BackgroundThe roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs) encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia.MethodsThis study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months.ResultsOf the 477 participants, 53.7% had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3%), insufficient awareness and knowledge about disease condition and medication (20.4%), adverse drug reactions (15.6%), therapeutic failure (13.9%), drug-choice problems (9.5%) and dosing problems (3.4%). Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52%) were classified as probably clinically insignificant, 38.9% with minimal clinical significance, 8.9% as definitely clinically significant and could cause patient harm while one issue (0.2%) was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3% were carried out as recommended.ConclusionsThis study demonstrates the importance of pharmacists working in collaboration with other healthcare providers especially the medical doctors in identifying and resolving pharmaceutical care issues to provide optimal care for patients with chronic diseases.

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Introduction: Neurons of peri-infarct region in the cortex have effects on neurogenesis and remodeling after ischemic stroke. However the role of penumbral striatum neuron in neurogenesis and remodeling after ischemic stroke is unknown. In this study, we use optogenetic tools to specifically regulate the activity of striatum neuron and investigate its roles in neurogenesis and remodeling after ischemic stroke. Methods: Lentivirus carrying NpHR and YFP fusion protein under CaMKII promoter was injected into striatum of experimental mice. 7 days after injection, ferrule with fiber or optrode was implanted at the same position and MCAO surgery was performed 14 days after the injection. 4 days after MCAO, mice were stimulated with constant 594 nm laser for two 15-min sessions each day for 4 days. Electrophysiology test was used to confirm the validity of NpHR in vivo. Neurobehavioral tests were carried out at 3, 7 and 35 days after MCAO. Results: When stimulated with 594nm laser, the firing rate of striatum neuron was reduced in NpHR transduced mouse after MCAO. Immunohistochemistry showed that the number of BrdU and DCX double positive cells was significantly increased in the SVZ area. Nestin positive cells were increased both in SVZ and peri-infarct area. Western blotting showed that Netrin-1 expression was significantly up-regulated. BrdU and NeuN double positive cells was increased and brain atrophy volume was reduced in laser-stimulated mice compared with control mice (p<0.05). Neurobehavioral test showed that inhibition of striatum neuron promotes motor function after MCAO compared to the control (p<0.05). Conclusion: Laser induced activation of NpHR reduces the firing rate of penumbral striatum neuron using optogenetics tools. Inhibition of striatum neuron promotes proliferation and migration of neural progenietor cells and neurobehavioral function recovery. This effect is related to Netrin-1 secretion.