Aneurysmal bone cysts are benign but locally aggressive tumors, with 80% diagnosed in patients younger than 20 years. We report a case of a 7-year-old male who presented with pain in his right thigh due to a mi- nor injury and was diagnosed with a pathologic fracture in the distal femur. The fracture was fixed with plate and screws augmented with antibiotic-impregnated bone cement, and the histopathological analysis con- firmed the diagnosis of aneurysmal bone cysts.

Introduction: Although prevalence of impacted canines has been analyzed in prior studies, there is a lack of evidence about the prevalence of impacted canines in the Malaysian population to support such practices. Understanding the prevalence of impacted canines will enhance awareness, knowledge, and understanding of the importance of obtaining preventive and interventional treatment. The research aims to establish the impacted canine prevalence in orthodontic patients using cone beam computed tomography (CBCT). Materials and Methods: An examination of clinical records of 175 patients with canine impaction from January 1st, 2010, to November 30th, 2020 who had CBCT scans and visited dental clinics for orthodontic treatment was done to determine their prevalence. Descriptive statistics and Chi-square test analysis were carried out to evaluate the results. Results: The results suggested that the impacted canine prevalence was 17.5 %, with a female preponderance. Impacted canines occurred most frequently in Class I malocclusion subjects. In addition, canine impaction is more frequent on the left side than on the right. Unilateral impaction dominated bilateral impaction. Palatal impaction was more prevalent than buccal impaction, while maxillary canine impaction was more common than mandibular impaction. Conclusions This study’s prevalence was higher than previously reported among other populations. The demography and gender have an effect on the incidence of impacted canines. These three-dimensional (3D) findings may provide clinical reference data for delivering information and education on impacted canines assessment and treatment.

Background: The increased use of digital devices during the COVID-19 pandemic highlighted its impact on the visual and musculoskeletal systems. This study aims to determine the combined prevalence and symptoms of digital-eyestrain and related musculoskeletal disorders and its contributing risk factors. Methods: A one-year cross-sectional study was conducted during the COVID-19 pandemic among computer-users in financial institutions in Brunei. A self-administered questionnaire was distributed via email, and non- responders reminded. Descriptive statistics and simple proportions were used to determine the sociodemographic factors, usage, prevalence, and digital device related symptoms. Chi-square tests and multiple logistic regression were applied to determine the associated risk factors. Results: Total number of participants was 281 (mean age 36.2 ± 8.3 years, 67.3% females and 62.6% spending >5 hours daily on digital screens without breaks). The prevalence of combined digital-eyestrain and related musculoskeletal disorders was 63.8%. The most common symptoms were pain, stiffness, numbness, or tingling sensation in the shoulder (87.5%), neck (86.3%), and back (85.4%), followed by headache (83.1%), itchy eyes (74.8%), increased light sensitivity (72.5%), and watery eyes (70.7%). Daily computer use of >5 hours without breaks, independently and significantly increased the risk of developing digital-eyestrain and related musculoskeletal disorders over two-fold (OR = 2.38, 95%CI:1.01,5.66). Only 18.5% of the participants had regular eye examinations and 58.7% did not consult a doctor (p<0.01) despite experiencing problems. Conclusion Digital-eyestrain and related musculoskeletal disorders are highly prevalent. Efforts made to manage these problems can prevent permanent damage. Mobility breaks at work, regular eye checkups and proper workplace ergonomics are recommended.

Primary retroperitoneal cavernous hemangioma is a very rare benign neoplasm. A retroperitoneal hemangioma may be detected accidentally or be symptomatic due to local compression on adjacent structures. We reported on the diagnosis and treatment of a patient with PRCH with a subtle clinical presentation and atypical findings on computed tomography imaging. The patient presented with right hypochondriac discomfort for one month duration. Computed tomography of the abdomen revealed a huge mass arising from right lobe of liver which was compressing the surrounding structures. Intraoperatively there was a huge cystic like mass arising from the retroperitoneum which had clear margin with the adjacent structures. The tumour was successfully excised with an intact capsule and histopathological examination revealed a cavernous hemangioma.
cystic ; hemangioma ; neoplasm ; retroperitoneal

Acute kidney injury (AKI) is increasingly prevalent in developing and devel- oped countries and is associated with severe morbidity and mortality. Most aetiologies of AKI can be prevented by interventions at the individual, com- munity, regional and in-hospital levels. Effective measures must include community-wide efforts to increase an awareness of the devastating effects of AKI and provide guid- ance on preventive strategies, as well as early recognition and management. Efforts should be focused on minimising causes of AKI, increasing awareness of the importance of serial measurements of serum creatinine in high risk patients, and documenting urine volume in acutely ill people to achieve early diagnosis; there is as yet no definitive role for alternative biomarkers. Protocols need to be developed to systematically manage pre-renal conditions and specific infections. More accurate data on the true incidence and clinical impact of AKI will help to raise the importance of the disease in the community, increase awareness of AKI by governments, public, general and family physicians, and other health care professionals to help prevent the disease. Prevention is the key to avoid the heavy burden of mor- tality and morbidity associated with AKI.

Introduction: Lung cancer has been the leading cause of cancer deaths in Brunei Darussalam for the past five years. This study is the first to supply data for the 5-year survival of patients diagnosed with non-small cell lung cancer (NSCLC) in Brunei Darussalam. Materials and Methods: From 2002 to 2009, 302 patients diagnosed with NSCLC were identified from the National Cancer Registry of Brunei Darussalam. Demographic and clinical data were retrospectively retrieved from the clinical notes. All deaths and dates of death were obtained and crosschecked with the National Birth and Death Registry at the Immigration Department. Data were analysed using SPSS statistical software and 5-year Kaplan -Meier survival curves were derived and analysed using Log Rank test. Predictors of 5-year survival were analysed using Cox regression analysis. Results: Mean age of the 302 patients was 64.9 ± 12.8 (27.4–90.6 years) with male to female ratio of 194:108. Racial distribution consisted of 84.4% (n=255) Malay, 12.5% (n=38) Chinese and 3.1% of other racial origin (indigenous and foreign nation- als). Histological types of NSCLC consisted of 67.9% (n=205) adenocarcinoma, 16.2% (n=49) squa- mous cell carcinoma, 6.3% (n=19) large cell carcinoma, 5.3% (n=16) bronchioalveolar carcinoma and 4.3% of other origin. Only 13.9% of patients underwent surgical resection. At completion of follow-up, only 47 (15.5%) patients were still alive. There were 255 deaths. Overall 5-year survival for the whole group was 3.6% with a median survival time of 6.5 ± 0.9 months (95% CI: 4.7-8.4 months) but ac- cording to stage of disease was 60.9% for Stage IA, 29.9% for Stage IB, 10.0% for Stage IIB, 7% for Stage IIIB and 3% for Stage IV. Significant prognostic factors were younger age at diagnosis, surgical resection, tumour types and tumour stages. Conclusion Overall 5-year survival of patients diagnosed with NSCLC in Brunei Darussalam is still generally poor but comparable to previously reported data. Significant prognostic factors were younger age at diagnosis, surgical resection, tumour types and tu- mour stages.

Introduction: The Day Ward or Observation Ward is an essential part of an Accident and Emergency Department (AED), and for the hospital as a whole. The Day Ward serves as an area where patients can be observed and reviewed after a few hours, before decisions are made whether admissions are required. This study was carried out to assess the profiles of admissions to the Day Ward of the AED of RIPAS hospital and to assess the rate of admissions to the hospital. Materials and Methods: A retro- spective study on 4,459 patients who were admitted to the day ward of the AED, RIPAS Hospital from 1 st January to 30th June 2007 was carried out. The triage sheets were analysed. Data on the time from triage to the time of admission/discharge, the presenting symptoms, and reasons for admissions to the various wards were extracted. Results: Close to 60,000 patients visited the AED during the 6 month study. There were more male patients than female patients; however female patients were more likely to be admitted to the day ward for observation. The most common age group was in the 31-60 years. The most common indications for admissions to the Day Ward were for abdominal pain (18%), non– specific giddiness (15%), non-specific body weakness (13%) and headache (12%). Of the 4,459 pa- tients who were admitted to the day ward, only 179 patients (4.01%) were admitted to the hospital wards, more female than male patients. The most common symptoms were giddiness and body weak- ness. They were mainly admitted to the medical wards primarily for deranged laboratory investigations. The average duration spent in the day ward was 5-6 hours. Conclusion The Day Ward is very essen- tial to the AED and hospital. Many patients present to AED with a wide spectrum of symptoms, but only a small fraction of the require admission, most of them are discharged after a brief period of observa- tion.

Introduction: Medication discrepancies can lead to serious consequences, and is more likely to occur in elderly patients and patients with chronic disorders due to polypharmacy. Such errors can contribute to drug-related problems, medication errors, adverse drug events and jeopardise patients’ health. The discharge period is a particularly vulnerable transitional interface as there is a higher risk of these dis- crepancies. The aim of this study was to assess the incidence of unintentional medication discrepancies during discharge of patients admitted to the medical wards of a tertiary referral centre. Materials and Methods: Data was prospectively collected over a period of three months (21st March to 21st June 2011). All the discharge prescriptions were carefully checked for errors: unintentional missed medica- tion, inappropriate or missing dose and unexplained dosage increase or reduction which required inter- vention, missing or inappropriate duration, illegible handwriting and inappropriate formulation. The types of pharmacy intervention were classified into ‘error’, ‘near-miss’ and ‘confirming’. Error is when a particular event had occurred in the ward prior to pharmacy intervention, near-miss is when there was intervention before a particular event had occurred, and an intervention was classed as ‘confirming’ when no changes were made in the actual prescriptions after pharmacy intervention. Results: There was a total of 845 discharge prescriptions consisting of 5,465 medications encountered during the study period. Overall, 18.7% (n=158) of the prescriptions required intervention, ranging from 11.8% to 22% per ward. The most common interventions was for unintended missed medications and dosage adjustments. Overall, 3% of all intervention required was classified as error whereas 49% classified as near-miss. Prescriptions from the Nephrology services required the most intervention. Conclusions This study demonstrated the importance of conducting a medication reconciliation process in ensuring patients are discharged with the appropriate and correct medications. It is an effective way of reducing medication discrepancies and is an essential process for optimizing the safe and effective use of medi- cines.

Ovarian cancer is the second most common cancer in women and up to a fifth of all ovarian tumours are metastatic in origin. Among these metastatic tumors, the most common primaries are the gastroin- testinal tract and breast. We report the case of a 66-year-old lady who presented with recent onset vague lower abdominal pain and distension who on evaluation was diagnosed to have bilateral ovarian metastases from a pancreatic primary. This case highlights the importance of considering metastasis and to include a pancreatic primary in the differential diagnosis of patients with bilateral ovarian tu- mours.

Cervical osteophyte is common in the elderly and is a recognised cause of dysphagia for this group of population. Depending on the location and volume of the mass of the osteophyte, it can cause direct impingement on the adjacent structures such as the alimentary tract and the airway to cause dyspnoea or foreign body sensation in throat. However, such occurrence is rare and compression of other struc- tures to cause symptoms is even rarer. We report a rare manifestation of an anterolateral cervical os- teophyte that caused unilateral vocal cord palsy in an otherwise healthy 56-year-old man.