Introduction: School refusal is a common cause of chronically poor school attendance. The basis of school refusal behaviour can be grouped into the symptomatic and functional models, the operant conditioning model and the cognitive model. Objective: This paper is aimed to discuss the various systems and models which explain the school refusal behaviour. Method: An initial search of published literature in English Language was performed on the online databases including Google Scholar, Science Direct, EBSCOhost, and Proquest with the main keywords were School Refusal and Self–efficacy. Further sources were identified after consulting the original author for recommendations, and references within the literature retrieved in the initial search. Results: Out of 57 articles found, 41 were used in this review. Development and maintenance of school refusal involve heterogeneous risk factors and processes. The existing theoretical basis of school refusal behaviour can be grouped into symptomatic models, the operant conditioning model and the cognitive model. Conclusion: School refusal depicts a symptom, heralding the need for early intervention before development of a more pervasive mental health disorder. Where the problem had persisted for months to years, the child or adolescent would commonly present with coexisting anxiety or depressive disorders.
Neonatal mastitis and abscess are rare and most often unilateral. Neonatal breast massage for physiological breast hypertrophy is suspected to be a predisposing factor in the case reported here: a 14-day-old neonate with bilateral neonatal breast abscess, treated effectively with intravenous cloxacillin and surgical aspiration.
The clinical diagnosis of snakebite is critical, particularly in Southeast Asia where venomous snakebites are a public health concern. Additionally, cases involving unwitnessed snakebite with no species identification, especially in non-verbal children posed a challenge in the emergency setting. A 2-year-2-month-old boy presented to our emergency department with signs of neurotoxicity. He was restless and mildly bradypnoeic with the respiratory rate of 24 to 28 breaths per minute. He also had bilateral ptosis with absent gag reflex. There were faint fang marks noted over the medial aspect of his left ankle with local swelling and bruises, despite no history of animal bite and no eyewitness. A high index of suspicion of neurotoxic envenomation was prompted and a total of 6 vials of neuro-polyvalent anti-venom were administered in scheduled batches. Progressive clinical recovery was subsequently observed after the first batch of anti-venom administration. The case illustrated the importance of clinical recognition of neurotoxic envenomation in the absence of snake bite history or species identification. Early administration of anti-venom may potentially reverse the neurotoxic effects of systemic envenomation and saves lives.
Airway managements in maxillofacial fracture patients are complex and crucial. Trauma to the maxillofacial region may cause hemorrhage, swelling which may lead to pulmonary aspiration and airway obstruction. Airway managements in maxillofacial fracture patients are complex and crucial. Besides being uncooperative, presence of fractures and soft tissue injuries posed challenges in managing pediatric patient who already have smaller airway opening. This condition is an important red flag which required extra caution from the treating clinicians. A 6-year-old boy was involved in a road traffic accident and presented with profuse bleeding from the oral cavity and nostrils. Physical examination showed oozing of blood with step deformity of the midpalate. Multiple attempts in intubation resulted in failure before succeeding with the aid of suction devices. After intubation was done, intraoral bleeding was successfully managed with transpalatal wiring and nasal packing. The patient was ventilated in the intensive care unit and was extubated two days later. He was discharged well from hospital after one week of admission. Airway management is a rush against time, particularly in a pediatric patient suffering from a palatal fracture. The need for helping hands for suction and child control must be emphasized to ensure the patient’s survival.
Background:Recent retrospective studies suggest irrelevance of urine screening for neonate with prolonged jaundice. We re-evaluated the incidence of urinary tract infection (UTI) among these infants, their renal outcome and evaluated the cost incurred. Methods: This is a prospective cohort study. Asymptomatic, prolonged jaundiced infants with unconjugated hyperbilirubinemia were screened for evidence of UTI as per local guidelines. Infants with pyuria would have urine sent for culture and sensitivity. Unit cost was referenced from hospital purchase. Statistical analysis was performed using SPSS 24.0. Results:A total of 291 cases were analyzed. Majority were term infants (93.8%). The commonest cause of prolonged jaundice was breast milk jaundice, hence an incidence rate of 0.34%. Only one infant persistently showed single uropathogen on urinary culture with concurrent pyuria. Urinary structures were normal on ultrasonography and there was no evidence of renal cortical scarring. No recurrence of UTI documented in the first year of life. Each “clean-catch” urinalysis costed RM7. This unit cost escalated to RM37 for catheterized sample. A negative urine culture costed RM28 while a positive culture twice this price. The average cost effectiveness ratio (ACER) in this study was RM5856.56 per detection of case. Conclusion: Incidence of UTI is low. In our study, an undesirable outcome is negligible. Unnecessary parental anxiety from the potentially laborious procedure could be avoided. This study refutes previous literature to include such screening in prolonged jaundice as this may well be irrelevant.
Objective: The present study examined the sensitivity and specificity of M-CHAT-Malay version [M-CHAT(MV)] to discriminate ASD from other developmental-behavioural disorders. Methods: This study was carried out in the Child Development Centre at a tertiary referral centre. Parents of 130 children aged 18–60 months, referred for developmental-behavioural disorders were asked to complete M-CHAT(MV). A child was considered to have ASD ifthey failed any 3 of the 23 total items or 2 or more of the 6 critical items. Results: Looking at the total items, M-CHAT(MV) has a good sensitivity (88.9%) to differentiate between ASD and other developmental-behavioural disorders, although specificity was only 47.8%. However, the critical items only has sensitivity of 71.4% and specificity of 77.6%. Sensitivity for children aged 49–60 months old was lower (80.0%) compared to those in the younger age group (100.0% and 90.3% for those aged 25-36 months and 37–48 months respectively). Based on the ROC curve, the optimal criteria to detect ASD was failing 1 out of 6 critical items or 3 out of 23 total items. Conclusion: M-CHAT(MV) is a good screening tool in differentiating ASD from other developmental-behavioural disorders although the critical items’ criteria may need to be lowered to improve its sensitivity in selected cohorts.
MeSH terms: Problem Behavior; Autism Spectrum Disorder; Child; Child Development; Child, Preschool; Humans; Infant; Malaysia; Mass Screening; Parents; ROC Curve; Sensitivity and Specificity; Tertiary Care Centers
Visceral hyperalgesia, intestinal dysfunction and unexplained irritability in neurological impaired children is a medical enigma for many healthcare professionals. The neuro-medical management can be challenging and difficult, due to poor understanding of the underlying aetiology and pathophysiology of the condition. Neuro-enteric axis has been proposed as emerging physiologic mechanism in the pathogenesis of many gastrointestinal diseases. The bidirectional connection between enteric and central nervous system may represent a direct relationship between neurological system and gut physiology. Insult to the brain indirectly contribute to the ongoing gut and brain axis sequalae. Microbiota has been an important modulator in the brain-gut axis. Irritability episodes in severe neurological impairment children has been commonly associated with pain originated from gastrointestinal pathology. Management of such condition requires a holistic approach to tackle multidimensional factors that has contributed to the ‘totality’ of the symptoms.
Introduction: Tissue-engineered oral mucosa (TEOM) is increasingly being used to model oral mucosal diseases and to assess drug toxicity. Current TEOM models are constructed using normal oral fibroblasts (NOF) contained within a hydrogel matrix with normal oral keratinocytes (NOK) cultured on top. NOK are not commercially available and suffer from donor-to-donor variability. Therefore, oral mucosal models based on immortalised keratinocytes may offer advantages over NOK-based models. The objective of this study was to construct and characterise the TEOM developed using TERT2-immortalised oral keratinocyte (FNB6) cells and validate its similarity to normal oral muco-sal tissue. Methods: TEOM were constructed by culturing FNB6 cells on top of a NOF-populated collagen type-1 hydrogel in tissue culture transwell inserts cultured at an air-to-liquid interface and collected at 14 day. TEOM were subjected to morphological (H&E and PAS), ultrastructural (TEM) and immunohistological (Ki-67, cytokeratin 14 and E-cadherin) analysis. Results: Histologically TEOM mimicked native oral mucosa displaying a stratified epithelium, fibroblast-containing connective tissue and basement membrane. Furthermore, TEM confirmed the presence of des-mosomes and hemi-desmosomes in the epithelium. IHC revealed expression of differentiation markers (cytokeratin 14), proliferation (Ki-67), cell adhesion (E-cadherin). Conclusion: FNB6 mucosal models able to mimic native oral mucosa structure. It has potential for drug delivery and toxicity evaluation, and replacing models based on NOK where access to primary cells is limited.
Introduction: One of the risk factors for cancer is the habit of smoking. Some carcinogenic substances in ciga-rettes are nicotine and nitrosamine. In cigarette smoke there are free radical molecules or Reactive Oxygen Species (ROS) that can cause DNA mutations that can disrupt the balance of cell metabolism. One of them is the apoptosis, apoptosis is a programmed cell death mechanism. In cancer conditions there are apoptotic disorders and excessive proliferation of cells. The process of apoptosis is influenced by the death receptor, Tumor Necrosis Factor apoptosis inducing ligand R1 (TRAIL R1). This study aims to determine the effect of smoke exposure to expression of TRAIL R1 on the mucosal epithelium of the tongue of the Wistar rat (Rattus Novergicus). Methods: The subjects of this study were 24 male Rattus Novergicus with the age range of 12-14 weeks and weighing ± 170 grams. Divided into 4 groups with 2 control groups 4 weeks (K4), 8 weeks (K8) and 2 treatment groups each given 2 cigarettes / day ex-posure to cigarette smoke for each rat for 4 weeks (P4) and 8 weeks (P8). Results: The results showed that exposure to cigarette smoke can cause interference with TRAIL R1 expression. There was a significant difference in TRAIL R1 expression between the control and treatment groups and there was a significant difference in TRAIL R1 expression between the duration of cigarette smoke exposure (P4 and P8). Conclusion: Exposure to cigarette smoke can interfere with the process of apoptosis.
Introduction: This study examined the antioxidant activity and phenolic, flavonoid and saponin contents from mul-tiple solvent extracts of Albizia myriophylla (ABZ) bark. Antioxidant activity of the methanol extract and its derived fractions namely hexane, chloroform, ethyl acetate, butanol and a residual aqueous fraction of the bark of ABZ was assessed. Methods: All the extracts showed a significant presence of phenolic, flavonoids and saponins. In DPPH (1, 1-diphenyl-2-picrylhidrazyl) radical scavenging test, ABTS (2-2’-azinobis 3-ethyl-6-sulfonic acid) radical scavenging test and reducing activity on ferrous iron (FRAP) test, the total antioxidant capacity was found to be varied in different fractions. Results: The IC50 calculated value of the three assays showed that the methanolic extract of ABZ bark had the lowest IC50 value for each assay, compared to the other extracts signifying highest anti-oxidant activity. Methan-olic extract of ABZ was tested in high-fat diet induced mice, which showed reduce adipocyte cellularity and reduces the cholesterol, triglyceride, LDL level while increasing the HDL level. Conclusion: The antioxidant capacity with probable free radical scavenging activity of the methanolic extract of ABZ may be useful for the treatment of chronic inflammatory-related metabolic diseases such as obesity.
Introduction:Acyclovir, a widely marketed antiviral drug is used for the treatment of Herpes Simplex infection. High doses of acyclovir are prescribed to patients to attain its maximum therapeutic effect due to its poor absorption and low oral bioavailability. The current therapeutics regiment of acyclovir are known to cause unwarranted adverse effects, thus prompted the need for a suitable drug carrier to improve the pharmacokinetic limitations. Develop-ment of solid lipid nanoparticles for oral delivery of acyclovir proposed in this study aimed to enhance acyclovir oral bioavailability. Methods: Comprehensive experiments and a series of optimization process were carried out to ensure reproducibility and assurance of product quality. The physicochemical characteristics of the solid lipid nanoparticles developed from plant-based solid lipid, Biogapress Vegetal 297 ATO with polysorbate 80 as an emul-sifying agent were also evaluated. Results: The spherical-shaped nanoparticles had an average size of 123 nm with good drug entrapment efficiency, up to 80%. The in vitro drug release study showed that solid lipid nanoparticles had prolonged acyclovir release in simulated intestinal fluid for 24 hours. The nanoparticles formulation was con-sidered stable during storage at refrigerated temperature for at least three months. In vivo oral bioavailability study showed that acyclovir-loaded solid lipid nanoparticles possessed superior oral bioavailability when compared with the commercial acyclovir suspension. Conclusion: In conclusion, this study exhibited the feasibility of solid lipid nanoparticles as an oral delivery vehicle for acyclovir and therefore represent a new promising therapeutic concept of nanoparticulate delivery system.
MeSH terms: Acyclovir; Antiviral Agents; Biological Availability; Drug Carriers; Feasibility Studies; Herpes Simplex; Humans; Lipids; Polysorbates; Suspensions; Temperature; Reproducibility of Results; Nanoparticles; Drug Liberation
Introduction: Currently, organoid technology provides a useful tool for modelling human organ development and pathologies in vitro. Salivary gland (SG) organoids developed from mice SG cells display self-organizing properties closely mimic the native organ. Thus, this study would like to investigate the potential of this organoid system to de-velop a human salivary gland in vitro. Methods: Organoids were developed from biopsy samples of normal human sublingual gland tissue. Cells were isolated and cultured in Matrigel at an Air Liquid Interface (ALI) for up to 14 days in an enriched media supplementing with Wnt-3A, R-spondin1, EGF, and FGF2. Specific differentiation factors like TGFβ, BMP, and LIMK inhibitors were added to enriched media for further differentiation studies. Haematoxylin and eosin-stained sections of the cultures were used to visualise growth. RT-PCR, immunohistochemistry and immunoflu-orescence were used to determine the differential expression of cell-specific markers. Results: Human SG organoids developed when the cells were grown in Matrigel at ALI in a defined culture system. The addition of TGFβ inhibitor and all the inhibitors (TGFβ, BMP and LIMK) to the culture media affected SG organoids development by displaying distinct characteristics that closely resemble native glands and expressed specific cell-type markers; BPIFA2, AQP5, CK5 and E-cadherin. The inhibition of BMP signalling demonstrated SG organoids growth more into ductal-like struc-tures and expressed ductal cell marker, CK7. While LIM kinase inhibition signalling showed significantly higher of amylase activity assay. Conclusion: This study certainly offers valuable insight into determining the optimal culture conditions for developing human SG organoids.
Introduction:Transfusion Transmitted Infections is occurring worldwide. The common organisms related reported in literature were Human Immunodefiency Virus, Hepatitis B and C Virus, bacterial contamination and Malaria par-asites. Meanwhile, Melioidosis is endemic disease in Malaysia and especially Sabah. Mortality due to Melioidosis septicaemia was also high. It ranges between 60%-80%. In Sabah, 74% of Thalassemia children were diagnosed with Bacteraemia Melioidosis and 50% had died due to the organisms. The incidence of Melioidosis Transfusion Transmitted Infection is rarely reported in the literature. Case Description: A 17-year-old girl was diagnosed having Beta thalassemia major since 5 years old and splenectomised 8 years ago. Currently on prophylaxis Penicillin and Ex-jade. She was admitted into hospital for monthly blood transfusion. Two days prior to admission, patient complained of having sore throat and cough but no fever and other complained. On examination, the tonsil enlarged and was treated as exudative tonsillitis. She was transfused with 2 pint packed cells within 2 days. No transfusion reaction noted. Day seven admission, she had high grade fever and redness of the right hand cannulation site and was treated as right hand cellulitis with intravenous Cloxacillin. Full blood count shows Total White Cell count was 24.9 x109 /L, Haemoglobin level was 9.3 g/dl and Platelets was 462x109/L. Blood for culture and sensitivity was taken and Chest X-ray noted haziness over the left mid and lower zone of the lung and was treated as Hospital Acquired Pneumonia. She was referred to tertiary hospital for further management. Her conditioned deteriorated and died at the casualty unit in the tertiary hospital. Blood culture was positive for Burkholderia pseudomallei. The case was reported to Dis-trict health office for further investigation. Blood donor tracing was done and was positive for Melioidosis through Elisa Antibody titre IgM for Melioidosis (1:320). The patient’s house and school were visited and investigated. All environmental samples were negative for Burkholderia pseudomallei. Conclusion: Its shows a relationship between blood donations infected with Burkholderia pseudomallei causing mortality of Beta Thalassemia patients. It is highly recommended to screen all blood products for communicable disease fatal organisms.
ABSTRACTS FOR THE 1ST INTERNATIONAL BORNEO HEALTHCARE AND PUBLIC HEALTH CONFERENCE AND 4TH BORNEO TROPICAL MEDICINE AND INFECTIOUS DISEASE CONGRESS
Introduction: Gestational Diabetes Mellitus (GDM) imposes a risk for both mother and child. Worldwide, it was estimated that GDM affects 1% to 28% of antenatal mothers. Previous studies revealed that prevalence of GDM ranged from 18.3% and 24.9% in Malaysia. This study was conducted with the aim of determining the prevalence of GDM among pregnant women and their sociodemographic characteristics in Tuaran District, Sabah State, Malaysia.
Methods: A cross sectional study was done in four Maternal and Child Health (MCH) Clinics at Tuaran, Tamparuli, Tenghilan and Kiulu in Tuaran District which included all pregnant mothers at gestational period of 24 weeks and above who attended these clinics from May 2018 to June 2018. Convenient sampling method was used. Secondary data was obtained from antenatal book records and primary data was collected by interview method using pretest-ed questionnaire. A total of 195 pregnant women participated in the study.
Results: The overall GDM prevalence among pregnant women who attended MCH clinics for antenatal care in Tuaran District was 28.2%, (95% CI: 22.0%-35.1%, n=55). Distribution of GDM cases were 34.5%, 34.5%, 18.2% and 12.7% for MCH Tuaran, Teng-hilan, Tamparuli and Kiulu respectively. Sociodemographic characteristics showed that majority of GDM was less than 35 years old of age (63.6%), multipara (60%), Kadazan/Dusun ethnicity (58.2%), attained secondary schools’ education and above (91%) and earning > RM1000 per month (65.5%). Percentage according to potential risk factors were 25%, 21% and 20% for history of abortion, family history of diabetes mellitus and previous history of GDM respectively.
Conclusion: Prevalence of GDM among pregnant women in Tuaran District was quite alarming. Further studies should be conducted about GDM and its determining factors for effective planning in strengthening GDM prevention and control programs.
MeSH terms: Child Health; Adult; Borneo; Child; Cross-Sectional Studies; Ethnic Groups; Female; Humans; Malaysia; Maternal-Child Health Centers; Mothers; Pregnancy; Prenatal Care; Surveys and Questionnaires; Prevalence; Diabetes, Gestational; Pregnant Women
Introduction: Hypertension is a condition where there is persistently raised pressure in the blood vessels. In Malay-sia, higher prevalence of hypertension could be explained by lifestyle factors such as higher rates of obesity, excess dietary intake of sodium and fat and lack of physical activity. The main objective of this study was to determine the prevalence, risk factors and co-morbidities of hypertension in villagers aged 18 years and above in Kampung Tajau Laut, Kudat, Sabah. Methods: Non-probability convenience sampling method was used to select a total of 210 villagers for interview, anthropometric examinations and blood pressure measurements. House to house and face to face interview by trained year four medical students done using a pretested validated questionnaire. The ques-tionnaire contained data on socioeconomic status, tobacco use, physical activity, diet, extra-salt use, family history of hypertension, co-morbidity, anthropometric measurements and blood pressure. Results: Respondents noted to be hypertensive were 67.6%, and out of this, 61.3% were undiagnosed. There was a significant association between hypertension and family history (Chi-squared test=38.280, p=0.000), hypertension and smoking status (Chi-squared test=7.673, p= 0.006), hypertension and obesity (Chi-squared test= 8.731, p=0.003), hypertension and gender (Chi-squared test=5.126, p=0.024), hypertension and age (Chi-squared test=26.110, p=0.000) of respondents. There was no significant association between hypertension with vegetable intake, fruit intake, physical activity, marital status, ethnicity, economic status, level of education, and occupational status of respondents. Half of the known hyperten-sive respondents have comorbidities with most commonly being dyslipidaemia and diabetes mellitus. Conclusion: Hypertension was found to have a significant association with family history, smoking status, obesity, age and gender among the studied population.
Introduction:Light’s criteria for pleural fluid analysis has long been the standard for distinguishing transudates from exudates. In pleural tuberculosis, the resulting pleural fluids are usually exudates. We present a case of presumed transudative effusion which was eventually diagnosed as pleural tuberculosis. Case description: A 59-year-old man with end-stage renal failure (ESRF) on regular haemodialysis presented with a one-day history of acute onset dys-pnoea associated with pleuritic chest pain and cough. Chest radiograph revealed bilateral pleural effusions and thoracentesis was done. The pleural fluid result was interpreted as transudative effusion according to Light’s criteria because his pleural fluid to serum protein ratio was less than 0.5. AFB 1+ was seen in the pleural fluid with negative gram stain and culture. This resulted in conflicting opinions on whether to start this patient on anti-tuberculous ther-apy (ATT) and there was even a suggestion to get a second opinion for the possibility of AFB fluid contamination. The initial diagnosis was written as fluid overload secondary to ESRF but ATT was started anyway to cover for pleural TB. On further analysis of his pleural fluid, the pleural protein 32 g/L which on its own is a marker of exudative effusion. Subsequent investigations revealed the presence of exudative ascitic fluid which further raised the suspicion for a concomitant peritoneal TB. Conclusion: Premature conclusion that the pleural fluid was transudative occurred prob-ably due to the bilateral nature of the pleural effusion associated with a known tendency for the patient to develop pulmonary overload secondary to his ESRF. This case is a reminder that Light’s criteria also requires serum and fluid LDH measurement for the diagnosis of transudative pleural effusion. More importantly, a high level of suspicion for TB is important when evaluating patients from areas where TB is prevalent and a positive AFB result should not be taken lightly.
Introduction: Tuberculosis (TB) of the elbow joint is uncommon. Prompt diagnosis and treatment are important to prevent joint destruction and preserve function. We present a case of TB synovitis of the elbow joint in a patient with active rheumatoid arthritis (RA). Case description: A 56-year-old woman with a known seropositive RA on metho-trexate and Leflunomide was seen in the outpatient rheumatology clinic as part of her monthly follow-up. She com-plained of persistent bilateral elbow pain and swelling, despite optimisation of her disease-modifying antirheumatic drugs (DMARD) and steroid therapy. The suspicion for another diagnosis for her elbow symptoms stems from the persistent pain and swelling amidst increased titration of methotrexate and prednisolone dosages. Ultrasound scan of her elbows revealed bilateral complex olecranon bursitis with active synovitis. The left elbow aspiration yielded cloudy yellowish synovial fluid and the sample was sent for fluid culture, acid-fast bacilli (AFB) stain, and GeneXpert. No AFB was seen but the GeneXpert test confirmed the presence of Mycobacterium Tuberculosis. Thus, a diagnosis of TB synovitis of the left elbow was made, and she was promptly started on anti-tubercular therapy (ATT) consisting of Rifampicin, Isoniazid, Ethambutol and Pyrazinamide with the aim to complete 9 months of ATT. Conclusion: The diagnosis of tuberculous synovitis is challenging. In the absence of constitutional or respiratory symptoms, joint TB is usually low on the initial differential diagnosis in patients presenting with joint pain and swelling. The diagnosis is made even more difficult in patients with concomitant rheumatoid arthritis. This case demonstrates the importance of a high index of suspicion for TB, particularly when evaluating patients in high TB prevalence area with an underlying immunosuppressive state.
Introduction:A unilateral enlarged tonsil always is a suspicion of carcinoma. Especially if it is with fungating ulcer-ative surface. Neoplasms in unilaterally enlarged tonsil include squamous cell carcinomas and lymphomas. Lym-phomas in oropharynx are not common specially with fungating surface. Usually lymphomas in these areas are Non-Hodgkin’s type. Case description: A 62-year-old woman was admitted in the tertiary level hospital of Kota Kinabalu, Sabah, with the complaint of sore throat, odynophagia and right neck swelling. She was treated as a case of acute tonsillitis by general practitioner without any noticeable improvement. Oral cavity examination revealed a hugely enlarged right tonsil with fungating ulcerative surface and almost obstructing the oropharynx. Trismus was seen which make the examination difficult. A non-tender right upper neck swelling was palpable. All baseline lab-oratory investigations were normal. A contrast-enhanced computed tomography (CECT) showed a heterogeneously enhancing mass at oropharynx compromising the airway, right supraclavicular lymphadenopathy. Histology of biop-sy from right tonsillar mass showed High grade B-cell lymphoma. Chemotherapy was planned. First cycle of chemo-therapy was administered, Patient was discharged home with the complete plan of chemotherapy. Conclusion: This patient was clinically suspicious of carcinoma of palatine tonsil. But later proven as high grade B-cell lymphoma. All unilateral enlarged tonsils are not always carcinoma.
Introduction: High altitude retinopathy (HAR) is part of high altitude illness (HAI) which includes acute mountain sickness, high altitude cerebral oedema and pulmonary oedema. We present a case of bilateral HAR with right eye central scotoma during Mount Everest expedition. Case description: A 37-year-old lady presented with decreased right eye (OD) vision and central scotoma during ascending to the top of Mount Everest at 5100m. She developed respiratory symptoms with shortness of breath at the same time and warranted her a rapid descend on day eight of her excursion. Ocular examination revealed visual acuity of 6/36 OD and 6/6 left eye (OS). Both pupils were normal without relative afferent pupillary defect. Anterior segment and intraocular pressure were unremarkable. Fundus examination revealed bilateral multiple retinal haemorrhages along vascular arcades, with macula involvement in the right eye only. Otherwise there was no sign of optic disc swelling, vascular sheathing or choroidal involvement. Optical coherence tomography (OCT) of the macula showed hyperreflectivity changes on the right fovea at the level of superficial nerve fiber layer. Diagnosis of bilateral HAR was made and treated conservatively. She was also diag-nosed with HAI with acute pulmonary oedema and pneumonia by the treating physician. The retinal haemorrhages started to resolve after two weeks with full recovery of vision in ten weeks. Conclusion: With increasing popularity of mountaineering, ophthalmologists should be prepared to recognise HAR as part of HAI. Visual impairment depends on the location and extent of the lesions. HAR is self-limiting with good prognosis but can be associated with poten-tially fatal conditions of HAI e.g. pulmonary oedema in our case.
Introduction:Malaysia has the highest prevalence of obesity among the Southeast Asian nations which increases the risk for non-communicable diseases such as diabetes mellitus and hypertension. Since rural communities regularly face challenges in receiving medical services, regular health screening programs targeting these communities are necessary for early diagnosis and intervention to prevent complications as well as preserve the patients’ quality of life. Methods: A community health screening program was performed in the Inanam sub-district of Kota Kinabalu, Sa-bah, Malaysia. A total of 50 participants via convenience sampling were examined for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) to determine their general and central obesity status. Estimation of body fat percentage (Fat%) and body fat mass was conducted by using bioelectrical impedance analysis. Addition-ally, systolic blood pressure (SBP), diastolic blood pressure (DBP), and capillary blood glucose were also measured. Results: The participants had a median age of 39.50 years. The prevalence of general obesity was 28%, while the prevalence of central obesity was 78% (based on WC) and 74% (according to WHR). Hypertension and hyperglyce-mia prevalence was reported at 24% and 20%, respectively. BIA showed that both Fat% and fat mass had positive associations with BMI (r=0.656, p=0.001 for Fat%; r=0.868, p=0.001 for fat mass) and WC (r=0.505, p=0.001 for Fat%; r=0.761, p=0.001 for fat mass). The DBP had positive associations with the BMI (r=0.390, p=0.005), WC (r=0.467, p=0.001), and WHR (r=0.331, p=0.019), while the SBP had a positive association with the WC alone (r=0.341, p=0.015). Conversely, there were no significant associations between capillary blood glucose and BMI, WC, or WHR. Conclusion: The rural community of Inanam sub-district had a higher prevalence of central obesity than the national level. This should raise concern among healthcare professionals regarding future hypertension and hyperglycemia risk in this community.
MeSH terms: Adult; Blood Glucose; Blood Pressure; Humans; Hypertension; Malaysia; Obesity; Public Health; Quality of Life; Rural Population; Body Mass Index; Prevalence; Electric Impedance; Waist-Hip Ratio; Waist Circumference; Obesity, Abdominal