INTRODUCTION: In the clinical setting, erectile dysfunction (ED) is a significant issue that should not be neglected, as it can adversely impact the quality of life of patients and their partners, especially among overweight and obese populations. This study aims to determine the prevalence of ED and its associated factors among non-diabetic, overweight, and obese patients who attend a government health clinic in Kuantan, Pahang, Malaysia. MATERIALS AND METHODS: A six-month cross-sectional study was conducted from February 2024 to August 2024 at twelve health clinics in Kuantan, Pahang. The selected respondents were married men over 18 years old, and those with diabetes mellitus, cardiovascular disease, psychiatric illness, or illiteracy were excluded. Data were collected using the validated Malay version of the International Index of Erectile Function (IIEF-5). ED was defined as an IIEF-5 score of less than 22. Descriptive analysis and simple and multiple logistic regression were performed using SPSS. RESULTS: All 221 eligible patients in the study responded (100% response rate). The prevalence of ED was 66.1% (n=146). Multiple logistic regression showed that ED was significantly associated with dyslipidemia [AOR (95% CI): 2.42 (1.06–5.52); p-value=0.036], anxiety [AOR (95% CI): 3.99 (1.44–11.01); p-value=0.008] and older age [AOR (95% CI): 1.07 (1.02–1.12); p-value=0.009]. CONCLUSION: The study revealed a high prevalence of ED among non-diabetic overweight and obese patients, potentially linked to increasing age, dyslipidemia, and anxiety. Increasing awareness among the public and healthcare providers could improve detection rates in primary care.

The use of Arabic in medical education and healthcare communication remains limited despite growing linguistic needs in Arabic-speaking populations. Issues related to translation accuracy, cultural sensitivity, and curriculum alignment hinder its integration. The objective of this study is to systematically review how Arabic medical terminology has been translated, validated, and applied in educational and clinical contexts. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Searches were conducted in May 2025 across three databases: Scopus, Web of Science (WoS), and the Education Resources Information Center (ERIC). A total of 769 records were retrieved, and 19 peer-reviewed articles were selected based on inclusion criteria. A six-point quality appraisal framework was applied to ensure methodological rigour prior to thematic synthesis. Three major themes emerged: (1) translation and cultural adaptation, highlighting the importance of expert validation and semantic accuracy; (2) psychometric evaluation, where tools such as the Postgraduate Hospital Educational Environment Measure (PHEEM) demonstrated strong internal consistency and contextual clarity; and (3) educational application, showing varied success in enhancing communication, comprehension, and learner confidence. Gaps in terminology standardisation and the limitations of automated translation tools were noted across studies. In conclusion Arabic medical terminology, when supported by structured processes and expert review, makes a meaningful contribution to education and communication. Further efforts should prioritise the development of validated terminology repositories, multidisciplinary collaboration, and the integration of Arabic-language resources into medical curricula to support inclusive and patient-centred care.

Purpose: This study evaluated the performance of the YOLOv8m-seg model in detecting and delineating interproximal caries and cervical burnout on bitewing radiographs and examined whether increasing the number of training epochs improved segmentation accuracy and consistency. Materials and Methods: In total, 1,410 bitewing radiographs were annotated using polygon-based masks by a trained dental clinician. The YOLOv8m-seg model was trained for 50, 100, and 150 epochs on 1,128 images and validated on 282 images using the Ultralytics segmentation framework. Model performance was assessed using precision, recall, and mean average precision at intersection-over-union thresholds of 0.5 and 0.5 to 0.95 (mAP0.5, mAP0.5-0.95) for both bounding box and mask outputs. Additional evaluation was conducted on a non-augmented validation subset. Results: Extended training duration was associated with improved segmentation performance. The highest mask mAP0.5-0.95 value was 0.828 at epoch 150. Both box-based precision and recall increased with longer training, whereas mask-based evaluation more accurately reflected the model’s ability to delineate the boundaries of caries and cervical burnout. Performance appeared consistent across both classes in the augmented validation split but was reduced in the non-augmented validation subset. Conclusion The YOLOv8m-seg model demonstrated high diagnostic accuracy in distinguishing proximal caries from cervical burnout on bitewing radiographs. Its mask-based outputs may assist clinicians in early lesion recognition and support improved diagnostic decision-making. Future studies should evaluate model generalizability across broader populations and diverse clinical environments and should prioritize assessment using non-augmented validation sets and independent test datasets.

A Literature Review on Risk Factors of Musculoskeletal Symptoms among Woodworker in Woodworking Station Introduction The wood industry is inherently hazardous, with workers frequently exposed to perils such as injuries, noise, and ergonomic strain. Therefore, ensuring workers' safety and health in such environments is critical. The objective of this review paper is to investigate the main factors affecting symptoms of MSDs among woodworkers in their workstations. Methods A literature search was conducted using work-related terms, such as musculoskeletal disorders (WMSDs), woodworkers, and carpenters. All studies on risk factors associated with WMSDs, published between 2014 and 2024, were included. Accordingly, databases searched were Google Scholar, Science Direct and PUBMED. Results 501 articles that assessed postural problems in woodworking activities were found, and only 12 articles regarding WMSDs among woodworkers were selected for further analysis. India had the highest number of articles among countries, followed by Pakistan. According to the results, 19% of lower back and shoulder pain cases were associated with MSDs symptoms. Conclusions Woodworkers face an increased risk of MSDs, particularly in the lower back, shoulders and neck, due to poor workstation setup, awkward postures, manual handling, exposure to vibration, and other physical factors in the workplace. The findings of this review inform the design of evidence-based ergonomic interventions, such as modifications to workstations, redesigned ergonomics tools, or unsafe work practices identified among woodworkers in workstations.

Introduction: Primary aldosteronism (PA) is a common yet underdiagnosed cause of secondary hypertension, associated with increased cardiovascular and renal morbidity. Early detection and subtype-directed management significantly improve outcomes. However, adherence to recommended diagnostic pathways in real-world practice remains variable. Case: We conducted a retrospective audit of patients diagnosed with PA in a Malaysian tertiary centre from January 2018 to December 2025. Data collected included demographics, clinical presentation, biochemical parameters, diagnostic workup (aldosterone-renin ratio [ARR], confirmatory testing, adrenal imaging, and adrenal venous sampling [AVS]), treatment modality, and outcomes. Audit standards were based on established international guidelines. A total of 14 patients were included, with equal gender distribution. The cohort comprised 57% Malay and 43% Chinese. Most patients presented with hypertension (mean ~170/100 mmHg), and hypokalemia was present in approximately 70% of the patients. ARR and adrenal imaging were performed in all patients (100%), while confirmatory testing was conducted in 85% of the patients. However, AVS utilization remained limited (50%). Contributing factors included failed cannulation, technical challenges in overweight patients, preference for medical therapy, refusal of surgery, and limited access to AVS services. The majority had unilateral adrenal adenoma (~75%). Treatment was divided between surgical (55%) and medical (45%) approaches. Post-treatment, hypokalemia resolved in 90% of patients, with a significant reduction in antihypertensive burden and complete hypertension resolution in approximately 35% of the patients. Quality of life improved in most patients. Conclusion This audit demonstrates good adherence to initial screening and imaging in PA but highlights suboptimal utilization of AVS. Barriers to AVS utilization are multifactorial, encompassing technical, patient-related, and system level limitations. Addressing these barriers is essential to optimize subtype-directed management and improve longterm cardiovascular outcomes in patients with PA. Despite this, clinical outcomes were favorable. Strengthening adherence to diagnostic pathways, particularly subtype confirmation, may further improve patient outcomes.
Hyperaldosteronism ; Treatment Outcome ; Retrospective Studies

Introduction: Tuberculosis patients with comorbid diabetes face a substantially higher risk of mortal outcomes. The “metainflammation” loop between hyperglycemia and tuberculosis (TB) infection exacerbates systemic severity and increases hazard rates for death. This study aims to quantify the association between baseline hemoglobin A1c (HbA1c) levels and all-cause mortality within a Malaysian cohort. Methodology: This was a retrospective cross-sectional audit analyzing 131 adult TB-DM (diabetes mellitus) patients during their treatment course (2022–2025) in the TB Clinic, Hospital Sungai Buloh. Primary outcomes were all-cause mortality and clinical severity, stratified by baseline HbA1c and diabetes mellitus DM treatment modality (OHA vs. insulin). Results: The overall mortality rate was 17% (22/131). A stark disparity in glycemic control was observed between survivors and deceased patients: those who died presented with extreme mean HbA1c levels of 16.0%, compared to 10.5% in survivors. High HbA1c was also associated with a higher prevalence of pulmonary involvement compared to extrapulmonary disease (10.9% vs 8.9%). Patients requiring insulin therapy experienced significantly higher mortality rates compared to those managed on OHAs, with 25% (12 out of 47) patients requiring insulin therapy having died during TB treatment, compared to only 8.2% (7 out of 84) patients in the OHA-only group. Conclusion Baseline HbA1c is a critical prognostic marker that identifies a high-risk “lethal threshold” at extreme glycemic levels (HbA1c ≥16). Furthermore, the nearly fourfold increase in death risk among insulin-treated patients likely reflects a high-risk phenotype of advanced metabolic failure, which corresponds with a study done in Kelantan (Siti Rohana et al., 2020). The study shows that TB patients with DM had three times higher risk of developing unsuccessful TB treatment outcomes compared to TB patients without DM. Collectively, these data necessitate mandatory early HbA1c screening and aggressive metabolic management to reduce the staggering mortality of this dual epidemic.
Retrospective Studies

Introduction: Skeletal disease in transfusion-dependent thalassemia is commonly attributed to reduced bone mineral density and managed with anti-resorptive therapy. However, chronic iron overload can induce progressive endocrine siderosis, disrupting anabolic pathways essential for bone homeostasis. This mechanism remains under-recognized and may underlie treatment failure in severe cases. Case: We describe a 34-year-old female with transfusiondependent HbE β-thalassemia, post-splenectomy, receiving regular transfusions and iron chelation, who sustained multiple pathological fractures following a trivial fall, including bilateral supracondylar femur fractures and a distal radius fracture. She had severe systemic iron overload (ferritin 2,621 ng/mL) complicated by hepatic cirrhosis, insulin-dependent diabetes, and hypogonadotropic hypogonadism. Bone mineral density assessment demonstrated severe osteoporosis (hip T-score −5.4) despite prolonged bisphosphonate therapy, with prior vertebral compression fracture. Endocrine evaluation revealed multiaxis dysfunction, including gonadal failure and probable growth hormone deficiency, consistent with pituitary and peripheral endocrine siderosis. Conclusion This case demonstrates that skeletal fragility in transfusiondependent thalassemia reflects an endocrine-driven failure of bone formation rather than isolated loss of bone mineral density. Iron overload–induced endocrine siderosis impairs osteoblast function and suppresses anabolic signaling, leading to profound skeletal vulnerability. The progression of osteoporosis despite anti-resorptive therapy highlights the limitation of conventional approaches and supports reframing thalassemia-associated bone disease as an endocrine disorder. Severe osteoporosis should prompt systematic endocrine evaluation, with early hormonal replacement and consideration of anabolic therapy to prevent catastrophic fractures and long-term disability.
Siderosis ; Thalassemia

Introduction: Autoimmune thyroid disease is frequently associated with other immune-mediated disorders; however, clinically significant pancytopenia is rare. In patients with Graves’ disease receiving antithyroid therapy, leukopenia raises concern for drug-induced agranulocytosis, a rare but potentially life-threatening complication characterized by severe neutropenia requiring immediate drug withdrawal. The coexistence of hemolytic anemia and thrombocytopenia may instead suggest Evans syndrome, defined by autoimmune hemolytic anemia with immune thrombocytopenia, with or without neutropenia. Importantly, uncontrolled thyrotoxicosis itself may cause immunemediated cytopenias, creating a diagnostic challenge. Case: We report a 55-year-old female with thyroid receptor antibody-positive Graves’ disease who presented with jaundice and pancytopenia while receiving carbimazole therapy. Laboratory evaluation demonstrated anemia with reticulocytosis and a positive direct antiglobulin test, thrombocytopenia and leukopenia. Complement testing revealed reduced C3 with normal C4, consistent with immune-mediated hemolysis. Peripheral blood film showed no blast cells or marrow infiltration, and autoimmune screening, including antinuclear antibodies and anti–double stranded DNA, was negative. The coexistence of Coombs-positive hemolysis and thrombocytopenia initially raised suspicion for Evans syndrome, while leukopenia during carbimazole therapy prompted concern for drug-induced agranulocytosis. However, neutropenia was not severe, and the absence of marrow infiltration or systemic autoimmune disease made alternative causes of pancytopenia less likely. Importantly, blood counts progressively improved following the optimization of thyroid control despite continuation of carbimazole at a reduced dose, without the use of immunosuppressive therapy. This clinical course supported the interpretation of thyrotoxicosis-associated immune cytopenia rather than primary Evans syndrome or carbimazole-induced agranulocytosis. Conclusion This case highlights thyrotoxicosis-associated immune cytopenia as an important mimic of Evans syndrome and carbimazole-related hematological toxicity. Recognizing this entity is essential to avoid unnecessary discontinuation of antithyroid therapy or inappropriate immunosuppressive treatment.
Evans Syndrome ; Carbimazole ; Pancytopenia ; Agranulocytosis ; Graves Disease

Introduction: Thyroid stimulating hormone (TSH) suppression following differentiated thyroid carcinoma is widely recommended to reduce recurrence risk. However, this strategy assumes cardiovascular tolerance to supraphysiologic thyroid hormone exposure. In patients with advanced structural heart disease, this assumption may fail, exposing a critical limitation of guideline-directed TSH suppression. Case: We report a 71-year-old male with end-stage renal failure on hemodialysis and severe ischemic cardiomyopathy (ejection fraction 23%) who presented with acute decompensation characterized by dyspnea, rapid atrial fibrillation, and non–ST-elevation myocardial infarction. He had a history of papillary thyroid carcinoma treated with total thyroidectomy and radioactive iodine over 20 years prior and was maintained on levothyroxine 200 mcg daily for TSH suppression. Despite biochemically euthyroid indices (TSH 1.8 mIU/L, free thyroxine 4 17 pmol/L), he developed recurrent arrhythmia with heart failure decompensation. This case highlights a dissociation between biochemical euthyroidism and tissue-level thyrotoxicity in a structurally compromised myocardium. Papillary thyroid carcinoma after definitive therapy typically follows an indolent course with low short-term mortality. In contrast, in severe left ventricular dysfunction, excess thyroid hormone increases adrenergic sensitivity and myocardial oxygen demand, precipitating arrhythmia and ischemia. This risk is amplified in end-stage renal disease, where altered hormone handling renders biochemical indices less reliable. Conclusion Biochemical euthyroidism does not equate to physiological safety. In patients with advanced cardiovascular disease, thyroid hormone therapy should be titrated to cardiovascular tolerance rather than oncologic targets alone, and routine TSH suppression may be inappropriate.
Thyroxine ; Heart Failure ; Thyrotropin

Introduction: Thyrotoxicosis following neck surgery is typically attributed to transient destructive thyroiditis from follicular disruption. In end-stage renal failure (ESRF), however, altered thyroid hormone kinetics, including reduced protein binding, impaired peripheral metabolism, and decreased clearance, can distort biochemical interpretation. This creates a high-risk scenario where laboratory values overestimate tissue thyrotoxicity, predisposing to inappropriate antithyroid therapy. We present a case demonstrating marked clinical–biochemical dissociation, reframing postoperative thyrotoxicosis in ESRF as a disorder of hormone handling rather than hormone overproduction. Case: A 45-year-old female with ESRF on maintenance hemodialysis and tertiary hyperparathyroidism underwent total parathyroidectomy. Preoperative thyroid function was consistently euthyroid. Within 48 hours postoperatively, she developed severe biochemical thyrotoxicosis (thyroidstimulating hormone 0.28 mIU/L, free thyroxine 4 [FT4] 68 pmol/L). Despite this, she remained clinically euthyroid, with stable hemodynamics, absence of adrenergic or neuropsychiatric features, and no evidence of thyroid eye disease. The temporal relationship strongly suggested destructive thyroiditis secondary to surgical manipulation, with passive release of preformed thyroid hormone. In the context of ESRF, impaired hormone clearance and altered binding likely amplified circulating free hormone levels without proportional end-organ effect, resulting in striking clinical–biochemical dissociation. A conservative strategy was adopted. Antithyroid drugs were withheld, given the non-synthetic mechanism of hormone excess, and the patient was managed with close monitoring and symptom-guided beta-blockade. Serial thyroid function demonstrated spontaneous improvement without complications. Conclusion Post-parathyroidectomy thyrotoxicosis in ESRF represents exaggerated biochemical derangement without true tissue toxicity. Management must prioritize physiology over laboratory values, as misclassification risks iatrogenic harm. This case demonstrates that in ESRF, elevated FT4 may not reflect true tissue thyrotoxicity, and reliance on biochemical severity alone can lead to inappropriate antithyroid therapy and iatrogenic harm.
Parathyroidectomy ; Hyperthyroidism ; Thyrotoxicosis