Sultan Ismail Hospital

Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disorder, affecting intertriginous areas and characterized by painful nodules, abscesses, fistulae, and scarring. Despite its impact on patients’ quality of life (QoL), HS remains underdiagnosed and mismanaged due to its heterogeneous clinical presentation. A panel of 14 Malaysian dermatologists, HS special interest group, developed a set of consensus-based recommendations on diagnosis, disease assessment, comorbidities, treatment, and follow-up care to improve HS management. A modified Delphi process was utilized to draft and finalize statements based on evidence sourced from literature between 2013 and 2023. The consensus highlights the importance of early recognition of HS clinical signs, differential diagnosis, and the use of validated tools such as Hurley staging, International HS Severity Score System, and Dermatology Life Quality Index to assess disease severity and QoL. Treatment recommendations for HS were stratified by disease severity, including topical, systemic, and biologic therapies, and surgical interventions for advanced cases. Adalimumab and secukinumab are currently the only approved biologics in Malaysia, showing sustained efficacy in moderate-to-severe HS. Adjunctive therapies such as zinc supplementation, lifestyle modifications, and wound care are also recommended. The consensus emphasizes a multidisciplinary approach to address the multifaceted nature of HS and optimize long-term outcomes, and aims to standardize HS care in Malaysia, promote early intervention, and enhance QoL for affected patients.

INTRODUCTION:Inadequate medication adherence is a significant problem globally, affecting up to 50% of chronic illness patients. The complications can also be significant, with increased rates of disease complications and hospitalisations due to lack of adherence. This research study seeks to find the medication adherence rate across select suburban areas in Johor, Malaysia, and to identify the relationship between medication adherence and treatment concordance. MATERIALS AND METHODS:A community-based cross-sectional study was conducted among patients with chronic diseases across various locations in Johor. A validated questionnaire, the Malaysia Medication Adherence Assessment Tool (MyMAAT) and a Modified Concordance Scale were used to explore the study objectives. RESULTS:Medication adherence is defined as a MyMAAT score of ≥54. A total of 82 chronic illness patients participated in this study, with males (48.8%) and females (51.2%). The mean age of the participants is 57.5 years old. The study reported 41.5% adherence (MyMAAT ≥54). Female vs male OR was calculated via logistic regression adjusting for confounding factors, with adherence (MyMAAT≥54) as a binary factor (OR=4.23; 95% CI 1.38-12.91; p=0.011). A statistically significant weak correlation was found between the MyMAAT score and the Modified Concordance Scale score (SR ρ=0.286, p=0.009). CONCLUSION:In conclusion, the study shows a potential relationship between medication concordance and improved patient adherence in the Malaysian setting. More research should be conducted to further verify these findings.

INTRODUCTION:Chronic Achilles tendon rupture (CATR) presents a therapeutic challenge due to tendon retraction, degeneration, and muscle atrophy that typically occur beyond four weeks after injury, complicating delayed repair. To address the resultant tendon defect and restore functional continuity, several reconstructive strategies have been described, including turndown flap augmentation and flexor hallucis longus (FHL) tendon transfer. OBJECTIVE:This study evaluated functional outcomes and complications following combined turndown flap augmentation and FHL tendon transfer for CATR. METHODOLOGY:This retrospective study included eight patients with CATR who underwent turndown flap augmentation combined with FHL tendon transfer between March 2018 and December 2024. Chronic rupture was confirmed clinically and radiographically. Functional outcomes were assessed using the Foot and Ankle Ability Measure (FAAM) and the Achilles Tendon Rupture Score (ATRS) preoperatively and at follow-up. Complications, operative time, and postoperative outcomes were recorded and analyzed. RESULTS:Eight patients (mean age, 53 ± 13.3 years; males, 5 (62.5%); females, 3 (37.5%)) were included. Four of the patients (50%) had a sedentary lifestyle, while another four (50%) were active in sports. Three patients (37.5%) had diabetes mellitus, while five (62.5%) had no comorbidities. A history of previous tendinitis was found in two patients (25.0%). Intraoperatively, tendinitis with calcification was found in four patients (50%). The mean tendon gap was 5.25 ± 1.58 cm, and the mean length of the distal stump from the tendo-Achilles insertion was 1.75 cm. The mean operative time was 122 ± 20 minutes. Reconstruction was performed at a median of 4 months after injury, with a mean follow-up of 13 months (range, 6-36 months). Significant functional improvement was observed. FAAM Activities of Daily Living scores improved from 49.6% ± 14.9% preoperatively to 83.5% ± 16.6% postoperatively (P = 0.0005), and FAAM Sports scores improved from 22.3% ± 13.1% to 71.5% ± 29.9% (P = 0.0002). ATRS improved from 31.4% ± 16.9% to 82.5% ± 12.8% (P < 0.001). All patients were able to perform a single-limb heel rise. Complications were limited, with one case each of wound dehiscence (12.5%), transient neuropraxia (12.5%), and complex regional pain syndrome (12.5%). No neurovascular injury or tendon re-rupture occurred. CONCLUSIONS:Turndown flap augmentation combined with FHL tendon transfer provides significant functional improvement with acceptable complications in the treatment of CATR. This technique represents a reliable option for the reconstruction of large tendon defects in delayed presentations.

Background: Chronic spontaneous urticaria (CSU) is a debilitating condition with substantial patient burden. In Malaysia, patient-centered data remain limited. Objective: To investigate the lived experiences, unmet needs, diagnosis, and treatment challenges of Malaysian CSU patients using a hybrid approach combining social media listening and in-depth interviews. Methods: This infodemiology study analyzed publicly available social media records related to CSU in Malaysia from October 2019 to September 2024. A keyword-based filtering and manual curation process was used to identify relevant records. In addition, qualitative interviews were conducted with 36 diagnosed CSU patients. Thematic analysis was applied to identify key insights across both data sources. Results: A total of 2,123 chronic urticaria-related and 325 pharmacological treatment-related social media records were analyzed, along with data obtained from 36 patient interviews. Patients frequently report delays in diagnosis, reliance on self-management strategies, emotional distress, and dissatisfaction with treatment outcomes. More than 80% of the interviewed patients reported moderate-to-severe itch and hives, with significant impacts on work, social life, and daily functioning. Nearly half of the interviewed patients (47%) had switched treatments because of inefficacies highlighting the limitation of prolonged reliance on antihistamine monotherapy. Both data sources revealed a significant psychosocial burden and a fervent desire for better patient education, emotional support, as well as digital tools and alternative treatments to help manage their condition. Conclusion: This study underscores the high burden of CSU in Malaysia, marked by significant quality-of-life impairments. The findings highlight the urgency of timely diagnosis, improved patient-centered communication, and timely escalation to effective therapies beyond antihistamines to enhance patient outcomes and quality of life.

Background Generalized Pustular Psoriasis (GPP) constitutes a rare yet severe variant of psoriasis, characterised by extensive pustule formation on the skin and imposes a significant economic burden. The study aimed to investigate the indirect costs associated with GPP in Malaysia, encompassing patients’ work productivity losses and out-of-pocket expenses.Methods This primary, multicentre, cross-sectional cost analysis study was conducted among patients diagnosed with GPP attending public hospitals under the Ministry of Health (MOH) in Malaysia. The indirect costs were assessed using the Work Productivity and Activity Impairment (WPAI) tool and standardised data collection form. Data were statistically analysed using descriptive and inferential statistics using IBM SPSS version 28.0.Results A total of 54 patients with GPP were enrolled in the study, with about one-fourth experiencing flares at the time of the interview. The total annual indirect cost associated with GPP was estimated at MYR 676,081 (MYR 12,520 per patient). The indirect costs of GPP were driven largely by work productivity loss. Both work and activity impairment were significantly higher during GPP flare periods compared to non-flare periods. Additionally, the annual work impairment cost per patient was substantially higher during GPP flare periods, indicating a marked increase in economic burden compared with the non-flare group.Conclusion The study demonstrates a substantial indirect economic burden of GPP, driven primarily by work productivity loss, particularly during acute flares. These findings highlight the broader socioeconomic impact of GPP beyond direct costs. Strategies to enhance patients’ presenteeism, reduce absenteeism, and prevent unemployment are likely to have the greatest impact on reducing societal costs.