MyMedR

Quinine interactions with tryptophan and tyrosine in malaria patients, and implications for quinine responses in the clinical setting

Islahudin F, Pleass RJ, Avery SV, Ting KN

J Antimicrob Chemother, 2012 Oct;67(10):2501-5.

PMID: 22763566 DOI: 10.1093/jac/dks253

OBJECTIVES: Recent work with the yeast model revealed that the antiprotozoal drug quinine competes with tryptophan for uptake via a common transport protein, causing cellular tryptophan starvation. In the present work, it was hypothesized that similar interactions may occur in malaria patients receiving quinine therapy.

PATIENTS AND METHODS: A direct observational study was conducted in which plasma levels of drug and amino acids (tryptophan, tyrosine and phenylalanine) were monitored during quinine treatment of malaria patients with Plasmodium falciparum infections.

RESULTS: Consistent with competition for uptake from plasma into cells, plasma tryptophan and tyrosine levels increased ≥2-fold during quinine therapy. Plasma quinine levels in individual plasma samples were significantly and positively correlated with tryptophan and tyrosine in the same samples. Control studies indicated no effect on phenylalanine. Chloroquine treatment of Plasmodium vivax-infected patients did not affect plasma tryptophan or tyrosine. During quinine treatment, plasma tryptophan was significantly lower (and quinine significantly higher) in patients experiencing adverse drug reactions.

CONCLUSIONS: Plasma quinine levels during therapy are related to patient tryptophan and tyrosine levels, and these interactions can determine patient responses to quinine. The study also highlights the potential for extrapolating insights directly from the yeast model to human malaria patients.

Matched MeSH terms: Malaria, Falciparum/drug therapy*; Malaria, Vivax/drug therapy

Fulltext In vitro evaluation of Pandanus amaryllifolius ethanol extract for induction of cell death on non-hormone dependent human breast adenocarcinoma MDA-MB-231 cell via apoptosis

Chong HZ, Yeap SK, Rahmat A, Akim AM, Alitheen NB, Othman F, et al.

BMC Complement Altern Med, 2012;12:134.

PMID: 22909149 DOI: 10.1186/1472-6882-12-134

Our previous study had shown that P. amaryllifolius was able to selectively inhibit cell proliferation of hormone independent breast cancer cell line MDA-MB-231. To understand the mode of killing and mechanism of action for P. amaryllifolius, the ethanol extract was evaluated for their alteration of cell cycle progression, PS externalization, DNA fragmentation and expression of anti/pro-apoptotic related protein.

Matched MeSH terms: Adenocarcinoma/drug therapy; Breast Neoplasms/drug therapy

Pisa syndrome secondary to rivastigmine: a case report

Muthupalaniappen L, Rosdinom R, Suguna M

Clin Ter, 2012;163(1):31-2.

PMID: 22362231

Pisa syndrome or pleurothotonus is the persistent flexion of the body and head to one side giving the appearance of the leaning tower of Pisa. It is most commonly caused by typical and atypical antipsychotic drugs. We report a case of Pisa Syndrome caused by prolonged use of high dose cholinesterase inhibitor, rivastigmine. Symptoms subsided when rivastigmine was withdrawn and did not reappear when a different cholinesterase inhibitor, donepezil was introduced. Physicians should be aware of Pisa syndrome and should alert patient of this possibility when starting and stepping up medications. The purpose of reporting this case is to create awareness among general practitioners as it is a reversible condition which responds to removal of the offending drug.

Matched MeSH terms: Delusions/drug therapy; Dementia/drug therapy

Fulltext Neuropsychiatric manifestation after a stroke: newly developed symptoms or side-effect of drug?

Tan EC, Aziz NA, Ahmad S

BMJ Case Rep, 2012;2012.

PMID: 22907854 DOI: 10.1136/bcr-2012-006518

A 55-year-old woman presented with sudden onset of left-sided body weakness and numbness, which was diagnosed as multifocal cerebral infarct with right thalamic bleed. She had concurrent hypertension, diabetes mellitus and chronic kidney disease. She suffered from central poststroke pain and reactive depression as poststroke complications, for which amitriptyline was prescribed. Unfortunately, she developed symptoms suggestive of mania and psychosis upon initiation of medications, which resolved upon withdrawal of amitriptyline. Amitriptyline is effective for treatment of poststroke pain and particularly useful in concomitant depression. Unexpectedly, this patient developed new psychopathologies after initiation of this medication. This case highlights the development of new psychopathologies that could be due to the antidepressant, underlying bipolar disorder or a complication of the stroke itself. Primary care providers need to actively enquire regarding neuropsychiatric symptoms because they can adversely affect the patient's quality of life as well as impede rehabilitation efforts.

Matched MeSH terms: Depression/drug therapy; Pain/drug therapy

Fulltext Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis--a case report

Shaharuddin NR, Leong CL, Chidambaram SK, Lee C

Med J Malaysia, 2012 Jun;67(3):337-9.

PMID: 23082432

Paraspinal abscess and spondylodiscitis due to Citrobacter koseri is a very rare condition. We report a remarkable case of Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis in a patient who has successfully been treated in our hospital. Our patient demonstrates one of the common challenges in the practice of infectious disease medicine, wherein an innocuous presentation may and often underlie a serious infection. This case report elucidates to us that the diagnosis of a paraspinal abscess and spondylodiscitis requires a high index of suspicion in at risk patient presenting with compatible signs and symptoms.

Matched MeSH terms: Discitis/drug therapy; Bacteremia/drug therapy

Fulltext Glycaemic control and cost analysis when changing from gliclazide co-administered with metformin to pre-combined glibenclamide-metformin tablets in type 2 diabetes mellitus

Lim PC, Lim SL, Oiyammaal C

Med J Malaysia, 2012 Feb;67(1):21-4.

PMID: 22582544

Type-2 diabetes mellitus (T2DM) patients who were on gliclazide co-administered with metformin were changed to pre-combined glibenclamide-metformin tablets in the Endocrine Clinic, Penang Hospital. We conducted a retrospective study to evaluate the differences in glycaemic control and treatment cost following the change. Eighty patients (60% females) with a mean age of 55 years old were studied. Mean glycosylated haemoglobin (HbAlc) reduction was -0.92% (p<0.01) and -0.83% (p<0.01) after three and six months respectively. Patients with baseline HbA1c > or =8% had greater reduction in mean HbA1c (-1.36%) after six months. The treatment cost per month was reduced by 45% at 3 months (p<0.01)) and 44% at 6 months (p<0.01). The change to pre-combined glibenclamide-metformin tablets resulted in significant improvement in glycaemia and reduction in treatment cost.

Matched MeSH terms: Diabetes Mellitus, Type 2/drug therapy*; Drug Therapy, Combination

Tumour Lysis Syndrome: a Rare Complication of Trans-Arterial Chemo-Embolisation with Doxorubicin Beads for Hepatocellular Carcinoma

Katiman D, Manikam J, Goh KL, Abdullah BJ, Mahadeva S

J Gastrointest Cancer, 2012 Sep;43 Suppl 1:S187-90.

PMID: 22692948 DOI: 10.1007/s12029-012-9373-6

Matched MeSH terms: Carcinoma, Hepatocellular/drug therapy*; Liver Neoplasms/drug therapy*

Scaling-up attention to nonmalaria acute undifferentiated fever

Naing C, Kassim AI

Trans R Soc Trop Med Hyg, 2012 Jun;106(6):331-2.

PMID: 22541873 DOI: 10.1016/j.trstmh.2012.03.003

Studies have reported that only a small fraction of fever cases in malaria-endemic areas are actually caused by malaria. Much greater emphasis is now needed to step up attention to the appropriate management of nonmalarial acute undifferentiated febrile illness. There is an overlap at the start of clinical manifestations of different febrile illnesses which makes it difficult to adhere to the clinical guidelines. The development of rigorous guidelines based on high quality research and a consensus from the core group of content experts are needed. An innovative financing mechanism for universal access to such appropriate management should also be considered.

Matched MeSH terms: Fever of Unknown Origin/drug therapy; Malaria/drug therapy

Fulltext Treatment patterns and outcomes in management of solid cancer patients suffering from anemia in Penang hospital

Hassan BA, Yusoff ZB

Asian Pac J Cancer Prev, 2011;12(6):1573-6.

PMID: 22126501

INTRODUCTION: Anemia is one of the most frequent hematological demonstration of malignant diseases, leading to impairment of function in all tissues and organs of cancer patients and associated with serious stress. This major problem may be exacerbated by radiotherapy or chemotherapy. It is characterized by lower hemoglobin (Hb) level or inadequate circulating red blood cells (RBCs). The present study evaluated the effectiveness of treatment guidelines for anemia among solid cancer patients in Penang hospital and to find associations between treatments and anemia onset and severity.

METHODS: This is a retrospective observational study was conducted on 534 cancer patients with anemia who were admitted to a government hospital on Penang island i.e., Penang General Hospital in the period between 2003 to 2009.

RESULTS: Effectiveness of standard anemia treatment guidelines was not sufficient because correction of anemia was just temporary.

CONCLUSION: According to the results, erythropoietin must be used as a cornerstone even for patients who suffer from moderate anemia and blood transfusion should be used just for emergency cases when anemia leads to a critical situation.

Matched MeSH terms: Anemia/drug therapy*; Neoplasms/drug therapy*

Adjunctive mood stabilizer treatment for hospitalized schizophrenia patients: Asia psychotropic prescription study (2001-2008)

Sim K, Yong KH, Chan YH, Tor PC, Xiang YT, Wang CY, et al.

Int. J. Neuropsychopharmacol., 2011 Oct;14(9):1157-64.

PMID: 21557883 DOI: 10.1017/S1461145711000563

Recent studies indicate relatively high international rates of adjunctive psychotropic medication, including mood stabilizers, for patients with schizophrenia. Since such treatments are little studied in Asia, we examined the frequency of mood-stabilizer use and its clinical correlates among hospitalized Asian patients diagnosed with schizophrenia in 2001-2008. We evaluated usage rates of mood stabilizers with antipsychotic drugs, and associated factors, for in-patients diagnosed with DSM-IV schizophrenia in 2001, 2004 and 2008 in nine Asian regions: China, Hong Kong, India, Korea, Japan, Malaysia, Taiwan, Thailand, and Singapore. Overall, mood stabilizers were given to 20.4% (n=1377/6761) of hospitalized schizophrenia patients, with increased usage over time. Mood-stabilizer use was significantly and independently associated in multivariate logistic modeling with: aggressive behaviour, disorganized speech, year sampled (2008 vs. earlier), multiple hospitalizations, less negative symptoms, younger age, with regional variation (Japan, Hong Kong, Singapore>Taiwan or China). Co-prescription of adjunctive mood stabilizers with antipsychotics for hospitalized Asian schizophrenia patients increased over the past decade, and was associated with specific clinical characteristics. This practice parallels findings in other countries and illustrates ongoing tension between evidence-based practice vs. individualized, empirical treatment of psychotic disorders.

Matched MeSH terms: Drug Therapy, Combination; Schizophrenia/drug therapy*

A survey on the management of acute rhinosinusitis among Asian physicians

Wang DY, Wardani RS, Singh K, Thanaviratananich S, Vicente G, Xu G, et al.

Rhinology, 2011 Aug;49(3):264-71.

PMID: 21866280 DOI: 10.4193/Rhino10.169

BACKGROUND: Based on the `European Position Paper on Rhinosinusitis and Nasal polyps (EP3OS 2007)`, this study aimed to investigate general practitioners (GPs) and other specialists` understanding when managing patients with acute rhinosinusitis (ARS) in Asia.
METHODOLOGY: Among a total of 2662 questionnaires completed, 2524 (94.8%) were valid for analysis. There were 1308 GPs (51.8%), 989 otolaryngologists (39.2%) and 227 paediatricians (9%) from Mainland China, Hong Kong, Indonesia, India, Malaysia, Pakistan, Philippines, Singapore, Thailand and Taiwan.
RESULTS: ARS is affecting an estimated 6 - 10% of patients seen in a daily out-patient practice. The EP3OS criteria are well supported by Asian physicians (94.1%). Most physicians (62.7%) agreed that radiological investigation is not needed to diagnose ARS. However, even for mild ARS (common cold), medical treatments were still recommended by 87% of GPs, 83.9% of otolaryngologists, and 70% of paediatricians. The top three first-line treatments prescribed were antihistamines (39.2%), nasal decongestants (33.6%), and antibiotics (29.5%). Antibiotics usage increased as the first line treatment of moderate (45.9%) and severe (60.3%) ARS.
CONCLUSION: ARS is commonly managed by GPs, otolaryngologists, and paediatricians in Asia. However, understanding of the management of ARS needs further improvement to minimize unnecessary use of radiological investigations, overuse of antibiotics, and under use of nasal corticosteroids.

Matched MeSH terms: Rhinitis/drug therapy; Sinusitis/drug therapy

An apparently healthy young man with a peculiar-looking chest radiograph

Khajotia R, Manthari K

Can Fam Physician, 2011 Mar;57(3):311-3.

PMID: 21402968

Matched MeSH terms: Drug Therapy, Combination; Tuberculosis, Pulmonary/drug therapy

Fulltext Anti-inflammatory and analgesic effects of Elephantopus tomentosus ethanolic extract

Yam MF, Ang LF, Ameer OZ, Salman IM, Aziz HA, Asmawi MZ

J Acupunct Meridian Stud, 2009 Dec;2(4):280-7.

PMID: 20633503 DOI: 10.1016/S2005-2901(09)60069-8

Elephantopus tomentosus is widely used in Asia, especially in Malaysia, for the treatment of pain and inflammation. In the present study, the analgesic and anti-inflammatory effects of a 95% ethanol extract of E. tomentosus were investigated in different experimental models. In the anti-inflammation study, 1000 mg/kg of extract significantly reduced carrageenan-induced hind paw edema (p < 0.05) and inhibited abdominal permeability compared with control (p < 0.01). The analgesic activity was assayed in several experimental models in mice: (1) hot plate, (2) tail flick, (3) writhing test; and rats: carrageenan-induced hyperalgesia pain threshold test. However, at the doses tested, no significant activity was found in the hot plate test and the tail flick test. E. tomentosus ethanol extract at 1000 mg/kg significantly (p < 0.05) increased hyperalgesia pain threshold and inhibited writhing activity. The results suggest that E. tomentosus ethanol extract at 1000 mg/kg dose is effective in anti-inflammatory and non-steroidal anti-inflammatory drug type anti-nociception activities.

Matched MeSH terms: Edema/drug therapy*; Pain/drug therapy*

Fulltext Phyllanthus spp. induces selective growth inhibition of PC-3 and MeWo human cancer cells through modulation of cell cycle and induction of apoptosis

Tang YQ, Jaganath IB, Sekaran SD

PLoS One, 2010;5(9):e12644.

PMID: 20838625 DOI: 10.1371/journal.pone.0012644

Phyllanthus is a traditional medicinal plant that has been used in the treatment of many diseases including hepatitis and diabetes. The main aim of the present work was to investigate the potential cytotoxic effects of aqueous and methanolic extracts of four Phyllanthus species (P.amarus, P.niruri, P.urinaria and P.watsonii) against skin melanoma and prostate cancer cells.

Matched MeSH terms: Melanoma/drug therapy; Prostatic Neoplasms/drug therapy

Effects of delay in infusion of N-acetylcysteine on appearance of adverse drug reactions after acetaminophen overdose: a retrospective study

Zyoud SH, Awang R, Sulaiman SA, Al-Jabi SW

Pharmacoepidemiol Drug Saf, 2010 Oct;19(10):1064-70.

PMID: 20712021 DOI: 10.1002/pds.1955

To investigate the relationship between different types of adverse drug reaction (ADR) and late time to N-acetylcysteine (NAC) infusion in patients presenting to the hospital with acetaminophen overdose.

Matched MeSH terms: Anaphylaxis/drug therapy; Drug Overdose/drug therapy*

Fulltext The antibacterial properties of Malaysian tualang honey against wound and enteric microorganisms in comparison to manuka honey

Tan HT, Rahman RA, Gan SH, Halim AS, Hassan SA, Sulaiman SA, et al.

BMC Complement Altern Med, 2009;9:34.

PMID: 19754926 DOI: 10.1186/1472-6882-9-34

Antibiotic resistance of bacteria is on the rise, thus the discovery of alternative therapeutic agents is urgently needed. Honey possesses therapeutic potential, including wound healing properties and antimicrobial activity. Although the antimicrobial activity of honey has been effectively established against an extensive spectrum of microorganisms, it differs depending on the type of honey. To date, no extensive studies of the antibacterial properties of tualang (Koompassia excelsa) honey on wound and enteric microorganisms have been conducted. The objectives of this study were to conduct such studies and to compare the antibacterial activity of tualang honey with that of manuka honey.

Matched MeSH terms: Gastroenteritis/drug therapy*; Wound Infection/drug therapy*

Fulltext An unusual cause of haemoptysis and headache: cryptococcosis

How SH, Kuan YC, Ng TH, Ramachandram K, Fauzi AR

Malays J Pathol, 2008 Dec;30(2):129-32.

PMID: 19291924 MyJurnal

Pulmonary cryptococcosis can be clinically silent in non-HIV infected patients but can also present as nodules and masses on the chest radiograph, which can be mistaken for tuberculosis or lung cancer. Common symptoms include fever and cough, and uncommonly haemoptysis. This report illustrates a non-HIV infected patient whose main complaint was haemoptysis and headache. He was diagnosed with pulmonary cryptococcosis from biopsy of an endobronchial mass found on flexible bronchoscopy. Disseminated cryptoccoccal infection should be considered as a differential diagnosis in non-HIV infected patients presenting with haemoptysis and headache. Early recognition and administration of appropriate therapy will improve clinical outcome in these patients.

Matched MeSH terms: Cryptococcosis/drug therapy; Lung Diseases, Fungal/drug therapy

Fulltext Spontaneous bladder perforation: a rare complication of tuberculosis

Kong CH, Ali SA, Singam P, Hong GE, Cheok LB, Zainuddin ZM

Int J Infect Dis, 2010 Sep;14 Suppl 3:e250-2.

PMID: 20117032 DOI: 10.1016/j.ijid.2009.10.006

Spontaneous bladder perforation secondary to tuberculosis (TB) is very rare. Only three cases have been reported so far in the literature. Due to its rarity, the diagnosis of spontaneous bladder perforation is often missed. Confirmation of TB via culture takes a long time and starting empirical treatment for TB is necessary. We relate our experience with a young woman who presented with clinical features of a perforated appendix and was only diagnosed with bladder perforation during laparotomy. She also had distal right ureteral stricture and left infundibular stenosis. The provisional diagnosis of TB was attained via typical histopathological features and a positive Mantoux test. She was started empirically on anti-TB treatment and recovered without any complications. Urine culture after 6 weeks confirmed the diagnosis of TB.

Matched MeSH terms: Urinary Bladder Diseases/drug therapy; Tuberculosis, Urogenital/drug therapy

Fulltext First isolation of Burkholderia tropica from a neonatal patient successfully treated with imipenem

Deris ZZ, Van Rostenberghe H, Habsah H, Noraida R, Tan GC, Chan YY, et al.

Int J Infect Dis, 2010 Jan;14(1):e73-4.

PMID: 19482535 DOI: 10.1016/j.ijid.2009.03.005

We report the first case of a human Burkholderia tropica infection. The patient was a premature neonate who had necrotizing enterocolitis with bowel perforation requiring surgical intervention. The stoma care and difficulties in feeding were a chronic problem. At the age of almost 4 months he developed septicemia due to B. tropica. Three consecutive blood cultures grew this organism. The organism was cleared from the blood after a course of imipenem and resolution of post-operative ileus. Our case suggests that environmental and plant pathogens can cause human infection especially in those in an immunocompromised condition.

Matched MeSH terms: Bacteremia/drug therapy; Burkholderia Infections/drug therapy

A placebo-controlled trial of oral pyridoxine in hyperemesis gravidarum

Tan PC, Yow CM, Omar SZ

Gynecol. Obstet. Invest., 2009;67(3):151-7.

PMID: 19077388 DOI: 10.1159/000181182

To evaluate oral pyridoxine in conjunction with standard therapy in women hospitalized for hyperemesis gravidarum (HG).

Matched MeSH terms: Drug Therapy, Combination; Hyperemesis Gravidarum/drug therapy*

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