Introduction: Immunoglobulin G4-related hypophysitis (IgG4-RH) is a rare fibro-inflammatory disorder affecting the pituitary gland. Glucocorticoids remain the first-line therapy, but their use may be complicated in patients with significant metabolic comorbidities. We report a case of suspected IgG4-RH presenting with hyperosmolar hyperglycemic state (HHS), highlighting the challenges of balancing disease control against glucocorticoid metabolic toxicity adverse effects. Case: A 32-year-old female with obesity and newly diagnosed diabetes mellitus was admitted with HHS. Prior to admission, she reported weight fluctuations, episodic headaches, progressive visual disturbance, and secondary amenorrhea. Following resolution of HHS, persistent polyuria of 10–16 L/day prompted further evaluation and led to a diagnosis of arginine vasopressin deficiency. Anterior pituitary hormonal work-up revealed hypogonadotropic hypogonadism. Pituitary magnetic resonance imaging demonstrated infundibular thickening measuring 0.5 cm, with concomitant marked bilateral parotid enlargement. Serum IgG4 was elevated at 2.26 g/L (0.63–2.01), raising strong suspicion for IgG4-RH with systemic involvement. Histopathological confirmation from the parotid gland biopsy was consistent with sialadenosis. She was commenced on sublingual desmopressin and cyclical sex hormone replacement therapy. Given the provisional diagnosis of IgG4-RH, oral prednisolone 40 mg daily was initiated as a reduced induction regimen. However, treatment was poorly tolerated, with rapid weight gain from 93 to 100 kg and worsening glycemic control. Prednisolone was therefore tapered rapidly to 10 mg daily. Repeat imaging demonstrated interval improvement in infundibular thickening, but no functional endocrine recovery was observed. Conclusion This case illustrates the therapeutic challenge of managing IgG4-RH in the setting of pre-existing metabolic syndrome. Although glucocorticoids are effective for induction, their metabolic adverse effects may significantly restrict treatment tolerability. Early consideration of steroidsparing agents, such as rituximab or azathioprine, may be important to achieve remission while minimizing glucocorticoid-related adverse effects.
Autoimmune Hypophysitis

Introduction: Short stature and delayed puberty characterize Turner syndrome (TS). The 2024 international clinical practice guidelines recommend growth hormone (GH) for latediagnosed patients if epiphyses remain open. For patients with remaining growth potential, initiating GH alongside low-dose estrogen effectively balances linear growth with the need for timely pubertal induction. Case: A 15-year-old female, born prematurely at 6 months gestation, presented with delayed puberty, primary amenorrhea, and short stature. Examination revealed a height of 122 cm (<5th percentile), weight of 26 kg, with no syndromic facies, and Tanner stage 1. Investigations confirmed hypergonadotropic hypogonadism. Metabolic screening, including thyroid, renal, and liver profile, was normal. Her baseline insulin-like growth factor 1 (IGF-1) was low at 117.5 ng/mL (127.5–541.5). Karyotyping confirmed mosaic TS (45,X/46,Xr). Her skeletal bone age was delayed at 12 years, indicating a viable window for linear growth prior to complete epiphyseal fusion. Subcutaneous GH was initiated at 0.3 mg up titrated to 1.2 mg (0.45 µg/kg) daily over 4 weeks, then 1.35 mg (50 µg/kg) daily at month 5. Low-dose oral estradiol (0.5 mg three times weekly) was introduced for pubertal induction at month 4. After 9 months of combined GH and estrogen therapy, the patient achieved a height increment of 6 cm, reaching 128 cm without an adverse event. To achieve the clinical target of a 10–15 cm increment in the first year, her GH dose was further increased to 1.50 mg (55 µg/kg) daily. She showed an appropriate biochemical response with IGF-1 increased to 40.2 nmol/L (16.4–67.8) with a total height gain of 6 cm over the first 9 months of GH therapy. Conclusion Concomitant GH and estrogen therapy in late-diagnosed TS successfully induced clinically significant height gain. This dual approach maximized the limited window for linear growth, without delaying pubertal induction and compromising patient’s psychosocial well-being.
Turner Syndrome

Introduction: The consumption of sugar-sweetened beverages (SSBs) among young adults in Malaysia has witnessed a notable increase in recent years, giving rise to concerns regarding the potential adverse health effects, including obesity and diabetes. Despite the urgent need for targeted interventions, there is a dearth of research examining the knowledge, attitudes, and practices (KAP) related to SSBs among Malaysian young adults. To address this research gap, the present study aims to assess the level of KAP concerning SSB intake and its associated factors in this specific population. Methods: A cross-sectional study was conducted involving 408 Malaysian young adults aged between 15 and 29 years. Respondents completed an online questionnaire survey, which encompassed the assessment of socio-demographic characteristics and KAP regarding SSB consumption. The collected data were analyzed using IBM’s Statistical Package for the Social Sciences (SPSS) version 22.0. Spearman correlation tests were performed at a significance level of 0.05. Results: The majority of respondents demonstrated moderate knowledge (60%) and practices (60%), while exhibiting a high positive attitude (100%) towards reducing SSB consumption. Significant correlations were observed between knowledge and attitude (p = 0.003, rs = 0.148) and between knowledge and practice (p = 0.005, rs = 0.138). Moreover, the attitude scores were found to be significantly associated with gender (χ2 (1, N = 408) = 10.421, p = 0.001) and locality (χ2 (1, N = 408) = 4.106, p = 0.043), while the practice scores exhibited a significant association with ethnicity (p = 0.006). Conclusion: This study provides valuable insights into the relationship between KAP related to SSB consumption and socio-demographic factors among Malaysian young adults. The findings underscore the importance of utilizing these insights to develop strategic interventions that aim to curtail SSB consumption and promote a healthy lifestyle, ultimately contributing to the reduction of non-communicable diseases. Health authorities are encouraged to capitalize on these findings to design targeted interventions tailored to the unique needs and circumstances of this population.

THE ACCURACY OF SMARTPHONE IMAGES FOR ORAL HEALTH SCREENING AMONG CHILDREN COMPARED TO CLINICAL EXAMINATION: A PILOT STUDY The aim of this study was to determine the accuracy of smartphone images for oral health screening among children compared to clinical examination. Children aged 7–12 years old were visually examined by Examiner 1 (E1) for caries status using the International Caries Detection and Assessment System (ICDAS), and carious lesions were classified as enamel or dentin caries, dental plaque assessment using the Debris Index (DI), and gingival health using the Modified Gingival Index (MGI). Following the clinical examination (CE), an iPhone 13 (Apple Corp.) was used to take five images of their teeth for caries detection and one frontal view image of anterior teeth coated with plaque disclosing gel for smartphone image examination (SIE) using the same clinical parameters. The smartphone image examination was conducted independently by Examiner 2 (E2) without any knowledge of the results from the visual clinical examination. The sensitivity of smartphone images to detect enamel and dentin caries was similar at 74% and 72%, respectively, which reflects its ability to correctly identify participants with dental caries. The specificity and positive predictive value (PPV) for dentin caries were both 100%, while the negative predictive value (NPV) was approximately 98%. The positive predictive value and negative predictive value of enamel caries detection were 76.9% and 77.4%, respectively. The inter-rater reliability between the two examinations was calculated using ICC, and the scores for DMFT, DI, and MGI were 0.842, 0.964, and 0.832, respectively. The Wilcoxon signed rank test was used to compare the mean DMFT, DI, and MGI between the visual and image-based examinations with p-values of 0.121, 0.965, and 0.445, respectively (not statistically significant). The findings in this pilot study showed that the mobile teledentistry approach using smartphone images has demonstrated its ability to identify caries, plaque, and gingival status in children with acceptable diagnostic accuracy when compared to visual clinical examination. Smartphone cameras can serve as a reliable and practical alternative in screening for enamel and dentin carious lesions, dental plaque, and gingival status when compared to the visual clinical examination.

Introduction: Studies show that adolescents are more reward sensitive compared to other age groups. The nucleus accumbens (NAcc) has been identified as a key brain area involved in reward through its connectivity to other reward-related brain areas. Our study aimed to characterise the white matter structural connectivity of nucleus accumbens with brain areas that are most often associated with reward in female adolescents. Methods: Fifteen healthy female Malay adolescents were recruited and underwent diffusion-weighted brain scanning. Two behaviour scales were also given to verify typical reward responsiveness. Then, probabilistic tractography and NAcc segmentation were performed on the data using FMRIB Software Library (FSL). Probabilistic tractography was performed to determine the relative connection probability of nucleus accumbens (NAcc) to areas shown to be associated with reward, namely amygdala, anterior cingulate cortex (ACC), medial orbitofrontal cortex (mOFC), hippocampus, ventrolateral prefrontal cortex (vlPFC) and dorsolateral prefrontal cortex (dlPFC). Connectivity-based segmentation of NAcc was performed to determine the spatial distribution of its connectivity with the target brain areas according to the highest connection probability. Results: The highest relative connection probability was found between NAcc to mOFC, while the NAcc parcellation showed the widest distribution of connection to mOFC compared to the other five targets on both sides of the brain. Conclusion: Our findings demonstrated the strongest structural connectivity and widest distribution between NAcc and mOFC compared with other brain areas related to reward. This study’s findings could be used as baseline to compare with people with atypical reward circuit problems.

Introduction: The use of assessment tools to measure postnatal mental illness is essential in healthcare settings. However, variations in the types of tools and their reliability in a particular population lead to under-recognition of mental health status in postnatal mothers. The aim of this review is to evaluate the most recent 10 year of research on the validity and reliability of postnatal mental illness assessment tools. Methods: A literature search of studies from online databases PubMed, Scopus, and Science Direct was conducted. Results: A total of 59 studies were selected for this review. Several studies utilised multiple assessment tools, and a total of 96 assessment tools were identified and classified into six domains: postnatal blues, postnatal stress, postnatal anxiety, postnatal depression, postnatal psychosis, and postnatal psychological disorder. In this review, EPDS was the most common tool used to identify postnatal depression and anxiety while DASS 21 was the most common tool used to identify postnatal psychological disorder. There is a wide range in preponderance of evidence for the reliability of each assessment tool and there were inconsistencies in assessing the validity of the assessment tools. Conclusion This review provides information regarding some of the main assessment tools currently available to measure postnatal mental illnesses. There were no standardised tools that were used in a particular setting. The results may differ in different population because there are differences in not only languages and dialects, but also cultural and racial backgrounds, which greatly influences their perception and interpretation of postnatal mental illness.
Mental Disorders

Knowledge on surface anatomy enables medical students and graduates to locate anatomical structures exteriorly, improve their clinical and procedural skills and interpret ultrasonographic and radiographic images. Hence, a standard surface anatomy knowledge is essential for attainment of clinical skill competency. Nevertheless, there is lack of attention given on surface anatomy in the medical curriculum as it is usually delivered didactically or during selfstudy by the students. Owing to limitations in cadaveric dissection in many institutions, lecture-based instruction, e-learning materials, living anatomy models, radiological imaging and anatomy software are used in teaching surface anatomy; however, none of these methods proved to be effective over the others. Furthermore, some of these teaching resources lack clinical relevancy, possibly impeding students’ appreciation on learning surface anatomy. Hence, integrating clinical input during surface anatomy teaching by involving patients in an actual clinical environment is pertinent. This article demonstrates the benefits and challenges of teaching surface anatomy in the clinical setting to medical students and highlights the need to design an evidence-based framework of work-based surface anatomy learning.

Aims: Andrographis paniculata (AP), a medicinal herb was selected to investigate the antifungal activity on selected dermatophyte fungi. The phytochemical screening was also carried out to evaluate its chemical constituents. Methodology and results: The potato dextrose agar (PDA) incorporated with aqueous, ethanol and methanol AP extracts at concentrations 0.99% (v/v), 1.96% (v/v) and 7.41% (v/v) were used for selected fungi culturing; Trichophyton mentagrophytes, T. rubrum, T. interdigitale, Microsporum fulvum, M. nanum, M. gypseum, M. canis, Fusarium solani and Aspergillus fumigatus. Phytochemical screening showed the presence of flavonoids, saponins and tannins in the ethanol extract and flavonoids alone in both aqueous and methanol extracts. Studies on antifungal effects indicated that the ethanol extract significantly increased the mycelial inhibition percentage of all tested fungi, especially at a concentration of 7.41% (v/v). All ethanol AP extract concentrations inhibited M. gypseum and M. canis (p<0.05) with at least 36.00% mycelial inhibition. In aqueous AP extract, it significantly increased the mycelial inhibition of T. mentagrophytes, T. interdigitale and M. gypseum (p<0.05), while the methanol AP extract significantly inhibited all fungi at a concentration of 7.41% (v/v) except for T. rubrum, M. gypseum and F. solani (p<0.05). No spore sedimentation was recorded for the fungal spores of T. rubrum, M. nanum, T. mentagrophytes, M. gypseum and T. interdigitale at 7.41% (v/v) ethanol AP. Conclusion, significance and impact of study It is concluded that the ethanol AP extract contained phytochemical constituents and showed the highest antifungal activity. In addition, this extract has a great potential to treat dermatophytes effectively.
Antifungal Agents ; Phytochemicals ; Andrographis paniculata ; Dermatomycoses

Aims: Knowledge of the Trichoderma taxa is important for both control efficiency and environmental conservation. Therefore, the objective of this study is to isolate and identify Trichoderma species from various rhizosphere soil samples using phenotypic and molecular characterization. Methodology and results: Native Trichoderma spp. were isolated from agricultural fields in 17 sites from seven states of Malaysia. These isolates were characterized via morphological observation and molecular phylogenetic analysis based on the translation elongation factor-1α (tef1-α) gene. About 42 isolates were classified into eight Trichoderma species, which are Trichoderma asperellum, T. hamatum, T. harzianum, T. koningiopsis, T. rodmanii, T. spirale, T. viride and T. virens. Comparison of DNA sequences of tef1-α showed that the isolates were 98-100% similar to respective Trichoderma species from GenBank, thus confirming the fungal identity. Phylogenetic trees of maximum likelihood (ML) dataset of tef1-α inferred that the isolates were clustered according to species. Conclusion, significance and impact of study Findings in the present study will be beneficial for the purposes of biodiversity conservation and plant disease management using biocontrol agents.
Trichoderma--isolation & ; purification ; Rhizosphere

Laboratory practices in a laboratory have changed worldwide due to the emergence of the COVID-19 pandemic. The changes occur concerning specimen collection, handling, transportation, processing, and disposal. Infection control practices are applied in all aspects, starting from specimen collection until the clinician gets the results. A retrospective review of laboratory practices used in a tertiary teaching hospital laboratory from microbiologists’ perspectives was performed, and the practices were compared with previously published articles.