Introduction: Hypoglycemia, a frequent and potentially life-threatening consequence of anti-diabetic therapy, remains a major barrier to optimal glycemic control. Effective inpatient management depends on frontline staff knowledge and preparedness; thus, knowledge gaps may compromise patient safety. This audit evaluated staff knowledge of hypoglycemia management in a district hospital in Malaysia to identify areas for improvement. Methodology: A cross-sectional audit was conducted among healthcare staff in a district hospital. A structured, modified questionnaire based on the Malaysian MEMS Inpatient Glycemic Guidelines was used. The 10-item questionnaire assessed definition, initial and subsequent management, reassessment, escalation, and documentation, yielding scores from 0 to 10. Descriptive statistics were used for analysis. Conclusion Despite high overall knowledge, critical gaps remain in reassessment, drug-related risks, and stepwise management, warranting targeted education, protocol reinforcement, and re-audit to enhance patient safety.
Hospitals, District ; Hypoglycemia

Introduction: Thyroid eye disease (TED) is a heterogeneous condition and the most common extrathyroidal manifestation of Graves’ disease. Although most cases are mild, disease progression may threaten vision and significantly impact quality of life. Methodology: We described four patients with active moderate-to-severe TED, highlighting their clinical characteristics, therapeutic approaches, and clinical outcomes. Results: Three males and one female patient were included in this descriptive study. Most were identified by the endocrine team. Their median age was 52.5 years (range 47–56 years). All patients had long-standing Graves’ disease (range 6–10 years). Two of them were active smokers. Their clinical activity score ranged from 3 to 5. Common presenting features included diplopia (60%), proptosis (60%), and ocular redness (60%). At the onset of active TED, all patients were euthyroid while receiving either antithyroid therapy or were maintained on stable levothyroxine following radioactive iodine treatment and thyroidectomy. Thyroid receptor autoantibodies were assessed in only two patients, with one elevated result. Orbital computed tomography, performed in 3 patients, demonstrated extraocular muscle enlargement consistent with TED, particularly involving the inferior and medial recti. All patients received standard-dose intravenous methylprednisolone (cumulative 3.5–4.5 g). They showed improvement in visual acuity following treatment, with partial improvement in ophthalmoplegia. Conclusion Clinical risk factors observed in this series were consistent with the literature. TED diagnosis relies heavily on recognition by the endocrine team, underscoring the importance of holistic Graves’ disease management. Highdose corticosteroids remain the mainstay of treatment in our setting, with generally favorable outcomes when timely multidisciplinary care is provided.
Graves Ophthalmopathy