Introduction: The commonest cause of paediatric hyperthyroidism is Graves' disease. Previous studies in the Malaysian context haven’t captured data from Negeri Sembilan. This study aims to describe the demographic and clinical features of children with hyperthyroidism from Hospital Tuanku Jaafar. Methodology: A retrospective cohort study collating socio-demographic and clinical data from electronic medical records was conducted. Statistical analysis was conducted using Microsoft Excel (v2602). Results: Fourteen children between 2015 and 2025 were identified. Females comprised 93% (n = 13). The mean age at diagnosis was 9.76 ± 3.4 years, with 64% (n = 9) aged >10 years. Malay ethnicity comprised 64% (n = 9). Family history was positive in 43% (n = 6). Three (21%) children were detected on routine screening. At presentation, 50% (n = 7) were prepubertal and 36% (n = 5) were underweight, with mean BMI SDS −1.4 ± 1.2. All had high fT4 78.43 ± 72 pmol/L and suppressed TSH TRAb positivity was 86% (n = 12). AntiTPO or anti-thyroglobulin antibodies positivity was 79% (n = 11). In one child, all three antibodies were negative. Thyroiditis was the commonest ultrasound finding. Carbimazole starting dose was 0.6 mg/kg/day and average treatment duration was 3.5 ± 2.4 years, which achieved biochemical euthyroidism in 49 days. Relapse rate on carbimazole was 57% (n = 8). No adverse effects occurred, and none had definitive therapy. Currently, 71% (n = 10) are euthyroid on a mean carbimazole dose of 0.2 mg/kg/ day; one is off carbimazole. Current height is −1.1 ± 1.31 SD and BMI SDS −0.42 ± 1.7 SD respectively. Conclusion Graves’ disease is the commonest form of paediatric hyperthyroidism in Negeri Sembilan, affecting prepubertal Malay females who commonly present with thyrotoxicosis. Carbimazole effectively achieves biochemical euthyroidism with minimal side effects. However, linear growth is affected. Future studies should evaluate the factors associated with these findings.
Child ; Retrospective Studies ; Hyperthyroidism

Introduction: Hyperinsulinemic hypoglycemia of infancy may be congenital or acquired, and rarely due to factitious hypoglycemia imposed by another. A thorough medical and social history, critical sampling, and screening for inborn errors of metabolism are crucial. Case: A 5-month-old, ex-29 weeker, twin female infant, born to a non-consanguineous couple was admitted at 4 months with severe refractory hypoglycemia and seizures requiring a glucose infusion rate (GIR) of 16 mg/kg/min. Critical sampling suggested hypoglycemia due to exogenous insulin: glucose 1.1 mmol/L, ketones 0.2 mmol/L, insulin 1,208 pmol/L (17.8–173), and C-peptide 18.2 pmol/L (366– 1,466). Free fatty acids were not raised; growth hormones were 2.223 µg/L (0.14–6.27) and cortisol >1,000 nmol/L (145.4–619.4). Metabolic and genetic testing excluded glycogen storage disorder. Two months prior, she was admitted with a severe human metapneumovirus and parainfluenza infection, hypoglycemia, lactic acidosis and left ventricular hypertrophy. Her twin had died of sudden infant death syndrome. Examination revealed a small puncture mark on the abdomen, but otherwise it was unremarkable. The GIR dropped dramatically over 3 days and the intravenous dextrose was discontinued. Normoglycemia was maintained on 3-hourly feeds and she tolerated an age-appropriate fast before discharge. No hypoglycemic episodes were reported. Of note, the mother suffered from bipolar disorder and had access to insulin for gestational diabetes mellitus. The infant is currently in foster care, is scheduled to have neuroimaging and continues to have growth and developmental follow-up. Conclusion Factitious hypoglycemia should be suspected when there are red flags in the clinical history and critical sampling demonstrates high insulin levels, suppressed C-peptide in the face of hypoglycem ia with low ketones and low free fatty acids. A multidisciplinary approach involving paediatrics, psychiatry, and child protective services is mandatory
Infant ; Hypoglycemia

Introduction: Intralesional triamcinolone acetonide (TAC) is an accepted management option for paediatric keloid. TAC is a corticosteroid with five times the potency of hydrocortisone and acts by inhibiting fibroblast growth and thus keloid size. Dermatological adverse effects of TAC are common, but repeated high-dose intralesional TAC can cause the rare complication of Cushing syndrome and suppression of the hypothalamic–pituitary–adrenal (HPA) axis. Case: We report the case of an 11-year-old female referred for worsening lower limb striae and low serum cortisol. Prior to referral, intralesional TAC was administered by a general practitioner to a left lower limb keloid which had developed following an orthopedic intervention. A total of five injections were administered over 4 months: a cumulative dose of 150 mg (equivalent to 700 mg hydrocortisone). The last dose was administered 6 months prior to referral. The morning serum cortisol was low (<13.8 nmol/L) with a concomitantly low adrenocorticotropic hormone (ACTH 0.41 pmol/L) level, consistent with suppression of the HPA axis secondary to exogenous steroids. Renin (84.80 mU/L), aldosterone (280.40 pmol/L), testosterone (0.31 nmol/L), estradiol (85.9 pmol/L) and thyroid function were normal. Physiological oral hydrocortisone replacement was promptly commenced, with education on adrenal crisis and sick days while awaiting recovery of the HPA axis. Conclusion This case illustrates the serious complication of Cushing syndrome with secondary HPA axis suppression due to repeated intralesional TAC therapy for paediatric keloid scars. Factors such as appropriate paediatric doses, size of the keloid, site of injection (dermal, not subcutaneous), and frequency of injections should all be given due consideration before using TAC. Clinicians prescribing steroids to children should be aware that suppression of the HPA axis is a very real and life-threatening complication and that steroids should be prescribed judiciously.
Child ; Keloid ; Triamcinolone

Adult ; Classification ; Diagnosis ; Humans ; Malaysia ; Malocclusion ; Passive Cutaneous Anaphylaxis ; Retrospective Studies

Postprandial hyperglycemia is independently related to cardiovascular disease. Garlic, ginger, lemon, honey and applecider vinegar are known to have anti-glycemic properties. However, the effectiveness of combination of these naturalproducts on reducing postprandial glycemia is uncertain. The aim of the present study was to investigate the glucoseloweringeffect of a novel mixture consisting of apple cider vinegar, garlic, ginger, lemon, and honey; alone and incombination with exercise in response to a high-carbohydrate meal in non-diabetic individuals. Ten, female subjects (meanage: 25 ± 2.67 years, mean BMI: 22.6 ± 3.5 kg/m2) participated in this randomised, cross-over intervention consisting offour trials: control (CON), mixture only (MIX), exercise only (EX), and exercise + mixture (EX-MIX). All trials involvedconsumption of a high-carbohydrate breakfast, then followed by rest in CON, consumption of natural product mixturein MIX, brisk-walking exercise in EX, and combination of mixture and exercise in EX-MIX. Blood glucose was measuredat fasting, and at 30, 60, 90, 120 minutes post meal. Postprandial glucose response was calculated as area under theglucose curve. Two-way repeated measures ANOVA showed a significant group and time interaction (p < 0.001). Comparedto CON, postprandial glucose responses were 8%, 13% and 15% lower in MIX (p = 0.049), EX (p = 0.001) and EX-MIX(p = 0.005) respectively. Postprandial glucose was 8% lower in EX-MIX compared to MIX (p = 0.002). In conclusion,consuming natural product mixture containing garlic, ginger, lemon, honey and apple cider vinegar reduced postprandialglycemia to a certain extent, however, combining mixture with exercise produced a greater attenuation effect comparedto consuming mixture alone. This finding is indicative of a potential benefit of the novel mixture as a complementarymanagement of hyperglycemia in high-risk individual

Tahfiz education has been well accepted by Muslims in Malaysia. Memorizing the Quran through rote learning can assistin improving the brain ability to process, store information and build memory. In addition, dietary intakes were reportedto contribute in the process of memorizing the Quran and to increase the levels of intelligence (IQ) among huffaz students.This cross-sectional study was conducted to measure and to determine the correlation between IQ and dietary intakeas well as between IQ and the level of trace elements among students in selected tahfiz schools and non-tahfiz school inSelangor. Questionnaires were used to obtain demographic data. Dietary intake was assessed via 3 days dietary record.Levels of trace elements in the nail samples were analyzed by using ICP-MS. Test for intelligence using WASI-II wasconducted to measure the students’ IQ. The results showed that there was a moderate positive correlation between IQ andcarbohydrate (r = 0.425, p < 0.001, a weak positive correlation between IQ and energy (r = 0.260, p < 0.05), vitaminB6 (r = 0.189, p < 0.05), vitamin B12 (r = 0.207, p < 0.05) and vitamin C (r = 0.211, p < 0.05). The levels of traceelements in nail samples showed no correlation with IQ, whereas there were moderate positive correlations between IQand dietary zinc (r = 0.375, p < 0.001) as well as between IQ and dietary iron (r = 0.303, p < 0.001). There was also amoderate positive correlation between IQ and the level of memorization (r = 0.375, p < 0.001). The results of stepwisemultiple linear regression showed that al-Quran memorization influence the level of IQ by 20 %. As a conclusion, dietaryintake of certain nutrients including energy, vitamins and selected trace elements can potentially improve memorizationactivities and also IQ.