Case Report Open Access 15 Sinocutaneous fistula is a rare complication of chronic rhinosinusitis (CRS), most commonly involving the frontal sinus, with maxillary sinus involvement being uncommon and typically associated with trauma, surgery, or odontogenic infection. We report a rare case of a maxillary sinocutaneous fistula secondary to chronic maxillary rhinosinusitis in the absence of trauma, prior surgical intervention, fungal infection, or neoplasia. The condition resulted from longstanding inflammation with associated osteitis and cortical erosion of the maxillary sinus wall, leading to abnormal communication with the overlying facial skin. Diagnosis was established through clinical evaluation and contrast - enhanced computed tomography of the paranasal sinuses. Definitive management consisted of functional endoscopic sinus surgery with complete excision of the fistulous tract and primary multilayered closure. This case underscores the potential for chronic inflammatory sinonasal disease to cause rare bony complications and highlights the importance of considering CRS in the differential diagnosis of persistent facial cutaneous fistulae

Case Report Open Access 15 Sinocutaneous fistula is a rare complication of chronic rhinosinusitis (CRS), most commonly involving the frontal sinus, with maxillary sinus involvement being uncommon and typically associated with trauma, surgery, or odontogenic infection. We report a rare case of a maxillary sinocutaneous fistula secondary to chronic maxillary rhinosinusitis in the absence of trauma, prior surgical intervention, fungal infection, or neoplasia. The condition resulted from longstanding inflammation with associated osteitis and cortical erosion of the maxillary sinus wall, leading to abnormal communication with the overlying facial skin. Diagnosis was established through clinical evaluation and contrast - enhanced computed tomography of the paranasal sinuses. Definitive management consisted of functional endoscopic sinus surgery with complete excision of the fistulous tract and primary multilayered closure. This case underscores the potential for chronic inflammatory sinonasal disease to cause rare bony complications and highlights the importance of considering CRS in the differential diagnosis of persistent facial cutaneous fistulae

Introduction: Bariatric surgery is an established intervention for obesity and its metabolic complications, including diabetes mellitus. However, most studies are from Western populations with limited data in Malaysia. This study evaluated glycemic status improvements and identified predictors of hemoglobin A1c (HbA1c) reduction at 12 months following bariatric surgery to contribute regional data to Southeast Asia. Methodology: This retrospective analysis included 110 patients who underwent bariatric surgery between 2015 and 2025. Pre- and post-operative parameters, including HbA1c, body mass index (BMI), and lipid profiles, were collected at 1, 3, 6, 9, and 12 months and evaluated as potential predictors of glycemic status improvement at 12 months. Univariate analysis followed by stepwise multivariate linear regression was performed to identify predictors of HbA1c improvement at 12 months. Regression coefficients (B), 95% confidence intervals, and p-values were reported. Results: The mean age was 40.5 years with a mean baseline BMI of 43.49 kg/m²; 58% were female. At baseline, 60.9% (n = 67) had diabetes, 30.9% (n = 34) prediabetes, and 8.2% (n = 9) normal HbA1c. In univariate analysis, baseline HbA1c (B = 0.579, p <0.001), age (B = −0.051, p = 0.034), and sex (B = 1.123, p = 0.044) were significantly associated with HbA1c change. In multivariate analysis, the final model identified baseline HbA1c, BMI difference at 12 months, and TG difference at 12 months as independent predictors of HbA1c change. Baseline HbA1c was the strongest predictor (B = 0.857, p <0.001) indicating that higher baseline HbA1c was associated with greater change over time. BMI difference at 12 months was also significantly associated with HbA1c change (B = 0.046, p = 0.016), indicating that greater weight loss contributed to improved glycemic control. Similarly, TG difference at 12 months was a significant predictor (B = 0.337, p = 0.023). The model explained 86.8% of the variation in HbA1c change (adjusted R² = 0.868). Conclusion Bariatric surgery resulted in significant weight loss and improvement in glycemic status at 12 months, with baseline HbA1c, BMI differences, and TG reductions emerging as key predictors of glycemic improvement in a Malaysian cohort.
Cohort Studies ; Bariatric Surgery

Lysosomal dysfunction plays an important role in neurodegenerative diseases, including Parkinson’s disease (PD) and possibly Parkinson-plus syndromes such as progressive supranuclear palsy (PSP). This role is exemplified by the involvement of variants in the GBA1 gene, which results in a deficiency of the lysosomal enzyme glucocerebrosidase and is the most frequently identified genetic factor underlying PD worldwide. Pathogenic variants in the SMPD1 gene are a recessive cause of Niemann–Pick disease types A and B. Here, we provide the first report on an association between a loss-of-function variant in the SMPD1 gene present in a heterozygous state (p.Pro332Arg/p.P332R, which is known to result in reduced lysosomal acid sphingomyelinase activity), with PSP-Richardson syndrome in three unrelated patients of Chinese ancestry.

Familial hypercholesterolemia (FH) is an autosomal dominant inherited genetic disease characterized by increased concentrations of low-density lipoprotein (LDL-C) cholesterol in the blood. The risk of premature coronary heart disease in FH patients may increase without early treatment. Advancement in molecular biology techniques has enable early detection and diagnosis of FH. These techniques are cost-effective and have a shorter turnaround time. The current diagnostic tools available for FH diagnosis involving algorithm-based scoring criteria and various molecular diagnosis methods including next-generation sequencing (NGS), Sanger sequencing, Multiplex ligation-dependent probe amplification (MLPA) and DNA hybridisation assay are discussed in this review. However, molecular genetic testing is not widely available due to time-consuming procedures, high cost and requires trained personnel. Thus, this 36 review highlights the use of point of care (POC) testing as an approach to diagnose FH, particularly in countries lacking infrastructure and expertise in this field. Lateral flow testing (LFA) has gained attention as a POC diagnostic tool due to its simplicity, low cost and involved simple procedure and settings. The advantages of LFA made this technique a potential tool in addressing challenges in diagnosing FH, particularly for early diagnosis of family members.

Full thickness skin graft is a simple and reliable method for closure of small facial wound defect. A thorough understanding of how a skin graft heals and how to perform the procedure is essential for successful outcome. We report the use of full thickness skin graft in a wound closure of a facial skin defect caused by Paederus fuscipes, locally known as charlie. An 8-year old boy developed blister and painful swelling over his right cheek following skin contact with charlie. This lesion gradually became extensive, eventually leading to tissue loss and facial wound defect. A full thickness skin grafting was performed with satisfactory functional and excellent aesthetic result.

Introduction: This study aimed to evaluate the correlation between Quality of Life Impact of Refractive Correction (QIRC) score with visual disturbances and contrast sensitivity in spectacle wearers. Methods: A total of 21 spectacle-corrected moderate myopes was recruited. Subjects completed the QIRC questionnaire for quality of life assessment. The functional and emotional QIRC scores were analysed separately. Visual disturbances were evaluated using the Halo and Glare Simulator, and contrast sensitivity was measured by the M&S Smart System II. All measurements were taken binocularly in 1 lux illumination. Spearman’s test was employed to evaluate the correlations. Results: The most common visual disturbance was diffuse glare. The functional QIRC score was significantly correlated with glare intensity (r = -0.54, P = 0.01). Whereas, the emotional QIRC score was significantly correlated with contrast sensitivity (r = 0.45, P = 0.04). Conclusion: The functional QIRC score is lower when the glare intensity is greater, and the emotional QIRC score is higher in person with greater contrast sensitivity. Hence, glare intensity and contrast sensitivity measurements are suggested to predetermine spectacle wearers’ functional vision and well-being, respectively

Introduction: Cardiovascular disease is the leading cause of death worldwide. Despite the proven benefit of secondary prevention medications (SPMs), their utilisation remains suboptimal in many countries. This study aimed to assess the use of SPMs in a Malaysian primary care clinic and factors associated with it. Methods: A retrospective review of electronic medical records was conducted to assess the prescription of SPMs among patients with coronary artery disease who attended the clinic between 1st January 2018 and 31st December 2018. Prescriptions of SPMs were documented in numbers and percentages. Multiple logistic regressions were used to analyse factors associated with the prescription of SPMs. Results: Of the 662 patients included in the study, 99.1% were prescribed statins, 97% antiplatelets, 81.7% angiotensin-converting enzyme (ACE)-inhibitors or angiotensin Ⅱ receptor blockers (ARBs), and 78.7% beta-blockers. Male patients were more likely to be prescribed statins (OR = 8.584, 95% CI: 1.431 – 51.510) and antiplatelets (OR = 6.818, 95% CI: 2.294 – 20.257). Another significant factor for antiplatelets prescription was having diabetes (OR = 3.318, 95% CI: 1.148 – 9.590). Having hypertension was associated with ACE-inhibitors or ARBs prescription (OR = 4.008, 95% CI: 2.522 – 6.370). Conclusion: Although the majority of patients received SPMs, there were significant disparities for some SPMs prescriptions among female patients. As these medications are widely available in the Malaysian primary care setting, steps should be taken to ensure that these medications are prescribed equally for all eligible patients.

Aims: Andrographis paniculata (AP), a medicinal herb was selected to investigate the antifungal activity on selected dermatophyte fungi. The phytochemical screening was also carried out to evaluate its chemical constituents. Methodology and results: The potato dextrose agar (PDA) incorporated with aqueous, ethanol and methanol AP extracts at concentrations 0.99% (v/v), 1.96% (v/v) and 7.41% (v/v) were used for selected fungi culturing; Trichophyton mentagrophytes, T. rubrum, T. interdigitale, Microsporum fulvum, M. nanum, M. gypseum, M. canis, Fusarium solani and Aspergillus fumigatus. Phytochemical screening showed the presence of flavonoids, saponins and tannins in the ethanol extract and flavonoids alone in both aqueous and methanol extracts. Studies on antifungal effects indicated that the ethanol extract significantly increased the mycelial inhibition percentage of all tested fungi, especially at a concentration of 7.41% (v/v). All ethanol AP extract concentrations inhibited M. gypseum and M. canis (p<0.05) with at least 36.00% mycelial inhibition. In aqueous AP extract, it significantly increased the mycelial inhibition of T. mentagrophytes, T. interdigitale and M. gypseum (p<0.05), while the methanol AP extract significantly inhibited all fungi at a concentration of 7.41% (v/v) except for T. rubrum, M. gypseum and F. solani (p<0.05). No spore sedimentation was recorded for the fungal spores of T. rubrum, M. nanum, T. mentagrophytes, M. gypseum and T. interdigitale at 7.41% (v/v) ethanol AP. Conclusion, significance and impact of study It is concluded that the ethanol AP extract contained phytochemical constituents and showed the highest antifungal activity. In addition, this extract has a great potential to treat dermatophytes effectively.
Antifungal Agents ; Phytochemicals ; Andrographis paniculata ; Dermatomycoses

Introduction: Coated archwires improve aesthetics during orthodontic treatment. However, little is known regarding their clinical benefit. This randomised controlled trial (RCT) compared the tooth alignment (TA), coating loss (CL), colour change (∆E*), and patient perception of coated archwires with their controls. Details of ∆E* and perception were reported in the second part of the articles. Methods: This RCT was done at three centres. Participants were randomised to receive one of four treatment interventions using 0.014” superelastic coated nickel-titanium archwires from Orthocare, RMO, G&H, and conventional uncoated 3M Unitek® archwires. These archwires were ligated during bonding and collected after eighth week and questionnaires were distributed to participants in the experimental groups only. After removal, TA and CL were measured using Little’s Irregularity Index and Autodesk® AutoCAD® software, respectively. At the time of this preliminary reporting, 84 participants had completed the trial. Two archwires fractured and were excluded. Therefore, 166 archwires (n = 166) were analysed. Results: Only non-extraction cases showed statistically significant differences in TA change between all groups (p = 0.005) and RMO showed significantly lowest mean of TA (1.5 mm). RMO and Orthocare showed significant TA change in the upper and lower arches (p = 0.037, 0.048). CL was found to be insignificant for both extraction and non-extraction cases (p >0.05). Comparison between upper and lower arches revealed no significant difference in TA and CL in all groups (p >0.05). Conclusion: From this preliminary analysis, Orthocare provides better TA in non-extraction cases despite highest percentage of coating loss.