Knowledge, Attitude, and Practice Towards Safety ; Health Risks ; Food Manufacturing Introduction Food manufacturing in Malaysia exposes workers to numerous potential hazards and health risks throughout the work process. This study aimed to determine the level of knowledge, attitude, and practice (KAP) towards safety and health risks among food manufacturing workers and to examine the relationship between these domains. Methods A cross-sectional study was performed involving 80 workers from three food manufacturing factories in Negeri Sembilan. KAP was assessed through a validated questionnaire adapted from a previous study. Results All workers (100%) demonstrated a positive attitude, 98.7% show good practice, and 93.8% exhibit a good level of knowledge towards safety and health risks. The correlation study showed significant positive correlations between gender and attitude, and between education level and attitude, indicating that these sociodemographic factors influence safety attitudes. Work experience is significantly associated with knowledge, suggesting that work experience enhances knowledge. The study also reveals weak positive correlations among knowledge, attitude, and practice (KAP) regarding safety and health risk, but a significant correlation is observed between knowledge and practice. Conclusions These findings suggest that fostering practical knowledge is essential for ensuring safe work behaviors. Prioritizing hands-on safety training can help bridge the gap between theoretical attitude and daily operational safety, ultimately reducing occupational health risks among food manufacturing workers.

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.

Objective: To explore the regulatory role of paternal involvement in parenting in the association between parental adverse childhood experiences (ACEs) and autism like behavioral problems in children aged 3-6, so as to provide a basis for intervention strategies targeting the intergenerational health effects of ACEs. Methods: A longitudinal study design was used to select 1 780 children aged 3-6 from 12 kindergartens in Wuhu City, Anhui Province in June 2021 as the subjects of the baseline survey by convenient sampling, and the follow up surveys were conducted once every six months, for a total of two follow ups. Pearson correlation analysis was used to examine the association of parental ACEs and paternal involvement in parenting with autism like behavioral problems in children. A binary Logistic regression model was used to explore the association between parental ACEs and autism like behavioral problems in children. Based on stratification, the potential role of paternal involvement in the association between parental ACEs and autism like behavioral problems in children aged 3-6 was explored. Results: Autism like behavioral problem score in children aged 3-6 was positively correlated with the total score ACEs of parents as well as scores of emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, community violence, peer bullying, and family dysfunction( r =0.18,0.16,0.18,0.14,0.06,0.05,0.12,0.18,0.09,all P <0.05). Autism like behavioral problem score in children was negatively correlated with score of paternal involvement in parenting( r =-0.16, P <0.01). After adjusting for covariates such as gender, age, and birth weight of children, binary Logistic regression analysis showed that children whose parents had experiences of childhood emotional abuse, physical abuse, sexual abuse, community violence, peer bullying, or family dysfunction had higher risks of developing autism like behavioral problems than those in the non exposed group ( OR =3.29, 3.28, 6.71, 2.34, 4.08, 2.02, all P <0.01). In the group with low paternal involvement in parenting, all dimensions of parental ACEs(emotional abuse, physical abuse, sexual abuse, community violence, peer bullying, and family dysfunction) were significantly associated with an increased risk of autism like behavioral problems in children ( OR =1.84-8.34, all P <0.05). In contrast, in the group with high paternal involvement in parenting, no statistically significant associations were found between any dimension of parental ACEs and children s autism like behavioral problems ( OR =0.57-1.82, all P >0.05). Conclusion A high level of paternal involvement in parenting can reduce the adverse effects of parental ACEs on the occurrence of autism like behaviors in preschool children.

Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

Introduction: The identification of a significant adrenal mass in a patient without a biopsy-confirmed malignancy poses a diagnostic challenge: Is it a metastatic lesion or an underlying adrenal condition? Adrenal metastases are the second most common site of spread for lung adenocarcinoma; approximately 3–7% of adrenal masses represent benign adenomas. Diagnosis is even harder if there are signs of primary aldosteronism (PA). Case: We present a case of a 62-year-old Chinese female with a 10-year history of hypertension, managed on dual antihypertensive therapy, who presented for evaluation of suspected PA following the discovery of hypokalemia. Biochemical screening revealed an elevated aldosteronerenin ratio (ARR, 65). The overnight dexamethasone suppression test (20 nmol/L) and testosterone (0.79 nmol/L) were both within normal limits. Saline Suppression Test (SST) showed an indeterminate post-infusion aldosterone level (202.8 pmol/L). Cross-sectional imaging via computed tomography (CT) Adrenals identified a large, 6.4 × 5.4 × 6.2 cm heterogeneous left suprarenal mass with a low mean attenuation (8.6 Hounsfield Unit [HU]). Concurrently, an incidental left upper lobe pulmonary lesion was identified, and PET-CT was performed; the SUVmax of the lung was identical to that of the adrenal lesion. An ultrasoundguided biopsy of the pulmonary lesion confirmed estimated glomerular filtration rate-mutation-positive lung adenocarcinoma. The patient started on targeted therapy with dacomitinib. Follow-up CT imaging at 9 months demonstrated disease progression within the thorax, marked by the appearance of a new pulmonary nodule. Notably, however, the adrenal mass remained stable in size and morphology. Conclusion The absence of mixed androgen/glucocorticoid hypersecretion, combined with the radiographically static nature of the mass, suggests a lower probability of adrenocortical carcinoma. This case highlights that while size is a major risk factor for adrenocortical carcinoma, it must be interpreted in conjunction with hormonal activity, HU, and growth patterns. Identifying these “mimics” helps avoid over-staging lung cancer and ensures patients receive targeted therapy instead of unnecessary adrenalectomies.

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

Introduction: Adrenal tuberculosis (TB) is a rare but important cause of adrenal insufficiency in TB-endemic regions, usually secondary to pulmonary or extrapulmonary disease, with primary involvement being uncommon. It typically affects both glands via hematogenous or lymphatic spread and presents late with nonspecific features after significant adrenal destruction, making diagnosis challenging. Diagnosis is more straightforward in the presence of extraadrenal TB, where imaging may obviate the need for biopsy, but remains difficult in isolated adrenal involvement. Case: We report a 69-year-old Malay male with diabetes mellitus, hypertension, and hyperlipidemia who presented with a 2-week history of chronic cough and 4 months of constitutional symptoms, including weight loss and anorexia. Initial TB workup in September 2025 was negative. He was subsequently admitted twice in October 2025 for pneumonia, with persistent upper lobe consolidation on chest radiography despite antibiotics. Contrast-enhanced computed tomography thorax, abdomen, and pelvis revealed bilateral mildly enhancing hypodense adrenal lesions (right 3.7 × 3.0 cm, left 2.5 × 2.6 cm), suggestive of adenoma, hyperplasia, or lymphoma. Bronchoscopy detected Mycobacterium tuberculosis via GeneXpert BAL, with no malignant cells on cytology. Adrenal biopsy was non-diagnostic. Biochemical evaluation showed low morning cortisol with elevated adrenocorticotropic hormone and findings consistent with adrenal insufficiency. The patient was treated as smear-negative pulmonary TB with adrenal involvement and initiated on anti-TB therapy, currently in the maintenance phase. Hydrocortisone replacement 10 mg twice daily was also initiated. Conclusion This case highlights the diagnostic challenge of adrenal TB, particularly when tissue sampling is inconclusive. In TB-endemic settings, a presumptive diagnosis based on clinical, radiological, and microbiological evidence is often necessary. Early empiric anti-TB therapy is essential to prevent adrenal crisis and preserve endocrine function.
Tuberculosis