Raja Isteri Pengiran Anak Saleha Hospital, commonly abbreviated as RIPAS Hospital, is the main and largest hospital in Brunei. It is the primary referral hospital, as well as a teaching hospital for medical and nursing students mainly from Universiti Brunei Darussalam, the only university in the country providing such courses. The hospital is funded by the government and administered under the Ministry of Health. It was officially opened on 28 August 1984. The hospital accommodates 1260 beds and has 257 doctors.
Melioidosis is caused by Burkholderia pseudomallei, with a broad clinical spectrum ranging from localized infections to fulminant sepsis. Cardiac involvement, particularly infective endocarditis (IE), is extremely rare. We report a 58-year-old patient with type 2 diabetes mellitus who initially presented with left knee septic arthritis and bacteremia due to Burkholderia pseudomallei. She was treated with intravenous ceftazidime followed by oral co-trimoxazole, with complete clinical resolution. Five months later, she represented with fever and recurrent knee swelling. Cultures again grew B. pseudomallei. Transthoracic and transesophageal echocardiography revealed vegetations on the aortic valve, confirming native valve infective endocarditis. She was treated with a prolonged course of intravenous ceftazidime and oral co-trimoxazole. Follow-up at one year after antibiotic cessation showed no evidence of recurrence. This case highlights relapsing melioidosis as a rare cause of native valve infective endocarditis and underscores the importance of long-term monitoring in patients with melioidosis. Although uncommon, cardiac involvement should always be considered and actively ruled out in cases of recurrent melioidosis.
Medial tarsometatarsal (TMT) injuries have often occurred. One of complications is post-traumatic osteoarthritis (PTOA). The Actual incidence of PTOA is still unknown and risk factors is no definite consensus. This systematic review and meta-analysis aim to examine the actual incidence of PTOA and determine the actual factors related following medial Lisfranc injuries. The systematic review were performed according to PRISMA guidelines. The search terms were searcheed in PubMed and Google Scholar. From an initial search,1532 studies were found ,14 eligible studies were selected for further review. The meta-analysis results were extracted and reported by the Forest plots model. Levels of heterogeneity were also evaluated from the eligible studies. A total of 686 patients was included. The primary outcome is actual incidences of PTOA following medial TMT injuries was 33
Purpose:This paper reports up-to-date expert consensus from the Asian Lymphoma Study Group (ALSG) on treatment recommendations for mantle cell lymphoma (MCL) in Asia. Materials and Methods:A closed session meeting of the ALSG was convened in August 2025 to discuss MCL management practices in Asia. Consensus recommendations from that meeting are summarized here, and take into consideration international guidelines, the current treatment landscape in Asia, and global and Asia-specific literature. Results:In Asia, effective MCL management is limited by difficulties in accessing Bruton's tyrosine kinase inhibitors (BTKi) and other novel agents. For patients with indolent and stage I/II disease, active surveillance and involved-site radiotherapy (with/without immunochemotherapy), respectively, can be considered. In advanced MCL, less intensive immunochemotherapy is recommended for elderly, unfit patients; young, fit patients typically receive aggressive cytarabine-based regimens prior to consolidation autologous hematopoietic stem cell transplantation (HSCT). If accessible, covalent BTKi (cBTKi) can be integrated into the first line, and clinical trial enrollment is strongly encouraged for patients with high-risk features. Rituximab maintenance with/without cBTKi is recommended following first-line treatment. In the relapsed/refractory (R/R) setting, cBTKi are more widely used, and novel agents like non-covalent BTKi and chimeric antigen receptor T-cell therapies can be considered where available. Allogeneic HSCT is an option for high-risk or R/R transplant-eligible patients. Conclusion:These recommendations aim to guide MCL management in Asia. Given the heterogeneity of the disease, diverse healthcare systems, and variable treatment access across the region, there is no one-size-fits-all approach and resource-stratified approaches should be considered.
Background: Cognitive impairment is a notable complication of end-stage renal disease (ESRD), associated with adverse outcomes. Early detection is crucial for improving treatment adherence and informing risk reduction strategies. This study screens for risk factors and cognitive symptoms in hemodialysis patients in Brunei Darussalam. Methods: A cross-sectional screening survey was conducted using cluster sampling of adults aged ≥ 50 years who were receiving hemodialysis. Participants completed a structured questionnaire on dementia risk factors and symptoms, followed by the Mini-Cog assessment. Results: In a study of 206 patients with a median age of 62 years (42.7% male), significant risk factors for cognitive impairment included hypertension (83.9%), hypercholesterolemia (55.8%), and diabetes mellitus (51.0%). Cognitive symptoms were reported by 159 patients (77.2%), with misplacing items (45.1%), visuospatial difficulties (38.3%), and forgetfulness (35.0%) being the most common. Mini-Cog assessment revealed that 17 patients (8.3%) were likely to have cognitive impairment. Conclusions: A significant proportion of hemodialysis patients exhibited cognitive symptoms, with approximately one in twelve screening positive for likely cognitive impairment. The feasibility of conducting cognitive impairment screenings in this population underscores the importance of early identification and intervention for cognitive issues in hemodialysis patients.
Introduction: Oral squamous cell carcinoma is associated with high morbidity and limited response to conventional chemoradiotherapy. Although chimeric antigen receptor T-cell therapy has shown remarkable success in hematological malignancies, its application in solid tumors is constrained by the tumor microenvironment and therapy-related toxicities. Recent advances suggest that chimeric antigen receptor T-cell - derived nanovesicles may replicate tumor-targeting properties while improving safety and tissue penetration. Procedures: Human Jurkat T-cells were engineered to express a second-generation anti-epidernanovesicles were generated using a serial extrusion method and characterized by dynamic light scattering, transmission electron microscopy, and Western blotting. Cellular uptake and cytotoxicity were evaluated in epidermal growth factor receptor-positive oral squamous cell carcinoma cell lines (HSC-3 and CAL-27) and compared with normal human gingival fibroblasts. Results: The engineered chimeric antigen receptor- nanovesicles exhibited a mean diameter of approximately 135 nm and retained key T-cell and chimeric antigen receptor-associated surface markers. Preferential internalization was observed in epidermal growth factor receptor expressing Oral squamous cell carcinoma cells, with minimal uptake in normal fibroblasts. Chimeric antigen receptor - nanovesicles induced significant, dose-dependent apoptosis in oral squamous cell carcinomacell lines while demonstrating negligible cytotoxicity toward normal gingival fibroblasts. Conclusion: Chimeric antigen receptor T-cell-inspired nanovesicles preserve the specificity and cytotoxic efficacy of their parental T-cells while overcoming key limitations of live-cell therapy. These findings highlight chimeric antigen receptor nanovesicles as a promising, safe, and off-theshelf immunotherapeutic strategy for targeted treatment of oral squamous cell carcinoma.
