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Subclavian artery occlusion is an uncommon condition affecting approximately 2% of the general population. Only 8.7% of patients with total occlusion of subclavian artery are asymptomatic. It has the potential to cause significant morbidity as it could contribute to the ischemic complications affecting the upper extremities, brain, and heart. We present a case of asymptomatic total occlusion of left subclavian artery which was found following investigations for discrepancy in blood pressure readings from the patient's right and left arm. The difference was noted due to the clinic's furniture arrangement. The patient was treated with stent insertion via percutaneous transluminal angioplasty. After three years of follow ups, she remains asymptomatic and free of cardiovascularrelated complications. [ABSTRACT FROM AUTHOR]

Primary adrenal lymphoma (PAL) is extremely rare, representing less than 1% of Non-Hodgkin's Lymphoma (NHL). We present a case of an elderly man who was evaluated for persistent abdominal pain and adrenal insufficiency. The computed tomogram (CT) of the abdomen showed a large bilateral adrenal mass. There were also multiple small lung nodules. The histopathology of adrenal gland showed features consistent with diffuse large B-cell NHL. He received two cycles of rituximab, cyclophosphamide, doxorubicine, vincristine and prednisolone (R-mini-CHOP) followed by five cycles of rituximab, methotrexate, procarbazine, and vincristine (R-MPV) after evidence of brain metastasis on imaging. He responded well to the current treatment at six months follow up. [ABSTRACT FROM AUTHOR]

Objectives Diabetic retinopathy (DR) is a major cause of blindness and its prevalence is increasing. Fibrate, specifically fenofibrate, has been shown to be efficacious in reducing the progression of DR. This study aims to determine the five-year trend of and factors associated with the prescription of fibrate among patients with DR in Perak. Methods Data on all patients with DR in 76 government health clinics in Perak who were audited between 2018 and 2022 were extracted from the National Diabetes Registry (NDR), excluding those who were lost to follow-up. Multivariable logistic regression was used to identify factors associated with the prescription of fibrates. Results Data from 4028 patients were analysed. Commonly prescribed medications were statins (n = 3466, 86.0%), metformin (n = 3212, 79.7%), and angiotensin-converting enzyme inhibitors (n = 2318, 57.5%). Only 63 (1.6%) patients were prescribed fibrate. Factors associated with the prescription of fibrates were patients from the clinics in northern (adjusted odds ratio (aOR) = 0.33, 95% CI: 0.12-0.65) and southern clusters (aOR = 0.23, 95% CI: 0.08-0.655), triglycerides > 1.7 mmol/L (aOR = 4.85, 95% CI: 1.85-12.70), and prescription of insulin (aOR = 2.77, 95% CI: 1.07-7.18) and statin (aOR = 0.10, 95% CI: 0.04-0.27). Conclusion The prescription of fibrate among patients with DR was low, highlighting a missed opportunity for early treatment and improved outcomes in primary care. The prescription of fibrates to reduce the progression of DR should be expanded to primary care. Clinicians should consider the factors associated with the non-prescription of fibrate identified when prescribing to these patients. Policies, including those at the ministry level, to enhance the availability of these medicines, including financial resources for procurement, are necessary to guarantee easy access for patients in different areas. It is crucial for healthcare providers to be knowledgeable about and follow guidelines. Moreover, improving the overall management of DR in patients with multiple comorbidities can be achieved by addressing worries about the side effects of combination therapies through educational campaigns and providing clear directives. Nevertheless, the study's findings should be interpreted in light of the limitations discussed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Jamaluddin et al.)