MyMedR

Fulltext Trends in inquiries on poisoning: a five-year report from the National Poison Centre, Malaysia

Awang R, Abd Rahman AF, Wan Abdullah WZA, Lajis R, Abdul Majid MI

Med J Malaysia, 2003 Aug;58(3):375-9.

This report describes inquiries relating to poisoning cases which were received by the National Poison Centre of Malaysia from the years 1996 to 2000. The study utilized data from the NPC report forms. Only data relating to patient contact with a poison or chemical were included in the analysis. The poison centre received an average of 186 poisoning inquiries per year. Doctors remained the highest group of caller to the poison centre throughout the five-year period. Nearly 50% of all inquiries was regarding pesticide poisoning and this trend remained constant during the five-year period. Overall, the findings showed that poisoning inquiries relating to patient care were lower than in Japan and the United States.

Lipase-catalyzed esterification of palm-based 9,10-dihydroxystearic acid and 1-octanol in hexane--a kinetic study

Awang R, Basri M, Ahmad S, Salleh AB

Biotechnol Lett, 2004 Jan;26(1):11-4.

PMID: 15005144

The esterification of palm-based 9,10-dihydroxystearic acid (DHSA) and 1-octanol in hexane as catalyzed by lipase from Rhizomucor meihei (Lipozyme IM) followed Michaelis-Menten kinetics. The esterification reaction follows a Ping-Pong, Bi-Bi mechanism. The maximum rate was estimated to be 1 micromol min(-1) mg(-1) catalyst in hexane at 50 degrees C, and the Michaelis-Menten constants for DHSA and 1-octanol were 1.3 M and 0.7 M, respectively.

Community-acquired vancomycin-resistant Enterococcus faecium: a case report from Malaysia

Raja NS, Karunakaran R, Ngeow YF, Awang R

J Med Microbiol, 2005 Sep;54(Pt 9):901-903.

PMID: 16091445 DOI: 10.1099/jmm.0.46169-0

Vancomycin-resistant enterococci (VRE) are formidable organisms renowned for their ability to cause infections with limited treatment options and their potential for transferring resistance genes to other Gram-positive bacteria. Usually associated with nosocomial infections, VRE are rarely reported as a cause of community-acquired infection. Presented here is a case of community-acquired infection due to vancomycin-resistant Enterococcus faecium. The patient had been applying herbal leaves topically to his cheek to treat a buccal space abscess, resulting in a burn of the overlying skin. From pus aspirated via the skin a pure culture of E. faecium was grown that was resistant to vancomycin with a MIC of >256 microg ml-1 by the E test and resistant to teicoplanin by disc diffusion, consistent with the VanA phenotype. The organism was suspected of contaminating the leaf and infecting the patient via the burnt skin. This case highlights the need for further studies on the community prevalence of VRE among humans and animals to define unrecognized silent reservoirs for VRE, which may pose a threat to public health.

Fulltext Identification of psychosocial factors of noncompliance in hypertensive patients

Hassan NB, Hasanah CI, Foong K, Naing L, Awang R, Ismail SB, et al.

J Hum Hypertens, 2006 Jan;20(1):23-9.

PMID: 16177812 DOI: 10.1038/sj.jhh.1001930

This cross-sectional study was aimed to identify the predictors of medication noncompliance in hypertensive patients. The study was conducted at the Family Medicine Clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia, which is a university-based teaching hospital. All hypertensive patients aged 40 or over-registered from January to June 2004, who had been on treatment for at least 3 months, were screened. Previously validated self-administered questionnaires were used to assess the compliance and psychosocial factors. A total of 240 hypertensive patients were recruited in the study. Of these, 55.8% were noncompliant to medication. Logistic regression showed that age (adjusted odds ratio (OR): 0.96; 95% confidence interval (CI): 0.92-0.997; P: 0.035), patient satisfaction (adjusted OR: 0.97; 95% CI: 0.93-0.998; P: 0.036) and medication barrier (adjusted OR: 0.95; 95% CI: 0.91-0.987; P: 0.009) were significant predictors of medication noncompliance. Therefore, younger age, poor patient satisfaction and medication barrier were identified as independent psychosocial predictors of medication noncompliant in hypertensive patients.

Simple, rapid and sensitive assay method for simultaneous quantification of urinary nicotine and cotinine using gas chromatography-mass spectrometry

Man CN, Gam LH, Ismail S, Lajis R, Awang R

J Chromatogr B Analyt Technol Biomed Life Sci, 2006 Dec 5;844(2):322-7.

PMID: 16908224

Nicotine is a major addictive compound in cigarette. Its smoke is rapidly and extensively metabolized to several metabolites in human. Cotinine as a major metabolite of nicotine is commonly used as a biomarker to determine active and passive smokers. Cotinine has a longer half-life ( approximately 20 h) compared to nicotine ( approximately 2h). A simple, sensitive, rapid and high throughput GC-MS method was developed for simultaneous quantification of urinary nicotine and cotinine in passive and active smokers. In the sample preparation method, the analytes and internal standard were first basified and followed by liquid-liquid extraction. Upon completion, anhydrous sodium sulphate was added to the solvent mixture to trap moistures. The clear extract obtained was directly injected into GC-MS, operating under selective ion monitoring (SIM) mode. Calibration curves in the range of 0.5-5000 ng/mL of the analytes in urine matrix were established with linear correlation coefficients (r(2)) greater than 0.997. The limit of detection for both nicotine and cotinine were 0.20 ng/mL. The mean recoveries for nicotine and cotinine were 93.0 and 100.4%, respectively. The within- and between-assay accuracies were between 2.1 and 7.9% for nicotine and between 0.7 and 11.1% for cotinine. Within- and between-assay precisions of 3.3-9.5% for nicotine and 3.4-9.8% for cotinine were also achieved. The method can be used in routine assessment and monitoring of active smoking and exposure to environmental tobacco smoke. The applicability of the assay was demonstrated in a small-scale comparison study between smokers and non-smokers.

Profile of poisoning admissions in Malaysia

Rajasuriar R, Awang R, Hashim SB, Rahmat HR

Hum Exp Toxicol, 2007 Feb;26(2):73-81.

PMID: 17370864

We retrospectively reviewed poisoning admissions to all government health facilities from 1999 to 2001, in an effort to expand our current knowledge on poisoning in Malaysia to a level that better reflects a nationwide burden. There were 21 714 admissions reported with 779 deaths. The case-fatality rate was 35.88/1000 admissions. The majority of admissions (89.7%) and deaths (98.9%) occurred in adults. Some 55.1% of all admissions were female, mostly involving pharmaceutical agents. Male poisoning admissions were more often due to chemical substances. The prevalence of poisoning and death was highest among Indians compared to all other races in Malaysia. Overall, the majority of poisoning admissions were due to pharmaceutical agents, with agents classified as non-opioid analgesics, anti-pyretics and anti-rheumatics the most common. Pesticides accounted for the largest number of fatalities. It was also the commonest substance reported in cases of intentional self-harm. Most cases of poisoning admissions occurred due to accidental exposure (47%), followed by cases of intentional self-harm (20.7%). Overall, this study has managed to contribute substantial additional information regarding the epidemiology of poisoning in Malaysia, highlighting important issues, such as the rampant poisonings involving pesticides and analgesics, as well as the high prevalence of poisoning among Indians in Malaysia.

Fulltext Levels and correlates of awareness of tobacco promotional activities among adult smokers in Malaysia and Thailand: findings from the International Tobacco Control Southeast Asia (ITC-SEA) Survey

Yong HH, Borland R, Hammond D, Sirirassamee B, Ritthiphakdee B, Awang R, et al.

Tob Control, 2008 Feb;17(1):46-52.

PMID: 18218808 DOI: 10.1136/tc.2007.021964

To examine the impact of tobacco advertising policy on adult smokers' awareness of tobacco promotion in two developing countries--Malaysia and Thailand.

User satisfaction with services provided by a drug information center in Sudan

Fathelrahman AI, Awang R, Bashir AA, Taha IA, Ibrahim HM

Pharm World Sci, 2008 Dec;30(6):759-63.

PMID: 18704750 DOI: 10.1007/s11096-008-9245-0

OBJECTIVE: The services of the Ministry of Health Drug Information Center--Khartoum State were evaluated by assessing users' satisfaction.

METHOD: Four hundred and twenty-three subjects were recruited from center records using a systematic random sampling technique. Subjects who consented were interviewed by telephone using a specially designed semi-structured questionnaire. Descriptive as well as comparative analyses were carried out. Differences between groups were tested using the Chi-square test when applicable.

RESULTS: The majority of users surveyed (89.6%) had called the center from within Khartoum State and 10.4% of users had called from other states. Of the enquiries, 36.1% were from pharmacists, 29.5% from physicians, and 22.3% from laypersons. The vast majority (93.1%) of respondents were educated to degree level or higher. Approximately one fifth, one half, and one third of the users surveyed had consulted the center >5 times, 2-5 times, and once, respectively. More than 90% of users rated the services provided as good to excellent and 94.7% declared their probable intention to continue utilizing the center in the future.

CONCLUSION: The center succeeded in satisfying and retaining its users by providing an acceptable quality of service.

Determination of hair nicotine by gas chromatography-mass spectrometry

Man CN, Ismail S, Harn GL, Lajis R, Awang R

J Chromatogr B Analyt Technol Biomed Life Sci, 2009 Jan 15;877(3):339-42.

PMID: 19109080 DOI: 10.1016/j.jchromb.2008.12.014

Hair nicotine is a known biomarker for monitoring long-term environmental tobacco smoke (ETS) exposure and smoking status. In general, hair nicotine assay involves alkaline digestion, extraction and instrumental analysis. The gas chromatography-mass spectrometry (GC-MS) assay currently developed has shown to be of high throughput with average approximately 100 hair samples being extracted and analyzed per day. This was achieved through simplified extraction procedure and shortened GC analysis time. The extraction was improved by using small volume (0.4 mL) of organic solvent that does not require further evaporation and salting steps prior to GC-MS analysis. Furthermore, the amount of hair utilized in the extraction was very little (5 mg) while the sensitivity and selectivity of the assay is equal, if not better than other established methods. The linearity of the assay (r(2)>0.995), limit of quantitation (0.04 ng/mg hair), within- and between-assays accuracies and precisions (<11.4%) and mean recovery (92.6%) were within the acceptable range.

Fulltext Smokers' responses toward cigarette pack warning labels in predicting quit intention, stage of change, and self-efficacy

Fathelrahman AI, Omar M, Awang R, Borland R, Fong GT, Hammond D, et al.

Nicotine Tob Res, 2009 Mar;11(3):248-53.

PMID: 19246625 DOI: 10.1093/ntr/ntn029

This paper is concerned with the effects of cigarette pack warning labels on quitting intentions. We examined whether different responses among smokers toward cigarette pack warning labels could predict quit intentions and self-efficacy in quitting. Variables studied were "noticing warning labels during last month," "reading or looking closely at warning labels," "avoiding looking at labels during last month," "thinking about health risks of smoking because of the warning labels, "more likely to quit because of the warning labels," and "stopping from having a cigarette when about to smoke one because of the labels."

Correlation between urinary nicotine, cotinine and self-reported smoking status among educated young adults

Man CN, Fathelrahman AI, Harn GL, Lajis R, Samin AS, Omar M, et al.

Environ Toxicol Pharmacol, 2009 Jul;28(1):92-6.

PMID: 21783987 DOI: 10.1016/j.etap.2009.03.003

The objective of this study was to correlate, differentiate and validate the self-reported smoking status of educated young adults with urinary biomarkers (i.e. nicotine and cotinine). Freshmen students were recruited on voluntary basis. They filled-up self-administered questionnaire and their urine samples were collected for analysis. The urinary nicotine (UN) and cotinine (UC) were measured by gas chromatograph-mass spectrometry. Smokers, non-smokers and ex-smokers were found to be both significantly correlated and different in their UN and UC levels. UC level of 25ng/ml was the optimal cut-off to differentiate smokers from non-smokers. Using this cut-off value, the prevalence of smoking among the students was found to be higher (15.4%) than the self-reported data (14.3%). UC is useful in validating individual recent smoking history and the cut-off could serve as a marker for assessing the clinical impact of smoking and environmental tobacco smoke (ETS) exposure on human health.
Study site: university health centre, Universiti SainsMalaysia (USM), Pulau Pinang, Malaysia

Fulltext Smoking beliefs and behavior among youth in Malaysia and Thailand

Parkinson CM, Hammond D, Fong GT, Borland R, Omar M, Sirirassamee B, et al.

Am J Health Behav, 2009 Jul-Aug;33(4):366-75.

PMID: 19182982

To characterize smoking beliefs among Thai and Malaysian youth and to examine associations with gender, antismoking media exposure, and smoking status.

Fulltext A medication-estimated health status measure for predicting primary care visits: the Long-Term Therapeutic Groups Index

Dhabali AA, Awang R

Health Policy Plan, 2010 Mar;25(2):162-9.

PMID: 19923207 DOI: 10.1093/heapol/czp051

BACKGROUND: Managed care is one of the means advocated for health care reforms. The Malaysian government has proposed managed care for its citizens. In the Malaysian private health care sector, managed care is practised on a small scale with crude risk adjustment. The main determinant of an individual's health service utilization is their health status (HS). HS is used as a risk adjuster for capitation payment. Prescribed medications represent a useful source for HS estimation. We aimed to develop and validate a medication-based HS estimate and to incorporate it in the Andersen model of health service utilization. This is a preparatory step in studying the feasibility of developing a model for risk assessment in the Malaysian context.
METHODS: Data were collected retrospectively from an academic year from computerized databases in University Sains Malaysia (USM) about users of USM primary care services. A user is a USM health scheme beneficiary who made at least one visit in the academic year to USM-assigned primary care providers. Socio-demographic variables, enrolment period, medications prescribed and number of visits were also collected. Chronic illness medications and some non-chronic illness medications were used to calculate the Long-Term Therapeutic Groups Index (LTTGI) which is an estimate of the HS of users. Using a random 50% of users, weighted least square methods were used to develop a model that predicts a user's number of visits. The other 50% were used for validation.
RESULTS: Socio-demographic variables explained 15% of variability in number of primary care visits among users. Adding the LTTGI improved the explanatory power of the model to 36% (P < 0.001). A similar contribution of the LTTGI was noted in the validation.
CONCLUSIONS: The Long-Term Therapeutic Groups Index was successfully developed. Variability in number of primary care visits can be predicted by LTTGI-based models.

Incidence of adverse drug reactions induced by N-acetylcysteine in patients with acetaminophen overdose

Zyoud SH, Awang R, Syed Sulaiman SA, Sweileh WM, Al-Jabi SW

Hum Exp Toxicol, 2010 Mar;29(3):153-60.

PMID: 20071472 DOI: 10.1177/0960327109359642

Intravenous N-acetylcysteine (IV-NAC) is widely recognized as the antidote of choice for acetaminophen overdose. However, its use is not without adverse drug reactions (ADR) that might affect therapeutic outcome or lead to treatment delay.

Association between gastrointestinal manifestations following acetaminophen poisoning and outcome in 291 acetaminophen poisoning patients

Zyoud SH, Awang R, Sulaiman SA, Al-Jabi SW

Pharmacoepidemiol Drug Saf, 2010 May;19(5):511-7.

PMID: 20333776 DOI: 10.1002/pds.1940

Acetaminophen poisoning is a common clinical problem, and early identification of patients with more severe poisoning is key to improving outcomes.

A cross-sectional observation of the factors associated with deliberate self-poisoning with acetaminophen: impact of gender differences and psychiatric intervention

Zyoud SH, Awang R, Sulaiman SA, Al-Jabi SW

Hum Psychopharmacol, 2010 Aug;25(6):500-8.

PMID: 20737523 DOI: 10.1002/hup.1140

The objectives of this study were to determine the risk factors and life stressors that are prevalent among the acetaminophen deliberate self-poisoning (DSP) cases, to identify gender differences in the associated factors, and to determine the prevalence of psychiatric diagnosis and the patterns and types of psychotherapeutic interventions provided by psychiatrists.

Fulltext Relationship between serum acetaminophen concentration and N-acetylcysteine-induced adverse drug reactions

Zyoud SH, Awang R, Sulaiman SA, Khan HR, Sawalha AF, Sweileh WM, et al.

Basic Clin Pharmacol Toxicol, 2010 Sep;107(3):718-23.

PMID: 20374238 DOI: 10.1111/j.1742-7843.2010.00567.x

Intravenous N-acetylcysteine is usually regarded as a safe antidote. However, during the infusion of the loading dose, different types of adverse drug reactions (ADR) may occur. The objective of this study was to investigate the relation between the incidence of different types of ADR and serum acetaminophen concentration in patients presenting to the hospital with acetaminophen overdose. This is a retrospective study of patients admitted to the hospital for acute acetaminophen overdose over a period of 5 years (1 January 2004 to 31 December 2008). Parametric and non-parametric tests were used to test differences between groups depending on the normality of the data. SPSS 15 was used for data analysis. Of 305 patients with acetaminophen overdose, 146 (47.9%) were treated with intravenous N-acetylcysteine and 139 (45.6%) were included in this study. Different types of ADR were observed in 94 (67.6%) patients. Low serum acetaminophen concentrations were significantly associated with cutaneous anaphylactoid reactions but not other types of ADR. Low serum acetaminophen concentration was significantly associated with flushing (p < 0.001), rash (p < 0.001) and pruritus (p < 0.001). However, there were no significant differences in serum acetaminophen concentrations between patients with and without the following ADR: gastrointestinal reactions (p = 0.77), respiratory reactions (p = 0.96), central nervous reactions (p = 0.82) and cardiovascular reactions (p = 0.37). In conclusion, low serum acetaminophen concentrations were associated with higher cutaneous anaphylactoid reactions. Such high serum acetaminophen concentrations may be protective against N-acetylcysteine-induced cutaneous ADR.

High prevalence of hypokalemia after acute acetaminophen overdose: impact of psychiatric illness

Zyoud SH, Awang R, Syed Sulaiman SA, Al-jabi SW

Hum Exp Toxicol, 2010 Sep;29(9):773-8.

PMID: 20144962 DOI: 10.1177/0960327110361759

Hypokalemia is not an isolated disease but an associated finding in a number of different diseases. It is also a commonly neglected condition among patients with acute acetaminophen overdose.

Effects of delay in infusion of N-acetylcysteine on appearance of adverse drug reactions after acetaminophen overdose: a retrospective study

Zyoud SH, Awang R, Sulaiman SA, Al-Jabi SW

Pharmacoepidemiol Drug Saf, 2010 Oct;19(10):1064-70.

PMID: 20712021 DOI: 10.1002/pds.1955

To investigate the relationship between different types of adverse drug reaction (ADR) and late time to N-acetylcysteine (NAC) infusion in patients presenting to the hospital with acetaminophen overdose.

Fulltext Assessing the impact of vomiting episodes on outcome after acetaminophen poisoning

Zyoud SH, Awang R, Sulaiman SA, Al-Jabi SW

Basic Clin Pharmacol Toxicol, 2010 Nov;107(5):887-92.

PMID: 20456332 DOI: 10.1111/j.1742-7843.2010.00594.x

Identifying indices of poor prognosis at first presentation after acetaminophen poisoning is the key to both improving clinical care and determining targets for intervention. This study intended to document the prevalence, clinical characteristics and predictors of vomiting and to investigate the relationship between episodes of vomiting at first hospital presentation and outcome in acetaminophen poisoning. This retrospective cohort study included patients who attended the emergency department and were admitted within 24 hr of acetaminophen ingestion. The study was conducted over a period of 5 years from 1 January 2004 to 31 December 2008. Parametric and non-parametric tests were used to test differences between groups depending on the normality of the data. SPSS 15 was used for data analysis. Data from 291 patients were included. Vomiting was present in 65.3% of patients with acetaminophen poisoning at the time of first presentation. Multiple logistic regression showed that significant risk factors for vomiting were present among patients who reported an ingested dose of acetaminophen ≥10 g (p < 0.001) and a latency time of more than 8 hr (p = 0.030). Overall, an increasing trend in prothrombin time (p = 0.03), serum bilirubin (p < 0.001), serum creatinine (p = 0.005), serum potassium (p < 0.001), length of hospital stay (p < 0.001) and the prevalence of patients who had a serum acetaminophen level above a 'possible toxicity' treatment line (p = 0.001) were associated with an increased number of episodes of vomiting. In conclusion, vomiting was common among patients with acetaminophen poisoning. This study suggests that an increase in episodes of vomiting at first presentation appears to be an important risk marker of subsequent nephrotoxicity and hepatotoxicity.

Displaying publications 1 - 20 of 59 in total