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

Modified Initial Era Checklist for Screening Ergonomics Risk Factors in Diagnosing Work-Related Musculoskeletal Disorders Introduction Work-related musculoskeletal disorders (WRMSDs) are known to affect a diverse range of occupations around the world. One major factor for their occurrence is the presence of ergonomics risk factors in the workplace; as such, steps to minimize WRMSDs in Malaysia include the development of the Initial Ergonomics Risk Assessment (ERA) checklist for on-site assessors. The checklist, however, may not be useful for medical doctors who diagnose WRMSDs in hospitals or clinics. Moreover, there is no tool to assist medical doctors in considering the role of ergonomics risk factors when diagnosing WRMSDs, which can hamper the overall management of occupational diseases. This study was therefore carried out to modify the Initial ERA checklist so that medical doctors can use it to consider the role of ergonomics risk factors when diagnosing WRMSDs. Methods In Phase I, document analysis was performed to construct the tool by integrating elements that were relevant for use in hospitals or clinics from the Initial ERA checklist and similar tools published overseas. In Phase II, the tool was reviewed by medical doctors and nurses and was found to have excellent content validity (I-CVI = 1.00). In Phase III, the tool underwent further improvement after trailing its application in two role-play sessions involving various healthcare professionals. Results The resulting Modified Initial ERA Checklist can assist medical doctors screen for various ergonomics risk factors when diagnosing WRMSDs in hospitals or clinics. Conclusions Future studies could further examine its application in the field to validate its actual use in hospitals or clinics

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.

Introduction: Differences in baseline characteristics and response to treatment in different age groups of patients with chronic myeloid leukaemia (CML) in resource-limited countries have not been extensively studied. We aimed to determine the differences in clinicopathological parameters at diagnosis and response to imatinib in adult CML patients with younger (under 60 years; YCML) and older (60 years and older; OCML) age treated at our institution from March 2001 to March 2021. Methods: A retrospective analysis of consecutive adult CML patients receiving imatinib was performed. Clinicopathological parameters and treatment response were reviewed and analysed using hospital medical records and electronic data reports. Results: The median age at diagnosis was 50 years. OCML patients (n=17) had significantly more comorbidities. The YCML group (n=50) generally had a palpable spleen >5cm from the costal margin, mild anaemia, hyperleukocytosis and thrombocytosis. A starting dose of 400 mg/day was observed in 84% of YCML and in 65% of OCML. Cumulative complete cytogenetic response was 50% in YCML versus 70.6% in OCML, p=0.158. OCML tended to have a higher percentage of major molecular response (MMR) (52.9% versus 32%) and a shorter time to MMR, 22 months (range 5-70) versus 35 months (range 8-53). OCML experienced more haematological and non-haematological treatment-related adverse events after imatinib therapy. Conclusion: Although OCML patients had more comorbidities and treatment intolerances, overall long-term treatment response was comparable to YCML. In OCML, a more personalised approach to initial and subsequent dosing of imatinib may be considered.

Introduction: The Healthier Choice Logo (HCL) was introduced in 2017 by the Ministry of Health Malaysia. This paper analysed acceptance of HCL, effectiveness of HCL in encouraging healthier product reformulation, and factors affecting reformulation among food industries. Methods: An online self-administered questionnaire consisting of four sections utilising multiple choice and 5-point Likert scale questions was distributed to food industries in Malaysia. Sample size calculation yielded 100 respondents. Results: Food industries had a higher acceptance of the processes and requirements involved in HCL implementation. HCL was highly effective in encouraging product reformulation among food industries in Malaysia. Meeting consumer demand, improving brand image, public health, more awareness around nutrition labelling, logo and national nutrition target, more technical knowledge and budget were found to motivate healthier product reformulation. However, product suitability, consumer acceptability, difficulties maintaining taste and shelf life, and limited budget were the challenges faced in product reformulation. There was no correlation between HCL acceptance and factors encouraging or inhibiting reformulation. Conclusion: These findings are expected to help relevant authorities or stakeholders make changes, if necessary, towards processes and requirements involved in HCL application to ensure wider HCL implementation. Future research should identify the relationship between HCL implementation and public health improvement among the Malaysian population.

To study the characteristics of paediatric patients admitted to two non-COVID-19 teaching hospitals before and during the implementation of the Movement Control Order (MCO) in Malaysia. The retrospective study was performed in two phases (before MCO between February to March 2020, and during MCO lockdown between March to April 2020) in two teaching hospitals on the East Coast of Peninsular Malaysia. Hospitalized children <18 years were included and those coming for elective procedures or oncology treatment were excluded. The clinical data were retrieved from both hospitals’ admission records. There was a total of 496 and 191 admissions to two teaching hospitals on the East Coast of Peninsular Malaysia, respectively. A significant reduction in the number of non-COVID-19 hospital admissions was seen in both hospitals. For Hospital Universiti Sains Malaysia, the daily hospital admissions were reduced with a mean of 10 (before MCO) to 7 (during MCO) admissions/day (95% CI 1.54,7.54, p=0.001). In Sultan Ahmad Shah Medical Centre, a reduction in hospital admission was seen from 5 (before MCO) to 3 (during MCO) admissions/day (95% CI 0.61, 3.15, p=0.005). Our study observed a general drop in non-COVID-related respiratory illnesses and infectious disease cases during the MCO period. There were significant differences in neurological (p=0.029) and accident (p = 0.001) cases admissions observed between the two periods. Public health social distancing has indirectly reduced the non-COVID-19 related cases in the hospital settings with an increase in accidental injuries among the children during the MCO period.
COVID-19

Herpes simplex virus remains the commonest organism of sporadic encephalitis. Common presentations in herpes simplex encephalitis are seizures and behavioural changes apart from fever, lethargy and headache. Cardiac manifestations, nonetheless, are uncommon in herpes simplex infection. We presented an 8-year-old boy with clinical meningoencephalitis and bradycardia. The initial impression was typhoid meningitis due to severe bradycardia. He was managed in paediatric intensive care unit with transcutaneous cardiac pacemaker and infusion of low dose noradrenaline until the bradycardia resolved. A diagnosis of herpes simplex encephalitis was made based on clinical and specific right temporal and focal radiological findings including right insular ribbon involvement, focal changes over temporal and frontal electroencephalographic (EEG) inference and positive HSV IgM serological confirmation.

his is a short-term longitudinal study of physical, cognitive, psychological and functional outcomes following mild traumatic brain injury (mTBI) in adults, caused by road traffic accident (RTA). Outcome measures were the Montreal Cognitive Assessment (MoCA), the Neuropsychological Assessment Battery Screening Module (S-NAB), the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7 (GAD-7) scale. Functional outcomes included returning to working/academia and driving, lifestyle changes, financial claims and litigation status. A total of 285 individuals were diagnosed with mTBI, involving young male motorcyclists (90%): uncomplicated mTBI, n=201; complicated mTBI, n=84. Ethnic distribution consisted of 204 Malays, 58 Indians and 23 Chinese. MoCA detected cognitive deficits (mean=23.11, SD=3.41) within 72 hours of injury. At two weeks, somatic manifestations, physical injuries, cognitive deficits and psychological symptoms were detected. At three months of injury, the language domain was persistently impaired, with a lower score on most cognitive domains in the complicated mTBI category than the uncomplicated mTBI. Psychological and somatic symptoms had improved. Almost 50% of patients had returned to a functional baseline within two weeks of injury and a further 24% within three months. A small proportion of patients made active lifestyle changes (<25%), financial injury claims (38%) and were involved in litigation (11%). In conclusion, mTBI in multi-ethnic Malaysia has multifaceted deficits and outcomes. Early management of symptoms may promote maximum recovery.
Brain Concussion

This review aimed to provide a comprehensive overview of ruminant and human fascioliasis in Malaysia and to identify research gaps in knowledge of the prevalence of fascioliasis in Malaysia and risk factors for the disease using available evidence-based data. We conducted a scoping review based on the framework of Arksey and O’Malley. The preferred reporting items for systematic reviews and meta-analyses were used to guide the review process. The citation search was performed between May and September 2018. Using specific keywords, literature published between 1998 to September 2018 was retrieved from electronic databases. Six articles related to fascioliasis in Malaysia were included in the final review from 1,932 screened articles and reports. Five studies focused on ruminants, including cattle, buffaloes, sheep and goats in the states of Terengganu and Perak. The most frequent ruminant fascioliasis outbreaks involved cattle and goats, with a prevalence of 82%–95% and these outbreaks occurred in Terengganu. Only one study examined the risk of fascioliasis in cattle. In the study, the age and sex of the cattle were important risk-related parameters. The search returned only one documented report of a suspected case of human fascioliasis with an atypical clinical presentation. At present, human fascioliasis in Malaysia remains under-reported and its prevalence remains unknown. The data summarised in this review based on existing evidence identifies research gaps on fascioliasis in ruminants and humans.

Introduction: The lubricant thickness in clearance between bearing surfaces for metallic hip implants are currently incapable of accommodating the motion experienced (high load and low entraining motion) in hip walking cycle. Thus, micro-dimpled surfaces were introduced onto surfaces of metallic acetabular cups to improve lubricant thickness. Micro-dimpled surface is a method of advanced surface improvement to increase the lubricant thickness in various tribological applications, such as hip implants. However, the application of micro-dimpled surfaces in hip implants has not yet been explored adequately. Therefore, this study aims to identify the influence of micro-dimpled depth on lubricant thickness elastohydrodynamically for metallic hip implants using Fluid-Structure Interaction (FSI) approach. Methods: Fluid-Structure Interaction (FSI) approach is an alternative method for analysing characteristics of lubrication in hip implant. Dimples of radius 0.25 mm and various depths of 5μm, 45μm and 100μm were applied on the cup surfaces. The vertical load in z-direction and rotation velocity around y-axes representing the average load and flexion-extension (FE) velocity of hip joint in normal walking were applied on Elastohydrodynamic lubrication (EHL) model. Results: The metallic hip implants with micro-dimpled surfaces provided enhanced lubricant thickness, namely by 6%, compared to non-dimpled surfaces. Furthermore, it was suggested that the shallow depth of micro-dimpled surfaces contributed to the enhancement of lubricant thickness. Conclusion: Micro-dimpled surfaces application was effective to improve tribological performances, especially in increasing lubricant thickness for metallic hip implants.