacin. The results indicate that education level of the mothers, is strongly associated with the mean percentage nutrient requirements of children and we strongly feel that this is a strategy to be adopted for improvement in nutrition of children.
Fulltext Methicillin-resistant Staphylococcus aureus (mrsa) in a Malaysian hospital

Cheong I, Tan SC, Wong YH, Zainudin BM, Rahman MZ

Med J Malaysia, 1994 Mar;49(1):24-8.
PMID: 8057986

Between August 1990 to November 1991, 905 of 2583 (35.4%) isolates of Staphylococcus aureus were found to be methicillin-resistant in a general hospital in Malaysia. A detailed study of 539 of these isolates showed a high prevalence of methicillin resistant Staphylococcus aureus (MRSA) in the surgical/orthopaedic wards, paediatric wards and the special care unit. The yield of MRSA was highest from wounds/ulcers/skin swabs accounting for 64.2 per cent followed by 6.9 per cent in blood cultures. Vancomycin remains the drug of choice with no resistance detected. The resistance to ciprofloxacin was 6.7 per cent, rifampicin 4.5 per cent and fusidic acid 2.0 per cent. Most isolates were resistant to aminoglycosides. In view of the high prevalence of MRSA in this hospital, the authorities must introduce more effective measures to control its spread as a nosocomial pathogen. Otherwise it may seriously disrupt the efficient delivery of health care services in the country.
Clinical patterns of X linked agammaglobulinemia in Malaysian children

Noh LM, Ismail Z, Zainudin BM, Low SM, Azizi BH, Noah RM, et al.

Acta Paediatr Jpn, 1995 Jun;37(3):331-5.
PMID: 7645382

X linked agammaglobulinemia (XLA) is rarely reported from developing countries especially from South East Asia. It appears that X linked agammaglobulinemia is less common in certain ethnic groups. It is very uncommon in black people in USA and South Africa. In multiracial Malaysia we have documented five XLA in Malays and Indians but not in the Chinese that constitute about 31% of the population. First degree relatives afflicted with XLA or other primary immunodeficiencies occurred more often in our study. All showed lung involvement although the etiologic organisms involved were atypical, being Gram negative.
Disseminated histoplasmosis presenting with ileal perforation in a renal transplant recipient

Zainudin BM, Kassim F, Annuar NM, Lim CS, Ghazali AK, Murad Z

J Trop Med Hyg, 1992 Aug;95(4):276-9.
PMID: 1495124

A renal transplant patient presented with ileal perforation due to histoplasmosis 3 years after transplantation. Mesenteric lymph nodes and lungs were also affected by the disease. She was successfully treated with amphotericin B followed by ketoconazole.
Fulltext A report of the first three cases of diffuse panbronchiolitis in Malaysia

Zainudin BM, Roslina AM, Fadilah SA, Samad SA, Sufarlan AW, Isa MR

Med J Malaysia, 1996 Mar;51(1):136-40.
PMID: 10967994

Three cases of diffuse panbronchiolitis (DPB) occurring in two Malaysian Chinese patients and one Malay patient are reported. They had similar clinical, radiological and physiological features which are characteristic of DPB. The diagnosis in one of the cases was confirmed histologically by transbronchial lung biopsy. These could be the first three cases identified in Malaysia.
Fulltext The role of diagnostic fiberoptic bronchoscopy for rapid diagnosis of pulmonary tuberculosis

Zainudin BM, Wahab Sufarlan A, Rassip CN, Ruzana MA, Tay AM

Med J Malaysia, 1991 Dec;46(4):309-13.
PMID: 1840437

The role of fiberoptic bronchoscopy for rapid diagnosis of pulmonary tuberculosis was examined among 74 patients who were suspected of having the disease but had negative sputum smear for acid fast bacilli. Bronchial brushing and washing were routinely performed in all subjects and bronchial biopsy was performed on abnormal mucosa in 7 of them. The diagnosis of pulmonary tuberculosis was confirmed in 44.6% of the patients studied from smear examination, culture, histology or the combination of them. Rapid diagnosis was achieved in 54.5% of the confirmed cases from smear or histology within a few days of examination. Two of the cases had concomitant bronchogenic carcinoma. We conclude that the fiberoptic bronchoscopy is a useful investigation for this group of patients as confirmation of the diagnosis can be made fairly rapidly in a significant proportion of them, hence the treatment can be started confidently.
Impacts of cocoa pod maturity at harvest and bean fermentation period on the production of chocolate with potential health benefits

Tee YK, Bariah K, Hisyam Zainudin B, Samuel Yap KC, Ong NG

J Sci Food Agric, 2022 Mar 15;102(4):1576-1585.
PMID: 34405409 DOI: 10.1002/jsfa.11494

BACKGROUND: Cacao beans are rich sources of polyphenols with an abundance of flavonoids and methylxanthines that have positive influences on human health. The main factors affecting the formation of flavor as well as the chemical and bioactive composition of cacao beans are cacao pod maturity and post-harvest fermentation. The purpose of this research was to evaluate the effects of pod harvest maturity (mature and ripe) and post-fermentation period (1, 3, and 5 days in a controlled temperature environment) measured by pre-harvest maturity indices, post-harvest quality tests, chemical measurements, and organoleptic evaluation.
RESULTS: As pods developed, flavonol accumulated while nitrogen content degraded. Mature pods produced beans with a higher flavonol, catechin, and total phenolic content (TPC). As fermentation progressed, the beans' fat, TPC, antioxidant activity, and catechin content increased, regardless of pod maturity at harvest. Free fatty acid (FFA) levels were highest in 5 day fermented beans. The 3 day fermented beans contained significantly higher epicatechin, with lower FFA content. Chocolate made from mature beans with 3 day fermentation was more pleasant as it scored the highest in flavor intensity and complexity and the lowest in acidity and astringency.
CONCLUSION: This study suggests that cacao pods harvested at the mature stage with further fermentation for 3 days under controlled temperatures produce specialty beans with potential health benefits. © 2021 Society of Chemical Industry.
Asthma control in the Asia-Pacific region: the Asthma Insights and Reality in Asia-Pacific Study

Lai CK, De Guia TS, Kim YY, Kuo SH, Mukhopadhyay A, Soriano JB, et al.

J Allergy Clin Immunol, 2003 Feb;111(2):263-8.
PMID: 12589343

Few data on asthma management are available for the Asia-Pacific region.

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