Sister Mary Joseph nodule is a rare manifestation of metastatic umbilical malignancy, most commonly associated with gastrointestinal and genitourinary cancers. It often signifies advanced disease and carries a poor prognosis. Early recognition is critical, yet diagnostic delays may occur due to nonspecific presentations in primary care. We report a case of a 63-year-old Malay woman with a history of diabetes mellitus, hypertension, and hyperlipidemia, presented with an 8-month history of progressive umbilical skin growth, mild abdominal discomfort, and constitutional symptoms, such as loss of weight and loss of appetite over two months. Retrospectively, she noticed an erythematous nodular skin lesion over the umbilicus, which had slowly increased in size over the last 8 months. She visited health clinics four times, where the lesion was treated as eczema, and she was prescribed steroid creams. However, her symptoms persisted. One month before referral, she developed significant weight loss, prompting her doctor to refer her to a dermatology clinic for suspected skin cancer. We aim to enhance clinical awareness among primary care providers about recognizing and promptly treating the disease to prevent further deterioration.
Femoral-facial syndrome (FFS) is a rare congenital disorder characterized by femoral hypoplasia and distinctive craniofacial anomalies, and it is frequently associated with maternal diabetes. We report the first documented Malaysian case of FFS in a neonate born to a 36-year-old Malay woman with gestational diabetes and obesity. Early antenatal ultrasound examinations did not detect any abnormalities. Fetal anomalies only became evident later in pregnancy when breech presentation and anhydramnios were noted, highlighting the difficulty of early prenatal diagnosis, particularly among high-risk mothers. Afemale infant was delivered via caesarean section at 35 weeks' gestation. She exhibited multiple dysmorphic features, including micrognathia, cleft palate, low-set ears, absence of the femur, hemivertebrae, and polydactyly. Despite multidisciplinary neonatal management, the infant died at two months of age due to severe nosocomial infection.
PurposeTo predict the development of traumatic angle recession glaucoma (TARG) and identify associated risk factors using Kaplan-Meier survival analysis.Materials and MethodsThis retrospective cohort study was conducted across three tertiary hospitals in Malaysia, involving patients treated for blunt ocular trauma and traumatic hyphaema between 1 January 2010 and 31 December 2020. Eligible patients had a minimum of one year of follow-up between 1 January and 31 December 2021. Data collected included demographics, medical and ocular history, injury mechanism, and initial ophthalmic assessment. Kaplan-Meier survival analysis and Cox proportional hazards regression were employed to evaluate glaucoma onset and prognostic indicators.ResultsOf 114 patients with angle recession, 30 (26.3%) developed TARG over a mean follow-up of 66.8 ± 52.1 months. Kaplan-Meier analysis estimated a mean survival time of 8.8 years, with most cases detected within nine months post-trauma. Age was a significant predictor, with a 1% increased risk per year (HR 1.02; 95% CI: 1.00-1.04; p = 0.022). Presence of peripheral anterior synechiae (PAS) conferred a 4.3-fold higher risk of developing TARG (HR 4.29; 95% CI: 2.02-9.13; p < 0.001).ConclusionOlder patients with PAS following blunt ocular trauma are at significantly increased risk for TARG and warrant close surveillance. Further research is needed to establish optimal follow-up duration and develop predictive tools for early identification of high-risk individuals.
BackgroundPharmacoeconomics (PE) is essential in optimizing healthcare resource allocation and ensuring cost-effective treatment decisions. Despite its recognized importance, limited evidence exists regarding healthcare professionals' understanding and application of PE in Malaysia. This study assessed the knowledge, perception, and application of PE among healthcare professionals within the Ministry of Health (MOH) Malaysia.MethodsA cross-sectional online survey was conducted among MOH healthcare professionals. The survey captured demographic characteristics, familiarity with PE, self-reported knowledge, perception of its importance, and its application in clinical and formulary decision-making. Descriptive statistics were used to summarize the findings.ResultsA total of 754 respondents completed the survey, comprising pharmacists (71.5%), doctors (24.3%) and other healthcare professionals (4.2%). While 63.7% reported familiarity with PE, substantial knowledge gaps were observed, particularly in cost-utility and cost-effectiveness analyses. PE application was most prevalent in budget impact assessments for formulary decisions. Notably, 94.8% of Drug and Therapeutics Committee members recognized the importance of PE in decision-making, and 96.9% supported the need for dedicated personnel with PE competency.ConclusionPE knowledge and application varied across MOH healthcare professionals, underscoring the need for targeted training and capacity building to strengthen PE competency, ultimately supporting evidence-informed, cost-effective healthcare decision-making in Malaysia.
BACKGROUND:Transitioning from pediatric to adult HIV care is critical for adolescents and young adults living with HIV (AYLH). This study assessed the timing and factors associated with this transition in Asia. SETTING:Retrospective study of AYLH enrolled in Therapeutics Research, Education, and AIDS Training Asia Pediatric HIV Observational Database clinics between May 1991 and December 2020. METHODS:Eligible AYLH were categorized into <18-year-old transitions, and ≥18-year-old transitions or continued pediatric care. RESULTS:The analysis included 1803 AYLH from 6 countries. Of these, 92.7% (n = 1672) had perinatally acquired HIV, and 69.9% (n = 1260) were ≥18-year-old transitions or continued pediatric care. Excluding AYLH who remained in pediatric care, median age at transition was 16.1 years (interquartile range [IQR]: 14.9-17.0) for <18-year-old transitions and 20.0 years (IQR: 19.1-21.2) for ≥18-year-old transitions. At age 18, among 1368 AYLH with available viral load data, 72.9% (n = 998) had viral loads <50 copies/mL (78.9% in <18-year-old transitions [n = 310/393] vs 70.6% in ≥18-year-old transitions [n = 688/975]; P = 0.002). The median CD4 count was 635 cells/μL (IQR: 450-842). Factors independently associated with transitions at ≥18-year-old or continued pediatric care included residence in an upper-middle-income country (adjusted odds ratio [aOR] 10.68 [95% confidence interval (CI): 7.76 to 14.68], P < 0.001), living with family (aOR 2.81 [95% CI: 1.99 to 3.97], P < 0.001), and previous antiretroviral therapy class switching (aOR 1.91 [95% CI: 1.34 to 2.72], P < 0.001). CONCLUSION:Most AYLH in this cohort transitioned at ≥18 years of age. About one-fourth had unsuppressed viral loads at age 18, irrespective of transition status, underscoring the need for personalized treatment approaches that support antiretroviral therapy adherence from pediatric care, preparing AYLH for transition to adult clinics.
