Clinical Presentation and Management of Severe Bilateral Duct Ectasia: A Case Report Mammary duct ectasia is frequently asymptomatic and found incidentally during routine screening but its presentation is varied. In this case report, we highlight a case of bilateral duct ectasia with extensive inflammatory changes in a parous, obese and diabetic middle aged woman. Her condition had been recurrent over several years, despite multiple courses of antibiotics and was increasing in severity. It was successfully treated with bilateral total ductal excision.

Introduction: Precocious puberty is increasingly recognized in children. Effect of gonadotropin-releasing hormone agonist (GnRHa) on height velocity (HV) and body mass index (BMI) during treatment of Central Precocious Puberty (CPP) is not welldocumented. Methodology: Records of all patients treated with GnRH for CPP who attended the paediatric endocrine clinic over a 5-year period (2021–2025) [N1.1] were reviewed retrospectively for HV and BMI changes for 3 consecutive years. Basal luteinizing hormone levels ≥0.3 IU/L or stimulated levels ≥5 IU/L are considered diagnostic of CPP. Results: Twenty patients were reviewed and median age at the start of study was 7.8 years (4.3–10.3). Majority were female (n = 18, 90%) with median Tanner Stage 3 and of Malay origin (n = 18, 90%[N2.1]). Median chronological age was 7.8 years (4.3–10.3) with bone age 10.3 years (5.8–13.4). Causes of CPP were idiopathic (n = 16, 80%), CNS lesion (n = 2, 10%) and poorly controlled congenital adrenal hyperplasia (n = 2, 10%). Nine (82%) of the 11 patients who had MRI brain done had normal findings. After 1 year of treatment, the median HV SDS was −0.83 (range −2.45 to 2.42), and BMI SDS was 0.45 (−1.94 to 2.15). After 2 years (n = 12), HV SDS declined to −1.3 (−3.44 to 0.69), with BMI SDS of 0.13 (−1.16 to 1.79). After 3 years (n = 9), HV SDS declined further to −1.51 (−3.52 to 3.13), and BMI SDS was 0.16 (−0.12 to 1.25). After 1 year of treatment, 20% (n = 4) of patients were overweight and 10% (n = 2) were obese. By 3 years, 22% (n = 2) remained overweight, and none were obese. Conclusion Premature growth plate senescence induced by prior estrogen exposure may lead to HV decline. Although obesity is a risk factor for the onset of CPP, whether GnRHa treatment directly increases BMI remains controversial as our cohort’s BMI change reveals otherwise.
Child ; Body Mass Index ; Puberty, Precocious ; Hormones

Cabaran Dalam Pencegahan dan Kawalan Plasmodium Knowlesi Malaria Di Rantau Asia Tenggara – Ulasan Naratif PengenalanDi sebalik kejayaan program penghapusan malaria manusia, terdapat peningkatan yang membimbangkan berkenaan jangkitan malaria Plasmodium knowlesi (P. knowlesi) di rantau Asia Tenggara. Pemahaman menyeluruh tentang cabaran dalam mencegah dan mengawal malaria zoonosis ini mesti diutarakan, terutamanya apabila menentukan strategi paling berkesan untuk menyekat penularan penyakit.MetodologiDi sebalik kejayaan program penghapusan malaria manusia, terdapat peningkatan yang membimbangkan berkenaan jangkitan malaria Plasmodium knowlesi (P. knowlesi) di rantau Asia Tenggara. Pemahaman menyeluruh tentang cabaran dalam mencegah dan mengawal malaria zoonosis ini mesti diutarakan, terutamanya apabila menentukan strategi paling berkesan untuk menyekat penularan penyakit.Hasil KajianKepelbagaian manusia, seperti sosioekonomi dan sosiobudaya tempatan yang majmuk, persepsi yang rendah dan pematuhan optimum terhadap langkah-langkah pencegahan dan kawalan perlu ditangani. Isu dana nasional, pelaksanaan program, dan birokrasi mesti diselesaikan dalam memastikan keberkesanan peranan kerajaan dan kerjasama pelbagai sektor apabila melibatkan pengurusan penyakit malaria. Kejayaan sesuatu program akan terhalang sekiranya tiada sokongan daripada pemimpin masyarakat dan bertentangan dengan dinamik sosial. Kebolehsuaian nyamuk Anopheles bertanggungjawab terutamanya terhadap cabaran yang dihadapi dalam kawalan vektor. Kesan anjakan ekologi dan perubahan iklim, ditambah dengan aktiviti antropogenik mewujudkan limpahan zoonosis dan variasi penyesuaian yang mengubah landskap transmisi sylvian dan manusia.KesimpulanCabaran daripada pelbagai faktor mengurangkan keberkesanan dalam mencegah penularan penyakit ini. Pendekatan baharu mesti dibangunkan untuk mencapai kawasan terjejas dengan intervensi jangka panjang, komprehensif dan berkesan.

Introduction: Poor appetite is prevalent among older adults and may negatively impact on their overall health. This is especially true for institutionalised residents. Despite this, there is a paucity of research on appetite and its associated factors among institutionalised residents, which signified the present study. Methods: A cross-sectional study was conducted among elderly residents at long-term care facilities in the state of Selangor, Malaysia to ascertain their appetite status and its associated factors. Results: A total of 97 residents with mean age of 74.2±8.4 years old were recruited. They comprised 61.9% females and 38.1% males. More than 50% had poor appetite with early satiety. There were 63.0%, 82.4%, and 94.8% who had poor oral health, poor sleep quality, and depression, respectively. Ethnicity (OR=2.73; 95% CI=1.00-7.44; p=0.049) was the only factor that predicted poor appetite among older adults in long-term care facilities, with Malay residents having poorer appetite than their Chinese and Indian counterparts. Conclusion: The prevalence of poor appetite was high among residents staying at long-term care facilities in Selangor, Malaysia, especially among Malays. This issue deserves further studies to identify the specific underlying factors contributing to poor appetite among older adults from different ethnicities. Acknowledging the high prevalence of poor appetite among older adults and its possible unfavourable outcomes, appropriate nutrition interventions are therefore needed to address this issue among institutionalised elderly.

Introduction: Ageing is commonly linked with physical inactivity. This review was performed to identify the factors associated with participation in physical activity among older adults in Malaysia. Methods: A systematic review was conducted using five databases; Pubmed, Sagepub, Scopus, Cochrane Library and Science Direct. Observational and intervention studies published between January 2010 and December 2020 were included, with Malaysian older adults aged 55 years and older being the main subject. Results: A total of 9 articles were included in the review. Analysis was guided by the Social Ecological Model for Health Promotion. The review had successfully identified gender, age, education level, health reasons, ethnicity and attitude as intrapersonal factors, social support (friend) and marital status as interpersonal factors, and locality as well as availability of facilities as environmental factors. Conclusions: Physical activity participation among Malaysian older adults were mainly determined by intrapersonal factors, particularly gender, health condition and educational level.

Introduction: This systematic review aimed to investigate the level of participation, obstacles, and facilitator factors that influence activities of daily living among persons with spinal cord injury (SCI). Methods: A comprehensive search was conducted in four online databases, namely Google Scholar, PubMed, OT Seeker, and Cochrane Library covering the ten-years period from January 2012 to December 2022. Inclusion criteria encompassed original published studies in English focusing on daily activities, work, participation, obstacles, and facilitators in persons with SCI. Non-peer review sources (e.g., abstracts, grey literature, preprints), and studies unrelated to occupational therapy were excluded. The selected studies were assessed for quality using McMaster University Occupational Therapy Evidence-Based Practice critical review form. Results: Out of the 678 articles identified, ten studies were included after the screening, exploring participation in daily living activities, employment, return to work, leisure activities, family tasks, and community mobility among persons with SCI. Obstacles and facilitators influencing participation in activities of daily living were classified using the International Classification of Functioning, Disability, and Health (ICF) framework. This review highlighted that long-term participation is challenging for persons with SCI, affected by obstacles such as body functions, pain, low self-esteem, and environmental and social factors. Conclusion: The findings underscore the importance of adopting a multidisciplinary rehabilitation approach to enhance participation in daily activities for persons with SCI. Occupational therapy plays a significant role in improving participation levels among persons with SCI.

Background: There are a few dry eye remedies available in the market. Currently, artificial tears and lubricants are still the most common management for dry eyes. Objective: We proposed a new method in managing dry eyes. Methods: A pre-soaked contact lens in virgin coconut oil (VCOCL) is being used as a vehicle to deliver virgin coconut oil (VCO) in dry eyes. VCOCL was prepared in sterilised conditions where daily soft hydrogel contact lenses were immersed in raw VCO. The efficacy of VCOCL in delivering the VCO to eyes was assessed by measuring the Tear Break-Up Time (TBUT) values, corneal staining of the anterior eye, Schirmer Test values and the measurement of residual VCO volume in tears at baseline and at 15 minutes after insertion on subjects with dry eyes. Pre- and post-data were used to analyse all the measurable variables. Results: This study showed a significant difference in the TBUT, corneal staining, and residual VCO volume for both eyes (p<0.05). However, there were no changes in the Schirmer Test value (p>0.05). VCOCL was proven to improve tear quality in dry eye subjects and was able to maintain its presence in the eye even after 15 minutes. Conclusion This study suggests a new method for dry eye management.
Contact Lenses ; Therapeutics ; Dry Eye Syndromes

Introduction: Detection of anti-cyclic citrullinated peptide (anti-CCP) antibodies in patients with rheumatoid arthritis (RA) is associated with higher disease activity and lower functional ability. This study investigated the presence of the new generation of anti-CCP antibodies (anti-CCP2 IgG, anti-CCP2 IgA and anti-CCP3.1 IgG/IgA) and their association with disease severity and functional status of RA patients. Methods: A total of 46 RA patients and 40 healthy controls participated in this cross-sectional study that was conducted at the Rheumatology Clinic, Hospital Universiti Sains Malaysia. Blood samples were taken from all participants for anti-CCP2 IgG, anti-CCP2 IgA, and anti-CCP3.1 IgG/IgA analysis. Disease severity and functional status of RA patients were measured using the Disease Activity Score-28 (DAS28) and the modified Health Assessment Questionnaire (mHAQ) respectively. Results: Significantly higher proportion of RA patients were found with positive anti-CCP2 IgG (63.0%), anti-CCP2 IgA (37.0%), and anti-CCP3.1 IgG/IgA antibodies (63.0%) than the healthy controls. No significant association was found between anti-CCP antibodies status and mean DAS28 score of the RA patients. However, RA patients with negative anti-CCP2 IgG status had higher mean mHAQ score than patients with positive anti-CCP2 IgG status. Conclusion: Our study has demonstrated detection of the new generation anti-CCP antibodies in RA patients, supporting the use of autoantibodies in RA diagnosis. While no significant association was found between the presence of anti-CCP antibodies and disease severity of RA patients, the absence of anti-CCP2 IgG was associated with worse function and greater disability of the patients.

Public health clinical rotation in the Faculty of Medicine, Universitas Islam Indonesia, was conducted in Puskesmas (community health center). This study aims to evaluate the public health clinical rotation in Puskesmas, part of the clinical clerkship of the Faculty of Medicine, Universitas Islam Indonesia. Several concerns have been highlighted regarding the implementation of clinical rotations in public health in Puskesmas. A briefing session before placement in the village must be coherent with a guidebook. The placement of students in the village was based on community health issues determined by the Puskesmas supervisor. Priority in the curriculum was given to converting the alertness village (Desa Siaga) into a Program Indonesia Sehat–Pendekatan Keluarga (Healthy Indonesia Program–Family Education) program throughout implementation. Moreover, scheduling after four major clinical programs was difficult, and the writing of reports served as a guide for establishing the correct format. Therefore, the objective of the evaluation was to assess knowledge, skill, and psychomotor, and the burden of assignment in Puskesmas was difficult to accomplish a primary task in the community.

Sjogren’s syndrome (SS) is an autoimmune disease affecting exocrine glands with known properties to cause chronic systemic multi-organ disease involvement. It produced the typical features of sicca syndrome, but due to insidious onset of the disease, patient may present with complications of the condition at the initial presentation. We present a case of primary Sjogren’s syndrome (SS) who first presented with pulmonary manifestations and was subsequently diagnosed as Lymphocytic Interstitial Pneumonia (LIP). The patient was extensively investigated and received appropriate treatment modalities.