Phenytoin follows Michaelis-Menten, a non-linear pharmacokinetics that occurs when drug molecules saturates the enzymes ability to metabolise the drug. When this occurs, steady state phenytoin serum concentration increases in a disproportionate manner after a dosage increase. General population data are usually used for the phenytoin dose calculation. However, many studies show that population pharmacokinetic parameters of phenytoin have high variations. Thus, use of specific local pharmacokinetic parameters for each population group in estimating individualised phenytoin dose can reduce phenytoin toxicity cases. This prospective, observational study was conducted to estimate a local Vmax and Km of phenytoin for adult epileptic patients in neurological ward and clinic at Hospital Pulau Pinang, Malaysia. All therapeutic drug monitoring of oral capsule phenytoin were studied in a three-month data collection period. Out of the 17 subjects in our study, there are 13 male subjects (76.47%) and 4 female subjects (23.53%). A total 11 Malay subjects (64.71%), 4 Chinese subjects (23.53%) and 2 Indian subjects (11.76%) were included. Median Vmax and Km were found to be 8.25 mg/kg/day and 3.80 mg/l. Male subjects have a higher Vmax (8.30 mg/kg/day) but a lower Km (3.3 mg/l). Chinese population has the highest Vmax (8.80 mg/kg/day). For Km, Indian population is the highest, with a value of 5.5 mg/l. From our study, gender does not correlate with Vmax and Km of phenytoin (p-value > 0.05). Ethnicity was also found to have no association with Vmax and Km (p-value > 0.05). Local Vmax (8.25 mg/kg/day) is higher and Km (3.8 mg/l) is lower when compared with standard Vmax (7 mg/kg/day) and Km (4 mg/l) obtained from Caucasian population.
An assessment on the use of acetaminophen (paracetamol) among consumers would
provide guidance for implementing strategies to overcome the misuse of acetaminophencontaining
products. This study aims to evaluate Malaysian consumers’ practices,
perceptions and understanding regarding the use of acetaminophen. A semi-structured
qualitative study utilising face-to-face interviews was conducted among 14 consumers
aged 24 to 82 years old who live in Pulau Pinang, Malaysia. Transcripts of all the
interviews were generated from audio tapes and were analysed for the issues and themes
emerging from the text; the transcripts were independently coded and verified by experts.
The consumers had a positive attitude towards the popularity, safety and efficacy of
acetaminophen. The consumers predominantly used acetaminophen for pain and fever.
Some consumers tended to increase the frequency and dosage of acetaminophen
consumption if their condition persisted. Consumers had difficulty recognising the generic
acetaminophen-containing products available in the market. Health literacy investigations
have found that consumers have a lack of knowledge regarding the correct dosing
regimen for acetaminophen in adults and children. The consumers were not aware of the
precautions and toxicities of acetaminophen. To increase awareness of acetaminophen
poisoning in Malaysia, the consumers suggested that educational tools regarding the
proper use of acetaminophen are needed from the Ministry of Health and policy-makers.
The information gained from this study emphasises the importance of educational
interventions to educate the public on the proper use of acetaminophen in Malaysia.
Medicine is an essential need for many people to treat their illness. Creating awareness among general public regarding medicines use and common illnesses can promote healthy lifestyles among them. The objectives of this study are to determine public knowledge and perception of medicines use and; to explore the pattern of medicines used in the past 3 months. A cross‐sectional survey was carried out among the general public in Pulau Pinang. People who were using medications during the time of the survey or in the last 3 months were invited to participate in the study. Only Malaysians ≥18 years were selected by convenient sampling to participate in the survey. The results of this study showed that most of the respondents were using some sort of medications during the last 3 months. Around 30% did not read the label of the medicines before use. Furthermore, participants had low awareness towards some aspects of medicines use such as the name of generic and brand medicines, overuse of paracetamol or vitamins and their side effects, discontinuation of antibiotics, storing ointments and syrups in refrigerator, and the side effects of medicines registered in Malaysia. Efforts are still needed to increase the awareness of medicines use among the general public. More quantitative studies are needed to understand the factors that may influence public knowledge and perceptions on the use of medicines.
Shared-decision making (SDM), occasionally called “participatory governance” is the approach in healthcare to ensure that patients have the right to participate effectively in the decision-making (DM) process. The aim of this research was to discuss the external aspect of SDM and put forward applicable solutions to ensure SDM at both patient and physician levels. A standardised validated nine-item SDM questionnaire (patient version SDM-Q-9) was employed. SPSS version 25 was used to perform data analysis. Multiple tests such as Mann-Whitney U and Jonckheere-Terpstra were used. Kendall’s Tau coefficient was used for interpretation of the significant relationship among all items of SDM-Q-9 and education. A total of 465 chronically ill patients took part, where majority (63.4%) of patients was above the age of 47. The cohort was dominated by females (67.5%) with 92% of the sample was married. Majority (86.9%) of the patient reported not involved in any decision. During analysis, considerable association was reported between gender and all items of SDM-Q-9, where more men were involved in SDM when compared with women. Our findings did produce significant association between education and SDM-Q-9, which reveals that increase in education can improve the SDM. SDM should not be limited to chronic or emergency in practice. Specific and tailored shared medical DM programmes must be developed for low literacy population implementation. SDM is to be supported at policy and operation levels.
Non-communicable diseases are raising much concern in Malaysia due to changing lifestyles which is parallel to the economic development. Intervention program like community health screening (CHS) allows early detection, prevention and reduction of chronic diseases and its risk factors. This study aimed to assess the obesity level, risk factors for chronic diseases and blood cholesterol level among the Malaysian public. A health screening program was conducted on April 2012 at Sungai Pinang township, in the state of Pulau Pinang, Malaysia. A convenient sample of the general public was recruited. Screening tests consisted of measurements of blood pressure, body mass index (BMI), body fat percentage, visceral fat accumulation (VFA) and blood cholesterol. Chi-square analysis was used to determine the difference between prevalence of obesity among subjects with different age groups and gender. Out of 76 recruited subjects, 23.7% had systolic blood pressure of 140 mmHg or greater and 7.9% had diastolic blood pressure of 90 mmHg or greater. Approximately 51% of the subjects were obese (BMI ≥ 27.5 kg/m2). Body fat percentage was high in 63.6% and 63.0% of male and female subjects, respectively. High VFA (≥15) was found in 19.8% of subjects. There were three newly discovered hypercholesterolemia cases (total cholesterol ≥ 5.2 mmol/L). Counselling was given during the health screening program to help the public to take necessary measures to reduce risk factors while preventing complication resulting from these chronic diseases. In conclusion, prevalence of obesity found to be high in the present screened population.