INTRODUCTION: Glaucoma is a leading cause of permanent blindness, often going undetected in its early, asymptomatic stages, especially in older age groups. In Malaysia, glaucoma is a growing public health issue due to an increase in the ageing population. While screening is essential for early glaucoma detection, the most suitable strategy for Malaysia's healthcare system remains unclear. This study explored the perspectives of eye healthcare professionals on the most suitable glaucoma screening strategies for Malaysia. MATERIAL AND METHODS: This qualitative study used semi-structured interviews with 19 eye health professionals (ophthalmologists, optometrists, nurses, ophthalmic technicians, and assistant medical officers) practicing in the Klang Valley. The interviews were conducted face-to-face in their workplace or via a video conferencing platform. All interviews were recorded, transcribed, and analysed using thematic analysis. RESULTS: Six major themes were identified: types of glaucoma screening programmes, accessible screening locations, target screening population, instruments and use of digital technology, trained personnel, and referral criteria. Opportunistic case finding and population-based programmes were identified as the glaucoma screening programmes in which trained personnel conducted screening at accessible locations. Glaucoma screening for high-risk individuals was recommended, focusing on visual acuity testing, tonometry, anterior chamber angle assessment, funduscopy, perimetry, and retinal nerve fibre assessment. A lack of clear referral criteria due to low awareness and poor implementation of existing guidelines was observed. CONCLUSION: Further investigations are required to identify the best combination of components for glaucoma screening. This will enable policymakers to develop an effective glaucoma screening programme in Malaysia.

Pulmonary atresia and ventricular septal defect (PA-VSD) with major aorto-pulmonary collaterals (MAPCAs) is a complex and extremely heterogeneous anomaly. Most untreated patients die in their first decade of life because of intractable congestive heart failure or respiratory distress. PA-VSD is characterized by a wide variety of anatomy of central pulmonary artery and nature of collateral lung perfusion. In most patients, collateral perfusion is provided either by MAPCAs or by patent ductus arteriosus (PDA). The management of infants and children with pulmonary atresia, ventricular septal defect, and MAPCAs has proven to be challenging. Therapeutic approaches include onestage surgical repair, staged unifocalization, shunting, and coiling of collateral vessels. Results have been variable and frustrating. In this case report, we discuss the characteristic, variants, and how far we can manage the patient who suffered from PA-VSD.

Pulmonary Hypertension (PH) is a heterogeneous condition defined by a mean pulmonary artery pressure (mPAP) >20 mmHg at rest, confirmed via right heart catheterization. PH can be classified into several groups based on underlying mechanisms, and mixed type PH involves overlapping features from different categories. We report a case of a 49-year-old woman with a history of HIV infection and hyperthyroidism who presented with progressive shortness of breath. Transthoracic echocardiography suggested severe pulmonary hypertension, while further evaluation revealed a combination of pre-capillary and post-capillary components, consistent with mixed type PH. Contributing factors included HIV-associated pulmonary vasculopathy and hyperthyroidism-induced high-output cardiac failure. The patient was treated with intravenous Furosemide, Beraprost sodium, Spironolactone, Digoxin, Warfarin, and Omeprazole. During hospitalization, she developed distributive shock requiring norepinephrine infusion. This case highlights the importance of thorough diagnostic evaluation to identify multifactorial causes of PH, especially in patients with coexisting HIV infection and hyperthyroidism. Management strategies should be tailored to address the complex interplay of underlying conditions while considering drug interactions and local therapeutic resources.

Introduction: This study aimed to develop an innovative bilayer tablet formulation of dapagliflozin and vildagliptin to increase therapeutic outcomes and patient compliance in diabetes management. Methods: By employing wet granulation, immediate-release, and sustained-release layers were formulated using various super-disintegrating and release-retarding agents, respectively. Several pre-compression parameters were utilized, such as Carr’s index, Hausner ratio, physical attributes (weight variations, friability, hardness), and disintegration time. Drug-excipient interactions were determined through employing FTIR, SEM, DSC, and TGA. In-vitro dissolution studies were performed to assess the release kinetics of these formulations. Results: For immediate-release dapagliflozin, our earlier study demonstrated that the formulations showed Carr’s index (23.5-33.3), physical attributes (weight (145–155 mg), thickness (4.42 ± 0.04 -4.46 ± 0.05 mm), hardness (3.7-5.6 kg/cm2), friability (<1%), and optimized rapid dissolution (F1: 80.50% ± 5.2 in 30 minutes). For sustained-release vildagliptin, the formulations showed Carr’s index (10.48-20), physical attributes (weight (194-203 mg), thickness (3.32 ± 0.06-3.33±0.04 mm), hardness (4.8 ± 0.1-7.6 ± 0.2 kg/cm2), friability (<1%)), and optimized controlled release (A5: 81.76% ± 2.4 in 360 minutes). The results found that F1 and A5 were the optimum formulation for the immediate release of dapagliflozin, and the sustained release of vildagliptin, respectively, and BT-1 was the optimum bilayer tablet because of its rapid onset of action for dapagliflozin (84.23% within 60 minutes) and sustained release for vildagliptin (80.026% within 360 minutes). Conclusion: Based on these data, the optimized bilayer tablet holds the potential to be a convenient and effective treatment option. Further, in-vivo assays are necessary to confirm its efficacy and safety.

Background: s/Aims: The role of surgery for pancreatic ductal adenocarcinoma (PDAC) with synchronous liver metastases remains controversial. Previous studies assessing the outcomes of combined surgery for primary PDAC and liver metastases have been limited by the inconsistent application of neoadjuvant chemotherapy (NAC). Methods: We identified patients with PDAC and fewer than three liver metastases who received at least six months of NAC and underwent simultaneous pancreas and liver resection between January 2018 and March 2023 at a single institution. Additionally, we queried the National Cancer Database (NCDB) from 2010 to 2019 to identify patients with synchronous metastatic PDAC to the liver who received NAC before simultaneous resection, serving as a comparison group. Results: Ten patients met the inclusion criteria for the institutional case series, with seven ultimately undergoing simultaneous resection. Among 224 patients in the NCDB who underwent simultaneous pancreas and liver resection, 70 patients (31.2%) received NAC.After a median follow-up of 59 months in the institutional cohort, five patients experienced recurrence, resulting in a median disease-free survival of four months (95% confidence interval [CI] 3, not reached). After controlling for confounding factors in the NCDB cohort, the administration of NAC was associated with improved survival (hazard ratio: 0.44, 95% CI 0.29–0.65, p < 0.001) compared to those who underwent upfront surgery. Conclusions Neoadjuvant therapy followed by simultaneous liver and pancreas resection for metastatic PDAC is safe and feasible, and it may provide a survival benefit in carefully selected patient populations.

Background: Iron deficiency (ID) and hemoglobinopathies are highly prevalent in Southeast Asia. Accurate estimation of reference intervals (RIs) for red cell parameters is complicated by the need to exclude individuals with these conditions from the reference population. Indirect RI estimations using machine learning could help overcome these challenges. Methods: We developed a binary classification model using eXtreme Gradient Boosting (XGB) to distinguish normal individuals from those with ID, hemoglobinopathies, or other anemias. The model was trained on an annotated dataset comprising 5,520 complete blood count (CBC) results and validated with a holdout dataset of 2,367 CBC results. An independent dataset of 64,100 CBC results was used to identify individuals predicted to be normal, from which RIs were estimated using the refineR algorithm. Results: The XGB model achieved an area under the ROC of 0.97 (95% confidence interval: 0.96–0.97) for distinguishing between individuals with normal versus abnormal values. Among individuals within the independent dataset, 40,300 (62.9%) were predicted to be normal. The refineR-based reference limits (RLs) derived from this subset approximated those obtained through a direct approach. Improvements in the accuracy of indirect RL estimates were most evident for hematocrit, hemoglobin, and red cell concentrations. Conclusions Combining XGB with refineR to indirectly derive RIs for red cell parameters improved the accuracy and yielded results comparable with those of directly derived RIs. A further benefit was the capacity to generate sex- and age-specific ranges, which has remained difficult to achieve through direct approaches.

Background/Aims: Chronic constipation is prevalent yet under-diagnosed across Asia, compromising quality of life and burdening healthcare systems. Cultural stigma, varied diets, and limited access to standardized diagnostic tools delay timely care. Methods: The Bali Chronic Constipation Roundtable in November 2024, brought together experts from 11 Asian countries. The group reviewed epidemiological data, analyzed multinational questionnaire on clinical practice pattern, and conducted structured discussions to identify key barriers and propose region-specific recommendations. Results: Chronic constipation prevalence varies across Asia, ranging from 1.8% in India to 16.6% in Japan, with women and the elderly disproportionately affected. Under-reporting persists owing to cultural taboos and widespread self treatment with laxatives and traditional medications. Although the Rome IV criteria remains the global standard, they may not fully reflect Asian symptom profiles, and diagnosis is limited by scarce motility laboratories. First line therapies such as dietary-fiber optimization and osmotic laxatives are widely available, but newer pharmacotherapies (prucalopride, linaclotide, lubiprostone, and elobixibat) remain costly and unevenly accessible. Biofeedback for dyssynergic defecation is underutilized due to limited availability. Experts recommend expanded regional research on to refine diagnostic criteria, coupled with enhanced physician education and public awareness. They advocate accessibility to second-line and novel therapies that incorporate culturally attuned regional guidelines, and improved access to gastrointestinal motility testing. Conclusions The Bali Chronic Constipation Roundtable highlighted Asia’s need for region specific diagnostics and management. Addressing diagnostic and treatment gaps will improve outcomes, while ongoing researcher clinician policy collaboration must standardize guidelines, advance research, and ensure equitable care across Asia.

Objectives: The objective of this study was to develop machine learning models to predict health insurance claim costs among older adults in Indonesia. Methods: This study utilized secondary data from the Indonesian National Health Insurance program (Jaminan Kesehatan Nasional [JKN]) spanning 2017 to 2023. Three modeling techniques—linear regression, random forest, and XGBoost—were employed to predict individual claim costs. Model performance was assessed using the root mean square error (RMSE), coefficient of determination (R2), and mean absolute error (MAE). Additionally, variable importance analysis was conducted to identify key predictors. Results: XGBoost with 500 boosting rounds yielded the best performance, with an RMSE of 11 360 283, an R2 of 0.81, and an MAE of 4 485 917, outperforming both linear regression (RMSE, 13 710 035; R2=0.72) and random forest (RMSE, 12 434 238; R2=0.78). Notably, outpatient care was identified as the most consistent predictor across all models. Other significant predictors included length of stay (LOS), diagnosis type (International Classification of Diseases, 10th revision chapter), facility type, facility classification, and severity of illness, particularly for moderate cases. Although LOS and diagnosis type were important predictors, these findings should be interpreted in the context of Indonesia’s fixed Indonesian Case-Based Groups payment system. Conclusions XGBoost provides reliable predictions of claim costs among older adults, capturing clinical, utilization, and structural drivers. These findings can inform targeted interventions, improve chronic disease management, optimize the referral system, and support integration of predictive tools into JKN to enhance responsiveness and promote sustainable, equitable financing.

Cystinosis is a rare autosomal recessive lysosomal storage disorder with an incidence of approximately 1 in 100,000 to 200,000 live births. It is the most common cause of inherited pediatric Fanconi syndrome (FS). Here, we describe the cases of two infants from unrelated families who presented with polyuria and features of proximal renal tubular dysfunction. Although no corneal cystine deposition was observed at presentation, clinical suspicion and genetic analysis confirmed the diagnosis of nephropathic cystinosis. Both patients carried the same pathogenic variant in the CTNS gene, suggesting that it is a hotspot in this region. These patients were managed with oral cysteamine therapy, cysteamine eye drops, and supportive therapy for FS and are currently doing well. Genetic diagnosis plays a crucial role in the early detection of cystinosis, facilitating timely initiation of cysteamine therapy, and should be considered in infants with FS.

Objectives: Autism spectrum disorder (ASD) is a major neurodevelopmental disorder characterized by persistent deficits in social communication along with restricted, repetitive patterns of behaviour and interests. FMR1 gene, which causes Fragile X syndrome (FXS), is the most common single-gene contributor to ASD. Variations in CGG repeat length within the 5' untranslated region of FMR1 are central to the etiology of FXS. Given the established connection between FXS and ASD, this study investigated whether the trinucleotide repeat region of FMR1 is associated with ASD in Bangladeshi children. Methods: Seventy-one children participated in the study, including 39 with ASD and 32 age-matched controls. The FMR1 region was amplified using polymerase chain reaction and subsequently sequenced. Results: There was no statistically significant difference in the number of CGG repeats between patients with ASD and controls (p>0.01), with the most common repeat number being 27 in both groups. Interspersion of the two AGG trinucleotides among the CGG repeats was the most common pattern found in the study participants, with frequencies of 56.67% and 50.00% in the ASD and the control groups, respectively. Conclusion This study provides preliminary evidence that CGG repeat expansion in the FMR1 gene is unlikely to represent a major genetic contributor to ASD in Bangladeshi children. However, given the limited sample size, further investigations with a larger cohort are required to confirm these findings.