Introduction: : Influenza is an upper respiratory infection is caused by the influenza virus. It occurs throughout the whole year in Malaysia with occasional outbreaks. Influenza-like illnesses (ILI) are generally treated as outpatient care while the more severe (SARI) is managed in patient care. The Casemix system, used in healthcare professionals' practices, may help in estimating the cost of influenza management. Methods: : This cross-sectional study extracts the cost of influenza management from different public hospitals in years 2016, 2017 and 2018. Data used selected ICD-10 codes, and the cost was abstracted from Malaysian Diagnostic Related Groups (MyDRG) software. The secondary data are from 2 sources, an urban teaching hospital Hospital Cancellor Tuanku Muhriz (HCTM) and Ministry of Health (MoH) inpatient hospitals database. The sample size of the study was 586, while a structured datasheet collating patients' sociodemographic data and cost of admission, per case, was obtained from the MyDRG software. Microsoft Excel and SPSS software were used in the analysis. Results: : Most influenza cases (61.8%) are between the ages of 0 and 10, Malays, and have similar gender proportions. Overall, the influenza treatment cost for inpatient care, totalled to RM 294,017,112. In 2018, the GDP for health consumed 3.76% of Malaysia's GDP income of RM 1.4 trillion, with an estimated RM 60,339 million used for health. Thus, the three-year public cost consumed 0.5% of 2018 GDP. Conclusion: Influenza screening at the primary healthcare setting, health education and treatment compliance should be scale-up to minimize the cost of influenza management of the public providers.

This study aimed to investigate the irrigation dynamics of the positive pressure side-vented (SV) needle, EndoVac (micropores) needle and modified apical negative pressure (mANP) open-ended needle using computational fluid dynamics (CFD). A simulation of a prepared root canal (conical frustum) of 15 mm length with an apical diameter of 0.40 mm following Protaper F4 apical preparation was created using three-dimensional (3D) CAD software. The 3D simulated needle of SV 30G needle, EndoVac with micropores needle and mANP, 30G flat open-ended needle were also created. The irrigation dynamics were evaluated through transient CFD simulations. In addition, the irrigation dynamics of mANP at 0.2 mm, 0.5 mm, and 1.0 mm short from the working length were also assessed. The EndoVac and mANP showed negative apical static pressure and streamline patterns able to reach the apical region, thus indicating negligible extrusion. Meanwhile, SV showed positive apical static pressure and almost nonexistent streamlines beyond the needle tip. The SV showed the highest wall shear stress (WSS) magnitude of 1030Pa whereas Endovac (161 Pa) and mANP1 (258 Pa). However, SV revealed lower average WSS (10 Pa) compared to mANP1 (13 Pa) and mANP2 (11 Pa). This is due to SV developed a localised maximum WSS opposite the open vent area only therefore, uneven distribution of WSS. The EndoVac system developed a localised maximum WSS in the pair of micropores furthest away from the apical. CFD analysis of the EndoVac, mANP and SV showed different technique approach, needle design and needle depths insertion affect the irrigation dynamics pattern and magnitude.