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No.11, 1st Floor, Lot 2343, Block 10 KCLD Bormill Estate Commercial Centre, Jalan Tun Ahmad Zaidi Adruce 93150 Kuching Tel: 082-258 212 Email: [email protected] KDN No.: PPK434/04/2013 (032273) Volumn 11 - Jun 2015 TYT Tun Pehin Sri Haji Abdul TaibMahmud Message from Editor YB Tan Sri Datuk Amar Dr. James Jemut Masing - Mr. Eric Lim Swee Khoon is also a Trustee of BoarD of trustees
Activities of 1st half of 2015 YABhg Datin Patinggi Dato Hajjah Jamilah Anu YB Senator Datuk Prof Dr Sim Kui Hian YB Dr Annuar Rapaee YBhg Dato Sri Empiang Jabu YBhg Dato Anne Teng The Role of Echocardiography in the YBhg Datuk Dr Stalin Hardin Management of Patients with heart disease YBhg Datuk Fong Joo Chung by Dr. Oon Yen Yee, Cardiologist, YBhg Datuk Prof Dr Chew Peng Hong SGH Heart Centre YBhg Dato Haji Abdillah Haji Abdul Rahim Dr Mohd Hirman Ritom 5-6 Understanding Generic Drugs Ms Pauline Kon Suk Khim By Yanti Nasyuhana San, Senior Pharmacist, Mr Eric Lim Swee Khoon Clinical Research Centre, Sarawak General Hospital YBhg Datuk Patinggi Tan Sri Dr. Wong Soon Kai Activities of 1st half of 2015 Mr. Eric Lim Swee Khoon

Volumn 11 - Jun 2015 message from editor
Happy New Year 2015, Gong Xi Fa Chai and Selamat Hari Gawai!! How time flies! We are already in the second half of 2015 and have celebrated 2 major festivities ie. the Chinese New Year on 19-20 February 2015 and the harvest festival, Hari Gawai on 1-2 June 2015.
The Foundation started the Year 2015 with a visit to the Sarawak General Hospital Heart Centre on 15 January 2015 to bring Chinese New Year cheers to the patients there to lift up their spirits. The Foundation also donated one unit of Philip ECG machine to the Emergency Unit at the Heart Centre.
This was then followed by a back to back Heart Week; the first one being the Sibu Heart Week 2015 on 20-21 March 2015 at Star Megamall and Miri Heart Week 2015 on 25-26 April 2015 at Bintang Megamall. The Sibu Heart Week was held in collaboration with Yayasan Jantung Malaysia. As usual, there were public health screening, poster exhibitions, Zumba, belly dancing, healthy cooking and various activities to liven up the atmostphere. The key message to drive home is of course to promote healthy living.
Apart from the Heart Weeks, the Foundation also conducted various public health screenings at Transformation Centre, Hills Shopping Mall and CityOne.
I would like to take this opportunity to thank all our corporate sponsors and donors, the staffs and nurses from the various public hospitals and friends of the Foundation for their support in all our events and hope that they will continue to support our cause. I also hope that other new corporations will step forward and adopt some of the future events of the Foundation as part of their Corporate Social Responsibility (CSR) Programme.
Eric Lim Swee KhoonEditor

Activities of 1st half of 2015 Volumn 11 - Jun 2015 DONATION OF 1 PHILIP
TO SGH HEART CENTRE SIBU HEART WEEK: 20-21 MARCH 2015 @ STAR MEGAMALL The Sarawak Heart Foundation in collaboration with Yayasan Jantung Malaysia had organized the Sibu Heart Week from 20/3/15 to 22/3/15. The event which carries the theme "Heart- Healthy Environments" was held at Star Megamall daily from 10.00 am to 9.00 pm.
Volumn 11 - Jun 2015 SIBU HEART WEEK: 20-21 MARCH 2015 @ STAR MEGAMALL The launching ceremony was officiated by the Guest-of-Honor, YABhg Datin Patinggi Dato Hajjah Jamilah Anu, Board of Trustee, Sarawak Heart Several activities had been organized in conjunction with the Heart Week which included health screening, health talk, blood donation, demonstration of healthy cooking for the heart, mini fun games and physical activities like zumba, aerobic, belly, flash mob and fun modern dances. Poster exhibitions in related to heart disease were also displayed for knowledge of the public. The Sarawak Heart Foundation also distributed obesity books for children in English, Bahasa Malaysia and Chinese languages to 26 primary schools in Sibu. These obesity books were to educate the children the right food and importance of physical activity and exercise they need.
The Heart Week campaign was supported by PANSAR, Star Megamall, Sibu Divisonal Health Office, Sibu Hospital and Fitness Centres in Sibu.
Volumn 10 - Dec 2014 The Role of Echocardiography in the Management of Patients with Heart Disease Dr. Oon Yen Yee Cardiologist, PJHUS
Echocardiography is an examination using pulmonary vessel (pulmonary embolism). When ultrasound waves to visualise the moving heart. It a patient is confirmed to have heart attack, is usually performed by trained sonographers but echocardiography is used to check on how well can also be performed by the treating doctor. The the heart is pumping and to look for complications examination can be carried out in clinics, wards, such as ruptured heart wall and malfunctioning emergency department and operating theatre. valve. The examination can also be used to guide During the examination, the patient is required to treatment strategy. For example, a patient with lie on his left side. The sonographer will then put poor heart function due to non-viable heart a probe and move it over the patient's chest to muscle may not be a candidate for angiogram or capture the image of the heart. The examination bypass surgery.
takes about fifteen to thirty minutes, depending on the complexity of patient's heart problem. Fig. 2 - Echocardiogram of a dilated aorta and tearing of its wall In patients with heart failure, echocardiography can provide information regarding its severity and cause. Other uses of echocardiography Fig.1 - A sonographer performing echocardiography include detection of blood clots and masses in heart chambers, fluid in the covering of the heart Echocardiography is used to visualise the (pericardial effusion) and disease involving the structure of the heart. When a patient is found to heart muscle (cardiomyopathy).
have a heart murmur, this test is ordered to look for any heart valves problem or congenital heart disease. During the examination, the severity of the underlying heart problem is assessed. The information gained from the examination helps the treating doctor to decide on the most appropriate treatment for his patient. Patient with severe heart valve problem or congenital heart disease often requires surgery. After surgery, echocardiography is used to monitor the function of the replaced/ repaired heart valve or to check for any residual in the heart. In patients with mild structural heart disease, echocardiography can be repeated to monitor disease progression.
Fig. 3 - Echocardiogram of a dilated heart and a clot in the left heart chamber Echocardiography can be used to evaluate patient who has chest pain. During the examination, the Over the last few decades, there are many advances sonographer will look carefully at how well the in card iac imaging. However echocardiography heart muscles are contracting. In patients with remains an invaluable test to cardiologists in heart vessel blockage, the heart wall or a section the assessment of heart structure and function. of the heart muscles may not contract well. The This is because it is simple to perform and under sonographer will also look for other potential good hands, it can provide detailed and accurate causes of chest pain such as tearing of the wall information comparable to that provided by newer of the aorta (aortic dissection) or clot in the main imaging modalities.
Volumn 10 - Dec 2014 Understanding Generic Drugs Yanti Nasyuhana Sani
Senior Pharmacist, Clinical Research Centre, Sarawak General Hospital If you were asked by your pharmacist to choose between a generic and a branded drug, which one would you pick? Many people assume that generic drugs have lower quality and are less efficacious. We think the innovators (i.e., original inventors of the drugs) are superior and expensive brands are always "better"! How true is this? Let the pharmacist correct these misconceptions. What are generic drugs? The United States Federal Drug Authority (U.S. FDA) defines a generic drug as one which is identical (or bioequivalent) to an innovator drug in terms of the active ingredient (the substance that produces the drug effect), dosage, how it works, labeled strength, route of administration, performance characteristics and intended use [1]. This means that the generic medicine should theoretically have the same quality as the innovator drug. To get a better understanding, let me illustrate with a drug called clopidogrel. Your doctor may prescribe clopidogrel, a drug used to prevent heart attack and stroke in someone diagnosed with heart disease or previous stroke. Clopidogrel was originally manufactured under the brand name PLAVIX by a global pharmaceutical company called Sanofi-Aventis. Therefore, PLAVIX is the innovator drug. A ‘new' drug like PLAVIX is protected by a patent that gives the company the sole right to sell the drug for a certain period of time. Once the patent expires, other drug companies can start manufacturing and selling clopidogrel. Because they are marketed under different brand names, they are easily identified as generic clopidogrel. An example of generic clopidogrel is CLOPIVID. CLOPIVID is manufactured by a local pharmaceutical company, Hovid Bhd. CLOPIVID has the same active ingredient (clopidogrel), identical strength per tablet (75mg), mechanism of action (P2Y12 Inhibition), dosage formulation (tablet), route of administration (oral), and more importantly same prescribing indications as the original PLAVIX. The only difference between PLAVIX and CLOPIVID is the inactive ingredient used in the tablet formulation. In a nutshell, generic drugs are copies of innovator drugs manufactured after patents have expired. How do we test the quality of generic products? Before any generic drug can be marketed, the drug company is required to conduct a bioequivalence (BE) study to prove that the generic product is as ‘good' as the innovator drug. The BE study compares the amount of generic and innovator drug absorbed into the body. When a generic product passes a BE study, it means that the concentration of the generic drug in the bloodstream is approximately the same or within an acceptable range, compared to the concentration of the innovator drug. In other words, the qualities of the two drugs are expected to be similar. In our country, the National Pharmaceutical Control Bureau (NPCB) is a national drug regulatory body that is responsible for ensuring all generic drugs planned for registration and marketing in Malaysia undergo BE studies. NPCB also regularly evaluates the safety of generic drugs after approval by monitoring adverse events reports. Whenever there is any concern that patient's safety might be jeopardized, the drug will be de-registered and no longer allowed to be marketed in Malaysia. Volumn 8 - Dec 2013 Many people are not aware that BE studies have been conducted in the Land of the Hornbills since 2013! The research team from the Clinical Research Centre, Sarawak General Hospital, led by a cardiologist Dr Alan Fong Yean Yip have taken proactive steps to help ensure Malaysians are prescribed the best medicines by conducting BE studies on generic products. The clinical phases of BE studies are carried out in a world-class facility, CRC Research Ward, Level 6, Sarawak General Hospital Heart Centre. Up till date, the centre has conducted a total of 15 BE studies covering a broad spectrum of pharmaceutical compounds ranging from antihypertensives to antibiotics. The Centre was also listed in the NPCB Compliance Programme for BE Centres in 2013, a programme established by NPCB to guarantee the quality of studies conducted in BE CRC SGH BE Study Team If generic drugs are as good as the innovators, why are they so cheap? Although generic drugs are chemically identical to their branded counterparts, generics are usually 80-85% cheaper because generic drug companies do not need to repeat the costly clinical trials of new drugs. They also do not need to spend substantial funds on advertising and marketing. The situation is different for innovator drug companies. They have to carry out costly and extensive research to find the right molecule and conduct animal and human drug testing. They also need to spend a lot of money on marketing and promoting a new drug. If there is still any doubt, an analysis of the results of 38 clinical trials that compared the effectiveness of cardiovascular generic drugs to their innovator counterparts found no evidence that innovator cardiovascular drugs worked any better than generic ones [2]. Hence, cheaper does not necessarily mean lower quality.
Take home messages
Generic drugs are required to have the same active ingredients, strengths, dosage formulations and routes of administration as innovator drugs.
Generic drugs have to pass BE studies before they can be approved for clinical use, hence the efficacy and safety of generic drugs are expected to be similar to innovator drugs.
Malaysia's drug regulatory body conducts stringent evaluations for all generic drugs to ensure their quality and safety. When a generic drug is approved, it has met their rigorous standards with respect to its identity, strength, quality, purity and potency.
As far as price is concerned, the generic is always cheaper than the innovator drug, but cheaper does not mean lower quality.
[1] [2] Kesselheim et al. Clinical Equivalence of Generic and Brand Name Drugs Used in Cardiovascular Disease: A Systematic Review and Meta-Analysis. JAMA. 2008;300(21)2514-2526 Volumn 10 - Dec 2014 25-26/4/15 MIRI HEART WEEK @ BINTANG MEGAMALL
Activities of 1st half of 2015 Volumn 8 - Dec 2013 28/3/15
Activities of 1st half of 2015 Volumn 8 - Dec 2013 21/6/15 HEALTH TALK @
CITY ONE WITH KUCHING Coming • 7/7/15 HAri rAyA VisiT AND DoNATioN of iTEms To sGH HEArT CENTrE,
events • 16/8/15 HEAlTH sCrEENiNG AND HEAlTH TAlK AT EAsTErN mAll, siburAN
• 19/9/15 WomEN's HEArT DAy AT boulEVArD sHoppiNG mAll, KuCHiNG • 27/9/15 WorlD HEArT DAy 2015 AT rEsErVoir pArK, KuCHiNG "frienD of the
sarawak heart founDation
how Can you help?
If you are someone who is caring and would like to help Sarawak Heart Foundation, you
can register as a "Friend of the Foundation" (as a volunteer to help in the various projects
undertaken by the Foundation from time to time and especially with fund-raising) Please fill in the below and send to us. Please specify how you can help? (eg. driver, food runner, general worker, exercise instructor, dancer, mc, photographer etc.) Sarawak Heart Foundation
No.11, 1st Floor, Lot 2343 Bormill Estate Commercial Centre , Jalan Tun Ahmad Zaidi Adruce, 93150 Kuching Sarawak
Tel: 082-258212 Fax: 082-258303 Email address: [email protected]
sarawak heart founDation
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Email: [email protected]
All donations payable to:
Sarawak Heart Foundation
No. 11, 1st Floor, Lot 2343, Block 10 KCLD
Bormill Estate Commercial Centre
Jalan Tun Ahmad Zaidi Adruce, 93150 Kuching, Sarawak.
Tel: 082-258212 ; Fax: 082-258303
All donations are tax exempted. Ref. JHDN 01/35/42.51/179-6.4381


Gender-specific immunological effects of the phosphodiesterase 5 inhibitor sildenafil in healthy mice

Contents lists available at Molecular Immunology Gender-specific immunological effects of the phosphodiesterase 5 inhibitor sildenafil in healthy mice Svetlana Karakhanova , Yuhui Yang , Julia Link , Sabine Soltek , Katharina von Ahn , Viktor Umansky , Jens Werner , Alexandr V. Bazhin a Department of General Surgery, University of Heidelberg, Heidelberg, Germany b Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Texte de consensus sur la vaccination contre la grippe 2010

Texte de consensus sur la vaccination contre la grippe en 2010 En raison de l'apparition du nouveau virus de la grippe A(H1N1) qui s'est répandu sur la planète en 2009, la vaccination contre la grippe a été organisée l'année dernière de manière spécifique. Pour de nombreuses personnes, l'administration de deux vaccins différents a été recommandée : une injection du vaccin trivalent contre la grippe saisonnière et une injection du vaccin contre la grippe pandémique A(H1N1). Pour la saison 2010-2011, on revient à une vaccination classique de groupes à risque avec un seul vaccin trivalent, qui confère une protection contre trois souches virales différentes, dont la souche A(H1N1). Dans ce texte de consensus, rédigé par un groupe de travail spécifique, nous voulons donner des réponses à quelques questions souvent posées et clarifier quelques controverses et malentendus. Membres du groupe de travail : Dr Rik Baeten (Vlaams Griepplatform), Paul Geerts (Omtrent Gezondheid), Dr Vincent Momin (SSMG), Dr Patrick Trefois (Question Santé), Dr Nathalie Van de Vyver (Domus Medica), Dr Yves Van Laethem (ULB, Hôpital Saint Pierre), Dr Marc Van Ranst (KU Leuven, Federaal Griepcommissaris). Sommaire 1 - Quels virus provoquent-ils la grippe chez l'homme ? 2 - Quels virus de la grippe circuleront-ils cette année 2010 ? 3 - Dispersion du virus de la grippe 4. Quelle est la gravité de la grippe ? 5. Pourquoi vacciner contre la grippe ? 6. Quelle est l'efficacité du vaccin contre la grippe ? 7. Pourquoi est-il recommandé de répéter la vaccination contre la grippe annuellement ? 8. Les personnes qui ont présenté des symptômes de grippe durant l'hiver 2009-2010 doivent-elles être vaccinées cette année ? 9. Les personnes vaccinées contre la grippe pandémique en 2009 doivent-elles être à nouveau vaccinées cette année ? 10. Quand vacciner ? 11. Qui est-il recommandé de vacciner cette année contre la grippe ? 12. Quelles sont les personnes qui ne peuvent pas être vaccinées ? 13. Pour quelles personnes le vaccin est-il remboursé ? 14. Peut-on vacciner une femme pendant la grossesse. 15. Faut-il vacciner l'entourage familial des personnes à risque et les personnes qui soignent des enfants de moins de 6 mois ? 16. Faut-il vacciner les enfants en bonne santé ? 17. Le vaccin contre la grippe peut-il être administré simultanément à d'autres vaccins ? 18. Les patients présentant une affection inflammatoire chronique ont-ils un risque accru de grippe ou de complications suite à une grippe ? 19. Les patients cancéreux peuvent-ils être vaccinés ?