Introduction: Pituitary stalk interruption syndrome (PSIS) is a rare congenital disorder characterized by the neuroradiological triad of an absent or interrupted pituitary stalk, ectopic posterior pituitary, and anterior pituitary hypoplasia. It is typically diagnosed in infancy or childhood due to growth failure or delayed puberty. Diagnosis in adulthood is uncommon and may occur after decades of untreated hypopituitarism. Case: A 34-year-old Malay male with underlying physical and intellectual disability presented after a mechanical fall resulting in left slipped capital femoral epiphysis, an unusual pathological fracture in adulthood. Clinical examination revealed marked infantilism with complete absence of secondary sexual characteristics (Tanner stage I). Laboratory evaluation demonstrated combined pituitary hormone deficiency, including severe central hypothyroidism, profound hypogonadotropic hypogonadism, and central adrenal insufficiency. Growth hormone and insulin-like growth factor 1 were undetectable, while prolactin was mildly elevated, consistent with pituitary stalk disruption due to loss of hypothalamic dopaminergic inhibition. Bone age assessment showed severe delay, corresponding to 15 years. Pituitary magnetic resonance imaging demonstrated the classical PSIS triad: anterior pituitary hypoplasia with partial empty sella, a high T1 signal nodule at the median eminence representing ectopic posterior pituitary, and non-visualization of the infundibulum, consistent with an absent pituitary stalk. Birth history revealed premature breech delivery, a recognized perinatal risk factor. The patient was commenced on hormone replacement therapy, including levothyroxine, hydrocortisone, testosterone undecanoate, and calcium–vitamin D supplementation. Conclusion This case illustrates that PSIS may remain undiagnosed into adulthood, leading to severe consequences of long-standing hypopituitarism such as osteoporosis and pathological fractures. Clinicians should consider hypopituitarism in adults presenting with unexplained fractures and delayed sexual maturation, particularly when supported by a suggestive perinatal history.
Fractures, Spontaneous ; Pituitary Gland

VITAMIN B12 DEFICIENCY IN METFORMIN-TREATED COMMUNITY-DWELLING OLDER ADULTS WITH DIABETES: A CROSS-SECTIONAL MULTICENTRE STUDY IN PERAK Introduction: Surveillance studies have shown a high prevalence of vitamin B12 deficiency in metformin-treated adults. Community-dwelling older adults have a higher risk of vitamin B12 deficiency due to lower gut absorption. To date, data on this specific cohort are lacking. We aimed to investigate the local prevalence of vitamin B12 deficiency and its associated factors among metformin-treated older adults. Methods: This prospective cross-sectional study investigated community-dwelling patients with diabetes aged ≥65 years from four healthcare facilities from August 2023 to March 2024. Blood samples were sent to a central laboratory to determine vitamin B12 levels. Vitamin B12 deficiency was defined as serum vitamin B12 levels of ≤221 pmol/L. Descriptive analysis, chi-square test (or Fisher’s exact test) and independent t-test (or Mann–Whitney U test) were performed. Results: One hundred two participants were included in the study, of whom 61.8% were women (n=63), and 55.9% were Malays (n=57). The median age was 70 years (interquartile range [IQR]=67–74), and the median duration of metformin usage was 9.0 years (IQR=5.0–12.3). The prevalence of vitamin B12 deficiency was 29.4% (95% confidence interval [CI]=20.4–38.4, n=30), with a median vitamin B12 level of 287.0 pmol/L (IQR=200.5–448.8). Vitamin B12 deficiency was significantly associated with advancing age (P<0.05), but not with sex, ethnicity, duration of diabetes, metformin use, BMI, latest HbA1c level recorded and haemoglobin level (P>0.05). Conclusion: Patients with diabetes aged ≥65 years have a high prevalence of vitamin B12 deficiency. Blood screening for vitamin B12 deficiency is needed for this population in Peninsular Malaysia.

PERCEPTION OF PRIMARY CARE DOCTORS TOWARDS TELEMEDICINE IN KUCHING, SARAWAK: A CROSS-SECTIONAL STUDY Introduction: Telemedicine is the provision of healthcare remotely via information and communications technology (ICT). is study aimed to assess the familiarity and factors related to the perception towards telemedicine and the willingness to practise telemedicine among primary care doctors. Methods: A multi-centre cross-sectional study was conducted prospectively at all public healthcare clinics across Kuching, Sarawak. A questionnaire was adapted and modied from an overseas validated questionnaire, consisting of four parts: demographic data, familiarity towards telemedicine, factors related to the perception of telemedicine and willingness to implement telemedicine. Results: A total of 131 doctors were recruited. Of them, 43.5% had never interacted with patients via email, WhatsApp or Telegram, while 68.7% had never attended any conferences, speeches or meetings regarding telemedicine. e doctors had low familiarity towards guidelines, technology and medical applications of telemedicine. e majority agreed on the ability of telemedicine to save patients’ time and money, the potential of ICT in healthcare and the necessity during a pandemic but perceived the possibility of technical diculties. e doctors who had experience in interacting with patients via email, WhatsApp or Telegram (P=0.001) and those who had ≤8 years of working experience (P=0.04) had a signicantly better perception towards telemedicine. Conclusion: Although the familiarity towards telemedicine among public primary care doctors is low, their perception is good in a majority of areas. Adequate technological support and continuous education on telemedicine and its guidelines, especially medicolegal issues, are imperative to adopt and propagate telemedicine in primary care.

Introduction: ABO blood group can be associated with chronic diseases, for example, cancer and coronary heart disease, however it is not proven in Type 2 Diabetes Mellitus (T2DM). The aim of this study was to identify the association between the ABO blood group and disease control among T2DM patients at Kepala Batas, Penang. Methods: Approximately two mL vials of fresh blood were collected and typed using the tube method from 129 T2DM and 132 non-diabetic (control) patients, who visited the specialist clinic. The sociodemographic characteristics of the T2DM patients was analysed using descriptive analysis. The proportions of A, B, AB, and O blood groups among the diabetic and control patients were compared using the chi-square test. Any association between the ABO blood group and disease control was identified using the bivariate correlation test. Results: No significant association was found between the ABO group and T2DM patients (p = 0.152) when compared with the control group. However, blood group B was the most frequent among T2DM patients (33.3%) compared to blood group O within the control group (36.4%). Negative associations were observed between the ABO blood group and BMI (r = 0.098, p = 0.268), as well as the HbA1C value (r = -0.065, p = 0.464). Conclusion: No association was found between the ABO blood group and the associated risk factors (BMI and HbA1C). However, individuals with blood group B and risk factors, such as older age group, obesity, and high HbA1C value (more than 7.0%), should be monitored.

Introduction: A custom-made Perspex male pelvic phantom was developed to measure and to compare absorbed, surface and effective doses obtained from Single-Energy and Dual-Energy Computed Tomography (SECT & DECT). Methods: A customised Perspex pelvic phantom that mimicked male Asian reference size was scanned with SECT mode at 80 kV, 100 kV, 120 kV and 140 kV. In addition, the fabricated phantom was also scanned with DECT mode at 80/140 kV. Thermoluminescence dosimeters (TLD) were used to measure the charges and doses obtained from the TLD calibration curve. The absorbed dose, surface dose and effective dose obtained from SECT and DECT were measured and compared between these two modes. Results: The DECT showed 55.9 % dose reduction compared to SECT at 140 kV tube voltage. It shows that DECT can be used with radiation dose sparing, and it is in good agreement with routine CTDI phantom study. The effective dose of DECT of the abdominal imaging was within the acceptable effective dose limit of AAPM Report No. 96. This study also found that the surface dose was lower than values reported in previous studies for both modes. Conclusion: The fabricated Perspex phantom shows a great potential to be considered as an alternative phantom for the commercially existing phantom in CT dosimetry application.

Indigenous communities in Malaysia practice traditional medicine, particularly from the surrounding plants to cure different diseases and illnesses. This traditional way of life has been practised for centuries and passed down through generations. This study aims to document medicinal plants that have been used by the Orang Asli to treat illness. A qualitative ethnomedical study was done to document the species that were believed to have medicinal value. This study was carried at all three resettlement villages in Terengganu. Eleven informants who were the head of household with the age of over 30 years old were interviewed. Fieldwork surveys, observation and face-to-face communication were methods used in this study. The finding shows that most of the Orang Asli community in Terengganu are still dependent on plants and herbs to cure ailments. A total of 106 species that belong to 55 plant families were used by them. This study will encourage researchers in various fields such as ethnobotanical, ethno-zoological, ethnomedicinal and pharmaceutical and toxicological accomplishment of flora and fauna from these areas. As such, these medicinal plants need some more extensive efforts to validate scientifically and clinically were to prove the ethnomedical claims toward them.

Introduction: Various phantom with varied materials has been proposed to replace the human body. Besides, there is always a demand to use the local material as a phantom material, which is readily available and inexpensive. Wood is usually preferred because it is multifunction, environmentally friendly, low in toxic, inexpensive, as well as easy to use and prepare. Previous studies have found that Rhizophora spp. is a suitable natural source material and has been suggested due to its comparable dosimetric properties to commercial phantom. Methods: In this study, fabricated Rhizophora spp. particleboards phantom was opted as a solid-equivalent phantom medium at low energy photon beams using Gafchromic film x-ray quality assurance 2 (XRQA2). Additionally, the characteristics of XRQA2 film in the diagnostic energy range were generated. Results: Interestingly, the density of the fabricated Rhizophora spp particleboards was observed to have the same density with the water equivalent material (ρ= 1.00 g.cm-3) and has shown to have loosened agreement with PDD of water phantom at approximately 25% of the dose error. Also, further analysis using XRQA 2 film showed that energy was independent at different ranges. Conclusion: The analysis of fabricated Rhizophora spp particleboards undertaken here has extended our knowledge of the possibility of manufacturing cost-effective water equivalent phantom by using binder-less particleboard from Rhizophora spp. Therefore, a definite need for smaller interspacing particles should be considered to elevate the potential of Rhizophora spp particle boards as water equivalent materials.

Introduction: Trauma is a Global threat and the 5th highest cause of all-cause mortality in Malaysia caused predominantly due to road traffic accidents. Majority of trauma victims are young adults aged between 21-40 years old. In Malaysia, 24 out of 100,000 population die annually due to trauma, rating us amongst the highest in South East Asia. These alarming figures justify aggressive preventive and mitigation strategies. The aim of this paper is to promote the implementation of evidence-based interventions that will reduce the rate of preventable death because of trauma. Tranexamic acid is one of the few interventions in the early management of severe trauma with level-one evidence. Tranexamic acid has been proven to reduce all causes of mortality and mortality due to bleeding. Evidence proves that it is most effective when administered early, particularly within the 1st hour of trauma. This proposed guideline is formulated based upon quality evidence from multicentre studies, clinical practices in other countries and consideration of the local demographic factors with the intent of enabling an easy and simple pathway to administer tranexamic acid early in the care of the severely injured. Conclusion: The guideline highlights select pre-hospital criteria’s and the methods for drug administration. The authors recognise that some variants may be present amongst certain institutions necessitating minor adaptations, nevertheless the core principles of advocating tranexamic acid early in the course of pre-hospital trauma should be adhered to.

Aims: Arbuscular mycorrhizal is an obligate mutualistic symbiosis fungus which survives by forming endomycorrhizal on plant roots. The arbuscular mycorrhizal fungi are not host-specific, allowing them to form a mutualistic symbiosis with a wide range of host plants including oil palm. In Malaysia, the arbuscular mycorrhizal fungi are used as a growth enhancer for the oil palm: Elaeis guineensis. The arbuscular mycorrhizal fungi are introduced only during transplantation to the field when the ages of the seedlings are approximately one year old. As such, this study is designed to investigate the ability of the arbuscular mycorrhizal fungi to form colonisation with pre-nursery oil palm seedlings. Methodology and results: Here, the arbuscular mycorrhizal fungi were introduced at the pre-nursery stage oil palm seedlings. After inoculation, the seedlings were harvested on different days, i.e. on day-3, day-7, day-14, day-21, day-40 and day-60 to determine the colonisation of arbuscular mycorrhizal fungi. We found that the arbuscular mycorrhizal fungi are able to form a mycorrhizal association with the oil palm seedling at the pre-nursery stage after 40 days of inoculation, and the arbuscular mycorrhizal fungi that formed the association are Glomus sp. and Scutellospora sp. Conclusion, significance and impact of study This study suggested that the oil palm seedling can be made into a mycorrhizal plant as early as the nursery stage before transplanting them into the plantation.

Background: This study is aimed to analyse the availability, prices and affordability of medicines for ischaemic heart disease (IHD) in Bangi, Selangor, Malaysia. Methods: A quantitative research was carried out using the methodology developed by the World Health Organization and Health Action International (WHO/HAI). The prices were compared with international reference prices (IRPs) to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used as the standard of the affordability for the medicines. In this study, ten medicines of the IHD were included. The data were collected from 10 private medicine outlets for both originator brand (OB) and lowest-priced generic brand (LPG) in Bangi, Selangor. Results: From the results, the mean availability of OB and LPG were 30% and 42%, respectively. Final patient prices for LPG and OB were about 10.77 and 24.09 times their IRPs, respectively. Medicines that consumes more than a day’s wage are considered unaffordable. Almost half of the IHD medications cost more than one day’s wage. For example, the lowest paid unskilled government worker would need 1.4 days’ wage for captopril, while 1.2 days’ wage to purchase enalapril for LPG. Meanwhile, for OB, the costs rise to 3.4 days’ wage for amlodipine and 3.3 days’ wage for simvastatin. Conclusion: The findings of this study emphasise the need of focusing and financing, particularly in the private sector, on making chronic disease medicines accessible. This requires multi-faceted interventions, as well as the review of policies and regulations.