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  1. Ng PH, NorAzlin MI, Nasri NI
    Int J Gynaecol Obstet, 2007 Dec;99(3):251.
    PMID: 17888439
    Matched MeSH terms: Methotrexate/administration & dosage*
  2. Widyastuti Y, Gentong M, Astuti W
    Med J Malaysia, 2020 05;75(Suppl 1):24-27.
    PMID: 32471966
    BACKGROUND: Procedural sedation and analgesia (PSAA) or monitoring anaesthesia care (MAC) must provide analgesia, amnesia and hypnosis with complete and rapid recovery that suits a particular operative procedure with minimum side effects. For a child undergoing a procedure, a major deciding factor is whether it is painful or not. Deep Sedation is required during the procedures to allay the anxiety, pain, and movement. The appropriate level of sedation depth will prevent consciousness, over-sedation, optimisation of dosage and prevents adverse complications. There are few studies about consciousness in pediatric patients during methotrexate injection with monitored anaesthesia care (MAC). The objective is to find out the incidence of consciousness of paediatric patients during methotrexate injection with Monitored Anaesthesia Care.

    METHODS: Observational study conducted on 68 patients (1- 18 yrs.) with physical status of ASA II during methotrexate injection with MAC at the RSUP dr. Sardjito. The depth of anaesthesia was monitored with Observer's Alertness Assessment Sedation Scale (OAAS) every two minutes. Consciousness was defined as OAAS=5, or if there is volunteer movement of patients. The result was analysed and categorised according to age, sex, physical status, Body Mass Index (BMI) and anaesthesia's medication of patients.

    RESULTS: Positive consciousness in paediatric patients based on OASS score at 2-minute and 4-minutes was 26.5% and 3.2% respectively, and was rescued by additional propofol 2mg/kg body weight.

    CONCLUSION: The incidence of paediatric consciousness in patients during methotrexate injection with Monitored Anaesthesia Care (MAC) in the Sardjito General Hospital is 26.5% (2-minute after induction) and 3.2% (4-minute after induction), and this is considerably high thus needing futher prevention.

    Matched MeSH terms: Methotrexate/administration & dosage*
  3. Tiash S, Othman I, Rosli R, Chowdhury EH
    Curr Drug Deliv, 2014;11(2):214-22.
    PMID: 24328684
    Most of the classical drugs used today to destroy cancer cells lead to the development of acquired resistance in those cells by limiting cellular entry of the drugs or exporting them out by efflux pumps. As a result, higher doses of drugs are usually required to kill the cancer cells affecting normal cells and causing numerous side effects. Accumulation of the therapeutic level of drugs inside the cancer cells is thus required for an adequate period of time to get drugs' complete therapeutic efficacy minimizing the side effects on normal cells. In order to improve the efficacy of chemotherapeutic drugs, nanoparticles of carbonate apatite and its strontium (Sr(2+))-substituted derivative were used in this study to make complexes with three classical anticancer drugs, methotrexate, cyclophosphamide and 5-flurouracil. The binding affinities of these drugs to apatite were evaluated by absorbance and HPLC analysis and the therapeutic efficacy of drug-apatite complexes was determined by cell viability assay. Carbonate apatite demonstrated significant binding affinity towards methotrexate and cyclophosphamide leading to more cellular toxicity than free drugs in MCF-7 and 4T1 breast cancer cells. Moreover, Sr(2+) substitution in carbonate apatite with resulting tiny particles less than 100 nm in diameter further promoted binding of methotrexate to the nanocarriers indicating that Sr(2+)-substituted apatite nanoparticles have the high potential for loading substantial amount of anti-cancer drugs with eventual more therapeutic effectiveness.
    Matched MeSH terms: Methotrexate/administration & dosage*
  4. Lin HP, Sinnah D, Menaka N, Cherian R, Singh P
    Med. Pediatr. Oncol., 1983;11(5):327-32.
    PMID: 6579342
    One hundred four children with acute lymphoblastic leukaemia were diagnosed at the University Hospital, Kuala Lumpur, Malaysia, between 1976 and 1982; 87 were evaluable with respect to treatment. They were divided into good prognosis (GP) and bad prognosis (BP) groups based on their initial total white cell count, their treatment differing only during the maintenance phase. Remission was achieved in 82 patients (94%) of whom ten (12%) subsequently died in remission from infection. Twenty-eight (34%) relapsed while on treatment and three while off therapy. Eleven patients ceased treatment after 3 yr of continuous complete remission (CCR). Three of these later relapsed, two within the first year. Survival in CCR was significantly better in the GP group up to 30 months, after which the difference diminished. There was no difference in survival between boys and girls. The overall disease-free survival at 3 yr and 5 yr was 40% and 25%, respectively, with a median follow-up period of 20 months (range 4-69 months). The reasons for the relatively low survival rates as compared with those in developed countries are discussed.
    Matched MeSH terms: Methotrexate/administration & dosage
  5. Ti TK, Yong NK
    Med J Malaysia, 1974 Mar;28(3):165-70.
    PMID: 4278036
    Matched MeSH terms: Methotrexate/administration & dosage
  6. Narasimha K
    Gan To Kagaku Ryoho, 1992 Jul;19(8 Suppl):1220-3.
    PMID: 1514835
    Matched MeSH terms: Methotrexate/administration & dosage
  7. Bosco I, Teh A
    Leukemia, 1995 Jun;9(6):951-4.
    PMID: 7596183
    Reports on the outcome of treatment in ALL in Asian (non-Caucasian) adults have been few, and published results compare very unfavourably with results of treatment from 'Western' centres. Seventy-four newly diagnosed Malaysian patients with ALL between the ages of 15 and 69 were treated from 1986 to 1990. The clinical features and prognostic factors were similar to those reported in 'Western' series. The chemotherapy protocol utilized was adapted from the one used by Hoelzer et al in the multicentre German study. The complete remission rate was 73%. The probability of continuous complete remission at 5 years was 29% with a median duration of remission of 15 months. This compares with Hoelzer's initial results of 77% CR rate and 35% CCR at 5 years. Patients with an initial white cell count of less than 30 x 10(9)/l at presentation were found to have a significantly better disease-free survival than those with a count of more than 30 x 10(9)/l (35 vs 22%, P = 0.026, univariate analysis). There was no difference in leukaemia-free survival according to age, sex, ethnic group, or immunophenotype. These results show that the use of moderately intensive chemotherapy protocols in Asian (non-Caucasian) patients achieves similar results to those used in Caucasians. We also showed that the difficulties in 'curing' approximately 70% of adult patient with ALL are universal.
    Matched MeSH terms: Methotrexate/administration & dosage
  8. Tang YL, Chia WK, Yap EC, Julia MI, Leong CF, Salwati S, et al.
    Malays J Pathol, 2016 Dec;38(3):315-319.
    PMID: 28028303 MyJurnal
    INTRODUCTION: Individuals who are exposed to cytotoxic agents are at risk of developing therapyrelated myeloid neoplasms (t-MN). Cytogenetic findings of a neoplasm play an important role in stratifying patients into different risk groups and thus predict the response to treatment and overall survival.

    CASE REPORT: A 59-year-old man was diagnosed with acute promyelocytic leukaemia. Following this, he underwent all-trans retinoic acid (ATRA) based chemotherapy and achieved remission. Four years later, the disease relapsed and he was given idarubicin, mitoxantrone and ATRA followed by maintenance chemotherapy (ATRA, mercaptopurine and methotrexate). He achieved a second remission for the next 11 years. During a follow-up later, his full blood picture showed leucocytosis, anaemia and leucoerythroblastic picture. Bone marrow examination showed hypercellular marrow with trilineage dysplasia, 3% blasts but no abnormal promyelocyte. Fluorescence in-situ hybridisation (FISH) study of the PML/RARA gene was negative. Karyotyping result revealed complex abnormalities and monosomal karyotype (MK). A diagnosis of therapy-related myelodysplastic syndrome/myeloproliferative neoplasm with unfavourable karyotypes and MK was made. The disease progressed rapidly and transformed into therapy-related acute myeloid leukaemia in less than four months, complicated with severe pneumonia. Despite aggressive treatment with antibiotics and chemotherapy, the patient succumbed to the illness two weeks after the diagnosis.

    DISCUSSION AND CONCLUSION: Diagnosis of t-MN should be suspected in patients with a history of receiving cytotoxic agents. Karyotyping analysis is crucial for risk stratification as MK in addition to complex aberrant karyotypes predicts unfavourable outcome. Further studies are required to address the optimal management for patients with t-MN.

    Matched MeSH terms: Methotrexate/administration & dosage
  9. Kamal WSA, Affandi AM, Bhullar A, Kamal WSZ
    Med J Malaysia, 2018 08;73(4):253-254.
    PMID: 30121690 MyJurnal
    Lymphoma presenting with ulceration is not typical. We report a case of relapsed DLBCL in a 73-year-old man presenting with a chronic non-healing leg ulcer. He has underlying varicose veins with recurrent venous ulcers. This patient was diagnosed to have DLBCL six years earlier when he presented with recurrent epistaxis originating from a left nasal cavity nodule. Complete resolution was achieved after eight cycles of R-CHOP and intrathecal methotrexate. For this current problem, this patient was treated with rituximab combined with chemotherapy which resulted in healing of the ulcer.
    Matched MeSH terms: Methotrexate/administration & dosage
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