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Assessing Retrospective Data on the Management of Ischemic Stroke

Zulkifly H, Othman PN, Shaharuddin S, Long CM

Value Health, 2015 Nov;18(7):A381.
PMID: 26532154 DOI: 10.1016/j.jval.2015.09.810
Interplay of medication errors and the separation of dispensing

Salmasi S, Long CM, Khan TM

Res Social Adm Pharm, 2016 Jan-Feb;12(1):171-2.
PMID: 26256742 DOI: 10.1016/j.sapharm.2015.07.004
COVID-19: Critical Role of Angiotensin 1-7 in ACE2 Modulation

Tan CS, Yeoh SF, Long CM

Ann Acad Med Singap, 2020 06;49(6):398-400.
PMID: 32712639
Fulltext Surface Dissolution UV Imaging for Investigation of Dissolution of Poorly Soluble Drugs and Their Amorphous Formulation

Long CM, Tang K, Chokshi H, Fotaki N

AAPS PharmSciTech, 2019 Feb 13;20(3):113.
PMID: 30761437 DOI: 10.1208/s12249-019-1317-z

The aim of this study is to investigate the dissolution properties of poorly soluble drugs from their pure form and their amorphous formulation under physiological relevant conditions for oral administration based on surface dissolution ultraviolet (UV) imaging. Dissolution of two poorly soluble drugs (cefuroxime axetil and itraconazole) and their amorphous formulations (Zinnat® and Sporanox®) was studied with the Sirius Surface Dissolution Imager (SDI). Media simulating the fasted state conditions (compendial and biorelevant) with sequential media/flow rate change were used. The dissolution mechanism of cefuroxime axetil in simulated gastric fluid (SGF), fasted state simulated gastric fluid (FaSSGF) and simulated intestinal fluid (SIF) is predominantly swelling as opposed to the convective flow in fasted state simulated intestinal fluid (FaSSIF-V1), attributed to the effect of mixed micelles. For the itraconazole compact in biorelevant media, a clear upward diffusion of the dissolved itraconazole into the bulk buffer solution is observed. Dissolution of itraconazole from the Sporanox® compact is affected by the polyethylene glycol (PEG) gelling layer and hydroxypropyl methylcellulose (HPMC) matrix, and a steady diffusional dissolution pattern is revealed. A visual representation and a quantitative assessment of dissolution properties of poorly soluble compounds and their amorphous formulation can be obtained with the use of surface dissolution imaging under in vivo relevant conditions.
Fulltext Empirical use of antibiotic therapy in the prevention of early onset sepsis in neonates: a pilot study

Manan MM, Ibrahim NA, Aziz NA, Zulkifly HH, Al-Worafi YM, Long CM

Arch Med Sci, 2016 Jun 1;12(3):603-13.
PMID: 27279855 DOI: 10.5114/aoms.2015.51208

To identify and assess the characteristics, risk and outcome of neonates treated with empiric antibiotics for suspected early onset sepsis (EOS).
Fulltext Relation of the time in therapeutic range (TTR) of warfarin to bleeding incidences in patients with atrial fibrillation [Abstract]

Jasmi MA, Mazlan MN, Shaharuddin S, Zulkifly HH, Long CM, Hashim R, et al.

Value Health, 2014 Nov;17(7):A478.
PMID: 27201388 DOI: 10.1016/j.jval.2014.08.1375

Conference abstract;
Objectives: Warfarin use in atrial fibrillation has been established for preventing occurrence of stroke in patients with atrial fibrillation. However, safety and clinical monitoring of warfarin use is crucial due to its risk of bleeding complications. This study aims to compare and establish relation of time in therapeutic range (TTR) of warfarin in patients with atrial fibrillation in the first 6 months and 6 month thereafter of anticoagulation therapy.
Methods: This is a retrospective study carried out at a tertiary-care hospital with anticoagulation clinic in the state of Selangor, Malaysia. Data collected included patients’ demographics, co-morbidities, and international normalized ratio (INR). TTR were determined using Rosendaal method based on records found in database (INR Desk 4.0 system) and patients’ hemorrhage events were also recorded. Samples of the study were patient who started warfarin from January 2009 until March 2013.
Results: A total of 167 patients with atrial fibrillation were enrolled and only 6% (n=10) achieved TTR of more than 75% for the first 6 months of warfarin use as compared to 16.8% (n=28) of TTR more than 75% 6 months thereafter. As for bleeding incidences, 29% (n=45) of patients in the group of TTR less than 75% in the first 6 months had bleeding complications as compared to 18.7% (n=26) in patients of TTR less than 75% 6 months after.
Conclusions: A more regular follow up is necessary during the first 6 months of new warfarin users as they tend to be out of the TTR and have a higher bleeding risk.
Study site: anticoagulation clinic, tertiary hospital, Selangor, Malaysia
Preliminary study of safety and efficacy of warfarin versus dabigatran in atrial fibrillation patients in a tertiary hospital in Malaysia [Abstract]

Mohd Hajiri M, Shaharuddin S, Long CM, Hashim R, Zulkifly HH, Kasim SS, et al.

Value Health, 2015 Nov;18(7):A378.
PMID: 26532133 DOI: 10.1016/j.jval.2015.09.795

Conference abstract:
Objectives: Warfarin has been used for more than 50 years as stroke prophylaxis in patients with atrial fibrillation. New oral anticoagulant, Dabigatran, was developed and shown to be safer and more efficacious compared to Warfarin due to its lower tendency of bleeding and in reducing stroke incidences. This study aims to compare the pattern of anticoagulants used and to assess their safety and efficacy by evaluating bleeding and stroke occurrences in both groups.
Methods: This is a retrospective study carried out at a hospital with hematology clinic in the state of Selangor, Malaysia. The samples of the study were patients with atrial fibrillation, prescribed with warfarin or dabigatran. Data collected includes patients’ demographics, co-morbidities, and stroke and haemorrhage events.
Results: A total of 71 patients were recruited in this study with 21, 21 and 29 patients were on Warfarin, Dabigatran 110 mg and Dabigatran 150 mg respectively. Out of 50 Dabigatran users, 36 of them are warfarin-experienced. 1 out of 21 patients on warfarin experienced stroke while none in both 110 and 150mg dabigatran group. A total of 11 (52.4%) of warfarin patients experienced bleeding with 2 of them having major bleeding whereas, only 4 (8%) out of 50 dabigatran patients experienced minor bleeding, 1 in patient who were on Dabigatran 150mg and 3 patients who were on Dabigatran 110mg.
Conclusions: The pattern of anticoagulant used for stroke prophylaxis in atrial fibrillation is slowly changing from Warfarin to Dabigatran. Evaluation of safety and efficacy profile of Warfarin shows that Warfarin requires more extensive management and monitoring in order to achieve therapeutic goals with fewer side effects. Comparison between both anticoagulants show that Dabigatran is safer and more effective compared to warfarin
Study site: Haematology clinic, hospital, Selangor, Malaysia
Relationship of Time in Therapeutic Range (Ttr) with Bleeding and Stroke Incidences of Warfarinised Patients with Pulmonary Embolism in a Tertiary Hospital in Malaysia

Sudirman N, Shaharuddin S, Long CM, Hashim R, Zulkifly HH, Kasim SS, et al.

Value Health, 2015 Nov;18(7):A378.
PMID: 26532135 DOI: 10.1016/j.jval.2015.09.794
Medication use and adherence among multi-ethnic community-dwelling older adults in Malaysia

Neoh CF, Long CM, Lim SM, Ramasamy K, Shahar S, Majeed ABA

Geriatr Gerontol Int, 2017 Aug;17(8):1214-1220.
PMID: 27489036 DOI: 10.1111/ggi.12849

AIM: The present study assessed adherence, barriers, belief and awareness towards the use of medications among multi-ethnic community-dwelling older adults in Malaysia. Medication accessibility, expenditure and perceptions towards medicine labeling among older adults were also evaluated.
METHODS: A cross-sectional study was carried out in the central region of Malaysia from January to August 2015. The older adults enrolled in an ongoing prospective community-based geriatric cohort study and prescribed with medicines were interviewed using a 50-item validated questionnaire.
RESULTS: Of the 79 older adults interviewed, 39.2% had ≥4 prescribed medications. Most obtained their medications free-of-charge from government hospitals (66, 83.5%). Nearly half (35, 44.3%) had trouble reading labels for medicines that they had received. Chinese older adults (P = 0.001) and those with lower monthly household income (P
6-OHDA-Lesioned Adult Zebrafish as a Useful Parkinson's Disease Model for Dopaminergic Neuroregeneration

Vijayanathan Y, Lim FT, Lim SM, Long CM, Tan MP, Majeed ABA, et al.

Neurotox Res, 2017 Oct;32(3):496-508.
PMID: 28707266 DOI: 10.1007/s12640-017-9778-x

Conventional mammalian models of neurodegeneration are often limited by futile axonogenesis with minimal functional recuperation of severed neurons. The emergence of zebrafish, a non-mammalian model with excellent neuroregenerative properties, may address these limitations. This study aimed to establish an adult zebrafish-based, neurotoxin-induced Parkinson's disease (PD) model and subsequently validate the regenerative capability of dopaminergic neurons (DpN). The DpN of adult male zebrafish (Danio rerio) were lesioned by microinjecting 6-hydroxydopamine (6-OHDA) neurotoxin (6.25, 12.5, 18.75, 25, 37.5, 50 and 100 mg/kg) into the ventral diencephalon (Dn). This was facilitated by an optimised protocol that utilised 1,1'-dioctadecyl-3,3,3',3'-tetramethyl-indocarbocyanineperchlorate (DiI) dye to precisely identify the injection site. Immunostaining was utilised to identify the number of tyrosine hydroxylase immunoreactive (TH-ir) DpN in brain regions of interest (i.e. olfactory bulb, telencephalon, preoptic area, posterior tuberculum and hypothalamus). Open tank video recordings were performed for locomotor studies. The Dn was accessed by setting the injection angle of the microinjection capillary to 60° and injection depth to 1200 μm (from the exposed brain surface). 6-OHDA (25 mg/kg) successfully ablated >85% of the Dn DpN (preoptic area, posterior tuberculum and hypothalamus) whilst maintaining a 100% survival. Locomotor analysis of 5-min recordings revealed that 6-OHDA-lesioned adult zebrafish were significantly (p cm/s) and distance travelled (cm). Lesioned zebrafish showed full recovery of Dn DpN 30 days post-lesion. This study had successfully developed a stable 6-OHDA-induced PD zebrafish model using a straightforward and reproducible approach. Thus, this developed teleost model poses exceptional potentials to study DpN regeneration.
Dikir Farmasi: folk songs for health education

Bahri S, Lee KS, Adenan MA, Murugiah MK, Khan TM, Neoh CF, et al.

Arts Health, 2016 Sep 01;8(3):272-278.
PMID: 27695527

In an effort to enhance public awareness, we develop Dikir Farmasi as an innovative approach to deliver health information. Dikir Farmasi combines the elements of dikir barat (a type of traditional folk song rhythm) and traditional sketches which are popular in the state of Kelantan, Malaysia. These sketches and dikir barat rhythmic songs, with lyrics touch on issues such as drug abuse and regulation are presented in an entertaining and humorous way. Health promotion messages are disseminated using Dikir Farmasi in the form of compact disks, video compact disks, stage performance, exhibition, social media, printed media (signboard, brochure and flyer).
Fulltext Simultaneous determination of tramadol and paracetamol in human plasma using LC-MS/MS and application in bioequivalence study of -fixed-dose combination

Loh GOK, Wong EYL, Goh CZ, Tan YTF, Lee YL, Pang LH, et al.

Ann Med, 2023;55(2):2270502.
PMID: 37857359 DOI: 10.1080/07853890.2023.2270502

The study aimed to develop a sensitive and high-throughput liquid chromatography coupled with tandem mass spectrometry method to quantify concentrations of tramadol and paracetamol simultaneously in human plasma. Sample preparation involved single-step protein precipitation using methanol and two deuterated internal standards, tramadol D6 and paracetamol D4. Agilent Poroshell 120 EC-C18 (100 × 2.1 mm, 2.1 µm) analytical column was employed to achieve chromatographic separation. Detection was in positive ion multiple reaction monitoring mode. A tailing factor (Tf) of <1.2, separation factor (K prime) of >1.5 from the column dead time and signal-to-noise (S/N) ratio >10, were obtained for analytes and internal standards. The standard curve was linear over the concentration range of 2.5-500.00 ng/mL for tramadol and 0.025-20.00 μg/mL for paracetamol. A small injection volume of 1 µL, low flow rate of 440 µL/min and short analysis time of 3.5 min reduced the solvent consumption, analysis cost and system contamination. The results of method validation parameters fulfilled the acceptance criteria of bioanalytical guidelines. The method was successfully applied to a bioequivalence study of fixed-dose combination products of tramadol and paracetamol in Malaysian healthy subjects.