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.

Evaluating the incidence, risk factors and glycaemic control of new-onset diabetes mellitus in kidney transplant recipients: a single centre study.

This study aimed to evaluate the incidence and risk factors for development of post-kidney transplant diabetes mellitus (PTDM) and its glycaemic control in a single centre. Adult kidney transplant recipients (n = 164) under follow-up at Penang Hospital, Malaysia since transplantation (mean follow-up time: 11.04±6.26 years) were retrospectively reviewed. Data were retrieved from year 1984 to 2010. PTDM was defined according to the American Diabetes Association Guideline. Clinical covariates of PTDM were determined by using binary logistic regression analysis. Thirty six patients (22.0%) developed PTDM with a cumulative incidence of 5.5%, 6.7%, 12.2% and 17.7% respectively at 1, 3, 5 and 10 years post-transplantation. Multivariate analysis showed that the number of concurrent diseases in the patients (OR = 2.26, p = 0.007) and fasting blood sugar (FBS) level at 6 months post-transplant (OR = 4.10, p = 0.001) were independent predictors of PTDM. The mean FBS level at the time of diagnosis for PTDM was 11.21±5.57 mmol/L. Treatments with anti-diabetic drug(s) were given and the FBS levels were under controlled (mean value of 6.50±1.14 mmol/L) at six months after the PTDM diagnosis. Close monitoring of blood sugar level particularly early after kidney transplantation is necessary for the detection of PTDM.

Community pharmacist's perceptions towards the quality of locally manufactured generic medicines: A descriptive study from Malaysia.

This study aimed to explore the perceptions of Malaysian community pharmacist towards locally manufactured generic medicines. A cross-sectional descriptive study involving entire population (N = 270) of Practicing community pharmacists in the State of Penang, Malaysia was undertaken using a self-completed anonymous mail questionnaire. Responses were received from 48 pharmacists (response rate 17.8%). Majority of the respondents (97.9%) actively dispensed generic medicines in their practice. Only 37.5% of the respondents viewed locally manufactured generic medicines as equal in quality compared to the imported generics from international manufacturers. However, approximately 60% of the respondents agreed that domestic generics are equal in safety and efficacy as the imported generic medicines. About half of the respondents (47.9%) believed that imported generic products need to pass more stringent approval process. Majority of the respondents (68.8%) urged that the Malaysian regulatory authorities should convince pharmacists about the quality of domestic generic medicines. The Malaysian pharmacists have lack of confidence with the generic medicines produced by local pharmaceutical companies.