A Brief Review of Severe Asthma

Severe asthma describes an asthma condition that requires a substantial amount of inhaled corticosteroid and bronchodilators to keep it under control including the frequent additional need for oral steroid to avoid exacerbations. The incidence of severe asthma in Malaysia is unknown but data elsewhere shows that it is around 5 to 10 % of asthmatics. This category of asthmatic patients has considerable morbidity, is disproportionate cost-wise to the number of sufferers and requires specialised and focused care. The management of severe asthma should be undertaken at a severe asthma clinic led by a physician with a special interest in its management. The diagnosis needs confirmation, comorbidities identified and triggering factors addressed. Inhaler technique and compliance are major contributing issues and must be addressed at all consultation opportunities. Once the diagnosis of severe asthma is confirmed, the disease needs phenotyping to plan for the most appropriate treatment, termed as a personalised approach to severe asthma care. The advances in biologics have changed the landscape of treatment of this disease but in Malaysia especially, there are many limitations namely the cost. This article briefly explores the current understanding of severe asthma, the assessment including phenotyping and possible treatment options.

Oral Health Literacy and Oral Health Status among Undergraduate University Students

Objective: To identify the prevalence of caries, plaque score, and periodontal disease and explore the correlations between oral health literacy scores and oral health status among undergraduate students. Materials and Methods: A cross-sectional study was conducted with a group of undergraduate students using the Malay version of the Oral Health Literacy (OHL) Index. A stratified random sampling technique was used to select the samples. Clinical oral examinations were conducted by a single trained examiner using a Community Periodontal Index (CPI) probe and a mouth mirror. Data analysis was conducted using statistical tests contained in SPSS version 26, and statistical significance was set at p<0.05. Results: A total of 280 students were recruited into the study. The prevalence of caries and periodontal disease was 58.9 and 13.2%, respectively. There was a significant association between OHL and field of study (p<0.001). There was also a significant negative but weak correlation between OHL and dental plaque scores (r= -0.147; p=0.014). A significant positive but weak correlation was found between dental plaque scores and dental caries (r= 0.135; p=0.024) and periodontal pocket depth (r= 0.168; p=0.005). Conclusion: The prevalence of dental caries was high, while the prevalence of periodontal diseases was low in this study. OHL correlated significantly with dental plaque scores and field of the study. Thus, OHL assessment is essential to understand a person’s OHL levels and can be considered a screening tool for early detection of poor oral hygiene.

Trigeminal Neuralgia as Nonodontogenic Toothache: A Case Report

Toothaches typically originate from the odontogenic structures such as dentin, pulp and periodontium. Toothaches which have an odontogenic origin are managed effectively in the dental clinic; however, toothaches with a nonodontogenic origin are often difficult to identify. This article presents a case of trigeminal neuralgia that was misdiagnosed as pain of odontogenic origin and initially treated surgically and endodontically, despite no abnormality detected in the physical examination or X-ray. The aim of this article is to present a case of trigeminal neuralgia that may mimic odontogenic toothache. This case highlights the importance of having thorough knowledge and the appropriate clinical skills to differentiate both odontogenic and nonodontogenic toothaches, as well as the need for careful diagnosis before undertaking any treatment.

Acute Mania as an Essential Contributor for Failed Extubation in an Asthmatic Patient: A Case Report

Failed extubation is not uncommon in intensive care unit and are known to have high morbidity outcomes. The predictors are well-established and known to intensivist, but the complexity is to identify the contributors of these predictive factors. The failure to treat the contributing factors hampered the effort towards successful extubation. To the best of our knowledge, this is the first reported case of acute mania as the essential contributor for failed extubation. This case report illustrates on how an acute mania state prompting an exacerbation of asthmatic attack due to the physical and emotional hyperarousal that ultimately led to the failed extubation.

Associated Factors of Plasmodium Knowlesi Malaria among Registered Malaria Cases in Terengganu, Malaysia 2011- September 2019 via Vekpro Online Database

Introduction: Plasmodium knowlesi (P. knowlesi), zoonotic malaria cases had been increasing in trend in Terengganu, Malaysia. This study aimed to determine the associated factors of P. knowlesi malaria among registered malaria cases in Terengganu from 2011 to September 2019 via the Vekpro Online Database. Methods: A cross-sectional study was conducted using registered malaria cases in Terengganu from 2011 to September 2019 extracted from the Vekpro Online database and secondary weather data from the Malaysian Meteorological Department. A total sample of 247 malaria cases [(P. knowlesi (n=187), P. falciparum (n=23), P. vivax (n=37), P. malariae (n=4), mixed infection (n=3)] were analysed. The cases were grouped into P. knowlesi group (P. knowlesi, P. malariae, mixed infection) and non-P. knowlesi group (P. falciparum, P. vivax) for comparison of their risk factors. Multiple Logistic Regression analysis was used to identify the associated factors. Results: Plasmodium knowlesi group contributed to 187 out of 247 (75.7%) of all malaria cases. Four factors were found to be significantly associated with P. knowlesi group in the final multivariable logistic regression analysis. Age [AOR=1.04 (95% CI: 1.01,1.08)], Malay race [AOR=39.43 (95% CI: 13.99,111.18)], agriculture and forestry worker [AOR=14.95 (95% CI: 4.10,54.51)] and Passive Case Detection [AOR=11.70 (95% CI: 2.60,52.63)] were the significant associated factors. Conclusion: Identified significant associated factors and characteristics of the high-risk group for P. knowlesi infection can help medical and health front liners in Terengganu in early diagnosis and prompt treatment of the cases. The factors also will help in the planning and development of health interventions in targeting P. knowlesi infection.

Quality of life following Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCABG) versus Conventional Open-Heart Coronary Artery Bypass Grafting (CABG): A 3-year data from a single centre

Introduction: In Malaysia, MIDCABG started in 3 centers developing the technique. As the technique is gaining traction in the country, this study aims to compare the quality of life following MIDCABG compared with conventional CABG in one of the centers actively developing this technique. Methods: A retrospective cohort study was performed involving 30 post CABG patients which consists of 15 MIDCABG and 15 conventional CABG from January 2015 to May 2018. 15 from 21 post-MIDCABG patients were included and selected, based on EuroSCORE II less than 5. Modified Post-Operative Quality of Recovery Scale was used to assess and compare the quality of life following respective approaches. Data were analyzed using SPSS version software and comparison using mean rank with p 0.05. Conclusion: There is no significant difference in quality of recovery following MIDCABG compared to conventional CABG. Modified PostOPQRS system can be a useful assessment tool to evaluate the impact of an intervention in relation of quality of life.

Bypassing a Separated Instrument in Mandibular First Premolar with Two Canals – A Case Report

Fracture of an endodontic instrument will impair the debridement procedure and thus affects the endodontic outcome. This case report focuses on the management of separated instrument and highlights the anatomical variation of mandibular first premolar. An in-depth knowledge on the internal anatomy of this particular tooth as well as following a proven and safe technique as a guideline is important in preventing these endodontic mishaps.

Relationship Between Concomitant Atopic Diseases With Atopic Dermatitis Severity And Persistence.

Introduction: The atopic march consists of atopic dermatitis (AD), allergic rhinitis or sinusitis (AR), allergic conjunctivitis (AC) and bronchial asthma (BA). The influence of concomitant atopic diseases on AD is under-explored. We determined the relationship between personal and family history of atopic diseases with AD severity and persistence. Methods: A cross sectional study involving AD patients was performed at dermatology clinics of two tertiary hospitals. Inclusion criterion was all patients diagnosed with AD. Demographic data, personal and family history of atopy (BA, AR and AC) were obtained by face-to-face interview. AD severity was evaluated using Investigator’s Global Assessment (IGA). AD was considered persistent if continued beyond age 12 years. Results: Sixty patients aged 21.6±17.2 participated. There were 25(41.7%) with concomitant AR, 16(26.7%) BA and 12(20%) AC. Forty seven (78.3%) patients had family history of atopy, 25(41.7%) had eczema, 24(40%) AR, 19(31.7%) BA and 2(3.3%) AC. Patients with BA [OR=3.8, 95%CI 1.04 to 14.4)], BA and AR [OR=9.74, 95%CI 1.13 to 83.67) and family history of BA [OR= 4.00, 95%CI 1.20 to 13.27) were more likely to exhibit moderate-severe AD. Personal AR, AC and family history of AD and BA were significantly more prevalent in patients with persistent AD. Conclusions: AR was the most common atopic disease associated with AD. Family history of eczema and AR were common. Personal BA, BA with AR and family history of BA were predictors of severe AD. Personal AR, AC and family history of AD and BA were associated with AD persistence.