PARENTAL KNOWLEDGE, ATTITUDES AND PRACTICES (KAPs) ON THE USE OF ANTIBIOTICS IN CHILDREN FOR UPPER RESPIRATORY TRACT INFECTIONS (URTIs)

Objective: This study aimed to assess the knowledge, attitudes and practices (KAPs) of parents on the use of antibiotics among children for upper respiratory tract infections (URTIs).Methods: This cross-sectional study was conducted from September to November 2014 at kindergartens around Kuala Lumpur. Data were collected using questionnaires which were distributed to parents with children aged ≤ 6 y.Results: A total of 169 parents participated in this study. Parental knowledge on the use of antibiotics in children for URTI was poor with a mean score of 1.99+1.27 (total score = 5). The overall attitude was positive with a mean score of 23.01+6.17 (total score = 60). Gender, educational level, personal and household monthly incomes were significantly associated with both knowledge and attitudes (a total score of p<0.05). A moderate, significant negative correlation was found between knowledge score and attitude score (rs =-0.498, p<0.001).Conclusion: This study provides an insight towards parental KAPs on the use of antibiotics among children for URTIs. Improving parental KAPs may reduce the inappropriate use of antibiotics among children

ADHERENCE TO INSULIN TREATMENT IN CHILDREN WITH TYPE I DIABETES MELLITUS AT A HOSPITAL IN MALAYSIA

Objective: This study aimed to evaluate adherence to insulin treatment and identify factors that influence adherence in children with T1DM at a tertiary care hospital in Malaysia.Methods: Patients were identified from the pharmacy computer system based on the prescribed insulin therapy from 2010 to 2014. Medical records of screened patients were then retrieved from the medical record department. Adherence was assessed via the medication possession ratio (MPR) and glycated hemoglobin A1c value. Patients were classified as adherent or non-adherent if the MPR calculated for the prescribed insulin regimen was ≥80% or <80%, respectively. Patients with A1c values <7.5% based on medical records were also classified as adherent.Results: A total of 57 patients were included in this study, with a 57.9% male predominance and a mean age of 14.39 ± 3.41 years. Thirty-nine (68.4%) and three patients (5.3%) were classified as adherent to insulin treatment according to MPR and A1c values, respectively. Poor agreement between the MPR and A1c value in determining adherence was found based on kappa analysis (kappa = −0.108, p=0.009). There was no association between age, sex, race, presence of comorbidities, or duration of T1DM diagnosed and adherence based on the A1c value (p>0.05). These predictors were also found to be insignificant based on multiple logistic regression analysis (p>0.05).Conclusion: Adherence to insulin treatment based on the A1c measurement was generally poor among children with T1DM. Further prospective research should be performed in this area to identify reasons for the non-adherence to insulin treatment so that appropriate interventions can be instituted to improve adherence and ultimately prevent complications from the disease.Â

Intravenous immunoglobulin therapy among pediatric patients: labeled and off-labeled indications

This study was designed to evaluate utilization patterns and clinical outcome of intravenous immunoglobulin (IVIG) therapy among pediatric patients in a tertiary hospital. Demographic data, IVIG prescribed, and clinical outcome were retrospectively reviewed from the pharmacy dispensing data and patient medical records between 2007 and 2014. One hundred and fifteen instances of IVIG administration to 108 pediatric patients were recorded. A total of 61 cases (53%) and 54 cases (47%) of the IVIG administered were for labeled and off-labeled indications, respectively. Age, weight, specialty, total IVIG usage, length of hospital stays, and mortality rate were found to be significantly associated with the indication being labeled or off-labeled (p;0.05). Guidelines should be developed and implemented for rational and evidence-based use of IVIG to avoid unnecessary wastage

A REVIEW OF ANTIBIOTIC USED IN SUSPECTED EARLY-ONSET NEONATAL SEPSIS FROM MALAYSIAN PERSPECTIVE: WHICH ONES TO CHOOSE AND HOW LONG TO GIVE?

Objective: Suspected early-onset sepsis is a common diagnosis among neonates which warrants admission to the neonatal intensive care unit. Prolonged empiric antibiotic is the biggest concern and treatment duration is still controversial. Antimicrobial stewardship (AMS) program promotes early antibiotic de-escalation to reduce unnecessary antibiotic exposure and its implementation in the intensive care setting seems to be feasible. The primary objective of this review was to compare the existing guidelines and review the literature regarding choice and duration of empiric antibiotic in managing suspected early-onset neonatal sepsis.Methods: Two Malaysian Ministry of Health guidelines were compared with guidelines from America (n=1), Australia (n=1), and United Kingdom (n=2). The literature search was conducted from January to June 2017 through open access journal and databases available at the author's institution library (EBSCOHost, Ovid and Science Direct).Results: All guidelines recommended similar antibiotics range and suggested to review treatment at 36– 72 h post antibiotic exposure. A total of 113 abstracts and full articles were identified, and only 11 full-text articles published in English were related to the subject of interest. All studies show differences either in study design, choice of antibiotics, treatment duration or outcome measures; thus, a meta-analysis was not possible to be conducted.Conclusion: From this review, we found the potential to performed early empiric antibiotic de-escalation especially in clinically well-appearance neonates, and it is best to customize our guidelines based on local evidence which justify the need for more local research in this area

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

Knowledge and perception of breast cancer and its treatment among Malaysian women: Role of religion

Purpose: To investigate the association between religiosity, perceptions, and knowledge of breast cancer and its treatment among women in Malaysia.Methods: Knowledge and perceptions of breast cancer and its treatment were determined via a questionnaire adapted from previous studies. The Duke Religion Index was used to measure participants’ religiosity. The questionnaires were distributed among women in public areas in Kuala Lumpur.Results: A total of 384 women participated in this study. Non-organisational religious activity (NORA; r = -0.113, p < 0.05) and intrinsic religiosity (IR; r = -0.183, p < 0.01) were significantly negatively correlated with knowledge of breast cancer. NORA (r = 0.115, p < 0.05) and IR (r = 0.229, p < 0.01) were positively, significantly correlated with the perception that patients who underwent treatment for breast cancer can enjoy good quality of life. There was also a significant positive correlation between NORA (r = 0.175, p < 0.05) and IR (r = 0.249, p < 0.01) on the statement that spiritual support improves treatment for breast cancer. IR was the only subscale positively, significantly associated with the perception of choosing breast-conserving surgery as a primary treatment choice (r = -0.111, p < 0.05) and dietary therapies (r = 0.126, p < 0.05) or acupuncture (r = 0.120, p < 0.05) as alternative treatments for breast cancer.Conclusion: Religiosity should be considered in improving women’s knowledge and perceptions of breast cancer and its treatment.Keywords: Breast cancer, Knowledge, Perceptions, Religiosit

Bleeding risk factors with enoxaparin for patients with NSTEMI/UA in HUKM

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 e v e n t s , w h i c h i n c l u d e d e a t h , my o c a r d i a l i n f a r c t i o n (MI) a n d u r g e n t 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 22 nd of March until 22 nd 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

Intravenous immunoglobulin therapy among pediatric patients: labeled and off-labeled indications

ABSTRACT This study was designed to evaluate utilization patterns and clinical outcome of intravenous immunoglobulin (IVIG) therapy among pediatric patients in a tertiary hospital. Demographic data, IVIG prescribed, and clinical outcome were retrospectively reviewed from the pharmacy dispensing data and patient medical records between 2007 and 2014. One hundred and fifteen instances of IVIG administration to 108 pediatric patients were recorded. A total of 61 cases (53%) and 54 cases (47%) of the IVIG administered were for labeled and off-labeled indications, respectively. Age, weight, specialty, total IVIG usage, length of hospital stays, and mortality rate were found to be significantly associated with the indication being labeled or off-labeled (p0.05). Guidelines should be developed and implemented for rational and evidence-based use of IVIG to avoid unnecessary wastage

Intravenous immunoglobulin therapy among pediatric patients: labeled and off-labeled indications

<div><p>ABSTRACT This study was designed to evaluate utilization patterns and clinical outcome of intravenous immunoglobulin (IVIG) therapy among pediatric patients in a tertiary hospital. Demographic data, IVIG prescribed, and clinical outcome were retrospectively reviewed from the pharmacy dispensing data and patient medical records between 2007 and 2014. One hundred and fifteen instances of IVIG administration to 108 pediatric patients were recorded. A total of 61 cases (53%) and 54 cases (47%) of the IVIG administered were for labeled and off-labeled indications, respectively. Age, weight, specialty, total IVIG usage, length of hospital stays, and mortality rate were found to be significantly associated with the indication being labeled or off-labeled (p<0.05). However, there was no significant difference in terms of adverse reactions between labeled and off-labeled indications (p>0.05). Guidelines should be developed and implemented for rational and evidence-based use of IVIG to avoid unnecessary wastage.</p></div

Penggunaan ubat-ubatan tidak berlesen dan luar label di kalangan pesakit dewasa di Unit Rawatan Rapi, Pusat Perubatan Universiti Kebangsaan Malaysia

Penggunaan ubat-ubatan tidak berlesen dan luar label di kalangan orang dewasa jarang dilaporkan dengan penyelidikan yang lebih terhad berbanding kanak-kanak. Kajian ini dijalankan untuk mencirikan penggunaan ubat-ubatan tidak berlesen dan luar label di kalangan pesakit dewasa unit rawatan rapi (ICU) di Pusat Perubatan Universiti Kebangsaan Malaysia. Data berkaitan ubat-ubatan yang dipreskrib kepada pesakit-pesakit dikumpulkan dari rekod perubatan pesakit dan klasifikasi setiap ubat sama ada tidak berlesen atau luar label ditetapkan. Seramai 49 (73.1%) dan 20 (29.9%) pesakit daripada sejumlah 67 pesakit menerima sekurang-kurangnya satu ubat tidak berlesen atau luar label, setiap satunya. Sebab utama penggunaan ubat luar label adalah frekuensi pendosan yang lebih tinggi berbanding frekuensi pendosan yang dilesenkan (29.6%). Penggunaan ubat tanpa lesen dan luar label yang paling kerap masing-masing adalah tablet amlodipine (5.8%) dan injeksi metoclopromide (11.1%). Tempoh penginapan di ICU merupakan prediktor yang signifikan untuk penggunaan ubat-ubatan tanpa lesen (OR 1.219; 95% CI 1.022-1.456; p = 0.028), manakala bilangan ubat-ubatan yang dipreskrib merupakan prediktor yang signifikan untuk penggunaan ubat-ubatan luar label (OR 1.130; 95% CI 1.010-1.263; p = 0.032). Penggunaan ubat-ubatan tidak berlesen yang lebih kerap berbanding ubat-ubatan luar label di kalangan pesakit dewasa di ICU menunjukkan perlunya lebih banyak penyelidikan dijalankan memandangkan keadaan pesakit yang kritikal