Introduction: Paragangliomas are rare neuroendocrine tumors arising from extra-adrenal chromaffin cells, with an estimated incidence of 2–8 cases per million per year. These tumors originate from neural crest–derived cells of the sympathetic and parasympathetic paraganglia and may secrete catecholamines, resulting in malignant hypertension or symptoms such as headache, palpitations, and diaphoresis. They can occur anywhere along the paravertebral and para-aortic regions from the skull base to the pelvic floor. Case: We report a case of a 14-year-old male with no known premorbid conditions who presented with presyncope and a 1-month history of headache. On examination, he had severe hypertension (242/167 mmHg), tachycardia (127 bpm), and grade IV hypertensive retinopathy. Investigations showed preserved renal function with markedly elevated 24-hour urinary metanephrines (normetanephrine 90.75 µmol/L). Computed tomography revealed a lobulated, heterogeneously enhancing mass measuring 5.0 × 6.1 × 5.4 cm along the left margin of the abdominal aorta at the infrarenal level, suggestive of an extra-adrenal lesion. Gallium-68 PET scan demonstrated a somatostatin receptor–avid left peritoneal mass. The patient underwent exploratory laparotomy and tumor excision, complicated intraoperatively by blood pressure lability requiring nitroprusside and inotropic support. Postoperatively, he improved significantly and was able to wean off all antihypertensive medications. Histopathology confirmed left retroperitoneal paraganglioma. Conclusion Primary peritoneal paraganglioma is a rare but important cause of secondary hypertension, especially in young patients presenting with hypertensive emergency. High index of suspicion is essential for early diagnosis. Management requires a multidisciplinary approach with careful preoperative optimization to minimize perioperative complications. Surgical resection remains the definitive treatment and, as demonstrated in this case, can result in marked clinical improvement with resolution of hypertension.
Paraganglioma

Introduction: Severe hypercalcemia is a life-threatening metabolic emergency that necessitates prompt initiation of systemic therapy due to the risk of cardiac arrhythmias. It is frequently linked to squamous cell carcinoma through the production of parathyroid hormone–related protein, which mediates the development of humoral hypercalcemia of malignancy. Case: This is a case of a 38-year-old male who was diagnosed 1 year ago with locally advanced poorly differentiated basaloid squamous cell carcinoma of the lower anterior mandibular alveolus involving cortical, medullary bone, and perineural invasion. He underwent extensive tumor resection with reconstruction, tracheostomy, and bilateral neck dissection, followed by multiple revision surgeries for postoperative complications. He completed adjuvant chemoradiotherapy. He presented with acute confusion without other systemic symptoms. His Glasgow Coma Scale was E4V4M5. Neurological and systemic examinations were unremarkable, and oral cavity assessment showed no evidence of recurrence. Investigations revealed severe hypercalcemia (5.94 mmol/L) with normal phosphate (1.16 mmol/L) associated with shortened QTc. Other tests were unremarkable, with no evidence of infection, uremia, liver dysfunction, or alternative metabolic causes. Lumbar puncture was unremarkable. His parathyroid hormone level was suppressed at 0.50 pg/ mL. Computed tomography brain showed no evidence of meningoencephalitis, hydrocephalus, cerebral oedema, or metastasis. Aggressive hydration was initiated alongside subcutaneous calcitonin, which was subsequently titrated. However, there was no clinical or biochemical improvement after 1 day, with persistent confusion and calcium remaining at 5.87 mmol/L. Subcutaneous denosumab was then administered, and hemodialysis was initiated on alternate days due to refractory hypercalcemia. This resulted in improvement of calcium levels to 3.2–3.6 mmol/L and resolution of confusion Conclusion Refractory hypercalcemia may represent a late manifestation of advanced squamous cell carcinoma and is an ominous prognostic indicator, necessitating prompt evaluation and oncologic management.
Calcitonin ; Denosumab ; Hypercalcemia ; Renal Dialysis ; Neoplasms

Introduction: Central precocious puberty (CPP) is defined as premature activation of the hypothalamic-pituitary-gonadal axis, resulting in the development of secondary sexual characteristics before 8 years of age in girls. While most cases are idiopathic, intracranial pathologies such as pituitary lesions may cause CPP. Early identification is essential to optimize outcomes and minimize psychosocial impact. We report a case of CPP associated with pituitary microadenoma and pineal cyst from the Paediatric Department, Hospital Sultanah Nur Zahirah. Case: A 4-year-old female presented with bilateral breast enlargement, with ultrasonography showing normal fibroglandular tissue. Breast development was noted since 3 months of age, with whitish vaginal discharge from 2 years. She demonstrated accelerated growth, with height and weight above the 95th centile. There were no features suggestive of peripheral causes or raised intracranial pressure. Examination revealed Tanner stage A1B3P2. Bone age was markedly advanced (11 years vs. chronological age 4 years). Hormonal evaluation showed elevated LH (3.28 IU/L) and follicle-stimulating hormone (4.79 IU/L), consistent with CPP. MRI demonstrated focal delayed enhancement in the posterolateral pituitary suggestive of microadenoma, and an incidental pineal cyst without complex features. Ophthalmological assessment was normal. Neurosurgical evaluation advised conservative management with annual imaging surveillance. Intramuscular Triptorelin was initiated at 4 years 1 month. Follow-up showed regression of pubertal progression, resolution of vaginal discharge, and reduced growth velocity to 6 cm/year. Conclusion This case highlights the importance of thorough evaluation in CPP to identify underlying intracranial pathology. Early initiation of gonadotropin-releasing hormone analog therapy effectively halts pubertal progression and preserves growth potential.
Central Nervous System Cysts ; Puberty

The detection of insecticide resistance is pivotal for characterising the phenotypic resistance of field-collected Aedes aegypti populations, enabling the early identification of resistance trends and safeguarding the efficacy of chemical interventions in vector control programmes. Although the World Health Organization (WHO) adult tube test remains the standard screening method, its reliance on binary classifications of susceptibility and resistance limits the ability to compare the magnitude of resistance among different insecticides. To address this limitation, probit analysis was performed on adult mortality data obtained from a field-collected strain exposed to WHO-recommended discriminating and intensity concentrations. LC50 values were subsequently normalised using a concentration ratio (CR) framework, allowing resistance levels to be quantified and compared across insecticides. The relationship between the CR and slope parameters derived from probit analysis enabled the inference of resistance magnitude within field populations. The results demonstrated that pirimiphos-methyl retained high efficacy against the tested populations, whereas substantial intra-population variation in resistance intensity was observed among pyrethroids and malathion. Lambda-cyhalothrin exhibited the highest level of resistance, followed by permethrin and alpha-cypermethrin. These findings highlight the value of data-driven approaches for enhancing the interpretation of insecticide resistance profiles and providing a more comprehensive assessment of resistance status. By utilising mortality data generated from WHO-recommended discriminating and intensity bioassays, resistance can be evaluated beyond the binary outcomes of standard susceptibility tests, thereby supporting more informed decisions on insecticide rotation and resistance management in vector control programmes.

BACKGROUND: Microplastics pose a significant environmental and health threat, yet the understanding and response of young adults to this issue remain underexplored. There is an increasing amount of microplastics in our environment and as the numbers grow, the danger that comes with it is still not fully understood. This study aimed to explore the knowledge, attitudes, and practices (KAP) of young adults in Muntinlupa, particularly students of a public university regarding microplastics and their health implications. METHODS: Employing a quantitative cross-sectional design, the research targeted college students aged 18 and older. RESULTS: Findings revealed that while students were knowledgeable about microplastics—particularly their harmful effects on health—attitudes and practices related to plastic disposal and recycling could be improved. Although the majority engaged in proper garbage disposal, only 41.5% consistently separated plastic waste from biodegradable materials. However, a weak positive correlation between knowledge and attitudes was observed, suggesting that increased awareness may enhance positive attitudes toward reducing microplastic pollution. CONCLUSION These results suggest that while students are aware of microplastics and generally responded positively, there remains a gap in the translation of knowledge into practices, highlighting the need for enhanced educational interventions.
Microplastics ; knowledge ; attitudes ; young adult

Aims: Enterococcus bacteria, including some strains that are resistant to antibiotics like vancomycin can pose a threat to public health. The purpose of this study is to identify the species, antibiotic susceptibility profile and VanA/VanB gene frequencies in Enterococci isolated from patients at a tertiary hospital in Kota Kinabalu, Sabah. Methodology and results : Various bodily fluid specimens were collected from 162 patients between July 2019 and June 2021. Species confirmation and susceptibility testing were performed using an automated system. Subsequently, PCR was used to determine the presence of VanA and VanB genes. Species identification revealed the presence of five enterococcal species, namely E. faecalis (91), E. faecium (64), E. gallinarum (3) E. casseliflavus (2), along with one isolate each of E. hirae and E. avium. Overall, resistance to antibiotics like ampicillin, quinolones, tetracycline, gentamicin-syn, nitrofurantoin, glycopeptides and linezolid was generally low (<50%). However, a significant number of isolates displayed high resistance to erythromycin (>50% of samples), while resistance to tetracycline was more moderate. The frequencies of VanA and VanB genes were low (0.6 and 0%, respectively) and they were only detected in E. faecium. Conclusion, significance and impact of study The results indicate that while the prevalence of vancomycin-resistant enterococci (VRE) may be low, there is an increasing incidence of multidrug-resistant enterococci, particularly with regards to erythromycin.

Aims: Wax apple is an important fruit crop in Malaysia and other tropical countries. However, the black spot disease caused by Lasiodoplodia theobromae can damage the wax apple plants, reducing fruit production and quality. Chemical fungicides are commonly used to overcome this disease. However, their overuse might increase fungal resistance to chemicals. Therefore, this study was aimed to evaluate the in vitro antifungal properties of an Aloe vera film incorporated with cinnamon oil on L. theobromae in wax apples. Methodology and results: In vitro antifungal tests were conducted using the poisoned food. This present study found that the inhibition of L. theobromae mycelia when treated with A. vera film with different percentages of cinnamon oil was significantly different compared to the control film at (P<0.05). Results suggest that A. vera film without cinnamon oil showed the highest percentage of inhibition (37.31%) than other films with cinnamon oil due to the antagonistic and less synergistic effect. However, A. vera film with 0.07% of cinnamon oil showed the highest percentage of mycelia inhibition (36.15%) compared to the film with 0.06%, 0.05% and 0.04% cinnamon oil, with mycelia inhibition of 30.55%, 24.25% and 18.82%, respectively, while the mancozeb (positive control) showed 100% inhibition. Conclusion, significance and impact of study In conclusion, A. vera film alone had 37.31% inhibition compared to 36.15% inhibition in A. vera film with 0.7% cinnamon oil. As a result, a tiny amount of cinnamon oil added to the mixture might aid in controlling the black spot disease in wax fruits.
Antifungal Agents ; Aloe ; Oils, Volatile ; Plant Extracts

Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Introduction: Anaemia is common during pregnancy and can lead to miscarriage, intrauterine growth retardation, premature labour and antepartum haemorrhage. Anaemia in pregnancy is defined as a haemoglobin (Hb) level of <11 g/dL. Methods: This retrospective review included 407 antenatal mothers diagnosed with anaemia at 36±1 weeks of gestation at all 10 health clinics in Alor Gajah between January and December 2018. Results: According to the district annual returns, 2,407 antenatal mothers (36 weeks of gestation) were registered in the health clinics in Alor Gajah in 2018. Among them, the prevalence of anaemia was 18.6% (n=448). However, there were only 407 cards found. Most participants were Malays (89.4%), aged 20–40 years (93.6%) and married (96.3%). Almost all anaemia cases (96.5%) were mild (Hb level of 9–10.9 g/dL). Approximately 34.4% of the mothers were already anaemic at booking; 77.6% belonged to the B40 income group; and 31.6% had poor pregnancy spacing of <2 years. Iron deficiency anaemia was the most common type of anaemia (51.0%), followed by dilutional anaemia (34.0%), which did not normalise at 36 weeks of gestation. Anaemia was associated with lower educational (P<0.05) and Hb levels at booking (P<0.001). Conclusion Having normal maternal Hb levels in early pregnancy especially at booking is crucial, as it may reduce the possibility of anaemia during pregnancy. Early screening and supplementation of at-risk pregnancies may be applied as a preventive strategy. Suitable methods of iron treatment and investigation need further exploration.

Purpose: Indonesia, a high populous and the second-highest country in epidemicity of hepatitis B in South-East Asia require maintaining its capacity of monovalent hepatitis B production to keep up with both the national immunization program and global needs. To keep the sustainability of the vaccine, a new bulk is needed to be made available. This study aims to evaluate the immunogenicity and safety of Bio Farma newly formulated recombinant hepatitis B vaccines, which came from different sources of bulk, compared to the already registered hepatitis B vaccine. Materials and Methods: An experimental, randomized, double-blind, cohort intervention phase II clinical trial was conducted on three recombinant hepatitis B vaccines from different bulk sources, with Bio Farma registered hepatitis B vaccine as the control group. A total of 536 participants around age 10 to 40 years old were thricely vaccinated with twice serological assessments. The subject’s safety was monitored for 28 days after each vaccination. Results: Of 536 enrolled participants, 521 finished the vaccination and serology assessments. The investigational products were proven not to be inferior to the control. All vaccines were well tolerated. No differences in rates of local and systemic reactions were seen between the investigational products and control. No serious adverse event was found to be related to the investigational vaccines. Conclusion Investigational vaccines are shown to be equally immunogenic and safe as the control vaccine.