Introduction:
Allopurinol, the first-line treatment for chronic gout, is a common causative drug for severe cutaneous adverse reactions (SCAR). HLA-B*58:01 allele was strongly associated with allopurinol-induced SCAR in Asian countries such as Taiwan, Japan, Thailand and Malaysia. HLA-B*58:01 screening before allopurinol initiation is conditionally recommended in the Southeast-Asian population, but the uptake of this screening is slow in primary care settings, including Malaysia. This study aimed to explore the views and experiences of primary care doctors and patients with gout on implementing HLA-B*58:01 testing in Malaysia as part of a more extensive study exploring the feasibility of implementing it routinely.

Methods:
This qualitative study used in-depth interviews and focus group discussions to obtain information
from patients with gout under follow-up in primary care and doctors who cared for them. Patients and doctors shared their gout management experiences and views on the implementation of HLA-B*58:01 screening in primary care. Data were coded and analysed using thematic analysis.

Results:
18 patients and 18 doctors from three different healthcare settings (university hospital, public clinics, private general practitioner clinics) participated. The acceptability to HLA-B*58:01 screening was good among the doctors and patients, motivated by improved prescription safety. We discovered inadequate disclosure of severe side effects of allopurinol by doctors due to concerns about medication refusal by patients. Barriers to implementation included out-of-pocket cost for patients, the cost-effectiveness of this implementation, lack of established alternative treatment pathway besides allopurinol, counselling burden and concern about genetic data security. Our participants preferred targeted screening for high-risk populations instead of universal screening.

Conclusion:
Implementing HLA-B*58:01 testing in primary care is potentially feasible if a cost-effective, targeted screening policy on high-risk groups can be developed. A clear treatment pathway for patients who test positive should be available with adequate training for the healthcare providers.

Background:
Primary diffuse large B-cell lymphoma (DLBCL) developed in the abdominal wall is an extremely rare disease. This presentation aims to describe a patient with an extremely rare primary DLBCL of the abdominal wall and explain the treatment course received so far.

Results:
An active 59-year-old Caucasian male presented to the General Practitioner with a rapidly growing lump on his lower abdomen. This is on a background of rheumatoid arthritis on Methotrexate. Ultrasound and magnetic resonance imaging (MRI) of the abdominal wall have revealed an oval shaped lesion with lobulated margin located in the subcutaneous tissue with no invasion into the underlying muscle. A surgical excisional biopsy was performed. The histopathology and immunochemistry features were used to diagnose DLBCL with a clear margin. Subsequent positron emission tomography-computed tomography (PET-CT) completed has shown a non-specific soft-tissue density lesion in the lingula of the left lung. There are discussions of the relationship between Methotrexate and DLBCL, which remain unclear whether it is relevant in this case. The patient is currently being followed up by a Haematologist and immunochemotherapy R-CHOP (Rituximab-Cyclophophamide, Doxorubicin, Vincristine and Prednisolone) have been commenced.

Conclusion:
Primary surgical excision and immunochemotherapy may be the treatment of choice for localised cutaneous DLBCL where complete resection can be achieved. Based on our literature review, primary DLBCL of the abdominal wall has not been reported worldwide with cutaneous DLBCL of the peripheral limb accounts for only less than 1 % in all lymphomas in Australia.

Background
Digital weight management programs are widely available across Europe as purpose-built mobile applications provide a scalable and flexible solution for providers and patients.

Objective
The primary objective was to explore the impact of a digital multi-disciplinary obesity management program during a 40-week follow-up period (26 weeks is the primary follow-up) with respect to change in body weight and use of semaglutide.

Methods
This study is a real-world, new-user cohort including individuals signing up for the weight management program no later than the 31st of March 2023. The program consisted of dedicated lifestyle intervention in combination with personalized dosages of semaglutide.

Results
As displayed in figure 1 a total of 1,057 participants were included, and after 26 and 40 weeks, respectively, 324 and 82 participants were still included. The program produced an average weight loss of 13.1% (95%CI, 12.8% to 13.4%) at week 26 (figure 2) with an average weight loss of 16.1% at week 40 (95%CI, 15.2 to 17.1).
The participants only used between 41 and 58% of the suggested cumulative dose. In addition, 96.9% of the participants had lost > 5% of their body weight and 79.4% had lost > 10% of their body weight at week 26. Analyses of participants’ baseline BMI and use of semaglutide revealed no difference between the different BMI groups in terms of their achieved weight loss.

Conclusion
In conclusion, regardless of the participants’ BMI upon enrollment they achieve clinically relevant weight loss through a lifestyle intervention combined with semaglutide.

A virtual clinic service delivers health services remotely to clients.These services complement the existing health service at health clinics.It is live, virtual, and interactive services between health care providers and clients.Furthermore, It is a historical moment for the Ministry of Health (MoH) Malaysia which initiated a Virtual Clinic Service in health facilities on 14 August 2019 with five selected health clinics for one year.Following that, these services expanded 40 health clinics in 2021, another 230 in 2022 and 106 more in 2023.Today, 376 health clinics are providing health services to the clients in Malaysia.The services are outpatient services such as communicable diseases and non-communicable diseases, maternal and child health services, and allied health services.It is a collaborative approach between the Ministry of Health Malaysia and the Malaysia Administrative Modernisation and Management Planning Unit (MAMPU).The supremacy of delivering these services is to address the client’s socioeconomic aspect and transportation challenges, minimal waiting time, increases productivity, and ability to get the service within their comfort zone

Methodology: The objective of virtual clinic services is to increase access to primary health care services and to reduce the frequency of visits to health clinics.Every three months, secondary data is collected from the 376 health clinics by using a google drive from each state in Malaysia from 2019.
Results: Up to 2022, almost 73,347 clients were benefitted from these services. A 90% out of the total clients, had a successful consultation through virtual clinics.A 60% of the clients were female users and 67% were between 25 to 59 years old.

Conclusion: Primarily, virtual clinic leverages continuity of care, seamless care, being closer to home, and reducing the frequency of visits to health clinics by increasing the access to the primary health care.

Objective: To show how well family physicians in Turkey can recognize common benign and malignant skin lesions and how they approach these lesions.
Method: It is a cross-sectional analytical study whose population is family physicians from all over Turkey. All family physicians in the provinces selected by stratified random sampling from 12 statistical regions of Turkey were reached via e-mail.
In the first and second sections of the questionnaire, general information and dermatological patient applications were questioned, while in the third section, the question of the benign/malignant distinction, including predetermined lesions and cases, and the approach to these lesions were questioned. Lesion images were used with permission from the New Zealand Dermnet website. Research data were evaluated in SPSS (24.0) program.
Results: Analyzes were made on 401 participants out of 416 who participated. The mean age of the participants was 48.7±7.5 years, 70.1% (n=281) were male, 7.5% were Specialist Family Physicians. The first of the two lesions of Malignant Melanoma was 65.3% of the participants, the first lesion of basal cell carcinoma 63.6%, the second lesion 79.1%, the second of the two lesions of squamous cell carcinoma 85.8%. they answered wrong.
In the mutual analysis of correct/incorrect responses to Seborrheic Keratosis and Malignant melanoma according to the job description, it was seen that Specialist Family Physicians gave correct answers at a much higher rate. (p=0.00, p=0.00)
Conclusion: It has been observed that family physicians can distinguish between benign and malignant lesions more clearly compared to malignant and premalignant lesions. It is important for the physician working in the primary care to recognize precancerous and malignant lesions and refer them when necessary, to ensure early diagnosis of these diseases and to increase the survival of the patients.

1. It is important for family physicians to recognize skin lesions correctly.
2. Family physicians can distinguish between benign and malignant lesions more clearly
3. It is important for the physician working in the primary care to recognize precancerous and malignant lesions.
3.