INTRODUCTION: Glaucoma is a leading cause of permanent blindness, often going undetected in its early, asymptomatic stages, especially in older age groups. In Malaysia, glaucoma is a growing public health issue due to an increase in the ageing population. While screening is essential for early glaucoma detection, the most suitable strategy for Malaysia's healthcare system remains unclear. This study explored the perspectives of eye healthcare professionals on the most suitable glaucoma screening strategies for Malaysia. MATERIAL AND METHODS: This qualitative study used semi-structured interviews with 19 eye health professionals (ophthalmologists, optometrists, nurses, ophthalmic technicians, and assistant medical officers) practicing in the Klang Valley. The interviews were conducted face-to-face in their workplace or via a video conferencing platform. All interviews were recorded, transcribed, and analysed using thematic analysis. RESULTS: Six major themes were identified: types of glaucoma screening programmes, accessible screening locations, target screening population, instruments and use of digital technology, trained personnel, and referral criteria. Opportunistic case finding and population-based programmes were identified as the glaucoma screening programmes in which trained personnel conducted screening at accessible locations. Glaucoma screening for high-risk individuals was recommended, focusing on visual acuity testing, tonometry, anterior chamber angle assessment, funduscopy, perimetry, and retinal nerve fibre assessment. A lack of clear referral criteria due to low awareness and poor implementation of existing guidelines was observed. CONCLUSION: Further investigations are required to identify the best combination of components for glaucoma screening. This will enable policymakers to develop an effective glaucoma screening programme in Malaysia.

Introduction: Sleep quality has become a public health concern due to serious impacts on individual’s health outcomes. Thus, this cross-sectional study aimed to determine the sleep quality and its associated factors among adults living in the province of Terengganu, Malaysia. Materials and Methods: Socio-demographic information was self-reported whilst anthropometric measurements were measured by trained researchers. Sleep quality was assessed using the validated Pittsburgh Sleep Quality Index (PSQI) whilst eating behavior was measured using the Dutch Eating Behavior Questionnaire (DEBQ). Descriptive statistics and multivariable linear regression models were employed using IBM SPSS version 25.0. Results: A total of 580 participants were enrolled (mean age = 29.1 ± 10.0 years; 51.2% female), of which 74.7% (n = 433) had poor sleep quality (PSQI global score > 5) with a total sleep duration per night of 6.2 ± 1.6 hours. Gender (p-value=0.044), educational level (p-value=0.001), emotional level (p-value=0.005) and external eating (p-value=0.026) were significantly associated with poorer sleep quality. Conclusion: This study underscored the high prevalence of poor sleep quality among adults living in Terengganu, Malaysia. The findings could serve as a basis for developing sleep education strategies that are tailored to improve sleep quality among adults.

Introduction: Tinea imbricata (TI) outbreak poses a significant health burden among indigenous populations in rainforest regions due to their geographical isolation and poor socioeconomic conditions. This study aimed to investigate the epidemiological trends, antifungal susceptibility patterns, and treatment outcomes of TI among the Bateq subtribe in Pahang, Malaysia. Materials and Methods: A cross-sectional survey was conducted between July–October 2023 in five villages within the National Rainforest Park, Malaysia. Socio-demographic characteristics, clinical manifestations, and treatment outcomes were collected through interviews, laboratory investigations, and clinical examinations. Treatment modalities were evaluated for their effectiveness in reducing disease burden. Results: 569 individuals were surveyed, revealing a TI prevalence rate of 7.91% with children aged 15 years and below exhibiting the highest susceptibility (9.22%). Antifungal susceptibility testing of clinical isolates of Trichophyton concentricum demonstrated high sensitivity to terbinafine (GM MIC=0.144 μg/ml, GM MFC=0.198 μg/ml, p<0.05) and griseofulvin (GM MIC=1.741 μg/ml, GM MFC=4.782 μg/ml, p<0.05), while clotrimazole showed moderate activity (GM MIC=5.897 μg/ml, GM MFC=22.291 μg/ml). Fluconazole demonstrated the least potency, with no fungicidal activity observed at concentrations up to 128 μg/ml. Treatment outcomes indicated that combination therapy (terbinafine gel and oral griseofulvin) significantly outperformed terbinafine gel alone, achieving an almost complete lesion resolution (LA reduced to 0.158±0.158 cm versus 3.684±1.522 cm , p<0.05). Conclusion: These findings provide critical insights into the epidemiology and emerging drug resistance of TI in the Bateq subtribe, highlighting the importance of continued surveillance, monitoring, and adaptation of treatment strategies to combat evolving antifungal resistance patterns.

PURPOSE: The purpose of this study is to surveil the injuries in wrestling according to the different age categories and wrestling styles throughout the competition season. METHODS: The study was designed as a descriptive study. The study was conducted during the wrestling competition season in 2023 (from January 2023 to July 2023), which includes 5 different age categories: U-15, U-17, U-20, U-23, and seniors, along with the Turkey National Wrestling Championships. The data of injuries was recorded immediately after the acute injury was treated by the medical expert during the competitions and evaluated according to the parameters that were obtained. In the statistical analysis, the frequency and percentage values were presented as descriptive statistics and the Chi-square test was used. RESULTS: The study incorporated a total of 6214 wrestlers and a total of 7151 wrestling bouts were performed during these competitions. The analyses indicated that the rate of injury incidence was 42.65‰ in all wrestling styles. When taking account of the injured body parts in all wrestlers' exposures, the occurrence of injuries to the head-face, neck, trunk, upper extremity, and lower extremity, rates of 17.6‰, 1.3‰, 3.6‰, 13.5‰, and 6.6‰, respectively, were observed. According to the pre-diagnosis based on freestyle, Greco-Roman, and female wrestling styles, injuries with bleeding (39.6%, 46.3%, and 14.6%, respectively) and muscle strain (37.9%, 28.7 %, and 52.6%, respectively) most often occurred. CONCLUSION The study findings indicate that most cases of injury appeared to occur in bleeding and muscle strain in all wrestling styles. We suggest that medical experts should set up their health equipment with consideration to the injuries that occur most frequently.
Humans ; Male ; Wrestling/injuries* ; Young Adult ; Adolescent ; Female ; Athletic Injuries/epidemiology* ; Turkey/epidemiology* ; Adult ; Age Factors ; Incidence ; Child

Multiple morphological abnormalities of the flagella (MMAF) represent a severe form of sperm defects leading to asthenozoospermia and male infertility. In this study, we identified a novel homozygous splicing mutation (c.871-4 ACA>A) in the adenylate kinase 7 (AK7) gene by whole-exome sequencing in infertile individuals. Spermatozoa from affected individuals exhibited typical MMAF characteristics, including coiled, bent, short, absent, and irregular flagella. Transmission electron microscopy analysis showed disorganized axonemal structure and abnormal mitochondrial sheets in sperm flagella. Immunofluorescence staining confirmed the absence of AK7 protein from the patients' spermatozoa, validating the pathogenic nature of the mutation. This study provides direct evidence linking the AK7 gene to MMAF-associated asthenozoospermia in humans, expanding the mutational spectrum of AK7 and enhancing our understanding of the genetic basis of male infertility.
Humans ; Male ; Sperm Tail/ultrastructure* ; Homozygote ; Consanguinity ; Asthenozoospermia/pathology* ; Infertility, Male/genetics* ; Mutation ; Pakistan ; Adenylate Kinase/genetics* ; Adult ; Pedigree ; RNA Splicing ; Exome Sequencing ; Spermatozoa

Background: Currently, clinical T staging in non-small cell lung cancer (NSCLC) is based on the largest radiological diameter observed on computed tomography (CT). Under this system, tumors with varying shapes—such as spherical, amorphous, or spiculated tumors—can be assigned the same T stage even with different volumes. We aimed to propose a 3-dimensional (3D) volumetric staging system for NSCLC as an alternative to diameter-based T staging and to conduct comparative survival analyses between these methods. Methods: We retrospectively analyzed data from patients who underwent surgery for pT1-4N0M0 primary NSCLC between January 2018 and May 2022. Digital Imaging and Communications in Medicine data from patient CT scans were uploaded to 3D Slicer software for volumetric tumor measurement. Using the paired samples t-test or the Wilcoxon test, we compared the expected tumor volumes, calculated by tumor diameter, with the actual volumes measured by 3D Slicer. Receiver operating characteristic analysis was employed to determine the cut-off value for tumor volume. Kaplan-Meier analysis was utilized to assess overall survival, while the log-rank method was applied to compare survival differences between groups. The significance of changes in T stage was evaluated using the marginal homogeneity test. Results: The study included 136 patients. Significant differences were observed between expected and actual tumor volumes (p=0.01), and associated changes in T stage were also significant (p=0.04). The survival analysis performed using tumor volume (p=0.009) yielded superior results compared to that based on diameter (p=0.04) in paients with early tumor stage. Conclusion T-factor staging based on tumor volume could represent an alternative staging method for NSCLC.

Background: Lowest instrumented vertebra (LIV) selection is controversial in Lenke 1A curves. Alignment of the LIV in coronal, sagittal, and transverse planes is important for correction of overall scoliosis, as well as the alignment of uninstrumented lumbar curve. In this study, we aimed to evaluate the 3-dimensional correction and clinical outcomes of Lenke 1A curves, corrected with rod derotation (RD) maneuver, according to the LIV level. Methods: Prospectively collected data of 46 consecutive idiopathic scoliosis surgery patients with Lenke 1A scoliosis who had been treated with posterior instrumentation and fusion were retrospectively evaluated. Patients were divided into 2 groups according to the LIV level: stable vertebra (SV) group (25 patients) and 1 level proximal to SV (SV-1) group (21 patients). Patients were compared pre- and postoperatively according to radiographic and clinical outcomes. Measured parameters in coronal plane were Cobb angle of thoracic curve, shoulder balance, coronal balance, LIV translation, and LIV tilt; in sagittal plane, thoracic kyphosis, lumbar lordosis, sagittal balance, and distal junctional angle. Transverse plane analysis included rotational measurement of apical vertebra (AV), LIV, and LIV+1 with computerized tomography. Clinical outcomes were evaluated with Scoliosis Research Society (SRS)-22 questionnaire. Surgical times were noted. Results: There were no statistically significant differences between the 2 groups in terms of preoperative radiographic values. In both groups, Cobb angle of thoracic curve, shoulder balance, LIV translation, and LIV tilt improved significantly after the surgery.Postoperatively, AV rotation decreased in both groups significantly. No significant change was observed in rotations of LIV and LIV+1 after the surgery. Clinical outcomes and surgical times were similar between the groups. Conclusions Selection of the LIV as SV or SV-1 in Lenke 1A patients led to similar results in terms of coronal and sagittal plane reconstruction, as well as AV and LIV rotation. With RD maneuver, an acceptable amount of rotation could be achieved at LIV and LIV+1. Radiologic and functional outcomes were satisfactory in both LIV levels. To save 1 more mobile segment, it seems reasonable to select SV-1 as the LIV if possible in order to obtain a well-aligned LIV in all 3 planes.

Background: This retrospective midterm study aimed to analyze seating properties, fracture types, noisy hips, and survivorship of a delta ceramic liner with a titanium taper locking band. Methods: A total of 451 patients (538 hips) underwent cementless total hip arthroplasty using the same design delta ceramic liner. Patients’ clinical functions were evaluated using Harris Hip score, and the radiological migration or loosening of cementless cups was recorded. Component survival was evaluated by Kaplan-Meier survivorship analysis, with failure defined as revision of any component or ceramic bearing for any reason. The worst-case survival scenario for noisy hip revision recommendations was estimated. Results: A total of 475 patients (514 hips) were evaluated with an average follow-up of 9.5 years (range, 5–13.9 years). One hip (0.19%) had intraoperative asymmetric seating. No hips had loosening, osteolysis, wear, or delta ceramic liner or head fracture.Three patients (0.58%) reported reproducible squeaking. Two cups were revised due to recurrent dislocation, 2 femoral stems were revised for periprosthetic fractures, and 1 hip was treated for deep periprosthetic joint infection. Kaplan-Meier survivorship analysis showed a 10-year cup survival rate of 97.8% (95% CI, 95.2%–99.9%), with any revision as the endpoint. The worst-case scenario showed a 10-year survival rate of 96.4% (95% CI, 94.2%–99.2%). Conclusions The Delta ceramic liner with a titanium locking band on the mutlibearing cementless cup offered secure intraoperative seating properties with fewer ceramic-related complications at the midterm follow-up.

Purpose: Pilonidal sinus disease is a chronic inflammatory disease that affects approximately 1% of the population.Although many treatment methods have been described, there is no consensus on the exact treatment method. This study was conducted to evaluate the wound healing-promoting effect of platelet-rich plasma (PRP) in patients treated using the unroofing and curettage technique. Methods: A total of 140 patients diagnosed with pilonidal sinus disease were included in the study. The patients were randomized into 2 groups; one group was followed up with a standard dressing after the operation, and the patients in the other group were treated with PRP in addition to the standard dressing. In this study, the wound healing rate between the 2 groups was determined as the primary objective. Results: In postoperative follow-up, a difference in wound healing rate was detected on postoperative day 10 (P = 0.007). While the average wound healing time of the patients in the control group was 41.1 ± 11.0 days (median, 40; range, 20–65), it was 23.6 ± 8.5 days (median, 25; range, 6–45) in the PRP group (P < 0.001). It was determined that the wound closure time of patients in the PRP group was faster. Conclusion In our prospective randomized study, we found that PRP significantly increased the wound healing rate and patient comfort, with recurrence rates below 1% and minimal pain. We think that it should be the first-choice method before operations that cause extensive tissue loss, such as flap surgery.