HIV Epidemic Among Men Who Have Sex with Men (MSM) and Transgender Women (TGW) in Sarawak, Malaysia: An analysis from the Integrated Biological and Behavioural Surveillance (IBBS) Lite 2024 Introduction Men who have sex with men (MSM) and transgender women (TGW) are among the key populations affected by the HIV epidemic in Sarawak, Malaysia. The objective of this study was to determine HIV prevalence and associated behaviour among MSM and TGW in Sarawak. Methods Respondent-driven sampling (RDS) was used to recruit MSM and TGW between June and August 2024. The study consisted of two components. The first component was a behavioural survey, conducted through a selfadministered online questionnaire via a web-based platform. The second component involved biological testing, where respondents were instructed to visit a community-based testing site of their choice for blood testing after completing the online survey. Statistical analysis was performed in RStudio using the Gile's Successive Sampling Estimator. Results This study recruited 217 MSM and 151 TGW. Consistent condom use among both groups remains low. While most MSM and TGW reported recent HIV testing, Hepatitis C testing and treatment rates are still low. HIV prevalence in Sarawak was 9.5% (95% CI: 2.9, 16.0) among MSM and 10.1% (95% CI: 1.8, 18.5) among TGW, with syphilis prevalence among MSM reaching a concerning 12% (95% CI: 1.8, 22.3). Conclusions In conclusion, improving HIV prevention and care for MSM and TGW in Sarawak requires promoting condom use, increasing awareness of Hepatitis C, and including substance use interventions in HIV programs. Community outreach using culturally sensitive approaches is crucial to improving access to services and building trust. Furthermore, integrating syphilis management into HIV prevention efforts is critical, given its strong association with increased HIV risk. Findings highlight the need for targeted interventions and continued surveillance among key populations in Sarawak to ensure a sustained and effective public health response.

Perception of Urban Air Pollution Among Working Individuals During Work-Related Commute in the Klang Valley Introduction Malaysia’s rapid economic growth, urbanization and motorization cause air pollution problems in addition to intense regional transboundary air pollution. The Klang Valley is often plagued by low-visibility air pollution, which has a negative impact on the physical and mental well-being of the public. This study aims to explore the commuters’ perception of air quality during their daily commute to work. Methods A self-administered questionnaire was used to collect data on air quality perception and travel behavior among working adults (N = 197). Pearson’s Chi-Square analysis was used to analyse public perceptions on air quality with demographic data, transportation modes and health concerns. Sixty-seven percent of the respondents perceived that the air quality was unhealthy. Results There were no significant associations between air quality perception with gender, age, or health status. However, air quality perception was significantly associated with educational background (p<0.05). A very small number (9.1%) of respondents checked the air quality status daily prior to leaving their dwelling. Conclusions There was widespread awareness of the health concerns posed by air pollution when commuting to work, however, none of the respondents significantly altered their commuting route. Our findings are broadly consistent with those of others and underscore a need for improved communication to the public of risks posed by air pollution.

Aedes aegypti and Aedes albopictus mosquitoes are the primary vectors of tropical diseases, including dengue fever (DHF), chikungunya, and Zika, particularly in tropical regions such as Malaysia. Vector control efforts are now increasingly focused on biological and environmentally friendly approaches, one of which is using insect growth regulator (IGR)-based insecticides such as pyriproxyfen. Pyriproxyfen works by disrupting the metamorphosis process of mosquito larvae into adults without causing direct death, but it is effective in inhibiting the emergence of adult mosquitoes by more than 90%, depending on the dose and environmental conditions. This study evaluated the concentration-dependent effects of pyriproxyfen on laboratory and field populations of Aedes spp. Laboratory strains exhibited 100% adult mortality at 1.04 ppm (Ae. aegypti) and 1.08 ppm (Ae. albopictus), whereas field populations required 1.15 – 1.71 ppm depending on locality. LC50 values were lowest in laboratory strains (0.267 ppm for Ae. aegypti and 0.236 ppm for Ae. albopictus), while field strains ranged from 0.326 to 0.571 ppm. LC95 values followed a similar trend, with 1.026 ppm (Ae. aegypti) and 1.107 ppm (Ae. albopictus) in laboratory strains. Inhibition of emergence (IE%) was high in laboratory strains, reaching 97.89% at 0.50 ppm in Ae. aegypti and 63.54% at 0.50 ppm in Ae. albopictus. Field populations required higher concentrations for similar suppression, with IE% ranging from 17.68 – 98.23% in Ae. aegypti and 13.14- 98.24% in Ae. albopictus, peaking at 1.50 ppm. From this finding, it is suggested that pyriproxyfen effectively inhibits adult emergence in both laboratory and field populations, with laboratory strains more sensitive at lower concentrations and field strains responding at higher doses. These results provide strong evidence for pyriproxyfen as an effective, adaptive, and sustainable component of integrated vector management in Malaysia.

Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

Introduction: Disseminated histoplasmosis is a rare but important cause of adrenal insufficiency (AI), particularly in tuberculosis (TB)-endemic regions, where it may mimic granulomatous diseases. Adrenal involvement occurs in up to 80% of disseminated cases, although overt AI is less common. Reported cases described bilateral adrenal masses mimicking malignancy or TB, even in immunocompetent individuals. Addisonian crisis may be the initial manifestation, especially when the diagnosis is delayed. In TB-endemic settings, fungal infections are often overlooked, leading to delayed diagnosis and inappropriate therapy. Case: We reported a case of a 68-year-old male with underlying diabetes mellitus who presented with fever, cough, dysphagia, and weight loss for 1 month. He was empirically treated as smear-negative disseminated TB. On day 2 of therapy, he developed hypotension (80/50 mmHg), hypoglycemia (3.9 mmol/L), hyponatremia (Na 129 mmol/L), and hyperkalemia (K 5.1 mmol/L), suggestive of adrenal crisis, and was started on intravenous hydrocortisone. Serum cortisol prior to treatment was 61 nmol/L. Computed tomography (CT) imaging revealed bilateral lipid-poor adrenal lesions (right: 3.6 × 2.2 × 4.9 cm, Hounsfield Unit (HU) 36 and absolute washout 33%; left: 3.5 × 2.4 × 5.4 cm; HU 35 and absolute washout 17%), raising suspicion of infectious or malignant etiologies. Endoscopic ultrasound-guided biopsy demonstrated necrotizing granulomatous inflammation with budding fungal yeasts on Pituitary Apoplexy Score and GMS staining, consistent with Histoplasma capsulatum. TB and malignancy were excluded. He received amphotericin B for 14 days, followed by oral itraconazole for 1 year, and oral hydrocortisone replacement. At 1-year follow-up, adrenal lesions remained stable on CT images, and he continued to require hydrocortisone replacement. Conclusion This case highlights the importance of considering disseminated histoplasmosis as a differential diagnosis of bilateral adrenal masses with AI, especially with poor response to anti-TB therapy. Early tissue diagnosis is essential, as imaging findings are non-specific. Prompt recognition is critical to prevent life-threatening adrenal crisis and improve clinical outcomes.
Histoplasmosis ; Tuberculosis

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: Tuberculosis patients with comorbid diabetes face a substantially higher risk of mortal outcomes. The “metainflammation” loop between hyperglycemia and tuberculosis (TB) infection exacerbates systemic severity and increases hazard rates for death. This study aims to quantify the association between baseline hemoglobin A1c (HbA1c) levels and all-cause mortality within a Malaysian cohort. Methodology: This was a retrospective cross-sectional audit analyzing 131 adult TB-DM (diabetes mellitus) patients during their treatment course (2022–2025) in the TB Clinic, Hospital Sungai Buloh. Primary outcomes were all-cause mortality and clinical severity, stratified by baseline HbA1c and diabetes mellitus DM treatment modality (OHA vs. insulin). Results: The overall mortality rate was 17% (22/131). A stark disparity in glycemic control was observed between survivors and deceased patients: those who died presented with extreme mean HbA1c levels of 16.0%, compared to 10.5% in survivors. High HbA1c was also associated with a higher prevalence of pulmonary involvement compared to extrapulmonary disease (10.9% vs 8.9%). Patients requiring insulin therapy experienced significantly higher mortality rates compared to those managed on OHAs, with 25% (12 out of 47) patients requiring insulin therapy having died during TB treatment, compared to only 8.2% (7 out of 84) patients in the OHA-only group. Conclusion Baseline HbA1c is a critical prognostic marker that identifies a high-risk “lethal threshold” at extreme glycemic levels (HbA1c ≥16). Furthermore, the nearly fourfold increase in death risk among insulin-treated patients likely reflects a high-risk phenotype of advanced metabolic failure, which corresponds with a study done in Kelantan (Siti Rohana et al., 2020). The study shows that TB patients with DM had three times higher risk of developing unsuccessful TB treatment outcomes compared to TB patients without DM. Collectively, these data necessitate mandatory early HbA1c screening and aggressive metabolic management to reduce the staggering mortality of this dual epidemic.
Retrospective Studies