Introduction: Histoplasmosis is a rare opportunistic, inhalation-acquired systemic mycosis caused by Histoplasma capsulatum, endemic to Southeast Asia, including Malaysia. Although classically seen in immunocompromised hosts, it is increasingly reported in immunocompetent individuals. Infection is associated with environmental exposures such as bat or bird droppings and soil disruption. Histoplasmosis is a progressive granulomatous disease that can closely mimic tuberculosis and malignancy, making diagnosis challenging. Case: An 87-year-old Malay male with a history of treated pulmonary tuberculosis presented with a 6-month history of intermittent fever, anorexia, weight loss, and hypotension. Initial computed tomography imaging demonstrated bilateral heterogeneous adrenal masses (right: 2.2 × 3.7 × 5.0 cm; left: 2.0 × 3.7 × 5.2 cm) with indeterminate washout characteristics. Biochemical adrenal evaluation, including a short Synacthen test, confirmed primary adrenal insufficiency. Extensive microbiological and malignancy workup, including bronchoscopy, cultures, and tumor markers, was non-diagnostic. In view of clinical deterioration and epidemiological risk, empirical antituberculous therapy was initiated; however, no clinical improvement was observed after 2 months. PET-FDG revealed intensely hypermetabolic bilateral adrenal masses (SUVmax right 16.7, left 13.2) with no other abnormal foci. Non-invasive fungal investigations were negative. Definitive diagnosis was established via computed tomography-guided adrenal biopsy, which demonstrated necrotizing granulomatous inflammation with intracellular yeasts, subsequently identified as H. capsulatum. The patient was treated with oral itraconazole and corticosteroid replacement, resulting in significant clinical improvement and planned interval radiological reassessment. Conclusion Disseminated histoplasmosis is a diagnostic challenge, particularly in frail elderly patients, where invasive procedures may be delayed. It can mimic tuberculosis and malignancy and may lack an identifiable exposure history. Non-invasive tests may be inconclusive, making tissue biopsy essential. Adrenal involvement may result in primary adrenal insufficiency, further complicating the clinical picture. Early consideration and timely confirmation are crucial for appropriate management.
Adrenal incidentaloma ; Lung Neoplasms

Introduction: Malaysia has one of the highest diabetes prevalence rates in Asia (1 in 5), with >50% fail to achieve optimal glycemic control. Continuous glucose monitoring (CGM) provides detailed insights beyond hemoglobin A1c (HbA1c), capturing daily glucose fluctuations and variability. Realworld data describing CGM patterns and their clinical associations in Malaysian adults with type 2 diabetes mellitus (T2DM) are limited. Methodology: This cross-sectional study analyzed CGM data from 25 Malaysian adults with T2DM, standardized over 14 days. CGM metrics included time in range (TIR), time above range (TAR), time below range (TBR), mean glucose, and coefficient of variation (CV). Weekday–weekend comparisons were performed, and correlations with age, diabetes duration, HbA1c, body mass index (BMI), treatment regimen, and complications were assessed. Results: Participants had a mean age of 56.2 ± 13.2 years (52% male), mean HbA1c 9.4 ± 2.7%, diabetes duration 10.7 ± 9.0 years, and BMI 29.8 ± 9.4 kg/m². Mean TIR, TAR, TBR, mean glucose, and CV were similar between weekdays and weekends (p >0.34 for all). TIR >70% was achieved by 52% of participants on weekdays and 48% on weekends, with no statistically significant difference (p = 0.75). Longer diabetes duration correlated with lower TIR (r = −0.62, p <0.001), higher mean glucose (r = 0.58, p = 0.002), and greater variability (r = 0.54, p = 0.004). Older age was associated with lower TIR (r = −0.48, p = 0.014) and higher mean glucose (r = 0.44, p = 0.025). Higher HbA1c correlated with lower TIR (r = −0.36, p = 0.04), higher TAR (r = 0.35, p = 0.05), greater variability (r = 0.51, p = 0.006), and increased target organ damage (ρ = 0.55, p = 0.004). BMI was not associated with TIR (r = −0.18, p = 0.38). Participants with ≥2 complications had lower TIR (55.8 ± 28.4% vs 76.7 ± 19.2%, p = 0.073), while insulin the Conclusion In Malaysian adults with T2DM, CGM metrics were similar between weekdays and weekends, indicating lifestyle differences had minimal impact on glycemic control. Longer diabetes duration, older age, higher HbA1c, multiple complications, and insulin therapy identified patients at highest risk for poor glycemic control, greater variability, and hypoglycemia. These findings support the use of CGM for risk stratification, individualized monitoring, and therapy optimization to reduce complications and hypoglycemia risk.
Adult ; Blood Glucose ; Blood Glucose Self-Monitoring ; Continuous Glucose Monitoring ; Diabetes Mellitus, Type 2

Keropok lekor is a fish-based snack and traditional food originating from the East Coast of Peninsular Malaysia, especially in Terengganu. This study was conducted to identify the ingredients and packaging used in the manufacturing of keropok lekor by entrepreneurs in Selangor. This study is a qualitative study that requires in-depth interviews. The Nutritionist Pro application was used to determine the nutrients in keropok lekor. The sampling method for this study is purposive sampling and involves five keropok lekor operators around Selangor. The ingredients used in making keropok lekor are salt, fish filling (fringescale sardine), baking powder, monosodium glutamate (MSG), margarine, and sweet potato flour. Through this study, it was found that the main source of sodium in keropok lekor is salt. For keropok lekor packaging, all keropok lekor operators use the same packaging method, which is vacuum packaging. In addition, the majority of keropok lekor operators (80%) have been introduced to Modified Atmosphere Packaging (MAP). The results of the study show that the average sodium content in keropok lekor is 372.11mg/100g and is categorized as medium-level sodium. Although the majority of keropok lekor operators have been introduced to MAP packaging, further research needs to be conducted to find out whether keropok lekor operators have renewed their packaging methods or vice versa. In conclusion, based on the findings, the content of sodium in the manufacturing of keropok lekor in Selangor is still under control. The results of this study can be used to help the government monitor the sodium content found in keropok lekor around Selangor.

ECOG Performance in Malaysian Oral Cavity Carcinoma: Treatment, Demographics, and Clinical Factors Eastern Cooperative Oncology Group (ECOG) is gaining importance as a valuable outcome measure in the field of oral cavity carcinoma (OCC). This study aimed to assess pre- and post-treatment ECOG changes in Malaysian OCC patients undergoing various treatments. We conducted a 12–36 months longitudinal observational study with 63 squamous cell carcinoma patients, evaluating ECOG perfomance, medical history, symptoms, sociodemographics, clinical details, and treatment modalities (surgery, surgery + radiotherapy, or surgery + chemotherapy and radiotherapy [CCRT]). OCC patients aged 50–70 years are at risk for impaired quality of life (QOL) up to several years after diagnosis.The analysis of the association between baseline ECOG Performance Status (ECOG-PS) scores and demographic data revealed a statistically significant correlation only within the age group, emonstrating a p-value of 0.031. CCRT treatment has a more pronounced effect on patient performance status, with significant results in the 3-year overall survival rate and poor ECOG-PS score in patients post-CCRT, as well as radiotherapy. These results highlight the need to provide OCC patients with specialised interventions and support, especially while they are undergoing CCRT, to lessen the potential negative effects on their general well-being and quality of life.

A systematic review was conducted to summarize health intervention program that aimed to increase physical activity and/or nutrition among middle income and low income countries employees from January 2008 until December 2019. The objective of this review is to identify the types of health intervention and its effects on increasing physical activities and nutrition at the workplace. A systematic search of the following databases was conducted: Scopus, PubMed and Web of Science following the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) guideline. A modified McMaster critical appraisal tool for quantitative studies was used to assess the methodological quality of the included studies. Given the heterogeneity of the included studies, a descriptive synthesis was conducted. Out of 6940 studies, 36 studies met the inclusion criteria range from health education, environmental change and behavioural change of healthy lifestyle. Based on a heterogeneous evidence base it can be surmised that workplace health interventions may have a positive impact on the health and behaviour of the employees. Current evidence however lacks clarity and uniformity in terms of intervention parameters and measurement outcomes, which limits broader application of these results. In conclusion, workplace health intervention is potential for increasing physical activity and improving the nutritional status of employees. Recommendation with regard to effectiveness however cannot be made. It is hoped that findings from this review may inform and guide future policies and practices regarding workplace health promotion.

The Performance Assessment of Self-care Skills (PASS-Home) is a client-centered, performance-based, criterionreference, observational form designed to capture client’s performance skills in completing daily task activities. The aim of the study was to describe the process of translating, adapting and validating the PASS-Home from English language version into a Malay language version. The development of the translated Malay version of the PASS-Home consisted of two stages. Stage one involved the exclusion of the items that were not culturally relevant to the Malaysian culture. Stage two involved the translation process. The five steps of the cross-cultural adaptation process were followed: (1) initial forward version; (2) a summary of recommendations by the expert panels; (3) the back-translation; (4) modifications of the translated Malay version of PASS and a summary of problems found during the pre-testing, and (5) the final version of the PASS Malay Version (M-PASS). A total of five items from the PASS-Home were omitted in the Malay version (M-PASS) and another five items that were considered as suitable in Malaysian context were added in the M-PASS. The Content Validation Index (CVI) showed perfect agreement with an average of I-CVI was reported at 0.99 and S-CVI/universal agreement (S-CVI/UA) was at 0.93. Test-retest reliabilty showed that the M-PASS were highly reliable reported of its three main constructs of Independence (ICC=0.706), Safety (ICC=0.906) and Adequacy (ICC=0.950). M-PASS showed strong evidence as a valid and reliable assessment in evaluating the functional level of older people who live independently in community.