Ahmad Rejab et al Brunei International Medical Journal 2025;21:78-81 Brunei International Medical Journal Supraglottic Non-Hodgkin Lymphoma Ahmad Rejab RAF1, Lott A2, Abdullah K2, Musa Z2, Mohamad I1*

Purpose: This study sought to examine the utilization of bone health evaluations in geriatric hip fracture patients and identify risk factors for the development of future fragility fractures. Materials and Methods: A consecutive series of patients ≥55 years who underwent surgical management of a hip fracture between September 2015 and July 2019 were identified. Chart review was performed to evaluate post-injury follow-up, performance of a bone health evaluation, and use of osteoporosis-related diagnostic and pharmacologic treatment. Results: A total of 832 patients were included. The mean age of the patients was 81.2±9.9 years. Approximately 21% of patients underwent a comprehensive bone health evaluation. Of this cohort, 64.7% were started on pharmacologic therapy, and 73 patients underwent bone mineral density testing. Following discharge from the hospital, 70.3% of the patients followed-up on an outpatient basis with 95.7% seeing orthopedic surgery for post-fracture care. Overall, 102 patients (12.3%) sustained additional fragility fractures within two years, and 31 of these patients (3.7%) sustained a second hip fracture. There was no difference in the rate of second hip fractures or other additional fragility fractures based on the use of osteoporosis medications. Conclusion Management of osteoporosis in geriatric hip fracture patients could be improved. Outpatient follow-up post-hip fracture is almost 70%, yet a minority of patients were started on osteoporosis medications and many sustained additional fragility fractures. The findings of this study indicate that orthopedic surgeons have an opportunity to lead the charge in treatment of osteoporosis in the post-fracture setting.

PREVALENCE OF VISUAL IMPAIRMENT AND EYE DISEASES IN MALAYSIA: A CROSS-SECTIONAL PROSPECTIVE STUDY AT THE UNIVERSITY OF MALAYA MEDICAL CENTRE Introduction: The prevalence of visual impairment and ocular diseases changes over time. This measure can help general practitioners in anticipating common eye disorders that may require ophthalmological referrals to government hospitals. This study aimed to evaluate the prevalence of visual impairment and ocular diseases in an outpatient ophthalmology clinic in a public hospital and the types of investigations frequently conducted to diagnose these diseases. Methods: A cross-sectional prospective study was conducted over three weeks in the eye clinic of the University of Malaya Medical Centre. The electronic medical records of all patients who attended the outpatient clinic were assessed to collect data on sex, age, type of visit, visual acuity, ocular presentation, investigations conducted and diagnosis of eye diseases. Visual impairment and blindness were categorised as per the World Health Organization criteria. Results: Among 1002 patients, 327 had visual impairments (32.63%), and nine had blindness (0.9%). Cataracts were the most common ocular disease diagnosed (n=294, 29.74%), followed by glaucoma (n=123, 12.28%) and diabetic retinopathy (n=84, 8.38%). Optical coherence tomography was the most common investigation performed (n=272, 64.9%), followed by Humphrey visual field testing (n=53,12.6%). Conclusion: Untreated refractive error is the leading cause of visual impairment in children, while cataract, glaucoma and diabetic retinopathy are the main contributors to visual impairment and blindness in elderly individuals. Our study highlights the urgent need for general practitioners to recognise avoidable visual impairment in all age groups to help prevent blindness.

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

Background and Objectives: Eye diseases have a high socioeconomic impact on society and may be one of the fields in which most stem cell-related scientific accomplishments have been achieved recently. In this context, human Pluripotent Stem Cell (hPSC) technology arises as an important tool to produce and study human Embryonic Stem cell derived-Retinal Pigmented Epithelial Cells (hES-RPE) for several applications, such as cell therapy, disease modeling, and drug screening. The use of this technology in pre-clinical phases attends to the overall population desire for animal-free product development. Here, we aimed to compare hES-RPE cells with ARPE-19, one of the most commonly used retinal pigmented epithelial immortalized cell lines. Methods: and Results: Functional, cellular and molecular data obtained suggest that hES-RPE cells more closely resembles native RPEs compared to ARPE-19. Furthermore, hES-RPE revealed an interesting robustness when cultured on human Bruch’s membrane explants and after exposure to Cyclosporine (CSA), Sirolimus (SRL), Tacrolimus (TAC), Leflunomide (LEF) and Teriflunomide (TER). On these conditions, hES-RPE cells were able to survive at higher drug concentrations, while ARPE-19 cell line was more susceptible to cell death. Conclusions Therefore, hES-RPEs seem to have the ability to incur a broader range of RPE functions than ARPE-19 and should be more thoroughly explored for drug screening.

A 33-year-old man presented with a four-day history of redness and blurring of vision of the right eye. A clinical diagnosis of adenoviral keratitis was made with a differential of microsporidia epithelial keratitis. The patient subsequently developed nummular keratitis which was resistant to topical steroids. He continued to develop multiple recurrences of the condition. Treatment with tacrolimus ointment was started as the patient had an elevated intraocular pressure due to prolonged steroid use. Tacrolimus ointment showed a favourable outcome in the management of recurrent nummular keratitis.

A 42-year-old gentleman presented with left eye pain after accidental contact with Euphorbia lactea sap while gardening. At presentation, left eye best-corrected visual acuity (BCVA) was 20/30. Ocular examination revealed left eye conjunctiva congestion and cornea abrasion. Eye symptoms and BCVA deteriorated over 12 hours. Cornea showed diffuse stromal oedema with presence of anterior uveitis. A diagnosis of toxic keratouveitis was made. He was treated with intensive topical steroids, cycloplegics, lubricants, prophylactic antibiotics and oral non-steroidal anti-inflammatory analgesic. Patient achieved complete resolution two weeks later. We aim to raise awareness among the ophthalmologists to detect and manage these injuries.