Relapsing polychondritis (RP) is a disease that confounds clinicians worldwide due to the difficulty in confirming its diagnosis and determining the best treatment plan. We report a case of a 34-year-old lady who presented with bilateral inflamed auricular swelling and red eyes, which turned out to be relapsing polychondritis. The patient was successfully treated with long-term oral steroids and is on regular follow-up. This report highlights how the subtle signs of her condition were picked up, leading to her diagnosis of RP and the treatment regime that successfully reversed her symptoms. The challenge of picking up subtle signs of the disease is best met by working as a team in a multidisciplinary setting. A literature study shows that RP is a rare disease that can present with many symptoms.
Polychondritis, Relapsing

Ocular trauma remains a significant cause of eye blindness. Disruption or violation of the globe's integrity can lead to an ocular emergency that usually jeopardises the vision. Early identification of this condition can fasten the management process to give the patients the best and most appropriate treatment. We described the role of point-of-care ultrasound (POCUS) in diagnosing globe rupture in the Emergency Department.
Emergency Service, Hospital

Malocclusion is an abnormal occlusion with regard to the position of the teeth and shows varied prevalence in different parts of the world. Crowding and spacing of teeth are two common features of malocclusion and are described as a lack or excess of space between the teeth. This study was conducted to evaluate the prevalence of crowding and spacing of teeth and their severity among Malaysian adults aged 18–25 visiting our institution, as well as their association with gender. A total of 150 adult patients were evaluated for crowding and spacing using the Boley caliper intra-orally. The severity of crowding and spacing was also noted. The study included Malay (70%), Chinese (25%), and Indian (5%) participants. Descriptive statistics were done and it was observed that crowding was more common in the mandibular arch (80%), whereas spacing was a common malocclusion found in the maxilla (14%). Based on the severity of crowding, it was observed that mild crowding (1-3 mm) was most frequent in both the maxilla (45%) and mandible (53%). However, in terms of spacing, moderate spacing (4-6 mm) (5.3%) was common in the maxilla; whereas in the mandible, mild spacing (1-3 mm) (9.3%). The Chi square analysis did not reveal any significant association between crowding and spacing with gender. Based on these results, it can be concluded that crowding is a common malocclusion affecting the mandibular arch, whereas spacing is common in the maxilla in the young Malaysian population visiting our institution. Both of these malocclusions were of the milder type and did not show any association with gender in our study population Studies conducted on a larger population are required to determine the association of these traits between genders and races in our population.
Malocclusion

Introduction: COVID-19 survivors with mental health issues are more likely to have a lower quality of life, reduced work productivity, social troubles, and other health issues. However, information on the mental health of COVID-19 survivors is scarce. Therefore, we aimed to determine the COVID-19 survivors’ mental health status in the form of depression and its associated factors. Methods: This cross-sectional study was conducted in Malaysia, during the nationwide lockdown. Data were collected using an online questionnaire. Socio-demographic variables, comorbidities, self-perception of health, information on the person’s acute condition during COVID-19 infection, symptoms and duration of symptoms postCOVID, and state of depression were gathered. The Patient Health Questionnaire 9 was used to assess depression. Factors associated with mild to severe depression were analysed using multivariable logistic regression analyses. Results: A total of 732 COVID-19 survivors responded to the survey. The respondents were mainly females and of younger age (in their 20s and 30s). One-third of the participants perceived themselves as having poor health. One in five participants reported having Long COVID. Slightly less than half (47.3%) of the respondents had mild to severe depression (total PHQ-9 score of 5-27). In the multivariable analysis, being female (aOR: 1.68; 95% CI: 1.08,2.62), of younger age (20s – aOR: 3.26; 95% CI: 1.47, 7.25; 30s – aOR: 2.08; 95% CI: 1.05, 4.15; and 40s – aOR: 2.43; 95% CI: 1.20, 4.90; compared to those in their 50s and above), being overweight/obese (aOR: 1.83; 95% CI: 1.18, 2.83), having Long COVID (aOR: 2.45; 95% CI: 1.45, 4.16) and perceived poorer health (aOR: 4.54; 95% CI: 2.89, 7.13) Conclusion Females, younger age groups, being overweight/obese, having Long COVID and perceiving themselves to be in poor health were factors associated with higher odds of mild to severe depression.
COVID-19

The high demand for sports abilities causes decreased performance in athletes. Nutrition may be closely related with performance decline. Dietitians play an important role in providing proper nutrition for athletes. This study aimed to determine the effect of nutrition intervention by a sports dietitian on the nutritional status and performance of sepak takraw players in The State Senior High School for Sports (SMANOR) Sidoarjo. A pre-experimental study was done using a one-group pre-post test without control design, on 27 sepak takraw players (20 boys, 7 girls) aged 14-18 years from SMANOR Sidoarjo. Participants were given nutrition interventions by a sports dietitian comprising nutrition education, nutrition counseling, and food assistance for three weeks. Nutritional status was evaluated using BMI-for-age and body fat percentage (BFP) and athletic performance using VO2 max (Bleep test method). Statistical analyses used were paired t-test and Wilcoxon signed-rank test. The results indicated a significant decrease in BMI-for-age (pre = -0.26 ± 0.52 and post = -1.23 ± 0.55, p ≤ 0.001), an insignificant increase in the male BFP (pre = 13.06 ± 2.22% and post = 13.44 ± 1.70%, p = 0.162), a significant increase in the female BFP (pre = 22.54 ± 2.25% and post= 23.47 ± 1.91%, p = 0.028), and there was no significant difference in the athletes’ performance (pre = 46.82 ± 6.22 and post = 46.34 ± 5.36, p = 0.360). Nutrition interventions by a dietitian have a significant effect on nutritional status according to BMI-for-age and female BFP, but not on male BFP and performing sepak takraw players in SMANOR Sidoarjo.
Nutritional Status

The importance of complete and valid written consent for medical procedure is indisputable. Written consent forms for ophthalmology related laser procedures and angiography were audited against guidelines regarding validity and adequacy. A full cycle clinical audit was carried out at a tertiary hospital providing ophthalmology service. A preintervention audit was performed in 2018 where consent forms of all ophthalmology related laser procedures and angiography were reviewed. Multiple interventions were taken to improve the adherence in obtaining a valid and adequate written consent prior to the post intervention audit. Standards of practice were compared to ‘Guidelines for Consent for Treatment of Patients by Registered Medical Practitioners’ by Malaysian Medical Council (MMC), and ‘Consent Forms in Ophthalmic Practice’ by Dr. Amit Khosla. A total of 412 consent forms were reviewed in the pre-intervention audit of 2018. Adherence to standard was 37.14%. In the post intervention audit, 256 forms were reviewed, and the adherence improved to 85.94%. Interventions taken include briefing to stakeholders, formulating a standardized risks checklist and multiple checks were done to ensure the interventions were adhered to by the doctors. The significant improvement in adequacy and validity of consent taking for ophthalmology related laser procedures and angiography showed that the interventions taken, were indeed useful. However, continuous effort in maintaining the standard is crucial for patient care and safety.
Clinical Audit

Obesity is defined as an excessive fat accumulation that causes metabolic syndrome such as diabetes, hypertension, and abnormal cholesterol levels. Adipocytes are a major part of the adipose tissue that grows the abnormal lipid droplets which leads to fat accumulation. In modern drugs, treating obesity without any side effects is challenging. Natural products such as plants and herbs are widely used to cure obesity. Natural products are safer because of their reduced toxicity and infrequent negative effects. This study focuses on examining the potential anti-adipogenesis effects of Elateriospermum tapos on 3T3-L1 cells. The extracts from both seed and shell of the fruit were extracted using hot, cold and ethanol extraction. The extracts were tested for the cytotoxicity on 3T3-L1 cells and on zebrafish embryo in vivo. Zebrafish study on heartbeat, heart rate and scoliosis formation, shell extract show less toxic compared to seed extract. This shell extracts showed a positive correlation determination of R2 = 0.96. Therefore, shell extracts were used to indicate the maximum non-toxic dose (MNTD) of each extraction. The lowest MNTD was observed in ethanol extract at 5.2 ± 0.01 µg/mL, hot extract at 7.6 ± 0.25 µg/mL and cold extract at 8.1 ± 0.31 µg/mL. Oil Red O staining to determine the amount of lipid accumulation showed a significant (P < 0.05) decrease of 70% when compared to adipocytes when treated with ethanol shell extract, and a significant (P < 0.05) decrease of 60% by hot shell extract. With the reduction in lipid accumulation, lipolysis was measured by accounting the amount of glycerol produced. The highest production of glycerol was significant when treated with hot shell extract at 42 mg/L, followed by cold extract at 38 mg/L. This is concluded that the hot shell extract has potential to curb obesity by reducing lipid accumulation through lipolysis at a maximum non-toxic dosage.

Introduction: A retrospective review of all burn patients admitted to the Burn Unit between 2015 -2020. To determine the demographics, causes, total body surface area (TBSA), length of hospital stay and their relationship with TBSA, percentage of patients requiring surgery, mortality and its causes, and the relationship of inhalational injury to mortality of burn patients in Terengganu over six years. Materials and methods: A descriptive study. Data were collected through the Hospital Information System (HIS). Data were analysed using IBM SPSS Statistics V21.0. Results: A total of 805 patients were admitted to Results: A total of 805 patients were admitted to the Burn Unit between 2015 -2020, with an average of 134 individuals annually. Minor burns accounted for 591 cases, moderate burns for 131 cases and 83 patients suffered major burns. Children were the most affected, accounting for 63% of all BI cases. The mean age for paediatric patients was 3.78, while for adults, the mean age was 36.7. The male-to-female ratio, irrespective of age group, was 1.67. The most typical BI causes were scalds. The average length of stay was 15 days, during which a 1.6% mortality rate was recorded. Inhalational injury was strongly linked to death. According to Fisher’s exact test, TBSA in BI and length of stay were significantly correlated (P < 0.001). Surgery was needed in 29% of children and 46.5% of adults. Conclusions: The significant incidence of burn injury in thi Conclusions The significant incidence of burn injury in this study suggests that raising awareness and increasing education by the authorities is a critical prevention initiative.
Burns

Introduction: Hyperlipidemia is a condition that may lead to many illnesses. The worldwide prevalence of hyperlipidemia is still relatively high. Lactoferrin is a glycoprotein found in mammals and fishes’ epithelial mucosa cells, also known for its protective roles. Objective: This study aims to d Objective: This study aims to discover the histopathologic changes in rat’s liver after the intervention of 100, 200, and 400 mg/kgBW lactoferrin. Method: This study involved 30 Sprague-Dawley rats divided into six groups: normal, negative control, statin-treated, dose 1, dose 2, and dose 3. The normal group was given standard feed, while the other groups were hyperlipidemic induced by a high cholesterol diet. The intervention for the statin-treated group was 1.5 mg/kgBW statin, while dose 1, 2, and 3 were respectively given 100 mg/kgBW, 200 mg/kgBW, and 400 mg/kgBW of lactoferrin. After six weeks, all rats were dissected, and the livers’ histopathologic slides were scored with Manja Roenigk scoring. Result: Lactoferrin improved the fatty liver condition. The statistical test results showed that 200 mg/kgBW of lactoferrin caused a significant change in the rats’ liver structures (p < 0.05). Conclusion 200 mg/kgBW of lactoferrin significantly improved the histopathologic structure of fatty liver
Histology

We report a literature review and a case of ocular toxoplasmosis in a patient with multiple drug allergies, who was successfully treated with regular intravitreal clindamycin and subconjunctival dexamethasone. A Malay lady in her twenties presented to us with right eye blurring of vision of 2 weeks duration, which she described as a central scotoma. Visual acuity at presentation was hand movements. Examination revealed intense ocular inflammation. The right eye had anterior segment inflammation of 3+ cells with fine keratic precipitates, whilst the posterior segment revealed papillitis, vitritis, retinitis, choroiditis, vasculitis and hyperpigmented chorioretinal scar inferotemporal to fovea. Ocular coherence tomography showed intraretinal fluid and retinal thickening. Fluorescein angiography showed early hypofluorescence of the lesion with progressive hyperfluorescence and leakage from the optic disc. Immunoglobulin G serology of Toxoplasma gondii was raised and immunoglobulin M levels were normal. The patient developed an allergic reaction with classical antibiotic and antifolate therapy. She was successfully treated with regular two-weekly intravitreal clindamycin and subconjunctival dexamethasone and her best corrected visual acuity was 6/18 at the end of her treatment. Intravitreal injection of clindamycin and subconjunctival dexamethasone is a good option in patients of ocular toxoplasmosis who are allergic to oral medications.
Toxoplasmosis, Ocular