MyMedR

Awareness and knowledge of epilepsy among students in a Malaysian university

Ab Rahman AF

Seizure, 2005 Dec;14(8):593-6.

University students represent a better-educated group of society and it is important that they possess the correct knowledge and attitude towards healthcare issues. The aim of this study was to determine the current level of awareness and knowledge of epilepsy among students at a public university in Malaysia.

Drug and chemical poisoning admissions at a teaching hospital in Malaysia

Ab Rahman AF

Hum Exp Toxicol, 2002 Jul;21(7):377-81.

PMID: 12269700

A retrospective review of medical records was carried out to determine the pattern of drug and chemical poisoning cases admitted to a teaching hospital in Malaysia. Medical records of patients admitted during the period January 1987 to December 1995 were reviewed. They accounted for 0.2% of total admissions during the period. While all ages were represented, there was predominance of children, which showed little change throughout the nine-year period. Of all cases of poisoning, 77.8% were unintentional, 12.6% intentional and 9.6% were undetermined. Kerosene, pesticides and medicinal substances remained the common agents associated with poisoning. A significant number of patients sought treatment elsewhere before being admitted to the hospital. Of those who came directly to the hospital, many were presented late in the course of their poisoning. Only seven patients died and none were children. This study supports the need for greater emphasis on prevention of poisoning in children and among farmers in the state.

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.

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.

Fulltext Monitoring adverse drug reactions in the community settings

Ab Rahman AF

Bull World Health Organ, 2019 Nov 01;97(11):730.

PMID: 31673185 DOI: 10.2471/BLT.19.245019

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 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.

Fulltext Obstetric and birth outcomes in pregnant women with epilepsy: A hospital-based study

Othman NH, Ab Rahman AF

Ann Indian Acad Neurol, 2013 Oct;16(4):534-7.

PMID: 24339574 DOI: 10.4103/0972-2327.120458

In addition to changes in seizure frequency, pregnant women with epilepsy (WWE) are at increased risk of complications during pregnancy or delivery. In the absence of a nationwide WWE registry, hospital-based studies may provide important information regarding current management and outcomes in these patients.

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.

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.

Fulltext Intraperitoneal Antibiotic Utilization among Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients with Peritonitis at a Tertiary Hospital Setting in Malaysia

Ahmad M, Zin CS, Ab Rahman AF

J Pharm Bioallied Sci, 2020 Nov;12(Suppl 2):S737-S742.

PMID: 33828370 DOI: 10.4103/jpbs.JPBS_298_19

Introduction: Patients receiving continuous ambulatory peritoneal dialysis (CAPD) are commonly associated with peritonitis. However, little is known about the utilization of antibiotics for the treatment of peritonitis in these patients.

Objectives: This study aimed to evaluate the patterns of intraperitoneal (IP) antibiotic utilization for the treatment of peritonitis in CAPD patients.

Materials and Methods: This is a retrospective study conducted at a tertiary hospital setting in Malaysia. Medical records of CAPD patients who were diagnosed with peritonitis and registered with National Kidney Registry from 2013 to 2018 were reviewed. Types of antibiotics used and its dose and duration were recorded and reported using the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system.

Results: A total of 105 peritonitis episodes were recorded from 72 patients. The most common first-line empirical antibiotic combinations used were ceftazidime/cefazolin (40%, n = 42), followed by cefepime/cefazolin (30.5%, n = 32) and ceftazidime/cloxacillin (25.7%, n = 27). The definitive therapy for culture-proven CAPD-related peritonitis (CAPD-P) showed that vancomycin was the most frequently prescribed antibiotic (31.7%, n = 26/82), followed by amikacin (14.6%, n = 12/82), meropenem (11%, n = 9/82) and ampicillin (11%, n = 9/82). Ciprofloxacin was among the least prescribed definitive antibiotics for CAPD-P (2.4%, n = 2/82) but the DDD/100 patient-days estimates showed that it had the highest therapeutic intensity.

Conclusion: There are various IP antibiotics used for CAPD-P and the most common empirical therapy was the combination of ceftazidime and cefazolin while vancomycin is predominantly used for definitive therapy. Future studies to evaluate the clinical outcomes of the antibiotic use should be conducted to have a better insight on the efficacy of the peritonitis treatment.

Fulltext Development and Psychometric Validation of a Questionnaire to Evaluate Knowledge and Attitude Towards Medication Error Reporting Among Pharmacists

Mamat R, Awang SA, Ab Rahman AF

Drug Healthc Patient Saf, 2020;12:95-101.

PMID: 32523381 DOI: 10.2147/DHPS.S249104

Purpose: Assessment of medication errors (ME) is crucial to improving the quality of health care. A questionnaire that can be used to explore pharmacists' perspectives regarding ME would be very useful as part of an ongoing process of quality improvement in patient care. The aim of this study was to develop and validate a questionnaire to measure perceived causes of ME and attitude towards ME reporting among pharmacists.

Methods: The questionnaire was developed from the literature together with outcomes from focus group discussions. It was divided into two domains which are knowledge on ME and attitude towards ME reporting. Content validity index (I-CVI), exploratory factor analysis (EFA), Cronbach alpha and intraclass correlation coefficient (ICC) to assess test-retest reliability were obtained during the validation process.

Results: Overall Cronbach alpha for internal consistency was good (0.742), where subscale of the questionnaire demonstrated adequate internal consistency, with Cronbach alpha value 0.83 for knowledge and 0.70 for reporting behaviour attitude. The I-CVI showed good scores (knowledge=0.88) and (attitude=0.81), while ICC was moderately accepted with a value of 0.77. Two factors were extracted from the 16 items in EFA.

Conclusion: The questionnaire to assess knowledge on ME and attitude towards ME reporting among pharmacists is valid and reliable. It demonstrates good psychometric properties.

Fulltext Characteristics and outcomes of paracetamol poisoning cases at a general hospital in Northern Malaysia

Mohd Zain Z, Fathelrahman AI, Ab Rahman AF

Singapore Med J, 2006 Feb;47(2):134-7.

PMID: 16435055

Paracetamol is available as an over-the-counter medication in many countries including Malaysia. This drug has been implicated in many poisoning cases admitted to hospitals throughout the country.

Master's program in clinical pharmacy at a Malaysian pharmacy school

Ab Rahman AF, Bahari MB

Am J Health Syst Pharm, 2004 Dec 15;61(24):2687-9.

PMID: 15646704

Cost evaluation of therapeutic drug monitoring of gentamicin at a teaching hospital in Malaysia

Ibrahim MI, Abdelrahim HE, Ab Rahman AF

Pharm Pract (Granada), 2014 Jan;12(1):372.

PMID: 24644520

Therapeutic drug monitoring (TDM) makes use of serum drug concentrations as an adjunct to decision-making. Preliminary data in our hospital showed that approximately one-fifth of all drugs monitored by TDM service were gentamicin.

Fulltext A survey of therapeutic drug monitoring services in Malaysia

Ab Rahman AF, Ahmed Abdelrahim HE, Mohamed Ibrahim MI

Saudi Pharm J, 2013 Jan;21(1):19-24.

PMID: 23960816 DOI: 10.1016/j.jsps.2012.01.002

In Malaysia, therapeutic drug monitoring (TDM) service was started in the 1980s. Since then, the number of hospitals that offer the service has increased. In this paper, we report the findings of a nationwide survey describing the practice of TDM in these hospitals. Questionnaires were mailed to 128 government hospitals. Data were collected for general characteristics of the hospitals, administrative, and laboratory activities related to TDM service. One hundred and twenty-one hospitals responded to the survey. Thirty-four hospitals (28.1%) provided the service with their own TDM laboratories, 44 hospitals (36.4%) provided the service using other hospitals' laboratories and 43 hospitals (35.5%) did not provide the service at all. TDM services were more likely to be offered in larger hospitals with various medical specialties. Since it is managed entirely by hospital pharmacists, these pharmacists assume an important role in ensuring optimum use of the TDM service.

Fulltext Therapeutic drug monitoring of gentamicin in patients with bronchopneumonia: cost considerations and patient outcomes

Ahmed Abdelrahim HE, Ab Rahman AF, Mohamed Ibrahim MI

Eurasian J Med, 2012 Apr;44(1):1-5.

PMID: 25610196 DOI: 10.5152/eajm.2012.01

In Malaysia, therapeutic drug monitoring (TDM) service started in the late 1980s. Serum concentration measurements depend on commercially available drug assays, which are costly. In the present study, we attempted to document the impact of TDM service on cost and patient outcomes.

Self-poisoning by drugs and chemicals: variations in demographics, associated factors and final outcomes

Fathelrahman AI, Ab Rahman AF, Mohd Zain Z

Gen Hosp Psychiatry, 2008 Sep-Oct;30(5):467-70.

PMID: 18774431 DOI: 10.1016/j.genhosppsych.2008.04.004

OBJECTIVE: Drug overdose exposures were compared with chemical poisoning in terms of demographics, associated factors and final outcomes.
METHOD: Deliberate self-poisoning (DSP) cases admitted to Penang General Hospital during the years 2000-2004 were studied. Chi-square, independent t-test and binary logistic were used whenever applicable.
RESULTS: Indian patients were more likely to use household products, whereas Malay and Chinese patients were more likely to take drug overdoses (P=.001). Drug overdose victims experienced more socioeconomic problems (P=.05) and were more likely to be admitted to the intensive care unit (P=.052). Chemical poisoning patients presented earlier (P=.011), were hospitalized for shorter time (P=.001) and had a higher rate of mortality (P=.01).
CONCLUSION: The present study has identified a unique ethnic variation in the choice of suicide attempts from toxic substances. DSP associated with drug overdose showed significant morbidity, but increased mortality was seen in chemical poisoning.

Factors associated with adult poisoning in northern Malaysia: a case-control study

Fathelrahman AI, Ab Rahman AF, Zain ZM, Tengku MA

Hum Exp Toxicol, 2006 Apr;25(4):167-73.

PMID: 16696291

Data on adult risk factors associated with drug or chemical poisonings in Malaysia are scarce. The objective of the study was to identify possible risk factors associated with adult admissions to the Penang General Hospital (PGH) due to chemical poisoning and/or drug overdose. The present study was a case-control study, conducted over 18 weeks. One hundred acutely poisoned adult patients admitted to PGH during the period from September 2003 to February 2004 were considered as cases. Two hundred patients admitted to the same medical wards for other illnesses, during the same period, were matched for age and gender with the poisoned cases and thus selected as controls. McNemar test and binary logistic were used for univariate analysis and logistic regression analysis for multivariate analyses. The odds ratio (OR) and its 95% confidence interval (95% CI) were calculated for each predictor variable. Positive histories of psychiatric illness and previous poisoning, problems in boy/girl friend relationships, family problems, marital problems, Indian ethnicity, Chinese ethnicity, living in rented houses and living in a household with less than five people were significant risk factors associated with adult admissions due to poisoning.

MS 04-044: demographic features of drug and chemical poisoning in northern Malaysia

Fathelrahman AI, Ab Rahman AF, Mohd Zain Z

Clin Toxicol (Phila), 2005;43(2):89-94.

PMID: 15822759

Acute poisoning is a significant health problem all over the world. In Malaysia, nationwide data on poisoning pattern is scarce and incomplete. The objectives of our study were to determine the pattern of acute drug and chemical poisoning at Penang General Hospital (PGH), in the northern region of Malaysia, and to compare poisoning characteristics between different ethnic groups. The study was a retrospective case review of all poisoned patients admitted to PGH during the years 2000-2002. We collected data concerning demographic parameters of patients, information about the agent(s) implicated, and circumstances surrounding the event. There were 493 poisoning incidents. Nearly two-thirds of the poisoned cases involved female patients. The predominant mode of poisoning was intentional (51.5%). The age group 15.1-30 years ranked at the top, constituting 55.2% of all cases. Drugs were the predominant agents implicated. Among cases associated with drugs, paracetamol was the main causative agent (44.7%). Chinese patients constituted 37.7% of all poisoning cases, followed by the Indians (31.6%) and Malays (26.6%). Between ethnic groups, Indian patients were found to have the highest rate of poisoning admission of 75.2 per 100,000 persons.

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