INTRODUCTION: Glaucoma is a leading cause of permanent blindness, often going undetected in its early, asymptomatic stages, especially in older age groups. In Malaysia, glaucoma is a growing public health issue due to an increase in the ageing population. While screening is essential for early glaucoma detection, the most suitable strategy for Malaysia's healthcare system remains unclear. This study explored the perspectives of eye healthcare professionals on the most suitable glaucoma screening strategies for Malaysia. MATERIAL AND METHODS: This qualitative study used semi-structured interviews with 19 eye health professionals (ophthalmologists, optometrists, nurses, ophthalmic technicians, and assistant medical officers) practicing in the Klang Valley. The interviews were conducted face-to-face in their workplace or via a video conferencing platform. All interviews were recorded, transcribed, and analysed using thematic analysis. RESULTS: Six major themes were identified: types of glaucoma screening programmes, accessible screening locations, target screening population, instruments and use of digital technology, trained personnel, and referral criteria. Opportunistic case finding and population-based programmes were identified as the glaucoma screening programmes in which trained personnel conducted screening at accessible locations. Glaucoma screening for high-risk individuals was recommended, focusing on visual acuity testing, tonometry, anterior chamber angle assessment, funduscopy, perimetry, and retinal nerve fibre assessment. A lack of clear referral criteria due to low awareness and poor implementation of existing guidelines was observed. CONCLUSION: Further investigations are required to identify the best combination of components for glaucoma screening. This will enable policymakers to develop an effective glaucoma screening programme in Malaysia.

Introduction: Sleep quality has become a public health concern due to serious impacts on individual’s health outcomes. Thus, this cross-sectional study aimed to determine the sleep quality and its associated factors among adults living in the province of Terengganu, Malaysia. Materials and Methods: Socio-demographic information was self-reported whilst anthropometric measurements were measured by trained researchers. Sleep quality was assessed using the validated Pittsburgh Sleep Quality Index (PSQI) whilst eating behavior was measured using the Dutch Eating Behavior Questionnaire (DEBQ). Descriptive statistics and multivariable linear regression models were employed using IBM SPSS version 25.0. Results: A total of 580 participants were enrolled (mean age = 29.1 ± 10.0 years; 51.2% female), of which 74.7% (n = 433) had poor sleep quality (PSQI global score > 5) with a total sleep duration per night of 6.2 ± 1.6 hours. Gender (p-value=0.044), educational level (p-value=0.001), emotional level (p-value=0.005) and external eating (p-value=0.026) were significantly associated with poorer sleep quality. Conclusion: This study underscored the high prevalence of poor sleep quality among adults living in Terengganu, Malaysia. The findings could serve as a basis for developing sleep education strategies that are tailored to improve sleep quality among adults.

Introduction: Tinea imbricata (TI) outbreak poses a significant health burden among indigenous populations in rainforest regions due to their geographical isolation and poor socioeconomic conditions. This study aimed to investigate the epidemiological trends, antifungal susceptibility patterns, and treatment outcomes of TI among the Bateq subtribe in Pahang, Malaysia. Materials and Methods: A cross-sectional survey was conducted between July–October 2023 in five villages within the National Rainforest Park, Malaysia. Socio-demographic characteristics, clinical manifestations, and treatment outcomes were collected through interviews, laboratory investigations, and clinical examinations. Treatment modalities were evaluated for their effectiveness in reducing disease burden. Results: 569 individuals were surveyed, revealing a TI prevalence rate of 7.91% with children aged 15 years and below exhibiting the highest susceptibility (9.22%). Antifungal susceptibility testing of clinical isolates of Trichophyton concentricum demonstrated high sensitivity to terbinafine (GM MIC=0.144 μg/ml, GM MFC=0.198 μg/ml, p<0.05) and griseofulvin (GM MIC=1.741 μg/ml, GM MFC=4.782 μg/ml, p<0.05), while clotrimazole showed moderate activity (GM MIC=5.897 μg/ml, GM MFC=22.291 μg/ml). Fluconazole demonstrated the least potency, with no fungicidal activity observed at concentrations up to 128 μg/ml. Treatment outcomes indicated that combination therapy (terbinafine gel and oral griseofulvin) significantly outperformed terbinafine gel alone, achieving an almost complete lesion resolution (LA reduced to 0.158±0.158 cm versus 3.684±1.522 cm , p<0.05). Conclusion: These findings provide critical insights into the epidemiology and emerging drug resistance of TI in the Bateq subtribe, highlighting the importance of continued surveillance, monitoring, and adaptation of treatment strategies to combat evolving antifungal resistance patterns.

Stunting remains a major public health concern in Southeast Asia, and is shaped by a complex interplay of genetic, inflammatory, and nutritional factors. This scoping review sought to map genetic polymorphisms associated with stunting in Southeast Asian children and to identify candidate biomarkers for early diagnosis and biologically targeted interventions. Following the Arksey and O'Malley framework and the PCC (Population, Concept, Context) model, a systematic search was conducted across 7 databases. Eligible studies were peer-reviewed, published in English from 2015–2024, involved children under 18 years of age, and investigated gene variants in relation to stunting. A total of 902 records were screened independently by 3 reviewers using predefined criteria, with consensus procedures to resolve any discrepancies. Eleven studies met the final inclusion criteria. Thematic analysis and protein-protein interaction mapping revealed that 5 key polymorphisms—IGF1R, GHSR, MTRR, CASP1, and CARD17—were significant contributors to growth impairment. IGF1R polymorphisms were associated with a 2.46-fold increase in stunting risk (odds ratio [OR], 2.46; 95% confidence interval [CI], 1.60–3.78), while MTRR< variants yielded an OR of 1.93 (95% CI, 1.22–3.05). Similarly, GHSR and CASP1 polymorphisms were linked to increased odds of stunting (OR, 2.15; 95% CI, 1.38–3.34 and OR, 1.67; 95% CI, 1.10–2.54, respectively). These polymorphisms were consistently associated with disrupted growth hormone signaling, chronic inflammation, and nutrient-sensitive pathways. The biological network underlying stunting in this population points to a converging mechanism of impaired endocrine function and inflammatory dysregulation. However, this review’s scope is limited by underrepresentation of some Southeast Asian nations and exclusion of non-English literature. Early genetic screening for high-risk biomarkers and precision-driven nutritional interventions may offer more effective strategies to reduce the burden of stunting in Southeast Asian children.

Objective: Biportal endoscopic spine surgery (BESS) has emerged as a minimally invasive alternative for lumbar decompression, offering improved visualization with reduced tissue disruption. Therefore, this study aims to identify key anatomical considerations, particularly interlaminar-disc mismatch and the “banana-shaped” curvature of the lamina, and to examine their impact on portal trajectory, alignment of the surgical corridor, and preservation of spinal structures. Methods: A retrospective, video-based analysis was conducted on 23 BESS lumbar decompression cases performed between January and March 2024. Surgical levels included L3–4 (n=3), L4–5 (n=17), and L5–S1 (n=3). Intraoperative anatomical landmarks were assessed independently by 2 spine surgeons. Interobserver agreement was evaluated using Cohen kappa, based on the identification of 3 landmarks per case in 23 cases, calculated with unweighted kappa. Visualization quality was scored on a 3-point scale. Cranial and caudal interlaminar-disc mismatches were measured and averaged. Results: Interlaminar-disc mismatch was identified in 93% of cases, with cranial and caudal mismatches ranging from 5.5±1.02 mm to 8±1.2 mm. Laminar curvature was consistently observed at L4–5 and L5–S1, which required a medial-caudal portal. In addition, the superior articular process (SAP) served as a reliable fluoroscopic and endoscopic landmark, facilitating safe access to the intervertebral disc. A limited medial facetectomy provided adequate operating space. The findings also demonstrated high interobserver reliability for anatomical identification (κ=0.84), and the use of layer-specific flavectomy preserved the inner layer of the ligamentum flavum. Conclusion Successful BESS requires integrating detailed anatomical understanding with intraoperative adaptability. Recognizing interlaminar-disc mismatch, laminar curvature, and SAP orientation enables optimal portal placement and targeted decompression. These principles are essential for achieving reproducible and safe outcomes in BESS.

Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDAR encephalitis) is an autoimmune encephalopathy increasingly recognized in the pediatric population. Although conventional immunotherapy-focused treatments have significantly improved outcomes, a substantial proportion of patients experience enduring neuropsychiatric and cognitive sequelae. Here, we present a three-year longitudinal follow-up report of a female case with confirmed anti-NMDAR encephalitis, focusing on the neuropsychiatric trajectory and cognitive sequelae management with memantine. A previously healthy 10-year-old girl presented with acute-onset psychotic, affective and cataplexy-like features, primarily such as severe irritability and dysphoria, mixed-type mood fluctuation, affective lability, disorganized speaking and thinking, mutism, visual hallucinations, cognitive regression, dysgraphia, and impulsive behavioral dysregulation. The patient received immunotherapy including intravenous methylprednisolone, intravenous immunoglobulin, and rituximab, as well as concurrent psychotropics, including valproate and olanzapine/aripiprazole. Despite psychiatric improvement in 6 months, she showed persistent deficits in memory, executive function, and impulse control, even after 18th month of conventional therapies. Despite appropriate immunotherapy and psychotropic treatments, exhibited persistent deficits in attention, memory, and executive functioning (dysfunction in language and learning), without any severe adverse events. Memantine, a non-competitive NMDAR antagonist with documented neuroprotective properties, was initiated during the chronic phase as complementary to psychotropic medications. While 20 mg/day dose of memantine was administering during 6 months, marked improvement was observed in her verbal fluency, academic functioning, and social engagement, that may be associated with post-acute initiation of memantine alongside conventional treatments. This case highlights the evolving understanding of post-autoimmune cognitive rehabilitation and discusses current evidence and theoretical rationale supporting memantine use in complementary treatment of prolonged cognitive dysfunction in the pediatric anti-NMDAR encephalitis.

Purpose: This study evaluated the performance of the YOLOv8m-seg model in detecting and delineating interproximal caries and cervical burnout on bitewing radiographs and examined whether increasing the number of training epochs improved segmentation accuracy and consistency. Materials and Methods: In total, 1,410 bitewing radiographs were annotated using polygon-based masks by a trained dental clinician. The YOLOv8m-seg model was trained for 50, 100, and 150 epochs on 1,128 images and validated on 282 images using the Ultralytics segmentation framework. Model performance was assessed using precision, recall, and mean average precision at intersection-over-union thresholds of 0.5 and 0.5 to 0.95 (mAP0.5, mAP0.5-0.95) for both bounding box and mask outputs. Additional evaluation was conducted on a non-augmented validation subset. Results: Extended training duration was associated with improved segmentation performance. The highest mask mAP0.5-0.95 value was 0.828 at epoch 150. Both box-based precision and recall increased with longer training, whereas mask-based evaluation more accurately reflected the model’s ability to delineate the boundaries of caries and cervical burnout. Performance appeared consistent across both classes in the augmented validation split but was reduced in the non-augmented validation subset. Conclusion The YOLOv8m-seg model demonstrated high diagnostic accuracy in distinguishing proximal caries from cervical burnout on bitewing radiographs. Its mask-based outputs may assist clinicians in early lesion recognition and support improved diagnostic decision-making. Future studies should evaluate model generalizability across broader populations and diverse clinical environments and should prioritize assessment using non-augmented validation sets and independent test datasets.

Background: Anthracycline-based chemotherapy agents are widely used and are highly effective, particularly for breast cancer treatment. Although the cardiotoxic effects of anthracyclines on left ventricular (LV) function are well established, their impact on right ventricular (RV) function has not been sufficiently investigated. This study aimed to evaluate the effects of anthracycline therapy on RV function and to compare them with LV function to determine the potential cardiotoxic effects on both ventricles. Methods: This single-center retrospective cohort study included 38 female patients with breast cancer who were treated with anthracyclines between January 2021 and June 2023. Echocardiographic parameters and cardiac biomarkers were evaluated at baseline and at 6-month follow-up visit. LV ejection fraction (LVEF) was calculated using the Teichholz method due to the retrospective design. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (sPAP), and the TAPSE/sPAP ratio. Cancer therapy–related cardiac dysfunction (CTRCD) was defined according to current European Society of Cardiology criteria. Serum troponin I and pro–brain natriuretic peptide levels were recorded. Paired comparisons were performed using the paired-samples t-test. Results: Following anthracycline therapy, LV end-systolic diameter increased (2.76 ± 0.24 cm vs. 3.03 ± 0.29 cm, P < 0.001), and LVEF decreased (67.3% ± 3.6% vs. 62.2% ± 4.5%, P < 0.001). No patient fulfilled the guideline-defined criteria for CTRCD. Early diastolic transmitral flow velocity (E wave) and mitral annular early diastolic velocity (e′) were reduced (E: 0.63 ± 0.16 m/sec vs. 0.52 ± 0.12 m/sec, P < 0.001; e′: 0.09 ± 0.03 m/sec vs. 0.07 ± 0.02 m/sec, P = 0.001).TAPSE decreased (2.28 ± 0.36 cm vs. 2.16 ± 0.27 cm, P = 0.047), and systolic pulmonary artery pressure showed a nonsignificant upward trend after treatment (P = 0.052). The TAPSE/sPAP ratio declined (1.11 ± 0.47 vs. 0.86 ± 0.20, P < 0.001), and pulmonary artery diameter increased (19.9 ± 2.0 mm vs. 21.3 ± 2.6 mm, P = 0.008). Serum troponin I levels increased significantly (4.84 ± 1.25 ng/L vs. 11.93 ± 4.91 ng/L, P < 0.001). Conclusions Anthracycline therapy may be associated with modest changes in both LV and RV parameters. Reductions in TAPSE and the TAPSE/sPAP ratio, together with a nonsignificant upward trend in systolic pulmonary artery pressure, may reflect subtle alterations in RV–pulmonary arterial interactions rather than overt RV dysfunction. Routine evaluation of RV function, alongside LV assessment, may provide additional insights during cardiotoxicity monitoring in anthracycline-treated patients. These findings should be interpreted cautiously and confirmed in larger prospective studies.

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.

Cost-Effectiveness of Mobile Application Use in Managing Type 2 Diabetes Mellitus: A Systematic Review Introduction Type 2 diabetes mellitus (T2DM) is a debilitating condition that imposes a significant economic burden on its management. This study aims to systematically review the published evidence on the cost-effectiveness of mobile health (mHealth) application interventions for T2DM. Methods A search strategy was conducted using electronic bibliographic databases, including PubMed, Web of Science and Scopus for published studies. The inclusion criteria included original articles that reporting cost-effectiveness evaluation studies on mHealth application interventions directed at patients diagnosed or at risk of T2DM, English-language articles and published in the year 2016 to 2020. Results A total of 6 eligible studies were selected. The cost savings per person for treating T2DM ranged from USD 1,346 to USD 3,781 per year. The major contributor to cost savings was reduced complication management resulting from good glycaemic control. The direct impacts of the intervention include reduced hospitalisation and fewer unplanned clinic visits, while diabetes- related mortality was indirectly reduced usingmHealth. Conclusions The mHealth intervention was cost-effective in managing patients with T2DM. Implementation can be extended to other disease management areas to not only reduce total healthcare expenditure but also improve patients’ quality of life.