In the past decade, there has been a global resurgence of bed bug infestations, especially in developed countries. Proper awareness and identification of bed bug infestations are essential to guide treatment and eradication. The purpose of this article is to familiarize physicians with bed bug bites so that they can effectively diagnose, treat, and address questions about bed bug bites and infestations. Bed bug bites are often painless. Typical reactions include pruritic, erythematous maculopapules occurring in clusters or in a linear or curvilinear distribution in exposed areas of the body. A small red punctum may be visualized at the center of the bite mark. Lesions that appear three in a row and papules on the upper eyelid associated with erythema and edema are highly suggestive of bites from bed bugs. Exaggerated local reactions such as vesicles, urticarial wheals, urticarial perilesional plaques, diffuse urticaria, bullae, and nodules may occur in previously sensitized individuals. Reactions to bed bug bites are self-limited. As such, treatment is mainly symptomatic. Topical pramoxine and oral antihistamines can be used to alleviate pruritus. Topical corticosteroids can be used for significant eruptions to control inflammation and pruritus, and to hasten resolution of the lesions. Integrated pest management, an approach for the eradication of bed bugs, includes monitoring devices (active monitors include the use of heat or carbon dioxide attractants and passive monitors include the use of sticky pads for trapping), and judicious use of nonchemical and chemical treatments known to be effective. Nonchemical interventions include keeping affected areas clean and free of clutter, vacuuming, washing linens with hot water, caulking wall holes and cracks where bugs can hide, proper disposal of highly infested items, and placement of bed bug traps/interceptors at the base of beds and furniture. Chemical interventions involve the use of insecticides such as synthetic pyrethroids, silicates, insect growth disruptors, carbamates, organophosphates, neonicotinoids, diethyl-meta-toluamide, chlorfenapyr, fipronil and plant essential oils. Insecticides should be used with caution to prevent over-exposure and toxicity (in particular, cardiovascular and neurologic toxicity), especially if there are young children around. It is important to note that multiple mechanisms of insecticide resistance exist and as such, chemical treatment should only be undertaken by trained professionals who understand the current literature on resistance. Both nonchemical and chemical technologies should be combined for optimal results. Bed bug infestations may cause diverse dermal reactions, stigmatization, poor self-esteem, emotional stress, anxiety, significant adverse effect on quality of life, and substantial socioeconomic burden to society. As such, their rapid detection and eradication are of paramount importance. Consultation with a professional exterminator is recommended to fully eradicate an infestation.

Roseola infantum is a common viral disease that occurs during childhood worldwide. The purpose of this article is to familiarize pediatricians with the clinical manifestations, evaluation, diagnosis, and management of roseola infantum. A search was conducted in April, 2022, in PubMed Clinical Queries using the key terms "roseola infantum" OR "exanthem subitum" OR "sixth disease". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Roseola infantum is a viral illness characterized by high fever that lasts 3 to 4 days, followed by the sudden appearance of rash at defervescence. The disease occurs most frequently in children between 6 months and 2 years of age. Human herpesvirus-6 (HHV-6) is the major cause of roseola infantum, followed by HHV-7. Transmission of the infection most likely results from the asymptomatic shedding of the virus in the saliva of the caregivers or other close contacts. Characteristically, the rash is discrete, rose-pink in color, circular or elliptical, macular or maculopapular, measuring 2 to 3 mm in diameter. The eruption is first seen on the trunk. It then spreads to the neck and proximal extremities. Typically, the rash blanches on pressure and subsides in 2 to 4 days without sequelae. Most children look well otherwise and appear to be happy, active, alert, and playful. The diagnosis is mainly clinical. Febrile seizures occur in 10 to 15 % of children with roseola infantum during the febrile period. In general, serious complications are rare and occur more often in individuals who are immunocompromised. There is no specific treatment. An antipyretic may be used to reduce fever and discomfort. Roseola infantum is generally a benign and self-limited disease. Failure to recognize this condition may result in undue parental fear, unnecessary investigations, delay in treatment for conditions that mimic roseola infantum and complications from roseola infantum, unnecessary treatment of roseola infantum per se, and misuse of healthcare expenditure.

The International Society of Nephrology (ISN) region of Oceania and South East Asia (OSEA) is a mix of high- and low-income countries, with diversity in population demographics and densities. Three iterations of the ISN-Global Kidney Health Atlas (GKHA) have been conducted, aiming to deliver in-depth assessments of global kidney care across the spectrum from early detection of CKD to treatment of kidney failure. This paper reports the findings of the latest ISN-GKHA in relation to kidney-care capacity in the OSEA region. Among the 30 countries and territories in OSEA, 19 (63%) participated in the ISN-GKHA, representing over 97% of the region's population. The overall prevalence of treated kidney failure in the OSEA region was 1203 per million population (pmp), 45% higher than the global median of 823 pmp. In contrast, kidney replacement therapy (KRT) in the OSEA region was less available than the global median (chronic hemodialysis, 89% OSEA region vs. 98% globally; peritoneal dialysis, 72% vs. 79%; kidney transplantation, 61% vs. 70%). Only 56% of countries could provide access to dialysis to at least half of people with incident kidney failure, lower than the global median of 74% of countries with available dialysis services. Inequalities in access to KRT were present across the OSEA region, with widespread availability and low out-of-pocket costs in high-income countries and limited availability, often coupled with large out-of-pocket costs, in middle- and low-income countries. Workforce limitations were observed across the OSEA region, especially in lower-middle-income countries. Extensive collaborative work within the OSEA region and globally will help close the noted gaps in kidney-care provision.

ABSTRACT Fordisc is a discriminant function computer program used to study ancestry, although it lacks representation from a Malaysian sample. Our aim was to evaluate ancestry estimates of Fordisc 3 with Malaysian crania of known sex and ethnicity. A dataset from Hisham and Ibrahim of 300 individuals was included in this study. They had undergone full-body computed tomographic scanning prior to post-mortem examination with scan resolutions of 1.0 mm. Maximum cranial length, maximum cranial breadth, nasal height, nasal breadth, and midorbital width were obtained from these images. Measurements were fed into the Fordisc 3 program and were analysed using the Forensic Anthropology Data Bank (FDB) and Howells’ reference populations according to sex, however midorbital width was excluded in all analyses. Ancestry assessment was evaluated on the basis of percentage of correctly classified individuals. Based on Howells database, 50.67% of the sample are correctly classified into Asian, in contrast to only 32.33% according to FDB. These classification trends are limited by the number of measurements, reference populations available in Fordisc and population history of the sample itself. We need to collect standard anthropological measurements in future research and potentially contribute to the database in Fordisc to improve its performance.

The COVID-19 pandemic has caused major impacts in various aspects of our life. In Malaysia, a Movement Control Order was imposed in March 2020. For almost two years, school going children and adolescents were not able to attend school physically, and their physical activity was confined within their room or house on most days. Case Description. We describe a case of a 14-year-old boy who was previously active in sports and sustained a low trauma fracture at the right neck of the femur following a prolonged period of extreme sedentary life along with poor dietary intake during the COVID-19 pandemic period. He underwent open reduction and screw fixation for the right neck femur fracture. He was thin with a low BMI (15.62 kg/m2) and a significant loss of muscle bulk in all limbs. Laboratory tests showed vitamin D deficiency (15.3 nmol/L) and the dual energy X-ray absorptiometry (DXA) showed a low Z-score for the total spine (-2.2) and total hip (-3.9). He was treated with activated vitamin D and vitamin D3 replacement. Sports physician was involved for individualized postoperative rehabilitation. Successive clinic visits showed remarkable improvements in physical fitness, sports participation, and normalization of vitamin D levels. A high degree of suspicion is needed to rule out secondary causes in adolescents who present with unusual fragility fractures.

To evaluate the olfactory acuity and quality of life in patients who have undergone total laryngectomy. The study also aims to identify any specific patient-related risk factors linked to worse olfactory outcomes. This is a prospective cross-sectional study conducted at the University Malaya Medical Centre. A total of 30 patients who have undergone total laryngectomy were assessed objectively using the Sniffin' Sticks test and compared against normal age-matched Malaysians. Subsequently, they also filled out the modified Questionnaire on Olfactory Disorders. Correlations of patient demographics, disease and treatment variables against olfactory outcomes were conducted. All subjects suffered olfactory impairment, with 66.7% of them being anosmic after total laryngectomy. The Sniffin' Sticks test demonstrated a statistically significant difference between laryngectomees and the normal age-matched Malaysian population in all three subtests for odor threshold, discrimination and identification. 37% of patients developed olfactory adaptive methods, which resulted in higher olfactory scores and a better quality of life. There were no patient demographics, disease or treatment variables associated with a poorer olfactory outcome identified. Olfactory impairment should not be overlooked among patients after total laryngectomy. Although as many as a third of patients developed some sort of olfactory adaptive behavior, early rehabilitation should be integrated into the multidisciplinary rehabilitation program after total laryngectomy.

Psoriatic arthritis (PsA) is a major comorbidity of psoriasis and may lead to irreversible joint damage and disability. This study aims to describe the clinical profile, treatment and quality of life (QoL) of patients with PsA in Malaysia. This is a multicentre retrospective cross-sectional study of psoriasis patients who were notified to the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018. Of 21 735 psoriasis patients, 2756 (12.7%) had PsA. The male to female ratio was 1:1. The mean age of psoriasis onset for PsA patients was 34.73 ± 14.44 years. They had a higher rate of family history of psoriasis (26% vs. 22.4%, p < 0.001), scalp (82.7% vs. 81.0%, p = 0.04) and nail involvement (73.3% vs. 53.3%, p < 0.001), obesity (62.6% vs. 54.4%, p < 0.001), dyslipidaemia (23.8% vs. 15.4%, p < 0.001), hypertension (31.1% vs. 22.7%, p < 0.001) and diabetes mellitus (20.9% vs. 15.2%, p < 0.001) compared to non-PsA patients. More than half (54.3%) had severe psoriasis [(body surface area >10% and/or Dermatology Life Quality Index (DLQI) >10)]. Most had oligo-/monoarthropathy (40.3%), followed by distal interphalangeal arthropathy (31.3%), symmetrical polyarthropathy (28.3%), spondylitis/sacroiliitis (8.2%) and arthritis mutilans (3.2%). Nearly 40% of PsA patients received systemic treatment, but only 1.6% received biologic agents. QoL was more significantly affected in PsA than in non-PsA patients (mean DLQI 10.12 ± 7.16 vs. 9.52 ± 6.67, p < 0.001). One in eight patients with psoriasis in Malaysia had PsA. They had a higher incidence of comorbidities, severe disease, impaired QoL and were more likely to receive systemic and biological treatment compared to non PsA patients.

Abstract Background Malignant tumours of the Central Nervous System (CNS) is the second most common paediatric malignancy, following haematological malignancy. CNS tumours depend significantly on the extent of tumour resection. In the past decade, intraoperative ultrasound (IOUS) has evolved into a widespread neuroimaging tool that offers real-time surgical guidance, and is a widely accessible imaging modality with minimal identified risk or additional operative time, and also lower economic investment. Recent studies found a strong correlation between IOUS and post operative MRI findings when evaluating extent of tumour resection in adult population suggesting that IOUS might have significant clinical implications, however not many studies involved the paediatrics population. The objective of our study was to compare correlation and reliability of the ultrasound as compared to MRI for tumour resection in paediatric population. We also evaluated IOUS as a real-time navigation tool during surgical resection of intra axial tumours in paediatric patients. Methods This was a prospective observational study done in a Hospital Tunku Azizah, Kuala Lumpur. Patients aged less than 12 years old, admitted between 1st December 2019 to 30th November 2021 with preoperative MRI diagnosis of intra-axial brain tumour were recruited in this study. IOUS was performed intraoperatively, and post-operative MRI performed within 24-72 hours post-op. IOUS utility assessment scoring was performed intraoperatively. Results We analysed a total of 25 paediatric patients that met the inclusion criteria. Concordance analysis between IOUS evaluation and MRI showed good agreement (kappa = 0.527). A multivariate logistic regression analysis was performed to look for any significant factors of discordance, and none of the variables were found significant for discordance. Hosmer and Lemeshow goodness of fit test was performed, and showed that our model is a good fit, with a good prediction value of 0.497. Conclusion The use of IOUS allowed reliable intra operative imaging modality to achieve more successful gross total resection of brain tumours in paediatrics.

Abstract Background Cutaneous squamous cell carcinoma accounts for 20% of all non-melanoma skin cancer cases and is primarily observed in the head and neck region. In specific scenarios, a minority of cases may exhibit metastasis to the primary regional basin drainage. Our objective was to review our 7-year experience with lymph node dissection cases in cutaneous malignancies and assess the trend over time at a tertiary referral centre. Method The Plastic Reconstructive Surgery Department of Hospital Kuala Lumpur conducted a retrospective analysis on patients who were diagnosed with cutaneous squamous cell carcinoma and underwent lymph node dissection over a span of seven years. Fifty six of 124 cutaneous squamous cell carcinoma patients had their data recovered. Twelve participants had lymph node dissection surgery. This study documented subject prognoses and lymph node surgery performed. Results Nine men and 3 women comprised the 12-person cohort. The median age of diagnosis was 56.9 years, and the minimum follow-up was 5 years. Two of twelve patients had positive nodes, indicating cancer. According to the National Comprehensive Cancer Network, the first patient had two high-risk indicators, while the second had four. The initial patient manifested cutaneous metastasis, whereas the subsequent patient demonstrated nodal metastasis and ultimately succumbed to the ailment. A total of six patients received radiotherapy treatment. Our patient group exhibited a higher negative rate for complete lymph node dissection in cases of occult regional metastases. Conclusion The identified high-risk factors included the presence of a palpable lymph node, moderate degree of differentiation, and perineural involvement. The utilisation of sentinel lymph node biopsy and PET/CT imaging as supplementary measures in instances of occult lymph nodes may prove advantageous, however, further investigation is warranted.