Introduction: Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder that significantly affects adolescent girls, particularly those with overweight or obesity. However, data examining the determinants and metabolic profiles of PCOS among adolescents with overweight and obesity remain limited, especially in Malaysia. This protocol describes a case-control study investigating the cardiometabolic, dietary, and psychosocial determinants of PCOS among adolescents with overweight and obesity. Methodology: This study is designed as a case-control study involving adolescent girls aged 13–16 years with a body mass index z-score >+1 standard deviation. Cases are defined as adolescent girls with a confirmed diagnosis of PCOS based on the recommendations of the 2017 International Consortium of Paediatric Endocrinology (ICPE), while controls are those who do not meet the diagnostic criteria for PCOS. A total sample size of 440 participants is required. Participants will be recruited from 22 secondary schools selected from a list of schools in Kuala Lumpur. Data on sociodemographic characteristics, psychosocial health, physical activity, and dietary intake will be collected using structured questionnaires. Blood samples will be obtained and analyzed for diagnostic testing (free testosterone), exclusion tests (thyroid-stimulating hormone, folliclestimulating hormone, luteinizing hormone, estradiol, prolactin, and dehydroepiandrosterone sulfate), and biochemical parameters (liver function tests, lipid profile, hemoglobin A1c, fasting glucose, fasting insulin, and inflammatory markers). Results: The study is expected to generate comprehensive data on the cardiometabolic, dietary, and psychosocial determinants of PCOS among adolescents with overweight and obesity. The findings will inform early screening strategies and targeted interventions aimed at reducing long-term reproductive and cardiometabolic complications. Conclusion This protocol outlines a structured approach to investigating PCOS in adolescence and addresses current gaps in early identification and risk stratification among highrisk populations.
Adolescent ; Humans ; Case-Control Studies ; Overweight ; Polycystic Ovary Syndrome ; Obesity

Introduction: Early identification of patients at risk for severe multisystem inflammatory syndrome in children (MIS-C) is essential for favourable clinical outcomes. This study aims to identify the clinical characteristics, factors and outcomes associated with severe MIS-C. Materials and methods: In this retrospective cohort study involving 14 major hospitals in Malaysia, children <15 years who met the United States Centres for Disease Control and Prevention case definition for MIS-C were included. Severe MIS-C was defined as children who required inotropic support, ventilatory support (invasive or non-invasive ventilation), or left ventricular ejection fraction of <55%. The factors investigated for severe MIS-C were demographic characteristics, the presence of comorbidities, clinical characteristics, and laboratory measures. Multivariable logistic regression was used to compute the adjusted odds ratio (aORs) of factors associated with severe MIS-C. Results: Among the 155 patients, 91 (58.7%) presented with severe MIS-C. Severe MIS-C was more likely in patients aged ≥5 years old (aOR 2.13, 95% confidence interval [CI] 1.08-4.21), with dehydration (aOR 3.80, 95% CI 1.53-9.45), lethargy (aOR 2.02, 95% CI 0.97-4.18), tachycardia (aOR 8.33, 95% CI 3.27-21.22), albumin <30g/L (aOR 3.36, 95% CI 1.58-7.13), creatine kinase >200U/L (aOR 3.68, 95% CI 1.57-8.64), D-dimer >3.0µg/mL (aOR 2.11, 95% CI 1.08-4.13), ferritin >500ng/mL (aOR 3.77, 95% CI 1.88-7.55), prothrombin time >12.7 seconds (aOR 3.22, 95% CI 1.61-6.43), and urea >6mmol/L (aOR 5.09, 95% CI 2.04-12.71). Conclusion: Identification of these associated factors of severity in MIS-C could aid in early recognition and prompt escalation of care, leading to better outcomes.

Introduction: The Theory of Planned Behavior (TPB) construct is recommended by the World Health Organization to assess intention for vaccination; however, there is yet a validated instrument in the context of booster dose Covid-19 vaccination in Malaysia. The purpose of the present study is to translate and investigate the factorial validity and internal reliability of the TPB construct for booster dose Covid-19 vaccination (TPB-BDV) questionnaire in Malaysia. Materials and methods: In the pre-testing of the study, five experts and 40 Malaysian adults respectively rated the content and validity index of all 11 items of the translated questionnaire in Malay version. Next, 160 Malaysian adults completed the Malay version of Theory of Planned Behavior- Booster Dose Vaccination (TPB-BDV) questionnaire via online. Results: In the pre-testing phase, Content Validity and Face Validity Index for 10 items in Malay version of TPB-BDV achieved cutoff mean score >3.0 for relevancy, clarity, ambiguity, and simplicity. Meanwhile, Item 8 scored low on relevancy. In the main study, exploratory factor analysis suggested three factors consisting of a final 10 items (without Item 8) which accounted for 74.0% of the total variance. The three factors were Attitude (5 items), Subjective Norms (3 items), and Perceived Behavioral Control (2 items). The internal reliability ranged from a = 0.83 to a = 0.93, with an overall value of a = 0.90. Conclusion: The findings suggest that the 10-items Malay version of TPB-BDV is valid and reliable to measure the individual decision in taking the Covid-19 booster-dose vaccine among Malaysian adult population.

Introduction: Women with uncontrolled diabetes may conceive but will result in poor pregnancy outcomes. This study aimed to assess the level of knowledge and attitude and determine factors associated with attitude towards preconception care. Method: A cross-sectional study was conducted in various government health clinics from all districts in Terengganu by using multistage random sampling. A self-administered questionnaire was applied to assess the level of knowledge and attitude towards preconception care. Multiple logistic regressions were applied to determine factors associated with attitude towards preconception care. Results: A total of 422 respondents were involved. The prevalence of respondents with unsatisfactory knowledge and attitude were 41.7% and 84.1%, respectively. Knowledge was not significantly associated with attitude. Respondents who used contraception had a better attitude (Adj. OR: 0.44, 95% CI:0.23,0.84). Low household income was associated (Adj. OR: 2.40, 95% CI:1.10,5.26) with an unsatisfactory attitude towards preconception care. Conclusion: Attitude towards preconception care amongst diabetic women who were attending primary care clinics was unsatisfactory. A structured and focused preconception educational programme care is necessary, especially amongst low-income women.

Healthcare providers are responsible for performing medical check-ups, analyse and interpret patient's laboratory results. It is common for an initially asymptomatic patient to receive abnormal results including liver enzymes such as alkaline phosphatase (ALP). The concern in these patients is the cut-off value for mildly elevated levels that requires intervention. This paper reports a case of liver malignancy in a 32-year-old man who presented with a mild elevation of ALP level less than five times the upper limit of normal. The patient had no clinical symptoms. Early ultrasound liver assessment showed dilated common bile duct, which led to an urgent CT scan of the liver that revealed supportive features of fibrolamellar carcinoma. The patient was managed successfully with early partial hepatectomy that has saved him from morbidity and mortality of liver malignancy. Indeed, liver malignancy can be detected early in a health clinic from a further assessment of trivial elevation of ALP.

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.

Artocarpus heterophyllus Lam. (Moraceae) has been traditionally used in treating various diseases such as diabetes, diarrhea, malarial fever, inflammation, wound healing and other diseases. Since various bioactive compounds have been found in this plant, this review focuses on the phytochemical and pharmacological properties of a potent bioactive compound artocarpin. Despite its various functions, a mechanistic review on this compound has not been reviewed specifically. Here, pharmacological studies in vitro and in vivo on artocarpin are discussed thoroughly stressing on anticancer, antimicrobial, anti-tyrosinase, antioxidant and antiinflammatory aspects of artocarpin. This review would be beneficial for future study to show the competency of natural products for theirtherapeutic characteristics.

Artocarpus heterophyllus has been used as traditional medicine. This plant is one of the sources of flavonoid. Flavonoid compounds possessed a wide range of biological properties including anticancer. This study was performed to investigate the cytotoxic effect of flavonoids from A. heterophyllus on H460 and MCF-7 cell lines. The interaction of flavonoids and cisplatin against tested cancer cells was also evaluated. MTT assay was used to determine the cytotoxic effect of flavonoid. Isobologram analysis was selected to evaluate the synergistic effect between flavonoid and cisplatin, their interaction was then confirmed using AO/PI staining method. Amongst of flavonoid compounds, artocarpin exhibited strong cytotoxic effect on both MCF-7 and H460 cell lines with IC₅₀ values of 12.53 µg/mL (28.73 µM) and 9.77 µg/mL (22.40 µM), respectively. This compound enhanced anticancer activity of cisplatin against H460 and MCF-7. The combination produced a synergistic effect on H460 and MCF-7 cell lines with a combination index (CI) values of 0.2 and 0.18, respectively. The AO/PI stained demonstrated that the combination of artocarpin and cisplatin caused morphological changes that indicated apoptosis. Moreover, artocarpanone also significantly increased cytotoxic effect of cisplatin compared to its single concentration with CI below than 1. This result suggested the potency of flavonoid named artocarpin to enhance the anticancer activity of cisplatin on H460 and MCF-7 cell lines.
Apoptosis ; Artocarpus ; Cell Line ; Cisplatin ; Flavonoids ; MCF-7 Cells ; Medicine, Traditional ; Methods ; Plants

INTRODUCTIONThis study aimed to determine the prevalence of asthma-like symptoms among schoolchildren with low birth weight (LBW), and to compare the lung function of these children with that of children with normal birth weight.

METHODSThis was a comparative cross-sectional study. We recruited children aged 8-11 years from eight primary schools in Kota Bharu, Kelantan, Malaysia. The children were divided into two groups: those with LBW (< 2,500 g) and those with normal birth weight (≥ 2,500 g). Parents of the enrolled children were asked to complete a translated version of the International Study of Asthma and Allergies in Childhood questionnaire. Lung function tests, done using a MicroLoop Spirometer, were performed for the children in both groups by a single investigator who was blinded to the children's birth weight.

RESULTSThe prevalence of 'ever wheezed' among the children with LBW was 12.9%. This value was significantly higher than that of the children with normal birth weight (7.8%). Forced vital capacity (FVC), forced expiratory volume in one second, and forced expiratory flow when 50% and 75% of the FVC had been exhaled were significantly lower among the children with LBW as compared to the children with normal birth weight.

CONCLUSIONLBW is associated with an increased prevalence of asthma-like symptoms and impaired lung function indices later in life. Children born with LBW may need additional follow-up so that future respiratory problems can be detected early.

Asthma ; epidemiology ; etiology ; Child ; Cross-Sectional Studies ; Databases, Factual ; Female ; Humans ; Infant, Low Birth Weight ; Malaysia ; epidemiology ; Male ; Prevalence ; Respiratory Function Tests ; Respiratory Sounds ; Schools ; Spirometry ; Surveys and Questionnaires

Current selection guideline for CRT uses broad QRS duration (>120 ms) as a marker for ventricular dyssynchrony. However, more recent data supports mechanical marker specifically measured by Tissue Doppler Imaging (TDI) as a better criterion to predict response to CRT. Sixty seven patients with significant left ventricular dysfunction (EF less than 40%) and narrow QRS complex were prospectively enrolled. They underwent Tissue Doppler Imaging (TDI) study to evaluate intraventricular mechanical dyssynchrony. Dyssynchrony index which is defined as standard deviation of time to peak systolic velocity in twelve ventricular segments was measured. A value greater than 32.6 is taken to reflect significant ventricular dyssynchrony. Overall 38 patients (56.7%) demonstrated significant dyssynchrony. There was no significant correlation between QRS duration and the Ts-SD-12 (r = 0.14, p = 0.11). Ventricular mechanical dyssynchrony is common in patients with normal QRS duration. Therefore, QRS duration alone will miss a substantial proportion of suitable patients for CRT and therefore deny them this adjunct therapy. We propose echocardiographic parameters, specifically TDI, to be included in patient selection criteria for CRT.