Background: Frailty is a health condition preceding impairment and disease, resulting in vulnerability and risk of poor outcomes. Frailty is a multidimensional geriatric syndrome encompassing physical, psychological and cognitive components. Psychological frailty refers to reduced emotional resilience, mood stability, and coping capacity. This paper aims to review the current literature on psychological frailty and mental health outcomes among older adults. Methodology : Four electronic databases, PubMed, Scopus, Science Direct and Web of science were used to systematically search for studies published between January 2019 and December 2023, that examined the effect of psychological frailty on mental health outcomes in older adults, including depression, anxiety, and overall well -being. Results: There were 154 articles screened, with 7 studies meeting inclusion criteria. All included studies assessed psychological frailty using the Tilburg Frailty Indicator (TFI), a multidimensional frailty tool with a psychological domain. Psychological frailty, as measured using the TFI, was consistently associated with depressive symptoms, anxiety, and reduced quality of life. The psychological domain of the TFI demonstrated moderate internal consistency (Cronbach ’s α = 0.712 -0.797). Conclusion: Psychological frailty is a potential risk factor for the development of adverse mental health outcomes in older adults. The use of validated measures, such as the TFI may improve the identification of psychological frailty for early intervention strategies in both community and medical settings to protect older adults ’ mental health

Background: Frailty is a health condition preceding impairment and disease, resulting in vulnerability and risk of poor outcomes. Frailty is a multidimensional geriatric syndrome encompassing physical, psychological and cognitive components. Psychological frailty refers to reduced emotional resilience, mood stability, and coping capacity. This paper aims to review the current literature on psychological frailty and mental health outcomes among older adults. Methodology : Four electronic databases, PubMed, Scopus, Science Direct and Web of science were used to systematically search for studies published between January 2019 and December 2023, that examined the effect of psychological frailty on mental health outcomes in older adults, including depression, anxiety, and overall well -being. Results: There were 154 articles screened, with 7 studies meeting inclusion criteria. All included studies assessed psychological frailty using the Tilburg Frailty Indicator (TFI), a multidimensional frailty tool with a psychological domain. Psychological frailty, as measured using the TFI, was consistently associated with depressive symptoms, anxiety, and reduced quality of life. The psychological domain of the TFI demonstrated moderate internal consistency (Cronbach ’s α = 0.712 -0.797). Conclusion: Psychological frailty is a potential risk factor for the development of adverse mental health outcomes in older adults. The use of validated measures, such as the TFI may improve the identification of psychological frailty for early intervention strategies in both community and medical settings to protect older adults ’ mental health

Introduction: Swyer syndrome (46, XY gonadal dysgenesis) is a rare disorder of sex development, characterized by a phenotypic female with streak gonads and hypergonadotropic hypogonadism. It presents with primary amenorrhea and delayed puberty. Overlapping clinical features with Turner syndrome may cause diagnostic uncertainty, highlighting the role of karyotypic evaluation in diagnosis. Case: A 35-year-old phenotypic female was first evaluated at age 27 during admission for an acute viral illness, when incidental findings of primary amenorrhea, short stature (height 131 cm), webbed neck, pectus excavatum, and absent secondary sexual characteristics raised suspicion of Turner syndrome. She had hypertension, with initial imaging suggesting coarctation of the thoracic aorta. CT angiography showed focal narrowing of the descending aorta; multidisciplinary review favored aortic folding, and she was managed conservatively. Endocrine evaluation demonstrated hypergonadotropic hypogonadism, with markedly elevated follicle-stimulating hormone (FSH 108.6 IU/L) and luteinizing hormone (LH 23.16 IU/L) in the presence of low estradiol levels. Pelvic imaging revealed an atrophic uterus with absence of bilateral ovaries, consistent with gonadal dysgenesis. Karyotypic analysis was performed, demonstrating a 46, XY genotype with confirmed SRY gene presence, establishing the diagnosis of Swyer syndrome. DEXA scan demonstrated osteoporosis, in keeping with prolonged hypogonadism. She was commenced on hormone replacement therapy, resulting in the development of secondary sexual characteristics and regular withdrawal bleeding. She remains under structured multidisciplinary follow-up, with endocrine-led management of hypothyroidism and osteoporosis, alongside cardiology follow-up and gynecological surveillance. Conclusion This case highlights the diagnostic complexity of disorders of sex development with overlapping phenotypes and the need for re-evaluation when clinical progression is atypical. Diagnosis enables hormone replacement therapy for induction of secondary sexual characteristics and preservation of bone health. Integration of clinical, biochemical, and genetic data within a multidisciplinary framework is essential to achieve diagnostic accuracy and optimize outcomes.
Turner Syndrome

Introduction: Tuberculosis patients with comorbid diabetes face a substantially higher risk of mortal outcomes. The “metainflammation” loop between hyperglycemia and tuberculosis (TB) infection exacerbates systemic severity and increases hazard rates for death. This study aims to quantify the association between baseline hemoglobin A1c (HbA1c) levels and all-cause mortality within a Malaysian cohort. Methodology: This was a retrospective cross-sectional audit analyzing 131 adult TB-DM (diabetes mellitus) patients during their treatment course (2022–2025) in the TB Clinic, Hospital Sungai Buloh. Primary outcomes were all-cause mortality and clinical severity, stratified by baseline HbA1c and diabetes mellitus DM treatment modality (OHA vs. insulin). Results: The overall mortality rate was 17% (22/131). A stark disparity in glycemic control was observed between survivors and deceased patients: those who died presented with extreme mean HbA1c levels of 16.0%, compared to 10.5% in survivors. High HbA1c was also associated with a higher prevalence of pulmonary involvement compared to extrapulmonary disease (10.9% vs 8.9%). Patients requiring insulin therapy experienced significantly higher mortality rates compared to those managed on OHAs, with 25% (12 out of 47) patients requiring insulin therapy having died during TB treatment, compared to only 8.2% (7 out of 84) patients in the OHA-only group. Conclusion Baseline HbA1c is a critical prognostic marker that identifies a high-risk “lethal threshold” at extreme glycemic levels (HbA1c ≥16). Furthermore, the nearly fourfold increase in death risk among insulin-treated patients likely reflects a high-risk phenotype of advanced metabolic failure, which corresponds with a study done in Kelantan (Siti Rohana et al., 2020). The study shows that TB patients with DM had three times higher risk of developing unsuccessful TB treatment outcomes compared to TB patients without DM. Collectively, these data necessitate mandatory early HbA1c screening and aggressive metabolic management to reduce the staggering mortality of this dual epidemic.
Retrospective Studies

Objectives: The integration of large language models (LLMs), particularly those based on the generative pre-trained transformer (GPT) architecture, has begun to revolutionize various fields, including dentistry. Despite these promising applications, the use of GPT in dentistry presents several challenges. Ongoing research and the development of robust ethical frameworks are essential to mitigate these issues and enhance the responsible deployment of GPT technologies in clinical settings. Hence, this systematic review aims to explore the trends, applications, strengths, and challenges associated with the use of GPT in dentistry. Methods: Articles were selected if they contained detailed information on the application of GPT in dentistry. The search strategy used in systematic reviews follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search of databases and other sources yielded a total of 704 studies. After removing duplicates and conducting a full-text screening, 16 articles were included in the review. The methodological quality of the research was evaluated using the Critical Appraisal Skills Programme (CASP) checklist. Results: Out of a total of 91 articles published on GPT in dentistry, 20 were editorials and 11 were narrative reviews; these were excluded, leaving 60 original research articles for further analysis. The articles were assessed based on the type of results they provided. Ultimately, 16 articles that reported positive findings with robust methodology were included in this review Conclusions The results highlight mixed responses; therefore, further research on integration into clinical workflows must be conducted with extensive methodological rigor.

Objectives: The integration of large language models (LLMs), particularly those based on the generative pre-trained transformer (GPT) architecture, has begun to revolutionize various fields, including dentistry. Despite these promising applications, the use of GPT in dentistry presents several challenges. Ongoing research and the development of robust ethical frameworks are essential to mitigate these issues and enhance the responsible deployment of GPT technologies in clinical settings. Hence, this systematic review aims to explore the trends, applications, strengths, and challenges associated with the use of GPT in dentistry. Methods: Articles were selected if they contained detailed information on the application of GPT in dentistry. The search strategy used in systematic reviews follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search of databases and other sources yielded a total of 704 studies. After removing duplicates and conducting a full-text screening, 16 articles were included in the review. The methodological quality of the research was evaluated using the Critical Appraisal Skills Programme (CASP) checklist. Results: Out of a total of 91 articles published on GPT in dentistry, 20 were editorials and 11 were narrative reviews; these were excluded, leaving 60 original research articles for further analysis. The articles were assessed based on the type of results they provided. Ultimately, 16 articles that reported positive findings with robust methodology were included in this review Conclusions The results highlight mixed responses; therefore, further research on integration into clinical workflows must be conducted with extensive methodological rigor.

Objectives: The integration of large language models (LLMs), particularly those based on the generative pre-trained transformer (GPT) architecture, has begun to revolutionize various fields, including dentistry. Despite these promising applications, the use of GPT in dentistry presents several challenges. Ongoing research and the development of robust ethical frameworks are essential to mitigate these issues and enhance the responsible deployment of GPT technologies in clinical settings. Hence, this systematic review aims to explore the trends, applications, strengths, and challenges associated with the use of GPT in dentistry. Methods: Articles were selected if they contained detailed information on the application of GPT in dentistry. The search strategy used in systematic reviews follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search of databases and other sources yielded a total of 704 studies. After removing duplicates and conducting a full-text screening, 16 articles were included in the review. The methodological quality of the research was evaluated using the Critical Appraisal Skills Programme (CASP) checklist. Results: Out of a total of 91 articles published on GPT in dentistry, 20 were editorials and 11 were narrative reviews; these were excluded, leaving 60 original research articles for further analysis. The articles were assessed based on the type of results they provided. Ultimately, 16 articles that reported positive findings with robust methodology were included in this review Conclusions The results highlight mixed responses; therefore, further research on integration into clinical workflows must be conducted with extensive methodological rigor.

Objective: The adoption of minimally invasive spine surgery techniques has increased globally over the past decade. These techniques are primarily used for percutaneous pedicle screw insertion. Surgeons in low socioeconomic settings often depend on fluoroscopy for accurate placement of percutaneous pedicle screws. Precise medial and sagittal angulation of the Jamshidi needle is essential to prevent misplacement during screw insertion. Here, we present a technique based on trigonometric calculations that allows the accurate determination of the medial angulation of the Jamshidi needle, using intraoperative measurement of the pedicle width at the targeted vertebral body. Methods: All patients who underwent percutaneous pedicle screw insertion using the described method between August 2023 and July 2024 were evaluated by 2 independent observers using computed tomography scan images. Pedicle violations were graded according to the Gertzbin-Robbins scale. The rates of pedicle perforation, significant errors in pedicle cannulation, and postoperative complications were analysed. Interrater reliability and the correlation between intraoperative pedicle width measurements and the medial angulation value of the Jamshidi needle were assessed statistically. Results: The mean age of the patients was 44.5 years. A total of 112 percutaneous pedicle screws were analysed. Among the 15 identified pedicle breaches, 9 were medial and 6 were lateral. The pedicle perforation rate was 13.4%. None of the patients with pedicle breaches developed significant postoperative complications. Interobserver agreement between the 2 evaluators was moderate (kappa coefficient, 0.597; p<0.001). There was a strong and statistically significant positive correlation between pedicle width measurement and the medial angulation value of the Jamshidi needle (r = +0.974, p<0.001). Conclusion The medial angulation of the Jamshidi needle for percutaneous pedicle screw insertion under fluoroscopy can be predicted using intraoperative pedicle width measurements. As the intraoperative pedicle width increases, the medial angulation required for the Jamshidi needle also increases.

Background: Cerebral vasospasm has been reported following various forms of bacterial meningitis; however, there have been no prior reports of meningitis caused by the non-K1 strain of Escherichia coli. Case Report: A 63-year-old man with chronic thrombocytopenia presented with new-onset seizures that progressed to coma. Cerebrospinal fluid (CSF) analysis showed Gram-negative rods, but CSF culture and the Biofire FilmArray Meningitis/Encephalitis Panel were negative. Additional 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction and sequencing of the CSF sample indicated E. coli meningitis when correlated with the results of urine culture. The patient eventually developed diffuse cerebral arterial vasospasms with multifocal brain infarcts that progressed to brain death. Conclusion E. coli meningitis in adults may be missed if diagnostic tests include only K1 strains. Clinicians should be aware of cerebral vasospasm as a potentially serious complication of E. coli meningitis, and should consider screening for it, particularly in patients with associated risk factors.