Leprosy caused by Mycobacterium leprae, primarily manifests with cutaneous and neurological symptoms. Bone marrow (BM) involvement without skin lesions is exceedingly rare, particularly in immunocompromised patients. Here is a case of a 40-year-old HIV-infected man with a nadir CD4 count of 29 cells/mm³ who presented with recurrent anaemia, massive hepatosplenomegaly, and no apparent skin lesions. BM analysis revealed epithelioid granulomas with foamy histiocytes containing acid-fast bacilli, confirmed by Wade-Fite staining. This case highlights the rare presentation of lepromatous leprosy, emphasising the diagnostic challenges posed by the absence of typical cutaneous features.
Leprosy ; HIV

Introduction: The COVID-19 pandemic in 2020 resulted in a complete lockdown of educational institutions in Malaysia necessitating an immediate shift from conventional face-to-face teaching to online teaching-learning (OTL). This invariably affected the work-life balance and mental health of medical lecturers. This study was done to assess the adequacy of training of lecturers to conduct OTL and the challenges faced, and the impact of transitioning to OTL on the work-life balance and mental health of medical lecturers. The mental health status of lecturers was compared according to age categories of Gen-X, Gen-Y and Baby Boomer (BB) generations. Methods: An online survey was conducted between August and October 2021. Participants were asked to answer a series of questions designed to assess adequacy of training received, impact on work life balance, and score themselves with validated scoring tools to assess for anxiety, depression, and stress levels. Results: A total of 179 lecturers participated in the study. Training for OTL was deemed to be adequate and prepared the lecturers well for OTL. The transition to OTL negatively disrupted work-life balance causing extra work hours, disruption to family life, sleep issues, exhaustion, and stress but were positive in many other aspects. Gen-X and Gen-Y lecturers had higher perceived stress compared to BB. Conclusions Transitioning to online teaching during COVID-19 pandemic impacted work-life balance positively and negatively. Moderate to high perceived stress were reported, especially among younger lecturers. Training to equip lecturers to conduct online teaching and support for mental health and wellbeing should be provided.
COVID-19 ; Mental Health ; Work-Life Balance

Background: Pre-exposure prophylaxis (PrEP) is an evidence-based strategy recommended for at-risk populations for prevention of HIV transmission. However, the level of PrEP awareness and acceptance among Malaysian undergraduate students is currently unknown. Objectives: To assess the sexual activities, sexual behaviors, risk perception, awareness, and acceptance of PrEP of medical compared to non-medical students in a private medical university. Method: Demographic data, sexuality, sexual activity and behaviors, source of HIV knowledge, self- perceived risk of HIV, awareness and acceptance of PrEP were collected using an online anonymous survey among medical and non-medical students at a private medical university. Descriptive, comparative and regression analyses were performed where applicable. A p-value < 0.05 was considered statistically significant. Results: A total of 369 (187 medical, 182 non-medical) students responded. The median age was 22 with female:male ratio of 2:1. Eighty-one (22%) were sexually active of which 54% used condoms inconsistently, 58% had condomless sex in the preceding six months and 35% had casual or transactional sex. Despite this, 33 perceived themselves to be at low risk of HIV. Most learned about HIV from their coursework. PrEP awareness was 40% versus 20% while PrEP acceptance was 69% versus 67%, between medical and non-medical students, respectively. Conclusion Awareness of PrEP among medical students was low and even lower among non-medical students. PrEP acceptance was fair after viewing an introductory video on PrEP. PrEP must be included in the course curriculum. Studies to identify reasons for PrEP-hesitancy should be conducted to help guide policies and initiatives toward promoting PrEP as an additional tool in HIV prevention.
Malaysia ; HIV ; Awareness

Introduction: Cyberbullying is the use of information and communication technologies to support deliberate, repeated, and hostile behaviour by an individual or group to harm others. Cyberbullying may negatively affect the studies, personal lives and mental health of victims who are students. We report on the prevalence of cyberbullying and its effects on personal lives, studies, and mental health among medical students. Methods: A self-administered online questionnaire was used to collect demographic data, determine the prevalence of cyberbullying, and its effects on personal lives, studies and mental health of medical students. Student-t test was used for comparison of means, and logistic analysis was used to identify predictors of being cyberbullied. Results: 40 out of 261 study participants reported being cyberbullied in the preceding 6 months (prevalence: 15.3%). Cyberbullying did not negatively affect the studies and personal lives of victims. Most victims reported none or minimal-to-mild depression. Malay ethnicity was a predictor of being cyberbullied. Female students were 5-times more likely to be cyberbullied because of their lifestyle compared to males. Conclusion The prevalence of cyberbullying among medical students in this study was relatively low compared to reports from other universities. Cyberbullying had little to no effect on the studies, personal life, and mental health of medical students in our study. Malay ethnicity was a significant predictor to being cyberbullied. Females were more likely to be cyberbullied for their lifestyle. Support systems, awareness of good internet etiquette, and promotion of early help-seeking behaviour, especially targeted at identified vulnerable groups, should be put in place to check the practice of cyberbullying.
Malaysia ; Students, Medical ; Mental Health

COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can result in multiple complications such as long COVID syndrome, pulmonary fibrosis, and organizing pneumonia (OP). Although OP is a well-known complication of COVID-19, several challenges remain; from suspecting and confirming the diagnosis to its management. These challenges are aggravated further in patients who are critically ill and when surgical biopsy is not feasible. Post-COVID-19 OP is a subset of secondary organizing pneumonia that shares similar clinical and radiological characteristics and similar computerized tomography (CT) scan features with OP of various etiologies. In this review, we propose a clinical approach based on current available evidence for the management of COVID-19 patients with suspected OP. Typical CT findings such as consolidations, perilobular opacity, reversed halo sign and ground-glass opacities are highly suggestive of OP, but are not pathognomonic. Confirmation by histopathology should be done but when not possible, a trial of corticosteroid therapy may be considered. However, biopsy should be done if corticosteroid therapy fails or when there is clinical deterioration and worsening of hypoxia while on corticosteroid therapy especially if the onset of the symptoms is longer than two weeks.
COVID-19 ; SARS-CoV-2 ; Organizing Pneumonia ; Adrenal Cortex Hormones

Background: Social media is a common channel for communication, information and education. However, it is also a potential forum where lapses of professionalism may occur. In this study we aimed to elicit medical students’ perspective on social media practices and their perceived implications of social media posts. Methods: We conducted a cross-sectional study of Semesters 1 and 9 medical students from the International Medical University (IMU). A score was created consisting of the sum of the Likert scale in the 10-item social media practices questionnaire. Categorical variables were compared using chi-square test, while continuous variables that were not normally distributed were compared using Mann-Whitney U test. Statistical significance was set at p<0.05. Results: Out of 118 respondents (61% females), 54.2% of them recalled previous instructions regarding the use of social media and 55.1% of them were familiar with the IMU Social Media Guidelines. In general, respondents showed high level of awareness of inappropriate social medial practices, with statistically better awareness among Semester 1 students. Students who reported familiarity with IMU Social Media Guidelines were more aware of inappropriate social media practices. Most respondents were aware of the potential adverse impact of social media posts. Conclusion IMU students who participated in our survey generally had a good grasp of what constitutes inappropriate behaviour on social media and its potential future impact. Lower level of awareness of inappropriate social media practices among the Semester 9 students points to the need for periodic reminders of IMU Social Media Guidelines.
Students, Medical ; Social Media ; Professionalism ; Ethics, Medical

We present a rare case of post-antiretroviral therapy (ART) paradoxically worsening of radiological findings in a patient with advanced HIV-infection on treatment for Rhodococcus pneumonia who was misdiagnosed with pulmonary tuberculosis. Despite clinical improvement, serial chest radiographs showed deteriorations a month after starting ART. This was attributed to Immune Reconstitution Inflammatory Syndrome (IRIS) which spontaneously resolved without any treatment.

Cardiovascular symptoms presenting in a patient with dengue fever may post a diagnostic dilemma. We describe a case of dengue myocarditis mimicking an acute myocardial infarction in a 56-year-old woman.

Introduction: In Malaysia, the prevalence of missed opportunities for HIV-testing is unknown. Missed opportunities have been linked to late diagnosis of HIV and poorer outcome for patients. We describe missed opportunities for earlier HIV-testing in newly-HIV-diagnosed patients. Methods: Cross sectional study. Adult patients diagnosed with HIV infection and had at least one medical encounter in a primary healthcare setting during three years prior to diagnosis were included. We collected data on sociodemographic characteristics, patient characteristics at diagnosis, HIV-related conditions and whether they were subjected to risk assessment and offered HIV testing during the three years prior to HIV diagnosis. Results: 65 newly HIV-diagnosed patients (male: 92.3%; Malays: 52.4%; single: 66.7%; heterosexual: 41%; homosexual 24.6%; CD4 <350 at diagnosis: 63%). 93.8% were unaware of their HIV status at diagnosis. Up to 56.9% had presented with HIV-related conditions at a primary healthcare facility during the three years prior to diagnosis. Slightly more than half were had risk assessment done and only 33.8% were offered HIV-testing. Conclusions: Missed opportunities for HIV-testing was unacceptably high with insufficient risk assessment and offering of HIV-testing. Risk assessment must be promoted and primary care physicians must be trained to recognize HIV-related conditions that will prompt them to offer HIVtesting.