Subcutaneous ulcerated nodule refractory to antibacterial treatment

Sporotrichosis is infection caused by dimorphic fungus Sporothrix schenckii. It occurs worldwide especially tropical and subtropical zone. It manifests as lymphocutaneous skin, fixed cutaneous or disseminated lesion following exposure to contaminated source like animals, plants, or abiotic components. Here, we present a case of a 75-year-old lady with right foot ulcerative nodule that refractory to antibacterial treatment. This case highlights the importance of early recognition and diagnosis of sporotrichosis which may avoid delay diagnosis and prompt effective therapy

Conceptual framework: development of Interactive Reading Malay Language Learning System (I-ReaMaLLS)

Reading is very important to access knowledge. Reading skills starts during preschool level no matter of the types of languages. At present, there are many preschool children who are still unable to recognize letters or even words. This leads to the difficulties in reading. Therefore, there is a need of intervention in reading to overcome such problems. Thus, technologies were adapted in enhancing learning skills, especially in learning to read among the preschool children. Phonological is one of the factors to be considered to ensure a smooth of transition into reading. Phonological concept enables the first learner to easily learn reading such to learn reading Malay language. The medium of learning to read Malay language can be assisted via the supportive of multimedia technology to enhance the preschool children learning. Thus, an interactive system is proposed via a development of interactive reading Malay language learning system, which is called as I-ReaMaLLS. As a part of the development of I-ReaMaLLS, this paper focus on the development of conceptual framework in developing interactive reading Malay language learning system (I-ReaMaLLS). I-ReaMaLLS is voice based system that facilitates the preschool learner in learning reading Malay language. The conceptual framework of developing I-ReaMaLLS is conceptualized based on the initial study conducted via methods of literature review and observation with the preschool children, aged 5 – 6 years. As the result of the initial study, research objectives have been affirmed that finally contributes to the design of conceptual framework for the development of I-ReaMaLLS

Psychological distress and its association with functional disability index among acne patients attending dermatology clinics in the Kuantan tertiary hospitals

Introduction: Acne is the most common skin disease among adolescents and has significant psychological distress. Our objective is to assess acne severity, functional disability, and its psychological distress among acne patients. Methods: A cross-sectional study was conducted from November 2021 to May 2022 among 163 acne patients at�tending Dermatology Clinics in the district of Kuantan, Pahang. The severity of acne was graded using the Compre�hensive Acne Severity Scale (CASS). The functional disability index was measured using a Cardiff Acne Disability Index (CADI), while Depression, Anxiety and Stress Scale (DASS-21) questionnaires were used as a screening tool to detect the psychological distress of acne. Data were analysed using a Chi-square test, Fisher’s exact test and multiple logistic regression. Results: The mean age was 23 years, 60.1% were female, 94.5% were Malay, and 68.1% were unemployed. The severity of acne was more prominent in the mild (30.7%) and moderate (28.2%) categories. A total of 20.2%, 11.7%, and 4.9% of the respondents had anxiety, depression, and stress symptoms, respectively. Regard�ing the respondents’ functional disability, 40.5% had mild impairment, 38.0% had moderate impairment, and 13.5% had severe impairment. Acne severity was found to be significantly associated with the functional disability index (P<0.05). The functional disability index was also found to be significantly associated with depression (p=0.019) and anxiety symptoms (p=0.042). Conclusion: Clinical management of acne patients should include not only pharmaco�logical treatment but also consideration of the disease’s functional disability status and psychological distress. Malaysian Journal of Medicine and Health Sciences (2024) 20(1):126-133. doi:10.47836/mjmhs.20.1.1

Visual analytics with decision tree on network traffic flow for botnet detection

Visual analytics (VA) is an integral approach combining visualization, human factors, and data analysis. VA can synthesize information and derive insight from massive, dynamic, ambiguous and often conflicting data. Thus, help discover the expected and unexpected information. Moreover, the visualization could support the assessment in a timely period on which pre-emptive action can be taken. This paper discusses the implementation of visual analytics with decision tree model on network traffic flow for botnet detection. The discussion covers scenarios based on workstation, network traffic ranges and times. The experiment consists of data modeling, analytics and visualization using Microsoft PowerBI platform. Five different VA with different scenario for botnet detection is examined and analysis. From the studies, it may provide visual analytics as flexible approach for botnet detection on network traffic flow by being able to add more information related to botnet, increase path for data exploration and increase the effectiveness of analytics tool. Moreover, learning the pattern of communication and identified which is a normal behavior and abnormal behavior will be vital for security visual analyst as a future reference

Prevalence and risk factors for recurrent Ischemic stroke at two tertiary hospitals in Kuantan

Introduction: Recurrent strokes are rising globally, especially in Malaysia, and is a major cause of morbidity and mortality. This study examines the prevalence and risk factors of recurrent ischemic stroke in two tertiary hospitals in Kuantan. Materials and Methodss: This study is a cross-sectional retrospective study which was conducted on ischemic stroke patients who attended two tertiary hospitals in Kuantan in 2022. Results: This study included 532 individuals, 380 with first episode of stroke and 152 with recurrent ischemic stroke. The prevalence of recurrent ischemic stroke is 28.6%. The mean age of recurrent ischemic stroke is 63.33 years and male gender and Malay ethnicity are more predominant. Risk factors that show significant positive association are hypertension (p < 0.001, OR 29.940, 95% CI 9.937-90.208), diabetes mellitus (p < 0.001, OR 11.089, 95% CI 4.181- 29.409), hyperlipidaemia (p < 0.001, OR 3.457, 95% CI 1.924-6.209) and ischemic heart disease (p < 0.001, OR 3.102, 95% CI 1.758-5.472). Our study did not reveal any significant correlations between age, gender, race, smoking, family history of stroke, HbA1c level, BMI categories, and compliance to medications with regards to recurrent ischemic stroke. We also examined stroke subtypes and severity in recurrent stroke patients using the Oxfordshire Community Stroke Classification (OCSP) classification and National Institute of Health Stroke Scale (NIHSS) score. Most common stroke subtypes are LACI and PACI. TACI is associated with age, atrial fibrillation and ischemic heart disease. Most patients had moderate stroke. Stroke severity is also associated with age, smoking, ischemic heart disease and atrial fibrillation. Conclusion: Our study found a high prevalence of recurrent ischemic stroke and associated risk factors includes hypertension, diabetes mellitus, hyperlipidaemia and ischemic heart disease. Therefore, it is critical to recognize and control these risk factors to reduce the likelihood of recurrent ischemic stroke, and thus reducing morbidity and mortality

Progressive and persistent Increase in prevalence of methyldibromo glutaronitrile (MDBGN) contact sensitization from 2010 to 2018 in a tertiary center

BACKGROUND: Contact sensitization allergens evolves periodically. Continual surveillance is necessary in order for clinicians to focus on current trend of allergen in contact dermatitis. Methods: This is a nine-year retrospective study on patch testing using European Baseline Series done on patients between 2010 to 2018 at Dermatology Unit, UKM Medical Centre. Results: There were 787 patients total. 70% were female and 30% were male. Mean age was 45 years old. 87% (725) of patients tested positive. Majority of cases were Malays (60.4%) followed by Chinese (23.4%) and Indians (6.2%). Cumulatively over 9 year period, the leading allergens were potassium dichromate (32.7%), methyldibromo glutaronitrile (MDBGN, 31.6%), nickel sulphate (30.6%) formaldehyde (29.1%) and fragrance mix (23.1%). Since 2014, MDBGN is on the emergence and is consistently the top allergen at our centre up till now with the highest rate of test positive 51% (2017).This was constantly followed by potassium dichromate (36%, 2018) and formaldehyde (34%, 2018). Conclusion: The emergence of MDBGN as chief sensitising agent is alarming and question should be raised on strict implementation of policies upon this banned substance

A case series exploring the efficacy, secondary failure, paradoxical event & relapse with ustekinumab therapy in chronic plaque psoriasis

Ustekinumab is an anti-IL12/23 biologic agent used for treatment of psoriasis with excellent efficacy. However, there are therapeutic obstacles such as secondary failure and paradoxical event. Disease relapse upon discontinuation of therapy is common. A case series was performed on patients with chronic plaque psoriasis who received ustekinumab between 2013 to 2018 at a tertiary referral centre. Demographics, clinical characteristics, duration of therapy, efficacy, treatment complications, rate and pattern of relapses were determined from the patients’ medical records. Out of 8 patients, 6 (75%) patients were males. There were 6 (75%) biologic-naïve patients. Median age was 41.5 years (IQR26.8-48.3), median duration of psoriasis was 16.5 years (IQR6.5-23.0). Median duration to achieve Psoriasis Activity and Severity Index (PASI)75 was 16 weeks and median total duration of treatment was 102 weeks. All patients achieved treatment success. PASI75 at week 12 was achieved by 37.5%, a median of 16 weeks was required to achieve at least PASI 75 but 6 (75%) attained PASI 90 by then. One patient (12.5%) developed paradoxical event with pustular and plaques. Secondary failure occurred in 2 (25%) patients. All patients relapsed after treatment discontinuation, relapse occurred at median of 40 weeks. Most (71%) developed plaques on relapse but 25% developed plaques and pustules. All but one patient required further biological agent for treatment of relapse. Ustekinumab was efficacious in all patients. Treatment success was achieved slightly later than standard duration. The rare occurrences of secondary failure and paradoxical were observed. Relapse was inevitable, new onset pustular eruptions featured in relapses

Lymphocutaneous sporotrichosis: clinical suspicion when lesion is refractory to antibacterial treatment

Sporotrichosis is a fungal infection caused by Sporothrix schenckii. It occurs worldwide especially in tropical and subtropical areas. It manifests as lymphocutaneous skin, fixed cutaneous or dis�seminated lesion following exposure to contaminated source like animals, plants, or abiotic com�ponents. We report a case of a 75-year-old lady with right foot ulcerative nodule which was re�fractory to repeated antibacterial treatment, and cultures were all negative including mycobacte�rium and fungus. Skin punch biopsy was also negative for granuloma or malignancy. Based on the history, physical examination and investigation findings, a clinical suspicion of lymphocutane�ous sporotrichosis was made. The patient was started on an empirical course of itraconazole 200mg od. The lesions responded well with 12 weeks of treatment. As clinicians we are occasion�ally faced with cases where investigations may not yield results that are helpful towards making a diagnosis and in such situations, we may need to start empirical treatment based on our best judgement

Conceptual Framework: Development of Interactive Reading Malay Language Learning System (I-ReaMaLLS)

Reading is very important to access knowledge. Reading skills starts during preschool level no matter of the types of languages. At present, there are many preschool children who are still unable to recognize letters or even words. This leads to the difficulties in reading. Therefore, there is a need of intervention in reading to overcome such problems. Thus, technologies were adapted in enhancing learning skills, especially in learning to read among the preschool children. Phonological is one of the factors to be considered to ensure a smooth of transition into reading. Phonological concept enables the first learner to easily learn reading such to learn reading Malay language. The medium of learning to read Malay language can be assisted via the supportive of multimedia technology to enhance the preschool children learning. Thus, an interactive system is proposed via a development of interactive reading Malay language learning system, which is called as I-ReaMaLLS. As a part of the development of I-ReaMaLLS, this paper focus on the development of conceptual framework in developing interactive reading Malay language learning system (I-ReaMaLLS). I-ReaMaLLS is voice based system that facilitates the preschool learner in learning reading Malay language. The conceptual framework of developing I-ReaMaLLS is conceptualized based on the initial study conducted via methods of literature review and observation with the preschool children, aged 5 – 6 years. As the result of the initial study, research objectives have been affirmed that finally contributes to the design of conceptual framework for the development of I-ReaMaLLS