Purpose: Adjuvant radiotherapy (RT), while effective in reducing cancer recurrence and improving survival rates, often comes with radiation toxicity that can adversely affect the patient’s quality of life (QoL). Evaluating toxicity after RT is crucial because it helps to identify and manage adverse effects that can significantly impact a patient’s QoL. By monitoring toxicity, we can adjust treatment plans to mitigate these effects, improve patient comfort, and ensure a better overall outcome. Therefore this study aimed to evaluate and compare QoL following 3D-conformal hypofractionated RT in breast cancer patients. Methods: We included twenty-one Malaysian women with unilateral breast cancer treated with lumpectomy (n=15) or mastectomy (n=6) followed by 3D-conformal hypofractionated RT. QoL was evaluated using the EORTC QLQ-BR45 questionnaire before, during, and after RT. Results: During RT, there was a significant increase in the mean score of the breast symptoms scale compared to baseline (p=0.002), with the most common symptoms being skin problems, followed by swelling and oversensitivity. However, these symptoms were generally mild for most patients. The other quality of life scales remained stable during RT. Post-RT, most QoL scales showed improvements compared to both baseline and during RT, with significant enhancements in the mean breast symptoms score and breast satisfaction score (all p<0.05). Conclusion: Radiotherapy negatively impacted the QoL of our breast cancer patients, specifically on the breast symptoms scale. However, these symptoms improved after 4 months, resulting in high breast satisfaction and indicating a near-excellent cosmetic outcome. Future studies with larger cohorts are essential to validate these findings, as the small sample size (n=21 at baseline; n=13 post-RT) may have limited the detection of more subtle changes

Objective: This study aims to describe histological manifestations and characterise the CDV strain in the tiger to determine its molecular epidemiology and postulate viral pathogenicity. Methods: Histopathology characterisation of the infected tissues were performed through haematoxylin and eosin and immunohistochemistry staining, respectively. We conducted virus isolation and titration in Chinese hamster ovarian expressing the dog signalling lymphocytic activation molecule (CHO-SLAM) cells. Reverse transcription polymerase chain reaction was performed to confirm the presence of CDV RNA, nucleotide and amino acid sequence analyses for comprehensive characterisation of the CDV strain. Results: Notable histopathological changes were observed primarily in the brain, lung, liver, kidney, spleen, and stomach, with viral antigens localised in the lung, liver, kidney, and stomach tissues. CDV-induced cell cytopathic effects yielding 4.27 × 10 6 TCID 50 /mL were observed at 48 h post-inoculation in CHO-SLAM cells. Phylogenetic analysis suggested that the virus originated from the Asia-1 clade. Notably, 549H and 519I mutations in the hemagglutinin protein were observed, indicating adaptation to a non-canid wildlife species. Conclusions and Relevance: Overall, this study enhances our understanding of the molecular characterisation and evolutionary dynamics of the CDV strain present in the Malayan tiger and serves as a benchmark for developing effective preventative measures to protect Malayan tigers and mitigate their risk of extinction.

Environmental and Health Impacts of Pesticide-Based Malaria Control in Low- and Middle-Income Countries: A Scoping Review Introduction Malaria remains a major public health challenge in tropical and subtropical regions, necessitating effective vector control strategies. This scoping review aims to evaluate the environmental and health impacts of pesticide-based malaria control in low-and middle-income countries (LMICs). Methods A comprehensive search was conducted across Scopus, Web of Science and PubMed for studies published between 2004 and 2024, using a predefined search string based on the PEO framework. Inclusion criteria focused on studies addressing malaria control programmes and their effects on the environment and human health. Data extraction followed PRISMA 2020 guidelines. Results 12 studies were included, most of which focused on indoor residual spraying (IRS) and insecticide-treated nets (ITNs). The review identified significant direct and indirect impacts. While effective in reducing malaria transmission, IRS and ITNs pose substantial risks. Direct health effects included acute poisoning and long-term neurodevelopmental issues linked to pesticide exposure, with residues detected in breast milk. Environmental impacts included soil and water contamination, biodiversity loss and ecological disruption. The overlap of pesticide use in malaria control and agriculture was found to exacerbate insecticide resistance in mosquito populations. Conclusions Pesticide-based malaria control, while crucial, carries significant unintended consequences for human health and the environment. The findings underscore the urgent need for Integrated Vector Management (IVM) strategies that reduce reliance on chemical pesticides, mitigate resistance, and ensure environmental sustainability and public health safety.

Introduction: Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant syndrome caused by mutations in the tumor suppressor gene MENIN, classically characterized by endocrine tumors of the parathyroid glands, pancreas, and pituitary. Beyond tumorigenesis, emerging evidence suggests a role for MENIN in immune regulation, with deficiency linked to CD4⁺ and CD8⁺ lymphocyte dysfunction and predisposition to autoimmunity. While autoimmune conditions such as thyroiditis and pernicious anemia have been described in MEN1, an association with autoimmune hemolytic anemia (AIHA) has not been previously reported. We describe a rare case of MEN1 associated with warm AIHA, highlighting a potential link between endocrine tumorigenesis and immune dysregulation. Case: A 56-year-old female presented with a 4-month history of lethargy, anorexia, weight loss, and painless jaundice. She is para 6 + 1, with no history of anemia in pregnancy, prior blood transfusions, or family history of hematological disorders. Examination revealed mild pallor, jaundice, and hepatomegaly without splenomegaly. She had a prior diagnosis of MEN1, with two hallmark features: primary hyperparathyroidism and a pancreatic neuroendocrine tumor. She underwent pancreatic enucleation, hemithyroidectomy, and hemiparathyroidectomy; histopathology demonstrated a benign thyroid nodule and parathyroid hyperplasia. Whole exome sequencing identified no pathogenic MEN1 mutation but revealed a c.1621A>G variant, classified as a non-deleterious polymorphism. Variants in TP53 and BRCA1 were also detected without phenotypic expression. Surveillance colonoscopy and mammography were unremarkable. Laboratory findings were consistent with warm AIHA, including elevated lactate dehydrogenase, indirect hyperbilirubinemia, low haptoglobin, reticulocytosis, and a positive direct Coombs test (immunoglobulin G). Peripheral blood film was nonspecific. She responded well to a tapering course of prednisolone. Conclusion This case highlights a possible association between MEN1 and autoimmune hemolysis. The presence of the MEN1 c.1621A>G variant, alongside TP53 and BRCA1 variants, raises the possibility of modifier effects influencing immune dysregulation. Further studies are needed to clarify this relationship.

Dengue remains a public health threat that consumes a significant number of resources for its prevention and control. This systematic review aimed to solidify recent costing evidence in dengue management among South East Asian (SEA) countries. All studies conducted between 2010 and 2020 were retrieved using four international databases i.e. PubMed, Scopus, Web of Science, and Emerald Insight. The review was reported according to PRISMA guidelines. Quality assessments were done independently by two reviewers using a checklist adapted for the cost of illness studies. We identified 13 original articles representing several SEA countries. Among the common reported costing measure include total cost/ health expenditure; direct medical cost; direct non-medical cost; and indirect cost. The estimated total cost for dengue management varied between countries largely due to the difference in the total incidence of dengue cases. The estimated cost spent on dengue per capita GDP ranges from less than 0.001% to 0.1%, depending on the recorded number of dengue cases of the year. The majority of the articles focused on the economic burden from the perspective of treatment such as hospitalization and ambulatory care. In a nutshell, the economic burden of managing dengue infection is costly and the evidence suggests a steady increase in health expenditure with the growing number of dengue cases

Giant Condyloma Acuminata or Buchke Lowenstein tumors: A Rare Manifestation of Human Papillomavirus (HPV) Infection Giant condylomata acuminata (GCA) or Buchke Lowenstein tumors are rare manifestation of Human Papillomavirus (HPV) infection. They are usually considered the intermediate state between benign condyloma and malignant squamous cell carcinoma. Usually these manifestations are related to HPV 6 & 11 infections and if left untreated can grow larger and is locally aggressive. The most important treatment method is surgical excision which differs from benign condyloma acuminatum cases due to its high degree of malignancy. This report presented a case of immunodeficient patient post renal transplant, with a presentation of large penile wart with histopathological findings of condyloma acuminata.

Background and Objectives: Malnutrition is a serious public health problem in developing countries, including Indonesia. Based on RISKESDAS 2018, the prevalence of stunting aged 13-15 years in Takalar Regency is 24.83%. This study aimed to assess the prevalence of stunting and the determinants of stunting in adolescent girls aged 13-15 years in the South Galesong District, Takalar Regency. Methods: This is a cross-sectional study using purposive sampling method that included 247 adolescent girls in selected junior high schools. Data collection used questionnaires and anthropometric measurements. An anthropometric measurement was converted to the indices of nutritional status using World Health Organization Anthro Plus software. Results: The prevalence of stunting was 25.1%. Bivariate analysis showed determinant factors related significantly to stunting were energy intake (p<0.001), protein intake (p<0.001), iron intake (p<0.005), and zinc intake (p<0.001). Multivariate analysis showed determinant factors related significantly to stunting were zinc intake (p<0.001, OR=7.993), protein intake (p<0.05, OR=2.248), and knowledge level (p<0.05, OR=2.032). Conclusion The occurrence of stunting is related to the quality and quantity of food and the level of adolescent knowledge about balanced nutrition. It is necessary to hold educational programs and interventions on improving nutrition initiated by stakeholders and the department of health, in this case, the health center is needed to reduce stunting rates, especially among adolescents.
Malnutrition ; Growth Disorders ; Adolescent

Effective and safe contraception is crucial for women living with Human Immunodeficiency Virus (HIV) to prevent unintended pregnancy, mother-to-child transmission, disease progression and psychological impact. Anti-retroviral treatments (ART) are known to have many drug-drug interactions, causing a dilemma among physicians in choosing the most suitable contraception for women living with HIV (WLHIV). One of the suitable choices is the long-acting reversible contraceptive (LARC), such as contraceptive implants, but this method is not without issues. This case illustrates an Implanon failure that led to an unintended pregnancy in an HIV-positive woman on anti-retroviral treatment and suffered from depression. Contraceptive implant failure has been reported in co-administration with Efavirenz-based anti-retroviral therapy, with studies demonstrating a decline in serum concentrations of etonogestrel and levonorgestrel.

Dealing with the Unexpected: Stercoral Perforation – A Surgical Conundrum Stercoral colon perforation is a rare surgical emergency primarily linked to chronic constipation and advanced age. Diagnosis is challenging and requires established criteria and imaging. Urgent surgery is the modality of choice, typically involving Hartmann's procedure. Mortality rates can be as high as 60%, emphasising the need for early diagnosis and intervention. We presented a case of a 71-year-old bedridden female with a history of stroke, diabetes, and hypertension presenting with abdominal pain, fever and diarrhoea. Initial evaluation indicated dehydration, sepsis, and abdominal tenderness. An urgent imaging revealed a suspected rectal perforation, prompting emergency surgery. Intraoperatively, stercoral perforation due to impacted hard faeces was identified. Despite prompt and intensive treatment, the patient's condition deteriorated, ultimately resulting in her demise. Stercoral colon perforation is a critical condition requiring rapid diagnosis. Symptoms include abdominal distension, tenderness, cramps, fever, and anorectal pain. Healthcare providers should consider the possibility of stercoral perforation in individuals exhibiting these symptoms alongside a background of persistent constipation. Treatment involves peritoneal lavage and surgery. Early recognition is vital for proper management and improved outcomes.

Alzheimer’s disease (AD) is classified as one of neurodegenerative disease caused by neuronal death. It is characterized as memory impairment, including the inability to produce new memories. Since AD has low treatment effectiveness, proteomics research opens possibilities for advancement. Proteomics is the study of proteomes produced by the disease-bearing host to identify and understand diseases. In this case, to investigate the use of protein as a reliable molecular entity and their involvement in AD. Therefore, this review focused on three main applications of proteomics; the potential use of proteomics as a diagnostic tool for AD, the use of proteomics to assess the treatment progression of AD and the advancement in AD research. The review discussed three research areas utilizing the proteomics approach: ageing, behavioural, and demographic research of AD populations. Proteomic approaches have also been shown to be effective to discover the biomarkers for infectious diseases, cancers, heart diseases, and neurological disorders. Although much work remained to be done, the proteomics approach is an interesting method to be carried out in detecting AD at an earlier stage and will be very useful for AD treatment and management in the future.