Pusat Pengajian Sains Farmasi - Tesis

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A Mixed Method Study On The Associating Factors, Reasons For Use, Perceptions And Quitting Behaviour Of E-Cigarette Among Dual Users In Malaysia
(2023-01)
Aimi Nadira Binti Mat Ruzlin
Several sociodemographic and smoking related factors have a significant association with dual use and its frequency of use. In addition, further investigation in phase II found that dual use was detrimental to its users. The findings from this study provide essential information to plan future preventive measures as well as recommendations for EC legislation in Malaysia.
A Study On Cyp2c19 Genetic Variations Of Clopidogrel And Ticagrelor Treatment Among Coronary Artery Disease (CAD) Patients Undergoing Percutaneous Coronary Intervention (PCI)
(2023-06)
Mohammed Ahmed Imran Ak-Kaif
The P2Y12 receptor inhibitors, especially clopidogrel, are common antiplatelet drugs used for the prevention of recurrent adverse cardiovascular events among patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). Several factors may affect the effectiveness of antiplatelet therapy, including genetic variations in CYP450 enzymes. Loss of function (LOF) carriers of the CYP2C19 gene are associated with the decreased metabolism of clopidogrel into active metabolites via CYP2C19 enzyme, leading to decreased platelet inhibition. This causes an increased risk of recurrent cardiovascular events. Drug regulatory authorities suggested using alternative P2Y12 inhibitor, which is ticagrelor. Therefore, this study aims to investigate the adverse effects, and CYP2C19 genetic variations of clopidogrel and ticagrelor treatment among CAD patients undergoing PCI.
An Insight Of The Policy And Access To Orphan Drugs For Treating Rare Disease In Malaysia: Quantitative And Qualitative Analysis
(2022-01)
Supian, Azuwana
An orphan drug is a medicine used to treat rare diseases. The disease has a very low population, with most of the diseases will impair the patients’ body functions and be life threatening. This study aimed to evaluate the rare disease policy and access to orphan drugs in Malaysia. Three phases have been completed. Phase one consisted of literature reviews to examine the current status of rare disease management in Malaysia and five other focus countries (Philippines, Singapore, Indonesia, Vietnam, and Thailand). They were examined based on the World Health Organisation’s (WHO) framework for action in strengthening health systems. A cross-sectional survey from ten public hospitals was also included in this phase to estimate the number of cases and treatment coverage for rare diseases in Malaysia. The second phase was designed by conducting 43 qualitative interviews and a focus group discussion on describing the perceptions among health stakeholders towards rare disease management.
Anti-Obesity Activity Of Pandanus Amaryllifolius Roxb. And Vitex Negundo Linn. : Isolated Compounds With PTP1B Inhibitory Effects
(2022-01)
Selestin A/P Rathnasamy
The role of protein tyrosine phosphatase 1B (PTP1B) as the negative modulator of leptin-mediated signaling, has made PTP1B an excellent target for obesity treatment. In spite of the enormous attempts, selective, effective, and safer PTP1B inhibitors are yet to be discovered. In this study, the effects of Pandanus amaryllifolius Roxb. (PA) and Vitex negundo Linn. (VN) on high calorie diet (HCD)-induced obesity were evaluated.
Antidepressant Effect Of Andrographis Paniculata (Burm.F.) Wall. Ex Nees Methanolic Extract And Andrographolide On Chronic Unpredictable Stress (Cus) Zebrafish Model Via Metabolomics Approach
(2023-07)
Aldurrah, Zenab
Depression affected at least 322 million people worldwide. Treatment for depression has been studied for a long time. However, the current antidepressants have many associated problems, such as delays in symptom resolution and relapse. Plants have been used as the main source of leads in drug discovery for decades. Andrographis paniculata (A. paniculata) is a widely used plant in Asian traditional medicine. This research investigates the effect of A. paniculata extract and its major compound, andrographolide on the chronic unpredictable stress (CUS) zebrafish model. A. paniculata methanol extract’s constituents was profiled using HPLC-ESI-MS/MS, and acute toxicity tests were analyzed before antidepressive evaluation. The behavioural study, i.e. open field test (OFT), social interaction test (SIT), and light dark test (LDT), were conducted to evaluate behavioural changes in the CUS group compared to the controls, A. paniculata (100 mg/L, immersion)-treated and fluoxetine (0.01 mg/L, immersion)-treated zebrafish. After the extract screening, the experiment was preceded by evaluating the antidepressive potential of andrographolide. Behavioural, cortisol and NMR-based metabolomics studies were evaluated in all groups. The behavioural study revealed a significant improvement in zebrafish locomotion after A. paniculata and andrographolide treatments. A significant reduction in cortisol levels (t-test, p=0.0003) were observed after andrographolide (25 and 50 mg/kg, i.p.) acute treatment.
Antihypertensive And Renoprotective Effects Of Hibiscus Sabdariffa Extracts On Doca-Salt Induced And Spontaneously Hypertensive Rats
(2022-07)
Hibiscus sabdariffa is widely used as a folk medicine for hypertension treatment throughout the world. The present study was carried out to develop a standardised, industry friendly and stable oral dosage form incorporating the effective dose of Hibiscus sabdariffa calyces extract, as determined through three animal models, namely spontaneous hypertensive rat model (SHR), DOCA-salt induced hypertensive model and normotensive rat model. Delphinidin 3-sambubioside and cyanidin 3-sambubioside are the major anthocyanins in Hibiscus sabdariffa calyces extract and were known to be very unstable under different storage conditions. The most suitable extraction and concentration methods for Hibiscus sabdariffa calyces water and 50 % ethanolic extracts were maceration and spray dry methods because these methods produced higher total phenolic contents, total flavonoid contents, antioxidant capacity, and anthocyanin contents than reflux boiling and rotary evaporation methods. Both Hibiscus sabdariffa calyces water and 50 % ethanolic extracts were then subjected to pharmacological study and it was found that Hibiscus sabdariffa calyces water extract showed a more potent anti-hypertensive effect. Hibiscus sabdariffa calyces water extract at 500 mg/kg dose was the most effective in reducing blood pressure based on the systolic and diastolic blood pressures in the SHR model and DOCA-salt induced hypertensive model. In the normotensive rat model, both Hibiscus sabdariffa calyces water and 50 % ethanolic extract had no hypotensive effect as the systolic and diastolic blood pressures did not reduce significantly.
Assessment Of Antiviral Usage, Barriers, And Strategies For Scaling Up Hepatitis C Treatment In Malaysia: A Mix Methodology Study
(2023-06)
Chan Huan Keat
Malaysia adopted three key strategies to pursue the global goal of hepatitis C elimination, namely applying compulsory licensing on a direct-acting antiviral (DAA), introducing a standard DAA-based treatment regimen (sofosbuvir and daclatasvir) and decentralizing hepatitis C care through primary healthcare centers. This three-phase study adopted both quantitative and qualitative methods, aiming to (i) assess changes in the treatment coverage of individuals with hepatitis C and the government spending on antivirals after applying compulsory licensing, (ii) evaluate clinical outcomes in treatment recipients of the standard regimen, and (iii) explore barriers and potential strategies to further scale up pharmacological treatment under the existing hepatitis C care decentralization model.
Assessment Of Digital Marketing Activities, Perception, Attitude, And Factors Impacting Purchasing Decision Of Over-The-Counter Drugs In A Malaysian Population
(2022-11)
Anis, Mohamad Saleem
Digitalization has permeated various daily activities of individuals and organizations. This spread encouraged pharma companies to take advantage of digital marketing strategies to promote over-the-counter (OTC) drugs that have fewer marketing restrictions. The value of these drugs is becoming greater with the rise of self-medication as an economical choice of treatment for common self-limiting illnesses. Therefore, this study was conducted to explore the general perception and attitude of Malaysia's population regarding using digital marketing and e-commerce for OTC drugs. It also aimed to assess the impact of digital marketing and its types on OTC purchasing decisions and to identify the main influential factors that affect these decisions. An exploratory sequential mixed methods design was used (qual → QUAN, a qualitative study followed by a primarily quantitative study). The qualitative data was collected through 13 in-depth interviews, while a total of 408 participants made up the final sample for the quantitative research that used a survey method. Thematic content analysis was used in the first phase. Four key themes were derived from the results of qualitative data analysis.
Assessment Of Prevalence And Outcomes Of Common Infections And Physicians’ Perception Towards Antimicrobial Prescribing Among Geriatric Patients In Penang, Malaysia
(2022-01)
Akhtar, Ali
Geriatrics are susceptible to infections, especially respiratory tract infections, urinary tract infections and skin infections due to their compromised immune system. Moreover, unnecessary antimicrobial use is an emerging problem throughout the world. The main objectives of current research project are to assess the prevalence and outcomes of respiratory tract infections, urinary tract infections and skin infections among the geriatric patients, along with the perceptions of physicians working at public hospital about antimicrobial use and resistance. A cross-sectional study was conducted at three departments (respiratory, urology, dermatology) of Hospital Pulau Pinang, Malaysia.
Assessment Of Risk Factors Associated With Mortality And Developing Drug Resistant Tuberculosis In Hospital Pulau Pinang, Malaysia: A Retrospective Study
(2023-02)
Yaghi, Aseel Rezeq Ali
Globally, Malaysia classified as an intermediate tuberculosis (TB) burden country. Increasing mortality rate and the emergence of multidrug-resistant TB (MDR-TB) played the major role in achieving unsuccessful treatment outcomes among TB patients. Despite the national efforts to control TB in the country, but little is known about the management and treatment outcomes of MDR-TB patients from Malaysia as well as the risk factors of mortality among TB population. For this purpose, a total of 351 TB patients, including 26 MDR-TB patients treated at chest clinic of Hospital Pulau Pinang were included in the present retrospective study. Medical records of TB patients were reviewed and sociodemographic, clinical and microbiological characteristics of the patients were extracted to data collection sheet designed by a team of doctors, pharmacists and health providers. Multivariable logistic and Cox regression were performed using SPSS version 23.
Assessment Of The General Medication Adherence Scale And Relation To Medication Belief Among Geriatric Patients Attending A Primary Healthcare Centre In The State Of Negeri Sembilan, Malaysia
(2023-06)
Payal Choudhury A/P Pk Choudhury
The study aims to assess the General Medication Adherence Scale (GMAS) and its relation to medication belief among geriatric patients undergoing treatment in a primary health clinic setting.
Association Of Nonadherence And Beliefs About Medicines Among Hemodialysis Patients In Penang
(2022-05)
Lee, Soik Fun
Medication nonadherence (MNAD) among hemodialysis patients can be caused by erroneous medication beliefs. However, assessment on hemodialysis patients’ beliefs about prescribed medicines is not routinely conducted in Malaysia. This study aimed to assess the prevalence of MNAD among hemodialysis patients and the association between patient’s beliefs about medicines and MNAD. This was a cross-sectional multicentre study among hemodialysis patients conducted in Penang by purposive sampling. Data was collected by using 5 items-medication adherence report scale (MARS-5) and Beliefs about Medicine questionnaire (BMQ). Multiple logistic regression was used to assess the association of MNAD with beliefs about medicines. A total of 325 patients were interviewed. Majority patients were aged 55 years or more (69.0%) and received 6-10 prescribed medications daily (58.2%). The prevalence of MNAD was 69.5% based on MARS-5 score. Considering the BMQ score, the median score for Specific–Necessity and Specific–Concerns domain was 19.00 (17.00-20.00) and 12.00 (11.00-16.00) respectively. Whereas, the General–Overuse and General–Harm domain showed total mean score of 11.00 (10.00-12.00) and 9.00 (8.00-10.00) respectively. The patients with belief of medication will protect them from becoming worse showed significant less MNAD (adjusted OR = 0.543, CI = 0.366, 0.903).
Characterisation And Formulation Of Topical Methyl Salicylate Patches: Effect Of Solvents On Adhesion And Drug Permeation
(2023-01)
Yeoh, Soo Chin
Topical methyl salicylate (MS) patch is popular for pain management. The skin permeation profile of MS is important for formulation design but limited studies were conducted. This project aims to investigate the effect of solvents on the characteristics of patches, drug release and permeation of MS. In this project, suitable solvents were first selected for the patch formulation. Attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy was utilised to scan the stratum corneum (SC) sheets treated with solvents and MS. Next, in vitro permeation studies were carried out with 10%v/v of MS in solvents. After that, patches containing 5%w/w of solvents and/or 10%w/w of MS were prepared with Durabond PC 1879A (8%w/w), Nikasol TS-620 (7%w/w), carboxymethyl cellulose (3.5%w/w) and polyvinyl pyrrolidone (3%w/w). Next, the patches formed were subjected to physiochemical characterisation tests, including ATR-FTIR spectroscopy, tackiness test using stainless-steel probe, peel strength test with porcine ear skin, swelling test, in vitro drug release and skin permeation studies. In in vitro permeation studies, MS in propylene glycol (PG) in drug solution displayed the highest skin permeation of MS and followed by Plurol® oleique (PLU), Labrasol® (LA), Transcutol® (TRC), Maisine® (MAI) and isopropyl myristate (IPM) at 24 h.
Comparison Of Eight Methods For Estimation Of Creatinine Clearance In Malaysia Patients With Unstable Renal Function
(2022-01)
Ng Yen, Ping
Unstable kidney function is a common complication in hospitalized patients and is associated with high mortality rate. Critically ill patients normally have fluctuating kidney function with serum creatinine changing from day to day. Creatinine clearance (Clcr) estimation is of great importance in daily clinical practice among critically ill patients with unstable kidney function. The Cockcroft-Gault method remained the most widely used method to estimate kidney function and to guide drug dosage adjustment. The Cockcroft-Gault equation was derived from conditions in which the serum creatinine was at steady state and it is not designed for patients with unstable kidney function. This study aimed to analyze the discrepancies of estimated creatinine clearance computed by Cockcroft & Gault, MDRD, CKD-EPI, Jelliffe, modified Jelliffe, Chiou, Brater, and an empiric estimating equation (modified Cockcroft-Gault) equations with 24 hours urinary creatinine clearance (standard control) in critically ill and unstable kidney function patients from local Malaysian population.
Computer-Assisted Evaluation Of Bacterial Susceptibility Patterns To Antibiotic Usage In District Hospital
(1992-12)
Yahaya, Ruhaiyem
A computer-based system developed using Dbase III Plus and Clipper Summer '87 runs on IBM PC/AT or its compatible was designed to assist in the evaluation of bacterial susceptibility pattern to antibiotic usage. 10,010 bacterial culture and sensitivity data from District Hospital Sungei Petani for the years 1986 to 1990 were processed by the system to study the susceptibility pattern of the various organisms isolated and then tested for correlation with antibiotic consumed during the five years.
Cost Evaluation Of Heart Failure Treatment, Cost-effectiveness Analysis And Budget Impact Of Adding Empagliflozin To Standard Treatment For Heart Failure With Reduced Ejection Fraction
(2023-09)
Low, Joo Zheng
Heart failure (HF) is a clinical condition caused by structural or functional heart abnormalities. The increasing prevalence of HF and frequent hospitalisation due to HF (hHF) significantly impact healthcare expenditure. Moreover, there is limited data on the economic burden of HF across different ejection fractions (EF). Empagliflozin is a novel antidiabetic medication that improves clinical outcomes of HF with reduced ejection fraction (HFrEF) patients. Therefore, this study was designed to determine the cost of HF treatment, cost-effectiveness, and budget impact of adding empagliflozin to the standard of care (SoC) compared to SoC monotherapy from the Ministry of Health Malaysia perspective. A prevalence-based, bottom-up cost analysis study was conducted in three tertiary hospitals in Malaysia to estimate the direct cost and resource utilisation throughout a one-year follow-up. The total costs consisted of outpatient, hospitalisation, medications, laboratory tests, and procedure costs, categorised according to ejection fraction. The cost-effectiveness of empagliflozin was determined using a cohort-based transition states model with health states defined as Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score quartiles and death. The lifetime direct medical costs and quality-adjusted life-years (QALYs) were compared, and the incidence of death and hHF were modelled for each monthly cycle. The clinical inputs and utilities were estimated from the EMPEROR-Reduced trial and supplemented by local costing data.
Cost-Effectiveness Of Mobile Phone Imaging Teledentistry (Mpit) For Early Detection Of Oral Cancer In Malaysia: A Markov Decision Analysis Approach
(2022-09)
Raman, Sivaraj
Although numerous national oral cancer screening initiatives are carried out in Malaysia, patients are still being disproportionately diagnosed at later stages, leading to substantial social and economic burdens. To overcome these challenges, a novel application called MeMoSA® was developed by incorporating a mobile phone imaging teledentistry for oral examinations (MOE). The application serves as a communication platform between primary healthcare practitioners and specialists located off-site. This study aims to report the cost-effectiveness of MOE, for screening patients with oral potentially malignant disorders (OPMD) and oral cancer compared to the conventional oral examination (COE) conducted routinely via either high-risk community screening camps (C1) or primary dental clinics (C2). A societal perspective was adopted to encompass all the far-reaching consequences of early detection of oral cancer. A Markov modeling was applied to simulate the impact of various MOE screening strategies on cost and quality-adjusted life-years (QALYs) for a hypothetical cohort of 100,000 adults aged 40 years. The initial findings from two tertiary healthcare centers demonstrated that late-stage oral cancer incurred significantly higher healthcare provider and patient household costs, in addition to a lower quality of life compared to the early stage and OPMD.
Design And Development Of Oral Antihyperglycaemic Formulations For Water-Soluble Palm Fruit Extract
(2022-07)
Dayoob, Mohamad
Water-soluble palm fruit extract (WSPFE) is recovered from the palm oil production waste stream in Malaysia. WSPFE consists of valuable water-soluble phenolic acids including protocatechuic acid (PCA), p-hydroxybenzoic acid (p-HBA), and three isomers of caffeoyl-shikimic acid. WSPFE demonstrated several therapeutic activities in vitro and in vivo. However, the high sugar content of WSPFE may lead to gastrointestinal side effects, likely resulting in compliance issues. Also, the lower phenolic content compared to the sugar content means that a large quantity of WSPFE should be consumed to achieve the therapeutic effects. Different methods were used to remove the sugars and extract the phenolic acids in WSPFE, namely liquid-liquid extraction (LLE), ethanolic precipitation, alkaline hydrolysis, and solid phase extraction (SPE) by using Amberlite XAD-2 and Oasis HLB resins. The most efficient method for removing the sugars and extracting the phenolics was found to be through SPE by Oasis HLB, followed by Amberlite XAD-2. The sugar-removed WSPFE (SR-WSPFE) samples were examined in vitro using different assays. The highest antioxidant, alpha-amylase inhibition, and alpha-glucosidase inhibition activities were observed in SR-WSPFE that was extracted by Oasis HLB, followed by Amberlite XAD-2. Therefore, the SR-WSPFE obtained by using Oasis HLB was chosen for further product development process. Preformulation studies revealed some drawbacks of SR-WSPFE including hygroscopicity, high moisture content, bitter taste, and poor flow properties. Different carriers and formulation approaches were applied to overcome the problems of SR-WSPFE.
Determination Of Plasma Metabolites, Its Related Metabolomic Pathways And Correlation With Clinical Parameters Of Cognitive Frailty And Mild Cognitive Impairment
(2023-09)
Bawadikji, Abdulkader Ahmad
Cognitive frailty (CF) has evolved over recent years, initially used to describe the co-occurrence of mild cognitive impairment (MCI) and physical frailty without dementia. Population ageing is occurring globally, and Malaysia has the most rapidly growing older population. CF in old age is likely to become of increasing importance. Metabolomics is a novel scientific discipline that may provide a novel method for diagnosing CF using a sensitive and specific technique such as nuclear magnetic resonance (NMR). This study aims to identify metabolic fingerprints that can be used to distinguish subjects with CF from MCI and robust (healthy group), to explore the pathway of the identified metabolites, and to explore the correlations between the identified biomarkers and the clinical data related to CF and MCI. Blood samples were collected from 56 CF (mean age: 72.6 years), 75 MCI (mean age: 65.1 years), and 78 robust (mean age: 63.3 years). Plasma was separated by centrifugation, and then plasma samples were mixed with phosphate buffer and analyzed using NMR spectroscopy. Data analysis was done using multivariate analysis, including principal component analysis (PCA) and partial least square discriminate analysis (PLS-DA). For discrimination between CF and robust, the PLS-DA model showed sensitivity, specificity, and accuracy of 66.1%, 67.9%, and 65%, respectively.
Developing The Prognostic Model Of Chronic Kidney Disease Progression And Elucidating The Global Prevalence Of Chronic Kidney Disease Depression Among Elderly
(2023-07)
Khan, Irfanullah
Chronic kidney disease (CKD) is a significant public health problem with increasing incidence and prevalence worldwide. This trend is also observed in Malaysia, where the prevalence of CKD was 9.07% in 2011. CKD progression is associated with specific metabolic and diagnostic parameters important in the disease's progression. CKD patients frequently experience depression, which can further impact their well-being. A prognostic disease progression model was developed for CKD patients to understand the variations among individuals about metabolic and diagnostic parameters, encompassing all relevant factors. The study consisted of a retrospective analysis of 470 CKD patients selected from the Hospital Universiti Sains Malaysia (USM) clinic and a cross-sectional evaluation of 300 patients from outpatient department clinics using the Beck Depression Inventory questionnaire to assess depression. Computational statistical modeling approaches were utilized to evaluate CKD patients' sociodemographic, metabolic, and diagnostic characteristics. The hazard ratio was tested and implemented using the R-Studio software and syntax, which was also used to design and develop the hybrid biometry approach. The advanced methodology was carried out in three stages: developing syntax for R for the hybrid biometry method, which consists of multiple layer perceptrons (MLP), logistic regression, and data bootstrapping.

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