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BACKGROUND: Multiple studies have been conducted on the level of knowledge, attitude, and preventive practices (KAP) towards leptospirosis, descriptively, analytically pertaining to its relationship and also associated factors such as sociodemographic and economic factors. Over the years, different community settings and sampling frames were applied. AIM: The goal of this review is to identify available literature evidence on the community's knowledge, attitudes, and behaviours about leptospirosis, taking into account variations and similarities in techniques, tools, and data analysis. METHODS: A literature search was undertaken using the electronic databases PubMed, Scopus, Web of Science, and Ovid. Open access articles produced between 2011 and 2021 were analysed, with an emphasis on community's KAP. RESULTS: Eight articles met the inclusion benchmarks. The relationship between knowledge, attitude and preventive practices is not congruent. However, most studies showed that good knowledge is attributed to good attitude, but attitude does not necessarily contribute to good practice. Socio-demographic factors such as educational level, ethnicity, age, income and geographical location (distance to the river) have an influence on knowledge, attitude and practice. CONCLUSION: More KAP studies with standardised methodology and questionnaires regarding leptospirosis are required in order to formulate effective, sustainable and replicable health program interventions to prevent the community from leptospirosis infection and fatality. In the future, more qualitative studies should be done to further investigate and combine with quantitative studies to form prediction modelling.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing Coronavirus Disease 2019 (COVID-19) commonly presented with neurological and respiratory disorders. Among the neurological symptoms, headache, myalgia, dizziness, impaired consciousness, cerebrovascular accident (CVA), olfactory dysfunction (OD), and gustatory dysfunction (GD) are typical. GD and OD have been included as new symptoms of COVID-19 infection by the World Health Organization (WHO). Taste disorders variedfrom dysgeusia to ageusia. Similarly, OD or smell disorder severity went from microsomia or hyposmia to anosmia. The merit of theseneurological disorders is an early screening criterion for a COVID-19 patient, especially where the diagnostic resources are limited. Most of the published articles demonstrate these two dysfunctions together. Our concise review aimed to determine whether GD in COVID-19 is a solitary (independent) symptom or a secondary (associated) symptom of OD. Besides, we were looking at the possible transmission pathways of SARS-CoV-2, if it can be an early diagnostic symptom, a predictor of severity, and a prognostic factor for impaired outcome. We have limited our study to publishing articles in English only. Therefore, further evaluation might be recommended to include studies published in other languages.

BACKGROUND: Acute arterial thromboembolism among the novel coronavirus 2019 (COVID-19) patients is worrying as it can result in significant thrombotic events. AIM: The research aimed to determine the clinical results of COVID-19 infected patients who had ALI (acute limb ischaemia) during the COVID-19 epidemic. METHODS: ALI patients who had a positive COVID-19 were included in the observational cohort study, which was conducted at a single centre. The primary outcomes were 30 days mortality, limb salvage, and successful revascularization. RESULTS: From May to October 2021, data from 21 ALI subjects who had positive COVID-19 were analysed. Of the 21 included subjects, 10 were males (48%). Their mean age was 65±5 years. In nine subjects (42%), revascularization was done. Four (19%) of the 21 persons died while they were hospitalized. Twelve patients underwent major amputation and among them, one patient died after a month of hospitalization for COVID-19-related pneumonia. Among the 12 patients that underwent amputation, 10 of them presented with ALI during the first week of COVID-19 illness. Only one patient developed acute limb ischaemia despite being on heparin thromboprophylaxis. CONCLUSION: Despite attempts at revascularization, ALI-associated with COVID-19 has high mortality and high rates of limb loss. In our experience, major amputation is required in up to a third of patients. This poor result appears to confirm that these infected individuals have a marked hypercoagulable condition. However, adhering to the treatment protocol of heparin thromboprophylaxis confers a benefit in this patient group.

IntroductionDesmoid tumours are rare benign tumours. The tumours may develop sporadically or they may be linked to familial adenomatous polyposis (FAP) in Gardner’s syndrome.AimThis article highlights a young lady with an intra-abdominal desmoid tumour that manifested as an acute abdomen and we discuss our management strategy.Case studyA 24-year-old lady with a known FAP who had undergone a panproctocolectomy with an ileal pouch-anal anastomosis and total thyroidectomy, later was complicated with acute abdomen for symptomatic desmoid tumour. Computed tomography of the abdomen showed a large intraperitoneal heterogenous mass with small bowel displacement and was confirmed by magnetic resonance imaging. An exploratory laparotomy and en-bloc resection of the tumour with an end ileostomy were performed.Results and discussionIntra-abdominal desmoid tumours usually present as a painless slow-growing mass, however, in severe form, it can cause bowel ischemia, intestinal obstruction, or deterioration of function in the ileoanal anastomosis, among post total colectomy. Surgery is indicated upfront in specific clinical scenarios namely complications (occlusion, perforation, or bleeding) or major cosmetic issues.ConclusionsDesmoid tumour, despite being benign, is challenging to manage due to its compressing nature. As a key point, the diagnosis of a desmoid tumour should be suspected and followed up closely in patients with a previous history of FAP in combination with extracolonic manifestation.

BACKGROUND: The respiratory tract often becomes the site of injury from occupational exposure. All construction sites generate high levels of dust, typically from concrete, silica, asbestos, cement, wood, and stone, sand, and therefore, the workers are exposed to this airborne dust and increased their risk of developing respiratory disorders. Limited studies have been conducted to assess the relationship between respiratory symptoms, lung function, and occupational dust exposure among construction workers in Sabah. AIM: The objectives of this study are to determine the occupational exposure to dust and the relationship with the respiratory symptoms as well as lung function among construction workers in UMS Teaching Hospital. MATERIALS AND METHODS: This cross-sectional study consisted of construction workers working in all sections in the development of UMS Teaching Hospital. A standard respiratory questionnaire was distributed to construction workers and lung function measurement was performed using Spirometry and the results of their respiratory status were compared between workers who were exposed and unexposed to dust. Occupational dust exposure was determined by the gravimetric method using an air sampler. The total duration of the collection was 8 h and the filters with the dust samples were analyzed in the laboratory. RESULTS: The result showed three parameters that were significantly associated with respiratory symptoms, namely, age, marital status, and smoking status. Male workers had a higher prevalence (42.7%) of having respiratory symptoms compared to female workers (21.4%). Widow/widower/divorced (50.0%) had a higher prevalence of having respiratory symptoms compared to married (45.8%) or single workers (25.0%). Workers who smoke had a higher prevalence (51.2%) of having respiratory symptoms compared to non-smoker’s workers (22.7%). CONCLUSION: The highest dust exposure is the piping workstation, followed by the cement and plastering workstations. These warrant the compulsory use of personal protective equipment by construction workers during work, improving the quality of dust masks, and standardizing their usage. Effective engineering controls should also be promoted on construction sites.

Colorectal cancer is a major public health problem with significant number of cases and death in the population. This study aimed to determine the 5-year overall survival rate and the prognostic factors for colorectal cancer patients in Sabah.This was a retrospective cohort study conducted using secondary data from Malaysian National Cancer Registry (MNCR) database. A 5-year overall survival and the median survival time were determined with Kaplan-Meier survival curve. Cox regression analysis was done to determine the prognostic factors on survival.A total of 1,152 patients were included in this study. The majority of the patients had colon cancer and presented at late stage (stage III and IV) as compared to early stage (stage I and II). From the analysis, the 5-year overall survival for colorectal cancer was 23.2% (95% CI: 21.8, 24.6) and the median survival time was 16 months (95% CI: 14.3, 17.7). Higher survivals are seen in males (23.6%, 95% CI: 20.4, 24.7), aged 50-74 years old (24.2%, 95% CI: 22.4, 26.0), Chinese (25.5%, 95% CI: 23.0, 28.0), lived in Keningau (25.6%, 95% CI: 20.8, 30.4), colon as primary tumor site (24.5%, 95% CI: 22.5, 26.4), diagnosed with stage I (55.6%, 95% CI: 48.7, 62.5) and received surgery with chemotherapy or radiotherapy (31.3%, 95% CI: 27.8, 34.8). The significant prognostic factor was the stage at diagnosis. Patients with stage IV colorectal cancer (HR: 11.18; 95% CI: 3.48, 35.93) had eleven times risk of dying as compared to stage I.The survival rate for colorectal cancer patients in Sabah was comparatively lower than other states in Malaysia and in some Asian countries. Those patients who presented at later stage had poorer survival. Health promotion and community-based screening program should be emphasized in addition to encouraging early diagnosis to improve survival.

This innovative health intervention aimed to reduce stress among university students through interaction with music and developing awareness of the effect of music in stressful situations such as the current COVID-19 pandemic. The setting for this intervention was an online Instagram community with Universiti Malaysia Sabah (UMS) students as participants. For research, a cross-sectional observational health promotion design was used for this online health intervention, in conjunction with the Diffusion of Innovation Theory. The Medical Tune Competition was open to students from all university faculties. Process evaluation was done using the RE-AIM framework, while impact evaluation was conducted via a non-experimental post-test only design. A Google feedback form was distributed to the participating students, and descriptive analysis was performed using SPSS version 26. In total, 21 contestants participated whereby 85% of the feedback responses indicated that the programme had been enjoyable. All respondents were made aware that music could make them happy, and they stated that they would advise their friends or relatives to sing or enjoy music when stressed, 90.5% of the respondents felt music helped them relieve stress (4.43 ± 0.67), 85.7% believed that the Instagram platform was appropriate for this contest, and 14.3% suggested using Facebook or YouTube as a platform. The conclusion was that an online music competition held during the COVID-19 pandemic could be adopted and likely to be effective in raising awareness of music for stress management. In the future, innovators could develop and grow their own innovative e-health intervention programmes modelled on the Medical Tune initiative.

Childhood obesity has become a major global health concern and has been increasing dramatically over the years. Previous study has shown that specific eating behaviours may have been associated with obesity especially under-responsiveness to internal satiety cues and over-responsiveness to external food cues such as the taste, smell, availability and emotions. However, there is still inadequate number of studies present to describe the association between the children's body mass index (BMI) and their eating behaviours, especially in Sabah, Malaysia. Therefore, the objective of this study is to established the association between the children's eating behaviours with their nutritional status based on their body mass index.A cross-sectional study involving 484 children aged 6-12 years old was conducted in Kota Kinabalu, which is a developing urban area in Sabah. The children were recruited from five primary schools that were selected based on multistage stratified and convenience sampling method. Sociodemographic details and anthropometric measures both parents and children, and eating behaviours of children were assessed using Children Eating Behaviour Questionnaires (CEBQ). Age-adjusted BMI z-scores were then calculated according to the World Health Organization recommendations to assess nutritional status.The prevalence of childhood obesity among children aged 6-12 years old is 13.2%. The mean scores of 'Food Approach' subscales from the CEBQ showed higher mean score in overweight and obese groups as compared to the mean score in normal weight group. The mean scores of 'Food Avoidance' subscales showed lower mean score in overweight and obese groups as compared to mean score in normal weight group.This study provides evidence that childhood obesity is yet to be a prevalent health problem in a developing urban area considering the "Food approach" subscales were positively associated with the excess weight in children.

Breast cancer is the most common cancer among women and one of the major causes of mortality and morbidity worldwide. The aim of this study is to determine two-year cumulative recurrence rates and survival rates and their influential factors among women with breast cancer after surgical treatment.The breast cancer registry with focus on patient's outcome after treatment was retrospectively review for relevant data. The study was started on 2019. All breast cancer patients who underwent surgical procedure between 2016 and 2019 were identified and recruited in this study and was follow up for two year. We performed Kaplan Meier method to determine 2-year recurrence rates and survival rates and compared unadjusted survival statistics using Log-rank test between baseline variables and outcomes.From 2016 to 2019, a total of 482 breast cancer patients underwent surgical procedure. The overall observed 2-year recurrence rate among breast cancer patients after surgical treatment was 11.8% (95%CI:8.5,16.4) while for the survival rate was 94.8% (95% CI:91.8,96.7). Log rank test showed that lymph node involvement (p 0.001) and high lymph node ratio (p 0.001) were associated with higher cumulative recurrence rates. Meanwhile, stage 4 breast cancer (p = 0.001), higher grade tumour (p = 0.011), larger tumour size (5 cm) (P = 0.005) and type of tumour (p = 0.018) were demonstrated to have lower survival rates.Recurrence rate were significant predictor among patient with lymph node involvement and higher lymph node ratio, while stages of tumour, tumour grade, size of tumour and type of tumour were all highly significant predictor for survival rate. Therefore, the aim for early diagnosis and management of breast cancer is crucial in improving the treatment outcome.

Background: Obesity is at a rising trend among the childhood age group and is a WHO priority on classification of non-communicable diseases. High income group countries once had a statistically higher percent of obesity problems which has been extended both to the developing and low- income countries. Prevalence rate of obesity in India vary between 11.8% to 31.3% and is higher among the women than men. Obesity also affects the physical and cardio-respiratory fitness thereby leading to a group of metabolic, cardiovascular and musculoskeletal disorders. An association between BMI, musculo-skeletal and cardio-respiratory fitness is less reported among the young adult girl population in the context of Indian professional students. Aim & Objectives: To assess few of the musculo-skeletal, cardio-respiratory parameters in relation to BMI among the young adult girl students of medical and dental colleges. Material & Methods: One hundred and seventy-one girl students in the range of 19 to 21 years were randomly selected from the educational institute of Sullia, Dakshina Kannada, Karnataka and were assessed for BMI, muscular strength, handgrip strength, flexibility test, cardio-respiratory test and pulmonary function test by standard methods. Data was analysed. Results: Musculo-skeletal flexibility, strength, cardiorespiratory fitness and pulmonary functions have an inverse association when compared to the BMI and weight of the girl students. Conclusion: Obesity and overweight reduces the flexibility, musculoskeletal and cardio-respiratory fitness in addition to the pulmonary functions among the young adult girl population as confirmed by the battery of tests. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.384-389

Introduction and importance The differential diagnosis of a paediatric abdominal mass can be extensive, as it potentially involves multiple organs including gastrointestinal, genitourinary, endocrine, and gynaecological systems. Hence, a systematic approach to history taking and physical examination is needed to clinch the diagnosis. Specifically, the approach for assessing, investigating, and managing a ballotable left hypochondrial mass in a child can be challenging. Case presentation We report a 10-year-old Dusun girl presenting with left hypochondrial pain and noted a left hypochondrial mass on examination. This report highlights the role of clinical imaging during the pre-operative and post-operative phases. Clinical discussion Ultrasound and CT imaging was useful in determining that the tumor originated from the tail of the pancreas. The presence of a definite capsule with internal solid-cystic components helped narrowed the differential diagnosis to solid pseudopapillary neoplasm (SPN) of the pancreas. MR liver was useful to rule out liver metastasis in this child. Intervention and outcome The patient was scheduled for laparotomy and tumour excision at a regional paediatric centre. Successful excision of the tumor en-mass was performed and the child's subsequent recovery was uneventful. Conclusion Clinical imaging plays a critical role in the diagnosis and management of paediatric solid organ tumours. Other than renal origin, suspicion of pancreatic tail origin should be considered by clinicians when encountering a ballotable left abdominal mass., Highlights • A mass arising from the pancreatic tail can present as a ballotable mass. • Imaging findings for solid pseudopapillary neoplasm and differentials are presented. • The role of imaging in the management of solid pseudopapillary neoplasm is discussed.

Background Metastatic neuroendocrine tumours (NETs) to the breast are very rare entities. Case presentation A 26-year-old lady presented with anterior neck swelling with symptoms of superior vena cava syndrome for 6 months. Imaging study revealed a mediastinal mass which was preceded with core biopsy which was consistent with high-grade small cell NETs. Despite second-line adjuvant chemotherapy and radiotherapy, her disease became advanced which was confirmed via restaging scan. There were bilateral breast lesions discovered during the scan which was deemed to be metastatic NETs histologically. Despite prompt initiation of treatment, she succumbed 1 year after the radiotherapy due to disease progression. Conclusion High suspicion of an index is needed for diagnosis when patients with known primary NETs present with suspicious breast lesions. Triple assessment is mandatory, however histopathology assessment and immunohistochemistry staining are the mainstay of diagnosis., Highlights • Metastatic breast neuroendocrine tumours are very rare entities especially when they arise from the mediastinum. • High suspicion of an index is needed for diagnosis when patients with known primary neuroendocrine tumours presented with suspicious breast lesions. • Any breast pathology requires a triple assessment including secondary breast neuroendocrine tumours.

Background Gastric trichobezoar happens when there is an indigestible substance or food found in the gastrointestinal tract. It is a rare presentation which is usually associated with trichotillomania and trichopagia. The presentation may not be specific and is usually related to dyspepsia-like symptoms. In the worst-case scenario, this may cause gastric outlet or intestinal obstruction which eventually requires surgery. Case presentation We present a 36-year-old lady with underlying end-stage renal failure (ESRF) and undiagnosed mental health issues who was treated for recurrent episodes of gastritis. Imaging modalities revealed intragastric foreign body ingestion which is consistent with gastric trichobezoar. She eventually underwent laparotomy and gastrotomy to remove the foreign body. Postoperatively, she was referred and followed-up by the psychiatric team. Conclusion Gastric trichobezoar has strong associations with psychiatric disorders. With the co-existence of an ESRF, uraemia might contribute to the aetiology of the trichotillomania and trichophagia. Open surgery is the choice of definitive management especially if bezoars are larger. Should the recurrence be remitted, a biopsychosocial modality and regular haemodialysis is the most sustainable approach to ensure the behaviour does not persist., Highlights • Depressive symptoms with concomitant end-stage renal failure might contribute to the occurrence of the trichotillomania and trichophagia, leading to gastric trichobezoar. • Surgery is the mainstay of treatment in trichobezoar with complications. • Referral to psychiatry is mandatory in addition to continuous medical treatment in patients with trichobezoar.

Healthcare professionals with an advanced level of knowledge and skills on diabetic wound care management are needed to effectively manage complex wounds. This study aimed to determine the effects of an educational intervention to enhance the management of wound care among healthcare professionals.This study was part of a quasi-experimental pre-post research design where 82 healthcare professionals were recruited and assigned to intervention and control groups. The participants in the intervention group attended two days of educational intervention training on diabetic wound care management, while there was no intervention in the control group. A questionnaire on knowledge, attitude, and practice was applied before and one-month post-intervention to both groups.Pre-test resulted in a low level of knowledge 72.1% and 74.4%, negative level of attitude 67.4% and 66.7%, and a moderate level of practice 79.1% and 76.9% in both intervention and control groups respectively. Post-test resulted in increasing levels of knowledge (76.7%), positive attitude (100%), and practice (76.7%) in the intervention group. At the same time, there was no significant change in the control group. Repeated Measure ANOVA for within-subject and between-subject effects resulted in a statistically significant p-value of 0.001 for knowledge, attitude, and practice after the educational intervention.Health professionals have only a moderate level of knowledge on diabetic wound care management. It is important to improve this level by specific trainings and by using a good training module.Karmaşık yapıdaki yaraları etkili bir şekilde yönetmek için diyabetik yara bakımı yönetimi konusunda üst düzeyde bilgi ve beceriye sahip sağlık uzmanlarına ihtiyaç vardır. Bu çalışmada, sağlık çalışanları arasında yara bakımı yönetimini geliştirmeye yönelik bir eğitimsel müdahalenin etkilerinin belirlenmesi amaçlamaktadır.Bu çalışma, 82 sağlık uzmanının müdahale ve kontrol gruplarına atandığı ön-son değerlendirmelerin olduğu yarı deneysel desende bir araştırmanın parçasıdır. Müdahale grubundaki katılımcılar, diyabetik yara bakımı yönetimi konusunda iki günlük eğitimsel bir müdahaleye katılırken, kontrol grubunda herhangi bir müdahale olmamıştır. Müdahaleden önce ve bir ay sonra her iki gruba bilgi, tutum ve uygulama üzerine bir anket uygulanmıştır.Ön-test hem müdahale hem de kontrol grubunda sırasıyla %72,1 ve %74,4 olumsuz tutum; %67,4 ve %66,7 orta seviyede uygulama düzeyi; %79,1 ve %76,9 ile düşük bilgi düzeyleriyle sonuçlanmıştır. Son-test ise müdahale grubunda bilgi düzeyi (%76,7), olumlu tutum düzeyi (%100) ve yüksek düzeyde uygulama (%76,7) için artışlarla sonuçlanmıştır. Aynı zamanda, kontrol grubunda önemli bir değişiklik olmamıştır. Gruplar içi ve gruplar arası etki için uygulanan Tekrarlanan Ölçümlerde ANOVA, eğitimsel müdahaleden sonra bilgi, tutum ve uygulama için istatistiksel olarak anlamlı bir p-değeri (0,001) ile sonuçlanmıştır.Sağlık çalışanları diyabetik yara bakımı yönetimi konusunda yalnızca orta düzeyde bilgiye sahiptir. Bu seviyeyi konuya özel tasarlanmış eğitimlerle ve iyi bir eğitim modülü kullanarak iyileştirmek önemlidir.

Background Tuberculosis (TB) is classified according to the site of disease as pulmonary or extrapulmonary. Extrapulmonary TB is less common than its counterpart in which it can be found anywhere in the body including the liver. Similar to ampullary carcinoma, TB liver can manifest with jaundice and deranged liver function tests, particularly in the obstructed biliary systems. Case presentation A 43-year-old gentleman with locally advanced ampullary carcinoma was noticed to have multiple suspicious liver nodules intraoperatively during curative ampulla resection. The surgery was then abandoned after a biopsy. The histology was consistent with chronic granulomatous inflammation. He was then subjected to a Whipple pancreaticoduodenectomy procedure after initiation of anti-tubercular treatment. He recovered well with no evidence of tumour recurrence and worsening TB. Conclusions A high index of suspicion and quick decision making can help to diagnose a possible extrapulmonary TB masquerading as a malignant disease in a patient with curative intention of ampullary carcinoma.

Metaplastic Breast Cancer (MBC) of the breast is a rare entity of breast cancer, with a very poor prognosis, and whose pathophysiology is still unwell established. Therapeutic management is very heterogeneous due to its incomplete understanding. The aim of this study is to describe the demographic, clinical, and therapeutic characteristics of our MBC patient.A cross-sectional study was conducted to evaluate the demographic and clinicopathological features of these patients. Data of patients diagnosed with metaplastic breast cancer were retrieved from our breast cancer database in Queen Elizabeth Hospital II from January 2015 to May 2021.14 patients were diagnosed with metaplastic breast cancer during this period of study. All of them were female, with the average age of 52 years old. The patients were predominantly Bajau and Kadazan Dusun, each comprising of 35%(n = 5). 57% (n = 8) of patients were postmenopausal. 85% (n = 12) of patients were presented with breast lump of an average largest diameter of 69.23 mm. BIRADS staging of the affected breast revealed that most of the patients were BIRADS 5.57% (n = 8) patients underwent mastectomy, 4 went for either breast conserving surgery of the breast. The most common histopathological type is squamous cell carcinoma, which accounts for 42% (n = 6) of the patients. 71% (n = 10) were pathologically triple negative. 7 patients were pathologically node positive. 35% (n = 5) had lung metastasis, and one of the patients had concurrent lung and liver metastasis.The prognosis of patients with Metaplastic carcinoma of breast remains poor because most of it detected late and histologically triple negative type. Till date, there is no specific management guideline which warrant a multi institutional studies evaluating role of new therapies such as Anti-PD-1 Therapy in combination with chemotherapy to improve patient outcome.

Globally, everyone has gone through an unusual and remarkable period during the COVID-19 pandemic. The pandemic has affected various sectors in the country and implicated society. Important services including the health care system, particularly in surgery, have raised challenges and issues that need to be sorted out. This action is prudent to justify the balance in between care on preventing the spread of COVID-19 infection and at the same time providing surgical services. In this article are the perspectives on how we elicit the issues and the solutions in providing surgical services during the COVID-19 pandemic in our state, Sabah.

Patient: Female, 83-year-old Final Diagnosis: Gastrointestinal stromal tumour Symptoms: Abdominal discomfort • abdominal distension Medication: — Clinical Procedure: Colectomy • distal subtotal gastrectomy Specialty: Surgery Objective: Unusual clinical course Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and mostly affect the stomach. The size of the tumors vary, ranging from 0.6 cm to 25.5 cm, with a median size of 6.8 cm. Case Report: We report a case of a giant GIST (25×18×8.5 cm) in an 83-year-old woman, which we believe is the largest reported GIST, in Borneo, Malaysia. She presented with gradually increasing abdominal distension with occasional discomfort on movement for 1 month. Computed tomography revealed a large multilobulated enhancing mass measuring 10×20×22 cm with no clear plane with the posterior gastric wall, duodenum, and pancreas. We performed a distal gastrectomy and transverse colon segmentectomy, as the tumor was plastered to the mesentery of the transverse colon. Despite extensive surgery, she recovered well after surgery. Due to her advanced age and the tumor size, a tyrosine kinase inhibitor was not given owing to the possibility of adverse effects. Conclusions: The management of GIST is complicated, especially for a huge GIST with local invasion. Despite the benefits of a tyrosine kinase inhibitor, the role of surgery in managing GIST is crucial, especially for patients with huge tumor size, advanced age, and local complications from the tumor.

A colo‐appendico‐duodenal fistula is a rare occurrence that results from extrapulmonary tuberculosis (TB) complications, especially in the endemic region.

The severe acute respiratory coronavirus 2 (COVID-19) pandemic impacts the health of women at reproductive age in different ways, starting from pregnancy planning to post-delivery. This narrative review summarises the challenges to obstetric practice posed by the severe acute respiratory coronavirus 2 (COVID-19) pandemic. In this paper, we highlight the impacts of COVID-19 to obstetric practice globally and the efforts taken to address these challenges. Further study is critical to investigate the effects of COVID-19 on pregnancy, the outcome of COVID-19 positive pregnant women, and the safety of vaccination during pregnancy and breastfeeding.

Background Occupational injuries are among the most important workplace issues. This study aims to determine the safety climate and prevalence of occupational injuries in the small-scale manufacturing industry. Methods A cross-sectional study with ten small scale manufacturers participated accounting for a total of 300 respondents. Data were collected from July to August 2020 using the NOSACQ-50 questionnaire. Results The prevalence of occupational injury for the past 12 months was at 18%. The most often injured body parts were hands and legs while among the most common injury types were open wound, burns and bleeding. The mean NOSACQ-50 scores for all dimensions are good. The associated factors are working hours per week, and compliance to SOP. There are differences in the mean scores of NOSACQ-50 between injured and non-injured workers across all dimensions. Conclusion The safety climate among manufacturing industry employees is at a good level, while the prevalence of occupational injury is relatively low., Highlights • Occupational injury is a global issue causing permanent disabilities as well as mortality including in Malaysia. • The prevalence of occupational injury in a small scale manufacturing industry is relatively low. • Safe behaviour in the work practice, and following designed SOP to prevent accident, can reduce the possibility of injury.

Vitiligo is one of the dermatomes affecting the melanocytes resulting in their destruction and subsequent patchy depigmentation of the skin. It is postulated to occur due to an autoimmune problem. Despite being a disease with limited systemic involvement and lack of mortality, it has a severe psychological impact. It may have a powerfully negative effect on a patient's quality of life. The relationship between vitiligo and pregnancy is not widely acknowledged. It may be associated with adverse pregnancy outcomes such as recurrent miscarriage, prematurity, intrauterine growth retardation and pre-eclampsia. Herein, this review describes the disease's adverse effects on pregnancy outcomes and the influence of pregnancy itself on the clinical evolution and prognosis of vitiligo., Highlights • Vitiligo may be associated with adverse pregnancy outcomes such as recurrent miscarriage, prematurity and pre-eclampsia. • In this review, a comprehensive literature search has been taken to outline the disease’s adverse effects on pregnancy. • This review also includes a literature search on the effects of pregnancy on the clinical progress of vitiligo.

Background Adult intussusception is a relatively rare clinical entity. The majority of cases of intussusception in adults are due to a pathologic condition that serves as a lead point and requires surgery. Small bowel intussusception is usually caused by benign or malignant neoplasms appearing at the head of the invagination. Inflammatory fibroid polyp (IFP) of the small bowel is an unusual benign neoplastic lesion that has been rarely reported to cause intussusception, especially in the jejunum. Case presentation We present a rare case of adult intussusception who presented with a triad of intestinal obstruction. Computed tomography revealed small bowel intussusception with bowel ischemia. Intraoperatively, she required resection of the small bowel and primary anastomosis. Macroscopic examination revealed a single pedunculated polyp, which is the lead point of intestinal obstruction and confirmed histologically. Conclusion Inflammatory fibroid polyp should be considered as a cause of intussusception among adults with small bowel obstruction., Highlights • IFP must be considered among adults with small bowel intussusception. • Surgery is the mainstay of treatment in obstructed small bowel intussusception. • Histological examination with immunohistochemistry is warranted to establish the final diagnosis.

Patients with systemic lupus erythematosus (SLE) going for surgery have put challenges to the treating surgeon, anaesthetist and physician as the patients can present with various medical complications perioperatively. It can be associated with polyarticular involvement especially avascular necrosis of the head of femur. The patients may present young with severe clinical findings and abnormal radiological features. The surgery in young SLE patients revolves on the longevity of the prosthesis used.We report a case of a 26-year-old lady with SLE going for right total hip replacement for her avascular necrosis of right hip. Bangladesh Journal of Medical Science Vol.19(2) 2020 p.322-325

Rectal schwannomas are rare mesenchymal tumour of the gastrointestinal tract. They are scarcely identified in the low rectum as compared to the proximal tract. If present, huge tumour tends to be symptomatic leading to obstruction, bleeding, and tenesmus. We highlight a 74-year-old man with malignant presentations mimicking low rectal cancer. Colonoscopy revealed a huge pedunculated polyp measuring 10 x 8 cm with a diagnosis of benign tumour of schwannoma upon punch biopsy. Transanal excision was made after failure of endoscopic resection. Microscopic evaluation of the tumour showed a benign nerve sheath tumour of schwannoma supported by positive S100 protein expression. His recovery was excellent, hence he was discharged on the following day. There are no similar symptoms and tumour recurrence on follow up. A huge rectal tumour is not always malignant. Despite their rarity, schwannomas can manifest as malignant features. In case of tumour that mimics rectal carcinoma, preoperative diagnosis is very important for a management plan. The definitive histological diagnosis is based on the morphological features with diffuse positivity of S100 from immunohistochemical study. Surgical resection either endoscopic or transanal approach is the mainstay of treatment, especially when dealing with local complication caused by the huge bulk of tumour.

Primary neuroendocrine tumours of the breast are rare. The WHO has classified them according to the tissue grading. The clinical presentation is similar to the usual infiltrating ductal carcinomas, however the histopathological assessment requires special staining to confirm the diagnosis of neuroendocrine tumour. We report a case of a primary neuroendocrine tumour of the breast in a 33-year-old lady who presented with a locally advanced breast tumour with multicentric disease. Bangladesh Journal of Medical Science Vol.18(2) 2019 p.419-422

A woman in her 70s presented with reduced vision in her left eye, progressive narrowing of right eye opening for 6 months and anosmia. On examination, she had right enophthalmos and pseudoptosis with inferior globe dystopia. Her visual acuity was 6/9 and nil light perception in the right and left eyes, respectively. Extraocular muscle examination showed limited right up gaze. Funduscopy showed a normal right optic disc and left optic disc atrophy. Systemic examination revealed left breast ulceration with skin tethering. CT revealed an infiltrative mass invading the ethmoidal sinuses, frontal sinuses and both orbits. A histological diagnosis of infiltrative ductal breast carcinoma was made after nasal endoscopic and left breast biopsy. She underwent palliative chemoradiotherapy and survived with good disease control after 1 year. Metastatic carcinoma is a differential diagnosis of a sino-orbital mass, and comprehensive clinical assessment is indicated for all patients presenting with non-acute eye injury.

Introduction:type 2 diabetes mellitus has become a global public health crisis. The increment in the cases has contributed significantly to the parallel increase in the prevalence of overweight and obesity. This paper aimed to analyse the relationship between lipid profile, waist circumference and body mass index (BMI) with the glycaemic control of the diabetes patients in Kedah. Methods:a cross-sectional study was conducted, using the Kedah audit samples data extracted from the National Diabetes Registry (NDR) from the year 2014 to 2018. A total of 25,062 registered type 2 diabetes mellitus patients were selected using the inclusion and exclusion criteria from the registry. Only patients with complete data on their HbA1C, lipid profile, waist circumference and BMI were analysed using SPSS version 21. Results:the means for the age, BMI and waist circumference of the samples were 61.5 (±10.85) years, 27.3 (±5.05) kg/m2and 89.46 (±13.58) cm, respectively. Poor glycaemic control (HbA1c>6.5%) was observed in 72.7% of the patients, with females having poorer glycaemic control. The BMI and waist circumference were found to be significantly associated with glycaemic control (P

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Patient: Male, 22-year-old Final Diagnosis: Rectal foreign body Symptoms: Failure to remove self inserted bottle per rectum Medication: — Clinical Procedure: — Specialty: Surgery Objective: Management of emergency care Background: A rectal foreign body (RFB) can be stigmatizing for patients and present a dilemma for the treating physician. Removal can be challenging owing to the variety of objects introduced. The goals of therapy are to safely remove the RFB and to minimize injury to the bowel. Case Report: A 22-year-old man was referred from a district hospital to our institution after being unable to remove a self-inflicted RFB after sexual gratification. He was hemodynamically stable with a soft and nontender abdomen. A mass was felt in the suprapubic region. Abdominal radiography revealed a well-defined radiolucent object in the pelvic region, which was consistent with a lubricant bottle. No sign of bowel obstruction or perforation was observed. The RFB was successfully retrieved by a combination of transrectal digital manipulation and directed gentle abdominal pressure, allowing for descent of the RFB and transanal traction at the bedside. Various approaches have been described for removal of a RFB, from simple bedside strategies to open surgery for complicated cases. Endoscopy and minimally invasive techniques have also demonstrated a role in formulating a tailored approach. Conclusions: We describe a successful retrieval of an RFB at the bedside, avoiding unnecessary open surgery.