Patient cancer care education aims to inform and empower patients by providing clear, relevant information about cancer, including its mechanisms, treatment options, and management strategies. This study evaluated the effectiveness and accuracy of existing patient cancer care education materials in Malaysia, specifically assessing patients’ understanding of treatment, side effects, and their management. Method: A descriptive, correlational study was conducted involving 20 cancer patients at Gleneagles Penang Medical Center, using the Patient Cancer Education Needs Assessment questionnaire. Data analysis was performed using SPSS version 21.0 and Microsoft Excel 2013. Result: Patient age, education level, occupation, and socioeconomic status were not significant factors influencing understanding. Findings highlight the need to improve existing educational materials to enhance patient comprehension and ensure materials are comprehensive, culturally appropriate, and innovative. Conclusion: Patient cancer care education materials should be comprehensive, interactive, and patient is friendly. Current materials require revision and enhancement to keep pace with technological developments, ensuring they are accessible, understandable, and effective in supporting patients’ knowledge of cancer treatment, side effects, management strategies, and psychosocial aspects.

Introduction: Medicinal herbs Acorus calamus, Curcuma longa, Zingiber officinale, and Piper betle have been traditionally used for treating stomach-related conditions such as irregular bowel movement, bloating, and gastric ulcers. The present study aimed to explore current status, research trends, and future directions of these herbs as functional herbal teas in prevention and treatment of gastritis. Methods: A total of 80 articles from Scopus database were retrieved and reviewed. Research trends were quantitatively analysed using VOSviewer software, focusing on the keywords, authors, countries, journals, and documents. A narrative review was integrated to provide comprehensive insights into the study. Results: Analysis revealed China and India as driving forces of this specific area of research, with the Journal of Ethnopharmacology emerging as a prominent source for publications in this field. “Curcumin”, “ginger”, and “Helicobacter pylori” were the main keywords of the study. Several gastroprotective mechanisms, including stimulation of mucosal proliferation, regulation of gastric acid production, reduction of inflammation in the gastric mucosa, protection of the gastric mucosa from oxidative damage, and inhibition of the growth of H. pylori, were associated with these herbs. Active compounds, such as α-asarone, curcumin, gingerol, and piperbetol, were found to be responsible for these effects. Conclusion: This study highlights various gastroprotective properties of A. calamus, C. longa, Z. officinale, and P. betle, providing researchers with a deeper understanding of the subject matter and opening new avenues for potential development into a functional herbal tea formulation known as “Lega Tea” (Relief Tea).

Introduction: Tinea imbricata (TI) outbreak poses a significant health burden among indigenous populations in rainforest regions due to their geographical isolation and poor socioeconomic conditions. This study aimed to investigate the epidemiological trends, antifungal susceptibility patterns, and treatment outcomes of TI among the Bateq subtribe in Pahang, Malaysia. Materials and Methods: A cross-sectional survey was conducted between July–October 2023 in five villages within the National Rainforest Park, Malaysia. Socio-demographic characteristics, clinical manifestations, and treatment outcomes were collected through interviews, laboratory investigations, and clinical examinations. Treatment modalities were evaluated for their effectiveness in reducing disease burden. Results: 569 individuals were surveyed, revealing a TI prevalence rate of 7.91% with children aged 15 years and below exhibiting the highest susceptibility (9.22%). Antifungal susceptibility testing of clinical isolates of Trichophyton concentricum demonstrated high sensitivity to terbinafine (GM MIC=0.144 μg/ml, GM MFC=0.198 μg/ml, p<0.05) and griseofulvin (GM MIC=1.741 μg/ml, GM MFC=4.782 μg/ml, p<0.05), while clotrimazole showed moderate activity (GM MIC=5.897 μg/ml, GM MFC=22.291 μg/ml). Fluconazole demonstrated the least potency, with no fungicidal activity observed at concentrations up to 128 μg/ml. Treatment outcomes indicated that combination therapy (terbinafine gel and oral griseofulvin) significantly outperformed terbinafine gel alone, achieving an almost complete lesion resolution (LA reduced to 0.158±0.158 cm versus 3.684±1.522 cm , p<0.05). Conclusion: These findings provide critical insights into the epidemiology and emerging drug resistance of TI in the Bateq subtribe, highlighting the importance of continued surveillance, monitoring, and adaptation of treatment strategies to combat evolving antifungal resistance patterns.

Knowledge, Attitude, and Practice Towards Safety ; Health Risks ; Food Manufacturing Introduction Food manufacturing in Malaysia exposes workers to numerous potential hazards and health risks throughout the work process. This study aimed to determine the level of knowledge, attitude, and practice (KAP) towards safety and health risks among food manufacturing workers and to examine the relationship between these domains. Methods A cross-sectional study was performed involving 80 workers from three food manufacturing factories in Negeri Sembilan. KAP was assessed through a validated questionnaire adapted from a previous study. Results All workers (100%) demonstrated a positive attitude, 98.7% show good practice, and 93.8% exhibit a good level of knowledge towards safety and health risks. The correlation study showed significant positive correlations between gender and attitude, and between education level and attitude, indicating that these sociodemographic factors influence safety attitudes. Work experience is significantly associated with knowledge, suggesting that work experience enhances knowledge. The study also reveals weak positive correlations among knowledge, attitude, and practice (KAP) regarding safety and health risk, but a significant correlation is observed between knowledge and practice. Conclusions These findings suggest that fostering practical knowledge is essential for ensuring safe work behaviors. Prioritizing hands-on safety training can help bridge the gap between theoretical attitude and daily operational safety, ultimately reducing occupational health risks among food manufacturing workers.

Sociodemographic and Environmental Factor of Tuberculosis: Retrospective Study in Penampang, Sabah Introduction Tuberculosis (TB) remains a critical global and national public health concern, with Penampang, Sabah experiencing a continuous burden and increasing case trends. Existing literature lacks localized research on the connection between environmental factors, particularly air quality, and TB incidence in specific district-level contexts like Penampang. Methods This retrospective cross-sectional study aimed to investigate the association of sociodemographic factors and Air Pollution Index (API) with TB cases in Penampang from 2019-2023, utilizing data from the National Tuberculosis Registry and Department of Environment. Results Results indicated a statistically significant association between age and TB cases (p<0.001), while no significant association was found for gender or nationality. While Moran’sI measures global spatial clustering, LISA identifies local clusters of TB cases, spatial analysis identified Donggongon as a localized TB hotspot, alongside an overall dispersed distribution across Penampang (Moran's I = -0.143, p<0.001). Furthermore, statistically, API showed no overall significant correlation with TB cases (p=0.070) and also no global spatial autocorrelation was observed between TB cases and the API in Penampang (Moran's I = 0); however, LISA analysis identified specific local clusters (p=0.01) where a significant spatial correlation between TB incidence and API levels was present allowing the study to distinguish between overall and localized spatial patterns. Conclusions The study shows that Sociodemographic, environmental, and spatial factors are all linked in the spread of TB. Effective public health measures must be tailored to these specific contexts. Future research should collect more detailed environmental and individual-level data to create better-targeted interventions.

Case Report Open Access 15 Sinocutaneous fistula is a rare complication of chronic rhinosinusitis (CRS), most commonly involving the frontal sinus, with maxillary sinus involvement being uncommon and typically associated with trauma, surgery, or odontogenic infection. We report a rare case of a maxillary sinocutaneous fistula secondary to chronic maxillary rhinosinusitis in the absence of trauma, prior surgical intervention, fungal infection, or neoplasia. The condition resulted from longstanding inflammation with associated osteitis and cortical erosion of the maxillary sinus wall, leading to abnormal communication with the overlying facial skin. Diagnosis was established through clinical evaluation and contrast - enhanced computed tomography of the paranasal sinuses. Definitive management consisted of functional endoscopic sinus surgery with complete excision of the fistulous tract and primary multilayered closure. This case underscores the potential for chronic inflammatory sinonasal disease to cause rare bony complications and highlights the importance of considering CRS in the differential diagnosis of persistent facial cutaneous fistulae

Case Report Open Access 15 Sinocutaneous fistula is a rare complication of chronic rhinosinusitis (CRS), most commonly involving the frontal sinus, with maxillary sinus involvement being uncommon and typically associated with trauma, surgery, or odontogenic infection. We report a rare case of a maxillary sinocutaneous fistula secondary to chronic maxillary rhinosinusitis in the absence of trauma, prior surgical intervention, fungal infection, or neoplasia. The condition resulted from longstanding inflammation with associated osteitis and cortical erosion of the maxillary sinus wall, leading to abnormal communication with the overlying facial skin. Diagnosis was established through clinical evaluation and contrast - enhanced computed tomography of the paranasal sinuses. Definitive management consisted of functional endoscopic sinus surgery with complete excision of the fistulous tract and primary multilayered closure. This case underscores the potential for chronic inflammatory sinonasal disease to cause rare bony complications and highlights the importance of considering CRS in the differential diagnosis of persistent facial cutaneous fistulae

Introduction: Prediabetes or intermediate hyperglycemia (IH) represents a critical phase in the trajectory toward type 2 diabetes mellitus (T2DM). Recent evidence from the International Diabetes Federation (IDF) suggests that 1-hour OGTT (1HOGTT) ≥8.6 mmol/L is a more sensitive biomarker for early beta-cell dysfunction, with enhanced detection of IH and future T2DM risk. Conventional screening using hemoglobin A1c (HbA1c) or 2-Hour OGTT (2HOGTT) may delay identification of prediabetes, narrowing the window for early intervention. This study evaluates 1HOGTT as a screening tool for prediabetes among Malaysians. Methodology: This cross-sectional study enrolled adults without prior T2DM or prediabetes. Participants underwent 1HOGTT, 2HOGTT, and HbA1c, classified as per the Malaysian Clinical Practice Guideline for T2DM (6th Edition) and IDF 2024 criteria. Agreement between tests was assessed using McNemar’s test and Cohen’s kappa. Diagnostic accuracy was evaluated via receiver operating characteristic (ROC) curve analysis. Cost-effectiveness was determined using reagent cost only. Results: The majority of the 310 participants were female (71.6%), Malay (87.1%), with average age of 40. The 1HOGTT identified prediabetes in 21.6% (n = 67) compared to 17.1% (n = 53) by HbA1c and 2.6% (n = 8) by 2HOGTT. McNemar’s test confirmed statistically significant discordance between 1HOGTT and 2HOGTT (chi-square = 53.397, p <0.001): 61 participants were prediabetic by 1HOGTT but normal by 2HOGTT, versus only 2 in the reverse direction. No significant discordance was found between 1HOGTT and HbA1c (chi-square = 2.817, p = 0.093). 1HOGTT demonstrated excellent discriminatory ability against 2HOGTT (AUC = 0.908; 95% CI: 0.837–0.978), significantly outperforming HbA1c (AUC = 0.664; CI: 0.462– 0.867; DeLong p = 0.012). In a population-level cost analysis, 1HOGTT achieved lowest cost per prediabetes case detected (RM 5.79) – approximately 8.3 times and 8.1 times more cost-effective than 2HOGTT (RM 48.08) and HbA1c (RM 46.78) respectively. Conclusion 1HOGTT identifies a significant proportion of individuals with prediabetes missed by 2HOGTT and HbA1c. Incorporating 1HOGTT enhances the detection of prediabetes, is cost-effective, and enables timely preventive measures in our population with high diabetes burden.
Glucose Tolerance Test ; Glycated Hemoglobin ; Prediabetic State

Introduction: Primary aldosteronism (PA), most commonly caused by aldosterone-producing adenomas (APAs), represents the leading form of surgically curable secondary hypertension. While genomic studies have elucidated the mutational landscape of APAs, the spatial organisation and functional role of immune populations across APAs, aldosterone-producing micronodules (APMs), and adjacent adrenal cortex remain poorly defined at single-cell resolution. Methodology: Single-cell RNA sequencing (scRNA-seq) was integrated with spatial transcriptomics in APAs and paired adjacent adrenal cortex, complemented by immunohistochemical (IHC) validation. Immune populations were spatially mapped using canonical markers (CD14, CD68, CD163, HLA-DR, CD8A, and CD4) across defined adrenocortical regions. Results: The adrenal microenvironment in PA demonstrates structured immune organisation rather than passive infiltration. CD14+ monocyte-lineage cells localize intraparenchymally within APAs (n = 10), intercalating between CYP11B2+ aldosterone-producing cells and forming a pattern distinct from perivascular immune niches. scRNA-seq further identified a transcriptionally distinct CD14+ population within the zona reticularis (zR) that co-expresses steroidogenic markers (CYB5A, SULT2A1, TSPAN12) while lacking canonical monocyte transcripts. IHC supported this observation, demonstrating CD14 expression within adrenocortical zR parenchymal cells (n = 5). In parallel, CD4 and HLA-DRA exhibited diffuse cytoplasmic staining within zR parenchymal cells in the absence of classical macrophage marker coexpression (CD68), suggesting non-canonical or context-dependent expression within steroidogenic compartments. CD68+ and CD163+ macrophages were sparsely distributed across APA, APM and adjacent cortex, consistent with lowdensity tissue-resident populations, while CD8A+ cytotoxic lymphocytes were enriched in APAs and APMs with diffuse parenchymal cytoplasmic staining of CD8A additionally observed within the zR. Conclusion These findings reveal a previously unrecognized spatially organised immune-steroidogenic interface within the adrenal cortex. The presence of immune-associated transcriptional and protein signatures within zR cells suggests potential functional plasticity of steroidogenic cells, possibly extending to antigen presentation-related pathways, warranting further mechanistic investigation
Hyperaldosteronism ; Humans

Introduction: Adrenal incidentalomas are increasingly detected with the widespread use of imaging, whereby the large or heterogeneous lesions often raise concern for adrenocortical carcinoma (ACC). However, certain rare benign and infectious conditions may closely mimic malignant features, posing a diagnostic challenge. Case: A 64-year-old female with diabetes mellitus, hypertension, and dyslipidemia was noted to have progressively rising alkaline phosphatase during routine follow-up. She had non-specific gastrointestinal symptoms. A computed tomography abdomen pelvis showed a large, lobulated mass at the left flank, likely of adrenal origin. An adrenal protocol computed tomography revealed a large, heterogeneously enhancing left suprarenal mass measuring 10.7 × 10.3 × 10.7 cm, with a plain-phase attenuation of +81 Hounsfield Unit and absolute (28%) and relative (18%) washout. The right adrenal gland was normal, with no evidence of distant metastasis. Hormonal evaluation showed normal 24-hour urinary metanephrines, excluding pheochromocytoma. The overnight dexamethasone suppression test demonstrated cortisol of 89 nmol/L, suggestive of mild autonomous cortisol secretion, without clinical features of overt hypercortisolism. DHEA was low (0.371 µmol/L), and adrenocorticotropic hormone was suppressed (1.26 pg/mL). Evaluation for primary aldosteronism was not done due to the absence of resistant hypertension or hypokalemia. The gonadotropin profile was consistent with postmenopausal status (follicle-stimulating hormone (89 IU/L) and luteinizing hormone (28.9 IU/L) with low estradiol. The patient underwent open left adrenalectomy. Histopathology revealed an adrenal cavernous hemangioma with extensive hemorrhage and infarction, alongside necrotizing granulomatous inflammation with numerous intracellular fungal organisms and narrow-based budding yeast forms, highly suggestive of histoplasmosis, with no evidence of malignancy. She was subsequently comanaged with infectious disease team and commenced on intravenous amphotericin B. Conclusion This is a rare coexistence of an adrenal hemangioma and histoplasmosis, presenting as a large adrenal mass mimicking ACC. The limitations of imaging in differentiating benign from malignant adrenal lesions are revealed and emphasize the role of histopathological confirmation. Increased awareness of such entities can support the diagnosis and management.
Neoplasms