MyPSA Newsletter June 2018 Issue

HIGHLIGHT

History of MyPSA Metamorphosis Developing Leaders

1st MyPSA National Pharmacy

Research

Competition

EditorĘźs Note Dear MyPSA members, Welcome to the June 2018 issue of MyPSA Newsletter. I would like to take this opportunity to express my heartfelt thanks for my subcommittees who helped me throughout the process of making this newsletter. We are proud to have Mr Hasryn, founder of MyPSA that have contributed an article for this newsletter. In addition, this newsletter also consisted of the reports of the whole new events by the members of MyPSA which were held in this year. Turn to the next page to find out more! Happy reading! JONG PEI JOO PUBLICATION OFFICER MyPSA 2017/2018

01 National Event 04 Metamorphosis 11 History of MyPSA 14 Student Exchange Programme

18 Academic Writing 37 Public Health Campaign

National Events National Event pg. pg. 01 02

1st MyPSA National Pharmacy Research Competition “Transforming creativity into a Scientific Research Knowledge” 1st MyPSA National Pharmacy Research Competition 2018 was successfully conducted with participation from seven universities, including UniKL RCMP. This event served as a platform for Pharmacy undergraduates to present their Final Year Project at the national level. The exhibition allowed both participants and visitors to appreciate these interesting student projects that could perhaps further developed at a later time. The judging session began at around 10.00 am and each team was evaluated by three judges. After judging session ended, all judges had a discussion before proceeding with marks calculation. Later at 2pm, a talk on research paper publication was conducted with the speaker being our very own lecturer, Prof. Gouri Kumar Dash. Befitting the competition, the talk gave its participants a better understanding on research paper publication. Gala Dinner, which was the main highlight of this event, was to honour the participants and to present award to the winners. There were five winners for gold medal, silver medal and bronze medal respectively. Besides, there were four special awards, including Piala Ahmad Fuad Shamsuddin which was won by Taylorʼs University.

Closing ceremony.

National Event Events National

SPECIAL AWARD

Creativity Award Social Impact Award Best Presenter Award Piala Ahmad Fuad Shamsuddin

GOLD Koh Wei Ying (UKM) Patricia Anne John Philip (Taylor始s) Shubbaneswarei a/p Selladurai (Taylor始s) Lim Chei Sin (UKM) Teoh Xin Yi (USM) Yeoh Yuyu (USM)

SILVER Muhammad Nabil Fikri bin Ahmad Khaidzir (CUCMS) Nur Asyiqin binti Masenwat (CUCMS) Muslihah binti Mohamed Nadzri (USM)

USM A CUCMS B UKM A Taylor始s University

pg. 02 03

BRONZE Nurulfalahin binti Daud @ Ibrahim (UniKL) Norhaslina binti Sauddi (UniKL) Nor Akhi Hijriyati binti Abdul Rahman (IIUM)

Kee Sher Li (Taylor始s)

Nur Anis Najlaa binti Mohd Suhaimi (IIUM)

Muhammad Fathullah bin Pardin (UKM)

Yoong Lai Keng Yeoh Yuyu (USM)

Deenna Noris Liyana Kamarudin (CUCMS) Zainol bin Johari (CUCMS)

Nur Fatin binti Zulkifli (UniKL) Nur Syahira binti Abdul Jalil (UniKL)

LEADER

Metamorphosis

PRESIDENT

CHAIRP

pg. 06

An Interview with

1

Mr Bryan

What is the main reason behind the thought of setting up this event?

To build up a pool of talents. There have been numerous "burnout" cases among students as it is always the same people taking on too many events, causing them to be worn out in the end of the day, not having sufficient leisure time for themselves. I believe this program will be able to empower new students to take up responsibilities, on the other hand giving a chance to the students with too much responsibilities a relief on their shoulders as others can take over a part of the weight. Only then, we can sustain the quality of the programs we have been conducting, in order to achieve their objectives.

ooJ ieP gnoJ

What are the difficulties you met while setting up this event? Getting sufficient participants willing to commit to all 3 phases. Targeting only year 1st and 2nd year students so that the objective of having a pool of talents for MyPSA will be achieved, as the 3rd and 4th year students will leave in just a year at max. This at the same time shows that MyPSA will need to put in more effort in encouraging the 1st and 2nd year students to participate in the events provided by MyPSA. Getting the right committee members. As this program is a new one, in addition that it will be a year long, the team with the right members is needed to be formed, to ensure that the program results in the goal we want, and not sway from it. Financial problem. We wanted to give a suitable price for students as personally, I do not believe in overpricing the events we provide for students, as students do not have purchasing power. It's always been a goal of mine to try and cut down the fees needed for students to participate in the events held by MyPSA. In addition, we only want a small amount of participants to ensure the quality of the program as in phase 2, they will have personal mentors from the MPS Young Pharmacist Chapter (YPC). I take this opportunity as well, to thank YPC for willing to collaborate with us, and giving us a helping hand to build up these young talents.

PERSON 3

How do you deal with the difficulties? The same way any successful people will deal with it: believe in yourself and your team, and more importantly, the benefit of the program will bring to MyPSA. That way, you will be able to persist no matter what difficulties or stress you encountered. I initiated the program due to the belief in what will this program bring to MyPSA, and I still believe so. It has never wavered.

4

What are some of the ways you measure eventĘźs success? Phase 3 of this event itself is the part where participants will try to use their skill sets to achieve something. This is the "practical" part. Phase 1 and 2 are more towards "theory". Once the participants have passed phase 3, I can consider that we have achieved something, and as for the future, hopefully, they will continue to contribute towards MyPSA.

5

What are the wishes/advices you would like to say for the future leaders? Different leaders have different visions and different beliefs. There will be people that trust your vision, there will be people who doubt it. Do not waver just because there are people who doubt you, for you will still attract people who trust your beliefs. You might have some time where you drop low, but still, stick to it, persist, and you will find what you are doing is worthwhile someday.

Metamorphosis

2

pg. 07

16-18th March 2018

pg. 08

VENUE Wisma MPS, Puchong Outbac Broga

DATE

ent) lopm eve t.D

hip.Evolve s r e .Ad ad e L ap ( . D

THEME L.E .A .

Metamorphosis

Metamorphosis Phase 1

19 potential pharmacy student leaders PARTICIPATION from pharmacy faculties across the peninsula

Leadership The next dayʼs event began after an early breakfast from 7.30 to 8.30 am, with Mr Mark leading the session expounding on the important tools needed in leadership. Ms See Jia once again led the activities to show how each and every one of the participants could be leaders, when the situation arises. Communication The third session was led by Ms Bernice, who got the participants hands-on with the various aspects of communication and how to communicate effectively. Ms Ravneet then helped out with an activity to drive home the importance of communication in a team. Outdoor Activities At 11.45 am, the participants and committee left by bus to Outbac Broga, where they had a brief introduction to the activities in the facility. After they had their lunch, the participants enjoyed some fun times with each other in outdoor activities. Project Simulation A short hands-on session would be carried out in the night after dinner regarding Project Simulation. This activity, designed to give the participants an idea on how to start a project, was led by Mr Alan. Throughout the session, the participants were exposed to the concept of SMART goals, the parameters of a project as well as pitching skills. Reflection Session The day would end with a short heart-to-heart session with Mr Jian Rong, who would lead a mindfulness session. After the session, the participants were briefed on the following dayʼs activities and adjourn to their dormitories.

2

Metamorphosis

Emotional Intelligence The first session kicked off at 9.00 pm, with Ms Sharon sharing on Emotional Intelligence – mainly looking at its components and significance in the current workforce. After her session, a short reflection time was carried out by Mr Alan who gave some visual aids to assist in the explanation on EQ. After the reflection time, a quick briefing was done by Ms Yuki regarding the next dayʼs activities and the participants were adjourned to their respective accomodations.

Day

Day

1

Briefing and Icebreaking The event started off with the briefing on the event by Mr Bryan, MyPSA President as well as Metamorphosis Organising Chairperson. He briefed on the purpose of Metamorphosis as well as the program content throughout the next few days. This was then followed by Ms See Jia, who surveyed the different personality types of the participants and explain the meaning to them briefly. After dinner from 7 – 8 pm, icebreaking session was commenced under Ms See Jia.

pg. 09

Student Exchange Programme

Day

pg. 10

3

Flying Fox More outdoor activities were lined up in store for the participants after a late breakfast at 8.00 am. Participants were allowed to join in the Flying Fox and other activities available in the resort before departing back to Wisma MPS at 11.00 am. Management After having lunch in MPS, the fourth session commenced with Mr Calvin sharing on event and time management to the participants, and Ms Ravneet conducting the activities on the importance of having vision in management. Personal Branding The last session was led by Mr John, who explained on the topic of personal branding, the way to create your own personal brand and the significance in a team. Ms Yuki led the activities which required participants to choose and select their teammates wisely to obtain the victory. Prize-Giving Ceremony and Briefing on Phase 2 At last, the five sessions reached its conclusion. Mr Bryan gave away the prize to the team who performed the best in all games, Team Banana. This was followed by a briefing on the proceedings of Phase 2 by Mr John who gave a rough overview of the Phase execution and the mentors involved.

Histor HIGHLIGHT

pg. 12

February 2005 marked the first communication between me and Mr Ahmad Munis Ahmad Sabri (President of USM Pharmacy Society). During that time, I was also the President of SOPHYS (Society of Pharmacy Students, UITM). We contacted each other through only e-mail and SMS, as the online messaging technology such as Whatsapp have not yet existed. Despite that, we were able to work on the proposal of Registry of Society (ROS) registration very well. Then, we planned the first meeting of the committee members for this society. Both of us met for the first time around July/August 2005 somewhere in Shah Alam area, to discuss on the plan for the first big meeting that will include various universities in Malaysia. We invited Mr John Nguyen, which was a Liaison Officer of Asia Pasific Regional Office (APRO), which is part of International Pharmaceutical Students Federation (IPSF). He was based in Australia. He joined the first big meeting in UiTM, which was held around October 2005. UiTM was the venue for the first meeting of MyPSA establishment, which was attended by most of the universities in Malaysia. Mr Ahmad Munis was appointed as the President and Hasryn Azzuar Mohd Khairy was selected as the Vice President. Then, Hanum Maisarah was appointed as the Secretary and Mr Adam Henry Sivapatham was selected as the Treasurer. The other post holders include Muhd Arif (Education Officer), Muhamad Haikal (Student Exchange Officer), Melissa Hong (IPSF Liason Officer), Fadhilah Hasbullah (Publication Officer) and Jasmin Ariff (NoGAPS Officer). The first event held by MyPSA was NoGAPS in 2006, which was held in UiTM, where it involved all universities in Malaysia, which followed by several events afterwards. MyPSA also joined ventures with APRO, IPSF and attended 7th Asia Pacific Pharmaceutical Symposium (APPS) on 27th June – 3rd July 2008 in Chulalongkorn University, Thailand.

ry of MyPSA Establishment

13

7th APPS Chulalongkorn Thailand

APPS is a big event which will be held annually. It is one of the prestigious event of the Asia Pacific Regional Office (APRO), IPSF. We succeeded to lobby for Malaysia to host the next APPS in 2009. USM Penang became the host for APPS 2009 (26th June – 1st July). In this event, pharmacy students and representatives from various countries including Malaysia, Indonesia, Japan, Thailand, Taiwan, Nepal, Bangladesh, and New Zealand were involved. They had the chance of exchanging opinions, while also having a fun time learning together. All of the first MYPSA committee members did very well and contributed to all of the events done from 2006 to 2008. In 2008, a new committee board was formed, as majority of the pioneer members had graduated and entered the career pathway. Written by, Hasryn Azzuar Mohd Khairy RPh 6783, Founder of MyPSA, Ex-President of SOPHYS 2005.

Written by: Huril Ain Binti Mohd Hanafi MyPSA, Malaysia Being surrounded by family and friends who have had a chance to study and join exchange programs abroad has always inspired me to get a similar experience. I also enjoyed traveling for IPSF programs for the past two years. To ensure that I stay active, I decided to apply for a Winter SEP in France. Honestly, I have never been outside of Malaysia on my own but I braced myself and took it as a challenge. I may look petite and vulnerable at times but I wanted to prove that these characteristics should not hold anyone’s dreams back. Throughout the whole three weeks in the heart-capturing city, Lyon, I have gained an abundance of knowledge (chemistry, pharmacy, cultures, values and languages). I also managed to develop my laboratory skills with sufficient guidance from my supervisor, Professor Marminon. In regards to values, one of the things I absolutely admire is how the locals randomly greeted each other “bonjour (hello)” even to strangers. This simple gesture lessened the "foreigner vibe" and made me feel more at home! I would never forget those who I have made friends with; Iveta, Mathilde, Lola, Sid and Khaoula. I wish I could type all the names but my point is, they are all lovely people and I am really privileged to have met and known them. We spent time together by visiting Lyon’s tourist attractions such as Place Bellecour, cooking and eating Quenelle at Lola and Mathilde’s houses. One evening, I even got invited to join the general assembly of l’AAEPL and I was extremely happy due to the fact that everyone was so welcoming.

As I was enjoying my first snow and how captivating the buildings were, I thought things were going to stay awesome but I was wrong. On 9th March, I woke up to the news that my grandmother, who I was so close with, was gone forever. Being 6000 miles away from my family and to think that I could not kiss her good bye was painful but I had to stay strong. I kept on reminding myself that although I could not look at her for the last time on earth, this was never a path I regret taking. How could I say so? My internship was mainly on organic synthesis of a new cancer inhibitor. My grandmother’s death due to cancer did not make me feel down, as a matter of fact, I became more driven as I thought that my hard work would benefit all the cancer patients just like her. My SEP also made me realize the importance of doing research and that researchers should be equally respected and appreciated because without them, doctors have nothing to prescribe and pharmacists have nothing to dispense. Before I end my essay, I would like to thank God, my parents, MyPSA, IPSF, l’ANEPF and l’AAEPL for giving me this once in a lifetime opportunity. Thank you!

Student Exchange Programme

SEPrience in France

pg. 15

Student Exchange Programme pg. 16

SEPrience in Japan Written by: Wong Poh Kuan MyPSA, Malaysia “It is snowing!” I come from Malaysia, which is a country that does not have four seasons. Therefore, when I first saw the fluffy snow in Hokkaido, I was so excited! With the presence of snow, the scenery was beautiful and I enjoyed taking photos. However, the snow also gave me in a hard time when I need to drag a 20 kilograms luggage. Luckily, the SEP member lent me a hand. When I went shopping in the mall, a lot of girls were buying chocolates and I realized that Valentine’s Day was around the corner. I was surprised when the Japanese girls told me that, in Japan, Valentine’s Day is not celebrated only for couples. Besides, the girls are the one who buys the chocolates for the boys. The girl needs to buy chocolates for her boyfriend, boss, as well as people that she appreciates. This culture is different from Malaysia because both the boy and girl can give their lover chocolates and it is only for couples.

Lunch in Fukuoka University.

During the study-session, one of the Japanese girls told us that cancer causes the most deaths in Japan. I had visited Kin-ikyo Chuo Hospital located in Sapporo, Hokkaido, which is specialized in treating cancer patients. We had the opportunity to see how the cancer medications were prepared for the patients. Furthermore, I also visited Chidori Community Pharmacy in Kyushu. The manager in the pharmacy provided us with sufficient information and answered our questions patiently. This community pharmacy focuses more on prescription screening and patients’ counselling on how to take the medications while the community pharmacy in Malaysia focuses more on over-the-counter medication.

Of course, I cannot forget the yummy food in Japan, such as sushi, ramen, omurice, mentaiko, takoyaki, unagi, gyoza, donburi and motsunabe. Although there are many Japanese eateries in Malaysia, but the taste are quite different. Among these, I like motsunabe the most and I missed it. This delicacy is not available in Malaysia, as it is only exclusively available in Fukuoka. The dessert that I like the most is the ice-cream. I found out that each place has its own distinguished flavour of ice-cream. For instance, Hokkaido is famous for milk ice-cream while Osaka and Kyoto are well-known for matcha ice-cream. I arrived at Japan as a stranger and I left Japan as a part of their family. I was touched when the SEP members told me that there is always a place for me in Japan. I am very fortunate that I had been chosen for this student exchange program. It was indeed a life-changing experience!

Study session in Hokkaido.

Farewell party.

Student Exchange Programme

I also learned some greetings in Japanese, such as oyasumi (good night), konbawa (good evening) and gomennasai (I'm sorry). Do you like to eat “Kit Kat”? (Chocolate-covered wafers) Do you know the meaning behind “Kit Kat”? It actually means good luck in examination as “Kit Kat” approximates to "kitto katsu". I would say that Japanese is a complicated language because it is made up of Hiragana, Katakana and Kanji. I regretted that I did not learn Japanese before I went to Japan. Knowing the language may be helpful in understanding more about the culture.

pg. 17

Jun Ni, Ho, Faculty of Pharmacy, Taylorʼs University, Malaysia

“Which therapy should my child receive?” – A question frequently asked by most concerned parents with autistic children. It is never easy for parents to manage children with autism in real life. As a child with autism requires support based on a holistic approach, patience and care must be provided to ensure they are able to learn, grow and live to their full potential. Many treatments are presently available to improve the quality of life of autistic individuals. An example of the treatments involved is medical therapy.

What is Autism Spectrum? According to the Centers for Disease Control and Prevention, autism spectrum disorder (ASD) is defined as a lifelong development disability that can cause significant challenges in life. ASD involves a wide range of conditions which are similar to each other, including autistic disorder, Asperger‘s syndrome and pervasive developmental disorder - not otherwise specified (PDD-NOS). The reason why it is termed as “spectrum” is because people with ASD can have a range of signs, symptoms and severity levels. For instance, some people may encounter difficulties in social interaction, language, behaviour and interest, while the others may possess extraordinary high IQ levels and unique talents. Studies have found that all individuals on the autism spectrum are different, thus no two people with ASD are alike.

Academic Writing

Pharmacological Intervention in Autism Spectrum

pg. 19

Academic Writing pg. 20

The signs and symptoms of ASD can be detected during early childhood, specifically at the age of two. The most prominent sign observed in people with ASD is having difficulty in expressing words or emotions. Often, these individuals struggle to engage themselves in conversations with the maintenance of eye contact. They also tend to have abnormal behaviours and reactions when responding to the people around them. In most cases, people on the autism spectrum may have secondary conditions such as seizures, anxiety, depression, aggression and problems with attention. Such conditions can be alleviated by drugs. “There is no medication to cure autism. However, there are a number of medications prescribed by doctors to help ease the conditions and symptoms experienced by individuals with ASD,” says Dr Jason Loo, lecturer of the School of Pharmacy, Taylorʼs University. The definite cause of ASD still remains a mystery, resulting in no standard medicine for its treatment. Nevertheless, research studies have investigated that medications which target the brain can be used mainly in relieving autism signs and symptoms, precisely self-injury, irritability, outburst of anger, obsessive and repetitive behaviour, short attention span, convulsion, as well as mood instability. Prescription drugs, for example, antipsychotic agents, stimulants, anticonvulsant and antidepressant drugs have shown benefit in reducing these manifestations. Below are some examples of drugs that may be beneficial.

ASD Elemental Facts 1. Autistic Disorder/ “Classic” Autism: People with autistic disorder commonly have distinctive delays in language, cognitive development and communication. 2. Aspergerʼs syndrome: Individuals with Aspergerʼs hold repetitive or restricted behavioural patterns. They do not have delays with verbal language or cognitive development, but experience challenges in social interaction and non- verbal communication. 3. Pervasive developmental disorder- not otherwise specified (PDD-NOS)/ “Atypical” Autism: Individuals possess only certain criteria of either autistic disorder or Aspergerʼs (not all criteria). They usually have milder symptoms than those with autistic disorder.

Stimulant drugs Children with ASD may be over impulsive and hyperactive. They are mostly inattentive and lack persistence in completing tasks. Previous research has shown that people with Attention Deficit Hyperactivity Disorder (ADHD) have very low levels of dopamine in the brain. As dopamine also plays essential roles in motivational process and attention, individuals with ADHD are easily distracted and have difficulty in sustaining focus most of the time. Psychostimulant drugs thus increase dopamine levels by activating dopamine receptors in the brain, enhancing cognitive performance in autistic people with ADHD. Centrally acting sympathomimetics This class of drug is also designated for ADHD treatment in individuals on the autism spectrum. Centrally acting sympathomimetics help in regulating noradrenaline levels in the brain. Noradrenaline or norepinephrine is a chemical substance that stimulates individuals to stay alert and be ready for action. Individuals are able to be more attentive to their surrounding environment when noradrenaline levels in the brain are high. By preventing the reabsorption of noradrenaline back to the sending nerve cells, centrally acting able to maintain sympathomimetics are noradrenaline levels optimally in the receiving nerve cell, lengthening the attention span of individuals.

Anticonvulsant drugs It has been reported that one-third of children with ASD experience seizures. Seizures occur when brain cell activities which excite and inhibit electrical messages become imbalanced. Anticonvulsant drugs commonly modulate the excitatory and inhibitory circuits in the brain, either by decreasing excitation or enhancing inhibition. Excessive transmission of charged chemical substances (ions) and electrical messages from one brain cell to another can be prevented, controlling seizure conditions. Antidepressant drugs There are three main classes of antidepressant drugs - selective serotonin reuptake inhibitors (SSRIs), tricyclic and related antidepressants, and monoamine oxidase inhibitors (MAOIs). SSRIs are normally prescribed as the first-line agents for treating depression as they are better tolerated and have safer profile than those of tricyclic and related antidepressants and MAOIs. SSRIs are accountable for blocking serotonin reabsorption in the brain. When serotonin (a chemical messenger important for regulating mood and emotion) is prevented from being reabsorbed by the sending nerve cell, it is then sent across to the receiving nerve cell. These signals are transmitted continuously from one brain cell to another, resulting in an increase of serotonin levels accordingly. As children on the autism spectrum can have depression due to low serotonin levels in the brain, SSRIs are often administered to alleviate these symptoms.

Academic Writing

Antipsychotic drugs New antipsychotic drugs, formally known as “atypical� antipsychotics are indicated for the treatment of agitation, aggression and self-injurious behaviours. Researchers have proposed that these drugs work by inactivating dopamine receptors in the brain. In general, they bind loosely to these receptors, and at the same time, block the 5-HT2A receptors, causing a reduction in dopamine release. Under normal circumstance, 5-HT2A receptor triggers dopamine release; dopamine (a chemical substance produced in the body), which is responsible for behaviour and cognitive functioning, fits into the dopamine receptor upon activation. When excessive dopaminergic activities occur in the brain, symptoms associated with aggressive response, irritability, repetitive behaviour and cognitive impairment consequently arise. These antipsychotic drugs, therefore, help to modulate the dopamine level in the brain, improving the aforementioned signs and symptoms.

pg. 21

The classes of drugs and examples for ASD symptomatic treatments are summarized in the following table.

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Drug Classes and Examples

Drug Status

Drug Indications in General

Risperidone

Licensed Drug

Alleviation of irritability, aggression, temper tantrums and self- injurious behaviours

*Olanzapine

Clinical Trial Progression

"Atypical" / Second- generation antipsychotic drugs

Aripiprazole *Ziprasidone

Licensed Drug Clinical Trial Progression

*Quetiapine Stimulant drugs

Clinical Trial Progression

Methylphenidate

Licensed Drug

Amphetamine Centrally ac�ng sympathomime cs

Licensed Drug

Treatment of ADHD

Licensed Drug

Treatment of ADHD

Carbamazepine

Licensed Drug

Management of seizure conditions

Phenytoin

Licensed Drug

Lamotrigine

Licensed Drug

Levetiracetam

Licensed Drug

Atomoxetin

Anticonvulsant drugs

Antidepressant drugs Citalopram

pg. 22

Treatment of depressive illness and obsessive- compulsive disorder

Licensed Drug

Escitalopram

Licensed Drug

Fluoxetine

Licensed Drug

Sertraline

Licensed Drug

Trypanocidal agents *Suramin

Clinical Trial Progression

Treatment of ASD

*These drugs are under clinical trial process, yet to be approved for use for ASD treatment.

Alternative Therapies for Autism Spectrum There is no single therapy that is the most effective for individuals on the autism spectrum. Pharmacotherapy often needs to be carried out hand in hand with other therapies to elevate the quality of life and functional independence of those individuals. As every child with ASD is unique in his or her own way, treatments are tailored to the individualĘźs needs. The following list comprises a few examples of nonpharmacological interventions for ASD: â–Ş Behaviour and communication approaches â–Ş Occupational therapy â–Ş Speech and language therapy â–Ş Educational therapy â–Ş Hippotherapy (horseback riding therapy, treatment with the help of the horse) Education intervention should be made mandatory as it enables children to learn not only academic subjects, but also other skills which can help improve their behaviour and interaction capabilities.

Clinical research projects have been extensively conducted to discover and invent new drugs for treating autism. Scientists are presently investigating the genes related to autism, which are believed to be the causative factor of ASD. This study of genes may eventually lead to the development of personalized medications. As technology is becoming more advanced, cost-effective and widely accessible, individuals with ASD will have the opportunity to get their genes tested, and then receive medications specially designed for them in the future. Dr Temple Grandin, the famous autistic professor of animal science at Colorado State University once claimed that, “A treatment method or an educational method that will work for one child may not work for another child. The one common denominator for all of the young children is that early intervention does work, and it seems to improve the prognosis.â€? At present, early intervention is indeed essential as it significantly enhances a childĘźs development and wellbeing. Healthcare professionals and parents hold great responsibilities in monitoring the physical and mental health progression of the children, as well as imparting knowledge and skills to them. Although they may at times experience stressful incidences with the children, it is crucial that they always stay calm and patient. It is recommended that parents should constantly seek advice from specialists and pharmacists to know whether the medications prescribed are appropriate for their children who receive medical therapy. The journey can be hard for autistic children and their family members, but with love and persistent care, they can definitely overcome all challenges together, as autism is not a disability, it is a different ability.

References: 1. Grandin, T. (2002, December). Teaching Tips for Children and Adults with Autism. Retrieved from http://www.aspennj.org/pdf/information/art icles/teaching-tips-for-children-and-adultswith-autism.pdf 2. How is Autism Treated? (2017). Retrieved from https://www.autismspeaks.org/familyservices/tool-kits/100-day-kit/treatments-t herapies 3. Interactive Autism Network: Medications. (2016, December 2016). Retrieved from https://iancommunity.org/cs/what_do_we_k now/medication 4. Top 8 Autism Therapies- Reported by Parents. (2017).Retrieved f r o m https://www.autismspeaks.org/blog/2012/0 9/25/top-8-autism-therapies-%E2%80%93reported-parents 5. U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. (2016, October). Autism Spectrum Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/aut ism-spectrum-disorders-asd/index.shtml 6. What Are the Symptoms of Autism? (2017). Retrieved from https://www.autismspeaks.org/what-autism /symptoms 7. What Is Autism? (2013). Retrieved f r o m http://www.autismcommunity.org.au/what-i s- autism.html

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Autism Spectrum Management in a Nutshell

pg. 23

Academic Writing pg. 24

Mental Health Care: The New Roles of Pharmacists Jun Ni, Ho, Faculty of Pharmacy, Taylorʼs University, Malaysia

“Mental illness is nothing to be ashamed of. It is a medical problem, just like heart disease or 1 diabetes.” The American Psychiatric Association (APA) proposed such statement to highlight that mental illness is in fact prevalent and treatable. According to the World Health Organization (WHO), one in four people in the world is affected by mental or neurological disorders, with 2 approximately 450 million people presently suffering from such conditions. In Malaysia, the National Health and Morbidity Survey 2015 has provided statistics that indicates one in three 3 Malaysians on average suffers from mental health issues. Mental disorders are common, it is therefore crucial to inculcate in every nation across the globe the awareness of mental health. Healthcare professionals are extensively accountable for this responsibility, in addition to providing first-class services and therapies to individuals with mental health problems.

An Overview on Mental Illnesses Mental illnesses are conditions whereby individuals experience mild to severe disturbances in thoughts, emotions, feelings and/ or behaviours, and are often incapable of dealing with lifeʼs 4 ordinary routines and demands. Mental illnesses can be defined as diseases of the brain, which comprise a range of disorders. Different mental disorders may have different specific signs and symptoms, however, the overall hallmark features are the development of nervousness, intense 5 fear, peculiar behaviour, illogical thinking and sudden mood changes. There are various possible 6 aetiologies of mental disorders, including genetic factors (family history), biological factors (biochemical imbalances), social factors (difficult or stressful life circumstances), psychological factors (negative or conflicting thought patterns), and psychological trauma 7 (physical, emotional or sexual abuse). The cause of each medical case varies from one patient to another.

Treatment Modalities of Mental Health Multiple treatment options are available for managing mental disorders, particularly those which involve pharmacotherapy and talking therapies. Pharmacotherapy is the treatment using pharmaceutical drugs, whereby patients are given medications to control, relieve and improve their symptoms. There are five main classes of medications commonly prescribed to patients with mental disorders - antidepressants, anxiolytics, stimulants, antipsychotics and mood 11-12 stabilizers. The types and indications of these medications are summarized in Table 1.1. Talking therapies include counselling, cognitive behavioural therapy (a therapy in which patients are guided on how to change the way of thinking and behaving), psychotherapy (a therapy in which patients are aided to understand more about themselves and their past experiences), family intervention programme, and drama therapy (a therapy in which patients are encouraged to apply drama or theatrical techniques such as role-playing, miming and 13 storytelling to express themselves). Electroconvulsive therapy is also applied as one of the mental disorders treatments, notably in improving severe symptoms of depression and mania. In most cases, patients are recommended to undergo ecotherapy. Ecotherapy is a range of nature-based programmes which enable patients to get close with the natural environment. For instance, care farming, gardening, rock climbing, rafting, and animals petting (animal assisted 14 interventions) assist patients to master self-development skill and relax mind. Community support programmes are also well known for their establishment and continuous advocacy in restoring patientsĘź health holistically, helping them to regain confidence and proceed with life.

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Terminology and New Discovery of Mental Health Mental illnesses are further classified into anxiety disorders (panic disorder, obsessive6 compulsive disorder, post-traumatic stress disorder and phobias), attention deficit hyperactivity disorder (ADHD), depression, bipolar disorder, schizophrenia, psychosis, 4-6 personality disorders and eating disorders. Borderline personality disorder and dissociative disorder are other examples of mental illnesses. Following a guideline suggested by the National Institute for Health and Care Excellence (NICE), 8 the most common mental illnesses are anxiety disorders and depression. Recently, reviews have reported the emergence of a new mental disorder that has constantly raised concerns among the affected populations. This new disorder, Sluggish Cognitive Tempo (SCT), which is 9 also known as the Second Attention Disorder or Concentration Deficit Disorder, is a cognitive-emotional condition that affects children, and may persist to adulthood. It can be characterized with symptoms such as “sluggish� or slow movement, lethargy, apathy, sleepiness, daydreaming and staring.10 The definite cause and response to treatment of SCT are still not fully comprehended, hence many studies are still on-going and under thorough investigations.

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Table 1.1. The types and indications of antidepressants, anxiolytics, stimulants, antipsychotics and mood stabilizers. Drug Classes and Examples

Drug Indications

Antidepressants Bupropion

Treatment of depression

Monoamine Oxidase Inhibitors (MAOIs) • Isocarboxazid • Phenelzine • Tranylcypromine Selective Serotonin Reuptake Inhibitors (SSRIs) • Citalopram • Escitalopram • Fluoxetine • Paroxetine • Sertraline Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) • Duloxetine • Venlafaxine Tricyclic Antidepressants (TCAs) • Amitriptyline • Imipramine • Nortriptyline Anxiolytics Benzodiazepines • Alprazolam • Diazepam • Lorazepam

Treatment of anxiety disorders

Buspirone Centrally Acting Sympathomimetics Non- Stimulants • Atomoxetine Stimulants • Amphetamine • Lisdexamfetamine dimesylate • Methylphenidate

Treatment of ADHD

Antipsychotics First- Generation (Typical) • Chlorpromazine • Haloperidol • Perphenazine • Fluphenazine Second- Generation (Atypical) • Aripiprazole • Lurasidone • Olanzapine • Quetiapine • Risperidone

Treatment of psychoses and schizophrenia

Mood Stabilizers Antiepileptics • Carbamazepine • Valproic acid Lithium salts

Treatment of bipolar disorder, mania and mood swings

There are a few pharmacy education programmes which are available for pharmacists and pharmacy students to specialize in mental health. The More Than Meds programme in Nova Scotia and the Bloom Program in Canada are founded to provide novel insights for pharmacists 18 on procedures of handling with the needs of mental health patients. Pharmacists should take initiatives to sharpen skills, specifically effective communication skills and crisis management 15 skills, by participating in courses and trainings to own hands-on experience. They should learn how to give initial support to individuals experiencing mental health illnesses, promote awareness of evidence-based medical, psychological and alternative treatments, and act dominantly whenever crisis situation arises - suicidal behaviour, threatening psychotic 19 behaviour, panic attack, or overdose. Most importantly, mental health pharmacists should persevere with their continuing professional development (CPD), keeping themselves 16 up-to-date to the latest pharmaceutical care knowledge and health care systems. Below are the summaries of pharmacist roles as partners in mental health care, a framework designed by the PSA.

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Roles of Pharmacists in Mental Health Care Provision The Pharmaceutical Society of Australia (PSA) claims that pharmacists are the most accessible 15 health professionals whom a majority of consumers first consult to seek for medication advice. The main responsibility of mental health pharmacists is managing medications. Mental health pharmacists or psychiatric pharmacists play important roles in promoting safe medication use, as well as improving medication adherence in patients. They ensure the safety and efficacy of 16 prescribed dose, besides minimizing antipsychotic polypharmacy. It is essential for them to consistently screen for drug interactions, for instance serotonin toxicity, in order to maximize treatment and avoid other complications. Furthermore, mental health pharmacists should detect any adverse drug reaction (ADR) in a proactive manner, and report adverse drug event to 16 the relevant authorities. As recording of ADR is conducted appropriately, pharmacists should then be able to monitor medication administration, revise drug formulation, and improve its pharmacokinetic and pharmacodynamic properties. It is also their obligation to follow up and monitor their patients始 conditions to prevent any abuse or misuse of psychotropic substances. Medication review services must be provided by pharmacists to mental health patients, so that dose reduction or titration can be determined precisely, reducing patients始 exposure to toxicity risk. Commonly cited examples include Home Medicines Review (HMR) in Australia, Medicines 17 Use Review (MUR) services in the UK and Medication Therapy Management (MTM) in the US. When it comes to medication adherence, pharmacists are encouraged to devise plans and solutions for patients with mental illnesses. They can help educate patients by providing oral and written information (e.g. patient information leaflet, phone reminder), as well as applying pictograms or illustrations to enhance patients始 understanding. They can also improve patients始 medication compliance by involving patients in shared-decision making with other health professionals. This method enables patients, pharmacists and other healthcare givers to openly discuss issues of medication use, medication management, and medication adherence. As pharmacists engage actively in multidisciplinary team, they are able to communicate and collaborate with physicians, psychiatrists and nurses to optimize individual medication 16 regimens. Patients who receive tailored drug therapy tend to maintain their conditions under good control. A holistic approach that comprises interdisciplinary teamwork is indeed required in mental health pharmacy practice to elevate the quality of life of patients.

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Keywords (*):

•

DAA - Dose Administra on Aids

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(Medica on Adherence Programme) •

MedsCheckMedicines Use Reviews (Medica on Management Programme)

•

HMR - Home Medica on Reviews (Medica on Management Programme)

•

RMMRs Residen al Medica on Management Reviews (Medica on

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Management Programme) •

ATSI Aboriginal and Torres Strait Islander

•

CALD Culturally and Linguis cally Diverse

[Link to ‘Medication Management ProgrammesĘź (further reference): http://6cpa.com.au/medication-management-programs/]

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Mental Health Care in a Nutshell Pharmacists are guardians of all drugs. They should uphold professional ethics, values and standards to ensure mental health medications that are dispensed are safe, efficacious and of good quality. Besides providing patients with accurate information and rational advice, pharmacists play pivotal roles in encouraging patients to adhere strictly to medications and reviewing medications on regular basis. Practising active listening and being empathy also allow pharmacists to obtain patientsĘź details of history, backgrounds and reasons of their admission. It is important that pharmacists should never stigmatize or discriminate patients with mental illnesses. As they are highly accessible health care and medication providers, they give a meaningful impact on mental health care in the community and clinical settings.

1. What is Mental Illness? American Psychiatric Association. https://www.psychiatry.org/patientsfamilies/what-is-mental-illness. Updated 2017. Accessed December 10, 2017. 2. World health report. World Health O r g a n i z a t i o n . http://www.who.int/whr/2001/media_centre/press _release/en/. Updated 2017. Accessed December 10, 2017. 3. Mental health status in Malaysia. Relate M a l a y s i a . https://relate.com.my/mental-health-status-inmalaysia/. Published November 4, 2016. Accessed December 10, 2017. 4. What is Mental Illness? Mental Health Association in Forsyth County. https://www.triadmentalhealth.org/what-is-mental -illness/. Accessed December 10, 2017. 5. Warning Signs of Mental Illness. American Psychiatric Association. https://www.psychiatry.org/patients-families/warni ng-signs-of-mental-illness. Updated 2017. Accessed December 10, 2017. 6. Mental Disorders. National Institutes of Health MedlinePlus. https://medlineplus.gov/mentaldisorders.html. Updated December 11, 2017. Accessed December 10, 2017. 7. What is Mental Illness? Mental Health Resources for Carers. h t t p : / / m h r 4 c . c o m . a u / a b o u t- m e n t a l illness/what-is-mental-illness/. Updated 2016. Accessed December 10, 2017. 8. National Collaborating Centre for Mental Health (UK). Common Mental Health Disorders: Identification and Pathways to Care. Leicester, UK: British Psychological Society; 2011. (NICE Clinical Guidelines, No. 123.) 2, COMMON MENTAL HEALTH DISORDERS. 9. Barkley RA. Sluggish Cognitive Tempo/Concentration Deficit Disorder. Oxford Handbooks Online. http://www.oxfordhandbooks.com/view/10.1093/ oxfordhb/9780199935291.001.0001/oxfordhb9780199935291-e-9. Published February 2015. Accessed December 11, 2017. 10. Mueller AK, Tucha L, Koerts J, et al. Sluggish cognitive tempo and its neurocognitive, social and emotive correlates: a systematic review of the current literature. Journal of Molecular Psychiatry. 2014; 2:5. https://jmolecularpsychiatry.biomedcentral.com/a rticles/10.1186/2049-9256-2-5. Published August 5, 2014. Accessed December 11, 2017.

11. Mental Health Medications. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/mentalhealth-medications/index.shtml#part_149856. Accessed December 12, 2017. 12. Treatments for Mental Disorders. Substance Abuse and Mental Health Services A d m i n i s t r a t i o n . https://www.samhsa.gov/treatment/mental-disor ders. Updated May 4, 2017. Accessed December 12, 2017. 13. Talking Therapies- Types of Therapy. Rethink Mental Illness. h t t p s : / / w w w. re t h i n k . o rg / d i a g n o s i s treatment/treatment-and-support/talking-treatm ents/types-of-therapy. Accessed December 12, 2017. 14. Ecotherapy. Mind. https://www.mind.org.uk/information-support/dr u g s a n d treatments/ecotherapy/types-of-ecotherapy/#.W jlCzlWWbIV. Published October 2015. Accessed 12 December 2017. 15. Pharmacists始 role in mental health. Mental Health Australia. https://mhaustralia.org/general/pharmacists-role -mental-health. Published June 12, 2014. Accessed December 15, 2017. 16. Standards of Practice for Mental Health Pharmacy. Journal of Pharmacy Practice and Research. 2012;42:2. https://www.shpa.org.au/sites/default/files/uploa d e d content/field_f_content_file/51._ps_mental_health _pharmacy.pdf. Accessed December 16, 2017. 17. Rubio-Valera M, Chen TF, O始Reilly CL. New Roles for Pharmacists in Community Mental Health Care: A Narrative Review. Salvador-Carulla L, Rosen A, Sanchez AF, eds. International Journal of Environmental Research and Public Health. 2 0 1 4 ; 1 1 ( 1 0 ) : 1 0 9 6 7 - 1 0 9 9 0 . doi:10.3390/ijerph111010967. 18. Emberley P. The pharmacist始s role in mental health. Canadian Pharmacists Association. https://www.pharmacists.ca/news-events/cpha-bl og/the-pharmacist-s-role-in-mental-health/. Accessed December 18, 2017. 19. Paola S. Pharmacy始s Role in Mental Health. Australian Journal of Pharmacy. https://ajp.com.au/news/pharmacys-role-mentalhealth/. Published October 11, 2016. Accessed December 18, 2017. 20. Medication Management Programs. 6th Community Pharmacy Agreement. http://6cpa.com.au/medication-management-pro grams/. Accessed December 20, 2017.

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Role and Novel Uses of Radioisotopes in Diagnostics and Treatments within Healthcare Facilities Article written by: Nandhini A/P Sivam Chan Jun Yi Chai Shin Yiing Tan Win Lynn Janice Ting Shen Ling Tai Zhen Fui PART 5, YEAR 3 IMU, BUKIT JALIL CAMPUS

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Introduction Elements that were once used to kill humans in a single attempt has now taken a revolution to save humankind. Naturally, there are existence of elements that are unstable and decay into a more stable element by emitting energy in the form of [1] When these elements also exist as radiation. [1] isotopes, they are known as radioisotopes. The discovery of radioisotopes dated back to beginning of 1900s has given rise to nuclear medicine which utilises the nature of radioisotopes in novel [2] treatment and diagnostic methods. According to American Nuclear Society, about 90% of radioisotopes are used in medical imaging and 10% [4] are used in therapeutics. The role and use of radioisotopes in diagnosis and treatment is evolving every day to provide better healthcare for patients. Radioisotopes used in diagnosis are able to provide images from their targeted site of distribution, while radioisotopes used in treatment emits radiation [3] energy to cure a disease.

Objective This review covers the roles and uses of radioisotopes in different novel diagnostic and treatment methods within healthcare sector. It will focus on describing the current usage of radioisotopes in diagnosis and treatment with regards to its mechanism of action and examples. It will also focus on the future researches that are ongoing to create more novel methods to diagnose and treat diseases.

In healthcare, diagnosis is an important aspect and novel advancements should be introduced to detect the many new diseases spreading among humans. Radioisotopes used in diagnosis act as tracer, whereby when they are bound to a targeted cell, antibody or tissue, their presence can be [5] detected from outside of body with the usage of suitable medical instruments. Technetium 99m pyrophosphate (Tc 99m PYP) cardiac imaging Transthyretin cardiac amyloidosis is a condition in which the fibril proteins produced by transthyretin are deposited in various organs and tissues, especially the cardiac tissue, which [6,7] eventually leads to heart failure. The novel way a radioisotope can be used to diagnose this [6,7] A condition is by using Technetium 99m pyrophosphate (Tc 99m PYP) cardiac imaging. retrospective observational study was performed to validate Tc 99m PYP as non-invasive [8] diagnostic tool for transthyretin cardiac amyloidosis and its association with survival. Participants who went for Tc 99m PYP scintigraphy for suspected transthyretin cardiac amyloidosis are used as study subjects. The retention of Tc 99m PYP uptake in heart was [8] measured using heart-to-contralateral lung ratio (H/CL) and semi-quantitative uptake score. The outcome of the study shows a ratio of more than ≼ 1.25 which indicates 100% sensitivity and [7] 97% specificity in predicting the semi-quantitative myocardial uptake. Even though H/Cl ratio is useful in diagnosing transthyretin cardiac amyloidosis, it is not able to indicate the risk [8] stratification of the disease. Positron emission tomography The discovery of combining imaging devices to detect the emission of radioisotopes has opened ways to diagnose many different diseases. One such advancement is positron emission tomography, PET; a procedure whereby radiopharmaceuticals that emits positron are injected [9,10] The into patients to study tissue metabolism, physiology and pathology of organs. radioisotopes used in PET emits positrons which eventually combines with free electrons and results in production of two 511 keV photons, travelling in opposite direction due to annihilation. [9] These photons are then detected by a gamma camera system to produce a three-dimensional [9] image of an organ that has the accumulation of the radiopharmaceuticals. The most favourable [9] radioisotopes used in PET are the nitrogen-13, fluorine-18, carbon-11 and oxygen-15. Oxygen-15 existing in gaseous form is used to study oxygen metabolism while in water and [9] carbon monoxide forms to study blood flow and volume. Fluorine-18 is present in fluorodeoxyglucose (FDG) helps in understanding glucose metabolism while blood-brain barrier permeability is studied using carbon-11 aminoisobutyric acid, gallium-68 citrate and [9] rubidium-82 chloride. There are many more radioisotopes vastly used in PET as PET advances into positron-emission tomography-computed tomography (PET/CT) and positron-emission [10] tomography-magnetic resonance imaging (PET/MRI). Ventilation-perfusion scintigraphy (V/Q scan) Besides, another diagnostic tool using radioisotopes that is helpful in diagnosing pulmonary embolism (PE), a life-threatening health problem that have non-significant signs and symptoms [11,12,13] is Ventilation-perfusion scintigraphy (V/Q scan). This scan has high sensitivity and specificity to diagnose or exclude PE in addition to identifying the presence of any blood clots in [13] For ventilation scan that measures airflow in lungs, patient will the lungs using radioisotopes. inhale small amount of radionuclide gaseous such as Xenon-133 gas, technetium-99m labelled [11] aerosol containing diethylenetriamine pentaacetic acid (99m Tc-DTPA) or krypton (81m Kr). Perfusion scan on the other hand is done to display blood flow in lungs by injecting [11,13] Scintigraphic images macroaggregated albumin that is labelled with 99m Tc intravenously. [11] can then be captured using gamma camera. This scan is superior to the computerised tomography pulmonary angiography (CTPA), another test that diagnoses PE because it is safer to be used in pregnant and young women who do not want to expose themselves to the radiation [12] and iodine containing contrast agents via CTPA.

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Current updates on diagnosis using radioisotopes

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Current updates on treatments using radioisotopes

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Another contribution of radioisotopes in healthcare is in treatment. They are widely used in treatment due to their ability to emit radiation to weaken or kill unwanted growth, especially cancer [14,15] Two types of radiation therapy namely external beam by disrupting the DNA of cancerous cells. [15] radiation therapy and internal radiation therapy use radioisotopes to treat cancer patients. External beam radiation therapy as the name suggest means high- energy rays such as protons or [14] photons are aimed to the site of tumour from outside of the body. The type of rays plays a vital role in external radiation therapy, whereby they should have good localised penetrating power and [14] Usually, X-rays generated from electron excitation less ionizing effects on surrounding tissues. using linear accelerators and cathode ray tubes, and gamma rays produced through radioactive [14] decay of radioisotopes such as cobalt-60 are used in this procedure. Internal Radiation Therapy The role of radioisotopes extends from external radiation therapy to internal radiation therapy too. Internal irradiation is a form of treatment where the patient receives a radiation source, that can be [15] This form of irradiation is localized either gamma or beta emitter at the target area via a catheter. and has lesser toxic side effects. Some of the radioisotopes that are currently used are the Iodine-131 in thyroid cancer and non-malignant thyroid disorders, iodine-125 or palladium-103 in [15] prostate cancer, and strontium-89 and samarium-153 in relieving pain due to bone metastases. Moreover, lutetium-177 and ytterbium-176 are the most appreciated radioisotopes for their widespread use in many different kinds of cancer, which are rare and difficult to treat such as [15] non-Hodgkinʼs lymphoma and liver cancer. Targeted Radionuclide Therapy (TRT) A novel method that branched out from internal radiation therapy about 75 years ago is the [16] TRT uses targeting vector such as peptide, small molecules, targeted radionuclide therapy (TRT). protein and antibodies together with radioisotopes that accumulates at designated target tumour and emit particulate radiation in the form of α particles, β particles and Auger electrons (electron that escapes an atom using the energy gained from the filling of vacancy in inner shell with outer [17,18] In this method, targeting vector contributes in detecting site of tumour through shell electron). [17] [17] physical and molecular specificity. They also transport radioisotopes to target site. On the other hand, the transported radioisotopes release ionizing radiation that causes cytotoxicity in the [17] TRT is a novel discovery that will be ever growing as long as there are new targeting tumour cells. vectors and new radioisotopes found or manufactured. The advantage of this method over external beam radiation and chemotherapy is the ability to accumulate radioisotopes in the targeted site [17] only, thus reducing toxic side effects. Besides that, in TRT there is flexibility to design different [17] combinations of radioisotopes and targeting vector. Therefore, TRT is a very successful method [17] to treat both localized and metastatic tumours. Targeted Alpha Therapy (TAT) One of the newest addition to novel treatment methods using radioisotopes is the targeted alpha [15,19] therapy (TAT). In TAT, alpha-emitting radioisotopes such as bismuth-213, lead-212 and [15] This method is beneficial in metastasised radium-223 are transported to cancer cells by carriers. cancer because alpha particles have a short range of emission only and will immediately enter [15,19] cancer cells when specific carriers like monoclonal antibody take them to target site. Radium-223 (Ra-223) is the most recently approved radioisotope by Food and Drug Administration [20] (FDA), to be used in palliative treatment of osteoblastic metastases. Radium-223 is a relatively [20] safe drug since it emits α-particles that have lower tissue penetration range than β- particles. Furthermore, shorter penetration range of α-particles compared to β-emitter reduces the [20,21] occurrence of crossfire (eradication of normal cells that is not the target of the therapy).

Usage

Principle

Examples

Diagnosis • To assess the functioning of organs such as kidney, liver and heart. • To examine blood flow to the brain • To assess any damage of bones • To diagnose stress fracture in sports medicine

Radioisotopes act as tracer, whereby when they are bound to a targeted cell, antigen, antibody, tissue or organ, their presence can be detected from outside of human body with the usage of suitable devices and medical instruments

Technitium-99m

Treatment • Radiotherapy (external beam or internal beam) • Targeted radionuclide therapy • Targeted alpha therapy

Generation of radiation energy by radioisotopes which can be used to kill abnormal growth and cancerous cells. (radiotherapy)

Cobalt-60

•

Iodine-131 in radioactive iodine (RAI) therapy Strontium-89 and Samarium-153

•

bismuth-213, lead-212, radium-223

•

• • •

Xenon-133 gas, technetium-99m labelled aerosol containing diethylenetriamine pentaacetic acid (99m TcDTPA), krypton (81m Kr) Carbon-11 Nitrogen-13 Fluorine-18 Oxygen-15

Future scopes of using radioisotopes in diagnosis

• •

•

•

Help in some bone cancer diagnosis Used in myocardial perfusion imaging Used in imaging of lungs, brain, thyroid, bone marrow. Detects infection Used to diagnose Pulmonary Embolism

Used in Positron Emission Tomography, an imaging technique to study the physiology and pathology of organs in addition to detecting cancer. Used to target tumours from outside of body using gamma rays produced through radioactive decay. (external beam radiation) Treat many of thyroid associated diseases via internal beam radiation Emission of β− particles that helps in reducing pain caused by bone metastases. (internal beam radiation/ targeted radionuclide therapy) Using alpha particle emitters transported by specific carrier to kill cancer cells.

Detection of infection using radioisotopes Technological advancement in this era has opened ways to many novel discoveries using radioisotopes in order to diagnose and treat the rising number of diseases, especially cancer. Aptamers are synthetic, single-stranded oligonucleotides containing DNA or RNA that can bind [22,23] They are non-toxic and non-immunogenic. complementarily to many different molecules. Aptamers can be labelled with different radioisotopes and used to differentiate between bacterial and fungal infection as well as inflammation because they can bind specifically to microorganism. [22] For example, Antibac1 and Antibac2 are used as new radiopharmaceuticals to diagnose bacterial infection. A recent research by Ferreira et al. used 99mTc-Antibac1 to test on mice infected by bacterial and fungal infection. Results showed that 99mTc-Antibac1 is more effective [22] in identifying bacterial infection compared to fungal infection. It also showed that some discrete uptake of aptamer in infection foci was due to inflammation. Currently, all radiolabelled [23] Aptamers can be a good alternative to aptamers are still undergoing preclinical testing. antibodies because radiolabelled antibodies will stay in body for longer time and may leads to [22,23] In addition, radiolabelled leukocytes, the gold standard method used bone marrow toxicity. now are unable to identify specific microorganism and distinguish inflammation from infection. [22] Hence, researchers are encouraged to evaluate the feasibility of Antibac1 as an imaging tool for bacterial infection diagnosis in the future.

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Table 2.1. Summary of the principle behind the use of radioisotopes in diagnosis and treatment [6,7,9,11,14,15,27,28] and some example of radioisotopes with their respective role in healthcare.

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Future scopes of using radioisotopes in treatment Peptide receptor radionuclide therapy (PRRT) and nanobodies in TAT In recent years, targeted radionuclide therapy (TRT) has caught the eyes of clinical researchers to explore its potential in improving treatment outcomes in cancer patients. Some recent advancements in TRT include peptide receptor radionuclide therapy (PRRT) and incorporation of [24,25,26] nanobodies as vehicle in TAT. PRRT is a targeted treatment that utilizes peptides radiolabelled with either Yttrium-90 or Lutetium-177 to locate and kill cancer cells with [24] It is becoming a trend in treating neuroendocrine disease as it targets somatostatin receptors. the cancerous cells at molecular level, which minimizes the toxicity to normal cells. As the current PRRT mainly employs beta-emitters, the future prospect of PRRT will most probably focus on the use of alpha-particle emitting radioisotopes in treating patients that develop resistance towards [26] [25] beta-emitter based PRRT. Besides, the combination of PRRT and conventional therapy in [24] On the other hand, recent treating neuroendocrine disease are currently under investigation. development of TAT is moving towards incorporating nanobodies instead of monoclonal antibodies (mAbs) as site-directed carriers in TAT due to its smaller size as well as higher affinity and specificity in antigen binding as compared to mAbs. The presence of Fc-region in mAb also causes unwanted interactions with normal cells that have Fc-receptors and its high molecular weight results in slower elimination rate, thus causing prolonged exposure to radioactive radiation.

Conclusion In conclusion, radioisotopes have a developing usage in medical field over the past hundred years. It can combine its usage with imaging devices in diagnosis to give information regarding the anatomy, physiology and pathology of inner organ as described under Technetium 99m pyrophosphate (Tc 99m PYP) cardiac imaging, PET and V/Q scan. Discoveries of newer carriers such as aptamers have opened ways to even diagnose the location and nature of infections which were traditionally diagnosed through blood test. Some radioisotopes are used to treat cancer as they have high penetration power that can kill cancer cells. Due to the presence of radioisotopes and carriers, these days radiation can be delivered specifically to cancerous cell without affecting normal cells such as via TRT, TAT and PRRT. This shows that usage of radioisotopes to create novel diagnostic and therapeutic methods in healthcare will be ever growing and developing, provided there are invention of newer carrier systems, imaging techniques and most importantly the discovery or manufacturing of new radioisotopes. A vigilant action many countries should take is to self-produce radioisotopes for diagnostic and therapeutic use so that the researches to create advancement in these aspects of healthcare will not be hindered by the market demand locally in [29] each country.

Academic Writing pg. 35 Reference 1. Maloth K, Velpula N, Ugrappa S, Kodangal S. Radioisotopes: An overview. International Journal of Case Reports and Images. 2014;5(9):604. 2. Yeong C, Cheng M, Ng K. Therapeutic radionuclides in nuclear medicine: current and future prospects. Journal of Zhejiang University SCIENCE B. 2014;15(10):845-863. 3. Seaborg G, Ramey J, Tape G, Johnson W. Understanding the atom series: Radioisotopes in Medicine. Oak Ridge, Tenn.: U.S. Atomic Energy Commission, Division of Technical Information; 1967. 4. Medical Use of Radioisotopes [Internet]. 2014 [cited 24 August 2017]. Available from: http://www.ans.org/store/item-750089/ 5. Maloth K, Velpula N, Ugrappa S, Kodangal S. Radioisotopes: An overview. International Journal of Case Reports and Images. 2014;5(9):604. 6. Castano A, Haq M, Morgenstern R, Pozniakoff T, Dispenzieri A, Grogan M, Johnson G, Bokhari S . Multicenter Study of Planar Technetium 99m Pyrophosphate Cardiac Imaging Predicting Survival for Patients With ATTR Cardiac Amyloidosis. JAMA Cardiol. 2016;1(8):880–889. DOI :10.1001/jamacardio.2016.283 7. Vranian M, Sperry B, Hanna M, Hachamovitch R, Ikram A, Brunken R et al. Technetium pyrophosphate uptake in transthyretin cardiac amyloidosis: Associations with echocardiographic disease severity and outcomes. Journal of Nuclear Cardiology. 2017 8. Castaùo A, Maurer M, Bokhari S. Technetium 99m pyrophosphate radioisotope for diagnosis and prognosis of transthyretin cardiac amyloidosis: A call for collaboration. Journal of Nuclear Cardiology. 2017

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9. Rao D. Positron emission tomography (PET) 20. J.Koo P. Radium-223:The Only Approved scanning. MagillĘźs Medical Guide (Online Edition). Targeted Alpha Therapy (TAT) in mCRPCOutcomes, Opportunities and Lessons Learned. 10. How Does a PET Scan Work? [Internet]. Everyday Urology-Oncology Insights [Internet]. Hopkinsmedicine.org. [cited 10 September 2017]. 2017 [cited 8 September 2017];2(1). Available from: f r o m : http://www.hopkinsmedicine.org/healthlibrary/test_ https://www.urotoday.com/journal/everyday-urol procedures/neurological/positron_emission_tomog ogy-oncology-insights/articles/96380-radium-223 raphy_pet_scan_92,P07654 -outcomes-opportunities-and-lessons-learned-ev 11. Mujoomdar M, Russell E, Dionne F, et al. eryday-urology-full-text-article.html Optimizing Health System Use of Medical Isotopes 21. DeNardo G. Concepts in and Other Imaging Modalities [Internet]. Ottawa radioimmunotherapy and immunotherapy: (ON): Canadian Agency for Drugs and Technologies Radioimmunotherapy from a Lym-1 perspective. in Health; 2012. APPENDIX 2.3, Detection of Acute Seminars in Oncology. 2005;32:27-35. PulmonaryEmbolism. Available from: 22. Ferreira IM, de Sousa Lacerda CM, dos https://www.ncbi.nlm.nih.gov/books/NBK174852/ Santos SR, de Barros AL, Fernandes SO, Cardoso 12. Pelletier-Galarneau M, Zannier E, Zuckier L, Le VN, de Andrade AS. Detection of bacterial Gal G. Referral Patterns and Diagnostic Yield of Lung infection by a technetium-99m-labeled Scintigraphy in the Diagnosis of Acute Pulmonary peptidoglycan aptamer. Biomedicine & Embolism. Thrombosis. 2017;2017:1-6. Pharmacotherapy. 2017 July 5;93:931-8 13. Lung VQ Scan - NHLBI, NIH [Internet]. 23. Gijs M, Aerts A, Impens N, Baatout S, Luxen Nhlbi.nih.gov. 2016 [cited 10 September 2017]. A. Aptamers as radiopharmaceuticals for nuclear from: imaging and therapy. Nuclear medicine and https://www.nhlbi.nih.gov/health/health-topics/topi biology. 2016 Apr 30;43(4):253-71. pg. 24. Zukotynski K, Fahey F, Jadvar H, Capala J. 36 14. Baskar R, Lee KA, Yeo R, Yeoh K-W. Cancer Targeted Radionuclide Therapy: Practical and Radiation Therapy: Current Advances and Applications and Future Prospects. Biomarkers in Future Directions. International Journal of Medical Cancer [Internet]. 2016 [cited 3 September Sciences. 2012;9(3):193-199. 2017];:35. 15. Radioisotopes in Medicine | Nuclear https://www.ncbi.nlm.nih.gov.ezp.imu.edu.my/pm Medicine - World Nuclear Association [Internet]. c/articles/PMC4874742/?report=classic World-nuclear.org. [cited 8 September 2017]. 25. Jadvar H. Targeted Radionuclide Therapy: from: An Evolution Toward Precision Cancer Treatment. http://www.world-nuclear.org/information-library/n American Journal of Roentgenology. on-power-nuclear-applications/radioisotopes-resea 2017;209(2):277-288. rch/radioisotopes-in-medicine.aspx 26. Dekempeneer Y, Keyaerts M, Krasniqi A, 16. Jadvar H. Targeted Radionuclide Therapy: An Puttemans J, Muyldermans S, Lahoutte T et al. Evolution Toward Precision Cancer Treatment. Targeted alpha therapy using short-lived American Journal of Roentgenology. alpha-particles and the promise of nanobodies as targeting 17. Gill M, Falzone N, Du Y, Vallis K. Targeted 27. Radioisotopes - ANSTO [Internet]. [cited 3 radionuclide therapy in combined-modality September 2017]. Available from: regimens. The Lancet Oncology. http://www.ansto.gov.au/NuclearFacts/AboutNucl earScience/Radioisotopes/index.htm vehicle. Expert Opinion on Biological Therapy. 28. Nilsson S. Radionuclide Therapies in Prostate Cancer: Integrating Radium-223 in the 18. Cazaux J. The Role of the Auger Mechanism Treatment of Patients With Metastatic in the Radiation Damage of Insulators. Microscopy Castration-Resistant Prostate Cancer. Current Microanalysis Microstructures. 1995;6(3):345-362. Oncology Reports. 2016;18(2). 19. Dekempeneer Y, Keyaerts M, Krasniqi A, 29. Ahmad Fadzil M, Abdul Hamid S, Mohd Puttemans J, Muyldermans S, Lahoutte T et al. Janib S, Kasbollah A, Fahlawi Wafa S. A Survey on Targeted alpha therapy using short-lived the Usage and Demand of Medical Radioisotope alpha-particles and the promise of nanobodies as and Radiopharmaceuticals in Malaysia. Jurnal targeting vehicle. Expert Opinion on Biological Sains Nuklear Malaysia (Online) [Internet]. 2016 Therapy [Internet]. 2016 [cited 8 September [cited 23 August 2017];28(2):37-53. Available from: 2017];16(8):1035-1047. Available from: https://jsnm.nuclearmalaysia.gov.my/index.php/js https://www.ncbi.nlm.nih.gov/pmc/articles/PMC494 nm/article/view/41/47

Public Health Campaign

Asian Institute of Medical, Science and Technology

pg. 38

AIMST Diabetes Awareness Campaign

T

“Diabetes – Life is sweeter with less sugar”

he public health campaign was successfully held by Pharmaceutical Society of Aimst (PHARMSA) on 24th March 2018 at Amanjaya Mall, Sungai Petani to educate the public and increase the awareness of making diabetes a healthcare priority by conveying vital messages to the general public through presentations and distribution of materials that raise awareness, in a way that is easily understandable and actionable. It also aimed to provide an opportunity for pharmacy students to engage in primary health care through participation in health exhibition and presentations and to enhance organizing skills and managing skills among the students. Around 10.30am, public were welcomed to carry out free health tests which included Blood Pressure, BMI, Bone Mineral Density, Glucose Test, Electronic Scale Measurement (e.g. skeletal mass, muscle mass) and Normal Eye Test. There was a counselling booth conducted by four Year 4 Pharmacy students to counsel and give advice based on the test result for public. Then, the exhibition department gave demonstration about the use of insulin pen and glucometer to public.

Opening Ceremony with the sponsors and invited guests.

They gave the first survey form to public before they visited the poster area. The posters were related to the diabetes topic for example facts and myth of diabetes, way to prevent diabetes. There was also showing of amount of sugar contained in different food that public consumed in their daily life. After the public visited the poster area, the second survey form was given to public. The objective of giving 2 survey forms to public is to test their knowledge before and after the public health event.

Public also visited the booths from MPOB, Organ Donation as well as Jabatan Farmasi to increase their knowledge. There were 2 talks which were entitled “Food Applications of Palm Oil” and “Nutritional Attributes of Palm Oil” were given to public to improve the knowledge by MPOB. Opening Ceremony started at 11.30am as mentioned in the event tentative followed by performance. Flashmob was carried out at the second floor of the mall at 2.30pm to attract the public to our event. All the health screening and exhibition were carried out until 5.00pm ending with the closing performance.

Committee members of the event.

AMU Mental Health Awareness Campaign

A

“Not all wounds are visible”

MU Pharmacy Society (AMUPS) had organized the “Mental Disease Awareness Campaign” on 16th March 2018 from 9.00am to 3.00pm at Townpark, MyTown Shopping Centre. One of the aims of this health awareness campaign was to spread the awareness on mental disease to the public as much as possible.

Booth activities

Booth 1: Anxiety and depression Booth 2: Stress Booth 3: Sleeping disorder Booth 4: Eating disorder Various activities such as interactive games, quizzes and poster exhibition were carried out to provide detailed information of the above topics and at the same time to educate the public about the various common mental illness encountered by the people in our country. Besides, gifts were given to the participants who had answered the questions correctly in order to encourage them to read and understand the information provided.

Free health screening

Counselling and free health screening tests were provided to the participants including the blood glucose test, body mass index and measurement of blood pressure and body fat percentage. This session was conducted by the final year students.

“Kenali Ubat Anda” booth

Kampung Pandan Health Clinic had sent two pharmacists to conduct the “Know Your Medicine” booth. Buntings and mascots were requested from the Pharmacy Division of Ministry of Health to be used throughout the campaign. During the campaign, the representatives from MOH will ask the participants about the medicines that they are taking and explain to them the purpose and the correct usage of the medicines so as to ensure that they take their medications rationally.

Health talk by Befrienders

The title of the talk was suicide prevention. The speaker was an experienced counsellor from the Befrienders, Kuala Lumpur. The topics included were suicide warning signs, suicide facts, suicide causes as well as the proper ways to help a suicidal person.

Antibiotic resistance booth

A game known as “Antibiotics vs Superbugs” was designed to teach the participants about the concept of antibiotic resistance. Besides, quiz based on the information presented on the posters was also given to the participants in order to assess their knowledge about antibiotic resistance.

Public Health Campaign

Asia Metropolitan University

pg. 39

Public Health Campaign

Cyberjaya University College of Medical Sciences

pg. 40

CUCMS Womenʼs Health Awareness Campaign “Ayuh lakukan perubahan mulai sekarang”

K

arnival Mesra Ubat (KAMU) which is an annual event by CUCMS was held in Kg. Batu 13, Jalan Cheras, Kajang from 3-4 March 2018. The activities carried out during the first day of the event were home medication review (HMR) and gotong-royong. There was a total of 8 booths set up during the booth exhibitions on the second day of the event. The booths provided awareness to the public on the following topics:Medical checkup Womenʼs health Health lifestyle Children-related booth BLS (Basic Life Support) Smoking Cessation Career-related booth Kenali Ubat Anda

The officers from Klinik Kesihatan Malaysia (KKM) and ambassador of Kenali Ubat Anda came to assist during booth exhibitions. The set up of booths were done by the students. It was an interactive session as various activities were done during the booth exhibitions like games and also cooking tutorials. All booths exhibited caught the audiences (orang kampong) attention and medical checkup, womenʼs health and smoking cessation booths attracted them the most! Orang kampong responded and coped well with all the activities planned throughout the two days of event. They were very satisfied with the HMR program as it helps them to understand better regarding their diseases and on how to manage their medications

Sukaneka with the kids

HMR Visit

Committees of KaMU 2018

Monash Depression Awareness Campaign “Depression: Letʼs Talk”

W

ith the objective of improving public health knowledge through education and provision of information and create mental health awareness among public, Monash University Pharmacy Society (MuPhaS) held a mental health awareness campaign with the theme of “Depression: Letʼs Talk” on 14-15 March 2018 in Monash University and 17 March 2018 in Bukit Komanwel. This campaign was targetting students and university staffs who may have experience with mental health ailments or those who have vague knowledge in mental health issues.

Presentation of Token of Appreciation to the speaker of Suicide Prevention Talk

Post-Opening Ceremony Photograph Session

Volunteer educated the publics about general information pertinent to depression and mental health

Different booths were set up during the event: • Counselling Units (in liaison with the universityʼs psychologists) • Registration Booth • Depression Information Booth • Health Screening Booth • Quiz & Pledge Booth • Food Sales/ T- Shirt Sales Booth Two talks were carried out by external speakers. “Suicide Prevention Workshop” was delivered by Mr. Vincent Pun TP from The Befrienders Kuala Lumpur, while “Depression: Silence Kills” was delivered by Dr. Mohd Fadzli bin Mohd Isa from the Hospital Kuala Lumpur with the aim of dispelling the stigma on depressions.

The ‘mobile exhibition postersʼ

Public Health Campaign

Monash University Malaysia

pg. 41

Public Health Campaign

University of Nottingham Malaysia

pg. 42

Nottingham Bone Health Awareness Campaign

B

“Health is not a HUMERUS matter�

one Health Awareness Campaign by UNMC PharmNotts was held on the date of 19-21 and 25 March 2018 in Nottingham University Malaysia Campus. It had successfully increased the awareness on bone health and diseases among students and staffs of UNMC. A total of 136 participants had their spine check and good feedbacks were obtained from them. Chiropractors were invited to educate the students and staffs of UNMC. The chiropractors explained the knowledge regarding bones by using the spine model to ensure that the students understand clearly regarding their bone conditions. One of the most interesting activities was yoga class where the students had participated to increase their bone health. The other activites were blood pressure checking, exhibition and quiz. The students find that the exhibition materials were very informative and able to enhance their knowledge regarding this topic. In addition, a total of RM 800 was successfully raised for Osteoporosis Awareness Society Kuala Lumpur during the event.

Yoga class

Chiropractor explained bone structure to the students

Taylorʼs Diabetes Awareness Campaign “Know diabetes, No diabetes” Booth Activities: Health Screening (BMI, BP, Blood Glucose, Pharmacist Counselling) Posture Assessment Eye Check Diabetic Foot Care Kidney Care Organ Donation Body Composition Analysis How to Accurately Read Nutritional Food Labels Awareness on Sugar Contents in Food Childrenʼs Activities Charity Sales Stage Activities: Cooking Demonstration Zumba Dance

Public Health Campaign

Taylorʼs University

Organizing committees pg. 43 Blood donation by National Blood Centre

T

he public health campaign was held on 29 April 2018 (Sunday) since Sunday is a family day and the campaign was aimed to target families as the main population for this event. This event was carried out in Subang Parade. There were approximately 400 people showed up for the booth & stage activities and another 71 for the blood donation drive. Survey was only answered by approximately 250 participants. 83% were very satisfied, 15% were neutral while another 2% claimed to have been dissatisfied with the event.

Body composition analysis

Through the counselling session, participant engagement at each booth and live interviews, one major issue was identified; that the public is highly unaware of the consequences of diabetes. There were very few of them knew that long-term poor control of diabetes may lead to kidney failure, retinopathy & increased risks of many other diseases. Hence, the organising team was glad that through this initiative they managed to reach out to a handful of the targeted population and to raise awareness among them. Hopefully in return, they too, will help to spread more awareness to their friends and family.

Lincoln University College

Public Health Campaign

LUC Physical Health Awareness Campaign “Healthy Kids are Better Learner” ACTIVITIES

Morning Exercise

I pg. 44

t is important to increase awareness on physical health and wellness to community from as young as 5 years old kids since studies showed a prevalence ranging from 27 to 31% for combined overweight/obesity in school children. Additionally, physical activity level was also low among school children. Therefore, pharmacy students from Lincoln University College were having Physical Health Awareness programme with a theme, “Physical Health Awareness: Healthy Kids are Better Learner” in conjunction with Every Kid Healthy Week from 23rd – 27th April 2018. It is an educational and interactive event designed for outreach to provide basic information on physical health to community especially kindergarten students.

Exercise for children is very important as it is not only functioning as a remedy for poor health and obesity problem, but also appears to stimulate brain growth and boost their cognitive performance. It helps kids to focus.

Proper Hand-Washing Technique Demonstration

Hand-washing is the best defence against many kinds of bacteria and viruses that cause infection. Practising proper hand-washing technique can help to reduce the spread of many illnesses.

Balanced Nutrition Education

This activity aims to expose kids in their early stage of learning process about what is a healthy diet according to the food pyramids and also the importance of taking a balanced nutrition. Besides, we also incorporate the “Suku Suku Separuh” concept from MOH whereby it explains the portion of meals requirement for kids in daily basis and a healthy snacking.

Quiz

Simple quiz session done to assess the childrenʼs understanding of all the previous conducted activities throughout the day as an evaluation to the program success rate based on the objectives.

Cleaning In collaboration with UMMC Blood Bank, a blood donation campaign was organised to encourage blood donation while an exhibition about the importance and facts of blood donation was conducted to raise the awareness among public in Petaling Jaya area.

Gotong-royong involving the committees helps to promote the importance of cleanliness aspect to create a healthy environment to the kids in school. This activity is also one of the ways to improve team-building by engaging with everyone and cultivate the sense of humility.

MAHSA Heart Awareness Campaign “Fight for Every Heartbeat� A two days public health campaign by pharmacy student of MAHSA University had successfully held on 28 and 29 April 2018 at AEON Mall Shah Alam. Free healthcare screening such as measurement of blood pressure, blood glucose and blood cholesterol were provided for all participants. Counseling were given to the public based on their health check-up readings. Posters on types of heart disease, risk factor of heart disease, cardiopulmonary resuscitation were displayed on the event. Some students were in charged of explaining the posters to the public.

Opening ceremony.

CPR demonstration. Poster presentation.

Nurses from Cardiac Vascular Sentral were invited to give CPR demonstration (Cardiopulmonary resuscitation and Heimlich Maneuver demonstration) to public. Participants that completed the demonstration were given souvenir. In collaboration with Malaysia National Blood Centre, blood donation campaign was conducted concurrently at the event. 143 people donated blood during the campaign.

Mascot of the event.

Public Health Campaign

MAHSA University

pg. 45