Introduction: This study aims to determine the prognostic factors and survival outcomes of patients that underwent this surgery. Method: A retrospective review of 43 patients who underwent exenteration for periocular malignancies over a 14-year period was carried out. Patient demographics, tumour histology, treatment details, surgical margins’ status and post-operative survival were recorded. The survival outcome examined was the overall survival (OS) rate. Cox regression and Kaplan-Meier analysis were used to evaluate post-exenteration survival. Results: In total, 20 females and 23 males with a median age of 62 ± 17.3 years were identified. The most common indication for exenteration was basal cell carcinoma (20.9%), followed by squamous cell carcinoma (18.6%), adenocystic carcinoma (14%), malignant melanoma (14%) and sebaceous gland carcinoma (11.6%). The independent predictors for worse OS on multivariate analysis were Chinese ethnicity (adjusted hazard ratio [aHR] 4.95, p =0.017), sebaceous gland carcinoma (aHR 57.61 p=0.006), adenocystic carcinoma (aHR 45.87, p=0.008), clear surgical margins (aHR 5.41, p=0.025), receiving only chemotherapy (aHR 169.13, p=0.004), and receiving both adjuvant chemotherapy and radiotherapy (aHR 41.51, p=0.010). Conclusion: We recommend targeted public health initiatives for Chinese patients due to their increased mortality risk from peri-ocular malignancies. In addition, we advise comprehensive adjuvant therapy for all patients regardless of whether a clear surgical margin is achieved. Basal cell carcinoma and adenocystic carcinoma may also benefit from genetic research. We advocate more training for ophthalmologists to identify periocular malignancies earlier for better treatment options and increased chances of survival.

Introduction: Burnout is a growing trend among medical students worldwide. The aim of this study was to determine the prevalence and factors associated with burnout among medical students at a public university in Malaysia. Methods: A cross-sectional study was conducted among 1st through 5th year medical students at a public university using a simple random sampling method in recruiting participants. In this study, The Maslach Burnout Inventory-General Survey for Student (MBI-SS) was used and burnout is defined as severely emotionally exhausted and severely depersonalised. Results: A total of 328 medical students were recruited with a with response rate of 88.6%. The burnout prevalence was 10.1%. Based on multivariate logistic regression, presence of smartphone addiction with adjusted (odds ratio (OR) 7.37, 95% confidence interval (CI) = 1.67, 32.49), course choice not based on personal interest or due to family pressure (OR 2.72, 95% CI = 1.08, 6.85) and the presence of family relationship problems (OR = 3.58, 95% CI = 1.27, 10.04) are more likely to be associated with burnout among the medical students. Conclusion: Our study has shown that every tenth medical students suffers from burnout. Medical students who are addicted to smartphone, have chosen medical course against individual interest or because of family pressure and have family relationship problems are at risk of getting burnout. Intervention is required to address this issue for the future well-being of medical students.

Introduction: This study aimed to determine the prevalence and associated factors of lipohypertrophy in insulin-injecting patients with diabetes at selected primary care clinics in Malaysia Methods: This cross-sectional study was conducted among adults aged ≥18 years with type 1 or 2 diabetes treated with insulin for at least 6 months at six selected public primary care clinics in Malaysia. The Injection Technique Questionnaire was used, and physical examination was conducted to detect the presence of lipohypertrophy. Univariate and multivariate logistic regression analyses were conducted using IBM SPSS version 26. Results: A total of 506 patients with type 2 diabetes were included in this study; of them, 60.47% were women, and 48.42% were Malays. The prevalence of lipohypertrophy was 39.6% (95% Confidence Interval, CI =35%–44%). The univariate analysis revealed that a larger number of injections per day, longer needle length, repeated use of needles, incorrect rotation of the injection site, longer insulin use duration, higher total insulin dose and higher HbA1c level were significantly associated with lipohypertrophy. In the multivariate logistic regression analysis, incorrect rotation of the injection site was the only independent associated factor of lipohypertrophy. Conclusion The prevalence of lipohypertrophy in this study is comparable with that in other studies. The identified associated factors of lipohypertrophy must be addressed in ongoing health education for insulin-injecting patients at Malaysian primary care clinics. Educating healthcare professionals and increasing awareness among patients with diabetes are important steps in preventing this complication.
Prevalence ; Insulin ; Diabetes Mellitus ; Primary Health Care

BACKGROUND: Human mesenchymal stem cells are being used for various regenerative applications in past decades.This study chronicled a temporal profile of the transcriptional pattern and promoter methylation status of the osteogenic related gene in dental pulp stem cells (DPSCs) derived from 3-dimensional spheroid culture (3D) vis a vis 2-dimensional (2D) monolayer culture upon osteogenic induction. METHODS: Biomimetic properties of osteogenesis were determined by alkaline phosphatase assay and alizarin red staining. Gene expression and promoter methylation status of osteogenic genes such as runt-related transcription factor-2, collagen1α1, osteocalcin (OCN), and DLX5 (distal-homeobox) were performed by qPCR assay and bisulfite sequencing, respectively. Furthermore, μ-Computed tomography (micro-CT) was performed to examine the new bone formation in critical-sized rat calvarial bone defect model. RESULTS: Our results indicated a greater inclination of spheroid culture-derived DPSCs toward osteogenic lineage than the monolayer culture. The bisulfite sequencing of the promoter region of osteogenic genes revealed sustenance of low methylation levels in DPSCs during the progression of osteogenic differentiation. However, the significant difference in the methylation pattern between 2D and 3D derived DPSCs were identified only for OCN gene promoter. We observed differences in the mRNA expression pattern of epigenetic writers such as DNA methyltransferases (DNMTs) and methylcytosine dioxygenases (TET) between the two culture conditions. Further, the DPSC spheroids showed enhanced new bone formation ability in an animal model of bone defect compared to the cells cultivated in a 2D platform which further substantiated our in-vitro observations. CONCLUSION The distinct cellular microenvironment induced changes in DNA methylation pattern and expression of epigenetic regulators such as DNMTs and TETs genes may lead to increase expression of osteogenic markers in 3D spheroid culture of DPSCs which make DPSCs spheroids suitable for osteogenic regeneration compared to monolayers.

Knee osteoarthritis is the commonest cause of knee pain in the elderly. It is characterized by unresolved pain, limitation of motion and reduced quality of life. Total knee arthroplasty (TKA) is a safe and effective method in treating chronic knee osteoarthritis. We report a rare case of a seventy-seven-year-old Chinese female with multiple comorbidities and bilateral degenerative osteoarthritis who had sought services of traditional and complementary medicine (TCM) for pain relief. The patient experienced unresolved pain and superficial skin scars following the unregulated procedure. This paper aims to outline the importance of awareness among surgeons regarding the unregulated practice of TCM that may exacerbate chronic osteoarthritis, joint synovitis, influence the surgical approach for future procedures with the presence of scars and prosthetic joint infection risk.

Ectopic pregnancy is an extra-uterine pregnancy and is a potentially life-threatening condition that can lead to death from intra-peritoneal hemorrhage. This case reports a rare occurrence of ruptured tubal pregnancy in which the patient presented early with abdominal pain and a negative urine pregnancy test but subsequently presented again with evidence of intra-peritoneal hemorrhage. A negative urine pregnancy test is often used to rule out pregnancy, but it is not 100% sensitive. Complete assessment is critical in this important diagnosis in order to plan for the appropriate emergency management.

Diabetes mellitus has reached epidemic levels in Malaysia due to increase in its risk factors such as obesity, dietary and sedentary lifestyle. In patients with uncontrolled diabetes mellitus, diabetic foot ulcer (DFU)is a common complication. Managing diabetic foot infection is often multifactorial and intricate. The management DFU demands multi-speciality approach and often tedious. Hyperbaric oxygen therapy (HBOT) is a promising adjunctive treatment used to enhance the healing process plus reduces cost and recovery time. This is a case of a 52 years old lady, with underlying poorly diabetes mellitus, who presented with diabetic foot ulcer Wagner IV classification in sepsis. She underwent trans-metatarsal amputation followed by split skin grafting with additional adjunctive HBOT in a tertiary hospital.

Introduction: Coronavirus disease-2019 (COVID-19) was declared a global pandemic in March 2020, with 15 million people have been infected worldwide, and this number is increasing. Our study sought to assess the knowledge and practice of healthcare workers (HCWs) in a teaching hospital in Malaysia. Methods: This cross-sectional study was undertaken using online Google form links among HCWs. Knowledge and practice were assessed using a validated questionnaire. The analysis was performed with SPSS version 26. Factors associated with poor knowledge were analysed using multivariate analysis. Results: A total of 193 HCW responded to our online survey. Majority of our HCWs were female (74.1%) with a mean age of 32.5 years. We found 53 (27.5%) and 134 (69.4%) of our HCWs had good knowledge and good practice on COVID-19, respectively. Knowledge gap was identified in the symptomatology, investigation methods and management. Based on multiple logistic regression, determinants of poor knowledge scores were those work as medical attendants (aOR = 3.626; 95% CI = 1.489, 8.834) and nurses (aOR = 4.107; 95% CI = 1.175, 14.358). Conclusion: Around one-third and 70% of our HCWs have good knowledge and practice of COVID-19 infection respectively. Continuous, specifically targeted and updated medical education, need to be carried out to improve the knowledge and practice among our HCWs in order to keep abreast of the fast-moving pace of COVID-19 knowledge development.

COVID-19 pandemic has brought many changes in daily life. The pandemic has affected all populations in the world and lead to WHO calling for the global action to minimize the spread of this infection. Social distancing, work from home and movement control order are some of the strategies implemented to mitigate this infectious outbreak. Health consequences on non-communicable disease, mental health, social crisis among schoolchildren and burnout among healthcare providers have been affected during the pandemic. This review will provide a brief explanation on these health consequences of COVID-19 to the population. Future strategies that can be implemented during pandemic will also be discussed in the review.

Acute coronary syndrome is a medical emergency with a high mortality and morbidity. Reperfusion therapy is widely used in its management. Ocular complications following reperfusion therapy is rare. A 51-year-old man treated with streptokinase, antithrombotic and dual antiplatelet therapy, developed mild proptosis following treatment. After four days, there was sudden worsening of the proptosis associated with orbital compartmental syndrome (OCS). The CT scan of the orbit showed a large spontaneous subperiosteal orbital hemorrhage (SSOH) occupying half of the left orbit. Despite performing an urgent lateral canthotomy and inferior cantholysis, the patient developed irreversible vision loss due to compressive optic neuropathy. While a few cases of mild SSOH have been reported in the medical literature, this is the first documented case of secondary bleed in SSOH. Early recognition and intervention by the treating physician, is crucial in preventing blindness.