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

OBJECTIVE

Previous studies have indicated that clinical hypogonadism is common among males with type 2 diabetes mellitus (T2DM). However, the reported prevalence varies due to the diverse diagnostic criteria used in these studies. This study aims to determine the prevalence of clinical hypogonadism among Malaysian T2DM males and their associated factors.

A total of 360 participants who fulfilled the inclusion criteria were included in this study. Their socio-demographic and clinical parameters were documented and a total testosterone level was sampled from a morning fasting serum. Patients with serum total testosterone of 8-12 nmol/L had their serum total testosterone repeated and their symptoms assessed with the Aging Male Symptoms (AMS) scale. Clinical hypogonadism was diagnosed with total testosterone 26.

The prevalence of clinical hypogonadism among Malaysian T2DM males was 17.5% (n = 63), with 55.6% of them having hypogonadotropic hypogonadism. There is a significant association between clinical hypogonadism with waist circumference > 94 cm (p < 0.001), obesity (p < 0.001), hypertension (p = 0.010), coronary artery disease (p = 0.014) and peripheral artery disease (p = 0.022). There is a significant difference in the weight (p = 0.001), BMI (p < 0.001), waist circumference P < 0.001), serum HDL-C levels (p < 0.001), serum triglycerides levels (p = 0.001) and serum TyG index (p < 0.001). Diabetic males with increasing age (adjusted OR = 1.070, 95% CI 1.004-1.146, p = 0.038), presence of coronary artery diseases (adjusted OR = 2.08, 95% CI 1.220-10.219, p = 0.020) and low total testosterone (adjusted OR = 2.451, 95% CI 1.908-3.155, p < 0.001) are at higher risk of developing clinical hypogonadism.

This study is the first in the Asian region to use stricter criteria for diagnosing hypogonadism. Despite these stringent criteria, the prevalence of hypogonadism remains significantly high among Malaysian T2DM males. It is particularly common in diabetic males over 35 years old with coronary artery disease, regardless of A1c control and the duration of diabetes.

Mullerian agenesis or Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH) Type-II is a congenital defect in the Mullerian duct that results in the absence of a uterus in women. The aetiology of this syndrome is unknown and has been considered a sporadic genetic disease. MRKH, together with anorectal anomaly, is an extremely rare condition and has only been reported in a few cases without any information on genetic analysis. This study investigated the mutational profile of a girl diagnosed with MRKH and anorectal anomalies with rectovaginal fistula. The whole exome sequencing (WES) trio-genetic analysis of a 5-year-old Malaysian girl diagnosed with MRKH (having anorectal anomaly with rectovaginal fistula) was performed together with her normal parents, using the Ion AmpliSeq Exome RDY kit (ThermoFisher Scientific, USA). Data were analysed using Torrent Suite v.5.0.4 and annotated using ANNOVAR. Single nucleotide polymorphisms (SNPs) with an allele frequency >0.01 were excluded, and the remaining variants were filtered based on de novo mutations, autosomal recessive, and autosomal recessive genetic traits. Related genes were analysed by biological pathway analysis (g:Profiler) and protein-protein interaction (HIPPIE v.2.3, STRING v.11.5, dan GeneMANIA). A total of 36 mutations were identified, and two of them, the LHX5 (p.P358Q), inherited from the father, and CFTR (p.R1158X), inherited from the mother. There were 28 de-novo mutations from 28 genes. All genes were involved in 27 biological processes that connected with 23 interactions, and are likely to cause MRKH syndrome in this patient.

Objective: High-throughput sequencing based on 16S ribosomal RNA genes was used to determine the baseline gut bacterial composition and identify potential pathogenic bacteria among three endangered gibbons housed in the NWRC. Methods: Feces were collected from 14 individuals (Hylobates lar, n = 9; Hylobates agilis, n = 4; and Symphalangus syndactylus, n = 1) from March to November 2022. Amplicon sequencing were conducted by targeting V3–V4 region. Results: The fecal microbial community of the study gibbons was dominated by Bacteroidetes and Firmicutes (phylum level), Prevotellaceae and Lachnospiraceae/ Muribaculaceae (family level), and Prevotella (and its subgroups) (genera level). This trend suggests that the microbial community composition of the study gibbons differed insignificantly from previously reported conspecific or closely related gibbon species. Conclusions and Relevance: This study showed no serious health problems that require immediate attention. However, relatively low alpha diversity and few potential bacteria related to gastrointestinal diseases and streptococcal infections were detected. Information on microbial composition is essential as a guideline to sustain a healthy gut condition of captive gibbons in NWRC, especially before releasing this primate back into the wild or semiwild environment. Further enhanced husbandry environments in the NWRC are expected through continuous health monitoring and increase diversity of the gut microbiota through diet diversification.

Modified Initial Era Checklist for Screening Ergonomics Risk Factors in Diagnosing Work-Related Musculoskeletal Disorders Introduction Work-related musculoskeletal disorders (WRMSDs) are known to affect a diverse range of occupations around the world. One major factor for their occurrence is the presence of ergonomics risk factors in the workplace; as such, steps to minimize WRMSDs in Malaysia include the development of the Initial Ergonomics Risk Assessment (ERA) checklist for on-site assessors. The checklist, however, may not be useful for medical doctors who diagnose WRMSDs in hospitals or clinics. Moreover, there is no tool to assist medical doctors in considering the role of ergonomics risk factors when diagnosing WRMSDs, which can hamper the overall management of occupational diseases. This study was therefore carried out to modify the Initial ERA checklist so that medical doctors can use it to consider the role of ergonomics risk factors when diagnosing WRMSDs. Methods In Phase I, document analysis was performed to construct the tool by integrating elements that were relevant for use in hospitals or clinics from the Initial ERA checklist and similar tools published overseas. In Phase II, the tool was reviewed by medical doctors and nurses and was found to have excellent content validity (I-CVI = 1.00). In Phase III, the tool underwent further improvement after trailing its application in two role-play sessions involving various healthcare professionals. Results The resulting Modified Initial ERA Checklist can assist medical doctors screen for various ergonomics risk factors when diagnosing WRMSDs in hospitals or clinics. Conclusions Future studies could further examine its application in the field to validate its actual use in hospitals or clinics

RECURRENT UROSEPSIS DUE TO NEPHROCOLIC FISTULA IN AN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE Nephrocolic fistula is an abnormal communication between the kidney and the colon, a rare clinical phenomenon with potentially serious complications. We present a case of a 37-year-old female with autosomal dominant polycystic kidney disease who complained of left lumbar pain, fever and urinary frequency. She had multiple similar presentations for years, refractorily treated for recurrent urinary tract infections. Contrast-enhanced computed tomography abdomen demonstrated bilateral staghorn calculi and perinephric abscesses connected to the descending colon. She eventually required surgical intervention after the failure of medical therapy. Our case highlights the diagnosis and management of nephrocolic fistula.

FACTORS ASSOCIATED WITH SELF-EFFICACY AND BEHAVIOUR IN PROVIDING SMOKING CESSATION INTERVENTION FOR ADULT PATIENTS AMONG PUBLIC DENTISTS IN NORTHEAST MALAYSIA Introduction: The smoking prevalence in Malaysia continues to be a crucial issue, and its negative effects not only on general health but also on oral health. Although dentists are in an ideal position to assist in smoking cessation, it is unclear to what extent they are prepared to do so effectively. Therefore, this study aimed to assess the self-efficacy and behaviour of public dentists in providing smoking cessation interventions to adult patients, as well as the associated factors. Materials and Methods: A cross-sectional study was conducted between November and December 2022, involving 160 dentists working in public primary dental clinics in Kelantan and Terengganu. Convenience sampling was applied, and data collection was carried out online using Google Forms®. The questionnaire comprised of 16 items in the demographic section and 11 items each for the self-efficacy and behaviour sections. The data was entered and analysed using SPSS version 26.0. The levels of self-efficacy and behaviour were categorised as low, moderate, and high based on percentiles: low at the 33rd percentile, moderate between the 33rd and 66th percentile, and high above the 66th percentile. Independent t-tests and Pearson's correlation coefficient analyses were performed to assess factors associated with self-efficacy and behaviour. Results: The study found that the majority of participants were female (83.8%), Malay (98.1%), and never-smokers (96.9%). The participants' mean (SD) age was 32.2 (3.64) years old. The results showed that most participants scored at or below the 33rd percentile for self-efficacy (38.1%) and behaviour (35.6%). Self-efficacy was significantly associated with gender (p = 0.037) and attended smoking cessation intervention training (p = 0.008). The study also revealed that self-efficacy had a significant moderate positive correlation with the behaviour towards providing smoking cessation intervention, r = 0.509, p < 0.001. Conclusions: The public dentists in Northeast Malaysia have been observed to have low self-efficacy and limited behaviour when it comes to providing smoking cessation interventions to adult patients. It was found that the gender and attendance of smoking cessation intervention training were associated with the self-efficacy of the dentists. It was also observed that an increase in self-efficacy had led to an increase in behaviour towards providing smoking cessation intervention. Therefore, it is suggested that smoking cessation intervention training be made available to public dentists in order to improve both self-efficacy and behavioural tendencies in providing smoking cessation interventions for adult patients.

Objective: To characterise a collection of pili-carrying and none pili-carrying pneumococcal isolates of clinical origin for serotypes, antibiotic resistance and genotype. Methods: In total, 42 clinical isolates were collected between October 2017 and December 2019. Those isolates were analysed for antimicrobial susceptibility, serotype distribution, detection of pneumococcal virulence and pilus genes. Multilocus sequence typing was performed only for piliated isolates, followed by phylogenetic analysis. Results: The common isolation sites among the pneumococcal isolates were tracheal aspirate (28.6%), blood (26.2%), and sputum (23.8%). Fifty percent isolates were resistant to erythromycin, tetracycline (50.0%) and trimethoprim-sulfamethoxazole (43.0%). The most frequent were serotypes 19F (28.6%), 6A/B (23.8%) and 19A (14.3%). Piliated isolates were detected in a small proportion (33.3%); 64.3% were multidrug-resistant. ST320 was the prevalent sequence type among the piliated isolates and genetically related to the Pneumococcal Molecular Epidemiology Network clones Taiwan 19F -14 (CC271). In the phylogenetic analysis, some piliated isolates showed a close association having similar ST320, carrying serotype 19A and both pilus genes indicating their clonal spread. Conclusions: Pneumococcal lineages of piliated isolates have been globally disseminated and pili could have played a role in the spread of antibiotic resistant clones.

Introduction: Food security can be defined as the availability of and accessibility to food, acquired in an acceptable means at any given time and place in a way that could maintain health and wellbeing. One critical dimension of food security is continued access to adequate food. To measure this dimension, the Food and Agriculture Organization (FAO) developed the latest measurement tool, namely the Food Insecurity Experience Scale (FIES), the first instrument to measure people who experience food insecurity globally. This study aimed to validate the construct validity and reliability of the Malay version of FIES (M-FIES) for Malaysians. Methods: This cross-sectional study was conducted among 145 households in Kuantan, Pahang. Rasch analysis was used to analyse the construct validity of FIES. Results: FIES met the Rasch model assumptions with all items having an infit value of between 0.7- 1.3 and an outfit value of <2.0. The item and person reliability were 0.97 and 0.71, respectively; while the item and person separation were 5.59 and 1.58, respectively. The FIES item severity indicated that the items “few food”, “healthy”, “skipped”, “ate less”, and “runout” were disordered. Conclusion: The M-FIES is a valid and reliable measurement tool for the food insecurity situation among households based on its construct validity assessed using the Rasch model. Furthermore, the severity of item in M-FIES was different in terms of order from the original FIES, suggesting that the same items may be interpreted differently due to cultural or societal differences.

Background: The spread of COVID-19 was inevitable and has not spared small and isolated communities, including the community of Perhentian Island in Besut District, Terengganu. Managing clusters in small islands can be difficult, given the limited resources. This study explores the characteristics of COVID-19 cases and the experience of outbreak containment at Perhentian Island. Methodology: A retrospective study involving record review of COVID-19 cases and at-risk individuals registered under Perhentian Cluster were retrieved from the Besut District Health Office COVID-19 online registry from the 16thAugust2021 until 6thOctober 2021. All notified cases and close contacts who fulfilled the inclusion criteria were extracted and analysed using descriptive statistics. Results: A total of 1,093 community members of Perhentian Island were screened of which 170 (15.5%) tested positive for COVID-19, while 923 (84.5%) tested negative. Among individuals who tested positive, the majority were adults (52.4%), male (51.8%), Malays (98.8%), and villagers (96.5%). Clinical characteristics were categorized into: asymptomatic (55.9%), had no known medical comorbidities (90.6%), low-risk groups (87.1%), vaccinated (57.6%), and admitted to PKRC (97.1%) for treatment. Multiple agencies were involved in the outbreak containment of the Perhentian Cluster, working collectively and in good coordination. Conclusion The outbreak was attributed to community gatherings and close interactions among villagers. Prompt actions, targeted planning, and inter-agency collaboration were the key factors in successful containment of further spread of COVID-19 in Perhentian Island.
COVID-19