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Type 1 Diabetes Mellitus, also known as insulin-dependent diabetes mellitus (IDDM), is a chronic disease caused by the autoimmune destruction of the pancreatic β cells, which function as insulin-producing cells. This study was aimed to assess the level of knowledge about T1DM and adherence to medications prescribed to T1DM patients at two different tertiary hospitals in Malaysia. This study was a hospital-based cross-sectional study conducted using self-administered questionnaire. The respondents were among caregivers of paediatrics patients with T1DM attending Paediatrics Clinics from both study sites . The study period was between January 2018 until December 2018 while the data collection period was conducted between May to August 2018. The mean age (SD) of the respondents were 41.07 (7.699). Studied samples were found to have good knowledge (mean=65.98, SD=12.62) and poor adherence (mean=60.08, SD=24.72). The correlation between knowledge score and adherence score among caregivers of T1DM patients showed that they were significantly correlated. As for the association between adherence to medication and HbA1c level showed that they were insignificantly associated.

The COVID-19 pandemic has tremendously increased the production and sales of disinfectants. This study aimed to systematically review and analyze the efficacy and safety of chlorine dioxide as a disinfectant. The literature relating to the use of chlorine dioxide as a disinfectant was systematically reviewed in January 2021 using databases such as PubMed, Science Direct, and Google Scholar. Inclusion criteria were studies that investigated the use of chlorine dioxide to assess the efficacy, safety, and impact of chlorine dioxide as a disinfectant. Out of the 33 included studies, 14 studies focused on the disinfectant efficacy of chlorine dioxide, 8 studies expounded on the safety and toxicity in humans and animals, and 15 studies discussed the impact, such as water treatment disinfection using chlorine dioxide. Chlorine dioxide is a safe and effective disinfectant, even at concentrations as low as 20 to 30 mg/L. Moreover, the efficacy of chlorine dioxide is mostly independent of pH. Chlorine dioxide can be effectively used to disinfect drinking water without much alteration of palatability and can also be used to destroy pathogenic microbes, including viruses, bacteria, and fungi from vegetables and fruits. Our review confirms that chlorine dioxide is effective against the resistant Mycobacterium, H1N1, and other influenza viruses. Studies generally support the use of chlorine dioxide as a disinfectant. The concentration deemed safe for usage still needs to be determined on a case-by-case basis.

The spreading of infectious diseases caused by the emergence of Multidrug-Resistant (MDR) pathogens is a global threat that has led to numerous deaths annually. In view of this, there is an overwhelming need to discover new bioactive compounds with effective antimicrobial properties. Concurrently, the genus Streptomyces has a growing reputation as a potential biological source of various antibiotics and other bioactive metabolites. Streptomyces sp. has been isolated from different sources, including terrestrial and marine habitats with a myriad of promising compounds that could be used to treat MDR pathogens. Therefore, this study presents a systematic review of the antibacterial activities of Streptomyces-derived secondary metabolites. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist were employed in this studyto collect relevant articles from two research databases, namely PubMed and Science Direct. The selection process includes identification, screening, eligibility, and inclusion of articles. Several keywords and criteria were established for the screening and selection process. Based on the results, a total of 26 articles were selected from 70 potential articles. The articles were published between 2015 and 2020 with most studies being published in 2020, indicating an increased interest in Streptomyces and its derived compounds. Approximately 51 different PMMB 2022, 5, 1; a0000281 2 of 25 Streptomyces-derived compounds have been identified, ranging from crude extracts, pure compounds, and partially purified compounds. Various parameters were also used to assess their antibacterial activities, particularly the Minimum Inhibitory Concentration (MIC) (69%) and the zone of inhibition (11%). Moreover, the antibacterial activities of these compounds were effective on numerous gram-positive and gram-negative bacteria. Furthermore, 46% and 54% of the selected studies were focused on inhibiting MDR and nonMDR pathogens, respectively. In conclusion, both crude and purified compounds from Streptomyces sp. exhibited strong antibacterial effects. It is expected that extensive future research would develop a standard method to compare the antibacterial strength of eachextracted compound from Streptomyces sp. and determine the most effective bioactive compounds to treat diseases caused by MDR pathogens.

Medication wasting has been adding to the cost burden on the healthcare system. Sustainable interventions such as using patients’ own medications have been implemented to upgrade the medicine management system. This review aimed to describe the studies related to patients’ own medication in hospital settings to explore its positive impacts. Current literature has studied the impact of using patients’ own medicines from cost-effectiveness, clinical, and patient safety perspectives. The economic impact was represented by determining the cost saved after implementing the patient’s own medications intervention. On the other hand, the efficacy of patient care was proven by reducing the frequency of medication error and prevalence of drug-drug interactions as the intervention was implemented. Patients’ knowledge of their medications was also proven to be improved with their own medicines during hospitalization, improving their adherence to their medication treatment. Improving patients' adherence to and knowledge of their prescriptions during hospitalization may also aid in the reduction of hospital readmissions, which could result in a net economic return.

Aims The Global Outbreak Alert and Response Network recently warned that the Zika virus-containing mosquitoes are being found in Pakistan and the health sector is on high alert. It is thus significant to understand public beliefs and perceptions of the Zika virus and vaccination in the current scenario of Pakistan. Methods Twenty semistructured qualitative interviews were conducted and analyzed through an inductive approach to analysis. Results The findings were presented in three main categories which were coded: Reality vs. Conspiracy, Vaccination Concerns, and Public Worries. The majority believed that the Zika virus is a real problem and that authorities might be trying to hide the Zika cases in Pakistan. Moreover, they believed that health organizations are being incompetent by failing to take timely remedial measures to manage the Zika. However, 20% have an opposing view and believed that the Zika virus is a conspiracy against Pakistan from the West. Conclusion Overall, most participants were concerned about the lack of treatment and preventive methods and emphasized the need to create awareness among the public. It is observed that the participants’ perceptions ranged from perceiving the Zika virus as real to as a conspiracy.

Objective: To compare the performance of Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) equations in estimating kidney function in CKD patients with diabetes and hypertension. Methods: This study retrospectively reviewed medical records in Hospital Kajang. The GFR was calculated using Cockcroft-Gault and MDRD equations. Kappa Measure of Agreement was used to check the consistency of CKD staging. Wilcoxon signed-ranked tests and Bland-Altman plots were used to determine the difference of both equations. Spearman correlation was used to determine the correlation between blood pressure and blood sugar levels with eGFR. Results: Data pertaining to a total of 81 patients were extracted. Results showed 22% of the patients were staged differently (Kappa value = 0.644 [P

Purpose: This study was aimed to systematically identify and review studies conducted using simulated client/patients that examine medicine selling prices in healthcare settings, including pharmacies, clinics, and hospitals. The quoted drug pricing information, including the dispensing fees and healthcare financing system of the countries involved, were also compared.Design/methodology/approach: We searched Pubmed, OVID, Scopus, Ebsco (Medline) and ProQuest for papers reporting on simulated patient studies in various medical settings, specifying drug or pharmaceutical pricings. Randomized controlled trials, non-randomized controlled trials, longitudinal studies, cohort or case–control studies, and descriptive studies were included. The quality of included studies was checked using a validated tool.Findings: A total of 19 papers from 13 countries from all regions of the world were included in this systematic review. Various ,edical conditions that were presented by the simulated patients, such as cancer, back pain, insomnia and diarrhoea. Information on certain prescription and non-prescription drugs such as buprenorphine, methadone and antibiotics were reported in four studies. Most healthcare facilities adhere to prescribed selling prices, according to the medicine selling price trend examined in this study. Only around half of the research found that medicine prices were higher than the typical selling price. Some countries that practise price control policies were found to have higher drug selling prices than those that do not.Originality/value: This review, for the first time, revealed that simulated patient method is a practical solution to obtain pharmaceutical price information from healthcare provider and most healthcare facilities adhere to the recommended selling prices.

Pharmaceutical products, apart from being essential for medical treatment, are of high value and heavily regulated to ensure the prices are controlled. This systematic review was conducted to identify pharmaceutical pricing mark-up control measures, specifically in the wholesale and retail sectors. The search method comprised the following databases: PubMed, Science Direct, Springer Link, ProQuest, and EBSCOhost and Google Scholar. The results were filtered systematically from the inception of the aforementioned databases until 23 April 2021. Eligible studies were those focusing on the implementation of pharmaceutical pricing strategies that involve a) mark-ups of medicine, and b) pharmaceutical cost control measures. A total of 13 studies were included in this review: seven covered European countries, four covered Asian countries, one covered the USA and one covered Canada. The main points of discussion in the qualitative synthesis were the implementation of medicine mark-ups, price mark-up regulatory strategies and the outcomes of these regulatory strategies. Our findings suggest that Western countries have a lower mark-up margin, around 4% to 25% of the original purchased price, compared to Asian countries, up to 50%.

Purpose The objective of this research was to examine the cold chain temperature maintenance for the supply of vaccines and other biological products by pharmaceutical wholesaler. Materials and methods In this study, six configurations using cold vaccine boxes or bags made with different materials, with and without insulation, of different sizes, and number of coolant-packs were used to simulate the configuration used by the pharmaceutical wholesalers for transportation of vaccine. Model vaccines (vial, n=10) were packed using these six configurations which then stored in an incubator at 38℃ and monitored for 24 hours. Each configuration was tested repeatedly for 5 times. Results In term of compliance to 2℃-8℃, four out of six tested configurations are effective in cold chain transportation. The effectiveness is highly dependent on the type of passive containers used, size of cold boxes, insulation, and number of coolant-packs. The configuration with a larger polystyrene foam box with five coolant-packs maintained the required temperature up to 23 hours. In contrast, configurations using a polystyrene foam box with four coolant-packs and a large vaccine cold box with two coolant-packs failed to reach below 8℃ throughout the 24 hours. Conclusion Packaging method, the material and size of the container could have a direct impact on the effectiveness of cold chain temperature maintenance. Polystyrene foam box, cold box with polyethylene interior lining and polypropylene insulation, a cooler bag with proper number of ice packs could be effectively used for transportation of vaccines within their respective transportation duration allowance.

Increasing prescription drug pricing often reflects additional work stress on medical professionals because they function as financial advisors for patients and help them manage out-of-pocket expenses. Providers or prescribers wish to help patients with prescription costs but often lack related information. Healthcare plan providers try to display prescription and drug cost information on their websites, but such data may not be linked to electronic prescription software. A mark-up is defined as the additional charges and costs that are applied to the price of a product for the purpose of covering overhead costs, distribution charges, and profit. Therefore, the policies implemented in the pharmaceutical distribution chain might include the regulation of wholesale and retails mark-ups and pharmaceutical remuneration. If mark-ups are regulated, countries are highly recommended to use regressive mark-ups rather than fixed percentage mark-ups. This narrative review provides insights into the framework of pharmaceutical mark-up systems by describing different factors impacting pharmaceutical prices and affordability. These include the interplay of medicine pricing and the supply chain, the impact of pertinent laws and regulation and out-of-pocket expenditure.

Eurycoma longifolia (commonly called tongkat ali ) is a flowering plant in the family Simaroubaceae , native to Indonesia, Malaysia, and, to a lesser extent, Thailand, Vietnam and also Laos. The roots extract of E. longifolia , is a well-known traditional herbal medicine in Asia used for many purposes such as sexual dysfunction, aging, malaria, cancer, diabetes, anxiety, aches, constipation, exercise recovery, fever, increased energy, increased strength, leukemia, osteoporosis, stress, syphilis and glandular swelling. The roots are also used as an aphrodisiac, antibiotic, appetite stimulant and health supplement. It is very important to conserve this valuable medicinal plant for the health benefit of future generations. The purpose of this review article is to evaluate and summarize the existing literatures regarding the efficacy and safety of products which contain E. longifolia as its main ingredient. In summary, based on the literature evaluated in this review article, products which contain tongkat ali showed a clinical benefit on improving erectile dysfunction as well as a good safety profile. We recommend consumers to check the level of the bioactive compound “eurycomanone” as their guide before choosing any E. longifolia product.

Background: A great deal of research has been carried out on the assessment of the eudaimonic perspective of psychological well-being and the hedonic perspective of subjective well-being. The Flourishing Scale (FS) has been extensively used in research and practice, as it assesses the fundamental aspects of social psychological functioning. Nevertheless, the psychometric properties of Urdu versions of eudaimonic measures, such as the FS, have not yet been ascertained. The translation and validation of the FS in the Urdu language was not available, and hence this study was planned with the aim to validate the Urdu version of the FS.Methods: We assessed the psychometric properties of the FS in a sample of adults aged 18 years and above in Pakistan (N = 130) using exploratory factor analysis based on principal component analysis with varimax rotation and confirmatory factor analysis.Results: The exploratory factor analysis confirmed the unidimensional nature of the 8-item FS. We assessed that the Urdu version of the FS showed a high internal consistency reliability (α = 0.914) with a significant intraclass correlation coefficient (ICC), p < 0.001). In our study, the Kaiser–Mayer–Olkin value was 0.915 with a chi-square test value (χ2) of 637.687, and Bartlett's test of sphericity was significant (df = 28, p < 0.001). The intraclass correlation coefficients (ICCs) at test–retest for all domains were statistically significant (p < 0.001) and showed excellent agreement for all the items. The revised confirmatory factor analysis revealed a good-fit model, but with item 8—“People respect me”—removed due to its lower factor loading.Conclusions: The findings suggest that the FS is a psychometrically sound instrument for assessing social psychological functioning among adults in Pakistan. Therefore, the validated Urdu version of the FS may be used in future studies of well-being in clinical psychology and positive psychology.

Hypertension is one of the major causes of morbidity and mortality. Worldwide, Hypertension is estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths. This accounts for 57 million disability adjusted life years (DALYS) or 3.7% of total DALYS. This led WHO to set a target of 25% reduction in prevalence by 2025. To reach that, WHO has adopted non-conventional methods for the management of hypertension? Despite worldwide popularity of such non-conventional therapies, only small volume of evidence exists that supports its effectiveness. This review attempted to make a critical appraisal of the evidence, with the aim to (1) describe the therapeutic modalities frequently used, and (2) review the current level of evidence attributable to each modality. Databases from Cochrane Library, MEDLINE, PUBMED, and EMBASE were searched from 2005-2015. A total of 23 publications have been identified and selected. Out of these, 15 systematic reviews and/or meta-analysis of RCTs, 5 RCTs, 1 non-RCT, and 2 observational studies without control. Among those 23 publications, therapeutic modalities identified are: fish oil, qigong, yoga, coenzyme Q10, melatonin, meditation, vitamin D, vitamin C, monounsaturated fatty acids, dietary amino-acids, chiropractic, osteopathy, folate, inorganic nitrate, beetroot juice, beetroot bread, magnesium, and L-arginine. The followings were found to have weak or no evidence: fish oil, yoga, vitamin D, monounsaturated fatty acid, dietary amino-acids, and osteopathy. Those found to have significant reduction in blood pressure are: magnesium, qigong, melatonin, meditation, vitamin C, chiropractic, folate, inorganic nitrate, beetroot juice and L-arginine. Coenzyme Q10on the other hand, showed contradicting results were some studies found weak or no effect on blood pressure while others showed significant blood pressure reduction effect. By virtue of the research designs and methodologies, the evidence contributed from these studies is at level 1. Results from this review suggest that certain non-conventional therapies may be effective in treating hypertension and improving cardiac function and therefore considered as part of an evidence-based approach.

Yaser Mohammed Al-Worafi,1,2 Yaman Walid Kassab,3 Wafa Mohammed Alseragi,4 Masaad Saeed Almutairi,5 Ali Ahmed,6 Long Chiau Ming,7 Ali Saleh Alkhoshaiban,8,9 Muhammad Abdul Hadi10 1Faculty of Pharmacy, University of Science and Technology, Sana’a, Yemen; 2Clinical Pharmacy Department, College of Pharmacy, Ajman University, Ajman, United Arab Emirates; 3Hospital and Clinical Pharmacy Department, Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Selangor, Malaysia; 4Faculty of Arts, Ibb University, Ibb, Yemen; 5College of Pharmacy, Qassim University, Qassim, Saudi Arabia; 6Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia; 7School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri Sembilan, Malaysia; 8College of Medicine, Qassim University, Qassim, Saudi Arabia; 9Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia; 10Leicester School of Pharmacy, De Montfort University, Leicester, UK Objective: The aim of this study was to compare the knowledge, attitude and barriers of pharmacy technicians and pharmacists toward pharmacovigilance, adverse drug reactions (ADRs) and ADR reporting in community pharmacies in Yemen.Methods: This cross-sectional survey was conducted among community pharmacists and pharmacy technicians in the capital of Yemen, Sana’a. A total of 289 community pharmacies were randomly selected. The validated and pilot-tested questionnaire consisted of six sections: demographic data, knowledge about pharmacovigilance, experience with ADR reporting, attitudes toward ADR reporting, and the facilitators to improve ADR reporting.Results: A total of 428 pharmacy technicians and pharmacists were contacted and 179 went on to complete a questionnaire (response rate: 41.8%). Of the 179 respondents, 21 (11.7%) were pharmacists and 158 (88.3%) were pharmacy technicians, of which, 176 (98.3%) were male and 3 (1.7%) were female. The mean age of the respondents was 25.87±2.63 years. There was a significant difference between the pharmacists and pharmacy technicians in terms of knowledge scores (P

Summary What is known and Objectives Pharmacists have the knowledge regarding optimal use of medications and the ability to influence physician prescribing. Successful interventions by a pharmacist to implement cardioprotective medications to a coronary artery disease patient's regimen would not only improve the patient's quality of care but may also increase his or her likelihood of survival. Therefore, the aim of this study was to (i) evaluate the effectiveness of pharmacist initiated interventions in increasing the prescription rates of acute coronary syndrome (ACS) secondary prevention pharmacotherapy at discharge, and to (ii) evaluate the acceptance rate of these interventions by prescribers. Methods This was a comparative study with a pre-intervention and post-intervention design. In the pre-intervention phase, a retrospective cross-sectional audit was performed. Patients with a diagnosis of acute coronary syndrome admitted to the hospital in the period from 2008 to January 2010 were identified from medical records and served as a historical control. The second phase (intervention phase) was conducted from the beginning of March to the end of September 2010. Two random samples of 190 patients with ACS were included. During the intervention phase, two hospital pharmacists made rounds with the cardiology team and gave secondary prevention recommendations when needed. The major reference for the recommendations was the Malaysian guidelines. Results and Discussion A total of 72 interventions were made by pharmacists of which drug initiation was most common (59.7%) followed by recommendations to change to another medication (23.6%) and optimization of medication dosing (16.6%). Most recommendations (72.2%) were accepted by prescribers. Majority of accepted recommendations were with β-blockers (38.46%) followed by those with angiotensin-converting-enzyme inhibitors (ACEI) (28.8%). The intervention had a significant impact on the utilization rates of β-blockers (increased from 75.8% to 84.7%, P = 0.028), angiotensin-converting-enzyme inhibitors/angiotensin II receptor bockers (from 65.3% to 74.7%, P = 0.044) and statins (from 91.6% to 98.4%, P = 0.002). The intervention had also led to a significant increase in the utilization rates of all these four classes together (from 42.6% to 62.6%, P = 0.001). What is new and Conclusion The study showed that the presence of a pharmacist on cardiology units increased the use of beta-blockers, aspirin, and statins for the secondary prophylaxis of ACS

Background Secondary prevention pharmacotherapy improves outcomes after acute coronary syndrome (ACS). However, poor medication adherence is common, and various factors play a role in adherence. Objectives The purpose of this study was to evaluate patients’ level of adherence to evidence-based therapies at an average of 6 months after discharge for ACS and to identify factors associated with self-reported non-adherence. Setting This prospective study was conducted in the outpatient cardiac clinics of Hospital Pulau Pinang, located in Penang Island, a northern state in Malaysia. Method A random sample of ACS patients (n = 190) who had been discharged on a regimen of secondary preventive medications were included in this study. Six months after discharge and during their scheduled follow-up appointments to cardiac clinics, patients were interviewed using the translated eight-item Morisky Medication Adherence Scale. Main outcome measure self-reported patients’ adherence to medication. Results Six months following their hospital discharge, only 35 patients (18.4 %) reported high adherence. Medium adherence was reported in majority of patients (51.1 %). Low adherence was reported in 58 patients (30.5 %). Forgetfulness was the most frequently reported reason for patients’ non-adherence to their medications (23.2 %). Furthermore, this study identified 5 factors—namely age, employment status, ACS subtypes, number of comorbidities, and number of prescription medications per day—that may influence Patients’ level of adherence to the prescribed regimens. Conclusions Our findings revealed a problem of non-adherence to secondary prevention medications among patients with ACS in Malaysia. Furthermore, this study demonstrates that older patients, unemployed patients, patients with more comorbid conditions, and those receiving multiple medications are less likely to adhere to their prescribed medications 6 months after hospital discharge.

Rationale Despite the availability of various prevention guidelines on acute coronary syndrome (ACS), secondary prevention practice utilizing aspirin, beta-blockers, angiotensin converting enzyme inhibitors and statins still can be sub-optimal. Aims and objectives To review and document the utilization of pharmacotherapy for the secondary prevention of ACS in patients discharged from a Malaysian hospital. Methods A retrospective cross-sectional study was conducted at a tertiary hospital in Penang, Malaysia. Patients with a primary diagnosis of ACS were identified from medical records over a 4-month period. A range of clinical data was extracted from medical records, including medical history, clinical presentation and pharmacotherapy both on admission and at discharge. This audit focused on the use of four guideline-recommended therapies: aspirin±clopidogrel, beta-blockers, statins and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blockers (ARBs). Results Data pertaining to a total of 380 ACS patients was extracted and reviewed, the mean age of the study population was 57.49 years and 73.9% of population was males. Patients with unstable angina accounted for 56.6% of the admissions whereas 23.4% and 20% of the patients were admitted for ST-elevation myocardial infarction and non-ST-segment elevation infarct respectively. 95.7% of the patients received antiplatelets comprising of at least aspirin, and 82% received aspirin plus clopidogrel. Furthermore, 80.3% of the patients received a beta-blocker at discharge, 95% a statin and 69.7% received either an ACEI or ARB. Compared with patients who presented with myocardial infarction (with or without ST-segment elevation), those presenting with unstable angina were less likely to receive the combination of aspirin plus clopidogrel or an ACEI/ARB at discharge. Patients over 65 years of age were also less likely to receive a beta-blocker at discharge, compared with younger patients. Conclusions There is a good adherence to evidence-based guidelines for the secondary prevention of ACS in this local setting. However, there is some potential underutilization in the older population and patients presenting with unstable angina.

To evaluate patients' adherence to evidence-based therapies at an average of 2 years after discharge for Acute Coronary Syndrome (ACS) and to identify factors associated with non-adherence. This study was conducted at Hospital Pulau Pinang, Malaysia. A random sample of ACS patients (n=190) who had discharged on a regimen of secondary preventive medications were included and followed up over a three follow-up appointments at 8, 16, and 23 months post discharge. At each appointment, patients were interviewed and given Morisky questioner to complete in order to compare their level of adherence to the prescribed regimens across the three consecutive time periods. Majority of patients reported either medium or low adherence across the three time periods with only small portion reported high adherence. Furthermore, there was a significant downward trend in the level of adherence to cardio protective medications during the study period (p0.001). This study also identified 6 factors-age, gender, employment status, ACS subtype, number of co morbidities and number of prescription medications per day that may influence Patients' adherence to their medications. Our findings suggest that long-term adherence to secondary prevention therapies among patients with ACS in Malaysia is sub optimal and influenced by many demographic, social as well as clinical factors.

Despite the availability of various prevention guidelines on acute coronary syndrome (ACS), secondary prevention practice utilizing aspirin, beta-blockers, angiotensin converting enzyme inhibitors and statins still can be sub-optimal.To review and document the utilization of pharmacotherapy for the secondary prevention of ACS in patients discharged from a Malaysian hospital.A retrospective cross-sectional study was conducted at a tertiary hospital in Penang, Malaysia. Patients with a primary diagnosis of ACS were identified from medical records over a 4-month period. A range of clinical data was extracted from medical records, including medical history, clinical presentation and pharmacotherapy both on admission and at discharge. This audit focused on the use of four guideline-recommended therapies: aspirin ± clopidogrel, beta-blockers, statins and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blockers (ARBs).Data pertaining to a total of 380 ACS patients was extracted and reviewed, the mean age of the study population was 57.49 years and 73.9% of population was males. Patients with unstable angina accounted for 56.6% of the admissions whereas 23.4% and 20% of the patients were admitted for ST-elevation myocardial infarction and non-ST-segment elevation infarct respectively. 95.7% of the patients received antiplatelets comprising of at least aspirin, and 82% received aspirin plus clopidogrel. Furthermore, 80.3% of the patients received a beta-blocker at discharge, 95% a statin and 69.7% received either an ACEI or ARB. Compared with patients who presented with myocardial infarction (with or without ST-segment elevation), those presenting with unstable angina were less likely to receive the combination of aspirin plus clopidogrel or an ACEI/ARB at discharge. Patients over 65 years of age were also less likely to receive a beta-blocker at discharge, compared with younger patients.There is a good adherence to evidence-based guidelines for the secondary prevention of ACS in this local setting. However, there is some potential underutilization in the older population and patients presenting with unstable angina.

Statins are common lipid lowering agents to reduce elevation of cholesterol or as prophylaxis against other cardiac diseases. It estimated that 62.5% to 91.7% of dyslipidemic patients in United State of America are using statins1 These agents widely used among cardiovascular patients in Malaysia2. In other countries, for example in UK, it has found that most patients who use statins are older than 35 years old and more of them are males (56%)3. In Canada, about 90% of cardiac patients are using statin, while in US, at least one third of all cardiac patients are using statins4. About 60% of American patients who older than 60 years old are using statin5. Thus, high number of users contributed to increase the risk of adverse drug reactions (ADRs). The Food and Drug Administration (FDA) has determined that common statin-associated ADRs are fatigue, muscle pain, joints pain, back pain, visual disturbance and insomnia6,7. Previous studies have examined the incidence of these ADRs, and their results showed that more than half of the reported cases of muscle pain were related to statin use8,9. Clearfield et al found that fatigue, muscle pain, and bone pain were common and frequent ADRs in UK, and related to atorvastatin and rosuvastatin use10. Other studies exploring ADRs in patients using atorvastatin and lovastatin in the US found that muscle pain and fatigue were the most common statin-related ADRs11. The UK Committee on Safety of Medicines, as well as other studies, have reported that these symptoms should consider as early signs for more serious ADRs8,12-15. However, from our knowledge, no data available on the common ADRs statin-related and their predictors for Asian patients. Only a few studies (not related with Asian patients) have found out the predictors of the statin-related ADRs8,9,10,16,17. As health care professional, they should find methods to ensure patients not only receive effective medication but also feel comfortable with the therapy. Thus, the objectives of this study was to determine the common statin-related ADRs and their predictors in one of the referral hospital in Malaysia (one of country in South East Asia).

The indoor radon gas released from concrete was measured using a 0.65 × 0.65 × 0.65 m fabricated concrete slab room, simulating a workplace. The indoor radon gas concentration was monitored, and the remediation method was examined. Radon concentrations were monitored using Radon Monitor Model 1023 from Sun Nuclear. Results show that average radon concentrations reached 111 Bq.m–3 before remediation, beyond the World Health Organization’s acceptable limit of 100 Bq.m–3. Hence, two layers of high-performance waterborne epoxy resin TRU-GLAZE-WB 4030 coating were applied, reducing the radon concentration average to an acceptable level of 14.8 Bq.m–3. Interestingly, the indoor radon concentrations were measured two months after applying the remediation and were found to be stable and within acceptable levels.

There is some evidence that self-rated perceptions of health are predictive of objective health outcomes, including cardiovascular disease, and mortality. The objective of this study was to examine the prospective association between perceptions of health during pregnancy and cardiovascular risk factors of mothers 21 years after the pregnancy. Data used were from the Mater University Study of Pregnancy (MUSP), a community-based prospective birth cohort study begun in Brisbane, Australia, in 1981. Logistic regression analyses were conducted. Data were available for 3692 women. Women who perceived themselves as not having a straight forward pregnancy had twice the odds (adjusted OR 2.0, 95 % CI 1.1–3.8) of being diagnosed with heart disease 21 years after the pregnancy when compared with women with a straight forward pregnancy (event rate of 5.2 versus 2.6 %). Women who experienced complications (other than serious pregnancy complications) during their pregnancy were also at 30 % increased odds (adjusted OR 1.3, 95 % CI 1.0–1.6) of having hypertension 21 years later (event rate of 25.7 versus 20 %). As a whole, our study suggests that pregnant women who perceived that they had complications and did not have a straight forward pregnancy were likely to experience poorer cardiovascular outcomes 21 years after that pregnancy. Electronic supplementary material The online version of this article (doi:10.1186/s40064-015-1639-6) contains supplementary material, which is available to authorized users.