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Journey of the Human Papillomavirus (HPV) in a Developing Country over 5 Years (2010 - 2015)

Danial M, Sivasangari S, Arulappen A, Ong L

Asian Pac J Cancer Prev, 2016;17(3):1363-8.
PMID: 27039773

Human papillomavirus (HPV) is a prevalent sexually transmitted infection with serious medical, sexual, and relationship consequences. HPV vaccine protection is available globally but unfortunately vaccine uptake is inconsistent everywhere. From this study, it was observed that the awareness of cervical cancer, HPV virus and HPV vaccination in Malaysia is high, at 83.1%, 73.9% and 73.3% of respondents, respectively. However, a considerably low percentage had undergone HPV vaccination (8.6%) compared to those who had experienced a Pap smear (32.9%). Awareness between cervical cancer and HPV virus and vaccination was low. Health care providers and the governing bodies have to play a vital role in disseminating holistic information on the vaccine and the importance of getting vaccinated to the public more vigorously in Malaysia.
Evaluation of reported adverse drug reactions in antibiotic usage: a retrospective study from a tertiary care hospital, Malaysia

Arulappen AL, Danial M, Sulaiman SAS

Front Pharmacol, 2018;9:809.
PMID: 30177879 DOI: 10.3389/fphar.2018.00809

Adverse drug reaction (ADR) primarily caused by many drugs including antibiotics. At present, the incidence and pattern of ADR caused by antibiotics have remained as neglected area in Malaysia. This study was conducted to determine the incidence and analyze the pattern of ADR caused by antibiotics among patients in a tertiary care hospital. It is a 2-year retrospective observational study conducted at Hospital Pulau Pinang, Malaysia. All eligible patients who had antibiotic prescribed belonging to any age group either from outpatient or inpatient that had experienced ADR was included in this study. The outcomes were measured with the aid of Naranjo's and Hartwig's scales. The incidence of the ADRs among patients prescribed with antibiotics in Hospital Pulau Pinang is about 1.1%. Vancomycin and Trimethoprim/Sulfamethoxazole both are considered to be the major contributors to ADR incidences. The skin was the most affected organ by ADRs followed by gastrointestinal system. Most of the severe ADRs were caused by Penicillin. The causality relationship of all the severe reactions was mostly probable. General Medicine unit had reported the highest number of ADRs caused by antibiotics. The common manifestations of ADRs are acute kidney injury and exanthem. In addition, majority of the ADRs caused by antibiotics were reversible. A large multicenter study is suggested to confirm the present findings.

Study site: Hospital Pulau Pinang
Fulltext Mitigation of COVID-19 clusters in Malaysia

Danial M, Arulappen AL, Ch'ng ASH, Looi I

J Glob Health, 2020 Dec;10(2):0203105.
PMID: 33403108 DOI: 10.7189/jogh.10.0203105
The Impact of Antimicrobial Stewardship Program on Injudicious Use of Cefuroxime

Arulappen AL, Danial M, Haron N, Hau LC, Khan AH

Front Pharmacol, 2020;11:565818.
PMID: 33664664 DOI: 10.3389/fphar.2020.565818

Antimicrobial stewardship (AMS) program promotes the judicious use of antimicrobials. Hence, this study was conducted to analyze the impact of stewardship on the prescribing pattern of cefuroxime injection among the surgeons as perioperative antimicrobial prophylaxis (PAP). This study was conducted retrospectively in Malaysia. Various outcomes were measured including cefuroxime usage, compliance with the guidelines, surgical site infections, and cost savings. A total of 1,601 patients were recruited in the study. In terms of usage, the total defined daily dose (DDD) prior to the intervention was 202 DDD/100 procedures compared to that after intervention which was 144 DDD/100 procedures (p < 0.05). On the other hand, the excessively long administration of PAP dropped from 94.4 to 30.3% (p < 0.001). Focusing on the compliance with the newly developed local guidelines, it has increased from 53 to 94.3% after the interventions were made (p < 0.001), whereas the rate of surgical site infections was reduced from 17.0 to 9.0%. The cost of antibiotic being used has significantly reduced after the study intervention (p = 0.007). The quality of PAP directly impacts the antimicrobial usage, the surgical site infections, and the total cost involved. Thus, it is crucial to maintain the standard of PAP at all times in healthcare settings.
Baseline predictors of antibiotics de-escalation from empirical therapies in an intensive care unit: a five-year retrospective study

Arulappen AL, Khan AH, Danial M, Hasan SS, Chow TS, Ahmed NJ, et al.

BMC Infect Dis, 2025 Mar 17;25(1):369.
PMID: 40097937 DOI: 10.1186/s12879-025-10752-6

BACKGROUND: The alarming rate of bacterial resistance has urged for vigorous antibiotic de-escalation cultures worldwide. However, the art of de-escalation remains challenging as most clinicians have the fear or stigma that antibiotic de-escalation is strongly associated with higher mortality. This study aimed to determine the factors strongly correlated with higher mortality rates after antibiotic de-escalation and possibly serve as a benchmark study for developing a validated antibiotic de-escalation tool in the near future.
METHOD: This retrospective study was conducted on patients hospitalized in a medical intensive care unit of a referral tertiary care center and subjected to antibiotics de-escalation over five years. Independent factors associated with mortality post antibiotics de-escalation were assessed. Various data were collected, including patient demographics, admission and discharge dates, a primary source of infection and free of infection status, choices of antibiotic used and de-escalation history, vital signs, data on X-ray changes, relevant laboratory investigations, microbiological culture history, mortality status, history of COVID-19 infection, presence of central line, number of vasopressors used, ventilator settings and respective SOFA scores.
RESULTS: Prevalence of mortality among patients continued on broad-spectrum antibiotics empirically is remarkable. Through this study, it was found that the significant factors associated with mortality post antibiotic de-escalation were hospital-acquired infection (HAI) (Adjusted OR: 12.56; 95% CI: 2.88,54.98; p