Tobacco induced illness remains a major contribution to premature death and global burden of diseases. The introduction of MPOWER policies by World Health Organization held the value to monitor the implementation of the anti-smoking measures in all signatory countries. This paper aimed to investigate the application of the six MPOWER indicators among Malaysia population. Methods: We utilized the data of Global Adult Tobacco Survey-Malaysia (GATS-M) which recruited 5112 nationally representative samples of Malaysians of 15 years old and above. Descriptive statistical analysis was used to illustrate the social demographic characteristic of the respondents while cross tabulation was employed to describe all elements of the MPOWER indicators. Results: About one quarter (23.1%) of Malaysian adults were current tobacco users. The SHS exposure at home (38.4%) and restaurant (42.1%) were high. Approximately eight in ten (80.2%) of the smokers intended to quit, while for those attempted to quit in past one year, 9.0% utilized pharmacotherapy and 4.4% attended counseling. The awareness about tobacco related diseases was generally excellent. The overall tax make up of the cigarettes’ retail price ranging from 41.7% up to 80%. Conclusion: Tobacco consumption remains prevalent and plateau among Malaysian adults over the last two decades with substantial proportion of the population exposed to SHS. The inadequacy in the current anti-smoking policies needs urgent improvement in order to reduce the smoking norms among Malaysians population besides to achieve the ultimate goal of tobacco control end game by year 2045.

A young lady presented with recurrent abdominal distention and pain. Over the past few years, she had been admitted several times with similar complaints. Each time the symptoms settled with conservative management. Abdominal radiography (Panel) on admission is shown above. What does the radiograph show and what is the syndrome ? Answer: refer to page 187 Images of Interest Brunei Int Med J. 2011; 7 (3): 165 Correspondence

(Refer to page 165) Answer: Chilaiditi’s sign and Chilaiditi’s syndrome Chilaiditi’s sign is defined by the asymptomatic interposition of part of the intestine (commonly the hepatic flexure of the colon) between the right hemi-diaphragm and the liver. It is usually an incidental finding. When symptomatic, it is referred to as the Chilaiditi’s syndrome. Presentations may range from intermittent recurrent mild abdominal pain to acute intestinal volvulus, though the symptoms reported so far have been inconsistent between different patients and can be nonspecific.

A young lady was evaluated for chronic iron deficiency anaemia and a long history of intermittent dysphagia especially to solids. The dysphagia had been more prominent in the previous few months. There was no history of menorrhagia. Apart from pallor and mild koilonychias, physical examination was unremarkable. She underwent a barium swallow (panel) and an abnormality was detected. What is the diagnosis? Answer: refer to page 236

(Refer to page 208) Answer: Plummer-Vinson or Patterson-Kelly-Brown Syndrome Plummer-Vinson syndrome (PVS) is defined as a triad of upper oesophageal web (or ring), dysphagia and iron deficiency anaemia (IDA). It was first reported in the early twentieth century, and is also widely known as the Patterson- Kelly-Brown syndrome (PKBS) or sideropenic anaemia with epithelial lesions.

Objective To discuss the features and surgical management of ectopic hyperparathyroidism.Methods Clinical data of 66 cases of ectopic hyperparathyroidism were retrospectively analyzed.Results There were 66 cases of ectopic hyperparathyroidism accounting for 11.5％ (66/575) of all ectopic hyperparathyroid cases admitted during the period from 1982-2010.Prevalence of mediastinal ectopic lesions was 71.2％ (47/66),among those 65.2％ (42/66) was in anterosuperior mediastinum,and 28.8％ (19/66) in the non-typical loci of the neck.Radionuclide imaging of parathyroid glands was the most sensitive (87.0％) method among all common positioning examinations.Average number of operation episode was 1.47,and all lesions were finally resected.After surgery 49 cases presented with transient hypocalcemia,and were cured by calcium administration.52 cases were followed up,with recurrent hyperparathyroidism in 1 case.Conclusions Diagnosis and treatment of ectopic hyperparathyroidism are dependent on the understanding of common locations of ectopic parathyroid glands.Preoperative correct location and surgical expertise are helpful for successful resection.