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Fulltext Management of Mild Valproic Acid Toxicity with Hemodialysis – A Case Report

Chow NK

Malaysian Journal of Pharmacy, 2018;4(1):4-6.
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The management of Valproic Acid (VPA) toxicity is mainly supportive treatment. Invasive management such as hemodialysis (HD) and hemoperfusion were only used in isolated cases where patient is highly VPA toxic, which results in coma. We described a case of mild VPA toxicity (VPA serum concentration 326.42mcg/mL), where the patient was successfully treated with two hours of low-flux HD with no complication. While the guideline of indication of HD in VPA toxicity has yet to be published, low-flux HD can be an effective treatment in cases of mild VPA toxicity, if other supportive measures failed or not available.
Health-related quality of life and its association with sociodemographic, economic, health status and lifestyles among HIV-positive patients in northern Malaysia

Chow NK, Harun SN, Khan AH

AIDS Care, 2021 Sep 20.
PMID: 34543113 DOI: 10.1080/09540121.2021.1981220

Sociodemographic status and medical problems were widely reported as the major factors in people living with HIV (PLHIV) with lower health-related quality of life (HRQoL). However, lifestyles and cultural changes are rarely studied. A multicentred cross-sectional study was conducted among 137 virally suppressed PLHIV on antiretroviral therapy (ART) in northern Malaysia by face-to-face interviews and World Health Organization Quality of Life (WHOQOL)-BREF questionnaire. It was to explore their health and socioeconomic status, lifestyles, and associations with different HRQoL domains. The result of multiple linear regression showed that smoking was a predominant risk factor of lower physical (beta coefficient (β): -5.82, 95% confidence interval (CI): -9.97 to -1.66; p = 0.006), social (β: -8.76, 95% CI: -15.12 to -2.40; p = 0.007), and environmental domain scores (β: -10.25, 95% CI: -15.21 to -5.30; p
The epidemiology and healthcare burden of rare diseases requiring hospitalisation among adult patients in Langkawi, Malaysia: Insights from a pilot study

Chow NK, Ghani NA, Zamri N, Anuar MN

Intractable Rare Dis Res, 2024 May 31;13(2):126-128.
PMID: 38836182 DOI: 10.5582/irdr.2024.01009

In Malaysia, rare diseases affect fewer than 1 in 4,000 people. As of 2020, 491 rare diseases have been recorded in Malaysia, but with limited epidemiological data. As the first study in Malaysia, this retrospective cohort study examined the epidemiology and admission-related healthcare costs for adult rare disease patients in Langkawi. Among the 38 patients, rheumatological rare diseases topped the list (39.5%). The annual admission rate for rare diseases was 0.9%. Langkawi patients had lengthy hospital stays (9.7 days) and a 7.9% mortality rate. 23.7% of patients defaulted to follow-up, and 7.9% were referred to a tertiary hospital due to inadequate equipment or speciality care. Admission costs were Malaysian Ringgits (MYR) 244,598.63 (~US Dollars (USD) 51,280), with 80.2% from medication. The average healthcare resource utilisation was MYR 6,436.81/ patient/year (~USD 1,350/patient/year).
The association between cigarette smoking and efavirenz plasma concentration using the population pharmacokinetic approach

Chow NK, Harun SN, Wong EJ, Low LL, Sheikh Ghadzi SM, Khan AH

Br J Clin Pharmacol, 2021 10;87(10):3756-3765.
PMID: 33608883 DOI: 10.1111/bcp.14783

AIMS: Efavirenz is still widely used as the preferred first-line antiretroviral agent in middle- and low-income countries, including Malaysia. The efavirenz population pharmacokinetic profile among HIV-positive smokers is still unknown. We aimed to assess the association of smoking with efavirenz and the differences in HIV clinical outcomes.
METHODS: A total of 154 stable HIV-positive patients on efavirenz in northern Malaysia were recruited with a sparse sampling for this multicentre prospective cohort study. The association between smoking and efavirenz pharmacokinetic parameters was determined using the nonlinear mixed-effect model. A mixture model of clearance was adopted to describe the metaboliser status because genetic data are unavailable. The effect of smoking on HIV clinical markers (CD4, CD4/CD8 ratio and viral blips) for at least 2 years after the antiretroviral initiation was also investigated.
RESULTS: Our data were best fitted with a 1-compartment mixture model with first-order absorption without lag time. Smoking significantly associated with higher clearance (β = 1.39; 95% confidence interval: 1.07 to 1.91), while weight affected both clearance and volume. From the mixture model, 20% of patients were in the slow clearance group, which mimic the genotype distribution of slow metaboliser. An efavirenz dose reduction is not recommended for smokers ≥60 kg with normal metabolism rate. Smoking significantly associated with slower normalisation of CD4 and CD4/CD8 ratio.
CONCLUSIONS: HIV-positive smokers presented with significantly higher efavirenz clearance and unfavourable clinical outcomes. Close monitoring of adherence and clinical response among smokers is warranted.