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Introduction: Diabetes mellitus is a known risk factor for the development of Peripheral Obstructive Arterial Disease (POAD). POAD is also one of the major cause of limb loss in diabetic patients. Yet, there is no Ankle-Brachial Index (ABI) screening among the diabetic population to quantify the disease burden or detect the disease at an early stage. This study aimed to find out the prevalence of POAD among diabetic patients in primary care and the associated risk factors and its implication on their quality of life. Materials and Methods: Ninety diabetic patients were included in this universal survey at Klinik Kesihatan (KK) Jaya Gading. ABI of lower than 0.9 was used to define POAD. A validated WHO-QOL BREF Malay version was used to assess the Quality of Life. Results: The prevalence of POAD among diabetic patients in KK Jaya Gading, Kuantan was found to be 20%. Age was a significant risk factor (p=0.005). Social domain of the Quality of Life was significantly affected in patients with POAD. Conclusion: The prevalence of POAD among diabetics in the primary care was relatively high and this supports early screening to prevent further deterioration.

Introduction: We aim to report an uncommon case of post ERCP perforation that effectively managed conservatively in non-hepatobiliary surgery centre. Case report: A 46-year-old man diagnosed to have obstructive jaundice secondary to distal common bile duct (CBD) stone. He underwent ERCP at a private centre, sphincterotomy was performed, but, the operator had failed to insert the stent and complicated with post ERCP perforation evidenced by contrast extravasation beyond 1/3rd of the CBD and referred to our centre. Patient was subjected for re ERCP. There were difficulties in cannulating the CBD and stent was inserted. Cholangiogram revealed contrast leak around the pancreatic duct and bifurcation of hepatic duct. There was no evidence of CBD stone. Computed Tomography (CT) of the abdomen revealed extensive subcutaneous emphysema on the right side of the abdomen to right inguinal region, extensive retroperitoneal free air and pneumoperitoneum, but there were no free fluid or contrast extravasation. The patient subjected for non-operative management (NOM) for the complication and kept fasting with total parenteral nutrition and intravenous antibiotic. He recovered well with the opted management. Patient was programmed with Gastrograffin study after 10 days that showed no evidence of contrast leak to suggest free bowel injury. He was allowed orally after that and was discharged well after 15 days with stent in situ. During follow up, he was well, and the stent removed after 3 months. Patient planned for laparoscopic cholecystectomy and on table cholangiogram. Conclusion:  Post ERCP perforation is uncommon but lethal. Early recognition of the complication is crucial hence appropriate management can be arranged to avoid death. To date, surgery is not the only choice available to manage this complication.

Introduction: Peripheral Occlusive Arterial Disease (POAD) is an important cardiovascular morbidity especially among diabetics. The goal of the treatment is to improve patients’ quality of life (QoL) starting by quantifying the disease burden in our population especially among high risk group such as diabetics. Materials and Methods: This cross-sectional study aims to provide a data on the prevalence of POAD among diabetic population in a primary health care in Kuantan and its’ effects on the patient’s QoL. Additionally, we examined for any other stipulated associated factors that may have contributed towards the development of POAD. We applied a universal sampling for the purpose of patient selection. POAD is universally defined as ankle-brachial index (ABI) of lower than 0.9. Individuals were assessed on validated Malay version of WHOQOL BREF to assess their QoL parameters. P value of <0.05 considered as statistically significant. This study was registered with the National Medical Research Register (NMRR registration no. 17-1375-35710). Results: The prevalence of PAD among diabetic patients in Klinik Kesihatan (Local General Practitioner) Jaya Gading, Kuantan was found to be 20%. We found a significant relationship between lower levels of education (p = 0.016), older age group (p = 0.02) and lower economic class (p = 0.03) with the presence of POAD among diabetics. The presence of POAD has a significant adverse effect on QoL evidenced by lower Physical Domain (p=0.001), Psychological Domain (p=0.066), Social Domain (p=0.005), and Environmental Domain (p=0.027) scores using validated WHOQOL BREF questionnaires. Conclusion: The significant prevalence of POAD among diabetics prompts a greater urgency for early detection to prevent the development of its’ associated morbidity and deterioration of their QoL.

Introduction: Foot ulcer is one of the most serious complications associated with diabetes mellitus that mat resulted in a disability and impairment of health related quality of life. Materials and Methods: The main objective of this cross-sectional study was to determine the factors adversely associated with quality of life among diabetic foot ulcer patients. Diabetic patients with evidence of diabetic foot ulcer attending outpatient orthopaedics and general surgical clinic of Hospital Tengku Ampuan Afzan were recruited into this study. A set of validated SF-36 questionnaire was employed to evaluate the health-related quality of life for each patient. This study was registered with the National Medical Research Register (NMRR registration no. 17-1520-36332). Results: There is a slightly higher proportion of female among the 104 respondents. Its prevalence is most pronounces in the lower income group. Majority presented with Wagner stage 2 and 3. Amputation has been performed in 54% of these patients. Physical health score fair worse than mental health. Age, low socioeconomic status, presence of comorbidities, major amputation, ulcer at the forefoot and wheelchair usage associated with an adverse effect on the physical health aspect in these patients. Interestingly, smoker seems to score better on the mental health aspect of the quality of life. Conclusion: Diabetic foot ulcer affected physical health aspect much more than mental health aspect within the context of the quality of life.