Investigating the association between medication regimen complexity, medication adherence and treatment satisfaction among Malaysian older adult patients: a cross-sectional study.

BACKGROUND: The prevalence of medication nonadherence among Malaysian older adults is approximately 60%. However, there is a lack of studies assessing the factors associated with medication nonadherence among this population. This research aims to explore the association between medication regimen complexity (MRC), treatment satisfaction and medication adherence among Malaysian older adults. METHOD: A cross-sectional study was conducted in outpatient clinics of a teaching hospital in Pahang, Malaysia, between April 2023 and September 2023. MRC Index (MRCI), Treatment Satisfaction for Medication version II (TSQM v.II), and the Malaysian Medication Adherence Assessment Tool (MyMAAT) were used. Multivariate linear and logistic regression models were performed to test the factors affecting treatment satisfaction and medication adherence. Mediator analysis was implemented to assess the mediating role of treatment satisfaction. RESULT: The study involved 429 Malaysian older adult patients, with a prevalence of nonadherence of 51.0% (n = 219) and an MRCI mean score of 17.37 (SD = 7.07). The mean overall treatment satisfaction score was 73.91 (SD = 15.23). Multivariate logistic regression analysis expressed four significant predictors associated with nonadherence: MRC (AOR = 1.179, p = 0.002), overall treatment satisfaction (AOR = 0.847, p < 0.001), partially self-managed medication (AOR = 2.675, p = 0.011) and fully managed medication by family members/caregivers (AOR = 8.436, p = 0.004). Multivariate linear regression shows three predictors of treatment satisfaction: MRC (ß = -1.395, p < 0.001), Charlson Comorbidity Index (CCI) (ß = -0.746, p = 0.009) and self-managed medication (ß = 5.554, p = 0.006). Mediator analysis indicated that treatment satisfaction partially mediated the association between MRC and nonadherence. CONCLUSION: Nonadherence was quite prevalent among Malaysian older outpatients and was associated with regimen complexity, treatment satisfaction and patient dependence on others to manage their medications. Future studies should focus on interventions to control the factors that negatively affect patients' medication adherence.

Impact of Board Certified Psychiatric Pharmacists on improving urinary tract infection antibiotic appropriateness at an acute psychiatric hospital.

Introduction: Urinary tract infections (UTIs) are one of the most common indications for antibiotic use; patients with psychiatric disorders have a greater risk for UTI compared with patients without these disorders. However, there is little guidance on how best to manage antibiotic therapy in psychiatric hospitals. This study assessed the impact of a Board Certified Psychiatric Pharmacist (BCPP)-driven guideline on managing UTI treatment in an acute psychiatric hospital. Methods: The guideline was developed by the psychiatric pharmacy team and distributed to internists, psychiatrists, and pharmacists. Preintervention data were assessed for patients admitted between November 30, 2019, and February 23, 2020; postintervention data were assessed from February 25, 2020, to April 24, 2020. All patients ages 13 years and older who were admitted and had orders for an antibiotic to treat a UTI were included in this study. Appropriate UTI management was defined as an appropriate agent, dose, route, and frequency per the treatment guideline. Additionally, the following criteria were to be ordered and assessed to be deemed appropriate: urinalysis, urine culture, complete blood count, basic or complete metabolic panel, temperature, and subjective symptoms. Results: Before intervention, 19.0% of antibiotic orders were appropriate; after intervention, 46.7% of antibiotic orders were appropriate (P = .048). Conclusion: The implementation of a BCPP-driven treatment algorithm was associated with a significant increase in appropriate antibiotic regimens for the treatment of UTIs in patients admitted to a psychiatric hospital.

Analysis of Essential Oils Components from Aromatic Plants Using Headspace Repellent Method against Aedes aegypti Mosquitoes.

This research serves as the basis for developing essential oil-based repellent activity tests against Aedes aegypti mosquitoes. The method used for the isolation of essential oils was the steam distillation method. Virus-free Aedes aegypti mosquitoes were used as test animals by applying the 10% essential oil repellent on the arms of volunteers. The analysis of the essential oils activities and aromas' components was carried out using headspace repellent and GC-MS methods. Based on the results, the yields of essential oil from 5000 g samples for cinnamon bark, clove flowers, patchouli, nutmeg seed, lemongrass, citronella grass, and turmeric rhizome were 1.9%, 16%, 2.2%, 16.8%, 0.9%, 1.4%, and 6.8%, respectively. The activity test showed that the average repellent power of 10% essential oils, patchouli, cinnamon, nutmeg, turmeric, clove flowers, citronella grass, and lemongrass, was 95.2%, 83.8%, 71.4%, 94.7%, 71.4%, 80.4%, and 85%, respectively. Patchouli and cinnamon had the best average repellent power. Meanwhile, the aroma activities showed that the average repellent power of the patchouli oil was 96%, and the cinnamon oil was 94%. From the GC-MS analysis, nine components were identified in the patchouli essential oil aromas' with the highest concentration being patchouli alcohol (42.7%), Azulene, 1,2,3,5,6,7,8,8a-octahydro-1,4-dimethyl-7-(1-methylethenyl)-, [1S-(1α,7α,8aß)] (10.8%), α-guaiene (9.22%), and seychellene (8.19%)., whereas using the GC-MS headspace repellent method showed that there were seven components identified in the patchouli essential oil aroma with a high concentration of the components, which were patchouli alcohol (52.5%), Seychellene (5.2%), and α-guaiene (5.2%). The analysis results of cinnamon essential oil using the GC-MS method showed that there were five components identified in the aroma, with E-cinnamaldehyde (73%) being the highest component, whereas using the GC-MS headspace repellent method showed that there were five components identified in the aroma, with highest concentrations of cinnamaldehyde (86.1%). It can be concluded that the chemical compounds contained in patchouli and cinnamon bark have the potential to be environmentally friendly repellents in controlling and preventing Aedes aegypti mosquitoes.

True thymic hyperplasia causing pure red cell aplasia: a case report.

Pure red cell aplasia caused by true thymic hyperplasia is extremely rare. We report the case of a 25-year-old female diagnosed with pure red cell aplasia. Following a thymectomy confirming true thymic hyperplasia and corticosteroid therapy, complete response was achieved. Patients diagnosed with pure red cell aplasia should be investigated with a computerized tomographic scan to assess for thymic pathology and if present, this should be resected. Follow-up is essential to monitor for recurrence.

COVID-19 Epidemic in Malaysia: Epidemic Progression, Challenges, and Response.

COVID-19 pandemic is the greatest communicable disease outbreak to have hit Malaysia since the 1918 Spanish Flu which killed 34,644 people or 1% of the population of the then British Malaya. In 1999, the Nipah virus outbreak killed 105 Malaysians, while the SARS outbreak of 2003 claimed only 2 lives. The ongoing COVID-19 pandemic has so far claimed over 100 Malaysian lives. There were two waves of the COVID-19 cases in Malaysia. First wave of 22 cases occurred from January 25 to February 15 with no death and full recovery of all cases. The ongoing second wave, which commenced on February 27, presented cases in several clusters, the biggest of which was the Sri Petaling Tabligh cluster with an infection rate of 6.5%, and making up 47% of all cases in Malaysia. Subsequently, other clusters appeared from local mass gatherings and imported cases of Malaysians returning from overseas. Healthcare workers carry high risks of infection due to the daily exposure and management of COVID-19 in the hospitals. However, 70% of them were infected through community transmission and not while handling patients. In vulnerable groups, the incidence of COVID-19 cases was highest among the age group 55 to 64 years. In terms of fatalities, 63% were reported to be aged above 60 years, and 81% had chronic comorbidities such as diabetes, hypertension, and heart diseases. The predominant COVID-19 strain in Malaysia is strain B, which is found exclusively in East Asia. However, strain A, which is mostly found in the USA and Australia, and strain C in Europe were also present. To contain the epidemic, Malaysia implemented a Movement Control Order (MCO) beginning on March 18 in 4 phases over 2 months, ending on May 12. In terms of economic impacts, Malaysia lost RM2.4 billion a day during the MCO period, with an accumulated loss of RM63 billion up to the end of April. Since May 4, Malaysia has relaxed the MCO and opened up its economic sector to relieve its economic burden. Currently, the best approach to achieving herd immunity to COVID-19 is through vaccination rather than by acquiring it naturally. There are at least two candidate vaccines which have reached the final stage of human clinical trials. Malaysia's COVID-19 case fatality rate is lower than what it is globally; this is due to the successful implementation of early preparedness and planning, the public health and hospital system, comprehensive contact tracing, active case detection, and a strict enhanced MCO.

Health Impact Assessment as a Planning and Decision-making Tool

@#Health impact assessment (HIA) is a versatile planning and decision-making tool that has been applied in many situations but more so in environmental impact assessment (EIA). In many developed and developing countries, many development activities and projects are now subjected to EIA. HIA in urban planning although limited, is now being increasingly applied, whereby the planning of a city including its transportation system and corridors can have significant health implications on city dwellers. This paper discusses the usefulness of HIA as an impact assessment tool in various applications including in urban planning. The International Finance Corporation (IFC) has introduced a comprehensive HIA which includes health risk assessment (HRA). Environmental HRA is a standardized characterization of potential negative health impacts resulting from human exposures to dangerous agents or circumstances within the environment. HIA as a planning and decision-making tool will become more universal in its applications.

Prevalence of comorbidities and their associations with health-related quality of life and healthcare expenditures in patients with rheumatoid arthritis.

INTRODUCTION/OBJECTIVES: Rheumatoid arthritis (RA) is known to be associated with an increased risk of comorbidities, premature mortality, and disability. We investigated the prevalence of comorbidities in RA compared with non-RA controls and the effect of comorbidities on health-related quality of life (HRQoL) and total healthcare expenditures. METHODS: Adult RA patients and age-, sex-matched individuals without RA (non-RA controls) were identified from the Medical Expenditure Panel Survey 2010-2015 data. Twenty comorbidities were investigated including cardiovascular, psychological, respiratory, and musculoskeletal conditions. The Short Form-12 physical and mental component summary scores for HRQoL and total healthcare expenditures (2015 US dollars) were summarized based on the number of comorbidities as well as the type of comorbidities. Outcomes were further investigated using multivariable regression analyses. RESULTS: A total of 2925 patients with RA and 14,625 non-RA controls were included. Approximately 60.4% of RA and 37.2% of non-RA controls had ≥ 3 comorbidities, and 23.5% of RA and 12.0% of non-RA controls had ≥ 5 comorbidities. The prevalence of comorbidities in RA was higher across different types of comorbidities compared with non-RA controls. The most prevalent comorbidities in RA were cardiovascular diseases (79.0%) followed by respiratory conditions (34.4%). Having ≥ 5 comorbidities in RA was significantly associated with lower SF-12 physical and mental scores and increase in healthcare expenditures compared with RA without any comorbidity ($23,214 ($19,941-$26,119) for ≥ 5 comorbidities vs. $11,137 ($7610-$14,396) for no comorbidity). CONCLUSION: A substantial number of patients with RA had multiple comorbidities. The comorbidities in RA were associated with poor HRQoL and higher healthcare expenditures. Key Points • The prevalence of comorbidities was significantly higher in RA compared to age- and sex-matched non-RA controls. • RA itself was associated with lower mental and physical health-related quality of life and increase in healthcare expenditures. • A higher number of comorbidities in RA were associated with poorer mental and physical health-related quality of life and increase in healthcare expenditures. • Specific comorbidities such as respiratory conditions and psychological disorders were associated with both health-related quality of life and economic burden in RA.

Effectiveness of selective risk based screening for Gestational Diabetes (GDM) in Malaysia: A retrospective cohort study based on the National Obstetric Registry (NOR) of Malaysia

Introduction: Gestational diabetes (GDM) has significant maternal and foetal implications. screening allows active interventions which significantly improves pregnancy outcomes. Despite World Health Organization (WHO), FIGO and National Institute of clinical Excellence (NIcE) recommendations for universal screening especially among high risk population; Malaysia currently adopts a selective risk based screening for GDM. Objective: the objective is to audit the effectiveness of the current practice of selective risk based screening in detection of GDM in Malaysia. Methodology: this is a retrospective cohort study based on the National Obstetric Registry (NOR) which comprises of 14 major tertiary hospitals in Malaysia. the study period was from 1st January 2011 till 31st December 2012 and a total of 22,044 patients with GDM were analysed. Logistic regression analysis was used to calculate the crude odd ratio. Results: the incidence of GDM in Malaysia is 8.4%. Maternal age of ≥25, booking bMI ≥27kg/m2, booking weight ≥80kg and previous hypertension are non-significant risk of developing GDM in Malaysia. Parity 5 and more was only associated with an odds-ratio of 1.02 (95% confidence Interval: 0.90-1.17) as compared to parity below 5. the association of women with previous stillbirth with GDM was not significant. conclusion: current risk based screening for GDM based on maternal age, booking bMI, weight and hypertension is inappropriate. An ideal screening tool should precede disease complications, which is the novel objective of screening. Universal screening for GDM in Malaysia may be a more accurate measure, especially with regards to reducing maternal and foetal complications.

HUMAN BABESIOSIS: A GENERAL REVIEW WITH SPECIAL REFERENCE TO EGYPT.

Babesiosis is a tick-borne malaria-like illness caused by species of the intra-erythrocytic protozoan Babesia. Humans are opportunistic hosts for Babesia when bitten by nymph or adult ticks. Currently, Babesia infection is transmitted by various tick vectors in Europe, Asia, Africa and the northwestern and northeastern United States. Human babesiosis was first described in 1957 but is now known to have worldwide distribution. The increase in reported cases is likely due to increases in actual incidence as well as increased awareness of the disease. Despite the diagnostic and preventive advances resulting from extensive research and a greater understanding of the disease, babesiosis continues to have significant medical impact as a confounding variable in the diagnosis and treatment of Lyme disease and as a potential threat to the blood supply, especially in the United States. Diagnostic advances, like the development of PCR assays, have resulted in increased sensitivity for detection as well as the discovery and characterization of new babesial species. Further studies using the molecular tools now available and those to be developed will lead to a better understanding of the natural history of these organisms, including the transmission cycle and the, potential role of Babesia parasites themselves as immunomodulAtor. Human babesiosis is usually an asymptomatic infection in healthy individuals. Several patients become symptomatic, and, within these subpopulations, significant morbidity and mortality occur, especially in elderly, immunocompromised, or asplenic patients. It is difficult to diagnose. Although the index of suspicion should be high in rural Babesia endemic areas, patients with babesiosis have few, if any, localizing signs to suggest the disease. Diagnosis confirmation depends on the parasitemia degree, the expertise and well trained laboratory personnel. Most patients infected by B microti who are otherwise healthy appear to have a mild illness and typically recover without specific chemotherapy; however, treatment is recommended for all diagnosed cases to prevent sequelae and potential transmission through blood donation. In addition, patients should be advised to take precautions against tick exposure and to refrain from donating blood until completely cured of babesiosis.

Isolation and identification of highly pathogenic avian influenza H5N1 virus from Houbara bustards (Chlamydotis undulata macqueenii) and contact falcons.

Highly pathogenic influenza virus (HPAIV) H5N1 has caused mortality and morbidity in many species of domestic and wild bird. The Houbara bustard (Chlamydotis undulata macqueenii) is a solitary bird that inhabits semi-desert regions. It is known to be susceptible to avianpox, avian paramyxovirus type 1, and low-pathogenicity avian influenza H9N2. We report an outbreak of H5N1 HPAIV in Houbara bustards, which were introduced into the Kingdom of Saudi Arabia for falconry purposes. Ninety-three per cent mortality (38 out of 41 birds) in the infected Houbara bustard flock and about 62.5% mortality (10 out of 16 birds) in falcons that came in contact with these birds were observed. Pooled cloacal and tracheal swabs from Houbara bustards as well as visceral organ homogenates collected in Houbara bustards and falcons were tested by real-time reverse transcriptase-polymerase chain reaction, and virus isolation was attempted in specific pathogen free hens' eggs. The viruses isolated were characterized as HPAIV H5N1. Phylogenetic analysis of the haemagglutinating and Neuraminidase (NA) genes revealed that the viruses isolated from Houbara bustards and falcons were closely related to each other and to Kuwaiti H5N1 strains isolated in 2007. Interestingly, they were genetically distinguishable from the co-circulating A/H5N1 viruses in Kingdom of Saudi Arabia causing outbreaks in domestic birds. This case emphasizes the need for surveillance of this endangered species in its natural habitat.