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Kuala Lumpur, Malaysia

Adnan S.,University of Queensland | Paterson D.L.,University of Queensland | Lipman J.,University of Queensland | Kumar S.,Hospital Sungai Buloh | And 4 more authors.
Surgical Infections | Year: 2012

Background and Purpose: The objective of this structured review was to analyze critically the findings of pharmacokinetic studies of beta-lactam antibiotics in patients with intra-abdominal disease; that is, intra-abdominal infection (IAI) or previous abdominal surgery and determine the requirements for dosage modification in this population. Methods: Data were identified by structured review of PUBMED from February 1983 to February 2011. All 14 articles reviewed described the pharmacokinetics of beta-lactam antibiotics in patients with intra-abdominal disease. Results: Antibiotic classes included carbapenems, penicillins, cephalosporins, and monobactams. Possible physiological changes in these patients include development of abscesses, perforation, or ischemia of the bowel as well as intra-abdominal hypertension. These disorders may cause changes in antibiotic pharmacokinetics, including increased volume of distribution and faster drug clearance, both resulting in lower antibiotic concentrations. High inter-individual pharmacokinetic variability was common to each of the studies. Conclusion: Most of the available data demonstrate that drug volume of distribution can be increased significantly in the presence of intra-abdominal disease. Drug clearance is likely to vary in line with renal or hepatic function. Thus, dose optimization is important to prevent development of antibiotic resistance or therapeutic failure. However, further research is necessary to determine the clinical outcome of individualized dosing on the basis of pharmacokinetic/pharmacodynamic studies. © 2012, Mary Ann Liebert, Inc. Source

Suzanna A.B.,Hospital Sungai Buloh | Liu C.Y.,National University of Malaysia | Syed Rozaidi S.W.,Prince Court Medical Center | Ooi J.S.M.,National University of Malaysia
Medical Journal of Malaysia | Year: 2011

Background: The LMA-Classic ™ laryngeal mask airway (Classic™ LMA) is an autoclavable and reusable laryngeal mask airway with strong evidence supporting its efficacy and safety. Due to the concern of infection risk particularly of prion disease, various single-use laryngeal mask devices were developed. The Ambu® AuraOnce™ LMA (Ambu® LMA) is a single use disposable laryngeal mask airway with special design that conforms better to the anatomy of the airway. Objectives: The Ambu® LMA was compared to the LMAClassic ™ Classic™ LMA in respect to ease of insertion, adequacy of seal intraoperatively and postoperative complications in patients undergoing elective general anaesthesia with positive pressure ventilation. Methods: One hundred and eighteen ASA I and II patients undergoing elective general anaesthesia were randomly allocated into receiving either the Ambu® LMA or the Classic™ LMA. The time taken and number of attempts taken to insert the laryngeal mask was recorded. Intra-operative adequacy of seal was assessed via the amount of nitrous oxide leak using a nitrous oxide analyser. Readings were charted at 0, 20, 40 and 60 minutes of operation. Complications postoperatively (blood stains on the device and occurrence of sore throat) were also recorded. Results: The success of first attempt insertion was comparable between the two groups (Classic ™ LMA 87% versus Ambu® LMA 83%). However the time of insertion was significantly shorter in the Ambu® LMA group (p=0.008). Nitrous oxide level was comparable between the two groups up to 20 minutes of operation. At 40 and 60 minutes, the Ambu® LMA showed a significant lower nitrous oxide leak compared to the Classic ™ LMA. Postoperatively, incidence of blood stains was comparable between the two groups, however the incidence of sore throat was lower in the Ambu® LMA group (p=0.025). Conclusions: This study demonstrated that the Ambu® LMA was comparable to the Classic™ LMA in terms of the ease of insertion, but provided better seal during positive pressure ventilation with less postoperative sore throat. Source

Syed I.A.,Universiti Sains Malaysia | Sulaiman S.A.S.,Universiti Sains Malaysia | Hassali M.A.,Universiti Sains Malaysia | Lee C.K.C.,Hospital Sungai Buloh
HIV and AIDS Review | Year: 2013

Background: Increase patients' life expectancy with quality of life remains as prime objectives of HIV/AIDS treatment. However it is well established that HIV/AIDS patients faces many challenges in adhering to their treatment due to many factors including adverse drug effects, social support, proper medical care including counseling, etc. Greater involvement of patients into their medical care will help in improving these outcomes. Therefore assessing patients' understanding and expectations should be an important aspect in HIV/AIDS management. Discussion: Experts argue on importance of patient perspective evaluations and their effectiveness in shaping medical practice. However many evidences in favor of such evaluations have suggested that such measures are robust and useful indicators of quality health services. Whether OR not one accepts this argument it is still one of the prime responsibilities of health care providers to help their patient with provision of best services. In order to achieve these quality assessment of HIV/AIDS patients understanding is imperative since studies have shown that patient understandings and beliefs do affect health related outcomes. Summary: Assessment of HIV/AIDS patients' understandings and expectations toward disease, treatment and care provided can help in finding issues which later can be incorporated into patient care. This may help in addressing issues of non-adherence. Both qualitative and quantitative methodologies have been used in assessing patients' perspective, however the focus should not be only on individual methodologies but how to use and improve such explorations so that it can be indicative of meaningful quality measures. © 2013 Polish AIDS Research Society. Source

Hasan S.S.,International Medical University | See C.K.,International Medical University | Choong C.L.K.,Hospital Sungai Buloh | Ahmed S.I.,International Medical University | And 2 more authors.
Journal of Alternative and Complementary Medicine | Year: 2010

Objectives: The primary objective of this study was to evaluate the pattern of use, reasons for use, and perceived effect of complementary and alternative medicine (CAM), accompanied by identification and comparison of the factors that are potentially associated with CAM use. Design: This cross-sectional study was carried out in 325 randomly sampled patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), at HIV/AIDS referral clinics in the Hospital Sungai Buloh, Malaysia. Simple random sampling was used, where randomization was done using patients' medical record numbers. Subjects and methods: Semistructured face-to-face interviews were conducted using 38 questions pertaining to type, pattern, perceived efficacy, adverse effects, and influential factors associated with CAM use. In addition, CD4 count and viral load readings were recorded. Results: Of 325 randomly sampled patients with HIV/AIDS, 254 of them were using some forms of CAM, resulting in a utilization rate of 78.2%. Vitamins and supplements (52.6%), herbal products (33.8%), and massage (16.6%) were the top three most frequently used CAM modalities. Sociodemographic factors including education level (p = 0.021, r s = 0.148), monthly income (p = 0.001, r s = 0.260), and family history of CAM use (p = 0.001, r s = 0.231) were significantly associated and positively correlated with CAM use. However, the majority of these patients (68%) did not disclose CAM use to health care professionals. About half of those who rated their health as good or very good perceived it as a result of CAM use. Conclusions: This study confirmed the range of 30%-100% CAM use among individuals infected with HIV/AIDS. Although, on the one hand some types of CAM reduced viral load and enhanced the immune system, on the other hand some forms of CAM produced a detrimental effect on the virological suppression, opening this platform to more research and investigation in order to optimize the use of CAM among patients with HIV/AIDS. © Mary Ann Liebert, Inc. Source

Phanuphak P.,Red Cross | Phanuphak P.,Chulalongkorn University | Sirivichayakul S.,Chulalongkorn University | Jiamsakul A.,University of New South Wales | And 13 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2014

BACKGROUND: We compared treatment outcomes of transmitted drug resistance (TDR) in patients on fully or partially sensitive drug regimens. METHODS: Factors associated with survival and failure were analyzed using Cox proportional hazards and discrete time conditional logistic models. RESULTS: TDR, found in 60 (4.1%) of 1471 Asian treatment-naive patients, was one of the significant predictors of failure. Patients with TDR to >1 drug in their regimen were >3 times as likely to fail compared to no TDR. CONCLUSIONS: TDR was associated with failure in the context of non-fully sensitive regimens. Efforts are needed to incorporate resistance testing into national treatment programs. © 2013 by Lippincott Williams and Wilkins. Source

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