Interrelationship between Heliobacter pylori and P-glycoprotein: potential role in drug resistance and carcinogenicity

The association between P-glycoprotein and Helicobacter pylori infection was explored. We found that P-glycoprotein expression is induced by H. pylori in the upper gastrointestinal tract and influenced by the genetic polymorphism. Further, reduce P-glycoprotein expression is associated with increased attachment of the bacteria to epithelial cells. Our results support the hypotheses that high levels of P-glycoprotein expression are protective against gastric cancer and may play a role in H.pylori eradication

Practice of dietary supplements and its influence towards treatment adherence among chronic disease patients

Introduction The use of dietary supplements had risen over the years among chronic disease patients with most of it were of patients' own initiative. This study aimed to describe the supplements use, assess the knowledge and attitude towards supplements and its interaction with prescribed medication, and determine whether knowledge and attitude towards supplements could influence treatment adherence in chronic disease patients. Methods A cross-sectional study was conducted among chronic disease patients in Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur from September to November 2016 upon their written informed consent. This study consists of a collection of validated instruments that measured the use of dietary supplements and its reason; the knowledge and attitude on dietary supplements and supplements-drug interaction and medication adherence. Results A total number of 250 respondents were interviewed and 72.4% was found to use supplements of own initiatives. Most of the respondents were using supplements to maintain health (78.8%), prevent health problems (72.4%) and improve overall health (63.2%). It was found that respondents' knowledge on supplement-drug interactions were not at the satisfactory level. The treatment adherence was found not to be associated with knowledge and attitude towards supplements nor numbers of supplements use. Conclusions Chronic disease patients mainly knew on the purpose of supplements for health and wellness, but had less knowledge on supplement-drug interactions, warranting patients' education on that particular field

LONG TERM USE OF LITHIUM AND FACTORS ASSOCIATED WITH TREATMENT RESPONSE AMONG PATIENTS WITH BIPOLAR DISORDER

Background: Lithium has been the gold standard in treating bipolar disorder. In recent years, the use of lithium seems to be diminished although it is well tolerated among the bipolar disorder patients. Subjects and methods: This study aimed to evaluate the efficacy and tolerability of lithium as well as to determine factors associated with lithium response among patient with bipolar disorder. A retrospective study was done in a tertiary care hospital in Malaysia which included 47 bipolar disorder patients that were prescribed with lithium maintenance therapy in the time frame of January 2009 until December 2013. Results: Of all the baseline characteristics tested, only psychotic feature differentiated lithium monotherapy group and combination therapy group significantly (χ2=4.732, p=0.03). When compared to period before lithium maintenance, all outcome measures (i.e. annual relapse rate, proportion time spent ill and duration of mood episode) showed significant improvement after lithium maintenance in both treatment groups. Lithium discontinuation only occurred in five cases of adverse effects. Predominant depressive mood episode before lithium maintenance (OR=0.159, p=0.033) and first euthymic interval after lithium maintenance (OR=1.109, p=0.047) significantly predicted lithium response. Discussion: Lithium significantly reduced the frequency and time spent in relapse in patients with bipolar disorder. Predominant depressive mood polarity before lithium maintenance and longer first euthymic interval after lithium maintenance had been identified to predict lithium response significantly

Green tea (Camellia sinensis) extract reduces peptic ulcer induced by Helicobacter pylori in sprague dawley rats

The study was conducted to evaluate the anti-peptic ulcer activity of ethanol extract of Camellia sinensis (green tea) induced by Helicobacter pylori in Sprague Dawley rats. The standard regimen of anti-peptic ulcer agents, clarithromycin 30 mg/kg, amoxicillin 30 mg/kg and esomeprazole 3 mg/kg used as the positive control. The rats divided into 6 groups (n = 6), normal control, vehicle control (2% of tragacanth suspension), positive control for preventive and treatment groups, preventive and treatment groups were given 50 mg/kg orally of green tea extract for 14 days before and after inoculation (as prevention and treatment, respectively) with 5×108 CFU/mL H. pylori suspension orally twice daily for 7 days. Anti-peptic ulcer activity was evaluated based on the pH of gastric juice, ulcer score and body weight of rats. The results demonstrated that the use of green tea for prevention or treatment showed a significant difference (p<0.001) in reducing the pH of gastric juice 3.88 ± 0.09 and 5.74 ± 0.08, respectively, compared to vehicle control 5.85 ± 0.12. Meanwhile, vehicle control rats had high significantly reduced body weight when compared with all groups treated. The preventive and the treatment groups showed significantly reduce in ulcer score to 0.50 ± 0.18 (p<0.01) and 0.83 ± 0.10 (p<0.05), respectively, compared to vehicle control 1.50 ± 0.22. Meanwhile, it was comparable to the positive control. In conclusion, H. pylori suspension 5×108 CFU/mL given orally twice daily for seven days able to induce ulcer in Sprague Dawley rats, and the green tea extract 50 mg/kg was comparable to the standard regimen as anti-peptic ulcer agent

The willingness of community pharmacists in collaborative care of frail elderly in nursing homes

An increase in the number of residents in nursing homes has become a significant concern due to the rise in medication demand and subsequently medicationrelated issues, especially in frail elderly. Community pharmacists are the closest healthcare professionals available that can contribute to this population to allow optimal utilization of the prescribed drugs and to prevent drug-related problems. The present study aimed to investigate the awareness of community pharmacists on issues regarding frail elderly and to determine their willingness in collaborative care of frail elderly in nursing homes and the services they are willing to offer. This was a cross-sectional study utilising a set of questionnaire that was delivered to practicing community pharmacists in Peninsular Malaysia from June 2018 until December 2018. Majority of the participants agreed to the fact that aging is the primary cause of frailty (n=98, 88.3%), and that chronic disease is also a cause of frailty (n=96, 86.5%). Most of the community pharmacists were also keen to participate in the collaborative care of frail elderly, and were willing to provide their pharmacy service to the frail elderly. There was a positive correlation between the awareness of community pharmacists on issues regarding frail elderly and their willingness on collaborative care of frail elderly in nursing homes (r=0.374, n=111, p=0.01). Majority of the pharmacists were aware of the issues regarding the frail elderly, and were willing to participate in the collaborative care of frail elderly in nursing home

Current practice and determinants of medication management in long-term care facilities

Background: Medication management is a complex process which involves different phases including prescribing, transcribing, ordering, dispensing, supplying, administering, and storing. This study aimed to assess the medication adherence and its barriers among the residents in long-term care facilities to identify residents who are at risk for medication-related problem and resident`s beliefs toward medication. Methods: A prospective cross-sectional study was conducted in 24 long-term care facilities in Malaysia. The Chi-square test was performed to see any association between the adherence level and medication beliefs. Results: A total number of 185 residents were interviewed and majority of the residents were identified as highly adherent to their medication. There was a significant association found between duration of disease and medication adherence (P = 0.002). With regards to their belief toward medication, most of the residents had weak necessity scores (mean = 16.85, standard deviation [SD] = ±3.41) and strong concern scores (mean = 13.91. SD = ±2.684). There was a significant association between medication beliefs and medication adherence (P = 0.007), and a high number of residents were identified as at high risk for medication-related problems. Conclusion: Residents′ risk for medication-related problems and their overall well-being should be emphasized and related actions should be taken to rectify the problems

Polypharmacy and Willingness to Deprescribe Among Elderly with Chronic Diseases

Summary: Background: Elderly are mostly affected by polypharmacy induced adverse drug events as they are vulnerable due to numerous comorbidities. Deprescribing is a series of medicine ceasing process introduced to solve the problem arisen from polypharmacy. This study aimed to investigate the attitudes, beliefs and experiences towards polypharmacy among elderly with chronic diseases and their willingness to be deprescribed. Methods: A cross-sectional study was conducted among elderly patients in a tertiary hospital in Malaysia from August 2017 to October 2017 using a researcher assisted and validated questionnaire. Results: A total number of 222 elderly patients were included in this study. 45.5% (n = 101) of the participants agreed that they were taking a large number of medicines (95% CI = 38.89%–52.10%). 56.3% (n = 125) of the participants had the desire to reduce their number of medications (95% CI = 49.73%–62.88%). Majority of them (n = 185, 83.33%) agreed to involve themselves in deprescribing process if permitted by their health care provider. 86.9% (n = 193) of the participants tended to not be afraid of deprescribing of their regular medications after a series of investigations by their health care provider (95% CI = 81%–89%). Conclusion: Majority of the elderly would like to participate in deprescribing process. Major factors that will affect patients' willingness to deprescribe were physicians' time and support as well as possible future benefits of their regular medications. Keywords: medication, aged, chronic disease, polypharmac

Knowledge, attitude and practice of caregivers on medication management at residential aged care facilities in Malaysia

An escalating proportion of the aged group is associated with a growth in the prevalence of ill health. With the complexity of age-related diseases, a good medication management system is important to prevent medication errors. This study was aimed to develop a questionnaire to assess the knowledge, attitude and practice (KAP) of caregivers on medication management at residential aged care facilities (RACFs). A cross-sectional study was performed involving caregivers from 90 RACFs throughout Malaysia. The validated self-administered questionnaire was developed based on the extensive literature review and expert`s opinions containing 41-items divided into three domains. In this study, the response rate was 71% with 128 questionnaires returned. Median scores obtained for knowledge, attitude and practice were 77.27, 70.83 and 68.66, respectively. Majority of the caregivers (71.9%) deemed to know what medication management was. However, nearly half of them (48.4%) did not experience any training. More than half of the caregivers possessed good level of knowledge (69.5%, n = 89), around half (57.8%, n= 74) had a good attitude and less than half had a good practice (46.9%, n= 60) of medication management. Level of education, special qualification and experience of medication management training were the factors that correlated with good score outcome (p<0.05). Therefore, it is assumed that more support and training can be provided to the caregivers in RACF on medication management

The use of fall risk-increasing drugs among older people in nursing homes

Medication use is one of the modifiable risk factors that causes falls. Falls are the leading cause of injury among elderly people. The incidence of falls does significantly impact elderly people‘s independence in carrying out their regular activities. This study aimed to determine the prevalence of drugs that cause falls and the fall risk status among elderly people residing in nursing homes. A cross-sectional study was conducted on residents in 27 long term care facilities in Malaysia from March 2018 until November 2018 using a researcher-assisted questionnaire. A total of 212 residents were recruited in this study. A majority of the residents were taking at least one fall-risk increasing drug (FRIDs) or orthostatic drug (ODs) (n=145, 68.4%), with two-thirds of them presenting high risk of falling (n=95, 65.5%). A significant association was found between the use of beta-blocking agents (p=0.033), renin-angiotensin system inhibitors (p=0.038), length of stay in facilities (p=0.031), frailty status (p<0.001), number of drugs in total (p=0.010) and as needed (p=0.025) with an increased risk of falls. Therefore, a majority of the elderly people residing in nursing homes were proven to be prone to the use of fall-risk medications. Frail elderly people have a higher risk of falling compared to those who were non-frail

Preference, Perception, and Acceptability of Fluid Gels as a Potential Age-Appropriate Dosage Form for Elderly Patients with Dysphagia

The development of pharmaceutical dosage forms that are tailored to specific populations according to their preferences and acceptability could improve medication adherence, which could lead to effective pharmacotherapy. This study evaluated the preference for and perceptions of fluid gels as a potential age-appropriate dosage form for older adults with dysphagia. The palatability and swallowability of the developed fluid gels were also assessed to determine the consumer acceptability of this formulation. A cross-sectional survey was conducted through the electronic distribution of a self-administered questionnaire among adults in Malaysia between April and December 2021. A randomized and double-blinded clinical study was conducted to evaluate the palatability and swallowability of the fluid gels in 30 healthy participants. A cross-sectional study involving 673 respondents revealed that the fluid gels were perceived positively by consumers (64.4%), were easily swallowed (50.8%), were safe to be consumed (45.3%), and were suitable as a new pharmaceutical formulation (43.8%). The clinical study shows that moderately thickened fluid gels masked the bitterness of the medication and were easily swallowed. The newly developed fluid gels were also positively perceived by the participants. Taken together, fluid gels have shown great potential as an innovative oral formulation that is suitable for consumption by elderly patients with dysphagia