White coat hypertension (WCHT) and white coat effect (WCE) are often thought to be of the same entity. They are in fact different conditions which carry distinctive definitions and prognostic significance. WCHT is diagnosed when office blood pressure (OBP) is ≥140/90 mmHg on at least 3 occasions, while the average daytime or 24-hour blood pressure is <135/85 mmHg. It is common with 15% prevalence in the general population and may account for over 30% of individuals in whom hypertension is diagnosed. Although individuals with WCHT were reported to have a better cardiovascular (CV) prognosis when compared to those with sustained hypertension and masked hypertension; they were also shown to have a greater prevalence of target organ damage (TOD) and metabolic abnormalities than that of normotensive subjects. In contrast, WCE is defined as the transient elevation of OBP induced by the alerting response to a doctor or a nurse. WCE can occur in both normotensive and hypertensive persons; and is not substantially influenced by reassurance and familiarisation. There is conflicting evidence with regards to prognostic significance of WCE, where most data indicated that it does not predict future TOD, CV morbidity or mortality; with some studies showed otherwise. This case scenario aims to solve the diagnostic perplexity with regards to WCHT and WCE, followed by an evidence-based commentary of how to best manage such conditions.

Complications of breast cancer metastasis may be the first manifestation of the disease. We report a rare case of left eye ptosis secondary to cavernous sinus syndrome in a 34-year-old lady due to refusal of proper medical treatment for metastatic breast cancer. The delay in seeking medical treatment was attributed to her use of Traditional Chinese Medicine (TCM).

This is a retrospective descriptive study of the chest imaging findings of 118 patients with confirmed A(H1N1) in a tertiary referral centre. About 42% of the patients had positive initial chest radiographic (CXR) findings. The common findings were bi-basal air-space opacities and perihilar reticular and alveolar infiltrates. In select cases, high-resolution computed tomography (CT) imaging showed ground-glass change with some widespread reticular changes and atelectasis.

We report a rare case of a young boy presenting with bilateral blurring of vision following a viral like illness. Fundus examination revealed multiple pale cream-coloured lesions scattered across the posterior pole of both eyes. Fundus fluorescein angiography showed characteristic features of early hypofluorescence and late hyperfluorescence, further confirming the diagnosis of acute posterior placoid pigment epitheliopathy (AMPPPE). He was treated with topical steroids for the accompanying mild anterior uveitis. He had a prompt visual recovery with no adverse sequelae.
Posters [Publication Type] ; Viral ; Acute ; Pigments ; After values

Magnetic Resonance-guided focused Ultrasound Surgery (MRgFUS) is gaining popularity as an alternative to medical and surgical interventions in the management of symptomatic uterine fibroids. Studies have shown that it is an effective non-invasive treatment with minimal associated risks as compared to myomectomy and hysterectomy. MRgFUS can be offered to a majority of patients suffering from symptomatic uterine fibroids. It has been suggested that the use of broader inclusion criteria as well as the mitigation techniques makes it possible to offer MRgFUS to a much larger subset of patients than previously believed. This paper will describe how MRgFUS treatment for uterine fibroids is performed at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

Measles virus causes three distinct neurological syndromes: acute disseminated encephalomyelitis, subacute sclerosing panencephalitis and the rare subacute measles encephalitis, or inclusion body measles encephalitis. There is a current debate of whether subacute measles encephalitis is an opportunistic infection or a subacute infection caused by a mutated measles strain. There is also no report of long term MRI of survivor. We reported a young Chinese girl with a history of relapsed acute lymphoblastic leukaemia and subacute measles encephalitis confirmed by brain biopsy who survived. Serial magnetic resonance imaging of the brain showed cortical and basal ganglial involvement in the initial phase, and generalized cerebral atrophy in the subsequent scan four and a half years later. The patient recovered from subacute measles encephalitis with substantial neurological deficits with the cessation of maintenance chemotherapy without specific antiviral treatment. This suggested that reconstitution of host immunity was adequate in effecting the clearance of the virus, and supporting the hypothesis that subacute measles encephalitis is primarily an opportunistic infection.

Background: The high prevalence and impacts of orofacial pain (OFP) have caused major sufferings to individuals and society. The purpose of the study was to investigate the problems and impacts of OFP among a group of Malaysian aborigines. The objectives were to determine (i) the prevalence, aetiology, duration, severity, types and persistence of OFP during the past 3 months preceding the study; (ii) its associated impact on daily performance; and (iii) the measures taken for pain relief. Methods: This is a cross sectional study carried out in Kuala Lipis, Pahang involving 6 villages of Orang Asli Bateq and Semai. Study sample was chosen using convenient sampling including adults aged 16 years and above. Participants were invited for an interview using structured questionnaire followed by clinical examination. Data analysis was carried out using SPSS ver12. Results: Response rate was low at 20% (n = 140). Over one-quarter (26.4%) of the sample experienced OFP in the previous 3 months. Toothache was found to be the main aetiology (83.3%) followed by gingival pain (18.9%), temporomandibular joint (10.8%) and facial pain (8.1%). Mean duration of pain was 9.8 days for toothache, 162.4 days for gingival pain, 7.3 days for TMJ and 5.7 days for facial pain. Of those who had OFP, over half rated the pain as moderate (37.8%) and severe (29.7%) and most of the pain was ‘intermittent’ in nature (81.1%). Over half (62.2%) admitted the pain had disappeared during the interview. In terms of pain relief, 56.8% of the sample used traditional medicine. The pain had impacted on the chewing ability (70.3%, p=0.01), ability to sleep at night (73.0%, p<0.001), levels of anxiety (70.3%), ability to perform daily chores (33.3%) and social life (35.1%) of the Orang Asli sample. Conclusion: This study suggests the prevalence of OFP was high among the Orang Asli sample, which imposed considerable physical and psychological impacts on daily life.

Melioidosis is a disease of public health importance associated with high case-fatality rates in animals and humans caused by Burkholderia pseudomallei (B. pseudomallei), a gramnegative bacterium that lives in tropical soil environments. This study determined the seropositivity for melioidosis among patients admitted to healthcare centres in Malaysia, from 2015 to 2019 and identified factors related to it. A total of 26,665 serum samples of suspected melioidosis patients from Malaysia hospitals were tested for IgM against B. pseudomallei. About 16.4% of total samples were seropositive and majority of them were 55 years old and above. However, younger people aged less than 15 years old were the most susceptible to the infection (AOR 3.04, p <0.001, 95% CI: 2.73, 3.39). Melioidosis infection was the highest in Sarawak (15.1%) while Perlis was the least exposed to the infection (0.9%). Further analyses showed that patients with chronic lung disease (adjusted OR: 4.03, p < 0.001, 95% CI: 2.77, 5.86) were more susceptible to melioidosis infection. In conclusion, although serology testing is not a gold standard test in diagnosing melioidosis, it has been used as a tool in treatment monitoring and disease surveillance among patients and at-risk community in the endemic hot-spots regions.

Background: Most postpartum women are prescribed at least one medication; so the safety of the medication is a major concern. In 2017, 11% of 815 questions received by the Pharmacy Drug Information Services at seven clinics in Dungun is related to medication use in breastfeeding. Thus, this study was carried out to evaluate the attitudes of healthcare providers (HCPs) and to investigate the effect of knowledge about medication use in breastfeeding among HCPs; pre- and post-educational intervention.Methods: An interventional study was carried out among medical officers, assistant medical officers, pharmacists and pharmacist assistants from seven clinics in the district of Dungun, Malaysia. The questionnaires were distributed during pre- and post-intervention period. The interventions in this study included continuous medical education (CME) and the use of a booklet regarding medication use for breastfeeding women. The data collected were analyzed using Statistical Package for Social Studies (SPSS) and presented as frequencies, means, and standard deviations.Results: Fifty HCPs were enrolled in this study and over 20% of them advised mothers to discontinue breastfeeding whenever they are prescribed any medication. The knowledge of HCPs about medication use in breastfeeding women was significantly improved (Z= -5.917, p<0.001) following the educational intervention.Conclusion: CME and a simplified booklet appeared to have a positive impact on the knowledge of HCPs regarding medication use in breastfeeding