UNMASKING THE CHIK SIGN: A CASE REPORT ON NASAL HYPERPIGMENTATION AS A DIAGNOSTIC CLUE FOR CHIKUNGUNYA FEVER Macular hyperpigmentation of the nasal region, often referred to as the ‘chik sign’, constitutes a distinctive physical manifestation associated with chikungunya fever. Chikungunya, a mosquitoborne viral illness, presents with acute febrile symptoms, intense arthralgia and cutaneous eruptions. The chik sign serves as a valuable clinical marker for discerning chikungunya from other febrile illnesses with analogous presentations, such as dengue fever and malaria. This differentiation is particularly crucial in endemic regions. Recognition of the chik sign underscores the significance of clinical acumen in diagnosing chikungunya. In conjunction with confirmatory laboratory testing, identification of this sign can augment diagnostic accuracy and guide appropriate therapeutic strategies. Herein, we present the case of a 44-year-old woman with chikungunya virus infection who exhibited acute febrile symptoms, severe polyarthralgia and hyperpigmentation of the nasal region. In conclusion, the chik sign is a crucial clinical marker for identifying chikungunya fever. Its identification can improve diagnostic precision and enable timely care, particularly in places with limited access to laboratory testing. Healthcare professionals should thus be vigilant for this skin pigmentation in patients who exhibit joint pain and feverish symptoms that are indicative of chikungunya virus infection. To further understand the clinical spectrum of chikungunya, more research into the presentation of this pigmentation would be helpful.

Introduction: Anaemia is common during pregnancy and can lead to miscarriage, intrauterine growth retardation, premature labour and antepartum haemorrhage. Anaemia in pregnancy is defined as a haemoglobin (Hb) level of <11 g/dL. Methods: This retrospective review included 407 antenatal mothers diagnosed with anaemia at 36±1 weeks of gestation at all 10 health clinics in Alor Gajah between January and December 2018. Results: According to the district annual returns, 2,407 antenatal mothers (36 weeks of gestation) were registered in the health clinics in Alor Gajah in 2018. Among them, the prevalence of anaemia was 18.6% (n=448). However, there were only 407 cards found. Most participants were Malays (89.4%), aged 20–40 years (93.6%) and married (96.3%). Almost all anaemia cases (96.5%) were mild (Hb level of 9–10.9 g/dL). Approximately 34.4% of the mothers were already anaemic at booking; 77.6% belonged to the B40 income group; and 31.6% had poor pregnancy spacing of <2 years. Iron deficiency anaemia was the most common type of anaemia (51.0%), followed by dilutional anaemia (34.0%), which did not normalise at 36 weeks of gestation. Anaemia was associated with lower educational (P<0.05) and Hb levels at booking (P<0.001). Conclusion Having normal maternal Hb levels in early pregnancy especially at booking is crucial, as it may reduce the possibility of anaemia during pregnancy. Early screening and supplementation of at-risk pregnancies may be applied as a preventive strategy. Suitable methods of iron treatment and investigation need further exploration.

Ocular Leptospirosis Presenting as Neuroretinitis in Patients without Systemic Symptoms Neuroretinitis is an atypical presentation of ocular leptospirosis. Patients present with neuroretinitis as the only sign of leptospirosis which poses a diagnostic challenge. We reported two cases of ocular leptospirosis with neuroretinitis presentation in healthy individuals. Both patients presented swollen discs, macula star and retinal vasculitis. None of the patients had systemic symptoms of leptospirosis before the ocular complaint. Both patients were treated with oral doxycycline for four weeks and recovered well.

Simulated/ standardized patients (SPs) have become one of the significant components in today’s medical education and students’ assessment. Some differences exist in the training method of SPs for psychiatry examinations compared to other medical disciplines. This brief report highlights the challenges encountered in the training process and methods to overcome those challenges. A wellstructured, intensive training remains as one of the most important factors in ensuring standardization of SPs for psychiatric examinations.
Education, Medical ; Psychiatry

Central venous catheter placement is indicated in patients requiring long-term therapy. With repeated venous catheterisations, conventional venous access sites can be exhausted. This case illustrates the expanding role of radiology in managing difficult venous access. We present a case of translumbar, transhepatic, and transcollateral placement of central catheter in a woman with a difficult venous access problem who required lifelong parenteral nutrition secondary to short bowel syndrome. This case highlights the technical aspects of interventional radiology in vascular access management.