Patient's need for endodontic treatment in a short period is on the rise nowadays. Technological developments in instruments and materials are allowing single-visit endodontic treatment to be performed. The success of an endodontic treatment is also influenced by the restoration, in consideration of the remaining tooth structure. This becomes a challenge for the clinician if the cavities are large or if minimal tooth structure remains, so it needs a
minimally invasive restoration like morphology-driven preparation technique. This case report aims to describe the single-visit endodontic treatment and minimally invasive indirect restoration of the mandibular first molar. A 13-year-old girl came to the Dental Hospital of Hasanuddin University with complaints of cavities in the mandibular left posterior tooth and pain for one month. The patient had taken analgesic medication but was afforded no relief. Intraoral examination showed tooth #36 with extensive cavities reaching the proximal area, a positive thermal test, and no pain to percussion. The case diagnosis was asymptomatic irreversible pulpitis. The treatment plan was a single-visit endodontic treatment and minimally invasive indirect restoration.

Despite publishing and securing research grants being obligatory in research universities, the literature on the factors influencing academic productivity is relatively scarce. Thus, in this study, we aimed to determine the personal and behavioural-related factors that influence the culture of publishing and securing research grants among academicians with lower research-related performance. This cross-sectional study was conducted among 49 academic staff members of Universiti Kebangsaan Malaysia (UKM). A self-administered questionnaire consisting of personal, attitude and behavioural (barriers, perceived stress scale, work extrinsic and intrinsic motivation scale, psychological well-being scale, and basic needs satisfaction scale) questions were distributed during a workshop and online. Simple linear regression (SLR) analyses were performed for each variable, followed by multiple linear regression (MLR) to identify the associated factors of research output. After adjusting for covariates, having a doctoral degree (β=0.396, 95% CI=0.221-2.146, p<0.05) and integrated regulation (β=0.574, 95% CI=0.036-3.612, p<0.05) were found to be associated with research grant acquisition (R2=0.273). Moreover, increasing age (β=0.426, 95% CI=0.088-0.397, p<0.05), living alone (β=0.331, 95% CI=0.944-6.626, p<0.05), having a doctoral degree (β=0.248, 95% CI=0.174-6.747, p<0.05), environmental mastery (β=0.318, 95% CI=0.013-0.347, p<0.05), self-acceptance (β=0.284, 95% CI=0.010-0.242, p<0.05), satisfaction incompetence (β=0.273, 95% CI=0.001-0.200, p<0.05) and relatedness (β=0.280, 95% CI=0.001-0.116, p<0.05) were found to be the factors that influence the publications produced among participants (R2 =0.423). The findings of this study could be used by management to formulate effective strategies to increase the productivity of academics in their research-related performance.

Introduction: Diabetic ketoacidosis (DKA) is a common complication of type 1 diabetes mellitus (T1DM). Neurological complications of DKA are rare in adults. We report a case of young lady with T1DM who presented with severe DKA and complicated with subarachnoid hemorrhage (SAH). Case: A 19-year-old female was diagnosed with T1DM following an admission for DKA 2 months earlier. Her hemoglobin A1c was 17.2%, and autoimmune markers showed positive anti-glutamic acid decarboxylase (anti-GAD) antibodies (71 IU/mL) with negative anti-insulinoma-associated antigen 2 (anti-IA2) and islet cell antibodies. Her C-peptide level was low at 69 pmol/L. She was discharged with basal bolus insulin analogues, but she defaulted on her medications. She presented to the hospital 2 months later with a history of epigastric pain, vomiting, and breathlessness for 2 days, and was then found unconscious at home. There was no history of trauma. She was intubated for a poor Glasgow Coma Scale (E1V1M1). Blood results showed severe DKA with glucose 25 mmol/L, blood gas pH 6.572, bicarbonate 2.6 mmol/L, and ketone more than 8.8 mmol/L. She was started on insulin infusion and fluid resuscitation. DKA resolved after 24 hours. Computed tomography (CT) of the brain showed SAH in the right frontal and left frontotemporal regions. CT angiography of the brain reported no evidence of an intracranial aneurysm. She was extubated on day 4 of admission. Subsequent cerebral digital subtraction angiography was unremarkable. The patient achieved complete neurological recovery on follow-up. Conclusion This case highlights that severe DKA may rarely be associated with spontaneous SAH, which increases morbidity and mortality. Proposed mechanisms include vascular injury, oxidative stress from severe ketoacidosis, and endothelial dysfunction related to inflammatory mediators. Clinicians should have a high suspicion and consider neuroimaging in DKA patients with unexplained reduced consciousness or atypical neurological findings.

Background: Work-related musculoskeletal disorders (WRMSDs) remain a major cause of occupational disability and productivity loss worldwide. Traditional statistical methods have identified numerous associated factors; however, they often struggle to capture complex non-linear relationships and interactions across multiple domains of risk. Machine learning (ML) offers an alternative analytical approach for modelling such multidimensional relationships. Methods: Following the PRISMA 2020 guidelines (PROSPERO: CRD420250605234), literature searches were conducted in Web of Science, Scopus, and PubMed for studies published between 2020 and 2025. Eligible studies applied ML methods to identify factors associated with WRMSDs using cross-sectional study designs. Included studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross-sectional studies. Results: Ten studies met the inclusion criteria, representing workers from healthcare, transport, manufacturing, and service sectors across Asia, Africa, and Europe. Frequently applied ML algorithms included random forest, support vector machine, and artificial neural networks, demonstrating strong internal discriminative performance (area under the receiver operating characteristic curve: 0.80–0.99), although the absence of external validation in several studies suggests a potential risk of overfitting. Commonly identified factors included age, sex, awkward posture, vibration exposure, prolonged working hours, stress, and burnout. Psychosocial factors, including post-traumatic stress disorder, job stress, and depression, were ranked among the most influential predictors within ML models. Conclusions ML models demonstrate strong capability in discriminating WRMSDs risk and identifying multidimensional risk factors compared with traditional statistical approaches. These models highlight complex interrelationships between ergonomic and psychosocial exposures. Future research should incorporate external validation, objective exposure measurements, and standardized ML reporting frameworks to enhance methodological transparency and generalizability.

Continuous exposure to cigarette smoke causes oxidative stress, leading to diseases in the respiratory tract. Secang (Caesalpinia sappan L.) wood is a popular herbal drink in Indonesia due to its antioxidant properties. To date, the protective effects of Secang on the respiratory system have not been widely studied.Ethanolic extract of Secang was prepared by maceration. An in vivo experiment was conducted on 24 male Wistar rats divided into four groups: Control (K), Negative control (KN), low-dose treatment of the extract (P1, 300 mg/kg), and a high-dose one (P2, 600 mg/kg) for 30 days of treatment. After finishing treatments, rats were sacrificed for histological analysis. Rats' average bodyweight showed a consistent increase, indicating tolerable toxicity of the extract, which does not interfere with rats' general health. Serum glutamic pyruvic transaminase (SGPT) and serum glutamic oxaloacetic transaminase (SGOT) depicted consistent results, where P1 and P2 groups significantly decreased (p < 0.001) compared to KN, indicating hepatoprotective activity of Secang.Histologically, tracheal lumen diameter in P2 significantly (p < 0.05) increased compared to KN, suggesting Secang’s potent antioxidant activity. The number of goblet cells increased in KN compared to K, indicating irritation and inflammatory conditions from cigarette smoke. Secang-treated groups exhibited improvement in the lumen diameter, goblet cells, and ciliated epithelium. The findings suggest protective potential of Secang against cigarette smoke-induced tracheal damage.

Osteoartritis lutut atau knee osteoarthritis (KOA) merupakan penyakit muskuloskeletal yang lazim dan semakin meningkat secara global. Di Malaysia, perbezaan etnik dalam kelaziman KOA telah dikenal pasti, namun kajian yang menilai sama ada perbezaan ini turut melibatkan ketidakupayaan dan kesejahteraan psikologi masih terhad. Kajian ini bertujuan untuk membandingkan ketidakupayaan, kesejahteraan psikologi dan kualiti hidup berkaitan kesihatan dalam kalangan pesakit KOA berbangsa Melayu, Cina dan India di Malaysia. Kajian keratan rentas ini melibatkan 90 orang dewasa yang telah didiagnosis secara klinikal dengan KOA, merangkumi 30 responden Melayu (57.97 ± 7.89 tahun), 30 responden Cina (60.00 ± 9.90 tahun), dan 30 responden India (59.20 ± 8.65 tahun). Ketidakupayaan berkaitan KOA dinilai menggunakan soal selidik Knee Injury and Osteoarthritis Outcome Score (KOOS), manakala kesejahteraan psikologi dan kualiti hidup dinilai menggunakan Short Form 36 Health Survey (SF-36). Analisis varians sehala dan ujian post hoc digunakan untuk membandingkan keputusan antara kumpulan etnik. Hasil kajian menunjukkan bahawa responden Cina mencatatkan skor tertinggi dalam hampir semua domain KOOS dan SF-36, menunjukkan fungsi lutut, kesejahteraan psikologi dan kualiti hidup yang lebih baik. Responden Melayu pula mencatatkan skor KOOS terendah dalam domain kesakitan dan kualiti hidup, serta menunjukkan tahap kesakitan yang paling tinggi. Responden India menunjukkan skor sederhana dalam kebanyakan domain, namun mencatatkan skor terendah dalam domain sukan dan rekreasi. Dapatan ini menunjukkan perbezaan etnik yang ketara dalam aspek ketidakupayaan, kesejahteraan psikologi dan kualiti hidup dalam kalangan pesakit KOA. Oleh itu, strategi pemulihan yang bersifat khusus dan mengambil kira latar belakang etnik adalah penting bagi meningkatkan kesaksamaan dalam penjagaan kesihatan muskuloskeletal di Malaysia.

Oropharyngeal Synovial Sarcoma: A Case Report Synovial sarcoma is a rare and aggressive type of sarcoma that develops from mesenchymal cells and accounts for around 8% to 10% of all cases of soft tissue sarcoma. The presence of synovial sarcoma in the head-and-neck region is characterised by aggressive behaviour and a generally unfavourable prognosis. Understanding the various manifestations of synovial sarcoma, particularly uncommon locations like the oropharynx, significantly improves patient outcomes by facilitating early diagnosis and prompt management. We report a case of a 57-year-old Malay woman who presented with a two-month history of sore throat and odynophagia, complicated with partial airway obstruction. She underwent endoscopic excision of the right oropharyngeal tumour via transoral approach, and the histopathological examination revealed monophasic synovial sarcoma. The surgical management, histopathological characteristics, and rarity of the disease are discussed.

Purpose: To report the factors affecting visual outcomes after small incision lenticule extraction (SMILE) in eyes treated with the Visumax 800. Methods: This is a retrospective study with cross-sectional design of eyes underwent SMILE Pro using Visumax 800 at Jakarta Eye Center. Patients ≤40 years old with a corrected distance visual acuity of >20 / 25, manifest refractive spherical equivalent ≤10.0 diopters (D), and cylinder refraction <5.0 D were included. Evaluation of visual outcomes was conducted at 1 day and 1 month postoperatively. Results: A total of 258 eyes from 132 patients were analyzed. Among the total, 94% achieved an uncorrected distance visual acuity (UDVA) of 20 / 20 at 1 month postoperatively. Of the eyes with high myopia, 81% achieved a UDVA of 20 / 20, followed by 97% and 99% in moderate and low myopic eyes, respectively. Spherical equivalent refraction (r = 0.273, p < 0.01), optic zone (OZ; r = 0.260, p < 0.01), cap thickness (r = 0.209, p < 0.01), and residual stromal thickness (RST; r = 0.256, p < 0.01) showed a significant but weak correlation with UDVA at 1 month postoperatively. There is increasing risk to get <20 / 20 UDVA in right eyes (odds ratio [OR], 3.101; p < 0.045), eyes with high myopia (OR, 9.964; p < 0.01), 100-μm cap thickness (OR, 4.578; p < 0.01), ≤6 mm OZ (OR, 10.556; p < 0.01), and <300-μm RST (OR, 9.100; p < 0.01) at 1 month postoperatively. Conclusions SMILE Pro results in promising visual outcome in early postoperative period. Patients with low to moderate myopia have better visual outcomes than those with high myopia. A small OZ, thin cap thickness, and low RST could increase the risk of not achieving the maximum visual outcome after SMILE. A prospective study with a longer follow-up period that includes comprehensive variables is needed to fully understand the factors affecting visual acuity after SMILE.

Newborn oropharyngeal teratomas are extremely rare disorders. Epignathus tumour is a congenital malformation characterised as a 'mature teratoma' located at the oropharyngeal region. Teratomas in the upper respiratory airway give rise to abnormal life -threatening airway obstruction during the neonatal period. It is associated with high morbidity and mortality, requiring proper and cautious planning and prompt surgery. We describe a rare case of oropharyngeal teratoma in a premature male neonate (35 weeks gestation) who presented with difficult intubation. On flexible laryngoscopy, it appeared as a large vallecular cyst, while the computed tomography scan demonstrated a posterior pharyngeal wall cystic lesion causing oropharynx narrowing. The patient was operated on 8th day postpartum. Histopathological examination was compatible with mature cystic teratoma.

Objective: Ovarian clear cell carcinoma (OCCC) is associated with chemoresistance. Limited data exists regarding the efficacy of targeted therapies such as immune checkpoint inhibitors (ICI) and bevacizumab, and the role of secondary cytoreductive surgery (SCS). Methods: We retrospectively analyzed genomic features and treatment outcomes of 172 OCCC patients treated at our institution from January 2000 to May 2022. Next-generation sequencing (NGS) was performed where sufficient archival tissue was available. Results: 64.0% of patients were diagnosed at an early stage, and 36.0% at an advanced stage.Patients with advanced/relapsed OCCC who received platinum-based chemotherapy plus bevacizumab followed by maintenance bevacizumab had a median first-line progressionfree survival (PFS) of 12.2 months, compared with 9.3 months for chemotherapy alone (hazard ratio=0.69; 95% confidence interval [CI]=0.33, 1.45). In 27 patients who received an ICI, the overall response rate was 18.5% and median duration of response was 7.4 months (95% CI=6.5, 8.3). In 17 carefully selected patients with fewer than 3 sites of relapse, median PFS was 35 months (95% CI=0, 73.5) and median overall survival was 96.8 months (95% CI=44.6, 149.0) after SCS. NGS on 58 tumors revealed common mutations in ARID1A (48.3%), PIK3CA (46.6%), and KRAS (20.7%). Pathogenic alterations in PIK3CA, FGFR2, and NBN were associated with worse survival outcomes. Median tumor mutational burden was 3.78 (range, 0–16). All 26 patients with available loss of heterozygosity (LOH) scores had LOH <16%. Conclusion Our study demonstrates encouraging outcomes with bevacizumab and ICI, and SCS in select relapsed OCCC patients. Prospective trials are warranted.