Introduction: Hyponatremia is the most common electrolyte imbalance in hospitalized patients, associated with increased morbidity and mortality. Tolvaptan effectively raises serum sodium in SIADH. However, concerns regarding rapid overcorrection and safety persist. This study evaluates the efficacy, safety, and real-world usage patterns of tolvaptan in a tertiary care setting. Methodology: A retrospective single-centre observational study was conducted at Hospital Putrajaya using the electronic records of patients treated with tolvaptan from January 2020 to December 2025. Overcorrection was defined as >10 mmol/L increase within 24 hours, and non-response as <4 mmol/L increment at 24 hours. Results: Twenty-one patients were included, with a mean age of 66.7 years; 57% were male. Most (90.5%) received 7.5 mg initially. Mean baseline sodium was 118.1 ± 4.1 mmol/L. Tolvaptan produced rapid correction, with mean sodium increasing to 127.0 mmol/L at 24 hours (mean increment 8.9 mmol/L). Only one patient (4.8%) was a non-responder at 24 hours. Median time to sodium >130 mmol/L was 1 day, with 60% achieving this within 24 hours. At discharge, mean sodium was 130.4 mmol/L. Median length of stay following initiation was 5.5 days. Overcorrection occurred in 23.8% (n = 5), all in the 7.5 mg group, particularly among those with baseline sodium 115–120 mmol/L. No cases of osmotic demyelination syndrome (ODS) were observed. The mean internal for initiation is approximately 6 days from diagnosis. Tolvaptan usage increased and peaked in the first 3 years, but subsequently dropped and plateaued over the last 2 years. Conclusion Tolvaptan is safe and effective for sodium correction; although overcorrection remains a risk, no long-term sequelae of ODS were observed, underscoring the need for vigilant monitoring. Its use in Hospital Putrajaya remains limited, with delayed initiation possibly due to tolvaptan being considered a secondary treatment after failure of other options
Hyponatremia ; Tolvaptan

Dental Students Perception on Online Classes Online learning has become the next frontier and the method of choice for some education providers. This study focuses on students’ insight on online classes and ways to improve it. The cross-sectional study was done at the Dental Faculty of the Islamic Science University of Malaysia (USIM), which include almost all undergraduate dental students who had attended online classes. In total, 179 respondents managed to answer the full set of questionnaires with thirty different questions. The data analysis reveals that mixed physical and online classes is recommended by the students to improve their learning experience and education performance. Excellent multimedia, video presentation, fast internet connection and communication is a crucial key for the success of student education. In conclusion, online learning has become an alternative to conventional teaching in dental institutions. The flexibility of the time to study and the option to pause/ playback are some of the benefits of online learning. However, not all subject in dentistry can be taught effectively in online learning. Students practical, laboratory and clinical teaching still need to be conducted physically as hands-on training is still the best. Nevertheless, online learning is still a viable teaching method for strengthening the theoretical academic part.

Idiopathic Osteosclerosis among UiTM Dental Centre Patients: A Retrospective Study Idiopathic osteosclerosis (IO) represents asymptomatic radiopaque masses within the jaw. IO is commonly found as an incidental finding in panoramic radiographs. The purpose of the present study is to determine the prevalence of IO among Universiti Teknologi MARA (UiTM) Dental Centre patients and to investigate the radiographic parameters of IO located in the maxilla-mandibular region. Panoramic radiographic images of patients attending UiTM Dental Centre from 2016 to 2020 were examined. Parameters such as gender, age, site, shape, size, and association with tooth were evaluated. The data obtained were analysed using SPSS version 27. Pearson chi-square test was used to evaluate the relationship between the parameters. IO was identified in 108 (9.67%) out of 1,117 panoramic radiographic images that were reviewed. There was a slightly higher prevalence of IO in female patients with 58 (53%) over male patients. Most of the radiographically identified IO were located in the posterior mandibular region, constituting 83% of the cases. Pearson chi-square test revealed a significant relationship between size and gender (p-value < 0.05). Significant associations were found between site and gender and association with tooth and foci (p-value < 0.01). The prevalence of IO among UiTM Dental Center patients was observed to be low at 9.67%. There was a higher occurrence of IO in female patients compared to males, and the posterior mandibular region emerged as the most common site where IO was radiographically identified. The accurate radiographic identification of IO is essential for providing a precise diagnosis and formulating an appropriate treatment plan.

INTERNET ADDICTION AND DEPRESSION AMONG ADOLESCENTS DURING COVID-19 PANDEMIC IN PUNCAK ALAM: A CROSS-SECTIONAL STUDY The global impact of the COVID-19 pandemic has led to substantial disruptions on a worldwide scale. People all over the world were expected to face a variety of mental health issues during this outbreak. Internet addiction may become a serious problem among adolescents, especially during online distance learning. Assessing adolescents' heavy Internet use is crucial for determining their psychological health. Thus, this study aimed to determine the level of internet addiction and depression among adolescents in Puncak Alam, Selangor, during the COVID-19 pandemic. A cross-sectional study was conducted on 174 respondents aged 13 to 17. The convenience sampling method was employed, where respondents completed questionnaires comprising eight items related to demographic information, 19 items based on the Internet Addiction Test (IAT), and 10 items related to the Depression scale, all specific to the COVID-19 pandemic period. The study revealed that 36.8% of respondents exhibited a mild level of Internet addiction, and 45.5% displayed a mild level of depression. A statistically significant (p = 0.01) yet weak positive correlation (r = 0.195) was identified between Internet addiction and depression, indicating that as Internet addiction increases, so does the level of depression, albeit weakly. These findings highlight the presence of mild Internet addiction and depression among adolescents. In the wake of the pandemic, it becomes crucial to tackle these issues through focused interventions and continuous research, aiming to bolster the mental health of young individuals in this digital era.

Introduction: There is an increasing demand for additional techniques to diagnose and treat cancer including CRC or colorectal cancer effectively. Utilizing antibodies as biomarker could contribute to accurate diagnosis of cancer due to its high specificity and sensitivity. One of the etiologies of CRC progression was proposed as the alterations of hexosamine biosynthetic pathway which could subsequently influence the rate-limiting enzyme, glutamine-fructose-6-phosphate aminotransferase (GFAT1). These increased enzymatic activities resulted in an elevation of glucose uptake that provides nutrients facilitating the progression of cancer cells. Therefore, we attempted to determine the potential of GFAT1 as the biomarker for CRC by correlating its expression with clinicopathological features of the patients. Methods: A total of 132 10% formalin-fixed paraffin embedded tissue were retrieved. Immunohistochemistry (IHC) was performed on the tissue sections and digital images were subsequently acquired. All the images were automatedly analyzed using IHC Profiler. GFAT1 immunoreactivity in colorectal tissues was calculated using an adapted H-score formula. Clinicopathological features of the patients were statistically correlated with the status of GFAT1. Results: Colorectal adenocarcinoma tissues had the significantly highest GFAT1 H-scores with the mean of 103.18 compared to adenoma and non-tumor tissues. There have been no significant associations between clinicopathological characteristics of the patients and the status of GFAT1 except for tumor size. Conclusion: Immunoreactivity of GFAT1 was significantly different between non-tumorous tissues and adenocarcinoma as well as between adenoma and adenocarcinoma tissues. GFAT1 could serve as one of the prognostic biomarkers or useful targets.

Introduction: Dietary inflammation is a significant risk factor for age-related cognitive impairments among older adults. However, information related to the relationship between Empirical Dietary Inflammatory Index (eDII) score and cognitive frailty (CF) among Malaysian community-dwelling older adults is still limited. The objective of this study is to determine the association between dietary inflammatory risk and CF among community-dwelling older adults. Method: This is a cross sectional study involving community-dwelling older adults in Klang Valley. The Fried’s Criteria and Clinical Dementia Rating (CDR) were used to determine CF status. Subjects were also interviewed using the Dietary History Questionnaire (DHQ) and eDII food checklist to assess the food intake and dietary inflammatory risk. Data collected was analyzed using SPSS version 26.0. Results: A total of 158 older adults (66.7 ± 5.2 years old) residing in Klang Valley were involved. Energy and macronutrients have a weak positive association with pro-inflammatory score (p<0.05). There is no significant mean difference between CF older adults consumed a more pro-inflammatory diet (mean 2.07 ± 1.10) compared to non CF (mean 2.06 ± 1.14). However, white rice food item significantly consumed by CF people (22.4%) than non CF (8.5%) (p<0.05). Conclusion: CF older adults were more likely to consume a pro-inflammatory diet particularly from the rice food group. There is a need to further assess the risk of consuming a pro-inflammatory diet using larger sample size and appropriate biomarkers.

Purpose: The impact of the coronavirus disease 2019 crisis on medical education includes reduced clinical training, a significant loss of learning time and a probable decline in confidence of being a doctor. These recent changes will have significant effect on the well-being of medical students and interventional support needs to be given early. This study explores the challenges faced and coping strategies used by preclinical medical students during the crisis. Methods: A qualitative study involving 13 preclinical medical students was conducted between August and September 2020 at a medical school in Malaysia. An in-depth individual interview via Microsoft Teams (Microsoft Corp.) with semi-structured questions was conducted. The recorded interview data were thematically analyzed using the six phases of Braun and Clarke’s Thematic Analysis. Results: The challenges faced were identified under three themes: psychosocial impact of lockdown, significant lifestyle changes, and impact on professional progression. Meanwhile, four themes emerged in coping strategies that include behavioral strategies, re-appraisal of the uncertainties of situation, active coping mechanisms, and regulation of emotion with coping reserve. There are indications that personality traits determine strategies to cope with challenges faced during the crisis which may either lead to resilience building or experiencing burnout. Conclusion The findings of the study highlighted the urgent need to develop early preventive and intervention strategies to address the mental health of medical students to mitigate stress and promote positive well-being in times of crisis.

Introduction: Most women with postpartum depression (PPD) remain undiagnosed and untreated, despite the adverse effects known to be felt by women and children. The aim of this study was to examine the coping strategies and help seeking behavior used by women having symptoms of postpartum depression. Methods: Using a mixed-method study design, the researcher used the Edinburgh Postnatal Depression Scale (EPDS), Brief COPE and General Help Seeking Behavior (GHSQ) inventories for the quantitative approach, while the qualitative approach was conducted by a semi-structured interview based on the topics listed. A total of 30 respondents participated in the quantitative study while seven respondents were chosen for the qualitative study. Results: Data analyses identified coping strategies with domains of emotion-focused and religion-focused subscales as the main coping styles, while help seeking behavior identified that families were the main groups of people that were sought by them. Conclusion: Women with symptoms of postpartum depression tended to cope with their mental health issues by strengthening their spiritual bonds and with help and support from their family members.

Introduction: Type 2 diabetes mellitus is a chronic disease which is highly prevalent in Malaysia. In managing diabetes, the American Diabetes Association (ADA) and the International Diabetes Federation (IDF) have advocated self-management to be the basic component of diabetes care. However, an ongoing discussion, education and assessment of the patient’s diabetic knowledge should be implemented in the patient’s empowerment process. There are various assessment tools available worldwide but very few are available in the Malay language. This study is aimed to perform the Malay translation of the Simplified Diabetes Knowledge Test (DKT) questionnaire and validate it. Methods: Forward-backward translation procedure was used to translate the simplified version of the DKT questionnaire. A total of 120 respondents with type 2 diabetes mellitus from a selected government health clinic were recruited to answer the questionnaire which consists of socio-demographic, diabetes characteristics and the 20-item Malay version of simplified DKT questionnaire. Reliability and construct validity were tested with Cronbach’s alpha coefficient and Exploratory Factor Analysis. Results: Factor analysis with Varimax rotation identified five meaningful domains for the final 18 items. The Cronbach’s alpha for the overall scale of the translated questionnaire was 0.573 with values of each five significant domain’s Cronbach’s alpha ranged from 0.370 to 0.564. Conclusion: The Malay version of simplified DKT is valid and reliable to be used as a brief assessment of knowledge among Malaysian diabetic patients.

Introduction: The use of assessment tools to measure postnatal mental illness is essential in healthcare settings. However, variations in the types of tools and their reliability in a particular population lead to under-recognition of mental health status in postnatal mothers. The aim of this review is to evaluate the most recent 10 year of research on the validity and reliability of postnatal mental illness assessment tools. Methods: A literature search of studies from online databases PubMed, Scopus, and Science Direct was conducted. Results: A total of 59 studies were selected for this review. Several studies utilised multiple assessment tools, and a total of 96 assessment tools were identified and classified into six domains: postnatal blues, postnatal stress, postnatal anxiety, postnatal depression, postnatal psychosis, and postnatal psychological disorder. In this review, EPDS was the most common tool used to identify postnatal depression and anxiety while DASS 21 was the most common tool used to identify postnatal psychological disorder. There is a wide range in preponderance of evidence for the reliability of each assessment tool and there were inconsistencies in assessing the validity of the assessment tools. Conclusion This review provides information regarding some of the main assessment tools currently available to measure postnatal mental illnesses. There were no standardised tools that were used in a particular setting. The results may differ in different population because there are differences in not only languages and dialects, but also cultural and racial backgrounds, which greatly influences their perception and interpretation of postnatal mental illness.
Mental Disorders