Dengue is an increasingly common infection among older adults, whose presentations are often atypical and easily misattributed to other causes of fever. We report the case of a 72-year-old man who presented with a short history of intermittent fever, lethargy and increased urinary frequency, initially treated as a suspected urinary tract infection. Laboratory investigations showed leucopenia, thrombocytopenia and mild anaemia. Urinalysis and cultures were negative. Dengue NS1 antigen testing confirmed the diagnosis. During the admission, the patient developed marked thrombocytopenia but did not progress to plasma leakage, bleeding, organ impairment or shock. He was managed with careful supportive care and frequent monitoring, recovering fully by Day 10 of admission. This case highlights the diagnostic challenges of dengue in older adults, whose altered physiological responses may mask classical features such as myalgia, rash and haemorrhagic manifestations.

Pressure injuries are areas of localised damage to skin and underlying tissue, usually over bony prominences. Pressure injuries are painful, worsen quality of life, increases hospital length of stay and risk of morbidity and mortality. In Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, there were previous concerns regarding pressure injuries, prompting service initiatives to improve prevention measures. However, after the COVID-19 pandemic, these concerns recurred warranting an audit of pressure injury prevention measures. The audit of routine pressure injury prevention forms in Geriatrics and Palliative Medicine inpatients was performed for 2 weeks. The completion rate of forms was 89.8% and 50% for Geriatrics and Palliative patients respectively. Among the Geriatrics and Palliative inpatients, one-third had pressure injuries before admission, while one-eighth developed them in hospital. The most prevalent risk factors were limited mobility, reduced physical activity and malnutrition.

Objective: to determine the distribution of various idiopathic inflammatory myopathies (IIM) and their profile at the largest university hospitals in Yangon, Myanmar. Method: It was a hospital based prospective study recruiting IIM patients admitted to Neurology and Rheumatology ward over a 1.5 year period from September 2017 to February 2019. Results: Among total 51 IIM patients recruited, 62.7% presented to Neurology ward and 37.3% to Rheumatology ward. Overlap myositis (OM) was the commonest (43%), followed by immune-mediated necrotizing myopathy (IMNM) 27%, dermatomyositis (DM) 24%, polymyositis (PM) 6%. Among OM, anti-synthetase syndrome (ASS) was 23%, and among IMNM, anti-SRP positive was 79%. IMNM and PM patients presented more to neurologists while OM/ASS and DM more to rheumatologists; 82% were females (F:M= 4.6:1). Mean age of onset of myositis was 40.2 + 17.8 years, and duration of symptoms before presentation was 10-3,600 days (shortest in anti-SRP and longest in anti-HMGCR myopathy). Myositis antibodies were positive in 67%. CK range was 40-25,690 U/l, highest in IMNM and lowest in DM. Associated connective tissue diseases among OM in order of descending frequency were 47% systemic lupus erythematosus, 24% Sjogren syndrome, 41% scleroderma and 12% rheumatoid arthritis. Associated cancer identified were one lung cancer in DM, one breast cancer in OM, one buccal cancer in IMNM cases. Conclusions: With recent availability of myositis antibody panel and MHC staining in Myanmar, we have applied current updated classification to describe the first Myanmar data on IIM cases.