Pancytopenia, Cholestatic Jaundice, and Pulmonary Hypertension: Rare Extrathyroidal Manifestations of Graves' Disease.

Pancytopenia, cholestatic jaundice, and pulmonary hypertension are rare but serious complications of thyrotoxicosis. It is uncommonly seen in patients with hyperthyroidism and may result in treatment-related dilemmas as bone marrow suppression and drug-induced liver injury are known complications of anti-thyroid treatment.  We describe a case of Graves' disease presenting with all three manifestations of pancytopenia, cholestatic jaundice, and pulmonary hypertension during a relapse of thyrotoxicosis.

Demographics and characteristics of endoscopic findings among COVID-19 patients with upper gastrointestinal bleeding in a single centre.

Introduction: Novel coronavirus 19 disease (COVID-19) pandemic poses healthcare providers challenges in the endoscopic suite. It is unclear whether it affects the endoscopic manifestations of upper gastrointestinal (GI) bleeding. This retrospective study was done to review demographic data, site of lesions and need of interventions for those lesions.

A case of sudden slow heart rate in a patient with atrial fibrillation - what could be the possible cause?

General practitioners regularly encounter atrial fibrillation in their daily practice. A crucial cornerstone of its management includes prescribing anticoagulants and controlling the heart rate. Tachycardia or bradycardia often reflects an ongoing pathological process that should be addressed.

Prophylactic intravenous tranexamic acid and thromboembolism in non-cardiac surgery: a systematic review, meta-analysis and trial sequential analysis.

Tranexamic acid is an antifibrinolytic drug that is widely used during surgery, but there are concerns about its thromboembolic effects. We aimed to investigate the effect of prophylactic intravenous tranexamic acid on thromboembolic outcomes in patients undergoing non-cardiac surgery. The MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched.

Pharmacists' experiences on adverse drug reaction: 10 years later.

Adverse drug reaction (ADR) is one of the leading public health concerns associated with high mortality rate. Healthcare professionals, particularly pharmacists, have a significant role in monitoring and preventing ADRs. This study was conducted on Malaysian Pharmaceutical Society (MPS) pharmacists who worked at the hospitals, health clinics, and community pharmacies to determine if pharmacists' experiences on ADRs are still the same 10 years later.

A practical approach to chronic kidney disease in primary care.

Chronic kidney disease (CKD), a common clinical problem in primary care, can be defined as any abnormality of the kidney structure and/or function that has been present for at least 3 months. Over the past 20 years, the incidence and prevalence of CKD have been increasing in Malaysia in line with the rising number of non-communicable diseases. At present, CKD has no cure.

Management of gout in the primary care setting.

Gout is a commonly treated inflammatory arthritis that is often managed in the primary care setting. This disease is prevalent among the multi-ethnic Malaysian population. Unfortunately, gout is still frequently managed sub-optimally, even in the hospital and primary care settings.

The study of relationship between ocular biometry and exophthalmometry in adult Malay population of Kelantan, Malaysia.

Purpose: Exophthalmometry value has great clinical significance in the presence of many orbital diseases which can cause proptosis, including thyroid-associated orbitopathy, tumors, inflammation, head and orbital trauma, and craniofacial abnormalities. Measurements of exophthalmometry and ocular biometry vary between races and countries. This study aimed to present the normative values of exophthalmometry in adult Malays of Kelantan and the relationship between ocular biometry (axial length, corneal curvature, anterior chamber depth, and white-to-white) with the obtained exophthalmometry values.

Erythematous plaques of the vulvo-perineal region.

Skin conditions are a common reason for consulting primary health care. The public frequently expects their primary health care providers to be able to recognise and treat common skin conditions with confidence. Primary care providers must be able to identify 'red flag' skin conditions that require dermatology referral.

Littoral cell angioma disguised as huge ovarian cyst: A thought to ponder.

Littoral cell angioma (LCA) of the spleen is a rare vascular tumour. It was thought to be a benign and incidental lesion. Given the relative lack of specific symptom in many cases, these tumours are found incidentally during abdominal surgery during a non-related procedure.

Hepatic Sarcoidosis: Diagnostic approach and management.

Sarcoidosis is a multi-systemic, non-caseating granulomatous disorder with an idiopathic aetiology. We report a 58-year-old Malay woman, with underlying type II diabetes mellitus, hypertension and history of stage II pulmonary sarcoidosis presenting with incidental finding of multiple hypodense liver lesions. Her recent contrasted enhanced computed tomography of the abdomen and pelvis demonstrated multiple intra-abdominal lymphadenopathies with evidence of liver and splenic infiltrations.

A retrospective cross-sectional study on the risk factors and survival outcome of End Stage Kidney Disease patients receiving regular maintenance haemodialysis with COVID-19 infection in Hospital Enche' Besar Hajjah Khalsom, Kluang.

Introduction: COVID-19 pandemic has affected healthcare services around the globe as hospitals were turned into designated hospitals to accommodate high risk groups of patients with COVID-19 infection including end stage kidney disease (ESKD) patients. In Malaysia, there was insufficient data on COVID-19 infection among ESKD patients. This study aims to determine factors and survival outcomes associated with COVID-19 infection among ESKD patients in a designated COVID-19 hospital in Malaysia.

Kimura Disease: A Rare Cause of Head and Neck Tumour in Children- A Case Report.

Background: Kimura disease is a rare inflammatory condition classically manifested as painless subcutaneous nodules in the head and neck region and associated with regional cervical lymphadenopathy and salivary gland involvement.

Objective: The purpose of this report is to illustrate the diagnostic difficulty due to its rarity and non-specific clinical presentation.

Case Presentation: We present a case of Kimura disease with bilateral eyelid swelling, parotid involvement, and cervical lymphadenopathy in a young boy.

Acute necrotizing encephalopathy in a child secondary to dengue fever: A case report.

Dengue fever (DF) is an important public health problem, and it is now endemic in more than 100 countries worldwide. Dengue associated neurological complication is estimated to be affecting 0.5 to 6.

A young lady with dysphagia.

Chest radiograph is one of the most commonly employed imaging modalities in primary care. It may be done for symptomatic patients or routine health screening. Hence, it is important for a primary care physician to be able to interpret chest radiograph systematically in relation to patient's clinical history.

A case of atrial septal defect presenting with recurrent syncope.

Atrial septal defect (ASD) is a congenital heart disease often encountered in the adult population, as it is frequently asymptomatic in childhood. In untreated patients with ASD, some may go on to develop complications such as atrial arrythmias, pulmonary hypertension and Eisenmenger syndrome. Pulmonary hypertension is seen in 6 - 35% of this group of untreated patients in adulthood as a result of left-to-right shunting.

A rare presentation of ectopic thyroid gland at right axilla.

The thyroid gland and its hormones play important roles in organ development and in the homeostatic control of physiological mechanisms in human beings. As a result of embryogenic descent of thyroid gland, it commonly resides along the midline - from tongue to mediastinum (90%). Ectopic thyroid gland is a rare occurrence, with extra-lingual ectopic thyroid gland being even rarer.

Incidence of Retrocaecal Acute Appendicitis at the Hospital Sultanah Nora Ismail (HSNI) Batu Pahat.

Background: A surgical audit study among Batu Pahat population was conducted in determining the commonest position of appendix in post appendectomy.

Methodology: This is a retrospective study. A total of 204 cases of patients underwent an appendectomy admitted to the surgical ward from January 2017 until January 2018 at Hospital Sultanah Nora Ismail (HSNI) were audited retrospectively.

Knowledge, attitude, practice and perception on sunscreen and skin cancer among doctors and pharmacists.

Introduction: Excessive ultraviolet light (UV) can cause premature skin aging and potentially skin cancer. Currently there is a lack of awareness among health care professionals and the public on sun protection. The objectives of this study were to determine knowledge on sunscreen and skin cancer among health care professionals, to evaluate the knowledge, attitude, practice and perception of doctors and pharmacists toward the usage of sunscreen as protection against UV radiation.

Length of hospital stay among oral and maxillofacial patients: a retrospective study.

Objectives: : Many conditions of the oral and maxillofacial region require hospitalization and in-patient care. The average length of stay (LOS) of these patients varies and is usually affected by multiple confounding variables. However, even with an increasing number of hospital admissions, published evidence on the factors that affect the LOS of oral and maxillofacial patients is lacking.