Falls are prominent health issues among older adults. Among hypertensive older adults, falls may have a detrimental effect on their health and wellbeing. The purpose of this study is to determine the prevalence of falls among hypertensive older adults and to identify the associated factors that contribute to their falls. This was a cross-sectional study conducted among two hundred and sixty-nine hypertensive older adults who were selected via systematic random sampling in two primary health clinics in Kuala Terengganu, Malaysia. Data on their socio-demographic details, their history of falls, medication history and clinical characteristics were collected. Balance and gait were assessed using the Performance Oriented Mobility Assessment (POMA). It was found that 32.2% of participants reported falls within a year. Polypharmacy (adjusted OR 2.513, 95% CI 1.339, 4.718) and diuretics (adjusted OR 2.803, 95% CI 1.418, 5.544) were associated with an increased risk of falls. Meanwhile, a higher POMA score (adjusted OR 0.940, 95% CI 0.886, 0.996) and the number of antihypertensives (adjusted OR 0.473, 95% CI 0.319, 0.700) were associated with a low incidence of falling among hypertensive older adults. Falls are common among hypertensive older adults. Older adults who are taking diuretics and have a polypharmacy treatment plan have a higher incidence of falls. However, older adults taking a higher number of anti-hypertensive medications specifically were not associated with an increased prevalence of falls.

Vanishing lung syndrome (VLS) is a rare condition characterized by giant emphysematous bullae. It is frequently misdiagnosed as pneumothorax. We describe a case of a 30-year-old male who presented with shortness of breath, reduced effort tolerance, and pleuritic chest pain for three months. He was initially diagnosed with bilateral pneumothorax based on clinical examination and chest radiograph findings. However, further imaging with a high resolution computed tomography (HRCT) of the thorax confirmed bilateral giant emphysematous bullae. Our patient subsequently underwent video-assisted thoracoscopic surgery (VATS) and bullectomy. In this report, we discuss the clinical presentations, radiological features, and the management of VLS. We also highlight the differentiating features of VLS from a pneumothorax.

There is no specific recommendation regarding the type of anaesthesia in hip fracture surgery. This study sought to examine the current local anaesthetic practice (general anaesthesia versus regional anaesthesia (RA)) in hip fracture surgery and to analyse their associations with perioperative outcomes. A retrospective observational study of hip fracture patients from April to December 2017 was undertaken. Patient characteristics and perioperative outcomes were analysed against the types of anaesthesia using multiple logistic regression. One hundred and twelve out of 154 patients (72.7%) had a general anaesthesia. Patients from residential care facilities were more likely to receive general anaesthesia (OR = 2.9, 95% CI: 1.1, 7.4; P = 0.03). There was no significant association between type of anaesthesia and specific postoperative outcomes; however, patients with postoperative delirium and hypotension were more likely to have received general anaesthesia [OR = 1.7, 95% CI: 0.68, 4.38; P = 0.25] and [OR = 1.6, 95% CI: 0.67, 4.04; P = 0.27] respectively). Subgroup analysis showed increased length of stay with patients who underwent general anaesthesia (OR = 1.26, 95% CI:1.04, 1.54; P = 0.02). Regional anaesthesia may be considered in patients without contraindications in view of increased risk of postoperative delirium and hypotension, and longer length of stay with general anaesthesia. A larger prospective study is needed to confirm these findings.

Acrocyanosis is characterised by persistent bluish discolouration of the extremities, resulting from reduced peripheral blood flow leading to increased oxygen extraction. The aetiology can be divided into primary and secondary causes. While primary acrocyanosis is generally painless and has a benign course, secondary causes may lead to complications. This case reported acrocyanosis secondary to cutaneous vasculitis which progressed to digital gangrene, which is a rare complication of cutaneous vasculitis. A 68-year-old man presented with a four-day history of bluish discolouration involving bilateral toes associated with pain and started to become gangrenous. Investigations for critical limb ischemia did not show evidence of critical arterial stenosis. Further history revealed history of recent administration of intramuscular injections with diclofenac, a non-steroidal anti-inflammatory agent for renal colic pain a few days prior to the onset of the. Thorough skin search showed multiple purpuric rash of his thighs, buttocks and abdomen. Skin biopsy confirmed the diagnosis of cutaneous (lymphocytic) vasculitis, which was likely to be drug-induced. The acrocyanosis initially responded to methylprednisolone, however unfortunately it progressed further to digital gangrene which required bilateral transmetatarsal amputations. Knowledge on clinical features, aetiology and investigations of secondary acrocyanosis is crucial for early recognition and treatment of the underlying cause to prevent irreversible complications.

Malaysia anticipates its elderly population will reach 15% by 2030, posing a significant challenge. Despite the worldwide and national emphasis on health and well-being, a gap exists in structured activities for elderly. The WeCare Program addresses this by offering an occupation-based, culturally tailored approach aimed at improving the engagement and well-being of older Malaysians. Conducted by occupational therapists across six districts in Kelantan, this program involved 30 elderly participants and was evaluated over six weeks. The results indicate that the program was highly accepted (M=4.94; SD=0.22), appropriate (M=4.85; SD= 0.20), and feasible (M=4.88; SD=0.33) for implementation among the target population.

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune demyelinating that predominantly affects the optic nerves and spinal cord. While AQP4-IgG seropositivity remains the diagnostic hallmark, a subset of patients presents as seronegative NMOSD, fulfilling clinical and radiological criteria in the absence of detectable antibodies. Notably, NMOSD can occur independently or coexist with other autoimmune diseases, including systemic lupus erythematosus (SLE). It is critical to differentiate NMOSD from neuropsychiatric lupus, as the treatment strategies differ significantly. Case summary: We present a case of a 25-year-old woman with no prior history of autoimmune disease who initially presented with acute urinary retention. She subsequently developed altered mental status, bilateral lower limb weakness, and brainstem symptoms such as ptosis, involuntary facial movements, and nystagmus. Magnetic resonance imaging of the brain and spine revealed longitudinally extensive transverse myelitis (LETM), indicative of NMOSD. Serological testing revealed positive ANA, high anti-dsDNA, low complement levels, and pancytopenia, fulfilling the 2019 ACR/EULAR criteria for SLE. However, the AQP4 antibodies were negative. After treatment with intravenous methylprednisolone and five cycles of plasma exchange, the patient’s neurological condition improved significantly. Conclusion: This case highlights that NMOSD may be the initial manifestation of SLE, even in the absence of AQP4 antibodies. A high index of suspicion for NMOSD is warranted when LETM or unexplained brainstem symptoms are present, allowing for timely diagnosis and initiation of appropriate therapy.