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

Background and Objectives: Auditory sensory gating deficits are abnormalities in patients with autism spectrum disorder (ASD) that may lead to sensory processing difficulties. It is particularly difficult for children with ASD to distinguish multiple auditory stimuli, which hinders them from focusing on a single auditory stimulus and separating unnecessary sounds. Suppression of otoacoustic emission (OAE) is an approach used to identify sensory gating deficits in the general population, specifically for children with ASD. This study aimed to investigate the suppression effect of various types of sound suppressors to measure their sensory gating capacity in children with ASD. Subjects and Methods: Twenty children including 10 with ASD and 10 normally developing children aged 6-12 years were recruited for this study. One accessible ear was exposed to transient-evoked OAE, whereas the other was exposed to suppressor tones. Contralateral suppressors included white noise, Quranic recitations, environmental noise, and natural sound. The magnitude of OAE suppression was determined from the difference between the OAE amplitude with and without the masker (in dB sound pressure levels) for all sound types. The sound with the highest suppression effect was determined using effect size calculation and repeated-measures analysis of variance at a 95% confidence level. A high suppression effect may suggest a high sensory gating performance, whereas low suppression may indicate low sensory gating performance. Results: Based on the analysis, the sound with the highest suppression effect was that of the waterfall. The suppression results were supported by descriptive analysis findings and effect-size calculations. Conclusions This study provides a better understanding of the alternative sound stimuli, besides the standard white noise tone, for the assessment of sensory gating deficits among children with ASD. Sounds with a high suppression effect have the potential to be used as sound therapy interventions for children with ASD as part of rehabilitation and therapy.

Background and Objectives: Auditory sensory gating deficits are abnormalities in patients with autism spectrum disorder (ASD) that may lead to sensory processing difficulties. It is particularly difficult for children with ASD to distinguish multiple auditory stimuli, which hinders them from focusing on a single auditory stimulus and separating unnecessary sounds. Suppression of otoacoustic emission (OAE) is an approach used to identify sensory gating deficits in the general population, specifically for children with ASD. This study aimed to investigate the suppression effect of various types of sound suppressors to measure their sensory gating capacity in children with ASD. Subjects and Methods: Twenty children including 10 with ASD and 10 normally developing children aged 6-12 years were recruited for this study. One accessible ear was exposed to transient-evoked OAE, whereas the other was exposed to suppressor tones. Contralateral suppressors included white noise, Quranic recitations, environmental noise, and natural sound. The magnitude of OAE suppression was determined from the difference between the OAE amplitude with and without the masker (in dB sound pressure levels) for all sound types. The sound with the highest suppression effect was determined using effect size calculation and repeated-measures analysis of variance at a 95% confidence level. A high suppression effect may suggest a high sensory gating performance, whereas low suppression may indicate low sensory gating performance. Results: Based on the analysis, the sound with the highest suppression effect was that of the waterfall. The suppression results were supported by descriptive analysis findings and effect-size calculations. Conclusions This study provides a better understanding of the alternative sound stimuli, besides the standard white noise tone, for the assessment of sensory gating deficits among children with ASD. Sounds with a high suppression effect have the potential to be used as sound therapy interventions for children with ASD as part of rehabilitation and therapy.

Background and Objectives: Auditory sensory gating deficits are abnormalities in patients with autism spectrum disorder (ASD) that may lead to sensory processing difficulties. It is particularly difficult for children with ASD to distinguish multiple auditory stimuli, which hinders them from focusing on a single auditory stimulus and separating unnecessary sounds. Suppression of otoacoustic emission (OAE) is an approach used to identify sensory gating deficits in the general population, specifically for children with ASD. This study aimed to investigate the suppression effect of various types of sound suppressors to measure their sensory gating capacity in children with ASD. Subjects and Methods: Twenty children including 10 with ASD and 10 normally developing children aged 6-12 years were recruited for this study. One accessible ear was exposed to transient-evoked OAE, whereas the other was exposed to suppressor tones. Contralateral suppressors included white noise, Quranic recitations, environmental noise, and natural sound. The magnitude of OAE suppression was determined from the difference between the OAE amplitude with and without the masker (in dB sound pressure levels) for all sound types. The sound with the highest suppression effect was determined using effect size calculation and repeated-measures analysis of variance at a 95% confidence level. A high suppression effect may suggest a high sensory gating performance, whereas low suppression may indicate low sensory gating performance. Results: Based on the analysis, the sound with the highest suppression effect was that of the waterfall. The suppression results were supported by descriptive analysis findings and effect-size calculations. Conclusions This study provides a better understanding of the alternative sound stimuli, besides the standard white noise tone, for the assessment of sensory gating deficits among children with ASD. Sounds with a high suppression effect have the potential to be used as sound therapy interventions for children with ASD as part of rehabilitation and therapy.

Electrolyzed water (EW) has been introduced as a surface disinfectant due to its antimicrobial properties without cytotoxic effects to oral tissues contrary to sodium hypochlorite (NaOCl), which is cytotoxic and can be detrimental if extruded beyond the root canal. This scoping review aimed to compare antimicrobial efficacy of EW with NaOCl on root canal pathogens and to assess effect of concentration and exposure time on antimicrobial efficacy. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews protocol guidelines. Electronic databases were searched for eligible articles published between 2011-2021 in PubMed, PLOS, Science Direct, and Google Scholar. Joanna Briggs Institute Critical Appraisal Tool was used for quality assessment. Of the 784 articles recovered, only 8 were eligible based on inclusion criteria. The included studies assessed several types of EW, which showed antimicrobial potential against E. faecalis in vitro in suspension and biofilm forms. EW demonstrated antimicrobial efficacy comparable with NaOCl in 5 of 8 studies. Only one study found that higher concentration and exposure time increased antimicrobial efficacy of EW; other studies showed otherwise. It can be concluded that EW can be a potential alternative solution for NaOCl as an endodontic irrigant.

In any infectious disease outbreak, early diagnosis, isolation of cases and quarantine of contacts are central to disease containment. In Brunei Darussalam, suspected cases of coronavirus disease 2019 (COVID-19) were quarantined either at home or at designated centres and were tested immediately for severe acute respiratory syndrome coronavirus 2. We report on 10 cases of COVID-19 that initially tested negative for COVID-19 and were positive on re-testing after becoming symptomatic. These cases comprised 3.8% of the 266 total confirmed COVID-19 cases in Brunei Darussalam as of 9 July 2021, when this study was conducted. All the cases were in quarantine at home and were tested early during their quarantine period. Since then, home quarantine has been replaced by quarantine at designated centres only, with testing on the 12th day of quarantine.

Sufficient intake of macronutrients and micronutrients are essential for child growth. Many children with autism spectrum disorder (ASD) however are reported to be picky eaters which may lead to malnourishment. As diet and behaviour are importantly interconnected, this study aims to determine the level of knowledge on nutrition among parents and special educators of children with ASD. A cross-sectional study was conducted at a National Autism Centre in Kuala Lumpur, Malaysia from May to August 2018. A 37-item questionnaire was self-administered to the respondents who attended series of training of trainers’ sessions. The data was the collected and analysed descriptively. A total of 209 respondents participated with 153 parents and 56 special educators of children with ASD. Only 37.9% of the parents agreed that their children’s diet contain balanced nutrition. Majority of the parents and special educators had the perception that sugar, junk food and gluten are bad for the children but they were still given due to the accessibility and convenience. The low level of knowledge among parents and special educators about the nutrition of children with ASD indicates that a measure should be taken to increase the awareness and to overcome the malnutrition among ASD children.

Introduction: The most common method to emerge latent fingermarks on non-porous surfaces is powdering by applying commercial fingerprint powders. However, the chemical composition of the powder is often toxic and poses health hazards to humans. This study was endeavoured to explore the effectiveness and potential use of natural resources for the enhancement of latent fingermarks. Methods: Eggshells and clamshells were prepared in fine powder form, and latent fingermarks were developed using each powder. Five non-porous substrates were selected for fingermarks deposition; glass, aluminium can, plastic book cover, painted wood, and compact disc. Results: Both natural powders have successfully developed high-quality finger marks with high clarity of ridge characteristics in comparison to commercial fingerprint powder (positive control) and untreated fingermark (negative control) on most of the tested surfaces tested. The sebaceous fingermarks have shown the best quality fingermarks when developed with both powders. In the ageing study, it was found that most non-porous substrates bearing latent fingermarks exposed to the destructive conditions can be successfully visualised in the early period of exposure. Conclusion: Eggshell and clamshell powders are as effective as commercial white powder but preferrable to be applied because of the low cost, abundant and non-hazardous.

Introduction: Antibacterial products contain active ingredients that are used to prevent bacterial growth and contamination. Previous studies suggest that antibacterial products are no more effective at removing s kin pathogen compared to plain soap. It is essential to collect the data regarding the effectiveness of antibacterial products with the purpose of continuous surveillance in the detection of emerging resistance pattern. Method: In vitro antimicrobial activity of six products were established on four species of bacteria namely Staphylococcus aureus, Streptococcus pyogenes, Escherichia coli, and Pseudomonas aeruginosa that represent the bacterial pathogen commonly found on human skin and the surrounding environment. These pathogens are also implicated as the causative organisms for skin infections. Results: Product that contains triclosan has the highest bactericidal effect as it is effective against a broad spectrum of bacteria. Body washes without any antibacterial agent also exhibit bactericidal activity but at higher concentrations. Gram-positive bacteria showed more sensitivity compared to gram-negative bacteria. Conclusion: Antibacterial and non-antibacterial products have bactericidal effects at different concentration. Different active ingredients showed different antibacterial effects on tested bacteria. Extend usage of antibacterial products pose adverse effects on skin normal flora and can lead to antimicrobial resistance.

Tuberculosis (TB) has become a worldwide public concern with 10.4 million new cases reported in 2015 and 1.4 million deaths. More importantly, an increase in trend in TB incidence among healthcare workers has become a major concern. Therefore, the present study was conducted to explore the knowledge and practice towards TB and the factors associated with it among nurses in a teaching hospital. The present study used cross-sectional design and stratified sampling method. A total of 275 nurses in a teaching hospital participated in this study. The knowledge and practice on management of TB was measured using a structured questionnaire. Majority of the respondents had good knowledge and practice on management of TB represented by 70.2% and 63.3%, respectively. However, knowledge gap (1.8%) and practice gap (0.4%) were identified in method of sputum collection. Work place setting was the only demographic factor found significantly associated with level of knowledge and practice (p=0.028). Level of knowledge and practice on management of TB identified among nurses was not associated with many socio-demographic factors. Nurses as frontline healthcare workers are at high risk of being exposed due to frequent contact with various patients especially those who are undiagnosed and TB suspect patients. Hence, implementation of TB Infection Control (TBIC) measures is important to minimize the risk of infection and cross-infection within hospital.