This is a rare but interesting case of Mr. MZ who had a lifethreatening pericardial effusion presenting to the primary care clinic. Through great clinical acumen and prudent targeted investigations, diagnosis of this rare condition was reached and urgent referral made to the cardiology team which performed an emergency pericardiocentesis which proved to be life -saving. However, the hovering poor prognosis of Mr. MZ may prompt for a referral to the palliative care team to provide quality end of life care for this unfortunate patient.

background: Hyperlipidaemia is a significant risk factor for cardiovascular disease. However, adherence to lipidlowering therapy is often unsatisfactory due to a combination of patient factors, therapy, socio-economic and health system-related factors. Aims: to identify the prevalence of adherence to lipidlowering therapy, the factors contributing to non-adherence and knowledge regarding hyperlipidaemia and its’ treatment among Malaysian patients with hyperlipidemia. Methods: A quantitative study using a cross-sectional survey was carried out in an urban primary care clinic in August 2015. Patients on lipid-lowering therapy for ≥ 1 year aged ≥ 18 years were selected using simple random sampling. consenting patients answered a selfadministered questionnaire (in Malay/English) which included socio-demographic profile, hyperlipidaemia profile, adherence to lipid-lowering therapy (using the Morisky Medication Adherence scale-8; score ≥ 6 taken as adherent), reasons leading to non-adherence, knowledge regarding hyperlipidaemia and its’ treatment, and use of non-allopathic medicine. results: the response rate was 90.7%. the prevalence of adherence to lipid-lowering therapy was 82.4%. “the most common reasons for non-adherence was being worried about side effect of lipid-lowering agent (71.4%), followed by the need to take too many drugs in a day (61.4%) and negative influences by friends, relative and mass media (60%)”. Factors associated with non-adherence include male gender, on longer duration of therapy, less frequency of follow-up, less number of follow-up clinics, taking medication at night/random timing and having lower knowledge scores. conclusion: Overall the prevalence of adherence was high in patients with hyperlipidaemia. Interventions to boost adherence should target those who were identified as non-adherent.

This study emulates the findings of a study by Zaidi et al. in Pakistan in which the authors reported the similar success story (2). Similar success has been reported in a randomized trial in Africa that found treatment of pneumonia in the neonate by either oral penicillin or procaine benzylpenicillin and gentamycin to be as equally effective (3). The author is confident that this method of combining of both inpatient and outpatient administration of antibiotics for neonatal sepsis will be successful in our local setting due to high quality medical care that is offered by both government and private medical facilities here with many health clinics supporting the local hospitals.
Neonatal Sepsis ; Antibiotics

Bronchial asthma causes great morbidity and mortality worldwide. Certain occupations especially those exposed to known triggers of asthma such as animal fur, dusts or solvents may trigger asthma attacks in a previously undiagnosed individual or worsen its’ control in a known asthmatic. This is especially true for adult-onset asthma. This may in turn the health of the affected workers and affect their productivity. Affected workers may be given job reassignment and eligible for medical compensation from Social Security Organisation (SOSCO). This case report will look at how two individuals in very distinct occupation were diagnosed with suspected occupational asthma
Occupational asthma

Dengue fever infection is common in many parts of the world and may result in serious complications such as dengue haemorrhagic fever, dengue shock syndrome, pleural effusion, pericardial effusion and multi-organ failure if not diagnosed early or treated adequately. This is more so in the so called susceptible group that includes children, pregnant mother, elderly patients, patients with heart, liver or kidney co-morbidity, obese patients as well as immunocompromised patient such as those with transplanted organs or human immune-deficiency infection. However in certain cases, severe dengue fever may mimic the presentation of septic shock which needs urgent and decisive management actions to be taken. This case report will look at a 7-year-old child who survived despite developing septic shock which was thought to be initially dengue fever with warning signs. Early referral and aggressive treatment in hospital prevented a direr consequence for this child.
Dengue fever

PURPOSE: Urinary calcium creatinine ratio (UCaCrR) is a reliable indicator for monitoring hypercalciuria following vitamin D supplementation. However, the reference range varies from region to region. Previous studies did not take vitamin D and parathyroid hormone status into account while evaluating UCaCrR. Hence, we undertook this study to establish the 95th percentile of UCaCrR as an indicator of hypercalciuria in North Indian children and adolescents. METHODS: Four hundred seventy-three participants (boys 62.2%, girls 37.8%) with adequate dietary calcium intake, normal serum levels of 25-hydroxy-vitamin D (>20 ng/mL), and without secondary hyperparathyroidism following supplementation were selected for evaluation of UCaCrR. RESULTS: The mean age and body mass index of subjects were 11.2±2.6 years and 18.0±3.6 kg/m2, respectively. The 95th percentile of UCaCrR in the study population was 0.126. The mean, median, and 95th percentile of UCaCrR was significantly higher in prepubertal children (age ≤10 years) (0.0586±0.0374, median=0.0548, 95th percentile=0.136) compared to those >10 years old (0.0503±0.0363, median=0.0407, 95th percentile=0.123, P=0.02). No significant difference in UCaCrR was observed between genders and different weight categories. CONCLUSIONS: UCaCrR of 0.13 defines the cutoff value for hypercalciuria in North Indian children and adolescents with adequate dietary intake of calcium and sufficient serum vitamin D levels.
Adolescent ; Body Mass Index ; Calcium ; Calcium, Dietary ; Child ; Creatinine ; Female ; Humans ; Hypercalciuria ; Hyperparathyroidism, Secondary ; Parathyroid Hormone ; Reference Values ; Vitamin D

Introduction: In first six months of life, breastfeeding is the recommended form of feeding by the World Health Organisation for the growing child. To enable the working mother to continue this noble practice, adequate workplace breastfeeding support and self- efficacy is needed.This study aims to determine the prevalence of breastfeeding among working mothers of children aged three months to two years and factors associated with breastfeeding practice including workplace support and mother’s self-efficacy. Method: This is a cross sectional questionnaire study carried out in a rural Health Clinic in Selangor using socio-demographic data, Workplace Breastfeeding Support Scale (WBSS), and the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF). This study was conducted for a period of three months from April to June 2015. The respondents were employed Malaysian mothers of healthy infants aged three months to two years. A total of 84 participants were involved in the study. Data analysis was done with SPSS 22.Results: The prevalence of breastfeeding among working mothers were high at 97.6%. We found significant association of breastfeeding practice with workplace breastfeeding support (p=0.005) and self-efficacy (p= 0.017). We also noted a significant correlation between breastfeeding workplace support and breast feeding self-efficacy (r= 0.40, p <0.01). Age, religion, ethnicity, educational level and place of employment were found to be not associated with breastfeeding practices.Conclusion: This study highlights the importance of workplace support and self-efficacy with workplace breastfeeding practices. Policymakers and stakeholders should provide a conducive and supportive environment to enhance breastfeeding among working mothers.

BACKGROUND: Human mesenchymal stem cells are being used for various regenerative applications in past decades.This study chronicled a temporal profile of the transcriptional pattern and promoter methylation status of the osteogenic related gene in dental pulp stem cells (DPSCs) derived from 3-dimensional spheroid culture (3D) vis a vis 2-dimensional (2D) monolayer culture upon osteogenic induction. METHODS: Biomimetic properties of osteogenesis were determined by alkaline phosphatase assay and alizarin red staining. Gene expression and promoter methylation status of osteogenic genes such as runt-related transcription factor-2, collagen1α1, osteocalcin (OCN), and DLX5 (distal-homeobox) were performed by qPCR assay and bisulfite sequencing, respectively. Furthermore, μ-Computed tomography (micro-CT) was performed to examine the new bone formation in critical-sized rat calvarial bone defect model. RESULTS: Our results indicated a greater inclination of spheroid culture-derived DPSCs toward osteogenic lineage than the monolayer culture. The bisulfite sequencing of the promoter region of osteogenic genes revealed sustenance of low methylation levels in DPSCs during the progression of osteogenic differentiation. However, the significant difference in the methylation pattern between 2D and 3D derived DPSCs were identified only for OCN gene promoter. We observed differences in the mRNA expression pattern of epigenetic writers such as DNA methyltransferases (DNMTs) and methylcytosine dioxygenases (TET) between the two culture conditions. Further, the DPSC spheroids showed enhanced new bone formation ability in an animal model of bone defect compared to the cells cultivated in a 2D platform which further substantiated our in-vitro observations. CONCLUSION The distinct cellular microenvironment induced changes in DNA methylation pattern and expression of epigenetic regulators such as DNMTs and TETs genes may lead to increase expression of osteogenic markers in 3D spheroid culture of DPSCs which make DPSCs spheroids suitable for osteogenic regeneration compared to monolayers.