Raja Ahsan Aftab

Smoking on Treatment Outcomes Among Tuberculosis Patients

Background:Smoking is a risk factor not only for the development of cancer and coronary heart disease but also for tuberculosis (TB). The aim of this study was to determine the prevalence of smoking in patients with TB, identify demographic and clinical characteristics associated with smoking and to evaluate TB treatment outcomes in the smokers. Method:A retrospective cohort study of patients with TB was conducted at Khyber Teaching Hospital, Peshawar, Pakistan. All patients with pulmonary and extrapulmonary TB and those coinfected with HIV, hepatitis or diabetes mellitus were included in the study. The patients were categorized into smokers and nonsmokers. Treatment outcomes were evaluated by smear testing at the end of the treatment. Results:Of 472 enrolled subjects, 68 (14.4%) were smokers. The prevalence of smoking among male and female patients with TB was 11.8% and 2.5%, respectively. Univariate analysis indicated that the gender, age group and marital status of patients with TB were associated with smoking. The results indicated that patient gender (P = 0.05), age: 15 to 24 years (P = 0.05) and age >55 years (P = 0.004) were risk factors associated with smoking among TB patients. Of the 68 smokers with TB, the treatment outcomes among 54 patients (79.4%) were unsuccessful. The treatment outcomes was statistically significantly associated with smoking (odds ratio: 2.58, P = 0.004). Conclusions:Findings from the current study proved smoking to be one of the main factors associated with the occurrence of TB and significantly reducing the outcomes of TB therapy.

A Study of Effectiveness of Medical Therapy in Benign Prostatic Hyperplasia Patients in HUSM.

Introduction : Benign prostate hyperplasia (BPH), a progressive disease, can cause various urinary complications if left untreated. Aims and Objective : The current study was desigined to compare international prostate symptom score (IPSS), urine flow rate (Qmax), Prostate specific antigen (PSA) in pre and post treatment among patients with Benign prostate hyperplasia and to asses their quality of life. Methodology : A cross sectional study was designed at Hospital Universiti Sains Malaysia, including all patients diagnosed as BPH from year 2007 to 2010. Based on inclusion and exclusion criteria 307 subjects were selected. New set of International Prostate Symptom Score (IPSS) and urine flow rate (Qmax) was obtained from all selected patients. SPSS version 19 was used for statistical analysis. Result : Out of the 307 patients currently treated at Hospital University Sains Malaysia (HUSM), 268(87.3%) were Malays, 38(12.4%) were Chinese and 1(0.3%) was Indian. Majority of the patients having BPH were above 50 years of age. One hundred and seven (34.9%) patients were associated with hypertension, followed by diabetes mellitus 12 (3.9%). urine peak flow rate (Qmax) had mean difference of 11.74 and 14.41ml/ sec, which shows the medical therapy do improve urine flow rate and benign prostatic hyperplasia (p<0.001). The prostate size also showed an increase having mean difference from 36.12 to 38.14cc 3 (p<0.001). There is significant relation between prostate gland volume and serum prostatic specific antigen (p<0.001). Conclusion : Benign prostatic hyperplasia although a benign condition, but still interferes with the normal life style of the patients. By initiating medical treatment this disease can not only be treated but also significantly improves the quality of life of the patients.

Efficacy of Losartan in the management of Post-Dialysis Euvolemic Hypertension (HELD-Trial): A Single-Blind Randomized Control Trial

To assess the effectiveness of losartan 50 mg on post dialysis euvolemic hypertensive patients against standard antihypertensive pharmacotherapy. A multicentre, prospective, randomized, single-blind trial was conducted to assess the effect of losartan 50 mg every other day (EOD), once a morning (OM) among post-dialysis euvolemic hypertensive patients. Covariate-adaptive randomization was used to allocate participants to a standard or treatment arm, and they were followed up for eight weeks. Pre-, intra- and post-dialysis session blood pressure (BP) measurements were recorded along with any adverse events. A total of 88 patients were randomized into standard (n = 44) and treatment arms (n = 44) and were followed for a period of 8 weeks. In the standard group, the mean post-dialysis blood pressure dropped by 0.3 mmHg by the end of the 8th week. However the treatment arm reported a drop of 2.4 mmHg of BP drop during the 8-week trial period. Analysis suggests that there was a significant difference in blood pressure readings at the end of 8 weeks among patients treated with losartan (P < 0.001). However, no such statistical association was observed in the standard arm (P 0.75). A slow, steady significant decline in post-dialysis BP was observed among euvolemic hypertensive patients that were treated with losartan 50 mg.

An assessment of adherence to asthma medication guidelines: findingsfrom a tertiary care center in the state of Penang, Malaysia.

BACKGROUND/AIM Multiple asthma guidelines have been developed to reduce asthma mortality, morbidity, and cost associated with asthma worldwide. In Malaysia, within this context, it is relatively unknown to what extent doctors adhere to the asthma guidelines. This study aimed to assess guideline adherence and calculate the cost of adhered and nonadhered prescriptions by medical doctors in a public tertiary health care facility. MATERIALS AND METHODS A cross-sectional study was carried out at Hospital Pulau Pinang, Malaysia. One hundred and eighty patients, a total of 30 patients per doctor, were enrolled to assess guideline adherence. The patients were followed for a second visit to assess their lung function. The costs of adhered and nonadhered prescriptions were calculated. RESULTS One hundred and forty-three patients (79%) received guideline (Global Initiative for Asthma 2011)-adhering pharmacotherapy. In the majority of patients (n = 133, 73.9%) asthma control was classified as partially controlled. There was no significant association observed between patient asthma control and patient demographics; however, there was a significant difference (P < 0.001) between lung function values from the first and second visits. The cost of adhered prescription was higher (70.1 Malaysian ringgit) than that of nonadhered prescription (13.74 Malaysian ringgit). CONCLUSION Fair levels of guideline adherence were observed. Emphasis should be placed on identifying appropriate cost-effective medication regimens based on patient asthma control and constant feedback from patients.

A systematic review on randomized control trials on rennin angiotensin aldosterone system inhibitors role in managing hypertension among hemodialysis patients

Abstract Randomized control trials (RCTs) are considered as most rigors way of determining the cause–effect relationship of a treatment and outcome. Activation of rennin angiotensin aldosterone system (RAAS) is an important contributor to hypertension in hemodialysis patients. The prevalence of hypertension in hemodialysis patients varies from 60% to 80% and hypertension management alone with conventional hemodialysis is insufficient. Hence, the current review was aimed to investigate the effect of RAAS inhibitors in managing hypertension among hemodialysis patients in a randomized control trial. Using PUBMED and EMBASE databases, randomized control trial with primary or secondary outcomes related to the effect of RAAS inhibitors on blood pressure among hemodialysis patients were included for analysis. The current review also assessed the quality of reporting of RCT. A total of eight RCT met inclusion criteria for current review. According to modified jaded scale, one (12.5%) study scored four points for quality reporting, whereas two (25%) studies scored one point that was the least score. The mean score for all included studies was 2.25. Six (75%) of the eight RCT included, involved ARB in hypertension management among hemodialysis patients, whereas two (25%) studies involved angiotensin-converting enzyme (ACE) inhibitors. Of the siz RCT involving ARB, two (33.3%) RCT also included ACE inhibitors comparison group. Altogether six (75%) studies report a reduction in blood pressure with the use of RAAS inhibitors compared to control group; however, of the six studies, two (33.3%) reported that the reduction in blood pressure was not significant. Whereas, two (25%) studies reported no reduction in blood pressure compared to the control group. The findings from current review do not indicate a clear pattern for a role of RAAS inhibitors for hypertension control among hemodialysis patients.

Physicians’ Adherence to Asthma Guidelines: A Prospective Prescription Review from Tertiary Care Hospital, Malaysia

RESEARCH ARTICLE Physicians’ Adherence to Asthma Guidelines: A Prospective Prescription Review from Tertiary Care Hospital, Malaysia Raja Ahsan Aftab, Amer Hayat Khan, Syed Azhar Syed Sulaiman and Irfhan Ali Department of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, 11800 Penang, Malaysia School Of Pharmacy, Taylor’s University, Subang Jaya, Selangor, Malaysia Department of Respiratory Medicine, Penang General Hospital, Penang, Malaysia

Safety and Efficacy of Losartan 50 mg in Reducing Blood Pressure among Patients with Post-Dialysis Euvolemic Hypertension: A Randomized Control Trial

The aim of current study was to assess the effectiveness of losartan 50 mg in reducing blood pressure among post-dialysis euvolemic hypertensive patients, observing their survival trends and adverse events during the course of study. A multicentre, prospective, randomised, single-blind trial was conducted to assess the effect of losartan 50 mg every other day (EOD), once a morning (OM) among post-dialysis euvolemic hypertensive patients. Post-dialysis euvolemic assessment was done by a body composition monitor (BCM). Covariate Adaptive Randomization was used for allocation of participants to the standard or intervention arm. Of the total 229 patients, 96 (41.9%) were identified as post-dialysis euvolemic hypertensive. Final samples of 88 (40.1%) patients were randomized into standard and intervention arms. After follow-up of 12 months’ pre-dialysis systolic (p < 0.001) and diastolic (p 0.01), intradialysis diastolic (p 0.02), post-dialysis systolic (p < 0.001) and diastolic (p < 0.001) blood pressure was reduced from the baseline among intervention-arm patients Compared to only pre-dialysis systolic blood pressure (p 0.003) among standard arm patients after 12 months of follow. Total of six deaths were reported among standard-arm patients compared to 2 deaths among the intervention arm. Losartan 50 mg achieve an overall significant decline in blood pressure among post-dialysis euvolemic hypertensive patients.