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Fulltext Outbreak of vaccine-preventable diseases in Muslim majority countries

Ahmed A, Lee KS, Bukhsh A, Al-Worafi YM, Sarker MMR, Ming LC, et al.

J Infect Public Health, 2017 10 04;11(2):153-155.
PMID: 28988775 DOI: 10.1016/j.jiph.2017.09.007

The increase in Muslim parents' refusal and hesitancy to accept childhood vaccination was identified as one of the contributing factors in the increase of vaccine-preventable diseases cases in countries such as Afghanistan, Malaysia and Pakistan. The spread of inaccurate and irresponsible information by the anti-vaccination movement may inflict more harm than good on Muslim communities. To curb this issue, health authorities in Pakistan and Malaysia have resorted to imposing strict punishments on parents who refuse to allow their children to be vaccinated. Information addressing religious concerns such as the halal issue must be made priority and communicated well to the general public, encouraging not only the acceptance of vaccinations but motivating communities to play an active role in promoting vaccination. Local government of the affected region need to work towards creating awareness among Muslim parents that vaccinations are a preventative public health strategy that has been practised and acknowledged by many doctors of all faiths.
Evaluating healthcare professionals' perceptions of dispensing separation and sale of pharmacy medicine in Brunei Darussalam

Juperi RNAA, Goh HP, Rehman IU, Lee KS, Ming LC, Hermansyah A

J Pharm Policy Pract, 2023 Aug 24;16(1):101.
PMID: 37620839 DOI: 10.1186/s40545-023-00594-5

BACKGROUND: Pharmacy medicine (P) is obtained exclusively from a pharmacy under the supervision of a pharmacist. This study aims to understand the perception of healthcare professionals towards the dispensing separation, as well as the dispensing of pharmacy medicine by community pharmacies to enhance patient health outcomes in Brunei Darussalam.
METHODS: A cross-sectional study was conducted between 1st March 2023 and 20th April 2023 among healthcare professionals. A newly designed and validated questionnaire was used. Its face and content validity, along with internal consistency, was adequately established. Convenient sampling was employed to recruit participants for the study. Statistical analysis using one-way ANOVA was performed, considering a p-value
Dikir Farmasi: folk songs for health education

Bahri S, Lee KS, Adenan MA, Murugiah MK, Khan TM, Neoh CF, et al.

Arts Health, 2016 Sep 01;8(3):272-278.
PMID: 27695527

In an effort to enhance public awareness, we develop Dikir Farmasi as an innovative approach to deliver health information. Dikir Farmasi combines the elements of dikir barat (a type of traditional folk song rhythm) and traditional sketches which are popular in the state of Kelantan, Malaysia. These sketches and dikir barat rhythmic songs, with lyrics touch on issues such as drug abuse and regulation are presented in an entertaining and humorous way. Health promotion messages are disseminated using Dikir Farmasi in the form of compact disks, video compact disks, stage performance, exhibition, social media, printed media (signboard, brochure and flyer).
Fulltext SARS-COV-2 as an artificial creation: scientific arguments and counterarguments

Yee S, Tan CS, Khan A, Lee KS, Goh BH, Ming LC

J Med Life, 2021;14(1):118-120.
PMID: 33767796 DOI: 10.25122/jml-2020-0175
Fulltext Plasmodium knowlesi: reservoir hosts and tracking the emergence in humans and macaques

Lee KS, Divis PC, Zakaria SK, Matusop A, Julin RA, Conway DJ, et al.

PLoS Pathog, 2011 Apr;7(4):e1002015.
PMID: 21490952 DOI: 10.1371/journal.ppat.1002015

Plasmodium knowlesi, a malaria parasite originally thought to be restricted to macaques in Southeast Asia, has recently been recognized as a significant cause of human malaria. Unlike the benign and morphologically similar P. malariae, these parasites can lead to fatal infections. Malaria parasites, including P. knowlesi, have not yet been detected in macaques of the Kapit Division of Malaysian Borneo, where the majority of human knowlesi malaria cases have been reported. In order to extend our understanding of the epidemiology and evolutionary history of P. knowlesi, we examined 108 wild macaques for malaria parasites and sequenced the circumsporozoite protein (csp) gene and mitochondrial (mt) DNA of P. knowlesi isolates derived from macaques and humans. We detected five species of Plasmodium (P. knowlesi, P. inui, P. cynomolgi, P. fieldi and P. coatneyi) in the long-tailed and pig-tailed macaques, and an extremely high prevalence of P. inui and P. knowlesi. Macaques had a higher number of P. knowlesi genotypes per infection than humans, and some diverse alleles of the P. knowlesi csp gene and certain mtDNA haplotypes were shared between both hosts. Analyses of DNA sequence data indicate that there are no mtDNA lineages associated exclusively with either host. Furthermore, our analyses of the mtDNA data reveal that P. knowlesi is derived from an ancestral parasite population that existed prior to human settlement in Southeast Asia, and underwent significant population expansion approximately 30,000-40,000 years ago. Our results indicate that human infections with P. knowlesi are not newly emergent in Southeast Asia and that knowlesi malaria is primarily a zoonosis with wild macaques as the reservoir hosts. However, ongoing ecological changes resulting from deforestation, with an associated increase in the human population, could enable this pathogenic species of Plasmodium to switch to humans as the preferred host.
Fulltext Plasmodium knowlesi malaria in humans is widely distributed and potentially life threatening

Cox-Singh J, Davis TM, Lee KS, Shamsul SS, Matusop A, Ratnam S, et al.

Clin Infect Dis, 2008 Jan 15;46(2):165-71.
PMID: 18171245 DOI: 10.1086/524888

BACKGROUND: Until recently, Plasmodium knowlesi malaria in humans was misdiagnosed as Plasmodium malariae malaria. The objectives of the present study were to determine the geographic distribution of P. knowlesi malaria in the human population in Malaysia and to investigate 4 suspected fatal cases.
METHODS: Sensitive and specific nested polymerase chain reaction was used to identify all Plasmodium species present in (1) blood samples obtained from 960 patients with malaria who were hospitalized in Sarawak, Malaysian Borneo, during 2001-2006; (2) 54 P. malariae archival blood films from 15 districts in Sabah, Malaysian Borneo (during 2003-2005), and 4 districts in Pahang, Peninsular Malaysia (during 2004-2005); and (3) 4 patients whose suspected cause of death was P. knowlesi malaria. For the 4 latter cases, available clinical and laboratory data were reviewed.
RESULTS: P. knowlesi DNA was detected in 266 (27.7%) of 960 of the samples from Sarawak hospitals, 41 (83.7%) of 49 from Sabah, and all 5 from Pahang. Only P. knowlesi DNA was detected in archival blood films from the 4 patients who died. All were hyperparasitemic and developed marked hepatorenal dysfunction.
CONCLUSIONS: Human infection with P. knowlesi, commonly misidentified as the more benign P. malariae, are widely distributed across Malaysian Borneo and extend to Peninsular Malaysia. Because P. knowlesi replicates every 24 h, rapid diagnosis and prompt effective treatment are essential. In the absence of a specific routine diagnostic test for P. knowlesi malaria, we recommend that patients who reside in or have traveled to Southeast Asia and who have received a "P. malariae" hyperparasitemia diagnosis by microscopy receive intensive management as appropriate for severe falciparum malaria.
Measuring quality of life in different cultures: translation of the Functional Living Index for Cancer (FLIC) into Chinese and Malay in Singapore

Goh CR, Lee KS, Tan TC, Wang TL, Tan CH, Wong J, et al.

Ann Acad Med Singap, 1996 May;25(3):323-34.
PMID: 8876896

Quality-of-life assessment has become an accepted method of evaluation in clinical medicine. The technique is based on a patient's self-assessment of physical, psychological, and social function, as well as the effects of distressing physical symptoms. The most important aspect of quality-of-life assessment is that it brings into focus a patient-centred view of health outcome, which is broader than the physiologic measures which predominate in Western medicine. Strategies for the development and use of assessment questionnaires have evolved over the past 15 years, and numerous questionnaires have been created. Most originate in Western societies, with English as the most common language of development. Adapting such questionnaires for use in other language and cultural settings is an imprecise practice. Language translation and equivalent cultural meaning must both be addressed. This paper reports on the language translation process and results for the Functional Living Index for Cancer (FLIC) as translated into Chinese and Malay in Singapore. We employed a step-wise process beginning with translation/back translation, followed by structured pilot field trials and population sampling. Taped versions of the questionnaire were devised to meet illiteracy problems in the sample population. Paired comparisons of the Chinese and Malay versions of individual questions with their English counterparts show good correlations and similar means most of the time. Factor analysis on a population sample of 246 (112 Chinese, 35 Malay and 98 English speaking) with cancers of minimal, extensive or palliative extent is convergent with that obtained on a North American population. However, a separate analysis of the Chinese questionnaires showed some differences in factor pattern. Specific language and cultural translation difficulties are discussed. Of note is the predicted significant decrease in total FLIC scores with extent of disease within each of the language preference populations, which provides some evidence for the validity for each language version in the Singapore culture(s). Thus, the FLIC translations into Malay and Chinese in Singapore can be considered for use in local trials, subject to ongoing evaluation.
Fulltext Water Quality Assessment of Tributaries of Batang Baleh in Sarawak Using Cluster Analysis

Ling TY, Soo CL, Heng TL, Nyanti L, Sim SF, Grinang J, et al.

ScientificWorldJournal, 2018;2018:8682951.
PMID: 30622445 DOI: 10.1155/2018/8682951

Assessment of river water quality is essential as it provides the knowledge required to make informed decisions. Therefore, water quality was determined at 15 tributary stations located along the Batang Baleh, Sarawak. Results of the study indicate that all tributaries were well-aerated (≈ 7.7 mg/L) with pH (≈ 7.3) and conductivity (≈ 37.3 μS/cm) values falling within acceptable ranges. However, there were tributaries that showed very high turbidity (> 1000 NTU) and suspended solids (> 800 mg/L) which were contributed by the soil erosion from logging activities in the watershed. Tributary stations associated with logging activities also showed significantly higher total phosphorus and organic nitrogen. Cluster analysis demonstrated that water quality at tributary stations along the Batang Baleh exhibited a longitudinal variation from upstream to downstream regions, particularly, dissolved oxygen, five-day biochemical oxygen demand, and nitrite-nitrate nitrogen, which were found higher in upstream region and steadily decreased towards the downstream region. Two stations located at Sg. Serani and Sg. Melatai were distinct from the other stations with the highest concentrations of turbidity, total suspended solids, organic nitrogen, and total phosphorus. Thus, there is an urgent need to reduce the pollutants in the tributaries of Batang Baleh for the health of the sensitive aquatic organisms.
Fulltext Cancer protective effects of plums: A systematic review

Bahrin AA, Moshawih S, Dhaliwal JS, Kanakal MM, Khan A, Lee KS, et al.

Biomed Pharmacother, 2022 Feb;146:112568.
PMID: 34963086 DOI: 10.1016/j.biopha.2021.112568

Plums is one of the most cultivated stone fruits due to its fast growing popularity. It has various traditionally recognized health benefits. There are two main commercial types of plums: the European plum (Prunus domestica) and the Japanese plum (Prunus salicina), each having many varieties. Researchers are gathering further evidence of pharmacological effects for plums by scientifically studying its anti-inflammatory, antioxidant properties. A systematic review analysing the literature related to the effects of plums on prevention and treatment of cancer is warranted. This is the first review examining the cancer-related effects of plums. Antioxidation properties of the active constituents of plum were also compared. Scopus, Google Scholar, PubMed, Medxriv and Cochrane Library databases, from their date of inception until July 2021 were utilized. The risk of bias was assessed using CONSORT checklist. A total of 6639 studies were screened and eventually only 54 studies were included. Full-text review of included studies revealed that plum extracts were rich in antioxidants. Overall, most of the studies that fulfilled the eligibility criteria were in vitro and a few clinical studies involving in vivo work. Therefore, it would be beneficial to perform more studies on animals or humans, to confirm that the result obtained from these in vitro studies are able to be extrapolated in a wider range of applications. Further clinical and in vivo studies are warranted to validate plums as a functional food for treatment and prevention of cancer.
Fulltext Combating Sale of Counterfeit and Falsified Medicines Online: A Losing Battle

Lee KS, Yee SM, Zaidi STR, Patel RP, Yang Q, Al-Worafi YM, et al.

Front Pharmacol, 2017;8:268.
PMID: 28559845 DOI: 10.3389/fphar.2017.00268
Fulltext Fish biodiversity and assemblages along the altitudinal gradients of tropical mountainous forest streams

Soo CL, Nyanti L, Idris NE, Ling TY, Sim SF, Grinang J, et al.

Sci Rep, 2021 Aug 19;11(1):16922.
PMID: 34413385 DOI: 10.1038/s41598-021-96253-3

Knowledge of the fundamental aspects of ecology such as the patterns of fish species distribution and biodiversity in the forest streams is the first and basic step to develop effective conservation strategies. Yet, studies on altitudinal changes of fish composition and assemblages in Bornean forest streams are scarce despite being one of the hotspots of biodiversity conservation. Hence, surveys on freshwater fish composition along the altitudinal gradients of the Baleh River Basin in Sarawak, Borneo were conducted from April 2014 to August 2015. The Baleh River Basin was divided into seven altitudinal groups with a total of 72 stations. Group elevation ranged from 53 to 269 m above sea level. The fish samples and environmental parameters were taken concurrently during samplings. A total of 3565 specimens belonging to six orders, 14 families, and 76 species were found in the present study. The most dominant family in the Baleh River Basin was Cyprinidae (74.4%), followed by Gastromyzontidae (16.2%) while the most dominant species was Tor tambra (12.9%), followed by Lobocheilos ovalis (12.3%). Fish abundance significantly higher at high altitude sites than those at low altitude sites except for Mengiong River which has the lowest fish abundance despite with high elevation. Species richness was found significantly lower in midstream segment. Noticeable altitudinal gradient of fish assemblages was observed along the Baleh River except a discontinuity at the midstream segment which is attributable to the poorer quality inflow from the Mengiong River coupled with the meandering feature of the segment. Fish abundance was significantly and positively correlated with elevation, water pH and conductivity while negatively correlated with turbidity. Anthropogenic activities in the Baleh River Basin had altered the environmental variables thus disrupted the altitudinal gradient of fish assemblages. This phenomenon is apparent when the Canonical Correspondence Analysis (CCA) revealed that the first axis (CCA1) explained 42.5% of the variation and has positive loading on dissolved oxygen (DO) and negative loading on water conductivity; whereas CCA2 explained 37.5% of the variation and positively loaded on elevation, water pH, and DO. The results demonstrated that Gastromyzon fasciatus preferred more oxygenated water than Protomyzon sp., G. sp 1, and G. punctulatus although they are all from Gastromyzontidae family that inhabiting high altitude sites. Barbonymus schwanenfeldii was also found most abundant with elevated dissolved oxygen value. On the other hand, Rasbora volzii and R. hosii inhabiting lower altitude sites with less oxygenated and more acidic water.
Fulltext Economic Analysis of Patient's Own Medication, Unit-Use and Ward Stock Utilization: Results of the First Pilot Study

Abdul Nasir HH, Goh HP, Wee DVT, Goh KW, Lee KS, Hermansyah A, et al.

Int J Environ Res Public Health, 2022 Sep 09;19(18).
PMID: 36141623 DOI: 10.3390/ijerph191811350

BACKGROUND: Medication wastage is causing a cost burden to the healthcare system that is worth millions of dollars. An economic and ecological friendly intervention such as using a patient's own medications (POM) has proven to reduce wastage and save the cost spent by the hospital. The potential benefits of using POM in inpatient settings have yet to be explored in a country with universal health coverage. This study aimed to pilot test the POM intervention in an adult ward setting and to perform the economic analysis of using POM and ward stock during hospitalization.
METHODS: A prospective cross-sectional observational study was conducted among the patients admitted to the medical and surgical wards in a public hospital located in Brunei Darussalam between February 2022 and April 2022. Hospitalized adults above 18 years old with regular medications with a minimum length of stay of 48 h and a maximum length of stay of 21 days were included in the study. These eligible patients were divided into a POM group and a non-POM group. The economic analysis of using POM was performed by calculating the direct cost per unit of medication used during admission (from unit-use, ward stock and POM) and comparing the cost spent for both groups. Expired ward stock deemed as medication wastage was determined. Medical research ethics were approved, and all participating patients had given their written informed consent before enrolling in this study.
RESULTS: A total of 112 patients aged 63.2 ± 15.8 years participated in this study. The average cost of medication supplied by the inpatient pharmacy for the non-POM group was USD 21.60 ± 34.20 per patient, whereas, for the POM group, it was approximately USD 13.00 ± 18.30 per patient, with a mean difference of USD 8.60 ± 5.17 per patient (95% CI: -3.95, 27.47, p ≥ 0.05). The use of POM minimized 54.03% (USD 625.04) of the total cost spent by the hospital for the POM group within the period of the study.
CONCLUSION: The pilot study showed that the supplied medication cost per patient was not significantly different between the POM and non-POM groups. Nevertheless, the utilization of POM during hospitalization is capable of reducing at least 50% of the total cost spent on inpatient medications by the hospital. The use of POM during hospitalization also helped in reducing the total time spent on the medication process per patient.
Fulltext Pricing appraisal of anti-cancer drugs in the South East Asian, Western Pacific and East Mediterranean Region

Salmasi S, Lee KS, Ming LC, Neoh CF, Elrggal ME, Babar ZD, et al.

BMC Cancer, 2017 12 28;17(1):903.
PMID: 29282008 DOI: 10.1186/s12885-017-3888-y

BACKGROUND: Globally, cancer is one of the leading causes of mortality. High treatment cost, partly owing to higher prices of anti-cancer drugs, presents a significant burden on patients and healthcare systems. The aim of the present study was to survey and compare retail prices of anti-cancer drugs between high, middle and low income countries in the South-East Asia, Western Pacific and Eastern Mediterranean regions.
METHODS: Cross-sectional survey design was used for the present study. Pricing data from ten counties including one from South-East Asia, two from Western Pacific and seven from Eastern Mediterranean regions were used in this study. Purchasing power parity (PPP)-adjusted mean unit prices for 26 anti-cancer drug presentations (similar pharmaceutical form, strength, and pack size) were used to compare prices of anti-cancer drugs across three regions. A structured form was used to extract relevant data. Data were entered and analysed using Microsoft Excel®.
RESULTS: Overall, Taiwan had the lowest mean unit prices while Oman had the highest prices. Six (23.1%) and nine (34.6%) drug presentations had a mean unit price below US$100 and between US$100 and US$500 respectively. Eight drug presentations (30.7%) had a mean unit price of more than US$1000 including cabazitaxel with a mean unit price of $17,304.9/vial. There was a direct relationship between income category of the countries and their mean unit price; low-income countries had lower mean unit prices. The average PPP-adjusted unit prices for countries based on their income level were as follows: low middle-income countries (LMICs): US$814.07; high middle income countries (HMICs): US$1150.63; and high income countries (HICs): US$1148.19.
CONCLUSIONS: There is a great variation in pricing of anticancer drugs in selected countires and within their respective regions. These findings will allow policy makers to compare prices of anti-cancer agents with neighbouring countries and develop policies to ensure accessibility and affordability of anti-cancer drugs.
Re-emergence of Chikungunya virus in South-east Asia: virological evidence from Sri Lanka and Singapore

Hapuarachchi HC, Bandara KB, Sumanadasa SD, Hapugoda MD, Lai YL, Lee KS, et al.

J Gen Virol, 2010 Apr;91(Pt 4):1067-76.
PMID: 19955565 DOI: 10.1099/vir.0.015743-0

Chikungunya fever swept across many South and South-east Asian countries, following extensive outbreaks in the Indian Ocean Islands in 2005. However, molecular epidemiological data to explain the recent spread and evolution of Chikungunya virus (CHIKV) in the Asian region are still limited. This study describes the genetic Characteristics and evolutionary relationships of CHIKV strains that emerged in Sri Lanka and Singapore during 2006-2008. The viruses isolated in Singapore also included those imported from the Maldives (n=1), India (n=2) and Malaysia (n=31). All analysed strains belonged to the East, Central and South African (ECSA) lineage and were evolutionarily more related to Indian than to Indian Ocean Islands strains. Unique genetic characteristics revealed five genetically distinct subpopulations of CHIKV in Sri Lanka and Singapore, which were likely to have emerged through multiple, independent introductions. The evolutionary network based on E1 gene sequences indicated the acquisition of an alanine to valine 226 substitution (E1-A226V) by virus strains of the Indian sublineage as a key evolutionary event that contributed to the transmission and spatial distribution of CHIKV in the region. The E1-A226V substitution was found in 95.7 % (133/139) of analysed isolates in 2008, highlighting the widespread establishment of mutated CHIKV strains in Sri Lanka, Singapore and Malaysia. As the E1-A226V substitution is known to enhance the transmissibility of CHIKV by Aedes albopictus mosquitoes, this observation has important implications for the design of vector control strategies to fight the virus in regions at risk of chikungunya fever.
Fulltext Levofloxacin: Insights Into Antibiotic Resistance and Product Quality

Izadi E, Afshan G, Patel RP, Rao VM, Liew KB, Meor Mohd Affandi MMR, et al.

Front Pharmacol, 2019;10:881.
PMID: 31474853 DOI: 10.3389/fphar.2019.00881

Counterfeit and substandard medicines are recognized as one of serious threats to public health. The product quality of antibacterial medicine will compromise patients' recovery and increase the chance of antibacterial resistance. The review aims to provide a summary of low quality levofloxacin issues and the risk factors as well as suggesting the aspects of product quality that need to be regulated strictly. Quality of the active ingredient, levofloxacin, has an important role to contribute to successful therapy. The poor quality of raw material, directly and indirectly, causes treatment failure as the presence of insufficient dose, mislabeled content, and poor dissolution characteristics can lead to lower bioavailability. Identifying and reporting these factors can potentially help in improving the quality of drug marketed in various developing countries and may also reduce the incidences of treatment failure. Dissolution test is used for testing the dissolution profiles and the rate of drug release from solid formulation such as oral formulations, thus providing information regarding the in vivo performance of a formulation and its bioequivalence. On the other hand, quality-testing procedures are used for comparing the quality of products.
Fulltext Mobile Health Apps on COVID-19 Launched in the Early Days of the Pandemic: Content Analysis and Review

Ming LC, Untong N, Aliudin NA, Osili N, Kifli N, Tan CS, et al.

JMIR Mhealth Uhealth, 2020 09 16;8(9):e19796.
PMID: 32609622 DOI: 10.2196/19796

BACKGROUND: Mobile health (mHealth) app use is a major concern because of the possible dissemination of misinformation that could harm the users. Particularly, it can be difficult for health care professionals to recommend a suitable app for coronavirus disease (COVID-19) education and self-monitoring purposes.
OBJECTIVE: This study aims to analyze and evaluate the contents as well as features of COVID-19 mobile apps. The findings are instrumental in helping health care professionals to identify suitable mobile apps for COVID-19 self-monitoring and education. The results of the mobile apps' assessment could potentially help mobile app developers improve or modify their existing mobile app designs to achieve optimal outcomes.
METHODS: The search for the mHealth apps available in the android-based Play Store and the iOS-based App Store was conducted between April 18 and May 5, 2020. The region of the App Store where we performed the search was the United States, and a virtual private network app was used to locate and access COVID-19 mobile apps from all countries on the Google Play Store. The inclusion criteria were apps that are related to COVID-19 with no restriction in language type. The basic features assessment criteria used for comparison were the requirement for free subscription, internet connection, education or advisory content, size of the app, ability to export data, and automated data entry. The functionality of the apps was assessed according to knowledge (information on COVID-19), tracing or mapping of COVID-19 cases, home monitoring surveillance, online consultation with a health authority, and official apps run by health authorities.
RESULTS: Of the 223 COVID-19-related mobile apps, only 30 (19.9%) found in the App Store and 28 (44.4%) in the Play Store matched the inclusion criteria. In the basic features assessment, most App Store (10/30, 33.3%) and Play Store (10/28, 35.7%) apps scored 4 out of 7 points. Meanwhile, the outcome of the functionality assessment for most App Store apps (13/30, 43.3%) was a score of 3 compared to android-based apps (10/28, 35.7%), which scored 2 (out of the maximum 5 points). Evaluation of the basic functions showed that 75.0% (n=36) of the 48 included mobile apps do not require a subscription, 56.3% (n=27) provide symptom advice, and 41.7% (n=20) have educational content. In terms of the specific functions, more than half of the included mobile apps are official mobile apps maintained by a health authority for COVID-19 information provision. Around 37.5% (n=18) and 31.3% (n=15) of the mobile apps have tracing or mapping and home monitoring surveillance functions, respectively, with only 17% (n=8) of the mobile apps equipped with an online consultation function.
CONCLUSIONS: Most iOS-based apps incorporate infographic mapping of COVID-19 cases, while most android-based apps incorporate home monitoring surveillance features instead of providing focused educational content on COVID-19. It is important to evaluate the contents and features of COVID-19 mobile apps to guide users in choosing a suitable mobile app based on their requirements.
Fulltext Cold chain time- and temperature-controlled transport of vaccines: a simulated experimental study

Ng CZ, Lean YL, Yeoh SF, Lean QY, Lee KS, Suleiman AK, et al.

Clin Exp Vaccine Res, 2020 Jan;9(1):8-14.
PMID: 32095436 DOI: 10.7774/cevr.2020.9.1.8

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.
Fulltext The Use of Blockchain Technology in the Health Care Sector: Systematic Review

Elangovan D, Long CS, Bakrin FS, Tan CS, Goh KW, Yeoh SF, et al.

JMIR Med Inform, 2022 Jan 20;10(1):e17278.
PMID: 35049516 DOI: 10.2196/17278

BACKGROUND: Blockchain technology is a part of Industry 4.0's new Internet of Things applications: decentralized systems, distributed ledgers, and immutable and cryptographically secure technology. This technology entails a series of transaction lists with identical copies shared and retained by different groups or parties. One field where blockchain technology has tremendous potential is health care, due to the more patient-centric approach to the health care system as well as blockchain's ability to connect disparate systems and increase the accuracy of electronic health records.
OBJECTIVE: The aim of this study was to systematically review studies on the use of blockchain technology in health care and to analyze the characteristics of the studies that have implemented blockchain technology.
METHODS: This study used a systematic review methodology to find literature related to the implementation aspect of blockchain technology in health care. Relevant papers were searched for using PubMed, SpringerLink, IEEE Xplore, Embase, Scopus, and EBSCOhost. A quality assessment of literature was performed on the 22 selected papers by assessing their trustworthiness and relevance.
RESULTS: After full screening, 22 papers were included. A table of evidence was constructed, and the results of the selected papers were interpreted. The results of scoring for measuring the quality of the publications were obtained and interpreted. Out of 22 papers, a total of 3 (14%) high-quality papers, 9 (41%) moderate-quality papers, and 10 (45%) low-quality papers were identified.
CONCLUSIONS: Blockchain technology was found to be useful in real health care environments, including for the management of electronic medical records, biomedical research and education, remote patient monitoring, pharmaceutical supply chains, health insurance claims, health data analytics, and other potential areas. The main reasons for the implementation of blockchain technology in the health care sector were identified as data integrity, access control, data logging, data versioning, and nonrepudiation. The findings could help the scientific community to understand the implementation aspect of blockchain technology. The results from this study help in recognizing the accessibility and use of blockchain technology in the health care sector.
Fulltext The Crux of the Medicine Prices' Controversy in Pakistan

Lee KS, Shahidullah A, Zaidi STR, Patel RP, Ming LC, Tariq MH, et al.

Front Pharmacol, 2017;8:504.
PMID: 28824429 DOI: 10.3389/fphar.2017.00504
Fulltext Trends and Disparities in Valvular Heart Disease Mortality in the United States From 1999 to 2020

Tan MC, Yeo YH, San BJ, Suleiman A, Lee JZ, Chatterjee A, et al.

J Am Heart Assoc, 2024 Apr 16;13(8):e030895.
PMID: 38587138 DOI: 10.1161/JAHA.123.030895

BACKGROUND: Percutaneous heart valve procedures have been increasingly performed over the past decade, yet real-world mortality data on valvular heart disease (VHD) in the United States remain limited.
METHODS AND RESULTS: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database among patients ≥15 years old from 1999 to 2020. VHD and its subtypes were listed as the underlying cause of death. We calculated age-adjusted mortality rate (AAMR) per 100 000 individuals and determined overall trends by estimating the average annual percent change using the Joinpoint regression program. Subgroup analyses were performed based on demographic and geographic factors. In the 22-year study, there were 446 096 VHD deaths, accounting for 0.80% of all-cause mortality (56 014 102 people) and 2.38% of the total cardiovascular mortality (18 759 451 people). Aortic stenosis recorded the highest mortality of VHD-related death in both male (109 529, 61.74%) and female (166 930, 62.13%) populations. The AAMR of VHD has declined from 8.4 (95% CI, 8.2-8.5) to 6.6 (95% CI, 6.5-6.7) per 100 000 population. Similar decreasing AAMR trends were also seen for the VHD subtypes. Men recorded higher AAMR for aortic stenosis and aortic regurgitation, whereas women had higher AAMR for mitral stenosis and mitral regurgitation. Mitral regurgitation had the highest change in average annual percent change in AAMR.
CONCLUSIONS: The mortality rate of VHD among the US population has declined over the past 2 decades. This highlights the likely efficacy of increasing surveillance and advancement in the management of VHD, resulting in improved outcomes.

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