1.Unlicensed and Off-labelled Use of Medicines among Adult Patients in Intensive Care Unit, Universiti Kebangsaan Malaysia Medical Centre
Malaysian Journal of Health Sciences 2019;17(1):17-20
The use of medicines in unlicensed and off-label manner for adults is less common with limited research compared to children. This research was carried out to characterise unlicensed and off-label use of medicines in adult intensive care patients of a hospital in Malaysia. Data on medications prescribed to patients were collected from the patients’ medical records and the unlicensed and off-label status for each medicine were determined. Forty nine (73.1%) and 20 (29.9%) patients from a total of 67 patients received at least one medicine in an unlicensed and off-label manner, respectively. The most common reason for off-label use of medicines was higher than the licensed dosing frequency (29.6%). The most common unlicensed and off-label medicine used was amlodipine tablet (5.8%) and IV metoclopromide (11.1%), respectively. Length of stay in the ICU was a significant predictor for unlicensed use of medicines (OR 1.219; 95% CI 1.022-1.456; p=0.028) and number of medication prescribed was a significant predictor for off-labelled use of medicines (OR 1.130; 95% CI 1.010-1.263; p=0.032). There was substantial prescribing of unlicensed medicines compared to off-label medicines in the adult ICU highlighting the need for more research to be carried out considering the critical condition of the patients.
2.Bleeding Risk Factors with Enoxaparin for Patients with NSTEMI/UA in HUKM
Noraida Mohamed Shah ; Azmi Sarriff ; Rosnani Hashim
Malaysian Journal of Health Sciences 2008;6(1):23-24
Low-molecular-weight heparins (LMWHs) are antithrombotic agents utilised in the treatment of acute coronary syndromes. They have been shown to be
more effective than unfractionated heparins (UFHs) in reducing ischeamic events, which include death, myocardial infarction (MI) and urgent revascularisation. Enoxaparin is one of the products of LMWHs. Its safety and
efficacy has been proven in the ESSENCE and TIMI IIB studies. This study was carried out to identify risk factors that may affect bleeding complications
associated with the use of enoxaparin for non-ST-elevation MI (NSTEMI) or unstable angina (UA) in Universiti Kebangsaan Malaysia Hospital (HUKM).
This observational, longitudinal study was conducted on patients who were admitted to the Coronary Care Unit (CCU), Coronary Rehabilitation Ward (CRW), Medical 1 and Medical 2 wards at HUKM and initiated on enoxaparin
for NSTEMI/UA from 22nd of March until 22nd of April 2004. A total of 40 patients were included in the study with median age of 65 years, male to female ratio of
3:1, diagnosed with NSTEMI (55%) and UA (45%). 45% of patients developed an episode of bleeding and among them 83.3% (15 patients) characterised by
haematuria. Higher percentages of women (80%) and those with creatinine clearance of < 30ml/min (100%) had incidence of bleeding as compared to
men (50%) and those with creatinine clearance ≥ 30 ml/min, respectively (p <0.05 for both parameters). Age, enoxaparin dose and duration of therapy,
smoking and concomitant aspirin/ticlopidine therapy did not significantly affect the incidence of bleeding. In conclusion, renal impairment and gender
were associated with bleeding in relation with the use of enoxaparin that may require dose adjustments.
3.Students’ perception of schooling in associations with externalizing/internalizing syndromes and truancy
Nik Ruzyanei Nik Jaafar ; Tuti Iryani Mohd ; Shamsul Azhar Shah ; Rozhan Shariff Mohamed Radzi ; Hatta Sid
ASEAN Journal of Psychiatry 2008;9(2):85-92
Objectives: To determine the association of students’ perception of schooling with externalizing/internalizing scores; and to examine the different perceptions related to truancy. Methods:
A total of 373 predominantly 16 year-old students attending three high risk schools in Pudu,
Kuala Lumpur completed the questionnaires on schooling variables (four items) and externalizing/internalizing syndromes (Youth Self-Report, 112 items). Results: Certain negative perceptions (uncertainty of the schooling purpose, thinking schooling as time wasting) were significantly associated with higher internalizing (p<0.05), externalizing (p<0.005) and total
problem (p<0.005) scores. Truants were significantly associated with disliking school
(OR=2.52, 95% CI=1.01-6.20), lower educational goals (OR=2.03, 95% CI=1.18-3.49) and
uncertainty of the schooling purpose (OR=3.14, 95% CI=1.47-6.67). Among truants, those
who thought schooling as time wasting scored significantly higher on externalizing (p<0.005)
and total problems (p<0.005). Conclusions: Certain negative perceptions of schooling are associated with self-reported emotional/behavioral problems and truancy. Positive schooling
experience may correct schooling misperceptions and solve related emotional and behavioural
problems.
4.Students’ perception of schooling in associations with externalizing/internalizing syndromes and truancy
Nik Ruzyanei Nik Jaafar ; Tuti Iryani Mohd ; Shamsul Azhar Shah ; Rozhan Shariff Mohamed Radzi ; Hatta Sidi
ASEAN Journal of Psychiatry 2007;8(1):85-92
Objectives: To determine the association of students’ perception of schooling with externalizing/
internalizing scores; and to examine the different perceptions related to truancy. Methods:
A total of 373 predominantly 16 year-old students attending three high risk schools in Pudu,
Kuala Lumpur completed the questionnaires on schooling variables (four items) and externalizing/
internalizing syndromes (Youth Self-Report, 112 items). Results: Certain negative perceptions
(uncertainty of the schooling purpose, thinking schooling as time wasting) were significantly
associated with higher internalizing (p<0.05), externalizing (p<0.005) and total
problem (p<0.005) scores. Truants were significantly associated with disliking school
(OR=2.52, 95% CI=1.01-6.20), lower educational goals (OR=2.03, 95% CI=1.18-3.49) and
uncertainty of the schooling purpose (OR=3.14, 95% CI=1.47-6.67). Among truants, those
who thought schooling as time wasting scored significantly higher on externalizing (p<0.005)
and total problems (p<0.005). Conclusions: Certain negative perceptions of schooling are associated
with self-reported emotional/behavioral problems and truancy. Positive schooling
experience may correct schooling misperceptions and solve related emotional and behavioural
problems.
5.Programmed intermittent epidural bolus as compared to continuous epidural infusion for the maintenance of labor analgesia: a prospective randomized single-blinded controlled trial
Christina W FIDKOWSKI ; Sonalee SHAH ; Mohamed Rida ALSADEN
Korean Journal of Anesthesiology 2019;72(5):472-478
BACKGROUND: Programmed intermittent epidural bolus (PIEB) techniques are a new area of interest for maintaining labor analgesia due to the potential to decrease motor block and improve labor analgesia. This study compares continuous epidural infusion (CEI) to 2 PIEB regimens for labor analgesia. METHODS: One hundred fifty patients undergoing scheduled induction of labor at term gestation having epidural labor analgesia were randomized to receive an epidural analgesia regimen of bupivacaine 0.125% with fentanyl 2 μg/ml at either PIEB 5 ml every 30 min (Group 5q30), PIEB 10 ml every 60 min (Group 10q60), or 10 ml/h continuous infusion (Group continuous epidural infusion [CEI]). The primary outcome is the pain scores throughout labor. Secondary outcomes include degree of motor block, dermatomal sensory levels, the number of physician-administered boluses, and patient satisfaction. RESULTS: While the average pain scores throughout labor did not differ significantly between groups, fewer patients in group 10q60 received physician-administered boluses for breakthrough pain (34.9% in 10q60 vs. 61.0% in 5q30 and 61.9% in CEI, P = 0.022). Dermatomal sensory levels, degree of motor block, and patient satisfaction did not differ significantly between groups. CONCLUSIONS: Our study suggests that high volume PIEB regimens for labor analgesia decrease breakthrough pain and physician-administered boluses.
Analgesia
;
Analgesia, Epidural
;
Breakthrough Pain
;
Bupivacaine
;
Fentanyl
;
Humans
;
Patient Satisfaction
;
Pregnancy
;
Prospective Studies
6.Value of Shock Index in Prognosticating The Short Term Outcome of Death for Patients Presenting With Severe Sepsis and Septic Shock in The Emergency Department
Shah Jahan Mohd Yussof ; Mohd Idzwan Zakaria ; Fatahul Laham Mohamed ; Mohamad Adam Bujang ; Sharmila Lakshmanan ; Abu Hassan Asaari
The Medical Journal of Malaysia 2012;67(4):406-411
Introduction: The importance of early recognition and
treatment of sepsis and its effects on short-term survival
outcome have long been recognized. Having reliable
indicators and markers that would help prognosticate the
survival of these patients is invaluable and would
subsequently assist in the course of effective dynamic
triaging and goal directed management.
Study Objectives: To determine the prognosticative value of
Shock Index (SI), taken upon arrival to the emergency
department and after 2 hours of resuscitation on the shortterm outcome of severe sepsis and septic shock patients.
Methodology: This is a retrospective observational study
involving 50 patients admitted to the University of Malaya
Medical Centre between June 2009 and June 2010 who have
been diagnosed with either severe sepsis or septic shock.
Patients were identified retrospectively from the details
recorded in the registration book of the resuscitation room. 50 patients were selected for this pilot study. The population comprised 19 males (38%) and 31 females (62%). The median (min, max) age was 54.5 (17.0, 84.0) years. The
number of severe sepsis and septic shock cases were 31
(62%), and 19 (38%) respectively. There were 17 (34%) cases
of pneumonias, 13 (26%) cases of urological sepsis, 8 (16%)
cases of gastro intestinal tract related infections and 12
(24%) cases of other infections. There were a total of 23
(46%) survivors and 27 (54%) deaths. The value of the shock
index is defined as systolic blood pressure divided by heart rate was calculated. Shock Index on presentation to ED (SI 1) and after 2 hours of resuscitation in the ED (SI 2). The median, minimum and maximum variables were tested using Mann-Whitney U and Chi square analysis. The significant parameters were re-evaluated for sensitivity, specificity and cut-off points. ROC curves and AUC values were generated among these variables to assess prognostic utility for outcome.
Results: Amongst all 7 variables tested, 2 were tested to be significant (p: < 0.05). From the sensitivity, specificity and ROC analysis, the best predictor for death was (SI 2) with a sensitivity of 80.8%, specificity of 79.2%, AUC value of 0.8894 [CI95 0.8052, 0.9736] at a cut-off point of ≥1.0.
Conclusion: (SI 2) may potentially be utilized as a reliable predictor for death in patients presenting with septic shock and severe sepsis in an emergency department. This parameters should be further analyzed in a larger scale prospective study to determine its validity.
7.A study on HLA-DR/DQ typing in adult Malay patients with acute amoebic liver abscess
Nazli Zainuddin ; Nurul Azira Mohd Shah ; Zeehaida Mohamed ; Nik Zairi Zakaria ; Nurul Khaiza Yahya ; Maya Mazuwin Yahya
The Medical Journal of Malaysia 2016;71(6):341-345
Introduction: Amoebiasis is a parasitic disease caused by
Entamoeba histolytica that may lead to death in developing
countries. Few important risk factors have been identified in
the development of amoebic liver abscess (ALA). There are
limited reports that suggest an association between
antigens of the major histocompatibility complex (MHC)
particularly class II antigens and ALA development. This
present work aimed at studying the possible association of
HLA antigens with ALA and disease severity. Results of the
study may serve as a guide for further immunological
studies dealing with E. histolytica.
Methods: This preliminary study involved two groups of
subjects: 20 ALA patients in the experimental group and 40
healthy individuals in the control group. Cases were
selected from adult Malay patients confirmed with ALA
based on clinical signs and symptoms, radiological findings,
microbiological findings and who were admitted to the
medical or surgical ward, Hospital USM, Kelantan. Venous
blood was obtained from each patient and HLA typing was
then conducted using polymerase chain reaction specific
primer sequence.
Results: HLA DR12 was most frequently found in the healthy
control and ALA groups at 40% and 55% respectively. HLA
DQ7 and DQ8 were found to have the highest percentage in
the ALA group at 65%. In the control group, HLA DQ8 (57.5%)
had the highest percentage.
Conclusion: HLA antigens play a role in acquisition of ALA
and provide understanding of the disease outcome.
8.HPV Positivity and its’ Influencing Factors among Invasive Cervical Cancer Women in Malaysia
Sharifa Ezat Wan Puteh ; Norin Rahayu Samsuddin ; Sharifah Noor Akmal Syed Hussain ; Shamsul Azhar ; Shah ; Syed Mohamed Aljunid
International Journal of Public Health Research 2011;1(1):13-22
Cervical cancer (CC) is the second most prevalent female cancer in Malaysia. Almost 70% of its’ causal factors are attributable to oncogenic human papillomavirus (HPV) types 16, 18 and other risk factors. HPV genotypes distributions are also noted to differ by geographical area. This was cross sectional study conducted in 2007, to determine the influencing factors of HPV positivity and prevalence of HPV infections among patients with cervical cancer in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Patients’ paraffin-embedded cervical tissues kept in the Pathology Department from 1999 to 2007 were randomly selected. A total of 81 medical records with complete information were chosen as samples and patients were contacted for consent. Tissue samples were further derived for PCR DNA for HPV genotyping. Analyses included descriptive statistics; bivariate χ2 test and correlation were used to determine relationship between factors and HPV positivity. Significance level of less than 0.05 was taken as statistically significant. Mean age of cancer diagnosis was at 52 ± 12.2 years. Women of Chinese ethnicity was the highest ethnicity to be HPV positive at 65.4% and squamous cell carcinoma was more commonly found (59.3%) compared with other types of cancers. The prevalence of HPV positivity was 92.6% with type 16 being the most common (74.1%), followed by type 33 (30.9%) and 18 (22.2%). Multiple HPV infections were a common finding at 54.3%. Factors thought to influence positivity i.e. age of intercourse, number of sexual partners, number of parity, smoking status of patients and their partners, oral contraceptive usage, presence of chronic illnesses and cancer stage were not significantly associated with HPV positivity. Increased CC severity level was not associated with increased number of HPV infections (Pearson correlation 0.58; p =0.607). High HPV positivity at 92.6% was found among ICC patients. Factors thought to influence HPV positivity were not significant. The top three HPV genotypes were type 16 followed by type 33 and 18. However, local women HPV serotypes findings need to be replicated in a larger population sample.
Papillomavirus Vaccines
;
Uterine Cervical Neoplasms
;
Genotype
9.Effectiveness of, and Satisfaction with, a Microsurgical Testicular Sperm Extraction Knowledge and Skills Masterclass for a World-Wide Audience
Walid El ANSARI ; Mohamed ARAFA ; Merilyn LOCK ; Rupin SHAH ; Ashok AGARWAL
The World Journal of Men's Health 2024;42(3):574-586
Purpose:
This is the first study to assess the impact of an online microsurgical testicular sperm extraction (mTESE) masterclass. We: 1) describe the masterclass’s scientific content; 2) appraise the participants’ acquisition of knowledge; 3) gauge whether the extent of improvement of the participants’ knowledge/skills was influenced by demographic/professional attributes; and 4) evaluate the participants’ satisfaction.
Materials and Methods:
This masterclass comprised five didactic lectures followed by 4 case discussions. Online surveys assessed the above objectives using a baseline questionnaire including demographics and past mTESE experience/training, a 24-question pre- and post-quiz, and a satisfaction questionnaire.
Results:
Participants were between 20–70 years old, with 80.37% males, mainly from Asia, Africa, and Europe, from clinical backgrounds (69.3%), and in public practice (64.4%). Half the sample reported no past mTESE training and very low skills, ≈60% wanted considerably more training, and 50% felt that good training was not readily available. Satisfaction was 98% to >99%. Pre- and post-quiz comparisons confirmed remarkable improvements in knowledge/skills, exhibiting five striking characteristics. Improvements were a) Broad i.e., across 19 of the 24 mTESE questions; b) Deep, of magnitude, as pre-/post-quiz scores improved from mean 13.71±4.13 to 17.06±4.73; c) Highly significant, consistently with p-values <0.001; d) Inclusive i.e., all participants enhanced their mTESE knowledge/skills regardless of demographic/professional attributes; and, e) Differential, e.g., non-clinical/clinical participants improved, but the former improved relatively significantly more, those with ≤5-year experience improved significantly more than those with >5-year, those in public practice significantly more than private practice participants, and those with lower self-rating in performing mTESE significantly more than those with higher self-rating.
Conclusions
The masterclass was successful with very high satisfaction levels, and markedly improved mTESE knowledge/skills among the participants. Global Andrology Forum’s model can be adopted by organizations with similar goals. Future research needs to evaluate such training to develop a practically non-existent evidence base.
10.Programmed intermittent epidural bolus as compared to continuous epidural infusion for the maintenance of labor analgesia: a prospective randomized single-blinded controlled trial
Christina W FIDKOWSKI ; Sonalee SHAH ; Mohamed Rida ALSADEN
Korean Journal of Anesthesiology 2019;72(5):472-478
BACKGROUND:
Programmed intermittent epidural bolus (PIEB) techniques are a new area of interest for maintaining labor analgesia due to the potential to decrease motor block and improve labor analgesia. This study compares continuous epidural infusion (CEI) to 2 PIEB regimens for labor analgesia.
METHODS:
One hundred fifty patients undergoing scheduled induction of labor at term gestation having epidural labor analgesia were randomized to receive an epidural analgesia regimen of bupivacaine 0.125% with fentanyl 2 μg/ml at either PIEB 5 ml every 30 min (Group 5q30), PIEB 10 ml every 60 min (Group 10q60), or 10 ml/h continuous infusion (Group continuous epidural infusion [CEI]). The primary outcome is the pain scores throughout labor. Secondary outcomes include degree of motor block, dermatomal sensory levels, the number of physician-administered boluses, and patient satisfaction.
RESULTS:
While the average pain scores throughout labor did not differ significantly between groups, fewer patients in group 10q60 received physician-administered boluses for breakthrough pain (34.9% in 10q60 vs. 61.0% in 5q30 and 61.9% in CEI, P = 0.022). Dermatomal sensory levels, degree of motor block, and patient satisfaction did not differ significantly between groups.
CONCLUSIONS
Our study suggests that high volume PIEB regimens for labor analgesia decrease breakthrough pain and physician-administered boluses.