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

Ascaridia galli infection compromises the health and productivity of chickens. this study aimed to determine the prevalence, pathology, and control of A. galli in backyard chickens. Four hundred and fifty-six faecal samples were tested using direct smear and concentration techniques. sixty chickens were grouped based on egg per gram into untreated control, mebendazole-treated, and derivative-treated. Key epidemiologic host based and environmental variables were recorded and analysed statistically (p < 0.05 significance level). Histopathological changes in the intestine were also assessed. Overall prevalence of A. galli was 72% (330/456). Infection was high in females (74%, 200/267) than in males (68%, 130/189). Adult chickens had a higher infection rate than young (64% vs 55%; p < 0.05). Weak chickens showed a markedly higher prevalence (96%, 150/156) than healthy chickens (60%, 180/300) (p < 0.05). Geographically, prevalence was highest in Swat (85.53%), followed by Lower Dir (72.3%) and Malakand (59.21%), with statistically significant differences (p < 0.05). Management system influenced infection: free range chickens had (63%) compared to semi-free range (37%), scavenging chickens were more infected (75%) compared to receiving supplemental feed (53%) (p < 0.05). The non-dewormed chickens had a significantly higher prevalence (92%) than the dewormed group (20%) (p < 0.05). Seasonal infection peaked during the rainy season (86%) compared to the dry season (44%) (p < 0.05). Intestinal histology revealed inflammation, epithelial necrosis, villous atrophy, and crypt hyperplasia. Treatment of the chickens nematodes using mebendazole resulted in 70% (14/20) of the treated eggs being egg-negative, and the comparison of treatment of the egg-negative derivative compound resulted in 80% (16/20) of the treated eggs being egg-negative. The A. galli infection are very common, and cause intestine damage. The mebendazole and its derivative decrease egg shedding significantly, Husbandry, management and treatment should be enhanced for effective control strategies.

Objective To investigate the correlation between serum Visfatin, CXC chemokine 12 (CXCL12) and silent information regulator 1 (Sirt1) levels and carotid atherosclerosis (CAS) in patients with type 2 diabetes mellitus (type 2 diabetes mellitus ,T2DM). Methods Four hundred and ninety-five patients with T2DM in the hospital from July 2021 to June 2023 were selected as the observation group, and 50 healthy volunteers were included in the control group. The levels of serum Visfatin, CXCL12 and Sirt1 were detected, and the above levels were compared between groups. The patients in the observation group were divided into simple T2DM group and T2DM with CAS group by means of the results of carotid ultrasound examination, and the clinical data were compared. Multivariate Logistic regression analysis was performed to analyze the factors affecting the occurrence of CAS in T2DM patients. Spearman correlation analysis of serum Visfatin, CXCL12 and Sirt1 levels and severity of CAS was analyzed by Spearman correlation analysis. Results Compared with the control group, the levels of serum Visfatin and CXCL12 in the observation group were higher (t=14.524, t=11.536, all P<0.05) while the level of Sirt1 was lower (t=21.912, P<0.05). There were statistical differences in age, body mass index (BMI), FBG, HbAlc, FINS, TG, LDL-C, Visfatin, CXCL12 and Sirt1 between T2DM with CAS group and simple T2DM group (P<0.05). Multivariate analysis suggested that age (OR=2.155), FBG (OR=2.563), HbAlc (OR=2.472), FINS (OR=0.438), TG (OR=2.492), LDL-C (OR=2.445), Visfatin (OR=2.404), CXCL12 (OR=2.214) and Sirt1 (OR=0.398) were the influencing factors of CAS in patients with T2DM (P<0.05). The levels of serum Visfatin and CXCL12 were positively correlated with the severity of CAS (r=0.574, r=0.530, P<0.05), and the level of Sirt1 was negatively correlated with the severity of CAS (r=-0.621, P<0.05). Conclusion Serum Visfatin, CXCL12 and Sirt1 in T2DM patients are related to the occurrence and severity of CAS. Visfatin, CXCL12 and Sirt1 may be involved in the occurrence and development of CAS in T2DM patients.

Serratia marcescens is an opportunistic gram-negative pathogen that causes pneumonia, bloodstream infections, and urinary tract infections, particularly in individuals who are immunocompromised. Although commonly associated with pulmonary infections, its involvement in pneumothorax-related infections is exceedingly rare. Secondary spontaneous pneumothorax (SSP) is a life-threatening condition that can complicate underlying lung diseases, such as chronic obstructive pulmonary disease (COPD). This case report describes a rare presentation of S. marcescens infection in a patient with SSP complicated by a bronchopleural fistula. A 64-year-old male with a history of COPD, chronic smoking, and alcohol use presented with progressive dyspnea, cough, and left-sided chest pain. Clinical evaluation revealed tachypnea, tracheal deviation, and reduced breath sounds in the left lung. Laboratory investigations revealed leukocytosis with marked neutrophilia and an elevated erythrocyte sedimentation rate. Chest imaging confirmed pneumothorax, necessitating intercostal drain (ICD) placement. Pleural fluid cultures identified multidrug-resistant S. marcescens, prompting antibiotic escalation to intravenous meropenem and oral faropenem. Despite prolonged antimicrobial therapy and ICD placement, persistent pneumothorax with a bronchopleural fistula was noted. Bronchoscopy with Fogarty balloon placement and cyanoacrylate closure was performed. However, owing to financial constraints, the patient declined follow-up cultures and high-resolution computed tomography imaging, and was discharged with an ICD in situ. This case underscores the need for heightened clinical awareness of S. marcescens in pneumothorax-associated infections. Early microbiological identification and targeted therapy are crucial for the management of rare yet challenging presentations, particularly in resource-limited settings.

Bungsu et al Brunei International Medical Journal 2025;21:82-87 Brunei International Medical Journal Brunei Colorectal Cancer Awareness and Risk Education for Screening (Bru-CARES) Community Project N BUNGSU1, AS HAJI MD ALI1, A HAJI GHAZALI1, S KONG1, MK ABU BAKAR1, NA GULZAR AHMAD1, S SUHAILI1, SK ONG1,2, P HASHMET1,3, VH CHONG1,2, K KOK1, E ERDAL1, H GHANI1*

The increasing number of homeless children is concerning. This study aimed to assess the dietary intake, diet quality, and nutritional status of homeless children in Klang Valley, as well as the relationship between diet quality and nutritional status. Methods: Approximately 120 homeless children aged 7 to 12 years from four locations in Klang Valley were enrolled. Their dietary intake and nutritional status were assessed using a two-day 24-hour dietary recall and body mass index-for-age, respectively. The Healthy Eating Index (HEI) was used to examine diet quality. Results: Prevalence of normal weight respondents was 58.3% (mean±SD: -0.79±1.80), with 25.0% classified as moderately and severely thin. Mean energy intake was significantly lower than recommended nutrient intakes (RNI) (p<0.050), while protein intake was higher (p<0.050). Calcium and zinc intakes were also significantly lower (p<0.001). Boys aged 7-9 years had significantly higher iron intake (median=11.6, IQR=8.7 mg, p=0.003), whereas girls aged 10-12 years had significantly lower intakes of iron (mean±SD=11.4±5.1, 11.1±4.7) and vitamin A (median=416.6, IQR=450.4 µgRE, p<0.001 for both). Mean HEI score was 51.30±6.78, indicating a need for diet quality improvement. No significant association between diet quality and nutritional status was observed (p=0.380). Conclusion: This study provided insights into dietary intake, diet quality, and nutritional status of homeless children. Further research is vital to shape evidence-based nutrition interventions.

THE EFFECT OF MARITAL STATUS AND CHILDREN ON PHYSICIAN’S ATTITUDE TOWARDS PSYCHOTROPIC MEDICATIONS Background: Psychiatric illnesses are a public health problem worldwide. An increasing number of Saudi citizens and residents utilize healthcare services for mental health concerns; hence, there is a need to assess these Physician’s attitudes towards psychotropic medications objectively. Aim: To examine of the effect of marital status on attitudes towards psychotropic medications among a sample of physicians in Saudi Arabia. Methods: A cross-sectional study was conducted over a period of three months. The study has been conducted on convenient Sample of physicians working in Saudi Arabia who accepted to share in research. Demographic data was gathered using an electronic self-administered questionnaire and Physician’s attitudes towards psychotropic medications have been evaluated by a previously validated questionnaire. Results: This study included 136 physicians, 67 (49.3%) physicians are married, with 48 (71.6%) of them having children and 19 (28.4%) not having children. Meanwhile, 69 (50.7%) are single, with 3 (4.3%) having children and 66 (95.7%) not having children. Physicians exhibit 83.3%-84.95% positive attitude, while 15.05%-16.7% display a negative attitude towards psychotropic medications. Conclusions: Physician’s attitudes may affect patients’ medication compliance, susceptibility to adverse drug reactions, and illness progression. Our study findings reveal similarities in attitudes towards psychotropic medications between the majority of married and single physicians in Saudi Arabia, regardless of whether they have children or not. Recommendations: Further larger studies are needed on large number of physicians in Saudi Arabia and other Arab countries to validate our study findings. Additionally, future research should explore the factors that influence Physician’s attitudes towards psychotropic medications, such as their personal experiences with mental illness or their training. Effective teaching and training programs are necessary to bring in Physician’s positive attitude towards psychotropic medications. ASEAN Journal of Psychiatry, Vol. 25 (1) January, 2024; 1-12.

Background: and Purpose The management of acute ischemic stroke (AIS) due to distal medium vessel occlusion (DMVO) remains uncertain, particularly in comparing the effectiveness of intravenous thrombolysis (IVT) plus mechanical thrombectomy (MT) versus IVT alone. This study aimed to evaluate the safety and efficacy in DMVO patients treated with either MT-IVT or IVT alone. Methods: This multinational study analyzed data from 37 centers across North America, Asia, and Europe. Patients with AIS due to DMVO were included, with data collected from September 2017 to July 2023. The primary outcome was functional independence, with secondary outcomes including mortality and safety measures such as types of intracerebral hemorrhage. Results: The study involved 1,057 patients before matching, and 640 patients post-matching. Functional outcomes at 90 days showed no significant difference between groups in achieving good functional recovery (modified Rankin Scale 0–1 and 0–2), with adjusted odds ratios (OR) of 1.21 (95% confidence interval [CI] 0.81 to 1.79; P=0.35) and 1.00 (95% CI 0.66 to 1.51; P>0.99), respectively. Mortality rates at 90 days were similar between the two groups (OR 0.75, 95% CI 0.44 to 1.29; P=0.30). The incidence of symptomatic intracerebral hemorrhage was comparable, but any type of intracranial hemorrhage was significantly higher in the MT-IVT group (OR 0.43, 95% CI 0.29 to 0.63; P<0.001). Conclusion The results of this study indicate that while MT-IVT and IVT alone show similar functional and mortality outcomes in DMVO patients, MT-IVT presents a higher risk of hemorrhagic complications, thus MT-IVT may not routinely offer additional benefits over IVT alone for all DMVO stroke patients. Further prospective randomized trials are needed to identify patient subgroups most likely to benefit from MT-IVT treatment in DMVO.

Objective: To evaluate the combination therapy of pyronaridine tetraphosphate and diminazene aceturate against Babesia in vitro and in vivo. Methods: Bioinformatic analysis was performed using atom pair fingerprints. An in vitro combination test was performed against Babesia bovis and Theileria equi. Moreover, the in vivo chemotherapeutic efficacy of pyronaridine tetraphosphate in combination with diminazene aceturate was investigated against the growth of Babesia microti in mice using a fluorescence inhibitory assay. Results: Pyronaridine tetraphosphate and diminazene aceturate exhibited nearly similar molecular weights. The in vitro combination of pyronaridine tetraphosphate and diminazene aceturate was synergistic on Babesia bovis and additive on Theileria equi. In addition, 5 mg/kg pyronaridine tetraphosphate combined with 10 mg/kg diminazene aceturate inhibited Babesia microti growth significantly compared with those observed after treatment with 25 mg/kg diminazene aceturate alone from day 6 post treatment to day 12 post treatment. The combination therapy also normalized the hematological parameters of infected mice. Conclusions: An oral dose of pyronaridine tetraphosphate combined with a subcutaneous dose of diminazene aceturate inhibits Babesia in vitro and in mice, suggesting it might be a new paradigm for the treatment of babesiosis.

Introduction: A prosthesis is an artificial assistive device designed to replace a missing body part (e.g., limb), secondary to a disease, injury or congenital deformities. Prostheses are often used to restore functional capacity while improving the quality of life (QoL). Methods: An analytical cross-sectional study was conducted among adults aged 19 to 64 years who were permanent residents in Luzon who had undergone unilateral lower leg amputation. This epidemiologic study employed the Modified Barthel Index for activities of daily living (ADLs), the Frenchay Activities Index for instrumental activities of daily living (IADLs), and the WHOQOL-BREF for QoL. Descriptive and analytical statistics of the responses of the Lower Limb Amputees (LLA) were done. Prevalence odds ratio (POR) was calculated, and statistical significance was determined. Results: Among 165 LLA respondents, only 47.88% used prostheses. Unilateral LLA who exhibited greater independence in ADLs (POR=19.22), more actively performed IADLs (POR=5.51), and had good QoL (POR=3.83) were more likely to have been using prosthesis. All these findings were statistically significant. Conclusion This study revealed a statistically significant association between prosthesis use to the physical functioning and QoL among adult unilateral LLAs. It showed that prosthetic use was likely linked with improved performance in ADLs and IADLs, and better QoL compared to those without.
Quality of Life