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.

Background: Cytomegalovirus (CMV) infection remains a major cause of morbidity, mortality, and increased healthcare burden in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Its clinical manifestations range from asymptomatic CMV replication to end-organ diseases such as pneumonia, gastroenteritis, and retinitis, all of which are associated with a higher rate of nonrelapse mortality. Methods: We reviewed case records of children who underwent allo-HSCT at our center between April 2013 and October 2024. CMV monitoring was performed weekly until at least day +100 post-HSCT using a quantitative polymerase chain reaction assay. All patients received acyclovir prophylaxis. Pre-emptive intravenous ganciclovir therapy was initiated when CMV-DNA levels exceeded 500 IU/mL Results: A total of 150 consecutive patients (58% male) were included. The median age at HSCT was 6.3 years (interquartile range [IQR], 3.4–11.3 years). Indications for HSCT were hematologic malignancy (n=81, 54.0%), inborn errors of immunity and bone marrow failure (n=46, 30.7%), and hemoglobinopathy (n=23, 15.3%). Donor and recipient CMV seropositivity rates were 86.7% and 94.0%, respectively. CMV infection occurred in 43.4% of patients, with a median onset of 30 days post-HSCT (IQR, 21–47 days). There were five (3.3%) cases of CMV disease, resulting in one (0.7%) CMV-related death. Human leukocyte antigen (HLA)-haploidentical donor status (odds ratio [OR], 5.00; 95% confidence interval [CI], 2.43–10.29; P<0.001) and the use of serotherapy in the conditioning regimen (OR, 2.87; 95% CI, 1.47–5.60; P=0.002) were significantly associated with an increased risk of CMV infection. Conclusions CMV infection was a common occurrence, particularly among patients with HLA-haploidentical donors. Preventive strategies such as weekly surveillance and pre-emptive ganciclovir therapy proved effective in preventing overt CMV disease.

Introduction: Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (T2DM), with nerve conduction studies recognized as the diagnostic gold standard. Serum neuron-specific enolase (NSE) has been linked with DPN. This study aims to determine the prevalence of DPN among T2DM patients, evaluate clinical characteristics, and explore the relationship between NSE and DPN. Methodology: A cross-sectional study was conducted at Universiti Teknologi MARA Specialist Centre Sungai Buloh and Hospital Al-Sultan Abdullah, involving patients aged 18–60 years, diagnosed with T2DM for more than 5 years (n = 132). All participants underwent anthropometric measurement, completed the Michigan Neuropathy Screening Instrument evaluation, and biochemical parameters, including lipid profile, hemoglobin A1c, and serum creatine and NSE. The diagnosis of DPN was made based on positive NCS findings. Logistic regression was used to identify factors associated with DPN. Results: The study population had a mean age of 60.16 ± 10.28 years and a mean duration of diabetes of 14.82 ± 6.66 years. The prevalence of DPN was 51.5% (n = 68). Serum NSE levels were significantly higher (p = 0.003) and independently associated with the presence of DPN (adjusted odds ratio [OR] 1.033, 95% confidence interval [CI] 1.009–1.058, p = 0.006). Participants with DPN were also more likely to be on insulin therapy (p = 0.040). In addition, retinopathy (adjusted OR 3.567, 95% CI 1.528–8.329, p = 0.013) and elevated Urine Albumin-to-Creatinine Ratio levels indicating albuminuria (adjusted OR 1.031, 95% CI 1.002– 1.061, p = 0.037) were significantly associated with DPN. Conclusion More than half of the study population had DPN, which was significantly associated with both retinopathy and nephropathy, as well as with elevated serum NSE. This emphasizes the importance of early screening and highlights the role of NSE as a surrogate marker for neuropathy in diabetes.
Humans ; Diabetes Mellitus, Type 2 ; Diabetic Neuropathies ; Prevalence ; Phosphopyruvate Hydratase

Introduction: The 2021 IDF-DAR risk calculator had been previously evaluated in multiple studies and subsequently widely accepted and applied in clinical practice as a practical standardized tool for patient risk stratification. Recently updated, the 2026 IDF-DAR Risk calculator enables a more individualized, evidence-related evaluation of patientrelated and disease-related risk factors, incorporating modern diabetes technologies, including continuous glucose monitoring (CGM), automated insulin delivery (AID) systems, and advanced insulin formulations to enhance risk stratification. This tool allows medical professionals to tailor Ramadan practices based on overall factors toward promoting safe fasting. Methodology: This prospective multicentre observational study recruited adults with Type 1 and Type 2 diabetes attending public hospitals nationwide. People with diabetes (PwD) intending to perform Ramadan fasting were invited to participate and assessed using the 2026 IDF-DAR Risk Calculator in the 6-week pre-Ramadan period between 30th January and 19th March 2026. Results: A total of 458 PwD were evaluated and stratified into low (15.7%), moderate (41%), and high risk (43.3%) categories. Most participants had Type 2 diabetes (83.6%), with 60.3% having a disease duration exceeding 10 years and 43% exhibiting poor glycemic control (hemoglobin A1c >9%). Insulin therapy was used by 76.4% of participants, including two individuals with Type 1 diabetes using AID systems. Most participants reported no recent hypoglycemia (76.4%), 81.0% performed glucose monitoring, and 3.3% used CGM. Severe comorbidities were uncommon, with 1.1% having unstable macrovascular disease and 4.4% advanced chronic kidney disease (estimated glomerular filtration rate <30). Notably, 72.2% received structured Ramadan education. Conclusion Majority of PwD attending tertiary diabetes clinics were in the moderate- to high-risk category and intended to fast despite medical advice against fasting in some cases. Although most participants were on insulin therapy, hypoglycemia was low in the pre-Ramadan period. Integration of modern technologies, advanced insulin therapies, and structured education may support safer fasting practices.
Risk Assessment ; Diabetes Mellitus ; Hospitals ; Fasting

Introduction: Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse maternal and neonatal outcomes, including hypertensive disorders, caesarean delivery, macrosomia, and increased lifetime risk of type 2 diabetes. Despite its clinical importance, considerable international variation exists in GDM screening and diagnostic criteria. Multiple frameworks are currently used, including those from the World Health Organization (WHO), International Association of Diabetes and Pregnancy Study Groups, Carpenter and Coustan, and the National Diabetes Data Group. Differences in glucose thresholds, testing protocols (one-step versus two-step), and universal versus risk-based screening contribute to heterogeneity in reported prevalence and healthcare burden. In multi-ethnic, middle-income settings such as Malaysia, identifying an evidence-informed and contextappropriate diagnostic approach is critical. Methodology: This scoping review follows the Joanna Briggs Institute methodology and will be reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed, Scopus, and ScienceDirect will be searched for English-language studies, reviews, guidelines, and consensus statements reporting GDM diagnostic criteria. Two reviewers will independently screen and select studies. Results: Data will be charted on country, study type, diagnostic criteria, gestational age at screening, and reported challenges. Findings will be synthesized descriptively and presented in tables and figures. No formal risk-of-bias assessment will be conducted. Conclusion This review will provide a comprehensive overview of global diagnostic practices, highlight variations and gaps, and support evidence-based selection of a suitable GDM screening and diagnostic strategy for Malaysia.
Diabetes, Gestational ; Malaysia ; Policy ; Review Literature as Topic

Introduction: Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder that significantly affects adolescent girls, particularly those with overweight or obesity. However, data examining the determinants and metabolic profiles of PCOS among adolescents with overweight and obesity remain limited, especially in Malaysia. This protocol describes a case-control study investigating the cardiometabolic, dietary, and psychosocial determinants of PCOS among adolescents with overweight and obesity. Methodology: This study is designed as a case-control study involving adolescent girls aged 13–16 years with a body mass index z-score >+1 standard deviation. Cases are defined as adolescent girls with a confirmed diagnosis of PCOS based on the recommendations of the 2017 International Consortium of Paediatric Endocrinology (ICPE), while controls are those who do not meet the diagnostic criteria for PCOS. A total sample size of 440 participants is required. Participants will be recruited from 22 secondary schools selected from a list of schools in Kuala Lumpur. Data on sociodemographic characteristics, psychosocial health, physical activity, and dietary intake will be collected using structured questionnaires. Blood samples will be obtained and analyzed for diagnostic testing (free testosterone), exclusion tests (thyroid-stimulating hormone, folliclestimulating hormone, luteinizing hormone, estradiol, prolactin, and dehydroepiandrosterone sulfate), and biochemical parameters (liver function tests, lipid profile, hemoglobin A1c, fasting glucose, fasting insulin, and inflammatory markers). Results: The study is expected to generate comprehensive data on the cardiometabolic, dietary, and psychosocial determinants of PCOS among adolescents with overweight and obesity. The findings will inform early screening strategies and targeted interventions aimed at reducing long-term reproductive and cardiometabolic complications. Conclusion This protocol outlines a structured approach to investigating PCOS in adolescence and addresses current gaps in early identification and risk stratification among highrisk populations.
Adolescent ; Humans ; Case-Control Studies ; Overweight ; Polycystic Ovary Syndrome ; Obesity

Introduction: Brown tumors, also known as osteitis fibrosa cystica, are focal bone lesions resulting from increased osteoclastic activity and fibroblastic proliferation. They represent a rare complication of uncontrolled hyperparathyroidism (HPT) and may affect any part of the skeleton, including craniofacial bones. Case: We report a case of a 31-year-old Malay female diagnosed with primary HPT secondary to multiglandular disease, who initially presented with symptomatic hypercalcemia. Biochemical evaluation revealed elevated corrected calcium (2.84 mmol/L; reference range 2.2–2.6 mmol/L), low phosphate (0.63 mmol/L; reference range 0.8–1.6 mmol/L), and markedly elevated serum intact parathyroid hormone (iPTH) (286 pg/mL; reference range 14.9–56.9 pg/mL). Ultrasound parathyroid showed a large right extrathyroidal lesion, most likely suggestive of parathyroid adenoma, where sestamibi scan suggested multiglandular parathyroid adenomas with possible mediastinal involvement. She underwent exploratory parathyroidectomy on 19 June 2024, with excision of bilateral inferior parathyroid adenomas confirmed on histopathology. Despite surgery, she had persistent hypercalcemia (2.8–3.1 mmol/L) and rising iPTH levels (307 pg/mL on 24 June 2024, increasing to 413 pg/mL by 2 September 2024), consistent with persistent disease. Repeat imaging demonstrated hyperfunctioning parathyroid tissue in the anterior mediastinum. Subsequently, the patient developed progressive enlargement of the left upper gingiva associated with significant pain during mastication. Clinical and radiological evaluation revealed aggressive lesions with cortical expansion. Excisional biopsy of the gingival lesion confirmed the diagnosis of brown tumors involving the jaws. She later underwent a second parathyroidectomy with intraoperative parathyroid hormone monitoring at another centre. Postoperatively, normalization of serum calcium and iPTH levels was achieved, which led to marked clinical improvement and regression of the craniofacial brown tumor. Conclusion This case highlights that skeletal manifestations of HPT, including brown tumors, may regress following adequate biochemical control without additional local therapy. Early recognition and definitive surgical management of persistent or ectopic hyperfunctioning parathyroid tissue are essential to prevent progression and promote spontaneous bone healing processes.

Introduction: Children with Down syndrome (DS) have a higher prevalence of hypothyroidism compared to the general population, and both conditions are linked to impaired growth. This study aimed to determine the prevalence and subtypes of hypothyroidism in DS and to compare growth outcomes with controls from general population at 2 years of age. Methodology: A retrospective review was conducted on 248 children with DS (aged 2–18 years) followed at Hospital Pakar Universiti Sains Malaysia from 2020 to 2025. Growth outcomes were analyzed in a subgroup of 41 DS children with hypothyroidism compared to 46 controls. Growth was compared using standard CDC charts for and z -scores calculated with PediTools (CDC 2–20 age). Mid-parental height, target height attainment, and height velocity were evaluated. Statistical analysis used t-tests and chi-square tests (p <0.05). Results: Of the 248 children with DS, 63.7% had hypothyroidism, predominantly subclinical (85.4%). No cases of acquired or secondary hypothyroidism were found. Children with DS had significantly lower mean height z-scores (−1.91 ± 1.45 vs. −0.54 ± 1.25; p <0.001), borderline lower height velocity (5.80 ± 2.15 vs. 6.92 ± 3.56 cm/year; p = 0.050), and fewer achieved target height (35% vs. 64.1%; p = 0.030) compared to controls. Baseline characteristics were similar between groups. Thyroid ultrasound showed normal anatomy in 50%, hypoplasia in 28.6%, and nodules in 21.4%. Common comorbidities included congenital heart disease (78.4%), pulmonary complications (16.2%), and other anomalies (32.4%). Conclusion Subclinical hypothyroidism was the predominant subtype in DS. Affected children demonstrated poorer growth, with reduced height z-scores, slower growth velocity, and lower likelihood of achieving target height.
Humans ; Down Syndrome ; Prevalence ; Hypothyroidism

Introduction: We report an insidious presentation of hypocalcemic dilated cardiomyopathy (HDCM) in an infant with nutritional rickets and severe hypocalcemia, highlighting the myocardium’s strict reliance on calcium-phosphate homeostasis. Case: A 3-month-old, small-for-gestational-age male (birth weight: 1.93 kg), with congenital cataracts and persistent neonatal cholestasis (negative hepatopathy and congenital infection screens) presented acutely with post-feeding cyanosis, requiring intubation for aspiration pneumonia. The mother denied prior apneic episodes, seizures, feeding difficulties, or heart failure symptoms. Clinically, there was no murmur or hyperactive pericardium. Chest radiograph revealed globular cardiomegaly. Echocardiography confirmed HDCM (LVEF 41%). Bloodwork revealed profound hypocalcemia (1.16 mmol/L; normal 2.1–2.6), hyperphosphatemia (2.97 mmol/L), and markedly elevated alkaline phosphatase (2,411 IU/L). 25(OH)D3 was deficient (34.08 nmol/L). Secondary hyperparathyroidism (iPTH 19.55 pmol/L) represented an appropriate response. The mother had introduced goat’s milk instead of cow’s milk due to inadequate lactation. She took no supplements during pregnancy and was also vitamin D deficient. Management included IV calcium gluconate, targeted antifailure therapy (captopril, furosemide, spironolactone), and mechanical ventilation. High-dose cholecalciferol replenished depleted stores, alongside an active vitamin D analog (alfacalcidol) to bypass impaired hepato-intestinal pathways, stimulating calcium absorption. Extubated after 2 weeks with stabilized serum calcium, he was discharged on anti-failure therapy, oral calcium carbonate (54 mg/kg/day elemental), D-cure 25,000 IU 4-weekly, Ursodeoxycholic acid (45 mg 12-hourly), and multivitamins. Repeat echocardiography is planned at 3 months. Conclusion This case underscores the vulnerability to nutritional rickets and late-onset hypocalcemia in SGA infants with inadequate maternal nutrition and impaired GI absorption. The calcium-phosphate axis is easily disrupted; highphosphate substitutes (goat’s milk) precipitously unmask hypocalcemia, overwhelming compensatory hyperparathyroidism. Proactive, dual-therapy metabolic supplementation is paramount to avert catastrophic, yet reversible, HDCM.
Cardiomyopathies ; Rickets

Introduction: Assessing radiation exposure is a vital step in determining the potential health risks associated with radiation and identifying the necessity for protective measures. The study assesses the occupational radiation dose encountered by undergraduate students specializing in diagnostic imaging and radiotherapy (DIR) during their clinical training in the radiology department. Materials and methods: An analysis was conducted to compare individual exposure doses with the dose limits established by the International Commission on Radiological Protection (ICRP), concurrently assessing the variations in mean effective doses among distinct student cohorts. Optically stimulated luminescence dosimeters (OSLD) were employed to monitor 143 students across five cohorts from 2017 to 2022. The electronic Secondary Standard Dosimetry Laboratory (e-SSDL) information security management system tracked the deep (Hp(10)) and shallow (Hp(0.07)) dose equivalents of DIR students. Results: The mean values for accumulated Hp(10) and Hp(0.07) were found to be 0.51 and 0.50 mSv, respectively, averaged over 800 hours of clinical training. The highest recorded exposure was 1.30 mSv, signifying that the radiation exposure experienced by DIR students was well below the threshold. The mean annual effective radiation dose per student amounted to 0.17 mSv. Small but significant difference (p < 0.001) in the radiation exposure between five cohorts was observed with increments over a 5-year period. Conclusion: The students' radiation dose was notably below the ICRP dose limit of 6 mSv/ year designated for trainees. These results indicate the efficacy of the existing radiation protection measures during clinical training, reducing the likelihood of overexposure