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Fulltext A ten year (1999-2008) retrospective study of amoebiasis in University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Farhana F, Jamaiah I, Rohela M, Abdul-Aziz NM, Nissapatorn V

Trop Biomed, 2009 Dec;26(3):262-6.
PMID: 20237439 MyJurnal

This is a ten year (1999-2008) retrospective study of amebiasis in patients admitted to UMMC. A total of 34 cases were analyzed. The most common were amebic liver abscess 22(65%) and the rest were amoebic dysentery 12(35%). Majority of the cases occurred among Malaysians 29(85%), with Chinese 14(41%), followed by the Malays 9(26%) and the Indians 6(18%). Foreigners made up of one Indonesian, one Pakistani and three Myanmarese and constituted 5(15%) of the total cases. Males 24(71%) were more commonly affected. Most of the cases occurred between the age group of 40-49 years, 8(23%) and 60 years and above, 8(23%). Age group of 20-50 years constituted 20(60%) of the cases. The most common clinical presentations were fever with chills and rigors 26(76%), diarrhoea 20 (59%), right hypochondrium pain 17(50%), abdominal pain 17(50%), hepatomegaly 16 (47%) and jaundice 7(20%). All were discharged well after treatment except for one case of death in a 69-year-old Chinese male with amebic liver abscess.
Fulltext Newcastle disease virus degrades HIF-1α through proteasomal pathways independent of VHL and p53

Abd-Aziz N, Stanbridge EJ, Shafee N

J Gen Virol, 2016 Dec;97(12):3174-3182.
PMID: 27902314 DOI: 10.1099/jgv.0.000623

Newcastle disease virus (NDV) is a candidate agent for oncolytic virotherapy. Despite its potential, the exact mechanism of its oncolysis is still not known. Recently, we reported that NDV exhibited an increased oncolytic activity in hypoxic cancer cells. These types of cells negatively affect therapeutic outcome by overexpressing pro-survival genes under the control of the hypoxia-inducible factor (HIF). HIF-1 is a heterodimeric transcriptional factor consisting of a regulated α (HIF-1α) and a constitutive β subunit (HIF-1β). To investigate the effects of NDV infection on HIF-1α in cancer cells, the osteosarcoma (Saos-2), breast carcinoma (MCF-7), colon carcinoma (HCT116) and fibrosarcoma (HT1080) cell lines were used in the present study. Data obtained showed that a velogenic NDV infection diminished hypoxia-induced HIF-1α accumulation, leading to a decreased activation of its downstream target gene, carbonic anhydrase 9. This NDV-induced downregulation of HIF-1α occurred post-translationally and was partially abrogated by proteasomal inhibition. The process appeared to be independent of the tumour suppressor protein p53. These data revealed a correlation between NDV infection and HIF-1α downregulation, which highlights NDV as a promising agent to eliminate hypoxic cancer cells.
Fulltext Evaluation on physico-chemical properties of pink guava puree residue as bioresource

Mhd Abd Kader, K. A., Ab. Aziz, N., Aziz, A., Talib, A. T., Ahmad, N. H., Tan, C. P., et al.

International Food Research Journal, 2016;23(101):125-131.
MyJurnal

Pink Guava Puree (PGP) factory produces tons of residues from its unit operation [refiner (R),
siever (S), and decanter (D)]. These residues represent a waste of nutrients and can contribute
to environmental problem. However, it can benefit related industries if the properties of the
residues are known. Thus, this research aims to determine the compositions of the residues
from PGP processing factory in order to evaluate possible value-added by-product and energy
sources. The residues from each unit operation were being tested for proximate composition,
dietary fibre components, pH value, emulsifying activity (EA) and emulsifying stability (ES),
carbon-to-nitrogen (C/N) ratio, and sugar analysis. The sugar content was analysed using High
Performance Liquid Chromatography (HPLC-RI detector). Results showed that the residues
have good composition of carbohydrate (11.82–12.18%), and thus potential as carbon source
and can be a good substrate for fermentation. These residues may also benefit the food industry
as a good source of dietary fibre (18.63–29.86%). The pH value for these PGP residues is 4;
thus they were considered as acidic food by-product. The low pH value also contributed to the
low EA and ES value other than the low content of protein in the sample. C/N ratio for PGP
residue from R (46:1) is the lowest compared to the C/N ratio from S (84:1) and D (115:1). The
amount of sugars detected in the PGP residues in descending order were fructose > glucose >
sucrose.
Short and long-run causal effects of agriculture, forestry, and other land use on greenhouse gas emissions: evidence from China using VECM approach

Si R, Aziz N, Raza A

Environ Sci Pollut Res Int, 2021 Dec;28(45):64419-64430.
PMID: 34312755 DOI: 10.1007/s11356-021-15474-1

Climate change caused by different anthropogenic activities is a subject of attention globally. There is a concern on how to maintain a clean environment and at the same time achieve optimal use of land. To this end, this study examines the causal effects of land use including agricultural, forestry, and other land categories on greenhouse gas (GHG) emissions. The data for China is collected over the period 1990 to 2012 for the empirical examination. By employing vector error correction model (VECM), it is found that there is significant long-run causality among variables. However, in the short run expectedly, only land under agriculture has strong causality with the GHG emissions. The results in case of variance decomposition analysis highlight that land under agriculture and other use significantly causes the GHG emissions in the long run. Further, impulse responses of variables are also measured with the Cholesky one standard deviation. The results are robust and support the argument that different land uses cause GHG emissions in China. The study provides insights for policy makers to improve the activities occurring on agricultural and other land uses. Assessment of overall potential, including bio energy, needs to include analysis of trade-offs and feedbacks with land-use competition. Many positive linkages with sustainable development and with adaptation exist but are case and site specific as they depend on scale, scope, and pace of implementation.
Revisiting the role of forestry, agriculture, and renewable energy in testing environment Kuznets curve in Pakistan: evidence from Quantile ARDL approach

Aziz N, Sharif A, Raza A, Rong K

Environ Sci Pollut Res Int, 2020 Mar;27(9):10115-10128.
PMID: 31989501 DOI: 10.1007/s11356-020-07798-1

This paper assesses the Environmental Kuznets curve based on quantile behavior of the relationship between economic growth, forest area, agriculture production, renewable energy, and environmental degradation. The current literature generally used a single indicator to address environmental issues; however single indicator neither measures overall environmental conditions nor does specify that the environment issue is generally diminishing. Our study is the first one that used ecological footprint (EF) as an indicator to test environmental Kuznets curve (EKC) hypothesis for Pakistan by employing recent approach of quantile autoregressive distributed lag (QARDL) initiated by Cho et al. (J Econ 188(1):281-300, 2015). The result of this study validates the EKC hypothesis for Pakistan and shows quantile-dependent relationship, and in that case, using the conventional methods may somewhat lead to biased results. Moreover, the rejection of the null hypothesis of parameter constancy is also confirmed by Wald test. In the long run, the findings of renewable energy consumption and forest area show significant negative effects on ecological footprints, which indicates that by increasing renewable energy usage and forest area, ecological footprints can be minimized. Interestingly, the short-term effects of agricultural production findings on EF show statistically negative results. This illustrates that EF can also be reduced in the agriculture sector by adopting environment-friendly technologies. In order to create efficient policies for environment deterioration, the empirical findings of the current analysis can be used as a guideline for policy implications.
The role of natural resources, globalization, and renewable energy in testing the EKC hypothesis in MINT countries: new evidence from Method of Moments Quantile Regression approach

Aziz N, Sharif A, Raza A, Jermsittiparsert K

Environ Sci Pollut Res Int, 2021 Mar;28(11):13454-13468.
PMID: 33180287 DOI: 10.1007/s11356-020-11540-2

We employ the new Method of Moments Quantile Regression approach to expose the role of natural resources, renewable energy, and globalization in testing Environment Kuznets Curve (EKC) in MINT panel covering the years 1995-2018. The outcome validates the EKC curve between economic progress and carbon emissions from the third quantile to the extreme highest quantile. The result also shows that natural resources increase CO2 emissions at the lowest quantile and then turn insignificant from the middle to the highest quantiles due to the potential utilization of resources in a sustainable manner. The renewable energy mitigates CO2 emissions at the lower half quantiles. Still, for upper quantiles, the results are unexpected and imply that the countries' total energy mix depends heavily on fossil fuels. As far as globalization is concerned, the significant results from medium to upper quantiles reveal that as globalization heightens due to foreign direct investment or trade, energy consumption also expands, leading to the worst environment quality. Thus, the present study's consequences deliver guidelines for policymakers to utilize natural resources sustainably and opt technologies based on clean energy, which may offset environmental degeneration.
Fulltext Social expectations and government incentives in Malaysia's COVID-19 vaccine uptake

Abdul Aziz NI, Flanders S, Nungsari M

PLoS One, 2022;17(9):e0275010.
PMID: 36156604 DOI: 10.1371/journal.pone.0275010

High vaccination rates are integral to reducing infection and severity rates of COVID-19 infections within a community. We examine the role of social expectations in COVID-19 vaccination take-ups and its interaction with potential government actions in Malaysia. We find that individuals' expectations of others in their social groups towards vaccination predicts those individuals' vaccination registrations. Using a vignette experiment, we examine the extent of normative expectations in normalizing pro-vaccination behavior beyond an individual's reference group. We find that unless moderated by a high level of public trust, individuals prefer punitive policies as a way to increase vaccination rates in their communities.
Bortezomib attenuates HIF-1- but not HIF-2-mediated transcriptional activation

Abd-Aziz N, Stanbridge EJ, Shafee N

Oncol Lett, 2015 Oct;10(4):2192-2196.
PMID: 26622817

Bortezomib is the first proteasomal inhibitor (PI) to be used therapeutically for treating relapse cases of multiple myeloma and mantle cell lymphoma. A proposed mechanism for its action is that it prevents the proteasomal degradation of proapoptotic proteins, leading to enhanced apoptosis. Although the α subunit of hypoxia-inducible factor (HIF)-1 is not degraded with bortezomib treatment, the heterodimeric HIF-1 fails to transactivate target genes. HIF-1 and HIF-2 are related hypoxia-inducible transcription factors that are important for the survival of hypoxic tumor cells. The majority of reports have focused on the effects of bortezomib on the transcriptional activities of HIF-1, but not HIF-2. The present study investigated the effects of bortezomib on HIF-2 activity in cancer cells with different levels of HIF-1α and HIF-2α subunits. HIF-α subunit levels were detected using specific antibodies, while HIF transcriptional activities were evaluated using immunodetection, reverse transcription-polymerase chain reaction and luciferase reporter assay. Bortezomib treatment was found to suppress the transcription and expression of CA9, a HIF-1-specific target gene; however, it had minimal effects on EPO and GLUT-1, which are target genes of both HIF-1 and HIF-2. These data suggest that bortezomib attenuates the transcriptional activity only of HIF-1, and not HIF-2. This novel finding on the lack of an inhibitory effect of bortezomib on HIF-2 transcriptional activity has implications for the improvement of design and treatment modalities of bortezomib and other PI drugs.
Fulltext Molecular DNA identification of medicinal plants used by traditional healers in Malaysia

Aziz NA, Ahmad MI, Naim DM

Genet. Mol. Res., 2015;14(4):15937-47.
PMID: 26662385 DOI: 10.4238/2015.December.7.5

Plants have been used throughout human history for food and medicine. However, many plants are toxic, and cannot easily be morphologically distinguished from non-toxic plants. DNA identification solves this problem and is widely used. Nonetheless, plant DNA barcode identification faces a number of challenges, and many studies have been conducted to find suitable barcodes. The present study was conducted to test the efficiency of commonly used primers, namely ITS2, rpoC1, and trnH-psbA, in order to find the best DNA barcode markers for the identification of medicinal plants in Malaysia. Fresh leaves from 12 medicinal plants that are commonly used by Malay traditional healers were collected from the Tropical Spice Garden, Pulau Pinang, and subjected to polymerase chain reaction amplification using ITS2, rpoC1, and trnH-psbA DNA markers. We found that trnH-psbA is the best DNA marker for the species-level identification of medicinal plants in Malaysia.
Fulltext Does the duration of smoking cessation have an impact on hospital admission and health-related quality of life amongst COPD patients?

Abu Hassan H, Abd Aziz N, Hassan Y, Hassan F

Int J Chron Obstruct Pulmon Dis, 2014;9:493-8.
PMID: 24868154 DOI: 10.2147/COPD.S56637

BACKGROUND: Lack of awareness among ex-smokers on the benefits of sustaining smoking cessation may be the main cause of their smoking relapse. This study explored health-related quality of life (HRQoL) and hospital admission amongst chronic obstructive pulmonary disease (COPD) patients according to the duration of smoking cessation.
MATERIALS AND METHODS: This study recruited COPD patients from a chest clinic who agreed to participate in a medication therapy-adherence program from January to June 2013. They were interviewed during their visits to obtain information regarding their smoking history and HRQoL. They were divided into three groups according to smoking status (sustained quitters, quit ≥5 years; quitters, quit <5 years; and smokers, smoking at least one cigarette/day). The effects of the duration of cessation on HRQoL and hospital admission were analyzed using a multinomial logistic model.
RESULTS: A total of 117 participants with moderate COPD met the inclusion criteria, who were comprised of 41 sustained quitters, 40 quitters, and 36 smokers. Several features were similar across the groups. Most of them were married elderly men (aged >64 years) with low-to-middle level of education, who smoked more than 33 cigarettes per day and had high levels of adherence to the medication regimen. The results showed that sustained quitters were less likely to have respiratory symptoms (cough, phlegm and dyspnea) than smokers (odds ratio 0.02, confidence interval 0-0.12; P<0.001). The hospital admission rate per year was increased in quitters compared to smokers (odds ratio 4.5, confidence interval 1.91-10.59; P<0.005).
CONCLUSION: A longer duration of quitting smoking will increase the benefits to COPD patients, even if they experience increased episodic respiratory symptoms in the early period of the cessation. Thus, the findings of this study show the benefits of early smoking cessation.
KEYWORDS: HRQoL; chronic obstructive pulmonary disease (COPD); hospital admission and hospital stay
Study site: Chest Clinic, Hospital Melaka, Malaysia
Adverse drug events in hospitalized patients with chronic kidney disease

Hassan Y, Al-Ramahi RJ, Aziz NA, Ghazali R

Int J Clin Pharmacol Ther, 2010 Sep;48(9):571-6.
PMID: 20860910

BACKGROUND AND OBJECTIVE: Adverse drug events (ADEs) are a common cause of hospitalization and in-hospital complications. The aim of this study was to determine the rates, types, severity and preventability of pre-admission and in-hospital ADEs in patients with chronic kidney disease (CKD).
METHODS: This study was conducted at the nephrology unit at Penang General Hospital. A random sample of 300 adult patients with CKD was included. Medical records and charts were reviewed by a clinical pharmacist every work day to find any evidence of errors or complications related to drug use. If a suspected ADE was found, further investigations were carried out to assess the causality, severity and preventability of the event.
RESULTS: A total of 159 ADEs were reported in 122 (40.7%) of the patients. We found 86 suspected pre-admission ADEs in 68 (22.7%) of the patients. These were either the cause of admission for some patients or discovered by the initial physical examination and laboratory investigations. During hospitalization, 64 (21.3%) patients had 73 suspected ADEs. Out of the total 159 suspected ADEs, it was highly probable that 31 events were due to medication, while 61 were of lower probability, and 67 were merely possible. A total of 48 (30.2%) events was considered preventable. 46 events (28.9%) were serious, 93 (58.5%) were less serious and 20 (12.6%) were insignificant. The medication classes most frequently involved in ADEs were diuretics, antibacterials, drugs used for diabetes mellitus, antithrombotic agents, mineral supplements and antihypertensive drugs.
CONCLUSION: ADEs are very common in hospitalized CKD patients, and some of these events are preventable. The service of a clinical pharmacist may help to reduce ADEs.
Knowledge of blood-borne infectious diseases and the practice of universal precautions amongst health-care workers in a tertiary hospital in Malaysia

Hamid MZ, Aziz NA, Anita AR, Norlijah O

Southeast Asian J. Trop. Med. Public Health, 2010 Sep;41(5):1192-9.
PMID: 21073041

This study aimed to assess the knowledge of blood-borne diseases transmitted through needle stick injuries amongst health-care workers in a tertiary teaching hospital. We also aimed to assess the practices of universal precautions amongst these workers and its correlation with the facts. We carried out a cross-sectional study from January to July 2008 involving various levels of health-care workers in Serdang Hospital, Selangor, Malaysia. A self-administered questionnaire assessing knowledge of blood-borne diseases and universal precautions, and actual practice of universal precautions was used. Two hundred fifteen respondents participated in this study; 63.3% were staff nurses. The mean knowledge score was 31.84 (SD 4.30) and the mean universal practice score was 9.0 (SD 2.1). There was a small, positive correlation between knowledge and actual practice of universal precautions (r = 0.300, n = 206, p < 0.001) amongst the cohort studied. Factors such as age and years of experience did not contribute towards acquisition of knowledge about blood-borne illnesses or the practice of universal precautions.
Drug use and dosing in chronic kidney disease

Hassan Y, Al-Ramahi R, Abd Aziz N, Ghazali R

Ann Acad Med Singap, 2009 Dec;38(12):1095-103.
PMID: 20052447

One of the most important drug-related problems in patients with chronic kidney disease (CKD) is medication dosing errors. Many medications and their metabolites are eliminated through the kidney. Thus, adequate renal function is important to avoid toxicity. Patients with renal impairment often have alterations in their pharmacokinetic and pharmacodynamic parameters. The clearance of drugs eliminated primarily by renal filtration is decreased by renal disease. Therefore, special consideration should be taken when these drugs are prescribed to patients with impaired renal function. Despite the importance of dosage adjustment in patients with CKD, such adjustments are sometimes ignored. Physicians and pharmacists can work together to accomplish safe drug prescribing. This task can be complex and require a stepwise approach to ensure effectiveness, minimise further damage and prevent drug nephrotoxicity.
Fulltext Skills amongst parents of children with asthma: a pilot interventional study in primary care setting

Aziz NA, Norzila MZ, Hamid MZ, Noorlaili MT

Med J Malaysia, 2006 Dec;61(5):534-9.
PMID: 17623952 MyJurnal

The increasing prevalence of childhood asthma has become a concern among health practitioners. Effective management emphasizes long-term management and inhaled therapy has become the mainstay home management for children. However, proper utilization of medication is pertinent in improving control. Proper asthma education is mandatory in improving skills and confidence amongst parents. To assess the skills of using the metered-dose inhaler (MDI) with a spacer among asthmatic children before and after educational intervention and to analyse any difficulties which may occur amongst the participants in executing the assessment steps. A cross-sectional clinic based study involving 85 parents and children with asthma. A standardized metered-dose inhaler-spacer checklist of eight steps of medication usage and five steps of cleaning the spacer were used as the assessment tools for pre and post intervention. The performance on using the inhaler-spacer and spacer cleaning knowledge pre and two months post intervention was evaluated. One point was given for each correct step and zero points for incorrect answers/steps. The mean score for skills of inhaler technique improved significantly after educational intervention (3.51 to 6.01, p < 0.0001) as did the mean score for parental knowledge of spacer cleaning technique (1.35 to 3.16, p 0.001). Analysis showed only a limited improvement even after an educational session in three steps of inhalation technique: step 5 (23.5%/69.4%), step 6 (28.2%/68.2%) and step 7 (25.9%/61.2%). Parents with asthmatic children had poor skills in utilizing their children's medication. A short-term educational intervention was able to improve overall knowledge and skill but certain skills need more emphasizing and training.
Study site: Klink HUKM Taman Jaya, Cheras, Kuala Lumpur, Malaysia (primary care clinic for Hospital University Kebangsaan Malaysia)
Discontinuation of penicillamine in the absence of alternative orphan drugs (trientine-zinc): a case of decompensated liver cirrhosis in Wilson's disease

Ping CC, Hassan Y, Aziz NA, Ghazali R, Awaisu A

J Clin Pharm Ther, 2007 Feb;32(1):101-7.
PMID: 17286794

To report a case of early-decompensated liver cirrhosis secondary to discontinuation of penicillamine therapy in a patient with Wilson's disease.
Patients' adherence to secondary prevention pharmacotherapy after acute coronary syndromes

Kassab Y, Hassan Y, Abd Aziz N, Ismail O, AbdulRazzaq H

Int J Clin Pharm, 2013 Apr;35(2):275-80.
PMID: 23283596 DOI: 10.1007/s11096-012-9735-y

BACKGROUND: Secondary prevention pharmacotherapy improves outcomes after acute coronary syndrome (ACS). However, poor medication adherence is common, and various factors play a role in adherence.
OBJECTIVES: The purpose of this study was to evaluate patients' level of adherence to evidence-based therapies at an average of 6 months after discharge for acs and to identify factors associated with self-reported non-adherence.
SETTING: This prospective study was conducted in the outpatient cardiac clinics of Hospital Pulau Pinang, located in Penang Island, a northern state in Malaysia.
METHOD: A random sample of ACS patients (n = 190) who had been discharged on a regimen of secondary preventive medications were included in this study. Six months after discharge and during their scheduled follow-up appointments to cardiac clinics, patients were interviewed using the translated eight-item Morisky Medication Adherence Scale.
MAIN OUTCOME MEASURE: self-reported patients' adherence to medication.
RESULTS: Six months following their hospital discharge, only 35 patients (18.4 %) reported high adherence. Medium adherence was reported in majority of patients (51.1 %). Low adherence was reported in 58 patients (30.5 %). Forgetfulness was the most frequently reported reason for patients' non-adherence to their medications (23.2 %). Furthermore, this study identified 5 factors-namely age, employment status, ACS subtypes, number of comorbidities, and number of prescription medications per day-that may influence Patients' level of adherence to the prescribed regimens.
CONCLUSIONS: Our findings revealed a problem of non-adherence to secondary prevention medications among patients with ACS in Malaysia. Furthermore, this study demonstrates that older patients, unemployed patients, patients with more comorbid conditions, and those receiving multiple medications are less likely to adhere to their prescribed medications 6 months after hospital discharge.

Study site: outpatient cardiac clinics of Hospital Pulau Pinang
Fulltext Severe hypertriglyceridemia in a nondiabetic treated with low dose insulin infusion

Tong CV, Velaiutham S, Aziz NA, Lim SL, Khaw CH

Med J Malaysia, 2015 Aug;70(4):249-50.
PMID: 26358023

We report a case of a 54-year-old man with severe HTG which did not respond to conventional anti lipid therapies. He was treated with intravenous insulin and concurrent dextrose infusions which led to a dramatic reduction in serum triglyceride levels.
T cell receptor beta chain RFLP in Chinese, Indians and Malays from Singapore

Tan JA, Tay JS, Aziz NB, Saha N

Hum. Hered., 1996 Jul-Aug;46(4):236-8.
PMID: 8807327

Restriction fragment length polymorphism (RFLP) of the gene encoding the beta chain of the human T cell receptor (TcR) was studied in three ethnic groups in Singapore by Southern blotting. Polymorphism in the beta chain gene was identified in BglII-digested DNA samples using a 770-bp TcR beta cDNA clone containing the joining and constant region segments. The TcR beta/BglII polymorphism was studied in 136 Chinese, 93 Indian and 88 Malay samples. The frequency of the less frequent allele (TcR beta*2) in all the ethnic groups was significantly lower (0.15-0.29, p < 0.01) than that in the Caucasians (0.46). Indians had a significantly lower frequency of this allele (0.15) than the Chinese (0.29) and Malays (0.26).
Vancomycin administration in continuous ambulatory peritoneal dialysis: the risk of ototoxicity

Gendeh BS, Gibb AG, Aziz NS, Kong N, Zahir ZM

Otolaryngol Head Neck Surg, 1998 Apr;118(4):551-8.
PMID: 9560111

A prospective study was undertaken in 16 patients with chronic renal failure on continuous ambulatory peritoneal dialysis, with 22 episodes of peritonitis treated with vancomycin, a known ototoxic agent. Twelve patients had one episode each, and four had recurrent peritonitis. Each treatment course consisted of two infusions of vancomycin (30 mg/kg body weight) in 2 L of peritoneal dialysate administered at 6-day intervals. Serum vancomycin analyzed by enzyme immunoassay showed a mean trough level of 11.00 microg/ml on day 6 and mean serum levels of 33.8 and 38.6 microg/ml about 12 hours after administration on days 1 and 7, respectively. Similar levels, well within the therapeutic range, were encountered with repeated vancomycin therapy for recurrent episodes of peritonitis, suggesting that no changes occurred in the pharmacokinetic profile of the drug. Pure-tone audiometry, electronystagmography, and clinical assessment performed during each course of treatment showed no evidence of ototoxicity even on repeated courses of vancomycin therapy. The results suggest that vancomycin therapy when given in appropriate concentrations as a single therapeutic agent is both effective and safe. We believe, however, that vancomycin administered in combination with an aminoglycoside may produce ototoxic effects that may be greatly aggravated, possibly because of synergism.
Gentamicin administration via peritoneal dialysis fluid: the risk of ototoxicity

Gendeh BS, Said H, Gibb AG, Aziz NS, Zahir ZM

J Laryngol Otol, 1991 Dec;105(12):999-1001.
PMID: 1787382

In a prospective study on 47 patients, 16 mg of gentamicin per two litres dialysate was administered intraperitoneally at every cycle of intermittent peritoneal dialysis, carried out over the course of several days. Serum gentamicin sampling, pure tone audiometry and caloric tests were performed before and during the treatment. The gentamicin levels reached at the end of the thirtieth cycle were observed to be low. In view of this, the risk of acute ototoxicity was considered to be minimal. This was confirmed by the absence of clinical audiometric or vestibulometric evidence of toxicity.

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