Paragangliomas are rare neuroendocrine tumors that are usually benign in nature. They may be either familial or sporadic in their occurrence. Numerous neuroendocrine tumors are collectively included under the umbrella of paragangliomas. Among them, carotid body tumors and glomus jugulare tumors are extremely rare. Thus, we present a rare case of 29-year-old male who was admitted with hearing difficulties and tinnitus in the left ear, with swelling on the left side of the neck. Based on clinical and radiological findings, a diagnosis of left-sided glomus jugulare with carotid body tumor was made. The patient underwent a twostage surgery with an interval of approximately 2 months. Histopathology revealed a paraganglioma. Herein, we present the clinical features, imaging findings, management, and a brief review of literature on the classification, evaluation, and management of carotid body and glomus jugulare tumors. Paraganglioma is a slow-growing tumor. The synchronous occurrence of carotid body and glomus jugulare tumors is infrequent. Microsurgical resection remains the primary treatment modality. Therefore, our patient underwent two-stage surgery. The rarity of occurrence and the proximity and adherence to vital neurovascular structures have resulted in the treatment of paragangliomas remaining a challenge.

Introduction: Among adolescents, asthma is an important public health burden that is associated with high morbidity and mortality. Poor asthma control is likely in this age group. Our aim was to identify the predictors of well controlled asthma among adolescents with persistent asthma in Northwest of Libya. Methods: A sample of 92 adolescents with persistent asthma were recruited from the respiratory clinic in Sabratha Teaching Hospital, and completed questionnaires measuring demographic and clinical characteristics, asthma knowledge, self-efficacy, and asthma control. Logistic regression analysis was carried out, taking the asthma control as the dependent variable. Results: Twenty-four percent of participants had well controlled asthma. In a bivariate analysis, well controlled asthma was significantly associated with adolescents having mild persistent asthma, not having allergic rhinitis, using preventive inhalers regularly, reporting higher level asthma knowledge, and higher self-efficacy. However, in multiple logistic model, only self-efficacy was an independent predictor of asthma control, with higher self-efficacy associated with well-controlled asthma (Adjusted OR= 1.107, 95% CI: 1.012 – 1.210, p= 0.026). Conclusion: Identifying and targeting modifiable predictors of well controlled asthma could improve asthma control. In adolescents with asthma, enhancing self-confidence of adolescents to undertake health behaviour modification seems to be an important step toward a better asthma control.

Introduction: Elderly is a vulnerable population that is prone to sarcopenia which is associated with the loss of muscle mass, strength and function which are some of the diseases that affect the elderly. The association between environmental factors with sarcopenia should be explored as it has the potential to influence the health and disability of a person. At present, limited research is conducted to investigate the association that could be attributed to the complex interaction between human and environmental interactions. Hence this review is conducted to identify the environmental factors associated with sarcopenia. Methods: A systematic review was conducted using PubMed, SCOPUS, Web of Science and manual search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. We used articles that had been written in English and relevant articles were then screened, duplicates were removed, eligibility criteria were applied, and studies that met the criteria were reviewed. The keywords environmental factors, pollutants food environment, neighbourhood environment, locality and sarcopenia were included. Results: Initial search generated 934 publications and 12 articles were included after the inclusion and exclusion criteria for this review. In this review, environmental factors associated with sarcopenia are divided into 3 themes that comprises of food environment (availability and physical access, economic access and food quality and safety), neighbourhood environment and pollutants. Conclusion This systematic review revealed an association between the food environment, neighbourhood environment and pollutants with sarcopenia. The findings are salient as they could aid policymakers in formulating the necessary strategy to reduce the morbidity and mortality associated with sarcopenia, especially with the increase in the ageing population globally.

Anterior cruciate ligament (ACL) tears are serious knee injuries, whether partial or total. ACL injuries are most typically diagnosed in the clinic settings using a combination of a detailed history, physical examination and corroborated with an appropriate imaging modality. Magnetic resonance imaging (MRI) is highly sensitive for identifying intra-articular knee pathology. This combination has been demonstrated to be effective and non-invasive in diagnosing ACL injury. The reliability of MRI for diagnostic purposes, on the other hand, is not always ideal. This might be due to various factors, including low-quality MRI magnets, post-surgical tissue changes, metallic artifacts, patient movement during procedure, and static rather than dynamic structural evaluation. Nevertheless, office-based diagnostic arthroscopy offers an alternative to imaging modalities by allowing clinicians to visualize large joints safely, painless, high-quality images, and time-efficient approaches. Furthermore, the risk of major and minor complications of office-based diagnostic arthroscopy is comparable to or lower than any standard office-based injection. This is the first office-based needle arthroscopy (OBNA) performed in Malaysia to evaluate intra-articular knee symptoms. Thus, we aim to understand and overview OBNA to identify intra-articular knee pathology by reporting this case report.
Anterior Cruciate Ligament Injuries

Aims: Symbiotic bee fungus associated with the stingless bee larval food has been revealed to play a major role in performing a mutual relationship with the host. The fungus is believed capable to produce crucial nutrients that are required for larval pupation. However, detailed information on the fungus identification isolated from the larval food of our native Indo-Malaya stingless bee, Heterotrigona itama (Hymenoptera: Apidae), is poorly understood. Hence, this study was conducted to determine the effect of fungus isolated from the stingless bee larval food on the survival of H. itama larvae and identify the isolated fungus using both morphological and molecular analyses. Methodology and results: Elisa plates designed with F-bottom type were used as artificial brood cells in a controlled condition. The eggs transferred to Elisa plates were kept in the incubator with 75%-100% humidity and 25 ± 2.5 °C of temperature. This study carried out in three different treatments: (1) microbes-free larval food, (2) fresh larval food and (3) microbes-free larval food with fungus supplement. Results showed that the survival of H. itama larvae depends on the presence of beneficial fungus with the highest survival rate (Treatment 2 = 85.71%). The absence of the beneficial fungus in the fluid food of H. itama showed the lowest survival rate (Treatment 1 = 37.14%). Microscopy analysis showed that the fungus had various forms, including unconjugated asci, round-shaped ascospore and pseudohyphae. The molecular characterisation of the isolated fungi was performed using 23S rRNA gene sequencing using universal primers ITS1 and ITS4. DNA barcoding of three isolated fungi confirmed all isolated fungi matched Panus lecomtei (Basidiomycetes; Poriales; Polyporaceae) with 99.70% of similarity. Conclusion, significance and impact of study This study provides information on the importance of whitish fungus in appearance that existed in the brood cell, which is proposed to be the crucial component of in-vitro stingless bee queen rearing protocol.
Bees--microbiology

Introduction: The question as to whether epidural analgesia during labour can cause chronic low backpain has become a concern lately but this association has not been tested locally and remains controversial. This retrospective study aimed to ascertain the relationship between labour epidural analgesia and development of subsequent chronic low backpain. Methods: We contacted 200 primiparous women who had delivered by normal vaginal delivery via telephone at six months after delivery. While 100 of them had previously received epidural analgesia for labour, the other 100 had not. The women had to quantify their backpain by yes/no responses, numeric rating score, and impairment of daily function. Both the epidural and the non-epidural groups were compared using independent t-test and Chi-squared test while logistic regression was used to control for confounding factors. Results: The two groups had similar baseline characteristics except for body mass index, employment status and labour duration. The women who received epidural analgesia had significantly higher prevalence of low backpain at six months after delivery than those who had not (28% versus 9%, P = 0.001). However, the two groups did not show any difference in terms of numeric rating score or level of impairment of daily function. The low back pain at six months (epidural versus non-epidural) had an adjusted odds ratio of 8.1 (95% confidence interval 2.7 to 24.0, P <0.001). Conclusion: While epidural analgesia during labour was shown to be associated with chronic low back pain, this association may not be causal, suggesting the need for a randomized-controlled study in this area.

Workplaces in tropical countries are associated with increasing temperature and humidity, thus, the workers are susceptible to heat hazards. The inability for self-cooling properly toward exposure to head hazards can lead to severe dehydration and even death. To date, there are several indices and models to assess heat stress, such as WBGT, ISO 7933, discomfort index, HIS, PhSI, etc. However, their accuracy and suitability for tropical regions are still under investigation since they are mostly developed for subtropical regions. This review assessed the indices to estimate heat exposure in tropical regions based on the various online database. Among those indices, WBGT is the most suitable despite its inability to estimate human thermal response in tropical regions with several adjustments. Based on this review, it showed that there is a need for improvement of current indexes to be used in tropical regions since they are more suitable for the subtropical countries.

Pengenalan: Kanser prostat merupakan ketiga tertinggi bagi golongan lelaki di Malaysia. Data 2018 melaporkan kanser prostat mencatatkan insiden 1,807 kes berbanding 1,186 kes pada tahun 2014. Kanser prostat ini turut memberi kesan terhadap beban penyakit serta beban ekonomi kepada negara dan memberi kesan terhadap kualiti hidup pesakit terutamanya pesakit berumur melebihi 65 tahun. Kajian ini dilakukan bagi mengukur tahap kualiti hidup pesakit kanser prostat dan menentukan faktor-faktor yang mempengaruhi kualiti hidup pesakit tersebut. Metodologi: Reka bentuk kajian adalah keratan rentas yang dilakukan dari Januari 2018 sehingga Disember 2018. Sampel kajian terdiri daripada pesakit kanser prostat yang didiagnos dan mendapatkan rawatan di Klinik Urologi, Jabatan Pembedahan dan Jabatan Onkologi dari tahun 2008 hingga 2017. Kajian menggunapakai set soal selidik EORTC QLQ-C30 dan EORTC QLQ-PR25 yang telah diterjemahkan ke Bahasa Melayu Hasil Kajian: Seramai 193 pesakit telah mengambil bahagian. Analisis mendapati tahap kanser memberi perbezaan yang signifikan kepada status kesihatan serta fungsi dan simptom kanser prostat (p < 0.001). Rumusan Kesimpulannya, analisis faktor penentu mendapati umur, skor Gleason dan juga tahap lewat kanser merupakan faktor penentu kepada kualiti hidup pesakit kanser prostat (p < 0.05). Langkah kesedaran, saringan serta rawatan awal dilihat perlu dipertingkatkan bagi meningkatkan tahap kualiti hidup pesakit kanser prostat di hopital ini.

Background/Aims: 17β-hydroxysteroid dehydrogenase 13 (HSD17B13) variants were recently reported to have significantly lower odds of non-alcoholic fatty liver disease (NAFLD). This is a two-part study that aimed to evaluate the association of HSD17B13 variants with NAFLD and its histological severity, and to identify the association of the variants with clinical outcomes in a cohort of biopsy-proven NAFLD patients. Methods: Consecutive biopsy-proven NAFLD patients and controls without fatty liver were recruited for this study between 2009 and 2014. Genotyping for HSD17B13 variants was performed using rhAmp assays. A total of 165 patients with NAFLD were monitored up until August 2019. Clinical outcomes were recorded. Results: HSD17B13 rs72613567 TA allele and rs6834314 G allele were associated with lower odds of non-alcoholic steatohepatitis (NASH) in the overall cohort and among ethnic Chinese, but not among ethnic Malays or Indians (P<0.05). During a mean follow-up of 89 months, 32 patients (19.4%) experienced at least one clinical outcome (cardiovascular events, n=22; liver-related complications, n=6; extra-hepatic malignancy, n=5; and mortality, n=6). The rs72613567 homozygous TA allele and the rs6834314 homozygous G allele were independently associated with a lower incidence of liver-related complications (hazard ratio [HR], 0.004; 95% confidence interval [CI], 0.00–0.64; P=0.033 and HR, 0.01; 95% CI, 0.00–0.97; P=0.048, respectively) and were associated with lower grade of hepatocyte ballooning among the ethnic Chinese. Conclusion HSD17B13 rs72613567 and rs6834314 variants were inversely associated with NAFLD and NASH, and were associated with lower incidence of adverse liver outcomes in a cohort of multi-ethnic Asian patients with NAFLD.

Background/Aims: 17β-hydroxysteroid dehydrogenase 13 (HSD17B13) variants were recently reported to have significantly lower odds of non-alcoholic fatty liver disease (NAFLD). This is a two-part study that aimed to evaluate the association of HSD17B13 variants with NAFLD and its histological severity, and to identify the association of the variants with clinical outcomes in a cohort of biopsy-proven NAFLD patients. Methods: Consecutive biopsy-proven NAFLD patients and controls without fatty liver were recruited for this study between 2009 and 2014. Genotyping for HSD17B13 variants was performed using rhAmp assays. A total of 165 patients with NAFLD were monitored up until August 2019. Clinical outcomes were recorded. Results: HSD17B13 rs72613567 TA allele and rs6834314 G allele were associated with lower odds of non-alcoholic steatohepatitis (NASH) in the overall cohort and among ethnic Chinese, but not among ethnic Malays or Indians (P<0.05). During a mean follow-up of 89 months, 32 patients (19.4%) experienced at least one clinical outcome (cardiovascular events, n=22; liver-related complications, n=6; extra-hepatic malignancy, n=5; and mortality, n=6). The rs72613567 homozygous TA allele and the rs6834314 homozygous G allele were independently associated with a lower incidence of liver-related complications (hazard ratio [HR], 0.004; 95% confidence interval [CI], 0.00–0.64; P=0.033 and HR, 0.01; 95% CI, 0.00–0.97; P=0.048, respectively) and were associated with lower grade of hepatocyte ballooning among the ethnic Chinese. Conclusion HSD17B13 rs72613567 and rs6834314 variants were inversely associated with NAFLD and NASH, and were associated with lower incidence of adverse liver outcomes in a cohort of multi-ethnic Asian patients with NAFLD.