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: Insulinoma during pregnancy is exceedingly rare, with fewer than 30 cases reported worldwide. Diagnosis is often delayed due to overlapping physiological and gestational symptoms, posing significant risks to both mother and fetus. Case: We report a case of a 36-year-old G4P2 + 1 female presenting at 7 weeks’ gestation with recurrent symptomatic hypoglycemia initially suspected due to poor oral intake. She returned at 12 weeks with persistent neuroglycopenic symptoms and weight loss. Biochemical evaluation demonstrated inappropriately non-suppressed insulin and C-peptide levels during hypoglycemia, raising suspicion for endogenous hyperinsulinemia. Imaging with magnetic resonance imaging identified a 2.3 × 2.5 cm pancreatic lesion consistent with insulinoma. A multidisciplinary team (MDT) approach involving Internal Medicine, Endocrinology, Obstetrics and Gynecology (Maternal-Fetal Medicine), Hepatobiliary Surgery, and Radiology guided management. Due to concerns regarding surgical and ablative risks during pregnancy, medical therapy with octreotide was initiated, achieving partial glycemic control. The pregnancy was complicated by fetal growth restriction, necessitating delivery at 34 weeks. Postpartum, the patient underwent endoscopic ultrasoundguided radiofrequency ablation (EUS-RFA), requiring two sessions before achieving glycemic stabilization. Conclusion This case highlights the diagnostic challenges of insulinoma in pregnancy and underscores the importance of MDTguided individualized management. It also illustrates the limitations of EUS-RFA and medical therapy, particularly in larger tumors, and raises important considerations regarding fetal outcomes.
Female ; Pregnancy ; Insulinoma ; Hypoglycemia

Introduction: Steroid-responsive encephalopathy associated with thyroiditis (STREAT) is a rare clinical entity. Clinical presentations of STREAT can range from a strokelike presentation to psychiatric symptoms. STREAT is diagnosed based on four major criteria which include altered cognitive function, new or worsening psychiatric symptoms, elevated antithyroid antibodies, and exclusion of infectious, toxic, metabolic, or neoplastic causes. Corticosteroids are the cornerstone of treatment, with reported excellent response in neurocognitive symptoms resolution. Case: This was a case of a 48-year-old male with Graves’s disease who underwent radioiodine therapy 4 months earlier and was started on levothyroxine 100 mcg 2 weeks prior to presentation. He presented with 4 days of behavioral symptoms, irritable mood with auditory and visual hallucinations. There was no history of fever, headache, limb weakness, or seizure. On general appearance, the patient was agitated, talking incoherently, and disorientated with normal vitals. There was no delayed relaxation of the reflex. The examination of the cranial nerve, motor, sensory, and cerebellar system was normal. A lumbar puncture showed normal opening pressure with a high protein CSF content of 1,596 mg/L. The thyroid-stimulating hormone (TSH) was elevated at 72.7 uIU/mL and T4 at 9.56 pmol/L. Serum antithyroid peroxidase was elevated at 877.42 IU/mL, and antiTSH receptor antibody at 21.30 IU/L. CSF oligonal band, serum aquaporin-4, and viral screening were negative; noncontrasted computed tomography brain revealed normal findings. Based on the clinical history and examination, a diagnosis of STREAT was made at the emergency department. The patient was initiated on hydrocortisone 100 mg three times a day. Within 24–48 hours of steroid therapy, marked improvement and subsequent resolution of the mental status and behavioral symptoms were seen. Conclusion Hashimoto’s thyroiditis can rarely lead to STREAT, a condition with diverse neurological manifestations, where early recognition and prompt corticosteroid therapy are essential for favorable outcomes.
Brain Diseases ; Thyroiditis ; Steroids

Methods: Patients with severe kyphoscoliosis having coronal Cobb angle >90° were applied with modified halo-pelvic Ilizarov distraction assembly preoperatively. The modified assembly consisted of a pelvic component and halo ring, and distraction was given at the rate of 2–3 mm/day for 6–12 weeks. Complete clinical assessments along with pulmonary function tests were performed, and scoliosis series X-ray images were assessed for coronal and sagittal Cobb angle and other spinopelvic parameters before applying the assembly and during 2 years of follow-up. Results: Thirty-four patients (age, 9–27 years; male/female ratio of 18:16) were included. The coronal and sagittal Cobb angles were 116°±16.2° and 84°±28.3°, respectively. Correction rates obtained through modified halo-pelvic assembly were nearly 52% (p=0.001) in coronal and 40% (p=0.001) in sagittal Cobb angles, with improvement in height (p=0.001). Apical vertebral translation and coronal balance were also improved significantly (p=0.001). Further improvements in all the parameters were obtained after definitive surgery, with improvements in the forced expiratory volume in 1 second (p =0.002) and forced vital capacity (p=0.001). Conclusions Our modified halo-pelvic Ilizarov distraction assembly can achieve good correction in severe spinal deformities without significant risk to neurology, has fewer complications, and promotes good patient compliance.

Severe hyponatraemia is defined as a sodium level of less than 120 mEq/L, and it is frequently accompanied by neurological symptoms like coma, convulsions, respiratory arrest, and death. Clinical cardiac toxicity from hyponatremia, such as bradyarrhythmia, is extremely rare. In this article, we present a case of acute severe hyponatraemia that induced unstable bradyarrhythmia and led to refractory bradycardia, which did not improve despite receiving treatment in accordance with the standard Advanced Cardiovascular Life Support protocol. The patient’s bradyarrhythmia has completely resolved with the administration of 3% hypertonic saline, which restored her sodium levels. Due to the possibility that severe hyponatremia may contribute to the aetiology of cardiac malfunction, this case raises awareness about the significance of closely monitoring electrocardiograms and telemetry in patients with severe hyponatremia.

A CASE REPORT OF ISOLATED INFANTILE HEMANGIOMA WITH MICROPHTHALMOS Purpose: To report a rare case of infantile facial hemangioma with orbital extension associated with microphthalmos and high intraocular pressure of the left eye. Case: A full term 1-day-old girl presented with left sided facial hemangiomas since birth. Observations: Findings include large left-sided facial hemangiomas with orbital extension enveloping the left lateral rectus and optic nerve. Clinical examination showed no involvement of the upper and lower eyelid. Cycloplegic refraction showed anisometropia between the two eyes. The axial length of the left eye was found to be significantly shorter compared to the right eye, and intraocular pressure of the left eye was high. Conclusions: Infantile facial hemangioma may be present with orbital extension without any eyelid involvement, and associated with microphthalmos of the left eye with no other systemic abnormalities.

CYTOTOXICITY AND CHARACTERISATION OF POLYMETHYL METHACRYLATE DENTURE BASE ENHANCED WITH LINSEED OIL (PMMA-L) Objectives: Polymethyl methacrylate (PMMA) is a widely used polymer for a denture base material. Dibutyl phthalate was previously utilised as a synthetic plasticiser in PMMA, but concerns about ester leaching have raised awareness of using organic plasticisers, such as linseed oil. The objective of this research was to assess the cytotoxic effects of linseed oil and to characterise the experimental polymethyl methacrylate enhanced with linseed oil (PMMA-L). Method: The cytotoxicity of linseed oil (LO) was evaluated by exposing Human Gingival Fibroblast (HGF) cells to different linseed oil concentrations (1%, 3%, 5%, 7%, and 10%) for 24, 48, and 72 hours. Afterwards, cell viability was measured with the WST-1 assay, and a spectrophotometer was used for cell quantification. Five groups of PMMA-L were prepared, each containing different percentages of linseed oil (1%, 3%, 5%, 7%, and 10% by weight). These samples underwent an ageing process involving 5,000 cycles of thermocycling between 5°C and 55°C with a 30-second dwell time. Compositional and leaching analyses of PMMA-L were performed using attenuated total reflection fourier-transform infrared spectroscopy (ATR-FTIR). Results: The results from the WST-1 assay consistently showed cell viability exceeding 95% across all doses and incubation periods, indicating the non-cytotoxicity of LO. Composition analysis revealed that the ATR-FTIR spectra of PMMA-L and linseed oil were identical within the C=C stretching vibration range (1536-1652 cm-1), originating from unsaturated triglyceride compounds found in linseed oil but not in PMMA. Additionally, the leaching analysis did not detect any leaching of linseed oil from PMMA-L. Conclusions: The research offers proof of the non-cytotoxic nature of linseed oil. Moreover, the successful creation of PMMA-L is evident, as indicated by the incorporation of the linseed oil component in PMMA-L and the absence of linseed oil in the leaching analysis.

Introduction: With the rising number of COVID-19 cases in Malaysia and the overwhelming strain on the tertiary healthcare system, home isolation has been introduced by the Ministry of Health Malaysia to reduce the admission of patients with mild COVID-19 to tertiary and low-risk quarantine centres. COVID-19 assessment centres (CACs) have been set up to provide initial assessment, triaging and monitoring of patients with COVID-19 prior to and during their home isolation. In this study, we aimed to share our experience in setting up CACs in Selangor, Malaysia. Methods: We described the steps taken in developing assessment tools and guidelines for assisting healthcare providers in safely monitoring patients with COVID-19 undergoing home isolation. Results: A total of 26,826 patients were clinically assessed from 1 to 28 February 2021 in various CACs in the state. The majority of the cases seen in the CACs were under category (CAT) 1 and 2.Only 0.2% (n=53) of the cases were categorised as severe COVID-19 (CAT 3 and above). Conclusion CACs coordinated by primary care providers play an important role in triaging,assessing and monitoring patients with COVID-19 undergoing home isolation in the community.There needs to be a better partnership between various stakeholders and the private healthcare sector to improve the services. The usage of a pulse oximeter in home monitoring of all patients withCOVID-19 in Selangor needs to be seriously considered.
COVID-19 ; Primary Health Care

Aims: Acaudina molpadioides is a highly valued sea cucumber that is distributed on the muddy shores on the west coast of Peninsular Malaysia and is considered a local delicacy. Carnobacterium maltaromaticum is a type of lactic acid bacteria commonly found in meat, fish and dairy products and is usually isolated from the intestine of aquatic animals. It is scarcely reported from the intestine of A. molpadioides. This species is known to be pathogenic in fish but unknown in humans. The aim of this study was to isolate and characterize C. maltaromaticum from the intestine of A. molpadioides. Methodology and results: Using standard methods, the strains were tested for their biochemical and carbohydrate properties, antibiotic sensitivity tests, temperature sensitivity tests and molecular identification. A total of 1642 isolates were obtained, out of which three strains were chosen as they were catalase-negative, Gram-positive bacilli, negative to IMViC tests, γ-hemolysis, and positive to lactose and glucose tests. Molecular identification was made to strain AM47e and 16S rRNA genes sequence showed 99.93% similar to C. maltaromaticum. The sequence was submitted to GenBank as Carnobacterium maltaromaticum (Accession No: MZ 934727). The optimum growth temperature for the strains was 37°C and the antibiotic susceptibility showed they were sensitive to tetracycline, ampicillin and meropenem. Conclusion, significance and impact of study In conclusion, C. maltaromaticum can be isolated from the intestine of A. molpadioides with the potential of the probiotic applications and less potential vulnerability for consumers.

Introduction: Poor waste management led to mosquito breeding grounds. Previous research found that construction sites are the mosquito breeding area thus it’s important to understand how construction sites affect mosquito breeding. Methods: This study utilized a prospective study to determine the characteristic of breeding preference in residential construction sites. On-field breeding preference survey was conduct in the selected project site in 12 weeks (1st October 2021 until 31st December 2021). Wet container inspection was carried out according to types of the residential construction building and progress of the site. All possible wet materials and containers was inspected and record accordingly in the form during the surveillance. Results: Result shows that the most preferred containers found was building floor (41.68%), others such as planter box that use for landscape purpose, drainage system, building mould and lift wells. The results of the research indicate that prospective containers with water and breeding sites at high rise construction sites were found to be more than those at low rise construction sites. Conclusion: Overall, substantially fewer water containers were discovered in low rise projects compared to high rise projects. Construction management need encourage all the workers to do best management practice such as proper waste disposal and removal of the water and possible wet container and conduct awareness among the workers.