Objectives: This study aimed to examine the temporal dynamics of dengue cases in Malaysia from 2022 to 2024 using seasonal-trend decomposition and time-series modeling. Methods: Weekly dengue case counts from the national registry were analyzed across all states using seasonal-trend decomposition using LOESS (STL) to separate trend, seasonal, and irregular components. Autoregressive integrated moving average (ARIMA) and seasonal ARIMA(SARIMA) models were fitted to validate temporal structures, with model selection based onthe Akaike information criterion (AIC), corrected AIC, and Bayesian information criterion.Diagnostic checks, including residual analysis and Ljung-Box testing, were performed to ensure model adequacy. Results: Dengue incidence showed marked heterogeneity across states. STL decompositionindicated that long-term trends contributed more strongly to case dynamics than seasonality in most states, although seasonal influences were significant in the states of Kedah and Kelantan. Seasonal peak timing varied between states, highlighting differences in epidemic cycles. ARIMA and SARIMA modeling confirmed that no single temporal structure could adequately represent all states; while some series were well fitted by simple ARIMA models,others required seasonal adjustments. Residual diagnostics demonstrated that the selected models were statistically adequate. Conclusion Dengue dynamics in Malaysia are shaped by both trend and seasonal components, with considerable variation across states. Combining STL decomposition with ARIMA/SARIMA modeling strengthens the evidence base for state-specific forecasting and proactive vectorcontrol. Tailoring surveillance systems and interventions to local temporal patterns may improve early warning capacity and optimize resource allocation for dengue prevention.

Objective: To translate the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) into Urdu and to determine the psychometric properties of its Urdu version. Methods: This cross-sectional study recruited 300 participants (18–60 years) with non-specific low back pain (NSLBP), who were able to read Urdu. Test-retest reliability was assessed using intra-class correlation coefficient (ICC), and reproducibility through Cronbach’s α. Face and content validity were examined via individual interviews, and construct validity by correlating with relevant reference standards. Exploratory factor analysis (EFA) & confirmatory factor analysis (CFA) was also carried out Results: ÖMPSQ was successfully translated into Urdu version with acceptable face and content validity. ÖMPSQ Urdu version showed acceptable internal consistency (α=0.789) & good test-retest reliability (ICC=0.784, 95% confidence interval, p<0.001) while good correlation was demonstrated between ÖMPSQ and Chronic Pain Grade Scale (pain and disability subscales i.e., r=0.809 and 0.807, respectively). However, Roland-Morris Disability Questionnaire showed moderate correlation (r=0.513). Additionally, no significant floor or ceiling effects were observed in the ÖMPSQ Urdu version. EFA revealed a five-factor solution using twenty items, 89.21% was the total item variance in the database, while CFA demonstrated good model fit with strong factor loadings and acceptable fit indices Conclusion The ÖMPSQ Urdu version is valid and reliable for assessing the risk of long-term disability & workplace absence in NSLBP patients.

Introduction: Insulin deintensification is an emerging strategy to reduce hypoglycemia and treatment burden in patients on multiple daily injection (MDI ≥3), with potential to improve adherence and glycemic control. However, evidence in poorly controlled type 2 diabetes mellitus (T2DM) remains limited. This study evaluated its effectiveness and identified factors associated with achieving adequate glycemic control following deintensification among patients with poorly controlled T2DM attending Malaysian primary care. Methodology: A retrospective cohort study was conducted among 107 T2DM patients with hemoglobin A1c (HbA1c) >9%, attending Enhanced Diabetic Clinic at Cheras Health Clinic between 2021 and 2025. All patients on basal-bolus insulin (BBI) underwent deintensification. Multivariate logistic regression was performed to identify factors associated with achieving adequate glycemic control (HbA1c <7.5%). Changes in HbA1c following deintensification were assessed using paired t-tests. Results: Overall, 50.5% of patients achieved adequate glycemic control. Hypoglycemia events (AOR 9.5, 95% confidence interval [CI] 1.6–58.3; p = 0.015), MDI (AOR 9.6, 95% CI 1.4–67.1; p = 0.023) and Diabetes Medication Therapy Adherence Clinic (DMTAC) visits (AOR 1.1, 95% CI 1.0– 1.2; p = 0.039) were significantly associated with achieving HbA1c <7.5%. Conversely, patients transitioned from BBI to premixed regimens were less likely to achieve HbA1c <7.5% (AOR 0.22, 95% CI 0.05–0.93, p = 0.039). All insulin deintensification strategies were associated with significant HbA1c improvements with transitioned from BBI to premixed human insulin (mean difference -2.54%, 95% CI 1.77–3.31, p <0.001, Cohen’s d = 1.09), BBI to premixed analogue insulin (mean difference -3.38%, 95% CI 2.26– 4.49, p <0.001, Cohen’s d = 1.62), BBI to basal insulin (mean difference -3.67%, 95% CI 1.79–5.54, p = 0.004, Cohen’s d = 2.05). Conclusion Insulin deintensification is an effective strategy for improving glycemic control in poorly controlled T2DM. These findings highlight the importance of deintensification with careful consideration of hypoglycemia, MDI-related treatment burden, and patient engagement through regular DMTAC visits, which are integral to achieving optimal outcomes and support a personalized approach to diabetes management in primary care.
Diabetes Mellitus, Type 2 ; Glycemic Control ; Retrospective Studies ; Primary Health Care ; Insulins

Introduction: Parathyroid carcinoma (PC) is an exceedingly rare malignancy. Definitive surgical management with en bloc resection is crucial for cure, but the post-operative course can be complicated by profound metabolic derangements, most notably hungry bone syndrome (HBS). We report a case of PC in a 15-year-old female to highlight the challenges in perioperative management. Case: A 15-year-old female presented with a painless, palpable neck mass. There is no family history of note. Investigations revealed severe primary hyperparathyroidism (PHPT) with a corrected calcium of 3.4 mmol/L and an elevated intact parathyroid hormone level of 118.6 pg/mL. Alkaline phosphatase was markedly elevated at 1,168 U/L. Ultrasound, computed tomography neck, and a sestamibi scan identified a large, lobulated 4.7-cm mass posterior to the right thyroid lobe, suspicious of malignancy. Bone mineral density of the forearm was severely diminished, with a Z-score of -6.6. The patient underwent right hemithyroidectomy and parathyroidectomy with intraoperative neural monitoring. Intraoperative parathyroid hormone levels dropped from a pre-excision level of 120.1–16.5 pg/mL 5 minutes post-excision, confirming complete resection of the hyperfunctioning tissue. Histopathological examination confirmed the diagnosis of PC, demonstrating lymphovascular invasion and clear resection margins. The Ki-67 proliferation index was 5%. Post-operatively, the patient developed hypocalcemia, with corrected calcium dropping to a nadir of 1.95 mmol/L. This was managed with intensive calcium and activated vitamin D supplementation. At 10 months post-surgery, the patient continues to require supplementation for persistent hypocalcemia. Surveillance ultrasound at 3 months showed no evidence of recurrence, and she is planned for ongoing annual monitoring. Conclusion This case illustrates the need for a high index of suspicion for PC in young patients with severe PHPT. The postoperative course highlights the challenges in managing HBS, hypoparathyroidism, and long-term surveillance.
Adolescent ; Humans ; Parathyroid Neoplasms

Introduction: Sinomenine, derived from Sinomenium acutum, has been reported as a potential treatment for morphine addiction but its mechanisms are poorly understood. Hence this study was conducted to investigate the potential mechanisms underlying sinomenine effects on morphine addiction. Materials and methods: Potential protein targets for sinomenine were predicted using SwissTarget Prediction and PharmMapper while morphine addiction targets were collected from DisGeNet and GeneCards databases. Protein-protein interaction was examined using GeneMANIA web server while Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were conducted using ShinyGO online tool. Topological network analysis was performed using Cytoscape to measure the degree centrality, betweenness centrality and closeness centrality values while molecular docking analysis was done using AutoDock Vina to determine the binding energies and interactions. Results: A total of 15 sinomenine targets were identified to be involved. Among the identified targets, 37.94% shared protein domains and 19.64% displayed physical interactions. Relevant biological processes, molecular functions, cellular components and signalling pathways were identified involving G-protein coupled opioid receptor signalling pathways and activities, integral component of presynaptic membrane and mitophagy. Molecular docking suggested that the substituted aromatic ring of sinomenine plays important roles in the binding to the protein targets. The top five most significant protein targets were identified based on the binding energies and degree centrality values, namely OPRD1, OPRK1, NOS1, OPRM1 and SRC. Conclusion: Sinomenine interacted with various protein targets and pathways which can potentially treat morphine addiction mainly via opioid receptors and their signalling pathways

OBJECTIVE: To explore the potential apoptotic mechanisms of 3 Morchella extracts (Morchella conica, Morchella esculenta and Morchella delicosa) on breast and colon cancer cell lines using apoptotic biomarkers. METHODS: Human breast cell line (MCF-7) and colon cancer cell line (SW-480) were treated with methanol and ethanol extracts of 3 Morchella species with concentration ranging from 0.0625 to 2 mg/mL. After that their effects on gene expression of apoptosis related markers (pro-apoptotic markers including Bax, caspase-3, caspase-7, and caspase-9, and the antiapoptotic marker including Bcl-2) were determined using reverse transcription polymerase chain reaction. RESULTS: All Morchella extracts reduced breast and colon cancer cells proliferation at half inhibitory concentration (IC₅₀) of 0.02 ±0.01 to 0.68 ±0.30 mg/mL. As expected, all Morchella extracts significantly increased gene expressions of Bax, caspase-3, caspase-7, and caspase-9 and downregulated the gene expression of Bcl-2 in MCF-7 and SW-480 cell lines (P<0.05). CONCLUSIONS Morchella extracts demonstrated significant anti-proliferative activity against breast and colon cancer cell lines via an apoptosis induction mechanism. Anticancer activity of Morchella extracts and activation of apoptosis in breast and colon cancer cells suggest that it may be used to develop chemotherapeutic agents against cancer in future.
Humans ; Apoptosis/genetics* ; Colonic Neoplasms/drug therapy* ; Breast Neoplasms/drug therapy* ; Cell Line, Tumor ; Cell Proliferation/drug effects* ; Plant Extracts/pharmacology* ; Gene Expression Regulation, Neoplastic/drug effects* ; MCF-7 Cells ; Ascomycota/chemistry*

Thymoquinone (Tq) and gallic acid (GA) are known for counter-tumorigenic characteristics. GA inhibits cancer cell proliferation by interfering with many apoptotic signaling pathways, producing more reactive oxygen species (ROS), focusing on the cell cycle, and suppressing the expression of oncogenes and matrix metalloproteinases (MMPs). In this study, thymoquinone (after reducing to thymohydroquinone) and gallic acid are esterified to form thymohydroquinyl gallate (a prodrug). Thymohydroquinyl gallate (THQG) possesses enhanced antineoplastic efficacy and targeted delivery potential. The chemical and spectroscopic analysis confirms ester synthesis. Gold nanoparticles (AuNPs) are employed as nanocarriers due to their physicochemical and optical characteristics, biocompatibility, and low toxicity. As an efficient drug transporter, gold nanoparticles (AuNPs) shield conjugated drugs from enzymatic digestion. The prodrug acts as a reducing agent for Au metal atoms and is loaded onto it after reduction. The nano drug is radiolabeled with ^99mTc and ¹³¹I to monitor the drug biodistribution in animals using a gamma camera and single-photon emission computerized tomography (SPECT). ¹³¹I is an antineoplastic that helps enhance the drug's efficiency. Chromatographic results reveal promising radiolabeling percentages. In vitro, drug release shows sustained release at pH⁓5.8. In vitro 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) cytotoxicity assay reveals drug potency on CAL 27 and MCF 7 cell lines.

Thymoquinone(TQ)and gallic acid(GA)are known for counter-tumorigenic characteristics.GA inhibits cancer cell proliferation by interfering with many apoptotic signaling pathways,producing more reactive oxygen species(ROS),focusing on the cell cycle,and suppressing the expression of oncogenes and matrix metalloproteinases(MMPs).In this study,TQ(after reducing to thymohydroquinone)and GA are esterified to form thymohydroquinyl gallate(a prodrug).Thymohydroquinyl gallate(THQG)possesses enhanced antineoplastic efficacy and targeted delivery potential.The chemical and spectroscopic analysis confirms ester synthesis.Gold nanoparticles(AuNPs)are employed as nanocarriers due to their physicochemical and optical characteristics,biocompatibility,and low toxicity.As an efficient drug transporter,(AuNPs shield conjugated drugs from enzymatic digestion.The prodrug acts as a reducing agent for Au metal atoms and is loaded onto it after reduction.The nano drug is radiolabeled with 99mTc and 131I to monitor the drug biodistribution in animals using a gamma camera and single-photon emission computerized tomography(SPECT).131I is an antineoplastic that helps enhance the drug's efficiency.Chromatographic results reveal promising radiolabeling percentages.In vitro,drug release shows sustained release at pH～5.8.In vitro 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide(MTT)cytotoxicity assay reveals drug po-tency on CAL 27 and MCF 7 cell lines.

Hypercalcaemic Paraneoplastic Syndrome in a Young Woman with Malignant Phyllodes of the Breast: A Case Report Paraneoplastic syndromes, though uncommon, present systemic effects secondary to primary malignancies or metastases. We presented a case of a 25-year-old nullipara with a left breast malignant phyllodes. Pre-operative investigations revealed hypercalcaemia. Her staging computed tomography scan did not demonstrate any enlarged parathyroid gland. Her serum intact parathyroid hormone level was not raised. After correction with saline hydration, she underwent a left mastectomy, axillary dissection and a supercharged bipedicle TRAM flap. The following day, due to flap congestion, she underwent flap exploration but unfortunately, the flap necrosed. She required temporary coverage with a split-skin graft to allow her post operative sepsis to resolve. She underwent a delayed extended latissimus dorsi myocutaneous pedicled flap for chest wall closure. The cause of hypercalcemia was attributed to be a paraneoplastic syndrome which has not been reported previously in a malignant phyllodes tumor. The hypercalcaemia is postulated to have caused the thrombosis leading to flap failure

Purpose: This study was performed to investigate the pattern of condylar pressure distribution in the discs of a patient diagnosed with disc displacement without reduction. Materials and Methods: This research consisted of a pre- and post-test observational clinical study. A patient diagnosed with disc displacement without reduction underwent treatment with an occlusal splint for 3 months. Finite element analysis employed a 3-dimensional model constructed from magnetic resonance images of the patient, taken both before the application of the splint and 3 months after its use. Results: The post-test model demonstrated a decrease in condylar pressure on the disc, with measurements dropping to 72 MPa from the pre-test level of 143 MPa. In the pre-test, the pressure distribution pattern was concentrated on the lateral posterior border, whereas in the post-test, it shifted toward the intermediate zone of the disc. Conclusion Utilization of a stabilization splint for 3 months resulted in decreased pressure and a marked change in the pressure distribution pattern on the temporomandibular disc.