Introduction: Current education on diabetes self-management is time-consuming as it is conducted face-to-face. This study aimed to evaluate the effectiveness of diabetes education via mobile application on hemoglobin A1c (HbA1c). Methodology: This was a double-blinded randomized controlled study conducted in the Department of Endocrinology, Hospital Pulau Pinang and Hospital Raja Permaisuri Bainun. Participants were stratified randomized according to HbA1c to intervention group (using T-Manis) and control group. The primary objective was to assess the difference in HbA1c between the groups. Secondary objectives were to assess the difference in body weight, hospitalization related to diabetes, diabetes knowledge between groups and usability and satisfaction of T-Manis. Laboratory investigations and questionnaires were conducted at baseline, 4 months and 8 months. Results: A total of 112 participants were randomized into two groups each with 56 participants. Mean age was 51 years with similar diabetes duration of 16 years in both groups. Participants comprised of 61.6% females with ethnic distribution of 49.1% Malay, 30.4% Chinese, 19.6% Indian and 0.9% Siamese. Baseline HbA1c levels were comparable between intervention and control groups (10.04% versus 9.91%; mean difference 0.13%; 95% CI −0.56 to 0.81; p = 0.718). At 4 months, HbA1c of the intervention group demonstrated a significant reduction compared to the control group (8.93% versus 9.80%; mean difference −0.86; 95% CI −1.59 to −0.14; p = 0.02). Sustained reduction of HbA1c in the intervention group was observed at 8 months (mean difference −1.01; 95% CI −1.85 to −0.16; p = 0.02). Baseline body weight was 77 kg, with no betweengroup differences in body weight, hospitalization related to diabetes and diabetes knowledge scores, although diabetes knowledge scores improved at 4 months in the intervention group. 89.3% of participants reported satisfaction with T-Manis Conclusion The T-Manis mobile application aided in significantly improving glycemic control with high user satisfaction, supporting its feasibility as an adjunct to standard diabetes care.
Diabetes Mellitus, Type 2 ; Glycemic Control ; Mobile Applications ; Pangolins

Giant Placental Chorioangioma: An Unusual Cause of Adverse Foetal and Neonatal Outcome Chorioangioma is the most common benign tumour of the placenta, accounting for 1% of the pregnant cases. Giant chorioangiomas are known to be correlated with a higher rate of adverse fetal and neonatal complications, including fetal cardiac failure, fetal anemia, hydrops, intrauterine death and neonatal demise. Early detection and serial ultrasound monitoring are essential for timely intervention to ensure a favourable pregnancy outcome. We report a case of giant chorioangioma complicated with polyhydramnios with poor fetal and neonatal outcome.

Bibliometrics ; Publications ; Research

The Singapore Health Services cluster (SingHealth) radiology film archives are a valuable repository of local radiological cases dating back to the 1950s. Some of the cases in the archives are of historical medical interest, i.e. cerebral angiography in the workup of patients with hemiplegia. Other cases are of historical social interest, being conditions seen during earlier stages of Singapore's development, i.e. bound feet. The archives form a unique portal into the development of local radiology as well as the national development of Singapore. A selection from the archives is published in commemoration of the International Day of Radiology in 2020, as well as the 200th anniversary of the Singapore General Hospital in 2021. This pictorial essay comprises gastroenterology, musculoskeletal and obstetrics and gynaecology cases from the archives.

The Singapore Health Services cluster (SingHealth) radiology film archives are a valuable repository of local radiological cases dating back to the 1950s. Some of the cases in the archives are of historical medical interest, i.e. cerebral angiography in the workup of patients with hemiplegia. Other cases are of historical social interest, being conditions seen during earlier stages of Singapore's development, i.e. bound feet. The archives form a unique portal into the development of local radiology as well as the national development of Singapore. A selection from the archives is published in 2020 in commemoration of the 20th anniversary of the formation of SingHealth, the 55th National Day of Singapore, and the 125th anniversary of the International Day of Radiology. This pictorial essay comprises cardiovascular, respiratory and neurological cases from the archives.

Introduction: Diabetic foot infection, a complication that is associated with lower-limb amputation, incurs a huge economic burden to the hospital and health care system of Malaysia. The bacteriological profile of pathogens in diabetic foot infections in Malaysia has been sparsely studied. We investigated the microbiology of diabetic foot infections in patients admitted to the district hospitals on the east coast of Malaysia. Methods: A retrospective analysis was conducted in three district hospitals (Hospital Kuala Lipis, Hospital Bentong and Hospital Raub) in Malaysia from 1st of January 2016 to 31st December 2016. The clinical specimens were cultured using Clinical and Laboratory Standards Institute (CLSI) guidelines. Antibiotic sensitivity testing to different antibiotics was carried out using the disc diffusion method. Result: A total of 188 pathogens were isolated from 173 patients, with an average of 1.09 pathogens per lesion. Majority of the pathogens isolated were gram negative pathogens (73.4%). The most commonly isolated pathogens were Staphylococcus aureus (17.5%). This was followed by Klebsiella spp. (17%), Pseudomonas spp. (15.4%) and Proteus spp. (13.8%). Gram positive pathogens were sensitive to most of the antibiotics tested except penicillin and fusidic acid. Gram negative pathogens were sensitive to all antibiotics tested except ampicillin and amoxicillin/clavulanic acid. Amikacin provide coverage for all gram negative pathogens in DFI. Conclusion: For the management of patient with infection in diabetic foot, the choice of antibiotic therapy depends on the sensitivity of the pathogens, the severity of the infection, the patient’s allergies history, toxicity and excretion of the antibiotics.

Stigma in epilepsy arises from the misconceptions and prejudices rooted in the patient’s culture and traditions. Upbringing also has an important impact on the quality of life of epilepsy patients. In Chinese tradition, the main purpose of life is to be a “gentleman” 君子, to fully express the true human nature. The essence of being a gentleman is “benevolence” and “virtue”. According to Zhuangzi’s concept of “virtue overcoming deformity” 德充符, virtue can prevail over physical deficiencies. Consistent with such a principle, a person with epilepsy should receive high honour if he can demonstrate the character of a “gentleman”. In - traditional Chinese culture, the sense of shame is the foundation of morality; “feeling shame” 知耻 and “being shameless” 无耻 are important moral concepts. A gentleman has a sense of shame, whereas a “petty person” 小人 is shameless. However, the ability to resist feeling inappropriate shame - “not feeling ashamed” 不耻 is also a trait of the gentleman. Thus, based on traditional Chinese philosophy, one should resist feeling ashamed for having epilepsy. Chinese culture emphasizes the importance of exerting vitality in the presence of adversity; people with epilepsy who do not feel ashamed of their deficiency is manifesting such a vitality. Traditional Chinese culture takes a positive attitude towards hardship and adversity, that it is essential for developing character and skills. Overcoming adversity requires responsibilities, the pre-requisite is personal freedom. Thus, allowing freedom and nurturing independence is consistent with traditional Chinese attitude to upbringing.

Introduction: Solat or prayer, as one of the five pillars of Islam, is associated with bio-psycho-social benefits in Muslim patients. Many Muslim patients neglected solat while being hospitalized as they are unaware of the convenience (rukhsoh) available for them. Ibadah Friendly Hospital Courses have been conducted in different states of Malaysia to impart knowledge to the hospital staff who can in turn educate their patients. This study aims to construct a content-validated assessment tool to assess the effectiveness of a state-level Hospital Mesra Ibadah course. Materials and methods: A self-administered questionnaire was constructed and content-validated by a panel of three experts (two religious teachers and one consultant spine surgeon). All 15 questions achieved item-level content validity index (I-CVI) of 1.00 after two rounds of validation. The questionnaires were distributed to participants of a state-level Hospital Mesra Ibadah course to compare the participants’ pre-course and post-course test scores. Results: A total of 88 participants (48.9%) were included in this study. There was a significant difference in the pre-course test mean score and post-course test mean score among the participants. There was also a significant reduction of unsure answers after the course. There was no significant association found between the gender, place of work and occupation with the pre-post test score difference. Conclusion This study demonstrates that the Hospital Mesra Ibadah course is effective in imparting as well as consolidating the knowledge among participants, hence it should be routinely organized to benefit more participants.
Islam ; Religion ; Medicine ; Quality of Life

Introduction: ‘InTec Blood Grouping Test kit’ using solid-phase technology is a new method which may be used at outdoor blood donation site or at bed side as an alternative to the conventional tile method in view of its stability at room temperature and fulfilled the criteria as point of care test. This study aimed to compare the efficiency of this solid phase method (InTec Blood Grouping Test Kit) with the conventional tile method in determining the ABO and RhD blood group of healthy donors. Methods: A total of 760 voluntary donors who attended the Blood Bank, Penang Hospital or offsite blood donation campaigns from April to May 2014 were recruited. The ABO and RhD blood groups were determined by the conventional tile method and the solid phase method, in which the tube method was used as the gold standard. Results: For ABO blood grouping, the tile method has shown 100% concordance results with the gold standard tube method, whereas the solid-phase method only showed concordance result for 754/760 samples (99.2%). Therefore, for ABO grouping, tile method has 100% sensitivity and specificity while the solid phase method has slightly lower sensitivity of 97.7% but both with good specificity of 100%. For RhD grouping, both the tile and solid phase methods have grouped one RhD positive specimen as negative each, thus giving the sensitivity and specificity of 99.9% and 100% for both methods respectively. Conclusion: The ‘InTec Blood Grouping Test Kit’ is suitable for offsite usage because of its simplicity and user friendliness. However, further improvement in adding the internal quality control may increase the test sensitivity and validity of the test results.

ervical spine injury is commonly associated with road-traffic accidents. The true incidence of cervical spine injuries is unknown due to under-reporting of such injuries. Cervical spine injury is associated with high morbidity and mortality if it is missed. With the advancement of imaging modalities, the number of missed cervical injuries has reduced. Nevertheless, some clinicians are dependent solely on imaging tools to rule out cervical spine injury in a trauma victim. We report two cases of “near miss” C6 fracture to highlight the importance of a detailed clinical history and clinical examination with imaging as an adjunct to rule out cervical injury.