TB on the rise in KL

From a recent news report indicating an alarming rise of tuberculosis and HFMD infections in an affluent area of Malaysia.

What is worrying is the actual incidence rate of MultiDrug Resistant TB infections in Malaysia. MDR TB is a problem in surrounding countries in South East Asia and has not yet been a major problem in Malaysia.

Tuberculosis has always been thought to affect lower socio-economic groups. Thus much blame has been put on migrant workers. The new style of living in high rise buildings could also have a role in this air borne infection where families are now living in closer proximity to each other.

It is however still of paramount importance to beef up the health screening of migrant workers and identifying illegal immigrants which is thought to be in the region of a few hundred thousands in Malaysia. Citizens of Malaysia will have play an important role here. Solely relying on the police and the immigration authorities may not be sufficient if we are to plug the holes in our borders.

At the same time, doctors should be thorough when examining immigrants during their compulsory health screenings. Being pressured to pass off an unhealthy individual should not occur and is tantamount to medical negligence.

Strengthening our DOTS program is important to ensure completion of treatment and thus reduce the likelihood of MDR TB. Complacency in this aspect will be catastrophic.

Ultimately, TB is a treatable condition. What is more ideal would be a more effective drug requiring a much shorter course of treatment. Many new compounds are currently being tested and still remains far from reaching clinical practice. There is a Tuberculosis Antimicrobial Acquisition and Coordinating Facility (TAACF) which accepts new compounds for testing against TB.

Perhaps a Nobel Prize is in store for the discoverer of a new more potent anti-TB drug which will revolutionise TB treatment and save millions of lives.

AIDS Vaccine Fails

Merck reported recently that they are halting their trial on an AIDS vaccine after it failed to prevent HIV infection.

Read their News Report here.

Rimonabant : Weight Loss wonder?

Rimonabant is a CB1 cannabinoid receptor antagonist, some say the next generation anti obesity drug. Observations that heroin causes an increase in appetite led to the discovery of the role that the endocannabinoid system played appetite control and subsequent weight problems.

It first came into prominence in 2004 and recent trials have churned out data proving long term safety and superior efficacy in terms of weight loss, improved cholesterol profile, reduced abdominal circumference and even benefits for Type II diabetics.

Patients in the RIO-Europe trial who were on 20 mg of Rimonabant achieved 15-20 pounds weight loss, 7.5 cm waist reduction, 30% increase in HDL and 9% reduction in triglycerides. RIO-North America displayed similar results.

Indeed a promising addition to the armamentarium in our fight against the flab.

Rimonabant (wikipedia)

More confusion on Drug Eluting Stents

When drug eluting stents (DES) was first introduced, it was touted to make bare metal stents (BMS) a thing of the past. These DES stents are to solve the problem of early restenosis that plaqued the BMS.

Unfortunately as more data surface, DES is losing its edge with high events of late stent thrombosis and increased mortality in some populations. Duration of antiplatelet therapy is now prolonged and some doctors are even contemplating lifelong therapy with antiplatelets. Reading study after study only causes more confusion, with advocates on either side of the fence.

Many cardiologists do not give satisfactory answers as there is obviously none. The choice of using DES or BMS on most occasions is settled due to financial constraints rather than clinical benefits.

In Malaysia, DES remains extremely costly and out of reach for many average Malaysians. Even worse, some patients are denied even BMS due to financial reasons despite strong clinical indications. Even antiplatelet therapy with clopidogrel is unaffordable.

As of now, the haze is only getting thicker.

Angioplasty.org

More to communication skills

From Medscape,

Physicians With Poor Communication Skills Linked With More Patient Complaints NeW YORK (Reuters Health) Sept 06 - Physicians who have low scores on assessments of patient-physician communications early in their career are more likely than their peers with higher scores to be reported to medical regulatory authorities, according to a longitudinal study in Canada reported in the Journal of the American Medical Association for September 5th. continuing story

Often times, the medical fraternity stresses on a good doctor-patient relationship as an ideal quality. Indeed it is. However, I feel that it is equally important to have a good doctor-doctor communication as well. This less often talked about subject is lacking in many doctors today.

Communicating effectively among doctors is an attribute that defines competence. A short tempered and condescending doctor paints a picture of instability and a lack of self confidence. Our daily practice unfortunately exposes many encounters that often lack civility. Does a grandiose position or degree grants a doctor the right to ridicule another?

Perhaps doctors need more training when it comes to communicating among themselves. Only when this is in order that a good doctor-patient relationship can blossom.

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