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There is scarce information on the adoption of e-commerce among retail pharmacists in developing countries. E-pharmacy is defined as community pharmacies provide either singular or a combination of online pharmacy services e.g., virtual dispensing of controlled medicines, online medicinal product consultation, medication-health related online services, health supplements and beauty product online consultation and product delivery services. This study aimed to explore the interest among licensed retail pharmacists to adopt e-commerce as part of their business provisions and to determine key determinants of their interest in providing e-pharmacy services. A self-administered online survey was distributed to 3858 licensed community pharmacists using an email list which was provided by the Pharmacy Enforcement Division, Ministry of Health. The response rate was 9.15% (N=353). Findings showed that 78.2% of the respondents were interested in providing e-pharmacy services. The key determinants of their interest were influenced by community pharmacists' perceptions towards consumer norms in subscribing to online services, socio-technology trends, pressure from competition and readiness to comply with e-pharmacy regulatory requirements. This study urges the pharmacy authority to formulate business-friendly requirements in empowering community pharmacists to adopt e-pharmacy services and establish a conducive environment for community pharmacists to innovate pharmacy practices. E-pharmacy will benefit the public by providing access to quality medicinal products at competitive prices. [ABSTRACT FROM AUTHOR]

Drug price in Malaysia has increased substantially over the years. Malaysian policymakers may learn from the Western countries on how to control pharmaceutical spending. We conducted a review to assess the pharmaceutical strategies adopted in Western countries to curb pharmaceutical pricing and compared it with the current Malaysian system. The study found that the European countries adopted a regulated pharmaceutical market. In this regulated market, the price of the drugs will be determined using external reference pricing. The reimbursement and pricing of the drugs are also based on a set of guidelines rather than arbitrary nature. Additionally, the health technology assessment in the European countries utilised rating systems to categorise the added therapeutic benefit of the drugs. This rating system will add more information for price negotiation between the government and pharmaceutical manufacturers. Furthermore, cost-effectiveness analysis is also being incorporated into the decision-making process to ascertain the optimal use of scarce health resources. On top of that, pooled procurement system has been established in order to benefit from the higher volume purchasing. These measures may help Malaysia to ensure that the pharmaceutical spending remain sustainable and that Malaysians, will continue to have access toward a high-quality and affordable healthcare in the future. [ABSTRACT FROM AUTHOR]

The rising prevalence of mental disorders and their impact on the global disease burden is an emergent public health concern. The present study was to assess the prevalence of depression, stress and anxiety level among the Malaysian community by using Depression Anxiety and Stress Scale-21 (DASS-21) and identify their correlates by using the Belief of Depression Questionnaire (BDQ). The cross-sectional study was conducted among the Malaysian community through a convenient sampling method from October to December 2019. The DASS-21 and BDQ scales were used to explore the level of mental health and the respondents' belief in their condition. The institutional ethics committee's approval and participants' written consent had been obtained before the commencement of the study. Spearman's rank correlation coefficient was used to determine the association between the DASS scores. A total of 462 respondents were recruited into the study. The outcomes revealed that the respondents fell into mild stress levels (mean=14.5 ± 10.3), moderate levels of anxiety (mean= 12.1 ±10.0), and mild levels of depression (mean=11.9 ± 10.8). The majorly observed symptoms were tiredness (68.4%), reduced energy (46.8%), and dizziness (44.2%). Exercise (82.9%), spirituality (81.2%), and changing "how I think about myself" (79%) were the majorly reported factors considered helpful by the respondents to control or cure their condition. The study reported a higher prevalence of depression, stress, and anxiety among the younger age group, females, Indians, divorced/ unmarried, and lower monthly income respondents. Considering the results, it is essential to develop evidence-based and suitable community-based primary and secondary mental health prevention programmes. [ABSTRACT FROM AUTHOR]

High drug price is a hot topic in Malaysia. In this systematic review of drug price comparison studies, we report on international comparison of drug prices with Malaysia. We systematically searched PubMed, Cochrane Library, ScienceDirect and Scopus for peer-reviewed articles. Only studies that made comparison internationally were included. Cost-effectiveness studies, budget impact analysis or costing studies were excluded. A total of 10 studies were included. Nine studies compared the price with median international reference prices (IRPs). Only one study compared the price with another country. The drug price in Malaysia for both government and public sectors was higher than IRP. This review provides the information that the drug price in Malaysia is higher than the international standard. The number of published studies in the drug pricing area is still inadequate with only one study that compares Malaysia drug price with another country. More studies are needed to improve Malaysia's drug pricing system. [ABSTRACT FROM AUTHOR]

We present a rare case of post-antiretroviral therapy (ART) paradoxically worsening of radiological findings in a patient with advanced HIV-infection on treatment for Rhodococcus pneumonia who was misdiagnosed with pulmonary tuberculosis. Despite clinical improvement, serial chest radiographs showed deteriorations a month after starting ART. This was attributed to Immune Reconstitution Inflammatory Syndrome (IRIS) which spontaneously resolved without any treatment.

Acute necrotising encephalopathy of childhood (ANEC) is an uncommon disease with characteristic clinical and imaging findings. We present two cases of ANEC secondary to Respiratory Syncytial Virus (RSV) and mycoplasma infections. An eight-month-old boy presented with features of gastroenteritis but soon developed multiple episodes of seizures. Blood and CSF cultures were negative but nasopharyngeal aspirate immunofluorescence was positive for RSV. A nine-year-old girl presented with abnormal behaviour following two days of prodromal symptoms. Her serological markers implicated mycoplasma (IgM titre 1: 640). CT brain of both patients showed bilateral symmetrical thalamic hypodensities, while MRI revealed more extensive white matter involvements.

Background: The transverse skeletal effects of rapid maxillary expansion (RME) have previously been assessed using cone-beam CT (CBCT). However, to date the majority of studies assess the changes based on two-dimensional slice images, which under utilises the three-dimensional (3D) data captured. This study optimizes the volumetric CBCT data by generating 3D rendered surface models to quantity and visualize the immediate 3D changes of the mid-facial bone surfaces following RME., Methods: The sample consisted of 14 patients who required RME prior to fixed appliances. Pre-treatment (T0) and immediate post expansion (T1) CBCT images were taken. Following superimposition the mid face was divided into six anatomical regions. A one-sample t-test was used to determine if the differences between the two surfaces were significantly ≥0.5 mm., Findings: All regions showed a change following RME ≥ 0.5 mm. The maxillary and nasal bones showed 2.3 mm and 2.4 mm expansion respectively, followed by the zygomatic bones (1.4 mm), 2 cases showing asymmetric expansion., Conclusions: The use of 3D surface rendered models allows quantification and visualisation of 3D changes in the mid-facial skeleton at anatomical sites distant of RME activation. Following activation there can be a pan mid-facial expansion, including not only the maxilla but also the nasal lateral bones and zygomas. The response was highly variable and asymmetric expansion can occur., (Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Introduction: This study aims to examine the usefulness of fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in thyroid carcinoma patients with elevated serum thyroglobulin (Tg) but negative iodine-131 (I-131) whole body scans., Methods: 17 patients with differentiated thyroid carcinoma who underwent FDG PET/CT scans were reviewed retrospectively over a period of one year from July 2003 to June 2004. All these patients had completion thyroidectomy and subsequently presented with elevated serum Tg but negative post-therapy I-131 whole body scans. Nine of these patients underwent FDG PET/CT in a hypothyroid state, while the remainder underwent FDG PET/CT while on thyroxine replacement., Results: 15 out of 17 PET/CT scans revealed lesions consistent with metastases, giving a sensitivity of 88.2 percent. Four of these patients were amendable to surgical treatment. Two scans were negative., Conclusion: FDG PET/CT is a sensitive diagnostic tool to detect radioiodine-negative recurrences/metastases in patients with thyroid carcinoma. Our preliminary results are comparable with published results based on PET.

Over a seven-year period, 170 cases of humerus fractures were plated in Hospital Melaka. Of these, 131 cases were successfully traced for this study. Besides looking at fracture epidemiology, its relationship with radial nerve injury was examined. The incidence of post-traumatic wrist drop in closed and compound fractures were 14.9% and 35.3% respectively. In relation to the site of fracture, lower third fracture had the highest incidence of wrist drop (29%). The recovery from post-traumatic wrist drop was 83%. The average duration taken for recovery was 11.8 weeks. The incidence of post-operative wrist drop was high at 17.6% but all recovered during follow-up.

Helicobacter pylori (formerly Campylobacter pylori) has been recently described as a gastritis-associated bacterium. We examined endoscopic biopsies of 100 patients with dyspepsia and found H. pylori in the gastric antrum of 34 (34%) by either culture, urease tests and/or histology. Thirty-one out of 41 patients (75.6%) confirmed to have chronic active gastritis histologically had H. pylori in their gastric antrum compared to 3 out of 59 patients (5.1%) with dyspepsia but normal histology (p less than 0.01). Histological examination, using gram stain and the Warthin-Starry Silver stain, detected 29 of the 34 positive cases (85.3%); urease test, 26 cases (76.5%) and culture, 22 cases (64.7%). A combination of histological examination and urease test increased the detection rate to 97.1%. Therefore we felt that for the detection of H. pylori in endoscopic biopsies, culture, which is time consuming and expensive, is not necessary in routine diagnosis as it did not improve the diagnostic rate over a combination of histology and urease test. A comparative study on three media (blood agar, chocolate agar and Skirrow's agar) used in the isolation of the organism showed that non-selective blood agar and chocolate agar were superior to Skirrow's agar. The strains isolated appeared to be homogeneous in their morphological and biochemical characteristics.