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Poh ME, Chai CS, Liam CK, Ho GF, Pang YK, Hasbullah HH, Tho LM, Muhamad Nor I, Ho KF, Thiagarajan M, Samsudin A, Omar A, Ong CK, Soon SY, Tan SN, How SH. Does dose reduction of afatinib affect treatment outcomes of patients with EGFR-mutant metastatic non-small cell lung cancer in real-world clinical practice? Transl Lung Cancer Res 2024; 13:307-320. [PMID: 38496703 PMCID: PMC10938108 DOI: 10.21037/tlcr-23-691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/02/2024] [Indexed: 03/19/2024]
Abstract
Background Afatinib can be started at a dose lower than the recommended starting dose of 40 mg/day for the treatment of epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC), however treatment outcomes in real-world clinical practice remains unclear. Methods This retrospective study of patients with NSCLC from 18 major hospitals (public, private or university teaching hospitals) enrolled in Malaysia's National Cardiovascular and Thoracic Surgical Database (NCTSD) assessed the efficacy of lower doses of afatinib on treatment outcomes in a real-world clinical practice. Data on clinical characteristics, afatinib dosing, and treatment outcomes for patients included in NCTSD from 1st January 2015 to 31st December 2020 were analyzed. Results Of the 133 patients studied, 94.7% had adenocarcinoma. Majority of the patients (60.9%) had EGFR exon 19 deletion and 23.3% had EGFR exon 21 L858R point mutation. The mean age of patients was 64.1 years and majority (83.5%) had Eastern Cooperative Oncology Group performance status of 2-4 at diagnosis. The most common afatinib starting doses were 40 mg (37.6%), 30 mg (29.3%), and 20 mg (26.3%) once daily (OD), respectively. A quarter of patients had dose reduction (23.3%) due to side effects or cost constraints. Majority of the patients had partial response to afatinib (63.2%) whilst 2.3% had complete response. Interestingly, the objective response rate was significantly higher (72.3%) with afatinib OD doses of less than 40 mg compared to 40 mg (54.0%) (P=0.032). Patients on lower doses of afatinib were two times more likely to achieve an objective response [odds ratio =2.64; 95% confidence interval (CI): 1.20-5.83; P=0.016]. These patients had a numerically but not statistically longer median time to treatment failure (TTF). Median TTF (95% CI) for the overall cohort was 12.4 (10.02-14.78) months. Median overall survival (95% CI) was 21.30 (15.86-26.75) months. Conclusions Lower afatinib doses (<40 mg OD) could be equally effective as standard dose in patients with EGFR-mutant advanced NSCLC and may be more suited to Asian patients, minimizing side effects that may occur at higher dosages of afatinib leading to dose interruptions and affecting treatment outcomes.
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Affiliation(s)
- Mau Ern Poh
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chee Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Sarawak, Malaysia
| | - Chong Kin Liam
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Gwo Fuang Ho
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yong Kek Pang
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Harissa Husainy Hasbullah
- Faculty of Medicine, Universiti Teknologi Mara, Selangor, Malaysia
- Oncology and Radiotherapy Department, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Lye Mun Tho
- Department of Clinical Oncology, Beacon Hospital, Selangor, Malaysia
| | - Ibtisam Muhamad Nor
- Oncology and Radiotherapy Department, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Kean Fatt Ho
- Mount Miriam Cancer Hospital, Pulau Pinang, Malaysia
| | | | - Azlina Samsudin
- Department of Medicine, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia
| | - Azza Omar
- Respiratory Unit, Medical Department, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
| | | | | | - Sin Nee Tan
- Department of Medicine, Hospital Tengku Ampuan Afzan, Pahang, Malaysia
| | - Soon Hin How
- Department of Medicine, Hospital Tengku Ampuan Afzan, Pahang, Malaysia
- Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
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Loong SK, Liam CK, Karunakaran R, Tan KK, Mahfodz NH, AbuBakar S. Non-classical Bordetella sp. (closely related to Bordetella hinzii and Bordetella pseudohinzii) lower respiratory tract infection in a patient with extensive bronchiectasis: a case report. J Int Med Res 2024; 52:3000605231214464. [PMID: 38216150 PMCID: PMC10787532 DOI: 10.1177/03000605231214464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
An increasing number of reports have described the pathogenic nature of several non-classical Bordetella spp. Among them, Bordetella hinzii and Bordetella pseudohinzii have been implicated in a myriad of respiratory-associated infections in humans and animals. We report the isolation of a genetically close relative of B. hinzii and B. pseudohinzii from the sputum of a woman in her early 60s with extensive bronchiectasis who presented with fever and brown colored sputum. The isolate had initially been identified as Bordetella avium by API 20NE, the identification system for non-enteric Gram-negative rod bacteria. Sequencing of the 16S rDNA, ompA, nrdA, and genes used in the Bordetella multilocus sequence typing scheme could not resolve the identity of this Bordetella isolate. Whole-genome single nucleotide polymorphism analysis positioned the isolate between B. hinzii and B. pseudohinzii in the phylogenetic tree, forming a distinct cluster. Whole-genome sequencing enabled the further identification of this rare organism, and should be considered for wider applications, especially the confirmation of organism identity in the clinical diagnostic microbiology laboratory.
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Affiliation(s)
- Shih Keng Loong
- Tropical Infectious Diseases Research & Education Centre, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chong Kin Liam
- Department of Medicine, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rina Karunakaran
- Department of Medical Microbiology, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
- Department of Medical Microbiology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kim-Kee Tan
- Tropical Infectious Diseases Research & Education Centre, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nur Hidayana Mahfodz
- Tropical Infectious Diseases Research & Education Centre, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sazaly AbuBakar
- Tropical Infectious Diseases Research & Education Centre, Universiti Malaya, Kuala Lumpur, Malaysia
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3
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Kee YS, Wong CK, Abdul Aziz MA, Zakaria MI, Mohd Shaarif F, Ng KS, Liam CK, Pang YK, Khoo EM. 30-Day Readmission Rate of Patients with COPD and Its Associated Factors: A Retrospective Cohort Study from a Tertiary Care Hospital. Int J Chron Obstruct Pulmon Dis 2023; 18:2623-2631. [PMID: 38022826 PMCID: PMC10658934 DOI: 10.2147/copd.s429108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Readmission of chronic obstructive pulmonary disease (COPD) has been used as a measure of performance for COPD care. This study aimed to determine the rate of readmission of COPD in tertiary care hospital in Malaysia and its associated factors. Patients and Methods A retrospective cohort study was conducted at a tertiary care hospital in Malaysia from 1st January to 21st May 2019. Seventy admissions for COPD exacerbation involving 58 patients were analyzed. Results The majority of the patients were male (89.8%), had a mean age of 71.95 ± 7.24 years and a median smoking history of 40 (IQR = 25) pack-years, 84.5% were in GOLD group D and 91.4% had a mMRC grading of 2 or greater. Approximately 60.3% had upper or lower respiratory tract infection as the cause of exacerbation; one in five patients had uncompensated hypercapnic respiratory failure at presentation, and 27.6% needed mechanical ventilatory support. Approximately 43.1% of patients had a history of exacerbation that required hospitalisation in the past year. The mean blood eosinophil concentration was 0.38 ± 0.46 x109 cells/L. The 30-day readmission rate was 20.3%, revisit rate to the emergency room within 30 days after discharge was 3.4%, and in-hospital mortality rate was 1.7%. Among all characteristics, a higher baseline mMRC grade (p = 0.038) and history of exacerbation in the past 1 year (p < 0.001) were statistically associated with 30-day readmission. Conclusion The 30-day readmission rate for COPD exacerbation in a Malaysian tertiary hospital is similar to the rates in high-income countries. Exacerbation in the previous year and a higher baseline mMRC grading were significant risk factors for 30-day readmission in patients with COPD. Strategies of COPD management should concentrate on improvement of symptoms control by optimisation of pharmacotherapy, and early initiation of pulmonary rehabilitation, and structured integrated care programs to reduce readmission rates.
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Affiliation(s)
- Yan Shen Kee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kuan Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Mohd Idzwan Zakaria
- Academic Unit Trauma and Emergency, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Fatimah Mohd Shaarif
- Academic Unit Trauma and Emergency, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Seong Ng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong Kek Pang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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4
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Soo CI, Ong DB, Chin KK, Sia LC, Munusamy V, Ibrahim NH, Loh TC, Tan JL, Poh ME, Wong CK, Pang YK, Liam CK. Pathological complete response in an advance stage IIIB non-small cell lung cancer secondary to neoadjuvant osimertinib targeted therapy: A case report and review of literature. Respirol Case Rep 2023; 11:e01181. [PMID: 37350988 PMCID: PMC10282595 DOI: 10.1002/rcr2.1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/03/2023] [Indexed: 06/24/2023] Open
Abstract
Neoadjuvant chemotherapy is a therapeutic option for potentially resectable non-small cell lung cancer (NSCLC). The role of neoadjuvant targeted therapy (NTT) remains less explored. This case highlights the use of neoadjuvant osimertinib in a case of advanced NSCLC. A 67-year-old woman had a left lower lobe lung mass measuring 5.0 × 5.1 × 7.0 cm with an enlarged subcarinal lymph node (LN) on her positron emission tomography scan. Following biopsy, a diagnosis of stage IIIB N2 (cT3N2M0) EGFR exon 19 deletion mutation-positive lung adenocarcinoma was established. NTT using osimertinib 80 mg once daily was commenced. Subsequent re-imaging at 3 months (ycT2bN2M0), 6 months (ycT1cN2M0) and 9 months showed tumour downstaging and resolution of the subcarinal LN (ycT1cN0M0). She underwent left lower lobectomy with systematic nodal dissection. All surgical specimens demonstrated no evidence of malignant cells (ypT0N0). Osimertinib could be the preferred NTT for potentially resectable NSCLC.
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Affiliation(s)
- Chun Ian Soo
- Division of Respiratory Medicine, Department of MedicineUniversity MalayaKuala LumpurMalaysia
| | | | - Ka Kiat Chin
- Division of Respiratory Medicine, Department of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Leng Cheng Sia
- Division of Respiratory Medicine, Department of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Vijayan Munusamy
- Division of Respiratory Medicine, Department of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Nur Husna Ibrahim
- Division of Respiratory Medicine, Department of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Thian Chee Loh
- Division of Respiratory Medicine, Department of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Jiunn Liang Tan
- Division of Respiratory Medicine, Department of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Mau Ern Poh
- Division of Respiratory Medicine, Department of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Chee Kuan Wong
- Division of Respiratory Medicine, Department of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Yong Kek Pang
- Division of Respiratory Medicine, Department of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Chong Kin Liam
- Division of Respiratory Medicine, Department of MedicineUniversity MalayaKuala LumpurMalaysia
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5
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Liam CK, Ahmad AR, Hsia TC, Zhou J, Kim DW, Soo RA, Cheng Y, Lu S, Shin SW, Yang JCH, Zhang Y, Zhao J, Berghoff K, Bruns R, Johne A, Wu YL. Randomized Trial of Tepotinib Plus Gefitinib Versus Chemotherapy in EGFR-Mutant NSCLC with EGFR Inhibitor Resistance Due to MET Amplification: INSIGHT Final Analysis. Clin Cancer Res 2023; 29:1879-1886. [PMID: 36971777 PMCID: PMC10183805 DOI: 10.1158/1078-0432.ccr-22-3318] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/01/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Abstract
Purpose: The final analyses of the INSIGHT phase II study evaluating tepotinib (a selective MET inhibitor) plus gefitinib versus chemotherapy in patients with MET-altered EGFR-mutant NSCLC (data cut-off: September 3, 2021). Patients and methods: Adults with advanced/metastatic EGFR-mutant NSCLC, acquired resistance to first-/second-generation EGFR inhibitors, and MET gene copy number (GCN) ≥5, MET:CEP7 ≥2, or MET IHC 2+/3+ were randomized to tepotinib 500 mg (450 mg active moiety) plus gefitinib 250 mg once daily, or chemotherapy. Primary endpoint was investigator-assessed progression-free survival (PFS). MET-amplified subgroup analysis was preplanned. Results: Overall (N=55), median PFS was 4.9 versus 4.4 months (stratified HR 0.67 [90% CI: 0.35, 1.28]) with tepotinib plus gefitinib versus chemotherapy. In 19 patients with MET amplification (median age 60.4 years; 68.4% never-smokers; median GCN 8.8; median MET/CEP7 2.8; 89.5% with MET IHC 3+), tepotinib plus gefitinib improved PFS (HR 0.13; 90% CI: 0.04, 0.43) and overall survival (OS; HR 0.10; 90% CI: 0.02, 0.36) versus chemotherapy. Objective response rate was 66.7% with tepotinib plus gefitinib versus 42.9% with chemotherapy; median duration of response was 19.9 versus 2.8 months. Median duration of tepotinib plus gefitinib was 11.3 months (range: 1.1–56.5), with treatment >1 year in six (50.0%) and >4 years in three patients (25.0%). Seven patients (58.3%) had treatment-related grade ≥3 adverse events with tepotinib plus gefitinib, and five (71.4%) with chemotherapy. Conclusions: Final analysis of INSIGHT suggests improved PFS and OS with tepotinib plus gefitinib versus chemotherapy in a subgroup of patients with MET-amplified EGFR-mutant NSCLC, after progression on EGFR inhibitors.
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Ahn MJ, Mendoza MJL, Pavlakis N, Kato T, Soo RA, Kim DW, Liam CK, Hsia TC, Lee CK, Reungwetwattana T, Geater S, Chan OSH, Prasongsook N, Solomon BJ, Nguyen TTH, Kozuki T, Yang JCH, Wu YL, Mok TSK, Tan DSW, Yatabe Y. Asian Thoracic Oncology Research Group (ATORG) Expert Consensus Statement on MET Alterations in NSCLC: Diagnostic and Therapeutic Considerations. Clin Lung Cancer 2022; 23:670-685. [PMID: 36151006 DOI: 10.1016/j.cllc.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/29/2022] [Indexed: 01/27/2023]
Abstract
Non-small cell lung cancer (NSCLC) is a heterogeneous disease, with many oncogenic driver mutations, including de novo mutations in the Mesenchymal Epithelial Transition (MET) gene (specifically in Exon 14 [ex14]), that lead to tumourigenesis. Acquired alterations in the MET gene, specifically MET amplification is also associated with the development of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) resistance in patients with EGFR-mutant NSCLC. Although MET has become an actionable biomarker with the availability of MET-specific inhibitors in selected countries, there is differential accessibility to diagnostic platforms and targeted therapies across countries in Asia-Pacific (APAC). The Asian Thoracic Oncology Research Group (ATORG), an interdisciplinary group of experts from Australia, Hong Kong, Japan, Korea, Mainland China, Malaysia, the Philippines, Singapore, Taiwan, Thailand and Vietnam, discussed testing for MET alterations and considerations for using MET-specific inhibitors at a consensus meeting in January 2022, and in subsequent offline consultation. Consensus recommendations are provided by the ATORG group to address the unmet need for standardised approaches to diagnosing MET alterations in NSCLC and for using these therapies. MET inhibitors may be considered for first-line or second or subsequent lines of treatment for patients with advanced and metastatic NSCLC harbouring MET ex14 skipping mutations; MET ex14 testing is preferred within multi-gene panels for detecting targetable driver mutations in NSCLC. For patients with EGFR-mutant NSCLC and MET amplification leading to EGFR TKI resistance, enrolment in combination trials of EGFR TKIs and MET inhibitors is encouraged.
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Affiliation(s)
- Myung-Ju Ahn
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
| | - Terufumi Kato
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Ross A Soo
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Chong Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Te-Chun Hsia
- Department of Respiratory Therapy, China Medical University, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chee Khoon Lee
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Thanyanan Reungwetwattana
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sarayut Geater
- Division of Internal Medicine, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Oscar Siu Hong Chan
- Department of Clinical Oncology, Hong Kong Integrated Oncology Centre, Hong Kong SAR, China
| | - Naiyarat Prasongsook
- Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Benjamin J Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Toshiyuki Kozuki
- Department of Thoracic Oncology and Medicine, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - James Chih-Hsin Yang
- Department of Medical Oncology, National Taiwan University Cancer Center and National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tony Shu Kam Mok
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
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Loh TC, Pang YK, Liam CK, Chew MF, Tan JL. Metastatic pulmonary calcification mimicking pulmonary tuberculosis: A case report. Respirol Case Rep 2022; 10:e01030. [PMID: 36090023 PMCID: PMC9434080 DOI: 10.1002/rcr2.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/17/2022] [Indexed: 11/09/2022] Open
Abstract
Metastatic pulmonary calcification (MPC) is characterized by deposition of calcium in the normal lung parenchyma secondary to elevation of serum calcium. Most patients are asymptomatic and routine chest radiograph is not sensitive to make the diagnosis. Further imaging is needed such as computed tomography (CT) which typically shows small centrilobular nodules in the upper lobes. We report a case of a 30‐year‐old woman with end stage kidney disease who was diagnosed with pulmonary tuberculosis which was then revised to metastatic pulmonary calcification. The CT thorax feature for this patient was atypical for metastatic pulmonary calcification where it demonstrated tree‐in‐bud nodules suggestive of infection. The final diagnosis was made based on bronchoalveolar lavage which was culture‐negative for Mycobacterium and transbronchial lung biopsy demonstrating calcium deposition in the interstitium.
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Affiliation(s)
- Thian Chee Loh
- Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Yong Kek Pang
- Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Chong Kin Liam
- Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Man Fong Chew
- Department of Pathology, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Jiunn Liang Tan
- Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
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How SH, Liam CK, Zainal Abidin MA, Hasbullah HH, Tho LM, Ho GF, Muhamad Nor I, Pang YK, Ho KF, Thiagarajan M, Ariffin R, Samsudin A, Omar A, Tan SN, Ong CK, Soon SY, Poh ME. Outcomes of Patients with EGFR-Mutant Advanced NSCLC in a Developing Country in Southeast Asia. Cancer Manag Res 2022; 14:1995-2005. [PMID: 35733510 PMCID: PMC9208817 DOI: 10.2147/cmar.s364713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background Although first- and second-generation EGFR TKIs are considered first-line treatment in EGFRm+ NSCLC, most patients develop resistance and progress, commonly, EGFR T790M mutation. The third-generation EGFR-TKI has demonstrated efficacy in patients with progressive disease harboring the T790M mutation and in the first-line setting, bypassing this mode of resistance. The primary objectives of this study are to describe the proportion of EGFRm+ NSCLC patients treated with first-, second- and third-generation EGFR TKIs, and cytotoxic chemotherapy in the first-line setting, and the time on treatment for each category. Secondary objectives are to determine the dropout rate, the rates for T790M mutation testing at disease progression and the type of subsequent treatment. Methods This multicenter retrospective study utilized data from the Malaysian Lung Cancer Registry that actively registers all lung cancer patients ≥18 years, with primary lung cancer confirmed histologically or cytologically. All patients diagnosed with advanced stages (ie stages IIIB, IIIC and IV) EGFRm+ NSCLC from 1st of January 2015 to 31st December 2019 were included. Results Of 406 patients with EGFRm+ NCSLC, 351 were treated. Types of first-line treatment were as follows: EGFR-TKIs (first generation - 54.1%, second generation - 25.6% and third-generation - 12.5%) and chemotherapy (7.7%). The median time of treatment for each generation of EGFR-TKI was 12 months, 12 months and 24 months, and 2 months for chemotherapy. The dropout rate was 28.7% (n = 101). Nearly half (49.4%) of patients who were on first- or second-generation EGFR-TKI had further genetic testing via liquid or tissue biopsies upon disease progression. About 24.9% of those who developed disease progression after first- or second-generation EGFR TKI were started on a third-generation EGFR TKI. Conclusion In the real-world, the management of EGFRm+ advanced NSCLC patients in an Asian cost-restrictive setting may adversely affect the choice of first-line therapy, time on each line of treatment and subsequently the overall survival of patients.
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Affiliation(s)
- Soon Hin How
- Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia.,Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
| | - Chong Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Harissa H Hasbullah
- Faculty of Medicine, Universiti Teknologi Mara, Sungai Buloh, Selangor, Malaysia.,Oncology and Radiotherapy Department, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Lye Mun Tho
- Department of Clinical Oncology, Beacon Hospital, Petaling Jaya, Selangor, Malaysia
| | - Gwo Fuang Ho
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ibtisam Muhamad Nor
- Oncology and Radiotherapy Department, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Yong Kek Pang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Azlina Samsudin
- Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Azza Omar
- Respiratory Unit, Medical Department, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
| | - Sin Nee Tan
- Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
| | | | | | - Mau Ern Poh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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9
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Liam CK, Ahmad AR, Hsia TC, Zhou J, Kim DW, Soo RA, Cheng Y, Lu S, Shin SW, Yang JCH, Zhang Y, Zhao J, Bruns R, Johne A, Wu YL. Abstract CT538: Tepotinib + gefitinib in patients with EGFR-mutant NSCLC with MET amplification: Final analysis of INSIGHT. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: In the INSIGHT trial primary analysis (NCT01982955; median follow-up: 21.8 months), tepotinib (a potent, highly selective, once daily [QD] MET inhibitor) + gefitinib improved efficacy vs chemotherapy (CTX) in patients with EGFR-mutant NSCLC and resistance to anti-EGFR therapy due to MET amplification (Wu et al, Lancet Respir Med 2020). Here we report final analyses from INSIGHT (data cut-off: September 3, 2021; median follow-up: 57.5 months).
Methods: Patients with EGFR-mutant (T790M-negative) NSCLC and anti-EGFR resistance, with MET gene copy number (GCN) ≥5 and/or MET:CEP7 ≥2 by FISH and/or MET IHC 2+/3+, were randomized to tepotinib 500 mg (450 mg active moiety) + gefitinib 250 mg QD or CTX. Primary endpoint was progression-free survival (PFS) per investigator. Preplanned analyses evaluated patients with MET amplification.
Results: In the 19/55 randomized patients (34.5%) with MET amplification (GCN ≥5, n=18; MET:CEP7 ≥2, n=13; MET IHC 3+, n=17), median age was 60.4 years, 68.4% were never-smokers, and prior EGFR inhibitors were gefitinib (57.9%), afatinib (21.1%), erlotinib (10.5%) and icotinib (10.5%). Median duration of tepotinib + gefitinib was 11.3 months (range: 1.1-56.5), with treatment duration >1 year in 6 patients (31.6%) and >4 years in 3 patients (15.8%). Two patients continued treatment outside the study.
Tepotinib + gefitinib improved PFS (hazard ratio [HR] 0.13; 95% confidence interval [CI] 0.04, 0.43), overall survival (HR 0.10; 95% CI 0.02, 0.36), objective response rate and duration of response vs CTX (Table). Treatment-related Grade ≥3 AEs occurred in 7 patients (58.3%) with tepotinib + gefitinib and 5 (71.4%) with CTX. Most common post-study therapies were kinase inhibitors (n=2 in the tepotinib + gefitinib arm; n=3 in the CTX arm).
In patients with MET IHC 3+ (n=34; including 17 patients with MET amplification), tepotinib + gefitinib also markedly improved PFS (HR 0.35; 95% CI 0.17, 0.74) and OS (HR 0.44; 95% CI 0.23, 0.84) vs CTX.
Conclusions: Tepotinib + gefitinib greatly improved PFS and OS vs CTX in patients with EGFR-mutant NSCLC with MET amplification. INSIGHT 2 is evaluating tepotinib + osimertinib in this setting.
Table. Summary of efficacy and safety data in patients with MET amplification Endpoint Tepotinib + gefitinib (n=12) CTX (n=7) PFS Events, n (%) 7 (58) 7 (100) Median, months (90% CI) 16.6 (8.3, 22.1) 4.2 (1.4, 7.0) HR (90% CI) 0.13 (0.04, 0.43) OS* Events, n (%) 7 (58) 7 (100) Median, months (90% CI) 37.3 (21.1, 52.1) 13.1 (3.3, 22.6) HR (90% CI) 0.10 (0.02, 0.36) ORR n (%) [90% CI] 8 (66.7) [39.1, 87.7] 3 (42.9) [12.9, 77.5] OR (90% CI) 2.67 (0.37, 19.56) DOR Median, months (90% CI) 19.9 (7.0, NE) 2.8 (2.8, NE) Treatment-related Grade ≥3 AEs†, n (%) Amylase increased 4 (33.3) 0 Lipase increased 4 (33.3) 0 Anemia 0 2 (28.6) Neutrophil count decreased 0 2 (28.6) WBC count decreased 0 2 (28.6) *Post-study therapy included an EGFR inhibitor ± a MET inhibitor in two patients in each arm (tepotinib + gefitinib arm: osimertinib ± cabozantinib [n=1], gefitinib + cabozantinib [n=1]; CTX arm: erlotinib, afatinib, and osimertinib ± crizotinib [n=1], osimertinib [n=1]). Post-study CTX was received by one patient in the tepotinib + gefitinib arm and two patients in the CTX arm.†Reported in >20% of patients in either arm. AE, adverse event; CI, confidence interval; CTX, chemotherapy; DOR, duration of response; HR, hazard ratio; NE, not estimable; ORR, objective response rate; OR, odds ratio; OS, overall survival; PFS, progression-free survival; WBC, white blood cell.
Citation Format: Chong Kin Liam, Azura Rozila Ahmad, Te-Chun Hsia, Jianying Zhou, Dong-Wan Kim, Ross Andrew Soo, Ying Cheng, Shun Lu, Sang Won Shin, James Chih-Hsin Yang, Yiping Zhang, Jun Zhao, Rolf Bruns, Andreas Johne, Yi-Long Wu. Tepotinib + gefitinib in patients with EGFR-mutant NSCLC with MET amplification: Final analysis of INSIGHT [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT538.
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Affiliation(s)
- Chong Kin Liam
- 1Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Te-Chun Hsia
- 3China Medical University Hospital, Taichung City, Taiwan
| | - Jianying Zhou
- 4The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Dong-Wan Kim
- 5Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Ying Cheng
- 7Jilin Province Cancer Hospital, Changchun, China
| | - Shun Lu
- 8Shanghai Chest Hospital, Shanghai, China
| | - Sang Won Shin
- 9Korea University Anam Hospital, Seoul, Republic of Korea
| | | | | | - Jun Zhao
- 12Beijing Cancer Hospital, Beijing, China
| | - Rolf Bruns
- 13the healthcare business of Merck KGaA, Darmstadt, Germany
| | - Andreas Johne
- 13the healthcare business of Merck KGaA, Darmstadt, Germany
| | - Yi-Long Wu
- 14Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
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How SH, Tho LM, Liam CK, Hasbullah HH, Ho GF, Muhammad Nor I, Poh ME, Ho KF, Thiagarajan M, Samsudin A, Omar A, Ong CK, Pang YK, Soon SY. Programmed death-ligand 1 expression and use of immune checkpoint inhibitors among patients with advanced non-small-cell lung cancer in a resource-limited country. Thorac Cancer 2022; 13:1676-1683. [PMID: 35502623 PMCID: PMC9161340 DOI: 10.1111/1759-7714.14442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Immune checkpoint inhibitor (ICI) therapy is an established treatment for advanced non‐small‐cell lung cancer (NSCLC) and programmed death ligand‐1 (PD‐L1) expression is a recognized biomarker to determine response to therapy. We retrospectively analyzed NSCLC patients in the Malaysia Lung Cancer Registry (MLCR) and report on the clinical characteristics associated with PD‐L1 expression and ICI use in Malaysia, a low‐ to middle‐income country. Methods All 901 NSCLC patients in the MLCR who were diagnosed from January 1, 2017 to December 31, 2020 from 14 hospitals across the country were analyzed. Results Out of 901 patients, 505 had PDL‐1 testing done with complete data available only in 489 patients. The most common histology was adenocarcinoma (84.7%) followed by squamous cell carcinoma (10.2%). The majority (95%) presented with stage 3 or 4. The number and percentage of patients with PDL‐1 tumor proportion scores of ≥50%, 1–49%, and <1% were 138 (28.2%), 158 (32.3%), and 193 (39.5%), respectively. In multivariate analysis, the presence of genomic mutation is the only independent characteristic associated with negative PD‐L1 expression (crude odds ratio 0.579, 95% confidence interval 0.399–0.840, p = 0.004). Of 292 patients eligible for ICI therapy, only 100 patients (34.2%) received ICIs. Seventy‐eight patients received ICI therapy as first‐line treatment, 15 patients as second‐line treatment, and 7 patients as third‐line treatment. Conclusions This is the first analysis on PD‐L1 expression and ICI use in Malaysia. Despite the proven efficacy of ICI therapy, only 56% of our patients had PD‐L1 tests performed and only 34.2% of eligible patients received ICIs.
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Affiliation(s)
- Soon Hin How
- Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Malaysia
| | - Lye Mun Tho
- Department of Clinical Oncology, Beacon Hospital, Petaling Jaya, Malaysia
| | - Chong Kin Liam
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Harissa H Hasbullah
- Oncology Unit, Faculty of Medicine, Universiti Teknologi Mara, Sungai Buloh, Malaysia.,Oncology and Radiotherapy Department, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Gwo Fuang Ho
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ibtisam Muhammad Nor
- Oncology and Radiotherapy Department, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Mau Ern Poh
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Azza Omar
- Respiratory Unit, Medical Department, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
| | | | - Yong Kek Pang
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Ayakannu R, Abdullah NA, Raj VL, Radhakrishnan AK, Liam CK. Clinical characteristics, cytokine profiles and plasma IgE in adults with asthma. Mol Immunol 2022; 143:50-57. [PMID: 35038659 DOI: 10.1016/j.molimm.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/06/2021] [Accepted: 01/10/2022] [Indexed: 12/29/2022]
Abstract
Asthma is a disease with complicated network of inflammatory responses of cytokines and ImmunoglobulinE (IgE). The aim of this study was to explore the clinical characteristics, cytokine profile and plasma IgE in the Malaysian population. This is a cross-sectional study involving physician-diagnosed asthma patients (n = 287) recruited from the Chest Clinic, University of Malaya Medical Centre (UMMC). Blood (8 mL) was taken after consent was obtained. The peripheral blood leucocytes (PBL) were cultured in presence of a mitogen for 72 h to quantify cytokines [Interleukin-5(IL-5), Interleukin-9 (IL-9), Interleukin-12 Beta (IL-12ꞵ) and granulocyte-macrophage colony-stimulating factor (GM-CSF)] and plasma was used to quantify IgE levels with commercial ELISA kits. Results were compared against the same biomarkers in healthy subjects (n = 203). In addition, the amount of the biomarkers in the asthma patients were compared with their disease severity and clinical characteristics. Statistical tests in the SPSS software (Mann-Whitney U test and the Kruskal Wallis) were used to compare cytokine production and plasma IgE levels. The mean plasma IgE level was markedly higher (p < 0.0001) in asthmatics compared to controls. There were higher levels of IL-5, IL-9, IL-12ꞵ and GM-CSF (p < 0.0001) produced by cultured PBL from asthma patients compared to controls. However, our results did not expose a significant association between these cytokine levels and severity and clinical symptoms of asthma. However, there was a marked association between asthma severity and blood lymphocyte count [ꭓ2(2) = 6.745, p < 0.05]. These findings support the roles played by cytokines and IgE in the airway inflammation in asthma. The findings of this study provide new information about inflammatory cytokines in Malaysian asthma patients.
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Affiliation(s)
- Rathimalar Ayakannu
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Department of Pharmacology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Nor Azizan Abdullah
- Department of Pharmacology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
| | - Vijaya Lechimi Raj
- Faculty of Medicine, Bioscience & Nursing, MAHSA University, Jalan SP 2, Bandar Saujana Putra, 42610, Jenjarom, Selangor, Malaysia
| | - Ammu K Radhakrishnan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Chong Kin Liam
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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12
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Rouhani-Rankouhi SZ, Kow KS, Liam CK, Lau YL. Seropositivity and risk factors of Toxocara canis infection in adult asthmatic patients. Trop Biomed 2020; 37:599-608. [PMID: 33612775 DOI: 10.47665/tb.37.3.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This cross-sectional study involving 86 adult asthmatic patients aimed to determine the relationship between Toxocara seropositivity and severity of asthma in adult asthmatics and investigate the risk factors for Toxocara infection. In all cases, T. canis IgG level was measured using an anti-Toxocara IgG enzyme-linked immunosorbent assay kit. Total serum IgE and eosinophil count were also determined. The anti-Toxocara IgG seropositivity was 68.6% among asthmatic patients. There were no statistically significant associations between Toxocara seroprevalence and other risk factors, clinical symptoms of asthma and high level of total serum IgE and eosinophilia. Pet ownership could be an important risk factor for Toxocariasis. Having a pet at home and wheezing were significantly associated with Toxocara seropositivity in adult asthmatic patients.
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Affiliation(s)
- S Z Rouhani-Rankouhi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - K S Kow
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - C K Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Y L Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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13
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Rajadurai P, How SH, Liam CK, Sachithanandan A, Soon SY, Tho LM. Lung Cancer in Malaysia. J Thorac Oncol 2020; 15:317-323. [PMID: 32093853 DOI: 10.1016/j.jtho.2019.10.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Pathmanathan Rajadurai
- Subang Jaya Medical Centre, Selangor, Malaysia; Monash University Malaysia, Selangor, Malaysia.
| | - Soon Hin How
- International Islamic University Malaysia, Pahang, Malaysia
| | | | - Anand Sachithanandan
- Subang Jaya Medical Centre, Selangor, Malaysia; Monash University Malaysia, Selangor, Malaysia; Sunway Medical Centre, Selangor, Malaysia
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Rajadurai P, Cheah PL, How SH, Liam CK, Annuar MAA, Omar N, Othman N, Marzuki NM, Pang YK, Bustamam RSA, Tho LM. Molecular testing for advanced non-small cell lung cancer in Malaysia: Consensus statement from the College of Pathologists, Academy of Medicine Malaysia, the Malaysian Thoracic Society, and the Malaysian Oncological Society. Lung Cancer 2019; 136:65-73. [DOI: 10.1016/j.lungcan.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/13/2019] [Accepted: 08/02/2019] [Indexed: 12/18/2022]
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Poh ME, Liam CK, Mun KS, Chai CS, Wong CK, Tan JL, Loh TC, Chin KK. Epithelial-to-mesenchymal transition (EMT) to sarcoma in recurrent lung adenosquamous carcinoma following adjuvant chemotherapy. Thorac Cancer 2019; 10:1841-1845. [PMID: 31350945 PMCID: PMC6718027 DOI: 10.1111/1759-7714.13156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/11/2019] [Accepted: 07/13/2019] [Indexed: 12/19/2022] Open
Abstract
Adjuvant chemotherapy has long been indicated to extend survival in completely resected stage IB to IIIA non‐small cell lung cancer (NSCLC). However, there is accumulating evidence that chemotherapy or chemoradiotherapy can induce epithelial‐to‐mesenchymal transition (EMT) in disseminated or circulating NSCLC cells. Here, we describe the first case of EMT as the cause of recurrence and metastasis in a patient with resected stage IIB lung adenosquamous carcinoma after adjuvant chemotherapy. We review the literature and explore the possible mechanisms by which EMT occurs in disseminated tumor cells (DTC) or circulating tumor cells (CTC) in response to adjuvant chemotherapy (cisplatin) as a stressor. We also explore the possible therapeutic strategies to reverse EMT in patients with recurrence. In summary, although adjuvant cisplatin‐based chemotherapy in resected NSCLC does extend survival, it may lead to the adverse phenomenon of EMT in disseminated tumor cells (DTC) or circulating tumor cells (CTC) causing recurrence and metastasis.
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Affiliation(s)
- Mau Ern Poh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kein Seong Mun
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Shee Chai
- Department of Medicine, Faculty of Medicine, University Malaysia Sarawak, Sarawak, Malaysia
| | - Chee Kuan Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jiunn Liang Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Thian Chee Loh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ka Kiat Chin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Wong TH, Tan TH, George UR, Kow KS, Liam CK. Application of 18F-FDG PET-CT in the management of pulmonary nodule and mass - a pictorial review. Med J Malaysia 2019; 74:250-256. [PMID: 31256186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Lung cancer is one of the leading causes of cancer-related mortality worldwide. Pulmonary nodules are commonly encountered in clinical practice because of the recent implementation of low-dose CT lung screening programme, incidental finding on cardiac CT or CT for nonthoracic related disease. 18F-FDG PET-CT plays an important role in the management of pulmonary nodules. METHODS In this pictorial review, we present six different scenarios of using 18F-FDG PET-CT in the management of suspicious pulmonary nodule or mass. The advantages and limitations of 18F-FDG PET-CT and Herder model are discussed. RESULTS 18F-FDG PET-CT with risk assessment using Herder model provides added value in characterising indeterminate pulmonary nodules. Besides, 18F-FDG PET-CT is valuable to guide the site of biopsy and provide accurate staging of lung cancer. CONCLUSION To further improve its diagnostic accuracy, careful history taking, and CT morphological evaluation should be taken into consideration when interpreting 18FFDG PET-CT findings in patients with these nodules.
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Affiliation(s)
- T H Wong
- Sunway Medical Centre, Nuclear Medicine Centre, Selangor, Malaysia.
| | - T H Tan
- Hospital Kuala Lumpur, Department of Nuclear Medicine, Malaysia
| | - U R George
- Sunway Medical Centre, Respiratory Medicine, Selangor, Malaysia
| | - K S Kow
- University of Malaya Medical Centre, Department of Medicine, Kuala Lumpur, Malaysia
| | - C K Liam
- University of Malaya Medical Centre, Department of Medicine, Kuala Lumpur, Malaysia
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Ayakannu R, Abdullah NA, Radhakrishnan AK, Lechimi Raj V, Liam CK. Relationship between various cytokines implicated in asthma. Hum Immunol 2019; 80:755-763. [PMID: 31054782 DOI: 10.1016/j.humimm.2019.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/18/2019] [Accepted: 04/26/2019] [Indexed: 01/01/2023]
Abstract
Asthma is a complex disorder involving immunologic, environmental, genetic and other factors. Today, asthma is the most common disease encountered in clinical medicine in both children and adults worldwide. Asthma is characterized by increased responsiveness of the tracheobronchial tree resulting in chronic swelling and inflammation of the airways recognized to be controlled by the T-helper 2 (Th2) lymphocytes, which secrete cytokines to increase the production of IgE by B cells. There are many cytokines implicated in the development of the chronic inflammatory processes that are often observed in asthma. Ultimately, these cytokines cause the release of mediators such as histamine and leukotrienes (LT), which in turn promote airway remodeling, bronchial hyperresponsiveness and bronchoconstriction. The CD4+ T-lymphocytes from the airways of asthmatics express a panel of cytokines that represent the Th2 cells. The knowledge derived from numerous experimental and clinical studies have allowed physicians and scientists to understand the normal functions of these cytokines and their roles in the pathogenesis of asthma. The main focus of this review is to accentuate the relationship between various cytokines implicated in human asthma. However, some key findings from animal models will be highlighted to support the discoveries from clinical studies.
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Affiliation(s)
- Rathimalar Ayakannu
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - N A Abdullah
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Ammu K Radhakrishnan
- Jeffrey Cheah School of Medicine, Monash University Malaysia, Jalan Lagoon, 47500 Bandar Sunway, Selangor, Malaysia
| | - Vijaya Lechimi Raj
- Department of Pharmacology, Faculty of Medicine, MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
| | - C K Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Zhou C, Fan Y, Wang H, Liam CK, Hu C, Cseh A. P2.06-013 Afatinib in Patients with Advanced HER2 Mutation-Positive (M+) NSCLC Previously Treated with Chemotherapy. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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David-Wang A, Price D, Cho SH, Ho JCM, Liam CK, Neira G, Teh PL. Development and Validation of an Attitudinal-Profiling Tool for Patients With Asthma. Allergy Asthma Immunol Res 2017; 9:43-51. [PMID: 27826961 PMCID: PMC5102835 DOI: 10.4168/aair.2017.9.1.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 05/13/2016] [Accepted: 06/10/2016] [Indexed: 11/24/2022]
Abstract
Purpose To develop a profiling tool which accurately assigns a patient to the appropriate attitudinal cluster for the management of asthma. Methods Attitudinal data from an online survey of 2,467 patients with asthma from 8 Asian countries/region, aged 18-50 years, having had ≥2 prescriptions in the previous 2 years and access to social media was used in a discriminant function analysis to identify a minimal set of questions for the Profiling Tool. A split-sample procedure based on 100 sets of randomly selected estimation and validation sub-samples from the original sample was used to cross-validate the Tool and assess the robustness of its predictive accuracy. Results Our Profiling Tool contained 10 attitudinal questions for the patient and 1 GINA-based level of asthma control question for the physician. It achieved a predictive accuracy of 76.2%. The estimation and validation sub-sample accuracies of 76.7% and 75.3%, respectively, were consistent with the tool's predictive accuracy at 95% confidence level; and their 1.4 percentage-points difference set upper-bound estimate for the degree of over-fitting. Conclusions The Profiling Tool is highly predictive (>75%) of the attitudinal clusters that best describe patients with asthma in the Asian population. By identifying the attitudinal profile of the patient, the physician can make the appropriate asthma management decisions in practice. The challenge is to integrate its use into the consultation workflow and apply to areas where Internet resources are not available or patients who are not comfortable with the use of such technology.
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Affiliation(s)
- Aileen David-Wang
- Section of Pulmonary Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines.
| | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.,Observational & Pragmatic Research Institute Pte Ltd, Singapore
| | - Sang Heon Cho
- College of Medicine, Seoul National University, Seoul, Korea
| | - James Chung Man Ho
- Department of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chong Kin Liam
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Glenn Neira
- Medical Affairs Department, Mundipharma Pte Ltd, Singapore
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Ch'ng LS, Bux SI, Liam CK, Rahman NA, Ho CY. Sandstorm appearance of pulmonary alveolar microlithiasis incidentally detected in a young, asymptomatic male. Korean J Radiol 2013; 14:859-62. [PMID: 24043987 PMCID: PMC3772273 DOI: 10.3348/kjr.2013.14.5.859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 06/27/2013] [Indexed: 11/21/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare chronic disease with paucity of symptoms in contrast to the imaging findings. We present a case of a 24-year-old Malay man having an incidental abnormal pre-employment chest radiograph of dense micronodular opacities giving the classical "sandstorm" appearance. High-resolution computed tomography of the lungs showed microcalcifications with subpleural cystic changes. Open lung biopsy showed calcospherites within the alveolar spaces. The radiological and histopathological findings were characteristic of PAM.
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Affiliation(s)
- Li Shyan Ch'ng
- Department of Biomedical Imaging, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur 50603, Malaysia
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Kuan YC, How SH, Azian AA, Liam CK, Ng TH, Fauzi AR. Bone mineral density in asthmatic patients on inhaled corticosteroids in a developing country. Ann Thorac Med 2012; 7:69-73. [PMID: 22558010 PMCID: PMC3339206 DOI: 10.4103/1817-1737.94522] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 12/10/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION: Prolonged use of oral corticosteroids is a risk factor for osteoporosis. However, the effect of inhaled corticosteroids (ICS) on bone mineral density (BMD) of asthmatic patients remains controversial. OBJECTIVES: We aimed to determine the prevalence of osteopenia and osteoporosis in our patients with asthma receiving ICSs for more than one year compared with patients who did not have asthma and to determine the risk factors for osteopenia and osteoporosis among the asthmatic patients. METHODS: This was a cross-sectional study conducted from August 2007 to July 2009. Asthmatic patients aged 18 years and older who had been on ICS for at least one year and a control group of subjects not on ICS were included. BMD was measured using DEXA (dual energy X-ray absorptiometry) scan. The WHO classification of T-scores for osteopenia and osteoporosis were used. RESULTS: A total of 143 subjects were recruited (69 asthmatics and 74 control subjects). T-scores of the spine, femur, and hip of the asthmatics vs the control subjects were mean, −0.72 vs −0.57 (P=0.98); median, −0.60 vs −0.80 (P=0.474); and mean, 0.19 vs 0.06 (P=0.275); respectively. T-scores of the spine, femur, and hip showed significant negative correlation with age and significant positive correlation with body mass index (BMI). CONCLUSION: The risk factors for osteoporosis and osteopenia among asthmatic patients were older age and lower BMI, but not the cumulative dose of ICS. Asthmatic patients on ICS have no added risk of osteoporosis or osteopenia as compared with non-asthmatic subjects.
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Affiliation(s)
- Yeh Chunn Kuan
- Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
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Ngui R, Lim YAL, Chow SC, de Bruyne JA, Liam CK. Prevalence of bronchial asthma among orang asli in peninsular malaysia. Med J Malaysia 2011; 66:27-31. [PMID: 23765139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A survey was carried out to determine the prevalence of bronchial asthma and their contributing risk factors among Orang Asli subgroups living in Malaysia using IUATLD questionnaire and spirometry without being discriminatory towards age or gender. Of the 1171 distributed questionnaires, 716 (61.1%) comprising of 62.7% Semai Pahang, 51.3% Temiar, 74.2% Mah Meri, 65.6% Semai Perak, 53.6% Temuan, 53.8% Semelai, 61.1% Jakun and 67.4% Orang Kuala subgroups completed their questionnaire and were included in the data analysis. Participants comprised 549 (76.7%) children and 167 (23.3%) adults, age between 1 to 83 years old, 304 (42.5%) males and 412 (57.5%) females. The overall prevalence of bronchial asthma was 1.4% of which 1.5% was children, 1.3% adults, 1.0% male and 1.7% female, respectively. Of the 8 subgroups surveyed, 5 out of 10 confirmed asthma cases were Semai Pahang, followed by 3 cases among Mah Meri, and one case each among Temuan and Semai Perak subgroups, respectively. This study also demonstrated that the prevalence of self-reported and confirmed bronchial asthma tend to be higher among those who had close contact with pets, smoking individuals and among those who had a family history of asthma.
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Affiliation(s)
- R Ngui
- University of Malaya, Department of Parasitology, Faculty of Medicine, Kuala Lumpur, 50603 Malaysia.
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Sivarani S, Chan YK, Liam CK, Kumar G, Abdullah BJ, Mahadeva S. Education and Imaging. Gastrointestinal: massive intraperitoneal haemorrhage in a young woman with hereditary hemorrhagic telangiectasia. J Gastroenterol Hepatol 2010; 25:1587. [PMID: 20796159 DOI: 10.1111/j.1440-1746.2010.06469.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- S Sivarani
- Department of Medicine, Faculty of Medicine, University of Malaya Kuala Lumpur, Malaysia
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Kasthoori JJ, Liam CK, Wastie ML. Lady Windermere syndrome: an inappropriate eponym for an increasingly important condition. Singapore Med J 2008; 49:e47-e49. [PMID: 18301826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Non-tuberculous mycobacterial infection (NMI) occurs in elderly women with no pre-existing lung disease, and this has been termed the Lady Windermere syndrome. NMIs are increasing in prevalence and an increasing number of pulmonary mycobacterial infections is due to non-tuberculous mycobacteria. The diagnosis is often difficult because the organism is not readily isolated or cultured, and the condition may not be considered by the radiologist. We report NMI in a 64-year-old woman, based on clinical and radiological findings. Although termed the Lady Windermere syndrome, the name does not correspond to the character in Oscar Wilde's play; hence the eponym is not widely used.
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Affiliation(s)
- J J Kasthoori
- Department of Radiology, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur 59100, Malaysia.
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Liam CK, Pang YK, Shyamala P, Chua KT. Obstructed breathing during sleep and obstructive sleep apnoea syndrome--assessment and treatment. Med J Malaysia 2007; 62:268-274. [PMID: 18246927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- C K Liam
- Division of Respiratory Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur
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Liam CK, Pang YK, Poosparajah S. Diagnostic yield of flexible bronchoscopic procedures in lung cancer patients according to tumour location. Singapore Med J 2007; 48:625-31. [PMID: 17609823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION This study aims to determine whether the diagnostic yield of flexible bronchoscopy sampling procedures in patients with lung cancer was dependent on tumour location. METHODS A retrospective analysis was conducted on the diagnostic yield of bronchial washing (BW), endobronchial biopsy (EBB), bronchial brushing (BB), bronchoalveolar lavage (BAL), blind brushing (B) and transbronchial biopsy (TBB) specimens obtained at fibre-optic bronchoscopy for patients with lung cancer. RESULTS Of 503 patients who underwent fibre-optic bronchoscopy examination, BW, EBB, BB, BAL, B and TBB were performed on 254, 325, 67, 155, 70 and 54 patients, respectively. For patients with bronchoscopically-visible tumours, BW, EBB and BB yielded diagnostic specimens for lung cancer in 28.3 percent, 77.5 percent and 53.7 percent of patients, respectively. For patients whose tumours were not visible bronchoscopically, BAL, B and TBB yielded diagnostic specimens for lung cancer in 35.5 percent, 22.9 percent and 31.5 percent of patients, respectively. EBB was less likely to be diagnostic in patients with tumours in the middle or lingular lobe bronchi. The diagnostic yields of all the other sampling techniques were not influenced by the location of the bronchoscopically-visible or non-visible tumours. CONCLUSION The diagnostic yields of bronchoscopic sampling procedures were dependent on tumour visibility during bronchoscopy and location of bronchoscopically-visible tumours.
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Affiliation(s)
- C K Liam
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur 59100, Malaysia.
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How SH, Liam CK, Jamalludin AR, Chin SP, Zal AB. Serum cancer antigen 125 in patients with pleural effusions. Med J Malaysia 2006; 61:558-63. [PMID: 17623956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
We studied the prevalence of raised serum CA125 in patients with pleural effusions and explored factors affecting its level. Sixty four patients with benign effusions and 36 patients with malignant effusions admitted to the University Malaya Medical Centre from May 2001 to January 2002 were included in the study. There were no significant differences in age, gender and ethnicity of the patients with benign and malignant effusions. There was also no difference in the frequency of the side of pleural effusion between the two groups but compared to benign effusions, a higher proportion of malignant effusions was moderate to large in size (66% versus 39%, p = 0.011). Serum CA125 levels were above 35U/dL in 83.3% and 78.1% of patients with malignant and benign effusions, respectively (p = 0.532). All patients with underlying malignancy and 95.3% of patients with benign effusions had pleural fluid CA125 levels above 35U/dL (p = 0.187). The median levels of CA125 were higher in the pleural fluid than in the serum in all aetiological groups. Higher serum CA125 levels were more likely to be found in patients with moderate to large effusions (p = 0.015), malignant effusions (p = 0.001) and in female patients (0.016). Serum CA125 level showed significant correlation with pleural fluid CA125 level (r = 0.532, p < 0.001) but not with pleural fluid total white blood cell count (r = -0.092, p = 0.362), red blood cell count (r = -0.082, p = 0.417) and lactate dehydrogenase level (r = 0.062, p = 0.541). We conclude that serum CA125 is commonly elevated in patients with benign and malignant pleural effusions.
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Affiliation(s)
- S H How
- Department of Internal Medicine, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, Jalan Hospital, 25150 Kuantan, Pahang Darull Makmur, Malaysia
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How SH, Liam CK. Melioidosis: a potentially life threatening infection. Med J Malaysia 2006; 61:386-94: quiz 395. [PMID: 17240600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Melioidosis is caused by the gram-negative bacillus, Burkholderia pseudomallei. It is endemic in tropical Australia and in Southeast Asian countries. The overall mortality from this infection remains extremely high despite recent advancement in its treatment. This review discuss about clinical manifestations, diagnosis and management of melioidosis.
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Affiliation(s)
- S H How
- Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, P.O. Box 141, 27510 Kuantan, Pahang, Malaysia
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How SH, Chin SP, Zal AR, Liam CK. Pleural effusions: role of commonly available investigations. Singapore Med J 2006; 47:609-13. [PMID: 16810434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Previous studies have reported high rates of undetermined causes of pleural effusions. We aimed to find out the proportion of pleural effusions in which the aetiology is uncertain despite commonly available investigations. METHODS A prospective study was carried out at the University of Malaya Medical Centre from May 2001 to January 2002. All patients with pleural effusion admitted to the medical wards and non-medical wards during that period were included in the study. RESULTS Of 111 patients with pleural effusion, malignancy was the commonest cause of pleural effusion (34.2 percent), followed by tuberculosis (22.5 percent) and parapneumonic effusions (18.9 percent). There were only two patients (1.8 percent) with undetermined cause despite extensive investigations. Carcinoma of the lung was the commonest cause of malignant effusions and bronchoscopic biopsy gave the highest yield of histological diagnosis (66 percent), followed by pleural fluid cytology (59 percent) and pleural biopsy (50 percent). The combination of these three procedures increased the diagnostic yield to 96 percent. In tuberculous pleural effusion, pleural fluid staining for acid-fast bacilli was negative in all cases but mycobacterial culture was positive in 24 percent of cases while pleural biopsy gave a better yield of 68.8 percent. Examination of sputum and bronchoalveolar lavage specimens confirmed the diagnosis of tuberculosis in 40 percent of cases. A combination of these investigations yielded the diagnosis in 92 percent of patients with tuberculous effusion. CONCLUSION Malignancy is the commonest cause of pleural effusion, followed by tuberculosis and pneumonia, in patients treated in a teaching hospital in Malaysia. The number of undetermined causes could be minimised with a combination of readily-available and established investigations.
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Affiliation(s)
- S H How
- Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, PO Box 141, Kuantan 27510, Malaysia.
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Pang YK, Liam CK, Leow CH, Shyamala P, Zal AR. Tracheobronchial stenting is safe and effective in relieving upper airway obstruction. Med J Malaysia 2006; 61:147-50. [PMID: 16898303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Many studies have shown that tracheobronchial stenting is effective in relieving respiratory distress secondary to major airway obstruction due to lung or oesophageal cancer. A retrospective review on the benefits and complications of self-expandable metallic stent (SEMS) insertion through flexible bronchoscopy for the palliative treatment of upper airway obstruction in University Malaya Medical Centre was performed. Ten patients underwent this procedure. Relief of dyspnoea was immediate following stent insertion in all patients. Stent migration occurred in one patient and three patients had restenosis of the central airway. We conclude that tracheobronchial stenting via flexible bronchoscopy is feasible and safe.
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Affiliation(s)
- Y K Pang
- Respiratory Unit, Department of Medicine, Faculty of Medicine, University Malaya Medical Centre, Lembah Pantai, Kuala Lumpur
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Wong CH, Chua CJ, Liam CK, Goh KL. Gastro-oesophageal reflux disease in 'difficult-to-control' asthma: prevalence and response to treatment with acid suppressive therapy. Aliment Pharmacol Ther 2006; 23:1321-7. [PMID: 16629937 DOI: 10.1111/j.1365-2036.2006.02888.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND The causal association between gastro-oesophageal reflux disease (GERD) and difficult-to-control asthma is unclear. AIM To determine the prevalence of GERD and response to proton pump inhibitor therapy in patients with difficult-to-control asthma. METHODS Consecutive patients with difficult-to-control asthma as defined by persistent and recurrent symptoms despite on optimal asthmatic medications were recruited for the study. GERD was diagnosed by symptoms, gastroscopy and 24-h oesophageal pH monitoring. All patients were prescribed a course of lansoprazole 30 mg daily for 8 weeks. Improvement to treatment was assessed by a change in pulmonary symptom score and also by patient's subjective assessment of improvement. RESULTS Seventeen of 30 (56.7%) patients with difficult-to-control asthma were diagnosed with GERD. Pulmonary symptom score improved significantly only in patients with GERD (35.0 to 21.0; P = 0.002). Twelve of 16 (75%) patients with GERD reported an improvement in asthma symptoms; 1 of 11 (9.1%) without GERD reported mild symptom improvement. There was no significant change in peak expiratory flow rate and forced expiratory volume. CONCLUSIONS More than half of patients with difficult-to-control asthma were diagnosed with GERD. In these patients the severity of asthma improved significantly with potent acid suppression therapy. This underlines the critical role of acid reflux in this subset of patients with difficult-to-control asthma.
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Affiliation(s)
- C H Wong
- Division of Gastroenterology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Affiliation(s)
- Kenneth W T Tsang
- University Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, SAR, China.
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Liam CK. Community acquired pneumonia--a Malaysian perspective. Med J Malaysia 2005; 60:249-65; quiz 266. [PMID: 16114172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- C K Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur
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Yeoh SM, Kuo IC, Wang DY, Liam CK, Sam CK, De Bruyne JA, Lee BW, Cheong N, Chua KY. Sensitization profiles of Malaysian and Singaporean subjects to allergens from Dermatophagoides pteronyssinus and Blomia tropicalis. Int Arch Allergy Immunol 2004; 132:215-20. [PMID: 14646382 DOI: 10.1159/000074302] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2003] [Accepted: 07/22/2003] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The house dust mites Dermatophagoides pteronyssinus (Der p) and Blomia tropicalis (Blo t) are the most common house dust mite species in Southeast Asia. To date, there have only been a few studies on the sensitization profile of the general populations in Southeast Asia to house dust mites. The aim of this study was to determine the profiles of Der p and Blo t sensitization among Singaporean and Malaysian subjects. METHODS Enzyme-linked immunosorbent assay was used to detect specific IgE to Der p and Blo t mite crude extracts as well as purified Der p 1, Der p 2 and Blo t 5 allergens. Sera used were from 229 Singaporean subjects (124 with rhinitis, 105 without rhinitis) and 143 Malaysian subjects (94 adults and 49 children with asthma). RESULTS The sensitization profile of rhinitis subjects to the dust mite allergens used in this study was as follows: Blo t extract positive: 91/124 (73%); Blo t 5 positive: 62/124 (50%); Der p extract positive: 61/124 (49%); Der p 1 positive: 53/124 (43%); Der p 2 positive: 45/124 (36%). The nonrhinitis subjects' sensitization profile was as follows: Blo t extract positive: 60/105 (57%); Blo t 5 positive: 24/105 (23%); Der p extract positive: 38/105 (36%); Der p 1 positive: 14/105 (13%); Der p 2 positive: 17/105 (16%). The study of Malaysian asthmatic adults showed that 39% of them were sensitized to Der p 1, 32% to Der p 2 and 37% to Blo t 5. Among the asthmatic children, sensitization to Blo t 5, Der p 1 and Der p 2 was 90, 57 and 39%, respectively. CONCLUSION This study clearly revealed that dual sensitization to B. tropicalis and D. pteronyssinus is common in the general populations of Singapore and Malaysia. Sensitization to Blo t 5 is more prevalent than to Der p 1 and Der p 2.
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Affiliation(s)
- S M Yeoh
- Department of Paediatrics, National University of Singapore, Singapore
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Liam CK. Significant morbidity associated with asthma: a need for increased doctor and patient education. Med J Malaysia 2003; 58:471-4. [PMID: 15190620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Jayaram G, Yaccob R, Liam CK. Mucinous carcinoma (colloid carcinoma) of the lung diagnosed by fine needle aspiration cytology: a case report. Malays J Pathol 2003; 25:63-8. [PMID: 16196380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Mucinous carcinoma of the lung, also known as colloid carcinoma, is an uncommon tumour that is rarely encountered in fine needle aspiration (FNA) cytological practice. A 64-year-old Chinese male presenting with blood stained sputum and hoarseness of voice was discovered to have a 3 cm sized mass in the left lung. Neither bronchial washings nor transthoracic FNA yielded positive results at this stage. Six months later the patient returned to the hospital with a larger tumour and mediastinal lymphadenopathy. Transbronchial lymph node FNA, reported as negative for malignancy showed normal, hyperplastic and mildly atypical bronchial epithelial cells as well as a few single cells and extracellular mucin. Transthoracic FNA of the lung lesion performed under computed tomographic guidance showed characteristic cytological features of this tumour, establishing the diagnosis.
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Affiliation(s)
- Gita Jayaram
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Wong CMM, Lim KH, Liam CK. Assessment and management of chronic cough. Med J Malaysia 2002; 57:515-23; quiz 524-5. [PMID: 12733182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Catherine M M Wong
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, 50603 Kuala Lumpur
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Chan PWK, Hussain S, Ghani NH, Debruyne JA, Liam CK. The direct cost of treating bronchial asthma in a teaching hospital in Malaysia. Southeast Asian J Trop Med Public Health 2002; 33:600-3. [PMID: 12693597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
A pilot study to evaluate the direct cost of treating 51 adults and 50 children with bronchial asthma was conducted. All aspects of the medical care provided over a 6-month period were considered. The mean treatment costs per month were US dollars 22.97 (adults) and US dollars 15.56 (children). The cost of maintenance therapy accounted for 55.5% and 73.4% of the total direct cost treatment for adults and children respectively. Only 27 (52.9%) adults and 17 (34.0%) children paid for their inhaled prophylactic drugs, amounting to 12.3% of the total maintenance therapy costs. Thirteen (25.4%) adults and 9 (18.0%) children were using alternative therapy at a monthly cost of US dollars 41.50 and US dollars 16.77 respectively. A substantial proportion of the direct cost of asthma treatment is heavily subsidized in Malaysia. Adequate attention to the allocation of the health budget, to ensure the optimal provision of health care, is warranted.
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Affiliation(s)
- P W K Chan
- Division of Respiratory Medicine, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia.
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Liam CK, Lim KH, Wong MM. Recent advances in the diagnosis and treatment of lung cancer. Med J Malaysia 2001; 56:514-31; quiz 532. [PMID: 12014776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- C K Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur
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Affiliation(s)
- K H Lim
- Division of Respiratory Medicine, Department of Medicine, University of Malaya Medical Center, Kuala Lumpur, Malaysia.
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Abstract
OBJECTIVE This study aimed to investigate the microbial aetiology of community-acquired pneumonia (CAP) in patients requiring hospitalization. METHODOLOGY A prospective study of consecutive non-immunocompromised patients aged 12 years and above admitted with CAP from August 1997 to May 1999 was undertaken. RESULTS Of 127 patients hospitalized for CAP, an aetiological diagnosis was achieved in 53 cases (41.7%). Klebsiella pneumoniae was the most frequently isolated pathogen and caused 10.2% of all the cases, followed by Streptococcus pneumoniae (5.5%), Haemophilus influenzae (5.5%), Mycoplasma pneumoniae (3.9%) and Pseudomonas aeruginosa (3.9%). Gram-negative bacilli were significantly more frequently identified in patients aged 60 years or older and in patients with comorbid illnesses. Twelve of 13 patients who died from CAP had other comorbid illnesses compared to 63 of 114 patients who survived (P = 0.014). Three of eight bacteraemic patients died compared with 10 of 119 non-bacteraemic patients (P = 0.035). CONCLUSIONS The microbiology of CAP in patients requiring hospitalization in Malaysia appears to be different from that in Western countries. Gram-negative bacilli were more frequently isolated in older patients and in those with comorbidity. Mortality from CAP is more likely in patients with comorbidity and in those who are bacteraemic.
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Affiliation(s)
- C K Liam
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Liam CK, Goh CT, Isahak M, Lim KH, Wong CM. Relationship between symptoms and objective measures of airway obstruction in asthmatic patients. Asian Pac J Allergy Immunol 2001; 19:79-83. [PMID: 11699724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The objective of this study was to determine the relationship between asthma symptoms and the degree of airway obstruction as measured by the forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR) in a group of 64 asthmatic patients with clinically stable disease attending a university-based urban asthma clinic. Asthma symptoms did not correlate with the degree of airway obstruction as measured by prebronchodilator PEFR (total asthma symptom score vs PEFR: r = -0.214, p = 0.104, n = 59) and only correlated poorly with prebronchodilator FEV1 (total asthma symptom score vs FEV1: r = -0.256, p = 0.041, n = 64). These results lend support to the recommendation that airway obstruction should be measured objectively when assessing patients with chronic persistent asthma.
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Affiliation(s)
- C K Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Liam CK. Risk of tuberculosis to healthcare workers. Med J Malaysia 2001; 56:107-11; quiz 112. [PMID: 11503290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- C K Liam
- Department of Medicine, University Hospital, 50603 Kuala Lumpar
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Affiliation(s)
- K H Lim
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Liam CK, Lim KH, Wong CM, Lau WM, Tan CT. Awake respiratory function in patients with the obstructive sleep apnoea syndrome. Med J Malaysia 2001; 56:10-7. [PMID: 11503285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
INTRODUCTION The flow-volume curves of patients with obstructive sleep apnoea (OSA) obtained during the awake state are frequently abnormal. OBJECTIVE To determine 1) the relationship between the awake respiratory function and the severity of sleep-disordered breathing in a group of Malaysian patients with the OSA syndrome and 2) the frequency of flow-volume curve abnormality in these patients. MATERIALS AND METHODS A retrospective analysis of the data from respiratory function tests during wakefulness and nocturnal polysomnography was performed on 48 patients with OSA. The severity of OSA was defined by the apnoea-hypopnoea index (AHI) and the lowest oxygen saturation during sleep (SpO2nadir). RESULTS AHI had a significant relationship with alveolar-arterial oxygen gradient (r = 0.34, p = 0.046) and SpO2nadir (r = -0.49, p < 0.001) but not with any anthropometric parameter or the other awake respiratory function variables measured. SpO2nadir had a significant relationship with body mass index (r = -0.54, p < 0.001), neck circumference (r = -0.39, p = 0.013), awake room air PaO2 (r = 0.61, p < 0.001), alveolar-arterial oxygen gradient (r = -0.41, p = 0.015) and baseline supine SpO2 (r = 0.53, p < 0.001). There was no correlation between SpO2nadir and any spirometric or static lung volume parameters. The maximum inspiratory and maximum expiratory flow-volume curves of 26 patients (54%) showed a ratio of forced expiratory flow to forced inspiratory flow at mid-vital capacity (FEF50/FIF50) greater than one. In addition, flow oscillations (the "sawtooth" sign) were noted in the inspiratory and/or expiratory flow-volume curves of 21 patients (44%), 9 of whom did not have an FEF50/FIF50 > 1. Altogether, the maximum flow-volume curves during wakefulness of 35 (73%) of the 48 patients showed variable upper airway obstruction and/or flow oscillations. However, the presence of these two upper airway abnormalities, either occurring alone or together did not have an effect on the severity of OSA as measured by the AHI or SpO2nadir. CONCLUSIONS Abnormalities of the flow-volume loop consistent with inspiratory flow limitation and/or upper airway instability during wakefulness are common in patients with the OSA syndrome. The degree of oxygen desaturation during sleep in these patients is related to their awake oxygenation status.
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Affiliation(s)
- C K Liam
- Department of Medicine, University of Malaya Medical Centre, 50603 Kuala Lumpur
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Liam CK, Lim KH, Wong CM. Lung cancer in patients younger than 40 years in a multiracial Asian country. Respirology 2000; 5:355-61. [PMID: 11192546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE This study aimed to determine whether the clinicopathological features of lung cancer in patients younger than 40 years differ from that of older patients in an Asian country. METHODOLOGY We undertook a review of the clinicopathological data of all patients with confirmed primary lung cancer at the Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia, from October 1991 to September 1999. RESULTS Of the 580 patients with lung cancer, 36 (6.2%; 23 males, 13 females) were 21-39 years old at diagnosis. The percentage of people who had never smoked was higher among the younger patients (58.3% vs 19.1%, P < 0.001). Although adenocarcinoma was the most common cell type in both groups, its incidence was higher in the younger patients (24/36 (66.7%) vs 228/544 (41.9%), P = 0.007). The mean World Health Organization performance status at presentation was worse in the younger patients (2.4 vs 2, P = 0.007). In the case of non-small cell lung cancer, all the younger patients presented with either stage IIIb or metastatic disease compared to 77.2% of the older patients (P < 0.001). CONCLUSIONS Younger lung cancer patients were more likely than older patients to have never smoked, to have adenocarcinoma, and to present with poorer performance status and with more advanced-stage non-small cell lung cancer.
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MESH Headings
- Adenocarcinoma/ethnology
- Adenocarcinoma/etiology
- Adenocarcinoma/pathology
- Adenocarcinoma/therapy
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- Carcinoma, Large Cell/ethnology
- Carcinoma, Large Cell/etiology
- Carcinoma, Large Cell/pathology
- Carcinoma, Large Cell/therapy
- Carcinoma, Non-Small-Cell Lung/ethnology
- Carcinoma, Non-Small-Cell Lung/etiology
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/therapy
- Carcinoma, Small Cell/ethnology
- Carcinoma, Small Cell/etiology
- Carcinoma, Small Cell/pathology
- Carcinoma, Small Cell/therapy
- Carcinoma, Squamous Cell/ethnology
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/therapy
- Female
- Humans
- Lung Neoplasms/ethnology
- Lung Neoplasms/etiology
- Lung Neoplasms/pathology
- Lung Neoplasms/therapy
- Malaysia/epidemiology
- Male
- Middle Aged
- Neoplasm Staging
- Population Surveillance
- Prospective Studies
- Sex Distribution
- Smoking/adverse effects
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Affiliation(s)
- C K Liam
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Liam CK, Aziah AM, Lim KH, Wong CM. Intravenous followed by oral ofloxacin in the treatment of community acquired lower respiratory tract infections in adults requiring hospitalisation. Med J Malaysia 2000; 55:304-7. [PMID: 11200708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Forty patients were treated with ofloxacin for community acquired lower respiratory tract infections. Eighteen pathogens were isolated in sputum; Streptococcus pneumoniae (4) and Haemophilus influenzae (4) were the most common, followed by Klebsiella pneumoniae (3), Klebsiella spp. (2), Staphylococcus anreus (2), Pseudomonas spp. (2), and Pseudomonas aeruginosa (1). Ofloxacin 200 mg every 12 hours was administered for an average of 3.7 days intravenously followed by 5.4 days orally. Response to therapy was judged to be cure in 38 (95%; 95% C.I., 85%-95%) patients, failure in one (2.5%) and "indeterminate" in one (2.5%).
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Affiliation(s)
- C K Liam
- Department of Medicine, University of Malaya Medical Centre, 50603 Kuala Lumpur
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Srinivas P, Liam CK, Jayaram G. Localised nodular pulmonary amyloidosis in a patient with sicca syndrome. Med J Malaysia 2000; 55:385-7. [PMID: 11200724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A 52 year old Chinese woman with a 25 year history of sicca syndrome (primary Sjogrens syndrome) was investigated for 3 episodes of haemoptysis. Clinical examination was unremarkable except for the presence of dry eyes and xerostomia. Computed tomography of the chest revealed a lobulated mass in the posterior basal segment of the left lower lobe. Histopathological examination of this resected nodule confirmed the diagnosis of nodular amyloidosis. The normal radiolabelled serum amyloid P component scintigraphy and the absence of monoclonal plasma cell dyscrasia in the bone marrow strongly support the diagnosis of localised nodular pulmonary AL amyloidosis in this patient. Nodular pulmonary amyloidosis can be associated with sicca syndrome and often simulates bronchogenic carcinoma, bronchiectasis or pulmonary tuberculosis.
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Affiliation(s)
- P Srinivas
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur
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Liam CK, Lim KH, Wong CM. Acceptance of the Accuhaler, a multi-dose powder inhaler, among asthmatic patients: a comparison with the pressurized metered-dose inhaler. Asian Pac J Allergy Immunol 2000; 18:135-40. [PMID: 11270467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
This study aimed to evaluate dry powder inhaler naive asthmatic patients' perception and preference of the Accuhaler, a multidose dry powder inhaler and the pressurized metered dose inhaler (pMDI). After the first instruction, 66.7% of 48 patients enrolled in the study could demonstrate the correct use of the Accuhaler. When the patients were asked to compare the pMDI and the Accuhaler after using the Accuhaler to administer salmeterol for 4 weeks, the Accuhaler scored significantly better than the pMDI for the following features: knowing how many doses are left, presence of an attached cover, taste, instruction for use, attractiveness, ease of use, ease of holding, shape, and comfortable mouthpiece. The pMDI scored better to the Accuhaler in terms of size. More patients preferred the Accuhaler than the pMDI; the presence of a dose counter and perceived ease of use were the main reasons cited for their preference for the Accuhaler.
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Affiliation(s)
- C K Liam
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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