IIUM Medical Journal Malaysia

Acute Suppurative Thyroiditis with Progression to Thyroid and Retropharyngeal Abscesses: A Case Report

2025-03-17T22:09:39+08:00

Acute Suppurative Thyroiditis (AST) is an exceedingly rare cause of thyroid gland infection. Due to its rarity and non-specific presenting symptoms, diagnosis and treatment of AST may be delayed. We report a case of an elderly male who presented with five days history of intermittent fever, sore throat, dysphagia and vomiting. Painless thyroid swelling was only noted during admission. Ultrasound scan (USS) of the neck showed a well-defined lesion occupying the left thyroid lobe and computed tomography (CT) of the neck showed a rim enhancing collection occupying the left thyroid lobe, extending to retropharyngeal and retrotracheal spaces. Pigtail drainage was performed with no clinical improvement, necessitating incision and drainage, where necrotic tissue mixed with pus was drained. Intraoperative tissue culture isolated Enterococcus faecium, and antibiotic therapy was changed following tissue culture sensitivities (IV Augmentin, 1.2 gram, TDS). This case highlights the importance of early diagnosis of AST particularly in elderly patients with multiple comorbidities, where symptoms may be atypical. Ultrasound and CT scans are important diagnostic modalities in AST and microbiological assessment is crucial in selecting appropriate antibiotics. The choice of type of drainage should be individualized based on disease extension and comorbidities. A multidisciplinary approach is crucial to ensure best treatment outcome.

Catamenial Pneumothorax: Breathing Through The Menstrual Cycle

2025-05-13T10:11:00+08:00

Catamenial pneumothorax (CP) is a unique disease related to thoracic endometriosis. It is often diagnosed in females of reproductive age presenting with recurrent spontaneous pneumothorax aligned with their menstrual cycle. We present a case of a woman presenting with recurrent episodes of dyspnoea coinciding with her menstrual cycle. Radiographic imaging confirmed a recurrent pneumothorax, and thoracoscopy with a pleural biopsy revealed diaphragmatic fenestrations and thoracic endometriosis. Multiple approaches, including medical pleurodesis, surgical pleurodesis, and hormonal therapy were used in her treatment. She recovered well after started on continuous oral Dienogest, and she has been asymptomatic for three years. This case illustrates the importance of recognizing the cyclical pattern of symptoms and a thorough diagnostic workup to confirm CP. This ensures timely management, which includes hormonal therapy and surgical intervention.

A Rare Case of Extramammary Paget’s Disease Mimicking Chronic Dermatitis

2025-02-24T21:42:51+08:00

Extramammary Paget`s disease (EMPD) is a rare malignant dermatological condition that usually occurs in regions with high concentrations of apocrine sweat glands. The vulva is the most commonly affected region, but it can also involve the skin of the penis, perianal area, scrotum, and perineum. This is a case of a 77-year-old postmenopausal lady who presented with a non-resolving and persistent itchy skin lesion on her genital area that had been spreading over three years and had not responded to topical and systemic steroids or antifungals. This case highlights the diagnosis challenges due to its almost similar features to genital dermatitis and fungal infection. Early recognition of this disease at the primary care level is important due to the high incidence of associated invasive disease with this rare condition.

Central Nervous System Tumour in Pregnancy, a Diagnostic Challenge or Management Quandary

2026-01-06T21:00:39+08:00

Central nervous system (CNS) tumour, being rare in pregnancy, posed different challenges. We report three challenging cases managed at our centre. The first case was a diagnostic puzzle, bringing a myriad of differentials since the eighth week of gestation. Diagnosis made after magnetic resonance imaging (MRI) post-delivery at 35 weeks of gestation led to cervical spine meningioma excision surgery and subsequent progressive, remarkable neurologic recovery. Two additional cases were not a diagnostic mystery, yet they posed management challenges. The second case was diagnosed with a cerebellar tumour complicated with hydrocephalus at a pre-viable gestation. Pregnancy was able to be prolonged up to viability at extreme prematurity at 26 weeks when she needed delivery with subsequent cerebellar haemangioma excision and recovery. However, the third case became pregnant during follow-up after radiation therapy for brain glioma, with persistent symptoms necessitating termination of pregnancy.

Ethical and Legal Issues at the End of Life for Critically Ill Patients

2026-03-31T15:27:48+08:00

A Systematic Literature Review on ICU Nurses’ Experience and Family Interactions during Death and Dying from Islamic Perspective

2025-12-26T15:05:56+08:00

The growing complexity of death and dying in Intensive Care Units highlights nurses' critical role, particularly concerning family interactions and spiritual needs from an Islamic perspective. However, there is a gap in understanding the nuances of these interactions, how nurses can best facilitate them, and how potential conflicts arising from differing interpretations of religious beliefs may impact care; this area remains underexplored. This systematic literature review aims to synthesize existing studies on ICU nurses' experiences with critically ill patients during death and dying, focusing on Islamic perspectives or spiritual care, employing a qualitative synthesis approach. The Scopus database was used to retrieve relevant documents published between 2005 and 2024. The review followed PRISMA guidelines for identification, screening, exclusion, and inclusion. Qualitative, quantitative, mixed-method studies, and review articles were included, with only qualitative papers appraised using the Joanna Briggs Institute’s criteria. Initially, 378 records were identified. After removing unavailable files and screening, 113 titles and abstracts were assessed. Of 84 reports reviewed for eligibility, 68 were excluded, leaving 14 studies that met the inclusion criteria for the final review. This review emphasizes the crucial need for better training, policies, and institutional support for ICU nurses. Such measures would enable them to manage the complexities of culturally sensitive care for family members during loved ones' death and dying. Implementing standardized guidelines addressing Islamic perspectives can significantly improve care quality and patient-family satisfaction.

A Bibliometric Analysis of Chatbot or ChatGPT in Nursing Fields from 2022 to 2024

2025-10-28T12:02:39+08:00

Nursing education has undergone a significant transformation as a result of artificial intelligence(AI). Chatbots, specifically ChatGPT, have emerged as vital AI technologies within the nursing domain as it is a computer program designed to simulate human conversation through text or voice interactions. This study aims to conduct a bibliometric analysis to gain insights into the publication trends, citation impact, and thematic evolution in nursing education and practice concerning ChatGPT and chatbots. A comprehensive bibliometric analysis was performed using VOSViewer, concentrating on citation networks for data analysis and visualisation. A review of LENS.org identified 344 relevant research publications regarding chatbots and ChatGPT within the nursing discipline, all of which were utilised in the study. The study examined various aspects, including types of publications, prominent authors, leading journals, participating nations, institutions, and the impact of ChatGPT on nursing practice. The primary objectives included categorising the papers, identifying the most influential authors, delineating the prominent areas and institutions in the field, and examining the impact of ChatGPT on nursing education and practice. The findings indicate that ChatGPT positively impacts nursing education by enhancing learning experiences, improving communication, and aiding clinical decision-making. The findings indicate that journal articles accounted for 76% of publications, with the U.S. leading in research output. The findings indicate that ChatGPT positively impacts nursing education by enhancing learning experiences, improving communication, and aiding clinical decision-making. Future research should focus on establishing frameworks for integrating ChatGPT into nursing education, addressing ethical implications, and assessing the long-term impacts on patient care.

Recent Updates on the Mechanism of Action of Spirulina as an Anticancer Agent against Breast Cancer

2025-05-02T11:23:56+08:00

Spirulina, a small blue-green algae that lives in warm, alkaline seas, is one of the world's oldest life forms. With century-old history, this nutrient-rich organism has received a lot of interest in recent years for its possible health benefits and sustainable production practices. Studies have indicated its antioxidant, anti-cancer, and anti-inflammatory qualities are contributed by its bioactive compounds, mainly phycocyanin. Other compounds or elements include phycocyanobilin, carotenoids, unsaturated fatty acids, selenium, and amino acids. Breast cancer is one of the major causes of cancer related death in women. As some of the cancer therapies are highly associated with side effects, nutraceuticals such as Spirulina could be an alternative therapeutic intervention. Although some research has been conducted to investigate the anti-breast cancer effects of Spirulina in the past, its mechanism of action is not entirely understood. Previous studies suggest that it may trigger apoptosis and autophagy via modifying signalling pathways such as NF-κB and Bcl-2/Bax ratio. It also has anti-proliferative properties, inhibits cell migration, causes cell cycle arrest, and lowers cancer cells' capacity to form colonies. Phycocyanin has been shown to produce reactive oxygen species (ROS) and down-regulate anti-apoptotic molecules, which contribute to its anticancer capabilities. These findings show that Spirulina fights cancer by targeting a variety of cellular mechanisms involved in carcinogenesis. While these data imply potential benefits, more clinical trials and research into the exact mechanisms of Spirulina in cancer treatments are needed to fully demonstrate its efficacy in treating breast cancer in humans.

Prevalence of Erectile Dysfunction & Its Associated Factors among Nondiabetic Overweight and Obese Patients Attending Government Health Clinic in Kuantan, Pahang.

2025-10-14T08:04:58+08:00

INTRODUCTION: In the clinical setting, erectile dysfunction (ED) is a significant issue that should not be neglected, as it can adversely impact the quality of life of patients and their partners, especially among overweight and obese populations. This study aims to determine the prevalence of ED and its associated factors among non-diabetic, overweight, and obese patients who attend a government health clinic in Kuantan, Pahang, Malaysia. MATERIALS AND METHODS: A six-month cross-sectional study was conducted from February 2024 to August 2024 at twelve health clinics in Kuantan, Pahang. The selected respondents were married men over 18 years old, and those with diabetes mellitus, cardiovascular disease, psychiatric illness, or illiteracy were excluded. Data were collected using the validated Malay version of the International Index of Erectile Function (IIEF-5). ED was defined as an IIEF-5 score of less than 22. Descriptive analysis and simple and multiple logistic regression were performed using SPSS. RESULTS: All 221 eligible patients in the study responded (100% response rate). The prevalence of ED was 66.1% (n=146). Multiple logistic regression showed that ED was significantly associated with dyslipidemia [AOR (95% CI): 2.42 (1.06–5.52); p-value=0.036], anxiety [AOR (95% CI): 3.99 (1.44–11.01); p-value=0.008] and older age [AOR (95% CI): 1.07 (1.02–1.12); p-value=0.009]. CONCLUSION: The study revealed a high prevalence of ED among non-diabetic overweight and obese patients, potentially linked to increasing age, dyslipidemia, and anxiety. Increasing awareness among the public and healthcare providers could improve detection rates in primary care.

Factors Affecting Triple Elimination Testing in Pregnant Women During Their First Visit (K1) at Harapan Baru Health Center, East Kalimantan.

2025-12-15T14:39:16+08:00

INTRODUCTION: Mother-to-child-transmission of HIV, syphilis and hepatitis B is a significant public health issue in Indonesia. Triple elimination screening, which tests these three infections, is a crucial strategy for early detection and prevention, ideally conducted during the first antenatal visit (K1). However, the coverage of this screening remains suboptimal in several regions, including the Harapan Baru Health Center. This study aimed to identify the factors associated with triple elimination screening during the first antenatal visit among pregnant women in the service area of the Harapan Baru Health Center. MATERIALS AND METHODS: A cross-sectional study was conducted involving 50 pregnant women who attended their K1 visit in June 2025. Participants were selected using convenience sampling. Data were gathered through structured questionnaires and maternal and child health (MCH) books and analysed using the Pearson chi-square test. RESULTS: Respondents’ knowledge (OR=5.4, p=0.023) and health worker support (OR=10.7, p=0.002;) were significantly associated with screening participation. However, the education level was not significantly associated. CONCLUSION: Good knowledge level and positive support from health workers could increase the likelihood of pregnant women undergoing triple elimination screening during their first antenatal visit.

Development of Components for A Glaucoma Screening Programme in Malaysia: A Qualitative Study

2025-12-02T10:21:14+08:00

INTRODUCTION Glaucoma is a leading cause of permanent blindness, often going undetected in its early, asymptomatic stages, especially in older age groups. In Malaysia, glaucoma is a growing public health issue due to an increase in the ageing population. While screening is essential for early glaucoma detection, the most suitable strategy for Malaysia's healthcare system remains unclear. This study explored the perspectives of eye healthcare professionals on the most suitable glaucoma screening strategies for Malaysia. MATERIALS AND METHODS: This qualitative study used semi-structured interviews with 19 eye health professionals (ophthalmologists, optometrists, nurses, ophthalmic technicians, and assistant medical officers) practicing in the Klang Valley. The interviews were conducted face-to-face in their workplace or via a video conferencing platform. All interviews were recorded, transcribed, and analysed using thematic analysis. RESULTS: Six major themes were identified: types of glaucoma screening programmes, accessible screening locations, target screening population, instruments and use of digital technology, trained personnel, and referral criteria. Opportunistic case finding and population-based programmes were identified as the glaucoma screening programmes in which trained personnel conducted screening at accessible locations. Glaucoma screening for high-risk individuals was recommended, focusing on visual acuity testing, tonometry, anterior chamber angle assessment, funduscopy, perimetry, and retinal nerve fibre assessment. A lack of clear referral criteria due to low awareness and poor implementation of existing guidelines was observed. CONCLUSION: Further investigations are required to identify the best combination of components for glaucoma screening. This will enable policymakers to develop an effective glaucoma screening programme in Malaysia.

Gender Variations in Hypertension Prevalence and Associated Factors in Malaysia: National Health and Morbidity Survey 2019

2025-07-08T20:08:16+08:00

INTRODUCTION: Hypertension represents a worldwide public health challenge related to chronic illnesses. This study set out to examine gender-based variations in prevalence and associated factors of hypertension in Malaysia. MATERIALS AND METHODS: We conducted a secondary data analysis based on the National Health and Morbidity Survey 2019, which was a nationwide cross-sectional study employing a two-stage stratified random sampling approach. Hypertension was defined as systolic BP≥ 140 or diastolic BP≥ 90 mm Hg, told to have hypertension by medical personal previously. Multiple logistic regression analysis was applied. RESULTS: The prevalence of hypertension among adults in Malaysia was 30.0% (95% CI: 28.57, 31.50), men 30.3% (95% CI: 28.2, 32.5), and women 29.7% (95% CI: 28.0, 31.5). For both genders, increasing age, adults with higher BMI, other Bumiputras, unemployed and those with diabetes and high cholesterol had higher odds of hypertension. Among men, alcohol consumption showed higher odds [AOR: 1.31 (95% CI: 1.02, 1.68)], meanwhile, active smokers [AOR: 0.74 (95% CI: 0.64, 0.86)] and married men [AOR: 0.74 (95% CI: 0.57, 0.94)] showed lower odds of hypertension. Among women, Chinese [AOR: 0.62 (95% CI: 0.49, 0.77)], Indian [AOR: 0.65 (95% CI: 0.49, 0.86)], and tertiary education [AOR: 0.49 (95% CI: 0.35, 0.69)] showed lower odds and physically inactive women [AOR: 1.31 (95% CI: 1.1, 1.55)] showed higher odds of hypertension. CONCLUSION: Prevalence and the factors associated with hypertension differ between the two genders. Intervention strategies related to hypertension should consider the gender differences particularly among young men and elderly women.

Judicial Medicine: How the Ivermectin Ruling Redefined Doctors’ Responsibilities in Drug Governance

2026-01-30T09:37:13+08:00

INTRODUCTION: Ivermectin, a tropical medicine recognised with the 2015 Nobel Prize, is safe at approved doses but in Malaysia remains registered solely for veterinary use under the Poisons Act, raising complex legal and regulatory issues when dispensed to humans. This paper critically analyses the Federal Court decision in Dr Vijaendreh a/l Subramaniam, situating it within Malaysia’s drug dispensing framework and assessing implications for medication safety and patient protection. MATERIALS & METHODS: Using a doctrinal legal research approach, statutory interpretation and case law analysis were applied to the Poisons Act, Sale of Drugs Act, Control of Drugs and Cosmetics Regulations, and appellate decisions, highlighting tensions between medical practice and pharmaceutical governance. RESULTS: The Federal Court affirmed that section 19 of the Poisons Act grants registered doctors’ statutory authority to dispense Group B poisons, including ivermectin, regardless of whether products are registered for human or veterinary use, and that this right cannot be curtailed by subsidiary legislation under the Sale of Drugs Act. The Poisons Act was deemed a complete code for practitioners, while the Sale of Drugs Act governs commercial trade. This interpretation exposes regulatory gaps: the Poisons List lacks human–veterinary distinction, NPRA’s product control may be undermined, and safeguards remain reactive, leaving no proactive mechanism to prevent unsafe prescribing. CONCLUSION: Legislative reform is urgently needed to distinguish human and veterinary medicines, ensuring safe prescribing, protecting patients, and modernising Malaysia’s regulatory framework for public trust.

An Investigation on Body Composition, Bone Parameters, Physiological Function, Quality of Life and Cancer-Related Fatigue in Malaysian Breast Cancer Survivors

2025-09-17T14:44:47+08:00

INTRODUCTION: The aim of the study is to determine the correlation of body composition, bone parameters, physiological functions, with the quality of life (QoL) and cancer-related fatigue (CRF) among Malaysian breast cancer survivors. MATERIALS AND METHODS: Eighty-three female breast cancer survivors participated. Assessments of body composition, bone speed of sound (SOS), and T-score. Physiological functions consisted of handgrip strength, shoulder and lower body flexibility, and peak expiratory flow rate (PEFR) were performed on the participants. The Breast Cancer Functional Assessment of Cancer Therapy questionnaire was used for determining their QoL, while the Brief Fatigue Inventory scale questionnaire was used for assessing the CRF.Descriptive statistics and Pearson correlation were performed for statistical analysis. RESULTS: The mean T-score value for the right and left radius and tibia of the participants ranged between -1 and -2.5 SD, i.e., under the osteopenia category. There was no significant correlation between the percentage of body fat and fat-free mass with components of QoL and CRF, respectively. In addition, statistically significant positive correlations of bone SOS with components of QoL were not evidenced. A significant negative correlation was found between left handgrip strength and CRF (r=–0.240, p=0.032). However, no statistically significant correlations were observed between shoulder and lower body flexibility or PEFR with components of QoL and CRF, respectively. CONCLUSION: Higher handgrip strength of participants was related to lower CRF. Thus, the aspect of improvement of muscular strength of the arm should be emphasized while designing interventions for rehabilitation among breast cancer survivors.

Exploring Transferrin Gene Expression as A Biomarker of Ineffective Erythropoiesis and Iron Overload in HbE/β-Thalassemia and β-Thalassemia Trait

2025-11-27T12:48:17+08:00

INTRODUCTION: Iron overload is a major concern in transfusion-dependent thalassaemia patients, with soluble transferrin receptors (sTfR) playing a key role in iron regulation. This study aimed to evaluate the gene expression of TfR1 and TfR2 and their association with ineffective erythropoiesis (IE) and iron overload in HbE/β-thalassaemia patients. MATERIALS AND METHODS: A total of 2 ml whole peripheral blood was extracted for RNA from 6 subjects recruited from each HbE/β-thalassaemia patient, β-thalassaemia trait carriers, and healthy controls. TfR levels were measured using ELISA, while TfR1 and TfR2 gene expression were assessed using RT-qPCR. Data were analysed using ANOVA, Student’s t-test, Kruskal–Wallis, and Mann–Whitney U tests with Bonferroni correction. RESULTS: Gene expression analysis revealed a significant downregulation of TfR2 in HbE/β-thalassaemia patients and β-thalassaemia carriers (P<0.001) compared to healthy controls, while TfR1 expression was significantly upregulated (P<0.001). Additionally, sTfR levels were statistically higher in HbE/β-thalassaemia patients and parents compared to healthy controls (P<0.001). CONCLUSION: These findings suggest that TfR1 and TfR2 expression patterns may serve as potential biomarkers for assessing IE and iron overload in β-thalassaemia. Furthermore, elevated sTfR levels indicated that the transfusion regimen was insufficient to suppress ineffective erythropoiesis. In β-thalassaemia intermedia patients, haemoglobin levels may not be the most reliable marker for monitoring transfusion therapy, whereas sTfR could help in tailoring individualised transfusion regimens.

The Efficacy of Orthokeratology in Controlling Myopia Progression in Primary School Children in Kuala Lumpur

2025-09-19T15:01:17+08:00

INTRODUCTION: Myopia is a global public health issue. Advanced myopia can lead to potentially serious ocular pathologies such as glaucoma and maculopathy, thus controlling progression of myopia is essential. Orthokeratology (Ortho-K) has been shown to be effective in controlling the progression of myopia in children. However, limited data is available on this from the East Asian populations. This study investigated the efficacy of Ortho-K in controlling the progression of myopia in children in Kuala Lumpur. The results were compared with those for single vision spectacles (SVS). MATERIALS AND METHODS: Children aged 8-9 years, with myopia of -0.50 to -4.00D and astigmatism of ≤1.00D, were invited to participate. Cycloplegic refraction at the central and peripheral retina, visual acuity (VA), corneal topography, and axial length (AL) measurements were taken at baseline (BL) and every 6 months over a 1-year period. RESULTS: In all, 70 children (35 males and 35 females), with a mean age of 8.31±0.47 years, participated. Forty-five children were fitted with Ortho-K lenses and 25 with SVS. Significant changes in the refraction, corneal curvature, and AL were found over the study period and between the groups (p<0.05). Significant myopic shifts in the relative peripheral refraction (RPR) (p<0.01) were noted in the Ortho-K wearers, while hyperopic shifts (p<0.01) were found in the SVS group. Myopia progression and AL elongation were slowed by around 50% and 44%, respectively. CONCLUSION: Wearing the Ortho-K lenses for 12M is effective in controlling myopia progression children and can be recommended when managing myopic children.

A Qualitative Exploration of Diabetes Self-Management among Young People with Type 2 Diabetes Mellitus in Malaysia

2026-02-11T12:55:05+08:00

INTRODUCTION: Diabetes self-management, an essential part of diabetes care, involves complex cognitive abilities such as performing medical, physical, and emotional management tasks. Nonetheless, little knowledge is available on how the young population with type 2 diabetes mellitus (T2DM) in Malaysia engages in self-management, despite the growing prevalence of T2DM in this group. Therefore, this study aimed to explore self-management behaviours among young people with T2DM. MATERIALS AND METHODS: In-depth interviews were conducted with sixteen young people aged between 10 and 24 years old at two tertiary hospitals in Malaysia, and data were analysed thematically. RESULTS: The themes that emerged revealed that young people demonstrated different levels of activation in self-managing their T2DM, which can be grouped into proactive, adaptive, inadequate, and negligent. CONCLUSION: The young people in this study recognised the importance of diabetes self-management; however, they needed the support from caregivers, friends, and healthcare professionals to maintain emotional well-being and sustain daily diabetes self-management.

Tualang Honey Ameliorates The Cholesterol Diet-Induced Non-Alcoholic Steatohepatitis in an Animal Model

2026-01-23T09:59:28+08:00

INTRODUCTION: Non-alcoholic steatohepatitis (NASH) is the progressive form of non-alcoholic fatty liver disease (NAFLD) with potential progression to cirrhosis. Currently, no definitive treatment is available. This study evaluated the protective effects of Tualang honey (TH), which possesses antioxidant and anti-inflammatory properties, against a high cholesterol diet-induced NASH in an animal model. MATERIALS AND METHODS: Thirty-six male Sprague–Dawley rats were fed a 1% cholesterol diet (CD) for 14 weeks, followed by a 12% CD for 6 weeks to induce mild to moderate NASH. At week 20, rats were randomised into groups that continued the CD, with three groups receiving TH at doses of 0.2, 1.2, or 2.4g/kg/day for 4 weeks. Liver function tests, fasting insulin, HOMA-IR, and lipid profiles were assessed. After 24 weeks, livers of the rats were harvested for histological evaluation. Data were analysed using one-way ANOVA with Duncan’s and Tukey’s post hoc tests; p < 0.05 was considered significant. RESULTS: TH significantly reduced serum ALT (77.25±16.32 to 50.25 ± 10.56 U/L; p=0.025) and AST (193.25±43.95 to 106.75 ± 24.46 U/L; p<0.01). The 1.2 g/kg/day group showed marked improvement in insulin resistance, with reductions in fasting insulin (4.61 ± 1.38 to 0.18 ± 0.18 mIU/L) and HOMA-IR (1.14 ± 0.38 to 0.03 ± 0.03; both p=0.001). LDL-c decreased while HDL-c increased significantly. Histological analysis of the liver demonstrated improved NAFLD activity scores across treated groups. CONCLUSION: Tualang honey improved liver function, insulin resistance, dyslipidaemia, and hepatic histology in a mild–moderate NASH rat model.

In-Silico and In-Vitro Assessment of Selected Fatty Acids against Vibrio Spp..

2025-12-22T17:27:25+08:00

INTRODUCTION: Vibrio spp. is a zoonotic pathogen that can cause mild or fatal infection in human and animals. The overuse of antibiotics has led to increasing antimicrobial resistance (AMR). Fatty acids (FAs) offer a potential alternative due to their broad-spectrum antibacterial activity. Hence, this study aimed to investigate the anti-Vibrio effects of oleic acid (OA), lauric acid (LA), palmitic acid (PA), and stearic acid (SA) through in-vitro and in-silico approaches. MATERIALS AND METHODS: Molecular docking was performed using PyRx against 21 receptors belonging to Vibrio spp. retrieved from the Protein Data Bank (PDB) for in-silico investigation. To validate the findings, LA, OA, PA and SA were experimentally tested. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) assays were conducted in-vitro against Vibrio alginolyticus and Vibrio parahaemolyticus. RESULTS: Molecular docking results revealed that OA exhibited the lowest binding energy (min=-7.2, mean=-4.8). OA also showed the second-highest number of hydrogen bond interactions and ranked third in van der Waals interactions. FAs demonstrated significantly stronger affinity (p<0.05) to proteins related to toxin production, nutrient acquisition, and quorum sensing. In-vitro assays aligned with in-silico where OA had the lowest MIC (125 µg/mL) against both V. alginolyticus and V. parahaemolyticus and exhibited bactericidal activity against V. alginolyticus at 500 µg/mL. CONCLUSION: Therefore, OA is a promising anti-Vibrio agent that might regulate environmental sensing and interaction with small molecules. The receptors 3MRU, 3WPW, 3A57 and 3X0T, matched in-vitro results and could be used in the design of new treatments for vibriosis.

Reproducible GC–MS Profiling of Urinary Metabolites as Biomarker Candidates for Dengue Infection: Seasonal Analysis Among Outpatients

2025-12-26T14:59:52+08:00

INTRODUCTION: Dengue diagnosis remains a clinical challenge as early symptoms might overlap with other febrile illnesses. Urine-based metabolic profiling offers a promising, non-invasive approach for detecting dengue infection biomarkers. In our earlier study among warded patients, gas chromatography mass spectrometry (GC-MS) identified nine urinary metabolites associated with dengue infection. This study assesses the consistency of these metabolites in non-warded outpatients. MATERIALS AND METHODS: A cross-sectional study was conducted at outpatient clinics in Kuantan involving 30 dengue-confirmed patients and 30 healthy volunteers. Midstream urine samples were collected prior to treatment, and dengue infection was confirmed through serological testing. The nine targeted metabolites were analysed using GC-MS method described in our previous study. RESULTS: Two metabolites (hexadecane and pentadecane) were consistently detected in dengue-positive patients but absent in controls. Hexadecane eluted at a retention time (RT) of 20.95 ± 2.23 min, with a spectral similarity index (SI) of 85.50 ± 5.00 % and a peak area of 1360566.25 ± 1066618.37 a.u. Pentadecane eluted at RT of 24.07 ± 3.35 min, with an SI of 86.00 ± 4.55 % and peak area of 853458.25 ± 523318.12 a.u. Hexadecane exhibited a stronger signal, approximately 1.6 times higher than pentadecane with 100% specificity and sensitivity of 8%. CONCLUSION: These findings confirm that the presence of urinary hexadecane and pentadecane remain consistent across different patient subgroups. These results provide preliminary evidence that urinary hexadecane and pentadecane are reproducibly detected in a subset of dengue patients and warrant further large-scale studies to confirm their diagnostic utility.

Two-Dimensional Radiological Analysis of Tibial Malalignment After Intramedullary Nailing: Prevalence, Associated Factors, and Outcomes

2025-10-25T11:01:46+08:00

INTRODUCTION: Tibial fractures are common long-bone fractures treated by orthopaedic surgeons. Intramedullary nailing (IMN) is the preferred standard treatment for tibial diaphysis fractures. This study aimed to evaluate the prevalence of tibial malalignment, its associated factors, and the outcomes following IMN. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted on skeletally mature patients aged over 18 years who underwent IMN for tibial diaphysis fractures at a single academic trauma centre from January 2015 to December 2023. Data were extracted from the hospital database, including plain radiographs, medical records, and intraoperative notes. The Pearson chi-square test was used to examine the outcomes of malalignment, followed by logistic regression analyses to identify factors associated with tibial malalignment. RESULTS: A total of 163 patients were analysed. The prevalence of tibial malalignment following IMN was 66.0% in the proximal third, 58.8% in the distal third, and 25.0% in the middle third. The degree of comminution, specifically in Type 42C fractures, and lateral nail entry point were significantly associated with malalignment (p=0.02 and 0.011, respectively). However, no significant correlation was found between malalignment and bone union. CONCLUSION: Tibial malalignment is most common in the proximal third following IMN, with the degree of comminution being a significant factor. Despite the high prevalence of malalignment, it did not adversely affect bone union. These insights can guide preoperative planning and intraoperative techniques to optimize patient outcomes in tibial diaphysis fractures.

Functional and Radiological Outcomes of Plate Osteosynthesis in Closed Displaced Intraarticular Calcaneal Fractures

2025-10-25T10:55:36+08:00

INTRODUCTION: Calcaneum fractures, particularly closed, displaced intraarticular fractures, are uncommon yet cause significant morbidity and impair quality of life (QOL). While open reduction and internal fixation a standard treatment, debate on optimal management continues. This study evaluated functional outcomes of plate osteosynthesis for these fractures, focusing on QOL and radiological measures. MATERIALS AND METHODS: This retrospective study reviewed records of patients with closed displaced intraarticular calcaneal fractures treated with plate osteosynthesis (January 2015-December 2020) at a single tertiary centre. Surgery involved open reduction and internal fixation using a locking calcaneal plate, performed on average 11 days post-trauma. Follow-up assessments were conducted for a minimum of one year, utilising the SF-36 for QOL and measuring Böhler’s angle. RESULTS: Twenty-six patients (25 males, 1 female; mean age 42.8 years) were included. Fractures were primarily caused by motor vehicle accidents (65.4%). The mean QOL score was 55.9, and the mean post-operative Böhler’s angle was 22°. Fracture type (Sanders’ classification) was significantly associated with Böhler’s angle. Correlation analysis revealed a weak, non-significant positive correlation between Böhler’s angle and SF-36 scores (r = 0.187, r² = 0.035, p = 0.360). Superficial infections occurred in 7.6% of cases, all resolving without further surgery. CONCLUSION: Plate osteosynthesis for closed, displaced intraarticular calcaneum fractures provides favourable functional outcomes and restores anatomical alignment. The weak correlation between radiological restoration and patient-reported function suggests that additional factors may influence overall recovery.

Closing the Perioperative Temperature Gap: Lessons from Implementation Science

2026-03-31T15:10:28+08:00