Testicular adrenal rest tumours (TART) are aberrant adrenal tissue within the testes (1). Although benign, they can lead to obstruction of the seminiferous tubules and infertility in patients with congenital adrenal hyperplasia (CAH). We report six boys who developed TART, a complication of CAH. Diagnosis was confirmed by ultrasound and testicular vein sampling of elevated 17-hydroxyprogesterone (17-OHP) levels. Glucocorticoids dosages were increased 1½-2 folds to suppress size of the aberrant adrenal tissues. Despite reductions in 17-OHP, the lesions remained unchanged. Three patients had testis-sparing surgery to excise the TART and to preserve normal testicular tissues.

INTRODUCTION: General anaesthesia is associated with higher maternal morbidity and mortality when compared with regional anaesthesia, related mainly to failure of intubation, hypoxia and aspiration. The aim of this retrospective review was to define the incidence of failed and difficult intubation in parturients undergoing general anaesthesia for Caesarean delivery at a high-volume obstetric hospital in Singapore. METHODS: All parturients who underwent Caesarean delivery under general anaesthesia from 2013 to 2016 were identified and their medical records were reviewed to extract pertinent data. Difficult intubation was defined as 'requiring more than one attempt at intubation or documented as such, based on the opinion of the anaesthetist'. A failed intubation was defined as 'inability to intubate the trachea, with subsequent abandonment of intubation as a means of airway management'. RESULTS: Records of 660 Caesarean sections under general anaesthesia were extracted. The mean age of the parturients was 32.1 ± 5.5 years and the median body mass index was 27.5 (interquartile range 24.6-31.1) kg/m². Rapid sequence induction with cricoid pressure was employed for all patients, with thiopentone and succinylcholine being administered for 91.2% and 98.1% of patients, respectively. There were 33 difficult intubations among 660 patients, yielding an incidence of 5.0%. Junior trainees performed about 90% of all intubations and 28 (84.8%) out of 33 difficult intubations. Repeat intubations were performed by senior residents/fellows (57.1%) and consultants (14.3%). No instance of failed intubation was reported. CONCLUSION The local incidence of difficult obstetric intubation was one in 20. No failure of intubation was observed.
Adult ; Airway Management ; Anesthesia, General ; Cesarean Section ; Female ; Humans ; Intubation, Intratracheal ; Pregnancy ; Retrospective Studies

Introduction: This study aimed to determine the views and practices of healthcare providers and barriers they encountered when implementing the national health screening program for men in a public primary care setting in Malaysia. Methods: An online survey was conducted among healthcare providers across public health clinics in Malaysia. All family medicine specialists, medical officers, nurses and assistant medical officers involved in the screening program for adult men were invited to answer a 51-item questionnaire via email or WhatsApp. The questionnaire comprised five sections: participants’ socio-demographic information, current screening practices, barriers and facilitators to using the screening tool, and views on the content and format of the screening tool. Results: A total of 231 healthcare providers from 129 health clinics participated in this survey. Among them, 37.44% perceived the implementation of the screening program as a “top-down decision.” Although 37.44% found the screening tool for adult men “useful,” some felt that it was “time consuming” to fill out (38.2%) and “lengthy” (28.3%). In addition, ‘adult men refuse to answer’ (24.1%) was cited as the most common patient-related barrier. Conclusions: This study provided useful insights into the challenges encountered by the public healthcare providers when implementing a national screening program for men. The screening tool for adult men should be revised to make it more user-friendly. Further studies should explore the reasons why men were reluctant to participate in health screenings, thus enhancing the implementation of screening programs in primary care.

Introduction: Delayed diagnosis of type 2 diabetes mellitus (T2D) increases the risk of presenting late with microvascular complications due to untreated long-standing hyperglycaemia. This study aimed to determine the prevalence of microvascular complications in newly diagnosed T2D patients in primary healthcare clinics. Methods: This was a cross-sectional study carried out in three government primary healthcare clinics in the state of Selangor, Malaysia. Malaysian aged 18 years and above with newly diagnosed T2D (≤ 6 months of diagnosis) were invited to participate in the study. Data collected included the sociodemographic characteristic and the clinical profile (weight, height, waist circumference, blood pressure, lipid, glycaemic, urine albumin, microalbuminuria and renal profile). The assessment of nephropathy, peripheral neuropathy and retinopathy were performed using standard protocol. Multivariate logistic regression analysis was used to identify the significant factors that contribute to the presence of microvascular complications. Results: A total of 162 newly diagnosed patients were recruited. The majority was women (64%). The mean age was 51 (SD 11) years. About one-third of the patients (27.7%) had developed at least one microvascular complication. Nephropathy was the commonest microvascular complication (19.2%), followed by peripheral neuropathy (8.6%) and retinopathy (6.5%). Poor glycaemic control was found to be a significant factor contributing to the presence of microvascular complications (OR 5.8, 95%CI:1.466, 23.288). Conclusion: There is a high prevalence of microvascular complications among the newly diagnosed T2D. There is a need to develop appropriate strategies to increase the awareness and early detection of T2D.