Introduction: The nutritional status of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Down Syndrome (DS) is influenced by multiple food environment determinants. However, the precise relationship between food environment determinants and nutritional outcomes in these children remains unclear. This study aimed to understand the food environment determinants that are associated with the intake and nutritional status of these children in Malaysia, Lao PDR, and Indonesia. Methods: This cross-sectional study involved 7- to 18-year-old students with ADHD and DS in three Southeast Asian countries. Sociodemographic characteristics, dietary habits, and repeated 24-hour food recall data were collected through a structured questionnaire. Anthropometric data were obtained through direct measurements and analysed using the WHO AnthroPlus software. Further analyses were done using descriptive statistics and chi-square tests. Results: Total participants were 284 children, comprised of 37.7% with ADHD and 62.3% with DS; 62.3% of the children were boys and 37.7% were girls. Among the food environment determinants collected during the study, monthly household income and school food assistance status had significant associations (p<0.05) with BMI-for-age z-score category and total energy, protein, zinc, and calcium intakes. While the country, type of residence, and type of school had significant associations with total energy, protein, zinc, and calcium intakes. Conclusions: Food environment determinants, particularly household income and access to school food assistance, significantly influence the nutritional status and intake of children with ADHD and Down Syndrome. Thus, strengthening inclusive nutrition programmes may improve outcomes for this vulnerable group in Southeast Asia.

PREVALENCE, RISK FACTORS AND ASSOCIATION WITH GALLSTONE DISEASE OF NON-ALCOHOLIC FATTY LIVER DISEASE AMONG RURAL INDIGENOUS COMMUNITIES: A CROSS-SECTIONAL STUDY IN SARAWAK, MALAYSIA Introduction: This study aimed to evaluate the prevalence and risk factors of non-alcoholic fatty liver disease (NAFLD) among Dayak communities in Malaysia, shedding light on an underexplored population. Methods: A cross-sectional study was undertaken among Dayak villagers in Sarawak aged 18 years and above using an interview-based questionnaire, followed by an anthropometric measurement, a blood test and an abdominal ultrasound. Results: A total of 324 participants met the inclusion criteria. Among them, 42.9% were men, and the mean age was 49.85±14.9 years. The prevalence of NAFLD was substantially high at 58%, with 43.1% of the participants having mild fatty liver (grade 1). NAFLD was closely associated with waist circumference and body mass index (BMI) (P<0.001). Central obesity, as indicated by waist circumference and BMI, emerged as a potent risk factor, with higher values correlating with an increased likelihood of NAFLD. A higher prevalence of NAFLD was observed in the participants with an advancing age, an elevated triglyceride level (66.7%) and a lower high-density lipoprotein cholesterol level (81.6%). However, these associations did not remain significant in the multivariate analysis. Gallstones, which share common risk factors with NAFLD, were not significantly associated with NAFLD in this population (P=0.853). Conclusion: This study defines the prevalence and association of NAFLD with sociodemographic characteristics, health profiles and gallstone disease among indigenous villages in Dayak communities. A high BMI and central obesity are found to be independent risk factors of NAFLD.

A 43-year-old male with no past medical history presented with acute onset palpitations, chest pain and diaphoresis. Electrocardiogram showed atrial fibrillation with rapid ventricular response. High-sensitivity cardiac troponin I was elevated at 87 ng/L at presentation and rose further to 1874 ng/L 8 hours later. Invasive coronary angiography revealed significant stenosis of the left circumflex artery, which was treated with percutaneous coronary intervention. Transthoracic echocardiography showed severe left ventricular hypertrophy with mild systolic anterior motion of the anterior mitral leaflet. Cardiac magnetic resonance demonstrated features consistent with hypertrophic cardiomyopathy with regional fibrosis. Of note, focal delayed enhancement was seen in the anterolateral papillary muscle.

A Survey on Knowledge, Attitude and Practice of Denture Care Among Elderly Patients As the elderly population grows, removable dentures remain an essential, viable, and economical option for replacing missing teeth. Enhancing patient understanding of denture care is essential for better oral and systemic health. This study aimed to evaluate the knowledge, attitude and practice of denture hygiene care among the geriatric denture users. A paper-based survey study was conducted on denture wearers aged 60 years old and above. Eligible participants, identified via convenience sampling, received a validated self-administered questionnaire about knowledge, attitude and practice of denture care that was translated into several languages. The study included 138 denture wearers, of which 60.9% were female and the remaining 39.1% were male. All participants cleaned their dentures at least once a day using mechanical (50.7%), chemical (25.4%), or combination methods (23.9%). Approximately 29.7% of the participants wore their dentures overnight. The mean knowledge score was relatively poor (46.5%) and was significantly associated with the denture cleaning method used, nocturnal denture use, and frequency of denture cleaning (p < 0.05). No association between a patient’s gender and educational level and their attitudes and practices of denture care was observed (p > 0.05). In conclusion, geriatric denture wearers were showing a low knowledge score and were significantly associated to their denture hygiene protocols and the habit of nocturnal denture use. Enhanced knowledge delivery to elderly patients is essential to ensure a sustenance of good attitude and practices in denture hygiene.

INTRODUCTION: Nail psoriasis treatment is challenging due to difficult drug delivery and systemic therapy toxicities. Self-dissolvable microneedle patches embedded with corticosteroids offers a potentially rapid, minimally invasive drug delivery platform with good efficacy and minimal adverse side effects. METHODS: We conducted a 4-month prospective randomised controlled trial. Subjects with psoriatic nails were randomised to receive microneedle device delivered topical steroids on one hand and control treatment (topical Daivobet gel) on the other. Two independent dermatologists blinded to the treatment assignment scored their Nail Psoriasis Severity Index (NAPSI) during visits at baseline, 2 and 4 months. All treatment was discontinued after 2 months. Average NAPSI score on each hand was analysed. RESULTS: A total of 25 participants were recruited, aged 22 to 73 years. Majority were Chinese (72%), followed by Indian and Malay. There was equal randomisation of treatment to the left and right nail. While there was a rapid significant improvement in average NAPSI score for the control arm at 2 months, the treatment arm had a greater, more sustained improvement of the NAPSI score at 4 months. The average NAPSI score improved for both treatment and control group at 4 months compared to baseline. However, only the NAPSI value improvement in the controls at 2 months compared to baseline was statistically significant (P=0.0039). No severe adverse effects were reported. CONCLUSION To the best of our knowledge, this is the first prospective randomised control trial comparing microneedle technology against conventional topical steroids in nail psoriasis treatment. Our findings demonstrate microneedle technology is as efficacious as topical therapy.
Humans ; Nail Diseases/drug therapy* ; Nails ; Prospective Studies ; Psoriasis/drug therapy* ; Triamcinolone

INTRODUCTION: Personal mobility devices (PMDs), such as electronic scooters or motorised bicycles, are efficient modes of transportation. Their recent popularity has also resulted in an increase in PMD-related injuries. We aimed to characterise and compare the nature of injuries sustained by PMD users and bicycle riders. METHODS: This retrospective study compared injury patterns among PMD and bicycle users. 140 patients were admitted between November 2013 and September 2018. Parameters studied included patients' demographics (e.g. age, gender and body mass index), type of PMD, nature of injury, surgical intervention required, duration of hospitalisation and time off work. RESULTS: Of 140 patients, 46 (32.9%) patients required treatment at the department of orthopaedic surgery. 19 patients were PMD users while 27 were bicycle riders. 16 (84.2%) patients with PMD-related injuries were men. PMD users were significantly younger (mean age 45 ± 15 years) when compared to bicycle riders (mean age 56 ± 17 years; P <0.05). A quarter (n = 5, 26.3%) of PMD users sustained open fractures and over half (n = 10, 52.6%) required surgical intervention. Among 27 bicycle users, 7.4% (n = 2) of patients sustained open fractures and 70.4% (n = 19) required surgical intervention. Both groups had comparable inpatient stay duration and time off work. CONCLUSION PMD-related orthopaedic traumas are high-energy injuries, with higher rates of open fractures, when compared to bicycle injuries. In addition, PMD users are significantly younger and of economically viable age. Prolonged hospitalisation and time off work have socioeconomic implications. Caution should be exercised when using PMDs.
Male ; Humans ; Adult ; Middle Aged ; Aged ; Female ; Bicycling/injuries* ; Retrospective Studies ; Fractures, Open ; Orthopedics ; Hospitalization ; Accidents, Traffic