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Objective: To elucidate the characteristics, management strategies, risk factors, and clinical impacts associated with adverse drug reactions (ADRs) induced by first-line antitubercular drugs to enhance tuberculosis (TB) management. Methods: A retrospective cohort study was conducted by retrieving drug-susceptible TB records among adult patients who received TB treatment from 2018 to 2021 at 10 public health clinics in Sarawak, Malaysia. Only the initial TB treatment and occurrence of specific ADRs within the study period were considered. Regression analysis was performed to identify the risk factors associated with both overall ADRs and individual types of ADRs. Results: Among 2 953 cases, 705 (23.9%) developed ADRs. Cutaneous reactions were the most prevalent (47.1%), followed by hepatotoxicity (32.8%) and gastrointestinal disturbances (29.8%). Six out of seven types of ADRs investigated occurred within the intensive phase, mostly manifesting at approximately 2 weeks of initiation. Hepatotoxicity resulted in the majority (85.3%) of treatment discontinuations, while vision problems led to treatment modifications in half of the cases. Risk factors for all ADRs included age ≥60 years, females, illicit drug use, and comorbidities such as HIV-positive, diabetes, and chronic liver disease. Alcohol consumption was independently associated with hepatotoxicity. ADRs caused around one-third of interruptions exceeding 2 weeks (33.0%) and subsequently necessitated treatment restarts (34.5%). Conclusions: Understanding these various aspects contributes to improving the overall management of ADRs in TB treatment. Close ADR monitoring and reporting are essential to strengthen ADR management. [ABSTRACT FROM AUTHOR]

Objectives: Treatment interruption is associated with poor tuberculosis (TB) treatment outcomes and increased drug resistance. To address the issue, we aimed to investigate the characteristics, predictors and consequences of treatment interruption. Methods: We conducted a retrospective cohort study by retrieving 4 years (2018–2021) of TB patients' records at 10 public health clinics in Sarawak, Malaysia. Adult patients (≥18 years) with drug‐susceptible TB were selected. Treatment interruption was defined as ≥2 weeks of cumulative interruption during treatment. The Chi‐square test, Mann–Whitney U test, Kaplan–Meier and Cox proportional hazards regression were used to analyse the data, with p < 0.05 being considered statistically significant. Results: Out of 2953 eligible patients, 475 (16.1%) experienced TB treatment interruption. Interruptions were most frequent during the intensive phase (46.9%, n = 223), with the greatest risk within the first 4 weeks of treatment. The median time to interruption was 2 weeks in the intensive phase and the cumulative interruption probability at the end of the intensive phase was 12.9%. Notably, treatment interruption occurred during both intensive and continuation phases for 144 patients (30.3%), while the remaining 108 (22.7%) experienced interruptions only during the continuation phase with a median time to interruption of 16 weeks. Three predictors were identified to increase the risk of treatment interruption: adverse drug reaction (aHR = 8.53, 95% Cl: 6.73–10.82), smoking (aHR = 2.67, 95% Cl: 2.03–3.53) and illicit drug use (aHR = 1.88, 95% Cl: 1.03–3.45). Conversely, underlying diabetes was associated with a reduced likelihood of treatment interruption (aHR = 0.72, 95% Cl: 0.58–0.90). Treatment interruption led to significant differences in treatment restarts (62.3% vs. 0.7%), changes in medications (47.8% vs. 4.9%), prolonged treatment duration (247 days [IQR = 105] vs. 194 days [IQR = 44.3]) and lower successful outcomes (86.5% vs. 99.9%). Conclusion: Understanding the temporal characteristics, predictors and negative consequences of treatment interruption can guide the development of time‐relevant approaches to mitigate the problem. [ABSTRACT FROM AUTHOR]

Personalized medicine in kidney transplantation has the potential to improve outcomes and reduce complications. The aim of this study was to investigate the influence of single nucleotide polymorphisms in genes encoding metabolizing enzymes (CYP3A5) and transporters (ABCC2) on clinical outcomes (acute graft failure and/or acute tubular necrosis (ATN)) in kidney transplant recipients (KTR). This was a multicenter, retrospective cohort study where adult KTR who had undergone kidney transplantation between 2020 and 2021 and received tacrolimus-mycophenolate treatment were enrolled in the study. DNA was extracted from collected blood samples using a commercially available kit. CYP3A5*3, ABCC2 -24C>T and ABCC2 3972C>T SNP were determined by polymerase chain reaction. Of the total 39 patients included, nine (23.1%) KTR had an incidence of acute graft failure and/or ATN. A multiple logistic regression showed wildtype ABCC2 -24C>T C allele had a higher risk of developing acute graft rejection and/or ATN compared to the variant allele carriers (adjusted Odd Ratios [aOR]: 27.675, p = 0.038). Recipients who had delayed graft function (aOR: 49.214, p = 0.012) and a history of CMV infection (aOR: 18.097, p = 0.009) were at 49.2 and 18.1-times increased risk for acute graft failure and/or ATN, respectively. The large aOR was inevitable due to the small sample size and required cautious interpretation. This is the first study to determine the effect of the ABCC2 -24C>T genetic polymorphism on clinical outcomes in Malaysian KTR and forms the basis for further work on ABCC2 -24C>T effects in long-term KTR. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) left a devastating impact on healthcare systems worldwide. The crisis initially emerged as a supply disruption issue but eventually evolved into a myriad of additional challenges, which were attributed mainly to the extensive scale of the pandemic. This study aimed to explore the barriers to the role of hospital pharmacists and related facilitators encountered during the COVID-19 pandemic. Methods: Pharmacists in Malaysia participated in a cross-sectional online questionnaire-based survey. The participants were recruited using convenient sampling. Cronbach alpha of the questionnaire was analyzed. Results: The study successfully enrolled 367 pharmacists. The major barrier in terms of knowledge and skills was the difficulty in investigating the trend and usage pattern of COVID-19 medicines (N = 183; 49.9%). A global shortage of medicines (N = 314; 85.6%) occupied the highest barrier in the supply chain. The clinical barriers cited by most of the respondents comprised conducting clinical trials in the search for effective treatments (N = 282; 76.8%), and the largest departmental barrier was the difficulty of predicting usage based on previous data (N = 262; 71.4%). Almost all respondents agreed that a course or module on COVID-19 treatments (N = 354; 96.5%) served as a facilitator, enhancing their awareness and preparedness to respond to the pandemic. Conclusions: The empowerment of pharmacists with the crucial resources, skills, and support that will enable them to effectively fulfill their roles and responsibilities can be instrumental in the transformation of our approach to addressing future pandemics. [ABSTRACT FROM AUTHOR]

Background: Coronavirus-19 has raised concerns as it causes post-acute symptoms among individuals. Appropriate knowledge, attitude, and practice with regards to COVID-19, and its post-acute complications among pharmacists is required for optimum management. Identifying the barriers, and facilitators encountered by pharmacists in providing care to these patients is also vital. The objectives of this study were to determine the knowledge, attitude, practice of COVID-19 and post-acute COVID-19, barriers, and facilitators among pharmacists. Materials & method: A cross-sectional survey was conducted among pharmacists registered and practicing in Malaysia with consent. An online survey was used to distribute the questionnaire using Google Form through convenient sampling. A questionnaire consisting of four sections was used in the study based on previous work. Data obtained in this study was interpreted using Statistical Package for Social Science (SPSS) (version 28; IBM Corp., Armonk, N.Y., USA). A p-value of <0.05 demonstrated statistically significant findings. Results: From a total of 405 pharmacists, the knowledge, attitude and practice score of the pharmacists was an average of 5.69 (±0.78) (maximum score 7), 3.56 (±0.63) (maximum score 4) and 3.38 (±0.61) (maximum score 4) respectively. A significant negative correlation was seen between COVID-19 knowledge, and attitude (r=- 0.16; p=0.001), while a positive correlation was seen between knowledge, and practice (r=0.11; p=0.025). The score for knowledge on post-acute COVID-19 was an average of 12.93 (±2.44) (maximum 20). 82.2% (n=333) respondents agreed that difficulty in accessing patient's clinical data was a barrier, whilst 95.6% (n=387) agreed support of healthcare system was regarded as the most common facilitator. Conclusion: There is a need for continuous education of COVID-19 as well as post-acute COVID-19 to ensure optimal management of patients. [ABSTRACT FROM AUTHOR]

Introduction: Thalassemia is among the most common genetic disorders globally and many patients suffer from iron overload (IOL) complications that mainly affect the heart, liver and endocrine system. These events may be further complicated by drug-related problems (DRP), an inherent issue among patients with chronic diseases. Objective: The study aimed to evaluate the burden, associated factors and impacts of DRP in transfusion-dependent thalassemia (TDT) patients. Method: Eligible TDT patients under follow-up in a tertiary hospital between 01 March 2020 to 30 April 2021 were interviewed and their medical records were reviewed retrospectively to identify any DRP. DRPs were classified using the Pharmaceutical Care Network Europe (PCNE) classification version 9.1. The incidence and preventability of DRP were assessed and the associated risk factors were estimated by univariate and multivariate logistic regression. Results: A total of 200 patients were enrolled with a median (interquartile range: IQR) age of 28 years at enrolment. Approximately 1 in 2 patients were observed to suffer from thalassemia-related complications. Throughout the study period, 308 DRPs were identified among 150 (75%) participants, with a median DRP per participant of 2.0 (IQR 1.0-3.0). Of the three DRP dimensions, treatment effectiveness was the most common DRP (55.8%) followed by treatment safety (39.6%) and other DRP (4.6%). The median serum ferritin level was statistically higher in patients with DRP compared with patients without DRP (3833.02 vs. 1104.98 µg/L, p < 0.001). Three risk factors were found to be significantly associated with the presence of DRP. Patients with frequent blood transfusion, moderate to high Medication Complexity Index (MRCI) and of Malay ethnicity were associated with higher odds of having a DRP (AOR 4.09, 95% CI: 1.83, 9.15; AOR 4.50, 95% CI: 1.89, 10.75; and AOR 3.26, 95% CI: 1.43, 7.43, respectively). Conclusion: The prevalence of DRP was relatively high amongst TDT patients. Increased medication complexity, more severe form of the disease and Malay patients were more likely to experience DRP. Hence, more viable interventions targeted to these groups of patients should be undertaken to mitigate the risk of DRP and achieve better treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Post-acute COVID-19 is known to affect multiple organs. It is essential to determine factors that affect post-acute COVID-19 syndrome and medications needed by patients for optimized care. Methods: A prospective cohort study was conducted among patients recruited by stratified sampling from two COVID-19 hospitals in Malaysia. Patients were followed up for 6 months using a standard questionnaire to identify demographics, symptoms, medications taken, and factors associated with post-acute COVID-19 syndrome. Results: A total of 388 were successfully followed up. The most frequently reported symptom was respiratory symptoms (N = 168, 43.30%), of which cough (N = 134, 34.54%) was the most common. After 12 weeks of follow-up, respiratory syndrome (N = 56,14.43%) was frequently reported, of which cough (N = 41, 10.57%) was the most common. For respiratory syndrome, patients were commonly managed with diphenhydramine cough suppressants (N = 6, 1.55%, month 4) and metered dose inhaler (MDI) salbutamol (N = 7, 1.8%, month 4). The risk factors for post-acute COVID-19 syndrome were increased by 1.02 times (95% CI: 1.01, 1.04) with each advanced year of age and 2.87 times (95%CI: 1.51-5.48) in the presence of co-morbidities. Conclusions: Post-acute COVID-19 causes multiorgan involvement, and symptoms may remain for months, with patients taking various medications. Patients with risk factors should be monitored closely for post-acute COVID-19 symptoms. [ABSTRACT FROM AUTHOR]

Adherence to iron chelation therapy (ICT) is fundamental for preventing iron overload complications and maintaining health-related quality of life (HRQoL) in transfusion-dependent thalassemia (TDT) patients. This study aimed to evaluate adherence, HRQoL, and their association among Malaysian TDT patients. Cross-sectional research was performed among TDT patients aged 18 years and above in Hospital Ampang, Selangor. The adherence and the HRQoL (SF-36) were evaluated using validated instruments. Correlation analyses were carried out to determine the association between ICT adherence and HRQoL. The study recruited 162 patients, with 46.91% (N=76) of respondents reporting being adherent. The mean SF-36 score for TDT patients is 74.58. Remarkably, adherent patients exhibit significantly higher HRQoL (mean SF-36 score 79.21) assessed by the SF-36 questionnaire versus nonadherent patients (mean SF-36 score 69.47) (p=0.00). The findings also revealed a significant positive correlation between female (p=0.032), employed (p=0.003), and age (p=0.050) factors with the patient's HRQoL. The rate of ICT adherence for adult TDT patients is suboptimal and non-adherent to ICT has significantly compromised HRQoL. Enhancing the rate of ICT adherence through interventions such as patient counseling and support programs may lead to enhanced HRQoL outcomes for the TDT population. [ABSTRACT FROM AUTHOR]