Introduction: Obesity is a heterogeneous metabolic disease in which individuals with similar body weight may exhibit markedly different physiological risk profiles. Conventional monitoring using weight alone may fail to capture underlying metabolic and cellular changes during lifestyle intervention. Integrating body composition and biochemical markers may improve risk stratification in clinical practice. Methodology: A prospective observational analysis was conducted among participants enrolled in a structured lifestyle programme. Baseline and follow-up assessments included biochemical markers (fasting glucose, renal function, lipid profile, and liver enzymes) alongside body composition parameters derived from bioelectrical impedance analysis, including percent body fat, visceral fat area, skeletal muscle index (SMI), and phase angle (PhA). Changes over time and associations between metabolic and body composition variables were analyzed. Results: Metabolic responses varied substantially despite similar anthropometric profiles. Renal function improved significantly, with increased estimated glomerular filtration rate (eGFR) observed over time (p = 0.01), and was inversely associated with fasting glucose (r = −0.41, p <0.01). Lipid abnormalities persisted, although reductions in lowdensity lipoprotein cholesterol were noted (p = 0.04). Total cholesterol remained elevated and correlated positively with fasting glucose (r = 0.36, p = 0.02). Improvements in aspartate aminotransferase were observed (p = 0.03), while other liver markers remained stable. Notably, body composition parameters, including PhA and SMI, demonstrated variability independent of weight change, reflecting heterogeneous physiological adaptation. Conclusion Metabolic and physiological responses to lifestyle intervention are heterogeneous and not fully captured by changes in body weight alone. The integration of bioimpedance-derived parameters with biochemical markers provides a more comprehensive approach to metabolic risk stratification and may support more personalized clinical management in obesity care.
Biomarkers ; Risk Assessment ; Body Composition

RECURRENT UROSEPSIS DUE TO NEPHROCOLIC FISTULA IN AN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE Nephrocolic fistula is an abnormal communication between the kidney and the colon, a rare clinical phenomenon with potentially serious complications. We present a case of a 37-year-old female with autosomal dominant polycystic kidney disease who complained of left lumbar pain, fever and urinary frequency. She had multiple similar presentations for years, refractorily treated for recurrent urinary tract infections. Contrast-enhanced computed tomography abdomen demonstrated bilateral staghorn calculi and perinephric abscesses connected to the descending colon. She eventually required surgical intervention after the failure of medical therapy. Our case highlights the diagnosis and management of nephrocolic fistula.

PUBLIC PERCEPTION ON THE USE OF ECO-FRIENDLY BAMBOO TOOTHBRUSH Plastic toothbrushes which are mainly made of polypropylene are one of the sources of plastic pollution. With the increased awareness of this alarming global issue, eco-friendly bamboo toothbrushes have been introduced and are becoming widely available in the market. The study aimed to explore the public’s experience with bamboo toothbrushes and identify their feature preferences. An observational study using a qualitative approach was conducted among 10 participants aged from 18 to 40 years old without any experience using bamboo toothbrushes (based on the inclusion and exclusion criteria). A selected standard bamboo toothbrush was given to the participants and they were asked to use the bamboo toothbrush for two weeks based on the instructions provided. At the end of two weeks of usage, a one-to-one, semi-structured in-depth interview was conducted either face-to-face or online. These interviews were recorded, transcribed and analysed using thematic analysis. Most participants expressed mixed views regarding their experience using the bamboo toothbrush in comparison to their previous conventional plastic toothbrush. The most preferred features of the bamboo toothbrush cited by the participants were related to a non-slippery handle, small-sized toothbrush and eco-friendly material. The majority of the participants have the intention to continue using the bamboo toothbrush provided some modifications to the design are made. Identifying the ideal features of a bamboo toothbrush could be a timely strategy to reduce the impact of plastic in oral health care.

Objective: This study aims to report the demographic features of patients with acromegaly the disease burden, and the corresponding treatment patterns and outcomes in Malaysia. Methodology: This is a retrospective study that included patients from the Malaysian Acromegaly registry who were diagnosed with acromegaly from 1970 onwards. Data collected included patient demographics, clinical manifestations of acromegaly, biochemical results and imaging findings. Information regarding treatment modalities and their outcomes was also obtained. Results: Registry data was collected from 2013 to 2016 and included 140 patients with acromegaly from 12 participating hospitals. Median disease duration was 5.5 years (range 1.0 – 41.0 years). Most patients had macroadenoma (67%), while 15% were diagnosed with microadenoma. Hypertension (49.3%), diabetes (37.1%) and hypopituitarism (27.9%) were the most common co-morbidities for patients with acromegaly. Majority of patients had surgical intervention as primary treatment (65.9%) while 20.7% were treated medically, mainly with dopamine agonists (18.5%). Most patients had inadequate disease control after first-line treatment regardless of treatment modality (79.4%). Conclusion This registry study provides epidemiological data on patients with acromegaly in Malaysia and serves as an initial step for further population-based studies.
acromegaly ; treatment outcomes

Liposomes are phospholipid bilayer vesicles, which are biocompatible, biodegradable and nontoxic vehicles suitable for numerous drug and gene delivery applications. In this review, we discuss the prospect of using liposome technology in the development of a vaccine for tuberculosis. Tuberculosis remains an important health problem that requires the development of an effective vaccine, especially since the only approved vaccine for it continues to be the Bacille Calmette-Geurin (BCG) one developed 100 years ago. This review focuses on the different applications of liposomes toward achieving this goal. Numerous liposomal formulations showing prospect in the research stage and in clinical trials are discussed.

Introduction: We clarified the extent to which white rice (WR)-based carbohydrate diets affect body weight and metabolic parameters in rats. Methods: In this experimental study, a male Sprague Dawley (n=32) rats fed with WRbased CHO diet in two different proportions of total energy intake (TEI 55% moderate-CHO (MCHO, n=8) and 65% High-CHO (HCHO, n=8)) or high-fat diet (HFD, n=8) were compared with rats maintained on standard pellet diet (SD, n=8) for eight weeks period. Carbohydrate sources in the HFD and SD were mainly based on cornstarch (25% of amylose). Outcomes measures include body weight and metabolic parameters. Results: At baseline, body weight and metabolic parameters (fasting plasma glucose, insulin, and triglyceride levels) were comparable in all rats. Despite higher daily caloric intake in rats fed with HFD (103.9±3.0) than the other diets, no significant differences in body weight between groups after 8 weeks of study. However, rats’ feds with WR-based CHO diets (both moderate and high carbohydrates) had higher fasting blood glucose (MCHO=12.8±1.6, HCHO=16.9±2.4) and triglycerides level (MCHO=1.2±0.0, HCHO=1.3±0.0) than rats in cornstarch-based HFD and SD (p<0.05). Both HFD and HCHO had higher fasting insulin than MCHO and SD (p<0.05), but the homeostatic model assessment of insulin resistance (HOMA-IR) was significantly higher in WR-based CHO diets (both moderate and high carbohydrates) than the rats in cornstarch-based HFD and SD (p<0.05). Conclusion: A WR-based CHO diet exhibits higher fasting blood glucose, triglycerides, and insulin resistance state than a high-fat diet without a significant impact on body weight. These findings may explain the growing incidence of diabetes in Asia and worth studying further.

Diabetes mellitus has reached epidemic levels in Malaysia due to increase in its risk factors such as obesity, dietary and sedentary lifestyle. In patients with uncontrolled diabetes mellitus, diabetic foot ulcer (DFU)is a common complication. Managing diabetic foot infection is often multifactorial and intricate. The management DFU demands multi-speciality approach and often tedious. Hyperbaric oxygen therapy (HBOT) is a promising adjunctive treatment used to enhance the healing process plus reduces cost and recovery time. This is a case of a 52 years old lady, with underlying poorly diabetes mellitus, who presented with diabetic foot ulcer Wagner IV classification in sepsis. She underwent trans-metatarsal amputation followed by split skin grafting with additional adjunctive HBOT in a tertiary hospital.

Objectives: A history of severe hypoglycemia (SH) is associated with cardiovascular (CV) events among patients with type 2 diabetes mellitus (T2DM). In this study, we compared the severity of atherosclerotic coronary artery disease (ACAD) in T2DM patients with and without a history of SH. Methodology: We conducted a comparative case-control study involving 28 T2DM patients with a history of SH within the last 5 years with no documented ACAD, and matched them with 28 T2DM patients with no history of SH. All subjects underwent coronary artery calcium scoring (CACS) with or without coronary computed tomographic angiography (CCTA) to evaluate the severity of ACAD. Results: A history of SH in T2DM was associated with a higher prevalence of significant ACAD (79% versus 46%, p=0.026). A high CACS (≥100) was seen in a greater number of patients with a history of SH compared to those without (75% versus 43%, p=0.029). Similarly, there was a higher prevalence of obstructive CAD in those with a history of SH compared to those without (72% versus 39%, p=0.036). Median C-reactive protein level was also higher among patients with a history of SH (0.41 mg/dL versus 0.16 mg/dL, p=0.029). Conclusion In patients with T2DM, a history of SH is significantly associated with ACAD compared to those without SH. A history of SH warrants screening for ACAD.
Hypoglycemia ; Coronary Artery Disease ; Diabetes Mellitus, Type 2 ; C-Reactive Protein

In higher education setting throughout the world, the practise of handwashing among staff is essential, particularly in the period of COVID-19 pandemic. Despite the overwhelming evidence on the effectiveness of proper handwashing, the knowledge, attitude and practice of handwashing among the staff of higher education have not been well investigated. Consequently, a cross-sectional study among staff in a university in Malaysia was conducted to identify the prevalence of proper handwashing and its associated factors. The data was collected using questionnaires in Google form from 18th June to 21st June 2020. Statistical analyses involved simple and multiple logistic regression with backward likelihood ratio method. Out of 349 participants, 31.8% (95% CI: 26.9,36.7) had proper handwashing practice. The results of the multivariable analysis revealed that the total knowledge scores (OR: 1.04, 95% CI: 1.001, 1.071) and the total attitude scores (OR: 1.23, 95% CI: 1.152, 1.321) were found to be significantly associated with proper handwashing practice among staff. Our study suggests that having the right knowledge and favourable attitudes are crucial towards achieving the proper handwashing practise. Additional supports for promoting a conducive ecosystem may also likely be needed to sustain a long-term practice of proper handwashing.

Secondhand smoke (SHS) carries many health risks and is associated with diseases and premature deaths among nonsmoking adults and children. Despite many health promotions and legislative measures executed by the government to protect the public from SHS, the prevalence of SHS exposure is still high. Personal appropriate practices to avoid exposure are crucial especially at home or private area. Therefore, the current study focused on describing individual preventive practices on SHS and determining its associated factors. A cross sectional study was conducted among 250 adults in a village, Kuala Terengganu. Data were collected using self-administered questionnaires. Multiple logistic regression analysis was performed to determine the association between all independent variables and the SHS preventive practice status. The prevalence of SHS exposure was 66.0%. Majority of the respondents (77.2%) has good knowledge on SHS. Nevertheless, despite having good knowledge, a large proportion of them showed poor attitude toward SHS (77.6%) and poor preventive practices (61.2%). Poor preventive practices on SHS were significantly associated with being older (OR­adj: 1.0206, 95% CI: 1.0004, 1.0412), female (OR­adj: 2.0644, 95% CI: 1.0753, 3.9635), smoker (OR­adj: 12.1107, 95% CI: 4.0630, 36.0991), not having existing tobacco-related morbidity (OR­adj: 3.6795, 95% CI: 1.1795, 11.4786), and poor attitude towards SHS (OR­adj: 4.1871, 95% CI: 2.0955, 8.3665). The preventive practices of SHS among the villagers were poor despite showing acceptable level of knowledge. Hence, health awareness on the potential impact of SHS to the public as well as instilling appropriate behavior for them to avoid SHS and educate smokers need to be emphasized.