Factors Influencing Excessive Gestational Weight Gain Among Pregnant Women in Urban Malaysia Introduction Excessive gestational weight gain (GWG) is a growing public health concern due to its association with higher risk of adverse maternal and perinatal outcomes. Recognising the key factors of underlying GWG incidence is thus crucial for developing targeted interventions. This study aims to determine the prevalence of excessive GWG and its associated factors among pregnant women in an urban district of Klang Valley, Malaysia. Methods A retrospective cross-sectional study was conducted (betweenNovember 2017 and October 2018) among 472 pregnant women who gave birth between January 2015 and December 2016. Data on sociodemographic characteristics, medical illnesses, and pre-pregnancy body mass index (BMI) were retrieved from the birth registry and maternal health records. The classification of GWG is based on the Institute of Medicine's recommendation Results The classification of GWG is based on the Institute of Medicine's recommendation. A total of 113 (23.9%) pregnant women had excessive GWG. Multiple logistic regression showed the odds of getting excessive GWG were higher among those with lower education levels (Adj. OR = 1.85; 95% CI = 1.084, 3.147), being employed (Adj. OR = 2.30; 95% CI = 1.342, 3.928), nulliparous (Adj. OR = 2.46; 95% CI = 1.450, 4.164), and having pre-pregnancy BMI of ≥25kg/m2(Adj. OR = 6.47; 95% CI = 3.909, 10.721). Conclusions Lifestyle interventions, such as weight reduction programs and health education, should focus on women with high pre-pregnancy BMI, nulliparous women, working women and women with low education levels. Pre-pregnancy clinics and workplaces can serve as platforms to promote healthy dietary choices and encourage regular physical exercise.

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

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.

UTILISATION OF THE WEB-BASED HOME ASSESSMENT TOOL AMONG PATIENTS WITH COVID-19 IN SELANGOR, MALAYSIA: AN OBSERVATIONAL STUDY Introduction: The COVID-19 pandemic has caused many countries to turn to web-based solutions. The Home Assessment Tool (HAT) is a web-based system using the MySejahtera application developed by the government. It serves as a communication platform for patients with COVID-19 to self-monitor their clinical symptoms and enables authorised healthcare personnel to access and manage collected data for clinical monitoring. Our study aimed to examine the utilisation of this internet-based tool among patients with COVID-19 in Selangor. Methods: This observational study analysed secondary data from the self-reported HAT within MySejahtera. It included all patients who were diagnosed with COVID-19 through molecular assays such as RT-PCR or RTK-Ag on 1–21 February 2021, aged ≥18 years and residing in Selangor. Patients who had documented their symptoms at least once in the HAT during the prescribed 10-day isolation period were classified as HAT users. Results: A total of 4438 patients were included, of whom 39.4% were HAT users, while 60.6% were non-HAT users. Logistic regression analysis revealed three significant factors associated with low utilisation of the HAT: absence of medical condition (odds ratio [OR]: 9.4; 95% confidence interval [CI]: 7.49–12.01), advanced age (OR: 1.35; 95% CI: 1.20–1.52) and non-Malaysian citizenship (OR: 3.4; 95% CI: 2.50–4.72). Conclusion: The utilisation of the HAT is low, which is associated with advanced age (≥65 years), absence of medical conditions and foreign nationality. It is imperative to develop inventive strategies tailored to address the unique needs of these particular demographics.

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: 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.