Friday, February 11, 2011
Workshops on 'Structural Elucidation of Organic Compounds' (1st - 3rd March 2011, IMU Bukit Jalil, Kuala Lumpur)
These workshops are unique in the sense that these workshops cover all the basic & advanced techniques in structural elucidation of organic compounds.
These workshops would be very useful to the researchers who are involved in identification of compounds from any source. Also, these workshops would act as a platform to network research collaboration.
The dead line for early bird registration is 15th February 2011.
HURRY!!The number of participants in each workshop is limited to only 25 participants.
1) MPS : http://www.mps.org.my/newsmaster.cfm?&menuid=37&action=view&retrieveid=3375
2) IMU : http://www.imu.edu.my/about_events.asp?pageid=1&browseeventsid=132
Saturday, January 22, 2011
Nicotine Replacement Therapy (NRT): 132 RCTs.
-Overall risk ratio (RR) and 95% confidence interval (CI) of abstinence: 1.58 (1.50 to 1.66); similar for gum, patch, inhaler, and lozenge.
-Adverse events (AEs): local irritation related to product type; no evidence of increased myocardial infarction.
Varenicline: 9 RCTs.
-The RR (95% CI) for cessation at 6 to 12 months over placebo was 2.33 (1.95 to 2.80).
-Varenicline AEs: primarily nausea, insomnia, and abnormal dreams; 10% AE drop-out rate; neuropsychiatric AEs (eg, depression, agitation, suicidal thoughts or behaviour) are infrequent butrequire monitoring.
-Reported benefit of varenicline might be influenced by industry funding and lack of a pragmatic design.
Antidepressants: 49 bupropion and 9 nortriptyline RCTs.
-The RR (95% CI) for cessation over placebo at 6 to 12 months: bupropion 1.69 (1.53 to 1.85); nortriptyline 2.03 (1.48 to 2.78).
-Bupropion AEs: primarily insomnia and dry mouth; 7% to 12% AE drop-out rate; rarely seizure (about 1/1000) and suicidal thoughts or behaviour (association unclear).
-Nortriptyline AEs: primarily dry mouth, drowsiness, light-headedness, and constipation (less at lower doses); 4% to 12% drop-out rate from AEs.
Smoking cessation is the most effective preventive manoeuver for high-risk patients: an RCT of aggressive intervention for 209 patients after critical care admission achieved a 2-year quit rate of 39% (9% for placebo) and mortality of 3% (vs 12%); number needed to treat was 11.
-Bupropion: 150 mg is equivalent to 300 mg.
-Varenicline: 0.5 mg twice daily is as effective (or almost as effective),as 1 mg twice daily, but with fewer AEs.
-Nortriptyline: start with 25 mg at bedtime and increase by 25 mg every 3 to 4 days, if the desire to smoke persists, to a maximum of 75 to 100 mg; encourage a quit date 10 days in (or so) and continuefor 10 to 12 weeks.
Nicotine replacement, bupropion, nortriptyline (off label), and varenicline are all effective in smoking cessation; AEs vary (and might relate to quitting smoking), but they are important and require monitoring.
In Malaysia, the recommended (and available) pharmacotherapy for smoking cessation are NRT (gum, lozenges, patch, inhaler) and varenicline.
Nicotine 16hour-patch and varenicline are listed in the Ministry of Health Drug Formulary as A/KK (Category of prescribers: Consultants/ Specialists/Family Physician Specialists).
Allan,GM, Ivers N and Els C. Can Fam Physician, 57 (1), January 2011: 47.
Sunday, January 9, 2011
So to summarise the discussion, When comes to asthmatic patients, there are few things you ned to make it clear before you jump into recommendation:
1) Patient's compliance on inhaler techniques. If non-compliance, there is a bigger issue for u to address before you add in an extra med.
2)How to step up and to step down in asthma management? What parameters you look at ?
If to step up, which agent will you choose ? What monitoring parameters are you interested to look at?
- after corticosteroid, what is next in the list?
- can long acting beta-agonist be given alone?
- what are the up-coming innovation in management of asthma patients, that could improve compliance, improve efficacy and reduce side effect?
3) think about what is the pathophysiology of asthma?
- why we will step up to inhale corticosteroid instead of other agent?
4) How different is the management of asthma vs COPD? why is it so?
5) How the difference of management of acute exacerbation of asthma vs chronic asthma?
- why do we have an invention of inhaler?
- When do we oral (systemic) corticosteroid in management of asthma patient?
7) Check the differences in each corticosteroid inhaler (Budesonide, beclomethasone, ciclesonide, fluticasone, betamethasone) By finding the differences, You will then understand why in the market, there is so many different corticosteroid inhalers, and why some inhale corticosteroid were phased out from the market already.
8) can asthma patient be given aspirin?
if can, what would be your concern?
if cant, what would you recommend to your doctor?
If you could find out all the answers, you will have a better understanding of how to manage an asthma patient! But dont forget about his/her other co-morbidity(ies).