Purpose: Adjuvant radiotherapy (RT), while effective in reducing cancer recurrence and improving survival rates, often comes with radiation toxicity that can adversely affect the patient’s quality of life (QoL). Evaluating toxicity after RT is crucial because it helps to identify and manage adverse effects that can significantly impact a patient’s QoL. By monitoring toxicity, we can adjust treatment plans to mitigate these effects, improve patient comfort, and ensure a better overall outcome. Therefore this study aimed to evaluate and compare QoL following 3D-conformal hypofractionated RT in breast cancer patients. Methods: We included twenty-one Malaysian women with unilateral breast cancer treated with lumpectomy (n=15) or mastectomy (n=6) followed by 3D-conformal hypofractionated RT. QoL was evaluated using the EORTC QLQ-BR45 questionnaire before, during, and after RT. Results: During RT, there was a significant increase in the mean score of the breast symptoms scale compared to baseline (p=0.002), with the most common symptoms being skin problems, followed by swelling and oversensitivity. However, these symptoms were generally mild for most patients. The other quality of life scales remained stable during RT. Post-RT, most QoL scales showed improvements compared to both baseline and during RT, with significant enhancements in the mean breast symptoms score and breast satisfaction score (all p<0.05). Conclusion: Radiotherapy negatively impacted the QoL of our breast cancer patients, specifically on the breast symptoms scale. However, these symptoms improved after 4 months, resulting in high breast satisfaction and indicating a near-excellent cosmetic outcome. Future studies with larger cohorts are essential to validate these findings, as the small sample size (n=21 at baseline; n=13 post-RT) may have limited the detection of more subtle changes

Nursing education has undergone a significant transformation as a result of artificial intelligence (AI). Chatbots, specifically ChatGPT, have emerged as vital AI technologies within the nursing domain as it is a computer program designed to simulate human conversation through text or voice interactions. This study aims to conduct a bibliometric analysis to gain insights into the publication trends, citation impact, and thematic evolution in nursing education and practice concerning ChatGPT and chatbots. A comprehensive bibliometric analysis was performed using VOSViewer, concentrating on citation networks for data analysis and visualisation. A review of LENS.org identified 344 relevant research publications regarding chatbots and ChatGPT within the nursing discipline, all of which were utilised in the study. The study examined various aspects, including types of publications, prominent authors, leading journals, participating nations, institutions, and the impact of ChatGPT on nursing practice. The primary objectives included categorising the papers, identifying the most influential authors, delineating the prominent areas and institutions in the field, and examining the impact of ChatGPT on nursing education and practice. The findings indicate that ChatGPT positively impacts nursing education by enhancing learning experiences, improving communication, and aiding clinical decision-making. The findings indicate that journal articles accounted for 76% of publications, with the U.S. leading in research output. The findings indicate that ChatGPT positively impacts nursing education by enhancing learning experiences, improving communication, and aiding clinical decision-making. Future research should focus on establishing frameworks for integrating ChatGPT into nursing education, addressing ethical implications, and assessing the long-term impacts on patient care.

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.

Objective: This study aims to describe histological manifestations and characterise the CDV strain in the tiger to determine its molecular epidemiology and postulate viral pathogenicity. Methods: Histopathology characterisation of the infected tissues were performed through haematoxylin and eosin and immunohistochemistry staining, respectively. We conducted virus isolation and titration in Chinese hamster ovarian expressing the dog signalling lymphocytic activation molecule (CHO-SLAM) cells. Reverse transcription polymerase chain reaction was performed to confirm the presence of CDV RNA, nucleotide and amino acid sequence analyses for comprehensive characterisation of the CDV strain. Results: Notable histopathological changes were observed primarily in the brain, lung, liver, kidney, spleen, and stomach, with viral antigens localised in the lung, liver, kidney, and stomach tissues. CDV-induced cell cytopathic effects yielding 4.27 × 10 6 TCID 50 /mL were observed at 48 h post-inoculation in CHO-SLAM cells. Phylogenetic analysis suggested that the virus originated from the Asia-1 clade. Notably, 549H and 519I mutations in the hemagglutinin protein were observed, indicating adaptation to a non-canid wildlife species. Conclusions and Relevance: Overall, this study enhances our understanding of the molecular characterisation and evolutionary dynamics of the CDV strain present in the Malayan tiger and serves as a benchmark for developing effective preventative measures to protect Malayan tigers and mitigate their risk of extinction.

Parenting Factors and Child Obesity: A Study Among Preschoolers in Selangor, Malaysia Introduction Child obesity is a pressing global concern. In Malaysia, the rates of child obesity have risen significantly over recent decades, with 5.6% of children under the age of five being categorized as overweight or obese. Children's behavior is influenced by their home environment, which includes both physical and social aspects such as parental behavioral models, parenting styles, practices, beliefs, and societal norms. However, there is a scarcity of data on the prevalence of child obesity and its relationship with parental factors. This research set out to explore the link between parenting styles, parental physical activity, dietary habits, body image perception, screen time, and child obesity. Methods A survey using a quantitative approach was conducted among preschoolers in Selangor to test the proposed relationships between these factors. Data were gathered from 354 preschool students in Selangor. This study used a multi-stage sampling technique. In the multi-stage sampling technique, the researcher used a series of sampling frames by developing population strata and then selected using purposive sampling method. Results The analysis was carried out using SPSS version 26 and Smart PLS version 4.0. The direct effect analysis revealed that parenting styles (p = 0.000), along with parental dietary habits and body image perception (p=0.001), were significantly associated with child obesity. In contrast, parental physical activity (p = 0.167) and screen time (p = 0.739) did not show a significant relationship with childhood obesity. Conclusions The study's outcomes can assist healthcare practitioners in understanding and providing substantial evidence of the significant relationship between parenting styles, dietary practices, body image perception, and child obesity.

Environmental and Health Impacts of Pesticide-Based Malaria Control in Low- and Middle-Income Countries: A Scoping Review Introduction Malaria remains a major public health challenge in tropical and subtropical regions, necessitating effective vector control strategies. This scoping review aims to evaluate the environmental and health impacts of pesticide-based malaria control in low-and middle-income countries (LMICs). Methods A comprehensive search was conducted across Scopus, Web of Science and PubMed for studies published between 2004 and 2024, using a predefined search string based on the PEO framework. Inclusion criteria focused on studies addressing malaria control programmes and their effects on the environment and human health. Data extraction followed PRISMA 2020 guidelines. Results 12 studies were included, most of which focused on indoor residual spraying (IRS) and insecticide-treated nets (ITNs). The review identified significant direct and indirect impacts. While effective in reducing malaria transmission, IRS and ITNs pose substantial risks. Direct health effects included acute poisoning and long-term neurodevelopmental issues linked to pesticide exposure, with residues detected in breast milk. Environmental impacts included soil and water contamination, biodiversity loss and ecological disruption. The overlap of pesticide use in malaria control and agriculture was found to exacerbate insecticide resistance in mosquito populations. Conclusions Pesticide-based malaria control, while crucial, carries significant unintended consequences for human health and the environment. The findings underscore the urgent need for Integrated Vector Management (IVM) strategies that reduce reliance on chemical pesticides, mitigate resistance, and ensure environmental sustainability and public health safety.

Introduction: Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant syndrome caused by mutations in the tumor suppressor gene MENIN, classically characterized by endocrine tumors of the parathyroid glands, pancreas, and pituitary. Beyond tumorigenesis, emerging evidence suggests a role for MENIN in immune regulation, with deficiency linked to CD4⁺ and CD8⁺ lymphocyte dysfunction and predisposition to autoimmunity. While autoimmune conditions such as thyroiditis and pernicious anemia have been described in MEN1, an association with autoimmune hemolytic anemia (AIHA) has not been previously reported. We describe a rare case of MEN1 associated with warm AIHA, highlighting a potential link between endocrine tumorigenesis and immune dysregulation. Case: A 56-year-old female presented with a 4-month history of lethargy, anorexia, weight loss, and painless jaundice. She is para 6 + 1, with no history of anemia in pregnancy, prior blood transfusions, or family history of hematological disorders. Examination revealed mild pallor, jaundice, and hepatomegaly without splenomegaly. She had a prior diagnosis of MEN1, with two hallmark features: primary hyperparathyroidism and a pancreatic neuroendocrine tumor. She underwent pancreatic enucleation, hemithyroidectomy, and hemiparathyroidectomy; histopathology demonstrated a benign thyroid nodule and parathyroid hyperplasia. Whole exome sequencing identified no pathogenic MEN1 mutation but revealed a c.1621A>G variant, classified as a non-deleterious polymorphism. Variants in TP53 and BRCA1 were also detected without phenotypic expression. Surveillance colonoscopy and mammography were unremarkable. Laboratory findings were consistent with warm AIHA, including elevated lactate dehydrogenase, indirect hyperbilirubinemia, low haptoglobin, reticulocytosis, and a positive direct Coombs test (immunoglobulin G). Peripheral blood film was nonspecific. She responded well to a tapering course of prednisolone. Conclusion This case highlights a possible association between MEN1 and autoimmune hemolysis. The presence of the MEN1 c.1621A>G variant, alongside TP53 and BRCA1 variants, raises the possibility of modifier effects influencing immune dysregulation. Further studies are needed to clarify this relationship.

Introduction: Congenital toxoplasmosis (CTox) is common in Malaysia and classically presents with brain and eye involvement, causing hydrocephalus, intracranial calcifications, cataract, chorioretinitis, blindness, epilepsy, and psychomotor or mental impairment. Cranial diabetes insipidus (CDI) and panhypopituitarism rarely complicate its clinical course. Case: From 2024 to 2026, we had encountered three cases of CTox infants, of whom 2 (C1, C2) had a stormy neonatal period and passed away by 3 months old due to refractory seizures, while the 3rd (C3) survived. C1 (2.2 kg) was diagnosed antenatally from fetal ultrasound brain with severe ventriculomegaly, whereas C2 (2.47 kg) had multiple syndromic features, cleft lip, palate and anopthalmos. C3 (2.6 kg) was only diagnosed later by 1-month-old when she had afebrile seizures. C1 and C2 had severe hypernatremia (Na >150 mmol/L) within 1st week of life, but C3 had hypernatremia after surgical drainage of her hydrocephalus and administration of steroids. All were diagnosed with CDI and fulfilled the triad of polyuria, hypernatremia and inappropriate paired osmolality. During acute period, they were managed with IV vasopressin infusion with intensive monitoring. At low dose (0.1–0.3 mcg/kg/hour), all achieved eunatremia and euvolemia within 12 hours with no inadvertent hyponatremia. They also had central hypothyroidism and received L-thyroxine, with prior oral hydrocortisone, except C1. Their CDI persisted with highest Na 165 mmol/L in C1. They were started on tab hydrochlorothiazide (HCTZ) alongside low renal solute load formula (LRSL) and EBM. HCTZ dose was titrated gradually from 0.5 to 1.0 mg/kg/dose and further to 1.5 mg/kg/dose. In between, subcutaneous desmopressin (DDAVP) 0.02–0.04 mcg were given during breakthrough DI. All cases responded to HCTZ at 1.5 mg/kg/dose, with varying intervals (daily to TDS). C3 went home after 6 weeks with HCTZ, L-thyroxine and hydrocortisone, together with oral anti-toxoplasmosis and anticonvulsants. Conclusion CTox with CDI presents a challenge during infancy, and a combination of LRSL with thiazide diuretics is an acceptable alternative, prior to definitive DDAVP therapy later.
oxoplasmosis, Congenital ; Hydrochlorothiazide ; Diabetes Insipidus

Introduction: ABCD syndrome (ABnormal Calcium-CreatinineCalcinosis in Down syndrome) is a rare tetrad of hypercalcemia, hypercalciuria, nephrocalcinosis, and renal impairment in children with Down syndrome, often with delayed diagnosis resulting in irreversible renal damage. : We report a 7-year-old male with Down syndrome, who previously had a stormy neonatal period due to large atrialseptal-defect and pulmonary hypertension, and required surgery at 3-years-old with prior prolonged ventilation. He was since bedbound with severe spastic diplegia, complicated by GERD and food aversion, requiring nasogastric tube feeding. He was discovered to have hypercalcemia and renal impairment during admission in district hospital for febrile illness with gastrointestinal symptoms. Initial serum calcium was 2.78 mmol/L, phosphate 1.54 mmol/L, magnesium 0.96 mmol/L, ALP 210 IU/L, urea 18.6 mmol/L, and creatinine 266 umol/L. Renal impairment did not improve and ultrasound KUB revealed bilateral small kidneys with medullary nephrocalcinosis. Consultation with the paediatric nephrologist concluded as CKDstage-4. He was transferred to our centre. He demonstrated severe hypercalcemia (3.44 mmol/L), hypercalciuria (urinecalcium-to-creatinine-ratio of 1.17 mmol/mmol, >95 th%), and suppressed iPTH (0.9 pmol/L,1.6–6.9), suggesting PTH-independent process. 25-OH-Vit-D3 was 134 nmol/L (74–250, sufficient). He was more irritable and moody, but no seizures. ECG was normal. Skeletal assessment did not reveal osteolytic changes or increased resorption. He was investigated by paediatric hemato-oncologists, with negative findings, despite extensive search for hematological or bone malignancy and granulomatous disease. His ESR and immunoglobulin level was high for unknown reasons. He was treated with intravenous and oral hydration, dietary calcium restriction with modified lowcalcium formula, assisted by dietitian, and IV pamidronate infusion (0.125 mg/kg) stat dose, resulting in stabilization of serum calcium level (2.5 mmol/L), which persisted for about 8 weeks during follow-up. Conclusion ABCD syndrome should be considered in Down syndrome children presenting with unexplained hypercalcemia. Early recognition and intervention are vital.
ABCD syndrome ; Down Syndrome ; Hypercalcemia

The detection of insecticide resistance is pivotal for characterising the phenotypic resistance of field-collected Aedes aegypti populations, enabling the early identification of resistance trends and safeguarding the efficacy of chemical interventions in vector control programmes. Although the World Health Organization (WHO) adult tube test remains the standard screening method, its reliance on binary classifications of susceptibility and resistance limits the ability to compare the magnitude of resistance among different insecticides. To address this limitation, probit analysis was performed on adult mortality data obtained from a field-collected strain exposed to WHO-recommended discriminating and intensity concentrations. LC50 values were subsequently normalised using a concentration ratio (CR) framework, allowing resistance levels to be quantified and compared across insecticides. The relationship between the CR and slope parameters derived from probit analysis enabled the inference of resistance magnitude within field populations. The results demonstrated that pirimiphos-methyl retained high efficacy against the tested populations, whereas substantial intra-population variation in resistance intensity was observed among pyrethroids and malathion. Lambda-cyhalothrin exhibited the highest level of resistance, followed by permethrin and alpha-cypermethrin. These findings highlight the value of data-driven approaches for enhancing the interpretation of insecticide resistance profiles and providing a more comprehensive assessment of resistance status. By utilising mortality data generated from WHO-recommended discriminating and intensity bioassays, resistance can be evaluated beyond the binary outcomes of standard susceptibility tests, thereby supporting more informed decisions on insecticide rotation and resistance management in vector control programmes.