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Effects of genetic polymorphisms of ABCB1 on the efficacy of anesthetic and analgesic agents: a systematic review

Liew Y, Capule FR, Makmor-Bakry M

Pharmacogenomics, 2021 11;22(16):1099-1106.
PMID: 34590490 DOI: 10.2217/pgs-2021-0079

Aim: To perform a systematic review to determine the effect of ABCB1 (1236C>T, 2677G>T/A and 3435C>T) variants on the effects of anesthetic and analgesic agents in various surgical procedures. Materials & methods: Literature was obtained from established databases and reference tracking. The main outcome measures were efficacy of anesthetic and analgesic agents intraoperative or within 48 h post surgery of human population. Results: Seventeen studies were included for data extraction from 1127 screened studies. The influences of ABCB1 gene polymorphisms on analgesic effects showed conflicting results. The mutational homozygous TT genotypes of 1236C>T and 3435C>T polymorphisms demonstrated significant association with the anesthetic effects. Conclusion: The mutational homozygous TT genotype in both ABCB1 1236C>T and 3435C>T is associated with weaker anesthetic effect but there are no clearly demonstrated analgesic effects.
Effects of MDR1 and OPRM1 genetic polymorphisms on the pharmacodynamics of propofol-remifentanil TIVA in pediatrics

Liew Y, Capule FR, Rahman RA, Nor NM, Teo R, Makmor-Bakry M

Pharmacogenomics, 2023 Apr;24(5):247-259.
PMID: 36999508 DOI: 10.2217/pgs-2023-0006

Aims: To investigate the roles of MDR1 (1236C>T, 2677G>T/A, and 3435C>T) and OPRM1 (118A>G) gene polymorphisms on the anesthetic and adverse effects of propofol-remifentanil total intravenous anesthesia in pediatric surgery. Materials & methods: The genotypes were identified through Sanger sequencing. The clinical data including hemodynamics on anesthesia, postanesthesia pain and sedation score and the occurrence of adverse effects were recorded and compared against the genetic data. Results: A total of 72 pediatric patients undergoing surgery were recruited. A weak to no association was found between the genetic polymorphisms of MDR1 and OPRM1 and the anesthetic and adverse effects of propofol-remifentanil. Conclusion: Genetic polymorphisms in OPRM1, but not in MDR1, gene polymorphism, demonstrated plausible association with the effects of propofol-remifentanil.
A qualitative study of type 2 diabetes mellitus outpatients' perspectives on readiness, acceptance and barriers of mobile apps for medication adherence

Chong CJ, Makmor-Bakry M, Hatah E, Mohd Tahir NA, Mustafa N, Capule FR, et al.

Patient Educ Couns, 2024 Nov 12;131:108547.
PMID: 39577304 DOI: 10.1016/j.pec.2024.108547

OBJECTIVES: This qualitative phenomenological study explored the perspectives of type 2 diabetes mellitus (T2DM) outpatients in adopting mobile apps for medication adherence management.
METHODS: Through 25 semi-structured in-depth interviews, themes were identified using thematic analysis, guided by the Technology Readiness and Acceptance Model (TRAM).
RESULTS: Anticipated convenience and benefits, openness to new technologies acted as drivers, while limited digital literacy and concerns about data privacy and security served as inhibitors of readiness to adopt health apps. Acceptance was influenced by elements related to medication, patient, healthcare professional, family and app aspects. The identified barriers were related to patient, smartphone and monetary factors. Patients perceived the need to adopt digital apps were for those with poor adherence, complex medication regimen and forgetfulness issues. However, concerns about effectively implementing this approach were noted as T2DM patients were predominantly late middle-aged adults who faced technical challenges, leading to combination approach between digital technology and conventional patient education and counselling.
CONCLUSION: The findings highlighted the factors influencing patient's readiness, acceptance, and barriers on effective utilisation of digital health solutions in managing adherence issues.
PRACTICAL IMPLICATIONS: The elements of TRAM provide guidance for strategic actions to enhance digital health technology adoption among T2DM patients.
Accumulation of trace metals in the embryos and hatchlings of Chelonia mydas from Peninsular Malaysia incubated at different temperatures

Ikonomopoulou MP, Olszowy H, Francis R, Ibrahim K, Whittier J

Sci Total Environ, 2013 Apr 15;450-451:301-6.
PMID: 23500829 DOI: 10.1016/j.scitotenv.2013.02.031

A variety of trace metals were measured in the egg contents of three clutches of Chelonia mydas collected from Kuala Terengganu state in Peninsular Malaysia. We quantified Mn, Cu, Zn, Se (essential trace metals) and As (anthropogenic pollutant) at several developmental stages obtained by incubating eggs at two different temperatures (27 °C and 31 °C). The incubation temperatures were chosen because they produce predominantly male or predominantly female hatchlings, respectively. The eggs were removed from the sand and washed before being placed in incubators, to ensure that the only possible source of the detected metals was maternal transfer. Other metals: Mo, Co, Ni, Cd, Sn, Sb, Hg, Tl and Pb (all non-essential metals) were detected at concentrations below the lower limit of quantitation (LLOQ). Trace metal concentrations, particularly [Zn], increased during development, other metals (Cu, As, Se and Cr) accumulated to a lesser degree than zinc but no significant differences were observed between the incubation temperatures at any stage of incubation. To date, only a few studies on trace metals in turtle embryos and hatchlings have been reported; this study will provide basic knowledge on the accumulation of trace metals during development at two different incubation temperatures.
Southeast Asian Pharmacogenomics Research Network (SEAPharm): Current Status and Perspectives

Chumnumwat S, Lu ZH, Sukasem C, Winther MD, Capule FR, Abdul Hamid AAAT, et al.

Public Health Genomics, 2019;22(3-4):132-139.
PMID: 31587001 DOI: 10.1159/000502916

Pharmacogenomics (PGx) is increasingly being recognized as a potential tool for improving the efficacy and safety of drug therapy. Therefore, several efforts have been undertaken globally to facilitate the implementation process of PGx into routine clinical practice. Part of these efforts include the formation of PGx working groups working on PGx research, synthesis, and dissemination of PGx data and creation of PGx implementation strategies. In Asia, the Southeast Asian Pharmacogenomics Research Network (SEAPharm) is established to enable and strengthen PGx research among the various PGx communities within but not limited to countries in SEA; with the ultimate goal to support PGx implementation in the region. From the perspective of SEAPharm member countries, there are several key elements essential for PGx implementation at the national level. They include pharmacovigilance database, PGx research, health economics research, dedicated laboratory to support PGx testing for both research and clinical use, structured PGx education, and supportive national health policy. The status of these essential elements is presented here to provide a broad picture of the readiness for PGx implementation among the SEAPharm member countries, and to strengthen the PGx research network and practice in this region.