Tumour-induced osteomalacia is a rare paraneoplastic syndrome that manifests as chronic hypophosphataemia, non-specific bone pain and muscle weakness. It is generally caused by phosphaturic mesenchymal tumour (PMT), which is uncommonly associated with synchronous tumours. However, diagnosis is often delayed for several years due to the rarity, indolent growing nature and non-specific symptoms of the disease, often resulting in an overlook by clinicians during assessments. The patient initially presented with hypophosphataemia and generalised skeletal pain with multiple atraumatic fractures. Blood tests revealed serum calcium levels at the upper limit and extremely low inorganic phosphate levels. Herein, we report a case where two synchronous PMTs from two different sites were detected by ‘extended’ whole-body Ga-68 DOTATATE PET-CT, leading to remission of the disease after complete surgical removal. Early detection and diagnosis of PMT neoplasm is crucial, as complete surgical resection of this tumour is the only definitive treatment currently known. Upon excision, this curable disease will result in complete resolution of symptoms and blood parameters, leading to remission of the disease which significantly improves the patient’s quality of life. PMT often over-expresses somatostatin receptors (SSTR), predominantly subtype 2A, and Ga-68 DOTATATE PET-CT is a selective SSTR imaging that targets this characteristic over-expression in these tumours. The high diagnostic accuracy of Ga-68 DOTATATE PET-CT should be the primary imaging modality for full evaluation of this disease.

Introduction: Nursing education and training is known to be an inherently stressful experience and poses challenging demands for students. The aim of this study is to evaluate the stress levels among nursing students from different ethnic groups in Malaysia. Methods: This cross-sectional study recruited the January to February 2020 nursing students from a private university in Malaysia with a self-administered questionnaire. Participants’ level of stress was measured using the Perceived Stress Scale (PSS) developed by Sheu and colleague in 2002. Data collected were analyzed with, One-way ANOVA and Spearman analysis to determine the significant factors associated with stress. Results: Two hundred nursing students across years one to three enrolled. The mean monthly household (family) income was MYR4686.25 ± 4660.38. Stress was significantly associated with ethnicity and monthly household (family) income (p< 0.05). Bonferroni post-hoc test demonstrated that the mean stress level of Malay students is statistically significant compared to Chinese and Indian students (p< 0.001). The PSS determined the nursing students’ stress level to be moderate. Conclusion: The association of stress levels with ethnicity, and monthly household (family) income suggested the need for suitable cultural and sufficient financial support for nursing students to reduce their stress levels.