Various initiatives and medications have been introduced to achieve better control of bronchial asthma. However total control according to Global Initiative for Asthma (GINA) remains elusive even at tertiary referral hospitals. Our study is to determine the level of asthma control (according to GINA 2009), Asthma Control Test (ACT) scores and the types of medications used among patients with bronchial asthma in a large tertiary hospital. Methods: A cross-sectional study of all patients with bronchial asthma who attended the Chest Clinic at Hospital Tengku Ampuan Afzan (HTAA) from 2009 to 2011. Patient demographics, self-administered ACT scores, GINA-defined level of asthma control and medications were documented. Results: 208 patients were recruited. There were 23.2%, 46.3% and 30.5% of patients with controlled, partly controlled and uncontrolled asthma respectively. The median ACT scores was 19 [inter quartile range (IQR) 6]. The most frequently used preventer therapy was inhaled long-acting β-agonist/corticosteroids (LABA/ICS) fixed-dose combination (61.7%), and 9.6% were not on preventer therapy. 75% of patients with controlled asthma were on LABA/ICS compared to 58.5% of the partly controlled and uncontrolled groups (p=0.039). Conclusion: The majority of the asthmatic patients attending the Chest Clinic at HTAA did not have GINA-defined controlled asthma. Patients with higher ACT scores had better control of asthma. There were more patients with controlled asthma who were on LABA/ ICS combination.

Intrapulmonary bronchogenic cyst is a rare congenital lesion originating from abnormal budding of the embryonic foregut. It is less common than mediastinal bronchogenic cyst. We describe a case of intrapulmonary bronchogenic cyst and discuss the treatment of this condition.

Background and Objectives: Despite much medical progress, stroke remains a leading cause of death and disability. The aim of our study was to analyze the frequency of various risk factors and determine predictors of in-hospital mortality among primary intracerebral hemorrhage (PICH) patients, thus providing insight in developing therapeutic strategies to improve the outcome. Methods: A prospective study conducted at a tertiary care hospital. Results: A total of 160 patients (108 male and 52 female) were evaluated. Their ages ranged from 25 to 85 years (mean age was 58.3 ± 11.4 years). Hypertension was the commonest risk factor (74.4%), followed by diabetes mellitus (18.8%) and cigarette smoking (36.3%). The commonest location of ICH was lobar (43.8%) followed by basal ganglia / internal capsule (28.1 %) and multilobar (13.1%). The overall in-hospital mortality was 32.5 %. About one third (32.7%) of the deaths occurred within fi rst 24 hours, this rose to 38.5% within fi rst 2 days and 84.6% within one week. The signifi cant independent predictors of acute in- hospital mortality were Glasgow Coma Scale (GCS) on admission, posterior fossa bleed (OR 11.01; 95% CI 3.21 to 37.81), hematoma volume >60ml (OR 4.72; 95% CI 1.34 to 16.64), mid line shift (OR 3.32; 95% CI 1.05 to 10.50) and intraventricular extension of haemorrhage (OR 5.69; 95% CI 2.24 to 14.47). Conclusion: Low GCS score, posterior fossa bleed, and large hematoma volume were main indicators of mortality following PICH in East coast of Peninsular Malaysia.

Massive haemoptysis can occur in lung abscess. Massive haemoptysis itself may be life threatening due to asphyxiation or respiratory failure secondary to acute large airway obstruction by blood clots. Prompt removal of the obstructing blood clots save life. We describe a case of lung abscess causing massive haemoptysis resulting in acute airway obstruction which required rigid bronchoscopy to remove the huge blood clot. (JUMMEC2010; 13(2): 107-110)
Bronchoscopy

This case report describes a rigid bronchoscopy-assisted placement of a silicone airway Y-stent in a patient who developed tracheobronchomalacia following repeated dilatations for post-tuberculous airway stenosis. This is the first report of an airway Y-stent insertion in Malaysia.

Klebsiella ozaenae is a Gram negative bacillus. It has been described as a colonizer of oral and nasopharyngeal mucosa and is a cause of atrophic rhinitis. Klebsiella ozaenae has seldom been isolated from serious infections. However, several reports have stated that Klebsiella ozaenae may cause invasive infections and even mortality. We report a 55-year-old man with Klebsiella ozaenae infection causing abscesses involving the right eye and left kidney and possibly also in the brain, lungs and prostate. The isolates were sensitive to ceftazidime, ciprofl oxacin, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim but resistant to ampicillin. He responded well to 4 weeks of IV ceftazidime and IV amoxycillin-clavulanic acid. To our knowledge, such a multiorgan infection has not been reported previously for this organism.