Introduction: Diabetes affects 15.6% of Malaysian adults and remains a leading cause of complications and mortality. Although locally developed artificial intelligence (AI) tools have shown strong technical performance, their integration with clinicians’ decision-making in primary care remains fragmented. This perspective proposes a synergistic AI– clinician framework to deliver truly personalized proactive diabetes care. Methodology: A multidisciplinary team designed a clinical workflow that integrates three validated Malaysian AI components: (1) LightGBM (LGBM) model trained on Malaysian National Diabetes Registry (MNDR) data for complication risk prediction, (2) DR.MATA AI retinopathy screening with automated triage, and (3) AI-enhanced mobile apps for real-time self-management. These layers feed into a single secure clinician dashboard. The framework was modelled using existing datasets (MNDR 2011–2021, NHMS 2023, DR.MATA validation cohort >14,000 images) and aligned with the National AI Roadmap 2021–2025 and the forthcoming National AI Action Plan 2026–2030. Results: The LightGBM model achieved ROC-AUC values of 0.84 (mortality), 0.71 (retinopathy/nephropathy), 0.66 (ischemic heart disease), and 0.74 (stroke). DR.MATA demonstrated 93.3% accuracy with automated triage. When integrated, modelling suggests the framework could reduce major complications by approximately 20–30% and unnecessary referrals by up to 35%. The system runs automatically upon opening the patient record, requiring no extra clinician steps. Conclusion Synergizing AI with clinicians’ expertise offers a scalable solution for Malaysian primary health clinics. A 12-month national pilot is recommended to generate real-world evidence and inform the National AI Action Plan 2026–2030.
Artificial Intelligence ; Diabetes Mellitus

BACKGROUND: Oral lichen planus (OLP) is an immune-mediated potentially malignant disorder of the oral cavity. Dysplastic OLP has an altered cytogenic profile and can progress into oral squamous cell carcinoma. The epidemiology of OLP is well-described in several relatively large series from various geographic locations, whereas such series from southern India is rare. The aim of the present study was to determine the epidemiology of OLP in a cohort of South Indian population. METHODS: All the case data records of 29,606 patients who visited Mar Baselios Dental College and Hospital, Kerala, India from 2014 to 2015 were retrospectively reviewed. For data review, 122 patients of OLP were selected Estimated were type, number, and location of lesions, clinical manifestation, age of the patient, gender, onset and duration of lesion, stressful life style, habits, skin involvement and associated systemic illness, and presence/absence of dysplasia. RESULTS: When the distribution of OLP among the gender was considered, we found more prevalence in females than males. Fifty-seven percent of patients were associated with stressful lifestyle. Reticular lichen planus was the most common clinical subtype found. Bilateral buccal mucosal was the common site, when the distribution of sites of OLP were compared (P < 0.05). Hypersensitivity reaction was frequently associated with systemic illness with OLP (P < 0.05). Anaplasia was found among 5% of lichen planus lesions. CONCLUSIONS: OLP patients had high incidence of hypersensitivity reactions and 5% of OLP lesions showed anaplasia. Long term follow-up is necessary to monitor the recurrence, prognosis, and malignant transformation of OLP.
Anaplasia ; Carcinoma, Squamous Cell ; Cohort Studies* ; Epidemiology* ; Female ; Follow-Up Studies ; Geographic Locations ; Humans ; Hypersensitivity ; Immune System Diseases ; Incidence ; India ; Lichen Planus ; Lichen Planus, Oral* ; Life Style ; Male ; Mouth ; Prevalence ; Prognosis ; Recurrence ; Retrospective Studies* ; Skin

BACKGROUND: The role of tumour inflammation and the dysplastic epithelial-stromal interactions on the nature of collagen fibres in the extracellular matrix of dysplastic epithelium is not fully understood. The present study was aimed to evaluate and compare the inflammation and pathological stromal collagen (loosely packed thin disorganized collagen) present in mild, moderate and severe epithelial dysplasias with that of inflammatory fibrous hyperplasias. The basement membrane intactness of epithelial dysplasias was also evaluated to determine if dysplastic epithelial mesenchymal interaction has any role in the integrity of stromal collagen in epithelial dysplasia. METHODS: Oral epithelial dysplasias, inflammatory fibrous hyperplasia and normal oral mucosal samples were used for the study. Packing, thickness and orientation of collagen fibres in mild, moderate and severe grades of oral epithelial dysplasias (n = 24), inflammatory fibrous hyperplasia (n = 8) and normal oral mucosal samples (n = 8) were analysed based on the polarisation of collagen fibres in picrosirius red polarising stain under polarising microscope. RESULTS: All the grades of epithelial dysplasias showed greenish yellow birefringence confirming the presence of loosely arranged pathological collagen in the presence of moderate inflammation. All the cases of inflammatory fibrous hyperplasia showed red polarisation hue and moderate inflammation. A statistically significant difference was found in the packing and orientation of collagen when epithelial dysplasias and inflammatory fibrous hyperplasia were compared (P < 0.01). When the intactness of basement membrane integrity was compared in all the groups of epithelial dysplasia, a statistically significant result was obtained (P < 0.05). CONCLUSIONS: Presence of significant amount of loosely packed thin disoriented collagen even in mild epithelial dysplasia suggests that tumourigenic factors are released to connective tissue stroma much earlier than expected. Hence we suggest considering the integrity of extracellular matrix collagen, intactness of basement membrane and inflammation associated with dysplasia along with the anaplasia of epithelial cells in the microscopic assessment of dysplastic epithelium.
Anaplasia ; Basement Membrane ; Birefringence ; Collagen* ; Connective Tissue ; Epithelial Cells ; Epithelium ; Extracellular Matrix* ; Hyperplasia* ; Inflammation* ; Microscopy* ; Mouth Mucosa

The infusion and persistence in a transplant recipient of donor-derived bone marrow cells (DBMC) of multi-lineage can lead to a state of permanent chimerism. In solid vascular organ transplantation, the donor bone marrow lineage cells can even be derived from the transplant organ, and these cells can be detected in very small numbers in the recipient. This has been called microchimerism. Much controversy has developed with respect to the function of chimeric cells in organ transplantation. One idea is that the occurrence of these donor cells found in microchimerism in the recipient are coincidental and have no long-term beneficial effect on engraftment. A second and opposing view, is that these donor cells have immunoregulatory function that affect both the acute and chronic phases of the recipient anti-donor responses. It follows that detecting quantitative changes in chimerism might serve as an indication of the donor-specific alloimmune or regulatory response that could occur in concert with or independent of other adaptive immune responses. The latter, including autoimmune native disease, need to be controlled in the transplant organ. The safety and immune tolerance potential of DBMC infusion with deceased and living donor renal transplants was evaluated in a non-randomized trial at this center and compared with non-infused controls given identical immunosuppression. Overall DBMC infusions were well tolerated by the recipients. There were no complications from the infusion (s), no episodes of graft-vs-host disease (GVHD) and no increase infections or other complications. In the deceased DBMC- kidney trial, actuarial graft survival at 5 years was superior especially when graft survival was censored for recipient death. Acute rejections were significant reduced in patients given two DBMC infusions, and chronic rejection was dramatically reduced in all DBMC treated patients. The most interesting finding was that the degree of microchimerism slowly increased over the years the DBMC group that had exhibited no rejection episodes. In the DBMC-living related trial, the incidence of acute rejection did not differ between groups. However, DBMC chimerism in recipient iliac crest marrow had increased more rapidly than might be predicted from results previously seen in the cadaver group, despite four times fewer DBMC infused, with the generation of T- regulartory cells in-vitro assays.
*Bone Marrow Transplantation ; Humans ; *Kidney Transplantation ; *Living Donors ; *Tissue Donors ; *Transplantation Chimera ; *Transplantation Tolerance