Introduction: Untreated iron deficiency (ID) can lead to severe anaemia, requiring blood transfusion, or increased mortality risk. Globally intravenous (IV) iron is increasingly recognised as a recommended option for patients. This study aims to evaluate the budget impact associated with introducing a new intravenous (IV) iron, ferric derisomaltose (Monofer® [IIM]) as one of the treatment options for the management of ID in the Ministry of Health Malaysia (MOHM) setting. Methods: A 5-year budget impact model was developed from 2020 to 2024 for patients with ID that require a high iron dose (≥500 mg), using the perspective of MOHM. The model was built with four external medical specialists, each with experience and deep knowledge of ID management, to support estimations on the future development of iron use in Malaysia. Results: Compared to the current market mix with the existing IV iron products (i.e., iron sucrose and iron dextran), a cost-saving of MYR 53,910 could be achieved with the introduction of IIM in 2020. The uptake of IIM into MOHM over five years is estimated to lead to an overall budget saving of MYR 11,837,524 over a 5-year time horizon. Conclusion: The use of IIM in place of the current IV iron products in MOHM resulted in a significant cost saving by reducing the number of visits required to achieve the targeted iron dose and the shorter IV infusion time with IIM.

Objective: This study examined whether the changes in reimbursement coverage of brain magnetic resonance image (MRI) affected practice for patients who visited the emergency department with dizziness as the chief complaint. Methods: Among the 5,423 patients who visited the emergency department for dizziness in 2017, 2019, and 2021, 4,497 patients were included in the study retrospectively and investigated by brain diffusion-weighted MRI and the presence of cerebral infarction on brain diffusion-weighted MRI. This study examined whether there was a significant difference before and after the change. Results: In 2017, 2019, and 2021, 1,489, 1,570, and 1,438 patients with dizziness visited the emergency department, respectively. The number of patients who underwent a brain MRI scan gradually increased from 237 (15.9%) in 2017 to 628 (40.0%) in 2019 and 948 (65.9%) in 2021 (P<0.001). The number of positive findings on brain MRI scan increased gradually from 30 patients (2.0%) in 2017 to 47 patients (3.0%) in 2019 and 53 patients (3.7%) in 2021 (P=0.025). The ratio of positive findings of brain MRI scans to the number of patients who underwent brain MRI scans decreased gradually to 12.7% in 2017, 7.5% in 2019, and 5.6% in 2021 (P=0.001). Conclusion The changes in the reimbursement coverage of brain MRI affect the number of brain MRI scans and the detection of cerebral infarction.

In this study, we report the case of a 59-year-old male patient with organophosphate pesticide poisoning. He visited the local emergency medical center after ingesting 250 ml of organophosphate pesticide. The patient’s symptoms improved after the initial intravenous infusion of pralidoxime 5 g and atropine 0.5 mg. However, 18 hours after admission, there was a worsening of the symptoms. A high dose of atropine was administered to improve muscarinic symptoms. A total dose of 5091.4 mg of atropine was used for 30 days, and fever and paralytic ileus appeared as side effects of atropine. Anticholinergic symptoms disappeared only after reducing the atropine dose, and the patient was discharged on the 35th day without any neurologic complications.