Purpose: Down syndrome (DS) is associated with metabolic dysregulation, obesity, and increased risk of chronic inflammation. This study aimed to assess subclinical inflammation in children with DS by evaluating inflammatory biomarkers, such as high-sensitivity C-reactive protein (hs-CRP), and their association with metabolic parameters including ghrelin, lipid profiles, and vitamin D levels. Methods: A total of 49 children with DS (aged 1–18 years) and 22 age-matched healthy controls were enrolled. Anthropometric data, body fat percentage, and metabolic parameters were assessed. Inflammatory markers (hs-CRP, apolipoprotein-B [Apo B], adiponectin), metabolic hormones (ghrelin, insulin), and lipid profiles were determined from venous blood samples. Statistical analyses included bivariate correlation, analysis of variance, and multiple linear regression to identify predictors of inflammation. Results: Children with DS exhibited significantly higher hs-CRP levels than controls (p=0.03), indicative of increased systemic inflammation. Higher hs-CRP levels were associated with older age (r=0.33, p=0.006), greater obesity (body mass index: r=0.32, p=0.011), and elevated serum insulin and low-density lipoprotein levels. Ghrelin levels correlated negatively with Apo B (r=-0.41, p<0.001) and positively with hs-CRP (r=0.30, p=0.012). Predictors of inflammation (based on hs-CRP) included older age, male sex, higher gamma-glutamyl transferase level, and a diagnosis of DS (adjusted R²=0.276). Conclusion Children with DS are prone to metabolic inflammation, with increasing age and obesity exacerbating inflammatory responses. Clinicians should monitor and manage weight, dyslipidemia, and inflammation in this population to prevent long-term complications such as cardiovascular diseases and insulin resistance.

Introduction: Dopaminomas or dopamine-secreting pheochromocytomas are rare neuroendocrine tumors that frequently lack the classic paroxysmal symptoms of catecholamine excess (headache, sweating, palpitation). Diagnosing these tumors is exceptionally challenging when biochemical markers— specifically markedly elevated urinary dopamine—are interpreted in patients receiving exogenous Levodopa (L-DOPA) therapy, as the intake obscures clinical significance. Case: A 76-year-old male with ischemic heart disease, stage 4 chronic kidney disease, and new-onset hypertension was admitted for acute cholecystitis. Imaging studies incidentally revealed bilateral adrenal masses and demonstrated lipid-rich characteristics upon further evaluation with computed tomography (CT) adrenal washout. Biochemical evaluation revealed extreme elevations in 24-hour urinary dopamine (47,534 nmol/24 hours; normal <3,237) and 3-methoxytyramine (18.93 µmol/24 hours; normal <2.60), whereas downstream urinary noradrenaline (5.0 nmol/24 hours; normal 71.5–505.3), adrenaline (4.0 nmol/24 hours; normal 9.2–122.3), normetanephrine (0.22 µmol/24 hours; normal 0.88–2.88), and metanephrine (0.25 µmol/24 hours; normal 0.33–1.53) levels were all significantly below their respective reference ranges. The diagnosis was complicated by the patient’s concurrent use of L-DOPA/Benserazide for flupentixol-induced parkinsonism. L-DOPA is a direct precursor to dopamine; its administration can cause massive, false-positive elevations in urinary dopamine, mimicking a dopaminoma’s biochemical signature. However, the unique combination of profoundly high dopamine alongside suppressed downstream catecholamines and metanephrines suggested a true dopaminesecreting tumor—potentially secondary to dopamine beta-hydroxylase (DBH) deficiency—rather than drug interference. Conclusion This case illustrates the profound difficulty in diagnosing dopaminoma when exogenous L-DOPA therapy creates a near-identical biochemical profile. The diagnostic dilemma is further amplified by vague symptomatology, multiple comorbidities, and non-suggestive imaging. However, the finding of isolated dopamine hypersecretion with suppressed metanephrines serves as a critical clinical clue. This pattern points toward an intratumoral biosynthetic defect rather than drug interference. Clinicians must maintain a high index of suspicion and perform meticulous biochemical fractionation to identify these rare, dopamineisolated secreting tumors.
Dopamine ; Levodopa

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

Introduction: Macro-thyroid-stimulating hormone (macro-TSH) is a rare complex formed by monomeric TSH with anti-TSH autoantibodies. Macromolecules of TSH are not renally excreted due to its large size, leading to elevated TSH measurements without clinical consequences. This rare condition frequently mimics subclinical hypothyroidism, often leading to misdiagnosis and inappropriate levothyroxine therapy. Case: A 17-year-old female with major depressive disorder was biochemically diagnosed with subclinical hypothyroidism (TSH 39.06 mIU/L, free thyroxine 4 12.9 pmol/L, antithyroid peroxidase negative) and commenced on levothyroxine. Over 5 years, her TSH levels heavily fluctuated (0.48–82.59 mIU/L) and remained persistently elevated with high-normal free T4 levels despite treatment adherence. An endocrinology consult was obtained, and clinical evaluation revealed a clinically asymptomatic and euthyroid patient, with no family history of thyroid disease or supplement use, and there was no goiter. Assay interference was excluded by analyzing her thyroid function tests on a different platform, which yielded similar biochemical results. Subsequently, a polyethylene glycol (PEG) precipitation test was performed. Her pre-PEG TSH of 29.24 mIU/L decreased significantly to 2.78 mIU/L post-PEG. This yielded a remarkably low TSH recovery rate of 9.5%, strongly indicating the presence of macroTSH. Levothyroxine was then stopped, and she remained clinically euthyroid. Conclusion While gel filtration chromatography remains the gold standard for diagnosing this condition, PEG precipitation is a more accessible, cost-effective, and reliable screening method in clinical practice. A TSH recovery rate below 20% is considered highly suggestive of macro-TSH. Clinicians should maintain a high index of suspicion for macro-TSH in asymptomatic patients presenting with isolated TSH elevations that do not respond to thyroxine therapy. Prompt recognition prevents misdiagnosis and avoids the potential risks of unnecessary thyroid hormone replacement.
Hypothyroidism ; Thyrotropin

Introduction: Medicinal plant use among indigenous people in Malaysia is commonly influenced by cultural beliefs, accessibility to traditional plants, and modern medicine availability. This study explores the usage, knowledge, and perceptions of medicinal plants among the Bateq people in Taman Negara National Park, Pahang. Materials and methods: A qualitative study conducted in June 2022 interviewed 12 adult Orang Asli from the Bateq tribe in Kuala Sat, Taman Negara. The qualitative study using face-to-face semi-structured interviews was approved by the Research Ethics Committee of Universiti Teknologi MARA and explored medicinal plant knowledge and usage among the participants. Thematic content analysis was employed for data analysis. Results: All participants, aged 18-60, utilized medicinal plants for various health purposes, including chronic diseases and general health maintenance. Older individuals possessed more traditional knowledge, acquired from their elders. Accessibility to medicinal plants in the local environment was emphasized. Despite diverse applications, challenges in obtaining plants in remote areas and the convenience of modern medicine contributed to a decline in traditional plant use. Perceptions varied, with some favoring traditional plants, while others expressed skepticism. Conclusion: This study offers insights into medicinal plant use, knowledge, and perceptions among the Bateq community in Taman Negara National Park, Pahang. It emphasizes the importance of preserving traditional knowledge, understanding diverse perceptions, and promoting collaboration between traditional and modern healthcare systems. The findings contribute to a broader understanding of healthcare practices among indigenous communities in Malaysia

An Evidence-Based Treatment Guide for Trauma from Occlusion: Essential Guidelines for Dental Students Trauma resulting from occlusion is a common clinical issue that can lead to significant discomfort, dysfunction, and long-term dental complications. This article is designed to offer a simplified, evidence-based overview of the pathophysiology of occlusal trauma, diagnostic approaches, and a treatment guide, making the management of occlusal trauma more accessible and easier to understand. Emphasis is placed on the importance of an individualized treatment planning, offering clinicians practical insights to optimize outcomes and minimize the adverse effects. The findings support the need for evidence-based decision-making in the management of occlusal trauma, ensuring both short-term relief and long-term dental health preservation.

Physicochemical Characterization and Biocompatibility of Bioactive Glass/Polycaprolactone Scaffold for Alveolar Bone Regeneration In bone tissue engineering, scaffold-based approaches offer great potential for regenerating damaged or lost bone tissue. Composite scaffolds have gained popularity because they combine the beneficial properties of two or more materials, providing promising biomimetic properties for tissue regeneration. In our study, combining the biocompatibility of bioactive glass with the mechanical qualities of polycaprolactone provides tailored properties and scaffold architecture conducive to alveolar bone regeneration. This study aims to develop a bone substitute using bioactive glass/polycaprolactone (BG/PCL) composites and to evaluate its biocompatibility for potential applications in alveolar bone regeneration. BG/PCL scaffolds were fabricated using a solvent-casting method at three different weight percentages (wt.%) ratios (10:90, 20:80, and 30:70). The scaffolds were characterised using scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, and methyl tetrazolium (MTT) (3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide) Assay to evaluate their physical, chemical, and biocompatibility properties. Among the three BG:PCL composite ratios tested (10:90, 20:80, and 30:70), the 10:90 ratio demonstrated the most favourable properties. SEM analysis of this composition revealed optimal surface roughness and well-distributed interconnected pores, which are conducive to cell attachment, enhanced cellular infiltration, and efficient nutrient diffusion. FTIR spectra displayed characteristic absorption bands corresponding to the functional groups of BG and PCL components while the biocompatibility test confirmed the viability and proliferation of periodontal ligament (PDL) fibroblast cells when cultured with the scaffolds. This study demonstrates that the developed BG/PCL composite, especially at the 10:90 ratio, possesses suitable properties and biocompatibility, highlighting its potential for use in alveolar bone regeneration.

Discal cysts (DCs) are an extremely rare cause of low back pain and sciatica. The few extant case reports have suggested many theories regarding the natural history and pathogenesis of these cysts. Furthermore, few criteria in various imaging modalities can differentiate DC from other causes of cystic lesions in the lumbosacral spinal canal. Despite the paucity of evidence concerning the optimal management of such lesions, endoscopic excision in our reported case was successful and also enabled closer inspection of the cysts’ structure and relation to the spinal canal constituents, yielding insights into the underlying pathology.

Fluid resuscitation is vital in the treatment of diabetic ketoacidosis (DKA) patients. The purpose of this narrative review is to analyze the role of Plasmalyte in the fluid resuscitation of adult DKA patients. A thorough search was conducted in PubMed, MEDLINE, and Embase. Studies conducted between January 1, 2010, and March 31, 2023, were collected. Of 123 results, five pertinent randomized controlled trials were included. The close resemblance of Plasmalyte’s electrolyte composition to that of human plasma, and its role in the prevention of hyperchloremic metabolic acidosis are some of its key benefits in patients with diabetic ketoacidosis. Plasmalyte’s role in length of stay, time to resolution of diabetic ketoacidosis, and mortality in DKA patients varied among studies. Hence, further research on these topics is needed.