Asian Journal of Medicine & Health Sciences
This free, open-access journal will cover epidemiological, fundamental, and clinical research related to health, ethical and social issues in the field of medicine, health sciences and health professions education. Broad Subject Term(s): Medicine, Health Sciences and Health Professions Education
UniKL Royal College of Medicine Perak (UniKL RCMP)
Journal of Engineering Technology (JET) is an open-access journal that follows the Creative Commons Attribution-Non-commercial 4.0 International License (CC BY-NC 4.0)
Kikuchi-Fujimoto Disease Triggered by Mycoplasma pneumoniae Infection: A Case Report.
Kikuchi-Fujimoto disease (KFD) is a rare inflammatory disorder which typically presents with cervical lymphadenopathy and pyrexia. It is frequently misdiagnosed as other more common medical conditions which share similar clinical manifestations. The diagnosis of KFD is often established only after a lymph node biopsy and histopathology evaluation that demonstrates the characteristic features of histiocytic necrotizing lymphadenitis. While the aetiology of KFD remains poorly-understood, certain microbial agents have been implicated as triggering factors. Here, we highlight a case of a young Asian woman who developed prolonged fever and cervical lymphadenopathy. She was initially being investigated for possible lymphoma, but was subsequently found to have KFD, alongside a Mycoplasma pneumoniae infection. She recovered well following the treatment with azithromycin.
Azithromycin, Kikuchi-Fujimoto disease, Mycoplasma pneumoniae.
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Evaluation of Fitness Levels and Associated Factors among Public Health Pharmacy Staff in Perlis.
Background: Maintaining good fitness levels is vital for healthcare workers due to the physical and mental demands of their roles. This study assessed the fitness levels of pharmacy staff at public health clinics in Perlis and explored associated factors. Methods: A cross-sectional study was conducted from April to June 2024 among pharmacy staff in 13 public health facilities in Perlis. Data on sociodemographic characteristics, fitness levels (cardiovascular endurance, muscle strength, and muscle endurance), and mental health symptoms were collected using an English-language questionnaire and analysed with SPSS version 25.0. Results: Of the 72 participants (mean age 36.3 years, SD=7.04), most were Malay (95.8%), female (77.8%), and married (70.8%). Obesity (BMI ≥30 kg/m²) was present in 11 participants (15.3%). Cardiovascular endurance was rated average or above in 87.5% of participants, muscle strength in 55.6%, and muscle endurance in 73.6%. Overall, 37.5% were classified as physically fit. Exercising four to five times per week significantly increased the likelihood of being physically fit compared to those who did not exercise (AOR=17.29, p=0.030). Conclusion: A considerable proportion of pharmacy staff were not classified as physically fit, highlighting the need for targeted interventions. Regular exercise, particularly four to five times per week, was strongly associated with improved fitness levels.
Muhammad Hassan Fikry Saiful Hilmi Hadad
The Intersection of Islam and Nursing: A New Perspective on Cleanliness and Care.
Introduction: Cleanliness is a key pillar of health, vital for infection prevention, patient safety, and overall well-being. In both nursing and Islamic teachings, cleanliness is essential to health and ethical responsibility. Nursing focuses on clinical hygiene and sanitation, while Islamic jurisprudence (Fiqh) provides a broader framework encompassing physical, spiritual, and moral dimensions. This study explores cleanliness from both perspectives, identifying similarities and potential integration into nursing practice. Objective: This article examines cleanliness in nursing and Islamic teachings, highlighting similarities and differences. It also discusses integrating Islamic principles of cleanliness into nursing to enhance culturally and religiously competent care. Methodology: A qualitative content analysis approach was used, drawing from nursing literature and Islamic sources, including the Qur’an, Hadith, and scholarly interpretations. Hygiene frameworks and infection control guidelines were analysed alongside Islamic purification concepts to develop an integrated understanding. Results: Both nursing and Islamic teachings emphasise cleanliness for disease prevention and patient care. Nursing focuses on hygiene protocols and infection control, while Islamic jurisprudence extends cleanliness to ritual purity, spiritual well-being, and ethical conduct. Integrating Islamic principles can enhance patient-centred care, address Muslim patients’ religious needs, and foster ethical cleanliness in healthcare settings. Conclusion: Integrating Islamic cleanliness principles into nursing bridges clinical hygiene with spiritual and ethical care. This integration can improve cultural sensitivity, patient satisfaction, and holistic well-being. Future research should assess its impact on nursing education, healthcare policy, and patient outcomes to promote inclusive healthcare practices.
Mohamad Firdaus Mohamad Ismail Mohamad Ismail
Phacoanaphylactic Endophthalmitis: A Rare Cause of Postoperative Intraocular Inflammation.
Phacoanaphylactic endophthalmitis (PE) is an uncommon and rare immune response to retained lens material after cataract surgery. This case involves a 71-year-old diabetic man who developed PE following a complicated cataract surgery with posterior capsule rupture (PCR) and retained lens fragments. The patient initially presented with mild postoperative inflammation, but eventually developed granulomatous uveitis, vitritis, and vasculitis. The diagnosis was made based on clinical findings and intraoperative evidence of retained lens material during pars plana vitrectomy (PPV) and anterior chamber washout, which led to resolution of inflammation and improvement in vision, though anterior chamber and vitreous chamber tap were not performed. Early recognition and timely surgical intervention are crucial in managing PE, especially in diabetic patients prone to postoperative complications.
diabetes mellitus, cataract surgery, phacoanaphylactic endophthalmitis, lensectomy, vitrectomy surgery
Exploring Balance as a Determinant of High-Level Mobility After Traumatic Brain Injury.
Traumatic brain injury (TBI) remains a major cause of long-term disability. Individuals with moderate to severe TBI often experience lasting difficulties in balance and mobility. High-level mobility, which includes tasks such as running, stair climbing, and quick directional changes, is frequently impaired in this population and poses significant barriers to independence and community reintegration. Despite the known importance of balance in rehabilitation, its precise contribution to the high-level mobility critical for independence remains poorly understood. This study aimed to determine the relationship between balance performance and high-level mobility in individuals with moderate to severe TBI. A total of 86 participants were assessed using the High-Level Mobility Assessment Tool (HiMAT), the Sensory Organization Test (SOT), and the Limits of Stability (LOS) test. The analysis demonstrated moderate to strong positive correlations between high-level mobility and both SOT and LOS measures, with maximum excursion (MXE) (r = 0.603) showing the strongest association. These results advocate for incorporating dynamic balance challenges (e.g., perturbed walking, reactive stepping) into rehabilitation to maximise mobility recovery. By highlighting balance as a modifiable and measurable contributor to mobility, this study offers practical insights for designing more effective rehabilitation strategies that support recovery and independence after TBI.
Understanding and Improving Workplace Violence Prevention Practices among Nursing Students: A Cross-Sectional Study in a Private College, Malaysia.
Background: Workplace violence (WPV) is a growing concern in healthcare settings, with nursing students at heightened risk due to their frontline roles during clinical placements. Although several studies have explored WPV among healthcare workers, research focusing on prevention practices among nursing students in Malaysia remains limited. This study aimed to assess nursing students’ perception and practice of WPV prevention and identify associated factors. Methods: A cross-sectional survey was conducted among 245 nursing students enrolled at a private nursing college in Perak, Malaysia. Data were collected using a validated structured questionnaire assessing WPV perception and practice across multiple domains. Descriptive and inferential analyses were performed using chi-square tests and logistic regression to determine predictors of good perception and practice. Results: Most participants demonstrated moderate perception and high practice of WPV prevention. Binary logistic regression revealed that bachelor-level students (aOR = 114.5, p = 0.03) and those with ≥ 6 months of clinical experience (aOR = 1.89, p = 0.046) were more likely to exhibit good perception towards WPV prevention. Multinomial regression confirmed these associations, indicating that educational level and clinical experience independently predicted good perception. No significant predictors were found for practice outcomes. Conclusion: Academic preparation and clinical exposure play crucial roles in shaping nursing students’ perception of WPV prevention. Integrating structured WPV prevention training into the nursing curriculum and strengthening institutional support mechanisms are essential to enhance awareness, preparedness, and safety culture among future nurses.
Subtherapeutic Target Attainment of Intermittent Vancomycin in a Paediatric Burn Patient: A Case Report.
Vancomycin pharmacokinetics in pediatric burn patients can be significantly altered compared to non-burned children due to the physiological changes caused by burn injuries, especially in the hypermetabolic and hyperdynamic phases. Subtherapeutic serum vancomycin concentrations and the consequent need for drastic modification of vancomycin dosage regimen has been reported. This is a case report of a paediatric patient with a Total Body Surface Area (TBSA) of 50 percent with subtherapeutic vancomycin target attainment even with a total daily dose of more than 80 mg/kg/day and the use of prolonged vancomycin infusion.
Burn, paediatric, pharmacokinetics, therapeutic drug monitoring, vancomycin.
Ethnic Disparities in Vitamin B12 and Folate Deficiency Prevalence and their Haematological Correlates in Malaysia.
Introduction: Vitamin B12 and folate deficiency are preventable conditions that can lead to serious haematological and neuropsychiatric complications if untreated. Global prevalence varies, and data from Malaysia is limited. This study aimed to determine the proportion and associated risk factors of these deficiencies in a Malaysian hospital population. Materials and methods: A cross-sectional, retrospective study was conducted using data from the Laboratory Information System of Hospital Teluk Intan from June 2023 to May 2024. Demographic data and serum B12/folate levels from 1,463 subjects were analyzed. Deficiency proportions were calculated, and associations with demographic factors and haematological profiles were examined using Chi-square and multinomial logistic regression. Results: The proportion of isolated vitamin B12, isolated folate, and combined deficiencies were 3.2%, 14.5% and 2.9% respectively. Indian ethnicity was significantly associated with higher odds of all deficiency types. Chinese ethnicity was associated with isolated B12 deficiency. Males and younger age groups (12-19 and 20-29 years) had significantly higher odds of isolated folate deficiency. A high proportion of macrocytic anaemia was observed in isolated B12 (52.17%) and combined deficiencies (64.28%), as was megaloblastic anaemia (56.52% and 61.90%, respectively). Conclusion: Significant racial, age, and gender disparities exist in the prevalence of B12 and folate deficiencies, which are strongly associated with haematological complications. These findings highlight the need for targeted screening and intervention strategies in high-risk groups within the Malaysian population.
Assessing Community Knowledge and Attitudes on Cardiopulmonary Resuscitation and Automated External Defibrillator in Ipoh, Perak
Introduction: Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use are critical interventions for out-of-hospital cardiac arrest (OHCA), significantly improving survival rates. This study assessed the knowledge and attitude towards CPR and AED among the local community in Ipoh, Perak, Malaysia. Methods: A cross-sectional study using convenience sampling was conducted from January to February 2024, involving 385 respondents. A self-administered questionnaire, available in English and Malay, collected sociodemographic data and assessed CPR knowledge (12 items) and attitude (10 items). Data were analysed using SPSS version 28. Results: Nearly all respondents (99.0%) had heard of CPR, but only 27.8% knew the correct initial step (call for help immediately). Knowledge was moderate (median score: 58.3%, IQR: 41.7-66.7), with significant associations with age group, education level, and employment status (p<0.05). While 65.5% were willing to perform CPR on family members, willingness decreased to 43.1% for strangers. Most (61%) had never received CPR training, but 76.4% expressed interest. AED awareness was lower (50.4%), and only 22.9% knew that anyone can use an AED. Conclusion: The Ipoh community demonstrates moderate CPR knowledge and attitude, but significant gaps persist, particularly regarding AED. There is a strong need for expanded community-based CPR and AED training, integration into educational curricula, and addressing barriers like legal fears and gender-related concerns to improve bystander intervention in OHCA incidence.
Cardiopulmonary resuscitation, cardiac arrest, automated external defibrillator, knowledge, attitude.
Primary Varicella Infection-associated Conjunctivitis: A Case-based Review and Insights into its Pathogenesis.
Primary varicella infection or chickenpox is a very common illness predominantly of childhood caused by the varicella zoster virus (VZV). Ocular involvement in chickenpox is relatively uncommon but is well documented in the literature. We present a case study of a healthy 6-year-old child developing unilateral serous conjunctivitis on day-2 of illness with spontaneous resolution by day-5. We narratively reviewed the findings of 2 larger case series in the English literature, highlighting ocular complications associated with chickenpox. Conjunctivitis is the second commonest ocular complication associated with chickenpox. Conjunctivitis associated with chickenpox generally runs a benign course and spontaneously resolve without anti-viral therapy. We reviewed the potential mechanisms of conjunctival involvement in chickenpox. These include epithelial homology to keratinocytes, the types of carrier T-lymphocyte involved in the secondary viraemic phase and VZV induced T-lymphocyte surface antigenic remodelling favouring ocular homing.
Syed Ibrahim Jamallulail Syed Zainal Yussof Syed Zainal Yussuf
A Bibliometric Review of Holy Basil (Ocimum tenuiflorum) and Its Therapeutic Potential in Dermatological Applications
Ocimum tenuiflorum (O. tenuiflorum), commonly recognised as Holy Basil or Tulsi, has garnered growing interest within the scientific and industrial communities due to its extensive phytochemical profile and diverse therapeutic properties. This bibliometric review examines global research trends concerning O. tenuiflorum from 2000 to 2024, utilising data from Web of Science (WOS) alongside bibliometric tools including VOSviewer and Biblioshiny. The analysis indicates a consistent increase in publication output, with India leading research contributions and notable inputs from the USA, Thailand, and other nations. Research clusters delineate five principal thematic areas: traditional medicine, phytochemistry, pharmacology, nanotechnology applications, and dermatology. The plant’s bioactive compounds- such as eugenol, ursolic acid, rosmarinic acid, and luteolin- exhibit significant antioxidant, anti-inflammatory, adaptogenic, antidiabetic, and dermatological effects. Particularly in dermatology, O. tenuiflorum demonstrates promising roles in anti-ageing, skin barrier protection, acne management, and wound healing via mechanisms involving collagen synthesis, cytokine inhibition, and UV protection. This comprehensive bibliometric and phytochemical review underscores the versatile therapeutic potential of O. tenuiflorum, thereby supporting its development within cosmeceutical and pharmaceutical sectors, while also highlighting opportunities for further multidisciplinary research.
Recovery from Knee Strain in a Young Athlete: A Case Study on Gluteal Activation and Core Stabilization.
Knee strain is a common cause of knee injury, particularly among rugby players, due to the high physical demands and frequent contact involved in the sport. Such injuries typically affect the soft tissues, including muscles and tendons around the knee joint. Delayed intervention can negatively impact mobility and interfere with daily activities, potentially leading to compensatory movement patterns and secondary complications. This case study focused on a 20-year-old rugby player with a history of left knee strain who received treatment approximately three months after the initial injury. He experienced difficulty with stair climbing and achieving cross-leg position during prayer. The objective of this case study was to demonstrate how targeted rehabilitation; specifically gluteal muscle activation and core stabilization exercises, can improve function and postural control. Notably, the patient showed measurable improvement as early as the first day of intervention, highlighting the effectiveness of timely physiotherapy assessment and appropriate exercise prescription.
Core stabilization, gluteal muscle activation, knee strain.
The Satisfaction-Success Paradox: Online Distance Learning Outcomes among Nursing Students during the COVID-19 Pandemic.
Introduction: The COVID-19 pandemic triggered an abrupt global transition to Online Distance Learning (ODL), posing significant challenges for nursing education, which depends heavily on hands-on clinical experiences. Although nursing students reported varying degrees of satisfaction with online learning, the extent to which these perceptions influenced academic success remained unclear. Methods: A cross-sectional study was conducted among 164 undergraduate nursing students at Universiti Kuala Lumpur Royal College of Medicine Perak (UniKL RCMP) between August 2023 and January 2024. Participants completed a sociodemographic questionnaire, a validated 20-item Learning Satisfaction Scale, and provided their cumulative Grade Point Average (GPA). Descriptive statistics were used to summarise participant characteristics and satisfaction levels, while Spearman’s rank-order correlation assessed the relationship between learning satisfaction and academic performance. Results: Most participants were female (82.3%) and aged between 18 and 25 years (93.3%). The majority reported average internet stability (62.2%) and financial burden (63.4%) during ODL. Overall, 70.7% of students demonstrated moderate learning satisfaction, while 29.3% expressed low satisfaction. The mean GPA was 3.37 ± 0.32, with 60.4% achieving satisfactory and 34.7% excellent performance. Correlation analysis revealed no significant association between total learning satisfaction and GPA (rs = 0.033, p = 0.672), indicating that satisfaction did not influence academic performance. Conclusion: Although nursing students maintained satisfactory academic results, their overall learning satisfaction remained moderate. Academic performance during ODL may have been shaped more by motivation, adaptability, and institutional support. Continuous improvement in instructional design, interaction, and learner support is vital to enhance satisfaction and academic outcomes in future blended or online nursing education.
Idiopathic Inflammatory Myopathy: A Hospital-based Case Review in the State of Perak, Malaysia.
Background: Idiopathic inflammatory myopathy (IIM) is a rare condition characterized by proximal muscle weakness and myositis. It includes dermatomyositis (DM), polymyositis (PM), inclusion body myositis (IBM), and juvenile dermatomyositis (JDM). They may share clinical and histological features but differ in underlying pathophysiology. Objective: To assess the diagnostic probabilities, and clinical characteristics of IIM. Methods: Clinical data from 50 IIM patients were retrospectively reviewed from Rheumatology and Dermatology clinics across four centres in Perak, Malaysia (2013–2023) and were evaluated using the 2017 The European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for adult and juvenile IIM. Results: According to the EULAR/ACR criteria, 98.2% of cases were classified as definite IIM (mean score 10.6), 74.1% as probable (mean score 6.6), and 47.8% as possible (mean score 6.4). IIM was excluded in 36% of patients (mean score 3.9; probability 20.8%). Eighty-four percent had DM, 8% had ADM or PM, with a mean age of 45.9±18.1 years. 95.6% were diagnosed within a year of symptom onset, and 72% showed proximal myopathy, significantly common in DM (P=0.001). Ethnic breakdown showed 46% Chinese, 42% Malay, and 8% Indian patients, with Malays developing DM at a younger age (39.8±16.9 years). The shawl sign and telangiectasia were more common in Chinese (P=0.018) and Malay (P=0.023) patients, respectively. Conclusion: The EULAR/ACR scoring system effectively identified IIM subgroups. Despite varying probabilities, cases of both DM and ADM were classified into definite, probable, and possible categories, with or without biopsy data. DM was more prevalent than ADM, primarily affecting Chinese patients, while Malays had earlier onset.
Knowledge and Perception of Abortion among Klang Valley Population.
Background: Abortion remains a significant public health issue, posing substantial risks to the health and lives of women. Public awareness and understanding of abortion laws in Malaysia are often limited. This study aimed to assess the level of knowledge and perception toward abortion among the population in the Klang Valley. Methods: A cross-sectional study was conducted using a non-probability voluntary sampling technique, involving 391 respondents from Klang Valley. The structured questionnaire included three sections: demographic information, knowledge of abortion, and perception toward abortion. Results: Most of the respondents were aged 20–29 years (5.99%), female (63.17%) and belonged to the B40 income group (monthly household income <RM4,850) (70.09%). Analysis indicated that majority possessed poor knowledge of abortion (64.96%), and 58.06% held poor perceptions. Perception was significantly associated with age, ethnicity, religion, and marital status (p < 0.05), whereas knowledge showed no such sociodemographic correlations. A significant positive association was observed between knowledge level and perception (OR = 3.13, 95% CI: 2.03–4.81, p < 0.001). Conclusion: The study concludes that deficient knowledge and generally negative perceptions of abortion prevail in the Klang Valley. The demonstrated association between knowledge and perception necessitates evidence-based educational interventions to improve public understanding and foster supportive attitudes toward reproductive health.
Parental Knowledge, Attitudes, and Concerns Regarding Childhood Febrile Seizures.
Background: Febrile seizures are the most common seizure disorder among young children, often leading to parental anxiety and unnecessary medical interventions. Despite their prevalence, limited research has explored parental knowledge, attitudes, and concerns in Malaysia. Objective: This study aimed to assess parental knowledge, attitudes, and concerns regarding febrile seizures among parents in Pahang, Malaysia. Methods: A cross-sectional study was conducted among 235 parents of children under five years old in selected kindergartens. Data were collected using a structured questionnaire covering sociodemographic characteristics, knowledge, attitudes, and concerns. Descriptive statistics and chi-square tests were applied. Results: The findings revealed that 55.3% of parents had moderate knowledge, with 53.6% believed recurrent febrile seizures could cause brain damage, and 43.8% incorrectly identified them as epilepsy. While 74% demonstrated a positive attitude, a similar proportion (74%) reported high levels of concern, particularly about potential brain damage (mean = 3.54, SD = 0.8) and subsequent epilepsy (mean = 3.38, SD = 0.8). Higher education level (p < 0.001) and prior experience with febrile seizures (p < 0.001) were significantly associated with better knowledge and attitudes. Conclusion: This study highlights persistent misconceptions and significant parental anxiety regarding febrile seizures. Targeted educational interventions are needed to improve parental understanding, alleviate fears, and enhance seizure management at home. Healthcare professionals should implement structured counselling and culturally sensitive communication strategies to support parents effectively.
Febrile seizures, parental knowledge, paediatric emergency, Malaysia
Healthy Gums Does It Matter?Amlodipine-Induced Gingival Overgrowth (AIGO): A Case Report
In Malaysia, more than half a million adults, representing 2.5% of the population, are living with four major non-communicable diseases (NCDs): diabetes, hypertension, hypercholesterolemia, and obesity. As for hypertension, 29.2% or 1 in 3 adults in Malaysia have hypertension, and 91% are on blood pressure medications. This includes dihydropyridine calcium channel blockers such as amlodipine, which is commonly used in primary care. We report a case from our primary care clinic involving a 70-year-old man with a known history of primary hypertension who developed painless gum swelling and discomfort while the patient was on T. amlodipine 10 mg. Oral examination showed diffuse gingival hypertrophy involving the upper and right lower gums. The condition resolved completely after discontinuation of the offending drug and substitution with an angiotensin-converting enzyme inhibitor. This case is notable because the gingival overgrowth developed only after 4 years of amlodipine 10 mg therapy. This paper aims to bring clinicians' attention to these adverse effects of amlodipine, so that timely and effective management can be given to the patient, avoiding complications and unnecessary treatment.
Hypertension, Gingival Overgrowth, dihydropyridine calcium channel blocker
Abdul Zaki Ar Rasyid Mohd Zainal Mohd Zainal
Erythema Nodosum Leprosum in a Treatment-Naïve Patient: Clinical Clues Not to Miss in Primary Care
Leprosy is known as a “great mimicker” due to its broad spectrum of clinical presentations. Erythema nodosum leprosum (ENL), a Type 2 lepra reaction, typically manifests as acute, painful erythematous nodules during or after initiation of multidrug therapy (MDT) in multibacillary patients. We report a case of a 66-year-old treatment-naïve man who presented to primary care with chronic and painless nodules in the absence of classical lepromatous features or prior therapy. Slit-skin smear (SSS) confirmed multibacillary leprosy with a moderate bacterial index (BI) and an inactive morphological index (MI), supporting the diagnosis of chronic ENL. The patient responded well to a second-line MDT regimen and corticosteroids. This case highlights an unusual presentation of ENL preceding treatment and underscores the diagnostic challenges faced in primary care, particularly when classical signs of leprosy are absent. We discuss key differential diagnoses and the importance of early recognition to avoid misdiagnosis and prevent complications.
clofazimine, erythema nodosum, Mycobacterium leprae, multibacillary leprosy
Transcending the Red Eye: A Nearly Missed Case of Adult Gonococcal Conjunctivitis.
Gonorrhoea is a sexually transmitted disease with a rising incidence worldwide. Adult gonococcal conjunctivitis is relatively uncommon but poses significant risks, including corneal perforation if not treated promptly. Diagnosis can be challenging, and delayed or misdiagnosis may occur due to its resemblance to other common forms of conjunctivitis. We reported a case of a 35-year-old sexually active male with persistent unilateral conjunctivitis that did not respond to standard topical antibiotics. Further investigation revealed Neisseria gonorrhoeae as the causative organism. Despite developing corneal thinning, the patient responded well to prompt systemic and topical antibiotics, with preservation of vision. This case highlights the importance of taking a comprehensive history, including sexual history, to facilitate early detection and treatment, which can help prevent complications.
A Case of Non-Immune Hydrops Fetalis in an HIV-Positive Mother
Mother-to-child transmission (MTCT) remains the primary route of HIV infection in children, with an estimated 30–40% risk in untreated pregnancies. We report a case of a pregnant woman with a high HIV viral load who developed non-immune hydrops foetalis (NIHF), a rare and life-threatening foetal condition characterized by excessive fluid accumulation in at least two compartments. Ultrasound examinations revealed left ventriculomegaly, cardiomegaly with pericardial effusion, pleural effusion, and ascites with an enlarged spleen, confirming NIHF. Extensive investigations ruled out common infectious and non-infectious causes, raising the possibility of a link between maternal HIV and NIHF. This case highlights the need for further investigation into the potential relationship between maternal HIV, congenital HIV, and NIHF, as well as the importance of early detection and multidisciplinary management in high-risk pregnancies.
A Scoping Review on Back Care Education Strategies for Farmers with Low Back Pain
ABSTRACT Background: Farmers frequently experience low back pain (LBP), which arises from the physically demanding nature of their work combined with multiple contributing factors. Hence, it is important to provide tailored back care education (BCE) to manage pain and enhance functionality effectively. Objective: This scoping review aims to identify, map, and synthesize the evidence on back care education (BCE) strategies designed to reduce pain and improve function for farmers with LBP. Materials and methods: The literature search was conducted in PUBMED, Scopus, and Web of Science to identify articles published between 2012 and 2024. The eligibility criteria included studies focusing on BCE in farming populations with LBP regardless of study design. Result: From 1,395 articles initially screened, only nine studies met the inclusion criteria. Thematic analysis identified three main BCE components: (1) ergonomic training for agricultural tasks, (2) prescribed therapeutic exercise, and (3) pain science and self-management education. Multi-component BCE programs were generally effective in reducing pain and improving function, although intervention protocols and outcome measures varied substantially. Conclusion: This review demonstrates that BCE is a promising strategy for the management of low back pain in farmers, particularly when adapted to the specific demands of agricultural work. Nevertheless, the heterogeneity of the interventions identified indicates the need for further research to formulate standardized and context-specific protocols, as well as to apply consistent outcome measures to build a more robust evidence base.
Integrative Ligamentous Articular Strain Technique and Muscle Energy Technique for Knee Osteoarthritis: A Pilot Study.
Background: Integrative Ligamentous Articular Strain Technique (LAST) and Muscle Energy Technique (MET) for managing pain, function, and range of motion (ROM) in patients with knee osteoarthritis (KOA) were examined in a pilot study designed to assess the effect size of the intervention. Methods: This was a pre-and post-intervention study involving twenty-eight participants with mild to moderate KOA (Kellgren-Lawrence grades II-III). The intervention included eight sessions over 4 weeks, combining LAST (which focuses on joint and ligamentous structure) and MET (which focuses on muscle action and relaxation). VAS for pain, KOOS, and goniometric measurement of ROM were tracked. The data were interpreted using Friedman test (α = 0.05). Results: Participants demonstrated significant improvements in VAS pain scores (pre 6.8 ± 1.2 vs. post 3.1 ± 1.5, P < 0.001), and KOOS subscores (pain, symptoms, level of activities performed, and quality of life; all P < 0.05). Statistical significance was also recorded for improvements in knee flexion ROM by 15.3° ± 4.2° (P = 0.002). Conclusion: In patients with KOA, a four-week integrative LAST and MET intervention resulted in meaningful clinically advantageous improvements for pain, function, and ROM. Despite limitations on sample size, these data suggest promise in combined manual therapy approaches for KOA, and further larger randomized trials are needed.
Ligamentous Articular Strain Technique, Muscle Energy Technique, Knee Osteoarthritis, Pain, Range of Motion, Functional Improvement
Granulomatous with Polyangiitis (GPA) Presenting with Mononeuritis Multiplex: A Case-based Review.
Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis (WG), is a rare rheumatological disease that can affect individuals of any age. ANCA associated vasculitis (AAV) with granulomatous with polyangiitis proteinase 3 (GPA-PR3) is present in approximately 85-90% of cases. We report a 52-year-old Indian female with positive cytoplasmic-antineutrophil cytoplasmic antibody (c-ANCA) presented with chronic sinusitis, orbital cellulitis, and mononeuritis multiplex of the right foot and possible sensorineural defect hearing impairment.
c-ANCA, Granulomatosis with polyangiitis, Mononeuritis multiplex.
A Chest Lump in a Toddler – A Report on Approach in Primary Care.
A chest wall lump is an uncommon clinical finding often indicative of underlying pathology, including abscesses, trauma, congenital deformities, or malignancy. Therefore, a systematic approach to evaluation is crucial. One such rare congenital anomaly is a bifid rib, typically asymptomatic but occasionally presenting as a palpable chest wall mass, potentially leading to unnecessary imaging or concern. Additionally, bifid ribs may coexist with syndromic conditions such as Gorlin syndrome, which is linked to an increased risk of skin malignancies. We present a rare case of a 4-year-old girl with a firm, immobile swelling in the right anterior chest wall, raising a diagnostic dilemma regarding the necessity of imaging. Given the clinical characteristics, radiological assessment was pursued, and a plain chest radiograph confirmed the diagnosis of a right bifid rib. This case highlights the importance of careful clinical evaluation and judicious use of imaging to avoid over-investigation while ensuring accurate diagnosis. Furthermore, we propose an evidence-based algorithm for evaluating chest wall lumps in primary care settings to inform clinical decision-making.
Anterior chest wall lump, Approach, Bifid Rib, Gorlin syndrome.
Unveiling The Unseen: Apathetic Hyperthyroidism in Primary Care – A Case Report.
Thyrotoxicosis is significantly more challenging to diagnose in elderly patients compared to younger individuals. The thyroid disorder may be masked and overlooked, yet its confounding effects may be devastating. The atypical presentation of the elderly thyrotoxic makes the patient's recognition difficult, and if left untreated, the morbidity may be considerable, but once correctly diagnosed, the condition is readily treatable. We report the case of a 67-year-old man with an unknown medical illness who presented with excessive weight loss for the past 4 months. On examination, he was not tachycardic, and his pulse was in regular rhythm and of normal volume. There was no palpable thyroid nodule. His biochemical investigation revealed hyperthyroidism.
Apathetic Hyperthyroidism, Thyroid Disorder in the Elderly.
Anti-synthetase Syndrome with Dermatomyositis Responding to Combination of Mycophenolate mofetil and Cyclosporin: A Case Report.
Anti-synthetase syndrome (ASS) is a rare inflammatory muscle disorder associated with dermatomyositis and polymyositis, characterized by autoantibodies targeting aminoacyl-tRNA synthetases. Clinical manifestations vary but typically include mechanic’s hands, interstitial lung disease (ILD), and Raynaud’s phenomenon. We report the case of a 42-year-old woman with a positive anti-Jo1 autoantibody, who initially presented with respiratory symptoms that progressed to myositis, along with severe, painful mechanic’s hands and feet. Her condition improved with a combination of mycophenolate mofetil (MMF), corticosteroids, and cyclosporine.
Anti-synthetase syndrome, dermatomyositis, polymyositis, anti-aminoacyl-tRNA synthetase, anti-Jo1 antibody, mechanic’s hands, interstitial lung disease, corticosteroid, mycophenolate mofetil, cyclosporin.
Amlodipine-induced Generalised Exfoliative Dermatitis: Not to be Missed!
Amlodipine a calcium channel blocker (CCB), is commonly used in treating hypertension, coronary artery disease, and chronic kidney disease. It is considered a first-line treatment for high blood pressure. Amlodipine acts by selectively inhibiting voltage-gated L-type calcium ion channels, which consequently decreases systemic vascular resistance, total vascular resistance, and muscle contractility. We report a case of amlodipine-induced exfoliative dermatitis, highlighting the importance of recognizing this rare but serious cutaneous reaction to amlodipine, a commonly used drug in primary care. Prompt discontinuation of the offending drug and appropriate management are crucial for improving patient outcomes. Clinicians should maintain a high index of suspicion for drug-induced exfoliative dermatitis in patients presenting with generalized erythema and scaling after initiating new medications.
Amlodipine, calcium channel blocker, exfoliative dermatitis
Challenges in Antenatal Diagnosis of Conjoined Twins in Primary Care Setting: A Case Report.
Conjoined twins (CT) represent a rare embryologic anomaly with an uncertain aetiology. Although uncommon, this condition is associated with a high perinatal mortality rate. Early detection during the first trimester is therefore crucial to enable timely intervention and referral to a tertiary care centre. First-trimester dating scans in primary care are essential not only for confirming viability and determining gestational age but also for identifying multiple pregnancies. However, anomalies in twin pregnancies-such as conjoined twins-may be overlooked during these early scans due to various challenges. This case report discusses the difficulties in detecting CT and explores factors that may contribute to missed diagnoses.
Conjoined twin, Siamese twin, thoracophagus.
Ramsay Hunt Syndrome: A Case Report Underlining the Importance of Early Diagnosis to Prevent Complications
Ramsay Hunt Syndrome (RHS) is a rare neurological disorder and a sequelae of Herpes zoster, resulting from the reactivation of the Varicella zoster virus (VZV) in the geniculate ganglion. Patients usually present with acute unilateral peripheral facial nerve paralysis, often accompanied by vesicular eruptions in the external auditory canal or oral mucosa, a hallmark of herpes zoster oticus. Due to its overlapping clinical features, RHS is frequently misdiagnosed as Bell's palsy, a more common cause of facial paralysis seen in primary care settings. This case report underscores the potential for RHS misdiagnosis, in which can lead to delayed initiation of antiviral and corticosteroid therapy, resulting in suboptimal patient outcome. This case emphasizes the importance of early recognition of the condition, which are critical to improving prognosis, reducing complications, and enhancing the quality of life for affected patients.
Ramsay Hunt, Herpes zoster oticus ,facial nerve palsy.
Refractory Livedoid Vasculopathy: Clinical Response to TNF-α Blocker in a Young Male Patient.
Livedoid vasculopathy is a rare condition characterized by thrombosis of dermal vessels, predominantly affecting the ankles. The patient presented with a painful ulcer, which is usually chronic in nature with relapsing-remitting episodes. It may resemble other vasculitides disorders, such as microscopic polyangiitis and polyarteritis nodosa. Hence, diagnosis is mainly based on clinical and histopathological findings. Livedoid vasculopathy required antiplatelet and anticoagulant therapy, in contrast to vasculitides disorders. We describe a young man who presented with a recent onset of painful ulcers on both ankle regions, consistent with livedoid vasculopathy and supported by histopathological findings. Clinical remission was observed after treatment with subcutaneous adalimumab, after failing to respond to a combination of anticoagulant, corticosteroid, vasodilator, and antiplatelet agents.
Adalimumab, Anticoagulant Antiplatelet, Corticosteroid, Livedoid vasculopathy, Refractory, Thrombosis, Vasculitis, Vasodilator.