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.

Objective: A cluster of leptospirosis and brucellosis cases in a semi-nomadic, pastoral community was reported in October 2023 from Village A, Uttarakhand State, India. This cluster was investigated to describe the epidemiology and potential exposures. Methods: Suspected cases were residents with sudden-onset fever or myalgia occurring from 1 August 2023 to 7 January 2024; confirmed cases were suspected cases with laboratory confirmation. Suspected cases were identified through a house-to-house case search and were interviewed regarding sociodemographic variables, symptoms and exposures. Those who consented were tested. Data were cleaned and analysed in Microsoft Excel. Results: Fifty suspected cases were identified among a total of 300 residents across 85 households. Among these, 27 agreed to be tested, and 25 were confirmed (13 with leptospirosis, 7 with brucellosis and 5 with both leptospirosis and brucellosis). The cases began in September 2023 following flooding and continued until January 2024, with no deaths. The median age (range) of cases was 30 (17–82) years for leptospirosis, 39 (25–56) years for brucellosis and 39 (22–50) years for coinfection. Altogether, females accounted for 92% (12/13) of leptospirosis cases, 57% (4/7) of brucellosis cases and 80% (4/5) of coinfections. Symptoms included fever, myalgia and arthralgia. All cases reported contact with floodwater and animal abortus. Discussion: This was a laboratory-confirmed co-occurring cluster of leptospirosis and brucellosis, including five cases of coinfection, following flooding, predominantly affecting female Van Gujjar dairy farmers. Education was provided to the community about the hygienic disposal of animal waste.

Introduction: Prediabetes or intermediate hyperglycemia (IH) represents a critical phase in the trajectory toward type 2 diabetes mellitus (T2DM). Recent evidence from the International Diabetes Federation (IDF) suggests that 1-hour OGTT (1HOGTT) ≥8.6 mmol/L is a more sensitive biomarker for early beta-cell dysfunction, with enhanced detection of IH and future T2DM risk. Conventional screening using hemoglobin A1c (HbA1c) or 2-Hour OGTT (2HOGTT) may delay identification of prediabetes, narrowing the window for early intervention. This study evaluates 1HOGTT as a screening tool for prediabetes among Malaysians. Methodology: This cross-sectional study enrolled adults without prior T2DM or prediabetes. Participants underwent 1HOGTT, 2HOGTT, and HbA1c, classified as per the Malaysian Clinical Practice Guideline for T2DM (6th Edition) and IDF 2024 criteria. Agreement between tests was assessed using McNemar’s test and Cohen’s kappa. Diagnostic accuracy was evaluated via receiver operating characteristic (ROC) curve analysis. Cost-effectiveness was determined using reagent cost only. Results: The majority of the 310 participants were female (71.6%), Malay (87.1%), with average age of 40. The 1HOGTT identified prediabetes in 21.6% (n = 67) compared to 17.1% (n = 53) by HbA1c and 2.6% (n = 8) by 2HOGTT. McNemar’s test confirmed statistically significant discordance between 1HOGTT and 2HOGTT (chi-square = 53.397, p <0.001): 61 participants were prediabetic by 1HOGTT but normal by 2HOGTT, versus only 2 in the reverse direction. No significant discordance was found between 1HOGTT and HbA1c (chi-square = 2.817, p = 0.093). 1HOGTT demonstrated excellent discriminatory ability against 2HOGTT (AUC = 0.908; 95% CI: 0.837–0.978), significantly outperforming HbA1c (AUC = 0.664; CI: 0.462– 0.867; DeLong p = 0.012). In a population-level cost analysis, 1HOGTT achieved lowest cost per prediabetes case detected (RM 5.79) – approximately 8.3 times and 8.1 times more cost-effective than 2HOGTT (RM 48.08) and HbA1c (RM 46.78) respectively. Conclusion 1HOGTT identifies a significant proportion of individuals with prediabetes missed by 2HOGTT and HbA1c. Incorporating 1HOGTT enhances the detection of prediabetes, is cost-effective, and enables timely preventive measures in our population with high diabetes burden.
Glucose Tolerance Test ; Glycated Hemoglobin ; Prediabetic State

Caesarean scar pregnancy (CSP) is a pregnancy where embryo is implanted in the myometrium of a previous caesarean scar and it is a rare type of ectopic pregnancy. Diagnosis and management of CSP is a challenge because caregivers lack awareness about the possibility of implantation in previous caesarean surgery scar. We present here six CSP cases. All patients presented with abdominal pain and/or bleeding per vaginum with history of previous caesarean section. On ultrasonography, caesarean scar pregnancy was diagnosed. We managed them endoscopically at an endoscopic surgery and training center during the year 2019 till the year 2022. The pre-operative and post-operative periods were uneventful and they were discharged on day 2 or 3 of surgery. Hystero-laparoscopic combined approach is a good option for managing CSP in expert hands. Although there are no clear guidelines for managing CSP, we suggest individualizing each patient's treatment plan, depending on their personal characteristics and available facilities at the managing center.

Background: s/Aims: The effect of preoperative biliary drainage (PBD) on outcomes for pancreaticoduodenectomy (PD) patients with moderate jaundice (10–15 mg/dL) remains understudied. While PBD aims to improve hepatic function, it may increase morbidity due to infections. Methods: This study analyzed PDs performed between July 2022 and 2025. Patients with periampullary cancers and bilirubin levels of 10–15 mg/dL were included. We compared patients who underwent upfront PD (upfront surgery [UP] group) with those who received PBD (via endoscopic retrograde cholangiopancreatography or percutaneous transhepatic biliary drainage) regarding perioperative outcomes, morbidity, mortality, bile microbiology, antibiotic use, and costs. Results: Among 92 PD patients, 40 met the inclusion criteria (UP = 16; PBD = 24). Baseline characteristics were comparable, except for higher bilirubin levels in the UP group (12.6 mg/dL vs. 1.35 mg/dL, p = 0.001). The PBD group exhibited a harder pancreatic texture (58.3% vs. 25.0%, p = 0.03), higher surgical site infections (SSIs) (70.8% vs. 18.7%, p = 0.001), and a greater incidence of positive bile cultures (75% vs. 25.0%, p = 0.001). Overall morbidity, Clavien-Dindo grade 3 complications, and 90-day mortality rates were similar between the groups. However, antibiotic costs were significantly higher in the PBD group (₹31,047 vs. ₹20,937; +50%). Conclusions In patients with moderate jaundice (10–15 mg/dL), upfront PD can be performed safely. Routine PBD offers no clinical benefit and is associated with higher rates of SSIs, bile contamination, and increased costs.

Background: s/Aims: Left lateral sectionectomy (LLS) is a commonly performed liver resection. The Rex-recess technique, an extrahepatic Glissonian approach through the umbilical fissure, provides earlier extrahepatic vascular control, potentially resulting in safer and faster resections. However, comparative data between these approaches is limited. This study aims to compare the Rex-recess technique with the standard technique for LLS regarding operative parameters, intraoperative blood loss, and postoperative outcomes. Methods: This retrospective cohort study included 48 consecutive adult patients who underwent open LLS at a tertiary hepatobiliary centre between January 2021 and November 2025. Patients were categorized based on the surgical technique used: standard technique (n = 25) and Rex-recess technique (n = 23). Primary outcomes assessed included operative time, blood loss, transfusion requirements, and postoperative complications. Secondary outcomes focused on selected early postoperative recovery parameters. Results: Baseline demographics were comparable between groups. The Rex-recess technique significantly reduced operative time (90 ± 17.1 minutes vs. 162 ± 27.2 minutes; p < 0.0001) and intraoperative blood loss (80 ± 42.3 mL vs. 250 ± 67.2 mL; p < 0.0001).Other postoperative outcomes, including complication rates and length of hospital stay, were comparable between the two groups. Conclusions The Rex-recess approach appears to be a feasible and anatomically sound technique for LLS, offering advantages in operative efficiency, such as reduced operative time and blood loss. However, due to the retrospective design and non-randomized allocation, these findings should be interpreted with caution. Further prospective studies are needed to validate these results.

Background: s/Aims: Early liver graft regeneration after living donor liver transplantation (LDLT) is critical for patient outcomes, yet prospective volumetric data from Indian recipients remain limited. This study quantifies early graft regeneration and identifies predictors using computed tomography (CT) volumetry. Methods: In this prospective single-center study, 34 consecutive adult LDLT recipients underwent CT volumetry on postoperative days 7 and 30. Results: Mean baseline graft volume was 607.9 ± 137.9 cm3 , increasing to 957.3 ± 175.7 cm3 at day 7 (+62%, p < 0.001) and 1,293.4 ± 247.0 cm3 at day 30 (+111%, p < 0.001), achieving 93% ± 22.7% of predicted standard liver volume (SLV). Multivariate analysis identified recipient body mass index (BMI) (β = 29.4 cm3 /kg/m2 , 95% CI 14.4–44.4, p < 0.001) and graft-to-recipient-weight ratio (GRWR) (β= 435.9 cm3 per unit, 95% CI 95–777, p = 0.015) as independent predictors of day-30 graft volume (adjusted R2 = 0.349). Left-lobe grafts showed higher proportional growth than right-lobe grafts (174% ± 41% vs. 103% ± 34%, p < 0.001) with comparable absolute volumes (p = 0.56). Younger recipients (19–41 years) demonstrated greater regeneration than older recipients (56–64 years; 160% ± 32% vs. 109% ± 38%, p = 0.01). Mild macrosteatosis (< 30%) did not impair regeneration. Conclusions Liver graft regeneration in this Indian LDLT cohort was rapid, with near-complete SLV restoration by 30 days. BMI and GRWR independently predicted volumetric recovery, supporting personalized graft selection and the expanded use of left-lobe grafts.

Objective: A high rate of implant failure is frequently observed in osteoporotic spines. The majority of patients with osteoporosis are relatively old and are often unfit for general anesthesia due to various systemic comorbidities. Cement-augmented pedicle screw fixation is designed to improve stability and fixation strength in patients with compromised bone quality. Methods: A total of 45 patients (23 women and 22 men), with a mean age of 71.37 years (range, 53–94 years), diagnosed with osteoporosis (T score > -2.5) and deemed unfit for general anesthesia, underwent instrumentation with polymethylmethacrylate augmentation of cannulated pedicle screws. In total, 214 pedicle screws were inserted: 28 patients received 4 screws and 17 patients received 6 screws, all with cement augmentation. Preoperative and postoperative visual analogue scale (VAS) scores for pain, as well as Oswestry Disability Index (ODI) questionnaire data, were analyzed. Screw migration, defined as the distance from the screw tip to the anterior cortex and the upper endplate of the vertebra, was also evaluated immediately after surgery. The mean follow-up period was 15.3 months. Results: The mean preoperative VAS was 8.76 (range, 7–10). As intractable pain was the most common complaint, significant improvement was observed postoperatively: the mean postoperative VAS decreased to 2.24 (range, 0–5) (p<0.001). ODI scores also showed significant improvement in quality of life as measured by the ODI (p<0.001). Conclusion Our results support the use of cement-augmented pedicle screw fixation in medically unfit patients with osteoporosis. This technique appears effective in increasing stabilization of fixation and preventing screw loosening in this patient population. The main complication observed was cement leakage.

Repair of moderate-to-large-sized ventral incisional hernias often requires component separation to achieve tension-free posterior layer closure. Transversus abdominis muscle release (TAR), although effective, increases operative complexity and morbidity. We describe a tissue-preserving laparoscopic transabdominal retromuscular repair with hernia sac-assisted mesh coverage without TAR. Five patients with incisional ventral hernia underwent this procedure. The hernia sac was carefully dissected while maintaining continuity with the peritoneum and used to cover the retromuscular mesh. Primary fascial closure was achieved using barbed sutures, and a polypropylene mesh was placed in the retrorectus plane. There were no intraoperative complications. Seroma occurred in three patients and resolved with conservative management without aspiration. At a median follow-up of 10 months, no recurrence or chronic pain was observed. This technique may be a feasible tissue-preserving option to facilitate posterior layer closure without TAR in selected patients, with preliminary outcomes.