Voltage-gated sodium channels (VGSCs) play pivotal roles in cancer progression and have emerged as promising therapeutic targets and biomarkers. VGSCs comprise multiple subtypes with distinct tissue distributions, influencing tumour characteristics in different ways. Among these, the tetrodotoxin-sensitive α-subunits and the β1 subunit, commonly found in breast cancer, have been implicated in metastasis and tumour aggressiveness. The NaV1.5 channel and its neonatal variant (nNaV1.5) are overexpressed in aggressive cancers such as breast, prostate, colorectal, and lung cancers, thereby enhancing their invasive capacity. nNaV1.5 is particularly significant due to its tumour-specific expression and strong association with poor prognosis, especially in breast cancer, where it regulates cell proliferation, invasion, and tumour microenvironment remodelling. This review highlights nNaV1.5 as a critical ion channel that drives metastasis through ion regulation, extracellular acidification, and cytoskeletal remodelling. We further evaluate current therapeutic strategies, including siRNA, monoclonal antibodies, and small-molecule inhibitors, while addressing translational challenges such as tumour heterogeneity, drug delivery limitations, and off-target cardiotoxicity due to its similarity with the adult isoform. In addition, we explore the potential of nNaV1.5 as a biomarker subject to epigenetic regulations by factors including RE1-silencing transcription factor (REST) and histone deacetylase 2 (HDAC2), which may facilitate patient stratification and treatment optimization. By integrating mechanistic insights, therapeutic opportunities, and translational challenges, this review goes beyond descriptive summaries to provide a framework for advancing nNaV1.5 research from preclinical studies toward clinical application in cancer therapy.

Over the past 4 years, trichorhinophalangeal syndrome type 1 (TRPS1) has rapidly gained attention among practicing pathologists, with numerous studies emerging that both support and question its diagnostic utility. Initially regarded as a highly specific marker for tumors of mammary origin, TRPS1 is now recognized to have broader expression patterns, including in a variety of cutaneous neoplasms. This is likely due to embryologic parallels between breast tissue and skin adnexal structures, an overlap that was underappreciated in early investigations. Although TRPS1 lacks absolute specificity—even among cutaneous neoplasms—it can still offer meaningful diagnostic value when interpreted alongside conventional immunohistochemical markers and within the appropriate morphologic context. Noteworthy diagnostic applications include mammary Paget disease, primary extramammary Paget disease, rare adnexal neoplasms such as endocrine mucin-producing sweat gland carcinoma and primary cutaneous NUT adnexal carcinoma, and cutaneous metastases from breast carcinoma. In this review, we present the most comprehensive and up-to-date evaluation of the utility and limitations of TRPS1 immunohistochemistry in dermatopathology. Our aim is to deepen understanding of this emerging marker and provide practical guidance on its optimal integration with established immunohistochemical panels to enhance diagnostic accuracy in routine practice.

Cryptococcosis is a potentially fatal invasive fungal infection with considerable health challenges. A seemingly immunocompetent middle-aged man with frequent exposure to pigeons and bird excreta presented with headaches, fever, gait instability and diplopia. Two years prior to his presentation, he sustained a blunt head trauma which resulted in sporadic headaches. On examination, a hard scalp nodule measuring approximately 3 x 3 cm was palpable on the topmost part of his head. Cryptococcus neoformans was cultured from his cerebrospinal fluid, blood and the biopsied scalp nodule. A diagnosis of disseminated cryptococcosis was made, with the scalp lesion being designated as the primary source of the infection. Following a protracted course of antifungal therapy lasting 10 weeks, the patient was asymptomatic without any neurological deficits when reviewed in the clinic at two months postdischarge.

Introduction: Accounting for less than 2% of all pituitary adenomas, TSHsecreting pituitary adenomas (TSHoma) are an uncommon cause of hyperthyroidism. Majority are macroadenomas with delayed diagnosis as most patients are unwittingly treated for primary hyperthyroidism. Recurring discordant thyroid function test (TFT) with elevated thyroidstimulating hormone (TSH) and Free T4 is a hint and warrants additional investigation to facilitate diagnosis. Case: We report a case of a 48-year-old female who was treated for primary hyperthyroidism since her late 20s with multiple admissions for recurrent congestive heart failure and atrial fibrillation. The cardiac issue was preceded by worsening thyrotoxicosis. Previous thyroid autoantibodies were negative. Of note, she had recurring discordant TFT results from two different assays (TSH:84.7, free thyroxine 4 [FT4]:75.43) (TSH:37.86, FT4:27.34) during admission, excluding assay interference and prompting toward TSHoma or Resistance to Thyroid Hormone (RTH). Examination revealed a large goiter (10 × 8 cm) hard in consistency, and pansystolic murmur over tricuspid area. No thyroid eye disease nor bitemporal hemianopia or clinical sign of acromegaly. Echocardiography showed dilated left atrium and mild to moderate tricuspid regurgitation with preserved ejection fraction. Thyroid-releasing hormone (TRH) stimulation test demonstrated blunted TSH response confirming TSHoma. Anterior pituitary hormone profile revealed normal insulin-like growth factor-1 level with suppressed sex hormones and prolactin, thus excluding co-secreting hormone. Sex hormone-binding globulin level, α-subunit, and T3 suppression test were not done due to unavailability. Magnetic resonance imaging pituitary uncovered pituitary mass measuring (2.6 × 3.3 × 2.2 cm) suggestive of macroadenoma with encasement of cavernous internal carotid arteries and cavernous sinus compression. Computed tomography neck revealed diffuse thyroid enlargement with compressive mass effects onto adjacent structure with trachea narrowing. After discussing with a multidisciplinary team, we planned her for total thyroidectomy followed by transsphenoidal surgery. Conclusion Late presentation and diagnosis in TSHoma remain a major challenge. TFT interpretation is fundamental in identifying the causes of secondary hyperthyroidism to avert detrimental sequalae and to guide optimal treatment.
Atrial Fibrillation ; Thyrotropin

Rhipicephalus linnaei is a widespread tick species infesting dogs and capable of transmitting pathogens of veterinary and zoonotic concern. However, its associated bacterial communities remain poorly described in Malaysia. This study profiles the bacterial microbiome of R. linnaei collected from stray dogs in Kampar, Perak, using 16S rRNA gene amplicon sequencing targeting the V3-V4 region. A total of 360 ticks were collected from 13 dogs, of which 290 were pooled according to life stages and sex for microbial profiling. Shannon diversity indices indicated the mixed adult/nymph pool exhibited the highest richness and evenness (H’=5.4), whereas engorged adult females displayed the lowest diversity (H’=2.35), dominated by Gammaproteobacteria. Principal coordinate analysis revealed distinct microbial assemblages among pools, explaining 72% of total variance. Among 137 detected genera, Coxiella (0.6–34%), Staphylococcus (0.4–29%), Stenotrophomonas (0.3–5%), and Streptococcus (0.02–6%) were consistently found across all pools. Low-abundance but clinically relevant genera, including Ehrlichia (0.64%) and Nocardia (<0.01%), were detected in adult males. The consistent presence of Coxiella-like endosymbionts across all stages suggests a likely symbiotic role in nutrient provisioning and reproduction. To our knowledge, this is the first 16S rRNA gene-based profiling of the bacterial communities associated with R. linnaei collected from stray dogs in Malaysia. This study highlights variation across pooled tick categories and contributes to improved understanding of tick-borne pathogen ecology within a One Health framework.

Plasmodium knowlesi is an emerging zoonotic malaria species and a leading cause of malaria in Malaysia. Although severe disease is increasingly recognised, cerebral malaria remains uncommon and is traditionally associated with Plasmodium falciparum. We report a fatal case of cerebral malaria caused by P. knowlesi in a previously healthy 61-year-old woman with a history of frequent orchard visits for peridomestic agricultural activities. She presented with rapid neurological deterioration and circulatory shock, complicated by an acute pontine infarction. Peripheral blood smear and polymerase chain reaction confirmed P. knowlesi infection with a parasite density of approximately 35,000 parasites/ µL. The patient met World Health Organization criteria for severe malaria and was treated promptly with intravenous artesunate in accordance with international guidelines, alongside intensive supportive care for septic shock and multiorgan failure. Despite a rapid reduction in parasitaemia, her condition deteriorated, and she died within 24 hours of presentation. This case highlights the potential for P. knowlesi to cause rapidly progressive and fatal cerebral malaria. Clinicians in endemic regions should maintain a high index of suspicion for zoonotic malaria in patients presenting with acute neurological deterioration.

EMPATHY, PROFESSIONAL VALUE AND PROFESSIONAL QUALITIES OF LIFE AMONG NURSING STUDENTS AT A PUBLIC UNIVERSITY IN SELANGOR Work stress and burnout are common among healthcare workers, including nursing students, due to heavy workloads and long-term exposure to patient care. Adaptation of empathy and professional values can affect the quality of life among nursing students. This study aimed to determine the relationship between empathy, nursing professional value, and professional quality of life (ProQOL) among nursing students at a public university in Selangor. A cross-sectional study was done using purposive sampling, and 128 nursing students from UiTM Puncak Alam were recruited to participate in this study. Students completed a self-report online questionnaire that included the Jefferson Scale of Empathy, the Nursing Professional Values Scale, and the Professional Quality of Life Scale. The finding shows that students reported a higher level of nursing professional value, an average level of empathy, and a medium level of ProQOL. A fair, positive correlation exists between empathy and nursing professional value (r = 0.309, p < 0.01). Empathy and professional values are essential for fostering resilience and reducing burnout among nursing students in clinical settings. Self-awareness and a firm grasp of these values help mitigate compassion fatigue and negative workplace patterns, promoting emotional well-being and high-quality care.

Vibrio vulnificus is a halophilic gram-negative bacillus that can cause fulminant septicaemia in immunocompromised patients. A 67-year-old man who was immunosuppressed as a result of cytotoxic chemotherapy presented with a brief history of fever, lethargy, myalgia, and reduced oral intake. He had recently travelled to the beach to consume seafood. His blood pressure was 81/47 mm Hg, necessitating fluid resuscitation followed by inotropic support and admission to the intensive care unit. His blood culture was positive for curved gram-negative bacilli. The isolate was oxidase-positive and produced an acid butt with an alkaline slant in triple sugar iron agar. Matrix-assisted laser desorption ionization-time of flight mass spectrometry conclusively identified the isolate as V. vulnificus. Intravenous ceftazidime plus ciprofloxacin were administered, and by the fifth day of admission, he was successfully transferred out to the general ward. In total, the patient completed a 14-day course of antibiotic therapy.

For centuries, deer antler velvet (DAV) has been a staple in traditional medicine due to its numerous health benefits, including immune stimulation, anti-ageing, wound healing, and anti-osteoporosis properties. Researchers attribute the therapeutic advantages of DAV to various compounds in its extract, ranging from growth hormones to minerals and amino acids. Recently, there has been renewed interest in these natural products for their potential use in treating chronic diseases such as bone health and development, bacterial infections, and sports supplementation to increase athletic performance. The available literature supports that DAV significantly affects bone development, chondrogenesis, and antimicrobial properties, making it a valuable resource in medical and dental settings. This review aims to provide an in-depth overview of the potential applications of DAV in modern medicine and dentistry.

Background: The value of direct decompression of neural structures to treat lumbosacral plexus injury associated with sacral fractures is still debatable. Direct decompression allows decompression of nerve roots by sacral laminectomy and removal of bone fragments in the spinal canal. In contrast, indirect decompression may offer similar neurological outcomes if good fracture reduction and correction of sacral kyphosis are achieved. In this comparative retrospective study, we analyzed differences between direct and indirect neurological decompression in terms of neurological recovery, complications, and functional outcome. Methods: This study included 33 cases with spinopelvic dissociation with variable degrees of lumbosacral plexus injury. All cases were managed by spinopelvic fixation. Eighteen patients (group 1) had direct decompression of lumbosacral nerve roots while 15 patients (group 2) had indirect decompression. Results: Initial sacral kyphosis, quality of fracture reduction, and postoperative residual kyphosis were the main factors that significantly affected functional and neurological outcome in both groups. The final neurological improvement was similar in both groups. No significant difference was observed between both groups in the residual Gibbons’ score recorded in the last visit (p = 0.206). The final Majeed score also showed no significant difference between the two groups (p = 0.869). Conclusions Indirect decompression of sacral fractures showed similar final functional outcome and neurological recovery compared to direct decompression. Restoration of lumbosacropelvic stability and anatomic reduction seem to be the cornerstone for better functional outcome and neurological recovery rather than direct decompression of neural elements.