This is a rare but interesting case of Mr. MZ who had a lifethreatening pericardial effusion presenting to the primary care clinic. Through great clinical acumen and prudent targeted investigations, diagnosis of this rare condition was reached and urgent referral made to the cardiology team which performed an emergency pericardiocentesis which proved to be life -saving. However, the hovering poor prognosis of Mr. MZ may prompt for a referral to the palliative care team to provide quality end of life care for this unfortunate patient.

background: Hyperlipidaemia is a significant risk factor for cardiovascular disease. However, adherence to lipidlowering therapy is often unsatisfactory due to a combination of patient factors, therapy, socio-economic and health system-related factors. Aims: to identify the prevalence of adherence to lipidlowering therapy, the factors contributing to non-adherence and knowledge regarding hyperlipidaemia and its’ treatment among Malaysian patients with hyperlipidemia. Methods: A quantitative study using a cross-sectional survey was carried out in an urban primary care clinic in August 2015. Patients on lipid-lowering therapy for ≥ 1 year aged ≥ 18 years were selected using simple random sampling. consenting patients answered a selfadministered questionnaire (in Malay/English) which included socio-demographic profile, hyperlipidaemia profile, adherence to lipid-lowering therapy (using the Morisky Medication Adherence scale-8; score ≥ 6 taken as adherent), reasons leading to non-adherence, knowledge regarding hyperlipidaemia and its’ treatment, and use of non-allopathic medicine. results: the response rate was 90.7%. the prevalence of adherence to lipid-lowering therapy was 82.4%. “the most common reasons for non-adherence was being worried about side effect of lipid-lowering agent (71.4%), followed by the need to take too many drugs in a day (61.4%) and negative influences by friends, relative and mass media (60%)”. Factors associated with non-adherence include male gender, on longer duration of therapy, less frequency of follow-up, less number of follow-up clinics, taking medication at night/random timing and having lower knowledge scores. conclusion: Overall the prevalence of adherence was high in patients with hyperlipidaemia. Interventions to boost adherence should target those who were identified as non-adherent.

This study emulates the findings of a study by Zaidi et al. in Pakistan in which the authors reported the similar success story (2). Similar success has been reported in a randomized trial in Africa that found treatment of pneumonia in the neonate by either oral penicillin or procaine benzylpenicillin and gentamycin to be as equally effective (3). The author is confident that this method of combining of both inpatient and outpatient administration of antibiotics for neonatal sepsis will be successful in our local setting due to high quality medical care that is offered by both government and private medical facilities here with many health clinics supporting the local hospitals.
Neonatal Sepsis ; Antibiotics

Bronchial asthma causes great morbidity and mortality worldwide. Certain occupations especially those exposed to known triggers of asthma such as animal fur, dusts or solvents may trigger asthma attacks in a previously undiagnosed individual or worsen its’ control in a known asthmatic. This is especially true for adult-onset asthma. This may in turn the health of the affected workers and affect their productivity. Affected workers may be given job reassignment and eligible for medical compensation from Social Security Organisation (SOSCO). This case report will look at how two individuals in very distinct occupation were diagnosed with suspected occupational asthma
Occupational asthma

Dengue fever infection is common in many parts of the world and may result in serious complications such as dengue haemorrhagic fever, dengue shock syndrome, pleural effusion, pericardial effusion and multi-organ failure if not diagnosed early or treated adequately. This is more so in the so called susceptible group that includes children, pregnant mother, elderly patients, patients with heart, liver or kidney co-morbidity, obese patients as well as immunocompromised patient such as those with transplanted organs or human immune-deficiency infection. However in certain cases, severe dengue fever may mimic the presentation of septic shock which needs urgent and decisive management actions to be taken. This case report will look at a 7-year-old child who survived despite developing septic shock which was thought to be initially dengue fever with warning signs. Early referral and aggressive treatment in hospital prevented a direr consequence for this child.
Dengue fever

Introduction: In first six months of life, breastfeeding is the recommended form of feeding by the World Health Organisation for the growing child. To enable the working mother to continue this noble practice, adequate workplace breastfeeding support and self- efficacy is needed.This study aims to determine the prevalence of breastfeeding among working mothers of children aged three months to two years and factors associated with breastfeeding practice including workplace support and mother’s self-efficacy. Method: This is a cross sectional questionnaire study carried out in a rural Health Clinic in Selangor using socio-demographic data, Workplace Breastfeeding Support Scale (WBSS), and the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF). This study was conducted for a period of three months from April to June 2015. The respondents were employed Malaysian mothers of healthy infants aged three months to two years. A total of 84 participants were involved in the study. Data analysis was done with SPSS 22.Results: The prevalence of breastfeeding among working mothers were high at 97.6%. We found significant association of breastfeeding practice with workplace breastfeeding support (p=0.005) and self-efficacy (p= 0.017). We also noted a significant correlation between breastfeeding workplace support and breast feeding self-efficacy (r= 0.40, p <0.01). Age, religion, ethnicity, educational level and place of employment were found to be not associated with breastfeeding practices.Conclusion: This study highlights the importance of workplace support and self-efficacy with workplace breastfeeding practices. Policymakers and stakeholders should provide a conducive and supportive environment to enhance breastfeeding among working mothers.

Sporotrichosis is a relatively uncommon fungal infection in human as compared to other fungal infectiction such as tinea corporis or cruris. The fungus can be found in the environment and on plant matter. Sporotrichosis usually results from trauma to the skin followed by exposure to the fungus. It can also be spread by cat scratch or bite. Sporotrichosis usually presents as multiple skin nodules arranged in a linear fashion over the limbs, often with associated lymphadenopathy. This calls for importance of full physical examination and a high index of suspicion in order to diagnose this infection that can either involve the skin or the lymphatic channel or both. If misdiagnosed, treatment can be delayed and lead to prolonged suffering of the patient. This is an interesting case report about a 43-year-old woman who presented with left axillary swelling and decreased range of movement of the corresponding shoulder which was feared initially to be linked to breast cancer. However, good clinal acumen lead to the actual diagnosis of sporotrichosis.

Pneumonia is a common lung infection. Common bacterial cause of this serious lung infection includes Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae. Haemophilus parahaemolyticus pneumonia is an uncommon cause of bacterial pneumonia, occurring mainly as an opportunistic pathogen in immunocompromised patients as in this case, diabetes mellitus. Therefore, this case report will look at a case of 49-year-old man who was diagnosed with this uncommon pathogen which was successfully eradicated with antibiotics. This case report will look at a case of 49 years old who was diagnosed with this uncommon pathogen which was successfully eradicated with antibiotics.

594Med J Malaysia Vol 75 No 5 September 2020SUMMARYMorel-Lavallee lesions (MLL) are post-traumatic, closedinternal degloving injuries that can result in severecomplications if not diagnosed early. It is conventionallyseen in cases of the high energy injuries of the pelvis andlower limb. The accumulation of extravasated blood,secondary to fracture and soft tissue damage may causeinternal degloving injury, skin necrosis, soft tissue damageand acute osteomyelitis. We report here the clinical andradiological features in a 32-year-old male referred from theemergency department of a tertiary hospital who hadsustained high energy motor vehicle accident. Onexamination, there was a fluctuant, mobile, non-tendersubcutaneous mass over the distal arm with suspicion ofinternal degloving injury. Plain radiographs showed nofractures. Ultrasound showed a fluid collection with thepresence of septations and echogenic debris within thecollection. Extravasation was noted between subcutaneoustissue layer and fascia at the posterolateral aspect of thearm. Wound debridement under general anaesthesia wascarried out. Intraoperative findings reported a significantamount of thick serous fluid with necrotic debris. Unhealthyskin and fat layers were debrided. Underlying muscles werefound to be healthy. The results of the intraoperative fluidculture and sensitivity showed no growth. Negative pressurevacuum dressing was carried out. After five cycles ofvacuum dressing, the wound showed signs of healing withan improved range of motion of the elbow. Orthopaedicsurgeons need to be vigilant of the possibility of MLL in theupper limb as a differential diagnosis in the management ofhigh energy trauma.