Sacroilliac joint diasthesis from high energy trauma is always complicated with chronic pain and long term morbidity. Open anterior stabilisation with plate allow direct reduction and stabilisation with biomechanically advantages. Here we report on four cases of pelvic injury with sacroiliac joint disruption treated with anterior plate stabilisation through a surgical approach similar to that used for anterior ring fractures.

Aim: This study was to determine the antibacterial activity of Melastoma malabathricum stem bark acetone extract (MMSBAE) against Streptococcus mutans. Methodology and results: Antibacterial activity of the extract was determined by minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), biofilm formation, adherence inhibition, time kill studies and effect on S. mutans membrane integrity. MIC and MBC values of MMSBAE were 1.25 and 5 mg/mL, respectively. Time kill studies showed that reduction of colony forming unit in treated cells is 3 log10 after 10 h of treatment (p ˂ 0.05). The extracts reduced 50% biofilm and adherence activity of S. mutans at 1.88 mg/mL. The effect on S. mutans membrane integrity after exposure to MMSBAE for 90 and 120 min was determined by measuring leakage of cell content at 2 different wavelengths of 260 nm and 280 nm. In leakage assay, the percentage of absorbance (260 nm) in treated cell material showed 57% at 90 min and 60% at 120 min which is higher than negative control (<20%) but less than positive control (100%). The percentage absorbance of treated cell material (280 nm) was 61% at 90 min and 63% at 120 min. Identification of compound in MMSBAE was done by gas chromatography mass spectrometry (GCMS). Ten compounds were identified in the MMSBAE with some of them important in antimicrobial activity such as ethyl ester, undecene, and gamma sitosterol. Conclusion, significance and impact of study: MMSBAE showed excellent bactericidal and antibacterial activities against S. mutans. The antibacterial mode of action of MMSBAE is suggested to be the disruption of the S. mutans membrane structure. The MMSBAE significantly inhibited biofilm and adherence activities of S. mutans in dose dependent manner (p ˂ 0.05). MMSBAE has potential in the development of antibacterial agent with anti-biofilm and anti-adherence activities.

Oncocytic carcinoma of the salivary gland is an uncommon tumour in the head and neck region. Owing to its rarity, identifying the histopathological features of a malignant tumour can be difficult and challenging. We report a case of a 70-year-old man who presented with a left facial weakness for six months in a background history of left parotid swelling over the past 10 years. Clinical examination revealed a 3x3cm left parotid mass and grade 4 facial nerve palsy. Fine needle aspiration of the mass showed scattered cohesive, monolayered sheets of uniform oncocytic cells. Subsequently, a left total parotidectomy and selective neck dissection were performed. Histological examination showed sheets of small oncocytes with minimal nuclear atypia. Evidence of nerve entrapment, capsular invasion and perivascular permeation were identified in focal areas. Thus, a final diagnosis of oncocytic carcinoma was rendered.

Coughing is an important reflex mechanism which enhances the clearance of secretions and particulates from the airways, however repetitive muscle strain due to prolonged coughing may cause the uncommon complication of stress fracture of the ribs. The following is an unusual case of cough induced multiple rib fractures associated with subcutaneous emphysema and pneumothorax which was missed in the emergency setting. Delayed diagnosis and treatment would have been avoided if this uncommon condition was considered as a possibility

Background and aims: Forest bathing or Shinrin-Yoku is a practice of being mindful of nature and it offers multiple health benefits in both physiological and psychological factors. This study aimed to determine the knowledge and attitude of Universiti Kebangsaan Malaysia (UKM) medical students towards forest bathing and its relationship with the sociodemographic factors. Materials and methods: A total of 165 UKM medical students were recruited using proportionate random sampling. The subjects were then categorized based on the academic year (Year 1 - Year 5). Exclusion criteria includes those who deferred their academic year and/or who were hospitalized. A questionnaire was given via a google form consisting of sociodemographic data details and 15 questions for each knowledge and attitude on forest bathing. Results: The prevalence of good knowledge and good attitude of UKM medical students towards forest bathing were 64.2% (n=106) and 50.9% (n=84) respectively. Female medical students had a good knowledge (n=63, 73.3%) and good attitude (n=52, 60.5%) compared to male medical students' knowledge (n=43, 54.4%) and attitude (n=32, 10.5%) leading to a p-value of 0.012 and p-value of 0.010. Otherwise, other sociodemographic factors including race, level of medical year and level of lifestyle did not affect participants' knowledge and attitude on forest bathing. Conclusion Majority of UKM medical students have a higher prevalence of good knowledge compared to good attitude on forest bathing. Therefore, intervention is recommended especially towards male medical students as forest bathing has enough evidence as preventive medicine.

Introduction: Infected diabetic foot ulcers may lead to serious complications if not recognised in the early stage. Diagnosis of infection is particularly challenging at that stage; thus, a sensitive inflammatory biomarker may be helpful. We aimed to evaluate the role of procalcitonin (PCT) as an early biomarker for infected diabetic foot ulcers (IDFU). Materials and method: This cross-sectional study was conducted at Klinik Rawatan Keluarga (KRK), Orthopedic clinic and wards in Hospital Universiti Sains Malaysia (USM) from May 2020 to December 2020. A total of 264 participants were recruited and divided into three groups: 50 diabetic patients with no ulcers (control), 107 patients with non-infected diabetic foot ulcers (NIDFU), and 107 patients with infected diabetic foot ulcers (IDFU). The level of PCT was taken for all patients. Total white count (TWC) and Creactive protein (CRP) were taken only for IDFU patients. Diagnosis of infection was based on the Infectious Disease Society of America-International Working Group of Diabetic Foot (IDSA-IMWGDF), and the severity of infection was graded according to the Wagner Classification. Results: The level of PCT was higher in IDFU than in NIDFU and diabetic patient, with a median (IQR) of 0.355 (0.63) ng/mL, 0.077 (0.15) ng/mL and 0.028 (0.02) ng/mL, respectively. PCT and CRP showed moderate positive correlations in IDFU patients (p<0.001). The sensitivity and specificity were 63.6% and 83.2%, respectively, at the best cut-off at 0.25 ng/mL. Conclusion: PCT is a valuable biomarker for the diagnosis of infection; however, it adds little value in the early diagnosis of IDFU in view of its low sensitivity.