The October issue (Vol 10.10) features Cystic Fibrosis:

• Impact of azithromycin on the clinical and antimicrobial effectiveness of tobramycin in the treatment of cystic fibrosis.
• Acquired resistance to macrolides in Pseudomonas aerigunosa from cystic fibrosis patients.
• Clostridium difficile carriage in adult cystic fibrosis (CF): implications for patients with CF and the potential for transmission of nosocomial infection.
• The impact of a national population cancer screening programme on cystic fibrosis birth rate and age at diagnosis: Implications for newborn screening.
• The cumulative effects of intravenous antibiotic treatments on hearing in patients with cystic fibrosis.
• Optimal correction of distinct CFTR folding mutants in rectal cystic fibrosis organoids.
• Consequences of expiratory flow limitation at rest in subjects with cystic fibrosis.
• Age-related survival disparity associated with lung transplantation in cystic fibrosis: An analysis of the registry of the International Society for Heart and Lung Transplantation.
• The lower airway microbiota in early cystic fibrosis lung disease: a longitudinal analysis.
• The quantitative link of lung clearance index to bronchial segments affected by bronchiectasis.

In Respirology Vol. 23 Issue 10, the Editors have especially chosen to feature the following two articles:

• Predictive value of eosinophils and neutrophils on clinical effects of ICS in COPD
  
  
  Floor J Hartjes, Judith M Vonk, Alen Faiz, Pieter S Hiemstra, Thérèse S Lapperre, Huib A M Kerstjens, Dirkje S Postma, Maarten Van Den Berge, and The Groningen & Leiden Universities Corticosteroids In Obstructive Lung Disease (GlUCLD) Study Group
  10.1111/resp.13312

  Groningen Research Institute for Asthma and COPD (GRIAC), Netherlands (Click photo to enlarge)

• Multidimensional improvement in connective tissue disease associated interstitial lung disease: Two courses of pulse dose methylprednisolone followed by low-dose prednisone and tacrolimus
  
  
  Yasuhiko Yamano, Hiroyuki Taniguchi, Yasuhiro Kondoh, Masahiko Ando, Kensuke Kataoka, Taiki Furukawa, Takeshi Johkoh, Junya Fukuoka, Koji Sakamoto and Yoshinori Hasegawa
  10.1111/resp.13365

  Research team at Department of Respiratory Medicine and Allergy at Tosei General Hospital in Seto, Japan (Click photo to enlarge)

The following cases have been selected for inclusion in the November 2018 Respirology Case Reports, Volume 06 Issue 8

Malaysian Thoracic Society (MTS) Annual Congress 2018

Dr Hooi Lai Ngoh FAPSR
Honorary Secretary
Malaysian Thoracic Society

The annual congress was held at the Zenith Hotel, Kuantan. A total of 484 delegates from all over Malaysia attended the congress. The Organizing chair was Dr How Soon Hin and the Scientific Committee was co-chaired by Dr Aishah Ibrahim and Dato' Dr Ahmad Fadzil Abdullah.

The three congress workshops held on 12 July 2018 were well attended by over 100 participants. The workshop topics were Interstitial Lung Disease, Respiratory Infections and The Difficult Paediatric Airway.

The main congress comprised 4 plenary lectures and 18 symposia covering a wide spectrum of respiratory diseases in adults and children. The faculty consisted of eminent local and overseas experts. In addition, there were Multidisciplinary Case Discussions for paediatric and adult respiratory medicine, and two sunrise sessions. There were 5 oral paper presentations, 40 poster presentations on scientific papers and 34 poster presentation on case reports. All 5 oral presenters were awarded prizes while the best 8 posters for scientific papers and best 3 case reports were also awarded prizes which were announced during the Gala Dinner.

Lung Function Tests Education Programme

In 2012 the programme started with the formation of an Education Committee to design training modules appropriate for the local setting. The MTS sent two of its members for training by attending the European Respiratory Society (ERS) Spirometry Driving License course. They completed their training in 2013 and were certified as providers and trainers. The first edition of the reading materials was published in 2014 and was registered under ISBN in 2015.

The Basic Lung Function Tests (LFT) Certification Provider Course was the first initiative by the MTS to provide standardized training for healthcare personnel. It has been held annually since 2014 and consists of three phases.

Phase 1 comprises a one-and-a-half-day course focusing on theoretical knowledge at the end of which candidates are required to sit for a written examination. Phase 2 consists of practice and training at their respective centres under supervision. A completed log book must be submitted prior to the Phase 3 course held a few months after the Phase 1 course. The Phase 3 course comprises another one-and-a-half-day course focusing on the practical aspects of spirometry testing and the candidate is assessed and evaluated at the end of the course. Upon successful completion of the courses, log book and examinations, candidates were certified as Basic LFT Providers by the Malaysian Thoracic Society and Ministry of Health Malaysia. Trainers for the Certification Programme have to undergo the Basic Lung Function Tests Train-the-Trainers Course after completing Basic LFT Certification Course. Spirometry for Primary Care Practitioners is the second initiative by the MTS to provide a platform for Primary Care Practitioners in Malaysia to gain knowledge and skills to manage respiratory diseases especially chronic obstructive pulmonary disease. The first course was conducted in 2016 and it has been organized annually since then.

Anti-tobacco advocacy

The MTS was amongst the 30 medical organizations that co-signed an open letter to the media in September 2018 to support the Ministry of Health's announcement that alfresco restaurants will be gazetted as no-smoking zones from 1 January 2019. The Ministry of Health intends to impose hefty fines on those defying the ban. This is in line with ongoing efforts to de-normalize tobacco use in the community.

Prepared by
Dr Hooi Lai Ngoh
Honorary Secretary
Malaysian Thoracic Society
24 October 2018

The Asian Pacific Congress on Bronchology and Interventional Pulmonology (APCB 2019) will take place at the Gold Coast Exhibition and Convention Centre, Australia, 28–30 March 2019, preceding the TSANZSRS Annual Scientific Meeting (30 March – 2 April).

It will attract a distinguished audience comprised of researchers and clinicians in the field of bronchology and interventional pulmonology. The theme is "Case Based Training – Practice and Theory" and it will have a novel design with a hands-on focus; workshops will provide the core part of the Congress.

APCB 2019 promises to offer an exceptional learning opportunity. Case-based learning will take centre stage and local and international faculty have developed a range of interesting and informative cases across 9 key topics. As part of your registration package you will get to choose 4 half-day courses, which will include theory as well as plenty of time to gain hands-on practice in key procedural points relevant to the particular topic.

REGISTER NOW

For more information, or to sign up to receive updates, please go to www.apcb2019.com

This event was held 30–31 October 2018 at the Phnom Penh hotel, where delegates could meet skilled experts from France and Cambodia, under the presidency of His Excellency Pr. Thir Kruy, Secretary of State of the Ministry of Health.

(Click either image to enlarge)

This APSR-endorsed Educational Event (APSREE) will be held on Friday 16 November 2018 at Hilton, Xiamen, China

An intensive, full-day programme, packed with the following sessions:

Further details will appear at apsresp.org/education/esap/esap-201811-china.html when available.

The 59th Annual Meeting of the Japanese Respiratory Society will be held on 12-14 April 2019 at the Tokyo International Forum.

The Meeting's president will be Prof. Koichiro Tatsumi (Department of Respirology, Chiba University)

Details: www.jrs.or.jp/english/?content_id=27

The careless use of antibiotics is contributing to a global crisis of antimicrobial resistance. An estimated 700,000 people die every year due to antibiotic-resistant infections, and the World Health Organization (WHO) projects that this will rise to 10 million deaths per year by 2050.

Poor and incomplete data means that the scope of resistance in Cambodia is still unclear, and a new government-run surveillance effort has still not collected its first round of data. However, individual studies and anecdotal evidence make it obvious that the problem is serious.

In 2011, over 10% of all tuberculosis cases in Cambodia were found to be resistant to multiple antibiotics, up from just 3.1% in 2001. A small follow-up study in 2015 called urgently for the resumption of national-level surveillance of drug-resistant tuberculosis, which showed signs of spreading in the population.

A 10-year study at the Angkor Hospital for Children in Siem Reap, which ran from 2007 to 2016 and had its results published in May, found that 82% of E. coli and K. pneumoniae samples at the hospital were resistant to multiple drugs.

The Institut Pasteur du Cambodge has also sounded an alarm, noting in a recent statement that it was detecting alarmingly high levels of resistance in several types of bacteria.

Over a four-year period starting in 2012, it found that the frequency of enterobacteria that produced extended-spectrum beta-lactamases (ESBLs), which give bacteria resistant to many types of antibiotics, increased from 23.8% to 38.4% in the samples it tested.

Most startlingly, as many as 80% of pregnant women and 42$ of infants tested by the Institut hosted enterobacteria that produced ESBLs, compared to less than 5% in Europe.

"The increase of these resistant bacteria can lead to a therapeutic impasse," said Institut Pasteur biologist Alexandra Kerleguer in a statement.

Dr Kerleguer said that when she first arrived in Phnom Penh, she was shocked to see how much more serious antimicrobial resistance was in Cambodia than in her home country, France.

Dr Phe Thong of the Sihanouk Hospital Center of HOPE in Phnom Penh told VOA that in the past several years, he had seen a number of patients with alarming drug-resistant bacterial infections.

In some cases, they were resistant to all drugs available in the country. Dr Thong said he had never encountered a serious case of antibiotic resistance before 2013.

Diseases like pneumonia and typhoid are especially hard to cure in Cambodia at the moment because the bacteria that cause them are highly resistant to existing antibiotics like ciprofloxacin and fluoroquinolone, Dr Thong said.

This would be daunting for doctors anywhere. But the problem is compounded in Cambodia, where third-line antibiotics are often unavailable or prohibitively expensive. They also require patients to adhere to a much more rigorous treatment protocol, usually while hospitalized. And there is always the risk that bacteria will also evolve resistance to the strongest drugs, making them impossible to fight.

"Here, we experienced a few very serious cases in which the bacteria resist all the existing antibiotics in the country," he said. "We were struggling to decide on the medication because we don't seem to have [antibiotics] to cure those patients.

Every study of antibiotic resistance in Cambodia has emphasized that a comprehensive national-level surveillance system is urgently needed. But getting it up and running has been slow going.

The Sihanouk Center, along with three other hospitals in Phnom Penh and four in provincial areas, are now enrolled in a World Health Organization program to track and fight resistance.

Although the program has existed for years, Cambodia only began collecting data in January 2018. There are still only eight hospitals in the country with the facilities to conduct the necessary tests for resistant bacteria, underscoring the depth of the challenges here.

The doctor who works on AMR issues said that without clear statistics on the scope of resistance, it has been impossible to create a national plan to control it.

"We don't have any guidelines at all now. It is taking a long time because we don't have any data to make them. We can't have [guidelines] until we can get good enough data," he said.

"Sweden leads this initiative, the WHO endorses the program, and the US' Centers for Disease Control supports the government with resources, but I think it is up to the government, which must work harder itself," the doctor added.

Dr Thong agreed that senior leaders and doctors must change their behavior before patients can be expected to.

"Of course every country faces this issue, but only those countries with proper control, guidelines and regulations on antibiotic use will be able to lower resistance levels," he said.

Until then, pett phum will keep doling out "healing medicine," people across the country will keep taking them unquestioningly, and bacteria will keep on evolving drug resistance inside the bodies of Cambodians.

San Ros, 51, lives in a village in Kampong Cham and always takes the medicines his village doctor tells him to. He said usually he does not know what they are, and sometimes they have no effect on his symptoms, but he just hopes for the best.

"I always seek help from the pett phum," he said. "When I tell them my symptoms – for example when I catch a cold – they give me some meds. Sometimes it cures the illness, but sometimes it doesn't cure the illness, but this is normal. I don't know. I just take it."

(Extracted from
When "Healing Medicine" Is Bad for Public Health
voacambodia.com/a/
when-healing-medicine-is-bad
-for-public-health/4560473.html
17 October 2018)

Comment by Dr Mark Lavercombe:
The authors review two years of data from their Malaysian hospital for correlation between respiratory admissions and local haze conditions. The findings demonstrate significantly increased rates of admission with respiratory symptoms during a haze, particularly in those with chronic lung or cardiac disease, and those with obesity. Length of stay and requirement for intensive care also increased in the haze periods.

• Dr Vijayaravindh Ramachandran FAPSR

The APSR is profoundly grateful for his generosity.

Congratulations to the following members who have recently become APSR Fellows.

• Dr Vijayaravindh Ramachandran FAPSR (India)
• Dr Sharma Ritesh FAPSR (India)

A warm welcome to the following members who have recently joined APSR assemblies. They will undoubtedly enjoy working with and networking with their assembly colleagues.

If you have news or announcements that may be of interest to other APSR members, please send details to Bulletin Coordinator Dr Arata Azuma (a-azuma@nms.ac.jp) or APSR Bulletin (bulletin@apsresp.org).