Introduction: This study aimed to develop an innovative bilayer tablet formulation of dapagliflozin and vildagliptin to increase therapeutic outcomes and patient compliance in diabetes management. Methods: By employing wet granulation, immediate-release, and sustained-release layers were formulated using various super-disintegrating and release-retarding agents, respectively. Several pre-compression parameters were utilized, such as Carr’s index, Hausner ratio, physical attributes (weight variations, friability, hardness), and disintegration time. Drug-excipient interactions were determined through employing FTIR, SEM, DSC, and TGA. In-vitro dissolution studies were performed to assess the release kinetics of these formulations. Results: For immediate-release dapagliflozin, our earlier study demonstrated that the formulations showed Carr’s index (23.5-33.3), physical attributes (weight (145–155 mg), thickness (4.42 ± 0.04 -4.46 ± 0.05 mm), hardness (3.7-5.6 kg/cm2), friability (<1%), and optimized rapid dissolution (F1: 80.50% ± 5.2 in 30 minutes). For sustained-release vildagliptin, the formulations showed Carr’s index (10.48-20), physical attributes (weight (194-203 mg), thickness (3.32 ± 0.06-3.33±0.04 mm), hardness (4.8 ± 0.1-7.6 ± 0.2 kg/cm2), friability (<1%)), and optimized controlled release (A5: 81.76% ± 2.4 in 360 minutes). The results found that F1 and A5 were the optimum formulation for the immediate release of dapagliflozin, and the sustained release of vildagliptin, respectively, and BT-1 was the optimum bilayer tablet because of its rapid onset of action for dapagliflozin (84.23% within 60 minutes) and sustained release for vildagliptin (80.026% within 360 minutes). Conclusion: Based on these data, the optimized bilayer tablet holds the potential to be a convenient and effective treatment option. Further, in-vivo assays are necessary to confirm its efficacy and safety.

Visual Status of Private Vehicle Drivers in Klang Valley, Malaysia Introduction Vision play an important role during driving and many driving related injuries have been connected with visual problems. However, there is little information in profiling visual status among private vehicle drivers in rural area of Malaysia. The aim of this study is to determine visual function and binocular function status among private vehicle drivers in Klang Valley, Malaysia Methods A descriptive cross-sectional study was conducted in the major towns within the Klang Valley of Malaysia. Participants were taken through a comprehensive eye examination after the administration of a structured questionnaire Results Fifty private vehicle drivers (52% males and 48% females) participated in this study with mean age of 26±7 year. The mean of visual acuity and contrast sensitivity is 0.03±0.1 logMAR and 0.2±0.1 at 2.5% respectively. This study also found 2% of subject with colour deficiency and 4% of subjects had constricted visual field. The mean value for amplitude of accommodation, facility of accommodation, and stereopsis is 10.16±2.11 D, 8±1 cycle per minute (cpm), and 46 second of arc respectively. Based on chi square test, there is a significant association (p=0.018) between reduced binocular vision function and history of road traffic accident (RTA). Conclusions Fifty private vehicle drivers (52% males and 48% females) participated in this study with mean age of 26±7 year. The mean of visual acuity and contrast sensitivity is 0.03±0.1 logMAR and 0.2±0.1 at 2.5% respectively. This study also found 2% of subject with colour deficiency and 4% of subjects had constricted visual field. The mean value for amplitude of accommodation, facility of accommodation, and stereopsis is 10.16±2.11 D, 8±1 cycle per minute (cpm), and 46 second of arc respectively. Based on chi square test, there is a significant association (p=0.018) between reduced binocular vision function and history of road traffic accident (RTA).

Introduction: Emergency contraception (EC) is an important method for preventing unintended pregnancies. By being knowledgeable and readily available to dispense this medication, pharmacists play a crucial role in preventing unintended pregnancies, which can have significant social, economic, and health repercussions. This study aimed to assess the knowledge and perception of EC among undergraduate pharmacy students in Malaysia, examining the socio-demographic factors associated with these dependent variables. Materials and methods: A cross-sectional study was conducted among 355 pharmacy students from 20 institutions offering a Bachelor of Pharmacy (Hons.) program. The data was collected from April to June 2022. The questionnaire was formatted as a web-based questionnaire consisting of 33 questions divided into three sections. Independent t-test and one-way ANOVA was used to compare the means in student’s knowledge and perception. Chi-square test was used to identify the association between the demographic variables and the knowledge and perception. Results: Three hundred and fifty-five students participated in the survey. Participants' mean (SD) knowledge score was 5.31(2.94) of 10 items. Factors affecting the mean knowledge of participants include academic year (P<0.001), institution type (P<0.001), race (P<0.001), religion (P<0.001), residence area (P=0.013), and prior knowledge of EC (P<0.001). The mean (SD) score of perception was 36.8 (4.9) from 50. Most of the students had an average perception of EC. Conclusion: The findings indicate that the majority of students held average perceptions but lacked sufficient knowledge about EC, highlighting the need to address these knowledge gaps for the development of an effective educational program.

Problem: In September 2024, an illegal toxic waste dumping incident along the Tebrau River in Johor State, Malaysia, raised widespread health concerns in Johor Bahru and Kulai districts. The pollution released a strong, unpleasant odour, resulting in acute symptoms among exposed individuals, including sore throat, dizziness and coughing. Context: The Tebrau River is a vital waterway supporting urban populations in Johor. This was not the first chemical pollution event in the region, as previous incidents, including the Kim Kim River crisis in 2019, highlighted the region’s vulnerability to such events. The involvement of multiple districts and agencies during the response presented challenges in coordination and data sharing. Action: The Johor Bahru District Health Office promptly deployed a rapid assessment team to assess the affected areas and implement both active and passive case detection. Community engagement targeted vulnerable populations, such as schoolchildren, to minimize exposure risks. Additional dumping sites identified along the Tebrau River prompted expanded surveillance and a state-level response to coordinate efforts across districts and all health-care facilities. Outcome: A total of 484 individuals were exposed to the pollution, 334 of whom developed symptoms related to chemical exposure. Timely public health actions consisted of actions to mitigate the impact. Health facilities were placed on high alert and community trust was maintained through proactive engagement. However, gaps in cross-district coordination and challenges accessing environmental data underscored areas for improvement. Discussion: This incident highlighted the importance of rapid assessment, cross-sector collaboration, community engagement and integrated data systems. It also showed that effective public health action is possible despite environmental data limitations. The strengthening of communication, standardized protocols and real-time data sharing will be critical to improving future chemical pollution events.

Cabaran Dalam Pencegahan dan Kawalan Plasmodium Knowlesi Malaria Di Rantau Asia Tenggara – Ulasan Naratif PengenalanDi sebalik kejayaan program penghapusan malaria manusia, terdapat peningkatan yang membimbangkan berkenaan jangkitan malaria Plasmodium knowlesi (P. knowlesi) di rantau Asia Tenggara. Pemahaman menyeluruh tentang cabaran dalam mencegah dan mengawal malaria zoonosis ini mesti diutarakan, terutamanya apabila menentukan strategi paling berkesan untuk menyekat penularan penyakit.MetodologiDi sebalik kejayaan program penghapusan malaria manusia, terdapat peningkatan yang membimbangkan berkenaan jangkitan malaria Plasmodium knowlesi (P. knowlesi) di rantau Asia Tenggara. Pemahaman menyeluruh tentang cabaran dalam mencegah dan mengawal malaria zoonosis ini mesti diutarakan, terutamanya apabila menentukan strategi paling berkesan untuk menyekat penularan penyakit.Hasil KajianKepelbagaian manusia, seperti sosioekonomi dan sosiobudaya tempatan yang majmuk, persepsi yang rendah dan pematuhan optimum terhadap langkah-langkah pencegahan dan kawalan perlu ditangani. Isu dana nasional, pelaksanaan program, dan birokrasi mesti diselesaikan dalam memastikan keberkesanan peranan kerajaan dan kerjasama pelbagai sektor apabila melibatkan pengurusan penyakit malaria. Kejayaan sesuatu program akan terhalang sekiranya tiada sokongan daripada pemimpin masyarakat dan bertentangan dengan dinamik sosial. Kebolehsuaian nyamuk Anopheles bertanggungjawab terutamanya terhadap cabaran yang dihadapi dalam kawalan vektor. Kesan anjakan ekologi dan perubahan iklim, ditambah dengan aktiviti antropogenik mewujudkan limpahan zoonosis dan variasi penyesuaian yang mengubah landskap transmisi sylvian dan manusia.KesimpulanCabaran daripada pelbagai faktor mengurangkan keberkesanan dalam mencegah penularan penyakit ini. Pendekatan baharu mesti dibangunkan untuk mencapai kawasan terjejas dengan intervensi jangka panjang, komprehensif dan berkesan.

Gema Ekologi: Meneroka Interaksi Antara Persekitaran Hutan dan Vektor Malaria Pendahuluan Malaria kekal sebagai salah satu cabaran kesihatan awam yang penting di seluruh dunia, dengan kemajuan telah terbantut dalam kebelakangan ini. Memandangkan peningkatan kes malaria terutamanya di beberapa kawasan tropika, pemahaman yang lebih baik tentang hubungan ekologi yang mendasari penularan vektor malaria perlu diberikan fokus. Pendekatan pelbagai disiplin yang melibatkan ekologi, entomologi dan kesihatan awam adalah diperlukanuntuk memahami kaitan antara malaria dan habitat persekitaran. Ulasan ini bertujuan untuk mensintesis penyelidikan sedia ada tentang bagaimana ekosistem hutan mempengaruhi dinamik penularan malaria.MetodologiMenggunakan pangkalandata PubMed, Google Scholar dan Scopus, kajian literatur komprehensif telah dijalankan menggunakan kata kunci tertentu. Artikel yang berkaitan telah dinilai untuk aliran tematik. Secara keseluruhan, 42 artikel telah dipilih untuk naratif ini.Hasil Iklim mikro hutan mempengaruhi kecergasan, tingkah laku, corak aktiviti dan fisiologi organisma. Relung biologiberbeza yang disebabkanoleh suhu, kelembapan, pendedahan cahaya dan kerpasan boleh memberi kesan kepada populasi nyamuk. Ciri-ciri fiziko-biokimia badan air, termasuk suhu, pH, jumlah pepejal terlarut (TDS), kandungan nitrat, dan paras oksigen terlarut, mempunyai kesan yang ketara ke atas banyaknya larva nyamuk anopheline. Kelimpahan vektor mungkin dipengaruhi oleh kehadiran perumah dan pemangsa semulajadi. Interaksi rumit geografi, tumbuh-tumbuhan hutan, kepadatan vektor malaria, dan tingkah laku mempunyai pengaruh besar ke atas dinamik penularan malaria. Penebangan hutan mengubah landskap dan ekosistem serpihan, yang mempunyai kesan besar ke atas habitat larva vektor Plasmodium. Perubahan iklim menimbulkan ancaman besar kepada kelimpahan vektor malaria dan dinamik penghantaran.KesimpulanTerdapat banyak aspek kepada interaksi kompleks antara persekitaran hutan dan penyebaran malaria,memerlukan pengetahuan yang mendalam dan lebih banyak penyiasatan. Kerjasama antara ahli ekologi, entomologi dan pakar kesihatan awam adalah penting dalam menghasilkan model komprehensif yang meramalkan risiko malaria dengan tepat dalam persekitaran yang berubah-ubah

Medication review is an intervention with the potential to reduce drug-related problems (DRPs) in the elderly. This study aimed to determine the effect of pharmacists’ medication reviews on geriatric patients. This study accessed two online databases, MEDLINE Complete and Scopus, and examined all studies published in English between 2019 and 2023, except for reviews. The studies included (1) participants over 65 years of age and (2) medication reviews conducted by pharmacists. The titles, abstracts, and full texts were reviewed for data extraction to determine whether the studies satisfied the inclusion and exclusion criteria. Forty-four of the initial 709 articles were included in this study. The articles included discussions on the incidence rates of DRPs and potentially inappropriate medications (PIMs) (n=21), hospitalization (n=14), medication adherence (n=9), quality of life (QoL) (n=8), and falls (n=7). Pharmacist medication reviews were associated with a reduced incidence of DRPs and PIMs, and improved adherence to medications. Patients’ overall QoL is also increasing. However, pharmacist medication reviews were not strongly associated with decreased hospitalization or falls. A pharmacist’s medication review may be a feasible intervention for reducing the incidence rates of DRPs and PIMs, regardless of whether it is performed as a sole intervention or supplemented with other interventions. The intervention was also effective in increasing medication adherence and QoL.

Introduction: Haze imposes a substantial health burden especially in Southeast Asia where occurrences are frequent. Reduction in air quality levels has resulted in an increase in healthcare utilization, especially to the front door of healthcare, the emergency department (ED). Data on ED utilization during haze period is lacking. Methods: This is a retrospective study aimed to determine the association between haze and ED utilization of haze-related acute respiratory illnesses between April 2013 to September 2013. The study period was divided into haze/ non-haze period. Clinical data was collected from the registration book and patients’ case notes. Environmental data was obtained from Institute of Environment and Development Universiti Kebangsaan Malaysia. Results: Total number of patients presented to ED during the study was 32,661. Fifteen percent (n= 5177) presented with acute respiratory symptoms. Total Emergency Department visits during haze period reduced due to emergency declaration, hence reducing non-emergency visits. However, there was a significant increase in hospital admission (p=0.0015) and infective respiratory illnesses (p=0.001) during haze which correlates with increase air pollutant. Patients with chronic respiratory illnesses were more affected by haze (p = 0.001). PM10 and ozone were the main pollutant during the haze period. Conclusion Increasing pollutant levels from the haze significantly increases ED hospital admission. Evidence from this study can influence policymakers to prepare and allocate resources to hospitals in response to haze-related illnesses.

Introduction: Tuberculosis (TB) patients default their treatment during the treatment course. Therefore, this study aims to analyze the demographic characteristics of the patient who missed follow-ups and identify the reasons for missed appointments or defaulted their treatment. Methods: The records of patients diagnosed with TB follow-up at the chest clinic from January to June 2023 were reviewed based on our inclusion and exclusion criteria. Results: The retrospective descriptive analysis was conducted based on the data collected. Based on the study sample (n=33), the result shows that the majority of the defaulted patients were male in gender (n=22). Most of the missed appointments patients and defaulters are of Malay (39.4%) ethnicity and Malaysian nationality (66.7%). Most patients gave the transport issues as the reason for missed appointments followed by financial issues and feeling healthy. The majority of them missed follow-up in the first month after starting anti-TB. Conclusions In conclusion, missed appointments, treatment compliance and defaulted cases in TB treatment remain as one of the main challenges in the effort to end TB epidemics. Further in-depth research is required to propose effective measures to solve this issue and improve the national TB control program.