MyMedR

Fulltext Laparoscopic sterilization with fallope rings - a Malaysian experience

Abdul Rahman A, Sinnathuray TA, Sivanesaratnam V, Ng KH

Med J Malaysia, 1981 Jun;36(2):92-9.

The early Malaysian experience of laparoscopic sterilisation with the Fallope tubal rings, as undertaken at the Obstetrical and Gynaecological Unit of the University Hospital, University of Malaya in Kuala Lumpur, Malaysia is reported in a study of 291 consecutive females that had had the procedure undertaken during the one year period, May 1975 to April 1976. Of the 291 cases, 247 women were sterilised in the "interval" period, 43 after "menstrual regulation" procedure and one after a spontaneous abortion. General anaesthesia was used in all except one case. The salient socio-demographic, contraceptive and reproductive characteristics of study cases are presented and discussed. The technical problems, the early complications and morbidity encountered in this study are presented and discussed in the light of other similar studies, and in relation to sterilisation by laparoscopic tubal electrocoagulation. The overall impression is that laparoscopic sterilisation with the Fallope tubal rings is preferred to that by tubal electrocoagulation, in view of the possible inadvertent serious electrical burns of other structures during the use of the latter procedure.

Fulltext Female sterilization with Hulka clips--initial experience at the University Hospital, Kuala Lumpur

Abdul Rahman A, Sivanesaratnam V, Nuruddin AA

Med J Malaysia, 1982 Sep;37(3):276-80.

PMID: 7177012

An analysis of 86 patients sterilized laparoscopically with Hulka clips is presented. We find that the method is simple, acceptable and has minimal complication. The failure rate is similar to that reported by others. However, this method could be done under local anaesthesia thus shortening the hospital stay for the patients. This method has the advantage of safety and prospects for reversal when desired.

Fulltext Vasectomy--experience in a Malaysian hospital

Sivanesaratnam V, Abd Rahman A

Med J Malaysia, 1984 Mar;39(1):69-72.

PMID: 6513843

A review of our experience of 916 cases ofpartial bilateral vasectomy performed under local anaesthesia at the University Hospital, Kuala Lumpur during the
period between January 1971 and June 1980 is presented. Minor post-operative complications occurred in 5.8% of cases with a low post-operative infection rate of 1.2%. In 35% ofpatients, persistence of non-motile sperms in the semen were seen after at least ten ejaculations in each instance. In four of these cases non-motile sperms continued to persist into the sixth month of follow-up even after at least 50 ejaculations in each instance.

Fulltext Therapeutic drug monitoring for gentamicin in Hospital Universiti Sains Malaysia

Ismail R, Sarriff A, Abdul Rahman AF

Med J Malaysia, 1990 Mar;45(1):57-64.

PMID: 2152070

We evaluated the usefulness of therapeutic drug monitoring (TDM) for gentamicin and the use of a two-point peak and trough pair concentration method to adjust its dose. Of the 194 patients included, initial concentrations were appropriate in only sixty nine. In the seventy one cases of dosage adjustments using this method, those attaining therapeutic levels increased overall from 38% to 67%. It is concluded that TDM for gentamicin with dosage adjustment using this simple pharmacokinetic approach is useful and adequate in monitoring for gentamicin therapy.

Michaelis-Menten pharmacokinetics of phenytoin in adult Malaysian patients

Ismail R, Rahman AF

J Clin Pharm Ther, 1990 Dec;15(6):411-7.

PMID: 2089048

We reviewed our data from 122 records of patients taking phenytoin for the treatment of various types of epilepsy and selected 15 (age range 10-43 years old) who were on phenytoin alone to calculate Michaelis-Menten pharmacokinetic parameters. The average Vm and Km for this age group was found to be 8.45 mg/kg/day and 6.72 mg/litre, respectively. Km was independent of age and weight. Vm correlated well with weight but there was no relationship with age.

Estimation of population pharmacokinetics for carbamazepine in Malaysian patients using the OPT computer program

Ismail R, Rahman AF

J Clin Pharm Ther, 1993 Feb;18(1):55-8.

PMID: 8473361

We used OPT to estimate individual and population pharmacokinetics for carbamazepine (CBZ) in Malaysian epileptic patients attending our Neurology Clinic. We noted that plasma CBZ concentrations and clearances correlated poorly with daily doses and body weights respectively but we found the values for clearance, volumes of distribution, elimination rate constants and half lives to be in good agreement with earlier reports. We conclude that OPT is a simple yet useful program to derive individual and population pharmacokinetic parameters for CBZ for use in dosage adjustments. We also conclude that although the Malaysian population do not differ substantially in handling CBZ, available data for the pharmacokinetic parameters must be used cautiously in applying it to the therapeutic drug monitoring for CBZ in our patients.

Analgesic use and chronic renal disease in patients with headache

Rahman A, Segasothy M, Samad SA, Zulfiqar A, Rani M

Headache, 1993 Sep;33(8):442-5.

PMID: 8262786

The pattern of analgesic use, abuse and incidence of analgesic-associated nephropathy in 79 patients with chronic headache was studied. Sixty-eight of these patients had migraine. Most patients had consumed a combination of analgesics (81%) while 19% had taken single analgesics for their headache. Nonsteroidal anti-inflammatory drugs were the most commonly used analgesics (96.2%) followed by paracetamol (70.9%) and aspirin, phenacetin and caffeine compounds (5.1%). Mefenamic acid was the commonest nonsteroidal anti-inflammatory drug consumed (97.4%). Analgesic abuse which was defined as a minimum total of 1 kg of analgesics such as paracetamol or aspirin, phenacetin and caffeine compounds or 400 capsules/tablets of nonsteroidal anti-inflammatory drugs was noted in 65 patients. Nonsteroidal anti-inflammatory drugs were the most commonly abused analgesics (89.2%) followed by paracetamol (38.5%). Forty-five of the 65 analgesic abusers had an intravenous urogram or ultrasound performed and renal papillary necrosis was documented in one patient. Three (4.6%) of the analgesic abusers had mildly raised serum creatinine levels. Mild proteinuria of less than 1 gm/litre was present in 27.7% of abusers. In conclusion, although analgesic use and abuse is common in patients with chronic headache, the short term incidence of analgesic-associated nephropathy (2.2%) and renal impairment (4.6%) was low. Prolonged observations will be necessary to ascertain the safety of these drugs for long term use.

Pharmacokinetics of phenytoin in routine clinic patients in Malaysia

Ismail R, Rahman AF, Chand P

J Clin Pharm Ther, 1994 Aug;19(4):245-8.

PMID: 7989403

We estimated individual and population Michaelis-Menten pharmacokinetic parameters for phenytoin (DPH) in epileptic patients attending our neurology clinic using the computer programme. OPT. Our results agreed well with literature values but were lower than those we obtained earlier in a smaller number of patients. The Km was independent of age, weight and sex but there was a weak, correlation between Vm and body weight. We conclude that the use of population Vm and Km in normograms could lead to errors in DPH dose estimations as they correlated very poorly with patient characteristics. OPT was easy to use and sufficiently accurate for deriving dose estimates in routine patients. Its use would enable practitioners to generate their patients' own parameters for use in individual dosage adjustments. The estimates can subsequently be updated as more data become available.

Fulltext How good are doctors as drug prescribers?

Rahman AR, Noor AR, Hassan Y

Med J Malaysia, 1994 Dec;49(4):364-8.

PMID: 7674972

The training of doctors in therapeutics has created interesting discussions internationally. A survey of senior hospital pharmacists currently practising throughout West Malaysia was embarked on during a recent postgraduate seminar. About sixty per cent said prescribing errors were common amongst doctors. Sixteen per cent of the prescribing errors were potentially serious. Most of the time errors were due to carelessness, lack of knowledge on drug action or a combination of both. Nearly 35% of prescribing errors were not acknowledged by doctors. Most doctors did not give reasons for not acknowledging pharmacists' intervention. About half (46.5%) of the respondents thought that doctors were not adequately trained in the use of drugs.

Fulltext Rheumatic heart disease: how big is the problem?

Ibrahim A, Rahman AR

Med J Malaysia, 1995 Jun;50(2):121-4.

PMID: 7565179

The effect of enalapril on tyramine induced changes in renal function in man

Rahman AR, Lang CC, Struthers AD

Int J Clin Pharmacol Ther, 1995 Jul;33(7):404-9.

PMID: 7582398

Increasing animal evidence support an important facilitatory interaction between angiotensin II and norepinephrine within the kidney. This angiotensin II/norepinephrine interaction was investigated in man by examining the effect of enalapril pretreatment (5 mg for 5 days) on the renal response to a low non-pressor dose of intravenous tyramine 4 micrograms/kg/min for 120 min in 8 healthy subjects undergoing water diuresis. Tyramine is an indirect sympathomimetic agent which causes neuronal release of norepinephrine. Enalapril and tyramine, alone and in combination, had no effect on glomerular filtration, effective renal plasma flow or sodium excretion. Tyramine caused a significant increase in urinary flow rate (p < 0.05) but this was not influenced by enalapril pretreatment. The lack of effect of enalapril on the renal response to tyramine contrasts with a previous study which examined the effect of enalapril on the renal response to circulating norepinephrine. This may suggest that enalapril affect renal function only when there is renal vasoconstriction (as with norepinephrine) and not when renal blood flow is unchanged (as with tyramine).

Blood pressure regulation by the kallikrein-kinin system

Sharma JN, Uma K, Noor AR, Rahman AR

Gen. Pharmacol., 1996 Jan;27(1):55-63.

PMID: 8742494

1. The kallikrein-kinin system has a significant role in regulating arterial blood pressure. 2. Reduced formation of the kinin compontents may cause hypertensive diseases. This is because of the fact that this system is responsible for vasodilatation, reduction in total peripheral resistance, natriuresis, diuresis, increasing renal blood flow and releasing various vasodilator agents. 3. Reduced kinin-kallikrein generation in hypertensive subjects may also be associated with genetic and environmental defects. 4. The kallikrein-kinin system when administered to hypertensive patients can lower their raised blood pressure to normotensive levels. 5. The mode of action of angiotensin-converting enzyme inhibitors principally may be dependent on the kinin system protection.

Constituents of the rhizomes of two Alpinia species of Malaysia

Sirat HM, Rahman AA, Itokawa H, Morita H

Planta Med, 1996 Apr;62(2):188-9.

PMID: 17252439

Therapeutic drug monitoring of gentamicin: a 6-year follow-up audit

Ismail R, Haq AH, Azman M, Rahman AF

J Clin Pharm Ther, 1997 Feb;22(1):21-5.

PMID: 9292398

In 1984 a therapeutic drug monitoring (TDM) service was established in Hospital Universiti Sains Malaysia (HUSM) and gentamicin concentrations were measured and used to design optimal regimens for the antibiotic. In this study we report on a 6-year follow-up audit since our first assessment of the service.

Fatal Campylobacter jejuni infection in a patient splenectomised for thalassaemia

Jackson N, Zaki M, Rahman AR, Nazim M, Win MN, Osman S

J Clin Pathol, 1997 May;50(5):436-7.

PMID: 9215130

A 35 year old man with a fatal Campylobacter jejuni infection is described. He had HbE/beta zero thalassaemia and had undergone splenectomy nine months previously for hypersplenism; he also had chronic hepatitis C infection. He presented with high grade fever but no gastrointestinal symptoms and rapidly progressed to septicaemic shock and hepatic encephalopathy despite treatment with penicillin, gentamicin, and, later, chloramphenicol and ceftazidime. Only one case of Campylobacter jejuni septicaemia occurring post-splenectomy has been reported previously, also in an iron overloaded thalassaemia patient. Unusual Gram negative bacilli must be covered by the chosen antibiotic regimen when splenectomised thalassaemic patients present with high grade fever.

Handling of drug-related inquiries by hospital nurses

Ab Rahman AF, Budiarti LE

J Clin Pharm Ther, 1998 Apr;23(2):127-31.

PMID: 9786098

To determine how nurses handled drug-related questions in the work environment of a teaching hospital in Malaysia and the type of information sources they used.

Field evaluation of cyfluthrin and malathion 96 TG ULV spraying at high-rise flats on dengue vectors in Malaysia

Sulaiman S, Pawanchee ZA, Othman HF, Jamal J, Wahab A, Sohadi AR, et al.

J Vector Ecol, 1998 Jun;23(1):69-73.

PMID: 9673932

Cyfluthrin (Solfac ULO15) and malathion 96 TG were evaluated against sentinel sugar-fed adults and 4th-instar larvae of Aedes aegypti at high-rise flats in Malaysia by ULV spraying. The impact of both insecticides on field populations of Aedes spp. (Ae. aegypti and Ae. albopictus) larvae were monitored weekly using containers. Both cyfluthrin and malathion 96 TG showed adulticidal effects but cyfluthrin showed more significant larvicidal effect than malathion 96 TG (P < 0.05).

Pulse wave velocity as an index of arterial stiffness: a comparison between newly diagnosed (untreated) hypertensive and normotensive middle-aged Malay men and its relationship with fasting insulin

Ngim CA, Abdul Rahman AR, Ibrahim A

Acta Cardiol, 1999 Oct;54(5):277-82.

PMID: 10596307

BACKGROUND: Arterial stiffness, an aging process which is accelerated by hypertension, is emerging as a useful index of vascular health. There are evidences to suggest that hyperinsulinaemia may be an independent risk factor for coronary artery disease, besides its possible pathogenic role in essential hypertension. The main objectives of this study were to compare arterial stiffness between untreated hypertensives and normotensives and to investigate the relationship between fasting serum insulin and arterial stiffness.

METHODS: A cross-sectional observational study was designed. Forty normotensive (median age 47 +/- 6 yrs.) and twenty untreated hypertensive Malay men (median age 50 +/- 7 yrs.) without clinical evidence of cardiovascular complications were selected. Pulse wave velocity measured using the automated Complior machine was used as an index of arterial stiffness. Other measurements obtained were blood pressure, body mass index, fasting insulin, cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glucose and creatinine level.

RESULTS: The blood pressure and pulse wave velocity (PWV) were significantly higher in the hypertensives compared to the normotensives (blood pressure 169/100 mm Hg +/- 14/7 vs. 120/80 mm Hg +/- 10/4, p < 0.001; PWV 11.69 m/s +/- 1.12 vs. 8.83 m/s +/- 1.35, p < 0.001). Other variables such as body mass index, fasting insulin, cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and haematocrit were comparable among the two groups. Within each group, there was a significant positive correlation between pulse wave velocity and systolic blood pressure (r = 0.76, p < 0.001 in normotensives; r = 0.73, p < 0.001 in hypertensives) and mean arterial pressure (r = 0.74, p < 0.001 in normotensives; r = 0.73, p < 0.001 in hypertensives). No correlation was noted between pulse wave velocity and diastolic blood pressure, age, body mass index, fasting insulin level, cholesterol, HDL-cholesterol, LDL-cholesterol or triglyceride levels.

CONCLUSION: Arterial stiffness as determined by PWV is increased in newly diagnosed untreated hypertensive subjects even before clinically evident cardiovascular disease. However, arterial stiffness is not correlated with the fasting insulin level in normotensives and newly diagnosed hypertensives.

First-dose response to angiotensin-converting enzyme inhibition in congestive cardiac failure: a Malaysian experience

Navookarasu NT, Rahman AR, Abdullah I

Int J Clin Pract, 1999 Jan-Feb;53(1):25-30.

PMID: 10344062

Despite their proven value in reducing morbidity and mortality in different grades of heart failure, angiotensin converting enzyme (ACE) inhibitors continue to be underused. One reason for this is clinicians' apprehension of first-dose hypotension. We conducted a double-blind, randomised, placebo-controlled parallel group study to investigate the effect of various ACE inhibitors on first-dose hypotension. Eighty unselected patients were randomised into five treatment groups: placebo, captopril 6.25 mg, enalapril 2.5 mg, perindopril 2 mg and lisinopril 2.5 mg. Blood pressure was measured at baseline, half hourly for two hours and hourly for three hours after drug treatment. The maximum drops in mean arterial pressure (in mmHg +/- SD) were placebo 5.89 +/- 2.65, perindopril 5.29 +/- 2.49, enalapril 13.28 +/- 3.31, lisinopril 15.04 +/- 5.74 and captopril 16.76 +/- 5.74 (all p < 0.05 vs placebo except for perindopril). Perindopril, unlike the other ACE inhibitors studied, did not produce first-dose hypotension following its initiation in patients with congestive heart failure.

Ethnic differences in response to non-selective beta-blockade among racial groups in Malaysia

Rasool AH, Rahman AR, Ismail R, Hatim S, Abdullah AR, Singh R, et al.

Int J Clin Pharmacol Ther, 2000 May;38(5):260-9.

PMID: 10839470

OBJECTIVE: To determine whether racial differences in response to blockade of beta receptors occur among racial groups in Malaysia that are the Malays, Indians and Chinese. SUBJECTS, MATERIALS AND METHOD: 35 healthy male volunteers representing the 3 main racial groups in Malaysia (12 Malays, 12 Chinese and 11 Indians) were studied in a randomized, placebo-controlled, crossover and single-blind design. Propranolol 80 mg 12-hourly was given orally for 48 hours. Six hours after the last dose subjects attended an exercise session where resting and exercise heart rate, blood pressure, plasma potassium and glucose levels, resting FEV1 and plasma propranolol concentrations were recorded.

RESULTS: No significant difference in plasma propranolol (mean +/- SEM) levels was seen between races six hours after the last dose (Malays, 59.7 +/- 8.8 ng/ml, Indians, 67.6 +/- 19.3 ng/ml, Chinese, 58.4 +/- 7.9 ng/ml). Chinese were least sensitive to the bradycardic and hypotensive effects of propranolol at rest and exercise. Indians and Malays had significant reduction of supine systolic blood pressure with propranolol but not Chinese. Comparison of percentage reductions of systolic blood pressure at supine, sitting and exercise by repeated measure analysis showed the Malays to have significantly higher change compared to the Chinese (p = 0.022). Similarly, comparison of percentage reductions of heart rate at supine, sitting and exercise by repeated measure analysis showed the Malays to have significantly higher change compared to the Chinese (p = 0.040). Average change in potassium concentrations at peak exercise and recovery showed the Indians to have significantly higher increase in potassium levels with propranolol compared to the Malays (p = 0.038). However, no significant interethnic difference was seen in the reduction of glucose levels at rest, peak exercise or recovery. Also, no significant interethnic difference was seen in reduction of FEV1 values.

CONCLUSION: We, therefore, conclude that ethnic differences in response to blockade of beta-receptors exist among racial groups in Malaysia. These differences were seen at similar plasma drug levels between races suggesting ethnic differences in drug sensitivity, rather than differences in drug disposition.

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