Psychiatric symptoms may be related to a silent cerebral infarct, a phenomenon that has been described previously in literature. Acute psychosis or other neuropsychiatric symptoms including depression may present in stroke patients and patients with lesions either within the prefrontal or occipital cortices, or in subcortical areas such as the basal ganglia, thalamus, mid-brain, and brainstem. Psychosis in clinical stroke or in silent cerebral infarction is uncommon and not well documented in the literature. Neurological deficits are the most common presentation in stroke, and nearly a third of patients that suffer a stroke may experience psychological disorders such as depression and anxiety, related to physical disability. The present case report describes an elderly female patient who presented with hallucinations and depressive symptoms, and was discovered to have a recent right frontal brain infarction, without other significant neurological deficits.
Aged ; Anxiety ; Basal Ganglia ; Brain Infarction ; Brain Stem ; Cerebral Infarction ; Depression* ; Female ; Frontal Lobe* ; Hallucinations ; Humans ; Occipital Lobe ; Psychotic Disorders ; Stroke ; Thalamus

Primary cutaneous lymphomas are rare diseases among the general population, and even rarer in children. Mycosis fungoides (MF) is the most commonly diagnosed form in childhood. Several atypical clinical variants of MF have been reported, and pityriasis lichenoides-like MF (PL-like MF) is a recently described subtype. We report about a rare case of PL-like MF in an 11-year-old Malay boy with a 2-year history of multiple scaly erythematous papules associated with progressive and generalized hypopigmentation. This case report illustrates the significant dilemma in the diagnosis of the disease, particularly in the early stages, because its symptoms can mimic those of many common childhood inflammatory skin disorders. Later, the widespread hypopigmentation obscured the characteristic lesions, leading to misdiagnosis. Moreover, due to unfamiliarity of the disease, the diagnosis of PL-like MF was missed and delayed until only 2 years after the onset of the dermatosis. Therefore, primary care practitioners must have a high index of suspicion for this cutaneous neoplasm in children with persistent or worsening skin lesions, not responding to standard therapy, to ensure timely referral, diagnosis, and treatment.

Primary cutaneous lymphomas are rare diseases among the general population, and even rarer in children. Mycosis fungoides (MF) is the most commonly diagnosed form in childhood. Several atypical clinical variants of MF have been reported, and pityriasis lichenoides-like MF (PL-like MF) is a recently described subtype. We report about a rare case of PL-like MF in an 11-year-old Malay boy with a 2-year history of multiple scaly erythematous papules associated with progressive and generalized hypopigmentation. This case report illustrates the significant dilemma in the diagnosis of the disease, particularly in the early stages, because its symptoms can mimic those of many common childhood inflammatory skin disorders. Later, the widespread hypopigmentation obscured the characteristic lesions, leading to misdiagnosis. Moreover, due to unfamiliarity of the disease, the diagnosis of PL-like MF was missed and delayed until only 2 years after the onset of the dermatosis. Therefore, primary care practitioners must have a high index of suspicion for this cutaneous neoplasm in children with persistent or worsening skin lesions, not responding to standard therapy, to ensure timely referral, diagnosis, and treatment.

Schizencephaly is a very rare congenital birth defect. It is characterized by a cortical brain malformation that manifests as a grey-matter-lined cleft extending from the ependyma to the pia mater. It is a rare condition, and few cases have been reported in the literature. The exact cause is unknown. Herein, we report a case of an infant presenting with left side hemiparesis. The CT scan of her brain revealed right fronto-temporal and left parieto-temporal open-lip schizencephaly; thus, urgent referral to a pediatric neurologist was made for early intervention.

Metformin-induced sexual dysfunction is rare in patients with diabetes mellitus. Herein, we present the case of a 57-year-old man newly diagnosed with type 2 diabetes mellitus who developed erectile dysfunction following treatment with metformin 500 mg BD. Prior to taking metformin, he had well-controlled hypertension, hyperlipidaemia and normal sexual function. Two weeks after beginning metformin therapy, he was diagnosed with erectile dysfunction after experiencing persistent difficulty achieving an erection. After discontinuation of metformin, his sexual function returned to normal. To determine whether sexual dysfunction is caused by metformin, we rechallenged the patient with metformin 500 mg BD. After 15 days, he became impotent again, confirming that metformin was the most likely cause of his sexual problem. Metformin was stopped, and his sexual function returned to normal after 3 weeks. The adverse reaction is ‘probable’ according to the World Health Organization–Uppsala Monitoring Centre.
Metformin ; Erectile Dysfunction ; Diabetes Mellitus ; Sexual Dysfunction, Physiological

Introduction: Thalassaemia is a common genetic blood disorder. Knowledge, awareness, attitude towards, and intention to screen for thalassaemia among Malaysians is poor. Screening for thalassaemia in unmarried individuals plays a key role in preventing thalassaemia major births. Methods: A cross-sectional study was conducted on unmarried individuals aged 18 years and older in Kota Bharu, Kelantan, Malaysia. A questionnaire was used to collect the general data of the participants, their knowledge of thalassaemia, attitude towards thalassaemia, and intention to screen for thalassaemia. Results: A total of 278 respondents were included in this study. The mean (SD) knowledge score was 8.8 (4.99) out of a possible score of 21, with higher scores indicating better knowledge. The factor associated with good knowledge of thalassaemia was being a professional. Most respondents agreed that unmarried individuals should be screened for thalassaemia before marriage. Conclusion In conclusion, knowledge of thalassaemia among unmarried individuals who were not professionals was low.
Thalassemia ; Knowledge ; Attitude ; Intention