Introduction: Euglycemic diabetic ketoacidosis (EDKA) is an uncommon but potentially life-threatening complication of diabetes, characterized by significant ketoacidosis in the absence of marked hyperglycemia. The increasing use of sodiumglucose co-transporter-2 inhibitors (SGLT2i) has contributed to its rising incidence; however, data describing its clinical spectrum remain limited. Methodology: We conducted a retrospective observational study of 19 patients admitted for EDKA between 2002 and 2025. EDKA was defined as metabolic acidosis with ketosis in the presence of blood glucose <11 mmol/L. Demographic characteristics, comorbidities, biochemical parameters, triggers, and clinical outcomes were analyzed. Continuous variables were reported as mean (SD) or median (interquartile range [IQR]), and categorical variables as frequencies and percentages. Results: The cohort displayed a mean age of 52 (SD 22.2) years, with a slight female predominance (52.6%). The majority had underlying type 2 diabetes mellitus (89.5%). Other comorbidities include hypertension (63.2%) and chronic kidney disease (31.6%). Despite severe metabolic derangement, the mean blood glucose at presentation was modest at 9.3 (SD 3.38) mmol/L. Median pH was 7.1 (IQR 0.35) and bicarbonate 9.1 mmol/L, with a markedly elevated median anion gap of 25.3 mmol/L. SGLT2i exposure was identified in 47.4% of patients, predominantly empagliflozin, with most initiated within 6 months. Nevertheless, infection was still the leading precipitant (68.4%), while 31.6% were adjudicated as having SGLT2i as the primary precipitating factor, probably due to underreporting during the diagnosis. Nearly half of the patients required intensive care (47.4%). The mean time to DKA resolution was 19 (SD 10.1) hours. Overall outcomes were favorable, with 89.5% of patients discharged and a mortality rate of 10.5%. Conclusion EDKA presents with severe metabolic acidosis despite deceptively normal glucose levels, increasing the risk of delayed recognition. Early assessment of ketones and acid– base status is essential in patients with diabetes presenting with unexplained metabolic acidosis, particularly among those receiving SGLT2 inhibitors, to facilitate timely diagnosis and management.
Diabetic Ketoacidosis

Objective: Problematic smartphone use (PSU) is the development of pathological dependence at the expense of performing activities of daily living, thus having negative health and psychological impact on the users. Previous PSU studies focused on medical students and little is known regarding its effect on students undergoing other courses. The objective of this study is to identify the pattern of smartphone usage and determine the psychological factors affecting PSU among undergraduate students in Malaysia and compare the pattern among students from different fields of study. Method: A prospective cross-sectional study was conducted using the validated Smartphone Addiction Scale–Malay version (SAS-M) questionnaire. One-way ANOVA was used to determine the correlation between the PSU among the students categorised by their ethnicity, hand dominance and by their field of study. MLR analysis was applied to predict PSU based on socio-demographic data, usage patterns, psychological factors and fields of study. Results: A total of 1060 students completed the questionnaire. Most students had some degree of problematic usage of the smartphone. Students used smartphones predominantly to access SNAs, namely Instagram. Longer duration on the smartphone per day, younger age at first using a smartphone and underlying depression carried higher risk of developing PSU, whereas the field of study (science vs. humanities based) did not contribute to an increased risk of developing PSU. Conclusion: Findings from this study can help better inform university administrators about at- risk groups of undergraduate students who may benefit from targeted intervention designed to reduce their addictive behaviour patterns

Objective: To identify regions of the brain affected during cognitive working memory during tasks to assess attention, planning and decision making among military aviation personnel who have chronic intermittent exposure to high altitude environment. Method: A case-control study was conducted in the Universiti Putra Malaysia among eight military personnel, four of whom had chronic intermittent exposure to high altitude training. They were divided into two groups, chronic intermittent exposure group (CE) (n=4) and a control group (n=4). They underwent a task-based functional magnetic resonance imaging (fMRI) that utilised spatial working memory task to objectively evaluate the neural activation in response to the Tower of London paradigm. Each correct answer was given a score of one and the maximum achievable score was 100%. Results: A consecutive dichotomised group of CE (4/8) and control (4/8) of age-matched military aviation personnel with a mean age of 37.23±5.52 years; showed significant activation in the right middle frontal gyrus (MFG). This in turn was positively correlated with response accuracy. A significant difference in the response accuracy was noted among both the groups at p<0.05. Conclusion: At the minimum results of power analysis of this preliminary fMRI study, our group of aviation personnel who had chronic intermittent exposure to hypobaric hypoxic environment, did not have any significant decrease in cognitive function namely attention, decision-making and problem solving compared to controls during a working memory task