Otitis Media With Effusion

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Rational Antibiotic Utilisation In Selected Paediatric Conditons

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Management of Hypertension

Hypertension is a major risk factor for cardiovascular, cerebrovascular andrenal diseases. The third National Health and Morbidity Survey of 2006showed that the prevalence of hypertension among adults 30 years oldand above was 43%, a relative increase of 30% from that of 10 years earlier.
It is now estimated that there are 4.8 million individuals with hypertensionin Malaysia. The estimated figure worldwide is a staggering 1 billion individuals. It is however alarming to note that, according to the findings ofthe Third National Health and Morbidity Survey of 2006, close to two thirds of individuals with hypertension in Malaysia were unaware that they have hypertension. Although there was an increase in the treatment rate among those who have been diagnosed, the control rate is still poor. The Third National Health and Morbidity Survey revealed that among patients with hypertension who were on drug treatment, only 26% of them achieved the target blood pressure. This finding is consistent with a separate survey conducted by the Institute of Health Management of the Ministry of Healthon the outpatient management of hypertension in government clinics.Only 28.5% of patients treated for hypertension in government clinicsachieved the target blood pressure.

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MANAGEMENT OF HEART FAILURE

Heart failure (HF) is the end stage of most diseases of the heart. The prevalence of HF varies between 3 – 20 per 1000 population, although in persons over the age of 65 years, it could be as high as 100 per 1000 population. The prognosis for HF is poor, far worse than some of the common cancers. Theone year mortality rate varies between 5% to 52% depending on the severity and the presence of co-morbidity. In a large community based study,about 40% of individuals with HF died within a year of initial diagnosis. About half of all deaths are sudden and may occur at any stage of the syndrome. Heart failureis an important cause of hospitalization accounting for about 10% of all medical admissions in Malaysia. About 45% of patients with HF are readmitted at least once within 12 months for acute decompensation. More recent epidemiological studies from the West seem to indicate that the prognosis has improved slightly with earlier detection of the condition and improved treatment strategies. The aims of management are:

• Preventing the development of HF
• Reducing the morbidity associated with the condition and improving the qualityof life of these patients
• Improving the survival of patients with HF

This guideline provides evidence based recommendations to help health care providers in the management of their patients with HF. Patient care should how ever be individualized and sound clinical judgement plays an important role in decision making.

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CONSENSUS ON MANAGEMENT OF ANDROGENETIC ALOPECIA

Androgenetic alopecia is a common disorder in Malaysia. It is estimated that at least 50% of men develop androgenetic alopecia or male pattern hair loss at some point in their lives. Androgenetic alopecia has important psychosocial impact fects on patients. This translates into a significant economic impact in the household health expenditure. It is important that doctors including family practitioners be involved and trained in the diagnosis and treatment of androgenetic alopecia. This will help educate the public on the misinformation and myths being propagated and marketed by non-medical sources.The basic pathophysiology of androgenetic alopecia involves the miniaturization of scalp hair follicles in sitespecificareas due to a genetic predisposition being translated by a hormonal mechanism. Current evidence indicates that dihydrotestosterone(DHT) is the hormonal messenger. Currently, the only pharmacological agents that are scientifically proven effective are oral Finasteride and topical Minoxidil. Surgical treatment is an option for selected patients. Except for surgery, currently available pharmacological treatments are suppressive and not curative. Supporting the patients emotionally and ensuring that they understand the limitation of these treatments remains an important component of the management of androgenetic alopecia.

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