QUALITY CONTROL OF MEDICAL TREATMENT INFORMATION DISCLOSURE THROUGH THE LENS OF PHYSICIANS The disclosure of medical treatment information has been an ongoing medical ethics conflict between physicians and patients. This research focuses on the quality control of how physicians should disclose medical treatment information – should they obey the law governing medical negligence or follow their own best judgement? Therefore, the main objective of this research is to investigate how a physician should disclose medical treatment information to their patients based on their point of view. This research used in-depth interviews of three physicians from different medical fields. They were required to provide their opinions concerning the disclosure of medical treatment information. The interview data were analysed and presented to compare their opinions regarding this issue. Based on the analysis, all physicians have different styles and approaches in disclosing medical treatment information, where several factors such as personalities, formal education on the topic discussed and years of experience contributed to their opinions and perceptions. This research highlights that physicians have different ways in disclosing medical treatment information with the aim to deliver the correct information in a timely manner.

RECENT EVIDENCE REGARDING FAMILY-CENTRED EMPOWERMENT IN IMPROVING QUALITY OF LIFE AND TREATMENT OUTCOMES AMONG ASIAN AND AFRICAN CHILDREN WITH CHRONIC DISEASES: A SCOPING REVIEW Chronic diseases directly impact children’s physical, psychological, and social health, determining their quality of life (QoL). Family support is essential for children with chronic diseases, and family-centred empowerment (FCE) programs may improve treatment outcomes and QoL. Using a scoping review, this study aimed to investigate the effectiveness of implementing FCE to improve QoL and other treatment outcomes among children with chronic diseases. The study followed the Arksey and O’Malley’s framework (2005) and the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) for Scoping Reviews checklist. Studies were systematically searched on PubMed, CINAHL, ScienceDirect, and DOAJ. The quality of the included studies was assessed using the Joanna Briggs Institute appraisal checklist for randomized controlled trials and quasi-experimental studies. The scoping review included 20 studies from the 4,380 retrieved in the initial search. The studies reported that FCE effectively improved QoL, and the physical, emotional, social, educational, and clinical outcomes among children aged 2–20 years suffering from chronic haematological, respiratory, renal, neurological, hepatological, and neurobehavioral disorders. Overall, FCE is a potentially effective, sustainable model for improving QoL among children with chronic diseases.

CHEST RADIOGRAPH ACCURACY IN DIAGNOSING PEDIATRIC PULMONARY TUBERCULOSIS (PTB): A SYSTEMATIC REVIEW AND META-ANALYSIS In endemic regions, tuberculosis (TB) is the major cause of morbidity and mortality among children under the age of five, accounting for a significant proportion of the global death toll among such children. Approximately 35% of pediatric TB cases are appropriately diagnosed, frequently resulting in a protracted or untreated illness. This study assessed the diagnostic value of chest radiograph examination in diagnosing pediatric pulmonary TB. The PRISMA 2020 guidelines were used to conduct this systematic review and meta-analysis of 379 articles identified in four databases. The software Meta-Disc 1.4 was used to assess the diagnostic accuracy of the pooled samples but due to insufficient data, the computed tomography (CT) and magnetic resonance imaging (MRI) examinations were removed from further investigation. Six articles containing comprehensive chest X-ray (CXR) data were analyzed with pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of 0.88 (95% confidence interval [CI]: 0.84-0.91), 0.50 (95% CI: 0.46-0.53), 3.07 (95% CI: 1.68-5.58), 0.29 (95% CI: 0.14-0.60), and 17.41 (95% CI: 3.38-89.41), respectively. The summary receiver operating characteristic (sROC) curve area under the curve (AUC) was 0.8242. In conclusion, CXR demonstrated high sensitivity, moderate specificity, excellent PLR, NLR, and DOR for diagnosing pediatric pulmonary TB.

MANAGEMENT OF PERIPHERAL OSSIFYING FIBROMA IN AN ADOLESCENT: A CASE REPORT Introduction: Peripheral ossifying fibroma (POF) makes up between 2-9% of all gingival lesions and a third of all localized hyperplastic gingival lesions. It is commonly seen in the anterior segment of both maxilla and mandible. Case report: This case describes the management of peripheral ossifying fibroma (POF) associated with tooth displacement affecting the anterior segment of the maxilla of a 15-year-old boy. Complete surgical removal was done followed by the placement of a BIPP dressing at the surgical site. The post-operative clinical outcome was successful whereby the pathologically displaced tooth erupted into the arch spontaneously and was well-aligned without the need for any orthodontic treatment. Conclusion: Complete removal of POF lesion followed by good oral hygiene maintenance ensures a favourable outcome and no evidence of recurrence.

CLINICAL PROFILE OF HOSPITALISED IRRITABLE BOWEL SYNDROME PATIENTS IN INDIA ntroduction: Irritable bowel syndrome (IBS) is the most frequent functional gastrointestinal disorder. However due to poor health-seeking behaviour of the people and difficulties faced by medical professionals to diagnose IBS, it remains an under-diagnosed gastrointestinal disorder. Objectives: To study the risk factors, clinical presentation, and management of IBS among in-patients admitted at two tertiary care hospitals in Mangalore. Methods: Forty-one patients diagnosed with IBS based on ROME IV criteria between January 2017 to March 2021 were included. A semi-structured proforma was used to collect the required information. Results: The mean age at diagnosis among the patients was 44.6 ± 17.8 years. Twenty-four (58.5%) of them were females. Family history of IBS was present among five (12.2%) patients. IBS-M [18 (43.9%)] was the most common type. Alarming signs like blood and mucus in the stools were present each among eight (19.5%) patients. Weight loss was the most common extra-intestinal symptom [nine (21.9%)]. Mental health problems and psychosomatic disorders were present among seven (17.1%) and six (14.6%) patients, respectively. The most common drug used to treat constipation was Ispaghula husk [17 (41.5%)], and to treat diarrhoea was Loperamide [14 (34.1%)]. As many as 15 (36.6%) patients did not improve with treatment. None of the patients were put on non-pharmacological therapies. Conclusion: Holistic management of alarming signs such as blood and mucus in the stools and extra-intestinal symptoms like weight loss is required among IBS patients. Various mental health problems and psychosomatic disorders need to be screened and treated as a part of its management. Non-pharmacological therapies need to be also introduced to improve its treatment outcomes.

FACTORS ASSOCIATED WITH PAROXYSMAL VERTIGO AMONG URBAN-DWELLERS AGED 55 YEARS AND OVER IN THE MALAYSIAN ELDERS LONGITUDINAL RESEARCH (MELOR) STUDY Background: Paroxysmal Vertigo (PV) negatively affects life quality and increases in prevalence with age, but the risk factors remain inconclusive. Objective: The present study aimed to investigate the risk factors of PV among a multi-ethnic urban population in late mid-life and late life within a middle-income Southeast-Asian country. Methods: Cross-sectional data from the first wave of the Malaysian Elders Longitudinal Research (MELoR) study were utilized for this study involving randomly sampled participants aged 55 years and over. Socio-demographics, comorbidities, and psychological status were obtained through home-based computer-assisted interviews. Results: Based on an analysis of 1530 participants, mean age (SD) = 68.81 (7.49), 64.9% female; 32.9% Malay, 34.6% Chinese), the lifetime prevalence of PV was 12.1%. The risk factors associated based on multivariate analysis were hypertension, osteoarthritis, depression, and vitamin B12 Deficiency. Chinese ethnicity (OR = 0.582; 95% CI = 0.390 to 0.870) and smoking (OR = 0.377; 95% CI = 0.223 to 0.637) were protective factors against PV. Conclusions: While the risk factors reported are similar to other studies, the lower prevalence of PV among ethnic Chinese and smokers had not previously been reported. Our study highlighted potential genetic and lifestyle links to PV which should be evaluated in future studies.

THE OUTCOMES OF GLIOBLASTOMA MULTIFORME: THE UNIVERSITY MALAYA MEDICAL CENTRE EXPERIENCE 2008-2018 Glioblastoma multiforme (GBM) is the most common and biologically aggressive adult primary brain tumour. The standard of care treatment is maximal safe resection (MSR) followed by post-operative concurrent chemoradiotherapy (CCRT) and adjuvant temozolomide (TMZ). This retrospective single-centre study was carried out at a tertiary academic hospital, University Malaya Medical Centre, between 2008–2018. This study aims to analyse the overall survival (OS) and progression free survival (PFS) and identify the prognostic factors affecting survival in our cohort of patients. Data including patient demographics, clinicopathologic characteristics and treatment characteristics were collected and correlated with survival. Survival analysis was performed with the Kaplan–Meier method. The multivariate analysis using Cox proportional hazard regression was performed to evaluate the prognostic clinicopathological for survival. A total of 100 patients were analysed. The median OS and PFS for the whole sample population was seven months (95% CI = 4-10 months) and four months (95% CI = 3.2-4.8 months) respectively. The factors associated with worse median OS were no adjuvant treatment (HR = 6.03; 95% CI = 2.40-15.16; p = 0.00), age older than 65 years old (HR = 2.22; 95% CI = 0.10-4.96; p = 0.05), post-operative ECOG PS >2 (HR = 6.13; 95% CI = 1.70-22.11; p = 0.01), and the temporal-lobe-located tumour (HR = 3.89; 95% CI = 1.51-10.01; p = 0.01). The fundamental points that could be deduced from the observed difference in survival outcome from our study to the literature are (1) age and PS were the two crucial pre-treatment factors that influenced the outcome, and (2) radiotherapy (RT) was demonstrated as the essential treatment in GBM and that the dose fractionation played an essential role on the outcome.

CASE REPORT OF A RARE PRESENTATION OF MULTIPLE GIANT BLADDER STONE Bladder stone can be classified as primary, secondary or migratory and the etiology can be multifactorial. Unlike kidney or ureter, bladder stone only constituted around 5% of all urinary tract stone. Generally bladder stones occur in conditions such as bladder outlet obstruction, neurogenic bladder, chronic infection and foreign body. The prevalence is higher in male with a reported ratio of male to female of 4:1. Giant bladder stone is a rare condition moreover of a case of multiple huge stones. There is a numerous case report about a single giant bladder stone but not so in case of multiple calculi. We reported a case of a lady presented with a sudden onset of acute renal impairment with multiple huge bladder stones detected from imaging. Open cystolithotomy was done and a few huge bladder stones were extracted. This case report is to illustrate a rare presentation of multiple giant bladder stones.

CARIES INCREMENT AMONG SCHOOLCHILDREN EXPOSED TO DIFFERENT FLUORIDE CONCENTRATIONS IN WATER: A FIVE-YEAR RETROSPECTIVE COHORT STUDY Previous studies have indicated that the cessation of community water fluoridation (CWF) leads to an increase in caries prevalence among schoolchildren. However, little is known about the rate of caries progression among schoolchildren exposed to different concentrations of fluoride in water. Hence, this study aimed to compare the mean caries increment in permanent dentition among Malaysian schoolchildren with partial exposure (in Pahang) and full exposure (in Perak) to CWF and determine its associated factors. This was a five-year retrospective cohort study using an analysis of secondary data of school dental records among schoolchildren exposed to different fluoride concentrations in the water supply. Children in Perak were exposed to CWF throughout life while children in Pahang were exposed to CWF for the first five to six years of their lives before it was discontinued. The children were followed retrospectively from 2015 (initially aged eight years old) to 2019 (12 years old). Relevant data such as demographic characteristics, caries experience and exposure to other clinical preventive dental treatments were extracted and analysed using SPSS 21.0. Descriptive, independent t-test and negative binomial regression were used to examine the data. The sample consisted of 462 school dental records in both states. The prevalence of schoolchildren with DMFT scores of 2 and ≥ 3 increased by 10.4% and 13.9%, respectively, in Pahang from 2015 to 2019, compared to 4.8% and 0.9% in Perak. The mean (M) and standard deviation (SD) of caries increment at tooth and surface levels in permanent dentition among schoolchildren in Pahang (M = 0.83, SD = ±1.50 and M = 1.00, SD = ±2.10) was significantly greater (p < 0.001) compared to Perak (M = 0.18, SD = ±0.53 and M = 0.22, SD = ±0.66) over the same period. After controlling for confounders, partial exposure to CWF remained a strong predictor for mean caries increment over a five-year study period. This study showed greater mean caries increment in permanent dentition among schoolchildren in Pahang after CWF ceased. Hence, the findings from this study could be used to assist policy makers to support reimplementation and continuation of CWF in Malaysia.

A CASE REPORT AND LITERATURE REVIEW ON GRANULOMATOUS CONJUNCTIVITIS AND LYMPHOCUTANEOUS LESIONS ASSOCIATED WITH SPOROTRICHOSIS Sporotrichosis, a skin mycosis caused by Sporothrix sp., is a rarely reported condition in Malaysia. In this case report, we present a case of granulomatous conjunctivitis and lymphocutaneous lesions caused by sporotrichosis, along with a review of the relevant literature available on PUBMED. A 70-year-old woman presented with mucopurulent discharge from her left eye and nodular skin lesions on her face. She reported previous contact with her cat, which had recently died from sporotrichosis. Upon examination, the left eyelid was edematous, and there was conjunctival hyperemia. Multiple granulomatous lesions were observed in the bulbar conjunctiva, covered by the mucopurulent discharge. Additionally, erythematous and granulomatous nodules were present on the left periorbital area, extending to the left malar area, accompanied by ipsilateral lymphadenopathy. Based on clinical suspicion, a diagnosis of ocular and lymphocutaneous sporotrichosis was made. Treatment was initiated with oral itraconazole and topical fluconazole empirically. The conjunctival sample tested negative for Sporothrix schenckii. Histopathological examination of skin biopsy specimens revealed nonspecific granulomatous inflammation. After three months of antifungal treatment, the patient recovered completely without any ocular complications.