Displaying publications 1 - 20 of 52 in total

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  1. Bitar AN, Sulaiman SAS
    Curr Med Res Opin, 2022 Dec;38(12):2097-2108.
    PMID: 35819071 DOI: 10.1080/03007995.2022.2100654
    OBJECTIVES: With no clear end for the outbreak, identifying the drugs that are effective in COVID-19's management is of utmost importance to reduce the impact on the general population and the healthcare systems.

    METHODS: This is a systematic review and a meta-analysis evaluating the evidence from clinical trials on the effect of colchicine and corticosteroids against COVID-19. In this review, we have systematically searched five databases [(PubMed, Embase, clinicaltrials.gov, ICTRP, CINAHL (EBSCO)]. Cochrane's data extraction sheet was used to collect the required information, and RevMan-5.4.1 was used to conduct the meta-analysis and to assess the risk of bias. The review was registered in Prospero (CRD42022299718).

    RESULTS: The total number of included studies was 17, with 18,956 participants; the majority were male 12,001. Out of which, 8772 participants were on colchicine, 569 took methylprednisolone, and 64 patients received prednisolone. The meta-analysis has shown that colchicine had no significant effect on reducing the mortality rate among COVID-19 patients [OR 0.98(95% CI 0.90-1.08), p = .70), I2:1%)], corticosteroids have significantly reduced the mortality rates [OR 0.55 (95% CI 0.33-0.91), p = .02, I2:40]. Colchicine did not reduce the incidence of ICU admissions [OR 0.74 (95% CI 0.39-1.40), p = .35, I2:0%], while steroidal drugs significantly reduced the ICU admissions [OR 0.42 (95% CI 0.23-0.78), p = .005, I2:0%]. Unlike steroidal drugs [OR 0.53 (95% CI 0.30-0.95), p = .03, I2:61%], colchicine failed to reduce the need for mechanical ventilation [OR 0.73 (95% CI 0.48-1.10), p = .13, I2:76%]. Steroidal drugs significantly reduced the duration of hospitalization among COVID-19 patients [OR -0.50 (95% CI -0.79-0.21), p = .0007, I2:36%].

    CONCLUSIONS: The use of colchicine did not significantly reduce the mortality rate, ICU admissions, and mechanical ventilation among COVID-19 patients. Conversely, corticosteroids significantly reduced the mortality rate, ICU admissions, mechanical ventilation, and hospitalization duration among COVID-19 patients.

  2. Bitar AN, Sulaiman SAS
    Nurs Open, 2023 Apr;10(4):2684-2688.
    PMID: 36443281 DOI: 10.1002/nop2.1501
    AIM: To evaluate the available evidence from clinical trials on the efficacy of gout medicines against COVID-19.

    DESIGN: Systematic review and Meta-analysis.

    METHODS: We are systematically searching five databases [PubMed, Embase, CT.gov, ICTRP, CINAHL (EBSCO)]. We are following the PRISMA statement and the EPOC guidelines. The meta-analysis will be conducted using Revman-5.4.1 from Cochrane collaboration, UK. This review's protocol was also registered in PROSPERO, University of York, UK (CRD42022299718).

    RESULTS: In this meta-analysis, we plan to give a conclusive overview of the available evidence on the efficacy of the medications used to manage gout in reducing COVID-19 mortality, ICU admission, ventilation rate and hospitalization duration. If the results were positive, these drugs would greatly add to the scarce treatment options against COVID-19. Furthermore, these drugs might provide an excellent alternative to inconvenient and expensive drugs. Additionally, most of these drugs have a well-established safety profile for use during nursing, making them a much safer option for nursing mothers with COVID-19.

  3. Abubakar U, Sulaiman SAS
    J Infect Public Health, 2018;11(6):763-770.
    PMID: 29933910 DOI: 10.1016/j.jiph.2018.05.013
    BACKGROUND: Evidence to demonstrate the prevalence and trend of Methicillin Resistant Staphylococcus aureus (MRSA) infection in Nigeria is scarce. This review evaluates the prevalence, trend and antimicrobial susceptibility of clinical MRSA isolates reported in published studies.

    METHOD: Electronic search (PubMed, Scopus and Google scholar) was conducted using the following search terms: "MRSA OR Methicillin Resistant Staphylococcus aureus AND Nigeria." Reference list of selected studies was scanned to identify more studies. Studies published between 2007 and 2017 that tested at least 30 non-duplicate S. aureus isolates were selected. An independent reviewer extracted data from the studies using a standardized form.

    RESULTS: Twelve studies were included in this review. Overall, prevalence of MRSA infection increased from 18.3% (2009) to 42.3% (2013). The prevalence of MRSA infection was less than 50% in all the regions during the period under review. There was a decline in the prevalence of MRSA infection in the North-East (from 12.5% to 8.0%) between 2007 and 2012, and an increase in the South-West (from 20.2% to 47.4%) between 2006 and 2010. Wound, blood and urine specimens had the highest proportion of MRSA isolates. Non-susceptibility of MRSA strains to cotrimoxazole and tetracycline was greater than 85%.

    CONCLUSION: Prevalence of MRSA infection in Nigeria is rising, albeit regional variations. Non-susceptibility to commonly prescribed, orally available and inexpensive antibiotics was high. Antimicrobial resistance surveillance system, infection control, and antimicrobial stewardship interventions are recommended.

  4. Elhag EAA, Sulaiman SAS
    Int J Clin Pharm, 2021 Jun;43(3):502-508.
    PMID: 33025448 DOI: 10.1007/s11096-020-01149-3
    Background Malaria is one of the main causes of death in Sudan with high prevalence among males, children under five-year and pregnant women. In 2016 near 13% of hospital admissions in Sudan were due to malaria. Community pharmacist dispensing of antimalarial drugs without prescription and malaria self-treatment may lead to the development of drugs resistance and delay disease control. Objective To assess the knowledge and practice of community pharmacists regarding malaria and its treatment. Setting Community pharmacies in Khartoum State, Sudan. Method A cross-sectional survey was carried using a structured pre-tested self-administered questionnaire for the pharmacists in charge of 320 randomly selected community pharmacies. Main outcome measures The community pharmacists'knowledge and practices regarding malaria and antimalarials dispensing. Results A total of 293 pharmacists participated in the study giving a response rate of 91.5%. About 92.2% of the respondents were from the age of 20-39 years and 63.8% had less than 5 years of experience. Community pharmacists showed inadequate knowledge regarding malaria and its treatment. In addition to that, they were dispensing antimalarials without prescriptions. The community pharmacists reported many barriers to their effective contribution in malaria prevention and treatment such as lack of knowledge, lack of time and lack of training. Conclusion Inadequate knowledge and irrational antimalarials dispensing practices were reported among the community pharmacists in Khartoum State. Although training was a significant predictor of pharmacists' knowledge regarding malaria and its treatment, health authorities were not providing regular training for the practicing pharmacists.
  5. 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
  6. Nahas ARF, Sulaiman SAS
    J Pharm Bioallied Sci, 2017;9(3):178-184.
    PMID: 28979072 DOI: 10.4103/jpbs.JPBS_64_17
    BACKGROUND: Depression imposes numerous changes on depressive men, promoting for low bone mineral density (BMD) and erectile dysfunction (ED), yet no published data on exploring the possible association between these two disorders among depressive men. We therefore investigated whether low BMD is associated with ED among depressive men and highlighted the possible mutual underlying factors that might give rise to these two disorders in this specific group of patients.

    MATERIALS AND METHODS: In this cross-sectional study, 119 depressive men were recruited and their sociodemographic and clinical characteristics were obtained. Erectile function was evaluated using the 5-item International Index of Erectile Function. All patients received a calcaneal BMD scanning. Chi-square test was conducted to determine if a significant association exists between ED and low BMD.

    RESULTS: Of the study participants, ninety patients reported ED, while 29 patients reported no ED. Within the ED group, there was a significantly higher proportion of patients with low BMD compared to the non-ED group (85.6% vs. 62.1%, P = 0.006). In addition, among younger participants (i.e., aged < 50 years old), the difference in T-score between ED patients (Md = -2.2, n = 41) and non-ED patients (Md = -1.3, n = 20) was significant (P = 0.001); but held no significance among older participants.

    CONCLUSIONS: While our findings are considered prefatory, we reported that low BMD was significantly associated with ED in depressive men and that only among young depressive patients, BMD was significantly lower in ED patients compared to non-ED patients. More research investigating these findings and the possible underlying mechanisms for such association are warranted.

  7. Atif M, Sulaiman S, Shafi A, Muttalif A, Ali I, Saleem F
    J Basic Clin Pharm, 2011 Jun;2(3):129-31.
    PMID: 24826012
    A 24 year university student with history of productive cough was registered as sputum smear confirmed case of pulmonary tuberculosis. During treatment, patient suffered from itchiness associated with anti tuberculosis drugs and was treated with chlorpheniramine (4mg) tablet. Patient missed twenty eight doses of anti tuberculosis drugs in continuation phase claiming that he was very busy in his studies and assignments. Upon questioning he further explained that he was quite healthy after five months and unable to concentrate on his studies after taking prescribed medicines. His treatment was stopped based on clinical improvement, although he did not complete six months therapy. Two major reasons; false perception of being completely cured and side effects associated with anti TB drugs might be responsible for non adherence. Non sedative anti histamines like fexofenadine, citrizine or loratidine should be preferred over first generation anti histamines (chlorpheniramine) in patients with such lifestyle. Patient had not completed full course of chemotherapy, which is preliminary requirement for a case to be classified as "cure" and "treatment completed". Moreover, patient had not defaulted for two consecutive months. Therefore, according to WHO treatment outcome categories, this patient can neither be classified as "cure" or "treatment completed" nor as "defaulter". Further elaboration of WHO treatment outcome categories is required for adequate classification of patients with similar characteristics. Likelihood of non adherence can be significantly reduced by applying the WHO recommended "Patient Centered Approach" strategy. Close friend, class mate or family member can be selected as treatment supporter to ensure adherence to treatment.
  8. Najjar MF, Sulaiman SAS, Al Jeraisy M, Balubaid H
    Ther Clin Risk Manag, 2018;14:557-564.
    PMID: 29588595 DOI: 10.2147/TCRM.S157469
    Background: There is a difference between evidence-based guidelines for geriatric patients and clinical practice of physicians. Prescribing potentially inappropriate medications (PIMs) can be attributed to the fact that many physicians are not aware of PIMs usage.

    Aim: The aim of this study was to assess the effectiveness of a combined intervention program comprising an educational and clinical pharmacist intervention to reduce the incidence of PIMs among hospitalized geriatric patients.

    Methods: This was a prospective pre-test versus post-test design study. The screening tool of older persons' prescriptions, 2nd version, and 2015 American Geriatric Society Beers' criteria were used to assess the appropriateness of medications prescribed for geriatric inpatients. The study was carried out in the medical wards of the Department of Medicine at King Abdulaziz Medical City in Riyadh, Saudi Arabia.

    Results: Four hundred geriatric patients were enrolled in the study: 200 in a pre-intervention group (control) and 200 in the intervention group. After the combined intervention, the incidence rate of PIMs decreased significantly from 61% to 29.5% (p<0.001). Out of 317 recommendations given by the clinical pharmacist, the physicians accepted a total of 196 (61.83%) recommendations. The most common PIMs to avoid regardless of diagnosis of geriatric patients before interventions were first-generation antihistamines (46%), sliding scale insulin (18.5%), antipsychotics (6.5%), benzodiazepines (9.5%), and antiarrhythmic drugs (15%).

    Conclusion: Using a combined intervention program that comprises an educational intervention of updated evidence-based guidelines and clinical pharmacist intervention would add a significant value to improve prescribing patterns in hospitalized geriatric patients.

  9. Laghari M, Sulaiman SAS, Khan AH, Memon N
    BMC Infect Dis, 2019 Jan 24;19(1):82.
    PMID: 30678656 DOI: 10.1186/s12879-019-3702-3
    BACKGROUND: Understanding the explanations behind unsuccessful treatment outcomes in tuberculosis (TB) patients is important to improve treatment success. Treatment completion for TB is the mainstay of TB prevention and control. The study was aimed to assess the treatment outcomes and predictors for unsuccessful outcomes among children with TB.

    METHODS: This was a prospective multicenter study conducted in Sindh. Children aged ≤14 years enrolled from June to November 2016 were included. A structured data collection tool was used to gather information with respect to patients' socio-demographic, clinical and microbiological data. Additionally, to collect the information related to socio-economic and education level of caregivers, validated questionnaire was administered to the caregivers. Treatment outcomes were assessed according to the World Health Organization (WHO) guidelines. The relationship of unsuccessful treatment outcome with socio-demographic and clinical attributes of TB patients was analyzed using logistic regression model.

    RESULTS: Childhood TB represented 19.3% (508/2634) of all TB cases in selected hospitals. Of these, 268/508 (52.8%) were females and one third of the children were aged ≤2 years (34.3%). In multivariate analysis, pulmonary smear positive TB (PTB+) (AOR = 5.910, 95%CI = 1.64-21.29), those with adverse drug reactions (AOR = 11.601, 95%CI = 4.06-33.12) and those who had known TB contacts (AOR = 3.128, 95%CI = 1.21-8.06) showed statistically significant association with unsuccessful treatment outcomes.

    CONCLUSIONS: The high proportion of childhood TB cases (19.3%) demonstrates the continuation of TB transmission in the study setting. Furthermore, an increased focus on PTB+ patients, those with adverse drug reactions and household contact with TB is warranted.

  10. Destiani DP, Naja S, Dewi S, Rahmadi AR, Sulaiman SAS, Abdulah R
    Osteoporos Int, 2021 May;32(5):805-816.
    PMID: 33210179 DOI: 10.1007/s00198-020-05743-z
    Even though new drugs for the treatment of rheumatoid arthritis (RA) have been developed, methotrexate (MTX) remains a commonly used drug for RA management. In addition to monitoring disease activity during RA treatment, bone erosion should be closely assessed throughout long-term RA management. In this review article, we present a systematic review of MTX effectiveness in reducing the risk of bone erosion. We reviewed randomized controlled trial studies that involved MTX monotherapy or MTX in combination with placebo. Evaluation of the progression of bone erosion was examined by radiographic assessment such as total Sharp score (TSS) or van der Heijde score (SvdH or vdH TSS), joint space narrowing (JSN), erosion score (ERO), and proportion of radiographic nonprogressors. Several key factors were found to influence the response to MTX treatment, such as gene polymorphism. The exact mechanism of the prevention of bone erosion by MTX remains unclear, which warrants future investigations. The variability of RA disease activity in study subjects resulted in variations in the results reported by individual studies. Collective analysis suggests that MTX could slow down the progression of bone erosion based on a radiographic score of less than 0.5-1/year.
  11. Abdulameer SA, Sahib MN, Sulaiman SAS
    Open Rheumatol J, 2018;12:50-64.
    PMID: 29755605 DOI: 10.2174/1874312901812010050
    Background: Type 2 Diabetes Mellitus (T2DM) and osteoporosis are both chronic conditions and the relationship between them is complex.
    Objective: The aims of this study were to assess the prevalence of Low Bone Mineral density (LBMD, i.e., osteopenia and osteoporosis), as well as, the difference and associations between Quantitative Ultrasound Scan (QUS) parameters with socio-demographic data and clinical related data among T2DM in Penang, Malaysia.
    Method: An observational, cross-sectional study with a convenient sample of 450 T2DM patients were recruited from the outpatient diabetes clinic at Hospital Pulau Pinang (HPP) to measure Bone Mineral Density (BMD) at the heel bone using QUS. In addition, a self-reported structured questionnaire about the socio-demographic data and osteoporosis risk factors were collected. Moreover, the study included the retrospective collection of clinical data from patients' medical records.
    Results: The mean value of T-score for normal BMD, osteopenic and osteoporotic patients' were (-0.41±0.44), (-1.65±0.39) and (-2.76±0.27), respectively. According to QUS measurements, more than three quarters of T2DM patients (82%) were at high risk of abnormal BMD. The results showed that QUS scores were significantly associated with age, gender, menopausal duration, educational level and diabetic related data. Moreover, the QUS parameters and T-scores demonstrated significant negative correlation with age, menopausal duration, diabetic duration and glycaemic control, as well as, a positive correlation with body mass index and waist to hip ratio. The current study revealed that none of the cardiovascular disease risk factors appear to influence the prevalence of low BMD among T2DM Malaysian patients.
    Conclusion: The study findings revealed that the assessment of T2DM patients' bone health and related factor are essential and future educational programs are crucial to improve osteoporosis management.
    Study site: Diabetes clinic, Hospital Pulau Pinang
  12. Laghari M, Sulaiman SAS, Khan AH, Memon N
    PeerJ, 2018;6:e5253.
    PMID: 30065869 DOI: 10.7717/peerj.5253
    Background: Regardless of the advancement in medical technologies, the diagnosis of tuberculosis (TB) in children has remained a challenge. Childhood TB is rampant and an important cause of morbidity and mortality. The objective of this study was to determine the trend of TB and treatment outcomes in children aged ≤14 years registered for TB treatment under DOTS course in three districts of Sindh, Pakistan.

    Methods: For this retrospective study, records of TB children (≤14 years) registered for the treatment of TB from January 2011 to December 2015 in three districts of Pakistan, were collected. Demographic data, baseline weight, clinical manifestations, radiography, histopathology results and treatment outcomes were collected from TB unit registers.

    Results: A total of 2,167 children were treated for TB during the study period. Of these, 1,199 (55.3%) were females and 1,242 (57.3%) were from urban areas. Over three-quarter of patients (76.9%) had pulmonary TB with 13.3% of sputum smear positive cases. The overall treatment success rate was 92.4%. In multivariate analysis, rural residents (OR: 2.146, p 

  13. Abdulameer SA, Sahib MN, Sulaiman SAS, Hassali MA
    Pharm Pract (Granada), 2019 12 13;17(4):1636.
    PMID: 31897262 DOI: 10.18549/PharmPract.2019.4.1636
    Background: osteoporosis and diabetes mellitus are highly prevalent diseases that have potentially devastating effects on health and socioeconomic status.

    Objective: The aims of this study were to assess: 1) the level of osteoporosis knowledge among T2DM patients; 2) the correlation, associations or differences of demographic characteristics, diabetes-related variable, as well as, lipid and blood pressure profiles with osteoporosis knowledge; and 3) the correlation between T-score measurement using quantitative ultrasound scan (QUS) and osteoporosis knowledge.

    Methods: A cross-sectional study design was chosen, where data was collected using a self-report structured questionnaire using osteoporosis knowledge - Malay version questionnaire (OKT-M) among T2DM patients. Furthermore, the clinical data regarding the patients were collected retrospectively from the hospital medical record after patient interview was completed.

    Results: The average age of the patients was 62.67 (SD 9.24) years (ranged from 33 to 87 years). Males (231, 51.30%) slightly outnumbered females. Among the racial distribution, the proportion of Chinese patients (204, 45.30%) was higher than Malay (127, 28.20%) and Indian patients (119, 26.40%). In addition, more than three quarters (343, 76.20%) of patients had poor glycaemic control. The average OKT-M total score, OKT-M Exercise subscale and OKT-M Calcium subscale were 12.55 (SD 4.06), 8.60 (SD 2.89) and 8.40 (SD 3.36), respectively. Only 33.30% of the T2DM patients were found to have high level of osteoporosis knowledge. There was a lack of identification and recognition of osteoporosis risk factors. There were significant differences or associations between osteoporosis knowledge and education level, monthly income, employment status, family history of fracture, smoking habit, alcoholic status, insulin use, therapy type and diastolic blood pressure. In addition, significant and positive correlations were found between T-scores and OKT-M total score (n=450, rs= 0.244, P=0.000), OKT-M Exercise subscale (n=450, rs= 0.219, P=0.000) and OKT-M Calcium subscale (n=450, rs=0.199, P=0.000) among T2DM patients (all Ps<0.05).

    Conclusions: Overall, the study results showed a valuable insight into the knowledge toward osteoporosis, as well as its relation to the bone loss among T2DM patients. It is important to understand the basics of osteoporosis prevention behaviours such as adequate calcium intake and regular exercise which are essential to build and maintain healthy bones throughout life among T2DM.
  14. Gillani SW, Sulaiman SAS, Abdul MIM, Saad SY
    PMID: 28770010 DOI: 10.1186/s13098-017-0257-6
    BACKGROUND: This study aimed to determine self-monitoring practices, awareness to dietary modifications and barriers to medication adherence among physically disabled type 2 diabetes mellitus patients.

    METHODS: Interview sessions were conducted at diabetes clinic-Penang general hospital. The invited participants represented three major ethnic groups of Malaysia (Malay, Chinese and Indians). An open-ended approach was used to elicit answers from participants. Interview questions were related to participant's perception towards self-monitoring blood glucose practices, Awareness towards diet management, behaviour to diabetes medication and cues of action.

    RESULTS: A total of twenty-one diabetes patients between the ages 35-67 years with physical disability (P1-P21) were interviewed. The cohort of participants was dominated by males (n = 12) and also distribution pattern showed majority of participants were Malay (n = 10), followed by Chinese (n = 7) and rest Indians (n = 4). When the participants were asked in their opinion what was the preferred method of recording blood glucose tests, several participants from low socioeconomic status and either divorced or widowed denied to adapt telemonitoring instead preferred to record manually. There were mixed responses about the barriers to control diet/calories. Even patients with high economic status, middle age 35-50 and diabetes history of 5-10 years were influenced towards alternative treatments.

    CONCLUSIONS: Study concluded that patients with physical disability required extensive care and effective strategies to control glucose metabolism.

    PRACTICE IMPLICATION: This study explores the patients' perspectives regarding treatment management with physical disability.

  15. Gillani SW, Sulaiman SAS, Abdul MIM, Baig MR
    Cardiovasc Diabetol, 2017 08 14;16(1):103.
    PMID: 28807030 DOI: 10.1186/s12933-017-0584-9
    BACKGROUND: We aimed to investigate the efficacy of ascorbic acid and acetylsalicylic acid among type II diabetes mellitus patients using metformin (only) for diabetes management therapy.

    METHOD: A 12-month single blinded multicenter randomized control trial was designed to investigate the measured variables [Glycated Hemoglobin (HbA1c), Renal function, Albumin Creatinine Ratio (ACR) etc.]. The trial was randomized into 2 experimental parallel arms (ascorbic acid vs acetylsalicylic acid) were blinded with study supplements in combination with metformin and findings were compared to control arm with metformin alone and blinded with placebo. Withdrawal criteria was defined to maintain the equity and balance in the participants in the whole trial.

    FINDING: Patients with metformin and ascorbic acid (parallel arm I) was twice more likely to reduce HbA1c than metformin alone (control arm) in a year (OR 2.31 (95% CI 1.87-4.42) p 

  16. Jaber AAS, Khan AH, Sulaiman SAS
    PMID: 29214026 DOI: 10.1186/s40545-017-0124-8
    Background: Evaluating outcomes after tuberculosis (TB) treatment can help identify the primary reasons for treatment success or failure. However, Yemen has a treatment success rate that remains below the World Health Organization's target. This study aimed to identify factors that were associated with unsuccessful treatment and prolonged treatment (>1 year).

    Method: Newly diagnosed cases of smear-positive pulmonary TB were prospectively followed at two centers (Taiz and Alhodidah, Yemen) between April 2014 and March 2015. Standardized forms were used to obtain information from the patients regarding their socio-demographic and clinical characteristics, treatment duration, and TB-related information. Multivariate logistic regression analyses were performed to identify factors that were associated with unsuccessful treatment and prolonged treatment (>1 year).

    Results: The study included data from 273 cases of newly diagnosed TB, with treatment being successful in 227 cases (83.1%) and unsuccessful in 46 cases (16.9%). Among the 46 patients with unsuccessful treatment, 29 patients (10.6%) stopped treatment, 6 patients (2.2%) transferred to another facility, 6 patients (2.2%) experienced treatment failure, and 5 patients (1.8%) died. The multivariate logistic regression analyses revealed that unsuccessful treatment was associated with female sex, illiterate status, and the presence of comorbidities. Prolonged treatment durations were associated with living in a rural area, smoking, chewing khat, a cough that lasted for >3 weeks at the beginning of treatment, and bilateral cavities during radiography.

    Conclusion: These results confirm that the treatment success rate in Yemen is lower than the World Health Organization's target for smear-positive pulmonary tuberculosis. Targeting the risk factors that we identified may help improve treatment outcomes. Furthermore, it may not be prudent to re-treat patients using first-line TB drugs after an initial treatment failure.

  17. Laghari M, Sulaiman SAS, Khan AH, Talpur BA, Bhatti Z, Memon N
    BMC Public Health, 2019 Sep 18;19(1):1274.
    PMID: 31533689 DOI: 10.1186/s12889-019-7597-0
    BACKGROUND: Source case investigation, for children with tuberculosis (TB), is conducted to establish the source of infection and to minimize the extent of on-going transmission from infectious persons in the community. The aim of the study was to evaluate the secondary TB cases and to investigate the risk factors in developing TB among the household contacts (HHC) of children with active TB.

    METHODS: A prospective cross-sectional study was conducted where 443 caregivers, of 508 children with active TB receiving treatment, were interviewed using a structured questionnaire. Logistic regression analysis was used to examine the risk factors for TB.

    RESULTS: A total of 2397 family members at the median of 5 persons were recorded. Of these, 223 (9.3%) were screened on symptoms basis and 35 (15.7%) of these contacts were diagnosed with TB. Multivariate analysis revealed HHC with TB (OR = 15.288, 95% CI: 5.378-43.457), HHC with smoking (OR = 7.094, 95% CI: 2.128-23.648), and contact of > 18 h with TB individual (OR = 4.681, 95% CI: 1.198-18.294) as statistically significant risk factors of TB among the HHC.

    CONCLUSION: With the current system of contact screening for TB, only 9.3% of all HHC were screened. The low rates of contacts screened are possibly a repercussion of the passive nature of the program, which mainly depend on distinctive clinical symptoms being experienced by the contacts. Strategies are required to certify adherence with contact screening among children with active TB and to critically consider the factors responsible for TB transmission.

  18. Aftab RA, Khan AH, Adnan AS, Sulaiman SAS, Khan TM
    Blood Purif., 2019;48(3):233-242.
    PMID: 31387098 DOI: 10.1159/000500997
    AIMS AND OBJECTIVE: To estimate the effect of losartan 50 mg on survival of post-dialysis euvolemic hypertensive patients.

    METHODOLOGY: A single center, prospective, single-blind randomized trial was conducted to estimate the survival of post-dialysis euvolemic hypertensive patients when treated with lorsartan 50 mg every other day. Post-dialysis euvolemic assessment was done by a body composition monitor. Covariate Adaptive Randomization was used for allocation of participants to the standard or intervention arm, and the follow-up duration was twelve months. The primary end point was achieving targeted blood pressure (BP) of <140/90 mm Hg and maintaining for 4 weeks, whereas secondary end point was all cause of mortality. Pre-, intra-, and post-dialysis session BP measurements were recorded, and survival trends were analyzed using Kaplan-Meier analysis.

    RESULTS: Of the total 229 patients, 96 (41.9%) were identified as post-dialysis euvolemic hypertensive. Final samples of 88 (40.1%) patients were randomized into standard (n = 44) and intervention arms (n = 44), and 36 (81.8%) patients in each arm completed a follow-up of 12 months. A total of eight patients passed away during the 12-month follow-up period (6 deaths among standard arm and 2 in intervention arm). However, the probability of survival between both arms was not significant (p = 0.13). Cox regression analysis revealed that chances of survival were higher among the patients in the intervention (OR 3.17) arm than the standard arm (OR 0.31); however, the survival was found not statistically significant.

    CONCLUSION: There was no statistical significant difference in 1 year survival of post-dialysis euvolemic hypertensive patients when treated with losartan 50 mg.

  19. Al Hariri YK, Sulaiman SAS, Khan AH, Adnan AS, Al Ebrahem SQ
    J Infect Public Health, 2019 07 04;12(6):751-759.
    PMID: 31281106 DOI: 10.1016/j.jiph.2019.06.014
    Leptospirosis is the most widely spread zoonosis and Leptospirosis Associated Acute Kidney Injury (LAKI) is common and fatal if not properly and swiftly treated. The aim of this review is to evaluate the mortality of LAKI and to identify the risk factors for its development. An electronic search was performed to identify the studies included LAKI patients series. Only studies which investigated mortality or risk factors for LAKI development in adults were included. Twenty-three studies with 24 patients series were included in the final analysis and included 1698 patients. The median series mortality was 10.05% (range 0-33.3%) with a total of 223 death. Only four studies identified the independent risk factors for LAKI development which were oliguria, jaundice, arrhythmia, crackles, elevated direct bilirubin level, elevated activated prothrombin time, hyperbilirubinemia and leukocytosis. Although the mortality of LAKI is high, its predictors are not studied enough in literature.
  20. Abubakar U, Muhammad HT, Sulaiman SAS, Ramatillah DL, Amir O
    Curr Pharm Teach Learn, 2020 03;12(3):265-273.
    PMID: 32273061 DOI: 10.1016/j.cptl.2019.12.002
    BACKGROUND AND PURPOSE: Training pharmacy students in infectious diseases (ID) is important to enable them to participate in antibiotic stewardship programs. This study evaluated knowledge and self-confidence regarding antibiotic resistance, appropriate antibiotic therapy, and antibiotic stewardship among final year pharmacy undergraduate students.

    METHODS: A cross-sectional electronic survey was conducted at universities in Indonesia, Malaysia, and Pakistan. A 59-item survey was administered between October 2017 and December 2017.

    FINDINGS: The survey was completed by 211 students (response rate 77.8%). The mean knowledge score for antibiotic resistance, appropriate antibiotic therapy, and antibiotic stewardship was 5.6 ± 1.5, 4.7 ± 1.8 (maximum scores 10.0) and 3.1 ± 1.4 (maximum score 5.0), respectively. Significant variations were noted among the schools. There was poor awareness about the consequences of antibiotic resistance and cases with no need for an antibiotic. The knowledge of antibiotic resistance was higher among male respondents (6.1 vs. 5.4) and those who had attended antibiotic resistance (5.7 vs. 5.2) and antibiotic therapy (5.8 vs. 4.9) courses (p 

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