TETRACYCLINE STAINING – A CASE REPORT

ABSTRACTTetracycline has been as an antibiotic since 1950s. One of its adverse effects is teeth discoloration. Restorative treatments could be performed to improve the esthetic of the patient. These include external bleaching, veneer and crown restorations. In this case report, veneer restoration was performed with minimal preparation to improve the esthetic.Keywords: Tetracycline, teeth discoloration, restorative, venee

Sodium-dietary intake, awareness and clinical outcomes in treated hypertensive patients

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EFFECT OF COMBINING LOSARTAN AND PERINDOPRIL IN DIABETIC PATIENTS WITH PROTEINURIA

  Objective: This retrospective study compared the efficacy and safety of losartan monotherapy versus losartan and perindopril combination therapy in diabetic patients with hypertension and albuminuria. Factors affecting the change in albuminuria were identified.Methods: Through quota sampling, the study recruited patients from a tertiary care hospital. Outcome parameters included urinary albumin creatinine ratio (UACR), blood pressure (BP), serum creatinine, and estimated glomerular filtration rate (eGFR). Both pre- and post-treatment measurements were traced from patient's medical records.Results: No significant differences (p=0.615) were detected in the pre- and post-treatment change in UACR between the monotherapy group (−38.3 mg/g, interquartile range [IQR]:−618.8-0) and combination therapy group (−88.4 mg/g, IQR: −729.3-+375.7). There was a considerably higher percentage of patients attaining the target BP of <125/75 mmHg in the combination group (66.7%; p<0.001). In terms of safety, combined losartan and perindopril caused more hypotension (p=0.003), higher rise in serum creatinine (p=0.481), and greater drop in eGFR (p=0.861). Body mass index was shown to have significant negative correlation with UACR reduction (r=−0.449; p=0.036).Conclusion: The main finding of this study was that losartan alone was as equally efficacious as combined losartan and perindopril in lowering UACR and BP among diabetic patients.Â

MANAGEMENT OF RHEUMATOID ARTHRITIS: SPECIAL CONSIDERATION FOR BIOLOGIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS

Rheumatoid arthritis (RA) is a progressive chronic inflammatory disease affecting 0.5–1.0% of the adult population worldwide. Due to the damages caused by this autoimmune disease, new biologic therapies, particularly the biologic disease-modifying antirheumatic drugs (bDMARDs), are now being the treatment of choice in the management of RA. However, special precaution and prescreening before the usage of bDMARDs are needed to ensure better clinical response and avoiding risk of adverse event during treatment with the selected bDMARDs. In this review paper, we will provide overview on the incidence and pathogenesis of the disease, available pharmacological treatment and emphasizing special consideration in need on initiation of bDMARDs among RA patients. A literature review was performed by searching for relevant articles in Medline database through PubMed using medical subject headings terms and keywords: RA, bDMARDs, special consideration, tumor necrosis factor inhibitor, and non-tumor necrosis factor inhibitor. All papers reviewed were from 1999 to 2017 and were written in English. In this article, use of conventional synthetic DMARDs (csDMARDs), bDMARDs and special consideration to be taken upon initiation of biologic therapies in RA will be reviewed

DIETARY SALT INTAKE: HISTORY, ASSESSMENT, AND BENEFIT IN HYPERTENSIVE TREATMENT

ABSTRACTMultiple lines of investigation including genetic, epidemiological, and interventional studies have demonstrated consistently a positive relationshipbetween salt intake, blood pressure (BP) increment, and cardiovascular consequences. In addition, it has been documented that excessive salt intakecan be attributed to various health complications such as asthma, osteoporosis, obesity, and gastric cancer. On the contrary, a reduction in salt intakehas been shown to reduce BP and improve health outcomes, although the evidence is not completely unequivocal. Despite this discrepancy, a lowsodiumdietis widelybeing recommendedtoall hypertensivepatients inparticular,as evidenceagainstits efficacy inconjunction with optimumhypertensivetreatmentiswellestablished.Determinationofsaltintakeamong hypertensivepatients is importantsince dietarysaltrestrictionhadbeenproventoimproveBP controlin conjunction with optimum pharmacological management.Variousmethodshavebeen used toestimatesodiumintakeincludes 24-hrsurinarysodium,overnighturinary sodium,spoturinary sodium/creatinineratio,and dietary surveymethods. Reducingpopulationsaltintakehas been proventobe beneficial, preventingmillionsofdeaths fromcardiovasculardiseaseandstroke,and reducingthe burdenonhealthservices.Manyindividualcountries aroundthe globehavealreadytakenaction againstreducingpopulationsaltintake.These strategieswereeither led bygovernment,nongovernmentorganizations,or industry.Keywords: Dietary sodium, Salt, Hypertension, Sodium measurement, Cost-effectiveness

Cardiovascular risks and primary interventions among treated rheumatoid arthritis patients: Experience from a tertiary care centre in Kuala Lumpur, Malaysia

Purpose: To investigate the cardiovascular risk among treated rheumatoid arthritis (RA) patients to predict the factors associated with high cardiovascular risk and to determine the presence of pharmacotherapy primary prevention among treated RA patients with high cardiovascular disease (CVD) risk.Methods: The study was a prospective cross-sectional study on adult patients diagnosed and treated for RA and without established heart disease/stroke. Cardiovascular risk scoring was based on Framingham Cardiovascular Disease 10-year risk prediction model (BMI model) x 1.5 factor while descriptive and inferential analyses were done using SPSS.Results: High CVD risk was defined as FRS-CVD cardiovascular risk categories (>20%) and 55.9% of patients were at high CVD risk. Use of Hydroxychloroquine (OR: 0.44; 95 % CI: 0.21- 0.92; p= 0.028) and COX-2 inhibitors (OR: 0.31; 95% CI:0.10- 0.95; p = 0.039) were found to be significantly associated with high CVD risk among treated RA patients. Significant number of high CVD risk patients did receive pharmacotherapy primary prevention (p = 0.001).Conclusion: Hydroxychloroquine and COX-2 inhibitors are independent negative risk predictors associated with high CVD risk among treated RA patients. Baseline cardiovascular risk data may be useful in rational use of medications to treat RA, considering that cardiovascular related mortality is the leading cause of death in RA

Drug-herb interactions : selected antihypertensive drugs with Moringa oleifera leaves extract

Moringa oleifera is a local plant which is commonly used in cooking and as a health supplement. It has been reported to possess blood pressure (BP) lowering effect and little is known about its possible interactions with cardiovascular drugs. This study looked into the possible drug-herb interactions between M. oleifera leaves extract and selected antihypertensive drugs. Ten groups of spontaneously hypertensive rats (SHRs) and one group of normotensive rats (NTs) were administered either M. oleifera extract alone, drugs alone or drugs in combination with M. oleifera extract for 14 days and BP of the rats were measured. Angiotensin converting enzyme (ACE) activity was also determined in vitro and ex vivo. Treated groups were found to produce significant BP reduction on day 15 when compared with the negative control but there was no significance difference when compared with positive controls (drugs alone). M. oleifera extract administered alone significantly reduced BP of SHRs on day 15 and this is comparable with the BP reduction observed when antihypertensive drugs were administered alone. However, no additive effect was observed when drugs were used in combination with M. oleifera extract. Similar results were seen in the in vitro and ex vivo ACE inhibitory activity of M. oleifera extract and enalapril. It can be concluded that there is a possibility of drug-herb interaction between M. oleifera extract and the selected antihypertensive drugs

Perceived barriers in providing cardiovascular diseases prevention services.

Perceived barriers in providing cardiovascular diseases prevention services.</p

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BackgroundCardiovascular disease (CVD) is a leading cause of death and disability worldwide, imposing a significant burden on patients and healthcare systems. The role of pharmacists in reducing cardiovascular disease (CVD) is pivotal as they play an essential part in the healthcare team, particularly in medication management and patient education. Pharmacists are well-positioned to contribute to the prevention and control of CVD through various roles, including medication management and patient education. This study aims to investigate the current involvement of community pharmacists in Malaysia, specifically in cardiovascular diseases-related health promotion activities and dyslipidemia management, including their perceived barriers.MethodThis cross-sectional survey was conducted among community pharmacists in all 14 states of Malaysia between November 2021 and July 2022. The self-administered survey was shared to relevant groups through various social media platforms.ResultsA total of 312 community pharmacists were involved in the survey. Majority of the respondents were females (66%), with a mean age (SD) of 32.9 (8.4) years. Most of the respondents showed satisfactory practice for patient counselling, but improvements are needed particularly in risk assessment and collaborative care aspect. Most of them expressed their interest for dyslipidemia management training (89.4%). Lack of access to medical records (71.2%) and lack of CVD-related educational materials (70.8%) were the two main perceived barriers identified.ConclusionCommunity pharmacists in Malaysia provide a satisfactory role in the provision of cardiovascular disease-related health promotion activities, especially in providing patient counselling. Strengthening collaborative care is essential for providing comprehensive and patient-centered intervention in dyslipidemia management. This requires ongoing efforts to address and overcome existing barriers for effective teamwork and coordination among healthcare professionals.</div