Background: Frailty is a health condition preceding impairment and disease, resulting in vulnerability and risk of poor outcomes. Frailty is a multidimensional geriatric syndrome encompassing physical, psychological and cognitive components. Psychological frailty refers to reduced emotional resilience, mood stability, and coping capacity. This paper aims to review the current literature on psychological frailty and mental health outcomes among older adults. Methodology : Four electronic databases, PubMed, Scopus, Science Direct and Web of science were used to systematically search for studies published between January 2019 and December 2023, that examined the effect of psychological frailty on mental health outcomes in older adults, including depression, anxiety, and overall well -being. Results: There were 154 articles screened, with 7 studies meeting inclusion criteria. All included studies assessed psychological frailty using the Tilburg Frailty Indicator (TFI), a multidimensional frailty tool with a psychological domain. Psychological frailty, as measured using the TFI, was consistently associated with depressive symptoms, anxiety, and reduced quality of life. The psychological domain of the TFI demonstrated moderate internal consistency (Cronbach ’s α = 0.712 -0.797). Conclusion: Psychological frailty is a potential risk factor for the development of adverse mental health outcomes in older adults. The use of validated measures, such as the TFI may improve the identification of psychological frailty for early intervention strategies in both community and medical settings to protect older adults ’ mental health

Snakebite envenomation remains a significant cause of morbidity and mortality in Southeast Asia. Accurate identification of the snake species or even confirming biting incident can be challenging, especially in children. This case report discussed the essential considerations for a suspected snakebite in a paediatric patient who presented to the emergency department with progressive neurological signs consistent with envenomation, necessitating empiric antivenom administration and mechanical ventilation. It highlights the diagnostic and therapeutic challenges encountered, emphasising the critical need for prompt identification of envenomation, judicious use of empirical antivenom therapy, and comprehensive supportive critical care. Urgent and effective interventions, including ventilatory support have been demonstrated to enhance outcomes in severe neurotoxic envenomation cases

Transdiaphragmatic intercostal hernia (TDIH) is a rare condition involving simultaneous disruption of the diaphragm and intercostal muscles, allowing abdominal organs to herniate into the chest wall. It is usually traumatic and spontaneous cases are uncommon and can be easily overlooked. We report the case of a man in his late 60s with six years of progressive right chest wall swelling and recent vomiting and breathlessness. Initial imaging was misinterpreted as pleural effusion, but a computed tomography confirmed a five cm diaphragmatic defect with bowel herniation through the 7th –8th intercostal space. Prompt recognition is vital, as delayed diagnosis may lead to bowel obstruction, strangulation, and life -threatening complications

Pulmonary embolism (PE) may present with subtle but specific radiographic clues on chest X -ray. We describe a series of three patients with acute PE demonstrating classical findings, including the Palla’s sign, Hampton ’s hump, and Westermark ’s sign, across varied clinical settings. In all cases, these findings prompted early diagnostic consideration and were subsequently confirmed by computed tomography pulmonary angiography. Echocardiographic findings varied between cases and ranged from normal ventricular function to evidence of right -ventricular strain. This case series highlights the continued educational value of recognising classical chest X -ray signs of PE, particularly in supporting early clinical suspicion when definitive imaging is delayed or not immediately available

Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

A 57-year-old woman with diabetes and hypertension presented with acute calculous cholecystitis and cholangitis. Incidentally, two splenic lesions were identified on formal abdominal ultrasound, one demonstrating the sonographic bright band sign. Computed tomography confirmed splenic infarctions and also revealed portosplenic vein thrombosis. Haematological workup, including JAK2 V617F mutation analysis, led to a diagnosis of polycythaemia vera, contributing to cholelithiasis via increased cell turnover and thrombosis due to hyperviscosity. She was started on venesection and hydroxycarbamide and discharged well. However, she defaulted follow -up and re -presented two years later with disseminated intravascular coagulation, eventually succumbing to the illness. This case highlights the utility of the sonographic bright band sign in identifying splenic infarction and distinguishing it from other hypoechoic splenic lesions

Case Report Open Access 15 Primary renal lymphoma without widespread nodal disease is a rare entity. Its diagnosis is challenging as it can mimic other more common renal malignancies such as renal cell carcinoma (RCC) or upper tract urothelial carcinoma (UTUC). We report a 65 -year-old male who presented a month history of bilateral flank pain. Initial computed tomography urography showed a soft tissue enhancing lesion with irregular margin in the left renal pelvis, extending distally to the left proximal ureter, suspicious of UTUC. He underwent laparoscopic left radical nephrectomy and bladder cuff excision. However, histopathology came back as a left renal in situ follicular B -cell neoplasm (ISFN). He was subsequently referred to haematology service for further management. This case report aims to raise awareness of ISFN and to consider renal lymphoma in a patient presenting with a renal mass. A high index of suspicion and judicious use of tissue biopsy can avoid unnecessary and potentially morbid surgical interventions