Background: In Malaysia, for more than a decade, dipeptidyl peptidase-4 inhibitors (DPP-4i) are among the oral antidiabetic medications used as monotherapy or in combination to manage type II diabetes mellitus (T2DM). These medications are known for the efficacy in glycated haemoglobin (HbA1c) reduction and weight neutral effect with minimal hypoglycaemia occurrence. This study aimed to identify the outcomes of DPP-4i use in one of the largest tertiary public hospital in Southeast Asia. Methods: This is a retrospective cross sectional study conducted in 2016, where stratified sampling method was used. Patients with T2DM treated with available DPP-4i; namely Linagliptin, Saxagliptin, Sitagliptin and Vildagliptin, for at least 3 months were identified from the pharmacy record. Medical records from Physician Clinic in Hospital Kuala Lumpur (HKL) were reviewed. Data on demographic, anthropometric, antidiabetic treatment modalities, laboratory and documented outcomes were collected. Outcomes endpoints which include changes in HbA1c, fasting blood glucose (FBG), and body weight were recorded and analysed. Adverse drug reactions (ADR) documented were also reported. Results and discussion: A total of one hundred and five patients were recruited. The patients were 49.5% men (n = 52), with a mean age of 57 years, mean HbA1c of 8.5% (69 mmol/mol) and mean BMI of 29.5 kg/m 2. At least 50% of the patients had T2DM for more than 10 years and more than two third of these patients had both T2DM and hypertension. Thirty nine patients were on Vildagliptin, 32 on Sitagliptin, 26 on Saxagliptin and the remaining on Linagliptin. The most commonly prescribed DPP-4i were Vildagliptin and Sitagliptin. Majority of the patients (90.4%) were prescribed with Metformin, with 62.8% of patients on fixed-dose combination, and the remaining on add-on Metformin therapy. Use of DPP-4i as an adjunct was associated with a mean reduction of 0.9% (9 mmol/ mol) in HbA1c (p < 0.0001) and 1.15 mmol/L (19.82 mg/dL) in FBG (p = 0.001) without significant weight changes (p = 0.745). Sitagliptin had the highest reduction in HbA1c (1.66%,19 mmol/mol; p-value< 0.0001). Twelve ADRs were reported with the highest report on gastrointestinal intolerance (n = 7). None of the ADR reported caused any significant harm to the patients. Conclusion: Overall, use of these DPP-4i as an adjunct antidiabetic was associated with reduction in HbA1c.

What is known and objective Nebulizer use has been suspended in Malaysian public health facilities due to the potential to aggravate COVID‐19 nosocomial transmission. Currently, our facility uses the pressurized metered‐dose inhaler (pMDI) bronchodilator with Venturi mask modified spacer (VMMS) in patients visiting the Emergency Department (ED) for mild to moderate exacerbation of asthma and chronic obstructive pulmonary disease (COPD). We sought to assess the outcomes and acceptance of pMDI‐VMMS in the outpatient ED of a tertiary hospital in Malaysia. Methods We analysed the total visits and discharge rates during periods of using the nebulizer and current pMDI‐VMMS methods. The acceptance of pMDI‐VMMS by patients and assistant medical officers (AMOs) were assessed by questionnaire. Results and discussion We analysed 3184 ED visits and responses from 103 patients and 32 AMOs. The direct discharge rate was similar for both nebulizer (n = 2162, 92.5%) and pMDI‐VMMS method (n = 768, 90.7%) (p‐value = 0.120). Twenty‐eight patients (27.2%) favoured the pMDI‐VMMS over the nebulizer, whereas 36 patients (35.0%) had no preference for either method. Sixty‐four patients (62.1%) felt that the current pMDI‐VMMS method was better or at least as effective in relieving their symptoms as a nebulizer. The current method was favoured over the nebulizer by twenty‐seven AMOs (84.4%). Twenty‐eight (87.5%) AMOs suggested that the current method was more effective than the nebulizer. What is new and conclusion The bronchodilator delivered via pMDI‐VMMS appeared to be comparable to nebulizer in treating mild to moderate asthma and COPD exacerbations in the outpatient ED. Most patients and AMOs accepted the use of pMDI‐VMMS in the outpatient ED during the current COVID‐19 pandemic. The Venturi mask modified spacer can be a cheap and effective alternative to the commercial spacer in a resource‐limited situation.

Objectives The prevalence of antimicrobial resistance (AMR) is rising globally as well as in Malaysia. AMR can lead to difficulty in the treatment of chronic infection if being neglected. This study aimed to assess the level of knowledge and attitude about antibiotic usage and AMR. Methods A cross-sectional study design was carried out at the Hospital Kuala Lumpur (HKL), Malaysia, where participants were recruited by using the non-probability convenience sampling from the six orthopaedic and four surgical wards. A self-administered questionnaire was used to collect the required data which were then analysed by using SPSS. Key findings A total number of 390 adult Malaysians (286 from orthopaedic wards and 104 from surgical wards) were involved in the study. This study showed that the level of knowledge and attitude about antibiotics among the majority of respondents were moderate. However, their knowledge regarding AMR was very low (i.e. lack of knowledge). In contrast, the majority of them (69.8%) showed a positive attitude towards antibiotics. Statistical analysis of data revealed that the level of knowledge of AMR was significantly associated with gender, age, race, marital status, educational level and knowledge about antibiotic resistance terms (P &lt; 0.05) while respondents’ attitude towards antibiotic usage was significantly associated with gender, race, marital status and education level (P &lt; 0.05). Conclusions It was necessary to formulate and develop strategies to improve the knowledge and awareness about antibiotics and AMR among health professionals. These might help them to improve their skills in delivering health information to the patients through a proper counselling technique.