Introduction: Compliance with medical nutrition therapy is important to improve patient outcomes. The purpose of this study was to determine dietary compliance and its association with glycemic control among outpatients with poorly controlled type 2 diabetes mellitus (T2DM) in Hospital Universiti Sains Malaysia (HUSM). Methods: In this cross-sectional study, patients who had a glycosylated hemoglobin (HbA1c) level of at least 6.5%, after attending a diet counseling session at the Outpatient Dietetic Clinic, HUSM, were enrolled. Out of 150 diabetic patients reviewed between 2006 and 2008, 61 adults (32 men and 29 women) agreed to participate in this study. A questionnaire-based interview was used to collect socio-demographic, clinical and diabetes self-care data. The patient’s dietary compliance rate was determined by the Summary of Diabetes Self-Care Activities (SDSCA) measure. Anthropometric and biological measurements were also taken. Results: Only 16.4% of the respondents adhered to the dietary regimen provided by dietitians. Among the 7 dietary self-care behaviours, item number 6 (eat lots of food high in dietary fibre such as vegetable or oats) had the highest compliant rate (54.1%); whereas item number 3 (eat five or more servings of fruits and vegetables per day) had the lowest compliant rate (23.0%). There was a significant association between gender (p=0.037) and fasting blood sugar (FBS) (p=0.007) with the compliance status. Conclusion: Dietary non-compliance is still common among T2DM patients. Dietitians need to improve their skills and use more effective intervention approaches in providing dietary counseling to patients.

AlM:To report an unusual case of neuroretinits with coexistent Bell's Palsy.METHODS:A case report.RESULTS: A 16-year-old boy presented with right eye blurring of vision for one week. It was associated with high fever and facial asymmetry. The visual acuity of the right eye was 6/60 and the left eye was 6/6. Funduscopy of the right eye showed swollen and hyperemic optic disc with presence of macular star. There was also left lower motor neuron nerve palsy. Humphrey visual field perimetry showed small paracentral scotoma with enlargement of blind spot. Complete blood count showed neutrophilia with increased erythrocyte sedimentation rate (ESR). Serology for syphilis, toxoplasmosis, Lyme disease and cat-scratch disease was negative. Herpes simplex virus, Herpes zoster virus, and human immunodeficiency virus investigations were negative. Rickettsia was also negative. MRI of the brain and orbit were normal without demyelinating lesion. He was started with high dose intravenous methylprednisolone 250mg four times per day for three days. He was then discharged home with oral prednisolone 1mg/kg for another 11 days. During the follow-up,the visual acuity was improved to 6/6 after six months with slightly pale disc.The Bell's palsy was also improved without obvious facial asymmetry.CONCLUSION:It is important for clinician to examine other cranial nerces in optic neuritis. Although neuroretinitis with coexistent facial nerve in optic neuritis.Although neuroretinitis with coexistent facial nerve palsy is a rare conditon,thorough examinations and investigations should be made to exclude the inportant infetice causes.Optic neuritis with coexistent facial nerce palsy responds well to the high dose steroids.

We report a case of a healthy 78 -year- old indonesian man who presented with chronic weight loss, poor appetite and lethargy. CT abdomen showed bilateral adrenal masses. EUS – guided FNA was performed on the left adrenal gland. Histopathology report was Histoplasma Capsulatum. He recovered well with antifungal treatment without any complication. In this case, we found that the role of EUS – guided FNA was not only limited to diagnosis but also helped in the prognosis of the disease since the method was able to assess the general anatomy of the adrenal gland better than other imaging modalities due to its close proximity and direct visualization.

We report a case of a healthy 78-year-old indonesian man who presented with chronic weight loss, poor appetite and lethargy. CT abdomen showed bilateral adrenal masses. EUS-guided FNA was performed on the left adrenal gland. Histopathology report was Histoplasma Capsulatum. He recovered well with antifungal treatment without any complication. In this case, we found that the role of EUS -guided FNA was not only limited to diagnosis but also helped in the prognosis of the disease since the method was able to assess the general anatomy of the adrenal gland better than other imaging modalities due to its close proximity and direct visualization.

·AIM: To assess the biocompatibility of bovine bone as orbital implants in rabbits.·METHODS: Bovine bone graft was used as an ocular implant in rabbits to determine whether it could be successfully used in the anophthalmic socket as an alternative to the expensive synthetic alloplastics. Evisceration of eyes with and without bovine bone orbital implantation was performed in the right eyes of 12 New Zealand white rabbits.Group Y (n =6) was eviscerated without implant, meanwhile Group X (n =6) was eviscerated with insertion of an orbital implant using bovine bone. Observation was carried out on day 1, day 7, day 14, day 28 and day 42. Serial clinical examination was carried out based on a few fixed criteria,which included rate of infection, implant migration, evidence of wound breakdown and any restriction of intraocular movements. The implanted eyes were then enucleated on day 42. The enucleated eyes were sent for histopathological evaluation to record the type of inflammatory reaction and rate of fibrovascular ingrowth.·RESULTS: Serial clinical examination showed presence of minimal infection in all eyes, both in Group X implanted) and Group Y (control) on first postoperative day, which responded well with antibiotics. Infection occurred in the implanted group after first postoperative day, but there was no evidence of orbital migration or extrusion of implant, wound breakdown, restriction of extraocular movement, severe infection or any physical abnormality. Histopathological examination revealed good fibrovascular ingrowth in the implanted group, with minimal rejecting reaction of rabbit eye towards bovine bone implant.·CONCLUSION: This study shows that bovine orbital implant has a good biocompatibility in rabbit eyes and its cost is acceptable.

The Hypoglycaemia Symptom Rating Questionnaire (HypoSRQ) is potentially useful for local research on hypoglycaemia. However, it requires adaptation and validation in local settings. This study reports the process and results of cross-cultural adaptation and linguistic validation of HypoSRQ for Malay and English versions in our local setting. The HypoSRQ underwent forward and backward translation and adaptation with support from professional translators and a clinical psychologist. Cognitive debriefing was done among patients with Type 1 and Type 2 diabetes mellitus from varying sociodemographic backgrounds. Discussion was done together with the original developers of the HypoSRQ to decide on the best version for local use. The finalised versions were proofread and formatted with the help of Health Psychology Research. Cognitive debriefing for Malay version involved 7 patients and for the English version5 patients. Direct literal translation into Malay language was unsuitable due to technical terms which were difficult for laypersons to understand. Amendments were made based on findings from the cognitive debriefing process. Participants found the questionnaire fairly easy to understand. The HypoSRQ-My (Malay) and HypoSRQ-EMy (English) is easily understood by local participants. These tools may undergo psychometric evaluation for future use in local settings.
Diabetes Mellitus ; Surveys and Questionnaires

Open tibial fractures result in high rates of complications. This study aims to elucidate the risk factors causing these complications, and suggest antimicrobial regimens based on the organisms grown in post-operative infections. Over a period of five years, 173 patients had sustained open tibial fractures and undergone operative treatment at a single institution. All surgical data was gathered retrospectively through online medical records. Thirty-one patients (17.9%) had sustained post-operative bony complications, while infective complications were reported in 37 patients (21.4%). Patients with Gustilo type III fractures were found to be more than three times as likely to sustain post-operative infective (p=0.007) or bony (p=0.015) complications, compared to Gustilo type I or II fractures. The fracture location and time taken to fixation did not significantly affect the complication rate, but results were trending towards significance. The commonest cause of infective complications were hospital-acquired organisms, such as Methicillin-resistant staphylococcus aureus (40.5%). Closer monitoring of patients sustaining high grade Gustilo open fractures, as well as antimicrobial prophylaxis for both hospital-acquired organisms and environmental contaminants, will result in the best outcome for patients. Further studies with larger sample sizes are warranted, to determine the significance of fracture location and time taken to fixation on complication rates.
Tibial Fractures

A 7-year-old boy with a diagnosis of advanced medulloblastoma refractory to treatment was discharged from hospital for further palliative care at home. During this short and eventful period, the child developed spinal cord compression with progressive weakness of upper and lower limbs, neck pain, faecal and urinary incontinence. This case highlights the important roles of a primary care doctor in the provision of palliative care for a child in the community.

INTRODUCTIONThis study aims to identify the demographics and hygiene behaviours associated with contact lens (CL)-related microbial keratitis in Singapore.

MATERIALS AND METHODSThe hygiene and social behaviours of lens wearers presenting with infectious keratitis in Singapore were examined using an externally validated questionnaire. Fifty-eight consecutive lens wearers who presented with infectious keratitis at Singapore National Eye Centre were surveyed using a self-administered questionnaire. Patients' demographics, CL-related behaviour, attitude to aftercare visits and microbial study results were collected and analysed.

RESULTSMore than half (55%) of the patients surveyed were female, and the average age of the participants was 25.7 ± 6.4 years. Ninety-six percent of participants used soft CL, with the majority wearing monthly disposable lenses (74.1%). Myopia was the commonest reason for use of CL. CL overwear (81%), sleeping (50.9%) and swimming (33%) with their CL were the major non-compliant behaviours discovered. When encountered with eye discomfort as a result of lens-related infective keratitis, 83% of patients sought the advice of general medical practitioners prior to presentation at the hospital. Many (59%) patients have encountered media coverage but only 24% had any behavioural change as a result. Many patients relied on the recommendations of eyecare practitioners when purchasing disinfecting solutions (26%) and other hygiene practices. Pseudomonas Aeruginosa was the most common organism grown in 22.4% of patients while 47% of patients were culture-negative.

CONCLUSIONInadequate lens cleaning, poor aftercare, sleeping and swimming with CL were the major non-compliant behaviours among participants, and these are significant factors when assessing risks in acquiring CL-related infectious keratitis. General eyecare practitioners are the first-line of contact in patients presenting with keratitis symptoms and play an important role in emphasising the need for regular aftercare and good hygiene practices to CL wearers.

Abstract Hematospermia is a distressing disorder in sexually active men resulting in great concern to the patient. We report an unusual case of hematospermia with an atypical presentation, involving a 54-year-old man presented with acute urinary retention after sexual intercourse. Although the causes are widely known, arteriovenous malformation as the cause of this disorder has not much been reported in the literature. Transcatheter embolization of internal pudendal artery is a promising option for hematospermia caused by arterial fistula or bleeding.
Hemospermia