RECURRENT UROSEPSIS DUE TO NEPHROCOLIC FISTULA IN AN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE Nephrocolic fistula is an abnormal communication between the kidney and the colon, a rare clinical phenomenon with potentially serious complications. We present a case of a 37-year-old female with autosomal dominant polycystic kidney disease who complained of left lumbar pain, fever and urinary frequency. She had multiple similar presentations for years, refractorily treated for recurrent urinary tract infections. Contrast-enhanced computed tomography abdomen demonstrated bilateral staghorn calculi and perinephric abscesses connected to the descending colon. She eventually required surgical intervention after the failure of medical therapy. Our case highlights the diagnosis and management of nephrocolic fistula.

Objective: This study aims to report the demographic features of patients with acromegaly the disease burden, and the corresponding treatment patterns and outcomes in Malaysia. Methodology: This is a retrospective study that included patients from the Malaysian Acromegaly registry who were diagnosed with acromegaly from 1970 onwards. Data collected included patient demographics, clinical manifestations of acromegaly, biochemical results and imaging findings. Information regarding treatment modalities and their outcomes was also obtained. Results: Registry data was collected from 2013 to 2016 and included 140 patients with acromegaly from 12 participating hospitals. Median disease duration was 5.5 years (range 1.0 – 41.0 years). Most patients had macroadenoma (67%), while 15% were diagnosed with microadenoma. Hypertension (49.3%), diabetes (37.1%) and hypopituitarism (27.9%) were the most common co-morbidities for patients with acromegaly. Majority of patients had surgical intervention as primary treatment (65.9%) while 20.7% were treated medically, mainly with dopamine agonists (18.5%). Most patients had inadequate disease control after first-line treatment regardless of treatment modality (79.4%). Conclusion This registry study provides epidemiological data on patients with acromegaly in Malaysia and serves as an initial step for further population-based studies.
acromegaly ; treatment outcomes

Introduction: We clarified the extent to which white rice (WR)-based carbohydrate diets affect body weight and metabolic parameters in rats. Methods: In this experimental study, a male Sprague Dawley (n=32) rats fed with WRbased CHO diet in two different proportions of total energy intake (TEI 55% moderate-CHO (MCHO, n=8) and 65% High-CHO (HCHO, n=8)) or high-fat diet (HFD, n=8) were compared with rats maintained on standard pellet diet (SD, n=8) for eight weeks period. Carbohydrate sources in the HFD and SD were mainly based on cornstarch (25% of amylose). Outcomes measures include body weight and metabolic parameters. Results: At baseline, body weight and metabolic parameters (fasting plasma glucose, insulin, and triglyceride levels) were comparable in all rats. Despite higher daily caloric intake in rats fed with HFD (103.9±3.0) than the other diets, no significant differences in body weight between groups after 8 weeks of study. However, rats’ feds with WR-based CHO diets (both moderate and high carbohydrates) had higher fasting blood glucose (MCHO=12.8±1.6, HCHO=16.9±2.4) and triglycerides level (MCHO=1.2±0.0, HCHO=1.3±0.0) than rats in cornstarch-based HFD and SD (p<0.05). Both HFD and HCHO had higher fasting insulin than MCHO and SD (p<0.05), but the homeostatic model assessment of insulin resistance (HOMA-IR) was significantly higher in WR-based CHO diets (both moderate and high carbohydrates) than the rats in cornstarch-based HFD and SD (p<0.05). Conclusion: A WR-based CHO diet exhibits higher fasting blood glucose, triglycerides, and insulin resistance state than a high-fat diet without a significant impact on body weight. These findings may explain the growing incidence of diabetes in Asia and worth studying further.

Liposomes are phospholipid bilayer vesicles, which are biocompatible, biodegradable and nontoxic vehicles suitable for numerous drug and gene delivery applications. In this review, we discuss the prospect of using liposome technology in the development of a vaccine for tuberculosis. Tuberculosis remains an important health problem that requires the development of an effective vaccine, especially since the only approved vaccine for it continues to be the Bacille Calmette-Geurin (BCG) one developed 100 years ago. This review focuses on the different applications of liposomes toward achieving this goal. Numerous liposomal formulations showing prospect in the research stage and in clinical trials are discussed.

Objectives: A history of severe hypoglycemia (SH) is associated with cardiovascular (CV) events among patients with type 2 diabetes mellitus (T2DM). In this study, we compared the severity of atherosclerotic coronary artery disease (ACAD) in T2DM patients with and without a history of SH. Methodology: We conducted a comparative case-control study involving 28 T2DM patients with a history of SH within the last 5 years with no documented ACAD, and matched them with 28 T2DM patients with no history of SH. All subjects underwent coronary artery calcium scoring (CACS) with or without coronary computed tomographic angiography (CCTA) to evaluate the severity of ACAD. Results: A history of SH in T2DM was associated with a higher prevalence of significant ACAD (79% versus 46%, p=0.026). A high CACS (≥100) was seen in a greater number of patients with a history of SH compared to those without (75% versus 43%, p=0.029). Similarly, there was a higher prevalence of obstructive CAD in those with a history of SH compared to those without (72% versus 39%, p=0.036). Median C-reactive protein level was also higher among patients with a history of SH (0.41 mg/dL versus 0.16 mg/dL, p=0.029). Conclusion In patients with T2DM, a history of SH is significantly associated with ACAD compared to those without SH. A history of SH warrants screening for ACAD.
Hypoglycemia ; Coronary Artery Disease ; Diabetes Mellitus, Type 2 ; C-Reactive Protein

Diabetes mellitus has reached epidemic levels in Malaysia due to increase in its risk factors such as obesity, dietary and sedentary lifestyle. In patients with uncontrolled diabetes mellitus, diabetic foot ulcer (DFU)is a common complication. Managing diabetic foot infection is often multifactorial and intricate. The management DFU demands multi-speciality approach and often tedious. Hyperbaric oxygen therapy (HBOT) is a promising adjunctive treatment used to enhance the healing process plus reduces cost and recovery time. This is a case of a 52 years old lady, with underlying poorly diabetes mellitus, who presented with diabetic foot ulcer Wagner IV classification in sepsis. She underwent trans-metatarsal amputation followed by split skin grafting with additional adjunctive HBOT in a tertiary hospital.

In higher education setting throughout the world, the practise of handwashing among staff is essential, particularly in the period of COVID-19 pandemic. Despite the overwhelming evidence on the effectiveness of proper handwashing, the knowledge, attitude and practice of handwashing among the staff of higher education have not been well investigated. Consequently, a cross-sectional study among staff in a university in Malaysia was conducted to identify the prevalence of proper handwashing and its associated factors. The data was collected using questionnaires in Google form from 18th June to 21st June 2020. Statistical analyses involved simple and multiple logistic regression with backward likelihood ratio method. Out of 349 participants, 31.8% (95% CI: 26.9,36.7) had proper handwashing practice. The results of the multivariable analysis revealed that the total knowledge scores (OR: 1.04, 95% CI: 1.001, 1.071) and the total attitude scores (OR: 1.23, 95% CI: 1.152, 1.321) were found to be significantly associated with proper handwashing practice among staff. Our study suggests that having the right knowledge and favourable attitudes are crucial towards achieving the proper handwashing practise. Additional supports for promoting a conducive ecosystem may also likely be needed to sustain a long-term practice of proper handwashing.

Secondhand smoke (SHS) carries many health risks and is associated with diseases and premature deaths among nonsmoking adults and children. Despite many health promotions and legislative measures executed by the government to protect the public from SHS, the prevalence of SHS exposure is still high. Personal appropriate practices to avoid exposure are crucial especially at home or private area. Therefore, the current study focused on describing individual preventive practices on SHS and determining its associated factors. A cross sectional study was conducted among 250 adults in a village, Kuala Terengganu. Data were collected using self-administered questionnaires. Multiple logistic regression analysis was performed to determine the association between all independent variables and the SHS preventive practice status. The prevalence of SHS exposure was 66.0%. Majority of the respondents (77.2%) has good knowledge on SHS. Nevertheless, despite having good knowledge, a large proportion of them showed poor attitude toward SHS (77.6%) and poor preventive practices (61.2%). Poor preventive practices on SHS were significantly associated with being older (OR­adj: 1.0206, 95% CI: 1.0004, 1.0412), female (OR­adj: 2.0644, 95% CI: 1.0753, 3.9635), smoker (OR­adj: 12.1107, 95% CI: 4.0630, 36.0991), not having existing tobacco-related morbidity (OR­adj: 3.6795, 95% CI: 1.1795, 11.4786), and poor attitude towards SHS (OR­adj: 4.1871, 95% CI: 2.0955, 8.3665). The preventive practices of SHS among the villagers were poor despite showing acceptable level of knowledge. Hence, health awareness on the potential impact of SHS to the public as well as instilling appropriate behavior for them to avoid SHS and educate smokers need to be emphasized.

Introduction: Lower limb cellulitis is a common superficial skin infection that leads to morbidity and mortality. Cellulitis risk factors have been well studied in many countries, but to date, not in Malaysia. Geographical and climate variables may affect risk factors. Early identification of the preventable risk factors is vital to prevent cellulitis and improve holistic patient care. Objective: To determine the risk factors of lower limb cellulitis amongst hospitalized patients at a tertiary center. Methods: A prospective case-control study of hospitalized patients with a clinical diagnosis of lower limb cellulitis was conducted at UKM Medical Centre, January–August 2015. Each patient was compared to two age and gender-matched control patients. All patients were interviewed and examined for risk factors of cellulitis. Results: A total of 96 cellulitis patients and 192 controls participated in this study. The cellulitis patients included 61 males and 35 females with a mean age of 62.07±15.43 years. The majority of patients were experiencing their first episode of cellulitis. Multivariate analysis showed a previous history of cellulitis (OR 25.53; 95% CI 4.73–137.79), sole anomalies (OR 16.32; 95% CI 6.65–40.06), ulceration (OR 14.86; 95% CI 1.00–219.39), venous insufficiency (OR 10.46 95% CI 1.98–55.22), interdigital intertrigo (OR 8.86; 95% CI 3.33-23.56), eczema (OR 5.74; 95% CI 0.96.–34.21), and limb edema (OR 3.95; 95% CI 1.82–8.59) were the significant risk factors for lower limb cellulitis. Conclusion: Previous cellulitis and factors causing skin barrier disruption such as sole anomalies, ulceration, venous insufficiency, eczema, intertrigo, and limb edema were the risk factors for lower limb cellulitis. Physician awareness, early detection, and treatment of these factors at the primary care level may prevent hospital admission and morbidity associated with cellulitis.

To evaluate patient’s subjective preferences to scaling with narrow probe-shaped EMS Perio Slim PS tips compared to conventional tip based on pain perception using the Visual Analogue Scale (VAS). Ten patients were treated using a piezoelectric ultrasonic device (EMS) and two different scaler tips representing a conventional scaler tip and a Perio Slim PS scaler tip in a split-mouth design. Pain was evaluated after 2 minutes scaling using Visual Analogue Scale (VAS). Data obtained was analysed by SPSS version 19.0 using Wilcoxon test. Pain assessment after treatment confirmed by the Visual Analogue Scale (VAS) showed that the Perio Slim PS scaler tip (maximum pain score: 4, minimum: 2) caused less pain than the conventional scaler tip (maximum: 8, minimum: 3) (p-value = 0.007). Using Perio Slim PS scaler tip caused less pain and discomfort during scaling treatment when compared with conventional scaler tip. Acrylic resin is commonly used to fabricate removable prostheses due to its adequate physical, mechanical properties and cost effectiveness. There has been continuous development of the materials to improve their properties and to widen its application in different clinical setting. To study the history development of the acrylic resin and elaborate on the properties of different types and the processing methods of acrylic resins used to fabricate denture base which are commercially available in the market. This would help the dental clinician in choosing the best material of choice. The authors have summarized the history, development and classification of different type of acrylic resins used in fabricating denture and processing methods based on all the published research available on this topic using published materials available in the Dental Library, University of Malaya and the database (Science Direct, PubMed). Every type of acrylic denture base material has its pros and cons. Therefore, careful selection of material and the processing method is crucial to ensure the best outcome for prosthodontic treatment. Hence, upholding the patients’ best interest and improving their quality of life.