Introduction: Osteoarthritis (OA) is the main cause of knee pain. It also affects individual’s physical functioning. Anti- inflammatory drugs and knee replacement are the mainstay methods in the management of knee OA in Malaysia. However, patients with knee OA often suffer pain. The general objective of the study is to evaluate the effectiveness of a cognitive behavioural intervention module on knee pain, functional disability and psychological outcomes among knee OA patients attending Orthopedics Clinics in Hospital Putrajaya and Hospital Serdang, Malaysia. This study aims to determine the baseline level of knee pain and functional disability among knee OA patients. Methods: Baseline results on the knee pain and functional disability were obtained from a two arm parallel- group randomized controlled study. Three hundred patients aged 35 to 75 years diagnosed with knee OA were recruited. A set of pre tested and validated Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire was used in this study. Results: Mean baseline of KOOS pain was 56.09 (SD=21.75) and 52.26 (SD=22.08) for the intervention and control groups respectively. Participants in the intervention and control groups had a mean KOOS function in daily living of 61.11 (SD=21.20) and 56.72 (SD=22.13) respectively. Overall mean baseline of KOOS function in sport and recreation was 35.30 (SD=27.38). Conclusions: Majority of participants had moderate level of knee pain and functional disability in daily living. However, participants had more extreme symptoms of functional disability in sport and recreation. Therefore, interventions to reduce knee pain and functional disability symptoms in knee OA are needed.

Introduction: The Hedgehog (Hh) signalling pathway is a developmental signalling pathway involved in normal mammalian developmental and homeostasis of adult renewable tissues. In most adult tissues, this pathway remains silent and previous studies have shown that constitutive activation of Hedgehog signalling pathway leads to various types of malignancies including medulloblastomas, basal cell carcinoma, gastrointestinal, breast and prostate cancer. The purpose of this study was to investigate the immunohistochemical expression of Hedgehog pathway proteins in Diffuse Large B-cell Lymphoma and determine their association with overall survival (OS). Methods: Positive control using normal tonsils were included in each batch of immunohistochemical staining procedure. Results: PTCH1 proteins were highly expressed in DLBCL and showed strong staining intensity in 107 (100%) cases and SMO proteins were expressed in 105 (98.1%) cases. PTCH1 proteins were localised in the nucleus of tumour cells, whereas SMO proteins were mainly localised in the cytoplasm of tumour cells. Positive expression of PTCH1 and SMO proteins and overall survival of DLBCL patients were correlated with age, gender, race and tumour location. There was no significant correlation between the expression of these two proteins with any of the parameters. PTCH1 expression showed significant association with SMO expression (P=0.03). Conclusions: Our findings suggest that high expression of both PTCH1 and SMO may be important in the pathogenesis of DLBCL. However, additional mechanisms that may contribute to the activation of HH signalling in DLBCL needs to be further explored.

Introduction: Open globe injury may lead to devastating visual outcome. Urgent management and subsequent follow-up is important to maximise recovery. More data on open globe injury in Malaysia is needed to identify risk groups and prognostic factors. This study was carried out to investigate open globe injury, the socio-epidemic profile, clinical characteristics and outcome of the open globe injury in the Hospital Serdang, Malaysia. Methods: All patients managed for open globe injury to Hospital Serdang from January 2006 to December 2013 were included in this retrospective case review. Student’s T-test was used to determine difference between means and chi-square for categorical data. P value of less than 0.05 was regarded as statistically significant. Results: There were 155 patients managed for open globe injury with three of them had bilateral involvement. As such, there were 158 cases eligible for analysis in this study. The average age was 32.2 ± 16.5 years (mean ± standard deviation, SD). Male was at higher risk for open globe injury. Predictors for poor visual outcome were foreign nationality (p=0.047), lid laceration (0.008), type of injury (p=0.001), site of injury (p=0.008), RAPD (p<0.001), uveal prolapse (p<0.001), hyphaema (p=0.008), lens damage (p=0.010), vitreous loss (0.014), retinal detachment (p=0.011), intraocular foreign body (IOFB) (0.014) and poor presenting uncorrected visual acuity (UCVA) (p<0.001). Conclusions: Occupational injury was a main cause of open globe injury in Hospital Serdang. Although in general the visual outcome is good, effort should be put to prevent work-related injury.

Introduction: Suspicious adnexal masses need to be investigated thoroughly as it may represent ovarian cancer, which is the fourth most common gynaecological cancer in Malaysia. Conventional cross sectional imaging may reveal non-specific findings, thus lead to unnecessary biopsies. 18F-Fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) has emerged as a useful tool, for characterization of indeterminate adnexal masses. Most studies have been conducted in Western population, and little information is available in Asian population in general and Malaysian population in particular. Methods: Prospective study of women with suspicious adnexal masses, referred to the Centre for Nuclear Diagnostic Imaging, Universiti Putra Malaysia to undergo preoperative whole-body contrast-enhanced 18F-FDG PET/CT scans from January 2014 to January 2016. Subjects underwent Contrast-Enhanced Computed Tomography (CECT) scans followed by positron emission tomography (PET) scans using a hybrid scanner. Two radiologists analyzed the CECT and PET/CT images by consensus; blinded to the HPE results. Then the PET/CT findings were correlated with HPE results as the gold standard. Results: 11 wholebody PET/CT scans and 18 adnexal masses (12 HPE-proven malignant lesions and 6 benign lesions) were analyzed. The sensitivity, specificity, PPV, and NPV of CECT alone compared to PET/CT was 91.7%, 50.0%, 78.6%, and 75.0% vs. 91.7%, 100%, 100% and 85.7% respectively. Conclusions: Improved diagnostic accuracy for characterizing benign and malignant adnexal masses can be achieved using contrast-enhanced 18F-FDG PET/CT, making it a potential investigation of choice which can help in treatment planning.

Introduction: Self-harm is an important global health concern as it is a strong predictor and risk factor for completed suicide. This paper is aimed to estimate the incidence rate of self-harm and to describe the profiles of people who self-harmed in 2011. Methods: This is a descriptive study based on secondary data retrieved from the Ministry of Health (MOH) of Malaysia hospitals’ discharge records from the 1st of January to 31st of December 2011. Results: The overall self-harm rate was 16.6 per 100 000 population (n = 4 815). Adults in the state of Johor had the highest rate of self-harm. There were more female self-harmers within the peak age group of 20-29 years. Indians, Muslims and those who were unmarried had the highest rates of self-harm. Male mostly used unspecified chemical (45.89%) while female used non-opioid analgesics (24.79%). Conclusions: In 2011, the rate of self-harm was 16.6 per 100 000 population with slightly higher rate observed among adult females compared to males and twice as high among girls than boys. Less lethal methods of self-harm were employed.

Introduction: Microbial keratitis (MK) is an important cause for corneal blindness and understanding its risk factors enable us to improve management and minimise its complications. Methods: In this retrospective case review, medical records of all patients treated for MK from 2006 to 2013 was analysed to know the socio-demography, preceding risk factors, clinical characteristics, causative organisms and final visual outcome. Results: A total of 174 patients (180 eyes) were included in this study. Identifiable ocular risk factors included contact lens (CL) usage (85, 47.2%), ocular trauma (50, 27.8%), ocular surface disease (21, 11.6%), steroid use (6, 3.3%) and immuno-compromy (19, 10.5%). Association factors for presenting uncorrected visual acuity (UCVA) were age group (p=0.013), size (p<0.001), location (p<0.001) and hypopyon (p<0.001). The predictors for final best spectacle-corrected visual acuity (BSCVA) were age group (p<0.001), nationality (p=0.020), occupation (p<0.001), CL use (p<0.001), ocular surface disease (p=0.048), size (p<0.001) and location (p<0.044), hospitalisation duration (p=0.002) and presenting UCVA (p<0.001). Conclusions: Contact lens was the most frequent predisposing risk factor for microbial keratitis, followed by ocular trauma. Understanding the association factors for presenting vision and predictors for final vision may help in the patients’ management and improve eventual outcome of microbial keratitis.

Free light chains (FLCs) are tumour markers of monoclonal gammopathies. Detection of urinary FLC or also known as Bence-Jones protein through urinary protein and its immunofixation electrophoreses (UPE and uIFE, respectively) have been considered the gold standard for its biochemical diagnosis. This is mainly due to their superior detection limits compared to their counterpart investigations in serum. However, urinalysis is limited in many ways. The emergence of serum FLC assay with markedly improved detection limit circumvents many of these problems and has gained much importance in biochemical investigations of monoclonal gammopathies. Nevertheless, they are not without limitations. This review discusses the advantages and limitations of serum and urinary FLC assays.

Multiple myeloma is a blood dyscrasias that accounts of almost 10% of all hematological malignancy. The presentation of myeloma kidney is highly variable and it often presents as renal insufficiency, renal tubular dysfunction and proteinuria of various types. In Malaysia the true incidence of myeloma kidney is unknown. Often the diagnosis of myeloma kidney was missed out despite the patient has sought medical treatment early. A high index of suspicion is required when the middle to elderly age patients present with unexplained renal impairment and enlarged kidneys. We present here the presentation of a rare subtype of myeloma in a relatively young patient whereby the patient presented with nephrotic syndrome and azotemia.

Enterobacter gergoviae is a gram negative rod-shaped opportunistic organism reported to cause urinary and respiratory tract infections, but peritonitis caused by this organism is unknown. We report a case of 50-year-old patient on peritoneal dialysis (PD) presented with Enterobacter gergoviae peritonitis with septic shock. Despite Intraperitoneal (IP) cloxacillin 250mg qid and IP ceftazidime 1gram q24h and subsequent escalation with IP amikacin 2mg/kg q24h and IP vancomycin 15mg/kg q24h within the next 48 hours, his peritonitis remained refractory and required catheter removal. Although Enterobacter gergoviae is naturally sensitive to aminoglycosides, carbapenems and quinolones, it reacts differently to the beta lactam antibiotics. Their resistance to third-generation cephalosporins is fast emerging and treatment with third-generation cephalosporins may cause AmpC-overproducing mutants. The majority of Enterobacteriaceae, including Extended-spectrum beta-lactamases producers, remain susceptible to carbapenems. Our report provides an unfavourable course of E. gergoviae peritonitis likely due to acquired secondary drug resistance during the therapy period.

Intraductal Papillary Mucinous Neoplasm (IPMN) of the pancreas in association with Autosomal Dominant Polycystic Kidney Disease (ADPKD) is extremely rare, even though 10% of ADPKD patients may develop simple pancreatic cyst. The first case report was published by Yasunori Sato from Japan in 2009. Since then less than 10 case reports are available worldwide to describe about this condition. We reported such a rare case of a 67-year-old man with ADPKD who was referred to our centre because of chronic abdominal pain and diagnosed as IPMN based on the serial imaging procedures. Despite of the high risk comorbidities, he successfully underwent pylorus preserving total pancreaticoduodenectomy with splenectomy.