Distal renal tubular acidosis (dRTA) is characterized by hyperchloremic hypokalemic metabolic acidosis, nephrocalcinosis and metabolic bone disease. It has been associated with Southeast Asian Ovalocytosis (SAO), particularly in malaria endemic region. We present a case of an older adult with dRTA who presented with respiratory failure as a result of hyperchloremic normal anion gap metabolic acidosis, in association with nephrocalcinosis and SAO, however, without hypokalaemia due to concurrent acute kidney injury. Oxygen therapy was able to be weaned off after treatment with alkali supplementation. Distal RTA may be associated with SAO, and early recognition and treatment of dRTA is paramount in preventing complications such as chronic kidney disease, metabolic bone disease and life-threatening respiratory arrest.
Acidosis, Renal Tubular

The existing shortage of local donor corneas in our institution (University Malaya) and Malaysia, in general, prompted us to attempt the use of one donor cornea for two transplantation procedures; Descemet Stripping Endothelial Keratoplasty (DSEK) in a case of a pseudophakic bullous keratopathy (PBK) with underlying Fuchs endothelial dystrophy (FED) and lamellar patch graft in a case of limbal dermoid. The donor cornea was divided into anterior and posterior lamellae manually. The anterior corneal button was used as a patch graft for anterior lamellar keratoplasty in a 6-year-old patient with limbal dermoid, and the posterior corneal button was used for a DSEK procedure in a 68-year-old patient with corneal decompensation. Both patients had a stable and good visual outcome throughout a 1-year postoperative period. This allows the use of one corneal tissue by more than one recipient to overcome the shortage in donor corneas.
Transplants

Penetrating injuries to the hand are common occurrence in the casualty. Careless removal of the penetrating foreign body potentially leads to retained fragments and infection. In diabetic patients, presentation might be delayed due to poor immune response and peripheral neuropathy leading to complications such as spread of infection and amputation. Detecting retained radiolucent foreign body when the entry wound has healed may pose a challenge. We present a case of retained pieces of wood in the first webspace of the hand which presents with infection distant from the healed entry site.
Foreign Bodies

This is a report to share the experience of managing a patient planned for surgical wound procedure under anaesthesia with medical hypnosis as a tool for sedation and pain relief with a wrist block to supplement the analgesic effect. This was a patient who presented with severe preoperative anxiety and pain concerning her surgical procedure. She developed an allergy to some analgesia from her first surgical procedure. Adequate motivational interviewing techniques with the patient enabled issues about her anxiety to be explored and helped to ease the patient's anxiety. The surgical procedure was successfully done with hypnosis and regional anaesthesia. The patient's response towards pain and anxiety was documented based on Numerical Reporting Scale. The patient's wound care in the ward and clinic proved to be less painful and more comfortable for the patient with her self-hypnosis skill. Empowering the patient with medical hypnosis during the procedure is an option that should be explored.
Hypnosis

Youth with physical disabilities may have concerns about their bodily functions and appearance, which do not typically conform to sociocultural norms. A mounting body of research confirmed that physical disability has an adverse impact on self-esteem development. This study aimed at developing a cognitive therapy module for professional counsellors to help Malaysian youth with physical disabilities enhance their self-esteem. The methodology comprised three stages: (i) self-esteem baseline assessment; (ii) module design and development; and (iii) module evaluation. First, the Rosenberg Self-Esteem Scale was used to collect data from 110 youth with physical disabilities. The results revealed that participants had moderate levels of self-esteem (mean, x̄ = 30.16). This finding highlighted the need to increase the level of self-esteem among youth with physical disabilities. The second stage involved the development of the cognitive therapy module for self-esteem enhancement (CTSEE) using Sidek’s model of module development, which resembles the ADDIE framework. The third stage involved evaluating the module’s content validity and reliability. Findings showed that the therapy module has high content validity and reliability. The overall findings demonstrate that the CTSEE module can be applied by professional counsellors to enhance self-esteem among youth with physical disabilities.
Cognitive Behavioral Therapy

Anterior cruciate ligament (ACL) tears are serious knee injuries, whether partial or total. ACL injuries are most typically diagnosed in the clinic settings using a combination of a detailed history, physical examination and corroborated with an appropriate imaging modality. Magnetic resonance imaging (MRI) is highly sensitive for identifying intra-articular knee pathology. This combination has been demonstrated to be effective and non-invasive in diagnosing ACL injury. The reliability of MRI for diagnostic purposes, on the other hand, is not always ideal. This might be due to various factors, including low-quality MRI magnets, post-surgical tissue changes, metallic artifacts, patient movement during procedure, and static rather than dynamic structural evaluation. Nevertheless, office-based diagnostic arthroscopy offers an alternative to imaging modalities by allowing clinicians to visualize large joints safely, painless, high-quality images, and time-efficient approaches. Furthermore, the risk of major and minor complications of office-based diagnostic arthroscopy is comparable to or lower than any standard office-based injection. This is the first office-based needle arthroscopy (OBNA) performed in Malaysia to evaluate intra-articular knee symptoms. Thus, we aim to understand and overview OBNA to identify intra-articular knee pathology by reporting this case report.
Anterior Cruciate Ligament Injuries

Introduction: Sampling of non-palpable thyroid nodule under ultrasound guidance has been widely used, however less studies done in comparing the efficacy of technique between fine needle aspiration cytology (FNAC) and fine needle capillary sampling (FNCS) under ultrasound guidance. Objectives: This study aimed to determine the cytologic adequacy rates and sample quality obtained by both techniques under ultrasound guidance. Methods: Ultrasound‐guided thyroid nodule samplings were performed on 88 patients, 44 of them had FNAC and another 44 FNCS technique. The slides obtained were scored using a predetermined scoring system comparing five parameters: background blood; amount of cellular material; appropriate architecture retention, degree of cellular degeneration and cellular trauma. The results were analysed using chi square and binary logistic regression test. Results: Patient who underwent FNCS technique was 0.61times (95%CI) less likely to have large amount of background blood sample; 0.39times less likely to have sample with excellent architecture retention; 2.31times and 1.13times more likely to have sample with minimal cellular degeneration and minimal cellular trauma respectively when compare to FNAC. These were however not statistically significant. FNCS was 0.23times less likely to obtain sample with abundant cellular material compared to FNAC and it was statistically significant. Diagnostic adequacy rate was similar in both techniques and it was statistically significant. Conclusions Ultrasound‐guided FNAC and FNCS yielded comparable diagnostic adequacy rates. Our study did not prove a clear superiority of FNCS over FNAC or vice versa. Both techniques could be use in tandem to achieve better diagnostic accuracy.

Hyperemesis gravidarum (HG) is the severe form of nausea and vomiting during pregnancy, which can extremely lead to dehydration, significant weight loss, electrolyte and metabolic imbalances. Importantly, early identification of HG symptoms can help to reduce the severity and prevent complications. Although HG is associated with many adverse maternal and fetal outcomes, there is limited understanding about the risk factors. This review provides current data of genetic and maternal factors that are linked to HG. All observational studies published in English that investigated the genetic or maternal factors associated with HG from 2011 until 2021 were systematically searched using PubMed, Scopus, and ProQuest electronic databases. A total of 1462 citation titles was identified, of which 47 potentially relevant abstracts were screened. Of those, 15 studies met the inclusion and exclusion criteria. The genetic variants in ryanodine receptor 2 gene (RYR2), growth differentiation factor-15 gene (GDF15), and protein coding insulin-like growth factor-binding protein 7 (IGFBP7) were found to be associated with HG. On the other hand, several potential maternal factors contributing to the onset of HG were age, Helicobacter pylori infection, body mass index status, a history of HG in a previous pregnancy, high serotonin levels, and reproductive factors. In view of the lack of strength of overall evidence for risk factors related to HG, it is first imperative to establish a precise definition for HG in a diverse study population. Nevertheless, to conclude, this review was able to provide current data of genetic and maternal factors that are associated with HG.
Hyperemesis Gravidarum

This study aimed to develop an Acceptance and Commitment Group Therapy (ACT-G) treatment manual for treating weight-related struggles by modifying and culturally adapting an existing self-help book, “The Diet Trap”. The research methodology comprised of two phases: (a) development of the treatment manual and (b) evaluation of the feasibility of the treatment manual using a pilot trial. First, the modification and cultural adaptation of the training manual was adopted based on the Psychotherapy Adaptation and Modification Framework (PAMF) (Hwang et al., 2006). Next, the modified and culturally adapted treatment manual was evaluated for its feasibility and effectiveness through experts’ feedback and focus group interview. The overall findings revealed that the treatment manual was straightforward and relatable to the Malaysian values and beliefs and promising in understanding the risk factors of weight gain and ways of living a healthy and meaningful life.
Acceptance and Commitment Therapy

Background: The spread of COVID-19 was inevitable and has not spared small and isolated communities, including the community of Perhentian Island in Besut District, Terengganu. Managing clusters in small islands can be difficult, given the limited resources. This study explores the characteristics of COVID-19 cases and the experience of outbreak containment at Perhentian Island. Methodology: A retrospective study involving record review of COVID-19 cases and at-risk individuals registered under Perhentian Cluster were retrieved from the Besut District Health Office COVID-19 online registry from the 16thAugust2021 until 6thOctober 2021. All notified cases and close contacts who fulfilled the inclusion criteria were extracted and analysed using descriptive statistics. Results: A total of 1,093 community members of Perhentian Island were screened of which 170 (15.5%) tested positive for COVID-19, while 923 (84.5%) tested negative. Among individuals who tested positive, the majority were adults (52.4%), male (51.8%), Malays (98.8%), and villagers (96.5%). Clinical characteristics were categorized into: asymptomatic (55.9%), had no known medical comorbidities (90.6%), low-risk groups (87.1%), vaccinated (57.6%), and admitted to PKRC (97.1%) for treatment. Multiple agencies were involved in the outbreak containment of the Perhentian Cluster, working collectively and in good coordination. Conclusion The outbreak was attributed to community gatherings and close interactions among villagers. Prompt actions, targeted planning, and inter-agency collaboration were the key factors in successful containment of further spread of COVID-19 in Perhentian Island.
COVID-19