Kuala Lumpur, Malaysia
Kuala Lumpur, Malaysia

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Fukuchi Y.,Juntendo University | Fernandez L.,University of the Philippines at Manila | Kuo H.-P.,Chang Gung Memorial Hospital | Mahayiddin A.,Institute of Respiratory Medicine | And 5 more authors.
Respirology | Year: 2011

Background and objective: Studies in respiratory diseases other than chronic obstructive pulmonary disease suggest potentially differing responses to medications among patients from different regions. We report a subgroup analysis of patients recruited to Asian centres from a previously reported 4-year COPD trial. Methods: Subgroup analysis from a randomized, double-blinded, placebo-controlled trial of tiotropium 18 μg daily in COPD. Primary end-point was rate of decline in FEV 1. Secondary end-points included spirometry at individual time points, health-related quality of life (St George's Respiratory Questionnaire), exacerbations and mortality. Results: Of 5992 patients, 362 were from Asian centres (100 from Japan). Mean age 66 years, 95% men, 13% current smokers, BMI: 21 kg/m 2; post-bronchodilator FEV 1: 44% predicted; St George's Respiratory Questionnaire total score: 44 units. No treatment effect was observed for rate of decline in FEV 1 although annual decline was less in Asian patients. Morning prebronchodilator FEV 1 and forced vital capacity improved in Asian patients (P < 0.05). Tiotropium reduced number of exacerbations (rate ratio (95% confidence interval (CI)): 0.73 (0.57-0.94)). Hazard ratios (95%CI) for exacerbations and hospitalized exacerbations (tiotropium/control) were 0.81 (0.62-1.05) and 0.85 (0.61-1.19), respectively. St George's Respiratory Questionnaire total score improvedby 1.5-6.1 units (P < 0.05 for months 18, 24, 30 and 36) with tiotropium. Fatal events occurred in 34 tiotropium (18.5%) and 42 control (23.6%) patients. Conclusions: In COPD patients from Asia, tiotropium improves lung function, improves health-related quality of life and reduces exacerbations over 4 years of treatment. © 2011 The Authors Respirology © 2011 Asian Pacific Society of Respirology.


PubMed | University of Pennsylvania, National Taiwan University Hospital, Institute of Respiratory Medicine, University of Indonesia and 6 more.
Type: | Journal: Vaccine | Year: 2017

The fourth roundtable meeting of the Global Influenza Initiative (GII) was held in Hong Kong, China, in July 2015. An objective of this meeting was to gain a broader understanding of the epidemiology, surveillance, vaccination policies and programs, and obstacles to vaccination of influenza in the Asia-Pacific region through presentations of data from Australia, Hong Kong, India, Indonesia, Malaysia, New Zealand, the Philippines, Taiwan, Thailand, and Vietnam. As well as a need for improved levels of surveillance in some areas, a range of factors were identified that act as barriers to vaccination in some countries, including differences in climate and geography, logistical challenges, funding, lack of vaccine awareness and education, safety concerns, perceived lack of vaccine effectiveness, and lack of inclusion in national guidelines. From the presentations at the meeting, the GII discussed a number of recommendations for easing the burden of influenza and overcoming the current challenges in the Asia-Pacific region. These recommendations encompass the need to improve surveillance and availability of epidemiological data; the development and publication of national guidelines, where not currently available and/or that are in line with those proposed by the World Health Organization; the requirement for optimal timing of vaccination programs according to local or country-specific epidemiology; and calls for advocacy and government support of vaccination programs in order to improve availability and uptake and coverage. In conclusion, in addition to the varied epidemiology of seasonal influenza across this diverse region, there are a number of logistical and resourcing issues that present a challenge to the development of optimally effective vaccination strategies and that need to be overcome to improve access to and uptake of seasonal influenza vaccines. The GII has developed a number of recommendations to address these challenges and improve the control of influenza.


PubMed | Institute of Respiratory Medicine, Seoul National University, Chang Gung Memorial Hospital, National Allergy Asthma Bronchitis Institute and 4 more.
Type: | Journal: Value in health regional issues | Year: 2016

Asia-Pacific Burden of Respiratory Diseases is a cross-sectional, observational study examining the burden of disease in adults with respiratory diseases across six countries. The aim of this study was to describe health care resource use (HCRU), work impairment, cost burden, and health-related quality of life (HRQOL) associated with respiratory disease in the Asia-Pacific.Consecutive participants aged 18 years or older with a primary diagnosis of asthma, allergic rhinitis, chronic obstructive pulmonary disease, or rhinosinusitis were enrolled. Participants completed a survey detailing respiratory symptoms, HCRU, work productivity and activity impairment, and HRQOL. Locally sourced unit costs for each country were used in the calculation of total costs.The study enrolled 5250 patients. Overall, the mean annual cost for patients with a respiratory disease was US $4191 (SGD 8489) per patient. For patients who reported impairment at work, the mean annual cost was US $7315 (SGD 10,244), with productivity loss being the highest cost component for all four diseases (US $6310 [SGD 9100]). On average, patients were impaired for one-third of their time at work and 5% of their work time missed because of respiratory disease, which resulted in a 36% reduction in productivity. Patients with a primary diagnosis of chronic obstructive pulmonary disease had the greatest impact on HRQOL.In the Asia-Pacific, respiratory diseases have a significant impact on HCRU and associated costs, along with work productivity. Timely and effective management of these diseases has the potential to reduce disease burden and health care costs and improve work productivity and HRQOL.


PubMed | Myung ENT Clinic, Hamchun Medical Clinic, Institute of Respiratory Medicine, Seoulbom IM Clinic and 11 more.
Type: Journal Article | Journal: Allergy, asthma & immunology research | Year: 2016

The Asia-Pacific Burden of Respiratory Diseases (APBORD) study is a cross-sectional, observational one which has used a standard protocol to examine the disease and economic burden of allergic rhinitis (AR), asthma, chronic obstructive pulmonary disorder (COPD), and rhinosinusitis across the Asia-Pacific region. Here, we report on symptoms, healthcare resource use, work impairment, and associated costs in Korea.Consecutive participants aged 18 years with a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Participants and their treating physician completed a survey detailing respiratory symptoms, healthcare resource use, and work productivity and activity impairment. Costs included direct medical cost and indirect cost associated with lost work productivity.The study enrolled 999 patients. Patients were often diagnosed with multiple respiratory disorders (42.8%), with asthma/AR and AR/rhinosinusitis the most frequently diagnosed combinations. Cough or coughing up phlegm was the primary reason for the medical visit in patients with a primary diagnosis of asthma and COPD, whereas nasal symptoms (watery runny nose, blocked nose, and congestion) were the main reasons in those with AR and rhinosinusitis. The mean annual cost for patients with a respiratory disease was US$8,853 (SD 11,245) per patient. Lost productivity due to presenteeism was the biggest contributor to costs.Respiratory disease has a significant impact on disease burden in Korea. Treatment strategies for preventing lost work productivity could greatly reduce the economic burden of respiratory disease.


PubMed | Medical Affairs, Institute of Respiratory Medicine, Seoul National University, Chang Gung Memorial Hospital and 8 more.
Type: Journal Article | Journal: Lung India : official organ of Indian Chest Society | Year: 2016

Chronic respiratory diseases such as asthma, allergic rhinitis (AR), chronic obstructive pulmonary disease (COPD), and rhinosinusitis are becoming increasingly prevalent in the Asia-Pacific region. The Asia-Pacific Burden of Respiratory Diseases study examined the disease and economic burden of AR, asthma, COPD, and rhinosinusitis across the Asia-Pacific and more specifically India.To estimate the proportion of adults receiving care for asthma, AR, COPD, and rhinosinusitis and assess the economic burden, both direct and indirect of these chronic respiratory disease.Consecutive participants aged 18 years with a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Surveys comprising questions about respiratory disease symptoms, healthcare resource utilization, work productivity, and activity impairment were completed by treating physicians and participants during one study visit. Costs, indirect and direct, that contributed to treatment for each of the four respiratory diseases were calculated.A total of 1000 patients were enrolled. Asthma was the most frequent primary diagnosis followed by AR, COPD, and rhinosinusitis. A total of 335 (33.5%) patients were diagnosed with combinations of the four respiratory diseases; the most frequently diagnosed combinations were asthma/AR and rhinosinusitis/AR. Cough or coughing up sputum was the primary reason for the current visit by patients diagnosed with asthma and COPD while AR patients reported a watery, runny nose, and sneezing; patients with rhinosinusitis primarily reported a colored nasal discharge. The mean annual cost per patient was US$637 (SD 806). The most significant driver of direct costs was medications. The biggest cost component was productivity loss.Given the ongoing rapid urbanization of India, the frequency of respiratory diseases and their economic burden will continue to rise. Efforts are required to better understand the impact and devise strategies to appropriately allocate resources.


PubMed | University of Technology Malaysia, University of Cagliari, Kuala Lumpur Hospital, Global Biomedical Technologies Inc. and 2 more.
Type: Journal Article | Journal: Journal of medical systems | Year: 2016

Human interaction has become almost mandatory for an automated medical system wishing to be accepted by clinical regulatory agencies such as Food and Drug Administration. Since this interaction causes variability in the gathered data, the inter-observer and intra-observer variability must be analyzed in order to validate the accuracy of the system. This study focuses on the variability from different observers that interact with an automated lung delineation system that relies on human interaction in the form of delineation of the lung borders. The database consists of High Resolution Computed Tomography (HRCT): 15 normal and 81 diseased patients images taken retrospectively at five levels per patient. Three observers manually delineated the lungs borders independently and using software called ImgTracer (AtheroPoint, Roseville, CA, USA) to delineate the lung boundaries in all five levels of 3-D lung volume. The three observers consisted of Observer-1: lesser experienced novice tracer who is a resident in radiology under the guidance of radiologist, whereas Observer-2 and Observer-3 are lung image scientists trained by lung radiologist and biomedical imaging scientist and experts. The inter-observer variability can be shown by comparing each observers tracings to the automated delineation and also by comparing each manual tracing of the observers with one another. The normality of the tracings was tested using DAgostino-Pearson test and all observers tracings showed a normal P-value higher than 0.05. The analysis of variance (ANOVA) test between three observers and automated showed a P-value higher than 0.89 and 0.81 for the right lung (RL) and left lung (LL), respectively. The performance of the automated system was evaluated using Dice Similarity Coefficient (DSC), Jaccard Index (JI) and Hausdorff (HD) Distance measures. Although, Observer-1 has lesser experience compared to Obsever-2 and Obsever-3, the Observer Deterioration Factor (ODF) shows that Observer-1 has less than 10% difference compared to the other two, which is under acceptable range as per our analysis. To compare between observers, this study used regression plots, Bland-Altman plots, two tailed T-test, Mann-Whiney, Chi-Squared tests which showed the following P-values for RL and LL: (i) Observer-1 and Observer-3 were: 0.55, 0.48, 0.29 for RL and 0.55, 0.59, 0.29 for LL; (ii) Observer-1 and Observer-2 were: 0.57, 0.50, 0.29 for RL and 0.54, 0.59, 0.29 for LL; (iii) Observer-2 and Observer-3 were: 0.98, 0.99, 0.29 for RL and 0.99, 0.99, 0.29 for LL. Further, CC and R-squared coefficients were computed between observers which came out to be 0.9 for RL and LL. All three observers however manage to show the feature that diseased lungs are smaller than normal lungs in terms of area.


PubMed | NIMS Medical College and Institute of Respiratory Medicine
Type: Journal Article | Journal: The Indian journal of tuberculosis | Year: 2016

CAT IV regimen or the standardized drug regimen (SDR) under the Revised National Control Program (RNTCP) uses six second-line anti-tubercular drugs in the initial intensive phase (IP). These drugs have many side effects and toxicity; they are less efficacious and have poor acceptability. The present study was conducted to evaluate the efficacy and outcome of Cat-IV regimen and the factors which influence the treatment outcome in MDR TB patients.It was a prospective observational study, which was done in the CAT II treatment failure, LPA proven MDR TB patients, above the age of 18 years, who were referred to DOTS Plus center for treatment. The study was approved by the hospital ethics committee and patient consent was obtained before inclusion.We observed culture conversion in 63.04% and ADR in 96.5%, default in 15.65%, and death in11.3% cases. The factors which influenced outcome included low body weight, long duration of illness cavitatory disease and indulgence in both tobacco & alcohol. The radiological favorable response strongly and significantly correlated with the bacteriological and clinical response during the IP.We suggest that the efficacy can be further augmented by reducing default and controlling deaths which accounts for substantial numbers and occur mostly during IP.


Than J.C.M.,University of Technology Malaysia | Noor N.M.,University of Technology Malaysia | Rijal O.M.,University of Malaya | Yunus A.,Institute of Respiratory Medicine | Kassim R.M.,Kuala Lumpur Hospital
IEEE TENSYMP 2014 - 2014 IEEE Region 10 Symposium | Year: 2014

This study's objective is to execute successful segmentation of the lung anatomy of HRCT of patients who have ILD and evaluate the segmentation performance. Initial segmentation process involved Otsu grey level thresholding and morphological filtering. Some of the problems encountered were the appearance of connected lungs because the left lung and right lung were very close to each other, and heavily diseased lungs with too much damaged tissue. By using Radon transform and accumulating the pixel width, a separation region could be found to split left lung and right lung. The separation process yielded 70.1% improvement for all the samples with connected lungs. This causes the segmentation results for Level 1 to increase to 79.01% for Right Lung and 92.59% for Left Lung, for level 2, successful segmentation increased to 88.89% for both lungs. In Level 3 segmentation results increased to 85.19% for Right Lung and 82.72% for Left Lung. For Level 4 segmentation results increased to 96.30% for Right Lung and 95.06% for Left Lung. For Level 5 segmentation results increased to 92.59% for Right Lung and 86.42% for Left Lung. Samples that could not be separated were due to the size of the splitting region which could be tackled with an adaptive splitting region in future works. © 2014 IEEE.


Noor N.Mohd.,University of Technology Malaysia | Rijal O.Mohd.,University of Malaya | Yunus A.,Institute of Respiratory Medicine | Abu-Bakar S.A.R.,University of Technology Malaysia
Computerized Medical Imaging and Graphics | Year: 2010

This paper presents a statistical method for the detection of lobar pneumonia when using digitized chest X-ray films. Each region of interest was represented by a vector of wavelet texture measures which is then multiplied by the orthogonal matrix Q2. The first two elements of the transformed vectors were shown to have a bivariate normal distribution. Misclassification probabilities were estimated using probability ellipsoids and discriminant functions. The result of this study recommends the detection of pneumonia by constructing probability ellipsoids or discriminant function using maximum energy and maximum column sum energy texture measures where misclassification probabilities were less than 0.15. © 2009 Elsevier Ltd. All rights reserved.


Yunus A.,Institute of Respiratory Medicine | Seet W.,Clinical Epidemiology Unit | Mohamad A.B.,Biostatistics Unit | Haniff J.,Clinical Epidemiology Unit
Malaysian Family Physician | Year: 2013

Objective: To validate the Malay version of Berlin Questionnaire (BQ) as a tool to screen for patients at risk of obstructive sleep apnea (OSA) in primary care Background: Most patients with OSA are unrecognised and untreated. Thus, the BQ has been used as a tool to screen for patients at risk for OSA. However, this tool has not been validated in Malay version. Materials and Methods: A parallel back-to-back translation method was applied to produce the Malay version (Berlin-M). The Malay version was administered to 150 patients in a tertiary respiratory medical centre. Concurrent validity of the Berlin-M was determined using the Apnea Hypopnea Index (AHI) as the gold standard measure. The test-retest reliability and internal consistency of the Berlin-M were determined. Results: Most patients were males (64.0%) and majority of them were Malays (63.3%). Based on the sleep study test, 121 (84.0%) were classified as high risk while 23 (16.0%) as low risk using the Apnea Hypopnea Index (AHI) ≥5 as the cutoff point. The test-retest reliability Kappa value showed a good range between 0.864 - 1.000. The Cronbach's alpha of BQ was 0.750 in category 1 and 0.888 in category 2. The sensitivity and specificity were 92% and 17% respectively. Conclusion: The BQ showed high sensitivity (92%) but low specificity (17%). Therefore, though the Berlin-M is useful as a screening tool, it is not a confirmatory diagnostic tool.

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