Environmental and Health Impacts of Pesticide-Based Malaria Control in Low- and Middle-Income Countries: A Scoping Review Introduction Malaria remains a major public health challenge in tropical and subtropical regions, necessitating effective vector control strategies. This scoping review aims to evaluate the environmental and health impacts of pesticide-based malaria control in low-and middle-income countries (LMICs). Methods A comprehensive search was conducted across Scopus, Web of Science and PubMed for studies published between 2004 and 2024, using a predefined search string based on the PEO framework. Inclusion criteria focused on studies addressing malaria control programmes and their effects on the environment and human health. Data extraction followed PRISMA 2020 guidelines. Results 12 studies were included, most of which focused on indoor residual spraying (IRS) and insecticide-treated nets (ITNs). The review identified significant direct and indirect impacts. While effective in reducing malaria transmission, IRS and ITNs pose substantial risks. Direct health effects included acute poisoning and long-term neurodevelopmental issues linked to pesticide exposure, with residues detected in breast milk. Environmental impacts included soil and water contamination, biodiversity loss and ecological disruption. The overlap of pesticide use in malaria control and agriculture was found to exacerbate insecticide resistance in mosquito populations. Conclusions Pesticide-based malaria control, while crucial, carries significant unintended consequences for human health and the environment. The findings underscore the urgent need for Integrated Vector Management (IVM) strategies that reduce reliance on chemical pesticides, mitigate resistance, and ensure environmental sustainability and public health safety.

Introduction: The identification of a significant adrenal mass in a patient without a biopsy-confirmed malignancy poses a diagnostic challenge: Is it a metastatic lesion or an underlying adrenal condition? Adrenal metastases are the second most common site of spread for lung adenocarcinoma; approximately 3–7% of adrenal masses represent benign adenomas. Diagnosis is even harder if there are signs of primary aldosteronism (PA). Case: We present a case of a 62-year-old Chinese female with a 10-year history of hypertension, managed on dual antihypertensive therapy, who presented for evaluation of suspected PA following the discovery of hypokalemia. Biochemical screening revealed an elevated aldosteronerenin ratio (ARR, 65). The overnight dexamethasone suppression test (20 nmol/L) and testosterone (0.79 nmol/L) were both within normal limits. Saline Suppression Test (SST) showed an indeterminate post-infusion aldosterone level (202.8 pmol/L). Cross-sectional imaging via computed tomography (CT) Adrenals identified a large, 6.4 × 5.4 × 6.2 cm heterogeneous left suprarenal mass with a low mean attenuation (8.6 Hounsfield Unit [HU]). Concurrently, an incidental left upper lobe pulmonary lesion was identified, and PET-CT was performed; the SUVmax of the lung was identical to that of the adrenal lesion. An ultrasoundguided biopsy of the pulmonary lesion confirmed estimated glomerular filtration rate-mutation-positive lung adenocarcinoma. The patient started on targeted therapy with dacomitinib. Follow-up CT imaging at 9 months demonstrated disease progression within the thorax, marked by the appearance of a new pulmonary nodule. Notably, however, the adrenal mass remained stable in size and morphology. Conclusion The absence of mixed androgen/glucocorticoid hypersecretion, combined with the radiographically static nature of the mass, suggests a lower probability of adrenocortical carcinoma. This case highlights that while size is a major risk factor for adrenocortical carcinoma, it must be interpreted in conjunction with hormonal activity, HU, and growth patterns. Identifying these “mimics” helps avoid over-staging lung cancer and ensures patients receive targeted therapy instead of unnecessary adrenalectomies.

Introduction: Improving glycemic control while minimizing unnecessary insulin exposure is an important goal in diabetes management. The Rapid Optimization Clinic (ROC) was established as a structured multidisciplinary service to support therapy individualization, close follow-up, and timely insulin deintensification. This audit evaluated early changes in glycated hemoglobin A1c (HbA1c) and insulin treatment burden following ROC care over 3 months. Methodology: We conducted a retrospective audit of routine clinical data from patients with diabetes managed in the ROC at a district hospital. Baseline and 3-month HbA1c and insulin data were extracted from non-electronic clinic records. Insulin dose was standardized as total daily dose (TDD) in units/kg/day. Insulin deintensification was evaluated primarily by change in TDD from baseline to 3 months and by the proportion of patients who discontinued insulin during follow-up. Paired analyses were performed for patients with complete baseline and follow-up data for each outcome. Continuous variables are presented as mean ± standard deviation or median with interquartile range, as appropriate. Exploratory analyses were undertaken to assess whether available patient factors were associated with HbA1c improvement. Results: Twenty-three patients were included. Paired HbA1c data were available for 12 patients, whereas paired TDD data were available for 21 patients. Mean HbA1c decreased from 10.78 ± 2.59% at baseline to 8.42 ± 2.29% at 3 months, representing a mean reduction of 2.36 percentage points (95% confidence interval [CI] 0.09–4.62; p = 0.043). Mean TDD decreased from 0.434 ± 0.248 to 0.286 ± 0.313 units/kg/day, corresponding to a mean reduction of 0.148 units/kg/day (95% CI 0.077–0.219; p <0.001). Insulin was discontinued in 9 of 21 patients (42.9%). No clear association was observed between HbA1c improvement and age, sex, or number of visits. Interpretation is limited by the small sample size, reflecting the early phase of a newly established clinic. Conclusion In this early audit, ROC care was associated with clinically meaningful improvement in glycemic control and significant insulin deintensification over 3 months. These findings support the potential role of a structured multidisciplinary optimization clinic in delivering individualized diabetes care and facilitating safe reduction of insulin burden.
Humans ; Glycemic Control ; Retrospective Studies ; Diabetes Mellitus ; Insulins

Introduction: Bariatric surgery is an effective treatment for morbid obesity and metabolic syndrome, including type 2 diabetes mellitus. However, metabolic complications such as diabetic and starvation ketoacidosis may occur in the perioperative period, particularly in patients with reduced oral intake, rapid weight loss, and altered insulin requirements. Case: A 37-year-old male with type 2 diabetes mellitus, hypertension, dyslipidemia, and morbid obesity (body mass index 60 kg/m²) was referred for bariatric surgery. Preoperatively, he was initiated on subcutaneous semaglutide 1 mg weekly for weight optimization, resulting in weight loss from 178 to 127 kg. His hemoglobin A1c was 9.5%. He subsequently underwent laparoscopic proximal jejunal bypass sleeve gastrectomy on 5 November 2025. Two weeks postoperatively, he reported lethargy and was clinically found to be dehydrated, following poor tolerance of nourishing fluids and inadequate caloric intake. Capillary blood glucose was 7.6 mmol/L. Investigations revealed metabolic acidosis with markedly elevated serum ketones (4.9 mmol/L), consistent with ketoacidosis. He was commenced on an intravenous insulin infusion and aggressive IV fluid resuscitation. Attempts to discontinue insulin infusion resulted in recurrent ketoacidosis, attributed to poor tolerance of nourishing fluids. Following multidisciplinary input involving endocrinologists, a diabetes educator, and a dietitian, he was able to tolerate enteral nutritional supplementation. Insulin infusion was successfully discontinued, and he was discharged on a basal bolus subcutaneous insulin regimen. Conclusion Ketoacidosis following bariatric surgery is an underrecognized complication and may occur even in patients with type 2 diabetes mellitus and relatively normal blood glucose levels. Contributing factors included prolonged caloric deprivation, rapid weight loss, postsurgical catabolic state, and relative insulin deficiency. Recently used glucagon-like peptide-1 receptor agonist may have further suppressed appetite, compounding postoperative nutritional intolerance. The involvement of a multidisciplinary team, including endocrinologists, a dietician, diabetic educators, and surgical teams, is essential to optimize outcomes and prevent severe complications.
Bariatrics

BACKGROUND

Stroke is a significant health concern globally, and dysphagia has been a very common complication. Early intervention for managing dysphagia is challenging with a lack of universally accepted treatment protocols. Noninvasive repetitive transcranial magnetic stimulation (rTMS) is emerging as a treatment option for stroke dysphagia. However, there is no standardized rTMS treatment protocol for it, leading to challenges in clinical decision-making.

To determine available rTMS protocols for unilateral hemispheric stroke dysphagia.

A scoping review using PubMed, ProQuest, and EBSCOHost databases was conducted using the keywords “dysphagia,” “stroke,” “repetitive transcranial magnetic stimulation,” “conventional therapy,” and “swallowing examination.” Eligible studies published from inception to April 2020 were appraised using the Oxford Centre for Evidence-Based Medicine and analyzed qualitatively.

Out of 42 articles, five randomized controlled trials met the eligibility criteria. A total of 108 patients with stroke and oropharyngeal dysphagia were randomized into one of the following treatment groups: (1) rTMS (unilateral or bilateral); (2) conventional dysphagia therapy (CDT); and (3) combined intervention (CI) of rTMS and CDT. The CI gave significant improvements in swallowing function and quality of life compared to CDT alone. The bilateral rTMS protocol resulted in more significant improvements than unilateral rTMS.

There are various and heterogeneous treatment protocols involving neuromodulation available for stroke dysphagia. The combination of bilateral excitatory-inhibitory rTMS and CDT seems to result in an optimal outcome for swallowing function among patients with unilateral hemispheric stroke dysphagia.

Extensive Palatal Necrosis Secondary to Chrysomya bezziana Myiasis: A Case Report Oral myiasis, a rare condition characterised by infestation of dipterous larvae in the oral cavity, poses unique diagnostic and therapeutic challenges. Herein, we present a case study of a 35-yearold quadriplegic man presenting with oral myiasis localised to the palatal region, likely attributable to malnutrition and suboptimal oral hygiene. Manifestations comprised oral bleeding, fever, and necrotic palatal ulcers infested with maggots. Initial diagnostic considerations encompassed mucormycosis and neoplastic lesions; however, further scrutiny revealed primary palatal myiasis caused by Chrysomya bezziana species. Therapeutic interventions entailed bedside maggot removal and meticulous wound care, with topical hyaluronic acid application and oral hygiene guidance. This case underscores the significance of uncommon conditions such as palatal myiasis, especially among patients with intricate medical backgrounds. A comprehensive diagnostic approach and optimal treatment ensure favourable outcomes.

Therapeutic Diet for Xerostomia in Head and Neck Cancer Patients: A Narrative Review Xerostomia significantly disrupts nutritional status, increases oral complications, and reduces quality of life in head and neck cancer (HNC) patients. This systematic review aimed to determine the best dietary interventions for the management of xerostomia in HNC patients by examining available therapies and their effects. A search of PubMed, Web of Science, and Scopus was conducted for randomised controlled trials, interventional, and observational studies published between December 2000 and December 2021. English articles involving adult HNC patients undergoing or having completed anti-cancer therapy were included. Non-HNC xerostomia causes and abstracts were excluded. Risk of bias was assessed using the Cochrane and Joanna Briggs Institute (JBI) tools. Fifteen studies were included out of 533 articles. Acidic candy, ginger extract, chewing gum, vitamin C/E supplements, and thyme honey were identified as helpful in reducing xerostomia. Dietary counselling and awareness of diet modifications improved symptoms, nutrition, and quality of life. Acidic candy was particularly effective in stimulating salivary flow but may cause dental enamel erosion, and timing precautions were necessary for thyroid patients’ post-radioactive ablation. Hydration techniques were commonly adopted by patients for symptom alleviation. Dietary modifications show promise in managing xerostomia in HNC patients, although further large-scale, randomised trials are needed to confirm these findings and explore new interventions.

Gender Identities and Orientations: Demographic Change and the Health Effects They Experience Introduction LGBT (lesbian, gay, bisexual, and transgender) refers to a diverse group of people who have different sexual orientations and gender identities. In population structure, LGBT individuals are considered a minority group because they represent a smaller percentage of the population, estimated at between 2% and 10% in the world compared to heterosexual individuals. Our objective in this paper is to highlight the demographic shifts associated with the increasing visibility and recognition of the LGBT community, while also examining the broader implications of these shifts on public health outcomes. Methods This brief communication review was based on a literature search conducted from four databases: PubMed, Scopus, Google Scholar and Web of Science. All articles published from 2012 to 2024 were accounted for by using keywords such as “LGBT”, “gay”, “transgender”, “bisexual” “population changes”, “population dynamic”, “population shift”, “demographic shift”, “demographic changes”. Results The extracted evidence from the literature was then formulated into 2 main focus areas: Population Dynamics Implications and Public Health Impact. Conclusions The health disparities faced by the LGBT community stem from stigma and discrimination, impacting their overall well-being. As the LGBT population grows, it will affect population dynamics by reducing growth rates, increasing migration to more inclusive countries, and raising mortality rates from related diseases. Addressing these challenges requires improved access to healthcare, including HIV and cancer screenings, gender-affirming therapy, and PrEP.