An assessment of health and social-economic status among Lanoh ethnic sub-group of Orang Asli (indigenous peoples) in Air Bah I village, state of Perak, Malaysia.

This study was conducted to assess the health and social economic status of Lanoh ethic sub-group of Orang Asli (indigenous peoples) in Air Bah I village, Malaysia. A one day study which involved health screening and structured interview was conducted on 16 April 2011. Forty five Orang Asli participated in the health screening. Fifteen subjects were newly discovered to have high blood pressure while 5 subjects had high blood glucose level. Only 37.8 % had normal body mass index and 26.7 % were pre-obese. Thirteen subjects were interviewed about their health seeking behavior and knowledge of the proper use of medications. Slightly more than half (53.8 %) of the subjects was uneducated and 69.2 % were rubber tappers with the median monthly household income of RM 400 (USD 122.31). Approximately 77 % of the subjects had visited the health centre for body checkups. The utilization of herbs as medications (23.1 %) was common and the majority (76.9 %) said that traditional medications were safe compared to modern medications. Around 46 % of Orang Asli had the opinion that medications should be kept in the refrigerator and exposed places and 61.5 % shared medications with others. In conclusion, the Lanoh are still categorized under the poverty group and their education level remains low. Therefore, education intervention is necessary to improve their knowledge on the proper use of medications.

A case report of a bipolar disorder patient with severe lithium poisoning possibly induced by interaction between risperidone, telmisartan, fluvoxamine and lithium.

We describe a case of severe lithium poisoning possibly induced by multiple drug interaction. A 45-year-old man with bipolar disorder was admitted with altered behavior and mental status. He was maintained on lithium for 20 years. Nine months ago, lithium dose was increased and risperidone was added. Telmisartan was prescribed around 25 days ago and he had mild tremor since then. Two days ago, fluvoxamine was initiated and he developed restlessness, agitation, insomnia and confusion after one dose. On admission, fluvoxamine, lithium, telmisartan and risperidone were discontinued. Abnormal findings were temporary ST depression, hyponatremia and high creatine kinase. He had fever since day 2 and was covered for meningoencephalitis and neuroleptic malignant syndrome. On the next day, he was comatose and treated for septic shock. On day 7, result of serum lithium taken on day 3 revealed severe toxicity (3.2 mEq/L). The lithium level was normalized after hemodialysis. He subsequently regained full Glasgow Coma Scale score and his toxicity completely resolved on day 16. Interactions of risperidone and telmisartan with lithium possibly precipitated the lithium toxicity. However, the onset of the toxicity suggested fluvoxamine as the major cause of poisoning. Clinicians should be aware of these potential drug interactions.