Johor Research Day 2024

ASSESSMENT OF IMPLEMENTATION OF PRE-PREGNANCY CARE SERVICES IN KOTA TINGGI, JOHOR PO 26 R Othman1, FR Ithnin1, J Abu Bakar1, WZ Wan Ismail1, R Mohamad1, R A. Rahman1 1Kota Tinggi District Health Office, Jalan Tun Habab, Kota Tinggi, Johor Darul Takzim INTRODUCTION: Pre-pregnancy care (PPC) is a set of healthcare and intervention of reproductive age women that has been widely implemented globally. Assessment on measuring the performance of the implementation of PPC services in primary healthcare is still insufficient. Therefore, this study aimed to assess the status of implementation PPC services among health workers in Kota Tinggi district. METHODS: A cross-sectional study was conducted among healthcare workers working in Kota Tinggi health clinics, in April 2024. Data was collected through online Google Forms using a validated structured selfadministered questionnaire named the pre-pregnancy care services questionnaire consisting background, perception, knowledge, attitude on PPC, PPC training and Transtheoretical Model. Multivariate analysis was used to identify factors associated with successful implementation of PPC services. RESULTS: Total of the 294 healthcare workers participated in this study. Half of the respondents were in the implementation action stage (54%), followed by the maintenance stage (31%), preparation stage (13%), contemplation stage (1%) and pre-contemplation stage (1%). Further categorisation showed that 57% of the respondents are successfully implementing PPC services. Support service group (Adjusted Odds Ratio, AOR 2.341; 95% Confidence Interval, 95% CI: 1.24, 4.369), good self-efficacy (AOR 1.680; 95% CI: 1.017, 2.774) and attended good PPC training (AOR 1.680; 95% CI: 1.022, 2.762) were significantly determining the success of PPC implementation. DISCUSSION/CONCLUSION: This study indicates that comprehensive PPC training, good self-efficacy and targeting the specific healthcare workers group should be considered to improve the PPC services implementation.

AN ANALYSIS IN IDENTIFYING HOT SPOTS FOR HARM AND BLIND SPOTS FROM COMPLAINTS ACROSS THE PRIMARY HEALTHCARE IN BATU PAHAT, JOHOR PO 27 A Mohd Faiz1, MS Mazhar1, MS Mohd Syahir1, S Loganathan1 1Pejabat Kesihatan Daerah Batu Pahat INTRODUCTION: Healthcare complaints tend to be underutilized when it comes to enhance the quality of primary healthcare. Through systematic analysis, we can pinpoint recurring issues; "hot spots" where problems occur frequently, and "blind spots" that may evade staff observation. Tailoring Healthcare Complaints Analysis Tool (HCAT) for general practice (HCAT(GP)), enables healthcare providers to gain deeper insights into areas requiring improvement in patient care and satisfaction. METHODS: Healthcare complaints underwent coding using the HCAT(GP) tool, categorizing them based on HCAT(GP) categories. They were classified by the stage of care, including accessing care and referral/follow-up, as well as by severity and harm level. Descriptive statistics were applied to pinpoint specific issues. Hot spots were identified using a Fisher’s Exact test, while logistic regression was utilized to detect blind spots. RESULTS: A total of 111 complaints, encompassing 137 issues, were categorized. Management issues emerged most frequently (n=106,77.4%). Hot spots were identified in the accessing care and while in the practice stages which accumulates 71.5% of total stage of care (F (5, n =137)) =28.445 P < 0.05). A blind spot for multiple issues identified were clinical quality (OR=10.134, 95% CI =2.736; 37.541, p=0.001), management environment (OR= 2.372, 95% CI =0.999; 5.628, p=0.050), management institution (OR=3.245, 95% CI= 1.528; 6.890, p=0.002), and relationship listening (OR=8.440, 95% CI= 1.069; 66.26, p=0.043). DISCUSSION/CONCLUSION: Complaints offer valuable insights for enhancing primary healthcare practice. This study showed how the HCAT(GP) can systematically analyse complaints and pinpoint both strengths and weaknesses in care provision. AN ANALYSIS IN IDENTIFYING HOT SPOTS FOR HARM AND BLIND SPOTS FROM COMPLAINTS ACROSS THE PRIMARY HEALTHCARE IN BATU PAHAT, JOHOR

PAIN ASSESSMENT AND POSTOPERATIVE PAIN MANAGEMENT IN SURGICAL PATIENTS AT HOSPITAL PAKAR SULTANAH FATIMAH PO 28 H Noraishah1, D Azlina1, MS Zaitun1 1Hospital Pakar Sultanah Fatimah, Muar, Johor INTRODUCTION: Postoperative pain management (POPM) is an important part of patient care. The aim of study are to evaluate surgical patients' painful experiences as well as the quality of nursing care provided in the management of acute postoperative pain. METHODOLOGY: A descriptive cross-sectional study, using purposive sampling method to all the patients who postoperative third day at surgical ward (N=22). Using questionnaire, the quality of POPM @ Strategic and Clinical Quality Indicators (SCQIPP) on a 5-point Likert scale. The scale's Cronbach's alpha was.81. Analysed data using SPSS IBM. RESULTS: Overall, the patient age below 35 years was 8(36.4%). The gender male was 12(54.5%) and female was 10(45.5%). Majority have high educations was 17(77.3%) and 10(45.5%) was having chronic illness. Have experienced of surgical was 12(54.5%) and expected time for pain management 11 to 20 minutes was 22(100%). There is significant association between the nurses are knowledgeable to relieve patient pain and the nurse believe the patient talk about pain (r=0.953; P= 0.001), also the association between the nurse helped until patient was satisfied the effects of pain reliever and the nurse/doctor have cooperated in treating the patient pain (r=0.770; P= 0.001). DISCUSSION/CONCLUSION: There was positive correlation between two variables SCQIPP. The insufficient knowledge of pain, inadequate assessment and evaluation of pain, and various attitudes towards pain may contribute to the problem of suboptimal pain relief. Two significant barriers to effective postoperative pain relief, identified from this study are the beliefs and attitudes of both patients and nurses also nurses’ time management.

KNOWLEDGE, ATTITUDE AND PRACTICE OF BREAST CANCER SCREENING AMONG HEALTHCARE STAFF IN HOSPITAL ENCHE' BESAR HAJJAH KHALSOM PO 29 KS Chong1, SL Lau1, SNA Zainal1, P Thanaaehiswari1 1Hospital Enche’ Besar Hajjah Khalsom, Kluang, Johor, Malaysia INTRODUCTION: Breast cancer is one of the commonest cancers in women globally and within Malaysia. Healthcare staff should be up-to-date with knowledge in promoting and spreading breast cancer awareness to local community. This study aims to determine the level of knowledge, attitude, and breast cancer screening practices among healthcare staff in Hospital Enche’ Besar Hajjah Khalsom (HEBHK), Kluang. METHODS: A cross-sectional study was conducted from 15th to 19th October 2023 on healthcare staff of HEBHK. Data were collected using predesigned, self-administered, interview structured questionnaire to test knowledge, attitude, and practices related to breast cancer. Data obtained were analysed using descriptive statistics. RESULTS: A total of 77 healthcare workers participated in this study. The modal age group of healthcare staff was 31-40 years. Participants included doctors (n=24, 31.2%), nurses (n=42, 54.5%) and allied healthcare workers (n=8, 10.4%). Overall, 50.6% has a moderate knowledge and only 35.1% has a good knowledge regarding breast cancer screening. 87% of them are practising breast self-examination. There is no association between knowledge and breast cancer screening practice among healthcare staff (p=0.308). DISCUSSION/CONCLUSION: There is a knowledge and practice gap that need to be rectified. More continuous medical education should be provided to healthcare staff before empowering them to educate local community on breast cancer screening

EFFICACY AND CYTOTOXICITY OF CALCIUM CHLORIDE AS SURFACE TREATMENT FOR ORTHODONTIC MINI IMPLANT PO 30 NA Alias1, M Md Dasor1, SD Sinniah1, MI Abu Hassan1, N Anuar1, SN Yusop1, MH Hasan1, NA Ramli1 1Oral Health Division, Ministry of Health,Putrajaya,Malaysia 2Centre of Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia 3Faculty of Dentistry MAHSA, Jenjarom, Selangor, Malaysia 4School of Chemical Engineering, College of Engineering, Universiti Teknologi MARA (UiTM), Shah Alam, Selangor, Malaysia 5Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Selangor, Malaysia INTRODUCTION: Mini implants have supplanted conventional anchorage reinforcements as the preferred method of anchorage in orthodontic treatment. Lack of stability might undermine the success of a mini implant. Calcium chloride (CaCl2) is a potential coating agent for the surface treatment of mini implant. This study aimed to investigate the cytotoxicity of CaCl₂ on the titanium surface at the different concentrations of CaCl₂ immersions (0.01 M, 0.1 M & 1.0 M). METHODS: In vitro study was done on human osteosarcoma cell line (Saos-2) to investigate the cytotoxicity of the CaCl₂ immersions (0.01 M, 0.1 M & 1.0 M) using MTT and scratch assays. RESULTS: Cell viability was best with 0.1M CaCl2 using MTT assay. The solution was most cytotoxic at 1 M CaCl2. The concentration of the CaCl₂ that causes a 50% reduction in cell viability (IC50) was 0.45 M. however, in the titration study,0.1 M and 1 M CaCl₂ immersions resulted in 0.00053 M and 0.0035 M of CaCl2 on the MI surface which are much lower than the IC50 value of CaCl₂ against Saos-2 cells. In the scratch assay, after 12 hours, the CaCl2 treatment accelerated Saos-2 cell migration by decreasing the distance of the gap by 66%, 4.4 times better than the control. DISCUSSION/CONCLUSION: Mini implant surface modification using CaCl2 surface treatment used in this study is proven to be non-cytotoxic against Saos-2 cells and improved cell migration. Hence, it increased the potential surface area of osseointegration and enhanced tissue renewal and repair.

THE USE OF A VIRTUAL LEARNING MODULE IN PROMOTING QUALITY USE OF MEDICINE: A PRELIMINARY STUDY AMONG UNDERGRADUATE STUDENTS IN JOHOR, MALAYSIA PO 31 ML Abu Bakar1, AH Ali1, NZ Abidin1, MC Segaran1, ZA Kadir1, SM Muhammad Iliyas1 1Pharmaceutical Services Division, Johor State Health Department 2Pharmacy Unit, Muar District Health Office 3Pharmacy Unit, Kluang District Health Office 4Pharmacy Unit, Mersing District Health Office 5Academy of Language Studies, Universiti Teknologi MARA, UiTM (Pasir Gudang Campus) INTRODUCTION: Limited health literacy and improper use of medicines result in poor health outcomes and higher treatment costs. Quality Use of Medicines- Consumer (QUM-C) strives for empowering public with medicine literacy to encourage informed decisions and preventive measures. This study assessed the usability and effectiveness of a virtual learning module (QUM-C VLM) in enhancing awareness on QUM-C among tech-savvy individuals, specifically undergraduate students in Johor, Malaysia. METHODS: This study utilizes cross-sectional analysis, drawing on retrospective data gathered from the QUM-C VLM user database. The QUM-C VLM is a validated learning tool introduced during the Jelajah Jom Kenal Ubat (JJKU) campaign exhibition in October 2023. Data from undergraduate students were included in this study. User satisfaction serves as a measure of usability, while the effectiveness of the VLM is assessed through post-VLM knowledge scores. RESULTS: A total of 498 students were engaged with QUM-C VLM during the campaign with 62.4% (n=311) had no previous exposure to QUM-C program. The mean knowledge score post-VLM was 11.8 (SD: 2.8) and 48% (n=238) of them were very satisfied with the module. The effectiveness of QUM-C VLM was significantly influenced by user satisfaction towards the module (One-way ANOVA; p: 0.028). DISCUSSION/CONCLUSION: In summary, virtual learning modules (VLMs) could replace traditional training. Health-focused VLMs, especially for younger people, can improve health knowledge and impact future health positively. Ensuring VLM content is both valid and engaging is crucial for user involvement and effectiveness.

KNOWLEDGE AND PRACTICE OF DIABETES SELF-MANAGEMENT DURING RAMADAN AMONG FASTING MUSLIM PATIENTS WITH TYPE 2 DIABETES MELLITUS (T2DM) IN KLINIK KESIHATAN ULU TIRAM (KKUT) PO 32 PL Tan1, SNF Nazri1 1Hospital Sultan Ismail, Johor, Malaysia 2Klinik Kesihatan Ulu Tiram, Johor, Malaysia INTRODUCTION: Ramadan is the month where all healthy adult Muslims are mandated to fast. People with chronic illnesses, such as uncontrolled diabetes, may be exempted from fasting due to the risk of acute metabolic complications. This study aims to assess the level of diabetes knowledge and its association with diabetes self-management practices during Ramadan among fasting Muslim patients with type 2 diabetes mellitus (T2DM) in Klinik Kesihatan Ulu Tiram (KKUT) METHODS: A cross-sectional study was conducted involving a sample of KKUT patients with T2DM. Patients aged 18 years and above, attending outpatient units of KKUT were recruited in June 2023. A selfadministered questionnaire was utilized to assess diabetes knowledge and diabetes self- management practices during Ramadan fasting. RESULTS: A total of 220 participants completed the questionnaire. Most of them were females (55.3%) and above 55 years old (76.2%). Resultantly, knowledge of diabetes was considered average among 53% of the participants. Only 9.6% of them avoided the consumption of sweet foods during iftar. Practicing late suhoor (p = 0.012) and self-monitoring of blood glucose (SMBG) (p = 0.026) during Ramadan were significantly associated with a better diabetes knowledge score. Education level (p = 0.000), working status (p = 0.030), and monthly income (p = 0.000) were significantly associated with participants’ knowledge level of diabetes. DISCUSSION/CONCLUSION: In conclusion, these findings reflect the need to improve patients’ knowledge of diabetes and diabetes self-management practices, especially during Ramadan. Effective strategies should be developed and incorporated into diabetes education interventions to improve patient’s knowledge of diabetes.

'THE LEVEL OF KNOWLEDGE, ATTITUDE, PRACTICE, CONFIDENCE AND BARRIERS IN PROVIDING KOTAK PROGRAMME AMONG DENTAL OPERATORS IN JOHOR SCHOOL DENTAL SERVICES' PO 33 SA Mohd Taha1, A Hamdan1, AHA Ab Razak1, MH Jamaludin1 1 Bahagian Kesihatan Pergigian Negeri Johor, Malaysia 2 Klinik Pergigian Bandar Maharani, Muar, Johor, Malaysia 3 Klinik Pergigian Tampoi, Johor Bahru, Johor, Malaysia INTRODUCTION: “Kesihatan Oral Tanpa Amalan Merokok” (KOTAK) is a smoking cessation program which was implemented upon schoolchildren since 2016. Dental officers and dental therapists from School Dental Service (SDS) teams are responsible for providing KOTAK service which consists of screening, brief advice, and counselling. METHODS: A cross sectional study involving dental officers and dental therapist from the SDS team. All districts in Johor were involved and categorized into urban and rural districts. Samples taken from primary dental clinics were proportioned using clustered random sampling and all the criteria-fulfilled dental operators were coded and chosen randomly using ballot method. All participants were instructed to fill a questionnaire consist of participant’s sociodemographic, knowledge, attitude, practice, barriers, and level of confidence. These collected data were analysed using IBM SPSS version 29.0. RESULTS: 117 (71.8%) dental officers and 46 (28.2%) dental therapists responded. 119 (73%) were graduated from local institution and 112 (68.7%) working in urban area while 51 (31.3%) were from rural area. Most of respondent have moderate level of knowledge (60.7%) and good attitude (74.2%). Dental officers were more confident in giving brief advice (61.3%), conduct the SCC for cigarette (50.9%) and e-cigarette smokers (48.5%) which were statistically significant (P<0.05). However, most respondent declared barriers like unmotivated patient (94.5%), heavy workload (90.8%) and lack of time (90.2%) while comply KOTAK programme at school. DISCUSSION/CONCLUSION: Dental therapist should receive more training and exposure in applying KOTAK programme at school.

PHARMACIST ROLE IN PRE-EXPOSURE PROPHYLAXIS (PREP) IN DETERMINING PATIENTS’ COMPLIANCE AS A HIV PREVENTION AT GOVERNMENT CLINIC SETTING; A CROSS-SECTIONAL STUDY PO 34 MA Zarwi1, CW Tai1, AP Mukunan1, GS Lim1 INTRODUCTION: Human immunodeficiency virus, HIV is a virus that affects the body's immune system. PrEP uses Tenofovir Disoproxil Fumarate 300mg and Emtricitabine 200mg to reduce the risk of getting HIV. Pill count is used to determine the compliance of the patients towards PrEP-GOV. An adherence level of at least 90% was defined as acceptable. The aim of this study is to determine the compliance of the patients that were using PrEP at KPLJB based on online pharmacy monitoring spreadsheet. The sociodemographic features, any side effects or ADR incidence of PrEP patients in KPLJB were also documented in this study. METHODS: This is a cross-sectional retrospective, single-centre study of the compliance of patients who joined the PrEP-GOV program at KPLJB. The duration of the study is from 1st January 2023 until 30th September 2023. The total number of the pills supplied to the patients will be subtracted with the number of pills left during the counselling session and then it will be divided with the number of days between the patient’s visit and multiplied by 100%. RESULTS: A total of 198 patients were included in this study. 78.79% of the participants have a good compliance towards the medication. The highest number of side effects is nausea (9.6%), followed by headache (5.05%), insomnia (2.02%), stomach upset (2.02%), bloating (1.52%) and vomiting (1.01%). DISCUSSION/CONCLUSION: Most PrEP-GOV participants in KPLJB has a good compliance towards the medications prescribed. No participants reported on non-compliance towards the medication due to side effects experienced

ISSUES ENCOUNTERED BY PATIENT ON HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) AND ROLE OF RETROVIRAL DISEASE MEDICATION THERAPY ADHERENCE CLINIC (RVD MTAC) PO 35 RA Maasah1, NAD Md Darwis1, T Raja1 1Klinik Kesihatan Sultan Ismail INTRODUCTION: Managing retroviral diseases often involves Highly Active Antiretroviral Therapy (HAART). Despite the effectiveness of HAART, patients undergoing this treatment regimen often encounter a multitude of challenges that impact their adherence and overall well-being which can hinder patients' ability to adhere to their prescribed medication regimens, leading to suboptimal treatment outcomes and increased risk of disease progression. METHODS: A cross-sectional retrospective study was conducted involving a sample of KK Sultan Ismail patient with HIV, enrolled under RVD MTAC from June 2021 until May 2023. Patients are either newly diagnosed HIV-positive patients or patients referred by a prescriber due to no adherence to treatment or other concerns relating to HAART. This study aims to identify and classify the diverse issues encountered by patients undergoing HAART treatment and their causes. We also aim to elucidate the nature of the intervention provided through RVD MTAC RESULTS: A total of 68 patients are included into this study. 40 patients had at least reported 1 issue throughout the visit. Majority of them were on EFV 600 + TDF/FTC (82.35%). More than half of the 77 issues (58.97%) are adverse drug reactions with HAART. Headache/dizziness contributes more than half of the reported side effects. Others include drug use problem and insufficient awareness/knowledge. Most involves patient/psychological factor (65%) in which they either take food that interacts with drugs, forgets to take drug, has any concern on medication and more. 25 interventions were performed by RVD MTAC involving change of HAART timing (36%), symptomatic treatment (28%), change of HAART treatment and dose reduction (16% respectively) and withhold treatment (4%). The rest only involves advices/counselling by pharmacist during MTAC session with patient which is considered as no intervention. DISCUSSION/CONCLUSION: In conclusion, this study identifies the type of PCIs encountered by patient and factors contributing to them. Adverse reactions of HAART involving headache/dizziness, vivid dream, vomiting and diarrhoea is associated with patient taking food that interact with drugs and incorrect administration of medication. All patients who are not comfortable with current HAART timing require changes of HAART timing. Rare adverse effect of Efavirenz 600mg involving gynecomastia resolves with dose reduction to Efavirenz 400mg.

'LEVEL OF KNOWLEDGE, ATTITUDE AND PRACTICE ON ORAL CANCER AMONGST REGISTERED MEDICAL PRACTITIONERS IN PRIVATE AND GOVERNMENT CLINICS IN MUAR DISTRICT, JOHOR PO 36 R Mohd Jalal1, A Hamdan1, NS Jalman1, AAH Abdul Hadi1, NFA Abdull Sitar1 1Klinik Pergigian Bandar Maharani, Muar 2Klinik Pergigian Bakri, Muar 3Klinik Pergigian Muar, Muar 4Klinik Pergigian Parit Jawa, Muar INTRODUCTION: Oral cancer is the 11th most common malignancy in the world making the role of general medical practitioners crucial for early identification of symptoms and treatment. Both dental and medical practitioners have responsibility for early detection, and referrals for early treatment. METHODS: A cross sectional study of the level of knowledge, attitudes, and practices of oral cancer amongst registered medical practitioners in private and government clinics in Muar district, Johor were conducted. Knowledge assessment of the questionnaire is adopted from Early Detection of Common Cancers and Referral Pathway: Module for Health Care Provider Ministry of Health. Attitude and practice assessment of the questionnaires is adapted from Gunjal et al (2020) with a sample size of 341 participants. A total of 346 respondent recorded. The data was analysed using IBM SPSS version 26. The Chi Square Test was used to analyse the difference between private and government medical practitioner. RESULTS: 237 (68.5%) with principal addresses in government practice and 109 (31.5%) in private practice were involved. Based on the result, practitioners in private practice (19.7%) have higher knowledge than government practice (16.8%) which is statistically significant (P<0.001). There are also significant differences in attitude of practitioner with higher number of practitioners in government practice (67.9%) showing good attitude compared to private practitioner (28%). Majority of the practitioners have good practice of oral cancer with majority from the government practice (62.1%) as compared to private practice (28.6%). DISCUSSION/CONCLUSION: Medical practitioners should be more involved to promote early detection of precancerous lesions and oral cancers.

RETROSPECTIVE OBSERVATIONAL STUDY OF COLONOSCOPY SCREENING ADHERENCE IN KLUANG DISTRICT POPULATIONS PO 37 N Nashruddin1, T Perumal1 1Hospital Kluang, Johor, Malaysia INTRODUCTION: Despite colorectal carcinoma being listed as the second most common malignancy in Malaysia, the rate of adherence to colonoscopy screening is still very low. This research was conducted to observe the colonoscopy screening compliance rate of the Kluang district population following iFOBT screening. METHODS: A retrospective observational study using data collected for the Kluang district population in Johor from the year 2021 until 2023. This study determined the rate of colonoscopy screening compliance and detection of neoplasia and carcinoma. RESULTS: A total of 1469 iFOBT screenings were recorded from 2021 until 2023. The rate of iFOBT screening from 2021 until 2023 in Kluang district showed a reduction in trend. Around 14.5% of the total iFOBT screening showed positive results. Only 33.8% of all positive cases were compliant with colonoscopy screening. The most common findings are tubular adenomas followed by hemorrhoids and the rate of malignancy detection from this observational study is 8.7%. CONCLUSION/DISCUSSION: The response rate of colonoscopy screening following positive detection of iFBOT remained low in Kluang population. Given this response detection of pre malignancy and malignancy is still very challenging. More awareness campaigns related to colorectal cancer screening should be conducted diligently involving public health clinics and hospitals to improve colonoscopy screening compliance.

AWARENESS AND PERCEPTION OF PATIENTS TOWARDS NEWLY INTRODUCED MYUBAT APPLICATION PO 38 NS Ahmad¹, NF Mezlan², PN Ahmad³ ¹Klinik Kesihatan Parit Raja, Batu Pahat ²Klinik Kesihatan Parit Raja, Batu Pahat ³Klinik Kesihatan Parit Sulong, Batu Pahat INTRODUCTION: In Klinik Kesihatan Batu Pahat (KKBP), the Value Added Services offered should be accessed through the MyUbat apps. This application is used to ease the registration and supply of followup medicines processes from Ministry of Health Malaysia facilities. The objective of this study is to determine the awareness and perception regarding MyUbat application among eligible patients in KKBP. METHODS: This cross-sectional study entailed distribution of self-administered questionnaires to patients collecting their repeat medications at KKBP pharmacy counter from 1st February to 3rd March 2024. Respondents' demographic data, experience in collecting medication, awareness, perception and likelihood to adopt MyUbat application were collected. The data was analyzed by using Pearson chi square and Fisher’s exact test based on the nature of the data. RESULTS: A total of 102 responses were analyzed. Demographic data for gender and age are well distributed, meanwhile for education level; most of the respondents are from secondary and tertiary education. From the study, 57.8% of respondents are not aware about MyUbat application, while 42.2% of respondents are aware. Among the demographic data, the education level of respondents is significant to patient awareness on MyUbat application. Save waiting time, reduce counter visits and no medication error, improving compliances are the significant perceptions that affect the likelihood to adopt MyUbat application. DISCUSSION/CONCLUSION: The majority of patients favor the recently introduced MyUbat, however there is room for improvement in terms of service awareness. To boost service acceptance, efforts should be focused on identifying the limitation.

MULTI-AGENCIES APPROACH SCREENING PROGRAMME FOR CHILDREN WITH LEARNING DIFFICULTY PO 39 INC Shukor1, KB Md Salimun1, WGW Liang1, MN Mohd Drauff1, NS M.Shauri1, FA Abdul Ghafar1, LR Yaakop1 INTRODUCTION: There were 97,220 children registered as having learning disability and attending special education class in year 2021 in Malaysia. The children with learning difficulty were usually identified by the schools and referred to any medical practitioner for diagnosis confirmation. Currently, there is no standardised screening process for children with learning disability in Malaysia. METHODS: This is an observational study of the multi-agencies collaboration screening programme for children with learning difficulty in Segamat District in 2023 involving Ministry of Education (State Education Department & Segamat District Education Department); Ministry of Health - Segamat Hospital (Paediatrics, Psychiatry, Opthalmology, Otorhinolaryngology and Occupational Therapy Departments), Segamat District Health Department; and Segamat Social Welfare Department. 105 students aged 7-12 years old were screened by 80 healthcare staffs in a single day programme. RESULTS: 58 from 105 students (55%) were diagnosed with learning disability (83% intellectual impairment, 9% ADHD, 5% dyslexia, 3% autism) and advised for special education class. 11 students (10%) failed hearing assessment and 41 students (39%) failed visual assessment. DISCUSSION/CONCLUSION: Multi-agencies collaboration screening programme for children with learning difficulty should be encouraged. A standardised guideline to diagnose children with learning disability should be established.

DEMOGRAPHIC STUDY AND PREDICTORS OF HOSPITALISATION AND MORTALITY AMONG PATIENTS WITH LIVER CIRRHOSIS ATTENDING A GASTROENTEROLOGY CLINIC IN NORTHERN JOHOR PO 40 R Jeevakanthi1, S Kauthar1, ZH Too1, K M Amin1 1 Gastroenterology Unit, Department of Medicine, Hospital Sultanah Nora Ismail, Batu Pahat INTRODUCTION: There are limited studies on the demographics of liver cirrhosis in Malaysia, in particular, Johor. This study aimed to assess the burden and predictors of hospitalisation and mortality among liver cirrhosis patients in Batu Pahat, Johor. METHODS: We retrospectively reviewed all liver cirrhosis patients case records in Hospital Sultanah Nora Ismail (HSNI), Batu Pahat, Johor from June 2022 till February 2024. Demographic and clinical characteristics associated with predictors of hospitalisation and mortality were assessed using statistical package for the social science (SPSS). RESULTS: There were 194 liver cirrhosis patients in Batu Pahat; mostly were males and Malays. The mean duration of hospitalisation is 5.99 days and 26 patients had died. The mean body mass index (BMI) was 25.49 and low density lipoprotein (LDL) value of 2.74mmol/L. There were 25 patients with hepatocellular carcinoma. 43 patients were alcoholic and 7 patients were found to have primary biliary cholangitis. Low LDL was found to be a predictor of hospitalisation (based on multivariate logistic regression (p value: 0.01, 95% CI: 1.17, 3.16) whereas an advancing age was found to be a predictor of mortality among liver cirrhosis patients (based on multivariate logistic regression (p value: 0.023, 95% CI: 1.01, 1.08). DISCUSSION/CONCLUSION: Liver cirrhosis patients should be monitored frequently especially elderly patients with low LDL to prevent mortality and further hospitalisations.

THE EFFECTIVENESS OF PARENTERAL ANTICOAGULANTS FOR VENOUS THROMBOEMBOLISM (VTE) AMONG COVID-19 PATIENTS PO 41 LF Low1, JW Wong1, NN Md Radhi1, NS Mohd Siraj1, KW Lim1 1Department of Pharmacy, Hospital Sultanah Aminah Johor Bahru, Malaysia. 2Universiti Kebangasaan Malaysia INTRODUCTION: Venous thromboembolism (VTE) in COVID-19 infection comprises deep vein thrombosis (DVT) and pulmonary embolism (PE), is managed through administering parenteral anticoagulants either prophylactically or therapy for favourable outcomes. This study intends to identify the prevalence of VTE and clinical outcomes of parenteral anticoagulants used in COVID-19 patients. METHODS: A retrospective cohort study was employed. COVID-19 patients who were hospitalized with prescribed subcutaneous (SC) anticoagulants in a tertiary hospital were recruited. Clinical outcomes of parenteral anticoagulants for VTE management were determined through simple and multiple logistic regressions. RESULTS: There were 450 patients included, whereas 423 (94.0%) patients were successfully discharged, whilst 27 (6.0%) patients required intensive care unit (ICU) care. Parenteral anticoagulants incorporated fondaparinux (n = 114, 38.1%), enoxaparin (n = 113, 37.8%), and heparin (n = 72, 24.1%). VTE prevalence was the primary finding, from which 87 (19.3%) patients, 80 (92.0%) reported DVT while 7 (8.0%) reported PE. Average length of hospitalization, indicating the secondary finding, was 9.9 (±4.7) days. VTE episodes were greater in patients without prescribed SC anticoagulants compared to those receiving SC anticoagulants (adjusted odds ratio [aOR] 54.330, 95% confidence interval [CI]: 7.086, 416.526); fondaparinux compared to heparin in VTE management (aOR 2.502, 95% CI: 1.175, 5.327). DISCUSSION/CONCLUSION: SC anticoagulants are necessary to minimize VTE episodes among COVID-19 patients.

BUMI HIJAU LESTARI DAPUR SIHAT MASYARAKAT JOHOR BAHRU (BHLDSMJB)/ SUSTAINABLE GREEN EARTH FOR HEALTHY KITCHEN COMMUNITY OF JOHOR BAHRU PO 42 A Farah ‘Adliah1, AH Aida Azna1,C Poh Ling1, R Ahmad Zaid1 1 Unit Pemakanan Pejabat Kesihatan Daerah Johor Bahru INTRODUCTION: Dapur Sihat Masyarakat Johor Bahru (DSMJB) successfully secured the Iskandar Puteri Rendah Karbon (IPRK) 2.0 Grant totaling RM13,000, to carry out the project of Bumi Hijau Lestari Dapur Sihat Masyarakat Johor Bahru (BHLDSMJB). BHLDSMJB’s objectives are reducing kitchen waste, implementing sustainable agriculture, and subsequently producing healthy recipes from the produce of BHLDSMJB. METHODS: An initial survey questionnaire regarding sustainable agriculture practices through a Google Form was conducted to 32 participants. A post-project survey questionnaire was conducted with 20 project participants. A healthy menu recipe creation competition to create healthy recipe book. RESULTS: The initial survey found that 87.5% of respondents had already started gardening at their own homes. 84.4% of respondents did not produce compost at home. Lack of knowledge about gardening was among the challenges faced before the BHLDSMJB was implemented. A final survey conducted after the BHLDSMJB found that 80% of participants agreed that the project had sparked interest and increased knowledge and skills in sustainable farming. More than half of the participants agreed that their knowledge had increased by up to 50% after participating in this activity. 90% of participants had also applied this knowledge of sustainable agriculture at their own homes after the BHLDSMJB was implemented. 10 healthy recipes were produced from the produce of the BHLDSMJB and compiled into a book. DISCUSSION/CONCLUSION: The percentage of knowledge in sustainable agriculture and healthy nutrition increased by 50% after the BHLDSMJB. Over 80% for both projects practiced sustainable agriculture at home as well.

PHARMACOVIGILANCE OF NIRMATRELVIR/RITONAVIR: REAL EXPERIENCE IN MALAYSIAN PRIMARY HEALTH CARE SETTING PO 43 NH Kamaruzaman1, F A.Sani1, HT Chuah1, JC Foo, H Yusoff1, JA Juma’at1, MM Pillai1, NI Abdul Razak1, NA Nazari1, RN Raja Arrif1, CW Tai1, PL Tan1, PL Tan1, XY Tan1, UH Aminurrahman1, JJ Woo1 1Pharmacy Unit, Johor Bahru District Health Office INTRODUCTION: Nirmatrelvir/Ritonavir is the only oral antiviral available at primary health clinics (PHC) in Malaysia used for people diagnosed with mild-to-moderate coronavirus disease (COVID-19). Questions have been raised about its safety, especially the side effects (SE) associated with its use. To determine the demographic and clinical characteristics of the study population, identify real-world reporting of Nirmatrelvir/Ritonavir-associated SEs, and estimate the cost of wastage due to incomplete Nirmatrelvir/Ritonavir course. METHODS: This is a multicenter, retrospective study involving all COVID-19 patients treated with Nirmatrelvir/Ritonavir in all 14 PHCs under Johor Bahru district, from May 2022 to December 2023. A standardized online record, the Pharmacy Monitoring Sheet was developed to collect demographic and clinical characteristics of the studied patients, as well as their SEs experienced. RESULT: During the study period, 12,381 patients were diagnosed with COVID-19. Among them, 2,272 (18.4%) patients were prescribed Nirmatrelvir/Ritonavir, with 689 (30.3%) of them aged 60 or older. A total of 1800 (79.2%) patients completed their COVID-19 vaccine booster dose. Additionally, 1472 (64.8%) patients had at least one comorbidity, with the highest prevalence observed in hypertension (32.4%), dyslipidemia (19.4%) and diabetes (17.7%). The main reported SEs are dysgeusia (44.3%, n=786), followed by diarrhea (3.7%, n=65), vomiting (1.6%, n=28), muscle pain (1.9%, n=34) and elevated blood pressure (0.5%, n=9). Notably, 252 (11.1%) patients failed to complete the 5-days course, resulting in an estimated wastage cost of RM265, 671.00. DISCUSSION/CONCLUSION: The safety profile analysis conforms to the current summary of product characteristics (SmPC) of Nirmatrelvir/Ritonavir.

JOHOR RESEARCH DAY 2024: CASE REPORT PRESENTATION ABSTRACT

ID PRESENTATION TIME TITLE PRESENTER CASE REPORT OR CASE SERIES 01 A Case of Hydatid Cyst in Malaysia Liang Yun Fei CASE REPORT OR CASE SERIES 02 Placental Mesenchymal Dysplacia; A Mistaken Molar Pregnancy Yogendren A/L Rakupathy CASE REPORT OR CASE SERIES 03 Endoscopic Diagnosis for Early Treatment of Cytomegalovirus Colitis in an Immunocompromised Patient Koh Lee Peng CASE REPORT OR CASE SERIES 04 CASE REPORT OR CASE SERIES 05 Acute Pancreatitis with Hypercalcemia: An Uncommon Presentation of Multiple Myeloma Too Zhan Hong CASE REPORT OR CASE SERIES 06 A Case Report of Trichotillomania Chai Yee Chin CASE REPORT OR CASE SERIES 07 A Rare Case of Paediatric Endobronchial Mass: Inflammatory Myofibroblastic Tumor. Christin Lim Wei Tong CASE REPORT OR CASE SERIES 08 A Rare Parotid Secretory Carcinoma in a Young Patient Muhammad Faiz Izzuddin Bin Md Rusli CASE REPORT OR CASE SERIES 09 Rehabilitating a Patient with Overlapping Guillain-Barre Syndrome (Pharyngeal–Cervical–Brachial Weakness subtype) and Miller Fisher Syndrome: A Case Report Saiful Adli Bin Mohd Zainudin CASE REPORT OR CASE SERIES 10 What Poked My Heart? The Mysterious Suspect of Cardiac Foreign Body. Kalaivani Murugesu CASE REPORT OR CASE SERIES 11 Meliodosis :A Deceptive Chameleon of Dengue: A Case Report Vinushah A/P Kaveri CASE REPORT OR CASE SERIES 12 Disseminated Cutaneous Tophi - Rare Presentation of A Common Disease (Gout) Ang Shu Ting CASE REPORT OR CASE SERIES 13 Benign Fibrous Histiocytoma Mimicking Soft Palate Lesions: A Case Report Muhamad Faisal Arief Bin Mohd Suhaimi CASE REPORT OR CASE SERIES 14 Discovering Lemmel syndrome; A rare case of obstructive jaundice. Nur Aisyah Binti Mohamad Idrus PROGRAMME : CASE REPORT PRESENTATION ABSTRACT

ID PRESENTATION TIME TITLE PRESENTER CASE REPORT OR CASE SERIES 15 Battling Cervical Necrotizing Fasciitis of Nodal Metastasis in Advanced Nasopharyngeal Carcinoma– A Management Odyssey Aqilah Binti Abdul Razak CASE REPORT OR CASE SERIES 16 Acupuncture Related Cardiac Complications Syarifah Norfarhana Nazihah Syed Nazim CASE REPORT OR CASE SERIES 17 Role of Conservative Treatment in Cases of Carpal Bone Coalition Nik Hasnan Bin Nik Ismail Azlan CASE REPORT OR CASE SERIES 18 Mandibular Gingival Swelling Unveiling Metastatic Breast Carcinoma: A Case Report Ng Ya Xin CASE REPORT OR CASE SERIES 19 CASE REPORT OR CASE SERIES 20 Incidental Finding of Malignant Pericardial Effusion Leading to Diagnosis of Lung Adenocarcinoma: A Case Report  Tan Sze Hao CASE REPORT OR CASE SERIES 21 CASE REPORT OR CASE SERIES 22 Dentigerous Cyst in Immature Permanent Tooth: A Case Report Amirul Aswad Bin Rosli CASE REPORT OR CASE SERIES 23 Cryptococcal Meningitis in Immunocompetent Patient with Low CSF Opening Pressure Abdul Hakim Bin Maiden CASE REPORT OR CASE SERIES 24 CASE REPORT OR CASE SERIES 25 A Diagnostic Challenge of Mixed Connective Tissue Disease (Mctd) with Initial Presentation of Orofacial Pain - A Case Report Azzura Binti Iszham CASE REPORT OR CASE SERIES 26 Doctor, Why Am I Seeing Double? Nur Farhana Binti Ahmad Hourmain CASE REPORT OR CASE SERIES 27 Case Report: Confronting Acute Invasive Fungal Rhinosinusitis in the Heart of Malaysian Healthcare Eric Wang Yuan Li CASE REPORT OR CASE SERIES 28 Challenges in Managing High-Risk Sexual Behavior Patient with Psychiatric Disorders. Izzah Binti Salim PROGRAMME : CASE REPORT PRESENTATION ABSTRACT

ID PRESENTATION TIME TITLE PRESENTER CASE REPORT OR CASE SERIES 29 Post Traumatic Intracranial Aneurysm Mohd Khairul Anuar Bin Jaffar CASE REPORT OR CASE SERIES 30 Common Condition, Uncommon Organism Tey Nian Jye CASE REPORT OR CASE SERIES 31 A Case Report of ARFID Management: ‘Roma Biscuit Boy’ and His Food Play Sessions Fatimah Amirah Binti Zakaria CASE REPORT OR CASE SERIES 32 Palatal Mucoepidermoid Carcinoma in an Adolescent: An Incidental Finding Fairuz Aisya Binti Mustapha CASE REPORT OR CASE SERIES 33 Clozapine-Induced Akathisia: A Case Report Nurul Amalina Binti Osman CASE REPORT OR CASE SERIES 34 Wide-Awake Orthopaedic Surgery: Hospital Sultan Ismail 3-Year Experience of Walant Technique Aina Shamira Binti Noor Hisham CASE REPORT OR CASE SERIES 35 Undifferentiated Sarcoma Mimicking as Retropharyngeal Abscess an Unexpected Twist Sherman Tay CASE REPORT OR CASE SERIES 36 Wide-Awake Orthopaedic Surgery: Comminuted Humerus Fracture Fixation under WALANT Aina Shamira Binti Noor Hisham CASE REPORT OR CASE SERIES 37 Atypical Presentation of Dengue Fever in Primary Care Nisha Nanthini A/P Tinakaran CASE REPORT OR CASE SERIES 38 Borderline Personality Disorder (BPD) and Bipolar Mood Disorder: Dilemma in primary care; A case report. Alvin Chai Chung Liang CASE REPORT OR CASE SERIES 39 Doctor, Is My Back Pain Serious? Puam Wen Hui PROGRAMME : CASE REPORT PRESENTATION ABSTRACT

A CASE OF HYDATID CYST IN MALAYSIA PC 1 YF Liang1, HH Chua1, M Amin1, M Nadzri1, S Tarmizi1, SC Loh1 1 Hospital Sultanah Nora Ismail, Batu Pahat, Malaysia CASE DESCRIPTION: A 69 years old gentleman presented to Emergency department of our centre for acute exacerbation of chronic obstructive lung disease. Chest radiograph showed focal elevation of right hemidiaphragm with ‘smooth hump’ appearance. A round mass with calcified wall noted at segment VII of the liver was discovered during the subsequent ultrasound scan. Multiphase contrast enhanced computed tomography (CECT) liver was used to further assess the liver mass. It revealed characteristics typical of hydatid cysts with several tiny scolices (daughter cyst) and a complete calcified wall indicates that there was no ongoing infection. The patient was then started on antiparasitic treatment and continue follow up at outpatient clinic. DISCUSSION/CONCLUSION: Hydatid disease is a parasitic infection caused by the Echinococcus granulosus tapeworm. It is a rare entity in Malaysia. It is associated with cyst(s) formation in various part of the body, most commonly found in the liver. Patients with hydatid cyst can be asymptomatic and diagnosed incidentally. This case emphasizes that hydatid disease should be included in the differential diagnosis for any cystic mass in liver even in non-endemic regions. The disease might be underdiagnosed in Malaysia as cases can be asymptomatic.

PLACENTAL MESENCHYMAL DYSPLACIA: A MISTAKEN MOLAR PREGNANCY PC 2 R Yogendren Hospital Sultanah Aminah, Johor Bahru, Johor CASE DESCRIPTION: A 33-year-old primigravida with a letrozole induced pregnancy was referred to maternal fetal medicine unit for follow up for polycystic feature of placenta. Transabdominal ultrasound showed single normal live fetus with posterior placenta with anechoic features with colour doppler uptake. Karyotyping showed xy fetus. The pregnancy was continued with close monitoring for complications of partial molar pregnancy. It was complicated with obstetric cholestasis and treated with Ursodeoxycholic acid. She had a preterm delivery at 30 weeks and 4 days. She delivered a baby boy weighing 1.2 kg with vesicle like placenta. Histopathological examination showed placental mesenchymal disease. The bhcg took 3 months to return back to normal. Baby was referred to paediatrics team for surveillance. DISCUSSION/CONCLUSION: A rare benign vascular anomaly that could be mistaken for partial molar pregnancy. Usually presented following abnormal ultrasound finding of placental. It is essential to rule out partial molar pregnancy through karyotyping, and need surveillance for pre-eclampsia, and preterm labour and fetal anomaly. Usually they are complicated with preterm delivery. Diagnosis is made following a histopathological examination. The newborn requires close monitoring for congenital growth disorder condition called beckwtih wiedmann syndrome.

ENDOSCOPIC DIAGNOSIS FOR EARLY TREATMENT OF CYTOMEGALOVIRUS COLITIS IN AN IMMUNOCOMPROMISED PATIENT PC 3 LP Koh1, MA Kader1, NH Yahya1 1 Department of Medicine, Hospital Enche’ Besar Hajjah Khalsom, Kluang, Johor 2 Gastroenterology Unit, Hospital Sultanah Nora Ismail, Batu Pahat, Johor INTRODUCTION: We report a case of a 28-year-old man who had sex with men (MSM) presenting with chronic diarrhoea for the past six months associated with copious amounts of mucus discharge and no rectal bleeding. Clinically he was well built with normal abdominal examination findings. His Human Immunodeficiency Virus (HIV) test came back positive with low CD4 count. As his risk was high for opportunistic infection, he was then subjected for a colonoscopy examination. Colonoscopy revealed to have a pancolitis features with multiple aphthous ulcerations with punched out lesions all throughout the colon. Based on the endoscopic findings and positive serologic test for cytomegalovirus (CMV) antibodies IgM and IgG, we then initiated him on IV Ganciclovir induction dose. Our preliminary diagnosis proven to be true when CMV polymerase chain reaction (PCR) then traced, positive at 13110 IU/ml. Histopathology report of the colonic biopsy reported viral inclusion bodies, indicative of CMV colitis. Patient showed a remarkable response towards the ganciclovir with resolved diarrhea. DISCUSSION/CONCLUSION: This case highlighted the early clinical suspicion in special population of immunocompromised status patients. Initiation of antiviral therapy for CMV colitis should not be delayed. In this case, therapy was initiated solely based on endoscopic findings and CMV serologic testing. This case illustrates early commencement of antiviral therapy for CMV colitis will reduce mortality and morbidity in these patients.

PC 4

ACUTE PANCREATITIS WITH HYPERCALCEMIA: AN UNCOMMON PRESENTATION OF MULTIPLE MYELOMA PC 5 Kothai M1, KM Amin1 1 Gastroenterology Unit, Department of Internal Medicine, Hospital Sultanah Nora Ismail, Batu Pahat CASE DESCRIPTION: Acute pancreatitis is the acute inflammation of the pancreas and can be caused by various causes. Although the commonest causes are gallstones and alcohol, it is important to investigate to rule out the other less common aetiologies such as hypercalcemia. We report a case of a 62 year old gentleman who initially presented with acute onset of epigastric pain. Laboratory investigations revealed anaemia, hypercalcemia with reversal of albumin globulin ratio and acute kidney injury. Computed tomography of the abdomen showed features of acute focal interstitial pancreatitis and bony lesions over ribs and vertebrae. During the first week of admission, patient deteriorated and required ventilatory support. Bone marrow aspiration and trephine biopsy later confirmed the diagnosis of multiple myeloma. Salvage chemotherapy with bortezomib and dexamethasone regimen was then initiated. His renal profile improved with hydration meanwhile the hypercalcemia was resolving post chemotherapy initiation. However, his acute pancreatitis was then complicated with pancreatic pseudocyst causing gastric outlet obstruction. His condition deteriorated further due to worsening sepsis and he eventually succumbed to death. DISCUSSION/CONCLUSION: The reported prevalence of hypercalcemia causing pancreatitis is 1.5-8%, but is mostly related to hyperparathyroidism. This case illustrates the rare association between pancreatitis and plasma cell proliferating disorders which may be easily overlooked. In terms of prognosis, acute pancreatitis related to hypercalcemia from malignancies is severe with a 3-fold increased risk of death. Hence, this reminds clinicians to be aware of this occurrence to enable timely diagnosis, effective management of hypercalcemia and early initiation of salvage chemotherapy.

A CASE REPORT OF TRICHOTILLOMANIA PC 6 YC Chai1,2, RA Ahmad Kuthi1, JMM Chang3 1Hospital Permai Johor Bahru 2Hospital Sultan Ismail Johor Bahru 3Hospital Miri, Sarawak CASE DESCRIPTION: Trichotillomania (TTM) is a psychiatric condition where there is recurrent pulling of one's own hair, resulting in hair loss and significant impairment of daily functioning. Here, we highlight a case of TTM accompanied by comorbid depression and panic disorder. Ms F, a 23-year-old single woman, demonstrated a mix of automatic and focused hair-pulling behaviours since teenage. During episodes of automatic hair-pulling, she would pull her hair while thinking or daydreaming. On the other hand, during focused hair-pulling, she would pick on hairs that were not straight, mostly found on the back of her head. This focused pulling was associated with temporary relief of tension. The episodic nature of the condition became evident as it initially emerged without a clear stressor, but over time, episodes of TTM surfaced during periods of intense stress. The habit of pulling her hair led to patches of scarce hair on her scalp. Seeking psychiatric assistance, she sought help when panic attacks and depressive symptoms worsened alongside her TTM. These issues have certainly impaired her daily functioning. Consequently, she initiated treatment. The gradual resolution of the case involving TTM unfolded through a combination of medication and stress reduction strategies. CONCLUSION: This case aims to highlight the episodic nature of TTM since adolescence, the changing pattern of hair pulling and the potential progression into more severe psychiatric disorders if not treated properly. Hence, healthcare providers should be more attentive to the hair-pulling habit when it emerges at a young age.

A RARE CASE OF PAEDIATRIC ENDOBRONCHIAL MASS: INFLAMMATORY MYOFIBROBLASTIC TUMOR PC 7 CWT Lim1, R Mohamad1 1Radiology Department, Hospital Sultanah Nora Ismail, Batu Pahat, Johor CASE DESCRIPTION: A 10-year-old boy presented with a two-week history of cough, fever, and respiratory distress, indicating left lung involvement upon examination. Investigations revealed a total white blood cell count of 29 x 10^9/l and chest X-ray displayed complete opacity of the left lung. Imaging showed an obstructive mass in the left main bronchus, necessitating non-invasive ventilation. Further assessment via contrast-enhanced CT confirmed left lung collapse due to intraluminal obstruction. Subsequent bronchoscopy identified a mass in the left main bronchus, leading to left pneumonectomy. Histopathology revealed an inflammatory myofibroblastic tumor. Two months post-surgery, the patient was in good condition, referred for ongoing monitoring. DISCUSSION/CONCLUSION: Inflammatory myofibroblastic tumor (IMT), primarily affecting children and young adults, is a rare neoplasm with pulmonary involvement in up to 50% of cases. Radiologically, IMTs present as peripheral lung masses, often in the lower lobes, occasionally exhibiting calcifications. Ultrasound typically shows hypoechoic or hyperechoic masses with variable Doppler signals. CT and MRI scans reveal a heterogeneous or homogeneous enhancement pattern. Invasion into adjacent structures can be visualized. Surgical resection is the mainstay treatment, boasting a five-year survival rate of up to 91.3% with minimal recurrence rates. Alternative modalities such as radiotherapy or chemotherapy may complement treatment. Understanding the distinct radiological features of IMT aids in precise diagnosis and tailored therapeutic approaches.

A RARE PAROTID SECRETORY CARCINOMA IN A YOUNG PATIENT PC 8 MFI Rusli1, SN Abdullah1, SW Lim1 1Hospital Sultanah Nora Ismail, Johor, Malaysia CASE DESCRIPTION: Our case is a 22 years old female presenting with an asymptomatic right parotid swelling for 2 years which progressively increased in size. FNAC was reported as a cystic lesion. CECT of the neck demonstrated a well-defined complex right parotid hypodense lesion with peripheral wall enchancement involving the deep lobe. Correlating the CT findings, cytology report and patient’s young demographic, a right subtotal parotidectomy was performed in view of possible malignancy. Patient underwent the surgery without complications. The histopathopathological examination reported findings of secretory carcinoma with clear margins. Currently, patient is managed conservatively with annual PET scan. DISCUSSION / CONCLUSION: Secretory carcinoma (SC) is a rare malignant salivary tumor with no gender predilections and a mean age of 40. Major salivary glands make up 80% of head and neck SC. The clinical course of SC is indolent. SC is often misdiagnosed as salivary acinic cell carcinoma (AciCC) as they share similar pathological morphology which is difficult to differentiate based on staining alone. SC shows a characteristic t(12;15) (p13;q25) chromosomal translocation on gene analysis that has not been identified in any other salivary gland tumor. Currently, management of SC follows the treatment of low-grade malignant salivary gland neoplasms, which includes complete surgical resection. Adjunctive neck dissection, radiation, and chemotherapy have been reserved for more invasive or metastatic disease or for positive margins. Due to the rarity of the disease, there are no standard management protocols up to date. Our case aims to demonstrates the importance of this rare disease presentation especially in young patients.

REHABILITATING A PATIENT WITH OVERLAPPING GUILLAIN-BARRE SYNDROME (PHARYNGEAL–CERVICAL– BRACHIAL WEAKNESS SUBTYPE) AND MILLER FISHER SYNDROME: A CASE REPORT PC 9 S Adli1, Z Ramli1, S Ibrahim1, N Jasmil1, A Kadil2 1Department of Rehabilitation Medicine, Hospital Batu Pahat 2Department of Otorhinolaryngology, Hospital Batu Pahat INTRODUCTION: Guillain-Barre Syndrome (GBS) and its variants, including Miller Fisher Syndrome (MFS) and Pharyngeal–Cervical–Brachial Weakness (PCBW), are rare autoimmune disorders characterized by progressive weakness of limbs and bulbar muscles. Overlapping presentations of these syndromes pose diagnostic and management challenges, particularly in rehabilitation settings. We report a case of a 52-year-old gentleman presenting with generalized weakness, dysphagia, and dyspnea. Clinical evaluation revealed overlapping features of GBS (PCBW subtype) and MFS. Following a 4- week hospital admission, the patient underwent intensive rehabilitation targeting limb strengthening, functional improvement and swallowing recovery. Weekly monitoring of the Medical Research Council (MRC) sum score demonstrated gradual improvement in muscle strength, and Modified Barthel Index (MBI) for functional improvement. DISCUSSION/CONCLUSION: Rehabilitation strategies for overlapping GBS and MFS syndromes focus on addressing both motor and autonomic dysfunction. Limbs and chest physiotherapy, and functional training are crucial components of rehabilitation to enhance muscle strength, respiratory function, and functional independence. Close monitoring of the patient's progress through objective measures such as MRC sum score facilitates tailored intervention and goal setting. Multidisciplinary collaboration involving physiotherapists, occupational therapists, speech therapists, and medical specialists is essential to optimize patient outcomes and holistic care. This case highlights the successful rehabilitation of a patient with overlapping GBS (PCBW subtype) and MFS, emphasizing the importance of multidisciplinary management and intensive rehabilitation. Despite complexities associated with overlapping syndromes, a structured rehabilitation program focusing on strength training, respiratory support, and functional activities can lead to significant improvements in motor function and quality of life.

WHAT POKED MY HEART? THE MYSTERIOUS SUSPECT OF A CARDIAC FOREIGN BODY PC 10 K Murugesu1, B Ravindran1, CC Ang1, J Rajendran1, MA Kader1 1 Hospital Sultanah Nora Ismail, Batu Pahat, Malaysia CASE DESCRIPTION: Cardiac foreign bodies are rare with only a limited number of cases reported. Foreign bodies in the thorax may cause an array of pathology depending on the location and route of migration. Here, we present a case of foreign body embedded in the left ventricle myocardium that presented with pericarditis and hemopneumothorax. Chest X-Ray, CT scan and Echoc- ardiography showed a suspicious foreign body within the left ventricular myocardium. This patient has had two internal fixation surgeries of the right humerus in the past making a migrated orthopedic implant the prime suspect. However, after reviewing the past x-rays and comparing the number of implants in the x-rays, orthopaedic team has concluded that it was unlikely a migrated orthopedic implant. Patient, subsequently, admitted that she has tried a self-acupuncture through left upper abdominal wall based on an online shopping platform just before the onset of the symptoms. The real culprit is still unknown as this patient refused removal surgery and opted for traditional treatment. DISCUSSION/CONCLUSION: In Asians, due to cultural practices, it is worth exploring other aetiologies of cardiac foreign bodies despite the glaring presence of previous medical implants.

MELIODOSIS: A DECEPTIVE CHAMELEON OF DENGUE: A CASE REPORT PC 11 V Kaveri1, CM Lee1, 1Medical Department, Hospital Segamat, Johor CASE DESCRIPTION: A 45-year-old male foreign employee with preexisting diabetes, working in Malaysia's oil palm state, visited the emergency room complaining of a one-week fever and three days of myalgia, nausea, headache, and loose stools. Upon initial assessment, the patient exhibited cool extremities, reduced pulse volume, capillary refill time longer than two seconds, and bibasal lung crepitations. Other systemic examinations were unremarkable. Blood investigation revealed bicytopenia (leukopenia and thrombocytopenia) with metabolic acidosis. Bilateral costophrenic angle blunting was observed on the chest X-ray. Initially treated as decompensated dengue shock due to the positive result on the quick dengue kit's NS1 test, the patient failed to respond to intravenous fluid treatment. Following a second and third negative dengue serology test, the impression was revised, and intravenous antibiotic ceftriaxone was administered. However, the patient's condition continued to worsen, requiring endotracheal intubation, inotropic support, and prolonged cardiopulmonary resuscitation with no return of spontaneous circulation. Burkholderia pseudomallei was later isolated in the blood culture. DISCUSSION/CONCLUSION: Melioidosis is a frequently fatal disease, and the diagnostic standard for this illness is the isolation of the organism from culture. Early diagnosis and treatment in this case were challenging due to false-positive NS1 result, with delayed positive organism development in blood culture. NS1 positivity in dengue often occurs within 7 days, although it can also result in false positives in other viral infections and hematologic malignancies, though it is almost unheard of in melioidosis. Because of its high mortality rate, a strong clinical suspicion is necessary to aid in diagnosis, particularly given the disease's nonspecific presentation and tendency to resemble other illnesses in endemic areas.

DISSEMINATED CUTANEOUS TOPHI - RARE PRESENTATION OF A COMMON DISEASE (GOUT) PC 12 ST Ang1, EWY Yap2, PW Yong3 1Hospital Pakar Sultanah Fatimah, Muar, Johor CASE DESCRIPTION: Gout is a common inflammatory disorder, caused by the accumulation of monosodium urate (MSU) crystals in the joints and soft tissues. Classically, these urate crystals are deposited in the joints, forming tophi, which leads to joint destruction. In rare occasions, disseminated cutaneous tophi is seen. This is characterised by widespread dermal and subcutaneous tophi on extraarticular body sites. We report a 49-year-old male with underlying chronic tophaceous gout who presented with multiple whitish papules and plaques on bilateral forearms, elbows, lower abdomen and bilateral thighs over 1-year duration. Multiple tophis were present on both hands as well. Laboratory investigation showed creatinine 81mg/dl and uric acid 587mg/dl. A skin biopsy done showed amorphous acellular pale eosinophilic materials in the skin tissue, consistent with gouty tophus. He was diagnosed with disseminated cutaneous tophi. DISCUSSION/CONCLUSIONS: Disseminated cutaneous tophi is a rare manifestation of chronic tophaceous gout.

BENIGN FIBROUS HISTIOCYTOMA MIMICKING SOFT PALATE LESIONS: A CASE REPORT PC 13 S Faisal,2, S Burhanuddin1 , R Sarah2, NS Raja Gopal1 1Department Otorhinolaryngology-Head and Neck Surgery,Hospital Putrajaya 2Department Otorhinolaryngology-Head and Neck Surgery, Hospital Pakar Sultanah Fatimah CASE DESCRIPTION: Benign fibrous histiocytoma (BFH) is a mesenchymal tumour primarily found in sunexposed skin areas. Its occurrence in the oral mucosa is rare, adding to its unique nature. Comprising fibroblasts and histiocytes in a storiform pattern with occasional foam cells, BFH may manifest at any oral mucosal site, including the soft palate. While the hard palate shows a propensity for benign salivary tumours, the soft palate often favours epithelial tumours. This distinction results in various tumour types. Only five cases of palatal BFH have been reported in the literature. This case report presents a soft palate BFH, offering an overview of its clinical, histopathological features, and immunohistochemical characteristics. DISCUSSION/CONCLUSION: The diagnosis of benign fibrous histiocytoma (BFH) remains challenging owing to its unassuming presentation. Histological examination stands as a crucial determinant, facilitating the distinction between benign and malignant lesions. The case presented aligns with similar cases reported in the literature, reinforcing the low risk of recurrence following complete excision. As we navigate the intricate landscape of BFH diagnoses, ongoing research and detailed clinical examinations remain paramount for accurate characterization and effective management.

DISCOVERING LEMMEL SYNDROME; A RARE CASE OF OBSTRUCTIVE JAUNDICE PC 14 NA Mohamad Idrus¹, N Ong¹, K Khairudin¹, LS Ab Latip¹ ¹Hospital Pakar Sultanah Fatimah Muar, Johor, Malaysia CASE DESCRIPTION: Lemmel syndrome is a rare cause of biliary obstruction. It refers to periampullary duodenal diverticulum which exerts mass effect onto the intrapancreatic common bile duct resulting in common bile duct dilatation. This incidence happens in about 22% of the population where patients often present with recurrent jaundice and right upper quadrant pain. We present a case of a 48 years old Chinese male with no previous medical illness, who presented to the emergency department complaining of altered bowel habits and reduced oral intake for 2 days. Physical examination noted the patient was jaundiced with coated tongue. Investigation showed deranged liver function test, raised serum bilirubin and elevated liver enzymes levels. Preliminary ultrasound showed cholelithiasis and dilated biliary system with no intraductal stone or soft tissue lesion. Subsequent CT and MRCP were done and showed biliary tree obstruction likely secondary to a periampullary duodenal diverticulum. The option for cholecystectomy was offered however the patient was not keen as his symptoms eventually subsided. DISCUSSION/CONCLUSION: Lemmel syndrome needs to be considered as one of the potential causes of obstructive jaundice when there is no evidence of intraductal stone, biliary or pancreatic soft tissue mass. This syndrome can be treated conservatively with a course of antibiotic. However, it poses the risks of recurrent obstructive jaundice and may further require surgical intervention later.

BATTLING CERVICAL NECROTIZING FASCIITIS OF NODAL METASTASIS IN ADVANCED NASOPHARYNGEAL CARCINOMA– A MANAGEMENT ODYSSEY PC 15 A Abdul Razak1, SH Sahab1, SS Razak1, N Yahya1,2, MK Abdullah1 1Department of Otorhinolaryngology- Head and Neck Surgery, Hospital Pakar Sultanah Fatimah 2Clinical Research Center, Hospital Pakar Sultanah Fatimah CASE PRESENTATION: Necrotizing fasciitis (NF) is an infectious disease of soft tissue that progresses rapidly and carries the potential for lethal outcome. Despite reported case studies, there remains limited research focusing on NF in cervical nodal metastasis. Managing NF involves a multimodal approach. It includes not only broad-spectrum antibiotics but also multiple extensive debridements. We are presenting a 69-year-old patient with multiple medical conditions and advanced Nasopharyngeal Carcinoma. DISCUSSION/CONCLUSION: The patient's health issues put her at higher risk with general anesthesia for extensive wound debridement. Additionally, the body's reaction to surgical stress can foster an environment that supports tumor metastasis, potentially elevating the risk of tumor recurrence and the spread of cancer cells. In this case, while chemotherapy or radiotherapy is a part of her oncological treatment, it will be a challenge for wound healing. This case study highlights how thorough wound care can really help in treating NF in patients who might be at risk with conventional surgical interventions.

ACUPUNCTURE RELATED CARDIAC COMPLICATIONS PC 16 SNN Syed Nazim1, SB Abdul Kadzir1 1Hospital Sultanah Nora Ismail, Johor CASE DESCRIPTION: Acupuncture is a well-known alternative medicine therapy and has been acknowledged throughout the world. Adverse complications may occur if acupuncture is performed by inexperienced personnel or using improper technique. Life-threatening cardiovascular complications by the acupuncture needle are rarely reported, however in the case illustrated here is a case of traumatic pericarditis with hydropneumothorax due to acupuncture needle. The needle is presumably migrated from the left chest wall via the bloodstream and eventually embedded in the left ventricular wall. Computed tomography angiography of the thorax disclose the presence of acupuncture needle in the left ventricular wall.

ROLE OF CONSERVATIVE TREATMENT IN CASES OF CARPAL BONE COALITION PC 17 Nik Hasnan1, Ibrahim Fuad2 1Hospital Sultan Ismail, Johor Bahru CASE DESCRIPTION: Carpal coalition refers to the abnormal union of two or more carpal bones, and is usually congenital, due to failure of separation of the involved bones during development (American society for surgery of the hand, n.d.). In this case, the patient has trapezium-trapezoid & capitate-hamate coalition During one of our sports medicine clinics we received a referral of a boy who practices weight lifting as his sport. He complained of occasional bilateral wrist pain during one of his practice sessions. His pain is felt more on the lower palm area, 2nd metacarpal (MCP) bone area. On clinical examination there was no obvious clinical abnormality observed, on palpation noted bony prominence at proximal 2nd MCP joint however non-tender. His range of movements were full, no restrictions in flexion and extension of the wrist. On plain x-ray, 2 gilula carpal arcs were present however there was fusion seen at his upper carpal bones, trapezium-trapezoid & capitate-hamate. No obvious fracture line seen. Clinically the area of bony prominence correlates with the area of fusion. Reassurance, physiotherapy advice and exercise were given to the patient. Patient was satisfied and was allowed to resume his normal sports as he was occasionally symptomatic. No surgical intervention needed. DISCUSSION/CONCLUSION: Most patients with these disorders will likely benefit from conservative measures. Surgery should be considered in patients with pain and limitations in wrist and hand function. (Michael B. Gottschalk et al., 2016).

MANDIBULAR GINGIVAL SWELLING UNVEILING METASTATIC BREAST CARCINOMA: A CASE REPORT PC 18 YX Ng1, R Parumo1, NA Zainal1, AR Yusof1, M Ravindran1, P Vairavan2 1Department of Oral and Maxillofacial Hospital Sultanah Aminah, Johor Bahru, Johor 2Department of Oral Medicine and Oral Pathology Hospital Sultan Ismail, Johor Bahru, Johor CASE REPORT: It is often challenging to diagnose metastasis carcinoma to the oral cavity as it does not have any pathognomonic signs and symptoms. Understanding metastasis is of great importance for the clinical management of the cancer because in most cases, cancer-related mortality is associated with disseminated metastatic lesions. A 56-year-old female patient referred from a government dental clinic, came with a chief complaint of gum swelling over her right jaw since a month ago after self-removal of her loose tooth. Clinically, noted 2 exophytic, sessile lumps over right lower alveolar ridge related to 44-46 region, which were erythematous, easily bled, had irregular surface and non-tender upon palpation. Excisional biopsy was done and reported as metastatic carcinoma of breast origin. DISCUSSION/CONCLUSION: All in all, early detection and treatment of oral cavity metastases possess a therapeutic challenge for the clinician, who plays an important role in improving the patient’s quality of life and lengthening survival. Therefore, it is mandatory to distinguish malignancies from inflammatory and reactive lesions of the gingiva by taking a detailed patient history, a thorough clinical and radiographic examination.

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INCIDENTAL FINDING OF MALIGNANT PERICARDIAL EFFUSION LEADING TO DIAGNOSIS OF LUNG ADENOCARCINOMA: A CASE REPORT PC 20 SH Tan1 Department of Internal Medicine, Hospital Segamat, Johor CASE DESCRIPTION: A 61-year-old male presented with short history of fever, vomiting, diarrhoea, reduced appetite, myalgia and non-productive cough came to hospital. In emergency department noted to have incidental finding of pericardial effusion. Subsequently pericardiocentesis was done in view of partial RV collapse (diagnostic and therapeutic purposes). Pericardiocentesis revealed haemorrhagic pericardial effusion and cytology showed presence of metastatic adenocarcinoma cells suggestive of a lung primary. Contrast enhanced CT thorax was proceeded and showed a well-defined lobulated peribronchiole mass at right lower lobe of lung. An incidental diagnosis of lung malignancy was made, and patient was referred to oncology department for further treatment. DISCUSSION/CONCLUSION: Pericardial effusion can be caused by several aetiologies, and it is known to be a slowly progressing condition that only becomes apparent when patients become haemodynamically unstable. This case underscores the importance of considering malignancy in patients presenting with unexplained pericardial effusion, even in the absence of typical symptoms. Timely intervention, including pericardiocentesis for diagnostic and therapeutic purposes, is essential for optimizing patient care and outcomes. Further research is warranted to explore the long-term implications of early detection and management of malignant pericardial effusion on patient survival and quality of life.

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DENTIGEROUS CYST IN IMMATURE PERMANENT TOOTH: A CASE REPORT PC 22 MN Mazlina1, R Amirul Aswad1, M Muhammad Haziq1 1Department of Paediatric Dentistry, Hospital Segamat, Segamat, Johor, Malaysia CASE DESCRIPTION: A fit and healthy 4 years old Malay girl attended the Department of Paediatric Dentistry, Hospital Segamat, presented with a swelling over upper left anterior maxillary region with serous discharge noted from previously extracted socket of deciduous teeth 61,62. The swelling, first noticed by parents about one year ago, started spontaneously, slowly growing causing deviation of left nostril and obliteration of nasolabial fold, not associated with pain and denied any history of trauma. Clinical examination revealed a solitary swelling over the left anterior alveolar region measuring about 1.5cm x 1.5cm. Swelling is of normal skin colour, firm, non-tender upon palpation with obliteration of labial sulcus in 61,62 region. Facial CECT was carried out and showed well defined cystic lesion measuring 1.7cm x 1.6cm x 1.7cm. Unerupted tooth seen within the lesion. Surgical enucleation was carried out under general anaesthesia and was uneventful. The soft tissue specimen was sent for histopathology examination (HPE) and was interpreted as a dentigerous cyst. There was evidence of eruption of tooth 21 after 1 year review. DISCUSSION/CONCLUSION: Combinations of clinical, radiographic and HPE will help for differentiating the diagnosis and management of the lesion. To date, surgical enucleation of the lesion is the treatment of choice for management of dentigerous cyst.

CRYPTOCOCCAL MENINGITIS IN IMMUNOCOMPETENT PATIENT WITH LOW CSF OPENING PRESSURE PC 23 MA Hakim1, OT Fatimah1, MA Wajidi1 CASE DESCRIPTION: Cryptococcal meningitis is a severe fungal infection primarily affecting individuals with weakened immune systems, such as those living with HIV/AIDS or undergoing immunosuppressive therapy. Although rare, there have been reported cases of cryptococcal meningitis in immunocompetent individuals. In a typical CSF examination, a cryptococcal infection is often associated with a high opening pressure. This is a case of a 34-year-old Malay male who resides in the Segamat district of Johor, Malaysia. He has no known medical history and has a healthy physical body size. The patient works as a farmer for few years. On October 3rd, 2023, he presented at Hospital Segamat with symptoms of headache, blurred vision, photophobia, and neck pain, which had been ongoing for the past week. The CT scan of the brain revealed superior sagittal sinus thrombosis. A lumbar puncture was performed. Although the opening pressure was only 15 mmHg, the CSF culture yielded an unexpected result, Cryptococcus neoformans. Subsequently, a repeat lumbar puncture was performed on day 2 of antifungal treatment due to persistent headache and photophobia. During this procedure, a different operator was involved, and the opening pressure remained low at 8mmHg. DISCUSSION/CONCLUSION: Cryptococcal infections are not exclusive to immunocompromised patients; they can also affect immunocompetent individuals, particularly those who come into contact with birds. This rare case report underscores the importance of recognizing atypical presentations, such as a normal or low opening pressure in cerebrospinal fluid, which may indicate cryptococcal infection.

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A DIAGNOSTIC CHALLENGE OF MIXED CONNECTIVE TISSUE DISEASE (MCTD) WITH INITIAL PRESENTATION OF OROFACIAL PAIN - A CASE REPORT PC 25 A Iszham1, P Vairavan1, NF Mohd Tahir1 1Oral Pathology and Oral Medicine Unit, Oral Maxillofacial Surgery Department, Hospital Sultan Ismail, Johor Bahru CASE DESCRIPTION: Mixed connective tissue disorder (MCTD) is a rare autoimmune disease which shares clinical features of at least two connective tissue diseases (CTD). Orofacial pain (OFP) is a term used to define pain that originates primarily from the region of the face and mouth. Numbness in OFP is referred to as trigeminal neuropathy (TN) when it involves the innervations of trigeminal nerve. Recognition of TN helps in diagnosis of MCTD as it is the most common CNS manifestation of the disease. Here, we report a case of our patient with MCTD initially presented with orofacial pain. A 54-year old female was referred to our Oral Medicine Clinic with a complaint of electric shock-like pain over bilateral cheeks, lips and right chin for the past 2 months. Our initial clinical impression was trigeminal neuralgia. She showed mild improvement with gabapentin and amitriptyline. Later on, she developed swelling, numbness of lower half face, Raynaud’s phenomenon with stiffness and knee-joint pain. Examination showed hypoesthesia in maxillary and mandibular branches of right trigeminal nerve. Blood tests were performed, suspecting autoimmune disorder. These tests revealed high level of ANA (>1:2560) and a strong positive anti-nRNP. She was referred to Rheumatology clinic and was diagnosed with MCTD. Patient showed improvement when treated with a combination of prednisolone and hydroxychloroquine. DISCUSSION/CONCLUSION: MCTD should be kept in mind in differential diagnosis of patient presenting with orofacial pain in order to prevent additional disease consequences.

DOCTOR, WHY AM I SEEING DOUBLE? PC 26 NF Ahmad Hourmain1, NM Mohd Khafi1, CR Ng2 1Hospital Segamat, Johor, Malaysia 2Hospital Pakar Sultanah Fatimah, Muar, Malaysia CASE DESCRIPTION: Sjogren syndrome (SS) is an autoimmune inflammatory disorder characterized by diminished lacrimal and salivary gland function due to lymphocytic infiltration. We would like described a case of young lady presenting with cranial mononeuritis multiplex with newly diagnosed SS. A 24-year-old single, Malay lady with no known medical illness was referred to rheumatology clinic by ophthalmologist for bilateral 3rd and 4th cranial nerve palsy with acute onset of double vision and photosensitivity for 2 weeks. She denied history of alopecia, recurrent oral ulcer or joint pain. She has BMI of 22.5 kg/m2,blood pressure 117/78mmhg and pulse rate 97bpm. Diplopia noted on horizontal and vertical gaze suggestive of bilateral 3rd and 4th cranial nerve involvement. No ptosis, facial rash, alopecia, oral ulcer or parotid gland swelling or cervical lymph nodes felt. Her schirmer test was negative. Other cranial nerves, neurological and musculoskeletal examination were unremarkable. Blood investigations and CSF panels within normal parameter. Her anti-nuclear antibody was positive (1:80, nucleolar pattern) with positive anti-Ro antibodies. MRI and CTA/CTV brain and orbit are normal. Her labial salivary gland biopsy exhibited chronic siadenitis. She was initiated on hydroxychloroquine and intravenous cyclophosphamide. Her diplopia resolved with cumulative dose of 1.5g. DISCUSSION/CONCLUSION: Early intervention with intravenous cyclophosphamide is crucial in the event of severe neurological manifestation for timely diagnosis and intervention with adequate dose to achieve treatment target for extracranial manifestations.

CONFRONTING ACUTE INVASIVE FUNGAL RHINOSINUSITIS IN THE HEART OF MALAYSIAN HEALTHCARE PC 27 EYL Wang1, SS Razak2, N Yahya3, MK Abdullah4, H Baharim5 1Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia 2Department of Otorhinolaryngology-Head & Neck Surgery Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia 3Department of Pathology, Microbiology Unit, Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia CASE DESCRIPTION: Acute invasive fungal rhinosinusitis is a challenging disease which is commonly diagnosed in immunocompromised patients. They are characterized by its extremely rapid progression. Despite advancements in both medical and surgical treatments, the survival rates for patients with acute invasive fungal rhinosinusitis (AIFRS) are still limited. Additionally, the factors that influence patient outcomes in this condition are not well understood. We share our experience in managing a case of acute invasive fungal rhinosinusitis in our center. Early diagnosis and intervention, which may involve aggressive surgical debridement, antifungal medication and addressing underlying predisposing factors are critical for facilitating recovery. A comprehensive approach involving otorhinolaryngology, medical and ophthalmology teams are crucial for promptly diagnosing and optimizing the underlying immunocompromised state. Hence, improving the patient's chances of survival in the long run. DISCUSSION/CONCLUSION: Despite years of research and efforts, AIFRS remains to be a disease with a high mortality rate and is a challenge for physicians to treat. Urgent diagnosis and management are imperative for these cases. A multidisciplinary approach is essential as patients require treatment not only for AIFRS but also for the underlying condition contributing to their immunocompromised state. Communications between patients is important to provide them with optimal treatment and care.

CHALLENGES IN MANAGING HIGH-RISK SEXUAL BEHAVIOR PATIENT WITH PSYCHIATRIC DISORDERS. PC 28 Izzah S1, Lim GS1 1 Klinik Kesihatan Mahmoodiah, Johor Bahru, Johor CASE DESCRIPTION: Sexually transmitted diseases (STDs) are on the rise worldwide. There is a strong relationship between high-risk sexual behavior and psychiatric disorders (Gebeyehu, 2018). A 23-year-old bisexual man first presented to a primary care clinic with STDs. STDs treatment was given and Pre-exposure prophylaxis (PrEP) was offered. He defaulted his PrEP appointment and treatment but he presented later several times to clinic with recurrent STDs. On his latest visit, he had concurrent anxiety symptoms. The diagnosis for generalized anxiety disorder (GAD) was established using DSM 5 criteria. Despite treatment with selective serotonin reuptake inhibitors (SSRIs) for GAD, his condition did not improve. Further question, patient was diagnosed with depression in six years ago and subsequently diagnosed with Bipolar Mood Disorder (BPD) two years ago. Patient did not convince with the changes of diagnosis and defaulted the treatment. Due to frequent default to follow-up leading to psychiatry diagnosis uncertainty and persistent high risk behavior with recurrent STDs. DISCUSSION/CONCLUSIONS: This case report describes a patient presented with recurrent STDs due to persistent high risk behavior and uncontrolled psychiatric disorders. Exploring current psychiatric symptoms and psychiatry history should not be missed in managing people with high risk behaviour. We call for clinical attention to these challenge to reduce the transmission of sexually transmitted diseases (STDs) among these key populations.