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

Tobacco uses and obesity are major global public health concerns, with adolescence being a critical period for the onset of these risk factors. In Malaysia, rising trends in adolescent smoking and obesity necessitate further investigation. This study examined gender-specific associations between different types of tobacco use and body mass index (BMI) among school-going adolescents. Data were derived from the NHMS 2017, a nationwide cross-sectional survey using a two-stage stratified random sampling design (N=27,497). Complex sample logistic regression was employed to assess the odds of past 30-day tobacco use by BMI category (underweight/normal weight, overweight, obese) stratified by gender. Confounders, including age, ethnicity, physical activity, fast food consumption, and mental health, were controlled for in the analysis. Adolescents classified as obese had a significant association with tobacco use, but this was not observed in overweight individuals. Male smokers were significantly less likely to be obese, whereas female smokers had a higher likelihood of obesity (AOR = 1.59, 95% CI: 1.25–2.02). Specifically, female users of e-cigarettes (AOR = 1.86, 95% CI: 1.36–2.56), smokeless tobacco (AOR = 1.66, 95% CI: 1.14–2.43), and other tobacco products (AOR = 1.62, 95% CI: 1.05–2.52) exhibited a higher risk of obesity. No significant association was found among male smokers. Female adolescent smokers showed a greater likelihood of obesity, emphasizing the need for gender-specific interventions. To mitigate these risks, public health efforts should incorporate education, policy measures, and lifestyle promotion. Further research is warranted to explore underlying biological mechanisms

Typhoid is an acute febrile illness primarily caused by Salmonella enterica serotype typhi (S. Typhi) which could be challenging to diagnose in children, owing to its non-specific clinical signs and symptoms which may resemble other febrile illnesses. Here, we present a case of typhoid which was atypically presented as fever of unknown origin (FUO) in a two-year-old boy with underlying glucose-6-phosphate dehydrogenase (G6PD) deficiency. This child was initially diagnosed and managed as acute tonsillopharyngitis, however remained febrile despite medications. A series of investigations were performed and S. Typhi was isolated from the bone marrow culture after almost a month of admission. The antibiotic was started based on antibiotic susceptibility testing and he recovered well. Our case underscores the challenges of diagnosis establishment and clinical management of typhoid in paediatric patients who has underlying disease and emphasizes the importance of having high index of clinical suspicion to ascertain timely and proper diagnosis.

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.

MEDICAL AESTHETIC AWARENESS AMONG PUBLIC IN MALAYSIA AND THE FACTORS THAT MAY INFLUENCE IT: A CROSS-SECTIONAL STUDY Introduction: Medical aesthetic practice is growing rapidly in Malaysia due to rising market demand, yet public understanding of these practices remains limited. This study evaluated the awareness and attitudes towards medical aesthetics among Malaysians. Methods: A cross-sectional survey was conducted among individuals aged ≥ 18 years old in Malaysia from December 2021 to May 2022. The survey was distributed both online and in public settings. The survey comprised of respondents’ sociodemographic, perception of physical attractiveness, knowledge and attitude towards medical aesthetic practices. The factors influencing respondents’ attitudes towards medical aesthetic practices in the country were analysed using binary logistic regression, with the significance level set at P<0.05. Results: A total of 382 respondents participated in this study with average age of 30.81 (±9.38) years, ranging from 18 to 68 years. The majority were women (77.5%), Malay (53.7%) and Muslim (57.1%). Although most respondents had no prior experience in medical aesthetic treatment (68.1%), 76.2% respondents demonstrated good knowledge and 70.2% had positive attitude towards these services. Additionally, 53.9% of the respondents highly valued the importance of physical attractiveness. The Buddhists and Hindus exhibited more positive attitude than the Muslims. Conversely, those who placed higher importance on physical attractiveness were 0.5 times less likely to develop a positive attitude towards medical aesthetic services. Conclusion: In conclusion, despite limited experience in medical aesthetic treatments and practice, most Malaysians possess good knowledge and positive attitudes towards medical aesthetics, indicating a growing interest and potential willingness to consider these services for enhancing their appearance.

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.

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: Older persons are more susceptible to malnutrition. However, malnutrition identification through nutrition screening is not routinely performed in Malaysia’s health clinics due to no specific nutrition screening guideline and validated tool in this setting. This study aimed to develop a nutrition screening guideline for older patients and assess its feasibility for use by healthcare staff in health clinic setting. Methods: This study was conducted in three phases. In Phase I, needs assessment was conducted amongst healthcare staff. Development of nutrition screening guideline in Phase II involved scoping review and validation amongst six experts and twelve healthcare staff. In Phase III, twenty-two healthcare staff participated in feasibility assessment using in-depth interviews after completing nutrition screening in older patients. Interview data was analysed thematically using NVivo Software 12.0. Results: A Malay language version of nutrition screening guideline in A4-sized with 31 pages was developed and validated. Items with a content validity index ≥0.83 from experts review were retained, while <0.83 were revised accordingly. Validation amongst healthcare staff showed positive responses. The guideline was then assessed for feasibility, where 110 older patients (mean age= 68.7±6.1 years) were screened by healthcare staff using the newly developed nutrition screening guideline. Four themes emerged from in-depth interviews: 1) Ease of use; 2) Identification and management of malnutrition; 3) Acceptability; and 4) Implementation of nutrition screening. Conclusion: The newly developed and validated nutrition screening guideline is well-accepted and feasible for healthcare staff to screen older patients in health clinic setting for timely malnutrition identification and management.