Introduction: The 2021 IDF-DAR risk calculator had been previously evaluated in multiple studies and subsequently widely accepted and applied in clinical practice as a practical standardized tool for patient risk stratification. Recently updated, the 2026 IDF-DAR Risk calculator enables a more individualized, evidence-related evaluation of patientrelated and disease-related risk factors, incorporating modern diabetes technologies, including continuous glucose monitoring (CGM), automated insulin delivery (AID) systems, and advanced insulin formulations to enhance risk stratification. This tool allows medical professionals to tailor Ramadan practices based on overall factors toward promoting safe fasting. Methodology: This prospective multicentre observational study recruited adults with Type 1 and Type 2 diabetes attending public hospitals nationwide. People with diabetes (PwD) intending to perform Ramadan fasting were invited to participate and assessed using the 2026 IDF-DAR Risk Calculator in the 6-week pre-Ramadan period between 30th January and 19th March 2026. Results: A total of 458 PwD were evaluated and stratified into low (15.7%), moderate (41%), and high risk (43.3%) categories. Most participants had Type 2 diabetes (83.6%), with 60.3% having a disease duration exceeding 10 years and 43% exhibiting poor glycemic control (hemoglobin A1c >9%). Insulin therapy was used by 76.4% of participants, including two individuals with Type 1 diabetes using AID systems. Most participants reported no recent hypoglycemia (76.4%), 81.0% performed glucose monitoring, and 3.3% used CGM. Severe comorbidities were uncommon, with 1.1% having unstable macrovascular disease and 4.4% advanced chronic kidney disease (estimated glomerular filtration rate <30). Notably, 72.2% received structured Ramadan education. Conclusion Majority of PwD attending tertiary diabetes clinics were in the moderate- to high-risk category and intended to fast despite medical advice against fasting in some cases. Although most participants were on insulin therapy, hypoglycemia was low in the pre-Ramadan period. Integration of modern technologies, advanced insulin therapies, and structured education may support safer fasting practices.
Risk Assessment ; Diabetes Mellitus ; Hospitals ; Fasting

Speech-language therapists (SLTs) are experienced in recognising the symptoms and signs of speech-language disorders and can help the afflicted children overcome those disorders with appropriate intervention. Furthermore, with the increase in the number of children with special educational needs, teachers are expected to identify students with speech-language disorders, which is also a shared responsibility of SLTs. However, the teachers’ awareness and knowledge of speech-language therapy are relatively unknown. Therefore, this study aimed to identify the primary school teachers' awareness and knowledge of speech-language therapy services in Kota Bharu, Kelantan. A total of 105 primary school teachers participated in this survey-based study. The findings discovered that the teachers' awareness and knowledge were limited. Among the participants, only 25.7% indicated a high awareness and knowledge regarding the SLTs' roles, yet 68.6% of the teachers had never read about speech-language therapy, and 63.8% had never heard anything about SLPs previously. Consequently, more emphasis on awareness and knowledge of SLPs should be executed for schoolteachers. This will assist the schoolteachers in identifying children with special needs in need of SLT services in the future.

Tooth avulsion is a dental emergency that needs prompt treatment to minimise complications. This study aims to evaluate the knowledge and awareness of avulsed tooth management among dental surgery assistants at the UKM Dental Polyclinic. This survey research design of a 19- item questionnaire was distributed to 59 dental surgery assistants (DSAs). The questionnaire consisted of demographic profile questions and questions regarding awareness and knowledge of tooth avulsion and its immediate management. The results showed that 78% of DSAs at the Institute know about first aid management of avulsed teeth, with the majority being taught during their training course. Moreover, 96.2% of the DSAs know what tooth avulsion is and recognise it as a dental emergency. Although 75% of the DSAs have never previously handled any avulsed tooth case, 50% are confident in advising the public on what to do with an avulsed tooth at the time of injury. As for the specific management questions of an avulsed tooth, the responses from the DSAs varied according to the questions, ranging from 50% to 85%. DSAs at the Institute have varying levels of awareness and knowledge regarding tooth avulsion. Therefore, regular education programmes on dental trauma and its management will help improve the DSAs’ current knowledge and ability to manage avulsion injuries better in emergencies.

Purpose: Oncological outcomes following rectal cancer surgery have improved significantly over recent decades with lower recurrences and longer overall survival. However, many of the patients experienced low anterior resection syndrome (LARS). This study identified the prevalence and risk factors associated with the development of LARS. Methods: This cross-sectional study involved patients who were diagnosed with rectal cancer and had undergone sphincter-preserving low anterior resection from January 2011 to December 2020. Upon clinic follow-up, patients were asked to complete an interviewed based questionnaire (LARS score) designed to assess bowel dysfunction after rectal cancer surgery. Results: Out of 76 patients, 25 patients (32.9%) had major LARS, 10 patients (13.2%) had minor LARS, and 41 patients (53.9%) had no LARS. The height of tumor from anal verge showed an association with the development of major LARS (P=0.039). Those patients with less than 8 cm tumor from anal verge had an increased risk of LARS by 3 times compared to those with 8 cm and above (adjusted odds ratio, 3.11; 95% confidence interval, 1.06–9.13). Conclusion Results from our study show that low tumor height was a significant risk factor that has a negative impact on bowel function after surgery. The high prevalence of LARS emphasizes the need for study regarding risk factors and the importance of understanding the pathophysiology of LARS, in order for us to improve patient bowel function and quality of life after rectal cancer surgery.

Aims: The antibiofilm activity of endophytic fungus Nigrospora sphaerica CL-OP30 isolated from Swietenia macrophylla King was investigated. Methodology and results: The ability of the fungal endophytic crude extract to impede Streptococcus mutans biofilm formation was preliminarily screened with Congo red agar test. It was proven that S. mutans biofilm formation was hindered on the agar supplemented with the fungal endophytic crude extract. The antibiofilm activity of the fungal endophytic crude extract was evaluated using a microtiter plate method on both initially formed and preformed biofilm. Antibiofilm activity was recorded in a concentration-dependent pattern whereby higher concentrations reduced biofilm formation better than the lower concentrations of extract for both initially formed and preformed biofilm. The architecture of biofilm tested with fungal endophytic crude extract was also observed. Visualization under a light microscope and SEM revealed that the adherence of S. mutans biofilm treated with fungal endophytic crude extract was significantly reduced in both initially formed and preformed biofilm. In addition, observation under SEM showed that the matrices surrounding the bacterial cells were disintegrated and bacterial cells in biofilm completely lost their original shape. The overall data demonstrated that the ethyl acetate N. spaherica CL-OP30 crude extract showed good antibiofilm activity. Conclusion, significance and impact of study The antibiofilm study suggested the potential of N. sphaerica CL-OP30 crude extract against S. mutans biofilm by disrupting the biofilm formation, the disintegration of matrices surrounding the biofilm and responsible for the formation of irregular cell shape. This extract may have a promising potential to be developed as an antibiofilm agent.

Readiness for treatment reflects the individual’s motivation to seek help and preparedness to engage in treatment activities. The READI-SF aimed to assess parental readiness to engage in treatment. The present study aimed to translate the English version of READI-SF into the Malay language and subsequently assess its content validity using the content validity ratio (CVR), content validity index (CVI) and modified kappa analyses. Four independent translators carried out the translation procedures. Eight clinical professionals were involved as content experts. Of 17 items, six items needed to be revised due to low CVR values (< 0.75). Based on unfavourable individual CVI (I-CVI) results (< 0.78), two items (for item relevancy) and six items (for item clarity) had to be modified. The overall CVI of the questionnaire (S-CVI) was found to be good (i.e., 0.91 for item relevancy and 0.83 for item clarity). Nine items needed to be revised, and the modifications were carried out accordingly. At the end of the study, a valid Malay-translated READI-SF was produced. It has good potential to serve as a clinical tool to assess the readiness of Malay-speaking parents to engage in treatment. However, prior to its intended clinical application, further research is warranted to assess other aspects of validity (e.g., face validity, construct validity, and criterion-related validity), as well as READI-SF reliability.

The interaction between adults and children during shared reading contributes to the conversation and reading in hand and makes the activity interactive. It is, therefore, imperative to understand parents’ goals for shared reading with their children as it will influence their behaviour and, in turn, affect their children’s development of language and literacy skills. In Malaysia, no local psychometric instrument identifying parent goals for shared reading is available. This study aims to translate the English version of the Parent Goals for Shared Reading Questionnaire (PGSRQ) into Malay and validate the translated questionnaire. Four qualified translators carried out the translation processes, and a panel of eight experts subsequently validated the Malay-translated version of PGSRQ. Of 33 items, the validation assessment revealed that 17 items had a content validity ratio (CVR) value of 1.0, while 12 items had a CVR value of 0.8. Only four items had a CVR value lower than 0.78 and were retranslated and modified. The findings of this study can pave the way for more research efforts in the field of shared reading in Malaysia. The questionnaire can also assist a speech therapist in assessing the goals that parents have on shared reading to come up with better designs for shared book reading intervention.

Introduction: Studies show that adolescents are more reward sensitive compared to other age groups. The nucleus accumbens (NAcc) has been identified as a key brain area involved in reward through its connectivity to other reward-related brain areas. Our study aimed to characterise the white matter structural connectivity of nucleus accumbens with brain areas that are most often associated with reward in female adolescents. Methods: Fifteen healthy female Malay adolescents were recruited and underwent diffusion-weighted brain scanning. Two behaviour scales were also given to verify typical reward responsiveness. Then, probabilistic tractography and NAcc segmentation were performed on the data using FMRIB Software Library (FSL). Probabilistic tractography was performed to determine the relative connection probability of nucleus accumbens (NAcc) to areas shown to be associated with reward, namely amygdala, anterior cingulate cortex (ACC), medial orbitofrontal cortex (mOFC), hippocampus, ventrolateral prefrontal cortex (vlPFC) and dorsolateral prefrontal cortex (dlPFC). Connectivity-based segmentation of NAcc was performed to determine the spatial distribution of its connectivity with the target brain areas according to the highest connection probability. Results: The highest relative connection probability was found between NAcc to mOFC, while the NAcc parcellation showed the widest distribution of connection to mOFC compared to the other five targets on both sides of the brain. Conclusion: Our findings demonstrated the strongest structural connectivity and widest distribution between NAcc and mOFC compared with other brain areas related to reward. This study’s findings could be used as baseline to compare with people with atypical reward circuit problems.

Background: The current conventional serotyping based on antigen-antisera agglutination could not provide a better understanding of the potential pathogenicity of Salmonella enterica subsp. enterica serovar Brancaster. Surveillance data from Malaysian poultry farms indicated an increase in its presence over the years. Objective: This study aims to investigate the virulence determinants and antimicrobial resistance in S. Brancaster isolated from chickens in Malaysia. Methods: One hundred strains of archived S. Brancaster isolated from chicken cloacal swabs and raw chicken meat from 2017 to 2022 were studied. Two sets of multiplex polymerase chain reaction (PCR) were conducted to identify eight virulence genes associated with pathogenicity in Salmonella (invasion protein gene [invA], Salmonella invasion protein gene [sipB], Salmonella-induced filament gene [sifA], cytolethal-distending toxin B gene [cdtB], Salmonella iron transporter gene [sitC], Salmonella pathogenicity islands gene [spiA], Salmonella plasmid virulence gene [spvB], and inositol phosphate phosphatase gene [sopB]).Antimicrobial susceptibility assessment was conducted by disc diffusion method on nine selected antibiotics for the S. Brancaster isolates. S. Brancaster, with the phenotypic ACSSuT-resistance pattern (ampicillin, chloramphenicol, streptomycin, sulphonamides, and tetracycline), was subjected to PCR to detect the corresponding resistance gene(s). Results: Virulence genes detected in S. Brancaster in this study were invA, sitC, spiA, sipB, sopB, sifA, cdtB, and spvB. A total of 36 antibiogram patterns of S. Brancaster with a high level of multidrug resistance were observed, with ampicillin exhibiting the highest resistance. Over a third of the isolates displayed ACSSuT-resistance, and seven resistance genes (β-lactamase temoneira [blaTEM ], florfenicol/chloramphenicol resistance gene [floR], streptomycin resistance gene [strA], aminoglycoside nucleotidyltransferase gene [ant(3″)-Ia], sulfonamides resistance gene [sul-1, sul-2], and tetracycline resistance gene [tetA]) were detected. Conclusion Multidrug-resistant S. Brancaster from chickens harbored an array of virulenceassociated genes similar to other clinically significant and invasive non-typhoidal Salmonella serovars, placing it as another significant foodborne zoonosis.

Background and Objectives: Despite few reports on the influence of ambient acoustic noise on auditory brainstem response (ABR) to click stimuli, its effects on ABR to level-specific (LS) stimuli have not been systematically investigated. This study aimed to investigate the influence of ambient acoustic noise on ABR findings using both LS chirp and click stimuli. Subjects and Methods: Twelve normal-hearing adults participated in this repeated measure design study. The ABRs were acquired at 80, 50, and 30 dBnHL using two stimuli (LS chirp and click) under two conditions (quiet and noise). The ABRs under noise conditions were acquired using babble noise and white noise. The noise level was set at 55 dBA. Two-way repeated measure analysis was used to identify the main effects of the test conditions, stimulus types, and their interactions at a 95% confidence level. Results: No significant influence of ambient acoustic noise on ABR findings was identified at all intensity levels. No significant difference was found in the number of signal averages to reach the 0.04 μV residual noise as stopping criteria among the ABRs recorded with different types of stimuli and test conditions. The ABR waves I and V amplitudes were larger with LS chirp than with click stimulus. Conclusions Ambient acoustic noise has no significant influence on ABR findings and the ABR test time based on the 55 dBA noise level used in this study.