Factors Influencing Excessive Gestational Weight Gain Among Pregnant Women in Urban Malaysia Introduction Excessive gestational weight gain (GWG) is a growing public health concern due to its association with higher risk of adverse maternal and perinatal outcomes. Recognising the key factors of underlying GWG incidence is thus crucial for developing targeted interventions. This study aims to determine the prevalence of excessive GWG and its associated factors among pregnant women in an urban district of Klang Valley, Malaysia. Methods A retrospective cross-sectional study was conducted (betweenNovember 2017 and October 2018) among 472 pregnant women who gave birth between January 2015 and December 2016. Data on sociodemographic characteristics, medical illnesses, and pre-pregnancy body mass index (BMI) were retrieved from the birth registry and maternal health records. The classification of GWG is based on the Institute of Medicine's recommendation Results The classification of GWG is based on the Institute of Medicine's recommendation. A total of 113 (23.9%) pregnant women had excessive GWG. Multiple logistic regression showed the odds of getting excessive GWG were higher among those with lower education levels (Adj. OR = 1.85; 95% CI = 1.084, 3.147), being employed (Adj. OR = 2.30; 95% CI = 1.342, 3.928), nulliparous (Adj. OR = 2.46; 95% CI = 1.450, 4.164), and having pre-pregnancy BMI of ≥25kg/m2(Adj. OR = 6.47; 95% CI = 3.909, 10.721). Conclusions Lifestyle interventions, such as weight reduction programs and health education, should focus on women with high pre-pregnancy BMI, nulliparous women, working women and women with low education levels. Pre-pregnancy clinics and workplaces can serve as platforms to promote healthy dietary choices and encourage regular physical exercise.

Introduction: Accurate diagnosis of thyrotoxicosis, a condition resulting from excessive thyroid hormone activity, is essential for appropriate management. However, access to diagnostic tools such as thyrotropin receptor antibody (TRAb) assays and thyroid ultrasonography remains limited in resource-constrained settings, highlighting the need for cost-effective alternatives. Recent studies suggest that the free triiodothyronine to free thyroxine (FT3/FT4) ratio may serve as a potential biomarker for differentiating the causes of thyrotoxicosis. Methodology: This cross-sectional study evaluated the FT3/FT4 ratio in newly diagnosed thyrotoxicosis patients aged ≥18 years recruited from Hospital Tengku Ampuan Rahimah, Hospital Banting, Klinik Kesihatan Pelabuhan Klang, and Klinik Kesihatan Pandamaran between February and December 2025. All participants underwent thyroid function testing (FT3, FT4, and TSH) and autoantibody assessment (TRAb and anti-thyroid peroxidase [anti-TPO]). Diagnostic performance of the FT3/FT4 ratio for Graves’ disease was assessed using receiver operating characteristic (ROC) curve analysis. Results: Fifty-eight patients were included, of whom 58.6% were diagnosed with Graves’ disease. Patients with Graves’ disease had significantly higher FT3 levels (median 16.8 pmol/L; IQR 10.9–25.7) compared to those with non-Graves’ thyrotoxicosis (median 8.3 pmol/L; IQR 5.3–13.5; p <0.001), with similar trends observed for FT4 levels (p <0.001). However, the FT3/ FT4 ratio did not differ significantly between groups (p >0.05), with an overall ROC AUC of 0.572, indicating poor discriminatory ability. Subgroup analysis based on FT4 levels improved performance; at FT4 <30 pmol/L, the FT3/FT4 ratio demonstrated 75.0% sensitivity, 91.7% specificity, and 87.5% diagnostic accuracy at a cutoff of 0.3445 (AUC = 0.813; 95% CI: 0.570–1.000; p = 0.069). No significant association was observed between the FT3/FT4 ratio and TRAb or anti-TPO. Conclusion The FT3/FT4 ratio has limited overall diagnostic utility but may provide adjunctive value in selected biochemical contexts, particularly in settings with limited access to immunological testing.
Diagnosis, Differential ; Thyroxine ; Triiodothyronine ; Thyrotoxicosis ; Cross-Sectional Studies

Pandemic fatigue encompasses exhaustion, emotional strain, and decreased motivation due to prolonged pandemic effects. This scoping review examines pandemic fatigue issues related to COVID-19, aiming to suggest effective management strategies. We assessed 2,558 records from 1st of December 2019 until 27th of March 2022 in PubMed, Science Direct, ProQuest, and ClinicalKey. Following Arksey and O’Malley (2005) and PRISMA-ScR principles, we selected 31 studies including research papers employing either quantitative or qualitative methods and editorials and other summary articles after excluding redundant and irrelevant works. The authors provide six critical answers to understand better and manage pandemic fatigue, including the need for more research and support, the collaboration between key stakeholders and the community, and the use of information to address pandemic fatigue. The review found that pandemic fatigue is prevalent among certain groups, such as students and healthcare workers. Factors contributing to pandemic fatigue include age, gender, high perceived severity of COVID-19, low trust in government or health organizations, and low social connectedness. The review also identified an instrument, the COVID-19 Pandemic Fatigue Scale, that can be used to measure pandemic fatigue. The review concluded that identifying pandemic fatigue as early as possible is absolutely important and people and their government should work together to handle the fatigue. Many countries have acknowledged the presence hence manage it differently. Nonetheless the strategy suggested by WHO has provided an excellent framework to tackle the pandemic fatigue.

Background: Malaysians, known for their diverse ethnicities, exhibit unique aesthetic features influenced by cultural nuances.Research indicates that factors including ethnicity, culture, and personal experiences affect how people perceive beauty. Objective: This study aims to address the lack of data on the preferred facial aesthetics among women from different ethnic groups in Malaysia. Methods: A questionnaire was administered to 290 Malaysian women, covering multiple regions and dimensions of facial aesthetics, including facial shape, forehead height and slope, cheekbone height, chin shape, eye region features (eyebrow shape, eyelid creases, and inner eye fold), nose (nose bridge shape, nasolabial angle, and nose width-length ratio), and lip thickness. Edited images of Asian models were used as references for facial aesthetic criteria in this study. Results: The survey revealed that the majority of participants were of Malay ethnicity (71.0%) and employed in the private sector (39.3%). The average age of the participants was 31.6±9.2 years, and most of them (66.9%) have not undergone aesthetic procedures before. Furthermore, a significant association was observed between ethnicity and women’s facial aesthetic preferences for facial shape and nasal width-length ratio (p<0.05). Oval facial shape was preferred by Malay (40.3%, n=83), Chinese (41.4%, n=12), and Indian (41.3%, n=19) women, due to its long, narrow, and rounded chin. For nasal width-length ratio, Malay (44.2%, n=91) and Chinese (37.9%, n=11) women preferred a ratio <1, whereas Indians (39.1%, n=18) favored a ratio >1. However, no significant association was found between ethnicity and other facial aesthetic criteria assessed in the study. Conclusion This study identified that Malaysian women’s preferences for facial shape and nasal width-to-length ratio are associated with ethnicity. These findings can serve as a valuable reference for aesthetic practitioners, emphasizing the importance of preservation and enhancement of unique ethnic features, customized according to the suitability of each ethnicity, rather than conforming to prevailing beauty standards.

Introduction: The COVID-19 pandemic significantly impacted the global teaching and learning process (TnL). Unfortunately, to date, not many qualitative studies have been published specifically on the impact of COVID-19 on the Family Medicine course, particularly in Malaysia. Hence, this study aimed to explore the impact of COVID-19 pandemic on the teaching and learning experience of undergraduate students undergoing their Family Medicine course at a local university. Methods: A qualitative study using focused group discussion (FGD), was conducted among undergraduate students during the lockdown period. A semi-structured interview guide was used to interview 20 students, in their fifth undergraduate year, undertaking their fourth to fifth week of a total six-week course. They were selected using purposive snowball sampling method. There were four focus group discussions (FGD) with five students in a group. All interviews were audio-taped, transcribed verbatim, and the contents were analysed using the standard content analysis framework. Subsequently, thematic content analysis was conducted, and three major themes were produced. Results: The three major themes were (1) facilitators to learning, (2) barriers to learning, and (3) rooms for improvement. Conclusion: Although COVID-19 pandemic had significant impact on TnL of Family Medicine course among undergraduates, the students remained optimistic and proposed some improvement from their point of view. However, a creative, realistic, effective, and impactful way of TnL, particularly in clinical aspects should be developed and experimented. Technological progress and advancement should permit this idea to be achievable and implemented in near future.

Introduction: Flooding has become a major natural disaster in Malaysia in recent decades. There may be a gender difference in many aspects related to flood response and practice. This study aimed to examine the gender gap in knowledge, attitudes, and practice of flood preparedness in Malaysia. Method: This cross-sectional study was conducted among patients attending the primary care clinic at Universiti Sains Malaysia health campus, Kelantan. A validated questionnaire was used for data collection. Results: 328 subjects were recruited, 56.1% of them were females. The female respondents were younger than the males (36 vs. 41 years old). However, females have better knowledge, and practice on flood preparedness compared to male respondents. Among those, women were more aware of the local emergency plan than males (p=0.01). More female respondents kept their vaccination and personal medical records in a waterproof container or sealed plastic bag during past and future flood preparations (3-5 day supply of non-perishable food) than male respondents (p<0.05). In addition, with the practice of keeping a one-week supply of medication, and having their medical records in a waterproof container along with a first-aid kit (p=0.001). For future flood preparation, more women would filter the cloudy water through clean clothes for boiling (p=0.035). The determinants of good preparedness for future floods for female were older-age (p=0.001), blue-collar (p=0.043); whereas male were lower household income (p=0.014), being blue collar (0.014) and white collar (0.039) compared with student/retiree based on multivariate logistic regression. Conclusion: Our study reported that the determinants of good preparedness for future floods were older-age, blue-collar and having a lower-household income.

Purpura fulminans (PF) is a severe clinical manifestation of Neisseria meningitides infection that is associated with high mortality rates in children. Survivors are frequently left with debilitating musculoskeletal sequelae. There is a paucity of reports on the musculoskeletal pathology of purpura fulminans. We report on a 2-year-old boy with purpura fulminans due to meningococcemia. The child developed distal gangrene in both the upper and lower limbs. Amputations were done for both lower limbs. Histological examination of the amputated specimens showed an inflammatory process and features of osteonecrosis. The latest follow-up at the age of 6 years showed a right knee valgus due to asymmetrical growth arrest of the proximal tibia. PF and its complications are challenging to treat and may require a multidisciplinary approach to improve patient’s functional ability.

Introduction: This study aimed to determine the prevalence of suspected depression and its associated factors among patients with hypertension in a Malaysian primary care clinic. Methods: This cross-sectional study was conducted in a primary care clinic from 1 June to 31 August 2019 using the Patient Health Questionnaire-9. Methods: This cross-sectional study was conducted in a primary care clinic from 1 June to 31 August 2019 using the Patient Health Questionnaire-9. Results: The prevalence of suspected depression was 9.0%. The significant predictors of depression were Indian ethnicity (adjusted odd ratio [AOR]: 2.373; confidence interval [CI]: 1.147–4.907), divorce (AOR: 3.5; CI: 1.243–9.860), singleness (AOR: 2.241; CI: 1.182–4.251), heavy episodic drinking (AOR: 7.343; CI: 2.494–21.624), low physical activity level (AOR: 1.921; CI: 1.093–2.274), low fibre intake (AOR: 1.836; CI: 1.061–3.178), uncontrolled blood pressure (AOR: 1.800; CI: 1.134–2.858) and presence of hypertension complications (AOR: 3.263; CI: 2.053–5.185). Conclusion Primary health care providers must screen for depression among patients with hypertension, particularly those within high-risk groups, and implement interventions that address modifiable risk factors.
Hypertension ; Primary Health Care ; Depression

Introduction: Eating-out is common in almost all countries, including Malaysia, but this frequent practice may affect human health. In Malaysia, data on eating-out is limited. This study aimed to assess the proportion of eating-out, to assess the association between socio-demographic factors and eating patterns, and to compare energy and nutrient intakes between people eating-out and eating-in. Methods: This cross-sectional study was conducted among 100 adults aged 30 to 70 years old. Three-day food diaries were used to collect data on dietary intake. Eating-out was defined as eating foods prepared outside the home. Respondents who ate outside for at least one meal per day, for two or three days per week were considered as those who frequently practised eating-out. Results: A total of 84% of respondents who ate out had significantly higher sodium intake than those who ate at home (2934 mg/day vs. 2165 mg/day, p=0.025). Foods and drinks that were most commonly consumed outside were nasi lemak, roti canai, rice, ayam masak kicap, vegetable soup, tomyam, rice vermicelli soup (mee-hoon soup), hot teh-o, iced tea, and orange juice. Occupation (p=0.004) and location type (p=0.001) were associated with eatingout. Government and semi-government workers (61%) and urban population (57%) had higher percentage of eating-out compared to eating at home (19% and 12%, respectively). Conclusion: More than two-thirds of our respondents ate out and this habit was related to poor diet quality with excessive intake of sodium. Interventions are needed to improve the diet quality of the overall eating-out behaviour among targeted population.