Introduction: Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder that significantly affects adolescent girls, particularly those with overweight or obesity. However, data examining the determinants and metabolic profiles of PCOS among adolescents with overweight and obesity remain limited, especially in Malaysia. This protocol describes a case-control study investigating the cardiometabolic, dietary, and psychosocial determinants of PCOS among adolescents with overweight and obesity. Methodology: This study is designed as a case-control study involving adolescent girls aged 13–16 years with a body mass index z-score >+1 standard deviation. Cases are defined as adolescent girls with a confirmed diagnosis of PCOS based on the recommendations of the 2017 International Consortium of Paediatric Endocrinology (ICPE), while controls are those who do not meet the diagnostic criteria for PCOS. A total sample size of 440 participants is required. Participants will be recruited from 22 secondary schools selected from a list of schools in Kuala Lumpur. Data on sociodemographic characteristics, psychosocial health, physical activity, and dietary intake will be collected using structured questionnaires. Blood samples will be obtained and analyzed for diagnostic testing (free testosterone), exclusion tests (thyroid-stimulating hormone, folliclestimulating hormone, luteinizing hormone, estradiol, prolactin, and dehydroepiandrosterone sulfate), and biochemical parameters (liver function tests, lipid profile, hemoglobin A1c, fasting glucose, fasting insulin, and inflammatory markers). Results: The study is expected to generate comprehensive data on the cardiometabolic, dietary, and psychosocial determinants of PCOS among adolescents with overweight and obesity. The findings will inform early screening strategies and targeted interventions aimed at reducing long-term reproductive and cardiometabolic complications. Conclusion This protocol outlines a structured approach to investigating PCOS in adolescence and addresses current gaps in early identification and risk stratification among highrisk populations.
Adolescent ; Humans ; Case-Control Studies ; Overweight ; Polycystic Ovary Syndrome ; Obesity

Introduction: Paediatric asthma, a prevalent chronic disease among children in Malaysia, can have its morbidity reduced through effective education. This study aims to assess the knowledge and perceptions of childhood asthma in the Malaysian general population. Materials and methods: A prospective study was conducted among visitors attending paediatric wards and clinics at the Institute of Paediatric Hospital Kuala Lumpur. Participants, who gave their consent, completed validated questionnaires in written form that evaluated their knowledge of asthma symptoms, triggering factors, medication, prevention, and myth perception. A higher score indicated a deeper understanding of asthma. Results: The study included 200 participants, predominantly female (88%), with a median age of 35.5 years. Among them, 12% were asthmatics, and 36% had a family member with asthma. The primary source of asthma information was electronic media (82%). The average score for knowledge of asthma symptoms, triggering factors, medication prevention and myth was 62.13% (SD 17.6). 62.88% (SD 16.3), 56.7% (SD 16.5), 82% (SD 15.1) and 57.8% (SD 15.4) respectively. Asthma myth perception and source of asthma information from family members were strongly related (p-value of 0.042). Conclusion: The general population exhibits an average understanding of asthma, comparable to findings from previous studies in other countries. This highlights the need for targeted educational interventions to dispel myths and enhance asthma knowledge.

Objective: This study aims to report the demographic features of patients with acromegaly the disease burden, and the corresponding treatment patterns and outcomes in Malaysia. Methodology: This is a retrospective study that included patients from the Malaysian Acromegaly registry who were diagnosed with acromegaly from 1970 onwards. Data collected included patient demographics, clinical manifestations of acromegaly, biochemical results and imaging findings. Information regarding treatment modalities and their outcomes was also obtained. Results: Registry data was collected from 2013 to 2016 and included 140 patients with acromegaly from 12 participating hospitals. Median disease duration was 5.5 years (range 1.0 – 41.0 years). Most patients had macroadenoma (67%), while 15% were diagnosed with microadenoma. Hypertension (49.3%), diabetes (37.1%) and hypopituitarism (27.9%) were the most common co-morbidities for patients with acromegaly. Majority of patients had surgical intervention as primary treatment (65.9%) while 20.7% were treated medically, mainly with dopamine agonists (18.5%). Most patients had inadequate disease control after first-line treatment regardless of treatment modality (79.4%). Conclusion This registry study provides epidemiological data on patients with acromegaly in Malaysia and serves as an initial step for further population-based studies.
acromegaly ; treatment outcomes

Introduction: Type 1 diabetes mellitus (T1DM) is an autoimmune disorder that requires a lifelong treatment regimen which may affect psychosocial development. Objective: To identify behavioural and emotional problems in children and adolescents with T1DM. Methodology: A cross-sectional study using the Child Behaviour Check List (CBCL) was conducted among all T1DM patients receiving treatment at the Paediatric Endocrine Unit, Hospital Tunku Azizah Kuala Lumpur, Malaysia. Results: Forty T1DM patients were included. The mean age of the participants was 12.4 years (SD=2.69), with 52.5% males, and 75% Malay. The average duration of illness was 4.8 years, 9 were pre-pubertal, while mean HbA1c was 9.4%. Thirty-five percent of the respondents had parent-reported internalizing problems and 17.5% had parent-reported externalizing problems. Those >12 years old had more internalizing problems (p=0.004) compared to those ≤12 years old. The differences were in the anxious/depressed syndrome subscale (p=0.001) and withdrawn/depressed syndrome subscale (p=0.015). There were no statistically significant differences in the 3 main global scores by gender, glycaemic control, duration of illness and pubertal status by univariate analysis. Conclusion T1DM patients >12 years old were at higher risk of developing psychosocial difficulties. This highlighted the benefit of screening of behavioural and emotional issues in children and adolescents with T1DM.
Diabetes Mellitus, Type 1

Introduction: The Asthma Knowledge Questionnaire developed by C. Rodriguez Martinez in 2005 was proved to be a valid instrument for asthma knowledge assessment for parents of children with asthma. 17 items were included in the questionnaire including their myths and beliefs, knowledge, and associated aspects. The objective of this study is to analyse the validity and reliability of the Malay version of the questionnaire. Methods: Forward-Backward translation method was used by language experts to obtain the Malay version of the questionnaire. The questionnaire was then given to twenty respondents at the Paediatric Institute Hospital Kuala Lumpur to ensure the clarity and relevance of the questionnaire as a pilot study. Subsequently, 60 respondents who fulfilled the inclusion and exclusion criteria were selected to proceed with the reliability test of the Malay version questionnaire. The results were analysed with SPSS version 26.0. The reliability and internal consistency were confirmed by intra-class correlation and Cronbach’s alpha coefficient. Results: There were 60 respondents to the questionnaire consisting of parents and caretaker who has child with asthma at the Institute of Paediatric Hospital Kuala Lumpur. The mean age of respondents was 34 ± 7.5year old. 91.7% of the respondents were female. The overall Cronbach’s alpha coefficient of the questionnaire was 0.84. Conclusion: The Malay version of the Asthma Knowledge Questionnaire has a good degree of validity, reliability and is culturally acceptable equivalent to the original version.

A Case Report of 46 XY Partial Gonadal Dysgenesis with Dual Gonadal Tumours 46XY gonadal dysgenesis is known as a disorder of sex development (DSD) that occurs due to abnormality in gonadal development. There is a conflict between one’s genotype, phenotype, and gonadal development, which influences the wide range of presentation and clinical appearance of 46XY females. This was a case of a 46XY female who presented with primary amenorrhea with delayed puberty at the age of 18 years old. She had ambiguous genitalia. Her breast and pubic hair were at Tanner Stage 2. Transabdominal ultrasound found a small uterus with a vagina; however, the gonads were not seen. A magnetic resonance imaging (MRI) showed a 20mm right gonad located extra-pelvis near the right iliac vessels while the 9mm streak left gonad was at the usual location next to the sigmoid colon. All her tumour markers were normal except lactate dehydrogenase (LDH) was elevated. She was given estrogen therapy for pubertal induction and underwent laparoscopy prophylactic bilateral gonadectomy. The intraoperative findings were similar to the MRI findings, and the histopathology examination (HPE) results showed left gonadoblastoma and right dysgerminoma FIGO stage 1A. She continued taking estrogen therapy until she had withdrawal bleeding, and oral progesterone was added. 46XY-DSD has high risk of developing germ cell tumour and requires prophylactic gonadectomy as soon as the diagnosis is established. However, delay in presentation and surgery may affect the outcomes and prognosis.

Background: The commercially available Newcastle disease (ND) vaccines were developed based on Newcastle disease virus (NDV) isolates genetically divergent from field strains that can only prevent clinical disease, not shedding of virulent heterologous virus, highlighting the need to develop genotype-matched vaccines Objectives: This study examined the efficacy of the NDV genotype-matched vaccine, mIBS025 strain formulated in standard vaccine stabilizer, and in carboxymethyl sago starch-acid hydrogel (CMSS-AH) following vaccination via an eye drop (ED) and drinking water (DW). Methods: A challenge virus was prepared from a recent NDV isolated from ND vaccinated flock. Groups of specific-pathogen-free chickens were vaccinated with mIBS025 vaccine strain prepared in a standard vaccine stabilizer and CMSS-AH via ED and DW and then challenged with the UPM/NDV/IBS362/2016 strain. Results: Chickens vaccinated with CMSS-AH mIBS025 ED (group 2) developed the earliest and highest Hemagglutination Inhibition (HI) NDV antibody titer (8log 2 ) followed by standard mIBS025 ED (group 3) (7log 2 ) both conferred complete protection and drastically reduced virus shedding. By contrast, chickens vaccinated with standard mIBS025 DW (group 5) and CMSS-AH mIBS025 DW (group 4) developed low HI NDV antibody titers of 4log 2and 3log 2 , respectively, which correspondingly conferred only 50% and 60% protection and continuously shed the virulent virus via the oropharyngeal and cloacal routes until the end of the study at 14 dpc. Conclusions The efficacy of mIBS025 vaccines prepared in a standard vaccine stabilizer or CMSS-AH was affected by the vaccination routes. The groups vaccinated via ED had better protective immunity than those vaccinated via DW.

Aims: This study aims to assess the impact of anthropogenic activities on shrimp microbiome in a biodiverse mangrove forest ecosystem, along the Merbok River, Kedah, Malaysia. Methodology and results: To assess the impacts, a microbiome study of wild post larvae shrimps along the river was conducted as a health indicator of the shrimp hosts which in turn would reflect the river conditions. A 16S rRNA gene amplicon sequencing of the wild post larvae shrimp microbiomes sampled across areas of varying human activities was conducted. Samples were obtained from four sites ranging from upstream river habitat to downstream brackish water towards the marine coast. Individuals detected from the sequence were then counted and their relative abundance of bacterial diversity were compared. All abundances are up to 100% and the diversity indices were calculated using proportions of each species. The Operational Taxonomy Unit (OTUs) were obtained by using USEARCH and UPARSE software. Twenty-eight bacterium phyla were detected, dominated by phyla Proteobacteria, Actinobacteria, Firmicutes and Bacteroidetes at each site. Eighteen families were dominant at each site with Streptomycetaceae being the major abundant. At the genus level, the most abundant genera were Streptomyces sp., Mesorhizobium sp., Rhizobium sp., Bacillus sp. and Pseudomonas sp. Conclusion, significance and impact of study In general, the diversity of opportunistic and coliform bacteria was low. Thus, despite being exposed to various levels of human activities, the Merbok River and its mangrove surroundings still serve as a good spawning and nursery sites of shrimps and presumably other inhabitants.
Biodiversity ; Decapoda ; Wetlands

Introduction: Biosimilar insulins have the potential to increase access to treatment among patients with diabetes mellitus (DM), reduce treatment costs, and expand market competition. There are no published studies evaluating the performance of biosimilar insulins in routine clinical practice in Asia. This study assessed the safety and effectiveness of biphasic isophane insulin injection in Malaysian DM patients. Materials and Methods: In this open label, single-arm, observational, post marketing study, patients received biphasic isophane insulin injection as per the Prescribing Information; and were assessed for safety (adverse events including hypoglycaemia), effectiveness (glycosylated haemoglobin [HbA1c]; fasting blood sugar, [FBS]; and patient’s condition by patient and physician) over a period of 24 weeks. Results: Adult male and female diabetes patients (N=119; type 2 DM, n=117) with a mean (SD) diabetes duration of 13 years were included. No new safety signals have been identified. Significant reduction in HbA1c was observed at weeks 12 and 24 (mean [SD] - baseline: 9.6% [1.9]; Week 12: 9.0% [1.7] and at Week 24: 9.1% [1.7]; p < 0.001). There were 10 serious and 9 non-serious adverse events reported in the study. Expected mild events included hypoglycaemia and injection site pruritus. However, the majority of the adverse events were non-study drug related events. No deaths were reported during the study. Discussion: Biphasic isophane insulin injection was well tolerated with no new safety concerns. It was found effective in post- marketing studies conducted in routine clinical settings when administered in DM patients in this study.

Some anecdotal reports suggest that maternal colonisation with Acinetobacter baumannii during pregnancy is associated with adverse maternal and neonatal effects, including preterm premature rupture of membrane (PPROM). The objective of this study was to compare the maternal and neonatal effects of A. baumannii colonisation in cases with PPROM and those with spontaneous onset of labour at term.