World Tuberculosis Day (24 March) is approaching once more; but tuberculosis seems to have become a “forgotten disease”! How much do you know about tuberculosis and its dangers?

Tuberculosis (more commonly known as TB) is transmitted from person-to-person by coughing or sneezing.[1] This produces “droplet nuclei” that are dispersed in the air. Each droplet nuclei contains one to three of the microorganism, Mycobacterium tuberculosis. Primary infection usually results from inhaling airborne particles that contain M. tuberculosis.¹

Tuberculosis was a major health issue in Singapore in the post-war period during the 1950s and 1960s. Back then, there were more than 5,000 new cases yearly owing to high transmission rates of the disease coupled with few effective testing and treatment options available.

The Singapore Anti-Tuberculosis Association (SATA) was set up in 1947 to cope with the problem. By the 1970s and 1980s, treatment improved as more drugs were developed and became accessible. Enhanced understanding of the pathophysiology of the disease also allowed clinicians to develop more effective treatment algorithms. Health-care facilities also became better equipped with more screening and identification options. All of these factors seemed to indicate that tuberculosis would be on the decline. However, the number has risen again today despite how developed we are. 1,451 new tuberculosis cases appeared in 2008, the highest over the last decade.

When the microorganisms enter the body, the body’s immune system usually contains them and the infected person may not know that he has the latent form of disease. This is because symptoms will not show up unless the person’s immune system is unable to fend off the microbial attack. ¹

Some symptoms include chronic cough (with sputum), unexplained weight loss, intermittent fever, night sweats and if serious, blood may surface in the sputum.[2] However, these symptoms are similar to many other ailments and thus, are often overlooked. While chest x-rays can be done, they do not point to a definite diagnosis.* Consequently, several tests may run to confidently diagnose tuberculosis.¹ This process can take up to two months.

Once diagnosed, treatment comes in the form of a daily cocktail of pills. Depending on the severity of the condition, different drugs are used. Some anti-tuberculosis agents include Isoniazid, Rifampicin, Pyrazinamide, Ethambutol etc. Treatment can take up to nine months and it is imperative that patients adhere strictly to the drug regimen to prevent the development of drug resistance.

Despite the need for compliance, as many as 50% of all diagnosed patients fail to adhere to the prescribed drug regimen. Patients tend to become non-compliant once symptomatic improvement is seen. However, as the microorganisms have not been completely eradicated from the body, they can develop drug resistance.[3] This causes a rather serious complication subsequently as they are likely to manifest symptoms but by then, drug therapy would have become ineffective in dealing with the microorganism proliferation.

The World Health Organisation (WHO) has warned of a rise in multi-drug-resistant tuberculosis (MDR-TB) cases which cannot be treated with conventional drugs. Although the number of resistant cases have remained very low so far in Singapore (no more than four cases each in 2007 and 2008), this may change if more patients do not comply with their treatment. The fact that no new anti-tuberculosis drugs have been developed to deal with the mutant strains simply increases the chance for MDR-TB to proliferate.

Children younger than 2 years of age and adults older than 65 years of age have two to five fold risk for active disease compared with other age groups. Patients with underlying immune suppression (e.g., renal failure, cancer, and immunosuppressive drug treatment) have 4 to 16 times greater risk than other patients.[4] Such special populations are advised to seek medical advice if they find themselves with the symptoms mentioned above. If left untreated, one infected person can pass the germs to up to 15 others within a year. In 2008, 78 people here died from tuberculosis, accounting for one in 200 (0.5 per cent) of all deaths.

Preventing the disease from multiplying in the country is a difficult task given the inflow of foreign visitors and workers. As a result, the only viable way to stop the number of cases from rising again is to keep transmission rates down. SATA has done this by promoting community health through smoking cessation, health education sessions and health screenings.

As with any other preventive health measures, boosting the body’s immune system with sufficient exercise, sleep and nutrition lowers the risk of contracting the disease. Good hygiene practices such as washing of hands and covering of mouth when coughing can also limit the spread of disease. Compulsory BCG^# vaccination for infants and children here has also kept the number of tuberculosis cases to a minimum. Nevertheless, it is still the social responsibility of every individual to minimise the threat of infection.

Pharmacists can play an important role in the prevention and treatment of tuberculosis. They can help ensure patient compliance by providing patients with more information about the drugs they are prescribed and how each drug can help them. Most importantly, they can press home the need for adherence to regimen.

Research pharmacists can also help develop drugs that are effective against MDR-TB as the drugs currently in use were developed in the 1970s and may no longer be relevant in MDR-TB cases. By pushing the frontier of modern medicine, it is hoped that they can better safeguard the health of our community and protect the world we live in.

Want to know more facts about Tuberculosis?

Find out more from the World Health Organization’s Tuberculosis page here

For facts closer to home, you can view the Ministry of Health’s FAQs page about Tuberculosis: here

Alternatively, for a quick overview of general facts about Tuberculosis, you may view the WHO’s Stop TB Partnership’s fact sheet for 2008 here

Picture Credits:

Stop TB Partnership (World TB Day Page)
Vaccination Guide for Children in Singapore

[1] Iseman MD. A Clinician’s Guide to Tuberculosis. Philadelphia: Lippincott Williams & Wilkins, 2000.

[2] World Health Organization Report on the Global Tuberculosis Epidemic. Geneva: WHO, 1998.
* The clinician normally makes a diagnosis based on a combination of factors that include physical examination, clinical presentations, laboratory tests results and chest radiographs.

[3] Mahmoudi A, Iseman MD. Pitfalls in the care of patients with tuberculosis: Common errors and their association with the acquisition of drug resistance. JAMA 1993;270:65–68.

[4] Centers for Disease Control and Prevention. Meeting the challenge of multidrug-resistant tuberculosis: Summary of a conference. MMWR 1992;41:51–71.

^#Bacillus Calmette-Guérin vaccination

Review done by: Winston Xu
Jolyn Seah
Pharmacy Year 1

PSS (Pharmaceutical Society of Singapore) will be organising two back-to-back Congresses. 1. The Asia Pacific Oncology Pharmacy Congress (APOPC, July 7-9)
and 2. The Asian Conference on Clinical Pharmacy (ACCP, July 9-12).

Both events are international conferences – over 200 international delegates for APOPC , and over 800 international delegates for ACCP will be expected to attend these 2 events.

As such, they have requested our participation as student helpers for these 2 events. The jobscope requires us to handle the registration, ushering of the delegates as well as various daily functions at the two events. They are expecting 15-20 students to help out for each day and I am appealing for dedicated students to volunteer as helpers.
Students who are helping at these events will also get to attend some sessions for free, when there is down time and it is a good chance to learn more about actual Pharmacy Practice, in the field of Oncology and Clinical Pharmacy.

A list will be passed around your class this week for those people who are interested to help out during these 2 events. Thank you and I look forward to seeing your active participation!

–
Warmest regards,
Tan Wei Zhe Edwin
President
49th Executive Committee
NUS Pharmaceutical Society

As an extension to the previous announcement about the upcoming health bazaar cum campaign (22 and 23 March), we also require some empty medication boxes to use as samples for a mock dispensary. The purpose of the mock dispensary is to supplement the counter on minor ailments, by demonstrating how pharmacists can assist people/patients in managing these ailments.

If you happen to have the boxes or packaging for any of these medications, please do let us know to us. If you do not have any, please also help to source for them!

Persons to contact:
Year 1 – Kheng Yong (u0902106@nus.edu.sg)
Year 2 – Dennis (chuacwd@hotmail.com)
Year 3 – Narendren (n2a0r0e0n@hotmail.com)

MEDICATION LIST [in line with minor aliments]

Actifed line – Red, Yellow and Green [for block nose, flu +/- cough or phlegm]
Zrytec and Zrytec D – Flu +/- block nose
Clarintyne – Flu +/- block nose
Chloropheniramine and Fedac – Flu +/- block nose w Drowsiness
Xepa Line – Sedilix, Cough En, Tussidex Forte, XSP Bena, Mucolix – Cough w/wo phelgm +/- Block and running nose
Panadol Line
Nurofen, Aleve, Fastum gel, Ketotop and Kefentech – Pain prep in various dosage forms
Yoko, Salom Plus, Cooling patchs – Non Pharmacy Pain Prep
Novomin - Motion Sickness
Stugeron - Anti Vomiting
Promethazine - Anti nausea w anti allergy
GI Meds – Dhamotil, Metospasmyl, H2 Recep blockers, Veragel, motilium and imodium

Your help would be greatly appreciated! Thank you!

The NUSPS will be having a health bazaar cum health campaign on the 22nd to the 23rd of March at the Science Foyer. We are currently asking for helpers for the event. More information will be given at a later date.

Basically, helpers would be there to look after the stores (by external store owners), as well as other roles which will be described more in another email concerning this event.

Nonetheless, we would be asking the class rep to send a list around to collate who would like to help out in this event. On the list you would probably find two-hourly slots so do put your name down for the times you would prefer!

Your help is greatly appreciated in this event. Thank you in advance!

Goh Daolin
Honorary General Secretary
49th Executive Committee
NUS Pharmaceutical Society

PS: don’t stop registering although the quota is almost reached,i’m trying to ask for more slots now!hopefully they’ll open more!

The recently concluded Xperience Pharmacy 2009 was an exciting and enriching 4-day camp! After a quick session of icebreaking games, the JC student participants were ushered to the lecture theatre for the opening address by Prof Chan, our head of department.

The camp got into full swing after that, starting with Sherman?s two-part lecture on Acne and Antibiotics. Through the lecture, the JC students ate their lunch gained a preview of the things we learn as Pharmacy students. Next up were the dispensing and dosage form practicals, where the students got to don lab coats and make their own capsules, mixtures, creams and injections. It proved to be a fun and enriching experience for the students. Even seniors had something to learn from the practicals; taking on a supervisory role led us to reflect on our time and bench workspace management skills!

The highlight of the day was the night game, Pharmapoly, for which OGs had to go around playing in various station games to earn revenue and gain market share to achieve the aim of becoming the largest Retail Pharmacy chain in Singapore. The games allowed the campers to learn about Pharmacy in a fun and engaging way. For instance, in ?Dispense a Prescription Through Webcam?, participants had to relay a message regarding a prescription of a drug from one person to another, and the last person in the chain had to pick out the correct medication from a huge pile of medications based on the message received.

The second day started off with a series of talks by pharmacists from various sectors. This gave the campers valuable insights about the diverse roles that pharmacists play in the healthcare industry. The next feature of the day was Sherman?s second lecture, this time on Nose Allergy and Antidepressants, before the students embarked on another practical session.
The final event of the day was the night game, Famashi Case Files Episode 2. It was arguably the most memorable part of the camp! Campers played detective, wandering about the Faculty of Science to gather clues from various stations to solve the mystery behind the death of Ms Poh Li Xin. Kudos to our seniors, who performed impeccably in their portrayal of the story?s characters. Mian Yi, for one, could consider a second career path in acting!

After gathering enough clues, the campers had to piece together the events behind Ms Poh?s death, and re-enact the scenes in a short skit. Lots of laughter ensued as each OG portrayed the events in their own unique (and hilarious) ways.
All good things must come to an end though, and after a night of supper and games it was time to wrap up the camp?s events with the awards presentation, where Johnson and Johnson?s were crowned the winning OG. They won for themselves a box that looked suspiciously like it was full of raisin buns, but in fact it contained an assortment of tasty food items.
Xperience Pharmacy 2009 has definitely left the JC students and seniors alike with not just an insight into the Pharmacy course and profession, but also many memories of the fun times and funny moments that we had over the course of the three days and two nights. Many thanks to the camp?s committee for organizing the camp. Indeed, it was a great XPERIENCE for us all!

Dispense-A-Dream 09 is proud to present to all of you our very own post-trip report. If you like to find out more about the activities we have conducted during our 17 days in Cambodia last December and take a look at the wonderful photos we have taken, pls read our post-trip report. Thanks.

Warmest Regards,
Dispense-A-Dream’09

For buyers:

The textbooks are sold on a first-come-first-serve basis.

Indicate the index no. of the textbook that you would like to purchase. You can fill in more than one index no. for the same textbook title if you do not mind the higher price.

The list of textbooks available for sale can be found here.

Details are to be included in the email as follows to the following email address: secondhandtext09@hotmail.com

Name:
Matriculation number:
Contact no.:

Textbook title 1:
Edition:
Index no(s):

Textbook title 2:
Edition:
Index no(s):

All fields are compulsory. Any field missing and the email would be void.

Once the transaction is confirmed, I would email you asap. If the textbook has been sold and no other is available, an email would also be sent to you. The sale of textbooks would be closed on Thursday 28th January 2010 6pm. Successful buyers and sellers would be emailed with regards to the passing over of the textbooks! Dead buyers/sellers would have to pay a fine of $1 to the NUSPS Welfare. So do take note!

Liew Xin Yi Cindy

Welfare Director
49th Executive Committee
National University of Singapore Pharmaceutical Society

Do take a look at THE REVISED powerpoint file for information about the upcoming 56th International Pharmaceutical Students’ Federation World Congress and the 9th Asian-Pacific Pharmaceutical Symposium!

This year’s IPSF conference will be held at Ljubliana, Slovenia and APPS will be held in Seoul, Korea. Both would definitely be fantastic opportunities to meet fellow pharmacy students from around the world

I think I didn’t make the registration procedure very clear during my presentation today, I’ll post a message either here and/or to the yahoo groups regarding registration procedure asap! In the meantime just drop me an sms or email to inform me if you are interested to register for APPS/IPSF.if you have any queries you can post on the tagboard,comment on the facebook group or look for me!

Warmest Regards,
Valerie Ng
Vice-President
IPSF Contact Person
49th Executive Committee
NUS Pharmaceutical Society

Hi everyone,

We celebrated World Diabetes Day (WDD) from 12-13Nov 09!(thu and fri) 
Thanks for join us in wearing BLUE on to mark WDD. I hoped you all learnt something from the information on the big floor stickers as well as the bookmarks given out!
Pictures can be found at: http://picasaweb.google.com/nuspspharmacy/WorldDiabetesDay

Today’s the actual day for WDD, and i would like to encourage everyone be aware of the risks of diabetes and lead a healthy lifestyle! Please read the previous entry on Dr Joyce Lee’s work and how she actually helped a diabetic patient!

WDD is celebrated every year on November 14, to mark the birthday of Frederick Banting who, along with Charles Best, first conceived the idea which led to the discovery of insulin in 1922. The World Diabetes Day campaign is led by the International Diabetes Federation (IDF) and its member associations. World Diabetes Day was created in 1991 by the International Diabetes Federation and the World Health Organization in response to growing concerns about the escalating health threat that diabetes now poses. 

Diabetes Education and Prevention is the World Diabetes Day theme for the period 2009-2013. The campaign slogan for 2009 is “Understand Diabetes and Take Control”. Diabetes is difficult. The disease imposes life-long demands on the 250 million people now living with diabetes and their families. People with diabetes must deliver 95% of their own care, so it is of paramount importance that they receive ongoing, high-quality diabetes education that is tailored to their needs and delivered by skilled health professionals. In addition, IDF estimates that over 300 million people worldwide are at risk for type 2 diabetes.Type 2 diabetes can be prevented in the many cases by helping and encouraging those at risk to maintain a healthy weight and take regular exercise. The key messages for everyone are:

Know the diabetes risks and know the warning signs
Know how to respond to diabetes and who to turn to
Know how to manage diabetes and take control

Let’s all work towards diabetes prevention!

Warmest Regards,
Valerie