1.Colistin-associated nephrotoxicity among patients in intensive care units (ICU) of hospitals in Selangor
Rashizal Sazli Mohd Rasidin ; Ami Fazlin Syed Mohamed ; Wan Mazuan Wan Mahmud ; Ling Siew Mei ; Aidalina Mahmud ; Syafinaz Amin Nordin
The Medical Journal of Malaysia 2017;72(2):100-105
Introduction: The increasing trend of extensively drugresistant
gram negative bacteria responsible for nosocomial
infections has prompted resurgence colistin usage.
Colistin-induced nephrotoxicity is a concern with disparity
in the reported rates between previous studies. This study
aims to evaluate colistin-induced nephrotoxicity among
Malaysian population.
Methods: The medical records of ICU patients receiving
colistin therapy in Hospital Serdang and Hospital Sungai
Buloh from 2010 to 2012 were retrospectively reviewed.
Demographics data, treatment characteristic as well as
culture result and creatinine level were documented.
Nephrotoxicity was determined based on RIFLE criteria.
Results: A total of 100 patients were included. Median daily
dose, cumulative dose and duration of colistin therapy were
3.0 MIU (IQR: 4, range 1-12), 17.8 MIU (IQR: 31.5, range 2-180)
and seven days (IQR: 4, range 1-30). Nephrotoxicity was
found in 23% of the study population. All cases were
reversible but marginally associated with higher mortality.
No statistical association exist between age, gender and
race as well as administration routes with nephrotoxicity by
univariable analysis. The association of dose and duration
with nephrotoxicity was also not significant by univariable
analysis. After adjustment for confounders, statistical
association between the independent variables and
dependent variable remains not significant.
Conclusion: Lower dose and shorter duration in local
settings contribute to lack of association between colistin
therapy and nephrotoxicity in this study. Higher dosing
regimen with loading dose application has been introduced
in the latest National Antibiotic Guideline. Further
evaluation of colistin-induced nephrotoxicity and potential
risk factors is therefore warranted.
Colistin
;
Intensive Care Units
2.A summary of the Malaysian Clinical Practice Guidelines on the management of postmenopausal osteoporosis, 2022
Terence Ing WEI ONG ; Lee Ling LIM ; Siew Pheng CHAN ; Winnie Siew SWEE CHEE ; Alan Swee HOCK CH’NG ; Elizabeth GAR MIT CHONG ; Premitha DAMODARAN ; Fen Lee HEW ; Luqman bin IBRAHIM ; Hui Min KHOR ; Pauline Siew MEI LAI ; Joon Kiong LEE ; Ai Lee LIM ; Boon Ping LIM ; Sharmila Sunita PARAMASIVAM ; Jeyakantha RATNASINGAM ; Yew Siong SIOW ; Alexander Tong BOON TAN ; Nagammai THIAGARAJAN ; Swan Sim YEAP
Osteoporosis and Sarcopenia 2023;9(2):60-69
Objectives:
The aim of these Clinical Practice Guidelines is to provide evidence-based recommendations to assist healthcare providers in the screening, diagnosis and management of patients with postmenopausal osteoporosis (OP).
Methods:
A list of key clinical questions on the assessment, diagnosis and treatment of OP was formulated. A literature search using the PubMed, Medline, Cochrane Databases of Systematic Reviews, and OVID electronic databases identified all relevant articles on OP based on the key clinical questions, from 2014 onwards, to update from the 2015 edition. The articles were graded using the SIGN50 format. For each statement, studies with the highest level of evidence were used to frame the recommendation.
Results:
This article summarizes the diagnostic and treatment pathways for postmenopausal OP. Risk stratification of patients with OP encompasses clinical risk factors, bone mineral density measurements and FRAX risk estimates. Non-pharmacological measures including adequate calcium and vitamin D, regular exercise and falls prevention are recommended. Pharmacological measures depend on patients’ fracture risk status. Very high-risk individuals are recommended for treatment with an anabolic agent, if available, followed by an anti-resorptive agent. Alternatively, parenteral anti-resorptive agents can be used. High-risk individuals should be treated with anti-resorptive agents. In low-risk individuals, menopausal hormone replacement or selective estrogen receptor modulators can be used, if indicated. Patients should be assessed regularly to monitor treatment response and treatment adjusted, as appropriate.
Conclusions
The pathways for the management of postmenopausal OP in Malaysia have been updated. Incorporation of fracture risk stratification can guide appropriate treatment.