MOHs micrographic surgery is a technique of microscopic margin control in the surgical management of skin cancers particularly at cosmetically sensitive sites. This review article is aimed at sharing our initial experience of performing MOHs surgery for skin cancers in Malaysia since 2015.

Background: An association of bullous pemphigoid with neurological disorders has been reported. The objectives of this study were to review the clinical characteristics of patients with bullous pemphigoid and compare the association between bullous pemphigoid and various neurological disorders and comorbidities. Methods: This was a retrospective case-control study involving 43 patients with bullous pemphigoid and 43 age-, sex- and ethnicity-matched controls. Results: There was a statistically significant association between bullous pemphigoid and neurological disorders [Odds Ratio (OR) = 3.5, 95% Confidence Interval (CI) 1.3 to 9.2, p=0.011 and adjusted OR=3.5, 95% CI 1.2-10.3, p=0.026], in particular for dementia (p=0.002). Although stroke was more common among patients with bullous pemphigoid, this association was not statistically significant with OR of 1.9 (95% CI 0.7 to 5.2) and adjusted OR of 2.1 (95% CI 0.6 to 7.2). Similarly both ischaemic stroke (OR 1.5, 95% CI 0.5 to 4.2) and haemorrhagic stroke (OR 1.5, 95% CI 0.2 to 9.7) were more common. Other neurological disorders more common among patients with bullous pemphigoid were Parkinson’s disease and epilepsy. Dyslipidaemia was significantly less common among patients with bullous pemphigoid (OR 0.4, 95% CI 0.1 to 0.9, p=0.033). Conclusion: A combination of an inflammatory process, prothrombotic state and endothelial activation leads to an increased frequency of neurological disorders among patients with bullous pemphigoid. Thus, a holistic approach to patient care, including screening for dementia and control of comorbidities, should be practised as bullous pemphigoid affects more than just the skin.
Pemphigoid, Bullous

Family engagement should be part of a holistic management of any patient. This is especially so in patients who have an acute change in their health condition or function that stresses their social setup. Conducting a family conference is one of the many ways to engage patients and their caregivers and address their bio-psycho-social needs. It is a focused and purposeful approach that engages every member of the health care team and family members in facilitating a common understanding and decision-making with the aim of improving patient care and outcome. A family conference is resource intensive, and should be planned well to maximise the goals that it was set out to achieve. This article was written as a primer to help family physicians understand the indications, preparations needed, and steps to take in conducting a family conference. To facilitate a family conference confidently is a skill and an art that requires practice and constant refinement.

Introduction: Steven-Johnson syndrome and Toxic Epidermal Necrolysis are rare but life threatening severe cutaneous adverse reactions to drugs. To determine the epidemiology of SJS, TEN and SJS/TEN overlap in University Malaya Medical Centre (UMMC). Methods: All patients admitted to UMMC from year 2013-2015 for SJS, SJS/TEN, TEN were recruited. The classification of SJS, SJS/TEN overlap and TEN was made based on the criteria laid down by Bastuji et al.2 Results: A total of 32 patients were recorded to have SJS, SJS/TEN overlap and TEN from 2013 to 2015. Drugs (n=32, 86.49%) remained the most common aetiology of SJS and TEN. The top three commonest drugs are allopurinol (n=6), followed by carbamazepine (n=5) and bactrim (n=3). Conclusion: This study demonstrates that drugs were the most common cause of SJS/TEN. Antibiotics were the most common drug group that caused SJS/TEN. Awareness of the common etiology such as drug is important and high index of suspicion of SJS and TEN is needed if patients were on the above medications.

Chickenpox may lead to several neurological complications. Optic neuritis is one of the complications which has rarely been described, especially in immunocompetent individuals. We report a case of an 11-year-old immunocompetent girl who presented with sudden onset bilateral vision loss three weeks after varicella eruption. Ophthalmic examination revealed bilateral optic disc edema. Diagnosis of bilateral optic neuritis secondary to varicella was established based upon the preceding medical history, supported with clinical and radiological fndings.

Iron deficiency (ID) has recently been identified as a threat to patients with heart failure with reduced ejection fraction (HFrEF). This study was conducted to determine the occurrence of ID among HFrEF patients in a Malaysian tertiary hospital and its correlation between left ventricular ejection fraction (LVEF). Methods: Stable patients with LVEF less than 45% were included. Demographic data, LVEF (Simpsons) and cardiac functional status were studied, along with full blood count and iron profile. Results: 81 patients with a mean LVEF of 33.6% were recruited. 43.2% of them were NYHA class II patients, followed by 38.3% class III, 13.6% class I and 4.9% class IV patients. About 2/5 of the study population were anaemic, and of those, 48.5% were iron deficient. Majority of these anaemic patients (87.5%) had an absolute iron deficiency. Pearson’s statistical analysis showed positive correlation between ejection fraction and serum ferritin (r=0.624, p< 0.001), serum iron (r= 0.302, p<0.05), transferrin saturation (r= 0.346, p<0.001) and haemoglobin (r=0.528, p <0.001). Among the HFrEF patients, mean LVEF of those without anaemia and without ID were the highest (35.75+4.35%), followed by anaemic patients without ID (31.71+4.47%) and anaemic patients with ID (28.94+2.57%). There was also a trend showing that anaemic patients with ID were associated with higher NYHA functional class. Conclusions: ID is correlated with HFrEF in this single tertiary centre of a developing country. Further studies are needed to explore this potential nutritional therapeutic target that may be used in the updates of existing advisory.

Background: Stem cell research has been extensively explored worldwide to enhance human health in medical setting. Nevertheless, there is currently no full understanding of the stem cell knowledge and attitude levels among student nurses in Malaysia. This study aimed to assess the level of stem cell knowledge, attitude toward stem cell application in medicine, and its association with years of education, among Universiti Sains Malaysia (USM) undergraduate nursing students. Methods: A cross-sectional study (n = 88) was conducted using self-administered questionnaire consisted of demographic information, stem cells knowledge and attitude statements. Data was analysed using Statistical Package Social Software 20.0. Results: The majority of participants (92%) had moderate knowledge score about stem cells. Many students (33%) worried that stem cell application might cause a harm to humanity yet had a positive (76.1%) attitude towards its therapeutic potential (45.5%). Poor correlation between knowledge and attitude (r = 0.08) indicated that acceptance towards stem cell is not solely based on the knowledge level but also on other factors including religion and culture. Conclusion: Therefore, this study suggests that various educational programs on stem cell should be implemented considering the religion, cultural, social, and behavioural determinants in the population to improve stem cell knowledge and encourage a more positive attitude towards stem cells in medicine among these nursing students.

We report a rare case of adult human metapneumovirus(HMPV) in a healthy 32-year-old man. There was dramaticdeterioration in his condition developing pneumonia withType-I respiratory failure and encephalitis. He neededmechanical ventilation in the intensive care setting and wastreated with intravenous ribavirin. Post-extubation heremained severely physically and cognitively impaireddespite rehabilitation. Treatment of HMPV pneumonia is atpresent, still without specific antiviral therapy. ManagingHMPV-encephalitis remained supportive and challenging.More definite treatment strategies are needed.

Anti-Bacterial Agents ; adverse effects ; Humans ; Hyperpigmentation ; chemically induced ; pathology ; Male ; Middle Aged ; Minocycline ; adverse effects